Seven clinical practice truths

endospective-jan2015Dr. Rich Mounce offers some advice on the pursuit of endodontic happiness

After 23 years as an endodontist in private practice, seven foundational clinical practice truths have manifested themselves to me. These are shared in no particular order of importance with the goal of stimulating readers to assess if any of these might have tangible value in their practices.


Endodontics is humbling to the true student intent on mastery. Mistakes are the best teacher. Accessing the wrong tooth for example is a significant mistake, but if it leads to marking every tooth slated for treatment with a grease pencil (once the problem tooth is identified), it will never happen again. Forgive yourself, learn, and move on with confidence.
Staff are our greatest strength and our biggest weakness. Praise when they perform well, and go the extra mile. Despite all manner of trying, I have yet to change an underperforming employee into a dependable and competent one. Employees who are not performing satisfactorily should be set free to pursue their dreams somewhere they can be happy and personally effective. If it’s not working, let them go early. If it’s working, move heaven and earth to make your office the greatest place in the world to work.

Endodontists in your same city, rarely, if ever, want to be friends or will be complimentary of you, especially if you are competing for the same referrals. Don’t expect respect from your fellow endodontists. Sad, but true. Brush it off. People criticize because they feel threatened. If you are being “slagged off” by your local competitors, it means you are doing something right.

Tell patients where appropriate, “It’s OK to be afraid; I understand,” and “You are safe here,” and then make them comfortable with whatever means necessary. Profoundly numb means profoundly numb, make them so. People can’t judge your technical skill, but they know if you care and if they were pain-free during the procedure. It is the greatest single marketing tool available to us.

We live in an emotional space not occupied by our general dental colleagues. Tough patients are the reason the general dentist referred the patient in the first place! As such, don’t take it personally. By whatever means necessary, such negativity cannot be internalized. Taking care of oneself physically, emotionally, spiritually, and in our relationships cannot be overstated in value. It’s no good to be the highest producer in your city or state and be miserable.

The dental industry is not made up of our friends. Beware the young perky sales representative with the “buy 10 get 2 free” offers of the latest and greatest. The markup on dental equipment and supplies is often 50%-100%. Bargain hard for your supplies and equipment. Never take the first offer made by a company on anything. They can almost always do better, until they can’t. The sales representatives have to make their quotas or they get fired. The higher the price you pay, the closer to their goals they become. Only one party wins in that transaction. Strange advice from a man who owns an endodontic supply company, but true. Savvy clinicians are consistently asking us for quotes. I appreciate that both as a clinician and owner of

Don’t be afraid to “go big” on new and innovative technology. For example, Sonendo® is virtually certain to forever change the endodontic landscape with regard to “ultracleaning” canals, simplifying technique, reducing iatrogenic events, and ultimately improving the quality of patients’ lives by retaining teeth that otherwise might be subject to “cold steel and sunshine” and ultimately implants. The pendulum is likely to swing back to natural tooth retention. If I were an oral surgeon or periodontist, I would be concerned. But Sonendo will come with a cost, a learning curve, and require a bold step for the early adopters. Putting one’s head in the sand and waiting will carry a heavy cost for the doubters.

I welcome your feedback.

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