Early in my career, I became frustrated with splint therapy. In the clinical area it was working. In theory, it made sense to me that I should be able to take the appliance back through well-articulated CR casts and ultimately to my patient’s mouth.

Turned out, patients treated with splints were not beating down my door for definitive dentistry. Like Mick Jagger, I Couldn’t Get No Satisfaction. A decade later, I have experienced something magical happening and am singing a new Rolling Stones song in my head, Time is On My Side. (Yes it is!)

Time and Splint Therapy

Perhaps I was not waiting on my patients or more than likely they were waiting on me. I have hundreds of splints on unrestored patients that visit me a couple of times a year. They bring along the plastic to have it ultrasonically cleaned, sometimes tweaked, sometimes repaired.

There was a time when I believed the transition to treatment was a given once the appliance was well-adjusted on a patient willing to trust me with their investment in therapy. (I mean geez, that happens every time for the folks who taught me how to make one, right?) The presentation of the next phase was a conversation that probably sounded a whole lot like a sales pitch and generally fell flat on its face.

Time is on our side. I’ve grown to realize the virtue of patience and listening. Specifically, I listen for compliments, appreciation of the appliance, and sometimes simply a statement of dependency on the plastic. Sometimes this takes years. This is the time to ask, “Would you like to discuss dentistry that can make your teeth feel this way?” Sometimes they outright ask me.

Time is on our side. Appliance therapy is a seed. Our caring attention is a well-nurtured garden. Patients will bloom when they are ready.

My experience with splint therapy was like most dentist’s prior to developing the skills taught at Pankey. In fact, my appliance was not really therapy at all. Perhaps just a shot in the dark “helmet” that protected teeth against collisions with very little intention.

Throughout the years there have been many facets of my experience I value greatly in guiding patients to health using plastic:

Splint Therapy and Appliance Design

Appliance design is a provisional analog (that is, a practice replacement) for any changes we make to the teeth and ultimately the stomatognathic system. The splint is a great diagnostic tool that is capable of healing, but it’s also an iconic part of the behavioral interaction between the provider and the patient.

Aside from physically being an orthotic analog, the splint is a training tool, maybe even the greatest reversible “do-no-harm” in our profession. Case by case, each patient experiences changes and familiarizes themselves with my touch and caring.

Month by month and year by year dentists educate themselves and develop an understanding of bite relationships by using therapy. This happens case by case too, much like waxing cars and painting fences for Mr. Miyagi. As the experiences compile, sometimes our questions do as well. Sometimes we turn to our mentors for answers, much like the Karate Kid.

For the learning dentist, different parts come together when bringing splint therapy from the classroom to the operatory. There is the initial understanding of the “why” that can be conceptualized in theory, but not realized in practice until the “how” of the technical piece arrives through experiential understanding.

Each provider comes into their own by developing skills to have patients relate needs and eventually invite them confidently to enter appliance therapy.

There’s more to come in Part 2! What challenges have you faced in splint therapy techniques to ease patient discomfort? 

There are three words on my business card that may seem obscure to patients at first. These words, which come to have important meaning later on in their relationship with my dental practice, are: Comprehensive, Restorative, and Esthetic.

Promising and Delivering a Luxury Patient Experience

Comprehensive

We look at the patient as a whole. We observe and diagnose globally. We intend to partner with our patients in a thorough individualized manner. The best dentistry does not happen when we just look at a tooth with a problem. In fact, it isn’t much better when a dentist has a look at ‘teeth’ plural.

Comprehensive dentistry considers the whole system and the individual. How are the muscles and joints that affect and are affected by the teeth and their use considered? How are the structures that support the teeth?

What are the factors unique to a patient’s habits, routines, and systemic health that relate to ideal dental health? What are a patient’s individual goals, desires, and expectations? Will the dentist take everything they can gather about the causes of problems and consider them in the solutions?

The list goes on. This is a highly intentional paradigm of patient care.

Restorative

The focus on restorative dentistry is just as it sounds. In our practice, we want to restore patients to an ideal state of health and function. We put tremendous effort toward continuing education, technology, and our approach to care beyond the average dental setting to achieve this ability.

Esthetic

Esthetic dentistry speaks to taking great care in the art and science of making dentistry beautiful. Yes, it is a nose thumbing at the overused term “Cosmetic Dentistry.”

We believe all good dental restoration is more beautiful if provided in the context of health and function. At the end of the day, we want to create smiles our patients can be proud of because they are beautiful, healthy, and durable.

We all have things we value enough to invest in. We all make choices that take effort because we want the result, just like my car that I enjoy and is reliable. I invite patients to consider that experience with their teeth through the approach of ‘Comprehensive, Esthetic, Restorative’ dentistry.

What do you do in your dental practice to make dental care a valued experience for patients?

When a car breaks down, the way we choose to have it repaired says a lot about how much we value our vehicle. A similar phenomenon occurs with dental care. 

In part 2 of this series about how we see a fix versus a valued service-based relationship, Dr. Kelly dives back into an experience that made him reflect on the dental profession. Keep reading for the rest of his story:

A Car Service Analogy: Obligation, Expense, or Experience

Coincidently, many days I use the analogy of cars to taking care of teeth with my patients. We wear away the surfaces of our teeth similarly to how tires age. We pay for maintenance and parts with an equal financial obligation and expense.

When we have to start over and restore our vehicle (or get a new one), sometimes it costs the same as major treatment we could have done for our teeth. Sometimes the auto investment is inconvenient and urgent. Often, if we choose, it is predictable and pleases us. We find ways to pay for it.

Individuals always seem to find ways to pay for the things they value. We choose our own experiences whether we know it or not. I invite my patients to consider experiencing dental care in my practice similarly to the good experience I have had with reliable and well-maintained cars.

The business card for my practice has three tag words on it: Restorative, Comprehensive, and Esthetic. I’ve been told that the meaning of these descriptors is too obscure for new patients to understand. Why not be like the dentist down the street and just say “Cosmetic” or “Family Dentistry”?

I believe every opportunity I have to help patients experience each of these focused goals for our patient care enriches the dentistry I can provide them. So many in our patient family have learned through these experiences exactly what these words mean.

To be continued …

What makes dental care a valued investment versus a fix patients choose begrudgingly? 

One morning I had an automobile breakdown in my “beater” weekend truck. We have all been there – filled with the inconvenience and anxiety of dealing with a problem that came up unexpectedly. I was hoping to find a place that could get me home that day.

I googled around until I found a reasonable looking repair shop close to the breakdown. They worked me into their schedule so I could get the old truck back on the road. It was pleasing to have the problem fixed, at least for that day, but I measured this against how I have experienced service at the shop that takes care of my daily driver car.

Dental Service Emergency vs Dental Relationship

There were many aspects of the breakdown with my old pickup truck that reminded me of a dental emergency. I found someone convenient and they had the best intentions to provide a fix.

It was a shop I didn’t have a relationship with. They were kind and helpful, but there were so many things missing that would have been unlikely to happen if I treated my old truck like I do the car I have been so much more diligent in taking care of.

The shop focused on the problem that was presented to them, not looking beyond a simple fix to get me back on the road. While I was appreciative, it is very unlikely that the next problem (or even the true cause of this one) was looked for. I did not leave with any feeling that I wouldn’t be in a similar situation as soon as the next problem arose.

I reflected on the years I have spent with the auto shop that takes care of my primary car. I have a valued relationship with them. They know me and know that I appreciate them taking the best care of the investment I have in the vehicle I drive every day.

When I take my car to an appointment, they look over everything. They tell me when to expect maintenance and repairs in the near future and throughout the life of the vehicle. I trust them and know that they have my best interest in mind. In return, I am very appreciative, expressing gratitude when I write them a check for their services. I have never broken down in the cars they take care of for me.

To be continued …

It’s time to start thinking of smartphones as an asset rather than a detriment to dental practices. Yes, they can be distracting, but they can also pose great opportunities for connecting to a younger generation of patients. Ultimately, they can directly contribute to case acceptance and smoother communication with specialists. 

How to Use a Smartphone for Better Case Communication

Videotaping patients with an iPhone has changed how I practice, especially with interdisciplinary care. Here is how that often takes place in an exam:

“You know Mrs. Jones, we are so blessed to have Dr. Periodontist, Dr. Orthodontist, and my Lab Tech, Mr. Awesome, working together with us on this case. I think we learned some things today that are important to share with them, wouldn’t you agree? I’ve got an idea … would you mind if I recorded a short video to text to them? I think this will keep them up to speed and enable them to give any input as we move forward.”

I state the patient’s name and date, then start describing the situation. We show things from exam findings while the patient experiences them again, usually nodding their head in agreement. With the right patient, I get them to state what we found while recording the video. The whole time, I imagine the patient feels like they are holding the attention of all the members of the interdisciplinary team at once.

These videos are an awesome way to communicate with specialists and other members of the case team. With care and knowing your patient, the behavioral learning opportunity is priceless for them. Sometimes the behavioral pieces can even guide a team member.

As we grow, we must embrace the possibilities of our current reality. We experience and process the world differently now that it is through the filter of a little device in our pocket that connects our mind to the world.

Do you love or hate smartphones in your dental practice? 

In my last blog, I discussed the possible scenarios that could occur when your patient answers their phone during an appointment. Now, I’ll explore how you can leverage smartphones to your advantage in your dental practice.

Leveraging Smartphones in the Dental Practice

Which scenario would you hope might happen with you the most? Are these all valuable experiences? Do you KNOW YOUR PATIENT more by observing each behavior? Do you KNOW YOURSELF more from your level of engagement and influence on the outcome? How will you modify your future interactions for each patient from what you have learned?

Let’s face it, for the past couple of decades we’ve had it easy. If we chose, a whole wall could be filled with charts of Baby Boomer patients. Boomers are everywhere in great numbers, most have comprehensive needs, most have the means to care for themselves, most have a high level of trust. It was an ideal patient population and still is.

Now we have Millennials. Frankly, they are initially a tough personality for more seasoned practitioners to relate with (we look at them like spoiled kids). The stark reality is that they outnumber Boomers and have plenty of dental needs. They are the future of our workload.

To relate with Millennials, they need information fast. They need to see to believe and establish trust. Fortunately, they have a camera in their pocket. Sure, I still take my full photo series and we keep the intra-oral cameras in our rooms, but when I see the slightest glimmer of doubt in a Millennial, I ask if they can open the camera on their phone. Then I pull out a photo mirror.

It’s almost as if saving the image in their device’s storage is connecting to their memory bank. They look at it several times. They text the picture to friends and post on social media. They seek validation. From cracked teeth to gingival needs to caries – for my millennials, seeing is believing. (Now if I can keep them off social media while I’m prepping their teeth.)

Here are two photos of a tooth that a skeptical patient refused to crown because there were no symptoms. The “just fill it Doc” attitude changed with two simple snaps on their phone using a mouth mirror.

To be continued …

It’s been a decade and a half since I hung my shingle. While setting up and decorating my first office, I printed several signs stating, ‘PLEASE POWER DOWN CELL PHONES’ and strategically placed them around the office.

Why Smartphones Work in the Dental Practice

Fast forward to today and my attitude towards mobile devices in the office has taken an about-face. We now harness the power of having them in the clinical area. Where years ago we viewed smart devices as a distraction, today I acknowledge that they are a part of who we are and how we relate. Perhaps they even store some of our Cartesian sense of self within their connections to the cloud beyond them.

I’d love to share a few tricks that use smart devices for obvious uses in documentation and communication, but more importantly, impress their magical power as a tool in behavioral development and patient assessment.

Consider this: A consult appointment has reached a critical moment. You are knee to knee and eye to eye with your patient. Your diagnosis is clear and it is the opportunity to pass ownership of the patient’s condition to them. Your eyes are connected and gleaming — then a loud siren blares from the patient’s pocket.

There are several alternative versions of how this vignette continues . . .

1.  The patient giggles with embarrassment and says, “Sorry I didn’t turn that off Doc.”  

2. The patient halts your conversation, answers the phone with unapologetic alacrity, and discusses weekend plans with the caller, index finger up, signaling “hold-on.”

3. The patient gives a meek apology, answers a call, and speaks softly with their head down. When you return from checking hygiene, they explain that their mother is in hospice care.

4. The patient lowers their eyes, returns a text message, and gives a subtle nod as if they didn’t miss a word of your conversation.

To be continued …