Both dentin and enamel can be worn down at a more than normal pace when exposed to very abrasive toothpastes.

We have learned that this damage is not being caused by the toothbrush, but the material being put on the toothbrush. As the desire to have whiter and whiter teeth has become popular, manufacturers have increased the abrasiveness of toothpaste to more effectively remove the external stains. In addition, tarter control and other newer versions of toothpaste designed to grab market share of consumers can also tend to be more abrasive. 

Ideally, we would like to be brushing with a material that has an RDA (relative dentin abrasiveness) of less than 80, but the FDA allows toothpaste to be sold with an RDA up to 200. The original Colgate toothpaste has an RDA in the 70’s. Most Sensodyne have RDA’s below 85, but several of the 2 & 1 tarter control and whitening have an RDA close to the maximum of 200. The abrasiveness can damage restorations, increase wear of exposed dentin and exacerbate sensitivity. At my Scottsdale, AZ practice, we keep a list of the most common toothpastes with their RDA, so we can discuss this with our patients. 

Prophy paste, even the fine, is generally more abrasive then over the counter toothpastes.

In addition, it is applied using a prophy cup going at 20,000 rpm’s with much more pressure. Even though the incidence is much less frequent, being 2 to 4 times per year instead of every day, this can still be a significant issue. 

A cool little experiment is to take some microscope slides and using your fingers rub prophy paste around on them and then rinse. Look at the slides with light behind them. You’ll be surprised to see a slide is scratched after just one application. This is the same thing that will happen to ceramic restorations. The glaze will be easily scratched. The surface of the crown or veneer will begin to deteriorate. 

Similarly, abrasive prophy paste will increase a patient’s sensitivity if used on exposed roots, accelerate the wear on exposed dentin or cementum, and can damage other restorative materials. The RDA of prophy paste can range from 150 for fine to up over 300 for coarse. Alternatives are to use products like Clinpro 5000 or MI Paste as a prophy product, both of which are low in abrasiveness. In my office, we use a product called Proxyt, from Ivoclar. It is a non-abrasive prophy product and is available in 3 grits and with and without fluoride. All three of the varieties have RDA’s between 7-83 and are safe to use on dentin, cementum, and ceramic. 

Every message a person tries to convey to another person has two components to it, the content of the message, and the feeling or attitude associated with the content. Both are critically important, as both give context and meaning to the information being shared.  

In some instances, the content of a story is less important than the feelings associated with it.

In fact, sometimes the content may be a complete distortion or a fabrication. Regardless, the person may believe the story because the story has a specific meaning to the person. Consequently, it is critical that we try to catch the full flavor of meaning underlying the story. 

Do they believe that they are going to lose all of their teeth no matter what they do? Do they believe that it is normal to lose all of their teeth? Do they believe that they are not worthy of investing in themselves through dentistry? Do they believe that all dental work fails and is a bad investment? Do they believe that most dentists are dishonest? Do they believe that their problems cannot be resolved?  

To discover meaning, we must respond to the feeling component of their communication:

“You seem really upset about this, can you tell me more about it?” “I can see that you are really anxious, can you help me to understand why you feel this way?” “You seem really frustrated – even angry about what happened. Can you tell me more about it? Do you think you will ever be able to work with another dentist?”  

We are attempting to discover is what their story really means to them. How do they see this story and their current situation affecting them going forward? How important is it to them that they resolve their current situation? Do they even know what their situation really is? 

Patients gravitate toward and stay loyal to dental practices in which the dentist and care team love what they do.  

When you are enthusiastic about your work and how you do it, you can’t help but talk about it, can you? You can’t help but show it.

This enthusiasm affects patients in multiple ways. 

• Your happy office is a delight to visit under most circumstances. 
• The confidence you exude makes potentially stressful visits more comfortable and allows patients to trust in your care.  
• Their curiosity in dentistry and what you can achieve together is peaked. They ask more questions. This, in turn, sparks the patient’s desire to make changes in their health and smile. 
• Because your happiness has spread throughout your care team, the support patients receive throughout their experience is exceptional. 
• You surround them with so much positive energy they feel free to get to know you too. 
• Consistent happy experiences lead to patients feeling like they are among family and friends. 
• And, you’ve all seen this. Patients want to emulate your happiness in their own lives. They want to be like you. 

What is happiness anyway? The definition that I like is “the ability to feel satisfied with your life, to enjoy yourself and others, and to have fun in the present.” This certainly is what your patients enjoy when they visit. 

So, what brings about happiness in dental practice? Perhaps, you’ll agree: 

• Doing what you love to do most of the time, applying your talents and strengths 
• Being outwardly focused on the well-being of others 
• Effectively motivating and leading others to optimal health 
• Being true to your own personal values 
• Ever be it dynamic–Pursuing your own vision of practice (in the case of the dentist) and a coherent practice vision to which you contribute (in the case of team members) 
• Working in a care team that is high functioning with high EQ 
• Effective systems that facilitate doing what you love most 
• Ability to successfully problem solve and adapt with confidence 
• Patients who appreciate what you do together  
• Continuously mastering higher standards of care 
• Multiple moments of true connection with others every day 
• Understanding of yourself and others 
• Satisfaction with your life outside the office 
• Optimism and gratitude 

I was recently rereading one of Avrom King’s essays and stumbled upon the deeply profound statement: “Fear and love cannot coexist; where there is one, there is the absence of the other.” 

I have discussed in the past that the central intention of L.D. Pankey’s interpretation of the phrase “quid pro quo,” was love.

And when I use love here, I am referencing M. Scott Peck’s definition: “The will to extend one’s self for the purpose of nurturing one’s own or another’s spiritual growth.” 

Note, that this definition has a “quid”—the giving of the self, and it has a “quo”—the spiritual development. The “first” (the quid) begets the reward (the quo).  

Dr. Pankey famously demonstrated this “first” principle when he elected to not quote a fee at the beginning of his treatment process, and then at the end of it, asked the person to pay him based on their perceived value of what he had done for them. Think about that for a moment, because to act in that fashion requires a tremendous amount of courage and self-confidence.  

Do you think that you could ever get to a place in your life where you could act in a similar fashion…to give freely of yourself in the very best ways possible, and then risk the possibility that the receiver of that gift might not appreciate everything you have done for them on an appropriate level? 

There is only one reason why Dr. Pankey could do this. He had an attitude of abundance which radiated through everything that he did. And as a result, others believed in him and followed his leadership to discover a better place for themselves. In other words, Dr. Pankey’s love for others led to their spiritual development, which then led to him being appropriately compensated. 

I am not suggesting here that you should stop quoting fees to your patients. I think most people need to know fees (or at least fee ranges) to be able to successfully manage their personal budgets, but I am suggesting that you learn how to give generously on the front end of your relationships with people without an expectation beyond appreciation…because if you can’t earn their appreciation, you can’t really earn your fee. 

Now, back to the Avrom King quote. “Fear and love cannot coexist; where there is one, there is the absence of the other.” You can’t successfully take this risk, unless you, like Dr. Pankey, possess an abundant mindset, so are therefore capable of loving (in the M. Scott Peck sense) your patients? 

That capacity comes from within. We can’t facilitate growth and development in others without simultaneously facilitating it in ourselves. 

In 2003, I was fortunate to dine with Pete Dawson and he spoke about his friendship with Dr. Morty Amsterdam and how he so enjoyed coming to Philadelphia. He spoke about L.D. Pankey. At one point he said something I will never forget, he said, “You know, L.D. was no fluke.” I asked what he meant. He told me, “L.D. really loved dentists and loved the dental profession. That is what drove him.”  

Dr. Dawson was no fluke, either.

Through his writings and teaching of over 50 years, he was a warrior for meaningful, excellent and dutiful dentistry. When news Pete’s passing came, tens of thousands of dentists all over the world wrote about how much he meant to their lives and careers. He had carried the torch of meaningful comprehensive dentistry into the hearts and minds of dentists for as long as I can remember. 

I carry a coin in my wallet which reads, Memento Mori. The Stoics used that phrase to remind themselves that everyone is mortal. “You could leave life right now.” When the news of his passing came, I was shocked. Joan Forest reported that Pete was prepared and yet on the Tuesday before he was still preparing lectures and writing a chapter for a new book. I guess that is what the keepers of meaning do right to the end. 

Excellence, duty, and meaning are the primary sources of Stoic joy.

Not the surface cheerfulness and pleasure that we have come to know on social media. The essence of what L.D. and Pete taught led to real inner happiness. I know it did for me.  

Erik Erikson, the developmental psychologist and psychoanalyst known for his theory on the psychological development of human beings, described the last tasks of adult development as generativity and keeper of the meaning. Erikson claimed that if one completed these tasks, the reward would be a full life. 

As the Pankey Institute continues passing on the knowledge of meaningful comprehensive dentistry to younger dentists (from one generation to the next) and to never waiver on the meaning of dentistry for patients and dental professionals, there is true potential for a new generation to become keepers of the meaning. And this makes me smile. 

Some time ago, I was listening to a person speak about love and replacing the word “love” with “forgiveness.” His argument was that if you truly expressed forgiveness, then you are a loving person. As I thought about it, I decided “acceptance” was a better word for me. I felt that if I could accept a person for who they are, then it would be easier for me to forgive, and thus love. This started me thinking about the present and past relationships in my life and how I could apply acceptance.

After intentional self-work in this area, I have found that life is more understandable and pleasant when I practice the art of acceptance.

Consider Relationships

We all have had concerns about relationships. We all wonder why others act a certain way towards us. We benefit emotionally, physiologically, and strategically by understanding where they are coming from and how their past experiences have molded them. Stephen Covey would use the phrase “seek to understand, before trying to be understood.” In other words, accept the person for where they are, before you feel you should be influencing them to be what you perceive is correct. In a bad situation, understanding the other person would be a big step towards forgiveness.

Consider Situations

Acceptance of situations has emotional, physiological and strategic benefits as well. It comes down to understanding what is happening instead of trying to control everything. I find this so true in my practice life when my patients have some sort of moderate to severe dental issue. Until they accept what is wrong and “take ownership” of the situation, there is very little that I can do to help them. Often, the worst thing you could do is to try to fix a bad situation without the patient having ownership of the problem, because if things go astray, it becomes your fault.

For Both Ourselves and Our Patients

The art of waiting for when the patient is ready to accept treatment—and the art of understanding, accepting, and positively influencing the patient during the waiting—have both become easier for me over time. Sometimes we need to have difficult conversations with patients to help them accept the truth. But oftentimes we simply need to better understand what they are thinking and why. And, the gentle way to get at this is to inquire why they are reluctant to move forward without a tone of judgment—instead, with genuine care.

One of the great discoveries of working with the public and patients so closely is that most of what we apply to them we can also apply to ourselves. Therefore, we can benefit from accepting who we are, our personal situation, and how those around us are trying to help us. These can be important keys to moving forward in our own lives. Remember, we all travel the same journey.