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Howard Speaks Howard Farran, DDS MBA, MAGD, Publisher, Dentaltown Magazine

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What is “Quality” Dentistry?
– by Howard Farran, DDS, MAGD, MBA, Publisher, Dentaltown Magazine

Last month, I wrote about tightening your variances when it comes to building a quality staff. Time and time again, I’ve said you only manage three things; people, time and money – people being the most important.
When patients enter your office, they expect to be seen by the same people who saw them at their last visit, and when they don’t, they raise the red flag. They expect consistency. So keeping the same superstars around in your office for as long as you can is a must. I’ve also said business only has three functions; you make something, you sell something and you watch the numbers. When it comes to making something, what can you do to make sure it’s quality?

If you answered “consistency,” you’re right (thanks for paying attention)! Quality in making something most definitely comes down to consistency. Take crown lengthening, for instance. I bet you could walk into a medical building where five dentists practice and find out four of them haven’t billed out or referred out a crown lengthening procedure in the last three months, but the other dentist does it five times a month. Why is that? Does that dentist corner the market in crown lengthening?

Would you really consider the work you do “quality” when your patients’ decay is subgingival, their gums are inflamed, and while you are trying to get an impression, you have to stop the bleeding with astringident, or you’re pumping the gingival with 1-50,000 epinephrine and you’re packing cord and you’re taking multiple impressions and you have to put on your 3.5x loupes to be able to read the impression because the decay is so subgingival, and… wait a minute… why are you doing that?

Why don’t you do a crown lengthening procedure? Or even better yet, if you don’t want to or don’t like to do crown lengthening, why don’t you refer it? Sure! The United States has close to 4,500 full-time periodontists. You should hook up with one of them and start referring crown lengthening their way.

Whenever I talk to periodontists about crown lengthening they tell me about the 80/20 rule; 80 percent of their crown lengthening comes from 20 percent of their referrals. These crown lengthening experts are telling the patient, “Look, we can do this once and right, and ‘once and right’ means your decay was in between the teeth, where the floss goes.” (That always makes patients feel guilty, but it’s true because they know they don’t floss and they’re being told the cavity was not where the toothbrush goes.) Your patients are being told, “This is where the floss is supposed to go, in between the teeth, and you obviously haven’t been flossing enough. This tooth needs a crown but this particular crown needs to go way underneath your gums. In order to make this work you have to be a very good flosser. If we want this crown to last 10-30 years and be permanent we are going to have to do two things. One: we are going to trim off a little bit of this gum tissue, and two: you are going to have to floss it every single day for the rest of your life. If you can handle the flossing, and make it routine every single day, this crown will be a permanent restoration.”

After I temporize a crown, having just seen the high degree of decay and how inflamed the tissue was, I’m still utterly amazed when the patient comes back into my office just six weeks after seeing the periodontist and voila! There’s the perfect margin right at or just above the gum tissue. The gums are pink and firm and the margin looks like a solid collar. Anybody could read the impression and anybody could trim the die. And when you get back those final restorations it is so satisfying to cement a crown after crown lengthening – it is just a perfect crown and bridge. With crown lengthening, it’s like this every single time. I love it! You say you are a quality practice? Well then let’s do more crown lengthening! Whether you do crown lengthening yourself or refer it out to a periodontist, you’re producing very consistent, very high quality dentistry.

So, what about implants? I bet if you strolled back into that same medical building, you’d find only one of those five docs doing five or more implants a month while the other guys haven’t referred a single implant in the last three months. Do you really consider your work to be “quality” when you file down two adjacent teeth that usually that aren’t going to benefit from a crown, making a three-unit bridge knowing that it is much harder to clean and floss? These bad boys are food trappers – you know this. You also know the longevity of bridges really isn’t that long. In fact, insurance companies are prepared for the worst-case scenario, and they figure they’ll have to replace your bridgework every five years. Every five years – sure, that’s consistent, but it ain’t the kind of consistency any of us should be aiming for.

Why not instead stop and tell the patient, “I don’t want to do a bridge. I don’t want to involve three teeth just because one tooth has failed to where it needs to be extracted. I was put on this Earth to perform quality dentistry. In order for me to do so, I want to place an implant here. It is a titanium screw that screws right up into your jaw bone. You will never have to worry about getting a cavity with this implant. The bugs that eat your teeth can’t eat titanium. You can floss around it like a normal tooth, and in my opinion, it is just the way to go.”

I remember 25 years ago you would do a big bridge and you might have had to change the bite and use a facebow. It was a lot of work getting all the preps even and parallel. These were big cases, high cost and your patients would leave the dental office thinking, “Man, I got all my teeth back – that guy’s a just a quality dentist!” Now I look back over these last 25 years and I see these big bridges as one of the biggest jokes in the profession. You can’t floss those things! The whole bridge will rest on the success of one tooth. When you have a 12-unit bridge – all connected together – and that one tooth fails, or abscesses or needs to be extracted you’ve just lost the whole bridge. That is not quality, guys. That is 25-year-old ancient history dentistry.

Today those bridges are being replaced by implants. I learned everything I needed to learn about placing dental implants at the Misch Institute. There are very few practitioners on the planet who have the same amount of implant knowledge than Carl Misch, and you can learn it all by seeing him (visit www.misch.com).

Doctor, get your patients involved and get them to see dentistry the way you see dentistry. Help your patients make right decisions so you can do consistent, quality dentistry.
Howard Live
Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, email colleen@farranmedia.com.

Dr. Farran’s next speaking engagement is April 23, 2010, at the Apogee Dental April Summit in Scottsdale, Arizona. For more information, please call Colleen at 480-718-9914.

Seminars 2010
April 23, 2010 • Scottsdale, AZ
Apogee Dental April Summit
Heather Driscoll: 712-899-4061
www.apogeedental.com		 April 24, 2010 • Orlando, FL
Excellence in Dentistry
Jennifer Jones: 800-337-8467 ext: 30
jennifer@theprofitabledentist.com
www.theprofitabledentist.com
May 1, 2010 • CoralVille, IA
Iowa Dental Association
Suzanne Lamendola: 515-986-5605
info@iowadental.org
www.iowadental.org		 May 12-13, 2010 • Dublin, Ireland
Irish Dental Group
Elaine Hughes: 00353 1 2950072
Elaine@irishdentalassoc.ie
www.dentist.ie
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