Lin-Manuel Miranda concludes his iconic musical Hamilton with a piece titled, “Who Lives, Who Dies, Who Tells Your Story.” The song causes the audience to reflect on why certain people in history are remembered, while others are forgotten. It draws them in and includes them in the drama to discover personal meaning through the experience.

L.D. Pankey knew and told his story. Others told it too.

One of my favorite quotes from Peter Drucker is, “The aim of marketing is to know and understand the customer so well the product or service fits him and sells itself… The aim of marketing is to make selling superfluous.” When I first read Drucker, is was a true “a-ha” moment for me; it completely shifted my paradigm about marketing while simultaneously connecting it to L.D. Pankey.

The light came on. L.D. Pankey was one of the greatest marketers in the history of dentistry. And he achieved it by first knowing who he was, and then clearly and consistently communicating it to the world. In other words, he was very good at telling his story, and it was through that narrative that others learned, grew, and our entire profession benefited.

Clarify your story to tell it well.

If we are to thrive in this rapidly-changing marketplace, our own compelling story must be known. Our story must be told by ourselves, by our care team, by our patients, and others. It’s ultimately up to us who will tell our story and what they will say. So, how do we go about telling our story? First, we must clarify our philosophy and vision to the point that they are “in our tissues” … to the point that we can’t NOT talk about them. Put your story out there with enthusiasm. The rest will follow.

It can be an incredibly frustrating clinical situation, when you have been meticulous about preparing a posterior tooth, (most commonly a molar) for a crown and things aren’t predictable. Using your burs you created depth cuts to ensure adequate occlusal clearance. After the impression you allow your assistant to fabricate the temporary only to have them come get you. Why? Because the temp is thin or perforated on the occlusal. When you go back to check, and have the patient bite, sure enough the opposing tooth is touching your prep.

A common reason that this happens is because we just prepared away the patient’s first point of contact in centric relation. The lateral pterygoid muscle in coordination with the elevator muscles has a learned pattern of firing that bring the mandibular teeth into maximum intercuspal position. This “learned” position is programmed by the patient’s first point of contact when the condyles are seated. For some patients when we remove this contact, and therefore the message that was programming the muscles to locate MIP, they release quickly. When the muscles release and the condyles seat, the occlusion is now totally different than MIP was moments before.

One solution that I considered briefly was to no longer work on molars! Alas, not a great business strategy.

Removing this frustration is about understanding which patients are at risk. Identifying risk begins with the exam, whether we are discussing caries or occlusion. There are several key factors that alert me to this potential issue. I start by identifying the patient’s first point of contact and clarifying if it is on the tooth we are about to prepare. If I am going to prepare FPC away, then I look at the magnitude and direction of the patient’s slide, or the difference between this position and MIP. If the difference is small (1-2mm), then even if their condyle does seat the occlusal difference will not cause an issue for clearance. So large slides (3mm or greater) could cost approximately 1mm of clearance on the prepared tooth. Other factors include whether they have a history of occlusal changes or more than one MIP they can find.

Understanding the risk, still leaves us with the question of how to proceed. That is a longer conversation for another post. However, if we proceed as we would before, at least knowing the risk we can explain this to the patient ahead of time, and help them understand how we would manage it if it happens.

On day one of the 2019 Annual Pankey Meeting, Dr. Gary Severance and Angela Severance will explore how digital technology continues to expand the opportunities dental professionals have to know their work and to provide better dentistry and ultimately better care.  Preliminary to this presentation, we share this quote with you.

“Be not the first to try the new or the last to leave the old aside.”

This is a statement from Dr. L.D. Pankey in his 1985 interview with the International College of Dentists. As a well-read and literary man, Dr. Pankey was familiar with Alexander Pope, an 18th-century English poet who is best known for his satirical verse and translation of Homer. Because Pope is the second-most frequently quoted writer in The Oxford Dictionary of Quotations (after Shakespeare), it is highly likely Dr. Pankey was inspired by the following famous couplet from Pope’s Essay on Criticism.

Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

We offer this conjecture, because Pope’s couplet is often used across the professions in the context of evaluating and adapting to technological change.

Pushing Forward Mindfully

Dr. Pankey was on the forefront of the technological and methodological changes that rapidly occurred in dentistry during the 1950s and onward. He was internally driven to be and do his best for his patients and profession. He urged dentists to “know your work” to provide better dentistry and ultimately better care.

Digital technology in dentistry has advanced to address special needs, just as Dr. Pankey advanced in his systems of thought and practice to address special needs. He did this mindfully.

His genius, in concert with those of Dr. Arvin Mann and Dr. Clyde Schuyler, had produced the “P.M.S. Technic.” They had selected the best of the procedures that had been developed by outstanding practitioners in their special fields and assembled them into a system that functioned well for addressing full mouth rehabilitation. They applied their intelligence to “try” new techniques and new materials. They gained knowledge through carefully doing their best for patient, after patient. They then stepped out to share what worked successfully for them. Along the way, Dr. Pankey was mindfully developing his philosophy of practice. He intentionally set out to learn from many great minds, and the composite of principles he lived by and generously shared through his lectures, publications, and ceaseless conversations with other dentists have rippled into our lives today.

Learn, Converse, Lead with Confidence

As a community, you can share your knowledge, immerse in conversation, and lead with confidence. The L.D. Pankey Institute from its beginning was a radical departure from dental school settings of the day. The Institute pioneered a training clinic with overhead cameras and closed-circuit TV, anatomical simulators (which had heretofore only been developed for training in medical schools), and it’s characteristic “hands on” learning process. The Institute’s founding leaders conceived of novel ways to fulfill their goals. But—building the unique learning environment and learning process involved tens of thousands of hours of research, thought, and conversation. A group of “top” minds in dentistry worked together to close the gap between what was known (the science) and what was practiced.  Adaptation to emerging digital technology is no different.

Seated Condylar Position

I know even the mention of the words centric relation probably has some readers bristling, as this is a much argued over topic. With that said the research by Lundeen and Gibbs at the University of Florida shows that we do seat our condyles into the fossa during the chewing stroke. This seated condylar position is often used as a reference position to treat patients whether as part of reorganizing their occlusion to alleviate TMD symptoms or for restorative or orthodontic treatments.

Centric Relation & Parafunction

The next question is do people seat their condyles other than during normal function as part of the chewing stroke. I believe the answer is yes. One of the pieces of evidence is the number of patients that I have with wear facets that correspond exactly to their first point of contact with their condyles seated. These same patients do not mark this area with articulating paper in intercuspal position or when following their excursives.

I took the photo with this post in my office. The patient has no other wear facets. #31 has a small, less than .5mm combination sealant/occlusal composite on this tooth. The distal wear facet does not touch in intercuspal position or excursives, but will mark using a leaf gauge to seat the condyles as the first point of contact. This facet marks in both the arc of closure and a power wiggle or abbreviated excursive movement from this first contact. #31 is also split from the gingival margin on the distal over the marginal ridge and right to the margin of the composite. I have seen and restored multiple examples just like this. In my experience when the crown comes back from the lab we will be able to adjust it in without issue, but the patient will report it feels high, or it will become chronically sensitive. The solution will be to either adjust this crown in both intercuspal position and centric relation, or incorporate an equilibration with the restorative care.

My belief is this patient parafunctions in centric relation.

The Least Understood Part of Dr. Pankey’s Cross

I’ve always thought that the least understood and least appreciated aspect of Dr. Pankey’s cross of life is the directive to “Know Yourself.” It seems more interesting and exciting to get into learning about your work and your patients. And applying that knowledge makes all the sense in the world. Many high achieving people are happy to dedicate themselves to a lifetime of learning about their work.

What about learning about ourselves? My experience is that it’s easier to believe we have “done that.” We take a psychological instrument and label ourselves as “Driver” or “Amiable.” Check! We survey our values and identify the top three. Check! We write a vision or mission statement. Check! How much more is there to learn?

I have come to understand that, over time, the self-discovery process of knowing yourself can be the most challenging and most rewarding aspect of your work. Knowing yourself is what makes you not only a better dentist, but a more effective leader, a more engaged family and community member, and a more fulfilled person. So, when I was asked to speak about that at the Pankey Institute’s Annual meeting I was both delighted and a bit intimidated. It is such a big topic!

“But, What about Self-Absorption?”

The idea of knowing yourself can have a connotation of self-absorption, a self-serving focus inward. This thought has arisen in our evening discussions at the Institute. We tend to think it is more appropriate to focus outward on our patients, our team, and our work. We want to facilitate their growth and their learning about how to become healthier. It can be difficult to see the value of that inner self-discovery focus. But Parker J. Palmer, whose writing has informed my work over many years wrote:

“. . . When I do not know myself, I cannot know who my students are. I will see them through a glass darkly, in the shadows of my unexamined life, and when I cannot see them clearly, I cannot teach them well.”

That lens through which we see others is an essential part of who we are. What I have learned so far is that my lens includes filters of impatience, and judgment, and assumptions about what I think I know. I have my blind spots. But my lens also includes compassion, and love, and understanding.

After 40 Years, Even New Discoveries

After 40 years in service of others, I am still learning about myself. As I learn to know myself, I am better able to take a step back and look at my filters, not just through them. I’m learning to question and understand where they fit and where they do not. I find it very interesting how on my best days I can see both the filter and the lens. With intention, I practice questioning my assumptions and suspending my judgment. Sometimes I can even laugh at the stories I make up about people and situations! And often I can also see the gifts I bring; the perspective, the compassion. Those are the times when I can bring all of myself to my work.

I serve better and I am better for knowing myself.

Mary will be presenting on Know Yourself at the Pankey 50th Anniversary Annual Meeting this year on Key Biscayne, Fl September 13,14.

Reactivity is hard-wired into all of us!

By definition reactivity is an autonomic function related to a perception of threat. When pressure and stress go up in a busy dental practice, reactivity tends to raise its ugly head.

Knowing Yourself is Hard Work.

From experience I know that seeing reactivity in others is usually easier than seeing it in myself, but I’ve learned to periodically focus on my emotional situation. I’ve learned that one of the best practices I can strive to embrace is to become a “step down transformer.” This means I focus on being someone who converts high-voltage, low-current power into low-voltage, high-current power. By taking in all of the energy and refocusing it in a positive and more relaxed direction, patients and team members are apt to feel better.

In the presence of ongoing stress—which easily produces an undercurrent of anxiety and reactivity, being less anxious will help others be calm. Stop and observe what is going on in your practice emotional system. Respond calmly and thoughtfully to allow time for others to reboot.

Your team and patients want you to be their guide.

As you work on yourself, you will see how much they appreciate the model of calmness you give them. By leading with calmness, you are creating an environment in which people can be their best and feel competent. Now, that’s leadership!