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.
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