Caring for a Dental Leaf Gauge 

Lee Ann Brady, DMD 

In the Pankey Essentials courses, we use dental leaf gauges to train dentists in how to feel for the first point of occlusal contact, as a method for occlusal deprogramming, and as a tool for articulating models on an articulator in centric relation. Dental leaf gauges not only assist us in diagnosis and treatment planning but also in enabling our patients to discover the nature of their occlusion as we help them understand how malocclusion can manifest in TMD symptoms, parafunction, tooth damage, and more. 

In our Essentials 1 course, I am sometimes asked how to take care of leaf gauges, so I thought I would share my answer.  

Although they don’t last forever, dental leaf gauges do last a long time and you can autoclave them between uses. When you sterilize them, the leaves become sticky, so I separate them like a hand of cards before putting the gauge in the autoclave bag and separate them again when I take them out of the bag just before going to the mouth. 

Over time, with use, a leaf gauge will start to look a little beat up. I’m looking at one now. The Teflon screw that holds it together has turned color from going through the autoclave. I can see some ink stains from Madame Butterfly silk. It’s at the point where I think it looks too grungy to keep using. Although it might continue functioning for quite some time, I’m going to toss it and use a new one. After all, they are relatively low cost with a high return on investment.  

I’ve never seen a dental leaf gauge break after many trips through the autoclave. I tested cold sterilizing one and discovered the chemistry in the ultrasonic cleaner started to make the leaves brittle and they came out stickier than when autoclaved. So, my preference (and the protocol in my practice) is to bag them and put them through the autoclave. 

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. 

I wrote this article 20 years ago for The PankeyGram, and it is still relevant today.  

As I walked into the room, the nurse was applying medication to a hand wound my grandmother had received from a fall a week earlier. My eight-year-old son, Tim, and I had traveled a thousand miles to say goodbye to my grandmother. At 89 years of age, her body was finally ready to give in to breast cancer, and her mind had fallen victim to Alzheimer’s disease over previous several years. 

I knew she would hardly know who I was, and if she did remember, the memory would be gone moments after I left. However, my father was an only child, and it was important to help him through these difficult times. My son also needed to learn about his roots. 

It was sad to see her unable to hold herself up in a chair, and she seemed so frail and weak. I said hello to her, and she opened her eyes enough to gaze at me. Her air-filled voice repeated, “I’m so tired. I’m so tired.” I held her hand and comforted her the best I knew how. I showed Tim to her, and she struggled out a sincere smile towards him. I told her stories about my family, my job, my tree we planted in honor of my grandfather, and how full and complete our lives were. It was as if I was trying to justify her life through the one, I was able to live now. 

We had brought some cinnamon cookies with us, and I offered one to her. Her dry frail hand reached for a cookie. She slowly nibbled on it.  

As you spend time with someone who is close to death and appears to have lost everything, one naturally thinks about how unimportant much of one’s life can be. I thought about the worldly parts of my life: the cars, the boat, my home, or ability to travel. I thought about the simple function of life: walking, running, feeding ourselves, dressing ourselves…. We have so much when we are healthy. Being a dentist, I reflected on how trivial teeth seem at a moment such as this. I pondered these thoughts as the first cookie disappeared, then another. 

My grandmother’s exhausted manner seemed to temporarily dissipate. She had found pleasure in nibbling the cookies. With her eyes closed and body relaxed, my attention focused on a collage of colorful photographs hanging next to her bed. Looking down at me was a picture of my grandfather, almost as if he approved that I had come. 

My grandfather was a righteous man who always felt it was important to do things the correct way. His home was not large, but it was perfect. Every part of it was neat, crisp, and clean. The saying “everything has a place and every place has a thing” describes how well he took care of his belongings. In the same manner, his and my grandmother’s health had been important to them, including their teeth. They both had most, if not all their teeth until the end. Even at the time of my grandfather’s death at the age of 84, he was scheduled to have some major dental work completed. My grandfather had been comprehensive about caring for his health and life. 

My grandmother was now working on a fifth cookie. I watched as she gently grasped it, lifted it to her mouth, bit and sighed with pleasure at its wonderful taste. Suddenly, I realized that because she had her own teeth at age 89, she was able to find some pleasure in what most would consider horrible existence. She could still eat and experience the pleasure of taste! What had seemed small in the scheme of things a moment ago had renewed importance. 

Many patients judge the competence of a dentist based on whether they are free of pain. However, a dentist’s true competence is measured by whether patients still have the ability to eat at the end of their lives. This can only be achieved with a comprehensive long-term approach to dentistry and helping people understand the importance of this type of care.  

No matter what you do in this world, you need to treat people in a personalized, comprehensive fashion. Now I look at every patient with the hope that when they have lost everything else, including their mind and most body functions, they might enjoy the ability to eat and the sense of taste. 

As her hand reached out, her fragile voice whispered to me, “May I please have another cookie?”