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!

Here I share abridged excerpts from my newest book The Porch: A Dental Fable to illustrate why the new patient exam is sacred time that sets the stage for trust.

In this story, Tom Parker, DDS has been invited to shadow a second-generation dentist by the name of Paul Wilson, who has been in practice many years in a small town in upstate New York. Paul is a close friend of Tom’s mentor Henry, and both Paul and Henry have been immersed in opening the eyes of dentists to the possibility of practicing in an intentionally virtuous way that is enriching for both patients and dentists.

Upon arrival at Paul’s dental office, Tom notes that Paul displays photos of his family and dogs, pictures related to his love of skiing and golf, and pictures that indicate he is as a person of prominence in his community. Tom feels like he is back in time to another era.

Paul tells Tom the first patient is a new one so Tom will see what a blank slate looks like for the doctor and patient. When Paul is finished, he escorts Tom into his private office and asks him what he thinks so far.

“To be honest, Paul, you did it just the way Henry taught me.”

“Okay, but what didn’t you see. You know, what was invisible to you?”

“What do you mean?”

“I mean the intangibles. The things we can’t see or touch or even explain sometimes — like love. Let me explain what the positive psychologist Barbara Fredrickson calls the cocoon of self-absorption. Most of us spend our days focused on ourselves. It’s just our default…Frederickson says love appears ‘anytime two or more people, even strangers connect over a shared positive emotion, be it mild or strong.’ The doctor-patient relationship is a dyad in which love can be present…The virtues of love, empathy, kindness, compassion, and gratitude take time.”

“I think Henry mentioned that trust is spelled T.I.M.E.”

“Yes, we like to teach that. And that is why we ritualize the comprehensive examination, so we can leave the cocoon of self-absorption and become other-focused. That is why we ritualize slow dentistry.”

“Slow dentistry…I like that. I also noticed that the first thing you did was thank Gloria for coming in.”

“Congratulations, Tom, good observation. Gratitude is another virtue that is most important for our well-being. Being grateful rather than feeling entitled or taking others for granted is important. My dad taught me that years ago. Every morning he would greet his team and tell them how thankful he was for them being with him. Science tells us that gratitude is a great way to improve our health, happiness, and general well-being. So, I ritualize my greeting, but I really do mean it. I must earn the right to treat them. Did you notice how much attention I was paying to Gloria? It’s a tricky thing. It’s more than just listening.”

“Yes, I have seen active listening demonstrated before, but what you were doing was different.”

“I’m sure Henry has told you there is no instant pudding. We all need to work on our attention. Love is attention. It’s the highest form of love there is. When we learn to pay attention with no expectation of reward, with no agenda, this is the rarest form of generosity. People can spot bogus attention in a heartbeat. Your wife and kids know when you’re not paying attention. Patients know, too. That is why we make the examination sacred time without interruption.

“People want to feel that they are the only one in the room. I always begin with a very open-ended question, for example, ‘What you are going through with your health?’ or ‘What is it that made dental care a priority now?’ I don’t keep a list of questions. I use different ones. Some land well. Others fall flat, but I keep trying, always looking for levels of comfort. The point is to not just acknowledge their presence but to truly notice their presence. This takes another level of awareness. We need to learn their stories. We need to learn their goals, not only their dental goals but their overall health and wellness goals. They want to know that we are here for them in every way.”

Tom’s face lights up in an Aha moment as he realizes love is operationalized through attention that is selfless. The examination is sacred time in which we pay attention – with no expectation of reward.

Staying in the question — staying curious about what more you can learn about each dental patient and the intention to help each patient be more curious about their own situation, enables dentists and dental hygienists to be more effective in helping their patients.

What Do You Think You Know?

The next time you are reviewing the chart of a patient you are frustrated with, try this exercise. Instead of going too quickly to thinking, “What is wrong with this person? Why don’t they get it?” – ask yourself these three questions:

1. What do you know about this patient and their situation, specifically because they told you this? They actually said it.
2. What do you think you know? This has to do with the guesses you have, your intuition about what is going on. What do you think the patient has implied by what they said? Recognize which of your thoughts are guesses because those assumptions might or might not be true. If you act based on what is not true, you may miss opportunities to learn more about what is important to your patient. Asking yourself what you think you know is a way of challenging your assumptions.
3. What do you want to know? What are you curious about? How can you take some of your “think you know” thoughts and move them into the category of “what you do know” about your patient.

The more you do this exercise, the more you become aware of the difference between what you know and what you think you know, and the more curious you will become about your patients. The more I have done this exercise, the more I have come to know that what I do know is small compared to what I do not know. I sometimes I realize I know very little about what is important to them.

Is the Patient Curious to Learn About Their Situation?

I have come to realize that the first question the patient asks is just the first step in their learning process. Sometimes they need help framing some of their more important questions. Or sometimes, a question is their attempt to share a little of their story, their struggles, their fears, their embarrassment. Often, I realize they have emotional discomfort I can address with empathy. In that moment, empathy is more effective in helping and leading the patient to higher health than the clinical information I could provide them.

Understanding that most patients have some level of anxiety about their oral health and oral health visits, I have learned to pause and ask a question before plowing ahead with information they may not want or need — or may not “hear” if they are anxious.

For example, if I see wear patterns on teeth when I do an examination, I could tell the patient what I see. I could say, “I see you grind your teeth.” But that type of statement is often perceived as accusing, not empathetic. What I have found to be more effective is to show the patient what I see. If the patient does not say anything that indicates she would like more information, I might ask her, “How long has that wear pattern been there?” or “What do you think has caused it?” I never want to deprive her of information. I want to give information when she has a little more curiosity — when she wants to know it and will hear it.

Sparking curiosity with a question often leads the patient to ask a question that reflects what is most important to them at that time. Discovering what is most important to them enables us to optimally make use of our time during that visit. We can provide information that is important to them, that they want. Or we can focus on providing the empathy they need to develop a relationship of trust.

Seventeen is young to decide what you want to do with the rest of your life. Deciding you want to become a dentist means that you are making a huge decision before you are aware of all the knowledge you will have to attain and the multiple skills and micro-skills in which you will need to become proficient.

It was a long time ago when I made that decision. I can’t even remember how I made it. I remember I was under pressure to decide from my parents and their friends. I remember telling others I thought dentistry was a good career because I had spent so much time in dental offices growing up.

That’s because I had malformed supernumeraries blocking the eruption of my centrals when I was seven years old. The dentist who suggested the supernumeraries should be removed, proceeded to remove the two good centrals by accident. This was followed by surgery to remove the supernumeraries and alas no centrals. This was traumatic to me at the time, but early in life, I learned to adapt to a dental prosthesis, having that replaced as I grew, and so on.

I wish now someone had set me down when I was in high school and given me real-world career advice like I did for my kids as they were growing up. Hoping they could avoid some of the mistakes I made, I would begin those conversations with Stephen Covey’s habit #2: Begin with the end in mind. And I would disqualify money as an end. Because money only buys people what they really want. I’d get my kids to think about what they really wanted to spend their lives doing.

Warren Buffet says he wanted to make money so he could be independent. In his biography, The Snowball, Buffet wrote, “It could make me independent. Then, I could do what I want to do with my life. And the biggest thing I wanted to do was work for myself. I didn’t want other people directing me. The idea of doing what I wanted to do every day was important to me.”

There’s truth in that for me. Independence is a universal thought that drives many of us, yet we are unique in our own lives…in how we ultimately determine and design our game plan to live independently.

If we had understood what we wanted to do for the rest of our lives when we were seventeen, then we could have better designed our careers to meet our adult desires. But that isn’t realistic, is it? It sometimes takes decades to a lifetime to understand ourselves.

Adam Grant in his book Think Again questions the unreasonable question kids are asked, “What do you want to be when you grow up?” In his book, he uses his cousin Ryan as an example of someone who chose to go into medicine because that’s a profession parents applaud. Once Ryan made his decision, he spent years staying on track.

Once you start, there is no turning back…financial debt…sunk costs…physical, mental, and emotional. We hit a certain milestone like owning our own dental practice and we tell ourselves we will be happy… that we will have all the things we want. But positive psychologists confirm that this is a poor prescription for happiness.

Positive psychologists say the road to happiness includes mastery, autonomy, positive relations, engaging work, and accomplishments. It’s a never-ending road. But each person takes their own road. There are many roads of mastery, freedom, positive relations, engaging work, and accomplishments.

Don’t get me wrong. I am not saying dentistry was a bad career choice for me. It is a great profession. The message of this blog is twofold. One, at the start of my predoctoral and doctoral education, at the start of my career in dental practice, and even midway through that career, I didn’t understand the complexity of what was before me–including getting to know myself well. And two, everyone needs to find their own happiness.

If you are reading this, you likely chose a career in dentistry. On your road of your own design, I believe you will find happiness in the continual act of mastering more, working with autonomy, fostering positive relations, and setting out to achieve new accomplishments. Money will be just a way to fund the things that really matter to you, and for many of you that will be making a profound difference in the health and lives of your patients. And when you segue, as I did, away from hands-on dentistry after practicing for four decades, you will find that new ways to use your people skills keep emerging. Your road to happiness continues.