In dental school most of us learned to use the same two sizes and lengths of dental anesthetic needles. Once I got out into practice and started to experiment with different sizes and lengths, I changed my protocol.

I discovered through my years of practice that I like to use an extra short 30 gauge needle that is 12 mm long for maxillary anesthetic injections and for mandibular injections that are premolars and forward. What I like about the extra short needle is that it does not bend. For these two types of anesthetic injections, the extra short needle is long enough and easier to control than the “short” one we learned to use in dental school. As a bonus, if a patient asks to see the needle, I usually hear them say, “Oh, that’s not so bad.”

On a mandibular block, I prefer to use a 27 gauge needle that is 25 mm long. What I like about this size is that it gets me to the depth I need and is easy to manipulate. Rarely do I need a longer needle that is more difficult to control.

As the Pankey community begins to re-open its practices, reports indicate that most patients are responding with high levels of trust and gratitude. This represents a clear indication that the investments we’ve made in building truly helping relationships with others are paying back significant dividends at a most critical moment. Relationship-based / health-centered dental practices are designed to give the kind of meaningful caring and support that relationship-starved people truly need as they venture back out into this brave new world. 

The truly person-centered Pankey practice model aligns well with research which shows longevity and happiness aren’t just linked to healthy diets, habits, and genetics, but also to the consistent presence of positive social engagement. My mother frequently spoke of these types of happy people as being “givers.” She’d say, “They are givers – not just takers, and they pass this attribute along to their children, because, well, that’s just who they are.” 

Abe Maslow called these types of personalities “B-Loving” individuals—individuals who self-actualize through their unconditional love of others. These are the folks who buck today’s meta-trend of consuming more, contributing less, and living a silo-type of existence. And we look forward to seeing them on our schedules, enjoy spending time with them, and feel a tremendous sense of loss when they finally pass.  These folks are the ones who intuitively know that the loving attention they give to others, no matter how simple or brief, is an ever-expanding positive experience that yields out significant benefits to themselves as well. 

When you add up all of those moments, hour after hour, day after day, year after year, you end up with the smiling and joking Betty or Bob. They’re the ones who are the first to give you a hug when you’ve had a bad day or experienced a personal tragedy. And they’re the ones who alter the course of our lives through a laugh, a smile, by demonstrating strength, courage, and irrepressible hope. In short, they are miracle makers. 

As practitioners of relationship-based / health-centered dentistry, we need to remind ourselves that we’re miracle makers as well, because we’re also in a perfect position to listen intentionally, care more deeply, and help more significantly. But that’s only possible when we choose to see dentistry as being a helping profession and not just about teeth, technology, production – and now PPE! 

On a personal level, I’ve found myself sharing my feelings about what we’ve experienced with my team and patients, and I’m finding myself opening-up on an emotional level more each day. As a result, we’ve ascended to yet another tier of caring as a team.  We’ve used this communal tragedy as an opportunity to strengthen our social bonds through love and understanding instead of allowing fear to drive us further apart.  Abe Maslow would likely say that we’re self-actualizing on the individual, group, and community levels through B-Love. This represents a key realization, because in spite of all the new stress which has been thrown into the middle of our lives, we’ve been able to see the huge practice development opportunity the situation has created for us.   

Those of us who have grown technically, intellectually, and spiritually through The Pankey Institute have “givers” hearts (just go to one Pankey Alumni meeting and you’ll understand exactly what I’m talking about). Consequently, this communal tragedy plays right to our natural strengths, inclinations, and existing practice structures. So, in spite of all of the changes surrounding us, it’s time to confidently step forward and demonstrate principle-centered leadership. And by so doing, we’ll be holding fast to what we already know is true – that the secret to living is in the giving. 

In light of today’s heightened need to reduce aerosol viruses, weighing the benefit of using a rubber dam may outweigh the challenges of using one. But I have found a barrier solution that is easy to use, highly efficient for isolation and reduction of aerosols, and more patient-friendly. It is actually a rubber dam replacement called OptraDam® Plus from Ivoclar Vivadent.

For some time now it has been part of my restorative toolkit, because the isolation improves restorative outcomes and, once again…it is efficient, easy to use, and patient-friendly. I call it “the friendlier version of a rubber dam.”

OptraDam® Plus comes prepacked in two sizes, regular and small. It has a figure 8 OptraGate for holding the lips out of the way and has a solid rubber dam back that is pre-marked for where to punch the holes. It is easy to insert and more comfortable in place. Because it does not require a lot of retention, I can use it without a clamp. This means I do not have to deliver palatal anesthesia on the maxillary or long buccal anesthesia on the mandibular. This is much kinder and gentler for the patient. It does not come in a Latex-free version, but it is a barrier solution you may want to consider.

As I watched the pandemic unfold from my vantage point in New Jersey, somehow the innocence of a child passed through my mind as I thought, “That won’t happen here.” As the pandemic got a death grip on the New York Metro area, the stark reality of “It happened here” came into full view. At first, we spread the patient visits with gaps for safety and eventually just closed our doors except for emergencies. As the weeks have turned into months, the economic impact and the sense of isolation has started to metamorphosize into a NEW reality. The phrase of “epic proportions” and “uncharted territory” were thrown around on every news cast.

Is this journey really uncharted?

Are we really cast to a horizonless sea? Haven’t we been preparing for this type of event through our education, study clubs, reading, and conversations within the community we call the “Pankey Family?” These examples come to mind:

After reading Gene D. Cohen’s book The Mature Mind, I learned that I’m resilient. I survived the big “C”, a 300-year flood in Havasu Falls, and my wife’s health issues. I realize “I’ll be able to get through this.”

Through the Gallup’s Strengths Finder and the leadership program with Dr. Richard A. Green at Gallup, I learned that my strengths are Ideation, Strategic, Learner, Communication, and Maximizer. Today I trust that the ideas and strategy will come to me. I have leveraged the Strategic strength over and over again.

The book How to Think Like Leonardo DaVinci by Michael J. Gelb tells us that when DaVinci was faced with challenges such as these, he trusted the answers “would appear.” He trusted the challenges would “seed the unconscious” to find a solution.

Waiting for the Unconscious…

While waiting for solutions to challenges, I’ve learned to free my mind and spirit by “chopping wood and carrying water”—TAO! So, when my practice closed normal operation, I went to Home Depot and bought paint…a LOT of paint. On day two I started painting my office. At first, I thought I would paint just the reception room, but as time went on, I had time to paint the entire office. I know myself, and I was doing all I could not to jump onto the “downward spiral” that I learned about in The Art of Possibilities: Transforming Professional and Personal Life by Zander and Zander.

Staying in Community

As the weeks went by the first solution to pop up was creation of a protocol for dealing with virus containment. If a patient did need to come in for emergency care, I needed to have a strategy. Joan Untershuetz and Denny Byrne presented new information last year at their Inspired Facilitation workshop about how the brain needs community. So, I formed a Zoom account and started weekly team meetings. We discussed what we were each doing to stay safe. This piqued my curiosity to wonder what patients were doing to stay safe and could they help me develop a protocol that would help them feel safe?

I recalled Dr. Irwin M. Becker lecturing in C1 on first steps to integrating this new way of practicing. He challenged us to select patients that trusted us already, and he called them “friends of the practice.” I asked my current team to list those they consider to be friends of the practice—those who put smiles on our faces when we see them on the schedule. The list was formed. The ball started to roll. I facilitated my first ever Patient Focus Group and asked two simple questions:

What have you been doing to keep your home safe from Covid-19?

What would you need to know in advance of an office visit in order to feel safe?

New Dimensions of Individualized Care

The focus group responses helped me understand that the protocols they were following at home ran the gamut from washing hands and taking off shoes to something resembling a chip manufacturing plant. I realized that individualizing the protocol could be another level of “values-based relationship-driven” individualized care.  I learned that my patients had high trust in my ability to forage through the regulations and come up with a safe protocol, and they thought it would help them to know the what, how, and whys before they came to the office.

Thanks go to several colleagues who helped by reviewing and critiquing my office protocols as they developed. Much thanks to Joan Untershuetz, Richard Green, Rolando Cibischino, Christine Shagaki and Dennis Stiles for letting me bounce ideas off of them and for their in-depth critiques.

Something else I did to stay in face-to-face contact with patients was to implement a form of “teledentistry.” After watching a presentation by Laurie Owens from DevDent at one of the ACT Dental CE online CE days, I set up an account with Doxy.me and now have regular telehealth hours. I get a push notice when someone is in the “waiting room” to have a tele-dialogue.

A Journey? Yes…Uncharted? No

There are boundless opportunities to put our best Pankey training to masterful use. We were all taught to slow the practice down and be more intentional. We were taught about personality styles and values. Open dialogue and full transparency can be the threads we hold with our patients to deeper levels of trust and appreciation. I feel poised and ready to bring my best self forward in these times that hold endless possibilities for values-based, relationship-driven, uniquely individualized care.

Imagine your life depicted as a metaphorical four-burner stovetop, with each burner representing a major quadrant of your life, and those quadrants being:  

Obviously, there are many times in life, during which by choice or circumstance, we find our life is severely out of balance, for example, dental school, parenting children, starting a practice, and so on. 

The Four Burners Theory tells us that to be successful in business we need to initially “turn down” two burners to establish an initial beachhead. But frankly, we don’t want to hear that kind of message. Rather, we would rather hear that we can have it all and soon.  

This impatient, short-term mindset has now permeated our culture, even to the point where many people seem to think that somehow “having it all” is their birthright. But viewing life balance as a birthright is a problematic perspective, because it can never be fully realized, and if we cling to it too firmly, it becomes easy for us to start to feel like a victim. 

And victims don’t act. Instead, they blame-shift. They sulk. They over-think. And they fail to act in ways that will move them toward greater life balance. A much more realistic perspective is to acknowledge that our life is full of seasons, around which we need to be aware, adapt, accept, and respond appropriately.