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How to Love Clinical Dentistry by Pete Janicki

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by Pete Janicki

John Nosti and Lee Ann Brady are rock-star educators, teaching relevant subjects to new clinicians from podiums all over the country. I had the privilege of interviewing both recently. Nosti and Brady can be easily found roaming around sharing expertise on the Dentaltown message boards.



For those new to dental education or living under a rock, tell us a little bit about your journey and background.
Nosti: I graduated from UMDNJ, now Rutgers School of Dental Medicine, in 1998 and went on to do a one-year general practice residency at Lehigh Valley Hospital. As a naturally competitive person, I knew I wanted to excel at a discipline in dentistry. I heard lectures where experts in cosmetics or restorative had "no desire" to treat patients in pain or TMD. I felt like I could be a general dentist who could bridge the gap and do both really well. So I took more than 2,000 hours of continuing education in occlusion, TMD, restorative dentistry, implants and cosmetics.

Brady: Unlike John, it took me a while! Truthfully, after 12 years of practicing, I ripped up my dental license. That's how much I hated clinical dentistry. My circumstances didn't allow for a permanent retirement, and two and a half years later I returned to clinical practice. I was so fortunate to be introduced to the Pankey Institute and that ignited a passion for clinical dentistry and more!

I was asked to join the faculty at Pankey in my third year back to practice. Fast-forward 10 years—my career has led me to teaching and leadership positions for not only Pankey, but also Spear Education. I joined Clinical Mastery because I'm a true believer in practical, hands-on small-group education, and this tremendous group of educators also had a desire to change lives.

It seems like you both have a bit of an achievement component that fuels your love for clinical dentistry. Why do you think so many young dentists in the profession are disillusioned?


Brady: Dentistry is hard work. We don't acknowledge that reality enough. Not only are clinical skills required, but also there is a "people" side of our business, and to be successful you need to excel at both.

When you experience failures in clinical dentistry and don't understand why, it is supremely frustrating. We were all taught how to read a bitewing, identify decay and fill a tooth. It is the "why" things happen—that don't meet our or the patient's expectation—that contributes to disillusionment.

Nosti: Dental school is expensive. And dental schools are tasked with ensuring that students can pass their state boards. But it would be nearly impossible to expect that you could graduate and throw out a sign and make a successful go of it. Out of residency, I tried a scratch practice with two friends and would have gone under if not for my associate's position. So you graduate under a mound of debt and you don't possess the fundamentals to avoid basic restorative failures. And in some cases, there is a gap between what you're taught and real-world realities.

What are some of the most common pitfalls or basic restorative failures, as you refer to them?
Nosti: Treatment planning and occlusion principles. Being able to identify "red flags" that would stop you from treating that tooth or quadrant until you had more information, to further the chances of the restoration's long-term success. Understanding what different types of wear patterns mean—and how they could influence your treatment plan—is a big piece of the puzzle. Honestly, we focus so much on what cement to use and the how-to's of technical dentistry that we sometimes pass over the "Why did this happen in the first place?" question.

Brady: I agree with John—comprehensive treatment planning is a huge opportunity in learning that alleviates so much stress, because when utilizing a treatment-planning system, you identify those risk factors and address them before failure. Or you are able to appropriately manage your patient's expectations. Being able to recommend treatment that prevents destruction of enamel is also incredibly satisfying and builds a great relationship and dialogue with your patient. These are all elements that we teach in our Mastering Functional Dentistry Course, along with Drs. Mike Smith and Jason Olitsky.

What does "functional dentistry" mean and why does it matter?
Brady: It's common to only consider function when dealing with pain or TMD patients, or when a tooth or restoration breaks prematurely. Over the years I have come to understand that function is an essential part of every treatment plan and functional health is important for every patient. I want to know where the functional risk factors are for my patients so that we can work together to minimize them.

Nosti: Functional dentistry is really about interaction—it's how the muscles, joints, teeth, and gum tissue all work together in a chewing system. It's not just about that broken filling on #31. The incorporation of functional treatment planning influences my decision on every patient I treat. It's a game changer!

You both have indicated that you love clinical dentistry and it's something that you'd never give up. How did you get there?
Nosti: Honestly, I spent more than $100,000 in continuing education in my first few years out of school, which in my opinion was way cheaper than the school of hard knocks! I didn't want to learn from my failures; I wanted to avoid them altogether. My whole purpose in authoring courses for the Clinical Mastery Series was to help dentists achieve a level of mastery in restorative dentistry—a knowledge that would help them avoid failures and achieve predictable clinical success. Brady: I care deeply that what I do for my patients is to the best of my ability. I also want to be able to partner with patients and help them accomplish their goals. Until I knew how to create that every day in my practice, I wasn't in love with clinical dentistry. Falling in love with dentistry is about great education, mentorship, a strong desire to be a lifelong learner, finding people who are already there and modeling that.

If you were graduating today, knowing what you know now, what would be the first thing you'd do?
Brady: My daughter, in her second year of undergrad, is considering dental school. She has been raised around Dr. Gary DeWood, Mary Osborne, Dr. Mark Kleive and so many of my friends and mentors that she hasn't really been exposed to the disillusioned side of dentistry. Mentorship is obviously a gigantic component in my own journey. I wish I had pursued that sooner.

Nosti: I can think of dozens! First and foremost, live within my means. I've avoided a lifetime of stress by simply making sure I don't spend more than I earn. It is difficult to consider investing in education that will make a huge difference in your career and, ultimately, your future earnings, if you are financially stressed now. Use Dentaltown's message boards. I don't think there is a larger body of knowledge in practical dentistry. The contributors really want to make a new dentist's path easier. I've met so many dentists on the boards who are just awesome human beings. That said, with four-million-plus posts, sometimes it's a little daunting. Subscribe to one or two educators who resonate with your style of patient care, and use that learning as your own online, free home study. Seek out an educational path and start your journey now!



Dr. John Nosti is the clinical director of the Clinical Mastery Series (Clinical mastery.com) and practices full time in Mays Landing, N.J., with an emphasis on functional cosmetics, full-mouth rehabilitation, and TMJ dysfunction. His down-to-earth approach and ability to demystify occlusion and all ceramic dentistry has earned him distinction among his peers.

Dr. Lee Ann Brady lives in Phoenix, Arizona, and owns Desert Sun Smiles Dental Care, a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady is the director of education for the Clinical Mastery Series, presents at meetings internationally, and writes a clinical dental education blog on her website at Leeannbrady.com.


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