Explaining Dentistry in a Way Patients Understand 

Clayton Davis, DMD 

Here are some of the ways I communicate with patients to help them understand dentistry. I hope some of these will be helpful to you in enabling your patients to make good decisions about their treatment.  

Occlusal Disease: In helping patients understand occlusal disease and the destruction it can cause, I have long said to them, “The human masticatory system is designed to chew things up. When it is out of alignment, it will chew itself up.” I tell them, “Your teeth are aging at an accelerated rate. We need to see if we can find a way to slow down the aging process of your teeth.” The idea of slowing down aging is very attractive to patients, and if you relate it to their teeth, they get it.  

Occlusal Equilibration: Typically, I come at this from the standpoint of helping them understand that teeth are sensors for the muscles, and when the brain becomes aware our back teeth are rubbing against each other, it sends the same response to the muscles as when there’s food between our teeth. In other words, the brain tells the muscles it’s time to chew, and this accelerates wear rates on the teeth. Equilibration is really a conservative treatment to reduce force and destruction of the teeth.  

Diseases of the Jaw Joints: Regarding jaw joints and adaptive changes and breakdown, patients understand that joints have cartilage associated with them. Saying there has been cartilage damage in your jaw joint gets the message across simply. 

Treatment Presentation: When patients say, “I know you want to do a crown on that tooth,” I jokingly say, “Oh, don’t do it for me. Do it for yourself.” I never say, “You need to get this work done.” Instead, I say, “I think you are going to want to have this work done.” 

Conservative Treatment: I have always enjoyed John Kois’s saying that no dentistry is better than no dentistry, so when talking about conservative dentistry, I’ll tell patients, “No dentistry is better than no dentistry. We certainly don’t intend to do any dentistry that doesn’t need to be done.” Another way I speak about conservative dentistry is to say, “Conservative dentistry is dentistry that minimizes treatment. In the case of a cracked tooth, a crown is actually more conservative than a filling because it minimizes risk.” 

Moving Forward with Treatment: I love Mary Osborne’s leading question for patients after they’ve been shown their issues and treatment possibilities have been discussed. The question is “Where would you like to go from here?” With amazing regularity, the patients choose a really good starting point for their next steps toward improved health, steps that feel right to them. Always remember, people tend to support that which they help create. 

Dental Insurance: I typically speak of dental insurance as a coupon that can be applied to their dental bills. I’ll say, “Every plan sets limits on how much it pays. The way dental insurance works, it’s as if your employer has provided a coupon to go toward your dental bills.” 

Presenting Optimal Care: If I want to present optimal care to a patient who is ready to hear it, I ask permission by saying, “Mrs. Jones, if I were the patient and a doctor did not tell me what optimal treatment would be for my problems because the doctor was concerned that I couldn’t afford it or that I would not want it, I would think, ‘How dare you make that judgment for me. You tell me what optimal care would be, and I’ll decide for myself if I want it.’ So, with that in mind, Mrs. Jones, would it be okay with you if I presented you with the optimal solutions for your problems?” 

Mastery sits atop L. D. Pankey’s Ladder of Competency. The question is how does one achieve mastery? Once again it has been reduced to “Just Do It.” But there is more science.

In his 1953 paper, The Achievement Motive, Harvard psychologist David McClelland wrote an original thesis about mastery. Psychologists Deci and Ryan (authors of Self-Determination and Intrinsic Motivation in Human Behavior) acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it is now known as mastery.

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve, and to make progress. It is the royal road to growth and flourishing and the opposite of languishing and drudgery (the low rung on Pankey’s Ladder of Competency).

The Process/Progress of Mastery Is Pleasurable

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Dan Pink, author of the popular book Drive, the single biggest motivator by far, is making progress in meaningful work.

At my lowest point in dentistry, I felt stuck…hopeless. My work had lost its meaning. Today we call that burnout. Remember those Thursday mornings I mentioned in Part 1 of How to Move Toward Independence in Dentistry? Those Thursday mornings turned on the light of hope.

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy, it is difficult to sustain the drive necessary to achieve mastery. This is based on our biology, not just some story, fairy tale, or business myth.

So, after scheduling Thursday mornings to practice autonomously, applying the Pankey Institute lessons I needed to learn and make second nature, I slowly put the complex elements of comprehensive, relationship-based dentistry together. I started with the comprehensive examination and built on that by learning all the components from mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice.

Behavioral Skills and Technical Skills Are Both Important

In time I came to realize that learning the softer behavioral skills were just as important as the technical, so I learned about case presentation. Through the years I learned new skills like digital photography and PowerPoint. This is the essence of mastery. I am retired now. Looking back, I see how that the moment Dr. Becker suggested implementing the “Pankey Morning” changed my life.

There Is a Way to Enjoy Dentistry

Today things are different than when I was a young. There is pressure to go right into corporate dentistry or practice in a way that is built on extrinsic motivators. Many of the newer models of practice are an assault on autonomy, and many dentists don’t realize the root of their unhappiness for years.

My new book, The Porch, is a fable about a dentist who is losing his autonomy and breaks down. By finding a mentor and keeping his eyes on the ultimate prize, he goes from despair to hope. The book provides lessons the young dentist learns along a path of mastery, with the leadership and support of other colleagues.

Pankey Institute instructors, mentors, and colleagues inspired and encouraged my personal path. As I recall, many of them started on their personal fee-for-service journey, like I did, with focus on changing and mastering a new approach to patient examination, education, and leadership — one new patient at a time, one morning per week.

Our constantly growing Pankey Institute community has stayed “on the porch” of conversation, like the Stoic philosophers under the stoa, to grow in shared wisdom over 50 years. This wisdom is never outdated, even as dentistry has changed. There is a way to enjoy dentistry. My mission is to keep writing and awakening hope.

Happiness for me in dentistry was always doing my best for patients who appreciated and wanted the best dentistry. When third parties began to heavily impact the care patients wanted and my ability to do my best, my happiness disappeared, and burnout set it.

Independence to me meant removing myself and leading my patients away from insurance dependence. The Pankey Institute showed me the way to do this, and I was able to start restoring my happiness one patient at a time, until I was finally once again “fee for service.” Whether you can do this in part or in whole, you will achieve more dentistry and have a greater impact on more lives.

I first attended The Pankey Institute in the late eighties. I was at the lowest point of my career. Admittedly times were a bit easier for a young dentist back then, but in many fundamental ways they were the same. On the first morning at the Institute, I remember feeling overwhelmed. I was focused on the herculean task of creating the practice of my dreams. Every moment of that first week tested my competence and potential to succeed. I kept comparing myself with other students as I paid attention and diligently took notes.

Later in the week, Dr. Irwin Becker was discussing how to schedule patients so we would have time to practice what we were learning. I returned home and secured every Thursday morning for practicing “the Pankey way” which included a lot of new techniques for me and my staff. Dr. Becker was more correct than he even knew when he recommended that we “just do it.”

The Science of Motivation

About the same time, during the eighties, two psychologists, Edward Deci and Richard Ryan from the University of Rochester were beginning to formulate their now groundbreaking Self Determination Theory of Human Motivation. Their advice also came down to “Just Do It.” Years later, while studying positive psychology, I was gratified that I took Dr. Becker’s advice; otherwise I may not have had an accomplished and fulfilling career.

Deci and Ryan defined motivation as the “energy required for action.” How many times do we attempt to accomplish a worthy goal but run out of steam? We need drive. Installing a fee-for-service practice is difficult…if we dare to do it. It requires resources like drive and energy.

Deci and Ryan noted extrinsic drives are the material rewards we are all familiar with, as well as status and recognition. The intrinsic drives are passion, curiosity, and purpose. They found intrinsic motivation is more effective in every tested situation, except when basic needs haven’t been met (think Maslow’s Hierarchy of Needs). They also found that autonomous work overrides controlled work because autonomy is aligned with our intrinsic drives.

Autonomy as an Intrinsic Driver Works

When we are the masters of our own destiny, we are also more focused, productive, optimistic, resilient, creative, and healthy. In retrospect, this is what I found on those Thursday mornings. When I was focused on doing a comprehensive, relationship-based new patient exam, to the best of my ability and focused on leading the special person before me to greater understanding and health without thoughts about personal gain… putting another first and giving them the gift of my time… I felt most alive and well myself.

I started with the comprehensive examination and built on that by learning all the components from the mundane mounting of models to the nuances of advanced occlusion. For those of you starting to implement a fee-for-service practice model, success can be measured one morning a week and one patient at a time. Your intrinsic motivation will carry you forward to expand your “Pankey style” approach to a greater and greater percentage of your patients.

Beyond Scheduling One Special Morning…Return to “The Porch”

My latest book, The Porch: A Dental Fable, tells the story of a young dentist who is led in mentoring relationship — by a retired dentist and an expanding group of encouraging colleagues who meet regularly on a porch. He discovers and practices a new philosophical and behavioral approach to practice that transforms his life. I’ll keep blogging on this theme, but between blogs, you might want to pick up the book and discover the richness of a life in dentistry based on intrinsic drive. If you have sampled The Pankey Institute offerings and been inspired, then stay on “the porch” of its philosophical approach, courses, study clubs, and collegial gatherings. Continuously sharing and supporting one another is what put me on the never-ending, meaningful, highly satisfying Road of Mastery…and never again to experience burnout.

When I speak with dentists who have dipped their toe in the waters of treating obstructive sleep apnea (OSA) in their practice, the number one reason they say they quit doing it or are not doing more is …

“I couldn’t get paid!”

You may be committed to helping patients achieve better health through treatment of OSA, but it’s challenging to make it financially possible. Here are three tips that will make dental billing for obstructive sleep apnea more consistent and predictable:

Use Practice Management Software to Simplify Dental Insurance

Understanding how to succeed in the complicated system of medical billing is a game-changer.

We have all figured out how to streamline our approach to making sense of dental insurance, but the rules are different for Dental Sleep Medicine (DSM). You should use a segment-specific software platform (DS3, NiermanDentalWriter, or other) for your SOAP notes and communication with physicians and payers.

These platforms ensure that you include the right notes, tests, patient status, and history to get paid. DSM and medical reimbursement are under the jurisdiction of rigid documentation of processes, protocols, and standard practices. Choosing the most effective DSM practice management software is the first step to payment because it will not let you forget to harness critical information.

Make It Easy for Patients to Say Yes to Treatment

My second piece of advice is the most difficult to implement because it requires a change in behavior. Talk less about co-payments, deductibles, and the patient’s responsibility than you may be used to in dentistry when dealing with obstructive sleep apnea.

As an example, consider this: When you visit your doctor and they suggest an x-ray, draw blood, or order a specific test, do you usually say, “How much will that cost?” No, you don’t. We know that tests and medical treatment recommended by our physician are necessary and not usually optional to achieve optimal health.

Plus, we know that their treatments will be covered by our medical insurance (after the deductible and with certain co-payments). As dentists, we are expected to have significant upfront financial discussions about how much the patient will have to pay out of pocket because of the different nature of dental insurance.

Unfortunately, this same approach when applied to a sleep apnea appointment may backfire. Treatment of sleep disorders can be life-changing, so it’s beneficial to the patient if you focus less on dollars and more on care outcomes.

When we get detailed about the financial arrangement, upfront copayments, and deductible discussion, patients think we are still treating them as a dentist, not as a medical care provider. Make it easy for patients to say yes by leaving out the money talk. Many will have good coverage and can make the treatment a possibility.

Outsource the Details to a Competent Billing Company

Hire a billing company to do the dirty work. Third-party billing companies (Four Pillar, Nierman, Pristine, Dedicated Sleep, GoGo, Brady) typically charge a small per claim fee around $50 and 8-12% of the paid amount. This fee is worth every penny.

I have seen far too many revolutions from the administrative teams in dental practices when they were forced to try to figure out the weird, ever-changing rules of insurance reimbursement.

Billing companies are experts. Plus, the cost as a percentage of sales works for medical practices, so why shouldn’t it for dentistry?

Treating patients for OSA with Oral Appliance Therapy (OAT) is easier clinically and technically than making bite splints in centric relation. And yet the minefield is littered with the remains of dental teams who tried to do the billing themselves.

If you only did one case per month, subscribed to a cloud software solution, paid a billing company their fair share, and risked not talking so much about money, you would still help patients get healthier, feel very fulfilled, and make more money than you are now.

That success can breed more success. You just might add $100,000 to your annual revenue! Curious how you can start incorporating treatment of sleep apnea into your practice workflow?

I’ll be holding a live, three-hour virtual course, “Treating Sleep Apnea In Your Practice With Oral Appliance Therapy,” on Friday, May 21st, 2021. Registration for my course is easy at Pankey Online.

Join me from 2 pm to 5 pm EST to learn more about the medical background of sleep conditions, marketing sleep appliance therapy, and more in-depth techniques I implement to transform medical billing.

Can’t wait to see you there!

Sign up for free at Pankey Online to access complementary and paid CE-granting webinars spanning hot dental topics like sleep apnea treatment, equilibration, and indirect bonded anterior restorations. 50+ cutting-edge courses at your fingertips …

Theresa Duncan from Odyssey Management has been one of the top 25 women in Dentistry, and for over 20 years, she has advised dental offices on how to correctly use insurance to their advantage and how to carry out a conversation about insurance.

Why? Because one of the biggest barriers to patient conversion is fear about how much it is going to cost.

Her book, ‘Moving Patients To YES!‘, doesn’t help only insurance dependent dental offices. It also helps insurance independent or blended practices have easier conversations about nonparticipation and out-of-network services.

The latest trends she is reporting will set you on the edge of your seat, because just when you thought it couldn’t get any worse, it has. And, this brings us back to the consideration that nonparticipation or getting off of plans might be best for you.

In a recent conversation, Duncan reported there are big changes being made in plan designs and how patients are getting their information. The plans are so difficult to understand that the front office of the dental practice is put in the spot of having to translate them. Patients get their plans and don’t understand what they mean. The plans are confusing even to professional insurance coordinators.

Patients are paying more for their benefits, so they are expecting to get more, which is unfortunate because dentists can’t deliver more. Duncan is seeing a lot more deductibles. The upshot is that more employees are opting out of dental benefits.

Dental practices, especially solo practices, now have less power to negotiate with insurance plans.

In the last twenty years, dentists have gone from “laughing at plans to getting on plans,” even rushing to get on them. And then, reimbursement got pushed down. The average dentist (according to the last ADA numbers) will participate in 8 to 10 plans, but Duncan sees the trend is now swinging back towards being selective and getting off of plans. Many dental offices are happy being in 3 to 4 plans. They don’t want to deal with plans that are costing them too much in revenue and time.

If you drop plans (or have never participated in plans), it doesn’t mean you lose patients, says Duncan. It means your team needs to be highly skilled at having conversations with patients when the topic of insurance arises.