#People
The Role of Fundamentals for Future Success
Dr. Dawson and Dr. Cranham talked about the challenges that today's dentists face.
Dr. Dawson, you have been teaching dentists for more than 50 years, and Dr. Cranham, you have been involved with dental education for more than 20 years. What new challenges do today’s dentists face?
Dr. Dawson: Every year, I spend a significant amount of time with 10 residents in the University of Florida Residency Program, held in St. Petersburg, and I am extremely impressed with their commitment to learn and their dedication to providing the best care they can to their patients.
The primary challenge for them, and all new dentists, is having a thorough enough understanding of the principles of occlusion and function to conduct a complete examination on every patient, make a diagnosis, and to then create a complete treatment plan to solve the patient’s problems, rather than being simply procedure-focused.
Dr. Cranham: There are 2 challenges that I see facing today’s dentists: the cost of their dental education, and the increasing complexity of the typical dental patient. While dental schools prepare students to handle a large variety of dental problems, graduates typically are not prepared to do larger, complicated cases that may involve cosmetic enhancement, implant reconstructions, or a worn dentition. The financial burden from dental school loans makes it very tempting to attempt these larger cases without the necessary postgraduate training. This can lead to frustration for the dentist, and a less than satisfactory result for the patient. There is no question that as patients live longer and keep their teeth, the number of these cases increases each year. Dentists who want to successfully treat these cases must find a way to get advanced training.
The issue is this: How can a dentist, with huge debt, invest in self-improvement and continuing education? What is the best path to have the predictability, efficiency, and the profitability that is desired? These are things that we spend a great deal of time thinking about at The Dawson Academy.
How has The Dawson Academy educational model evolved to meet these challenges?
Dr. Dawson: Early on in my teaching, I offered a series of 3 seminars. In 1994, under the supervision of Joan Forrest, our executive director with expertise in adult learning, we added a series of hands-on classes to better facilitate our students not just to obtain knowledge, but to develop the skills and confidence to implement that knowledge. Those classes made a tremendously positive impact on our students. As we continue our emphasis on the true implementation of what is learned at The Dawson Academy, we have added a study club component as well as online support materials to our offerings. As a result, dentists coming to Seminar Three (Advanced Problem Solving), which is the termination point of our core curriculum, are better prepared than I have ever seen before.
Dr. Cranham: The major changes in The Dawson Academy have involved the expansion of our team and a move to decentralize from Florida. While St. Petersburg is, and always will be our headquarters, we realized after the 9/11 tragedy that we needed to bring our classes closer to the dentists. The first satellite location was The Mid-Atlantic Center for Advanced Dental Study in Chesapeake, Va (owned by Buddy and Rick Shafer [Bayview Dental Lab]). Since that time, we have established affiliate locations in Chicago, Southern California, and Denver. Internationally, we are in the United Kingdom, Japan, and Poland; with courses also now scheduled to begin in Toronto, Spain, and Brazil.
This is an incredibly exciting time for us at The Academy. Realizing our vision has required the expansion of our team, and dedicated teachers devoted to the Dawson process have joined us. We have standardized the classes, lead instructors, and teaching assistants, and have created mobile modules that can be delivered at our affiliate locations anywhere in the world, all with consistency. The dream that was visualized in 2006 is now a reality, and we have quietly brought our core curriculum much closer to dentists here in the United States and around the world. This strategy makes taking classes much less expensive (decreasing travel and time away from the office), as well as keeping younger professionals closer to their families.
How did the Dawson-Cranham partnership come about?
Dr. Dawson: John started taking my courses within a few months of graduating from dental school, and he stood out from the beginning as someone incredibly dedicated and talented. I was so impressed with him that I invited him to participate in one of my focus groups of 20 dentists. These groups met a few times a year, and my team analyzed their practice results monthly. John definitely was implementing what I taught and having success in doing so.
Our executive director, Joan Forrest, had heard the story of the young Dr. Cranham sleeping in his car when he took Seminar One because he couldn’t afford the hotel room, so when a brochure came across her desk promoting a one-day course he was doing in Tampa, she decided to attend and meet him personally. She was so impressed that a few months later she convinced me to go to Orlando at 6 am to hear John’s program on the cosmetic-occlusal connection. It was the most impressive and thorough application of my occlusal principles to cosmetic dentistry I had ever heard; and, as they say, the rest is history.
Dr. Cranham: I was very fortunate to take “The Concept of Complete Dentistry” series from Dr. Dawson immediately after graduation from Virginia Commonwealth University in 1988. Using what I learned about occlusion, the temporomandibular joints, and aesthetics enabled me to transform the older practice that I purchased early in my career into a thriving and contemporary one. In the mid-1990s, I began furthering my training by learning about adhesive dentistry, implants, and the myriad of new materials that were hitting the market. By the end of the 1990s, I was giving a one-day lecture around the country called “The Cosmetic-Occlusal Connection,” a class that combined the latest materials and aesthetic information with Dr. Dawson’s timeless principles of occlusion. In 2003, I was lecturing in Orlando, and to my surprise, Joan Forrest and Pete Dawson walked into the room, and yes, I was definitely nervous lecturing in front of Pete! After the lecture, they took me to dinner and asked me if I would consider doing some teaching with them. It’s hard to describe how much that moment meant to me personally and professionally. I have been part of the team ever since. The merger of Cranham Dental Seminars and The Dawson Academy became official in 2007, at which time I became the clinical director of The Dawson Academy.
Who are the primary teachers (lead faculty) within The Dawson Academy, and how did they get selected?
Dr. Dawson: John has done a fantastic job of assembling an extremely talented and dedicated team. All of them have what I call a teacher’s heart, meaning they are dedicated to sharing with other dentists what they have learned along the way. It is critical that all of our instructors know that their role is to meet the students’ needs, not to be teaching for their own egos’ needs. It’s challenging to find instructors with enough confidence to be in front of a room and teach, but with the selfless goal of only meeting the students’ needs. Our entire faculty meets that bill. It is also a requirement that all of our faculty members maintain full-time practices and use commercial dental laboratories, thereby facing the same daily challenges that our students face. They successfully face the challenges of marketing, managing staff, presenting treatment, monitoring their results, etc, that we teach dentists to do during our classes. My requirement is, “we do what we teach, and we teach what we do.”
Dr. Cranham: While it is hard for me not to express my enthusiasm for all of the people involved with The Dawson Academy, for brevity, let’s focus on our lead instructors practicing in the United States. These dentists were carefully selected based on 3 basic criteria, as they must:
1. Maintain a busy, successful, and full-time practice,
2. Understand and implement Dr. Dawson’s principles in all the procedures that they provide, and
3. Exhibit a true passion for teaching.
So, in addition to Dr. Dawson and me, there are 6 other lead teachers: Drs. Drew Cobb, Glenn DuPont, Scott Finlay, Lenny Hess, DeWitt Wilkerson, and Laura Wittenauer. These dedicated professionals, all carefully selected according to the outlined criteria above, are devoting countless hours to our students.
How
do you see clinical digital technologies impacting the practice of dentistry?
Dr. Dawson: The technologies available today are mind-boggling. However, utilizing these technologies to obtain the best patient results requires an understanding of the principles of function and aesthetics like never before. My fear is that postgraduate education is going away from teaching foundational principles to teaching procedures and techniques. In my opinion, simply utilizing advanced technologies without understanding how the masticatory system works is not in the best interest of our patients. My hope is that young dentists will spend the time and money to invest in their education first, and then invest in the technology. In our many years of teaching experience, we have seen dentists who learn how to get predictable and quality lasting results without the new technologies, so the idea of first learning about the fundamentals is a viable educational and treatment model.
Dr. Cranham: To me, one of the most exciting aspects of dentistry is what is happening at the digital level. While making digital impressions is certainly a reality, digital articulation is right around the corner. In the very near future, the need to mount casts on an articulator will be gone. Mounting casts in centric relation via a cone beam image and being able to clearly see all the occlusal interferences is also now possible. We are working hard to be able to find the easiest way to equilibrate, move, restore teeth, and even visualize orthognathic movements all in one software. When you couple this with the ability to virtually place implants and print a variety of surgical guides, the future is incredibly exciting.
My daughter is in the predental program at Virginia Tech and will be applying to dental school in one year. I cannot imagine where all this will be by the time she graduates. Our goal at The Dawson Academy is to be at the forefront of these developments, while ensuring that dentists fully understand functional principles.
Implants are the fastest growing area of dentistry. What competencies should a dentist have to effectively place implants and create implant-retained restorations?
Dr. Dawson: As in any restorative case, success is dependent upon a thorough diagnosis and complete treatment plan prior to beginning treatment. Thus, the abilities to perform a complete exam, follow a systematic, predictable treatment planning process and involve capable specialists as needed are essential factors for success. It is too common for a dentist to take a weekend course on implant placement and then believe that he or she is ready to take on these cases. I think implants are a fantastic treatment option, but a dentist needs to know when implants are appropriate and when another solution is better. In addition, dentists need to have other options available if implants are not viable for the patient due to finances or other health issues. Implant cases are an excellent example of why having a like-minded specialist team in place is critical to successful patient outcomes. This is why we encourage our students to bring their specialists to classes at The Dawson Academy to develop a common philosophy of practice and treatment.
Dr. Cranham: Nothing will test a dentist more then a complex implant case. When teeth are missing, often the underlying bone and gingival tissues have resorbed. Properly restored implant restorations rely on the final restorations being in proper position from an aesthetic and functional perspective. The implant should then be properly positioned under the restoration for optimal loading.
Dr. Dawson has always said that implant dentistry is a prosthetic-driven discipline. Therefore, it is imperative that any dentist who is involved in an implant case understand where teeth need to go from an aesthetic and functional perspective in 3 dimensions. They must then have access to cone beam technology to make sure the patient has adequate quality and quantity of bone to have an implant placed in the correct position. This will clarify whether or not grafting procedures need to be employed, or if the implants can be surgically placed without the grafts. The amazing thing is Dr. Dawson’s treatment planning principles apply perfectly to this discipline. Doctors who do not know how to visualize optimal tooth position within the masticatory system will struggle with implant dentistry.
What are the characteristics you observe in successful dentists and dental practices?
Dr. Dawson: The overriding characteristic that I observe in successful dentists is empathy. A successful practice results from putting the patient’s needs first and following what I have termed the WIDIOM rule, which means Would I Do It On Me? This should be the primary thought process when developing a treatment plan. Then, if proceeding with that treatment will cause a greater problem for the patient than the existing issue, the compassionate and successful doctor will help the patient find the best way to obtain a healthy mouth. This may involve phasing treatment over a period of time, while getting the tissues healthy and removing any caries and stabilizing the bite. The successful dentist is never selling dentistry, but always seeking to solve patients’ problems in a loving and empathetic manner.
Dr. Cranham: The best dental practices create systems that predictably lead to consistent and successful patient outcomes. These systems must be both efficient and flexible enough to evolve as dentistry and dental teams also evolve, so that new procedures can be put in place as needed to continuously improve the quality of dentistry being delivered.
The best dental practices will put diagnosis and treatment planning at the center of everything they do. Learning how to isolate any biologic or functional factor that could break down the dentition is essential for complete treatment planning. Learning to phase treatment when financial obstacles exist is also critical. Contrary to popular opinion, there is still a huge opportunity for those dentists who are interested in doing optimal dentistry from an aesthetic, biologic, and functional perspective.
What challenges do you see facing the profession in the next 5 to 10 years, and how is The Dawson Academy evolving to help dental professionals thrive in future times?
Dr. Dawson: The 2 major factors facing the profession are the aging population and the commoditizing of dentistry.
Many years ago, I coined the term physician of the masticatory system to appropriately describe the extensive responsibilities of the dentist, and I think the term is more appropriate now than ever before. As our patient population ages, they often come to us with health issues and medications that impact their treatment. We need to recognize these issues and understand how to treat our patients within these constraints. In addition, our patients may be seeing us more regularly than their physicians as access to care becomes more difficult. We are in prime position to recognize signs and symptoms of disease and refer patients to other physicians if necessary. Also, we are positioned to help educate our patients about overall health and help them adopt a healthy lifestyle. This is what Dr. DeWitt Wilkerson has developed in our new program in the Medical Dental Track entitled “The Total Wellness Dental Practice,” and I think it’s incredibly exciting and important.
The other factor, the commoditization of dentistry, makes the need to differentiate your practice more important than ever. Our curriculum is designed to teach dentists to become the go-to dentists in their community. Regardless of what happens with the US Affordable Care Act, insurance, corporate dental groups, etc, there will always be a percentage of the population seeking out the best dentist to solve their problems. The curriculum at The Dawson Academy is designed to help dentists to identify signs and symptoms of disease, make a correct diagnosis of the cause of the disease, and create and execute a treatment plan that solves the problem with predictable, lasting, beautiful results, and provides a balanced life for the dentist with stress-free time outside of work. The joy of seeing a patient with a pain-free, beautiful smile is incredibly rewarding, and having the time to create the life you want, not just make a living, is priceless. This is what drives me to continue to share with dentists what we know works.
Dr. Cranham: While the future of dentistry is very bright, there are some challenges. The technological advances in the profession, many of which have been discussed in this article, involve technologies that are expensive for the doctor to acquire. Digital impressions, CBCT, virtual articulation, and digital radiography are all the current reality. The question that remains is the degree to which these technologies will be able to penetrate the current marketplace. The debt that new dentists have to deal with plays a role in this. While they are the very population that best sees the potential of these technologies, they are also the ones who are so saddled with educational and start-up debt that obtaining these technologies may seem impossible. Additionally, the cost of dental school is not getting any cheaper. While we are currently seeing dental school applications at higher levels than any other time in history, there could come a time when the return on investment of becoming a dentist will not be there. If that happens, dentistry will no longer be attracting the best and brightest.
As a profession, we need to deal with these realities. Better penetration of these incredible technologies and increased competition among manufacturers should help drive the costs down. I encourage those who have experienced great success in our profession to support our dental schools to help control the ever-increasing costs. If we do, 10 years from now, we will still be proud of our own caring involvement in the world’s best profession.
Dr. Dawson is known internationally for his contributions in the field of occlusion and restorative dentistry and for his concepts on diagnosis and treatment of temporomandibular disorders. For more than 50 years, dentists from around the world have been traveling to St. Petersburg, Fla, to attend Dr. Dawson’s seminars on “The Concept of Complete Dentistry.” He is the founder and director of the The Dawson Academy, a teaching center and multidisciplinary think tank in which active clinicians from all dental specialties combine their expertise in a search for better understanding of dental diagnosis and treatment. Still active in lecturing, writing, and consulting, he is a former professorial lecturer for Georgetown University School of Dentistry, and is a former visiting professor at Emory University School of Postgraduate Dentistry; he is also a former member of advisory faculty at the L. D. Pankey Institute. He is a Fellow in the American College of Dentistry and the International College of Dentistry, past president of the American Academy of Restorative Dentistry, the American Equilibration Society, the American Academy of Esthetic Dentistry, the Pinellas County Dental Society, the Pinellas County Dental Research Clinic, and the Florida Academy of Dental Practice Administration. Once a consultant to the International Journal of Periodontics and Restorative Dentistry, he is the author of the all-time best selling dental textbook, Evaluation, Diagnosis, and Treatment of Occlusal Problems (2 editions). His textbooks have been published in 11 languages and used in dental schools around the world; his latest, Functional Occlusion: from TMJ to Smile Design, is currently being translated into multiple languages and has been adopted into numerous dental school curricula. He can be reached at (800) 952-2178 or via the Web site located at thedawsonacademy.com.
Disclosure: Dr. Dawson reports no disclosures.
Dr. Cranham has a contemporary dental practice in Chesapeake, Va, focusing on cosmetic, restorative, and implant services. An honors graduate of the Medical College of Virginia in 1988, he maintains a strong relationship with his alma mater as an associate clinical professor. He has lectured extensively and has published numerous articles on restorative dentistry. He founded Cranham Dental Seminars, which in February of 2008 merged with The Dawson Academy. He is currently the clinical director/partner of The Dawson Academy, where he is involved with many of the lecture and hands-on courses within curriculum. He is an active member the ADA, American Academy of Cosmetic Dentistry, American Academy of Fixed Prosthodontics, and American Equilibration Society. He can be reached at (757) 465-8900 or via e-mail at smildoc@aol.com.
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