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Grades. We live and die by them throughout our academic journeys. And it starts right out of the gate during that tender time we call kindergarten. Yep, right then and there it happens: we’re labelled. By a combination of our peers and our teachers we’re either lumped into the smart kid group…or the other group…because of our grades. It’s really easy to be moved out of the smart kid group but it’s nearly impossible to ever move into the smart kid group. And once we are assigned to a group we all start to look at each other differently: “oh yeah, there go the smarty pants” and vice versa. Often the two groups find it hard to intermix and socialize together. The two groups usually remain segregated throughout their entire precollege journey right through to graduation from high school. AND WITHIN the smart kid group we find competition.

And throughout our precollege years we are constantly reminded that grades are everything. Grades mean college. Better grades mean a better college. A better college means a better job. And a better job means a better income. And people with better incomes…well, you do the math. However, once in college some folks seem to finally relax just a little bit because they made it to college and they’re on their way to their career.

However, those who need college as a means to be accepted into graduate school, well, you probably already know the story. Better precollege grades mean a better college. Better college grades mean a better graduate program. Better graduate degrees mean a better income…and so on and so forth.

Dental students work damn forking hard to get into dental school. And making it into dental school is such an incredible accomplishment and reward for soooo many years of hard work and sacrifice. But right out of the gate starts the whole grade shit show again. People become segregated. People get labeled. People become competitive. People do silly things in the name of grades. And grades can lead folks down dark paths of cheating, horrible stress, anxiety, and depression (even to the point of suicide). Grades can and do make generations of emotionally scarred dentists. And to what end? Can there be a better way?

Dentistry and dental school can, in my opinion, do without segregation, labeling, and competition. I may be a bit of a socialist (yeah, more on that a different day) but we’re all training to do the very same things in order to SERVE THE PUBLIC. In other words, we are a profession: we’re not trying (or at least we shouldn’t be trying) to put our colleague down the street out of business. We are a profession: we are a group of professionals coming together with a common goal to serve (…and to try to earn an income). We are a profession: we should be somewhat united in our ambitions and beliefs when it comes to the ideals of the profession.

But, in my opinion, it doesn’t always seem to run that way. Shouldn’t it be enough to be accepted into dental school and become a doctor working as a team with other doctors? Well, things get a bit murky. We have good folks who wish to specialize. Unfortunately those folks are judged by the very same thing that we’ve all been measured against since kindergarten: grades. Our system of grading forces those who wish to specialize to continue fighting for grades. And competition can be fierce. And competition can be polarizing. And competition can be segregating. And competition can make people act in ways…well, you do math.

I’m not a specialist so I want to make sure I’m not just doing a sour grapes thing here: I graduated with honors; I was going to be a pediatric dental specialist but withdrew my application right at match because of my having to attend to family needs. I even won the University of Minnesota Pediatric Dental Award…and I boycotted my awards ceremony! Why? I was disgusted by the competition fostered by my dental school (you know which one it is). I was disgusted by the lavish awards given to the grade getters in my class. I was disgusted by my dental school’s fostering a culture that promoted specialty over general dentistry. I was disgusted by HOW FORKING HARD my friends worked to just be able to graduate and they got NOTHING. It’s as if becoming a general dentist was JUST a consolation prize.

Let me tell ya, our profession thrives because of general dentists. And being a general dentist ain’t a bad place to be (seen any recent US News & World Reports about forking good jobs to have?). And please don’t get me wrong: I’ve been around some great specialists and some GREAT people who went on to become specialists. That said, the opposite is also true. And I think we need to remember that specialists work to SUPPORT general dentists. Specialists can not work unless given work by a general dentist (it’s called a referral). And the specialists that I have CHOSEN to work with have all been OUTSTANDING SUPPORT for my practice. That said, I have chosen to NOT work with some specialists who could or would not support my mission with MY patients. And it makes you wonder: what kind of people were those specialists before they were specialists? Did grades and competition play into anything related to the formative processes that led some specialists to their station in life? Specialists: doctors with magical dental super powers who can exercise those powers only in a supportive manner when called upon by a general dentist (it ain’t about the jerk docta with magical super powers cuz that docta ain’t gettin’ my bizness).

So, maybe there’s a better way? Maybe there’s a way that we can all play together nicely? Perhaps there’s a way that we can come together as a team for the greater good of society? Maybe there’s a way that we can support and reward hard work free from the debilitating, segregating, and down right nasty effects that arise from grades? Has the time come to rid ourselves of grade competition? Has COVID-19 finally woke us up to the liberation of pass/fail??? Is it time to recognize that it’s DAMN FORKING COOL TO BE A DENTIST WORKING WITH OTHER DENTISTS IN A PROFESSION AND WE DON’T NEED A FORKING GRADE TO SUPPORT THAT FEELING OF COOLNESS??? And remember: I HAVE NEVER HAD A PATIENT ASK ME ABOUT MY GRADES IN DENTAL SCHOOL!!!

DDS…’nuf said.

So let me preface this opinion/discussion with a few disclosures: I BELIEVE THAT CORONAVIRUS AND COVID-19 ARE REAL; I follow news sources that provide factual information regarding coronavirus and COVID-19; I believe in the ever-changing scientific evidence and data regarding coronavirus and COVID-19; I believe in measures that help mitigate the spread of coronavirus such as but not limited to WEARING A MASK; and I believe the State of Wisconsin is currently up shit creek regarding COVID-19 infection rates, hospitalizations, and deaths. OK, that said, let’s continue (and if my above listed disclosures make one uncomfortable then I suggest one refrain from reading any further).

Being a student dentist, in general, kinda sucks. Dental school has always kinda sucked and it might always kinda suck (yeah, I hated dental school…I think I may have turned hating dental school into an art). And with that student dentists (and even practicing dentists long graduated from dental school) have always been at high risk for suffering from mental illness. I have lived through and continue to live with mental health issues (I have PTSD). And, yes, I unfortunately have had to live through losing student dentists and dental colleagues to suicide.

But it’s my opinion that this year is PARTICULARLY HARD to be a student dentist. Heard of this thing called coronavirus? Complete disruption of everything we ever viewed as normal. There isn’t anything that isn’t forking weird right now. Everything is FORKED UP!!! And then we throw in the stress of dental school?! Quite possibly it’s a complete recipe for some dark and tough days. I’ll say it again: being in dental school during this time of coronavirus is, in my opinion, STUPID HARD!!! Let’s not sugarcoat it. Students, staff, and faculty are all under tremendous EXTRA pressure due to coronavirus. There was a tremendous amount of pressure on all of us BEFORE coronavirus but our pressures have grown exponentially as we struggle with the ever-tightening grip of this forking pandemic (not to mention political and civic/social strife which likely are being fueled by this forking pandemic).

Due to the coronavirus there are enormous extra pressures on ALL student dentists like never before including but not limited to: shortened lab time; early morning practice sessions; late night practice sessions; not enough time to get work done (and certainly NO time to redo work should something go awry); heightened expectations for perfection from faculty; social isolation; worry regarding another COVID school shutdown; worries about catching coronavirus and falling WAY behind in school; worry about not having enough skills acquisition to pass practical/PBCE/Board exams; missing family; missing friends; missing being able to participate in activities that were curtailed due to coronavirus scares; anxiety about social justice issues; anxiety regarding political issues; anxiety about the economy (especially if a student’s family has been hit by the coronavirus economy); anxiety about family members becoming ill; anxiety about friends becoming ill; anxiety about not seeing enough patients/having enough clinic time; anxiety about graduating on time; anxiety about tuition increases; anxiety about the possibility of not being able to become a dentist; and I can go on and on. And I have sensed anger, despair, distress, worry, anxiety, hopelessness, and a general malaise like never before from most of my student dentists and this gives me a great deal of concern. We are only a month and a half into Fall Semester and we have a ways to go (and the tough stuff ain’t even hit yet).

Yes, I am sensing a great amount of anxiety, depression, and panic emanating from my student dentists. Anxiety, depression, and panic are insidious foes. They make you feel defeated and this is only heightened in over-achievers also known as student dentists. And mental illness is an illness like any other illness that knocks us away from living life to its fullest. I go to my MD to get my asthma treated when it knocks me on my ass. And I have the strength to go to my MD and my therapist to have my panic attacks/PTSD treated when they knock me on my ass. I should not be and am not afraid/embarrassed to admit that I am suffering from a mental illness. Yet many folks are afraid to admit to and/or seek care for mental health issues as there may be a perception that our society does not accept mental illness as REAL and, worse, may stigmatize mental illness. But my wish and my hope is that folks can and will rise above any perceived stigmas our society has assigned to mental health issues. I am Danish and Denmark is empirically the happiest country on the planet. Denmark’s happiness comes from many different sources but Denmark doesn’t stigmatize mental illness: Denmark embraces mental illness and treats it effectively and its people are empowered to live wonderful stigma free lives. We Danish Americans are arguably one of the smallest ethnic minorities in the USA because ya gotta be nutz to leave Denmark. And I believe with all my heart that student dentists who suffer with and through mental illness may be the strongest people I know as it takes SO MUCH energy and fortitude and courage to succeed at dental school AND push through the massive struggles of mental illness.

So what can we do about mental health issues amongst student dentists right now and into the future (hopefully a COVID free future)? Here are some of my brainstorming thoughts (and they’re not in any particular order and this list will likely expand with time):

I believe we constantly need to nurture a community-wide belief within our dental schools that suffering with mental health issues is OK and NOT a sign of weakness.

I believe we constantly need to educate/re-educate student dentists regarding the signs and symptoms of mental illness.

I believe we need to empower student dentists to recognize mental health issues within themselves AND/OR within their student colleagues.

I believe we need to constantly provide student dentists with up-to-date mental health information/resources. This can include but not be limited to: web addresses that provide relevant and pertinent information and help; phone numbers that student dentists can call for help; utilization of on-campus organizations that work to promote mental health (such as Active Minds); utilization of on-campus counseling and health centers; pamphlets; flyers; etc.

I believe we need to empower and maintain a student run mental health and wellness committee that can be in constant communication with their student dentist colleagues.

I believe we need to train several student dentists to be able to intervene in a mental health crisis (for instance, Johns Hopkins University offers a certification in Psychological First Aid which allows practitioners to help triage and stabilize patients who are in the grips of a psychological crisis).

I believe we need to empower faculty and staff to recognize mental health issues within our student dentists.

I believe we need to train several faculty and staff to be able to intervene in a mental health crisis (Johns Hopkins University’s Psychological First Aid).

I believe we need to train and empower student dentists to contact designated, trained, and trusted student colleagues, staff, or faculty during a mental health crisis.

I believe student dentists need a safe forum to gather to discuss mental health issues especially with fellow student colleagues. This forum should empower students to believe that they are not alone, that they are not suffering in silence, and that others are suffering alongside them. This forum should be a community where suffering students can learn to share and trust each other and work together to overcome the challenges of mental illness. This forum can also include outside-of-school activities that nurture mental health such as group nature hikes, outings, etc.

Life is worth living well and I believe we all can work together to achieve a life lived well.

And maybe that’s enough for Saturday October Seventeenth, 2020. Stay safe, stay healthy, keep the Faith, and please help your neighbors. We’re all in this together. We can go the distance. Don’t stop believing.

Sunday October Fourth, 2020. And let me preface this entry with a few disclosures: I BELIEVE THAT CORONAVIRUS AND COVID-19 ARE REAL; I follow news sources that provide factual information regarding coronavirus and COVID-19; I believe in the ever-changing scientific evidence and data regarding coronavirus and COVID-19; I believe in measures that help mitigate the spread of coronavirus such as but not limited to WEARING A MASK; and I believe that the State of Wisconsin is currently in deep shit regarding COVID-19 infection rates, hospitalizations, and deaths. OK, that said, let’s continue (and if my above listed disclosures make one uncomfortable then I suggest one refrain from reading any further).

Dental education in this time of coronavirus is STUPID HARD!!! Let’s not sugarcoat it. Students, staff, and faculty are all under tremendous EXTRA pressure due to coronavirus. There was a tremendous amount of pressure on all of us BEFORE coronavirus but our pressures have grown exponentially as we struggle with the ever-tightening grip of this forking pandemic (not to mention political and civic/social strife which likely are being fueled by this forking pandemic…maybe more on that a different day). OK, so now where do we go with this conversation in a coherent and logical manner when all my brain can give me is a bunch of jumbled panic thoughts rocketing from one thing to the next?

I am grateful that the dental school is open for business. Patients are receiving care, students are receiving an education, and staff/faculty are able to work and collect a pay check (which in turn allows folks to care for their families which subsequently boosts self esteem and pride). But being open for business DOES NOT MEAN WE ARE BUSINESS AS USUAL! Far from it. And when the only other option for the dental school is to be CLOSED (a path that some dental schools have chosen) then being open, even in a limited capacity, is OK for me.

But what we’re doing is not sustainable. The level of care and education that we’re providing is compromised and cannot continue at this level without further drastic changes. We’re already working in a drastically altered reality but the hope (my hope) has always been that the changes we’ve made are only temporary and that we will revert back to a sense of normal once the pandemic wanes (hopefully it does). So I gather strength from the hoping that our temporary pressures and compromises will abate. In other words, I’d rather take OPEN right now with all the extra pressures AND all the compromises and deal with all their related issues at a later time as we’re able.

Patience is always a virtue. But I cannot stress that EXTRA PATIENCE IN THIS SITUATION, RIGHT NOW, IS A MUST. There are too many unknowns and too many questions that CANNOT be answered. We don’t know when the pandemic will wane. We don’t know when we will be able to revisit that which we knew as normal. We don’t know how long we will have to function in our compromised state. We don’t know how long we will have to live with extra PPE’s. We have no idea how the price of PPE’s will affect our finances. We don’t know if we will continue to be able to procure adequate PPE’s. We don’t know how long folks within our building will remain healthy. We don’t know if we’ll be able to remain open. We don’t know when part-time faculty will feel safe enough to return to teaching (which in turn means we have no idea when we will have enough faculty to boost our clinical activities and patient numbers back to normal). We don’t know when we’ll be able to have a lecture hall filled with students to capacity again. We don’t know when we’ll be able to move away from on-line classes. We don’t know when we’ll be able to end our physical distancing. We don’t know when we will be able to bring an entire class together again in the Sim Lab. We don’t know if D4’s will be able to graduate on time. We don’t know if (or how for that matter) clinical requirements will have to be altered. We don’t know what’s going on with Board Exams. Sensing a theme? And guess what? NO ONE KNOWS AND NO ONE HAS ANY ANSWERS!!! Even our supreme Government doesn’t have any answers!!!

“So what the FORK am I supposed to do?”. Try to take everything moment-by-moment. Maybe even extend that out to one-day-at-a-time. Show up wherever it is you’re supposed to be. Be on time for wherever you’re supposed to be. Be EXTRA PREPARED for whatever it is you’re supposed to do wherever it is you’re supposed to be (time is precious, time is limited). No one can ever fault you for doing your best within each given moment and/or assignment! But be prepared to be flexible in altering whatever plan there may be for that particular moment and/or assignment. And always plan on there being a tomorrow but be prepared for whatever may land when tomorrow arrives.

“What else can I do?”. Be patient with oneself. I will be honest in saying that this pandemic has been REALLY HARD for me on so many levels. I have a distinct lack of joy about…EVERYTHING, and that translates into a tremendous lack of energy and motivation (which has a direct effect on my mental health). The pandemic and its accompanying political and civil/social issues has tainted and painted EVERYTHING in my life. It’s like one of those dementors from Harry Potter is always right nearby. And EVERYTHING becomes a burden! Simple everyday tasks are exhausting but it gets even worse when I have to add in: grocery shopping; going to the gas station; going to the post-office; going to Target; picking up cat food; taking out the trash; vacuuming the house; cooking meals; playing guitar; brushing my cats; mowing the lawn; and I can keep going and going. Some days I am so exhausted and so unmotivated that I’m too tired to even get into bed (the floor becomes more comfortable when you make the decision that you’re too tired to get into bed). So what do I do to keep going? I keep taking deep breaths, focus on things I can control, and keep telling myself: I can get out of bed; I can have a cup of coffee; I can take a shower and put on deodorant; I can put on my shoes and tie them too; I can drive myself to work; I can handle twenty minutes of fast driving crazy angry drivers; I can get through the next fifteen minutes in the Sim Lab; I can get through this crazy hard procedure on this patient; I can drive myself home; I can give kitty medications and kitty supper; I can brush my teeth; I can fall asleep on the floor; I can wake up and start a new day tomorrow. And I always try to keep myself aware of mental health and my PTSD. Anxiety, depression, panic, and trauma are insidious foes. They make you feel defeated. But I am not afraid to REACH OUT FOR HELP! Mental illness is an illness like any other illness that knocks us away from living life to its fullest. I go to my MD to get my asthma treated when it knocks me on my ass. And I have the strength to go to my MD and my therapist to have my panic attacks/PTSD treated when they knock me on my ass. I should not be and am not afraid/embarrassed to admit that I have mental health challenges. And I wish that folks would not feel stigmatized by our society’s views regarding mental health. I am Danish and Denmark is empirically the happiest country on the planet. Denmark’s happiness comes from many different sources but Denmark doesn’t stigmatize mental illness: Denmark embraces mental illness and treats it effectively and its people are empowered to live wonderful stigma free lives. We Danish Americans are arguably one of the smallest ethnic minorities in the USA because ya gotta be nutz to leave Denmark.

“And what else can I do?”. Be patient with one another. We all got shit going on right now. Some things we can handle. Some things we can’t (and that’s OK). Sometimes things happen (like a pandemic) that tip the scales toward not being able to handle things (and that’s OK too). Sometimes our actions toward others can take someone’s precarious situation and turn things toward a bad direction (and I would say that most people right now are dealing with some precarious situations). So maybe we can remember to be nice to each other. Or maybe we can at least try to be respectful toward others. We don’t know all the burdens that people are carrying right now. And our actions can make or break someone’s day. Kind words and a smile (you can tell when someone’s smiling behind a mask) are healing gestures (or at least they’re comforting). Even our body language can make or break someone’s day.

And that’s probably enough for Sunday October Fourth, 2020. Stay safe, stay healthy, keep the Faith, and please help your neighbors. We’re all in this together. We can go the distance. Don’t stop believing.

About a year ago I shared my thoughts regarding what it means (to me) to be a second year (D2) student dentist. Well, my thoughts about being a D2 (and what the second year of dental school represents) have not changed a bit. Being a D2 student sucks. It has always sucked and it might always suck. But it’s my opinion that this year is PARTICULARLY HARD to be a D2. Heard of this thing called coronavirus (well I suppose it depends on one’s news source…I personally follow news outlets that verify the legitimacy of coronavirus)? Complete disruption of everything we ever viewed as normal. There isn’t anything that isn’t forking weird right now. Everything is FORKED UP!!! And then we throw in the most stressful year of dental school?! Quite possibly it’s a complete recipe for some dark and tough days.

Also about a year ago I came face to face with mental illness: I suffered a trauma that triggered overwhelming panic attacks. Thankfully I was able to gather the strength to reach out for help (I wrote about it in a blog entry called “Panic Attacks Suck: Part One”). Thanks to a great medical team I was diagnosed with PTSD. And last year’s trauma was not the precipitating incident: I mentally blocked a trauma I suffered more than twenty years ago (1994 to be exact) namely I was wrongly accused of causing a medical mishap that led to the death of a patient (more on that a different day). I didn’t have any recollection of that trauma yet it was there lurking within the depths of my mind. My therapist was able to open doors into my mind that I couldn’t open on my own. And once those doors were opened healing truly began (finally). Last year’s trauma was only a reminder (or a trigger). But it’s amazing what that new trauma triggered within me. And I don’t know if I would have been able to truly reach a place to begin healing without skilled help from a trained mental health professional. So, I am ever so grateful that there can be (and is) healing from mental illness. I am ever so grateful for my medical team. And I am ever so grateful that long held stigmas about mental illness are finally starting to erode (a little).

So why the fork am I sharing all this self-indulgent crap? Well, I have learned a whole lot about mental illness this past year. I’ve spent a whole lot of time contemplating mental health this past year. I have become acutely aware of mental health issues this past year. And I even went so far as to become certified in Psychological First Aid from Johns Hopkins University this past year. Yeah, so what, right? And what does this have to do with the second year of dental school, right?

Due to the coronavirus there are enormous EXTRA pressures on D2’s like never before including but not limited to: shortened lab time; early morning practice sessions; late night practice sessions; not enough time to get work done (and certainly NO time to redo work should something go awry); heightened expectations for perfection from faculty; social isolation; worry regarding another COVID school shutdown; worries about catching coronavirus and falling WAY behind in school; worry about not having enough skills acquisition to pass practical exams; missing family; missing friends; missing being able to participate in activities that were curtailed due to coronavirus scares; anxiety about social justice issues; anxiety regarding political issues; anxiety about the economy (especially if a student’s family has been hit by the coronavirus economy); anxiety about family members becoming ill; anxiety about friends becoming ill; anxiety about the possibility of not being able to become a dentist; and I can go on and on. And I have sensed anger, despair, distress, worry, anxiety, hopelessness, and a general malaise like never before from my group of student dentists who I now recognize as D2’s (that would be the Teal Wave at MUSOD also known as the Class of 2023). D2 year has always been tough but I’ve never seen a D2 class suffer like this D2 class.

I am worried about and for my D2’s. We are only a month into Fall Semester. We have a ways to go and the tough stuff ain’t even hit yet. I implore any and all who are suffering from anxiety, depression, panic, or trauma to reach out for help. Please don’t suffer alone in silence and isolation. Anxiety, depression, panic, and trauma are insidious foes. They make you feel defeated and this is only heightened in over-achievers also known as student dentists. REACH OUT FOR HELP! Mental illness is an illness like any other illness that knocks us away from living life to its fullest. I go to my MD to get my asthma treated when it knocks me on my ass. And now I have the strength to go to my MD and my therapist to have my panic attacks/PTSD treated when they knock me on my ass. I should not be and am not afraid/embarrassed to admit that I am suffering from a mental illness. And I wish that folks would not feel stigmatized by our society’s views regarding mental health. I am Danish and Denmark is empirically the happiest country on the planet. Denmark’s happiness comes from many different sources but Denmark doesn’t stigmatize mental illness: Denmark embraces mental illness and treats it effectively and its people are empowered to live wonderful stigma free lives. We Danish Americans are arguably one of the smallest ethnic minorities in the USA because ya gotta be nutz to leave Denmark.

I can’t say it enough: I encourage anyone who’s suffering from anxiety, depression, panic, or trauma to seek help. I know how stressful dental school is especially second year and MOST especially second year during a pandemic. And I have had to live through losing student dentists and colleagues to suicide. There’s a lot of life worth living. And it’s good and right to seek help and live to see beautiful todays and tomorrows.

And we all got shit going on. Sometimes we can handle it. Sometimes we can’t handle it (and that’s OK). Sometimes things happen (like a pandemic) that tip the scales toward not being able to handle it (and that’s OK too). Sometimes our actions toward others can take someone’s precarious situation and turn things toward a bad direction. So maybe we can remember to be nice to each other. Or maybe we can at least try to be respectful toward others. We don’t know the burdens that people are carrying. And our actions can make or break someone’s day. Kind words and a smile (you can tell when someone’s smiling behind a mask) are healing gestures (or at least they’re comforting). Even our body language can make or break someone’s day.

It’s OK to have shit going on. And it’s OK if that shit overwhelms us. There are really good people out there who can help us when the shit gets too deep. Please reach out for help. Life is worth living well and we all can work together to achieve a life lived well.

We probably need to do a little bit more art class stuff. And we need a little physics review (shit, sorry). And, as in previous blog/lectures, my blog/lecture has a whole bunch of cheesy and hokey shit in it. However, I put a whole lot of time and effort into that cheesy and hokey shit. Most of the pictures/photographs and “art work” are my own. So I ask that people please be kind as to what they do with my intellectual property (Notice of Copyright: Copyright © 2020.  Patrick James Knapp Jr, BS, DDS, MDR.  All rights reserved.  No part of this presentation may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission of Patrick James Knapp Jr, BS, DDS, MDR.). Also, unless otherwise stated my reference is: Rosenstiel, S.F., Land, M.F., & Fujimoto, J. (2016). Contemporary fixed prosthodontics (5th ed.) (pp. 624-640), St. Louis, MO: Elsevier.

So in addition to our two types of color mixing (additive and subtractive color mixing) we have two different color mixing systems. The first color mixing system is an acronym called CIELAB which stands for Commission Internationale de l’Eclairage L*a*b*. This color matching system is used exclusively for color research in dentistry. I don’t get it. Somebody does (not me) and CEILAB is beyond my limited abilities to discuss in this blog/lecture so I’m not going to talk about it. And the second color mixing system is Munsell. Munsell is the color mixing system utilized in art school, ceramics, paint mixing, pigments, and dental materials/dentistry.

But all color starts with light. There is no color without light (and for we humans there isn’t any vision without light either). And what is light? It’s electromagnetic energy that’s composed of waves and particles (also known as photons…Einstein shit).

Ugh, quick physics review. Our human visible light spectrum is made up of waves of energy that exist within a band of electromagnetic energy with wavelengths between 380-750 nanometers. And visible light is a part of (a very small part of) the entire known electromagnetic energy band. For now our known electromagnetic energy band, starting from really really small wavelengths and getting bigger and bigger, are cosmic rays, gamma rays, X rays, ultraviolet rays, visible light, infrared rays, micro waves, television waves, and finally radio waves.

Getting back to visible light, particularly white light, we can split visible light into its constituent parts which cover the entire visible light spectrum. I think we all have come to know the splitting of white light into its constituent parts as ROY G BIV. Rainbow! In other words, those 380-750 nanometer wavelengths translate into (starting small then getting bigger) ultraviolet (not visible), violet, indigo, blue, green, yellow, orange, red, and infrared (not visible). Nothing but a simple rainbow.

So now that we’ve talked about ROY G BIV, let’s talk a bit about the Munsell color mixing system. Munsell describes color as having three dimensions (Munsell calls them elements) much like height, length, and width. And the first element of Munsell is HUE. What is hue? Simply, what “color” is it? In other words, red, orange, yellow, green, blue, indigo, violet, etc. That’s Hue.

And the second element of Munsell is CHROMA. And what the heck is chroma? It’s HOW MUCH of a SINGLE COLOR we see. We can also describe chroma as intensity, saturation, purity, strength, etc. Huh? Well, picture dark blue, not-so-dark blue, light blue, and really light blue. They are all blue but they have different amounts of blue. That’s Chroma.

And the third element of Munsell is VALUE.

This is where things get really weird yet value is the most important aspect of shade matching in dentistry (and it’s really forking hard to explain/understand). Value refers to HOW MUCH BLACK there is, or how dark (or light) something is, or how many photons are reflecting out of a color and subsequently reaching our eyes/retina. And this is NOT to be confused with CHROMA which refers to HOW MUCH of a particular HUE (saturation, intensity, strength, purity) is contained within a particular “color” we see (for instance, how “blue” is it?). VALUE refers to HOW MUCH BLACK (or white) is contained within a particular hue/chroma combination “color” we see. Forking confusing right?

Hmm. Black. Let’s revisit Part Two of this blog/lecture when we talked about how black is very cool. Black ABSORBS ALL WAVELENGTHS and reflects back NOTHING! Nothing escapes black. Just like a black hole, light and its energetic photons can not and do not escape from black. So if there are no escaping energetic photons then we get zero photons entering our eyes and subsequently zero retinal stimulation in our eyes. No retinal stimulation in our eyes means zero visual signal going to our brains. And therefore we see NOTHING when we’re seeing pure black. Black has zero wavelength and gives zero photons.

OK. So what! So let’s try to talk about value a little bit more. If something is lighter it means it has a higher value AND is less (contains less) black. And increasing something’s value means that we’re making it lighter AND we’re decreasing the amount of black. And decreasing something’s value is to make it darker AND means we’re adding more black. Clear as mud, right?

Let’s look at some examples and hopefully we will start to see what the fork I mean. So a black and white photograph is nothing more than hue and chroma taken away and translated into its constituent values.

And now let’s completely blow this open to confusion. Two different hue/chroma combinations can have the same value. And why is this important? Because teeth in the same person’s mouth can have differing hue/chroma combinations AND have the SAME VALUE (this will hopefully make more sense when we start talking about commercially available shade matching tabs…more on that a different day).

And let’s get even more forking confusing. Identical hue/chroma combinations can have differing values. What the fork? Let’s bring in some pictures to illustrate this. What is the hue and chroma of the green grass within the sunny and shaded areas in the picture?

They’re the same! Same wavelength is flying at our eyes. Huh? Yeah. So what’s going on? It all has to do with energy, reflectance of light, and photons (ooh, Einsteinium shit).

Let’s go back to our picture of a wave with a photon.

When there is less energy from a light source hitting a colored object there is subsequently less reflectance, fewer photons being released, less retinal stimulation, less signal to the brain, and a dimmer view.

When there is more energy from a light source hitting a colored object there is subsequently more reflectance, more photons being released, more retinal stimulation, more signal to the brain, and a brighter view.

Looking at green grass on a golf course we know that the hue and chroma of the grass is the same in the sunny area and in the shady area.

But the area of that golf course that’s in the shade is giving less reflectance, fewer photons are being released, there’s less retinal stimulation, there’s less of a signal to the brain, and we subsequently “see” a dimmer view. That grass has been “shaded”. We’ve added more dark/black. We’ve decreased its value (still the same wavelength though). And THAT is the essence of dental shade matching. First and foremost, what’s the value of the tooth? How many photons are being released from that tooth and subsequently stimulating our brain? More on that a different day.

Color is amazing. And holy shit is it complex! What seems so innocent and simple (and we usually take for granted) is ridiculously crazy. And even harder is researching color and actually making sense of it. In fact, color can be downright esoteric, avant-garde, incredibly weird, and, some would argue, spiritual. But aside from all that brainiac shit, look at what we’ve done with color! It’s incredible what artists do everyday with color. Walk through an art gallery and one can’t help but be amazed at (or afraid of) what people have done with color. Leonardo DaVinci and the Mona Lisa: WOW! We’ll never get to the bottom of how Leonardo mixed and placed pigments on a piece of canvas!

But this stupid blog/lecture is about teaching color (lucky me). And how the fork do I do that? Well, some really smart people (that would NOT be me) came up with theories about color. I am certainly not going to get into the intricacies of color theories cuz I will severely fork that up. So, I shall try to keep things simple (I love a little saying from our friend Winnie the Pooh who was brought to life by A.A. Milne: “It is more fun to talk with someone who doesn’t use long, difficult words but rather short, easy words like, ‘What about lunch?’”).

Now, my blog/lecture has a whole bunch of cheesy and hokey shit in it. However, I put a whole lot of time and effort into that cheesy and hokey shit. Most of the pictures/photographs and “art work” are my own. So I ask that people please be kind as to what they do with my intellectual property (Notice of Copyright: Copyright © 2020. Patrick James Knapp Jr, BS, DDS, MDR. All rights reserved. No part of this presentation may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission of Patrick James Knapp Jr, BS, DDS, MDR.). Also, unless otherwise stated my reference is: Rosenstiel, S.F., Land, M.F., & Fujimoto, J. (2016). Contemporary fixed prosthodontics (5th ed.) (pp. 624-640), St. Louis, MO: Elsevier.

Color theory. What the heck is color theory? Well, the good folks at Wikipedia have an answer for that: “In the visual arts, color theory or colour theory is a body of practical guidance to color mixing and the visual effects of a specific color combination.” (https://en.m.wikipedia.org/wiki/Color_theory). And I feel like the most important bullet point from this definition is COLOR MIXING. Color mixing can be really WEIRD! And the ensuing VISUAL EFFECTS from color mixing can be equally as weird, frustrating, NOT intuitive, yet STUNNING under the right conditions and circumstances. So, if we’re going to do anything with color we have to know a little bit about color mixing and what the fork happens when we mix colors (that would be the visual effect/s).

Now there are TWO different types of COLOR MIXING. The first type of COLOR MIXING is called ADDITIVE COLOR MIXING. Huh? Yeah. This is the type of COLOR MIXING where we mix wavelengths of LIGHT. Put simply, this is the color mixing that gives us all the colors we see in things like televisions, computer monitors, iPhones, iPads, stage lighting (yes, even Hamilton on Broadway), etc. And how the fork do we even start to mix wavelengths of light? Simply, we start with primary colors. Three primary colors to be exact. RED, BLUE, and GREEN. And what’s totally nutz is we can mix varying levels of the three primary colors to make EVERY forking color! And, if we mix EQUAL amounts of all three additive primary colors we get WHITE! What’s even more whacked is that WHITE light contains EVERY wavelength known to the human race (split white light with a prism and ALL the wavelengths of color/light shoot out of that prism). Now you’re probably wondering why the fork we call it ADDITIVE COLOR MIXING? Keeping in mind that our three primary colors mixed together give us white light. And also keeping in mind that white light contains EVERY wavelength of color/light known to the human race. Then let’s think of additive color mixing as this: we’re mixing three unique/different colors of light, each with their own unique/different wavelengths, in order to yield MANY more wavelengths (white light contains every wavelength of light/color known to the human race), and so we say that we have ADDED wavelengths together (cuz white light is the resulting color and white contains EVERY wavelength). Additive color mixing. Mixing light.

Our second type of color mixing is called SUBTRACTIVE COLOR MIXING. And this is the type of COLOR MIXING where we are mixing pigments and dyes. This is what we use in dentistry. It’s also what we use in arts, ceramics, painting, photography, paint mixing, textiles, dental materials, etc. And just like in additive color mixing we have three primary colors. RED, BLUE, and…YELLOW. But these are actually the OLD SCHOOL subtractive primary colors. For reasons that I don’t want to get into (because I’ll probably just fork it up) the new subtractive primary colors are CYAN, MAGENTA, and YELLOW. You know these colors well because you’re always having to add these forking expensive pigments to your color printer. But, like dentistry, old habits die hard and much of the dental and art world are still using the OLD SCHOOL subtractive primary colors of RED, BLUE, and YELLOW. Now, subtractive color mixing works a bit like additive color mixing but with a few stark differences. As with additive, the three primary subtractive primary colors can be mixed in varying quantities to make EVERY color. And we can mix equal levels of all three subtractive primary colors to come up with something. BUT that something is NOT white. It’s BLACK and that is the stark difference between additive color mixing and subtractive color mixing (aside from the fact that we’re mixing pigments versus light).

Black is very cool. Black ABSORBS ALL WAVELENGTHS and reflects back NOTHING! Nothing escapes black. Just like a black hole, light and its energetic photons can not and do not escape from black (more on photons and wavelengths and Einstein stuff at a different time). So if there are no escaping energetic photons then we get zero photons entering our eyes and subsequently zero retinal stimulation in our eyes. No retinal stimulation in our eyes means zero visual signal going to our brains. And therefore we see NOTHING when we’re seeing black. Black has zero wavelength and zero photons. Where does that energy go? How the fork do I know? Maybe heat? Einstein knows but he ain’t talkin’ no more.

And so why do we say subtractive color mixing? Because we’re mixing TWO or MORE different colored pigments, each with unique/different wavelengths, to get only ONE or NO wavelength. So we have SUBTRACTED wavelengths. We’re going from several wavelengths to one or no wavelength. SUBTRACTIVE. And please remember that a pigment is something that absorbs ALL wavelengths of light and reflects back ONE WAVELENGTH ONLY and that one wavelength is the color we actually see.

Much, much more on subtractive color mixing and wavelengths and photons and other shit (like physics) in a future blog. Stay tuned.

Several year ago I was asked if I would teach shade matching to D2 students in their second year fixed prosthodontics dental course. As this lecture was (and still is) the one shot for students to get that information I thought to myself: “wow, what an honor and a privilege!”. I immediately said yes and got to work researching my subject matter. Quickly I realized: “what the fork was I thinking? What the fork did I get myself into? This is some really boring shit! How the fork am I going to pull this off? Thanks George?!”.

Well, several years have passed since that fateful and lame brained idea came over me. I actually did put together a shade matching lecture and presented it. What’s more is I’ve actually presented that lecture several times since then. Further, I keep getting invited back each year to present that lecture (probably because it’s such boring shit that no one wants to tackle that lecture). What’s even more is I have had a few (very few) students over the years actually tell me that my lecture was valuable (liars).

And here we are in 2020 and we’re staring down the COVID-19 pandemic. Here we are standing in front of the firing squad wondering who will get mowed down by the bug. Will it be me? Will it be any of my friends and/or loved ones? How long will this last? What will America look like after this bug passes? When will we get a coherent and consistent message from our so-called “leaders” in Washington DC?

Well, I was supposed to give my shade matching lecture again this year (March 31st to be exact). That ain’t happening. Collective big sigh of relief from my D2 students! Yeah, no. I found a lecture capture recording of me presenting that lecture several years ago. And this may actually be an improvement as students can see my powerpoint slides and hear me talking and NOT have to see my ugly mug!

Truth be told, I love presenting my shade matching lecture. And I present that lecture in a way that I want lectures to be presented to me (I have endured a shit load of shitty lectures). For instance, I throw in a whole bunch of audience participation. And I generally throw in a bunch of my crazy shit in an attempt to make the information accessible, interesting, and maybe even a little fun (people will probably disagree with that). So I am a bit bummed that I am not presenting my lecture this year. Yes, my lecture capture and my study guide were distributed to all of my D2 students (all of my test questions come directly from the study guide). But I feel like my lecture needs…me (some would argue against that). So I’m trying to bring a little bit of my lecture to my blog (in small digestible parts).

Now, my lecture has a whole bunch of cheesy and hokey shit in it. However, I put a whole lot of time and effort into that cheesy and hokey shit. Most of the pictures/photographs and “art work” are my own. So I ask that people please be kind as to what they do with my intellectual property (Notice of Copyright: Copyright © 2020. Patrick James Knapp Jr, BS, DDS, MDR. All rights reserved. No part of this presentation may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission of Patrick James Knapp Jr, BS, DDS, MDR.). Also, unless otherwise stated my reference is: Rosenstiel, S.F., Land, M.F., & Fujimoto, J. (2016). Contemporary fixed prosthodontics (5th ed.) (pp. 624-640), St. Louis, MO: Elsevier.

Color! Imagine flying out of dull gray damp Milwaukee in early March, landing in sunny Orlando, and taking Disney’s Magical Express to Walt Disney World. EPCOT to be exact. And your eyes (and vitamin D depleted brain) awaken to EPCOT’s International Flower and Garden Festival. Color! Color brings life to…life. We crave color. We depend on color. And our world has evolved around color.

With color we can go from lifeless lumps of clay:

To beautiful and functional works of art:

With color we can go from another strange lump of clay:

To something that comes to life:

And even:

Breakfast. Maybe this looks artistic but:

And look at what happens when we add color:

So the crux of this blog/article/rambling is Porcelain Shade Matching. And why is porcelain shade matching important? It certainly helps us communicate with our dental labs more effectively as our labs are charged with crafting beautiful restorations for our patients. But ultimately it’s about esthetics and PLEASING our patients. Pleased patients means happy patients (even though they may still hate dentists). Patients won’t know why a restoration does or doesn’t look right but patients won’t be happy when their restorations don’t look right and we have an obligation to give patients restorations that work well…and look right.

Now, I feel like there is no way that we’ll be able to really appreciate shade matching without taking a trip to ART CLASS (with a little physics…and maybe even a little dentistry thrown in for good measure). More on that in Part 2.

Disney trips are always tremendously fun (at least my Disney trips are tremendously fun). And accompanying that tremendous amount of fun is usually a distinct lack of sleep (who can sleep with all that fun!). Early flights to Orlando, early morning races to the parks, thousands of daily steps around the parks, late night fireworks and/or shows, and then outside-the-parks attractions like Disney Springs and the Boardwalk and it is no surprise that a little fatigue starts to settle in. PLUS, my wife REFUSES to allow me to take breaks (yeah, she’s continually paying me back for my July Disney Death March Honeymoon where I had EVERY moment of EVERY day meticulously planned…sorry Dear). So when that after lunch mid-afternoon sleepy (and crabby) starts to creep in these are a few of my favorite places to catch a little nap on the go (I will update/expand this list as I nap in more places).

Magic Kingdom: Carousel of Progress; Hall of Presidents; Country Bear Jamboree; People Mover.

Epcot: Spaceship Earth; Awesome Planet Movie (at Living with the Land Pavilion); Impressions of France Movie (at the France Pavilion); the American Adventure Show (at the American Pavilion); The Three Caballeros (in the Mexico Pavilion).

Animal Kingdom: Finding Nemo-The Musical; Rafiki’s Planet Watch Train.

Hollywood Studios: Journey of the Little Mermaid; Beauty and the Beast Show.

Hope this helps you catch a little nap while on the go at Walt Disney World.

I have been asked this question by many people. The short answer: I am a mentor. Perhaps the question is more appropriately: why am I not a part of the WDA Mentor Program? Well, that may be a bit more complex.

Truly, I am not a part of the WDA Mentor Program. Once upon a time I did participate in that program. And I believe that the WDA Mentor Program is an excellent opportunity for students and dentists. However, the WDA Mentor Program is not a good fit for me. That doesn’t mean I’m not a mentor though.

Huh? Yes, I do consider myself to be a mentor. So maybe this begs the question: what the heck is a mentor? And now that’s a really tough question to answer as there are MANY ideas and definitions regarding what a mentor can and should be. Mix in the whole idea of mentoring programs, both formal and informal, versus individual mentoring, both formal and informal and I could go on and on. And how do we separate mentoring from teaching and coaching? To me there is much overlap and confusion and certainly not anything that I can clearly define…but let’s try.

So I am a teacher. As such I feel obliged to provide to my students educational materials usually in the form of information. Sometimes that providing of education/information requires a higher level of input and attention from me and that’s when I believe I step into the role of coach. In fact, I believe a great deal of my daily teaching falls into the category of coaching. And what do I mean by that? I provide step-by-step instructions on how to perform an activity and then I stand by to monitor and critique progress toward an end product or goal. Much like a baseball batting coach analyzing a player’s swing then making suggestions on how to improve/maximize a swing technique, I will give feed back on how a student is: holding a hand piece; developing a margin; carving anatomy; collecting data; just about everything that leads to a dental end goal.

Mentor. Now that’s a bit more complex. I believe I am a mentor and, as such, I am necessarily going beyond a teaching and/or coaching role (although teaching and coaching are integral parts of being a mentor) with someone. To me, being a mentor is about a deeper relationship that develops organically all on its own (two people who’s philosophies and mannerisms align and are compatible). Oftentimes a teaching relationship provides a convenient means/venue for a mentoring relationship to develop but, to me, mentoring doesn’t necessarily depend upon a teaching environment to flourish. And I don’t believe someone just declares themself to be a mentor: I believe we become a mentor only when a person chooses us to be their mentor. In other words, I am a mentor because someone chose me to be their mentor (versus being a teacher where no one has a say in my being their teacher). And the person who chooses me to be their mentor then becomes recognized as a protégée or protégé.

So what happens in a mentor/protégée/protégé relationship? Certainly teaching and coaching. But there is necessarily a great deal more dialogue. Comfortable dialogue. Richer dialogue. And that dialogue usually spills over into thoughts and ideas beyond the educational or workplace task at hand. Oftentimes dialogue includes bigger picture ideas such as life experiences. And continual dialogue necessarily leads to the development of richer levels of trust. Mentors, I believe, must necessarily bare their souls to their protégées/protégés and this requires trust. At the same time protégées/protégés trust that they can initiate dialogue with their mentor about their deepest fears, darkest moments, and greatest elations (mentors are sometimes the first people that protégées/protégés will go to with pressing educational and/or workplace issues). Most often, solid mentor/protégée/protégé relationships develop into lifelong meaningful friendships.

So I am proud to say that I am a mentor. I have been chosen to be someone’s mentor. I take great pride in that fact. I am humbled when someone chooses me to be their mentor. And I am acutely aware of the responsibility that comes along with my being someone’s mentor. In other words, my being a mentor is not something I take lightly yet it’s something I cherish.

With your permission I wish to take you on a journey to a realm where many dentists fear to tread: dental office disputes. And I wish for us to establish a mindset in which we believe that disputes can be beneficial and can be a powerful motivator for change when managed well.

Let’s face it, though. Disputes are not something we typically look forward to. Thousands of years ago Aristotle pondered disputes and offered that anyone can become angry—that is easy; but to be angry with the right person, and to the right degree, and at the right time, and for the right purpose, and in the right way—that is not within everybody’s power and it is not easy. Several years after Aristotle the Christian tradition painted a somewhat more positive picture of disputes when suggesting that blessed are the peacemakers. However we choose to look at disputes I believe that we need not fear disputes. We have dispute resolution tools at our disposal that empower us to collaboratively transform disputes from something to fear into something to embrace.

(For simplicity the terms “conflict” and “dispute” will be used interchangeably throughout this posting. However, please be aware that the literature suggests differences which will not be discussed.)

Most dentists work in private practice, the military, and/or accept university appointments and, as such, are likely responsible for hiring, training, critiquing/reviewing, and disciplining staff. And many dentists report that their number one office concern is staff and staff issues: staff disputes and turnover can be detrimental to the profitability and emotional chemistry of a dental office; hiring staff and training staff is expensive and time consuming; and staff conflicts detract from the chemistry of an office which may ultimately affect the bottom line. Plus, it’s mentally challenging for the office team, dentist included, to work in a toxic environment. But staff are not the only disputants in a dental office. Other potential disputants can be patients (and their families), associates, business partners, spouses of business partners, labs, dental suppliers, repair techs, landlords, lawyers, elected officials, insurance companies, the government, etc.

Anytime, anywhere, and in any job there are going to be disputes. Christianity says that where two or three gather in My name, there I am with them. At the same time when two or more gather disputes are likely also with them. A dental office is no exception. And dentists, like many Americans, tend to avoid conflict as much as possible. In fact, studies show that 50% of Americans are conflict avoidant meaning that one half of all Americans in a conflict or dispute will choose to ignore it, choose to not deal with it directly, never address the issues that led to the dispute, and hope it will blow over all on its own. In a dental office (or any office/relationship) conflict avoidance can have serious repercussions. Untreated conflicts and disputes will fester, bubble over, and eventually become worse (think of an untreated abscess…).

Dentists are the leaders of their respective offices or departments. As such dentists are expected to lead their offices/departments through disputes. In other words, the dentist is responsible for resolving disputes in her/his office or department and this creates a potentially bad scenario: as discussed previously many dentists want to avoid and/or ignore disputes. And how disputes are ultimately handled is of the utmost importance: disputants need to be treated well and in the right way (as difficult as this may be at times).

As stated previously, we have dispute resolution tools at our disposal that can transform disputes from something to fear into something to embrace. What exactly do we mean when saying “dispute resolution”? Dispute resolution refers to the process of moving disputants toward the settlement of a dispute. And there exist many different processes that we use for the resolution of disputes. Some may be familiar, some not so. And all employ varying degrees of win-win (collaborative, joint problem-solving, interest-based bargaining) or win-lose (adversarial) interactions/techniques. The most recognizable dispute resolution processes in the U.S. are litigation, arbitration, mediation, and negotiation. (In the recent past all non-litigation dispute resolution processes were referred to as “alternative” dispute resolution. With “alternative” dispute resolution gaining more traction and becoming mainstream the literature is trending toward dropping the “alternative” designation. Now most non-litigation processes are being designated as simply “dispute resolution”. This is effectively excluding litigation as a labeled dispute resolution process and establishing “dispute resolution” as something separate/distinct from litigation. This posting supports the concept of a stand alone dispute resolution designation separate from litigation and all further mention of dispute resolution in this posting will refer to non-litigation processes.)

Dispute resolution executed well does not mean there will be an absence of disputes: there will always be disputes. Typically, what is dispute resolution expected to accomplish? Aside from the obvious settling of disputes, dispute resolution may establish and/or strengthen the relationship of trust and respect between people or terminate relationships in a manner that minimizes emotional costs and psychological harm. Further, disputes can have a positive side because good can arise from disputes. Usually disputes exist because something is not right and most likely needs fixing. Good can arise if the not-so-good issue that’s causing a dispute is discovered and effectively remedied.

Disputants (people in a dispute) typically argue because they want something and, dentistry notwithstanding, many feel that disputants share in a general lack of communication or perhaps even fail to communicate. This may not necessarily be true as we find that many disputants know and communicate all too well with their opponent/s. What is usually lacking between disputants is effective communication that discovers and explores the issues driving their particular dispute (disputes are all too often motivated by unfulfilled needs and/or a clash of values). How do we effectively communicate with our opponent/s? How do we jointly problem-solve with someone who may be irate? How do we collaborate with our opponent/s and keep our sights on win-win? Enter “[t]he method of principled negotiation developed at the Harvard Negotiation Project” (Fisher and Ury 1981, p. xviii) which, by many accounts, has become the well-spring of today’s dispute resolution movement. The method is comprised of four distinct parts and they are as follows:

“Separate the People from the Problem” (Fisher & Ury 1981, p. 10)

Great care must be taken to ensure that ingrained human frailties do not turn negotiations away from the original problem that precipitated the dispute. Further, we need to ensure that we create and maintain an environment that supports effective negotiations and joint problem-solving. All too often disputant’s inner dialogues, outward verbalizations (including word choices), body language, and emotions turn negotiations away from objective problem solving and create entirely new problems (and subsequent disputes). Often disputants become so engrossed in new problems created by out-of-control emotions and language that the entire precipitating problem is supplanted and may become nearly impossible to re-discover (all too often disputants give up and hire attorneys to continue the battle until someone wins and someone loses and all at great financial and emotional cost). Essentially, barriers to effective negotiations become ensconced.

William Ury (1991) suggests that negotiations can not and should not proceed until negotiation barriers are breached (as stated previously, we need to create and maintain an environment that supports negotiation and joint problem-solving). How do we get around negotiation barriers? Ury’s (1991) answer is the five strategies of “breakthrough negotiation” (p. 9). Strategy number one is first and foremost we must manage our personal emotions and reactions. Ury (1991) calls this “go to the balcony” (p. 11) with the balcony representing a calm mental promontory from which to step back from a situation, calm down, ascertain the situation, and regain perspective and composure before re-entering the situation or negotiation. Strategy number two is management of the other disputant’s emotions and reactions. Ury (1991) calls this “step to their side” (p. 53) which requires doing the opposite of what the other party expects. Ury (1991) suggests that opposites, such as listening and acknowledging (rather than attacking), can catch the other party off-guard. This creates a psychological condition called “cognitive dissonance” (p. 67) which is “an inconsistency between perception and reality…inducing [the other disputants] to change their perceptions of you in order to reduce the cognitive dissonance” (p. 67). Strategy number three is reframing the other party’s tactics as means to tackle the problem. For example, the opposite of rejecting the other party’s tactics is to acknowledge their proposals and then reframe the proposals as potential options (thereby turning the proposals toward identifying interests). Ury (1991) calls strategy number four “build them a golden bridge” (p. 4) in which we help give our opponent/s a voice in developing their own answers and solutions (this effectively supports appreciation and autonomy). Strategy number five is to use our power not to attack or escalate the conflict but to educate the other party. Ury (1991) suggests “(u)se your power to educate the other side that the only way for them to win is for both of you to win together…Don’t try to impose your terms on them. Seek instead to shape their choice so that they make a decision that is in their interest and yours” (p. 133).

“Focus on Interests, Not Positions” (Fisher & Ury 1981, p.10)

According to the famed psychologist Abraham Maslow, every human has innate needs and values. Maslow (1943) labeled them “physiological” (p. 372), “safety” (p. 376), “love” (p. 380), “esteem” (p. 381), and “self- actualization” (p. 382). Fisher and Shapiro expanded upon Maslow’s (1943) “hierarchy” (p. 386) and introduced the “five core concerns” (Fisher and Shapiro 2005, p. 15). “Core concerns are human [needs] that are important to almost everyone in virtually every negotiation. They are often unspoken but are no less real than our tangible interests. Even experienced negotiators are often unaware of the many ways in which these concerns motivate their decisions…These core concerns are appreciation, affiliation, autonomy, status, and role” (Fisher and Shapiro 2005, p. 14).

In dispute resolution we collectively refer to each person’s unique needs, values, and core concerns as their interests and understanding interests is key to the effective resolution of disputes. Interests speak to each one of us subconsciously and are the powerful yet silent motivators that drive people toward particular wants. We collectively refer to people’s unique wants as their positions. For example: “I want a million dollars” = a position; or “I want a Rolls Royce” = a position. So what are the interests (why’s/needs) that are driving the positions in our examples? “I want a million dollars” (why?…here comes the interest) “because I need to start my charitable foundation”. “I want a Rolls Royce” (why?…once again, here comes the interest) “because I need to start my luxury chauffeur business”. In sum, needs and values equal interests…interests generate positions…positions represent wants.

Positions are usually expressed as singular wants and each position is silently motivated by multiple interests and herein lurks a problem: fixation on positions is the fuel that sustains disputes. It is unfortunately all too easy for disputants to lose sight of the multiple interests that generated their particular position and all too often people believe that the only way to achieve satisfaction is through the fulfillment of their position. And people will go to great lengths to get what they want and often adopt a winner take all attitude which can drive people to extreme and unspeakable lengths such as violence and war. However, by uncovering and discovering people’s interests, and by understanding and recognizing interests, we can generate creative options that may satisfy a person’s position in a multitude of different and alternative ways. To re-cap, interests, which are usually multiple in nature, are the silent motivators that generate singular positions; recognition and understanding of the multiple interests that generated a particular position provides creative options that may satisfy the position and may ultimately lead to resolution of the dispute. To illustrate, think of an iceberg. The tip of the iceberg sticking out of the water is a person’s position (you don’t see a whole lot, only the little bit that a person allows you to see). But the biggest part of the iceberg rests underwater, invisible, and that invisible part is made up of all the interests that support that tiny and precarious position that we see above the water. Until we see and understand a person’s interests (and even help that person to acknowledge their interests) we may never really know how to satisfy a person’s position.

Here’s another way to look at the struggle between positions and interests. Argue for your position and you will most likely be fighting for one thing, and one thing only, which you may or may not get, and it will become a battle that you must win at all cost at the expense of your opponent (win-lose). Argue for your interests and you will be able to negotiate over several different and creative options with the likelihood that you and your adversary will collaborate and walk away from the dispute each with something to show and both of you will have won (win-win).

So, with dental office disputes a big mistake we dentists make is to assume we know what’s wrong with office disputants and well intentioned fixes can end up blowing up in our faces only because we have not uncovered, identified, and understood disputant’s interests. Shuffling staff hours, repositioning staff in the office, discounting procedures for angry patients, etc., usually don’t work unless we’ve first diagnosed the issues by uncovering, identifying, and understanding the underlying interests. An analogy is two children who want an orange and are subsequently fighting for the orange. Mom comes along, splits the orange in two, gives each child a half and now the children become angry and agitated at mom because that’s not what they needed. Mom says “huh?”. One child says that she needs the rind so she can bake and now she has only half of what she really needs and a bunch of pulp she doesn’t want. The other child says that he needs the pulp for juice and now has only half of what he needs and a bunch of peel he doesn’t want. If mom had taken the time to uncover the children’s interests then she could have generated options to satisfy the reasons why the children needed the orange in the first place. Position=I want the orange. Interest=I need the rind. Interest=I need the pulp.

“Invent Options For Mutual Gain” (Fisher & Ury 1981, p. 56)

As just alluded to, discovery of interests allows for brainstorming of multiple creative options for settlement. And a very important part of this step is to not squelch the creative process. Many options, including some that may seem outlandish, should be generated and considered. The amazing part of this stage in the negotiation is when disputants discover that they really needed the very same things all along. After just consideration of each option disputants are empowered to choose the best means for everyone to walk away from the bargaining table with a degree of satisfaction.

“Insist on Using Objective Criteria” (Fisher & Ury 1981, p. 80)

“The more you bring standards of fairness, efficiency, or scientific merit to bear on your particular problem, the more likely you are to produce a final package that is wise and fair. The more you and the other side refer to precedent and community practice, the greater your chance of benefitting from past experience…A constant battle for dominance threatens a relationship; principled negotiation protects it. It is far easier to deal with people when both of you are discussing objective standards for settling a problem instead of trying to force each other to back down” (Fisher & Ury 1981, p. 83).

In Conclusion

Dispute resolution is not a panacea. Understanding someone’s interests does not always mean that changes can be made in a dental office setting to satisfy disputant’s interests. We can generate creative options through understanding a person’s interests but sometimes even those creative options may not satisfy a person’s interests and this is the time to decide if a person is truly compatible with the interests of the office. So, uncovering people’s interests in dental office disputes can help us to decide if, for instance, terminating someone’s employment or dismissing a patient may be the best thing for the office. As previously stated, dispute resolution may establish and/or strengthen the relationship of trust and respect between people or terminate relationships in a manner that minimizes emotional costs and psychological harm. Further, disputes can have a positive side because good can arise from disputes. Broken parts of the office can be mended, broken relationships in the office can be repaired and strengthened, and people who should no longer be together in the office can go their separate ways and find new ways to be happy and prosper.

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