By Lee Ann Brady, DMD 

When a crown comes off and we are going to put it back in the mouth, we need to remove the old resin cement that is inside the crown. What is the best way to go about this? 

First, we need to know if the crown is made of zirconia or lithium disilicate. If you have a radiograph of that restoration, you can tell immediately which one of those two things it is. If you don’t, you can always attempt to X-ray it. (That’s what I do.) Alternatively, you can assume the crown is made of lithium disilicate, which is the more technique-sensitive material when it comes to removing cement. 

For crowns confirmed to be zirconia, employing 30-micron aluminum oxide air abrasion effectively clears out the old resin cement. Subsequently, re-etching the inside of the zirconia prepares it for reseating. For crowns presumed to be lithium disilicate, this approach should be avoided to prevent crack propagation. 

In the case of lithium disilicate crowns, two alternative methods can be employed: 

1. The crown can be placed in a porcelain oven to liquefy and evaporate the old resin. However, caution must be exercised to avoid rapid heating of the hydrated ceramic that has been in the oral environment. Rapid dehydration will introduce cracks and lead to crown fracturing. 

1. An alternative method involves using a brown silicone point in a high-speed handpiece, adjusted to lowest speed. A brown silicone point at slow speed effectively removes resin without damaging ceramic. 

How will you know when all the resin has been removed? When etching lithium disilicate, whether using red 5% hydrofluoric acid or Monobond Etch & Prime from Ivoclar Vivadent, any remaining resin will be evident because the dye sticks to it after the etching solution is rinsed off.  

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. 

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.  

Gary M. DeWood, DDS, MS 

Learning begins from our first moment of awareness as our eyes open and we have a response to something external to us that is brand new. That experience and all the ones that follow until the moment awareness leaves us to shape our reactions to and our actions in the world. 

Experiential Learning 

The brain is a dynamic and ever-changing organ, constantly adapting to new experiences and knowledge. 

When our youngest daughter Katie was a child, I was cooking dinner one night–my turn–and Katie was sitting at the island where the stove was. I turned around to get something from the cupboard and heard a loud inhale followed by a whimper. Upon turning quickly, I saw her move her hand rapidly behind her back. No more sounds came forth, but I saw a tear and I asked her what was wrong. She said in a wavering voice, “Nothing,” and then looking at the stove burners, “Mom told me those were HOT and never to touch them.”  

I gently took her hand from behind her and saw the blisters rapidly forming on her fingers. She started crying and said to me, “Please don’t tell mom.” I’m certain she never felt the need to verify the information her mother had given her again. THAT is learning. 

All of us have experiences like that every day. Some are memorable and become part of us, embedded in a manner as yet not fully understood inside our brains for almost instant access. Some “learning” seems to fade quickly or never even get recorded. I “touched” a lot of biochemistry information over the years without burning much of anything into my brain. Maybe I should have been touching the stove at the same time. Learning is not simply having an experience of something and then being able to view the recording later.  

The Definition of Learning 

In nearly all of the definitions I have located in my research I see that CHANGE and PROCESS are prominent parts of learning. For example: 

• A change in disposition or capability that persists over time and is not simply ascribable to processes of natural growth. 
• Relatively permanent change in a person’s knowledge or behavior due to experience. 
• A transformative process of taking in information that, when internalized and mixed with what we’ve experienced previously, changes what we know and what we do. 

Choice & Focus 

My personal experiences have shown me that a big part of lifelong learning is what you believe about it and how you embrace it. It’s driven by some measure of choice and focus. 

Cheryl and I have sought out new ideas in dentistry wherever they took us. One of my friends in dental school, a wonderful man whom Cheryl and I still hold close, took a different path. Sometime around the 10th anniversary of our graduation we were visiting, and he told us that he had been able to get all the continuing education he needed without traveling.  

I discovered that his feelings around need and learning as it pertained to dentistry meant satisfying the requirements to stay current with licensure. He is NOT a bad dentist, but like many of the dentists I have come to know in the last 48 years, a hunger for dental learning changed once school was finished.  

A Drive for Learning 

I am reminded of one of the most original and influential thinkers on the creativity process, Robert Fritz, who believed you can create your life in the same way an artist develops a work of art. He said, “If you limit yourself only to what seems possible or reasonable, you disconnect yourself from what you truly want and all that is left is a compromise.” 

As a philosopher and scientist-physician, Dr. L. D. Pankey intentionally observed processes and their results (change) with the goal of becoming better at helping others. The embodiment of compassion, he was highly curious and actively sought ways to alleviate the sufferings and misfortunes of patients and colleagues. He traveled long distances to learn from others’ experiences. He inspired others to know themselves, their patients, and their work on a continuous road of mastery. As a lifelong “leisure” learner, he was interested in a wide range of subjects outside of dentistry as well. Through reflection, he often discovered he could apply this outside learning to his work. 

Philosophy has to do with the relationship between belief and action. In the end philosophy is what gives meaning and purpose to our lives. As dentists who are consciously aware of our own beliefs and what holds meaning to us, our daily work and our routine are not merely unrelated actions and episodes, but integral parts of our personal lives.

There is an important distinction to be made between having a philosophy and living a philosophy. “Having” a philosophy implies having an idea or set of ideas, but it doesn’t necessarily mean that those ideas are being acted on. Learning can best take place when we are “living” a philosophy—that is, living in a state of inquiry—based on our personal values, our knowledge of ourselves, and our individual goals.

Questions lead to answers.

According to Jim Dyce, a British dentist/philosopher and good friend of L.D. Pankey, “Philosophy can do no more than initiate questions.” When Dr. Pankey decided to devote his life to saving teeth, he was forced to ask himself a difficult question, “How can I help people keep all of their teeth for a lifetime?” In 1925 L.D. didn’t know the answer. Out of that question he was able to uncover and develop many principles which have proven instrumental in the understanding of comprehensive restorative dentistry and patient education. Therefore, Philosophy, in its most valuable form, is more about asking right questions than with right answers.

How useful the Pankey Philosophy will be to you depends on how willing you are to put yourself in the questions. In the process of moving toward the answers to your questions will help you clarify your goals and ways to accomplish them. Questions can open the floodgates to new insights and information for you.

How do you define and measure success?

The Pankey Philosophy itself seems simple enough at first glance. Each one of us must decide for ourselves what and how to measure our success. Once we have conceived an idea of success, we must believe in it, and then work out ways to achieve it. Achieving the greatest success in dentistry–both gratitude from our patients and financial and spiritual reward, requires a commitment to always give the best you can. This involves knowing yourself, knowing your patients, knowing you work, and applying your knowledge conscientiously.

Dentists can fall into a rut of boredom and frustration.

This sobering statistic may have been attributed to two main factors related to the practice of dentistry. First, dental work is usually confined to a small office, where dentists go day after day, week after week. Second, once dentists become good at what they are doing, their work becomes very much the same. The result could be developing a feeling of not being appreciated by their patients and staff. Or maybe feeling being trapped in their small office. They may think they are not achieving much in the way of mental stimulation, and start wondering to themselves “Is this all there is to dentistry?”

Now, this is not to say that all or even most dentists live lives of “quiet desperation.” Yet most dentists have felt they are in a rut at one time or another, at which point it becomes increasingly difficult to see the real rewards in this great profession of dentistry. Reviewing your questions again can pull you out of the rut.

Dentists can climb out of the rut through increased service to mankind.

In 1947 L.D. began teaching the Philosophy of the Practice of Dentistry which he had been developing since 1932. His purpose was to help dentists confront and move past feelings of frustration and boredom. L.D. wanted to move dentists toward higher levels of excellence in their technical work, improve their communication skills with their patients, and achieving greater satisfaction in their lives through increased service to humankind.

Are your goals clear and well-defined? Are you willing to pay the price to achieve them?

L.D recommended dentist look more closely and objectively at themselves and their individual situation. He would suggest asking his class to really think about their goals. He would ask them,” Are your goals clear and well-defined? Can you measure your goals so you can measure your success? Do your goals belong to you or are they someone else’s goals? Are you willing to pay the necessary price to achieve them? Are your goals and objectives in line with your circumstances and temperament?” Satisfaction is achieved not only in reaching your goals, but also by understanding the progress you are making during your journey as you move slowly and steadily toward them.

As poet and musician Bob Dylan wrote, “He who is not busy being born is busy dying.”

Understanding the Pankey Philosophy can help you transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the path we urge you to take. Essentials 1: Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of risk assessment, patient ownership and risk management creates technical excellence and predictability.

In his recent book Subtract–The Untapped Science of Less, University of Virginia professor of design Dr. Leidy Klotz points out many instances where we allow ourselves to be overwhelmed with information and complexity. He argues and demonstrates that subtracting the extraneous often leads to greater clarity and efficiency.

Reading Klotz’s book, brought to my mind the Pankey Institute’s Essentials continuum that begins with Essentials 1 (E1). Dentists arrive at E1 overloaded with information taught in their dental schools and other CE programs. All that information may have some value but the role of the Essentials courses is to subtract the extraneous and focus on what is essential.

We arrive at E1 thinking everything is important, and we discover that there are essential elements of dentistry that are key to effectively working with patients, performing a complete exam, diagnosis, and technically excellent, predictable care. From these key elements, we can build practice systems that are clear and efficient.

What Is Essential?

We aren’t born with complete wisdom like Athena born from the forehead of Zeus. We learn wisdom (what is essential) faster by being in the company of others who have traveled the same road, asking, “What is essential? What do I NEED to know?”

The Pankey Essentials continuum exposes dentists to the clinical, behavioral, and financial aspects of practice. And goes beyond exposure to exercises and exploration. The courses invite dentists to understand themselves, their patients, and their work exceptionally well. The courses invite dentists to focus on and develop essential skills.

Our profession has undergone a technological explosion over the past few years. Some of this is wonderful. But how much of what we invest in are we fully utilizing? What is the best technology to invest in? What is the best way to implement it? The Institute’s faculty help us cut through the clutter and determine what works best…what we can implement with our teams and patients that will improve our dentistry and the patient experience. But first, the Essentials courses peel away the layers of hype and technology to help us grasp the core skills we must attain.

The core skills are behavioral as well as technical. And because the behavioral aspects of dentistry are not discussed to great extent in dental school curriculums, one of the roles of the Essentials continuum is to fill in this gap. In the Essentials courses, we learn the importance and skills of behavioral science. We learn how to most effectively lead and affectively influence. We dig deeper into understanding ourselves and our patients…our emotions, our motives. We discuss the behavioral concepts that were taught by Dr. L. D. Pankey because they remain valid today. These concepts are straightforward and help us develop lifelong patient relationships and personal skills.

The business aspects of dental practice are overwhelming. Dental schools do not have time to teach business essentials. In the Essentials, dentists learn essential financial skills such as how to understand their financial statements. If we are not making a profit in our practice we can’t stay in business.

Self-Examination

When I first attended an Essentials course (then called C-1), I worried that I might not know enough. I discovered that I knew a great deal but I had not clearly defined what was essential. I learned I needed to be more assertive about asking myself why questions. For example, I found myself asking:

• Why am I doing this? Does this step add value to the final result?
• Why is my final result not stress free and predictable? What step did I miss?
• Why am I “telling” my patients rather than “asking” for their input and values?

An Intentional, Essential Community of Support

The Essentials faculty and my fellow students helped me understand that getting rid of what is not needed is not simple. Determining what is essential and building my practice systems around the essentials takes time, thought, and effort but was made easier for me because I had the help and constant encouragement of the Pankey faculty and community in shaping my approach to dentistry and my career.

My friend and colleague Dr. Richard A. Green has always said, “Intentionally becoming both more affective and more effective is essential to excellent patient care.” So often we intend to do something but don’t have the encouragement we need to remain intentional. As my friend and colleague Dr. Barry Polansky says, “We humans tend to slip, slide away. It is by developing habits intentionally and self-checking our assumptions that we stay alert to the possibilities of how we can become more.”

I have spent the last 27 years developing my abilities to restore patients to the dental health they desire. One of my favorite aspects of dentistry is creating a customized plan to help patients achieve their dental health goals, and I do this by hearing each patient’s story, so I not only see the care they need but know the person that needs it. I look forward to that challenge with every patient I see.

Let me share with you my routine for setting the stage at every dental visit for a successful interaction. As I come into the room, the patient is sitting up in the dental chair, and I sit down in front of them knee to knee. Then I say, “Tell me how you feel about today’s appointment,” or “Tell me what questions you have about what we are doing today.”

This does two things:

1. It sets the stage for “I am here for you as your friend and doctor.”
2. It prepares me to be present with them. I get to hear where they are before we start that appointment.

Once we establish what they are thinking and feeling, I ask their permission to lean back the chair. It signals that I am ready to initiate the procedure.

This routine gives them comfort, and when the procedure is done, I can sit them up and basically go through the same two questions: “How do you feel about today’s appointment? What questions do you have moving forward?”

Before and after every procedure, there is intentional time in which we are in relationship. I have found this to be very beneficial in how we move forward with patients. A very small amount of time and intention helps optimize each patient’s time with me, and I believe is a key to the success of my practice.

Why Occlusal Appliance Therapy Is My First Step Prior to Ortho, Equilibration, or Restorative

Occlusal changes on an appliance are easy and reversible. An appliance can immediately reduce elevator muscle activity and give the patient relief. The patient also experiences what changes to their tooth contacts could provide for them long term. We can test the changes that would be made by ortho, equilibration, and/or restorative.

As reviewed in Part 2 of this series, our goals are to stabilize the joint anatomy and reduce the activity of the elevator muscles because those muscles are what overload the joints and teeth. We also want to slow down the rate of damage to the dentition and move that rate back to a more age-appropriate pace. We also may need to reorganize a patient’s occlusion to manage occlusal forces to ensure restorations that last.

Removing Posterior Contacts Does Not Work for Every Patient

Over my years of clinical practice, I have found that changing the occlusion does reduce functional risk for most patients. But we all have patients with perfect occlusion who present with TMD symptoms. We have some patients who continue to parafunction after we move them into immediate posterior disclusion.

Studies show that proprioception causes the elevator muscles to engage in only 80 to 85% of the population. This means that when the brain receives the signal that teeth are touching, the brain elevates the masseter muscles in 80 to 85% of people. Tooth contact is the trigger. Because this proprioception does not occur for 15 to 20% of the population, it is not the universal trigger for excessive loading.

Over my years in clinical practice, I have learned there is nothing I can do that is 100% dependable to stop a patient from para-functioning. Some of my patients continue to excessively load after posterior contacts are removed. Their functional risk does not diminish.

If we cannot reduce elevator force and redistribute force enough on an occlusal appliance to eliminate or at least relieve TMD symptoms, then occlusal therapy via ortho, equilibration, or restorative will not satisfactorily help the patient. We will need to turn to other forms of therapy.

Other modalities I use are BOTOX to deactivate muscles, massage therapy, and physical therapy. There are also systemic medications, cold lasers, and TENS therapy we can use to reduce the activity of the muscles or reduce inflammation in the muscles and joints. Sometimes one modality will alleviate symptoms for a while and when symptoms return, we can try it again or try another modality.

An Exercise to Identify the Patients Who May Not Benefit from Occlusal Therapy

You can do what I call a poor man’s EMG on yourself by placing your hands on your masseter muscles. Put your back teeth together, clench and release, clench and release, clench and release to see how much masseter activity you have. Then move your teeth into protrusive edge to edge and try to clench a little bit, making sure your back teeth do not touch. If you now have a posterior tooth touching in the edge-to-edge position, then put a pencil or pen between your front teeth to separate your back teeth.

With no back teeth touching and contact on the centrals, try to clench and release two or three times while feeling your masseters. Most of you will find your masseters do not move or move a lot less when no back teeth are touching. Some of you, even with your back teeth separated, can still clench in protrusive and can still increase the muscle activity almost the same amount as when your back teeth touch.

I do this exercise with my patients, but when they move into protrusive, I put a bite stop over their front teeth or have them bite on a Lucia jig we have lined for their bite registration. If you do this test with your patients, you can use an EMG or feel the muscle activity with your hands.

If the patient can still generate almost the same force or the same force with their back teeth separated, you have identified one of the around 15% of people who might not benefit significantly from occlusal therapy. You’ve also identified someone who might not do well on an anterior-only appliance because, if they can generate that same force on just two teeth, they are at risk for those teeth becoming sore and moving.

Interested in Learning More?

The Pankey Institute Essentials courses and multiple focus courses include hands-on exercises and over-the-shoulder training designed to help dentists develop mastery in reducing functional risk and treating TMD symptoms.

I think all dentists would agree that mutually beneficial and enjoyable relationships with patients are key to a dental practice’s long-term success. But what does that “relationship” look like in a health-centered practice?

To some, a good relationship represents two people who get along and perhaps enjoy being in each other’s company. But I would argue this is not enough to build a successful health-centered dental practice. Getting along and even enjoying the presence of another person alone doesn’t go deep enough. It only addresses good rapport, and good rapport is only the starting point of a truly helping relationship. We need more to help patients achieve optimal oral health.

The More We Need

We need shared values, shared understanding, and shared goals. And to a large degree, we also need a shared vision of a preferred future so that all the goals are oriented in a specific mutually agreed upon direction. That vision must largely originate from the patient because it is their water to carry, and not ours. We can facilitate the development of the patient’s vision, but we cannot realize it for them.

This type of relationship is often called “patient-centered” or “client-centered.” And it is only possible through mutual trust — and a lot of it at that. We must have enough trust present within the relationship to allow for open and transparent communication to occur. This type of communication is much deeper.

The Deeper Communication We Need

Communication that is deeper includes discussions around:

• concerns,
• personal challenges,
• barriers,
• fear,
• short-term agendas, and
• longer-term goals.

When a patient trusts us, they are essentially allowing themselves to be vulnerable to our actions, which could, if something went wrong, harm them physically, emotionally, and/or financially.

A first sign of trust is the willingness to have these types of discussions.

Some patients will trust us quickly because we have big capital letters after our name, but this de facto trust is becoming rare. We must EARN our patient’s trust through the quality of the relationships we build, our attitude, our philosophy, and our actions that lead to deep communication and development of shared understanding and goals.

I would argue that meaningful conversations around important issues are what distinguishes a “health-centered” or “patient-centered” dental practice from one that is an attractive and pleasant place where dental services are provided in exchange for money. A key metric to monitor in each patient record is whether the deeper discussions are taking place. A key objective is to schedule time to gently have those discussions.

Doctor L.D. Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.”

Years ago, I had been asked by a young dentist to come to his office and help him with the implementation of his new learning with occlusion applied to bite splints and equilibration. I suggested he line up a few patients for us to work on together during my visit. When we arrived at his office early in the morning to talk about the patients we were going to see together over the next two days, I asked him to bring me up to speed on where he was in treatment with the patients and the conversations he had had with them. We also looked at full mouth models, models of bite splints, and radiographs. I asked him what he wanted me to do with the first patient who was coming in that morning.

He said, “I want to watch you sell him a bite splint!” A little surprised, I asked him to tell me about the patient. He said he was a new acquaintance. They played golf together and occasionally gambled as they played to keep their interest up in the game. They also gave each other a hard time about handicap ratings. He mentioned he felt a bit embarrassed because he thought he knew what was best for his new friend and had kind of hustled his friend on the golf course to be a patient. Now he was feeling a bit guilty about having his new friend come in as a patient, and he could not bring himself to a have conversation concerning the benefits of a bite splint.

Charlie (the friend) appeared, and the dentist introduced me. Charlie and I stood about the same height. We looked each other in the eye, and we smiled at each other – a good beginning. In my mind, I was repeating slowly to myself, “Find a relevant connection.”

I said, “Thanks for taking the time to come in and meet me on such a beautiful Spring day, as I pointed to a comfortable chair for him to sit in.”

He offered something about how golf could be a bit boring if you played it too much. Still looking for a relevant connection, since my “stated task” was to sell him a bite splint, I asked him about his work, and he said he was retired from directing filmed commercials. I asked him what he did with his new found time aside from golf. He smiled a big smile and said he ran about five to seven miles a day. I smiled as I remembered the years when I ran three to five miles a day during the week and seven to ten miles on weekends. A light bulb went on, in my head, and I knew a question I could ask to engage him and tweak his curiosity.

I asked, “How often do you buy new running shoes?” And without hesitation, he said, “Every four hundred miles.” I then asked, “How did you discover that interval?”

He reached down with his right hand and rubbed the lateral surface of his right leg from the mid-thigh, across the lateral surface of his knee, to the lateral surface of his calf, while telling me of the discomfort he would experience in his muscles when the bottoms of his running shoes became worn.

I made the statement, “You must run with the traffic!” Surprised, he asked, “How do you know that?”

I told him I experienced the same thing when I ran on a road with the traffic, especially when the road had a bit of a “crown” on its surface. I thought I had found a relevant connection, and I let it sink in a bit. Then, I told him his dentist friend wanted to offer him a new pair of shoes for the top of his teeth in the form of a removable bite splint. It would be like getting a new pair of running shoes. It would be professionally custom fitted to the tops of his teeth, which would please your chewing muscles and create greater comfort, just like a new pair of running shoes pleased his leg muscles and knee joint.

Charlie looked at his dentist friend and then at me before standing up. With a big smile he said, “I will make an appointment with the receptionist.” Hmmm… Isn’t that Interesting!