Risk or reward?

hat was the crossroads that Dr. Wilton Guillory, Jr. and Dr. David M. Carlton III faced. Each month, 50-60 new patients were walking in the door of Family Dentistry at the Lakes in Alexandria, Louisiana, and the office was simply out of space. The waiting room was crowded on busy days and there was just a small, single check out for patients. Yet, the economic downturn made it a risky time to consider any type of expansion or new construction, even though it appeared to be the logical next step for the practice. What did the Doctors decide to do?

The doctors took a calculated risk and moved ahead with the construction of a new building, knowing that lower interest rates and construction costs made it an opportune time to build. Dr. Courtney Richter joined in the discussions, and the three doctors decided to merge into one practice and move forward with their vision.

They wanted a new office with: 1) More square footage and a layout that facilitated high-quality care. It also needed to accommodate the future growth to a fourthdoctor. 2) Latest technology to give patients an exceptional experience and make the practice more efficient 3) An upscale yet comfortable interior that matched the level of care given to patients.

“Wow” Factor

Construction was completed in November 2009, and the finished office is nothing short of “wow.” It is 6,300 square feet and offers plenty of space to have four doctors practicing full time. Yes, four… even before construction was completed, Dr. Aaron Mangum joined the trio, making the added square footage an instant return on investment!

The “wow” factor begins even before you walk inside. The exterior of the building, with its rich architecture, inviting covered entry, double doors with transom, potted plants, and large windows sets the stage for the service patients receive inside.

“The interior was designed to have a comfortable, “home-like” feeling,” said Dr. Richter. “We paid special attention to the lighting throughout the building, as research has shown that lighting can affect the mood of our guests. We eliminated all commercial-type lighting features and incorporated canned, sconce, and pendant lighting fixtures where possible. The ambiance is now that of a home rather than a clinic.”

Even the floors were carefully chosen – the environmentally friendly bamboo floors don’t just look stunning with the blend of light and dark graining: they also absorb noise. The operatories are painted in earth-tone colors to calm and relax and are outfitted with Belmont cabinetry and chairs, giving an upscale look and storage while also offering ergonomic benefits to both the doctors and patients. The hygiene rooms are painted a crisp and clean oyster blue. Pulling all the colors and design elements together is the original canvas-wrapped photography of Dr. Guillory, which is displayed throughout the waiting room, halls and offices.

The space houses 13 operatories, all of which feature LCD monitors for patients’ use, an in-house dental lab, five centrally-located hygiene ops, a centrally located hygiene coordinator office, a consult office, spacious lounge area, and three privacy checkouts. A large and welcoming waiting area greets patients with a feeling that can only be described as southern hospitality – warm, comfortable, and elegant.

“We visited other state-of-the-art multidoctor practices and drew a design using what we felt were the best qualities from those offices with what we felt was the most efficient patient and team flow for our type of practice,” Dr. Carlton explained.

We located and purchased a great piece of property in a growing area of our community and hired a local architect to help with the building process. We then met with our Field Sales Consultant, Scott Rogers who immediately introduced us to Equipment Sales Specialists John Pruitt and Chris Bratton. From there, we never looked back.”

The Move to Digital

From the initial planning stages all the way through the final construction, Rogers, Pruitt, and Bratton were closely involved with essential aspects of the project. “Henry Schein assisted with plan review and plumbing, electrical and medical gas drawings for the operatories, sterilization, and dental lab. They also assisted with onsite monitoring of the construction and were instrumental in training for the new equipment,” noted Dr. Guillory.

“The interior was designed to have a comfortable “home-like” feeling,” said Dr. Richter.

The new equipment was perhaps the biggest change for the doctors and their staff. In the old office, they didn’t use digital technology; in the new office, they’ve embraced it with the purchase of Dentrix practice management software, which has automated many of their administrative duties, allowing patients to be scheduled, billed, and checked out more quickly.

“The office used film before. It was time-consuming and the chemicals could be messy,” said Rogers. “We looked at what the dollar cost savings would be, and it made sense for them to move to digital imaging.” The Gendex 8500 Digital Pan and an Aribex Nomad X-ray gave the office higher image quality, instant images for faster review and treatment plan discussion, and seamless integration.

Positive, Motivating Work Environment

The new work environment seems to agree with the staff, made up of three hygienists, six assistants, four front-office employees, and an office manager and hygiene coordinator.

“We cannot say enough about what this has done for the team,” said Dr. Guillory. “All the team members feel very fortunate to work in such a great environment, and several have actually improved their patient interaction. New-patient referrals are very high, and the compliments make us feel great about what we have built and can offer to our community. The relationships created early on and the enthusiasm that the team from Henry Schein portrayed made us feel confident that we would be not only satisfied, but also impressed with the final outcome.”

Featured Equipment

• Aribex Nomad X-ray
• Belmont E-Style Cabinetry with Cambria
• Belmont Quolis Chairs
• Brewer Stools
• Dentrix Practice Management Software
• DEXIS Sensors
• Gendex 8500 Digital Pan
• KaVo Quatrocare
• Midmark M11 Sterilizer
• Pelton & Crane Vista Pure
• Pelton & Crane Helios Track Lights
• Ramvac Bulldog Vacuum
• SciCan Statim 5000

It must meet the challenges and satisfy the clinical demands of your practice, your patients and lab partners. It is my opinion that digital impressioning has achieved the status of the gold standard in restorative dentistry. Computers operate with an efficiency and an accuracy that conventional materials cannot consistently attain. One such technology that truly meets these criteria is the 3M™ ESPE™ Lava Chairside Oral Scanner C.O.S.  The following case illustrates how the Lava C.O.S. can provide excellent results in restorative dentistry from impressioning to seating.

Case Report

The patient, a 79-year-old female, presented to the office with a failed fixed partial denture #2XX5. The prosthesis had failed due to recurrent caries beneath the mesial abutment. The patient was given all options for replacement of the failed restoration. She chose to have us fabricate a new ceramometal fixed-partial denture.

Following accepted restorative protocols, the old prosthesis was removed and all decay beneath the abutments was excavated. FluoroCore® (Dentsply, Inc.) was used as a foundation for the preparations, which were then refined to support a four-unit fixed-partial denture. Its design included a semiprecision slot connection between the pontic #4 and abutment tooth #5.

We then proceeded to isolate the teeth in order to scan the full arch using the Lava C.O.S. After verifying that 100% of the preparations were captured in the scan, the jaw relation was recorded by the scanner with the patient closed into centric occlusion. A provisional restoration was fabricated and the patient was dismissed.

The digital information, along with a digital prescription, was transferred wirelessly to the Authorized Lava Design Center. The lab used the digital files to mark the margins. The virtual model was then sent to a model-manufacturing facility to produce a stereolithographic (SLA) model.

This model was used for fabrication of the prosthesis, using the same techniques that would be followed if using gypsum die stone. (The difference is that the digital information does not change dimension in any way after it is captured by the scanner. The same cannot be said for conventional impression materials.) We placed the final restoration without any adjustments needed. The patient was ecstatic about the complete treatment process and she was truly amazed at the difference this new technology brings.

Placing restorations without making any adjustments has become the norm since incorporating the Lava C.O.S. The fit of the restorations is so accurate that rarely are any adjustments needed, provided that the provisional restoration satisfies all requirements.

The Benefits of Digital

When implementing the Lava C.O.S. in my practice, my goal was to provide an increased benefit to the patient through delivering a higher quality restoration. In the end, the benefits of the Lava C.O.S. have extended to my practice as well.

Dentists who have used the system reported a 41% reduction in seating times for single-unit crowns1 and remake rates due to marginal fit were up to 80% lower than the industry average.

In fact, since using the system in my practice, only 6 units of 250 have required modification prior to cementation. None of the errors were related to the scanner. My experience with the first 250 units scanned has been exceptional from both the perspective of my patients and my own. With experience and with continued software improvements from 3M, I see no tarnish on this technology.

Many dentists continued to practice their profession without those first films that showed the inside of the human body, but soon dentists realized that utilizing the best information available resulted in the best service to and the best result for their patients.

The necessity to use the best diagnostic tools is as valid now as it was then, and 3D imaging is as important an upgrade to dentists in 2010 as 2D radiographs were to dentists in 1910.In addition to being a necessity, quality imaging, such as digital intraoral and digital panoramic radiology and Cone Beam scanning technology, has brought even more opportunities for professional excellence and growth.

As an assistant clinical professor in Periodontics & Implant at N.Y.U., I’ve experienced the many facets of technology. Having referred my patients for medical CT scans for many years, my patients’ dental experiences were disrupted by long waits and indifferent service. I was fortunate to discover that my film panorex could be eliminated, and a Cone Beam machine with a 2D panoramic feature was reasonably priced and would fit in the same small space.

I use these machines predominantly for implant-related cases so that I can identify crucial structures. Of utmost importance to me, the GXCB-500, or the “500,” exposes my patients to less radiation than other 2D and 3D options. This leaves my patients and me very comfortable, as its 2D radiation measures 80% less than an FMX, and its 3D emits up to 10 times less radiation than a medical CT scan.

This medium-field-of-view 3D unit is ideal for virtually all services I render and provides the details that I need for successful treatment. I have recently used it midsurgery during an implant placement. The scan revealed a residual root that was undetectable on the prior 2D image and allowed me to complete the procedure successfully.

The software that accompanies the “500” allows me to share information easily with my colleagues, and that is an added bonus, important both from a practice management and a therapeutic viewpoint. I can also display the images on every office computer, enlarge or zoom in on images, and slice the 3D images in any direction, which result in a higher diagnostic capability and greater patient understanding of their condition.

The “500” has markedly increased case acceptance, and patients who come in for consultations and second opinions realize they do not need to look further to decide where they want to be treated. I strongly believe that we should use all tools that enable us to provide the best service possible to our patients. Patients want their dentist to have all of the facts before they begin treatment. They don’t want to hear, “I think we can do it,” or “The nerve shouldn’t be a problem, but you could be numb forever.” If a member of your family were considering treatment, you would want the most precise diagnostic information available before commencing treatment. I want that for my family, and our patients deserve no less.

To Charles Kettering’s point above, have you identified your issue(s)? I am a firm believer in knowing that properly identifying the concerns of your practice is the most important aspect of solving any potential problems. The team at Henry Schein Dental is eager to help you find out what your practice’s main challenges are and expose the objective points of data that will lead you toward the best solutions.

Henry Schein Dental’s Business Discovery Surveys and the Digital Practice Analysis Tool allow us to gather important information about how to improve your practice’s overall performance. In 2009, we set out to effectively state and address the challenges that were affecting dentists across the country. In order to do so, we surveyed over 13,000 dentists.

The results of this survey should not be a surprise to many of you because they represent common issues that you may be experiencing on a daily basis.

The Results:

Of course, a full detail of solutions to these issues above cannot be addressed without knowing the specifics of your practice. I can assure you that our sales team is prepared to help you find solutions to the most commonly identified problems in your practice. Our team participates in career development courses, which requires them to complete over 350 hours of dental business training. Using Henry Schein Dental’s offerings and tools, our sales force can help you identify your challenges and define solutions. We would like to start by sitting down with you, asking questions and most importantly, listening to your concerns.

Today, we are helping our current and future customers uncover challenges and work toward actionable solutions. In over 10 years, we have mastered analyzing dental practices and have concentrated on creating tools to help you grow, sustain, or sell.

One tool we are extremely proud of is the Digital Practice Analysis Tool (DPAT). By using a few pieces of information from your practice management software, we are able to show you how your policies and procedures are playing out in your practice. Of course, all the results are confidential.

We examine many aspects of your practice to see how they influence your standard of care. The chart on the previous page shows you just a few of the many aspects the DPAT focuses on.

Fee Analysis:

Using your current fee schedule and our statistical analysis, we explore with you the possibilities of changes in your fee structure that could involve major financial gains in your practice and evolve into you receiving the fees that you deserve based on your efforts, education, and risk in owning a practice and small business. In addition to showing you what you could financially achieve, we can also discuss possible impacts to your patient base and help you in coaching your team to discuss fees and fee changes with your patients.

Recare:

How often should your patients be seeing you? That’s your call as an expert and doctor. One of the common pitfalls in a practice is the follow-up in communicating with patients. It is often an eye-opening experience when dentists are able to see how many patients are actually coming back twice a year to see their hygienist, and how many true hygiene days that department is filling. Henry Schein Dental Sales Consultants are trained by well-respected practice-management consultants, such as Kerry Straine, on how to effectively get patients in the chair and keep them there.

Production Mix:

It’s often a surprise to see a year’s worth of you and your team’s efforts summed up in one chart, and the information here is amazing. Using coding, you’ll see what percentages certain aspects of your offerings are representing in regard to production. See the Procedure Mix example above.

Obviously, one can see that the DPAT is unique in how it measures the effectiveness of your policies and procedures, and it’s been built based on your challenges and your needs. Basically, anyone can forecast rain; the challenge is partnering with someone who can help you “build the arc.” We’re prepared and excited to help you bring your practice into the future that you desire and help you sustain the practice you’ve worked so hard to create and grow.

For more information of the Digital Practice Analysis Tool, please visit: henryscheinwedothat.com

The person that was interviewing me asked me how many things that I was taught in dental school was I still doing the same way. Having graduated from The Medical College of Virginia in 1988, I had to think about that for a minute. I was struck by the conclusion that I do nothing the way I did it in dental school!

While dentistry has certainly changed dramatically in the last 20 years, the technological advances that are occurring today are moving our profession at warp speed. Even though this is exciting, there are numerous challenges in correctly implementing these high-tech tools in a way that they will be optimally utilized, while not creating a financial burden to the practice  The mistake, often made, is to think the technology will be a “magic bullet” for the practice. A dental office that is in a financially unhealthy place will generally not benefit from an expensive technology, which may even put more economic stress on the practice. It is important to remember that these devices are simply tools that will allow us to do our dentistry better, be more efficient and provide our patients with a better experience. If we start with a well-run practice, with a clear vision for who we are and the services we provide, it will become obvious which technology we should implement first, and a logical timetable for which the other technologies can be brought into the practice environment.

Start with a Philosophy of Practice

Getting clear on the specific mission of your practice is probably the most important thing any dentist can do. In dental school, most of us just hope for a full schedule, but as that begins to happen, most mature practices begin to focus on some aspect of dentistry. At The Dawson Academy, we attract dentists who want to learn to solve complex aesthetic and functional problems. We place a high emphasis on diagnosis, treatment planning and sequencing dentistry in a way that the vast majority of our patients can afford optimum care. The curriculum is structured to train doctors to visual optimally, to procedurally do the work clinically, and to organize the team around them to optimize efficiency as well as profitability. While this is not the only philosophy out there, it has certainly worked with thousands of doctors who have chosen this path. The important philosophy: develop a practice vision and stick to it.

Don’t Let the Technology Define the Practice

All too often, if the vision for the practice is lacking, when technology is purchased it can become the center of the practice. A perfect example of this is chairside CAD/CAM technology. I have been involved with chairside CAD/CAM, currently using the D4D, for 5 years. It is an incredible tool for providing beautiful all-ceramic restorations for your patients. It is not, however, a machine that will allow you to do 100% of fixed prosthetics. Having a solid foundation for treatment planning, restoration selection and adhesion is vital to the integration of this tool into your practice. If this background is lacking, then it is easy for the technology to drive the practice.

This can lead to using the wrong materials in the wrong places, and ultimately an increased failure rate. Whatever technology you choose, remember that it is a tool designed for specific situations. While the training you will receive will emphasize the proper use of the instrumentation, pay special attention to its limitations. As you integrate it into your own practice of excellence, find the “sweet spot” in the practice for when it works best. This will increase the predictability, efficiency and profitability of your purchase.

Align the Technology with the Practice Focus

Once a philosophy of practice is established, the technology that would be of most value is often very obvious. If the doctor does a lot of surgery, perhaps placing implants and doing complex extractions, Cone Beam technology will be a huge benefit. On the other hand, if the dental team does a lot of operative dentistry, crown and bridge, and soft-tissue surgical procedures, the Waterlase MD® will increase the number of procedures you provide your patients, while also increasing efficiency.

Over the years we have gradually implemented various technologies into our restorative practice. These five are at the heart of our new practice:

Digital Radiography (DEXIS)

Digital radiography, in conjunction with digital photography, are often the first technologies introduced into a dental practice. Since we all take X-rays, digitizing the process increases efficiency and diagnostic capabilities of the team. I choose Dexis because of the quality and versatility of the sensor, the software platform, and the integration into Dentrix (my management software). Having the patients chart, progress notes, photographs and X-rays on one screen make treatment planning extremely efficient.

Chairside CAD/CAM (D4D)

Being able to do a percentage of your crowns, inlays and onlays in one appointment, with one injection, and without the need of a temporary restoration, is a tremendous service to the patient. Today with the addition of EMAX CAD, a lithiumdisilicate material, which is an extremely strong ceramic, only expands our opportunity to utilize this technology with total confidence. Dental teams that focus a percentage of their practice to lab-fabricated, indirect restorations will find a good fit with this technology. I chose D4D because of the ability to scan without powder (I do paint a liquid on the teeth prior to scanning), taking images from multiple angles to increase the accuracy of the model, the ease of use of the software, and the quality of the people running the company.

Laser Dentistry (Waterlase MD)

The Waterlase is the latest technology integrated into our practice. While I have had several years of experience with a couple of different diode lasers, the Waterlase MD is at a different level. It gives the dental team the ability to perform procedures on both soft tissue and hard tissues. We utilize it during crown-and-bridge procedures to create microtroughs around our crown preps prior to impressioning, for closed-flap crown-lengthening procedures (when indicated), gingivectomies, and the preparation of teeth during operative procedures. It has decreased the amount of anesthetic that is required during operative dentistry (allowing us to work in multiple quadrants in one appointment), and attracted dentalphobic patients who hate the sound of the drill.

Cone Beam Computerized Tomography (Sirona GALILEOS)

Cone Beam computerized tomography (CBCT), is providing the third dimension in virtual diagnosis and treatment plan. While I was initially interested in the ability to image patients with TMJ problems, I soon found it invaluable when treatment planning implant cases. Having the ability to virtually place implants and precisely communicate to the surgeon where the implants need to go is a “game changer.”

There is no longer the patient who gets opened up and we find that there is not enough bone. We can plan for bone grafts so that the implants are placed in the ideal position for the prosthetic solution. This technology has expanded my diagnostic capabilities helping TMJ patients and increased my confidence enough to begin placing the easier implants in my practice.

Dental Microscopy

Any time we can see better, we have the ability to improve our clinical skills. Caries detection, margination, trying in restorations, tooth preparation and endodontic procedures will all be better performed under a microscope. While dental microscopy has primarily been utilized by dental specialists, it is making its way into restorative practices throughout the world. We have found it not only dramatically improved our ability to see, but also forced us to keep our backs straight, into an ideal posture to provide dental services.

Get Help in Developing Your Business Plan of Implementation

Whatever technology you may be thinking about, get some help with the implementation process. The better your local Henry Schein Technology Specialist knows you and your practice, the better recommendations he or she can make about which technologies should be considered first and how to integrate them into your practice.

Beyond the obvious financial implications to be considered, also do not forget to discuss the training requirements with your team. Remember that not everyone is crazy about change, and some teams have a harder time with it than others. The earlier they get involved with the process, the greater the excitement will be and the smoother the transition. Having the right team attitude about something new in the office can make or break the implementation process. Utilizing the latest technologies to do routine and complex dental procedures has allowed us to do procedures with better quality, increased efficiency, and increased profitability. Beyond that, it is just plain fun! Dentistry is now moving at an everevolving, rapid pace. As you consider technology integration, first get clear on the specific vision of your practice. Then and only then can we choose the right tools for the time. Following this path will make the integration of the latest technology a smooth, fun and rewarding experience.

Lasers are an excellent instrument for everyday dentistry. That statement may surprise many dentists. But a recent study1 indicates that highly successful practitioners are utilizing lasers for common dental procedures, including caries treatment and restorations. Research conducted by Levin Group has found that general dentists who use lasers for routine care able to create a better patient experience and increase practice production, the ideal combination from a practice-management perspective.

Higher case acceptance resulting from happier patients has not been the only important benefit reported by dentists using the laser to perform everyday dentistry. In the same study, doctors attribute robust production growth in part to adding a laser to their standard tray. Everyday dentistry, such as the treatment of caries (even Class V composite restorations), is successfully and effectively performed, frequently in less time, with the use of lasers. “I use the laser with every patient that I see on my schedule,” said one research participant. Another dentist added, “Integrating the laser into our practice has increased production between $12,500 and $15,000 per month.”

Growing the Practice

Lasers increase production of common dental procedures. While most dentists have struggled during the current economic slowdown, many practices with lasers have actually grown during this period. The research indicates that dentists who own lasers are achieving production gains, not by adding complex or “exotic” treatment, but by more efficiently treating the conditions that present most frequently in the practice, such as caries and damaged/broken teeth. These successful dentists are seeing more new patients coming into their practices and accepting treatment. One dentist said, “New patients travel long distances to come to my practice because my patients have told them about how much easier dental treatment is with my laser.

“Practices have also attracted new patients with advertisements offering “an alternative to needles and drills.” Patients who responded to this kind of message told doctors that they appreciated not only a way to avoid injections and drillings, but also the fact that these dentists stood out as progressive and patient-friendly. By letting consumers know about options for their dental care, these doctors attracted new patients to their practices.

The key to practice growth is not only bringing patients into the practice but also offering treatment that they will accept. Lasers, according to our interviews, were extremely helpful as a means to increase case acceptance. Some doctors actually demonstrated the Waterlase MD^TM for patients by aiming the activated yet harmless water stream into a patient’s hand from a distance of a few inches. For patients who delayed or avoided dental treatment in the past due to anxiety, this kind of instrument was reassuring and made them comfortable with the doctor’s recommendations.

“Patients are just more at ease when we use the laser,” said one Northwest dentist. “Some of them have already researched the idea before they come in.”

A Better Patient Experience

Lasers reduce dental anxiety and improve the overall patient experience. When used appropriately, lasers greatly decrease the need for anesthetics and drilling, which are the two leading causes of dental anxiety. Satisfied patients are the goal for every practice. A dental experience that exceeds expectations will motivate patients to keep appointments, accept recommended care and refer their friends, neighbors and family members. The idea of dentistry is often connected to pain or discomfort in the minds of many patients. Practices that can remove this connection through the use of appropriate technology will be the offices that increased patient referrals and case acceptance.

Changing someone’s mind can be a transformative experience. When dentists are able to help patients overcome their dental anxiety, these individuals often become the practice’s biggest advocates. When asked about the connection between patient referrals and laser usage, one California dentist said, “We get lots of new patients that way.”

Another laser user related this experience: “I had seen one of my patients before his golf game. I had restored Class V caries on #20 and #21 using the laser with no anesthetic. He was so impressed that he told all his friends he played with that day and they told their wives.” A few days later, when the dentist was playing a round at the same course, he was inundated with inquiries. “In the span of 15 minutes, he said, “I had five patients and four nonpatients (who after talking to me wanted to become patients) ask me if it was true that I treated their friend using a laser and no anesthetic.” Summing up, the dentist said, “Do not underestimate the power of the laser, especially when a patient experiences it for the first time.”

Ease of Use

Lasers are easy to implement into the practice’s daily regimen. What was reassuring to Biolase owners when they bought the laser was how quickly the device could be incorporated into the practice. Handling a laser, dentists told us, felt very similar to having a drill in their hand. With appropriate training, these doctors were soon performing laser treatment on their own patients. “I felt it was relatively easy to use the laser,” said a West Coast dentist. “After basic training, I felt comfortable performing basic operative and soft-tissue procedures.” Another doctor commented, “It’s not much different than using a handpiece.”

Although dentists with lasers reported that they “would not work without them,” they also said that they would not give up either their drills or the use of local anesthetic. Lasers have made dentistry “much easier,” but that they were “still just another tool on the tray.” Rather than replace their drills, doctors identified what lasers do best and used them in conjunction with other instruments.

Many laser owners were able to grow their practices during the recession. By their calculations, these dentists said it was possible to pay for a laser based on adding only a few more new patients per month. After counting the gains from increased patient referrals, more new patients from advertising, more hygiene production and higher case acceptance, these doctors said that they were very pleased with their investment. “Without a laser today, you’re not as up-to-date as people expect,” said a NorthWest dentist.

Conclusion

Many dentists mistakenly perceive lasers as only an adjunct for high-end procedures. Levin Group research found that dentists who made lasers as a standard part of their armamentarium were able to derive the most benefit from this technology. The frequent use of a laser by offices resulted in a higher level ofpatient comfort, increased case acceptance for routine care and larger cases, and often improved doctor productivity.

“Patients are just more at ease when we use the laser,” said one Northwest dentist. “Some of them have already researched the idea before they come in.”

“Without needing anesthesia, I can take care of 8-10 cavities at a time anywhere in the mouth,” said a research participant. “For a small to medium cavity, I’ve done the procedure in the time I would’ve been waiting for the anesthesia to take effect.”

The popularity of lasers has grown steadily during the last decade, as more dentists became aware of the benefits that laser technology brings to their practices. Once solely the province of high-tech practices, lasers are now widely viewed as just another instrument on the tray by many dentists. In addition, as dentists enhance their clinical skills and offer new treatments in their practices, lasers can easily be used for a variety of procedures, including periodontal, endodontic and surgical treatment.

With the economy expected to improve this year, more consumers who postponed dental treatment during the recession will be looking to resume regular dental care. Practices that offer compassionate care using the advanced technologies, such as lasers, will be the offices that experience the largest influx of new patients. One California doctor captured the sentiments of many research participants about the importance of lasers, “It is a friendly instrument both for me and the patients.” he said.

Levin Group interviewed a cross-section of Biolase users and laser nonusers during October 2009 about the rationale for incorporating lasers into their practices, the frequency of use, and the device’s impact on patient care, productivity and production.

Financials and tooth numbering referenced by U.S. practitioners.

Rushing one appointment so you can get on to the next? Wondering why, at the end of the day, it feels like you’ve been running a chaotic zoo more than an orderly business?

Scheduling can cause stress of great magnitude! The management issue of “running behind” seems to affect all of the dental teams I’ve coached and researched over the past few decades. You feel uncomfortable when others are held up or inconvenienced. This strong feeling of responsibility for so many others—for personnel and patients alike—weighs heavily on you when you are unable to stay on schedule.

Rest assured that organizational and management systems that function effectively with one another are essential for the control of stress in the dental environment. Each of the 25 systems within your practice must work with every other system. One system can’t be “out of whack”, or the flow of your practice will be interrupted. Without a doubt, scheduling is one of the most critical systems that must be in place if stress is to be controlled. If you don’t control your appointment flow, who does? Your patients. If your patients control your appointment flow, what results? Chaos, and Chaos breeds stress!

The day of simply putting names into the book or filling in lines is over. Managing your schedule affects the productivity, profitability and stress control of each and every one of your procedures. Scheduling is the heartbeat of the practice. Thus, it deserves the greatest care and attention. The person responsible for making and confirming appointments must have the ability, training, time and desire to engineer each day. That training and subsequent attention will be able to help you avoid the top ten causes of scheduling stress.

(1) LATE PATIENTS

Patients are trained to be late when the office consistently runs late. Waiting is one of the main patient complaints about dentists. In our fast-track world, people want and need to stay on schedule. Your respect of patients’ time will gain the same respect for your time. Do your best to understand the times necessary for each procedure and each appointment. Stay within that time frame. If you are ten minutes past the patient’s scheduled time, acknowledge this to the patient. You will offset some negativity if you will graciously accept the responsibility for the delay. For example: “Mrs. Jones, Dr. Jameson has needed to spend more time with his patient than he had anticipated. He would certainly do the same for you. It will be approximately ten minutes before he can see you. Thanks so much for your patience Can I get you anything – water, a new before-and-after album to look through?”

(2) IMPROPER SCHEDULING OF TIME

One of the most critical aspects of excellent scheduling is having a clear identification of doctor time/assistant time/decontamination of room time. Having this information clearly identified in the appointments gives the scheduling coordinator clear guidelines for the following:

• When the doctor is captive
• When the assistants are captive
• Length of time the room will be occupied
• Length of time the patient will be in the office.

Take one staff meeting and dedicate this meeting to the designing of procedure-analysis sheets. These sheets will identify the following:

• The steps of each procedure
• Who’s doing what
• How long each step of a procedure takes.

With this information, the scheduling coordinator can properly interface one appointment with another. Then you can:

• Practice excellent time management
• Maximize the skills of each team member
• Prevent patients from spending too long at an appointment because of inappropriate scheduling.

Use a procedure-analysis sheet to provide your scheduling coordinator with the data he or she will need to appropriately engineer each appointment. Remember, these are NOT written in concrete! However, they will prove to be an excellent roadmap.

(3) WRONG SOFTWARE OR INSUFFICIENT TRAINING

Use an appointment system with 10-minute units. High tech dentistry and the excellent talent and skill of assistants allow for more efficient management of time. Be careful selecting your appointmentmanagement software and, once selected, maximize training so your scheduling coordinator can provide succinct planning for each active chair.

(4) EMERGENCIES

Placing the coding for the doctor and the assistant in the appointment system will show you where you can schedule emergencies. Emergency patients need to be seen as quickly as possible. However, you do not want emergencies to have a negative effect on your regularly scheduled patients.

Therefore, emergencies (for the most part) should be palliative. Do a quick analysis, prescribe the necessary x-ray, get the patient comfortable and reschedule for the appropriate time. There areexceptions, of course, if you and the patient have the necessary time and if the patient is comfortable with the financial responsibility, you’ll certainly want to proceed with treatment.

Cathy Jameson is founder and CEO of Jameson Management, an international comprehensive coaching firm. As a speaker, she offers fun, entertaining and educational programs packed with decades of proven practice management systems. Cathy and her team of 20+ coaches have lectured and consulted with dental professionals in 26 countries. Cathy’s firm has changed thousands of lives through not only speaking and coaching but books, CDs, DVDs and other products.

Did you max out your credit card? Expect a credit score drop of 10 to 45 points.  Declare bankruptcy? Your score will plummet by up to 240 points, and your odds of getting credit will nosedive with it.

The “damage points” data, unveiled recently by Fair Isaac Corporation (FICO), a leading consumer credit-scoring system, are part of the most revealing glimpse into the firm’s oncesecret – and still mysterious–credit scoring model.  The new information discloses how many points borrowers’ scores will drop when they make the most-common mistakes.

“Help People Understand” Scores

“I hope this information will help people to better understand FICO scores and the value for them of avoiding credit misstep,”
says FICO spokesman Craig Watts. “It illustrates key points such as the higher your score, the farther it can fall if you stumble. Getting and maintaining a good score isn’t complicated.  We all just need to pay our bills on time, keep credit card balances low and take on new debt sparingly.”

The greater transparency about FICO scores is important because American consumers’ ability to get credit rises and falls with the number. FICO, the company that pioneered credit scoring, assigns consumers a three-digit number from 300 to 850, depending on how well they handle credit. Other companies also offer scores, but FICO’s version is the most widely used by lenders in determining whether a consumer can borrow and at what rate.

FICO’s credit score has been around for decades, but only within the past decade have consumers gradually gained access to theirs. Though the raw numbers can be purchased, how they’re figured remains a FICO secret, as closely guarded as the formula for Coca-Cola. Until recently, FICO revealed only broad categories of factors influencing the score, but not the number of points at stake for consumers who fail to pay as agreed. The “damage points” information, revealed in a report by personal finance writer Liz Pulliam Weston, is now available through FICO’s Web site, myfico.com.

The Details

FICO’s information shows that bankruptcy does the most serious damage to a credit score (up to 240 points), followed by foreclosure (up to 160 points), while maxing out a credit card has the least numerical impact (as few as 10 points).  Those with good or excellent credit–so-called prime borrowers––put more points at risk with each mistake. For example, someone with an average credit score of 680 who pays a bill 30 days late will see a drop of 60 to 80 points. But for someone with an excellent credit score–780–that same delinquency can send a FICO score tumbling by 90 to 100 points.

The Cost in Dollars

In order to show just how badly a drop in your FICO score can hurt your wallet, we spoke with members of the home mortgage, auto and credit card lending industries. We presented hypothetical scenarios of a consumer who decided to apply for a $200,000, 30-year mortgage; a $20,000, five-year auto loan; and a credit card. While all the industry insiders stressed that a FICO score isn’t the only factor in determining who gets credit and at what cost (other factors they cited include the borrower’s debt-to-income ratio and whether they have already established a relationship with the lender), they were able to provide an idea of what a borrower who had the following credit scores could expect.

Here’s some of what they told us:

For a consumer who started with a FICO score of 780:

• Following a 30-day late payment, the consumer’s car loan rate would jump nearly 3 percent, costing the borrower $26 more each month.
• Following a debt settlement, the consumer would pay as much as $109 more each month on a home mortgage.

For a consumer who started with a FICO score of 680:

• Following a 30-day late payment, the consumer would pay $41 more each month for a car loan.
• Following a 30-day late payment, the consumer would pay as much as $95 more each month on a home mortgage.
• Following a debt settlement, the consumer would no longer qualify for a credit card.

Some Are Surprised by the Details

Consumer advocates say it’s important for borrowers to know what can damage their FICO scores. “If they know it in advance, they won’t go out and step in a pile of doo-doo,” says Linda Sherry, director of national priorities with advocacy group Consumer Action.“ They won’t go out and do some of these things.”

Even experts found some surprises in today’s news. “FICO imposes bigger hits than I would have thought for being maxed out or 30-days late just once, reinforcing my view that it is a cruder, blunter instrument than they like to claim,” says Ed Mierzwinski, consumer program director for the U.S. PIRG consumer advocacy group. “Nevertheless, it is a powerful, widely used crude blunt instrument.”

Of course, knowing the impact on a FICO score and actually avoiding these mistakes are two separate things: Amid rising unemployment and other daily financial struggles, paying bills and staying on-track financially becomes a much bigger challenge for many borrowers. “Some of these things are out of their control,” Sherry says of consumers.

Additionally consumers with identical FICO scores can have different credit histories. That means the same slip-up-such as maxing out a credit card-could have different impacts on consumers who have the same FICO score. In the examples they provided, FICO assumed each borrower had several active major credit cards, a mortgage, car loan and student loans.

Serry acknowledges the benefit of putting a number to a financial blunder. “I dficoon’t think we necessarily knew the numbers that a bankruptcy could apply to a credit score,” she says.

Helping You Make Better Decisions

While knowing the numbers may not keep you filing for bankruptcy if given no other choice, the information may help you make the best decision when faced with a bad situation.

FICO scores-and the access to credit they provide-are a valuable asset to consumers and supply a safety net when incomes are stretched. Sherry says that it is an asset that needs to be protected, even if job loss or catastrophic illness makes bill paying problematic. “In that period of time, paying down debt is the last thing on your mind,” she says. “Paying the minimum payment may also be the last thing on your mind, but you’ll be doing yourself a big favor if you do.”

The dental office of Dr. E. Morgan Scheiber in downtown Plymouth, Massachusetts was definitely showing its age.

A 200-year old Victorian building housed the practice he purchased from Dr. Joseph Santelli in 2001, and it had character and charm, but it also had problems. It was extremely inefficient to heat and cool and was also repair-prone, requiring the purchase of three new furnaces in less than ten years. Sadly, the stately Victorian home was simply not designed for a modern dental practice. The outside of the building also had issues – the parking lot was cramped and inadequate for handicapped patients.

A Wish List Come True

Dr. Scheiber, a specialist in sedation and cosmetic dentistry, discovered a new medical building slated for construction in an upscale shopping district, and he was gripped by the possibilities of a new office that would be energy efficient and have a smoother flowing floor plan, contemporary décor, and state-of-the-art equipment. Shortly after learning of the new building, he contacted his Henry Schein Equipment Sales Specialist Philip Riley, who had worked with the practice for over 30 years.

“Dr. Scheiber put me in contact with the developers of the proposed building and their architect,” remembered Riley. In just four days, the Henry Schein team began to create a layout that would meet the doctor’s specifications. “We worked together to determine the best location in the building for Dr. Scheiber and the amount of square footage needed to accomplish his wish list for a new facility,” said Riley. “Over time, a footprint was developed for his space, and the planning process began.”

Today, the new office is 3,600 square feet of modern excellence with seven treatment rooms including a private sedation suite, a panoramic X-ray area and digital processing area, a sequential flow sterilization room, onsite lab, employee lounge and changing area, business manager’s office, hygiene coordination station, and a separate office for the doctor with a private bathroom.

The hygiene rooms and operatories have an open, airy feeling with high ceilings that make them appear larger than they are. The virtual floor-to-ceiling windows bring natural light in, and the crisp blue walls are cheerful and bright. The Sirona rear console keeps equipment within easy reach for the doctor, but out of the patients’ view. Instead, patients are treated to views of LCD monitors that broadcast cable TV, educational DVDs, or digital images for treatment planning. Upon Riley’s recommendation, the doctor chose Midmark cabinetry, stools, and chairs for all of the offices because they provide a perfect blend of high-end aesthetics, function, storage, and comfort. Patients enjoy the safety of purified water that comes from Pelton & Crane’s Vista Pure Reverse Osmosis Filtration System, another addition to the office.

With an estimated 30% of the population avoiding dental visits because of fear,* the oversized private sedation room fills a growing need in Dr. Scheiber’s practice to provide anxious patients with a gentle alternative to the traditional dental visit.

Green Office That’s Cost Efficient and Eco-Friendly

In contrast to the Victorian home he previously worked in, Dr. Scheiber’s new office is a shining example of energy efficiency, thanks to a number of green features. Solar panelsproduce added electricity to the office.  Dr. Scheiber also had a state of the art heating system installed, which heats the floor and is one of the most efficient boilers on the market.  The doctor is even able to sell back the unused solar energy produced on weekends to the utility company in exchange for a credit on his monthly bill.

Latest Technology

“Henry Schein handled the office design, equipment purchases, and full install of everything that I needed,” said Dr. Scheiber. That “everything” encompasses a large amount of new technology that was not feasible in the previous building. Working with Riley, Dr. Scheiber chose the Instrumentarium intraoral X-ray machine and OP-200 D Panoramic with VT, which delivers high-quality digital images in real time, saving time and eliminating the cost and mess of film and chemicals. Every aspect of patient contact–check ins, scheduling, and billing–has been computerized and streamlined for more efficient patient flow, thanks to Dentrix practice management software.

“My staff has been bursting with enthusiasm when telling our patients about the new office,” said Dr. Scheiber. “I have planned for this for a long time, so having it actually completed was a huge goal fulfilled.”

Next on the doctor’s to-do list is to add a fourth hygienist to his staff and eventually a third doctor. Dr. Scheiber also has an associate on his team that specializes in implant dentistry. When asked what advice he would give other doctors who want to take on a similar project, he responds simply, “Use Phil Riley of Henry Schein for all your plans.”

“My staff has been bursting with enthusiasm when telling our patients about the new office,” said Dr. Scheiber.

Left to Right: Jeff Blair, Regional Manager; Tommy Smith, Equipment Service Technician; Dr. E. Morgan Scheiber; Evan Harris, Field Sales Consultant; and Phil Riley, Equipment Sales Specialist

“Henry Schein handled the office design, equipment purchases, and full install of everything that I needed,” said Dr. Scheiber.

Equipment List

• Air Techniques ScanX
• DentalEZ Ramvac Vacuum
• Handler Lab Suction
• Handler Dry Model Trimmer
• Instrumentarium Intraoral X-rays
• Instrumentarium OP-200 D Pan w/VT
• Instrumentarium Scanner
• KaVo Lab Bench
• Midmark Chairs and Stools
• Midmark Delivery System
• Midmark Euro Design Cabinets
• Midmark M11 Autoclave
• Pelton & Crane Vista Pure Water Treatment
• Porter Nitrous/02
• SciCan Hydrim
• SciCan Statim Autoclave
• Sirona Rear Treatment Consoles
• Sirona Rear Delivery System

Today’s CAD/CAM systems–both chairside and laboratory based–are being used to design and manufacture metal, alumina, and zirconia frameworks, as well as all-ceramic and composite full-contour crowns, inlays, onlays and veneers that may be stronger, fit better, and are more aesthetic than restorations fabricated using traditional methods.

The accuracy of these types of technologies also allows us to provide cosmetic and restorative options that are minimally invasive. There are more than 20 different CAD/CAM systems that have now been introduced as partial (framework, models) solutions for restorative dentistry. However, still only two promise to offer these options as well as complete chairside solutions for better dentistry. While many of us may have appreciated the evolution of each generation toward the desire of a “more perfect” and whiter smile, the pursuit of perfection is not always the reason to undergo a restorative dental procedure.

Patients that have experienced oral trauma or need only minor cosmetic improvement can greatly benefit from this new approach and the capabilities of new technology. A conservative approach to restorative dentistry allows us to increase patient satisfaction and in some instances complete “minimal or no-prep” restorations without the need of local anesthetic or invasive procedures to hard or soft tissue, making the procedure quicker and less uncomfortable. CAD/CAM technology offers an option for cosmetic dentistry patients seeking an alternative to traditional dental veneers when direct composite bonding is not an option.

Case Studies:

A 22-year-old female with traumatic injury to the maxillary central incisors and left lateral was presented. The original tooth fragments were not available. After the gross initial examination the teeth in question were examined in detail, the teeth were found to be vital with no pulpal exposure. There was absolutely no discernable mobility and the patient was not experiencing any distress or pain. In all other aspects the teeth did not show any other pathology. After detailed clinical observation and further evaluation of the photographs, it was noticed that there were areas of minimal tooth structure, which had been crushed at places along the fracture line and the break was not a clear cut. (Fig. 1)

Hence, a decision was made to incorporate a small chamfer at the fracture line so that it could be masked more effectively with an indirect bonding procedure, which would also help in blending the ceramic restoration fragment seamlessly with the tooth. An intraoral digital impression (scan) was taken using the E4D® Dentist System. The digital model was used to design the restorations that would later be milled from ceramic blocks. (Fig. 2)

During the try-in procedure, it was obvious that the restoration would blend seamlessly with the remaining tooth structure. After glazing, the restorations were prepared with a hydrofluoric acid silanating agent (Monobond-S) and then were bonded using Variolink Veneer resin cement (Ivoclar Vivadent). (Fig. 3a, 3b)

Case 2

A 21-year-old male was presented requesting veneers to improve his smile. After further examination it was discovered that the only aspect that he wanted to improve was the length of his maxillary laterals. The teeth did not present any type of pathology. Both laterals were slightly in linguoversion and no undercuts were found in the facial aspect. (Fig. 4)

The diagnostic findings directed us to conclude that no-prep veneers would be the ideal treatment choice. Recontouring of the gingival architecture was performed using a diode laser (Odyssey Navigator, Ivoclar Vivadent). An intraoral digital impression was taken using the E4D Dentist System. Because no powder was used, there was no hesitancy scanning the intraoral condition immediately following the laser surgical procedure and wound. The digital model was used to design the restorations that would later be milled from ceramic blocks. (Fig. 5a, 5b)

Because of the precision of the mill, the restorations could be designed ideally to a minimal thickness in areas of less than 200 microns. The restorations were bonded without the need of anesthetic, since no tooth structure was removed. (Fig. 6a, 6b & 6c)

While the most obvious benefit for those considering chairside CAD/CAM dentistry is to replace the conventional methods and materials for the restoration of single-unit posterior teeth, the ability to maximize the performance of the system, the capabilities of the technology, and the opportunity to provide better dentistry for the patient, all endorse the profession’s expanding embrace for chairside CAD/CAM options. These cases illustrate how CAD/CAM dentistry represents a completely new way to diagnose, treatment plan, and create functional aesthetic restorations for our patients in a more productive and efficient manner.

Dr. Lida Swann is clinical instructor at E4D University and Assistant Professor at the Advanced Technology Clinic, Baylor College of Dentistry.