Complex Dentistry: Overcoming Hurdles to Make Cases Less Stressful

Is doing bigger or more complex cases one of your goals? If it is, you're not alone. It's a common goal, especially for Spear dentists committed to extensive or high-level continuing education beyond dental school. However, as you start down the road of doing bigger and more complex cases there may be some hurdles, but there are ways to overcome them and keep stress levels low.

Unfortunately, many think that having the technical skills and knowledge is all that's needed to carry out these types of cases, but there is a lot more to know to keep these cases under control. Even if you have all the skills in the world but you can't conquer the other hurdles that complex cases bring with them, you'll end up creating a stressful nightmare for you, your team, and your patient. I know too many dentists who take on complex cases only to return to simple ones because they found it too stressful.

So, what are the hurdles that make these types of cases so stressful? And how can you avoid them?

Hurdle #1: Communication

After technical knowledge and skill, communication is the most important attribute you must master. If you can't communicate well, it won't matter much that you know how to do a case. I can't emphasize enough how important the role communication plays with all of those involved in the case — from the patient and your practice team to specialists and lab technicians.

So, when it comes to complex cases, what is excellent communication? Fundamentally, it is sending and receiving clear messages. For instance, if you send what you think is a very clear message, but the receiving party misunderstands it, that's poor communication. Or if you receive a message from another party that isn't clear to you, that's poor communication. This clear message sent, and clear message received is critical for complex cases.

To be a good communicator means being proactive. If you are unsure if the message you sent was received clearly, it's best to err on the side of it probably was not, and you should reach out and ask clarifying questions like, “What's your understanding of XYZ?”

When it comes to patients, it's important to clearly define their goals. This is often best uncovered by asking simple open-ended questions and waiting for and listening to their answer. For example, “Tell me what you hope we can do for you?” or “What do you wish was different about your teeth?”

What's key is waiting and listening for their answer. After you ask the patient an open-ended question, stop and don't say another word. Don't speak again until the patient responds. It may seem like an eternity, but I can't stress enough how important it is to wait. Most people don't wait more than a split second for an answer after they ask a question. And, if you must, silently count in your head if it helps you from speaking while you wait for their answer. I know it may seem like forever, but it's not.

When it comes to your team, it's important to clearly define what they need from you to do their best job and know their communication preferences (i.e., phone, email, text, in-person, etc.). For example, I work with some specialists and labs that communicate via email, while others prefer texts or phone calls. And there are times when an in-person meeting is needed.

Additionally, have open conversations so everyone on the team understands each other's capabilities on what they can and cannot achieve. There may be some things I would love to have the lab or specialist do for a case, but because of our open conversations I understand it will be impossible. Sometimes, the lab or specialist may want something from me, but it is unachievable, as well. Sometimes patients ask for something that can't be delivered by anyone working on the case.

Defining goals, understanding what can and cannot be achieved, and communication preferences are all things that must be discussed upfront and with everyone involved for the case to go as smoothly as possible.

Even if you are a skilled communicator, it doesn't necessarily mean other team members working on the case will be just as good, especially when it comes to specialists and labs techs. If those involved are weak communicators it affects everyone. However, the better you are at communication, the more you can help make up for others' weaknesses.

As you get better at complex case communication here are some important reminders.

1. There's always room for improvement. Even those who are considered master communicators can still make mistakes and are constantly working to improve.
2. It takes deliberate effort. At first, you may find communication difficult, but it does get easier. However, it's an ongoing effort. Like so many things in life, no matter how good you are, you are still prone to mistakes.
3. Start with your office team. If you can't communicate with your office team, how can you expect to do so with others? Start down the better communication road with your internal staff.

Hurdle #2: Planning

The next hurdle to overcome when taking on complex cases is planning, which is connected to technical skills and knowledge, and communication. For planning to be effective, you need to know or determine who on the team is going to do what and when. One tool I use to help plan complex cases is a flow chart. A flow chart lets you and your team see a case progressing. Look at an example of one of the flow charts I made for a case (Fig. 1).

The flow chart also includes a decision tree because there were variables and unanswered questions prior to starting the case, like if some of the teeth were going to be able to be moved with orthodontics or the possible need for jaw surgery. Also, this chart indicates who on the team is doing what and the projected time frame. (If you want to read about this case go to, “Replacing Teeth and Tissue Using a Mini Bar”

Hurdle #3: Your Team

What's the final hurdle to take on complex cases? You may have guessed it by now, but it is your team — both your office team that you work with every day and your team of specialists and labs that you work with on a case-by-case basis. While teams can be the hardest or most elusive to get in place, the rewards of doing so are immense. Just like the other hurdles, it takes intentional effort to make a good team and one of the keys to help you develop a great team is great communication. Here are some other tips:

1. When it comes to hiring team members it's better to hire people who possess character, a good attitude, and work ethic versus just skill and knowledge. You can teach team members knowledge and skills, but trying to teach someone to have good character, attitude, or work ethic is incredibly difficult.
2. Be clear about what you expect. It's important to set clear expectations for both your office team and the teams you work with on complex cases. If a team doesn't know what you expect from them, how can they predictably deliver it? Do you want to rely on dumb luck?
3. It's OK to have a different opinion, and often it's even good. When you and your team have differing opinions talk and work it out. It's OK to respectively push each other to be better. I admit that sometimes the respective part may fall short and we all call each other out but we may be better because of it.

The takeaway is that you need to push each other. I know there may be general practitioners who will not work with opinionated and strong-willed specialists. But do not take the easy way out. If those specialists respectfully push you and call you out at times, you might just become better at handling complex cases.

I hope exposing these hurdles helps you. It is worth knowing that becoming a better communicator, a better planner, and better at finding a team can make your entire practice less stressful.

John R. Carson, D.D.S., is a member of Spear Visiting Faculty and a contributor to Spear Digest.