New Dentist Spring 2010 by The New Dentist

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Editor’s Choice

FROM THE PUBLISHER’S DESK SPRING 2010

Dear Readers,

PUBLISHER

elcome to the spring issue of The New Dentist™ magazine. Not all that long ago Madonna sang about the “Material World.” Today, it’s all about the “Virtual World” as seemingly everyone is tweeting and yelping about everything from their favorite restaurant to your dental practice and at rapid-fire pace. In this issue, Fred Joyal of 1-800-Dentist, a leader in dental marketing, explains how to make the most of social media to market yourself and your new practice. You’ll also learn about the waiting room full of new patients out there, just on the other side of the computer screen. They are actively searching for the right dentist and they are doing it using Pricedoc.com. It’s a unique new Internet service that has exploded in popularity among dentists as an unconventional tool to link them with patients seeking dental services. Additionally, Lance McCollough of Prosites, Inc. shares the top five steps you need to take to ensure that your practice website is patient-friendly and power-packed with excellent content. Also in this issue, I am pleased to introduce you to a new regular feature in the magazine, Been There, Done That. We talk with dentistry’s leading experts, all of whom remember well what it was like to be a new dentist. They share insights and perspectives about their personal experiences and the specialties in which they have distinguished themselves. In this issue, cosmetic dentistry’s pioneer, Dr. Lorin Berland, offers a few words to the wise for new dentists. Dr. Josh Austin revisits the fundamentals of bonding and dental student Jim Heidenreich urges new dentists to make sure they have a voice in public policy decisions that affect the practice and the business of dentistry. I hope you enjoy this issue of The New Dentist™, and I encourage you to learn more about the many services available to you at www.thenewdentist.net. You’ll discover a wealth of materials to guide you at every step throughout your dental career.

Fondly,

Sally McKenzie, Publisher

visit www.thenewdentist.net #1 Web-site for New Dentists 2 WWW.THENEWDENTIST.NET

SPRING 2010

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Picante Creative picantecreative.com Managing Editor

Tess Fyalka Tess@thenewdentist.net Consulting Editors

Tom Snyder, DMD MBA Jim Stehman, DMD Keith W. Dickey, BS, DDS, MBA, SIU, School of Dental Medicine SALES AND MARKETING

For display advertising information contact ads@thenewdentist.net or 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 US dollars only). Copyright ©2010 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 visit our website at www.thenewdentist. net to download a media kit.

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TABLE OF CONTENTS

SPRING 2010

6 F E AT U R ES

6 Been There, Done That

Dental Pioneer Offers Advice for New Dentists

8 Bonding: Focus on the Fundamentals By Josh Austin, DDS

11 5 Steps to Powerful,

Patient-Friendly Websites By Tess Fyalka, Managing Editor

Imaging 16 3-Dimensional Two Dentists’ Perspective

18 Making the Most of Social Media

By Fred Joyal, CEO 1-800-Dentist

Virtual Waiting Room: 22 The A New Challenge for Dentists

24 Managing the Message By Belle DuCharme

16 DEPARTMENTS 2 Publisher’s Desk 14 Dental Students: What’s on Your Mind?

30 Skinny on the Street 30 Ad Index

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N O D W EN H TI IRI ST N S G

Listen to her story and you’ll understand ours. Leaving a positive impression on kids is nothing new for Dr. Jodi, who has been with a FORBA associated dental center since 2005. And like her dental peers, making kids feel comfortable and starting them on a lifetime of good dental health is a common mission. “I’d never really considered working with children, but I know this will be my career. There’s just a great sense of satisfaction in helping kids like Julian and Jaydon who need access to quality dental care.” After all, the five-year-old twins set up their own imaginary dentist office at home after their first visit with Dr. Jodi. The work environment at a FORBA associated dental center is another positive for Dr. Jodi. “I love working here. Our entire organization is committed to the highest ethical standards and to always doing things the right way, especially as it refers to providing quality care to our patients. With a network of more than 60 associated centers in 23 states for over 40 years, our mission has always been about serving the oral health needs of underserved kids she says. “The entire staff is very professional, but we have fun because we want the kids to have fun. We want them to have the best experience possible.”

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BEEN THERE, Done That

Cosmetic Dentistry Pioneer Offers Advice for New Dentists

f cosmetic dentistry is an area in which you would like to build your practice, chances are good that you’ve heard of Dr. Lorin Berland. If you haven’t, you’ll want to get to know this renowned expert. Dr. Berland, whose cosmetic and family practice, Berland Dental Arts Center, is based in Dallas, Texas, has built an international reputation for his expertise in cosmetic dentistry and his tremendously popular Lorin Library Smile Style Guide. He is one of the most widely published authorities on cosmetic dentistry in the world today. He has been featured in every major publication from the Wall Street Journal to Time Magazine and on numerous television programs, including “20/20.” The New Dentist magazine recently spoke with Dr. Berland and asked him to share his insights and expertise as a dentist who has “been there, done that” in the world of cosmetic dentistry. He is a pioneer in the field and began considering the shape, length, and look of teeth long before cosmetic dentistry was ever considered a serious component of the dental profession. “I started out working in a denture lab in high school and then I worked for a dentist as his lab technician. I started thinking about the Smile Guide when I was setting up denture teeth because the dentist I worked for told me way back then that a really good looking denture always fits better. So I started looking at the different shapes and lengths of the teeth that made an individual yet attractive smile. But it was in my residency program after dental school when I really started getting into the cosmetic side of dentistry. That was the dawn of esthetic bonding. Back then, it wasn’t considered ‘serious’ dentistry, but my patients sure considered it important. And so did I. I was fortunate to be there at the beginning but as a result, I made more mistakes than most and certainly more than new dentists have to make today.” New dentists might be surprised to learn that this trail blazer in the arena of cosmetic dentistry urges practitioners to take the conservative approach. “Your first obligation is to do no harm. The least amount of treatment that yields the desired outcome is the best amount of treatment. You can always do more, but you can’t put back what you’ve already taken away. Almost all cosmetic cases begin with whiten-

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ing. Then consider bonding before veneers, veneers before crowns.” He notes that he is seeing an increase in post treatment problems associated with some cosmetic cases and other dentists eager to cash in on the public’s interest in cosmetic dentistry. “If the patient wants a movie star smile and is willing to pay for it, you had better know how to create it. That’s what they are paying you the big bucks for, your knowledge.” Dr. Berland emphasizes that new dentists can help to maximize their success in cosmetic cases using pictures. “Take photos and more photos of your work. Go over them on your own, maybe with an assistant. Everyone must have a digital camera in their office. We do a full-series of photos on every new patient. In my opinion, it can be more important than X-rays because I can pull up the photos, put a face with the teeth, and best of all, put them on the screen to share with the patient.” In addition, he notes, “Recent studies have proven that what they teach in dental school – men have square teeth, women have round teeth – is not always the case. Nor should it be. That’s why I created the Smile Style Guide and Lorin Library products (www.digident.com) to help the patient choose the appropriate shape and length combination for the front teeth. I also recommend composite mock ups, cosmetic imaging and/or a Trial Smile before beginning any big cosmetic case. When it comes to radiography, “If you are buying x-ray, I strongly recommend you go digital. I have been using DEXIS for 12 years and have never had a problem. You want to go with a good name and a reputable company. I would stay away from CONTINUED ON PAGE 28 >>

Lorin Berland, DDS, is an internationally recognized expert in cosmetic dentistry. He has an exclusive cosmetic and family dentistry practice in Dallas, Texas, The Berland Dental Arts Center. And he is creator of the Lorin Library Smile Style Guide and www.denturewearers.com. Dr. Berland can be reached at www.dallasdentalspa.com.

BONDING:

Focus on the Fundamentals

BY Josh Austin, DDS, Clinical Advisor for The New Dentist

here are very few topics that apply to most, if not all, aspects of dentistry and dental specialties. I feel that bonding is one of the few that does. Bonding is something that is important to almost every type of practicing dentist. Unfortunately, it seems that many practitioners ignore the intricacies of bonding in favor of the newest and easiest iteration. There are mountains of sound science behind bonding and, when done well, it can be a great benefit to many patients. Alternatively, bonding is extremely technique sensitive and when not executed well can set a restoration up for quick failure. Bonding is actually somewhat of a misnomer. The fact is that we are not chemically, covalently, or ionically bonding anything to natural tooth structure. What we know as bonding relies strictly on micro-mechanical retention.1 When we bond to a tooth, we penetrate the enamel rods or dentinal tubules with resin tags that lock into undercuts present. Creating and maintaining these microscopic undercuts (in enamel rods or

is no stronger than the attachment of the smear layer to the tooth. To successfully bond, we must remove the smear layer.1 We do this by acid etching with 30-40% phosphoric acid. This removes the smear layer and increases surface area of the enamel and dentin which increases bond strength.1 If we only bonded to enamel, little energy and focus would ever be applied to the science of bonding. Enamel bonding is quite easy and yields impressive bond strengths. Bonding to dentin is much more problematic. Part of the intricacy of bonding to dentin stems from the complexity of the dentin itself. Dentin is not a static substance. Different types of dentin are present in different areas in every tooth.5 For example primary, secondary, tertiary, coronal, radicular, sclerotic, non-sclerotic, intertubular, peritubular, deep, shallow, vital, and non-vital dentin may be present in any given tooth. The possibilities and combinations are endless yet we bond to every type of dentin with the same materials. No wonder we see varying levels of success!

“...bonding is extremely technique sensitive and when not executed well can set a restoration up for quick failure. “ dentinal tubules) during the bonding process is the key to producing long-lasting and consistent restorations. First and foremost, isolation is a fundamental key to successful bonding.2 We all know this intimately. Any number of different isolation methods may be used including a rubber dam, cotton rolls, or dry angles. A good assistant is also key to isolation. I utilize all of these methods in different situations. I do rely on rubber dam isolation heavily, but this may not be beneficial for every practitioner. Isolation techniques are quite practitioner-dependent. In other words, use what works for you, although don’t dismiss the rubber dam. It can be a valuable tool despite what you remember suffering through in dental school! Remember the smear layer? That might be just a distant memory from dental school days, but it is an important concept to remember. The smear layer is a result of our own hands. It is created by cutting enamel and dentin with a bur, stone, or hand instrument and contains cut organic or inorganic tooth structure, bacteria, mucoproteins, and other materials.3 This material is smeared over the cut surface of the tooth and attaches at around 2.5 to 4 MPa. If we bond to the smear layer, the maximum bond strength we can achieve 8 WWW.THENEWDENTIST.NET

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After removal of the smear layer with phosphoric acid etch, we are ready to advance into the steps of bonding. After the etch is rinsed away, collagen fibers are exposed from the dentin. It is not uncommon for these collagen fibrils to be collapsed and compressed by the rinsing and drying after etch. We use a primer to “re-fluff” these collagen fibrils because the more sponge-like the collagen, the more resin can become inter-diffused leading to higher bond strengths.6 Primers may be either water based or acetone based and contain hydrophilic monomers.1 These hydrophilic monomers associate CONTINUED ON PAGE 10 >>

Dr. Josh Austin is a 2006 graduate of the University of Texas Health Science Center San Antonio Dental School. After working as an associate for two years, Dr. Austin opened his own practice last fall. He is a regular columnist for The New Dentist™ magazine and website. He can be reached at jaustindds@ thenewdentist.net or www.thenewdentist.net/clinicalblog.php.

What’s your experience with bonding? Tell Dr. Austin. Blog on at www.thenewdenetist.net/clinicalblog.php.

2009 Top Sectional Matrix System

Bonding

continued from page 8 with the collagen matrix and also have an affinity for the hydrophobic resin of the adhesive.7 Of the two types of primers, water based primer systems are preferred because they more efficiently rehydrate and re-expand the collagen network, especially if the preparation is over-dried after etching and rinsing. Acetone based primers require the dentin surface be left moist so there is less room for error by over-drying.1 Now we have created a smear layer, removed it, exposed a collagen matrix and filled that matrix with hydrophilic monomers. We have created a hybrid layer which refers to the layer of collagen matrix interfused with the hydrophilic monomers of the primer.1 At this point we apply the adhesive resin to the preparation. The adhesive resin penetrates through the hybrid layer and into the dentinal tubules forming resin tags which produces our micro-mechanical retention.1 At this point, we have a layer of hydrophobic resin around the preparation, to which we bond our restorative resin.

There we have it. A summary of everything you learned about bonding during dental school. I feel it is important to review the fundamentals before we can explore tips and tricks associated with bonding. As we all know, bonding is incredibly technique sensitive and a thorough understanding of the principles will help us provide our patients with the best restorations possible. 1. Summitt JB, Robbins JW, Hilton TJ, Schwartz RS. Fundamentals of Operative Dentistry, ed 3. Chicago: Quintessence, 2006. 2. Barghi N, Knight GT, Berry TG. Comparing two methods of moisture control in bonding to enamel: A clinical study. Oper Dent 1991; 16:130-135. 3. Eick JD, Wilko RA, Anderson CH, Sorenson SE. Scanning electron microscopy of cut tooth surfaces and identification of debris by use of the electron microprobe. J Dent Res 1970;49:1359-1368 4. Asmussen E, Munksgaard EC. Adhesion of restorative resins to dentin tissues. In: Vanherle G, Smith DC (eds). Posterior Composite Resin Dental Restorative Materials, ed 1. Utrecht, The Netherlands: Peter Szulc, 1985:217 5. Pashley DH. Dentin: A dynamic substrate- a review. Scanning Microsc 1989;3:161-174. 6. Erickson RL. Surface interactions of dentin adhesive materials. Oper Dent 1992;suppl 5:81-94 7. Eliades G. Clinical relevance of the formulation and testing of dentine bonding systems. J Dent 1994;22:73-81

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5 Steps to POWERFUL,

By TESS FYALKA, MANAGING EDITOR

ome would argue that in today’s “google” this and “google” that world of Internet surfing for virtually every product and service in the marketplace, your website is more important than your telephone. The fact is that the Internet, not the Yellow Pages, is often the first place prospective patients look for a new dentist. According to the 2009 Internet World Stats, nearly 75% of those living in North America use the Internet. Certainly, for today’s newer dentists that statistic is not surprising as many grew up navigating the information superhighway from an early age. Lance McCollough is CEO of ProSites, Inc., which is a leading provider in dental website design. He notes that it’s very likely that the first place patients are introduced to their dentists is through the practice websites. “It’s really important to give consideration to what kind of image you want to convey on your website. Your parents may have taught you ‘don’t judge a book by its cover,’ but that is exactly what people do every day. And when it comes to your website, studies show that in less than the blink of an eye, patients will make a decision on your site, and if it doesn’t appeal to them, they will move on.”

1 ‘Look’ Like Your Target Audience So how do you make your site appealing? Mr. McCollough has a few recommendations, starting with appearance. “The audience drives the design and content of the site. You want

to make sure that the website has a look and feel that will resonate with your audience.” For example, the type of website that will appeal to the target audience in Beverly Hills, CA will not be the same type of website that will resonate with the target audience in Brushy, Oklahoma. The images on the site should reflect the audience. If your practice focus is dental implants, dentures, and your demographic is older patients, your website shouldn’t have numerous images of teenagers and young people.

2 Keep Content Relevant Content should be written in a patient-friendly style. “The content can’t be too technical. You also don’t want to scare them. You want to make sure that the content provides enough information to enable the patient to understand it to the point they are comfortable calling the practice.” In addition, Mr. McCollough notes that while technology is something that many dentists want to promote on their websites, patients are not necessarily interested. “You may have that new CERAC machine, but don’t give it too much space because patients really don’t care about that anymore than they care about your hand instruments. It’s not what the patients are looking for.” Another key consideration is the use of content to drive search engines to your site. “Give enough CONTINUED ON PAGE 28 >>

Courtesy of ProSites, Inc.

Patient Friendly Websites

DENTAL STUDENTS: What’s on Your Mind? The New Dentist recently caught up with senior dental student Jim Heidenreich. He is graduating from the University of Connecticut School of Dental Medicine. He will soon begin AEGD training in Michigan as well as work on a Master’s of Public Health degree. His long-term goal is to work with children and special needs individuals as a pediatric dentist. TND: As you wrap up your senior year, what do you see as the biggest challenge still ahead? Jim: I am daunted by how much I need to learn about the non-dental aspects of practicing dentistry. The increasing volume of information that dental stu-

dents need to learn in four short years competes with students’ ability to learn practice management skills and prepare to become business owners. TND: What are you most looking forward to in beginning your career as a dentist? Jim: I am looking forward to being able to use the critical thinking and basic clinical skills that I’ve learned in dental school in making my own clinical judgments. A dental education is a license to learn. I hope that I can continue to learn something new each day so that I am always providing my patients the best possible dental care. TND: What do you see as the greatest challenge facing new dentists today?

Jim: We are going to see a huge turnover of dentists in the next few years as many older dentists begin to retire. With that comes a risk of loosing ground in patient advocacy and influence in public policy. It is so important that young dentists get involved in organized dentistry so we are able to maintain the quality of dental care in our country. What many young dentists do not realize is that if we are not at the table when it comes to discussing the issues facing dentistry, we are most likely to end up on the menu.

Dental students, tell us what’s on your mind. Email Managing Editor Tess Fyalka at tess@thenewdentist.net. We want to hear from you.

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3-DimensionalImaging: TWO DENTISTS’ PERSPECTIVE Better Treatment Planning, Fewer Patient Visits

or some new dentists, 3-dimensional imaging is a technology that they look forward to incorporating into their practices at some point in the distant future. For Dr. German Trujillo, it’s a means of ensuring that he is delivering the very best care for his patients today. Dr. Trujillo, an oral and maxillofacial surgeon, received his DDS from the Health Sciences Institute CES in Medellin, Columbia and his specialty degree from the University of Illinois College of Dentistry at Chicago. He recently opened his first practice in San Diego after spending five years in Seattle as an associate oral surgeon. He acknowledges that many dentists consider 3-D imaging to be leading edge, but, from his experience, it is a technology that is here to stay because the quality of the product delivered is unsurpassed. Dr. Trujillo began using the KODAK 9000 3D System last August. The added third dimension allows dental professionals to view and analyze complete anatomies, make accurate measurements, and more easily conduct dental pathology assessments. Bony lesions, calcifications, fractures, and the apex/sinus relationship can be viewed in detail. “It enables you to have a global view of the patient’s tissues. That allows you to plan the case in more detail and to be more accurate in your diagnosis, which saves you time in surgery. The system I use takes powerful 3D images, offering an unprecedented level of anatomical detail with less radiation. It’s breakthrough technology that provides superior views of the jaws and the oral cavity,” explained Dr. Trujillo. “I have found that the capabilities of 3D imaging offer a wide range of diagnostic possibilities such as implant placement, surgical planning, extractions, examination of oral pathologies, and third molar evaluations. And it has allowed our practice to perform a wider range of diagnoses and treatments in the office, reduce multiple patient visits, as well as save time and money,” he added. Moreover, Dr. Trujillo notes that the 9000 system focuses only on the area in need of diagnosis; therefore, the amount of radiation exposure is significantly reduced, delivering 1016 WWW.THENEWDENTIST.NET

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Kodak 9000 in Dr. Trujillo’s Pearlmax Oral Surgery office. Photo courtesy of Dr. German Trujillo

to-30 times less exposure than other dental radiography systems. As with any new technology, incorporating CONTINUED ON PAGE 32 >>

Dr, German Trujillo, DDS, practices oral and maxillofacial surgery in San Diego, CA. He can be reached at www.pearlmax.net.

Photo courtesy of Dr. Mark Hanna

3D—The New Generation of Technology for a New Generation of Dentists

or a successfully evolving dental practice, new practitioners need to explore technologies that can set their practices apart from the others. With a list of growing technologies on the market, these new innovations must fulfill a range benefits—from expanding treatment options, improving clinical outcomes, increasing practice profitability, and cultivating better communication between the patient and the dentist. Dr. Mark Hanna, a general practitioner, in Framingham, MA, has found that his investment in a Gendex GXCB-500 medium field-of -view Cone Beam machine has accomplished all of these goals. Dr. Hanna, a graduate of Tufts University School of Dental Medicine, purchased his own practice in May of 2004. Before purchasing his “500,” Dr. Hanna studied the art of implant surgery and sought advice from experienced colleagues regarding the best cone beam machines out on the market. “I did a mini residency at the Misch Implant Institute in Michigan, where we thoroughly discussed Cone Beam technology and learned how to properly read the scans,” he says. “The more I researched it, having a 3D scanner fulfilled all of my imaging needs for being able to perform bone grafting and implant surgeries on my patients, while providing the highest standard of care. For my purposes, I didn’t need to view the entire head and neck area on the scan, but I also needed something that would display more than a small field of view. The 500 was a perfect fit that allowed me to do the procedures I

desired within the focused area of the oral cavity.” This model, which has a built-in panorex, also allowed him to forego other large equipment purchases. That freed up more of his budget for soft tissue lasers and other state-of-the-art equipment. Before investing in his CBCT scanner, Dr. Hanna calculated the financial considerations of investing in a Cone Beam system. The Section 179 tax incentive was compelling since it allows for business owners who acquire new equipment such as machinery, furniture, fixtures and off-the-shelf software to deduct up to $250,000 of the value during the first year of ownership. Dr. Hanna notes, “A new dentist usually is still paying for setting up his/her practice so there are already many up-front expenses burdening them. This tax break lets you get a huge chunk back at the end of the year, and allows you to get a hold of this great technology for your patients sooner rather than later.” Besides the tax savings, Dr. Hanna says that having the capacity for in-house CBCT scanning improves his reputation with patients. “I want to provide the best level of care for my patients, but I don’t want to inconvenience them by sending them from Framingham to Boston or Watertown just to get a 3D radiograph at the nearest imaging center.” When he first implemented his system, he contacted other area practitioners, and soon oral surgeons and other specialists began referring patients for scans as well. “Between my patients and the referrals needing 3D scans, I am making a profit on the machine, while still paying for it, all while providing a great service for many patients and doctors” says Dr. Hanna. The 3D view is imperative for discovering critical anatomy that would otherwise not be visible on a traditional 2D scan. The field of view that Dr. Hanna chose scan size ranges from either 8 or 14 cm diameter with a height from 2 to 8 cm, allowing for a single arch, both arches, or a view that includes the TMJ as well; the orbits and the sinuses can also be viewed if necessary. Tipped teeth, nerves that extend into critical surgical sites, or an uncommon anatomical phenomenon that goes undiagnosed before an implant procedure, can lead to painful post-surgical complications for the patient and stress for the dentist. CBCT alerts the clinician of anatomical anomalies well before surgery begins. For patient education, Dr. Hanna placed a flat screen monitor next to the 500 so patients can see the scan right after capture. He explains, Dr. Hanna owns “When a third molar Grace Dental in Framshows up right in ingham, MA, www. gracedental.org. Contact the nerve canal, they Dr. Hanna via email at truly understand the CONTINUED ON PAGE 32 >>

SPRING 2010

drmarkhanna@hotmail. com.

WWW.THENEWDENTIST.NET 17

Making the Most of

Social Media T he Internet has changed. Five years ago, a website was all that was necessary to successfully promote your practice on the web. Today, that’s no longer the case. Don’t get me wrong — an optimized practice website is still a critical component of your practice marketing. But it’s now just the start of what the web can do for you. The Internet has become truly interactive, with social networks like Facebook®, Twitter®, and Yelp® inviting users to play an active role in their web surfing experience. Users have embraced this phenomenon in a staggering way. Consider the following: • Facebook grew from 100 million to 200 million users in less than eight months. It now has over 400 million active users. If it were a country, it would be bigger than the United States and smaller only than China and India.1 • It’s estimated that Twitter will reach 26 million users this year2, with an estimated average of 27.3 million tweets being sent each day.3 • Google BuzzTM launched just recently and within days had accumulated more than 9 million posts and comments. That’s an average of over 160,000 posts and comments per hour.4 Those are all staggering numbers, and they speak volumes. While individual social networks may come and go, social media as a whole has become the single most important trend to hit the Internet since its inception. This isn’t a passing fad. This is the future of the web. If your practice hasn’t begun incorporating social media into your marketing, now’s the time. Start with Facebook. It’s currently the largest social network by far, so you want to make sure you’re represented on it. Create a profile for yourself with a nice photo and a good description of yourself and your interests. Once the profile’s created, post updates regularly. These shouldn’t be advertisements. These should be updates about you and your life. Your personal profile should humanize you and help your patients see you as a person and not just their dentist. Once your personal profile is set up, you should also set up a “fan page” for your practice. Fan pages are designed for businesses and organizations, but they’re not all that different

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BY Fred Joyal, CEO and Co-Founder of 1-800-DENTIST

than personal profiles. On your fan page, it’s perfectly reasonable to advertise your practice, post beforeand-after pictures, talk about your new team members and everything else you would typically showcase on a business website. I still suggest keeping a light tone, however. You don’t want your page to come off as dry and boring. Otherwise, why would anyone want to visit it? Your fan page is where you want people on Facebook to go to find out about your practice. Your personal profile is where you want them to go to find out about you. Each serves a purpose, so don’t neglect either of them. Ask your patients to friend you on Facebook and become a fan of your practice. Together, they make a powerful marketing tool. Okay, you’re on Facebook, now it’s time to move on to Twitter. If you’re not familiar with it, Twitter is a “micro-blogging” site. You create a profile, then update it by writing short entries — or “tweets,” as they’re called on the site — about whatever it is that’s on your mind at the time. And I mean short. Each tweet must be under 140 characters. Yes, I know what you’re thinking: “What am I really CONTINUED ON PAGE 20 >>

Fred Joyal is the CEO and Co-Founder of 1-800-DENTIST. He is one of the industry’s leading experts in dental consumer marketing. His recently published book, Everything is Marketing: The Ultimate Strategy for Dental Practice Growth, is available at www.goaskfred.com.

Social Media continued from page 18 going to gain from this?” Well, you’d be surprised. Twitter is a direct response to the fast-paced, busy lifestyles many of us lead today. The reality is that many people no longer have the time to read long blog entries or newspaper articles. Twitter provides them with short, bite-sized nuggets of information that can be read and absorbed in seconds. Again, this can make for powerful marketing, but it’s a little more challenging than Facebook because you can’t invite people on the site to follow you. What I recommend is that you create a Twitter profile and then link it to your Facebook account. This is easily done in Facebook and it allows you to update your Facebook profile whenever you update Twitter. Then add your Twitter address to your business cards. Eventu-

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SPRING 2010

ally, the word will get out and people will start following you. When they do, you may want to follow them as well. It’s a great way to learn more about your patients, which can help you build a closer relationship with them. With Facebook and Twitter established, it’s time to move on to Yelp. As you’ve likely discovered, Yelp is a little different because people create profiles not just for themselves, but for businesses they want to review. Once a business profile is created, it remains and anyone on Yelp can review it. Yelp is important because younger patients in particular have increasingly come to rely on peer-review sites like Yelp and Citysearch. Many make decisions on where to take their business based entirely on reviews by other customers and Yelp “scores” (which are a cumulative rating of one to five stars based on your individual reviews). If your practice isn’t on the site, they likely won’t even consider you, and that’s to say nothing of what they’ll think if you are on the site, but only have negative reviews. Therein lies the problem with websites like Yelp. Unless the reviews are profane or false, they remain. There’s nothing you can do to take them down. Therefore, it’s important that you encourage your happy patients to write positive reviews of your practice on Yelp to offset the occasional negative review. CONTINUED ON PAGE 32 >>

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2010

BY DAVID CLOW

The Virtual Waiting Room:

A New Challenge for Dentists

t’s obvious that the technology of dentistry is evolving rapidly. Whether it’s materials, instrumentation, lighting, or even DVD players, every piece of equipment in today’s operatory represents a giant leap forward compared to what came before. It’s a challenge for any dentist to stay “state of the art” inside a practice. Perhaps an even greater challenge lies in the new technologies outside the operatory. Advancements in communications, marketing, and patient learning opportunities may all be evolutionary forces in dentistry, changing the way you and your patients relate to each other. Virtually every dentist reading this came of age during the Internet era, and while online research, communications, and transactions were once exotic, they’re now second-nature. Very likely we’ve all bought something on Amazon, booked a flight on Travelocity, Orbitz, or Expedia, or sold something on eBay. For some of us, that’s the first choice versus buying through a store or booking through a travel agency. We can investigate sellers, comparison shop, get pricing information, and make the most informed decision without ever leaving home. And there’s the challenge: patients have greater interest and greater access than ever to information about you. Where printed flyers, Yellow Pages ads, or word of mouth were your predecessors’ best options, now the Internet offers dentists and patients a virtual waiting room where their interaction begins. For example, a new website called PriceDoc.com, which started in Seattle in late 2009, offers a telling glimpse of dentistry’s future. Aimed to serve the millions of Americans who don’t have health insurance, PriceDoc.com offers providers of all kinds, physicians, dentists, ophthalmologists, even practitioners of alternative care, a web presence through which they can introduce themselves. Patients can use the site without any fees and examine the services offered, credentials, and baseline fees for services. For dentists, this means that a patient can seek you by ZIP Code, view a roster of your services from basic to advanced—and all with a price attached.

A New Marketing Paradigm for Dentists PriceDoc creators set out to open the door to communication 22 WWW.THENEWDENTIST.NET

SPRING 2010

between dentists and prospective patients, explains President and Chief Operating Officer Patrick Bradley, Ph.D. “We thought we could use PriceDoc to start relationships between dentists and prospective patients based on full transparency— Web pages for practices with a set of messages about services, credentials, training, personal greetings, views and video of the premises, as well as baseline prices for procedures, all of which permit the patient to perform detailed due diligence at a level that traditional marketing doesn’t permit.” The strategy appears to be working. In sheer numbers, dentists are the leading subscribers to the site. Additionally, there’s no fee to patients. “And ‘booking’ a procedure for a certain price isn’t a contract that obligates either side—no money changes hands on the site. All that’s really accomplished is the beginning of direct communication between a dentist and a patient. Most patients start with something basic, a cleaning or a full-mouth exam, and they can get CONTINUED ON PAGE 26 >>

David Clow consults with dental professionals on practice culture, case acceptance, and patient expectations. His book, A Few Words from the Chair, the first book written by a patient for dental professionals and students, is available at 877-777-6151.

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he telephone is the lifeline of dentistry; it is vitally important that those on the front line learn professional telephone skills. It is not just about answering the phone; it’s about creating a positive experience for the caller, securing an appointment, and giving the future patient what they want. An analysis of your telephone system should answer the following questions: • How do you set the stage for an uninterrupted call from a new patient? • Who is first in line to take a call and what is their level of customer service skill? • What is said when the phone is answered? • Is the phone answered by the third ring? • How are calls prioritized and time managed? • What is the protocol for placing calls on hold and is there message on hold? • Does the business staff know how to assess the tone, rate and pitch of their voices to meet the listening needs of different patients? • Does the business team know how to close a caller to secure an appointment? Many dental practices create barriers for patients and don’t realize how many they are losing every month. The most important call the office can get is that of a new patient and secondly anyone who wants an appointment. Having available times within one to two weeks is essential. Anything later may result in the patient calling another dentist. When talking to the patient, be mindful of your tone. A hurried or stressed tone when answering the phone can send a message that you are too busy or this office is too stressful for the patient. Ask questions and repeat back to clarify the message and ensure that there are no misunderstandings when the patient is in the office. Calls regarding questions about statements or insurance can be prioritized to be returned at a more convenient and less busy time of day or perhaps can be answered through email. Telling the caller, “I will be happy to answer the question about your insurance payment. I will need to research your account to get the facts and call you back at 2:00 pm today or I can send you an email if you would prefer?” Sending emails can free up the phone lines for incoming calls and are often a more convenient way for some people to communicate. 24 WWW.THENEWDENTIST.NET

SPRING 2010

When placing a patient on hold, ask first for permission. Saying, “I have an incoming call; may I place you on hold for a moment?” When returning to the caller, say “thank-you for your patience” and proceed with the call. Consider messaging on hold. It’s one of the best marketing tools available. Instead of music or silence, a message on hold tells the patient about the doctor and the practice. Placing calls to patients is much different than receiving calls because the staff member is now a “seller” versus a “scheduler.” Remember, not everyone likes to talk on the phone. There are those that perk up with the sound of the phone and those that see it as an interruption. Be prepared with the following information: • Identify yourself and the practice. • Know who you need to speak to? (Speak to the parent or guardian of a child.) • What is the reason or objective of the call? (Check chart notes before calling to see if there is any information you need to know about the patient before scheduling an appointment.) Be brief and direct but also friendly. Offer convenient appointment times and be prepared to answer any questions they may have about the Belle DuCharme, treatment and insurCDPMA is a Senior ance. Being confident Instructor/Consultant for McKenzie and knowledgeable will Management. guide the patient into an appointment.

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Virtual continued from page 22 to know that dentist as much as possible before making the appointment,” notes Dr. Bradley.

Patient’s Perspective Shane Harris, an uninsured small business owner who travels the Pacific Northwest, suffered with four abscessed teeth for over a year because he couldn’t find affordable, high quality dental care. “My job is sales,” he says, “and that involves lots of human contact and personal impressions. So my smile is essential. But I had abscesses that caused me constant pain. I was taking Tylenol and Anbesol to cope with it for a long time, and it just got to be too much.

“This explosion of media can’t take the place of empathy, friendliness, and good advice delivered chairside, face-to-face.“ “I was in Washington where I had no contacts or friends who could recommend a local dentist. I saw an ad on TV for this new website. The dentist who treated me gave me a price that covered everything—no hidden costs,” he said. “I appreciated that transparency. It gave me confidence. For the first time in a decade I’m free of pain. It’s liberating—this is the first time in years that I’ve felt great.”

Should Dentists be Concerned? Is PriceDoc an invitation to patients to self-diagnose and develop false expectations about treatment? One of the early adopters, Dr. Tulay Kent of Seattle, said, “I was concerned at first that the site might permit patients to get mistaken impressions, but in actual practice, that’s not a possibility. Patients don’t really know most of the time what they need to be treated for. All they know is that there’s a need, pain, discomfort and the first diagnosis is made by the dentist, not by the patient. I always explain in detail why I would suggest a course of treatment. If that’s different from what they anticipate, then I have a chance to clarify their understanding and earn their trust. In my practice it’s very important for me to educate my patients; my appointments are an opportunity to develop the relationship, show them pictures of their mouths, explain incipient problems and try to collaborate with them in 26 WWW.THENEWDENTIST.NET

SPRING 2010

their health. I might refer the patient to someone else, and they might seek a second opinion; but anything that permits me to meet a patient, offer advice, and make a good impression is worth the time.”

Some Things Will Never Change PriceDoc started in the Puget Sound area, but after its initial testing phase the site has rapidly achieved nearly national coverage. It’s likely that variations and imitators will appear, offering additional opportunities for dentists to open dialogues with new patients. The evolving technology of dentistry now includes Facebook, Twitter, targeted emails, and texting. These media are the first glimpses of a change that will impact dentistry as greatly as any new instrument beside the chair. What never changes, however, is the need for dentists to develop relationship skills. Dentistry as a profession and dentists as individual entrepreneurs need to communicate not just rapidly, but effectively and with meaning, in a market where personal impressions can start—or end—a long relationship. This explosion of media can’t take the place of empathy, friendliness, and good advice delivered chairside, face-to-face. Your webpage and social media might only add to the hurricane of information now available to patients, without clarifying their understanding. The real challenge for dentists is the same as it ever was: it’s what happens after the introductions.

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Cosmetic Dentistry continued from page 6 the emerging markets because a lot of these companies come and go. When looking at purchasing expensive equipment, talk to users. Go to dental meetings and visit the booths. If you have your own office, they will come by and demo it. Compare the products and gather information.” Dr. Berland urges new dentists to be their own worst critic rather than their biggest fan. “Be very critical of your work. We can always do better.” Moreover, Dr. Berland, who is a Fellow of the American Academy of Cosmetic Dentistry, recommends that dentists who want to expand cosmetic services to join the AACD. Finally, Dr. Berland has this advice for every new dentist, “Introduce yourself to the established dentists in the area, and offer to take care of emergencies if they are out of town. Too many new doctors come to town, open their practices, and never make the effort to reach out to those dentists already well established in the community.”

Website continued from page 11 information that the search engines will find you, and avoid limiting information to just bullet points because 28 WWW.THENEWDENTIST.NET

bullets alone reduce the chances that the search engines will find your site. “For example, if we do a page on porcelain veneers, it will explain what they are, the reasons for getting porcelain veneers, and what is involved in getting them. You want to make sure that you are repeating the key words, so that it’s relevant to the search results, without overdoing it. About one to one-and-a-half pages of content per topic is good.” But Mr. McCollough urges dentists to use click through pages that give visitors the option of reading more by clicking on specific items on a list rather than large blocks of text, which will overwhelm the reader. “Remember, people want to skim and scan on the Internet.” Be careful that content is not copyrighted. Mr. McCollough notes that some web designers who do general design work, don’t have content specific to dental practices. It is not uncommon for them to copy and paste from other sites. “We literally have thousands of people violating our intellectual copyright and we find them all the time.”

3 ‘Flash’y Can Stop Traffic When it comes to the design of the site, Mr. McCollough cautions doctors not to use Flash based websites. “The problem is they are virtually invisible to search engines. Search engine robots cannot SPRING 2010

read Flash because it is more of a photo than a document.” In addition, he emphasizes that Flash sites often are difficult to navigate. They may look slick, but they tend to be a hassle for users, and they take a long time to load, even with high-speed Internet connections, and many people will not wait. He also encourages doctors to avoid music. “It’s annoying for the users. When the music starts, the user is looking for the off button.”

4 Keep the Clicks to the Point As for navigation on the site, keep it consistent on every page. “This enables people to dig through your website and drill down to what they are looking for. If you make them work, they will leave your site and go to your competitor’s.” Mr. McCollough also urges doctors to avoid setting up vertical navigation buttons lined up along the left side. “We recommend horizontal navigation, and nest pages under a ‘parent’ page. For example, if you have multiple doctors, have one button that says ‘Our Practice’ and list the doctors giving visitors the option of clicking on a name to learn more. Limit

to navigation buttons to no more than two rows.”

5 Consider Cost and Maintenance Today’s dentists should expect to get a very attractive website with excellent content that is easy to maintain for about $2,500. “Our technology, which is database driven, enables us to create websites that have the look and feel of $20,000 sites, but don’t cost $20,000. And dentists have a much greater level of control allowing them to edit, change, delete, and do what they want with the site when they want. We have a website editor not a text editor, and there is a canyon between those two concepts,” explains Mr. McCollough. In addition, ProSites allows dentists to take a “free test drive.” “Doctors can go to www.prosites.com and in less than five minutes they can build their website from our predesigned styles and see it right before their eyes before they ever spend a dime. They have total control, and we’ve removed the risk associated with creating a website. With ProSites, it’s point, click, launch,” says Mr. McCollough. For additional information visit www.prosites.com.

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Offer Code: McKenzie WWW.THENEWDENTIST.NET 29

SKINNY

on the Street

The latest news on new products and services for dentists and their practices Axis Dental

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Smile Radio Dental offices now have a better alternative for their in-office music with Smile Radio. Smile Radio, specifically designed for dental practices, is multiple channels of professionally programmed, continuously updated music handpicked to enhance the sound and atmosphere of dental offices. Smile Radio channels are broadcast on the Internet and received on a specially designed Internet receiver – there is no PC required. Contact www.smile-radio.com, 1-303-444-7700.

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INDEX O F A D V E R T I S E R 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 www.thenewdentist.net Resource section to receive information from more than one company. 1-800-Dentist...................IFC www.1800dentist.com/ newdentist 866-970-9861

Bank of America................10 www.bankofamerica.com/ practicesolutions 1-800-541-3535

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Keller Laboratories, Inc.....25 www.kellerlab.com 800-325-3056 KODAK 3-D Imaging...........3 www.kodakdental.com/ NEW3D 800-944-6365 Mac Practice.......................15 www.macpractice.com 646-305-9008 McKenzie Management.....14 www.mckenziemgmt.com 877-777-6151

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3-D Imaging continued from page 16 the system effectively into the practice does require an investment in training. “There is a learning curve and you must be trained how to take the image, how to load it into the computer, how to interpret it, and how to bill the insurance companies. But once the system is established, it simplifies the process and reduces surgical time because we know what we will find when we perform the surgery. And it is actually very easy to use with the patient.” Dr. Trujillo and his team participated in a training program when the system was installed. Additionally, they take advantage of web seminars, live seminars, and telephone support offered by KODAK. Prior to launching the new system, Dr. Trujillo estimates that he and his employees invested approximately one week learning how to use the technology. “It offers so many features and capabilities that you are always learning more about how to use it to its fullest.” To patients, the technology looks like a panoramic imaging system, which it is as well. According to Dr. Trujillo, the process is very quick. It takes about 30 seconds or less to capture the picture, and within a minute it is loaded into the computer. “It does take a little 32 WWW.THENEWDENTIST.NET

more time to interpret the image because it has more features, but it is not significant and it offers tremendous benefits in terms of patient care. The imaging just allows far greater accuracy in diagnosis and in surgery.” In choosing the KODAK 9000 system, Dr. Trujillo explains that he considered several factors before selecting this 3-D imaging system. He urges other dentists to do their homework. “Shop around. Compare the models and compare the prices. And definitely negotiate the price. You need to understand that this is not just a machine that takes x-rays, it is an entire imaging system. It requires training, software, software upgrades, and computers. You need to consider all of those factors before making your purchase. I have found that the customer support is quite good and new dentists should not be afraid of incorporating this into your practices. But do your research and make an educated decision.”

3D-New Generation continued from page 17

risks or benefits of certain treatments and my concerns.” He continues, “I don’t feel comfortable any more placing an implant without taking a CBCT scan. This

SPRING 2010

will be the standard-of-care in a few years and should be right now.” Dr. Hanna credits 3D technology for his practice’s continued growth. “In this slow economy, I thank God that we have this machine. It has made a huge difference in my practice. With Cone Beam scans, patients are impressed, referring doctors are happy to have this technology close by, and many more procedures can be done predictably and safely in the office without always having to refer patients out.”

Social Media continued from page 20 Resist the urge to plant positive reviews. People can spot fake reviews a mile away and they reflect even more poorly on your practice than negative reviews since they’re firsthand proof that you’re operating your business less than honestly. By having your practice on Yelp, of course, you do risk an occasional bad review. But if you’re running your business correctly, the good reviews

should far outweigh the negative ones. Facebook, Twitter, and Yelp are a good starting point for any dental practice, but they’re just the beginning when it comes to social media. Social networks like LinkedIn®, YouTube® and Google Buzz each offer unique opportunities for marketing your practice and should also be given serious consideration. You may be new to Facebook and Twitter, or you may already be using social networks at home. But using them to grow your practice…that’s truly making the most out of social media. 1. “Facebook - Statistics.” Facebook. 2010. Web. 18 Feb 2010. <http://www.facebook.com/ facebook?ref=pf#!/press/info. php?statistics>. 2. Srinivasan, Anand. “Number of Twitter Users in USA.” Tech Crunchies. 14 09 2009. Web. 18 Feb 2010. <http://techcrunchies.com/ number-of-twitter-users-in-usa/>. 3.Solis, Brian. “Guess How Many Tweets Fly Across Twitter Each Day.” BrianSolis.com. 15 11 2009. Web. 18 Feb 2010. <http:// www.briansolis.com/2009/11/ guess-how-many-tweets-flyacross-twitter-each-day/>. 4.Parr, Ben. “Google Buzz Surpasses 9 Million Posts and Comments.” Mashable. 12 02 2010. Web. 18 Feb 2010. <http:// mashable.com/2010/02/11/ google-buzz-9-million/>.

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Toothflix DVDs are ideal for use in reception areas, treatment rooms and community presentations. For product details and demos, visit www.ada.org/goto/toothflix.

Visit adacatalog.org or call 800.947.4746 to place an order today!

Save 15% on all patient education products with offer code 10500; Minimum $100 purchase expires 9/30/2010 and may not be combined with any other offers, discounts, or promotions. Shipping and handling not included.

“After the Practice Start Up

“After the Practice Start Up training, I feel better and more conﬁdent about opening my dental practice. For anybody thinking about opening his/her own dental ofﬁce, this training is a must. I received a tremendous increase of knowledge about dental management. Now I know the game plan!!!”

training, I feel better and more confident about opening my dental practice. For anybody thinking about opening his/her own dental office, this training is a must. I received a tremendous increase of knowledge about dental management. Now I know the game plan!!!

”

Practice Practice Start Up Start Up PROGRAM Program

2 Days, one-on-one training.

• 2 Days, one-on-one training.

• Preferred time 3 to 18 months prior to opening. • 6 months of follow up support after the training

or once you are in your new practice. • Training location - La Jolla, CA or Your City.

• Training and Support Materials.

ENROLL TODAY•

16 hours of AGD CE Credits.

and receive Realizing The View course curriculum at Practice’s True Potential, www.mckenziemgmt.com/cons-startup.htm a 5-Hour DVD Set,

FREE

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Preferred time 3 to 18 months prior to opening. 6 months of follow up support. Training location - La Jolla, CA or Your City.

Training and Support Materials.

16 hours of AGD CE Credits.

and receive a 5 hour DVD Set: Realizing The Practice’s True Potential by Sally McKenzie (with your enrollment)

View course curriculum at w w w.mckenziemgmt.com/cons-star t u p. ht m

Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. 10/19/2007 to 10/31/2011

1.877.777.6151 training@mckenziemgmt.com