Kelley Brummett, DMD 

After you do a crown preparation, do you tell your patients that you’re going to make them a temporary or a provisional?  

Provisionals are more than temporary restorations. They are part of a process. They’re the dress rehearsal to the final outcome. They are the prototypes for the final restorations.  

The “provisional” process is an opportunity to gain trust with the patient while modifying the length of teeth, the shape, or the color. It is also a way to communicate with the patient how their functional and parafunctional findings may have contributed to the destruction of their teeth. 

As the patient comes back to have their bite checked and to talk about what they like and don’t like, we are building trust. We’re involving them in understanding what they feel and think. We’re listening to improve their conditions. 

I’ve had patients who were fearful about moving forward with extensive treatment because they couldn’t envision the transition from the prep appointment to the final. What would those temporaries look like? What would they feel like? How would they function?  

So, when I am discussing a case with a patient, provisionals are all part of one treatment fee. We talk about the prep process, the provisional process, the lab process, and the final seating process—all as one process for which there is a fee. We discuss how the provisionals will guide us in optimizing the lab plan to achieve the desired comfort, function, and aesthetics.  

Whether it’s a single tooth or whether it’s multiple, I encourage you to help the patient understand that what you are providing in the interim between a preparation and a seat of a restoration is called a “provisional.” 

A provisional protects the underlying tooth structure. It keeps tissue in place. It helps the patient feel confident. It allows us to understand what might be going on functionally. It helps us communicate better with the lab. It’s more than a temporary restoration. It’s a guide on our journey toward predictable and appreciated relationship-based dentistry. 

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. 

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. 

Upstream Thinking in the Dental Practice 

Leigh Ann Faight, RDH 

In my years of working with dentists and teams, I have noticed that leaders tend to address what is directly in front of them. They are simply too busy to notice that the issues of today will likely be back tomorrow, and the next day and so on if they don’t find the root cause and build systems from there.  

My favorite book on this subject is Upstream by Dan Heath. I was so impressed by it that I named my dental coaching company Upstream Dental Practice Coaching. The idea of the book is to help us stop reacting to problems and instead look for ways to prevent them in the first place. 

In the book, Dan Heath recalls a quote from Paul Batalden: “Every system is perfectly designed to get the results it gets.” I love this quote; it is as exact as it is simple and begs the follow-up question: Are your systems working to get you the results you want? 

I’m not writing this with just dentists in mind. I recommend that all dental team members appraise together how well your systems are working and think about where the lack of systems is causing stress. As you meet as a team and pull back the layers of your processes, do you discover barriers that get in the way of moving upstream? As a team, you can intentionally rebuild your systems to remove the barriers and prevent them from rolling back into your stream. 

Fixed thinking gets in the way.  

As I coach, I see three behaviors that get in the way of improving the many systems operating in dental practices. 

Problem Blindness 

This is the belief that negative outcomes are natural and inevitable. We treat these problems like we treat the weather, as something out of our control. We normalize problems and even stop seeing them. Teams tell me, “That’s just how it is here.” This finite thinking is one of the first challenges we uncover when I work with teams on intentionally “going upstream.” 

Lack of Ownership 

If an issue arises and no one claims ownership for fixing it, the problem will persist. To really develop upstream thinking you need someone who will say, “Even though I did not create this problem, I will lead us to find a solution.” 

To create a culture where teams have ownership over decisions, leaders must trust the team to make decisions on behalf of the group. On the flip side, the team must choose to take charge of issues as they see them.  

Tunneling 

Tunneling is exactly like it sounds. You focus on short-sighted problems and have reactive thinking. You get stuck in a routine of short-term decision-making and are unable to move forward. You think, “I can’t deal with that right now.” 

The more problems you are juggling at once, the harder it is to solve them all. If you can’t solve problems systematically you will stay in an endless cycle of reaction, because tunneling begets more tunneling. Compound tunneling with stress and scarcity, and you get stuck. 

“Getting Unstuck” is the name of the game. 

You might want to take your team offsite for a day to talk about what isn’t working in your dental practice. What are the big problems they and you see? Talk about the common human responses of problem blindness, lack of ownership, and tunneling. Talk about upstream thinking and proclaim, “Today is the day we become unstuck.” 

In helping teams find ways to make their systems more successful, I have often found that small changes can make a big difference. If you add target metrics to your systems, “the team” will more likely see and remove barriers that have gotten in the way, redesign systems, and work as a united group to improve the outcomes.  

In the Pankey course held February 2024 — The Pankey Hygienist: Where Clinical & Behavioral Science Unite – The Pankey Institute, we focused on “the flow” of the hygiene-restorative partnership, leading patients toward higher comprehensive care, and getting clarity around the why and how of optimal behavioral and clinical methods. We took a critical look at the habits and assumptions we have developed. We applied upstream systems thinking with the goal of collaboratively achieving with our patients greater oral and systemic health.

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

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

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

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

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

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

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

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

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

Here’s how to become an instant leader.

A while back, I sat in on a Facebook Live interview with a dentist who was discussing practice management for young dentists. Like so many times, the interviewer asked the guests, “What’s the one piece of advice you would give to a dentist who is just starting out in his or her career?” And like so many “experts” the dentist replied, “Learn leadership.”

It was like asking for advice on how to live a long life and responding, “Keep breathing.”

Yes, leadership is the right answer, but have you ever looked at the number of books available on leadership? Today I looked on Amazon and found 60,000 leadership books.

Young dentists need better answers.

Young dentists need more practical answers—answers that allow them to apply what they know. Leadership comes in many styles and sizes. Leadership is a universal concept. Did the dentist mean the Leadership Lessons of Abe Lincoln…or the Navy Seals? There is a big difference.

A better question might have been: Where should I start regardless of style, personality or even mission?

What is the one thing that all leaders have in common?

The answer is followers. No one can be a leader without followers, and in a dental practice, followers are patients and staff. Not one of them will take one step forward if they don’t believe that you are the doctor that will take them where they want to go.

What is it that the followers in a dental practice want to know?

They have two silent questions in their mind. You must answer the two silent questions for them to trust you. And they must trust you to follow you.

The first question is: “Do you care about me?” So that is your starting point. Don’t take for granted that you are being perceived as someone who puts their patients and staff ahead of themselves. It takes lots of time to develop the mindset and habit set that leads to this perception. As a young dentist you need to start there and work on this.

The second question is: “Can you do the job?” or “Are you competent enough to do the job?” As a young dentist, understand that you are still in your apprenticeship stage of your career. That means there is plenty more to learn. In my career I remember taking many technical courses that were disconnected and I had to make sense of them. It was more like a self-directed apprenticeship.

Who can help you become a leader?

Mastering leadership, trust and technical dentistry is a combination you will find at The Pankey Institute. I tried numerous CE programs and read thousands, of books. But it was the inspiration and mentoring I received in the Pankey community, and the discipline of journaling (reflection) that I adopted mid-career that kept me on task towards mastery.

Today I would advise the young dentist to find a mentor or mentoring community, and when you find them, ask, “Do you care about me and can you do the job?”

That would be my advice to any young dentist looking to learn about leadership, trust and even mastery.

Change can be difficult even when it has benefits for everyone.

Some people are simply averse to any kind of change. As a result, we may encounter pushback from staff while attempting to initiate changes in protocols, practice policies, or practice systems. Anticipating and preparing for potential negative feedback is the best way to defuse staff concerns and smooth the way for needed change.

There are two prerequisites to navigating change successfully. First, the staff must believe that we have their best interest in mind. This is a matter of trust that is developed over time. Secondly, the staff must feel safe in offering unfiltered feedback before and during the change initiative. As the leaders of our practice, we are responsible for creating a practice environment that makes both of these essential prerequisites possible.

The following suggestions will prove helpful in developing a change strategy.

1. Be prepared.

Before introducing any change initiative, we must have clarity regarding the necessity and advantages of the proposed change. Painting a clear picture for the staff that includes the specifics and anticipated benefits is an essential first step. Anticipating the staff’s concerns and potential questions as well as our response will help in creating a smooth presentation. Set the expectations for how everyone might feel throughout the different stages of the transition, for example: resistance, frustration, skepticism, excitement, relief, and high energy.

2. Seek early adopter support.

Identify those people that are likely to support your ideas and seek their help in moving a change initiative forward. Most likely, these will be the leaders of the clinical and administrative staff. Collaborate with them in creating the best possible change model. By allowing them to contribute their input, they are much more likely to buy into the concept.

3. Present the change Initiative with humility and transparency.

“My way or the highway!” is the worst possible way to present any significant change. We gain acceptance by being as transparent as possible and patiently addressing staff questions and concerns. Seek collaboration and request input. Be more coach-like by using open-ended questions to draw out their underlying concerns, for example, “What concerns you about this?” and “What would need to happen for you to feel better about this change?”

4. Ask for their help.

There is something about asking for help that creates buy-in. Let your team know that you cannot achieve the desired result without their help. If the intended change is experimental in nature, let the staff know that it is reversible if the desired results are not achieved. Ask them how they think that they can positively contribute and re-affirm how important their role is in the process.

5. Consider scheduling more frequent staff meetings during periods of change.

Depending on the nature of the anticipated change, more frequent staff meetings may be necessary to address concerns and problems that may arise. For example, changing practice computer software seems to be problematic and frustrating for both clinical and administrative staff. Allowing more time to address the technical issues and frustrations of the staff has proven to the most effective means of addressing both issues.

6. Check in frequently with the staff:

Although checking in with our staff should be a common practice, it is most beneficial during periods of change. Simple questions like “How is it going?” or “What do you need from me now?” are a quick and simple way of letting your staff know that you recognize and appreciate their efforts in making the change a reality.

7. Celebrate the staff’s accomplishment:

Whenever the change is fully implemented there should be time for celebration. Consider doing something special for the team as a means of recognition for a job well done. An appropriate bonus and/or a special event away from the office are ways of expressing gratitude. Never pass up celebrating a team’s successful effort in achieving change.

Ancient wisdom has taught us that as “Iron sharpens iron, so one person sharpens another.”

I love education and learning. As a long-time student and faculty member at The Pankey Institute, I am challenged by and learn from all of my colleagues every time that we gather for an educational event, whether in person or online.

Some of that learning is from the program. Much of it is from one another as we discuss and share what is pertinent in our practices and careers and how we apply what we are learning. In short, these experiences improve my performance as a dentist, leader, and practice owner.

The grid of improving performance according to Todd Herman, performance coach, looks like this:

1. Observe & measure past action (Data from yourself & others)
2. Reflect on that data and the feedback from other key trusted people
3. Reflect / Visualize on the future, especially with key trusted people
4. Design Future Action (Experiments) & Acclimate to this new behavior
5. Repeat

This formula for change is almost always best done with other likeminded people who are on similar journeys. They can give you encouragement, feedback, perspective, resources, & connections.

Even more importantly, it can be very therapeutic to hear the stories and experiences of others to realize that you are not alone in your challenges and the ups and downs of attempting to do something difficult. It is simply reassuring to come face to face with the humanness of friends and colleagues that you respect. It makes our own human frailty much easier to accept and can give us the courage to try again and again.

Keep in mind that every thriving and durable organization has gone through countless failures in route to accomplishing their vision.

The highest performing individuals in any endeavor are working in a team of likeminded individuals who are seeking to accomplish similar things. Those individuals have a much-expanded capacity to understand one another’s challenges and needs. This expanded capacity is often the difference between success and failure.

Isolation is the enemy of progress. Don’t let it determine your possibilities.

Seek out ways to include shared experiences in your personal and professional development by joining like-minded groups like Pankey study groups, group masterminds, and group coaching programs. You even can create groups of your own to surround yourself with positive energy.

Once you have experienced the power of shared experiences like these, you will see the difference from working in isolation.

If I were to select one word most strongly associated with a successful relationship-based, health-centered practice, it would be the word growth.

What kinds of growth? The kinds I am thinking of are growth in knowledge and growth in sophistication of attitudes toward people and dentistry. As I meditate on this, I am enlarging my hope for and commitment to fostering personal growth … interpersonal growth … care team growth … patient growth … and, of course, practice growth. I welcome you to come along with me as I breathe fresh energy into leaving 2020 behind and growing in 2021.

Notice I didn’t mention a single word about teeth or techniques. I didn’t mention a word about technology, or what you must physically own to achieve growth. And that’s because growth isn’t a material thing; it’s a spiritual thing.

Growth can be promoted, or it can be impaired by the way we think, and consequently the things that we do and say day-in and day-out. And what we do repeatedly is driven by what we believe … what we believe about ourselves … what we believe about others … and what we believe about the purpose of dentistry.

What is your purpose in dentistry?

Each of us have a purpose that is driven by our philosophy … our world view … our perspective of things … and therefore what it all means to us. This changes as we grow in knowledge and sophistication of attitudes.

Avrom King said that it all boils down to these three questions:

1. Who am I?
2. Why am I here?
3. What is it that I am trying to achieve?

All three of them are philosophical questions, and all three lead us to answers which directly influence almost everything else. If we do not understand who we are on a values and beliefs level—what Mac McDonald likes to refer to as “the deep structures of ourselves,” we cannot predictably lead ourselves in any desired direction. And as a result, we cannot predictably lead others in a desired direction either.

Growing with Purpose

Growing with purpose requires Hope and Agency. If we do not hope for something of greater meaning to ourselves and we think we have truly little personal agency, we flounder.

In a world where we believe we have minimal personal value, everything around us starts to look scarce, and everything around us starts to look scary, so we’re tempted to take short cuts. We’re tempted to just grab what we can get for ourselves as quickly as possible. After all, who knows what tomorrow will bring? If we “stay on shore” with feelings of disempowerment and a little too much wine and whining, we ultimately achieve very little with our lives.

If we “stay on shore,” we will attract others who similarly think and behave. Like attracts like. Avrom King liked to call this “King’s Law.”

We tend to create our practice in the exact image of what we believe about ourselves, and consequently, that could be some version of heaven or hell. All of this happens because we choose to grow or to not grow.

Growth requires hope, courage, attitude, energy, and action, i.e., self-determination and self-control. Talk is cheap, so what will you do to master these? Surround yourself with a vision of your preferred self … your preferred career … your preferred dental practice. Acting on that vision leads to a next step and a next. In doing this, you will attract “likes,” and this positive reinforcement will help keep you on the road of your personally purposeful life. How much growth is happening in your practice today?

Can you see the green shoots of enthusiasm and creative change all around you, evidence of constant renewal? Or do you see an ossified structure struggling to maintain the status quo? Are you surrounded by people who are down, frustrated, and thinking that they have no other choice but to keep plodding on as they are?

Who are you?

Why are you here?

What is it that you are trying to achieve?

Philosophy Matters.

And that’s why L.D. Pankey, Bob Barkley, and other of our dental heroes constantly talked about it.

When I was 19 years old, I started to work as a dental assistant and front office person. In 2003, after 9 years of temporary hygiene work and multiple associate positions, I opened my own dental practice. To obtain bank funding, I had to write a business plan and a vision statement. In 2001, I wrote the following vision statement for the practice I wanted to create. I often look at this statement and find that it still stands true and even more so as time goes on.

My Vision, circa 2001: To create an environment full of learning and growing, that is open and honest, in order to provide individual optimal care with compassion and mutual professional respect for each other and our clients.

Over my years in practice, I have increasingly realized that that a culture of collaboration in the practice is essential for providing the comprehensive quality care that I’ve learned at The Pankey Institute—the care I believe patients deserve to receive.

The Benefits of Team Collaboration

A healthy and positive office culture is not only important for patients, but also for the team, including the leader!

• Healthy Relationships: A culture that is inclusive, compassionate, empathetic, and safe creates healthy relationships that are supportive, understanding, and positive.
• More Appropriate Solutions: An environment that is based on abundance versus scarcity is one that allows an organization to build on all the strengths and positive aspects of every team member. In fact, it is my belief that all team members’ perspectives are valuable. Solutions are more creative and appropriate when there is input from all perspectives of the team. Diversity in thoughts and ideas provides a pathway toward implementation and outcomes that are sustainable, because collaborative agreements are better suited for everyone involved—the leader, team, and patients!
• Increased Trust, Individual Growth, Leadership, and Fun: The fruits of genuine collaboration are trust, appreciation, and ownership…and so much more! Genuine collaboration facilitates learning, growth, accountability, and individual leadership for all members of the practice team. Collaboration breeds shared responsibility, less isolation, and more fun!

Steps Towards the Creation of a Collaborative Team

1. Establish your WHY. The first step is to create a shared vision of your purpose. Why do you do what you do every day? What brings you joy?
2. Stay in Kindness. An office culture built on mutual respect and trust allows for more effective collaboration. Be humble and focus on the strengths of each team member. Stay centered in giving one another the benefit of the doubt. Others will reciprocate with kindness when you are kind and fair. I always think, Do the right thing and the rest will follow.
3. Share. Share your expectations of how you will achieve your shared purpose and vision. Be vulnerable by sharing your needs and desires for achieving the shared purpose and vision.
4. Formulate agreements. Come to shared agreements to help, support, and keep one another accountable in the process of collaboratively reaching your shared vision of your purpose.
5. Celebrate. An important, solidifying step is to enjoy the process of collaboration, celebrate your successes, and have fun along the way!

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Christine Shigaki, DDS is a private practicing dentist in Seattle, WA.
She can be reached at cshigaki@gmail.com