New Trends in Dentistry and Treatment Planning

Frank M. Spear, DDS, MSD

In your opinion, what is the greatest challenge dentists are facing today?
Dr. Spear: The challenge for general practitioners (GPs) is that for the most part, patients are unaware of what’s really going on in their mouths, and most practitioners have anxiety about how much to tell the patient. 
Today with the economy being tighter and insurance playing more of a role than it did 20 or 30 years ago, the dentist also feels the pressure of doing enough treatment to pay the bills. They’ve got to do something productive.
For me, this topic is still the biggest problem in general practice: thinking that patients only want a tooth fixed…only what their insurance will cover. That starts to pervade the head of the dentist and the team, and they start treating all of their patients with that belief. All of a sudden, they have a practice that is basically trying to survive on tooth-by-tooth dentistry. 
The only way patients can choose more is if they are informed of what’s possible. But informing patients can be scary for the dentist, unless they learn how to do it in a very nonthreatening way.
We try to teach students to move into the role of being an advocate for the patient by saying, “Let me inform you about what I’ve found in your mouth and help you understand what that means; let’s talk about what might need to be done now, and what is probably going to need to be done in the future.” Reporting findings is very different than telling a patient what to do.

Are dentists in private practice evolving with dentistry?
Dr. Spear: Without question, I believe that the majority of dentists have moved along with the changes in techniques and materials; some have assimilated new technologies into their practices. The risk comes when a dentist starts to believe that technology is the solution to their problems. Technology allows us to deliver dentistry in different ways and with different materials. It doesn’t solve what I believe are the bigger problems within the profession: How do I talk to my patients? How can I help them fully understand the possibilities that are available to them?

What is the most important thing today for a dentist to focus on to remain current with technology and techniques?
Dr. Spear: My personal bias is that to change what you’re doing to something new, it needs to be more efficient, cost effective, and provide a better result. If it’s not, you have to ask yourself why you’re doing it.
Dentists tend to jump on a lot of “what’s-new” bandwagons because they don’t want to be left out. But sometimes we try things that are, in fact, inferior to what we were doing before. There is no question: some products improve, some don’t. You can expose yourself to lots of techniques and technologies, but that doesn’t mean that you want to apply all of them in your practice.
When I was younger, I jumped on some products that turned out to be somewhat disastrous. So, I found myself remaking lots of restorations at no charge because of my desire to be right on the cutting edge of everything new and current. New technology can be very seductive. However, you have to be careful that the technology you are buying into has, in fact, a successful track record.

Dr. Spear working with an individual doctor: The Spear faculty combines comprehensive classroom education with practical hands-on application.

How do you see dentists and dental education evolving?
Dr. Spear: The evolution that I see relates to the pure fact that education is a repetitious phenomenon. You have to learn conceptually how to think and put different concepts together to make decisions, but that does not teach you how to actually do the dentistry. You also need hands-on application taught by a skilled person who sits down with you and shows you how to do it.
At Spear, what we’ve tried to create, for lack of a better word, is a very deep curriculum. We provide attendees conceptual learning in the form of seminars. You immerse yourself for 2 days, but when you leave, we understand you may forget some of what was said. That is why every Spear seminar is now available online through Spear Digital Campus—so it can be reviewed back home in 20- to 40-minute segments. In addition, we have taken that same content to help create Spear Study Clubs, which support the dentists in their local communities. They can go to the seminar, return home and have the online repetition, and now they’ve got their study club where they can review all of that material, collaborate on cases with their peers, and get support from the specialists.
I think that’s something relatively new in dental education. I don’t know that a lot of people have ever integrated a campus with conceptual and hands-on application courses, created study clubs for you to learn in your local community and provided the content to drive them—and have also made all of this available to review online on your own timeline. To me, that’s a pretty big shift within dental education: to have that kind of depth of experience at a campus setting, at your home/office reviewing online, and learning in a monthly study club meeting with your local peers.

How do you keep learning?
Dr. Spear: Even though I have taught as long as I have, I recognize there are still a lot of things that I can learn. For me, a lot comes from the students and the questions they ask. I’m also very self-driven, and at least once a year I’ll do a full literature search on the topics I teach and find out what’s current. I am also exposed to professional friends who are clinically gifted in a lot of ways. It is also helpful to attend academy meetings around the world, to hear people talking about their research before it’s published. But if you asked what has been the single biggest learning experience for me since the day I walked out of graduate school, it would be the study club to which I belong. I have learned more in our 29 years together than from any other single source in the field. 
In a study club, you’re with people who have different ways of thinking and seeing things. Different specialties are represented, so you often hear how the orthodontist and the periodontist see things. The study club environment, for me personally—especially in my treatment planning—hands down, is where I’ve learned the most during my 30 years in practice.
I have also had the honor of mentoring more than a dozen study clubs earlier in my career. So when people ask me about the importance of study clubs, I can speak to it from the perspective of a member who’s learned a huge amount, and as a person who has also learned through mentoring.

Please update us on what’s new at Spear.
Dr. Spear: One of the things that I’m very proud of is that we assess every seminar and workshop that we offer, and look at what needs to be changed or updated every 6 to 9 months. We read every evaluation that’s written at every course, and then ask ourselves how we can make it better. That’s kind of a natural evolution.
In June 2012, we launched what we call Case Assistant. It is a tool that allows the dentist to educate his or her hygienist, treatment coordinator, assistant, self, or the patient, through the use of very short videos; or dentists can simply show their patients images from the videos and narrate the presentation themselves. Case Assistant gives us the ability to package information that we think is incredibly valuable but is also very difficult for most practitioners to get on their own. Through Case Assistant, we now have the ability to help dentists in their own operatory. We knew that dentists could be helped on campus, and by creating study clubs that help them locally, but the one place we really never felt like we could help them was sitting in the operatory with a patient. Personally, I always knew that this was the big missing link.

Spear Study Club.

How was Case Assistant developed?
Dr. Spear: One of my longtime students, Vivek Mehta, got the idea of systematizing the documentation for practices by means of an application, like an iPad app. That app would have the ability to organize and structure data the same way we do our treatment planning. It wouldn’t be just gathering data; it would organize it and place it into a pathway that would lead to the potential treatment planning outcomes.
As Vivek and I worked together, we realized there were a lot of possible directions this thing could go in, but what was clear from our focus group feedback was that what dentists wanted the most was something that would help them educate patients and help them with case acceptance.
When we looked at the original concept of data gathering and organization, we realized there are other tools on the market that do some of those things. What we wanted to focus on was the whole concept of how we help dentists educate patients, educate team members, and get patients to accept treatment in their best interest.

What was the inspiration?
Dr. Spear: One of the challenges that any educator faces is to realize that to be truly effective in education, the material has to impact people of different levels of experience. I have to admit, as one becomes more mature and experienced in dentistry, it is easy to forget some of the challenges that occur for the younger practitioner.
For me, one of the really big areas that helped me develop Case Assistant is having a daughter who is 4 and a half years out of dental school who just bought a practice. She would e-mail or call at night and say, “Hey, this just happened. Can I e-mail you the photos? What should I do?” As a result, I started to realize that her challenges were very different than some of the challenges of someone who has been doing it for 25 years. So, when we developed Case Assistant, I looked at what are the biggest issues that students always have when they come for a workshop or seminar.
But there’s also the issue of, how do we help with some real fundamental issues that occur almost daily for any GP? How do we talk to patients about a problem? What causes it? When do we treat it? How do we treat it? 
Case Assistant really evolved from my experience of 30 years in education, and what I know dentists want and need to talk about with patients. It was designed to literally be an in-office tool for the hygienist, the treatment coordinator, the assistant, or the dentist to use to help patients understand the problem, whatever that problem happens to be. We put it in a format that is very efficient and visual so it’s quick and easy to use.

How is Case Assistant different from other patient education tools?
Dr. Spear: Case Assistant was designed for the patient, team, and dentist. These are not simply illustrations or 3-D animations like most patient education tools. It is, in fact, real-life photographs of patients before, during, and after treatment, but done in a patient-friendly way. There are no images that would scare a patient. Plus you have additional resources that will help the dentist diagnose and treatment plan virtually any clinical findings they encounter.
For the initial launch, we’ve picked 50 key topics that most dentists find difficult to talk about, and we’ve pulled from my archives of completed cases to find the images to put into each of those case assistant modules.

How do you see Case Assistant being used in practice?
Dr. Spear: I think that really depends on the experience and comfort level and the practice style itself. I did the recordings in a very lay-friendly style, but in a way that a dentist can also learn from it. If you’re a hygienist or an assistant or a receptionist, you’ll learn from it as well. And the patient can absolutely understand. What a lot of dentists have found very helpful is to train their teams to use it. We have dentists who have literally taken a half day with their team so that the receptionist, treatment coordinator, hygienist, and assistant actually know the content.
One office I know of has chosen to do this: when the hygienist is doing a recall, she’s making notes of the problems she’d like to talk to the patient about. At the end of her visit, she shows the patient the areas of concern in the mouth, pulls up those findings on Case Assistant, and plays the narrated version for the patient while she cleans up the operatory. They have been very effective that way.

What void does Case Assistant fill in the dental practice?
Dr. Spear: I think it potentially fills several voids.
Most patients are very visual learners. Case Assistant has a wealth of images in so many different areas of dentistry; you can show the patient in real life: here are people with your problem. This is what they were like before. Here’s how they were treated. Here they are after.
Case Assistant addresses team training. The dental team doesn’t get to come to very many dental meetings or be exposed to the possibilities dentistry can provide. Now the team gets it: dentistry is more than just a crown or a filling. Now they get why you take pictures. They see that dentistry is so much bigger and the possibilities are so much greater than they thought.
Finally, it fills the void of something most dentists simply do not have time to do: document cases. It takes a huge amount of time and practice, and the dentist may not have the opportunity to see that many of these different kinds of cases. Case Assistant is here to show the dentist and the patient what’s possible, and help both of them understand what happens next. 

We want to thank you for taking some of your valuable time to meet with us for this interview, Dr. Spear. You have touched the lives of so many patients and fellow dentists, and your work and leadership has been an inspiration to all of us! To what do you attribute your success?
Dr. Spear: People often ask me how I ended up doing what I am doing today. My parents were both big advocates of education. My dad was a mechanic in the small town that I grew up in, and my mother was a second grade school teacher. They both placed a lot of importance on education. Even when I was in dental school, I had a desire to teach and, on the day I graduated, I told my best friend, “Someday, I’m going to have a teaching institute.” Then, I went to graduate school, where you have to do seminars and make many presentations.
Sometimes people will look at you and tend to forget that you didn’t just walk out of dental school and onto a stage. It has taken 33 years to get where I am sitting right now. I feel extraordinarily fortunate to do what I am passionate about, and to be able to share that passion with others.
 
Read more by Dr. Spear by visiting The Spear Review at speareducation.com/spear-review.


Dr. Spear is a dual-trained periodontist/prosthodontist. He earned his dental degree and an MSD in periodontal prosthodontics from the University of Washington. Dr. Spear is an affiliate professor in graduate prosthodontics at the University of Washington and maintains a private practice in Seattle limited to aesthetics and fixed prosthodontics with long-time practice partner Dr. Greggory Kinzer. He is also founder and director of Spear Education. Dr. Spear’s memberships include the American Academy of Esthetic Dentistry, the American Academy of Restorative Dentistry, the American College of Prosthodontists, the Pierre Fauchard Academy, and the International College of Dentists. Dr. Spear is a former president of the American Academy of Esthetic Dentistry. He can be reached at fspear@scottsdalecenter.com.

Disclosure: Dr. Spear maintains a salaried position at Spear Education.

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