Pagina di esempio

The basic armamentarium for great Dentistry

Surrounded by a pletora of devices, techniques and toys we easily get confused by the multitude of things that we apparently need for performing a good dentistry. Being a sports-lover it resembles the pressure for supplements you find in each sport. Nutrition is for sure a great part of every sportsman but the emphasis on supplementation is overwhelming. I recently read a book where the importance of every detail of nutrition was classified in a sort of pyramid. hence I had the idea to to something similar in dentistry. What are the most important things in order to work with a good outcome in dentistry,
What is really important and what is instead just marketing or mainly so?
I had several chitchat on this topic with some younger colleagues who were thinking they were in need of many things. My opinion instead is different. We really need few things in dentistry to perform well.

So let’s start with my “List”:
On the top of the list I place the rubber dam, I am not a fanatic and I find there are some situations where to put a rubber dam is not worthwile but, in general, in +90% of cases rubber dam is a game changer. You work more relaxed, a better view, a better access and it allows a unparalleled management of deep margins when you need to cut some soft tissues and some bleeding occurs, in these cases the rubber dam will do its job allowing you to work dry .

Immediately after I would place a good magnification system with light, teeth are small objects and the ability to manage details with naked eye is not the ideal. You don’t need microscopes or very expensive things, a simple 3,5-4 x loupes with light will do their job for a long time. Being completely honest if you re very young and your sight is stunning (like I was in my twenties ) you can think you don’t really need, but approaching some more years of work (especially after forties ) this is no more a chance.
Endodontic revolution has been brought by Ni Ti files …doing endo with rotating instruments is way more easier and faster than in the past ….it’s still very unclear in my experience the role of irrigants on the final outcome and warm gutta-percha…I started working with single cone and cement and without irrigants (just physiologic water) at all .My father worked like this for all his life (roughly 35 years ) and I have to admit that, as long as you are close to the apex during instrumentation and obturation, the rate of failures is a little bit more, but many times less than you would expect. In the same way I don’t use any kind of activator or special device for activating irrigants. In the same way I also shortened my irrigation time without any clinical difference to just the time needed for shaping, after which I immediately move to dry the canals .

In Prosthetic field I found in 2009 my “path “ in vertical preparation, I performed from 2001 to 2010 mostly horizontal ones but after my +13 years experience with vertical and its follow up I think that the never ending topic of what is better is completely closed in my mind. For doing vertical preps you just need burs and even normal flame burs available all over the world with a little more dexterity may do the job .
I was in Colonia at IDS this year and it seems all the world is moving digital, digital impression, digital modeling ,cad cam machine and so on …yet what I ve seen is just a faster workflow /especially for lab), probably most comfortable for patients…but I didn’t see a better quality of the product, if anything quite the opposite. If I had to choose I would choose a good technician working in analogically way and pay him more than spending money for some digital toys. A old fashioned PVS impression will do his job more than anything else. The same trend is on orthodontics, all the world is moving towards aligners but, again, I saw zero clinical advantages if not again the reduced time on chair for each appointment and the esthetic of the treatment. A good Niti wire and braces will do a great job, the only advancement I saw in ortho was the MEAW technique by sato but this is beyond our topic (you can easily check it on the web).

Really we need few things to work with a good outcome … maybe the only thing that makes the biggest difference is the one we never talk about …TIME.
The time you spend on a procedure is chief…you can have all the toys of the world but If you run through two or three chairs behind your schedule, everything is useless.
If you don’t spend a little time documenting your cases so that you can see your follow ups and understand what is working what is not …everything is useless .

Getting older, I also realized that a good time is also beneficial for our health, for our wellbeing, to avoid burn out, to get a peaceful environment in the office. Time is the same for everybody, we all share 24 hours a day, yet many complain about not to have time…you have all the time you need as long as you set correctly your priorities in your life. That is maybe very old wisdom, even Hemingway in his famous “ the old man and the sea “ wrote : “Now is no time to think of what you do not have. Think of what you can do with what there is “.
and time is yours.

THE THIN LINE OF VALUE IN DENTISTRY

In my 20 years Journey I realized the big challenge of giving an high value to a dental practice ? What do I mean with “value “ ? Value is a subjective topic but for sure value is NOT determined by dentists or the owner of the practice ….value is assessed by our final customers , our patients .
Our patients , of course , are not doctors so the perception of value is biased by personal “interpretations” and cognitive bias .
For the success of a dental office is chief a good “perceived “ quality of the practice by patients .
Under this point of view , we realize that giving value is something complex in our field for many reasons I am going to highlight in this article .
The funny thing is , year by year , despite my increasing skill in delivering “360° value “ to my patients and bringing forward my office , I realize that this task is always more complex than I was thinking in the past .
It’s really the famous Dunning Krueger effect : if you don’ t know this effect , it’s a cognitive bias where people with scarce experience and expertise feel more confident than more experienced ones. In my case , this worked at its best ! I was much more confident in my quality and dentistry when I was younger than now …now , despite my higher reliability in my procedures and the smoother workflow , I feel myself to say nothing more than doing dentistry at 360° is “complicated” . I will introduce several reasons because dentistry is complicated in the attempt to give an order to our daily struggle .
1)Patients are not doctors ..stupid maybe but probably the most important ..patients are not able to understand technical details and “quality “ , their perception of quality is based on different things we often take care of . People look at other “indicators “ of quality , like how the office is clean , how the office is in time , how people like ,your secretaries and assistants ,behave . A smile and a nice talk and the perception of being understood in his/her own needs is much more important than the use of rubber dam or other “quality clinical indicators “ in a talk with a patient .
2) People is not able to choose between different options …often we propose different options with the idea of giving some freedom ..instead the final result is the opposite ..patient has no means to decide and the final result is “stress” . A STRESSED patient often will decide to wait , doing nothing , or , sometimes , to look for another opinion .
3) Based on the first 2 the problem of dentistry is that we need to learn a lot about psychology , sales’s psychology and cognitive bias that affect patients and dentists themselves.
4) Courses and congresses push dentists toward an idealized version of dentistry , something that doesn’t exist in the real world, Frustration and feeling of being unlucky is the typical reaction , till you are able to realize that there is a gap between theory and practice few courses are able to fill , and these are usually not the most famous one (in my experience more famous the speaker , more idealized his dentistry )
5) Time : in other works where we sell a product , the time spent working on the “product “ is a value .Doing an extreme example when we read about pyramids and how many decades of work and number of workers were needed , that translated in our mind as a enormous value for the future owner . In dentistry , instead , time is a problem cause it’s paid by the patient with tiring sessions in the dental chair . Also the number of appointments required is an issue in the real world . The ability to develop reliable , efficient , and fast protocols in dentistry is chief in the success of an office .
6) Delivery of the service : in other fields the “product “ is made far by the eyes of the future owner , if the work is done underpaying people , in third world countries , or in dirty places this is not perceived by the customer . Just think to how easy is to buy some chicken in the market without any regret and going to a farm and asking to kill , under your eyes , a chicken . In dentistry we do our “product “ while the patient is there with us . In this way even the production and the delivery of the service become and experience that has an enormous value in the perception of the customer . An anxious dentist , despite his good technical level , will perform for a patient in a worse way than a colleague with better communicational features and a lower technical level.
7) We live in a strange era where we have often the chance to go back . You write a comment on facebook and you can delete . You edit a video , you cut it , you adjust colors , you add scenes since the result is satisfactory . You say something wrong to somebody , and , after , you are going to say “sorry” . We do things by approximation with that inner feeling we are able to go back . But dentistry is not like that . Many things in dentistry are made “one shot “ …when you perforate a pulp chamber , a damage is done, when you drill to much interaxial dentin , the same , when you clean too much dentine looking to the “yellow “ dentin of congresses you harm the tooth and so on ..Dentistry is like writing on a paper , once you wrote something , everything is there , is not like writing on your laptop and just push “delete”.
😎 Human interactions are not just between the doctor and patients but the majority are between patients and staff…so you need to develop a culture in your dental office about employees must behave with patients . You need to develop strong ideas and you must become the “ example “ of behavior for your staff..if you are rude with patients , they will feel the freedom to do the same (probably when you’re not present ), you have to become the better version of yourself . You have to become an example of behavior .
9) Communication : Words matter..how you say things is very important . I dove in several books and courses about communication , human interactions , I also read a little about NPL , there is a he world in these fields .
10) Leader ship : you need not to command staff but to do push them to do what you want , this is a complete different strategy but much more effective . If you “command “people, they will usually not perform at their best , when you are not present they will behave even worse and they will always complain with somebody else lowering the mood of the office . You will also be the first “slave “ in your practice unable to go away , cause things won’t work . Even this point should become a “course “ itself . I spent the last 5 years improving and studying on this topic.
This list may go on endlessly but I cited the main ones my mind is thinking about . Dentistry is complex …no way..if you think differently you’re new to this game or not really working 🙂.

TOXIC PEOPLE all around you

A topic we have never discussed is : TOXIC PEOPLE , in our work as dentists we usually have  a great number of interactions with other people .In our clinic we deal every day with our employees and with our patients…on average in a month I see something like 200-250 patients  and i deal everyday with my staff (10 people plus 2-3 more like technicians , financial consultants and so on ) .

Finished the work and , apart personal life like family , relatives , friends and so on ,  I have other several opportunities on social media to meet/discuss with other people and , in our case , even colleagues.

The reality is that , in every field of your life , you will have to deal with some people we can define TOXIC.

I’ve met several of these in my life (just statistic and big numbers at work !) and I realized that there are some traits in common that are helpful to identify these people . I will also highlight some strategies to deal with them .

TOXIC  people are a wide category of people but they all share a feature : their behavior is designed in order to exploit , belittle , harm friends , colleagues , relatives.

They usually have a fragile ego , well hidden below a facade of aggressiveness , extreme certainty of their suppositions.

Their aim is to feed their ego BUT in order to do this , they need to push down other people . The game is easy : he wins , you lose and you or the whole world is blamed for everything .

They are often good doing conversations and doing complex reasonings to bring people to their position . They usually tend to indulge in long monologue and they are always strong and sure of their point of view. They are usually very good at exploiting sentences or actions of other people and use them at their unique advantage , their aim is just to show your ideas and opinions are absurd and stupid .

I read a book on this topic recently and I discovered that most of the toxic people share similar strategies in their life I am going to talk about .

-they look for small defects making them bigger in order to carry on personal attacks , the main point is that they criticize in order to destroy and NEVER to make people grow or improve  ( a completely different thing and what we should  do if we are NOT toxic people)

-they easily blame others and are prey of anger

-if they can , they try to threaten  people, blackmail them  or use other similar means ; they are able to use force of fear to make people follow them .

-Love -bombing : toxic people easily follow this pattern..they  start developing  relation with people with  a high level of appreciation . Only after this stage they start their typical behavior attacking them . This is very typical in Love relation where he/she always belittle and denigrate  the previous wife/husband .

-he/she often uses a paternalistic tone treating you like a small child or stupid person.

-One of the sentences very typical of these toxic people is : “You must be ashamed” , so when you listen at this ….beware of those!

-They look as much as possible for control and they will try to put other people in the middle in order to make their strategy more effective (look for triangulation for more informations)

-They are very good in circular reasonings, they easily try to move the discussion from the subject to the person with the attempt to destroy the person and not the topic ( this is very common in politics , like in the last US presidential ; the typical politician attacking the other one not for his ideas but the person himself).

During your life you will be often exposed to these people.Of course closer they are , worse is the situation . The worst option is when you have , of course ,a toxic wife/husband . This a very challenging one …but ,apart this hellish scenario , you will find yourself dealing with them often …may be an assistant in your office , maybe a collaborator ,  a patient , maybe a colleague or friend in your personal life . Nowadays with social network it will be very easy to deal with them even online….the best way to deal with them is to drive them away . Sometimes they will try to bother you and the best solution is just : IGNORE  them . Don’t let them bring you back at their game , their diseased game .

If , for any reasons , (let’ s say you have a toxic brother …)you are not  able to drive them away you have to minimize your contact with them and to recognize , in your interactions  , that they have power on you just if you give credit to what they say .

Nobody has power on you , unless you give them that freedom .

If a very old man with advanced dementia would scream that you’re a horrible person  , you would’t take their words as real but just think  : Poor old mad man…..

In the same way , when you deal with toxic people and they attack you , you have to think almost the same. They are the problem , they have their problem , you re not the problem .

What is your personal experience and way to deal with them ?

Is talking with your technician tougher than talking to your wife?

I started dentistry thinking it was a very technical work …everything was about doing perfect details like drawing perfect shoulders, sealing cervical margins with perfectly adapted matrices, doing endodontic treatments with the precision of a sniper.

During my journey, instead, I realized that there was a fundamental skill i was lacking.
Communication.
And during my courses going everywhere in the world I realized that this is a general problem.
In the last years I dedicated myself a lot to this topic and, honestly, this improvement has paid me in several ways.
We have, on average, trouble communicating properly with our patients, with out employees, with our technicians.
We shouldn’t amaze ourselves too much, cause we experience this problem also in our houses.
How often we have troubles communicating with our spouses and we have different opinion on several topics?
Useless to say, in western countries like in Europe the number of divorces skyrocketed in the recent years because of these.
There is a strict analogy I found in dentistry, and this is the relation between a dentist and his technician.
Most of the times this is a really tricky relation.
All the doctors complain about their technicians.
All the technicians, more politely, complain about doctors.
The problem is that both of these two parties are focused on their different needs and problems.

When I started with minimal vertical preparations my technician was complaining about the lack of space. This will be a very frequent complain if you start working with vertical preparations.
You ‘re just making their work tougher and they don’t understand why.
When doctors receive a faulty work, they are much more prone to complain than think about which kind of work has been sent, most of the mistakes coming back from the lab are doctor-generated in my experience.
We work in a harsh environment and we usually over estimate our work,
We easily overestimate also occlusal reduction.
We easily overestimate lack of parallelism between different abutments…and so on.
Our technicians often just go on with the work cumulating mistakes over mistakes.
What i am talking about is a recurring topic I see all over the world.
The solution is just one. Both of two parties have to learn each other’s work.
Of course not in detail but the minimum required to understand the problems each part experiences during the work.
Just understanding lab problems we can really communicate with our technicians and realize good dental work.
Only understanding lab problems we can improve many mistakes we do in our office.
Have you ever put two models in articulator? Have you ever checked with exocad your prep? Have you ever done the preparation of the die? have you ever seen the deformation of the wax after the removal on a preparation with some undercuts?
Is your technician aware of the biological and biomechanics problems our patients have when we give them “more space”?
Are they aware of what happens to their work in the mouth after few years?
Prosthetic is a really team work and it’s not possible to work in this branch of dentistry thinking : this is not my job, this is the technician’s job!
In the same way in a football team, the player has to know exactly where to pass the ball in order to make other players do the goal, we have to know exactly how to pass the “ball” in order to make the goal.
If you wanna really thrive in prosthodontics, this is my advice : stop thinking, this is not my job! when talking about lab part.

Your job is even that!

The perfect patient

There is  a common canvas in the patients presented by the dental speaker , up there in the podium .

The patients are always well educated , able to understand all the possible alternatives beautifully exposed from the doctor , they have always high esthetic requests , they have ( or they develop during the first plan of the treatment )   a good oral hygiene and they have no financial constraints.They also , it seems , understand the high value of the dental treatment they have to go trough..

Simply the perfect patients we all would like to have in our offices .

This description was someway ubiquitous in most of dental courses and conferences .

You go to an endodontic course and you see patients willing to stay 3 hours with their mouth wide open in order to save  a tooth with broken instruments , ledges , apical lucency . …cause they understand the value of  a tooth .

You go  to an implant course and you see patients going under the third  graft from the palate in order to rebuild the lost thickness of soft tissues and improve their esthetics .

The list of perfect patients in each specialty is endless.

The problem arises when you go back in your office and your patients are anything but not perfect .

You discuss with your patient about saving a tooth because of  a deep decay ;the treatment , a normal root canal treatment , is highly predictable yet the patient decides for a simple extraction .

You talk each day with your patients and your feeling is exactly the opposite : your patients are not good ,definitely  .

The good ones are those going to the famous ’s speaker , yours are the worst ever .

And because your patients are not “good”  enough is almost impossible to perform a good every day dentistry .

The quality of your patients become one of your strongest reasons to justify your dentistry .

How many times I ve heard the sentence : I wish I could do that , but in my office I simply can’t”.

The problem is at the foundation of our education . We develop protocols and techniques for ideal scenarios . But everything falling apart this ideal scenario is not covered . This is something peculiar to dentistry .

If you go in other fields like , let’s say , engineering , the techniques , materials and protocols are tested in the worst environment before being applied in the real world .

For example aircraft’s wings are tested with a 50% increase according to expected maximum load during their life cycle .

If you study about skyscrapers and the effects of wind on their safety you will learn incredible tests and this was the incredible  ability of the skyscraper Taipei101 to withstand a wind of 233 km /h  in 2014 during a typhoon .

Back to dentistry …quite the opposite . We develop protocols for ideal situations and when conditions are just less than ideals we are alone .

And real dentistry is anything but not ideal , especially nowadays .

We have financial limitations both from our patients and the competition we have to deal with everyday from our competitors .

We have time constraints , we have to deal with multiple health problems and assumption of drugs .

I get crazy when I read the nth article on implant dentistry with a 95% success where they selected young people , without parafunctions, non smokers , good health , no periodontal problems , good oral hygiene ….cause the simple problem is that most of the patient where I place implants are people with some periodontal problems , often with  a less than optimal oral hygiene and , maybe, also smokers.

I think we can do  a “quality “ dentistry everyday in our office , but to do so we have to redesign our mindset . we have to stop , as speakers , to show just our best and share our daily struggle .

We have to redesign our goals treating our patients, They are the ones paying for our bills and our employees .

Too many times we have different values in deciding goal of treatment .

The perfect patient is  a chimera .

Looking for the perfect patient in order to do great dentistry is  useless.

We have to rebuild a “perfect “ dentistry around imperfect dentists and imperfect patients.

But the first step is to stop self deceiving ourselves : perfection is not a goal , it’s a chimera.

The value of “screaming “

I am not talking exactly about screaming or talking with a loud voice, neither doing doing something taking the lead like at Speaker’s corner in Hyde park!
It’s about our attitude towards goals, any kind of goals we do in our life.
It may be improving our technique, it maybe losing weight, or start doing some different activities.
The main problem we do is how do we approach to them.
The first seed of these action is just in our mind, it’s just an idea in the backyard of your brain.
The problem is that too many times we are not fully in that idea, we are just wandering about doing that thing, already acknowledge that the idea is a good one …but we are not really believing we will do it properly …so what we do ?
we start with a shy approach.

We start in an almost invisible way doing this new plan, probably when we have time, probably when we are in the right mood, probably when we are inspired.
Think to writing, how many people love the idea of writing something but they never start waiting for the “ inspiration “.?
The writer Stephen King once said that the most important feature for a writer is: put down their ass on that chair even when their brain is empty and start writing 2000 characters, every single day.
How many people stop their diet during the weekend thinking to start again the following week ?
The same applies to dentistry …how many courses you ve followed about a procedure and, going back to your office, you got a busy day and thought: I will try this procedure tomorrow.

Tomorrow becoming the following week, the following week becoming the following month.
I‘ve managed several courses in restorative and prosthetic procedures and what I realized doing some follow up of these colleagues was that the majority was NOT doing the technique, but not cause they were thinking it was wrong, not because of the learning curve we have also to face, but, very simply, cause they never started trying a first time.
Some, instead, start thanks to the enthusiasm of the course but get lost during the typical mistakes of learning a new work, going back to their usual routine.
We never start something, or we start weakly something in the solitude of our dental offices in most of the cases. We fail in our willings without anybody acknowledging this.
That’s what I mean about the importance of “screaming”…not to scream in the literal term..but to say to the bigger group of people possible that you’re committing yourself to do something.
I find very useful doing this, and writing a plan of how you will make this possible, to develop a detailed plan and, if possible, to take a diary, a journal to all the steps you reading ahead.
We live in the era of TouchScreen and smart devices, Yet I find a huge power in using a pen.
Journaling is sort of writing meditation. Our mind easily goes in the past or in the future losing the clarity of the plan. That small time you dedicate to writing is the best time to meditate and make detailed plan for your goals, to set some milestone, to see the progression, to reach the goal. I will make you a short example..it was a while I had the desire to learn a new language and I was looking at french, I started a couple of times but stopped after few lessons. During the spring of 2022 I received an invitation to lecture in France in Bordeaux. I knew almost zero about French and I also had the possibility to have a translator but, a back voice in my head, said: NOW or NEVER.
Despite my zero knowledge of french language I said no to a translator, I took with the french guys the duty to lecture a full day in their language. I said to my friends and colleagues that I was going to lecture in French. I did my PUBLIC PROMISE. I took back my old french manual, there were 25 chapters, I took a paper and started writing my plan, a detailed one. 9 months available. 36 weeks available. I took my lecture, it was almost 700 slides. I planned to translate all the slides in french and write all the speech. I put the goal of doing this work by 20 weeks in order to be able to train myself several times before lecturing. I divided the 700 slides in 20 weeks, just 35 slides each week, just 5 slides each day. I usually talk around 1 min on a slide so it was a realistic effort. I hired a tutor on an educational platform and I payed immediately all the lessons till January and I immediately booked all the lessons. Each thursday, one a week, from 10 to 11 pm. Doing so I had not to think to book each lesson (easier to skip ) but I had to contact the tutor in advance to move the lesson or I had to pay in case of no show. I followed my plan. Of course I had some impossible days, it’s part of daily life, sometimes I did more on Sunday to get back on the program. I always tracked my advancement. In August I completed the manual, the french grammar and to translate the lecture and I started exercising myself in order to be more relaxed.

Finally January came and I went to Bordeaux. The place was an amazing chateau and had a small group of french doctors under the organization of Dr. Jonathan Murcia. I was quite relaxed ,useless to be anxious and I had also the awareness to have done properly my duty.
I asked them to use english for some questions cause listening spoken french is still my weak area, I put bigger effort in speaking on my lecture. And I did …I did a full day of lecturing on dentistry from 9 to 5 pm. I did my pubic promise, I did my plan, I followed the plan and i got my goal.
And what’s your goal now ? not next week, not next month …right now.
Do you really want it? If yes start mixing all the ingredients you deserve for your goals.

Failure may be a part of the game, it happens. But Inaction is way more worse than trying and fail. Failing is losing a battle, and you learn at least how to improve your planning, your scheduling and your goals ,you gain experience but the real “war” is your whole life and you can just succeed in a way …starting NOW.

The dichotomy of quality in dentistry

ARE YOU PAYED ENOUGH FOR YOUR HIGH QUALITY DENTISTRY?MAYBE NOT 🙁

Maybe it’s just dentistry, cause we do this ! Most probably it’s the whole world, hidden by the popularity of the top player in each field…but the underlying feeling is always the same.
We feel that quality doesn’t pay as really deserved. What I see on a daily basis is that we are better payed doing things we don’t like to admit.
We have a paradox between ethic and profitability. An insane paradox.
The truth is that, nowadays, we are better rewarded for quantity over quality.
The truth is that we are better rewarded when we extract and replace teeth following the easy path than struggling for saving teeth.

There area many reasons behind this problem, Today i wanna address the 2 main ones.
The first is a lack of proper communication. Some can call this marketing, or whatever you want but the essence of this is always the same.
We “sell” treatments to people that don’t understand the technical details of our work, so we need to change the lexicon we use to make them appreciate what we do.
We all see people buying expensive laptop or smartphone amazed by the incredible number of apps and functions, many of them won’t be ever used at all.
We love the idea of the potential hidden in things, the social value they give (like luxury brands do in their advertising and marketing).
The Apple brand for example has been great in translating technical and raw words like frame rate, Gigabyte, resolution in more ready to grasp words like “all the music of your life in your pocket” , or
the technology behind the camera like HDR4 simply become” so that in each photo everyone looks amazing and full of sharp details”.
The ability to communicate the message for the customer’s benefit is the only way to improve the connection between quality and profitability.
Most of us still struggle accepting this idea, thinking that we as doctors have not to go” down “to the level of sales men, yet the real point is that not accepting this is to negate the essence of how humans beings interact, do their choices and their” real “behavior.
The myth of a rational human being has been already destroyed in the field of financial behavioral sciences decades ago. It’s useless to fight the reality. We have to adapt …ethically but we have to adapt. Also there is no war between” selling “and ethics, they can survive together. Selling is just a skill, how to use it it0s up to the person.

The second is “patient experience”. In contrast to most of the products available in the world where the manufacturing is done far from our eyes, in dentistry we have a very special and unique condition.
The” product “is made in real time by a human working on an other human being, completely awake and with his senses often sharpened by a little anxiety.
This changes completely the rules of the game. Beyond the mere technical quality of the work HOW we deliver the product is even more important.
A painless, relaxed procedure.. maybe seemingly effortless for the dentist will leave a greater sense of quality in the patient and an increased satisfaction.
A quiet environment where you can feel a friendly relation between people working there gives a different feeling than the same treatment developed with a nervous operator, despite the real outcome of the work.
This changes completely the rules of our game. We have to realize that the amount of time our patients are willing to spend in the dental chair and the amount of discomfort they have to bear is limited …so we have to take this in consideration in our treatments if we want our office to thrive.
This places us the question about what is really quality.. cause as dentists we are everyday exposed to some ideas of what high quality dentistry is, without realizing that often we lose ourselves in technical details adding almost zero to the real outcome of the work while consuming like a ferrari the amount of” patience and endurance “our patients have.
We have to make clear in ourselves what really is important and patients care about, and what is instead something useful just for going around with our cases and competing with other dentists.
Nobody in the scientific and academic work will teach you this.
Just people passionate on dentistry but working every day in a real office walk on this balance trying to find the right one.
That is why in the last years i spent my time trying to find the balance between giving high quality in a smart way, a way patient enjoy.
That is why I stopped performing in prostho horizontal preparations and I switched to vertical ones.
Because I ve been able to deliver great quality patients care about in a efficient way.
That is why I changed my restorative approach, far from the” detailed anatomy and colors “to a plain biomechanical friendly approach.
We like to think in absolute terms yet here we have to face that quality has two faces, the dichotomy of quality.
We have to find this balance in order to thrive.

If you wanna see how I got my balance in my office and how vertical preparations changed my life don’t miss the chance to take a seat at my next in person course in syracuse, 3 more places available or prebook my next virtual course (soon in 2023, first has been sold out in 2 weeks). Send me a private message for further informations.

 

The false myth of experienced dentists

There is a common belief in dentistry…that with time we get better with our work.
This is quite logic cause with time we gain experience but are there any real data behind this?
Reading the book of K.Anders Ericcson I was amazed by this research. According to the author, research in the field of medicine proved that doctors practicing from 20-30 years were worst than doctors just specialized.
What Ericcson found was the the mere repetition of a task every day is not, as usually thought, related to improving nor maintaining this skill.

Just doing is not enough…

I read this sentence a while ago and it was something like floating in my mind looking for some other connections till yesterday.
Reading another book (yes, you’re right! I am a compulsive reader !) I stumbled in a sentence from a great thinker, John Dewey.
The sentence was : we don’t learn from experience, we learn if we have time to think about that experience.

Reading this sentence my brain immediately made the connection with Ericcson’s one.
These sentences are so connected and meaningful together, cause this is what I see in dentistry.
The first bias we fall into is a sort of selection bias or confirmation bias.

Most of the times when we talk about experienced colleagues we look at the top of that category. But if we look to the whole segment of doctors practicing from a long time what we see many times is “not so acceptable ” dentistry …the point is that we just don’t look at these people, yet they are the majority. People working in the same way since 20 years. People bored by the repetition of the same task losing the right focus and getting even worst.

According to Ericson what we need in order to thrive is what he calls ” focused practice “, and this word is perfectly matching with Dewey’s one.

What we need to thrive infact is not only to gain experience but to gain experience in a correct way. The most important part is getting feedback.
If you’re lucky enough to have a mentor you’re already in a good position. I think that having a mentor driving you is the best accelerator of your learning curve.
Like a coach in a football team, a mentor is able to drive you, to accelerate your results.
But, unfortunately, not everybody are so lucky to have a mentor.
I hadn’t at all….just to say one.
In the ideal world each one of us would need a mentor. But we live in the real world and, for truth’s sake, this is hardly the rule.
No mentor, no help.
I still remember my early years…20 years ago …
Alone in my office fighting with patients. trying to getting better in this hard job called dentistry with its claustrophobic space and so many limitations of space.
How to solve this scenario? a real scenario for many colleagues like me at that time? Are there any solutions?
And here came to my mind Dewey’s sentence…time for thinking.
What I did in my first years was to collect documentation about what I was doing and, every day, i was looking again at my photos comparing them with the photos of books and courses trying to analyze the main differences, which steps had I to manage in a different way.

Without a real awareness I did what Dewey suggested …thinking to my experience in order to improve.

If you have the chance to read Benjamin Franklin ’s biography you will understand that his life has been a paradigmatic example of self improvement, and among his daily habits there was to retire in a quiet place and think to the spent day. He was thinking to any action, the right ones and how to make them stronger, the wrong ones and how to avoid them and he was writing strategies in order to harvest the best information from each day.

I started unconsciously doing something like this just with dental photos almost 20 years ago. .

20 years passed since that day and. .you know what? I became every year more diligent and organized in doing this sort of approach, I expanded this action beyond dentistry moving to other fields of my life.
And the result had been a huge step forward in my dentistry and in my life. The time I take for thinking and reflecting on topics related to clinical and extraclinical skills has been the most valuable time of my life.
But to think you need to build material …so if it is about clinical work you have to collect photos, documentation, data and analyze them, compare the,, check the follow up over the time. If it is about extraclinical you have to write a sort of diary and write and test your ideas. There is not a single and perfect recipe but I know the wrong one: …to think that time and mere work will bring you towards excellence.
Remember John Dewey ‘ s words : we don’t learn from experience, we learn if we have time to think about that experience.

If you wanna read more about my experience, what I learned and my struggles take a look at my free ebook ” Reality in dentistry “, you will find my mistakes, my lessons and How I arrived to choose some techniques in my daily practice…

Download it for free here: https://educational.studiomaiolino.net/ebook-reality-in-dentistry 

Not to be enough…

NOT TO BE ENOUGH…
Scrolling on Facebook and instagram some bios and some dental cases there is just a feeling you can feel …not to be enough.
Beautiful cases , beautiful people , probably wealthy people , beautiful photography.
The narrative behind these stories is quite similar .
It’s the story of a golden life with happy patients , successful cases , predictable work .
Each one of these successful guys has his own recipe for getting this .
Most of the times the recipe is not complete for all the needs you have ,but each one of them has a small recipe for success.
Follow this protocol and you will be successful in endodontics .
Follow this selling protocol and you will be able to increase your acceptance rate .
Advertise in this way and you will get plenty of implant patients.
In the last decades all over the world we have moved toward a different kind of society .
Competitivity and anxiety become the main movers of our era .
Nobody want to be below expectations so what happens is simply this : people tries to leverage your anxiety and your fears in order to see you something .
Of course the award has to be exceptional in order to push you even more .
The recipe is almost the same : push hard on people’s fears and problems in order to make the problem bigger and after make them dream about an amazing solution .
There is nothing really wrong about this approach . We know that humans are quite lazy so we have to push a little bit harder in order to make them change something .
The problem is just one …and it’s on the “seller “ …what is he selling really? which actions is he performing exactly?
Being simple ,the actions we perform in our life may be collected in 4 actions :
1. we look for improve our situation at the expense of others
2. we look for improve ourselves and in the same time others
3.we look to improve others situation at the expense of our life
4.we damage ourselves together with others.
The most frequent action I see is the first one…the problem is that often this ends up with the fourth .
Selling something with scarce value to the world , pushing the product with all the available marketing tools in the hope of selling enough so to improve his /her economical status , to improve his small personal world .
What happens after time is simply the loss of reputation and the final failure ….so..number 4: we damage ourselves together with others.
Useless to say …..the number two , the real number two , is what we have to strive for …
Improving our situation and in the same time improving others giving them a real help in their life .
So when you do your work for example and you wanna be successful what is the real goal you have to aim for ?
Make your patients happier and satisfied , your success is just the proportional measure of their success.
But to make patients happy is not just about giving a good clinical work , we are humans being with multiple needs beyond a mere “restorative work “ or a “root canal “. We are human beings with human ’s perceptions so you r real work is beyond dentistry .
That’s why for example I started focusing many years ago on patient centered outcomes and started redesigning all my dentistry toward that concept , against the traditional process or doctor centered outcomes.
And that’s why in the last years I expanded the concept of patient centered outcomes far beyond the clinical needs…
And which dentistry are you practicing ? which courses are you following?
If you wanna learn more about my approach and my idea of dentistry and the protocols I follow have a look at my ebook , it’s free and it ’s about my 20 years journey in dentistry and the lessons I learned. Download it at :It’s the story of a golden life with happy patients , successful cases , predictable work .
Each one of these successful guys has his own recipe for getting this .
Most of the times the recipe is not complete for all the needs you have ,but each one of them has a small recipe for success.
Follow this protocol and you will be successful in endodontics .
Follow this selling protocol and you will be able to increase your acceptance rate .
Advertise in this way and you will get plenty of implant patients.
In the last decades all over the world we have moved toward a different kind of society .
Competitivity and anxiety become the main movers of our era .
Nobody want to be below expectations so what happens is simply this : people tries to leverage your anxiety and your fears in order to see you something .
Of course the award has to be exceptional in order to push you even more .
The recipe is almost the same : push hard on people’s fears and problems in order to make the problem bigger and after make them dream about an amazing solution .
There is nothing really wrong about this approach . We know that humans are quite lazy so we have to push a little bit harder in order to make them change something .
The problem is just one …and it’s on the “seller “ …what is he selling really? which actions is he performing exactly?
Being simple ,the actions we perform in our life may be collected in 4 actions :
1. we look for improve our situation at the expense of others
2. we look for improve ourselves and in the same time others
3.we look to improve others situation at the expense of our life
4.we damage ourselves together with others.
The most frequent action I see is the first one…the problem is that often this ends up with the fourth .
Selling something with scarce value to the world , pushing the product with all the available marketing tools in the hope of selling enough so to improve his /her economical status , to improve his small personal world .
What happens after time is simply the loss of reputation and the final failure ….so..number 4: we damage ourselves together with others.
Useless to say …..the number two , the real number two , is what we have to strive for …
Improving our situation and in the same time improving others giving them a real help in their life .
So when you do your work for example and you wanna be successful what is the real goal you have to aim for ?
Make your patients happier and satisfied , your success is just the proportional measure of their success.
But to make patients happy is not just about giving a good clinical work , we are humans being with multiple needs beyond a mere “restorative work “ or a “root canal “. We are human beings with human ’s perceptions so you r real work is beyond dentistry .
That’s why for example I started focusing many years ago on patient centered outcomes and started redesigning all my dentistry toward that concept , against the traditional process or doctor centered outcomes.
And that’s why in the last years I expanded the concept of patient centered outcomes far beyond the clinical needs…
And which dentistry are you practicing ? which courses are you following?
If you wanna learn more about my approach and my idea of dentistry and the protocols I follow have a look at my ebook , it’s free and it ’s about my 20 years journey in dentistry and the lessons I learned. Download it at :eautiful people , probably wealthy people , beautiful photography.
The narrative behind these stories is quite similar .
It’s the story of a golden life with happy patients , successful cases , predictable work .
Each one of these successful guys has his own recipe for getting this .
Most of the times the recipe is not complete for all the needs you have ,but each one of them has a small recipe for success.
Follow this protocol and you will be successful in endodontics .
Follow this selling protocol and you will be able to increase your acceptance rate .
Advertise in this way and you will get plenty of implant patients.
In the last decades all over the world we have moved toward a different kind of society .
Competitivity and anxiety become the main movers of our era .
Nobody want to be below expectations so what happens is simply this : people tries to leverage your anxiety and your fears in order to see you something .
Of course the award has to be exceptional in order to push you even more .
The recipe is almost the same : push hard on people’s fears and problems in order to make the problem bigger and after make them dream about an amazing solution .
There is nothing really wrong about this approach . We know that humans are quite lazy so we have to push a little bit harder in order to make them change something .
The problem is just one …and it’s on the “seller “ …what is he selling really? which actions is he performing exactly?
Being simple ,the actions we perform in our life may be collected in 4 actions :
1. we look for improve our situation at the expense of others
2. we look for improve ourselves and in the same time others
3.we look to improve others situation at the expense of our life
4.we damage ourselves together with others.
The most frequent action I see is the first one…the problem is that often this ends up with the fourth .
Selling something with scarce value to the world , pushing the product with all the available marketing tools in the hope of selling enough so to improve his /her economical status , to improve his small personal world .
What happens after time is simply the loss of reputation and the final failure ….so..number 4: we damage ourselves together with others.
Useless to say …..the number two , the real number two , is what we have to strive for …
Improving our situation and in the same time improving others giving them a real help in their life .
So when you do your work for example and you wanna be successful what is the real goal you have to aim for ?
Make your patients happier and satisfied , your success is just the proportional measure of their success.
But to make patients happy is not just about giving a good clinical work , we are humans being with multiple needs beyond a mere “restorative work “ or a “root canal “. We are human beings with human ’s perceptions so you r real work is beyond dentistry .
That’s why for example I started focusing many years ago on patient centered outcomes and started redesigning all my dentistry toward that concept , against the traditional process or doctor centered outcomes.
And that’s why in the last years I expanded the concept of patient centered outcomes far beyond the clinical needs…
And which dentistry are you practicing ? which courses are you following?

If you wanna learn more about my approach and my idea of dentistry and the protocols I follow have a look at my ebook , it’s free and it ’s about my 20 years journey in dentistry and the lessons I learned. Download here!

The frustration of the invisible quality in dentistry

The work we do is often invisible to the eyes of our patients … Do they know the quality of the adhesive ? the brand of that expensive implant ? or the diligent “know how” hidden in a procedure ? “know how” maybe developed during a long course travelling abroad.
There are details of quality that we are the only ones able to see and recognize and we feel often frustrated….. a lot of work, a lot od care to details for what?!’ nobody knows, it seems nobody cares.
And after all your care you have maybe a patient asking : Why this treatment, doctor, is more expensive in your office than others ?!?
The world collapses in these moments…I know. .cause I ‘ve been there.
I had the feeling I was doing that sometimes just for a sort of feeling of “duty” without any reward for my effort. Just the fear of feeling guilty was bigger. So I was going on with a slight sense of frustration.
But That was just the surface …finally I understood what was beneath the surface …and it was when I started reading about a sport I was not really aware of ….Aikido, a martial art.
A good Aikido athlete when goes over the ring (tatami ) is dressed with a special dress (called hakama), this uniform has very long and wide pants completely hiding the feet.
Coming over the ring the athlete will take his place before the match…. sitting in a traditional position (za-zen) :
Knees of the floor, weight on their heels, straight back, a neutral expression on their face and, despite nobody will recognize this …they will force themselves to put the big toe of the left foot over the big toe of the right foot.
Everything happens under the big pants covering feet.
Who could recognize that he is performing everything int he right way? the answer is easy…
Nobody but himself.
Doing this small gesture he is taking a commitment with his teacher, with the art of the discipline he is training for and, moreover, with him self.
Knowing he is performing in the right way gives harmony to the soul of the person.
Knowing that he is doing the right thing shapes his behavior in order to improve his discipline.
The discipline he is building, along the time, gave him the strength to struggle for a goal.
The discipline he is building, is the key to improve the trust in himself and the motivation to overcome the struggles of the life that, soon or later, always arrive.
The discipline he is building soon or later will grow in something other people can recognize..confidence.
So when you re figthting in silence on your dental chair, don’t think you re doing this without a reward.
It’s a ritual you ‘re doing, a ritual where you’re building discipline, determination and confidence in yourself.
You have to wait for the reward…it’s not about doing this a couple of times but hundreds of times.
Like all rituals, the daily gain is invisible but, along time, the result is huge.
Patients recognize the confidence you have built in yourself, and they are attracted by people with real confidence, they accept their treatment plan and they are willing to pay more.
But gaining confidence is not something you can buy, or that you can obtain with shortcuts.
Gaining confidence is a long process, day by day, and everything starts like in Aikido with two big toes in the right, maybe painful, position ….with a neutral and relaxed face waiting further instructions from their sensei, their teacher.
So when you re struggling on your dental chair doing the right thing, don’t think you’re wasting energy, don’t think to the feedback of that single patient.
You’re building something greater…
You just need time.

If you like my articles , have a look at my free ebook on dentistry and what I learned in the last 20 years . Download it at https://educational.studiomaiolino.net/ebook-reality-in-dentistry/