Muhalab Al Sammarraie, D.D.S., originally from Baghdad, is a site dental director at AltaMed Health Services in Los Angeles, the nation’s largest federally qualified health center. A fellow of the International College of Dentists and graduate of the ADA Leadership Institutes, he was named a 2023 ADA 10 Under 10 Award winner and an Incisal Edge magazine 40 Under 40 Top Dentist in America. He serves as an international lecturer at Universidad De La Salle Bajio, a preceptor for Tufts University School of Dental Medicine students, and a member of the ADA House of Delegates. Beyond clinic walls, he advances oral health equity in underserved U.S. communities and leads humanitarian efforts supporting displaced populations worldwide, including Iraqis.
“I was holding the mirror with one hand, and my breath with the other.”
It wasn’t the first time I performed that procedure. But that day, everything felt off.
The patient was anxious. The assistant wasn’t in sync. The impression failed, and so did the rhythm I usually trust.
My hand didn’t tremble, but inside, I did.
That quiet moment of doubt is one we rarely discuss in dentistry. But we should.
Because this profession isn’t just about precision, it’s about presence under pressure. And when the hand shakes, leadership begins.
The myth of unshakable hands
Dentistry celebrates calm hands and flawless execution. We measure in microns. We train for certainty. We’re taught that steadiness equals mastery.
But certainty is a myth, and perfection, as I’ve written before, is its most dangerous illusion.
What no textbook prepares you for are moments like these:
• When anesthesia fails and a patient’s eyes fill with fear.
• When your assistant freezes mid-procedure and you have seconds to restore flow.
• When a parent confronts you over a plan they never fully understood.
• When a team member breaks down and your clinic becomes a space for humanity, not production.
These aren’t “technical errors.” They’re ethical intersections. And they demand something deeper than clinical mastery: judgment, humility and leadership.
Precision is a skill. Composure is a discipline.
Across my journey — from private practice to federally qualified health center leadership, from human resources boards in Baghdad to community clinics in California — I’ve learned this truth:
Your hands may slip. Your schedule may collapse. But your presence, your ability to stay composed, intentional and ethical, must not.
Composure isn’t silence; it’s strategic calm. It’s pausing instead of panicking. It’s saying, “Let’s step back and do this right,” instead of pushing through chaos. It’s remembering the compass that has guided me in war zones, boardrooms and operatories alike: When systems fail, values lead.
What happens when…
1. The procedure breaks down
The crown won’t seat. The file fractures. The clock runs out.
What to do: Pause. Reframe. Speak it out loud: “Let’s reassess and do this right.” Patients don’t expect perfection. They expect honesty and safety.
2. A team member loses confidence
The assistant avoids eye contact. The hygienist hesitates. The room shifts.
What to do: Redirect with grace. Ask: “What do you need from me right now?” Leadership isn’t about control; it’s about presence.
3. Burnout creeps in
You’re depleted. Then one difficult patient tips you over.
What to do: Recognize the signs early. Protect your integrity before exhaustion erodes it. Rest isn’t weakness; it preserves your leadership.
The mistakes we don’t document
We all record clinical errors, complications, revisions, delays. But what about the ones we don’t: the rushed procedure because the schedule was tight, the softened truth to avoid discomfort, the choice of “what’s easy” over “what’s right”?
No one will sue you for those. But the mirror knows.
I don’t lose sleep over technical missteps. I lose sleep over the moments I knew I could do better, but didn’t. Because peace of mind doesn’t come from avoiding hard truths; it comes from facing them with integrity.
5 rules for leading when the hand shakes
1. Calm the room: Your tone sets the rhythm. Breathe. Then speak.
2. Communicate the plan: Uncertainty breeds fear. Even saying, “We’re going to pause and reassess,” builds trust.
3. Anchor in values: When the patient’s best interest conflicts with the day’s schedule, choose the patient.
4. Document with clarity: In uncertain moments, your notes become your voice. Write them with integrity.
5. Reflect, don’t ruminate: Learn. Adjust. Then let it go. Growth requires grace, not guilt.
Leadership isn’t the absence of mistakes, it’s how you rise after
There is no universal protocol for pressure. But there is preparation for presence.
And that preparation isn’t taught in lectures. It’s forged in long nights, difficult conversations, failed moments and choices that cost you something.
Leadership is not formed in titles or honors. It’s shaped in tension and proven in humility.
When the hand shakes, let the heart hold steady
The future of dentistry doesn’t just belong to those with the steadiest hands. It belongs to those with the strongest character.
If you’re a young dentist reading this, remember: It’s not your mistakes that define you. It’s how you hold the mirror when they happen.
Hold it with humility. Hold it with presence. Hold it with truth.
Because your patients don’t just trust your hands, they trust your humanity.
Dentistry is more than beautiful restorations. It’s about shaping trust, sometimes rebuilding it. We don’t just shape smiles. We shape character, clarity and courage.
This post completes my leadership trilogy, which also includes “Mastering difficult conversations: A guide to leadership with resilience and heart” and “Speak to lead: How dentists can communicate like leaders, not just clinicians.” Each piece builds one truth: Dentistry’s future won’t be written by perfect hands, but by present hearts.
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