Their Ideal Day 

September 22, 2023 Christine Shigaki

I’m sure there are many aspects of your work that are really fulfilling, and I’m sure there are aspects of your daily work that you wish could be easier, maybe even less stressful. What about your work brings you joy? What would it take for you to provide your best work? What would it look like? What would it feel like?

I took an informal survey of dentists and hygienists about what they would need to have an ideal day. When I examined the dentists’ answers, I realized the answers would resonate with every member of a dental team.

The top five answers from dentists were:

  1. Having the appropriate instruments to provide excellent care.
  2. Opportunity to gain knowledge and skills.
  3. Excellent performance/execution of their work.
  4. Opportunity to implement new learning.
  5. Working with patients who are grateful for their care.

All hygienists desired “time to provide appropriate care for each patient.” Specifically, they asked for:

  1. Time to select and sharpen instruments for each person and for the specific procedures they will be doing.
  2. Time to properly assess each person’s unique periodontal condition, including time to accurately measure gum pockets and recession, minimal attachment/thickness, and to assess bleeding (blood thickness, how much bleeding, and where it is coming from—is it systemic or localized?).
  3. Time to explore possibilities with patients regarding their current condition, past condition, and potential future.
  4. Time to debrief and collaborate with the doctor to explore the next steps for the patient.
  5. Supportive teamwork across the practice to provide the best care.

Speaking of collaborating with team members, I invite you to ask your team members what their ideal day would include. Discuss, as a team, your shared ideals, and expectations. Consider where expectations do not match and discuss why this is and what must change to meet shared agreements.

Understanding and affirming the needs of others will have a positive impact. The exercise of writing down what works, what could be better, possibilities, goals, and a pathway towards implementation of superior supportive teamwork is likely to increase your practice joy factor.

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Christine Shigaki

Dr. Shigaki has been in dentistry since 1989 where she started as a dental assistant while completing her undergraduate studies at the University of Washington. In 1994, she graduated with honors from University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA. Dr. Shigaki, a native of Seattle, has built her practice since 1995 and opened Belltown Dental in 2003. She is a life-long student of dentistry and believes that it is her professional responsibility to provide optimal, comprehensive care in a modern facility with state of the art equipment and techniques. She has completed and continues her studies with extensive post graduate dental education, including several dental study clubs and coursework at the distinguished Pankey Institute, where she is also currently an advisor and faculty member. Christine also facilitates teams and mentors dentists. She enjoys the work/life balance that dentistry allows her and hopes that others can find their joy in dentistry. When not at the office, teaching/studying dentistry, she enjoys spending time with her husband, two children, and extensive extended family. She enjoys being involved in her children’s activities, yoga, reading, various outdoor activities and cooking.

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Better Blood Pressure Readings Using BP Cuffs 

July 24, 2023 Lee Ann Brady DMD

In our office, we routinely take our patients’ blood pressure, and we have a variety of cuffs. Most commonly, both hygienists use one of the convenient, digital wrist cuffs. A few months back, they noticed a trend of higher BP readings than they thought were appropriate. We wondered if the wrist cuffs were giving us accurate readings. We did a little research and I decided to reach out to my own primary care physician to ask her advice.

I learned two important things about taking blood pressure:

  1. My physician recommended that we give our patients three to five minutes sitting up in the dental chair, relaxed, and not moving. While pleasant chitchat to reduce anxiety might help, we were advised to steer away from asking any medical history questions and other questions that might produce a bit of anxiety before taking the patient’s blood pressure.
  2. One of the challenges with wrist cuffs is that the cuff is supposed to be at the level of the heart. In a dental chair, the patient is likely to rest their arm on their leg unless we instruct them to do otherwise. She advised that we have the patient take the arm that is wearing the cuff and place it across their chest to hold it at the level of their heart. To be at heart level, the hand shouldn’t come up to the shoulder but be horizontal with the elbow.

My physician asked me if we have arm cuffs that go above the elbow. I told her that we have two digital arm cuffs. She said she prefers using the arm cuffs herself because they tend to be more accurate than a wrist cuff, especially in picking up subtle variations.

This great information has enabled us to take blood pressure readings with more confidence and would be valuable to share with your team members who measure blood pressure. 


In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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I’ve Learned a Lot About Face Shields

June 17, 2020 Lee Ann Brady DMD

Most dentists have some stories about buying and trying different types of face shields as we have started to practice again. The challenges of fit, being comfortable and working with loupes are common conversations. I have tried six types to date with more on the way.

I started with “What can we get?” Then I moved on to “What will be the most comfortable and best on our loupes?”

I and my two hygienists wear loupes. I wear a 4.0x power, flip-up loupe. The hygienists wear 1.5x power loupes. In addition to the loupes, we wear a light.

We’ve tried face shields that hang from a visor. This is the kind my assistants love and wear all the time. However, this type of shield does not fit over my loupe. It fits over my hygienists’ loupes but by the end of the day, they have a headache from the pressure of the temple pieces on the visor.

We tried the disposable face shields that hang from a headband with foam padding. They did not fit over loupes.

A third type from Bio-Mask® turned out to be my hygienists’ favorite and the one I wear when I am doing a consult and not wearing my loupe. This type of visor frame has replaceable face shields. It is lightweight and comfortable (due to its weight, adjustable head strap, and foam padding), and it is designed to be worn with loupes. The replaceable shields can be washed with hot soapy water. The shields are designed to protect from splatter and spray that might come over the top of the visor, so you have full-face protection. I can wear it over my loupe by enlarging the headband and resting the front of the visor frame on my light.

Just recently I came across a different face shield designed to wear over dental loupes that I really like. It’s the PRO-TEX® extra-wide 13″x 7″ shield (model FSX). It clips directly onto the frame of my loupe. I wear eyeglasses, a face mask, my loupe with a light, and then clip the face shield to my loupe frame. This is the least pressure on my ears and temples that I have discovered. The shield can be washed between patients with warm soapy water.

I know a lot of people are praising loupe face shields from Ultra Light Optics®. I am looking forward to trying these when they come in because they are designed so you can mount your light outside the shield and not have to reach under the mask to flip down your light.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Bringing Your Efficiency

January 9, 2020 Drs. Christina & Bill Blatchford

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 patientsWhen 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 themAlong 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 thdoctor 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 treatmentAsk, “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 assistantsUse 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 $3kdon’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.  

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Drs. Christina & Bill Blatchford

Dr. Christina Blatchford is a graduate of Oregon Health Sciences University, School of Dentistry and has her doctorate degree in medical dentistry. She practices family and general dentistry in Milwaukee, OR. With her father, Dr. Bill Blatchford, she is Co-CEO of Blatchford Solutions, coaching a maximum of 50 dentists each year to reach their goals. Bill has written two books: Playing You ‘A’ Game – Inspirational Coaching to Profitability and Blatchford Blueprints: The Art of Creating Dental Practice Success. He also writes a monthly column for Dental Economics, “Flourishing in Changing Times.” You may call 888-977-4600 to receive a free copy of their latest book, Seven Principles of Highly Profitable Dentists.

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