New Dentist Fall 2013

THE #1 JOURNAL FOR NEW DENTISTS

Designing Your Practice?

Where to Begin

PLUS Creating the Right Partnership Structure for YOU Patients Turning to Dentists for Sleep Apnea Treatment FALL 2013

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FROM THE PUBLISHER’S DESK

FA L L 2 0 1 3 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Dear Readers,

Picante Creative http://www.picantecreative.com

Welcome to the fall issue of The New Dentist™ magazine.

Tess Fyalka Tess@thenewdentist.net

MANAGING EDITOR

T

he summer vacations have been enjoyed.

The long, lazy days have come to pass, and the kids are heading back to school. In many respects, fall is a time of new beginnings and anticipation.

For new dentists, building your first practice or becoming a partner in an existing practice signals a significant new beginning. You’ve learned all you can as an associate; now it’s time for you to make your own mark.

If that describes where you are in your career, you’ll want to be sure to read two articles in this issue right away. The first is on p. 6, Designing Your Practice?

Where to Begin by Mohsen Ghoreishi, CEO and president of The Kohan Group, Inc. The second is Dollars and “Sense”: Creating the Right Partnership Structure for YOU by Patrick J. Wood and Jason P. Wood. A poorly structured partnership can have all the repercussions of a messy divorce. Turn to p. 12 and learn what these attorneys have to say about creating the perfect partnership.

And whether you are buying, building, or staying exactly where you are, you need a solid financial plan for today as well as the future. Certified Financial Planner Chau Lai offers specific strategies to help you get your financial priorities in order.

Also in this issue, more and more patients are turning to their dentists for a good night’s sleep. Discover what three experts in the field of dental sleep medicine have to say about integrating this life-saving treatment into your dental practice.

Also in this issue, meet Advisory Board member Dr. Mary Shields and discover what this gutsy young entrepreneur did immediately out of dental school.

Finally, be sure to visit The New Dentist™ website at www.thenewdentist.net. You’ll discover a wealth of FREE information and materials to guide you at every step throughout your dental career as well as hundreds of FREE continuing education opportunities using interactive webbased training provided by Viva Learning™, an ADA CERP provider.

Fondly,

Sally McKenzie, Publisher

New Dentist™ Advisory Board

Dr. Josh Austin San Antonio, TX UT San Antonio Dental School 2006

Dr. Charley Cheney III Dr. Katie Montgomery Newnan, GA Marysville, OH Tufts University School Ohio State College of Dental Medicine of Dentistry 2004 2006

2 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

SALES AND MARKETING

For display advertising information, contact ads@thenewdentist.net or 877.777.6151. Visit our digital media book at www.thenewdentist.net/ mediabook.htm The New Dentist™ magazine is published quarterly by The McKenzie Company (3252 Holiday Court, Suite 110, La Jolla, CA 92037) on a controlled/complimentary basis to dentists in the first 10 years of practice in the United States. Single copies may be purchased for $8 U.S., $12 international (prepaid U.S. dollars only).

Copyright ©2013 The McKenzie Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the publisher.

Authorization to photocopy items for internal or personal use is granted by The McKenzie Company for libraries and other users registered with the Copyright Clearance Center.

Disclaimer — The New Dentist™ does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damages incurred by readers’ reliance on such content. The New Dentist™ cannot be held responsible for the safekeeping or return of solicited or unsolicited articles, manuscripts, photographs, illustrations, or other materials. The opinions, beliefs, and viewpoints expressed by the various authors and contributors in this magazine or on the companion website, www. thenewdentist.net, do not necessarily reflect the opinions, beliefs, and viewpoints of The New Dentist™ magazine or The McKenzie Company.

Contact Us — Questions, comments, and letters to the editor should be sent to Tess@thenewdentist.net. For advertising information, contact ads@thenewdentist. net or 877.777.6151. Visit our website at www.thenewdentist.net to download a media kit.

Dr. Kevin Rhodes Round Rock, TX UT San Antonio Dental School 2005

Dr. Mary Shields Louisville, KY University of Louisville Dental School 2011

Dr. Jared Simpson Bakersfield, CA UT San Antonio Dental School 2005

Facebook.com/NewDentist

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Wells Fargo Practice Finance is the only practice lender endorsed by ADA Business ResourcesSM

ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.

All financing is subject to credit approval © 2013 Wells Fargo Bank, N.A. All rights reserved.Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

1915-0713-New-Dentist-September

TABLE OF CONTENTS

FALL 2013

FE ATU R ES

6 Designing Your Practice?

Where to Begin

Mohsen Ghoreishi, CEO and President, The Kohan Group, Inc., Dental Medical Consultants

8 A New Era of Biocompatible

Dental Implants — Achieving Periointegration With Zirconium Nitride Coating Anthony Feck, DMD

10 Dr. Dan Fischer, ‘Guardian of the Oral Cavity’

12 Dollars and ‘Sense’: Creating the Right Partnership Structure for YOU Patrick J. Wood, B.A., J.D. Jason P. Wood, B.A., J.D.

13 Infection Control Is Your

16

Responsibility Debra Z. Sabatini

for Obstructive Sleep Apnea Treatment Tess Fyalka, Managing Editor

24 Dr. Mary Shields, Balancing Compassion and Care

26 Schweitzer Fellow Andrew

Soule-Hinds, DMD ’15: On a Mission to Improve Dental Care for Underserved

4 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

PHOTO COURTESY OF AADSM

D EPA RTM E N TS 2 Publisher’s Message 36 Skinny on the Street 36 Index of Advertisers

10 PHOTO COURTESY OF ULTRADENT

Your Financial Priorities 14 Get In Order From Day One 16 Patients Turning to Dentists

6

PHOTO COURTESY OF THE KOHAN GROUP, INC.

Are you buying a dental practice?

Contact us for a FREE LETTER OF INTENT negotiation.

this could be the

TVZ[ PTWVY[HU[ KLJPZPVU of your career.

are you sure you hired the See our Article:

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DOLLARS AND “SENSE”:

to protect you?

Creating the Right Partnership for YOU.

Written By: Patrick and Jason Wood

>L

have represented more dentists in buying and selling their practices than any other law firm in the JV\U[Y`.

REPRESENTED OVER 4,000 DENTISTS Practice Acqusitions/Sales • Partnerships • Business Transactions

THE AUTHORITY IN DENTAL LAW

Lease Negotiations • Estate Planning • Transitions

800-499-1474 • 800-511-2138 fax

www.DentalAttorneys.com Look online for upcoming seminars in your neighborhood!

Patrick J. Wood & Jason P. Wood

([[VYUL`Z H[ 3H^

Designing Your Practice?

Where to Begin

By Mohsen Ghoreishi, CEO and President The Kohan Group, Inc., Dental Medical Consultants

As a new dentist, you are probably wondering how to go about designing and building your first practice. It seems like a daunting task and can be quite overwhelming. The cost of setting up a dental practice and the length of time you will be in your office are considerably higher than in other professions. There’s a lot at stake as you take those first steps.

B

ut like most everything else in life, if we break the challenge down into clear steps and concise directions, it becomes much more manageable.

Here’s my first piece of advice: Let the professionals help.

Wouldn’t it be nice to do what you do best — dentistry — and to find people who specialize in setting up the physical environment in which you can do your best work? These people do exist, and they can help you through the entire process, from brainstorming your ideal office to the day you see your first patient in your new space.

But where do you start?

Step 1: Do your homework.

• Create a budget. How much money are you willing to spend? As we all know, you can spend a great deal, but is that necessary? With help and good planning, you can get your dream office without breaking the bank.

• Next, set a timeline. How soon do you want to move in

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•

to your new practice? What are the steps involved before you can take occupancy of the new space and schedule your first patient?

Ask yourself where you want to be in 5, 10, even 15 years.

Make sure the practice you set up now will give you room to grow and change. One client of mine wanted to put just three chairs in a space that would have accommodated CONTINUED ON PAGE 18 >>

Mohsen Ghoreishi is CEO and president of The Kohan Group, Inc. He has more than 18 years of experience in architectural/design practice working on healthcare facilities, specifically dental office design and construction management. The Kohan Group, Inc. Dental Office design was established in 2002 and has designed many dental offices nationally. Mr. Ghoreishi has won numerous awards including the first Oral Surgery LEED Platinum certification through the United States Green Building Commission.

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A New Era of Biocompatible Dental Implants — Achieving Periointegration With Zirconium Nitride Coating

ANTHONY S. FECK, DMD

D

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Figure 2. The causes of ental implants have come a long way since periimplantitis Brånemark’s groundbreaking research in The PerioType® X-Pert the early 1950s on the osseointegration of Implant system addresses all titanium in human bone. For nearly all the time since, four causes of periimplantitis the definition of implant success has centered around as a result of its abutment maintaining and sustaining osseointegration, defined as coating and its engineered “the formation of a direct interface between an implant design. and bone, without intervening soft tissue”.1

The coating of its abutAs the process of placing and maintaining implants has ments and transgingival parts (Zirco-Seal™) consists of zircoevolved, so have expectations for the long-term success to nium nitride (ZrN). Zirconium nitride is a ceramic material incorporate more than just a sound connection to bone, but that has proven to be more suitable for tissue growth versus the whole periodontal apparatus. Thus the concept of perioother dental implant surfaces.5 A zirconium nitride surface integration has risen to the new standard of defining implant displays a significantly better biocompatibility for attaching success. Periointegration goes further than osseointegration, gingival fibroblasts.6 (See Figure 3) involving the integration of the dental implant into all the Figure 3. Fibroblast growth on ZrN surface surrounding structures, including the soft tissue, which is Its biocompatibility also important for long-term viability. extends to the biofilm that it This is evidenced by the fact that after as few promotes, both in regard to as nine years after placement, the rate of reported quantity and quality. Studies peri-implant gingivitis exceeds 50%, with the rate of have shown that titanium periimplantitis (the destructive inflammatory process implant surfaces coated with affecting the soft and hard tissues surrounding dental 2 3,4 ZrN reduce bacterial coloniimplants ) approaching 16%. Given this, it can be assumed that within a time period of 10 years a zation compared with other clinically used implant surfaces.7,8 significant portion of all implants placed will develop Rehman et al. compared the microbial composition of an inflammation of the peri-implant tissue, possibly both ZrN-coated polished titanium and uncoated polished resulting in loss of the implant. Therefore, developing titanium and found the bacteria in the microfilm of the implant systems with periointegrative features are

9 essential to increasing the long-term success of Figure 1. ZrN-coated titanium to be less pathogenic.

In addition to being more biocompatible, the zirconium dental implants.

PerioType® nitride coated surface has a Vickers hardness number that Recently, the U.S. Food and Drug X-Pert implant with zirconium CONTINUED ON PAGE 20 >> Administration gave approval for the nitride coated PerioType® X-Pert Implant (see Figure 1), Dr. Anthony Feck is an author, educator, and abutment designed specifically to prevent periimplantitis. speaker on clinical dental topics, emphasizing

The primary reasons for periimplantitis include (see Figure 2): 1. Lack of soft-tissue adhesion 2. Bacterial colonization 3. Micromovements 4. Lack of physiological load transfer in the cortical region 8 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

sedation and anesthesia, implants, and dentofacial esthetics. He is the co-founder and dean of faculty of DOCS Education, where he maintains a diplomate status; a member of the board of directors for the American Academy of Facial Esthetics, where he maintains a diplomate status; and the clinical director of Six Month Smiles. He is the recipient of numerous faculty appointments and awards for excellence in education. Dr. Feck maintains a private practice in Lexington, KY.

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Dr. Dan Fischer,

D

‘Guardian of the Oral Cavity’

r. Dan Fischer is founder, president, and chief executive officer of Ultradent Products, Inc., based in South Jordan, UT. The company, which employs 1,100, is a global leader in dental products, 95% of which are made in America. The New Dentist™ recently had the opportunity to talk to Dr. Fischer about his life and work as a dentist and entrepreneur.

TND: In the early days of developing your products, did you ever imagine that Ultradent would grow to become the dental products powerhouse that it is today?

Dr. Fischer: It was not even in my mind. When I was developing a hemostatic for controlling gum bleeding and a device for facilitating the hemostatic action, my goal

was to offer it to another company, get some remuneration for it, and continue treating my patients because my passion was for dentistry. But I was rejected by some large companies; they couldn’t see the value of it. I came to the conclusion that if dentists were going to be able to obtain this technology, we would have to do it as a family. It started at the kitchen table, and from there it moved to a hay barn that was converted to meet Food and Drug Administration requirements.

TND: How many products does the company manufacture today?

Dr. Fischer: Roughly 450 to 500 products, but there are thousands of different SKUs. We started an orthodontic division seven years ago, which also sells thousands of SKUs. While almost everything we make is made in America, 70% is exported. We recently got approval to sell our products in China.

PHOTO COURTESY OF ULTRADENT

TND: Is it common for dental products from companies based in the U.S. to be made in the U.S.? Or is the manufacturing typically outsourced overseas?

Dr. Fischer: For a company our size, it is not the norm.

We don’t know of another one that has such a vast product line that is made in America. It’s been an interesting evolution after WWII. America was by far the leader in dental materials and education. Since then Germany and Japan have become powerhouses in dental equipment and materials manufacturing. Switzerland and Austria are also strong. China is coming up quickly, but they don’t pay attention to intellectual property, so they tend to get there quicker by copying.

10 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

TND: What does it mean to be president of this company? In other words, how do you inspire and motivate those around you to be the best?

Dr. Fischer: First and foremost, what it means to be president and CEO is to be willing to make the sacrifices, to put in the time, but most importantly to set the example. You have to lead from the front and show what you expect others to do.

You don’t dictate what others should be doing. I think new dentists can relate to that. People cannot respect someone who does not walk the walk. Yes, I need to be knowledgeable, but I also need to have a team around me who also are very knowledgeable, independent thinkers, and quality contributors who can make up for my inadequacies. One of my most CONTINUED ON PAGE 29 >>

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Dollars and ‘Sense’:

S

Creating the Right Partnership Structure for YOU Patrick J. Wood, B.A., J.D., and Jason P. Wood, B.A., J.D.

o, you’ve been out of school a few years, and you’ve developed your skill sets as a dentist. You are capable of delivering your work skillfully and in a reasonable amount of time. You are comfortable with your patients and have a good case acceptance rate. You have been associating with a senior doctor and feel you have learned all you can in that position and believe that it may be time to start making some real money, pay off that student loan, and buy a home.

Your friends from school have been buying dental practices or starting new ones, and you’d like to do the same. As you start looking at practices, a really great opportunity comes up to buy into a practice and become partners with another doctor, or maybe your senior doctor asks you to become his partner. You’re wondering, what’s the best way to go about doing this the “right” way so that you don’t regret the decision after you have sealed the deal.

We believe that most partnerships are rushed into without a lot of thought given to the complexities of what is needed to formulate a good partnership, or they are created by companies that really do not have the experience necessary to create complicated legal documents. Too often, people believe that because they are friends or family they

care, and (dare I say it?) the individual personal lives of the partners. If you are not prepared to discuss these topics with your possible partner, don’t even think of getting “into bed” with them, because it will be a long, cold, sleepless night.

Money Matters In some situations, there simply isn’t enough money to go around. Routinely, individual doctors call our office because they want to bring on a partner to “lighten” the work load.

This is almost always a poor reason to enter into a partnership. First, the workload the doctor is complaining about is oftentimes well below the threshold needed to provide for a healthy two-doctor practice. Second, a partnership

“A friendship founded on business is a good deal better than a business founded on friendship.” —John D. Rockefeller can work together without having to deal with the specifics of a partnership. “We’ve known each other for years and are best friends” is probably one of the worst thoughts that can ever go through your head when contemplating a partnership. If you don’t plan this properly and protect the value of that relationship, your best friend (or family member) will become your greatest enemy. It is that serious and thus needs to be approached from a position of protecting that relationship, because, aside from your spouse (and maybe your kids), this will be the most important relationship in your life.

Therefore, when formulating a partnership, you need to analyze the individual dental practice, the individual personalities of the partners, the individual philosophies of patient 12 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

should not be based upon a lessening of the workload, rather it should be based upon a sharing of the workload in order to get to an overall higher plateau than an individual doctor might be able to accomplish, while at the same time providing more family and vacation time to the individual practitioners. Although there is no set rule, we like to see a CONTINUED ON PAGE 22 >>

Patrick Wood is the founder and senior partner and Jason Wood is a partner in the law firm of Wood & Delgado, which specializes in representing dentists for their business transaction needs. Wood & Delgado represents PATRICK JASON dentists nationally and can be reached at (800) 499-1474, www.dentalattorneys.com, or by email at jason@dentalattorneys.com or pat@dentalattorneys.com.

ADVERTORIAL

By Debra Z. Sabatini

Infection Control Is Your Responsibility

C

ongratulations on your achievements that have allowed you to become a dentist and a trusted care provider for your patients. As a new dentist, you want to choose products that give you total solutions to your practice needs. It may seem like a somewhat trivial issue, but disinfection policies are critical components of a well-organized, safe office.

It is well known that OSHA-mandated infection control in your dental office is vital to preventing exposure to or the spread of infection from you to your patients or from your patients to you. Unfortunately for our profession, this very subject has recently received a lot of worldwide attention. In Oklahoma City, a dental specialty office was closed due to failure to follow basic universal precautions for cross-contamination of bloodborne pathogens and sterilization violations. As a practice owner or associate, it is your responsibility to know which infectioncontrol products and policies are being effectively administered to stop another story like this.

Protocols for disinfecting instruments, hard surfaces, skin, hands, and hard-to-reach places are necessary for your safety and the safety of your patients. Consider making the Monarch line of products from Air Techniques part of the disinfection protocols in your practice.

Some of the key features of this new line of products are: 1.

A 10- to 60-second kill time for over 99% of all gramnegative pathogenic microbes. An EPA-approved disin-

fectant to kill TB, viruses, bacteria, and fungi in less than a minute, who wouldn’t appreciate this? These products exceed the world standards for killing bugs! This is significant because as the demand for your service intensifies, there will be increasing pressure to shorten the turnaround time between patients. This compromises the surface contact time required for most traditional disinfectants, but with the Monarch line you can be assured you and your team are providing the best and most effective operatory decontamination for room turnover.

Safer, quicker turnover time = More production time = More $$$.

2.

Significant cost effectiveness over traditional disinfection products. As you develop your career strategies, you

need to be aware of your finances. Warren Buffet’s No. 1 Rule for money is: Never lose money. Ironically his No. 2 Rule is: Never forget Rule No. 1.

When you use stronger, more effective Monarch products that save storage space and are cost effective and environmentally friendly, you won’t be breaking any rules!

3.

Nonmedicinal, pleasant botanical fragrance. Gone

are the days of the oil of clove smell as your clients enter your warm and inviting office.

4.

Biodegradable and noncorrosive ultrasonic solutions allow for shorter soak times and significantly

decrease aerosols, while quickly and effectively eliminating the bioburden accumulated during patient care.

My clients value the ROI of using the Monarch line of office products for more than their “green” philosophy of reusable canisters. They appreciate a product that provides soothing comfort and softer, more hydrated skin at the end of a busy day, regardless of the multiple hand washings and glove changes.

In summary: Implementing products that provide efficiency, reliability, cost-effectiveness, and simplicity are important for organizational success. With the Monarch line of products, you benefit from the relief of knowing you have this important area of the practice addressed. You rest assured and have confidence that you are well protected. The Monarch line of disinfection products achieves these goals and at the same time maintains environmental consciousness and employs the latest science in microbial control.

We want, need, and demand tangible results from our decisions in practice. Choosing Monarch products will result in consistent, reliable disinfection of everything you need to best serve your patients and your clinical team. Let’s face it, there is a tremendous variety of products to choose from in the market today. In practice, it is best to choose products that are reliable, backed by sound science, and provided by a company you can trust.

You have many things to think about and decisions to make as a new care provider. Take your disinfection worries away by building your policies around the Monarch line. By implementing their products, your concern about disinfection reliability can become a memory. As a health care provider, you want to provide the best for your patients and your team as you build your professional reputation. Make Monarch products part of your overall success!

Debra Z. Sabatini is a speaker on oral systemic health, oral cancer prevention, truth and consequences of oral HPV in dentistry, and effective communication skills for healthcare providers. She is a HygieneFusion practice management consultant and corporate trainer for Oragenics, the world leader in oral care probiotics. She can be reached at: debbiezrdh@gmail.com or 561.358.7660.

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13

Get Your FINANCIAL PRIORITIES In Order From Day One Graduate. Find a job. Attract new patients. Buy a house.

Build your own office. Get married. Start a family.

Enjoy life. Oh, and by the way, don’t forget to plan your financial future as well.

For many dentists, the early years of practice are a blur of demands, opportunities, and frantic activity. They can also be a time in which serious and potentially catastrophic financial mistakes are made.

Early in your professional life, often you are faced with a multitude of expensive decisions. Some of these affect your lifestyle, others affect your career, and all can have a profound and powerful effect on your bank account. Yet few dentists fully understand the impact of these decisions on their longterm professional success and financial security.

Chau Lai, CFP®, ChFC®, is a certified financial planner and chartered financial consultant for Pacific Advisors, a wealth management and preservation firm. She urges dentists in the first 10 years of practice to take a step-by-step approach to ensure their financial stability both early in their careers and over the long term.

Step #1 Protect the investment that is you. Ms. Lai emphasizes that every new dentist needs personal disability insurance to protect the investment you have made in your education. “This is extremely important particularly when you consider the doctor’s income potential over the life of their career.” She notes that it is essential that the doctor own a personal insurance contract. “The doctor should not purchase the disability policy through an association or rely on an employer group plan for coverage. The reason being, the terms of the contract can be changed or cancelled at any time and the insured has no rights. That’s why it’s very important to lock in your own personal disability insurance coverage early on.”

Additionally, she recommends that new dentists invest two to four years working as associates to learn the business 14 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

side of dentistry and gain an understanding of management, insurance plans, software systems, and business models. “These years of associateship serve as the doctor’s business residency to prepare him or her for practice ownership,” emphasizes Ms. Lai. Step #2 Create a savings safety net. Ms. Lai advises doctors to build their savings to cover a minimum of three months’ worth of expenses. This helps to ensure that the doctor has a financial cushion in the event s/he cannot practice for a period of time for personal, family, or health reasons. Moreover, should the doctor become disabled, there is typically a three-month waiting period before disability benefits kick in.

Step #3 Protect your credit rating. Although many new dentists rack up significant personal expenses upon graduating from dental school — in addition to the large college loans they’ve accrued — Ms. Lai urges doctors to steer clear of the consumer debt trap and protect your credit rating.

For those who are carrying significant consumer debt, such as credit card debt, a mortgage, and a large car payment, the first priority is to get your consumer debt under control, starting with debt consolidation.

“With multiple loans there are multiple payment schedules and different amounts for each and that can be a lot to keep track of. Consolidating the loans will simplify the new dentist’s life, and right now interest rates are very low, making consolidation a cost-effective option.”

Additionally, Ms. Lai notes that doctors who have family members with considerable cash liquidity may want to consider borrowing from the family member. This arrangement would allow the dentist to borrow the money at an interest rate that is slightly higher than what a traditional savings account yields, perhaps 3%, but lower than they might be able to secure with CONTINUED ON PAGE 28 >>

Chau Lai, CFP®, ChFC®

Patients Turning to Dentists for Obstructive Sleep Apnea Treatment

By Tess Fyalka, Managing Editor

A It is estimated that some 18 million Americans suffer from obstructive sleep apnea (OSA), yet 80-90% of them are undiagnosed. Many of these individuals snore, and snoring is the sound of partially obstructed breathing during sleep. Although snoring can be harmless, in some cases it is a sign of obstructive sleep apnea. About half of loud snorers have some form of sleep apnea, which occurs when the tongue and soft tissues fall back into the throat during sleep, blocking the airway.

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s one dentist describes it, those with obstructive sleep apnea (OSA) must expend so much energy simply trying to breathe while they sleep, it’s as though they’ve run a marathon overnight.

“During the day you breathe through an opening similar to the inside cardboard tube from a roll of paper,” explains Dr. Gail Demko a general dentist and expert advisor to the Food and Drug Administration on the treatment of OSA. “When you sleep, the size of the airway drops by half, but you don’t have a huge demand for oxygen, so it’s not a problem. But for those with sleep apnea, the size of the airway is reduced to a tiny little hole. People with OSA are expending more energy just trying to breathe at night than they do during the daytime, which is why they wake up so tired. For those with severe OSA, their airway closes completely,” Dr. Demko also serves as president of the American Academy of Dental Sleep Medicine (AADSM). She cautions her colleagues that a simple appliance fix may not be so simple. “Many dentists just want to ask their

PHOTO COURTESY OF AADSM

patients if they snore and then make them a snoring device. But if the dentists don’t know the severity of the problem, because many patients just think they are snoring, the mouthpiece can address the snoring but not the sleep apnea. The patients then have silent sleep apnea.”

There is no way to tell if a patient who snores has OSA without medical testing, specifically a sleep study, emphasizes Dr. Demko. It is the viewpoint of the AADSM that every patient who receives an oral appliance for snoring must be diagnosed by a physician.

STANDARD OF CARE Dr. Shouresh Charkhandeh is clinical director of The Snore Center in Calgary, Canada. He lectures extensively in the United States and Canada on topics related to dental sleep medicine and how to incorporate the treatment into the dental practice.

From his perspective, this type of treatment is poised to become the standard of care in the dental practice. “This is one of those areas of dentistry that is growing very fast. I believe it is going to become part of the everyday practice of dentistry. It is consistent with a more holistic approach to caring for patients as dentists learn more about their patients’ medical histories, comorbidities, and the like. It won’t be a matter of dentists choosing to incorporate this into their practices; patients will be and are demanding it.”

Dr. Charkhandeh emphasizes that virtually all appliances are similar. While a quality appliance is important, what is critical for successful treatment of OSA is for dentists to fully understand what obstructive sleep apnea is and what can be done to treat it. “Learn about sleep.

Take medical courses and learn what normal sleep is and what the sleep disorders are,” he urges.

START WITH YOUR CURRENT PATIENTS Dr. Katherine Phillips is a 2008 graduate of Detroit Mercy Dental School and a diplomate of the American Board of Dental Sleep Medicine. She treats patients with OSA at the Midwest Dental Sleep Center, located in the Chicago area.

Dr. Phillips began treating patients with OSA within months of graduating from dental school. She recommends that new dentists who want to pursue this area of care in their practices begin by screening their existing patient base.

“While loud, frequent snoring is the most common sign of OSA, existing health concerns can also be an indicator

of the condition, such as hypertension, congestive heart failure, history of stroke, myocardial infarction, even depression. When doing intraoral exams, look for things like retrognathia, narrow maxillary arch, maxillary or mandibular tori, and bruxism, because these are all intraoral cues that the patient may be likely to experience some type of airway obstruction.

Measure the patient’s neck circumference. If it’s greater than 17 inches for male patients and 15.5 inches for female patients, they are very likely to have obstructive sleep apnea.”

Similarly, Dr. Demko encourages new dentists interested in treating OSA patients to look at their own practices first, as some 20% of the population has some form of OSA. She recommends asking patients if they snore or if an immediate family member snores. In addition, she urges fellow practitioners to begin using the “Stop-Bang” questionnaire. It is a brief questionnaire that is commonly used to identify patients at high risk of sleep apnea. “This is used by physicians in emergency rooms and in operating rooms to quickly determine if a patient has a high probability of obstructive sleep apnea.”

From there, OSA candidates should be sent to their primary doctor or local sleep center to ascertain if the patient indeed has the disorder.

The key is to build relationships with the physician community. Contact the primary care physicians in your own practice and reach out to them, recommends Dr. Demko.

“Explain that you are interested in treating patients with sleep apnea and ask them where they refer their sleep apnea patients. That will give you a foot in the door. Secondly, take time to understand sleep apnea.”

Dr. Demko recommends a book she co-authored, Sleep Apnea: The Phantom of the Night. “The first 75 pages will teach a dentist about sleep apnea and the vocabulary that doctors use.

If you don’t speak to physicians in language they understand, they will shut you down because you sound like you don’t know what you are doing.” From there, Dr. Demko urges new dentists to take the time to meet with sleep physicians and build a referral network in which the dentist refers patients to the physician, and those patients who do not do well with CPAP (continuous positive airway pressure) machines are referred back to the dentist for appliance therapy.

TREATMENT RX While the CPAP is commonly the first line of recommended treatment for patients with the disease, patient compliance is weak. As Dr. Demko explains it, wearing the CPAP machine is like trying to breathe with a 40-mile-an-hour wind blowing up your nose.

Patient David Hedrick was diagnosed with OSA and directed to use a machine at night to enable him to breathe. “I was fitted for a CPAP machine, but I found the mask uncomfortable and did not tolerate the treatment. I would put the mask on and apparently would rip it off as soon as I fell asleep.

After a few weeks I just gave up.” Similarly, patient Susan CONTINUED ON PAGE 32 >>

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17

Designing Your Practice? continued from page 6 five. She was the mother of young children and saw herself working only three days a week.

I encouraged her to project into the future, to imagine a time when she didn’t have to see to the day-to-day needs of young children. At that time, she might very well want to extend her work week, and to even add other dentists to her practice. She chose to put in five chairs.

Step 2: Select your architect.

It’s best to engage your dentalspecific architect as soon as you have selected a site for your new office, but before

you’ve signed on the dotted line. The architect and his/ her team (interior designer, as well as mechanical, electrical and plumbing engineers) can verify existing site infrastructure such as power, sewage, and water. They will let you know if the required elements are in place in order to go forward, and this knowledge will give you more negotiating power in purchasing or leasing the space. The architect can also make suggestions as to the design possibilities of any given space to make sure you are making the right investment.

Simply put, the architect is your agent throughout the entire process, from conception to occupancy. He or she

18 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

will be your eyes and ears through design and construction, affording piece of mind during a process that is most likely unfamiliar to you.

The architect is also a sort of conductor, leading and working with your team of contractors, equipment suppliers, and information technology consultants, as well as his/her own team of designers and engineers.

Step 3: Select your dental equipment.

Engaging a dental equipment consultant early on will allow the architect and the equipment specialist to work as a team from the early stages of design all the way through completed construction. The architect will then know the speci-

fications required for each piece of equipment, from size to power requirements, and will coordinate these needs with the engineers and contractors. This will eliminate discrepancies in the drawings and help avoid change orders, which can increase the final price of construction.

You’ll want to think about your preferences in terms of chairs, delivery systems, cabinetry, sterilization, and lab equipment. Try to imagine all the details of your preferred setup. If you are using cassettes, do you bag or rap? Each approach has certain requirements when doing custom cabinetry. If you are purchasing prefabricated or modular CONTINUED ON PAGE 30 >>

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Figure 4. Comparison of titanium abutment with ZrN-coated abutment following use of a standard curette

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This stable internal connection, in combination with an extended internal octagon, ensures an optimal load transfer in the cortical region. The associated reduction of micromotions enhances the stability at the implantabutment junction.

As an added benefit to its periointegrative capabilities, the ZrN coating yields a golden color, making the gingival portion of the abutment more esthetic.

CONCLUSION Critical to the long-term success of a dental implant is the health of the associated periodontal tissues, including both hard- and soft-tissue components. Given the relatively high frequency of periimplantitis around implants currently in place, a search for more periointegrative implant materials is warranted. Extensive basic research has distinguished zirconium nitride as the material of choice capable of significantly improving the long-term health of tissue. It behaves like a ceramic and has less inflammation and less bacterial accumulation, and the bacteria that do colonize its surface are less pathogenic. Zirconium nitride also has the added benefit of being an exceptionally hard material, making it scratch-resistant.

These characteristics strongly confirm the suitability of zirconium nitride as an implant coating to decrease periimplantitis.

An implant system, the PerioTypeÂŽ X-Pert, utilizing zirconium nitride in its transgingival components, as well as an abutmentimplant connection design that seals the interface and resists micromovement, has recently received FDA approval.

References: 1 Miller, Benjamin F.; Keane, Claire B. (1992). Encyclopedia and dictionary of medicine, nursing, and allied health.

Philadelphia: Saunders. ISBN 0-7216-3456-7.

2 Mombelli, A., â&#x20AC;&#x153;Microbiology and antimicrobial therapy of peri-implantitis,â&#x20AC;? Periodontology 2000 2002;28:177â&#x20AC;&#x201C;189.

3 Roos-Jansacher, et al., â&#x20AC;&#x153;Nine to fourteen year follow-up of implant treatmentâ&#x20AC;?. Part 1-111: I. Implant loss and associations to various factors, J Clin Periodontol 33, 283-289, 2006 II. Presence of peri-implant lesions, J Clin Periodontol 33, 290-295, 2006 III. Factors associated with peri-implant lesions, J Clin Periodontol 33, 296-301, 2006 4 Listgarten and Lai (2000), AAP In-Service Exam, 2008-B12 5 GrĂśĂ&#x;ner Schreiber, et al., â&#x20AC;&#x153;Fibroblast growth on surfacemodified dental implants: an in vitro studyâ&#x20AC;&#x153; J Biomed Mater Res 64A, 591-599, 2003 6 Becker, â&#x20AC;&#x153;Biocompatibility of zirconium nitride (ZrN) coated dental implant surfaces compared with commercially pure (cp) machined titanium surfaces, Final Report on the Research Contractâ&#x20AC;?, U DĂźsseldorf, 2008 7 GrĂśĂ&#x;ner Schreiber, et al., â&#x20AC;&#x153;Plaque formation on surface modified dental implants: an in vitro studyâ&#x20AC;?, Clin Oral Impl Res 12, 543-551, 2001 8 GrĂśĂ&#x;ner Schreiber, et al., â&#x20AC;&#x153;Do different implant surfaces exposed in the oral cavity of humans show different biofilm compositions and activities?â&#x20AC;? Eur J Oral Sci 112, 516-522, 2004 9 GrĂśssner-Schreiber et al., Microbial Community Composition on Modified Dental Implant Surfaces: An In vivo Study, The International Journal of Oral & Maxillofacial Implants Volume 27, Number 4, 2012 10 MAT Dresden, Zirconium Nitride vs. Pure titanium, Test Reports No. 051207 & 071023, 2007

Dollars and ‘Sense’ continued from page 12

percentage of ownership. Assuming a 50/50 partnership, Dr. A’s total compensation would be $330,000 and Dr. B’s would be $270,000.

Collections on Individual Production Let’s say one doctor wants to take more time off and pursue other passions, while the other partner’s passion is dentistry, and as a result puts in more hours at the office. Using this model, the collections are totaled on each doctor’s production, and compensation is based upon the individual doctor production relative to the overall doctor production of the practice. Using the example above for this scenario, Dr. A, who collected 58.33% of doctor production, would get $350,000 and Dr. B, who collected the remaining 41.67%, would get $250,000.

practice with revenue of roughly $1,500,000 and an active patient count of 3,000 (for general practitioners). When broken down utilizing normal statistics (a healthy practice typically has +/- 25% hygiene revenue), this equates to $1,200,000 in doctor production, which leaves each doctor producing $50,000 per month. Doesn’t seem like such an unattainable number when broken down that way, does it?

Far too often, a doctor wants to bring on a partner when they are producing between $800,000-$1,000,000. When you analyze the practice using the metrics above, there isn’t enough doctor production to go around. This will lead to both doctors becoming frustrated, which substantially increases the likelihood of the partnership dissolving.

So, when the practice does provide enough cash flow to allow for the creation of a partnership, how do we divide up revenue between the partners? Below is a list of possible compensation formulas, along with the pros and cons of each.

Individual Doctor Collections and Profit Pools In order to incentivize the partners to work hard, work as a team, and grow the dental practice, one approach is to pay each doctor a standard associate wage based on a percentage of collections from each doctor’s production (e.g., 25-35% in a general dentistry practice, depending upon overhead). All profits go into a pool to be distributed based on your ownership interests. So, Dr. A collects $700,000 on production, Dr. B collects $500,000, and if you are using a 30% compensation model, Dr. A receives $210,000 and Dr. B earns $150,000 as compensation on production. If the dental practice is collecting $1,500,000 and generating 40% profit (before doctor distributions), the practice will have a total profit of $600,000. Once overhead has been paid (which will include the initial doctor compensation of 30% of production), the profit pool should have $240,000 available to distribute as profits based upon the partners’ 22 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

Individual Production Against Fixed and Variable Expenses This model involves identifying common expenses (e.g., rent, insurance, utilities, etc.) and paying them on a 50/50 basis. Other expenses such as chairside staff, laboratory, supplies, maintenance, etc. would be paid by each partner based on the respective percentage of the individual doctor production compared to the total doctor production. To put it in simple terms, each doctor would keep 100% of his/her individual collections generated from production, while all expenses associated with that production would be paid 100% by the individual doctor, and all fixed costs not related to production would be shared equally between the partners. This can be a complex model to work with due to the difficulty of identifying individual expenses and must be weighed against the additional accounting fees a partnership would have to pay to ensure accurate accounting.

Profits Split 50/50 Unless you are in a partnership that primarily manages associate doctors, we strongly advise against this type of compensation model as it doesn’t incentivize the partners financially. Last time I checked, we still lived in a capitalistic society (debatable, I guess) and socialism doesn’t seem to work too well in business. This model tends to have a negative pull against increasing production and actually incentivizes one not to work as hard.

Finally, even though there are numerous other issues that need to be dealt with in a partnership, what is the proper structure for a partnership? Depending upon which state your practice is located in, this could have huge tax and liability consequences for you if you get it wrong. We generally recommend staying away from a single-entity partnership as it is the most restrictive from a tax strategy standpoint, and it provides the least amount of protection from a liability standpoint. Yes, it will save you some money by only having to deal with one tax return for the partnerCONTINUED ON PAGE 26 >>

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Meet Dr. Mary Shields, Advisory Board Member Balancing Compassion and Care

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alk into the reception area of Triple Crown Dentistry in Louisville, KY, and as you look around the beautifully appointed space your eye might catch a framed picture on the wall. Upon closer inspection, you’ll see that it is a typed paper complete with an illustration that is obviously drawn by a child. It is the quintessential “What Do You Want to be When You Grow Up” school essay. At the tender age of 9, New Dentist™ Board member Dr. Mary Shields had her heart set on becoming a dentist. In the paper, Dr. Shields wrote that she wanted to become a dentist “so her life wouldn’t be boring.” Since graduating from the University of Louisville Dental School in 2011, her days are anything but dull.

Shortly after graduating from dental school, Dr. Shields and her husband, Dr. Eric Nunnally, also a dentist, had their first child. Although she had worked as an associate for the first year, Dr. Shields remained committed to her lifelong goal of owning her own business and soon built her own practice.

“I wanted to make my own business decisions and my own treatment decisions to do what is best for my patients. And I really like the independence.”

While Dr. Shields enjoys the autonomy that being a practice owner gives her, it’s the connection she quickly established with her patients that has had a profound and powerful impact on her. “When I was an associate, I felt like the patients I saw belonged to the practice, and I was merely the care provider for that particular day or treatment plan. But now that the patients are exclusively my patients, and I am exclusively their dentist, I have an extreme connection to them. I really think of

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Dr. Mary Shields with her husband, Dr. Eric Nunnally, and their son, Stone.

them as an extension of my own family. It’s very special.”

As a compassionate and caring health care provider, Dr. Shields says she often feels conflicted in situations in which patients are either uninsured or underinsured. “That’s frustrating for me as a provider because I know that getting paid for my dentistry is what pays the bills. Yet I go home thinking about the person who needs a bridge to chew his food, but the most he can afford is a partial. I feel badly for the patients who can’t afford the care they need. I see the needs that the patients have, and I want to take care of them, but I also have to run a business.” Moreover, Kentucky has one of the highest edentulous populations in the country. “Even in Louisville, which is a metropolitan area and home of the Kentucky Derby, there are patients with significant dental needs,” she adds.

The business side of the practice presents the greatest test for Dr. Shields, specifically the marketing. “Deciding where my advertising budget should be spent to get patients in the door is a real challenge. I’ve done everything from bridal shows to direct mail. I keep trying different things, but I just don’t know what is the best thing to do. It’s very hard for me when something doesn’t work because every penny counts.”

She notes that one very pleasant surprise as a new dentist is how her status as a recent graduate has worked to her advantage. “I worried so much about how I would be perceived as a new dentist and trying to establish credibility with my patients. But a lot of my patients will say, ‘Oh, you’re a recent graduate; I bet you know all the up-to-date techniques and use all the latest technology.’ It was a big surprise that patients saw it as a positive thing and not a handicap.”

CONTINUED ON PAGE 29 >>

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DENTAL STUDENTS: What’s on Your Mind?

Schweitzer Fellow Andrew Soule-Hinds, DMD ’15: On a Mission to Improve Dental Care for Underserved

B

oston University Henry M. Goldman School of Dental Medicine (GSDM) student Andrew Soule-Hinds, DMD ’15, has been chosen for the highly selective Boston Albert Schweitzer Fellowship. He joins the nearly 500 Schweitzer Fellows who have collectively delivered over 90,000 hours of service to communities in and around Boston and Worcester since the program’s founding in 1992. Each fellow executes a yearlong project that provides service to the local population.

The fellowship provides talented students from diverse health professions the opportunity to become leaders in service by learning from nationally recognized experts and from each other.

Past fellows have had a tremendous impact on the health and quality of life of the communities they served and report that the fellowship was one of the most meaningful experiences of their education.

This is the second year in a row that GSDM students have chosen to dedicate their service to the community under a Schweitzer Fellowship. As a 2012–13 Schweitzer Fellow, Dhara Shah, DMD ’13, has been working on a mission to establish a sustainable and duplicable dental program with Harbor Area Early Childhood Center.

The target population for Soule-

Dollars and Sense continued from page 22

ship, but the negatives far outweigh the meager monetary benefit. In our opinion, the best structure for a partnership is a multientity approach where each individual doctor has an entity that owns the interest in the partnership. That way, (i) each partner has full control over his/her own taxes; (ii) can sell the partnership interest to a potential buyer as an asset sale without impacting the other partner’s taxes; and (iii) provides as much liability protection as possible with the management and operation of the dental prac-

New Dentist Podcasts VISIT

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Hinds’ project is survivors of human trafficking living in the greater Boston area, typically women in their 20s. These survivors usually have had little or no health care while being trafficked, including oral health care. SouleHinds discusses his choice of this topic: “Not even a month ago I was unaware that human trafficking was something that existed in my area. Knowing that such a horrific problem exists, and knowing that it exists in our own neighborhood was a harsh realization for me. As I learn more about the problem and what can be done to help, I look forward to sharing what I have learned with others,” said Mr. Soule-Hinds.

tice. Depending upon which state your practice is in, the multientity approach may take the form of professional corporations forming the partnership, or it may be LLCs/ PLLCs that form the partnership. You need to discuss with your CPA and your attorney the right corporate entity for your particular situation, but always make sure that you are creating an entity for your partnership interest.

Regardless of the eternal debate about partnerships, both sides will agree that it is doomed without proper planning and thought. When considering the possibility of entering into a partnership, everything should be on the table for discussion. The two main reasons why partnerships fail are (1) divorce and (2) not having a partnership document or having a poorly written partnership document. While you cannot control the first issue, you can definitely eliminate the second. When you enter into a partnership, it is in effect a marriage, which means you need to know as much about your potential partner as his/her spouse does. If you make sure the hard, tough questions are asked and the planning and strategies are put forth into your partnership agreement, you can virtually guarantee that you have placed yourself into a very stable relationship that should last your entire career.

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Financial Priorities continued from page 14

a bank. “This type of arrangement can be particularly beneficial for those with high consumer debt. And it benefits the family member loaning the money as well.”

If you are considering taking out a consolidation loan from a bank, Ms. Lai urges those doctors early in their careers to build a relationship with a local bank. “Local banks are excellent options for new dentists because they are going to look for ways in which they can work with the new dentist, and they may have more flexibility than larger national banks to address a new doctor’s unique financial circumstances.”

Ms. Lai also recommends investing in identity theft protection services, such as LifeLock. And she urges doctors to be vigilant in paying off credit card balances monthly to protect their credit ratings.

Step #4 Build your savings safety net before you start saving for retirement. When considering when to

begin saving for retirement, Ms. Lai notes that new dentists should consider how much financial liquidity they have.

If the doctor has a great deal of consumer debt, the first objective must be to pay that down. The next is to have the financial safety net in place. “You should have a least one year of liquid savings in a savings, checking, money market, CD and/or cash value in a whole life insurance contract before

funding a retirement plan. Accessibility and control of your money are critical for financial security and wealth building.”

After that, the doctor should be in a position to begin saving for retirement.

Step #5 Purchase business overhead insurance and life insurance.

Most dentists build or purchase their own practice within the first 10 years of their careers. At that point, business overhead insurance is essential. “Should a doctor not be able to work due to accident or illness, this enables you to keep the business operating. It pays for your fixed expenses, your business mortgage, your staff salaries, your utilities, etc. It covers everything to ensure that your office can be kept open until you can return to work or find a qualified buyer for your practice,” explains Ms. Lai. Additionally, business overhead insurance is tax deductible.

At this point in their careers, new dentists should have a term life insurance policy in place. Ms. Lai emphasizes that life insurance is essential to pay off any practice loans as those are not forgiven in the event the doctor dies.

As your practice grows and your financial liquidity improves, you can explore longer-term financial investments such as stocks, bonds, mutual funds, and whole life insurance to protect the lifestyle and family obligations that you assume CONTINUED ON PAGE 30 >>

Helping Dentists Protect & Build What Matters Chau Lai CFP , ChFC ®

®

Financial Advisor, Park Avenue Securities r Over 16 years of experience r More than 900 dental & medical professionals have entrusted Chau & her team with designing, building, & protecting for their professional & personal financial future r Understanding of the unique financial, tax, & legal concerns of dental professionals r Provides comprehensive planning to address: investment analysis, risk management & cash flow allocation, as well as retirement, business, tax & estate planning

Contact to schedule a personal conversation to discuss your pressing financial concerns 858-550-9312

www.pacificadvisors.com/chau_lai

clai@pacificadvisors.com

Chau Lai, CA Insurance License #0C08038, Registered Representative and Financial Advisor of Park Avenue Securities LLC (PAS), 3585 Maple St. Ste. 140, Ventura, CA 93003, 1-909-399-1100.

Securities products/services and advisory services are offered through PAS, a registered broker/dealer and investment advisor. Financial Representative, The Guardian Life Insurance Company of America (Guardian), New York, NY. PAS is an indirect, wholly owned subsidiary of Guardian. Pacific Advisors, Inc. is not an affiliate or subsidiary of PAS or Guardian. Insurance Products offered through Pacific Regional Insurance Services, a DBA of Pacific Advisors, Inc. Pacific Advisors, Inc. is not an independent Registered Investment Advisor. Guardian, its subsidiaries, agents or employees do not give tax or legal advice. You should consult your tax or legal advisor regarding your individual situation.

PAS is a member of FINRA, SIPC GEAR #2013-6350

28 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

aspendentaljobs.com

Dr. Dan Fischer continued from page 10

important duties is to continually remind us all of our vision, where are we going and our core values — the values that are so important to us that we would forego money to uphold those. It is my job to continually reinforce our culture with the employees — what we are and what we are not. There has to be more to coming to work here than money, and virtually every quality employee appreciates that.

TND: What makes Ultradent unique in the dental industry?

Dr. Fischer: A number of things make Ultradent unique.

First and foremost, our family roots, our determination, and drive to maintain and keep family values. Ours is a culture where people are welcome. We treat them with kindness and respect. Likewise our dentist customers and dental dealer customers know us as a hospitable and caring company.

Relative to our product line and our belief system for treatment, we are passionately driven to improve oral health globally through science, creativity, and education. We put the patient even ahead of the dentist customer. Why? Because none of us have any business being in business except for the patient. If we lose sight of the patient and cease to become patient centered, I believe we’ve lost the most important element required for being in the health care industry. We are driven to create products, materials, devices, and techniques that show ultimate respect for the natural tissues. The best dental material is what nature has made, not what Ultradent makes. We are driven to develop materials that help preserve that to the greatest degree possible. After all, dentists are guardians of the oral cavity.

Practice greatness every day.

At Aspen Dental, you have the power to earn a high income, own a practice, and focus on what you love most: dentistry. You also have the chance to make a real difference in the lives of patients. So join the team that’s spreading good dental health and goodwill all over America. To learn more, please visit our website or call us today at 866.748.4299 to talk to a recruiter.

Dr. Shields continued from page 24 When it comes to advice for fellow new dentists, Dr. Shields urges them to join their state and local dental societies to stay informed about the profession. “The dental societies are keeping track of licensure requirements and changes in your state’s dental practice laws that can affect how you practice dentistry. You can be in violation and not even know it and lose your license just because you are not up to date on new regulations.”

Dr. Shields has a staff of three, a full-time office administrator, a full-time expanded-duties assistant, and a parttime hygienist. She keeps a full schedule seeing patients five to six days a week, working every other Saturday. “I have the mindset that if I work hard now while my children are young, I will be able to take time off later. I came from a family where my mother worked, and that is the vision that I have for my family.”

Dr. Shields and her husband, Dr. Nunnally, are expecting their second child this fall.

practice made perfect

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Financial Priorities

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continued from page 28

throughout your personal and professional life. Just don’t jump into the deep end of this pool too early, warns Ms. Lai. “One of the biggest mistakes I see doctors make is investing in the stock market before they’ve paid off their consumer debt or built their savings.”

Ultimately, it will be careful planning and preparation that will enable you to achieve the greatest return on your financial investments at every phase in your career. Want to learn more? Visit www.pacificadvisors.com/chau_lai.

Designing Your Practice? continued from page 18

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cabinets, what size and type will best serve your needs? A dental equipment specialist can help you answer these questions and ensure that your choices are incorporated into the architectural and engineering drawings.

Step 4: Select your general and millwork (cabinetry) contractor.

In the dental field, most general contractors do not provide cabinetry, which means that there will be a separate bid for the cabinetry portion of the job.

Although you will choose your contractor, if you have no one in mind, the architect can recommend several reputable contractors to competitively bid the project. The architect can also provide valuable assistance during the bid process, helping you in reviewing bids and selecting a contractor.

The bid and selection process should occur while your project is being submitted to the city or county for building permit approval. Just as your architect is helping you with the bids, this person will assist you with all questions from the city or county government agencies responsible for issuing building permits. An experienced archiCONTINUED ON PAGE 34 >>

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Sleep Apnea continued from page 17 Lubers says she used the CPAP for one night. â&#x20AC;&#x153;I couldnâ&#x20AC;&#x2122;t stand it on my face.â&#x20AC;?

For both Mr. Hedrick and Ms. Lubers, oral appliance therapy was the best option. However, for insurance companies to pay for appliance therapy, the patientâ&#x20AC;&#x2122;s physician must refer the patient back to the dentist with a diagnosis and a recommendation that the patient receive oral appliance therapy. And for some patients, the best alternative is a combination treatment that involves both oral appliance therapy and a CPAP machine.

While CPAP may be the first line of physician-recommended treatment, Dr. Charkhandeh notes that recent studies show that oral appliance therapy is proving to be equally, if not more, effective in mild to moderate cases of sleep apnea. â&#x20AC;&#x153;It comes down to the relationship that the dentist has with the physician and informing them about the progress that oral appliances have made. In many studies, over 50% of patients can be treated effectively with oral appliance therapy, but 95% of patients diagnosed with obstructive sleep apnea in North America are prescribed the CPAP first and only 5% are getting oral appliances. This is completely out of balance with what the studies are showing.â&#x20AC;?

Whatâ&#x20AC;&#x2122;s more, notes Dr. Charkhandeh, almost 75% of patients will not tolerate the CPAP. â&#x20AC;&#x153;On top of that, the diagnosis

6(( <28 ,1 6$1 ',(*2

is becoming more prevalent. As more patients are diagnosed, the oral appliance will become more and more popular because patients will ask for it.â&#x20AC;? Until now, there was no way to identify which patients could be successfully treated using oral appliance therapy, thus making CPAP the more common, although less effective, treatment option.

However, a recent paper published in the Journal of Sleep Medicine and co-authored by Dr. Charkhandeh reports the results of a study in which a specific test effectively determined which patients would be successful candidates for treatment using oral appliance therapy. Referred to as the MATRx study, the MATRx is the only test that can successfully predict if oral appliance therapy will work. â&#x20AC;&#x153;The MATRx test will take the guesswork out of patient selection.â&#x20AC;? And identifying the right patients for treatment will significantly improve outcomes for both the dentists and the patients.

Dr. Charkhandeh, Dr. Demko, and Dr. Phillips all agree that for new dentists interested in providing this type of care in their practices, focus first on continuing education. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s important that new dentists understand that helping patients with obstructive sleep apnea is not simply a matter of providing a mouthguard type of device and sending them on their way. OSA is a serious chronic disease. With education, dentists are in a position to provide quality treatment. Learn about the disease and align yourself with a reputable organization,â&#x20AC;? emphasizes Dr. Phillips.

The American Academy of Dental Sleep Medicine promotes research and the clinical use of oral appliances and upper airway surgery for the treatment of sleep-disordered breathing and provides training and resources for those who work directly with patients.

Three-For-Free Membership Promotion Join October - December 2013 to receive the remainder of the 2013 membership year for free in addition to your 2014 membership!

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â&#x20AC;˘ Practice Marketing and Patient Management: A Team Approach â&#x20AC;˘ Scope of Practice, Medico-legal Issues and ABDSM Board Certification â&#x20AC;˘ Various Methods of Making Impressions and Records â&#x20AC;˘ Insurance Reimbursement

Find out about all of the resources the AADSM offers and become a member online by visiting www.aadsm.org.

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Designing Your Practice? continued from page 30

tect will make sure all the elements come together in a timely fashion so that as soon as you get a building permit, your contractor will be ready to start on the project immediately.

During construction, the architect will provide construction administration, visiting the site and verifying that the design is going according to plan and that the right materials are being used.

It can be a big relief knowing you have someone on your side, helping you plan, overseeing the project, and making sure youâ&#x20AC;&#x2122;re not paying too much. Getting the right kind of help can put you on the road to your dream office, one that you can be proud of with state-of-the-art equipment and enough space to expand and grow. But you canâ&#x20AC;&#x2122;t get there unless you take that first step.

New Dentist Clinical Buzz Blog

www.thenewdentist.net/clinicalBuzz

34 WWW.THENEWDENTIST.NET FA L L 2 0 1 3

ACQUISITION | CONSTRUCTION | REMODELS | REFINANCING | COMMERCIAL REAL ESTATE

Let’s Build Your Dream Practice Together.

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on the Street

The latest news on products and services for new dentists and their practices World Dental Expo (WDE) The first-of-its-kind World Dental Expo invites everyone to attend the industryâ&#x20AC;&#x2122;s most sophisticated virtual trade show at www.marketplace365. com/worlddentalexpo. Registration is free. At WDE you will find â&#x20AC;&#x153;Exhibitorâ&#x20AC;&#x2122;s Boothsâ&#x20AC;? representing leading companies, featuring up-to-date information about their products/services in easy-to-use multimedia files. Visit the Media Library to discover free content from industry leaders. Review the continuing education courses in the Learning Center and Auditorium. Mingle in the Lounge with fellow attendees and vendors on popular social media sites. World Dental Expo delivers a unique visitor experience â&#x20AC;&#x201D; 24/7/365.

Imagine an accredited professional trade show without costly travel or lost workdays. Visit www. worlddentalexpo.com for complete information.

BiteDownDeals.com Launches Comprehensive Online Catalog

Sof-Lexâ&#x201E;˘ Spiral Finishing and Polishing Wheels The new, single-use Sof-Lexâ&#x201E;˘ Spiral Finishing and Polishing Wheels from 3M ESPE offer an improved way to put a natural-looking gloss on restorations. Featuring an innovative spiral shape that adapts to all tooth surfaces, Sof-Lexâ&#x201E;˘ spiral wheels provide dentists with a versatile and simple alternative to traditional points, cups, discs, and brushes. The wheels are ideal for use with composites, such as Filtekâ&#x201E;˘ Supreme Ultra Universal Restorative from 3M ESPE, as well as resin-modified glass ionomers, bisacrylic temporary materials, and precious and semiprecious metal. For more information, call (800) 634-2249 or visit www.3MESPE.com/SofLex.

BiteDownDeals.com, the first daily-deal website dedicated exclusively to dental professionals, has introduced what all its customers have been waiting for: a full product catalog. Due to popular demand, the companyâ&#x20AC;&#x2122;s website has evolved from its original daily-deals concept to also feature a catalog of dental supplies available at the click of a button. With BiteDownDeals, customers simply sign up to receive free daily emails highlighting the deals of the day, which improves the ease of purchasing while reducing the time spent searching for the best prices.

The site will maintain its $5 flat-rate shipping nationwide, regardless of the size of the purchase.

Learn more at www.bitedowndeals.com.

INDEX OF A D V ER TIS ER S Advertisers in this issue of The New Dentist have made it possible for you to receive this publication free of charge. Please support these companies. Contact information can be found below, or visit The New Dentistâ&#x201E;˘ Resources at www.thenewdentist.net to receive information from more than one company. â&#x201E;˘

Air Techniques .......................... 9 www.airtechniques.com American Academy of Dental Sleep Medicine........... 32 www.aadsm.org Arrowhead Dental Laboratory ............................. IFC www.ArrowheadDental.com 877-358-0285 Aspen Dental .......................... 29 www.aspendentaljobs.com 866-748-4299 Aurum Ceramic Laboratory .............................. 33 www.aurumgroup.com 800-423-6509 Bank of America ..................... 25 www.bankofamerica.com/ practicesolutions Matthew Christie, 614-623-5768 Ali Karjoo, 614-403-8295

CareCredit ............................... 27 www.carecredit.com/dental 800-300-3046 x4519

Live Oak Bank ......................... 35 www.liveoakbank.com 877-890-5867

Ultradent ................................. 23 www.ultradent.com 800-552-5512

Carestream Dental ................. 11 www.carestreamdental.com/ solutions 800-944-6365

MacPractice .............................. 1 www.macpractice.com/dds 855-679-0033

Viva Learning.......................... 30 www.vivalearning.com

Clinical House Europe ............ 21 www.clinical-house-europe.com +41(0)44 220 10 60 Curve Dental ............................. 7 www.curvedental.com 888-910-4376 Dental Dreams........................ 34 Danielle Tharp, 312-274-4524 Juliette Boyce, 312-274-4520 Henry Schein Professional Practice Transitions ...............IBC www.henryschein.com/ppt 800-730-8883

McKenzie Management.........BC www.mckenziemgmt.com 877-777-6151 Midwest Business Capital...... 19 www.midwestbusinesscapital.com 877-751-4622 Pacific Dental Advisors .......... 28 www.pacificadvisors.com/chau_lai 858-550-9312 Smile Reminder ...................... 31 www.smilereminder.com 866-605-6867 The Kohan Group, Inc. ........... 18 www.kohaninc.com 415-348-0008

Wells Fargo Practice Finance ..................................... 3 www.wellsfargo.com/ thenewdentist 888-937-2321 Western Dental ....................... 15 www.westerndental.com 888-256-9976 Wood & Delgado Attorneys at Law ...................... 5 www.dentalattorneys.com 800-499-1474

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Scan the code with your mobile device to receive more information from these advertisers.

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13YS8165

This represents only a sample of our practice sales.

For a complete listing, visit www.henryschein.com/ppt ARIZONA

When it’s time to buy, sell, or merge your practice, you need a partner on your side!

Tucson-4 Ops, 1400 SF, Dentrix & Dexis #12111

ARKANSAS

Western-3 Ops, Great Opportunity, Modern, Nicely Designed Office Space, GR $494K #AR500

CALIFORNIA

Indian Wells-6 Ops, 4000 SF, Built Under 2 Yrs Ago, All New Equip & Fixtures, GR $350K, #CAM530

COLORADO

Western Slope/Mountains-3 Ops, Great Established Practice, Digital Sensors, GR $640K, #CO101

CONNECTICUT

Waterbury-Established FFS Practice w/Condo for Sale, Great Patient Base, GR $417K #CT501

• Practice Sales • Appraisals • Transition Planning • Mergers • Partnerships

1.800.730.8883 www.henryschein.com/ppt

FLORIDA

Pompano-Small Office - Great Potential as a “start-up” practice in Nice Prof. Bldg. GR $160K #FL504

GEORGIA

W Georgia-Wonderful Opportunity, FFS, GR $690K #19143

HAWAII

Maui-4 Ops, 1198 SF, Pano, Laser, I/O Camera, GR $636K #20101

ILLINOIS

Bureau County-Near Princeton-3 Ops + Building for Sale, GR $400K #22148

INDIANA

Near Evansville-4 Ops, Well-Established, Low Overhead, 6 Days Hygiene, GR $495K #IN503

KANSAS

Wichita-5 Ops, Well-Established, Very Profitable, Pan, Digital, GR $1M #KS500

KENTUCKY

Western-Established Practice & Office Building, 1800 Active Patients, GR $487K #KY500

MAINE

York County-2 Ops w/Room for One More, 1,800 SF, Bldg. Must be Sold W/Practice, GR $600-650K #ME100

MARYLAND

Montgomery County-3 Op Perio Practice, Referral Base of Over 25 GP’s, FFS & PPO, GR $450K #MD105

MASSACHUSETTS

South Coast Boston-4 Ops, Beautiful Practice 45 Min. So. of Boston, RE Available, GR $742K, #MA102

MICHIGAN

Southwestern-Solid Gen Den Prac in Attractive Stand Alone Office Bldg, GR $373K #MI106

MINNESOTA

Southern MN-Small Town Practice with Great Growth Potential, GR 364K #MN500

NEW HAMPSHIRE

Wolfboro-4 Ops, 3000 SF, Cerac, Pan, Digital, Free Standing Building, GR $774K #NH500

NEW JERSEY

Sussex County-2 Ops, Well-Established in Center of Historic Town, GR $400K #392156

NEW YORK

Western Suffolk-Perfect Starter Practice! Great Potential! Central Location, GR $262K, #NY115

NORTH CAROLINA

Washington County-Established Practice, Great Opportunity for Small Investment, GR $250K #NC104

NORTH DAKOTA

S Central-Wonderful Productive Rural Practice, GR $696K #43102

OHIO

Summit County-3 Large Ops w/Room for 4, Well-Established, FFS, Modern 2-Story Professional Building, GR $500K #OH3903

OKLAHOMA

Tulsa Area-WOW! 4,000 SF, 8 Ops, 45 Min.Outside of Tulsa, GR $807K #OK503

PENNSYLVANIA

Snyder County-5 Ops, Contemporary Design, Building Also Available #472087

RHODE ISLAND

Scituate-3 Ops w/4th Available, PPO & FFS Patients, Pan, Dentrix, Dexis, GR $454K #RI500

SOUTH CAROLINA

York-5 Ops, 2300 SF, Great Mix of FFS & Insurance, Building Also Available #SC100

TENNESSEE

Pigeon Forge-Near Dollywood, Five Miles from Great Smokey Mtn. N.P., GR $400K #TN100

TEXAS

Yoakum County-4 Ops w/2 Additional Plumbed, Long-Term Staff, Stand Alone Bldg., #TX503

VERMONT

Windsor County-Immediate Sale! Well Established General Cosmetic Practice, Digital #VT100

VIRGINIA

Northern Virginia-5 Ops, 2,100 SF, Digital Scanner & Pan, A Gem of Gems!! #VA108

WASHINGTON

South Snohomish County-6 Ops, 1700 Active Patients, Strong Hygiene, GR $1.2M #WA500

WISCONSIN

Madison Area Practice Wanted-Buyer Interested in Acquiring a Satellite Practice w/Owner, Willing to Stay as Associate #WI500

© 2013 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.

Starting Buying

a Practice a Practice

My business knowledge prior to starting my practice was minimal. You have to make a lot of decisions and I didn’t have any experience with hiring my first employee, what my financial arrangements were going to be or even how to create a business plan. I didn’t realize how much the banks valued this service to include it as part of my start-up loan! My personal McKenzie Coach was there to help me from before I found my location to supporting me the entire first year. I am very comfortable and confident now in my ability to own a dental practice. I’m MUCH farther ahead with McKenzie Management as my trusted advisor than I would have been thinking I could do it myself. I understand, now, the difference between “I think” and “I know”.

Partnering with McKenzie Management was the best!

They helped me get financing for my new practice which included their expertise for my first year. Honestly, I had no idea what I was doing. They helped through the acquisiton phase and then after I got the keys they were there to help get the existing staff on board. I knew that gaining the respect of the employees was not going to happen just because I signed their paycheck now. My McKenzie Coach went over all the business operations and developed a plan that enrolled them in the process, opened up the lines of communication and leveled the playing field for me as the “newbie” coming into their world. We had our new plan of action and the first year we increased the production by 23%! I haven’t worried one second about paying my loan! I have complete confidence in myself as a business owner thanks to McKenzie Management!

Helping Dentists For Over 30 Years KWWS ND\ZD PH )\( U

For More Information Visit www.mckenziemgmt.com/con-startup.htm www.mckenziemgmt.com/practiceacquisition.htm

1.877.777.6151 info@mckenziemgmt.com

KWWS ND\ZD PH ]-10