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Q&A with Dr. David Little

March 1, 2004
Following is an interview with Dr. David Little. Dr. Little serves as a professional international speaker and lecturer on behalf of Pinnacle Practices.
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Following is an interview with Dr. David Little. Dr. Little serves as a professional international speaker and lecturer on behalf of Pinnacle Practices. His private dental practice in San Antonio, Texas, since 1984, specializes in full-mouth restorations including restoring dental implants. He speaks at various dental schools, continuing education seminars and Pinnacle's Advanced Leadership and Management (PALM) workshops. His topic of specialty is emerging restorative techniques and materials. Dr. Little's presentation topics also include clinical possibilities in dentistry, leadership and vision; self and team motivation; and case acceptance. He is a fellow of the International and American College of Dentistry, as well as a member of the American Dental Association (ADA), Texas Dental Association (TDA), American Academy of Cosmetic Dentistry (AACD), and the Academy of General Dentistry (AGD).

DE&M: Please describe your office for our readers.
Dr. Little: Our office is unique. It's a building that surrounds a lake, which provides a great view for our patients. Also, every specialty in dentistry comes into this office. We have a fully equipped surgery suite, an orthodontics bay, an in-house lab, and all the latest in technology. Actually, we can do just about anything in terms of restorative work right here under one roof. And we treat everyone from kids to adults. We focus on cosmetic, restorative, and implant dentistry, and we aspire to keep up with the latest in technological advances.

DE&M: Obviously patients are trying to keep up with the latest advances as well. What are some of the procedures your patients are most interested in?
Dr. Little: A lot of patients have been asking about whitening, because of the increased marketing of take-home whitening products. The best thing about the marketing is that people are becoming aware of their smiles more than ever before. When they come to us seeking information, they are excited to learn they can get excellent results in just one hour. Often they begin looking at older dentistry in their mouths too. As a result, we've been able to replace much of the older work with ceramic and veneers. Implants are another area that patients are learning more and more about. Perhaps most importantly, patients now know that their smiles can be restored, whether they're missing one tooth or all of their teeth.

DE&M: In your lecture series, you discuss the importance of the entire dental team when it comes to implants. Why is having the entire team on the same page so important?
Dr. Little: The dental team is everything, whether you're talking about implants or any other procedure. If a dentist goes to a conference and learns about a procedure, but doesn't implement it with the team, it doesn't do anyone any good. Let's face it — the team spends more time with patients than anyone else. If we're all on the same page, team members can answer questions and can even communicate office philosophy directly and clearly whenever the situation calls for it. My team, for example, has watched an implant surgery from start to finish. Doing this together has prepared them to handle varied scenarios and to know how all the pieces in the puzzle go together.

DE&M: In your opinion, what are some of the more important recent advancements in cosmetic dentistry?
Dr. Little: All-ceramic Zirconia restorations are the future of dental restorations. Zirconia offers strength, biocompatibility, and beautiful esthetics with conventional crown and bridge procedures. Dental lasers are another advance in patient care for cosmetic dentistry. The ability to do predictable periodontal plastic surgery enhances the cosmetic result.

DE&M: With a laboratory in-house, what are some of the tips you might suggest in terms of laboratory communication?
Dr. Little: Communication is crucial in so many ways. It is important to establish a relationship with your ceramist and to set solid ground rules. The dentist also needs to tell the lab what he or she expects and include typical information with each case submitted. Such as:

  1. Master impressions that detail all prepped margins which should be clear and readable. Don't ask the lab technician to be a magician. If you can't see your margins, take a new impression and disinfect all impressions prior to sending them to the lab.
  2. Bite registrations should be taken. This may include facebow and an incisal edge indicator that is typically used when a facebow is not.
  3. Photos should accompany all cases that will include preoperative, preparations, shade guide, and provisionals. The images should include full-face and retracted views.
  4. I prefer to use a diagnostic wax-up. If this is used, it should also accompany the case. Study models and models of the provisionals should be included if you want the lab to duplicate your contours.
  5. Finally, an accurate detailed lab prescription should be very specific. Information should contain the type of restoration and specific material — ceramometal or resin — to be used. If anterior restorations are required, the length and shape of the teeth — rounded or sharp point angles, as well as what should and shouldn't be emphasized — should also be supplied. And don't forget about the shade to include translucency, surface texture and anatomy, gingival embrasures, and occlusal groove staining (none, light, or heavy)?

DE&M: With all of the materials that constantly come on the market, how do you help practitioners decide what is best for their practices?
Dr. Little: Personally, I like to keep things simple. There are really four things we can use to fix teeth—amalgam, composite, gold, and porcelain. If you're doing esthetic work, amalgam and gold are out, so dentists need to ask if composite or porcelain is better. The clinical situation dictates whether it is to be direct or indirect composite or porcelain restorations.

DE&M: You mentioned Zirconia restorations earlier. What kind of learning curve is involved?
Dr. Little: For dentists, well, there isn't a learning curve. We're still working with an all-ceramic preparation, so it's no different. The learning curve actually comes on the lab side, though it's a very small learning curve. Instead of trying to block out dark material, they're now starting with a white material. With Zirconia, you have excellent esthetic qualities. It's biocompatible, strong, and cementable.

DE&M: What are some of the ideas you try to leave with an audience that comes to listen to your lecture?
Dr. Little: I really try to talk about motivation. I think all of us forget from time to time that what we do is a gift to our patients. We get to change people's lives. We don't fix teeth; we help people. Periodically reminding ourselves of that message helps us maintain a strong, positive focus. That's motivating in itself.

DE&M: How do you keep your staff motivated?
Dr. Little: In several ways. We begin the year with what I like to call the "state of the union" meeting. The main purpose of the meeting is to plan the coming year, review the successes of the past year, and set our daily and monthly goals. Everyone is given the opportunity for input. On the first of each month, we set our daily and monthly goals for all departments based upon the days available to see patients, keeping in mind the goals we have set for the year. If our monthly goal is met and exceeded, profit pay is shared among the whole dental team. If the daily goals are met, there is instant reward with a "grab bag" that contains $1 to $50 in a mix in which each member grabs into a bag and pulls out. Having weekly staff meetings contributes to the overall success of keeping the staff motivated. Along with keeping the staff focused on how the month is progressing in meeting our goals, it allows for lunch/learn sessions on new products and techniques and, as a bonus, it doesn't allow for anything to brew among members. We also plan "fun days" periodically where we block out the schedule and the entire staff does something as a group, such as going to a lake or a sporting event or maybe just dinner. It's important for all dental team members to realize it isn't just about the money, but about appreciating what they do for a living and each other.