As a supplement to Lee’s tips on Centric Relation Bite Records, in this video Gary expands on techniques for capturing protrusive bite records.
If you cannot see the video, please visit speareducation/blog.
Occlusal Reduction
In this video, Lee shares her insight on occlusal reductions on posterior teeth.
If you cannot see this video, please visit speareducation.com/blog.
Courses, Cases and Cars
In this video, Frank brings us up to date on March happenings: Spear courses, a special Mastery of Treatment Planning seminar for the Spear Faculty Club, the “What Do I Do with This?” blog series and a European car club get-together on Whidbey Island.
If you cannot see the video, please visit speareducation.com/blog.
What I Learned About Case Presentation from Scaring Small Children
One of my closest team members, Sarah (the daughter of my business partner, Dr. Glen Wysel), has a delightful little daughter, Allegra. When Allegra was born, I was as excited as if she were my own granddaughter, so it broke my heart that for the longest time she rejected every move I made toward her. Every time I tried to hold her or play with her, she would break out in tears and turn away. Until one day, after yet another screaming rejection, Sarah suggested that I just stop trying so hard and let Allegra decide when she was ready. And it worked. Eventually, her curiosity got the better of her, and she came to me. She was cautious at first, but soon she began to see that I was friendly and fun, and now we get along just great. She just had to make the connection on her own terms.
There is an analogy here to how you present to patients. Just as kids get scared off by people who are trying to be too familiar too quickly, patients can have the same reflexive response (but without the tears, I hope) when presented with case options before they’re ready to engage. They don’t have your level of understanding or expertise, and your well-meaning passion for their possibilities can easily overwhelm them.
I’m not saying you need to treat patients like babies. Well, ok, maybe I am—at least to the extent of borrowing from the universal three-step process for getting through to a young child: First of all, engage at their level. That means looking for the signs that demonstrate their level of openness and not trespassing beyond that level. Second, be clear about your intent. You know that you have their best interests at heart—once you get them to know (and feel) that your intent is pure, you’re ready to move on to the final step, which is to take them on the journey. At that point, if you’ve taken the right approach in the first two steps, their trust in you will be absolute, and they will follow your lead and feel great doing it.
Yellow Gums
Do your clinical images sometimes appear to have a yellow or blue cast? The above left image has a yellow cast to it that doesn’t accurately portray what is in the patient’s mouth. The most likely cause is an inaccurate setting for white balance – how the camera’s sensor interprets white for the image.
Depending on your camera, you may either set white balance by setting the color temperature by number or to a white balance range. Go to your camera’s menu and select white balance. If you see a series of icons (sunshine, clouds, lightning, etc.) choose sunshine. That will give you a white balance range of 5,500-6,000 kelvins. If you have the option to select a specific temperature, set the camera to 5,200-5,500 kelvins.
Those settings will give you light interpretation that is close to natural sunlight and the blue or yellow casts should go away.
The “Social Proof Effect”
Do you pay much attention to those cards in a hotel room asking you to reuse your towels? Many people don’t. But one researcher, Robert Cialdini, a University of Phoenix professor and the author of Influence: The Psychology of Persuasion, found a way to get guests to cooperate. He created a card saying that most guests who stayed “in this room” reused their towels. The response beat the typical compliance rate by 33 percent.
Cialdini calls this the “Social Proof Effect,” and it is a powerful force in our increasingly connected culture. It’s not about peer pressure. It’s about peer information, and how we behave and make decisions based on the standards, expectations, and recommendations of our social groups. It’s why people share TV talk around the water cooler, and it explains the popularity of social media like Facebook and Twitter, which make it easier than ever to be plugged into what our peers are thinking and doing.
So how can you bring peer information into the practice? First of all, you can—and should—use social media yourself to connect with patients and bring discussions of dental issues into their cyber-world (I’ll have more on this in a future post). But beyond that, it can be as simple as using the social proof effect to stimulate the right responses during case presentations by saying things like: “Most patients with your kind of condition choose to…” With many people it’s reassuring—a way of validating that the choice they’re about to make has been endorsed by people like them in similar circumstances.
No, Bite on Your BACK Teeth – Part Two
We talked about this bilateral posterior open bite secondary to long term snore appliance wear in my last blog. The patient is having chronic muscle pain secondary to this anterior position. What do we do?
We started by using an aqualizer, a posterior cushioning appliance that takes the load off the front teeth and lessens the load in the joints. He experienced almost immediate relief of most of the muscle symptoms.
In his case, we might move into a full-coverage appliance without any expectation of his bite returning to normal. After several years, there is most likely tissue change that will prevent it from returning to its original position.
Assuming he regains muscle comfort and has a stable position in the joints, we can consider next steps. Prior to moving forward, though, my personal comfort zone requires an MRI and cone beam CT to fully understand all the hard and soft tissue conditions present.
Once I know where the disks are, the condition of the condyles and have muscle stability, I can consider restorative options. He will probably be restored in this forward position due to irreversible changes in the retrodiscal tissues. That may require ortho and a combination of restorations to gain adequate overjet and to close the posterior open bites.
What Do I Do with This? Tyler Part One
In the first video from Dr. Spear’s “What Do I Do with This?” treatment planning series using actual cases, Frank presents the initial findings in a fractured central incisor case.
If you cannot see the video, please visit speareducation.com/blog.
Planting Mind Seeds
Sometimes a metaphor is more than just a metaphor. New research cited in an interesting article found that, for instance, “people who were told to move marbles from a lower tray up to a higher one while recounting a story told happier stories than people moving them down.” It seems that we tend to be influenced by metaphors in a very literal way.
I find this kind of insight into human nature fascinating and instructive, and it illustrates something I have long believed about success in life: that we can be profoundly influenced by the power of what I call “mind seeds.” Ever notice how putting on a new suit can lift your spirits and make you feel more confident? How listening to an upbeat song can instantly change your mood? These influencers are all around us, and usually infiltrate our minds on a subconscious level. The trick, then, is to plant these mind seeds in a mindful way, so you can purposefully influence your thoughts and actions.
What are the triggers that put you in a positive frame of mind? What makes you feel strong and confident? Look around you. Are you in an environment that feels right, one that energizes you to diagnose at the highest level? Are your team members and patients in turn picking up that positive energy? Look for the little tweaks you can make to enhance and influence your—and their—perceptions. Plant the right seeds and you’ll find yourself cultivating a life of inspiration.
No, Bite on Your BACK Teeth – Part One
Don’t get mad at the patient; in this case he can’t bite on his back teeth. (The images are not underexposed; his teeth are really this dark). This is the result of long term snore guard appliance wear.
He has been in a snore appliance every night for five years. He noticed some changes in his bite almost immediately but was always able to get back on his back teeth. It slowly changed until he can no longer touch his back teeth.
This is a well-documented sequela of snore guard or forward-positioning appliances and should always be discussed with the patient before making the appliance. Most sleep physicians suggest a sleep study for patients whose snoring is a problem, and if therapy is indicated will prescribe CPAP before a snore guard.
If CPAP fails or the patient can’t tolerate the mask, then a forward-positioning appliance may be indicated. The consequences, of course, should always be discussed prior to beginning treatment.
Stay tuned for my next blog when we talk about treating this condition.