The Profitable Dentist Fall 2013

Dentist
The Profitable
Fall 2013
News & Information to Increase the Profitabilit y of Your Practice
7 Simple Steps for Dentists to get into the Best Shape of Their Lives
SCIENTIFIC METALS:
Promoting Dentistry:
Breaking Down The Barriers
ONE GIANT LEAP FOR REFINING
What Every Dentist Needs to Know About Disability Insurance BIOFILM:

Are You Treating It Properly?
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FALL 2013 | I s s u e 2 4 5
PRACTICE MANAGEMENT
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CONTACT US
Phone: 800-337-8467 or 812-949-9043 Fax: 812-949-8535 Mail: The Profitable Dentist 3211 Grantline Rd, Ste 20 New Albany, IN 47150 Email: info@theprofitabledentist.com
From the Editor
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A Word from Woody Cover Story: Scientific Metals Leap of Faith
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Practice Management

STAFF
Editor-in-Chief William W. Oakes, DDS Associate Editor CRAIG CALLEN, DDS Executive Vice President of Operations/Finance DELAINE STEWART Seminar Coordinator JENNIFER JONES Front Office Coordinator/Marketing Director CHRISTY CLAYWELL Seminar Coordinator Assistant HOLLY SWITZER Administrative Assistant Ashley Scharlow TPD Designer Leah Conder Taylor Taylor & Associates
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Your View Of The Future Bleak or Bright? by Dr. Michael Kesner One Size Doesnt Fit All 50 States 5 Areas of Employment Law You Must Get Right by Teresa Thienhaus and Paul Edwards Whats the Purpose of (Web) Marketing? by Colin Receveur Promoting Dentistry: Breaking Down The Barriers by Howie Horrocks & Mark Dilatush Broken Appointments... Fix Them! by Dr. Michael L. Curtis From Your Patients Point of View by Janice Hurley-Trailor 7 Simple Steps for Dentists to get into the Best Shape of Their Lives by Dr. U.P. Odiatu Staging a Successful Associateship Partnership by Dr. Mike Abernathy Overcome Capacity Blockage by Dr. John Meis and Wendy Briggs Its Not Just What You Say, But How You Say It by Dr. Craig Callen
EDITORIAL ADVISORY BOARD

DR. MICHAEL ABERNATHY Dr. Keith Dobracki DR. DAVID HORNBROOK DR. MARK HYMAN CATHY JAMESON DR. BILL KIMBALL DR. ROGER LEVIN DR. TOM ORENT DR. STEVE RASNER DR. LARRY ROSENTHAL DR. ROY SMITH DR. BILL STRUPP Dr. Joe Steven, Jr McKinney, TX Madison, WI La Mesa, CA Greensboro, NC Davis, OK Encinitas, CA Baltimore, MD Framingham, MA Bridgeton, NJ New York, NY Tyler, TX Clearwater, FL Wichita, KS
The content of this publication may not be reproduced either in part or full without the written consent of The Profitable Dentist .
2013 Excellence in Dentistry, Inc., Publisher. Copyright enforced no part of this publication may be reproduced without written permission. This publication is designed to provide reliable information in regard to the subject matter covered. However, it is distributed with the understanding that it does not replace the need for advice from your personal, competent professional advisors.
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Profitable Thoughts

42 44
Practice Mergers: A Potential Fast Track to Profits by Dr. Mark Diekmann What Every Dentist Needs to Know About Disability Insurance by Mark Tonoff
Clinical

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The Second Golden Age of Dentistry: 3 Top GP Implant Procedures by Dr. Brady Frank Dramatic Cost Reduction and Superior Endodontic Results by Dr. Barry Musikant BIOFILM: Are You Treating It Properly? by Patricia A. Worcester, RDH, BS
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Great Info

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A Word From Woody

Good Morning everyone and welcome to another issue of The Profitable Dentist! This issue is jam-packed with some awesome articles that can really help your practice IF you implement the ideas/techniques presented. Also, we encourage you to support our advertisers because without them, we couldnt publish the magazine or maintain our high circulation. SAVE THE DATES... In closing, I want to personally invite you to attend our annual Fall Seminar in San Diego, California October 4-5, 2013. We are calling it The Profit Masters of Dentistry seminar and each speaker promises to share their best profit making ideas. Also, mark your calendars for our 23rd Annual Spring Break seminar in Sandestin, Florida which will be held April 11-13, 2014. To register for either event, call 1-800-337-8467 today so that you get the Early Bird tuition rates. Regards,
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Dentist
The Profitable
Fall 2013
Practi ce Profit abilit y of Your to Increa se the News & Inform ation
7 Simple Steps for Dentists to get into the Best Shape of Their Lives
S: SCIENTIFIC METAL
ONE GIANT LEAP FOR REFINING
Breaking Down The Barriers
What Every Dentist Needs to Know About Disability Insurance BIOFILM:

Are You Treating It Proper ly?
At Your Home. At Your Office. On the Go.

Get The Profitable Dentist right on your tablet just email us at info@theprofitabledentist.com, put e-magazine in the subject line and well start sending you the electronic version of TPD in addition to your valued hard copy. Just download and read whenever, wherever its convenient for you. Dont wait, email us today!
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COVER STORY
onsider that if you could simply melt down the contents of your scrap jar and put the gold straight into your safe, you would, right? After all, why pay a refinery, let alone a salesperson? Traditionally, your two options were usually either to sell your scrap for cash or have a local refinery rep pick it up at the office. However, cash offers are usually very conservative in order to account for uncertainty, while the second option may have left you wondering how much of the pie you were left with after everyone involved in the transaction got their cut. Scientific Metals offers dental professionals a more efficient solution. They have no sales reps or middlemen and cut overhead to the bone, leaving the lions share for you. The Profitable Dentist spoke with Dave Weinberg of Scientific Metals to get a peek into the status of the refining industry and how they are redefining refining as we know it. For years, the scrap refining business was dominated by either guys stopping by the office weighing and paying or by local refinery reps stopping by to pick up the scrap to have it shipped for processing. Scientific Metals does neither. Why? D. Weinberg: We heard from dentists around the country who questioned the amount of money they were receiving for their scrap. They felt that with in-office
SCIENTIFIC METALS
LEAP OF FAITH
Flying in the face of industry practice, Scientific Metals launches a bold strategy of direct refining with no sales reps and no personal office visits for dental scrap. Why does such a bold move work so well for dentists?
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cash payments, they were leaving money on the table by selling for cash to a middleman or that too many hands were in the scrap cookie jar meaning too many people were getting a cut of the value leaving the dentist with less than a stellar return. As a result, we made a strategic and philosophical decision many years ago to completely revamp our business model to address this. We felt if we could considerably lower our costs somehow, we could then begin to deliver a scrap return that no one could match. And so we took a big risk and did what other refining companies laughed at. We decided to go with a direct refining approach without ANY sales reps, commissioned or salary based. I hear you have a name for this new strategy. Can you share that with us? D. Weinberg: We refer to this model as the Amazon.com of the refining industry. Why are books and TVs cheaper on Amazon than in the big box stores? Simple, Amazon has less overhead and can therefore have better prices. The same applies to refining less overhead equals better prices, which in the refining world means higher scrap returns.
Wow. Thats a big risk you guys took. While everyone is clamoring to get their foot in the dentists door, you were clamoring to get your feet out of the door. D. Weinberg: Ha. Thats an interesting way of putting it, but yes, we wanted to do everything we could to radically alter the way scrap payments were returned. And I think we did.
Is it just labor costs that you have tried to cut in order to stay lean? D. Weinberg. No. Not at all. Its a philosophy that permeates every part of our company. Everything we do is centered on cost savings, which means we do not send out scrap collection jars across the country, nor do we send out brochures to every dentist in the country. We also dont attend very many trade shows. All of this is for one reason and one reason only lower costs for us translate into great scrap returns for our customers. You mentioned that others in the industry scoffed when they heard you would not be offering inoffice, personal pickups. But how did the dental world respond to this approach? D. Weinberg: The strategy has been an overwhelming success. Dentists will take higher payouts and give up a physical office pickup by a refinery rep any day of the week. I think Woody Oakes nailed it when he wrote in one of his articles many dental products demand and justify a reliable and knowledgeable sales rep for technical and customer support, etc. many pieces of equipment and software immediately come to mind. But dental scrap rening is not one of these. Oh, plus I dont think dentists really care whether a rep picks it up or a FedEx driver picks it up. One could argue that the FedEx driver is actually more convenient and less intrusive on the days activities. Dont you guys sometimes get tempted to get some reps on the road to spread your message? D. Weinberg: Yes. But thats the discipline. First of all, our message is no reps. So hiring reps to spread the
Everything we do is centered on cutting costs to the bone in order to deliver the best and most accurate scrap returns to our customers. That means no reps, not sending out jars and brochures to every dentist and not being a fixture at every dental show across the country. After all, the precious metals belong to our customers , not to us.
Dave Weinberg
800-337-8467
The Profitable Dentist.com
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message of no reps would be kind of interesting (chuckle comes across the room). But in all seriousness, hiring reps means adding costs and overheard which means undermining our overall objective of cutting costs to the bone to deliver the exact percentage return we say each and every time. Are there any drawbacks from the companys point of view of not having any sales reps on the road?
D Weinberg: Not constantly being in the dentists or assistants ear means we have to rely on other avenues to communicate our philosophy. And of course, not being physically present in areas means we are going to understandably sacrifice quantity (number of customers). But we are more than happy to give up quantity and, in return, have each and every customer feeling that they received an accurate and reliable scrap return.
We felt that if we could considerably lower our costs somehow, we could then begin to deliver a scrap return that no one could match. And thats exactly what we did David Weinberg
In many cases, the benets of a sales rep warrant higher costs. However, the evidence here strongly suggests this is not the case when it comes to dental scrap rening.
Dr. William Woody Oakes
3 Tips To A Better Return

1) Do not sell your scrap for cash. It has been reported that dentists may be receiving as little as 30-50% of their scrap value as a result of the deeply discounted in-office cash spot transactions. It is nearly impossible to accurately determine the precious metal content with just a visual inspection. As someone pointed out very humorously, For door-to-door scrap buyers to tell you precisely the precious metal content of your scrap, theyd need a furnace and refinery in their briefcase. 2) Study the business model of prospective refining companies. How many people are getting a cut of your scrap return? Does the refining company have to pay out commissions to anyone from your scrap return profit or are you getting to bypass that step? Is the refining company having to pay a finders fee or split to 3rd party reps who broker the deal? For any batch of scrap larger than just a few crowns, direct shipping to the refining company with the most economical business model may prove beneficial to your bottom line. 3) Dont be lazy. Choosing a company to send your precious metal scrap to is a serious choice and should not be taken lightly. You should conduct your due diligence and not just hand over your precious metal scrap to the company whose jar is sent most often to the office or whichever company knocks on your door most frequently. Go with who your colleagues have had success with and ask questions.
Preliminary testing using X-Ray Fluorescence Spectrometer
Contact Information:
Phone: 1-888-949-0008 Website: www.scientificmetals.com
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800-337-8467
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Practice Management
Your View Of The Future Bleak or Bright?

by Dr. Michael Kesner
oes the future of dentistry look bleak or bright to you? Do you see great opportunities, or great problems?
pay for your services. Many dentists feel like they have all these wonderful services to offer, but it seems like no one can afford it. However, dental expenditures nationally continue to rise at a rate of 6.2% a year. Dentistry is a $105 billion per year industry that is expected to increase to $170 billion by 2020. If your practice revenue is either flat or declining but the statistics show dental spending is up, then what does that mean for your practice? My practice has grown more in the last 7 years than the 22 years prior to that. We made the Inc. 5000 list in 2012 and 2013 as one of the fastest growing businesses in the nation. Why is this when the economy is so bad? Because I have continued to change the way I practice the business of dentistry as our world changes. Let me explain. You can either adapt your practice to the new environment and profit from it, or remain the same and die a slow death. Many businesses either dont see the changes happening, or they stick their head in the sand. They will often watch their business decline for years, while hoping things will go back to the way they used to be. Blockbuster Video stores are a good example of this type of behavior. They waited too late to change and were forced to close their doors. Here is an example of this principle in dentistry.
Things are changing in the world of dentistry. If you are not changing the way you practice as the world changes, then I believe your future is bleak. If you are making the right changes to your practice, then I believe this is one of the brightest times in dentistry ever! The only thing certain about the future is that there will be change. Just look at what we are seeing in dentistry now. Insurance companies are dictating and controlling your fees in ways they didnt 10 years ago. Low UCRs and fee schedules are controlling what you can charge your patients. PPOs and DMOs are on the rise as companies cut employee costs. The annual maximum insurance reimbursement has continued to remain basically the same for the last 30+ years, which buys less and less dentistry each year. Large group practices are the fastest growing segment of dental practice today. This trend will continue to increase while the number of traditional solo practices will continue to decline. Heres why. Most dental students are graduating with $200K to $300K in school loans, so most cannot afford to go into private practice. In fact, it is estimated that only 20% of graduating dentists aspire to own a solo practice. Around 50% of dental graduates are now female. When I graduated from dental school in 1984 less than 10% of the class was female. Historically most women do not go into private solo practice. The financial pressures on our patients from a fragile economy provide less and less discretionary income to
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I started a scratch practice when I got out of dental school in 1984. Our state dental board had just recently changed the rules and said it was OK for dentists to advertise. For years after this rule change many dentists still considered it unprofessional to advertise. The only advertising that dentists would do back then was to get a bold listing in the Yellow Pages. Even that was frowned upon by some. The first thing I did when I opened my practice in 1984 was to start sending direct mail advertising. I was the only dentist in my area doing this, which didnt help my reputation among my colleagues. I decided that I could either be accepted by my peers and starve or ruffle some feathers and be successful. I chose the latter. I know this sounds funny 29 years later when most dentists are advertising, but in 1984 direct mail advertising for a dentist was earth-shattering. What earth-shattering things are you resisting in your practice today that will be commonplace in 10 years? Will you take advantage of the opportunities in dentistry today or let them pass you by? As a traditional private practice, how are you going to compete with the growing group dental practices? What if you formed a small group practice or is that an earth-shattering thing for you? What changes are you going to make in this new economic and dental insurance environment? Are you going to find a way to be profitable with the declining insurance reimbursement? Or, are you going to put your head in the sand and hope that this changing insurance market wont impact your practice? What may be earth-shattering to you today will be normal in a few years. It is highly improbable that you can remain the same and continue to grow your practice. You must change or be left behind. Change is always uncomfortable. We must get to the point where not changing is more uncomfortable than changing. Here are some of the changes that I see as necessary for practices to be successful today?
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Another change to make is to know how to market in a way that appeals to regular people and not dentists. Marketing has to answer this question for the reader Whats in it for me? Things that dentists believe distinguish their practice from others, like friendly staff, lots of CE, latest technology, being gentle, etc., is an expectation to the reader, not an exception. Develop a team driven practice. When you delegate the running of your practice to your team, your stress goes down. A team-driven practice also increases success because the team is motivated and incentivized to inspire patients to want the dental treatment you recommend. Create the capacity in your practice to be consumer friendly. We live in a demanding society. People want it done now because they are busy and impatient. Why not do the dentistry today, instead of making an appointment in a week or two?
If your team isnt running the practice for you and you are not efficient with your time, then same-day-dentistry is impossible to pull off. You must spend some money to increase your capacity in treatment rooms, staff and efficiency. This will pay for itself many, many, many times over. The future of dentistry is very bright if you make the right changes.
Dr. Mike Kesner is a practicing dentist and author of Multi-MillionDollar Dental Practice. He is founder and CEO of Quantum Leap Success in Dentistry, a consulting company that helps dentists build the practices of their dreams in 24 months or less Guaranteed! Dr. Kesner speaks nationally on topics related to mastering the business of dentistry. You may contact Dr. Kesner at 480-282-8989 or drkesner@ QLSuccess.com. His website is: www.QLSuccess.com.
One is to incorporate systems in your practice that increase efficiency and quality. By being more efficient you can do more dentistry in a shorter period of time while maintaining quality and increasing profitability. In every other industry when efficiency is increased the quality is also increased. Why is it that dentists often believe that decreasing treatment time through efficiency causes quality to decline?
800-337-8467
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Practice Management
s e t a t S 0 One Size Doesnt Fit All 5

5 Areas of Employment Law You Must Get Right
by Teresa Thienhaus and Paul Edwards
n the HR community, we have a saying: For every one office policy, there are 50+ laws that apply.
What that means is, that there are often both federal AND state laws that apply to any particular policy or situation, and the state-specific rules vary from state to state in strictness and coverage. Where the two differ, the one that treats the employee best is the one that controls. As an employer, it is your responsibility to get these rules right as they apply to you and your employees. Having even one policy in place that doesnt meet the prevailing laws requirements can lead to liabilities for you and your practice. In particular, there are five fundamental areas that can create problems if not properly understood and applied.
bruce jones@bigstockphoto.com
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speyeder@istockphoto.com
Paydays and Paychecks

The laws on how often employees are paid vary from state to state. Most require that nonexempt employees be paid twice per month, within a few days after the pay period ends. Some states only require you to pay once per month. If you are or have purchased an existing practice, dont assume that the former owner has been paying the employees properly, or that your payroll company is paying employees in accordance with state and federal laws. Visit your states labor department website to learn more about your states requirements. In addition, many states also have laws governing the types of deductions that can be taken from an employees paycheck (beyond taxes and the like). For example, some states dont allow you to deduct for uniforms and medical examinations, or tools and equipment. Federal law also prohibits deductions for breakage or loss. There are restrictions in some states that dont allow you to deduct for amounts owed to you by the employee, such as payroll advances or dental treatment. A big no-no is to hold a final paycheck in return for the payment of a debt or return of property.
the existing handbook. Be aware that almost all states treat paid vacation as a wage, meaning that once its accrued or earned, it must be paid out when employment has ended. However, many states do allow you to set a policy where employees forfeit unused vacation after a reasonable amount of time, commonly called a use it or lose it policy. You can track vacation either by calendar year or by the employees anniversary date of hire. Always have the employees earn and accrue their leave on a certain schedule. They earn vacation days along with their pay, either per hour worked, per pay period, per month, etc. Think of vacation as time off that you put into an employees leave basket. If your policy says, After one full year of employment, each full time employee begins to accrue four days of vacation per year, you dont have to immediately dump the four days into the basket as soon as the employee has reached one year. Instead, the employee can accrue it over time. If the employee quits or is fired without using any vacation days, and youre in a state that requires you to pay vacation at termination, you would only be required to pay the unused vacation accrued up to their last day (as long as this is clear in your policy).
unpaid days off per year are acceptable. If you do offer paid leave, your policies must be clear as to how its earned and whether they forfeit the leave if its not used. Most states dont require you to pay out unused sick leave upon termination.
Medical Leave of Absence/Maternity Leave

For the past twenty years, employers of more than 50 employees have been required to provide at least twelve weeks of unpaid leave per year under the Family Medical Leave Act (FMLA). Many states have their own version of the FMLA that, in some cases, apply to employers with less than 50 employees. If youre a small practice, even though the federal and state laws may not apply, be aware that the Pregnancy Discrimination Act requires all employers of 15 persons or more to treat maternity leave the same as other short-term disability leave. Other employee protections may apply to even smaller businesses. To lessen your risk, you should offer your employees a certain amount of short-term leave with an extension at your discretion. Typically, in a smaller practice, employers will allow four to eight weeks of medical or maternity leave, with an additional 30 days at the discretion of management. Once you set a standard, you must apply it consistently for similarly situated employees. Since pregnancy discrimination lawsuits lead the pack in EEOC complaints and litigation, its critical to have a properly written policy.
Vacation
There are no laws that require private employers to provide paid vacation. Most state courts have ruled that vacation must be paid only if its promised to the employees. However, if you have a policy or practice of giving time off, you must stick to your promises. If you are buying an existing practice, familiarize yourself with the handbook and the way vacation leave has been handled in the past. You dont have to continue what a prior practice has done; rather, you should look into your state rules instead of relying on
800-337-8467
Sick Leave
In the private sector, requiring employers to provide paid sick leave is becoming more common. The cities of San Francisco, New York City, and Portland, Oregon have laws mandating employers give a certain amount of paid sick leave. Still, for most employers, its your choice whether to allow paid or unpaid time off for sickness or personal reasons. If you dont offer paid sick leave, you should designate how many
Breaks and Meal Periods

Despite the common misconception, there are no federal wage and hour laws
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that require employers to provide breaks and meal periods. However, some states do have laws requiring a certain amount of time for break periods at regular intervals, or an unpaid meal period of 30 minutes for a shift of at least five hours. In the absence of state laws, its typical to allow employees to take brief, paid breaks of no more than 10 minutes. Such breaks are paid due to the Federal Labor Standards Act (FLSA), which states a 10-minutesor-less break is not enough time for an employee to be completely relieved of all work away from the work site. Therefore, it must always be paid. If employees take a mid-day meal period of 30 minutes or more, this is an unpaid break, as this is generally considered enough time to leave the premises. As a general rule, employees may not be required to clock out for breaks of 20 minutes or less.
In Summary
As you can see, the laws that apply to you as an employer are involved and complex. But with the right employers tool kit at your disposal, you will lessen your risk and improve your ability to run your business. Weve created a guide entitled Employment Law 101: Essentials for Employers. If youre a new employer, this information is critical. If youre a seasoned veteran, this information is still incredibly useful, as weve found that many long-term employers often have misconceptions as to what they can and cannot do when it comes to their employees. The guide is free for readers of The Profitable Dentist for a limited time. Please visit www.cedrsolutions.com/ PD101 to download your copy.
Teresa Thienhaus, J.D. is an HR Solution Center Advisor at CEDR Solutions (www.cedrsolutions.com), which provides individually customized employee handbooks and HR solutions to dental offices of all sizes across the United States. She has over 10 years experience in personnel and employment law and received her J.D. from the University of Cincinnati. Paul Edwards is the CEO and CoFounder of CEDR. He has over 20 years experience as a manager and owner and specializes in helping dental offices solve employee issues. He is a featured writer for The Profitable Dentist, Dental Town, AADOM, and Dental Economics magazines. To reach Teresa or Paul, please email CEDR Solutions at info@cedrsolutions.com.
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Stoneybrook manages the entire process and has proven many times that they really care about us and our results. And we DO get results ! We have more than doubled our New Patient numbers every month. We get New Patients from Stoneybrook pretty much every day, and on many occasions, more than one a day. Their service has enhanced our practice so much.
Stoneybrooks New Patient neighborhood program is getting us an average of 21 New Patients every month. I know it works ! And they are very helpful. My efforts are very minimal, and I get great results. We look forward to hearing the phone ring every time their publication hits the mail.
Before using Stoneybrook and The Scheduling Institute, we were averaging 10 to 12 New Patients per month. Now, with Stoneybrook, we average 4 to 5 times that number every single month. Weve been using Stoneybrook since February 2009 and they are the source of almost all of our New Patients. They take care of everything and get us a consistent, very profitable return on our marketing investment.
Valid for new clients only.
PUBLISHING, INC.
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DPD
Practice Management
Whats the Purpose of (web) Marketing?

by Colin Receveur Fact: Your dental website is a tool used to attract the
patients that YOU want. We talk to many dental offices that have a #1 Google ranking, a beautiful mobile website, and done everything right, but their phone still isnt ringing The purpose of dental web marketing shouldnt be to drive traffic to your website. It should be to get the prospective patient to DO something that is likely to result in you making money, such as: Download our free book: How To Smile With Confidence and Eat The Foods You Love
My Advice: Dont look for Magic Bullets.

Instead, concentrate on: 1. The specific result you want to achieve. 2. How you can improve the lives of your targeted prospective patients. 3. What specific action you want to motivate your targeted prospective patients to take.
How does that become profitable for a dentist?

1. It builds an opt-in list of your prospective patients. 2. While providing genuine value, the free book includes subtle, irresistible offers & upsells to your paid dental services. 3. Within the book is another offer of something valuable for free something that brings the prospective patient closer and closer to becoming a paying patient. 4. Educating your prospects sets you up as the Expert or Celebrity Dentist in your marketing area. You wrote the book on that. Check out the services we offer is NOT a good enough call to action. On the other hand, Download your coupon for a $1 Initial Exam & X-rays might well be a compelling incentive. Successful advertising solves the consumers problems. Most dental websites fail because theyre all about the dentist and what the dentist wants to sell (crowns, bridges, veneers, etc.). Make your prospective patient aware of how and where their problems can be solved. Tell them the first step to take toward improving their lives as a result of solving those problems.
Colin Receveur is a nationally recognized speaker, author and internet marketing expert. He has been pioneering the way dentists market themselves online since founding SmartBox Web Marketing over a decade ago. Colin is the author of 3 best selling books: The Dentists Strategy Guide to Video Marketing, How to Stay In Front of Your Patients Until They Are Ready to Buy, and Web 3.0: What Every Dentist Must Know to Thrive in the New Economy. For more visit www.smartboxweb.com.
Getting people to visit your website wont make you money.

Increasing the sheer number of people who visit you online can not be expected to increase your bottom line.
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Tired of Roadblocks In Your Practice?

Meet the Experts at
If you feel your practice has hit a roadblock, youre probably right! As consultants, we observe dentists who easily produce $200K per month, while others struggle to produce only 20% of that. Whats the difference? Successful dentists have eliminated blockages to maximum production and high profits. Let us help you Break Through Your Roadblocks.
John J. Meis, DDS, FAGD, DICOI Wendy Briggs, RDH
Request Your FREE DVD Today!

Overcoming Capacity Blockages
Order it online at www.FreeUpCapacity.com
Or call (877) 732-2124

For more information visit www.TheTeamTrainingInstitute.com
TPD0713
2013
Practice Management
Breaking Down The Barriers by Howie Horrocks & Mark Dilatus

h
Dentistrys Seemingly Endless Quest, To Get In Its Own Way
Whenever we write or speak on this topic, we typically get boos, sneers, rolled eyes and various forms of head shakes. Thats ok. We understand. Certainly, if someone came into our business and pointed out how we were getting in our own way we would likely have the same initial reaction. What we are going to ask you to do as you read this, is to be conscious of your initial reaction but then be honest, logical and realistic once the initial shock to your ego wears off. Sometimes it is really good to get an outside perspective. We all work so closely within our own operations that many times it is difficult to see the forest through the trees. Specifically, in this article, we are going to talk about barriers. Barriers = Anything you do (or do not do) that stops the consumer from choosing you. There are literally hundreds of barriers. We dont have space here to list them all. So we will discuss the barriers that we see as the most common. We work directly with hundreds of dental offices and have spoken or communicated electronically with thousands of dental offices. During that interaction, the most popular barriers come into focus. relationship with a different dentist, a different assistant, a different hygienist and a different business administrator 4. You will have to remember their office days/hours, their payment policies, whether they accept your insurance or not, their phone number, etc. Todays mom is busier than ever. She knows, before she ever calls your office for the first time, that she is looking for a practice that can treat her whole family. For some moms it is a conscious criteria within their selection process. For other moms it is subconscious. But for all moms it exists. Want to add a boost to your current promotion? In your advertising, tell mom that her whole family is welcome in your practice.
Children
We understand. They squirm. The parents have to be in the treatment room (or really want to be). Many times, the parents are more stressed out and unreasonable than their children! For many of you, treating children is likely not the highlight of your day. We get it. But, if mom is the gatekeeper among consumers, their children (and the way they react in your practice) are the keys to building a very healthy, younger, higher-end family practice. Promoting that children love coming to your practice is an extremely powerful promotion tool. By not seeing children and not promoting that you do see children, you are basically saying the following to the gatekeeper (mom). 1. You will have to select a different provider to see your children 2. You will have to have a different dental practice to learn and get used to 3. You will have to manage another
Strict New Patient Protocols

We see this one constantly. We dont know who started it. Likely, it was a dentist selling something to other dentists. Here is the scenario: New patient calls, just moved to the area and asks specifically for a cleaning. The business administrator immediately goes into a (supposed) value-building script of
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how you cannot clean her teeth until she has a full set of x-rays, a comprehensive examination, full mouth probing and a sit down conversation with the dentist. By the way, this first visit will consume an hour-and-a-half. Then, after that visit, the doctor will have her back into the practice to go over everything she might need (another hour) and at that time, we might be able to schedule your cleaning (in the future). Huh? The consumer is now thinking... Hmmm, my old dentist just cleaned my teeth! These guys sound way too fancy for me, or, These guys are trying to sell me more than a cleaning, or OMG 3 hours over two visits and my teeth still arent going to be cleaned? Click. We understand there are some odd states with odd state board regulations. We get it. But you cant clean her teeth on the first visit? You cant do a limited exam and clean her teeth, then have her back in for a comprehensive exam? We are not attorneys, nor pretend to be, but we seriously doubt that the intent of a
state board regulation is/was to stop the masses from getting their teeth cleaned.
We are open 9am to 4pm Monday through Thursday

If you polled 1 million females on earth, and asked them to give you the least convenient hours within their lifestyle, the answer would be 9am to 4pm Monday through Thursday. Dont believe us? Go look at your own schedule! If you have hours outside of 9am to 4pm Monday through Thursday, those hours are booked out the farthest in your schedule. If you see patients from 11am to noon and 1pm to 2pm those hours are likely booked out quite far as well. Your own schedule is telling you that the local consumer market is demanding more convenience from your practice. You just happened to find the consumers that are willing to put up with you being inconvenient. Many of you can take the same operational hours (30 per week) and simply start and end earlier one day, then open later and end later on
another day. Promote that you have convenient early morning AND early evening appointments available for new patients and pre-block those days/times for your newest patients. If you are in or near a business district, promoting that you have convenient lunchtime hours is also beneficial. Convenience is tied for second among what matters most to dental consumers. Within the category of convenience, hours of operation is #1. It even trumps distance (travel time to and from the dentist). That means mom is willing to drive further to find a dental practice with convenient hours (for her). We understand you may have the threat of staff mutiny on your hands if you even bring up the subject of altering your operational hours. But the truth is the truth. Dental consumers demand convenience.
These are two extremes. Some dentists completely ignore the cost of
800-337-8467
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fotosav@bigstockphoto.com
Avoiding the cost question or promoting primarily base on price
dolgachov@bigstockphoto.com
dentistry within their promotion, fearing it will scare potential new patients away. Other dentists, lead with some kind of price incentive, build big starbursts in their designs to highlight how inexpensive they are and even promote in media (like ValPak to use an example) that is really nothing more than an envelope filled with nothing but deals. Well, the dentists who say nothing about price arent promoting as effectively as they could. The dentists who are promoting primarily on price are alienating half of the dental market instantly (half the females in the world would never choose a healthcare provider based on price). Two extremes neither works well consistently. Price (or the perception of price) is the #1 consumer concern when they initially learn about any dentist. Avoid (like the plague) either extreme. Part of the reason (we believe anyway) that dentists use extremes rather than communicating down the middle (so to speak) is because they dont know what to say. OK. We can help with that. 1. If you participate with any insurance plans, put them in your promotion.
2. If you do not participate with insurance plans, communicate that you process all of their necessary insurance paperwork for them. 3. If you have technology that saves them time and money (Cad/Cam, Diagnodent, Lasers, etc.) tell them that they will save them money. 4. If you offer CareCredit or another alternative tell them. Avoiding price communication (or building the proper perception of your pricing) is not the answer. Neither is being all about price, where the dominant visual or audio image is some kind of a deal. Both are bad. Addressing price properly is good.
Howie Horrocks is the Founder and CEO of New Patients, Inc., the marketing firm exclusively for dentists. He can be reached at whh@newpatientsinc.com. Mark Dilatush is the President of New Patients, Inc. He can be reached at markd@ newpatientsinc.com. For more information about New Patients, Inc., call: 866-336-8237 or on the web at www.newpatientsinc.com.
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Our BEST-SELLERS Will Knock You And Your Staff Off Of Your Feet This Summer!
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Practice Management
Broken Appointments... Fix Them!

by Dr. Michael L. Curtis
Do your patients break appointments? Cancellations & no-shows may be the largest single expense in dentistry! Why do we get them and what can we do about them? We hear that fear, cost or time are the problems but the real issue is that people too often dont see their dental needs as a priority. you remind me of Marty. He had a time-bomb like yours. He let it go and he swelled up and ruined his vacation in Cancun. 7. Delegate To Staff: Assign as much of this presentation to your team, as possible. Why? Patients commonly trust a disinterested third party with no obvious financial gain. Many patients feel more open about asking questions or expressing concerns to staff members. It is more effective for you to confirm problems and solutions than to present the care yourself. 8. How to Build Better Rapport: These communication skills are not about manipulating or coercing people into treatment. If you want to follow the Golden Rule and help others, your people skills are often more important than clinical abilities and they can be learned. Contact my office and ask about one of my books if youre interested in specific tips, scripts and narratives. 9. Monitor Your Phone: Do you know how your front desk is handling people on the phone? Most large companies monitor and record phone calls and so can we: Contact your IT or phone company to inquire how to record calls with your phone system. Dentists do not have time to review all calls, so consider listening to inbound calls over 2 minutes, where more information is exchanged and more staff errors may occur. 10. Put It In Writing: How often do patients seem eager for treatment in the office, only to have it fade later? Help your front desk reinforce your case presentations when patients attempt to cancel. Our Awesome Appointment Card takes only seconds to fill-out and prompts your team on what to say when patients call to break appointments. See our Financing & Collections guide for 29 ways it can transform your practice.
Dr. Michael Curtis practices in Connecticut and is the author of the 100s of Pearls books on Anesthesia, Endodontics, Collections & Case Acceptance; each with over 400 pearls in 80 categories. For questions or to order, visit www.100sofPearls.com or call 800-427-2830.
Some Tips:
1. Ask, Dont Tell: Passive learning is when we tell patients what treatment they need. Active learning is when people discover their problems themselves. The difference in follow-through can be profound! For example, lets say you find a fractured filling (recurrent decay, etc.) with no symptoms. You can tell the patient about it, or you can project an image with your camera or digital x-ray and show the problem. Great communicators ask rather than tell. John, tell me, what you see? Then direct people to consider the implications of waiting. 2. A Cavity Is An Infection: Making reference to the latest research paints you on the cutting-edge, and can add credibility to your recommendations: John, a cavity is a bacterial infection. The latest research has shown that as dental infections progress, oxygen gets depleted. This allows more dangerous organisms that may be resistant to antibiotics to take over. The longer you wait, the faster the problem worsens and the harder it is to eradicate. 3. Graphic Analogies: If it fits your style, torment your patients a bit with graphic images they cant help but remember: John, bugs are crawling right though that crack. When they creep under your filling, they eat away at your tooth, gum and jaw bone like termites. Their waste is toxic, causes foul mouth odor and the infection can enter your blood stream. 4. Say Nothing: One of the most effective communication tools is silence. Give patients time to assimilate information. Count to 10. Make the silence deafening until they implore: How soon can you fix it?! 5. Mid-Treatment Photos: Consider mid-treatment photos to your before & after albums. The image of dark, ugly decay we see every day can be quite motivating. 6. Someone Like Them: Think of a real patient and discuss a disaster that occurred due to their inaction: John,
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2-Day Mini-residency:
Simplified & Efficient Implant Placement for the GP
This hands-on program features several live surgeries demonstrating the continual emergent trend of reducing the invasive nature of implant surgery, thus increasing procedure efficiency.
You will learn:

The 5-minute Implant, Abutment and Crown Procedure
(Ideal for CEREC and E4D Dentist users)
Founder, Implant Efficiency Institute

A renowned speaker and continuing education trainer, Dr. Frank has devised a pioneering method entitled the No-drill Implant technique. Allowing dentists to perform once highly invasive and complex procedures with relative ease, the No-drill Implant has propelled implantation procedures into the 21st century.
Brady Frank, DDS
The 1-drill Implant Procedure
The No-drill Implant Procedure

Extract and place an implant directly into the socket using the Osteoconverter Introducing the Osteoconverter
Check It Out!
Unrestorable tooth necessitating an extraction. (Applicable for any tooth in the mouth)
The Osteoconverter is threaded into the socket. (Completing the task of both an osteotome and bone condenser)
The socket is prepared for an implant three ways:

1. Converts socket curvesand irregularities into asuitable implant site 2. Scores the internal socket wallin 1 mm increments providing optimal blood flow for implant healing
The Osteoconverter is also an implant. It may be left in the socket as the final implant, or you may place an appropriate size implant of your choosing.
3. Expands bone to provide ideal initial implant stability (45Ncm to 65Ncm on average)
A student placed this posterior case weeks after attending the 2-Day Mini-residency.
Upcoming course dates and tuition: Ashland, Oregon

July 25-26, 2013 ................. $4,500 $3,800 FULL August 1-2, 2013 ................ $4,500 $3,800 August 15-16, 2013 ........... $4,500 $3,800 August 29-30, 2013 ........... $4,500 $3,800 September 19-20, 2013 ... $4,500 $3,800
To register call 855.300.1490

Visit OsteoReady.com for more information.
Early registration offer: SAVE $700

Practical Implant Solutions
Must register 30 days prior to course date
From Your
by Janice Hurley-Trailor
eve all heard the statement that says: if we want to really understand someones situation, we need to walk a mile in their shoes or moccasins or sneakers, right? I think we can use this philosophy and apply it to our patients everyday experiences in the dental practice. The suggestion is to take a look from the patients viewpoint and see what they see from their perspective. Look high and low. Look all around.
Old posters of cartoon characters? Leaky ceiling tiles? Twirling teeth on a mobile? Chipping ceiling paint? Old television screens?
LOOKING UP
On the high side, when your patient is tipped back in their chair and they are looking up, what do they see? Before the light is shining in their eyes what are they looking at?
I have been in dental practices that have inadvertently treated their patients to those eyesores listed above. I think its easy to forget about whats on a ceiling. In fact my parents once bought a home with hideous wall paper on the ceiling of their newly purchased kitchen. Neither of my parents liked it and had plans to replace it right away. Year after year as I returned home to visit my parents, I would ask about their plans to replace the kitchen wallpaper until my Mom answered
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vvvstep@bigstockphoto.com
Dr.Alex@bigstockphoto.com
Practice Management
on one visit by saying, you know I just dont notice it anymore. I am afraid that scenario sometimes happens in our hygiene treatment rooms. We either forget about what our patients are looking at when they are looking up at our ceilings or we dont notice those items that need repair or replacement. Another area that needs consideration is what our patients see when they are receiving treatment and they look up. Please double check: The cleanliness of your own glasses or loops The cleanliness of the overhead light The cleanliness of the protective glasses you hand your patients (no scratches please)
your eyes open from the patients perspective and oftentimes it is the base of your chairs that get missed in the cleaning process.
LOOKING AROUND
How would you describe the overall esthetics of your treatment room? Do you have equipment that stands out as being dated? Do you have dental chairs or x-ray heads that creak and groan when you move them? Patients are looking down and around and sometimes they take notice of things we take for granted. They look at the floors and the carpet the cabinets and the equipment. Please take a look at your treatment room with the eyes of a first time patient who is noticing their environment with keen alertness.
LOOKING DOWN
Finding cleaning staff to properly clean and maintain the physical properties of your dental practice can be a challenge I know. Many times when its time to cut practice overhead we look at reducing what is spent on cleaning services. There is certainly no guarantee that spending more gets you more but... sometimes it does. Either way, its important to keep
Janice Hurley-Trailor is known as Dentistrys Image Expert for Optimal Presence and Impact. She has more than 25 years experience as a dental consultant helping professionals use the tools they have to gain higher treatment acceptance and attract quality patients. Janice is an international author and speaker. To contact Janice, call 480-219-2210, email JHurley@JaniceHurleyTrailor.com or visit her website at www.JaniceHurleyTrailor.com.
Hathaway@bigstockphoto.com
800-337-8467
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EIDs Seminars are a huge value for your money. There are so many great speakers and vendors in an awesome setting.
registration Quick, easy x by phone, fa or online!
The Profit Masters Of Dentistry

October 4-5, 2013
REGISTER before AUGUST 31 using CODE TPD and one team memb er attends FREE! EZ PAYMENT PL AN!
Youre Invited To Attend...
- Dr. Dan Finn, Perry, IA
i Georg
Hilton San Diego Mission Valley San Diego, California

After multiple visits to Excellence in Dentistry, I am still excited to get rejuvenated with enthusiasm. Ive practiced dentistry over 30 years and attended much continuing education and you still come up with new ideas and motivations to keep me in dentistry. -Dr. Mark Messer, Bridge City, TX
Dr. Brady Frank
Making Implants The #1 Profit Center In Your Practice Dr. Frank will explore the rapid expansion of three specific implant procedures among GPs in the United States, Canada and Europe. Heres just some of what Brady will cover: The No-Drill Implant Procedure, the 1-Drill Implant Procedure and the 3-in-1 Implant Procedure The top five minimally invasive, no suture implant approaches Detailed financial information including an explanation of why the typical GPs overhead can go down as much as 20% Objective: This course is designed to teach doctors who currently place implants to be more efficient and it encourages doctors who dont place implants to get started and take their dentistry to a higher level.
Dr. Michael Apa & Dr. Brian Chadroff
Shelly Ryan
Treatment Decisions For Interdisciplinary Challenges In The Aesthetic Zone Understand the concept of beauty and how facial aesthetic design affects tooth preparation, function and gingival margin placement for the periodontal/restorative team Learn to diagnose, treatment plan and execute complex interdisciplinary aesthetic cases To understand the biologic rationale for aesthetic crown lengthening and learn current concepts in regeneration, root coverage and site development Learn how to predictably treatment plan immediate vs. delayed implant placement, abutment selection and provisionalization techniques for implants in the aesthetic zone Objective: After this course, attendees will learn how to produce excellent aesthetic results with a step-by-step protocol.
How To Increase Profits By Reducing Cancelled and Failed Appointments
Bertha Triche, RDH
Digging For Diamonds Mining Profits From Preventative Services Bertha Triche is a registered hygienist with over 32 years experience in dentistry. She is a practicing hygienist and is currently coaching and training for Hygiene Diamonds, with Wendy Briggs, RDH, and The Team Training Institute. She will discuss: The preventive role of the dental hygienist New research regarding the value of prevention Using CAMBRA, risk assessment effectively in dentistry Building value for hygiene servicesits not just a cleaning 3 simple preventive diamonds that can make a huge difference How to have patients say yes even when insurance doesnt cover it Tracking and monitoring, vital statistics critical for profitable hygiene Objective: To help hygienists understand what they can do more effectively in their preventive role that can help improve productivity and patient service overnight.
Excellence in Dentistry is an ADA CERP provider.
Shelly is a practice management coach with Advanced Practice Management in Minnesota a state ravaged with HMOs, PPOs and corporate dentistry. Her mission at this event is to teach you and your team how to STOP cancelled or failed dental appointments! Why do more patients cancel hygiene appointments than operative appointments? Every practice faces downtime in the schedule. How much is normal? (Are you expecting too much or too little from your staff?) Do we charge a fee for missed appointments? Know the benefits and dangers Top 4 excuses patients use to fail and how to deal with them Verbiage stopping repeat offenders What about auto confirmation systems? Do they work? How do they compare? The entire Dental Team will know how they each can measurably reduce cancellations and failures thus increasing yearly production. Objective: Youll leave with helpful scripts you can use the very next week.
Dr. Woody Oakes & Sasha Burau, MBA

Work Smart, Buy Smart, Achieve 55% Overhead And Boost Profits How to set a 50% overhead budget (target overhead) Cost per day analysis Doctor time, per day, per minute How to buy dental equipment at up to 50% off retail How to save 15%+ on all your dental supplies The amazing website for the best price on everything How to triple the capacity of your dental office without adding additional operatories EXIT STRATEGIES how to sell your practice for more than its worth A $156 (new, made in USA) intra-oral camera
Dr. Bill Kimball
7 Magic Profit Centers Most Practices Are Missing
Dr. Bill Kimball, of Kimball Consulting, is a California based dental consultant who has gained a nationwide reputation for increasing the profits of every practice he works with. At this event Bill will share: 7 of the profit centers that he has seen missing in most dental practices. Systems that can be implemented Monday to grow your practice NOW! o Bonus System o Internal Marketing o Case Presentation o Financial Arrangements Objective: This course is designed to help practices increase their production, lower their overhead and thus create a financially stable practice based on clinical excellence.
Objectives: Attendees will learn how to manage the finances of their practice and their lifestyle.
REGISTER TODAY!
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Doctor $777 Staff/Spouse $297 Student $97

r Visa r MC r Amex r Discover r Check
Date: _________
Doctors Name: ______________________________ CC# _________________________ Exp. Date: ______ Email Address: _______________________________ Amount: _____________________ Code: TPD CF
EID designates this activity for 10 CE CREDITS

Payment Terms: Your credit card account will be charged upon registration. Cancellation policy: All cancellations must be made at least 30 days prior to the conference and must be in writing. No refunds for cancellations within 30 days of conference. Videotaping consent: I hereby consent and authorize the use and reproduction by Excellence in Dentistry, Inc of any and all photographs, videotapes, or other likenesses of me produced at the conference, for marketing or any purpose whatsoever.
Address: ____________________________________ Signature: ___________________________________ City: ___________________________ State:_______ Please include doctors/team member names and job titles on separate sheet and fax with this form. Zip: ___________ Phone: _____________________ Fax: _____________________
FAX Form to 812-949-8535 or call 800-337-8467 to register
OR REGISTER ONLINE NOW... www.theprofitabledentist.com/Seminar
Practice Management
7 Simple Steps
to get into the
for Dentists
by Dr. U.P. Odiatu and NSCA Certified Personal Trainer
of Their Lives
Best Shape
intense approach is fine if youre a Spanish Conquistador landing your ships on the shores of the Yucatan. But for the 45-year-old general practice doc, an all or nothing approach could leave you with a bad back, plantar fasciitis, acid reflux and disappointing long-term results. I love the quote by Confucious, The journey of one thousand miles begins with a single step. This insight doesnt mean launching out on Saturday morning for a four hour ride on a $3,000 racing bike, 10 Power Bars and cycling tights. Some entry level prep is needed. For example: a complete physical by a physician; a graduated periodized cycling program by a certified trainer, a nutritional assessment, etc. I enjoy having a long term vision for my health. It isnt a wild and woolly race to an unknown finish line. It entails making mindful decisions each meal, enjoying playing with my young children and a regular complete exercise program. We have found that taking one simple step in the right direction can lead to a whole new existence. Dr. Martin Luther King, Jr. said: Take the first step in faith. You dont have to see the whole staircase, just take the first step.
ver 65% of North Americans are overweight or obese and diseases related to inactivity and overeating are on the rise. At the rate we are growing, researchers from Johns Hopkins have estimated that over 92% of North Americans will be overweight by 2030. Something has to give soon. Other than looking a little bit better in your Facebook picture profile, why else should we get a little leaner? There are numerous articles in major medical journals pointing to excess body mass as a culprit in supporting chronic inflammation. In turn chronic inflammation plays a key role in many serious systemic illnesses. Dr. Walter Willet from Harvard School of Public Health reported that the number one way to reduce chronic inflammation in the body was to reduce excess body fat. So here we are. What to do about this common dilemma? The problem is not a lack of information. Libraries, bookstores and the Internet are overflowing with exercise and nutrition advice. It can be overwhelming for the average dentist when they Google nutrition and come up with 161 million results. Or Google fitness and find 494 million resources! Combine the plethora of information with lack of time and energy from a busy practice and you can guess the outcome an expanding waistline! There are some simple action steps that will have a significant impact on your health and vitality. Many dentists sabotage their success with an all-or-nothing attitude. This
De-junk Your House Eating is one of the

most intimate things we do with our environment. The food we select to eat literally becomes our skin, our muscle and our hair follicles. It must be chosen with reverence and a mindfulness befitting of the magnificence of the human body. Not a carcass youre pulling from operatory to
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operatory. What does De-Junk Your House involve? Purge your house of high glycemic junk food and treats. If the high fat snacks and treats are not around, they are less likely to whisper your name in the night! Author of Mindless Eating, Brian Wansink, PH.D., reported that eliminating junk food from the home will prevent absent minded overeating. Did you know that 100 extra calories per day (e.g., medium size cookie) can add up to 10 pounds in one year? As a leader in the dental office, why not walk the talk on the home front too?
processes. Aim to drink at least six to eight glasses of water every day. It is natures true elixir! It detoxifies, re-hydrates, refuels and rejuvenates. Start by adding one extra glass this week. Increase the next week and you will soon notice that your breath is fresher, your body feels less sluggish, and your skin more supple. I have emails from past attendees at my seminars reporting weight loss up to 20-30 pounds stemming from a renewed commitment to drinking water. Lets toast to H20.
Count Your Steps Walking is one of the easiest, safest and most beneficial forms of exercise. Dr. Andrew Weil, author of Healthy Aging, recommends walking as the number one exercise that can be maintained for a lifetime and the whole family can participate. Purchase a pedometer (keeps track of the number of steps you take) and aim to increase the number of steps you take each day. A long term goal of 10,000 steps per day will put you in the elite group of walkers. A Stanford University 20 year study with 4,384 people showed that walking just once a week would cut your risk of mortality from cardiovascular disease in half. Okay, what are you waiting for? Eat Slowly - Look closely at the food that you are about to order off the menu or put in your shopping cart. Honestly ask yourself if it will add to your health or subtract from it. Your body is very intuitive, if you listen, you will choose food for function. Food for Function is a way of eating whereby you seriously look at how each food item is going to help your wellness plan or hinder it.
It takes about 20 minutes for the stomach to signal the brain that it is full. It is easy to overeat when you polish off the entire meal in less than 10 minutes! The top world record holders at international eating competitions can eat up to 83 hot dogs in 12 minutes. Lets leave the speed eating to the professionals and chew your food until its liquid and allow your stomach and intestines to provide you with more nutritional bang for each bite.
Sleep Tight - In a long term study from Case Western Reserve University in Cleveland, Ohio - of 68,000 middle-aged women, researchers found that women who slept only 5 hours per night were 32 percent more likely to gain a significant amount of weight compared to those who slept at least 7 hours per night. Inadequate sleep also increases your arterial aging and your risk of heart attack according to doctors Roizen and Oz in their bestseller, You: The Owners Manual. Try adding to your sleep time by getting to bed 10 minutes earlier this week. Your waistline will shrink and guess what? You will be more alert for your treatment planning and crown preps. The Canadian Medical Journal reported that people who are sleep deprived and only get six hours or less of sleep a night operate similar to someone at a .05 alcohol level the next day. Muscle Up Without exercise, after age thirty, you will lose up to 1% of your muscle mass annually. This means if you dont do any form of resistance training between ages 30-75 you will lose about 45% of your muscle mass. This translates into an inevitable physical decline and loss of independence. You can enjoy the benefits of resistance training in as little as two 30-minute workouts per week. My advice? Hire yourself a trainer and get some introductory sessions. Also read some entertaining, yet informative, fitness magazines like Mens Health and Oxygen Magazine. Exercise Your Mind Harvard professor and author of SPARK, Dr. John Ratey, reported a direct correlation between cardiovascular exercise and brain function. Students in a morning fitness program scored better in science, math and language arts. Forget about the term: Dumb Jock! Experts
Wet Your Whistle - Water is an extremely important nutrient. W.H. Auden once said, Thousands have lived without love, not one without water. Water is a key factor in all our bodys metabolic
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recommend that you elevate your heart rate to about 80 percent of your age-adjusted maximum (to calculate your age-adjusted maximum: 220 age) for about 20 minutes three times per week to experience benefits for your brain, heart and lungs. Taking action on any one of these seven simple steps will help your family unit toward better health and well-being. You will feel great knowing you are taking charge of an important aspect of your health. The obesity epidemic is not going to respond to just the federal government throwing money at it. Families must step up and take some responsibility. As oral health care providers, why not us? Since dentists and hygienists spend proportionately more time with their patients than the average medical doctor, lets show our leadership in the wellness realm. I firmly believe we can inspire patients and their families to enjoy a higher standard of health. It all starts with a conversation. First with oneself. Then your team and then your
patients. Theres an American Indian quote that says in every seed lays the promise of 1,000 forests. Lets plant some seeds. All the best in your personal wellness quest.
Dr. Uche Odiatu, BA, DMD is the co-author of Fit for the LOVE of It and The Miracle of Health. He is a professional member of the American College of Sports Medicine and a board member of the Holistic Allied Professional Association. This life long athlete is an NSCA certified personal trainer and maintains a dental practice is Toronto. With his infectious energy and keen insights he has been an invited guest on over 330 TV (including ABCs 20/20, City TV, CTV Canada AM) and radio shows. www. FitSDentist.com.
References: Wansink, Brian. Mindless Eating. New York: Random House, 2006. Weil, Andrew. Healthy Aging. New York: Random House, 2005. Roizen, MF, and Oz, MC. You The Owners Manual. New York: Harper Collins, 2005. Ratey, John. Spark New York: Little, Brown and Company, 2008.
In every seed lays the promise of a 1000 forests.

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Selling your Dental Practice Now? In 2 years? 5 years? or 10 years?

Contact PARAGON today for your free Dental Practice Transition Guide.This practical guide will help you avoid common practice transition mistakes and can add tens to hundreds of thousands of dollars to your retirement fund!
PLAN N OW WORRY LATER
Call 866.898.1867 or email us at info@paragon.us.com and request your free copy today.
Practice Management
Staging a
by Dr. Mike Abernathy
Associateship Partnership
3. Clear Expectations. Not cloudy, not
grey and not fluctuating. Crystal clear. If you cant write down your expectations, how will anyone else know what you expect? Its always surprising to me that the senior doctor, as well as the new hire, have never sat down and discussed and recorded how they both expect this to go. Generally you have two people who are clueless about what is required and what to expect. Kind of like two ticks and no dog. Is it any surprise that this will end in failure? One thing to keep in mind is that new doctors dont decrease stress and problems they multiply them. In fact most, if not all, of your systems, which may work fine for you, will be woefully inadequate for the new transition. Heres a short list of things you both should consider before continuing: a. Staffing b. Responsibilities c. Clinical setups d. Hours e. Pay f. Philosophy g. Treatment planning h. An organizational chart for communication i. What the long-term relationship will look like j. A timetable for these expectations
urviving your first associate/ potential partner is fraught with hundreds of twists and turns. One of the easiest ways to avoid these pitfalls that lead to failed associateships 93% of the time, is to begin with the end in mind. I am actually writing this article as a way to discuss what I see in many offices, but to mainly help an Endo practice that is struggling with a new doctor as an employee hired with the goal of having him buy in. Guess what? Its not working well. Both doctors are looking at each other as if they are from different planets. Kind of like that book about males and females: Men are from Mars, Women are from Venus. So lets create a list of the most common problems and fixes so that we can smoothly move toward a successful transition.
the benchmarks of a Super General Dental Practice. I will just list them here for your reference. a. 50-75 new patients a month and the ability to double that at will b. $20,000-25,000 of production per employee per month (at least $15.000-20,000 at the lowest) c. Recall of at least 70% d. A wide range of services meeting the demand of the demographic of your area e. An overhead being no greater than 65% (ideal would be 50-60-%)
1. Timing is everything. Finances,

new patient load, great systems, and a strategic plan and vision are paramount to a successful transition. Dentists spend more time planning their vacation than they do strategizing a transition. Everything matters, and anything you forget will create a very predictable ripple effect in your plans. This strategy for practice growth must follow the READY, aim, fire process. Cowboys that shoot from the hip will die every time. More than any other business strategy in dentistry, transitions demand that everything be in order. These follow
2. Beginning with the end in mind.

What will this practice look like if everything could work out right: overhead, production, new patients, hours, types of patients, services, duties, etc. You should take the time to create a word-picture of exactly how you hope this will turn out. In a perfect world, what would this look like? Write it down. You will get what you deserve, not what you expect. This is a time in your practice where you have to be intentional about modeling and staging for a particular result. You need to know what that result looks like.
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k. Productivity expectations l. Needs of both parties m. People skills n. Being on time o. Case presentation
Use a mentor or coach to help you with this.
6. Any transition should be based on a profit motive for each party.

The senior doctor wants to grow the practice and lower the overhead. The junior doctor wants to pay off debt while beginning his/her career. Anything that would diminish the return for either side will be a mistake. Its kind of a do whatever it takes attitude by both parties guided by the expectations you outlined.
doctor happy and productive. Involving them also goes a long way in creating a bond with your staff so that they begin to have this staff ownership mentality. Its no longer just your practice, but our practice.
4. Measure their performance. In other

words, measure their progress and give them a constant source of feedback from you and the staff. They need to stay on purpose and on track to make sure you both arrive at your objective. Thats why, as the senior doctor, you need to be engaged with the process. Calls should be made to patients by your staff to make sure things went well. Lab work needs to be checked in order to be sure that the quality you seek is there. If not, train the doctor to acceptable competence. Measure, give feedback, try again, and repeat is the only way of getting a consistent product. As they get better, back off. This should only take about 4-6 weeks before you no longer micromanage them.
10. Become the leader you should have been all along. So often I
find doctors bring in associates as a burnout strategy. Theyre just tired and worn out and in debt and think that this new doctor will stem the bleeding and lead to new momentum. Leadership filters down from the top, not up from the bottom. Leadership can be learned but is seldom practiced in the offices I visit. If you think youre struggling in this area, just give me a call and let me walk you through a leadership discussion for a dental practice. There are no perfect transitions or doctors. Just like Kmarts blue light specials: all objects being sold have some defect or problem. Thats the doctor pool you are selecting from. Just like you, life isnt through with them yet. Look for doctors that have people skills and self-motivation, everything else can be learned. Being in dentistry for over 40 years affords me the perspective to know that those with these two traits end up doing well, those with just clinical skills end up struggling.
7. Never hire someone just like yourself. By far the worst thing you
could do is to go out and get a MiniMe. Do that, and you have effectively hired someone who will halve your practice and both doctors will starve. You need to find someone who complements you. Someone who brings something more to the table. If there are procedures or types of patients you dont enjoy or dont do, then hire someone who does like and can do them. If kids are not your thing, get someone who loves to work with them. You get the idea. Expand the range of patients you can inspire with this transition. Do this and the practice will grow.
5. An incredibly detailed contract.

Summit was helping a senior doctor draft an associate agreement. In the process the client was given a contract drafted by us, to compare to the one his attorney drafted. The comment we got from the attorney was that we were making the contract too long and detailed. His justification for this was: Why would you want to address every possible problem and expectation in the contract? Its just a small business and you doctors can just work it out later. A contract should address every possible problem that might occur and create remedies for them through a thoroughly thought out plan that meets both parties expectations and desires. Short of that, you have a worthless piece of paper that serves no one. This should include your expectations along with your business draft that both parties have agreed upon.
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8. Hire slowly and fire quickly. It is counterproductive for you to take more than a couple of months to figure out if this is the right person or not. With clear expectations and a measured progress report, the trend will be apparent and then you must take action to move to the next level or free up their future. 9. From day one of the search, involve the staff. Partner with your staff to
find the very best candidate. Their participation will go a long way in making the process move to a successful completion. Failure to involve them early on guarantees that you will fail in the process of bringing in and keeping your
You may contact Dr. Mike Abernathy at 972-523-4660 or at abernathy2004@yahoo.com. If you do not have a copy of The Super General Dental Practice, contact Dr. Abernathy or Max Gotcher at 800-2520955 and they will send you a free copy. Visit www.summitpracticesolutions and click on the radio show link and be one of the 30,000 doctors and staff that follow him monthly. There are 4 past shows that can be downloaded about transitions in the Super General Dental Practice.
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Practice Management
Overcome
by Dr. John Meis and Wendy Briggs
Capacity
Its a cost with no number. Luckily, there is a way you can get a feel for your own capacity: The inability to accept emergency patients immediately. If you have new or existing patients with a dental emergency and you cannot see them today, you have a production blockage. Another way to evaluate capacity blockage is to take a good look at hygiene. How long are patients having to wait to schedule an appointment with a hygienist in your practice? Capacity blocked hygiene is a very common issue, that many practices often incorrectly view as a positive symptom. For many years we often bragged about how many weeks out we were booked, as a measure of success! Having capacity blockages in hygiene is a very costly situation. We have even seen hygienists holding back from discussing periodontal disease with patients, because they know there is no room in the schedule to treat them! Even more frustrating, is schedule inefficiency that often occurs in a capacityblocked hygiene program. No open time for weeks, but the day before or even sometimes the day of the schedule falls apart and valuable time in the hygiene operatory is wasted. The symptoms dont feel significant, especially when you are capacity blocked, because you are already busy. And sometimes when one patient doesnt show up, its often a relief. Once again, this is why having expert help identifying and addressing blockages is extremely beneficial. Eliminating production blockages almost always involves investment in people, technology, equipment, supplies and/ or facility. If the blockage is correctly identified and the correct strategy is used to solve it, the investment pays off rapidly. If the blockage diagnosis is incorrect, the treatment is less likely to be effective and the payoff is negligible or none.
e have observed dentists who produce $200,000 per month easily and other dentists who struggle to produce 20% of that. What is the difference? The myth is that super-productive dentists do a lot of big cases. The reality is that hyperproducers mainly do bread and butter dentistry. They have simply eliminated blockages to production.
Its our belief that practices will naturally grow until something stops them from growing. And what usually stops the growth is something that were doing. Its our mindset or some condition of our physical space. Here are some examples of common blockages: Inadequate investment in technology Inadequate number of equally equipped treatment rooms Too few chair-side assistants Room turnover inefficiency Lack of standard clinical protocols
One of the things that is subtle about capacity blockages is that you dont feel them.
Hyper-producers know the early symptoms of blockages and aggressively treat them. The problem is these blockages are often too subtle to be detected by a busy practitioner. The symptoms dont feel significant to the capacity blocked as their plates are already full. They dont have a sense of how much more they could be doing. An expert team is therefore an invaluable resource for any practice looking to grow. One of the things that is subtle about capacity blockages is that you dont feel them. You cant put a number on them.
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For many dentists, the usual response to a production blockage is to misidentify the problem. Commonly the blocked dentist tries to x the blockage by trying to attract more new patients. These new patients only exacerbate the problem. Like a dam full to capacity, your practice cannot handle anymore without causing a spillover. The spillover in this case are the patients who dont return to your practice. As you add more patients in the front door, you increase the patients slipping away through the back. Any investment you make into removing blockages in your practice should have maximum effectiveness. When you are working with precious resources such as time and money, expert help can remove trial and error so you can start reaping the rewards.There are two different ways that practices choose to plateau and common results that follow:
Weeding Out Dentistry

As practices get nearer and nearer to their capacity, some get very good at weeding out less productive dentistry. They end up focusing more on the higher productivity in dentistry. But thats not what usually happens. Usually, you get mired in busyness and you are not as productive. Decreasing demand because you dont have enough capacity isnt a great strategy. As we said before, practices will naturally grow until something stops them from growing and usually what stops the growth is something that were doing. So choose to be happy where you are (assuming this is an option financially), or make the necessary investments to grow. Any other move will not give you the results you wish to achieve.
The Sweet Spot

Whenever you run into capacity, whatever your capacity is, we call that a sweet spot. People like to stay in sweet spots because the profit per effort is high. Also, it usually requires an investment to get beyond this sweet spot. Theres nothing wrong with saying: Im enjoying what I am doing. Right here is good enough. This is one perspective, but more frequently, we find practices that are capacity blocked and try to eek a little bit more out of what theyve got. These practices would do much better if they focused on just one thing to eliminate a capacity blockage. As the expression goes, you cant have your cake and eat it too. Either you can be satisfied with your practice as it is or you need to make the necessary investments to grow. Extracting out minor improvements will not get you the results you desire.
Dr. Meis is an innovator in the field of practice management, marketing, leadership and team development. He is a practicing dentist in Sioux City, IA and partners with Wendy Briggs to bring innovative clinical and management training to the entire dental team. He has studied with some of most compelling thought leaders inside and outside of dentistry: Dr. Peter Dawson and the Dawson Academy, Bill Glazer, Walter Hailey, Dan Kennedy, Dr Carl Misch, Wendy Briggs, Dr. Wayne Mortenson, Dr. Ross Nash, Joe Polish, Dr. Frank Spear, Dan Sullivan, and many others. Wendy Briggs is a practicing dental hygienist, and the President and CEO of Hygiene Diamonds. She and her team of Hygiene Coaches (all hygienists) work with practices who are extremely productive, while still providing world class service to patients. If you would like help identifying and addressing blockages and increasing the profitability of your practice, call to request our FREE CD on overcoming capacity blockages. Contact Dr. Meis or Wendy Briggs, visit www.freeupcapacity.com or call (877) 732-2124.
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Practice Management
y a S u o Y h t a W t s u J t o N s It
by Dr. Craig Callen
But How You Say It
or years I have tried to hammer home to my staff the importance of the words they use when talking to patients and how they phrase their questions and responses. I have gone so far as to give them lists of words to use and words to avoid when talking to patients. Because I do quite a bit of marketing these days in keeping our new patient flow up, I am always aware of the words I use in my ads. For instance, there is a reason the Discover Card is called the Discover Card. Discover is a powerful word that tends to evoke a positive response in a person. How we phrase our questions to patients is critical to obtain the response that we want. My staff is told never to ask a question that will give them an answer they do not want. For example, when making an appointment for a patient they are to choose 2 appointment times that need to be filled and offer the patient a choice. First, they would ask the patient if they prefer the mornings or the afternoon times for their appointment. Once that choice is made, they ask if they would like Tuesday at 10 a.m., or Wednesday at 11 a.m. We really dont care which one they choose as we need to fill both times. The patient is given a choice and feel they have a say in their appointment time, while we have controlled the conversation to elicit the response we wanted. Try this on your family the next time you want to go out for dinner. Rather than ask where they would like to eat, give them two choices of places that you would like to eat. We even have scripts in the office on how to handle a patient who is upset with us. Language skills are critical in case acceptance trying to get patients to accept the care that they need. This hit home for my 14 year old daughter Meghan recently. Meghan is growing very tall and just hit 5 foot 8 inches. She decided she wanted to play basketball this year. While she is the fastest and the tallest kid on the team, she lacks experience. She made the team, but the coach was not giving her any playing time in the games.
While she certainly was not the best player on the team, she was as good as many of the girls who were playing. The coach just seemed to overlook her. Even if the team was winning or losing by a large margin, she did not get playing time. Being the competitor that she is and being used to starting while playing soccer, she was getting very frustrated. She wanted to confront the coach as to why she was not getting played. This coach does not have the best personality around and I felt if she confronted her, she might get the opposite effect and ride the bench the rest of the season. So I counseled Meghan on how to approach the coach with her problem. Rather than challenge the coach, Meghan told her of her frustration with not being able to play in the games, then asked what SHE could do to improve so as to get more playing time. The coach was almost speechless. She told her to work on learning the plays better. Then told her that she really had no reason to not play her and that she had unintentionally overlooked her. She was just not part of the coachs regular rotation of players. The next game Meghan played a full quarter. While she did not score she used her height and drive to make quite a few rebounds. She got her chance to show the coach what she could do. She controlled the conversation and got the result she wanted. By the way she told me she heard another girl confronted the coach head on last year about playing time and she had to run laps! Meghan has learned first hand the importance of the words we use and HOW we use them to get the results we want. Maybe it is time to talk to your staff about their language skills to improve your results.
Dr. Callen can be reached at craigcallendds@gmail.com. For additional information about the companies mentioned in this article, visit: www.paragonmgt.com and www.newpatientsinc.com.
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Imagine the trust and confidence you would have in your scrap metal results if you had your own refinery in your office that you could control and watch over from melt to assay? That would be great. Well, lets be honest. Thats not really practical. But when you refine with Scientific Metals you get the exact same precise and honest returns as you would get with your own refinery, but without the smoke in your examining room. And thats our guarantee.
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Profitable Thoughts
PRACTICE MERGERS
A POTENTIAL FAST TRACK TO PROFITS
practice merger occurs when an existing practice owner buys out another practice in their immediate market area and merges the two practices together to form a larger, more profitable, single practice. Contrary to what some believe, a practice merger does not create two owners of a single practice. Rather, in a practice merger, the purchaser is the solo owner of the newly created, larger practice. Experts generally agree that a practice merger is the fastest, most reliable way to jump start any dental practice. If youre really serious about practice growth, there is no debate that a merger is the best means possible. A merger provides an immediate inflow of quality patients as well as an instant reduction in your practice overhead percentages both of which instantly produce greater profits! Practice mergers can be structured as a walk away sale (meaning the seller retires immediately after the sale) or as a PreSale (meaning that the seller remains with you as your associate for a set period of time). Practice mergers can also be utilized to create a viable opportunity to add an associate without you having to relinquish any of your patients. Creating passive income (income that does not require that you personally do the production) is often a desired outcome of a practice merger. Thus, practice mergers are a very attractive option for dentists who are seeking more production for themselves personally or also for those dentists who are very busy already, yet wish to substantially increase their personal income through passive means. We have a long history of helping to assist numerous clients with practice mergers and we have watched each of these doctors instantly increase their personal incomes by significant levels and dramatically enhance their quality of life. Below are just a few of the reasons why a practice merger may be a great option for you to consider:
by Dr. Mark Diekmann
A practice merger can increase your personal income:

It is not uncommon to experience an increase in your personal income the very first month after completing a
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practice merger transaction. Depending on the size practice you acquire, a practice merger can easily increase your annual income by $75,000, $150,000, $200,000, or, in some cases, even more the very first year!
A practice merger will instantly increase your patient flow:

Not only will a practice merger supply you with a large and steady inflow of new patients, a practice merger often provides new patients for your practice who are already highly educated about the benefits of optimum dental care. Some of the new patients will already be active in a hygiene recall program (a wonderful source of passive income). How long will it take you to cultivate another 1,000 quality fee-for-service patients without a practice merger? In a merger it can happen overnight literally!
in sneaking YOUR patients away from you or otherwise damaging your practice? In fact, a seller is actually just working because the seller wants to stay busy and continue to have some income because he or she is just not quite ready to fully retire. A seller brings both patients and years of practice experience to a purchaser. The purchaser can take some welldeserved time off and still know that the patients are being handled and the purchasers practice income is still flowing! When is the last time you took a three-week vacation? You could do so after completing a PreSale Practice Merger!
Your total office overhead percentage goes down:

After a merger, you are likely doing considerably more dentistry in your office. In fact, you are combining the collections of two offices while at the same time eliminating; one of the rents, one of the utilities, probably some of the staffing, much of the advertising (you now have plenty of patients) and much more. This is the brilliance of merging a practice into your own. After a merger, you are actually able to take home more money on each dollar you produce. If your practice is suffering from high overhead, buying and merging a practice into your own is one way to cure that problem.
A practice merger will eliminate a competitor in your market area:

As we said, a practice merger occurs when you acquire a practice that is in your immediate market area. This practice was a competitor prior to the merger but after the merger, they are part of your practice one competitor is gone.
A practice merger may prevent another competitor from entering your market area:
Purchasing a practice for merger may also prevent another doctor from acquiring the practice and instantly achieving a stronghold in your area. By not acquiring the practice, you run the risk of allowing a more aggressive and formidable competitor than the seller ever was, to enter your marketplace! It is often hard to justify setting a practice up from scratch in a saturated market area. The costs are great and the risk of having no patients is great. It is not impossible, but it is unlikely that a competitor will be able to set up from scratch in your area and have a major negative impact on your practice. But a competitor who acquires a thriving practice in your area is a completely different scenario. That is a true competitor!
The fundamental economics of a practice merger makes financial success likely:

The success of any transaction of this nature is not something that anyone can guarantee. Before entering into any business transaction, you should exercise due diligence. While practice mergers are one way to quickly boost patient flow, each practice has its own footprint that may or may not fit your own. It can be costly to make the wrong shoe fit and growing pains need to be anticipated. Consider various aspects of the practice to be acquired and be sure you have clearly identified your own goals. If the the practice to be acquired will help you reach your personal and professional goals, then a practice merger could be a fantastic option.
A practice merger will provide you with additional doctor coverage in your practice:
If you elect to acquire a practice for merger under a PreSale Program, the seller will remain with you and work as your associate for a specific period of time. What better associate could you have than a doctor who is in no way interested
Dr. Mark Diekmann, is Vice President of PARAGON Dental Practice Transitions, a National Dental Practice Transition Firm assisting both buying and selling dentists with practice sales, mergers, consolidations, and co-ownership plans. You may contact him at 1-866898-1867 or mark@paragon.us.com or visit www.paragon.us.com.
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Profitable Thoughts
What Every Dentist Needs to Know About Disability Insurance

by Mark Tonoff
ith your income levels and job satisfaction decreasing as a result of managed care, insurance companies are convinced that dentists are more likely than ever before to file claims on their disability insurance policies. This understanding, along with a significant increase in claims, forced many insurance companies to drastically change the way they insure dentists, especially those who perform invasive procedures. If you have not thought about purchasing or supplementing your current disability insurance coverage recently, you might not be aware of the negative changes that have taken place. This article should help you avoid many common mistakes when purchasing a policy or supplementing your coverage.
Purchase coverage early in your career

Disability insurance coverage should be purchased as early in your career as possible. Rates are based on several factors, including age. The younger you are when the purchase is made, the lower the cost of the insurance. In recent years, it has become more difficult for females to purchase affordable coverage. Insurance companies have gone from unisex rates to sex-distinct rates costing women 40% to 50% more than men. However, unisex rates may be available using a multi-life billing structure. Even a sole practitioner could qualify for a multi-life rate by providing minimal coverage for her office manager or other staff member. Often, the total premium outlay for both policies is less than the dentist would have paid for her policy alone. Additionally, the practice is entitled to a tax-deduction for the premiums paid on the employees behalf.
company no longer offers similar policies in the future. An individual policy would also not be affected by any additional disability coverage provided by a future employer.
Purchase a policy with an ownoccupation definition of disability

Under this definition, benefits are contingent upon your ability to practice general dentistry or your dental specialty. With an own-occupation policy, a dentist would collect full benefits if he or she could no longer perform general dentistry or their dental specialty, even if he or she returned to dentistry in some other capacity, such as teaching or doing research. Although difficult to find, particularly for dentists, a policy with this clause is advantageous. Check to see how long the own-occupation coverage lasts. Many policies have shortened the time such benefits will be paid. Ideally, you want to purchase a policy with an own-occupation definition to age 65 or longer.
How policies are offered

Disability insurance can be purchased on an individual or group basis. Group insurance is usually provided by an employer or purchased individually from a sponsoring medical association. Although initially low in cost, group policies have several limitations. They can be cancelled (by the association or insurance company), rates increase as you get older and premiums are subject to adjustments based on the claims experience of the group. Finally, group and association contracts often contain restrictive definitions of disability, as well as less generous contract provisions.
Purchase a non-cancellable, guaranteed renewable policy

With a policy that is non-cancellable and guaranteed renewable, you are in control of your financial security. The insurance company cannot cancel, increase premiums, change provisions, or add restrictions to the policy. Therefore, once you own a policy with liberal definitions and contract provisions, you are guaranteed that it will remain that way, even if the issuing
Purchase a policy with a residual disability rider

This rider pays benefits based on your loss of income due to disability, rather than to loss of ability to practice dentistry and/or perform dental surgery. Many afflictions could reduce your effectiveness and your income, but still allow you to work in your occupation. With combination coverage (own
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occupation with a residual rider) you would collect full benefits if you could not practice dentistry and/or perform your dental specialty and continue to receive benefits, proportionate to your loss of income, if you returned to dentistry on a limited basis. Without a residual rider the policy can be viewed as a bare-bones policy that pays benefits only in case of total disability. Therefore, if you could practice dentistry and/or perform your dental specialty (even one day a week), you would not be entitled to any benefits. There are few points to watch for with combination coverage - the residual rider should pay benefits even if you never suffer a total disability, and benefits should be payable to age 65.
are guaranteed to be the same as the original policy that you purchased. Other companies offer the right to purchase a new policy, which would then subject you to definitions, terms and premium rates that may differ from your original policy. This might mean a limited own-occupation period and/or higher premiums for the additional policies that you will be purchasing.
tax deduction and your benefits remain income tax-free.
Summary
Purchasing a high-quality disability insurance policy has never been easy. In addition, the types of policies that were once commonplace are virtually impossible to find today. The availability of certain policy provisions varies widely among the insurance companies. It is important to take the time to ensure that you completely understand the contract provisions of the policies you are considering. The best approach is to meet with an independent insurance agent who specializes in insurance coverage for dentists (not a captive agent who must sell only his or her company products). Then, based on your budget and objectives, you can decide which companys policy suits your insurance needs.
Know the maximum benefit level on the policy

Most insurance companies will issue disability insurance coverage equal to approximately 60% of income. However, insurance companies have decreased the amount of coverage they will sell to dentists, regardless of earnings. The most common maximum benefit limit is $10,000 per month. Therefore, if you have an old policy with a future purchase option rider, you might be subject to the rules that applied at the time you bought the policy. In that case, you might be able to purchase coverage of more than $10,000 per month. Another possibility would be to supplement your individual policy with association coverage, provided it allows for a higher cap on monthly benefits.
Purchase a policy with a COLA rider

A cost of living adjustment (COLA) rider is designed to help your benefits keep pace with inflation after your disability has lasted for 12 months. This adjustment can be a flat percentage or tied to the Consumer Price Index. Ideally, you want a COLA that is adjusted annually, based on a compound interest rate and which has no cap on the monthly benefit. Although important, if cutting the cost of coverage is an issue, this might be the first optional rider to consider excluding from the policy.
Mark Tonoff, is the founder of Tonoff Financial Services, Inc. A NJ based firm specializing in disability insurance, life insurance, annuities and retirement planning. Contact him at 856-795-7571 or www.tonofffinancial.com. The information in this article is not intended to be tax or legal advice and it may not be relied on for the purpose of avoiding any federal tax penalties. You are encouraged to seek tax or legal advice from an independent professional advisor. The content is derived from sources believed to be accurate. Neither the information presented nor any opinion expressed constitutes a solicitation for the purchase or sale of any security. This material was written and prepared by Emerald. 2013 Emerald Connect, Inc.
Think carefully
Disability insurance benefits are generally received on an income tax-free basis. However, if your practice provides you with coverage and takes a tax deduction for the premiums, the benefits are taxable when received. This means that you could lose as much as 50% of your benefits at the time you need them most. A better alternative would be to forego the tax deduction or have your practice give you a bonus equal to the policys premium. You will owe taxes on the bonus, but the practice retains its
Purchase a policy with a future purchase option rider

This rider is a must for young dentists. It offers the ability to increase your disability coverage, regardless of your medical condition, as your income rises. When this rider is exercised, some companies amend your original policy to reflect your new benefit level. This is preferable, because the definitions, contract terms and premium rates
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45 45
Clinical
The Second Golden Age of Dentistry: 3 Top GP Implant Procedures

by Dr. Brady Frank
hile so many general dentists are worrying about health care reform, reductions in allowable fees by major insurance companies, more competition for new patients from the ever expanding corporate practices in our nation, other general dentists are quietly enjoying revenue growth rates that we have not seen in the industry as a whole since dentistrys first golden age. As many know, dentistrys first golden age was a time, several decades ago, when insurance reimbursement for procedures was at 100% without all of the documentation and administrative hassle. While cosmetic dentistry has had a steady revenue decline since 2007, implants and implant dentistry has experienced quite the opposite. The ADA came out with some statistics last year detailing the growth of implant dentistry in the US. They stated that conservatively, we will see a 13% growth in implant dentistry through the year 2015. What is interesting about this ADA study is that it does not include the legions of dentists who have successfully studied and apply the three key implant procedures that we are going to briefly overview in this article. Those that have embraced these procedures have experienced much higher growth rates in their personal practices. Just to give a little deeper understanding as to why these three procedures have caused such abundance in hundreds of GP practices around the nation, lets go over some facts.
I have had the pleasure of consulting with some of the most successful medical practices in the Northwest. The medical practices that have beat medical reform have stuck to the feefor-service niches within medicine. For instance, bariatric surgery and Lasik surgery, which are almost purely elective. I personally have not signed up with any insurance companies over the last 10 years and have increasingly chosen to provide fee-for-service procedures that allow us to free ourselves from insurance dictates. Secondarily, implant procedures represent the highest fees per procedure with some of the lowest procedure times. This allows for extremely high hourly production rates. Lets go over the three most efficient and simplified implant procedures that are most effectively integrated into a busy GP practice with a minimal investment of educational time. These procedures are streamlined enough to comfortably schedule side-byside endo, crown & bridge or composites. One week prior to writing this article I was teaching the 3 procedures in Ashland, Oregon and had a gentleman GP by the name of Andy attend. He stated that he already placed implants and had been doing on average 15 a month at around $4,000 per implant
abutment and crown combo ($60,000). After reading two of my articles published in The Profitable Dentist he said he immediately jumped to doing 30 implants a month. I use this example solely for the purpose of allowing you, the reader, to understand that learning a few minimally invasive, simplified techniques designed for a GP who places implants can be very predictable and effective. The problem you may run across after learning these three procedures is that the clinical time necessary to complete them will be far less than the usual and customary fees charged in your area for the procedures. This means that patients will potentially pay large dollar amounts for procedures that take you, the clinician, very little time or effort. However, this efficiency also gives us, as GPs, the opportunity to give our services to those in need and still find a prosperous balance. For instance, a single mother raising three children may only charge $1,900 for an implant, abutment and crown. You can actually make that work out in your practice while at the same time providing the patient with a significant discount on your implant services. You see, these procedures and techniques that we are about to overview utilize a GPs tools, techniques and protocols. For years GPs
Figure 1L
Figure 1R
Figures 12: Pre- and post-op pan of 3-in-1 Implant procedure, tooth #30.
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have been trained largely by specialists using specialist tools, techniques and protocols. For instance, in a moment you will read how the use of the highspeed handpiece with a special implant surgical bur can be the most exacting implantology tool. In fact, I would argue that the high-speed handpiece is the most exacting tool in a GPs hands. Properly used, it is one of the most efficient and effective tools for a GP providing implant dentistry. Lets briefly overview the three procedures that I promise will transform your practice if you choose to dig deeply into them. The first procedure that I would like to review is called the 3-in-1 Implant Procedure. Many GPs call this the 5-Minute Implant, Abutment and Crown procedure. This simply means that what used to take implant dentists three appointments to accomplish is now accomplished in one, relatively brief, single appointment. This is a huge benefit to your patients because there is less time investment in the dental office and there is typically much less discomfort associated with the procedure. The reduction in discomfort is largely related to the usage of one of the top 5 minimally invasive, no suture, soft tissue accesses. Remember, bone is not innervated, nerves may travel through the bone but do not directly innervate. Any discomfort related to an implant procedure post-surgically is caused by soft tissue. When we provide less invasive surgery, we reduce soft tissue involvement and thus pain. The
3-in-1 implant procedure is applicable for almost any edentulous area in the mouth that is suitable. The initial soft tissue access and first 2 to 5mm of the pilot hole in bone are created using a circular motion with the high-speed handpiece and a Duobur. To view a video, go to www.OsteoReady.com Final osteotomy is created and the implant is placed. Immediately after implant placement a final impression is taken after customizing a straight stock abutment, placing wax in the top of the abutment and taking a standard check bite or full tray impression. Of all of the advances made in implant dentistry over the last 10 years, the No-Drill Implant Procedure, using an Osteoconverter, has had the greatest impact on the general practitioners productivity and patient satisfaction. Immediately after extracting a tooth, an Osteoconverter is inserted with a spiraling motion into the socket which achieves two important tasks: 1. The PDL is scored in roughly 2mm increments allowing blood flow and highly bone forming cells to enter the site. 2. The unique curvature of the root is converted to a cylindrical shape which allows for an implant worthy osteotomy.
The Osteoconverter doubles as OsteoReadys Prestige series implant. Clinicians who place OsteoReady implants may leave the Osteoconverter in place after inserting to serve as the final implant. The Prestige implant doubles as an instrument, the Osteoconverter which is a hybrid between a bone condenser and osteotomb. If the clinician uses another companys implant, simply use the Osteoconverter to convert the site, remove the Osteoconverter by unscrewing counterclockwise and insert a final implant. The majority of GPs who learn this procedure are able to immediately incorporate it into their busy practices. In many practices about 50% of extractions have transformed to extraction and implant cases using the No-Drill implant procedure. Undoubtedly, the extraction takes more time to complete than the implant procedure. Join the hundreds of GPs in the US who are successfully placing no drill implants in their practices using the Osteoconverter. CONTINUED ON PAGE 51.
Figure 4
Figure 2
Figure 3
Figure 5
Figures 3-5: No-Drill Implant placement site #13 using OsteoconverterTM.

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47
Clinical
Dramatic Cost Reduction and Superior Endodontic Results

by Dr. Barry Musikant
are primarily used in the centered position with little deviation. eve all learned about NiTi instrumentation and This form of usage is predicated on their vulnerability if and how used either in rotation or in the form of when they are used with an aggressive laterally applied force. asymmetric reciprocation it has improved our results and the speed with which these results are attained. The limitations imposed by more difficult cases are Yet, the use of NiTi as used in the present systems where the perhaps easier to understand. Tight curved canals produce pulp tissue is within highly curved calcified roots presents both torsional stress and cyclic fatigue. There is a general challenges to these NiTi systems most noted by instrument awareness that the greater separation, the need for an the tip size and taper of the increased amount of instrument NiTi instrument the greater recapitulation and the tendency the potential for instrument to be more conservative in our separation when negotiating preparations. It is in both the such challenging canals (Fig. NiTi easier and more difficult cases 2). When negotiating canals that demonstrate situations where Instrument with difficult anatomy, the alternative methods may present initial use of K-files in creating opportunities for more effective the glide path increases the and efficient treatment. incidence of blockages and Engagement No Engagement ledging that can result in loss of One might question why length complicating the use of easier cases should be treated subsequent NiTi instrumentation. by means other than rotating NiTi. Simply stated, easy cases While the problems associated are generally defined by gaining with K-files and NiTi can be reduced access to the apex more easily and through careful and selective usage, then widening them along length a far more efficient way to overcome to a proscribed dimension with their shortcomings is to adopt the little resistance. One reason little use of K-reamers unrelieved through resistance may be encountered is a 10 and relieved with a flat along that the instruments being in larger length thereafter, confined either to a oval canals touch the walls less. short manual watch winding motion The mesio-distal conical shape or a 30 arc of motion generated by produced by these instruments a reciprocating handpiece. A 30 may not be contacting the walls arc of motion represents one twelfth particularly in the bucco-lingual of a circle or 5 minutes on the face plane of oval canals leaving a good of a clock, an amplitude of motion deal of remaining tissue (Fig. 1). so small that it virtually eliminates any chances of instrument This would not be a problem if those using these instruments separation allowing the dentist to use the instruments were encouraged to work them against all the circumferential multiple times before replacement. This fact truly represents walls of the canal. However, knowing the vulnerability of these a reduction in procedural stress because the downside of instruments to both torsional stress and cyclic fatigue, they CONTINUED ON PAGE 50.
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Continued from page 48. overuse results in a dull instrument not a separated one. For the same reasons, these relieved reamers may be used aggressively against the walls of the canals without fear of breakage (Fig. 3). The cost savings of using instruments that are less expensive to start with and can then be used multiple times in cleansing oval shaped canals to greater apical dimensions without excessive taper along length are substantial. What many dentists dont appreciate is the immediate improvement that occurs simply by switching from K-files to a sequence of unrelieved and relieved reamers. These instruments engage the canal less while shaving more dentin away. They produce a superior tactile perception of what the tip of the instrument is encountering giving the dentist the ability to know when a solid obstacle is being hit and then taking the appropriate steps to negotiate around such impediments. The sensitive tactile perception that the K-reamers both unrelieved and relieved offer the dentist is unmatched by K-files leading to the well-known problems of lost length, blockages and ledging. When we talk about increased productivity, it should never be at the expense of quality and when we consider quality, our goals include thorough cleansing of the canals, or at least, as thorough as possible consistent with the removal of the least amount of dentin as possible. Furthermore, a good deal of research is now questioning the way the dentin is removed. If removed abruptly, say with a single instrument that rotates through repetitive full arcs of motion, research is correlating such action with the development of dentinal micro-cracks 1-9. Those defending systems that induce such damage state that no studies confirm an increased rate of failure. Yet no increased rate of success has been observed with the use of rotary NiTi compared to the traditional use of K-files. If we extend our reasoning just a bit, the fact that rotary NiTi doesnt produce superior results means that the distortions associated with K-files have minimal bearing on success rates, since this was the traditional way endodontics was performed until recently. The data on success rates could lead one to a nihilistic state where we can conclude that techniques of all persuasion have little impact on success rates so why not simply perform endodontics in the least expensive most efficient manner. I think this is simplifying things a bit too much. Such studies are often conducted in universities where, independent of the technique, only acceptable results could be included in the study. Teeth with missed canals, perforations, separated instruments and gross distortions would necessarily be excluded from any comparative study. In comparisons of what is considered effectively done endodontics, there is no evidence of one way being superior to another. Where does this leave the dentist who wants to be procedurally effective and time and cost efficient? Are these goals compatible? Judging the impact of five generations of NiTi instruments making their way onto the market, there seems to be little compatibility with cost control. Since the introduction of rotating NiTi, the cost of endodontics to the dentists have gone up by several hundred percent. Where instruments were once used multiple times, they are now recommended for single usage. Where inexpensive K-files once did the bulk of the work, they are now replaced by one or more (often several more) expensive single use NiTi instruments. Of more importance, the K-files make canal instrumentation in even mildly challenging situations difficult and time consuming to use. So, the success rate may remain the same, but the difficulty in attaining good results with K-files was challenging enough to usher in rotating NiTi which in turn increased the procedural costs dramatically. One well thought out answer established over the years is the replacement of inexpensive K-files with relatively inexpensive K-reamers unrelieved through a 10 and relieved with a flat along length thereafter. Unlike the K-files, the reamers both unrelieved and relieved shave dentin with far more efficiency than K-files while engaging the canal walls far less. Used with either a tight watch winding stroke or in a 30 reciprocating handpiece, the two factors that cause instrument separation, torsional stress and cyclic fatigue are reduced to being inconsequential factors allowing the multiple usage of all these instruments. The result is greater procedural efficiency and reduced procedural stress with the procedural costs being reduced by about 90% in the process. What is being argued here is the rationality of a system independent of marketing hype. K-reamers unrelieved and relieved do away with the shortcomings associated with K-files. They also do away with expensive and vulnerable rotating NiTi. If we compare oranges to oranges, after a glide path of 20 is created, it takes three instruments to create a 25/06 taper the length of a canal using the SafeSider system no matter how narrow and tortuous the canal. Some single file systems claim
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to produce this shape with one instrument when the canals are so wide that a good deal of tissue will be left behind. When the canals are narrow and such shaping might be appropriate, crown-down preparations requiring more than one instrument and repetitive recapitulations are required. In fact, 25/06 preparations are generally not wide enough apically given the research that notes irrigation only begins to be effective with a minimum of a 30 apical preparation with 35 being better. Typically, the SafeSiders open the apex to a 35, step back to a 40 and then overlay a 25/06 tapered preparation as the last step in blending in the middle and apical canal preparations.
Dr. Musikant is a second generation dentist specializing in endodontics. After noticing a dearth of products within the industry, he began Essential Dental Systems, a company dedicated to supplying, safe, effective and affordable endodontic alternative products. Dr. Musikant has been happily married for 28 years to his wife Brunilda. Together they have 2 sons, Julian and Gabriel. You can contact Dr. Musikant at 201-487-9090.
Adorno C.G., Yoshioka T., Suda H. The Effect of Root Preparation Technique and Instrumentation Length on the Development of Apical Root Cracks. Journal of Endodontics (JOE). 2009; 35(3); 389-392. Shemesh H., Bier C.A.S., Wu M.K., Tanomaru-Filho M., Wesselink P.R. The effects of canal preparation and filling on the incidence of dentinal effects. International Endodontic Journal (IEJ). 2009; 42; 208-213. Kim H.C., Lee M.H., Yum J., Versluis A., Lee C.J., Kim B.M. Potential Relationship between Design of Nickel-Titanium Rotary Instruments and Vertical Root Fracture. Journal of Endodontics (JOE). 2010; 36(7); 1195-1199. Burklein S., Tsotsis P., Schafer E. Incidence of Dentinal Defects after Root Canal Preparation: Reciprocating versus Rotary Instrumentation. Journal of Endodontics (JOE). 2013; 39(4); 501-504. Liu R., Kaiwar A., Shemesh H., Wesselink P.R., Hou B., Wu M.K. Incidence of Apical Root Cracks and Apical Dentinal Detachments after Canal Preparation with Hand and Rotary Files at Different Instrumentation Lengths. Journal of Endodontics (JOE). 2013; 39(1); 129-132. Barreto M.S., Moraes R.A., Rosa R.A., Moreira C.H.C., So M.V.R., Bier C.A.S. Vertical Root Fractures and Dentin Defects: Effects of Root Canal Preparation, Filling, and Mechanical Cycling. Journal of Endodontics (JOE). 2012; 38(8); 1135-1139. Yoldas O., Yilmaz S., Atakan G., Kuden C., Kasan Z. Dentinal Microcrack Formation During Root Canal Preparations by Different NiTi Rotary Instruments and the Self-Adjusting File. Journal of Endodontics (JOE). 2012; 38(2); 232-235. Adorno C.G., Yoshioka T., Suda H. The effect of working length and root canal preparation technique on crack development in the apical root canal wall. International Endodontic Journal (IEJ). 2010; 43; 321-327. Khademi A, Yazdizadeh M, Feizianfard M. Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. J Endod. 2006 May;32(5):417-20. Usman N, Baumgartner JC, Marshall JG. Influence of instrument size on root canal debridement. J Endod. 2004 Feb;30(2):110-2.
Bier C.A.S., Shemesh H., Tanomaru-Filbo M., Wesselink P.R., Wu M.K. The Ability of Different Nickel-Titanium Rotary Instruments To Induce Dentinal Damage During Canal Preparation. Journal of Endodontics (JOE). 2009; 35(2): 236-238.
TOP 3 GP IMPLANT PROCEDURES continued from page 47.

The third and final procedure that is transforming GP practices around the nation is the 1-Drill Implant Procedure. Quite simply, instead of the clinician going through a series of four or five drills to complete one osteotomy, one drill is used to complete the final osteotomy. The drill is called a Multi-drill and has the widths of 4-5 drills built into the drill. This procedure is transforming the versatility of Implantology in the GP practice much like recent advances in endodontics have benefitted the general practitioner. The 1-Drill implant may be placed into an immediate extraction site or an area that has been edentulous for the short or long term. The 1-Drill procedure relies on two important variables: 1. The drill used must be end cutting, side/axial cutting and have a modified taper (6% is ideal) 2. The implant used with the 1-drill procedure
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should ideally have aggressive threading, a 6% taper and be self-tapping (OsteoReadys Prestige series implants are approved for this procedure). By utilizing a tapered drill the osteotomy is wider toward the coronal aspect (more dense cortical plate bone) and more narrow apically (generally softer type 2/3 bone). Maxillary 1-Drill implants are inserted using the same tool that is used with the No-Drill procedure (Prestige series). If the site has been edentulous for over 6 weeks, then an impression for the final crown may be taken immediately after the implant is placed. The typical Implant placed with this procedure takes less time to complete than an Im occlusal composite. Now you know why I think that we have a problem with the fees we charge in implant dentistry! If you currently place implants in your practice, I hope that you consider
adding these influential procedures into your daily mix. If you do not currently place implants or currently only place mini implants, I would encourage you to find out more information on upcoming courses offered. It is an honor to partner with you in your journey to provide a greater quantity of streamlined and simplified implant services in your practice.
Having placed thousands of implants, Dr. Frank developed OsteoReady Implants to better meet the needs of his patients. A frequent speaker on implant education, Dr. Frank is an active member of the International Congress of Oral Implantology. You may reach him at bradyfrank74@icloud.com. Go to www.OsteoReady.com for course information or more explanation of the procedures.
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Clinical
BIOFILM:
Are You Treating It Properly?
by Patricia A. Worcester, RDH, BS
Diagram of the biofilm life cycle

Bacteria attach to the surface (A) and begin excreting extracellular polymers (B) that form the cohesive biofilm matrix. Eventually microcolonies are formed (C) and continue to grow into mature biofilms which release cells using specific dispersal mechanisms (D). Contributed by: Dimensions Digest of DENTAL HYGIENE September 2011
iofilm has been studied for more then 300 years. In this time span, we have learned how these micro organisms work in our mouth and their deliberate attack on our oral health. One definition of Biofilms is that they are made up of heterogeneous composites of bacterial communities within a nonbacterial protein, polysaccharide, and glycol-protein matrix of bacterial and salivary origin. The matrix allows for a circulation of nutrients and bacterial metabolites between communities and the environment outside the biofilm. There are extreme variations in oxygen levels ranging from highly aerobic areas within fluid channels to almost completely anaerobic areas in micro-colonies. This article will address biofilm in the oral cavity and what a clinician must do to successfully remove the biofilm. The importance of this is a direct relationship between biofilm and periodontal diseases. Periodontitis is not profoundly different from any other chronic
biofilm-mediated disease.1 In 1978 Costerton and his colleagues renamed plaque as biofilm. However, plaque is a term still used in popular culture. We hear plaque on television commercials and read about it in school textbooks. But for the duration of this article, the term biofilm will be used exclusively. Biofilm is found supragingival and subgingivally. The gingival sulcus presents a very unique living condition for bacteria. In our sulcus, the bacteria cling to its non-shedding surface, the only place in our body where this occurs. Our gingival sulcus is a protected microhabitat for bacteria to multiply. Our mouth contains over 500 different bacterial species. At the end of the day, our mouth has over 7 billion bacteria, and if you have the genetic gene for periodontal disease, your mouth will have over 28 billion bacteria. No wonder the American Association of Periodontologys Classification for gingival diseases consists of 8 categories and 72 subcategories and periodontal diseases consists of 8 categories and 67 subcategories.
The new model of periodontal disease is dependent on the resistance of the host, in other words, your patients risk factors. Risk factors can be local or systemic in nature. Local factors can include both, anatomic or iatrogenic which facilitates bacterial biofilm, and therefore, calculus. Systemic diseases and /or conditions are also contributing factors for periodontal disease. P. Gingivalis and A. Actinomycetemcomitans are two exogenous periodontal pathogens that are resistant to eradication by scaling and root planing. Because their persistence in high numbers after mechanical therapy is associated with continuing periodontal deterioration, the eradication of these and endogenous periodontal pathogens is viewed as major success criteria for successful periodontal therapy. The use of systemic antibiotics as adjuncts to mechanical periodontal therapy to reduce the levels of periodontal pathogens below detectable levels.2 Biofilm disruption must be employed
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at the beginning of antibiotic therapy to maximize the effectiveness of the chosen systemic antibiotics. Intact biofilm acts to protect the most pathogenic bacteria from antibiotics. 3, 4, 5, & 6
The special feature of the infected sulcus is the presence of crystalline calculus, which protects the biofilm and acts #3 EDUCATION. Encourage as a foreign body for additional hands-on courses to expand biofilm formation, so that the expertise. Hygiene school calculus must be removed before Dimensions Digest of DENTAL HYGIENE September 2011 is just the beginning of our the biofilm can be controlled. knowledge. I offer clinical irregularities during your SRP/RDT visits. Even minor roughness like hands-on training using your You must be very methodical in your scratches or grooves of less than a periodontally involved patients, techniques and use over-lapping strokes micrometer on the root surface will taking hygienists to a higher level with ultrasonics and hand instruments. facilitate the adhesion of bacteria. In of patient expertise. Doctors For my tips on both ultrasonic and root irregularities and grooves of only advance their clinical expertise by hand instrumentation, refer to the last a few micrometers the first traces of investing in their clinical training. two editions of The Profitable Dentist bacterial re-colonization start in less With new knowledge, advancement (these are also available online at www. than 24 hours after biofilm disruption. and instruments, hygienists need theprofitabledentist.com). Also, obtain Scratches and grooves have been to keep up to keep current. Our extracted teeth and paint the roots shown to enhance biofilm formation patients deserve excellent care by with magic marker. The magic marker and to protect extant biofilms from knowledgeable clinical experts. will represent the biofilm. You will see mechanical cleaning. Clean smooth how challenging it is to remove all the surfaces colonize biofilm at only a 1. Donlan RM, Costerton JW. Biofilms: survival marker biofilm and that is with using mechanisms of clinically relevant microorganisms. 10% rate compared to scratched or Clin Microbiol Rev 2002;15(2):167-193. 7 direct vision, which a hygienist does not grooved surfaces. 2. Serio FG, Hawley CE. Nonsurgical Therapy. Manual have when scaling. of Clinical Periodontics: Chapter 6:61. Therefore, as hygienists, we 3. Serio FG, Hawley CE. Nonsurgical Therapy. Manual of Clinical Periodontics: Chapter 6:69. Here is a great word picture to help must spend more time during our 4., 5., 6. Schaudinne, C, Gorur, A, Keller D, Sedghizadeh, the patient and hygienist understand the SRP/RDT appointments to remove P, Costerton, JW. Periodontitis An archetypical biofilm disease: JADA, Vol. 140 August 2009 (980). time and techniques involved in removal the root irregularities and biofilm in 7. Costerton JW, Schaudinn, C, Melrose Diane. of biofilms. Biofilm is similar to having a order to arrest periodontal disease. DENTAL BIOFILMS in the ORAL CAVITY: Dimensions Digest of DENTAL HYGIENE; January 2011(18-20) thin smear layer of peanut butter left in By removing all the calculus, biofilm, the jar. Now take that jar and cover the Patricia Worcester RDH, BS, a full and root irregularities, any adjunctive time practicing hygienist for over 30 years, outside with black paper and cut a thin chemotherapeutic agent or systemic founder and director of Mission Possible slit into the top of the jar. Take a spoon antibiotic that is used will be effective. Best Hygiene. Pats knowledge and training and remove all the biofilm from the jar. is your answer to a comprehensive dental This would be a very tedious and timehygiene training program for the entire The 3 Most Effective Strategies consuming task. This is the procedure team. She combines advanced clinical for Removal of Biofilm protocols and the latest technology with we go through to remove biofilm from clinical excellence and hands-on education. the root surface and the sulcus. #1 TIME. Please allow yourself enough time to completely and thoroughly remove all the biofilm, smear layer, pellicle layer, calculus and root
invest in the Hu-Friedy EverEdge and the After Five hand instruments, which are designed to reach 5-10mm subgingivally. Hand instruments must be razor sharp. And ultrasonic tips need to be checked for proper length, which equates to effectiveness.
#2 INSTRUMENTS. Please invest

in new ultrasonic tips such as the Slimline Universal, right and left. Also,
Please call Pat today for a free analysis of your hygiene department. Contact at: patworcester@comcast.net, 954-536-0700, www.missionpossiblehygiene.com
54 54 F A FL AL LL 20 21 03 13
Puzzle Piece
Bernie the Detail Guy

by Dr. Woody Oakes
Recently, my wife was at the landscaping place and noted a business card for an auto detailing company had been placed under the windshield wiper of her car. When she got home, she decided to call him to ask some questions and get some pricing. When she called, Bernie answered the call. He said, I hope that youre not mad at me for placing my card on your car. Not at all, she said. Weve been looking for someone to detail our cars. What do you charge? He said, I charge $90 per car or $100 if you want me to pick up the car at your house Of course she chose the pick it up at your house option. When Bernie arrived at our house, he showed us a before and after photo album of cars he had detailed in the past. He also told a brief story of how he got to detail the owner of Papa Johns Pizzas car. We were sold! When he returned our first car, he gave us his check list showing everything he had done. It included double wax on the hood and trunk lid. Wow, can you see how this concept could be adapted to your hygiene department? Each car was returned to us in pristine condition so thats when Bernie went into the UPSELL. You know Mrs. Oakes, cars last longer and get better mileage when they are kept clean, but commercial car washes are not good for your car because they often scratch the cars paint. However, I can come to your house and wash all of your cars for only $20 each are you interested? Of course we said, YES! But wait, theres more... Bernie sent us a thank you note with before and after photos of our car AND he asked for referrals! So, the lessons learned that can be adapted to your dental office are: 1) Dont be afraid to market. 2) Provide value by communicating everything you have done. 3) Prevent buyers remorse by using before and after photos and by sending thank you cards. 4) Ask for referrals.
(2006) sgame @ bigstockphoto.com
800-337-8467
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The teeth whitening market is growing exponentially and more patients are looking toward cosmetic dentistry. Venus White Teeth Whitening System offers a comprehensive product system: Venus White Max in office, Venus White Pro take-home for custom trays and Venus White Ultra pre-filled disposable trays for an easy new profit center within your practice. Through their online resources you are able to easily access and customize marketing materials through Printon-Demand... postcards, web banners, ad designs, letters and more are ready to go. This guide will provide tips on how to make the most of Venus White in your practice. Order at 1-877-545-6837, ext. #125 or online at www.DDSdentalsupplies.com/tpd
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Dr. Woody Oakes
How to Turn Your Dental Practice Into a Cash Cow (in 12 Months or Less!)
When my copy arrived, I could not wait to open it and dive right in. I have learned so much from Woodys previous books that I wondered how this new book wold compare. I was not disappointed. It is filled with a wealth of information for any dentist at any level in these challenging economic times. It helps to have a cookbook for practice success from the best mentor you will find and this is it! Another great Woody Oakes book added to my collection.
Dr. Craig Callen, Mansfield, OH
Now Also Available on Audio CDs
Woodys One Day Practice Management Course

Only 3% of dentists age 65 can afford to retire and maintain their current lifestyle. And, according to ADA statistics, this same group retires with net assets of less than $300K. Most of this is due to the lack of business skills still not being taught at most United States dental schools. But with the knowledge in Woodys latest practice management book, youll know everything you need to know in order to build a stellar practice and retire in style!
Dental Practice Into a Cash Cow Book for $24.97. Dental Practice Into a Cash Cow CDs for $47.00.
NAME ADDRESS CITY/STATE/ZIP PHONE/FAX EMAIL* *Valid email address must be included to verify/provide tracking information. PAYMENT METHOD CC #:
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YES! I want to order Woodys How to Turn Your
YES! I want to order Woodys How to Turn Your
I believe if you will implement half of his ideas, you could easily double your income over the course of the next year while experiencing greater team harmony and lowered practice stress.
Dr. Brad Pueschel, Peoria, IL
To Order:
Call 1-800-337-8467 or visit www.TheProfitableDentist.com or fax this completed form to: 1-812-949-8535. CODE: NEWS-BKCC
The best 170 pages on dentistry to date! A must read.

Dr. Steven Poulos, Scottsdale, AZ
Exp. Date:
57
From Our Readers

, Hi Woody e I found th ewsletter. . I was n r u o y f o g last issue interestin e joyed the cing very ces for us I really en treatment sequen treatment sequen re o ut article ab here I can find mo w g n ri e d n wo u. n office. g from yo in our ow to hearin rd a rw fo I look Gabriel J Gabriel,
We can send you the treatment sequencing sheets from Dr. John Lyons. Please email us your mailing address. The best ways to create your own is to have a staff member time each procedure that you do. Then come up with an average time for each. Create your own sequence for each procedure and make yourself do it that way every time. Then elimnate the steps you dont need. Look at the sequence chart and eliminate additional steps you dont need. It will take about 30 days to refine those, but then it will work well! Regards,
Woody, In this recent magazine (TP D Sumer 2013 for the Quick ), there was an Shot that can ad conver t film to have you had digital. What about the com reviews pany and thei r product? Thanks for yo ur help. Greg B
Greg, To date , I have not product althoug seen any revie h it look s like a ws on this great id Id reco e a. mm end th DentalT at you m own.co a k e a p o st o m an d s have us n ee if ed to conta it yet. I encou any of the me mbers rage ou ct us wit rT h we get these, w reviews of the PD readers ir ell be s informa ure to p own. As tio as s o n will be re n. Dr. Gordon C the hr v they rate iewing the prod istensen and C uc t an d R it. revealin A g h ow Regard s,
(2008) casaalmare@bigstockphoto.com
Woody, I have a patie nt who has D elta Preferred posterior com of PA . We did posites and th some ey downgrade gams. In the d the fee to am past, I have al always charged ence between the patient th the Delta amal e differgam fee and fee. One patie the Delta com nt was upset, posite called Delta an have to accept d they told he the amalgam r that I fee as paymen t in full. Is that I didnt do an amalgam, I di true? d a composite I should be ab . It seems to m le to charge th e that e Delta differe tell the patient nce to the pa they dont have tient or posterior com and charge he posite covera r the full fee. ge Any help you can give me would be Jef frey, greatly apprec iated. Unfortunately, all Delta has Jeffrey to do is pay you the amalgam fee. You may wan t to order the 2 audio CDs by Dr. Charles Blair tha t we sell covering coding secrets and how to work with Delta.
Woody, We have a long narrow building setup with 9 rooms. What systems are out there for hygiene alert? Thanks. Tony
Tony,
with an mend the radio We would recom scodental.com Ki at e available earpiece which ar White Board nt to look at the Also, you may wa from Dr. ve DVD that we ha or Route Board calling us by is th r u can orde Chris Grif fin. Yo both of these . Dr. Grif fin uses at 800-337- 8967 e radio by tices but claim th in his dental prac not enough. themselves, are Regards,
Send me your questions, comments or interesting observations! Email them to info@theprofitabledentist.com with TPD Reader in the subject line.
In the past, many offices did like you did, but now Delta is cracking down on this and have actually sued dentists who billed the patient for what insurance doesnt cover. In reality, many practices are charging patients the difference, but if a patien t calls Delta, like your patient did, you cou ld be in trouble. Regards,
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Give Me Two Hours And Ill Show You How To Increase Your Revenues From Dental and Medical Insurance $50,000 To $100,000+ Per Year! (What you dont know can hurt you and your pocketbook!)
m not going to lie to you, keeping up with all the new dental insurance plans (and the latest changes in the CDT codes) is hard work. Therefore, I strongly recommend sharing this information with your insurance expert in the practice. Some may not like the fact that they have to study and spend additional time to learn about all of the changes in insurance billing and coding, but it has to be done. One of our coaching clients - in a small town in Texas - added $100K/year to his practice income just by having his fees equilibrated and by using proper insurance billing and coding! Does the thought of losing $50K to $100+K per year really bother you? Dentists work way too hard not to receive every dollar that is owed to them. Its time to plug the leak that is costing your practice thousands of dollars each and every year! Heres some of what Christine Taxin reveals: I dont have to memorize something I can look up in a book When a recall visit isnt a recall visit Emergency visit take the patient out of pain (your only responsibility) 35 new codes/37 revised codes Fee positioning Thought out protocols Audit protection and documentation People retain more if they are exposed to new knowledge at least six times Can you charge different fees for different people? The gas station story amazing! Different fees for different plans? The classification of materials changed this year What you MUST report on the insurance header Why you are allowed to file medical and dental at the same time Why you always have to back up your code (a back up to your diagnosis) Tell the patient what will happen if you dont do the treatment now Diagnostic codes go in order (the second code is your back up code) Media Gap ever heard of it? How to get medical insurance to cover an over denture with mini implants Brush biopsies be sure to attach the lab report to the insurance form Dr. Christine Dumas Probe each tooth 6 times whats biofilm doing?
The SOAP format for dentistry New addition pre-diagnostic services D0191 limited exam by limited clinical exam or independent hygienist Radiographs will now be known as diagnostic imaging The new codes for CT scans in the dental office The changes in topical fluoride coding medical reasons? D0140 (merely looking) D2990 restorative? New build up codes a big problem in billing! D3352 canal medication for endo can this be billed twice? Ignoring perio is more dangerous than alcohol or smoking to pregnant women Perio deleted code now replaced by two codes Florida Probe DANGER, BLEEDING! 100% What code do you report for gingival curettage? 60-DAY The amazing cut hand photo wow! MONEY The protocol for white spot reversal/removal BACK Oral DNA coding GUARANTEE Candid tissue regeneration? How to get CVS to pay for Arestin Use informed consent and no refusal forms (Dont get sued!)
presents Christine Taxin
And much, much more!
Dont wait another day to obtain this valuable information. You know what they say Another day, another dollar! In this case Another day, another dollar lost!
To order Christine Taxins lecture Advanced Billing And Coding on DVD for ONLY $157 call 1-800-337-8467 and mention CODE: NEWS-D1315, or visit www.theprofitabledentist.com TODAY!
Regards, William W. Oakes, DDS PS Order within 48 hours and you will also receive Christines EXTENSIVE lecture handouts! CODE: NEWS-D1315
Does
3211 Grantline Rd, Ste 20 New Albany, IN 47150
PRSRT STD U.S. Postage Paid Louisville, KY Permit No. 354
SERVICE
Dear Doctor,
Matter?
When you call you will speak to a person NOT an answering
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I am so happy with the service provided by DDS Dental and Jason Edson. Their service from the start has been exemplary and on a professional, knowledgeable, yet friendly level that far exceeds all other dealers I have worked with. Nothing ever seems to be too much trouble for Jason. I never feel that I am just one of many clients that he has to deal with each day. It is so refreshing to receive prompt and professional service you can trust.
Melody of Childrens Dentistry of Lake County
We are always looking for ways to save our members $$$... AND provide them with better service! From the feedback we get, I think the NEW TPD Buyers Club is doing a pretty good job. But dont take my word for it, see for yourself.
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Kim McGrail is a great rep. She reports to me every time your company is running an offer or savings. She has a high level of knowledge of all your products and is always willing to help me with our busy dental practice. She is not a clock-watcher she presents herself well and is very patient and willing to go the extra mile for me. I find her to be consistently pleasant, tackling all my orders with dedication and a smile.
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1-877-545-6837, ext. #125

The Profitable Dentist Fall 2013

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News & Information to Increase the Profitabilit y of Your Practice

Breaking Down The Barriers

ONE GIANT LEAP FOR REFINING

What Every Dentist Needs to Know About Disability Insurance BIOFILM:

Dramatic Cost Reduction and Superior Endodontic Results

Your One-Stop Shop for Quality New Patients Since 1998!

on ign s e ps rt D kto Sma s e D es lets hon Tab P t r Sma

Attracting Quality New Patients Since 1998!

Dr. Tom Orent www.1000Gems.com

Dr. Steve Rasner s.com www.PearlSmile

From the Editor

A Word from Woody Cover Story: Scientific Metals Leap of Faith

EDITORIAL ADVISORY BOARD

Advertiser Quick Guide

Were here to help!

Get Two Free DVDs

Stop the Bleeding!

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Retail Price: $397

www.wealthindentistry.com or call 1-888-283-1395

A Word From Woody

The Profit Masters of Dentistry

NAR I M E S L FAL ber 4-5, 2013

ONE GIANT LEAP FOR REFINING

Breaking Down The Barriers

What Every Dentist Needs to Know About Disability Insurance BIOFILM:

At Your Home. At Your Office. On the Go.

Get TPD by mail and email!

ction and Dramatic Cost Redu Results Superior Endodontic

AchiEvE A hiGhEr LEvEL OF cArE. AnD A hiGhEr PrOFit MArGin.

With Zirconia from EA Dental Labs.

The Profitable Dentist.com

3 Tips To A Better Return

Preliminary testing using X-Ray Fluorescence Spectrometer

The Profitable Dentist.com

Your View Of The Future Bleak or Bright?

The Profitable Dentist.com

s e t a t S 0 One Size Doesnt Fit All 5

Paydays and Paychecks

Medical Leave of Absence/Maternity Leave

Breaks and Meal Periods

Valid for new clients only.

Whats the Purpose of (web) Marketing?

My Advice: Dont look for Magic Bullets.

How does that become profitable for a dentist?

Getting people to visit your website wont make you money.

Tired of Roadblocks In Your Practice?

John J. Meis, DDS, FAGD, DICOI Wendy Briggs, RDH

Request Your FREE DVD Today!

Or call (877) 732-2124

Breaking Down The Barriers by Howie Horrocks & Mark Dilatus

Strict New Patient Protocols

We are open 9am to 4pm Monday through Thursday

The Profitable Dentist.com

Avoiding the cost question or promoting primarily base on price

*Valid email address must be included to verify/provide tracking information.

Broken Appointments... Fix Them!

You will learn:

Founder, Implant Efficiency Institute

Brady Frank, DDS

The 1-drill Implant Procedure

The No-drill Implant Procedure

The socket is prepared for an implant three ways: