Dr. Sarah Jebreil is a member of the American Academy of Cosmetic Dentistry.

Sarah Jebreil, DDS, AAACD

	When I graduated from dental school, I started working in my father’s private practice. To some it was an ideal situation, but I have to say there was a lot of anxiety that came with it.

	Joining a new practice that had never had an associate dentist was very intimidating. Patients didn’t trust me because I was a new graduate and because I wasn’t their “beloved” dentist. It was challenging being a new dentist, but it was equally challenging acting confident and cool while also trying to win over new patients. In a private practice, patient communication is more pronounced than in a clinic setting. In a private practice, the front office lets you know if a patient didn’t like you or is complaining. In a clinic setting, a disgruntled patient is passed along to another practitioner and you’re assigned some new patients. As a new dentist trying to develop your confidence and speed and swagger, it’s difficult to brush off patients not wanting to see you because they believe you’re inexperienced.

	Coming out of school I thought I could do everything - extractions, root canals, pedo, you name it. I soon began to learn root canals, extractions and pedo all give me anxiety. Case selection is really a key factor in each of these specialties as well as managing patients’ (and parents’) expectations. Since graduating I can say I sleep much better at night referring all of these out. The benefit is that if something fails or goes wrong at the specialist’s office, I’m the one the patient returns to for guidance. Having a team of doctors to refer to also fosters great relationships, which creates a fantastic support system that’s much needed within our profession.

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	Now that I’m a much more seasoned practitioner, I would have to say there are three things that still give me anxiety.

1. A patient leaves your practice for some reason and his or her new dentist is telling him or her that your work needs to be replaced. This is beyond frustrating because we’re all colleagues and working to give the best to our patients. It would be so nice if, as a New Year’s resolution, we could all do the courtesy of calling the patient’s prior provider and discussing our findings if we deem the work questionable. We may learn a wealth of knowledge and the circumstances that lead us to our findings. We’re all professionals and we should all support each other. When this situation happened to me, I called my patient’s new dentist and discussed the case with the dentist. She was so thankful that she could now understand the patient’s previous condition. It was a win-win for everyone because patients don’t enjoy repeating procedures over again either.

	2. You get a bad review online. This is so common that it shouldn’t bother us, but it does. Most often people leave bad reviews because of money, or they’re just in a really foul mood and need to vent their negativity. What’s important in these situations is first reaching out to the offender and finding a way to ameliorate the situation. If that doesn’t work, then try writing a thoughtful, heartfelt response. Other reviewers love to see that you’re human, and they love to read the other side of the story. Don’t be quick to post your response; take some time and really write something that others will be compelled to read and side with you.

	3. One of your trusted employees quits or disappears. This is a nightmare situation. Your office is running smoothly, and then your trusted employee gives you his or her  two weeks’ notice. This can really shake your world. You spend more time with your staff than you do with your family. They’re like family, and when they leave it’s heart-wrenching and stressful at the same time. You have to worry about what the patients will say, you have to find a replacement, and you have to make sure you understand all the duties he or she was doing before he or she leaves.

	The best thing to do is ensure everyone is cross-trained and that anyone can pick up the slack when needed. Systems should be in place in the office so that if someone is sick or on vacation, then all the other team members understand their office duties and can step in at any time. Preparing yourself for the worst is key. Employees come and go, but if you have some really great ones, then always make sure you make them feel appreciated.
	 

Articles

Patients aren't the only ones dealing with stress at the dental office. 

Addressing the anxieties dental professionals face

	Cosmetic dentistry can seem complex and intimidating, but it is actually very rewarding when the treatment goals that were outlined are actually achieved and the patient obtains a dream-worthy smile they are excited to share with others.

	Using the right tools in the treatment planning phases paves the way for success, and also helps identify patients who may have unrealistic expectations. Cosmetic dentistry is about understanding what the patient wants to achieve and helping them to achieve a realistic goal that is communicated in the treatment-planning phase. 

	When your patient has interest in improving their smile, the best way to further the conversation is by taking some photos. Placing these photos somewhere large so you and the patient can view the photos is ideal.  When the patient sees their image it gives insight to how the patient views themselves and what it is that they most want improved - and if it can actually be done. 

Related reading: 5 questions patients have about cosmetic dentistry

 is a great way to get patients interested in cosmetic dentistry. Patients become more accountable for their smile and it alerts them to other areas that are discolored or blemished.  I always have any patient who is interested in any cosmetic procedure do whitening first. This is ideal for final shade selection as well as identifying additional teeth to be added to the treatment plan (i.e., they did not get light enough or old fillings or decalcifications became more apparent). Use whitening as a tool to re-evaluate the patient's smile, take more photos, and together observe the changes and nuances that take place.

	Whether it is with some quick bonding or with a laboratory-fabricated wax up, a mock-up is a great way for the patient to visualize a more harmonious smile. It is a great way to observe a patient and determine if he or she would be a good fit for the treatment, as well as if it is what he or she is aiming to improve. It almost always "seals the deal" and opens up the opportunity for more questions. You can use it as a medium for you and the patient to discuss desired outcomes.  

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	 If your patient has an uneven smile but is not interested in braces or wearing 

. These are great ways to slightly broaden the buccal corridors so that the patient develops a broader smile. It is also great for unraveling light crowding in the anterior. These cases can be done in 10-14 weeks, which is amenable to most patients. Moving teeth into a better position allows you to be more conservative in the restorative phase because you do not need to prep as much, or you may not need to do crown lengthening because you have leveled the gingival levels, and so on. 

 is always a conservative option that should never be overlooked. 

 is my go-to treatment for younger patients who have some uneven edges, decalcifications or too much "negative space" in their smiles. With some nice beveling and microabrasion, I will bond the edges of the centrals and laterals to make them more attractive and give the patient a broader feel to their smile. Bonding is an inexpensive way to have the patient be more excited about his or her smile, and it is often the gateway to other procedures. 

Making cosmetic dentistry minimally invasive can mean greater case acceptance and patient comfort.

5 ways to make cosmetic dentistry minimally invasive

	I have always been inspired by beauty and how symmetry and balance are key factors to creating a visual masterpiece.

	Cosmetic enhancements whether they be dental, surgical or simply hair and make-up have the ability to create balance and symmetry within the face. 

	In dental school, I was driven to complete a handful of cosmetic cases because I knew this was my passion. The cases I completed were straightforward cases with not many variables, leading to beautiful predictable results. The rush I got from transforming these patients’ images was exactly what I had hoped for and I knew I wanted to do more of it. 

Related reading: The top 5 ways cosmetic dentistry can benefit your practice

	After graduation, I was cavalier; I equated the success I achieved in my in cosmetic cases in clinic to being seasoned in cosmetic dentist. In my early days of private practice, I was overly confident taking on as many cosmetic cases as I could, soon to find out the results I was achieving were sub-par and unpredictable. 

	I no longer felt that rush; instead my stomach was in knots thinking where did I go wrong?

	This gut-wrenching feeling started a fire within me to learn to present treatment plans with results I knew I could achieve while managing patient expectations

American Academy of Cosmetic Dentistry (AACD) website

 and read about the accreditation process and was amazed by the beautiful cases that were showcased in the 

. I was blown away by the caliber of dentistry and seamless artistic beauty members were achieving on their accreditation cases. I was determined to become accredited in hopes that it would give me the tools I needed to practice the level of dentistry I had imagined I would be doing out of school. 

	I took the written exam and embarked on the accreditation process, taking every hands-on class at the AACD general meetings. I learned immensely from the workshops and working with the amazingly passionate and supportive mentors. 

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	I remember picking a case that I thought I could use for an accreditation case and my mentor pointing out a plethora of challenges that I had not seen or even thought about. It is truly amazing how each of the five accreditation cases in itself are so simple, but yet finding an ideal case with predictable results is quite challenging. This obstacle is exactly what I was experiencing when I started private practice. Simple cases are easy to complete with predictable results, but identifying the difficult cases and treatment planning the complexities all while achieving a beautiful result, that is an art.

	The accreditation process trained my eye to identify ‘complex’ cases, allowing for more thorough treatment planning as well as the ease of discussing the esthetic challenges with the patient and managing their expectations. In addition, I learned to use my camera to document my cases and communicate to my laboratory technician exactly what I wanted.

	 Pursuing the credential was indeed challenging and tested my patience and drive, but if changed my life, the way I practice dentistry and the joy it brings me.

One practitioner explains the benefits cosmetic dentistry brought to her career.