By Paul A. Henny, DDS 

Effective leadership in dentistry requires open-mindedness and empathy, while at the same time, assertiveness, consistency, adaptableness, and resilience.  

That’s a tall order! 

Many of us struggle to be assertive and empathetic at the same time, particularly when we are under pressure. All too often, we lean into our positional power and superior knowledge and don’t stop to ask ourselves: 

• How does the patient feel about my message? 

• Does the patient understand the long-term implications of the information I have presented? 

It’s important to remind ourselves that decision-making is a two-step process: 

Step 1: The recognition of accurate, relevant, timely, and important new information 

Step 2: Reasoning to make choices that align with values and goals 

Few people fully understand the nature of their problems, needs, and the complex processes necessary to realize their goals when they first come into our dental offices. Patients often behave dogmatically or too emotionally, which leads them to choices that result in more failure and frustration. 

Our ability to facilitate learning in others and lead them to decisions with predictably better outcomes can be developed. This is good news! With understanding, practice, and reinforcement through successful experiences, we can all learn how to become more effective leaders and develop a more successful practice. 

The 6 Key Steps to Effectively Guiding Our Patients 

1. Slow down and manage your time more strategically to spend more time with each patient.
2. Demonstrate empathy. Stay in conversation and ask questions to understand what they know and how they feel about the information you are giving them. 
3. Create a safe and effective environment for learning. This entails slowing down your delivery of information into the bite sizes that are appropriate for the patient and pausing often for their minds to catch up and for them to experience self-discoveries.  
4. Show deference for the fact that each person is the best expert regarding themselves, their feelings, values, and goals. Let them know you will support them in their process and invite them to learn more and weigh their new knowledge against their values, priorities, and long-term goals.
5. Give each person enough time to make complex decisions as well as work through the logistics necessary to make their decisions fit into their life.
6. 6. Remain clear and assertive about what is in the patient’s best health interests and consistent with your values. Only proceed with treatment decisions that are mutually agreed upon as appropriate.

By Steve Carstensen, DDS  

“Hypoxic burden” is the challenge that the body has to low levels of oxygen on an intermittent basis. Our physiology has an adaptive capacity to manage hypoxic burdens. We can hold our breath. We can dive under water. We can go up in an airplane. We can live at different altitudes. When that adaptive capacity is exceeded, low oxygen places our physiology under stress. At the extreme level, organs are injured. Frequently occurring or sustained hypoxic burdens at lower levels lead to chronic disease conditions. These are chronic non-infectious diseases of inflammation. 

As people sleep most keep their airway open. Whether they are on their backs or on their sides, they have an open airway and breathe through their noses. But 29 millions of us in the United States have some form of obstruction in their airway while they sleep. The general term for all levels is sleep-related breathing disorders. At the most serious level we call it obstructive sleep apnea. 

Many of our patients have daytime breathing problems as well but during sleep a large percentage of our patients have intermittent hypoxia because their tongue occludes their airway and their oxygen levels drop. The brain kicks in when the body exceeds its adaptive capacity and wakes the patient up. Their physiology is under stress. They are not getting a restful night of sleep.  

The Size of the Problem 

Millions of people have some form of sleep related breathing disorder. The American Academy of Sleep Medicine commissioned Frost & Sullivan to do a study in 2016 that calculated the annual economic burden of undiagnosed sleep apnea among U.S. adults as approximately $149.6 billion (about $460 per person in the US). The estimated costs included $86.9 billion (about $270 per person in the US) in lost productivity, $26.2 billion (about $81 per person in the US) in motor vehicle accidents and $6.5 billion (about $20 per person in the US) in workplace accidents. There is no dispute about the size of the problem, but even the best efforts of dentists working in tandem with sleep physicians have not addressed the volume of people who would benefit from care. 

Currently there is a shortage of Sleep Medicine specialists. The recent approximation is 7,500 but not all are practicing. Even if there were 10,000 diagnosing physicians, it is a small number compared to 193,000 practicing dentists. There is a consensus of leaders in the field who think there are a few thousand dentists actively treating sleep-related breathing disorders, but maybe only a few hundred delivering a significant number of devices per year. There need to be many more. We can incorporate airway assessment and patient education into our workflow to support the breathing and airway health of our dental patients. We can add more services to our practice mix to address their needs within our licensure. So, I am on a mission, if you will, to take this challenge to my Pankey Institute colleagues through a series of blogs and educational opportunities, starting here and in presentations during the Essentials continuum. 

The Consequences of Sleep Fragmentation 

During a normal night’s sleep, we’re supposed to go through cycles of light sleep, deep sleep and dream sleep (REM sleep). If you have a new baby, a new puppy or breathing disorders and your sleep is interrupted frequently because of these things, you’re not going to get a good night’s sleep. When fragmented sleep is created by a breathing-related sleep disturbance, we have cycles of apnea and arousals—intermittent hypoxia that leads to health problems.  

Our patients may not call it sleep fragmentation. They may say I get terrible sleep. If they are not able to breathe well through the night every night for decades, there are pathophysiologic consequences. The worst are systemic inflammation, adrenergic activation, and oxidative stress. If the human body responds to chronic intermittent hypoxia after the adaptive process is exceeded, the body starts to break down. Manifestations include insulin resistance, hypertension, Type 2 diabetes, heart failure, atrial fibrillation, stroke, non-alcoholic liver disease, chronic kidney disease, cancers, and polycystic syndrome.  

The respiratory system manages gas exchange in our bodies. It is the foundation of our physiology. We disrupt that and we allow the body to develop these other issues. Our patients complain they have had difficulty having these diseases diagnosed and treated. But now we have ways to intervene to prevent these problems upstream. We can do that as dentists.  

Breathing and airway support is a powerful place for dentists to impact the whole-body health of those we serve. 

By Edwin A. McDonald, DDS 

Case Study 1 

Early in my practice I was introduced to a periodontist in Dallas. We began a close working relationship for many years. He was a great mentor to me. His work was superb, and his patients had great experiences. He got to know our patients so well he could guide them to the best treatment decisions.  

One day we met, and he told me that he was retiring. I told him that he couldn’t do that to me! His response was that he had found the perfect person to partner and transition with. He had.  

The most important thing that happened was my mentor took the time and made the effort to communicate with me about what was happening. It made me realize that I was important and significant in all of this. The incoming periodontist, Ron, was a young version of his predecessor with the same meticulous surgical technique, superb results, and great patient experiences. In fact, in many ways he became better.  

Years later, Ron’s office is in the same location, just beautifully remodeled and updated. The hygienists remained for many years as did most patients and almost all referral sources. Ron has been extraordinarily successful. That makes me happy. He makes me a better dentist. 

In this case, the two periodontists were philosophically aligned, clinically similar, consistent in their judgement, and had great ability to build high trust relationships. Those four components created a powerful foundation to move smoothly from the past to a great future. 

Case Study 2 

Unlike the first case study, most transitions have gaps between the old and the new. In addition, often the existing practice needs an infusion of energy, a new and expanded mindset, and a more powerful vision to move toward what is possible. 

I have a friend that bought a very traditional relationship-based practice with tons of potential. He is different than his predecessor in his management style, approach to relationships, and desire to grow his practice. He has more than doubled it in just a few years. He also has had a complete turnover in the team. In this case, he needed a team that fit how he wanted to practice. He hired individuals who were prepared to embrace a new approach to practice.  

My friend needed to become a more effective leader of his team and develop a deeper understanding of how important they are to his current and future success. That meant investing more time and energy into getting to know everyone, communicating his career goals and learning about their career goals as they together cast a vision of the future …a worthy destination that honored the past as it created an abundant future. That meant leaving behind some beliefs, assumptions, and patterns of thinking as he matured and as they matured. 

“All of the stakeholders around a practice transition will embrace the change if they see the incoming dentist and new team members living the values that have kept them connected to the practice for many years, there is clear and frequent communication, there are genuine efforts at building trust, and there is an expressed understanding of what is mutually beneficial to all parties.”
–Dr. Edwin A. McDonald (LineofSightCoaching.com) 

By Paul A. Henny, DDS 

Coping with Stress and Trauma 

If you hang around me long enough, the conversation will eventually turn toward the amazing work of Gabor Maté, MD. Maté is a Canadian of Hungarian decent. He is also Jewish, and barely survived the Nazi invasion of Budapest. He has spent his life studying the effects of trauma on the body, both physical and emotional, and he has authored several books. WHEN A BODY SAYS NO is a favorite of mine. 

All of Maté’s work has a common theme: how we individually cope with stress, and when it’s severe enough, trauma. He also advances the bold theory that most of our diseases and dysfunctions today are self-inflicted, even cancer and autoimmune disorders. They are self-Inflicted in the sense that our body does it to itself in its dysfunctional attempt to cope with chronic stress.  

Maté maintains that chronic stress, particularly in a young child, causes the child to dial back their sensitivity to the environment, to stop paying close attention, because it is or might be too painful. 

If you can follow this line of thought, then you will be led to better understand Mate’s theory regarding the common mental dysfunction ADHD, and even some of the milder forms of autism. Maté states that a stressed mother releases stress hormones into the placenta, and when chronically present, these can negatively influence brain development resulting in autism in some cases.* 

Note: Stress can also originate externally from toxins in the environment and food, and from working and living in toxic cultures. 

Today’s Toxic Culture and It’s Impact on Dental Practice 

Those of you who have heard me speak, have heard me say this before. We live in a very toxic culture today. We all try to cope with too much information, too many decisions, and too many stressful issues lingering in the back of our mind left unresolved. And the outcome is similar: we tend to dial back on our sensitivity to the environment. 

Consequently: 

• We start to think of others as being problems to be resolved instead of people. 

• We stop sensing other people’s feelings. 

• We stop paying attention to our gut and intuition. 

• We start blaming instead of understanding. 

• We start manipulating instead of listening. 

Combine all of these together, it isn’t hard to imagine the daily functioning of the average dental practice: 

• Detached 

• Unauthentic 

• Reductionistic 

• Money-centric 

• High stress 

Hence, lots of personal dissatisfaction occurs among staff and patients. 

Getting Back to Whole-Self, Whole-Person Dentistry 

Whole-person dentistry takes into consideration the whole person physically and emotionally. It requires us to be sensitive to our patients feelings, expectations, and experiences. It also requires us to be sensitive to our own feelings, because without them, we can’t sense others and the world around us accurately.  

Without sensitivity, we work through the day like an autistic child in a bubble, and then wonder why our patients don’t listen to us or take our advice. Thus, the road to true person-centered care must first run through us. And that needs to be a life-long pursuit —the process of getting back in touch with who we truly are inside and how we feel. THAT is what L. D. Pankey was trying to tell us when he said, “Know Yourself.” 

By Deborah Bush 

Imagine this: a valued member of your dental team walks in, resignation letter in hand. It’s a blow, not just to patient care, but to the overall morale of your practice. But what if you could have prevented it? Enter the “Stay Interview,” a powerful tool used by thriving dental practices to keep their top talent happy and engaged. 

Why Stay Interviews Matter 

Studies by Gallup and Pew Research show that money isn’t the only reason employees leave. Often, it’s a feeling of being undervalued, lacking growth opportunities, or simply not having a voice. A Stay Interview allows you to proactively address these concerns before it’s too late. 

Benefits of Stay Interviews for Dental Practices 

• Reduced Turnover: Replacing an employee costs a significant portion of their annual salary. Stay Interviews can help you identify and address issues that lead to departures, saving you time and money. 

• Improved Morale: When employees feel valued and heard, their morale soars. This translates into a more positive work environment for everyone, including patients. 

• Increased Productivity: Engaged employees are more productive. By identifying and addressing roadblocks, you can help your team work smarter, not harder. 

• Enhanced Patient Care: A happy, stable team provides better care for patients. Stay Interviews can help ensure your dental team feels supported and equipped to deliver top-notch service. 

Turning “Stay” into Action 

Here’s how to implement Stay Interviews in your dental practice: 

1. First, focus on high-performing team members, those critical to the practice and whose departure would be a major loss
2. Schedule private, dedicated time for the interview. Ensure a relaxed atmosphere. I recommend having a stay interview twice a year and strategically schedule one of the interviews before planned vacations. This way your valued team members have happy thoughts about their employment while gone and look forward to returning. If you are going through a practice transition, you may need to adjust when you do stay interviews to make sure you meet with each employee early in the transition to help them see the value of the transition for them. See Effective Strategies for Managing Transition in Your Dental Practice Part 3  – The Pankey Institute
3. •  Start and continue a conversation. Remember that “the relationship is the conversation.” Two-way listening and recognition are key. 
     • You might start the conversation with this question: “What do you enjoy most about working here?” 
     • Go deeper by asking: “What could make your job even more fulfilling?” “Have you considered leaving?”  
     • Trigger their professional drive by asking: “Do you feel challenged?” “Have I given you enough opportunities to grow professionally?” “What would you like to do more of?” 
     • Affirm their value. “I may not say it often enough, but I value you and recognize your contributions to the practice. In fact, recently….” “Would you consider leading on our next project to _______. It’s important to me that I have someone like you I can rely on to champion this and help make sure we make headway.” 
     • Ask: “What could we do to improve our office culture?” “Do you think I have been clear enough about the direction we are headed?” “Am I providing you with enough feedback?” “How do you like to get feedback?” See How Do You Like to Receive Feedback?  – The Pankey Institute. 
4. Actively listen and respond without becoming defensive.
5. Summarize the key points of the conversation and create a plan to address concerns.
6. Follow up with more conversations as needed. 

Remember, the key is to listen, respond, and act. Let Stay Interviews be the bridge to building a thriving dental team with happy smiles all around! 

About Deborah E. Bush: Deb is a contributing writer specializing in dentistry and a subject matter expert on the behavioral and technological changes occurring in dentistry. A graduate of the University of Michigan and a student of positive psychology, Deb has more than four decades of technical writing experience for medical and dental outlets and authorities. Before becoming a dental-focused freelance writer and analyst, Deborah served as the Communications Manager for The Pankey Institute for Advanced Dental Education and as Director of Communications for the Preeclampsia Foundation. Her work with leading dental brands includes Curve Dental, Patient Prism, and Alatus Solutions (which includes DentalPost, Illumitrac, and Amplify360). She has co-authored and ghostwritten books and articles for multiple dental authorities. 

By Edwin A. McDonald, DDS 

It is amazing to me to realize that I have practiced for more than 40 years in a relationship based, fee for service dental practice. Dentistry has become much more complex during that time. What has not changed is the need for human beings to be loved, accepted, significant, understood, and heard. Also, people who have a high value for their health seek high clinical competence and thoughtful patient management.  

Two years ago, I started looking for a partner to continue providing my patients with comprehensive, relationship-based care. (My hands, back, and body had been telling me that it was time to slow down.) My primary goal in this transition was to create a future where the culture of my practice would continue, and the practice would thrive and grow. 

I received a call 18 months ago from my good friend, Dr. Lynne Gerlach. She said: “Mac, I want you to meet Dr. Shawn Luck.” Lynne went on to say, “I interview young dentists every day and I rarely meet people like him.” 

Shawn and I met, and I immediately understood what she meant. After a few more meetings, several phone calls with colleagues that knew Shawn well, and a thorough financial analysis, it was time for “Team Mac” to meet Dr. Shawn.  

Team relationships are critical to a successful transition. Shawn was met with enthusiasm from my team. That meant we could move forward with a detailed agreement that included terms of employment and terms of practice purchase.  

Shawn’s well-grounded character, confidence, enthusiasm, and intelligence were the factors that guided my decision. We both needed what each other had. I needed Shawn’s character, youth, energy, ambition, and strong desire to own a practice. He needed my clinical training, experience, and commitment to be a focused, consistent, and relentless teacher. 

I began communicating the transition with my team and patients a few months before meeting with Shawn. I mailed a formal letter to my patients that said that I saw three to five years of clinical practice remaining for myself. The letter began and ended with a big thank you for their loyalty, trust, and support. It let them know that I was actively looking for a young dentist to partner with who would continue to take care of them. This letter was a huge success with a thank you from almost every patient. A few patients began to schedule pending treatment that had been on their mind. 

We sent a second letter four months later to announce Dr. Luck. We began communicating about his arrival in person with enthusiasm and emailed a digital copy. The main takeaway here is that the transition immediately benefitted from consistent, focused, and abundant communication with all practice stakeholders about what we were planning and hoping for.  

We are in the middle of year one and I am focusing on mentoring Dr. Luck. We are hoping to play the infinite game as we create and pass on opportunities to the next generation. 

My hope for my Pankey Institute colleagues is you will surround yourself with great people that make you better. Build partnerships with them. Build trust at a deep level. Build community. Serve one another. Seek opportunities to pass on the values of relationship-based practice to the next generation. If you invite young dentists into a relationship and repeat the mentoring you received, we can all play this forward. Dr. Shawn Luck has already captured the spirit of wanting to do just that. 

By John C. Cranham, DDS 

Pete Dawson and I talked about this often. No matter how many years in practice, dentists never have everything figured out. The things that you are doing now are not going to be right forever.  

My advice to young dentists is to be open to new processes and new materials even if you have a predictable way of doing things now. Learning and adapting makes dentistry incredibly fun. Even in my 60’s I am always learning something new—like the digital 3D world of dentistry. I haven’t been this excited about dentistry ever. 

Starting out as a new dentist wasn’t easy for me. I wanted to be known for something in my community. I wanted to be known as the dentist who solved problems that other dentists couldn’t. The first thing I needed was courage to put myself out there and do whatever I needed to do.  

The second thing I needed was training, mentoring, and experience. I went to The Pankey Institute and Dawson Academy. I took all their courses. I took a veneer class with Bill Dickerson back in the day. I listened to Ross Nash and Larry Rosenbaum. At the turn of the millennium, I was trying to take the traditional occlusal information and blend it with the hottest cosmetic information at the time. (Those concepts were diametrically opposed back then. It was blasphemy to put them together.) I prevailed and became better at solving functional problems and improving aesthetics at the same time. Today, dentists do this all the time. 

I and all my colleagues coming up over the last 30 years have had to be open to change. We’ve had to try new things and work at mastering them. I don’t think I am doing anything today in the same way I was trained in dental school.  

My message in this blog is that it’s important to evolve as a dentist to stay enthusiastic about what you do and to provide the best care you can. It’s common for maturing dentists to let go of certain procedures and focus on what they enjoy most and develop specific expertise in niche services. It’s also common for other maturing dentists to continue enjoying general dentistry half of their time and focusing on complex cases the other half.  

Enjoy the relationships you build and take pride in improving your restorative work as you need to redo it. Patients are wowed by what you can do now and how you do it compared to how you did it years ago. They love learning about the advances in dentistry that benefit them.  

The relational part of practice will always be rewarding. Being able to choose what you do and who you do it with will always be wonderful. Passion for what you do is fueled by learning, so keep setting goals to learn something new and be open to that learning changing you. 

By M. Johnson Hagood, DDS 

 As a general dentist in Vero Beach, Florida, who does a lot of restorative whole mouth dentistry, I rely on a wonderful interdisciplinary team but lately I’ve wanted to have more resources in my own practice.  

 A year ago, I decided to purchase a practice with a larger office on the beachside of town with the aim of bringing on an associate dentist with a background in periodontics and prosthodontics. I wasn’t sure if I would need to keep the 900-square-foot space I had practiced in for over two decades, so I only recently put my bungalow-style building on the market and moved fully out of it.  

 The transition has been fraught with challenges…the financing, the physical move, the tech setup, accommodating the exiting dentist and his team two days a week for a few months, and transitioning patients to a new location. Some might say I am going through a mid-life crisis, and they would be correct. My team and family have been incredible. I don’t think I could have done it without their support. They keep me going through the choppy waves. 

Many of you know that I am a surfer. I still surf in my 50s but for the last six months, I haven’t had the time. Something with the transition is always rising to my attention. Many days, I feel the kind of burnout that I haven’t felt in years. Six months from now I hope to be writing again about what has transpired and how I am finally feeling on top of my game again. But for now, I can say that it’s been tough. 

 Some of you know Debbie Bush, who helps as a remote editor for Pankey. She was in the office a couple of days ago. She knows about the trials and tribulations we have been going through, and we spent some time talking about them. 

 She observed, “I’ve been here twice, and my husband has been here twice since you moved. I can tell that your patients think the change has been seamless. From their perspective, you and your team are providing them with the same personalized attention, interest, encouragement, and care. The other dentist’s patients are getting to meet you and your team. They are sensing the positive culture of your practice. It’s okay, Doc. You will get where you want to go. It’s going to be okay. You’ll be on an even keel in a few months.”  

 That meant the world to me.  

I was able to tell her, “I wish it were easier, but I would do it all over again because I have a vision for the future, and this is the path to getting there.”   

She reminded me that much of “the chop” we are weathering through is due to things outside our control. Our values and culture have remained the same. She asked me what the biggest benefits have been since moving to the new office, and we started talking about “the bright side.” 

For starters, I am grateful for the greater space. We have one more operatory, and all our rooms are larger. It “feels good.” There is tremendous natural light coming in, pristine walls to hang my paintings on, and we have moved from a tiny, gentrified environment to an expansive more modern environment. My team is more physically comfortable. Patients have greater privacy and don’t overhear conversations outside the room they are in. On top of that, most of my patients live on the beach and are delighted I have moved closer to them. 

 The other thing I am excited about is my new CBT system. Moving into a larger space meant I could finally do 3D imaging for my patients in-house. Many patients come to my practice specifically because they are seeking treatment for TMD. I want cone beam images for every TMD patient. For years, I sent them to my endodontist for the 3D images, but now I do those images right away in my own office.  

 When my patients see the 3D images there is a wow factor but more importantly, I can be more thorough with diagnosis, and there is practically no radiation. In addition to the value-add of CBT with TMD, I’m seeing abscesses in teeth that don’t show up on regular X-rays, and the CBT will be important to a partner doing surgeries. 

 Debbie encouraged me to write about the choice of technology I made because it might help others in a similar situation. So, here goes. I considered the cone beam options on the market and decided to go with the Dexis OP 3D LX platform with a 12×15 cm field of view that enables us to see the entire dentition and TMJs in one high resolution image—the mandible, maxilla, bilateral TMJs, sinuses, and pharyngeal airway. I have always been impressed by the quality of Dexis imaging products, and the latest software with the OP 3D is intuitive. 

 I still have a long way to go to achieve my vision for expanding practice. I’ll report back on my experience early next year. I am grateful for the encouragement I receive from you, my colleagues, as I step up to pay the price, continue taking a leap of faith, and stay on course to reach my goals. 

By John C. Cranham, DDS 

 When I’ve looked at and really studied my practice numbers over the years, my favorite has always been productivity per hour. I have aimed to focus on a low volume of patients who need advanced dentistry. As my practice developed, I was able to earn more per hour on fewer patients. I was able to earn as much or more while working fewer hours, and my overhead went down because the office was open fewer hours. 

 Rather than just firing off from the hip and trying to make a treatment plan with the patient who is in the chair, I now invite them back for what I call an “advanced records visit.” Then I focus on making comprehensive records and studying those to create a well-thought-out treatment plan. The time spent planning the treatment may be an hour.  

 When you become good at treatment planning, it may take as little as 20 minutes. But the idea is to do better dentistry for your patients and get to where you are working on about 12 big cases each month. I have found that doing more than that is exhausting and makes it difficult to maintain general patients.  

 As you develop your reputation for being a “go to” dentist who solves problems, the big cases will flow in steadily. When you are planning a big case, you are generally working off a treatment plan where you’ve mounted models, you’ve studied photographs, and you’ve got an architectural plan of where you’re going. It’s very cerebral.  

 When you’re executing the plan, everything must be done in a specific way. So, in my office, we have time scheduled for executing planned dentistry—without interruption. We have another time scheduled for seeing general patients and moving between operatories. In the morning huddle, we review the plan for the day and decide where we can fit in an emergency appointment if one is needed. 

 Over the years, my schedule has changed. I’ve tried various schedules and had to experience them to know what works best for me. Now, I like to arrive at 6:00 AM, do my cerebral case workups in solitude, schedule patients with advanced needs in the morning, and have short afternoons for general dentistry. I don’t bother with lunch because I have determined that I don’t need that break in my day.  

 You’ll find what works for you. Keep in mind that your schedule might change over the years in response to patient needs, staff needs, family needs, and your pursuit of other activities. That’s okay. There is no perfect one schedule that fits all dental practices all the time.  

 Once I had a steady flow of big cases coming in and productivity per hour was high, I no longer felt the need to keep my office open long days or to offer evening appointments. I discovered that evening appointments were the ones patients most often cancelled. And when we cut back on our afternoon appointments a few years ago, patients were accepting once they heard it was because the team and I wanted to spend more time with our families.  

 You may discover that when there are fewer appointment slots available, your patient’s perceived value of them rises, and patient calls to cancel or reschedule diminish. 

 Starting out in practice means delaying the gratification of shorter workdays. It will take some time to get your steam engine rolling but stay the course, balanced with being kind to yourself so you can keep going. Keep your vision alive and educate your patients toward the comprehensive dentistry that will serve them best. Be patient. Your low-volume/high-earning productivity per hour will grow slowly and then faster. 

 At every stage of practice, I think there is one thing all dentists have in common. They relish the quiet hours when they are alone planning treatment. Those are the hours when they feel most at peace, most able to solve complex problems, and actively create plans for efficiently delivering dentistry. As a young dentist, you might experience this once per month, and after a few years, you may experience this nearly every day. Those quiet hours are powerful hours for driving productivity. 

By Stephen K. Malone, DMD and Michael Costa, DDS, MHS 

We all know that the instrumentation options for dental hygiene services have come a long way since the first dental hygienist scaled teeth in 1906.   Early in the 20th century, the only technology a hygienist had was a set of sharp metal instruments and a spinning brush of gritty pumice. In the 1950s, ultrasonic technology was invented which helped disrupt calculus, but hygienists still had to follow up with scalers and polishers. Similarly, since the days of first scientific articles regarding oral micro-organisms in the 1870’s, our knowledge has increased exponentially regarding the role of oral biofilm not only in oral diseases, but whole-body health.   

In 2021 our office staff attended continuing education courses with legendary periodontist, Dr. Sam Low. Dr. Low introduced our practice to new technology that would help elevate our hygiene practice by improving biofilm removal, increasing patient ownership of personal oral hygiene practices, decreasing damage to root surfaces and restorations, and providing a gentler patient experience.   

The instrumentation is provided though a unit called a Prophylaxis Master – which is a combination of two different treatment modalities.  The hygienist first uses the Airflow unit to remove soft biofilm and young calculus.  The airflow handpiece delivers a combination of water, air and fine erythritol powder to lift and suction away the biofilm as well as stains.  Once the biofilm, young calculus and surface stains are removed, the hygienist moves to the integrated Piezo scaler to gently emulsify the remaining calculus. There are several different tips for both units to access deep pockets and implant surfaces safely. 

Scientific research has demonstrated this system is the gentlest and most efficient way to eliminate bacteria around cosmetic work and titanium implants, on enamel and root surfaces, and even on soft tissues. 

The GBT Protocol 

To get the most out of our investment, we implemented the “GBT” protocol, which is recommended by EMS, the company that manufactures the Prophylaxis Master. The 8-step GBT protocol is as follows:  

1. Assess the teeth, gingiva, periodontal tissues, and any implants and peri-implant tissues. 
2. Use disclosing solution to identify areas of biofilm accumulation. The color will also guide the hygienist to remove the biofilm with Airflow handpiece, after which calculus is easier to detect. 
3. Show the patient the colored biofilm to raise awareness. Spend time educating the patient and emphasizing the importance of prevention. 
4. Removal of biofilm, early calculus and stains with the Airflow. Airflow Plus powder is safe to use on teeth, root surfaces, gums, tongue, and palate. It can also be used to clean dental implants, restorations, orthodontic appliances, and clear aligners. 
5. Use Airflow Plus powder with the Perioflow® nozzle to remove biofilm in >4 to 9mm pockets, root furcations, and on implants. 
6. Remove the remaining calculus, using the minimally invasive EMS PIEZON® PS instrument supra and subgingivally in up to 10mm pockets and clean >10mm pockets with a mini curette. Use the EMS PIEZON® PI MAX instrument around implants up to 3mm subgingivally and on restorations. 
7. After checking to make sure all biofilm and calculus has been removed, diagnosing for caries, and applying fluoride for a fresh and smooth feeling. 
8. Schedule the patient’s recall visit based on risk assessment. 

What Our Patients Love About It  

• Patients trust the thoroughness of the therapy because they can see the disclosed biofilm before it is removed and its absence after it is removed.  

• The therapy is more comfortable than traditional methods. The water is warmed, and there is minimal root surface sensitivity compared to traditional hand and ultrasonic instrumentation.  

• This technology gently reaches into places where traditional instruments couldn’t remove stains and tartar.  

• The education patients receive from our hygienists highlights the value of the therapy.  

• We have found that this is a superior stain and calculus removing technology.  

• The erythritol powder that is mixed with warm water is pleasant tasting.  

 What Our Hygienists Love About It  

• Less hand instrumentation means less body fatigue.  

• There is superior stain removal and visual evidence that the biofilm is completely removed.  

• Patients don’t complain about sensitivity or “poking.”  

 What Doctors Love About It 

• Patients are happier.  

• Hygienists are happier.  

• It eliminates patient complaints about hygienists who are either “too aggressive” or “not aggressive enough” with instrumentation.  

• It prevents damage to cosmetic and implant restorations, as well as root and enamel surfaces.  

Note: We are not paid to promote EMS or Guided Biofilm Therapy. We honestly think this is the best way we can efficiently, comfortably, and thoroughly provide the comprehensive care our patients deserve—and we thought we should share our great experience