The Best Practices Show with Kirk Behrendt

The 3-Step Process in Adopting Digital Dentistry

Episode #620 with Dr. Daren Becker

Whether you know it or not, you're using digital technology somewhere in your dentistry. It’s time to embrace it! To reveal how adopting digital dentistry will transform your practice, Kirk Behrendt brings back Dr. Daren Becker from the Pankey Institute to share three important steps to successfully modernize your workflow. If for no other reason, go digital for your patients! To learn about the advantages that digital can offer, listen to Episode 620 of The Best Practices Show!

Episode Resources:

• Send Dr. Becker an email
• Join Dr. Becker on Facebook
• Follow Dr. Becker on Instagram
• Learn more on Dr. Becker’s website
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Register for Dr. Becker and Dr. Cranham’s Digital Workflow course (June 13-15, 2024)

Main Takeaways:

Master the tried-and-true occlusal, restorative, and esthetic principles.

Figure out where digital technology fits into your practice.

Find a mentor or people that will support you.

Start by getting an intraoral scanner.

Go digital for your patients.

Quotes:

“Pete Dawson said in 2005, ‘Digital dentistry in the absence of sound, occlusal, esthetic, and restorative principles will only allow a dentist to screw up mouths even faster.’ To me, that's everything because everybody is jumping on the digital thing. He's right. The same way you could screw up a mouth if you didn't pay attention to sound occlusal principles, or good biologic principles with your margin design, and good restorative principles with your prep design, and good esthetic principles — if you didn't do that in the analog world, you're going to screw things up.” (9:36—10:19)

“For most people, the start [to adopting digital] is an intraoral scanner. We've had conversations about this on the podcast before. There are lots of scanners out there. I'm not here to tell you which is the right one. I happen to use iTero. I love my iTero. I have two of them, actually, and we use them for everything. We do wellness scans in hygiene. Once a year, we scan every patient, kind of the opposite of having radiographs made. It's a great way to monitor changes. It's incredible because you put the screen up in front of a patient — I think it's called TimeLapse. It'll flash between the two years ago scan and the new scan. They can see the change. They can see the shifting of the teeth, or the wearing down of the teeth, or the gum recession. It's right in their face. You don't have to say anything. They'll go, ‘Oh, what happened there?’ And then, you can have the conversation. So, it’s a brilliant tool. I'm sure other scanners have similar features. The point of it is replacing the gooey mold stuff with the digital scan.” (11:59—13:14)

“If you aren't doing digital dentistry but you're sending your restorative dentistry to the lab, you're doing digital dentistry — you're just not aware of it. Every lab, unless you have a little guy sitting in your office, is doing it digitally. If you send them an impression or a model, the first thing they do is scan it. So, you're already at a disadvantage because now it's a copy of a copy. You've introduced some errors because that impression material distorts. It shrinks, swells, or whatever it does. And then, the stone has a dimensional change as it sets, so it's already a disadvantage there. And even though there are studies that show that the accuracy of the scan may not be quite as definitive as the accuracy of a reversible hydrocolloid impression — first of all, no one is taking reversible hydrocolloid impressions. No one is. And then, secondly, those distortion features, to me, when you introduce the distortion, it changes everything. Here's what I know. When we started scanning, just routine crown and bridge, our time to deliver a restoration was cut in half without changing anything else. Same lab, same restorative material. That, to me, was huge. So, scanning is where you start. Lots of people are scanning now, and every company on the planet is making a scanner. And they're all good. You’ve just got to find the one that works for you.” (13:25—14:55)

“Patients hate impressions. If there's any other reason to go to digital scanners, patients hate gooey goop in their mouth. They just do. But you can't just scan and get a whitening tray. There's an intermediate step of making a model. Even that requires some design, some software, some way of taking that scan and turning it into a model that you can then either mill or print. Today, I would say it’s mostly printing. You can still get milled models, but 3D printing is pretty much taking over that world, especially in your office. In a big lab, or if you're sending it to a commercial lab, they may still be using a mill for models. So, learning how to do that is not hard. It's just you’ve got to learn the steps.” (15:48—16:46)

“Whatever it is we're doing, the same way we would wax up on a set of models in the past in the analog world, we can do all that in the digital world. We can do it on a virtual articulator that mimics all the functionality that we would get from a regular articulator. But what's really cool, because it's digital — the one thing we couldn't do on a regular articulator is you can't put the patient's face on the articulator. So, even if you have a facebow or a facial plane analyzer, you still don't have their face on the articulator. Well, in the digital world, you can import their photograph. You can import a CBCT of their head and you can mount that model on that digital articulator, I think, maybe more accurately than we could with traditional facebows and DFAs in the analog world. It's really crazy how well we can do that. And then, in terms of recording bites — we talked about occlusion. We make such a big deal about getting a proper mounting in a seated condylar position or centric relation position. How did we do that in the digital world? I think it's actually easier to do that. So, using all the same tools, leaf gauges, anterior bite stops, and all the things that we've always used to help us get those bite records. That's where we're at. It's pretty cool and it's fun.” (17:11—18:46)

“The basic understanding — or, not even basic. The advanced understanding of occlusal principles, esthetic principles, restorative principles — that, you have to learn. You have to learn that. We get a taste of it in dental school. Most people say they got next to nothing in occlusion in dental school, depending on where you go to school. So, that's where taking a course at Pankey, taking a course at Dawson, at Kois, at Spear — there are lots of places to go learn how to do this. I'm biased because I'm a Pankey faculty. I think we do the best job of that, not just in the technical piece of it, but how do I implement that in my practice, and how do I talk to my team about it, and how do I talk to my patients about it. We get into all that. That's the baseline.” (19:25—20:14)

“One of the interesting things is we've been having this argument of, do you have to know how to do a trial equilibration on stone models before you can learn how to do it in the digital world? And we came to the observation that, yes — if you're over the age of 40. If you're under the age of 40, no, you don't have to. In fact, you'll learn it a lot faster on the computer.” (21:27—21:53)

“We can design a bite splint on the computer and then print that on our 3D printer. Best bite splints I've ever made. I've made them by hand with powder and liquid acrylic for 20-whatever years. The digital ones are so good, and they drop right in. They fit beautifully. They're easy to adjust. You don't reline them because they fit so well. To me, that's the proof of the accuracy of digital, is we always relined. I relined every single bite splint I ever made when I made them by hand with acrylic. And now, there's no distortion. It's incredible.” (22:08—22:46)

“How do we not screw up people's mouths? Make sure you have a great understanding of the occlusal, restorative, and esthetic principles that are tried and true. You can't skip those. Then, figure out where digital works in your world. Again, I think scanning technology is first, working with a lab that's already probably digital, working with them hand-in-hand. And then, maybe if you're going to get into production in your office, a 3D printer is a great way to start. Today, you can get an excellent 3D printer for not a ton of money . . . And then, finding people to support you, finding people like John Cranham and Lee Culp that are doing consulting on this, or finding a mentor. I've stressed it so many times on podcasts, having a mentor that can help you get where you want to get. So, if this is something you want to do, reach out to folks that are already doing it that can help you.” (28:33—30:05)

Snippets:

0:00 Introduction.

1:52 Dr. Becker’s background.

7:16 About Pankey’s Masters’ Week.

9:22 Learn the important principles.

11:49 Start with scanners.

18:48 The three steps to get started.

23:57 Should you learn analog before digital?

28:09 Last thoughts.

30:09 Work enough days in your office.

32:55 Dr. Becker’s digital design course in 2024. 

Dr. Daren Becker Bio:

Dr. Daren Becker earned his Bachelor of Science Degree in Computer Science from American International College, and Doctor of Dental Medicine from the University of Florida College of Dentistry. He began private practice in Atlanta, Georgia, in 1998 with an emphasis on comprehensive, restorative, implant, and aesthetic dentistry. He is the owner and full-time dentist at Atlanta Dental Solutions, and is in full-time, fee-for-service private practice.

Dr. Becker began his advanced studies at The Pankey Institute in 1998. He was invited to be a guest facilitator in 2006 and has been on the visiting faculty since 2009. In addition, in 2006, he began spending time facilitating dental students from Medical College of Georgia School of Dentistry at the Ben Massell Clinic (treating indigent patients) as an adjunct clinical faculty member. In 2011, he was invited to be a part-time faculty member in the Graduate Prosthodontics Residency at the Center for Aesthetic and Implant Dentistry at Georgia Health Sciences University, now Georgia Regents University College of Dental Medicine (formerly Medical College of Georgia).

Dr. Becker has been involved in organized dentistry and has chaired and/or served on numerous state and local committees. Currently, he is a delegate to the Georgia Dental Association. He has lectured at the Academy of General Dentistry annual meeting, is a regular presenter at ITI Study Club, as well as numerous other study clubs. He is a regular contributor at Red Sky Dental Seminars.

In addition to his enthusiasm for sharing his knowledge, Dr. Becker’s strengths are in meeting and special event planning, and CE program development. Dr. Becker lives in the Dunwoody area of Atlanta, Georgia, with his wife, Amanda, and their daughters Alicia and Addison. He is passionate about fly-fishing and enjoys traveling, golf, and outdoor photography. 

The Next Big Thing in Dentistry

Episode #619 with Dr. Christian Coachman & Philippe Salah

You don't have 24/7 access to your patients’ mouths — until now! Today, Kirk Behrendt brings back Dr. Christian Coachman, founder of Digital Smile Design, and Philippe Salah, CEO of Dental Monitoring, to introduce a revolutionary system that will help you monitor your patients’ oral health in real time. With DM, you can optimize the care you give before, during, and after their time in your chair. Prevention and maintenance have never been easier! To learn more about the next big thing in dentistry, listen to Episode 619 of The Best Practices Show!

Episode Resources:

• Learn more about Dental Monitoring
• Join Dr. Coachman on Facebook 
• Follow Dr. Coachman on Instagram
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Main Takeaways:

Remote dental care is possible and powerful.

Dental Monitoring cuts down wasted appointment time.

DM will detect problems much faster than standard appointments.

Using DM, you know exactly when and what treatment patients need.

Remote care is already the standard in medicine. Start using it in dentistry.

Quotes:

“When you are doing treatment for your patient, you never know what is happening when you don't see your patient — when the patient is at home. And you all know, especially in orthodontics, that the clinical relevance, the clinical action, is happening outside your practice. [Dental Monitoring] brings you back necessary information to be able to drive the treatment in the best direction possible at every moment during the treatment. So, how does it work? It’s very simple. Your patient gets a smartphone. From that, we take several pictures — more than 100 pictures, automatically with our system, with a pretty cool way of taking them. From that, we use these pictures — taken by the smartphone, not your patient — and we triage lots of clinical notifications where we indicate to you, to the orthodontist, if there is some concern or great achievement that you want to communicate with the patient. Or maybe it will trigger an appointment. Or the opposite — it will trigger, ‘No need to see my patient.’ So, for the first time in dentistry, we really synchronize the delivery of care with the need of care. You see the patient as much as you need to see them, and at the right moment. Never less, never too much.” (3:53—5:11) -Philippe

“[Dental Monitoring is] like taking care of the patient before they are sitting in your chair, and after they are sitting in your dental chair. If you count all the hours that somebody lives in a full year, maybe the patient is one, two, or three hours in your dental chair during the whole year. So, you have all the other 365 times 24 hours where you're not seeing what is happening in the patient's mouth. That's why I think remote care is so powerful. Everybody is already taking advantage of this in other areas with smartwatches, physically and even emotionally, sending information, sharing information with their physicians through devices. So, physicians can actually control what is happening in our body when we are not there with the physician.” (5:16—6:09) -Dr. Coachman

“When I started to work in the dental field, I was working in practices where lots of the patients coming in for the first appointment were not ready for the treatment. If it was an ortho treatment, they were too young. They were baby teeth, not ready for the treatment, or they get perio problems and they need to see their periodontist or their GP to be treated first. This was pretty inconvenient for the patient and a big waste of time for the orthodontist. Here, we fixed the problem. Now, before arriving at the clinic, we allow the doctor to get a pretty accurate screening of the patient prior to the first visit. And then, based on the result, the orthodontist, the specialist, or the GP will be able to qualify the patient and drive them in the right direction, ‘Yes, you can come to my practice. This is a good time to see you,’ or, ‘Maybe go see my colleague in another discipline that will help you first before you come to me.’” (6:22—7:19) -Philippe

“Let's say you are [doing] an aligner treatment or braces treatment. When do you see your patient? You see them every six weeks, eight weeks, 12 weeks, 16 weeks. On what basis? What is the rationale behind that? The rationale for most orthodontists in that example is what we call their comfort zone. They feel comfortable that within the next six weeks nothing bad will happen. But, in fact, they never know. Most of the time, the patient arrives at the practice and it's a surprise. It's a good surprise, sometimes. Nothing bad happened, and everything is fine. The patient arrives, and you say to little Timmy, ‘You're good, Timmy. You can go back home.’ Isn't that a waste of time for Timmy and your practice? Or the opposite scenario. Timmy arrives [with five broken] brackets, and from a five-minute check appointment, it transforms to a 40-minute appointment. And then, stress comes to the practice. This is another scenario. Is it not a failing scenario again? I think these two scenarios, which are 99% of appointments, is not a good scenario for the orthodontist.” (7:23—8:33) -Philippe

“What is the chance, without a monitoring solution, that the patient is coming to your practice the exact day you need them to come? Very little chance. So, we make it happen [with Dental Monitoring]. Every week, the patient is taking a scan. Then, we needed artificial intelligence. We needed something to automate it because we knew that the orthodontist or the dentist will not look at the patient every single week. We needed to automate through artificial intelligence to screen at the medical device level that the accuracy of the records is sufficient for the dentist or the orthodontist to make a decision, ‘Do I need to see my patient? Do I need to act with him?’ This was the power we created.” (8:33—9:19) -Philippe

“[Remote care] is not new technology for medical. If you have a cardiac problem, cardiologists now will give you some metrics with some monitoring devices, and they will track down your pills on your appointment based on the recording. They will see you as much as needed based on the recording, or as little as needed based on the recording. Diabetes problems are the same. You've now got probes that are constantly measuring where you are in terms of your glucose level and will adapt your treatment based on the monitoring solution. In dentistry, we deserve the same level of quality. We deserve the same level of standard. It’s a new standard of care, to bring as much care as needed or as little as needed. Don't overtreat or undertreat. This is really the core value of DM. We never say to our dentist, ‘Don't see your patient.’ We tell them, ‘See them better.’ Some of your patients, who are disasters, you will need to see them more. Luckily, most of your patients will be very good patients. Because of that, you will see them less. So, it's really improving the quality of care, improving the quality of the perception of the dentist on the progress of the treatment they do.” (9:47—11:07) -Philippe

“I was blown away when I first saw this. What [DM] did is something very cool. If you start a first appointment and you scan your patient in your practice — so, you have a 3D model of the patient's mouth — from that moment on, every time the patient scans their mouth with their phone, their technology, through those images, is able to adapt the original STL, the original intraoral scan with the pictures, and transform the STL into a new 3D model of the existing scenario. So, in the future, you're going to scan your patient on the first appointment. From then on, you will not need to scan them anymore because 2D images will create 3D models of the existing situation of the patient. You can track orthodontics without having to scan the patient during treatment. The software will do that by itself.” (14:30—15:38) -Dr. Coachman

“We believe that we are a very good complement to intraoral scanners. It means you take an initial intraoral scan, but you know that during the life of a treatment you will need multiple intraoral scans. Let's take a scenario. You've got an aligner treatment. You scan the first time. You provide this STL file to your manufacturer, whoever it is. This manufacturer will provide you with a first set of aligners. Very often, if it’s not all the time, you need to do a refinement. This refinement triggers two appointments, one appointment to take a new scan, then wait for the manufacturing of the additional aligner, and then bring the patient in again, deliver the aligners, and then you start with a new cycle. Now, we want to invent a new way of treating, which is, you scan the patient, as before, treatment plan, deliver the first set of aligners. And throughout the progress of the treatment, we identify when it's going wrong, when there is untracking in a set of aligners, a misfitting, or whatever. And then, we will produce an STL file at that particular moment, send it directly to the manufacturer, which will produce the next set of aligners. And this next set of aligners will be delivered to the practice even before the patient is there. So, it means that when your patient is coming to your practice, you already have the next set of aligners.” (15:59—17:35) -Philippe

“The world where you produce 40 aligners through Beam, and then you produce another 30 through Beam, this world will disappear. You will produce aligners only on demand based on the tracking. So, as you understand, it's better for the manufacturer. It's better for the planet. It's better for the patient. And obviously, the more the treatment is good, it's better for the practice. So, everybody is winning by this new cycle, which is a more dynamic production of aligners. And this also works for braces. If you, for example, use custom braces where you want to adapt your wire remotely for SureSmile or LightForce, imagine the fact that you can have a dated scan throughout the treatment. You can adapt the treatment like this. If you want to do retainers, today, you have to ask the patient to come in, then hope that the patient will be coming back in the next few days to be sure that you can give them the retainers, and so on. Now, you don't need to. Just ask the patient to scan. And when they come, you already have the retainer ready. So, it's changing the way you interact with your patient, making it far more convenient for everybody, for all the stakeholders of the value chain and the treatment chain.” (18:44—20:11) -Philippe

“Bringing the patient in only when they need it, at the right moment, for the right reason, should be mandatory. It should be the new standard of care. Don't ask little Timmy and his mom or father to waste an afternoon of their day for just, ‘Everything is good, Timmy. Come back next time.’ Or the opposite, where you stress your entire clinic because everything is a mess and you did not capture sufficiently early that Timmy was actually not a good patient, not complying, breaking everything in his mouth. You want to make sure that this is under control. And if you take an adult patient, what do they want? They want efficiency. Time is super valuable.” (22:04—22:54) -Philippe

“I love to take myself as an example. I've got four kids, myself, and my wife. My wife, I don't have to take care of her. But for my four kids and myself — if I had to see the orthodontist of my kids every six weeks, you imagine four kids, I would be dead like more days going to the orthodontist than taking the days off. And if I speak for myself, I love the fact that my dentist is using DM to see if everything is fine. Do I need cleanings? Do I need plaque removal, etc.? Everything is fine. I don't need to come. He charges me, no problem. And then, the next time I need to do my cleaning, I go at the right moment. It's better for my life, better for the orthodontist, for the dentist, for whoever wants it. It's the way it should be.” (22:55—23:50) -Philippe

“Why should we live in a world where we are fixing the problem instead of living in a world where the appliance is actually produced and generated dynamically based on what the patient and the treatment needs at that particular moment? It wastes time for the doctors and the patients, and is a big, big, big manufacturing headache for the manufacturers. All this should be disappearing.” (32:38—33:06) -Philippe

“We know that there is no treatment in dentistry which is just one time. Every dental treatment has multiple visits, multiple checkups, and needs maintenance. And so, there are multiple ways to synchronize the delivery of care with the need of care. Let me give you an example. We work in elderly homes where we help elderly people scan their mouths. They take pictures of their dentures, and then the dentist evaluates, ‘Do I need to change the denture? Do I need to act on these elderly people who are suffering?’ because there is an abscess, and nobody at the care home has seen it, and they are actually suffering. All this, we believe that it should be a standard of care. Do we need to take a DM scan every week? Absolutely not. Of course not. But should we scan every elderly person once every three months, once every six months, to make sure that our elderly people are good? I think so.” (35:43—36:54) -Philippe

“Most periodontists know that they need to fix the behavior before actually going to perio treatment. Otherwise, it's a failing scenario. So, could we not monitor the patient for a period of three to six months, seeing if the perio is stabilized before we go to the perio treatment? Implants, the healing process. Wouldn't it be great to see every three days, automatically, AI-driven, if the healing process is good? Is it not a better service? Maybe there is not much of a problem. But would the patient not feel super good that the dentist is capable of detecting if there is inflammation? It does not prevent the patient from coming to the dentist or to need the care, but it gives sufficient information to avoid problems and to make the patient feel good. So, there are tons of applications [for Dental Monitoring].” (37:52—38:50) -Philippe

“Too many things in dentistry are not standardized. Too many things in dentistry are not protocolized, not systematized, are not organized as we see in medicine — diagnosis, treatment planning, and treatment follow-up. There's so much dentistry needs to evolve, and technology will transform this world.” (40:01—40:26) -Dr. Coachman

Snippets:

0:00 Introduction.

1:36 Philippe’s background.

3:06 How Dental Monitoring works.

9:23 A better way to see patients.

11:08 The technology behind DM.

20:12 Problems that DM solves.

23:51 The evolution of the DM super system.

30:13 The future of DM and dentistry.

34:38 Synchronizing delivery of care with need of care.

38:59 Last thoughts.

42:29 More about DM and how to get in touch with Philippe.

Dr. Christian Coachman Bio:

Combining his advanced skills, experience, and technology solutions, Dr. Christian Coachman pioneered the Digital Smile Design methodology and founded Digital Smile Design company (DSD). Since its inception, thousands of dentists worldwide have attended DSD courses and workshops, such as the renowned DSD Residency program.

Dr. Coachman is the developer of worldwide, well-known concepts such as the Digital Smile Design, the Pink Hybrid Implant Restoration, the Digital Planning Center, Emotional Dentistry, Interdisciplinary Treatment Simulation, and Digital Smile Donator. He regularly consults for dental industry companies, developing products, implementing concepts, and marketing strategies, such as the Facially Driven Digital Orthodontic Workflow developed in collaboration with Invisalign, Align Technology.

Dr. Coachman has lectured and published internationally in the fields of esthetic and digital dentistry, dental photography, oral rehabilitation, dental ceramics, implants, and communication strategies and marketing in dentistry.

Philippe Salah Bio:

Philippe Salah received his MS degree in bioinformatics and his PhD in biophysics from the prestigious École Polytechnique in Paris, France. He has traveled and worked in Europe, the US, Africa, Asia, and the Middle East.

In 2007, after graduating, Philippe fell in love with orthodontics after partnering with a renowned French orthodontist to build Harmony, a fully customized digital orthodontics solution. In 2011, Harmony was purchased by American Orthodontics, the world's largest privately held manufacturer of orthodontic appliances.

By 2014, Philippe had realized that Artificial Intelligence was the next frontier in medical care. He brought together a team of engineers and orthodontists and created Dental Monitoring, the world’s first AI-based system for treatment monitoring, practice management, and patient communication.

Less is More: How One Dentist’s Radical Approach Transformed Her Practice!

Episode #618 with Dr. Rachel Barone

Changing office hours seems like a bad idea. What if it doesn't work? What if it makes patients angry? What if production plummets with the new schedule? To help you dispel those negative thoughts, Kirk Behrendt brings in Dr. Rachel Barone, a mentor from the Global Diagnosis Education Study Club, to share how changing her hours improved her life and the life of her team and patients. More isn't better — it’s just more! To learn how you can seamlessly change your hours, listen to Episode 618 of The Best Practices Show!

Episode Resources:

• Join Dr. Barone on Facebook
• Follow Dr. Barone on Instagram
• Learn more on her website
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Learn more about Global Diagnosis Education

Register for the Global Diagnosis Education Symposium (September 7-9, 2023)

Read books by Patrick Lencioni

Main Takeaways:

Be clear about why you want to change your hours.

Use your core values as a guide in this process.

Get your team’s buy-in for the new schedule.

Learn to use the time you have effectively.

More isn't better — it’s just more.

Quotes:

“As I've grown as a clinician and as a person, I started to have better clarity around what I wanted in my life. I realized that it's very important to me to have time and space away from the office so that I can show up and be the absolute best practitioner I can be when I'm at the office. I want to be able to show up fully for my team, my patients, and anyone I have the privilege of serving. So, I realized that when I was working longer hours and not really giving myself breaks, I was depleted. I was starting to feel burned out. And so, the shift in hours has not only served me in being able to be rejuvenated and a resource to come into the office, but it’s also served my team. I have to have their backs because they have mine every single day, and I want to make sure that whatever we're doing fits for all of our lives, not just what's going on in the practice.” (3:33—4:30)

“We used to work from 8:00 to 5:00, Monday through Thursday. Sometimes, we would do 9:00 to 1:00 on Fridays, depending on if we had some overflow or catch-up lab work or anything like that that we needed to do. And I'm very fortunate. I have team members that are dedicated to work for our practice that some of them drive from 30 minutes to an hour away to get to the office. We found that not only were the days really long, we were leaving exhausted, but then some of these team members had really long commutes. And when the weather gets bad in Colorado, it's snowy and sleety. They're not safe driving home in the dark. So, we all made the decision as a team that we wanted to reevaluate what our office hours were. We had a lot of discussions around what works for us as a team. It was really important for me to be able to make sure that it wouldn't just fit my life, but that it would fit the life of my team members as well.” (4:38—5:40)

“The gentleman I bought my practice from, his name is Dr. Jerry Savory. He often said to me, ‘People help support that which they create,’ and I've kept that with me for years now. It's so true in terms of team buy-in with anything, is giving them the autonomy, the respect, the space to be a part of that decision. It creates more buy-in and more support of whatever that decision is. So, we all talked about it a lot, and we decided that 7:30 to 3:30 were hours that would work well for us. Most of us got to the office pretty early anyway, and that time was being wasted just in prep for the day. By leaving at 3:30, even if we run a little late, the latest we get out is 3:45, maybe 4:00, and it makes their commutes home so much easier. They're not in rush-hour traffic. If it's wintertime, they're leaving closer to when daylight is happening. It's been a really good shift for our team. Now, I don't think any of us could imagine working until 5:00.” (5:41—6:51)

“One of our hygienists had a planned vacation where she was going to be off for three weeks. One of the barriers, I think, when you're thinking about changing your hours is the hygiene schedule because it books out so far in advance. So, we had this whole conversation with the team buy-in and really got excited about changing our hours. But because of the way the hygiene schedule was booked, we didn't think we would be able to do it until August. My front office manager had the brilliant idea of testing these new hours while our hygienist was out since we didn't have hygiene patients anyway. And so, we did that with our restorative schedule. After a week, my assistants and my office manager and I all said, ‘I don't think we can wait until August.’ We had a taste of it, and it was so nice to have the space in the afternoons to ourselves. So, I have to give huge props to my team. They really worked hard to make this a reality. There were many hours on the phone rescheduling hygiene patients and rearranging the schedule. But as a result of their hard work, we've been able to implement this since April. It's been incredible for our practice.” (7:09—8:20)

“In this profession, we want to serve our patients. We want to make sure that we're meeting their needs. That's a really beautiful thing. But I think in doing that, we sometimes forget our own needs. What I have found in my own practice is by changing the hours, we haven't lost a single patient. We've had two patients that have had a little bit of challenge in the way that their schedules work. But we've been flexible and creative, and we've figured out ways to be sure that they're still accommodated. For the most part, our patients are really lovely humans, and they want us to have a good life too. And so, when we tell them why we're changing our hours, that it makes the commutes easier on the team and that it allows more time with family, they're in support of it because they want to be with their families. They know what that feels like, and so they want that for us as well.” (8:45—9:35)

“We, as a culture and as dentists, all want to be really efficient. And it's not that efficiency isn't important, but I think we underestimate how important being effective is and how important efficacy is. What I mean by that is, if we can be effective with the way that we use our time, then the efficiency comes. For us, I own a small, restorative, fee-for-service practice. In that model, efficacy is what matters. You have to be effective in the way that you communicate. You have to be effective in forming relationships and building trust with patients. You have to be effective with the way that you schedule. And it seems like there's more work on the front end with that, but it pays dividends in the back end, and it actually allows for you to be more efficient because you have the patient who trusts you, who trusts your process, who is engaged in the care that they're getting. And then, you have a team that can support you with a very effective schedule.” (12:06—13:11)

“We have built our block schedule in a way that we have daily production goals. We have been just as productive, if not more productive, since cutting our hours than we were before. There's a lot less wasted time. You have to be effective with how you use your time when you're doing a model like this. You can't schedule ineffectively. But as a result, you get more time with your family, and you get more time away from the office. And again, we're finding that we're more productive with this shift.” (13:22—13:52)

“We've been working with ACT for several years, at this point, and so we've been very intentional about building systems that work for our practice and having everyone know what roles they play in upholding those systems. I think we did the work, foundationally, to be able to have that be our springboard toward these new hours. I think because we have the system, we have the block schedule that if we just plug into the block schedule and manage it effectively, then we'll hit our production goals. That has been a really big part of it. And the team, I think, is more energized around it because they had a say in it. They got to help build this new vision for the practice, essentially, and they're feeling the benefit of being able to go home and be with their family. So, they show up more engaged and ready to work.” (14:25—15:16)

“I inherited a practice that was incredible in so many ways. It had such a good foundation, a kind, wonderful, patient community, a wonderful team. I couldn't have been more fortunate. And I, over time, needed to be able to transition it into a reflection of me and the way I practice. What we found is there were a couple of team members who didn't transition as well into my model of practice. We tried to support them in the best way we could. But what we learned is that by having them in the office, it actually detracted from the other team members’ ability to show up with enthusiasm and presence to the work that they were doing. There were people I also hired that weren't good fits before I knew better and knew what to look for. I know you talk about it a lot, Kirk, but the thing that has been so instrumental for me to be able to get the clarity is having core values and a core purpose. They're posted all over the office. We do core values celebrations once a week. They're the hill I'm going to die on. They are what I value in my practice. And if people do not align with them, then it doesn't make them a good or bad person. There's no judgment here. It's purely that they're not a good fit for me and the type of practice I'm trying to create. Once I had that clarity, it made so much more sense in terms of who was going with me and who was maybe not going to be in alignment as well.” (16:05—17:52)

“Core values was the template we used for our hiring process. We had an assistant who left our practice in October of last year. We didn't end up hiring a new one until January of this year because we needed someone who fit the core values. It's really easy to get a warm body in a seat. But the impact that can have if they're not a core values fit can be so, so draining on the team, on the management, on the patients. Patients can feel the dissonance there. I've had examples of that too where we were in a pinch, and we had a position open for so long that we just hired the next, most qualified person. And it really ended up being detrimental to the practice, and the morale, and ultimately created a lot more work for all of us.” (18:04—18:58)

“[Having core values] feels like practicing in the dark versus practicing in the light. I think, at least for my own journey, my dental school did a wonderful job of getting me to the point where I could be a practicing dentist. And I understand so much the limitation of, you only have four years to take people from zero to dentist. We didn't get a lot of business training. We got the basics. We got the stuff that we needed to know, but we didn't get the nuts and bolts of what it takes to run a business that is effective and profitable and that feeds your lifestyle and your desires. So, I think it's just a lack of knowing, a lack of familiarity around it.” (20:07—20:56)

“When I was learning about core values, it felt overwhelming. I read some of the books, the Patrick Lencioni book. And then, there's the Harvard Business Review article where he talks about it. I remember reading it and thinking like, all the stuff that I thought were my core values, like loyalty and integrity, those don't go deep enough. And so, it takes a lot of intentionality and a lot of patience. I think between the management group in my office and Courtney, we reworked the core values probably four or five times to really make sure that they felt in alignment.  But again, now that we have them, I can't imagine not having them. What I realized is they are such a reflection of me that I live them without realizing it in my daily life as well. I find that it's become an internal barometer around how I spend my personal time as well as the time at work.” (20:57—21:57)

“It comes back to core values because you have to know who the right person is. As we know, there can be many different types of dental assistants, many different types of hygienists, many different types of dentists. You have to know what your practice needs, and not just that they're going to come in and be able to do their job. How are they going to engage as a part of a team, and how are they going to be able to support you in totality — in your mission for the practice, in the purpose, and in the way you care for people? So, I think getting very, very clear on what your core values are is the very first step.” (22:12—22:53)

“I use [core values] as a benchmark when I'm interviewing people. We can even ask questions in the interview that are in alignment with our core values and try to get a sense of, is it something that this person really can be in alignment with, or is it something where maybe they're not as good a fit? That's been our guiding principle. We use them for everything, and we talk about it as a team afterwards. For example, when we were hiring our most recent hygienist, we gave her a list of our core values. We asked questions around the core values. We really made it a big part of the interview process because it is so important to us. Our existing hygienist, she's our lead hygienist, was there during the interview. Afterwards, we had the conversation in terms of, ‘Does she meet our core values? Is she going to be a good fit? Is she going to help take the load off of the lead hygienist and further the practice in the way that we want to go?’ You can't go somewhere if you don't have a roadmap, and I feel like the core values are a little bit of our roadmap. We use them to be sure that we have the right people to take us in the direction we're going.” (22:54—24:10)

“I think about when we had a person in our practice who — technically, they weren't quite the right person because they weren't 100% a core values fit. But there were things about her that was a core values fit, and we really tried to see, ‘Do we need to be creative? Maybe she's not in the right role.’ We really talked about it and tried to think if there was another position in the practice that would serve her better and speak to her talents more. But unfortunately, I think being not a good core values fit made the right seat part a moot point.” (24:44—25:22)

“The other thing is that your seat can evolve over time, I would imagine, which is exciting. I know, for me, what excites me and what keeps me engaged in my life and in my profession is the opportunity for change and growth and metamorphosis. You want that for your team as well. And sometimes, you get in a position where the team — they're a hygienist. They have the mindset of, ‘I'm just a hygienist. I'm going to be a hygienist forever.’ Or you have other people who really want to be able to grow. And so, maybe you have someone who's a rockstar assistant, and she then takes on more and more responsibilities and maybe grows into an office manager position. I think as long as they're a core values fit, at least in my office, I can generally figure out where they should sit in the office and allow it to change over time.” (25:25—26:21)

“For us, it’s like, why do we even exist? Why are we getting out of bed every day and providing dental care to people? For us, it's about providing person-centered dentistry that helps a patient understand and take ownership of their dental and overall health so that we can create lasting relationships and lasting health for them. That's another thing that the team buys into and that allows us to gauge, not only are the team members that we have good fits for the practice, but also, do our patients match our core purpose? I think that's something we don't always talk about or is readily talked about. I don't have to be everybody's dentist. One, I'd be exhausted by being everybody’s dentist. Two, my style doesn't work for everyone. And that's okay. But if I have people who understand our core values for the team, the core purpose for why we exist, then we can attract patients who value what I value and that want what I'm providing. Then, we can all enjoy work a lot more and actually help people in a really meaningful way.” (26:35—27:47)

“It sounds like lunacy [to have two-hour team meetings]. But it's actually one more of those things that I can't imagine not having. Having the space to be able to, one, connect with them — because I love my team for the humans that they are. They come in and support me in such a beautiful way. They give me their most valuable resource — their time. So, I want to make sure that when they're there, we're a work family and that we care for and tend to one another. And in doing that, we can care for and tend to our patients. So, it’s a time that we use for connection.” (28:46—29:22)

“We undervalue things sometimes if we can't put a dollar amount on them. [Weekly team meetings] is something that I think, personally, in my office, is invaluable. I would absolutely not think of putting a patient during this meeting. The time that we get for connection and growth is so invaluable. And then, we use this time too to make sure we're aligned. We make sure that our systems are in place, that we don't need to change anything. And also, it's a forum for the team to be able to express whatever is on their minds so that we can allow it to be resolved as opposed to — what I had before was a monthly team meeting as opposed to a weekly team meeting. What I found is things would backlog until this monthly meeting rather than having a five-minute conversation about it. Inevitably, it would get pushed to the backburner, pushed to the backburner. And so, if we had something that happened that was maybe an activating experience for our team members, it wouldn't actually be addressed, and it would either be swept under the rug and create resentment, or it would be brought up three weeks later when no one is feeling engaged...

Everything Works Until It Doesn’t

Episode #617 with Dr. Jim Otten

Have you ever thought that everything should work all the time, only to be frustrated when it inevitably doesn’t? Today, Kirk Behrendt brings back Dr. Jim Otten to explain that very problem and how you can think better and enjoy your career in dentistry more. Everything works until it doesn’t, so learn how to focus on the outcomes and push through the difficult times by listening to Episode #617 of The Best Practices Show!

Episode Resources:

•  Send an email to learn more about Global Diagnosis Education
• Dr. Otten’s Facebook
• Dr. Otten’s social media: @jamesottendds
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here 
• Get the Best Practices Magazine for Free! 
• Write a Review on iTunes

Links Mentioned in This Episode:

Register for the Global Diagnosis Symposium

Learn more Global Diagnosis Education

Main Takeaways:

Be curious and ask questions.

Your dentistry is going to fail eventually.

Don’t copy someone else—just be you.

Focus on the outcomes.

Define what success means to you.

Work hard and put yourself out there.

Quotes:

“It's important because we come out of dental school with a perfectionist mindset, and it's perpetuated in our profession by a lot of different things. It's perpetuated by a lot of myths that if you build this facility, they will come to you and you'll be successful. If you use this technique, you'll be successful. If you follow this protocol, if you go to this course and do this curriculum, you'll be successful. And everything works to some degree, But it doesn't at some point as well. And so what your mindset has to be is not in this perfectionism like the outcome’s going to be exactly the way you think it's going to be, but what you learn along the way.” (07:21—08:04)

“Jack Nicklaus used to say when he played a whole round of golf in a competition; the three or four days they play, he only hit two shots pretty much the way he wanted. He missed everything well. So our job is really to miss it well and realize that it doesn't matter what you use, who you follow, what material, what clinician, what protocol you use. You're still dealing with people who have a certain amount of their own particular disease resistance and host response, and they're all going to be different. You can't take responsibility for that. That's not your responsibility. Your responsibility is to help them decline at the lowest rate possible. And that means that they're going to decline. It's going to fail.” (08:06—08:51)

“Be a student, not an acolyte. No one has all the right answers. Everyone has a bit of information to help you move forward.” (10:30—10:43)

“You can emulate characteristics and philosophies that you think can work for you, but if you're trying to copy someone else, you'll never find the right mix of things to unleash your creativity and your potential. You've got to be you; just be you and do what you think is best for you.” (12:27—12:47)

“If you decide, for example, that you want to differentiate yourself and you want to specialize and become fee for service, you want to really build enormous value for your clients. You still have to feed the animal, right, still have to feed the bulldog, still have to feed the practice, so how do you do that? Well, [Steven Pressfield] talked about writing the book that you want and writing the book that sells, and if you think about it in two concentric circles that overlap, it's the part in the middle. How can you find that area right in the middle where those things overlap? And it's the same in dentistry. Can you have that overlap somewhere where you create value, for what you want to do, but it still has the capacity to help your practice move forward?” (13:53—14:38)

“You really want to have the mindset of giving yourself enough space in your work time to pay attention to the outcomes that you get. Why does this work? Because if you're the type of dentist that's looking at just the means to get somewhere, then you're going to miss the real essence and the real value in helping your patient move forward.” (15:37—16:01)

“I remember I was coming out of dental school and said, ‘My goal is to do my crown and bridge so well that in my entire practice, people never have to replace it.’ You know, there are a few that worked, but there were a bunch that didn’t because you can't control everything. But I started to pay attention and thinking, ‘Well, that was a dumb idea.’ Why are they failing? Let's figure that out so that what we're really doing is we're slowing the decline of the individual over time. How do I slow their decline to the lowest rate possible? If you pay attention to the outcome and you learn from the failures, they don't have to be catastrophic failures. But why do they keep chipping this? Why does this happen? Then you start to look deeper and deeper, and you really start to pay attention to really what are the fundamental issues that are going on here that you really can become a great diagnostician and really help them become healthier, not just fix their teeth.” (18:17—19:17)

“What you have to realize is that through every one of those failures, you at least became a little bit better. That's the key. If you can become a little bit better, become a little bit better diagnostician, you could become a better historian, essentially, understanding the patient that you're dealing with. If you can become a better practitioner, a sense of organizing and planning treatment in ways that make it work better. You get a little bit better and that's how you learn, really. You know, you don't learn much in the stuff that goes really well.” (20:06—20:42)

“You have to be curious and pay attention to these outcomes and realize that you'll have failures. They don't have to be catastrophic failures. But just pay attention to the little nuances that happen so that you can be a little bit better, a little bit better, a little bit better. Excellence is improving just a little each step.” (22:39—22:57)

“We tend to focus on ‘Oh, we have to be like this, or we use this or we're going to be like this person,’ then that defines success. Or, you know, ‘I've got to be able to do 2 million a year right now.’ These things that just sometimes are ridiculous and create enormous amounts of pressure on people that it really doesn’t have to be that way.” (25:08—25:33)

“And certainly we have to have a successful profitable practice to have that comfort and be able to provide for our families and provide for ourselves. Some people would define [success] as more freedom. Some will define it as the ability to help others.” (25:50—26:06)

“If you determine your why, then your success can be an outcome of the why, not the opposite way around. There's one saying that really sticks with me too, and I don't know where I heard it. They said, ‘If you're always focused on the means, you're going to miss out on the need.’ So if you're always focused on a means to get to $100,000 a month, $150,000 or whatever it is, and you’re always focused on the dollars, you’re always focused on the profit, you’re always focused on the production, you miss out on the meaning. What's the meaning? What brings meaning and joy to again, write the book you want to write, not the crap that has to sell. And anyone can do it. With enough intention, anyone can do that. I say that because I believe that whatever your definition of success is, however you define it, it always takes three things. It always takes hard work, some luck, and some talent.” (26:10—27:11)

“Anything worth doing takes hard work. It takes the ability to absorb that failure we talked about and learn from it and move to the next level. And it takes some luck. Sometimes things just fall together in the right place at the right time. But that doesn't really happen unless you're putting yourself out there. If you're not in the game, you're not going to get those opportunities.” (27:56—28:20)

“If you put it out there, then these opportunities are going to present themselves. And then when they do, you have to try to be aware of them and take advantage of them and go back and do the hard work it takes to take advantage of it.” (30:54—31:07)

“Great teachers are the ones who recognize something in you that you don't see in yourself, necessarily. And I was the recipient of that. And so now I try to be the purveyor of that, but I'm the purveyor of that to the people who really want to learn, who really are taking an active role.” (31:16—31:38)

“In dentistry, you can develop talent. You really can. Now you've got to realize also that everyone has gifts and strengths and certain subsets of strengths that they have that are unique to them. I'm a big picture guy and philosophical thinker. So my talent is to kind of put big things together and put the ideas together and try to make them all merge and help people see the connections in between things.” (32:13—32:49)

“Everybody has their own innate talent, but you can develop that. If you don't have a talent in something, if you're self-aware, then you can develop those sorts of things. And that's an important thing as well. When you've got it, that self-awareness is really important to realize ‘This is who I am. This is where I want my life to look like, how I want to manifest it, what do I want them to say at the eulogy?’ I don't want anybody to say at my eulogy, ‘Oh, he did $1,000,000 in 1980’—no, that doesn't matter. ‘He made a difference in somebody's life. He helped somebody learn something, helped somebody move to the next level, he made the profession a little bit better by teaching these other people along the way.’ And that's what really matters, is what are you doing every day to get out of your own head and help somebody else? Because if you're helping somebody else, and you’re helping somebody else grow and develop, you can't be in your own head. And that's how we get in trouble—when we’re in our own head.” (33:11—34:09)

“I think it's important just to keep [everything works until it doesn’t] in the back of your mind. It's one of those truisms that we all have to manifest in our own mindset. Don't try to hit the target perfectly every time. Just keep aiming and keep trying and push through. Even this week I had to push through some stuff that was tough, emotionally: coming to the end of clinical practice. I'm going to teach, I'm going to consult; so I'll be active. But coming to the end of that journey, it's the appropriate time, don't get me wrong. But it's an emotional struggle. But I've got to push through. There are bigger things ahead. There are better things ahead for everyone. And so you've got to just stay focused, work through the difficult times, take it easy on yourself.” (34:32—35:25)

Snippets:

0:00 Introduction.

02:11 Dr. Otten’s background.

07:10 Be a student, not an acolyte.

10:55 Find your own way.

14:38 Focus on the outcomes.

20:03 Learn from your failures.

23:31 Define what success means for you.

27:15 Luck doesn’t happen unless you show up and work hard.

31:56 Talent can be developed.

34:25 Last thoughts.

35:34 About Global Diagnosis Education.

39:02 Global Diagnosis Symposium.

Dr. Jim Otten Bio: 

Dr. James F. Otten is a 1981 graduate of the University of Missouri-Kansas City School of Dentistry. He completed a one-year residency in hospital dentistry with emphasis on advanced restoration of teeth and oral surgery at the Veterans Administration Medical Center in Leavenworth, Kansas. He taught crown and bridge dentistry as an Associate Professor at UMKC before entering private practice in 1982, where he served as Chief of Staff of a large group practice in Fayetteville, Arkansas, before opening his practice in Lawrence, Kansas, in 1984. 

Dr. Otten has pursued rigorous post-graduate education since 1986, accumulating thousands of hours in advanced continuing education that he has intentionally applied to his practice in order to develop its personalized care philosophy. He has completed the rigorous curriculum at two prestigious institutions, The Pankey Institute for Advanced Dental Education, and the Dawson Center for Advanced Dental Education. He lectures nationally and internationally and has recently been asked to join the faculty at the Newport Coast Orofacial Institute in Newport Beach, California. 

Dr. Otten has been named a Fellow of The American College of Dentists and is an active member of The American Academy of Restorative Dentistry. 

In pursuit of excellence, Dr. Otten has gained a considerable reputation, both regionally and nationally, for his expertise in disorders of the jaw joints, as well as crown and bridge dentistry, implant restorations, complex bite problems, removable and partial dentures, and naturally beautiful esthetic dentistry. 

A Case Against the Implant

Episode #616 with Dr. Bill Robbins

More and more people have dental implants, and that number keeps growing. But is it always the best option for patients? To reveal why some implants are problematic, Kirk Behrendt brings back Dr. Bill Robbins, co-founder of the Global Diagnosis Study Club, to make a case against some of the most commonly placed implants in “younger” patients. It’s the way we've always done it, but there’s a better way! To unlearn what you've been taught about implants, listen to Episode 616 of The Best Practices Show!

Episode Resources:

• Send Dr. Robbins an email
• Join Dr. Robbins on Facebook
• Learn more on Dr. Robbins’s website 
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Learn more about Global Diagnosis Education

Register for the Global Diagnosis Education Symposium (September 7-9, 2023)

Sign up for Dr. Robbins’s lecture “My Failures and Lessons Learned”

Main Takeaways:

Don't get stuck in the “that's the way we’ve always done it” mindset.

Understand why certain implants will inevitably fail faster.

In some cases, implants should be the last option.

There are better options than implants. 

Treatment plan for the long term. 

Quotes:

“Dentistry can be a fairly dogmatic discipline. I've seen that through my 50 years, that people learn some piece of dogmatic information, and they learned it maybe in dental school, and they've continued to believe it, repeat it, and do it dogmatically — and they'll fall on their swords for it. That's true, especially with younger dentists. They come out of dental school. They believe that they had a great dental education, and really wonderful faculty, and because their faculty taught them that, it's got to be true. And it may not be true, or it might be partially true. But they live with that partial truth for the rest of their lives, and they never really are open to asking the question, ‘Is this really true? Is this really the best way to do it?’” (5:07—5:58)

“Implants have been available to us in our profession for about 40 years. As we all know, they've been incredibly successful. It has become the go-to way to replace missing teeth all over the mouth, and certainly in the anterior maxilla. Through my many years of being involved in the placement of implants in the anterior maxilla, I have become more and more reticent to place them in the anterior maxilla, for reasons we're going to talk about. In the last five or six years, my statement has become this: I do not treatment plan single implants in the anterior maxilla in the young adult.” (6:43—7:31)

“I'm still fairly active in my practice, and I get referrals commonly from a patient or a dentist who has told this patient, generally an orthodontist, that, ‘We're going to align your teeth to your implants. When you get to be 18 or 19, you'll go see Dr. Robbins. He'll put an implant in, and that will replace your upper missing lateral incisor.’ That's what I did for many years. And then, I started looking at some of the long-term results of my implants in the anterior maxilla. About ten years ago, I started developing a concern about this. And, by the way, I'm not unique in this. We're starting to hear more and more from the podium speakers saying, ‘We need to take a closer look at implants. They're not doing as well as we thought they might be doing long term. We need to be a little bit more analytical about the placement.’ So, I'm not the only one that's saying this. I'm just one of the ones that's carrying the banner right now.” (7:38—8:41)

“I started making the transition away from replacing especially maxillary lateral incisors. It's a very common tooth to be lost for two reasons. First of all, it's the second-most common tooth to be missing, genetically. It's just not there. The other is trauma. It's a very common tooth to be avulsed and lost during those formative years between the years of, say, eight to 14. I used to replace those lateral incisors routinely with an implant. I had concerns about it, but we didn't have a good solution to the problem until a number of years ago. For me, it was about six or seven, and that is the bonded bridge . . . The bonded bridge has become my go-to replacement for the maxillary lateral incisor.” (8:43—9:42)

“We were traditionally taught that using either wrist films or serial cephalometric X-rays that are overlaid over each other, starting at about age 18, you could tell whether or not a person's growth was complete. Once you can confirm that their growth is complete, then you can feel comfortable placing an implant. Generally, that was in the range of age 18 for females, and around age 21 for males. Those were the common ages that we were given. And so, we were told you can do these wrist films or cephalometric X-rays that are overlaid to determine if it's now finally the time to place the implant. Well, it turns out that neither of those are predictors of whether or not growth is complete.” (11:06—11:52)

“This is a lovely young woman in my practice that was 20 years old. We confirmed that her growth was complete, so we placed an implant in the number seven site replacing a lateral. She was missing a lateral and a canine on the other side, so we placed an implant in the canine site and put a pontic off the canine. So, two implants replacing three teeth, 2004. I saw her back on recall through the years, but didn't pay really close attention up until 2019, which is a 15-year post-op on her. It looked like, to me, things were changing. And so, I took a photograph of the way she looked in 2019. I had a wonderful photograph, exactly the same magnification that was taken in 2004. When I put those two photographs up next to each other, there had been tremendous changes in this young woman in 15 years.” (12:01—13:00)

“What happens [with single-tooth implants] is if a patient grows, the maxilla grows down vertically, and the teeth move with the maxilla as it grows vertically — but the implants don't. They are like an ankylosed tooth that stays in the same space as the other teeth continue to grow. In this period of 15 years, her other teeth, adjacent to the implants, had grown vertically more than two millimeters, compared to the implant. It was becoming obvious now that her implants were no longer in the correct positions in her face because her maxilla had grown vertically and brought teeth down with it, but the implants didn't move with the maxilla. So, the implants are high. The edges of the implants are three millimeters apical to the edges of the adjacent teeth. The gingiva is also in the wrong place because the implant holds the gingiva up. So, this was a seminal turning point for me when I finally came to the conclusion that it made no sense to use implants to replace missing single anterior teeth in a young adult.” (13:01—14:13)

“Now, let me make a caveat here. I'm not talking about a patient that's missing a bunch of front teeth either due to trauma or agenesis. We don't have a good solution for those people other than implants. So, I'm talking about the single tooth that's missing in the anterior maxilla. I no longer believe in the young adult — and when I say young adult, I'm talking about 20, 30, 40. I don't think we should be putting single implants in until other ways have failed. That's my whole point today. If things that are available to us have failed, then we can move to the implant as the last treatment option. But the implant is, by far, the most aggressive way to replace a tooth. We have much more conservative ways. That's my belief system today.” (14:14—15:07)

“The second thing that happens to implants, long term, is the tissue tends to thin over the implants with time. As it thins, the color of the implant and the abutment starts to show through, and now you can see the grayness or blueness under the tissue. It's a giveaway that this is not a natural tooth. The other problem is that as we age, the maxilla moves back in this direction. If the implants are here, and the maxilla is moving more centrally over 20, 30, 40, 50, 60 years, the implants are no longer in the correct position. They're facial to the rest of the bony housing. So, I think the important question we have to ask is, when we replace a missing maxillary lateral incisor with an implant when the patient is 20 years old, how long does this have to last? Assuming that the person we place it in doesn't have a major illness by the time they're age 70, there's a very high probability they'll live to be at least 100. So, we're expecting this implant that we're putting in on a 20-year-old to serve them successfully for another 80 years. My question is, what are the chances? And we don't have the data. We clearly don't have any 80-year data on implants. But I think our hearts tell us what the answer is. And the answer is, in a lot of circumstances, this implant has not a chance to be successful for the next 80 years, first of all, because of growth. Secondly, because of tissue thinning.” (15:08—16:52)

“I had another seminal patient recently in my practice. This patient, we placed implants in number nine and number 11, and did a three-unit bridge when he was 80 years old. Eighty years old, two implants in the central and the canine, a three-unit bridge. I recently saw him on a 15-year post-op. This gentleman is now 95. He's still a really cool guy, a wonderful person to be around. The edges of his implants were up here, and the edges of his natural teeth were down here. So, not only do we not know who is going to have late growth, because it doesn't happen to everybody, but we don't know how long it's going to occur. This gentleman had vertical growth of his maxilla from age 80 to age 95. And so, these patients that I'm taking a close look at are making me very nervous about not only my patients, but the whole world of dentistry that are putting in tens of thousands of implants in the anterior maxilla every year with really no thought of the long view. We have to do our dentistry with the long view.” (16:53—18:07)

“When I first started [my lecture, “Failures and Lessons Learned”], it made me a little nervous because I'm standing in front of a group of dentists that are the referrals of the surgical specialists, and I'm saying, ‘I absolutely believe we should stop placing implants in the anterior maxilla in young adults.’ But here's what I found very interesting. Over the last four years, I've probably presented this lecture 50 times. Never have I gotten pushback from the surgical specialists. And my case is a really strong one. It's a very strong case when I go through the literature of the point I'm trying to make. So, there may be some that are not willing to argue the case because I've made a strong case. But most of the surgical specialists say, ‘I absolutely agree.’ So, it's interesting. Even though they have all continued to put implants in the anterior maxilla, especially the lateral spot, when I bring it up as a subject to be discussed, I almost never get any disagreement from the surgical specialist. And so, I really believe the profession is open to hear this. I believe that it has become an automatic response to a missing lateral incisor. You put an implant in when the patient is 18 or 21. It's “just the way we've always done it.” So, it's not necessarily that everybody believes it's the best. It's just the way we've always done it. And the other problem is, our profession is not really up on the alternative treatments. And, of course, you can't just talk about the problem. You’ve got to talk about the solutions.” (19:51—21:33)

“Another problem is mechanical failure of the implants. Everybody that has done implants has dealt with broken screws and broken implants, and there are more and more of those issues to deal with because we have more implants in the head now. It's the worst call ever, as a restorative dentist, when you get a call and your front office person comes and says, ‘Mrs. Jones just called, and her implant crown is loose.’ Ugh, that's the worst because you don't know if the implant is loose, or if the screw is broken. The majority of the time, it's not the implant, it's the screw. And as a restorative dentist, you don't know how long it's going to take to retrieve that screw, or whether you're going to be able to retrieve it at all.” (21:40—22:24)

“Here's one practice management trick. When you have a patient in to deal with a broken screw in an implant, it should always be the last patient of the day. You don't want to get them in at 1:00 or 1:30 and get into it, because once you get into it, you can't quit. It's an anterior tooth. You can't send the patient home without some replacement. So, you may be diddling with this all afternoon, and you don't want to foul up your afternoon. It must be the last patient of the day when you start to try to retrieve a screw.” (22:24—22:58)

“The fourth problem is an interesting one, and it's a new one to the profession. In the last six or eight years, we've been starting to talk a lot about maxillary palatal expansion in adult patients. In the old days, the only way we could do that was with orthognathic surgery, SARPE, Surgically-Assisted Rapid Palatal Expansion, where you would have an adult patient with sleep apnea, a very narrow arch, all those issues we deal with every day. In the past, the only way we could widen the arch to make more tongue space and a larger oral airway was to do a complicated oral-maxillofacial surgery. Well, today we've got the ability, more and more, to do this palatal split more conservatively with many implant-assisted rapid palatal expansion devices. Up until recently, we could only do that in maybe up to 20-year-old males and 40-year-old females. But now, they're making custom appliances that go into the palate. And they don't have just four implants holding the appliance — they have six or eight. They're custom made for the patient. And there's getting to be a lot of reports now that we can do the palatal expansion on older males, which is very exciting. But the problem is, if the older male has an implant in the anterior maxilla, one of the four incisors, and the palatal split is done, the orthodontist can't redistribute the space to make it all work at the end because you can't move the implant. So, once we put an implant in the anterior maxilla, that inhibits the ability of our profession to ever do a palatal expansion on that patient. And as we get better at that and pay more attention to it, we're going to be doing a lot of palatal expansions on adults as we become more influenced by the airway part of dentistry. That wasn't a problem ten years ago. It's a new problem. It's going to be, I think, a giant problem because anybody that's got an implant in the anterior maxilla, we cannot do a palatal expansion on.” (23:00—25:17)

“As I start looking at the literature now in terms of problems with implants, I started looking at medications. It turns out that there are a significant number of medications that at least have a correlation with implant failure. I'm not proposing that it's a cause and effect. The data is not really strong on a lot of these medications. But there's a bunch of medications that appear to have a negative impact on long-term success of implants. For instance, SSRI, Lexapro, Prozac — all the mood elevator drugs. There is a relationship between implant failure and those drugs. There is also a relationship to vitamin D deficiency. There is also a relationship to proton-pump inhibitors. That is, omeprazole, Nexium. How many people in the world are taking large doses of Nexium? Well, there's a relationship between that and implant failure. Another one is allergy to penicillin. Who would have ever guessed that there would be a relationship between penicillin allergy and implant failure? But it turns out that it may not really be related to the penicillin allergy because many clinicians that place implants put the patient on a short course of antibiotics before the implants are placed. Amoxicillin is the antibiotic of choice. But if a patient is amoxicillin/penicillin allergic, then commonly, the next choice was clindamycin. It turns out that clindamycin is a very poor choice as an antibiotic prior to placement of implants, and there is a relationship between using clindamycin prior to implant placement and an increased risk of failure. And after having said all of that, then you've got genetic factors. There are clearly some genetic factors that lead to implant failure also. So, when you put all that together it becomes, I think, an anxiety-producing procedure, especially in the anterior maxilla. I'm much more comfortable placing an implant in the posterior maxilla or the mandible because the results of a failure are commonly hidden from view. But in the anterior maxilla, you can't hide it. That's the problem. There is no good way to hide it. And once the failure occurs, sometimes it's very, very difficult to recover from that failure.” (25:22—28:06)

“The final and most common reason that implants fail is periimplantitis. When we look at the literature, we can assume that of all the implants that we place across the world, somewhere between 25% and 50% of those implants will suffer periimplantitis. So, there are a lot of reasons for our profession to have anxiety about the placement of implants. And I think we should be more thoughtful in the future about where and when we place implants, especially in the replacement of missing anterior teeth.” (28:10—28:53)

“Implants aren't going away. We're going to be replacing missing teeth with implants forever because they're such a wonderful adjunct to what we do. But I'm talking about a much more specific circumstance, and that is single teeth in the anterior maxilla. I would hope that the implant companies would be open to the idea that we need to look at that. And if, in fact, replacing a maxillary lateral incisor with an implant isn't the best idea, then let's not recommend it there. Let's recommend other options and let's put implants in places where they're going to function the best. Now, I

1 Game-Changing Way to Save Your Practice Money!

Episode #615 with Miranda Beeson

Anyone who works in the dental world has felt the pain of rising costs—though we work harder and harder, we have to keep pinching pennies more and more. To help solve this problem, Kirk Behrendt brings back the Solutionist, herself: Miranda Beeson. Your money doesn’t have to be working against you, so learn how to get your supply budget under control and your money working for you by listening to Episode #615 of The Best Practices Show!

Episode Resources:

• Send Miranda an email
• Follow Miranda on Instagram
• Email Gina for a copy of the ACT Dental Financial Gaps Calculator
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
•  See our Live Events Schedule here 
• Get the Best Practices Magazine for Free! 
• Write a Review on iTunes

Links Mentioned in This Episode:

Episode #575 of the Best Practices Show: “How to Calculate Your Overhead in 60 Seconds,” with Dr. Barrett Straub

Main Takeaways:

Costs are on the rise, so you need to get your money under control.

If you don’t tell your money how to work for you, it will work against you.

Inventory what you have.

Set a supply budget.

Track what you spend.

Make sure there’s accountability.

Work with your rep to get a price comparison on your top supplies.

Evaluate and re-evaluate your ordering system often.

Quotes:

“Anyone who's listening, who works in the dental world and practice owner, you have felt that pain over the last couple of years. We're pinching our pennies harder and harder as time goes on and if we aren't moving forward and keeping up with those trends, then we're ultimately moving backwards. So we want to make sure that we're doing things within the practice to keep up with those changes and the costs going up within just society in general with our economy. If you don't tell your money how to work for you, then it's going to take over. It's going to control you. And at the end of the month you're sitting there going, ‘Oh man, I feel like I worked so hard and I thought we would have more in the bank than this.’ And so if we can get control of that and tell our money how to work for us in the practice, then we're going to be happier in the end and we're going to feel a little less stressed and maybe even take some more vacations throughout the year and reward our team a little bit more.” (03:04—03:54)

“If you have a plan for your money and you're telling it how to work for you, you're going to end up better in the end; you're going to have a little extra in your pocket at the end of the day or at the end of the month. You have to make sure that you're in charge—don't let your money control you.” (04:41—04:56)

“One of the gaps is our overhead gap. And how can we shrink that gap to help save the practice money and become more profitable? And one of the pieces of that overhead gap—and it's a piece that we can share with our team because they contribute to this—is our supply budget. And our supply budget should be around that 5% mark of our overall budget. And so if you're consistently at 7 or 8%, it doesn't seem like it's that much more, but when you look at 7 or 8% of $1,000,000 or multimillion dollar practice, like that's a lot of money throughout the year. So that's where those small changes really come in to making big impacts.” (05:46—06:26)

“So when we're looking at our supply budget, the first thing that I have teams do is inventory what you already have. So go through every single operator and do some spring cleaning. Usually there's things tucked away. There's an assistant who is like, ‘Man, my doctor uses this so often, I'm going to keep a couple extra in here so that I don't have to hunt down or fight Suzy for it.’ So first things first, inventory your operatories; do a good clean sweep and get everything standardized. Not only is that going to help you to find materials that you may have in the practice that you don't realize you have—maybe you think you're out of. It's also going to help you standardize and make your flow more efficient when your rooms are now clean and set up and functioning just like one another throughout the practice. But the big factor is you're going to find a lot of gems when you go through and clean out your operatories.” (06:26—07:19)

“A lot of offices will just have a list. That's kind of their ordering system. They have a list, a clipboard or dry erase board or something in a general space. And when someone realizes, ‘Oh, we're out of this,’ they write it on the list, and then that's how they decide what gets ordered. But are we really out of that? We might have seven of that object, that item spread throughout our operatories, and we just don't know because we're keeping this back stock or we're hoarding things.” (09:08—09:34)

“What I really love, as well, that I've had the opportunity of using when I was in practice was a barcode scanner ordering system where you can have the item barcode right there in front on the shelf in front of whatever it is, and you just have a little scanner. And when you see you've hit that threshold of two or whatever you decide that it is, all you have to do is grab it, scan it, and now whoever's doing your ordering, when they go in to order from their supplier, it's already uploaded right off of that scanner and everything's there and it'll highlight duplicates for you and help do some of that work. So we want to work smarter, not harder for sure. We don't want to make this a bigger job for someone than it needs to be. We want to make it an easier job for somebody and a more efficient process in the practice.” (12:33—13:17)

“So really you want to look at your previous month’s collections . . . if you're looking at the month that just happened, then you want for last month's supply budget to be within 5% of your overall spend. However, you don't know what your collections are going to be for this month. So how do I predict 5% of this month? Well, we're going to base it off of last month because that's the most predictable, closest way we're going to get to knowing. So we'll look at last month's collections and that's going to guide our budget. So we're going to take whatever we collected last month. 5% of that will be our max budget for this month when we're placing orders. And so now whoever's responsible for your ordering, or if it's you as the practice owner, you know, ‘I have this much money, $12,000, whatever it may be, to work with this month. And when I hit that limit, I'm done spending.’ That's the key, right? It's not just setting the budget, but stop when you hit that budget. You want to make sure that you align with your team around this and that they know. If you're not the person doing the ordering, you have to share with the person who's doing the ordering what that budget is and why, so that they know and can be responsible to stay within the expectations of that budget.” (14:13—15:30)

“If you don't have a budget set up within your practice, it may just be that, you know, maybe you don't know what the budget should be; what is our profession's industry standard for what the budget should be around that?” (16:10—16:24)

“If you set the budget, that's great. But how do we know if we're staying within that budget? And there's a lot of ways that you can do this as well. And it's really pretty simple. So one of the tools that we use is a supply budget tracker where we look at collections from last month. Okay, what's 5% of that? That's going to go right at the top of our supply budget. And now we know we're working down from there. Everything that we order throughout the month, we need to track and determine how much we have left to spend next.” (18:32—19:09)

“You want to double check [your invoices] just like you would if you go out to a restaurant and you just do an eye test, you do a glance over, ‘Did I buy extra beer? No. Okay, good. I'm going to go and take care of this.’ Let's just look at your invoices, make sure you're on track, but then look at where you are compared to your budget for the month. And have you hit that budget?” (19:21—19:39)

“Every supply ordering system that you develop should have a little contingency plan at the end. A Plan B, ‘When we hit max, what do we do?’ And maybe it's, ‘Okay. I go to my office manager or I go to the practice owner and we talk about we've hit budget, but we are going to run out of gloves before the next month.’ Great. Now they may stamp approval for you, but they're going to be intentional about that decision. You're going to think it through instead of just swiping the card and getting more.” (20:05—20:33)

“There are things within the practice that you could probably get a generic version of or another brand of, or maybe something’s on sale this month. So there's also that mindset around exploring new things and having an open mind to trying something new. So when you're tracking what you're spending, part of what you should be tracking is looking at how much these things cost. Look at each item at some point, maybe not every time, every month, but looking at ‘What am I really spending? Oh my goodness, prophy paste is how much? I bet I can find a comparable that saves me half the amount of money.’ And I bet you can too, because I've seen it happen. I've seen teams do it.” (22:42—23:23)

“[When ordering from supply chains] you can set parameters within their software. So if you're a practice owner and you have an assistant who's responsible for ordering, you can set a max that alerts you. ‘Once we've spent this much each month, send me an email so I know we're close to budget.’ So now as the practice owner, I don't have to worry about ordering. I have delegated that to someone else that I trust. However, if we're getting close to budget or if we hit budget, I can get alerts in my email and now I know I need to work a lot tighter with my ordering coordinator until the end of the month to make sure we're staying on track for that target.” (23:47—24:23)

“But if you don't try new things and experiment, then you might [not] find something that you really, really do like—you like it even better. And guess what? You saved the practice some money on that new product as well.” (27:48—27:59)

“Work with your rep, let them know, you know, you can request, ‘Hey, here's what I'd like to do. I'd like to have a list of the top products that we ordered last year, maybe the top 25, top 30 products that we ordered last year. And I'd really like to do some cost comparison,’ and have them help you with that. They can do that for you, and they will do that for you.” (28:25—28:44)

“Evaluate and reevaluate your ordering system. Hold yourself accountable. Hold your team accountable to the budget and revisit that over and over again. You're going to want to revisit it month by month by month, and then check in with your team quarterly.” (29:24—29:40)

“You always want to know where you're at—have meetings monthly or quarterly with your ordering coordinator to make sure you're in alignment and then just keep the whole team communicated with throughout the process and getting their feedback. But just don't set it and forget it. ‘Okay, we set up an ordering system, now Susie is going to run with it,’ but Susie might fall off a little bit with that too, because she got really busy last month and if you're not checking it, she's never going to be held accountable, so then it starts to be less important for her. And Susie's got a lot of priorities in the office and for this to maintain as a top priority, she has to know that it's something that's a top priority for you, the practice owner. So we have to have repeated accountability and evaluating that system to make sure it's working for us.” (29:44—30:29)

“It's one of the easiest things that I think practices can do to make an impact with minimal effort and not really having to affect other things within the practice. A lot of the things that we do and coach with teams, they do have ripple effects into other areas of the office. This is something that's pretty streamlined and you can jump into it quickly. You can make an impact within a month's time, and it really doesn't have a ripple effect on much of anything else in the practice. So it's an easy go-to to start saving money month by month.” (30:37—31:11)

Snippets:

0:00 Introduction.

01:42 Miranda’s background.

02:45 You control your money; your money doesn’t control you.

05:26 Step 1: Inventory what you have.

07:18 Keep your cabinets clean.

09:03 Don’t rely on “the list.”

10:11 Organize your shelves.

13:36 Step 2: Set a supply budget and stick to it

16:07 There’s no shame in asking for help.

18:26 Step 3: Track what you spend.

20:33 The importance of the invoice.

21:49 Look for cost-effective alternatives.

25:00 Involve your team to control the narrative.

28:15 Final thoughts.

Miranda Beeson, MS, BSDH Bio: 

Miranda Beeson, MS, BSDH, has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches. 

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach. 

50 Shades of Grey: Strategies for Co-diagnosis, Early Treatment, and Patient Engagement of Periodontal Disease

Episode #614 with Angela Heathman

No one suddenly has a seven-millimeter pocket. It happens gradually, often without patients knowing it! Once you identify and diagnose periodontal disease, you also need to communicate it to your patients. To help you follow through with that responsibility, Kirk Behrendt brings back Angela Heathman, one of ACT’s amazing coaches, with strategies to facilitate co-diagnosis and getting them into the schedule. To start prescribing treatment for better health and a better life, listen to Episode 614 of The Best Practices Show!

Episode Resources:

• Send Angela an email
• Join Angela on Facebook
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Register for Katrina Sanders’s workshop (October 5-6, 2023)

Main Takeaways:

Have a common language for talking about periodontal disease.

Understand what co-diagnosis is and how to do it with patients.

Tell patients what to expect before their periodontal screening.

You have a responsibility to tell patients what you're seeing.

Don't wait for patients to have a seven-millimeter pocket!

Quotes:

“It's really important, I think, to start with figuring out the language you guys are going to use when you're talking about periodontal disease. Everybody needs to be using the same language, using the same visuals, understanding that we're going to go through a co-diagnosis with the patient, doing intraoral photos. We have to really figure out how we're going to diagnose and talk to our patients before we start talking about treatment at all.” (5:19—5:45)

“It’s funny, sometimes I talk about the mouth, and then the patient. It's really easy to diagnose the mouth, and then it gets a little bit more complicated when the patient comes into it. And then, we have to think about, ‘How are we going to communicate? How are we going to explain? How are we going to diagnose?’ and everything. But you're right, Kirk. First, we have to think about if this mouth walked in, what would the appropriate care be for this pocketing, this bone loss, everything that we're seeing? So, if we can get really clear on that using staging and grading and very objective criteria, then we go into the second part, working with the patient, a little bit easier if we're completely aligned on that part.” (6:20—7:02)

“The first part is having everybody in the office figure out how to co-diagnose with their patients. When I say co-diagnose, I don't want to be telling the patient after I've done a perio exam that they have periodontal disease. I want to let them in on the signs, symptoms, things that I am looking for when I'm looking in their mouth to check for periodontal disease. So, I’m taking X-rays, I'm taking intraoral photos, I’m doing a periodontal screening, and I'm saying the numbers out loud. So, if I can include the patient in that, then they already know that we're going to have a more serious conversation when I set their chair up.” (8:50—9:30)

“[Saying pocket numbers out loud] makes people sometimes feel awkward. When I say people, I mean hygienists, at heart. We might all agree like, ‘Oh, yeah. Definitely, patients should be involved in this diagnosis.’ But then, when it comes to like, we're going to have to say these numbers out loud, we're going to feel silly when we're calling out the numbers — we have to get over that, and we have to agree this is the best thing for the patient, and this is going to help their understanding of their disease. Because I've been in offices too where we talk and we agree, ‘This is the way we're going to do it. We're going to say it out loud.’ And then, we go to patient care and it's like, ‘Oh. Well, I didn't want to say the numbers out loud this time because I didn't have an assistant to write them down for me,’ or, ‘I didn't have any voice-activated software or anything like that.’ It's like, no — that's not the reason why you do it. You do it for the patient. So, it's not silly to do that.” (10:38—11:34)

“It saves a ton of time for the hygienist too if they tell the patient what they're going to be looking for before they start the periodontal screening. So, I would always say to my patients — and this is while I have the chair up, ‘You're going to hear me call out numbers. I'm going to say one, two, or three is healthy. Four is borderline. Five, six, or seven is a sign of infection.’ And I'm using the word infection because that's what it is. I'm not saying “is a concern” or anything like that. No. Five, six, seven-millimeter pockets is a sign of infection.” (11:36—12:15)

“Also, I would say, ‘If you hear me say the word bleeding, then that's also a sign of infection.’ And so, if I would explain to the patient what I was going to be looking for before I would see them, then as I'm going along doing my perio chart, even if I'm saying them out loud — I know it seems like it’s to myself, but really, it's to them. And it's three, two, three; three, two, three; three, two, four; five, two, five. Then, I'm going through the whole mouth, and then I'm sitting the patient up at the end, and they're the ones asking me, ‘Oh my gosh. What do I do about that?’ So, that's how it saves me time. Even though it might seem like it takes a little bit longer, it really saves me time at the end.” (12:16—13:00)

“I would even go as far as explaining, ‘I'm going to use a small ruler. I'm going to measure this space,’ because if you don't explain those things to the patient beforehand and you try to do it the opposite where you're telling them afterwards, then they're going to say, ‘Well, of course I'm bleeding. You were poking me.’ So, I think it's really important to set the stage from that standpoint too.” (13:42—14:08)

“Sometimes, patients come into our chair thinking that they're going to get a routine prophylaxis. And mostly, that's because that's what they scheduled for, and that's what we've done the last ten years. But that doesn't mean if what we're seeing today is different that we have to go through with that plan. The plan can change. If we're seeing that gum disease, periodontal disease is progressing, we can stop, pause, and have that conversation with patients. And that's what I see a lot when I'm working with hygienists — and I've been guilty of this myself. I've done it a hundred times where it's really easy to not mention it. It's so easy to stay on schedule and not upset the patient and not upset the admin team that I'm throwing more services in if I do what is on my schedule. That's super easy, and we all do it. But that's not the best thing for the patient's health. And so, that's what we have to focus on is, we might have to shift that appointment. It might not be a preventative prophylaxis anymore. We may need to enter treatment, or therapy, or whatever you want to call your periodontal treatment. We might have to shift into a different mode and stop and talk to the patient about that. And if the patient understands, then the best thing that we can do is to start treating that today.” (14:28—16:02)

“In the office that I worked at for many years, our admin team did an excellent job at setting that stage from the initial phone call that [a cleaning is] not the type of appointment that they were scheduling. They did a really good job at explaining that the doctor was going to do a thorough, comprehensive exam. We were going to take a full set of X-rays. And then, we may or may not get to this piece of it. There were still folks, though, that came into my chair with the, ‘Well, I just want my teeth cleaned’ attitude, even though they had already been told, and they got through our gatekeeper and ended up on our schedule. So, that would absolutely happen. But I could diffuse that pretty easily by saying to the patient, ‘This is all the stuff I'm planning on doing today.’ And then, I would broach the subject before they would. I would say, ‘I know that you told Judy upfront that you wanted to get your teeth cleaned. However, if I find during my assessment that we need to spend time talking about any disease, cracked teeth, or things like that, is it okay with you that we spend our time addressing those things?’ And the patient is like, ‘Well, yeah. Of course!’ I trail off and wait for their response. Every once in a while, like one out of a hundred, there would be like, ‘No, I just want my teeth cleaned.’ But usually, when you led it like that, they were very cool like, ‘Well, yeah. That makes sense. We need to spend time talking about disease or fractured teeth. For sure, we should do that.’ And then, the one out of a hundred or whatever, I would say, ‘Okay. Tell me a little bit more why this is so urgent that you want to have your teeth cleaned today.’” (17:32—19:38)

“I remember this one lady in particular that had really bad perio. She had a wedding that weekend, and she said, ‘The reason why I came in is I don't like this stain. I don't want people to see that my teeth are brown.’ I'm like, ‘Oh, okay. Well, I can polish that off.’ So, I polish that off. And then, a few days later, she came back. We did — it was quite a series, four quads of scaling and root planing. So, sometimes, a no isn't that they don't want the service. They just might have something else that they're thinking is most important. It's very rare that someone says no to rescheduling the prophy part, if that's really what they came in for.” (19:45—20:33)

“That's the problem, is that we don't even always offer [treatment]. Sometimes, we just go, ‘Okay, this is what they're scheduled for, so this is what I'll do,’ and we don't pause and really talk to them about like, ‘Gosh, I'm starting to see changes that are not positive changes. I'm seeing things that I'm not liking here.’” (21:01—21:21)

“You have a responsibility to let [patients] know what you're seeing. So, back to that co-diagnosis part, assuming they are part of that and are understanding, then we have a fork in the road. We have to decide, are we going to treat this today in the patient's best interest? That's what we should do. Or are they on the fence, and for some reason they can't do it today — they need to maybe have a little bit better understanding of what's going to happen if they don't treat this, and things like that. That's what I call delayed treatment. But I'm really big on still putting that treatment into the treatment plan and planning on, ‘That's our next visit.’” (21:53—22:44)

“[Clinicians will] kind of threaten the patient, for lack of a better word, with, ‘Okay. Well, if you don't want to do this today, you need to go home and floss better, and use all these interproximal aids.’ And then, they'll say, ‘Next time, we'll recheck it.’ And I want to argue, well, what are you going to be rechecking? They haven't been flossing in ten years. Like, all of a sudden, we're threatening them, and then we're going to recheck. What we're going to find is they're going to look exactly like they did today. And so, I like to put that into the treatment plan because if we plan on it, then we can move into that type of appointment really easily next time. But if I don't, if I just schedule them next time for a “prophy” to “check” and see what they look like, I'm going to discover that they look the same. And then, I'm going to be complicating the appointment with needing to grab the admin team to go over financials. I probably don’t have enough time in my schedule today.” (22:47—23:48)

“I like to plan ahead. If they're not looking like they're going to do it today, I want to plan and assume that that's what we'll do next time. So, I might be scheduling 90 minutes for their next appointment, and I'm going to have the admin team go over financials so that when they're in my chair in three months — and I said three months because I always see that also too, like, ‘Oh. Well, we'll just keep you on six months.’ Like, no! You just told them they have periodontal disease. They need to come back! Today is best, but second best is three months from now. So, I want them to have that expectation so that next time, in three months when they come on my schedule and I check to see what things look like and they look the same, then I can go right into that procedure that I was planning on doing, and they're already prepared financially. They're already prepared with the time, and it's really easy to transition those patients.” (23:49—24:54)

“What we do is very serious. It's not “just a cleaning”. And it's really interesting when I go into the offices that we coach because I'll have a room full of hygienists, assistants, administrators, and I'll ask, ‘How many of your patients look like this?’ Or I'll ask them, ‘What does a healthy patient look like?’ And then, they'll give me all the words, and then I'll switch and say, ‘Okay. How many of your patients looked like that yesterday?’ And they'll say, ‘Oh, I don't know. One, maybe. We had that kid who was home from college. He was healthy.’ And that blows the admin team away because then they're sitting there thinking, ‘Well, wait. I charged out prophys on everybody. And now, I'm hearing today that the hygienists are saying that they weren't actually healthy?’ So, I think that that's really interesting.” (26:34—27:36)

“It’s so important that we realize that we are treating the patients’ infections and we're keeping their mouths healthy. It's not just that we're cleaning their teeth. Especially — you mentioned Katrina [Sanders]. She talks a lot in her course about systemic health, risks, and complications, and we play a really important role in that. I think that we have to remember that sometimes.” (27:44—28:15)

“No one comes in and gains 30 pounds in a year — well, maybe some people. But it's the same thing for perio. Nobody goes from a three-millimeter pocket to a seven-millimeter pocket. Maybe with a crack or something like that. But, for the most part, it happens very gradually. I feel like that's the way weight gain happens too. It's a pound this year, a pound next year, a pound the year after that. But if our physicians don't recognize like, ‘Hey, Ange. You're 10 pounds heavier than you were ten years ago when I first started seeing you,’ and she never has that conversation with me then, all of a sudden, I'm going to be 50 pounds bigger. Same thing with perio. If we aren't telling the patient like, ‘I'm noticing that this three-millimeter pocket is bleeding. I'm noticing that now it's a four. Now, it's a five.’ If we aren't talking about these small, incremental changes that we're seeing and, ‘Oh, now you have a three-millimeter pocket that's bleeding, but now you're diagnosed with diabetes,’ if we aren't talking about these slight changes that we're seeing every time they come in and we're just waiting for them to have a six or seven-millimeter pocket, then we're doing a disservice to our patients.” (29:21—30:39)

Snippets:

0:00 Introduction.

1:53 Why this is an important topic.

3:27 Use common language when talking about perio.

5:47 Have clarity around staging and grading.

8:30 Know how to co-diagnose with patients.

9:32 Provide examples of co-diagnosis to your team.

10:37 Get over the awkwardness of calling out numbers.

11:36 Co-diagnosis saves your hygienists some time.

13:42 Explain your process to patients in advance.

14:21 Start treating it today.

16:03 Use the word “healthy”.

17:32 How to navigate the “I only want my teeth cleaned” patients.

21:36 Put it into the treatment plan.

25:54 Prescription for treatment, explained.

31:23 About Katrina Sanders’s upcoming course.

Angela Heathman, MS, RDH Bio:

Angela Heathman is a Lead Practice Coach who works with dentists and their teams to help them accomplish their goals. She believes the hard work you do on your practice is just as important as the work you do in your practice!

Angela has over 20 years of clinical dental hygiene, dental sales, and practice coaching experience. When she transitioned from her role as a clinician to her role as a sales account manager, she realized both her passion for education and practice development. Angela holds a master's degree in dental hygiene education from the University of Missouri-Kansas City. 

The 3 Things I Wish I Learned in Dental School

Episode #613 with Dr. Jim McKee

Do you ever wish you could do things differently in the past to help your career? While you can’t get in a time machine, you can learn from the experiences of others. To help you with this, Kirk Behrendt brings back Dr. Jim McKee to offer you his advice about the three most useful things he didn’t learn in dental school. You can’t change the past, but you can learn from it by listening to Episode 613 of The Best Practices Show!

Episode Resources:

• Dr. McKee’s email
• Dr. McKee’s Facebook
• Dr. McKee’s social media: @jim.mckee.104
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here 
• Get the Best Practices Magazine for Free! 
• Write a Review on iTunes

Links Mentioned in This Episode:

Sign up for Dr. McKee’s Advanced Occlusion course 

Check out the Chicago Study Club

Main Takeaways:

Listen to your patients

Work with your team members

Set your fees differently

Structure your meetings to make them more effective

Your patients have to understand the value you provide

A restorative diagnostic practice can be incredibly productive

Quotes:

“And when I look back at dental school, while there's a lot of things that I really wish I would have learned, I think there's three that kind of stick out. The first one is I really wish I learned how to listen to my patients. Because, you know, as a young dentist, you don't quite know how to set your practice up. And you hear a lot about ‘What you want to do is to create a personal relationship with the patient.’ So I remember this guy came in, and he grew up in an area relatively close to where I did. He needed quite a bit of work, actually, probably five or six crowns, needed some root canals. What I was busy doing was creating a personal relationship with him. We talked about similar places on the South Side of Chicago where we grew up together, people we might have known. When he came back for the consultation, basically he looked at me, went up to the front and said, ‘Could I get my X-Rays,’ and I never saw him again. And I realized something didn't connect. And it really brought home the fact that it's taken me a while to learn this. But ultimately, patients want two things. Patients want answers and patients want options. I was busy trying to create a personal relationship with him so we could get along well. The reality was he wasn't coming to me as a friend. He was coming for someone to solve his problems.” (01:46—03:16)

“So it became really clear that in order to treat these types of patients, it seemed like I needed to be able to up my clinical game a little bit. So I always said I lived in the golden age of dentistry. I heard Pete Dawson, I heard a lot of guys who weren't around anymore. But like any dentist today, whenever you learn new material, our tendency is to go back and to tell everything we know to the patient. You know, I did that when I came back from Dawson. I hear dentists doing it today with airway stuff, and all of a sudden now the patient becomes overwhelmed. So ultimately, I realized, ‘Yeah, you have to have a personal connect with the patient, but at some point, we have to be there to understand what they're looking for.’ I wasn't able to do that as a young dentist.” (03:20—04:14)

“The philosophy in dental school is one of learning. So what you're trying to do, you're literally drinking from a firehose. There's so much to learn in four years. You look at the medical side, you look at the dental side, you look at the nuances of having a drill in your hand for the first time and putting a diamond that’s spinning at 250,000 times a minute in someone's mouth, and all of a sudden, you're terrified. You're trying to think, ‘What degree do I prep the tooth?’ So there's all these things running through your head. So, quite frankly, we're trying to manage our own issues. So it's hard to get in someone else's—hadn't had the time to listen to theirs. And that kind of magnifies when you get out in dental school, because when you get into private practice, a lot of times the way the fees are set up is you're not being paid unless the burr is spinning. So it's difficult to take the time to listen to patients. What developed over time is I started to realize something . . . that whoever asks the questions controls the conversation. And ultimately, I think our job as really good diagnosticians, is to hear what the patient is saying and then lead them to the questions that they should ask. And what that means is we have to listen to what their issues are.” (04:51—06:18)

“So as a new patient coming into your practice, how are my issues being listened to from a patient perspective? Am I coming in and getting my teeth cleaned and having a two second look and saying, ‘This is okay,’ or is it a different experience where I'm meeting with the doctor first and trying to get an understanding of what my problems are and quite frankly, what do I need as a patient? Sometimes all I need is the cleaning. So Frank Spear talks about filtering your patients, and he'll give patients the options. ‘Would you just like the cleaning? Would you like the complete exam along with that cleaning?’ So it kind of gives the patients a little bit of leeway to make that choice.” (06:20—07:05)

“That's where it gets down to, I think, really starting to figure out how those patients are coming into our practice, which leads to a discussion probably at some point then about how do we answer the phone and how does all that stuff work together. But that's all the things that we need consultants to teach, because so many times, quite frankly, if we're busy at the chair, there's not really time for that. So it needs to get done somehow, so whoever does it, whether you in-source it or outsource it, it needs to be handled.” (08:15—08:50)

“Every patient is going to communicate differently. I remember I had a patient who really needed a lot of comprehensive dental care, and I did a consultation with them, and I was done in 15 minutes with the consultation. Patient walked out, my front desk person came up and said, ‘They didn't accept the treatment, did they?’ I said, ‘Yeah, they did.’ But he was a type-A driver type personality. And he was ready to hear it. So he didn't need a lot of time, but what I have found is the greater the complexity of the case that you're treating, generally, the more time we have to spend upfront in diagnostics and exams before diagnostics, quite frankly. But if it's just two or three fillings, then yeah, then maybe you can move through the process a little bit more quickly. If it's a more comprehensive problem, and I'll tell patients this, dentistry is like a funnel. If you spend a lot of time at the beginning, the end comes out pretty easy. If you don't spend as much time at the beginning, then you tend to have a lot of problems later on in the process.” (10:09—11:19)

“Number two, without a doubt is I wish I learned the importance of how to work with my staff members. You know, it's funny, we typically call it staff management, and I used to think that I needed to manage people all the same because that way I could be fair to everyone. What I realized is that everyone brings different strengths to the table, and everyone brings different weaknesses to the table, myself included. And it's taken a while to get comfortable, to realize that what I need to do is I need to try and accentuate the strengths that my staff members have, and I need to try and compensate for the weaknesses that they have as well.” (13:01—13:45)

“My advice would be to find the strengths that people have and build on them. But ultimately, I think the term staff management is kind of a troublesome term because I don't think people like to be managed, I think they like to be led.” (14:02—14:18)

“I think what I found is my ability to lead the staff became infinitely greater once I started having regularly scheduled staff meetings, because I had time with them, and it gave me a chance to understand from a leadership perspective what I had to change in the practice technically. But not only technically, but non-technically as well.” (14:59—15:26)

“I used to always get stressed out the night before a staff meeting because I never knew what I was going to do. And then sooner or later, after I kept talking about the same thing over and over again, even I got tired of listening to myself. So I sat down and I don't know how this came, but I put together a staff meeting format that I will tell you has been bulletproof, and the dentists who use it will uniformly tell you to a person that it decreases the stress in their office and it increases the ability of their staff to understand the big picture view of the practice, which is ultimately practice leadership.” (16:01—16:39)

“So we do a review preview. We look at last week's schedule, what worked and what didn't work. From a scheduling perspective, from a patient management perspective, from a financial perspective. So we said, ‘Okay, this situation comes up again. Here's how we're going to handle it.’ And here's the thing, I'm going to recommend you really develop this skill. There are things that our staff does well every day, and we never tell them because we're too busy. During that time at the staff meeting, ‘You know, these are great diagnostic photos. This is exactly how we're trying to capture this look, great job,’ and start to build the process that way.” (16:54—17:41)

“Then the other thing we did is we looked at our new patients and our consults. This is a new patient coming in. They were referred by Mrs. Jones. Their chief concern is they have clicking in the left joint. They need some implant work on the lower right. So basically what it did, it became a treatment planning discussion. If this patient's going to need implants on the lower right, then we're probably going to want to get a CT scan so we can look at the bone. We're probably going to want an intraoral scan so we can do our digital diagnostic wax up so we can start planning our implants. So the whole philosophy, the culture in the practice was what was developed during the staff meeting time. You couldn't pay enough to develop that culture. So when people say they can't afford it, I'm going to look back and say, ‘I don't think you can afford not to do it, because all of a sudden, then what happens is the next week the new patient comes in—they have a consultation. So now you looked at the new patient last week. Now you've got the scans in front of you. You're looking at the case that your oral surgeon or your periodontist or if you're putting the implants in. You look and see where you've got this all developed digitally. You've got your guides on how you're going to place the implants. Your clinical verbiage and training skills with your staff becomes off the charts because they understand the cases and all of a sudden now it's not difficult for them to talk to patients while you go to get a hygiene check because they understand the process completely. So all of a sudden, all that time the dentist had used cleaning up the bits and pieces of the questions from the consult, that all gets handled because staff can handle it, because they know exactly what they're doing. (17:45—19:38)

“What most dentists don't do with staff is they don't define their roles. I'm going to go back to an old tool that Pete Dawson taught me, and you probably remember the script. He talked about looping, and I use looping for lectures I put together for staff, I taught my kids how to write their papers in high school with it. Basically, for any position in your office, you write down everything related to front desk as fast as you can, go back and prioritize it, combine like topics, eliminate anything that's extraneous, and then go back and prioritize the top one of those and do the same thing about the top one. Loop everything and what you end up with is as many times as you want to loop that, basically standard operating procedure manual for your office.” (20:08—20:56)

“So it gives you a chance to validate them, which honestly is what we should be doing more than we do, quite frankly. We have enough time to nitpick the things we need to change. We need to make sure that they're validated and that they understand that we know that they can do a good job.” (21:15—21:28)

“I wish I had learned how to set my fees differently. You know, let's think back, are our dental school fees set? They're typically based upon government fees. And then when you get out of dental school, you go in to practice and you're either going to be in-network or out-of-network. If you're in-network, that's real clear. Your fees are set by a network, by whatever plan that you're with. And a lot of times when you get out of school, that's what you have to do. When I got out, I did welfare dentistry, so I was working in a fixed fee practice that the government set the fee for. But usually, even when I started the fee for service practice, if you really think about it, I wasn't involved with insurance plans, but my fees were still set by insurance companies. Because how do most dentists, when they get out of school, set their fees for a crown? They call their buddy down the street and say, ‘Hey, what are you charging for a crown?’ And usually their buddy’s charging and usually customary or maybe just a little bit above usual and customary because we don't want to have a talk about why insurance isn’t covering. And that's usually how the fees are set.” (24:43—25:55)

“Most of the time, if you look at people that own small businesses that are basically into construction, or reconstruction is what we are basically in the mouth, if you think about it. It's basically a time and materials fee structure. That's what we need to be. I have someone who's coming over to do something at my house, it's going to be a time and materials. Someone comes to the practice; it really should be time and materials. We're not good at that because again, we've been taught that we really don't have value unless the burr is spinning. And that's because insurance companies generally don't pay for things unless they're decayed, or they're broken. So the ability to diagnose is gone because we're not being paid for it. so unless you're able to create value for your patients on something that you're going to be able to give them answers and options for which they need and they want, you're going to have a hard time.” (26:10—27:05)

“The thing that no one talks about, though, is the foundation of the entire system, which are the jaw joints. So send us your huddled masses, we’ll be happy to take care of them. And really, what's happened actually, honestly, in my practice, it's what allowed me to have a fee structure that was not tied to usual and customary. Now, when I started, it was. But the more I realized these cases take time to work up and diagnose, and once I started to realize that I was doing something different than the patient was getting when they went somewhere down the street, I became more comfortable raising my fees.” (28:05—28:45)

“I would suggest—because most of the people listening to this, I'm going to guess, are going to be a restorative dentist—create a restorative diagnostic practice. So basically diagnostics in our practice is a subspecialty now. I have one column with restorative booked, and I have one column with diagnostics booked. And quite frankly, my assistants out produce hygienists every day of the week because of the fees for diagnostic records. What it allows you to do is to have a practice model that doesn't have to be 8 to 10 chairs and have a huge overhead. And yet you can be extremely profitable because you're going to have a referral-based system with well-trained staff with fees that are significantly higher than usual and customary. It is a practice model that, in my opinion, is not discussed enough, and I think today is a practice model that is really underserved. You can do airway in this model. You could do implants in this model; you could do whatever.” (31:02—32:03)

Snippets:

0:00 Introduction.

01:26 #1: Learn to listen to your patients.

04:15 Understand why the patient is there.

08:52 The level of communication required depends on the treatment.

12:47 #2: Learn how to work with your team members.

15:26 Structuring a better team meeting.

21:46 Build a more attractive practice to attract team members.

24:34 #3: Learn to set your fees differently.

27:05 Create the practice you want that builds value for patients.

33:30 Why has occlusion gone away?

38:22 Learning advanced occlusion from Spear Education.

41: 44 The Chicago Study Club.

Dr. Jim McKee Bio:

Dr. Jim McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.

Trouble-Free Dentistry: Unpacking Corporate Compliance Laws in the Dental Industry

Episode #612 with Linda Harvey

Since the pandemic, things have shifted in dentistry. Everything from infection control protocols to HIPAA laws has changed, and you need to keep up! To give you a preview of key upcoming compliance changes, Kirk Behrendt brings back Linda Harvey, founder of The Linda Harvey Group, to decode everything you need to know. Don't be the practice paying a $50,000 fine! To learn more about how you can prepare, listen to Episode 612 of The Best Practices Show!

Episode Resources:

• Join Linda on Facebook
• Learn more about The Linda Harvey Group
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Learn more about the Dental Compliance Institute

Use HIPPA-compliant apps like Tiger Connect

Listen to The Compliance Divas podcast

Main Takeaways:

Be prepared for upcoming compliance law changes.

Always use apps that you have vetted as HIPAA-compliant.

An app with security features is not necessarily HIPAA-compliant.

Understand social media etiquette to keep patient information secure.

Don't copy the policies and procedures from the practice down the street.

Build accountability into your team so your compliance efforts don't get lost.

Quotes:

“Many offices have gone back to the way things were. And I would like to briefly say, on that note, things really shouldn't be the way they were. Nothing has stayed the same in our world. Technology has changed the way we deliver dentistry and how we communicate with patients, and it's changed the way we perform and carry out all of our infection control tasks as well. So, hopefully, all the offices listening are still keeping up their strong points when it comes to all the PPE and infection control protocols that they put in place back then. So, we don't want to go backwards. We want to keep going forwards.” (2:35—3:06)

“Many dentists oftentimes feel like they're smothered by all the regulations — federal, state, local — but that's part of doing business. And when you think about HIPAA, they should think about everything that's required in a security role, for example, as best practices to protect their data and their business — and along with that comes protecting patient information. We see so many different areas where there are ransomware breaches running amok, and we're trying to stay one step behind these thieves and cyber crooks as they create ransomware, keep up with our antivirus, and so forth, and have good controls with having a good managed care services IT provider.” (4:58—5:37)

“One of the things that will change is that the release of records will change from 30 days down to 15 days. Currently, under the federal law, you're allowed to have one extension. So, there is a 30-day extension under the current HIPAA Privacy Rule. But that typically violates most state dental practice acts. So, you have to look at two sets of laws and rules, if you will, to make sure you're not in violation of privacy rules in your state or your state dental regulations. Well, they will drop down to 15 days, with a 15-day extension. But most of our clients that we work with tell us that they usually get their records out the door within just a couple of days, if not the same day, as the patient’s request. At that point, they're able to get it off their plate and they know it's done so it's not stacking up. So, I don't think that's going to be a big challenge.” (6:24—7:08)

“Some of the other challenges include the fact that we have to be able to give the patient a copy of that record wherever and to whoever they want. So, if they want us to send a copy of their dental record to their personal health app, we have to be able to do that. If a patient comes in, not only do they have a right to request a copy of the records, but they can take a video and take pictures of their records. So, while we've been harping at offices for years, ‘Don't allow any pictures in the back. Do so in a very controlled manner because you don't want patients to accidentally get a picture of another patient in their photograph, or maybe a copy of your schedule in their photograph.’ But how many parents love to have that picture of their little one, the first time they visit, sitting in the chair? So, it's something that has to be navigated throughout every practice. But if the patient wants to make an appointment, come in, go through it, get a copy, and do all that, that's fine. So, we'll have to make it work.” (7:08—8:00)

“Unlike COVID-19, where we had to do everything yesterday to try to figure out what we were doing, there will be a specific timeline under the federal law. That's always the same any time a new law passes. When this gets published in the Federal Register, it will go into effect 30 days after that. And then, I believe there's a six-month period of time before the enforcement date kicks in. So, offices will have a good six or seven months to update their policies and procedures, whether they're working with a compliance company, a compliance consultant, or maybe a healthcare attorney, whatever the case might be. They'll have a chance to get those updated, get everything implemented, and be ready. The main thing I'd like to stress is if you're not working with a credible compliance consultant, please don't copy policies and procedures from your friend down the street. Why? You cannot do that. You're busted. You are so busted.” (8:48—9:41)

“There’s been a lot of dental fines last year. Dentistry has been under the microscope and had some big fines levied by the Office of Civil Rights. To share a couple of those to give our listeners an idea, it’s not that the Office of Civil Rights, who is the HIPAA enforcement agency, is targeting dentistry. It's more that our patients are becoming savvy, and as a result they're filing complaints with the Office of Civil Rights. Where there's merit, thus follows the investigation. And after that, usually the fine and corrective action plan. So, it's very complex.” (10:11—10:48)

“Back in 2019, the Office of Civil Rights started a program called the Right of Access Initiative. This Right of Access was really focusing on the patient's rights to get access to the records within the required scheduled timeline. And so, as complaints came in from patients and they got investigated by the OCR, there's been a lot of big fines — in dental, and across all of healthcare — for not releasing them in a timely fashion. Here are a couple. For example, a corporate group in Georgia got fined $80,000 because they wanted to charge the patient $170 for a copying fee. Slightly different topic but same category, so to speak, within that release of records. The Office of Civil Rights looks at that as being excessive, and they don't allow those types of fees. So, they get fined $80,000. In Chicago, there was a dentist. They didn't release the records within the required timeframe as well. Received a $30,000 fine. Nevada, same thing. Release of records — not releasing records, I should say, in the required timeframe. That office was fined $25,000. In Pennsylvania, a $30,000 fine to another dentist. Those are a few of the situations.” (10:54—12:11)

“I mentioned the corrective action plan. So, not only do you have to fork over this money within 30 days to the Office of Civil Rights — there's no payment plan for $30,000 and $80,000 — but you also have to fall under what's called a corrective action plan, a CAP. Usually, that lasts anywhere between a year or two, and there are a lot of stipulations put in place about what the office is going to do with having new policies, new procedures, training, disbursing the policies to their staff, all the different things they have to do, and also report back as if you're under probation. And so, it’s very similar to having a disciplinary action against your license with the dental board with this kind of corrective action plan. So, it's very serious. And you've got OCR watching you for the next couple of years. Now, granted, unlike the DEA or maybe a state agency, they don't have the ability to shut down your practice. But they can still make life pretty difficult.” (12:20—13:19)

“Social [media] is a challenge for everybody, and it’s such a gray area. What can we post? What can we not post? What can we say to respond to a patient who's thanking us for their care and saying that they're happy to be in our practice? Because when we say too much, now, we're actually divulging they're a patient of the practice. And there have been a few times where healthcare providers — including dentists — have gotten in trouble for that. So, it's really a fine line.” (13:32—13:55)

“What's the etiquette of replying [to patients’ comments], and what's the etiquette of not divulging information? I think the etiquette of replying has always been to use that plain, vanilla approach, ‘Thank you for your kind remarks,’ or, ‘We love hearing those wonderful comments or feedbacks,’ something generic in nature, if you will. But what happened to these offices last year — actually, there were two that I can remember last year, and one from 2016. All these offices, what they had in common is they responded to a negative review. How many times does the dentist and the staff look at a negative review, and the hairs go up in the back of their neck? It's a very personal attack when someone is saying something negative about your practice, especially if their patient memory or the facts aren't correct. And then, the office wants to take it upon themselves to correct the record, and they do so in a public forum. It's sort of like airing your dirty laundry. And when they do, they end up getting fined and punished for doing so.” (13:55—15:04)

“One office, the one from 2016, was in Texas. They were only fined $10,000. But part of the news story that came out was the fact that they had no policies and procedures. They had no HIPAA privacy officer named, and they hadn't had training. So, even in 2016, although the privacy rules have been in effect since 2003, they weren't compliant. Maybe the office is newer, so we can grant them that. But they weren't compliant. Then, there was an office in North Carolina that did the same thing. This patient had posted an anonymous negative review, to which they responded and divulged the patient's name, parts of treatment, information about their insurance. They were fined $50,000. Pretty big chunk. But I've got one that's going to top that. This one comes from California. We can't top the $50,000, but part of the corrective action plan was the fact that they had to go back all the way to 2014 and remove all of their social media postings that had any patient information in it to the current date. So, when I saw that, it made me think about the fact that the OCR is stepping up their punitive portion and really making a difference. They're making a statement about what's going on on social media.” (15:28—16:48)

“What [dentists] get wrong is in today's environment with money being so tight, there's not any money in the budget for compliance right off the bat. So, everybody realizes they need to get an OSHA manual. They might buy one that's fill-in-the blank or get something quick. But they don't really know what to do with HIPAA because there's a lot more. A fill-in-the-blank manual that you don't know how to fill in does not make you compliant. So, that's where they miss the mark.” (17:52—18:14)

“Also, [dentists] miss the mark with not being able to afford proper IT services up front from the security role side. In other words, you need to have — and you must have, to be compliant — managed services, meaning that your IT company is watching the henhouse 24/7 for any types of threats and vulnerabilities and attacks on your network. One group I know puts canary files on the client server. I believe it's on the server. At that point, those get attacked first. So, when the canary files get attacked, then they're alerted that something is going on. So, there are all different strategies that the IT companies can use. I think sometimes offices don't appreciate that because they can't afford it right off the bat. They can find some free training somewhere. Whether or not it meets the needs of their practice, they can always check that box. But as you said in the beginning, it's all compliance — not just OSHA and HIPAA, but everything. HR, corporate compliance — everything. DEA compliance. It's so much more than checking a box.” (18:14—19:11)

“You can have apps and so forth like WhatsApp. There's another one — I'm drawing a blank on the name of it right now — that is compliant from the security section. But are they going to sign a business associate agreement? That doesn't mean that they're HIPAA-compliant. A true HIPAA-compliant company follows the security rule to whatever degree that's required by business associates. They sign a business associate agreement, and they provide training for their team about security, and so forth. So, while it's secure — yes, it's got a lot of security features to it, I would still be very careful about what you're putting in any of those apps related to patient information.” (20:03—20:36)

“Another thing that ended with the end of the public health emergency was using these non-HIPAA-compliant apps and teledentistry programs for patient information. So, this is where doctors will want to split hairs, ‘What if I just put the patient's initials? Can I just put the last name? Can I just put the first name?’ As a consultant, I can't say yes or no. But I can say you should be using HIPAA-compliant apps. Tiger [Connect] is one that comes to my mind off the top of my head, and there are plenty of others.” (20:38—21:07)

“Build in accountability into the office and the team, because with the turnovers that your clients and our clients are experiencing, and the shortage of team members, and hiring folks with no dental experience to come in, you need to build in accountability so that your compliance efforts don't get lost. And I'm using a term now that I'm trademarking called compliance memory. Don't lose your compliance memory. So, while we're talking about some specifics with HIPAA, social media, and release of records — yes, we can talk about those all day long. But the bigger picture is, put compliance and safety into your team meeting agendas. Spend three to five minutes there. Make sure that you are laying eyes on those waterline tests, on the sterilizer tests. You're checking out what records requests do we have this past month. Everybody knows when there's an autoclave failure, or something big, or a big patient complaint. But show that you are following up with that. That way, your team is staying on top of those duties, and that way you're transferring the duties to new team members as they come on board and getting them trained as well.” (21:47—22:47)

Snippets:

0:00 Introduction.

1:57 Linda’s background.

3:09 Things to be aware of.

6:14 New changes that are coming.

8:40 Timelines for implementing new changes.

9:41 Don't copy/paste policies and procedures.

10:09 Examples of practices that were fined.

12:13 The corrective action plan, explained.

13:21 Social media etiquette, explained.

17:42 What dentists get wrong.

19:35 Always use HIPAA-compliant apps.

21:36 Last thoughts on regulatory compliance.

23:12 How Linda can help you and how to get in touch.

23:59 The Compliance Divas podcast.

Linda Harvey, RDH, MS Bio:

As president and founder of The Linda Harvey Group, Linda M. Harvey, RDH, MS, LHRM, DFASHRM leverages her unique credentials and expertise to help you and your staff significantly reduce risk and legal liability in your practice. Linda’s services complement practice management consultants whose clients need a specialist in risk management. Along with that, she teaches dentists and physicians how to protect their million-dollar practices through effective risk management and patient safety. Linda’s practical guidance effectively integrates regulatory statutes into your practice to close deficiency gaps in your policies, procedures, and workflow.

Linda brings more than 30 years of experience in providing quality/safety perspectives for healthcare professionals as well as state licensing boards. She is a featured writer in trade journals, publications, and newsletters such as Contact, RDH, and Resource Connections. Her training products have been featured in Medical Economics, RDH, and Dental Materials and Equipment. As an active member of the National Speakers Association, she presents content-rich courses sprinkled with real-life stories of medical errors and many practical, easy-to-implement solutions.

Linda authored Helping Hands for Dental Hygienists: 101 Timeless Treasures for a Successful Career, plus four risk management and patient safety professional development courses. Clients internationally utilize her risk prevention training systems so they can focus on what they do best—providing exceptional patient care and services. She works with licensees in multiple states who have been sanctioned by the licensing board and assists in their compliance. As a result, she understands the quality/safety perspectives of both healthcare professionals as well as state licensing boards. Many clients frequently express how they wish they had called her before the subpoena arrived. 

4 Keys to Increase New Team Member Retention

Episode #611 with Christina Byrne

If you want to retain great team members, you need more than a good paycheck. To help you keep more of the people you want in your practice, Kirk Behrendt brings back Christina Byrne, ACT’s Director of Operations, to share four keys to unlock what your team members truly want. When you can keep the right people, your life gets better! To learn how to get started, listen to Episode 611 of The Best Practices Show!

Episode Resources:

• Send Christina an email
• Follow ACT Dental on Instagram
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Get ACT’s 3-3-3 Onboarding Resource

Main Takeaways:

Take time to thank your team members.

Have a robust onboarding and training process.

Give new team members time to understand your culture.

Show new team members that your core values are alive in your practice.

Give clear, consistent communication about team members’ roles/responsibilities.

Quotes:

“The key to team member retention starts at the onboarding process. There are a lot of things that go into hiring a team member, and that's great. But a lot of times, the doctor thinks, ‘Okay, we're done. I've hired that person. Now, they should know what to do,’ and that is just not the case. And so, it is so important that we support that team member and give them all the tools to be as successful as possible because it costs a lot in time, and money, and stress to keep bringing new people in. So, the key to retaining your great team members is to start at the beginning, which means starting with the onboarding process.” (2:40—3:22)

“A lot of our teams and a lot of our doctors are stuck in this gerbil wheel of tolerating bad team members because they're so afraid of the market. A lot of people have not come back to the market, so we've got a lot of jobs and not a lot of people to fill them. So, one of the things that can set you apart is having a really robust onboarding process and training process. And just to be transparent, we go through that ourselves. Whenever I've interviewed someone for a new position here at ACT, almost every person will ask me, ‘What does the training look like? What does the onboarding look like?’ I'm really proud to say that we do walk the talk and we've got our 3-3-3 onboarding process, which we're going to link in the show notes. It's really a way to dial in on, we're not just saying, ‘Go do this job.’ We're saying, ‘By the end of three days, you should know how to do this. By the end of three weeks, you should know how to do this.’ The same thing for three months. I think that when we can compartmentalize the job and then build on the job, it gives everybody more confidence to do the job better.” (4:04—5:28)

“When you're looking for someone and when you're interviewing someone, let them know ahead of time that you do have a well-thought-out, documented onboarding process. Because I'll tell you what, if it's me and I have a choice of two positions, that's the one I'm going to go to because that to me says that they care about the new team member and they're willing to invest in my future and my career. And so, I think that is going to be one thing that sets you apart. It might even be a great idea to put that in your ad, full onboarding process, detailed and outlined, letting the applicants know that this is what we do. And, of course, if you're going to do that, you have to follow through on it.” (6:42—7:25)

“There's a recent Gallup study that said only 12% of employees strongly agreed that their organization did a great job of onboarding the new hires. That's 12%. So, think about that. That really can set you apart. If only 12% of people are doing that now, be one of them and shout that from the rooftops.” (7:36—7:58)

“Everybody thinks like, ‘I've got to train this person on how to be a good assistant. They need to know how to mix this, and do that, and scan this.’ But we also need to give them time to understand our culture as well because that's really important too. That's another thing that needs to be identified in the hiring process and also throughout the onboarding process. I like to pair new hires with existing coaches and get our existing coaches involved in that process too, because then the new team member can understand the culture from somebody else rather than the person who hired them. I think that's really important because we do stress that, and that is a huge reason why people come to us.” (8:39—9:23)

“[Culture and values have] got to be the overseeing factor as to everything that we do. So, for example, if I have a team member and they're struggling, let's say, if you have a really good culture in place and you lean into your core values, you're going to be someone who looks inward to say, ‘Okay. If they're struggling, what is my role in this? How can I help to support them?’ If you don't have that good basis and that good foundation of a great culture and core values, then you're going to be looking outward and saying, ‘Well, that person doesn't know what they're doing,’ when, really, you need to set that up and set them up for success.” (10:11—10:48)

“The people who fit your core values and want to be there are going to exceed your expectations. So, when we give our 3-3-3, I lay the whole thing out for people. Like, they know what they need to be doing by the end of three months. And the goal is that they are going to accomplish everything sooner because we're setting them up for success, because we're showing them that these things are important. They're going to want to stay involved, and they're going to want to stay a good fit. Even if they feel a little bit uncomfortable, if they feel that the fit is better, then that's one of the things that they're going to stay for.” (10:50—11:28)

“Lead by example. Don't just put [your core values] on the wall. Don't just put them on a medal or a T-shirt. That new team member needs to see them coming alive every day, and it has to start with the doctor or the leadership team, because if that doesn't happen, they're going to know that it's fragile and that it can be broken at any time. But if they see the doctor actually doing this and living by these core values — they're going to be way more likely to stay when they see that they're alive.” (13:06—13:40)

“It's not the paycheck. It really isn't. Most people want to feel appreciated, and they want to feel like they're in the right place, and that everybody is doing something that's worthwhile and valuable.” (15:07—15:20)

“I caution doctors too. I always let them know, ‘Look, when you're putting these core values in place, that is a mirror. You are allowing your team members to say, hey, dude, you're not following this. This isn't showing up on your end.’ And if that were me, I would be like, ‘Thank you so much for pointing that out,’ because I never want anybody to feel that this is not the place that they thought it was. But we're all human. Right? You get bogged down. And so, it's okay. Like you said, we work hard at it. It's because we are intentional about it that our core values are so important.” (17:55—18:34)

“Don't just hire somebody and say, ‘Okay, you're going to be an assistant,’ and then leave it at that because that is so broad and so vague. Oftentimes, when we've got a room full of dental assistants, and hygienists, and admin team members and we ask the question, ‘Show of hands, who would like to have a detailed outline and job description of everything that your doctor is expecting of you?’ every single person raised their hand. So, from the doctor's perspective, they think two things. Number one, ‘Oh, they should know what I want. They should know what to do.’ And then, the other side of it is, sometimes the doctor doesn't want to appear mean. ‘I don't want to tell people what I want.’ But that's what they're asking you to do! How can we expect somebody to thrive in a role when we haven't told them exactly what that role is and how they can be successful? So, having that really clear outline, job description, responsibilities, what are you accountable to, and what are the results that we're expecting you to get for us, that's going to be amazing.” (18:48—19:55)

“A 2018 study showed that employees are 23% more likely to stay at a job when they know exactly what's expected of them. I think that's huge. And so, we need to really be clear and consistent around what that is. And when I say consistent, I mean across the responsibilities of all the jobs. So, all the assistants need to be responsible and have certain things that they are responsible for. You can't say, ‘Okay. Well, this is what you do, but I'm not going to hold Mary responsible because Mary's my neighbor,’ and whatever. Everybody has to be held responsible and held accountable to the things that are important to the practice’s function.” (19:59—20:44)

“Set up an environment where if you are clear, and you think you've been clear, go one step further and encourage your team members to come to you and ask for further clarity if they don't have it. Because it's not on them if they don't understand what you said. The responsibility of a message being delivered is on the deliverer. So, if I've given somebody direction or instruction and they don't understand it, I want to have a culture where they feel comfortable coming to me and saying, ‘You know what? I really didn't understand what you said. Can we go through this one more time? I want to make sure I do it right,’ instead of somebody saying, ‘Well, I don't want to ask her. I'm just going to do it,’ and then it's wrong. Then, nobody wins. So, I think that that goes back to the culture piece of setting up an environment where everybody has the freedom and the ability to get the best clarity for them, because people learn in different ways. Some people are very visual. Some people need step-by-step instructions. Some people need to hear it instead of just looking. Everybody has a difference there, so we need to honor that for people.” (21:19— 22:27)

“Performance reviews — I really hate that term because it doesn't support the growth of that person in their role. A performance review is almost like a lagging indicator, and a check-in is like a leading indicator. So, I can tell you how you've done. But I'd much rather sit down with you and say, ‘Hey, here's where you are. Let's talk about some ways that you can grow and improve upon some of the things that you're doing already that are great.’ So, to me, I think that's a much healthier way to have a conversation with a team member. I do them every two weeks with every single coach, and I love it. In the beginning, of course, it's a little awkward, especially if it's a new team member. They don't know what to expect. But now, I think everybody really likes the cadence. Most of them have them set up for every two weeks for infinity, which I love.” (22:52—23:48)

“Having that check-in — and it's not really about, ‘You didn't do this. You didn't do that.’ It's really about, ‘How can I help you?’ I want to have a personal connection with the team and get their personal high, personal low, whatever they're willing to share. I don't ask people to be completely vulnerable if they don't want to be. And then, we want to know, ‘How is it going professionally?’ And I'll ask, ‘What's going on with your clients? Is there anyone that you're struggling with? What can I help you with?’ And so, I think it's really a valuable way to build a deeper relationship and a deeper connection with the people you work with.” (23:52—24:32)

“The other thing [a check-in] does is it helps to continue to deepen that trust, not just with new team members, with existing team members as well. Because if you encourage that feedback to come the other way, like you said, ‘What's the best way for me to support you today?’ or, ‘How can I be better? How can I be a better coach for you?’ it encourages that feedback to come from the bottom up. I think that's really, really cool. And it shows that the leader wants to get better as well. Just because you're in a leadership position doesn't mean you're done. Like, ‘Oh, I'm done. I don't have to do anything.’ So, I think it's really important for team members to see that and to see that their feedback has been taken and is valuable.” (26:16—27:04)

“I've heard some people say, ‘Oh, I just can't remember [to say thank you]. I'm busy. I'm wrapping up the day,’ or, ‘Why do I have to thank somebody for doing a job that I hired them to do?’ That one really threw me for a loop. But I think it's a great way to acknowledge that, yeah, they are there for a job, and that is the job you hired them for. It's still nice to be appreciated. Right?” (27:20—27:44)

“If you're not saying thank you, there's a reason. It could be it's just not the right person. Or maybe it's, like you said, our responsibility. We haven’t onboarded them in the right way. So, I think it really does help to build that culture. And also, when it's a new team member, giving them an atta girl, atta boy, ‘You're doing a great job. Thank you for sticking around with this onboarding and going the extra mile,’ I think it gives people a sense of accomplishment, and also the confidence to do better and to work ahead, be a little bit more proactive in their learning.” (29:45—30:25)

“I think a robust and consistent onboarding process is going to be the key. It's a positive experience from the very beginning that that new hire is — we're going to invest the time in training them. And it also shows the rest of the team like, ‘Hey, this is the person, and we want everybody's input. Everybody is going to help this person to succeed,’ and that's going to help to build a stronger team. It also saves time and money because turnover is hard. The research that I found on that is that, on average, the cost of replacing a new employee is about 20% of their annual salary. So, if you think that you have a lot of turnover, do the math. And if you don't think that training and onboarding and taking the time to slow down isn't worth the investment, then compare it against that math of 20% of that person's annual salary and then give us a call.” (31:33—32:26)

“There are many reasons that team members leave. Somebody could move away. So, it doesn't mean that things are bad, but you always have to be prepared. Even if you think, ‘I've got the team of a lifetime. Nobody's going to leave me,’ still do this because people move, and things happen. And so, you need to be prepared.” (34:07—34:27)

Snippets:

0:00 Introduction.

1:48 Why this is important for dentistry.

3:23 Give team members the ability to succeed.

6:27 Set yourself apart.

8:33 Give team members time to understand your culture.

9:39 Culture and values should take center stage.

12:59 Lead by example.

14:04 It’s not the paycheck.

15:20 Hold one another accountable.

18:36 Specific is terrific, vague is the plague.

22:38 Check-ins, explained.

27:06 Thank your team.

31:26 Last thoughts.

32:59 More about ACT’s 3-3-3 resource and To The Top.

Christina Byrne Bio:

Christina Byrne has been involved in dentistry since 1985. Over the years, she has held many positions on the dental team, including dental assistant, business office, and dental hygienist. Christina’s extensive knowledge of the front office and clinical procedures is a great asset, and she loves to impart her knowledge to guide dental teams do the best they can to achieve a Better Practice, Better Life!