It is my professional mission to offer you, my valued dental patient the finest dental care possible in the most comfortable, relaxing environment my staff and I can create. Here are a few words about my philosophy as a “health-centered” dentist and how I got there.
My life’s aim is to live it with full purpose, both personally and professionally. My home and family is what grounds and nourishes me. My innate curiosity and passion for life, together with my formal and informal learning experiences have shaped my values and viewpoint, and especially shaped who I am as a dentist. My curiosity as a youngster of ten or so got me in trouble for taking apart my parent’s nice clock. I believe it was this inquisitiveness and need to know how things function that eventually led me to dental school.
After graduation, I remained insatiably curious. I soon realized that there was something missing in my dental school education. I graduated with honors, especially in the area of manual dexterity, but soon realized that many of my patients continued to lose teeth and have gum disease in spite of my best efforts. I embarked on an adventure of dental and medical post-graduate studies that helped me realize the complexity of the human body and how it interrelates with the health of the teeth and mouth – areas that were not addressed in dental school, and unfortunately, still are not. Dental school was merely a primer to the more broad, overall knowledge necessary to realize this intimate relationship between one’s oral and general health - and self-esteem. I discovered things I had not learned in dental school, such as how people who have gum disease are twice as likely to suffer a heart attack and how migraines, head/neck aches and vertigo can be directly caused by a bite that doesn’t match the jaw joints (TMJ’s).
Realizations such as these compelled me to integrate teaching into my dental practice, so that my patients could understand the basis of their dental problems and their potential implications. Then we could treat the problem and teach them how to prevent future problems. I have truly come to understand why the word “doctor” means “teacher” in several languages.
I have found dentistry to be a wonderful and challenging profession, one that is a true blend of art, science and skill. As crucial as it is to provide excellent technical skill, the one type of skill-learning that was missing in dental school was that of interpersonal relations. This leads me to my next point that was another important realization: no matter how gifted, skilled or technically gifted the dentist may be, true dental health cannot be achieved by the dentist alone. It must involve the participation and partnership of the patient as well. Realizing this necessitated a big shift in my practice philosophy – one from mainly fixing things to one of engaging my patients in a learning process wherein we would each learn our mutual roles in becoming healthy. This is why I take the time to get to know my patients, and through this co-learning process, gain their confidence and trust before we even begin dental treatment. If one has a willingness to learn and improve as a patient, combined with my expertise and passion as a dentist, the true formula for success appears! This relationship development and emphasis on patient learning is the core of what has been called the “health-centered” dental practice, to which mine has evolved. The result is that for the first time in their life, the patient understands the nature of their oral system to such a degree that they can direct their treatment over as long a period as they want with the goal of not only keeping their teeth for a life time, but becoming healthier systemically as well!
A little insight into the dental profession: Most dentists typically are not the greatest of teachers. We were selected for dental school based mainly on our manual dexterity and analytical skills, not on our ability to interact with people. We were taught to diagnose dental problems and create a laundry list of things to do to “fix their teeth.” We were trained to perform procedures on patients sitting passively in dental chairs, not involve them in learning, an interactive process. Consequently, most dental offices you see today are designed mainly for “doing” or “fixing” rather than for “teaching” and “learning.” I have made a concerted effort, over time, to gear my practice towards offering learning experiences for my patients that can empower them to take a large portion of their dental health into their own hands.
This may sound simple enough, but there are obstacles that work against the dentist developing a health-centered approach to their practice. For instance, if you are a new dentist starting out today, you are saddled with major debt. It is not uncommon for the new dental school graduate to have an indebtedness of $300,000, to which a return on invested capital including interest, as well as lost income while in school must be realized. Add to this the fact that, unlike a physician who has hospital privileges, which includes staff, the dentist must set up and operate his/her own dental “hospital” with expensive equipment and quality staff. This financial burden puts pressure on the dentist to produce, rather than to take the time to further their studies as well as teach their patients which offers no dental insurance benefits. These are the realities that tempt the dentist to be concerned more with treating teeth - reimbursed by insurance benefits - than teaching patients how to become healthy.
Another obstacle in the way of a health-centered approach is that of a dental school curriculum based mainly on developing the student’s dexterity involved in repairing mouths, not engaging the patients to improve their oral and general health. With this early mechanistic outlook, I stumbled in my efforts to teach patients who were used to only having things “done” to them. I found that I was rushing my patients into solutions to their dental problems that they had not yet owned, because of my poor approach in teaching them. It was too one-sided, as they did not yet realize that the best chance for success depended upon our becoming partners as dentist and patient. It wasn’t the patent’s fault, as I too had a lot to learn. I persisted, as I noticed early on that those patients with whom I had developed good relationships experienced the best dental outcomes. Those with whom this type relationship did not exist continued to have dental problems. This realization compelled me to continue integrating teaching into my practice. This learning journey taught me a lot about myself. I discovered that to effectively create this partnership with my patients, I would have to change my way of thinking, which was based on my early dental school experiences. Since I discovered this need to involve my patients more in the process of treating their dental problems, I learned to value more the initial time with them during the first appointments to develop trust. In medicine this is known as a “therapeutic relationship.” I was learning that without it, the process won’t get off the ground.
However, as mentioned, to allot this time is another risk because insurance companies provide little or no paid benefits for education and diagnosis that only further supports the mode of “fixing teeth.” Most patients (probably including yourself if you can admit it) are used to paying to “have something done.” To pay the dentist to take the time needed to develop a trusting relationship, and to work through a “co-learning” process, seems foreign to most patients, and I understand this. I understand that I am asking for a lot of mutual trust upfront when I suggest to you that it would be in your best interests to take this time initially to learn. For example, if I would tell you that you would benefit from special self-care training that would allow you to have better dental and general health, or that halting your headaches and excessive teeth wear would require more extensive investigation, would you be willing to spend the time and monetary investment necessary to do this, even if your insurance company wouldn’t cover it?
Dentists essentially sign on with insurance companies as a marketing move, in that the patient receives a list of dentists who are on their plan in their area. They call the dentist for an appointment with zero marketing cost for the dentist—or is that really the case? What the dentist really pays for in procuring these patients is a loss of his autonomy. Treatment decisions are based on the least costly treatments, with no preventive benefits, which fosters the above-mentioned insurance attitude from patients.
A little insight into the dental insurance industry: Insurance companies see patients essentially as “units of work” in a “factory,” to be handled cost effectively as they move along through various dental treatments. They pay mostly for basic “repairs,” not listening and learning procedures that involve prevention and the promotion of health. This emphasis on repair rather than a learning process only helps to support both the public and dentists’ low value of taking the time to learn and diagnose by offering “fix it” benefits only. The whole language of dental insurance companies presents a view of dental health not so much as a service, but as “units of things being sold,” such as fillings, crowns, partials, dentures, and cleanings. Their benefit schedules list one fee for each procedure, with no flexibility for the differing needs and individual complexities that may be involved with each mouth, tooth or patient. They offer inadequate preventive benefits and, per their own acronym “LEAT,” offer only the Least Expensive Alternate Treatment. If you become contracted with them, your fees are regulated that differ from zip code to zip code.
Other barriers encountered were finding and training staff in high-level oral assessment and preventive protocols, and developing a physical environment conducive to relationship building and learning. So, it has come to a point where a dental practice is defined based upon how it chooses to deal with these realities. Let me offer you these definitions. We now see the development of several modes, or “tiers” within the dental profession, which exist based upon the viewpoint of the dentist and his/her basic values:
Tier 1 – This is the dentist who is basically “putting out fires,” seeing patients who just want to get out of pain through having teeth removed, or basic “patch and repair.” These dental practices are heavily based upon insurance company policy, and the patient may be treated by several dentists who have little time for interaction or teaching. I would say that I practiced this type of dentistry in the earliest stages of my career after I graduated from dental school and gained a lot of practical experience having done so.
Tier 2 – The preponderance of dentistry is performed within this tier that is heavily influenced by insurance policy as well. The dentist is primarily is a “fixer,” perhaps even touting “cosmetic dentistry” to attract new patients. There is a hygienist, or multiple hygienists who clean patients’ teeth. They may educate the value of having good dental repair, having teeth cleanings regularly, and a “perfect smile,” but don’t take it much further, as they are also influenced by insurance company policy that has more to do with the company’s bottom line than the health of its enrollees (patients). I confess that I passed through this mode of dentistry as well. While within it, I discovered that there was little time to teach and provide high quality services, as the insurance companies were in essence dictating how much time I should spend with my patients. I eventually had to get out of that mode, as I felt that the regulation of my dental practice based on insurance company policy was a disservice to my patients and conflicted with my sense of ethics.
Tier 3 – This tier is comprised of dentists who become highly educated through post-graduate education in the complexities of restoring and replacing teeth. They are still immersed in a “fix-it” approach based upon the principles espoused in dental school and predominant within Tier 2, but aspire towards seeking a higher level by tackling more complex oral rehabilitations involving oral surgery, implants and full-mouth reconstructions involving both natural teeth and implants. Some advance their education in this area through formal specialty training wherein they become a recognized specialist in these areas. Having achieved formal recognition in this area grants them the right to receive higher than insurance company “usual and customary” fees for their services.
Tier 4 – This is the tier of dentistry that I aspire towards as it offers more value to my patients than each of the other three. A dentist practicing within this tier (maybe 1% or less of dentists) offers his/her patients a more holistic view of oral health and its relationship to general health. S/he has travelled through the other three tiers and found them deficient through discovering that optimum oral and systemic health cannot be achieved even by solely having the best of reparative and restorative dentistry. This tier views dentistry from a wellness and learning approach addressing the cause of dental problems rather than the “fix-it” mode of treating the results of disease. It didn’t take me long after becoming a dentist to discover that the head is connected to the rest of the body and that I needed to find educational experiences that recognized the “bigger picture” of the connection between oral and general health. During this learning evolution, it became more and more apparent that each patient is unique, with individual needs. A health-centered, wellness approach was what naturally followed this ongoing learning process. I now take the time with each patient to delve further into diagnosing their dental needs, and thus provide a wider range of preventive and treatment services. This interactive process is very important because it facilitates the development of trust. As indicated, trust is of paramount importance in the healing professions, especially dentistry. Many patients who have described past negative dental experiences to me say that the dentist spent little or no time with them from the beginning, which resulted in rushed diagnosis and uncomfortable and/or poor treatment. Trust was not given a chance to develop, so the patient eventually learned to avoid going to the dentist altogether, until their pain finally outweighed their fear. This negative experience is completely avoidable, and I have learned that the uniqueness of each person demands that they cannot just be put into “time slots” to fill appointment times on a schedule. Excellent dental service can only occur where quality becomes the constant, and time the variable, not the other way around.
I have noticed that only a few of the dentists out there have “taken the leap” and moved on to a health-centered mode. This is probably due to a combination of the above-mentioned factors. The tough question for me was, “How can I exist and be nurtured through really helping people if they only relate dental fees to things being done to them rather than engaging in a health development process? Will they pay for relationship building time, data collection and diagnostic procedures not covered by dental insurance? It was difficult and risky for me to all of a sudden change my office physical environment, staff and systems into a wellness mode, so I tried to ease into it alongside a “fix-it” mode. The question then became, “How would I manage in one facility, two distinctly different modes of dentistry and stay alive financially while doing it? I discovered the futility in attempting to “serve two masters” by providing two contrasting modes of care under the same roof. I tried for some time to “dance to two tunes,” but soon discovered that it didn’t work. I have seen other dentists try this and fail which added negativity to the mix. I still don’t know of any dental practice in which these two tiers co-exist successfully. I have discovered that if I wanted my patients to benefit as I have through the knowledge I have gained, I must cherish, and therefore allot the time necessary for my patients to realize these benefits. I must “assume the full mantle” of this rare tier, rather than tiptoeing back and forth between the two, no matter what the risks.
I certainly could not have done this alone. My staff has been selected for their expertise and health-centered values, and each has chosen to continue their learning process along with me. They all have become patients and have experienced becoming free continuing head and neck pain and understand the basis of the treatment procedures that they have undergone, therefore they have become great teachers themselves. They also see the potential for self-fulfillment through what we are able to offer our patients. They know that a health-centered practice offers the most opportunity for patients who value their health, and each member of my team strives to optimize this process to allow for excellence in dental care. My staff walks their talk having committed to their own dental and general health, which gives them a fuller realization of what we are able to offer our patients.
It is a sad fact that many people fear the dentist and suffer irreversible dental damage, not because of “poor genes,” but because they never were offered the opportunity to develop a quality relationship with a health-centered dental practitioner. My hope is that in sharing a little about myself and by defining the modes of dentistry out there, that it will help you understand the choices that you have. Like I said, it’s all out there…if you’re looking for the “drill and fill,” you can find it online or in the yellow pages. If you want just the “cleaning and whitening,” just pick up that flier that comes in the mail every so often. But if you truly want a dentist who will take the time to get to know you, to listen to your concerns and desires and help you to make informed choices about your dental future with a dedicated staff that provides excellent personal service, then our practice is the place for you.