By Gary M. DeWood, DDS, MS 

As a dentist, our role in fostering a learning culture for our team is essential for their thriving success and that of the practice. When there is cultural alignment between the values and priorities, team satisfaction is significantly enhanced. By investing in our team’s growth, we reap numerous benefits, including: 

• Improved Patient Care: When team members are equipped with the latest techniques and information and understand why to use them, they can better help us diagnose and treat our patients. A well-trained and knowledgeable team, empowered with a deep understanding of their role in patient care, will lead to superior outcomes.  

• Increased Efficiency and Productivity: A learning culture can enhance problem-solving skills, improve decision-making, and foster a more efficient workflow. This leads to reduced errors, improved patient turnaround times, and increased productivity. 

• Enhanced Team Morale and Retention: When team members feel valued and supported in their professional development, they are more likely to be engaged and satisfied with their jobs. This leads to improved morale, reduced turnover, and a stronger sense of team cohesion. 

• Financial Benefits: Investing in your team’s development can have a positive impact on your practice’s bottom line. Improved care, increased efficiency, and enhanced team morale can all contribute to increasing revenue and reducing costs. Additionally, a strong learning culture will attract and retain top talent, ensuring the long-term success of your practice. 

Embracing a Learning Philosophy 

To establish a strong learning culture in your dental practice, it’s essential to define your values regarding learning and professional growth. Clearly articulate your commitment to continuous improvement and create a shared vision that inspires your team. Lead by example by demonstrating your own passion for learning.  

Attend conferences, stay updated on the latest dental research, and actively seek out new skills and techniques. This inspires your team to follow suit and prioritize their own professional development.  

Finally, create a supportive learning environment where team members feel comfortable asking questions, making mistakes, and learning from each other. Encourage open communication, provide constructive feedback, and celebrate successes to foster a positive and collaborative atmosphere. 

• Define. 

• Lead. 

• Create. 

Auditing Your Learning Culture 

To assess your practice’s learning culture, identify any barriers that may hinder learning, such as a lack of dedicated time, resources, or support. Prioritize professional development by blocking out time and allocating resources for training and development initiatives. Encourage a culture of knowledge sharing by creating opportunities for team members to share their expertise and learn from each other. This will help foster a supportive and collaborative environment that promotes continuous learning and growth. 

• Identify barriers. 

• Prioritize learning. 

• Encourage knowledge sharing. 

Empowering Your Team 

To foster a flexible and empowering learning environment, offer a variety of learning options to cater to different preferences and support individual development by encouraging team members to set their own goals. To address lack of time, prioritize learning by making it a strategic priority in employee growth interviews and allocating dedicated time for professional development. Then provide necessary resources, and empower them to make informed decisions about their learning paths so they can apply their knowledge in meaningful ways. 

• Offer diverse learning options. 

• Support individual development. 

• Empower self-direction. 

Fostering a Growth Mindset 

To foster a growth mindset, encourage a culture where mistakes are seen as opportunities for learning and growth. Provide supportive and actionable feedback to help team members improve, and recognize their achievements to motivate and inspire them. 

• Celebrate mistakes. 

• Provide constructive feedback. 

• Recognize achievements. 

Leveraging Technology 

To leverage technology for learning and development, explore software and tools that can enhance efficiency and create a library of online resources such as articles, videos, and webinars for team members to access at their convenience. Incorporate microlearning techniques, such as short online modules or podcasts, to fit learning into busy schedules. 

• Utilize dental technology.  

• Share online resources. 

Encouraging Collaboration and Peer Learning 

To foster collaboration and peer learning, facilitate the formation of study groups or learning circles where team members can collaborate and share insights. Additionally, establish mentorship programs to pair experienced team members with newer ones, providing guidance and support for their professional development. 

• Form study groups. 

• Create Mentorship programs. 

Remember 

Investing in your team’s development is a direct and powerful investment in the future of your practice. It takes energy to intentionally get the momentum rolling toward a place with a learning culture that extends beyond yourself. But once the momentum is rolling, these strategies become second nature, empowering your dental team to adapt to change, to enhance their skills, to deliver exceptional patient care, and to create a career for themselves and everyone around them.   

By Deborah E. Bush, MA 

This blog draws on insights from Dr. Michael Melkers’s 2022 Pankey Webinar, “Managing New Patients in Challenging Times.” While the blog offers a unique perspective, it is informed by the valuable strategies and experiences shared by various dentists during the webinar. For a more comprehensive exploration of these approaches, I recommend watching the full webinar on YouTube. 

Interestingly, the challenges and strategies discussed in the webinar are reflected in a broader industry trend.  

Mature Dental Practices Often Become Overwhelmed with New Patient Requests 

A year ago, I conducted a dental marketing survey for Alatus Solutions, which provided revealing statistics about how independent private dentists seek and manage requests for new patient appointments.  

• Responding to the survey were 474 dentists aspiring to be 100% fee-for-service.  

• We found that 5% were so booked that they couldn’t make new patient appointments for more than 30 days. 

• 15% had new patients waiting more than two weeks.  

• The 5% had stopped paid marketing because they didn’t want more new patients, overloading their schedules, exhausting themselves and their team, and negatively affecting the care they provide. 

Multiple Strategies Are Possible to Control New Patient Flow 

One strategy to control the number of new patient calls tying up the front desk is to stop all paid marketing and rely solely on referrals from patients who truly appreciate your comprehensive care. Another response (which happens frequently) is to screen calls and do callbacks. That’s something I do not recommend as you will see in my “Do and Do Not” section below. Alternatively, some dentists expand the practice by bringing on a new associate or refer new patient inquiries to a like-minded dentist who is growing their practice.  

Dr. Melkers’s online seminar emphasized the effectiveness of prescreening potential patients during live calls and having knowledgeable front desk staff act as gatekeepers. This concept is discussed in more detail below as an effective strategy for managing this challenge.  

Do and Do Not 

• Even when you are overwhelmed with patients, I do not recommend frustrating your loyal patients by screening calls and relying on voicemail to call them back. Do pick up as many calls live as possible. 
• You can turn off your paid ads, but don’t ignore your website or your Google business page. Your digital presence is necessary to sustain your practice. And the referred prospective patients (who are most likely to be prequalified for comprehensive care) will be curious to see your persona, credentialed expertise, and reviews before reaching out for an appointment.  
• Do keep your website and Google listing frequently SEO-refreshed and up to date with your services. The current Google algorithm prioritizes Quality Content, Mobile Utility, and Local SEO (location, business hours and contact information visible and consistent across all platforms). 

The New Patient Funnel 

The new patient funnel is a metaphor for a potential patient’s journey from initial contact to becoming a regular patient. The stages include: 

• Awareness: The patient learns about your practice through marketing, referrals, or online research. 

• Consideration: The patient evaluates your practice and decides whether to call to discuss scheduling an appointment. 

• Conversion: The patient schedules and completes a new patient exam. 

• Retention: The patient becomes a regular and ongoing part of your practice. 

The funnel helps us conceptualize the flow of interactions we can control. When you have a “leaky” funnel, potential patients fall out near the top of the funnel before being qualified. This can occur if the front desk does not answer calls live or fails to return messages. A lack of training in optimal call handling contributes to this failure. 

​​​In ideal scenarios, receptionists are initiative-taking and well-trained in moving new patients through the funnel or onto a more suitable path for finding the type of dental care they want. However, according to Patient Prism’s AI evaluation of over 50 million new patient calls over the past nine years, more than 80% of the U.S. dental practices participating in Patient Prism’s AI evaluation do not benefit from such attentive phone handling until their performance is tracked and new behaviors coached.  

Prescreening Patients: Identifying High-Quality Candidates 

Prescreening is an effective strategy for managing the new patient funnel. By asking targeted questions during initial contact, your team can determine which patients fit your practice well.  

My Notes for Call Receptionists: 

• Understand Their Needs: Ask, “How may I assist you?” and engage in a conversation to understand the patient’s dental needs and expectations. 

• Set Expectations: Explain the benefits of a thorough examination, the process, the time involved, and the fees. Assess the patient’s willingness to commit to a comprehensive exam, consultation, and finding solutions for their current problems. 

• Note Previous Dental Experiences: The caller’s freely offered comments about their dental history, health history, or concerns about dental care are revealing, but be careful of assumptions based on your biases. Stay in the conversation long enough to understand the person on the other end of the phone. It’s okay to simply say, “Please tell me more.” And, if the caller seeks a “Pankey dentist” because they are accustomed to the highest level of comprehensive care, note that this person has prequalified themselves for your practice. 

• What to Do When in Doubt: If you are unsure, saying, “Our schedule is full right now,” is okay and not impolite. Continue with, “I need to consult with my supervisor to determine if we can fit you in. May I put you on a brief hold or call you back in a few minutes?”  

• Complimentary Consultations: Offering complimentary consultations is a common practice for implant and clear aligner services, but the front desk of a busy practice must prequalify patients for those appointments, or the dentist will spend a lot of unpaid time prequalifying the patients herself or himself. 

Make Room for the New Patients You Want 

Even highly qualified patients may become frustrated if they wait more than a week for an appointment. Consider reserving one extra patient slot per week for the type of new patient you want. If no such patient calls early in the week, use the slot for an existing patient who needs attention. You can also modify your new patient protocol to offer this person a shorter appointment to get started–with the recognition that there will be more than one appointment to complete the new patient process. 

Coach Your Front Desk 

If you have an inexperienced or new receptionist answering your phone, it’s important to discuss with them the types of high-value patients they should prioritize for you. Additionally, provide guidance on how to nurture these new patient leads, so they are more willing to wait for an available appointment. This is a Team Meeting Topic every fee-for-service dental practice should discuss periodically. A high-value patient to you is likely one who wants the highest-level of comprehensive care, appreciates your approach to patient-centered care, and eagerly wants you. 

Lee Ann Brady, DMD 

The origin of a patient’s dental wear may be deceiving. Is it physiological or pathological? This minor difference could spell major consequences for the lifetime oral health of your patients. We care about understanding the differences and how to manage them for the benefit of our patients. 

What is the amount of normal tooth wear? 

To understand normal tooth wear, let’s compare the size of teeth at age 10 to their size at age 70. Based on extensive research, we’ve found that the average loss of tooth structure over this 60-year period is approximately: 

• 1.74 millimeters on posterior teeth (first molars) 

• 1.01 millimeters on upper anterior teeth (centrals and laterals) 

This equates to roughly 15-26 microns of wear per year, depending on the tooth type. 

It’s important to note that this includes all forms of wear, such as attrition, erosion, and abrasion. Even with this normal wear, most people should still have a layer of enamel on their teeth at age 70. In fact, you might expect to retain at least half of the original enamel thickness on your incisal edges and cusps. 

While a certain amount of tooth wear is a normal part of aging, it’s important to distinguish between physiologic wear and pathologic wear. Physiologic wear is a natural part of aging and includes abrasion, erosion, and attrition. It occurs at a predictable rate and typically does not result in significant tooth structure loss. If you notice excessive tooth wear beyond the expected range of 15-26 microns of wear per year, it may be a sign of an underlying issue that requires further evaluation. 

What is the patient-centered approach to discussing wear and understanding the cause of tooth wear? 

When discussing tooth wear with patients, it’s essential to approach the conversation with empathy and understanding. By using a patient-centered approach, you can foster open communication and encourage patients to take an active role in their oral health care. 

• Open-Ended Questions: Ask open-ended questions to encourage patients to share their observations and experiences. For example, you might say, “I’ve noticed some wear on your teeth. Have you noticed any changes in how your teeth feel or look?” 
• Avoid Assumptions: Don’t jump to conclusions about the cause of tooth wear. Instead, ask questions to gather more information and explore potential contributing factors. 
• Emphasize Collaboration: Emphasize that you’re working together to identify the cause of tooth wear and develop a treatment plan. This fosters a sense of partnership and encourages patient involvement. 
• Avoid Blame: Avoid blaming the patient for tooth wear. Instead, focus on identifying the underlying causes and developing strategies for prevention and treatment. 

What do I say to my patients? 

I always start from a place of curiosity. I might say, “When I examine your teeth, I notice some wear that seems more than what’s typical for your age. I’m curious if you’ve noticed any changes in how your teeth feel or look. Sometimes, unusual wear can be a sign of underlying issues like teeth grinding, acid reflux, or other factors.” 

Many times, patients will then say to me, “I don’t know. Do you think I grind my teeth?” or “I don’t know. I do have acid reflux.” If the patient says, “Gosh, I don’t know what that’s about,” the next piece of the puzzle is to take my curiosity and help them understand what we would do diagnostically to figure that out and potentially what we would do to manage that. 

If I think the wear is erosive, the conversation can turn to acid reflux or an acidic diet or abrasive toothpaste. If I think it’s erosive, the conversation leads to “seeing if we can learn what your teeth are doing when you sleep at night. If you’re grinding your teeth, that is something we can manage.” 

I never start with “I think you grind your teeth,” or “I think you have acid reflux,” no matter how confident I am that that is the case. I don’t approach it that way for a couple of reasons. I need to give the patient a chance to process that information and come to terms with the fact that something may be going on that they weren’t aware of beforehand. There’s an emotional impact from hearing that information, so we want to deliver it in a gentle way. And I want the patient to become aware of what may be happening on their own. I want to create a co-discovery process.  

The general message is “We can work together to figure out what might be causing this. By understanding the cause, we can work together to determine the best course of action to protect your teeth and prevent further wear.” 

By Deborah E. Bush, MA 

How I Came to Know the Word “Eudaimonia” 

During the Covid pandemic, retired dentist Barry F. Polansky, DMD, noticed a shift in people’s perspectives, with many becoming more thoughtful about life’s purpose and values. This period of reflection inspired him to encapsulate his own views in a story aimed at guiding young dentists. This story became his 2021 book, The Porch: A Dental Fable.  

The Porch is the tale of a young (new) dentist who is guided by a philosopher mentor, learns to integrate eudaimonia into his practice, and regularly discusses dental philosophy with colleagues in a porch setting. Dr. Polansky hoped the book would help new dentists discover how to practice virtuously, foster responsible relationships focused on well-being, and lean on mentors and study clubs to encourage them. While authoring the book (before ChatGPT), he asked me to help with the writing, and I was pleased to assist in refining the narrative, ensuring it resonated with readers. 

Eudaimonia in Patient-Centered Dentistry 

“Eudaimonia,” rooted in Aristotelian philosophy, translates to “human flourishing” or “well-being” and is integral to a comprehensive approach to dental care. It extends beyond clinical outcomes, considering the broader impact on patients’ overall health and life satisfaction. For example, here are some of the principles shared by Aristotle’s philosophy and patient-centered care. 

• Holistic Approach: Embracing eudaimonia means addressing not just the physical, but also the emotional and psychological well-being of patients. This includes understanding their aspirations and fears related to oral health and aligning care with their life goals. 

• Empowerment through Co-Discovery: Involving patients in exploring their health and treatment options to foster informed decision-making, aligning with their values and aspirations. 

• Personalized Care: Tailoring treatment to each patient’s unique needs supports their journey toward their own fulfilling life. 

• Mutual Growth: Collaborative patient-provider relationships lead to mutual professional and personal growth, contributing to a shared pursuit of well-being. 

Eudaimonia in Ethical Practice 

Integrating virtue ethics—compassion, honesty, integrity—into practice fosters trust and well-being for both dentists and patients, leading to professional fulfillment. This sounds easy but we know it is not. 

In The Porch, Barry Polansky’s protagonist is initially hindered in his attempts to lead patients to treatment by (1) patient resistance and (2) his internal frustration with that resistance. The young dentist goes to the brink of giving up. The philosopher-mentor helps him off the cliff’s edge and back onto comfortable footing as the young dentist learns relational behaviors that lead to positive results. 

Eudaimonia in Work-Life Balance 

Polansky’s book emphasizes the importance of balance between work and personal life, continuous learning, and maintaining physical and mental health for a fulfilling career. Polansky draws on his deep roots in the Pankey philosophy as he persuades his colleagues to support young dentists in study club communities focused on well-being. 

His Take-Home Message  

A long fulfilling career in dentistry is based on developing a systematic approach to practice that enhances the doctor-patient relationship for the benefit of patients, living purposefully with balance, striving for personal holistic health, and being in community with colleagues to nourish the wellness and careers of younger dentists—all hallmarks of The Pankey Institute. 

Note: You might find this interesting…I’m learning to learn from AI. My first draft of this blog was nearly 2,000 words. Then, I ran it through ChatGPT, knowing it needed to be shortened, and voila! I liked the concise results (620 words). In my line of work as a dental writer, I sometimes use CoPilot AI for research, Gemini AI for drafts, and Grammarly AI for polishing, but overall, I think ChatGPT does the finest job of critiquing what I write, suggesting revisions, and explaining why.  

Paul A. Henny, DDS 

Charisma is the ability to attract and influence others with our ideas and communication style. There are many different types of charismatic styles, with no moral component associated with any of them, which means that some charismatic people are quiet, graceful, and principle-centered like Jackie Kennedy, while others are more extroverted, and self-centered like her husband JFK. In other words, some charismatic people are exuberant like Oprah Winfrey, while others are more introverted Elon Musk. 

Charisma is often said to be a “subjective ineffable quality,” something we either have or we don’t have, with attributes such as confidence, passion for a topic or a cause, optimism, a ready smile, expressive body language, and a friendly voice. In other words, the social characteristics of a charismatic person reflect feelings of someone with high self-regard. 

Is charisma an important attribute if we want to become a more successful, relationship-based, health-centered dentist?  

Simply answered —yes. 

But the basis of our charisma must originate from an “other-centered” world view, because if we use charisma as a strategy to simply get more of what we want out of others (act in a manipulative fashion), then it won’t work well for us long-term, because empathetic patients are able to detect insincerity very quickly, and the perception of insincerity will cause them to steer away from us. 

On the two-way street where relationship-based, health-centered practices live, both charisma and empathy are essential. Even if we’re introverted (most dentists are), we can still be charismatic if we present ourselves and our message in a fashion that’s “other-centered,” sincerely helping, and in an “I’m willing to give-before-I-receive” fashion.

L.D. Pankey, Bob Barkley, F. Harold Wirth, Peter Dawson, Mike Schuster, Richard A. Green, Frank Spear, John Kois, Lee Ann Brady, and other stars who shine in our dental firmament all had/have different personalities and communication styles. In common, they all shared/share their deep love for others and an insatiable desire to help others learn and become better at helping others. We know them because they have drawn us in. They have engaged our attention and inspired us to push our personal envelope and follow their lead.

Christopher Mazzola, DDS 

The purpose of looking at recent research data is to see how we can improve our clinical success. Different scholarly journals inform us of ways to decrease risk and hopefully increase the longevity of the services that we’re providing to our patients. In this article, I’ll summarize what I’ve learned from recent research literature about the various types of zirconia we receive from our dental laboratories and properties of zirconia that influence the quality and longevity of the dentistry we do. I found these facts fascinating from the perspective of wanting to know how to use zirconia optimally.  

Composition: There are three primary compositions of zirconia on the market: 3y, 4y, and 5y. The Y in the composition descriptor refers to Yitria or Yttrium Oxide (Y2O3). The more Yitria the zirconia contains, the more translucent the crown will be. Adversely, the more Yitria the crown contains, the less flexural strength the crown has. The 3y zirconia can handle adjustments better than 4y and 5y in terms of both strength and optical properties. 

Color: The marketplace offers zirconia that is prestained and zirconia that is not prestained. In the case of prestained zirconia, we have about a tenth of a millimeter in reduction capability before we notice a color change. Knowing this is important when we need to adjust a restoration, so we can manage adjustments to deliver the shade of restoration our patient expects. 

Wear on Other Materials: If zirconia is rubbing against other zirconia there is less wear than if zirconia is rubbing against lithium disilicate and softer ceramics or composites. When you’re setting up an occlusion or you are looking at a hybrid denture versus a normal denture, you must take this into account. If a patient has an upper fixed-hybrid denture, zirconia is going to wear those denture teeth relatively fast. Knowing this, we can best prepare our patient for the wear that is likely to occur. 

Zirconia Removal Burs Vs. Restorative Diamond Burs: In an in vitro study, the burs that are marketed specifically for adjusting zirconia restorations did not perform better on 3y, 4y, or 5y zirconia, and they did not generate less heat. 

Note About Polishing Zirconia: When we are polishing high-strength ceramics like zirconia and lithium disilicate, we must be careful not to push too hard, and we must use a continuous cooling spray of water. Otherwise, we risk nerve damage due to thermal irritation. Also, if we generate too much heat, we will overheat the glue that bonds the fine diamond particles on the bur and are likely to render the bur useless. 

By Barry F. Polansky, DMD 

These thoughts were first published in May of 2021 on my blog Stoic Dentistry. Parts one and two of this blog series tell the story of how The Pankey Institute provided me with inspiration that shaped my career and provided me with purpose to live a meaningful life. 

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According to the findings of motivational researchers Deci and Ryan (discussed in Part 1 of this blog series), when we are the masters of our own destiny, we are more focused, productive, optimistic, resilient, creative and healthy. 

In retrospect, this is what I found I was experiencing on my Thursday mornings reserved for practicing “the Pankey way.” 

Autonomy as an intrinsic driver works—so starting slow to install fee-for-service just one morning per week is a sound idea. 

The Riddle of Mastery 

And then there is the riddle of mastery. Mastery sits atop L. D. Pankey’s Ladder of Competency. The question is how does one achieve mastery? It could be reduced to “Just do it,” but there is more science. 

In a 1953 paper by Harvard psychologist, David McClelland, a leader in achievement and motivation theory, he wrote an original thesis titled “The  Achievement Motive.” Deci and Ryan acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it now is known as mastery. 

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve and to make progress. It is the royal road to growth and flourishing and the opposite of languishing and drudgery…the low rung on Pankey’s Ladder of Competency. 

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Daniel Pink, author of the popular book Drive, “the single biggest motivator by far, is making progress in meaningful work.” 

At my lowest point in dentistry, I felt stuck. Hopeless. My work had lost its meaning. Today we call that burnout. Those Thursday mornings turned on the light…the light of hope. 

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy, it is difficult to sustain the drive necessary to achieve mastery…this is based on our biology, not just some story, fairy tale, or business myth. 

Driven by Dopamine and Progress 

After installing the Pankey Thursday mornings where I could practice autonomously, applying the lessons I needed to learn, I slowly put the complex elements of comprehensive relationship dentistry together. I started with the comprehensive examination and built on that by learning all of the components from the mundane mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice. 

I realized that learning the softer behavioral skills were just as important as the technical, so in time I learned about case presentation. Through the years I learned new skills like digital photography and Power Point. Today’s dentists are mastering digital 3D treatment planning. 

I am retired now and looking back I see how that moment when Dr. Becker suggested the Pankey Morning changed my life. 

Today things are different. There is pressure on young dentists to dive into corporate dentistry or adopt practice models focused solely on extrinsic rewards. Many of these newer models undermine autonomy, which, in my view, is a critical error. The Pankey Institute continues to thrive because it champions the principles of autonomy and mastery that are essential for a fulfilling and sustainable career. By embracing a fee-for-service approach and fostering an environment where personal growth and patient relationships take precedence, dentists can build practices that not only endure but flourish.  

As I reflect on my own journey, I see that the true essence of a rewarding career lies in balancing professional excellence with the autonomy to pursue one’s own vision—a hallmark of L. D. Pankey’s philosophy of practice. 

By Lee Ann Brady 

Many dentists warm composite by placing it on top of the operatory light, but I wonder what the patient is thinking when you reach for it on top of the light.  

Some dentists have water heated in one of the green bowls from the lab. I wouldn’t do that either because I wouldn’t know the precise temperature and water intrusion could occur into the composite syringe or compule. 

Composite warmers are not a big expense in a dental practice. I have one in every one of our operatories. The warmers come with two interchangeable top pieces. One is designed for syringes, and one is designed for compules. They warm composite to a specific temperature. 

When you heat composite, there’s no permanent change to the chemistry. As composite is warmed, its viscosity is reduced but as soon as the composite cools, it goes right back to its original viscosity. Studies show that the reduction in viscosity results in better marginal adaptation because it is more flowable, softer for sculpting, and much easier for us to push it against the margins. We also get a greater depth of cure because composite polymerizes more effectively at reduced viscosity. This reduces the shrinkage of the material and increases the longevity of our restorations.  

Note: If you leave a composite warmer on with composite in it for days on end, the warming will evaporate some of monomer and the composite will become brittle and crumbly. So, have your assistant load the composite you plan to use for the day at the beginning of the day or at the beginning of the appointment. You can turn the warmer on when you are delivering anesthetic, and it will be warm when you are ready to use it. We’ve developed the habit of turning off the warmer at the end of each appointment. 

By Barry F. Polansky, DMD 

These thoughts were first published in May of 2021 on my blog Stoic Dentistry. Parts one and two of this blog series tell the story of how The Pankey Institute provided me with inspiration that shaped my career and provided me with purpose to live a meaningful life. 

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I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. The fundamentals never change; but how best to use them is something you must always stay on top of. Over the years, things have changed but the fundamental wisdom of dental practice has stayed the same. 

For that reason, I believe the best and really the only way to have a fulfilling career in dentistry is through comprehensive, relationship based, fee-for-service practice. 

My First Day at the Institute 

On the first morning at the Institute, I remember feeling overwhelmed. It was like the first time I sat down to write a book…I was focused on the herculean tasks of creating the practice of my dreams…an unbearable project. Every moment of that first week tested my competence and potential to succeed…and then there was the comparisons and contrasts I made with the other students. But I paid attention and took notes. 

In a lecture late in the week, the instructor was discussing how to schedule this new type of practice. He told us to reserve just a morning to practice what we were learning. I returned home and secured every Thursday morning for practicing the Pankey way. That included a lot of new techniques for me and my staff. It was an easy way to introduce the new school of thought to my staff. 

How do you eat an elephant? I used to ask myself…one bite at a time. 

The lecturer that day, Dr. Irwin Becker, who later became my mentor, was righter than he even knew. 

The Self-Determination Theory of Human Motivation 

Just about the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking self-determination theory of human motivation. 

Let’s face it, writing a book or designing a fee for service dental practice takes a lot of energy and motivation. Back then and sadly today, the advice came down to “Just Do It.” Deci and Ryan put some science behind human motivation for me…and then I backed into it…but years later, while studying positive psychology, I was gratified that I took Dr. Irwin Becker’s advice; otherwise, I may not have had an accomplished and fulfilling career. 

Let’s look at the science. 

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam. We need drive. Many people never even try. Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy. 

Deci and Ryan went on to further describe the elements of the drive and motivation they were describing. Firstly, they noted the difference between extrinsic and intrinsic motivation. The extrinsic drives were the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives included passion, curiosity and purpose. What they found was that intrinsic motivation was more effective in every tested situation, excluding when our basic needs haven’t been met. (See Maslow’s Hierarchy of Needs.)  

Then something interesting occurred to them. They separated motivation again into controlled motivation, a form of extrinsic motivation and autonomous motivation, a form of intrinsic motivation. If it is work you have to do or are being forced to do, that’s controlled. Autonomous motivation is doing work you choose to do. Deci and Ryan found that, in every case, autonomous motivation destroys controlled motivation.  

The psychologists further explained autonomy by saying it occurs when we are doing what we are doing because of “interest and enjoyment” and because “it aligns with our core values and beliefs.” In other words, it is in alignment with the other intrinsic drives: curiosity, passion and purpose. 

To be continued in Part 2. 

By Andrea Beerman, DDS 

The late Dr. Andrea Beerman (1978-2013) was a beloved member of the Pankey Institute community. She contributed this to my CoDiscovery blog years ago. I think she would be glad her words will inspire our Pankey community forever. – Paul A. Henny, DDS 

Nothing is at last sacred but the integrity of your own mind. ~Ralph Waldo Emerson 

I love this quote from Emerson and understood it with greater depth as it reconnected me with one of my personal Core Values – originality. 

It reminds me that it is my natural state to follow my own mind – my own unique ideas. Personally, I know I struggle when I try to do things like others. In these instances, I feel like I am not being my authentic self. Sometimes, I have found myself conforming or doing something “the way it’s always been done”, because it seems quicker or easier. 

I don’t have to face the truth or something that may take me to my learning edge if I do things in a rote way. I do not have to make time to enter the “classroom” of silence to know more clearly the path to choose. In these moments, I know I am not realizing the sacredness of my own mind and spirit. With this quote, I am reminded to continue to trust and tap that potential – the beautiful, unique spark of life within me. 

A friend and mentor of mine encouraged me to find a picture of myself when I was a child and put it somewhere I would see it every day. So, now I have a picture of myself at age four on my desk. I keep it in front of me, because sometimes I forget who I am in the midst of my busy days. Of course I am a dentist, but the truth is, deep down – I am still that little girl. That same bright spirit, eager to live fully, and embrace life. All I wanted then was to be loved, accepted and understood. What do I want now? If I answer honestly, I’m not sure the answers are different. 

When I see her picture it makes it really easy for me to forgive myself for all the times I came up short and for the mistakes I’ve made along the way. I see her innocence when I look at this picture, and remember I am truly doing the best I can with what I know. 

So, I have this picture on my desk – to help me remember who I am and what I really want from life. What I’ve learned – it also reminds me of the truth about others – you, my patients, family and friends. 

Beneath the layers of life, lie our bright spirits. I am at my best – in patient interactions and with my friends and family- when I can see others for who they truly are. I think e.e. cummings said it best, “It takes courage to grow up and become who you really are.” 

I wish you my very best in your journey. ~Andrea