Bite Treatment, Part 1: Applying the “Puppy Dog Sales Technique” to Dentistry

Dentistry Today


Many dentists do not like the term “sell,” and they like even less to feel that they are “selling.” I do not know where that comes from, but few dentists would disagree that many members of our profession have a severe aversion to “pushing their patients to accept treatment.” When asked why, many dentists reply, “It is too commercial,” “too unprofessional,” or “too undoctorly.” They do not want to feel like the proverbial used car salesman.

But is dentistry really that different than our other roles in life, where we have to “sell/encourage” someone to accept an idea or a decision that is in his or her best interest? Parents need to sell their children on working hard in school, not taking drugs, respecting their family and friends, and so on. A religious leader has to sell the congregation on following the scriptures and living a spiritual life. A medical doctor has to sell patients on the benefits of exercise, a healthy diet, not smoking, and accepting the appropriate medical care for their needs. We as dentists have the responsibility to guide our patients who may be driven by fear, finances, or lack of priority to make the right decisions about their oral health.

Figure 1. Triad for successful sales.

Dr. L.D. Pankey, founder of The Pankey Institute, once told me that in order to provide a service for a patient, you first need to have it on the shelf. Just like retailers cannot sell something they do not have in stock, dentists cannot sell a service they cannot appropriately deliver. Therefore, successful sales is a combination of customer education to create demand and availability of the goods or services (Figure 1).

This article is the first of a 2-part series on bite treatment. It is a 2-part series because successful bite treatment depends on 2 key variables: patient education/communication and clinical expertise. It is impossible to provide your patients with the quality of care they deserve if you are unable to guide them to accept the treatment they need and then provide them with the highest quality care.

Figure 2. Flow of money through the economy.

In today’s super communication/mass-media world, people have so much information coming at them it is virtually overwhelming. Our multitrillion-dollar economy is driven by the consumption of goods and services, like it or not. Our economy is a giant conveyer belt, where each dollar that is transacted multiplies itself at least 8 times as it trickles, or gushes, through the economy (Figure 2).

I know many dentists who really worry about trying to overly influence their patients, and I truly respect their integrity, as I have the same concerns. At the same time I ask myself which of the following our patients need most:

•a new car to replace one in good operating condition?

•a giant TV?

•a vacation at the beach?

•the newest titanium golf clubs?

•quality dental care?

The reality is, with all the communication “noise” in our society, if we do not successfully communicate the importance of quality dental care and deliver it in a timely fashion, it will be drowned out and overlooked. If we allow this to occur, then we are letting down our patients and not accepting our responsibility as members of the healthcare community. It is important to remember that most of the work we do is to treat problems that the patient does not understand or think we can help solve.



Walter Hailey once told me that there was no need to invent mediocrity when we can more easily copy excellence. With that in mind, let’s examine other industries to see how they ensure successful customer decision making   and how we can apply it to our profession with integrity.

Consider things that you purchase all the time, such as cars, clothing, food at the mall, and puppies. How do they sell us those things? Mostly they sell by creating an experience for the customer. When you go to a clothing store, the first thing they say is, “let’s try it on.” At the auto dealer, once they think you are serious, they want you behind the wheel for a test drive. At the mall, they have people giving samples of food snacks or a puff of perfume at the cosmetics counters. And any parents who have ever taken their child to a pet store can probably remember the reaction when they put the puppy into their child’s arms, or held the puppy in their own arms, for that matter. This sales method has proven so successful that the term used for selling by trial acquisition has become known as “the puppy dog sale.”

The principle is based on the natural law of comparisons and is part of our physiology. For example, if you put your hand into water at 90°, it will typically feel quite warm. However, if you first put your hand into water that is 110° and then into the 90° water, you would likely report that the water at 90° feels cool, even though it was the same temperature that felt warm at first. Simply stated, one of the primary ways the brain evaluates something is by comparison.

Our current standard may be fine, but once you experience something new, everything changes. You may feel perfectly happy with your car…looks okay, runs fine. But one day when you are at the dealer for an oil change, you notice the new models and begin to reconsider. Ever notice that you often have to walk through the showroom to get to the service area? Coincidence? I think not.



In the cosmetic dentistry arena the “puppy dog sale” has been applied quite successfully. Computerized cosmetic imaging via digital photography and computer rendering allows us to close a diastema or make crooked and rotated teeth straight. Thirty seconds later a side-by-side print enables patients to have a comparison where none had existed before.

They have seen people with straight teeth before, and they may have liked it better than crooked teeth, but they have not seen themselves with straight teeth. The difference is so dramatic that they often become dissatisfied with their present appearance and ap-preciate the value of cosmetic treatment.

Another great option is a composite mock-up on patients’ own teeth without a full etch and bond, which allows them to see and experience cosmetic treatment in their own mouths. While this is more time-consuming than computerized imaging, it is an awesome patient experience. This can be done by sculpting composite directly onto the teeth. It can also be done by having the dental laboratory create a modified wax-up from a study model and then transferring this to the patient’s teeth by using a vacuum-formed shell filled with a product like LuxaTemp (Zenith). Some practices do this for a modest fee that patients may apply to the ultimate treatment if they decide to proceed.

Figures 3a and 3b. Cognitive dissonance. The patient’s present condition (yellow teeth, 3a)
becomes unacceptable when compared to a new standard (whiter teeth, 3b).

With either method, once the composite is hardened on the teeth, you can create a nice, natural polish. Then tell patients that you want them to “try out their new smile to see if they can live with it.” Remind them that it is much bulkier and not nearly as “finished” as the work would be when you do the real veneers and that it will fall off fairly easily. Then let them leave with their new smile and return to their homes or offices. They will like how they look when they leave, and the people around them will certainly respond positively. However, when the composite falls off and they see their ugly teeth after seeing the nice smile for a while, they will experience what psychologist Dr. Leon Festinger identified in 1957 as cognitive dissonance. In simple terms this theory states that the present condition, which was not really a problem before, by comparison to the new standard appears totally unacceptable (Figures 3a and 3b). The spaces now look much bigger and the rotated teeth look much more crooked. How is the patient going to explain to family and friends that he or she prefers ugly teeth? I have had patients call the office and demand to schedule a prep appointment that day after this type of mock-up.



It is easy to see how this technique works well for helping patients experience the benefits of cosmetic care, but cosmetics is only one very small elective part of dental care. It is important to understand how this technique can be applied to other, more fundamental parts of dental care, such as bite treatment for head, neck, and facial pain.

Most dentists would agree that their case acceptance for bite treatment is not very good, and that their fees for bite splints or equilibration are substantially lower than fees for a crown. Why is that?

The answer is that the fee for any service foundationally depends on the combined value of the service from the buyer’s and seller’s viewpoints. In the case of a crown, the combined value is high. First, the patient understands the purpose of a crown, as he or she may have one or know someone who has one. Second, crowns have a general reputation of being successful. While they may not be happy about getting their teeth drilled, the injections of anesthetic, or the fees involved, patients do have a basis for judging the value of the service. Finally, and equally as important, the dentist who is recommending the treatment has extensive experience with crowns and a high certainty of having a predictable outcome. Therefore the dentist also has a high value for the treatment.

Figure 4. A crown compared to a bite splint.

Bite treatment for head, neck, or facial pain is entirely different. Most patients have not heard of bite treatment for eliminating headaches. In addition, it is often very difficult for patients to relate the jaw muscles to migraine, sinus, or stress-type headache symptoms. Also, they have frequently heard stories of friends getting nightguards that “did not help,” resulting in a waste of time and money. This creates doubt that bite treatment would help them. From the dentist’s point of view, they may have done this procedure on a limited number of patients and have had mixed success. This lack of predictability and certainty with the procedure, compared to crowns, results in a lower perceived value on the part of the dentist as well. If the patient has a low value and the dentist has a low value, the fee that can be presented and possibly accepted must also be low (Figure 4).

The low fee, if the patient accepts it, is worse than just an issue of remuneration for the dentist. It results in both parties proceeding with reduced expectations. In addition, if the dentist is not fairly compensated for the time and care required, he or she will be unlikely to take the time and follow all of the steps required to get to a proper end point, resulting in a treatment failure. The patient will often report this dissatisfaction to friends and family. The dentist will likely share this frustration with colleagues. This results in the medical community and the insurance and regulatory people accumulating another piece of evidence demonstrating that “bite treatment does not work.” Going forward, the dentist will not take appropriate CE courses in this area. As a result he or she will diagnose fewer bite problems, and patients will not get the treatment they need. Clearly, everyone loses.



The truth is, the story does not have to end this way, and for many dentists it does not. Part 2 of this article will discuss the patient education, communication, diagnostic, and clinical techniques that thousands of dentists are using to provide predictable bite treatment that creates value for the patient and the practice.

Dr. Simon has been an active dental practitioner in Stamford, Conn, for more than 30 years, with a focus on bite dysfunctions. The author of the book Stop Headaches Now: Take the Bite Out of Headaches, he can be reached at (888) 865-7335 or by visiting

Disclosure: Dr. Simon is the inventor of the Best-Bite Discluder.