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Dentistry That Lasts

August 6, 2017


I started practicing dentistry in 1973…that’s 44 years ago. A lot has happened in those years. We went from the predominance of amalgam to chiefly metal free restorations. From bridgework to implants. I saw the advent of new materials, new equipment and all kinds of new technology.

Some of it, like veneers and implants, and digital radiographs changed dentistry. Other advances are now obsolete like air abrasion for cavity preparation. And some had questionable benefits, like computerized local anesthesia.

No matter how long you have been in dentistry I am sure you have seen many trends and fads come and go. That is why the best dentistry is principle centered dentistry.

I recently read a post on Facebook by an older very prominent dentist who confessed that as he got older he was becoming frustrated when he saw some of his work failing. He blamed it on patient’s non-compliance I sympathized with him. I too have gotten older and see the same phenomenon.

Years ago I bought into the idea of doing “predictable” dentistry – or dentistry that lasts. I came to realize through some pretty good mentors that the only way to get there was to do comprehensive relationship based dentistry. I was so taken by that concept that I wrote my first book, The Art of the Examination which spelled out the entire system. It’s that philosophy that attempts to create dentistry that lasts – not any trend or fad such as digital radiographs or lasers.

Younger dentists these days are enamored with the latest technology. The newer practices promote the latest fads and technologies rather than focus on great diagnosis, treatment planning and creating strong high quality relationships.

I came of age in dentistry when perennialism ruled. In other words we were taught everlasting principles that could create success through many generations. Preventative dentistry for example is a perennial philosophy. For those who have been around, I think you understand what I mean by some of the changes we see.

Less and less people see the dentist regularly. More and more full mouth implant cases are being done these days. Sure–a lot has happened culturally, politically and economically, but I still believe that comprehensive relationship based dentistry holds the answers to this cultural mismatch.

Comprehensive relationship based dentistry that is based on human universals which are features of a culture, society, behaviors, and psyche that stay consistent through time and place. These include leadership, trust, empathy and storytelling among many others.

We tend to throw the term comprehensive relationship based dentistry around as if it has lost its meaning. If we want to do our jobs properly with a sense of duty then we must do this type of dentistry.

Comprehensive means complete. If we do complete dentistry it starts with a complete exam in order to uncover every single etiologic factor of disease. Everyone knows that…it’s the practicing that makes it difficult. I am sure the dentist I mentioned above practices comprehensively.

It’s the second part—the relationship-based part where things get sticky. This is the part, I believe, that dentists truly have let go. Fully understanding and taking the time to create and maintain strong relationships is less common today than ever before. The cultural mismatch.

If the dentist is experiencing frustration because his or her work is failing because of non-compliance, then this can’t get fixed with more technical advances. These are relationship issues. These are leadership and communication issues. That is why it is impossible to do comprehensive dentistry with the human factor.

Dentistry is changing. The profession needs to step up from within. I see major gaps in thinking between the older generation of dentists and the younger dentists just starting out. There has been a paradigm shift. Blog posts and social media groups are questioning the future of dentistry.

Please weigh in with your feelings – what have you experienced and what do you see happening as we go into the future?






How is Your Charisma Score?

June 16, 2015




Presentation is ubiquitous.  Someone once said, you can not, not communicate.  Most of us fall back on our habits and say things during the course of our workday that we wish we could take back.

Everything is a presentation, and you are the message.

I realized this years ago when I read Bert Decker’s excellent book on public speaking, You’ve Got to be Believed to be Heard: Reach the First Brain to Communicate in Business and in Life.  That book set me on a journey that changed the way I communicated…to the critical emotional element of the human brain.

I have used Decker’s work for years, and now his son and daughter in-law have written a brand new updated version titled Communicate to Influence: How to Inspire Your Audience to Action. 

Some of the lessons that are discussed in both books can be gleaned from the titles:

  • Communication is mostly at an emotional level.
  • Leadership is influence and influence is communication.
  • Honesty and integrity count for everything.
  • The purpose of presenting is action.

With this in mind, why do some people seem to have it and others just never get it?  Can leadership and communication skills be taught, or do some people just have that magic “gift”?


The word charisma can be misleading.  Charisma comes from the Greek kharisma which means: divine favor, or a gift from above.  The implication is that charisma can’t be learned.

Synonyms for charisma include inspire, empower, uplift and motivate.  Now those are words I would use for any leader.

Can you be inspiring, motivating, empowering and uplifting?  I think those things can be learned.

In one word, let’s call it charisma.

In their wonderful book Communicate to Inspire, the Deckers explain a very useful tool.  They call it the Communication Roadmap.  Imagine a grid with four quadrants.  The vertical axis describes how emotionally connected we are and the horizontal axis separates those communicators who tend to be self-focused versus other focused.

Each quadrant then describes the type of communication we use: Informers (lower left), Entertainers (upper left), Direct (lower right) and Inspirers (upper tight).

Guess where the charismatic communicators go…yep…the upper right.  Inspirers…highly emotionally connected and other focused.

When you think about it, if the goal for leaders is to influence and motivate people to action, then being nice, warm and likable really works…yet the dental community seems to be just the opposite.  I know that’s a generalization but we have a reputation for being well…paternal.

Many of us are quite directive.  We tell people what they should do, because that has always been our role.  Actually most dentists lean to the lower left quadrant…we inform people.  Under the heading of educating patients we think that is most effective.

Well, informing is actually the least effective…it’s not emotionally based and it’s self-centered.  It’s self-centered because it leaves us with the impression that we have done our jobs.

After all…we told them, right?

What’s worse is that this is what is taught in dental schools and most CE programs.  It’s the blind leading the blind.

Charisma can be taught.  It must be practiced…you can’t learn it from a book…my apologies to the Deckers.

Jack Kennedy, before he entered politics was not a very good communicator.  The story that Ben Decker tells in his book is that Kennedy went to Hollywood and watched charismatic actors like Jimmy Stewart and Clark Gable.

Then he practiced (practice said Allen Iverson?), until he developed a persona that today means “charismatic leader.”

Think about what it might take for your case presentations to be better.  Better photographs?  Better explanations?  Better referrals?

Or just a bit of connection.

If you would like to learn more about leadership and communication, drop me a message…I am putting together a series of webinars.



It’s Not About the Teeth

January 5, 2015

Filed under: Leadership — Tags: , , — Barry @ 10:14 PM

Screen Shot 2014-12-18 at 12.22.40 PMEvery so often a patient enters my practice with a very interesting problem  The case that is pictured above is a good example that had me stuck. 

The patient came in with a toothache in the lower left quadrant.  She was convinced it was gum disease and wanted “laser surgery.”

Well, for those who know how I practice, I completed my comprehensive examination.  It revealed absolutely no gum disease.  What she thought was gum disease was a fistula associated with tooth #19.  But the tooth only had a small filling and I saw no reason to believe that caries was the cause.  I also noted that she had significant mobility on numbers 18 and 19.

Note the presence of occlusal disease…note the severe wear.

My biggest question was how she was able to wear down those front teeth…if she couldn’t get into the position to reach them.

What did I do?

Well, I am lucky enough to have some friends in high places.  I sent the photos and the records to twelve of my esteemed colleagues, members of my study club (that’s a plug for all study clubs).  We kicked it around for a couple of days and came up with a few possibilities.

Dentists are great for coming up with answers to tough technical problems.

I’m not going to give you the answer.  Most dentists love to solve these puzzles.  All I can tell you is that the answer was Sherlockian.

So I presented my case.

She was amazed and very happy that she didn’t need laser surgery because she could only imagine how much that would have cost.  I wondered how she would feel when I told her how much my restorative plan would cost.

The patient’s bigger problem, after the fistula, wasn’t dental…it was financial.  And it was real.  It was real to me and it was her number one priority in life.

She hadn’t worked in over two years.  She stayed home taking care of a disabled husband.  Things were difficult, like they are for many people these days.

I am not throwing this problem out to the dental community to see what types of solutions come back.  I am tired of all the “shoulds” I see on social media.

We have a big problem in this country.  Dentistry, with all of its technology and sophistication has the ability to fix just about anything these days…but the paradox is that less and less people are able to afford our advanced and innovative solutions.

As a community, we are better than that.  The dental community continues to get more and more fragmented.  Everyone has their own agenda yet we have a bigger more global problem that is growing everyday.

This is why there has to be a greater emphasis on leadership in our dental education.  I don’t know what the answer for this lady is…but it will be some combination of using my technical skills, and my leadership, planning and listening skills.  She doesn’t need a highly technical dentist to take care of her…just someone who cares enough about her.

I can fill this blog with case after case like this, most not as complex.  I see too many good people not getting dental work done because it is becoming unaffordable for them.  I would love to hear from you about what we can do as a community for this growing problem

If your solution lacks a sense of compassion, please put that stuff on Facebook or the other sophisticated dental sites.






How to Get Clear

January 28, 2013

Starts with Vision

In my long career in dentistry I notice one trait that dentists seem to have.  They seem to get in there are “do” things.  Most of the time they acquire the knowledge and then they “do.”  It’s not only dentists.  Bookstores are filled with titles that fall into the “how to” category.  The self-help genre sells millions of titles promising people how to do anything.  We all want to achieve…it comes with our software.  So we believe that the key skills for success are knowing and doing.

I would like to add one more key skill to the mix.  Maybe the most important skill of all, the one that every leader must possess to be effective.

That skill is vision.  Seeing clearly where you are going, or the “where” you are taking your patient.

We have all heard it before—Covey said, “Begin with the end in mind.”  He called it a habit, but it is really a skill. And it requires practice and developing a style.

Think about writing…even this blog post began with a vision.  There are two types of writers.  Those that just write by the seat of their pants and those that use outlines.  Some use “jot” outlines and others use a very elaborate outlining process.  But all three have some ideas where their writing is going.

And so it goes with treatment and life planning.

I recently read a quote from Dr. Peter Dawson,

“This is why I have such great disdain for the hurry up…exam.  Unfortunately, this is typical ‘usual and customary’ dentistry.  It is what most patients expect, but it certainly sets aside any competent dentist who goes beyond these expectations.”


A strong word, but I agree.  Why do dentists do a hurry up exam.  They just don’t take the time.  Most know what to do.  Most can do it.  But most don’t have a style or process of visualizing the future.  The real shame is they don’t take the time to clarify their future.

Everything starts with the examination process…a dental exam or a self exam, it doesn’t matter.  In order to find problems we must take the time, and then discover new places to go to.  Get as clear as possible.

I call the skill of vision, getting clear.

It may be the most worthwhile skill you develop.  It will turn you from a dentist to a leader.