What do you see? Looking at the bigger picture

Let’s take a look at our practice routines for a moment. When a patient concern prompts a visit, how do we respond?

Frank M. Spear, DDS, MSD

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Let’s take a look at our practice routines for a moment. When a patient concern prompts a visit, how do we respond? Do we focus solely on the area needing attention, successfully treat the concern, and conclude the appointment? The problem is fixed, the patient is happy, and we have provided treatment. But have we given the patient, our practice, and dentistry the best service we can?

If we practice in this "drill, fill, and bill," only-fix-what-is-broken mindset, we miss opportunities to engage the patient in the discovery process, to provide regenerative and ideal treatment, and to change the patient’s thinking about his or her dental health. In addition, after several years of practice using this model, we may become weary of dentistry, think "Is this all there is?" and wish that we had a way out.

More than 25 years ago, just out of my perio-pros program and under the auspices of a trusted mentor, I made a conscious decision to engage each patient in discovery at every opportunity. I still do it today.

You treat what you see. You see what you know. What do you see? These three phrases guide my thoughts in patient interactions, and help me see more than the patient’s chief concern during an exam.

What do you see?

What you see represents the beginning of all treatment the practice will ever complete, and it necessarily encompasses patient concerns. Just like us, patients know only what they see (or feel), and that is all they can tell us. They generally come to us with a limited viewpoint of their dental health, and they share information only if they believe there is some reason we should know about it. Consider the patient who presents with significant wear at an early age, who when asked if he or she has noticed the damage to dentition, responds, "Not really; isn’t wear normal?"

The patient’s chief concern must be heard; it is often the primary reason he or she is requesting services. But if we limit the exam only to areas in which the patient expresses a concern, we are shortsighted at best and negligent at worst. We discuss the chief complaint, place it into a context around the exam experience, and continue to gather more information.

What you need to know

Quite simply, everything. Our desire to have patients experience a lifetime of dental health means that we must gather all of the diagnostic data on each and every patient of record.


Spear Practice Model

Collect all information necessary for diagnosis and patient education, regardless of the manner through which the patient enters the practice.

  • Test for muscle pain, tenderness to palpation, hypertonicity, and movement through a normal range of motion
  • Evaluate joints for comfort on palpation, comfort with load, comfort through translatory movements, locking or limitation to normal movement, and joint sounds
  • Examine dentition and supporting structures
  • Measure sulcus depths
  • Note any tissue changes: recession, clefts, dehiscence, hypertrophy, inflammatory reactions, bleeding
  • Examine teeth for sensitivity, caries, mobility, cracks/fractures, wear, fremitus
  • Complete radiologic and photographic exams


The Spear Practice Model takes into consideration how the patient’s teeth look, how they work, how healthy they are structurally, and the health of the gums and bone. This is a lot of data, but it can easily be gathered and recorded in the time allotted for an interactive comprehensive evaluation, or for most patients, in 30 minutes at an initial examination. Once the data has been gathered, answers to all the questions are there for you.

What you need to do

  • Learn to see. Our Facially Generated Treatment Planning and Occlusion in Clinical Practice workshops focus on what you see, and present systems for broadening perspective.
  • Design systems with your clinical team that create transparency in the collection of data.
  • Orchestrate what is done and said in your practice with intent so that the message is consistent.
  • Create opportunity for patients to see discretionary and regenerative dentistry as something they want for themselves.
  • Invest the time to answer your patients’ questions, develop awareness, and create desire for comprehensive dental therapies.

As the founder and director of Spear Education, Dr. Frank Spear continues to be recognized as one of the premier educators in esthetic and restorative dentistry in the world. He and long-time practice partner, Dr. Greggory Kinzer, maintain a private practice in Seattle limited to esthetics and fixed prosthodontics. Dr. Spear can be reached through www.speareducation.com.

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