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Wor$hiping Fal$e God$

December 29, 2014

Filed under: Art of the Examination — Tags: , — Barry @ 10:43 PM


Breaking rules always comes back to bite us.  All patients come into my practice through my new patient examination process.  Except this one time!

The patient wanted a cleaning and then have her teeth bleached.  She had a baby at home and time was a big issue…so we allowed it.  Her first appointment was for a cleaning.  When I did my examination I noted significant wear for a thirty two year old.  I backtracked and told her I needed to do a complete exam, which she scheduled.

On the morning of the exam, I overheard a conversation between her and my receptionist.  The talk was all about insurance.  If I’ve heard it once….

This time however I saw the image of that Gary Larson cartoon of a dog owner explaining to his dog Ginger what she should and shouldn’t eat (no porkchops Ginger – they cause pancreatitis), and what Ginger hears (blah, blah, blah, Ginger, blah, blah, blah…Ginger).

In other words, it’s hard to train dogs and it’s even more difficult to lead people.  The information my receptionist gave to the patient about dental insurance was just perfect.  All she heard was what the insurance covered…next to nothing.

So I did my examination.  It was great.  A wonderful opportunity for the patient to understand her own mouth and good dentistry.  Everything went as expected: sore tight muscles, a centric slip, clicking on opening, significant wear.

Then I noticed something on her x-rays.  She had no fillings, but she did have four crowns and two root canals.

I asked her, “How did this come about?  You have no history of decay and yet these four teeth have been maximally restored.”

She said it was because of the grinding and the wear.  Then she put two and two together…the slip, the clicking, the wear the sore muscles…and now the history of pain.

The ravages of occlusal disease!

No one had ever done a comprehensive examination for her.  I felt she really appreciated the diagnosis.

She got it and I felt fulfilled.  Then she turned and asked, “When can I get my teeth bleached?”

This is what dentists are up against these days.

When I thought about the insurance conversation and the examination I thought of the The Ten Commandments…you know the scene in the movie in case you never read the Bible, where Charlton Heston (playing Moses) comes down from the mountain with the two tablets.  Do you remember when he raises the tablets and smashes them out of frustration because the people were worshiping a Golden Calf?

Well, at that moment I felt like Moses…frustrated, alone, trying to convince yet another patient of the principles of dental health when all they’re interested in is the false gods of insurance and cosmetics.

Leadership is a lonely line of work. 

But it is the most important work we do.  The definition of a leader is a person who has followers.  People will follow when they get to know, like and trust…that you will lead them to the promised land…instead of the land of four crowns and two root canals.

I wish our education system put more emphasis on leadership instead of trying to get these lessons out of watching old movies.  Maybe then the idolatry will end.





Can You Hit the Curveball?

March 16, 2014

Melrose Incarnation Baseball - 060708 - 053-4x6


 Spring is coming…very slowly, but they tell me it’s on its way.  With spring comes baseball and lots of sunshine and fresh air.  I can’t wait.  I admire Major League baseball players for their skills and their devotion to mastering a very difficult sport.  Most ballplayers start early by learning to hit the ball.

They say that most ballplayers can hit a fastball, and what separates the average hitter from the very best is the ability to hit the curve-ball…or the slider…or any off-speed pitch.

It’s the same with dentists.  Most can hit the fastball…the low hanging fruit, but only the best can hit the off-speed stuff.  Major League dentistry is mostly curve-balls – from tough technical cases to tough patients, if you want to succeed in dentistry these days you must hit the curve ball.

Like learning anything it all starts with the fundamentals – hitting the fastball until proficiency develops and then adjusting to circumstances.  Just like driving a car…paying conscious attention to every detail until driving becomes automatic.

That’s why I get concerned when dentists ask me if I recommend doing a comprehensive examination on every patient.  I never flinch—my answer is always “yes.”I wrote that 10 years ago in The Art of Examination, and my reasoning holds true today, even though the business of dentistry has changed.

The comprehensive examination is the fastball.  It must be mastered before it can be altered.  If you watched me bring patients into my practice you might question “how” I do that…you might say it doesn’t look like what I wrote…but it is.

I have earned the right to alter it by doing thousands of exams-and if you really watch, they may all look a little different, but I accomplish everything I need…nothing gets left out…I just adjust for the various curves the each patient shows.

My examination process, at this point, is a habit.  It’s automatic.  That is the biggest reason I tell dentists to do the exam on every patient…so it becomes a habit…for them and the staff.

When everyone is on the same page, the examination process becomes the culture of the practice.

The collective mind of dentistry has devalued the examination process…and that’s a big problem today.

Dentistry has changed and dentists meet all kinds of resistance everyday.  Creating alternate treatment plans, and completing treatment over time are acceptable ways to help patients accomplish their goals.  As I said before the examination is your best opportunity to get to know and understand your patient.  The goal doesn’t have to be to “sell” them all the dentistry you can…the goal is to know and understand how you can help them…now, and in the future.

It’s worth the time investment…I guarantee it.  It’s a win-win.

The examination is the source of all meaningful dentistry.  If I have learned one thing in forty years of practice it’s that no two patients are the same.  They come to you with different needs and circumstances.  Your job is to figure out the puzzle—the dental puzzle and the human puzzle.  Patients are the curve-balls and we must learn how to adjust.


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Do You Recognize the 9 Signs of Practice Stagnation (Part II)?

June 26, 2012

Filed under: Business of Dentistry,Philosophy — Tags: , — Barry @ 10:20 PM

In my last post I wrote about why most people are immune to change.  In that post I explained 5 of 9 reasons I have discovered for this hesitation.  This post will describe 4 more.  I am sure there are others and I urge you to chime in.  One thing I know is that if you want to change anything in your personal life or business it will require a lot of thought, courage, hard work to create a better future.

6. We get too comfortable.  Guess what…the Golden Age of Dentistry is over.  It officially ended (more…)

Relationship-Based Dentistry Brings Satisfaction.

April 8, 2012

A new patient waited for me to do her examination.  She held a book in her hands.  When I entered the room, the first question I asked was, “What are you reading?”  She told me, and so began my preclinical interview.  I learned she was an avid reader and she was recently diagnosed with diabetes.  Audrey H. became my patient.  I completed her dentistry twenty five years ago.

Audrey never missed a dental appointment.  She always carried a book with her, and we traded reading lists.  My first questions to her were always, “What are you reading and how is your blood sugar.”

Through the years she slowly lost her ability to read.  First she went to Large-print, and then to audiobooks.  She had a difficult time controlling her blood sugar and eventually had to go on dialysis.  Through all of this, she never missed an appointment.  Audrey couldn’t drive after a while so she would take a taxi to her appointments.

Eventually she went to an assisted living facility.

She still came for her hygiene appointments. (more…)

One Thing that Will Give Your Exam Process a Quantum Leap

April 28, 2010

Filed under: Art of the Examination — Tags: , , — Barry @ 2:12 PM

I have done a lot of examinations in my career.  Readers who are familiar with my book, The Art of the Examination, know how much stock I place in the examination process.  As the years go by I only become more firm in my admonition about the importance of a comprehensive examination.  I know what it has done for my practice and career, and I know what it can do to practices when it is not included in the daily management.
As the owner of Niche Dental Studio, I get to (more…)

TAO-The Book Installment 5 – Meet Abe Maslow

April 1, 2010

Filed under: TAO - The Book — Tags: , , , , — Barry @ 10:21 PM

Maslow’s Hierarchy of Needs

My practice began to remind me of the poem by William Wordsworth, Intimations of Immortality.  I was building a prison for myself, like the one Richard Cabot wrote about in his description of drudgery.  The practice wasn’t serving me.  I was losing sight of my values.  The values that I was more in touch with as a child watching Willie.  Wordsworth was a master at describing life through natural metaphor.  You can almost feel the cycle of life I was in when you read Wordsworth’s poetry:

Shades of the prison-house begin to close
Upon the growing Boy,
But he beholds the light, and whence it flows,
He sees it in his joy;
The Youth, who daily farther from the east
Must travel, still is Nature’s priest,
And by the vision splendid

Is on his way attended;

At length the Man perceives it die away,

And fade into the light of common day

You see, the reason I became a dentist (more…)

TAO -The Book Installment 2

March 7, 2010

Human Universals

I have certain fundamental beliefs about life. One

is that we are all alike at some level, and although the stories of our individual lives – our biographies – differ, our biology is the same. We share basic needs and wants. At various stages of our lives we must fulfill those needs. Humanistic psychologist Abraham Maslow described this evolution with his famous Hierarchy of Needs. At its base are the physiological needs like food and shelter. At its top is what Maslow believed to be our ultimate goal, which is to fulfill our true selves.
Maslow wrote, (more…)

The TAO – Introduction (1)

February 24, 2010


“Success follows doing what you want to do. 
There is no other way to be successful.”

––Malcolm Forbes

In March 2002, I self-published my book, The Art of the Examination. Drawing on my 30 years of experience as a dentist, I told the story of how I developed my philosophy of practice, how important that foundation was to my everyday work, and how the initial patient examination could allow patients and staff to understand your values, share in them, and benefit from them.
Since the publication of that book, I have been asked by many dentists to provide them with a more information about the examination process.  They told me that the book should be required reading in every dental school.   The TAO of Dentistry is (more…)