Clackamas Dental Consultant | Dental Practice Solutions

Can We Alternate Periodontal Maintenance With a Prophy?

By: Debbie Seidel-Bittke, RDH, BS

March 12, 2020

There is a common question asked by dental professionals and it’s also a question we get from our dental patients.

The question is, “Can we alternate periodontal maintenance with a prophy?”

Read this blog to know the truth and what you really need to do when your patient has completed periodontal therapy – Scaling and Root Planing.

The purpose of this information is to help dental professionals communicate the value of oral disease and inflammation which can contribute to other systemic diseases.

There has been an important paradigm shift in the last 20 yrs. Have you caught the wave? What’s new is that dental hygienists are no longer “cleaning teeth.”

Today’s most successful dental practices are treating the whole body not “just” the mouth. We can help our patients live a longer and healthier life.

Why Periodontal Maintenance?

According the American Dental Association, “Periodontal maintenance is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.”

Notice these important phrases as you read this description of Periodontal Maintenance.

instituted following periodontal therapy.
for the life of the dentition.
If new or recurring periodontal disease appears, additional diagnostic and treatment must be considered.

Some insurance companies don’t cover periodontal maintenance. Are you in the business of providing your patients only what their insurance will pay for?

If you said “Yes,” think again.

What if your patient asked you, “Dental hygienist, is cleaning my teeth when you told me my gums are bleeding, the best service you have to offer me?”

What would you say?

Can you honestly answer that a “cleaning” will put a halt to periodontal disease?

Think again. Do your research. There are thousands of journal articles to support the mouth-body connection and how to put a halt to systemic disease and periodontitis. If you have not read this information, I assure you, putting a halt to inflammation does not include “cleaning teeth.”

Prophylaxis Does Not Address Inflammation and Halt Progression of Disease

According to the American Dental Association, Prophylaxis includes the following, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

As you read the above two descriptions, Periodontal Maintenance and Prophylaxis, notice the clear distinctions between these two dental hygiene services.

Periodontal Maintenance is after periodontal therapy.
Prophylaxis is intended to control irritational factors.

Periodontal Maintenance includes site specific scaling where indicated and Prophylaxis is intended for irritational factors.

When a dental office offers adjunctive services such as localized antimicrobial antibiotics and/or soft-tissue diode laser, these can be included in the Periodontal Maintenance service however, Prophylaxis is indicated for a healthy patient and these adjunctive services are not a part of treating a healthy patient.

What Your Patients May Think

Your patients may only think that Periodontal Maintenance is more expensive, and they don’t want to return for this service when their insurance won’t pay for it.

Dental hygienists and all clinicians must show patients and help them understand what is happening in their mouth.

Super important that during the exam process to engage your patient. Before you lay your patient back in the chair, before you begin and services, explain to your patient what you will do during today’s appointment.

Ask them to listen and participate during the exam process. If you are completing a comprehensive periodontal exam (CPE), explain the numbers you will call and let your patient know what these numbers mean. For example, “4 mm’s means inflammation. If you hear a 5 or higher, that means active infection and we will put a plan together, so you don’t have infection in the near future. Let your patient know that you will ask them what the highest and lowest number they when you are completing your CPE. This is engaging your patient in their treatment.

When you have completed all of your wellness exams, with doctor and the patient, you can now make a diagnosis. It is super important that once you complete your wellness exams when you see anything abnormal, show your patient what you see. Include your patient by asking them what numbers they heard and ask them to look at what you see by showing them intra-oral pictures, x-rays and your CPE. Help your patient to take ownership of their disease.

Once patients truly understand the disease process and the cascade of events that can occur with their systemic health when active gum disease is left untreated, you will find it much easier for patients to pay and schedule treatment for preventive maintenance (AKA: Periodontal Maintenance).

As you are explaining “active gum disease” to your patient, sit with them knee-to-knee and eye-to-eye showing them what you see. Ask your patient questions as you look together at their x-rays, their comprehensive periodontal exam (CPE) and intra-oral pictures, etc.

An example of what you will explain to your patient:

“Mr. Patient, during your gum maintenance appointment (AKA: Periodontal maintenance) I will remove bacteria and plaque buildup below the gumline (AKA: hard and soft deposits).

Two years ago (Or say the last time they had SRP/Perio Therapy), we treated you for active infection and inflammation. As we have talked about before, inflammation and gum disease contribute to systemic diseases such as high blood pressure, diabetes, rheumatoid arthritis, Alzheimer’s, etc., etc.

I will be using these special instruments to remove bacteria, soft plaque and hard deposits below and above your gumline. (If you use a soft tissue laser you will explain the following) Each time you return for your gum maintenance I will re-treat these areas with my laser which we have previously treated for gum disease This will regenerate the fibers that hold your gums in place and our laser is FDA approved (If you have Millennium Laser) to regenerate bone that was lost during active gum disease.

Gum disease is episodic and at times we need to retreated these areas. At times the disease can become active disease, with infection and inflammation. Just like sometimes you may have the flu and other years you are perfectly healthy, it’s the same thing with gum disease.”

Once your patients understand the value of periodontal maintenance (“gum maintenance” or preventive care”) and when they know that putting a halt to inflammation, infection and active gum disease, will help them live a longer and healthier life, they will be more comfortable paying for the correct service.

I have yet to meet a patient who did not want to live a longer and healthier life, have you?

I sure hope not!

Let’s share this message about optimal oral health and how this relates to living a longer and healthier life!

Will you help me conquer this disease process?

ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS

Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.

Please check out the FREE RESOURCE on treating the gingivitis patient which also leads to a CE Course on Gingivitis (2 CE Credits). Grab a FREE RESOURCE here today because when you do, you will be one of the first to know about our FREE Training RE: Treating the Gingivitis Patient.

What is a Dental Hygienist to Do with The New AAP Classifications?!

By: Debbie Seidel-Bittke, RDH, BS

January 30, 2020

The American Academy of Periodontology has not updated their guidelines for categorizing periodontitis since 1999.

This should be a big deal; right?!

Most clinicians: dentists, dental hygienists and even periodontists tell me they are confused with the new staging and grading for categorizing periodontitis.

What is a dental hygienist to do with the new AAP classifications?

Are you using the new AAP classifications?

Most clinicians I speak to are not using the new classifications.

We are currently working with our client hygienists to embrace this. We show them how to laminate the forms and refer to these when making patient clinical notes.

Let me shed some light on the topic here.

If the AAP has not re-classified periodontitis since 1999, there is a good chance it will be at least ten or twenty years before we have new guidelines.

Let’s embrace the “change!”

The American Academy of Periodontology Classifications are created to help dental hygienists diagnose and treat periodontitis. Follow these guidelines so consistent diagnosis can occur.

The first step is to assess your hygiene patients and of course, every new dental patient must have a comprehensive periodontal exam.

Steps to Use the American Academy of Periodontology Staging and Grading

Step 1: Assessment

Up-to-date full mouth radiographs
Up-to-date comprehensive periodontal exam (CPE)
Chart missing teeth

Step 2: Establish the Stage

As you know cancer is categorized by stages. Think stages of cancer only this is oral inflammation causing destruction of the supporting bone that results in tooth loss.

When you are assessing the stage of periodontitis, explain to your patient and show them what you “see.” Refer to the mouth/body connection as you explain inflammation in your patients mouth.

Now is your opportunity to speak with your patient about the connection between inflammation in your patients mouth and inflammation in the body.

Inflammation in the body year after year contributes to other inflammatory disease such as (and not limited to) heart attack, stroke, rheumatoid arthritis, Crones, Alzheimer’s, diabetes, etc.

Confirm clinical attachment loss (CAL)
Rule-out non-periodontitis causes of CAL (cervical restorations, caries of root fractures)
Determine CAL or radiographic bone loss (RBL)
Confirm RBL patterns (Ex: Vertical or horizontal RBL)

For moderate to severe periodontitis (think Stage III or Stage IV):

Determine CAL or RBL
Confirm RBL patterns
Assess tooth loss due to periodontitis
Evaluate complexity factors (Ex: severe CAL frequency, surgical challenges)

Based on your findings from step 2, determination of mild-moderate periodontitis can be made, and this is considered Stage I or Stage II. Severe or very severe periodontitis is considered Stage III or Stage IV.

Step 3: Establish the Grade

What I like best about this new system to categorize periodontitis is we now bring into the picture: inflammatory diseases, systemic considerations and outcomes of non-surgical periodontal therapy.

What’s a Dental Hygienist to Do with the New Classifications?

So glad you asked!

Your first step is to print out this article including the staging and grading charts.
Take the staging and grading charts, add them to a plastic sleeve or laminate them. Keep these in your operatory.
When you evaluate your patients, refer to your staging chart.
1. In your clinical notes write, “Stage I, II, III or IV”.
2. Write as indicated
When a patient has 15%-30% RBL definitely consider writing clinical notes a category for the stage and refer to your Grading chart printed and on the flip side of your staging chart.
If a patient has <15% CAL but smokes 10 or more cigarettes, you will write in your clinical notes: Stage I, < 15% localized horizontal BL (Ex: @ #19 & 30), Grade C (Pt smokes 10+ cigarettes daily).
1. That is all. If you have a positive outlook on this, it won’t be difficult to write these chart notes
2. If you have templates add staging, horizontal, vertical < or >, etc.
3. Now using your template mark or indicate the correct description
4. Use the staging and grading charts to add these notes in your practice management templates
For patients who have diabetes and/or a tobacco user with RBL you will grade them B or C and this is your time to talk about their “potential” for tooth loss if things do not improve.

Conclusion

Many clinicians I meet are fearful about scaring patients ‘if” and “when” they do tell patients “the facts.”

Imagine this, if you have a colonoscopy or mammogram and the doctor finds a suspicious lesion, will the doctor not tell their patient about this for fear of the patient never returning?

Does a physician feel concerned that their patient’s insurance may not pay for removal of an abnormality?

I have never heard of a physician not telling a patient they have an abnormality because of the above mentioned.

Why do us dental professionals fear telling patients what is truly happening in their mouth?

We have a legal and ethical responsibility to tell our patients what we “see” happening in their mouth and body.

In 2020, dental hygienists are doing more than cleaning teeth.

Dental professionals are in the business of helping people live a longer and healthier life.

Will you join me and help conquer the disease process?

This…….is our JOB!

ABOUT THE AUTHOR

Debbie Seidel-Bittke, RDH, BS

is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.

Check out this FREE RESOURCE to treat the gingivitis patient which also includes a new patient appointment sequence of treatment here.

Dental Hygienist’s Patient Scheduled for a Prophy but NOT a Prophy!

By: Debbie Seidel-Bittke, RDH, BS

December 30, 2019

I want to talk about the elephant in the room. Let’s take for example Ronda who is a twenty-year patient of Dr. Curry. Susan is her hygienist of ten years, but Ronda is out sick today. On this particular day the dental hygienists’ patient is schedule for a Prophy but Ronda, the patient, is NOT a Prophy!

To set the stage for the first challenge, Sally is the temp hygienist.

Sally is an amazing clinician. She is good with patient’s; knows how to build rapport and she definitely has excellent clinical skills.

Sally completes all the necessary clinical exams and discovers that Ronda is more than a prophy patient.

The next thing Sally does is talk to Ronda about the change in her oral condition and explains she needs more than a “cleaning” at today’s dental hygiene appointment.

Sally begins treating Ronda for gingivitis and Dr. Curry enters to complete the hygiene patient exam and everything seems fine with Rona.

Everything seemed fine until Ronda got to the front desk and was asked to make a 2^nd hygiene appointment in two weeks PLUS, Ronda was told that only one of these two hygiene appointment would be covered by her insurance.

WOW! Now we have a problem!

Ronda complained about all this to the lady at the front desk!

Ronda was NOT happy! She says, “No one ever told me I have gum problems until today!”

I do NOT like this hygienist I just saw!”

Ronda continues, “That hygienist does not know what she is doing!”

Oh my!

The lady at the front desk is rather new and she did not know what to say.

Ronda left without a next appointment.

OVERCOMING OVERWHELM AND CONFUSION

How can this situation which turned sour become like lemonade at your next party?

Well, a dental hygiene appointment (to most) doesn’t feel like a party but how can we overcome this overwhelm and confusion.

Let me outline a few steps that can make a positive change:

When possible, for the long-term patients of your hygienist, let the know you have a temp hygienist
1. This may take out some of the shock of a different hygienist
Always explain what your patient is there for
1. Ex: Routine preventive care, x-rays, “abnormality exams (oral cancer and “gum exam”., Comprehensive perio exam), doctor exam, etc.
Before you complete the Comprehensive Periodontal Exam (CPE. To the patient it is called “Gum exam), let your patient know you will check the health of their gums with a ruler. Explain what the numbers mean. Ex: 1 through 3 is healthy. If you hear a 4, that means there is inflammation and if you hear a 5 or higher, that most likely means you have infection and active gum disease.
Ask your patient to listen for the numbers because at the end of your exam you will ask them, “What was the highest and what was the lowest number you heard me call out?”
1. The purpose of having your patient listen is because when they do hear a number that is more than 3, they will TELL YOU. Rarely, does the hygienist need to ask the patient, “What was the highest number your heard and what was the lowest number you heard?”
2. I can almost guarantee you that when your patient hears a 4 or 5, they WILL be letting their hygienist know, “that did not sound good!”
3. If your patient hears you call out “Bleeding on Tooth #3, etc.,” your patient will also be very likely to let you know,
  that did not sound good!”
Whenever you see something that is abnormal, always take this opportunity to “show” your patient.
1. Use the intra-oral camera
2. Take pictures of heavy supra build-up on lower lingual of lower anterior, take pictures of BOP and holes, discolored teeth in your patients mouth. When you see areas of papillary and marginal inflammation, take a picture of the area with your intra-oral camera. Use the intra-oral camera for stains on their teeth and old composite stains and discoloration.
When showing your patient, the intra-oral pictures, ask your patients to tell you what “they see.”
1. Interestingly, many patients will not be able to tell you they see anything out of the ordinary so at this point in the conversation, you will want to compare health to the disease in their mouth.
1. Be sure to show them the heavy supra calculus especially if they don’t recognize anything abnormal on the picture you will show them.
Be sure you sit your patient up-right in the chair as you discuss what you “see.”
Explain what you see, using words your patient will understand and yet, use words that add value to the hygiene service.
1. For ex: Deep cleaning is not going to be value enough to return and pay more money.
2. Use words like Gingivitis, gum disease, inflammation, infection, bleeding, disease.
Explain the change in today’s appointment after your initial exam of abnormalities.
Explain what future appointments are necessary to treat the abnormality today and what is necessary to prevent disease in the future.
Always follow the system and process of each dental practice.
1. Many offices find it valuable to quote a fee to the patient when there is a change in the service.
  1. Be aware that it is not “best-practice” to have a patient lying or sitting in a dental chair and then give financial estimates.
  2. Patients should always be in a place that feels “Safe” and “confidential” when discussing private matters such as “finances, etc.”
What do you do when a patient is angry like Ronda became?
1. This is where a written office- hygiene department system is super important!
2. When you have a new hygienist and especially when you have a temp hygienist, you should have a guide, a blueprint written for when you treat a prophy and when it is not a prophy.
  1. When does a prophy patient receive treatment for gingivitis?
  2. When does a gingivitis patient return for their next hygiene appointment?
  3. When does a prophy patient become a perio patient?
  4. What happens after scaling and root planing is completed? When does that patient return for a hygiene appointment?
  5. The list of processes for the hygiene appointment is long. It must be written out so everyone on your team knows what is expected……and especially when you have a new or temp hygienist.

HYGIENE-DOCTOR-PATIENT EXAM

Not every dental office has a system where the doctor will complete a hygiene-patient exam in the hygiene room.

It is very helpful to have doctor and hygienist together for the hygiene patient exam. This provides effective communication, and nothing should be missed.

When doctor and hygienist complete the patient exam together, the hygienist can bring doctor into the loop on what has transpired during the hygiene appointment, up-to-this point.

In the situation with Ronda being new to Sally the hygienist, Dr. Curry can also build up Ronda’s confidence about the temp hygienist and let her know how great Ronda is even though she is the temp hygienist today.

At the end of the doctor exam, instead of asking the patient, “Do you have any questions,” change this question and ask, “What questions do you have for me today?”

This is an open-ended question and gets the patient thinking.

When asked a yes or no type of question, patient will usually tell the doctor,
“No, I don’t have any questions.”

But as you can see in this situation, Ronda had a lot of questions. She never felt comfortable asking.

I could provide a one-two hour course on this topic.

It’s a hot topic in today’s world of dental hygiene. It’s a big-reason, dentists have been calling our office for support.

Dentists and dental hygienists want to know, what to say to a patient who has always been a prophy but is now “more than a prophy patient.”

I recently wrote a course called, “What’s Blood Got to Do With it?” and I highly recommend you enroll because I will review in two video training modules how to handle patients who are more than a prophy patient.

In this training you will have numerous resources to support reimbursement and so much more. This is not only for the knowledge of the dental hygienist but will support the front office with patients who will pay for more than a prophy appointment.

Also remember, we are here to provide optimal oral health for our patients. It is not the standard-of-care to treat a patient with a specific service because you know a specific service is what their insurance will or will not pay for.

When you are able to help patients “own” their disease, they will be most likely to schedule and pay for treatment.

These patients will continue to return for their appointments at your office.

These are your patients who will tell their friends and family about your dental office!

ABOUT THE AUTHOR

Checkout our latest training about treating the gingivitis patient. Each paid registration will receive 2 CE Credits once the complete the course.

Five Reasons Dental Temp Agencies are Outdated

By: Trey Tepichin, CEO, Cloud Dentistry

December 24, 2019

As a dental practice owner, it’s almost certain you work with dental temp agencies when one of your employees is absent due to illness, vacation or personal reasons. Maybe you use a dental temp agency because it’s what you’ve always done. Or maybe you use one because you don’t think there’s a better way to find temporary staff. Whatever your reason for filling vacancies this way, it’s important you’re aware of how working with temp agencies damages your business.

And in a world where businesses develop so quickly, there are much better options open to you when you need to fill a vacancy in your dental practice.

Stop hurting your business and start nourishing it. Here are five reasons traditional dental temp agencies are outdated. You will want to avoid temp dental staffing agencies. Most dental practices find them to be a waste of time.

When you hire your staff via a dental temp agency, very rarely do you get to talk directly to the person you want to hire. Instead, you’ve often got to go through a middleman who will pass messages back and forth between you and your potential employee.

Thanks to smartphones and the internet, you can get in touch with pretty much everyone almost instantaneously. It should be entirely possible to connect with someone, have a discussion and hire them in less than an hour. Yet with traditional dental temp agencies, hiring someone can literally take days or even weeks. This setback can cost your business some serious cash if you have to do without an RDH or another valuable member of your team while you’re waiting for a third party to get back to you.

1. Expensive

Dental temp agencies make their money by adding a mark-up onto the dental professional’s hourly rate. The mark-up could be as much as a staggering 50% of the worker’s hourly rate. This means you’re either paying way too much for your temp dental staff or you’re hiring someone who’s being forced to work for less than they’re worth. Either way, you’re not getting value for money.

Instead of working with a company which takes money away from the professionals it’s supposed to help, it’s important you find a solution which allows workers to set their own rates and take it all home with them. This way, your temp staff are receiving the money they deserve and they’re much more willing to give you 100% when they’re working in your practice.

2. Don’t give you what you want

Despite technically being independent contractors, people who work for dental temp agencies don’t actually have as much control over their careers as they like. Their salaries, schedules and working locations are often controlled more by the agency than the workers themselves. This results in people working at places they don’t want to be at. And when someone’s forced to work somewhere they don’t want to be, they’re never going to give the job their all.

This seems such an antiquated way to work — and it is. You’ll get much higher quality dental professionals by opting for a solution which gives dental employees complete control over their careers.

3. Prevent growth

Temp dental staffing agencies don’t give dental practice owners much scope to show off their dental office and how great it is to work there. The best dental professionals are constantly in high demand and you need to stand out to those you want to work with to attract them. Unfortunately, when you’re just a name in amongst countless other brands, catching the eye of the right dental professional can be a challenge to say the least.

When you don’t have much means of attracting the best staff, you’re stuck with whoever the dental temp agency sends. Working with less than stellar employees means you’re not providing your dental patients with the optimal care they expect and deserve. This significantly inhibits your ability to grow your business. It’s much more in your favor to choose a staffing solution which lets you sell your practice and attract the best staff by highlighting your office’s strengths.

4. Create a never-ending cycle

Since finding the perfect staff first time from a dental temp agency is almost impossible, you’re forced to return to the agency each time you’ve got a vacancy to fill and begin the whole process all over again. The more you use a traditional dental temp agency, the more time you waste, the more money you spend, the more badly-matched employees you work with and the more you restrict the growth of your business.

It’s easy to get stuck in a never-ending cycle and professionally tread water for the rest of your dental career. It’s much more beneficial for the growth of your dental business if you find a solution which saves you time, saves you money, helps you find the best dental employees for your dental practice first time round. This will support you while you grow your dental business.

ABOUT THE AUTHOR

Trey Tepichin, is Co-founder & CEO of Cloud Dentistry, an online company that matches dental offices with specialists, dentists, hygienists, dental assistants and dental front office–all with just a few clicks. He is a successful Boston attorney with numerous multimillion-dollar victories and former teacher of economics at Harvard.

Defining Success for Your Dental Practice in 2020

By: Debbie Seidel-Bittke, RDH, BS

December 19, 2019

That’s the question you want to answer for yourself when you embark on year-end planning.

It always starts in November. Most dental practice owners work hard in Q4 to finish the year strong, while planning for the coming months.

And, of course, the analysis starts.

Here we are, the end of December and you may be asking yourself, “How will 2020 be different?”

If you are asking yourself this question, you are on the road to success.

We recently ran a poll on social media asking dental professionals what they wanted to learn from me?

There was a resounding response that dental professionals wanted to hear what my success secrets were.

Let me define success for your dental practice in 2020.

1. Create the Plan

You must take time to create your success plan. What this requires is looking at the previous year and assessing where you are today.

What did you do differently this year?
What worked well this year?
What did not work well this year?

2. Share Your Vision

Take time to write your vision. Plan for the next five years and break it down into bite-size pieces. What will life and your dental practice look like in one year?

Next, break this down into nine months, then six months and a ninety-day plan.

Basically, you are re-engineering where you want to be in five years and then plan down to what you will do in ninety days to get where you want to be in five years.

3. Systems

Maybe this should be listed as number 1. Having systems in place will help you STOP working so hard.

Everyone on the dental team needs to know what is expected of them from greeting, seating patients, up to handing off the patient and everything in between.

At Dental Practice Solutions, we teach our clients a Dental Practice Optimization method. Our focus is the hygiene department but with a team approach.

Everyone on your team needs to understand the sixteen systems for the hygiene department. There are a lot of moving parts. If you wish to have a hygiene department that operates like a well-oiled machine, you must have systems for each one of these 16 areas and everyone on your team must know their exact role within each of these systems.

This is a team approach.

Create and implement a strategic success plan that takes the guesswork out of how things are handled for the next year and farther.

ABOUT THE AUTHOR

Do you need systems for your dental hygiene team? Check-out our Dental Practice University which is robust in hygiene department systems as well as what your entire team will need to support the hygiene department in your dental practice.

Transition Now – Dentist Retirement Planning

By: Dr. David Black, DDS, FICD, FACD

June 25, 2019

I retired from private practice four years ago. I had a successful 40+ year run doing general restorative and cosmetic dentistry. I had associates, and I worked as a solo practitioner. In the end, a couple of young entrepreneurs bought my practice and I worked as an associate for four years before stepping away from the chair.

This blog is about transitioning your practice now. It’s about retirement planning.

Retirement from dentistry, done right, is not just the act of stepping away from clinical dentistry but many things need to be considered first.

There are many things that need to be considered before retiring and transitioning from your dental practice.

1. Can I get full value at the sale?

2. Can I even sell the practice?

3. Do I have adequate funds to be able to live well for the next 20-30 years?

4. What will I do in retirement?

Can I get full value at the time of the sale?

This is also tied to the question, do you have enough saved to retire? I worked with consultants about ten years before I sold to analyze my situation. I discovered I needed to increase the value of the practice by increasing the production and collections in the practice. Most sales are based on one of several evaluations, but mostly a three- year average of your collections. What that meant for me was the need to get another consultant to help me improve my systems, train my staff to be more productive, and save a large portion of my increases.

Values and production have changed in the ten years since I did this, but back then the magic number was to get production/collections above one million dollars. I am sure the ideal number is higher than that now.

The proposition is that you have to create an asset that someone finds valuable. To get top dollar, you must create something that is something of value, but also something the buyer sees as having growth potential. This sometimes means improving the physical plant or doing cosmetic things to increase value. The biggest thing you have to do is increase the total collections.

Can I even sell the practice?

I bought the records of a practice for $5000 when the aging doctor decided to retire. Unfortunately, he had ridden the practice down to next to nothing. His physical plant was old and the equipment was ancient.

I have seen several doctors just walk away from their practice. For that reason, I intentionally positioned myself to sell at the peak of production and I made my office attractive and functional. Some small rural areas may have the same problem as this dentist I bought out because it is hard to find doctors who want to live in the area.

You can discuss what you have with a broker or a dental consultant that helps with transitions to see if you have a problem practice you want to sell.

Do you have adequate funds to be able to live well for the next 20-30 years?

We are living longer. My financial planner told me we have to plan to survive until age 93. The good news is that we are enjoying a longer life.

The bad news is that we need more money and other assets to support us for more years. This is something I did not have the skill to project, so I found another expert to help me plan.

Hopefully you will have a paid-for home and other cash producing assets in addition to your retirement funds to help.

You also have to figure what your standard of living is and how much it will cost you to have a lasting income. The answer to this is to start early, defer as much gratification as you possibly can, so that you can survive your extra years in comfort.

My reality was that I did not have enough money and I wasn’t on the correct financial trajectory at first, but with planning and execution, I finally made it. At the rate I am going, I should spend my last dollar at age 93.

What will I do in retirement?

Some people are lucky enough to feel good just laying back, resting, playing golf every day and generally just taking it easy. Unfortunately, I was not wired that way. I wanted to do something that fulfilled my need to create a legacy and create more income to do extra things around the house or for my family.

I work part-time in a FQHC clinic, teach, coach and consult, along with lecturing and writing. I call that being “REPURPOSED”, not retired. That is me.

What about YOU?

As long as you have a transition plan that makes you feel good and cares for whatever your needs are, go for it.

We all will retire or die first. The sad news is that our bodies cannot continue to do the hard job of dentistry forever. Plan, Save, Enjoy!

If I can help you in your Retirement planning, contact me at: drblack@dentalpracticesolutions.com or Schedule a call here

ABOUT THE AUTHOR

DAVID BLACK, DDS, FICD, FACD

Dr. Black is an associate coach/dental consultant for Dental Practice Solutions. He is “The go-to-expert for all dentists who are thinking about transitioning into retirement or buying their 1st dental practice.

Dr. Black owned his own dental practice for over 30 yrs. There he developed an understanding of the critical importance in development of the owner-doctor’s leadership abilities, in addition to having great clinical skills. Once he built a high-level of productivity in his dental practice, he was able to sell to a group practice; and the rest of his career

Does Your Dental Hygiene Schedule Include a Black Hole?

By: Debbie Seidel-Bittke, RDH, BS

June 20, 2019

Holes in the dental appointment schedule are a huge challenge in today’s world of dentistry.

How much does one hole in your schedule each day cost your dental practice over the next year?

The truth is that is costs your dental practice hundreds-of-thousands-of-dollars over a year, if you have just one hole in your schedule.

Does your dental hygiene schedule include a black hole?

Does your dental hygiene appointment include a black hole?

How many times does a dental patient call your office to change their appointment and they tell you they will “Call you back when they have more time?”

In the video I share today, you may think, “this is not our office!.” Your’e saying to yourself we never let patients leave or change an appointment without scheduling their next appointment!

We hear this statement all the time.

THE NUMBERS DON’T LIE

Our team of consultants and dental coaches currently evaluates dental practice key performance indicators (important measurements of success in a dental practice) and I can tell you that it is all too common that we see a huge, long list of patients who left the office without scheduling a next appointment.

Until you look at your numbers, it may appear that you are scheduling every patient with a next dental appointment.

The administrative team is responsible for most of the patient schedule. It’s important that every team member who will schedule a patient appointment understands the dental practice system for scheduling patients.

Working together as a team to have strategic systems and protocols are a key component of every successful dental practice.

The best way a dental hygienist can help reduce the holes in your dental practice schedule is to create value around what is completed at a dental hygiene appointment.

● What does your scheduling system look like?

● Does your team know what is included in your scheduling system?

● What do you say when a patient does need to change their dental appointment?

● How can you reduce the number of patients who call to change a dental appointment?

Much of this relies on your verbal skills, the words you use to add value to the dental services your provide.

Words like “teeth cleaning,” scaling and root planing and even the word decay,” do not add the same value as words such as, “preventive care appointment, gum therapy or gum treatment and cavities or hole in your tooth.” Try using Portland Pothole or just the word “Pothole” next time you see a cavity.

Patients can relate to these words.

One important point to make is this, until your patients say, “Do NOT call me anymore,” continue to follow-up.

Let your patients know you miss them, that you care about them and that a healthy mouth more likely means a healthy body.

No one I know has ever complained because I told them I cared about them.

I must ask, what is your scheduling and change of appointment system?

Does a dental hygiene appointment ever go into a black hole?!

ABOUT THE AUTHOR

DEBBIE SEDIEL-BITTKE, RDH, BS

Debbie Seidel-Bittke, RDH, BS is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.

Check out the Dental Practice University intended for dentists and the entire team.

The university has training video modules, forms and scripts for each department in your dental practice.

The video modules are created for doctor(s) and include information to create a culture to bring in new patients, keep your dental team (employees) the life-time of your dental practice, as well as re-create or create your vision and mission. Doctors receive a 90-Day goal setting journal.

The hygienists have their own training video modules that cover time management, caries risk, treating the gingivitis and perio-patient.

The front office has video modules on phone calls, new patient calls, we provide job descriptions and a lot of information for hiring and keeping employees long-term.

You receive 24 AGD CE Credits. Try the University for FREE the first 2 weeks. Then you pay $97.00 a month indefinitely. You are locked in at $97/month!

The training includes 24 AGD CE Credits over a 12 month time for one person. You can use the training for your entire team but for individual log-ins and the additional AGD CE Credits you pay $20/month for each additional employee.

Learn more about the Dental Practice University here.

Dental Practice Transition How Do You Create A Saleable Practice?

By: Dr. David Black, DDS, FICD, FACD

June 12, 2019

You cannot have a dental practice transition unless you have a practice that someone else wants to buy. It is critical that you have many factors working in your favor to sell your practice.

There are both physical and esthetic attributes, along with sound business metrics and positive staffing considerations.

The question when considering a dental practice transition is, How do you create a saleable practice?

PHYSICAL AND ESTHETIC ATTRIBUTES

Location is always an important factor in any business or real estate deal. How much traffic goes past your office will help drive up new patients.

● How easy it is to enter and exit your office will help get new patients?
● Are you close to a school or a shopping center?
● Are you in a new or growing part of town or are you in a tired area that is not showing growth?

Next you have to consider the appearance from the road and what the interior of your office is like. Make sure trim is painted and not peeling. Is the landscaping inviting? Is the upholstery on your furniture torn and dirty or bright and comfortable.

● Do you have a physical barrier between the reception area and the receptionist?
● Is the carpet or tile in good shape?

Buyers look at all these things and it will affect their attitude about buying the office.

● Is your dental equipment modern or antique?

Both will sell, but the old stuff will bring a lower price. You will need to calculate what buying new equipment will cost against what the buyer is willing to pay for the old equipment.

Also you need to consider whether you can recoup the cost of replacement against just reducing the price to offset buying new equipment.

● Are you digital?

Any more the standard in any modern office is to have computer records and digital x-rays at the very least. A digital Panorex is prevalent in most offices also. If this is not the case, you will need to consider buying the digital upgrades or recognize that this is a big liability when selling.

BUSINESS METRICS AND STAFFING

If someone is going to buy a business, they have one of two approaches. The first is to buy an office that is profitable with good systems in place. They expect to pay a reasonable price.

The second type is looking for a bargain basement sale. If you are not making a good profit, if your production and collections are not high, if you are not seeing many new patients or have a sizeable group of patients of record, you are not going to get a good offer.

A few years before I sold my practice, I approached an older doctor who was going to close his office without selling it. He had run it down to nearly nothing and the physical plant was old and dated. I bought his phone number and his charts for $5000. I could not activate all his patients of record because they had left because of the state of the practice, but I did activate enough of his clients to more that pay for the cost to buy out the practice and not have another doctor come into our community in his office space.

You have two choices if you do not have good metrics:

1. Sell for less or improve your metrics.

When I sold my office, I had above average numbers, but I wanted to get the maximum return on my 40+ years of practice.

2. Hire an expert to boost your performance and profitability.

I hired consultants to help me improve all the key performance indicators that create success.

This is what you need to make the practice very attractive to the buyers.

I had long-term employees that had good relationships with our patients. This makes a buyer feel better about patient retention after you are gone. We had put in place many systems so that the team knew how to run the office without me micromanaging each and every thing going on in the office. I had many long-time patients that created the base for a smooth transition. The result of these efforts was to increase the sale price by about 30%.

The choice is yours:

Create a great, saleable practice, or bail out of the practice with less return on investment than you could have realized.

If you need help with your transition, give me a call for a free thirty- minute consultation, or engage us for coaching you all the way through your TRANSITION. Also you can get my free E-BOOK at our website, dentalpracticesolutions.com/resources

ABOUT THE AUTHOR

DAVID BLACK, DDS, FICD, FACD

Dr. Black is an associate coach for Dental Practice Solutions. He is “The go-to-expert for all dentists who are thinking about transitioning into retirement or buying their 1st dental practice.

In 2015, Dr. Black decided to share his knowledge to help other dentists duplicate his level of success, so he became a leadership coach and practice management consultant. His niche is treatment planning and case presentation.

Dr. Black is currently an associate coach and consultant, for Dental Practice Solutions, one of the leading consulting firms for nearly twenty years. As a seasoned practitioner, Dr. Black adds to the proven hygiene profitability coaching that Dental Practice Solutions is well-known for providing, to dental practices around the world.

Dr. Black’s expertise as an EQ and DISC trainer, makes him the best person to help more patients to say “YES!” to your patient care, as well as to enjoy working together as a team and loving what you do for your patients!

Want to have Dr. David Black speak to your study club or dental association?

Click to know more about Dr. David Black’s courses: Speaker Packet

Thinking about taking your dental practice to the next level?

We are looking for a few dental offices to beta-test our Dental Practice University training.

The training has video modules for the doctor, front office, dental hygienists and the entire team. There are scripts, forms and written processes.

You get information about Creating your culture, vision, team huddles that creat big productivity, hygiene video trainings on time management, treating the gingivitis and periodontal patient, CAMBRA, Lasers, phone skills, time management for the front office, handling cancellation calls, reactivating overdue patients, treatment planning, case acceptance, presenting financial arrangements, etc, etc.

There is a lot of training you receive over the next year. There will be hundreds of training video modules. You will also receive 24 AGD CE Credits for participating.

As a beta-tester, you pay nothing. We do ask that you provide feedback and give your opinion and ways to improve the University trainings.

To learn more about the University and to see if your dental team qualifies to be a beta-tester please TEXT: DPU to: 949-351-8741. Please text us: your name, your office name, your best email address and phone number. We will schedule 15 minutes to share more and let you know what we need from you and your team should you be chosen as beta-testers.

Without A Strong Foundation The House Will Fall

By: Dr. David Black, DDS, FICD, FACD

March 5, 2019

The young associate dentist evaluates a new patient.

This patient is a 50-year-old woman, who is a type II diabetic, and taking medications for both diabetes and high blood pressure. She is missing her lower right first molar (#30) and has several old amalgam fillings that are breaking down plus, they all have recurrent decay.

The woman has periodontal probing’s measuring 4-6 mm’s in depths. The periodontal infection is localized to the posterior quadrants and includes a 6 mm distal pocket depth on #31. All of the periodontal pockets have BOP.

Excited, the young doctor immediately discusses and schedules a three-unit bridge to replace the missing #30, with abutments on #29 and #31.

WHAT IS WRONG WITH THIS PICTURE?

To use the analogy of building a house, this young doctor placed the roof before he poured the foundation. I can still remember from many years ago, when I was in dental school, they gave us a sequence that we were told to never violate. Oral surgery, endo, perio, restorative, and finally; prosthetics.

When we presented our dental treatment plans to our instructors, we always had to follow this same sequence.

FOUNDATION- FLOOR- WALLS -ROOF

The Foundation refers to removal of infection and any non-restorable teeth. If there are teeth that cannot be saved, get them out of the mouth first! Stop pain and take care of any abscesses. Either treat teeth with endodontics or extract them. This is important to eliminate systemic infection because we know that infection in the mouth causes infection in the does body.

There is one exception to this rule: you must address the patient’s primary need first, IF, it does not seriously violate the rest of the sequence. An example could be, a missing filling in a front tooth, and the patient was self-conscious about the esthetic problem.

The Floor can be built. The floor is built on the foundation and is similar in function. Our next step is to control or eliminate any periodontal infection so the patient will have a strong foundation that will not become progressively worse after we build our fine restorations.

This is the rule that the young dentist in the above story broke. He constructed a bridge before he had cured the periodontal problems his patient had. I can’t imagine trying to locate where the margin on the abutments will be with the pocketing present, the over extension into a sick periodontal pocket, and trying to have a dry field when trying to cement the bridge. This treatment can include debridement, scaling and root planning, any grafts and surgery that may be needed, and maintenance to be sure our house will be strong and healthy.

The Walls can now be placed on a healthy, strong foundation and the floor. The Walls can be compared to doing the necessary removal of decay and broken fillings present in the patients mouth. This will make smoother margins and will often uncover decay that may be present. Now we must go back to our foundation. If there is a pulp exposure this requires treating the nerve before going any further. When a tooth needs a crown later in the process, sometimes a core filling will be needed to make sure the tooth is strong and will retain the crown.

The Roof comes next. This can include a number of procedures, including the bridge our young doctor immediately decided was the most important project; the shiny thing, the high priced project he wanted to get completed in the first sequence of the treatment plan. Unfortunately, this sequence of treatment is the case too often. We hear of all the total restorative make-overs, the implant retained prosthesis that are done in one day, and also the twelve veneer cases that are done on the second visit in some offices. My prayer is that when you place the roof on your cases, you have made sure the foundation, the floor and the walls are all solid, so that the roof won’t collapse, a few years after you have placed that last nail to hold the shingles in place.

FOUNDATION, FLOOR, WALLS, ROOF. Make sure you follow the correct treatment sequence and work through each needed step to insure your patient’s dental house will be strong and last for many years to come.

About Dr. David Black, DDS, FICD, FACD

To schedule a No-Cost Profit Boosting Session Contact Dr. Black Here

How to Grow an In-House Membership Program

By: Debbie Seidel-Bittke, RDH, BS

January 9, 2019

Debbie Seidel-Bittke, RDH, BS, talked to Jordon Comstock, founder and CEO of Boomcloud about their membership program.

Dental Practice Solutions niche is teaching hygienists how to talk to patients about necessary treatment and Boomcloud is a great adjunct to helping patients pay for the dental treatment they need.

During this short podcast, Debbie and Jordon talk about:

1. A predictable, recurring revenue stream for your dental practice.

2. They talk about a specific tool to help market your dental practice.

Attrition is a part of every business so this is one important tool you must learn about to help market your dental practice and create sustainable profits.

3. They also talk about reducing a dentist’ dependence on PPO’s.

4. When you listen to the podcast you will learn the benefits of a “subscription system.”

a. Think Amazon Prime but for your dental practice.

We are in a new age of dentistry and this information will bring you into a forward-thinking world to grow your dental practice.

How can we help you grow your dental practice in 2019?

Please call us @ 949-351-8741 or Email Us to schedule a No-cost profit boosting session Click to Schedule and discover the easiest way to make 2019 your best year ever!

ABOUT THE AUTHOR

Debbie Seidel-Bittke, RDH, BS, is one of Dentistry Today’s top dental consultants. She is an international coach, speaker and author. Debbie is the CEO of Dental Practice Solutions.

Debbie is a world-class leader in creating profitable dental hygiene departments. She is a well-known as a former clinical assistant professor at USC in Los Angeles and a former hygiene department program director.

Dentistry Today recognizes Debbie as a Leader in Dental Consulting for the past 16 years.