A quick, easy way to create a mission statement for your dental practice involves your team. Last year, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series.

Sometimes we suspect a dental patient has tooth wear or damage from attrition. In these cases, we want to help the patient understand what they do with their teeth while sleeping. We also want to see for ourselves the patterns of wear. I recently learned about the Brux Checker® diagnostic material during the 2022 Masters Week at The Pankey Institute.

During Masters Week, Dr. Ricardo Armanetto from Genoa, Italy, showed us this material, which is 0.1 mm in thickness. One side of the material is red, and the other is foil. The material can be placed in your MiniStar®, BioStar®, or Vaquform thermoformer to create a suck-down device that your patient wears over their upper arch overnight. A suggestion is to make two of these devices and ask your patient to wear one for one night and one for a second night.

If the patient is para-functioning during sleep, they will wear the red off the device in the places where their teeth are touching within 0.1 mm of each other. You will see which teeth are touching and grinding.

In thinking about using Brux Checker, the following cases came to mind:

• Brux Checker is designed as a patient education tool. I want to use Brux Checker for patients I think are para-functioning because of signs of wear and attrition—and now I need them to take some ownership of their parafunction. This is an easy, inexpensive way to do that, in addition to the QuickSplints I use in my practice.
• I also want to use Brux Checker with patients I have equilibrated to double-check my equilibration. Sometimes, when the patient is in the dental chair, it is difficult for the patient to find a posterior interference that I failed to clear out. I want to ensure they are not damaging their teeth while para functioning on molars during sleep.
• Similarly, after placing dental restorations, I can use Brux Checker to fine-tune the occlusion after seeing what happens during the night versus in my dental chair.
• In the case of Class IV corners or incisal edge repairs that people want to be replaced in composite and the composite pops off, they may not know that they parafunction and there is a need to fine-tune their occlusion. I don’t know if I can get one of these patients to wear a Brux Checker during the daytime, but it should be easy to get them to wear one of these devices during the night. If the red wears off the foil at the spot where the composite has been used to repair a Class IV corner or incisal edge, there will be no question about the stress they are placing on the repair.

You can see that I’m thinking beyond patient education to using Brux Checker to help me fine-tune someone’s occlusion. I know there are places where people bring their teeth together at night that they can’t show me in the chair.

After practicing dental hygiene for more than twenty years, I went to work in the office of Dr. Doug Roth who was attending courses at The Pankey Institute. He had a copy of Dr. Bob Barkley’s book, Successful Preventive Dental Practices. Reading that book was a revelation for me. Although I never knew Bob Barkley, his work so resonated for me that I had the feeling he had read my thoughts about working with patients.

I had believed for some time that more was possible in dentistry. I had worked with good dentists and felt as though I took good care of my patients in the time I was allowed to spend with them. We were kind, thorough in our exams, and conscientious in treatment recommendations. Sometimes they took our recommendations, and sometimes they did not. I did not think there was much we could do to change that.

As a result of Bob Barkley’s book and the courses Doug was taking at the Pankey Institute, we incorporated a new model for bringing new patients into the office. Instead of moving patients quickly through an exam and treatment recommendations, we invested time and attention to get to know patients in a different way before we recommended significant treatment. I had no idea of the depth of connection we could have with patients, and the impact we could have on their health and well-being!

We spent “engaged” time with patients over a variety of appointments. We came to understand that the clinical tasks we had to accomplish were a small part of caring for patients. We began to see every interaction, with every patient, as an opportunity to get to know them and what was important to them to help them make healthy choices.

Over time we discovered with our patients:

• The status of the dental health
• The challenges of their current conditions
• The implications of these conditions if nothing was done to intervene
• Interventions they and we could do to change the trajectory of disease.
• A possible preferred future of choice
• Considerations involved in various treatment choices.

When we met patients where they were instead of where we thought they “should be” we found that some were ready sooner than others. We stopped giving patients solutions to problems they did not yet own. We came to understand that if we gave patients the time and attention they needed to own their existing conditions they were more curious about what Dr. Barkley called their “Probable Future” and more likely to pursue a “Possible Future.”

Without this spirit of collaboration and intentional patient development, we cannot do our best work.

Our influence develops throughout a process in which the patient is learning, in touch with their body, and engaged in thinking about the implications of the various aspects of their oral health. Because the conditions we discover today and our patient’s choices will impact their future health, we have a moral obligation to share what our experience tells us is likely to happen (the probable future) if they do nothing or if they choose a stop-gap treatment.

It is also our responsibility to help them see a preferred future that is possible for them when they are ready.

By engaging them in the exam process, creating opportunities for them to experience learning about their health, and welcoming them into collaboration, we enable them to partner with us in shaping their future. We must help them understand the implications of any choice they might make including its limitations, so they are fully informed to make true choices.

We have been trained to be efficient, and most dental clinicians have pride in their efficiency. But by prioritizing being “effective” over being efficient we make better use of our time and theirs. We experience an increase in trust, in our patient’s confidence in their decisions, and a more comprehensive view of treatment. Patients begin to see dentistry as a vehicle to create optimal health, function, and esthetics. Patients are more likely to keep their appointments, follow through on suggestions, and pay for our care with gratitude.

When we invest time in the early stages of our relationships, everything down the road flows more easily.

Many times, patients have some sense about their overall health, but have no idea about what is going on in their mouths. They tell us they’ve never looked in their mouths. Our challenge is to engage them during the exam process in such a way that it raises their curiosity and awareness.

Our goal should be for patients to be so engaged in the exam that they continue to pay attention to their mouths, even when they leave our office. As they are driving home, we would like them to be touching their facial muscles. We would like them to be paying attention to how their teeth come together when they take out a nightguard in the morning. We would like them to notice if there are points of bleeding when they floss. As they go about their lives, we hope they pay more attention to all the things we talked about.

Think of engagement as being like the gears on a bicycle. If the gears on your bicycle are not engaged, the bike will not move forward. You may be inclined to pedal harder, but you are still going nowhere. Similarly, if a patient is not engaged, you might be inclined to give them more information. But you might as well stop talking because you are probably going nowhere.

Engagement has been described by educators as when the student is working at least as hard as the teacher.

We all know what patients look like when they are engaged. They ask questions, they touch their faces, they lean forward, or they point to images on the computer monitor. They give us signals that they are paying attention. On the other hand, when a patient’s eyes glaze over and they blankly nod, it’s a good indication they are not engaged. When you notice that polite smile, stop talking and look for a way to engage them in the process. You might ask them a question. “I know I’ve been giving you a lot of information, and I’m curious, what are your thoughts about what we have discovered so far?”

One of the things I like to do when I begin the exam process is to ask the patient to hold a mirror in case I have some questions for them as we go through the exam. Most patients will take the mirror and put it on their lap. I look for the first opportunity to ask any kind of question that involves the mirror. I might ask them to bring the mirror up to their face and show me in the mirror an area they mentioned as a concern. I might ask them to point to changes made in their mouth by orthodontics and restorations and inquire about how they feel about those changes. Once they do, they are more engaged and understand that what they are telling me has relevance. They begin to see themselves as part of the process with expertise about themselves.

We want to engage as many of the patient’s senses as we can…seeing…hearing…touching… tasting. As I examine the mouth, I might say, “I notice that when I slide the perio prob into this deeper space between the tooth and the gums, there is bleeding. Do you ever see or taste bleeding there?” Their personal involvement in the exam gives rise to questions that are opportunities for them to connect what is going on in their mouth with their self-care behaviors and the choices they will have about seeking treatment from us.

We don’t want our patients to just comply with our recommendations. We want them to be actively engaged in understanding, planning, and working toward improved health. We want them to feel responsible for their choices and to partner with us in improving their health.

Engagement leads patients to take ownership of their health and make healthy choices.

After the next exam or consultation you do with a patient, consider:

• How engaged was the patient?
• How much “work” were they doing relative to how hard you were working?
• What did you do to activate engagement?
• If you could do it all over again, what “one more” question could you have asked the patient?

In dentistry, we’re clear about the connections among the teeth, the muscles, the bone, and the joints—and how all these pieces are related to esthetics. We understand how those pieces fit together. Unfortunately, most patients don’t come to us with that understanding.

Dr. Bob Barkley used to talk about patients not understanding “the web”—the connection of how all the pieces come together.

Just as with a delicate spider web, if you touch any one aspect of it, you change everything. Bob Barkley would say to his patients, “I know you are concerned about that one tooth. That’s your job to be concerned about that one tooth. My job is figure out and to help you understand how what’s happening with that one tooth is related to everything else that is going on in your mouth.”

The exam is a process by which we can do exactly that. We can help our patients understand the connections in their mouths. The exam is also an opportunity to encourage our patients to have confidence in us. Confidence building starts with the new patient exam and continues in subsequent interactions. The more thorough the examination we do, the more in touch we are with what is really happening in our patients’ mouths and the more confident patients will feel about our ability to help them.

Our thoroughness and knowledge aren’t the only aspects of the exam that develop patients’ confidence in us. The gentler we are in our touch and the more careful to include the patient or others in the room during exams are important. These aspects of the exam communicate our character and the way we tend to approach our work. Patients anticipate our care and approach will be similarly open and comfortable during future consultations and procedures.

People don’t take risks when they don’t feel confident. Unfortunately, many patients do not have confidence in making decisions for themselves when they sit in a dental chair. They think of significant dentistry as a risk. For best long-term results and positive relationships, we always want the patient to feel as strong and confident about their choices as they can.

Repeated comfortable interactions are needed for them to develop their confidence. Every time we find something good in their mouth, every time we point out health such as healthy gum tissue or a beautiful restoration, and areas not needing restoration, we are reinforcing healthy choices they made in the past. This can be a confidence booster to help them move forward in making next choices.

The examination process is an opportunity for the clinician to:

• Understand what the patient is experiencing emotionally and physically,
• Provide sensory learning experiences (see Art of the Examination: Part 1),
• Help the patient draw connections for deeper understanding of their health
• Explore options for what the patient might choose to do.

The examination is an opportunity for the patient to develop understanding of:

• The clinician’s ability to help them.
• The current condition of their teeth and other oral structures.
• The impact on them of what they are learning.
• The choices they can make to improve their health.

Every examination is a next opportunity to develop our patients’ confidence in us and in their ability to make healthy choices for themselves.

All dental schools teach a system for doing a clinical examination. The goal is typically to gather as much information about current clinical conditions as possible, as efficiently as possible. It is an important aspect of patient care. The science of the exam is useful, but it misses the art of the examination. In my experience, it is often a missed opportunity

In dentistry, we are always trying to figure out the best way to influence our patients to make healthy choices for themselves. When I left Hygiene school, I thought it would be simple to influence patients. I thought that if I did a good examination, a good diagnosis, and then made a good presentation, patients would go ahead and do the treatment.

What I experienced when I was in practice was different. Over time, multiple conversations, and multiple interactions—in their own time and in their own way, patients would move forward with treatment. Sometimes it seemed random, but what I’ve come to understand now is that every interaction was an opportunity to influence the patient.

Every single interaction, with every single patient, by every single member of the dental team is an opportunity to influence.

I think most of us have learned over the years to be skillful at providing information. We know how to “Teach and Tell” what we are finding and recommending. But there is an aspect of that process that has to do with experience. What we have not always paid attention to is how we can go beyond information to create learning experiences for our patients.

When I see a baby touching grass, I imagine that the experience of learning about grass through the senses is entirely different than learning by being told about grass. Creating opportunities for people to interact physically with their own bodies is an opportunity we have in a number of different situations. We can do this during a consultation, but we really have this opportunity during an examination.

If we place priority on effectiveness over efficiency, we will do our exams with the intention of creating physical-sensory experiences, which can be as simple as having them touch their muscles as they touch their teeth together, sliding their jaw forward and side to side, finding a relaxed jaw position, tapping their teeth together, clenching, feeling fremitus with their tongue or finger, feeling the difficulty of flossing between tightly packed teeth, and taking us on a tour of their mouth in a mirror while telling us about their concerns. It’s natural to say, “Tell me more about that. Show me where.”

Consider the new patient exam as the initiation of an experiential learning process to influence our patients to make healthy choices.

The new patient exam is not “the one” opportunity we will have to influence patients. We’ll have many more opportunities, but it sets the tone for every conversation you will have with your patients about their health, about the conditions present in their mouth, about the implications of what is going on in their mouth, and some of the choices they might be able to make.

Job one is to engage the patient in discovering just how intriguing their mouth is and why the health of its various components matter for long-term comfort, function, beauty, and overall health.

“How does who you are becoming fit into your vision of the future?” When Dr. Mac McDonald (Mac) asked that question on a call with several Line of Sight Coaching clients, I could not stop thinking about the significance of the question. It resonated with me on several levels.

I began considering how who I was becoming had changed my life for the better. Then, I realized that these changes could not have happened without my awareness of what I had been before. It allowed me to see how I was unknowingly showing up for the people that mattered most in my life. This awareness was unquestionably life-changing and the beginning of my journey to becoming a better, more authentic person and leader.

I then thought about one of my favorite quotes from Carl Jung: “Until we make the unconscious conscious, it will direct our lives, and we will call it fate.”   The truth of this statement now impacts me more than ever.

Next, I contemplated why Mac chose the word “becoming” rather than asking us to consider what we had become? And the answer came to me. We are always becoming. We never become. Life is a fluid process, and we are all in the process of becoming. To state that we have become something implies a state of stasis that is incompatible with our existence and vitality.

In the context of purposeful leadership, becoming is a never-ending journey filled with constant reflection and self-directed change. Leaders face many challenges and occasional failures that require reassessment and purposeful redirection.

Finally, I thought about the unquestionable connection between who we are becoming and our vision of the future. One could easily restate Mac’s question by asking how our vision of the future fits with who we are becoming. The question is reversed, but no less meaningful. Who we are becoming will lack purpose and significance without a vision of what the becoming means, and conversely, our future vision is unachievable without our realization of who we must become to attain it. The two are inextricably linked.

Each of us has a vision of a preferred future. For some the vision lacks clarity and the necessary positive tension required to achieve the future vision. These folks are stuck in a state of limbo, constantly wishing for something they want desperately but believe to be unattainable.

For emerging leaders in a state of becoming, the vision of their preferred future is crystal clear and a powerful driving force.  By living as if their preferred future currently exists, they are better able to anticipate and preemptively remove potential barriers to realizing their vision.

Knowing who we need to become is a vital realization and opens new unrealized potentials for our preferred future. It does not mean that we must change who we are. Instead, the state of becoming requires us to mitigate our negative reactive tendencies and emphasize our unique creative competencies, all of which already reside within each of us and exist within our reach.

I know we are all familiar with the devastating effects cancer therapy can have on our patient’s oral health. We think of chemo and radiation and know this can increase the risk of caries and root resorption. A very common cancer therapy called Androgen Deprivation Therapy can have a significant impact on periodontal risk.

This therapy is an injectable medication given to a significant number of men who have been diagnosed with prostate cancer. It is a commonly chosen therapy because, on the medical side, it is one of the medications with the lowest impact on the patient’s life and ability to more forward with other medical procedures.

Now that it is common among our older male dental patients, I’ve been reading about it. It turns out that this therapy does significantly increase the periodontal risk of bone loss.

When they study males receiving chemotherapy for prostate cancer, 80%+ of the patients on Androgen Deprivation Therapy develop periodontal bone loss. Less than 10% of the males receiving different chemotherapies develop periodontal bone loss.

This is interesting because we think of periodontal disease as being driven by our immune system and that some patients are hyperresponsive to the bacteria in their mouths. In this case, the origin of periodontal risk appears to be different but there is no argument that the risk is there.

Knowing our patients’ medical histories is important yet again! When you do your med-history reviews with your patients, ask them if they are receiving cancer therapy and review the drugs they are on.

As soon as we know a patient is on Androgen Deprivation therapy, we need to start the preventative high-recall, high-maintenance process. Take them to three-month recalls instead of six-month recalls. Apply chlorhexidine varnish and start home hygiene protocols–brushing with baking soda…hydrogen peroxide…all the things we normally advise for our patients when we know they are at high periodontal risk.

Start this as soon as possible even though the patient is presenting with a healthy mouth. The risk percentile is in the 80s, so we can expect to see loss of mucogingival attachment, deepening pocket development, and bone loss.

An essential technique in effective listening with new patients involves an interviewing discipline known as “bracketing.”

Psychiatrist and author M. Scott Peck described bracketing as “the temporary giving up or setting aside of one’s own prejudices, frames of reference, and desires so as to experience—as far as possible, the speaker’s world from the inside, stepping inside his or her shoes.”

True listening requires a setting aside of ourselves. It also requires acceptance of the person as they are in the moment.

In his book Ways of Being Unconditional, Carl Rogers defined “unconditional positive regard” as accepting and supporting another person exactly as they are, without evaluating or judging them. At the heart of this concept is the belief that every person has the personal resources within to help themselves. They simply need to be offered an environment of acceptance that can foster their own recognition of this.

The goal is to create a safe psychological space where the patient senses acceptance, and therefore feels less vulnerable and thus more inclined to open up to share their fears and concerns regarding dental issues. This is challenging, particularly in the middle of a busy schedule, as most of the time, we lack the capacity to truly listen while other responsibilities and distractions are present.

We need to set the environment with intention.

To do this well, uninterrupted times in the schedule must be established as well as a comfortable non-clinical location. The battle seems to always be between structuring our schedule for efficiency versus creating more open-ended opportunities for trust to develop and knowledge conveyed.

We need to truly listen.

Are you able to turn your focus to orchestrating an interview in which you actively listen? Yes, well, then good but how easy is it for you to maintain that focus?

Even though we may feel we are truly listening, what we are often doing is listening selectively, with a preset agenda in mind…thinking about what we want to happen next…procedurally or financially, wondering as we listen how we can achieve a certain desired result by redirecting the conversation in ways more satisfactory to us.

Even though we may feel we are truly listening, we often respond to what the patient is saying by assuming our interpretation of the question they ask or the concern they relate is actually what the patient is attempting to say. And this is why Mary Osborne’s Staying in the Question Part 3 blog is so on point that I recommend others read it. 

True listening, no matter how brief, requires effort and total concentration. This means we cannot truly listen to another person and do anything else at the same time. While in the middle of a busy day at the office, this is challenging—very challenging.

The first step is willingness.

Our willingness to truly listen is the most tangible form of esteem we can give to another person. And if we give a new acquaintance our esteem, they will feel less ashamed or embarrassed. Consequently, they will start to feel less threatened and more valuable. And it’s those who feel valuable to themselves, who are most likely to be interested in taking better care of themselves through fine dentistry.

Carl Rogers helped us see there is no better way for our patients to learn they are valuable (rather than deficient or flawed) than by our valuing them first through careful listening.

• When we offer no judgement, they feel less fearful, and they can share their thoughts and emotions more freely.
• As we accept them, they feel encouraged to find self-acceptance and think for themselves.
• As we invite them openly to share, instead of asking questions designed to illicit certain answers, we give them space to think for themselves, and with such space, they can begin to cultivate their inner resources and rise to our expectations for what is in their best health interest—on their own.