What makes a truly great dentist?

A note on what this is

This is an opinion piece written for the dental profession, not patient health information. It challenges some entrenched beliefs about how dentists should practise.

Dr Decent and Dr Closer are composite characters — invented illustrations of two approaches, not real practitioners.

If you arrived here as a patient trying to choose a dentist rather than as a colleague, two other pieces will be more directly useful: Finding a dentist online in Australia, on how to read what a practice says about itself, and Is it important to have a family dentist?, on what continuity actually buys you.

And one thing worth saying at the outset, because the title invites it. There is no independent Australian source — no regulator statement, no professional guideline, no body of trial evidence — that establishes what makes one clinician better than another, or that ranks practice styles against each other. We have looked. What the regulator does define is a floor, in the form of registration standards every dental practitioner must meet, and a set of limits on what any practice is allowed to claim about itself. Those are set out further down, and they are the only objective material this question has. Everything between the floor and the title of this article is argument, including ours.

Dental myth #1: selling dentistry is a dirty act

Dr David Decent

Proud to be a clinician, not a salesman. Crisp white gown, eloquent and measured speech. Highly respected among peers and well trusted by his patients.

He educates patients with a list of standard options for treating various problems, on the basis that passing on information is part of his role as a caregiver. To educate them about dental disease, he emphasises the perils of inaction.

He applies himself clinically, keeps abreast of most new technology, and remains vigilant with ongoing education.

And here is the crux of the character: he declines to be distracted by how many new patients reschedule, how many of his treatment plans convert to completion, how many recalls return in six months, and what proportion of patients opt for better treatment options rather than more limited ones.

That last one is not an abstraction. A recall that does not come back is a patient whose disease is progressing unobserved — which is the whole argument of How often should I go to the dentist? and of the importance of dental hygiene.

Dr Claire Closer

She loves to sell, and lives for the thrill of closing a deal.

She brings personality to her profession and speaks with passion about ideal treatment options. She is comfortable discussing money, large or small, because she holds a core belief that good medicine is not cheap. Her language adds colour to a dry subject. Her energy is palpable through the corridors of a practice designed as an extension of her personality.

She embraces technology. Her digital OPG machine changed her whole approach to the sequence and presentation of a treatment plan consultation. Her chairside CAD/CAM system changed the way she practises. What that equipment does, and the conditions under which it is worth using, is set out on the technology page.

She analyses her success through conversion rates of new patients, treatment plan completions and staff retention rates — and, she would add, the quality of the chocolates she receives from patients.

Her clinical record, in her own framing: she has never extracted a salvageable tooth, has not made a partial denture in years, and many of her cosmetically driven patients are having Invisalign and whitening rather than porcelain veneers.

That sentence is doing more work than it appears to. Saving a salvageable tooth usually means root canal treatment rather than extraction; avoiding a partial denture usually means an implant or a bridge; and aligning teeth instead of veneering them means leaving the enamel intact. Each of those is the less destructive choice — see replacement options for missing teeth and bridges, implants or dentures for how those decisions are actually weighed.

The question

As a practice owner, which would you want working for you? As a dental assistant or practice manager, which would you rather work for? As a patient, which would you rather be treated by?

The expected answer is “whichever is the better dentist, not the better salesperson” — and the argument of this piece is that the second question is not separable from the first.

The argument

What Dr Closer is actually improving, from the moment a patient picks up the phone:

• Mentoring ancillary staff in communication skills
• Installing sound practice-management systems
• First impressions of the practice, the ancillaries and the primary carer
• Listening skills, and tuning into patients’ motivations and expectations
• Discussing treatment options, managing budgetary concerns, allaying fears — leading to choices consistent with good, or preferably ideal, medicine
• A high standard of clinical competence within a strong and empathic relationship
• Ongoing self-assessment of non-financial success rates, to keep improving

Read as a list, almost none of that is selling. It is communication, systems, listening and follow-through — and it is measured by conversion rates because those are the only numbers that reveal whether it is working. How important is communication in dentistry? takes the same ground from the patient’s side, and “allaying fears” has a literature of its own — see dental anxiety, how to ease anxiety about visiting the dentist and the technique piece on giving a virtually pain-free injection.

The “budgetary concerns” line is the one most open to misreading, so it is worth being concrete: the practice publishes indicative fee ranges in its price guide, and understanding your treatment describes how a written plan is produced before anything begins. A conversation about money that ends in a written estimate is a different thing from one that does not.

The piece offers three justifications.

First: the clinician’s influence is part of duty of care

Where there is a choice between a favourable treatment and an unfavourable one, the clinician plays a critical role — and arguably has a duty of care in directing, inspiring and motivating a patient towards what is universally accepted as better oral health.

Examples given:

“Universally accepted” is carrying a lot of weight in that sentence, and the table should be read as this author’s clinical preferences rather than as settled evidence. Two of those rows are contested in the literature and one of them is contested on this site. That third row deserves highlighting, because it cuts against the commercial reading of the whole argument. Orthodontics over invasive cosmetic dentistry means moving teeth rather than cutting them down for veneers — the more conservative option, and often not the more profitable one. The counter-example of what happens when that principle is ignored is documented in Turkey Teeth: the real risks of getting veneers overseas.

The porcelain-over-resin row is the one a reader should push back on hardest, because it is not universally true — porcelain, amalgam or composite resin and the differences between bonding and veneers both set out cases where the resin option is the better clinical answer, not merely the cheaper one. And the first row assumes the root canal is done well: whether it is done by a general dentist or a registered specialist matters, which is the subject of endodontist versus dentist for root canal and, on the orthodontic side, general dentist versus specialist orthodontist. On that last point specifically we have to be honest about a gap: we hold no independent comparative outcome data — no systematic review, no controlled trial — that measures success rates for the same procedure between general practitioners and registered specialists in Australia. Figures in circulation on practice websites, here and elsewhere, should be read with that in mind.

Second: a patient who disengages is exposed to risk

Every patient lost at any stage of the process is potentially exposed to harm — whether through further self-neglect, or through care that falls short of what they needed.

Third: good medicine costs more in the short term

The path of good medicine is better for the patient in the long term, both physically and financially — but it is often more expensive in the short term.

The piece is unusually direct about where that money goes: the additional revenue funds better-skilled ancillaries, improved equipment and enhanced technology — a better practice, from which that patient and their family benefit for years.

Whether you find that argument persuasive or self-serving is exactly the debate the piece is trying to start. A related argument about how patients finance long-horizon treatment is made in patient dental payment plans.

Where the argument meets the rules

This is the part of the subject that is not a matter of opinion, and any colleague persuaded by the piece needs to know where the boundaries sit.

The floor is set by registration standards, not by philosophy. The Dental Board of Australia publishes the standards that define, in its words, “the requirements that applicants, registrants or students need to meet to be registered”. They cover scope of practice, continuing professional development, recency of practice, professional indemnity insurance arrangements, English language skills, criminal history, specialist registration, and endorsement for conscious sedation. The most relevant to this argument is the Scope of practice registration standard, which applies to every practitioner the Board registers and “requires dental practitioners to practise within the scope of their education, training, and competence at all times.” Enthusiasm for a treatment does not extend that scope, and nor does having bought the equipment.

Specialist registration is a defined pathway, not a description of interest. The Board requires an applicant for specialist registration to have “completed a minimum of two years general dental practice” and to “meet all other requirements for general registration as a dentist”, holding general registration in the division of dentists. The titles themselves are protected: section 115 of the National Law provides that a person must not knowingly or recklessly take or use the titles “dental specialist”, “medical specialist” or a specialist title for a recognised specialty unless the person is registered under that specialty, and section 117 extends that to holding oneself out as registered or qualified when one is not.

And the piece's central proposal — measure yourself — runs into a rule as soon as those measurements leave the practice. Ahpra's advertising guidelines, made under section 133 of the National Law, state that advertising a regulated health service may be false, misleading or deceptive where it “makes statements about the effectiveness of the treatment that are not supported by acceptable evidence”, where it “compares health outcomes, regulated health professions or practitioners or prices without complete information”, or where it “makes claims about providing a superior regulated health service”. The evidence bar is specific: “acceptable evidence mostly includes empirical data from formal research or systematic studies in the form of peer-reviewed publications”, and the guidelines list among what will generally not be accepted “anecdotal evidence based on observations in practice”, “self-assessment studies”, and “outcome studies or audits, unless bias or other factors that may influence the results are carefully controlled.”

So a conversion rate is a legitimate internal management number and is not evidence of clinical quality — and it cannot be advertised as though it were. Maximum penalties for advertising offences were increased in 2022 to $60,000 per offence for an individual and $120,000 for a body corporate.

The guidelines also draw a distinction that goes to the heart of this article. They note that “there is an important difference between acceptable evidence for claims made in advertising and the evidence used for clinical decisions”, because in the surgery “practitioners must obtain informed consent and are expected to discuss the evidence for different treatment options”, giving the patient the chance to weigh benefits and potential negative effects and ask questions, whereas “advertising does not provide this opportunity as the claims are generic and practitioners are not available to clarify whether a treatment is appropriate for an individual.” That distinction is the answer to the piece’s own worry: persuasion inside a consultation, where the alternatives and their downsides are on the table and consent is documented, is a different act from persuasion in a shop window.

The conclusion

The position taken: dentists have an unwritten obligation to their patients to improve their communication skills, maintain their passion for good medicine, and pay attention to their conversion indicators in order to keep improving as care providers.

Dr Closer, as both a good communicator and an advocate of ideal dental care, is delivering good medicine — just as Dr Decent is. The difference is that she inspires more patients to want it.

The honest counter-argument, which the piece invites rather than answers: the same skills that persuade a patient towards a root canal instead of an extraction can persuade them towards treatment they did not need. Conversion rates measure whether people said yes. They do not, on their own, measure whether they should have.

Which is why the list above matters more than the label. Communication in service of the patient’s interest is care. The same communication in service of the invoice is not — and the difference lies in what is being recommended, not in how well it is explained.

For a patient, the practical safeguard against the failure mode is not suspicion but a second view: a second opinion on a large plan is routine, and the questions worth asking are collected in 5 questions you’ve always wanted to ask your dentist. The other check costs nothing: look the practitioner up on the Ahpra public register yourself, where current registration, division, any specialist registration and any conditions are all published.

Common questions

Is there an objective answer to the question in the title?

Not one we can source. No Australian regulator statement, professional guideline or body of trial evidence in the material behind this library establishes what makes one clinician better than another, or ranks styles of practice against each other. What does exist is the Dental Board of Australia's set of registration standards, which define the minimum every practitioner must meet, and Ahpra's advertising guidelines, which prohibit any practice from claiming to provide “a superior regulated health service”. Anything above that floor — including the argument on this page — is opinion.

The first row of that table prefers saving a tooth over extracting it. How would anyone know whether a particular tooth is worth saving?

There is a literature on this, and it moves the decision away from philosophy and onto the tooth in front of you. A narrative review, Tooth survival after endodontic treatment, makes the framing point first: root canal treatment “is performed to prevent extraction”, and when the European Society of Endodontology ran a consensus process to choose outcome measures, “Tooth survival was rated as the most critical patient-reported outcome measure”. So survival of the tooth, not the appearance of the X-ray, is the number that matters to a patient.

What predicts it turns out to be mostly not the root canal. A review in the British Dental Journal's series on endodontic outcomes sets out the factors, and they are structural:

• How much tooth is left. In a study of root-canal-retreated posterior teeth, “when less than 29.5% of tooth structure was remaining, the percentage of extractions was three times higher compared to teeth with more than 29.5% tooth structure remaining.”
• Whether it can be sealed and crowned properly. A 1.5–2 mm ferrule — a band of remaining tooth encircling the crown margin — has a positive effect on fracture resistance, and “an incomplete ferrule is considered better than a complete lack of ferrule”. Absence of an adequate ferrule “reduces survival of both the restoration and the root-filled tooth”.
• Cracks. Their presence “is considered a negative prognostic factor for survival”, and a localised narrow pocket beside the tooth is described as often “pathognomonic of cracks affecting the root”.
• Where the tooth sits. “terminal or lone-standing teeth show poorer survival, being at a greater risk of fracture due to increased occlusal forces.”
• What goes on top, and when. Cuspal coverage restorations “significantly improved survival of the root-filled tooth”; root-filled molars restored with a direct filling “demonstrated a significantly higher frequency of extraction over a period of ten years” than those restored indirectly; and posterior root-filled teeth crowned four months after treatment “were extracted at three times the rate of those that received a crown within four months”. Leaving a root-filled tooth in a temporary filling is not a neutral delay.

One honest figure from the other direction, which the narrative review reports rather than hides: “about 40 per cent of root filled teeth have AP when investigated in cross-sectional studies” — apical periodontitis, meaning inflammation persisting at the root tip. Many of those teeth are still in the mouth and functioning. Whether that is an acceptable state or a failure is genuinely contested; the review notes the ESE guidelines treat it as a failure to be retreated, while epidemiological data suggest dentists and patients often accept it.

So the questions to ask are concrete: how much sound tooth is left, is there a ferrule, is there a crack, is this tooth at the end of the arch, what restoration is planned and how soon. A dentist who can answer those is answering the actual question. See Endodontists and Everything you need to know about root canal treatment.

Someone told me an implant has a better success rate than a root canal. Is that a fair comparison?

Historically it was not, and the reason is the clearest example on this page of how two real numbers can be made to say something neither supports.

The narrative review on tooth survival puts it directly. Describing the period when implants were being promoted as the answer to everything, it records that “It became obvious that it was biased to compare the success of implants to the success of root canal treatments since success of implants was equal to survival and success of root canal treatment was most often based on periapical conditions.” In plain terms: an implant was counted a success if it was still in the jaw, while a root canal was counted a success only if the bone around the root tip looked perfectly healthy on a radiograph. Those are different tests. Applying the implant standard to a root-filled tooth — is it still there and comfortable? — produces a very different figure from the one usually quoted.

The implant figures themselves are good, and worth stating with their populations. A retrospective analysis of one health fund's records covering 158,824 implants in 53,874 patients reported an overall survival rate of 97.79%, with failure highest in the first year. An ITI consensus statement reports cumulative survival of implants supporting fixed bridgework at 95.4% after 5 years and 92.8% after 10 years — and, in the same document, that “biologic and technical complications occurred in about half the cases after 5 years of function.” Survival is not the same as trouble-free.

There is also a cost dimension that cuts against the assumption that replacing is cleaner than keeping. The endodontic review cites a randomised clinical trial in teeth with periodontal attachment loss all the way to the root tip — about as compromised as a tooth gets — which found “statistically comparative outcomes of periodontal regenerative surgery (± endodontic treatment) versus extraction and tooth replacement”, and that “the total mean cost of treatment over the observation period was significantly lower for teeth retained with regeneration”.

None of which settles any individual case. It settles only this: if someone offers you a percentage for one option and a percentage for the other, ask what each percentage counted as a success, over how long, and in whom. See Implant versus bridge for a single tooth replacement and Who should I see for dental implants?.

The piece argues good medicine is not cheap. Is the more expensive option actually better value?

Sometimes demonstrably, sometimes not, and the useful move is to ask for the comparison over years rather than at the counter.

Where the evidence does support the long-view argument, it is quite specific. The endodontic literature above found that a root-filled posterior tooth crowned within four months was extracted at a third of the rate of one crowned later, and that molars left with a direct filling came out significantly more often over ten years than those restored indirectly. That is a case where spending sooner and spending more genuinely bought tooth years. Likewise, the randomised trial on severely compromised teeth found the retained-tooth pathway cost less in total over the observation period than extracting and replacing. On the restoration itself, five-year single-crown survival figures from a systematic review sit closely together across materials — metal ceramic 94.7%, leucite or lithium disilicate reinforced glass ceramic 96.6%, densely sintered zirconia 92.1%, with a separate prospective study reporting 92.3% for gold — which is a useful corrective to the idea that the dearest material is decisively the best one.

Where it does not support the argument is anywhere the claim is generic. This page's own table lists “Porcelain” over “Resin” and then concedes the row is contested; the material evidence above is about full crowns on root-filled teeth, not about every filling in every tooth. And note what the regulator says about exactly this kind of reasoning being used in advertising: Ahpra's guidelines treat “anecdotal evidence based on observations in practice” and uncontrolled “outcome studies or audits” as generally unacceptable support for a claim about effectiveness.

So the practical version. Ask for the cheaper reasonable option and the do-nothing option in writing alongside the recommended one, with ADA item numbers so you can check a health fund rebate and compare between practices — see the price guide and Understanding Your Treatment. Then ask the question that actually separates value from price: what is the most likely reason this will need doing again, and roughly when?

I feel pushed towards a bigger plan than I expected. What can I do in the room?

Slow it down, and know that the rules are on your side about the tactics that create the pressure.

Ahpra's advertising guidelines identify the language that may make advertising unlawful because it encourages unnecessary use of a health service: wording that “Creates an impression or a sense of urgency that is linked to a person's health suffering if they do not use a regulated health service, where there is no clinical indication to support this”, and they name the phrases — “‘don't delay', ‘act now before it's too late', ‘don't miss out', ‘time is running out', or ‘for a limited time only'”. Two further items are directly relevant to a page about conversion rates and recalls: advertising may be unlawful where it “Encourages a person to attend periodic or regular appointments where there is no clinical indication to do so” — including “contracting for future services” — or where it uses “incentives such as prizes, discounts, bonuses, gifts that would encourage people to use services regardless of clinical need or therapeutic benefit”.

Four things to say, none of them confrontational:

• “Can I have this in writing, itemised, before I decide?” A written, itemised plan is the normal output of a treatment-planning appointment, not a special request.
• “What is the least I could reasonably do, and what happens if I do nothing for now?” Both are legitimate answers and a plan that names neither has not been fully explained.
• “Is any of this urgent?” Genuine dental urgency is a short list — spreading facial swelling, difficulty swallowing or breathing, uncontrolled bleeding, a knocked-out permanent tooth, facial trauma. Most elective dentistry can wait a fortnight.
• “I'd like a second opinion, and my records.” You are entitled to your clinical notes and radiographs, and a practitioner who responds to that request without irritation has told you something reassuring. See Second Opinions & Corrective Dentistry.

And if what you encountered was an advertisement rather than a consultation — a countdown, a limited-time price on irreversible treatment, a prize draw — a complaint about advertising can be made through the complaint form on the Ahpra website, or by calling 1300 419 495.

Does this article replace an individual dental assessment?

No. It provides general information. Symptoms, suitability, risks and treatment choices depend on examination and, where indicated, imaging or other records from an appropriately registered practitioner.

Sources named on this page

• Dental Board of Australia, registration standards (including the Scope of practice registration standard and the Specialist registration standard) and the FAQ on specialist registration
• Ahpra and the National Boards, Guidelines for advertising a regulated health service, made under section 133 of the Health Practitioner Regulation National Law, including Appendix 2 on title protection (sections 113–119)
• Fransson H, Tooth survival after endodontic treatment (narrative review), and the British Dental Journal review of prognostic factors in endodontic outcomes, for the tooth-survival figures quoted in the questions above
• ITI Academy consensus statement on implant survival and complications, and the published retrospective analysis of 158,824 implants, for the implant figures quoted

Related reading

• How important is communication in dentistry?
• Is it important to have a family dentist?
• Finding a dentist online in Australia
• Why would I need to see a dental specialist?
• Dental myths exposed
• The Smile Solutions experience
• Everything under one roof
• I want a smile makeover. Where should I start?
• Why choose us
• Careers at Smile Solutions, the graduate program and the dental internship — for the colleagues this piece was written for

Practical details

Written by Dr Kia Pajouhesh. This is a personal opinion piece addressed to the dental profession and reflects the author’s views.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — see how to find us. Phone 13 13 96, or theteam@smilesolutions.com.au; full details on the contact page. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. The clinicians and support staff are listed on our team.

Published 17 July 2014. General information only; it does not replace advice from your treating practitioner. Survival, failure and cost figures in the questions above are quoted from the published studies named, with their populations and time points, and are not this practice's own results.

Smile Solutions trades under ABN 28 193 514 103.