I had a patient in a provisional on tooth #7, and he called to tell me he ate the crown. When he came in, I checked his occlusal marks in MIP, and there was a nice coupling with the opposing tooth. He was not hitting the tooth at all in protrusive, in right and left, and in crossover. He had not used floss and had not chewed on something sticky that would pull the provisional off. So, I put articulating paper between his teeth and used my iPhone to video him as he chewed like he was chewing food. What I discovered in the video is that he had a functional interference. He had broad strokes on the provisional whenever he was in his chew stroke.

I sent the video to the lab with the hope that the new information could be used to make a crown that would protect the tooth from breaking or becoming loose. This patient was adamant about not wanting orthodontics. I was able to show him why equilibrating his opposing tooth would be beneficial and he accepted equilibration.

Having run into this problem once, I am now checking for functional interferences with more patients by having them do “the chew test.”

In dental school most of us learned to use the same two sizes and lengths of dental anesthetic needles. Once I got out into practice and started to experiment with different sizes and lengths, I changed my protocol.

I discovered through my years of practice that I like to use an extra short 30 gauge needle that is 12 mm long for maxillary anesthetic injections and for mandibular injections that are premolars and forward. What I like about the extra short needle is that it does not bend. For these two types of anesthetic injections, the extra short needle is long enough and easier to control than the “short” one we learned to use in dental school. As a bonus, if a patient asks to see the needle, I usually hear them say, “Oh, that’s not so bad.”

On a mandibular block, I prefer to use a 27 gauge needle that is 25 mm long. What I like about this size is that it gets me to the depth I need and is easy to manipulate. Rarely do I need a longer needle that is more difficult to control.

Every successful dental case begins with a conversation. 

A Case of Great Dental Expectations

“So what should we do next?” my patient asked. I rolled my chair beside him, excited about the challenge of achieving his preferred future.

I looked him in the eye. “Do you really want to know?”

“Yes!” he said.

I responded, “I don’t know right at this moment. However, may I take some models, photographs, and study your mouth? Taking time to study your mouth with this information will allow me to develop viable options for you to decide what you would like to do next.”

This conversation came after my patient lost #12 and had an implant placed. He had never asked this question before and his past dental history was single tooth dentistry.

Once the records were gathered, I spent some time in my office lab opening up his vertical according to the principles that Mike Fling teaches in his worn dentition course as well as the Pankey restorative footprint and clinical sequence taught in our Essentials 3 curriculum.

From my patient’s diagnosis, I discovered that he had two options: ortho plus restorative treatment or restorative treatment without ortho. Space was needed and form and function would definitely improve with improved space. We met for a conversation.

We looked at photos and models, then discussed the options. He explained to me that he would prefer to do the restorative plan without the orthodontics. My team and I invited him to experience a mock-up of the potential outcome from a wax-up by our own John Lavicka of Dental Ceramics. The patient immediately replied, “Let’s do it!”

Even though the patient understood why I wanted to do the orthodontics, he wanted to attempt treatment without it. I was happy to move forward with a restorative-only treatment with one agreement: If it did not work, I could initiate orthodontics. He agreed.

To be continued …

Dental failure and being ‘perfect’ in patient care is a key stressor for dentists. In her first blog on this topic, Dr. Brummett talked about deciding to work toward perfection rather than feeling frustrated about not achieving it. Read on for the rest of her story:

Stop Trying to Be the Right Kind of Perfect

The next morning after my revelation about perfection, I woke up, had coffee, and realized the patient who had been the focus of my upset (over a mistake I made) had texted me. She wrote, “Good morning Dr. Brummett! I just wanted to let you know that I am doing well and have not had any pain.”

What? My patient was doing well, texting me to tell me how well, and she was thanking me?

A quest to provide myself with a new perspective and a reminder acronym began. This perspective would hopefully take shape so that I could share it with my team, my children, and anyone suffering from the punching match of perfection.

Perfection can be the root of depression and upset, which is why becoming perfect will be my focus and acceptance of the process my goal. Perfect will stand for seven perfect words:

P is for position, as it’s good to remain humble about one’s status.

E is for effort, not the result.

R is for resilience, as I will fall, get back up, and grow from the failures.           

F is for facing the fear, embracing the challenge, and striving in the face of fear.

E is for empathy, treating myself and others with compassion.

C is for courage, as though I might not have a cape, I can still use my whole heart.

T is for trust, because with perseverance I can trust that everything will work out.

Later that day, my patient contacted me again and wanted me to know one last thing. She said, “I forgot to thank you for your gentle touch.”

This acknowledgment really drove home the point to me. I will attempt to stop looking through my rearview mirror and look forward through the front window of my life. I will allow myself, and encourage others, to become.

I am thankful for Dr. Pankey’s courage to share his failures and for our patients that believe in us and show us gratitude and appreciation. Now, isn’t that perfect? 

Failure is a hard thing to accept in dentistry. This is especially true because what constitutes ‘failure’ can mean different things to different patients and different dentists.

Keep reading for an anecdote that puts failure in the dental practice into perspective:

Changing Your Perspective on Dental Failure

On my way home from work one day, I turned the radio off, looked through the rearview mirror, and thought, what a day! I had just left my dental office dealing with a “dental failure.” I felt disappointed that this sort of difficult situation had occurred.

Then, this question came to the forefront of my mind: Why do I think I can or should be perfect? With that question, a wonderful reminder appeared out of the blue.

Bill Davis had conversations with LD Pankey about his philosophy and wrote an amazing book that I refer to often. The story I remembered was about Dr. Pankey sharing his own failures. He had worked five cases out on the Monson articulator and said that he basically obliterated the patients’ occlusion.

He shared how all five of the cases failed. He then stated that four of the five patients stuck it out with him because they felt he was conscientious enough to see them through. That’s when it hit me! I realized I had been thinking about this perfection thing all wrong. And, in the voice of Richard Green in my head, I could change my perspective. 

What if I didn’t focus on being perfect, but on becoming perfect?

In my own personal religious growth, I am learning how to develop my physical, mental, and spiritual health. I can learn the principles and values inherent to my faith and develop my character, but I can never truly be perfect. What if I approach my dental life in the same way? On becoming.

To be continued…