In my last post I said that the introduction of dental insurance has led to a mindset in many patients – the “Anything That’s Covered” (ATC) mindset – that has become a barrier to ideal care. But that patient mindset has, in many cases, also led to a clinician mindset – one that feeds off of and plays into this kind of thinking.

It’s a natural human reaction. You hear the “no” repeatedly from “ATC” patients, so you begin to anticipate it. And because you don’t want to keep hearing it (nobody enjoys rejection, after all) you begin to alter your presentations to accommodate what you think patients want to hear. You start self-censoring based on the perceptions you have of what they think their needs are, and what you think they will accept. And when you do that, you’re both playing a self-defeating game.

Even when you do present the absolute best treatment plan for them, you still often end up playing the game. “There’s no way I can do all of that, doctor,” the patient says. “What should I do first?” What they’re really asking is: “Which part of this treatment plan is not really necessary?” They want to divide it into the “needs” and the “wants” and the “wants” usually end up losing to other more exciting priorities. And they want you to help them prioritize; they want you to tell them which part of their treatment it’s ok to say “no” to.

If you want proof that allowing yourself to be pre-programmed by the “no” is self-defeating, you don’t have to look any further than the surprises. There are the patients who you know very well can afford it but who unexpectedly refuse even basic treatment. But there are also the good surprises – the ones you thought could never afford it but ended up saying yes. That’s not to mention the ones who ask you for treatment you didn’t even present.

These patients are living evidence that it does not pay to make assumptions. This is why you need to fight the impulse to play into the limiting mindset. You have to immunize yourself against the “no” reflex and make the commitment to “go in fresh” every time. A “no” today just means you fulfilled your obligation to present to the fullness of your ability. It’s just another opportunity to build the relationship further tomorrow. Stay committed to that purity of purpose and, over time, there will be more pleasant surprises in store.

Great dentistry is what it is, and being a great dentist means standing by that commitment to always say what you see, to educate, and to take patients on a journey towards valuing quality care.

If you note where the lesions are present, mostly on the facial surfaces and more cervical, that would indicate an extrinsic acid source. There is no palatal erosive pattern that would indicate either GERD or an eating disorder. He denies fruit mulling, fruit sucking, soda swishing, or any other common cause of erosion.

I am out of ideas for the causes of his erosion; in addition I’d love to know what you all think about the very prominent texture of his maxillary anteriors. Is it related to his erosion?

I need your help here, I really don’t know what is happening, and all ideas are welcome!

But the insurance breakthrough did something else too. First of all, insurance providers also introduced a lot of limits: limits on fees, on payouts, on types of treatment, on which dentists patients could see, just to mention a few. Most importantly, perhaps, they eventually created an artificial (but real) barrier in the minds of many patients – a line they draw between two kinds of dentistry. Below the line is dentistry that is covered (and therefore “necessary” in their minds); above it is dentistry that is not covered (and therefore “optional’ in their minds). This is the dentistry that has to compete with TVs, iPads and vacations for discretionary dollars.

But of course the fact is that dental insurance isn’t really like any other insurance we have come to know. When you buy insurance for your home or your car, or life insurance or that matter, the process is the same: you shop around and select a provider, they perform an assessment to determine your needs and their level of risk, and set your premiums accordingly. What’s your driving record like? Is your home in a high-risk flood zone? Are you a smoker?

But for dental insurance, there is no exam performed and no evaluation of needs versus risks. The insurer (who is usually chosen for you by your employer) draws a line of coverage for everyone in the “plan.” That’s the line that many people have in their minds when they think of dental care. And it has nothing to do with their individual dental care needs.

Dentistry has spent decades supporting patients on their dental insurance coverage because, after all, it’s still an important benefit for patients who have it and they have every right to want to use it to its full potential. But the system has also trained patients to develop what I call the “ATC mindset” of dental care: “Anything That’s Covered.” Many, if not most, patients think in terms of what is paid for, rather than what is needed to achieve ideal oral health.

That’s a big mindset barrier to overcome. And it becomes even more difficult when you fall into similar mindset traps yourself – which is what I am going to address in my next post.

Teeth interact differently with light than many other objects in nature. Teeth fluoresce. This means that they will emit visible light when exposed to ultraviolet light. To make it simpler, the light shining on the tooth versus the reflected light is a different wavelength.

Why is this important? Because light is changed BY the tooth.

Let’s take an example of another optical property that is influenced by the tooth: Gloss. A porcelain crown in its bisque bake stage versus glazed and polished looks different. Is it different? The answer is no. We changed the tooth’s gloss or the smoothness of the surface.

These are two examples of how the object can influence our perception of the shade. What is the take-home message? If light is changed by the object and if different objects reflect light differently, then the restorative material you choose (and its underlying substructure when required) matters! Depending on the clinical situation (reduction of the prepared tooth, position in the arch underlying tooth color, etc.) your laboratory may recommend one type of restorative material over another.

Picking the final desired shade is an important step, but understanding that other factors influence our perception of color is also critical to the decision-making process of shade and material selection.

Wait until you see this:

When Glen and Lisa were there only a few weeks ago, they were looking at a bare patch of land. I could hardly believe my eyes when photos like these arrived in my inbox several days ago – pictures of how the whole community came together and accomplished so much over the course of one weekend. In fact, in just about six weeks they have been able to take this project from vision to reality.

Workers laid the foundation and then more than 100 volunteers from the community came to help raise the walls of their new facility…

And before long they were unpacking equipment and setting up…



I look at these pictures and my heart soars. This is a perfect illustration of what I meant in my last post about the power of belief, and how you have to believe it before you see it.

Take a look again at that child’s drawing:

…and compare it with the reality we see in the pictures above.

That’s the power of belief.

I have to thank all the people – the people in Peronia, the industry leaders who are donating equipment, the people like Patterson L.A. Branch Manager, Jason Owens, who sent a small team to help with the installation of equipment, the dentists who are donating their time and money – for believing with us. If you want to find out more about exactly what we’re doing, go here.

We welcome you to join us.

Update: This post was written just before I left for Guatemala last weekend to attend the opening of the clinic. The events of that weekend have had a profound effect on me and I can’t wait to tell you all about it in an upcoming post.

In my last blog we discussed the four pieces to the shade-taking puzzle. Let’s take the first piece: The light. There are two aspects to this variable that we need to keep in mind: light quality and light quantity.

Light quality relates to the degrees Kelvin (K) or color temperature. You want to look for light sources that are closest to 5,500K, which is ideal for dental shade matching. Illuminants with the nomenclature of D50 fulfill this requirement. So-called “daylight” bulbs are available which can have range up to 6,500K. Color-corrected lighting is available from dental product distributors and home improvement stores. Any source for the bulbs is acceptable as long as it has the D50 designation.

Light quantity relates to the intensity of light, and can be measured by a light meter. The range of acceptability that you should strive for in the operatory is 150 – 200 foot-candles. The amount of light can be of concern in one of two situations: One is where the patient chair is situated directly in front of a window, and the other is in an operatory that has no natural daylight source.

Having the correct quantity and quality of light is a great starting point for accuracy in shade selection.

I followed the protocol I’ve learned from Spear for many years, prep to the free gingival margin, place first cord (#00 in this case), position margins as necessary and finish, place second cord (#1 in this case), let sit a bit, take the impression. I’ve followed that protocol for many years and it’s still a banner day when I can get them all, or even almost all. Hope all of your impressions today are perfect … or so close that the second one is just comfortable.