Change can be difficult even when it has benefits for everyone.

Some people are simply averse to any kind of change. As a result, we may encounter pushback from staff while attempting to initiate changes in protocols, practice policies, or practice systems. Anticipating and preparing for potential negative feedback is the best way to defuse staff concerns and smooth the way for needed change.

There are two prerequisites to navigating change successfully. First, the staff must believe that we have their best interest in mind. This is a matter of trust that is developed over time. Secondly, the staff must feel safe in offering unfiltered feedback before and during the change initiative. As the leaders of our practice, we are responsible for creating a practice environment that makes both of these essential prerequisites possible.

The following suggestions will prove helpful in developing a change strategy.

1. Be prepared.

Before introducing any change initiative, we must have clarity regarding the necessity and advantages of the proposed change. Painting a clear picture for the staff that includes the specifics and anticipated benefits is an essential first step. Anticipating the staff’s concerns and potential questions as well as our response will help in creating a smooth presentation. Set the expectations for how everyone might feel throughout the different stages of the transition, for example: resistance, frustration, skepticism, excitement, relief, and high energy.

2. Seek early adopter support.

Identify those people that are likely to support your ideas and seek their help in moving a change initiative forward. Most likely, these will be the leaders of the clinical and administrative staff. Collaborate with them in creating the best possible change model. By allowing them to contribute their input, they are much more likely to buy into the concept.

3. Present the change Initiative with humility and transparency.

“My way or the highway!” is the worst possible way to present any significant change. We gain acceptance by being as transparent as possible and patiently addressing staff questions and concerns. Seek collaboration and request input. Be more coach-like by using open-ended questions to draw out their underlying concerns, for example, “What concerns you about this?” and “What would need to happen for you to feel better about this change?”

4. Ask for their help.

There is something about asking for help that creates buy-in. Let your team know that you cannot achieve the desired result without their help. If the intended change is experimental in nature, let the staff know that it is reversible if the desired results are not achieved. Ask them how they think that they can positively contribute and re-affirm how important their role is in the process.

5. Consider scheduling more frequent staff meetings during periods of change.

Depending on the nature of the anticipated change, more frequent staff meetings may be necessary to address concerns and problems that may arise. For example, changing practice computer software seems to be problematic and frustrating for both clinical and administrative staff. Allowing more time to address the technical issues and frustrations of the staff has proven to the most effective means of addressing both issues.

6. Check in frequently with the staff:

Although checking in with our staff should be a common practice, it is most beneficial during periods of change. Simple questions like “How is it going?” or “What do you need from me now?” are a quick and simple way of letting your staff know that you recognize and appreciate their efforts in making the change a reality.

7. Celebrate the staff’s accomplishment:

Whenever the change is fully implemented there should be time for celebration. Consider doing something special for the team as a means of recognition for a job well done. An appropriate bonus and/or a special event away from the office are ways of expressing gratitude. Never pass up celebrating a team’s successful effort in achieving change.

In the 1960s, L.D. became so busy traveling to present three-day courses that traveling started negatively affecting his private practice. He decided he would no longer travel to make presentations. Instead, he would hold classes in Miami.

L.D. never had to advertise his courses. Instead, dentists would call his office and ask where and when the next course would be. So, when he decided to hold them in only Miami, Rose Quick kept a list of dentists who called. When 20-30 doctors were on the list, she rented space at the DuPont Plaza Hotel in Miami and invited them to come.

The Idea

James Cosper, Billy Anderson, and Jack Wilkins were talking with Rose Quick during a break at one of L.D.’s courses. They asked her, “What can we do for Dr. Pankey? He has done so much for us in our practices and personal lives.”

They wanted to do something meaningful for him. Out of their discussion came the idea of developing a foundation to continue to teach the clinical Pankey-Mann-Schuyler Technique and L.D.’s philosophy of the practice of dentistry which was known as “the Philosophy.”

It was fitting that they included Rose Quick in their discussions as she had played a major role in L.D.’s courses and would play a major role in the formation of the Institute. She had been L.D.’s right-hand person for over 35 years, smoothly managing his practice finances and the details of his courses.

When Rose first came to Florida from Iowa, she taught business courses in the Ft. Lauderdale high school system. She had become a good friend of L.D.’s sister Georgia who worked in L.D.’s office as a dental hygienist. Both women belonged to the same women’s business and professional groups. When L.D. found himself overwhelmed with the details of a thriving practice plus his work on the State Dental Board of Examiners, Georgia suggested L.D. interview Rose for the position of secretary-business manager. He then hired Rose.

L.D. was known to say, “Hiring Rose Quick was one of the best decisions I ever made in all my years in dentistry.”

The Proposal

The idea of the Institute was first suggested to L.D. in 1970 by his best friend and traveling companion, Dr. F. Harold Wirth, from New Orleans. Harold asked L.D., “How would you like to have a teaching institute named after you?” He continued, “It would be a place where dentists from all over could come to learn the PMS technique and Philosophy. It wouldn’t be like a typical graduate school where students were graded, but a place where they could learn to evaluate themselves. It would be a place where dentists could relax, enjoy themselves, and reflect on their personal lives and practices.”

L.D. thought it was an interesting idea. However, before he said yes, he told Harold there would be two conditions. First, everything would have to reflect up-to-date, high-quality dentistry; second, it had to be financially successful.

The Start

The Pankey Institute opened at the DuPont Plaza Hotel in Miami in 1972. It was more successful than anyone could have imagined. Although the Institute carried his name, L.D. never had anything to do with running it. Dr. Loren Miller from Texas was the first Director, Dr. John Anderson from Illinois was the first Director of Education, and Dr. Henry Tanner from California came to assist Dr. Anderson. It was mainly due to their energy and farsightedness that the Institute became so popular.

In 1985, the Institute moved to a new home on the island of Key Biscayne. Under the strong leadership of Executive Director Mr. Christian B. Sager and Director of Education Dr. Irwin M. Becker, the institute continued to help serious dentists in their quest for technical excellence and philosophical understanding, which is now–and always will be, the objective of the Institute.

The Original Curriculum

The original curriculum consisted of four one-week continuum courses. The Philosophy was studied and discussed during each of the four:

• Continuum 1 (C1) – The Comprehensive Examination
• Continuum 2 (C2) — Occlusal Equilibration and the Tanner Appliance
• Continuum 3 (C3) — The Curves of Spee and Wilson and the Functionally Generated Path
• Continuum 4 (C4) — Treatment Planning Complex Cases Using the Pankey-Mann-Schuyler Technique

Today

Over the years, the Institute has profoundly affected thousands of dentists and continues to do so today. Dr. Lee Ann Brady started at the Institute in 2005 as an instructor and became the Director of Education in 2017. In 2019, she was asked to become Executive Director. Under the capable leadership of Dr. Brady, the current curriculum is much broader than it was in the beginning to better match the current needs of dentists.

For many, The Pankey Institute has meant becoming more proficient and efficient as clinical dentists and finding the balance essential for personal wellness and fulfillment in dentistry. True to the L.D. Pankey Dental Foundation’s original mission, the Institute is still “The One Place” where dentists come to study the Philosophy of relationship-based practice and advanced dental techniques.

If the color of a prepared tooth darkens between the time you prepare it and the restoration is seated, the aesthetics of the final restoration can be impaired. This frustrating situation can be eliminated by knowing the causes of discoloration and what to do when planning treatment and prepping the tooth.

There are two processes that cause prepared teeth to discolor to a darker shade:

1. Pulpal necrosis
2. Chemical interaction between liquid vasoconstrictors and bacteria in the dentin tubules

Note that both processes can continue to further darken dentin weeks to months after you have seated the restoration. For more predictable aesthetic results, I learned some time ago to do the following.

Assess pulpal vitality first.

I am highly cautious when planning significant restorative treatment such as crown and bridge. Before prepping teeth, I review CBCT radiographs to make sure there are no pulpal health issues that need to be treated first. Like most dentists, I do not have CBCT imaging in my own practice, but I do have access to CBCT imaging via a collaborative relationship with a nearby specialist.

Use retraction paste instead of liquid vasoconstrictors for hemostasis.

Because the chemistry in liquid-viscosity vasoconstrictors can interact with bacteria in the dentin tubules to darken the dentin, I use retraction paste when I need hemostasis.

For me, these two seemingly simple steps are important ones when seeking optimal aesthetic results.

The Pankey Philosophy evolved slowly as L.D. built his practice and solidified in his mind which elements of his philosophy worked and which did not. L.D. served on the Florida State Board of Dental Examiners from 1932-1944. During that time, many dentists started hearing about his philosophy. Some dentists had a problem with the State Dental Board and needed to get their licenses back. Others were dentists who came to Florida to take the state board exams. L.D. always encouraged them to go out and do the best possible dentistry they could for every patient. Dentists from Tampa, Orlando, Jacksonville, and other areas of the state heard about L.D.’s work and would spend a week in his office to see what he was doing.

In 1947, L.D. was asked by the Florida State Dental Society to talk about how he ran his unique group practice. The presentation went well but it was evident to L.D. that few participating dentists had heard what he said. The transcript was printed in the Florida Dental Association Journal following his presentation. L.D.’s philosophy of dental practice, known as “The Philosophy,” had evolved as L.D. used it to build a practice. He knew from his own experience the elements of the philosophy that worked. Five years after the Florida Dental Association meeting and journal article, L.D. received invitations to present his philosophy to other groups.

Early in 1952, L.D. was invited to participate in a workshop on practice management at the University of Michigan, where a hundred dentists of various persuasions would be invited. At first, L.D. declined the invitation until the event’s general chair explained that he had been invited because he owned a group practice in Florida. At the time, group practices were not common in the profession. The facilitators of Michigan’s practice management workshop wanted to know how he had structured his practice. L.D. had three associates and fourteen staff members. Since he had experience running a group practice, he decided to attend.

During one of the breakout sessions at the Michigan meeting, L.D. was asked, “How do you run your group practice?” L.D. answered, “That would be like asking a golf pro to sit down over lunch and tell you how he plays golf.” He continued, “Managing a group practice while still practicing and using my philosophy involves much more than learning to play golf.” Just as not everyone has the natural talent to play golf, some dentists may never learn to become highly competent practice managers. L.D. told the session group that if they gave him at least three months to prepare and three days to present the information, he could answer their questions.

Some group members gave him five months and arranged a meeting in Milwaukee the following February, just before the Chicago Mid-Winter Dental Meeting. The Milwaukee seminar, “A Philosophy of the Practice of Dentistry,” was successful. Soon, he received many calls to give additional seminars.

Even before the class in Milwaukee, L.D. had many requests from dentists asking to visit his office to observe how the group practice worked and learn the philosophy, which was working well in the practice. For several months, Rose Quick, his private secretary, was glad to arrange these visits. However, the demand was so heavy that it became obvious that other arrangements would have to be made. Not only was it interfering with his ability to treat patients, but The Philosophy also had too many components to teach under these circumstances.

As an alternative, L.D. and Rose decided to set up two- and three-day lectures. When requests came to the office, it was explained, and classes were organized according to demand. For the first several years, L.D. traveled to various cities and offered three-day philosophy courses at the invitation of the study clubs. Those were the days before color slides and sophisticated projection equipment, so he used the blackboard and hand-outs. Then, Rose gave him the idea of having the material printed on roll-up window shades. The roll-up shades were portable and could be easily hung from the classroom ceiling or the top of a blackboard.

Eventually, the demand for classes became so great that L.D. did not have the time and energy to travel that extensively. Arrangements were made for a meeting room and housing accommodations at the DuPont Plaza Hotel in Miami. Rose took on the monumental task of coordinating the classes. A new course manual was developed, and the equipment necessary for conducting the classes was purchased.

A friend suggested that an evening of relaxation and fellowship should be included. Class participants and their spouses were taken by chartered bus to see L.D.’s first bungalow office built exclusively for dentistry in Coral Gables, followed by a buffet dinner in his home.

About a year ago, in my office, we reviewed our protocol for managing and treating patients with traumatized teeth. We reviewed the literature to learn how we could improve how we help our adult patients who have avulsed or mobile teeth following a traumatic event.

Antibiotics? Yes

One of the new things we read and thought about was whether to put the patient on antibiotics. We added this to our protocol—the patient goes on antibiotics for seven days after learning what antibiotics the patient can take, i.e., will not likely cause an allergic reaction.

Splinting? Yes

The literature now recommends splinting the traumatized teeth for two weeks and then removing the split after two weeks. Although there has been a conversation over the years about whether to splint or not to splint and if splinting has anything to do with the teeth ankylosing or resorption, the current recommendation is to splint but for just two weeks.

Improved Counseling of Our Patients? Yes

We learned that three common sense items needed to be reviewed with our patients, because it is easy to retraumatize teeth, and patients easily forget to be attentive to personal “gentleness.”

• We added to our protocol list counseling the patient to go on a soft diet that does not require biting down for three to four days, then longer if they sense the tooth roots are still mobile.
• Similarly, we added counseling the patient to do gentle mouth cleaning. They should brush traumatized teeth very, very gently so as not to re-traumatize or move them.
• We also added to our list making sure patients understand the importance of follow-up visits and radiography to track the health of the traumatized teeth.

Following the Health of the Teeth

We use periapical or CBT radiography to follow the teeth at one month after the initial trauma and again after two months, four months, and six months. If there appears to be healthy pulp and attachment of the teeth to the bone and connective tissue at six months, we can extend the time between making new images.

When L.D. Pankey returned to Coral Gables from the International Congress of Dentists in Paris, in 1931, knew he needed additional education if he was going to follow his personal commitment of not extracting any more teeth. With a recommendation from his new friend in Paris, Dr. Daniel Hally-Smith, the dentist, L.D. wanted to emulate, he signed up for a three-month summer course at Northwestern University in Chicago.

The program was designed to cover all the phases of modern dentistry including how to interview patients and do a proper clinical tour of the mouth so the student could determine what was really needed to give their patients optimum dental care. They were saturated with topics both technically and psychologically related to diagnosis and treatment planning concepts. Most of the information presented was focused on clinical procedures.

The patient psychology course was taught by George Crane PhD. During that summer, George Crane, a trained psychologist, was between his freshman and sophomore years in medical school at Northwestern. He had been hired to teach a summer course to physicians and dentists on how they could better understand and communicate with the patient.

At that time, there were no definitive textbooks about doctor/patient communications. During his lectures Dr. Crane brought in loose-leaf handouts for the class. The handouts later became the framework for his first book on applied psychology. Crane’s course was the highlight of L.D.’s summer, and it turned out Dr. Crane’s course became the foundation of what became the Pankey Philosophy.

Crane’s lectures were centered around psychology to be used by doctors to develop interpersonal relationships between the professional and the patient. The course included an overview of Carl Jung’s work, defining Jung’s four personality types: the introvert, the extrovert, the ambivert and the compensated types. The students also looked closely at the 1905 Binet-Simon Scale to determine the intellectual capacity of children. They studied the first “mental horsepower” test – otherwise known as the IQ test.

Later, when L.D. developed his own philosophy, he used much of the Crane course ideas for his Dental IQ, patient intellectual, sociological, and economic classifications. After finishing the George Crane course, L.D. felt confident that he had taken a giant step toward gaining the knowledge and communications skills that were needed in his practice.

Dr. Crane was a strong proponent of the balanced life and spent a great deal of time discussing Cabot’s “Cross of Life” which emphasized the need to balance work, play, love, and worship for a truly fulfilling life. The cross diagram was developed by Richard C. Cabot (1869-1939), who was a physician, philosopher, and Unitarian minister.

Following his graduation from Harvard University Divinity and Medical School, Cabot started his clinical work at Massachusetts General Hospital where he established a hospital based Social Service Department and became the first Chairman of the Department of Social Ethics at Harvard. Over the years, Cabot wrote twelve books on Medicine and Ethics.

Cabot also became a major educational leader in medicine by publishing monthly “Cabot Cases” in The New England Journal of Medicine. Each month physicians in local study clubs throughout the county would read and study the information provided by Cabot. They would try to determine the diagnosis for the patients in the case. The final diagnosis was provided the following month in The New England Journal of Medicine.

Crane assigned one of the Cabot books, What Men Live By, to L.D. and his classmates to read. The book explored how to achieve personal happiness. According to Cabot, happiness could be achieved by striving for balance in personal life. When explaining this concept to his patients and other professionals, Cabot recommended drawing a simple diagram with Happiness in the middle and four arms labeled Work, Play, Love, and Worship.

What Men Live By was published in 1913 and has long been out of print. Many of the references seem archaic; however, the basic principle of balance has stood the test of time. There are needs for all of us to be productive, to enjoy daily life, to have people in our lives that we care about, and to extend our interests beyond ourselves. An excess or a deprivation of any of these basic needs of life can set our lives out of balance, destroy our sense of self-worth, dull our enjoyment of life, or alienate us from our fellow human beings.

When L.D. Pankey developed his philosophy, he uses the Cabot Cross as a starting point for dentists on their journey to fine personal happiness.

I’m a restorative dentist with a passion for occlusion. I’m a firm believer that our patients deserve our best efforts to eliminate deleterious stomatognathic forces that impact comfort, function, smile aesthetics, and whole health. So, I encourage all dentists to wrap their minds around the area of “occlusion” and become immersed in hands-on, mentored courses to better diagnose and treat their patients.

In teaching at The Pankey Institute, I often hear clinicians view occlusion as a great, big mystery, and yes, sometimes misery. At each stage of my developing interest, knowledge, and skill, I have found my passion for occlusion grows and results in better clinical management and outcomes with my patients. When a well-planned full mouth equilibration is completed, the patient’s elation over how their “bite feels” cannot be matched in dentistry.

So, What’s So Hard About Occlusion?

L. D. Pankey was said to say that occlusion is getting the posterior teeth to touch all at the same time with light contact, and when you bite firmly, neither the joint nor the teeth should move. In addition, when you move your jaw left, right, or forward ONLY the front teeth should touch. He would chuckle and say, “So what’s so hard about Occlusion?”

Another way to think about it is that the jaw operates like a tricycle; the two little wheels are the joints, and the big wheel is the front teeth. To have a smooth ride, the steering mechanism and the joints shouldn’t have any notches in them!

Where My Journey in Occlusion Began

Although occlusion was integral to my dental school education, it really wasn’t until I went to the Pankey Institute that my real journey in occlusion began. While I went through the Continuums at the Institute, I joined several technical study clubs. Under the direction and encouragement of Drs. Richard A. Green and Herb Blumenthal, I explored many facets of Occlusal Therapy and TMD.

My View Today

Today I see the occlusion/bite as a potentially significant factor in the balance and harmony of the patient’s whole health. Integrative dental health involves looking for the impact of “other” on the entire body, as my colleague Dr. John Droter states it. The airway, myofunctional impact, and the body’s posture and structural integrity may influence how the teeth come together. If the teeth are chipping, breaking, or intermittently sensitive, it could be the bite. Headaches can be directly associated with the bite. Establishing occlusal harmony – getting rid of “any notches” in the steering mechanism and joints, is a process best tested with a finely balanced bite appliance.

Today I see occlusion as a case-by-case riddle. Every patient is an individual, and their occlusal management is customized accordingly. When solving each patient’s riddle, I’m trying to see how harmony can be re-established in the system of joints, muscles, and teeth. I utilize a bite appliance as a mechanism to test out an occlusal scheme for the patient. Once harmony is achieved, the challenge is to wax and plan the case to mirror the harmony established on the appliance.

For each patient, I’m also trying to figure out how the patient responds to appliance therapy to determine the best treatment modalities or modality. Is the treatment limited to the dentition or is intervention in the joint appropriate?

Either way, my governing philosophy is to make the fewest changes to the dentition while producing the best result for the patient. For some patients, this could be full mouth rehabilitation and for others simply equilibration and/or orthodontics.

Beyond the Teeth and Joints

We are a closed loop from head to toe, and the influence of the stomatognathic system on the “whole” body is best not ignored. Research shows that the teeth, jaws, and tissue affect different areas of the body, impacting for example head, neck, heart, pulmonary, and gastrointestinal health.

In establishing harmony between the dentition and joints, we are calming the musculature. In my mind’s eye, I see occlusal harmony calming the whole system.

Is Pankey Essentials (E1) Right for You?

Dentists who participate in E1 invariably say it is both an inspiring and practical course, and they want to come back for E2.

In E1, you will receive enormous encouragement to stay inquisitive and engaged in learning. You will gain insights that impact all aspects of dental practice, and when it comes to occlusion, you will be immersed in a combination of presentations and hands-on exercises coached by experts. The Pankey Institute excels at removing “the misery” out of occlusion by coaching you as you perform exams on colleagues, do diagnostic work ups, and practice making occlusal changes with models, wax, and appliances in the Pankey lab.

“Patients, who seek your care, want the best care you can give them. I believe the Pankey Essentials continuum is one of the best continuums on the planet to learn how to solve occlusal puzzles. Without this “essential” development, we are not the best physicians we can be.” –Kevin Muench DMD