In his recent book Subtract–The Untapped Science of Less, University of Virginia professor of design Dr. Leidy Klotz points out many instances where we allow ourselves to be overwhelmed with information and complexity. He argues and demonstrates that subtracting the extraneous often leads to greater clarity and efficiency.

Reading Klotz’s book, brought to my mind the Pankey Institute’s Essentials continuum that begins with Essentials 1 (E1). Dentists arrive at E1 overloaded with information taught in their dental schools and other CE programs. All that information may have some value but the role of the Essentials courses is to subtract the extraneous and focus on what is essential.

We arrive at E1 thinking everything is important, and we discover that there are essential elements of dentistry that are key to effectively working with patients, performing a complete exam, diagnosis, and technically excellent, predictable care. From these key elements, we can build practice systems that are clear and efficient.

What Is Essential?

We aren’t born with complete wisdom like Athena born from the forehead of Zeus. We learn wisdom (what is essential) faster by being in the company of others who have traveled the same road, asking, “What is essential? What do I NEED to know?”

The Pankey Essentials continuum exposes dentists to the clinical, behavioral, and financial aspects of practice. And goes beyond exposure to exercises and exploration. The courses invite dentists to understand themselves, their patients, and their work exceptionally well. The courses invite dentists to focus on and develop essential skills.

Our profession has undergone a technological explosion over the past few years. Some of this is wonderful. But how much of what we invest in are we fully utilizing? What is the best technology to invest in? What is the best way to implement it? The Institute’s faculty help us cut through the clutter and determine what works best…what we can implement with our teams and patients that will improve our dentistry and the patient experience. But first, the Essentials courses peel away the layers of hype and technology to help us grasp the core skills we must attain.

The core skills are behavioral as well as technical. And because the behavioral aspects of dentistry are not discussed to great extent in dental school curriculums, one of the roles of the Essentials continuum is to fill in this gap. In the Essentials courses, we learn the importance and skills of behavioral science. We learn how to most effectively lead and affectively influence. We dig deeper into understanding ourselves and our patients…our emotions, our motives. We discuss the behavioral concepts that were taught by Dr. L. D. Pankey because they remain valid today. These concepts are straightforward and help us develop lifelong patient relationships and personal skills.

The business aspects of dental practice are overwhelming. Dental schools do not have time to teach business essentials. In the Essentials, dentists learn essential financial skills such as how to understand their financial statements. If we are not making a profit in our practice we can’t stay in business.

Self-Examination

When I first attended an Essentials course (then called C-1), I worried that I might not know enough. I discovered that I knew a great deal but I had not clearly defined what was essential. I learned I needed to be more assertive about asking myself why questions. For example, I found myself asking:

• Why am I doing this? Does this step add value to the final result?
• Why is my final result not stress free and predictable? What step did I miss?
• Why am I “telling” my patients rather than “asking” for their input and values?

An Intentional, Essential Community of Support

The Essentials faculty and my fellow students helped me understand that getting rid of what is not needed is not simple. Determining what is essential and building my practice systems around the essentials takes time, thought, and effort but was made easier for me because I had the help and constant encouragement of the Pankey faculty and community in shaping my approach to dentistry and my career.

My friend and colleague Dr. Richard A. Green has always said, “Intentionally becoming both more affective and more effective is essential to excellent patient care.” So often we intend to do something but don’t have the encouragement we need to remain intentional. As my friend and colleague Dr. Barry Polansky says, “We humans tend to slip, slide away. It is by developing habits intentionally and self-checking our assumptions that we stay alert to the possibilities of how we can become more.”

The goal of treating severely worn teeth is to extend the life and function of the teeth while improving their function and aesthetics. For the patient’s optimal comfort and health, we seek to achieve a stable posterior occlusion and efficient anterior guidance.

This article is written for the purpose of inspiring dentists to learn indicators for using this technique, and the no-prep “index technique” of diagnosing and restoring worn teeth with composite restorations.

The Benefits of the Index Technique

Conservation of the natural tooth structure—Whenever possible, dentistry should be additive, not subtractive-additive. The adhesion of composite resin is now so reliable that retentive cavity preparations are not always necessary. The digital index technique protocol proposes a conservative and alternative approach based mainly on minimally or noninvasive copy-and-paste composite restorations on both ante¬rior and posterior teeth. In anterior sextants with undercuts, a direct molding technique allows the clinician to be extremely conservative.

Simple repair—Another positive trait of this technique is the relative ease with which chipping or restorative failure can be managed by applying a simple adhesive protocol. Full loss or detachment of the restoration is an unlikely occurrence. Partial failure can be easily repaired with fresh composite following proper surface treatment: sandblasting, salinization, and bonding all surfaces.

Less clinical time and expense—This technique shortens the time to finalize a case. The technique requires a wax-up for planning the case and the fabrication of a transparent index but no other digital or analog lab expense. (See accompanying images above.) With this technique, you can avoid or postpone a more biologically invasive and financially costly solution.

Long-lasting aesthetics—Nano hybrid composite has good wear characteristics. Its superficial gloss lasts, and the composite can be easily repolished during patient re-calls.

Reversibility—With the index technique, you can remove the composite to restore the patient’s teeth to the occlusion they had before treatment if necessary. It should be noted that it is not easy to remove composite after adhesion due to bonding strength and composite chromatic integration with the natural tooth.

Join me for “Worn Dentition: Direct & Indirect Adhesive Management through a Non-Invasive Approach”

In October 2023, I will present an in-depth, two-day workshop at The Pankey Institute. During this workshop, you will learn the indications and protocols for diagnosing and treating severely worn dentition using the new direct “Index technique” approach. The course also will cover when and how to bond on worn dentition using additive partial indirect restorations (onlays/overlays) in composite and/or ceramic. The step-by-step protocols for digital and analog workflows will be addressed during the workshop through step by step images and videos on patients in order to understand this “hybrid approach”. I look forward to being back at the Institute, and I hope you will join me there!

The photos below refer to an INDIRECT additive adhesive ceramic cementation case:

while these photos refer to a DIRECT additive adhesive molding copy&paste protocol through the “Index Technique” protocol:

Here’s how to become an instant leader.

A while back, I sat in on a Facebook Live interview with a dentist who was discussing practice management for young dentists. Like so many times, the interviewer asked the guests, “What’s the one piece of advice you would give to a dentist who is just starting out in his or her career?” And like so many “experts” the dentist replied, “Learn leadership.”

It was like asking for advice on how to live a long life and responding, “Keep breathing.”

Yes, leadership is the right answer, but have you ever looked at the number of books available on leadership? Today I looked on Amazon and found 60,000 leadership books.

Young dentists need better answers.

Young dentists need more practical answers—answers that allow them to apply what they know. Leadership comes in many styles and sizes. Leadership is a universal concept. Did the dentist mean the Leadership Lessons of Abe Lincoln…or the Navy Seals? There is a big difference.

A better question might have been: Where should I start regardless of style, personality or even mission?

What is the one thing that all leaders have in common?

The answer is followers. No one can be a leader without followers, and in a dental practice, followers are patients and staff. Not one of them will take one step forward if they don’t believe that you are the doctor that will take them where they want to go.

What is it that the followers in a dental practice want to know?

They have two silent questions in their mind. You must answer the two silent questions for them to trust you. And they must trust you to follow you.

The first question is: “Do you care about me?” So that is your starting point. Don’t take for granted that you are being perceived as someone who puts their patients and staff ahead of themselves. It takes lots of time to develop the mindset and habit set that leads to this perception. As a young dentist you need to start there and work on this.

The second question is: “Can you do the job?” or “Are you competent enough to do the job?” As a young dentist, understand that you are still in your apprenticeship stage of your career. That means there is plenty more to learn. In my career I remember taking many technical courses that were disconnected and I had to make sense of them. It was more like a self-directed apprenticeship.

Who can help you become a leader?

Mastering leadership, trust and technical dentistry is a combination you will find at The Pankey Institute. I tried numerous CE programs and read thousands, of books. But it was the inspiration and mentoring I received in the Pankey community, and the discipline of journaling (reflection) that I adopted mid-career that kept me on task towards mastery.

Today I would advise the young dentist to find a mentor or mentoring community, and when you find them, ask, “Do you care about me and can you do the job?”

That would be my advice to any young dentist looking to learn about leadership, trust and even mastery.

I heard about the new Inspire sleep apnea device over a year ago. If you have not heard of “Inspire” yet, be on the lookout. TV commercials are everywhere.

What is Inspire? It’s an implantable device that helps treat sleep apnea. Much like a pacemaker, a surgeon implants a little control device with some electronic leads to manage neural inputs to the muscles around the airway in order to help hold the airway open.

After the device is implanted, the patient presses a button on a smart device app to turn it on and off. It’s as simple as pressing the button when they are ready to go to sleep and pressing it again when they wake up. There is no need to wear a CPAP or oral appliance.

Over a year ago, when I first learned about Inspire, I mentioned it to a patient who had already had orthognathic surgery, had tried CPAP, and was still struggling with his quality of life while dealing with OSA. He was tired of having a dry mouth and increased risk of caries. We had already had several conversations.

At a subsequent appointment, he shared with me that he was extremely grateful we had had that conversation about Inspire. It motivated him to talk to his primary care physician and look at having the device.

He also shared with me that this treatment was covered by Medicare and then his gap insurance. Why did they cover it? Interestingly, it was not because he was CPAP intolerant or he had failed—because he was regularly wearing his CPAP. They covered it because he was suffering dental decay, dry mouth, and other secondary issues due to the CPAP.

I think we’re going to hear about this device more from our patients, and there will be times when we think it is in our patient’s best interest to start a conversation about it. If you are not familiar with Inspire, I recommend that you hop on the Internet and learn more about it.

Interested in Learning More About Dental Sleep?

Course: Creating Healthier Patients & Practices: Integrative Dental Medicine
Date: August 11 – 12, 2023
Location: The Pankey Insititute | 1 Crandon Blvd Key Biscayne, FL 33149
Register: Click Here

Introversion and extroversion are psychological preferences first outlined by Carl Jung and then implemented in psychological models such as the Myers-Briggs type indicator (MBTI). The terms introversion and extroversion share the Latin root vertere meaning to turn. These preferences enable individuals to relate to the external world in different ways

Extroverts gain a significant part of their sense of self via feedback from others. Consequently, they thrive on interaction, which is energizing to them. They find more isolating situations stifling.

By contrast, introverts tend to develop their sense of self individually through reflection and clarification. They thrive in quieter and less stimulating environments, such as small gatherings with others whose thinking and values are aligned with their own. (I think this is why introverts tend to thrive in small person-centered practices that are values-driven–where their values are commonly shared by team members and patients alike.)

A Pankey Institute study in the 1980s showed that most dentists lean toward introversion. This makes sense because the profession requires full attention to small details all day—both physically and psychologically. Consequently, most dentists will say something like, “I love the technical aspects of dentistry, but I’m constantly frustrated with my staff and patient management responsibilities.” And in response, they will delegate the latter to others, creating a psychological wall between doing what they enjoy and the responsibilities they find too frustrating.

On the other hand, dentists who are more gregarious and outgoing tend to build up practices more quickly but struggle to stay on task because they thrive on social interaction. Consequently, these dentists tend to benefit from consultants who help them create systems where they “stay at the chair” and produce for the team.

If you lean toward being an introvert, you will likely discover that your practice grows more slowly, but with more intention. That can be a good thing and a strength if you learn how to leverage it. Why?

• The more conservative approach introversion brings to decision-making is more values-driven. Consequently, it’s not as heavily influenced by the environment and emotions as it is by personal insight. Thus, behaving more like an introvert helps us to identify smart risks that are worth taking because they have long-term, values-aligned potential.
• Additionally, Introverts are very sensitive to the environment. They tend to spot “warning signals” from team members and patients.
• Running a dental practice is a long-term investment, much like what Warren Buffet said about stock investing, “You need a stable personality. You need a temperament that neither derives great pleasure from being with the crowd nor against the crowd because this is not a business where you take polls. It’s a business where you must think.”
• Additionally, introverts can be more creative IF they structure their work environment in such a way that it tends to support their creativity. That’s because it is the nature of extroverts to mimic the opinions and behavior of others. Having a more solitary thinking style allows a person to tap into more creative solutions.

Introverts can learn to be more extroverted and many adults become ambiverts as they experience life. Certainly, in my case, I grew in my ability to engage in both patterns of listening and talking more equally—and effectively, despite being an introvert at heart.

From my blogs, you probably have ascertained that I am drawn to human psychology. I agree; both the psychological and clinical aspects of dentistry interest me. One of the benefits of lifelong learning is that I have learned to enjoy the business and social operations of my practice more over the years, and any psychological wall I started to build (between them and the clinical side) has been intentionally torn down.

Workplace environments are more enjoyable when there are variety and balance. If you are an introverted dentist, I recommend that you have extroverts on your team to encourage conversation and draw out the group’s perspective on various challenges. If you are an extrovert, I recommend hiring introverts in key positions whose instincts and intuition you deeply trust, so you can listen to their thoughts before making final decisions.

Susan Cain is the author of Quiet: The Power of Introverts in a World That Can’t Stop Talking. Cain says weighting our teams to having everyone be like us is “a colossal waste of talent.” It’s my opinion that businesses, dental practices included, are better served by taking a yin and yang approach to team hiring to create a balance of the two personality styles.