|  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:
 
                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. Scaling and root planning on a two or three month recall basis
                 Local antibiotics
                 Sub-systemic antibiotics
                 Therapeutic rinses
                 Tongue cleaning
                 Laser therapy 
 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.
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