One of the most common questions I get is about the use of a category of materials we refer to as prep scrubs, prep wetting agents or desensitizers.  The question is usually do they actually make a difference, and are they worth the cost. The answer is “yes” and “yes”.

There are 4 things we are trying to accomplish: prevent sensitivity, antimicrobial activity, moisten dentin for bonding, reduce bond degradation over time. The prevention of sensitivity is caused in two ways. The first is the inclusion of HEMA in products like Gluma from Kulzer. The HEMA occludes the dentinal tubules and prevents fluid movement that triggers a pulpal response. The second is the anti-microbial activity of either glutaraldehyde (GLUMA) or chlorhexidine (Consepsis by Ultradent). Fewer bacteria left behind int he dentin means lower chances of a pulpitis that causes sensitivity or the ultimate need for a root canal.

Both chlorhexidine and glutaraldehyde also minimize the production of MMP’s (Matrix Metal Proteinases) the biologic process responsible for bond degradation. This means our bonded restorations last longer before we see marginal breakdown, leakage and secondary caries. The last function is to moisten the dentin to allow optimal penetration of the primer in our dentin adhesives. This means better hybrid zone development and better bonds and sealing of dentinal tubules.

So the answer to do they have benefit is a resounding yes. I have used Gluma on every tooth I have prepared for many years. I consider it extremely cost effective as I am not sure how to put a price on greater restorative longevity and less patient dissatisfaction due to sensitivity or post operative issues. The true cost should be about $2 a prepared tooth if dispensed properly, so that’s hard to argue with.

It’s a hard truth to swallow: acquiring more and more new patients won’t always lead to success or contentment. What we think will solve all of our dental practice problems can sometimes be the exact opposite of what we really need.

I remember talking with a dentist who had empty patches in his schedule that he was desperate to fill. He had also noticed that his practice did a half day less of hygiene than the previous year. He then made it clear to me that he needed new patients, but wasn’t sure how to go about getting them.

Before I dove into a solution that might not work, I clarified the problem. It turned out we were dealing with a very different animal.

The New Patients Conundrum

I immediately asked him how many new adult patients he was averaging per month in the last year. His answer was around fifteen. This piqued my interest and set alarm bells ringing. I told him that doesn’t make sense and explained the math.

Fifteen new adult patients per month should imply two one-hour maintenance visits for every person. That ends up totaling 360 extra hours in the schedule or 45 full days of hygiene. Clearly, this dentist’s problem wasn’t attracting new patients, it was keeping them!

He was blown away by this realization, but it’s not uncommon for dentists to assume new patient acquisition is the problem. In reality, we need to think more like business owners and measure what is worth measuring. In this situation, my advice was to focus on figuring out why patients weren’t sticking around for the long haul.

How we see a problem can be a problem in and of itself. Once we recognize the true source of our frustration, we can take active steps toward a resolution. Hygiene is the core of a practice, after all, and deserves the right kind of attention.

When we love what we do, we do it better. This is a popular lesson in literature and in life. Tom Sawyer had an aha moment after convincing his friends to whitewash the fence his aunt had tasked him with by making it seem like play rather than work.

This quote from Mark Twain says it all: “If he had been a great and wise philosopher, like the writer of this book, he would now have comprehended that Work consists of whatever a body is obliged to do, and that Play consists of whatever a body is not obliged to do.”

Obligations v. Choice: Loving Dentistry

While there was a time that I felt obliged to do dentistry (to pay off debt, to take care of family, etc.), I am now blessed to choose the vast majority of what I do and how I do it. I still have plenty of debt to pay off and am a long way from financial freedom, yet I find myself most days with a smile on my face.

This is because of the conscious choices I’ve made over the last 18 years after I first learned of Dr. Pankey’s Cross of Life. Many of those choices have helped blur the line between work and play for me.

When Work Becomes Play

When any of my mentors would talk about their work as any semblance of play, my initial response was one of significant skepticism. I had even seen my childhood dentist, Dr. Mark Stetzel, truly loving his work, his team, and his patients.

But early in my career, I had a difficult time envisioning that for myself. With the ‘Golden Age of Dentistry’ supposedly in the rearview mirror, I wasn’t sure my work could ever actually feel like play.

Today, I am so grateful to have a team around me that has chosen me and vice versa. They believe what I believe. We are pulling on the rope together because we get to do more of what we enjoy doing each day. We have learned about our own and each other’s strengths and we play to those strengths more and more.

So much of what we do on a daily basis has become play for us because we have realized we’re not obliged to do dentistry in a way that doesn’t align with our own values. We get to help people who want to be healthier make choices to do just that.

The choice to incorporate Dr. Rich Green and Don Clifton’s work on maximizing strengths in a dental office was such an important one for me. It created an aha moment much like Tom Sawyer’s. When people get to do what they are good at on a daily basis, they don’t feel obliged to go to work. Rather, most days can seem more like play!

One of the challenges we face today in dentistry is managing tissue health during the time period our patients are in provisonal restorations. This has become even more critical as we have incorporated more resin bonding techniques to seat indirect restorations. Isolation is critical to the long term success and can be challenging after multiple weeks in a bisacryl provisional.

We all stress oral hygiene to our patients during this time period, but let’s be honest there are barriers to optimal tissue health at the seat appointment. One barrier is often patients are fearful that their hygiene procedures will displace the provisional. This fear has them brush less vigorously, floss less or not at all, and even sometimes avoid that part of their mouths completely. Even when patients are undeterred int heir hygiene the provisional itself is often a barrier. Contacts can be less then optimal and increase interproximal food impaction. The Bisacryl itself, tends to hold and attract plaque due to a different surface texture even when finely polished.

Given the barriers and the goal of super healthy tissue, Chlorhexidine varnish (Cervitec Plus by Ivoclar) has become one of my favorite products. We are all familiar with the incredible anti-microbial effects of chlorhexidine, and also the reasons we dislike it. Cervitec does not have a bad taste, does not cause the typical brown staining, does not effect the patients taste buds, and they don’t have to remember to use it. Cervitec plus is a clear liquid applied with a micro-brush. At the end of any appointment where we have placed a provisional my assistants will coat the gingival margin with Cervitec as the last step before the patient leaves.

I have been using this as a critical step in my restorative procedures for over 5 years now, and I swear by it. I see almost perfect tissue health at seat appointments, and it is rare for me to struggle with isolation due to poor tissue management.

When a patient has periodontitis, they suffer from a destructive inflammatory infection that significantly impacts their oral health and damages their periodontal structures. Understanding how occlusion impacts or worsens this damage is key to helping these patients prevent unnecessary trauma.

Periodontitis and Occlusal Trauma

Even before the 1960s, there was research linking occlusal trauma and progression of periodontal disease. More recent research has found that this link isn’t as strong as once thought. Still, a relationship has been identified between the extent of damage and whether the patient has an occlusal interference.

One crucial aspect of periodontitis is that it is unique to every patient. This means we have to be careful not to apply a blanket approach to all patients or rely too heavily on past data that may not help us treat our current patient. Their individual susceptibility to periodontitis must be assessed based on their distinct risk factors.

The Relationship Between Occlusion and The Periodontium

For each tooth, occlusal experience matters and may be one of the reasons that loss of attachment worsens. A 2001 study by Harrel and Nunn found that there was a correlation between amount of periodontal damage and existence of occlusal interference. Perhaps more interesting, they also found that changing the occlusion had a positive impact on the periodontal issue.

Even in light of this research, the relationship between occlusion and periodontium is hotly contested. Regardless of one’s opinion on this matter, there’s no denying that the periodontium is effected by occlusal force. When there is no occlusal loading, there may be over-eruption or drifting of the tooth. On the other hand, when the force is appropriate, the periodontium is healthy and stable.

We must remember that there is a spectrum of susceptibility to periodontitis. For those who are very susceptible and also have teeth experiencing occlusal trauma, the latter only serves to worsen the situation.

Amidst all the details that must be managed day in and day out at a dental practice, I’d like to bring to light something I find super important that is often neglected. Let me begin by asking a question: When is the last time you took a good look at your perio probes? I mean a really good look!

My guess is you will find different shapes, sizes, colors, materials, ages, and markings. Maybe this doesn’t seem like the worst tragedy in the grand scope of the world, and yet, having even two different probes in the office can set the stage for lack of continuity in your patient diagnoses. 

Why Perio Probes Matter

It does seem like there are as many choices in probes these days as there are stars in the sky, so how can you make the best decision when it comes down to buying?

Although I do recognize the need and desire to have options, at the end of the day I encourage you to consider which probe provides the LEAST probable chance of creating error. Although I have used (and observe people using) a huge variety of probes, my favorite by far is the UNC-15. Due to markings at every mm up to 15, there is virtually no guesswork in capturing and documenting data with a high level of accuracy.

As you make the decision of exactly which probe you will use exclusively in your practice, please also consider calibrating all dentists and hygienists on an ongoing basis. It is typically easy to notice that probing techniques will vary from person to person. Watching and learning from each other with the ultimate goal of having everyone in agreement about how you will probe is invaluable.

Lastly, remember that an accurate periodontal diagnosis can only be made when a comprehensive periodontal assessment is completed and documented. Your probe is designed to be used for measuring pocket depths, recession, bleeding, pus, and attached gingiva. Oh, and don’t forget to check for mobility and furcations while you’re at it.

Here’s to a future of more accurate and calibrated perio probing in your office!

Growth should be the primary goal of every dental practice. No matter how well things are going, planning for and promoting growth ensures that any setbacks do not completely derail you. Growth is also valuable because it keeps your practice lively with new patient energy and ensures your team stays engaged.

In Part 1 of this series, I discussed my first two tips for 2018 that encouraged developing a marketing plan and increasing whitening services. Keep reading for my final two pieces of advice:

Thrive in 2018: Patient Education and Experience

Use Digital Photos for Patient Education

Take the following series of six digital photos on all new patients:

1. Natural smile
2. Close up retracted view
3. Upper occlusal view
4. Lower occlusal view
5. Left buccal corridor
6. Right buccal corridor

Load the photos onto an iPad or tablet for patient viewing. This will convert the process from passive to active for the patient. Be prepared to hear two frequent comments from patients: (1) “Wow, I have never seen my teeth like this before!” and (2) “Yuck!”

Provide a Remarkable New Patient Experience

The first visit to your practice should be an awesome experience that helps new patients become more interested in their oral health. Take some time with your team and design a new patient experience that is more ideal.

Consider beginning with a simple office tour that shows the patient some services that are available. Include a new patient interview where a team member takes the time to get to know your patient and understand their ‘dental story.’ Make it a ‘wow’ experience where patients leave saying, “I have never been treated so thoroughly before!”

The four tips presented in Part 1 and 2 of this series are an excellent way to develop a thriving practice in 2018 and beyond.

As you begin to implement these recommendations, think of the following axiom: To achieve what you have never achieved, you must do what you have never done. Here’s to your success!

It’s my strong opinion that dental practices are either growing or they are in decline. A case could be made that there is a third option, staying the same, but with ever-rising overhead, staying the same is just another form of decline.  

In Part 1 and Part 2 of this series, I’ll share 4 specific tips that will help you thrive in 2018 and beyond.

Thrive in 2018: Marketing and Whitening

Develop a Comprehensive Marketing Plan

New patients are necessary for a growing practice. Oftentimes the difference between a good practice and a thriving practice is the volume of quality new patients.

Spend some time crafting a comprehensive marketing plan that includes internal, external, and digital marketing activities. In my own practice, our most effective internal marketing strategy is the dentist calling all new patients and any patient who receives an injection on the evening of treatment.

An effective external marketing strategy for us is making NFL-quality mouth guards for our local high school football team. Also, one very effective digital marketing strategy has been getting online patient reviews. An appropriate marketing budget for a growing practice is 4-5% of revenue.

Embrace Whitening

Growing your whitening business is a great way to attract patients. Here are 3 simple things you can do to increase the amount of whitening treatments you perform:

1. Take a shade match at the beginning of the hygiene appointment. Then show the patient their current tooth shade on a shade guide organized chromatically from dark to light.
2. Value-price whitening. Consider value-pricing as a means of making it more affordable and accessible for your patients. The real economic benefit is the restorative and elective treatment that results from increasing your whitening.
3. Offer lifetime whitening. Consider offering free gel to your whitening patients, provided they keep their recommended hygiene appointments. This is a win/win strategy that patients love!

To be continued …

When you come to Key Biscayne and Miami, you should treat yourself in as many ways as you can. From the moment your plane sets down, it’s time to embrace the Miami spirit of indulgence and fun. The best way to do this is by shopping ’til you drop.

One of the most common questions we hear all the time is: Where is the best shopping in Miami? It’s not an easy question to answer. Miami has the kind of fashion, jewelry, and beauty scenes that celebrities are known to wander.

Still, we’ve managed to narrow down the list to a few fun locales. These excursions may lighten your wallet or may have your jaw dropping at the decadence. Either way, you won’t be bored!

Luxurious and Indulgent Shopping the Miami Way

1. Bal Harbour Shops

This beautiful open-air shopping mall in Miami Beach requires mental preparation for the shopaholic. Designer boutiques are the norm at Bal Harbour, where the air oozes exclusivity. Wander this super high end, exquisite mall and settle in for a long meal at one of the restuarants. It’s truly an unmissable experience.

2. Miami Design District

Fashion fiends will swoon over this trendy shopping location. It’s a hotspot for flagship stores from top designers and becomes an even more enriching visit when you witness the thought provoking art and sculptures around the area.

3. Coconut Grove Boutiques

Coconut Grove is a region of Miami known for its quirky boutiques. Here, you definitely won’t be overwhelmed by pricey displays or high fashion. It’s a much more approachable shopping experience. Peruse the central business district for an hour or two of casual fun.

All in all, Miami is a prime destination for shopping, which makes a great low-key activity. How do you indulge yourself on trips? We’d love to hear from you!

There are so many different processes, techniques, and skills that go into a functional dental practice that it can be hard to keep track of them all. Seemingly inconsequential things like referrals can get the better of us if we don’t have a solid system in place.

Patient Friendly Referrals

The best specialist referrals involve open communication and provide patients with a sense of care and consideration. Patients prefer to be given a tangible referral tool, such as the specialist’s brochure, along with your confident assertions of their quality. This gives them something solid to associate their trust with and provides further familiarity.

Validation of your referral comes in other ways as well. Patients will want you to provide the introductory information that you might assume the specialist will want. It’s important to remember that they won’t automatically feel comfortable putting their health in someone else’s hands.

You might consider asking the patient if they would like your office to call the specialist to establish the referral and set up their first appointment. This strengthens their sense that you are actively involved in the referral and have a strong relationship with the other office and team. It’s proof of your commitment to their health.

A big no-no is not discussing the patient’s condition with the specialist before their appointment. It will become very obvious to the patient if you haven’t done your due diligence in helping the specialist understand their needs. They will feel stranded and ignored, and often are uncertain that the specialist will communicate back with you after their visit.

Finally, make sure you have an arrangement with the specialist ahead of time that they will check in with you after the treatment. Then, once the patient returns to your practice, you can share with them all you learned from the specialist since they were there.

How do you ease patient concerns during the referral process? Leave a comment below!