Frankly, I have no illusion that I can single handedly change the quality and nature of periodontal therapy in every dental office in the world – at least not over night.

There will come a day when dentists and dental hygienists train patients in ways very similar to how they perform clinical procedures today, because that is how they will be trained themselves. Even communication within dentistry is a trainable procedure. In time, the importance of effective communication within periodontal therapy will grow to the point where it will no longer be considered an esoteric topic. Instead it will be taught as a learned communication skill requiring memorization, rehearsals and performance. Critical conversations will be planned out behind the scenes and standardized into templates similar to composing musical compositions – and every member of the office team will learn how to read the music and perform their important role in patient support. Eventually more dentists will begin to grasp the overarching protection provided by proactively training patients and their teams. Informed consent will simply be subtly built into the everyday conversations office personnel have with patients because it has simply become a part of the story and culture of the office. When this happens friction between patients and dental offices will dramatically decline. Dental teams (not just a handful of dental hygienists) will no longer simply accept that patients never will floss or that they always do. Instead they will actually and automatically show them how to do it effectively and work with them when they have difficulty getting the hang of it. And patients will change their attitudes about their responsibilities when it comes to dental care, no longer treating it like a commodity or entitlement. Instead they will actually understand and acknowledge how fundamentally important it is that they take care of themselves effectively first. How do I know all of this? Well, it’s what goes on in my office every day and what I want to show you so you can do it in yours.

Having stepped out and made all of these bold predictions, I will readily acknowledge that right now trends in dentistry actually seem to be going the other way. Patients more than in the past seem to hold others responsible to give them health and yet decline to accept responsibility for what only they can do. In large part I believe this is due to living in an intense advertising/sound byte culture that promises quick fixes to complicated problems in order to push products and procedures. Dentists and other healthcare providers in general, who know better, are, for the most part, permitting patients to live under untrue assumptions because they fear that the required patient interactions would be time consuming and fall on deaf ears anyway. Sadly, by being silent we are giving tacit endorsement to the messages others are promoting for their own benefit and not our patients’.

But it won’t go this direction forever. Bubbles burst. False assumptions are unsustainable indefinitely. And like a pendulum, rational principles of patient treatment, will swing back at some point.

So, what’s my advice?

Buy low and sell high. Become a leader and help start the movement back. Get ahead of the crowd. Speak out. Keep reading.

How long does it take to change or impact culture? There are so many variables I dare say no one knows for sure.

What we do know is that it is one decision at a time, one person at a time, and that momentum builds when choices made are positive, repetitive and strong. At the same time it’s good to remember that every good idea is opposed and that every bad idea is fixable. What can’t be fixed is the belief that nothing can or ever will change and to therefore go passive. This is not the same as accepting that some people will refuse to change in ways we want them to. The question is, should this stop change agents? Leadership always requires courage because it is the position of most exposure. It is the willingness to take slings and arrows.

 And what’s wrong with becoming a dental office culture that fights for better dental care for patients over and above other worthy goals – like lighter work, shorter work days, higher pay?

Patient care actually is the only idea, or common denominator, that can draw an office together and turn it into a team. None of these other desires are wrong, they just are not enough to improve morale and ultimately result in a sustainable business. Frankly, other than working together for the best interest of patients, team members really have little in common. We aren’t equal educationally or with regards to earnings or potential earnings. Even our personal life missions are just that, personal.

In fact, let’s face it. Everyone who works in the dental office is doing so for two basic reasons and neither is cohesive in nature. First we go to work where we do because we choose to do so. This doesn’t necessarily mean that we want to be there, but we always choose to be there, at least for now. Certainly when wanting and choosing are in line, there is the possibility for career longevity, otherwise we will choose to be where we are today and may decide to go somewhere else tomorrow. Secondly, everyone is in the dental office (including patients) because each one, independent from the others, is building a life somewhere else. They are in the office because they want something. We all have families, friends and interests elsewhere and anyone who believes that dentistry is their entire life needs therapy.

So I say the common denominator is patient care. If you can think of another, let me know.

More specifically, the common denominator is patient care within the profession of dentistry. To the extent that dental teams keep this as the primary focus will be the extent to which the practice will not just survive, but thrive, in spite of the two personal reasons each one of us comes to work in the first place.

What does a dental practice need in order to make patient care the common focus of the team?

I believe it needs at least two things. First, it needs a leader, and the leader it most needs is the dentist.

Now I can already hear people reading this saying a couple of things. First, some are saying that everyone is a leader. Others are saying that I don’t know their dentist otherwise I would know this is a bad idea. They believe that a more democratic office is to be preferred.

Both of these, in my opinion, are misunderstandings of good teachings on leadership. True, everyone has influence, and perhaps everyone has a sphere in which they are the leader, however, whenever anyone takes the leadership role of the dental practice over the dentist, the best that can be expected is mediocrity. So if I am a dental assistant, an office manager, a dental hygienist and I am offered opportunities to work in two offices, one where the dentist leads and one where the dentist is passive, I will pick the office with the leader simply for this reason. I will make more money and will work in an environment with less stress.

Good leadership stabilizes the work environment. But what about a dentist who is autocratic and harsh? Surely this individual should not lead. First, if he doesn’t lead the culture will suffer and office turnover will likely be high. Secondly, to describe what this dentist is doing as leadership is incorrect. True there is an automatic pecking order depending on who hired who and what people are paid, etc. so orders can be given and taken – for a while. But true leadership persuades and inspires. True leadership can gain cooperation from people in ways in which they feel better about themselves and others, not worse. Finally, good leaders lead themselves first. They own responsibilities including a high respect for others and personal self control. And they lead by example.

The second thing a dental practice needs to center activities on patient care, in my opinion, is a common strategy. I see this as a common message and, yes, I call it the dentist’s story. It is what this dentist believes about how dentistry helps people and how he or she fits into this vision. It is the dentist, as leader, who must own and continually teach every member of the team. The story is the script or blueprint that connects teams and patients together on the journey toward better health and better working relationships for the duration. If this sounds sappy or silly, it is because it is not embraced by the dentist. The dentist, followed by everyone else, will quickly become detached from any story when it is not personally embraced and constantly discussed.

The story sounds basic and simple, doesn’t it? It sounds to be beneath the level of the office’s combined intelligence, and that’s because it is. But it is not beneath the level of patients who didn’t go to dental school and don’t work in a dental office every day.

The purpose of this story is to put people on the same page when it comes to care and the one who needs to know it most is the patient. Spending the time telling patients how they can reestablish health and then maintain it for life is not a waste. Rather it is the foundation for forming a long-lasting alliance, one that will cause patients to trust more and send their friends and family to your practice. The story by far is the most important internal marketing strategy for the office. Having said this, many will not incorporate it into their offices simply because it requires work and the discomfort that always comes with significant change.

So now let me tell you my version of the dentist’s story. I expect you to modify it, but still I recommend you study it in depth. As I go through it here I will discuss all the principles behind the words that I can think of and within reasonable constraints of time. Shortly I will record my presentation and will show you the form I have created to document the discussion.

For today, let me simply tell you the story behind the title.

I call my presentation A Tooth has Four Parts.

It isn’t profound or glamorous as a title, but I went for functional over clever. The reason I call it this is in order to help everyone on my team know how to start the talk. Tell the patient that “A tooth as four parts.”

 Why do I start with a tooth? Because most everything in dentistry can be explained by starting here. If it doesn’t start with a tooth and it is in the mouth, it’s oral medicine. Even a discussion about dentures should begin with the tooth. But my subject is periodontal disease so I will travel down this line. If I were going to talk about veneers or a root canal, I would move in a different direction, after explaining that a tooth has four parts.

 So what are the four parts? Enamel, dentin, pulp and cementum.

 Isn’t this too much technical information?

Anything less and you are changing reality. Patients, unaware of the fact that enamel is a shell, or that dentin is more organic than enamel and thus can be utilized as food for some bacteria, or that pulps have nerves and throbbing toothaches are the result of the fact that this nerve is encased in a solid block of material that doesn’t expand, are at a loss at really understanding what it is you propose to do. Always describe normal first.

But it’s the fourth part of the tooth that is important in periodontal disease because cementum holds little fibers that surround the dentin in all directions attaching the tooth to the bone and gums. Without this understanding, patients don’t understand that bacteria are attacking a weakness between cementum and bone, or why a dental implant is fundamentally different in the way it attaches to the body compared with a tooth.

Is everything I have just told you in my presentation?

No. But everything I need to explain to a patient comes out of first explaining the parts of a tooth. Normally, what I have just shared with you takes twenty seconds or less. That’s how far into the presentation we are right now.

 A penny for your thoughts.

Until next time.