Zen and the art of case presentation

Dental Economics’ Chief Editor Dr. Chris Salierno likens case presentation in dentistry to Zen. He says, “I believe case presentation is an art form. We have tools at our disposal, but we should also be receptive to our environment and live in the moment.”

The history of the Zen philosophy is quite interesting. Ancient Indian meditation practices were adopted by ancient Chinese Buddhism and then spread throughout Southeast Asia and Japan. The concept was shaped over centuries by various cultures, but the core practices of mindfulness and meditation remained. The concept was brought to international audiences in part by the 1948 book Zen in the Art of Archery by Eugen Herrigel. He described how once-challenging feats (such as hitting the bull’s-eye in archery) are made seemingly effortless through years of practice and being mentored.

We can draw many parallels to our work in dentistry. An MO prep on a maxillary second molar was once a stressful, two-hour procedure in dental school, and now it takes only minutes. We drift into a trance or talk to our chairside assistants about their weekend plans, while paying little attention to the metal bur spinning at 400,000 revolutions per minute inside someone’s head. An onlooker might marvel at how mundane this extraordinary feat has become.

And yet, for many of us, there are still some daily routines in our practices that have not become, well, routine. I rank case presentation high on that list. We complete our examination and begin the process of telling someone that he or she will have to spend money to make his or her problems go away, even if the individual doesn’t realize that those problems exist. Some of us fumble through a string of awkward sentences that confuse rather than motivate. Even after many years in practice, with our bur-wielding skills at their apex, we can still botch presenting our treatment plans with a surprising frequency.

In 1974, Robert M. Pirsig published Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values, a play on the title of Herrigel’s book. One of the core themes Pirsig presented was that there are two fundamental personality types: romantics who live in the moment and rationalists who seek to understand the inner workings of things. Pirsig suggests we strive to find balance between the two. I think this concept would apply well to our case-presentation problem.

I do believe that an improved approach to case presentation will involve solid systems, preplanned phrases, and other repeatable mechanics. But that approach should also invite intuition, active listening, and paying attention to the emotions of the patient. In this issue, we have David Black, DDS, Janet Hagerman, RDH, Mustafa Shah-Khan, DDS, and Gregory Winteregg, DDS, all adopting a larger view of case acceptance.

I believe case presentation is an art form. We have tools at our disposal, but we should also be receptive to our environment and live in the moment.


Chris Salierno, DDS


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