Dentistry North Texas
VOLUME 2
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ISSUE 4
a business and lifestyle magazine for north texas dentists
Smiles in the Spotlight Dr. Stephen Bass Maxillary Sinus Lift and Dental Implant Placement
New Technology Update Making Oral Cancer Detection Faster and Easier
Practice Marketing
Dental Headache Medicine
Peter R. Barnett, DMD Star Ranch Dental
How Google+ Local Will Impact Your Practice
In partnership with:
KOHL’S CH A M P
ION S for K I DS
Thank you for helping us smile! We would like to thank these dentists for donating their time, talent and resources. They are the heart of this program, and we are honored to have them as partners. Dr. Mark Angerbauer Dr. Sayeed Attar Dr. John Avila Dr. William Baltazar Dr. Randall Barkley Dr. Daniel Bekish Dr. Amy Bender Dr. John Boyd Dr. Jerod Brazeal Dr. Jessica Brigati Dr. Brandon Brown Dr. Jake Brown Dr. Kent Brown Dr. Sonia Cartwright-Smith Dr. Joe Cecere Dr. Sean Cerone Dr. Johnny Cheng Dr. Jose Chow Dr. Austin Church Dr. William Cook III Dr. Philip Cordell Dr. Gerald F. Cox Jr.
Dr. Christopher M. Davis Dr. Dakota Davis Dr. Lauren Davis Dr. Paul Davis Jr. Dr. Russell T. Dix Dr. R. Danford Doss Dr. Debra Duffy Dr. Chad C. Duplantis Dr. Steven J. Fuqua Dr. Tonya K. Fuqua Dr. Ray C. Gillespie Dr. Mark Givan Dr. Michael Goulding Dr. Erin Greer Dr. Gary A. Greer Dr. William Grover Dr. Monjit Guram Dr. O.Z. Helmer Jr. Dr. Lan Hoang Dr. Eduardo A.C. Humes Dr. David K. Hunter Dr. Andrew Jamison
Dr. Ramakrisha Kammili Dr. Suketu Kapadia Dr. John M. Kelley Jr. Dr. Ken Kirkham Dr. David Kostohryz Dr. Mark C. Lantzy Dr. Hoang Le Dr. Phu H. Le Dr. Ronald Lee Dr. Diana Lois Dr. E. Dale Martin Dr. Deanna Mathisen Dr. Mark A. McAdams Dr. Brad McConnell Dr. David Mikulencak Dr. Charles Miller Dr. Louis Miller Dr. Sarah J. Morris Dr. Jack W. Morrow Dr. Partha Mukherji Dr. Leslie Ann Nason Dr. David M. Nelson
Dr. Tim Oakes Dr. David Parmer Dr. Robert Peak Dr. Hai Pham Dr. Janell Plocheck Dr. G. Stan Preece Dr. David Purczinsky Dr. Ben Quenzer Dr. Diana Raulston Dr. Susan Roberts Dr. John Rubin Dr. William Runyon Jr. Dr. Vincent Sanchez Dr. Jeff Saunders Dr. Monica Saunders Dr. Gregory Scheideman Dr. Mack Snead Jr. Dr. Christopher Sorokolit Dr. Robert Sorokolit Dr. Brent Spear Dr. Warren Spielman Dr. Fred Spradley
Dr. Larry W. Spradley Dr. Brooks M. Stevens Dr. Deborah Sullivan Dr. Charles M. Thorne Dr. Jennifer Thorne Dr. David Tillman Dr. Christopher Tran Dr. Casey Turner Dr. Peter Vo Dr. Christa Walker Dr. Amy Watts Dr. Edmond Watts Dr. Maureen Weber Dr. Bruce Weiner Dr. Nathan West Dr. Kathleen White Dr. R. Renan Williams III Dr. Walter G. Williams Dr. Danny Wright
Save a Smile is an innovative, nationally recognized, collaborative program dedicated to improving the health of underserved children through the prevention and treatment of oral health disease. Our volunteer doctors have donated dental care worth more than $5.2 million for children in Tarrant County since the program was developed in 2003.
Dentistry North Texas
ON THE COVER
Dental Headache Medicine COVER Photos: Ray Bryant, Bryant Studios
Dr. Peter R. Barnett
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COVER FEATURE: Dr. Peter R. Barnett, of Star Ranch Dental began implementing the TruDenta system in 2010 to help his patients suffering from chronic headaches, migraines, and TMJ/D.
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BAYLOR COLLEGE OF DENTISTRY Guiding Principles in the Clinic
NEW TECHNOLOGY UPDATE
Making Oral Cancer Detection Faster and Easier Exciting new cancer finding technology from UT Austin research lab
SMILES IN THE SPOTLIGHT
Dr. Stephen Bass Maxillary Sinus Lift and Dental Implant Placement
PRACTICE MARKETING
How the New Google+ Local Will Impact Dentists Understanding the recent changes that will affect your practice
COMMUNITY NEWS
Pediatric Dentist Launches Oral Health Summer Program Featuring Sesame Street’s Healthy Teeth, Healthy Me initiative
WINE CELLAR
A Rosé By Any Other Name Pairing great wines with warm weather and lighter fare
PRACTICE MANAGEMENT
Could Assisted Hygiene Be Your Solution? Being too busy is a good problem to have – but it’s still a problem
MONEY MATTERS
Inflation: The Great Retirement Robber Making sure your retirement money lasts as long as you do
PRACTICE TRANSITIONS
An Unfortunate Story The Case for Estate Planning... While You’re Still Alive
SPECIAL ISSUE Q&A UPDATE
Creating the Ultimate Dental Practice BCD Senior Students Will Receive Issue www.northtexasdentistry.com
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from the publisher
Dentistry North Texas
Publisher | LuLu Stavinoha Photographer | Ray Bryant, Bryant Studios Contributing Writers | Dr. Stephen Bass, Tina Cauller, Kim Clarke, Jennifer Fuentes, Cathy Jameson, Dr. Richard Lyschik, Bob Michaels, Kelly Rucker, Dr. Anthony Stefanou
I hope all of you are having a great summer! As far as Texas summers go, this year has been pretty pleasant, but I am sure our 100+ days will be here before we know it.
For this issue North Texas Dentistry visited the very ‘cool’ Star Ranch Dental, the dental practice of Dr. Peter Barnett. Patients at Star Ranch Dental are treated with the latest technology in a spectacular facility. A spa-like environment relaxes the patient to improve the total dental experience. Dr. Barnett has practiced dentistry for over thirty years and in addition to general and cosmetic dentistry he also provides care to patients with chronic headaches, migraines, and TMJ disorder. Dr. Barnett has added the TruDenta system to his practice to treat and improve the lives of these patients. His story focuses on the TruDenta system and the steps involved in the treatment process. I observed a therapy session and was very impressed.
Periodontist Dr. Stephen Bass presents this issue’s Smiles in the Spotlight featuring a case presentation on maxillary sinus lift and dental implant placement. Contact North Texas Dentistry to present your case in Smiles in the Spotlight. There is no charge to present your case.
You will find some great articles in this issue. In the column, Guiding Principles in the Clinic, Baylor College of Dentistry announces Dr. Charles Arcoria and Keri Pearson as the Dental and Dental Hygiene Teachers of the Year. Practice Management offers some suggestions for an overscheduled hygiene department and Money Matters looks at retirement savings. Update on the Special Issue, Creating The Ultimate Dental Practice: We have received approval to distribute this issue to the senior class at Baylor College of Dentistry. What a useful guide for them as they make post-graduation plans! Contact North Texas Dentistry today for more information on being part of this issue.
Ray Bryant
PHOTOGRAPHY
Tina Cauller
WRITING / DESIGN
Thanks to all who support North Texas Dentistry and make its publication possible. Keep smiling and have a great day!
Lulu Stavinoha, RDH Publisher
4 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Although every effort is made to ensure the accuracy of editorial material published in North Texas Dentistry, articles may contain statements, opinions, and other information subject to interpretation. Accordingly, the publisher, editors and authors and their respective employees are not responsible or liable for inaccurate or misleading data, opinion or other information in material supplied by contributing authors. Copyright 2012. All rights reserved. Reproduction in part or in whole without written permission is prohibited.
Advertise in North Texas Dentistry For more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 or email lulu@northtexasdentistry.com. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225
guiding principles in the clinic Arcoria and Pearson on
and what students look for in their instructors
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By Jennifer E. Fuentes
here’s a reason why Texas A&M Health Science Center Baylor College of Dentistry students selected Dr. Charles Arcoria and Keri Pearson as the 2012 Dental and Dental Hygiene Teachers of the Year. It’s those guiding principles that impact how they interact with students each time they step foot in the clinic or classroom.
For Arcoria, it’s a belief that instructors should always be mindful to interact with professional students in an understanding, compassionate and deliberate manner. An instructor should utilize all of the available technological resources, in addition to the effective use of their time and talents when teaching. The prevailing goal is to be certain that every student completely understands what tasks need to be accomplished and then to help them successfully complete such tasks in a timely manner.
Pearson believes you have to treat students the way you would want to be treated — with patience, respect and compassion. These are the same qualities that she thinks are valuable in professors and students.
The Teacher-of-the-Year Awards are presented annually by the TAMHSC-BCD Alumni Association. Recipients receive a plaque, $1,000 and an engraved gold apple. In addition, the honorees carry the college’s ceremonial mace and baton during the com-
mencement processional and recessional. Arcoria and Pearson received their awards during the award ceremony prior to commencement on May 21.
Dr. Charles Arcoria is an associate professor in the Department of Restorative Sciences.A 1980 graduate of Texas A&M Health Science Center Baylor College of Dentistry, he earned a bachelor’s degree in 1978 from Case Western Reserve University, where he was inducted to Phi Beta Kappa honorary society. In 1992 he earned a Master of Business Administration from the University of Dallas, where he was a member of Sigma Iota Epsilon honorary society. Arcoria has been a faculty member since 1984, teaching and directing Dental Anatomy & Occlusion and Clinical Operative Dentistry. He last won the Teacher-of-theYear Award in 1988. In addition, he teaches dental anatomy and occlusion at the Arizona School of Dentistry and Oral Health. From 2000 to 2011, Arcoria administered the Office of Continuing Education and Alumni at TAMHSC-Baylor College of Dentistry.
“I am thankful for the superb students we have at this institution, who make the job that I do much easier,” Arcoria says. “I am also grateful to several administrators who have invested in me over the course of my career, including Drs. James Cole, Amp
Miller, Jesse Bullard and Steve Karbowski,” he says. “I appreciate my faculty colleagues who make me a better educator because of who they are and what they believe, including Drs. Burt Bryan, Stan Cobb, George Cramer and Brent Hutson.”
Recently, Arcoria and his wife, Bunny Vitasek-Arcoria, opened a dental extraction clinic for the homeless in south Dallas, in partnership with LakePointe Church and Cornerstone Baptist Church. They serve as dental directors of the all-volunteer extraction clinic. During most of the 90s, they operated a dental consulting business, assisting young dentists in setting up their dental practices.
Keri Pearson is an assistant clinical professor in Texas A&M Health Science Center Baylor College of Dentistry’s Caruth School of Dental Hygiene. She joined the clinical faculty in 1993 after completing her bachelor’s degree in dental hygiene at Baylor College of Dentistry in 1992. She previously received the Dental Hygiene Teacher-ofthe-Year Award in 2007.
Pearson is a past president of the Dallas Dental Hygienists’ Society, in which she has held numerous elected offices. She also is a past president of Sigma Phi Alpha’s beta chapter and a former board member of the CONTINUED ON PAGE 27
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cover feature
Dental Headache Medicine A New Niche For Practice Growth
by Anthony Stefanou, DMD
Dr. Peter R. Barnett - Star Ranch Dental
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he National Institute of Dental and Craniofacial Research (NIDCR) estimates that more than 10 million Americans suffer from TMJ disorders, but a recent report from the National Institutes of Health (NIH) suggests more staggering numbers: between 15 and 45 million patients have some form of TMJ issues. Additionally, according to the National Headache Foundation, more than 45 million Americans suffer from chronic recurring headaches and, of these, 28 million suffer from migraines. Alarmingly, 20% of children and adolescents suffer from headaches as well. It is estimated that up to 80% or more of headaches are caused by dental force related problems.
While practitioners from many different health care disciplines offer various treatments for patients suffering from chronic headaches/migraines, sleep apnea, and TMJ/D, consumers are quickly starting to recognize that the first and best place for them to go for treatment is the dental office! With all the current research surrounding the oral-systemic link, dentists are now incorporating new programs, systems, and technologies designed to diagnose and treat these conditions and are experiencing excellent results. As a result, an interesting “shift” is occurring in the health care industry. 6 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Dr. Peter Barnett of Star Ranch Dental in Plano, Texas, is among the dental professional shifting to a more comprehensive approach to patient care. Dr. Barnett, who has been treating TMJ/D and occlusion issues for 30 years, acknowledges that new research findings led him and his practice to adjust how they approach such core services as periodontal health and bacterial testing, laser therapy for bacterial reduction and therapy, antioxidant therapy, oral cancer screening, TMD and sleep treatment.
“Our understanding of the role of muscle and nerve hyperactivity is mightily different. We used to think stress “caused” this problem and that biofeedback was an answer; now we understand it exacerbates but doesn’t cause the problem,” Dr. Barnett says. “We understand the role of occlusion and bite forces much differently as more than just a restorative position. We now know it’s more of a muscle/bite force/balance joint support issue, as well as understand sleep (perhaps one of the biggest issues) and its role in exacerbating TMD for some and, of course, its effect on overall health.”
Dr. Barnett’s progressive general and cosmetic practice reflects a dental office environment unlike other offices. When a patient
walks in, it doesn’t feel, look, or smell like a dental office. This environment immediately changes a patient’s mindset to expect a different type of experience; they’re more relaxed than they would be in other dental offices.
TruDenta is a complete system of hardware, software, training and marketing which enables dentists to objectively diagnose and predictably treat patients suffering from dental force related headaches, migraines and TMJ/D issues.
“We are very health oriented and incorporate leading edge technology throughout the practice,” Dr. Barnett explains. “We integrate esthetics into all that we do as part of our health philosophy because function is a vital part of health.”
Dr. Barnett began implementing the TruDenta system in 2010 to help his patients suffering from chronic headaches, migraines, and TMJ/D. TruDenta provides technology and advanced training in conjunction with major dental schools to quickly diagnose and painlessly resolve patient’s dental force related symptoms. One of the unique aspects of TruDenta is its objective, digital diagnostic technologies that produce data to AMA guidelines. This element is key to accelerating physician referrals of new patients. The patented devices can quickly and painlessly determine if patients are suffering from dental force related conditions, which can be treated with the TruDenta approach. Patients can literally be shown the potential causes of their symptoms, thus increasing patient education and case acceptance rates.
Over 80 million Americans are suffering from symptoms which can be successfully and profitably treated by TruDenta member practices. The conservative approach utilizes a combination of advanced dentistry and patented sports medicine rehabilitative technologies. Practices which implement TruDenta provide a superior level of care to all patients and typically increase profits by over $100,000 per year.
Photos by Ray Bryant, Bryant Studios
“TruDenta offered a complete system of equipment, training, and operations that put it into a perspective that immediately made sense to me,” explains Dr. Barnett. “Although there are many
The team at Star Ranch Dental believes that patients’ needs come first and enthusiastically support the TruDenta program. www.northtexasdentistry.com
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Photos by Ray Bryant, Bryant Studios
cover feature
uation for quite a while and are well informed due to visits to many different types of health care providers. Other times, they have no understanding, and education is an integral component of the initial evaluation and consultation.
Joint function, jaw movement, opening capacity, trigger points, and occlusion are evaluated and measured. Trigger points are manually palpated; the occlusal assessment can best be accomplished with a T-Scan; range of motion, opening, and jaw movement can be measured as a deficiency from average. Finally, a Panorex radiograph conveys valuable information about the joint and mandible condition.
Patients are diagnosed according to four classification levels. Level 4 is the most complex categorization. These patients have been in pain for quite some time, may have tried other modalities or seen other health professionals (like neurologists) who have not been able to address this issue long term; and may have migraines that are triggered by their TMJ/D pain. In most cases, Level 4 patients have been dealing with these issues for years or, in some cases, their entire adult life, with multiple headaches and pain episodes each week.
Dental force analysis can best be accomplished with a T-Scan. patient benefits to the TruDenta system, the primary benefit is that it does not involve any drugs or needles. TruDenta is a non-invasive approach in comparison to what else is out there: drugs and surgery. However, it should be noted that because the body is getting rid of these painful stimuli and toxins, there can be a little discomfort in the early stages. ”
Dr. Barnett elaborates that the TruDenta system addresses the causes of the pain, not just symptoms, by retraining muscles, nerves, and the occlusal disharmonies. An orthotic alone does not address retraining muscles, but only the cause of the grinding/clenching that causes pain. Smile makeovers/rehabilitations, which are expensive, are sometimes done on these patients and may not address the underlying causes of the problems.
“Finally, TruDenta is a complete comprehensive therapy program in one office, which makes it convenient to patients and that is greatly appreciated,” Dr. Barnett adds. “Addressing these underlying causes increases a patient’s function, productivity, and quality of life.”
Dr. Barnett explains that during the first appointment, the most critical part of the process begins with the patient history in the initial examination. It is imperative that the dentist listen to the patient’s verbal report of what the problem is, how long it has been a problem, where the problem is, what might have triggered it, etc. He says that many times patients have been dealing with this sit8 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Level 3 patients have significant headaches, although maybe not migraines; limited range of motion; perhaps a displaced disk without reduction; and have been dealing with these issues for months. They may have multiple pain episodes or headaches each week, but not necessarily migraines.
“The primary differences between Level 3 and 4 for me are the severity of the problem and the length of time the individual has dealt with their issues,” Dr. Barnett says.
Level 2 patients experience some pain episodes and headaches that have begun recently, have some pain or discomfort, and have some occlusal discrepancies contributing to muscle imbalance. When an individual is evaluated and judged “not likely to be helped with an orthotic alone,” a Level 2 diagnosis and therapy can help reestablish the proper muscle and joint balance. This involves occlusal equilibration as a small but integral part of their therapy sessions, but they do not require the home care therapy that the more severe Level 3 and 4 therapies include.
Level 1 patients have mild symptoms of grinding and clenching but also some muscle pain and/or occlusal discrepancy that requires some equilibration and an orthotic. These patients may have muscle tightness or soreness but are not likely to have headaches.
Once diagnosed, patients receive a series of treatment therapies using a proprietary combination of low level laser therapy, therapeutic ultrasound, and microcurrent. Each of these modalities was originally developed by MDs in sports medicine to speed the healing of joints and force related traumas. While the TMJ is the most complex joint in the body, it responds to therapies in a similar fashion to ankles, knees, shoulders, and other joints typically
sound, microcurrent, cold laser therapy, and other treatments, Dr. Barnett’s practice increased her range of motion to within normal limits. TruDenta technology was used to balance her occlusion to reduce the type of muscle contraction that could create disk loss from the joint.
Patient #2: This patient arrived to Dr. Barnett’s practice with severe pain in his joints, head, and neck that persisted for years. He was missing lower left teeth, so posterior support was severely compromised. His long-term prognosis was discussed, along with the need to replace the missing teeth with implants. Over 16 weeks and 13 sessions of ultrasound, microcurrent, and cold laser therapy, Dr. Barnett’s team increased his range of motion to within normal limits and balanced his occlusion as best as possible given the missing teeth. The patient’s pain levels were reduced by nearly 95% based on his activity diary, and his follow-ups have consistently shown no recurrence of symptoms.
Obviously, technology like TruDenta requires a financial commitment by the dentist, and since running a practice is a business, it is important to note the potential long-term “return on investment” (ROI) when considering implementing a system like this. Dr. Barnett offers a very modest and grounded example of what to expect.
Photos by Ray Bryant, Bryant Studios
A patient’s range of motion evaluation helps to determine muscle disability.
“If an office has merely one new therapy patient per month that
treated in sports medicine. Treatments are usually performed by staff members trained by TruDenta doctors at either the University of Nevada Las Vegas or NOVA Southeastern dental schools. TruDenta combines these with advanced dentistry to provide patients with predictable and long lasting outcomes.
Dentists reading this may wonder where they will “find” patients that would benefit from the TruDenta technology. Statistically, 20% of any general dental practice’s current patients are suffering. For Dr. Barnett, patients come from other sources as well.
“In addition, we receive patients referred by area medical doctors (i.e., ENTs, neurologists, family practice) and some from other general dentists and orthodontists (including pediatric dentists),” Dr. Barnett says. “We see a major opportunity with a referral program in place.”
To illustrate his point, Dr. Barnett offers some details of two patient cases he has been treating in his practice using TruDenta.
Patient #1: This patient had one episode about 15 years ago when her jaw locked. She eventually worked it open. Then, about two weeks before meeting Dr. Barnett and his staff, her jaw locked and she couldn’t open it. A Level 2 treatment with an anterior DE orthotic was initiated and, over 8 weeks and 5 sessions of ultra-
Because a critical part of the examination is the patient’s history, it is imperative for the dentist to listen carefully to the patient’s story.
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Most dentists who have implemented the TruDenta system report an average treatment plan of $3500-$5000 per patient. As far as dental insurance, Dr. Barnett does admit that he is in a network dental PPO practice, so some patients seen for consults seek his practice because of that, and their expectations about costs are influenced by insurance.
Photos by Ray Bryant, Bryant Studios
was severe, Level 3 or 4, their payback should be within the two year range,” Dr. Barnett predicts, adding that there are offices that can see 2 to 4 patients or more per month, which greatly reduces the payback time frame.
“Since this is a medical condition/problem, with a dental solution, dentists have to address the medical billing/insurance issue with patients up front, and that can affect acceptance rates,” Dr. Barnett says.
As with any “specialized program” that general dentists consider incorporating into their practices, in addition to the solid clinical and hands-on training TruDenta provides, a strong background in the science behind what they will be doing is necessary and important. Dr. Barnett emphasizes, “It is crucial to learn as much as possible about occlusion, pain, sleep, and TMJ/D initially. While TruDenta offers a systematic approach, they also provide education on the fundamental underpinnings of what we are doing to be the most help to people.”
Even with the general and financial benefits of a system like TruDenta, it also offers a way to differentiate and build dental practices, and a profit center. Another key benefit that should not be underestimated is how gratifying providing this service is. Whereas some programs are simply not embraced by everyone in an office because they are too complicated to learn and, therefore, never get off the ground, patients will see the office team is enthusiastic about what TruDenta can do for them. It is, therefore, important to have the entire team participate in the training process.
Ultrasound TMJ therapy helps brings blood circulation back into strained or sore muscles (above left).
“TruDenta has made a big difference to all of our team. We have a much more comprehensive approach and, more importantly, an approach to treatment that they (the team) can understand,” Dr. Barnett points out. “Therefore, they can participate more than they ever could before.”
The bottom line is this: to be able to see patients finally getting relief from conditions they have had for many years and then actually offer a ‘thank you’ is priceless. Every dental practitioner would take more of that!
Star Ranch Dental is located at 5944 W. Parker Road, Suite 500 Plano, Texas 75093. For more information call (972) 943-5944 or visit www.starranchdental.com. n
Alpha-Stim treatment focuses on trigger points going directly to the nerve to release the muscles (above left). 10 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Over 80 Million Americans Need and Want this Treatment Patients will THANK YOU for Changing their Lives TruDenta is a turnkey system of technology, training and marketing. It enables dentists to improve care for existing patients, and to receive new patient referrals from Medical Doctors. Statistically, about 20% of your existing patients are symptomatic, yet are undiagnosed and untreated today. In less than 60 days you could be helping countless more patients, without pain, drugs or needles. A doctor invests about 120 minutes of their time in a typical $5000 case. Patients demand care, because pain relief is not elective, it is life changing. But, TruDenta is not about the money, it is about providing your current and future patients with a superior standard of care. Treatment is provided by your team members who are trained by TruDenta doctors at major dental schools, with C.E. One TruDenta doctor said,
“If you truly love your patients, you will get this system.” Only TruDenta member practices are exclusively empowered to help the over 80 million Americans suffering from chronic headaches, migraines and TMD. Experts estimate that 80% of these symptoms could be dental force related within the muscles, tendons, nerves, ligaments and joints. Until TruDenta, there has never been a predictable and consistent system to help these patients. We equip and train practices to objectively diagnose and successfully treat eager new patients. Only a dentist can do what we do. Our approach to dental force management is a combination of advanced dentistry and sports medicine technology. The patented technologies are used in thousands of hospitals and medical clinics around the globe. The methods are taught in virtually every dental school. TruDenta combines these proven elements into a single, successful system which helps patients and dramatically boosts practice performance. Our member doctors say TruDenta improves their overall practice, and that the patient response is “amazing.” Some practices earn hundreds of thousands of dollars per year with TruDenta, others pay off their system in the first year treating only a single patient per month. The investment can be 100% financed, and is immediately tax deductible. We are currently selecting a limited number of advanced dentists in the U.S. to join us in improving patients’ lives. Opportunities are still available in many markets. To learn more, call 866-233-4322 to schedule a brief consultation with a company principal. Every dentist should ultimately adopt our approach and technologies, because all patients deserve an opportunity for the best outcome from your care.
See dozens of patient, doctor and team member videos at www.DRSdoctor.com
To learn more, call 866-233-4322.
Making Oral Cancer Detection Faster and Easier
The ingenuity of UT Austin bioengineers elevates barcode scanner technology from checking prices to finding cancer by Tina Cauller
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his year 40,000 more Americans will learn that they have oral cancer1. A little more than half of them will still be alive five years from now. In the U.S., one person dies from oral cancer every hour. This deadly cancer flies under the radar of the mainstream media, overshadowed by other types of cancer like cervical cancer, Hodgkin’s lymphoma, testicular cancer, laryngeal cancer and malignant melanoma, even though it takes more lives than any of those cancers. While it isn’t particularly hard to discover or diagnose, there is no efficient real-time screening tool for oral cancer, so it is usually detected only after it has metastasized to the lymph nodes of the neck. It progresses without causing symptoms, silently and painlessly invading deep into surrounding structures. Even when the primary cancer is found and treated, survivors have a twenty times higher risk of developing a secondary cancer, a risk that persists for years after the first occurrence.
The primary causative factors behind oral cancer may be changing. Scientists have implicated a recently emerged pathogen known as human papilloma virus 16 in the sharp rise of oral cancer incidence, particularly in the oropharynx, tonsils, and base of the tongue, where it can grow without revealing any noticeable warning signs that might improve the likelihood of early detection. As the leading causative factors shift, the demographic profile of oral cancer is also changing. Although historically most oral cancers occurred in individuals over 40, more and more people under 40 are now being diagnosed, and newly published research indicates that the sexually transmitted HPV-16 is replacing smoking as the primary cause for oral cancer in patients under 50. Additionally,
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The research team working in the lab at UT Austin (from left): Gauri Behave, Nick Triesault, Youmin Wang, and John X.J. Zhang.
the proportion of female oral cancer patients has risen from one in seven to one in three.
While dentists have long been the front line in the battle against oral cancer, a group of bioengineers at University of Texas at Austin recently unveiled a fast, convenient, noninvasive and portable device that promises to give dentists an even greater capacity for lifesaving early detection. The results of their study were published on April 27, 2012 in the Journal of Micromechanics and Microengineering. The UT bioengineers, who specialize in manipulating photons at microscales, adapted the micromirror technology used in barcode scanners and fiber optic switches to create a highly miniaturized version of the traditional confocal microscope. According to John X. J. Zhang, PhD, lead author on the study, the fast-scanning micromirrors were a central component because they dramatically shrink the size of the imaging probe, with the additional benefits of being inexpensive, easily fabricated, and readily integrated into electronic systems.
Current oral cancer diagnosis requires invasive biopsy and timeintensive histopathology. The handheld confocal probe, which is just 20 cm long with a 1 cm wide tip, allows the user to view tissue up to 500 microns deep without using a scalpel or waiting days or weeks for tissue samples to be sent to the histology lab where they are processed, sectioned, stained, and then evaluated. Most oral cancers originate in the superficial tissue layers very close to the surface, and the probe can identify abnormal structures within
500 microns of the surface. (While a 500-micron sample may seem small, it represents about 100 conventional paraffin sections.)
The probe uses the microelectromechanical system (MEMS) technology to control the micromirrors and scan regions of tissue with a laser beam in a specially-programmed high-resolution grid pattern that significantly speeds up the imaging process. The probe relies on efficient algorithms to balance field of view and resolution, which makes it possible to layer many frames of digital images to create a three-dimensional image and then tile them together to expand the field of view.
To compare the performance of the MEMS scanner-based handheld probe with a conventional confocal microscope, Dr. Zhang and his team at the University of Texas at Austin, in collaboration with UT Health Science Center at San Antonio (UTHSCSA), scanned oral cancer tissue samples, including neurofibroma, giant cell fibroma, and epithelial ossifying fibroma, with both systems. The preliminary images acquired with the handheld probe were somewhat less crisp but still showed excellent correlation with the images acquired with the conventional confocal microscope. The results of the study were promising and the team now believes that the confocal imaging probe shows exciting potential to become an effective clinical tool in oral cancer diagnosis and treatment. According to Dr. Zhang, the next step will be to do real-time diagnosis. The research team is presently collaborating with multiple
100 µm
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PERIPHERAL OSSIFYING FIBROMA
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GIANT CELL FIBROMA
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Comparison of images obtained from a commercial Olympus microscope under a 2x objective lens (L) and those from MEMS confocal imaging (R).
be on the market within two or three years, with an initial cost between $60K and $80K (compared to $300K-$500K for an advanced conventional confocal microscope). While this is still a prohibitively expensive outlay for most private dental practices, Dr. Zhang expects the probe cost to drop even further as the technology matures. Like other high-end imaging systems now commonly used in dentistry, such as cone beam CT, the confocal probe may first emerge as a tool accessed and supported by multiple dental practitioners. If so, it could make the early detection of oral cancer and a corresponding reduction in cancer mortality a reality on the near horizon.
For more information on the miniature confocal probe, visit http://www.bme.utexas.edu/research/zhang/. n 1 Oral Cancer Facts. Web. 07 June 2012. <http://www.oralcancerfoundation.org/facts/>.
Handheld confocal imaging probe. institutions to further develop and test the probe, including UTHSCSA, UT Southwestern Medical Center in Dallas, and M.D. Anderson Cancer Center in Houston. These facilities will also be involved in conducting the human clinical trials that precede regulatory approval. Dr. Zhang’s team is working with NanoLite Systems to commercialize the device, at which point the probe could be used by physicians to diagnose oral cancer in real-time or might guide surgeons to ensure correct surgical margins. It could also be used in dental offices to screen for identifying biomarkers of early-stage cancer. While the confocal probe is yet to receive U.S. Food and Drug Administration 510(k) clearance, Dr. Zhang anticipates that it may
John X.J. Zhang is an Associate Professor at the University of Texas of Austin (UT Austin) in the Department of Biomedical Engineering, with joint affiliations with Institute for Cellular and Molecular Biology (ICMB), Microelectronics Research Center and Texas Materials Institute. He received his Ph.D. from Stanford University, California, and was a Research Scientist at Massachusetts Institute of Technology (MIT), Cambridge, before joining the faculty at UT Austin in 2005.
Zhang’s research focuses on designing microchips and nanotechnology towards new diagnostic devices for cancer. He has published over 120 peer reviewed papers and proceedings, presented over 45 invited seminars worldwide, and filed over 15 U.S. patents. His research findings have been highlighted in many public media, and were licensed to two companies. In addition to being the Principal Investigator of many major grants from U.S. federal agencies such as NIH, NSF and DARPA, Dr. Zhang was also recipient of many prestigious awards, including: the Wallace H. Coulter Foundation Early Career Award for Translational Research in Biomedical Engineering in 2006, the British Council Early Career RXP Award in 2008, NSF Faculty Early Career Development Program Award in 2009-2014, DARPA Young Faculty Award in 2010, and one of 85 invitees from both academia and industry under the age of 45 to attend U.S. National Academy of Engineering, Frontiers of Engineering (NAE-FOE) program in 2011. www.northtexasdentistry.com
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SMILES SPOTLIGHT
Pre-treatment
in the
Pre-treatment buccal view
LEADERS IN NORTH TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES
Pre-treatment occlusal view
Dr. Stephen Bass
CREDENTIALS Diplomate of the American Board of Periodontology Fellow of the Institute for Advanced Laser Dentistry EDUCATION BS, Biology - Southwestern Univ., Georgetown, 1985 DDS - UTHSC, San Antonio, 1990 MS / Periodontal Certificate - UTHSC, San Antonio, 1993 PROFESSIONAL AFFILIATIONS Dallas County Dental Society Texas Dental Association American Dental Association Texas Society of Periodontists, President, 2003 Southwest Society of Periodontists, President, 2011-2012 American Academy of Periodontists
Maxillary Sinus Lift and Dental Implant Placement
A 56 year old white female presented to my office for evaluation of a missing first maxillary molar in site #3. She was interested in replacing this missing tooth with a dental implant. The tooth had been extracted about 6 months prior to her examination due to endodontic failure. Medical history was positive for hypertension and codeine allergy. Dental history revealed a periodontally stable patient that was receiving regular recall cleanings in her general dentistâ&#x20AC;&#x2122;s office.
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Surgical guide in place
CLINICAL EVALUATION Clinical evaluation of the site revealed adequate bone width and interproximal space for placement of a dental implant. A periapical radiograph demonstrated only 6mm of bone height from the crest of the alveolar ridge to the maxillary sinus floor. In order to place an implant of adequate length, a maxillary sinus bone augmentation would be necessary. With the existing 6mm of bone height, the implant and the maxillary sinus augmentation could be performed simultaneously. Since the maxillary sinus has limited blood supply, the sinus augmentation bone graft would be combined with Platelet Rich Plasma (PRP) to enhance the healing and maturation of the bone graft. The patient provided consent, impressions were taken for fabrication of a surgical guide and then she was scheduled for her surgical procedure.
PROCEDURE At the time of her surgery, pre-procedural rinse with chlorhexidine was performed for one minute and then local anesthetic was provided. A 20cc venous blood draw was performed from her right arm and the PRP was prepared using the manufacturer’s guidelines. Crestal and sulcular incisions were made from teeth #2-5 with a vertical releasing incision on tooth #5 disto-buccal. A full thickness flap was reflected. A lateral window osteotomy was created using a large round diamond bur. After accessing the sinus membrane, the soft tissue membrane was reflected from the sinus floor using specially designed sinus lift elevators. When adequate reflection of the sinus membrane was confirmed, a bone graft of combined Bio-Oss (bovine bone) and Mineralized Freeze-Dried Bone Allograft (human cadaver bone) were combined with the PRP. This bone graft mixture was incrementally placed into the sinus osteotomy. The surgical guide was then placed on the teeth and the implant osteotomy was drilled to 6mm to the level of the sinus floor. A Straumann wide neck/wide body tissue level implant was placed with good engagement. The sinus osteotomy was then packed further with bone graft to achieve good fill. A collagen resorbable membrane (Bio-Guide) was placed over the lateral window osteotomy and remaining PRP was applied over the wound. Closure was obtained with 4-0 and 5-0 chromic gut sutures. Oral and written post-operative instructions were provided.
Sinus osteotomy window
After sinus bone graft
Post implant
Post implant
Final restoration
Permanent crown in place
RESULTS The patient was followed for multiple post-operative visits and uneventful healing was observed. At the 4-month follow-up, a periapical radiograph was taken to confirm adequate bone density and the patient was released for the restorative phase. The abutment placement was coordinated with the patient’s general dentist. The abutment was placed and torqued to the appropriate force. The patient was then sent to her dentist’s office for the abutment impression and placement of a temporary cap over the abutment. The crown was then placed by the general dentist when it was returned from the dental laboratory. The patient was seen for a final radiograph and photograph about 6 weeks after abutment placement. She will resume regular dental cleanings with her general dentist and with radiographs on an appropriate interval to diagnose decay and to monitor the bone stability around the implant.
Final result
For more information concerning this case, contact Dr. Bass at Dental Implant & Periodontal Partners, LLP by calling (972) 612-2040 or visit www.implantperioteam.com. www.northtexasdentistry.com
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Dentistry North Texas
“On July 13, 2005, an ad consultant sent us our 1st proof for our 1st ad in our 1st issue of a local publication serving dentists in the North Texas area. We continue to work with LuLu Stavinoha, the rep we met some seven years ago, although her role is much more than just selling ads. Today, LuLu owns and publishes her own magazine, North Texas Dentistry, and she continues to deliver the A+ service she delivered the day we met her. North Texas is just a part of the country we serve, but it’s where we started. Thank you, NTD.” - Brian Berry, President Med-Tech Construction
“Our company has worked closely with LuLu and North Texas Dentistry magazine and I am very impressed with the professionalism and quality of the publication and the exposure has been excellent. I know our target audience is reading it, because each time a new issue goes out we get calls telling us they saw us. I would highly recommend the magazine to anyone who wants to put their message in front of the North Texas dental community.” - Marc Fowler, CEO, Bullseye Media
“It has been a pleasure working with Doctor of Dentistry, now North Texas Dentistry, under the direction of LuLu Stavinoha and her great staff. They are all true professionals and put together a first class publication. I am proud to put my advertising in such a quality magazine and I look forward to continuing the valued relationship I have with the organization.” - Kayce Hollingsworth, CDA, RDA Dental Keynote Concepts in association with Baylor College of Dentistry
“LuLu Stavinoha and her staff at North Texas Dentistry magazine produced an outstanding article with incredible photos about our office. Our referring dentists and new patients love the professional and in-depth brochure that they received. This has been a wonderful way to grow our practice, and the quality of their product truly sets itself apart from other companies. I would highly recommend North Texas Dentistry Magazine!” - Melissa Rozas, DDS
“LuLu is a lulu! The entire North Texas Dentistry team is a dream to work with. They couldn’t be better!” - Lorin Berland, DDS
“I have worked with LuLu Stavinoha and her team for almost a decade while she was publisher of Doctor of Dentistry magazine. AFTCO has continued to support her publishing efforts with the launch of North Texas Dentistry. In fact we increased our ad size to a full page! The professional response from my advertising and articles in North Texas Dentistry continues to be very rewarding and we foresee many additional years of commitment to LuLu and her new publication.” - Richard V. Lyschik, DDS, FAGD Senior AFTCO Transition Analyst
"I want to commend the excellent job done by Tina Cauller and North Texas Dentistry on the layout & quality photos of my recent orthodontic case highlighted in 'Smiles in the Spotlight'. Very sharp!" - Deji V. Fashemo, DDS, MPH
! s r e v i de l “We have looked forward since last year’s publication to being featured again in the 2012 North Texas Dentistry Convention issue. Monarch Dental has been a highly recognizable brand name for many years in North Texas and the opportunity to keep us in the forefront to a targeted audience of dentists is very important to us. Working with LuLu Stavinoha and her artistic and editorial team is always satisfying and the end result is an excellent presentation of our “Smiles For Everyone” message. Our goal is to be a regular contributor and partner with North Texas Dentistry as they highlight our future plans for growth and continued success.” - Mike Duda, Doctor Recruiter Smile Brands Inc./Monarch Dental
“As a CPA who has specialized in working with dental practices for 20 years, I have found that North Texas Dentistry has very helpful articles about managing a dental practice as well as wonderful features on dental practices and those who serve their community. I find the articles to be extremely informative on a wide range of topics like Marketing, Practice Management, Dallas opportunities, and how to run your dental practice most effectively.” - Nancy Bahr, CPA
“I am an oral surgeon in Fort Worth. I really enjoyed your first two issues of North Texas Dentistry and it seems your magazine is very well put together. I especially enjoyed the Mission Dentistry spotlight. Keep up the good work!” - Fayette C. Williams, DDS, MD Clinical Faculty, John Peter Smith Hospital Dept. of Oral & Maxillofacial Surgery
“As a business owner, it’s imperative to continue to market your business in cost effective ways, while ensuring your target market is being reached. The 2011 Future of Dentistry Special Issue was ideal for i3. It was within our budget, targeted our market and delivered positive results. i3 will definitely continue advertising in the North Texas Dentistry Special Issue.” - Blake Eaton Founder, i3 Outsourcing Solutions, LLC
“Writing the Future of Mission Dentistry article allowed me to explore the immense dental needs locally and within developing countries worldwide. It was encouraging to learn about the leading organizations and their products created to assist these undeserved areas. It was a joy working with North Texas Dentistry magazine and the feedback I've received from this article and those interested in volunteering their talents has been phenomenal! - Sloan Hildebrand, DDS
practice marketing
How the New Google+ Local Will Impact Dentists
A
ccording to Google, 97% of consumers search for local businesses online. Up to this point, Google Places has been a helpful tool to connect those consumers with local businesses. However, Google Places is now a thing of the past. Google recently introduced the merger of Google Places and Google+ Profiles, to create Google+ Local. If you had a Google Places listing it was automatically merged into a Google+ Local page. Many of the merged pages lost their formatting, so you’ll want to log in and clean up your page, pay particular attention to your banner and profile images. It is important to understand the changes, as they will ultimately affect your practice.
What makes Google+ Local different?
n Pages feature a new layout to showcase your business in a detailed way- allowing more photos, text, links and tabs.
n Google’s star ratings are being replaced by the Zagat 30point rating scale, which has been widely used in the restaurant industry for years. Note: Google purchased Zagat last year.
by Kelly Rucker
What will happen to your Google Places reviews?
Google says they will be transferring the reviews from your Place page to your Google+ Local page automatically. However, the old star ratings system will be replaced with Zagat ratings. By dismissing the traditional 5 star ratings and upgrading to the Zagat 30 point system, consumers now have the ability to grade your practice on separate facets, including service, decor and cost. Reviewers will rate your practice on a scale of 0 to 3, Google will then average the scores and multiply them by 10 for a maximum score of 30. Google has also announced that the content on Zagat.com will now be free for registered users of Google+.
What if you already created a Google+ Business Page?
You will need to continue to manage it separately from your newly created Google+ Local Profile. At the moment, the two are independent of one another. Google plans to eventually consolidate Google+ Business Pages and the new Google+ Local Pages into a single listing.
n Google+ now features a “Local” tab.
While this new format will take some getting used to, the ability to create richer, more user friendly pages with integrated Zagat ratings will be beneficial. n
n You now have the option to add blog posts, photo albums and updates to your profile feed.
Kelly Rucker is a digital marketing assistant with Bullseye Media in McKinney, TX. She manages online content & visibility for dentists nationwide. Learn more about Bullseye Media by visiting OnlineDentalMarketing.com or calling (214) 592-9393.
n Google+ Local pages will be indexed so they show up in the search results.
n Enhances the ability to engage and socialize with consumers.
www.northtexasdentistry.com
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Summer program participant, Oscar colors an oral health activity sheet.
Pediatric Dentist Launches
Oral Health Summer Program Featuring Sesame Street’s Healthy Teeth, Healthy Me According to the Centers for Disease Control and Prevention “Tooth decay (dental caries) affects children in the United States more than any other chronic infectious disease.” To help reduce cavities and dental illnesses among children in our local community, Children’s Dental Centre of Irving has launched Healthy Teeth for Life: Summer Program, aimed to promote good oral health in children during the summer months.
The Centre expects more than 500 children to participate in the summer program, which consists of a weekly activity focusing on a different area of oral health. The Centre’s summer activities will predominately feature Sesame Street’s Healthy Teeth, Healthy Me initiative. Sesame Street’s Healthy Teeth, Healthy Me is a bilingual (English/Spanish), multimedia outreach initiative motivating children 2 to 5 years of age, their parents,
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and caregivers to care for children’s dental health. The initiative, produced by Sesame Workshop, the nonprofit organization behind Sesame Street, was developed in partnership with Sam’s Club Giving Program and MetLife Foundation. Healthy Teeth, Healthy Me emphasizes the easy everyday routines and good habits to keep children’s teeth, mouths, and therefore bodies, healthy and strong.
Organizations participating in the Centre’s oral health program include: YMCA of Metropolitan Dallas (Irving and Coppell locations), Cimarron Recreation Center, Mustang Park Recreation Center, Lee Park Recreation Center, Northwest Recreation Center, Senter Park Recreation Center, Hackberry Creek Country Club and Rockbrook Montessori Academy.
Reena Kuba, DDS, MS, the Centre’s board certified pediatric dentist, is committed to working with the community and parents to create a positive, educational atmosphere to get children on the right path to a lifetime of optimal oral health.
“We are very excited to continue our mission of dental education and prevention with our summer activities – and we are thrilled to incorporate the new educational materials created by Sesame Workshop and promoted by the American Dental Association, which we know the kids will love!” said Dr. Kuba. n
CHILDREN’S DENTAL CENTRE OF IRVING
Children’s Dental Centre of Irving provides comprehensive dental care for children ages six months to 18 years of age. Reena Kuba, DDS, MS is certified by the American Board of Pediatric Dentistry and is the founder of Children’s Dental Centre of Irving. Dr. Kuba is also a clinical assistant professor at Baylor College of Dentistry and was named one of the Best Dentists by D Magazine in 2011. Learn more at www.irvingchildrensdental.com.
www.northtexasdentistry.com
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R
wine cellar
A Rosé By Any Other Name...
osé wines don’t get enough attention in the United States. Perhaps the name is, indeed, part of the obstacle. Somewhat generic sounding, “rosé” is often equated with sweet “blush” wines (as in white zinfandel). And there’s typically a scant amount of retail shelf space dedicated to rosé, few wine shops make a point to hand-sell it and selections are scarce on restaurant wine lists. Rosé, however, is one of the most versatile wines around. It’s been a staple in the south of France for centuries and French rosé now outsells white wine in France.
Rosé (French for “pink”) wines are not a blend of red and white wines – they are made solely from red or black-skinned grapes. But unlike in the production of red wine, the grape skins are only allowed contact with the juice for a short period of time, imparting only a portion of the color and tannins normally contained in red wine. Colors range from light pink to salmon depending on the length of time the skins are left in the mix. The result is a wine with the lighter red fruit and tannin of a red and the brisk acidity of a white. They are not sweet – in fact, the traditional French rosé wines from Provence are bone dry. While many of the French rosé are blends, rosé wines made from single red grape varietals are plentiful and virtually
by Kim Clarke
all wine-producing regions of the world make rosé wines. Bordeaux producers such as Chateau Pavie Macquin and Chateau Phelan Segur make very affordable rosé wines. Most of the Champagne houses also make a rosé based on the Pinot Noir grape, but these rosé Champagnes typically carry a higher price tag than their counterparts.
Warm weather and lighter fare like fish and fowl match up well with rosé. The strawberry, raspberry and cherry fruit flavors compliment rather than overwhelm, and the crisp, dry finish keeps your taste buds alert. Rosé wines are meant to be drunk young – the tannin content is already low and age will only reduce the vibrance of the fresh fruit.
Here are a few favorite rosé wines that are widely available and worth a try:
Chateau Paradis – Located just north of the town of Aix-en-Provence in the south of France, the home to many top rosé producers. A beautiful pinkish/salmon color with spicy strawberry and cherry flavors and a crisp dry finish. This wine is a blend of Grenache (60%), Syrah (20%) and Cabernet Sauvignon (20%). A great example of the rosé wine from Provence. Around $18.
Chateau Pavie Macquin – From a top red wine producer in the Bordeaux region of France, this wine has strawberry and
20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
raspberry fruit along with a little white pepper and spice. A fragrant floral nose and a long finish. An inexpensive wine from a highbrow Bordeaux winery. Around $12.
Etude rosé of Pinot Noir – Made from 100% Pinot Noir grapes grown in the Carneros region of California, this rosé is salmon in color. Raspberry and strawberry flavors abound with a long drying finish. Great with seafood and grilled fowl. Probably my favorite rosé and a good buy at $20.
Borsao rosé Campo de Borja – An inexpensive little Spanish rosé made from 100% Grenache grown in a region known for its capabilities to produce fabulous Grenache-based wines. Light, elegant and crisp, this is a good pool party wine and goes well with cheese and hors d’oeuvres. Best served well-chilled. Around $7.
When I find a rosé wine made from a single grape varietal such as zinfandel or syrah, I like to try it and compare the rosé version to the regular red wine of that varietal. While you’re able to pick up on the characteristics of the grape, it’s interesting to note the part that’s been left out by the exclusion of the skins in the winemaking process.
Pick one up and see what you think. It doesn’t matter which one you get as they’re all pretty good and most aren’t expensive. I recall a visit once to a local wine shop that had quite a few cases of Goats do Roam rosé (from Fairview, a pretty good South African winery) on sale at a clearance price of $3. The manager said they just couldn’t sell it at regular price ($8) and it still wasn’t moving at $3. I’d never had the rosé and didn’t know much about them, but I knew the regular Goats do Roam Grenachebased wine was pretty good, so I bought a case. Never regretted it as it turned out to be good wine and a great deal. n
WWW.AFTCO.NET
Helping dentists buy & sell practices for over 40 years. AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.
Victoria E. Ortiz-Parsons, D.D.S. has acquired the practice of
Alan S. Martin, D.D.S. - Dallas, Texas (Baylor College of Dentistry 2003)
Jennifer D. Hedrick, D.D.S. (Baylor College of Dentistry 2010)
has acquired the practice of
Martin Weinberg, D.D.S. - Dallas, Texas (MeHarry Medical College 1973)
AFTCO is pleased to have represented all parties in these transactions.
Call 1-800-232-3826 today for a free practice appraisal, a $2,500 value!
COULD
Assisted Hygiene
practice management
BE YOUR SOLUTION? by Cathy Jameson, PhD
B
eing too heavily booked or booked out too far can cause problems, as you may know. Are you experiencing situations where treatment is compromised because scheduling in a specific time frame impacts treatment results (such as in periodontal therapy)? Do you have patients going elsewhere so they can be seen more expediently and more conveniently? Does stress sometimes over-
whelm you or all members of the team? If you are overbooked in hygiene or if you cannot see a new hygiene patient for three or more weeks, you need to consider some alternatives.
n Make sure that you have a hygienist scheduled into every available room every possible hour. Add hygiene days or hours if and when possible.
n Increase your fees. Supply and demand call for this business move.
n Pre-block your appointment book so each hygienist is reserving approximately half of the day for primary procedures, such as non-surgical periodontal therapy.
n Analyze each of your hygiene procedures and make sure you are maximizing time. Schedule enough time to perform all necessary aspects of each procedure, but make sure each procedure is engineered efficiently. Don’t schedule either too much or too little time.
n And, if all the above still leaves you overbooked or booked out too far, consider implementing assisted hygiene.
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Let’s look at this Assisted Hygiene concept with wide open eyes. There was a time when doctors were not assisted. The dentist worked alone and, in many cases, standing up! It’s hard to imagine either of these situations today, but that was “the way” decades ago. A paradigm shift occurred in the industry that showed, without a doubt, how assisted dentistry was more cost efficient and more ergonomically healthy. Now, I doubt if there are many dentists who would consider working without a qualified assistant.
The same kind of paradigm shift has now mostly swept the industry in hygiene. Once upon a time, the profession thought patients only wanted to be with the doctor and that it would be a sacrilege to have a patient spend time with a clinical assistant. Now we know differently. We know the time patients spend with a qualified assistant is excellent. In fact, much of patient education is done by the assistant (in addition to everything else he/she is doing), and many patients will ask him/her questions that they will not ask a doctor. Not only has production gone up, but time management has been enhanced and patient care has accelerated.
Some of the most elegant and quality hygiene programs I have ever known have a solid team — hygienist and assistant. The patient care is without flaw. Get out of the thought process that assisted hygiene is a compromise. Rather, think of assisted hygiene as a patient benefit.
To develop an assisted hygiene program, analyze your present hygiene situation, including fees, schedule preblocking and treatment room usage. How long has it been since you increased fees? Did the increase cover your rising costs of operation? Even though patients may have complained about the fee increase, what percentage of your entire patient family actually left? Consider an across-the-board increase of 10%. Are you pre-blocking for approximately half of your production goal? Are you reserving these pre-blocked times for primary procedures such as periodontal therapy appointments? Can you see periodontal therapy patients expediently? Once they start therapy, can you treat them in the appropriate time intervals (2-3 weeks)? Are you maximizing your available treatment rooms and the days/hours available for hygiene? Determine what must be done by the hygienist and what could be delegated to the hygiene assistant.
In most practices, “dove-tailed” scheduling lets the practice schedule an additional four patients per day. So, obviously, you are not going to double your hygiene department with this type of delegated hygiene but you can see 16 more patients
per week, and that makes a huge difference in dealing with the above mentioned problems of being too busy.
You may not have an additional treatment room available for hygiene. If not look at the doctor’s schedule and see if you can schedule more succinctly. Or, pre-block the doctor for long crown and bridge appointments during certain times of the day and use two of the treatment rooms for hygiene during those pre-blocked times.
Being too busy is a good problem to have, but it can still be a problem. In order to improve your patient care, see patients in a more timely fashion, and maximize the time and talent of your hygienist, consider assisted hygiene. Put the pencil to it. Not only will the assistant pay for his/her way, but your hygiene revenue will increase significantly. n
Cathy Jameson, PhD founded Jameson Management, Inc., an international team of nearly 40 advisors who improve the lives of dental professionals through business, marketing and clinical coaching. Visit www.JamesonManagement.com for details and complimentary educational webinars. To reach Cathy, call 877.369.5558 or email Info@JamesonManagement.com.
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money matters
INFLATION
The Great Retirement Robber by Bob Michaels, CLU, CLTC
M
ost people know how inflation works. When the prices of goods and services rise, our money doesn’t stretch as far. During our working years, if we’re constantly climbing the money ladder, it can be easy to overlook inflation’s overall impact on our bottom line because those raises in take home income can help to offset the effects of rising prices. It’s sort of a buffer against the pain of inflation.
But what happens when you take a long-term view of inflation? You’ll notice that the prices of everyday goods have significantly increased over the years. Take a look at this inflation graph2, which tracks inflation for the 10-year period from 2001 through 2011:
5% 3% 1%
2001
2003
2005
2007
2009
2011
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In the chart, price changes are measured by the U.S. Department of Labor’s Consumer Price Index (CPI). The CPI provides an estimate of a price change between two periods of time for a sampling of goods people buy for day-to-day living. It represents the degree to which prices change between these two points of time. Interestingly, the government decided to stop including the change in prices of food or energy some time ago.
Can your retirement income do two important things?
Once you’re retired, inflation can pose a big threat to your budget, since you’ll be on a fixed income. Your retirement income will most likely come from Social Security, withdrawals from qualified retirement plan assets and other assets you have accumulated to support your lifestyle during retirement.
Once you’ve left the workforce, your retirement income will need to do two important things: last for your lifetime and fully cover your expenses during retirement. But here’s why you may find it difficult for your retirement income to achieve both of these goals:
1) Social Security is designed to last for your lifetime and can provide a cost-of-living adjustment (COLA), but this adjustment is not guaranteed to happen each year – for example, there was no COLA in both 2010 and 2011. (The Social Security Administration uses the CPI-W to help determine the amount of any COLA that is granted to Social Security recipients.1) It’s been widely reported that, with the high number of retiring baby boomers and low number of workers in the field force, changes in Social Security will be needed. Potential changes may include things like reduction in benefits, FICA tax increases, and increasing the normal retirement age. The Social Security Administration has projected that, without any changes, by 2037 the Social Security Trust Fund will only be able to pay about 78 cents for each dollar of scheduled benefits, as estimated based on the intermediate assumptions from the Social Security Trustee’ Annual Report to Congress.
2) The longevity of your other retirement income sources will depend on how much your investments earn (investment earnings can be unpredictable and your investments may lose value) – and the amount of money you withdraw from your retirement account(s) each year. (Too high of a withdrawal rate may mean you could run out of money during your lifetime.)
Creating your retirement income strategy today
Speak with your financial professional
Having a plan designed to provide a lifetime income may give you the confidence and ability to enjoy retirement without the worry of running out of money before you run out of life! n Source: Social Security Online http://www.ssa.gov/oact/COLA/latestCOLA.html> 1
2
Source: www.usinflationcalculator.com
Rates calculated using the Current Consumer Price Index published monthly by the Bureau of Labor Statistics.
Bob Michaels, CLU has been in the insurance business in Dallas, Texas for over 40 years. He has been an Associate with the TDA Financial Services Insurance Program for the last eight years. Bob’s scope of operation in the TDA Insurance Program includes life, health, disability income, employee benefits, long term care, and malpractice insurance.
For more information, visit www.TDAmemberinsure.com. You can contact Bob at bmichaels@TDAmemberinsure.com or call (214) 696-5103.
There are several steps you can take to help yourself counteract the effects of inflation – and help you to ensure that your retirement income will last. These include:
Developing a diversified investment strategy by investing some of your assets into a mix of stocks (“equities”) and fixed income funds. Over the long term, equities have tended to outpace inflation (more so than fixed income investments), but stocks tend to have a higher level of investment risk than fixed income investments, such as bonds. Consider including asset classes that are not directly correlated to the stock market like gold, silver, and real estate.
Following a distribution/withdrawal plan by withdrawing some of your assets at certain points in time. This can help you lengthen the life of your assets, gain the potential benefit of compounding growth and help you systematically increase your retirement income.
Purchasing the right kind of conservative financial products, such as annuities and cash value life insurance. An Annuity is the financial instrument that can guarantee payments for life. Cash Value life insurance can allow you to leverage your premium dollars by providing a permanent death benefit while at the same time providing a living benefit through cash values.
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(CONTINUED FROM PAGE 5) u
Baylor College of Dentistry Alumni Association. She is employed as a dental hygienist in the offices of Dr. Mark Santamaria in DeSoto, Texas, and Dr. Jessie Andrews in Mansfield, Texas.
“It is such an honor to accept the Teacher-of-the-Year Award,” says Pearson. “This graduation marks the anniversary of my 20 years as a dental hygienist. I have enjoyed every year that I have been blessed to serve my students and the public.
“I have been teaching for 19 years and am thankful for the opportunity to pass on to the students what I have learned from my years of practice. I love teaching and hopefully am making a difference, both professional and personal, in the lives of students.”
Jennifer Eure Fuentes is a communications specialist at Texas A&M Health Science Center Baylor College of Dentistry. A 2006 graduate of Texas Christian University, she has worked in the communications and editorial field for five years. Founded in 1905, Baylor College of Dentistry in Dallas is a college of the Texas A&M Health Science Center. TAMHSC-BCD is a nationally recognized center for oral health sciences education, research, specialized patient care and continuing dental education. The TAMHSC serves the state as a distributed, statewide health science center that is present in communities throughout Texas.
Upon her graduation in 1992, Pearson received the Phillip Earle Williams Award and an honorable mention for outstanding achievement in community dentistry in the American Association of Public Health Dentistry Student Merit Award Competition. She has remained involved with her alma mater, serving on the Caruth School of Dental Hygiene 50th Anniversary Committee from 2004 to 2005.
Her devotion to service is evident: “I want my students to be competent clinicians as well as compassionate individuals,” she says. n
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AN UNFORTUNATE STORY
practice transitions
The Case for Estate Planning... While You’re Still Alive by Richard V. Lyschik, DDS, FAGD
Dr. A died not long ago. He had a growing general dental practice in a desirable location. He died without a will (intestate) and without instructions for the disposal of his practice. The grieving widow contacted her attorney and accountant, neither of whom had any idea how to sell a dental practice, but they both told the widow that they would take care of selling the practice for her.
Both advisors were totally unaware of how much value a dental practice would lose by delaying the practice sale. The first thing they did was to instruct the staff to forward all patient calls to another dentist in the same small town while they tried to determine what to do with the practice. This immediately decreased the value of the practice since most of those patients referred to that other dental office would probably remain with that dentist once the practice was finally sold, and any purchaser candidate would know that and their offer to purchase it would reflect that mistake.
A quick determination of the value of the practice should have been made, and then locating a purchaser who was willing to pay that fair market value should have been top priority for the estate. That purchaser could have worked in the practice for the estate (as an independent contractor under a contract to purchase) until all the legal matters were settled, and then the actual title of the practice could have been transferred to the purchaser once probate was completed. Instead, several purchasers who inquired were told to wait while the attorney spent weeks filing the necessary legal papers for the estate, and then the attorney took a two-week vacation!
The delays went from weeks into months while the practice was appraised by the local dental supply house (they too took their time because they did not want their potential customers buying the equipment from the estate). Potential purchasers were eventually told by the dental dealer that the practice no longer had any value since it was closed for so long. The accountant and supply salesman made a complete list of all the supplies, and counted every instrument, knowing that this amounted to nothing more than a waste of time because it did not have any effect on the overall value of the practice. A practice’s real worth is demonstrated in its active patient base, not the tangible assets. Meanwhile, as time marched on, the practice value continued to decline. Three months from the time the dentist died, the
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attorney decided to accept bids for the practice. Where there had been a number of purchaser candidates, there remained two interested parties, both of whom were looking for a “good deal”. At the time Dr. A died, buyers were willing to pay $500,000 for this practice. Because of the delays caused by the wrong advisors, the final selling price was less than $60,000.
The estate ended up paying the lawyer and accountant for their professional services. The dental supplier was delighted that none of his potential customers bought the practice. The widow and her children ended up losing over $460,000. A codicil to Dr. A’s will instructing the executor to appoint the right Transition Advisor to dispose of the practice could have prevented all of this loss.
While you’re still alive… here are some Common Sense rules to live by: laugh a lot; tell the truth; buy low, sell high; never lend money to friends; floss; marry for love; clean up your own mess; be nice; determine the value of your practice; call the right advisor to plan your estate! n
Richard V. Lyschik, D.D.S., FAGD is one of AFTCO’s leading innovative Senior Analysts who has helped over 2,900 dentists in associating, buying, expanding, or merging and guided older, disabled and/or “burned out” dentists to sell their practices. Dr. Lyschik’s clients have seen the considerable benefits of incentive programs, pension funding plans and increased productivity through his guidance. There is no substitute for experience in this business. Who better could you choose to talk to about your future transition plans than a seasoned fellow dentist, a recognized premier transition expert, and AFTCO Analyst of the Year Award winner? Check out the impressive AFTCO website at www.AFTCO.net, then call for a free appraisal and a no-obligation consultation with Dr. Lyschik at your office or the AFTCO office in Dallas, TX at (214) 893-0410 or 1-800-232-3826.
Dentistry North Texas
special issue
A: Businesses that sell products and provide services to the dental profession will be featured in the issue.
a business and lifestyle magazine for north texas dentists
A
Q &
Q: How will the guide be formatted?
Creating the Ultimate Dental Practice
GE OLLE OR C TRY L Y A S B E NT I OF D LASS C R IVE O SENIALSO RECE! WILL IS GUIDE TH
Q: Who should be part of this guide?
Putting it all together
Q: What is the purpose of this issue?
A: North Texas Dentistry wants to develop a handbook for the dental community to use as a guide to the many facets of the successful practice. Creating the Ultimate Dental Practice will present leading companies and individuals in the community and will be a reference doctors refer back to.
A: The issue will be divided into sections to showcase the specific industries that impact dentistry. The categories are: The Building (real estate, architecture, construction and design), The Finances (banks, accounting, wealth management, insurance), The Equipment (dental supplies, specialty equipment), The Practice (personnel, marketing, management, sales and transitions), The Technology (computers, software, networking, audiovisual) and The Laboratory (full service, CAD/CAM, implants).
Q: What marketing options do I have?
A: Print advertising and Custom Profiles will spotlight Individuals, Companies or Products. You may supply your own content and photography or let the team of North Texas Dentistry assist you for an additional charge.
Q: What other editorial will be part of the guide?
A: The editorial team of North Texas Dentistry will contribute a feature for each section which will include input from those individuals participating in the issue.
Q: When will this Special Issue come out?
A: The special issue will come out in early Fall 2012. Call LuLu Stavinoha at (214) 629-7110 or send an email to info@northtexasdentistry.com.
Creating the Ultimate Dental Practice North Texas Dentistry Special Issue www.northtexasdentistry.com
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NORTH TEXAS DENTISTRY
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ADVERTISER’S INDEX
Acclaim Networks.........................................23
AFTCO .........................................................21 Bob Michaels, CLU.......................................30 Bryant Studios ..............................................26
Bullseye Media ............................................27 Dental Logic..................................................19 Destiny Dental Laboratory............................21
Dr. Ravi Doctor .............................................22
Legacy Bank.........................inside back cover
Med+Tech Construction...................back cover Reliable Dental Laboratory...........................23
Save a Smile.........................inside front cover SMILE Walk & Run.......................................25 Structures and Interiors ................................19
Tina Cauller ..................................................30
TruDenta.......................................................11
30 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
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