Transcription
The Kois Center Graduate:Pursuing Dental Excellence
ARE ALL DENTISTSCREATED EQUAL?Surprisingly, the answer is “Yes.”All dentists graduate from dentalschool with similar skills andknowledge. At the beginning oftheir careers, dentists can provideadequate care to the averageperson. However, dental schoolgraduation is merely the start of along career, and that initial equalitysoon comes to an end, based onthe educational path your dentistdecides to follow. Each individualchooses how far to grow in theirprofession—how good a dentistthey want to become. It is yourdentist’s commitment to lifelonglearning that determines what kindand level of dentistry you receive.Many dentists choose to providegood dental care that is satisfactoryand meets the standard forserviceable dentistry. Another groupwill develop more skills to becomebetter than average. Finally, thereis a small group who choose a long,difficult journey to become the bestthey can be, to practice dentistry atthe top level. These dentists committo excellence.To move beyond beginner status,dentists must regularly take classesto improve existing skills and learnnew ones. Dental courses are notcreated equally, so it can be achallenge to find comprehensiveclasses with teachings based inpublished science, a requirementfor dentists who want to developinto skilled and knowledgeablepractitioners. Dentists need qualitypost-graduate training that willchallenge them, mentors that willguide them, and strategies toimplement these new skills in theirdental practice. Your dentist hasfound this at the Kois Center.This book is about the rigorouspath your dentist chose to becomethat skilled expert and why theircommitment to excellence isimportant to you, their patient. Youwill learn what makes a Kois Centergraduate unique. Flip through a fewpages to see how this dentist’sfocus on excellence will help yousmile and chew for a lifetime.3
ACKNOWLEDGMENTSEditorMichael Palmer, DMDContributing EditorsNancy E. Hartrick, DDSJean Allen Martin, DDSBook CommitteeTony Cascino, DDSBryce Chandler, DDSMatt Falkenstein, DDSNancy E. Hartrick, DDSKen Hovden, DDSJamie LaViola, DDSKen LeVos, DDSJean Allen Martin, DDSDoug McMaster, DDSAndrew Mogelof, DDSMichael Palmer, DMD (Chairman)Sam Romano, DMDScott Rice, DDS, MBADeb Schwartz, DDSPhotographyAll the photography within this book was graciously donatedby graduates of the Kois Center who have the same passionfor beautiful photography as they do for their profession.Mark Benavides, DDSPat C. Beug, DDSDave Brown, DMDLloyd Fujimoto, DDSChris Mei, DDSMichael Palmer, DMDDesignRob WarnickThe committee would like to extend its warm appreciation forthe support given by the staff members at the Kois Center.The concept of the coffee table book was developed byDr. Sam Romano and his wife Terry.The committee would like to thank Dr. John Kois for hisrelentless pursuit of excellence and his undying devotionto the education of dentists throughout the world.5
TABLE OFCONTENTS9What is the Kois Center?33 Dentistry 10110Who is John Kois?35 One size does not fit all!15What is a Kois Center Graduate?37 Got bone?17Excellence in dentistry39 Not another cavity!19Not guilty as charged!4121Time for a new way of thinking?43 Smile, please!My teeth are worn!23 Prove it.45 How long will this last?27 Why do you need that just to check my teeth?47 Moving forward.29 Where do we start?48 Dedication7
WHAT IS THEKOIS CENTER?“ a system that enablesus to share information,develop new ideas andcreate solutions in dentistrythat will leave a legacy ”John KoisThe Kois Center is an advancedgraduate didactic and clinicalprogram for practicing dentists.The Center features a comprehensive nine-course curriculum, withthe latest advances in esthetics,implant and restorative dentistry.The curriculum is based uponthe mission statement: “Enablingmotivated dentists to achieveextraordinary levels, expandingknowledge and application skills inrestorative dentistry.”What makes the KoisCenter special?The Kois Center is located inSeattle, Washington, on the shoreof Lake Union. Fifteen years ago,the Center began forty miles southof Seattle in the back room of adental office in Fife, around a tablewith room for only twelve studentsto attend each class. As word travelled about the incredible teachingto be found in that back room,dentists from around the worldsought spaces on waiting lists,hoping to be one of the twelve.The Kois Center in Seattle was builtto accommodate the increasingnumber of dentists eager tobecome students, and incorporatesthe latest technology to maximizestudent learning over each three-daycourse. Live patient demonstrationscan be broadcast directly to eachof the 26 students. Multimediaelectronic presentations allowrich content to be memorablyshown, and students have theopportunity to practice new skillson patient simulators.But the Kois Center is uniquebecause it is SO much more than aphysical location or a facility. TheKois Center is part of an educationalnetwork inspired by John Kois andpopulated by dentists who havemade a commitment to a rigorousprogram of continuing education.This network is actually a living,maturing postgraduate educationalthink tank. The Center’s growth isthe result of the continued supportand participation of those whohave graduated. The collaborationof these members has created anever expanding knowledge base atthe Center and is a pathway forextraordinary professional growth.Graduates can return annuallyto attend the Symposium, whichincludes a review of the prioryear’s published dental science,speakers who are pioneers in theirfield, and the inspiration of likeminded colleagues. As graduatesincorporate their new knowledgeinto their dental practices, they canapply to become Mentors, whoreturn regularly to the Center tooffer help to current students, continuing the cycle of contributing toan improved dental profession.The Kois Center can now use theknowledge of its membership toimprove the curriculum of theCenter, enhance the professionalgrowth of its members and improvethe dental health of the patientsthey serve.The Kois Center provides an intenseeducational experience whichallows your dentist to acquire thenecessary skills and knowledge toassist you, the patient, in keepingyour teeth healthy and estheticallypleasing for a lifetime.9
WHO ISJOHN KOIS?John C. Kois, D.M.D., M.S.D.Received his D.M.D. from the Universityof Pennsylvania, School of DentalMedicine and Certificate in PeriodontalProsthodontics with an M.S.D. fromthe University of Washington, Schoolof Dentistry. He maintains a privatepractice limited to prosthodonticsin Tacoma and Seattle, Washingtonand is an Affiliate Professor in theGraduate Restorative Program at theUniversity of Washington. Dr. Koiscontinues to lecture nationally andinternationally, is a reviewer for manyjournals and is the Editor-in-Chieffor The Compendium of ContinuingEducation in Dentistry. Dr. Kois is the10recipient of the 2002 Saul SchlugerMemorial Award for Clinical Excellence in Diagnosis and TreatmentPlanning, and received a LifetimeAchievement Award from boththe World Congress of MinimallyInvasive Dentistry and the AmericanAcademy of Cosmetic Dentistry. Heis the past president of both theAmerican Academy of RestorativeDentistry and American Academy ofEsthetic Dentistry, and a member ofnumerous other professional organizations. In addition, he continues towork with restorative dentists at theKois Center, a didactic and clinicalteaching program.Who Is John Kois?John is not a master because hehas “great hands”—an inborn talentfor dentistry. He became a masterthrough dogged perseverance andyears of hard work, with an attitudethat embraced challenges. He is astudent every day, willing to bewrong and willing to change hisbeliefs when necessary. Johnchanges the lives of those whocome to his teaching center, boththrough his personal example andhis unwavering belief that insideeach student is an expert waiting tobe born.Master clinician“ I don’t have a problem with failure;I have a problem with not learningfrom failure.”John Kois is an outstanding clinicaldentist because he views everypatient and every restoration as anopportunity to excel. Yet he is notafraid to examine a failure, regardingit as an opportunity to improve andavoid that pitfall tomorrow. Hisdentistry sets a standard for precision and he is recognized by hispeers as a master clinician. Heis the expert that other dentistsseek for their own dentistry.He uses practical experience todevelop systems and checklistsso Kois-trained dentists can moreeasily and uniformly provide excellent care to their patients. It isthese systems that form the coreteachings at the Kois Center.Creative innovator“ If you have to think outside thebox, you need a bigger box.”John Kois is a relentless questioner:Why does this smile look so natural?Why have the teeth worn in thisparticular pattern? How can wemake our success more predictable? He is unwilling to blindlyaccept conventional thinking aboutdentistry without rigorous evaluation. He is also willing to rejectpopular theories that have noscientific basis. When he saw toomany exceptions to acceptedbeliefs, he carefully examined hisown work to better understandwhat was successful and why. Heformed his own research center totest theories and add to the scienceof dentistry—entirely so dentistscan make better decisions for theirpatients. He continues to developinnovations and instruments tomake excellent dentistry easier toprovide.Master teacher“ Never the teacher, ALWAYS thestudent.”Have you ever been inspired by ateacher: One who saw the greatness inside of you? A teacher whohelped you reach a goal that youwould have never believed waspossible? A teacher who couldpresent complex material in a clear,understandable way? John Kois isthat teacher. Passionate about hissubject, he works long hours yearafter year to stay current anddesign new ways to teach. He is asuccessful teacher because he hasnever stopped being a student:questioning, challenging, learning.He understands new knowledgemust be used for learning to beeffective, so he developed comprehensive notebooks for each studentto take home to aid in implementingwhat they had learned.Visionary leader“None of us is smarter than all of us.”John believes that together we canbe better than any of us could everbe separately, and his leadershiphas created and fostered a uniquecommunity of likeminded dentistswho are committed to continuouslearning. Kois Center graduates aremembers of a family—a think tankpopulated with dentists dedicatedto helping each other and theirpatients achieve the absolute best.When a dentist completes a class,they can stay connected with peersand mentors for support andadvise them on their own journeyto expertise.11
“ A master in the art of living draws no sharp distinction between his work and hisplay; his labor and his leisure; his mind and his body; his education and his recreation.He hardly knows which is which. He simply pursues his vision of excellence throughwhatever he is doing, and leaves others to determine whether he is working orplaying. To himself, he always appears to be doing both.”Francoise Rene Auguste de Chateaubriand13
WHAT IS A KOISCENTER GRADUATE?The Kois Center is a family ofdentists and dental professionalswho are passionate about dentalhealthcare and have the disciplineto pursue excellence. A heavyemphasis on community exists, andI am proud to associate with theprofessionals who attend theCenter which promotes a cultureof generosity, humility, kindnessand passion for learning. Theseindividuals are integrity-based andcommitted to both their patientsand education. Dentists who attendthe Center seek evidence-basedknowledge, willing to question theirbeliefs in pursuit of excellence. TheKois Center community works toprovide the best, most efficient andcost-effective care to their patientsand help one another to achievethis goal.Graduates have completed all ninecourses in the curriculum at theCenter. Once students becomegraduates, they have the opportunity to attend an Annual Symposium. At the Symposium, currentupdates based on new studies arediscussed, and our community ofprofessionals and their familieshave the opportunity to networkand get to know each other better.Graduates also have the privilegeof being part of our referral serviceon the website, wherein othergraduates can search for contactinformation and refer patients whoare moving or are out of townto another highly trained andskilled dentist.Graduates have made a seriouscommitment to this rigorouscurriculum—sacrificing time awayfrom families, home and their practices—challenging themselves tobe the best. To achieve this goalhas required questioning of tradi-tional standards and examinationof strongly held beliefs under thelight of published evidence. It hasalso required the courage and willingness to change, when necessary,how they practice dentistry.Above all, dentists attending theKois Center are committed to excellence and doing their best fortheir patients.John C. Kois15
EXCELLENCEIN DENTISTRYWhat does it meanwhen your dentistautographs theirwork with excellence?excel at customer service, alsohave a tendency to hire carefullyand provide in-depth trainingfor their employees. These officespersonify excellence.It simply feels different when youwalk into a store or an office whereexcellence is the standard. In an erawhen people are constantly bombarded with mediocrity and apathythrough poor customer service andthe performance of products belowexpectations, it is refreshing andreassuring to encounter excellence.Dental offices that consistentlyExcellence in dentistry includeswords like integrity, trust, andempathy. It means you can trustyour dentist and staff to autographtheir work with excellence; they aimfor perfection on every procedure,every day, even when no one iswatching. Decisions that will affectyour oral health and well-being fora lifetime must be made in collabo-ration with someone who is lookingout for your best interest now andin the future.Excellence cannot be static. Thedoctors and staff that you entrustwith your dental health mustcontinually seek new knowledge toenhance the predictability of theirwork and remain connected withexceptional colleagues who supportcontinuing professional growth.Excellence is the sum of many parts.Attention to detail and accuracy ofdiagnosis, along with the skilledhands of an experienced dentist,will provide you efficient, informative, individualized treatment ina cost-effective manner. Your dentistry will be fabricated using thebest materials available with abuilt-to-last attitude. At the KoisCenter, EXCELLENCE permeatesevery educational and interpersonalinteraction—ALWAYS! This book isan overview of how Kois-traineddentists make excellence theirstandard and how you, theirpatient, will benefit.17
NOT GUILTYAS CHARGED!Have you ever felt a twinge of guiltwhen the dental hygienist askedabout your flossing habits? Do youhesitate to make a dental appointment because you will have toadmit how long it has been sinceyour last cleaning? These twingesof guilt can be greatly magnified ifyou believe that your mouth is unhealthy or your smile unattractive—and it is YOUR fault. But the surprising truth for many is that faultand guilt have simply nothing to dowith your oral health.Some people have spent hundredsof hours and thousands of dollarscaring for their teeth throughouttheir lifetime, yet continue to experience new areas of decay, gumdisease, or teeth that break andwear—seemingly no matter whatthey do. Often these people areembarrassed to seek help becausethey believe that the conditionof their mouth is purely theirown fault. Sadly, they may evendescribe their mouth as “hopeless.”Your Kois-trained dentist understands that gaining or maintainingoral health depends on more thanjust daily flossing. They are concerned about risk because sciencetells us that your resistance to getting a cavity or losing the supportaround your teeth is specificallyrelated to both your ability to fightdisease and to the type of bacteriathat inhabit your mouth. Your dentist also knows that bite and jawproblems occur when the musclesand joint cannot adapt to imperfections in the way you chew. Some ofthese tendencies are determinedby your genetic makeup, and somestart when you are an infant. Yourrisk for dental problems beginseven before your first birthday!people, hesitant to seek dental care,please let go of any guilt andunderstand that your Kois-traineddentist will not judge you. They willthoroughly learn about yourcurrent oral conditions, determineyour susceptibility to future breakdown and discuss a plan to helpyou successfully achieve and maintain a healthy attractive smile.If you are one of those embarrassed19
TIME FOR A NEWWAY OF THINKING?Paradigm shiftA paradigm is defined as a modelto follow with a set of rules andregulations (written or unwritten)that does two things:1. Establishes or defines boundaries2. Tells you how to behave insidethe boundaries in order tobe successful.A paradigm shift: a change to a newgame, a new set of rules.Dentistry has been a very traditionalprofession with a long-establishedparadigm where the rules of thegame have changed very littleover the past 100 years. Acceptedpractices of dentistry, with little orno scientific basis, have been andcontinue to be taught in dentalschools and continuing educationprograms. This has had an unfavorable outcome on the level of dentalhealth care, perceptions of what isneeded in order to maintain dentalhealth and what insurance companies will cover for their participants.For instance in the 1960s, the original Crest toothpaste advertisingcampaign promised healthy teeth ifone would brush twice a day withCrest and see their dentist twicea year. This advertising sloganbecame part of the dental paradigm, accepted as scientific factwithout any research to test thevalidity. Dental insurance companies subsequently established apolicy to cover teeth cleaningstwice a year. The scientific truth issome people do not need twocleanings a year while others wouldbe better served by having theirteeth cleaned four times a year. Thebest cleaning interval depends onyour risk for disease.At the Kois Center, we are not constrained by dental philosophies andpractices just because they weretaught to us years ago. We arecommitted to learning, growingand getting better for our patientsand their care. All dental practicesand procedures are questioned asto their purpose; the rationale andbasis for their use are continuallybeing examined. We are willing tobuild a bigger box—or even throwaway the box—if science and treatment in the best interest of ourpatients calls for that action. In thismanner a Kois Center Graduate isat the forefront of technology andknowledge when diagnosing andtreating patients with the most upto date and predictable proceduresand technologies.21
PROVE IT.As a patient of a Kois-traineddentist, recommendations made toimprove your dental health oftenuse evidence-based dentistry. Theword evidence may bring tomind a courtroom, where materialsare gathered and manipulated toprove or disprove a point. Evidencebased dentistry is different; quitesimply it is dentistry firmly rootedin proof and confirmation. Whendentists base their practice onevidence, they are using thelatest reliable research to makedecisions and recommendationsfor you, their patient. They usetheir knowledge and experienceto properly apply the availableevidenceandmayadapttheir treatment recommendationsbasedontrustworthyandresponsible research.For example, when evaluating atooth with a large filling, yourdentist knows from publishedstudies how much weaker it isbased on the size and width of thefilling coupled with the strength ofyour bite. The evidence gives yourdentist reliable information aboutwhich teeth in your mouth are morelikely to break and why. Your dentistcan apply the evidence to makerecommendations on how best
good dental care that is satisfactory and meets the standard for serviceable dentistry. Another group will develop more skills to become better than average. Finally, there is a small group who choose a long, difficult journey to become the best they can be, to practice dentist
