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How did I get here?

Feb. 1, 2009
Squish! That's the sound I heard, accompanied by a sinking feeling in my stomach, when my drill sunk into the surgical site of my second-ever implant placement.

by Barry F. Polansky, DMD

For more on this topic, go to and search using the following key words: risk, risk taking, comprehensive dentistry, implants, trust, Dr. Barry Polansky.

Squish! That's the sound I heard, accompanied by a sinking feeling in my stomach, when my drill sunk into the surgical site of my second-ever implant placement. I know that neither my assistant nor my patient heard the sound. It was magnified in my head. The feeling was much worse.

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It brought back my memory of walking on a frozen lake when the ice caved and I fell through. That incident left scars. I forever became a very cautious man. It's the little things in life that affect the way we look at risk taking and how they affect the way we live. When my drill slipped through the cortical plate of bone, it felt more like taking a bite out of a cannoli … squish. Maybe placing implants wasn't a risk I wanted to take so late in my career.

The first question I asked myself — just after the silent Oh, fudge! entered my mind — was, How in the world did I get here? It was only the second implant I had ever placed, and the first was a piece of cake (and I don't mean a cannoli). My batting average was falling fast, from 1.000 to .500 in a matter of seconds. I placed my guide pin and snapped an X-ray. Perfect placement. No perforation ... a sigh of relief. My emotions changed quickly from utter defeat to unconditioned success when I corrected it.

I have been in practice since 1973. Some might call me an old-timer, but I don't feel like one. I still love dentistry and want to keep learning until the day I don't enjoy it anymore. I still go to seminars and read many of the new textbooks and journals. I have always kept up with the latest techniques and materials. Long ago, I realized that being knowledgeable in my field is part of making me who I am.

The other part is in taking the risk to actually apply what I learn. Dentistry is a profession of action. We get paid to produce a product … an outcome. So many dentists are overly concerned with production and never really think about the product.

Many years ago, when I first began, I concentrated on single-tooth dentistry — a filling, a crown — and if I was adventurous, multiple units or even a bridge. Most of my days were filled with what we called our “bread and butter” dentistry. It was mostly amalgam fillings in those days. It didn't take long before I wanted to do more. More dentistry — not in quantity but in terms of meaningful dentistry. I wanted to create dentistry that had more value for my patients. I had to step up my game. I knew the rewards, both material and immaterial would increase, so I set out to learn how to do comprehensive dentistry. Of course, this entailed more risk.

“More risk?” I hear you saying. Sure, comprehensive dentistry is way more risky than single-tooth dentistry. It requires that you take the time with patients to do a comprehensive examination, and then take the time to work up the cases. This may require a considerable amount of laboratory work. Your skill levels must improve; your ability to make and maintain relationships must improve. You must train your staff to do more complicated procedures.

And, of course, there is much greater responsibility with a case as opposed to a failed filling or post. Probably one of dentistry's greatest risks is the responsibility of effective listening and case presentation. This is where we face the fear of failure and rejection.

So, why take the risk?

Well, for one thing, production will certainly increase. But what about those immaterial rewards? If you can get through enough of those “How did I get here?” moments, you will find many great benefits. Stress reduction is one of the greatest benefits of taking on risk. I am reminded of the quote by Joseph Campbell, “The secure way is really the insecure way and the way in which the richness of the quest accumulates is the right way.”

By taking on more risk, you will probably make some mistakes, but you will learn through trial and error what works and what doesn't. You will gain more control over your work and hence create your secure way.

Campbell speaks of the richness of the quest, which I interpret as gaining a profound understanding of our field. This would be the quest of a master. With understanding dentistry at such a scholarly level comes a powerful sense of control. This leads to lower stress levels as shown by many studies in stress reduction. Lower stress leads to greater amounts of physical, mental, and emotional energy that will prolong your professional life.

One of the things I constantly hear from dentists as they get older is how much fatigue they deal with on a daily basis. Is it any wonder why the masters seem to be like the Energizer bunny? They keep going, and going, and going.

Taking on more risk also gives us more time. Doing more comprehensive cases and more surgical procedures increases our hourly wages significantly. We don't feel rushed. Recently my Pankey Study Club, The Three Knots, met in Montreal. Our assignment was to present to each other “the greatest mistake we ever made in dentistry.” At the completion of the presentations, we all noticed a theme that ran through every case: we let the patient dictate the treatment.

Our mentor, Dr. Irwin Becker, suggested that the difference between the master dentists and others is that the masters took the time necessary to make sure their cases were done when the patient was ready. I thought that was interesting, and I was reminded of a quote by the distinguished basketball coach John Wooden: “Be quick, but don't hurry.”

It's hard not to hurry in our daily practice. By taking risks and achieving a level of practice that allows us to treatment plan ideally, we create the time and the leeway to gain acceptance for extraordinary dentistry.

I think the most important thing we get from taking risks is we learn to trust. Sure, we will be disappointed occasionally, and as I said before, we will make our share of mistakes. But think of the alternative. Doubting others and doubting yourself is a much lower instinct. It is so easy to doubt and so difficult to trust, but look at all the rewards from trusting others and ourselves.

I don't want to sound like a preacher. I had to learn these lessons ... that's how I got here. Early in my career I looked at mistakes as failures. I said I was cautious, too cautious. The main lesson is that we need to take risks; we need to make mistakes and learn from them. We only fail when we give up on ourselves. I have no regrets. I am just glad I learned the lessons.

This is why — at age 60 — I still enjoy dentistry, doing more and more complex cases, even the surgical aspects that I feared years ago. There is no limit to learning. Let me cite Joseph Campbell once more, “If you have the guts to follow the risk; however, life opens, opens, opens up all along the line.”

Then you will find yourself in a place you never knew existed.

Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, “The Art of the Examination,” and publisher of Dental Life, he is on the visiting faculty of the Pankey Institute. Send him an e-mail at [email protected].

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