Your Best Dentistry May Never Get Done

A few months ago I had two appointments with a financial advisor at my firm of accountants. I went in genuinely open-minded — curious to find out whether there was anything he could do to improve my investment returns.

The first appointment was forty-five minutes and was described as information-gathering. It wasn't. It was forty-five minutes of him demonstrating how much he knew. He asked me almost nothing meaningful. Our accountant was sitting right there in the room — a complete picture of my financial life available for the asking — and the advisor didn't ask him a single question. He arrived at an information-gathering meeting with no apparent interest in gathering information.

Two weeks later we reconvened in a boardroom high in a city office tower — the kind of room with floor-to-ceiling windows and views that are supposed to make you feel like you're in capable hands. He presented his findings for two hours. The one thing I genuinely wanted to discuss — how much my wife and I could afford to spend each year without risking running out of money — was treated as a minor consideration, barely worth pausing on. Everything else was language I couldn't follow. At one point he described something as the need to "develop cashflow strategies to identify the most effective ways to access capital." He presented this as a response to something I had asked for. I still don't know what it means.

I left having promised to think it over. I was deeply annoyed. Two hours had passed. Ninety percent of the conversation had gone over my head. I had come in wanting clarity and confidence and left feeling more confused and more anxious than when I arrived.

He had no idea.

The mirror you don't want to look in

I've shared that story with dentists at seminars and watched the room carefully. There's usually a ripple of laughter — people nodding, making faces, recognising the type. And then a pause. Because most dentists, if they're honest with themselves, have been that financial advisor. They just didn't know it at the time.

There is no more important skill in dentistry than the ability to communicate with patients. Not implants. Not endodontics. Not occlusion, or cosmetic dentistry, or any of the clinical disciplines that fill the continuing education calendar year after year. Communication. Full stop.

Over many years I've had the privilege of visiting a large number of practices and observing dozens of dentists at work. In all that time I have not been able to find any meaningful correlation between clinical excellence and financial success. I've seen technically gifted dentists who struggle to fill their books, and I've seen dentists of modest clinical skill who run thriving, profitable practices. The difference, without exception, comes down to how well they communicate with patients.

But financial success is only part of the story — and not even the most important part. Skilled communicators get to practise a different and far more satisfying form of dentistry. Every day they perform their finest work on patients who understand their situation, have made a genuine choice, and are grateful for the outcome. Their clinical abilities are fully utilised on challenging, interesting and rewarding cases. Poor communicators, by contrast, find themselves doing patch-up dentistry on patients who were never given the opportunity to choose anything better. The tragedy is not just financial. It's clinical. Some of their finest work never gets done.

How it starts

I remember the feeling vividly from my own early years in practice. I'd graduated knowing how to do all these wonderful things — crowns, complex restorations, treatment that could genuinely transform a patient's mouth and their confidence. And then I'd sit down with a patient, explain that they needed a crown, nervously mention the fee, and hear: "Nah, just rip it out."

When that happened a few times I stopped offering good treatment. Not consciously, not all at once — but gradually, quietly, the ambition contracted. It was simply too painful to keep putting yourself forward and being knocked back. So you diagnose what you think the patient will accept. You present the filling instead of the crown. You protect yourself from rejection by never quite asking the question.

I've since discovered that almost every dentist has a version of this story. It's not laziness or indifference that drives under-diagnosis. It's scar tissue. It's a young dentist who got hurt a few times and, without anyone teaching them a better way, made a completely understandable decision to stop putting themselves in that position.

The problem is that the patient who needed the crown still needs the crown. Your discomfort with the conversation doesn't change their clinical situation. It just means they leave without knowing the full picture — and without the chance to make a real choice about their own mouth.

What patients actually experience

In November I took delivery of a new Lexus. At the handover the salesman walked me through the car in exhaustive detail — forty minutes of technical specifications, features and functions that meant nothing to me. I don't care about cars. I want to get in and drive. The first new car I ever bought was a Mazda 6. A friend asked me afterwards how many cylinders it had. I had absolutely no idea.

The salesman was enthusiastic, thorough and well-intentioned. He was also completely absorbed in what he found interesting rather than what I needed to know. I listened politely, thanked him warmly, and went home.

He had no idea either.

This is one of the most common communication failures in the dental surgery — the assumption that because something is clinically significant or technically fascinating to you, it must be important to the patient. It isn't. Patients don't want to know everything you know. They want to know what they need to know to make a confident decision about their own mouth. Those are very different things, and confusing them is the source of an enormous amount of wasted time and lost treatment.

Excessive clinical detail doesn't inform patients. It overwhelms them. It shifts the focus from their needs to your expertise. And it can, quite unintentionally, make patients feel exactly the way I felt in that boardroom — out of their depth, quietly embarrassed, and desperate for the whole thing to be over.

One word can make the difference. Implants are a remarkably comfortable form of treatment — most patients don't even need analgesics afterwards. Tell a patient the implant will be "screwed into the jaw" and you will almost certainly trigger anxiety about pain. Tell them it will be "placed into the jaw" and the same question rarely arises. Same procedure. Same outcome. Completely different conversation.

The fear that makes things worse

Many dentists hold back from presenting comprehensive treatment because they worry about frightening patients away. I once visited a practice and watched a dentist examine a patient who needed seven crowns. He told the patient they needed two crowns and five fillings. When the patient left I asked him why. His answer was simple: "I didn't think they'd accept seven crowns so I only told them about two."

He had made a unilateral decision about what this patient could afford, or would accept, or was capable of understanding — without asking. He had removed their right to make an informed decision about their own mouth before the conversation even started. And he had substituted his assumption for their autonomy so routinely that he didn't even seem troubled by it.

The correct approach is to diagnose and present everything — without pressure, and always with an alternative. Every patient deserves to know the full picture. What they do with that information is entirely their decision, not yours.

I always saw my job as showing patients what excellent dentistry looked like for their mouth. Their job was to tell me how much of it they wanted, and how quickly. Some days one patient would proceed with a crown. Some days fourteen would. The number was never the point. The point was that every patient left the chair knowing what their mouth needed and had been given a genuine choice about what to do next.

When a patient decides they're not ready — for financial reasons, personal reasons, or no reason they want to share — that decision must be accepted with grace. A sigh, a flicker of disappointment, an "are you sure?" and you have made them feel guilty for exercising their own autonomy. A patient who leaves feeling guilty doesn't come back. But a patient who says no today and feels completely respected in that moment? They come back. They refer their friends. They say yes next time. The patient who declines and feels respected is far more valuable to your practice than the patient who accepted and felt pressured.

What a great consultation actually looks like

There is a practice I visited in an affluent suburb of Sydney — the kind of area where a one-bedroom flat costs over a million dollars. Two dentists, working in adjacent operatories, seeing the same demographic of patients every day.

One was a master communicator. His appointment book was full of crowns, implants, veneers and full-mouth rehabilitation cases. He attracted an average of eighteen new patients a month and was consistently fully booked.

The other was a poor communicator. His book was full of check-ups, fillings and scale-and-cleans. Very little significant work. He was getting forty-five new patients a month and still couldn't keep his book full. The front desk told me it was like trying to fill a bucket with no bottom.

Same building. Same suburb. Same patient base. The only variable was how each dentist communicated.

When you visit a practice run by a master communicator, the atmosphere tells you something before a word is spoken. It is calm. Unhurried. The patients seem at ease. And the majority of them book in for significant treatment. Great communication is not a long courtship. It is not forty minutes of rapport-building or a detailed clinical education. It is clear, purposeful and efficient. The patient understands their situation. The patient makes a decision. The patient proceeds. Treatment consultations in excellent practices are neither arduous nor time-consuming — because the dentist has learned to give patients exactly what they need to make a confident choice, and nothing more.

A note on the word "rapport." Poor communicators often have a slow, laborious style built on educating the patient and establishing rapport. Consultations drag on for twenty, thirty, forty minutes or more. The irony is that long-winded attempts at connection can be entirely self-defeating. You begin to resemble the financial advisor who spent two hours in a boardroom without once asking what actually mattered to the person sitting across from him. Genuine rapport is not built through talking. It is built through listening — and through making the patient feel that their concerns are the centre of the conversation, not a minor consideration barely worth pausing on.

Bad communicators often don't know it

Here is the most uncomfortable truth in this article: poor communicators usually believe they are good ones. There are two reasons for this.

The first is that many unskilled communicators have developed a style that is never truly tested — they rarely ask the patient for a direct decision. Patients leave holding a printed quote and a pamphlet, earnestly promising to think it over. It's only months later, when someone asks what ever happened to Mrs Jones, that the truth announces itself.

The second is under-diagnosis. Instinctively sensing that they cannot navigate the conversation a complex treatment plan would require, they simply don't present it. Case acceptance looks fine. But it's an illusion — a measure of what the dentist was willing to present, not what the patient actually needed.

There's also a version of this that happens before the dentist even enters the room. Patients find it deeply frustrating to tell their entire story to the nurse, in detail, and then have the dentist walk in and say: "So — what are we doing today?" It signals that nobody thought their story was worth passing on. Or worth reading. Or worth knowing. The financial advisor in my story had an accountant sitting in the room who could have told him everything he needed to know — and didn't ask. The principle is identical.

What that boardroom meeting should have felt like

I still think about how different those two appointments could have been. He could have arrived at the first meeting genuinely curious — asking our accountant to walk him through our situation, finding out what mattered to us, making my core concern the centre of everything that followed. He could have returned two weeks later with recommendations in plain language that left me feeling more capable and more confident than when I walked in. I would have left that boardroom clear, energised, and ready to proceed.

That is what a master communicator does. In a boardroom. In a car showroom. And in a dental surgery, every single day.

I am not a naturally gifted communicator. The young dentist who used to nervously mention the fee and brace for rejection — that was me. If I was able to learn how to do this well, I am absolutely certain that anyone can.

Your patients sit down in your chair carrying their own version of my boardroom anxiety — uncertain, hoping to be guided, ready to trust someone who makes them feel genuinely understood. The question is whether the consultation they're about to have will leave them feeling clear and confident, or whether they'll be walking to their car two hours later, promising to think it over, while you have no idea that anything went wrong.

Your best dentistry is sitting there, waiting to be done. The only thing standing between you and it is the conversation.

If this piece started you thinking, you might enjoy other articles in my Deep Dive library.