I’ve seen it more times than I care to count: a dentist takes a sleep or TMD course, feverishly takes pages of notes, asks the important questions, and leaves excited to implement back at the practice. Then Monday comes…crickets…nothing changes.
That is the biggest difference I have seen between dentists who succeed with something new and those who dip and dabble before finally abandoning it altogether. It has nothing to do with how smart they are, how successful they’ve been so far, or where they practice.
I have a saying I have used for a long time: there is a big difference between 20 years of experience and one year of experience repeated 20 times. Real experience requires a commitment to continual learning, questioning what we think we know, and a propensity for action.
You don’t need to know everything before you begin. You just need to know enough to get started.
Platelet Rich Fibrin injections for arthritic TMJ pain is a good example.
When a member of Spencer Study Club first told me I needed to look into platelet-rich fibrin, I was skeptical. Eventually, I read a book on the subject, dove deeper into the literature, and realized how compelling the evidence actually was. We started using PRF, and it has completely transformed how we care for people and what I teach.
Years earlier, I saw something similar when sleep entered the TMD conversation. Some clinicians dismissed it as a fad and continued doing what they’ve done for years, but when my patients with TMJ concerns also showed obvious signs of sleep apnea, I couldn’t pretend those issues existed in separate universes.
Experience should make you better at recognizing what you do not know. Then, you can fill those knowledge gaps and take action.
I have worked with a bajillion dentists over the years, and the ones who progress and build successful practices have something in common: they learn something useful and find a way to use it.
Plenty of dentists take course after course after course without ever treating a patient with what they learned. Collecting information feels safe. Implementation involves a little discomfort. Once an actual patient is sitting in the chair, the questions become real too.
What if I don’t know the answer?
What if it doesn’t go the way they say it should in the course?
What if? What if? What if?
Those are reasonable questions, and they will all remain unanswered if you don’t do one thing: START!
At some point, you have to be able to say to yourself, I know I don’t know everything, but I know enough to get started.
When I’m asked what separates the dentists who succeed in TMD and sleep from those who flounder, a lot of it comes down to a naturally human desire to avoid discomfort. It’s an evolutionary holdover of our lizard brain’s desire to avoid pain. But guess what? Delivering your first EMA to your assistant’s husband is very different from being attacked by a saber-tooth tiger outside your cave.
The people who move forward are willing to dance with discomfort. That doesn’t mean being reckless. Training, diagnosis, standards of care, and knowing your limitations all matter. A lot.
The problem arises when fear cloaks itself in cautious responsibility.
Dentists can think through every possible adverse outcome until doing nothing feels like the safest option. Don’t fool yourself. Doing nothing is a decision, and it’s almost always the wrong one.
I see this all the time in dental sleep medicine. People get swamped in concerns about medical billing before treating their first patient. They fret over physician referrals before they have enough experience to confidently have a conversation with a potential referral source, and they aspire to build out a ten operatory sleep practice replete with a CBCT in every room before they’ve taken a single bite registration.
Start small. Treat team members. Treat their spouses. Treat yourself. Get the reps in. That will build confidence and competency. It’ll mitigate risk. It’ll equip you to address problems when they arise. And they will. You cannot mitigate 100% of the risk from life.
Medical insurance, physician referrals, testing, SOAP documentation, team training, and follow-up are all critical facets of a mature dental sleep medicine program. A dentist’s need to solve all of these issues before patient number one is probably analysis paralysis in disguise.
I want dentists to get meaningful clinical experience before reimbursement and workflow dominate the conversation. First, learn whether you can help people, whether you enjoy the work, and whether your team can support it. Once you have some real-world experience, many of these issues will organically take care of themselves. For the others, you’ll have a better grasp by knowing what you don’t know.
One of dental sleep medicine’s oddities is how many dentists think they need to hunt sleep patients. They are already in the practice.
Dentists see people every day who snore, wake up tired, or have a bed partner who lies awake terrified because their spouse stops breathing. These patients are not hiding. Most well-intentioned dentists are willfully ignoring them because they wrongly feel unequipped to have a simple conversation.
That is a major contributing factor to why dental sleep medicine has struggled to reach the masses. We can simplify education, streamline testing processes, and make reimbursement less confusing, but eventually you still have to act. There are just too many people who need our help not to.
Direct-to-consumer OAT companies make some dentists nervous. It’s completely understandable, but I look at them a little differently.
If these companies can spend heavily on advertising and treat thousands of patients, that tells us there is demand and an access problem that Dental Sleep Medicine has not solved. More public awareness of OSA and PAP alternatives doesn’t scare me. The heightened public awareness will ultimately send more people to qualified dentists.
The real question is why these models found footing in the first place. If patients cannot find dentists prepared to help them, someone else is going to fill that void.
Uh, hellooo, opportunity, anyone?
One thing I have changed my mind about as an educator is how much structure people need when they are starting. For years, I focused heavily on principles and teaching people how to think through cases. I still believe all of that matters, but I underestimated how useful it can be to simply tell someone what to do next.
That realization became the foundation for my book, Practical Dental Sleep Medicine. I describe it as a cookbook for dentists who want to implement sleep in their practices.
If five experienced clinicians answer the same question five different ways, an experienced DSM practitioner can spot the valuable pearls in each answer, but a novice just becomes paralyzed trying to decide which approach is right. The outcome is inaction.
I’ve come to believe that a How-To cookbook is necessary. Get the step-by-step information. Then take action. Get reps in. Build confidence. And then you can get your creative juices flowing and make the recipe your own. A dash of this. A sprinkle of that.
None of this is an argument against expertise. Expertise is composed of a cycle of learning, doing, observing what happened, adjusting, and applying your new knowledge. That is true in PRF, TMD, dental sleep medicine, and almost anything worth becoming good at. Rinse. Repeat.
Following this process will empower you to make better decisions than you ever could while standing on the sidelines trying to predict every variable. You’re not a Monday Morning Quarterback. You’re a Monday Morning Implementer.
Dentists spend an inordinate amount of time talking about techniques, systems, reimbursement, courses, and clinical decisions, but those are not the reason this work matters.
The reason is what happens after somebody gets helped. Spouses return to the same bed. Grandpa is able to kick the soccer ball around with his granddaughter. No one is falling asleep behind the wheel endangering your own kids.
You learn something that changes how you see patients. Patients get the right treatment and function better at home, at work, and with the world around them. A clinician teaches another clinician, and that person may go on to help hundreds of patients the original educator will never meet.
We will never really understand the impact we have had on increasing vitality on this planet and all of the ripple effects from that.
That is worth remembering the next time you are sitting in a course wondering whether you are ready.
None of us knows everything. Learn what you need to learn, surround yourself with people who can help when you get stuck, respect the responsibility that comes with treating patients, and then start.
The world needs you to take action.
If not now, when?
Dr. Spencer is providing a free audio version of his new book to Sleep Intel subscribers. Visit PracticalDSM.com and click “Buy the Audiobook”.
It will prompt you to enter payment details. On the left, there’s a field to enter a promo code. Enter our exclusive code SLEEP and the book will cost you ZERO BUCKS.
Dr. Jamison Spencer is a dentist, educator, founder of Spencer Study Club, and author of Practical Dental Sleep Medicine. His work focuses on helping dentists practically implement dental sleep medicine, TMD care, and related treatment approaches through education, systems, and clinical experience.
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