Dental Sleep Medicine in Restorative Practice Part 9: Marketing Dental Sleep Medicine 

February 28, 2024 Todd Sander, DMD

Dental Sleep Medicine in Restorative Practice Part 9: Marketing Dental Sleep Medicine 

By Todd Sander DDS 

How do you start reaching out to physicians and other providers to build a dental sleep medicine practice? Start with the ones you know. Start with your own personal physician and start a conversation. If your dental patient is on CPAP, get permission to converse with their doctor. I spend time contacting many primary care doctors and find they are the ones who know patients are non-compliant with their CPAP therapy. They help me get patients re-evaluated by a sleep specialist. 

This may not be true in your community, but in Charleston, SC, where I practice, many primary care doctors don’t know what to do with their non-compliant CPAP patients. They are thrilled to have someone to refer them to try alternative therapy. 

Years ago, I reached out to sleep testing centers to communicate my services. Both independent sleep labs and hospital-based sleep labs have been great sources of referrals. For many years, I was the dental advisor to a sleep lab. A great conversation starter with sleep physicians, is the potential of combining CPAP and an oral appliance. This often allows the CPAP air pressure to be turned down so their patients be more comfortable and compliant. 

When you screen your dental patients for airway issues such as sleep apnea and snoring, the next step is referring your patients with issues for a sleep study. When the patient discusses their symptoms with their primary care physician or a sleep physician, you are mentioned and often documented as making the referral. Over time, physicians come to know you as a go-to provider of dental sleep appliance therapy. This process is sped up when you take the time and initiative to contact your patient’s primary care physician with your patient’s permission. You can guide physicians and remind them of the recommended standards-of-care, including appliance therapy in place of or in combination with CPAP therapy. 

Some patients self-refer to me, as friends and family talk about their experiences in my office, but I am not spending money on digital advertising to bring in dental sleep medicine patients. Mostly, they are referred to me by physicians, dentists, and other patients.  This is the same for my dental practice. 

As mentioned in a previous part of this series, our hygienists have attended dental sleep medicine courses with me and screen for airway issues. They adeptly educate and guide patients who have signs and symptoms to schedule an examination and consultation with me. 

Note: When patients are referred to me for dental sleep medicine, I never encourage them to become dental patients in our practice. This is a choice they might make but I am extremely careful to refer patients referred by a dentist back to their referring dentist for all dental needs. I am an adjunct to help other dentists’ patients fulfill a prescription for a dental appliance. 

If a patient comes in for sleep-disordered breathing but is also experiencing facial pain or TMD, I understand that this patient’s two issues are likely connected and I will not be able to successfully treat one without treating the other. This is an opportunity to communicate in depth with the referring dentists and let them know I plan to treat the patient for both issues simultaneously. This has been easier for me to do because I have had years of experience in treating facial pain and TMD issues in my dental practice, as well as sleep apnea and snoring. 

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Todd Sander, DMD

Dr. Todd Sander is a graduate of The University of North Carolina at Chapel Hill, the School of Dentistry at Temple University, and a one-year Advanced Education in General Dentistry residency with the US Army at Fort Jackson, SC. He completed three years of active duty with the US Army Dental Corps and served in Iraq for 11 months. Dr. Sander completed more than 500 hours of postgraduate training at the Pankey Institute for Advance Dental Education and is one of only three dentists in the Charleston area to hold such a distinction. Dr. Sander is also affiliated with the American Dental Association, South Carolina Dental Association, American Academy of Cosmetic Dentistry, Academy of General Dentistry, and American Academy of Dental Sleep Medicine. Areas of special interest include: TMJ disorders; advanced dental technology; cosmetic dentistry; full mouth reconstruction; sleep apnea /snoring therapy; Invisalign orthodontics.

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Getting Case Acceptance to 90%

February 26, 2024 Paul Henny DDS

Getting Case Acceptance to 90% 

Paul A. Henny, DDS 

Studies show that the average comprehensive care treatment plan acceptance rate is in the 30% range. Why do you suppose that is? 

Humankind’s Innate Prediction Machine 

Our brain is a prediction machine that’s always turned on. To a large degree, it operates like the autocomplete function on our phone – it’s constantly trying to guess the next word when we listen to a book, read, or conduct a conversation. Contrary to speech recognition AI bots, our brains are constantly making predictions at different levels, from meaning and grammar to specific speech sounds. Our brain continuously compares sensory information with memories. The more negative the memories, the more negative the predictions. 

Additionally, there’s a central purpose behind our prediction machine: Survival, successful reproduction (propagation of our genome), and rewards that might take the form of rising up in the social hierarchy or gaining scarce resources. 

Regarding survival, our brain likes to stack the odds 4:1 in its favor, meaning, it tends to predict negative outcomes 4X more often than it will positive outcomes. This is nature’s way of staying safe so we’ll have the opportunity to live another day. 

Stacking odds in Its favor is very primal, yet the stacking influences many of our impressions and decisions. Complex situations requiring complex decisions must go through this 4:1 negative bias loop. 

A Steep Slope to Climb 

Now, apply this information to how you work with your patients. Unless you enter a relationship with a stellar reputation that has transferred a high level of trust, you are starting off with 4:1 odds against the advancement of your agenda. That’s a steep slope, yet we ignore that truth every day. 

The only way to overcome the 4:1 odds against us is to allow trust to organically develop in the relationship. And that must be achieved in small steps: Simple proposals, agreements, and experiences that meet unspoken expectations.  

Would you agree to hire a contractor to build your dream home after talking with them for only 15 minutes? Wouldn’t you want to see examples of their work and call one or more of their clients to learn how good they are at following through and sticking to their word? 

I thought so but for some reason, we all want to believe that when a person needs extensive oral restoration or rehabilitation, that they will be ready to make a multi-thousand dollar decision within minutes of seeing our amazing digital presentation. In fact, we’re so confident that it will work, that we’ll do our exams for free to create a “sales funnel.” 

The Common Approach Fails 

Most people don’t react well to this approach because it’s too much information-too fast, and it’s all coming from a virtual stranger. They’re not ready to have us build their dream home for obvious reasons. Why, then, do we ignore all of that and call them “tire kickers?” 

The Alternative Approach 

Dentists who deploy the co-discovery, co-diagnosis, and co-success treatment planning process outlined by Dr. Robert F. Barkley often get above 90% case acceptance. I bet you wouldn’t be surprised to know that Pankey Institute faculty are among them. Understanding how the mind works and structuring your new patient processes to beat the 4:1 odd is more than possible. I invite you to read my recently published book: Co-Discovery: Exploring the Legacy of Robert F. Barkley, DDS. The book is available at the Pankey Institute now with all proceeds benefiting the Institute. 

  

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Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

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Do You Know Your Team’s Threshold?

February 23, 2024 Robyn Reis

Do You Know Your Team’s Threshold? 

Robyn Reis, Dental Practice Coach 

While visiting a dental practice that had amazing hospitality and incredible relationships with its patients, I observed a doctor’s presentation to a patient who was in his forties and who had been saving for a smile makeover for a long time. The doctor did an amazing job with his presentation of what was possible and the phases of treatment. The patient was very excited, even teary-eyed.  

The patient wanted to get started and asked about the cost. The doctor said, “You know what? My team at the front are experts in figuring that out.” So, the patient was taken to the front and handed over beautifully. In a few minutes, he was presented with the treatment plan on paper with the approximate dollar amounts. In phases, they would do the full mouth. All seemed to be going well until it wasn’t. 

Intrinsically, everyone has a monetary threshold that up to a certain point, you have no problem with the amount. It’s something within your range of expectations and easy to say yes. When you cross that threshold, anxiety may creep in and for sure, you become uncomfortable.  This is what I witnessed in a matter of moments. 

I observed the front office team member look uncomfortable after glancing at the paperwork, despite being experienced with treatment presentations. The clinical assistant who had been part of the diagnosis and treatment planning process, would also help with scheduling and any questions. 

Together, they gave the patient the opportunity to ask questions after reviewing the plan again. The full mouth restoration was going to be in the neighborhood of $25,000. The first phase would be about $18,000. They offered CareCredit financing. The patient said, “It’s only $25,000 and I have $20,000 saved. This is wonderful! I don’t know how I will pay the other $5,000, but I know I have the means. It’s only $25,000.”  

The team appeared somewhat shocked because they were obviously uncomfortable with quoting that amount. This treatment plan crossed their personal thresholds. They suggested the patient go home and sleep on it “because this was a big investment.” The patient was so committed to moving forward that, despite their advice, he scheduled his first appointment. He would call them back once he figured out how to pay the remaining balance, knowing insurance would contribute very little. 

What I also found interesting was that neither team member asked for a deposit. No money was exchanged to reserve an extended appointment. The patient could back out and the doctor’s time spent on the case work-up would be uncompensated. In my experience, making a signed financial agreement would be the responsible step to take at this stage.  

This example illustrates the discomfort many dental teams feel about asking for a deposit if the treatment estimate crosses their personal threshold. Of course, dental teams will want to explain what can be done to make treatment more affordable and the financing options that are available. But it is beneficial for team members to understand their personal threshold and to become comfortable saying, “Grab your checkbook or pull out your credit card, Mr. Jones. Here’s what your investment is going to be to get started.”  

What’s your threshold? This is a great team exercise you can do at your next meeting because a patient might ask anyone they interact with about the cost of dentistry, and what options you offer for the dentistry they want.  Every team member will benefit from considering their personal threshold and discussing it — even role-playing — to become comfortable with the best ways to manage these questions. Depending on the situation, it could be referring the patient to the treatment coordinator or to the financial administrator to have a comfortable conversation. 

It is my belief that when patients are excited about what the treatment results will be and they want to move forward, it’s the right time to ask the patient to make a financial commitment to get the process started. 

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Caring for a Dental Leaf Gauge

February 21, 2024 Lee Ann Brady

Caring for a Dental Leaf Gauge 

Lee Ann Brady, DMD 

In the Pankey Essentials courses, we use dental leaf gauges to train dentists in how to feel for the first point of occlusal contact, as a method for occlusal deprogramming, and as a tool for articulating models on an articulator in centric relation. Dental leaf gauges not only assist us in diagnosis and treatment planning but also in enabling our patients to discover the nature of their occlusion as we help them understand how malocclusion can manifest in TMD symptoms, parafunction, tooth damage, and more. 

In our Essentials 1 course, I am sometimes asked how to take care of leaf gauges, so I thought I would share my answer.  

Although they don’t last forever, dental leaf gauges do last a long time and you can autoclave them between uses. When you sterilize them, the leaves become sticky, so I separate them like a hand of cards before putting the gauge in the autoclave bag and separate them again when I take them out of the bag just before going to the mouth. 

Over time, with use, a leaf gauge will start to look a little beat up. I’m looking at one now. The Teflon screw that holds it together has turned color from going through the autoclave. I can see some ink stains from Madame Butterfly silk. It’s at the point where I think it looks too grungy to keep using. Although it might continue functioning for quite some time, I’m going to toss it and use a new one. After all, they are relatively low cost with a high return on investment.  

I’ve never seen a dental leaf gauge break after many trips through the autoclave. I tested cold sterilizing one and discovered the chemistry in the ultrasonic cleaner started to make the leaves brittle and they came out stickier than when autoclaved. So, my preference (and the protocol in my practice) is to bag them and put them through the autoclave. 

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Lee Ann Brady

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A History of the Pankey-Mann-Schuyler Method

February 19, 2024 Bill Davis

A History of the Pankey-Mann-Schuyler Method 

By Bill Davis 

During his three-month summer course at Northwestern University in 1931, L.D. Pankey was introduced to the principles of occlusion. This was a new term for him and many of his dentist colleagues. The students were assigned an article by Clyde Schuyler and published in the 1926 New York Dental Journal. Dr. Schuyler was a promenade prosthodontist from New York City. The article talked about the basic principles of occlusal function, its dysfunction (malocclusion), and the basic requirements for restoring occlusal harmony. 

1931: Dr. Clyde Schuyler Prompts Considerable Thinking 

At first, L.D. did not understand what Dr. Schuyler had written. He was not alone because most of his classmates had the same problem. L.D. eventually made personal contact with Dr. Schuyler and, after a series of conversations, understood Schuyler’s work.  

Schuyler told L.D., “Those in the field of dental reconstruction must have and cultivate the creative mind of the artist and the accuracy of the engineer.”  

That was easy for Schuyler to say, but he did not explain to L.D. how to approach and visualize a dental reconstruction. Before L.D. met Dr. Schuyler, he had restored posterior occlusion using a Munson articulator and a chew-in technique. The Schuyler article pointed out the importance of anterior teeth guidance. This made L.D. start thinking about approaching occlusion in a more logical step-by-step manner. 

1947: Dr. Arvin Mann Looks Up Dr. L.D. Pankey 

In 1947, Arvin W. Mann moved to Ft. Lauderdale from Birmingham, Alabama. Dr. Mann had graduated from Western Reserve and moved to Alabama to do nutritional research at the University of Alabama before he moved to Florida. L.D. also had an interest in nutrition. His first published article in the Florida State Dental Journal was related to the connection between carbohydrates and dental decay. 

While in Alabama, Arvin became interested in occlusal rehabilitation and the relationship between periodontal disease and restorative dentistry. A periodontal faculty member told Arvin, “When you get to Florida and want to do a restorative work where you won’t have to do all this grinding to correct occlusal restorations, look up Dr. L. D. Pankey in Coral Gables.” 

As soon as Arvin got to Florida, he went to Coral Gables to meet L.D. They became fast friends because they realized they had the same goal of helping their patients keep their teeth for their lifetime. Over the next ten years, they worked together to develop a predictable diagnostic and treatment method for restoring patients’ teeth to health, comfort, function, and esthetics that would fit into the Philosophy of doing their best to help patients keep their teeth. 

1947: Drs. Mann and Pankey Begin Collaborating on Cases 

Arvin began bringing a set of mounted diagnostic casts and an intraoral series of radiographs to L.D.’s office. Arvin and L.D. would review the case together and develop an optimum treatment plan. L.D. would then present the case to Arvin using Arvin as the patient. This was a way to demonstrate to Arvin how to use the Philosophy, get to know the patient, explain what needed to be done, and educate patients to accept the treatment plan.  

Arvin would practice the presentation on L.D. He would then return to his office and explain the treatment plan to his patient. When the dentistry was finished, Arvin would have another appointment to “resell” the case to the patient and make them a missionary for his practice. Within a short time, Arvin had a busy and successful practice. Arvin eventually helped four young dentists from outside his office like L.D. had helped him.  

Mann and Pankey Replace the Munson Articulator with the P-M Articulator 

They used L.D.’s Munson articulators when they started working together on their new restorative method. But soon, they found Munson articulators had limitations for their 3-dimensional approach, including a functionally generated path. Along with an engineer from the Ney Gold company, they designed their own — the P-M instrument and face-bow.  

Arvin became excited about their restorative technique and wanted to share this information with the profession at a Chicago Mid-Winter Dental Meeting. L.D. felt that it would be best to work with a small select group of dentists interested in occlusion and comprehensive restorative dentistry. By now, L.D. had been teaching the Philosophy for a few years.  

L.D. and Arvin selected eleven dentists from various geographical locations around the country who had taken the Philosophy course at least three times and were already using a conventional method to do restorative dentistry. They asked them to try the new P-M technique and articulator for a year. At the end of the year, the group got together in Dallas. The reports from the eleven dentists at the meeting were positive and gratifying. L.D. and Arvin then started the Occlusal Rehabilitation Seminars to teach other dentists the P-M technique and how to use their articulator and face bow.  

1959: The P-M Method Is Presented to the AARD 

In 1959, they presented the P-M therapeutic method to the American Academy of Restorative Dentistry at the Chicago Mid-Winter. They were then asked to write up two articles describing their new process showing the use of the P-M articulator for publication in the 1960 Journal of Prosthodontic Dentistry 

1960: The Occlusal Rehabilitation Seminars Begin 

Arvin and L.D. wrote the Pankey-Mann Manual for the Occlusal Rehabilitation Seminars and started teaching the restorative technique to other interested dentists. The seminar schedule was coordinated by L.D.’s long-time secretary, Rose Quick.  

One of the most significant difficulties in teaching the P-M technique was the inability of dentists to understand occlusion. At that time, no dental school in the United States taught occlusion. L.D. and Arvin realized it was essential to have Dr. Clyde Schuyler present his work on occlusion at their seminars. Also, they did not want Clyde to go to his grave without the profession appreciating his contribution to dentistry.  

L.D. asked Clyde if he would help them teach occlusion. Clyde was reluctant because he anticipated much opposition to this new method and articulator. Also, he didn’t want to upset his friends and colleagues who had authored books or conducted clinics with him about occlusion. 

Eventually, Clyde agreed, and from that point forward, the P-M technique became the Pankey-Mann-Schuyler Technique for Oral Rehabilitation. 

 

 

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Bill Davis

William J. Davis DDS, MS is practicing dentist and a Professor at the University of Toledo in the College Of Medicine. He has been directing a hospital based General Practice Residency for past 40 years. Formal education at Marquette, Sloan Kettering Michigan, the Pankey Institute and Northwestern. In 1987 he co-authored a book with Dr. L.D. Pankey, “A Philosophy of the Practice of Dentistry”. Bill has been married to his wife, Pamela, for 50 years. They have three adult sons and four grandchildren. When not practicing dentistry he teaches flying.

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Why Use an Essix Retainer Versus a Flipper During Dental Implant Therapy

February 16, 2024 Lee Ann Brady DMD

Why Use an Essix Retainer Versus a Flipper During Dental Implant Therapy 

Lee Ann Brady, DMD 

When it comes to choosing a provisional during implant therapy in the anterior aesthetic zone, we have two removable options. One is called a “flipper.” It’s an interim partial denture composed of an acrylic base and a denture tooth. The other is an Essix retainer.  

There is no question that both options are taxing for the patient for the three to five months that the patient is edentulous and must deal with having this removable device to replace the tooth. So, I always tell my patients that they are going to have to manage the provisional for that time, but it’s worth it because, in the end, they have replaced the tooth with an implant with all the benefits of an implant versus an alternative prosthetic solution. 

In my practice, I use Essix retainers in nearly 100% of the cases. Why? Because an Essix retainer is tooth-borne. The pressure is placed on the teeth and not on the surgical site. In the case of a flipper, the prosthesis is primarily tissue-borne with a little pressure placed on the adjacent teeth. We really don’t want any pressure on the surgical site while it is healing. Pressure can induce biological problems in bone grafts and connective tissue, which affect the long-term outcome. From an aesthetic perspective, the most challenging thing about anterior implant aesthetics is replicating the size, shape, and position of the tissues of the alveolar ridge and papilla. I want to do everything I can to eliminate pressure on the healing tissue. 

In my practice, we do Essix retainers that don’t have a full solid tooth in them. Instead, we simply paint flowable on the facial so that there’s zero pressure anywhere around that surgical site after extraction, after grafting, and after implant placement.  

In addition to explaining the improved outcomes associated with using an Essix retainer, I assure my patients that the retainer will be more comfortable to wear than a denture and be easily removed by them for eating, for drinking liquids other than water that are likely to stain the retainer, for teeth cleaning, and for cleaning the prosthesis. When out in public, such as in a restaurant, patients may carefully eat while wearing the Essix retainer.  

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Culture Fit Versus Culture Add

February 16, 2024 Robyn Reis

Culture Fit Versus Culture Add 

Robyn Reis, Dental Practice Coach 

When you are hiring team members, you are likely thinking about how those you interview will fit into your practice culture. Do their values align with yours? Do you share similar backgrounds and philosophies? A business’s culture is a system of shared values, beliefs, and behaviors that influence how people dress, act, and perform their roles. Most practice owners work hard to have everyone get along, support one another, and work as a team to give every patient a wonderful experience. So, it’s only natural to want to find someone who fits into that culture when a position opens up. 

In the HR world, recruiters have a different approach – they are moving away from “culture fit” towards “culture add.” What does this mean exactly? A great mentor of mine, Sheri Kay, says it best, “People come together in their similarities, but they grow together in their differences.” 

On the pages of Harvard Business Review, Forbes Magazine, Fast Company, Inc., and Entrepreneur, you will read that more and more companies are moving away from the traditional culture fit that creates a monoculture where everybody has shared similarities and there is no growth. Instead, they are recreating a culture that is open to new ideas, open to conversations where people poke holes in traditional ideas and say, “Hey, what if we did this? This is what we think we want to do. Now let’s figure out why it will or will not work.” 

In recruiting a hygienist for a client, one of the candidates stood out to me. In addition to her clinical hygiene education, she also had a financial background which represented a “culture add” for this particular practice. She had a greater understanding of goal setting, the finances of the business, and how to create a profitable hygiene department. She ended up being a fantastic and productive member of their team. 

When you are in the hiring process, do you think about adding to your culture? Diverse backgrounds correlate with more diverse problem-solving and decision-making processes. In studied corporations, diversity leads to increased profitability.  

In dentistry, diverse backgrounds can lead to the attraction and retention of diverse patients. Diverse backgrounds can fill in operational holes in your business model. Does a candidate have a background in psychology, finance, education, customer service, computer IT, office administration in another industry, or marketing? Does a candidate speak a second language that will be an asset in your community? Is a candidate artistic, an exceptional writer, a community volunteer, or actively participating in other activities? 

During each interview, seek to learn what the candidate could add to your practice culture in addition to culture fit. After talking about a candidate’s resume and interests, talk about situations that occur in the practice and current needs. Ask if the candidate has ever been in similar situations and how they handled them. Do the answers indicate personality traits and strengths that will add to (complement) the team? Ask the open question, “Based on your personal experience, what insights could you add to this situation?” 

In today’s competitive market for talented team members, consider what a new hire with additional skills could add to your culture and what these new contribution possibilities could be for an amazing patient and team experience. Happy hiring! 

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Explaining Dentistry in a Way Patients Understand

February 14, 2024 Clayton Davis, DMD

Explaining Dentistry in a Way Patients Understand 

Clayton Davis, DMD 

Here are some of the ways I communicate with patients to help them understand dentistry. I hope some of these will be helpful to you in enabling your patients to make good decisions about their treatment.  

Occlusal Disease: In helping patients understand occlusal disease and the destruction it can cause, I have long said to them, “The human masticatory system is designed to chew things up. When it is out of alignment, it will chew itself up.” I tell them, “Your teeth are aging at an accelerated rate. We need to see if we can find a way to slow down the aging process of your teeth.” The idea of slowing down aging is very attractive to patients, and if you relate it to their teeth, they get it.  

Occlusal Equilibration: Typically, I come at this from the standpoint of helping them understand that teeth are sensors for the muscles, and when the brain becomes aware our back teeth are rubbing against each other, it sends the same response to the muscles as when there’s food between our teeth. In other words, the brain tells the muscles it’s time to chew, and this accelerates wear rates on the teeth. Equilibration is really a conservative treatment to reduce force and destruction of the teeth.  

Diseases of the Jaw Joints: Regarding jaw joints and adaptive changes and breakdown, patients understand that joints have cartilage associated with them. Saying there has been cartilage damage in your jaw joint gets the message across simply. 

Treatment Presentation: When patients say, “I know you want to do a crown on that tooth,” I jokingly say, “Oh, don’t do it for me. Do it for yourself.” I never say, “You need to get this work done.” Instead, I say, “I think you are going to want to have this work done.” 

Conservative Treatment: I have always enjoyed John Kois’s saying that no dentistry is better than no dentistry, so when talking about conservative dentistry, I’ll tell patients, “No dentistry is better than no dentistry. We certainly don’t intend to do any dentistry that doesn’t need to be done.” Another way I speak about conservative dentistry is to say, “Conservative dentistry is dentistry that minimizes treatment. In the case of a cracked tooth, a crown is actually more conservative than a filling because it minimizes risk.” 

Moving Forward with Treatment: I love Mary Osborne’s leading question for patients after they’ve been shown their issues and treatment possibilities have been discussed. The question is “Where would you like to go from here?” With amazing regularity, the patients choose a really good starting point for their next steps toward improved health, steps that feel right to them. Always remember, people tend to support that which they help create. 

Dental Insurance: I typically speak of dental insurance as a coupon that can be applied to their dental bills. I’ll say, “Every plan sets limits on how much it pays. The way dental insurance works, it’s as if your employer has provided a coupon to go toward your dental bills.” 

Presenting Optimal Care: If I want to present optimal care to a patient who is ready to hear it, I ask permission by saying, “Mrs. Jones, if I were the patient and a doctor did not tell me what optimal treatment would be for my problems because the doctor was concerned that I couldn’t afford it or that I would not want it, I would think, ‘How dare you make that judgment for me. You tell me what optimal care would be, and I’ll decide for myself if I want it.’ So, with that in mind, Mrs. Jones, would it be okay with you if I presented you with the optimal solutions for your problems?” 

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Clayton Davis, DMD

Dr. Clayton Davis received his undergraduate degree from the University of North Carolina. Continuing his education at the Medical College of Georgia, he earned his Doctor of Dental Medicine degree in 1980. Having grown up in the Metro Atlanta area, Dr. Davis and his wife, Julia, returned to establish practice and residence in Gwinnett County. In addition to being a Visiting Faculty Member of The Pankey Institute, Dr. Davis is a leader in Georgia dentistry, both in terms of education and service. He is an active member of the Atlanta Dental Study Group, Hinman Dental Society, and the Georgia Academy of Dental Practice. He served terms as president of the Georgia Dental Education Foundation, Northern District Dental Society, Gwinnett Dental Society, and Atlanta Dental Study Group. He has been state coordinator for Children’s Dental Health Month, facilities chairman of Georgia Mission of Mercy, and served three terms in the Georgia Dental Association House of Delegates.

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Dental Sleep Medicine in Restorative Practice Part 7: Team Investment

February 12, 2024 Todd Sander, DMD

Dental Sleep Medicine in Restorative Practice Part 7: Team Investment 

By Todd Sander DMD 

If a dentist wants to provide dental sleep medicine within a restorative practice, everyone needs to be on the same page when making room on the schedule for sleep patients. It would be best to have a couple of champions on your team to support you in your efforts. 

The first champion you need is a sleep patient coordinator who has excellent phone skills and a high interest in what you want to achieve. This team member needs a working knowledge of sleep medicine and to be able to talk with patients about dental sleep medicine over the phone. Ideally, this team member has excellent phone skills and cares about sleep-related breathing disorders and pulmonary issues.  

If another receptionist receives a sleep dental medicine inquiry, our protocol is to take a message and have our sleep patient coordinator call the prospective new patient right back. This has worked well in our practice with a high rate of conversion. 

The second champion you need is a motivated clinical assistant. Hygienists and expanded-function dental assistants make phenomenal sleep assistants because they are driven to learn and do new things. In Parts 3 and 4 of this series, I described tasks my clinical assistant typically performs, so I can best use my time with the patient. For many years, one of our hygienists who had a passion for dental sleep medicine worked with me in developing the sleep side of the practice and was my clinical assistant with sleep patients. In our practice, her role was half traditional hygiene and half sleep dental medicine. 

For years, I have taken our entire staff to sleep courses, even team members who are not helping a lot with dental sleep medicine. I want my team to understand why I am developing the dental sleep medicine practice inside my restorative practice, how they can support it best, and receive formal training to pitch in when needed.  

Don’t forget to invest in yourself because you are the key team member. Today, there are several good sleep dental medicine courses, including at The Pankey Institute. The Pankey Institute courses and its dental sleep medicine study club are excellent.  

Related Course

TMD & Orofacial Pain: Managing Complex Patients

DATE: January 29 2025 @ 8:00 am - February 2 2025 @ 1:00 pm

Location: The Pankey Institute

CE HOURS: 37

Dentist Tuition: $ 7200

Single Occupancy with Ensuite Private Bath (per night): $ 345

TMD patients present with a wide range of concerns and symptoms from tension headaches and muscle challenges to significant joint inflammation and breakdown. Accurate thorough diagnosis is the first step…

Learn More>

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Todd Sander, DMD

Dr. Todd Sander is a graduate of The University of North Carolina at Chapel Hill, the School of Dentistry at Temple University, and a one-year Advanced Education in General Dentistry residency with the US Army at Fort Jackson, SC. He completed three years of active duty with the US Army Dental Corps and served in Iraq for 11 months. Dr. Sander completed more than 500 hours of postgraduate training at the Pankey Institute for Advance Dental Education and is one of only three dentists in the Charleston area to hold such a distinction. Dr. Sander is also affiliated with the American Dental Association, South Carolina Dental Association, American Academy of Cosmetic Dentistry, Academy of General Dentistry, and American Academy of Dental Sleep Medicine. Areas of special interest include: TMJ disorders; advanced dental technology; cosmetic dentistry; full mouth reconstruction; sleep apnea /snoring therapy; Invisalign orthodontics.

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Dental Sleep Medicine in Restorative Practice Part 6: The Question of Software

February 9, 2024 Todd Sander, DMD

Dental Sleep Medicine in Restorative Practice Part 6: The Question of Software 

By Todd Sander DMD 

Numerous companies offer software solutions for dental sleep medicine that integrate with billing services. These companies can take over the paperwork and billing for medical insurance. Some of them have letter templates built into them.  

I look at software all the time, and when I do, I evaluate the efficiency we would gain versus the number of appliances I would need to deliver to make using the software worthwhile. Their billing service fees are high. Currently, I average 10-15 dental sleep medicine patients per quarter and not all of these are candidates for oral appliance therapy. Remember, I have a busy restorative practice. Colleagues who practice full-time dental sleep medicine may see this number in a week! 

I’ve been fortunate to have team members who don’t mind researching how to file medical insurance claims for appliances. Most of my colleagues use a software platform designed for dental sleep medicine. So far, I have chosen not to use one. Instead, I have assigned the duties to team members and they have taken dental sleep medicine, Eaglesoft, and medical billing courses. Currently, we have customized template forms and letters in our Eaglesoft system but it is not set up for filing medical claims.  I must admit, it is getting harder to do this. and I may be forced to decide about dedicated software soon. However, the decision will be made considering financial feasibility as a primary concern. 

It did take time to develop our template forms and letters in Eaglesoft but now we are highly efficient. I dictate the notes for our records, the SOAP note for medical insurance, and the information we want to share in letters with physicians. In addition to the cost savings, I like that I am recording the data I want in my documentation in a structure I want for how I practice—not just for the SOAP note and representing my findings to referring physicians. 

One of my mentors has me considering the possibility that I might want to separate my dental sleep medicine patients’ charting from my dental patients’ charting. Using software designed for the practice of dental sleep medicine would give me a clean way to segregate the patients on my computers. So far, I’ve decided that the expense of the software will not give me a return on my investment. 

Related Course

TMD & Orofacial Pain: Managing Complex Patients

DATE: January 29 2025 @ 8:00 am - February 2 2025 @ 1:00 pm

Location: The Pankey Institute

CE HOURS: 37

Dentist Tuition: $ 7200

Single Occupancy with Ensuite Private Bath (per night): $ 345

TMD patients present with a wide range of concerns and symptoms from tension headaches and muscle challenges to significant joint inflammation and breakdown. Accurate thorough diagnosis is the first step…

Learn More>

About Author

User Image
Todd Sander, DMD

Dr. Todd Sander is a graduate of The University of North Carolina at Chapel Hill, the School of Dentistry at Temple University, and a one-year Advanced Education in General Dentistry residency with the US Army at Fort Jackson, SC. He completed three years of active duty with the US Army Dental Corps and served in Iraq for 11 months. Dr. Sander completed more than 500 hours of postgraduate training at the Pankey Institute for Advance Dental Education and is one of only three dentists in the Charleston area to hold such a distinction. Dr. Sander is also affiliated with the American Dental Association, South Carolina Dental Association, American Academy of Cosmetic Dentistry, Academy of General Dentistry, and American Academy of Dental Sleep Medicine. Areas of special interest include: TMJ disorders; advanced dental technology; cosmetic dentistry; full mouth reconstruction; sleep apnea /snoring therapy; Invisalign orthodontics.

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