Repeat after me:
“I will be better organized.”
“I will figure out how to be more productive.”
“I will get a handle on my debt.”
“I will get the most from my technology.
“I will get training for my team.”

Any of these sound familiar? If they do, do you follow through with these resolutions? Many of you may say, “No,” and that is not uncommon.

Know the Power of Planning

Perhaps the biggest reason our New Year’s resolutions peter out after the first two weeks of January is because we do not make a PLAN to support them. An idea can only take you so far without establishing detailed steps to make it successful. These same concepts translate to the business world, and a major annual strategic planning session is crucial for the success of your practice.

The dental business can also throw us curve balls, and our survival depends on whether we have a well thought-out annual plan — or fly by the seat of our pants. It’s not unlike airline pilots, who always fly with emergency plans in place.

On January 15, 2009, US Airways Flight 1549 took off from New York’s LaGuardia airport for Charlotte, N.C. Shortly after takeoff, the plane went through a flock of geese at 3,000 feet, and both engines were knocked out. Captain Chelsey Sullenberger had not landed on water before, yet his training and the emergency plans allowed him to take appropriate actions in an extreme situation and make a safe, successful landing on the Hudson River.

Though many of us have faced crises (economic, professional, or personal), surprisingly few organizations are ready with a plan. Don’t let your dental practice be one of them.

That said, what is your annual plan, and how will you make it a reality? How can you ensure your plan is successful, makes a positive impact on your practice, and offers the highest profit on your bottom line?

The answer: By working with an expert practice management coach. Don’t wait until the New Year. Our coaches are ready to help you PLAN and discuss these questions now. Do this, and allow yourself to enjoy the benefits of a well thought-out plan — even when life just happens.

Take These Steps to Your Success

1. Decide on New Year’s resolutions for your practice.

2. Schedule an appointment with a dental practice expert who can help you make a strategic plan — and ensure it’s a reality in 2012.

3. Schedule a date to meet with this expert before 2012 arrives.
-Discuss your plans for 2012.
– Put this on the calendar before December 31, 2011.
– Count this as your “Team Annual Planning Session.”

4. Assemble a P&L (Profit and Loss) statement of the past 12 months
– Collaborate with a dental expert who is trained to turn your P&L into a management tool for increased profits in 2012

5. Determine with your dental practice expert (consultant/coach) if your overhead stacks up against the true dental industry standards.

6. Project your expenses and goals with the guidance of your practice expert.
– Base these on history, expenses, and potential.

7. Have an annual planning session. Discuss with your team how many working days will be needed to meet your budget needs.
-What services will you provide? (e.g. same-day services, new services, standard of care services, etc.)
-What products can you offer and sell to add value and benefit your patients’ oral and total health?
-With the guidance of your dental practice expert, determine your practice potential and identify your obstacles.
-Brainstorm with your consultant/coach and team to plan how to move beyond these obstacles.
-Finally, develop an action plan.
– This is the step that pulls your plan together and will make your resolutions stick!

Getting Expert Guidance Pays Off

Planning is your ticket to success, but make sure it’s done right. Even the dental practices that do have annual plans often lack a well thought-out strategic plan. Add to that poor execution, and many of these weak plans derail, leading to lost patient appointment time, loss of practice profitability, wasted money, contentious patient issues, and even legal quagmires.

The solution: Have an expert dental consultant guide your annual planning so you leave no stones unturned. Asking for help is the key to creating a profitable year in 2012! Don’t delay. Put this appointment on your calendar today! A ten-step plan will find your practice’s untapped potential and successfully manage your profitability.

The rewards you can reap from New Year’s resolutions don’t occur in a minute. It takes a series of successive milestones as you work toward the change that you seek. This is the reason you need to begin planning today. So, mark your calendar, get set, Go!

How are you preparing your practice for the new year?

The holidays are here and when reading this, you will feel inspired to offer holiday gifts for patients to purchase and give their friends and family. What a great way to share the good word about your dental practice and give the gift of optimal oral health! This is also a great way to add another income stream before this year ends.

When I speak about dentistry now, I say things like, “It changes as fast as the speed of light,” or “If you miss that annual meeting, you miss the turn of the century!” Trends change so quickly in the field of dentistry, so let me fill you in on the latest change that can really boost your bottom line:
New ways to think about promoting your practice.”

Holiday Gifts Increase Sales & Promote the Practice

Imagine the ability to reinforce prevention with your patients and market your practice on a regular basis. This is an open opportunity to all of us in the field of dentistry…if we change our old paradigm about self-promotion and sales.

When I think about my early days as a dental professional, I remember when the ADA spoke of the “undignified” practice of advertising. The belief that no practice should stoop to advertising was a solid mass in most minds who stepped foot in a dental office. Never did I hear phrases like, “Dentistry is a business.” Times have changed, however, and in order to financially thrive, we must start thinking in a business mindset. Here are a couple pointers to get you started and get your practice pointed in a profitable direction.

Don’t Be Afraid to Try New Promotional Activities

Successful businesses seek more business, and so should you. Back in the day, it was taboo to solicit referrals. Today, however, we no longer need to feel uncomfortable asking our patients and friends for referrals. There are many ways to do this without feeling awkward or pushy. For example, your auxiliaries and of course the doctor, can simply say to patients upon their checkout, “be sure to tell your friends about us!” Another idea is to develop a referral rewards system. Perhaps you have a stack of business cards in the waiting room that say, “Refer a friend and receive 20% off your next home care products purchase from our office. Have you checked into any of the new patient referral programs? — for example: Loyal Patients, Inc.

That leads me to my next point: selling oral care products. When analyzing the success of your business you must learn where the profit centers lie — and where you can build new profit centers. This is a proactive step in any business. One main profit center today in dentistry is home care products, and lots of dental practices are missing out because of old habits.

I specifically remember a dentist I worked for saying, “I don’t have a pharmacy in my dental office!” Think about it, though: Do we want our patients to go to their local drug store to buy the least expensive toothbrush or the mouth rinse that is on sale this week, when we could have offered them a better product AND contributed to our own bottom line? In the practice I worked where the dentist refused to have a “pharmacy,” I took note that 2/3rds of my patients never did get that prescription for Gel Kam filled at their local pharmacy. (Now that is sold over-the-counter in many areas.)

You’re a Business First

Yes, times have changed, and on top of viewing ourselves more and more as business people, we must foster a preventive patient-centered dental practice, that offers patients more options for maintaining oral health. We want to be certain that patients receive the best procedures, products, and services. We also want to promote an atmosphere where team members are encouraged to grow and build a rewarding career — and that’s a lot easier when the purse strings aren’t so tight.

Recently, a team member of Dental Practice Solutions and I, analyzed the amount of money added to a dental practice’ profits when they have these prevention products available for purchase in the dental office. These can contribute easily to an added $30,000USD annually, to your dental practice. The best part: selling home care products requires a very small upfront investment, and the return is quick and very easily done by everyone on the team participating.

Sample Gift Package

You can get creative, too. For example, group together a Waterpik
™, power toothbrush, toothpaste, mouth rinse, tongue cleaner, and floss. Then, wrap in beautiful packaging, and promote as a gift pack around special holidays. This is just one more opportunity to add that personal touch.

Not only are patients going to be asking for refills on the products they use when they come in for their dental visits, but imagine these same people coming by your office to buy a beautifully wrapped gift for someone they love in the month of November, December and even the day of Love; February 14th. Be sure to put your dental practice’s business card in every packaged gift.

Gift packs are not only a wonderful way to keep your patients healthy but also for them to share the good word and have a reason to return to your office. So now, we’ve made a complete circle back to the topic of referrals. In this case, you can let your oral care gift packages do the referring for you!

We are the oral care experts, so why wouldn’t we want our patients to come to us for the expert advice about the products and care that can help them live a longer and healthier life?

Your Thoughts

Will you offer home care products to your patients during this holiday season? If so, have you done this in the past? What were your results? If not, tell us why in a comment below.

The following is Part II of yesterday’s post by Debbie Siedel-Bittke titled, “You Decide: Prophylaxis of Periodontal Maintenance.”

Periodontal Maintenance vs. Prophylaxis

The Prophylaxis Appointment (CDT Code D1110 prophylaxis) is only for patients who exhibit healthy gingiva. They have a healthy periodontium. The Prophylaxis (CDT code D1110) definition says “the removal of plaque, calculus, and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

The Periodontal Maintenance (CDT Code D4910 periodontal maintenance) is a post-therapeutic procedure used to maintain the healthy results of periodontal therapy, not to prevent disease in healthy patients. The Periodontal Maintenance (CDT code 4910) definition states: “It can only be used “following periodontal therapy and continues at varying intervals … includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site-specific scaling and root planing where indicated, and polishing the teeth.”

The Periodontal Maintenance appointment is to be used following Phase I – definitive periodontal therapy and for an indefinite time, determined by the patient’s progress over time to achieve stability and the absence of the signs and symptoms of disease. Periodontal maintenance patients who have poor oral hygiene, smoke, exhibit bone loss and/or excessive bleeding, have not achieved an acceptable level of stability and in addition, have various immune deficiencies such as Rheumatoid Arthritis, Diabetes, Arteriosclerosis, etc., etc. When these patients continue to return for dental hygiene appointments and these disease challenges persist they will need to be referred for a consultation by a periodontist.

What are the specific differences between a periodontal maintenance procedure and. a regular prophylaxis? Periodontal maintenance procedures include a predominance of power scaling with thin inserts to access and debride the depths of periodontal pockets. Think scaling SMART not hard! Your patient may need localized areas of local anesthesia. The goal of this appointment is thorough debridement of pathogens that have repopulated in the sulcus. Periodontal pathogens reside in the sulcus and on the plaque and calculus. Biofilm is always present on the root in the presence of calculus or no calculus. Annually, a comprehensive periodontal exam is mandatory. (Six-point periodontal probing is necessary in order to reassess changes that have occurred in pocket depths.) A pre-procedural rinse and irrigation post-procedural with an appropriate antimicrobial, such as Povidone-iodine or Chlorhexidine, is the Gold Standard. You may need to apply desensitizing agents, such as Colgate’s Pro-Relief™, with a rubber cup if your patient has sensitivity and/or exposed root surfaces. If you have a fluoride varnish you can easily apply this for immediate relief from any root sensitivity. There are numerous choices for today’s sensitive dental hygiene patient. Always polish with low-abrasion pumice and/or pastes if your patient has exposed root surfaces. This is often the case for periodontal patients.

Communicating the difference

One way to explain to patients when they need to understand the difference between Prophy and Periodontal Maintenance is to say this: “Your gums are not healthy and this can also affect your total health. Usually, your dental hygiene appointment is only a preventive therapy but today I will need to treat areas of disease. I am recommending that we do something different today. Today I (fill in the blank with your own plan) will let the patient know if you will do a gross debridement, scale and root plan an area, etc.” Ask the patient if they have any questions and find out if they have objections and why. It is at this point in time you will need to address financial issues.
For some patients the most challenging part is the finances. It is well known that most people will buy what they want. This is when you have effective communication skills that you can overcome the financial barriers to accepting non-surgical periodontal care. Most people will find the money when they understand they will live a longer and healthier life!

When patients still don’t comprehend the importance of optimal oral health in relationship to their total overall health, try to explain that you are not providing appropriate treatment with only a prophylaxis appointment. Patients also need to understand they are not there to get their teeth “cleaned”. Dental hygienists are in the business of preventing disease.

One more way to communicate the importance of more than a prophylaxis is to show the patient radiographs of their teeth, the surrounding bone and/or intraoral photographs of the diseased areas, bleeding staining, plaque, calculus, etc. Show them actual tooth mobility if it exists. A loose tooth is not a pretty sight to see!

Some computerized patient management software programs, stand-alone devices and programs, such as the DENTRIX periodontal chart where you can color code areas with different colors, (Red for BOP, green for mobility, etc.) Dental R.A.T.® and PerioPal®, also produce impressive probing charts. Even giving the patient a hand mirror and showing him/her how his/her gums are bleeding can be a powerful, emotional tool. The main point here is that the independent authority has to be highly visual and vivid to counter the emotional belief that they’re being cheated. Some patients will believe “It’s all about the almighty dollar”, when in reality we are in the business to provide optimal health.

It is becoming more common to have Physicians gather systemic information with lab tests, and dentists are beginning to use lab tests as well. Four outside labs have periodontal tests: two are culturing services – Oral Microbiology Testing Service (OMTS) and Oral Microbiology Testing Lab (OMTL). The other two are DNA tests: OralDNA Labs® and micro-IDent®plus. All four tests can detect pathogens that are associated with periodontal disease. There is also a third-party statistical test, PreViser™ based on clinical findings that estimate the likelihood of periodontal disease. In addition to these outside tests, there are two microbiological tests that can be used chair side. BANA™ is an enzymatic test for periodontal pathogens, and the other is a video microscopy test called BioScan™.Any of these above listed tests can provide the type of important information dental practices and patients may consider prudent.

Final Thoughts

The dental hygienist has two important roles. The first role is to determine which type of periodic preventive care is needed, by each individual patient. It is the role of a healthcare provider to educate and communicate to patients exactly what type of care is appropriate for their overall health. Education is the second role.

We are not talking about the almighty dollar. We are concerned about our patients overall health. When you understand and communicate the difference between health and disease. Prevention and treatment, you are providing optimal care.

Disease means Periodontal Maintenance for life. Prophylaxis means the patient is healthy and there is little plaque, calculus and no bleeding.

Sources
1. www.perio.org September 2003 Issue
2. www.perio.org

All throughout the day, we treat them one by one. Each individual patient is treated in a different way. This is our standard of care. Will you agree with this statement? If you don’t agree, then let’s make a “Red Letter Day”- – today!

What is the difference between a Prophy and a Periodontal Maintenance?

Are you scaling more than twenty minutes during a regular continuing care appointment? If you are then it is probably more than just a Prophy.

Periodontal Maintenance

When a patient completes phase one treatment for non-surgical periodontal therapy, they are now and forever considered a “Periodontal Patient”. If you have Diabetes or high blood pressure, you will always be evaluated by your doctor to prevent progression of the disease. A patient diagnosed with cancer, high blood pressure and/ or Diabetes, doesn’t just get treated and then never see their doctor for regular preventive measures. This is the same protocol for patients diagnosed with Periodontal Disease.

One reason hygienists may choose to eliminate the periodontal maintenance appointment is for financial reasons. In the United States and other countries a billing code is used and more money is charged for the service. In the United States code D4910 (Periodontal Maintenance after scaling and root planing has been completed.) is a much higher fee than the fee for code D1110 (Prophylaxis. This means no disease is present.) The other reason dental professionals do not provide the periodontal maintenance appointment or bill appropriately is that many third-party payers do not cover the periodontal maintenance appointment at frequent intervals. (Example: Less than six months interval.)

When we understand the research regarding periodontal pathogens we will understand how to communicate to our patients “Why” they need to return in most likely twelve weeks. The research, the science, reports that periodontal pathogens will repopulate a healthy and recently scaled sulcus as early as nine to twelve weeks, post maintenance.1 A patient can brush and floss all day long and this may not be enough to remove the periodontal pathogens. These pathogens are what will cause tooth loss in periodontal patients.

Following a 10-year study, researchers found that patients who received regular periodontal maintenance had significantly reduced probing depths and lost fewer teeth than patients who did not have periodontal maintenance procedures. Here are the arguments to use regarding regular twelve week periodontal maintenance for your periodontal patients. This is the information to communicate to patients. It is our role as a healthcare provider to read the research, know the science, and share it with everyone who needs to know.

It still happens each day in many dental hygiene treatment rooms throughout the world. No matter how much time is spent removing plaque and calculus, the office still charges the same fee for what are actually a different procedure and a different diagnosis. The problem that is seen most likely is that the hygienist is not individually assessing patients for periodontal disease. The other problem is that the hygienist will do an assessment but there may be a lot more calculus present than is considered a regular prophylaxis procedure. If it has been awhile and if you live in the United States, look at the CDT Codes and read the description for D1110. No matter where you live, review the billing code description. Exactly what type of plaque and calculus does this billing code refer to? Does the code say this is a procedure for a preventive or a disease state? Read this description and see for yourself that (For example, in the United States) CDT Code D1110 refers to a healthy dentition, small amounts of plaque and calculus. If you are spending more than twenty minutes scaling, then you are not adequately treating this patient. Scaling calculus for more than twenty minutes is not the description of a prophylaxis. In the presence of moderate to heavy calculus you have more than a CDT Code D1110. (The Prophylaxis code for insurance billing purposes in the United States.)

No one wants to spend more money! People will pay for what they want not always what they need. It is our job as a healthcare professional to be an advocate for prevention. We need to share the research and the science behind the disease and how to prevent it, with our patients. We are the experts and we want to be an advocate of optimal oral health for our patients. We have a responsibility to spread the word that without good oral health a person will not have a healthy body.
“Working as a team of healthcare professionals, we can conquer the disease process. Together we can make a difference in our world!

Can you effectively explain to your patients why they need to return for non-surgical periodontal treatment? Do you know what to say when a patient returns with heavy calculus? What do you say when the patient had scaling and root planing last year and returned today with a 6-mm pocket? That pocket was there prior to scaling and root planing a year ago but what do you say when it occurs again at the periodontal maintenance appointment?

Tell Your Patients the Truth

You told your patient about the research and science behind the disease and you also need to tell them that periodontal disease is episodic. The disease process can and will most likely return at some point. This is why your patients need to continue coming back every twelve weeks, (or at frequent and the appropriate intervals.) even if they seem healthy for many years after the scaling and root planing is completed.

As mentioned previously, when a patient has Diabetes or high blood pressure, the doctor will ask the patient to be examined frequently because the disease is likely to return. Today, it is all about prevention. Prevention needs to be your message to the patient. When there is a new area of bleeding upon probing (BOP) or a new 5-mm pocket, now is the time to sit the patient upright in the chair and discuss early intervention. This will most likely mean prevention in the future. In dentistry today, during the twenty first century, we no longer “wait and watch”. Waiting is not the standard of care. What are your “waiting” for?

Look for part II of this post tomorrow…

What to look for in Part II tomorrow

In part II of this post, we’ll learn the difference between Prophylaxis and Periodontal Maintenance. We’ll then discover an effective way of communicating the difference to our patients. We’ll see you tomorrow!

In Part 1 of Communication Tips You Must Know to Improve Case Acceptance, we talked about the advances in technology and our knowledge of the current evidence-based science, regarding the oral health and systemic health link.

We understand that dental hygienists have a huge impact on communication and patients’ acceptance to a treatment plan. It is crucial to guide patients to have a healthy body and in return, we are adding value to the services we provide and this will in return increase the dental practice profits.

Critical components for patient case acceptance:

1. Rapport: The patient connection.
2. Visuals: Most people are visual learners. Have these ready to use at each appointment.
3. The words we use.
4. The questions we ask . (Open-ended questions.)
5. Review, repetition and closure with the patient.

Case acceptance is critical for clinical results and the success of all dental practices.
Without patients accepting the treatment plan we cannot provide optimal care and your dental business will not survive and thrive. When we communicate with our patients, it is valuable to ask open-ended questions. Without asking open-ended questions, our patients will be answering yes or no to our questions. We can learn a lot more about our patients needs when we ask questions that cannot be answered with just a yes or no.

Time is a big concern during the hygiene appointment and asking open-ended questions will allow us to communicate the important facts quickly. In Part 2 we will give examples of critical communication for patient case acceptance.

Example of an Open-Ended Conversation:

RDH: “Mr. Jones, Can you see the brown line and discoloration around this composite filling?”
Mr. Jones: “Yes, I can see this.”

RDH: “How do you feel about these dark discolored areas on your front tooth?”
Mr. Jones: “I have never noticed this before you mentioned it today. I don’t like my teeth not being white. What does the discolored area mean for my tooth?”

RDH: “This means there are open areas around this filling. I see from your chart, this restoration was preformed about 15 years ago. There are toxins, bacteria or poisons that will creep under the filling and cause destruction of the tooth. Do you see the small amounts of food trapped in this area?”
Mr. Jones: “Yes, I do see the food trapped there.”

RDH: “The bacteria that creep into this area on the tooth can also get into your blood stream and contribute to disease. This can affect your immune system.” Does this make sense to you?”
Mr. Jones: “Yes, that does make sense. I have never thought about it in this way.”

RDH: “What are your thoughts about restoring this tooth, returning it to a healthy status?”
Mr. Jones: “Well, yes, of course I want to be healthy. How can you do this?”

RDH: “Mr. Jones, the first thing I would like to talk about is your discolored tooth in the front of your mouth. I know you have never noticed this before today and with a new restoration, we can remove the bacteria, which causes oral disease and more destruction on your tooth. The bacteria will get into your blood stream if not removed. The way we fix this tooth for you is to very easily remove the darkened, stained enamel from the tooth and replace it with a new tooth colored material. Of course, all the recommendations for treatment I am going to make will be dependent on your budget. I know that the economy has also affected how you are spending money at this time. The doctor will look closely to make sure all the recommendations make sense for you and what is happening in your life at this time.”

This is the time to take out the brochure regarding restorative treatment. (Circle, highlight or underline the areas which pertain to the patient.)

RDH: “What are your thoughts about this treatment recommendation? Does this information make sense?”
Mr. Jones: “Yes, it does make sense. Although money is tight, I still want to have the healthiest mouth and body as possible. I would like to think about ways I can pay to have this treatment completed.”

RDH: “I can have Mary, our financial coordinator, discuss payment options with you. The second area I can help you with is your dry mouth. I noticed that you circled this on your medical history. This is most likely due to the medication you are taking for high blood pressure. Today, I will show you a few products, which will relieve this situation very easily.”
“Is this something that you will use at home?”
Mr. Jones: “Yes, I definitely want to know more about these products today.” “I don’t want to leave without asking Mary about the financial options you can offer.”

RDH: “I will show these products to you after the doctor completes your exam today. The other area I want to address is the bleeding gums and the areas, which measure 5mms. I completed a periodontal screening exam and I want to review my findings with you at this time.” (At this time if you have an electronic chart, put the perio chart up on the monitor and review with the patient. Also, bring out the periodontal brochures and outline, highlight or circle important areas that relate to the patient.)
“Your oral health is related to your overall health. We need to remove the bacteria causing the periodontal disease. You may have heard about gum disease before today. Some of the factors which can contribute to periodontal disease are stress and various systemic diseases such as your high blood pressure. I am recommending that you return for four appointments to scale and root plane these areas. I will place a chemotherapeutic agent called Arestin in the areas, which measure 5mms. This is similar to what you know as Tetracycline. This is a sub-dose of Tetracycline and will work only on the enzymes, which are causing the inflammation, bleeding and disease process. After the four appointments are complete, you will return four – six weeks later to re-evaluate these areas and make certain they are healthy. Usually with this treatment and the use of chemotherapeutics at this early stage, we can halt the progression of periodontal disease. I will also recommend that you return every three months for supportive therapy to prevent further disease. Does this make sense to you?”
Mr. Jones: “I think it does. I have been hit hard from the economy these past two years and it has caused a lot of stress. My daughter is getting married which adds to the financial problems and my stress. Are you telling me that if I don’t have this gum treatment for the periodontal disease, that I can lose my teeth?”

RDH: “Yes, that is correct. Usually this is a slow disease process but without the treatment, scaling and root planing, the disease process is likely to progress. The scaling and root planing will also help establish good health around that tooth before the doctor provides you with a new restoration or filling in that front tooth. The end result with a new filling is very positive once your gums are healthy. The doctor can add a much better restoration when the gums are healthy.” “I know you have your daughters wedding in a few months so maybe you want your smile to be the very best possible for this big event. Before doctor comes in to do the final examination and make the diagnosis, I want to show you some photos of patients with a similar situation as yours. In our computer, I have some photos of patients who had the same type of slight bleeding and redness around their gumline. (Now have photos of patients before and after scaling and root planing on the monitor) They completed the scaling and root planing and as you can see in this photo here, the patient now has gums that are a light coral pink color. How much difference do you see in the patients’ gums from the beginning to the end of treatment? Can you see a difference between these photos? Do you notice something is different?”
Mr. Jones: “Okay, I see, the teeth and gums look a lot better in this photo on the right. I understand what you mean about improving my oral health. That second photo doesn’t have any blood around the gumline. The front teeth on this patient are also much whiter. I have never even noticed this discoloration or bleeding before today. I never noticed those brown areas around that old filling and I definitely didn’t think anything about a little bleeding on my gums every once in awhile.”

RDH: “Our dental assistant Marcie had an old filling completed for the first time about twenty five years ago, before we had these great materials to restore teeth. The filling was redone few times over the past twenty-five years and last year doctor completed a veneer on this tooth. Doctor also whitened her teeth so they would all be much whiter. This is something very similar to what doctor can do for your teeth. Of course, this is only if you decide to have something more permanent completed on that tooth. It is very simple to complete and not much of your tooth will be taken away, contrary to having a crown placed.”
“I wanted to show you what we did to her tooth because we work for an amazing doctor who can make everyone’s teeth look better than ever. I wanted to show you this other type of treatment because it is longer lasting and all your teeth will look much whiter. Dr. Carter takes us to a lot of excellent educational courses and we just learned about a new procedure which can really make your smile look good for your daughters wedding!”
“Mr. Jones, we have talked about many things today. I want to make sure you are comfortable with your care. What questions do you have for me?”
Mr. Jones: The photo of the tooth after she had the veneer placed looks fantastic! I really like how natural it looks. How long will the restoration last?”

RDH: “With proper home care, the veneers can last over twenty-five years.”
I believe that doctor may want to discuss these various treatments with you at another consultation appointment. If you are interested in having all the teeth look great in the front of your mouth, doctor can talk to you about what you want your teeth to look like. We can make another appointment during your lunch hour next week so you don’t have to be so rushed today. You can take your time to decide on the type of treatment you want to make your smile look the very best. We will accomodate you so you don’t lose time from work. Is this something you would like to discuss with doctor further?”
Mr. Jones: “Yes, I think I would like to find out how all my teeth can look better. Let’s make a lunch time appointment for me to discuss this more.”

RDH: “I am looking at the schedule here on the computer and I see that we have a lunch time appointment next Thursday. Does 12:00pm on March 24th work for you?”
Mr. Jones: “Yes, I think that will work for me.”

RDH: “Before you leave today I will schedule the appointments for the scaling and root planing and a six week appointment to re-evaluate the outcome from the scaling and root planing. I will also review those products for your dry mouth. Here is doctor now.” Now the doctor will come into the hygiene room and complete the exam. Doctor will confirm the initial diagnosis and review the discussion between the hygienist and patient.

Recap for Critical Communication

At this point, the hygienist has talked about stress and the affects of this on the patient’s oral health. The hygienist has talked about something pleasant to continue with rapport building and the personal relationship between patient and practitioner. The hygienist has also used various types of visuals. In this scenario, the hygienist used brochures and individualized these by highlighting, underlining and/or circling important aspects. The hygienist also showed some real patient photos on the monitor. During the verbal communication, throughout the case presentation, the hygienist used open-ended questions. When possible, the hygienist engaged the patient in conversation.

The hygienist explained the purpose for good oral health and allowed the patient to choose the level of health they want. The hygienist allowed the patient to decide if they would like to hear other treatment options. This put the patient in charge of their oral health and options for treatment. The patient took responsibility.

During the case presentation, the hygienist suggested and asked the patient if they would like more time to discuss other options with the doctor. These other options were more permanent alternatives to treatment. The hygienist talked about a more complete treatment plan and asked leading questions to discover if this is the type of treatment the patient would be interested in. (RDH: “Is this something you would like to discuss with doctor further?”)

The Next Crucial Step For Patient Case Acceptance

The next step when doctor enters the room for the exam is for the hygienist to provide a verbal synopsis to the doctor about the discovery during the patient-hygiene appointment. The hygienist will begin with something personal about the patient. For example, Mr. Jones has a daughter who will be married in a few months. Then the hygienist will report to doctor what treatment options were discussed and what the patient felt about the treatment options and if Mr. Jones is interested in moving forward with any of the options discussed.

Another Crucial Step for Patient Case Acceptance

The next crucial step is to get closure before any financial arrangements are made. You need to know if the patient is ready to move forward with treatment. This one thing needs to occur before you will have an answer to this next step to discuss the financials. If the patient is not ready to move forward with treatment, discussing financials will become a losing option for your patient schedule.

If you do not proceed with this next step the patient can most likely make an appointment and then cancel. The patient may also follow through with financial arrangements but they will tell you they will call when they are ready to schedule their treatment. This is why it is crucial to have a commitment from the patient to move forward with treatment.

When presenting the treatment plan both doctor and the hygienist need to be on task. Neither of these two people can miss a step. If doctor misses a step, the hygienist needs to give a verbal cue for doctor to return on task and verbally communicate. Same thing occurs if the hygienist misses a step. There needs to be conversation and a buy in from the patient after explanation of the treatment.

Repetition. Repetition. Repetition.

In real estate, they say this phrase “Location. Location. Location.” When we discuss communication with our patients, we need to understand that, many times a patient needs to hear the information two or three times before, they will say “Yes” to a treatment plan.

When the hygienist and entire dental team understand the science behind communication for case acceptance, the hygienist and other members of the team can increase the chances a patient will move forward with their treatment plan.

It is the responsibility of the hygienist to continually review the periodontal, restorative and aesthetic treatments, regarding the structured process within the Science of Communication each time they see the patient. The time for communicating this will not always be as long; however it is still the responsibility of the hygienist to continue communicating as long as the patient says they are still interested in the information. The dental professionals are the experts and need to continually create a desire for patients to move forward with necessary treatment.

Conclusion

It is important to understand the science behind communication. We are all guilty of talking and not communicating.

Key components to understanding how to get a “YES” for patient case acceptance:

- Understand the patient’s personality style.
- The tone and speed or your words
- The words we use
- Stay away from “speaking in code.”
- Use visuals
- Seat patients upright in the chair and face each other eye to eye
- Focus on the patients concerns and not your own agenda

Once the dental team feels more confident explaining the treatment needs to patients, the patients’ confidence in scheduling their treatment will also increase. In order to improve our patient case acceptance we need to improve the patient experience. To improve the patient experience, we must first improve the dentist and team experience. The goal of communication is about changing what we do. Once we have mastered the Science of Communication, the patients will notice the value added to their appointment and the overall improvement of their experience. With the patient experience improving, so will the referral of the patient’s friends, family and colleagues. When we create a great patient experience, the dental practice will benefit with an increase in the bottom line.

With advances in technology and our knowledge of the current evidence-based science, regarding the oral health and systemic health link, there is a wide diversity of services we can now offer.

One of the significant changes within the business of dentistry is the dental hygienists impact on communication and case acceptance. The dental hygiene department needs to have an integral part in affecting case acceptance. This is one area of the dental business where the team members will contribute to a large part of the total dental practice production and profits.

For many years, oral hygiene and patient education has been an important role as a dental auxiliary. As dental professional’s we spend hours educating ourselves about the best methodologies to educate and teach our patients about improving their home care and oral health.

The science of communication and creating a structure for patient case acceptance is crucial to guide patients towards a healthy body and increasing the dental practice profits. The communication skills need to be defined and refined in order to enhance your patient communication, increase patient case acceptance and add to the total production of your dental business.

Patient Connection Is Key

The patient connection is the first step. As a healthcare professional, you feel passionate about what you do and over seventy percent of all patient case acceptance should come from your passion for the profession and your compassion for the patients.

Utilize Visuals Properly

Visuals are similar to having a third eye. Many of your patients are visual learners. Visuals do not need to take extra time but if thought out, they can be effectively and efficiently utilized during all dental visits. Sit down during a team meeting, discuss and write down the available visuals your dental team can currently use. Pre-determine the logistics of how to use your current visuals, which ones to use, which visuals you would like to implement and how you can have them available to expedite the appointment time.

Case Acceptance Tips

1. Before the patient enters the rooms have the appropriate visual set up. For example if the patient has pending treatment, have the latest digital photo of that tooth up on your computer screen for patient to see when they enter the room.

2. Always have the intra oral camera ready for a tour of the patients’ mouth.

3. As you complete your visual exam, provide the patient a tour of their mouth. This includes restorative, aesthetics, oral and soft tissue lesions and periodontal findings. Show these areas to your patient on the computer monitor in front of them.

4. Use pamphlets and brochures when possible. This will give third party documentation of your clinical findings.

5. Individualize the pamphlet. Highlight paragraphs that pertain to their condition. Outline with a pen certain areas and/or circle specific sentences of importance. You may also want to write notes on the sides of the paragraphs inside the brochure.

6. If you have a video or Casey System have this playing as you are documenting in the chart or doing something else and the patient remains sitting in the chair.

7. Be open to showing patients similar type of work the doctor or a colleague has completed in your mouth. Put it up on the monitor as an example. If you have before and after photos to place on the monitor, have these up and ready to discuss and show the patient. Combine the brochure and your visuals on the monitor.

8. The dental team is the very best testimonial that you can use to provide the patients’ trust in the doctor’s work.

9. The co-diagnosis with hygienist and doctor will be a verbal review of what the patient just saw on the computer monitor in the hygiene room.

10. There has probably been a lot of new information communicated to the patient and comprehension is about 30% of what was just presented. Review your findings a second time while doctor is in the room. Review with doctor what you have reviewed with the patient and review again the specific areas in the brochure, which you have highlighted, outlined or circled.

11. Verbally confirm with the patient that they understand what you have just presented and that they understand the value of completing treatment.

12. At the last transfer of the patient to the treatment coordinator, give a short synopsis about what was provided to the patient today. Hand the brochure or pamphlets to the treatment coordinator instead of the patient. Now the treatment coordinator can use the brochure, which you have personalized to review the case and then the financial aspects of the patient treatment plan for final case acceptance.

13. The final part of this patient visit will be the treatment coordinator handing the patient their personalized brochure or pamphlet as well as their treatment plan and the payment options.

The goal of every successful dental practice is to provide the very highest level of patient care. Spending time with patients and utilizing visuals will provide patients the best opportunity to understand “Why” this treatment plan will best support their overall dental health, systemic health, self-confidence and overall well-being.

If you are still asking “Why” communication and case acceptance are so important, remember that case acceptance is critical for clinical results and the success of all dental practices.

Part II Preview

In part 2 we will discuss the various important questions to ask patients, what type of communication needs to occur between the doctor and hygienist during the examination and how to close the treatment plan before financial arrangements are made.

It is very important that the hygienist thoroughly understands their responsibility to review restorative and aesthetic needs through a structured process of communication each time they see a patient.

Many times a patient needs to hear the information two or three times before they will say “Yes” to a treatment plan. When the hygienist and entire dental team understands the science behind communication for case acceptance, the hygienist and other members of the team can increase the chances a patient will move forward with their treatment plan.

As the dental team feels more confident explaining the treatment needs to patients, the patients’ confidence in scheduling their treatment will also increase.

Your Tips

How do you utilize visuals to increase case acceptance in your practice? Do you agree or disagree with some of the tips outlined above? Why?

It is a new year. The goals are set and you are ready to run the marathon and win the grand prize. The prize is an increase in practice profits, happy patients and a stellar team. Nevertheless, wait! There seems to be a bump in the road. Someone is asking for some important information. One question that needs to be answered is: How many periodontal patient appointments did your dental practice see in 2010?

How easily can you access this information? I speak to many offices that have no idea of their numbers. They do not know the number of periodontal patients they see each month. Did you know that recently the American Academy of Periodontology reported that periodontal disease in Northern America was underestimated by about 50%? Well, if no one keeps track of his or her monthly statistics then how would you know where you stand? Are you one of these statistics and are you guilty of underestimating who has periodontal disease in your dental practice?

When was the last time you looked at the numbers? Let’s just talk about your dental hygiene numbers. Here is the first question and a place to begin: “How many periodontal patients did you see in 2010?” This is only a starting point for looking over the numbers in your dental practice. Dental Professionals have a legal and ethical responsibility to assess and diagnose periodontal disease. This means that annually every patient seen in the dental office needs a periodontal screening exam completed. This is a legal document recorded in the patients’ chart.

Early Intervention Means Prevention

It still happens in the majority of dental hygiene departments. The dental hygiene department used to be thought of as a loss leader. This is not true. The dental hygiene department can produce at least 40% of the total production if your systems are in place. Look at the patient charts (You can view the patient periodontal charts easily if you have electronic charts.) and see what patients have 4mm pocket depths. Of these patients with 4mm pockets, what was the diagnosis for periodontal disease? Did these patients also have recession and mobility? Does the patient have Rheumatoid Arthritis or Diabetes? Look at the American Academy of Periodontology and review the classifications for periodontal disease. Many times dental hygiene patients have 5mm pockets and early intervention (scaling, root planing, chemotherapeutics, laser treatment, etc.) has not been diagnosed to treat these areas of disease and prevent further destruction.

Many times patients with moderate to heavy calculus and 4mm pockets are requested to come back for a prophy in 6 months. When a patient has several areas where 4mm’s are measured, bleeding on probing, systemic health conditions or illness (even the flu) and/or moderate to heavy calculus, it is time to sit the patient upright in the chair and talk “oral health/systemic health”. This is the time to discuss the cause of periodontal disease, early intervention, prevention, home-care and re-evaluation – sooner than later. We no longer “wait and watch” when there is an oral disease condition. Today – in 2011, we discuss early intervention and prevention.

All Systems Are A Go

It is a valuable service to add the periodontal screening exam to each patient. This needs to be completed annually on every patient. This includes measurement of all areas, which include but may not be limited to pocket depth, bleeding on probing, (BOP) furcation involvement, mucogingival involvement, mobility, recession and suppuration. Also noted are various disease conditions and systemic diseases. These all play a role in the classification of periodontal disease and the extent of treatment necessary.

When you begin to implement just this one service in the hygiene department, you will not only improve the value of the hygiene appointment but the practice profits will increase. This is because you now begin to diagnose patients who have early signs of periodontal disease and recommend non-surgical treatment – sooner than later. Not only will you be treatment planning for scaling, root planing, chemotherapeutic use and laser therapy, but home care products and same services will also increase. Now you are talking about adding value to patient services and increasing the practice profits! You can add to your practice profits without adding more appointments to the current schedule. It is all about planning your day before the patient walks in the door of your dental office.
When all practice management systems are in place, your net-profits will be maximized!

Profit Centers Raise Production

When you diagnose periodontal disease, you also recommend home care products to create a healthy mouth. The products you recommend such as power toothbrushes, toothpastes and oral rinses, need to be available for patients to buy and begin using that same day when they leave your office. You need to have these products available for patients to buy in your office. When the patient is seated in your chair, you can show patients exactly how to use these products effectively. You are the expert, you know exactly what the patient needs and now you can show them how to use that new product, while they are in the office.

Many periodontal patients have areas of sensitive roots and/or areas of root (cervical) decay, which requires a fluoride varnish treatment approximately every 90 days. These same day services are provided at the time of the hygiene appointment. This is just one example of adding valuable and time saving services (“same day services”) to patients. It is another way to increase profits in the dental practice. By the way – patients who have root (cervical) decay need to be using fluoride or Xylitol products at home – daily. These are just a few more products you need to have in the office and available for patients to purchase and use at home immediately.

When you have a well organized dental practice the dental hygiene department can be a huge profit center within a dental practice. Inside the dental hygiene department are other areas of profitability. Some examples of these are: home care and esthetic products along with same-day services.

Implementing special systems in the dental hygiene department is when it will produce 40% of the total office production.

Time-Saving Tips

The past 2-3 years have been unstable economically and more often than not dental offices are cutting back dental hygiene appointment times. This is not something considered a strategic business plan to increase profits. There are various other strategies to increase profits in difficult economic times.

Always take time for team meetings. The morning huddle is a great time to organize your dream day. The hygiene team members come with what their needs are. This includes a list of what patients will need an exam, x-rays and even a periodontal screening exam. If you don’t have a hygiene assistant this is the time to organize who can be there in the hygiene room to document the periodontal exam, assist with x-rays and the doctors assistants will write down when to have doctor move to the hygiene room for an exam. Meetings are a time to streamline systems and organizational skills in the dental practice.
Each month office policies should be discussed. Examples of the types of policies are to write down what types of patients need a 20, 40, 50, or 60-minute hygiene appointment. In addition, you will want to sit down as a team and discuss what services you should add to your mix of services. There are many types of services, which can be added to same day services and in the hygiene room. This saves many patients an extra appointment to your office and increases daily production from the hygiene room.

Action Items

• How many prophy patients were seen?
• How many root planing patients were seen?
• How many periodontal maintenance appointments?
• How many chemotherapeutic sites were administered?
• How much production came from the hygiene room?
• Etc., etc.

List all new products you believe are valuable to patients and the practice:
• Write a number next to each product and list the highest priority at #1
• Examples of new products are ViziLite® Plus, WAND STA, Caries Risk Assessment, Saliva pH assessment, etc.
• Oral Hygiene Products: Oral Rinses, Cosmetic Toothpastes, Sodium Lauryl Sulfate (SLS) free Products, Xylitol, Power toothbrushes, Oral Irrigator, etc.

Final Thoughts

There is no need to feel overwhelmed. Be patient with yourself when you are learning and implementing something new. Write down your “to do list”. Schedule a time to discuss your options and action steps with the entire team. This is only one reason why you want to have a 2-hour team meeting on your schedule every month. It is how you plan that creates your dream day and success in your dental business. If you fail to plan your day and especially if you fail to plan for 2011, you have planned to fail. Creating a plan is the first step to success.

There are dental experts who are here to guide you to find increased dental practice production, increased net-profits, streamline the systems in your practice and add value to your current patient services. You do not have to run the marathon alone. Call upon a partner to help you win the marathon and experience the rewards you deserve.

New Patients

New patients are also a crucial part of every successful and profitable dental practice. What does it cost for you to schedule a new patient in your dental practice? What is a new patient worth to your dental practice? There is a normal attrition of new patients annually. This can mean that 10-15% or your patients move or decide to go somewhere else due to finances, loss of insurance plans or other unknown reasons. What are you currently doing to keep the patients continually entering through the front door of your dental office?

Patient Retention

It costs the office less money to add value at the time patients are in the office. This is the easiest and most cost effective way to market your dental practice. You will find you can easily increase referrals by word-of-mouth. Why do patients choose your office over another? Think of your heart, how it beats and the fact that your blood has a constant, steady flow. This is the same constant beat and flow of patients you want to have coming into the front door of your dental practice. The patient flow should never stop. Patients need your dental office just as they need their heart to beat and the blood to constantly flow through their body. You will find when patients value the services that you provide for them they are most likely to accept your recommendations. They are more likely to pay for treatment before and when services are rendered. When patients understand the value that your dental practice brings to them, they contribute to the success of your dental practice. When you communicate the importance of good oral health and its relationship to their overall health they will take action. These are your patients who will be the main source of referrals and they are most likely to be on time for their dental appointments.

The dental hygienist (Including the dental hygiene team – hygiene assistants, if you have them) is the one auxiliary on your team who sees patients at least twice a year. Sometimes, it is recommended that a patient return to see the hygienist three to four times a year. The continuing preventive care appointments are where patients have a chance to establish an intimate relationship with the entire dental office. This is how the hygienist (And the hygiene team) play a key role in building and maintaining the active patient base. This is where patients build life-long relationships.

Keeping the Pulse

The dental hygienist is the dental practice preventive specialist. Dental hygienists are the primary oral health educators in the office. It is very important that not only the dental hygienist but also the entire team consistently educate patients about the importance of good oral health, and how it contributes to the overall health of the body. This is communicated in everything to do with the office: everything written; brochures, the website, plaques on walls, and verbally communicated on a consistent basis.

The practices who communicate this important scientific knowledge are the offices that keep patients coming in their front door. In other words, they retain their active patient base and new patients constantly call to schedule appointments throughout the lifetime of the dental practice. These are the people who understand and feel how much you really care about them.

It is important that patients understand the oral health/systemic health relationship because this is where patients become highly motivated to be involved in and take ownership of their disease and overall health. How many patients have told you they don’t want to live a healthy and longer life?!

A new study recently reported by the Centers for Disease Control (CDC) and the American Academy of Periodontology (AAP) suggests the prevalence of periodontal disease in US (Northern American) adults has been underestimated by up to 50%. The underestimate was attributed to data from partial – rather than full-mouth periodontal exams used in recent National Health Nutrition Examination Surveys (NHANES).*

Scheduling Preventive Care

Ninety percent of all hygiene appointments need to be prescheduled. It is helpful for the hygienist (Or auxiliary who just treated the patient and understands the patients’ disease process, etc.) to be the one in charge of scheduling the patients next hygiene appointment. If the office has a hygiene assistant, this person will be scheduling and dismissing the hygiene patients. When the hygiene team is fully engaged in scheduling you will find that patient compliance improves and they are most likely to have a positive attitude towards preventive care appointments. There is symmetry in the communication process when scheduling and communication are a team effort. This is when the hygiene patient flow is most likely to constantly occur. It helps patients continue their schedule for preventive care and not lose track of their routine appointments.

Scheduling for the next hygiene appointment is most effective when scheduled in the hygiene room prior to the dismissal of the patient.

Accountability

Everyone on the team needs to be held accountable. At monthly team meetings, the person who is responsible for hygiene scheduling, will give a report of cancellations, openings in the hygiene schedule and how many patients have not scheduled their necessary hygiene appointments. These patients need to be followed up on with a phone call as soon as possible. The phone call is the first step to contacting a patient for a dental appointment. An email, letter or postcard is too passive to begin contact with a patient who needs an appointment or some form of follow-up.

With computers and electronic charts, audits can be a more effective process. Chart audits and patient follow up needs to be an ongoing system in the office – daily. Everyone on the team has an important role and someone from the hygiene team needs to be designated as the scheduling coordinator. This is the one team member who will not only report on these statistics (At monthly team meetings.) but will be responsible and accountable for a daily hygiene schedule that is booked solid. When discussing the scheduling effectiveness at the team meetings, everyone needs to be able to give suggestions about what can be changed if the schedule and patient retention is not successful or challenges occur. Everyone on the dental team can be a part of all problem-solving solutions when challenges occur.

Putting it all together

Each month on the same day and same week of each month, schedule a two-hour team meeting. This should always begin with the entire team together and can include breakout sessions for each of the various departments of the dental team. Examples of these breakout sessions can include Dental Assistant training to provide improved and effective digital x-rays. Front Office: Phone communication skills and the Dental Hygiene team can learn new local anesthesia techniques for example the “Gow-Gates” injection or use of the CCLAD local anesthesia device.

Always allow an open pathway to communication for the entire team. This is just one way, which creates mutual respect and admiration. A positive and open pathway to communication will be reflected by an increase in productivity and net-profits. A happy team will lead to healthy patients and long-term success of the dental business.

Final Thoughts

Create a new and clear path moving in a direction to future successes. There are numerous high-performance systems and strategies to implement and only a few of these are listed above. These are only a few strategies that will generate positive results to improve quality of life and patient care, create higher productivity, increase net-profits and reduce stress. Every successful leader has a mentor who can lead them down a clear path and hold them accountable for their goals. This is how your vision becomes success in your life professionally as well as personally.

* Reference: Eke Pl, Thornton-Evans Go, Wei L, et al. Accuracy of the NHANES periodontal examination protocols. J Dent Res 2010 Nov; 89(11): 1208-1213.

Your Thoughts

Are you effectively utilizing your Hygiene Department? What challenges have you faced while trying to drive your practice’s profitability with your Hygiene Department?

One area of the dental practice that can drive referrals and is the second highest profit center of your dental practice is the hygiene department. The hygiene department should produce over 30% of the total office production. All systems must be in place for this productivity and profitability to occur.

The hygiene team has a key role in supporting the practice by adding value to the patient appointment. This occurs through communication and education of the dental hygiene patient. The hygiene team; hygienists and hygiene assistants, are the people who will make recommendations to the doctor, educate patients about home care and the advancements in dentistry. These are the team members who educate patients about procedures and products available to improve their overall general health.

Hygiene Team Rapport

Patients see the hygienist and interact with the hygiene team on a regular- routine basis. This is a perfect opportunity for patients to spend quality time during their dental hygiene appointment and we can easily add value to their services. During the hygiene appointment, when the hygiene team effectively communicates the value of the hygiene appointment, a positive rapport will be developed between members of the dental hygiene team and the patients. The end-result is that patients will want to continue a long-term relationship with the dental practice. When the hygiene team is providing optimal care, there will be improved case-acceptance, increased productivity and profitability for the dental practice.

Providing Optimal Care

1. Value-ad dental hygiene appointments
2. Customized patient schedule
3. Communicate oral health and systemic relationship (Educate)
4. Provide home-care products
5. Implement same day services (Whitening impressions, fluoride varnish, night guard impressions, etc.)

Words can paint a thousand pictures. Too many dental offices still use words such as “cleaning” and “recall” when communicating with patients about the dental hygiene appointment. What words do you currently use when speaking to patients about their dental hygiene appointment? The words you use to describe or speak about dental treatment will either add value or devalue their appointment and treatment. Prophylaxis isn’t the only service that dental hygienists provide in today’s’ world of dentistry. The hygiene appointment is more than a “cleaning”. The hygiene appointment includes many types of services which may include a blood pressure screening, smile analysis, periodontal screening exam, oral cancer screening, salivary pH, biofilm assessment, xerostomia, caries risk assessment (CAMBRA), scaling and root planing, nitrous oxide sedation, limited restorative dentistry, polishing, antimicrobial treatments, impressions, radiographs, etc. The dental hygiene appointment should always include patient education and post operative instructions when necessary.

Change Your Vocabulary

At your next team meeting, agree to change the vocabulary you will use with patients. Write down a list of the words that you plan to use when communicating with your patients. Add a list of these words for your team-training manual. This helps everyone can refer to this information as necessary and new employees are trained with current vocabulary words your dental practice uses. Notice how your patients will now begin speaking the same language.

Years ago, the dental hygiene appointment was an “all-for-one-and-one-for-all” type of appointment. Today’s successful dental hygiene appointment provides customized, specific appointment times for the specific treatment needs of each patient. When the dental practice utilizes a customized schedule for patient, treatment, the practice profits will increase and the patients receive optimal care.

Customize Your Appointment Schedule

Customize your appointment schedule by using 10-minute units. The practice can now comfortably accommodate: 10-minute post-op care, periodic oral hygiene assessments with fluoride treatments, delivery of whitening trays, 20- minute appointments for impressions or CAMBRA protocols, 30-minute preventive care appointments (adults, with missing teeth and little to no stain, children under 10 yrs of age with no calculus, etc.); 40-minute appointments (patients with excellent oral health, little calculus, no stain and no x-rays or exam); 50-minute appointments (preventive care patients with more calculus or a lot of stain. Patients that need x-rays and exams); and 60-minute appointments (scaling and root planning and more difficult periodontal maintenance appointments which also include x-rays and exam. (Those patients who need antimicrobial therapy.) The same type of schedule is customized for the dentist with regard to restorative, cosmetic, implant, oral surgery and endodontic procedures. It only a suggested prototype to set up for your dental hygiene department. Each professional will most likely need to be consulted to make certain they feel comfortable with these appointment time limitations.

Adding value to the dental hygiene appointment will not only inspire patients to continue returning for dental appointments in your dental practice but will allow you to provide optimal care. This systematic process is critical for the dental practice’ future productivity and profitability. It also means you keep the patients coming through the front door of your dental practice. This is how dental practice growth occurs. Using the appropriate vocabulary with patients as well as putting these words into scripts will build value for each appointment throughout the entire patient experience. Case acceptance improves with this one system in place.

Educate Your Patients

We know for many decades now, that periodontal disease is at epidemic levels. According to the National Institute of Dental and Craniofacial Research, approximately 80% of the population has gingival or periodontal disease.1 Most patients are unaware of periodontal disease due to it’s’ often painless nature. This is one of various diseases that will be detected and patients still decline your diagnosis. Why does this happen? The answer is because patients don’t feel pain. They may experience bleeding gums but this has been occurring for numerous years and they now consider this “normal“ for their mouth.

The solution to this challenge is to educate patients about the science, which corresponds to good oral health improving their overall health. Explain and give patients the scientific literature (explain the research) so they understand the importance of good oral health. The hygiene team is responsible for educating patients about their oral health and its relationship to overall health. When patients understand that untreated periodontal disease can have a negative affect on their overall health, they will now be interested in the information and more likely to schedule their necessary treatment. Periodontal assessment, combined with education, will provide patients the necessary information to improve their overall health. CAMBRA (Caries Management by Risk Assessment) is the same type of strategy. We know how to prevent decay. Current CAMBRA research identifies how to assess for a patients risk for decay. The focus is now on preventing decay not about treating the disease.

Provide Home Care Products

Continued and improved oral health starts with the patient at home. There are various products patients can use to improve their oral health. Some of these include oral irrigators, power toothbrushes, Xylitol mints and gum, fluoride gels, non-alcohol-natural oral rinses and toothpastes, etc., etc. Providing these home care products will provide patients added value by your dental practice because you will educate them how to use the product while they are in the office. When you dispense the appropriate products in the dental office, you provide patients with a resource for information and a specific place to go for immediate use of the product replacement of these when necessary. We want our patients to come to us and understand that we are the dental experts. Patients should not be going to the local drug store and ask a sales person what toothpaste, mouth rinse or oral irrigator, etc., is best to buy. We are their health care provider and we are the expert who understands what is best for their specific oral health condition. When our patients leave the dental office with their home care products, they are most likely to immediately begin follow through with their home care regimen.

When you have home care products easily available for your patients, you will notice patients not only appreciate your knowledge about how to improve their oral health, but they are happy that you made it convenient for them to purchase. When patients leave the office with the appropriate home care products, they will be more likely to use the recommended product. This is just one of the ways we can assist patients to improve their overall health.

Provide Same-Day Services

Once you have a customized patient appointment schedule, you can strategize (also discuss in the daily team huddle) to offer same-day services. One example of this is found through patients completeing the smile analysis. Because you have a questionnaire to discover what areas of the oral cavity are important to your patient, you can make some easy recommendations, which may take only a few extra minutes to

create a positive appearance and/or experience for your patient. If you understand that your patient wants whiter teeth at the beginning of the appointment, after doctor examines the patient, someone from the office (either a dental assistant or a hygiene assistant) can take the impressions and schedule the patient to return to pick up whitening trays, the gel and the homecare instructions. This saves time for the patient returning foranother appointment to take impressions and another appointment for delivery of the whitening appliance and solution.

Same day services are also helpful for patients who are categorized as moderate to extremely high risk for caries. These patients will quite possibly receive a salivary pH or biofilm assessment, review of home care and a fluoride varnish treatment. These services can very easily be administered the same day the patient is in the chair for their hygiene appointment. These are just two examples of same-day services.

These services save time for patients returning for an additional appointment and add to the daily production of the dental hygiene department. These same-day services can very simply add another $50,000.00 + US dollars to the dental practice annually.

Final Thoughts

The hygiene team is a vital part of all successful dental practices. The dental hygiene department is one of the critical components for every successful dental practice. When you implement these suggestions, the hygiene team will develop strong relationships with patients. The patients will believe in and value your team and the dental practice. When you communicate the awareness of prevention, add products to improve health and offer time saving, same-day services, you will improve the level of patient care. Once the patients understand this, you will reap the benefits by receiving new-patient referrals, increase productivity and profitability.

Your thoughts

How is your Hygiene Department adding value for your practice?

Reference: 1. http://www.adha.org/media/facts/total_health.htm Accessed on Jan. 15, 2011.

Preventive Care Appointments = Lifeline

One system in the dental office, which is often overlooked, is the dental hygiene departments’ recare system. It works best when the office doesn’t need to call patients to come in for a missed or delayed dental hygiene appointment. The dental hygiene preventive care appointments are the lifeline of your dental practice. At least 80% of the diagnosed dentistry in your practice should be coming from the dental hygiene preventive care appointments. When patients leave the dental hygiene appointment without a future appointment scheduled this will dramatically decrease your practice profitability by at least 50%.

Pre-Block/Tier Your Schedule

The most effective way to keep the hygiene schedule full is to number one, pre-block your schedule. Once you have set up a pre-blocked and tiered schedule you need to understand the meaning of all patients leaving their dental appointment with an appointment for their next dental visit; always scheduling their hygiene appointment in advance.

This strategy is designed to keep the hygiene schedule full and productive. When the hygiene schedule is not full, a domino affect will occur. Not only is it possible to have patients fall through the cracks with timely hygiene preventive care appointments but the dentist will see openings in the treatment schedule in the future. Many years ago, it was the standard of care to have a patient complete a postcard and then call in for their next hygiene appointment. Long time ago it was discovered this did not set up a good system of productivity for the dental practice as a whole.

Most offices that adhere to a strategy of having patients call to reschedule appointments will have many openings on the hygiene schedule. People are very busy in the 21st century: numerous email addresses to check, various voicemails, family activities, exercise class, church, work and professional agendas to attend to, etc. If it isn’t on their calendar months in advance they tend to put it off – near the bottom of that “to do” list. With technology today, we are able to lock in our appointments and then even have a pop-up reminder occur months, days and even minutes before an appointment is to occur.

When patients do fall through the cracks, the best method to have them return is to call them on the phone. When the correct recare system is in place, the hygiene schedule will be full. This keeps the practice “in touch” with its patients and increases patient retention dramatically. Sending a postcard to patients is too passive and impersonal. The best plan for the success of scheduling appointments is to have communication skills in place and effectively use them while the patient is in the dental office. This will avoid numerous patients falling through the cracks each year.

Dealing With Procrastinators

There will be a few patients who will not commit to scheduling a future dental hygiene appointment. You will find it very productive for all (patient and the practice) to have patients in the habit of always leaving their dental hygiene appointment with a future appointment scheduled to return to the hygienist for their preventive care. There are just some patients that will not do this. Until that patient has a feeling of urgency to schedule or else – they may not change this behavior. Once the patient understands the importance of preventing disease and when they understand that calling in a week before they are due for their preventive care appointment means they will have to wait for an appointment until they are a month or so overdue, there may never be a change in behavior.

There are some patients who may live in another country or state and they don’t know when they will be back in the area. It is very valuable to recommend that these patients have another dental hygienist see them in that other state or country while they are not available to return to your office.

The Power of Communication & Visualization

Words can create a thousand pictures.

Which question would you choose to ask your patients?

“Mr. Jones, would you like to schedule your next cleaning with me?”
“Mr. Jones, when you would like to schedule your next cleaning appointment?”
“Mr. Jones, I can see you on Wednesday July 6th or Thursday July 7th for your next continuing care appointment. Which day will work best for you?

1. Mr. Jones, would you like to schedule your next cleaning with me?

The first sentence is a closed-ended question and allows the patient to say “No” very easily. Saying “No” can cause many negative situations. Worst of all is that the patient may forget to call back in 3 or 6 months of their next hygiene appointment. When they come back to their next appointment, they have dental disease of some type, when all along we intended to prevent disease. All the hard work of the patient and hygienist was for nothing more than treating disease. (Again and again!) This is like putting a band-aid on an infected area in your body.

2. Mr. Jones, when you would like to schedule your next cleaning appointment?

The second question again, allows the patient to say “No” to an appointment. It also allows the patient to be in charge of the appointment book. You are the professional and you are the one in charge of the schedule so give patients a couple options of dates and times available for their next appointment.

3. Mr. Jones, I can see you on Wednesday July 6th or Thursday July 7th for your next continuing care appointment. Which day will work best for you?

The third question gives the tone that the patient will be coming back and they already understand the importance of why and when they will be returning for continuing care, preventive care or a periodontal maintenance appointment. In the third scenario, there are no questions to be asked. The patient already has “bought” into their treatment plan and they understand the importance of regular preventive care. It also saves time trying to figure out what time works best for the patient and your schedule.

Words to Avoid

When implementing a system for scheduling the hygiene appointment avoid using words such as “cleaning” and “recall”. The perception among patients is that a “recall” appointment is not significant. After all, you are not “recalling” the patient? Have you heard of a recall on a car with a problem? This is nothing similar to what you are doing in your dental office. You are informing patients they need to return for preventive care. Asking a patient to return for a “cleaning” is similar to having a person come clean your house. Hygienists are now thought of as a preventive care professional or non-surgical periodontal therapist. The dentist is not “recalling” the patient back into the practice to check whether they need a cleaning or tune-up, etc. We need to add value to the dental hygiene appointment by using words such as preventive care appointment, continuing care, periodontal maintenance, etc. Take out the word cleaning.

Once the patient responds to your appropriate question about their appointment and they respond with a day that works, now try to ask them to come back at a time similar to the one they are currently scheduled for on this day. Many people work best if they have specific and consistent times for special types of appointments. For example: dental, psychologist, chiropractic appointments, etc. You will begin to find that some patients want afternoon dental appointments and some prefer first thing in the morning appointments. It is a great way to help people remember their appointments when there is continuity and consistency. For younger patients always try to schedule them before the noon hour.

The significance of excellent verbal skills will help to implement a successful continuing care (“Preventive Care”) system.

When you have a strategic schedule arrange you will include pre-scheduling dental hygiene patients, blocking time for specific types of treatment and have a tiered schedule. This is the most effective system for keeping your schedule(s) full and productive.

When dental practices commit to a system of pre-scheduling the preventive care patients, the dental practice will experience the positive benefits of superior care, productivity and effective use of time, which increases the net profit.

Consider Scheduling in Hygiene Room

While a pre-scheduling patients is superior, various problems can detract from a successfully booked schedule(s).One solution is to have the dental hygienist schedule or hygiene assistant schedule, all future hygiene appointments in the hygiene room. The hygienist and/or hygiene assistant understands what and why regarding the purpose(s) of the specific interval for the next patient visit. The hygienist knows how much time needs to be allotted and what procedure(s) need to be scheduled. Without good organization and excellent verbal skills, patients will not respond well to many of the systems in your dental practice. Most of the time when a patient declines to schedule a future dental appointment; it is usually because a closed-ended question was asked when asking to make the next appointment.

Keep Communicating Throughout Dismissal

When the hygiene assistant or hygienist hands off the patient at the front office there needs to be more dialogue between the front and back office team members. When communicating, always create a perception of value and importance in the mind of the patient by saying something similar to this: “Mrs. Smith., I look forward to seeing you in July and I want to hear more about your daughters’ wedding. See you at your preventive care appointment July 6th and I will recheck that one area I was concerned about on the lower left side.” Every patient should be dismissed with a verbal reminder that there is another appointment, even if it is six months away.

Run Preventive Care Reports

Each month a member of the dental team has the daunting task of running the dental hygiene report and calling patients who don’t have an appointment but need to have an appointment. These can be patients who are over-due or who are due at this time, when the report is run.

Before any calls can be made, research has to be completed. This team member needs to research when the last hygiene appointment occurred, what are areas of concern regarding the patients periodontal health, are there other areas of concern, is there outstanding treatment, what does the insurance allow, (Not intended to dictate treatment but answer any questions about finances.) what X-rays are needed, what is the length of the appointment needed, and is there an outstanding balance? All phone numbers must be called and messages left at each number. The results of these phone calls need to be documented in the patients chart. (Paper and/or eChart.)

This is where it becomes a daunting task at best because it turns into a numbers game. Maybe one in twenty patients will answer the phone and then actually schedule an appointment. Statistics prove that it is easier to reach patients by phone between the hours of 5 p.m. and 8 pm. Now, you understand the systematic approach of pre-appointing preventive care patients, which becomes much more efficient and productive. Some offices have late evening schedules. Some offices even have Saturday appointments. This is another great time to make these calls. In addition, these are perfect times to begin calling patients who need an appointment.

Final Thoughts

One of the important systems for every successful and profitable dental hygiene department needs to include a systematic and strategic method of scheduling regular continuing care, preventive care or periodontal maintenance appointments. These appointments must be communicated in a manner that allows patients to understand the importance of preventing disease. When patients understand that without good oral health they will not have good overall health, they will listen and take action.

Continuing care, preventive care or periodontal maintenance scheduling is one of the most important systems that you will organize for the success of your dental practice. Scheduling future dental hygiene appointments is a routine system that you must follow daily. This is key to any successful dental practice. This is just as important as running your end of the year report, running daily reports, making bank deposits, etc.

This is just one of many systems, which will make your dental hygiene department rock solid.

Making resolutions for the New Year is common practice. Let’s begin the mantra now. Repeat after me:
“I will be better organized.”
“I will figure out how to be more productive.”
“I will get a handle on my debt.”
“I will get the most from my technology.”
“I will get training for my team.”
Is it common for you to follow through with these resolutions?
Do you have a plan in place to follow through and be more successful in 2011?

Many Businesses Plan to Fail

Why do businesses fail to plan? And do they plan to fail by not sitting down annually to analyze and plan their future potential? The real reason for failure is that usually there isn’t a strategic plan. What are the benefits of having a well thought out plan? “Stuff’ will happen in our dental business, whether we have a well-thought-out annual plan or fly by the seat of our pants. Acknowledged, well-led organizations tend to experience fewer crises, but situations will arise that demand an immediate, clear response and a series of activities to prevent the issue from getting out of hand. Here is an example where delayed acknowledgement and resolution of the issue led to less negative press, less loss of consumer faith and fewer lawsuits. It could have been worse if a plan were not in place.

Learn from Sully

On January 15, 2009, US Airways Flight 1549 took off from New York’s LaGuardia airport for Charlotte, North Carolina. Shortly after takeoff, the plane went through a flock of geese at 3,000 feet and both engines were knocked out. Captain Chesley “Sully” Sullenberger later said that he felt an “adrenaline rush” right to his core. As his heart rate increased, he forced himself to ignore the physical symptoms and face the situation.

Most of us know what happened next. Captain Sullenberger and the crew were able to guide the crippled Airbus A320 to an emergency landing on the Hudson River. Despite the fact that “no modern airliner has ever ditched in water without fatalities”, all 155 passengers survived. Sullenberger certainly hadn’t landed on water before, yet his training and planning ahead (Emergency plans in place) allowed him to make rational decisions and take appropriate actions in an extreme situation.

Though many of us have been or eventually will be involved in a crisis, surprisingly few organizations will be ready with a plan to manage any crisis let alone what the world may hold for our future; economically, professionally and personally.

How will you put an annual plan in place so that you can take charge of your practice in 2011? How do you make this a stellar plan with superior impact and get the highest profit on your bottom line? The answer: When you work with an expert practice management coach to P L A N. This is what will allow you to enjoy the benefits of a well thought out plan-even when life just happens. This is the answer to reap the benefits of success all throughout the year!

What should do today?

1. Schedule an appointment with a dental expert who is knowledgeable and can make your strategic plan a reality in 2011. Allow the expert to guide your success.

2. Schedule a date to meet with this expert in 2010 before 2011 arrives.

3. Schedule a date to meet with your team: discuss and plan now for 2011. This needs to be on the calendar before December 31, 2010. This is your “Team Annual Planning Session”.

4. Get together your P & L (Profit and Loss Statement) for the past 12 months.

5. Determine with your dental practice expert (Coach) if your overhead stacks up against the true dental industry standards.

6. Project expenses and goals with the guidance of your practice expert. This is based on the 3 logical indications: history, expenses and potential.

7. After working with your dental business expert discuss with your team at the annual planning session, how many working days will be needed to meet your budget needs. What services will you provide? (“Same Day Services”, New and Standard of Care Services). What products can you offer to add value and benefit your patients’ oral and total health?

8. With the guidance of your dental practice expert determine your practice potential and identify your obstacles.

9. Understand how to move beyond the obstacles.

10. Develop an Action Plan. This is the step that pulls your plan together and makes your resolutions stick

Download a Sample Action Plan

To download a copy of an action plan.

Few dental practices plan their future success in an effective and proactive manner. Whether through chance or poor execution, many of these dental practices who do have plans will not have a well thought-out strategic plan. Due to poor planning and/or or poor execution, many of these annual plans derail, and the crises that arise lead to lost patient appointment time, loss of practice profitability, wasted money, contentious patient issues, and can cause potential, legal quagmires.

Having an expert dental consultant guide your annual planning is only the tip of the iceberg to creating a profitable year in 2011! Don’t delay. Planning needs to be put on your calendar today! A ten-step plan will find untapped potential and successfully manage your profitability.

New Year’s Resolutions don’t occur in a minute. It’s not as if you will suddenly lose 20 pounds or instantly have more money in your 401k. Rather, it will take a series of successive moments as you work towards the change that you seek. This is the reason you need to begin planning today. Mark your calendar, get set…Go!

Your Thoughts

Does your practice have a strategic plan for next year? Do you have some tips for creating a strategic plan?

You are driving on a nice vacation and need gas. You stop at a gas station and go inside to buy some snacks while you gas is being pumped. How much do you spend while in the convenience store? The national average is $5.00US (US = American Dollar).

This month Nordstrom (A major and very popular US department store) is having their Anniversary Sale. I know all the stores were mobbed. How much do you think the average shopper spent this year at the sale? The sale just ended so I am not certain about the exact number but I just read that sales this year for Nordstrom Department Stores are up 35%!

Monitor Average Patient Revenue

Have you ever taken time to monitor what the average patient spends at a dental appointment in your office? If not, then please take time to run this report in your office. Studies say that patients will spend $300-$500.00US at each dental visit the same day they are offered the treatment or product! This means that if we communicate with powerful words, patients will complete and pay for treatment and products we recommend – the same day.

What type of services do you have available for patients to buy right now?

Do you have a complete menu of services? – – And – – Do your patients know exactly what these services are? Do you have categories of various services available? Where can patients read about the services you provide? Are they written down somewhere in the office and on your website? Plan to offer these services on your social media sites. There are so many ways you can get the word out about the services your dental practice offers.

Meet With Your Team

Take time this summer to meet with your team and discuss what services you offer in these three categories: Preventive Treatments, Restorative Treatments and Cosmetic or “Elective” Treatments. Discuss, as a team, how patients currently find out about what you offer and share as a team, ways that patients may be able to read and learn about your services more easily. How can you create in patients, the desire to buy what they want not just want you tell them they need?

Here are some suggestions to discuss at the team meeting:

• How can you make your “same day” – – cosmetic (elective) services seem and feel more appealing?
• How can you create urgency for patients to begin getting impressions taken “same day” for teeth whitening, fluoride treatments, etc., instead of making an appointment?
• Do you have desensitizing agents available for patients?
• Do you recommend fluoride varnish?
• Do you recommend Xylitol products?
• Do you recommend Power toothbrushes, toothpaste(s), mouth rinses, etc.?
• Do you utilize the intraoral camera while patients are in the chair?
• Is there something more you can add to educate patients while they are in the office?(In the reception area, consult room and operatories)
• How do you educate patients about your services when they are on your website?
• What type of photographs do you use on the website to show off your valuable services?
• Do you show off before and after photos for patients to view while they are in the office? (In the reception area, the back office and consult room?)

There are so many “same day” preventive services that you can offer patients. Even “same day” cosmetic services and products can be recommended and provided to patients that day, while they are already there for an appointment. People will buy on the spot (“Impulse buying”) when you communicate with powerful words that add value to the recommended and/or diagnosed service(s) and products. People are thinking: What’s in it for me. “WIIFM”

When you meet as a team to discuss various services you provide patients, make time to discuss ways to educate and communicate these valuable services to your patients. You can now add over $100,000.00US in production to the dental practice in 2011, when you add “same day” services. Additionally, have patients leave the office with their recommended dental products and the knowledge about how to use these properly.

One easy way to guide your patients to live a longer, healthier life and build practice revenue is to ask questions during the 1st five minutes a patient is seated in the chair.

A few of these questions are:

• Do you ever notice your mouth feels dry?
• Do you feel the need to frequently sip water?
• Do you have sensitive teeth?
• Do you like the appearance of your teeth?
• Do you like the color of your teeth?

Pay Attention to Cambra

CAMBRA (Caries Management by Risk Assessment) recommends that patients be categorized into risk levels for managing decay. When patients are at moderate to extremely high risk for caries it is recommended they have a fluoride varnish treatment every 90-120 days. Patients may say: “Insurance doesn’t pay for it.” “I don’t want it if my insurance doesn’t pay for it.” Many insurance companies will pay for fluoride varnish under the CDT code D1206. (This code is used in the United States for billing purposes.) There are insurance companies paying for this service every three months. If patients don’t have insurance or if their insurance will not cover this benefit then we have a responsibility to communicate the risks, benefits and the value of this preventive treatment to the patient. (The WIIFM part) Many patients come into a dental office and spend over $1,000.00US on restorative and even cosmetic (“Elective”) treatment. Many of these patients qualify (Meaning this is a necessary preventive treatment.) under CAMBRA for a fluoride varnish every 90-120 days and they will benefit by spending just as little as $100.00US annually to prevent decay. This service is a huge savings when a patient spends maybe $100.00US annually for prevention vs. $250.00US for possibly one mandatory restoration, a few times each year.

Offer Over-The-Counter Products

What about over the counter products for preventive care? This is another area, which will benefit the patient and the practice. Research tells us that 70% of patients who leave the dental office to fill a prescription for 5% Sodium Fluoride or Peridex, etc., return to the dental office and say they did not get the prescription filled. When we have these products available to our patients, not only are we able to have them take the products home and utilize immediately, but we can have a team member in the office teach the patient how to use the new product so self-efficacy is at the highest level possible. (Yes, even someone at the front desk can be available and educated to show the patient how to use the new power toothbrush, whitening product, or fluoride, etc.)

Offer Xylitol Products

For those patients who are in the dark and refuse to see the light (The truth!) and say, “Fluoride is a poison!” they may benefit by using Xylitol products. Xylitol products need to be available for patients to purchase in your office and utilize daily. Many dental companies sell 100% high quality Xylitol. (Read labels and find out how much Xylitol is really in the product.) The patients who are at risk for caries need 5g of Xylitol daily and the dental companies that sell Xylitol have tablets, gum, mints, etc., in a form, which allows patients to monitor their daily intake and effectively prevent decay.

Did you know that over 1,000 medications cause dry mouth? Xerostomia (Dry mouth) sets up patients for cervical decay. Fluoride treatments in the office and at home can prevent patients from spending money on mandatory restorative treatment. This also adds value to the patient appointment and revenue to the practice.

Add Fluoride Varnish to the Mix

Many years ago, patients spent 4 minutes with a bulky tray in their mouth to receive a fluoride treatment. Patients were only offered a few flavors to choose from and it was an unpleasant experience. Now, we have fluoride varnish that can be applied in less than 90 seconds. You can offer patients various flavors and no tray is used. No one needs to worry about the patient swallowing fluoride varnish. No time is spent suctioning the mouth or drying teeth. This can be applied in a wet environment with the swipe of a tiny brush over the teeth. Fluoride varnish will creep into the interproximal surfaces so there is no need to attempt applying into the interproximal surfaces.

Fluoride varnish usually costs less than $2.00US per application and the patient cost is anywhere from $25.00 – $50.00.00US per treatment; 3-4 times a year. The cost benefit ratio to the patient and the practice is huge! Think about how happy 100 patients will be, this year, if you offer just this one service. Patients may now save $1,000.00US next year on restorative treatment if they prevent decay. Choose just 4 patients in your practice each day, beginning this week, who you know can benefit from a fluoride varnish treatment. If you charge $25.00US, (A very conservative fee for this treatment.) for each treatment this increases your revenue $100.00/dayUS. This is just the tip of the iceberg when adding profits to your practice and improving patients’ health.

Start Tomorrow

During your morning team meeting (“huddle”) tomorrow I challenge you to pick 4 patients who you believe can benefit from a fluoride varnish treatment. Discuss ahead of time, what the cost will be to the patient. What will you say to the patient so they can understand why this is necessary? In addition – – What will you say to communicate the benefit to them financially? How will this affect the health of their mouth and their overall health? This is the WIIFM. Think about this with regard to each patient you offer this one service to, beginning this week.

2 Tips to take away today:

1. Create a list of questions to ask patients and discover their desires, wants and needs, etc., regarding dentistry.

2. Offer “same day” treatments and products for patients to take home with them.

You’re The Expert

We are the healthcare professionals – “The Experts”. When we share, the scientific evidence and understand how to communicate effectively, patients will sit up, listen and take action. These are just a few suggestions so you to tap into same day Preventive and Cosmetic, (“Elective”) treatment, add value to the patient appointment and profits to the practice.

If you have not read the information about CAMBRA and the benefits to patients and your practice, visit dentalpracticesolutions.com and click on the Membership Center link. It is free to all of you. Once in the Membership Center click to Register. We have a lot of information about CAMBRA right there for you!

Your Thoughts

Which same-day services are you offering your patients? Which have proven to be successful in your practice?

Where does your practice production stand this time of the year? How are you utilizing the team to assess and connect with the practices’ patients? Many dental practices are still feeling the economic crunch but there is still time to capture six figures of production. Just making simple changes can create more than $100,000K in additional production this year. (Less than six months left in 2010 today!)

The Secret to Capturing This

If you could increase hygiene production by $500 each day or just $62.50/hour you will have an additional $62,000K in added profits for 2010. At the time I am writing this there are approximately 100 working days left this year. This is treatment sitting in patient charts (or your computer) which has been undiagnosed and/or unscheduled production. Each time I go into an office I find that there are at least 200 patients who have untreated periodontal disease. Why did this happen? There are many reasons this happens and the best thing we can do for these patients to create a longer and very healthy life is to get them into preventive treatment. It is our responsibility to share our knowledge: the science behind periodontal disease – the oral/systemic link and how this can change the way they live life!

Now imagine that if this hygienist can co-diagnose at least $2,000/week in restorative, cosmetic dentistry and even appliances, (Occlusal guards, snore guards and/or whitening) this can boost your production potential even higher. There are approximately 26 weeks left in 2010 at this point in the year so this means another by $52,000. Together, these two services provide for over $100,000 in scheduled production on the books during the next 6 months. I will honestly and very simply tell you how to get to this profitability on your appointment schedule and in 2010. There are few steps to get this done!

Step 1 – Prevent Periodontal Disease

This is my mantra and it should be yours as a dental professional. We have a lot of scientific information available to us so we can appropriately educate our patients about the importance of good oral health. Science tells us that if we treat the disease process sooner than later we can prevent future disease (Heart disease, Diabetes, Alzheimer’s, Arteriosclerosis, etc., etc.) If we share this information with our patients most people will sit up, listen and take action. How many patients have you met and they said “No” to living a longer and healthier life? Not many!

The fact is that if one hygienist (Working 4 days a week) enrolls just 100 of your current patients into active, non-surgical periodontal therapy and then periodontal maintenance every 3-4 months; hygiene production will increase by at least $150,000.00 in the next twelve months of these scheduled treatment plans. As a dental professional you probably understand that 80% of our adult population has some form of periodontal disease. The sooner we treat the disease the more likely it is we can halt the disease process. When patients understand this they will make this an important matter in their life. They will say “Yes” to scheduling and completing treatment.

Step 2 – Remember Restorative Dentistry Needs to come from the Hygiene Department

Please remember that the entire team needs to be educated on the doctors’ philosophy. Everyone on the team needs to understand what they are expected to do and what procedures are available to the patients in your practice. Write these things down in your office manual for all future employees. Enrolling $2,000/wk out of each hygiene operatory is a very conservative number. One secret is these patients need to schedule their treatment for these production dollars to actually show up. I recommend that you take time to always schedule the next appointment before the patient walks out the door. I recommend all hygiene appointments be scheduled in the hygiene operatory not at the front desk.

Step 3 – Financial Arrangements and Follow-up

Always have patients leave your office with a written and signed financial arrangement. If patients decline treatment they also need to sign a disclosure that they understand the risks, benefits, alternative treatment and disadvantages of not completing the treatment. This is a legal liability and if you don’t explain this it can come back to bite you in legal bills, etc., if patients lose teeth or have other problems. If you don’t have a financial arrangement form, make sure you create one this week. Most dental software programs can make this a very simple thing to do.

When patients trust you and understand it is about their total health they feel an importance to have treatment completed immediately. Patients that say “No” to treatment are many times uneducated about the oral and systemic link. Make financial arrangements clear and easy for them. Help patients understand what portion of the fee they are responsible for and when it’s due. Always follow up. If a patient declines treatment always follow up with a conversation each recare appointment. The economy is difficult for many people, and at this time in our world in can be very hard for a patient to even pay $100.00/month. It sometimes takes time to change patients’ thought pattern about oral health and disease. If a patient isn’t ready to schedule that day, then put them on your follow-up list and ask for their permission to call in 2- 3 weeks.

We are more than half way through another year. These past 3 years have been tough financially but if you know how to communicate with your patients you can see the benefits of a win-win! Your patients can save money by completing preventive care now rather than later. Your patients will be happy to know they can stop future health problems and not spend more money on their teeth. Most patients would prefer to not spend their money on endodontic treatment, implants, tooth extractions, dentures, etc. Always discuss alternative treatment if the current treatment is not accepted. Most people want to live a long and health life. Having a beautiful smile makes most people feel good about themselves. When patients understand the facts they are happy about your team and know you really care. Your dental practice and the benefits you provide for them will really pay off. When patients return for the appropriate treatment you win by increased profits.

How can you expand your practice growth next year? Sometimes offices can’t get to the next step alone. Most successful leaders also have a guide or mentor. We are here to be your guide and offer special tools to make your future profitability a reality. Many times an experienced dental consultant can get you there very – very- – quickly! Pick up the phone and ask us what we can do to make this a seamless process for you and your team. Just call and ask us how today.

Much Success to all!

Your Thoughts

Are you already employing some of these tactics in your practice? What kind of results are you seeing?

Prioritize Your Schedule

A full schedule translates into revenues and production only if the patients come in. If a practice loses 1 to 2 appointments/day, either on the hygienist’s schedule or on the dentist’s schedule, the lost production from this could be anywhere from $100 (minimally) to $900 per day, depending upon the procedure. These are dollar figures for clients and dental offices during the year 2009. Let’s assume you have 200 working days during the year, the annual lost production works out to $20,000 at the low end to $180,000 at the high end. Take into account that you lose even $20,000.00 over the next 5 years. This is $100,000.00 which can be used in many areas for a successful and profitable dental practice. Think about your salary being reduced by this much. This can really hurt a dental practice!

These figures are for a solo practitioner, with one full-time hygienist. The figures multiply for a multi-doctor office, or for a solo practitioner with more than one hygienist. Improving practice performance in this one area alone could significantly improve the financial status of many dental practices.

Practice success depends on the strength of a strategically planned schedule. It is important to have a systematic method for scheduling patients. On a daily basis, the entire dental team probably spends much of their day discussing and dealing with the topic of appointments: cancellations, broken appointments, and no-shows. This is a big source of endless frustration. No-shows and cancellations are the biggest single source of lost revenue.

It is helpful to be proactive, have a strategic approach and design a systematic schedule. Having a system in place will decrease the level of stress and increase revenue in your dental practice.

Stephen Covey, author of many professional management and family management planning books has said, “The key is not to prioritize what’s on your schedule but to schedule your priorities.”

Your first thought may be that is seems impossible to create the ideal dental practice schedule. Every dentist and most auxiliaries practice on different days, each professional may have different hours, they will provide treatment at different speeds and they will offer different services. All successful dental practices will take account for all these scheduling variables. Having a scheduling system is what creates success in all areas of the dental practice.

Effective Schedule Systems

When you have an effective scheduling system the doctor and team are now in charge of managing the patient flow. The patient flow should not manage the team.

Think of the schedule as the center of all dental practice systems. This is one system that will significantly decrease stress. When the team manages the schedule it will become efficient and predictable. This is where productivity will create increased revenues quickly.

Six tips to help you manage your practice’s scheduling

1. Use 10-minute units
Using 15 minute increments on the schedule costs the practice approximately seven days of treatment time every year. This means the doctors are working that much harder and not smarter. When you change the practice schedule to 10-minute units you are able to schedule procedures with a higher degree of accuracy. When you utilize 10-minute units of time the practice can schedule a 20-minute procedure with ease. With 15-minute units, the procedure must be scheduled either with not enough time (15 minutes) or too much (30 minutes). Ten-minute units will now offer greater flexibility and result in increased productivity.

2. Create a template for each operatory
Every 10 minute unit needs to be put into the schedule in advance. A schedule built on a 10-minute template outlines exactly how every 10-minute increment will be used for each operatory. Doctor and the auxiliaries need to take a look at the 10 minute units first. This is how they will know how each day is going to flow. This needs to be reviewed even before the team huddle begins.

3. Schedule by production
Again this allows you to take control of the schedule and the schedule will not control you. When setting up your annual schedule template decide how much production you need to stay in the black. Decide what procedure blocks will be added and at what times on the schedule. Many practices make the mistake of scheduling by reactively filling empty time slots.

3. Be proactive. First things, First
Most people during the day have more energy and as the day progresses they tend to run out of steam. For many people the time after a lunch break seems to create a decrease in energy. Try having longer, more intensive treatment options in the morning. This is the time to fill the schedule with longer procedures and high-production cases.

When you have a strong scheduling system in place you have increased productivity and profitability. When you create a schedule with production as a priority you create harmony, less stress and help the practice meet all the daily goals; production and otherwise.

4. What is a “Perfect Day”?
It doesn’t need to be a calculus equation or statistics but there needs to be a strategic mathematical formula to make certain the practice meets their goals. It is best to schedule an average daily level of production which will be equal to your annual production goal. For example, if you want to produce 1.5 million in 200 days, you need to schedule $7,500 per day. This will include the hygiene schedule and doctor’s schedule. It is not realistic to produce this same number each day. The important part is the daily average.
Having “Perfect Day” schedules and daily production goals also tend to reduce practice stress because they allow doctors and their teams to achieve a consistent day-in day-out workload.

5. Your “Perfect Day” Schedule
It will increase efficiency when you schedule the doctors, hygienists and all auxiliaries separately. If you are utilizing an assisted hygiene model the hygiene assistant should also be scheduled into the 10 minute increments.

The doctor and assistant do not always need to be in the room together. This follows true especially when using an assisted hygiene model.

It may take a few weeks and a process of time but it will significantly increase the total office productivity, decrease stress, improve patient flow and increase the annual revenue.

6. Communication is the Key to Reduced Cancellations
It is the nature of business and life in general that there will be cancellations and no-shows. When scheduling tell patients that you are “reserving” this time specifically for them. Educate all patients about the importance and leave them feeling the urgency for reserving appointments prior to leaving the office.

When the front office is speaking with patients they need to request patients give 72 hours notice if they need to change an appointment. If patients need to change their appointment on Monday it doesn’t do the office any good to cancel an appointment on Saturday. This is why you need to ask for at least 72 hours cancellation.

Take time to retrain your patients about this policy if you don’t have this in place currently. Let patients know there will be a fee for a missed appointment. The fee needs to be dependent upon the type of procedure and should be written in all policies you publish to your patients. These policies are included in the new patient package. Appointment cards need to mention there is an appropriate fee charge for cancellations outside of the 72 hours.

Quick Overview

• Schedule in 10-minute units, with a template for each operatory
• Schedule the most productive procedures first by creating ideal day schedules with ideal production goals
• Schedule longer and high end production early in the day
• Schedule doctors and assistants separately
• Build patient value for appointments to reduce no-shows and cancellations

You will create a more efficient and effective system for scheduling patients when you create your “Perfect Day” schedule. The bottom line is harmony in the office, value to the patients, improved productivity, increased revenues and reduced stress. It is a “win-win” that creates success!

Do you need guidance setting this up? Do you know how many days and hours you actually need on the schedule? Please contact us for a free assessment. Find the answers to these questions, lower your overhead and increase your revenue.

Years ago the dental hygiene department was thought of as a loss leader. When looking at the business of dentistry in the 21st century we realize there are numerous profit centers inside the dental business. When looking at the dental hygiene department there are numerous areas in this department that bring profits to the dental business.

Four-handed dentistry has been popular for dentists and by utilizing this assisted model it is only one avenue to bring increased productivity and added revenue to the hygiene department as well. This is not to be misunderstood as accelerated hygiene but as a way to provide added value to the dental hygiene department, optimal care to the patients and in addition bring increased revenue to the dental practice.

There are many factors which play a big role in the success of this dental hygiene model for business success. This is part I of 3 articles to discuss what you need to explore to understand if this business model is correct for your dental practice.

Defining these Two Words

What do the two words assist and hygiene mean? Assist means to give support or aid. What does the word hygiene mean? According to Merriam Webster this word means the science or establishment of health.

It is important to look at the meaning of these two words. This is where we begin developing a true foundation for a successful assisted hygiene model. Specifically these two words when put together mean giving support to establish health.

The challenge to a successful assisted hygiene business model is to develop a course of action where the hygiene team can continually strive as a team to provide optimal health and preventive patient-centered care with consistency and effectiveness.

Sharing the Vision

Definition of Vision: “The Fundamental Source of Power.”

As owner of a dental practice you are considered the main leader in the success of the business. Your vision implies an understanding of the past and present. More important, it offers a road map to the future and suggests guidelines to those in a given enterprise— (The business of providing health. The business of dentistry.) how people are to act and interact to attain what they regard as desirable. As a leader your vision may be intuitive or highly structured. It is the bedrock for success in meeting the twin tests of competition and selection of what your business model(s) will look like.

Before deciding to implement an assisted hygiene model in your dental business it is important to ask yourself a few questions “Is this where I want to be?” “Do I want to expand my practice?” “Do I wish to have more employees?” “Are we ready to grow?” “Do we have the correct players on our team to move forward with this business model?”

These are some of the initial questions you need to answer. If you are not set up physically, mentally or financially this may not work. Once the primary leader or business owner feels comfortable with this business model they need to share this with the team and then the patients. If everyone on the team is not on board this new business model will not work. Once the team is on board you can share your new business model for assisted hygiene with the patients and all who enter through the door of your office.

Code of Ethics

These are the driving principles, of your business. An example of this can be seen with the code of ethics the Ritz Carlton shares with all who enter through the doors of a Ritz Carlton Hotel. (Did you know the employees keep a card of these on them at all times while on the job?) The leaders at the Ritz Carlton are responsible for stewarding an icon in the luxury market, through a constant quest for excellence, to continue its success in a changing global economy and with changing customer needs.

You can also think of your code of ethics similar to the Ten Commandments for your dental business. You may ask why have a code of ethics? Below is a list of important reasons why you need to have this, share it with everyone on the team and everyone who walks through the door of your dental office.

Why you need a code of ethics

• Sets up expected behaviors (for the team and what the patients can expect)
• Promotes high standards of practice for the dental office
• Provides a benchmark
• Establishes a framework for professional behavior and responsibilities
• Gives a specific Identity to the practice – what they can be known for
• Shows development of a systematic approach and maturity of the business

When people know why you are in the business of dentistry they are more likely to remain a life-long patient and most likely be a disciple of what you represent referring all their friends and family members.
When changes occur in the practice, for example changing to an assisted hygiene model, patients are more likely to weather the change because these are the people who understand you are all about their best well-being. They know you care by everything you do and say: written and verbal.

Critical Components

A systematic approach is the key to making this and any transition a seamless process.

Define what assessments are to be completed during the hygiene appointment and which auxiliary(ies) can perform these assessments. The hygiene team in particular needs to meet and write down what screenings will be completed and at what intervals. An example may be: “At each preventive appointment patients will receive the medical history review and an oral cancer screening. The patient will also receive a caries risk assessment form and this will be reviewed by an auxiliary. The auxiliary will ask about xerostomia (dry mouth) and give oral hygiene instructions (or a review of) before the patient leaves the operatory.”

“Annually each patient seen for preventive treatments will receive a full mouth periodontal screening exam, a blood pressure screening and smile analysis.” This is just an example so you may want to meet and decide what is in the best interest of the patients and your practice model.

Once you meet with the team and create this model you will nurture and create an atmosphere of optimal preventive patient-centered care.

It is very important that you develop a customized and written protocol so each member of the assisted hygiene team and even future members of the assisted hygiene team can acknowledge, accept their role and responsibility within this new business model. The written protocol will include the daily goal(s) for production and may even include how many referrals you ask for from current patients. The written protocol will include challenges and how they will be handled, when to implement new technologies, budgets for new equipment and treatment adjuncts to continue improving the quality of patient care.

Cross-training the hygiene department and having the operatories set up the same in a systematic manner will promote a system of effectiveness. The hygienist and assistant must acknowledge the benefit of sharing duties which overlap their scopes of practice and contribute to the success of the assisted hygiene program.

Scheduling is very important and the various patient treatments (procedures) need to be categorized into low, medium or high production. Having specific blocks of time pre-scheduled in the appointment book will also help keep the assisted hygiene program on track for not only a preventive patient centered practice of optimal care but will help the team meet production goals.

Determine your expectations and each person’s perceptions. Be open to listening to your patients’ perceptions about this change. This awareness will help you and the team to proceed with clarity for success and to progress towards peak performance with a patient centered preventive program.

Journey through Peaks & Valleys

These are just a few guidelines to begin your journey for patient centered hygiene care. Possibly you already use the assisted hygiene business model. There will always be peaks and valleys in anything we do in life.

Even if you have already implemented this program of assisted hygiene you may consider the expertise of a hygiene coach or consultant as they are the experts who will provide the team with powerful solutions to bring the valleys up to peak performance.
When you become clear about your values and understand everyone’s perception not only will you exceed your expectations but those of your patients.

Happy Patient = Continued Success!

Stay Tuned

Stay tuned for part II of Debra Bittke’s series on The Assisted Hygiene Business Model…

What an exciting time we live in! We are living in a time where we are discovering new technologies. We have social media marketing strategies, everyone has a website and we are just a Google search away from one another. If you want to be on the leading edge you are looking for ways to set your practice apart from the rest.

We must pay close attention to increasing profitability, efficiency and our overhead while providing a high level of quality, attention and detail to our patient care. These are exciting times in dentistry as we explore and implement new strategies to enhance and improve our current dental practice business strategies.

Over the years, dentistry has evolved into realizing that we must carry out a patient-centered, prevention-oriented health care practice that is prosperous. It is imperative to employ sound business principles and expect our practice to be an environment in which our team has an opportunity to build a rewarding career and our patients receive extraordinary care and service. One thing that may change for our patients is a re-adjustment of their priorities as it relates to their treatment plan.

The goal of helping our patients has now progressed from treating infection and disease to good overall health. One thing that hasn’t changed is the cost of doing the business of dentistry. It is important that the team understand the cost of running a business in dentistry and a hygiene department. It is when the team understands these financial aspects of the business that members of the dental team are committed to excellence.

Working as a Team

When we work as a team we can make a difference. Everyone on the team needs to understand what systems are in place. Cross-training the team can create a harmonious playing field. When your entire team is enrolled in communicating patient education, delivering home care instructions and increasing the patient’s dental IQ we now provide a rich environment for enthusiastic teamwork, enhanced level of communication and a committed effort to improving the overall health and wellness of your patients. With a team fully engaged, your patients begin to connect and establish trust with your entire team and view the team as an invaluable resource for their total health. Working as a cohesive team provides an immediate and lasting impression for your patients. This is a cost effective marketing plan which we all know as internal marketing.

When reading about productivity in the hygiene department you may think of coming in early, working through lunch and staying late. Maybe you think the office has a prophy mill. Does this make you feel like you are running on a treadmill or riding a roller coaster? When you take time to add assessments such as a periodontal screening exam, CAMBRA, smile analysis and xerostomia, etc., you will begin to treat the total patient, work more efficiently and higher end treatment will begin to take place. Patients now have a reason to say “Yes” to treatment needs when they understand the science and importance of oral health related to their total systemic health. The assessments initiate communication for the necessary treatment and when patients understand the importance a “Yes” to treatment most likely means you are more likely to complete higher end treatment plans. This means your revenue will increase.

Another avenue to increase patient oral and systemic health is by recommending home care products. Home care products can also increase revenue and become another profit center. Can you imagine patients coming by the office even when they don’t have an appointment? They do when they purchase home care products from you. These products can be a great gift for patients to share with other friends and family members when there is a special occasion or holiday. This gives patients a reason to stop by the office frequently.

Offering home care products is just one more opportunity to add a personal touch, top of the line preventive services and exposure to your patients without marketing. When you offer products to support patients who request natural products, support your cosmetic dentistry, offer products for caries prevention and treatment of xerostomia, just to name a few. Adding home care products to what you currently offer your patients will not take time out of your schedule and will not add more patients to your schedule. It adds simple revenue with little effort on the part of the dental team.

Every time you prepare a crown or place an implant you are paying a lab bill. When you sell home care products you will not have a high overhead but many of the products you will have your patient purchase have a 70% return on investment. (ROI) This is called passive income. It is an easy way to add value to what your patients receive and it also increases your bottom line in the dental practice.

Providing a patient centered prevention – oriented atmosphere in your practice will bring out the vision, values and quality of your practice. It will set your practice up to harness to ride the big waves depending upon whatever the economic climate may be.

Creating a cohesive team and a dental practice based on excellence and the extraordinary, realizing the potential of the dental hygiene department and the entire team is essential to building the dental practice you have always dreamed of. This assures long-term relationships along side your success.

Your team members are all very important assets to the health, profitability and success of the dental practice. Your patients and the team are priceless!

When you see the words “the business of dental hygiene” what do you imagine? Perhaps you see a treadmill where high volume and financial reward are the main focus of the dental hygiene department? Or do you see a hygiene department where quality patient care and profitability are congruent, operating with systems and protocols that would not allow one to compromise the other?

A Paradigm Shift

During the past ten+ years the goal of helping our patients has now progressed from treating infection and disease into good overall health. One thing that hasn’t changed is the cost of doing the business of dental hygiene. It is important that the team understand the cost of running a business and a hygiene department. It is when the team understands these financial aspects of the business that the members of the dental team will be committed to excellence. It is important to have team meetings that educate every team member of the cost associated with the daily operations of running the business of dentistry and dental hygiene.

The Facts

The fact is, the hygiene department is the second largest profit center in the dental practice and provides support for the practice as a whole. Within the hygiene department are several other areas of profitability for the dental practice.

Most of your patients spend one hour–two to four times a year with the dental hygienist(s) and because of this ongoing relationship patients are more likely to remain in your practice, accept treatment recommendations and refer patients to the dental office. This makes your hygiene department a business within a business and it makes the executive in this department held accountable for his/her success. When the dental hygienist is held accountable for the department success and when he/she understands the vision and principles of the dental practice, success will follow. You will find the team working in harmony when they understand the vision for the practice share the same code of patient ethics and take ownership for the way patients are treated.

When every team member takes ownership of their role the patients are sure to experience a caring attitude, an ultimate dental experience, the highest level of care and the profits are sure to follow. This provides a win-win situation.

One of the most important aspects of the dental hygiene treatment that is often overlooked is the list of assessments. Dental hygienists feel as if they are on a treadmill but when the team plans the day effectively these assessments can really make the day run smoothly, allow patients to feel they received the highest level of care and now allows for a more comprehensive treatment plan to occur. The treatment plan now moves to a higher level of care.

New Treatment Heights

There is a list of 10 assessments and patient procedures that stimulate profitability in the dental hygiene department. These ten are all important aspects of the patients’ oral and total health. Not all offices participate in this list of 10 and
If you take a look at the list below and notice a missing piece choose to just implement 1 or 2 within the next month. Make an appointment this month to discuss with your team how to implement these ten successfully into the hygiene patient appointment time. Be patient with these changes and take time to discuss how to effectively implement these with full participation from the entire team.

The most overlooked assessments are the annual full-mouth periodontal screening exam. Still in the 21st century many hygienists who see a patient every six months, neglect to pick up a periodontal probe prior to picking up a curette. Most dental offices have approximately 15% of their adult patients with untreated periodontal disease. If each of these patients continues down this path we know that the research states this disease process will continue and the patient will at some point experience tooth mobility and possible tooth loss.

What will this cost the dental business? Take into account that most non-surgical periodontal treatment plans are approximately $1,000.00 for four quadrants of just scaling and root planing not taking into account the use of antimicrobials or laser therapy. Now take into account the frequency of the periodontal
maintenance appointments that follow about every 90 days. Once a periodontal patient, always a periodontal patient. It is the same as a patient with diabetes or high blood pressure. These patients are seen frequently and always at risk for future disease after the disease have been halted. We are not talking about money lost but improved health!

Another new area of treatment that is overlooked at this time is the pediatric patient – first visit. CAMBRA is a new evidence-based protocol for assessing caries. It is now the standard of care for the pediatric patient to have their first visit when the first primary tooth erupts. This appointment can be done in a consult room with the child seated on the mothers lap. This is an appointment to assess the tooth structure, biofilm and any suspicious areas of the child’s oral cavity. If you are concerned about receiving payment the CDT codes have you covered.

How many patients qualify for this preventive measure? How will this benefit your patients and your bottom line?

When the hygienist and team all understand the need to prevent and intervene at an early stage vs. wait and watch; not only does the patient gain an improved level of health but the dental hygiene production will increase. Establish periodontal and the various preventive protocols today. Now is the time to cease treating the periodontal patient with a prophy appointment and begin to utilize the
preventive measures according to the new CAMBRA guidelines.

Another area in dentistry that has changed in the past decade or more is selling home care products. Many decades ago we wrote a prescription or sent our patients to a pharmacy with names of products written on a piece of paper. Our knowledge and research over the past few decades states that 70% of these patients returned to our dental office and never took time to get the prescription filled. Patients seldom took that piece of paper with them to purchase the specific product recommended. When patients have the toothbrush they are to use and shown in the dental office how to use that new power toothbrush they are more likely to use the brush effectively.

This is the one area of your dental practice that has a net profit of about a 70%. You can spend hours preparing a crown or bridge and you have lab fees to pay at the end. The ROI (return on investment) for home care products sold in the dental office is about 70%. We want patients to buy their home care products from the experts, the people who know which toothpaste, toothbrush, mouth rinse, etc. is appropriate for the individual patient to use at home. The sales person at the local drug store and even the pharmacist is not the person to educate a patient about xylitol and its benefits let alone what type of silica is appropriate to use on the expensive restorations the dental patient just paid for.

By engaging and empowering the entire team your dental business is certain to excel. You will create a cohesive team and a dental practice based on excellence and the extraordinary. Realizing the potential of the dental hygiene team and creating a thriving profit center inside this valuable department of your business is essential to building the dental practice you have always dreamed of. This assures you long-term relationships along side your success.

Your team and the dental hygiene department are all very important assets to the health, profitability and success of the dental practice.

10 Profitability Centers in the Dental Hygiene Department

1. Perform oral health care assessments that include the review of patients’ health history, dental charting, oral cancer screening, periodontal assessments, biofilm assessment, saliva pH test, smile analysis, xerostomia, etc.

2. Expose and interpret dental radiographs (x-rays); co-diagnose

3. Non-surgical periodontal procedures, antimicrobial agents, laser therapy, etc

4. CAMBRA

5. Apply cavity-preventive agents such as fluorides varnish and sealants to the teeth

6. Administer local anesthetic and / or nitrous oxide analgesia

7. Educate patients on proper oral hygiene techniques to maintain healthy teeth and gums and recommend home care products

8. Discuss whitening treatment and take impressions when applicable

9. Administer smoking cessation programs

10. Counsel patients on the importance of good nutrition for maintaining good oral hygiene

Your Take

Which of these profitability centers currently exist in your practice. Do you plan to introduce any of the others listed here? Would you add any to the list?

Each day is a fast, frenetic ride on the practice racetrack. As hygienists we say “Treadmill”. Daily stresses morph into emergencies. You and the team dash from one procedure, patient, or task to the next and each are more critical than the last. At the end of the day you promise yourself you’re going to make changes and try to get things under control. But the fact is, it’s a rush. You’re living on chewing gum and caffeine and gulping at the fountain of adrenaline addiction, and with every near crisis averted, a sudden emergency addressed, and an urgent situation managed you do take a moment to give the team a quick high-five and congratulate yourself.

But that momentary thrill is creating long-term problems. Living in a constant state of crisis management typically means there is little happening in the way of real system management. The team is constantly reacting and scurrying in one direction one day and another the next day depending on what seemingly random course your so-called urgent priorities happen to take. Your crisis addiction, urgency addiction, adrenaline addiction – whatever you want to call it – is being satisfied at a price.

We work hard, not smart

The days are long and exhausting. What was once an exciting thrill is starting to feel a lot like burnout. The worst part, for all of your running, panting, and dashing to handle the latest and most urgent issue, practice productivity is teetering precariously between the “sorely lacking” and “barely good enough.” The problem is everyone is working hard but no one’s working smart. The focus is on dealing with whatever problem has to be managed right now and not on addressing what caused that problem and what can be done to prevent it in the future.

Turning your practice around

Had enough of life and work on the run? A mere 24 hours over the next year could transform a practice locked in a seemingly perpetual state of crisis management or lackluster success into one of superior efficiency and productivity. It also could go along way in weaning both doctor and team from an inefficiency addiction that is costing you thousands in productivity and an untold amount in long-term professional satisfaction.
It begins with a simple two hour meeting each month and a genuine commitment to making a change. This is dedicated, uninterrupted time in which doctor and all team members commit to continuously improve the practice.

Follow this 12-step plan to practice efficiency and increase profitability.

1. Create an agenda with input from the entire team. (Go to: http://dentalpracticesolutions.com/members-center/ for a copy of agenda to use.)

2. The agenda will be specific for the type of meeting you are holding. In our Tuesday Tooth Pick January 18, 2010, we listed various meetings you need to schedule during each year. For example one meeting you need to report on frequently are all areas of your dental office that impact the profitability and the success of the practice, such as: numbers of new patients, recare patients, non-surgical periodontal procedures, home-care products sold, unscheduled time units for doctor and hygiene, unscheduled patients for treatment and hygiene appointments which are not scheduled, treatment acceptance, collections, production, accounts receivables, uncollected insurance revenues over 60 days, overhead, etc.

3. Post a list of comments in one area of the office (Preferably a room where the team meets each am for the team huddle) for each team member to contribute their important thoughts and ideas on the topic for the monthly meeting.

4. Distribute the agenda at least two days in advance of the meeting.

5. Assign a different ring master (Leader of the meeting) each month who will lead the meeting and keep team members on task.

6. Assign each member of the team to report on the area for which she/he is responsible. For example, the Scheduling Coordinator reports on the monthly production as compared to the goal, the number of unscheduled time units for the Doctor, and the Doctor’s daily average production. . (Go to: http://dentalpracticesolutions.com/members-center/ for a copy of each person’s role.)

7. Designate the amount of time you will spend discussing each issue and avoid getting bogged down on unrelated topics. Discuss only what’s on the agenda.

8. Eliminate outside interruptions, and when possible hold team meetings off-site in a conference room. Many local libraries, community colleges, hospitals and other public facilities have public meeting rooms available for use. This is especially important when you are holding your annual strategic planning session. It is recommended the strategic planning meeting be held during an 8 hour period of time somewhere relaxing and fun for the team.

9. Encourage team members to come prepared to participate in the discussion. For example, if there are more unscheduled time units than desired the team can discuss strategies for addressing the openings. Seek input from everyone.

10. Delegate responsibilities and establish deadlines for completing tasks identified during the staff meetings. (See the agenda sample at http://dentalpracticesolutions.com/members-center/)

11. Share ideas during team meetings for improving the work environment, the patient experience, and the efficiency of the practice. Seek consensus from the team as to the best time to hold team meetings; meetings scheduled outside normal work hours should be considered paid time.

12. Hold meetings at least once per month, more frequently if you are implementing several changes. Before long you’ll be amazed at your cravings for stability and predictable outcomes. You’ll also be very likely to find you and your team all but addicted to the very real and measurable strides you are making in practice productivity and efficiency.

Have fun with your new addiction to efficiency! It may just increase your bottom line.

Your thoughts

Have you utilized any similar ideas within your practice? What were your results? Do you have additional tips for increasing practice efficiency?

As a dental consultant/coach, I have the opportunity to talk with dental practice owners every day. I also review and analyze dental practices on a weekly basis using my extensive dental knowledge to educate practitioners on how they can improve their practice bottom line.

What I hear consistently are dental practices which on average, see 30 new patients each month. Most dental practices have an average of 2,500 active patients. Most of our clients have been in practice for a minimum of 12 years and examine about 30 new patients every month. You may wonder why most of these practices have a mere active patient base of only 2,500 patients.

If all of these patients continued to return to the office the dental practice should have an active patient base of at approximately 3,500 patients. I am accounting for some attrition and being very forgiving with the accounting of these patient numbers.

In the United States, 78% of general dentists are solo practitioners. Why is there only enough work to keep one dentist busy? The answer is simple, dentists are losing more patients out the back door than are coming in the front door. Most practices I review have only 6 days of hygiene patients each week. With this point arises the question: why are these practices only seeing 6 days of hygiene patients each week?

First of all, I want to address the reason behind why patients may not be coming back to your office. The lack of a “personal relationship” with your patients could be to blame. By building a personal relationship with each patient, you will establish trust and give them a reason to choose your office over another one down the street.

One of the most common questions that I hear on a daily basis is, “why do we need to change? We have always done things this way.” This statement signals a major breakdown and is a silent killer for any dental practice. Dental practitioners should also keep in mind that the field of dentistry changes constantly and dental management skills that worked five to ten years ago probably do not work in today’s world.
There are many reasons why a practice might lose patients.

The “New Patient”

Your first impression is a lasting impression. I always ask doctors to periodically call their own office so they will understand how the phone is being answered. The dental practice owner and all team members need to be aware of how a client may feel when calling in to make an appointment. Do you get the feeling that the phone is answered with someone who has a smile on their face?

Offer good “Customer Service”

How long does your new patient need to wait until they are able to get an appointment in your office? If you have blocked times for new patients you are more likely to successfully accommodate them in a timely manner. If you heard something good about someone and are anxious to meet them, do you want to wait a month to meet them? Neither do your patients!

I have called many offices and an answer machine let me know the office staff was busy with another patient and was not able to answer my call. If I were a new patient calling to schedule my first appointment and I was greeted by a recorded message. I would be discouraged by this not so warm welcome.

What types of information do you send your patients home with? Do they have written oral hygiene instructions or post op instructions? Do you send out a new patient package prior to the first appointment? This can easily be done if you have a website that patients can download information from. If it is not possible to distribute the information through your website, think about emailing a package of information to save the cost of postage.

Do you make post – op calls? Do you call even after the scaling and root planning appointments? If you have a difficult or a fearful patient, think about the impact you would make if you called after hours to make certain they were feeling okay about their dental appointment that day. My niece just had her 3rd molars extracted and it was so comforting when the oral surgeon called to check on her much later that night.

How long does it take you to return patient calls? Do your patients leave with a written treatment plan for any future treatment? Are they able to send emails to confirm their appointments? What type of payment plans do you offer? These are only a few questions you should take into consideration when trying to improve upon your dental practice.

Team Hiring and Training

How do you know what type of personality fits into your practice? There are various models for testing temperaments. You need to know what type of personality fits each job description in your dental practice. You need to know if hiring another person with a strong personality will interfere with any other strong personalities that currently work in the office now.

Your Thoughts

Are you already implementing some of Debbie’s suggestions in your practice? What have been your results?

Have you ever heard the saying “If you fail to plan, you plan to fail”? Well this holds true for your dental business as well. You can not start a business and proceed blindly and just expect that everything will work out and you will achieve great success. It rarely will happen that way. At the very beginning of each year you need to sit down outside the regular dental office atmosphere and make a plan. This plan needs to include the entire team. It starts your practice off on the “right tooth”. Well, it is one way to keep you in the black.

Don’t set yourself up for failure

Without a plan you won’t know which way to progress, you won’t know what you need to do or where you should be when the day begins; let alone another year ends. The entire team will be confused about what you are working towards. What happens next? What happens in most cases is a loss of focus on the interest of the business of dentistry and loss of motivation to get where you need to go.

Would you take a journey somewhere you’ve never traveled without a road map? Of course you wouldn’t. Not if you want to successfully reach your destination. In the year 2010 you most likely have a sophisticated device such as a GPS to guide you directly to your destination.

Considering this, do you think you could successfully reach the goal in your dental business without a strategic plan?

If you are going to put your time and money into something, you don’t want to set yourself up for failure; rather you want to ensure your success.

Have an annual plan to ensure your success

When you have a plan, you will create direction for yourself and the entire team who follows your lead. You will now understand what you need to accomplish your tasks and move to the next step.

You don’t have to do this on your own. As the year ends many consulting/business firms are offering discounts to guide you to plan effectively, to travel in the right direction and end at the pot of gold.

Once you have a plan in place, you won’t have to guess what you should do next, as you will already know. You won’t spend your time wondering and waiting for success to come, only to be disappointed and clueless as to where you went wrong. I’m not saying that just any business strategic plan is going to ensure you success, but having a plan in place will significantly improve your chances!

Be prepared

This is your business…your lively hood. Having a well thought out business plan will also reduce your stress as you move along.

If you’ve ever been a parent or a babysitter of a young infant or toddler, you will know that if you go on an outing with a carefully packed diaper bag, you will feel a lot less stressed than if you just threw some things together right before you left. What if you forgot something? What if you forgot something important like diapers, bottles for formula, or the baby food?

While you are away trying to enjoy yourself your mind may constantly be stressed, trying to think if you have forgotten anything. Not a good way to run an outing at the park… or your business. Find yourself some business plan opportunities and get started!

Have all your cards in place and you will give yourself the best chance possible to be successful.

January is almost here and if you don’t have your annual strategic planning meeting on the calendar, now is the time to schedule that for you and the entire team. I want to suggest that it be held outside of your office. Make it a fun event for the entire team. There needs to be an organized agenda but make it fun, be concise and yet directive about what needs to be accomplished. Be sure to address what has been accomplished in the past year and decade as well. (Remember we begin a new decade on January 1, 2010!!) At this important meeting make it known to the team when you plan to have the office closed in 2010, holidays for the office, vacation requests and annual review dates for each team member need to be set or suggested at the least. This is just a short list to get you started on the “right tooth” when 2010 begins.

“If you don’t know where you are going; any road can take you there. Be sure to have your map in hand as you begin 2010!”

Happy Holidays and Happy New Year!

May you have a happy, healthy and prosperous 2010!

Author Bio

Debbie Seidel-Bittke, RDH, BS, is founder of Dental Practice Solutions, is a national coaching, full-service consulting, speaking and writing business focused on increased profitability in the dental office without increasing days of work in the office or more stress.

Debbie began Dental Practice Solutions in 2000. Her career has focused on all aspects of dentistry since 1975. Most recently she is known for increasing profitability in the dental office be driving the production in the dental hygiene department. Debbie has 4 specific ways to drive profits in your dental hygiene department.

You can reach Dental Practice Solutions by calling: 503-970-1122. Please visit the website for more free valuable resources: weekly newsletter, webinars and the membership center.

Your Thoughts

Does your practice have a strategic plan in place – annual or otherwise? Please share in a comment below.