New Dentist Spring 2015 by The New Dentist

THE #1 JOURNAL FOR NEW DENTISTS

EQUIPPING

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75% ] of U.S. doctors use an Apple device of some kind.

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] Traditional PC shipments have declined 11%.

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] Smart tablet shipments have increased 68%.

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Call (855) 679-0033 - WATCH WEBINAR & DEMOS MacPractice.com/dds Sources: A Manhattan Research study claims 75% of U.S. physicians own Apple products. Vitera Healthcare reported that 60% of healthcare professionals use an iPhone for work, and 45% use an iPad. A KLAS study found that 94% of healthcare organizations adopt Apple devices when user preference is a factor. Samsung was the second most frequently adopted technology in this study with just 26% of organizations having at least one device. Gartner detailed market forecast data - "Forecast: Devices by Operating System and User Type, Worldwide, 2010-2017, 2Q13 Update."

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FROM THE PUBLISHER’S DESK

S P R I N G 2 015 PUBLISHER

Sally McKenzie Sally@thenewdentist.net

Dear Readers,

DESIGN AND PRODUCTION

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

Picante Creative www.picantecreative.com

hether you’ve already been practicing for a few years, are ready to buy an existing practice or are starting a new practice from scratch, every new dentist needs to learn several essential lessons if they want to build a profitable practice. If you take these lessons to heart and implement these proven strategies in your practice, you’ll not only be prepared to tackle the business challenges that come with owning a dental practice, you’ll also become the leader your practice needs to succeed. One of these essential lessons involves the importance of providing proper training. Give your team the tools they need to succeed. I know you’ve just started out and want to save money wherever possible, but training isn’t the place to cut costs. Yes, you have student loans to pay off and new equipment to invest in, but what good will that new equipment do if your team doesn’t know how to use it properly? If you’re ever tempted to skimp on training think about this: a poorly trained dental team is the single biggest contributor to inefficiency and mismanagement in a new dental practice and that can cost you huge in both time and money. If you don’t take the time to properly train your new practice’s business staff, you could be setting yourself up to lose thousands upon thousands of dollars in revenue over the course of your beginning years in business. Just like you need to take part in continuing education to keep performing at your best, your team needs ongoing training to ensure they’re as efficient as possible. There are a wide variety of affordable training options available, including FREE webinar programs that enable team members to get to know key systems management techniques. Visit www.practicemanagementlearning.com. For more information about other Essential Business Lessons for New Dentists, please visit http://mckenziemgmt.com/files/McKenzie-Essential-Lessons-Booklet.pdf. In this issue, find out what it takes to equip a new dental office. On p. 14, several equipment specialists for top dental suppliers share their best advice for embarking on this process. Our experts include Don Hobbs from Henry Schein Dental, John Bettencourt from Patterson Dental, and Marc Meiner from Burkhart Dental Supply. Use our handy checklist to guide your planning and keep you on track. One decision every new dentist starting out must make is whether to use traditional film or digital x-rays. Find out what our The New Dentist™ Advisory Board members say about their experience integrating digital x-rays into their practice, p. 26. On p. 22, we learn firsthand what a career in pediatric dentistry is like. Several new pediatric dentists share why they chose this career path and what makes their jobs meaningful as well as challenging. The New Dentist™ also explores how generational differences can impact the practice of dentistry. Nancy Haller, Ph.D., Senior Leadership Consultant at McKenzie Management, shares how Millennials, Gen Xers, and Baby Boomers may view work/life balance, practice philosophy, and work style differently. Find out how understanding these differences can help you work more effectively and harmoniously with your colleagues and staff. On p. 10, Mary Govoni, educator, consultant, and speaker, discusses how using dental assistants to their full potential can help dental practices reach their productivity and profitability goals. Finally, we are so pleased to welcome 17 new dentists to our Advisory Board. That brings our total Advisory Board to 21 members. We’ve spent the past months actively recruiting board members and sorting through applications to select those dentists best positioned to help guide us in making this publication all that it can be.

Terri Yablonsky Stat, M.A. terri@thenewdentist.net

2 THENEWDENTIST.NET S P R I N G 2 0 1 5

MANAGING EDITOR

Here to help,

Sally McKenzie, Publisher

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 dental school graduation in the United States. Single copies may be purchased for $8 U.S., $12 international (prepaid U.S. dollars only). Copyright ©2015 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 terri@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.

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All financing is subject to credit approval. 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. © 2015 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. 2434-0115-New-Dentist-Spring-2015

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TABLE OF CONTENTS

SPRING 2015

FEAT U R ES

6 Generational Differences in Communication Nancy Haller, Ph.D.

10 Utilization of the Dental Assistant

Mary Govoni, CDA, RDA, RDH, MBA

14 Equipping the New Dental Practice

18 Meet The New Dentist™ Advisory Board

20 Barbeque, Bliss, and Ten Bullets

Drs. Ben Poest and Brad Guyton

22 Is a Career in Pediatric Dentistry for You?

26 Digital Radiography: New Dentists Share Their Experience

30 Dr. Ross Nash Encourages Hands-on Training

32 Should You Lease or Should You Buy?

Michael Pakula

26 D EPARTMENTS 2 Publisher’s Message 34 Dental Students 36 Skinny on the Street 36 Index of Advertisers 4 THENEWDENTIST.NET S P R I N G 2 0 1 5

Generational Differences in Communication Create Synergy in Your Practice with Just a Little Respect BY NANCY HALLER, Ph.D.

New dentist Dr. A recently joined the practice of veteran Dr. B. Within a month of working together, they are clashing on schedules and philosophy. Dr. A wants to start work later in the morning, so he can see his kids off to school. But Dr. B has always started seeing patients at 7 am. Dr. A wants a flexible schedule so he can make his kids’ athletic games, while Dr. B hadn’t thought much about work/life balance early in his practice. Dr. A envisions a collaborative style of working together and a desire for mentorship. Dr. B is much more independent.

ow that you’re out of school and you’ve sharpened your dentistry skills, you still might have a lot to learn in terms of “meshing” with your colleagues and staff. As people live and work longer than ever before, the modern dental office may now employ up to four different generations under one roof. Each generation grew up in vastly different times with wide-ranging value sets that can affect relationships, work styles, and communication in a dental practice. Understanding and respecting each generation’s key formative environments and values is the first step in building a cohesive work environment and partnership. Traditionalists (born before 1945) grew up in a time of crisis in the aftermath of the Great Depression and during

6 THENEWDENTIST.NET S P R I N G 2 0 1 5

World War II. Dealing with economic hardships made them disciplined and self-sacrificing, and their reward was living the American Dream and enjoying a lifetime of steadily rising affluence. CONTINUED ON PAGE 8 >>

Dr. Nancy Haller holds a doctorate in psychology and served as a Commissioned Officer in the U.S. Navy. She co-founded and leads Applied Psychometrics, a consulting firm that specializes in employment testing and talent retention. She is also an Adjunct Faculty at the Center for Creative Leadership as well as a Senior Leadership Consultant with McKenzie Management. Contact her at nhaller@ mckenziemgmt.com.

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Generational Differences continued from page 6

Baby Boomers (born 1945 to 1964) are the largest generation in the United States and typically grew up amid economic prosperity, suburban affluence, and strong nuclear families with stay-at-home moms. Generation X (born 1965 to 1980) grew up as “latchkey” kids in a world of divorce and working moms. This led to independence, resilience, adaptability, and a “I don’t need someone looking over my shoulder” attitude. Millennials (born since 1981) were raised during the most child-centric time in our history. Due to the great deal of attention and high expectations from parents, they are confident and may appear arrogant. When younger and older generations work together, their differences may come to the forefront and each may attribute judgments to the other. People can adapt to a situation easily if they learn to look at it from a position of reason and logic. Let’s take a look at how the older and younger generations view the following values.

AUTHORITY Typically disciplined, Traditionalists such as Dr. B tend to be loyal team players who work within the system. They are respectful of authority, have patience, and follow the rules. They have a vast knowledge legacy to share and embody a traditional work ethic. Dr. B is likely to operate with more formal authority and accountability linked directly to hierarchy. Dr. A, the younger associate, tends to define authority based on competence and expertise. If a young knowledge expert is outspoken to a more tenured professional who feels he should be listened to because he has more years in service, this is a recipe for conflict. Dr. B wants to have his experience and knowledge recognized, and engaging through a mentoring process can allow him to feel like an expert. COLLABORATION Older generations, with more limited social networks, took more time to develop trust. Social engagement was a much more personal experience contrasted with today’s detached email, texting, or social media as a primary communication channel. When Dr. B had a problem, he’d pick up the phone and call the person to discuss while Dr. A would use some form of technology to accomplish the same task. Understanding different collaboration styles can help people stop and think before implying motive or making assumptions. DEALING WITH CHANGE Millennials tend to judge themselves on their potential and ambition. (This is not surprising since Millennials are famous for receiving trophies for participation as kids!) However, older generations judge themselves on results and professionalism. 8 THENEWDENTIST.NET S P R I N G 2 0 1 5

That’s the key disconnect. It can be a shock for Dr. A to have Dr. B do things differently. Because Dr. A grew up with the Internet, he may move quickly and wants to share all his good ideas for upgrading the office technology. However, he needs to be mindful that Dr. B makes practice decisions differently. To win him over will require Dr. A to present information in a logical manner, including costs and benefits. Dr. A will need to emphasize the practice vision and mission and how the changes can improve patient care and productivity. It’s best to avoid the blunt question that Millennials often ask: “Why are you doing it this way?” because it can sound critical.

COMMUNICATION Typically older generations tend not to seek applause. They adhere to the notion that no news is good news and satisfaction is a job well done. However, Dr. A likes to be given regular job feedback. He doesn’t want to wait until the end of the year to get his review. It’s important for him to have casual meetings to get to know Dr. B and to ask for feedback. Being able to have dinner together and talk outside the office will help both doctors to share stories and hopefully connect in a way that promotes mutual understanding. Requesting mentorship is bound to go a long way in establishing a trusting rapport. Regardless of societal differences over the past 60-plus years, all generations have inherent value and deserve respect. Increasing awareness of generational differences can close the gap if both sides understand each other’s perspective. Colleagues who develop relationships built on trust and respect will enjoy the greatest practice success and personal satisfaction.

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Utilization of the Dental Assistant:

A Key to Efficiency and Productivity BY MARY GOVONI, CDA, RDA, RDH, MBA

ery few dentists would choose to work without a dental assistant. However, most dentists are never taught in dental school how to work with a dental assistant. A great deal of research was conducted in the 1960’s and 1970’s regarding the use of dental auxiliaries and the benefits of performing patient care procedures with dental assistants and by dental assistants working independently of the dentist. Much of this research was performed by Dr. Thomas M. Cooper at the University of Kentucky College of Dentistry and is still relevant some 40 years later. According to Dr. Cooper, if dental assistants are not used to their full potential, a dental practice will have a much more difficult time reaching its productivity and profitability goals. He says that a dentist could produce “as much as 33% to 78% more when fully utilizing the skills of the well-trained full-time chairside assistant.”

What Functions Can You Delegate to Your Dental Assistant? Utilization of dental assistants must be done within the provisions of dental rules in the state where you practice. Each state dental board lists, in their rules, the functions that may be delegated to and performed by a dental assistant. It’s the dentist’s responsibility to be familiar with and to work within the scope of the rules. An excellent resource for determining allowable

10 THENEWDENTIST.NET S P R I N G 2 0 1 5

functions on a state-by-state basis is the Dental Assisting National Board https://www.danb.org/. Once you’re aware of what you can delegate to the dental assistant, you must then decide whether your dental assistant(s) are qualified to perform the functions and if you’re comfortable delegating those functions. For example, in some states, dental assistants are allowed to place composite and/or amalgam restorations. Some dentists choose not to delegate these functions, even though their assistants may be qualified to do so. This remains the choice of every dentist, however, choosing not to delegate may have a negative impact on productivity. Many times dentists are reluctant to delegate because they believe they can complete the procedure in a shorter amount of time. Given time and practice, the dental assistant can develop the skills to complete procedures as well as and in the same time frame, but they must be given the opportunity. Ms. Govoni is a certified dental assistant and a registered dental hygienist with more than 42 years of experience in the dental profession as a chairside assistant, office administrator, clinical hygienist, educator, consultant, and speaker. She is the owner of Clinical Dynamics, a consulting company dedicated to the enhancement of the clinical and communication skills of dental teams. She is a past president of the American Dental Assistants Association, a columnist for Dental Equipment and Materials, and a featured speaker on the ADA Seminar Series.

Organization After determining what can be delegated and to whom, the dentist, assistant, and scheduling coordinator should together determine the scheduling matrix of doctor/assistant time and assistant time for each procedure, and incorporate the matrix into the scheduling software. For example, if the procedure is a crown prep, the doctor is not needed in the treatment room once the tooth is prepped and the final impression seated. If the assistant is allowed to fabricate and seat the temporary crown, the doctor can be scheduled in another treatment room with another patient, while the dental assistant completes the procedure (Table 1). This scenario assumes that the practice is using traditional impression techniques and lab-created crowns. If the practice is using a digital impression system or CAD technology for in-office fabrication of crowns, the matrix may look slightly different. Appointment times and scheduling increments may also vary, based on the doctor’s preferences. The highlighted areas are times when the doctor can do hygiene patient evaluations or start procedures on other patients, depending on the amount of time available. TABLE 1 - CROWN PREP APPOINTMENT EXAMPLE Assistant

Anesthesia, tooth preparation

Assistant

Placement of retraction cord/material (if allowed)

Dr./Assistant

Placement of final impression tray

Assistant

Fabrication and seating of provisional crown (if allowed)

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The first step is to establish a scheduling matrix and which procedures can be delegated to assistants. The next step is standardization of all treatment rooms used by the dentist, so that any procedure can be done in any treatment room. Use tubs for organizing materials and armamentarium and instrument cassettes or some type of instrument management system for grouping instruments by procedure. Instrument cassettes are most efficient, since less time is needed for handling and sorting the instruments after use and in preparation for sterilization.

Dr. Melissa Thompson

AspenDentalJobs.com CONTINUED ON PAGE 12 >>

SPRING 2015 KHJ20778_ASP-195_BrandDentist_3.7125x9.925.indd 1

THENEWDENTIST.NET

1/5/15 12:59 PM

Dental Assistant continued from page 11

TABLE 2 – OPTIMAL POSITIONING

Give careful attention to how equipment and often-used items in the treatment rooms are arranged to reduce the need for bending, twisting, or getting up from chairside. Frequently used items should be within arms-length of the dentist or assistant when they are seated at chairside – with the most frequently used items placed closest to the doctor or assistant.

Ergonomics The doctor and assistant team should now focus on their posture and positioning at chairside. Optimal doctor/assistant positioning provides better visibility and access, thus improving efficiency. Table 2 lists the basic parameters for optimal doctor/assistant positioning. Keep in mind that optimal posture is not always possible, but a reasonable goal is to work in good posture 80% of the time. Research shows that the most neutral posture for the dentist/operator is working from a 12:00 position behind the patient. In this position, the dentist can work with his/ her upper body more relaxed, with little or no twisting of the upper body. The dentist doesn’t need to raise his/her shoulders and elbows to accommodate the patient’s head position. It also

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12:00 position for most procedures Head upright – using magnification Back straight – supported by backrest Elbows down – possibly supported by arm rests Seated with hips slightly higher than knees Feet resting flat on floor

1:00-3:00 (right) 9:00-11:00 (left) Head upright

Legs together underneath back of patient chair

Back straight- supported by backrest Elbows down – resting on body support on stool Seated with hips slightly higher than knees Feet resting on foot support of stool Eyes approx. 6” above doctor’s eye level

allows the dentist to use magnification and indirect vision, allowing the dental assistant to see into the patient’s mouth for correct placement of the suction tip and for more effective retraction. If your equipment will not allow for optimal positioning, you may need to make modifications to increase efficiency and to prevent ergonomic injury to the team.

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Access and visibility during treatment are critical to the dentist’s ability to prepare teeth and place restorations. Not only does the dentist need to see, but the assistant needs to see as well. Allowing the dental assistant to position suction and retraction before the doctor begins to use the handpiece can significantly increase visibility for both. When working on the mandibular arch, the assistant can retract the tongue or cheek with a mirror, which gives much more control than using the air/water syringe tip. The use of magnification greatly increases visibility for the dentist. The powerful combination of maintaining good posture and increased clarity of the image helps the team complete treatment in a shorter amount of time with less physical stress. Hygienists should use magnification, as well as the dental assistant, if they are performing expanded functions, such as placing retraction material or restorations.

Communication Since the doctor and chairside assistant work together so closely, there’s a tendency to rely on assumptions and nonverbal communication at times. Unless the doctor/assistant team has developed telepathic skills, verbal communication is essential to smooth sailing at chairside – and patients and practice productivity are the ultimate beneficiaries.

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Equipping

the New Dental Practice BY TERRI YABLONSKY STAT, M.A., MANAGING EDITOR PHOTO COURTESY OF PATTERSON DENTAL

Starting your own dental practice is a milestone in your dental career that can be both exciting and daunting. You’ve got many decisions to make, ranging from choice of practice management software to type of delivery system. The possibilities for your new space are endless, but chances are, your budget isn’t. New dentists must consider many factors when starting a practice, not the least of which is how you envision your future practice. Short of having a crystal ball, where do you see your practice in five or 10 years? Will you limit your practice to general dentistry or will you offer other services?

3 •

• •

•

• • •

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Will you bring in an associate or two? How much are you willing to expand, staff-wise and space-wise? What is your preferred work style, open office or private room? All these considerations affect which equipment you choose to invest in.

CONTINUED ON PAGE 16 >>

EQUIPMENT CHECKLIST CONSIDERATIONS Treatment rooms – How many treatment rooms will you

have? Consider setting up every treatment room the same, so you can do the same procedures in any room. Hygiene rooms – How many hygiene rooms? Will you have full-time hygienists or visiting? Patient chair – Key things to consider are stability, patient comfort (adjustable headrest, good lumbar support), and dentist access to the patient (right/left convertibility). Dentist and assistant stool – Choice of stool will affect your health and comfort, so ergonomics are paramount. Equipment specialists will watch you work to determine what you need. Sterilization center – Will you have a full suite or a specific area? Instrument management system – This system will streamline instrument cleaning and sterilization. Handpiece – What types of procedures do you perform? What feels comfortable ergonomically? How long does the warranty last? How much are repairs and who does them? Delivery system – Side, rear, or over the patient. Consider your space to determine what type of system works best for you. Those who practice in a larger city with smaller treatment rooms may choose over-the-patient units, while those in larger offices may prefer rear delivery systems.

14 THENEWDENTIST.NET S P R I N G 2 0 1 5

•

• •

•

Light units – Consider both room illumination lighting

and patient lighting. Choices include ceiling post mounted, track lights, center cabinet mounted, chair mounted, and wall mounted. Monitors – Every treatment room has two monitors: one for staff use and one for patient use. Consider track mounted, ceiling mounted, chair mounted, wall mounted. Small lab – Most offices have a lab. Do you want this close to the operatories or out of patient view? Lab equipment includes model trimmer, lathe, plaster trap, and CAD/CAM. A solid digital platform – This should allow you to integrate technologies. Technology – This includes digital x-ray, digital panoramic system, cone beam imaging, CAD/CAM, intraoral cameras, lasers. Mechanical room – This will house vacuum pump and air compressor. Small x-ray area – Depending on your office flow, this may be near the treatment room or wherever most efficient and protected from scattered radiation. Other items – Depending on your budget, other items to consider are staff lounge, waiting room, private offices, private consultation room.

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Equipping the New Dental Office PHOTO COURTESY OF BURKHART DENTAL SUPPLY

continued from page 14 The New Dentist™ asked several experts to share their best advice for new dentists about to start a practice.

N Don Hobbs, Vice President – Equipment/Technology Sales at Henry Schein Dental in West Allis, WI

N THE IMPORTANCE OF DISCOVERY The most important part of equipping a new dental practice is the “discovery” phase. During discovery we try to better understand a particular dentist. We ask lots of questions and exchange information so we can help them design the right practice. It is important that we understand their vision of the office and what sort of ideas they have about the practice. We then start to focus on their budget, in terms of their wish list vs. how much they can truly spend. We work with them to keep them focused on their actual budget. That’s critical when you’re talking to any dentist, especially a new one. New dentists all have a dream of what their office will look like one day. Often we have to reel them in and remind them they only have X amount of dollars to spend. There’s great equipment and a variety of technology products that don’t require you to break the bank. It’s not hard to stay within one’s budget when designing a new dental office. It’s also important to understand a dentist’s current financial situation. Do they have any current debt they plan to pay off? Do they have existing loans? All that information gets worked into the budget. Together, with the dentist, we figure out a budget for the new office and build a plan for the future. We ask them, “What do you want your practice to look like, 5, 7 years from now? Are you going to start doing implants, ortho, endo or referring those procedures out? That will help us know what other equipment they’ll need down the line.

N John Bettencourt, Vice President of Marketing, Equipment, and Technical Service at Patterson Dental in St. Paul, MN

N FIND THE RIGHT PARTNER Whether building a new dental office or updating an existing one, find the right distributor to guide you through the process. A strong partnership with a full-service distributor can guide you every step of the way. Find an experienced full-service team that understands the dental market and has a good reputation in your community. You should be able to visit the branch and personally meet the people who will help you build your practice. Your dental supply team can recommend the best equipment for your office. You’ll avoid the time-consuming, cumbersome step of comparing and purchasing equipment from multiple companies. When selecting equipment, keep in mind reliability, durability, and ease of use. The foundation of the modern dental practice is practice 16 THENEWDENTIST.NET S P R I N G 2 0 1 5

management software that seamlessly connects the front and back office. Patterson’s Eaglesoft software is free to new users. Having a solid technology platform is important as dentists are increasingly updating their offices with new technologies like CEREC chair-side CAD/CAM and digital and 3D conebeam x-ray to meet efficiency and productivity goals and keep pace with patients’ desire for a comfortable experience. The same dental supply partner that equipped your office should have the technical service structure in place to support your investments. They should also be able to train your team on how to get the most benefit from the technology. One of the best ways dental teams can ensure that the final result matches their vision is to work with a dental supply partner using 3D office design software. Patterson’s DesignEdge platform, for example, creates a 3D rendering – right down to the flooring, wall colors, and equipment placement – to help clients visualize what their dream will look like.

N Marc Meiner, Equipment Specialist at Burkhart Dental Supply in San Diego

N TEAM UP WITH EXPERTS Let the specialists do the heavy lifting, whether that’s me as a dental supplier or a financial, real estate, or legal entity. That allows the doctor to practice dentistry. Use specialists available to you in the field. Doctors are often disappointed to find out they missed something when they’re already so far down the process. Contractors, real estate professionals, and bankers are trained to run you through the rules and regulations and construction codes. Don’t count on your next-door neighbor or your legal friend to review your documents. Find a dental contractor, lawyer, and a dental IT company that understands HIPAA, CAD/CAM, cone beam, operating system, and what the future holds for dentistry. The worst thing is to spend tons of money on equipment and then find out you’re noncompliant. Call the specialists. It’ll save you money. Keep your eye on what’s going to pay your bills. Don’t invest in stuff that looks cool but doesn’t help your practice. You’ve got to have your business practice in place before you put technology into practice.

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Meet The New Dentist

™

Advisory Board

We are pleased to announce the expansion of The New DentistTM Advisory Board to 21 members. Board members serve for a two-year term in a volunteer advisory capacity and are critical to the success of our publication. Because they are in the trenches themselves, they know what issues are most important to their fellow new dentists. We’re very fortunate to have their expertise in guiding our publication. Julie Blais, DMD, is a 2010 graduate of the University of Montreal School of Dental Medicine. She is pursuing her MBA at Stony Brook University where she is also an assistant clinical professor in their School of Dental Medicine. She practices dentistry in East Islip and Patchogue, NY.

Dennis Frazee, DDS, is a 2012 graduate of Indiana University School of Dentistry. He worked as an associate for one year in pediatric and emergency settings prior to opening his own “technologically advanced scratch practice” in Mooresville, Ind.

Bryan Basom, DDS, is a 2007 graduate of The Ohio State University College of Dentistry. He worked as an associate for three years at two different practices and now owns two practices in Chillicothe and Columbus, Ohio.

Hal Cohen, DMD, is a 2010 graduate of Temple University Kornberg School of Dentistry. Prior to entering dentistry, he worked as a science writer and public relations specialist. Dr. Cohen has worked in private practice in and around Philadelphia.

Rebecca Berry, DMD, is a 2011 graduate of Tufts University School of Dental Medicine. She completed two years working in a VA Medical Center after completing a certificate in Advanced Education in General Dentistry at the same facility. She now owns a fee-for-service private practice in Oakland, Maine.

Larry Dougherty, DMD, is a 2008 graduate of Nova Southeastern University. He has chaired a number of committees on new dentists, has taught at the University of Texas Health Science Center at San Antonio School of Dentistry, and now owns a start-up practice in San Antonio, where he practices with his wife, who is also a dentist.

Lindsay M. Goss, DMD, MPH, is a 2010 graduate of the Arizona School of Dentistry & Oral Health and AT Still University School of Health Management. Dr. Goss completed an Advanced Education in General Dentistry program through the Lutheran Medical Center before she worked with four different types of practice settings, and prior to starting up a solo “space share” in Chandler, Ariz.

Dr. Christopher Banks, DDS, is a 2011 graduate of West Virginia University School of Dentistry. He has worked alongside his father at Smile Designs of the Shenandoah Valley in Inwood, WV, for the past three years. He is about to open his own practice in Chevy Chase, Md.

18 THENEWDENTIST.NET S P R I N G 2 0 1 5

Erica Haskett, DDS, is a 2008 graduate of New York University. She has worked in New York City and San Francisco as an associate and independent contractor and as a dentist in a hospital setting. She is currently working in mobile dentistry while maintaining a private practice on Park Avenue in New York City.

Robert Klein, DDS, practices at Highland Dental Clinic in Kansas City, Mo. He graduated from the University of Missouri–Kansas City School of Dentistry and worked at a group practice prior to starting his own practice. Aaron Layton, DDS, is a 2010 graduate of Indiana University School of Dentistry. He worked in a large group practice in Vermont before buying his own practice in Fort Collins, Colo. Leah Massoud, DMD, is a 2009 graduate of Tufts University School of Dental Medicine. After completing her Advanced Education in General Dentistry and struggling to find work as an associate in California she opted to buy a private practice in Morgan Hill, Calif. Dr. Katie Montgomery, DDS, is a 2006 graduate of The Ohio State College of Dentistry. She purchased All Smiles Family Dental Care in 2011. In the past year, she’s expanded her staff to include a part-time hygienist in addition to a full-time hygienist and fulltime assistant to help with the growing practice. She’s made some equipment upgrades and improved her office hours to better accommodate patients, staff, and herself to help achieve a better work-family balance.

Michael Potter, DDS, is a 2014 graduate of the University of Minnesota School of Dentistry. He has been a member and made significant contributions to the Minnesota Dental Association and several student committees. Prior to dental school he completed a Master’s of Business Degree. Dr. Kevin Rhodes, DDS, PA,, is a 2005 graduate of the University of Texas San Antonio Dental School. After over five years of practice in San Antonio, Dr. Rhodes opened Royal Vista Dental in Round Rock, Texas, in 2010. The practice is steadily growing and he just refinanced both practice and commercial property loans to pay off completely in 10 years. Tyler Scott, DDS, is a 2009 graduate of The Ohio State University. He is one of the newest ADA Lecturers on CAD/CAM dentistry. He is the local dental society president and a delegate for the Ohio Dental Association House of Delegates. He works as a general dentist in a group practice in Loudonville, Ohio. Dr. Mary Shields, DMD, MPH, is a 2011 graduate of the University of Louisville Dental School. She and her husband, Eric Nunnally, DMD, CDT, own Triple Crown Dentistry, PLLC, in Louisville, Ky.

Matthew Silverstein, DMD, is a 2012 graduate of the University of Pittsburgh with dual degrees of DMD and MPH. He is on track and expected to complete his Periodontist Specialty certification this year from the University of Connecticut. Dr. Jared Simpson, DDS, is a 2005 graduate of the University of Texas San Antonio Dental School. In 2010 Dr. Simpson started his own practice in family and cosmetic dentistry in Bakersfield, Calif. A few days a month he helps clinically supervise pre-doctoral candidates at a community health center. Nicole Smith, DDS, is a 2009 graduate of New York University College of Dentistry. She was class president for three years, is a member of several professional organizations, and has received honors and awards for her contributions. She partnered with a group practice organization and now owns two dental offices in Southern California. Gregory Snevel, DDS, is a 2011 graduate of The Ohio State University College of Dentistry. He is a part-time clinical instructor at a local community college and a third-generation dentist running a general dentistry practice in a suburb of Cleveland, Ohio. He took over his father’s existing practice after working there as an associate.

SPRING 2015

THENEWDENTIST.NET

ADVERTORIAL

Barbeque, Bliss, and Ten Bullets New Dentist Practice Success—Texas Style Have you been out of school for a year or two and life isn’t what you expected? For some reason, that mandate for success just isn’t happening, even though your name got longer. In today’s environment, are happiness and success really possible three years out of practice? Can you have a stress-free practice in a desirable market at this point in your career? Dentistry continues to be a lagging indicator of the recession and solo practice owner incomes remain flat or may still be trending down slightly. We keep hearing that it is increasingly difficult for new graduates to emerge from school and find success in a desirable market. When roughly 5,400 new dentists are graduating each year with so many outdated practices for sale, it’s no surprise that some new graduates are finding Mom and Dad’s basement couch looking better each day. Recently, the two of us sat down over barbeque and discussed the fundamentals of practice success. With one of us starting a practice a decade before the other, the question emerged: “Do the basic principles of finding success in dental practice still hold true in today’s environment?” We concluded that even with all the changes in dentistry over the past decade and a half, the basic fundamentals still hold true. Below are the Ten Bullets we find necessary for success as a new dentist.

Your PATIENTS: 1. Open your practice to your community. This means accepting some plans that don’t sound so appealing. These patients have friends and family on other plans and they are great referral sources. 2. Get involved in your community. Dental society involvement, study clubs, and happy hours with other dentists are paramount. Know the sport scores of the local high school teams and who the key players are. Sponsor local events—take time on Saturdays to go to community festivals and hand out toothbrushes. In our offices, we keep a running list of great patients that come into the office, but just can’t afford the dentistry. Then we follow up with those patients on designated free dentistry days in the office. 3. Treat people well. It starts with your team. It continues with greeting your patients in the reception area. Be approachable. Be interested in their family, job, and life. When you connect with patients they no longer view you as the “scary 20 THENEWDENTIST.NET S P R I N G 2 0 1 5

BY DRS. BEN POEST AND BRAD GUYTON

dentist.” Treat each person as an individual without stereotype and allow that to drive your treatment plan.

Your TEAM: 4. Set expectations for your team up front. 5. Make sure your associates respect YOUR team. When the entire team views the same person as the weakest link, consider letting them go today. Listen to your team and learn from them. Assistants can often be great mentors for new dentists. 6. Show interest in the everyday life of each team member.

Your SELF: 7. Build your clinical confidence. Identify a clinical mentor very quickly. If you don’t have one in your office, consider joining a study club. Become great at one procedure, build confidence in it, and then master another procedure. 8. Avoid having personal office space for dentists in your practice—docs often retreat to these offices and avoid getting to know their team and contribute to the office flow and work. 9. Don’t go big day one. Pace yourself. Get off the treadmill of intent to practice “herodontics.” Stop trying to save hopeless teeth and thinking that unless you place implants and do full-mouth reconstructions you aren’t a good dentist. Stop looking at the guy/ girl you graduated with who is driving the Bentley and has the huge house. Remember: most dentists don’t own their Bentleys or their homes. 10. Create a financial plan so you can pay off your debt consistently, but don’t overpay to the point that you feel pressure to overtreat patients. Finally, enjoy the journey. It goes a lot faster than you think. Make sure you have a day or two a week to blissfully kick back in that rockin’ chair on the front porch and take time to smell the…barbeque. Benjamin Poest, DDS, is a 2010 graduate of the University of Michigan School of Dentistry. He is the Pacific Dental Services-supported owner of Pflugerville Modern Dentistry and Orthodontics in Pflugerville, Texas. He can be reached at poestb@pacden.com. Brad Guyton, DDS, MBA, MPH, serves as Dean of Dentist Development for Pacific Dental Services and as Associate Professor at the University of Colorado School of Dental Medicine. He practices dentistry in Denver, Colo. He grew up in East Texas and went to dental school in Dallas, so he is still qualified to judge good barbeque. He can be reached at guytonb@pacden.com.

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Cody Mugleston, DMD Multiple-Office Owner Dentist

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Is a Career in

Pediatric Dentistry for You?

BY TERRI YABLONSKY STAT, M.A., MANAGING EDITOR

f all the specialties in dentistry, pediatrics has the potential for the most smiles and the greatest challenges. Working with the youngest dental patients takes a special kind of personality – marked by patience, energy, and lightheartedness – with infinite rewards. Pediatric dentists have the chance to make a difference in kids’ lives that goes way beyond just protecting teeth. And with increased employment opportunities for all dentists, including pediatric dentists, projected in the near future, pediatric dentistry is a career worth considering. According to the U.S. Bureau of Labor Statistics, an estimated 23,300 new dental positions are forecast between 2012 and 2022 (www.bls.gov). The New DentistTM spoke with several new graduates about their careers in pediatric dentistry. Each has chosen a slightly different path. 22 THENEWDENTIST.NET S P R I N G 2 0 1 5

Dr. David Avenetti, MSD, MPH Clinical assistant professor in the Department of Pediatric Dentistry, University of Illinois at Chicago College of Dentistry The native of Upland, Calif., graduated from UCLA Dental School in 2010. He then completed a three-year residency at the University of Washington in Seattle and earned a Master of Science in Dentistry (MSD) and Master of Public Health (MPH), graduating in June 2013. “People traditionally think of grads from dental school as being purely clinical but I’m in academics,” says Dr. David Avenetti. He’s full-time faculty at the University of Illinois at Chicago College of Dentistry and also practices one day a week in Logan Square, on Chicago’s northwest side, where he treats high-risk kids covered by Medicaid. “These children are first-generation immigrants who need a lot of work done, with conditions like early childhood caries,” he says. “Managing behaviors can be challenging with the amount of work that needs to be done.” Dr. Avenetti’s interest in dentistry began in high school. “I was always interested in health care of some kind.” As an undergrad public health major at the University of Southern California, he shadowed a pediatric dentist to learn more about the field. “Pediatric dentistry was about helping people and it seemed like a lot of fun. I found it the best fit for my personality style and what I wanted to do with my public health background.” Dr. Avenetti spends time in education, research and scholarly activities, service, and patient care. He spends time with pediatric CONTINUED ON PAGE 24 >>

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Pediatric Dentistry continued from page 22 dentistry residents serving as an attending in the graduate clinic and in the University of Illinois Hospital operating room. He also serves as course director for three resident courses and lectures in CE and pre-doctoral courses. “I always knew I would do something less traditional with my career,” he says. In dental school he was involved with community service and teaching activities through the American Student Dental Association. “I realized academic dentistry would be a good balance of being able to see my own patients and clinical, didactic, and research activities.” He advises new dentists to follow their passion. “Lots of new dentists think about pediatric dentistry because it’s developed a reputation as being lucrative, but don’t base your decision on that. Consider all factors and make sure you’re passionate and feel confident before getting sidetracked. If you have the skill set and personality to work with kids, it can be a very rewarding choice.”

Dr. Courtney Alexander, DDS Stone Oak Pediatric Dentistry Dominion Pediatric Dentistry San Antonio, Texas When Dr. Courtney Alexander graduated from dental school in 2005, she spent two years working as an associate general dentist in a pediatric practice before starting a pediatric residency at the University of Texas Health Science Center San Antonio. “Before I made the two-year commitment and took out the loans I thought I’d better check it out first,” she says. Those experiences working in a pediatric practice solidified her decision that this is where she wants to be. When she finished her pediatric residency in 2009 she returned to work at the same practice and in 2010, she bought in as an owner. “Working with kids is fun and exciting,” says Dr. Alexander. “Sometimes dentistry can be bland and boring but when you’re working with kids you don’t know what you’re going to get. You need to be on your toes every day.” Mostly, you need energy to deal with kids every day, she says. “You also need to be fun loving. In dental school everything is so serious. With pediatrics you need to be a kid at heart.” Pediatric dentists need patience to work with both kids and their parents, she says. “During treatment, parents are at the edge of the chair asking, ‘Are you hurting them?’” As a child she was a patient of a general dentist and doesn’t have fond memories, she recalls. “But sadly, that’s why the adult generation has fears and anxieties. Kids, however, love to come to the dentist and we hope they maintain their preventive care and recall for the rest of their lives.” Gaining the confidence and trust of children early on can be challenging, she says. “We have to show them that this is a

24 THENEWDENTIST.NET S P R I N G 2 0 1 5

fun, friendly, loving place and cater our approach to the child we’re working on. Our motto is to treat the kids as if they were our own. “Parents are becoming more aware of the need to bring kids in early,” she says. “Ten to 15 years ago it was a challenge and we’re finally winning the battle. Pediatricians and the American Academy of Pediatrics are helping spread the word that we need to see kids by their first birthday.”

Dr. Kennon Curtis, DMD Pediatric Dental Group Germantown, TN; Southaven, MS; Memphis, TN; Olive Branch, MS Dr. Kennon Curtis grew up in a family of pediatric dentists, with both his father and younger sister in the field. “I’ve wanted to do this my entire life,” he says. “My dad was my hero and I wanted to be just like him,” he says. When he got older he spent time at his dad’s practice and attended American Academy of Pediatric Dentistry meetings where he met pediatric dentists from all over the world. “I learned a lot about what it is to be a pediatric dentist. “When I was growing up we couldn’t go out to dinner without a kid running up to my dad and telling him about their latest T-ball game or ballet recital,” he says. “These children loved my dad and he loved them. I’ve still yet to meet someone in another profession who has such satisfaction in their work as I do with pediatric dentistry. “You’ve got these kids coming every 6 months and it’s a chance to be a part of their life,” he says. “My dad says fixing a cavity is easy, making a difference in a child’s life is hard.” Dr. Curtis hopes to make a positive impact on kids’ lives. “More has to do with showing them love and attention when they come in and helping them to develop a healthy and confident outlook on life.” At the office, kids get to see their friends and socialize with others. All kids sit together during treatment. “It’s an environment that helps decrease anxiety in both kids and parents,” he says. “There’s nothing scary here, other kids are back here having a good time.” He works 20 minutes from the Mississippi Delta, one of the poorest regions of the country. In dentistry, 80% of the disease is in 20% of the population, he says. “The challenge we’ve faced for years is how do we get to the 20%? How do I get to this community? How can I impact those children’s lives? He’d like to find a way to get parents involved and kids excited to take care of themselves. “Sometimes it’s as simple as giving them a bouncy ball, or letting them come in and play on the Xbox. It helps make that connection.” He’s just starting to see patients for a second time. “I love hearing about what’s going on with them. It’s really special to have these kids want you to be so involved in their lives. Recently a little girl invited me to her birthday party.”

Digital Radiography:

New Dentists Share Their Experience

ore and more new dentists have integrated digital radiography into their practice. Despite the initial investment, the benefits of digital radiographs over traditional film x-rays are great. Take for example, immediate viewing of images on a screen, less radiation, and the ability to manipulate images to aid in diagnosis. Digital radiographs can be sent electronically to specialists for immediate review or second opinion and can also be a tremendous tool for patient education. We asked our The New Dentist™ Advisory Board members about their experience integrating digital x-rays into their practice.

Christopher Banks, DDS SMILE DESIGNS OF THE SHENANDOAH VALLEY, INWOOD, WEST VIRGINIA

I’m an associate in an office that has used digital radiography for several years prior to my joining. Our office recently switched to the Carestream digital sensor. I researched several systems and made a final decision at a dental conference where I was able to compare several companies at once. Several factors played a role in our choice of sensor. We have a wide range of team members, so ease of use was a top

priority. All of the sensors must be used with the computer so the less technologically advanced employees needed to be able to take radiographs just as easily as our young, techsavvy hygienists. Image clarity was also important. I ended up choosing Carestream due to several features that other sensors didn’t have. It’s wireless so it syncs easily with the computer by turning on the sensor in close proximity to the computer you’re taking radiographs with. Also, the enhancement features and diagnostic tools were more impressive with the Carestream sensor. They provide cavity detection software, which I frequently use to show patients where a cavity is located. I wouldn’t rely on the software as a dentist, but it’s nice to show the patient the depth of the cavity in the bright red outline the software uses. I would recommend the Carestream sensor for its ease of use, quality images, and diagnostic tools. It’s one of the more expensive systems, but it has one of the longer warranties. The sensor can be slightly uncomfortable for some patients, but I feel that in general all sensors are a little unpleasant. The sensors have been worth the investment for us. Enhanced images, decreased radiation, and immediate viewing of images are just a few advantages of digital radiographs. I’ll use digital radiographs in the practice I’m currently starting.

Mary K. Shields, DMD, MPH TRIPLE CROWN DENTISTRY, PLLC, LOUISVILLE, KENTUCKY

I opened a new practice in Louisville, KY, in May 2012. I wasn’t interested in standard film x-rays. After agonizing about ScanX (phosphor plate scanning system) versus digital radiography, the answer was clear when I viewed an online demo of the Planmeca Promax S3. The appeal of capturing vertical bitewings extraorally and PAN images from the same machine was a great concept. I was the first dentist in Louisville to purchase this machine and I loved telling my patients I’m truly offering the latest and greatest in dental technology. Patients love to hear that. This machine has many advantages. First, there’s patient comfort while capturing bitewing images, because no bulky sensor needs to be placed intraorally. For taking bitewings, patients often say how great it is not to have anything placed inside their mouth for x-rays. They only need to bite down on a standard PAN bitestick. Another benefit is the ability to block 26 THENEWDENTIST.NET S P R I N G 2 0 1 5

out any areas of radiation that aren’t needed (i.e., if I just need left side BWs, the right side can be left out of the radiating field by simply using the touch screen on the machine). Also, having vertical bitewings allows me to see not only the crowns of the teeth but also the apex of all teeth. This is a great advantage, especially for periodontal patients. Although I have an intraoral sensor, I rarely use it. I take approximately 10 PAs a month (most often when doing endodontic therapy). The S3 can take PAs (by selecting radiation areas as I mentioned before). Another plus is that the robotic arm allows for easy entry in and out of the machine, which is great for patients with limited mobility and those who are wheelchair-bound. The image quality is exceptional. I also have the ability to upgrade the software to be able to take cephalometric and CBCT images in the future.

Robert Klein, DDS HIGHLAND DENTAL CLINIC, KANSAS CITY, MISSOURI

From day one, my vision was a digital practice. I started out with one type of x-ray system and it broke constantly. After two years I knew I had to make a change. After lots of research and talking to my colleagues I chose DEXIS, which I’ve used for six or seven years now. I still have the same sensor. I’ve never had it worked on. Everything works seamlessly with Dentrix practice management software, too. I switched to both at the same time. I wanted a high quality image and something durable that would last over the years. I liked the full integration of DEXIS with Dentrix. I’d recommend Dexis to anyone. Patients are amazed at how quickly images appear on a large 22-inch monitor and how I’m able to manipulate it instead of holding up a small piece of film. It’s wonderful for patient education and for my own ability to diagnose diseases.

Jared Simpson, DDS JARED SIMPSON, DDS, BAKERSFIELD, CALIFORNIA

I started my practice in 2011 with digital radiography. I also use an electronic signature pad so documents can be signed electronically. I decided to go with the Schick Elite digital sensors because they integrated very well with my Eaglesoft software and were priced well for the quality of the image. They come with an interchangeable cable, which is nice because most of the problems with sensors seem to be at the cable level. I made my decision based on what would work best with my software and what would be easiest to maintain over time. Schick has been very good with warranty help and has even gone above and beyond it to ensure satisfaction with their

product. I think all sensors are bulky and patients object to them regardless of brand, so providers need to evaluate sensors from a cost and maintenance standpoint. I’d recommend the product to other clinicians because I think they provide high-quality images and the support has been excellent. Most everyone hates x-rays and doesn’t find them pleasing no matter which sensor. A lot of the benefit comes when you have well-trained staff to take images. Patterson has invested a good amount of time helping to train my office staff for image taking. Our ROI has been great. I see lots of issues I can show patients quickly and clearly on the computer screen. I find that the lower radiation dose with digital helps patients feel more comfortable having images taken. Having immediate images on screen helps minimize inefficiencies in exams and procedures, too.

Kevin Rhodes, DDS, PA ROYAL VISTA DENTAL, ROUND ROCK, TEXAS

I started my practice in 2010 using digital radiography. I worked with Patterson for a big opening order to get everything needed for a start up practice. I chose Schick CDR Elite sensors because I already had a good relationship with both Patterson and Sirona. I got a good deal by bundling from Sirona getting the CEREC AC unit, MCXL milling chamber, and two sensors all at the same time. At the time, this sensor was one of the top-rated choices in terms of clarity. It also had a great ratio of active sensor size to outer housing so there wasn’t a lot of extra dead space. It integrated seamlessly with Eaglesoft software. It was and still may be the only sensor to come with a replaceable cord that can be changed out in the office without having to send it off for repair. As with all sensors, they are a bit large relative to the films people had gotten used to. Patients love to see the films pop up so quickly and how they can be blown up to full screen size to show them our findings. They’ve paid for themselves over and again. I have two sensors (adult and pedo) and they’ve been going strong for almost four years. I’ve generated and billed out countless radiographs. I have no idea how much film and processing solution would have cost over this time but it has to add up. The time saved with retakes and processing is huge.

Katie Montgomery, DDS ALL SMILES FAMILY DENTAL CARE, MARYSVILLE, OHIO

When I bought my practice in 2011, it was already fully digital and paperless. With some systems, you’re forced to use CONTINUED ON PAGE 28 >> SPRING 2015

THENEWDENTIST.NET

Digital Radiography continued from page 27 one brand of sensor. I like that my system can accommodate whichever sensor I choose. We have one pedo sensor and one adult sensor, which seem to work well. I haven’t had to

purchase my own sensor yet, but when I do, I’ll probably stick to what I know because it has done well for me. I’ve had no trouble with my Gendex sensors. It’s nice that I can just call them with a question and they can help me. I’m not required to be on a support plan like some of the other systems. Patients love digital x-rays. They love seeing them on the screen and feeling a part of their treatment planning because they can see the x-ray, and therefore the problem, right in front

FROM THE EXPERTS Dale Miles, DDS, MS

Larry Emmott, DDS

CEO, CONE BEAM RADIOGRAPHIC SERVICES, LLC PRESIDENT, EASYRITER, LLC

PRACTICING DENTIST/SPEAKER/ CONSULTANT

It’s astonishing to me that after the introduction of solid state detectors (sensors) at the Chicago Midwinter meeting in 1988, only about 55% of dentists in the United States have adopted digital x-ray technology. I’ve been lecturing to dentists about digital x-ray imaging since 1990 and have had information on digital technology on my website, http://www.learndigital.net since 2000. It’s very rewarding to see that the new dental graduates, at least, get it! The responses of The New Dentist™ Advisory Board about their experience, decision-making processes, and understanding of the profitability of digital x-ray imaging demonstrate that they really did their due diligence prior to adopting digital x-rays. These dentists understand the power of digital x-ray imaging for their practice and their newfound ability to make better clinical decisions with better tools. All dentists should follow their examples and adopt these technologies into their offices. They love it, their patients love it, and they have become better clinicians because of it! Most dentists who stick with traditional film or even phosphor plates don’t get it. Why? Because most dentists do not actually perform their own x-ray procedures in their offices. My advice to these dentists is to have their office manager run a productivity report just on the radiographic services they delegate in their office for six months or preferably one year. The numbers will astound even the most resistant dentist. And then they, like these new dentists, will realize the losses they are incurring for not adopting digital x-ray technology. Congratulations you young dentists – you are my heroes!

28 THENEWDENTIST.NET S P R I N G 2 0 1 5

The only choice is to start with digital radiography from scratch, as these dentists have done. One of the myths about digital radiography is that it’s expensive to start, $40,000 to $50,000. This goes back to when the office had to install an entire computer network, but that’s no longer the case. The actual cost to using digital radiography is the sensors and software, which runs from $10,000 to $15,000. If you were going to start from scratch with film you have to get a film processor which is $7,000 to $8,000 and build a dark room which is another several thousand. So the initial cost to go digital or film is the same. There’s no excuse for starting with film anymore. That’s last century. Digital radiography is now considered the established norm. It’s absolutely more economical long term. There’s no film, no developer, no repair of machine. Even without the time saving it pays for itself almost immediately. Almost all of these new dentists mention patient acceptance. Because a sensor is different than film, there’s the feeling that patients don’t like it or that it’s uncomfortable. But in reality certain people have a difficult time with x-rays. They may be gaggers or have high anxiety. It’s not the sensor but the patient. Patient acceptance for digital radiography is the same as with film. Some dentists think digital radiography is expensive because they have to buy multiple sensors. In my experience the vast majority of patients can be served with a single sensor. The only exception is if you treat very small children. I would advise to buy just one sensor and if that’s not working then buy another. It really depends on your practice but typical general practice may find they can get by with one sensor.

“Patients love to see the films pop up so quickly and how they can be blown up to full screen size to show them our findings.” —Kevin Rhodes, DDS, PA

of them. We love them because they are fast and a good teaching tool for our patients. It doesn’t really cost to take a digital x-ray because the processing time and materials have been eliminated. It’s definitely a win-win situation for my patients as well as my staff and myself.

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SPRING 2015

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Dr. Ross Nash Encourages Hands-on Training

espite the abundance of opportunities for online continuing dental education, Dr. Ross Nash believes there’s no substitute for handson learning.

“I learned early on that to be a dentist, you not only have to be a scientist but you have to be an artist, and you have to learn those things firsthand with your hands,” says Dr. Nash, a world-renowned cosmetic dentist and founder of The Nash Institute for Dental Learning in Huntersville, NC, a suburb of Charlotte. He acknowledges that many modern dentists are very efficient with computers and social media, making online CE a convenient and natural choice. “However, the only way I have found to really learn a new procedure is through hands-on training.” Dr. Nash advises new dentists to search for hands-on learning opportunities such as those offered by The Nash Institute, where he teaches two-day hands-on courses in aesthetic dentistry (direct composite resin dentistry, indirect aesthetic dentistry, and full-mouth esthetic reconstruction). The Nash Institute has six operatory offices used for teaching, a lecture hall, and 30 hands-on stations. When taken together, the three clinical courses make up the Nash Institute’s “Esthetic Epitome” series and earn 42 AGD PACE credits. “We want each participant to take their learning back to the office and make it work for them on Monday morning,” Dr. Nash says. He and his wife, Debra Engelhardt-Nash, also offer a two-day dental business school course for dentists and their teams covering practice development skills, team training, and practice management. Running a business requires sound business sense. Most of the time that means recruiting outside help, Dr. Nash says. “Dentists need to find a consultant, someone they feel comfortable asking questions and who guides them in the business aspects of running a practice.” In addition to maintaining a cosmetic dentistry practice in Huntersville, Dr. Nash teaches CE at New York University College of Dentistry, the Medical College of Georgia, and Texas A&M University Baylor College of Dentistry. “There are many individual independent-type CE courses where dentists can sit down and talk and get hands on,” he says. “It’s absolutely necessary and missing in the early career.” Dr. Nash has long believed that CE is a must for new dentists, especially in today’s unpredictable economy. “As most of us know, getting out of dental school and getting your license

30 THENEWDENTIST.NET S P R I N G 2 0 1 5

is a license to continue to learn,” he says. “You have the basics when finishing school. Keeping up with technology and skill is a continuous learning experience and if you don’t do CE you get behind really quick. CE is a must.” Above all else, Dr. Nash says, never treatment plan around money. “My feeling is if you plan treatment around money, you are going to lose,” he says. “The only way to treatment plan is for the patient benefit. Just because a patient is willing to pay for some type of treatment doesn’t mean it’s right for them. Treatment plan around patient benefit and it will always come out right.” He also advises new dentists never to underestimate the value of staff training. “A dental team can make or break you,” he says. Staff training in both customer service and clinical skills is extremely important to the success of your practice. Have good people and spend time on team building, he says. “It’s one thing to know how to treat the patient clinically,” Dr. Nash says. “It’s another thing to know how to treat the patient with exceptional customer service and communication skills so they accept the treatment the practice offers.” Dr. Nash has some favorite products he could never be without. These include the Isolite® dental isolation device, ring-type matrix systems for direct composites, and the OptraSculpt Pad to contour composite fillings. Dentists who become proficient at direct composites will be more successful in today’s economy, he says, because they can be placed at lower fees. “Little things like that keep me excited about dentistry.” He’s a big believer in technology that can help dentists in today’s economy. These include CareCredit patient payment plans and Solutionreach Smile Reminders that text patients when due for a visit. “Young dentists are extremely good at technology and these modern computerized services can really help their practices.” Dr. Ross Nash is a cosmetic dentist in Charlotte, NC. He is the founder of The Nash Institute for Dental Learning in Huntersville, NC, which offers training in both the clinical and business aspects of dentistry. Dr. Nash graduated from North Carolina State University as a textile engineer and four years later went on to the University of North Carolina at Chapel Hill for his dental degree. He has served as an adjunct faculty member in post-graduate training for many dental schools including Texas A&M University Baylor College of Dentistry, Medical College of Georgia, and New York University College of Dentistry. He lectures on cosmetic and esthetic dentistry internationally and is one of only 46 accredited fellows worldwide in the American Academy of Cosmetic Dentistry.

Flexible financing meets important insights

Practice Relocations

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With Bank of America Practice Solutions, you get financing* and guidance that matches your needs Over the years, we’ve helped thousands of dental practices become more efficient, productive and successful. We’ll sit down with you, ask lots of questions and ensure that we totally understand your needs. Then, we’ll develop a financial package that’s customized to your practice. Call now and we’ll give you a complimentary Dental Practice Business Plan that can be invaluable to your business.

Let’s talk Michael Pakula Area Manager

619.879.0423 | michael.pakula@bankofamerica.com To learn more, visit bankofamerica.com/practicesolutions All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. The term, amount, interest rate and repayment schedule for your loan, and any product features, including interest rate locks, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. † Bank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2015 Bank of America Corporation | Rev. 12/14 *

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Should You Lease or Should You Buy?

ave you ever asked yourself, “Would I be better off purchasing a location instead of leasing?” Each situation is different, and you need to carefully review the advantages and disadvantages of leasing or purchasing property for your practice. Buying real estate certainly does have its rewards. Building equity in real estate can be a sensible way to grow your business as well as your personal wealth portfolio. So, what are some advantages and disadvantages of leasing property? An advantage to leasing a space for your practice is that your credit rating is not as crucial and normally requires little or no down payment. In addition, you don’t have to worry about selling the building when you want to move to a new location. Also, your monthly rent may be considered a tax deduction that you could deduct as a business expense. The disadvantages of leasing typically begin the internal argument that leads to the question: “Should I lease or should I buy?” These disadvantages are obvious. When leasing, you never build any equity in the property and your rental rates could increase based on market conditions. Doing your homework and crunching the numbers is vitally important when it comes to determining the true advantages and disadvantages of purchasing property. One advantage is that when you own the property you eliminate the landlord, and your interest on the mortgage loan can be tax deductible. Another advantage is that by making improvements to your property, you could increase the value of your location. Also, with a fixed-rate mortgage, you never have to worry about your payments increasing, as is typically the case with leased spaces. 32 THENEWDENTIST.NET S P R I N G 2 0 1 5

BY MICHAEL PAKULA

There is, of course, a potential downside to owning real estate. Owning real estate could require you to invest time and energy in tasks that are not business-related. Costs, such as unexpected repairs, routine maintenance, trash pick-up, landscaping, and possibly snow removal should be considered in your cash flow. Also, becoming a property owner could require you to be subject to legal and regulatory laws that are not usually associated with leasing a space for your practice. Have you taken a look at your business plan? Have you asked yourself, “How much space will I need 10 years from now?” Will I be able to grow my practice and expand with the possible restrictions of a property manager or landlord? These questions will help you make the best decision for the direction you plan to take your practice. Whether you are an established dentist purchasing the building where you are currently located, relocating your clinic to an existing building or condo unit, refinancing the existing debt on the building, or even starting or purchasing an additional practice, it is extremely wise to weigh all options before moving forward. Leasing benefits some practices and purchasing benefits others. The key is to contact a specialist that can list all options and go over all pros and cons to help make the best business decision. Michael Pakula is regional business development officer with Bank of America Practice Solutions. He leads the Practice Sales & Acquisitions lending team as well as the Start-Up and Relocation team in San Diego, focusing his efforts in the dental market. He has more than five years of experience in healthcare financing nationwide.

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DENTAL STUDENTS

Tufts Awarded for Treating Patients With Disabilities

ufts Dental Facilities Serving Individuals with Disabilities (TDF), a network of clinics that provides comprehensive oral health care to adults and children with intellectual, developmental, or acquired disabilities, has won the William J. Gies Award for Outstanding Achievement by an Academic Dental Institution, part of the William J. Gies Awards for Vision, Innovation and Achievement. Tufts Dental Facilities receives this distinction for advancing dental education to improve care for people with intellectual and developmental disabilities. TDF is the only statewide oral health care network in the nation for people with intellectual and developmental disabilities (I/DD). Tufts University School of Dental Medicine has operated these clinics since 1976. The TDF clinics provide direct care to patients, train oral health practitioners, and have led to landmark studies on the oral healthcare status of persons with I/DD. People with I/DD face challenges obtaining access to oral health care and have a high risk of oral health disease. Patients with I/DD may have difficulty articulating medical or dental concerns, behavioral challenges that require treatment modifications, and/or physically and medically compromising conditions. Many private practitioners do not have the educational training or office facilities to accommodate patients with I/DD, or the extra staff typically required to manage additional administrative and insurance obligations. “TDF is a national leader in fostering better health outcomes for patients with I/DD,” says Mark Nehring, DMD, MEd, MPH, Delta Dental of Massachusetts professor in public health and community service and chair, department of public health and community service at Tufts University School of Dental Medicine. “The clinics provide a model for population-based care and for training dental practitioners to provide care to individuals with I/DD. We are honored to receive the distinction of outstanding achievement from the ADEAGies Foundation, which provides a platform for raising awareness about the oral healthcare needs of persons with disabilities around the nation.” All fourth-year students at Tufts University School of Dental Medicine are trained in a special care rotation in TDF clinics. Dentists in the post-graduate general practice residency program also spend about 25% of their time working with patients with I/DD - significantly more than they would at a typical hospital or community health center. The TDF clinics also provide training to dental assisting and dental hygiene students. The TDF clinics have fostered landmark studies on the oral health status of individuals with I/DD. In 2012, public

34 THENEWDENTIST.NET S P R I N G 2 0 1 5

health researchers from Tufts University School of Dental Medicine and Tufts University School of Medicine used records from more than 4,700 TDF patients to create the country’s largest database of information on the oral healthcare status of patients with I/DD. The resulting study determined that access to care alone is not sufficient to meet the I/DD population’s substantial oral health needs. A follow-up study published earlier this year suggests that, in addition to addressing access to care, policy initiatives must improve support for caregivers. Originally established as a result of lawsuits about institutionalized care in Massachusetts in the 1970’s, seven of the eight TDF clinics operate under a contractual partnership with the state’s Departments of Developmental Services and of Public Health. In recent years, the state’s share of the operational cost has decreased from 50% to 25%, requiring TDF to rely more heavily on revenue from Medicaid reimbursement. This has been a challenge because of flat Medicaid reimbursement rates, billing restrictions, and overall increases in overhead and cost of living expenditures. Approximately 95% of TDF’s patients are covered through MassHealth, the Massachusetts Medicaid program. An eighth clinic in the TDF network is run in partnership with the Seven Hills Foundation. The Tufts Dental Facilities clinics are a dental home to more than 7,000 current patients. The Gies Awards, named after dental education pioneer William J. Gies, Ph.D., honor individuals and organizations exemplifying dedication to the highest standards of vision, innovation, and achievement in dental education, research, and leadership. William Gies was a Columbia University biochemistry professor and founder of the College of Dental Medicine at Columbia University. The William J. Gies Foundation, created in 1950, was the first U.S. foundation to support dental education and scholarship. In 2002, the foundation joined with the American Dental Education Association (ADEA) to form ADEAGies Foundation, the presenter of the Gies Awards. As the voice of dental education, ADEA leads individuals and institutions of the dental education community to address contemporary issues influencing education, research and the delivery of oral health care for the improvement of public health. ADEA members — which include all U.S. and Canadian dental schools and many allied and advanced dental education programs, corporations, faculty, and students — engage in ADEA’s wide-range of research, advocacy, and faculty development activities. Information courtesy of Tufts University School of Dental Medicine.

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SKINNY

on the Street

The latest news on products and services for new dentists and their practices MiniCam HD

Practice SafeGuard

Los Angeles-based medical devices company L.A. Lens introduces a new technology that will revolutionize dental video communication. The MiniCam HD is a lightweight (0.56 ounces), loupe-mounted HD camera that attaches to dental loupes and headbands to provide users with hands-free video documentation and image capturing. The MiniCam HD software sets it apart from any other camera. This easy-to-use, intuitive software allows for easy recording, playback, and storage. The camera also allows for storage of your HD videos and images on its private cloud server. The cloud allows you to access your videos anytime, anywhere, with any smart device. For more information call (844) 332-8383 or visit www.la-lens.com.

Practice SafeGuard, a Henry Schein-certified vendor, is a confidential service for tech-savvy doctors: a simple software add-on that monitors the Dentrix G5 ledger to help you detect entry errors and prevent financial loss to mistakes or embezzlement. With Practice SafeGuard monitoring the Dentrix ledger 24/7, doctors and office managers get secure, worry-free financial oversight from anywhere – without running any reports. For more information visit www.PracticeSafeGuard.com/NewDentist.

PHOTO COURTESY OF LA LENS

PHOTO COURTESY OF PRACTICE SAFEGUARD

Butler® Prophyciency™ Disposable Prophy Angles Sunstar Americas, Inc. announces the new Butler® Prophyciency™ Prophy Angle with ButlerBloom™ Contouring Cup. The revolutionary new prophy angle has polishing and stain-removing agents incorporated right into the cup. This results in a more efficient cleaning and polishing process because no separate prophy paste is required. The patent-pending technology provides dental professionals with better visibility and virtually no splatter during the prophylaxis process because there is no prophy paste in the mouth. All of this leads to a more satisfying cleaning and polishing experience for the patient. Free samples are available. For information visit www.prophyciency.com.

PHOTO COURTESY OF SUNSTAR

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 The New Dentist™ Resources at www.thenewdentist.net to receive information from more than one company.

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