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Rule 1 The Patient

Posted By Stephanie Wilhelm, Friday, June 9, 2017
Updated: Tuesday, May 23, 2017

Section 1: The Patient

“When asked where most practitioners fail in their extreme makeover cases.”

Dr. Bill Dorfman (Discus Dental; Extreme Makeover TV series) answered: 

“They don’t listen to their patients …”

Dentaltown 2003

The Basic Rules of …..Basic Rule 1: Be Nice


Upon embarking on the journey for an oral rehabilitation the practitioner first and foremost must recognize that they will spending a considerable amount of time with their client, ie. the patient. It only makes practical sense therefore that everyone gets along with each other. It’s far easier to work with someone that we like and care for rather than in an adversarial relationship. In fact it’s imperative! One way we can build successful relationships is by being nice. Being nice means more than just smiling and telling jokes. Being nice involves developing a good relationship with our patients where mutual respect is fostered. Open communication and active listening are an integral part of this as well. The roadway of oral rehabilitation is fraught with many forks and pitfalls. A team approach which incorporates patient values as well as those of the dental personal will help smooth the ride when the road gets bumpy. Patients generally do not sue the practitioners they like.1-6


Over the years I have made my share of technical blunders. This I am not proud to state but it is a fact of my life. Nevertheless, the one smart thing that I always have done, though, is tell the truth. When it became apparent that a serious error had occurred, the patient was always informed immediately. Looking the patient in the eye and admitting that the treatment I have performed is less than ideal has always been, and still is, a humbling experience for me. Using simple words to express what has occurred and saying I’m sorry always goes miles in improving customer relations and satisfaction. Patients realize that I’m only human and their level of trust in our team skyrockets because of our honesty and the fact that we spent the time on developing a solid relationship before treatment commenced. In other words, we’re nice.


Being nice also takes advantage of the placebo effect or the “complex social interaction” that occurs between humans.7 It’s sort of like “love at first sight”. Research has shown that up to 50% of treatment efficacy for chronic pain patients is placebo related.8 Furthermore, it is known that the endogenous opioid system is activated in this process. Not only are placebo effects (the vehicle) of merit but also is an understanding of patient expectations. Through open communication and relationship building, what the patient realistically expects and the practitioner can reasonably deliver can be ascertained and leads to a nice way to practice dentistry. On the other hand, the harmful effects of an adverse patient-clinician interaction (nocebo effect), whereby negative words and attitudes of the clinician may induce negative expectations, can occur as well.9 A good example of the power of words is the fascinating study by Pollo A et al.10 In this study three separate groups of patients were created. Each group was told that they were being given a complementary medication to supplement an analgesic. All were given the same placebo (saline solution), however, each group were told they were being given something different. The first group was told they were being given a rehydrating solution, the second group that it could be a potent analgesic or a placebo, and the third group was told they were being given a potent painkiller. Group three ended up having a significant decrease in the amount of the original analgesic that was required compared to the other two groups. Therefore, placebo and expectations are another way to look at practice management and the delivery of optimal services through developing good, open, caring relationships with our patients.

As dental professionals we are caring, trustworthy individuals. Aren’t you? So being nice is easy enough for us to do. And it will definitely make our journey as smooth as possible on the road ahead.

Mike Racich  

 For questions or comment: Contact me at  or (604)922-3465 or Skype at mikeracich1 

Further Suggested Reading and References:



  1. Dunne M, Brown JL. Risk management in dentistry.
    Curr Opin Dent. 1991;1:668-71.
  2. Irving AV. Twenty strategies to reduce the risk of a malpractice claim.
    J Med Pract Manage. 1998;14:130-3.
  3. Colon VF. 10 ways to reduce medical malpractice exposure.
    Physician Exec. 2002;28:16-8.
  4. Worthington K. Customer satisfaction in the emergency department.
    Emerg Med Clin North Am. 2004;22:87-102.
  5. Lal S. Consent in dentistry.
    Pac Health Dialog. 2003;10:102-5.
  6. Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-33.
  7.  Stockstill JW. The placebo effect in the management of chronic myofascial pain: a review. J Am Coll Dent 1989;56:14-8.
  8. Benedetti F. How the doctor’s words affect the patient’s brain. Eval Health Prof 2002;25:369-86.
  9. Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: Unraveling the mechanisms of the nocebo effect. Neuroscience 2007;147:260-71.
  10. Pollo A, Amanzio M, Arslanian A, Casadio C, Maggi G, Benedetti F. Response expectancies in placebo analgesia and their clinical relevance. Pain 2001;93:77-84.

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The Basic Rules of......

Posted By Michael J. Racich, Thursday, March 2, 2017

The Basic Rules of …..

The solution to complex puzzles is often quite simple. When something that has perplexed us for a long time is finally solved it can be very gratifying to put our minds at rest. Sometimes it can be exasperating too as we might wonder why we did not think of the simple solution first. This applies not only to all walks of life but also dentistry. When it comes to dentistry and performing any restorative or prosthodontic task we are often confronted with this conundrum. Such questions as: “Is it really this difficult?” or “Is there an easier way?” immediately come to mind. The simplification of the art and science of oral care, specifically oral rehabilitation, is what I wish to share with you over the ensuing months via a series of short essays. 

Like most of my colleagues I attend numerous programs and congresses throughout the year. As I attend these meetings a common thread appears to run through them as I tend to hear the same messages over and over. Instinctively, I want to distill down what was really important from these messages for our profession and what is on the periphery so to speak. I have spent a considerable amount of time reflecting on and reviewing what is essential for an oral rehabilitation and what our profession has recommended over the last six decades and it appears to me that there are some basic fundamentals that optimize success; basic rules if you like. Yes, being a meticulous single tooth dentist and paying attention to all the details for an oral rehabilitation is important but it is essential to know the overall basic rules and what the end points are. This series of essays will be a tribute to this concept.

As such, I plan to be as transparent in my writing as possible. These essays will be written as an overview of the complex topic of oral rehabilitation. They will be also written to be concise and entertaining, food-for-thought if you like, that can be easily read on an overseas flight or poolside. In no way will these essays be assembled as a definitive source or to minimize the heroic efforts of the countless published academics and master clinicians that have made dentistry the wonderful profession that it is today. We all owe an immense amount of gratitude to these individuals. My intention, therefore, is to be synergistic and complimentary to the works of others. Evidence-based dentistry affords the practitioner the tools to rate the information that is presented to them and blend this information with patient values and professional beliefs and experiences; this is the key thought behind the motivation for these essays.

The Basic Rules of Oral Rehabilitation essay series will create and simplify for the reader a practical approach for the diagnostic, treatment, and maintenance phases of patient care by providing Basic Rules which are memorable, sequential, and gratifying. Appropriate references are included with each Basic Rule for further study by the reader. The Basic Rules will be divided into 4 major sections: The Patient, The Plan, The Process, The Payoff. Each major section of the Basic Rules essay will sequentially lead the reader through the steps necessary for an oral rehabilitation. 

I hope you enjoy these informative essays as much as I will enjoy putting my thoughts into words.  Depending on the feedback from this first essay series foray, a second Basic Rules essay series (The Basic Rules of Occlusion) will follow. I enjoy the art, science, and practice of dentistry and I particularly enjoy sharing it with my colleagues. Please feel free to contact me at your convenience, preferably via media such as Skype (mikeracich1). I wish you good health and continued success in your dental journey, no matter how lofty or humble you choose it to be.


Tags:  Basic Rules  Racich  Rehabilitation 

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Dr. Michael Racich introduction

Posted By Stephanie Wilhelm, Wednesday, March 1, 2017
Updated: Thursday, March 9, 2017

ADI is proud to have one of our Fellows offer his writings to ADI Fellows.  Dr. Michael Racich of West Vancouver, British Columbia will share his series. ADI is extremely grateful Dr. Racich ~ Thank you!


Dr. Racich, a 1982 graduate ofthe University of British Columbia, has a general dental practice emphasizing comprehensive restorative dentistry, prosthodontics and TMD/ orofacial pain. Dr. Racich is a member of many professional organizations and has lectured nationally and internationally on subjects relating to patient comfort, function and appearance. He is a Fellow of the Academy of General Dentistry and the American College of Dentists as well as a Diplomate of the American Board of Orofacial Pain and the International Congress of Oral Implantologists. Dr. Racich has published in peer-reviewed scientific journals such as the Journal of Prosthetic Dentistry and the International Journal of Periodontics and Restorative Dentistry and has authored the books: The Basic Rules of Oral Rehabilitation (2010), The Basic Rules of Occlusion (2012), The Basic Rules of Facially Generated Treatment Planning (2013), and The Basic Rules of Being a Dental Patient (2016). Currently he mentors the didactic/clinical FOCUS Dental Education Continuum (study clubs, proprietary programs, coaching, 2nd opinions only).

Tags:  Basic Rules  Racich  Rehabilitation 

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