Stephen Malone, DMD 

Our Knoxville, Tennessee, dental practice has grown to where we now have four dentists, as well as four hygienists, six dental assistants, two patient coordinators, a practice manager with two front-office patient care specialists, and one more primary partner in our dental practice—Bob Cutshaw. Bob is a master lab technician with over 40 years of experience and owner of Cutshaw Labs. He has been a partner in care with me for nearly 25 years and collaborates with our doctors on all dental restorations requiring lab work. 

Recently, I was thinking again about how grateful I am for my association with Bob and for the many benefits of having his lab located downstairs within our practice facility. Perhaps, having a lab in-house is something other dentists might aspire to eventually have in their own private practice. 

Bob is involved in care planning just as much as I and the other dentists. We can sit side by side to collaborate on treatment using a combination of digital 3D modeling and analog articulated models and wax-ups. 

For patients with complex needs, he routinely comes into the operatory or the consultation room to meet with patients. As he explains his involvement in their care and how the highest quality materials and latest techniques will be used, they become fascinated in the laboratory methods and technologies. Some request a tour of the lab and want to watch some of the process. 

We use digital designs for all prosthetics. Bob’s professional-grade 3D printers work all day long for predictable, efficient fabrication of custom restorations. Then he hand-paints and glazes the crowns and prosthetics for optimal natural aesthetics. Because he is involved in planning our most complex cases that involve implant supported hybrid denture, he is deeply invested in the details that allow the finished product to be delivered with ease. 

Having his lab in-house allows us to rapidly fix issues that arise, for example, alterations to a restoration when it doesn’t quite fit right or has a slightly incorrect shade. Instead of waiting for days or weeks to deliver back and forth a restoration to an outside lab, we make the changes here on the same day. 

For Patients undergoing clear aligner treatment, we manufacture our clear aligners in-house. If a patient loses or damages a tray, it is immediately replaced so the patient doesn’t lose precious time in treatment. The same goes for our occlusal splints, night guards, sports mouth guards, and Essix retainers. 

One of the branding traits of our practice that has earned us our high reputation is the in-house laboratory. Without a doubt, having this lab just downstairs is a major way in which we enhance the quality of care we provide to our patients. 

By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Kelley Brummett, DMD 

After you do a crown preparation, do you tell your patients that you’re going to make them a temporary or a provisional?  

Provisionals are more than temporary restorations. They are part of a process. They’re the dress rehearsal to the final outcome. They are the prototypes for the final restorations.  

The “provisional” process is an opportunity to gain trust with the patient while modifying the length of teeth, the shape, or the color. It is also a way to communicate with the patient how their functional and parafunctional findings may have contributed to the destruction of their teeth. 

As the patient comes back to have their bite checked and to talk about what they like and don’t like, we are building trust. We’re involving them in understanding what they feel and think. We’re listening to improve their conditions. 

I’ve had patients who were fearful about moving forward with extensive treatment because they couldn’t envision the transition from the prep appointment to the final. What would those temporaries look like? What would they feel like? How would they function?  

So, when I am discussing a case with a patient, provisionals are all part of one treatment fee. We talk about the prep process, the provisional process, the lab process, and the final seating process—all as one process for which there is a fee. We discuss how the provisionals will guide us in optimizing the lab plan to achieve the desired comfort, function, and aesthetics.  

Whether it’s a single tooth or whether it’s multiple, I encourage you to help the patient understand that what you are providing in the interim between a preparation and a seat of a restoration is called a “provisional.” 

A provisional protects the underlying tooth structure. It keeps tissue in place. It helps the patient feel confident. It allows us to understand what might be going on functionally. It helps us communicate better with the lab. It’s more than a temporary restoration. It’s a guide on our journey toward predictable and appreciated relationship-based dentistry. 

Gary M. DeWood, DDS, MS 

Many dentists believe that provisional restorations don’t really matter. After all, they are not really a stand-in for the final restoration. I would respectfully disagree. I am a proponent of creating functional, durable, and highly esthetic provisional restorations, every time. They have the potential to impact your dental practice a lot more than you might think. Whether you print them, form them, or free-hand them, a GREAT temporary is a great billboard for your practice. 

1. Make the provisional as Esthetic as the final restoration.

I contend that the more your provisionals look like what you are hoping for when you seat the final restorations, the more people will talk about them, AND you. 

I was able to build a referral restorative practice by creating provisionals that made patients want to come to my practice and specialists want to send people. For much of our career, almost the entire team of the oral surgery office we worked with, and many of the team members from the other specialty practices we worked with, were our patients in Pemberville, Ohio. 

Front teeth or back teeth, when you make them look like teeth, people will like it and they will show and tell other people. “This is just the temporary?!” was not an uncommon question or exclamation from our patients.  

2. A GREAT guide makes a GREAT provisional restoration.

Your wax-up** cast/model serves as your vision, as your preparation guide fabrication device, and as your provisional former. When the preparation is appropriately reduced for the material selected, the temporary can mimic the restoration. 

** The wax-up might be created with wax then duplicated with impression material and stone to create a cast, or it might be scanned to be duplicated with resin and printed or milled to create a model. 

3. 3. Use that provisional to highlight the talents of your team members.

You might LOVE to make those provisionals, but if your assistant is equally excited when it comes to recreating nature for the patient to appreciate, then it could be an opportunity for patients to see that your assistant does much more than set-up, clean up, and hand you an instrument. My dental partner, Cheryl, (who is also my wife) and I actively sought out things that could help our patients experience our team as much more than our helpers. 

As we all know, dental assistants are an integral and vital part of what the practice is and are a powerful force in how and why patients ask for dentistry. Assistants who fabricate provisionals have an opportunity to be seen differently, and we were always looking for ways to create partnership with them in our treatment. 

4. 4. Take pictures of them.

Photographs of the temporary will make it easier for the lab to design the outcome. They will be able to see what you are thinking, able to visualize what you want, AND maybe even more importantly, see what you do not want. With anterior provisionals, I have frequently noted to my ceramist, “Please put the incisal edge in exactly this position vertically and horizontally in the face, then use your artistry to create the tooth that belongs in the face you see in the photographs of the patient before, prepared, and temporized.” 

There were many times when the technician was able to see and create effects that I might have not recognized as being “just the thing that would make these teeth extraordinary.” And don’t forget to show the patient the photograph. 

5. 5. Love the material you make the temporary with.

The better the provisional material is at holding tooth position and functional contact, the less adjustment we’re going to have, so using a high-quality material is important. There are a lot of them out there. I like bis-acryl materials that polymerize with a hard surface, have little or no oxygen inhibited layer, and can be polished easily. The polish is more about feeling smooth than about the shine. Ask you patients how their provisional tooth “feels” when you are done, so they sing your praises. 

6. 6. Use high-quality core material.

When you use a good core material the prep will be smoother, making it easier to fabricate nice provisionals. Ideal prep form goes a long way toward better provisionals. 

7. ASK your patient to tell people.

As noted above, when you can elicit an emotional response about the awesomeness of your provisional, ask the patient to tell other people, “….and this is just the TEMPORARY!” 

The Pre-Clinical Interview – Part 1 

Laura Harkin, DMD, MAGD 

I am a third-generation, restorative dentist in New Holland, Pennsylvania, which may be best known for its blue, New Holland tractors. I own my grandfather’s and father’s dental practice where I am the sole provider for approximately 1,000 patients. My dental team consists of two hygienists, two assistants, and two front office administrators. 

I graduated from dental school in 2008 after short careers both in the actuarial sciences and as a stay-at-home mom. In 2010, I purchased my practice and signed up for my first course at The Pankey Institute. Note, my father also studied at the Institute when it first opened its doors in the early 70’s. One of my greatest challenges, early in my career, was learning how to diagnose oral conditions, develop and present treatment plans, and execute that treatment via phases. I found it quite overwhelming to simultaneously manage multiple, complex cases. Now, I love sharing my experience and the approach I’ve found works best for me. 

Above all, I’ve learned that in the midst of daily pressures in dentistry, we need to maintain our own health and strength to properly treat our patients and lead our teams. Surrounding ourselves with knowledgeable, positive, and compassionate colleagues helps! 

Knowing ourselves is as important as knowing our patient. 

Dr. L. D. Pankey’s Cross of Dentistry supports the belief that knowing oneself is of equal importance to knowing a patient whom we choose to treat. This challenge forever evolves because no person remains unchanged with time. I frequently evaluate my strengths and weaknesses as a provider, team leader, and mentor. At the same time, I ask myself what aspects of patient care and business management I excel at and most love to do. I can then choose my specialist team accordingly and empower my office team to best support me. 

Together we ultimately provide a better product and higher level of care. 

To prepare specifically for the treatment planning process, my team helps me gather key information and clinical records from a patient for a comprehensive evaluation. After a thorough analysis, I carefully craft written documentation which will help educate my patient, my team, and the specialist team I’ve chosen. An added benefit is its ability to serve as legal documentation.  

I always ask a team member to join me during treatment plan presentations. They bring another set of ears and eyes so that we may better understand a patient’s motivating factors as well as the challenges they may face in receiving treatment. We encourage open and honest conversations and understand that treatment plans evolve to fit the needs of individuals. 

How do we get to know our patients? 

In addition to gathering a thorough health history and dental history, we are seeking to learn more about our patient’s chief complaint, perception of their current state of oral health, desires for treatment, and barriers to care. 

We listen intently for clues to identify a patient’s communication style. I’ve always heard that we have two ears and one mouth for a reason. I practiced with my father for two years and once, after observing me, he said, “Laura, you do far too much talking. You need to really listen to what your patients are sharing.”  

I’ve had to develop the skill of active listening. To stay in the question and become comfortable with silence takes practice. Some observations that I try to make in order to effectively communicate and build a relationship with a patient are as follows: 

• Do they seem to enjoy conversing or are they responding with short answers in order to get through the interview quickly? 
• Do they readily ask questions and express thoughts, or are they quiet and need to be invited and prompted to share? 
• Are they amiable? 
• Are they distrustful or fearful due to past dental experiences? 

We need to intentionally verbalize our empathy when we’re in conversation with a patient to help them recognize that they’re being both heard and understood. 

It is beneficial to understand a patient’s background. For example, what have they done in life? What do they love to do? Who is important in their life? Sharing in these conversations will help build a rapport, lead to improved doctor/patient communication, and can help to begin a trusting relationship. 

Does the patient have limitations such as the ability to drive to appointments, afford dentistry, or find time for treatment? Do they need to discuss their oral health condition and treatment options with a trusted family member before making a decision? 

Understanding these answers helps us to not only provide respectful and resourceful solutions but also limit inaccurate assumptions. This knowledge is especially helpful in my third-generation practice, where I have many elderly patients who are dealing with health issues, multiple medical appointments, and scheduled drivers. Their desire is to simply make a careful decision for an oral rehabilitation which fits their objectives and abilities. 

Do we hear the desire for treatment? When speaking with an existing patient, I can often recognize signs of interest to move forward with previously recommended treatment. At that point in time, I often ask, “Why now?” The answer helps me clarify their chief concern(s) so that we can move forward fittingly. 

In Part 2 of this series, we will explore additional techniques to clarify our patient’s desire for oral health and long-term, oral stability. 

Do You Know Your Team’s Threshold? 

Robyn Reis, Dental Practice Coach 

While visiting a dental practice that had amazing hospitality and incredible relationships with its patients, I observed a doctor’s presentation to a patient who was in his forties and who had been saving for a smile makeover for a long time. The doctor did an amazing job with his presentation of what was possible and the phases of treatment. The patient was very excited, even teary-eyed.  

The patient wanted to get started and asked about the cost. The doctor said, “You know what? My team at the front are experts in figuring that out.” So, the patient was taken to the front and handed over beautifully. In a few minutes, he was presented with the treatment plan on paper with the approximate dollar amounts. In phases, they would do the full mouth. All seemed to be going well until it wasn’t. 

Intrinsically, everyone has a monetary threshold that up to a certain point, you have no problem with the amount. It’s something within your range of expectations and easy to say yes. When you cross that threshold, anxiety may creep in and for sure, you become uncomfortable.  This is what I witnessed in a matter of moments. 

I observed the front office team member look uncomfortable after glancing at the paperwork, despite being experienced with treatment presentations. The clinical assistant who had been part of the diagnosis and treatment planning process, would also help with scheduling and any questions. 

Together, they gave the patient the opportunity to ask questions after reviewing the plan again. The full mouth restoration was going to be in the neighborhood of $25,000. The first phase would be about $18,000. They offered CareCredit financing. The patient said, “It’s only $25,000 and I have $20,000 saved. This is wonderful! I don’t know how I will pay the other $5,000, but I know I have the means. It’s only $25,000.”  

The team appeared somewhat shocked because they were obviously uncomfortable with quoting that amount. This treatment plan crossed their personal thresholds. They suggested the patient go home and sleep on it “because this was a big investment.” The patient was so committed to moving forward that, despite their advice, he scheduled his first appointment. He would call them back once he figured out how to pay the remaining balance, knowing insurance would contribute very little. 

What I also found interesting was that neither team member asked for a deposit. No money was exchanged to reserve an extended appointment. The patient could back out and the doctor’s time spent on the case work-up would be uncompensated. In my experience, making a signed financial agreement would be the responsible step to take at this stage.  

This example illustrates the discomfort many dental teams feel about asking for a deposit if the treatment estimate crosses their personal threshold. Of course, dental teams will want to explain what can be done to make treatment more affordable and the financing options that are available. But it is beneficial for team members to understand their personal threshold and to become comfortable saying, “Grab your checkbook or pull out your credit card, Mr. Jones. Here’s what your investment is going to be to get started.”  

What’s your threshold? This is a great team exercise you can do at your next meeting because a patient might ask anyone they interact with about the cost of dentistry, and what options you offer for the dentistry they want.  Every team member will benefit from considering their personal threshold and discussing it — even role-playing — to become comfortable with the best ways to manage these questions. Depending on the situation, it could be referring the patient to the treatment coordinator or to the financial administrator to have a comfortable conversation. 

It is my belief that when patients are excited about what the treatment results will be and they want to move forward, it’s the right time to ask the patient to make a financial commitment to get the process started. 

Culture Fit Versus Culture Add 

Robyn Reis, Dental Practice Coach 

When you are hiring team members, you are likely thinking about how those you interview will fit into your practice culture. Do their values align with yours? Do you share similar backgrounds and philosophies? A business’s culture is a system of shared values, beliefs, and behaviors that influence how people dress, act, and perform their roles. Most practice owners work hard to have everyone get along, support one another, and work as a team to give every patient a wonderful experience. So, it’s only natural to want to find someone who fits into that culture when a position opens up. 

In the HR world, recruiters have a different approach – they are moving away from “culture fit” towards “culture add.” What does this mean exactly? A great mentor of mine, Sheri Kay, says it best, “People come together in their similarities, but they grow together in their differences.” 

On the pages of Harvard Business Review, Forbes Magazine, Fast Company, Inc., and Entrepreneur, you will read that more and more companies are moving away from the traditional culture fit that creates a monoculture where everybody has shared similarities and there is no growth. Instead, they are recreating a culture that is open to new ideas, open to conversations where people poke holes in traditional ideas and say, “Hey, what if we did this? This is what we think we want to do. Now let’s figure out why it will or will not work.” 

In recruiting a hygienist for a client, one of the candidates stood out to me. In addition to her clinical hygiene education, she also had a financial background which represented a “culture add” for this particular practice. She had a greater understanding of goal setting, the finances of the business, and how to create a profitable hygiene department. She ended up being a fantastic and productive member of their team. 

When you are in the hiring process, do you think about adding to your culture? Diverse backgrounds correlate with more diverse problem-solving and decision-making processes. In studied corporations, diversity leads to increased profitability.  

In dentistry, diverse backgrounds can lead to the attraction and retention of diverse patients. Diverse backgrounds can fill in operational holes in your business model. Does a candidate have a background in psychology, finance, education, customer service, computer IT, office administration in another industry, or marketing? Does a candidate speak a second language that will be an asset in your community? Is a candidate artistic, an exceptional writer, a community volunteer, or actively participating in other activities? 

During each interview, seek to learn what the candidate could add to your practice culture in addition to culture fit. After talking about a candidate’s resume and interests, talk about situations that occur in the practice and current needs. Ask if the candidate has ever been in similar situations and how they handled them. Do the answers indicate personality traits and strengths that will add to (complement) the team? Ask the open question, “Based on your personal experience, what insights could you add to this situation?” 

In today’s competitive market for talented team members, consider what a new hire with additional skills could add to your culture and what these new contribution possibilities could be for an amazing patient and team experience. Happy hiring! 

Upstream Thinking in the Dental Practice 

Leigh Ann Faight, RDH 

In my years of working with dentists and teams, I have noticed that leaders tend to address what is directly in front of them. They are simply too busy to notice that the issues of today will likely be back tomorrow, and the next day and so on if they don’t find the root cause and build systems from there.  

My favorite book on this subject is Upstream by Dan Heath. I was so impressed by it that I named my dental coaching company Upstream Dental Practice Coaching. The idea of the book is to help us stop reacting to problems and instead look for ways to prevent them in the first place. 

In the book, Dan Heath recalls a quote from Paul Batalden: “Every system is perfectly designed to get the results it gets.” I love this quote; it is as exact as it is simple and begs the follow-up question: Are your systems working to get you the results you want? 

I’m not writing this with just dentists in mind. I recommend that all dental team members appraise together how well your systems are working and think about where the lack of systems is causing stress. As you meet as a team and pull back the layers of your processes, do you discover barriers that get in the way of moving upstream? As a team, you can intentionally rebuild your systems to remove the barriers and prevent them from rolling back into your stream. 

Fixed thinking gets in the way.  

As I coach, I see three behaviors that get in the way of improving the many systems operating in dental practices. 

Problem Blindness 

This is the belief that negative outcomes are natural and inevitable. We treat these problems like we treat the weather, as something out of our control. We normalize problems and even stop seeing them. Teams tell me, “That’s just how it is here.” This finite thinking is one of the first challenges we uncover when I work with teams on intentionally “going upstream.” 

Lack of Ownership 

If an issue arises and no one claims ownership for fixing it, the problem will persist. To really develop upstream thinking you need someone who will say, “Even though I did not create this problem, I will lead us to find a solution.” 

To create a culture where teams have ownership over decisions, leaders must trust the team to make decisions on behalf of the group. On the flip side, the team must choose to take charge of issues as they see them.  

Tunneling 

Tunneling is exactly like it sounds. You focus on short-sighted problems and have reactive thinking. You get stuck in a routine of short-term decision-making and are unable to move forward. You think, “I can’t deal with that right now.” 

The more problems you are juggling at once, the harder it is to solve them all. If you can’t solve problems systematically you will stay in an endless cycle of reaction, because tunneling begets more tunneling. Compound tunneling with stress and scarcity, and you get stuck. 

“Getting Unstuck” is the name of the game. 

You might want to take your team offsite for a day to talk about what isn’t working in your dental practice. What are the big problems they and you see? Talk about the common human responses of problem blindness, lack of ownership, and tunneling. Talk about upstream thinking and proclaim, “Today is the day we become unstuck.” 

In helping teams find ways to make their systems more successful, I have often found that small changes can make a big difference. If you add target metrics to your systems, “the team” will more likely see and remove barriers that have gotten in the way, redesign systems, and work as a united group to improve the outcomes.  

In the Pankey course held February 2024 — The Pankey Hygienist: Where Clinical & Behavioral Science Unite – The Pankey Institute, we focused on “the flow” of the hygiene-restorative partnership, leading patients toward higher comprehensive care, and getting clarity around the why and how of optimal behavioral and clinical methods. We took a critical look at the habits and assumptions we have developed. We applied upstream systems thinking with the goal of collaboratively achieving with our patients greater oral and systemic health.

What I Brought Back from Napa (and it wasn’t wine!) 

Robyn Reis, Dental Practice Coach 

A while back, I made a business trip to Napa Valley. I was enjoying lunch on the patio of the Ottimo Café which is attached to a shop featuring wines, gourmet provisions, and culinary tools. It was a lovely day, and I was out in the beautiful California sun by choice. A nearby covered area provided shade, and there were multiple diners inside the shop waiting for those shaded tables. 

The maître d’ had given me a choice of tables and made sure I was comfortable. The food, wine and service were excellent. 

A family of four wandered over and sat down at an empty table in the sun. One of the waiters approached them and must have told them there was a line inside because they got up and went into the building. A few minutes later, they came out escorted and sat with menus at the same table they had left. There was obviously a system in place and it was working. Not long after, the two children became unhappy sitting in the sun. 

Being a parent myself I empathized with the parents as they struggled to keep the kids entertained. The little boy put his shirt over his head to block the sun, and I watched the dad looking at the covered area to monitor those shaded tables. As people from the shaded area got up, the tables were cleared, and the maître d’ seated more people.  

There was a lag between one table being bussed and people being seated because in a flash, the family left their table and sat down at a shaded table. The maître d’ approached them again. The family was speaking a different language and the father was using hand gestures. Obviously, communication was difficult. Ultimately, the family remained seated at the shaded table. There was no doubt that “good” customer service for this family was out of balance with “good” customer service for the people inside waiting to be seated. 

It was fascinating to observe the maître d’ having a conversation with the waiter who had been serving the family. My guess is that he was saying something like, “Hey, stay alert to maintain the seating system.” The waiter only nodded. It reminded me of a dental practice where you may have a patient in the hygiene chair and think to yourself, “Oh, it’s a small filling. Let’s go ahead and take care of that today.” Unbeknownst to you, someone may have walked in the front door hoping to be seen, and the front office thinks the walk-in can be accommodated based on the schedule.  

In both situations, it’s best not to make assumptions and communicate, communicate, communicate! In the back, check with the front to see if that filling can be done now. In the front, check with the back to see if the walk-in can be accommodated now. And in the case of a scheduled patient waiting in reception, you don’t want to keep them waiting unless it is really unavoidable.  

Sometimes we’re going to disappoint someone, however, we want to plan our schedule so no one is left waiting. We’re not in the restaurant business where customers are willing to wait in line for a seat at our table. Despite a fine reputation, if you cannot see new patients within a reasonable timeframe, they are going to call elsewhere.  

Look at your own schedule and converse with your team. Do you have an adequate number of new patient appointments available? Are you allotting sufficient time for each type of procedure? How good is your back-to-front and front-to-back communication? Do you keep patients waiting? 

My meal and business trip were a success in Napa. And while I didn’t bring back any wine, I did bring back the importance of having systems in place to ensure a great experience for every patient at every visit. 

In recent years, dentists, physicians, and the public have become highly aware of the interrelationships among occlusion, oral inflammation, airway problems, and systemic health. As dentists, we’ve stretched our care domain to coordinate patient care across all settings of care. Often, we are dismayed at the growing prevalence of chronic diseases among our aging patients. We want to help improve their lives. We know of ways to do this.

To do our best for our patients, it does matter if the patient has diabetes, cardiovascular disease, sleep apnea, gastric reflux, or poor nutrition. It does matter if we want to be master problem solvers in collaboration with our medical colleagues. Looking for oral and systemic health interrelationships every day with every patient is a basic element of many dental practices. Collaboration with physicians is a basic element of my practice.

Has your approach to patient care extended into at least the first phase of integrative dental medicine? This is the phase of sincerely asking the Why questions and searching for solutions. While I was in practice with Dr. Pete Dawson, for 40 years, I heard him say, “We’re going to ask why about problems until we don’t have to ask why anymore.” He called this “finding a better way.”

The 3 Pillars of Integrative Dental Medicine

In 2019, Dr. Shanley Lestini and I published a book titled The Shift: The Dramatic Movement Toward Health Centered Dentistry. In this endeavor, we were fortunate to have the support and input of two of the world’s most preeminent clinicians and educators, Dr. Peter E. Dawson and Dr. Bradly Bale. It was our goal to influence dentists and medical physicians toward fostering solutions together for their mutual patients in three pillar areas of integrative dental medicine:

1. TMD and Occlusion
2. Inflammation & Infection
3. Breathing and Sleep Disorders

Finding a Better Way Is Up to All of Us

My goal in this essay is to fuel your passion for operationalizing what we all know will make us better doctors – that which will enable us to be truly health-centered dentists. It comes down to relentless curiosity about the causes of diseases, the modalities for eliminating those causes, and how our best “individualized” efforts with a patient will have the greatest positive impact on the prevention, elimination, and management of health conditions that adversely affect their quality of life.

“We’re going to ask why about problems until we don’t have to ask why anymore.” – Peter E. Dawson, DDS

In this era of heightened awareness surrounding the intricate connections between oral health, overall wellness, and the growing prevalence of chronic diseases, we, as healthcare providers, find ourselves at a crossroads. It is our commitment to improve the lives of our patients that propels us forward. Embracing the principles of Integrative Dental Medicine (IDM) beckons us to explore the “Why” questions and seek innovative solutions. Don’t miss your chance to embark on a journey that redefines the boundaries of healthcare with the upcoming course “Integrative Dental Medicine: Creating Healthier Patients & Practices” – for more information visit the course page.