When my daughter Kaitlyn (currently in through E2 at Pankey) finished dental school in 2020, I strongly recommended that she learn analog first, then once mastered, make the transition to digital. This lasted about four months. I learned rapidly that this generation sees things in the digital realm far better than we do. She reminded me that “she grew up with a screen in her hand.” 

We began to focus on her learning the concepts of occlusion, esthetics, biology, tooth-by-tooth structural integrity, and visualizing and planning in the virtual (digital world). We quickly learned that, although she could easily visualize things on the computer, the patient is ultimately analog. We began to utilize an analog articulator for her to learn the hand skills of what we would do on the patient. 

A great example of this is equilibration. A “trial equilibration” on a virtual articulator is a 5-minute process that lets us determine if equilibration is an appropriate treatment option. The problem is that, unlike analog, you do not learn the brush strokes that will be required to perform this skill in the mouth. I have performed hundreds if not thousands of equilibrations. I know the brush strokes. For me, once I see on the virtual articulator that I can do the equilibration without too much tooth structure removal, I am ready to go to the mouth. For Kaitlyn, who has very limited equilibration experience, once visualized on the virtual articulator, then it’s time to go back to analog. She mounts the printed models on an analog articulator to perform a traditional trial equilibration. In this way, she learns the brushstrokes of this incredibly important procedure. 

I think it is extremely important that dentists, who are learning to equilibrate intraorally, work on mounted analog models to develop their equilibration skills. 

Returning to the consideration of the financial cost of bringing new technology into your practice—input devices (scanners and CBCTs), output devices (printers and mills), and software to manipulate the data all cost money. Doctors that are going down this road usually like technology and consider the dramatic increases in efficiency to ultimately increase the productivity and profitability of the practice. This is certainly something I have seen. The bottom line is dental stone will go away. We all must make the decision when it is appropriate to make the jump. 

Dr. Lee Ann Brady has invited me to audit all the Pankey Essentials courses over the next year. I am super excited about this. She has asked me to recommend ways to appropriately implement examples of digital technologies and workflows into these core classes. While younger dentists are drawn to digital information, it is important for us to remind them that our patients are ANALOG. We are training dentists to perform complex procedures on patients, not on computers. This requires great study and a commitment to understand timeless concepts, while simultaneously developing the hand skills to accomplish these procedures accurately and use digital workflows to make things more efficient. 

In 2024, The Pankey Institute is also implementing a digital hands-on course for those doctors who would like to make the transition over to virtual articulation and digital workflows—something that I am excited to be part of. Dentistry is in a great transition. I look forward to making sure the concepts that we have all built our practices around do not get lost in the digital world. 

After practicing dental hygiene for more than twenty years, I went to work in the office of Dr. Doug Roth who was attending courses at The Pankey Institute. He had a copy of Dr. Bob Barkley’s book, Successful Preventive Dental Practices. Reading that book was a revelation for me. Although I never knew Bob Barkley, his work so resonated for me that I had the feeling he had read my thoughts about working with patients.

I had believed for some time that more was possible in dentistry. I had worked with good dentists and felt as though I took good care of my patients in the time I was allowed to spend with them. We were kind, thorough in our exams, and conscientious in treatment recommendations. Sometimes they took our recommendations, and sometimes they did not. I did not think there was much we could do to change that.

As a result of Bob Barkley’s book and the courses Doug was taking at the Pankey Institute, we incorporated a new model for bringing new patients into the office. Instead of moving patients quickly through an exam and treatment recommendations, we invested time and attention to get to know patients in a different way before we recommended significant treatment. I had no idea of the depth of connection we could have with patients, and the impact we could have on their health and well-being!

We spent “engaged” time with patients over a variety of appointments. We came to understand that the clinical tasks we had to accomplish were a small part of caring for patients. We began to see every interaction, with every patient, as an opportunity to get to know them and what was important to them to help them make healthy choices.

Over time we discovered with our patients:

• The status of the dental health
• The challenges of their current conditions
• The implications of these conditions if nothing was done to intervene
• Interventions they and we could do to change the trajectory of disease.
• A possible preferred future of choice
• Considerations involved in various treatment choices.

When we met patients where they were instead of where we thought they “should be” we found that some were ready sooner than others. We stopped giving patients solutions to problems they did not yet own. We came to understand that if we gave patients the time and attention they needed to own their existing conditions they were more curious about what Dr. Barkley called their “Probable Future” and more likely to pursue a “Possible Future.”

Without this spirit of collaboration and intentional patient development, we cannot do our best work.

Our influence develops throughout a process in which the patient is learning, in touch with their body, and engaged in thinking about the implications of the various aspects of their oral health. Because the conditions we discover today and our patient’s choices will impact their future health, we have a moral obligation to share what our experience tells us is likely to happen (the probable future) if they do nothing or if they choose a stop-gap treatment.

It is also our responsibility to help them see a preferred future that is possible for them when they are ready.

By engaging them in the exam process, creating opportunities for them to experience learning about their health, and welcoming them into collaboration, we enable them to partner with us in shaping their future. We must help them understand the implications of any choice they might make including its limitations, so they are fully informed to make true choices.

We have been trained to be efficient, and most dental clinicians have pride in their efficiency. But by prioritizing being “effective” over being efficient we make better use of our time and theirs. We experience an increase in trust, in our patient’s confidence in their decisions, and a more comprehensive view of treatment. Patients begin to see dentistry as a vehicle to create optimal health, function, and esthetics. Patients are more likely to keep their appointments, follow through on suggestions, and pay for our care with gratitude.

When we invest time in the early stages of our relationships, everything down the road flows more easily.

Being efficient with your time increases profitability. 

Life is busy and everyone is trying to find a better balance between work and time off. If you could produce the same amount of dentistry in three days as you did in four, how would your team react?

Efficiency is a mindset and can become part of your practice culture. Producing more in less time does not mean running around like chickens or being hasty with patients. We can learn the art of using time better for our patients. Focusing on the conversation rather then multi-tasking is one example. Being prepared is the Boy Scout motto and fits perfectly here. Most patients would prefer fewer visits to your office.

Being prepared for any possibility allows your team to feel confident.

Having enough tray set-ups for any opportunity that presents itself is a start towards efficiency. Having a team completely cross-trained allows the team members to shine by being prepared and results in greater efficiency.

More time is created when the practice culture is to offer a complete exam on patients. When there is a comprehensive plan, this moves a practice beyond patching and emergency care. There is a reason why patients come to you, and most want to know you have a plan for them. Along with this, at the end of every appointment, team members need to ask the doctor, “Is there anything else we can do at the next appointment?” It is a signal to the doctor to maximize every appointment. 

Combining treatments can be a measure of efficiency.

Always combine crown prep and endo, or any other treatment. If there are fillings and a crown, do the fillings first as you will complete the crown prep in the allotted time. This works well with CAD/CAM as there is downtime available during milling and baking time.

In Hygiene, collect the fee at the time of service. “Yikes,” say the hygienists, “We’ve never done that before.” Patients love it, and once the hygienists do it, they like the connection, too. This eliminates the line at the front desk and allows more concentration on phone conversations.

Follow Nordstrom and Apple examples. Clinically, encourage hygienists to do full mouth debridement at one appointment.  It saves the patient time, and the result is a healthier mouth.

Become completely paperless.

Operating two systems is a waste of time.  New patient forms are on your websites, and all patient records are digital. To be paperless, just start one day at a time, and don’t waste time putting people in digital who have not been in yet.

Efficiency starts over the phone by asking questions to eliminate the 30-minute “look-see” emergency appointment. With the patient records on your computer, ask, “Is this broken tooth one the doctor had already recommended for a crown?” From the records, ask if there are any other previously diagnosed teeth in the same quadrant needing treatment. Ask, “Would you like to have all three of these taken care of at the same time? I can make arrangements for that.”

The team is accountable for an efficient schedule.

Phone training is a big part of making days efficient and profitable. You can save a lot of time for the doctor and patient, practicing phone scripts for different scenarios that occur in your office on a regular basis.

Timing your procedures is a great way to evaluate your efficiency. We can learn great lessons from efficient assistants. We call this “Ruth’s Rule” as a tribute to one of those fine assistants: Use one bur or instrument, do what you need to do, and then move on. That bur does not appear again for that patient.

Efficient scheduling in blocks has a profound effect on efficiency and profit. 

For example, booking alike procedures at the same time eliminates the team having to shift gears both mentally and physically. Blocks of two hours with a production goal forces the team to focus on better scheduling.

For example, if your goal for each two-hour block is $3k, don’t schedule “look-see” appointments during this time. When you produce $6k in the morning, you are on track to efficiency and more time away from the office to rejuvenate.

Drs. Blatchford are America’s leading dental business coaches. Their book, Bringing Your ‘A’ Game 2.0 is now available at Blatchford.com (888) 977-4600. Blatchford Coaching results in less patient contact days, greater net, more focus on what is important to you.