What to do with the claims of biomimetic dentistry.

We all love a good, bold claim about biomimetic dentistry... right? Right?  

If you’ve been on social media at all over the past few years, you’ve probably have seen thousands of posts about biomimetic dentistry.  The posts typically have insane photogrpahy, amazing clinical skill work, and are very detailed in their documentation.  You probably love it and are intimidated by it at the same time.

Like "How can I ever attempt those crazy procedures?  I'm so lost on how to even start that".  

Or "How do they get those perfect images...all the time? ...  I don't even have time to get pictures."

Or perhaps my personal favorite, maybe because it applies to me, or maybe it doesn't...

"Wow... I'm hardly using a dam.  I'm not even sure I even really remeber how to put them on lol".  

Hopefully, you've seen my account I started in 2015 talking about biomimetic dentistry.  This was my attempt to break down all the nuances and give some clairty to these detailed and complex topics.  When I was starting it out, I'd search and find a picture that I thought showed a clear step that exemplified a biomiemtic concept, article or technique.  This was before carousel posts, so i was limited on what I could show but I tried to find that 'perfect' pic.  

I viewed posting this type of content as a window into my own personal studies and was sharing what I was learning at the time.  As my own personal understanding grew, so did my confidence and trust in what biomimetic dentistry could truly offer.  

I'll speak to my own efforts here for a second.  As I listened to those around me, on occasion, my aim for clarity on the account missed and infact often presented as more complex than what was intended.  Some of the claims I would make also became more bold about what biomiemtic dentistry was capable of doing.  Was that a bad thing?  Was it a good thing?  Was it annoying?  Or perhaps was it needed to help shape the industry?  Well... maybe it was a 'yes' to all of it.  For me, biomimetic dentistry became about pushing the boundries, pushing the limits as to what we could offer our patients.  I get it though, that line of thought could potentially become reckless if not careful, especially if having a mixed understanding of the sciences and its applications.  And especially if the patient understanding of the procedure and its complications wasn't there.   

In the biomiemtic world, we make all sorts of claims.  We say things like, in a bragging pompous type tone...

"This tooth is now perfectly restored to how it was before the damge was done.  It won't ever need to have work done on it again.  I did Immediate Dentin Sealing on it, I got so many bonds on that I don't even know what to do with them all.  That thing is gonna stay it intact forever."  

Raise your hand if you can relate!  I can't see you right now, but you better have your hands up.  Both of them!  

Cough. Cough...

Umm...  this has definitly been me...  I'm speaking to myself here.  I've been guilty of this in my office as well as online... gulp...  

Its easy when we're starting out to be excited, to be confident, and also to be a little naive.  However, this really isn't the best way to talk about what we do and the treatments we offer.  Without context, these claims just land flat and miss the point of what you're trying to show them.

Its weird though.  I gotta be honest, becasue, while I feel the sentiments of these statements are valid and probably mostly accurate, there are so many variables that we just don't know and can't even control if we wanted to.  

But perhaps the delivery is just bad?  

In some ways, it always sounds a bit pretentious to say biomiemtic dentistry does this claim, or it does that claim.  We all love sounding big and that our work is amazing.  Its human nature.  But what is the patient doing once they leave the office?  Are they brusing regular?  Is there malocclusion? How is the bite pattern? The chewing forces? The list goes on.  I know you get it.

But really thats not the entire point.  While the patient is in our chair, we need to do the best for them that we physically can.  We should be a little arrogant and confident.  As long as its founded in actual results and we are in fact helping our patients.

But do me a favor for a second and take all those claims and put them all aside for a bit.  

It took me sometime, probably more than I care to admit, but I've learned a lot from this type of approach of making unwarrented bold claims.  I've learned from my failures, my successes, the things I could have improved on, etc.  

Here is the reality of what I've seen in my practice.

At the end of the day, patients want to know that they can trust you and that you have their best interest at heart.  Ultimately thats it.  They are trusting their dentist.  

How many times have you heard "Whatever you think is best Doc.  You know more than I do" or "I'm not a dentist, thats why I'm here.  Just help me with this issue and we're be good"?  Often, they can be fairly ignorant.  And possibly depending on the procedure we're talking about, completely vulnerable, by the way.  

When you tell them what you are doing, what you can do to preserve their teeth, and how you are trying your best to avoid some of the early failures and complications that we often see by doing advanced adhesive based steps, something resignantes within the patients and they become comfortable trusting you with their dental care.  

In my opinion, biomimetic dentistry is one of the best practice builders.  It helps you get on their level.  It makes the barrier between doctor and patient seem to dissappear.  It allows for an honest discussion between two people, with one of them needing help and the other having the skill set to help them.

Patients are dying to find this.  They crave this transparency and honesty.  They've either been burnt themselves or have family and friends that have.  Patients will go to great lengths to find this.  

The other day a patient was telling me that she discovered my office website at like 2:00 in the morning!  She was stressed.  She was pressed up trying to make a decission the night before her daughter's appointment in a different office, to that she didn't want to go to.  That morning, she called my office and scheduled.  She then cancelled her appointment with the other office.  

Thats a pretty easy example but it shows she was thinking about her options and what she liked and what she didn't like.  It shows that she was putting in time and effort to find something that fit her ideals.  It also shows they are willing to commit, as they live about like about 90- 120 min from my office.  

They've actually been in the practice for about 5 years now.  They've turned into a great referral source.  She's convinced her husband, who hasn't been to a dentist in years, due to busy schedules and a general lack of trust in the dental industry, go come see me.  It's kind of amazing to see what people will do for you when they know you are actually trying to care for them.

So back to the claims topics I asked you to hold on...

So what I am saying, is I've found it best not to hide behind those gargantuan claims and trying to convince people you're the best dentist out there, but rather present the dentistry in an honest and transparent maner, educating on the good and the bad.  

Show them what they need.  Show them why you care about their situation.  The people will then be lining up at your door.

Lets start with the comprehensive or periodic exam.  How many times have we seen a situation where things could be on the border of two treatments? Which way are we leaning?  The more expensive one, becasue its Suck-tember and our production is down?  Does this tooth need a filling?  Does it need an onlay? A crown?  

Perhaps, what if we see those super small incipient leasions? Do we wait and put it on watch? Do we treat?  What if that same person is a new patient and came to you on a second opinon from another office where they saw those same incipients you are seeing and wanted to treat them, perhaps even aggressively? Oh yeah... and its still Suck-tember.  

Lots of times, its really us, the dentists, that get put in a hard spot.  We are oftentimes put between weighing out you own personal ethics, what you've been taught clinically, and possibly some realistic financial pressures.  I'm saying, these exams can be loaded.  They can be tough knowing which way to lean. Sometimes its extremely balancing everything, gaining their trust, honoring your own morals and values all while trying to make a buck in production.

So my answer... is... somewhat simple.  

Honesty is the best policy, at least for me.  I'll point out what I'm seeing and what I don't.  I'll either validate or invalidate and then offer my treatments for treating that tooth.  I don't try to get into that other dentist's line of thought as to 'why' they wanted to do that.  Patients always ask that.  But I'll then explain what treatment options exist for a given scenario.  I'll tell them what I feel comfortable treating and how.  

In the cases where I get second opinions on a proposed crown, I'll explain what an onlay is (they already know, btw.  They were up till 2:00am researching the topic).  I'll explain the process of how its done, the benefits, the full gamit.  Depending on their questions and how they are reponding, sometimes I'll push back on crowns and offer as to why I don't do them.  Maybe I'll explain an onlay as a 'baby step' before we get to a crown. But here's the thing too, I'm not invalidating a crown, per se.  I'm just saying I prefer the intermediary steps, like an onlay, before we ever need to get to a crown,... which... we wont ever need.  

Ha, see?  Theres these biomimetic claims coming out!  I can't help it.

Quick side story, I'd like to consider that I've been practicing a long time, 10 years.  I guess you can count it as 12 if you consider clinic in dental school.  I did my first onlay on my wife in school and its doing great.  To the best of my knowledge, maybe you could call it some form of 'geographic success' (the term the people love to say), but I've never had an onlay that I did turn into a crown.  

Sorry for the digression.  But theres a purpose.  

Honesty can also mean boldness.  Don't confuse honesty with modesty or passivity.  If we are certain a case looks very similar to other cases you've treated and tons of succes with, say it! If we have the information to back up a bold claim, let it be known!  We're treating thousands of teeth each year.  You have already built up a solid database with your own statistics.  Even if you haven't measured out your success rates officially, you still know what you are good at.  Take more of those cases on.  Become the person that does that X treatment in your area.  Be known for what you're good at.

Ok, back to the patient exam.

If you feel confident in your work, dont be shy on making bold statements like that.  Maybe preface it with a condition or scenario if you feel that you need to, but your honesty and confidence will only help build their confidence in you.  Tell them they are a great candidate for X procedure that they are needing and that you do all the time, then deliver amazing results for them.  They will love you for it.  

For the extreme cases.  You know those cases where things could go bad quick? Like if you're not sure how long a treatment could last? Or even  maybe when you're sitting on the fence and its 50/50, if they need a root canal or not?  If you feel good about it, let them know!  If you do those cases a lot and enjoy them, tell them!  Get excited about the possibiltiy that you could actually be helping them with what they want.  Sure, you need and have to tell them the possible scenarios, ramifications, and outcomes as to what might happen, but you'd be suprised how many will accept these 'baby step' type procedures before jumping into the larger more permanent  ones.

When it comes down to it, biomimetic dentistry can offer a different approach to dentistry than what patients might be accustomed to.  We can prevent root canals.  We can prevent crowns.  We can be minimal in how we treat teeth.  So why not lean into it?  Use it as a practice builder.  Use it to get that stubborn husband from an amazing family in to see you.  Use it as way to build your practice the way you want it to be.  Get comfortable with the nuances of biomimetic dentistry.  Get comfortable with the sciences and evidences and the techniques that then follow the research.   And I guess... get comfortable presenting those insane claims... when the situations arises.