All of you have heard me quote the famous proverb: “Guard your heart for it is the wellspring of life.” It is great wisdom. It is also very practical.

To remain healthy and safe, our “hearts” need to be protected. We need rest, downtime, and peace of mind. We need a life that gives energy as well as demands it. We need people around us to remind us of who we really are and what is important. We need to say yes to what is most essential and no to the things that aren’t essential.

In recent weeks I have heard a podcast interview of two people on the other side of burnout and a forced six-month sabbatical. I have had multiple conversations with dentists and dental teams that are overwhelmed and disillusioned. In addition, I have listened to a sad story of a friend who started behaving carelessly and out of character secondary to the fatigue and frustration of unrelenting pressure and career demands. He just wasn’t himself.

Many of you are running full speed, meeting the relentless demands of your practice as well as pursuing teaching and writing opportunities. The question I pose to each of you is “Which opportunities and demands are the most important—essential, to you and your unique life?”

We needlessly increase stress when we compare ourselves to others and think we should achieve what they are achieving. We create pressure on ourselves when we feel we should say yes to others’ requests for our energy and time. In contrast, we honor health when we pause to consider what is best for ourselves and recall our personal priorities.

Our purpose, capacity, energy, desires, loves, dislikes, and circumstances are unique to each of us and unlike those of anyone else.

I have listened to and read about people, who have been through periods when they struggled with their physical health, energy, and emotional state. To recover, they found that vacations were only a part of the solution. They had to find a community of peer support. They had to find ways to make each day healthier and more productive. They had to intentionally create “white space” in their life, place only the most important events on their schedule, and develop a respectful way to say “no” or “not now.”

Saying no is difficult for most of us but is required to live our one short life on purpose. In addition to living on purpose, there are other essentials for wellness. I’m thinking of:

• Resilience—Restoring physical, mental, and emotional strength often requires more rest, exercise, and recreative interaction outside of work with family and friends to reframe perspective.
• Meaningful work—Do what you love at least 50% of the time.
• Energy management—Pace yourself, take breaks, enjoy the “flow” that occurs when you are highly engaged in your work, and respectfully rely on your leadership team to help you maintain a schedule that prioritizes the most important activities.
• A peer-to-peer community of support—We have the human need to give and receive empathy, understanding, wise counsel, sparks of creativity, and encouragement.
• Dedicated time to recreate the self—Think in terms of daily, weekly, monthly, and seasonal-yearly rhythms. Create time to regularly relax, relate, and play outside of dental practice. Like a surfer running to the beach when the waves are perfect, allow yourself some flexibility to embrace spontaneous opportunities.
• Spiritual nourishment and expression—What nourishes the most foundational part of you? Seek the goodness that elevates your soul and feed on those nutrients. Celebrate that goodness with gratitude.

We talk a lot about balance at Pankey, and we do this because it is all too easy for healthcare providers to run out of steam…to run out of oxygen. Like the airline steward says, “Put on your emergency oxygen mask first before assisting others.”

Our positive thoughts, emotions, words, and actions—our joyful hearts, are what make it possible for us to be a wellspring of understanding, compassion, and love. We need to protect our hearts to enjoy our work and improve the wellness of everyone around us.

When L.D. Pankey visited Dr. Hally-Smith in Paris, Hally-Smith was curious about how L.D. could afford to come to the International Dental Congress in Paris. L.D. told him about his benefactor, Mrs. Blanchard. Hally-Smith said, “That is wonderful, just wonderful!” Turning serious, he then said, “You know of course that you will make it. Your benefactor has started the process for you but there are many things you will have to do before you will be there.”

Hally-Smith gave L.D. a personal tour of his office. The office had five dental technicians and three associate dentists. His personal dental assistant was a White Russian woman dentist who had been driven out of Russia during the Russian Revolution. She was wearing a long, highly starched nurse’s gown that went all the way to her ankles. L.D. began to understand what Mrs. Blanchard, his benefactor, was talking about. She wanted him to know some of the outstanding dentists in the world! When she suggested he take the trip, she said, “I think you have the potential of becoming an outstanding dentist.” This was after he had completed her dental work.

L.D.’s time at the Dental Congress was a busy one. There was so much to learn! Even though Taggart had cast the first inlay nineteen years earlier in 1912 by the “lost wax” technique, investments and casting techniques were far from perfect. Many slides were shown, and many papers were given on new techniques in restorative dentistry. New impression materials and impression techniques were shown in lectures and table clinics. Much of the denture information did not interest L.D. because he was mainly interested in saving teeth.

After their first meeting, L.D. made rearrangements to spend an additional week in Paris with Dr. Hally-Smith. Hally-Smith was old enough to be L.D.’s father. One morning, they were talking about patient communications, and Hally-Smith asked, “Did you ever take the Bosworth course?” L.D. said he had taken the course.

Hally-Smith said, “Isn’t Bosworth the dental supply man who suggests dentists say this when speaking with their patients, “I can do a good job for so much, do a halfway job for this much, or I louse it up at a very reasonable price’?” L.D. answered by saying, “That is not exactly what Bosworth says but pretty close.”

Hally-Smith then asked, “L.D., do you like that approach?”

L.D. said, “No, I’ve never liked it, but I have tried it.”

Dr. Hally-Smith became serious and said, “L.D. it all starts with communication. You should tell your patient the optimum way their dentistry should be done. Then what the patient decides is their own decision. If you’re going to make a compromise with them, then compromise based on your patient’s knowledge, not because you have prejudged them. You should tell every patient what optimum dental care would do for them. If they decide to go elsewhere, leave the door open for them to come back later. I have found over the years that a lot of these people return after they’ve lost half their teeth.”

They discussed this premise for a while longer, and L.D. realized how right Hally-Smith was. Tell patients about the best treatment plan. Then, if there were any compromising to be done, let them decide. L.D. realized Dr. Hally-Smith’s way of communicating was easier said than done.

When L.D. returned home from Paris, he never felt comfortable using the Bosworth Plan again. Instead, he presented patients with the optimum treatment plan. If they resisted, he would compromise and do only what they would allow or just put off the work, except for emergencies. After a while, L.D. began calling this compromise time a “Holding Program” – a time of doing only what had to be done until the patient chose to move on to optimum care. With enough time, patients would usually follow through with optimum care, but not always.

This is part of a two-part story about L. D. Pankey’s trip to the International Dental Congress in Paris in 1931.

Thanks to the generosity of one of his appreciative patients, Mrs. Blanchard, L. D. was able to go to the International Dental Congress. She had expressed the desire for him to meet with the outstanding dentists of the world, and L. D. was determined to make the most of the trip.

Before he left, another one of his patients, who was a retired dentist from Chicago by the name of Frank Davis, suggested L. D. meet with his old friend Dr. Daniel Hally-Smith who practiced dentistry in Paris.

Before L. D. Left for Europe, Davis provided him with a letter of introduction. Hally-Smith had worked for Frank Davis as his lab clean-up boy when Hally-Smith was going through dental school at Northwestern University. It was following graduation in 1901 that Hally-Smith moved to Paris.

Davis said, “Hally-Smith has the most outstanding dental practice in the world and when you meet him, you will find he’s a real character.” As a senior dental student, Hally-Smith wore a bowler hat, spats, and carried a cane – both when he went to dental school and to work as a laboratory assistant.

On his third day in Paris, L. D. found Dr. Hally-Smith’s office on the top floor of a five-story building. On the street level was the famous Van Cleef and Arpel’s Jewelry Store, a location considered by many to be the best in Paris. When he got off the elevator on the fifth floor, he found himself in a sterile-looking, bright white hallway with high ceilings, no signage, and tall twelve-foot white doors. As he made his way down the hall, he found one door with a small gold plaque engraved with D. H-S. He guessed it was the correct door for Daniel Hally-Smith.

The door was locked. From the ceiling hung a heavy rope with a tassel on it. So, L.D. pulled the tassel. When the door opened, he found standing in front of him, a proper-looking gentleman wearing cut-away coat and striped trousers, holding a silver platter. The gentleman said something to L. D. in French. L. D. said, “I’m looking for Dr. Daniel Hally-Smith.” Then, in perfect English, the gentleman asked L. D. for his card and “Do you have an appointment?” L. D. did not have an appointment or a card, but he did have the letter of introduction from Frank Davis in an envelope with Dr. Halley-Smith’s address written on it. He placed envelope on the tray. The butler invited him in and took me down a hallway lined with fine tapestries. They arrived at a large reception room with a fireplace and original oil paintings on the walls. This was surely the fanciest dental office L.D. had ever seen.

In a short while, Dr. Hally-Smith came in. He took L. D.’s hand and said, “Glad to see you.” Come right in, Dr. Pankey.” That is when L.D. realized that Frank Davis must have written to Hally-Smith to tell him he was going to have a young dentist-friend visit him from Florida.

Hally-Smith was just as gracious as he could be. “We don’t see too many Americans over here these days,” he said. During their first meeting, L. D. learned that Hally-Smith was going to be busy because he was the general chairman of the entire International Dental Congress. L.D. knew right away that Dr. Davis had done him a great favor in sending him to meet Daniel Hally-Smith.

In Part 2, you will read that L. D. soon received Hally-Smith’s best advice and put that advice immediately into practice when he arrived back home.

Often something I read or hear will trigger a cascade of retrospective thoughts about friends, team members, patients, family, teachers, and mentors who have touched my past and present. These memories are constantly shaping my future.

Recent Reflection

Within the past month, I experienced the third session of a six-session Pankey Virtual Study Club on “A Philosophy of the Practice of Dentistry_v2.0.” As a small group, we reviewed the timeline that each of us had created on Dr. L. D. Pankey’s personal story and the timeline we had created on our own story.

As the decades pass, I find this process keeps revealing insights for me and others, and the process is connected to other things as well. Once again, I became more aware of events in Dr. Pankey’s story and the one-on-one conversations we had over twenty-plus years.

Dr. Pankey would often invite us to better understand the depth of processing involved by saying, “It can take fifteen years to get a philosophy into our tissues.”  Some in his tutelage received that statement with some despair and others with relief, as they honestly looked at themselves in their mirror of life and celebrated their slower understanding, in bits and pieces. Years have demonstrated there is a lot to chew on and begin to digest, through experience.

Another one of his favorite statements was a Dr. G. V. Black quote, “No dentist has a moral right to be anything but a continual student.” One of Dr. Black’s many roles was Dean of Northwestern University Dental School. As a dental student there, I saw that statement written in many halls and heard it in many lectures.  It took me a while to understand it as an encouragement for a lifetime of living and learning…hmmm…Isn’t that interesting?

Recent Realization

My most recent reflections on Dr. Pankey’s timeline and the conversations we had brought me to the realization that his formation of “A Philosophy of the Practice of Dentistry” began long before he started talking about it in 1947.

He graduated in 1924 when he was soon to be twenty-three in July. In eighteen months of budgeting his cash flow, he had paid back his school debt and the total cost of his practice debt (new equipment and all). By then, he had received a letter from his mother congratulating him on his success and telling him about the treatment she had received from one of his classmates. She wrote that she hoped he was not doing the same to other people’s mothers and removing all their teeth.

He shared in a conversation with me that he had never been able to talk with his mother about those dental events! Her letter impacted him deeply and caused him to create a Vision Statement, which included “saving people’s teeth and never removing another tooth” for the rest of his life. To me, that is a true Vision Statement because, at that time in dentistry, the process of helping people keep their teeth for a lifetime had not been clearly identified.

Dr. Pankey continued to learn about many things throughout his life, which shaped “A Philosophy of the Practice of Dentistry.” Even though he started talking about it for the first time in 1947, it was twenty-two years in the making and more years in the refining. Hmmm…

Dr. L.D. Pankey, Sr. (“L.D.”) was born on July 31, 1901. He received his Doctorate in Dental Surgery degree from the College of Dentistry at the University of Louisville, practiced in New Castle, Kentucky, for one year, and then relocated his practice to Coral Gables, Florida, in 1926.

The motivation for his decision to leave New Castle came when he received a letter from his mother. She wrote,” I am happy you are doing so well in your practice, but I hope you are not doing to your patients what has been done to me. I have had all my teeth out and now have dentures. This has been the unhappiest experience of my life.”

L.D. had examined his parents while in dental school and was sure they did not need dentures. After reading his mother’s letter, he made a commitment to practice dentistry in a new way, focused on saving teeth. This was a difficult decision because at that time he did not know how to achieve his commitment. In 1926 the typical dental practice provided examinations, cleanings, extractions, silver and silicate fillings, and complete and partial dentures.

His decision to leave New Castle, Kentucky was driven by the desire to have a new, fresh start and to find his own way to practice dentistry without removing teeth. Over his lifetime, he often said, “When I left New Castle, I vowed that I would never take out another tooth as long as I lived.”

Shortly after arriving in Coral Gables, he was lucky to be invited to join a unique dental study club in Miami headed by an oral surgeon. The purpose of the study club was to study ways to prevent tooth loss. He couldn’t have moved to a better place to learn with and from other like-minded professionals.

What made this club unique was they did not pay an honorarium to speakers., Instead, they paid their travel expenses, and they personally entertained the speakers in their homes for the week. The speakers were happy to have a mini vacation with their families in Miami. This gave L.D. the opportunity to meet and befriend them.

Among the visiting speakers were notables such as Winston Price who talked about nutrition as it related to caries, C.C. Bass MD who talked about flossing and home care (the Bass tooth brushing technique and unwaxed floss), Harry Morton who talked about restorative dentistry and showed them how to use of the Munson articulator to create the curve of Spee and Wilson, and Clyde Schuyler who came down from New York City to discuss his ideas on occlusion.

The letter from his mother launched his unique career and influence on dentistry which has been indelible for the last 90 years. Reflecting on L.D., the person who inspired me most to take the career journey I have been on for over 50 years, I realize his philosophy of dentistry and his friendship still inspire and shape me. His mother’s letter is always on my mind as I continue to teach prosthodontics and chair the Department of Dentistry at the University of Toledo. I can’t imagine a more meaningful life than providing others with optimal health, function, and the happiness of having a beautiful smile.