By Clayton Davis, DDS 

About 15 years ago, my wife and I were on a trip to New York City. My laboratory had told me about two dentists there who practiced together and did an amazing amount of cosmetic and restorative dentistry. Their best month was about six or seven times more than my best month, so I was curious. I knew they had studied with some of the same mentors I had. They had gone to Pankey and Dawson. They have a a comprehensive approach. While I was in New York, one morning I told my wife I was going to visit their Manhattan office and see what I could learn. 

Their office had reasonable furnishings (nothing fancy) and a reasonable level of equipment. It was tidy with nice staff. It seemed similar to what I have in my office. I sat down with the dentist who was there that day, and he shared with me what they do in their practice. They do a fair amount of marketing in health and beauty magazines that are circulated in the New York City area but otherwise it all sounded very familiar to my practice.  

A few moments later, there was a knock at the door. It was the hygienist, and she said, “Doctor, ready when you get a chance for your examination. Mr. Anderson is in today, you may not recall, but he had said that he wanted to get his veneers done after his daughter graduated from college. That was a couple years ago when he said that, and his daughter is graduating in June, so it’s time to bring that up again. I mentioned it to him today, and he’s scheduled to start that in July. So, when you want to come on in and talk to him about it, that would be great.” 

She walked away, and I looked at the dentist. I said, “What just happened? The hygienist handled everything about moving that patient forward for treatment. I can’t get mine to do that. As a matter of fact, we’ve had conversations, and they don’t seem to feel comfortable doing that.” 

He said, “I don’t know. We talked to them about it, and they’re tremendous about it. They really help our practice move patients into treatment.” 

I went home wondering how I could move my hygienists in the same direction, and an old business concept came back to me. If you want to improve something, you need to come up with a way to measure it. So, I came up with a form for logging what I call “Hygiene Points” and presented it to my hygienists. We talked about how we want to improve our ability to move patients forward with their treatment through the hygiene department. I simply asked them to score themselves on how it went at each appointment in talking to patients about any kind of treatment that came up. 

As each patient passes through hygiene, they receive a score. The lowest score, a score of 1, is for when I come into the operatory, talk to the hygiene patient, bring up some previously recommended treatment, and they go ahead and schedule it. A score of 2 is for when the hygienist finds a problem like a cracked tooth and says that it needs to be monitored. A score of 3 is for when I’m in hygiene and diagnose something new and get the patient to commit to schedule treatment. A score of 4 is for when the hygienist gets previously recommended treatment scheduled at the front desk without my involvement. A score of 5 is for when the hygienist takes an intraoral picture and points out a problem to me and I get a commitment to schedule. In other words, they say, “Let’s take a picture of this. I want Dr. Davis’s opinion on it when he comes in the room.” And then because the hygienist was concerned and I confirm in front of the patient that this is an issue that needs to be addressed, the patient schedules treatment. The collaboration and communication go so well, this is worth 5 points. And then the ultimate score is 6 for when the hygienist gets a commitment to schedule treatment for an obvious problem before I come in to confirm the diagnosis.  

The first couple of months that we used this scoring, we recorded a baseline monthly total.  After that, the competitive instincts of the hygienists kicked in and they wanted to improve their total score each month. I did not give them a reward incentive, and over two years, more production was coming out of hygiene. The old saw “You can improve what you measure” has certainly increased restorative collaboration and revenue in our practice, and the pursuit of higher Hygiene Points has been fun. 

Clayton Davis, DMD 

Hint: It wasn’t because I was cold. 

A First Impression I Will Not Forget 

One of the activities my family enjoyed on our vacation to Ireland 25 years ago was visiting the famous McGee tweed factory in Donegal. They had a loom set up so visitors could pick out threads, weave with the shuttlecock, and make a pattern. My children were at an age when that was very entertaining. 

On our last day in Ireland, we walked the main street of Sligo and stopped in the Mullaney Brothers haberdashery. While my wife looked for a few things, I waited with no intention of buying. An elderly gentleman walked up behind me, and with a charming Irish brogue asked, “I say, sir, are those your children over there?” I said, “Yes.” And he said, “Oh, they’re fine looking  children. They are a credit to you, well behaved.”  

As the conversation proceeded, he introduced himself as Mr. Johnny Mullaney. He inquired about where I lived and what we had done while in Ireland. He mentioned how he enjoyed watching the Olympics in my hometown of Atlanta. He knew a lot about Markree Castle, our accommodation for the week, and Rosses Point, a golf course I played at. He enthusiastically shared his opinion of its famous 18th hole. He was immensely proud of the golf course. Then he mentioned the pride they had in their tweed jackets made from tweed from the McGee tweed factory.  

He pointed to the jackets and asked which of the tweeds I liked best. I pointed to one and he said I appeared to be size 41L (exactly right), and before I knew it, he had slipped the jacket over my shoulders. As he brushed his hands over my shoulders and down the sleeves and tugged at the cuffs and bottom of the jacket, it felt tailor-made for me. I told him I liked the way it fit, but our luggage would be tightly packed for our trip home. I expressed my concern the jacket would end up badly wrinkled. He said, “Oh, it’s tweed, sir. We can fold it very nicely and have it ready for you to pack and it will unfold without wrinkles when you get home.” 

I liked the look of the jacket, yes, and I appreciated the quality of McGee tweed. But ultimately, what I appreciated most, what made me want the jacket, was Johnny Mullaney, himself; the consummate haberdasher, a master at his craft, who won me over by becoming my friend in a mere five minutes.  

I thought, “I don’t have a memento of this trip. This jacket will always remind me of our wonderful trip, our day at McGee factory, and this endearing Irish businessman.” I said, “Mr. Mullaney, I will take the jacket.” 

What I Learned from that Lasting Impression 

There are four elements from meeting Johnny Mullaney that I apply to meeting every new patient in a preclinical interview: 

1. Make a friend. (How can you trust each other if you don’t become friends?) 

1. Make an invitation. (Accepting an offer to be examined makes co-discovery exams flow.) 

1. Make it easy. (Find out their concerns, and address them.) 

1. Connect the feeling to the choice. (People do business with people they like.) 

You see, we always make choices based on our feelings. The preclinical conversation allows the new patient to feel good about my desire to genuinely help them and understand their feelings and needs. This is how we can move forward toward optimal care.  

A Series of Invitations Lead to the Treatment “Yes” 

When dentists ask me how they can do more cosmetic and restorative cases, they are usually surprised when I tell them it begins with doing pre-clinical conversations at the first visit.  

• You can’t do comprehensive cosmetic and restorative treatment until you’ve presented a treatment plan.  

• You can’t produce a treatment plan until you’ve done a good diagnosis.  
• You can’t produce a diagnosis until you’ve done a thorough exam. 
• And that thorough exam is incomplete when it doesn’t start as a good preclinical conversation with the new patient. 

The preclinical conversation sets the tone for trust and healthy open communication. It is the essential first step in creating a lasting good impression that leads to the first “yes” in a series of invitations on the way to treatment.  

Explaining Dentistry in a Way Patients Understand 

Clayton Davis, DMD 

Here are some of the ways I communicate with patients to help them understand dentistry. I hope some of these will be helpful to you in enabling your patients to make good decisions about their treatment.  

Occlusal Disease: In helping patients understand occlusal disease and the destruction it can cause, I have long said to them, “The human masticatory system is designed to chew things up. When it is out of alignment, it will chew itself up.” I tell them, “Your teeth are aging at an accelerated rate. We need to see if we can find a way to slow down the aging process of your teeth.” The idea of slowing down aging is very attractive to patients, and if you relate it to their teeth, they get it.  

Occlusal Equilibration: Typically, I come at this from the standpoint of helping them understand that teeth are sensors for the muscles, and when the brain becomes aware our back teeth are rubbing against each other, it sends the same response to the muscles as when there’s food between our teeth. In other words, the brain tells the muscles it’s time to chew, and this accelerates wear rates on the teeth. Equilibration is really a conservative treatment to reduce force and destruction of the teeth.  

Diseases of the Jaw Joints: Regarding jaw joints and adaptive changes and breakdown, patients understand that joints have cartilage associated with them. Saying there has been cartilage damage in your jaw joint gets the message across simply. 

Treatment Presentation: When patients say, “I know you want to do a crown on that tooth,” I jokingly say, “Oh, don’t do it for me. Do it for yourself.” I never say, “You need to get this work done.” Instead, I say, “I think you are going to want to have this work done.” 

Conservative Treatment: I have always enjoyed John Kois’s saying that no dentistry is better than no dentistry, so when talking about conservative dentistry, I’ll tell patients, “No dentistry is better than no dentistry. We certainly don’t intend to do any dentistry that doesn’t need to be done.” Another way I speak about conservative dentistry is to say, “Conservative dentistry is dentistry that minimizes treatment. In the case of a cracked tooth, a crown is actually more conservative than a filling because it minimizes risk.” 

Moving Forward with Treatment: I love Mary Osborne’s leading question for patients after they’ve been shown their issues and treatment possibilities have been discussed. The question is “Where would you like to go from here?” With amazing regularity, the patients choose a really good starting point for their next steps toward improved health, steps that feel right to them. Always remember, people tend to support that which they help create. 

Dental Insurance: I typically speak of dental insurance as a coupon that can be applied to their dental bills. I’ll say, “Every plan sets limits on how much it pays. The way dental insurance works, it’s as if your employer has provided a coupon to go toward your dental bills.” 

Presenting Optimal Care: If I want to present optimal care to a patient who is ready to hear it, I ask permission by saying, “Mrs. Jones, if I were the patient and a doctor did not tell me what optimal treatment would be for my problems because the doctor was concerned that I couldn’t afford it or that I would not want it, I would think, ‘How dare you make that judgment for me. You tell me what optimal care would be, and I’ll decide for myself if I want it.’ So, with that in mind, Mrs. Jones, would it be okay with you if I presented you with the optimal solutions for your problems?” 

It has been a life-long observation of mine that leaders who are well-loved, who people are drawn to, who friends just want to hang out with, have a comic side to them. A quick wit and the ability to tell a funny story are traits people enjoy.

This was certainly true of Dr. L. D. Pankey, as I found out the first and only time I ever met him.

It was July of 1988 and I was making my first ever visit the renowned Pankey Institute for Continuum Level 1 taught by Drs. Irwin Becker and Donald “Ozzie” Asbjornson. To say the week for me was monumental is, quite frankly, an understatement. It would be like saying smartphones have had an influence on our culture. You see, I knew I had a passion for dentistry, but before that week at C1, I had no idea what to do with it.

And the perfect ending to the week was a visit to our class by the legend himself, Dr. L. D. Pankey. He was well up into his 80’s and had been “under the weather” for the last month, or so. But he was extremely excited that there were some international students in the class – four actually: two from the U.K., one from Denmark, and one from Alabama. So, on the last day, which was Friday morning, Dr. Pankey had asked to be brought up to the Institute for a surprise visit to the class.

Executive Director, Chris Sager, was speaking to the class in Mann Hall when Dr. Pankey stepped into the back of the room and took a seat. Chris immediately stopped what he had been saying and announced, “We’ve had a special visitor just come into the room.”

All eyes turned to the back of the room where we saw a humble, elderly man wearing a white starched shirt, necktie, and freshly pressed suit. Honestly, it didn’t immediately dawn on me who he was.

Then Chris asked from the front of the room, “Dr. Pankey, how do you feel?”

Without missing a beat, Dr. Pankey responded, “Oh…mostly with my fingers.”

The whole room laughed. The witty retort was funny, but even funnier was the fact that Dr. Pankey had played Chris Sager as the straight man. What a moment. What a gift. By the following March, L. D. Pankey would no longer be with us. But we had the privilege in that one glimpse of seeing the cleverness of the man who had charmed so many.

After we all finished laughing. On that Friday morning so many years ago, Chris invited Dr. Pankey to come upfront and speak to the class. He welcomed us and expressed his pleasure that we were there. Then he picked up a marker to begin writing on the whiteboard. After a pause, he put the cap back on the marker and placed it in the tray. He looked at us and with his voice a little shaky said, “There’s so much I want to tell you. Just read my book – it’s all in the book.”

Most of us in the Pankey family today never got to meet Dr. L. D. Pankey. But you can still “meet” him in the pages of A Philosophy of Dental Practice, the book on which he and Dr. Bill Davis collaborated. If he could speak to us today, I believe he would tell us a little joke and say, “Just read my book – it’s all in the book.”