Howard Speaks by Howard Farran, DDS, MBA, MAGD

Everyone on the planet wishes the world was twice as wealthy. Think of all the things people could buy if everyone earned twice as much money. So the question is, "How do you double the wealth of a nation?" You would simply have to double everyone's productivity. If every person on the planet made ten widgets everyday, and you figured out how they could each make 20 widgets a day, the world would be twice as wealthy. To double your productivity you would need motivation, capital, and technology. How many dentists do you know who scheduled 1-1/2 hours to do a single unit crown on #30, ten years ago? If you ask them today, "How much time do you schedule for a single unit crown on #30?" they will usually answer, "An hour and a half!" Why? It certainly isn't necessary!

The greatest advances in productivity come from paying close attention to operations and logistics. Start with an electronic timer in each operatory that has both minutes and seconds. Take anesthesia for an example. I have observed that most dentists will give anesthetic for a tooth, and then walk off. I ask the dentist, "How long are you going to let that anesthetic soak in?" "Oh I don't know! A little while I guess" says the dentist. I ask the dental assistant, "How long are you going to let that anesthetic soak in?" "Usually after 10 or 15 minutes I will go and find the doctor," says the dental assistant.

I switched to Septocaine when it became legal in the States about a year ago. I have found that Septocaine works twice as fast and twice as profound as the old traditional Lidocaine. Using an electronic timer, I started telling my dental assistants to set the timer for 8 minutes for a routine filling. Then I started to say 7 minutes. Now, a year later I am down to 4 minutes for a filling, 6 minutes for a crown, 8 minutes for a root canal, and 10 minutes for an extraction.

After you give your anesthetic for a crown prep on #30, why get up and walk away? Unless you have another patient waiting, stay in the room. Start setting a timer for 10 minutes. Take your impression for the temporary. Check the occlusion. Look twice at the opposing tooth. Take your shade. Fill out your crown and bridge form for the lab. The next thing you know the timer goes beep beep and you can start preparing the tooth. Pack your own Ultradent Ultrapak (knitted displacement) zero cord and then one cord. Why have your dental assistant pack the cord if you don't have anywhere to go? You don't really need to make a phone call, leave your spouse alone and if you drink any more coffee you're going to need to wear Depends! Do you realize that you can pack both cords in less than two minutes, but if you let your dental assistant do it, by the time it's done and they find you, and get you back to the chair, ten to fifteen minutes have passed.

Now it’s time to add a little composite build up on your prep. Why use the old 40% phosphoric acid, then rinse, primer, bonding agent etc., when you can do all of this at the same time? Everyone is using self-etching primers these days. If you log onto the message boards at DentalTown.com everyone is ranting and raving about Touch & Bond by Parkell, Clearfil SE Bond by Kurraray, One-Up Bond and M-Bond available through J. Morita. Furthermore, when you go to rinse off your old style 40% phosphoric acid it makes a mess. You get all of your cotton rolls wet! Yuck! With self-etching technology, no rinse means no mess, means no changing out your cotton rolls, less steps and equals doing it in half the time. Now it's time to cure your composite. Get the biggest, fastest, hottest light you can find. I use the Sapphire light by Den-Mat. It cures 5mm of light shade composite in 9 seconds.

Now you're ready for your impression, right? WRONG!!! Make your temporary first! You and your dental assistant can make any temporary in 3 to 5 minutes. But if you delegate this out to your dental assistant while you go make phone calls to other non-productive people, by the time it's all said and done, you’ve spent half an hour on a temporary. Plus, if you make the temporary ahead of time, you will learn a lot about your prep. You will never get back another reduction coping from the lab. You figured that out while you made the temporary.

Now you can take your final impression. We use 3M-ESPE Impregum from the Pentamix mixer in a sideless triple tray from Premier. This fast, smooth, creamy mix is perfect for blowing down the impression material over your prep. You set the timer for 5 minutes. You go do a hygiene check now whether your Registered Dental Hygienist is ready or not. You come back in 5 minutes; check your perfect impression wearing your 2.5x Designs For Vision surgical telescopes. Cement your temporary, and guess what, it has only been 30 minutes. And you're spending an hour and a half?

If your country is getting wealthier by increasing its productivity between 1-1/2 and 2-1/2 percent per year, why can't we? If you spend an hour on something today, why not shoot for less than an hour next year. Before you know it, everyone is going faster and the world will be a better, faster, easier, cheaper, higher quality place to hang out!