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The Best Techniques for New Practitioners by Gordon J. Christensen DDS, MSD, PhD

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New dental practitioners in 2012 have significant challenges peculiar to this time in the continuing progression of the dental profession. In most geographic locations, there are enough dentists to satisfy the needs of the population. New dentists have the highest dental school debt of all time, averaging from $250,000 to $300,000. It is nearly impossible to begin practice alone, and most new dentists are going into their initial practice with a mature practitioner, joining a corporate-sponsored practice group or going into the military. However, on the positive side, there are many actions that a new dentist can take to make the move into professional life easier and faster.

Over the years of my career, I have started four practices as I have moved geographically to assist in initiating dental schools. The launching of these practices has been somewhat painful but provided highly educational learning experiences. I can conclude that new practitioners can elect to behave and act in ways that either stagnate their new practices or that encourage new patients to come to and remain with their practices. Among the proactive aspects of practice building is incorporating numerous techniques and practice policies that are attractive to patients.

This article enumerates and briefly explains some of the most important productive techniques to stimulate practice development and continued growth. I will only provide introductory information on each of the concepts or techniques. For more complete information, our continuing education group, Practical Clinical Courses, has detailed information provided in courses, videos and written material on all of the topics discussed.

Complete Patient Education by Staff
Most new dentists have yet to experience the challenge of soliciting new patients. They were provided patients by their school. On the other hand, mature practitioners know that ongoing daily patient education is mandatory for patient acceptance of elective procedures. Patients will come to you if they are in pain, but you need to educate them about the procedures you provide so they will accept elective procedures, such as bleaching, veneers, tooth-colored restorations, elective orthodontic procedures, implants and many others. Dental assistants, dental hygienists and business personnel should be taught how to tactfully and thoroughly educate new patients about the elective procedures available in your practice.

Complete Treatment Plans
There is a tendency to be hesitant to present complete treatment plans to new patients because you fear the treatment cost will cause them to reject the plans. I suggest dividing every treatment plan into two categories, mandatory and elective. Obviously, the mandatory treatments are the ones that are causing pain or objectionable disfigurement, while the elective ones are those that could be postponed. If the patient knows that youare not trying to “sell” them some procedures they do not need, they are far more prone to stay with you. On the successful completion of the mandatory treatment, most will go on with at least some of the elective procedures. By using this concept, their initial treatment plan cost can be moderate, and the elective treatment, provided over a period of time at moderate cost, does not frighten them away


Fig. 1: Complete patient education by staff. Fig. 2: Complete treatment plans.

Bleaching/Whitening
This procedure is the most simple, relatively painless and inviting dental procedure available to attract new patients. Studies have shown that about 80 percent of women and 60 percent of men will accept bleaching when asked the simple phrase, “How do you feel about the color of your teeth? Would you like them to be a lighter color?” This educational process can easily and effectively be delegated to staff members. I suggest that every new patient should be tactfully asked about his or her interest in bleaching. Most will accept it. Interestingly, when the bleaching is completed, they become more aware of and concerned about diastemas, amalgam discolorations, crooked teeth and other oral problems, and many request further treatment.

Veneers
Although placement of ceramic veneers has been notably reduced during the recession, patients are still interested in the less expensive direct resin veneers. When bleaching does not appear to be a viable procedure, suggest veneers. If you keep the cost moderate, patients will agree to the treatment. Soon, satisfied patients tell their friends about you, and you’ll receive other referrals.



Fig. 3a: Before bleaching/whitening. Fig. 3b: After at-home bleaching.
Fig. 4a: Before veneers. Fig. 4b: After veneers.
Fig. 5: Conservative periodontal therapy.
Fig. 6: Endodontics.

Conservative Periodontal Therapy
Many patients want to avoid periodontal treatment because of the known painful recovery stage and the objectionable after effects of the treatment, including sensitive teeth, tooth mobility, spaces between teeth and unsightly gingival architecture. Conservative periodontal therapy includes:
  • Scaling and root planning on a two or three month recall basis
  • Local antibiotics
  • Sub-systemic antibiotics
  • Therapeutic rinses
  • Tongue cleaning
  • Laser therapy
When your patients hear you are providing such relatively painless and moderate cost treatment, they come to you, and they send their friends. Our video at www.pccdental.com, “Minimally Invasive Periodontal Therapy” (item V4323) shows these techniques in detail.

Endodontics
Most patients wrongfully think of endodontic therapy as being among the most painful dental procedure they can experience. Develop a painless endodontic procedure, using up-to-date techniques, complete thorough local anesthesia and analgesic coverage during recovery. Endodontic therapy can be almost totally painless. Your reputation for painless dentistry will grow, if you develop that ability. Endodontic treatment is a significant part of a general dentist’s revenue. Perfect it!

Class II Resin-based Composites
The well-known “bread and butter” portion of dentistry can be simple, effective, rewarding and financially acceptable. But, you must make it fast, predictable and non-sensitive. Those characteristics are difficult to develop in dental school. Take a good course by a “real-world” teacher on how to make restorative dentistry a viable and enjoyable part of your practice. Patients prefer tooth-colored restorations, and if you can do them rapidly, at a moderate cost and at high quality, your general practice will grow and prosper.

Ceramic Crowns
This area is the most rapidly growing and most desired portion of all areas of dentistry. A revolution is in progress as the profession changes from porcelain-fused-to-metal to zirconia and lithium disilicate restorations. Find a dental laboratory with which you feel comfortable. Perfect and speed up your techniques in fixed prosthodontics, and ethically promote this part of dentistry. It constitutes about one-third of a typical general dentist’s gross revenue.

Simple Impressions
You were probably not taught how to do adequate double-arch quadrant impressions in dental school. However, they have been proven to be more predictable and accurate than full-arch impressions for one or two units of crowns or onlays. Learn how to do them and discuss the concept with your technician. You should be able to develop a technique that is easy, predictable and requires only a few minutes.
Soon there will be less expensive digital impression devices that will revolutionize this part of dentistry. Already, over onehalf of laboratories accept digital impressions. However, good tooth preparations and excellent soft-tissue management will still be necessary.

In-office Milling of Restorations
This area of dentistry is still in its developmental stages. There are about 12,000 practices (about seven to eight percent of dentists) in the U.S. using the in-office milling technique, which, when perfected, is highly desirable to patients. If you are fortunate enough to have the resources to purchase a CEREC or E4D device, and you take the time to learn how to effectively use it, this can be a major practice builder.

Implants
This area of dentistry is exploding, especially in the small diameter implant area (1.8mm to 2.9mm in diameter). It has been estimated that about 40 million patients in the U.S. are edentulous. Most of these patients hate their lower dentures. Learn how to place and restore these well-proven implants when they are indicated. Even one satisfied patient will send many others to you.
Small-diameter implants (or “minis”) are a good starting place. As soon as you feel comfortable with them, I suggest that you move on to learning how to place conventional-diameter implants (3 mm and over in diameter). It has been estimated that 178 million of the 200 million adults in the U.S. have at least one missing tooth, and it has been further estimated that only one percent of Americans have a dental implant. Get going!


Fig. 7a-b: Class II resin-based composites.
Fig. 8a-b: Ceramic crowns.
Fig. 9: Simple impressions.
Fig. 10a-b: In-office milling of restorations.
Fig. 11: Implants.

Dentures, Partial and Complete, with Implants
You probably dislike making dentures, both partial and complete. You are not alone. Many mature practitioners share these feelings. How about placing implants in appropriate locations under these dentures? Patients love them, the dentures stay in place and your practice grows. We have two videos on this subject, both showing easy use of this concept: “Making Complete Dentures a “Win-Win” Service” (item V2549) and “Predictable Removable Partial Dentures” (item V2551).

Occlusal Splints
One-third of your adult patients are bruxers or clenchers. What are you doing about it? They should be taught about occlusal splints, and you should be doing them. If they are shown photos of a late bruxer/clencher, they become believers and accept your suggestion of an occlusal splint. This task can easily be delegated to a competent staff person, since it is a reversible procedure.


Fig. 12a-b: Implant-supported partials at 8 years of service. Fig. 13: Occlusal splints. Fig. 14: Preventive appointment.

Preventive Appointment
I estimate that at least 10 percent of the patients in a typical general practice need more preventive therapy than normal. These patients are easy for you to identify. Educate them about how to slow down or actually prevent new caries. Suck-down trays with 5000ppm fluoride gel in them, used twice per day, after breakfast and before bed for five minutes each, constitutes a well-proven preventive technique. Well-educated patients will accept this procedure, which is worth considerably more revenue than a hygiene appointment, and may save the patient from potentially more expensive and painful future treatment.

Continuing Education
Numerous procedures have been identified that will build practices and keep patients coming back to you. Almost all of them require some continuing education and experience for competency. Select which ones are attractive to you and go for them. Our organization has CE available to you as described on two websites www.pccdental.com and www.cliniciansreport.org, as well as many courses and videos on all of the techniques identified in this article. Call 800-223-6569 for details.

* Director, Practical Clinical Courses CEO and Cofounder, CR Foundation Diplomate, American Board of Prosthodontics Adjunct Professor, Brigham Young University and University of Utah.
Author's Bio
Dr. Gordon J. Christensen is CEO of Clinicians Report, and founder and director of Practical Clinical Courses (PCC) in Utah. This group is an international continuing education organization providing courses and videos for all dental professionals. He is also co-founder of the nonprofit Gordon J. Christensen Clinicians Report (previously CRA), as well as an adjunct professor for the University of Utah. He is a diplomate with the American Board of Prosthodontics. Dr. Christensen has presented more than 45,000 hours of continuing education throughout the world and has published many articles and books. Further information is available at www.pccdental.com.
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