Office Visit: Smile Design with Dr. John Nosti by Chelsea Knorr, Editor, Dentaltown Magazine


Smile Design with Dr. John Nosti
by Chelsea Knorr, Editor, Dentaltown Magazine

Dr. John Nosti has become a well-recognized name among dentists in the last several years. From his presence on Dentaltown to his co-taught Clinical Mastery Series, he's always seeking to become better at dentistry, something he is already good at. Herein we talk to Dr. Nosti about what motivates him, both inside and outside the office.

Name: John Nosti, DMD, FAGD, FACE, FICOI
Graduate From:University of Medicine and Dentistry
New Jersey Dental School
Practice Name: Advanced Cosmetic and General Dentistry
Practice Location: Mays Landing and Somers Point, New Jersey; and
Manhattan, New York City, New York
Practice Size: Six operatories
Staff: 10
Website: www.CosmeticDentistryofSJ.com and www.SmiledesignNYC.com

Dr. Nosti, why did you go into cosmetic dentistry?
Nosti: Early on I recognized this was an area I wanted to concentrate on because of the happiness it brought to patients. Going through school we are taught that everyone hates the dentist. When we start practicing we realize that many patients are fearful and do express how much they dislike their visits, regardless of how many times they have had great office visits with you and how much they like you personally. Cosmetic patients have an entirely different experience and outcome. Their energy level is so much different during the process and once they achieve their desired result. Having that level of effect in someone’s life is deeply rewarding.

What drew you to cosmetic dentistry?
Nosti: It was seeing a before-and-after, close-up retracted view of eight maxillary teeth in a journal. I thought it was the coolest thing I had ever seen.

What’s your practice like? How is the layout? Describe a normal day.
Nosti: I practice the majority of time in my Mays Landing, New Jersey, location, which for the most part is a blue collar, working community. I think most dentists would not believe you could build a “cosmetic” based office in my area. We have six ops in the practice and the average day is usually a mix general restorative, new patient exams or consults, and hygiene.

Tell us a little about your practice philosophy.
Nosti: I believe in treating patients as if they are my family members. My staff ’s goal is to exceed patients’ expectations, to be courteous, friendly and caring. When a new patient comes to our practice, one of the most common things we hear is how kind and friendly our office staff is. Most medical practices I feel have forgotten this.

Do you have partners or associates?
Nosti: I have two partners, Drs. Milton Noveck and Steven Katz. Steve is retiring in 2014 and we are fortunate his son Bryan is joining the practice. I would not be able to practice the way I do and teach without having the partners I do.

New York is second only to California in number of practicing dentists. How do you set yourself apart?
Nosti: My home base is still in New Jersey. The reason why I started practicing in New York City is to challenge myself to be the best in my field. Word of mouth from specialists and other general dentists is still my primary referral source. Of course having a great website that patients can go to once they have been referred is key.

Life story: Ready. Set. Go.
Nosti: I was born and raised in a close family with my parents, one older sister, and many uncles, aunts and cousins who all lived in the same town of Nutley, New Jersey. We moved to the “Jersey Shore” in 1990 once I graduated high school (and yes many of my relatives moved to the same town as well). Growing up, my father owned his own plumbing business, which I would help out during the summers when I was older. These summers helped build my work ethic and ability to relate to patients. Everyone understands construction terminology, and I relate dentistry to construction many times when discussing large restorative cases. Also seeing how my father presented either “needed” work or “wanted” work helped shape my people skills as well.

If you want to know how I became interested in dentistry all together, it was a career report on “oral surgery” my sophomore year in high school. From then on becoming a dentist was my goal.

What’s it like to own a practice?
Nosti: I don’t think there is anything in the work force world like owning your own business. It obviously has moments of difficulty, but the positives far outweigh the negatives if you run your business correctly.

What’s your favorite part? Your least favorite part?
Nosti: The freedom to practice the way I want to practice is my favorite part. And honestly, every practice out there has “drama” or complaints. This is by far my least favorite part of my practice.


Clinical Mastery Series
Clinical Mastery is dedicated to excellence in practical restorative postgraduate education. Directed by Drs. John Nosti, Jason Olitsky, LeeAnn Brady and Mike Smith. Look for live Implant courses coming soon! For more information, call 480-489-5551 or visit www.clinicalmastery.com.

 
Spring/Fall 2014 Schedule

Mastering Functional Dentistry: Ultimate Occlusion Level I
April 11,12 – Wichita, Kansas
June 6, 7 – Philadelphia, Pennsylvania
September 26, 27 – Dallas, Texas

Mastering Full Mouth Rehabilitation: Ultimate Occlusion Level II
November 7, 8 – Tempe, Arizona

Mastering Complex Cases: Ultimate Occlusion III
October 10, 11 – Englewood Cliffs, New Jersey

Full Mouth Rehab Live
September 19, 20 & Oct 17, 18 – Englewood Cliffs, New Jersey

Anterior Aesthetics Live
October 10, 11 – Englewood Cliffs, New Jersey

Art of Digital Photography Hands On
June 6, 7 – Philadelphia, Pennsylvania
September 26, 27 – Dallas, Texas
November 7, 8 – Tempe, Arizona

 
Describe how you integrate cosmetics into your practice.
Nosti: I think most young dentists feel you have to market to try to get “cosmetic patients” into your practice. This is completely untrue. The first type of cosmetic patients you will find in your practice are patients who have wear from attrition, erosion or abrasion. By simply educating your patients on how you can reverse this process can be an easy way to integrate cosmetics into your practice. I call this “functionally-driven cosmetic dentistry.” The second type of patient who is currently in your practice are the patients who are unhappy with their smiles. They typically do not tell you they are unhappy with their smile until you question them. Because of this I recommend you have a way to bring this up so you don’t offend your patient. Asking them to rate their smile on a scale of 1-10 is an excellent way to start the cosmetic discussion. Always follow this up with “what would it take for you to rate your smile a 10?” when they provide you with any number less than 10. Don’t be fooled by the patient who rates their smile a nine. Many times these patients want “a straighter, whiter smile.”

What are your favorite marketing techniques?
Nosti: Hands down the must-have marketing piece required these days is a website. It astonishes me the number of dentists who are in practice and do not have a website, or who do not keep up with the one they have. Where do you go to find something? Your iPhone? Your computer? Google? Without a website you are invisible, and honestly, spending money, in other marketing avenues without a website to steer someone to is a waste of money in my opinion.

You’re an active Townie and you post frequently on Dentaltown.com. How did you learn about Dentaltown?
Nosti: I first learned of Dentaltown through the magazine that came to my office one day. As much as I was intrigued by it, it still took me a couple of years to go to the site and start “poking around.”

You are very involved in the cosmetic and occlusion forums on Dentaltown.com, and have several CE courses on the website. What CE courses would you recommend outside of Dentaltown?
Nosti: When doctors send me emails on Dentaltown saying that they enjoy reading about the cases I post, I direct them toward my Dentaltown CE. When they’ve exhausted those options, I recommend the Clinical Mastery Series (see sidebar on page 60).

How has Dentaltown affected your professional life and your social life?
Nosti: I feel it has affected my office in a positive way because when patients move into my town they are being referred to me by their previous dentist. It has allowed me and my dentistry to be visible on a world-wide level. My CE courses with Clinical Mastery Series have become more popular, and more nationwide dental societies are asking me to speak at their conferences. I feel this is because people who read my posts like my teaching style, and know that I genuinely enjoy teaching.

I now get to meet Townies everywhere who come up to me at meetings to introduce themselves. I love this. It has definitely allowed me to meet more people than I would have otherwise.

What’s your favorite feature of Dentaltown?
Nosti: If you don’t know something in this field, there is someone out there who does and is willing to help you. Post it in the appropriate area and you will get an answer from someone who is a leader in that field. To me, that is amazing.

What is the greatest advancement or change you have seen during your tenure as a dentist?
Nosti: Wow! There are so many. Veneers have become a household name, direct composite material is preferred over amalgam, the availability of implants, everything is digital… I could go on and on.

  Dr. Nosti's Top Products
Joint Vibration Analysis (JVA) Electric Handpieces T-scan Empress/Emax and Variolink Veneer Cement
When did you start using it?
2002 Around 2004 2005 2002-2005 (Empress 2002, Variolink Veneer 2004, e.max 2004 or 2005).
Why can’t you practice without it?
It allows me to establish the health of a patient’s TMJ and detect any potential issues prior to initiating any complex reconstructions or cosmetic cases Air-driven handpieces simply do not cut as easily or efficiently. I would never be able to be as efficient with reconstruction and cosmetic cases without it. Articulating paper is great to mark teeth, but those marks have no bearing on sequence, timing or force. To be able to test forces on new ceramics, complete dentures, implants, or even splints is invaluable. I have used two labs over the past 9 years, both of which report my fracture rate is around 2 percent long-term on cosmetic, reconstruction cases, and my all ceramics. I believe T-scan has a big part to play in that. These three materials have allowed me to be provide outstanding cosmetic results and be very predictable in my cosmetic cases.
When do you use it?
Every new patient gets a JVA quick scan and obviously every patient prior to restorative dentistry is evaluated. On every patient. Every time I treat more than three indirect restorations, equilibrations, implants, dentures, splints, reconstructions, cosmetic cases, etc. Every “single unit” I do is an e.max restoration. Cosmetic cases are either Empress or e.max, and they are all cemented with Variolink Veneer.
How do you market this item to your patients?
I don’t think patients fully grasp the benefit to this item until it is used on them, or unless they are a pain patient who has sought me out. However, there is a page on my website regarding JVA. We tell patients prior to its use that it is a quieter, more efficient hand piece than when they were younger. Like the JVA, I don’t think patients fully grasp the benefit to this item until it is used on them. My photo gallery is full of these materials.

Who are some of your mentors?
Nosti: On a day-to-day basis, my partners Drs. Katz and Noveck have taught me a ton about running a business, and dealing with patients and staff. I would not be the dentist I am today if I had not joined their practice. Early on Drs. David Hornbrook, Pete Dawson and Mark Piper each had a strong impact on the way I practice. Hornbrook was a great mentor for my speaking/teaching as well. Currently, Drs. Jason Olitsky and Mike Smith are guys who push me to continue to improve in both areas. On Dentaltown you can never go wrong reading the entire posts of guys like Drs. Lane Ochi (velogeek), Barry Glassman, Mike Melkers, Thomas Mitchell and DoctorEd!

Tell me about one of your favorite or most rewarding cosmetic cases.
Nosti: One of my favorite patients from years past was a patient who lost her husband on 9/11. She came to my office one month or so after this tragic event and I can honestly tell you that her and I cried together for about 30 minutes following the health history and “get to know you” introductions. I ended up restoring her smile and she became one of those patients who I hug when they come in and hug when they leave. Many times hugs are better than words.

Currently I have a patient who is going through a complex implant reconstruction. The entire time, up until now, she has been wearing an implant-supported denture that she absolutely hates. About a week ago, we did a “try in” of what her new fixed prosthetic is going to look like and she broke down in tears. Up until now she believed I could provide her with what she wanted, but it was still a leap of faith to her because of her bad previous experiences. Now she really believes. Despite having other people tear up with their new smile, this patient isn’t the “crying type,” so her response was humbling and provided for one of those “moments” you don’t forget.

What do you do in real life (family, hobbies, community involvement, etc.)?
Nosti:
I am a husband, a father of a nine-year-old girl and one-year-old boy, a brother, a son, a cousin and a nephew. I spend a lot of time with friends and family members in my town. Dinners at my house or a relative’s easily adds up to 20-30 people… love it! Living on the Jersey Shore, I enjoy boating, fishing, hitting the beach, riding my motorcycle and anything outside in the summer. I am a big Giants fan and I hate shoveling snow (when will this winter end?)!

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