Thursday, September 22, 2016

The Art of Listening to Your Patients

Imagine lying flat on your back with your eyes closed, being surrounded by loud noises, constantly having water and air sprayed in your mouth, and trying to breathe and stay calm although half of your face feels paralyzed and people are cramming in, closer and closer to your face. This is not the picture of serenity most of us would seek. In fact, being in a dental chair makes most people feel vulnerable, and vulnerability can easily manifest into fear and distrust.

The only way you will know how to take care of your patients is by understanding how they feel in that moment and knowing what is important to them. I’ve been in private practice for more than 16 years, and one of the most important things that I have learned to do, and still struggle with, is to stop talking and start listening. As dentists, when we hear patients say that they have a problem or an issue, we immediately start offering them solutions. We get so excited to help that most of the time, we’ll even interrupt the patient because we can’t wait to offer our advice. Even our team members do this. How many times have you heard someone on your team “educating” or “consulting” over the phone?

The enthusiasm to help is great, but we must remember it is all about the patient — the person. We cannot provide sound guidance without first understanding the person’s story and perspective. Let your patients talk, and you listen. Then, if there are things that don’t make sense to you, or if their story seems incomplete, ask them questions until you understand. This is also a great way to interview a patient. Maybe that person is not the right fit for your practice.

People don’t listen if they don’t feel like they are being listened to. When people feel that they are truly heard and understood, a connection immediately is created, and trust starts to build. Now, they are ready to listen because you did. Remember, patients call your office with the assumption that you already have the skill set and knowledge to take care of their dental needs. They are not there to interview you to see what bonding steps you take or what type of composite you believe in. They will select you if they feel a connection with you and your team. When you care about your patients, they feel it, your team feels it, and you feel it. Dentistry becomes about more than teeth; developing the partnership toward wellness becomes the mission. This synergy is what will keep your patients coming back, and not only will it bring and sustain financial success, but personal fulfillment as well. What matters more: How amazing your porcelain crown looked on No. 7, or how you helped that person and made him or her feel throughout a vulnerable and scary procedure? Are we treating procedures or people?

“First seek to understand, then be understood.” Start by just listening.



Pamela Marzban, DDS, FAGD

Tuesday, September 20, 2016

Alternative Approaches to the Treatment of ‘Restrictions’

Artists, musicians and other creative people have the ability to look at the world and see it through different eyes than maybe scientists or dentists would, and this is fascinating to me.

Take, for example, the speaker of a course I attended on myofascial release (or MFR). John F. Barnes, PT, has a guru-like presence. I was surrounded by about 100 physical, massage and occupational therapists in a hotel conference room, all dressed in gym shorts, yoga pants and T-shirts. It was a lot more relaxed than your typical AGD meeting is.

Barnes thinks that all physical and even emotional problems can be traced to “restrictions” in the connective tissue system of the body. The physical-therapy aspect of his program was reasonable, but it soon got into a metaphysical realm that left me feeling pretty uncomfortable. This is more than just lower back pain or a sore shoulder. I heard him say “restrictions” can all be worked out by applying light pressure on the affected parts of the body. I listened but was mainly interested in how it may apply to temporomandibular dysfunctions (TMD).

It was enlightening though to hear him ask the crowd members for their own experiences and to listen as several of the attendees started their story with, “My trouble started off when this dentist….” I kept my head down the whole weekend for fear of being found out.

But I did start to wonder about whether our treatments can be at times traumatic in an emotional sense. A lot of people certainly seem to think so.

If you’ve been keeping up with this series of holistic-themed blog posts from me, you’ll see that it has been my attempt to expose my dear readers to some of the alternative approaches to medical treatment that are out there. If my editor, Stacy, wasn’t getting so frustrated with trying to write headlines for these non-dental topics, I would go on about Reiki or “energy therapy” in psychology or chakra or yoga.

More than me droning on about it, what I’d like to learn is: Does anybody in dentistry use any of this stuff in their practices? How do you incorporate these modalities? To be honest, MFR is a viable approach to treating TMD, but I wouldn’t use it in place of traditional treatments.

Next time, I’ll talk about something relevant to teeth. Stay tuned.



Bruce M. Scarborough, DMD, FAGD

Thursday, September 15, 2016

The Pokémon of Dentistry

I have to be honest: I’m probably one of the least “tech-savvy” new dentists of my generation. I have a Facebook account that my cousins made for me a few years ago, and although I finally learned the password, I still don’t check it. I don’t use Instagram, Snapchat, LinkedIn or Twitter. I feel like I’ve got the email and the Google thing figured out pretty well, though.

When I first learned about AGD’s plans to develop a series of digital badges, I was skeptical. I asked myself: Why would anyone want a digital badge? What would you do with it?

The more I learned, the more I came to understand how digital badges related to the more traditional world I’m used to. I realized the Starbucks app on my phone issues digital badges in the form of gold stars. Each time I buy a coffee, I am awarded gold stars. Eventually, I can collect enough stars and get my next coffee for free!

While AGD doesn’t promote coffee sales, it does promote continuing education. AGD’s ultimate “gold stars” are Fellowship and Mastership awards — and there are badges for those as part of AGD’s digital badging program. Thanks to AGD’s digital badging program, a paper certificate I might receive for earning my AGD Fellowship Award can now be represented digitally. While I can hang the certificate on the wall in my office, I can post the badge to my practice website. My colleagues who use LinkedIn and Facebook can develop a virtual diploma wall on which they can share their accomplishments in dentistry with potential future employers or patients. Free marketing!

As a member of AGD’s Dental Education Council, one of the most exciting parts of AGD’s digital badging program is the potential to help promote the positive aspects of our profession. It’s also great to be able to give each individual member something tangible he or she can use to improve his or her practice. Recognizing dentists who go above and beyond to improve themselves, their profession and the care they provide to patients is going to make us all better practitioners.

I don’t know about you, but I’m much more excited about collecting AGD badges than I am about catching Pokémon!

For more information and to access resources about AGD’s digital badging program, visit www.agd.org/digitalbadges.


Marcus K. Randall, DMD

Monday, September 12, 2016

Poised for Future Oral Health Care Success

In the middle of summer, our family invited my eldest daughter’s boyfriend’s entire family over to our home for a barbecue dinner. The four kids in attendance (all younger than age 8) looked bored, as we did not have a lot of children’s toys in our home.

People of any age just want to be noticed. They want to matter, and knowing this, I engaged these kids in conversation. I sat on the floor to bring myself to their level, physically, and enjoyed a silly conversation with them. They perked up and had a great time, and soon, I was known as a “doofy nugget.” Once I had won them over, it was easy to go back and forth between the kids and the adults, and all seemed to have had a good time.

I don’t know what it is about children. So many adults have no idea how to engage them, how to talk to them, how to entertain them or how to treat them. The old saying about how children should be seen but not heard does not really work. It does not raise those children to become engaged, responsible adults who contribute to society more than they take away. They are just like “us,” only younger. Find out what interests them and engage them in that topic, and they will light up and be wonderful to work with.

Dr. Steve Baylin, a good friend and now a retired pediatric dentist, visited my office many years ago. When he arrived, there were some children in the office being treated by my team and me, and he told me later he now understands why I don’t refer a lot of children to him. He was one specialist who understood that general practice dentists can, and should, be using our skills and training in all areas of dentistry where we feel competent and confident.

I like treating children, but I could not do it full-time. Steve told me that children who come to the dentist office are either wonderful or horrible patients. Fortunately, 95 percent of the time they are wonderful patients; for the 5 percent who are not, I use the specialty skills of the pediatric teams to turn that experience around so they have a better oral health care future. Often, after some time, these referred pediatric patients return to my office for regular care.

And now we have a generation of children growing up and not just being OK with going to the dentist, but rather actually looking forward to it. We have worked hard to develop the whole package of prevention, minimal invasive treatment and an atmosphere of professional fun. This generation of patients are set up for a lifetime of oral health care success. I have witnessed this happening and am pretty proud of what role I may have played with some of these good people.

I love being a general dentist and am thrilled AGD exists to be an active advocate for us and what we do every day. And if that means I have to be a doofy nugget on occasion, I am OK with that, too.














Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

Wednesday, September 7, 2016

A Nod to Modern Dentistry Founder Dr. G.V. Black

Recently, I was preparing a tooth for an onlay and thinking about Dr. Greene Vardiman (G.V.) Black (1836–1915), one of the founders of modern dentistry. As my bur moved around the tooth, I thought of his “extension for prevention” concept about extending a prep outline to an area of the tooth the patient had easy access to clean. And that way, the risk of recurrent decay around that margin decreased — in theory. Nowadays, dentists have archived this theory thanks to our amazing composite materials that don’t need anything extended anywhere. We put our filling material only where we need to and can keep the preparation size small and, dare I say, conservative. That sounds like true modern dentistry in 2016 and a far cry from that ancient extension idea of the 1800s. 

However, after practicing for nine years, which I know is hardly extensive experience, I’ve noticed the occasional inverse relationship between how advanced our materials are and true “conservatism” of our preps. Allow me to be frank: I think many of us should admit that there are dentists who do the exact opposite of what Dr. Black was trying to promote. We then hope that our patients floss and our margins stay beautifully sealed for 20 years.

Really? I think Dr. Black would laugh at that.

On one hand, we may be trying to say extending a filling prep margin out is overkill, overaggressive and totally unnecessary, yet on the other, we’re perfectly fine with dropping our indirect margins all the way around a tooth and down to where we might hope that our margins don’t become a condominium complex for the friendliest of bacterial residents in our mouths.

And by “we,” I mean that I, too, was once guilty of that. In my mind, also covering the tooth (the whole tooth and nothing but the tooth) was swearing in the tooth to the protection it needed to not break. Lately, I’ve been mentored to do otherwise, and I’ve been enlightened by the wonderful world of onlays and inlays. I love not cutting away so much tooth anymore and putting margins in easy-to-reach and easy-to-clean places for the patient. I know this may not be news to anyone and biomimetic dentistry is not a new trend; rather, it has been a solid concept circulating in dental circles with many dentists who practice it every day.

But for me, not having cut an onlay or partial crown since dental school, I had to relearn this skill, and I’m loving it. The concept of preserving tooth structure has always been inherent to my philosophy, but now, I feel empowered by preserving most of the tooth by altering my prep design. If I don’t have to remove two-thirds of sound enamel, then why remove it? If I can place the margin of my onlay high above the gumline where my patient can easily keep it clean, that makes me a happy dentist. After all, we have amazing cements that will help keep that onlay bond to the tooth, so why not take advantage of them?

“I suppose I’m applying an under-extension for prevention,” I thought to myself as I made my way around the tooth. I think Dr. Black would be proud.


Zeynep Barakat, DMD, FAGD

Wednesday, August 31, 2016

Understanding the Fundamentals of Operating a Business

Most dental clinicians are not accustomed to or comfortable with managing their businesses. How can they be? The general dentist is the primary revenue producer (2/3 dentist and 1/3 dental hygiene) and needs to be chairside generating income 95 percent of the time. Practicing dentistry and running a successful and profitable business is not easy. As colleagues, we all know dentistry can be demanding, both physically and emotionally. 

A December 2015 study published in Dental Economics revealed that only 7 percent of dentists enjoy managing their businesses. In other words, 93 percent of dentists do not enjoy their management roles and would prefer to focus on providing dental treatment and leave the administration to others. Intuitively, this makes sense, as most dentist were science majors, not business majors. Herein lies one of the problems.

Few dental offices employ office managers who have a comprehensive knowledge or formal education in the basics of managing any type of business. Instead, most clinicians rely upon front-office employees who have acquired their knowledge through on-the-job training or from others who may be ill-equipped and lack the comprehensive knowledge to train them. The results can be catastrophic. This is the reality in most dental offices across the country.

As a clinician and dental analyst who uses data and metrics to make informed decisions, I am astonished at the number of colleagues (new and experienced) who are being taken advantage of by staff, vendors, landlords, corporate dental offices and insurance companies. And because many clinicians haven’t received formal business training and don’t possess a thorough knowledge of how to operate a business, they simply don’t know what they don’t know. Many owners are afraid of change and/or admitting that they need help. I have witnessed far too many great clinicians who have left hundreds of thousands of dollars on the table.

Speaking of insurance companies, can you name all of the insurance companies your front-office managers have signed up for, your unified carrier registration fees and the percentile within your area? Were your fees balanced before your office manager negotiated with the insurance company? If not, you just lost money that you can never recover. Can he or she really negotiate on your behalf? What leverage do they have? How about the back-door arrangements and umbrella of insurance companies that affect your in-network status? Maybe it would be good to ask your office manager to review this with you next week. Understanding dental insurance is a full-time job. Maybe you could hire a dental insurance adjudicator who has worked for an insurance company and has a comprehensive knowledge of the dental industry.

Remember when you prepared your first crown? Your first set of veneers? Your first full-mouth rehabilitation in a patient with a gummy smile? It took time to learn how to diagnose and treat the case properly. Learning how to manage your business is no different. Our dental school curriculums have failed to provide the graduating dentist with a comprehensive knowledge of the business of dentistry. I suspect this is associated with time and money and the fact that there are many lifetime dental instructors/academicians who are not educated in this field. They may be great dental school instructors, but they can’t teach what they don’t know.

For those owners who run lean, efficient operations supported with systems, processes, excellent human capital, monthly review of all key performance indicators, return on investment (ROI) on marketing efforts, call tracking systems and a thorough understanding of their surrounding demographics, congratulations! For those who are struggling to survive and haven’t experienced a successful business operation, you need to take the time and learn how to do so. Surround yourself with mentors and experts in your field who have walked in your shoes and possess a comprehensive knowledge clinically and operationally and have the business acumen to help you. Your return on investment should conservatively yield you 10 times the cost of a qualified mentor or expert over your career. As the great golfer Lee Trevino said: “I don’t need advice on how to correct my swing from someone who hasn’t stood on the ninth tee at the Masters with the world watching.”

Historically, the dental profession has been fortunate to have realized net profit margins of 20–50 percent and beyond. Other industries would be ecstatic with a 10 percent net profit margin. For example, the big-box wholesaler Costco reported a 2.09 percent net profit margin for the fiscal year ending August 2015. Imagine if we had to operate on such low profit margins. Or, the grocery business that routinely operates on a 1–2 percent net profit margin. No wonder corporate and big-box dentistry is growing and will continue to do so. Why wouldn’t they?

Remember the saying, “Follow the money?” We all want to make sound financial decisions and maximize our ROI. In order to maintain and increase our profit margins, we need to take the time to understand the fundamentals of operating an excellent business built upon great leadership, systems, processes, human capital and continuous improvement. I have seen way too many dental offices that are struggling to make ends meet. Don’t wait until it is too late. We have all invested substantial money and time in our educations, and we deserve more.


Duke Aldridge, DDS, MBA, MAGD, DICOI, MICOI, FMISCH

Monday, August 29, 2016

Five Tips for Effective Morning Huddles

Anyone in practice knows how busy our workdays can be and how easily they can get out of control. To keep our days running smoothly, and to make sure we are maximizing our potential production, our team runs a morning meeting every day. Now, most offices I’ve seen are doing some type of morning huddle, but quite often, they end up becoming time for everyone to gossip or complain rather than an opportunity to set the day in the right direction. If you think your office needs some redirection, the following five steps can guide you to conducting effective and efficient morning meetings. 
  1. Let go of the reins. The morning meeting should be run by the team, not the doctor. This means that each member present comes prepared to briefly review his or her assigned information and will take turns presenting it to the rest of team. As the team and doctor listen, the team member can ask questions.
  2. Review the front office report. It is the responsibility of the patient care coordinator or office manager to go over the previous day’s treatment acceptance, what got on the books, and what went out the door and why. This creates a great opportunity for team members to assess how effective their communication skills are, as well as how they can approach things differently. It will also provide insight for scheduling coordinators on how to follow up with a patient. 
  3. Review the hygiene report. Our hygienists are next. As they go over each individual on their schedule, they highlight what needs to be followed up with on that specific patient. For example, is there treatment pending, and why? The front office and assistants can provide input as to why treatment has been delayed so everyone can decide how to approach the conversation.
  4. Review the dental assistant report. While I know we dentists love and get excited about our schedules, and we can chat it up with our wonderful and just-as-excited dental assistants (DA), this should be the briefest report of the huddle. The only thing that should be discussed is what procedures are being done and any specific questions the DA may have about the appointment. Also, this is the time when the team can solidify how the patient continues on with care … what’s next?
  5.  Review numbers in “The Daily Huddle Report.” Every dental software program has the capability to generate reports. The one I recommend being reviewed in the morning meeting is called “The Daily Huddle Report.” This can be customized to whatever numbers you want to track and deem relative to the daily production. Don’t spend too much time on this. Numbers are important, but they can be boring. We all want to have great production and collection, but ultimately, the focus should be on patient care. Increased revenue is just a wonderful byproduct of quality care!
I enjoy coming into my office in the morning and seeing my team. I love to have fun with them, but our days need to start with positivity and laser-sharp focus. If we start the day off fully prepared and headed in the right direction, we are always more productive and relaxed and have more time for fun together as a team and with our patients.



Pamela Marzban, DDS, FAGD

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