In a world where the profession of dentistry is facing commoditization with the development of Dental Service Organizations (DSO’s) and large group practices, those of us committed to private, fee-for-service, comprehensive care are facing increased competition. Over many years in practice, I have observed why people choose us and what we can do to foster this even more.

Our Competitors

1. DSOs and multi-location groups are on the top of all our minds, as their centralized business services and approach to higher volume scheduling allow them to be profitable while offering extremely low-cost new patient exams and reduced fees for restorative services.
2. “One-tooth dentistry” dentists in private practice are also a form of competition as they seem to be lower cost to consumers since they only treat “the problem” rather than looking at the whole person.
3. Smartphones compete for attention. With the entire world’s knowledge lodged in our smartphone, we now find the average attention span in America has shrunk to a meager 9 seconds! Now we are in a world of TMI (Too Much Information) where a less than a 5-star review might eliminate your office from consideration even though it has no bearing on your professional skills.
4. Nonstop digital advertising for all kinds of desirable goods and services constantly competes for patient dollars.

The Reputation of Private, Fee-for-Service, Comprehensive Care Dentists

It is interesting to note that, throughout the current Covid-19 pandemic people, have continued to visit their dentist. What have we been doing right?

We have a reputation for:

1. Being sanitary.
2. Following proper safety protocols.
3. Being trustworthy.
4. Treating people with genuine interest, respect, kindness, and thoroughness — one person at a time.

Your Approach to Patient Engagement Is Special

To continue growing our restorative practices with new patients who need and desire our type of comprehensive care, we need to create an environment of mutual engagement between our office and our clients. This is not a “paint by numbers” exercise. Each dentist and care team must create and commit to a philosophy that fits their core values and style. The way you engage with your patients is “special” to you.

Your philosophy of care distinguishes you and allows you to stand out in the marketplace. When your actions are consistently guided by your ideals, patients know it. They value it. They refer other like-minded patients to you. Your special behavioral foundation is why they come to you.

4 Tips for Building an Environment of Optimal Patient Engagement

To execute on this philosophy, we need to build a behavioral foundation that promotes alignment with our team, commitment to excellence, ample time with patients, and mutual respect. Here are some tips that have guided many private practices focused on individualized, fee-for-service, comprehensive dental care.

1. Doctor, start by engaging and educating your team to be the best that they can be by modeling the behavior you want to see in them. Commit to high quality Continuing Education for you and your staff. Join a study club and associate with like-minded members of your profession.
2. Engage your new patients with a patient-centered experience from first contact onward. Make a special effort to create a first visit that includes time for becoming acquainted with one another on the behavioral level and more time for a true comprehensive exam.
3. Make sure that your patient understands that you respect them as “the expert” in choosing what outcome is right for them at this moment in time.
4. Make sure your patient understands that your office is “the clinical expert” at determining the various outcomes that are available based on the:

• Situation they are bringing to you,
• Findings of your exam,
• Technology available, and
• Time and dollars they choose to spend.

More tips will follow next in Part 2.

The Great Pandemic of 2020 has created mass disruption in the lives and work for most people. In a current bestselling book, Post Corona, author Scott Galloway has an interesting perspective on the many various changes that we have seen and reveals his theory of what the “new normal” will look like. But don’t be shocked to discover it will just be more of the same.

The virus has been an accelerant.

As the premise of his book, Galloway uses a quote that is often attributed to former premier of the Soviet Union, Vladimir Lenin: “Nothing can happen for decades, and then decades happen in weeks.” Of course, Vlad was speaking about the Russian Revolution, but we can apply that logic to what we have witnessed over the past 11 months.

In other words, social and business trends that were already in motion went into turbo mode. The virus has acted as an accelerant. It has affected every one of our lives and every market in the world. Take e-commerce as an example. We have been using Amazon.com for years, yet e-commerce has only grown at a rate of 1% every year. Just before the pandemic, e-commerce was 16% of the economy. Then, from March 2020 through April 2020, that number jumped to 27% in just 8 weeks…just like Vlad said.

Think about other instances like virtual meetings and the emergence of Zoom. I hope you bought their stock. Zoom was around before the virus…now look at it. Stay at home stocks have been on a tear. With gyms closing and people social distancing, Peloton, and Lululemon’s Mirror have really taken off.

What about dentistry?

Early on, dental practices were seeing the effect of fears of close contact and aerosol transmission. Then things eased up. Practices became busier. Now, with the rise in cases, the fears are returning.

Private dentists with reputations for genuinely caring about what is in the best interest of their patients, have earned patient trust already that helps immunize their patients from fear.

One thing we must respect is that we have no control over other people’s behavior. And we have no control over the pesky virus. The vaccine is coming but human behavior will prevail.

As a retired dentist, people continue to ask me one question: “Is it safe to get my teeth cleaned?” My answer, as a dentist, is always yes, but as a patient, they will be asking that question for a long time to come…vaccine or not. Dentists must see this through the eyes of their patients.

What should we expect post-Corona?

Galloway, in his book Post Corona, tells us that the existing trends will continue to accelerate:

• The good ones (like hand washing and stay at home practices),
• The unpopular ones (like masks and excessive PPE), and
• Even the ugly ones (like misunderstandings in business and within families).

So, what do we do?

As a good Stoic, I would advise first to accept what we cannot change the circumstances. Just like a war…it’s unfortunate and not fair but a Stoic accepts the challenge and moves forward. It never pays to get frustrated or angry. Now is the time to build resilience and pay attention to leadership and communication skills.

Yes, the troops are coming, and there is a light at the end of the tunnel. (I love clichés.) But basic human behavior will prevail.

I think pre-operative rinsing is here to stay. Science supports it is effective against viruses, including COVID19. And it is easy to do.

Pre-operative rinsing has been discussed in dentistry for a long time, especially before hygiene visits. Today this is an even more relevant conversation, and we are examining its efficacy again with renewed interest. Here are three to consider:

Hydrogen Peroxide Mouthwash

We know hydrogen peroxide works. It is highly effective against the virus and is recommended as a pre-operative rinse right now. A readymade hydrogen peroxide mouthwash is Peroxyl. You can also take 1% hydrogen peroxide and mix it 50/50 with a flavored mouthwash. The required time for effectiveness is a minimum of 30 seconds. Some publications are recommending the patient rinse with hydrogen peroxide for two 30-second cycles. If 30 seconds is too long for a patient, they can increase the number of times they swish for fewer seconds. You can set a timer to guide the patient and make sure the patient is swishing at least 30 seconds in total.

Iodine Based Mouthwash

The literature indicates iodine based rinsing solutions are also highly effective against the virus. There are iodine based mouthwashes you can purchase for use in your practice. As some people are allergic to iodine, you will need to carefully screen patients before use, asking if they have a known or suspect allergy. Can they have betadine on their skin? Can they eat shellfish? If iodine should be avoided, then you will want to use hydrogen peroxide.

Chlorhexidine Mouthwash

The process of rinsing with chlorhexidine before an appointment and/or adding chlorhexidine so it comes through the water spray of a Cavitron or Ultrasonic Scaler is not new news. For a long time, we have been using chlorhexidine mouthwash as an adjunct to oral hygiene following periodontal treatment. There is science that chlorhexidine kills microbial cells withing 30 seconds of contact in the sulcus biofilm, but is it effective as an antimicrobial pre-operative rinse to reduce the risk of COVID19 exposure? We do not know. We cannot point to the science that would tell us it is equally effective against the virus as other options. However, I have heard studies are underway with good clinical results so far.

If I were to select one word most strongly associated with a successful relationship-based, health-centered practice, it would be the word growth.

What kinds of growth? The kinds I am thinking of are growth in knowledge and growth in sophistication of attitudes toward people and dentistry. As I meditate on this, I am enlarging my hope for and commitment to fostering personal growth … interpersonal growth … care team growth … patient growth … and, of course, practice growth. I welcome you to come along with me as I breathe fresh energy into leaving 2020 behind and growing in 2021.

Notice I didn’t mention a single word about teeth or techniques. I didn’t mention a word about technology, or what you must physically own to achieve growth. And that’s because growth isn’t a material thing; it’s a spiritual thing.

Growth can be promoted, or it can be impaired by the way we think, and consequently the things that we do and say day-in and day-out. And what we do repeatedly is driven by what we believe … what we believe about ourselves … what we believe about others … and what we believe about the purpose of dentistry.

What is your purpose in dentistry?

Each of us have a purpose that is driven by our philosophy … our world view … our perspective of things … and therefore what it all means to us. This changes as we grow in knowledge and sophistication of attitudes.

Avrom King said that it all boils down to these three questions:

1. Who am I?
2. Why am I here?
3. What is it that I am trying to achieve?

All three of them are philosophical questions, and all three lead us to answers which directly influence almost everything else. If we do not understand who we are on a values and beliefs level—what Mac McDonald likes to refer to as “the deep structures of ourselves,” we cannot predictably lead ourselves in any desired direction. And as a result, we cannot predictably lead others in a desired direction either.

Growing with Purpose

Growing with purpose requires Hope and Agency. If we do not hope for something of greater meaning to ourselves and we think we have truly little personal agency, we flounder.

In a world where we believe we have minimal personal value, everything around us starts to look scarce, and everything around us starts to look scary, so we’re tempted to take short cuts. We’re tempted to just grab what we can get for ourselves as quickly as possible. After all, who knows what tomorrow will bring? If we “stay on shore” with feelings of disempowerment and a little too much wine and whining, we ultimately achieve very little with our lives.

If we “stay on shore,” we will attract others who similarly think and behave. Like attracts like. Avrom King liked to call this “King’s Law.”

We tend to create our practice in the exact image of what we believe about ourselves, and consequently, that could be some version of heaven or hell. All of this happens because we choose to grow or to not grow.

Growth requires hope, courage, attitude, energy, and action, i.e., self-determination and self-control. Talk is cheap, so what will you do to master these? Surround yourself with a vision of your preferred self … your preferred career … your preferred dental practice. Acting on that vision leads to a next step and a next. In doing this, you will attract “likes,” and this positive reinforcement will help keep you on the road of your personally purposeful life. How much growth is happening in your practice today?

Can you see the green shoots of enthusiasm and creative change all around you, evidence of constant renewal? Or do you see an ossified structure struggling to maintain the status quo? Are you surrounded by people who are down, frustrated, and thinking that they have no other choice but to keep plodding on as they are?

Who are you?

Why are you here?

What is it that you are trying to achieve?

Philosophy Matters.

And that’s why L.D. Pankey, Bob Barkley, and other of our dental heroes constantly talked about it.