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Second Opinion: Treatment Planning Meets Reality Dr. Frank Spear, DDS, MSD

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Treatment Planning Meets Reality
An Interview with Frank Spear, DDS, MSD


Dr. Frank Spear needs no introduction. He is one of the most legendary dental educators currently working in our profession. Don't believe me? Do a search for "Frank Spear" on Dentaltown.com and you'll find posts from hundreds of his adoring fans that have taken his courses. The man is the dental profession's equivalent of a rock star. While he is continuing to offer hotel seminars in Boston, Orlando and at the Spear Institute for Advanced Dental Education, Dr. Spear's courses have become so popular that he moved them to the Scottsdale Center for Dentistry to accommodate his ever-expanding list of students. Dr. Spear took some time out of his busy schedule to share some words of wisdom on treatment planning, occlusion and dental education in an interview with Dentaltown Editorial Director Dr. Thomas Giacobbi.

– Howard Farran, DDS, MAGD, Publisher, Dentaltown Magazine
 On Treatment Planning
One of the most common mistakes I see dentists make is that they think they have to develop and present treatment plans where all the decisions are made. Let's say a patient comes in and he's going to lose an anterior tooth and maybe there are a couple other teeth in there that are going to be restored anyway. The dentists I interact with often find themselves trying to decide how they proceed; should they do an implant for that tooth coming out, should they do a bridge, if it's multiple teeth how many implants should they use?

What they often leave out of the planning process is the patient's decision. The patient should be involved at some point in the process. I see dentists get stuck in the plan because they're not sure what the right decision is when, often, they're not the ones who should make the decision. A lot of those decisions belong to the patients. Treatment plans should be developed to give patients choices. My philosophy on treatment planning, in a nutshell, is it has to have somewhat of a systematized nature to it. In other words, every patient needs to be approached with a system where you can start on step one and if you discover that step one on that patient is fine, then you can move on to step two or step three and so on. I basically tell my patients, "My job, initially, is to evaluate your mouth and report to you what I found and tell you what I believe will happen based on what I found. Then you and I can have a conversation about whether you want to do anything about it or not."

There's no question that there are some patients who will come to you and just ask you what they ought to do. You shouldn't present the plan unless the patient is ready to hear it. Of course this begs the question, "How do you know when the patient's ready to hear it?" What makes people ready to hear anything is when they understand they have a problem and they understand what's going to happen to them if they don't do anything about it. My goal with a patient is to get them to ask me, "What are we going to do about that?" As soon as patients ask me questions about their own mouth, they are ready to hear that I have a plan for what could be done.

I feel strongly that the dentist has to have a plan. The nice thing about tooth decay is, without too much explanation, most everyone knows what could happen if you don't treat it. Where I see dentists get stuck is with patients who have occlusal problems like severe wear or teeth that are going to be lost or with something more complex. Wear is a difficult area to treatment plan because unless it looks really bad to the patient, it's not really perceived as a problem. In treatment planning, dentists find themselves thinking, "First of all, what am I going to do about the wear and then how am I going to talk to the patient about it?" There are so many things that could happen in a patient like that unless you have a systematic way of going through the case. My own bias is that you have to treatment plan aesthetics before you can treatment plan anything else. You have to treatment plan tooth position, which is an aesthetically derived thing. In my treatment planning seminars, I teach eight steps to help identify the position of teeth and tissue in both arches. Once you know what's going on in the face, then you'll understand how to correct the occlusion. If you don't have a system, you won't know what to do.
How to Get Started with
Frank Spear

The best place to start is through one of his hotel courses. They're called "hotel courses" because, for years, this was an efficient way to bring his material to different parts of the country and educate large groups in a comfortable setting. Courses such as "Creating Natural Beauty," "Occlusion 2009," "Treating the Worn Dentition," "The ‘Practice of Excellence'" and "Mastering the Art of Treatment Planning & Case Presentation" can now be taken at the Scottsdale Center for Dentistry. For more information, please visit www.scottsdalecenter.com or call 866-781-0072.
On Treatment Plans Influenced by Patient Finances
In this day and age, you have to be incredibly realistic about each dentist's practice, the demographics of the community the practice is in, the economic times we're in, and the dentist's own busyness. When you're booked out four or five months, you can be more selective in what you want to do, but when you're trying to grow a practice or when your book has a hole in it two days from now you need to see as many people as you can.

In dental school we're all made to feel guilty if we didn't do everything "ideal," and I think that's a completely unrealistic way to practice. What we need to do is report findings to patients and tell them what those findings mean. And then if the patient says, "I get that, but this is all I can afford," you modify your treatment plan and you do what they can afford. Having said that, another mistake dentists make is when they tell themselves that patients aren't going to have the money, so they don't present an ideal plan to them and miss patients who would have said "yes." In my treatment planning courses, I tell dentists to explain to patients that their mouths are like cars. I'll say, "You can drive a car and maintain it and keep driving it, but sooner or later you've got to replace the car and your mouth is at a place where that could apply to your fillings. I don't know if you have an interest in this or not but dentistry can do some really amazing things these days." Then I show them some before and after pictures and then the question becomes, "How do we make this work for you financially?"

On Dental Education
Some instructors tend to hold onto self-developed techniques or products. They fail to evolve with new technology that they did not fully or at least help develop. Additionally, they falsely believe that there is one right answer. That could not be further from the truth. Dental school educators drill into our heads that there is one right way to do something – this is not reality. Not all situations are the same, and dental students need to understand that.
Author's Bio

As the founder and director of the Spear Institute for Advanced Dental Education, Dr. Spear continues to be recognized as one of the premier educators in aesthetic and restorative dentistry in the world today. Dr. Spear received his degree from the University of Washington in 1979, and a MSD in periodontal prosthodontics in 1982, also from the University of Washington. Dr. Spear is an Affiliate Professor in the graduate prosthodontics program at the University of Washington and maintains a private practice in Seattle limited to aesthetics and fixed prosthodontics.
On Orthodontics and Occlusion
My most popular courses have been on treatment planning and occlusion. In treatment planning we do a lot of aesthetics. We go through how aesthetics relates to the overall treatment plan, why it's so important to treatment plan aesthetics at the beginning of the case and once the aesthetic plan is set up, it often requires an occlusal alteration. So the two topics really fit well together.

I think the key to all occlusal issues is diagnosis. The question is, is there evidence that orthodontics creates TMD? If you look in the literature, it says "no" because there's not a correlation. Having said that, are you going to find patients that have symptoms who've had ortho? Absolutely, because a lot of people have orthodontics. Is it possible that ortho did something occlusally that could have related to those symptoms? In some people the answer is yes, in some people the answer is no.

I'm very particular about occlusion; it's one of my favorite topics to teach. The key to occlusal therapy is to make a diagnosis so you know what you're treating. Are you treating someone with a true TMD problem, are you treating someone with just a muscle problem, are you treating someone with a muscle problem that might be related to an occlusal issue or are you treating someone with muscle problems because that person happens to be in a really stressful period in their life and they're grinding the heck out of their teeth right now? Maybe the appliance will help them and maybe it won't. I'm not very dogmatic when it comes to occlusion. I believe in it strongly and I believe that there are types that need to be corrected but I was trained that every patient needs to be equilibrated. I can tell you I don't follow that line anymore. I've adapted to reality.
Dentaltown Magazine
September 2025
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