I want to do the BIG cases!

New to dentistry, I proudly took my place in the ranks of my chosen profession. I had high anticipation for reaping the reward of 20 years of academic pursuit...

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by Gary DeWood, DDS, MS

New to dentistry, I proudly took my place in the ranks of my chosen profession. I had high anticipation for reaping the reward of 20 years of academic pursuit, years of self-denial, years of discipline, and long nights. Sitting among my colleagues around the table at the dental society meeting, I listened intently as they discussed dentistry. (Wow! I was a colleague.)

There was so much I needed to learn. In the months and years that followed, I found a place at many tables, in many meetings, and tried to tap into that gathered wisdom. I learned much from these shared meals and experiences, and I became firmly convinced of one constant. It didn’t matter where I sat or who was at the table, it always seemed that the only dentistry being done was BIG cases. Everyone was doing them.

I tried to melt into the background, in great fear that they would ask me how many full-mouth reconstructions I had started that day. The answer, of course, was none. What was wrong with me? If all of the other dentists in the world had practices that were made up completely of big cases and mine was not, I must be a hopelessly inept dentist (and there probably wasn’t much hope for me as a person either).

I worked hard to convince patients that a quadrant of amalgams was better than doing one at a time, let alone a mouth full of crowns. The big case dentists were successful and confident; they had patients knocking their doors down, begging them to do their big cases. They had beautiful offices, their children were brilliant, they didn’t need to lose weight, and they were better looking than me. I wanted to do the big cases. I wanted to be a BIG CASE DENTIST.

I dreamed about a future as a big case dentist. It was compelling, but it was also frightening. The big cases must bring big headaches. I thought of the struggles I had making my small cases work. If I had to grind to seat one crown, what would grinding on 28 crowns be like? What if I had to remake an entire case instead of one crown? Still, I really wanted to do the big cases! I just needed to learn how.

Learning the skills

I was quite certain that when I had learned the skills to do big cases, my patients would never again want me to “just do one crown.” I saw them imploring me with “Give me your best stuff!” So I went to The Pankey Institute to learn the technical skills needed to be a big case dentist. The skills I learned were:

  1. Evaluation
  2. Diagnosis
  3. Interactive thought with specialties and laboratory professionals
  4. Visualizing the result before beginning
  5. Knowing the tools and materials which will produce that result
  6. Practicing the application techniques that bring all of it to reality

I worked hard. I learned that the concepts are applicable to every case, whether it is a single crown or a reconstruction. The concepts remain constant.

Sure, some of the big cases have really big sequences, but the process of thought makes every case the result of straightforward thinking and application. The big cases didn’t seem so big anymore. I could think through them one step at a time, and they worked predictably. I was a BIG CASE DENTIST! I sat back waiting for the rush to begin.

The real story begins

This is where the real story begins. I was quite certain that because of my newly-acquired skills and my new level of understanding that the big cases would inevitably find me. I had the knowledge. I had the skills. I had the answers. I was ready to go to dinner and take my rightful place at the table. As time passed, I went through feelings of disappointment, resentment, and anger. I did not have the piles of big cases I thought I would.

I was doing everything I was supposed to do. I did a very thorough examination. I had the patient return for a discussion of findings. I presented clearly and concisely the necessary services from my ample bank of incredible skills ... the solutions that would return my patients to optimal dental health. How could they not see the logic of my thought? And yet, flying in the face of this irresistible force, most chose not to partake of the skills I had learned.

My anger turned to hatred.

I needed to find some new patients; these were obviously not the right ones. There must be some place where they would “get it.” (It’s the same place where the sun always shines and all the children are above average.)

The real truth

Then, I discovered the real truth behind BIG CASES, and the truth is that ALL CASES ARE BIG CASES!

L.D. Pankey once said, “I never saw a tooth walk into my office.” I disagreed. I saw lots of them. Unfortunately, the teeth didn’t want what I had worked years to provide them. Maybe I just wasn’t making it clear enough. Maybe I needed to create a better presentation. Perhaps I needed to be trained to handle objections posed by the person the teeth were hooked to. What would happen if I had better technology so they could see the benefits of my incredible plans for their teeth and get the message? I had to believe that the teeth were on my side! If only I could get the people who had the teeth to see it. I am the doctor, after all! Don’t they know that I know what’s best?

They say when the pain gets bad enough, you will open your eyes to the truth around you. It got bad. The truth I saw was this … it’s not about me! Unless and until the patient can see what you recommend is a benefit that exceeds all of the costs, he or she will not be motivated to action.

This motivation is not about knowledge. It’s about feelings - feelings of want, based on the things that they value. You can never learn to handle the patient’s objections. Only the patient has the power to do that. You can never show the patient why he or she needs to do something. Your patients will do whatever is in their best interest … as they see it. You can never show them that you have their best interests at heart by telling them you do.

A new definition of big

I’d like to offer a new definition of “big”: “If it’s my mouth, it’s a big case, and every case is somebody’s mouth, so they’re all big.” If you want to learn to treat technically big cases, you only need to seek the experiences and information that will allow you to develop the skills necessary to do that. I have an obvious bias regarding where you can best get those, so I’ll just say, “Identify what you want to learn and seek it.” If you want to treat all of the big cases (including the technically big ones), there is some additional discovery you may want to consider. That discovery will take you away from yourself and into the experiences of those you serve, not those you fix and not those you help. “Fix” and “help” are power words that give you the power to apply them … or not. When we serve, we leave ourselves at the door.

The Pankey Institute taught me what I need to know to be aBIG CASE DENTIST. It can teach you the same.

As the years have passed, I have come to understand that much of what I “heard” at those dinners was created in my mind. So much of what we do is hard work, uncomplicated and straightforward. The cases that we talk about are the ones that excite us, and why not? Most of us have no one to share the excitement with. The dental society meeting is often the only interaction with people who appreciate the technical intricacies of what we do. Maybe some of the big case dentists did expand reality in their excitement, but what’s the harm? I saw what I wanted to see in them because I wanted what I believed they had. I wanted to be a big case dentist. I AM.

Gary M. DeWood, DDS, received his degree from Case Western Reserve University in Cleveland, Ohio, in 1980. He has run a successful private practice since 1981. In 1995, Dr. DeWood became assistant professor in the Department of Otolaryngology at the Medical College of Ohio. He was appointed Visiting Faculty member of The Pankey Institute in 1993 and is currently the Institute’s Director of Marketing, as well as clinical and business instructor. Dr. DeWood is a member of the American Dental Association, the Ohio Dental Association, the Toledo Dental Society, the Chicago Dental Society, the American Equilibration Society, the Academy of General Dentistry, and the Academy of Fixed Prosthodontics. In 1980, Dr. DeWood received an Academic Award from the Pierre Fauchard Academy. Since 1993, Dr. DeWood has presented on numerous occasions, both nationally and internationally.

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