Are Your Temporaries a Practice Builder or Simply Temporary? 

April 10, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

Many dentists believe that provisional restorations don’t really matter. After all, they are not really a stand-in for the final restoration. I would respectfully disagree. I am a proponent of creating functional, durable, and highly esthetic provisional restorations, every time. They have the potential to impact your dental practice a lot more than you might think. Whether you print them, form them, or free-hand them, a GREAT temporary is a great billboard for your practice. 

  1. Make the provisional as Esthetic as the final restoration.

I contend that the more your provisionals look like what you are hoping for when you seat the final restorations, the more people will talk about them, AND you. 

I was able to build a referral restorative practice by creating provisionals that made patients want to come to my practice and specialists want to send people. For much of our career, almost the entire team of the oral surgery office we worked with, and many of the team members from the other specialty practices we worked with, were our patients in Pemberville, Ohio. 

Front teeth or back teeth, when you make them look like teeth, people will like it and they will show and tell other people. “This is just the temporary?!” was not an uncommon question or exclamation from our patients.  

  1. A GREAT guide makes a GREAT provisional restoration.

Your wax-up** cast/model serves as your vision, as your preparation guide fabrication device, and as your provisional former. When the preparation is appropriately reduced for the material selected, the temporary can mimic the restoration. 

** The wax-up might be created with wax then duplicated with impression material and stone to create a cast, or it might be scanned to be duplicated with resin and printed or milled to create a model. 

  1. 3. Use that provisional to highlight the talents of your team members.

You might LOVE to make those provisionals, but if your assistant is equally excited when it comes to recreating nature for the patient to appreciate, then it could be an opportunity for patients to see that your assistant does much more than set-up, clean up, and hand you an instrument. My dental partner, Cheryl, (who is also my wife) and I actively sought out things that could help our patients experience our team as much more than our helpers. 

As we all know, dental assistants are an integral and vital part of what the practice is and are a powerful force in how and why patients ask for dentistry. Assistants who fabricate provisionals have an opportunity to be seen differently, and we were always looking for ways to create partnership with them in our treatment. 

  1. 4. Take pictures of them.

Photographs of the temporary will make it easier for the lab to design the outcome. They will be able to see what you are thinking, able to visualize what you want, AND maybe even more importantly, see what you do not want. With anterior provisionals, I have frequently noted to my ceramist, “Please put the incisal edge in exactly this position vertically and horizontally in the face, then use your artistry to create the tooth that belongs in the face you see in the photographs of the patient before, prepared, and temporized.” 

There were many times when the technician was able to see and create effects that I might have not recognized as being “just the thing that would make these teeth extraordinary.” And don’t forget to show the patient the photograph. 

  1. 5. Love the material you make the temporary with.

The better the provisional material is at holding tooth position and functional contact, the less adjustment we’re going to have, so using a high-quality material is important. There are a lot of them out there. I like bis-acryl materials that polymerize with a hard surface, have little or no oxygen inhibited layer, and can be polished easily. The polish is more about feeling smooth than about the shine. Ask you patients how their provisional tooth “feels” when you are done, so they sing your praises. 

  1. 6. Use high-quality core material.

When you use a good core material the prep will be smoother, making it easier to fabricate nice provisionals. Ideal prep form goes a long way toward better provisionals. 

  1. ASK your patient to tell people.

As noted above, when you can elicit an emotional response about the awesomeness of your provisional, ask the patient to tell other people, “….and this is just the TEMPORARY!” 

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The Value of Consultants, Coaches, and Mentors in Dental Practice 

April 5, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

As an associate dentist, you may be fortunate to learn from the instruction and observation of a senior dentist, but over your career, you will gain innumerable benefits from outside consultants, coaches, and mentors. 

One of my mentors, Dr. Richard A. Green, told me that one of the keys to my success would be to surround myself with a Board of Directors. He was correct. My board is composed of people who are willing and able to see my vision and hold me accountable for going to it. Some are consultants, some are coaches, and some are mentors. Sometimes they are all three in one person but no one person has all the answers. 

Consultants, coaches, and mentors help us in different ways. 

In dental practice, I often hear the words mentor, coach, and consultant used interchangeably to describe the activities of someone assisting the doctor with the management of his or her practice. I believe that these functions, while not mutually exclusive of the same individual, are different in their roles with regard to all three of you. 

What do I mean by that? “You #1” is the entrepreneur and leader of the business you have established. “You #2” is the manager of that business. “You #3” is the dentist working in the business. Each you possesses a different level of training, understanding, and ability. Each you benefits differently from consulting, coaching, and mentoring. 

Early in practice my partner and I hired consultants to see what escaped us and to give us solutions.  

Consulting is all about being an outsider looking in. The adage that consultants are individuals who are paid a lot of money to tell you what you already knew but couldn’t see, does not diminish their effectiveness or necessity, particularly in offering solutions.  

I met Jim Pride while I was still in dental school. In the early years of our relationship, following the acquisition of our practice, Laura, our Pride consultant, consulted us by telling us what to do. I was directed to employ systems that were developed by Jim Pride and his team while working with many Pride Institute clients. I did as we were “consulted” because I had no reference for individualizing the systems, something that changed as we found the parts and pieces that delivered and left behind parts that did not resonate for us.  

As my partner (who happened to be my wife) and I changed, our expectations changed, and our needs changed, we continued to need that outsider looking in to see for us that which we could not see. We did not, however, need or want to be offered solutions. The best consultants understand that their ultimate goal is to empower and develop their clients’ skills and abilities so that they can eventually operate independently. 

When we no longer needed a consultant, we needed a coach. 

Unlike consulting, where solutions with precise instructions are offered, coaching offered us a process out of which our vision for our practice developed. Dental practice coaches ask questions rather than give answers. They are observers. They take us inside ourselves and assist in our development as leaders. They draw out what is already within and empower us to act on it. 

What, then, is a mentor? 

For me, mentors are individuals who have traveled the path we seek to follow. They may fill the role as a consultant and/or a coach depending on our needs and their comfort with the things that are challenging us at any given time, but frequently their primary role is that of an example. The Pankey Institute community abounds in them. 

I have observed that dentists who develop a relationship with a mentor are able to move more quickly and clearly toward their preferred future. It is precisely for this reason that one of the goals of participation in a study club is to build groups with a broad range of experience and experiences. It is the third YOU, the practicing dentist, who gets the most from being mentored 

Dentistry is a tough job. It’s demanding and stressful to perform highly technical, intricate procedures continuously on a daily basis. Our mentors show us that we can do it because they did. Often there is peer-to-peer collaboration in “surfacing up” the mindset, approaches, and solutions that will work best for us. Always there is encouragement. 

Sometimes mentors listen. Sometimes they challenge. Always they support. Their map is not always the map we choose to follow, but their example–as individuals who continue to see their vision and map their future accordingly–inspires us to do the same. 

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DATE: March 6 2025 @ 8:00 am - March 8 2025 @ 2:00 pm

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Trust Is Essential to Helping Our Patients 

April 3, 2024 Paul Henny DDS

Paul H. Henny, DDS 

Trust is commonly thought of as a firm belief in the reliability, truthfulness, and capability of another. But trust is about vulnerability . 

The more a person trusts, the more they are willing to allow themselves to be potentially hurt. They make a risks-benefit analysis, and when they feel they are ready, they decide to throw the dice.  

Conversely, when a person isn’t willing to trust, they have strategically chosen to minimize their vulnerability.  

Think about the times when you were personally unwilling to let someone into your life—when you were feeling too vulnerable. 

It’s easy for us to project our values without sensitivity to others’ often hidden concerns. When a patient says no to x-rays, to allowing us to proceed with a proper restoration, or other appropriate procedures, they don’t trust us enough right now. And when that occurs, it’s easy for us to instinctively respond by projecting our values onto the situation.  

A better strategy is to empathetically explore why a person responded to the situation the way they did—try to understand the situation from their perspective, and then focus on finding common ground in shared goals and values. Hopefully, with the right questions and empathy, we can build a bridge of trust and help our patients cross over to a place of more information on which to make the appropriate decisions for themselves. 

“No” often means “not yet,” as in “You haven’t convinced me yet that I should allow myself to be that vulnerable around you.” 

Co-Discovery requires a leap of faith on our part—a belief that most people will eventually do the right things for themselves. If we are unable to trust our patients on that level, then we’re going to struggle emotionally, demonstrate frustration, and to some extent inadvertently manipulate patients into doing what we want them to, a behavior that drives emotionally sensitive patients away. 

We need to trust our patients will make the leap as well. We need to willingly take the time and energy to continue in and trust the Co-Discovery process during which the patient starts to believe that we are the best resource to help resolve their problems and achieve their goals. When we allow our patients the time to make decisions based on what they think is in their best interest, they usually make healthy choices and appreciate the services we provide. This is how we succeed in helping them (and us) have a healthier, happier life. 

For an in-depth look at Co-Discovery and multiple essays on patient-centered dentistry, you are invited to read my recently published book: CoDiscovery: Exploring the Legacy of Robert F. Barkley, DDS, available at The Pankey Institute and on Amazon. 

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Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

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Life-Long Learning Part 4: Challenge What You Know 

March 29, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

Challenging what you think you know will pique your curiosity and lead to pursuing more information and interactions from which you learn. Challenging what you think you know leads to learning with the benefits of brain development, longer life, emotional wellbeing, and inspiration to share yourself in new ways with others. Simply said, challenging what you know prompts intentional learning to BE more expansive, to grow. 

My hope is that after reading this blog series, you will take time to reflect on the following statements from three of the many people who have influenced me over the years. 

Quotes from Daniel J. Boorstin, historian and Pulitzer Prize winning author of The Americans: 

Education is learning what you didn’t even know you didn’t know. 

The single largest obstacle to discovery is NOT ignorance; it is the illusion of knowledge. 

Quote from Herbert E. Blumenthal, DDS: 

Don’t believe everything you think. 

Quotes from William J. Davis, DDS, co-author with L. D. Pankey of A Philosophy of the Practice of Dentistry: 

Learning best takes place when we “live” a philosophy, meaning living in a state of inquiry based on our values, knowledge, and goals. 

When the late Dr. L.D. Pankey decided to devote his life to saving teeth, he was forced to ask himself, “How can I help people keep all of their teeth all of their lives?” In 1925 L.D. didn’t know the answer or even if there was an answer. When he decided to never extract another good tooth, he was taking an enormous professional and economic risk. He was able to uncover and develop many principles that have proven instrumental in our understanding of restorative dentistry and patient communication.  

Philosophy, in its most valuable form, is more concerned with the right questions than the right answers. 

Now that I am back actively within the Pankey community of learning and inspiration, I have four wishes for you: 

  • May you come face-to-face daily with something that you don’t even know you don’t know.  
  • May you not be blinded by what you think you do know when it shows up and fail to see it because you believe everything you think.  
  • May you ask questions and intentionally seek answers. 
  • May intentional leisure learning be not just what you do but how you live. 

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Life-Long Learning Part 3: Leisure Learning Is Intentional Learning 

March 27, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

We might define leisure learning as “Anything that is taught in an organized formal or informal plan of education to assist an adult in learning something about his or her occupation, occupational opportunities, personal happiness, or social enhancement and into which that adult engages him or herself for the purpose of learning about it.”  

I’d like to rename it “Intentional Learning” for the purpose of our discussion. My best guess is that your intent in coming to The Pankey Institute is to learn something about dentistry that will help you do what you do better. The incentive for that goal, being better, is why you come. You are choosing to use leisure time to learn dental stuff with intention. 

Any information you perceive as other than about being “better at clinical dentistry” you might be less interested in retaining and consequently likely to forget quickly. You will not really learn the stuff for which you have limited curiosity. Interestingly, that stuff that is not about the “dentistry” is the most important part of what The Pankey Institute sends you home with. At least I and countless others have found this to be true. 

Intentional learning is essential if you want to live a longer life. 

In the absence of Intentional Learning, defined as “actively seeking out new information that you WANT to integrate into your experience and understanding of the world,” certain parts of your brain will shrink. Your capacity for learning and your critical thinking/problem-solving skills will diminish. A reduction in neurons and neurotransmitters will affect your memory, your concentration, your mood, and your physical movement. Blood flow to parts of the brain can even be reduced–use it or lose it is a common thread in nature.  

So, Intentional Learning is GOOD for your brain and necessary if you wish to thrive. Synapses continue to form and re-form if you are acquiring new information, experiences, and knowledge with intent. Intentional Learning reduces stress levels. Stress reduction not only helps us perform better in our professional life, but our personal lives as well. 

Intentional learning opens social possibilities. 

Homo Sapiens are social creatures, we crave interaction, in fact we require it. Intentional learning encourages us to take risks, adjust, and adapt as we go. It sparks social engagement which leads to happiness in so many aspects of our lives. It enhances motivation, creativity, and innovation. It provides an opportunity to open our minds, challenge ourselves, and appreciate new opportunities. 

Intentional Learning fuels even more learning
as it stimulates curiosity, renews our purpose,
and moves us toward problem solving actions.
It has the potential to keep us young. 

My mother’s desire for Intentional Leisure Learning, never left her; she was and is a voracious reader, and to this day at the age of 90, she loves nothing more than sharing something she has read recently and is busy integrating into her view of the world and how it works. Her beliefs are open to what she experiences in her life, to what she learns.  

The day will come, sooner than I wish, when “dental” learning will not be as applicable to my daily life as it is today. I will still want to be part of a dental study club, still challenge what I think I know, and offer whatever wisdom I’ve been able to store to the conversation.  

Once found, intentional lifelong learning is something one does not easily lose the desire for. 

I will never forget Dr. Parker Mahan’s words, “I know I too can never live long enough.” Some might hear those words as limiting. I hear them as liberating. The well of knowledge will never be dry. It is and will remain an infinite source of things that I can still learn. 

I am so grateful to be back home at The Pankey Institute after spending my intentional learning (and teaching) time for the past fifteen years in a place that has made a choice to focus on “dental” learning. The behavioral aspects of dentistry and developing understanding of oneself and others have always had equal focus at Pankey. And since that “other stuff” is not something that can ever be checked off as “learned” no matter how many years I have left to be here, my intentional learning can and will always be young and new. It’s why The Pankey Institute is not a place you DO, it’s a place you learn to BE. 

The Institute is a place where learning never stops because, when you learn to BE, you have learned to act. Being is an ongoing and continuous process. It’s something that is lived. It is community. It is home. It is still The One Place.  

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Lifelong Learning Part 2: We’re All Lifelong Learners 

March 25, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

Adults have a wealth of experience to draw on and they like to do so as part of their learning. Adults are not used to taking direction in education; they choose what they want to learn. When my friend (in Part 1 of this series) lost his active interest in seeking out dental education, he had made a choice to learn other things he hoped to know.  

One of my heroes, Doctor Parker Mahan, told me once that one of the harshest lessons of mortality for him was the realization that he could never live long enough to learn everything he wanted to know. 

Adults need to create specific opportunities to self-reflect and internalize what they are learning in order to integrate it with what they already know. Adults have preconceived notions about education, learning style, and subject matter that interfere with their learning. Adults are often afraid to fail so they frequently guard their learning process by telling themselves why what they are hearing is wrong. 

Where children are sponges when it comes to learning, as adults our brains adapt to experiences and interactions that occur “on purpose.” We acknowledge a reason to remember that experience…to have that new knowledge. 

Here’s an example. 

Our eldest child, Patricia, entered a world in which those charged with her immediate care had barely learned to care for themselves–a world to which she adapted very quickly. In no time she had taken control of the lives of two sentient beings who proudly professed their independence and right to make decisions about their own lives but nonetheless jumped through the hoops of her creation as soon as they were offered. 

After the grandmothers had departed and Cheryl and I were now totally responsible for this baby FOR REAL, her training of us began in earnest. Turns out Cheryl and I CAN be taught, proven by our immediate response to Patricia’s guidance in managing her universe. A visit by Uncle Toby and Aunt Patsy presented us with an opportunity to learn from another source. 

Following a hearty meal, a very sleepy baby was laid in her crib for some sleep. Almost immediately upon our return to the living room Patricia realized she was no longer being held, and realized she was no longer where the “party” was happening. Being WITH the party is very high on Patricia’s list. When she “called out” in response to that situation, two very well-trained parents immediately stood to head for the emergency that was happening for the helpless baby. Uncle Toby looked at us as we simultaneously rose and said, “What are you thinking?” 

That might sound like a question, but it was really a statement that meant “stop.” So, when Uncle Toby asked his “question,” Cheryl and I stopped as we were instructed. Uncle Toby then asked, “What are you teaching that baby if you go in there and pick her up every time she cries?” 

As brand-new, first-time parents, this thought was alien to us. Being so well trained, we thought our only mission in life was to keep the baby from crying. With some angst in our stomachs that tightened each time Patricia’s wailing reached a new crescendo, we sat in the living room and pretended to ignore what we were hearing.  

Suffice it to say that when our second child Dale came along, he learned, and reasonably quickly, that we were not necessarily coming every time he rang the bell.  

Every day, we hear and see a lot of information that never makes the transition to “learning” because it does not produce change.
Change can only occur for adults when we enter into an agreement with ourselves that there is something we want to learn in what is being said or shown to us. We ACT on it. 

The truth is EVERY interaction we have with any other person or situation is a potential learning experience if we reflect upon it and internalize its meaning for us and act on it. It’s impossible not to learn. We do it all the time. Lifelong learning is thus a forgone conclusion.  

One of the greatest joys in dental practice is creating learning moments for patients by providing intentional opportunities for them to experience their oral health and interact with us in a way that provokes their curiosity, internal reflection, and acknowledgement of needs. Just as we are lifelong learners, we can trust that they are lifelong learners, too. 

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DATE: March 6 2025 @ 8:00 am - March 8 2025 @ 2:00 pm

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Life Is More About Possibilities than Probabilities

March 18, 2024 Paul Henny DDS

Paul A. Henny, DDS 

Dentistry can be an isolating profession, wherein there are few people around who fully understand the pressure we’re under and the extreme level of responsibility and personal accountability we face on a daily basis. As a result, the isolation and pressure can easily cause us to feel like we’re in a lonely battle against a cold world that simply doesn’t care about what we are trying to accomplish. 

When we get into that mindset, it’s easy to think that competition is outside of us, that ultimately life is a battle of “us” against “them” and zero-sum. But few things in life are truly zero-sum, because very few things in life are that black and white. In truth, life is more about possibilities than probabilities, which means life is largely what we make of it instead of what happens to us. We are only in competition with others and the world at-large when we try to be like others, and we try to play the game by other people’s rules by aping of their behavior and adopting their mindset and values. 

The belief that we are in a constant state of competition is just an illusion because we can never become someone else, nor can we replicate their path to success, much-the-less become a mirror image of how other people think. 

Our true and authentic self has no competition. There is nobody else on this planet who can do exactly what we do, the way we can do it – that is, if we have the courage to try and fail until we master it. Hence, our authentic self has no competition because there’s nobody quite like us, and the sooner we accept who we are with grace, the sooner we can stop fighting our identity by attempting to become something that we cannot become. 

When we are clear about who we are, what we believe in, and what we are willing to fully get behind and make sacrifices to achieve, the more we’ll come to the realization that our feelings of competitiveness are a self-created illusion. Achieving this deeper level of self-understanding allows us to see ourselves from a perspective from which we are no longer envious of what others have accomplished, and we no longer desire what others have created, because we understand that we cannot build a life that’s not our own and we need to proceed forward and do the work necessary to create something for ourselves and others. 

The fastest way up the ladder of success is through the lifting up of our true selves. Sometimes that process can take a while, because in the beginning we don’t fully understand who we are, and we therefore can’t be clear about what we’d like to accomplish with our life. 

We can only rise up when we care enough about ourselves to invest in our future self – today. We can rise up by developing ourselves into the best person we can be today instead of spending our energy chasing after other people’s ideas of what “good,” “optimal,” and “admirable” mean. 

The simple fact is that we’ll never become our best self until we stop trying to be something that we can’t be.  

To quote a line from one of the songs of my childhood, “If you’ve found your place at last, then you need not use the looking glass.“ 

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Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

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Dental Photography Part 1: What Photography Equipment Should I Buy? 

March 15, 2024 Charlie Ward, DDS

Charlie Ward, DDS  

Whether you want to use a digital SLR camera for documentation, patient education, lab communication, making presentations at dental events, dental publications, or accreditation in the American Academy of Cosmetic Dentistry, you have choices to consider in multiple price ranges.  

Dentists can spend $1,800 and get a good system for documenting cases, patient education and lab communication. Dentists can easily spend $3,800 or more on a setup to equip themselves to take higher quality images. 

Camera Body: Most dentists shoot with a Nikon or Cannon DSLR camera. These are comparable brands. My experience is with Canon but my lab technician uses Nikon and gets wonderful results. I am shooting with the Canon EOS 90D. The comparable Nikon is the D7500. More entry-level models are the Nikon 3500 and the Canon Rebel T8i. 

Lenses: We can get a third-party Sigma 105mm or a Tokina 105mm lens that gives us decent quality, or we can purchase the Canon 100mm or Nikon 105mm version at twice the price. When I upgraded to the finer Canon lens, I noticed a huge difference in image quality. I recommend an upgraded lens for the highest-quality images you need for accreditation. 

Flashes: The ring flash is a great entry-level option and significantly less expensive but there are limitations to what you can do to control your light. I’ve been using a dual point flash for some time. I can pull a flash off and shoot from a different angle. By changing where the light is coming from, I can accentuate the angle lines for more depth and visual clarity.  

Sometimes, I’ll take one of my flashes off, hold it on the opposite side of what I am shooting, and shoot the flash back into the lens of the camera. When I do this, I get an ethereal-appearing image or an image with a white background. I appreciate the versatility of using the dual point system.  

For my best-looking images and portraits, I’ll use softboxes. This gives smoother, more diffuse light and a beautiful appearance. These are necessary for everyday dentistry but make a huge difference in showcasing aesthetic cases.  

 

Consider the Long Term: When dentists invest in cameras and lenses, they typically use them for a long time. If you are on the fence about how much you want to invest, my own experience might be helpful. I honestly wish that I had upgraded sooner than I did with the Canon EOS 90D and the Canon 100mm lens. After taking photos for 12 years, the upgraded equipment has only increased the joy I have for photography and pushed me to take more pictures! 

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DATE: March 6 2025 @ 8:00 am - March 8 2025 @ 2:00 pm

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CE HOURS: 16

Dentist Tuition: $ 2795

Single Occupancy with Ensuite Private Bath (per night): $ 345

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Charlie Ward, DDS

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Dental Sleep Medicine in Restorative Practice Part 9: Marketing Dental Sleep Medicine 

February 28, 2024 Todd Sander, DMD

Dental Sleep Medicine in Restorative Practice Part 9: Marketing Dental Sleep Medicine 

By Todd Sander DDS 

How do you start reaching out to physicians and other providers to build a dental sleep medicine practice? Start with the ones you know. Start with your own personal physician and start a conversation. If your dental patient is on CPAP, get permission to converse with their doctor. I spend time contacting many primary care doctors and find they are the ones who know patients are non-compliant with their CPAP therapy. They help me get patients re-evaluated by a sleep specialist. 

This may not be true in your community, but in Charleston, SC, where I practice, many primary care doctors don’t know what to do with their non-compliant CPAP patients. They are thrilled to have someone to refer them to try alternative therapy. 

Years ago, I reached out to sleep testing centers to communicate my services. Both independent sleep labs and hospital-based sleep labs have been great sources of referrals. For many years, I was the dental advisor to a sleep lab. A great conversation starter with sleep physicians, is the potential of combining CPAP and an oral appliance. This often allows the CPAP air pressure to be turned down so their patients be more comfortable and compliant. 

When you screen your dental patients for airway issues such as sleep apnea and snoring, the next step is referring your patients with issues for a sleep study. When the patient discusses their symptoms with their primary care physician or a sleep physician, you are mentioned and often documented as making the referral. Over time, physicians come to know you as a go-to provider of dental sleep appliance therapy. This process is sped up when you take the time and initiative to contact your patient’s primary care physician with your patient’s permission. You can guide physicians and remind them of the recommended standards-of-care, including appliance therapy in place of or in combination with CPAP therapy. 

Some patients self-refer to me, as friends and family talk about their experiences in my office, but I am not spending money on digital advertising to bring in dental sleep medicine patients. Mostly, they are referred to me by physicians, dentists, and other patients.  This is the same for my dental practice. 

As mentioned in a previous part of this series, our hygienists have attended dental sleep medicine courses with me and screen for airway issues. They adeptly educate and guide patients who have signs and symptoms to schedule an examination and consultation with me. 

Note: When patients are referred to me for dental sleep medicine, I never encourage them to become dental patients in our practice. This is a choice they might make but I am extremely careful to refer patients referred by a dentist back to their referring dentist for all dental needs. I am an adjunct to help other dentists’ patients fulfill a prescription for a dental appliance. 

If a patient comes in for sleep-disordered breathing but is also experiencing facial pain or TMD, I understand that this patient’s two issues are likely connected and I will not be able to successfully treat one without treating the other. This is an opportunity to communicate in depth with the referring dentists and let them know I plan to treat the patient for both issues simultaneously. This has been easier for me to do because I have had years of experience in treating facial pain and TMD issues in my dental practice, as well as sleep apnea and snoring. 

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TMD & Orofacial Pain: Managing Complex Patients

DATE: January 29 2025 @ 8:00 am - February 2 2025 @ 1:00 pm

Location: The Pankey Institute

CE HOURS: 37

Dentist Tuition: $ 7200

Single Occupancy with Ensuite Private Bath (per night): $ 345

TMD patients present with a wide range of concerns and symptoms from tension headaches and muscle challenges to significant joint inflammation and breakdown. Accurate thorough diagnosis is the first step…

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Todd Sander, DMD

Dr. Todd Sander is a graduate of The University of North Carolina at Chapel Hill, the School of Dentistry at Temple University, and a one-year Advanced Education in General Dentistry residency with the US Army at Fort Jackson, SC. He completed three years of active duty with the US Army Dental Corps and served in Iraq for 11 months. Dr. Sander completed more than 500 hours of postgraduate training at the Pankey Institute for Advance Dental Education and is one of only three dentists in the Charleston area to hold such a distinction. Dr. Sander is also affiliated with the American Dental Association, South Carolina Dental Association, American Academy of Cosmetic Dentistry, Academy of General Dentistry, and American Academy of Dental Sleep Medicine. Areas of special interest include: TMJ disorders; advanced dental technology; cosmetic dentistry; full mouth reconstruction; sleep apnea /snoring therapy; Invisalign orthodontics.

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Do You Know Your Team’s Threshold?

February 23, 2024 Robyn Reis

Do You Know Your Team’s Threshold? 

Robyn Reis, Dental Practice Coach 

While visiting a dental practice that had amazing hospitality and incredible relationships with its patients, I observed a doctor’s presentation to a patient who was in his forties and who had been saving for a smile makeover for a long time. The doctor did an amazing job with his presentation of what was possible and the phases of treatment. The patient was very excited, even teary-eyed.  

The patient wanted to get started and asked about the cost. The doctor said, “You know what? My team at the front are experts in figuring that out.” So, the patient was taken to the front and handed over beautifully. In a few minutes, he was presented with the treatment plan on paper with the approximate dollar amounts. In phases, they would do the full mouth. All seemed to be going well until it wasn’t. 

Intrinsically, everyone has a monetary threshold that up to a certain point, you have no problem with the amount. It’s something within your range of expectations and easy to say yes. When you cross that threshold, anxiety may creep in and for sure, you become uncomfortable.  This is what I witnessed in a matter of moments. 

I observed the front office team member look uncomfortable after glancing at the paperwork, despite being experienced with treatment presentations. The clinical assistant who had been part of the diagnosis and treatment planning process, would also help with scheduling and any questions. 

Together, they gave the patient the opportunity to ask questions after reviewing the plan again. The full mouth restoration was going to be in the neighborhood of $25,000. The first phase would be about $18,000. They offered CareCredit financing. The patient said, “It’s only $25,000 and I have $20,000 saved. This is wonderful! I don’t know how I will pay the other $5,000, but I know I have the means. It’s only $25,000.”  

The team appeared somewhat shocked because they were obviously uncomfortable with quoting that amount. This treatment plan crossed their personal thresholds. They suggested the patient go home and sleep on it “because this was a big investment.” The patient was so committed to moving forward that, despite their advice, he scheduled his first appointment. He would call them back once he figured out how to pay the remaining balance, knowing insurance would contribute very little. 

What I also found interesting was that neither team member asked for a deposit. No money was exchanged to reserve an extended appointment. The patient could back out and the doctor’s time spent on the case work-up would be uncompensated. In my experience, making a signed financial agreement would be the responsible step to take at this stage.  

This example illustrates the discomfort many dental teams feel about asking for a deposit if the treatment estimate crosses their personal threshold. Of course, dental teams will want to explain what can be done to make treatment more affordable and the financing options that are available. But it is beneficial for team members to understand their personal threshold and to become comfortable saying, “Grab your checkbook or pull out your credit card, Mr. Jones. Here’s what your investment is going to be to get started.”  

What’s your threshold? This is a great team exercise you can do at your next meeting because a patient might ask anyone they interact with about the cost of dentistry, and what options you offer for the dentistry they want.  Every team member will benefit from considering their personal threshold and discussing it — even role-playing — to become comfortable with the best ways to manage these questions. Depending on the situation, it could be referring the patient to the treatment coordinator or to the financial administrator to have a comfortable conversation. 

It is my belief that when patients are excited about what the treatment results will be and they want to move forward, it’s the right time to ask the patient to make a financial commitment to get the process started. 

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Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

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Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

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Robyn Reis

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