I’m a restorative dentist with a passion for occlusion. I’m a firm believer that our patients deserve our best efforts to eliminate deleterious stomatognathic forces that impact comfort, function, smile aesthetics, and whole health. So, I encourage all dentists to wrap their minds around the area of “occlusion” and become immersed in hands-on, mentored courses to better diagnose and treat their patients.

In teaching at The Pankey Institute, I often hear clinicians view occlusion as a great, big mystery, and yes, sometimes misery. At each stage of my developing interest, knowledge, and skill, I have found my passion for occlusion grows and results in better clinical management and outcomes with my patients. When a well-planned full mouth equilibration is completed, the patient’s elation over how their “bite feels” cannot be matched in dentistry.

So, What’s So Hard About Occlusion?

L. D. Pankey was said to say that occlusion is getting the posterior teeth to touch all at the same time with light contact, and when you bite firmly, neither the joint nor the teeth should move. In addition, when you move your jaw left, right, or forward ONLY the front teeth should touch. He would chuckle and say, “So what’s so hard about Occlusion?”

Another way to think about it is that the jaw operates like a tricycle; the two little wheels are the joints, and the big wheel is the front teeth. To have a smooth ride, the steering mechanism and the joints shouldn’t have any notches in them!

Where My Journey in Occlusion Began

Although occlusion was integral to my dental school education, it really wasn’t until I went to the Pankey Institute that my real journey in occlusion began. While I went through the Continuums at the Institute, I joined several technical study clubs. Under the direction and encouragement of Drs. Richard A. Green and Herb Blumenthal, I explored many facets of Occlusal Therapy and TMD.

My View Today

Today I see the occlusion/bite as a potentially significant factor in the balance and harmony of the patient’s whole health. Integrative dental health involves looking for the impact of “other” on the entire body, as my colleague Dr. John Droter states it. The airway, myofunctional impact, and the body’s posture and structural integrity may influence how the teeth come together. If the teeth are chipping, breaking, or intermittently sensitive, it could be the bite. Headaches can be directly associated with the bite. Establishing occlusal harmony – getting rid of “any notches” in the steering mechanism and joints, is a process best tested with a finely balanced bite appliance.

Today I see occlusion as a case-by-case riddle. Every patient is an individual, and their occlusal management is customized accordingly. When solving each patient’s riddle, I’m trying to see how harmony can be re-established in the system of joints, muscles, and teeth. I utilize a bite appliance as a mechanism to test out an occlusal scheme for the patient. Once harmony is achieved, the challenge is to wax and plan the case to mirror the harmony established on the appliance.

For each patient, I’m also trying to figure out how the patient responds to appliance therapy to determine the best treatment modalities or modality. Is the treatment limited to the dentition or is intervention in the joint appropriate?

Either way, my governing philosophy is to make the fewest changes to the dentition while producing the best result for the patient. For some patients, this could be full mouth rehabilitation and for others simply equilibration and/or orthodontics.

Beyond the Teeth and Joints

We are a closed loop from head to toe, and the influence of the stomatognathic system on the “whole” body is best not ignored. Research shows that the teeth, jaws, and tissue affect different areas of the body, impacting for example head, neck, heart, pulmonary, and gastrointestinal health.

In establishing harmony between the dentition and joints, we are calming the musculature. In my mind’s eye, I see occlusal harmony calming the whole system.

Is Pankey Essentials (E1) Right for You?

Dentists who participate in E1 invariably say it is both an inspiring and practical course, and they want to come back for E2.

In E1, you will receive enormous encouragement to stay inquisitive and engaged in learning. You will gain insights that impact all aspects of dental practice, and when it comes to occlusion, you will be immersed in a combination of presentations and hands-on exercises coached by experts. The Pankey Institute excels at removing “the misery” out of occlusion by coaching you as you perform exams on colleagues, do diagnostic work ups, and practice making occlusal changes with models, wax, and appliances in the Pankey lab.

“Patients, who seek your care, want the best care you can give them. I believe the Pankey Essentials continuum is one of the best continuums on the planet to learn how to solve occlusal puzzles. Without this “essential” development, we are not the best physicians we can be.” –Kevin Muench DMD

One of the greatest challenges of dentistry is developing a conceptual framework for how to approach complex cases. We leave dental school bright-eyed but unfamiliar with the personal and professional tools that help us get to know patient needs and provide optimal care over a lifetime.

Phased therapy is a skill that takes time to develop but creates the mental space to build relationships and techniques simultaneously. How do you follow through on a treatment plan over the course of many years, phasing out the process to improve the patient’s experience, your experience, and their ability to afford it?

Single tooth dentistry may seem simpler than a full mouth reconstruction, but it still poses its own set of challenges. You’ll be able to gain skills without requiring patients to commit to a heavy financial burden, but you’ll still need to manage esthetics and deal with unforeseen issues with occlusion.
A dental career is one marked by introspection that necessarily leads to improved patient care as you gain greater self-knowledge alongside technical skills. Here are 2 tips you can use to develop your love of both simple and complex cases, your long-term relationships with patients, and your passion for dentistry:

1. Approach Learning as a Layered Process

It’s easy to get hung up on technical prowess and let your communication skills or personal development suffer. The mountain of knowledge that exists in dentistry is formidable, especially the way it is presented early on in our dental educations.

But you don’t have to build Rome in a day. Start with single tooth dentistry so that you have time to learn the technical and behavior skills along the way that will build your confidence to tackle bigger cases.
Longevity in a career as physically and emotionally demanding as dentistry requires that we approach learning as a layered process. Each case deepens our understanding of how to evaluate and succeed at the next one. Along the way, we can find joy in each incremental improvement.

2. Build Trust Through Patience and Demonstrable Success

Nothing works without the patient’s trust and acceptance. They will be more likely to say yes to a simpler restorative case. What you’ll find is that as they get to know you and you get to know them, their willingness to engage in future dentistry will improve.

With patience, you’ll put in the work to improve their health and esthetics. The fruits of your labor will naturally result in greater trust.

Later this year, I’ll be hosting my course “Think Global, Work Local,” at Pankey Online. During this course, I’ll dive deeper into the concepts I’ve brought up here.

I’ll be covering three cases that stood out in my career, including the details on preparations, impressions, fee presentation, treatment planning, restorative care, and case results.

I can’t wait to see you there for this opportunity to dive into a Pankey-infused approach to learning over a lifetime!

As I watched the pandemic unfold from my vantage point in New Jersey, somehow the innocence of a child passed through my mind as I thought, “That won’t happen here.” As the pandemic got a death grip on the New York Metro area, the stark reality of “It happened here” came into full view. At first, we spread the patient visits with gaps for safety and eventually just closed our doors except for emergencies. As the weeks have turned into months, the economic impact and the sense of isolation has started to metamorphosize into a NEW reality. The phrase of “epic proportions” and “uncharted territory” were thrown around on every news cast.

Is this journey really uncharted?

Are we really cast to a horizonless sea? Haven’t we been preparing for this type of event through our education, study clubs, reading, and conversations within the community we call the “Pankey Family?” These examples come to mind:

After reading Gene D. Cohen’s book The Mature Mind, I learned that I’m resilient. I survived the big “C”, a 300-year flood in Havasu Falls, and my wife’s health issues. I realize “I’ll be able to get through this.”

Through the Gallup’s Strengths Finder and the leadership program with Dr. Richard A. Green at Gallup, I learned that my strengths are Ideation, Strategic, Learner, Communication, and Maximizer. Today I trust that the ideas and strategy will come to me. I have leveraged the Strategic strength over and over again.

The book How to Think Like Leonardo DaVinci by Michael J. Gelb tells us that when DaVinci was faced with challenges such as these, he trusted the answers “would appear.” He trusted the challenges would “seed the unconscious” to find a solution.

Waiting for the Unconscious…

While waiting for solutions to challenges, I’ve learned to free my mind and spirit by “chopping wood and carrying water”—TAO! So, when my practice closed normal operation, I went to Home Depot and bought paint…a LOT of paint. On day two I started painting my office. At first, I thought I would paint just the reception room, but as time went on, I had time to paint the entire office. I know myself, and I was doing all I could not to jump onto the “downward spiral” that I learned about in The Art of Possibilities: Transforming Professional and Personal Life by Zander and Zander.

Staying in Community

As the weeks went by the first solution to pop up was creation of a protocol for dealing with virus containment. If a patient did need to come in for emergency care, I needed to have a strategy. Joan Untershuetz and Denny Byrne presented new information last year at their Inspired Facilitation workshop about how the brain needs community. So, I formed a Zoom account and started weekly team meetings. We discussed what we were each doing to stay safe. This piqued my curiosity to wonder what patients were doing to stay safe and could they help me develop a protocol that would help them feel safe?

I recalled Dr. Irwin M. Becker lecturing in C1 on first steps to integrating this new way of practicing. He challenged us to select patients that trusted us already, and he called them “friends of the practice.” I asked my current team to list those they consider to be friends of the practice—those who put smiles on our faces when we see them on the schedule. The list was formed. The ball started to roll. I facilitated my first ever Patient Focus Group and asked two simple questions:

What have you been doing to keep your home safe from Covid-19?

What would you need to know in advance of an office visit in order to feel safe?

New Dimensions of Individualized Care

The focus group responses helped me understand that the protocols they were following at home ran the gamut from washing hands and taking off shoes to something resembling a chip manufacturing plant. I realized that individualizing the protocol could be another level of “values-based relationship-driven” individualized care.  I learned that my patients had high trust in my ability to forage through the regulations and come up with a safe protocol, and they thought it would help them to know the what, how, and whys before they came to the office.

Thanks go to several colleagues who helped by reviewing and critiquing my office protocols as they developed. Much thanks to Joan Untershuetz, Richard Green, Rolando Cibischino, Christine Shagaki and Dennis Stiles for letting me bounce ideas off of them and for their in-depth critiques.

Something else I did to stay in face-to-face contact with patients was to implement a form of “teledentistry.” After watching a presentation by Laurie Owens from DevDent at one of the ACT Dental CE online CE days, I set up an account with Doxy.me and now have regular telehealth hours. I get a push notice when someone is in the “waiting room” to have a tele-dialogue.

A Journey? Yes…Uncharted? No

There are boundless opportunities to put our best Pankey training to masterful use. We were all taught to slow the practice down and be more intentional. We were taught about personality styles and values. Open dialogue and full transparency can be the threads we hold with our patients to deeper levels of trust and appreciation. I feel poised and ready to bring my best self forward in these times that hold endless possibilities for values-based, relationship-driven, uniquely individualized care.