Why are big dental cases described as "golden needles in haystacks" and what does the metaphor actually capture? The metaphor captures both the rarity of the qualifying patients and the disproportionate value of finding even one. Of every hundred patients with serious dental problems, only three to seven will actually pursue complete treatment in a given year. Of every inquiry that arrives at a properly run big-case practice, only a fraction convert into accepted cases. Each case that does convert produces revenue in the $20,000 to $40,000 range or higher. The mathematics work because the case value compensates massively for the [...]