How we demonstrate leadership outside the practice inevitably impacts how we lead once we return. That’s why it’s beneficial to seek out opportunities for growth wherever we can. Choosing to hold a leadership role is one particularly impactful way of doing this.

Leading Outside the Dental Practice

Re-connecting with dentistry and friends in Chicago in mid-February has been a very significant part of my journey in dentistry. The energy and buzz of new technology, new research findings and great speakers is always invigorating. But it’s not just the CDS Mid-Winter that brings me out to the Windy City in February. It’s also the smaller focused groups that make Chicago very significant and special.

The AES, APS, AAFD, AOD AARD and Lab Day are the crown jewels of dentistry that all meet over 5 days. The Chicago mid-winter vibe always reminds me of a family reunion where we catch up with each other and reboot our love for dentistry together. Over the last 30 years, I  have attended meetings held by all of the groups mentioned above.

The place I’ve chosen to plug in and serve in leadership has been the American Prosthodontic Society (APS). Founded in 1928, the APS has always been a voice for collaboration between the specialist, the generalist with interest in the discipline, and the laboratory technologist.

In 1960, LD Pankey served as President. This year, the APS will be celebrating their 90th annual meeting. For the first time in dentistry they will be installing a laboratory technologist as President. I am very grateful for the APS and its voice of commitment to quality learning and leadership in the discipline of restorative care for the patients we serve.

Taking on leadership in an organization like APS is the type of experience that can translate back to better working relationships at home.

Buyers are actively seeking dental practice opportunities all over the country. With the influx of doctors to desirable areas, sellers must have a strategy for how to identify the right buyer for their legacy practice.

Navigating the Best Transition For Your Dental Practice Legacy

Complementary technical skills to properly care for a patient base are essential. Behavioral considerations like interpersonal skills and communication are part of the success of a relationship-based practice. Timing and financial considerations play a large role in buyers identifying their opportunity as well. Working with a seasoned transition consultant allows for the vetting of these necessary components.

Some practice brokers seek a transactional experience for a changing of the guard with a processing of documents and a single strategy for its completion. This is driven strictly by financial and legal considerations. That transactional mindset is what you have been working to avoid in your practice for a career. So why would you consider growing your practice or ending your career with a philosophy that goes against the grain of what your practice has become?

Curiosity Driven Dental Practice Transition Strategies

Why not become curious about practice transition strategies? You could explore a co-discovery experience of what best fits your practice model and philosophy. Asking more questions and learning more about what makes your practice a successful legacy is the first step.

Transition consultants offer a complete approach to evaluate your relationship-based practice. The approach seeks all the financial and legal considerations plus works to transfer the technical, behavioral, and business culture. The purpose of this is for continuity in your practice and security for your future built on strategic solutions. Finding a transition consultant with successful business experiences helps make them uniquely qualified to collaborate with you to develop your strategic transition or expansion solution.

Whether you are a specialist or a general dentist, seek a consultant that will perform a comprehensive exam on your practice. They should report their findings with a thorough and professional strategy to meet your wants and needs. Developing a legacy plan for your relationship-based practice model that creates opportunity and security for your next phase must be intentional.

Are you ready to discover the best strategies for you and your practice future?

As dental practices grow and change, new seasons bring opportunity and security for both sides of a transaction. Charting a new path can be stressful and uncertain as many practitioners have not weathered a transition in years.

Considering a Transition Change In Your Relationship-Based Practice?

Young dentists are often seeking that opportunity for the first time. Experienced doctors often bought a practice many years ago or started their practice from scratch as a young doctor themselves.

The practice climate is changing! It is a competitive market with educated young professionals seeking the right opportunity and practice owners wanting to finish well while leaving a legacy with their practices better than they found them.

Organizational changes in practices can take many paths. Growing a practice through a merger or partnership brings its own set of challenges and opportunities. However, a practice based on relationships with patients, teams, referral bases, and communities requires special care.

Evaluating Your Practice Philosophy During a Transition

This process can be a stressful distraction to owner dentists. Those dentists that have committed their professional growth to technical excellence and relationship-based practice culture may need strategic help in navigating the right practice transition.

Dental practice transitions have been around for decades. Selling a practice to a young colleague and walking away has been the standard solution. Today, there are many different solutions that reach the goals of the seller and the buyer. Many relationship-based dental practices are seeking a like-minded professional to carry the torch and move the practice legacy forward. This goal requires intentional planning and careful follow through.

The time to evaluate practice philosophies is BEFORE a transition occurs. Examining wants, needs, timelines, and the type of transition that best suits those needs develops during the pre-sale process. You likely didn’t build your relationship-based, highly technical practice by doing what everyone else has done.

Becoming an expert in your field has been intentional and constructed with the concept of excellence and communication as a basis for that success. When it’s time to expand your dental practice or find your successor those same themes should continue.

To be continued…

Everyone who heads to Miami expects to try world-class cuisine from all over Latin America. But did you know Miami is also a fantastic place to sample delightful European dishes? In particular, the area boasts a wealth of French restaurants you won’t want to pass up.

If you’re unfamiliar with French food, it’s usually rich, flavorful, unique, and satisfying. Think coq au vin, bouillabaisse, hearty soups, delicate seafood, croissants and crepes. Here are our top four favorite spots:

4 French Must-Try Restaurants in Miami & Key Biscayne

1. La Boulangerie 

For giant, flaky, out-of-this-world croissants, you have to visit La Boulangerie on Key Biscayne. This is hands-down one of the best breakfasts in the area. The service is fast, the fresh orange juice is to die for, and it’s extremely convenient for Pankey participants. Make sure to get there as early as possible before they run out of the most coveted treats!

2. Otentic Fresh Food Restaurant

Appreciate a traditional French meal in an atmosphere that screams Miami Beach. This quaint and cozy dining experience serves up the classics: foie gras, escargots, charcuterie, savory crepes, fresh mussels in white wine and cream, quiche lorraine and more.

3. A La Folie Cafe

Refined without breaking the bank, A La Folie is known for its extremely yummy crepes. Relax over a meal that will transport you to France in the best way possible. Sweet and savory are right at your fingertips.

4. Brasserie Central

This Parisian-style brasserie in Coral Gables is perfect for sipping cafe au lait and diving into a luxurious dessert. Try our favorites: the Belgian waffle with chantilly and chocolate or the crisp apple tart.

Please run, do not walk to each of these fantastic purveyors of all things French. If you try one out, let us know what you thought! Miami never ceases to amaze us with its international flavor.

Maintaining the gingival margin during a restoration is one of the more challenging aspects of restorative care. Part of why this can be so difficult is that the gingival crevice is not always well understood.

The goal with a restoration should be to limit the possibility of inflammation or gingivitis post-treatment. This can only be accomplished if the intracrevicular margins (meaning those placed within and limited to the gingival crevice) are properly created.

There are multiple techniques needed for this goal, but one critical piece is how the tooth is prepared.

Successful Tooth Preparation Guidelines

There are multiple components of an ideal tooth preparation, including distinct margins and sufficient tooth reduction. If you have to extend the material you are using into the gingival crevice, then you must ensure the intracrevicular tooth reduction is large enough to account for the cosmetic material that will inevitably recess into the tooth’s normal shape.

One thing that absolutely must be avoided is forcing cosmetic material out into the tissue. This can occur as a result of under reducing the cervical aspect of the tooth. The negative effects of this problem are plaque growth, decreasing the patient’s ability to adequately cleanse the area, and a crevice that appears flabby and retractable. You’ll see these problems happening because as the cervical bulge protrudes, it distends the crevicular epithelium and connective tissue.

Sometimes, you may put plenty of care and precision into your effort and still find that the tissue is injured during your tooth preparation. To avoid this, you can consistently follow these simple guidelines:

1. Don’t overextend the rotary instrumentation circumferentially.

2. Avoid permanently damaging surrounding tissue during retraction or while making impressions.

3. Create polished and excellently contoured margins, as well as a great fit, for the interim restoration.

4. Prevent retention of temporary cement in the gingival crevice.

5. Sustain control of intracrevicular plaque.

Follow these guidelines and you’ll be on your way to long-lasting results.

How do you go about enacting successful tooth preparation in your restorations? We’d love to hear from you!

How do you make your dental practice resilient? 

In a recent article in INC magazine, venture capitalist Dave Whorton and Red Herring co-founder Chris Alden used the term ‘evergreen’ to describe the increasing number of private, profitable, market leading businesses designed to remain independent for a long, long time.

In other words, they possess abundant, healthy longevity that is grounded in their very nature. To me, that sounds exactly like the high quality, relationship-based practice each of us is attempting to create and develop all day every day in our professional lives.

Whorton and Alden identified seven very instructive characteristics of an evergreen company. I adapted them to be relative to a relationship-based dental practice. Let’s take a look.

How to Create a Relationship-Based Evergreen Dental Practice

1. Purpose

Being passionately driven by a compelling vision and mission. There is no substitute for clarity around your WHY. It is your unique story.

2. Perseverance

Having the grit to get through and past barriers. When you have a long term perspective of your practice, professional career, and life, the short term trials seem much less daunting. Those trials also occupy much less space in what you measure as important. The destination is a fixed standard. The time required to get there is a variable. I call that standard an ‘unchanging point of light.’

3. People First

The people of your world are both the reason for your work and the vehicle to make that work come to life. Surrounding yourself with the best and most talented people available to you is the most powerful accelerator to your practice development.

4. Private

Your dental practice, even with multiple dentists and a large team, is still a micro enterprise owned and operated by practicing dentists within the practice. This makes your enterprise much more agile, responsive, and tactical. It is one of the critical advantages we have over large corporate ownership.

5. Profitability

Profitability is a measure of value delivered to the patient. By building high trust relationships that essentially function as partnerships, the patient is much more likely to choose comprehensive solutions to their problems. This builds productivity and profitability.

6. Paced Growth

Focusing on long term strategies of practice growth and development creates a mindset of investment in people, technology, and skills. This creates a brand and practice culture that are unique in the marketplace with the power to attract and retain great people. These people are your team, your patients, and your interdisciplinary team of specialists and technicians.

7. Pragmatic Innovation

The best dental practices we know continually educate themselves and their patients. They employ contemporary technologies that are critical to their performance and results. They never stop seeking a better way to do what they do. In short, they lead, they innovate, and they teach others to do the same. It is a mindset and a way of life.

Are you thinking it’s time to bring in an associate and start the process of planning a practice transition?  

Most dentists contemplate this matter at some point during their practice career but often struggle through the process and don’t know where to start. Taking the plunge is much easier once you feel more comfortable with your own perspective on dentistry.

As with all relationships, you have to work on you before you can offer something to another person. 

The Missing Link of Choosing an Associate

After many years of private practice and four associates who stayed an average of four years each (and left for “greener pastures”), I finally figured out the missing link.

This link is a clearly written and spoken practice philosophy. It is not your mission and/or vision statements (although they are important too). 

A Practice Philosophy

A practice philosophy is grounded in the 3-5 core values that describe the essence of WHO you are and WHAT you stand for. These crucial values also answer the question WHY? Why do you do what you do?  

My practice philosophy is rooted in the tenets of the Philosophy of Dentistry presented by Dr. LD Pankey. Living a life of success and happiness for Dr. Pankey meant being balanced in the areas: Work (Profession) – Love (Relationships) – Worship (Spirituality) – Play (Recreation).  

My philosophy is similar to Dr. Pankey’s, but also incorporates the values of Excellence, Integrity and Life-long learning. For me, being very clear in my principles and ideals made it much easier to evaluate and assess all potential candidates who considered joining me in my practice.   

Before embarking on the process to find the right associate/partner for your practice, ask yourself if you are clear on your core values and practice philosophy.  

Don’t miss Dr. Crete’s writing on 6-handed bonding restorations and his favorite dental material.

When the tongue can’t function properly (especially the middle portion), a cascade of events can happen. This is a very important point because many assess proper tongue function by mobility alone, but this does not uncover a posterior tongue restriction.

Assessing a tongue by how far a child or adult can move it is simply not enough. The middle portion of the tongue must be addressed because it is the biggest driver in normal development.

Tongue Restriction or Dysfunction

Following the Functional Matrix theory, if there is a tongue restriction or dysfunction while in utero and the tongue cannot reach the palate, the facial muscles will be the biggest factor shaping the palate. This  results in a high, vaulted palate at birth.

In infancy, a lack of function may lead to an inability to nurse properly or create a proper seal. This can be worsened by a high vaulted palate. If the palate is not stimulated, oxytocin release is limited and the facial muscles continue to be the largest influence on the shape of the palate. Symptoms of this problem can show up in both mom and baby immediately or a few days after birth. They can include: 

• Swallowing too much air resulting in: gassiness, reflux, spitting up, colic, getting “full” on air, or not draining breast, which leads to frequent feedings.
• Increased effort needed to eat, so falling asleep when nursing, short nursing sessions, and poor sleeping/frequent waking.  
• Excessive non-nutritive sucking/thumb sucking to stimulate palate and release oxytocin.
• Incorrect latch, which can be painful and lead to cracking/bleeding nipples or not fully draining breast, which leads to mastitis, etc.  

So many times, a “simple” answer to these problems would be switching to bottles or special formula and/or reflux medications instead of addressing the real issue. This is all too often missed by the medical field. When the underlying dysfunction goes untreated because the symptoms have been pacified by those treatments, the dysfunction continues and more symptoms develop.

The function or dysfunction of a tongue can lead to more health issues than many realize. Recent research has linked tongue dysfunction to a myriad of issues such as skeletal and bite changes. These issues can also lead to sleep apnea and TMD among other things. 

The evolution of recent thought is that sleep apnea and TMD are chronic “end stage” diseases whose roots develop early in life. Interventions as early as birth may help prevent or at least curb the severity of these diseases.

Exploring Tongue Function

The tongue is used not only for speaking, swallowing, and tasting, but also for other less obvious functions. The most important may be the tongue’s function of protecting the airway. When touching the palate, the tongue releases oxytocin, which has a calming effect.

The tongue is a large factor in normal growth and development of the face including the nasal and oral spaces. The Moss functional Matrix theory in essence states that the soft tissues will dictate how the hard tissues form. Or, in other words, form follows function.

According to this theory, the tongue will influence development of the palate, nasal cavity, and overall facial form. It then stands to reason that normal function is important for normal facial growth and development.

Development of Swallowing Patterns

The normal function of a tongue begins at the 18th week in utero when the fetus begins swallowing. Infants are born with a congenital suckling/swallowing reflex. At birth, the infantile swallowing pattern (called a “Tooth apart” pattern) is characterized by positioning of the tongue between the gum pads and the jaw slightly apart.

Stabilization of the mandible is from facial muscles and the interposed tongue. The middle portion of the tongue must lift and touch the roof of the mouth to create a seal when nursing and also release oxytocin.

Then, as teeth erupt, children change to a transitional swallow pattern. They will fluctuate between the infantile tooth apart pattern to an adult tooth together pattern. In the tooth together pattern, the teeth are together and the tongue is to the roof of the mouth.

This transition may be altered if the tongue cannot learn the proper position. An altered swallow pattern such as a tongue thrust may occur. Issues that can alter swallower pattern can be a tongue tie, poor or hyperactive muscle tone, a high vaulted palate, delayed non-nutritive sucking habits, or essentially anything that will not allow the tongue to reach the proper spot.

To be continued …

The Pankey Institute has positively changed how I practice dentistry. My work–life ‘flow’ would not be what it is today if I had not integrated the philosophy and dental training. As Dr. LD Pankey said: “A tooth never walked in the door.”

I too have integrated my own personal touch at the practice and have said, “We don’t treat strangers in our practice.” I get a little chuckle from patients at times when I say this. I also get a warm and welcoming look because they can connect with those words. This statement is an invitation that helps them open up.  

Better Cases From a Better Practice Philosophy

My training at Pankey and learning about LD Pankey’s Practice Philosophy has given me insight into how to create, formulate, and execute my own. I strive to live that philosophy with my dental team and my patients. We have created a practice culture that allows me to do many comprehensive cases.

I integrate concepts of restorative dentistry that have resulted in a rewarding outcome for both the patient and dentist. Appreciation and gratitude from the patient along with pride and care from the team have continued to fuel me to deliver the best dentistry with my best self.

It all starts with a comprehensive exam. For the case shown in these pictures, I utilized a thorough examination complete with understanding, listening, and hearing what the patient’s goals were. This was followed by a focus on airway, occlusion, TMJ, and restorative and esthetic goals. Digital photography, mounted study casts, evaluation of occlusion, wax up, and communication with the patient and the laboratory enabled me to create a smile that the patient was very comfortable with both in function and in form.  

Treatment consisted of an occlusal equilibration to improve occlusal interferences, which had caused fremitus on #7 and instability in occlusion and discomfort. I placed a porcelain crown on #8 and veneers on #7, 9, and 10. The patient was also given take home whitening trays.  

The patient’s final comments were: “I love my new smile and my bite is comfortable” and “Oh, did I tell you that since the dental work was completed, my jaw has felt more relaxed and comfortable?”