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Dental Schools (of Thought)

October 1, 2017

Filed under: Article,Happiness,Self-development — Barry @ 9:14 PM

Democracy was born in the middle of the 5th century bce in a little town known as Athens, Greece. I am sure you have heard of it.

Athens at that time was surrounded by the Persian Empire which spanned from Egypt in the west to Turkey in the north, through Mesopotamia to the Indus River in the east.

Sorry for the geography lesson but I am just trying to emphasize how difficult it must have been to try to develop a new political system during that time.

Democracy which literally means rule by the people, required the people to take on new responsibilities, and even though slavery still existed to some degree, it meant that most people were given their right to exercise their new freedom of choice.

In order for people to make the most out of their lives they needed an education system that taught young people the answers to their most pressing questions about “how to live a good life.” So parents sought to find teachers who could give their children a good education. In Athens there were many philosophers and many “schools of thought.”

Many of the teachers were disciples of Socrates, the first philosopher that spoke about the importance of looking inward for the key to happiness. His most famous students were Plato (The Academy) and Aristotle (Lyceum). Take note of the two guys standing front and center in the painting above (School of Athens by Rafael).

There was another disciple, Zeno of Citium. He was the headmaster of his school of thought…the Stoics. Other stoics you may be familiar with are Epictetus, Seneca and the Roman Emperor Marcus Aurelius. Zeno’s school taught a philosophy that was divided into three main subject areas: logos, physics and ethos. I know—it’s all Greek to you. Let me explain in modern terms.

Logos—This educational heading included general knowledge. It was believed that in order to become successful in Athens, students would have to understand how to put an argument together in a logical way, and then learn how to express it. This would benefit all those who chose to become lawyers, teachers, politicians and doctors (not many dentists back then).

Today, the subjects included under logos might be communication skills, problem solving, systems thinking, project management and teamwork. Specifically, for dentistry logos might include examination, diagnosis, treatment planning and presentation skills. I am sure most would agree that logos is quite important for success…the Stoics did.

Physics—This heading would be what Napoleon Hill would have called the specific skills for success. This is the area most Greek philosophers focused on before Socrates showed up speaking about the “Unexamined life.” It’s the stuff of science and the external world. In today’s world it’s biology, physics, chemistry, medicine…and all of the basic sciences. These are the subjects that actually make you who you are. Without them you cannot be a doctor or dentist. Yes—very important, and the reason why everyone goes to any school. In dentistry—it’s all technical dentistry.

And finally:

Ethos—This is the area of study that was most useful. It includes the personal skills. These are the skills that the Stoics considered important because they taught young people how to live the good life, or how to achieve eudaemonia. This course of study attempted to answer all of the questions surrounding the big question which is, “How do I live the good life?” In Ancient Greece it was the philosophers who were charged to teach this. Today it is the psychologists and neuroscientists. Some of the skills needed for personal well-being fall under emotional intelligence, resilience and decision-making. How important is ethos today? The Surgeon General once said that the number one healthcare problem in this country is the well-being of physicians…it’s important enough to teach, when the burnout rate of our physicians is approaching fifty percent.

In order to practice complete dentistry we must become complete dentists. Not in the sense that we do comprehensive dentistry but more so in the sense that we make sure everything is considered from the health and well-being of our patients to the health and well-being of ourselves and our careers. This should be the responsibility of the dental education system. Until that responsibility is taken more seriously we will only be offering dentists an incomplete education.







Dental Screening is it Necessary? Part II

May 26, 2015

Filed under: Article — Tags: , , , — Barry @ 10:58 AM




Writing blog posts is an exercise in discovery.  I start with an idea and a few thoughts and then the finished post barely resembles what I set out to write.

My last post started off about wisdom teeth and ended up being about over diagnosis, over treatment and cancer.  This week I want to get back to wisdom teeth.

Dr. H. Gilbert Welch, the Dartmouth epidemiologist and author of the book Less Medicine More Health, referenced oral cancer and wisdom teeth in his book, as examples of over-diagnosis and over-treatment.  The last blog post discussed the oral cancer issues.

Just to give you an idea about how he feels, at one point he writes, “But I’m not a dentist.  If you’re one, you already know that the topic of too much dentistry could fill a whole book.  Write it.”

Well I’m not going to write a whole book about over-treatment…my last post garnered enough interest to send me numerous articles about that topic.

His point referring to wisdom teeth is that way too many wisdom teeth are removed in this country for prophylactic reasons.  Most of these extractions are on asymptomatic patients.  He claims that there is no data that supports the removal of wisdom teeth prophylactically and that the “UK’s National Institute for Health and Care Excellence and the American Public Health Association – recommend that wisdom teeth not be removed propylactically and should only be removed in patienbts who are experiencing problems.”

After over forty years of practice it’s difficult for me to believe such hard and fast rules—in other words I believe I can exercise a bit more judgement than that.  But I do agree that we take out too many wisdom teeth.

Why?  Well that’s a deep discussion…but dogma may have something to do with it.

For the patient the major concern is risk assessment.  The pros and cons of the procedure.  Whether the procedure is wisdom tooth extraction or placement of veneers or implants, risks should be discussed.  Let’s face it all surgery has risks…believe me I know.

In the last post I referred to my mother’s wisdom tooth…at her age and even way before she passed, surgery would have been risky business.  Then again risk is part of life…everytime I get in my car I am taking a risk, but people don’t usually see it that way.

“Can’t get your wisdom teeth out Lisa?  Stop texting and driving.”

Welch writes about levels of risk in his book:

  1. Patient Autonomy.  As dentists we see a lot of this.  All patients have the right to refuse treatment and accept no risk.  Most dentistry, unlike medicine, is not life-mandated.  We have all seen patients refuse treatment and live long happy lives.  In my history I have seen patients refuse to take medications and also refuse treatment for oral cancer.
  2. Baseline Risk.  This is the old Ben Franklin saw about assessing pros and cons.  Know exactly what the benefits are compared to the possible complications.  How many teeth through the years have been mutilated (not my word—but one used by a very prominent and highly ethical dentist) for the sake of cosmetic dentistry—or foregoing orthodontics for aggressive restorative dentistry (instant ortho anyone?)
  3. Certainty of Benefit.  This is where most of our dentistry should fall.  Our examinations should reveal the obvious benefits and then should be discussed with the patient.  In many cases the patient doesn’t understand the benefits and the doctor’s role is to open that discussion because of his or her experience.
  4. Certainty of Harm.  Now this is the discussion that usually doesn’t get done.  I divide my treatment options into Phase I and Phase II.  Phase II options are irreversible…that could mean more risk.  Sometimes dentists get into heroics without full disclosure to the patient…and real; trouble comes.

My suggestion is to use wise clinical judgement and openly discuss all options and risks with patients.  I am amazed at how many of the “smartest dentists in the world” I meet everyday.  There is very little humility in dentistry – medicine and dentistry could use a bit more humility – or else we will never improve…individually or collectively.  And maybe those articles about over-diagnosis and over-treatment will go away.








Blame Your Dental Lab?

March 17, 2015

Filed under: Article — Tags: , , — Barry @ 9:31 AM




One of my favorite movies is Stanley Tucci’s 1996 hit,  The Big Night.  The movie resonated with me.  It’s the story of two brothers who open an Italian restaurant at the Jersey shore.  They continually squabble about how the business should run.  Primo (Tony Shaloub) is the perfectionist chef and Segundo (Stanley Tucci) is the businessman.  I identified because a dental practice and an Italian restaurant have a lot in common…they are both small businesses, they serve the public and they run on the philosophy of the owner/technician.  Take a look at the clip I supplied to get a feel for the movie.

The problem with many small businesses that fit these parameters is something that has been called in business: silos, or a lack of collaboration between the parts.  Sometimes those parts are within the same person (mindset), or between the various departments of the business (operations, finance, marketing), or between the suppliers (labs).

The Internet provided me with the following definition of silos in business:

A silo mentality can occur when a team or department shares common tasks but derives their power and status from their group. They are less likely to share resources or ideas with other groups or welcome suggestions as to how they might improve. Collaboration in a business culture with silos among teams or departments will be limited, unless collaboration benefits the members of the department. In addition, the members of a silo tend to think alike. They get their power from association with their function and their shared technical knowledge.

Let’s talk about the third one…labs and the silo mentality.

There is a common scenario that occurs in many dental practices that has been going on for time immemorial.  When something goes wrong…blame the lab.  If dentists get to hear the other side they wouldn’t like it.  This is how silo mindset works.  Blame the invisible man…for the sake of the patient.

It’s one thing to lack collaboration, but quite another to start the blame game.  Eventually blame leads to major stress.  We all have been guilty of the silo mentality if we run a small business.

Each department in a small business is critical to the final outcome.  Total collaboration is a must.

If anyone drops the ball, we all suffer.

So what is the root cause of the silo mentality?  I believe that reductionist thinking causes us to look for simple answers when something complex occurs.

In other words the coordination, and collaboration of complex systems working together leads to success.  When it breaks down, we blame whoever or whatever is closest.

The key to creating a well run integrated small business is to make sure each component is communicating openly.

Communication is key.  Putting together the systems is the hard part but so very well worth it…because how do you think complaining and blame sound to the poor patient who just wants to get it right?








Dentistry Been Very Good to Me

December 3, 2013

Filed under: Article,Business of Dentistry — Tags: , , , — Barry @ 10:21 PM



Sitting in a Barnes & Noble just chilling out after a hot yoga class and looking through one of John Wooden’s leadership books.  

I come across a lesson that reads:

“If you don’t have time to do it right the first time, how will you find the time to do it again?”

My mind wandered to where I originally heard that old piece of advice.  It was repeated over and over again in dental school…over 40 years ago.  I still use that advice in my practice and daily life.  Good thoughts from the old coach.

I took out my iPhone and posted on Facebook under the heading of Dental School Wisdom.  Within minutes there were a whole slew of responses.  The problem was that no one was responding to the Wooden quote, just to the phrase “Dental School Wisdom.”

It was as if I had just said the magic words like Niagara Falls in that old Abbott and Costello skit.  If you never saw the skit it’s worth watching and you will appreciate the emotional response I got toward people’s dental school experiences.

I was severely outnumbered.  I had a great dental school experience.  Some of the best years of my life.  Maybe it was the time, late sixties to early seventies, but I felt no pressure, and I wasn’t some sort of child prodigy.  Compared to what came before it, I thought it was a piece of cake.  After all when I finished I would get the prize…a license to practice that would enable me to have a great life.  I felt fortunate…still do.

But obviously, after reading the responses, I was in the minority.

It seems that dental school bashing is all the rage these days.  Whatever happened to gratitude?  While reading the comment thread I was reminded of a blog post written a couple of years ago on the Lolabees Blog.  It was called 10 Reasons Why I Hated Dental School.

That blog post produced a ton of comments that supported the “I hated dental school theme.”  What was I missing?

I follow Lolabees blog and noticed through the years that her blog posts attract many people who seem to want to leave dentistry.

Is there something inherently wrong with this profession?  Did I miss an important meeting?

Sure I would have loved to play third base for the Phillies, but Mike Schmidt was a smidge better than me.  Look I don’t apologize for liking dental school or actually enjoying the fruits of of last forty years of labor in a field that I had total control over.

But as an author and an educator—it bothers me that so much bashing is going on when I know there is nothing inherently wrong with dentistry.

So stop complaining!

Then, in a dream one night, the word Millennial kept flashing in my mind.

I’m a Baby Boomer.  I come from a generation where a job meant something different than it does to today’s young people.  Millennials would prefer meaning over money…and so they change jobs more often.  My generation was satisfied in finding a job that provided a good life and we stayed with it forever.

When I looked at the bashing from that point of view I softened my outlook.

You see…I am very sensitive about doing meaningful work.  I spent the last forty years creating conditions that afford me the freedom to do meaningful, and important dentistry…dentistry with purpose.  Basically that is what my two books are about.

It’s tougher to do that these days.  But if you are willing to create that opportunity…it’s still there, and the grass is still not greener.

The one problem that I see is that of all the attributes needed for a purpose driven dental career...self-esteem is number one.

I have to admit that even forty years ago…my self esteem was tested in dental school.  But I am not one to give the advice to just “buck up and take it.”

No, dental education has to improve— dental schools must build their students up rather than tearing them down and destroying confidence.  Maybe I was lucky.  Maybe I was just born at the right time.  Either way—if dentistry is going to survive as a profession, the dental schools must reform.













The Truth About…

June 17, 2013



Just when I think I’m out…they pull me back in.  Last week I wrote a blog post warning readers to be aware of chauffeur knowledge.   Of course I am always on the lookout for potential chauffeurs, so when it came to my attention that TV doctor, Mehmet Oz did a series of shows called Toxic Teeth: Are Amalgam Fillings Safe? my chauffeur radar sounded an alarm.

Just the act of Googling Dr. Oz will show you that he has an opinion on just about everything known to man, and with a surgeon’s credentials and the backing of the media…you always have to wonder about his purpose.  Not that I am the suspicious type, but when he treads on my industry…I prefer the truth…if there is a truth.

I don’t want to get into the so called facts about amalgam.  The Internet is filled with conflicting information (of course if you have a dog in the fight you won’t think the info conflicts).  That’s why we may never know the truth about many things.  Yet we all have to make decisions…everyday.  Amalgam? Composite resin? Gold (there’s one Dr. Oz never mentioned)? X-rays? Centric relation occlusion? Neuromuscular occlusion?

Did you ever notice how all the chauffeurs start off by saying, “The Truth About…”

That’s what Dr. Oz did—he used words like poison, firestorm, potential toxicity, all the while an ominous soundtrack played like the one you hear when a political candidate has an ad about his opponent.  Well done production…but it doesn’t get us any closer to the truth.

I know the truth.

Well it’s my truth anyway.  Another word for my truth is opinion...I formed it by observing the field for over forty years and working in the profession…I’m not the chauffeur.  At the end of this post I will give you my truth.

Rolf Dobelli, in his fascinating book, The Art of Thinking Clearly, writes about two ideas that may come into play when making choices like the ones above:  Neglect of Probability and Zero-Risk Bias.

The first one, Neglect of Probability is our tendency to make decisions based on magnitude rather than true probabilities.  For example many people invest money in start-ups because of the high potential of profits to be made, and ignore the poor odds of a business actually making it.

Another example is the way many more people play the Mega- Jackpot lotteries even though the odds of winning are so much smaller compared to the normal lotteries.  Magnitude over probability…got it? Good.

Now let’s talk about Zero-Risk Bias…this is a bit more complicated.

The example Dobelli gives is to examine two methods of treating drinking water.  A river gets its water from two equally large tributaries.  One is treated with method A and the other with method B.  Method A reduces the risk of dying from contamination from 5 to 2 percent.  Method B reduces the risk of dying from 1 to 0 percent.

So which would you pick? (more…)

10 Ways to Get out of Network

May 20, 2013

Filed under: Article,Business of Dentistry,Happiness — Tags: , , — Barry @ 9:40 AM

images-1In previous posts I have promoted the idea of autonomy.  I am big on autonomy for may reasons.  Firstly, I believe most people go into dentistry to be the masters of their own destiny.  I know I did, but that was a long time ago.  I don’t know what motivates people these days.  One thing I do know is that if a dentist wants to be the very best he can be then having autonomy and the ability to make his own decisions is important.

Being in a network takes some of that independence away.  I know dentistry is heading in a direction that will change the way most of us practice, but I do believe there will always be room at the top.

Years ago getting out of network and building an insurance free practice was a lot easier, there was less traffic on the road less traveled.  And more patients looking for a ride.  These days getting out of network will require a bigger commitment.  Here is my list of things you can do to build a career of freedom and autonomy.  You may not get wealthier, but you will be happier.

  1. Become lean and mean.  In other words build the policies and systems in your practice that keep your expenses down.  By not being sub-servant to large monthly expenses, you can get to do the dentistry of your choice.  Don’t be lured into more expense by manufacturers looking to sell you the latest equipment if your practice doesn’t warrant the expense.  Your patients come to you for your care, skills and judgement.  Being hi-tech is only one factor that people judge your service by…dependability, reliability, competence and empathy come way before the expensive toys.  You would be amazed at how many staff members it takes to produce significant dentistry, especially when time management systems and financial policies are in place.

  2. Take more time with your patients.  Once again, building systems for re-care, new patients, treatment planning and scheduling will make you lean and mean.  All of these systems require the dentists to develop and build his communication and leadership skills.  Putting a system in place without being able to carry it out won’t work.  Think about football teams with great schemes.  Without the players executing, nothing matters.

  3. Become an expert in examination, diagnosis, planning and communication.  Take courses in these areas.  Get coached.  Don’t concentrate on the technical…step back and take leadership courses.

  4. Be a doctor not a businessman.  (more…)

The 9 Turning Points of Mastery

May 1, 2013


I received a complimentary DVD in the mail last week.  I don’t usually give these free discs much attention, but this time I slipped it into my MacBook and started to watch.

And man, was I surprised.

It was titled The Path of a Master, Nine Turning Points That Changed the Practice of Dentistry.  Don’t look for a link because it’s not available for distribution to the general public.  That’s a shame because rarely do we get to see the evolution of a master dentist with such great clarity.

Firstly, I want to thank Jeff Baggett and Bill Lockard, from the Pankey Institute, for putting this project together.  Both did a tremendous  job of telling a story that the dental community needs to hear.

Most people who watch the video may just see a story, but as someone who has practiced dentistry for close to forty years, and had my share of ups and downs, I was reminded of how we all are on the “hero’s journey” as described by mythologist Joseph Campbell.

Campbell used to quote the philosopher Soren Kierkegaard, who said, “Life can only be understood backwards; but it must be lived forward.”  The DVD brought me to a point of reviewing my own life and career.  It reminded me of what my friend Chris Sager the retired Executive Director of the Pankey Institute told me about L.D. Pankey.

He told me that when the Institute fist opened in the early seventies, students would follow L.D. around attempting to “touch the hem of his garment.”  But he said that L.D. was as human as anyone of us…more so in fact.  We tend to deify our heroes.  I identified with Bill Lockard’s narrative because it emphasized how human L.D. was, and that the nine turning points could have happened to each and every one of us if we were aware and prepared.  There are distinct differences between a master and the rest of us, but little has to do with talent.  Sometimes it has to do with preparation, persistence and luck.

I am amazed that in my own life I spent so much time planning and goal setting when it was those few turning points that made all the differences.  I am not knocking planning and goal setting, but I am reminded of another quote from my favorite mythologist/philosopher, Joseph Campbell:

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.”

Pankey’s first two turning points occurred long before he became a dentist.  His story actually started with the story of Daniel Halley-Smith who he met years later on a trip to Europe.  Smith graduated Northwestern University Dental School in 1899 (where G.V. Black was the first dean), two years before Pankey was born.  He practiced in Chicago with Dr. Frank Davis who later retired in Coral Gables, Florida, where Dr. Pankey practiced.  Those of us who understand quantum physics also understand that (more…)

How To Get a Discount From Your Dentist

January 27, 2013





Nothing bothers me more than the bad rap dentists get these days.  It truly bothers me when I read how uncaring and greedy dentists are as told by dissatisfied patients.  I know that there are many people who love their dentist.   They are the ones who have the beautiful smiles and the pleasant breath.  In my forty years of dental practice I can say I honestly believe the majority of dentists are good, honest and caring people.  Sure they went into dentistry to earn a good living, like everyone else.  But remember they had to go through many barriers to entry like the high cost of education, the minimum four years of study and the tremendous amount of work needed to graduate.  A person really must be committed to their work to do that…and like most humans they want to “do good.”

I truly believe that most dentists want to help their patients first.

Then why all of the complaints about dentistry these days.  I have read some nasty rants on Facebook that really should have been censored.  But who am I to restrict someone’s freedom of speech.  Yes, dentistry can be uncomfortable but most dentists try to make it as comfortable as possible—no we’re not sadists.  There has never been a better time in history to get painless dentistry.  Yes, dentistry is expensive…but that’s not the dentist’s fault.  Your iPad is expensive too.  But between fear and cost…Houston, we have a problem.

Last June Frontline did a story on dentistry that was more about the current state of the economy than the actual state of dentistry…it is worth watching if you haven’t seen it.


People are staying away from the dentist.  I heard that even people with dental insurance are leaving 95% of the benefits on the table because they can’t afford or don’t want to pay out-of-pocket.

People believe that they are entitled to dental benefits.  That’s a political discussion I would rather not get into.  Entitled or not…most people aren’t covered to the extent that covers their dental needs…there will always be out-of-pocket under the current system.

After working with dental insurance companies for many years…generally I  can tell you they are not the hero of your dental story.  They are in business to make money.

The government?  Not yet…and when they do get involved…to the government it’s just a matter of making the numbers work.

So who can you turn to?

Yep—the man behind the mask.  He or she is your only friend if you want to keep your teeth.  Learn to trust him…stop saying such bad things about him, stop writing in the social media how greedy dentists have become.  Be nice, don’t cancel, pay your bills on time and be courteous to the staff.  When it comes down to it no one is entitled to anything in this world.  Be nice because if you truly need some important dentistry he’s the one who can discount it for you…if he likes you.

The Man Who Mistook his CT Scanner for a Hat

July 17, 2012

Filed under: Article,Marketing,Philosophy,Uncategorized — Tags: , , — Barry @ 6:15 PM

How I imagined myself.

Okay fans…that’s not me.  But it is who I imagined I could be.  It just didn’t work out.  Let me explain.

Earlier this year I found myself in one of those newer discount malls you see around these days.  A sprawling, never-ending sea of brand names at marked down prices.  My wife was on a mission to get the deal of the century (she just didn’t know what it was yet), while I was out for a walk in the park.

I like the John Varvatos brand, so I naturally gravitated into that store.  While looking over the boots and leather goods I spotted a felt hat.  You know the type of hat…the one worn by just about everyone hanging out at the Promenade in Santa Monica.  Forget that I am 64 years old.  I tried it on and I became 25 again.  I tipped it this way and that…it looked great.  How much?  I asked. (more…)

How to Structure a “Deal” for Social Commerce Websites

July 17, 2011

Filed under: Article,Marketing — Tags: , — Barry @ 9:54 PM

“Deals” are the current trend and they won’t be leaving us soon. 

Make sure your deal is Win-Win-Win

There is a growing sub-category of social media known as social commerce. The group is dominated by the popular buying sites, Groupon and Living Social which promote daily deals in specific cities through e-mails and social network.

Most of the deals are very appealing…even sexy. I read where they actually employ comedy writers to write the copy for the ads. I have bought some very good deals myself…like 5 Yoga classes, a car wash with detailing, and numerous meal deals.

Let me tell you about one…a charming little restaurant in my town that is known for good food. I bought the deal which entitled my wife and I to two fixed price meals for half price. Normally the meals cost $80 but we paid $40.

We arrived to an unreasonably crowded restaurant, and as instructed by the deal, revealed our coupon at the start.

Everything went downhill from there. The place was being served by one waitress, who was the owner, helped out by a busboy. Totally understaffed. My first thought was to feel bad for them until I realized that I was being treated like a second-class customer. I could feel the chill in the air.

The courses were served in an arrhythmic fashion but actually were pretty good…but the service and the cold shoulders ruined the experience. The waitress actually threw the check down at the end of the meal…I didn’t know how to interpret this behavior until I went home.

I definitely left angry…and you know what they say about angry customers…they will tell 25 people.

At home I immediately checked out this particular Living Social deal. They had sold over 550 of them. They had to be fulfilled in 4 months. My bill that night was $8.50, not including the $40 that I prepaid…it was for coffee and taxes.

I did the math. Five hundred and fifty quality 4 course meals served by an overworked waitstaff over 4 months for $20 per meal (the social commerce group gets 50% of the deal), is a formula for disaster. No wonder we got the cold shoulder.

Old Model New Tools

The model that these social commerce websites are using has been around for many years. It is known as “buy first then sell.” For example, say you had a group of customers that you knew were in the market for certain products or services, and say you had a place to procure (good word) these products or services at a very cheap price…and you sell them fairly cheaper than the marketplace…in other words you could make a deal. That concept has been around since the dawn of man.

You would be in a pretty good position if you had the customers, or could buy the goods at great prices, or both.

Okay…what’s this got to do with dentists?

Well, insurance companies, HMOs and PPOs having been making these deals for years. Now with the new tools of social media we have new players in the game.
Actually people who “fence” stolen goods could be considered using this model. Think about it. I know that poor waitress entered into the deal with her own free will…but it was pretty seductive to get all those new patients…er, customers.

I Want to Be Honest With You

I ran a Living Social deal. (more…)

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