The New Dentist Summer 2018 by The New Dentist

THE #1 RESOURCE FOR NEW DENTISTS

DENTISTRY THAT ATTRACTS NEW PATIENTS

PLUS Top Accounting Tips Buying a Dental Practice Chairs and Stools SUMMER 2018

Wells Fargo Practice Finance

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Is your practice a winner? The 19th annual Dental Office Design Competition opens in June. • All newly built offices and offices with leasehold improvements or renovations completed between January 1, 2015, and December 31, 2017 are eligible to enter. • Award categories include Outstanding New Dentist Practice. For an entry form and complete Competition rules, call 1-800-326-0376 or visit dentalofficedesigncompetition.com.

FROM THE PUBLISHER’S DESK Dear Readers, Welcome to the Summer issue of The New Dentist™ magazine.

ou’re always looking for ways to improve your practice. You want to provide patients with the best experience possible, and to give them the results they’re after. As a young dentist, you’re hungry for guidance to help make those improvements—and who better to offer that guidance than your patients? Patient feedback is vital to practice growth. When you know what your patients are thinking, you can determine what areas of your practice are hitting the mark and what areas are not. Maybe some of your patients would be happier if your practice offered evening hours, or would appreciate shorter wait times when they come in for their appointment. The point is, you’ll probably never know if you don’t ask. To get this powerful feedback, I suggest you send patient surveys out after every recall visit and to patients who just finished a treatment plan. You’ll not only receive valuable information that will help you grow your practice, patients will see how much you care about their input and making their experience as positive as possible—which helps foster loyalty and might even lead to referrals. You can easily send out surveys via most patient communication systems. It’s also a good idea to ask patients to review your practice online. Positive reviews represent a great way to attract new patients. Potential new patients often spend time Googling before they call to make an appointment, and if you have positive reviews associated with your name, they’ll be more likely to make that appointment at your office. Remember, patient surveys and reviews aren’t the only way to get patient feedback. Some patients will happily tell you and your team members about problems they’ve experienced with your practice. While this can be annoying at times, always take these complaints seriously. Thank patients for sharing their concern and let them know you will address the issue. Listening to your patients can help you grow your young practice. When you take concerns seriously, seek out feedback and take action, your practice will flourish. In this issue… We’ve put together a variety of articles also designed to help your practice flourish. Turn to pages 14 and 19 for articles with advice on buying a practice, and page 6 to learn about the dentistry that can help you attract patients to your office. Dental accountant, Brent L. Saunier, shares his best tips on page 16, and two dentists outline how treating sleep issues helped them grow their practices on page 24. Find out how to choose the best chairs and stools on page 20, and read about how eAssist can help ease your insurance headaches on page 13. Finally, Dr. Jaimee’ Morgan offers advice on how to use whitening to grow your practice on page 30.

Advisory Board

Christopher Banks, DDS Inwood, WV WVU, 2011

Rebecca Berry, DMD Oakland, ME Tufts, 2011

Julie Boerger, DMD Patchogue, NY University of Montreal, 2010

David Carter, DMD Zachary, LA University of Mississippi Medical Center, 2014

Hal Cohen, DMD Haverford, PA Temple University, 2010

Larry Dougherty, DMD San Antonio, TX Nova Southeastern, 2008

Dennis Frazee, DDS Mooresville, IN Indiana University, 2012

Lindsay M. Goss, DMD, MPH Chandler, AZ ASDOH, 2010

Erica Haskett, DDS New York, NY NYU, 2008

Crystal Johnson, DDS Powder Springs, GA University of Tennessee College of Dentistry, 2009

Aaron Layton, DDS Fort Collins, CO Indiana University, 2010

Leah Massoud, DMD San Jose, CA Tufts, 2009

Michael Potter, DDS Quincy, WA University of Minnesota, 2014

Tyler Scott, DDS Loudonville, OH Ohio State, 2009

Matthew Silverstein, DMD, MPH West Hartford, CT University of Pittsburgh, 2012

Nicole Smith, DDS Newport Beach, CA NYU, 2009

Gregory Snevel, DDS Cleveland, OH Ohio State, 2011

Bryan Stimmler, DDS Brooklyn, NY University of Southern California School of Dentistry, 2009

Here to help,

Sally McKenzie, Publisher

2 THENEWDENTIST.NET S U M M E R 2 0 1 8

couch & crown new

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With CareCredit, patients donâ&#x20AC;&#x2122;t have to choose. When dental needs require an out-of-pocket investment, patients may think they have to choose family priorities or recommended treatment. Happily, you accept the CareCredit healthcare credit card, so patients can pay monthly and take advantage of promotional financing,* helping to make it easier for them to enjoy a new couch AND a new crown. Go to www.carecredit.com/adtoolkit to access FREE Online & Social Media assets to easily promote CareCredit on your website.

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*Subject to credit approval. NEWD0618DA

SUMMER 2018

TABLE OF CONTENTS

S U M M E R 2 018 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Picante Creative www.picantecreative.com EDITOR

Renee Knight renee@thenewdentist.net SALES AND MARKETING

Contact Melissa Rataiczak at melissa@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 Management Company, LLC (302 N. Chestnut St., Barnesville, OH 43713) on a controlled/complimentary basis to dentists in the first 10 years of practice in the United States. Single copies may be purchased for $8 U.S., $12 international (prepaid U.S. dollars only).

FE AT U R ES

What is eAssist Doing for New Dentists?

Dentistry that Attracts New Patients

Copyright ©2018 The McKenzie Management Company, LLC. 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 Management Company, LLC for libraries and other users registered with the Copyright Clearance Center.

Buying a Dental Practice? Top Tax and Financial Tips for New Dentists

Thinking of Acquiring an Existing Practice?

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 Management Company, LLC.

Finding the Right Stools 20 and Chairs for Your Practice Help Grow a New 24 Dental Practice Through Dental Sleep Medicine Dr. Jaimee’ Morgan on Bleaching as a Practice Builder

32 4 THENEWDENTIST.NET S U M M E R 2 0 1 8

DEPARTMENTS 2 Publisher’s Message 32 Skinny on the Street 32 Index of Advertisers

Contact Us — Questions, comments, and letters to the editor should be sent to renee@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.

FOR SOME ELITE SOLDIERS, THIS IS A TACTICAL ADVANTAGE. As a U.S. Army Reserve dentist and ofﬁcer on our health care team, you’ll work in advanced facilities, learn new procedures, treat a diverse patient base, and network with colleagues from across the country. You will go beyond the boundaries of your civilian practice, earning a second income and serving your country. Plus, you can train part-time, ready to serve when needed. To see the beneﬁts of being an Army dentist call 800-431-6712 or visit healthcare.goarmy.com/ha85

©20 018. Paid 01 d for o by the he Uni Uni nited nite nit d Sttates a at Army. Arm y. All right y right ig s reserv rre eserv served. ed ed.

By Renee Knight, Editor

Dentistry that

ATTRACTS New Patients Looking for ways to grow your practice? Here are ideas that can help. the many products that will help attract new patients to your practice and boost your productivity numbers. These products also can improve the overall experience, making first-time patients more likely to become loyal patients who accept treatment and refer.

ttracting new patients is something many dentists struggle with—no matter how many years they’ve been practicing. This can be especially difficult for new dentists, however, as they’re still trying to figure out the best services to offer and the best products to invest in—all while working to pay off their debt and learning the business side of running a practice. Investing in the right products will help you elevate the level of care you provide. That, in turn, will attract new patients to your practice, whether it’s through word-of-mouth referrals or targeted marketing campaigns. Patients are more educated about their dental options than ever before, so offering and promoting the services they both want and need will entice them to make that first appointment with your practice. Once patients are there, you and your team members can provide the exceptional care and service that will keep them coming back, so you can offer them comprehensive treatment while quickly growing your practice and your bottom line. “Part of doing dentistry is meeting the patient demand,” said Dr. Salvatore Lotardo, who is a member of the American Academy of Cosmetic Dentistry (AACD). “We also have an obligation to provide the services patients need. If we can’t get patients in the door by providing what they want, we will never have the opportunity to really treat the patient.” Whitening, clear aligners, lasers and implants are among

WHITENING Bleaching is one of the services Dr. Lotardo features in his external marketing campaigns to get patients through the door (clear aligner therapy is the other). Once he’s chairside with patients interested in whitening, he talks with them about other treatments that might benefit their smile or improve their overall health. Dr. Brian Baliwas, who is also a member of the AACD, uses whitening to attract patients to his office as well. He has a variety of solutions available, including Opalescence from Ultradent Products. He offers both in-office and take-home options, and as a young dentist, says it’s important to try many different brands. Doing so will help you determine which whitening systems best fit the needs of your patients and your practice. Dr. Marci S. Guthrie, on the other hand, has always used Ultradent whitening products in her practice. She offers both the in-office Opalescence custom trays and Opalescence Go, which are pre-filled trays patients can take home and dispose of when finished. Dr. Guthrie and her patients are happy with the results from both options, and the one patients choose usually depends on which fits best with their lifestyle. Whitening is an easy, affordable way for patients to get a brighter, more confident smile, Dr. Guthrie said. It doesn’t take a lot of time and is pretty conservative. It’s also easy to maintain once you get patients to the shade they’re after. “Everybody wants whiter teeth,” she said. “When I ask people what they want to change about their smile, the No. 1 comment is brighter, whiter teeth. It’s the most conservative treatment you can do to obtain a pretty smile.” CLEAR ALIGNERS Straightening teeth via clear aligners rather than traditional braces is attractive to many patients who want to improve their smile, and is among the treatments that prompt firsttime patients to make an appointment at your practice. CONTINUED ON PAGE 8 >>

6 THENEWDENTIST.NET S U M M E R 2 0 1 8

BRIGHT SMILE T O G O Part of the Opalescence family, Opalescence Go prefilled, disposable trays are a professional take-home whitening system. Offering a prescription-strength formula at an affordable price, Opalescence Go whitening is easier to use than over-the-counter products, and itâ&#x20AC;&#x2122;s available in three concentrations and three delicious flavors.

Before wearing UltraFit tray in the mouth

UltraFit tray after just 10 minutes in the mouth

Dentistry continued from page 6

PHOTO COURTESY OF BIOLASE

Dr. Melissa D. Shotell, DMD, MS, began offering ClearCorrect aligners in her practice about two years ago. She had used other systems in the past, but after seeing clinical research on the strength and effectiveness of ClearCorrect’s solution, she decided it was time to make the switch. Offering clear aligners has brought more patients to her practice, Dr. Shotell said, with many of the cases she treats the result of referrals from patients who were happy with their outcome. “New patients I see for aligners often mention a friend I treated was impressed with the results and advised them how comfortable the treatment was,” she said. “While I certainly do a fair amount of direct-to-consumer marketing via mailers, social media/internet marketing and traditional media advertisements, it’s amazing how effective “organic” marketing is.” ClearCorrect also offers flexibility and different pricing options, Dr. Shotell said. She can order replacement retainers at no additional cost for more difficult, long-term cases, and receives a discounted price when she needs aligners to treat minor relapse cases. This makes it possible to offer flexible, competitive pricing options to her patients, which also helps boost case acceptance. Dr. Lotardo uses Invisalign and, like whitening, said this service attracts patients who might need other treatment as well. He takes the opportunity to talk with patients about a comprehensive cosmetic treatment plan, as well as the importance of addressing any other issues discovered during that first appointment. And once patients are in the chair, he can use other products, like Smile Designer Pro smile design software, to help them see the benefits of accepting treatment. Smile design software gives patients a digital preview of what their smile will look like after recommended treatment is completed, helping to get them excited about the possibilities and encouraging them to move forward. For new dentists interested in learning how to offer cosmetic treatment such as clear aligners, Dr. Shotell suggests taking continuing education courses and seeking out mentors already providing the service. The companies also offer resources to help you get started and to answer questions along the way. ClearCorrect’s online resource, the “Doctor Help Center,” houses educational information to help guide doctors as they start offering clear aligners.

LASERS Dr. Lauren Anderson, a periodontist, began using BIOLASE’s Waterlase Express (ER/CR:YSGG) in 2017. After witnessing the favorable results and patient approval achieved with the

Waterlase, she decided to integrate the Epic X diode laser into her practice in 2018. She has successfully used both wavelengths in her practice to enhance traditional therapy, and is confident laser dentistry will become integral to the future of periodontal therapy. After vetting new technology through research validation and personal experience, Dr. Anderson strategically introduces technology that enables her to provide minimally invasive therapeutic treatment outcomes while maintaining patient comfort, function and esthetics. The way periodontal and peri-implant infections are currently managed requires modification to meet patient demands, she said, which means less resection of periodontal structures. With lasers, she’s able to marry traditional techniques with innovative applications that conservatively achieve the results she’s after—with less need for anesthetic, reduced bleeding and a better post-op experience—and that’s something patients appreciate. “I’m a practitioner who doesn’t market, but one who focuses on organically growing my practice through delivering the results patients are looking for,” she said. “With the integration of the Waterlase and now the Epic X, patients are relaying their experiences to their family and friends, who we are now seeing as well.” Dr. Baliwas also offers laser dentistry in his practice and said it’s a great alternative to using a scalpel. It promotes better healing and is useful in a variety of applications, allowing him to take on cases he would otherwise have to refer out. He uses the Picasso from AMD Lasers and said it’s a great, affordable option for new dentists, like him, who might not have a lot of money to invest in all the technologies that help build a practice. “It’s an awesome laser,” Dr. Baliwas said. “It looks sleek and when it comes to performance you have the top cosmetic guys using this exact laser. It’s nice to see some of this technology isn’t necessarily out of reach.” There are also lasers that allow dentists to cut teeth and remove decay, Dr. Baliwas said, which helps get people who are fearful of drills and other traditional dental tools in the door. These procedures can be performed without the need to deliver anesthetic, which is very attractive to patients who prefer to avoid needles at all costs.

DENTAL IMPLANTS Implants also have become popular in recent years, with many patients looking for general dentists who offer this service in-house. They’d prefer to have their GP perform the procedure rather than going to a specialist they don’t know. That means if you opt to implement implant dentistry, it can be a real practice builder. CONTINUED ON PAGE 10 >>

8 THENEWDENTIST.NET S U M M E R 2 0 1 8

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Dentistry continued from page 8 Dr. Lotardo offers All-on-4 dental implants to his patients, which has really captured their attention. More and more patients know about this technique and even ask for it by name. Many like the idea of using four implants to support their new smile instead of six, seven or eight. Mini dental implants represent another option, and are more affordable for patients than traditional dental implants, said Dr. Todd Shatkin, founder and head lecturer of Shatkin First. They provide a great way to attract patients who are interested in implant dentistry but don’t think they can afford it, or who don’t want to wait for the implants to be placed and restored. Dr. Shatkin’s mini implants typically can be placed and restored the same day, without the need for bone grafting or long healing periods. “We can stabilize loose dentures in about an hour, so a patient who has had a loose, ill-fitting denture for years can come in and in less than an hour leave with a stable, comfortable denture. They can go out and eat a meal that evening,” he said. “If they’re missing one tooth or multiple teeth, we can have them replaced in one or two short visits.”

MARKETING While you’ll likely get plenty of referrals from happy patients when you offer the products your patients want most, you’ll get the best results if you also let people know what services you offer through targeted marketing. Dr. Guthrie, for example, promotes whitening via her website. She offers discounts during certain holidays and also makes it possible for people to buy gift certificates. Dr. Lotardo turns to dental marketing specialists to promote his practices. “Many of these companies have their niches, so it’s a matter of marrying

the right company with your practice type,” he said. “You have to investigate to see what services they offer and how they fit into the type of practice you’re trying to create. If you have an insurance-driven practice you need a different type of marketing company than if you have a high-end cosmetic practice.” Often, the companies behind the products you invest in will help you market as well. Shatkin First, for example, has a marketing team that educates consumers about mini dental implants and their benefits. They work with dentists to record 30-minute infomercials they can air in their community, as well as help them put together TV, radio, print and direct mail promotions. Dr. Shatkin recommends educating existing patients about your services as well; these are the patients who already entrust you with their care, after all. Send an email to existing denture patients to invite them in for a free cleaning and consult to determine if they’re candidates for mini implant supported dentures, for example.

DIGITAL PHOTOGRAPHY AND SOCIAL MEDIA For Dr. Lotardo, digital photography is one of the most important aspects of anything he does in his practice. He takes before and after photos and uses them to show how he’s helped patients with similar conditions, improving case acceptance. That’s a great benefit, but digital photography can actually help attract patients as well. Dr. Baliwas posts before and after photos along with images of successful cases to his various social media accounts, which he said has been

COMMUNITY INVOLVEMENT Becoming an active member of your community also will help attract patients to your practice, said Dr. Marci S. Guthrie. Dr. Guthrie and her team sponsor the local elementary school 5K, for example, and give away toothbrushes and talk about good oral health during the event.

10 THENEWDENTIST.NET S U M M E R 2 0 1 8

instrumental in getting new patients to schedule appointments. Of course, for this to be successful, you have to know how to properly capture the images. Dr. Baliwas has taken classes to learn how to use his DSLR camera to its maximum potential, enabling him to show patients what their smile looks like today, and then altering the images in Photoshop to show them what their smile will look like once recommended treatment is complete. Patients accept more treatment because of it, and when he posts the images to social media, other patients want to know how they can get the same results. “In the past week, I posted highres photos of my work as well as artistic photography and I’ve had follow up from people who have said ‘I want that kind of work in my mouth,’” he said. “You can do the best veneer work in the world, but if you don’t take the right photos and portray it in a way that makes people say ‘wow, that’s awesome work,’ it’s not doing you any good.” Beyond posting photos of his cases, Dr. Baliwas also uses social media to connect with patients and show them his personality. He talks about his interests outside of the office and shows his sense of humor. New patients feel like they know him before their first visit, and are more comfortable with him because of it. Dr. Baliwas mostly posts on Instagram, but also uses Facebook, Snapchat and basically anything digital that allows him to have a profile. While there are companies that can help you create and manage your social media presence, Dr. Baliwas chooses to handle his on his own. If you’re thinking of doing the same, it’s important to remember social media isn’t the place to post whitening specials or two-for-one deals. Use it to convey your personality and make patients want to schedule an appointment with your practice. To figure out what to post, ask yourself what patients want to know about you and your practice that isn’t already on your website. While Dr. Baliwas posts just about every day, he said three or four times a week is enough to make an impact. CONTINUED ON PAGE 12 >>

OTHER SHATKIN FIRST PRODUCTS

Dentistry continued from page 10 OTHER TECHNOLOGIES THAT HELP ATTRACT PATIENTS There are also more expensive technologies that help attract patients, including CAD/CAM systems that make same-day dentistry possible and intraoral scanners that provide digital impressions and eliminate the need for impression materials. While you might not be able to purchase these types of technologies now, they certainly can help serve as practice builders down the road. Keep up-to-date on the latest advancements, take CE courses and learn from other dentists already using these systems. You’ll be more prepared when you are ready to invest in the technology.

LISTEN TO YOUR PATIENTS Often, patients come in wanting to whiten their smile or straighten their teeth, but they have bigger problems that need addressed first. Let them

know about the problems you’ve identified, but don’t ignore the fact they still want to fix a specific issue, Dr. Lotardo said. If you start leading patients down a different path, they’ll feel like you’re not listening to them. “It’s a balancing act,” he said. “You have to address what the patient came in for. Let them know you understand they want to whiten their teeth, but that certain other things need to get done before that’s an option. If you skip over their chief complaint, they’ll get the feeling you only want to do what you want to do. You’re going to lose a lot of patients that way.” OFFERING TOP NOTCH CARE No matter what products you choose to invest in, providing the best care

Shatkin First offers Krystal Klear aligners, iSmile whitening and a system that’s designed to help patients with sleep apnea. The company also offers seminars all over the world to help dentists learn how to place and restore dental implants, said Dr. Shatkin, who is a graduate of the University of the Pacific School of Dentistry. Shatkin First supplies the instruments dentists need, the mini implants, the lab work that goes on top of the implants, including dentures, crowns and bridges, and surgical guide stents to help ensure the mini implants are placed in the proper position.

possible will prompt current patients to not only stay loyal but also to refer— helping to bring in new patients to your practice. Investing in the right products also will help get patients in the chair, but remember it’s the overall patient experience and the way they feel when they leave your practice that will keep them coming back, accepting treatment you recommend and referring your office to family and friends.

FREE Online Dental CE Earn live interactive and self-study credits from the comfort of your home or office • ADA CERP Provider • World-respected Speakers • Instant CE Certification

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What Does eAssist do for New Dentists? By James V. Anderson, DMD CEO and founder of eAssist Dental Solutions

ne of the best ways to answer that question is to listen to and observe what new dentists face when starting up a new practice. As an example, here’s a common new dentist frustration described in a dentaltown.com post: “I am a 6-month practice owner here. Took over a small practice. We run very lean and mean; 1 registered hygienist, 1 assistant, and 1 front desk. I do payroll, marketing, team meeting, ordering, paying bills, dealing with parts/vendors, occasionally check for collection/production, etc. I feel like I’m always running behind. I have charts piling up to write clinical notes and sign. I barely have time to catch up on emails and deal with vendors, service providers, etc. When I go home, I’m completely knocked out mentally and physically. It is impossible to open my laptop and get more work done. I’d like to find out if there’s better ways to do things. The stress is real.” The stress is real but so are the solutions. There are better ways to manage your practice. As the CEO, delegating to employees and/or outsourcing to remote contract workers is always an alternative to doing it all yourself. Delegating to existing staff can be fraught with errors and inconsistences as the experience and skill necessary to do jobs such as payroll, bill paying, insurance filing and understanding collection and production numbers are often limited or null.

The benefits of outsourcing eAssist can be a solid solution. Billing agents work remotely, making sure insurance claims go out correctly and are appealed on a timely basis, and that insurance payments are posted correctly and ledgers balanced. Workers monitor collections and production but never touch your money. This improves the cash flow that’s so necessary to a new practice’s survival. Unlike in-house employees, we are never absent from our job. Accounting and bookkeeping services provide timely information and accountability dentists may not find with an inexperienced employee, relative or other bookkeeping service. As a dentist who has “walked the walk” of the new dentist, I am sensitive to revenue constraints. Many outsourced billing services charge about 7% of collections. eAssist is affordable with a flat rate for small practices and a range from 3.5% to 2.5% of collections for larger practices. The percentage drops as the practice grows in collections. Our fees are transparent and are listed on the website dentalbilling.com. Startup challenges Lean times are real for anyone starting a new business. Dental

practices usually have a large startup price tag. One of the biggest challenges, building a reputation of excellence in dentistry, can sometimes be left on the back burner, with the pressure to pay bills putting the emphasis on “selling dentistry.” Staffing is the most challenging startup task. Being able to afford a front office business manager with experience, especially one with experience working with your dental software, can cost an average of $20-$26 an hour plus benefits. Many dentists hire spouses, other relatives or someone without much experience to “grow” with the practice. Instead of hiring another person when you don’t have enough work for eight hours a day and compound that with payroll taxes and benefits, outsource to a professional billing company for lower costs and less drama.

Why eAssist eAssist is the largest national dental billing company in the U.S. We contract with more than 350 professional billing agents. Our people come from all 50 states, and we have the choice of the best people in the field. Before being assigned to work in one of our client offices, the billing agent must pass, with an 86%, an application process that includes a background check, a personal interview and skill testing modules in customer service, claims coding, claims filing, claims follow-up, claims appeal, narrative writing and dental software proficiency. We offer many services critical to practice success such as:

• •

Dental and medical insurance billing/follow-up and appeals Insurance payment posting and balancing accounts with the EOBs • Managing the EOBs for future reference • Accounting and bookkeeping services/payroll • Insurance verification • Fee updating services • Patient portion billing, calling and collecting monies/ ledger audits • Providing daily, weekly, monthly production and collection reports Patients should receive 100% of your attention while in the office. Outsourcing your important dental business tasks to professionals, such as eAssist, prevents valuable time being taken from your patients.

James V. Anderson, DMD, is a practicing dentist in Syracuse, Utah, and is the CEO/Founder of eAssist Dental Solutions, the largest national dental insurance billing company (dentalbilling.com) in the U.S. After building nine successful practices, Dr. Anderson understands the challenges facing today’s dental teams. Since 2009 he has provided proven solutions to dental/medical insurance billing, patient portion billing, accounting for dentists and related services for management of accounts receivables. He can be reached at james.anderson@eassist.me SUMMER 201 8

THENEWDENTIST.NET

By Matthew Christie VP and Regional Sales Manager Bank of America Practice Solutions Division

BUYING A DENTAL PRACTICE? Avoid these five pitfalls to ensure a successful purchase and transition.

s a lender who specializes in the dental industry, I have worked with hundreds of buyers on transition into practice ownership. The vast majority of these have gone extremely well, but there have been a few where things did not go exactly as planned. Based on those experiences, I’ve identified five common pitfalls that caused problems and unnecessary stress. Avoiding them can ease the way for prospective practice owners.

PITFALL NO. 1: CREDIT REPORT SURPRISES. Before you apply for a loan, it’s imperative to understand what your credit file says about you. Clients often say they have “A+” credit without knowing what that actually means. There is more to your credit score than on-time payment history, such as length of credit history, use of existing credit and how often you apply for credit. Historically, most dentists have extremely good credit, with many approaching 800. FICO scores may range from 300 to 850. The national average for consumers was 699 as of April 20161. Dentists move frequently in their young adult lives. Through all of the moves, you may miss a small bill, and it could turn into a delinquency. Small creditors may not be as diligent at collections as a credit card or bank, and may simply put a charge off on the credit report. Many times, the doctor is not aware this negative mark exists on his or her credit bureau 14 THENEWDENTIST.NET S U M M E R 2 0 1 8

report until it is uncovered during the underwriting process. However, a debt like this can usually be resolved by paying the outstanding amount prior to the bank funding your loan. To avoid situations like this, I recommend you do two things before you purchase a practice. First, take some time to review myfico.com, where you can learn more about how scores are derived. Having a general understanding will not only make you a better consumer, it may benefit you financially. On a side note, many insurers review credit reports and use credit scores as part of their algorithm to determine your premiums. Next, you should obtain a free copy of the three major credit reports, which you can do at annualcreditreport.com. As a consumer, you are entitled to reports from all three major credit bureaus (Equifax, Experian and Transunion) once a year. Each reporting agency charges a nominal fee to obtain your FICO score. It’s also worth noting this is considered a “soft” credit inquiry and doesn’t result in a reduction of your score.

PITFALL NO. 2: INADEQUATE CASH RESERVES. Today, most banks will finance 100% of the money you need to purchase a practice. The money banks will lend includes working capital, which should be an adequate amount to cover the practice’s day-to-day operations. Often, first-time practice owners run into trouble when there are additional expenses above and beyond standard operating costs. Inevitably, something happens when you least expect it – and when it is most inconvenient. Your car will break down,

your cat will need to go to the vet, an air conditioning unit will break or the roof will start to leak. None of these circumstances are covered by the bank’s working capital funds, so it’s important to have a “rainy-day” fund for life’s unexpected events. Having personal cash reserves will prevent you from relying on credit cards.

PITFALL NO. 3: UNKNOWN PRODUCTION ABILITIES. The size of the practice you purchase should be a reflection of your personal ability to produce and manage. Unfortunately, some dentists purchase practices that don’t match their abilities; the practice may be too large or too small, which leads to an uncomfortable situation for the new owner. I have probably seen more incidents where doctors wished they’d purchased a larger practice rather than a smaller one that they hoped to grow over time. Understanding your production will put you in a much better position. My recommendation is to track your production abilities as you work as an associate. The software some offices use can do this for you, while others require you to manually keep track of the amount and type of dentistry you are doing. Asking your employer for a copy of your production reports may alert them to your intention of owning your own practice, so use discretion.

PITFALL NO. 4: NOT HAVING INDUSTRYSPECIFIC REPRESENTATIVES. Too many dentists try to cut costs by having a family friend or relative work on the transaction—with poor results. I recommend hiring professionals who truly understand the business of dentistry, such as a dental-specific Certified Public Accountant and an attorney who specializes in the dental industry. Your dental CPA will understand if your costs are in line with industry averages and where you can cut expenses. A specialist attorney will understand the clauses in the purchase contract and lease. Items pertaining to retreatment/rework, work in progress, patient records and staff transfer should only be drafted by someone with expertise in your vocation. Case in point: I had a dentist who had a family friend and licensed attorney form the dentist’s LLC. Unfortunately, LLCs were not permissible in the dentist’s state. This caused undue headaches, as the dentist needed to re-file as an S-Corp. While this may not seem like a big deal, it did cost the dentist valuable time and money. This is just one example of where a dedicated team of experts may help guide you through these important issues. CONTINUED ON PAGE 27 >>

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THENEWDENTIST.NET

TAX AND TOP FINANCIAL TIPS for New Dentists By Brent L. Saunier, CPA

Advice from a dental CPA.

ost dentists don’t know much about taxes and the financial considerations that come with buying and operating a new practice. They prefer to focus on the clinical side and hope the rest just falls into place. Unfortunately, taking that approach usually leads to problems. While it can be overwhelming, it’s important to understand this side of practice ownership. I’ve put together my best tax and financial tips to help you avoid the most common pitfalls dentists encounter when buying a practice.

You can research the salary in your area on salary.com by searching for “dentist” and entering your practice zip code. Keep in mind the owner only makes money if the business is profitable after paying all expenses, including the doctor’s salary. This is taken via distributions. Distributions are the owner’s reward for running a profitable business. So, at minimum, the first $120,000 in income made by the owner-dentist should be run through salary (payroll), and any additional income can potentially be taken as distributions. If you make less total income than $120,000, you probably shouldn’t take distributions yet. The same is true if your bottom line Net Income is not a profit.

1. Decide on the proper tax entity to file your

3. Follow the 40% Tax Rule.

business as. There are three different types to consider: Sole Proprietor (Schedule C). This is appropriate for startup practices with unexpected (low) income. If you go this route, you should have a plan to convert to a corporation in the future. LLC/Partnership (Form 1065). This is appropriate for startup practices and partnerships. You must file with your secretary of state and obtain a business EIN to file as an LLC/Partnership. S-Corporation (Form 1120S). This is today’s most advantageous entity type. When you become an S-Corp, I suggest you separate your compensation into wage/salary and distributions to save on self-employment taxes.

2. Understand the difference between how the

doctor gets paid and how the owner gets paid (assuming you are an S-Corp): The doctor is an employee of the business and should be paid a “fair and reasonable wage/salary” per the IRS rules. The cost of a dentist nation-wide ranges from $120,000 to $180,000. 16 THENEWDENTIST.NET S U M M E R 2 0 1 8

A great rule-of-thumb to follow to keep yourself out of trouble and avoid those tax burden surprises is to always subtract 40% of what you take home into a Tax Account. This primarily comes into play on distributions. A payroll company will help you properly withhold taxes on a payroll salary/wage check. Distributions require your personal discipline. Here’s an example. If you want to distribute $10,000 out of the business, set aside $4,000 into the Tax Account and take the remaining $6,000 home as after-tax income to spend or save. Never, never, never take pre-tax dollars home! They will get spent. If you follow this rule, when it comes time to pay quarterly estimated taxes or year-end taxes, you will have the money to do it! And when other deductions get applied, you will likely get to keep some of this money instead of sending it to the tax-man.

4. Choose a reputable, service-oriented payroll

company. Be careful when going with a cheap, small-shop operation. Payroll taxes are nothing to fool with! CONTINUED ON PAGE 18 >>

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Tax and Financial Tips continued from page 16 Payroll information needs to be easily communicated to your bookkeeper, accountant and tax advisor. Outsourcing to a third party payroll company transfers a lot of risk off you and onto them. I would suggest going with a big, well-known company such as ADP or Paychex.

5. Choose a qualified bookkeeper with

accounting education. Many doctors, especially when starting out in a smaller collections practice, attempt to do their own bookkeeping to save a few bucks. After all, how difficult can it be to enter transactions into software like QuickBooks? It’s also common for the clinician’s spouse to pick up this task and watch over the financial side of the business while the doctor oversees the clinical side. The problem? What often gets produced is no more than a glorified electronic check register that does not adhere to the principles of accounting that have a direct impact on your taxable outcome. This can create significant problems in the practice financial records, which must be corrected by a professional with an accounting degree and background. Ultimately, the bookkeeping work is in preparation for a tax return to be created. If your bookkeeping data is inaccurate all along the way, you may either get an inaccurate tax return or be delayed in filing until the records are corrected according to accounting principles. Not only can fixing accounting errors cost you money with the accountant, all that time the doctor or spouse spent incorrectly entering data was for naught. You have to ask yourself, what is your time worth? What is your doctor production per hour? Is your time better spent seeing patients and generating revenue, or doing historical data entry that may be inaccurate and not helpful? Here are a few questions to ask when choosing your bookkeeper: • What is the education level and background of this person that qualifies him/her to handle your organization’s financial records? • Does he or she have an accounting degree or background in principles of accounting to properly record your transaction, or will you be paying twice to have this work done by your employee and again by a professional accountant?

6. Don’t run EVERYTHING through the practice. Contrary to popular blanket tax advice, just because you now own a business does not mean you can let it pay EVERYTHING for you. For example, in my personal experience with an IRS auditor, the question was asked, “What does a car have to do with dentistry?” You can’t deduct driving from your home to your office. If it is not fully wrapped, it can’t be deducted for marketing. If you don’t have multiple

office locations to travel between, or you’re not a travelling dentist making house calls, it’s not deductible. Just because the real estate agent gets to do it doesn’t mean you can. Another auditor asked to see Costco receipts from a general practice (GP) dentist. Upon review he asked, “What do diapers have to do with dentistry?” Now, this was no huge amount to overturn, but the auditor used it as an opportunity to say, “Oh, so you did that…let’s see what else you’re doing.” And he hung around for three months, creating an auditing nightmare for the dentist. Ultimately, you shouldn’t try to drive your bottom line Net Income to zero or negative for a loss just to avoid paying taxes. You should want to increase profitability and margin to ultimately increase the valuation of your practice!

7. Avoid comingling expenses. Have separate credit cards to use for business and personal expenses. Avoid putting both on the same card. If it’s business, swipe the business card. If it’s personal, swipe the personal card.

8. Learn what your practice’s Tax Basis is. This is a very complex tax topic. Make it a priority to get educated on it by your CPA so you can position yourself to benefit from the tax deductions available.

9. Take advantage of Section 179 accelerated

depreciation deduction on equipment. At the time of this article, you can deduct up to $1 million per year in equipment purchased. This does not mean you should just purchase equipment you don’t need for a tax deduction. Only buy it if needed and if it can create a return on investment for you in the practice. Make sure you have enough Tax Basis to take full advantage of this.

10. Be strategic with pre-paid expenses at

year-end. You can accelerate some deductible expenses by pre-paying them before December 31 each year. For example, did you know you can legally pre-pay up to 10 months of rent before December 31 and deduct it in this calendar year? You can prepay, or open a “prepaid tab” as I like to say, with your lab and supply vendors for next year, and you get to expense it this year. Remember, amounts charged on credit cards on or before December 31 get counted as this year’s deductible business CONTINUED ON PAGE 26 >>

18 THENEWDENTIST.NET S U M M E R 2 0 1 8

Thinking of Acquiring an Existing Practice? Follow these tips to successfully integrate your philosophy and vision so you can quickly reach your full potential.

uying your first practice certainly can be an exciting time. You likely have plenty of ideas and a clear picture of where you’d like the practice to go. That’s great, but you also need a plan to help you get there. When you buy an existing practice, it comes with established employees, systems and protocols. For a successful transition, you need to find a way to integrate your philosophy and vision into the practice, which can get tricky. Here are a few tips designed to make this transition as smooth as possible. Hire a consultant. Partnering with a dental consultant is one of the first steps you should take when you decide to buy an existing practice. The consultant should work with you to develop a customized business/action plan to put your practice on the right track, teach you how to be an effective leader, and support you throughout your first year. Be prepared to take on more than dentistry. While offering patients top-notch care is an important part of a successful dental practice, you have to focus on more than just the clinical if you want your practice to meet its full potential. Be prepared to wear many hats, including practice CEO, HR manager, financial wizard, marketing director and IT specialist. Get the existing staff on board. This can be challenging but is vital when taking over a practice. It’s important to remember that no matter how excited you are to be the practice owner, current employees might be leery of working for a new boss and worried about the future. As you make the transition and start implementing your vision and practice philosophy, get team members involved. Show them you want to earn their respect, and let them know you’re interested in hearing their ideas for practice improvements. Keep the lines of communication open and create an environment where employees feel comfortable sharing concerns as well as ideas they have to help the practice thrive. Make sure team members know you value their opinions and the contributions they make to practice success. Provide team training. Once the practice purchase is complete, I suggest you provide team members with whatever training they need to properly implement the customized business and strategic action plan you developed. This will help ensure everyone is on the same page and ready to help move

By Sally McKenzie, CEO of McKenzie Management

the practice forward. I also recommend developing detailed job descriptions and offering employees continual feedback. Evaluate practice systems. Work with your consultant to identify all the practice’s strengths and weaknesses as well as opportunities for growth. Create a targeted marketing plan. As the new owner, you’ll need to market yourself and your brand in the community. This includes brochures, updating the practice website, placing local ads and offering patients an excellent experience. For best results, you’ll need to determine your niche and understand your demographics. Look at fees and payment policies. See how your fees compare to other practices in the area and make adjustments if necessary. Determine a fee structure that is fair to both you and your patients, and communicate any changes you make. It’s also important to develop a financial policy that makes it clear when payment is expected for services rendered. This will help with practice cash flow and reduce the amount of time team members spend chasing down past due payments. Manage overhead. You don’t want your overhead expenses to get out of control, which is a common problem many dentists face. It’s important for you to understand how to measure overhead in your practice and how to manage business details such as payroll and accounts payable, as well as how to read and understand profit and loss statements. Streamline your schedule. Your Scheduling Coordinator should be scheduling your days to keep you productive, not busy. Sit down with team members to determine daily production goals based on the type of lifestyle you want to lead and how much you want to work. Then make sure you’re scheduled to meet those goals each day. You’ll also want to come up with a plan to reduce the number of broken appointments you deal with each day, and ways to quickly fill cancellations when they come up.

YOU DON’T HAVE TO DO THIS ALONE. While these tips will help get you started, there’s so much more you need to be prepared for when you purchase an existing practice. Finding an experienced consultant to partner with will help you address these and many other issues. If you’re ready to get started, feel free to contact McKenzie Management at 877-777-6151 or at sallymck@mckenziemgmt.com. SUMMER 201 8

THENEWDENTIST.NET

Finding the Right Stools and Chairs for Your Practice Comfort is key when making these investments.

hen Dr. Larry Dougherty first invested in stools for his practice in 2011, price was his No. 1 concern. He knew he wanted to purchase the stools from a reputable manufacturer but, as a new dentist, he also wanted to save as much money as possible. He used the stools for a few years and then decided it was time for an upgrade. After a sales rep convinced him to try a higher-end option for a week, Dr. Dougherty realized just how uncomfortable his models actually were. Now, comfort is Dr. Dougherty’s No.1 concern when it comes to the stools he sits in every day. PHOTO COURTESY OF “I didn’t think it mattered at the beginASI MEDICAL ning because I was trying to save money,” said Dr. Dougherty, who is a member of The New Dentist™ magazine Advisory Board. “I didn’t realize how important it was to sit in a comfortable stool. It’s a corner you really can’t cut.” So what exactly should you look for when you invest in a stool, as well as patient chairs? We talked to John W. McPeek, President of ASI Medical, who, along with Dr. Dougherty, offers advice on how new dentists can find the most comfortable stools possible.

KEY FEATURES TO LOOK FOR There are a variety of stools on the market with different price points, so it can be difficult to determine what will work best. You have to be ergonomically supported. Look for a stool that has a seat tilt function that allows operators to sit slightly higher than the patient. This opens up the angle of how your eyes are positioned so you’re not sitting perpendicular; it’s better to have your eyes slopping slightly downward. You also need good lumbar support. The shape is important, McPeek said, and it shouldn’t be horizontally curved around the back. It should be a vertical curve that’s adjustable so operators can find the right positon to properly support

their back. The stool you invest in also should have high-quality dense foam or memory foam that adjusts to the operator and quality upholstery so it lasts. ASI’s Momentum stools are designed to offer stability during magnification. They feature a wellpositioned arm rest that supports the forearms and elbows so they’re stable when you’re working with magnification such as loupes and microscopes. Remember, there isn’t one stool that fits every person’s height and stature. A chair that’s comfortable for a smaller person won’t work for a larger dentist. Find a stool that’s appropriate for your size. “To prolong operator efficiency and effectiveness and how long they can continue to be a dentist, they have to make sure they’re working ergonomically,” McPeek said. “A quality stool is one of the best investments they can make.” Dr. Dougherty agrees and said he won’t work on a patient unless he’s comfortable. He wants his stool to support his back and for the cushion to adapt to the contours of his body. “When I was in my 20s I didn’t care as much about comfort. I would just sit down and how I was sitting was how I was sitting,” he said. “The more you work and the more time that goes by, you realize how important comfort really is. I’m not going to sacrifice my body. I want to do this for a while, and I don’t want to be uncomfortable.”

COMMON MISCONCEPTIONS Many dentists McPeek talks with are most concerned about price. They don’t think there’s much difference between the lower-end stools and the higher-end stools, but there really is. Another common problem is dentists don’t know how to properly sit on the stool. McPeek and his team spend time showing clinicians how they should be sitting—which CONTINUED ON PAGE 22 >>

20 THENEWDENTIST.NET S U M M E R 2 0 1 8

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Stools and Chairs continued from page 20 makes a big difference in their comfort level. The most common mistake dentists make is sitting on the edge of the stool, when they should be sitting further back so they’re properly supported. “We tell them to put their fingers between the front of the chair and the back of their calf so they’re sitting in a fully upright position, and then adjust the chair from there,” he said. “Too many dentists sit leaning out of the chair, so they’re not being supported. They’re trying to hunch over to see the oral cavity instead of sitting upright in a good ergonomic position.” Dentists tend to be pretty focused when they’re starting a procedure and often don’t realize they’re not sitting correctly, which could lead to pain and muscle fatigue later. McPeek suggests taking 10 seconds to observe your positioning before you begin treating a patient, and to make the necessary adjustments so you’re as relaxed and comfortable as possible.

CHOOSING THE RIGHT STOOL ASI is putting together an online guide to help dentists find the best stool based on their stature. While consulting such a guide is helpful, McPeek said the best thing to do is visit the manufacturer’s show room and actually sit in different stools before you decide what you’re going to buy. While some dentists might think they can find a stool at a tradeshow, Dr. Dougherty said testing out a stool for 30 seconds or so isn’t enough to tell if it’s right for you. You really have to spend time practicing in it. He suggests asking manufacturers to let you borrow a chair for a week. By the end of those seven days, you’ll know if the stool is for you or if you need to keep looking. Dr. Dougherty also said it’s a good idea to have a few different stool styles in your office so you’re not always sitting in the exact same way. Investing in high-quality chairs for your office and front desk is important to Dr. Dougherty as well. He spends a lot of time at his desk, going over notes and managing the practice, and sitting in an uncomfortable chair that was purchased at an office supply store just isn’t going to cut it.

PHOTO COURTESY OF ASI MEDICAL

22 THENEWDENTIST.NET S U M M E R 2 0 1 8

PATIENT CHAIRS ASI introduced a new line of patient chairs at the end of April. The chairs are designed not only for traditional dental care, but for specialty procedures such as implant dentistry. The chairs have a swivel feature, McPeek said, that enables them to move with patients from left to right. This makes it possible to reach patients without having to move around. It’s suited for right or left handed use, making it easy to position wherever you’d like in the room. The backrest is one of the most critical components of a patient chair, McPeek said. It should properly support the patient, but also be thin enough so both the doctor and the assistant can get as close to the patient as necessary. Operators should be able to work ergonomically, and positon patients for different procedures without worrying about running into protruding knobs as they work. “With some of the lower-end chairs, there’s usually too much distance between you and the patient’s head because the headrest is too thick,” Dr. Dougherty said. “A quality chair has a small amount of distance between the base and the patient’s head so you can get close enough without having to raise your arms up or crush your knees.” The new ASI chairs feature a third motor for advanced procedures. This motor allows the chair to tilt, which is useful when placing prosthetics and for implant procedures. The seat tilt is also beneficial for the operator’s ergonomics. “It’s good to change your position throughout the day,” McPeek said. “You might want to do a procedure standing up instead of sitting, for example. This gives muscles relief from being in the same position. A good chair has a height range so you can do dentistry seated as well as standing up.” Like with stools, many dentists think all patient chairs are the same, but that isn’t the case, McPeek said. Dentists try to adjust to the chair rather than finding one that adjusts to them as well as the patient. Find a chair that makes it easy for you to practice comfortably. IT ALL COMES DOWN TO COMFORT You spend a lot of time seated during the day, which is why it’s so important to invest in high-quality patient chairs and stools. If you don’t have the proper support from your stool while you’re working, it won’t be long before you start experiencing back pain and muscle fatigue. Investing in quality stools now will help ensure you can keep practicing for many years into the future. “I can’t sit in a bad chair,” Dr. Dougherty said. “Obviously, as a new doctor out of school you have to decide where you’re going to spend your money. We get excited about intraoral scanners and expensive equipment, but having good seating should be right up there. If I’m not sitting in the right seat, my back starts hurting and I’m not happy. It’s an important investment for sure.”

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Dental Sleep Medicine By Dr. Nancy Addy, DDS, AADSM President

Establishing a dental practice can be challenging, taking five to 10 years to build up and gain a solid patient base. There is a growing need for dental sleep medicine (DSM) practitioners and, for those who commit to it, providing this service can accelerate this timeline, unlocking opportunities for new patients and creating partnerships with our medical colleagues. Physicians and patients nationwide are seeking more qualified dentists to provide oral appliance therapy (OAT) â&#x20AC;&#x201C; making now the opportune time to enter the field.

OBSTRUCTIVE SLEEP APNEA (OSA) AND DENTAL SLEEP MEDICINE If left untreated, OSA can increase the risk for health problems such as heart disease and diabetes. Nearly 30 million adults suffer from OSA. It is estimated that almost 80% of adults with OSA are undiagnosed, and up to 50% of patients diagnosed with OSA and treated with CPAP therapy do not have good compliance.

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24 THENEWDENTIST.NET S U M M E R 2 0 1 8

OAT is an effective alternative to CPAP. Once a patient is diagnosed with OSA and prescribed OAT by a physician, a qualified dentist can provide treatment. OAT uses a custom-fit mandibular advancement device to maintain an open airway during sleep. There are currently more than 100 FDA-cleared oral appliances, which are often covered by insurance companies. Two new dentists, Dr. Jason Hui, DDS, of McKinney, Texas, and Dr. Laura Dyras, DDS, of Lansing, Mich, recognized the growing demand for DSM practitioners and decided to offer OAT. Both are already seeing the benefits of their decision. While at different stages in their business expansion, they offer great insights into what it takes to achieve success in DSM.

BUILDING A SUCCESSFUL DENTAL SLEEP MEDICINE PRACTICE Dr. Jason Hui made the move to DSM after learning about the connection between OSA and several of his patientsâ&#x20AC;&#x2122; bruxism and health issues. Dr. Hui noticed there were no in-network DSM practitioners in the area. He also realized the costs to start a DSM practice

SLEEP APNEA

“For those interested in DSM, education and an extensive referral network are important and will position you to better serve your patients.” —Dr. Laura Dyras

are relatively low. His biggest challenge was getting patients through the door, as Dr. Hui found DSM is a referral-based practice. As a result, he focused first on building relationships with physicians who could refer OSA patients to his practice. “Many people don’t even know they have sleep apnea and, consequently, they don’t understand the root of their snoring or health problems – making physician referrals so important,” Dr. Hui said. The best way to start referral relationships with physicians is to set up face-to-face meetings, Dr. Hui said. However, physicians are busy. It all comes down to making calls and consistently communicating. The key to strengthening your network is demonstrating you are willing to collaborate with our medical colleagues and that you care about the patients. Five years later, Dr. Hui has established a second practice dedicated to DSM. In addition to developing a reliable physician network, continuing education (CE) has played a key role in his success. Dr. Hui is currently in the process of becoming a Diplomate of the American Board of Dental Sleep Medicine – the gold standard in the field of DSM.

GETTING STARTED IN DENTAL SLEEP MEDICINE Dr. Laura Dyras recently decided to integrate DSM into her practice. Her first step was enrolling herself and her staff in a DSM CE course. She became a member of the American Academy of Dental Sleep Medicine (AADSM), a notfor-profit membership organization that provides unbiased educational offerings. Dr. Dyras is completing a course to earn her durable medical equipment (DME) licensing to provide patients OAT through Medicare coverage. She is also incorporating OSA screenings and is having sleep conversations with her patients, while laying the groundwork for physician partnerships at the same time. “While preparing my practice through DSM CE and certification, I’m screening and educating patients and referring them to physicians,” Dr. Dyras said. “My goal is to create an easy, cross-collaborative referral system for physicians to quickly expand my patient base once I begin continued on page 26

Nearly 30 million adults suffer from untreated obstructive sleep apnea.

The AADSM Mastery Program will give you the skills, knowledge, and judgment you need to confidently treat these patients using oral appliance therapy.

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THENEWDENTIST.NET

Sleep Medicine continued from page 25

Tax Tips continued from page 18

providing oral appliance therapy.” Dr. Dyras is currently working with a sleep physician who is very excited about their partnership. “For those interested in DSM, education and an extensive referral network are important and will position you to better serve your patients,” Dyras advises.

expenses, even if the credit card isn’t paid until the following year, so you don’t have to part ways with the cash this year.

Dr. Nancy Addy is the president of the American Academy of Dental Sleep Medicine. Since 1999 she has been treating patients with sleep disorders and in 2008 limited her practice to Dental Sleep Medicine.

AADSM LAUNCHES MASTERY PROGRAM The AADSM recently announced its Mastery Program, which ensures dentists have the necessary training and skills to provide OAT to patients with sleep-related breathing disorders. The Mastery Program launches in September 2018 and will consist of 65 hours of learning. After completing Mastery I, attendees will be eligible to earn the Qualified Dentist Designation. Individuals who complete all three Mastery sessions will be eligible to sit for the ABDSM certification examination. More information is available at aadsm.org/mastery.

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11. Learn about the benefits of real estate ownership and a Cost Segregation Study. If you purchased a practice that came with building ownership, or you can financially afford to purchase your own building, there can be enormous tax benefits. The standard 39-year depreciation schedule on commercial owneroccupied real estate can be accelerated based on a qualified study and breakdown of the materials the building is comprised of. Finding the right support team is key to operating a successful practice, and that includes working with an accountant who specializes in dentistry. Follow these tips, and be sure to look to an accountant for more guidance. Brent L. Saunier, CPA, is a Founding Partner of Pro-Fi 20/20. He has been advising business owners for 20 years with a CFO mentality in all aspects of accounting, finance, tax, operational strategy and best practices. He also directs the Pro-Fi 20/20 team in establishing the strategies for growth of the firm and continually raising the bar on its standards of exceeding clients’ expectations.

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Buying a Dental Practice continued from page 15 PITFALL NO. 5: NOT HAVING A CONSULTANT OR MENTOR AFTER THE SALE. So you have closed on a practice. Now what? You’ll likely have a slew of questions once the transition is completed, such as: • How will you transition the staff? • Do you have a plan for your patients to recognize you as the new owner? • Does the practice run as efficiently as it could? • How is the hygiene recall program working? • Is your fee schedule aligned properly? • How do you get all of these questions answered and run a practice? Leveraging a professional consultant can help alleviate stress and provide beneficial feedback designed to maximize results. Having a sounding board will go a long way toward—and could potentially ensure—sustained success. There are so many moving parts to consider and things that can feel like they’re outside of your control when you decide you want to be a practice owner. These are five simple things you can control, and being mindful of them should help eliminate snags along the way. These suggestions also will

help manage your personal stress levels before and after you close on your practice loan. A better overall beginning experience can put you on a solid path to becoming a successful practice owner. Note: Bank of America, N.A. provides informational articles for your discussion or review only and is not responsible for the information and materials third parties present. Please consult your financial, legal and accounting advisors, as neither Bank of America, its affiliates, nor their employees provide legal, accounting and tax advice. Bank of America Practice Solutions is a division of Bank of America Corporation. Bank of America is a registered trademark of Bank of America Corporation. Matthew Christie is a Vice President and the Regional Sales Manager for Bank of America’s Practice Solutions division in Southern California. He is responsible for generating business in the medical professional field with a specific concentration in dentistry.

References 1. Constance Brinkley-Badgett, “FICO Scores Are at an All-Time High,” Sept. 21, 2016, finance.yahoo.com: http://finance.yahoo.com/ news/fico-scores-time-high-133000418.html

Starting a Practice or Buying a Practice? Your first time being a business owner will take more knowledge than getting the margins right on that 3-unit bridge. Prepare yourself for the role of CEO, Operating Officer, HR Manager, Financial Wizard, Marketing Director, IT Specialist, Etc, etc, etc…

Contact our New Dentist specialists at 877.777.6151 | info@McKenzieMgmt.com www.McKenzieMgmt.com SUMMER 201 8

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Minimal Time, Minimal Trauma:

The Benefits of Immediate Implant Placement Only a few decades ago, implants in the U.S. were placed by a select few. Implants are now being placed by specialists, certified implantologists, and general dentists. In the past, it routinely took more than a year to complete extraction and grafting, the healing phase, implant placement (a two-stage approach), tissue healing, final Jedediah V. Huss, DDS impressions, and delivery. The recent advancements in materials and techniques surrounding dental implants have enabled us to provide many of these treatments at a single visit. Studies show similar success rates between immediate implant placement versus delayed implant placement on fully healed sites.1 There even have been studies showing greater results and bone levels surrounding immediate implants than delayed implants.2 Immediate placement can be more technique sensitive and is not always indicated; however, it can offer excellent outcomes for viable candidates while improving clinical outcomes, patient management, and profitability. Clinical benefits include, but are not limited to: • High success rates • Minimal trauma to the area if tooth is removed atraumatically • Improved hard and soft tissue outcomes when the area is temporized appropriately • Reduction in potential dental complications due to fewer surgeries • Faster healing times Patient benefits include, but are not limited to: • Less waiting time for the final restoration • Fewer appointments, especially for busy and anxious patients • Fewer surgeries and minimal trauma Lastly, financial benefits for the practice can include, but are not limited to: • More initial treatment is completed in fewer appointments, increasing cost effectiveness • A faster process to complete the final impressions, achieving quicker production for the practice • Minimizes the risk of losing the patient to another office • Minimizes the chance of losing the patient on follow up due to priorities and/or finances • Less opportunity for the patient to not care about replacing the tooth and leaving edentulous space to chance Immediate implant placement, when indicated, is a winwin for all parties. Many busy and anxious dental patients are

28 THENEWDENTIST.NET S U M M E R 2 0 1 8

grateful to have both surgical procedures completed at the same visit, eliminating the need to go through the process of getting numb, having surgery, and healing multiple times. Patients who have traditional implants will also appreciate the benefits of the immediate placement treatment option. If ample bone is present, research and clinical case studies show the benefits and high levels of success of immediate implant placement when done correctly. Immediate implant placement offers a plethora of advantages for the clinician, the patient, and the practice. There are always exceptions to the rule, and specific teeth have a higher probability of immediate implant placement than others, but the days of delayed implant placement and burying the implant as a common practice should be behind us as we strive to be more efficient and effective in caring for our patients. Immediate implant placement is predictable and provides great benefits for the practice and the patient. So what is next? 1. Seek out and commit to learning these techniques. We must commit to be students of these methods long before we attempt our first case. 2. We can reach out to mentors and ask them to assist us in cases as we start this journey and gain experience. 3. Case selection is key. We must search out simple immediate implant cases to build confidence and competence with immediate implant placement, such as lower premolars and upper premolars, and then move to lower first molars. Once our techniques and confidence improve, we can begin applying what we’ve learned to anterior cases and upper molars. For dentists who are not interested in performing the surgical aspect, consider talking to the specialist about having immediate implant placement as an available treatment option for referral patients when indicated. As we implement immediate implant placement as a treatment option in our offices, we will further realize the benefits of improved clinical outcomes, better patient management, and financial growth. References 1. Romanos G, Froum S, Hery C, Cho SC, Tarnow D. Survival Rate of Immediately vs Delayed Loaded Implants: Analysis of the Current Literature. J Oral Implantol. 2010;36(4):315-324. 2. Hur Y, Ogata Y. No Clinically Significant Differences in Crestal Bone Loss Between Immediate Implant Placement and Implants Placed in Healed Bone. J Am Dent Assoc. December 2016; 147 (12):987–989.

Jedediah V. Huss, DDS, received his doctorate in dental surgery from the Herman Ostrow School of Dentistry of USC in 2011 and is an owner dentist supported by Pacific Dental Services.® He holds the status of Master with the International Congress of Oral Implantologists (ICOI). Contact him at restoredsmiles@gmail.com or via Instagram @restoredsmiles.

“Through the PDS® PRIVATE PRACTICE +® platform, I was able to achieve my dream of owning my own dental practice sooner than I ever could have imagined. The support from PDS makes it possible for me to focus on clinical excellence and helps me enjoy a balanced lifestyle.” BIANCA VELAYO, DMD Owner Dentist

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BEEN THERE, Done That

Key Opinion Leader

products not available through the internet or department stores. Give them options such as in-office power bleaching like Opalescence Boost 40% hydrogen peroxide, prefilled bleaching trays like Opalescence Go, and custom at-home bleaching trays like Opalescence PF 10%, 15%, 20%, 35%, and 45% carbamide peroxide, all from Ultradent Products. Explain the benefits of each, and why one might be better for that patient’s lifestyle or type of stain. Dr. Jaimee’ Morgan In-office power bleaching appeals to many patients and on bleaching as a clinicians because it infers it will work faster at removing stains. One appointment may be all some patients need. Many practice builder will require more than one visit, or may need to complete he Dental Cosmetic Pyramid lists bleaching as the very bleaching at home using prefilled trays. foundation of cosmetic dentistry.1 Most patients who Research has shown light and heat sources do not make want an esthetically enhanced smile want whiter teeth bleach more effective, and therefore negates having to puras part of that enhancement. As a new dentist, you may not feel chase expensive equipment for in-office bleaching. A freshly comfortable educating your patients about cosmetic procedures mixed, chemically activated bleaching material with a high including bleaching, but one of the easiest and safest age defying hydrogen peroxide concentration has been shown to be more procedures is to remove years of stains from a patient’s teeth. effective and potentially more comfortable because there is no heat source to dehydrate the teeth, which can lead to post-op sensitivity. TALKING TO PATIENTS ABOUT Pre-filled trays are exceptional when WHITENING it comes to convenience. No impressions, To inspire your patients, you must be well stone models or vacuum formers are needed informed and passionate about the services to provide patients with a comfortable, easyou provide. If you visit a high-end departily adapted tray that already has the whitenment store and go to the center of the cosing agent in it. Opalescence Go trays are metics area, you will get a taste of the type of available in 10% and 15% hydrogen peroxenthusiasm needed. ide. Patients usually wear them between 15 There is a reason the cosmetic counters are and 60 minutes per day. usually located on the first floor and as close Custom tray bleaching has been shown to the center and the escalators as possible. to be the most effective method for whitenObserve the people behind the counter. They ing when a low concentration and sustained are always well informed about their products, release carbamide peroxide is used overnight have good eye contact, seem to know the inside for several nights in a row. Also, knowing the secrets, and are willing to share those secrets bleaching agent is safe and does not harm with clients. Now watch the customers. How PHOTO COURTESY OF ULTRADENT PRODUCTS teeth allows patients to bleach as many nights are they receiving the message? Are they nodor as often as they want. One study showed six months of ding their head in agreement with the product specialist? Are bleaching every night, over night was safe and achieved sucthey asking questions? Are they purchasing the product? What cessful results even for tetracycline stained teeth. you can learn at the cosmetic counter is golden and can be applied to your dental practice. CONSIDER OFFERING COMPLIMENTARY Remember, you have the upper hand when it comes to whitening via bleaching because your bleaching products have WHITENING a 97% success rate. The success rate of the latest wrinkle cream When I opened my new practice 10 years ago, I decided to wanes in comparison. For the record, when speaking to profesoffer complimentary whitening to all my patients. This may sionals, I use the term “bleaching.” When speaking to patients, I not appeal to all business owners, but when I put pen to paper use the term “whitening.” and figured what it would cost, it was far less expensive than any other marketing/advertising program I had invested in before. This internal marketing program has proven to be very GIVE PATIENTS OPTIONS effective because of the word of mouth referrals it generates. When you educate patients about the safety and efficacy We use quality products and still invest less than $36 per of bleaching their teeth, remind them you use professional

30 THENEWDENTIST.NET S U M M E R 2 0 1 8

PHOTO COURTESY OF ULTRADENT PRODUCTS

patient (alginate, stone, two bleach trays, up to 12 syringes Opalescence PF bleach, and a tray case) initially, and then maybe an additional $5 every 6 months when patients come in for recall visits.2,3 We buy refill sizes of bleach syringes, tray material, tray cases, and alginate in bulk to get the best prices. If we order product at dental trade shows and conferences, we may garner an even bigger discount. Be cautious shopping for bargain products online. If you do not know the source of your materials, you and your patient could be disappointed with the results. A return-on-investment (ROI) exceeding a 3 to 1 ratio is considered a successful endeavor. When you consider a new patient brings a value of $800 to $1000,4 our $36 investment yields a return ratio of about 22+ to 1. Again, complimentary bleaching isn’t for every practice, but you may be able to increase profitability by following my protocol.

MY ONE-ARCH-AT-A-TIME BLEACHING PROTOCOL Every patient must be current with their recall appointments and recommended treatment to participate in the program. Impressions of the upper and lower arches are taken. An appointment is made to deliver their upper bleaching tray only along with four syringes of 10% carbamide peroxide. At this appointment, patients are given instructions on how to properly use the trays and bleaching agent. We let them know each syringe will provide two nights of bleaching and we emphasize we want them to bleach every night, overnight for eight nights. The overnight method using this highly viscous, sustained release, low concentration carbamide peroxide provides the best results with the least amount of discomfort, which also helps protect our investment. Patients return to the office after completing eight nights for a shade check. Patients and clinicians can easily see how successful the bleaching treatment is when comparing upper to lower arches. We have found patient satisfaction is much higher using the one-archat-a-time protocol.

At the second appointment, we determine whether patients should continue bleaching the upper arch or if they’re ready for the lower tray and four more syringes of bleaching agent. Every patient is allowed up to 12 syringes of bleaching agent at no cost. If patients exceed the initial 12 syringe limit, they are charged a maintenance fee. If patients lose their custom trays, they are charged a fee to replace them. At each recall appointment, we ask patients if they need more bleaching agent. If they say yes, they are given two syringes, which will provide two nights of bleaching for upper and lower arches. We also keep Opalescence Go prefilled trays in the office for purchase.

A PRACTICE BUILDER FOR NEW DENTISTS Keeping your overhead as low as possible (whether you are charging for bleaching services or not) while using reliable, high quality products, is a must. I’m not suggesting complimentary bleaching is for every practice, but considering the ROI my practice has experienced, as well as the patient satisfaction, it was right for me—and could be right for your young practice as well. References 1. 2. 3. 4.

Morgan JA, Presley S. Follow the cosmetic pyramid for optimal aesthetic results. Dent Today 31(3):82-87, 2012. Products and Procedures Manual 2015, Ultradent Products, Inc. pp 9,25,26,28. Full Product Line Catalog 2015, Dentsply Raintree Essix, pp 44,49. Gandolf S, Hirsch L. 7 misleading myths of dental marketing. Dental Economics. 2007;97(9).

Dr. Morgan received her dental degree from the University of Texas Health Science Center at San Antonio. She was recently named one of the top 25 women in Dentistry. She divides her professional career between clinical practice and teaching. She regularly contributes articles to dental periodicals and journals on cosmetic dental techniques for the general practice. Salt Lake City, Utah, is the site of her dental practice where she provides cosmetic, restorative and orthodontic treatment with her husband, Dr. Stan Presley.

SUMMER 201 8

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SKINNY

on the Street

The latest news on products and services for new dentists and their practices AdvantaClear Surface Disinfectant AdvantaClear Surface Disinfectant is the newest product from Hu-Friedy, a trusted leader in infection prevention. AdvantaClear Surface Disinfectant is designed to clean and disinfect dental surfaces while working extremely fast and effectively killing a broad spectrum of disease-causing microorganisms in one minute*. Features include: • Fast-Acting One Minute Contact Time: A broadspectrum disinfectant with one minute kill time* — faster kill times mean faster turnover. • It is Safe on Surfaces: The disinfectant is compatible with a wide range of surfaces including acrylic, aluminum, brass, copper, stainless steel, chrome, plastics and more.

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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 The New Dentist™ Resources at thenewdentist.net to receive information from more than one company. American Academy of Dental Sleep Medicine......................................25 aadsm.org 630-686-9875 Army...............................................5 healthcare.goarmy.com/ha85 800-431-6712 Arrowhead Dental Laboratory................................. IFC Arrowheaddental.com 877-358-0285

BIOLASE.........................................9 biolase.com 888-424-6527

Pro-Fi 20/20 CPAs........................17 profi2020.com 404-495-4895

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McKenzie Management........................ 27, BC mckenziemgmt.com 877-777-6151

Bank of America..........................15 Bankofamerica.com/practicesolutions 614-753-1603

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Berman Instruments...................23 bermaninstruments.com 855-539-8167

Pacific Dental...............................29 pacificdentalservices.com 714-845-8500

Ultradent Products.......................7 ultradent.com 800-552-5512 Viva Learning...............................12 vivalearning.com Wells Fargo Practice Finance........1 wellsfargo.com/practicefinance 888-937-2321

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