If you are a GP dentist or a Pediatric Dentist you take on the responsibility for your patients, of functioning as the “gate-keeper” or “dental home.”
You provide comprehensive and often extensive evaluations of your patients’ needs, and from there, along with the appropriate records, create a treatment plan addressing the various and varied needs of that patient. Those needs may cross into every area of dental care, and as well, cross into medical areas, where you request information and clearance from medical providers. And/or, you may refer TO medical providers, having found medical issues in your evaluation that should be addressed by a medical specialist.
In summary, you
A little side note - it is critical that you help the patient understand their findings and pathology, whether TMJD or decay. This is because if they do NOT understand it is their problem, it is all too easy for the patient to expect the dentist to "just fix it.”
There is NO “just fix it.”
There is only a team effort between medical provider AND patient where the provider evaluates, informs, guides, counsels, refers and treats the AREAS OF THAT PROVIDER’S EXPERTISE AND COMPETENCE; the PATIENT attends appointments, consents to evaluation, listens to the information, takes the time and energy and spends the money necessary to follow-up on referrals and treatments.
Do you see? It is not the provider who is responsible for ascertaining the completion of treatment in the face of all odds. (Read recent blog, “Way Too.”) It is not the provider who is responsible for providing the treatment if the patient is not compliant in attendance, following the guidance and instructions of the provider, including self-care, referral attendance, and so forth.
Which brings us to the fact that you as a generalist, gatekeeper, dental home, have the opportunity to study and learn any one or more of many topics, many dental specialty areas. Any and all treatment you provide in any area of dentistry, by law, must be at the level of what is expected of a specialist in that area. That goes for and includes, endodontics, surgery, prosthodontics, implants, orthodontics, periodontics, and pediatric dentistry.
And to have a full life, a resoundingly successful life and practice, and provide truly great care to your patients, you must choose and adapt to providing the areas of care in which you are interested, have fun, can be great, and continue learning and growing. In other words, keep growing and working in your areas of expertise. You will spend much less money on equipment, supplies, staff training, and learning curve time. If you instead, invest in equipment, staff training and learning curve time for you area of “specialization”, rather than all areas, it will cost you much less and you will be much more profitable.
Choose - Make it profitable. Your dental practice is your living. It is your source of income for you and your family.
Choose - Make it fun for you. Do what you enjoy the most, and consider delegating the rest. (Whether another doctor, or staff, you can delegate the rest.)
Choose - Find what you really love and get REALLY good at it. Your practice will be distinguished by the area in which you focus. What does your practice do that distinguishes you from the others?
Choose - and get FREE. An area of expertise and excellence in expertise gives you freedom. Get free of the stress of the parts you don’t like, free of spending the money on so many different courses, so many supplies, equipment, staff training, and learning curves where you aren’t making much or an money while you are learning. Free to discover a main mentor in your area of expertise-to-be. Free to become a mentor and possibly a teacher of your area of expertise. Free to enjoy life. Free to work ON your practice, and not just IN your practice.
Choose and change your life!
In school, you had regular teachers, substitute teachers, favorite teachers, and not-so-favorite teachers.
You knew where they were. They were in their classrooms; they were in the hallways while you changed classes, on the playground, in the school parking lot to help you get on the right bus, and they were in the teachers’ lounge sometimes.
It is confusing to children to see their teachers in the grocery store. That’s not where their teachers usually are found. Don’t you love hearing a little one say, “Mommy, LOOK! There’s my teacher!” with surprise and excitement.
Where are your teachers now?
Your classroom is your life. Your hallways between classes are your journeys, your vacations, your change in routines.
And the teachers are everywhere. Life is a school.
Now, you are in your Master’s Program of Life — or maybe your PhD! Your courses are much more challenging than in third grade.
Your teachers are in your questions and your confusions. They are in your challenges, your problems. They are getting you on the right bus.
“You’ll find your teachers in life in the most unlikely places and they can be the most unlikely of people.“ ~ Claude Hammond
This week, notice where your teachers show up. Get on the right bus. Enjoy recess when it’s time, and thank your teacher for the lessons.
Find the Joy in Your Everyday Practice Life : Part III
The Critical Elements
Critical element: Loving your patients and your patients’ parents
As your practice begins changing (because YOU are changing), you will find it easier and easier to love your patients. They will love you more. You will have created a love-fest.
And, by the way, you can learn to choose your patients. You will sense a patient who does not fit your GREAT practice, and help them with referral out. It’s amazing how easy it gets to say to a patient, “I do not believe I can meet your needs. I am not the right dentist for you.” And, less and less, do you need to say anything, because your patient population will begin to mirror and fit your joy, your great practice. It’s part of the magic of greatness and gratitude.
Your love and your great practice’s love will transform everything. You will be amazed how nice patients come “out of the woodwork.” They will flock to your practice because you and your staff are loving - kind, gracious, caring.
While you work on loving everyone, your practice is transforming before your eyes, and you need less (or no) marketing, practice management gurus, techniques, and formulas. You do need mutual support and love between yourself and your staff, patients, and yes, practice enhancers, those energetic, loving, caring people who help you and your staff in the transition, and beyond.
Critical element: Curiosity
It’s a new curiosity. Not the old gossipy-what’s-happening-around-town type of curiosity. This is a new curiosity about each person - staff, patient, visitor, and neighbor. This is a what-in-your-life-is-good sort of curiosity. It’s a magic curiosity.
All of a sudden you care. Why do you care about your assistant’s pregnancy? Because you love her and she is so happy. Your curiosity is more about how she is seeing this exciting change, and less about what are her symptoms, concerns, progress, and so on.
You care about a patient who shares with you that she is working to change her nutrition, and you care that that will reduce her oral illnesses as well.
You care about your neighbor dentist who wants to come talk and talk and talk, fussing about all his travails. You care and so you ask him, “What’s good in your day today?” And when, after his stunned silence, he answers, “Good patients coming today,” you respond, “Me too! Isn’t it wonderful?” And he grumps less and less.
You care. And somehow life turns in your favor. Not everything is perfect, but even the things that are not perfect, you see as opportunities to learn, to get strong. You know all is the way it is supposed to be. You feel it in your bones! It’s a new curiosity!
Critical element: Your "slight edge"
Author Jeff Olson named it “The Slight Edge”. It’s NOT a self-help gimmick or motivational tool. The Slight Edge is actually what you are doing every minute of every day. Your moment-to-moment actions are either the slight edge going to GREAT, or going to NOT-GREAT.
Your simple daily activities in your life are powerful. They may be powerful GREAT or powerful NOT-GREAT.
The ability to change the slight edge to positive and powerful, is already in you. If your actions are taking you down to NOT-GREAT, you can become aware of that and change your trajectory! As you realize how important it is to arrive for your day in gratitude, choose a healthy bite of food, hang out with people who support love and greatness, your beliefs and attitude will give you strength to make these positive powerful choices. Your tiny actions will build to GREAT results.
And this creates YOUR LIFE! which will never be the same again.
Read about Jeff Olson’s "Night of Despair" and "Day of Disgust" that brought him to realize he was on the slight edge going the wrong way, instead of toward a powerful, joyous life! It's in his book, "The Slight Edge."
Think about significance.
Your deepest needs and fears originate way down in your subconscious mind, in the primitive parts of your brain. They include the need to be significant - the need to be important, and the fear of not mattering.
EVERYONE needs to feel that they matter.
You (and everyone else) are not consciously aware that your need to matter is controlling your behavior. When you are defensive, you are not aware that’s why. When you are angry and needing to be right (feeling as if the other person doesn’t understand that you are right), you are not aware of your need to matter, to have the other person recognize you are right, to be important.
When you are craving praise, hating criticism, feeling very defensive, you are not consciously aware of your need to be important. Think about that. When you feel hurt, you are not consciously aware of your need to matter. Yet that’s what is driving the emotion and your reactions/behavior.
You can learn and become more aware.
You can look for your deep-seated need to matter when you feel hurt, defensive, wronged, not listened-to. You can be quiet and think about your deep primitive instincts. You can know that it is true for every one.
You can look for opportunities to love and help others. As you do, you will feel the love, the significance you crave. As you do, you’ll realize how much you matter.
Compliment that Walmart clerk on doing a great job! Sincerely thank the people who help you - at the office, at your home, out and about in your world.
Let the other driver into the traffic land when it is safe. Pick up an item that has fallen to the floor in Target and put it back on the shelf, as you are shopping.
And the easiest and most rewarding might be - to SMILE at every single person you encounter today! It gives them love.
Significance is achieved by leaving the world better than you found it. People who feel their lives really matter are the happiest people of all!
As a dentist, you are a special kind of person.
Special because you went into dentistry to help others. Special because you have love to give. Now before you go and feel guilty because you hoped dentistry would make you a good living, let me say, “Congratulations."
You are also special because you want to take great care of yourself and your family.” Dentistry is what you do for a living! It should be a good living! You spend your time working hard and loving others. That’s the idea!
The most important thing is that you feel in your heart, a desire to serve, to love! If you aren’t interested in serving others, you might want to rethink being in dentistry.
Love is the whole thing. “All you need is love.” ~ the Beatles.
And, "love is all we’ve got.” ~ Kenny Rogers.
“Love your neighbor as yourself.” ~ the Bible.
Love is the answer - to any question; to any quandary; to life’s toughest times.
And, love is the answer to your success - as a spouse, as a dentist, as a parent, friend, as a soul.
"You can have everything in life you want, if you will just help other people get what they want." ~ Zig Ziglar.
You can’t teach an unhappy person to be full of love, even though it’s in there somewhere. But you can practice yourself, AND TEACH your people to consciously share love. When love is shared, it comes boomeranging back many-fold. What a deal!
The Southeastern Society of Pediatric Dentistry has long held its winter educational meeting in Atlanta, at the Buckhead Ritz-Carlton. I was "wowed" by a gentleman who helped me, when he smiled broadly and answered my “thank you” with, “It is my pleasure.”
It was his pleasure to help me. His pleasure to serve me. After that meeting, I began teaching my own office team as well as the seminar doctors the beautiful, easy, precious words to express love to those we serve: “It’s my pleasure.”
Today, some 15 or more years later, our culture has adopted an ubiquitous colloquialism, “No problem.” While typically totally well-intentioned, it is actually not kind in its implication.
Think about it - when someone does something for me - serves me - then responds to my gratitude, “No problem,” the implication is basically, “It typically is a problem, but this time maybe it’s not such a problem.” or something related.
No matter - you have the incredible opportunity to demonstrate your love, by responding, not with a nod, not with a “you’re welcome,” but with, “It’s my pleasure!” When delivered genuinely with a smile, that struts your love stuff!
The tiny change of EVERY time someone says thank you, to respond, “It’s my pleasure,” has just elevated your client fulfillment system tremendously.
In dentistry, you went in to take care of people; to be good to people;…. for heaven’s sake, and then to imply it might have been a problem?
Strut your stuff! It pays great dividends back ‘at-cha.’ It’s what distinguishes your practice from the others.
Strut your stuff! Strut your love stuff!
It’s my pleasure!
The question is, what should we do when we can’t have both, beautiful alignment AND occlusion?
Why can’t we always have both? Simply because the teeth in a human body don’t work like the teeth on a wax typodont or a plaster model.
Neither can the occlusion be changed as it can on models, by trimming the models, nor can the teeth necessarily be put into what we consider “ideal” alignment, as identified, for example, by the American Board of Orthodontics parameters for “ideal.”
“Wha??," you ask.
Ovoid arch forms
Ovoid arch forms, which, according to Ricketts, are found in 25 percent of the population, do not align to meet ABO criteria due to the greater curvatures and resulting positions of the teeth in alignment.
In an article by Kazuhito, A., and Will, L., the ovoid arch form is shown to be the arch form having the greatest variations among the examiners who are ranking them. (https://doi.org/10.1016/j.ajodo.2009.12.032)
Second molar prematurities
This may be the most common reason to consider carefully before bracketing 7’s. Second molars have a good chance of extrusion, when included in the archwire. And, if they extrude, voila! an iatrogenic prematurity, iatrogenic CR-CO discrepancy, and a risk introduced for future dysfunctional occlusion, need for RCT on a tooth that takes a pounding (and has no decay). We never want our orthodontic treatment to contribute to dysfunctional occlusion.
Here’s the real problem; the variable human body and variable tooth responses. Each body acts and reacts differently. Some folks can eat carbs/sugars all day and not get fat. Some cannot. Some people smoke and live to be 100 years old. Most do not. Why?
Some people can have a CR-CO slide and never have a symptom or problem. Many people have symptoms - craniofacial, neck and back pain, fractured molars, non-carious, non-vital molars needing RCT, gingival margin recession, especially in bi’s and molars and in the absence of perio disease, posterior crowns, abfractions, worn occlusal surfaces of posterior teeth?
Each human body reacts differently. And, adults are often not very adaptable. Our orthodontic treatment – mechanics – must be considered at risk of being etiologic (iatrogenically) in occlusal dysfunction.
So where does this leave us with those blessed second molars? It leaves us with a strong and careful consideration if they should be bracketed, or not. It just may be that the occlusion may be better without putting the 7’s into “harm’s way.” Even rotated, or malposed, are they quietly ok in the occlusion?
A patient may have MANY “CO” bites. Some patients are all over the map with their comfortable or uncomfortable bite. And some patients’ musculature and resulting joint movements will change the bite with the tiniest - and I do mean TINY - changes, like a new restoration with even tiny high spot. Consider that we never really know where a patient’s functional AND dysfunctional occlusion will be next. Keep that in mind when you consider bracketing those most-likely-to-extrude-7’s.
Which brings us to another reason not to bracket teeth:
The patient presents with signs and symptoms of dysfunctional occlusion.
Perhaps minor treatment, anterior alignment, with anchored posteriors is a consideration. Perhaps NO orthodontic treatment is the right choice. Neither you nor your patient want the situation to be worsened.
Don’t bracket a tooth just because it’s white.
New Year’s resolutions originated a long time ago. Perhaps with the Babylonians who made promises to their gods at the start of each year; perhaps with the Romans who made promises to the god Janus, for whom January is named; perhaps in the Middle Ages when the knights reaffirmed their commitment to chivalry.
Do resolutions help? Do they work?
The answer is, that without a goal to pursue, without a target to shoot toward, it is unlikely that you will hit that goal or target.
However, with a goal, a resolution, your success depends on your recurring, repeating work toward the resolution.
Tony Robbins says to keep on re-visiting the resolution. Every day, for the whole year. Why? Because you reinforce your belief in your goal. You reinforce your thinking toward your goal. You reinforce your actions toward your goal.
You power up!
Gratitude also reinforces your perspective and belief in your goal. It’s amazing. When we are grateful for what we HAVE, we receive more. The Universe is abundant and unlimited. There is enough for everyone. Truly. “Ask and you shall receive.” ~ Matthew 7:7
Ask. Tell the Universe your goal. Even write it down and look at it a few times every day.
Be grateful for what you NOW have. You are setting your beliefs, your perspective, to abundance.
Take actions toward your goal. Tiny steps, tiny decisions that work toward your goal.
Go on living life. It’s too good to miss!
You are POWERED UP!
Dr Chris Baker
Dr. Chris Baker is Past President of the American Orthodontic Society, a pediatric dentist and teacher of orthodontics, An author, dental practice consultant, mentor, and a current or former faculty member of three U.S. dental schools, Dr Chris practices and blogs in beautiful Abu Dhabi, UAE, and glorious Texas, USA.
Text and images
© 2019 Dr Chris Baker