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30 Years of Dentistry: Lessons Learned
Lesson #6: Become More Efficient Dr. Joe Steven, Jr., DDS

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The lesson this month dovetails into last month's lesson (see July issue of Dentaltown Magazine) in regards to seeing more patients during your work day by becoming more efficient. You have to be more efficient! I do three seminars on efficiency because dentists are always telling me, "I know I am just not efficient enough." It doesn't matter how great of a dentist you are, if you are not efficient, you are not as profitable as possible.

In my Efficient-endo program I discuss how every dentist should be doing their own endo, especially on molars. However, I do explain that if it is taking you hours to do a molar endo, then you are better off to refer the procedure to someone else. Same is true with extractions. If it is taking you 30 minutes or more to extract a few wisdom teeth, you should refer this procedure as well. The goal is to decrease the number of referrals to specialists and keep the profits in office. But, only if you can do these procedures efficiently and properly.

There have been volumes written on efficiency in the dental office, ranging from performing various procedures, to better ways of equipping your tray setups, to more efficient scheduling. In this article I would like to address three clinical efficiency systems we all deal with day in and day out that can dramatically increase every dentist's bottom line.

First on the list is the H&H cordless impression technique. If you are not doing the H&H technique, you need to start doing it. I would venture to say some of you reading this just rolled your eyes and thought, "Here we go again with this H&H technique. I have tried it; it doesn't work!" Yes, it does work! Thousands of dentists are doing it. Get it mastered, one way or the other. If you have to eat the cost of redoing several impressions until you get it mastered, do it. You have the rest of your career to enjoy the benefits of the H&H technique. My daughter, Jasmin, who has been out of dental school just three years now, mastered it the first week in my practice.

The H&H impression technique is the system that neither requires retraction cord nor the need to create a dry field. After placing my handpiece down following a crown prep, the final impression is completed in two minutes. No stopping the bleeding! No packing of cord! This is Dr. Jeffrey Hoos' innovation, which I have been doing for nearly 10 years and it saves valuable chairtime, not to mention there is much less trauma to the patient because we are not packing cord. I actually did a crown prep on a dentist-friend of mine and the total appointment took 15 minutes. I used the Paroject interligament syringe for immediate anesthesia and made the temp myself following the H&H impression technique.

Second, quit referring out endo! That is one of the most profitable procedures we have to offer our patients and yet too many dentists are referring this to the endodontist. Dr. Jake, who graduated with Jasmin and practiced with us for one year, told me in one of his e-mails from his current office in Iowa where he is an associate, "They just can't believe how much molar endo I am doing and how many wisdom teeth I am extracting." If you have a good system, endo does not take long. My recommendation has always been "six-handed molar endo." Get two assistants in the room, whereby one is going back and forth to the dentist's side and setting up different reamers, and the other one is assisting. It should not take more than 20 or 30 minutes to do a molar endo procedure (excluding anesthesia time or time to do a hygiene check).

The system I've been using for the past five years is the EndoExpress SafeSider system developed by renowned Manhattan endodontist, Dr. Barry Musikant. This is the one incorporated in our hands-on session of my Efficient-endo program. It's amazing to see the enthusiasm of the dentists at these meetings when they see how simple and safe this system is. No more broken instruments! No more expensive reamers or files! No more long endo procedures! And, far less referrals! I had a dentist tell me that it doesn't bother him to refer molar endo because he gets them back to do the crown. I have trouble turning down $1,500 per day and sometimes twice a day because we usually do the endo, build-up and crown the same day when an emergency patient comes in. I'm not looking down the road to do the crown later after the endodontist is finished. I want the production same-day. He had a whole different outlook after I told him my system. Plus, patients hate to be referred.

Extractions are next on my list. Too many dentists are referring even simple extractions from their office. I understand referring out impacted teeth, but general dentists should rarely refer out simple extractions. So many dentists refer out because they come across difficult extractions which run them behind schedule. Once again, it is a matter of using the right instrumentation. I wish I would have learned about Luxators 30 years ago. And, I wish the Physics Forceps were developed sooner as well. Jasmin and Dr. Courtnee Martin, Mark Troilo's associate, are extremely proficient and confident at extracting many teeth now that they are using the Physics Forceps.

The Luxators look similar to an elevator but are sharper and thinner. They come in various widths and some are angled for retrieving broken or sectioned roots on posterior teeth. I started off with just two straight ones and soon ordered the complete set once I saw how valuable they are. You position a Luxator along the long axis of the tooth in the periodontal space and rotate, not elevate. It's amazing to see these roots loosen up for easy removal. No more drilling bone around these roots in order to remove them.

The Physics Forceps utilize a totally different concept in extracting teeth. The bumper of the forceps is placed on the facial aspect of the roots on the mucosa and the beak of the forceps engages the lingual aspect of the tooth in the sulcus. You simply squeeze lightly and hold for about a minute. Then, you rotate and the tooth disengages the socket and is removed easily. These are truly amazing instruments that make extractions easy. No more long extraction appointments and definitely less frustration!

These are just three of my favorite innovations in dentistry. I have incorporated them in my practice which has made our office much more efficient and profitable. We should always continue to seek more efficient systems and techniques to help our offices do procedures in a better, safer and more efficient manner. Everyone wins when we do!
Author’s Bio
Dr. Joe Steven graduated from Creighton Dental School in 1978 and has been in solo practice in Wichita, Kansas up until June 2007 at which time his daughter, Dr. Jasmin Rupp, joined him. He is president of KISCO, a dental products marketing company, providing “new ideas for dentistry,” and is the editor of the KISCO Perspective Newsletter. Dr. Steven along with Dr. Mark Troilo present “The $1,000,000 Staff" & the “Team Dynamics” seminars. Dr. Steven also presents three other seminars: “Efficient-dentistry,” “Efficient-prosthetics” and “Efficient-endo.” Dr. Steven also provides the KISCO Select Consulting Program to dentists in the form of a monthly audio cd recording. (Contact info: jsteven@kiscodental.com, 800-325-8649, www.kiscodental.com)

This story, originally published in the KISCO Perspective Newsletter, is reprinted with permission.
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