Happiness for me in dentistry was always doing my best for patients who appreciated and wanted the best dentistry. When third parties began to heavily impact the care patients wanted and my ability to do my best, my happiness disappeared, and burnout set it.

Independence to me meant removing myself and leading my patients away from insurance dependence. The Pankey Institute showed me the way to do this, and I was able to start restoring my happiness one patient at a time, until I was finally once again “fee for service.” Whether you can do this in part or in whole, you will achieve more dentistry and have a greater impact on more lives.

I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. On the first morning at the Institute, I remember feeling overwhelmed. I was focused on the herculean task of creating the practice of my dreams. Every moment of that first week tested my competence and potential to succeed. I kept comparing myself with other students as I paid attention and diligently took notes.

Later in the week, Dr. Irwin Becker was discussing how to schedule patients so we would have time to practice what we were learning. I returned home and secured every Thursday morning for practicing “the Pankey way” which included a lot of new techniques for me and my staff. Dr. Becker was more correct than he even knew when he recommended that we “just do it.”

The Science of Motivation

About the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking Self Determination Theory of Human Motivation. Their advice also came down to “Just Do It.” Years later, while studying positive psychology, I was gratified that I took Dr. Becker’s advice; otherwise I may not have had an accomplished and fulfilling career.

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam? We need drive. Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy.

Deci and Ryan noted extrinsic drives are the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives are passion, curiosity, and purpose. They found intrinsic motivation is more effective in every tested situation, except when basic needs haven’t been met (think Maslow’s Hierarchy of Needs). They also found that autonomous work overrides controlled work because autonomy is aligned with our intrinsic drives.

Autonomy as an Intrinsic Driver Works

When we are the masters of our own destiny, we are also more focused, productive, optimistic, resilient, creative, and healthy. In retrospect, this is what I found on those Thursday mornings. When I was focused on doing a comprehensive, relationship-based new patient exam, to the best of my ability and focused on leading the special person before me to greater understanding and health without thoughts about personal gain… putting another first and giving them the gift of my time… I felt most alive and well myself.

I started with the comprehensive examination and built on that by learning all the components from the mundane mounting of models to the nuances of advanced occlusion. For those of you starting to implement a fee-for-service practice model, success can be measured one morning a week and one patient at a time. Your intrinsic motivation will carry you forward to expand your “Pankey style” approach to a greater and greater percentage of your patients.

Beyond Scheduling One Special Morning…Return to “The Porch”

My latest book, The Porch: A Dental Fable, tells the story of a young dentist who is led in mentoring relationship — by a retired dentist and an expanding group of encouraging colleagues who meet regularly on a porch. He discovers and practices a new philosophical and behavioral approach to practice that transforms his life. I’ll keep blogging on this theme, but between blogs, you might want to pick up the book and discover the richness of a life in dentistry based on intrinsic drive. If you have sampled The Pankey Institute offerings and been inspired, then stay on “the porch” of its philosophical approach, courses, study clubs, and collegial gatherings. Continuously sharing and supporting one another is what put me on the never-ending, meaningful, highly satisfying Road of Mastery…and never again to experience burnout.

Orofacial pain is one of the greatest diagnostic challenges that exists in the modern dental practice. It takes a keen ear to listen for the nuances it presents and to know which diagnostic path to follow. The trickiest element of pain is its inherent subjectivity. But as clinicians, we have to learn to determine where the pain actually is, versus just where patients feel it.

Treating orofacial pain is first and foremost about learning the true source of the issue. To do this effectively, you have to be asking the right questions in the right situations. Pain can seem mysterious from the outset, but once you dive deep, you may find a trail of clues leading you to the first set in a litany of possible solutions.

Keep reading to learn some of the questions you should ask when you encounter orofacial pain.

Key Questions To Diagnose and Treat Orofacial Pain

Consider these common and crucial questions regarding orofacial pain:

Toothache

Have you ever had a patient present with a toothache, but you see absolutely nothing wrong with the tooth? It has no visible cracks, any restoration present seems okay, the tooth has no associated radiographic lesion, periodontal probing is normal, and it tests vital.

Should you provide an endodontic treatment or extract the tooth anyway? Is the patient just making it up? Or could this be referred pain from a trigger point, a headache disorder, neuropathic pain, or pain secondary to another condition?

TMD

Or maybe you have a patient who presents with Temporomandibular Joint Disorder (TMD) symptoms, it may or may not be painful. What should you look for and how should you treat it?

Possibly, you have a patient who gets headaches, or earaches, and you wonder if they could be related to TMD. What should you do to try to answer these questions? How do you determine if it’s muscular, joint, or both?

Diagnostics

What diagnostic tests should you order and when should you order them?

Treatment

What are the best way to treat these conditions? What conservative options are there? Is there more that can be done if my patient is unresponsive?

There are no easy answers to these questions and many more that arise for patients in pain. This is an area where you can transform a patient’s life, so it’s important to know what to ask, when, and what answers to look for.

On Friday, July 9th, 2021 from 2-5 pm ET, I’ll be holding a live, three-hour virtual course, “An Introduction to Orofacial Pain,” that will dive into these types of questions. You can easily register for my course, which provides 3 CE credits, at Pankey Online.

I will go through a review of TMJ and masticatory and auxiliary muscle anatomy. I will also discuss how these muscles and the joint should function, plus symptoms if they are not functioning properly. We will also discuss a variety of treatments for different types of TMD.

I will cover referred pain, which is the reason that the site and source of pain do not always match. We will also review other disorders that can be in the differential for tooth pain or for TMD. Sometimes these differentials require additional tests. We will determine what to order and when. We will also go over the best ways to talk about the diagnosis with the patient.

I look forward to sharing an overview of what we focus on in Orofacial Pain and how to gather information to answer the questions above. Please join me on July 9th to dive into these topics!