Dentists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we introduce Dr. Robin J. Henderson, a Townie who transformed an outdated chiropractor’s office into the dental practice of her dreams, focusing on a seamless digital workflow and an in-depth two-hour new-patient experience. By staying involved at every step in the redesign process, Henderson is extremely proud of her modern, sleek practice, which won the 2019 ADA Design Innovation Award in the remodel category.
Read on and get an exclusive look at how this aspiring math teacher-turned-dentist earned these honors and how she plans to maintain her smooth workflow and minimalist design even though certain protocols have changed because of the pandemic.
Name and practice location:
Robin J. Henderson, DDS
The University of Michigan School of Dentistry
3,200 square feet
1 dentist, 1 hygienist, 1 practice manager,
1 office manager, 2 dental assistants
Dentistry wasn’t your first career choice; you initially wanted to be a math teacher. What made you change your mind?
I loved my teachers when I was growing up and I loved high school sports. Math was always my favorite subject and when I started undergrad, I planned to teach high school math and be involved in high school athletics. By my second year of undergrad, I began to really enjoy science and that was when I started to think about the dental profession. I worked in my longtime neighbor’s dental office and I could see myself as a dentist. However, I have recently loved doing high school math with my daughter during quarantine!
Tell us about your journey from assistant to practice owner.
Dentistry was less complex when I started as an assistant in the early 1990s: Our health history was three questions and we used materials that weren’t particularly challenging to use. I remember very seldom we would use Panavia. That was stressful to manage, but it seems like it was usually a Hail Mary situation, like trying to get more life out of a bridge (we didn’t call it a “fixed partial denture” then) in an elderly patient where root caries had undermined an abutment. We mostly used amalgam, prepped and sat cemented metal or PFM crowns, and did extractions.
I have always been really thankful for my time working in my neighbor’s office. I worked in the front office too to cover vacations. I processed insurance claims and handled the phone. When I got to clinic in dental school, I was comfortable with dental materials and patient management.
After dental school, I returned to that same practice. I began to add technology, even before I became the owner. After working as an associate for six months, I assumed ownership and he retired. Today, materials and isolation requirements are more complex and demanding, and resin bonding went from an infrequent experience to the main thing that my current dentistry is based on. I almost never use metal anymore and extractions are very infrequent.
In 2014, you purchased and remodeled a former chiropractor’s office that was a block away from where you practiced for about 15 years. Why didn’t you choose
to remodel your old practice?
I had looked at all of the options over the years. At one point, I was going to build a new office, and then our daughter was born and the new office became less of a priority. Then I was going to stay where I was and remodel, but that space was just way too small, and I had already renovated anything possible to do in a long weekend. To do it comprehensively would have been a two-month closure and I still would have had too small of a footprint with very limited parking.
Our remodel team was amazing to work with and so helpful in the process. Our banker was one of the first team members. She showed us how affordable the project would be and was with us every step of the way—including bringing the champagne to toast at the end of our first day in our new office!
1. The Wand (Milestone Scientific). I would never practice without it. The typical anesthetic syringe seems so archaic, and these injections usually aren’t felt at all even though I’m not using topical anesthetic. I find it to be very delicate and less stressful, and my patients love and appreciate it. I appreciate the option of alternative injections that can be hugely beneficial, such as the AMSA and PDLs instead of the IANB. I don’t see any time requirement as an issue because I’m doing dentistry the second I’m done delivering anesthetic.
2. Primescan (Cerec). I’ve used Cerec Omnicam for six years and had Primescan since December 2019. While I feel faster at designing on my Omnicam, the Primescan is so much faster with processing and I never use spray, yet achieve beautiful images quickly. The Primescan is amazing for full-arch scans and for grabbing the image of the proximals on adjacent teeth easily.
3. Zeiss 3.5x loupes. My loupes are the only thing that haven’t changed since dental school and I can’t accomplish anything without them. I’ve tried other manufacturers but these cannot be beat.
4. Ultrasonic instrument washer (ESMA). One of my favorite efficiencies! It washes, rinses and dries instruments so they are ready for optimal sterilizing; you aren’t manually filling an ultrasonic and removing dripping cassettes to a location to dry. This frees up team time and does a better job than other ultrasonics.
5. VistaCool (Vista Research Group). Another favorite part of sterilization—it is plumbed in to deal with the hot water you normally have to manage from the SciCan Statim or Midmark M3. No more bottles to empty or cycles that don’t run because you didn’t realize the bottle was full and needed to be emptied.
6. Nomad Pro 2 handheld portable X-ray (Kavo). The time reduction to take an FMX is incredible. In less than half the time you can have a perfect FMX and your team member isn’t exhausted from running in and out of the room. I also appreciate not having the tubehead obtrusively hanging on the wall and not dealing with a drifting tubehead ever again. Because it’s portable, you don’t need a unit for each room, making it economical. Patients are always impressed by the Nomad and feel much safer with you not running out of the room to expose the radiograph.
Five years later, you won the
ADA Design Innovation Award in the remodel category. How involved were you with the renovation?
Very involved! The renovation took 10 months and the new office was conveniently located just one block down from my previous office, so my husband acted as the general contractor and was on-site many times per day. I was on-site during lunch and often after patient hours.
I fleshed out the floor plan based on our digital workflow, new patient experience and desired efficiencies with daily operations. My team inventoried all of the equipment we planned to move to the new space and made their wish list so all could be considered in the planning. Working in a nonideal environment for so many years allowed me to clearly envision what I wanted.
I visited Dentsply Sirona in Charlotte, North Carolina, and they helped finalize how to position my treatment rooms, because I am left-handed but future dentists who work here might not be. My childhood friend’s father is an architect and he took my crude graph paper and converted it to construction plans. He made the entrance much more exciting by raising the roof and installing impressive beams. His son and daughter-in-law are also architects in Las Vegas, and they sourced a light that is the focal point of the reception area and the carpet. They specifically named the interior paint colors from my vague description.
One of my favorite parts of the design aesthetic was the lighting. I designed the lighting plan to layer the lights to transition from the nonclinical areas to the clinical areas. There are uplights and downlights depending on what we want to feature. There’s a lot of task lighting, including in sterilization drawers where cassettes are wrapped. The team entrance has a switch to turn on all hallway lights as they enter. Lighting in the team locker room turns on when they open the door, so we don’t leave that light on all day when no one is in there. As they change into their uniforms and head to sterilization, one switch turns on all of the clinical areas. There are dimmers in each treatment room so overhead lights can be lowered for appointments such as sedation. I am very thankful for the wide availability of LED lighting.
I designed more than 100 cabinets for the new office. I used a lot of Ikea cabinetry—at the time, Ikea didn’t ship like it does now, so I drove almost six hours each way for each trip. It was worth it: I got exactly what I wanted, and the accessories like under-cabinet lighting, automated openers and soft closers make a huge difference in our days.
My dad is an excellent (retired) carpenter and helped me cut cabinets down. I also planned all of the backing and electrical locations so that items could be placed exactly as desired. My parents, my husband and I assembled and installed the cabinets. We are nearing three years in our new space and the cabinetry shows no wear at all.
In addition to helping you
with treatment room positioning, how did Dentsply Sirona help with your design?
I first connected with Dentsply Sirona Treatment Centers and Kappler cabinetry when they were introduced to the U.S. market at Siroworld. There, I met Matt Ehrenstrom, a territory manager for the company. I loved the sleek appearance of the Kappler cabinetry and the thought given to left-handed dentists with the Intego Treatment Center. Matt was very helpful in making sure the treatment center would be a good fit for me.
During my visit at the company’s headquarters, I spent time with a Kappler designer and my floor plan to configure my operatory with the goal of the cabinetry housing my small-equipment needs while keeping the work zone extremely efficient. They also confirmed the entry to the dental suite from the side versus the head of the chair, which I really like for ease of entry and greeting patients. It also gives the room a cleaner appearance. We have sliding barn doors for these single-entry rooms, which has been great during COVID because we are attempting to clean the room air and better manage aerosols.
With my previous equipment, I would frequently change my operator stool to a saddle to maximize ergonomics. The Intego Pro has me doing dentistry more comfortably and efficiently, while my patients appreciate their ergonomic seating.
Tell us about your emphasis on digital workflow and how that played a role in your redesign.
In our old building, computer network cables were strung in the crawl space and our server occupied a too-warm 5-by-5-foot room that also housed our compressor, vacuum, sound system, janitorial supplies and retail products. We adopted DSLR photography by 2003, charting and radiographs (paperless) in 2005 and Cerec in 2014. All of this was just added into our space wherever we could put it; computer towers sat on the floor and the Ivoclar Programat Oven was in our nonclinical team area.
The new office allowed for us to plan our environment to support what we do all day, instead of us working inefficiently to access what we needed. Most dental offices position the lab away from patient care so that it’s quiet and not messy. With digital dentistry, we very rarely use alginate and stone, but we do need a very clean space near patient care for staining and glazing porcelain.
We have our Cerec MC Mill just outside the treatment rooms in a Sirona Kappler Cerec Milling Cabinet for noise reduction and Cerec block organization. We designed a very small lab space directly behind it where a KaVo lab handpiece is used with a Vaniman Dental dust collector to prevent dust from contaminating the staining and glazing process. Above the staining palette is a monitor showing digital photographs of the patient we’re working on. The milled E.max is finished in the Ivoclar Programat Oven and the restoration is cleaned with the Reliable Corp. 5000CD Dental Lab Steam Cleaner.
All of this is just steps away from the treatment room and just outside my personal office. If I have a chance to work on charting or reading radiographs or CBCT while crowns are in the oven, I can readily hear the oven cycle finishing. We also house our 3D printer in this same “clean lab” space.
Walk us through an average
day at your practice.
We start with a team meeting where the clinical team briefs me on each appointment’s goals. What treatment are we accomplishing and why? What is the next appointment for that patient? What else is going on with that patient or his/her family? What celebrations do we have? What potential concerns or conflicts do we have with the schedule? The team meeting helps me get a feel for the day, gives me an opportunity to address further questions that I might have or point out additional areas of focus. It can also give me a lot of confidence in my team when they can demonstrate their level of understanding about what we plan to accomplish.
I typically see very few patients a day in my restorative schedule; four to six patients a day is typical, and two or three is not uncommon. I have diagnosed and treatment- planned comprehensively for most of my time in practice, so I most often treat a quadrant at a time. I do longer procedures such as E.max Cerec crowns and Bioclear restorations.
I start patient care at 8 a.m., break for lunch at 1 p.m. and finish patient care at 5. I really like having the longer morning to be extra-productive with long appointments.
Your husband is your practice manager. Do you find it easy to separate work from your home life?
My husband has always been involved in the practice, but in 2013 he started working there full time. It isn’t the career he would have chosen for himself, but he does enjoy dentistry. He was there all through dental school, too, so he really understands what he calls “the process of becoming professionalized.” He makes the technology possible, because he’s who we always turn to to make things work! He dealt with the challenges of 3D printing and now I can’t imagine doing dentistry without our 3D printer.
I don’t usually work directly with him at the office, so it’s not unusual for me to barely see him during the day. I am, however, a failure at separating work from home! Even our daughter is pretty aware of what goes on at the office and she has a gift for understanding people and situations, so I trust her instincts.
What do you do to enhance
the new patient experience?
We enjoy that our new patient experience is just that—an experience. It is rewarding to exceed patient expectations as we share findings they’ve never heard from their dentist before. We bring our new patients into an area that is removed from the flow of patients we are actively treating. The room has a nonclinical feel to it and there are large fingerprints on the windows to the adjoining hallway as a reminder that each patient is a unique individual, which guides our treatment planning. As we have adopted 3D-printed models, the fingerprint whorl also reminds me of the surface appearance of the printed models.
A new patient visit is most frequently two hours long, and it doesn’t involve a prophy or any treatment. We know this is extreme, but whenever we’ve tried to shortcut this visit and just get on with diagnosed care, we’ve found our patients to be much less likely to follow through with the care we’ve recommended and they require a lot more time down the road, when it can be disruptive to the schedule and not give them the best experience.
We enjoy taking the time to get to know our patients and discovering their oral health goals, educating them and helping them in the decision-making process. Because this is often overwhelming for patients, it’s helpful to have time to listen to their concerns and help them through accepting their conditions and discovering ways we can help them achieve the best long-term outcome.
We start with a series of high-resolution digital photographs with our Nikon DSLR camera, followed by a full series of digital radiographs with the Nomad handheld X-ray unit and Dexis Titanium/Platinum sensor. If needed, we can take a CBCT on our Sirona Orthophos XG. As my team is obtaining this information, I am at my desk reviewing it, charting existing conditions and findings, and developing a diagnosis and treatment plan. Often this will lead me to specific things I want to look at during the exam portion or questions that I want to ask to better understand what I am seeing. I am also considering what I know about their health history, which primarily includes what medications and supplements they are taking.
After radiographs have been taken, the patient views the Patterson Caesy Cloud co-diagnosis video on an iPad, which helps prepare him or her for the exam portion. Finally, our office manager reviews the medical history and begins getting to know the patient while I’m finalizing my tentative treatment plan. My office manager and I complete the exam together; it always includes evaluation of the TMJ, extraoral exam/palpation, Velscope-assisted oral cancer screening, range-of-motion recordings, Mallampati classification and classification of occlusion. We then complete a comprehensive periodontal charting.
One of our frequent findings in the past 15 years is the evidence of gastric juices entering the oral cavity. I believe the dental team has great power in helping patients identify signs of this new epidemic. We often refer patients to gastroenterology experts. In fact, one of our pediatric patients was diagnosed with Barrett’s esophagus (BE) as a result of our findings. When you see the signs of acids in an adult patient, they often have the potentially precancerous BE condition. And, sadly, it is becoming more common in adolescents. So often, these findings are as a result of the largely asymptomatic laryngopharyngeal reflux, also known as “silent reflux.”
We share our findings with our patient, largely utilizing the photographs that we obtained at the visit’s onset. We also make very specific product recommendations as we go over individualized home care instructions. Most often, our treatment plans are multidisciplinary, so we have specialty offices that we work very closely with.
Your practice has a very specific layout and a distinct workflow. How have new COVID-19 protocols affected this?
It has been a little sad to take away some of the things we so recently designed in our practice. We love that our patients enjoyed just hanging out in our office: They came in just to sit on the couch. They liked to look through the photobooks of our remodel and the book that shows all of the Scripture and quotes that friends sent during our remodel that’s written in the walls on the studs. They came in to have a coffee.
All of those things are now removed. The furniture is six feet apart, including a glass table that used to display a large Pewabic Pottery bowl that my team gave me. The table has been moved near the entrance where we take our patients’ temperatures.
Several patients travel an hour to two hours each way and it seems weird to have them wait in their cars instead of inviting them in to relax.
Despite many people spending time on their phones in the reception area, we provided current and well-kept magazines that we have now removed. The front counter has sneeze guards (designed by my father) that definitely were not a part of the front desk I designed. Luckily, my dad—age 80 at the time of our remodel—did the finish work and still had the stain that I custom-tinted for the other woodwork. It blends perfectly and looks relatively intentional. He optimistically made it so that it could easily be removed in the future.
I do love the Medify Air MA-40 air purifiers that I added because of COVID-19; they help overcome the difficulty of wearing two masks (respirator and surgical) and a face shield. I wish that I had known about them earlier, but I hate adding stuff to sit on the treatment room floor. I had a lot of that in my old office and it felt so good to get away from that in my new one. For the HVAC system we have added Reme Halo in-duct air purifiers.
By and large, digital dentistry is much cleaner. We don’t have impressions that we have to decontaminate and send from place to place. We don’t have to move around the office a lot because we can access information from virtually any workstation. One advantage we have with reopening is that we have always been a low-volume office. Our COVID-19 protocol includes me doing very few hygiene exams (which is so nice for me!) as we attempt to not move in and out of treatment rooms during aerosol-generating procedures. I trust my hygienist and she can radio my assistant with our Black Diamond radios if she has any questions. She gathers photos, radiographs, probings and descriptions of any areas of concern and I evaluate those at my convenience after the hygiene patient leaves and we use a teledentistry code for the exam.
Because I tend to do quite long appointments, I was worried that after more than two months away, I would not be able to jump back in, but it has been surprisingly normal for me. It is harder on my team to deal with the respirator/surgical mask/face shield, especially as they walk outside to get patients from their cars.
In June, I received a Vector Fog ULV cold fogger. Although I like the idea of using a nonnoxious substance to decontaminate the office, I am worried that it will adversely affect the artwork and other surfaces in the office.
What’s your favorite patient story?
I have so many incredible patients that show such kindness to my team and my family. One of the biggest surprises was when we completed full-mouth treatment for severe wear on a patient who worked in the mountains as a logger. He had a limousine take us to lunch in a private dining room at a nearby hotel. That was definitely a fun memory!
As for one of the times I provided a patient with a result that I felt had a significant impact, that would be when my then-99-year-old patient reached the point where I could no longer patch the tooth I had been trying to maintain with myriad fillings. It was one of her few abutment teeth supporting her over-60-year-old maxillary removable partial denture. I provided her with a Cerec E.max crown that fit perfectly to her partial that she loved. Her smile was intact as she celebrated her 100th birthday and she is still going strong!
What gives you the most professional satisfaction?
I used to chase after so much continuing education, especially courses related to occlusion and how to manage the bite in a large case. Now, I realize that my biggest sense of professional satisfaction comes from seeing and hearing my team perform well.
I enjoy hearing their thoughtful and productive conversations with patients and reading their fully diagnostic radiographs. I also enjoy knowing that they will come to me with questions or ideas to better serve our patients or our team. This gives energy to my days and makes the biggest difference in my satisfaction.
I am only one person, so when my team can meet and exceed the standards that I desire in the care of our patients, how much more powerful is that? That is when I am smiling behind my mask!
What do you enjoy doing
in your spare time?
I love to enjoy the activities that our 14-year-old daughter is involved with. I also find time that we spend at our cabin to be most relaxing.
How do you think COVID-19
will affect dentistry in the years to come?
I think aerosol management will quickly supersede our standard precautions of surface treatment that has been based on bloodborne pathogens. I am really looking forward to emerging research, and I am optimistic that it will conclude that the high-volume evacuator (HVE) is extremely effective in preventing adverse outcomes from dental aerosols.
Because effectiveness with the HVE varies greatly among dental assistants, I hope to see accessible instruction on techniques for achieving the biggest benefit from the HVE. That said, I think the open-concept operatory will be a thing of the past.
I also believe that dental schools may adopt more simulation dentistry. Virtual learning will likely continue to grow.
I was thankful every day of quarantine for all of the free continuing education made available by so many.
You’re a member of quite
a few dental groups and clubs. Tell us about your involvement.
I have been involved with the American Dental Association at my local component, currently serving as president for the second time. I’m also active at the state level, serving on various committees and as a delegate to our state House. I also served once at the ADA House as an alternate delegate. I really enjoy the relationships I have with dentists all over the state because of that involvement.
I’ve been a member of the Seattle Study Club for more than 15 years. My club is more than two hours away, so it’s a fairly significant commitment to be involved, but I enjoy the treatment-planning sessions and my family has great memories from the Seattle Study Club Symposiums. I am a fellow of the American College of Dentists, the International College of Dentists and the Pierre Fauchard Academy. I also serve as editor of the newsletter for the Washington state section of the ACD.