A great doctor-patient relationship is the key to delivering quality care. The ideal model to help people move toward optimal oral health is based on a behavioral approach that we can use every day. This approach is allowing the patient to drive outcomes.

An illustrative example:

There is a stark difference in a patient’s emotional response between being told, “You need a filling,” and saying, “You have decay in your tooth. How would you like us to address that?”

The principles of this approach are not difficult.

1. You need to honestly commit to always placing the best interest of the patient first. You cannot fake this. All of us know when others are not sincere.
2. Letting the patient drive the outcomes is a habit developed from committing to this approach and intentionally choosing your words to put the ball in your patient’s hands, then waiting for their response and listening well to clearly understand the outcome desired by the patient.
3. Is the outcome congruent with your philosophy and standard of care? Does the patient need more information and time to come to an understanding of what is in their best health interest? How might you lead them there? Most folks really do want the best for themselves and their family. They will make good decisions if we provide the proper environment and education.
4. You, the patient, and your team must be comfortable with the means necessary to get to the outcome desired. Both you and the patient must be comfortable with the time, energy and dollars involved in reaching a mutually agreed upon goal. A key element in eliminating stress and dependence on insurance, is painting the picture for your patient that they are in control of the outcome–not their insurance company. You and the patient have the patient’s best interest at heart, not a third party. I say this again. You are working on behalf of your patient, and with this approach, they are in control, not an insurance company.

Does this approach take more time and effort up front? Yes. However, once you adopt this approach you will be forever glad you did. Patients who enter your practice through this system will value you, your staff, and your care. They will commit to more and better dentistry and pay with gratitude. You and your staff will have lower stress and more fun because you are dealing with people you understand at a deeper level. Long-term, these people will refer new clients just like them.

I didn’t invent this model. I learned it from great mentors like L. D. Pankey and half a century of folks participating in The Pankey Institute and passing forward the priceless and timeless value of this approach.

Mentorship from the Institute will help you on your way to long-term success as a thriving dentist. As my colleague Dr. Barry F. Polansky often writes, “Mastery in dentistry is a continuous journey.” It’s a lifetime of learning, practicing, and reflection that enables us to more easily and fully transform the health of others who present themselves for our care. The journey, itself, propels us forward into greater and greater connection with our patients and our true selves.

Pankey Institute mentoring and encouragement made all the difference in my life and the lives of countless others. When I try to sum up the dental professionals and patients this “approach” has positively impacted, I get lost in counting the millions we have touched as a community dedicated to putting the dental patient’s best interest first.

Not every tooth that has been endodontically treated requires a crown to insure it has great longevity and doesn’t crack or fracture.

Molars

Very clearly the literature supports that molar teeth in the posterior absolutely must have four cusp coverage—a four-cusp onlay or a full coverage crown. We are trying to use the phenomenon of containment with strong ceramic or metal material around the entire circumference of the tooth. We are holding the buccal and lingual together and replacing the top of the root chamber, so the tooth doesn’t fracture.

Bicuspids

Bicuspids that have been endodontically treated do not need two-cusp coverage if there have been no previous restorations and the endo access is very conservative. In the case of a premolar that has never had an MO, a DO, or an MOD, and has a tiny access hole, you can do a composite buildup or chamber retaining composite restoration. If the patient has high functional risk, a reasonable decision would be to restore the tooth with an onlay or crown

Anterior Teeth

There is no scientific support for doing a crown on an anterior tooth just because it has had endodontic therapy. We do a crown on an anterior tooth that has had endo when it is already structurally compromised, for example with previous mesial lingual and distal lingual composite fillings, missing tooth structure, and significant structural compromise between the endo access and other restorations.

I have spent the last 27 years developing my abilities to restore patients to the dental health they desire. One of my favorite aspects of dentistry is creating a customized plan to help patients achieve their dental health goals, and I do this by hearing each patient’s story, so I not only see the care they need but know the person that needs it. I look forward to that challenge with every patient I see.

Let me share with you my routine for setting the stage at every dental visit for a successful interaction. As I come into the room, the patient is sitting up in the dental chair, and I sit down in front of them knee to knee. Then I say, “Tell me how you feel about today’s appointment,” or “Tell me what questions you have about what we are doing today.”

This does two things:

1. It sets the stage for “I am here for you as your friend and doctor.”
2. It prepares me to be present with them. I get to hear where they are before we start that appointment.

Once we establish what they are thinking and feeling, I ask their permission to lean back the chair. It signals that I am ready to initiate the procedure.

This routine gives them comfort, and when the procedure is done, I can sit them up and basically go through the same two questions: “How do you feel about today’s appointment? What questions do you have moving forward?”

Before and after every procedure, there is intentional time in which we are in relationship. I have found this to be very beneficial in how we move forward with patients. A very small amount of time and intention helps optimize each patient’s time with me, and I believe is a key to the success of my practice.