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The Changing Landscape of Dentistry

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When I was a kid, pharmacists had their own pharmacies and optometrists had their own eye clinics. Now these models have been replaced by Walgreens and CVS, with EyeMasters and Pearle Vision.

In France they actually have ATM machines for prescriptions. A physician loads the prescription onto a medical card and a patient can pick it up anywhere there is one of these machines. The machine dispenses however many pills the electronic script is written for, puts a sticker on the bottle and drops it into a drawer, the same way you’d grab chips from a vending machine. Prescriptions are now a commodity.

When we go get glasses, most of us don’t care if we look into a machine to tell us we have 20/80 vision because that number goes to a lab tech who crafts the lenses. Most of us are more worried about how the frames look. Glasses are now a commodity.

It’s like “The Jetsons” where a mechanized robot brushes George Jetson’s teeth, shaves his face and dresses him based on a scanner view of his body. What we once thought was futuristic and unattainable is here and now!

All this has me thinking about dentistry’s model and how it’s changing. What will the dental landscape look like in 2050? Will dentistry go the way of Walgreens and EyeMasters? I asked several of my colleagues this question and they shared their opinions, which we feature in this issue (page 64).

Let’s talk about the reality. Dentistry’s unique selling proposition is surgery. We work in an operatory. Our hands and fingers are in someone’s mouth. It’s not the same as a pharmacy or an eye clinic. It takes human hands and human eyeballs to perform dentistry.

Commodities are things you buy on price. When you buy corn, you don’t care if it’s from Iowa or Nebraska. The silliest ad campaign I’ve ever seen is the Florida orange juice one. Have you ever heard anyone at the grocery store asking for Florida oranges because they don’t want the ones from Arizona?

My practice is 25 years old. I have a lot of contacts from Dentaltown who have significant roles in the business to consumer (B to C) marketplace, and we all agree: half of America buys dentistry on price. Some of these people do perceive dentistry as a commodity and some buy on price simply because they don’t have money. If they have bad dental insurance and their insurance says they can only go to one doctor in town, they’ll go to that one doctor in town. This phenomenon is going to be around forever. There are people who are poor who really do value dentistry and there are rich people who don’t value it.

The other half of America has strong opinions about who gets to work in their mouths. The relationship with their provider has a huge impact on their choice of dentist. Have you ever once based whether you want a prescription filled at Walgreens on which pharmacist is going to be there? No! You just want to know when Walgreens is opened and if it has a drive-thru!

The argument is that corporate dentistry fuels the side that says dentistry is a commodity. These companies are representing a brand instead of an individual dentist. They’re often marketing on price, rather than procedure or specialty or dentist. So, yes, there are real-live dentists, not robots, performing the procedures, but it seems to be the beginning of taking the relationship out of the process.

Once you’re 50, you’ve seen everything at least twice, particularly in economics. This is the second time I’ve seen the idea of corporate dentistry come around. Black Monday in 1987 was just months after I graduated dental school. I was practicing during the stock market crash in 2000 and Lehman Brothers fall in 2008. When everyone thinks it’s the end of the world, it’s not. It’s a cycle. We create an economic bubble and then it explodes. It’s just economics.

Corporate dentistry chains have a good grasp on sophisticated marketing and management. When I got out of dental school, not a single dentist I knew, including myself, could use QuickBooks to make payroll. I hadn’t taken one class on management or communication with staff. For some, the answer is: let someone else do it. So if you hate dealing with all things social media and Excel, corporate might be the way to go.

For those who would rather learn it for themselves, check out all the practice management courses on Dentaltown.com. They’re only $18 each. Or, if you want more than a few hour-long classes, maybe you’re interested in going back to school. I went back to school in my 40s! I took two business classes each semester. I attended class on Monday and Wednesday evenings from 6-10 p.m. every week for two years. And I about cried when it was over because I loved it and learned so much! Another solution is to hire street-smart staff—an office manager, specifically. Recognize your limits and delegate!

The other advantages to corporate dentistry are better access to capital and better patient financing. It’s nice not to have to worry about these things. The CAD/CAM unit and other equipment is part of the package and there is no third-party when it comes to financing treatment.

It’s nice to have access to capital and to have patient financing, but you can have these things in a group practice, too. You can split the cost of the rent and the CAD/CAM and the payroll with other partners. You can work with CareCredit for patient financing. So in these ways, I don’t see how a corporate chain in all 50 states is any more competitive than an independent group practice.

I’m not opposed to corporate dentistry. I think it provides needed services for many Americans who need treatment. But unless corporate chains can preserve the one-on-one relationship that a patient gets when he or she visits her independent dentist, I don’t see corporate taking over the dental landscape or dentistry going the way of Walgreens. I think they’ll always be a spot in the marketplace for both private offices and corporate chains. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=354&aid=4817#sthash.L80fMs9A.dpuf

“Ethical Dilemma” – A Series Kickoff

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When the 2013 Townie Choice Awards was in full swing this summer, and dentists and hygienists were voting for all their favorite products and services, we asked all the voters to answer the question “what’s the biggest crime in dentistry?” We got some interesting answers – overtreatment, managed care, insurance reimbursement, indifference, embezzlement – just to name a few.

Dentists deal with all sorts of ethical dilemmas on a daily basis, and the Dentaltown the ethics forum on our message boards are filled with debate. This month we’re starting a series called “Ethical Dilemma” that will address some of the stickier, less black and white, 50- shades-of-gray areas in dentistry. These articles will run throughout the duration of 2014. I’m kicking off the series with the topic of managed care.

There are some ethical issues the majority of us can agree on. Right now most of the world agrees we shouldn’t eat cats, dogs and dolphins even though I bet they all taste like chicken anyway. But sometimes the lines are more blurred, or aren’t universal. I once lectured at a dental school in India. A dental student came up to me and said she couldn’t listen to my talk because I eat cows. When you go to McDonalds in India, there is no Big Mac on the menu. It’s a McVeggie Burger or a fish sandwich.

Everyone sees everything differently. It’s hard to get 150,000 dentists (that’s about how many are on Dentaltown.com) to even agree what day of the week it is, let alone about how managed care should or shouldn’t work.

When it comes to ethics, most people, dentists included, fall within a midrange. This middle is the silent majority. A normal distribution curve (Fig. 1) says 68.5 percent of people make up the middle ground. The further out from the middle, the fewer the people, but the more extreme. I envision this Ethical Dilemma series sparking conversation on the boards, but chances are only the extreme outliers will argue. This series is meant to start a conversation, not be the world according to Howie! It’s meant to get you thinking and discussing your views and experiences from what you see going on in your practice and in what ways you deal with the ethical issues that arise everyday. Can’t we just have an honest conversation?

About Half the U.S. Market is Focused on Price.

If someone asks you “What’s the best car?” you’re going to say something like Lamborghini or Maserati or Ferrari, or some luxury car that costs an absorbent amount of money. While this is ideal, a $200,000 car isn’t realistic for the average buyer.

Jay Leno might throw these numbers off, but the most popular cars, according to Forbes are: Ford Focus, Toyota Corolla and Volkswagen Jetta—all midsize, reasonably priced sedans. These are the top cars because they are what most of us can afford. No, they’re not the best cars, per se, but they are the most practical based on cost, safety and mileage.

This same idea can be applied to dentistry. Sure, you could have a high-end boutique style practice in a lower economic area, but it would be like setting up a Mercedes-Benz dealership in Parsons, Kansas. It could work, and would depend entirely on the dentist being exceptional in many areas, but a Ford dealership would probably do a lot better, and would be a lot easier of a sale. Demographics act like gravity, they’re hard to deny. In business we call this market segmentation and markets are usually carved up by price, quality and service.

Americans basically divide the dental market in half meaning half are primarily focused on cost and will go wherever their dental insurance, employer, Medicare or Medicaid tells them to go while the other half sees dentistry as a relationship and they absolutely want to pick their dentist. They have a special relationship with their dentists and do not want to go to another dentist just because a third party told them to, and they will pay more for this privilege.

I hear so many dentists say that the problem with third-party insurance fees is they can’t do the treatment a patient really needs, and they’re only willing to do treatment that they’d do for themselves. I personally think this view is a little extreme, especially having traveled the world over.

If someone has a cavity, the decay needs to be removed and you need to fill it. If you’re getting $300 for the filling, then get out your fanciest materials from 3M and Ivoclar, do your tooth-colored adhesive restorations, and make some money. That’s basic; Cost + Profit = Price. But when managed care comes in and sets an exact price, you’ve got to switch to Price – Profit = Budget. A budget means you will need to have a plan. Why are you doing a tooth-colored restoration when bonding agents cost nearly $1 million a barrel? Is it because it’s the only thing you would have in your mouth? Why is it that you don’t place amalgams when research says they’re lasting 30-35 years and 3 billion earthlings live off of $3 a day? This was the only material available when I was a kid and at least a few people would say I turned out just fine!

You might have very different values and priorities than the patients you are treating. Your patient has the right to have different values than you, the dentist. I heard a speaker once say how horrible a parent was because he didn’t have money for his kid’s braces but he took his whole family to Disneyland. I’m good with that. I still remember driving from Kansas to California with five sisters in a green station wagon playing Monopoly in the back the whole way to Disneyland, without seatbelts, I might add, and it still is an awesome memory.

If you’re doing low-cost dentistry then treatment plan accordingly. Be aware of all the upgrades that are not covered like ortho, implants, bleaching, bonding and veneers. And if a patient only has enough resources or dental values for an amalgam, then place one.

I’m not a firm believer that the highest price is always the highest quality. Southwest Airlines is a testament to this. Southwest is the lowest cost airline and no one has ever died in one of its planes. If the plane doesn’t fall out of the sky, and it takes off and lands on time (and preferably doesn’t lose my luggage), it passes my test. High-cost dentistry isn’t necessarily the best quality or what’s best for the patient anyway. Which lasts longer, amalgam or composite?

You can never afford to get complacent and ignore your own unique dental marketplace. You must cultivate relationships and provide exceptional service at a fair price. The case of low cost dental offices and those who don’t participate is not about the quality of dentistry. It’s perceived value. Managed care fills a necessary market. For a free enterprise system to successfully exist, you must have different market providers for different price points. If this does not happen it is called a market failure and this almost always invites the government in to correct the failure. Do you want government-owned dental offices? If the answer is no, then start treating the low end providers with more respect.

Don’t try to dictate what people can choose or afford. That’s not your decision to make. They’re the consumers. They’ll make their own decisions as to how to spend their money based on what they want and how much they have to spend. It’s our decision as to how we deal with their choices. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=351&aid=4778#sthash.v4VaGYlH.dpuf

Go West, Young Man

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Made popular by author Horace Greeley in the mid-1800s, the quote, “go west, young man,” was a proclamation to embrace new opportunity in the new western country. Granted, today I’d personally have to travel 1,457 miles east to get to St. Louis – the gateway to the west – from where I live in Phoenix, negating any literal meaning of the quote, but even so, it still has significance today. If you want to take advantage of new opportunities and possibilities, it might be necessary for you to move to an entirely new area or change your practice to accommodate a certain demographic.

In late November 2013, I started a message board thread on Dentaltown.com, which links to an article in The Denver Post titled, “Flood of new dental patients in Colorado meets trickle of caregivers” (Editor’s note: To view the thread, please visit www.dentaltown.com/ColoradoPatients). The article explains the new dental benefits Coloradans will receive via Obamacare and Medicaid, but that dentists are concerned that they won’t get paid enough to treat these new patients and keep their doors open. Also in the article, nine Colorado counties are listed as having no dentists in them whatsoever. In just a few days, this thread generated more than 130 posts from Townies. I invite you to check out this particular message board. It’s a pretty touchy issue, but I feel the concerns of some dentists surrounding this issue aren’t correct.

One of the arguments I hear is that those nine counties in Colorado have no money, hence, no reason for a dentist to open up a practice there. That’s ridiculous. Were that true, there wouldn’t be any Wal-Marts or McDonald’s in those counties either (and there are). If Wal-Mart and McDonald’s are in those counties, why can’t there exist a dental practice? For 25 years I’ve said all major businesses start with this equation:

Price – Profit = Budget
And I’ve always said that dentists seem to arrive at their price backwards:
Cost + Profit = Price

Ford Motor Co. has no problem starting with the average price of a Ford Taurus (at around $26,000 minimum average), from which they will subtract their profit, and from which the engineers will work off of the budget. Similarly, if they are designing a lower cost Ford Escort, they will say, “Here is what we are selling a Ford Escort for, we will subtract the profit we need to remain healthy, and then we will arrive at a budget.” Dentists don’t do that. Dentists don’t think they have two distinct markets. They will go into an area that has less income, taking HMOs and PPOs, but they won’t do amalgam. They’ll insist on doing composite. They won’t use a lowcost lab – they’ll go with some high-end cosmetic lab. They’ll insist on providing high-cost dentistry that much of the poulation of that town cannot afford.

These are the dentists who say, “I refuse to do dentistry on my patients that I wouldn’t do on myself.” That’s very altruistic of you, doc, but let’s get real here. The dentistry you would do on yourself is high-cost, high-quality dentistry only the upper class could afford. If that’s the way you think, you have to stay in the upper-half of the market and only that section of the market. You can’t be everything to anyone because eventually you will become nothing to no one. If you cannot figure out that there is lowcost dentistry, and that some people get amalgams and extractions and flippers and partials and dentures, and you need to use a low-cost lab, then you need to stay away from that geographic zone and let another dentist in who will make a killing offering low-cost dentistry. If all you offer is high-end dentistry, you’re going to make money on some patients and lose money on others – it will be a wash. You might as well pick low or high, run off half of your patients and only focus on the demographic you want to treat.

Also, consider the underserved areas themselves. No, they are not San Diego, Manhattan, Florida or Arizona where everyone seems to want to practice these days, but you have to remember those areas are already oversaturated with dentists. If it was always your goal to become a dentist and practice somewhere warm, you’re going to need to do something major to differentiate yourself from the rest of the pack. It takes a lot of work to practice in a saturated area. On the other hand, if you’re the only dentist in an entire county, people are going to flock to your practice in droves. When you serve the masses you dine with the classes, and that’s what will happen if you practice in an underserved area of the country. Do you really want to practice in San Francisco now, when you can make a killer living in a part of the country with no dentists and visit San Fran any time you want? Think about it.

There are already practices that are moving into underserved areas – corporate practices like Aspen or Heartland – and they’re doing it the right way. You know, the scariest question being asked around the dental profession is, “Is dentistry going to go the way of Walgreens and CVS the way pharmacies did?” Mom-and-Pop pharmacies collapsed because all the profit margin came from the buying power to purchase the pills. Group purchasing of drugs by Walgreens and CVS was everything that the small independent pharmacist couldn’t do. Secondly, there was not a single continuing education class pharmacists could take that would differentiate them from other pharmacists. We all know what happens when a dentist goes through Pankey or LVI or the Misch institute; we all know how dentists who take tons of CE each year for a decade can differentiate themselves from their competitors so much they’re almost playing a different game.

Corporate dental practices like Aspen and Heartland are making some very smart moves. They’re opening up practices in rural, underserved areas where there are few or even zero dental practices, and they’re making a killing. We’ve all heard why corporate dentistry is dominating – buying power for supplies and lab costs, and better marketing. But its Achilles Heel will always be staff turnover. How many dentists who sell their practices to corporate chains are still there three, four or even five years later? In my backyard, they are all gone. And when the dentist leaves, the patients stand around wondering what happened, and they become a lot less loyal. Staff turnover trumps brand name every time. While writing this column, I asked my office manager Sandy how big a blow it would be to our practice if we let Jan, my assistant of 25 years, go, and Sandy literally gasped. It would have a devastating impact on our patients and our practice.

There is a lot of opportunity out there, doc. You don’t have to sit in an oversaturated area spinning your wheels trying to figure out how you’re going to get your next new patient. Take a look at demographics in your own state or states around you. Figure out where the underserved live. “Go west!” – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2606&t=219440#sthash.ba2IC3ce.dpuf

Best Practices, 2013

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At the end of my September 2013 column, I asked readers to visit www.dentaltown.com/besttips2013 and post what they did this year to make their dental practice the best it can be. I really love the responses this thread generated. For the sake of this column, and for the health of your business, I’m going to share with you my favorite posts from this thread and my thoughts about them.  First of all, for this thread to be kicked off by a first-time poster on Dentaltown.com – and that the advice drkinnarshah provided was spot on – thrilled me to no end. When we look at patterns of a successful dental office, practices that have morning huddles do infinitely better in any way you want to measure, whether it’s stress reduction, or increases in productivity and net income. The only thing I want to add to drkinnarshah’s post is to remember, after the morning huddle, it’s imperative to keep in constant contact with the team via walkie-talkies throughout the day.

Dr M’s post is spot on. Everyday since the economy tanked on September 15, 2008, (aka, “Lehman Day”), when asked “If you could have just one magic bullet to improve your practice, what would it be?” four out of every five dentists would say, “I need new patients.” I’m personally proud to say that October 2013 was the best month my practice, Today’s Dental, has ever had in terms of production, collection and new patient intake; I attribute this to two things. The first thing we did was begin nurturing online reviews; this is very powerful. In my neck of the woods, Internet marketing is very strong. We know nine out of 10 appointments are made by women, and more women post online reviews than men do. At my practice, our staff outright asks our patients to post reviews about their positive experiences online. We know that we might receive a negative review from time to time (you can’t please everyone all the time), but if you can drown out any negative review with a ton of positive reviews, you’re doing something right. Our staff hands our patients a card prompting them to say something nice about us, and it’s been a great success.

The second thing we did in order to obtain more new patients was handing our current patients a referral card. I know pretty much every practice management consultant on the lecture circuit and just about all of them have told me when they do in-office consulting, the first day is always observation. They want to go in there and see what the team is doing and not doing. In almost every instance, on the day of observation consultants never hear a single employee – whether it be the dentist, assistant, receptionist or hygienist – ask for a referral of a friend or a loved one. This is the number-one most powerful form of marketing, and it’s never done. When we hand out our referral cards, our patients refer a friend to our practice and when their friend becomes a patient of ours, our patients and their friends will receive a $20 Visa gift card. These cards aren’t validated unless a member of our staff signs it. Also, we incentivize our staff to hand these cards out; whomever on the team has the most referral cards with their initials turned in at the end of the month receives $100.

Also in this thread, Jen Butler wrote…  For years, I’ve said all leaders are readers, and I’m glad Jen made this recommendation. In my practice, we all read a book a quarter (we’d love to do a book a month, but it is hard to try to find the time to fit a book in each month). I highly recommend getting your team to all read the same business book once a quarter, and discuss it – but, for non-readers, instead of reading the book, you might consider the audio version of it. All non-readers can knock an audiobook out in the same amount of time it takes to do three loads of laundry and mow the lawn. It’s team building and total enrichment for the entire practice.

 I applaud dave27 for implementing new procedures into his practice (it already seems to be paying off for him), and for streamlining his processes to do dentistry faster, cheaper, higher in quality and lower in cost. If you’re burning out in dentistry, start learning new procedures like short-term ortho, or implants, or CAD/CAM.

 Dr. Duke talks about how she set up a private Facebook group for her team and in the thread, Sandy Pardue quotes that as saying that this is the top pick of this entire thread. I have to agree with Sandy, but I am going to have to one-up it a bit. You have to have a communication platform for your team, at Today’s Dental we’ve had our own e-mail platform that has been very effective. The Facebook group Dr. Duke refers to is very interesting; I like that a lot. It’s also why we set up the same kind of platform on Dentaltown.com. Dentaltown’s private groups are far more robust than the Facebook private groups, however, because you can organize them by subjects. I mean you can set something up for hygienists, something for the entire office, something just for insurance or marketing, etc. It’s more organized. But here’s what I like even more: If the dental office staff members are on Facebook in the private Facebook group, they are extremely tempted to hop off that page and go see what all their nieces and nephews and girlfriends are doing. When they are on the Dentaltown.com private group, now when your hygienist, receptionist, assistant or office manager leaves that group she sees three-million other posts by thousands of other dental assistants. And if she gets caught up and lost and distracted in that, she’s still learning about dentistry.

I want to thank everyone who participated in this thread, and I invite everyone to read what’s been posted already, and continue to contribute their best practices from 2013 as we move into the new year. Best of luck to you in 2014, and I’ll see you on Dentaltown.com! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=343&aid=4683#sthash.tTzSBN8t.dpuf

Not Getting It Done? Hire a Consultant!

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There is a very interesting thread on Dentaltown.com called “43 and Burned Out” that, as of this writing, is pushing 6,000 views and almost 250 replies.

Every year since we launched Dentaltown in 1999 a thread like this pops up, where a dentist admits to being burned out. You read upsetting declarations like, “I just don’t feel it anymore,” or, “I’m trapped because my lifestyle is based on the earnings of a dentist, but I hate dentistry and there’s no way I can get another job to make this kind of income.” They’re desperate for help or even a point in the right direction.

I’ve written about burnout before. Sadly, it is still the biggest problem facing the dental profession, leading to awful, harmful vices like alcohol and drug addiction, and even suicide. You can focus on improving your environment and your gear, and you can retool your practice so you can work on what gets you excited, but another thing you need to focus on is your own health.

I’ve written often about my Four Bs – the four things I always focus on to remain successful: my Body, my Babe, my Babies and my Business. Take notice of the first B: my Body; it’s the most important one. Once you lose your body, it’s game over, and the other three Bs don’t matter anymore.

The most powerful and productive dentists I’ve known over the last 25 years all have one thing in common. No, they weren’t all valedictorians. No, they’re not all second- or third-generation dentists. No, they didn’t have specific undergrad degrees in business, marketing or finance. All of the successful dentists I know have their bodies together! They’re healthy. They eat right. They exercise.

I know far too many dentists who are couch potatoes. They work a high-stress job and come home at the end of a long day and just veg out, eating and drinking awful things, and generally do not take very good care of themselves. Then they wonder why they’re depressed and sick all the time. We still have a society that is based on the ancient model of medicine that goes all the way back to when people saw witch doctors: You have a problem, you go to the witch doctor, they make you a lotion or a potion with herbs, or they pull out their knives and cut something off of you. No pill a doctor gives you will counteract years and years of destructive living! It’s time you realize your health is in your own hands and you need to do something about it!

That’s easier said than done, though. I should know! On the day I turned 50, I asked myself, “What’s my goal?” I mean, every New Years Day when I was in my 40s, my goal was to lose 10 lbs. Then it became, “I want to lose 20 lbs.” Then it became 30 lbs. On my 50th birthday I realized I was 50 lbs. overweight and I wasn’t getting it done. So, what did I do? I hired a diet coach who came to my house, threw away about six grocery bags of food I had laying around in my pantry, sat me down and went over nutrition. That coach came to my house every Tuesday for three months before I finally figured out the proper way to eat.

Once I figured out my nutrition, I signed up for maybe what is the craziest goal I ever could sign up for: I decided I was going to participate in an Ironman triathlon where I would have to swim 2.4 miles, bike 112 miles, and then run a full marathon. Everyone I told about my new goal literally laughed in my face. They’d say, “Dude, you’re 50 lbs. overweight, you don’t swim or bike or run, you’re a workaholic and you basically sit at a desk all day.” Because I wanted to achieve this goal, I knew I had to train properly. I couldn’t do this myself, and I had such success with my diet coach that I hired coaches to help me train for my triathlon. I started taking swimming lessons and found after swimming for two minutes straight, I’d either have to stop to catch my breath, or I’d turn my head to breathe in and I’d breathe in water. I also had to relearn how to ride a bicycle. You think all you need to do is mash your foot down on the pedal, but when you’re training for a triathlon, you clip your shoes onto your pedals and learn to push and pull. I even needed a running coach who taught me the proper way to run. People who run marathons have a high cadence, they lean forward, and they try not to swing their arms left to right. Basically, the point I’m trying to make is I raised my hand. I realized, “I ain’t gettin’ it done,” so I brought in consultants for my body.

If you’re stressed and burned out, it’s time to start getting your body in better shape. I’ve met thousands of dentists over the last 25 years and any dentist I’ve ever met who had his or her body in shape was never burned out. Ever. Since I’ve been training for an Ironman triathlon, I’ve been really tuned into a message board on Dentaltown.com called “Ironman Training“. The other Townies who post on this thread will get up early in the morning, ride their bikes 50 miles in two hours, come home, shower and get ready for work. The cool thing is, because they’ve worked out, they come to work totally fired up and engaged! Why? Intelligent people know that even though they weigh 150 lbs., they live inside a 3.5 lb. brain. The brain has a trillion circuits, was built by 3.6 billion DNA base pairs, and it’s probably the least-taken-care-of organ in the body. People take better care of their teeth by brushing and flossing and getting their teeth cleaned every six months than they take care of their brain. If your diet is horrible and you don’t exercise, don’t sit there and wonder why your 3.5 lb. brain isn’t working right. It’s all connected.

Once you start taking care of your body, then you can really focus on the remaining three Bs. Along the same lines as what I’ve explained previously, when you start focusing on your business and you realize that your practice is just not getting it done, guess what? Raise your hand and hire a consultant! I’m serious! When I started my practice, right out of the gate I hired Sally McKenzie. I thought I was doing well, but Sally McKenzie came in and took us to another level pretty much overnight. Since then, I’ve had Sandy Pardue and other consultants come to my office to help me figure out the best way to run my practice.

When I talk about consultants, I’m usually asked, “Well, is it worth it?” Dentistry is a cottage industry – if you sneeze in dentistry at one end of the ADA convention hall, everyone knows about it at the other end of the hall. Consultants cannot make a living in dentistry by taking money from dentists and providing no value. Every consultant I know has reams of happy customers. Consultants wouldn’t exist if they didn’t work. Believe me, consultants work!

My friend and colleague Dr. Jerome Smith in Louisiana might have one of the best – if not the best – operating practices in the profession. I mean, his practice runs better than a Rolex watch, and he still has Sandy Pardue come in and consult on a regular basis. When you ask him why, he just laughs and says, “You can always do better! It’s always a value. I’ve always seen Sandy as an investment. She’s never come here once when she didn’t bump us up to the next level.”

If you’re burned out, there’s a good reason you’re burned out, and nine times out of 10, it’s because of something you’re doing (or not doing). If you’re not taking care of yourself, it’s time to hire a coach, and if you’re not taking care of your business, it’s time to hire a consultant.

– See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=340&aid=4641#sthash.gXy4fc6M.dpuf

Treatment Plans, Social Media Marketing and the Meaning of Life

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People don’t buy on facts or information. You see it every day in dental practices everywhere. The dentist will explain a treatment plan to a patient, telling her what percentage of a certain type of restoration typically fails or the chances she’ll get paresthesia or what her insurance will cover, producing nothing more than a blank stare or a remark like, “Well, I’ll think about it and I’ll call you.” But when someone presents the treatment plan with enthusiasm, excitement and emotion, people buy into it.

I learned this the hard way 25 years ago when I would present a treatment plan to patients and maybe half of them would schedule treatment. I asked my assistant, Jan – who is high energy, on top of her game and radiates enthusiasm – to review and answer questions about diagnosed treatments with our patients to be sure they understood everything. When she started talking to our patients about treatment, people just got excited!

Then when it came time to schedule treatment, our Treatment Coordinator, Dawn, would continue the positive, uplifting discussion. Instead of merely getting a necessary filling done, Dawn would even talk them into getting their teeth cleaned first, then she would sell them into whitening their teeth because then we could do a tooth-colored filling so everything would match properly. Then she would say, “Another way you could make those teeth brighter is to contrast your teeth with darker lipstick. Oh my goodness, you’re going to have a million-dollar smile and it’s only going to cost you a few hundred dollars!” Any questions patients had about financing, Dawn would answer and provide great payment options such as CareCredit. The way Jan and Dawn reviewed and presented these treatment plans really spoke to our patients’ needs and desires. Patients got excited about it because Jan and Dawn were excited about it and because of this patients would agree to come in for treatment.

There’s a funny cartoon that depicts evolution and the meaning of life (see page 18), where all of the animals leading up to the evolved human have three things on their mind: eat, survive, reproduce. Then when you get to the human, he’s wondering what it’s all about. Well, if you talk to any evolutionary biologist, it’s still all about eating, surviving and reproducing! When Jan and Dawn review treatment plans, they enthusiastically appeal to our patients’ base needs: eating, surviving and reproducing. You can’t eat very well without teeth; you need to eat to survive, of course; and if you want to reproduce, you want to look as attractive as possible. Functional, aesthetically pleasing teeth hits on all three of those needs. I can present all of the facts about a case to a patient, but the difference in case acceptance is because Jan and Dawn elicit a deeper response from the patient, which boosts their dopamine and serotonin levels because Jan and Dawn excitedly appeal to the patient’s base needs.

The way you present an effective message applies to social media, too. I really got into Facebook about three years ago. In fact the main reason I got into it was because I read an article about Facebook reaching 400 million users. It was exploding and I wanted to see what it was all about. Since then I’ve branched out onto Twitter, Google+ and Pinterest. I’ve really enjoyed learning about and measuring this marketing medium, and it’s interesting to see the correlation between an effectively presented treatment plan and an effectively marketed message.

I see so many Facebook pages with posts that read, “Did you know that one in three people have this disease or that disease?” It’s all facts, figures and information. There’s never any excitement. Nobody clicks “Like” or shares those posts because they’re just white noise. There’s no reason to interact with a message like that.

Mothers make a major percent of all health-care appointments. Of all of the users on Facebook, more than 60 percent are women (according to a July 2012 article from the Huffington Post); but Pinterest is truly the social media site for women; in fact I’ve read that of the 70 million users on Pinterest, 80 percent of them are female. I have a Pinterest account and I find it amazing that almost all of the 1,500+ people who follow me on Pinterest are women. When women post on Pinterest and Facebook I see a lot of meal plans, diets, healthy snacks, etc. But it’s the base need of reproduction that is the most meaningful part of life, and that’s why a lot of women who have children post pictures of them on social media. People draw the most purpose and passion from reproduction – that’s why three out of four married couples have babies. Women are hard wired with maternal instincts, and when you start posting anything about babies and children on social media – like when you should bring your baby in for his or her first check up, or the germs that live on your baby’s toothbrush – it gets viewed, commented on and shared. I mean it just comes alive.

 

One of the biggest posts we had on my practice’s Facebook page (www.facebook.com/todaysdental) was when one of our staff members had a new baby. It’s one thing to post about the new laser or CAD/CAM system that you just got in your practice, but if you want more excitement or shares of what you’re posting on Facebook, post a photo of your newborn granddaughter. Post about the people who work at your practice. Post about the community outreach function everyone participated in over the weekend. That is the kind of stuff people will click the “Like” button for, comment on or even share. The average dental practice Facebook page has about 300 followers, and when you post something to Facebook, those followers have 300 followers of their own. If they all share what you’re posting, you have the potential of reaching up to 90,000 people – it’s huge!

The only way your social media efforts are going to get you new business is when your existing patients see what you are posting, make an emotional connection and share it with all of the people who follow them. There are three things you can do on Facebook: you can like something, you can comment about it, and you can share it. Sharing something is the big deal. You want people to share your Facebook posts, because all of their friends and followers will see it on their timeline. Facebook users almost never share high-quality dental information or facts about disease, and they certainly don’t interact with it. What they share are the things that make them secrete dopamine and serotonin. And for the majority of people who make dental appointments – women – the number-one thing they share is anything that has to do with babies and children. My practice always increases its Facebook “Likes” when we make our posts more personal.

Here’s something else you should consider in regard to social media: When you share information and it ends with a period or an exclamation mark, the person viewing it sits there, takes it in and moves onto the next post. They don’t do anything with it. But when you end your post with a question mark, you are engaging with them. So if you post something and end it with a question, they’re more inclined to answer, and that’s how you engage people on social media. That’s how you get people on Twitter to answer you back. That’s how you get people on Google+ to actually post back. Instead of making a statement or a fact about you or your dental office or your dental technology, engage with them. Ask them a question. If you ask your fans a question, they will answer you. When they answer you, all of their followers will see it. This is how you can judge how successful your social media campaign is going. There are a lot of companies that do social media for dental practices, and dentists will often show me how great they think their Facebook page is. What I usually see is a page with a plethora of information, with zero likes, zero comments and not a single share. The dentist thinks her Facebook page is good because her page is filled with a bunch of great scientific dental information that could really educate all of her patients. But there’s no interaction whatsoever. The dentist might as well be putting all of her practice’s marketing efforts into direct mail – a one-way conduit of information.

Real social media is about interacting with your fans and followers – so do it the right way! Remember the cartoon on the meaning of life: eat, survive and especially reproduce. Women have maternal instincts and are a lot more likely to communicate about their children than men. They are far more likely to show up to a parentteacher conference, or a PTA meeting, or schedule their kids for a recall than dad. So engage with them. Post fewer facts. Get personal! Show them your babies. Tell them what you’re doing for their babies. Ask them what they are doing for their babies. Get focused on children. Aim your marketing around babies and children, share the personal side of your practice, and you will absolutely crush the meaning of life and get more new patients.

SUBMIT YOUR ARTICLE TO BE PUBLISHED IN DENTALTOWN MAGAZINE!

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Visit: http://lnkd.in/b-QskFX …We will review all ORIGINAL submissions for possible publication in a future edition of Dentaltown Magazine. Any questions, e-mail our Editor, Ben at ben@farranmedia.com.

Can’t wait to hear from you and see your original submissions!

 

 

Quit Rambling On

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In 1980, when I was a freshman at Creighton University, one of our professors told us we’d earn 10 extra credit points if we went to see Warren Buffett speak when he visited our campus. One of the clearest things I remember Buffett say to the crowd was when someone pitches him an idea for something in which they wanted him to invest, he would hand that person a 4×6 recipe card and a No. 2 pencil and ask them to explain their entire idea on the card. He said 90 percent of those people couldn’t do it.

This doesn’t just apply to investing, gang – this applies to dentistry! Dental manufacturers will call my practice and try to sell their products to us. We’ll tell them, “For a product to be successful, it has to meet four criteria; it has to be faster, easier, higher in quality and lower in cost.” Many of them can’t explain their products to me with those four simple criteria in mind. In fact a few weeks ago, just out of morbid curiosity, I listened to someone pitch an idea for one hour and 45 minutes. Even after all the time my team and I spent with the salesman we still had no idea what the value proposition was. It blew my mind! It doesn’t just stop at dental manufacturers, though – this also applies to treatment plans. If you can’t explain to your patients what they need on a 4×6 index card, you fail at presenting treatments. Period.

Effectively presenting a treatment plan to your patients is one of the most serious aspects of dentistry. It can be the difference between a dentist who treats one-third of the caries in his or her practice to a dentist who treats twothirds or better. In the best dental practices, treatment plan presentations are typically done by a staff member; someone who can speak your patients’ language and sell the necessary dentistry. In other practices, what you often see are dentists rambling on, trying to explain what’s going on in their patients’ mouths. The patient has a toothache and the dentist says, “You have irreversible pulpitis. You’ll need endodontic therapy, post build-up and a fullcoverage restoration.” And then the dentist opens up a computer program and jumps into a giant, in-depth, scientific lecture about what a root canal is, what it does, what can go wrong, etc. Forty-five minutes later, the dentist asks, “Any questions?” and the patient looks like she got run over by a truck with no real comprehension of what just occurred.

The best treatment plans are simple and explained in ways patients can understand them. The reason Christianity thrived was because the religion was recited in short, simple, understandable parables – and there was a point to each one of them! Stop complicating things and get someone on your team to explain treatment plans to your patients in the simplest terms.

Your treatment plan also needs to be interactive. You need to follow your patients’ cues. When you talk to someone and they break eye contact with you, it means their mind is processing. When they do this, you need to stop what you’re saying and let them process. More often than not, they’ll respond with one of the following: “How much is it?” “Will my insurance pay for it?” “When would you do it?” “How long will it take?” “Will it hurt?” or “Will I need antibiotics?” What matters is you listen to their concerns, explain it in plain English and cut to the chase. I have had several patients come to my practice after they visited other offices to address their loose-fitting denture. In literally two minutes, I present the choices by saying, “Well you’ve got just a few options here. One, we can do nothing. Two, we can re-line it. With a reline, you drop it off at eight in the morning and you come back and pick it up at the end of the day. Three, we can make you a new denture. The fourth option, which would be a lot better, involves implants. We can put two of these little titanium screws into your jaw where the denture snaps on and stays in place. Better yet, we can put four implants in there and then the denture would really snap-on nicely. Or we can put six implants in there and that denture wouldn’t even come out of your mouth. Which one of those options sounds best for you? Let’s have Dawn, our treatment coordinator, go over the fees for these different options and assist you with reserving a time to get started.” What I just wrote would literally take you two minutes to recite. It was simple, explanatory and to the point. Why can’t we all do this?!

We continually see data that suggests dentists treat only 38 cavities for every 100 cavities diagnosed. That’s a terrible statistic. You might be earning your FAGD or your MAGD and think you’re on your way to total dental enlightenment, but I’ll let you in on a little secret – you’re not. Why? Because two of every three kids come into your office with caries and you don’t remove them. I don’t care if you’re using composite or amalgam – you need to treat as many cavities as you can. It’s your sacred and sovereign duty! Easiest way to do this is to get your staff involved in the treatment plans. It’s one thing for a patient to try to trust the guy who’s presenting a treatment plan in Latin (that’s rare), but it’s another thing for the patient to implicitly trust the entire staff standing behind the dentist nodding their heads in agreement and better explaining the treatment plan.

When you and/or your staff can explain a treatment plan in plain English and combine it with some great visuals from your digital X-ray system, every single one of your patients is going to fully understand what’s going on in their mouths and will want you to do something about it. It’s impossible for your patients to grasp what you’re trying to explain to them on a one-inch by one-inch X-ray film. I still can’t believe there are dental practices that do not employ digital X-rays in 2013. You want to explain something to your patient? Blow up the image on screen and do some teaching. Better yet, print off their X-ray on a piece of paper and circle the trouble spots, then give them the printout to take home as a reminder of what they need to have fixed.

Every single dental practice consultant I’ve ever met has told me when they walk into an office and pull up the report generator on the practice management software, 80 percent of all of the reports have never been run once. So, maybe you are only treating a third of the diagnosed dentistry, or maybe you’re doing a better job than that… or maybe you aren’t. You’d never know because you don’t know what the score is. You don’t know what your close rate is. You don’t track it. When you start tracking the dentistry you’re doing against the dentistry you’re diagnosing, you start to become a much better dentist. You start to realize you might not be the best person in the practice to sell dentistry to your patients. Your close rate will improve and your patients will be much happier with healthy mouths. You owe it to yourself, your practice and your patients to start running your treatment plan reports and actively reviewing them to help identify your monthly close rate. It’s time you start taking the selling process more seriously. Taking 500 hours of CE and earning your MAGD is completely useless if you’re not going to treat two-thirds of the people who come through your doors.

Getting Poised for Growth

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Humans are social animals. Social animals exist in tribes, and for the survival of every tribe you need order. For there to be order, there needs to be control. Social animals are hard wired for control, and because of this a lot of businesses become unsuccessful because the owner or CEO abhors delegation and feels the strong need to control everything. How does the CEO of a Fortune 500 company run her operation of 100,000 employees if she doesn’t delegate anything? It would be impossible! The leaders who rise to the top don’t fear risk or delegation – they retain and attract quality key people, give them responsibilities and then get out of their way. Success is counterintuitive to how humans operate.

Another great example is how most dentists imagine the way they are going to retire and sell their practices at age 65. At age 55 they start thinking, “Well, I’m going to retire in 10 years, so the last thing I’m going to do with this practice is invest in any new equipment or new technologies or implement any new techniques into my repertoire.” They’re content with milking the cow dry and refuse to feed it anymore oats, grass, grain or water. But here’s the amusing part: when it comes time for that dentist to sell her practice, she thinks it is going to sell for some huge amount, but it’s not going to happen. Nothing in the practice has been updated, new patients have dwindled to zero and it has become a business that nobody in their right mind would purchase at the price in the dentist’s head.

You have to realize the final 10 years that you are in practice are the most important years to double down on your business bet! In this time you can’t be milking your practice of what it’s currently worth only to sell it for pennies on the dollar. You need to modernize your practice. You need to move it from a lousy 1,000 square foot rental space on the third floor of a medical building to a premium 4,000 square foot building right out on Main Street with a huge sign. This is the time for you to upgrade from 2D X-rays to 3D cone beam computed tomography! This is the time to invest in CAD/CAM! In dentistry the only dogs that can’t learn new tricks are dead dogs!

If your practice is neglected because you milked it for the last 10 years, you will end up with an illiquid asset. You have to get your business poised for growth. You can’t sell a sinking ship. Just like with the sale of a home, when a window breaks, you don’t say, “Let’s just wait until two other windows break and then we’ll fix it.” No way.

Here’s another housing example tied to liquidity: a three bedroom, two bath house in Phoenix, Arizona, can easily sell within 30 days, but a 10 room house with an eight-car garage and a tennis court and Olympic-sized pool can sit there for three years because it is just not a liquid asset. Nobody wants it or can afford it. Along these same lines: the corner commercial lot on the corner of 1st and Main, you can sell in a heartbeat for premium price. But if you go just 300 yards down the street either way, you might be looking at half the price and, worse, you might never be able to sell it. I mean there are intersections in Phoenix that are still vacant from when I moved here 25 years ago because they just weren’t perfect. This is why location is key! So if you’re renting in a medical building or you aren’t set up on a great location, you need to be poised to sell, so get moving!

Here’s something else you need to think about if you’re considering retiring and selling your practice in the next 10 years: interest rates on CDs right now are at two percent, so that means for every million dollars in cash you have in the bank, in government bonds or CDs, you are going to make $20,000. Let’s say the average dentist makes $140,000 dollars a year. That means they would have to have $7 million in cash in a two percent government bond or CD at Bank of America or Chase to maintain their income. That is just not going to happen. I don’t know of too many dentists that can walk away at 65, sell their practice and have $7 million in cash earning two percent.

If you’re a renter and you sell your practice for $400,000, that’s it. That’s all you get. But if you owned your practice and you owned the building, you could sell your practice for $400,000, but keep the building, so you would charge rent to the new dentist who purchased your practice. Every year you can adjust the price of the rent based on the Consumer Price Index, and over the next 10 years, you could earn an additional $400,000. Then, maybe, at the end of the 10- year lease, the new dentist wants to buy the building. Then you finance that to the new dentist and you end up with yet another 10-year income stream. Think about it: the renter made $400,000 and gave half of it to Uncle Sam, so she’s sitting there with $200,000, which at two percent is making $4,000 a year. At that point the renter dentist is going to have to go be an associate somewhere else (at age 65) in order to live the way she did when she was practicing! So instead of continuing to rent the space for your practice, you need to get poised for growth. Buy that premium property on 1st and Main or a 4,000 square foot building right next to a WalMart, then sell your practice and rent out your building to earn revenue the smart way.

But this only applies to dentists who want to retire. Me, personally, I never want to retire. Sure, the first year of retirement is fun – you get to golf all the time and go fishing. It’s like a really long vacation. But by the second or third year of retirement, you start to see some dysfunctional behavior. There’s no passion for life. They let themselves go. They don’t have a reason to shower in the morning, let alone get out of bed. Here’s something you should consider if you’re actually considering retirement: don’t retire! I’m serious! There are 5,000 new dental school graduates entering the dental profession every year and they’re looking for a job. These kids are so desperate for a job, when the government asks them to join the military and sit on an aircraft carrier in the middle of the Pacific Ocean or Afghanistan, it sounds really enticing to them. And I hear the excuse all the time from dentists in rural areas that they can’t find an associate because they practice in Middle of Nowhere, Montana. Really? You can’t convince someone to stay in America where nobody’s shooting at them but the government can convince them to practice in Iraq? Stay in practice and be a mentor for crying out loud! Do you know what your unique selling proposition is to these new grads? Do you know what you have to sell more than anything? You! You get out there, you get poised for growth, you go to the finest finishing schools in America like The Pankey Institute or Spear, you get your practice to the very top of your game, and then you get your pickings from 5,000 graduates, some of which are seriously considering going into the military and practicing dentistry in some third world country. Instead you could just reach out and say, “Hey you, new grad, come work for me. You’ll probably look back on this decision when you are 65 years old and realize it was best decision you’ve ever made, because I’m going to teach you how dentistry gets done. It’s all going to be cool, we are going to have a good time working together and you are going to become a very successful dentist.”

Best Tips for Better Practice in 2013

Dentaltown Magazine wants to know what you’ve done this year to make your practice the best it can be! Visit www.dentaltown.com/BestTips2013 to tell us what you’ve done to improve your practice. Keep your eyes peeled for the December issue of Dentaltown Magazine and your tips could be featured in that issue. One lucky contributor will be drawn to win a copy of Dr. Howard Farran’s One-day Dental MBA DVD.

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=334&aid=4538#sthash.iedaYMzG.dpuf

Dentists are Still Doing Way Too Many Three-Unit Bridges

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Dr. Carl Misch, who is regarded by many as the number-one implantologist in the world today, (and who just filmed a series of four awesome online CE courses for Dentaltown.com), wrote in his book Dental Implant Prosthetics that the 15 year survival rate of implant restorations is 95 percent and for a three-unit bridge the survival rate is 74 percent. In this day and age, dentists really have to ask themselves, “If an implant and crown has a 21 percent higher success rate over a three-unit bridge, why are we doing so many three-unit bridges?”

Insurance Coverage?

Is it because insurance still doesn’t cover implants? We all know that’s not true! Twenty-five years ago, when I opened my Phoenix, Arizona, dental practice – Today’s Dental – almost zero insurance companies offered any coverage of dental implants. Today, based on the insurance plans that we have verified and have in our system at my practice, we have come up with the following percent of insurance plans that have implant coverage:

  • Delta of California 86%
  • Metlife 76%
  • Delta of Arizona 74%
  • Aetna 53%
  • Cigna 35%
  • Humana 18%

When I started my practice in 1987, implants were not a covered benefit under most insurance plans, but today, we are seeing an upward trend in insurance companies realizing the benefits of implants; such as, preserving tooth structure and making it virtually impossible for decay to form. With more and more insurance plans covering dental implants, it can’t possibly be a good enough reason to not be placing implants.

Pricing and Presentation?

Here’s another reason why we might be placing way too many three-unit bridges: price breakdown and case presentation. When I graduated from dental school in 1987, I argued with a lot of local Medicaid plans because coverage of an extraction was $2 cheaper than a filling. Moms in lower socioeconomic brackets had the economic incentive to pull their babies’ teeth instead of fixing them, just because it was cheaper. I always thought the extraction should cost $2 more than an amalgam filling, because when it comes to certain procedures for certain patients, affordability was always the key decision maker.

The same thing is happening with bridges vs. implants. Most dentists will offer their patients an exact flat fee for a bridge, and they’ll say they can prep it today and cement it in two weeks. Then when the patient asks about an implant, most dentists break it down to something like, “Well, um, it’s $1,500 for the implant and it’s $1,000 for the crown, but then we might have to do a bone graft, and we might have to do a gum procedure, and I won’t really know what we’re looking at until I pull the tooth to know how long this will take…” It’s a total confusing quagmire! The implant is the better option, but you make it so difficult for the patient to understand. I mean, I’m a dentist with an MBA and an MAGD and because of the way you present a bridge vs. an implant even I would opt for the bridge!

You need to figure out a way to explain that the cost of an implant is the same as the cost of a bridge. If you charge $3,000 for a bridge, then an implant should be $3,000 as well. Now, whether or not you have to do a bone graft or something more, that’s just the cost of doing business. Obviously some cases will be easier than others, but that’s life. It’s also the way everybody else does business. When you take your car in to fix your radiator, they’re going to do it at a flat fee. I guarantee some radiators are easier to fix than others – you’re not going to get nickel and dimed because your radiator was harder to fix than the last one they worked on.

You know what would help you place more implants in your practice? If your implants cost less than a bridge! They have a 21 percent better success rate, after all! You need to take the economic incentive to do the cheaper but less effective option out of the equation. If you tell your patients it’s cheaper to do an implant and a crown than it is to do a bridge, you’re going to be placing a ton more implants, doc!

Specialists?

I recently spoke about this issue with Dr. August de Oliveira, the author of Implants Made Easy, and he brought up a survey conducted by Straumann, which indicated the United States of America currently ranks fifth in total implants placed. More than 85 percent of general dentists in South Korea place implants, more than 50 percent of all general dentists in Europe place implants, and the most implants placed in the world is Israel. When I asked August why he thinks so many dentists still do bridges over implants he said, “It’s a loss in production if general dentists send out the implant case. Rather than learning how to do implants themselves, they do bridges and send out an occasional implant. That is changing as patients are getting educated on the benefits of an implant crown vs. a three-unit bridge.”

In America, culturally, we got into this groove where oral surgeons and periodontists place implants. GPs don’t want to do implants because it’s inconvenient, it’s a loss of revenue to send out, and you have to work with a specialist. If you’re not going to place implants yourself, you need to work with a specialist who will agree with your vision of a flat fee for all implants placed. If you charge $3,000 for a bridge, you’re going to charge $3,000 for an implant whether you place it or the specialist does. You want the safety of being able to tell your patients that they’re going to go to another doctor who will place the implant, it will be the same fee, and there will be no nickel and diming. If your specialist cannot work with the laws of averages like every other service industry does, then find another specialist! Either that or learn how to place implants. Too hard, you say?

Implants Are Hard? Really? In 2013?

I learned how to place implants early on in my dental career. I earned my Diplomat in the International Congress of Oral Implantologists (DICOI) and my fellowship at the Misch Institute. In 1987 placing an implant was hard. You had 2D Xrays, panos and PAs, and you never truly knew what was going on until you laid a flap. Today, with 3D cone beam computed tomography (CBCT), diagnosis is twice as easy – heck, even the software that’s been developed for these systems will tell you how long and wide the implant can be to place in your particular patient. You almost don’t need to think about it. Oh, and anatomical features that scared us to death back in the day, like the inferior alveolar nerve and the sinus, are all spelled out for you in a 3D image. You know exactly what you’re looking at before you even pick up an intrument. This harkens back to my May 2013 column “Is Dentistry Getting Too Easy?” It’s twice as easy to do a root canal today (with high-speed handpiece-driven NiTi files), and it’s just as easy to place an implant with the help of 3D CBCT.

It’s time we all sit back and rethink placing implants. Placing an implant today is so much easier than pulling a wisdom tooth – yet I know more dentists who pull 10 to 30 percent of their wisdom teeth but don’t place a single implant. I think that’s completely backward (and bizarre)! That’s like saying you can repair your car but can’t fix the chain on your bicycle. You need more skill to pull a wisdom tooth than to place an implant. With the technological advancements we have at our fingertips today, it just doesn’t make any sense why dentists don’t place more implants.

Remember the 4,000lb Gorilla in the Room

When it comes to the dentistry we do, nobody likes to talk about the 4,000lb gorilla in the room – mortality. The average man dies at age 74, and the average woman dies at almost 80. When grandma and grandpa go into the nursing home to live out their remaining days, all the dentistry we’ve performed over their lifetime crumbles and rots after 18 months. I’ve been a huge proponent of there being less inert and more bacteriostatic restorative materials in the dental market – and dental implants fit that bill. When I visit nursing homes, it’s sad to say that the lucky ones are the people who have dentures and implant-supported prosthetics. The people who have their mouths full of $20,000 worth of root canals and crowns are the most unlucky, because their teeth turn to mush from root surface decay. These people are too old and brittle to do any extractions or full-mouth restorative, and their home care is essentially nonexistent. You really need to start asking yourselves, especially by the time a patient turns 60 years old, are we really going to do a root canal buildup, a crown and a three-unit bridge instead of titanium implants, which the Streptococcus mutans won’t eat? Think about it.

In Summary

While I was wrapping my head around this issue, I talked to longtime Townie, Dr. Jay B. Reznick, oral surgeon at the Southern California Center for Oral & Facial Surgery, in Tarzana, California, and founder of OnlineOralSurgery.com. He sent me an e-mail that summed up the issue of why dentists don’t place implants more than bridges quite nicely. Jay says:

“A dental implant is designed to be ‘permanent,’ however there are a lot of factors, such as hygiene, patient general health and nutrition, systemic disease, local factors, age, implant positioning, prosthetic stresses and individual variation that will reduce the longevity. I always tell my patients, ‘Dental implants are as permanent as their “permanent” teeth,’ so they understand that even what nature gave them is not always perfect and can fail under the right set of conditions. A three-unit bridge is also meant to last a long time, but dental insurance companies will pay to replace a bridge after five to 10 years (depending on the policy), so that should tell you a lot.

“There are a number of reasons why dentists may choose to do a bridge over an implant. I think the biggest is still the misconception, especially in the older practitioners, that implant dentistry is too complicated. They also feel the bridge will be delivered sooner than in the case of an implant, where the extraction site needs to heal and the implant needs time to integrate. Right behind that is the economic desire to keep all the revenue within their practice, rather than sharing the case with a surgical specialist. Of course, that model is changing rapidly, as more and more general dentists are becoming trained and placing their own implant fixtures and then restoring them.

“We are seeing an increase in the number of dental insurance carriers that are covering implant treatment. They are usually the more expensive plans for the patient or employer, and reimburse at a substantially reduced rate from usual, customary and reasonable (UCR) charges.

“The only advantage a bridge has over an implant is that it is faster. The implant helps preserve bone and soft tissue architecture, is easier for the patient to maintain, and leaves a one-tooth problem as a one-tooth problem, rather than creating a three-tooth problem (which will become a four-tooth problem, and eventually a denture).”

It’s time to change the way we think about implants and the way we present this incredible option to our patients – the future of the dentistry we provide depends on it!