Dental Practice Management Winter 2010 by Annex Business Media

Dental Practice

CANADA’S CANADA’S LEADING LEADING BUSINESS BUSINESS & & LIFESTYLE LIFESTYLE MAGAZINE MAGAZINE FOR FOR DENTISTS DENTISTS

MANAGEMENT

WINTER 2010

Online Patient Engagement Insights to Improved Practice Success

Deal or No Deal?

The Perils of the Unrepresented Buyer and Seller

Maximize Your Pension and Care for Your Loved Ones

Internet Advertising

What works, what doesn’t, and what can’t

The Greatest Practice Success Determinant (The Economy vs. Our Internal Beliefs/Activities)

A Case Study

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Dental Practice WINTER 2010

MANAGEMENT

Features RESEARCH REPORT

7 Online Patient Engagement:

Insights to Improved Practice Success 2010 North American Dental Practice Survey Findings

OFFICE DESIGN

10 Crossroads Dental

PRACTICE MANAGEMENT

12 Deal or No Deal? The Perils of the Unrepresented Buyer and Seller

John McMillan, LL.B. and Andrea Chan, CA

The Greatest Practice Success Determinant:

28 (The Economy vs. Our Internal Beliefs/Activities) Peter Barry, CMC, RRDH INVESTMENT PLANNING

Have Your Cake and Eat It Too: Maximize Your Pension and Care for 18 Your Loved Ones Lorne Dubros, CFP MARKETING

Internet Advertising:

22 What works, what doesn’t, and what can’t Neil J. Gajjar, DDS FINANCE

Best Pratices for a Successful Retirement Adam Butter, CFI A

Dep a r t m e n t s 5 Editorial

Dental Care: A Basic Human Right?

6 News Briefs

Infection Control in Dentistry; Adding Preventative Dental Care Coverage Benefits Elderly in Long Run

18 www.oralhealthjournal.com

41 Dental Marketplace

Dental Practice Management Winter 2010

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Editorial

Dental Care - A Basic Human Right?

I Catherine Wilson, Editor

f oral health is intrinsically linked to overall health and overall health care is universally covered in Canada... In the summer of 1962, Saskatchewan became the centre of a hard-fought struggle between the provincial government, the North American medical establishment, and the province’s physicians, who brought things to a halt with the 1962 Saskatchewan Doctors’ Strike. The doctors believed their best interests were not being met and feared a significant loss of income as well as government interference in medical care decisions even though Premier Tommy Douglas agreed that his government would pay the going rate for service that doctors charged. The Saskatchewan program was finally launched in 1962. Another Saskatchewan politician, newly-elected Prime Minister John Diefenbaker, decreed in 1958 that any province seeking to introduce a hospital plan would receive 50 cents on the dollar from the federal government. In 1966, the Liberal minority government of Lester B. Pearson created such a program, with the federal government paying 50 percent of the costs and the provinces the other half. So, the adoption of healthcare across Canada ended up being the work of three men with diverse political ideals – Tommy Douglas, John Diefenbaker and Lester Pearson. Canadians strongly support the health system’s public rather than ‘for-profit’ private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported “public solutions to make our public health care stronger.” In November 2004, Canadians voted Tommy Douglas, Canada’s “father of Medicare,” the Greatest Canadian of all time following a nationwide contest sponsored by the Canadian Broadcasting Corporation. Researchers are just beginning to understand the relationship, but these are some of the diseases and conditions linked to oral health: •Cardiovascular disease. Research shows that several types of cardiovascular disease may be linked to oral health. These include heart disease, clogged arteries and stroke. Although in some research periodontal disease seems to be associated with heart disease, more studies are needed before the link can be confirmed. •Pregnancy and birth. Gum disease has been linked to premature birth. This is why it’s vital to maintain excellent oral health before and during pregnancy.

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•Diabetes. Diabetes increases your risk of gum disease, cavities, tooth loss, dry mouth and a variety of oral infections. Conversely, poor oral health can make your diabetes more difficult to control. Infections may cause your blood sugar to rise and require more insulin to keep it under control. •HIV/AIDS. Oral problems are very common if you have HIV/AIDS. Common symptoms include ulcers, dry mouth and related painful mucosal lesions. Mouth problems are caused by either fungal, viral or bacterial infections and, in some cases, one of the first signs of AIDS may be severe gum infection. You may also develop persistent white spots or unusual lesions on your tongue or in your mouth. •Osteoporosis. The first stages of bone loss may show up in your teeth. Systemic loss of bone density in osteoporosis, including bone in the jaw, may create a condition where the bone supporting your teeth is increasingly susceptible to infectious destruction. •Other conditions. Many other conditions may make their presence known in your mouth before you know anything’s wrong. These may include Sjogren’s syndrome, certain cancers, eating disorders, syphilis, gonorrhea and substance abuse. Are these conditions not treated by doctors? Are they not covered under Canada’s universal health care system? Are you not a health care provider? Recently, I received this comment on www. oralhealthjournal.com ...I have not ‘cleaned it up’ because I want you to hear the pain in this voice, then maybe you’d like to answer it for me: My name is ***** and I am wondering what most dentists think about [dentistry] being covered by Medicare. I am thinking about starting a petition on getting the Canadian government to recognize that oral health is as important as any other part of the human body, and emergency procedures and pain relief should be covered by Medicare. I’m wondering about letting people who live in low income situations live with pain, the chance of major infection and possibly death and about basic human rights. I was wondering if you can tell me of any organizations that are out there trying to fight for this cause, or if you can tell me if the dental profession would accept being part of Medicare? Thank you for taking the time to read my questions...I am one of the 34 percent of Canadians who have been living with tooth pain now for 14 years and the pain I’m living with can’t go on any longer. DPM

Dental Practice Management Winter 2010

News Briefs

Infection Control in Dentistry CHICAGO, IL – How often do dentists suffer cuts with sharp objects? How often do they make contact with blood, saliva, tissue or other potentially infectious body fluids? It takes ONLY one incident to expose dental healthcare personnel to hepatitis B virus, hepatitis C virus or HIV infection. During dental procedures it is predictable that saliva will become contaminated with blood, even when the blood is not visible. The risk of HBV from a single needle stick or a cut exposure to HBV-infected blood can be as high as 30 percent! Even though the risk from HCV or HIV is miniscule, it rises if contact involves a large area of skin or if the contact is prolonged. The unsettling fact of the matter is that dental professionals, despite the precautions they take - wearing gloves, sterilizing equipment, washing their hands - are not always as knowledgeable about necessary precautions as they should be. Retail hand care products do not meet the standards of medical grade products which means, says Mary Govoni, past president of the American Dental Assistants Association, that infection control in the dental office cannot be assumed. Dental instrument manufacturer, Hu-Friedy recently launched Hu-Friedy Hand Essentials, a complete line of premium hand care products, including moisturizers, soaps and sanitizers which provide dental professionals with medical grade products for hygiene and help with infection control program compliance. For more information, visit www.hu-friedy.com or www.handessentials.com

Adding Preventative Dental Care Coverage Benefits Elderly in Long Run BALTIMORE, MD – Older Americans could likely have lower overall dental expenses with preventive dental care and more routine dental visits, as indicated by a new study of public records of Medicare beneficiaries says John Moeller, PhD, research professor at the University of Maryland Dental School in Baltimore. In the November issue of the American Journal of Public Health [http://tiny.cc/ ou12b], Moeller and colleagues in the School’s Health Services Research Division have published a comprehensive analysis of a 10,582 representative sample of the nearly 34 million Medicare beneficiaries in community-based homes. The Dental School study showed that Medicare beneficiaries who used preventive dental care had more dental visits but fewer visits for expensive non-preventive procedures and lower dental expenses than beneficiaries who saw the dentist only for treatment of oral problems. “For many retirees, paying for dental care treatment can be difficult,” says Moeller. “Without assistance, older Americans, who are poorer, may choose to delay or forgo dental care, but postponing dental care may lead to expensive complications.” He recommends that adding dental coverage for preventive care to Medicare could pay off in terms of both improving the oral health of the elderly population and limiting the costs of expensive non-preventive dental care for the dentate beneficiary population. Moeller and colleagues Haiyan Chen, MD, PhD, research assistant professor; and Richard Manski, DDS, PhD, MBA, professor, conducted the study because younger people have primarily been the focus of previous studies of the impact of preventive dental care visits. “We felt that insufficient attention has been paid to the possibility that preventive dental care may limit expensive nonpreventive dental care procedures among an older population,” the team wrote. To fill the information gap, the team identifies characteristics of older adults who used preventive and non-preventive dental care as well as those who used no dental care at all, using data from the Medicare Current Beneficiary Survey. MCBS is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, sponsored by the Centers for Medicare & Medicaid Services, is the only comprehensive source of information on the health status, health care use, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries.

A BUSINESS INFORMATION GROUP PUBLICATION Editorial Director: Catherine Wilson 416-510-6785 cwilson@oralhealthjournal.com Art Direction: Valerie Perrott Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca Consumer Ad Sales: Barb Lebo 905-709-2272 barblebo@rogers.com Classified Advertising: Karen Shaw 416-510-6770 kshaw@oralhealthjournal.com Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@oralhealthjournal.com Associate Publisher: Hasina Ahmed 416-510-6765 hahmed@oralhealthjournal.com Senior Publisher: Melissa Summerfield 416-510-6781 msummerfield@oralhealthjournal.com Vice President/ Canadian Publishing: Alex Papanou President/ Business Information Group: Bruce Creighton OFFICES Head Office: 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Telephone 416-442-5600, Fax 416-510-5140. Montreal: 1 rue Holiday Street, East Tower – Suite 705, Pointe-Claire, Quebec H9R 5N3, telephone 1-800-363-1327, 514-630-5955, Fax 514-630-5980. Dental Practice Management is a quarterly publication designed to provide the entire dental team with business management information to make practices more successful. Articles dealing with investment planning, personal finances, scheduling and collection procedures, in addition to lifestyle issues, are geared to all practicing Canadian dentists, hygienists, dental assistants and office managers. Please address all submissions to: The Editor, Dental Practice Management, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Dental Practice Management (ISSN 0827-1305) is published quarterly, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Subscription rates: $10.00 single copy Canada. One year: ON & rest of Canada $26.70; QC $28.70; NB, NF, NS $28.69; U.S.A. US$27.95; Foreign US$45.95. Dental Guide $18.40 in ON, QC, NS, NB, NF; rest of Canada $17.12; US & Foreign US$16.00. Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 1-800-668-2374; Fax: 416442-2191; E-mail: privacyofficer@businessinformationgroup. ca; Mail to: Privacy Officer, Business Information Group, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Canada Post: Return undeliverables to Circulation Dept. – DPM, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Canada Post product agreement No. 40069240. Dental Practice Management, USPS 019-616 is published quarterly by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-to-business information services. US office of publication: 2424 Niagara Falls Blvd., Niagara Falls, NY 14304-0357. Periodicals postage paid at Niagara Falls, NY. US postmaster: Send address changes to DPM, P.O. Box 1118, Niagara Falls, NY 14304. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)

Winter 2010 Dental Practice Management

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Research Report

Online Patient Engagement Insights to Improved Practice Success

2010 North American Dental Practice Survey Findings

dvances in web-based software and services, and their integration with advanced communication and mobile devices, have been the catalyst to a profound evolution in practice management tools. While practice management software is nothing new, integrated web-based services that help manage all aspects of a practice through the entire patient lifecycle are new. And, they are the equivalent of several extra sets of hands – expert hands at that. This report discusses common issues and challenges surrounding marketing and practice growth faced by dental and orthodontic practices of all sizes. Research clearly shows a need for a solution to these challenges that doesn’t require a shift in resources away from other important practice objec-

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tives. A new breed of engagement technology is quickly proving to be a viable option for many practices. A recent survey of over 9,000 dentists and orthodontists from across the U.S.

highlights common issues and challenges being faced by practices of all sizes. This paper shares the findings of the research and how advanced web-based practice management tools help bring

Dental Practice Management Winter 2010

Research Report

new levels of business performance and patient satisfaction. A challenge that many dentists and orthodontists face is that they are experts at dentistry or orthodontics, not marketing – and definitely not marketing in the evolved world of digital and social media. However, the TeleVox research shows that almost 50 percent of dentists and orthodontists are taking on the marketing responsibility of their practices. It also shows that almost three quarters of the staff responsible for marketing the practice have no qualifications or experience in the field. Imagine being able to reduce appointment no-shows by having an informed insight into patient trends and the means

Winter 2010 Dental Practice Management

to send ‘just-in-time’reminders. The TeleVox research shows that there are some very clear trends around appointment no-shows. Over 50 percent of respondents confirmed that Mondays are the worst days for missed appointments, over three quarters of appointments are missed by men, and nearly half of missed appointments are in the 14-25 age group. With this knowledge and insight, practices can take proactive steps to minimize missed appointments by, for example, booking more appointments for women on a Monday than men or increasing the number of reminders. In the case of the 14-25 age group, engaging with them via text messaging might be most effective.

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Research Report

Practice Success is Dependent Upon Quality Data

Considering that accurate data is such an asset to practices, it is odd that nearly half of the practices surveyed only capture and update patient data once a year. It is also interesting that while practices invest much time and resources into capturing patient mailing addresses, very few actually use them for appointment reminders. Similarly, while most respondents of the survey rank text messaging as one of the most successful means of reminding patients of appointment times, only 40% of practices are currently collecting information to send text messages. DPM

In Spring 2011, DPM will highlight more findings from the TeleVox Research Report.

PROFITABLE PRACTICE “A dentist deserves to retire with dignity - and profitably!”

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Dental Practice Management Winter 2010

Office Design

Crossroads D Project Brief

Winter 2010 Dental Practice Management

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Office Design

Dental

SDG Interiors Inc.’s principal Keath Seeton describes the project as exuding a clean and vibrant environment for Crossroads Dental clients and staff. The undulating wall finish in the consultation room and rippled textured glass at reception add textural interest and calming elements that balance the energetic atmosphere. The space is grounded by a sophisticated, yet simple palette of white concrete floors, white walls, bold accent paint and glass, and satin stainless accents. Backlit artwork within the six operatories becomes a feature, but also offers a glow of light, in the absence of exterior glazing and natural light. The design team created a space welcoming family clientele with a safe and engaging child play area. Crossroads Dental supports holistic and environmentally friendly dental practices. The project is located in a LEED Silver Certified building, in a busy and diverse neighbourhood. The majority of finishes were low V.O.C., furniture was either re-used or contains recycled material, and the DIRTT demountable glass walls allow light to flow between the spaces, economizing the use of space and adding a crisp, contemporary element. www.ssdg.com

Interior Design: SSDG Interiors Inc. Contractor: CDC Construction Ltd. Photographer: Nick Didlick Photography

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Dental Practice Management Winter 2010

Practice Management

Deal or No Deal? The Perils of the Unrepresented Buyer and Seller

John McMillan, ll.B. and andrea chan, ca

lmost invariably, when the parties to a practice purchase and sale endeavour to negotiate, finalize and agree upon the terms of the sale without the benefit of legal and accounting advice, they are often much farther away from a final agreement than they hoped or realized. As well, unrepresented parties run the risk of suffering a loss of confidence in one another when they later realize that there was not in fact a meeting of minds as to the terms of the purchase and sale and they cannot

reconcile their respective “reasonable” positions. In approaching a practice purchase and sale, there are many factors to consider, monetary and otherwise, that will influence the direction of negotiations and the final terms and conditions. Having accounting and legal advice early in the process is critical for both parties so they may make fully informed decisions in the negotiation process. This article is for the benefit of both purchaser and seller, as a truly successful negotiation and transaction

Winter 2010 Dental Practice Management

is dependent upon both parties being well informed and fully advised. Discussed will be some (but certainly not all) points often missed by unrepresented parties.

The Valuation The valuation of a dental practice is usually a voluminous, comprehensive and sometimes complex document containing information on the practice being sold. It is strongly advised that a valuation be obtained from a qualified practice valuator.

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Practice Management

Next Stop – Your Accountants

Once the purchaser and seller have resolved to enter into negotiations, the first stop should be their respective accountants.

Value Analysis If you are planning to sell your practice, make sure that your accountant is involved during the valuation process. From the purchaser’s perspective, your accountant should be walking through the valuation with you so that you can make the appropriate decisions, with the first threshold decision being whether or not the practice is worth pursuing based on the information provided. As well, your accountant may suggest that you request further particulars in the course of this

from this. The seller’s intentions in this regard should be communicated to the purchaser (and their advisors) before review by the purchaser’s accountant and certainly well before any drafting begins by the purchaser’s solicitor. As a purchaser, it is important to understand the implications of an asset sale versus a share sale, as the direction of negotiations will be significantly affected by this determination. The seller generally wants to sell shares of their Professional Corporation so they can minimize taxes on the sale by taking advantage of the $750,000 capital gains exemption. The seller needs to work with their accountant and lawyer to ensure that the rules are complied with to implement the tax-free sale. On the other hand, the purchaser general-

amount of income tax and HST the seller and purchaser have to pay. There are also instances where the allocation may not affect the seller at all, but will benefit the buyer.

Next Stop – Your Solicitors While your solicitor should be notified as soon as possible of your contemplated transaction, their involvement in terms of drafting becomes more significant once the accountant has completed his or her analysis and has made recommendations. Otherwise, you may needlessly incur legal fees for documents drafted in a context that may not ultimately apply. Before any drafting begins, the solicitors for the purchaser and the seller will wish to review certain key aspects of the

Both parties should consult with their respective solicitors to fully understand the potential liabilities to employees at or beyond the completion of the transaction initial analysis. This would also be a good time to contact your lender to confirm that financing can be approved to the extent required.

Asset vs. Share Sale From the seller’s perspective, you must consult with an accountant to determine whether it will be a sale of shares (of the professional corporation that owns the practice) or assets (by either the seller personally or his or her professional corporation), as there are significant tax implications to both parties that stem

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ly wants to buy assets to avoid hidden liabilities and increase the asset base for tax write-offs. When the purchaser buys shares, there is an actual tax cost to them, which can often be negotiated to justify a reduction of the sale price.

Purchase Price Allocation – Asset Sale

Should the buyer and seller decide on buying/selling assets of the practice, the allocation of purchase price will also need to be negotiated. The allocation can have a significant impact on the

business – aspects that can have a significant effect on the value of the practice and perhaps the parties’ approach in negotiations.

Identifying the Vendors – Share Sale

It might be surprising to hear that your family members may need to be named as sellers in the Agreement. It is not uncommon for family members to hold equity shares for the purpose of duplicating capital gains exemptions on the sale of shares. It is critically impor-

Dental Practice Management Winter 2010

Practice Management

tant for the solicitors to be aware of this, as the form of agreement will be vastly different as it must make allowances for the additional parties and their respective rights (and obligations) under the Agreement.

Preliminary Due Diligence While a properly drafted agreement contains due diligence conditions to be satisfied within a prescribed period after acceptance, it might be prudent for your solicitor to research the background of the other party. This would involve various searches available in the public record. As a selling dentist, you may wish to have the comfort of knowing that the dentist taking over the care of your patients is a dentist of good character and credit-worthiness and without past or pending complaints or claims. As a purchaser, you may wish to know that the seller is a person of good character and without any past or pending claims, or liabilities which may be an impediment to the completion of the transaction.

Employee Liabilities On the sale of a business, a significant potential liability can arise from the subsequent termination of employees. As a result, a properly framed agreement will expressly address the allocation (and time limits) of such liabilities between the purchaser and the seller. Both parties should consult with their respective solicitors to fully understand the potential liabilities to employees at or beyond the completion of the transaction.

Premises Lease There is almost invariably provision under the premises lease in relation to the assignment of the Tenant’s rights and obligations. In the event of a practice sale, the Lease often requires the Landlord’s consent. This may also apply in a share sale if the Lease has a provision that deems a change in control to be an assignment of the Lease. At

times, the Lease will provide that such consent shall not be unreasonably withheld and other times it may say that the Landlord may “arbitrarily withhold consent” or worse, “terminate the Lease without compensation to the Tenant”. The solicitors for both parties should review the premises lease and consult with their respective clients as to the requirements and possible obstacles to an assignment of lease (or new lease). It is also important for the purchaser to understand any onerous provisions in the lease (with the view of eliminating them wherever possible). The purchaser should also be aware that if they are financing the purchase, lenders invariably require a lease with aggregate terms (including available renewals) equal to or greater in duration than the term of the loan.

Preparation of Agreements While it can be helpful to maintain nonbinding reference memoranda during the initial stages, attempting to reduce the parties’ understanding to writing in some form of binding agreement or something purporting to be a “standard form” agreement without the benefit of legal and accounting advice can lead to disastrous results for one or both parties. Too often the writers receive initial calls from purchasers and sellers who indicate either “we have a deal and just need you to quickly write something up” or worse “we have drafted and signed an agreement and just need you to help us close the deal”. For the reasons cited above (and others), it is important to leave the preparation of binding agreements to the solicitors, with proper and timely input from your accountants from the beginning and throughout the process.

Representation Throughout and Beyond the Transaction

After the offer is signed and accepted, regardless of whether you are the buyer or seller, you will still need an accountant to help you through the process.

Winter 2010 Dental Practice Management

For the purchaser, a properly drafted agreement provides for a period of time to conduct detailed financial due diligence by your accountant. Financial due diligence includes a review of financial statements and tax returns, accounts receivables listing, and production reports. You want to ensure that the valuation gave an up-to-date picture of the practice. Particularly if you are buying shares of a professional corporation, you take over all the liabilities of the corporation, including tax liabilities. For the seller, there are tax returns and financial statements that need to be filed. If you are incorporating right before a sale, your accountant will need to prepare appropriate documents for filing with the Canada Revenue Agency to ensure the available capital gains exemption. In addition, these documents need to be provided to the buyer’s accountant for their due diligence. The solicitor for the purchaser will also conduct further due diligence after execution of the agreement and before completion of the sale to ascertain and requisition action by the seller in relation to any liabilities, claims, judgments or any other impediment to the completion of the purchase of the practice (clear of all encumbrances). It is also important to retain your accounting and legal advisors not only to the completion of the transaction, but beyond as well, as there are a several routine (and sometimes unexpected) tasks that will require your accounting and legal advisors. DPM John McMillan is a Toronto business lawyer serving dental professionals. He can be reached at (416) 364-4771 or johnmcmillan@bellnet.ca Andrea Wong, CA is a Toronto chartered accountant at Meyers Norris Penny LLP specializing in providing strategic and tax advice to health professionals. She can be reached at( 416) 515- 3831 or Andrea.Chan@mnp.ca

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27.10.10 11:03

Dental Practice Management Winter 2010

DPM2010_

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3 Eliminate paper charts and chart handling with our secure chartless solutions

3 Minimize non-productive “empty chair” time using a variety of scheduling tools

3 Increase efficiency and improve accuracy of payment handling with support for integrated electronic credit/debit card processing

3 Increase collection efficiency with flexible payment options and real time electronic claims

3 Save time and reduce paper use by capturing signatures electronically/ protect e-documents using electronic signature devices

As Canada’s dental software leader, ABELDent Inc. provides more than great software. We offer 24/7/365 telephone support, on-site and online training, interactive training videos and a range of other value-added services, including:

3 ABELHealthNet Patient/Practitioner Porta

3 Remote Backup and Backup Data Verification Service

3 Remote Computer Monitoring and Administration

3 Hardware Purchase and Installation

Over 6,000 of your colleagues already benefit from using ABELDent software and associated services. Our primary focus is on serving the needs of Canada’s dentists. For over 25 years we’ve collaborated with dental professionals to create innovative features that enhance patient care and practice profitability. Our Microsoft Gold Certified Partnership, achieved by only 1% of Microsoft partners and ABELDent’s Class II Medical Device Licence attest to our technical excellence.

Today and for the life of your practice - ABELDent is your best choice. Call 800-267-ABEL (2235), press 1 and ask for Sales or visit www.abeldent.com/dpm for more information. 16

Winter 2010

Dental Practice Management

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Canada's dental software leader, ABELDent Inc.'s mission is to maximize your benefit from dental software for as long as you practice dentistry. ABELDent is feature-rich, user-friendly software for your entire practice and it is backed by an experienced team with a 30-year track record of delivering innovative, high quality software and services to Canadian dentists. Comprehensive software that adapts to your needs. ABELDent's comprehensive clinical and management features include secure recordkeeping and other tools for the paperless dental office. Developed in collaboration with over 2300 practices that use it daily, ABELDent offers a perfect balance of ease of use and flexibility to support a variety of practice styles/needs. High quality, low cost support. Professional, responsive support 24/7/365 at a very reasonable price. Support plan options to meet your needs - flat rate packages available, or pay only for the support you actually use. High client satisfaction. In an independent survey sponsored by Microsoft, 97.4% of the respondents reported satisfaction with ABEL products, support and customer service.

Freedom of choice. As an independent company, we will work with dental equipment and hardware suppliers of your choice to provide the most seamless experience possible. ABELDent integrates with many imaging and digital radiography solutions. Services with impact. Innovative services including online/on- site training options, web-based patient services, websites, remote system monitoring, remote data backup and integrated payment processing, help ABELDent users to maximize the benefits of their technology investment. Committed to Canadian dentists. ABELDent Inc. is guided by and responsive to the needs of Canadian dentists. ABELDent is taught in dozens of dental programs and there are thousands of experienced ABELDent users across Canada.

Health Canada now requires patient management software to hold a Class II Medical Device Licence. ABELDent obtained a current medical device licence on July 23, 2010. Visit www.abeldent.com to learn more.

800-267-ABEL (2235) - info@abeldent.com - www.abeldent.com/dpm

Investment Planning

Have Your Cake and Eat It Too:

Maximize Your Pens and Care for Your Loved Ones

hen it comes to making important decisions, everyone likes to have options. This is especially true as one nears retirement and the time to choose the pension option that’s most appropriate for you and your family is quickly approaching. Not only will the decision you face have wide ranging repercussions – as it will determine the income you’ll receive for the rest of your life as well any survivor’s benefit- but it is irrevocable.

Benefit payment options Pension plans provide a benefit to the retired plan member that continues to the surviving spouse for life (normally as a reduced amount) once the retiree passes away. This is commonly referred to as a “joint life” pension. Most plans, however, offer retirees a number of additional payment options, one of which is a “single life” pension. These do not pay a pension to the surviving spouse. Since single life pensions pay benefits over just one lifetime, the monthly payments to the pensioner are

Winter 2010 Dental Practice Management

higher than if the pension is guaranteed for two lifetimes. However, because single life pensions provide an income for just one person, they effectively disinherit the pensioner’s spouse in the event of the pensioner’s prior death. Because most plan members with spouses aren’t willing to accept that risk, the single life pension isn’t really an option. Instead, most individuals opt to build in a risk management component by selecting a joint life pension. That is, they accept a smaller income in exchange for the certainty of knowing

www.oralhealthjournal.com

Investment Planning

Pension

Lorne Dubros, CFP their spouse will receive an income in the event of their death. The “premium” they agree to pay for this certainty, therefore, is a reduced monthly pension. Accepting a smaller income appears to be the only choice for most people approaching retirement. Further, some plans literally prohibit married retirees from choosing a single life pension-they offer them only one choice, the joint life pension. With careful planning, however, you may be able to opt for the larger benefit that comes with a single life pen-

www.oralhealthjournal.com

sion while resting assured knowing your spouse will enjoy a comfortable lifestyle in the event of your death. The right life insurance policy, purchased at the appropriate time, can provide the best of both worlds. How does this “pension maximization” concept work? It’s quite simple. Upon the death of the pensioner, proceeds from their life insurance policy are invested to provide an ongoing income for his or her spouse. It’s the knowledge that cash is certain to be made available to provide income for the surviving spouse that allows a pensioner to choose a single life pension. This income may exceed the survivor’s pension that would have been available to them through a joint life pension. In addition, there could be some capital remaining upon the death of the surviving spouse to share with loved ones or to form part of their charitable legacy. Should the pensioner’s spouse die first, the pensioner still retains complete control of the insurance policy. The pensioner may choose to cancel the policy or designate other beneficiaries. You may not necessarily need to purchase additional life insurance coverage to implement this strategy. The coverage you bought once upon a time to serve another purpose could be used to maximize your pension. If your existing coverage is term insurance, however, it may be necessary to convert it to some form of permanent coverage. So what is the ideal time to consider pension maximization? One thing’s for certain- if you wait until you’re within a few years of retirement, it’ll probably be too late. The ideal time to implement the strategy is at least 20 years from retirement, as that’s typically when it’s most affordable.

Understanding the Costs of Certainty

Given the choice between a single life pension and one that provides a sur-

vivor’s benefit, most people opt for the latter. As we see in the illustration below, however, choosing the selfless option often forces retirees to accept a smaller monthly income. The illustration is based on a hypothetical, 45-year-old male, with a 43-year-old spouse, who anticipates retiring at age 65. Should he opt for a single life pension, his pension income is projected to be $3,200. Should he opt for a joint-life pension, his income will be $2,637.1 Pension Option

Monthly Pension

Single Life pension

$3,200

Joint & Survivor pension

$2,637

Cost of certainty

$563

Through the use of life insurance, the pension maximization strategy can allow you to opt for the significantly higher pension income that comes with a single life pension and provide you with peace of mind knowing your spouse will be taken care of in the event of your death. The cost effectiveness of the strategy depends on several things, including the cost of the life insurance, the investment return needed to produce the survivor’s pension and the availability of indexed benefits through the company pension plan. DPM REFERENCE 1. The projected pension figures provided are for illustration purposes only.

Lorne Dubros, CFP, is senior financial consultant with Investors Group Financial Services Inc. He can be reached at lorne. dubros@investorsgroup.com or (416) 491-7400.

Dental Practice Management Winter 2010

ADVERTORIAL

CARESTREAM DENTAL is known for providing high-quality, affordable imaging solutions to dental professionals throughout Canada and around the world. From the introduction of dental film in the nineteenth century to the invention of dental digital radiography in the 1980s, our history of innovation continues to thrive with the addition of cutting-edge dental imaging products, such as:

•˜THE KODAK 1500 Intraoral Camera: Our award-winning camera makes conversations with patients easier than ever. Thanks to the camera’s unique liquid lens technology that works like the human eye, you can consistently capture clear, detailed images. Combined with the industry’s highest still image resolution, true autofocus, and LED lighting, the KODAK 1500 camera ensures every shot is superb—right down to the smallest detail.

•˜The KODAK 9000 3D Extraoral Imaging System: Boasting the highest resolution, industry-leading voxel edge of 0.076 mm, and the lowest radiation in its class, the KODAK 9000 system’s focusedfield imaging is ideal for endodontic, periodontic, and orthodontic evaluations, as well as implant placements for 1 to 2 teeth. And, our optional stitching software combines 3D volumes to allow practitioners to address a larger view of the dental anatomy—a great feature for procedures such as full mouth restorations.

•˜The KODAK RVG 6100 Digital Radiography System: Featuring the highest resolution digital imaging sensor on the market today, the RVG 6100 system makes even the most complex examinations quick and easy. Available in three convenient sizes (0, 1 and 2), the sensor is designed to ensure patient comfort and easier positioning for its users. Plus, like all of our dental imaging systems, RVG 6100 sensors are backed by comprehensive warranty programs to provide complete peace of mind.

About Carestream Dental On September 1, 2010, Carestream Health’s dental systems group, the exclusive manufacturer of KODAK Dental Systems, announced the harmonization of its worldwide dental divisions under the Carestream Dental name. Carestream Dental offers imaging and practice management systems that enable dental and oral health professionals to easily capture and share images, streamline their workflow and enhance patient care. For more information, or to contact a Carestream Dental representative, call 800.933.8031 or visit www.carestreamdental.com. About Carestream Health, Inc. Carestream Health, Inc., is a worldwide provider of dental and medical imaging systems and healthcare IT solutions as well as molecular imaging systems for the life science research and drug discovery/development market segments, and x-ray film and digital x-ray products for the non-destructive testing market.

Winter 2010

Dental Practice Management

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*Financing available for qualified buyers only. Free Kodak 1500 intraoral camera with purchase of a Kodak 9000 3D extraoral imaging system only. RVG offer includes full product replacement at no cost for years 1-3 and a $2,500 deductible in years 4-5. Order must be placed by December 15th for shipment no later than December 22, 2010 to be eligible for the promotion.

11/19/2010 2:44:06 PM

Marketing

Internet Advertising:

What works, what doesn’t, and what can’t Neil J. GaJJar, DDS

aving spent a lot of time in Canada and the United States, interacting with dentists of both countries, it is clear that there has been a slowdown in dental office production in both countries. This has been obvious, more so over the last six months than we have previously experienced. Rest assured you are not in this boat by yourself; it is affecting every industry, every profession, including ours. One of the main principles in marketing is that a business should spend more money in advertising when the economy is slow. This is based on the fact that there are limited dollars being spent in the market and that your brand should be the one that captures that dollar when it is spent. This has always been the case, but it is less so this time than in the past. The reason being is that there has been almost a stop in the movement of money. When there is very little money people have to spend, even with all the advertising, they may want to spend it with you, but can’t. Hence, the key in today’s economic condition is to hold tight and weather the storm. During this slow period, I believe

the best thing to do is work on your website, search engine optimization, and build your social media sites. However, many still believe that they should spend more money to advertise and over the last few months I have seen some very creative internet advertising – Zoom Whitening for $99, Light Activated Whitening for $25, and a Complete Exam, Two Bitewings, and one hour of Cleaning for $39. While these dentists have meant well with these creative internet promotions, I can tell you that there are serious problems with the approach. First, you are not a restaurant where you have something unique to offer and want people to try your food and hope-

Winter 2010 Dental Practice Management

fully keep coming back to your restaurant. Your service is like everyone else, and as such, there is only so far a person will travel and pass so many other dental offices to see you. You will however, drive to the other side of town to eat a good meal and you will recommend the place to others if you like the food. You may think that you and your staff will provide such good service you will win their loyalty from the patients’ current dentist. Do you really think you and your staff are that good and better than the other thousands of dental teams out there? I believe that each has their unique offerings. Have you ever wondered why these internet ‘fans’ are coming to your office? It’s not because of your service, but because you are offering your service at a discount. So, by attracting this price conscious client, do you not think they will ask you for a deal on every service you provide? If you gave an 80% discount on the cleaning, why can’t you discount their restoration, denture, or implant? Is this the patient you really want? Do you actually think you are going to get good patients and that these promotions will help build your business? You have

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Marketing

to understand that many people outside your backyard subscribe to these emails. When I mean outside, I mean, Stephenville, Newfoundland and Detroit, Michigan. Remember, when you advertise a deal, many people will subscribe/purchase it to use when they visit. Hence, you will not get any follow up business other than the one-time loss you experienced. A loss leader works for milk and water, hoping consumers will buy other lower ticket, high margin items, but even these stores are finding themselves having to set limits, something you cannot do in dentistry. Those are my thoughts on why you should not waste your time and money on this type of internet advertising. However, you may think I’m wrong and want to take the advice of those who advocate the use of these channels. Remember, these guys have an incentive for you to use these channels. You buy product from them at full cost and sell it to recoup half your cost in the hope of getting patients. Who wins? The patient and the supplier! Regardless, if you don’t want me to help save you some money, at least let me help save your dental licence. That’s right; the rules in Ontario regarding

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these advertising channels are much different than those of the United States. First, you cannot split your fees with anyone other than a Dentist and under certain situations, a Dental Hygienist. The terms of most of these Email Marketing companies is that they take 50% of the revenue received for these services. By you signing a contact with one of these many Email Marketing companies, you are splitting your fees for a particular service and hence subject to professional misconduct and the potential discipline which may include fines and/or suspension from the Royal College of Dental Surgeons. A second violation is in regards to Referral Fees. A dentist in Ontario cannot pay anyone a fee for the referring of patients to their office. By virtue of these companies charging 50% for referral of patients to your office, this could put you in jeopardy for another area of professional misconduct. Finally, if reductions of fees are advertised, those reduced fees must be charged to everyone, whether they have third-party coverage or not. Furthermore, by offering reductions to only new patients, you may upset patients who have been loyal to you. If you choose to offer light whitening with no

expiry for $99 or consults, radiographs and cleanings for $39 to the members of the website, than be ready to do it for anyone for the rest of your life or find yourself with complaints resulting from patient dissatisfaction. I hope that helps with your marketing decisions, saves you some money, and keeps your Certificate of Registration on your wall. DPM

Dr. Neil J. Gajjar has written numerous articles and lectured on practice management, marketing, and advertising. In addition to being involved in industries outside of Dentistry, he has served on the Marketing Committees of both the Ontario Dental Association and the Academy of General Dentistry. He has also acted and continues to act as a marketing consultant to numerous dental drug, suppliers, and device manufactures. Dr. Gajjar can be reached at: info@drgajjar.com or visit www.drgajjar.com

Dental Practice Management Winter 2010

ADVERTORIAL

Winter 2010

Dental Practice Management

ADVERTORIAL

With Lasers: It’s the Wavelength, Power, Control, and Ergonomics; That Matters! By Scott D. Benjamin, D.D.S. The promotion, popularity, and success of laser treatment outcomes in other healthcare areas, like ophthalmology, have made patients more inquisitive about dental laser use. This desire facilitates the investigation and use of lasers in all aspects of dentistry by patients and clinicians alike. The benefit of laser use for soft tissue treatment and management is that treatments are often less invasive, more precise, and very conservative, preserving healthy tissue while treating the diseased site. When evaluating which laser is best important considerations are; who will use it, what procedures will be performed, why will it be beneficial, where will it be placed, and how will training be done. This simple, who, what, why, where, when and how philosophy, seems elementary, yet often over looked with new technology acquisition. This also translates into investigating; the science of laser physics, the ergonomics and device portability, the type of training, cost and dependability of the manufacturer. How the laser interacts with tissue is strictly dependent on laser physics. The science does not change from device to device, but the individual properties do. I am often asked, “When will we have one laser that will be the best to do everything?” With the introduction of the portable SIROLaser Advance we are as close as the laws of physics will ever permit for soft tissue procedures. This 980nm class laser’s wavelength takes advantage of soft tissue’s 70% water content which highly absorbs its light energy and enhances the laser’s ablating (vaporizing / cutting) efficiency. The absorption coefficient of the 980nm wavelength is by water 10 times greater than the 810nm wavelengths used by most other lasers. Additionally, because the 980nm wavelength interacts with tissue using light energy, as well as thermal conduction, it allows for water irrigation to cool surrounding tissues, controlling collateral thermal damage. This is not possible with most lasers in the 800-940nm range; their interaction mechanism is strictly thermal conduction which may be negated by the cooling process.

Winter 2010

Dental Practice Management

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The SIROLaser Advance’s high 14 watt peak power with microsecond pulse feature allows microscopic tissue to be precisely removed with each pulse and allows thermal recovery (relaxation) between pulses, minimizing collateral tissue damage and post-operative discomfort. Other benefits of the portable battery operated SIROLaser Advance are its phenomenal ergonomics, with its integrated finger switch eliminating the need for another foot control, and its intuitive, easy navigation touch screen, simplifying its use and improving treatment outcomes. With increasingly significant differences being introduced into dental lasers, it is important to understand their enhancement values. It is the responsibility of clinicians to become knowledgeable about laser physics and select the best devices for their practices. It is imperative that practitioners become properly trained specifically on the lasers they use enabling the best patient care possible.

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17.09.10 18:12

Practice Management

The Greatest Practice Success Determinant (The Economy vs. Our Internal Beliefs/Activities) Peter Barry, CMC, rrDH

ecently, practice owners, laboratories, distributor sales reps, consultants and marketing leaders and others met over an informal breakfast to discuss the current status of our economy and its impact on dentistry. I was amazed at how divided the individual perceptions amongst the group were. One dentist explained that his office was the last remaining business open in a strip mall that previously housed 12 retailers. His belief was that the economy is “in the pits”. Another dentist from a neighboring community expressed that her practice is having its best year ever and is planning an expansion. Her belief was that the economy is doing just fine and full of opportunities. Similar contrasting accounts were expressed by the most others in attendance. There seems to be a significant trend amongst those already doing well but wanting to move to the next level. They are usually of the opinion that the economy is doing well and full of greater opportunities. Those experiencing any sort of slowdown tend to be of the opinion that the economy around them is in decline. In a sense they feel handcuffed and victim to the unfortunate circumstances of the marketplace around them. In his international bestseller “You’ll See it When You Believe It” Dr. Wayne Dyer suggests that your belief in something before it actually exists in your life has everything to do with your ability to create/achieve it. He goes on to explain that our emotional responses to everything in life are caused by our thinking about a situation,

Winter 2010 Dental Practice Management

and not the situation itself. Most of us erroneously believe otherwise. If you believe that the economy is the pits and that your practice is victim to the economy then it will be impossible for you to tap into greater opportunities that may be available to you, even if they are staring you in directly in the face. Simply put, “in life we become what we believe and think about the most. I guess Henry Ford was right when he said “if you think you can, you’re right! If you think you can’t, you’re right”! Let’s examine what really determines practice success. Is it the economy or is it our internal strategic activities? To break free of our external circumstances we must become internally driven and develop an attitude of abundance. Blaming a slowing economy (however real) will only serve to handcuff you and imprison your future to the limits of those beliefs. If we are to compete effectively in the 21st century marketplace, we must raise our belief in our selves, our services and in our patients, especially during periods of economic slowdown. This is important because what you are thinking in your mind and feeling in your heart while you interact with your patients, will be projected onto them more loudly than the actual words you use. Of course we cannot fully dismiss the impact of the economy on our dental practice. I am well aware that certain communities thrive on one or two local businesses (as an employer) and that these communities can be greatly impacted if one of the employers suddenly decides to shut down or relocate out of the area. Let’s keep in mind that even in a grossly down market, not all sales dry up. People in business are still purchasing things and patients still require dentistry. Commerce doesn’t come to a full and absolute standstill. This realization is crucial. I am work-

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Practice Management

ing with a client whose practice had been stuck in a decline for years but they didn’t actually feel it financially until recently. For years they have been coasting/riding their rapidly growing local community marketplace. Then suddenly things began to change, large openings began to appear in the schedule, treatment acceptance went down, new patient flow decreased and their profits started to be affected. So they blamed it on the most obvious culprit... the economy. Yet there were still a few offices around them that were not feeling it and doing quite well. If your office is doing well merely because the marketplace (economy) is doing well, then you’re not really in control of your level of success. You could even be stuck! If your dental business that produced $1-million last year produced $1.1 million this year you could argue that your business is growing, but in actuality it may have been the marketplace that has grown without any internal proactive or strategic action on your part. In such cases when the market dries up, it takes the stuck practice down with it. Therefore, linking your practice opportunities to the status of your local economic marketplace cripples any control you may have over your level of success. We must always ask ourselves the empowering time tested question “what role do we play in our results”. What can we do? What control do we have? In a slow market it becomes even more important for each community practice to more strategically compete with all the other things your patients are spending their discretionary money on. You have to believe you are worth more to your customers than what you sell. The way you package the entire experience people have while under your care will determine how well you are able to compete. It will also determine how well you are able to influence your customers to prioritize and see greater value in your services. There is a difference between good clinical dentistry and good patient care. Good clinical dentistry is delivered into a mouth but good patient care is served into the

www.oralhealthjournal.com

life of the human attached to the teeth. The following are six personal growth and development initiatives that will enable you/your office to escape the forces of a slowed local economy... 1. Attend practice management courses that teach you about the business aspects of operating your practice. 2. Strengthen the effectiveness of your team meetings so that you continuously innovate and recreate yourselves. 3. Spend time strengthening your positive beliefs by talking with those clinicians that are doing well and not perceiving an economic slowdown. 4. Boost your patient communications excellence by learning the art of question techniques and high level listening. 5. Develop a healthy view of selling and strengthen your sales skills through courses and reading. 6. Enhance the people skills of your entire team. Developing deep bonds and healthy personal relationships with your patients is a tribal effort. Life truly is a mirror. If you stand in front of a mirror and make a pleasant face, a pleasant face looks back at you. Our practice life is no different. The results we experience in large part are a mirror reflection of our output. We can all heed the advice of the late Dr. Jim Pride of the Pride Institute who often said ‘stop blaming...your team, your location, your patients, dental insurance the economy or whatever other external factors you see on your radar screen and adopt the attitude if it’s going to be, it’s up to me’. We are only limited by our imagination. It’s a recession if it’s around us; it’s a depression if we surrender to it.

Peter Barry is a Practice Mastery Coach and founder of Successful Practice Architects a coaching company dedicated to serving the Growth & Development needs of Dental Professionals. He is the creator of “The Dental Olympics Advantage(tm) Growth & Development Programs”. He is also a member of the Academy of Dental Management Consultants. Peter provides customized group and one-on-one success coaching to dental teams across Canada and the U.S. peter@practicemastery.com or (416) 568-5456.

DPM

Dental Practice Management Winter 2010

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Winter 2010

Dental Practice Management

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Paper has always been an aspect of dentistry. Whether it’s a dental chart, questionnaire, or client information, paper is the tested and traditional way of recording and archiving information. Yet because these archives are made of paper, they have limitations. They can’t be searched quickly, they can’t be organized quickly, they can’t be edited or viewed simultaneously and more importantly they have the unfortunate ability to be misfiled, lost or damaged.

With Power Practice Px with Power Chart all dental chart information can be accessed simultaneously in the paperless office environment. Power Practice Px and Power Chart work together so that charts can be viewed and edited whether you are performing chairside or working at the front desk. This means that every team member can view and edit his or her part of the chart while, at the same time, other team members can view the chart for their task.

The paperless or virtual office remedies these problems as the charts and other traditionally paper information are all replaced with electronic copies. This makes it possible to organized and query your information based an any criteria quickly and thoroughly, back up all your charts and information to keep all your information safe and impervious to loss and have the ability to edit the same chart from different stations so multiple team members can work simultaneously and efficiently on a single chart.

Be Secure How secure are your paper charts? Do they have encryption algorithms? Are they stored in a system at the security level of banks or hospitals? Is it even possible to make complete back ups?

Be Organized. How great would it be to pull up all the charts for the day in about 30 seconds instead of 30 minutes? And how great would it be to never have to re-file and possibly misplace these charts everyday at the end of the day. What would it feel like if detailed information about your patient were available at chairside while you are practicing?

Power Practice Px and Power Chart store and retrieve information from a robust MySQL database. This data in the Power Practice Px and Power Chart database is encrypted at a 128-bit level - the same security level as banking websites or hospital information portals. Additionally copies can be made of all your charts on a back up device so that, in the event of a catastrophe, you can restore all data and continue on as quickly as possible.

This is what Power Practice Px with Power Chart does for practice organization. Patient Profiles are found quickly and easily and are accompanied with the ability to view all recorded details. Be Efficient with Time and Resources Have you ever tried to share a chart between all team members? Well then you’d know that everyone wants to fill in his or her part at the same time.

Most of these security features are difficult, if not impossible, for paper charts to achieve. Yet these features comes standard with the paperless office made possible with Power Practice Px and Power Chart.

With Power Practice Px and Power Chart, never worry about information security or reliability ever again. The Paperless Office Unparallel organization, increased efficiency, enhanced security and peace of mind: it’s easy to see how moving to the paperless office with Power Practice Px and Power Chart can reduce costs and enhance your practice.

Power Practice Px with Power Chart. Software you can trust.

Winter 2010

Dental Practice Management

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AdAm Butler, CFA

Best Practices for a Successful Retirement

“Contradictions do not exist. Whenever you think you are facing a contradiction, check your premises. You will find that one of them is wrong.” – Ayn Rand

e often have an opportunity to re-educate clients about the mechanics of retirement finance. New clients often bring along financial plans from previous advisors, so we can compare the practices of advisors from many other firms. Most firms use financial plans as a sales tool to bring new clients in the door, and then stuff the plan with optimistic assumptions. Plans constructed in this way offer the illusion of pleasing results, and clients eagerly sign on for solutions which promise to deliver retirement Nirvana. Unfortunately, these plans often leave retirees only slightly better than a 1 in 2 chance of outliving their retirement savings (see calculations table). This article will present a retirement planning case study, and apply two different techniques to discover safe retirement income. The first technique should be familiar to many readers, as we will present standard charts and tables included in plans from most wealth management firms. Next, we will test the results of the traditional approach by applying them to a more robust planning approach adopted from the pension and insurance field. This should be a harsh eye-opener for readers as we demonstrate how the planning approach applied throughout the wealth management industry amounts to a coin-flip as to whether retirees will run out of funds before they pass away. Table 1 shows how the actuarial approach makes use of 4 inputs, while the traditional approach only accounts for 2.

Case Study Scenario Imagine a 65 year old couple, Jack and Diane, about to retire. Like so many private healthcare professionals, they

TABLE 1 ACTUARIAL APPROACH

TRADITIONAL APPROACH

–> Inputs

––—> Expected Return

—––> Expected Return

––—> Portfolio Volatility

—––> Median Remaining Lifespan

––—> Median Remaining Lifespan ––—> Confidence Level

–> Output —––> Extraction Rate

–> Output ––—> Safe Extraction Rate Source: Butler|Philbrick & Associates

DEFINITIONS Expected Return: the average annual return that the portfolio is expected to return over a person’s retirement horizon, adjusted for inflation. Portfolio Volatility: the degree to which the portfolio experiences ups and downs in value as markets rise and fall. Median Remaining Lifespan: the number of years between a person’s current age, and the age at which the person has a 50% chance of mortality. Confidence Level: the degree to which a retiree wants to be certain of success. For example a more conservative retiree may want to be 85% confident of outliving his or her portfolio. In contrast, a more adventurous retiree may wish to have a higher retirement income and thus settle for a lower confidence level, say 70%. Note that a traditional plan, by definition, provides for a maximum of 50% confidence. Safe Extraction Rate: the portion of a retiree’s portfolio that can be safely withdrawn each year for income while maintaining an appropriate level of confidence in the future success of the plan. For the traditional plan, the extraction rate reflects a median outcome: 50% of future outcomes will cause the plan to fail.

have no private pension. Jack worked outside the home for over 40 years in Canada, and Diane worked infrequently outside the home. In concert with their Advisor, they collect the following information and assumptions. Note that Jack and Diane are both 65, and will retire at the end of this year. The ‘Lifespan planning horizon’, also called ‘Median Remaining Lifespan’ or MRL, needs some explanation. A person’s MRL is the age at which the person has a 50% chance of mortality. For example, at age 65 Jack has a 50% chance of living to age 82, so his

Winter 2010 Dental Practice Management

Combined RRSP Assets Expected investment returns Expected inflation rate Lifespan planning horizon (MRL)

$1,000,000 7% per year 3% Age 85

median remaining lifespan is 17 years. In contrast, at 65 Diane can expect to live over 20 more years to age 85. For simplicity, we will assume that Jack and Diane elect to have a constant, inflation adjusted income until Diane’s death, so they assume a time horizon equal to Diane’s MRL of 20 years. Couples often elect to model for retirement income to drop upon the death of the

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Finance first spouse, but our contrary assumption does not materially affect the conclusions of our comparison.

END OF YEAR PORTFOLIO VALUE AND INFLATION ADJUSTED INCOME

Traditional Approach The traditional planning model assumes that the couple will experience 7% returns on their portfolio every year throughout retirement, with no ups or downs. This allows us to model a simple pro-forma portfolio value and cash-flow forecast for each year of retirement, as shown in the tables and charts below. These tables and charts should look familiar to those who have worked through a financial plan with one of the major investment or accounting firms. Savings Expected Return Inflation Portfolio Income

$1,000,000 7% 3% $70,102

You can see that a traditional model provides for Jack and Diane to extract $70,104 from their portfolios each year, adjusted for inflation. This equates to an extraction rate of about 7% per year from the portfolio ($70,000 / $1,000,000). We will use this 7% rate in our second analysis below. It is important to identify the salient features of the traditional plan as illustrated above. Specifically, the solution above assumes: • constant returns to the portfolio of 7% every year with no variability • constant inflation of 3% • a fixed lifespan of 85 years The use of averages in the models without accounting for the variability around the averages implies a great deal of ambiguity about the model’s likelihood of success. For example, if expected average returns are to be 7% per year, by definition one must acknowledge a near 50% possibility of experiencing returns below this average, which would result in a failed retirement plan. Further, if we assume an average (median) expected lifespan of another 20 years, there is by definition a 50% chance of living beyond this age, which would again result in a failed retirement.

Actuarial Approach Next we will contrast the results from the standard planning exercise above with an actuarial approach. Our actu-

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CALCULATIONS TABLE YEAR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

AGE

STARTING VALUE

INCOME

ENDING VALUE

66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

$1,000,000 $994,991 $987,380 $976,919 $963,339 $946,349 $925,637 $900,866 $871,675 $837,673 $798,439 $753,524 $702,440 $644,665 $579,638 $506,754 $425,365 $334,772 $234,227 $122,925

$70,102 $72,205 $74,371 $76,603 $78,901 $81,268 $83,706 $86,217 $88,803 $91,468 $94,212 $97,038 $99,949 $102,947 $106,036 $109,217 $112,494 $115,868 $119,344 $122,925

$994,991 $987,380 $976,919 $963,339 $946,349 $925,637 $900,866 $871,675 $837,673 $798,439 $753,524 $702,440 $644,665 $579,638 $506,754 $425,365 $334,772 $234,227 $122,925 $0

EXAMPLE OF ‘MILESTONES REPORT’ TRACKING FUNDED STATUS OF RETIREMENT PORTFOLIO

arial approach allows us to tailor the model inputs in ways that account for the random nature of lifespan, inflation, and market returns. The purpose of an actuarial approach is to tailor plans to accommodate the level of safety needed by each individual retiree. In our experience with retirees, couples are uncomfortable with the 50% chance of failure that is implied by the traditional approach above. In contrast, the actuarial model allows couples to raise their level of confidence to 80% or more. This approach also facilitates annual reviews which quantify whether a plan is on track based on whether current

Assumptions: Total Return Inflation Expected Portfolio Volatility Median Remaining Lifespan

7% 3% 13.25% 20 years

portfolio values fall into a certain confidence level range. For example, a plan can be reviewed each year, and incomes can be adjusted if confidence levels rise above, or fall below certain thresholds, say 90% or 70% respectively. What happens when we input the results from the traditional model into our actuarial model? Before we can run this analysis, we must compute the ‘Portfolio Volatility’ input discussed above. This is computed by finding

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Finance

the combination of stocks and bonds in a portfolio that would provide for the 7% expected return assumed in our case study. In fact, if we use historical returns as a guide a portfolio consisting of 70% stocks and 30% bonds would average 7% annual returns. This combination has a ‘Portfolio Volatility’ of 13.25%. (Source: Shiller, Yale, 2010) The red bar on the chart represents the 7% portfolio income rate per the results of the traditional retirement analysis. Note the red line drawn from the red bar to the y-axis which highlights the confidence level that arises from this 7% income extraction rate. The actuarial analysis suggests that a 7% extraction rate, which equates to $70,000 income from Jack’s and Diane’s $1 million portfolio, has a 54% chance of success. In other words, if they choose to take $70,000 per year in income, adjusted each year for inflation, there is a 46% chance that Jack and Diane will run out of retirement savings before Diane passes away. This is about the same odds as a coin flip. When we run this analysis with clients, we generally suggest that they target a confidence level somewhere between 70% and 90%. The green bar on the chart marks a 4% extraction rate, which represents an 83% chance of successful retirement. Many clients feel that a confidence level of 80% to 85% offers the right mix of income for lifestyle, and safety for the future.

On Monte-Carlo Analysis Some firms have begun to offer retirement plans based on Monte-Carlo analysis. This type of analysis enables Advisors to provide a similar ‘confidence interval’ to the actuarial approach described above. A MonteCarlo approach is substantially better than the traditional approach, because it accounts for the wide variety of possible futures by creating ‘alternative histories’ from historical market data. If used properly, this approach can provide a slightly more accurate confidence interval than the actuarial approach described above. Unfortunately, this approach is rare-

PROBABILITY OF A FULLY FUNDED RETIREMENT AT VARIOUS INCOME EXTRACTION RATES

ly used properly. Before engaging in a planning exercise that incorporates Monte-Carlo simulations, it is imperative to ask your Advisor the time period the model uses to source its data. For example, many Monte-Carlo models often use data just from the past 20 or 30 years. By using data from 1990 or 1980 on, the results will be skewed to higher returns than were experienced over longer time periods. An analysis based on this data will suggest a higher withdrawal rate than might be advisable based on data over longer time periods. This allows the Advisor to provide a more palatable answer for prospective clients, but the answer may not be in the clients’ long-term interests.

Conclusion and Future Applications

We have examined two different approaches to retirement planning, and demonstrated how a traditional planning model leaves unacceptable ambiguity about the likelihood of retirement success. The vast majority of financial plans delivered to Canadian clients by major wealth management, accounting and legal firms, apply the traditional approach. These plans make it simple to present clients with many pages of detailed pro-forma retirement cash-flow forecasts. Unfortunately, this approach to planning amounts to a coin-flip in terms of its likelihood of delivering retirement success. These plans are very

Winter 2010 Dental Practice Management

precise, but not very accurate. We propose that retirees should demand that Advisors apply an actuarial approach to calculate their safe retirement income rate. This technique allows retirees to quantify their likelihood of success, and track their progress. Further, investors should make sure that plans account for after-tax management and/or trading fees, which might easily represent a drag of 2% or more for most investors. It is important to note that the analysis above is not a prescription, and should not be used for planning purposes. The assumptions used are not necessarily appropriate for many investors, and each retiree will have a different mix of values, goals, risk tolerances, and financial means. Investors should consult their Advisor or contact us to discuss the creation of a customized plan. More information is available at our website and blog. DPM The opinions expressed in this report are the opinions of the author and readers should not assume they reflect the opinions or recommendations of Richardson GMP Limited or its affiliates. Adam Butler is a Director, Wealth Management and Portfolio Manager at Butler|Philbrick & Associates with Richardson GMP Limited in Toronto. For more information, please visit them on the Web at ButlerPhilbrick.com.

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JOHN McMILLAN — Barrister & Solicitor Serving Dental Professionals Professional Corporations • Practice Purchases and Sales Professional Agreements • Commercial Contracts Commercial Leasing • Regulatory Matters 8 King Street East 416 364 4771 Suite 1807, Toronto johnmcmillan@bellnet.ca McMILLAN LAW PROFESSIONAL CORPORATION

Alglobe

Construction Company

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ONTER CONSTRUCTION • Specialized in dental office design & construction. • In-house architect and interior designer. • We are qualified code consultants to review all drawings and make your building permit application easy. • Own millwork facilities for best quality of custom built cabinets and time control of your project.

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Dental Practice Management Winter 2010

Professional Services

Careers

CAREER IN IMPLANT DENTISTRY CANADIAN DENTAL IMPLANT INSTITUTE Full Time Implant Resident wanted (new grad welcome). Looking for Dental Residents to staff our various exclusive implant Clinics in SW Ontario. 6 Months training period $5000 per month, Guaranteed yearly minimum income $150,000 plus bonus after 6 months of training. Registration with RCDSO is required. Send resume to cdii@dental-implant.com or Fax 905-682-8495

LOCUM DENTIST GTA AND SURROUNDING AREA

Keep your practice healthy and growing while you are away. Over 25 years of caring experience in my very successful private practice. Excellent communication and treatment planning skills. From $100.00 per hour or 40% of billing. Contact Jonathan Palter 416-602-2434 or jpalter@rogers.com

Practices & Offices

Practices & Offices THORNHILL OFFICE SPACE

Specialist Only Yonge Street, 1000 sf of high end finished retail space, 3 ops., Tripar Built 2002, excellent high traffic location, ample parking, general DDS in same plaza. Contact Bryan at 416.566.0394 for showings or e-mail: bryan@myforesthillagent.com

OTTAWA, ONTARIO PRACTICE FOR SALE 20 year well established general Practice for sale. Three operatories. Central with easy access from Highway. Call 613-232-2610 E- mail: P_T_Y_B@hotmail.com

ESTEVAN, SASK

Longest established practice, rapidly growing progressive city, 90% 3rd party insurance. 4 chairs, new patients daily, 10-12K charts. Highly motivated to sell below market value. Call Dean - 306-634-6015 or 306-634-6795 DANFORTH VILLAGE, TORONTO OFFICE SHARE/COST SHARE

Excellent opportunity for a dentist with own patients. Street level, bright 3 ops and hygiene. Computers, digital radiography, intra oral camera, nitrous. Subway, high traffic, friendly staff. Fax: 416-465-3221

SPACE AVAILABLE

Great location in Aurora/Newmarket Area. Modern, caring family practice. Looking for associate dentist with existing clientele. Move your practice or retire with us Tel: 416-464-8051 Email: michael_aharon@yahoo.com

GEORGETOWN DENTAL OFFICE FOR LEASE

Fully equipped dental office which can also be shared with other professionals. Map and photos available. E-mail: piotrk@sympatico.ca or tel: 905-873-4413.

BURLINGTON, ON Looking to purchase an established family practice. Reply in confidence to: todentist@hotmail.com

WHITBY-OSHAWA, ON

Building and well established dental practice for sale. Reasonable price and flexible terms. No agents!. Call after 6:00 PM. 289-251-0204.

Winter 2010 Dental Practice Management

OFFICE SPACE STRIP SHOPPING MALL SOUTH SURREY, BC

Highly visible, well established location with documented, high new patient flow in the fastest growing area in the lower mainland. Modern 4 operatory, contemporary leasehold improvements, reasonable lease. Computer wired for paperless management. We’ve outgrown the office in less than 10 years are relocating. Connect your equipment and you are ready to go. Please email kcreek@telus.net, or call 604-576-8822 for more information.

GTA PRACTICE WANTED I am looking for a large dental practice in the GTA, ideally with production in excess of $1M. I am flexible as far as transition terms go, whether you want to get your equity out while continuing to practice or if you just want out. Either way, save yourself anywhere up to 10% commission by selling your practice privately! If you’re interested, please contact me at: pract.wanted@gmail.com

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Practices & Offices

LESS OFFICE RESPONSIBILITY EXCEPTIONAL OPPORTUNITY We are a progressive office in mid-town Toronto that is able to accommodate your existing practice 2-4 days per week. All aspects of practice management looked after. This is an ideal opportunity for someone facing lease termination due to sale and demolition, or simply wants to practice without additional stress. Our practice offers comprehensive care with a strong preventive model and on-site periodontist. Dreaming of an easier 9-5? Consider joining our high profile practice that is quality centered. Serious Inquiries Only: info@aestheticsindentistry.com

ESTEVAN, SASKATCHEWAN

Long established, modern and successful solo, 3 op family practice in a unique and recently restored 60 year old house -1500 sq.ft. total. Digital radiography and intra-oral cams in all computerized ops. Strong hygiene and restorative. Private sale by retiring owner/dentist. Will consider any/all offers: sale/rent/associate to purchase. Estevan - youngest average age, highest per capita income, highest retail sales per capita in Saskatchewan 2 hrs. to Regina, 2 hrs. to Minot, 4 1/2 hrs. to Winnipeg, 4 1/2 hrs. to Saskatoon. Call Dr. Doug Blue - 306-634-2341 or e-mail: bsnt@sasktel.net

Associateships

FORT ST. JOHN, BC PRACTICE FOR SALE

EDMONTON ALBERTA

Excellent opportunity for Highly motivated and confident practitioner dedicated to providing the best quality dentistry in a progressive family clinic with a great dental team. Email resume to aponiadental@gmail.com or call Krista at 780-944-1999 visit us at aponiadental.ca

FORT ST. JOHN, BC FULL TIME ASSOCIATE

Self motivated, full time associate invited to join our successful dental team. Established patient base, compassionate staff, the latest in technology offers growth in all aspects of dentistry - family, esthetics, general sedation and invisalign. Successful applicant will be enthusiastic, energetic. If this is “YOU” please apply in confidence, to amazingsmile@shaw.ca

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To check out Fort St. John go to www.cityfsj.com or www.fsjnow.com

For further information please contact Dr. Don Hughes or Lynnette Pittam at (250)785-1867

Associateships

ASSOCIATE — TRENTON, ONTARIO

We are seeking a full time associate for a very busy family practice in Fort St. John, B.C. We currently have 3 dentists and 4 hygienists in a new facility. The successful applicant would assume an established practice from a longtime departing associate. The position is available February 1st, 2011. Fort St. John is a rapidly growing North-East B.C city servicing a population of 35,000. We have a very friendly community with all services ranging from outdoor recreation to established arts and culture programs. To check out Fort St. John go to www.cityfsj.com or www.fsjnow.com For further information please contact Dr. Don Hughes or Lynnette Pittam at (250)785-1867

ASSOCIATE — EDMONTON, AB

Productive, well established family practice for sale in Fort St. John, B.C. This is a full time 2 dentist practice with the potential for a 3rd dentist. With 11 operatories and 4 hygienists, this practice grosses approximately $2.4mm annually. Owner looking to retire with the option of staying on as associate to ensure a smooth transition. Fort St. John is a rapidly growing north-East B.C city servicing a population of 35,000. We have a very friendly community with all services ranging from outdoor recreation to established arts and culture programs.

Dr. Steven Bongard and Associates at West End Dental Centre in Trenton, Ontario are looking for a caring, compassionate dentist with strong communication and clinical skills to join our busy, progressive practice. This full-time position is an excellent career development opportunity for a dedicated dentist with excellent income potential and the potential for future partnership. We offer the knowledge and experience of our doctors along with the support of a friendly and well-trained staff. The office is located 1 hour east of Oshawa on the beautiful Bay of Quinte. Please e-mail your CV to westenddental@bellnet.ca or fax 613-392-3783, Att’n: Diane Shalai, Practice Manager

DRUMHELLER, AB

2 Full-time Associate Positions available in a newly renovated, well established, busy practice in Drumheller. Excellent opportunity for new graduate or experienced dentist wanting to live in a great family community close to Calgary. Hospital privileges available. Also open to practice partnership or ownership to the right candidate. Please call (403) 823-7755 or e-mail jcaravan@magtech.ca

BRANTFORD, ON Associate required for growing practice, preference will be given to those with experience and skill in Implant Dentistry, Conscious Sedation, Soft and Hard Tissue Grafting, Surgical and Non-Surgical Endodontics, and Oral surgery. Tremendous potential and opportunity for personal and professional growth as well as steady increase in hours with option for future ownership. Pease E-mail Cover Letter and Resume to: ddpc2009@live.ca

Dental Practice Management Winter 2010

Associateships

SOUTH CALGARY / SUBURB PRACTICE

Part-time Associateship available for a Dentist interested in realizing an exceptional opportunity. Two consecutive days per week (Thursday and Friday) presently available with an opportunity to expand. Modern, busy practice with a well established patient base. Excellent team support. The ideal candidate will have 3 to 5 years of general dentistry experience and aspire to continually provide patients with high standards of general and cosmetic dental care. All inquires held in strictest confidence. Email resume to sbodentistry@gmail.com Successful candidates will be contacted.

ASSOCIATESHIP AVAILABLE DOWNTOWN TORONTO PRACTICE Rapidly growing contemporary practice requires dedicated, conscientious associate, 1-2 yrs minimum experience. No weekends, excellent clientele. Serious inquiries fax resume to 416-2142948 or e-mail: concoursedental@bellnet.ca

EDMONTON, AB

Full-Time Associate dentist or locum required in an established south side practice. Individual with good communication skills needed to care for the patient base of our outgoing associate dentist who is leaving to expand her family. This position will be available March 1, 2011. Week days only. Please contact us at: hvdc@telus.net

TORONTO WEST

Hospital Based Dental clinic seeking part time dentist; Interest in geriatric dentistry and excellent clinical skills with a focus on comprehensive care. Confidentiality assured! hospitaldentalclinic@gmail.com

EDMONTON, AB

THUNDER BAY, ONTARIO

We are an extremely busy and modern (newly relocated) office looking for an experienced full-time associate. Our amazing staff and patients contribute to a great work environment. No evenings or weekends. Please send resume to tbaydental@yahoo.ca, fax to 807-623-4724, or call 807-623-1813.

KENT PLACE DENTAL

Seeking full-time or part-time associate for busy general family practice in Lindsay and Minden, Ontario. Excellent team in place and enjoyable work atmosphere. High remuneration. New grads welcome. Contact Dr. Rene Boljkovac at bobcaygeonfamilydentistry@hotmail.com

RED DEER, AB Busy, high tech practice in need of new associate. Averaging 90 new patients a month. Fully integrated for all Alberta IPS. Excellent, personable staff. Current associate moving closer to family in ON. Future partnership. Apply with resume to: bestbetdental@me.com

OAKVILLE, ON

Part time associate required to join our progressive dental team. Established patient base, compassionate staff, the latest in technology offers growth in all aspects of dentistry. Please fax resumes to 905-469-3181 or e-mail to foxcreekdental@bellnet.ca

PART-TIME ASSOCIATE OSHAWA, ONTARIO

Busy dental office in Oshawa area looking for a part-time associate. Please email resume to drmint@rogers.com.

FULL-TIME ASSOCIATE REQUIRED for a well-established and constantly growing, FULLY RENOVATED & UP-TO-DATE office in a FABULOUS area of Edmonton. Wonderful, fun, capable staff. Applicant should be enthusiastic, fun, confident (with a desire to learn and grow), and hold patient well-being as a TOP PRIORITY. Confidentiality assured. Please e-mail: acesdentalcare@gmail.com for more information

CHATHAM-KENT, ONTARIO

DOWNTOWN TORONTO ASSOCIATE NEEDED

MARKHAM/ UNIONVILLE, ON

Part time associate needed for a busy downtown office. Need to be proficient in endodontics and oral surgery. If interested, please fax resumes to 416 929-7640 or contact Dr. Atwal at 416 918-4099

Looking for an experienced, mature, part time (2-3 days per week) associate for the Chatham-Kent area in a progressive busy dental office. Please email karenm@myibocs.com or phone 416-906-7099.

Dental associate needed for Unionville/Markham. Part-time. Please fax resume to 905. 477. 1763

Winter 2010 Dental Practice Management

KITCHENER, ONTARIO

Associate wanted, part-time or full-time for busy Kitchener family practice. Great location in a busy plaza. Position is replacing an existing associate who is relocating out of the province. Please fax resumes to 519-744-7354 or e-mail to mbensky@rogers.com

OTTAWA, ONTARIO

Do you want to be an Associate with the opportunity of becoming a partner? If so, we are a busy, progressive practice looking for a people oriented dentist seeking to associate with the opportunity of becoming a partner. Please fax resume to 613-523-5318. ASSOCIATE DDS REQUIRED MISSISSAUGA, DOWNTOWN TORONTO, EAST YORK

Established practices. Excellent Recare. Competitive remuneration. Saturdays, Fridays, and Thursdays. E-mail: 2009dental@live.ca

RED DEER ASSOCIATESHIP This is it……the opportunity I wish I had available when I graduated. Please help by taking over an established full time family practice for me. Just think; no worries about busyness; no management worries; no weekends. Incentives negotiable. Experience an asset. Reply in confidence to RDdentist@yahoo.ca for further information.

CANADA - CENTRAL TORONTO

ORTHODONTIST NEEDED IN CENTRAL TORONTO AS ASSOCIATE LEADING TO PARTNERSHIP FULL-TIME FOR A PROGRESSIVE ORTHODONTIC PRACTICE APPLYING CERAMIC AND METAL IN-OVATION BRACKETS, INDIRECT BONDING, TOPS MANAGEMENT PROGRAM, ETC. PLEASE CONTACT GEORGIA AT 647-308-1012

CALGARY/ EDMONTON

Full and part-time associates required for growing and established practices in successful areas of Calgary and Edmonton. Great patient flow, wonderful staff. For more information on our group, please visit dentalchoice.ca. All applications kept strictly confidential. Contact Candice at fax 780-444-9411 or info@dentalchoice.ca. Please identify which city you are applying for.

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ABUNDANT OPPORTUNITIES IN THE SOUTH GENERAL PRACTITIONERS AND ALL DENTAL SPECIALTIES ABLE DENTAL GROUP Jump start your career with us… Associate or Buy-In Opportunities for the Right Candidate Exciting career opportunities are awaiting you in sunny southern Alberta. Our Dental Group is looking for motivated individuals to join the team of dental professionals who use “big city technology”, yet serving the needs of the community and surrounding areas. Our Group has always been one step ahead of the rest to take advantage of new technology and “looking outside of the box” attitude and ideas. This enthusiasm is shared with the Associates and Staff, who pride the company’s success on teamwork and providing a team environment. Our Group has a career opportunity that will accelerate your career in our Crowsnest Pass office. Our office requires a Dentist who wants to call this community home and establish themselves in the area. Our brand new equipped, 3 chairs, HIGH GROSSING office with an exceptional and dedicated team includes a full-time Hygienist and 2 experienced RDA II, and reception staff. There is also an on-site Bachelor Pad to call home, for as long as you need.

www.broadwaydental.ca

BROADWAY DENTAL ASSOCIATES • Experience the Medicine Hat advantage. • Protect your career from gridlock. • You are interested in predictable community living. • How do you value family time? • Lowest tax and utility rates in the province. • Children walk to nearby schools. • Highest grossing private practice in Southeastern Alberta. • Enjoy all the technological advances in today’s dentistry. • Achieving excellence with our experienced team is assured. • You are interested in above average compensation. • Check out our website, contact Dr. Greg Bradley. • Home of the Medicine Hat Tigers, the team has

“If you have the stuff, we’ll know”

won two Memorial Cups, five WHL Championships

Please contact our office to arrange an on-site meeting and viewing Shari Mead, Office Manager 403-327-7227 shari@abledentalgroup.com

and seven Division Titles.

GEORGETOWN, ON

Family Oriented dental practice in Georgetown, looking for part-time associate. With possible full-time potential. Please send email to gtdentalclinic@bellnet.ca OTTAWA, ON P/T OR F/T ASSOCIATE REQUIRED Seeking highly motivated and experienced individual to work in established family practice. Candidate must be knowledgeable in most aspects of dentistry. Please email resume to: ottawadentalgroup@gmail.com

PART TIME ASSOCIATE PAPE/DANFORTH

101 - 7 Strachan Bay S.E. • Medicine Hat, Alberta • T1B 4Y2 Ph: (403) 548-7000 Fax (403) 548-7111 Toll Free 1-888-607-6453 www.broadwaydental.ca

OTTAWA, ONTARIO

We are searching for an associate to join our team in an office that practices a broad spectrum of dentistry with a particular focus on crown and bridge work. Our growing practice needs a qualified associate that would help care for our existing patients as well as the fifty new patients that join our “family” each month. Please email your resume to ottawadentalcareers@gmail.com ASSOCIATE REQUIRED OTTAWA, ON

TECUMSEH, ONTARIO

Associate wanted, full-time or part-time, for busy, modern, well-established family practice. Some evenings and Saturdays required. Great opportunity to grow. January 2011 start date. Apply in confidence to: scbdental@gmail.com

PART-TIME ASSOCIATE TORONTO, ON

A store-front dental office in Toronto, looking for a part time associate, with possibility of buying or partnership. Experience in surgery is an advantage. Fax Resume: 416-640-0779.

DOVE DENTAL CENTRES

Busy, modern office with established patient load 2½ days per week. Come join our progressive dental team. Please forward your resume and availability to dds.resumes11@gmail.com

Immediate position in a well established, adult oriented office. 3-4 days, no evenings or weekends. Please contact: colleen@greatsmile.com

Full-time associate required for one of their dental centres in London ON. Any inquiries, please e-mail to: dovedental@ody.ca

WEST TORONTO

ASSOCIATE REQUIRED IQALUIT, NUNAVUT

PART-TIME ASSOCIATE TORONTO,ON

Part-time Orthodontist required immediately for 2 – 3 days per week.Office located in West Toronto. Please contact: Ms. Dai Jaimangal, Manager T:416-651-5151 Email: drrubinoff@bellnet.ca

NEWMARKET, ON

Needed: P/T Associate DDS. Thursday, Friday and alternate Saturdays. Call 416-270-2026 www.oralhealthjournal.com

Part time associate for well established famExperience the North in Canada’s ily practice in Toronto(Roncesvalles Village), youngest and fastest growing capiwith own patient base, minimum 3 years tal city. Well established clinic seeks experience, Polish, Russian preferred. associate with all-round skills. GenE-mail: daadent@gmail.com erous fee guide in effect. Retention bonus payable to committed indiviual. KITCHENER/WATERLOO, ON Just three hours from Ottawa, Iqaluit Part-time dentist needed in offers a range of recreational activities. Kitchener/Waterloo. Chinese and Call administration at (867) 873-6940, fax:Oral (867)Health 873-6941 Classified Ads Vietnamese fluent preferred. Kindly e-mail us at or write to Box 1118, dental_clinic@rogers.com Yellowknife, NWT X1A 2N8

Dental Practice Management Winter 2010

ADVERTORIAL

POSTERIOR CROWN TROUGHING WITH THE AMD PICASSO LITE DIODE LASER By Dr. Glenn van As

The recent and dramatic drop in the price of diode lasers has made this technology an attractive and increasingly popular alternative to traditional methods for the management of soft tissue in fixed prosthodontic procedures. Many clinicians find the laser to be easier, and quicker than ‘packing cord”. Often, clinicians who are looking to replace their electrosurgery units discover that the laser can be used around adjacent restorations that are metal or implants. In addition, when the laser is used at low to moderate settings, they offer less risk of harm to dental hard or soft tissues. Diode lasers can be used to trough around an endodontically treated tooth with minimal need for anesthetic, and these lasers have antibacterial capabilities as well. CEREC users use the reliable and small diode laser to enhance the gingival trough prior to powdering their preparation before the optical impression. Their safety for tissue retraction has been found to yield less bleeding and less recession than either double cord or elecro-

surgery techniques. Laser techniques were “less traumatic to the periodontal tissues”. The total time for the troughing circumferentially should be around 45-90 seconds and careful analysis of the laser/tissue interaction should reveal minimal to no charring of the soft tissue which can create postoperative discomfort and greater risk of gingival recession. After the initial laser trough has been completed, the clinician places the final margin on solid tooth structure or slightly subgingival on the facial for esthetics. Vigorous rinsing of the sulcus after 90 120 seconds will yield a clean, dry and well delineated margin and the final impression can be taken. Provisional restorations should be evaluated to make sure that they do not extend into the sulcus which can iatrogenically cause the tissue to recede. Careful removal of temporary cement completes the initial appointment. The patient returns for final insertion of the crown in 10-14 days and upon removal of the pro-

Occlusal view of tissue management with laser (first premolar) and cord (2nd premolar)

visional crown, the tissue appears healthy, and situated exactly where the laser troughing placed it at the first appointment. The diode laser with topical (Cetacaine) and settings of 0.6 -0.8 watts (CW) can be used to remove any soft tissue overhanging the margins and the crown can be tried in and cemented. With careful attention to detail the results can be identical to those obtained with traditional methods. Be ready for the ultimate crown troughing experience! To read the complete article and view clinical videos, visit www.oralscience.com.

CLINICAL PROCEDURE FOR LASER CROWN TROUGHING Step

Procedure

Initial gross reduction and margin placed equi-gingival with magnification.

Diode laser troughing: suggested settings 0.6-1.1 w CW (less in anterior)

Final margin placement subgingivally as needed for esthetics.

Hydrogen Peroxide or wet cotton pellet to remove tissue tags

Lateral distention of tissue if needed (Expasyl, Traxodent)

Rinse and take PVS impression

Provisional fabrication – Careful to make sure no overhangs.

Winter 2010

Dental Practice Management

CMJ

Dental-Practice-Management-Winter10-11-Picasso-Ad.pdf

CMJ

10-11-24

15:06

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