Special Section for New Dentists: ‘Hi, I’m So Sorry I’m Running Behind!’ by Drs. William Jacobson, Christina Platia, and Fotini Anagnostopoulos-King

How to go from two patients a day to 20 without falling behind schedule

by Drs. William Jacobson, Christina Platia, and Fotini Anagnostopoulos-King

In dental school, running 30 minutes behind may have meant missing lunch. In practice, running behind can affect an entire day’s schedule.

In dental school, you may have been accustomed to treating one or two patients per day. In private practice, a dental service organization (DSO), or a federally qualified health center (FQHC), you may suddenly find yourself responsible for 15–20 patients daily.

This transition can feel overwhelming. Working with dental assistants significantly improves efficiency, but dentistry is often unpredictable. A routine filling may take longer than expected, while a difficult extraction may be completed in minutes.

The good news? Efficiency is a learned skill. Some days you feel like you’re a dentist; other days, an air traffic controller. Here are practical tips to help you stay on schedule in the real world.

Morning huddle
Conduct a daily team huddle before clinical sessions to review procedures and anticipate challenges. Huddles improve communication, coordination, and workflow efficiency throughout the day.

Scheduling
Most of a day’s delays are built in before the first patient sits down.

• Have patients arrive 15 minutes early to complete paperwork and update medical history forms.

• Create a policy for late patients to minimize delays and disruptions.

• Schedule longer appointments for patients requiring language interpretation services.

• If a patient arrives early and a room is available, seat them.

• If you anticipate a procedure running long, notify the front desk proactively so subsequent patients can be informed in advance.

Dental exams
Most of the time you lose during an exam is lost before you sit down. Walk in already knowing what you’re looking at and the appointment shortens itself.

• Review radiographs and medical history before entering the operatory whenever possible, and enter the room with a treatment plan rather than discovering issues chairside.

• Develop a consistent exam routine. It improves efficiency and reduces missed findings.

• Use intraoral photos and radiographs to educate patients rather than overexplaining verbally.

• Examine the patient first and document afterward. A dental assistant should be trained to document your findings as you go.

• Avoid discussing diagnoses while the patient is reclined whenever possible.

• Keep patient communication concise. Patients appreciate clarity more than lengthy explanations.

• Complete documentation immediately after the exam. Delayed charting creates an end-of-day backlog and increases the likelihood of incomplete notes or forgotten details.

• Use templates for common exam findings and treatment recommendations to improve consistency and reduce documentation time.

• When presenting treatment plans, prioritize urgent needs so patients aren’t overwhelmed with excessive information.

Emergency exams
Emergencies get squeezed into a schedule that is already full, so the expectations set at the front desk matter as much as the exam itself.

• Have front desk staff explain in advance that same-day treatment cannot always be guaranteed, that emergency visits are often accommodated within an already full schedule, and that a referral to a specialist may be necessary.

• Have an assistant obtain the chief complaint and pain level, both current and worst, on a scale of 0–10. A current pain level of 10 is more urgent than pain that only occurs when eating ice cream.

• Document all chief complaints and ask which concern is most urgent, as time may be limited.

• Address the patient’s primary concern before discussing comprehensive treatment needs. If additional concerns arise during a limited or emergency exam, acknowledge them and schedule a comprehensive exam for a future visit.

• Know when to refer. Recognizing when to refer difficult surgical procedures or root canals is an important clinical skill, and it reflects the ethical principle of nonmaleficence. Attempting procedures beyond your comfort level or expertise can negatively affect the schedule, the patient experience, and your license.

Hygiene checks
Hygiene checks are often double-booked while you are treating your own patient, which makes them the easiest place in the day to lose 10 minutes.

• Administer anesthesia to your restorative patient before stepping into hygiene for an exam check.

• Develop a quick, systematic hygiene-check routine that becomes muscle memory: chief complaint, review of radiographs, extraoral and intraoral exam, tooth mobility, caries and defective restorations, then discussion of findings.

• If a patient presents with multiple concerns requiring extensive diagnosis or treatment planning, schedule a separate comprehensive evaluation.

• If hygiene is running behind, perform doctor exams strategically during radiograph acquisition, anesthesia onset, or while the hygienist is charting findings.

• Avoid creating bottlenecks by lingering in hygiene rooms for nonclinical conversations during busy schedules.

Restorative procedures
Consistency in setup prevents many of the small interruptions that add up over the course of a day. Set up trays consistently for every appointment, and ensure handpieces are functioning properly and water tanks are filled before beginning treatment. Verify shade selection while waiting for anesthesia to take effect, and avoid repeating steps because of incomplete isolation.

If time becomes limited, it is often better to complete fewer high-quality restorations than to rush through several. Patients typically appreciate quality and longevity over speed. Creating proper anatomy, marginal ridge height, and interproximal contacts can also minimize excessive occlusal adjustments.

Crown and bridge procedures
Crown and bridge is where a few minutes of sequencing discipline pay off most.

• Verify shade selection and obtain the preliminary impression while waiting for anesthesia.

• During crown preparation, be deliberate and avoid unnecessary refinement that may compromise the preparation.

• Consider fabricating the temporary restoration before making the final impression. A translucent temporary may reveal under-reduction, and if time runs short, refinement and the final impression can be completed at the next visit. A patient can leave without a final impression. They cannot leave without a temporary.

For a digital workflow, this order saves the most time:

1. Administer anesthesia.

2. Obtain the initial scan.

3. Prepare the tooth.

4. Fabricate the temporary.

5. Delete the prepared tooth from the scan and rescan only that area.

6. Cement the temporary.

Documentation
Charting is the work that follows you home if you let it.

• Review charts the night before, or print the schedule and jot down notes throughout the day. This minimizes excessive back-and-forth within the electronic health record (EHR) and prevents awkward moments like reintroducing yourself to a patient you have already met.

• Short and complete notes are better than perfect but unfinished ones.

• Use templates whenever possible.

• Consider having your assistant complete portions of the template. Assistants may document the tooth shade or the number of anesthetic cartridges used, for example. The dentist must review, edit if necessary, and sign the note.

• Always document the next-visit plan for continuity of care, especially if another provider needs to cover your patients.

• Finish all notes before leaving for the day.

Dental assistants
A well-prepared assistant is the single biggest lever you have on your schedule.

• Learn the scope of practice for dental assistants in your state. Understanding legal delegation improves both efficiency and compliance.

• Have your assistant obtain the patient’s chief concerns and brief you before you enter the operatory.

• Ensure operatories are set up before seating, with water tanks filled and handpieces functioning properly.

• Don’t spend time searching for burs in a bur block. Wet a 2x2 gauze with water from your air-water syringe and place the burs on it in the order you will use them. The wet gauze keeps them from rolling off (Figs. 2 and 3).

• Designate specific time for sterilization, spore testing, and water testing.

• Notify patients if the schedule is running behind and ask whether they are able to stay longer.

• Consider hiring expanded function dental assistants (EFDAs), who can help with cord placement, impressions, and restorations.

Fig. 1

Fig. 2

Fig. 3

Operatories
Set up each operatory consistently, and use customized bur blocks for specific procedure types such as operative, crown and bridge, and endodontics.

Communication
How you talk about a delay changes how patients experience it.
With patients, say, “Thank you for your patience” instead of repeatedly apologizing for delays, and avoid excessive apologizing in general. Patients respond better to calm confidence and clear communication.

If you are learning a new EHR system, explain that while the software may be unfamiliar, the dentistry itself remains the same. This can reassure patients who sense uncertainty while you navigate the computer. For highly conversational patients, politely redirect the appointment by emphasizing the importance of maximizing clinical time.

With your team, ensure everyone is consistently punctual. Chronic lateness disrupts patient flow and erodes trust. As the team leader, you set the tone for the office. If you are routinely late, patients and staff may conclude that punctuality is not important.

Conclusion
Falling behind schedule is inevitable at times, especially early in your career. Efficiency in dentistry is not about rushing treatment or sacrificing quality. It comes from preparation, communication, delegation, repetition, and developing systems that work consistently. With experience, workflows that once felt overwhelming become routine. The goal is not perfection. It is creating a practice environment that allows you to provide quality dentistry while maintaining efficiency, professionalism, and sanity.

Townies!
What additional advice would you give new graduates about not falling behind schedule? Share your thoughts, suggestions, and opinions in the comments section under this article.
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William Jacobson, DMD, MPH, is a general dentist, clinical assistant professor, curriculum consultant, and the author of Clinical Dentistry Daily Reference Guide, a book to help dental students and dentists with day-to-day decision-making across a range of clinical scenarios. He is a member of the Dentaltown editorial advisory board.

Christina L. Platia, DDS, MS, FICD, is a clinical assistant professor in the Department of Comprehensive Dentistry at the University of Maryland School of Dentistry. She earned her DDS there in 2010 and completed a general practice residency at Christiana Care Health System in 2011 before entering private practice. She joined the Maryland faculty in 2012 and earned an MS in health professions education from the University of Maryland School of Graduate Studies in 2025. She is passionate about curriculum development and assessment optimization in dental education, and she is a fellow of the International College of Dentists.

Fotini V. Anagnostopoulos-King, DMD, earned her DMD from Tufts School of Dental Medicine and completed an advanced general dentistry residency at the University of Maryland School of Dentistry. After 20 years in private practice, she joined the University of Maryland faculty, where she serves as a clinical associate professor in the Department of Comprehensive Dentistry. She is the secretary of the American College of Dentists, Maryland chapter, a University of Maryland, Baltimore faculty senator, and a fellow of the International College of Dentists.