Office Visit: Community, Cooperation, Canada! by Chelsea Knorr, Editor, Dentaltown Magazine

by Chelsea Knorr, Editor, Dentaltown Magazine

One of an estimated 23,000 Canadian dentists, Dr. Terri Pukanich (or “Dr. Duke” as you may know her on the Dentaltown message boards) hails from Slave Lake, Alberta, and offers us a glimpse into one of the first Canadian dental offices we’ve visited. With a team of more than 20 and big expansion plans on the horizon, Dr. Pukanich proves to have mastered private practice ownership. She quips that Canadians are some of the nicest people on the planet, and with her dedication to promoting cooperation over brutal competition in the dental profession, we are inclined to agree.

First off, what drew you to the dental profession?
Pukanich: When I was 10 years old I fell off my bike and broke my two front teeth off — subsequently needing two root canals, two posts and later, two crowns, and then, much later, an implant. I remember distinctly being in awe at what the dentist was able to do to restore my smile, which I thought was totally ruined. It was then I decided to become a dentist and have never looked back. The ability to help people in such a profound way was what really drew me to dentistry.

You’re one of the first offices we’ve featured in Canada. What do you love about Canada?
Pukanich: Our vast natural resources and spectacular scenery! There is not one area of the country that doesn’t have something really cool and unique to offer. Plus Canadians are just the nicest people on the planet, eh?

What’s it like to practice in a country with socialized medicine? Does dental care operate under the same terms? How does this work?
Pukanich: The fact that we have socialized medicine in Canada has no effect whatsoever on dental practice. And, in fact, in Canada there is no such thing as a PPO or HMO. Every practice in Canada is essentially fee for service, with many of my patients having dental insurance offered through their employers. In Alberta where I practice, we do not even have a provincial fee guide, so every dentist charges a fee they feel is appropriate to their practice and service level. When the insurance company does not pay up to that fee the patient is responsible for the rest.

Name: Terri Pukanich, DDS
Practice Name: Slave Lake Dental
Graduate From: University of Alberta, 2002
Practice Location: Slave Lake, Alberta
Practice Size: Currently 5,000 sq. ft. main floor with 12 ops and 1,656 sq. ft. lower level team area and lab
Staff:Five dentists, four hygienists, six RDA level 2s, four administrative coordinators, two sterilization support staff and one marketing director/personal assistant

    Bonding Agents
  • 3M ESPE, Scotchbond Universal Adhesive
  • Apex Dental Materials, Simplicity 1 and 2 and Interface A and B

  • Burs:
  • Diamond and carbide burs

  • Cements
  • 3M ESPE, RelyX Luting Plus
  • 3M ESPE, RelyX Unicem 2

  • Implants
  • Basic Dental Implants, Omni-Tight Implants
  • BioHorizons Implants

  • Impression Materials:
  • 3M ESPE, Position Penta Quick (catalyst and base)
  • 3M ESPE, Impregum Penta Soft Medium Body (catalyst and base)
  • 3M ESPE, Impregum Soft (light body)
  • Clinicians’ Choice, Template Ultra Quick Matrix Material
  • Sultan Healthcare, Genie Berry (light body)
  • ACU-flow, Hydrophilic Impression Material

  • Patient financing:
  • CareCredit
  • Lay-away program, financing treatment before actual treatment date
  • Monthly payment plans for larger treatment plans
  • 10 percent discount when treatment fees are paid up front in full

  • Restoratives
  • Sultan Healthcare, Topex Topical Anesthetic
  • 3M ESPE, Supreme Ultra Composite
  • Heraeus Kulzer, Gluma
  • Microbrush
  • Waterpick, Original Toffelmire
  • Ivoclar, Empress Direct Composite
  • Mynol Blue Articulating Paper
  • Kerr, Expasyl
  • Premier, Traxodent
  • 3M ESPE, Protemp Plus Temporization Material
  • Dentsply, Gutta Percha Points
  • Premier, RC-Prep
  • Dentsply, Absorbent Paper Points
  • SybronEndo, Pulp Canal Sealer

  • Technology:
  • Planmeca Intra, Digital Radiograph System
  • Planmeca Intra, Panoramic Radiograph Machine
  • Planmeca Intra, Cephalometric Radiograph Machine
  • Sirona, CEREC Crown System

Life story. Ready. Set. Go.
Pukanich: Pretty boring actually! Born and raised in Slave Lake — the name originates from the Slave Indian Tribe (pronounced “Slawvey”), my parents divorced when I was in kindergarten and I grew up with my mom and stepdad and one younger sister. Growing up, my mom was always a secretary and my stepdad worked in one of the three mills in our town. I left for the University of Alberta right after high school and got into the dental program after three years. In my first summer of undergrad I met my husband who is also from Slave Lake. We were married in 2001, the year before I graduated dental school.

Upon graduation I immediately moved back home and began practicing with my childhood dentist and bought the practice in 2003 at the age of 25 (yikes!). In 2005 we had our first son, Cooper, and that was also the time my husband joined the practice as what I now refer to him as, our CFO. It was born out of the fact as many women dentists know when you own a business you don’t get maternity leave. After four weeks I was back at work and my husband John and our son were in the basement at the office with us every day! Then in 2007 we became parents once again to our daughter Darby who is now 6. Also in 2007 our first associate joined the practice, Dr. Natalie Stone. Natalie and I went to school together and I think of her as much more than an associate doctor. She actually won the gold medal for outstanding student in our class (I joke with her that I was a close second) and is the most amazing dentist I know — she makes me a better dentist every day I practice with her.

Tell us a little about your practice? How is it laid out? What is the workflow like?
Pukanich: Our practice, I would say, is a very typical bread-and- butter style practice with a few tweaks that I think make us different. Currently we have eight doctor’s operatories, three dedicated hygiene operatories and a new patient operatory, which is a chair, light, desk and, most importantly, a closed door. We are expanding shortly to have eight doctor’s operatories. All of our new patients see the doctor prior to seeing hygiene and meet with our phenomenal new patient coordinators, Stephanie or Karen. We have a pan, four bite wing and a full set of photos (which patients can view on an iPad) taken on every new patient. After they meet with Stephanie or Karen one of our doctors takes the time to do a complete exam, diagnosis and case presentation. The patients then will meet with our patient care coordinators to discuss appointments and financial arrangements. From there they enter either hygiene or restorative care. We also have a large hygiene recall practice. Each day we have a minimum of three hygienists practicing and one to three doctors at a time. I currently also work with a restorative hygienist. She can anesthetize the patient after which I prep the teeth and then she fills and finishes. Having her allows us to keep our doctors schedules full with very productive procedures.

What is your practice philosophy?
Pukanich: It’s definitely changed throughout my 12 years in practice but currently we try to provide transformational experiences for our patients and our team. We like to create raving fans in our patients and empower our team to create those opportunities for them.

Do you have partners or associates?
Pukanich: No partners, but four associate doctors.

What do you do to set your practice apart from others?
Pukanich: Invest in my team tremendously, utilize photography and by far, our new patient experience. We are also highly engaged in giving back to our community and have just recently launched “The Smile Project” ( to help us do that!

What are your concerns for the graduating dentist?
Pukanich: Principal dentists don’t know how to treat associates well and hence the tendency toward solo practice — and solo practice is hard! If associates were treated well, compensated fairly and given equal opportunities, new grads would have a much easier time in practice and in life! Principal owners and dentists need to stop thinking in scarcity and treating these young dentists poorly. It reflects poorly on us and the profession, and pushes our young, eager dentists into ownership far too early when they may not be ready, forcing them to struggle for years to make what they deserve. What they deserve is a mentoring associateship to get them off their feet and on the right track.

What are your favorite marketing techniques? How do you get the word out about your practice?
Pukanich: Marketing is actually something fairly new for our office, in the last year or two, and can be tough in Alberta as our college has very strict guidelines around marketing. I can tell you that word-of- mouth referrals are our biggest source of new patients and the number- one way I think most established dentists should focus marketing before turning to external avenues. We do a patient newsletter and we are active on Facebook (we have more than 1,000 likes, which I hear is pretty hard for a dental office!). I will admit it’s much better being a big fish in a small pond when it comes to marketing our practice.

You are an active Townie and post frequently on How did you learn about Dentaltown?
Pukanich: I became a member in 2004 — I had received the magazine and then decided to check out the website. I was hooked immediately!

What has Dentaltown done for your professional life? For your social life? What is your favorite feature?
Pukanich: Professionally it has changed my practice a great deal. I joke to my team to never let our patients know that all I know in dentistry I learned on the Internet! I actually watched the entire 30-day Dental MBA by Dr. Howard Farran when it was on VHS and picked up one huge pearl from Howard that turned my practice around. It was about having only three principles of business: price, quality, service, and you can only satisfy two of those three. I choose quality and service and never looked back. It has also driven all of my choices for CE, which has allowed me to be in contact with some truly amazing people in dentistry.

Socially I have met some really great friends and reconnected with some dental school friends! Favorite feature is “Today’s Active Topics” — that’s my go to when I log on, which recently has been on the mobile version more and more.

What do you think is the biggest problem dentistry faces today?
Pukanich: Dentists thinking from a scarcity mindset and eating each other alive. There is more than enough for everyone, you may just have to move to find it. Think abundantly and quit being so competitive. Don’t be afraid of going rural — there are still hugely underserved communities all over Canada and the U.S. and we don’t have to all be fighting over the same piece of pie.

What is the greatest advancement of change you have seen during your tenure as a dentist?
Pukanich: For me personally it has been photography and how it has completely changed our record keeping process and our engagement with our patients. Also, the changes in CAD/CAM and 3D imaging have been cool to see evolve. I bought my first CEREC in 2004 but have yet to jump into the 3D imaging, although I can see one day when it could become standard of care.

Looking ahead, what would you like to see dentistry do in terms of the way it operates as a profession in the next five to 10 years?
Pukanich: I would love to see more dentists practicing together — it just makes sense and can make your professional life much easier if it’s done in the right way.

Who are some of your mentors?
Pukanich: Jay Geier, Mary Osborne, Lee Ann Brady, Mike Melkers and Gary Dewood.

What is your favorite procedure?
Pukanich: That’s a hard question. Although it’s not a procedure, my favorite time in practice is the time I spend with new patients during their pre-clinical interview. It’s so rewarding and fun to raise their awareness through questions and see light bulbs go off for them. Patients also leave feeling as though they have been truly listened to, which happens far too infrequent in health care. But if pushed for a procedure, I really enjoy splint therapy (we do NTIs, DAASAs and Tanners) — there is something about grinding on acrylic that is fun for me and I think it may be that most of dentistry is very mechanic-like (it’s broke and we fix it), whereas I liken splint therapy to more like internal medicine — you need to figure out the puzzle, which, when I do, is very rewarding for both me and the patient.

Describe your most successful or rewarding experience in your professional life.
Pukanich: I take my role as the leader and mentor in my practice as my primary job (not being the dentist) and by far the most rewarding feeling has been growing my team to become what they are today. I have come from times when I had a team of six and we could not get on the same page to now having a team of 23 or so (I lose count!) and feeling like they are the best team I have ever had. I have people who have been with me for years stepping into true leadership roles and I am slowing delegating more and more, and they are blowing me away with what they can accomplish if I just can get out of their way. I empower them to make decisions and tell them we will deal with it if it turns out to be a mistake. We have a saying in our office: “Our team is EFFECTIVE — Engaged Fully, Fully Empowered, Committed to Impact, Vision and Excellence.” We are not perfect but I am really proud of how far we have come.

What do you do for fun?
Pukanich: Boating is my all-time favorite thing to do and we live on the biggest lake in the province. While boating, we fish, waterski and hang out with friends on a private beach on the lake. We also enjoy camping, quadding (four wheeling for the Americans), and all the outdoors. On my own I love to read, mostly biographies and books on business and leadership, can’t resist a good facial and have an admittedly ridiculous obsession with all of the Real Housewives.


Jay Geier’s
Scheduling Institute

Transitions Group
North America

Mary Osborne

Digital SLR

2012-present: This has changed my office in numerous ways. Their telephone training is absolutely the best, and they have been outstanding coaches in helping me clarify my vision and reach unbelievable goals. They have taught me to think creatively, not competitively, and have been instrumental in growing my team and our revenues — increase of 50 percent last year!

2005-2012: My first set of practice coaches, and to whom I owe tremendous gratitude on how they transformed the systems in my practice. They were just what I needed to get my practice on the right track and get it very ordered and systematized. They were the systems gurus and I could not be where I am today without them.

2012-present: As I progressed on my CE journey my clinical skills were getting better and better, but my communication was not up to par. Whenever I questioned mentors about where I needed to go they all had the same answer: Mary Osborne. She teaches communications techniques that are truly from the heart and that have helped me clarify my vision and my role in the practice. A truly exceptional lady.

Since 2005: We currently have three in the office. Single-best tool for patient education and increasing their awareness. It truly makes them own their problems. We use it on every new patient and on recall patients every two to three years, or as needed with individual tooth problems. The only thing I would change is to have more of them — one in every op would be perfect!


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