I check my splint patients at their hygiene appointments.  Imagine how I felt when I asked a patient if she was wearing her splint, and she said “yes,” and when I asked to see it she handed me her old orthodontic retainer.

She looked up at me and said, “Oops, you caught me.”  She hadn’t worn her splint in a long time, because she didn’t feel she needed it anymore.  Somewhere along the line my message didn’t stick.

That’s not the first time a splint patient either stopped wearing their splint, or lost the splint, or maybe even fed the splint to the dog.  It’s the same feeling I get when a perio patient goes back to the same bad habits that caused their disease in the first place, or I find out that their very expensive partial denture is lying at the bottom of their night table drawer.

The consequences for the patient are pretty grim, but for me I feel as if I am not doing my job because I place a high emphasis on doing meaningful work.

The key to meaningful work is to gain commitment from the patient.

Dentistry that changes people’s lives isn’t, and should not be restricted to, cosmetic dentistry.  Changing people’s lives in meaningful ways is about health, comfort and function as well.  Function is the one that lies under the radar.  Function is the one that requires more education, and splint therapy is the educational and motivational tool.

Let’s face it when people enter into comprehensive dental treatment some level of commitment is necessary in order to get the best long-term benefits.  People weigh the benefits of treatment against the consequences of treatment…the result is the level of commitment.  When the benefits far outweigh the consequences…the cost, the time, the levels of discomfort, real or imagined…then there will be commitment.

And the work will be more meaningful for all.


Many cosmetics dentists use a technique called a trial smile or cosmetic mock-up.  The purpose is to show the patient the benefits of cosmetic dentistry.  In sales they call that demonstrating the solution.  You see demonstrations on TV all the time.  The famous pitchman Ron Popeil would wow viewers with demonstrations of his Chop-o-Matic hand food processor or his Veg-o-Matic slicer.

Think of a splint as a way to demonstrate to the patient problems they never knew they had.  They will accept your splint like people accepted the Pocket Fisherman.  Just kidding of course.  The point is that dentists need to educate patients when they are not aware of the problem.

People will never accept a solution to a problem they don’t understand in their own mind.  Many will nod yes because of the positional authority of the dentist…only not to follow through with treatment or put the partial in the drawer and never come back.

Here are a few guidelines for using a splint as an educational and motivational tool:

  1. Splint therapy can be the gateway for patient’s accepting long-term comprehensive dentistry.  Become an expert in diagnosis and splint treatment options.
  2. Take the time to educate the patients as part of your new patient examination process.  Make sure they thoroughly understand the problem before treatment is presented.  Make use of photography, muscle palpation, diagrams, TMJ trainers, and of course mounted study models.
  3. Relate your findings to any signs and symptoms.
  4. If they do not acknowledge a problem…don’t treat through the occlusal issues.
  5. Once they own the problem…the splint becomes the ultimate demonstration.  The next natural question for them is “where do we go from here?”
  6. Slow down the examination-presentation process.

I started this post with a description of the uncommitted patient, but in reality nothing, except maybe cosmetic mock-ups and pulpotomies, has done more for educating and motivating patients than splint therapy.

That’s how you can continue to do meaningful work that patients thank you for.

How do you use splint therapy for education and motivation?  Leave your response in the comment section.






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The day after Labor Day…the unofficial start of the new year.  The Tuesday after Labor Day has always been my New Year’s Day and I haven’t been in school since 1973.  I left the beach in St. Maarten on Sunday, where I made my yearly goals, read a few good books, worked on my tan and played a lot of blackjack.

I read Doctored, The Disillusionment of the American Physician by Sandeep Jauhar.  It’s a good read, and I highly recommend it for all health care professionals who are concerned with the changing nature of health care delivery in America.  I related.  I feel it should be required reading for younger dentists who are facing the long career.  It’s about the ups and downs of balancing a life in medicine between creating a good lifestyle and being a good doctor.

Jauhar struggles with providing his patients with the best care while earning a good living during his early years when his responsibilities at home are demanding more time.

I felt his pain…especially since the recession hit and third parties began to flex their muscles.

In case you don’t know, I’m all about the private practice of dentistry...what they now refer to as fee-for-service dentistry.  There was a time when we didn’t make that distinction.  A time where you just went to work and focused on your dentistry without interferences.  Today, in order to maintain and sustain a fee-for-service practice the dentist must have an approach…a philosophy if you will.  Jauhar writes about taking control of the two things that you can…mastering your craft and controlling relationships.  It’s funny, but that is essentially what this blog is about…controlling relationships as best as you can through trust, appreciation and ownership and providing excellent care through complete dentistry.

The book was very helpful…especially when I got to the blackjack tables at night.  Because life is a little like blackjack.

Let me explain.  Blackjack, like life is not very complicated.  It has rules, and if you know them and don’t stray too far from the guidelines you’ll be a winner…in the long run (those are key words).

The game is set up so the dealer or the house has a very slight advantage.  That means that if you play, for arguments sake, one thousand hands, the dealer will win approximately 510 of them and you will lose 490.

The dealer plays by the rules—she never waivers…no emotion.  The dealer also gets relief every 40 minutes so they never get tired.  They do deserve the slight edge because after all it’s their house…and they serve free drinks.

That kind of control is available to the player as well.  Play right (master the craft) and control the quantity of the individual bet.  That’s all you need to know.

You see out of those 490 wins that every player will get they don’t alternate between the player and the dealer.  Many times there are streaks.  Imagine that a streak started that lasted 10 hands…and the player kept increasing the best (called pressing the bet), well I can tell you that winning, and winning big is now in the player’s future.

When that train slows down and the streak goes to the dealer…then revert to the minimum bet.  Of course the player must play the game correctly.

The vast majority of blackjack players lose…even those who play right…who know what the “book” says.

Why?  Emotions and energy.

Let’s take energy first.  You have to be prepared to play blackjack…if you to be able to last.  That means don’t show up to a $25 table with $100.  No one can sustain a losing streak…you need excess energy (cash).  Just like practice, you need to show up everyday with excess energy…mental, physical and emotional.  That’s what all the self-improvement stuff is all about.  That’s what makes sustaining a dental practice difficult.  No one particular case, but the entire population of patients we see that visit us with difficult technical problems.  It’s the emotional issues that wear down most dentists.  Be prepared.  Not everyday is going to be a holiday.

And how about emotions?  I can’t tell you haw many blackjack players get blown out because they don’t exercise discipline and consistency.  Listen…here’s what the book says…player hits on 16 when the dealer has a 10 or picture showing.


That situation occurs a lot…and yet I see most players get nervous (fear) when it comes up.  Mostly, they stick…and sometimes they win…but mostly they lose.  When asked, they say they hope the dealer is going to bust and they are afraid to bust.

Huh?  The dealer has a 10— the odds are they can’t beat the dealer with their weak 16…and by the way, hope is not a strategy.

People live their lives the same way, with fear.  Or they take unnecessary risks…like betting the house on one hand.  They go for broke…even after playing a disciplined game…they go all in.

Stay consistent, follow the rules, manage your energy and relationships…it’s they keys to blackjack, and most games…after all life is a game.





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