America s Most Productive Dentist An Exclusive Interview With Dr. Bruce Baird

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1 Spring 2010 News & Information to Increase the Profitability of Your Practice The Secret of America s Most Productive Dentist An Exclusive Interview With Dr. Bruce Baird Ten Actions You Must Take To Increase Hygiene Profits Surefire Ways to Get In Your Own Way SECOND MOLAR MISERY Many Great Articles, Products and Services to Help You Become a Profitable Dentist Dr. Bruce Baird and Vicki McManus Productive Dentist Academy


3 Spring 2010 Issue 232 The content of this publication may not be reproduced either in part or full without the written consent of The Profitable Dentist. DeniseTorres istockphoto/ Andresr EDITORIAL A Word From Woody... 6 In the Spotlight... 8 The Truth About Debt and What Your Banker Doesn t Want You To Know Editorial by Dr. Ralph Duffin... 9 CLINICAL/TECHNICAL Tips for Better Dentistry & More Profit! by Dr. Michael Curtis...34 Second Molar Misery by Dr. Michael Kinsley...36 PRACTICE MANAGEMENT Reciprocity... I Owe You! by Dr. Tom Orent Pre-Selling by Dr. John Davignon Design, Implement & Achieve Success in 2010 by Dr. Chris Griffin Surefire Ways to Get In Your Own Way by Howie Horrocks & Mark Dilatush Discounting Your Fees Is NOT the Answer by Robert H. Maccario, MBA Protect Yourself! by Ralph Laurie Top Five Employee/Employer Myths of 2009! by Paul Edwards...22 You re Going to be Spending $50,000+ So Don t Blow It! (continued) RESULT CONTROL by Bill Rossi America s Most Productive Dentist An Exclusive Interview with Dr. Woody Oakes & Dr. Bruce Baird Ten Actions You Must Take To Increase Hygiene Profits by Rachel Wall, RDH, BS How Do I Find Office Space? by George Vaill STAFF Editor-in-Chief WOODY OAKES, DDS, FAES Associate Editor CRAIG CALLEN, DDS Seminar Coordinator JENNIFER JONES Front Office Coordinator / Administrative Assistant CHRISTY CLAYWELL EZ Stent by Dr. Craig Callen...39 Your Marketing Minute: Convert Clinical Skills to Profit by Dr. Chris Bowman...39 Preformed Guidance Appliance Technique The Sensible Solution for Adult Orthodontics by Dr. Earl O. Bergersen...40 Shade Taking Just Got Simple by Dr. Woody Oakes...42 Treatment For Primary Herpes...44 Tooth Desensitizer...44 ChaseHealthAdvance and Nationally Renowned Dentist, Woody Oakes, Team Up to Offer Patient Financing Options...45 SnoWhite for Dentures by Dr. Joe Steven, Jr...46 PRODUCTS & SERVICES Puzzle Piece Automatic Referral Generator A Word From Our Readers Products & Solutions Excellence In Dentistry Feature Products & Services CONTACT US Phone: or Fax: Mail: The Profitable Dentist 3211 Grantline Road, Suite 20, New Albany, IN Website: Executive Vice President of Operations/Finance The Profitable Dentist EDITORIAL ADVISORY BOARD DELAINE STEWART Designer DR. MICHAEL ABERNATHY McKinney, TX Leah Taylor Shipping Manager DR. BILL DORFMAN Los Angeles, CA Taylor & Associates LISA MERKEL DR. DAVID HORNBROOK La Mesa, CA DR. MARK HYMAN Greensboro, NC Graphic Designer CATHY JAMESON Davis, OK Susan Vandyke DR. BILL KIMBALL Encinitas, CA DR. ROGER LEVIN Baltimore, MD 2010 Excellence in Dentistry, Inc., Publisher. Copyright enforced no part of this publication may be reproduced without written permission. This publication is designed to provide reliable information in regard to the DR. TOM ORENT Framingham, MA DR. STEVE RASNER Bridgeton, NJ subject matter covered. However, it is sold with the understanding that it does not replace the need for advice DR. LARRY ROSENTHAL New York, NY from your personal, competent professional advisors. DR. ROY SMITH Tyler, TX 4 SPRING 2010 DR. BILL STRUPP Clearwater, FL

4 Here Are Just Some Of The Rave Reviews From Dr. Oakes Latest Triumph In Dentistry: The best 170 pages on dentistry to date! A must read. -Dr. Steven Poulos, Scottsdle, AZ Thank you for your recent book, How To Turn Your Dental Practice Into A Cash Cow. There are so many different strategies recommended to improve your practices that they can sometimes be overwhelming. However, your book gives a step-by-step guide for us to grow our practices and provide a better service to our patients. Creating an office with satisfied patients (most of them), a smooth-running practice (most of the time), and a bottom line constantly growing while working less hours is a worthy goal and dream that can become a reality with your book and the consulting work you do. -Dr. Roy R. Smith, Tyler, TX When my copy arrived in the mail, I could not wait to open it and dive right in. I have learned so much from Woody s previous books, that I wondered how this new book would compare. I was not disappointed. It is filled with a wealth of information for any dentist at any level in these challenging economic times. It helps to have a cookbook for practice success from the best mentor you will find and this is it! Another great Woody Oakes book added to my collection. -Dr. Craig Callen, Mansfield, OH I thought this was a great book that covered a wide range of material, tons of good ideas and food for thought. -Dr. Ted Pinney, Jacksonville, AR Woody s latest book covers a wide variety of subjects that affect your office s profitability. It includes chapters on how to be a more effective manager/leader in order to create a more effective and harmonious team. The final two chapters detail the most profitable way to transition to retirement from your practice. I believe if you will implement half of his ideas, you could easily double your income over the course of the next year while experiencing greater team harmony and lowered practice stress. -Dr. Brad Pueschel, Peoria, IL Here s How You Can Get A Copy Of The Best-Selling Book In Dentistry! You knew that building a solid dental practice wouldn t be easy. But, did you ever dream that it would cost this much emotionally and physically? If you re tired of working long days, late nights and even weekends, only to realize that neither your practice nor your profits are growing like they should, then it may be time for a change. Turning Your Dental Practice Into A Cash Cow In Just One Year, is designed to take you, dear doctor, through every phase of making your practice everything you ever dreamed it could be. Chockfull of practical tips and advice, it is the guide s aim to answer all of your questions regarding: Patient Demographics and Bringing In A Continuous Flow of The Right Kind of Patients Establishing a Solid Marketing Plan Increasing Your Bottom Line Controlling Overhead Costs Converting Every Call Into a Scheduled Appointment Scheduling Dilemnas Motivating Your Staff Incorporating New Technologies Into Your Practice Handling Office Finances Developing an Exit Strategy including Selling Off Partnership And More Much, Much More ONLY $24.95 Sound ambitious? It is! But I guarantee that it s going to be a great ride and one well worth taking. Now, take one last look at your dental practice. This may be the last time you see it as it is right now. By the time we re done, you may hardly recognize it (or your staff). No matter where your practice is today, be prepared to be amazed at where, and what, it is exactly one year from now. Even the smallest practices that have utilized the ideas found in this book have as much as doubled their profits within the first 12 months. Ready to get started? Great! First, let s learn more about the patients you have now, and how to fill your chairs with more of the ones that ll enhance your practice and make your business grow Order your ticket to success TODAY with Dr. Woody Oakes How To Turn Your Practice Into A Cash Cow In Just One Year for ONLY $24.95! YES, please send me How To Turn Your Practice Into A Cash Cow In 12 Months Or Less for ONLY..$24.95 YES, Please send me the book and audio CDs for ONLY.... $97.00 YES, Please send me the Cash Cow book, audio CDs and workbook for ONLY... $ (Please include $9.95 shipping/handling. Checks may be made payable to Excellence in Dentistry.) Name: Address: City: State: Zip: Visa MC Amex Discover Check CC# Exp. Date: Signature: For Faster Service Call:? Fax: (812) Phone: ( ) Fax: ( ) Fill out order form and return to: E mail: Cell: ( ) Excellence in Dentistry, Inc Grantline Rd., Suite 20 New Albany, IN Copyright EID 2009 Code: NEWS

5 A Word from Woody Welcome to 2010! Except for the weather, I really enjoy the month of January. Why? Well, because it s a do over time for all of us. Even if 2009 was a total bust, we can start over and decide to make 2010 our best year ever. Remember that the past is the past, we must enjoy the present and the future is what we decide to make it. Each year I make a list of 10 personal/business goals and I m proud to report that in 2009 I accomplished all of them including getting married to a beautiful lady! So at the very least make a goal for your health, your personal life and lastly your business. As Yogi Berra once said, You can t hit the target unless you have one! On the next page is a form that you can use to set your practice goals for 2010 and we ll do our best to help you hit every one of them! Lastly, be sure to make plans now to join us for our 19 th annual Spring Break Seminar to be held this year in Orlando, Florida, April I truly believe this will be our best event ever! We re calling it the Dental Survivor seminar because this year will be critical to the survival of many dental practices. At this event we re going to teach you and your team to become William W. Oakes, DDS Editor-in-Chief and wife, Megan Dental Survivors. Don t you dare miss it call ILUVORLANDO to register today or visit www.! Regards, William W. Oakes, DDS Are You Taking Home HALF of What You PRODUCE? You Can Be With COACHING from SUMMIT PRACTICE SOLUTIONS Produce More, Collect All, Keep Half Mike Abernathy, DDS Summit ComphrehenSive CoaChing program is one of a Kind! 8 intensive IN-OFFICE Doctor & Staff coaching sessions (we don t just call) Unlimited phone & consultations Highly successful systems developed in Dr. Abernathy s practice producing $6 million per year with 50% overhead New & Improved Hygiene Coaching Designed to Increase Hygiene Productivity $1795 a mo* - One of the lowest cost coaching programs in the nation designed to give you a BIG Bang for your Buck and not Big Bucks with no bang Take the 50% Practice Overhead Test Staff Compensation Facility Lab Marketing Office Supplies Dental Supplies 24-25% 7-9% 8-10% 3% 2% 6% CALL for a FREE Dr. Abernathy s Practice Overhead and Benchmark Analysis Thinking about a Transition or Expansion? We now offer expert customized Transitions or Expansions for your practice! Call TODAY to learn more! 6 SPRING

6 If you ve never done a year-end review or established clear goals for your practice, you really need to make that your New Year s resolution. This doesn t really have to be a complicated procedure. Just spend a few minutes reflecting on where you are and where you d like your practice to be this time next year. You can copy and use the form below as a guideline. Then (here s the key), post your review/goals someplace where you ll see them daily. Share your targets with your staff, because they ll be an important component in reaching your goals, but only if they know what they are working toward (obviously you may want to use discretion in sharing some of the information). You ll be surprised how quickly you ll begin to see changes, simply because you ve put your goals on paper and have them close by as a daily reminder. Year-End Practice Review and Goal Setting 2008 Production +/ Production 2008 Collections +/ Collections 2008 New Patients +/ New Patients Review Goals for 2009: Goal #1 Achieved Y or N Why? Goal #2 Achieved Y or N Why? Goal #3 Achieved Y or N Why? Projected Production for 2010 Projected Collection for 2010 Ideal Goals for 2010: Goal #1 Explain Goal #2 Explain Goal #3 Explain Marketing Dollars Spent in /- Marketing Budget 2010 Total Staffing # /- Projected 2010 Staffing # Areas of Staffing Concern SPRING

7 In The spotlight GeofferyHolman Productive Dentist Academy Featuring Dr. Bruce Baird, CEO Imagine a dentist sitting in his office thinking of a strategy to raise production in this tepid market. He begins by thinking about external marketing, How can I get new patients? then turns to internal marketing, How can I squeeze more dentistry out of existing patients? and so on. The problem with that approach is that the thinking is backwards. The thinking has to start in the clinical chair: What are your annual production goals? How about hourly? How many days/week do you want to practice? Then, you need to work your way backwards from there. I know the dentist above (okay, it was me). I was continually frustrated because I kept focusing on the wrong things, but then one day, it all clicked. PDA is unique because we focus on clinical production. If you re like most dentists, you ve worked with a few consultants. And as a result, you probably have some decent systems in place but as you now know, systems alone do not drive production. PDA is unique because my partner, Vicki McManus, and I focus on clinical production and efficiencies. Yes, we teach you and your team how to refine your systems, but the systems aren t the focus. Helping you do more dentistry is. And I think that is what we do better than anyone else. Everyone told me you couldn t teach this stuff; that high level production, what we consider $1,250/hour or more, is largely personality driven. In the beginning, the only way I could get people to our course was to offer a 100% unconditional, money-back guarantee. Today, we still offer it: if doctors don t increase their production by $300/hour then they get their tuition back. A dentist could go from $350/ hour to $650/hour in just 60 days by implementing the tools we teach. I m a Texan; I only believe in real-life, meatand-potatoes kind of stuff. If it doesn t directly impact your production, we don t teach it. Plain and simple. I d love to be able to claim that it s brilliant, earthshattering material, but frankly, I m just not that smart. If you re dealing with anemic production, the first thing you have to do is stop blaming your staff. You either have the right people who are in need of training, or you have the wrong people who need to be replaced. Either way, it s a leadership issue that only you can address. The second thing you have to do is stop blaming low production on the economy, the size of your town, or any other influence outside of your control. You, and you alone create your reputation and are responsible for attracting patients to your practice. In life, as in football, you won t go far unless you know where the goalposts are. You can t credit me with that quote; it s from Arnold Glasgow, whoever the heck he is (told you I m not that smart!). Still, it s true in dentistry. So many dentists come to our course without a production target or a good game plan to get there. At the end of our seminar, they ve got both. We think we can make the practice of dentistry a lot less painful. Putting on our 3-day programs take a lot of work and time away from my family. People ask, Why bother? I teach because we ve landed on an efficient way to create wealth which makes the practice of dentistry a lot less painful and a whole lot more fun. There are few problems that an extra $150,000 in your pocket won t help. Continued on page 45. Productive Dentist Academy specializes in helping dentists produce $1,250/hour or more Productive Dentist Academy offers a 3-day clinical coaching program for doctors and teams. The program outlines the specific clinical skills, strategies, equipment, and technology required to consistently produce $1,250/hour and net $600,000/year. The PDA program is under the direction of co-owners Dr. Bruce Baird and Vicki McManus. PDA is ideal for doctors who have attended hands-on programs, invested in team training and the latest technology yet are still producing under $1,000/hour, says McManus. Programs take place in Dallas, Texas on: April 15 17, 2010 July 15 17, 2010 September 30 October 2, 2010 Productive Dentist Academy is also the only clinical coaching program that comes with an UNCONDITIONAL GUARANTEE: raise your production by $300/hour or your doctor tuition is refunded in full. For more details, call Or visit 8 SPRING

8 Editorial The Truth About Debt And What Your Banker Doesn t Want You To Know! by Ralph Duffin, DDS At a time when most dentists are considering retirement, Dr. Duffin s life took a turn for the worse. Ralph s son, Steve, was involved in a near-fatal plan crash and Ralph lost his retirement nest egg in a business venture that went sour. To add insult to injury, the IRS overturned one of his tax shelters and he was left broke and hundreds of thousands of dollars in debt. During this sink or swim time, Ralph began exhaustive research on investments, banking, and how to create a family fortune. And here s what he learned: Pearl #1: Avoid debt with a passion and pay cash whenever possible. When you use credit cards (plastic), you will spend at least an extra 20-30%. Paying by cash or check is like paying with real money, and thus the tendency is to purchase less! Pearl #2: Establish a family budget and learn to live on less and save the rest. Remember: It s not what you make, it s how you make what you make work for you. An example of using the family budget would be planning the purchase of a new car. For example, try saving (budgeting $300/month) for a car. At the end of four years you will have saved $14,400 plus interest. This amount, coupled with your trade-in ( roll in as my Dad used to say), will purchase a pretty good mid-sized car or a super top-of-the-line used car! Pearl #3: Stop impulse buying! Discount and department stores are great when it comes to making you impulse buy. They get you in the store with a great price on one item and you end up buying that item plus a bunch of junk priced higher than usual at times. Therefore, you must plan your shopping, make a list, and stick to it. Recognize the true cost of what you buy. If you gross $100 and have 60% overhead, you net $40. Of that $40, nearly half goes to state and federal taxes. So, an item costing $20 actually costs $100 (5x20). Keep this scenario in mind each time you decide to buy something. A $1 pack of baseball cards actually requires $5 of production in your dental practice. Pearl #4: Make savings an expense. Each Friday, write a check for at least 10% of that week s collections and put it in investments. You don t have to draw out this much, but pay yourself before paying any other bills. Think how much money you d have now if you had saved 10% of everything collected since you started practice! And, this is so easy and painless to accomplish! Pearl #5: Teach your children the value of a dollar. Teach your kids how to work and let them open their own savings account. Pearl #6: Unbank. You ll drop your teeth when you see how much that 30-year mortgage costs! Credit cards are really disastrous! MasterCard and Visa charge rates almost equal to loan sharks. They all offer charge cards to college kids now, and many owe thousands in a short period of time! And be sure to read the book Rich On Any Income by James P. Christensen. Consider Dr. Havitnow and Dr. U.R. Smart. Both want a $125,000 starter house and a $50,000 sports car. Dr. Havitnow buys both just out of school and makes payments on both. Dr. U.R. Smart pays off the house first (using the car payment as accelerated payoff money) and buys the car when the house is paid off. He then makes car payments and invest the old house payment. After 30 years, Dr. Havitnow owns a house and a sports car, but Dr. U.R. Smart owns a house, a sports car, and has $569,000+ invested in his retirement plan! Therefore, it s better to be smart than to have it now. (Why doesn t someone tell senior dental students this amazing story?) Dr. Ralph Duffin practices in an unconventional setting and enjoys high profit and low stress delivering comprehensive treatment to totally cash paying patients. Dr. Duffin enjoys 85% profit with only 15% overhead, sends no statements and has no accounts receivable SPRING bloggityblog

9 practice management Reciprocity... I Owe You! by Dr. Tom Orent my flower. One of the boldest examples of the psychological Principles of Reciprocity. Hari Take Krishna. In decades gone by (fortunately), you could barely walk through an airport without being accosted by a member of Krishna. They would do just about anything to get you to take that little wilted flower. And you knew their game. Like it or not... like them or not...if they got the flower into your hands, you gotta pay up! Bizarre as it may have seemed, you just couldn t walk away without making some small donation if you had their flower. Like you didn t even realize why at the time. The reason, according to Dr. Robert Cialdini, Psychology Professor at the University of Arizona, is the Principle of Reciprocity. Once you ve been tagged with their flower, you can no more walk away from a Krishna without donating than you could ignore the hungry cry of your newborn infant. It s nature. Natural. Instinct. And Krishna knew it. According to Dr. Cialdini, we have a set of these principles ingrained in our being. They re just as much a part of you as breathing. We act without needing to think. This is a good thing. Every day we are faced with thousands upon thousands of little decisions. No way we could deal with them all on a conscious level. So we have our psychological principles to help guide us unconsciously from moment to moment. The Irresistible Donation to Veterans of the XYZ War and How to Get Invited to the Joneses. We ve all been there. You get an envelope in the mail. It s thicker than just a regular letter. Seems as if there s some little free gift maybe? You open the letter. There they are. Return mailing labels with your name and address on them! And a little tiny picture of the American flag. Can t throw them out. First they ve got your name and address on them. Second, there s a little picture of an American flag. I m sure they ll come in handy for something. Of course, now you re stuck. Your feel obligated to make a donation... though you ve never heard of the Veterans of the battle of Florida. Anyway, it ll be your first chance to try out your new return mailing labels! How convenient! Do You Ever Wonder Why Patient s Leave? by Dr. Woody Oakes The Profitable Dentist, did a survey of 100+ dental offices and this is what we found. 1% Died 5% Moved away 5% Heard word-of-mouth from friends to stay away 14% Unhappy with the product 16% Left for competitive reasons, such as an HMO, PPO or office closer to home 59% Were displeased with an attitude of indifference on the part of an office representative How can we make sure we don t demonstrate this attitude of indifference? 10 SPRING

10 practice management PRE-SELLING by Dr. John Davignon for results As you know, one of the irrefutable laws of success in the dental office is the ability of the dentist and his staff to sell the dentistry that the patients require. Most dentists try to present all the needed treatments immediately after having completed the examination on a given patient. One of the problems with this approach, especially with new patients who do not yet have complete confidence in you, is that the patient is led to play the role of the consumer. He will ask himself, what will the doctor try to sell me? He will then try to find an objection to everything you propose. On occasion, the dentist will begin to argue with the patient. The atmosphere quickly deteriorates and the dentist ends up with either 1) losing the patient or 2) establishing a treatment plan worthy of a third world country: fillings, extractions and removable prosthetics! I have developed a system that permits me to sell elaborate treatments such as periodontics, crown and bridge before I have even done the exam! When I see a new patient for a complete exam, the hygienist will greet the patient and proceed to take the needed x-rays, complete the medical and dental history and note all the previous dental work, the missing teeth plus the bleeding index and the periodontal probing results. She then seats the patient and hands him a magazine or the TV remote control and comes to notify me that all the preliminary steps have been completed and that the patient is ready for the complete exam. As soon as I can free myself, I step out of the operatory and make my way to the room where the new patient awaits. However, rather than immediately stepping into the room, I have my hygienist give me a short briefing which must answer the following questions: 1. Who or what made this patient come to OUR office (referral source) 2. What is the patient s main problem? 3. Is this a nervous patient? 4. What is his periodontal condition? 5. What is the state of his dental health? 6. What is that patient s primary motivational goal (esthetics, health, money, pain, etc.) This briefing should last no more than 2 minutes. Now when I enter the room, I know the patient much more than he knows me and I will steer this edge to my advantage. Studies have shown that when a stranger (the patient) meets you (the dentist), you have no more than four minutes to make a favorable impression on him. Once the 4-minutes have expired, a first impression has been created and will be very difficult to change. I therefore use those first four minutes to project a favorable image of myself. I always greet the patient alone, without any auxiliary personnel present. I start by introducing myself and engage into a non-dental conversation with the patient. I then ask the patient what he desires and let him speak as I take down notes and question him in order to clarify his wishes. Studies have shown that when you meet someone, you have no more than four minutes to make a favorable impression on him. When the patient has finally said all he has to say, I tell him that I will go over his questions and concerns in a few minutes but that I would first like to share our office philosophy and our objectives to determine if they are compatible with his own. This leads me to give my small presentation taking into account the information gathered earlier by my hygienist. For example, if this patient s primary motivation is money, I will say something like this: My objective is for my patients to keep dental care costs to a minimum. However, if the patient s concern is esthetics, my presentation may start this way: My objective is for my patients to have the brightest and most beautiful smile they possibly can and to keep their teeth for a lifetime, I think you get the picture Then I will ask the patient if this reflects his way of thinking: Is this what you are looking for in a dentist? If my hygienist did her job right, 99% of patient will say YES! O.K. So far so good. You have been with the patient for approximately 5 to 10 minutes, he finds you friendly, you have created a good first impression, you are human and you have listened with interest to all he had to say (you even took notes). The patient feels that he has finally found a dentist who wants what he wants. He is now ready for pre-selling SPRING

11 So my little speech continues this way: The only way to reach this objective is through prevention. Our office is prevention oriented as we would rather prevent things than fix them. Prevention will evoke a positive image for most people. I then follow up with: There are four things that can make you lose your teeth: 1-decay, 2-gum disease, 3-tooth breakage or 4-teeth that move. Luckily all four of these problems can be prevented. Once again you should attempt to custom fit your presentation to the patient s needs. Only a brief description is given about a problem for which the patient does not have. A more elaborate presentation is given for problems the patient does have. Let us take for example a patient who has moderate gum disease with a few periodontal pockets and requires scaling and root planning and also has large 5 surface amalgams on a few molars. The patient is also very nervous about dental treatment and is frightened by lengthy or extensive work. [Remember, you have obtained this information through the quick huddle with the hygienist and by rapidly glancing at the patient s x-rays. You have not yet done the exam.] THE LIVE PRESENTATION Let me tell you exactly what you must do to prevent any of the four problems that could bring on extensive treatment or the loss of any teeth. The first problem is decay. The secret to avoid cavities is to reduce the number of times you eat! Ideally we should eat three meals a day and only drink water between meals. Doing this alone can reduce cavities by up to 80%. The second problem is periodontal or gum disease (the patient has this problem so extend your discussion a little longer here). This is the biggest reason for tooth loss in adults. (Now you may go on and explain what periodontal disease is ) To detect if you have gum disease we measure the depth of the space between your gums and your teeth with an instrument. When the depth is no more than 3 millimeters the gums are normal. At 4 mm there is slight periodontal disease, 5 mm means moderate periodontal disease, 6 mm shows severe gum disease and when a pocket reaches 8 mm or more the tooth becomes too loose and can no longer hold properly. Did the assistant measure your periodontal pockets? (The patient says yes.) Okay, let us look at the results together. (Look over the probing results written on the chart with the patient.) You have 5 mm pockets here and here You have moderate gum disease. Fortunately, you re lucky that we discovered the problem at this stage. Had we noticed this only in a few years, you would have required complex surgery in an attempt to save your teeth. custom fit your presentation to the patient s needs However, all you will need now to arrest the disease is an indepth cleaning under the gums with a local anesthetic which is even more comfortable than a regular cleaning since you will be numb. Afterwards, in order to prevent the progression of the disease, studies have shown that cleanings every three months are ideal. (Often, after seeing the probing scores on his own chart, the patient will himself ask what we can do.) Now you have sold the case and you have not even done the exam yet! The third problem is teeth that break. Studies have shown that when a filling extends to more than half the tooth, the tooth is weakened and will have a tendency to break. Since the tooth holds the filling, the more filling there is on a tooth the less tooth structure is left. Furthermore teeth become more brittle as we get older. Sometimes a tooth breaks in a way that we can repair it, but often the tooth breaks vertically and we have to extract it which often requires surgery. To prevent extensively filled teeth from breaking and to strengthen weakened teeth we place what we call a crown or a cap on them. This is simply like a hat that goes on top of the tooth and surrounds it, strengthening it. While doing my exam I will look to see if you have any fragile teeth. The fourth problem is teeth that move. (The patient does not have this problem so you can be brief.) The reason teeth start moving is because they are no longer supported by the adjacent teeth. When you lose a tooth, the others may shift and lead to more tooth loss. Prevention of this problem is simple if you lose a tooth you have to replace it. There you go, you have just completed your course in Dentistry 101. Do you have any questions before I proceed to examine your teeth? Talking about dentistry and prevention and not specifically about the patient s mouth puts the patient at ease. He is less cautious and more open and attentive. Instead of being defensive, he tries to understand the explanation rather than putting forth objections. Then, once the patient has understood the explanation, you can relate to his particular condition. THE PRINCIPLES OF PRESELLING: 1. Huddle with the hygienist (get to know your patient before making your presentation) 2. Glance at the x-ray 3. Custom fit your pre-sales dialogue with the patient 4. Know what you are going to say (rehearse your dialogue until you know if perfectly) 5. Educate before speaking of the patient s condition. 12 SPRING

12 practice management Design Implement and Achieve Success in 2010 by Dr. Chris Griffin Is there one super ultimate secret that we can use to guarantee success as we try to improve our practice? That is the question that I posed for myself and some of the greatest dentists of today as I began researching for my book last year. I interviewed some of the best dentists in the country, including our very own Woody Oakes, to try to get their take on this question. All of them have an opinion on the topic. They may all have a little bit of difference when it comes to specifics. I ll tell you what I did find, though. Each and every one of them has a high degree of enthusiasm. This is an enthusiasm for dentistry, education, and just life in general. If they all share this trait, let s take a look at it. As I began to get consulting clients and newsletter subscribers, I found out why motivation was included in all the other programs with which I had been involved. It s darn hard to get someone up off the couch and get them doing something. So, here we are talking about enthusiasm and motivation. I hate that I am going against one of my early tenets of not talking about so much rah-rah stuff, but I hope that I will always be open to change when I know I am doing the right thing. As I get older I am finding it less difficult to admit that SPRING

13 I was going in the wrong direction. I can then switch paths more easily, without the feelings of guilt I once had. It has become obvious to me that there is a place in learning for any type of motivation that will get the job done. There are many obstacles that any dentist or businessman will encounter along the way to success that can only be endured with motivation and enthusiasm. If you are reading this and you have a great idea to implement, you will need motivation to get past the initial idea phase. You will need it to sell the idea to yourself, your staff, and your spouse. It is not impossible to succeed without your spouse on your side, but if you can get them, you need them. It will make life so much easier. Who needs to ride up a mountain on a tricycle with a 50 pound sack of concrete over their shoulder? You will need motivation to get past the roadblocks your staff or employees will invariably throw up. You will certainly encounter both overt and covert obstacles and varying degrees of entrenchment when you try to sell your staff. Heck, you will need motivation to get past yourself when you realize just how much work all this is going to be to get in place. Please don t try to do this if you re not excited about it. Put it aside for another time. If you can t muster up the energy, you will never reach the top of the head. I know you have heard that the air is better at the top and the company is better up there. Let me tell you that to get to the point where you can put your practice or business on auto-pilot and coast down the other side, you will have to find some way to motivate yourself. I know it s hard, but what s not hard if there is a big, fat reward sitting on the other side? Motivation is more than hard now, and it s getting harder every day. It is impossible for some people to become motivated. I ve seen it both ways. I have seen seemingly dull, lifeless people catch fire and implement not only my stuff, but all they could get of anyone else s stuff, too. That s the power in motivation. I have seen others come alive at a seminar, only to later inquire about them and find that they just couldn t force themselves to implement once they got home. It is not simply enough to say that motivation is important. To truly understand motivation and the way it helps you get stuff done, you need to find out what really gets you going down deep inside. There are only a few big categories of true motives in my opinion. Here are three: Social Motivation: People who are motivated by this are usually more interested in the cementation and propagation of social connections and affiliations than anything else. They may enjoy stature if it improves their standing in their own community. They will not try to achieve anything drastic if it means they will be isolated and cut off from their current affinity group. It is also hard for these people to be bosses or managers because they are always caring about what others think of them. Other people s opinions are big motivators for them. Social Motivator: You want to learn a new technique or procedure so you can enjoy the community of others who have mastered this skill. You will work best when some group acknowledgement is expected. Outcome Motivation: These people really are out for the money. Well, not exactly. They are after the final result of their pursuit, whatever that result might be. Many times it is money, but it could be anything. These people will always pick the easiest path toward the final goal with the least resistance. Outcome Motivator: You will feel pride and accomplishment when you grow your practice to a certain level. You will work best when lofty goals are attempted with some risk and a large reward is involved. Security Motivation: These folks are more concerned with keeping the status quo than anything else. If they go after a difficult goal, it is because it was their only hope of maintaining their current situation. They will rarely throw caution to the wind to achieve something new. Their main focus is on not losing things. They don t like risk. Great rewards don t motivate them much if there is even a moderate risk involved. Oftentimes these people are very competent at what they do. They got that way because they selected something to go after that they knew they could master pretty easily. Once it was mastered, they stayed right there. They didn t want to climb the achievement ladder any further because they didn t want to risk what they had already gained. Security Motivator: You are motivated by the freedom you will feel when you know your retirement is secure and guaranteed. You will achieve best when safe retirement goals are attempted. You really need to be honest with yourself if you want to truly succeed. There is no right or wrong reason for motivation, but you must define yours if you want to really get it. So, get it, get motivated, and start the new year off right. To download the FREE ebook, The Ultimate Success Secret: Not Just For Dentists, go to Dr. Griffin is a solo private practitioner in Mississippi who does consulting, writing, and product creation for dentists. 14 SPRING


15 Practice management Surefire Ways to Get In Your Own Way by Howie Horrocks & Mark Dilatush Warning: This is a shoot straight from the hip article. The tone of our writing is purposely antagonistic to make a point. We do so, not because we are antagonistic. The tone is there because we want to motivate you to take action. Be as demanding as you can be during the initial phone call. If a new patient calls asking to have their teeth cleaned, is there a legitimate reason you can t clean a new patient s teeth during their first visit? You can always educate the patient of their need for soft tissue treatment after you clean their teeth (satisfy their initial reason for calling in the first place). Is there a legitimate reason why you might require a deposit over the phone to reserve their appointment time? Did you institute that barrier because you had a high percentage of new patient no-shows? It was likely your promotion at fault not the patients. Don t build more walls! Take the walls down! Is there a legitimate reason every new patient must go through a 1.5 hour new patient workup and come BACK to the practice to find out the dentistry they need? Can t you do a limited exam and present the comprehensive exam as part of your future treatment recommendations? In other words, can t your new patient exam protocol be more fluid rather than more rigid? Can t you adapt after the initial phone interview based on the patient s stated needs/objectives? Let your ego drive your design and deployment decisions. Is the goal of your promotion to attract great new patients? Or, is the goal of your promotion to create a monument of your professional achievements? We re not saying that graduating from a certain dental school isn t important, it is. We re not saying that completing oodles of post graduate education isn t important, it is. We aren t saying that the dental work you did on a supermodel wasn t terrific dental work, it was. What we are saying is that these are not important to the dental consumer. If you take it too far, you can actually turn off the dental consumer! There is a fine line between promoting your practice and seeming full of yourself. You know what resonates far better with the majority of dental consumers? The candy buy-back program you sponsored at Halloween, where you bought the candy back from kids in the local community and sent the candy overseas to our troops! The discerning dental consumer is fickle. What you think makes you a great dentist doesn t necessarily make you a great dentist in the consumers minds. 16 SPRING

16 Let your staff, spouse, family, friends, or a generic graphic designer dictate your design/copy/ targeting choices. The scenario is all too common. Your staff, spouse, family, friends, and a generic graphic designer have NEVER promoted a dental practice before. The chances that they will stumble upon effective design layout and copy are slim very slim. This adds significant risk to your advertising dollar. The same thing can be said about targeting. Every dentist, spouse, and staff wants to promote only to the visibly perceived high income areas in town. They want to ignore all of the areas that aren t as visibly upscale. That s a mistake, potentially, a very costly mistake. All of the population in the US does not live beyond their means. There are plenty of potential high quality new patients that do not use their home as their primary source of wealth. There are plenty of high income earners in this country that live in modest housing. We understand this is a tough one. The best solution is to simply delegate the promotion of your practice to a reputable firm. Let the professionals dictate design, copy, and targeting. Whatever you do, don t bother tracking the number of inquiries by promotion source. Every dentist in America thinks their referral source data in their practice management software is accurate. So, they run a report once a year and use the data on those reports to gauge whether a promotion was successful or not. We have another shocker for you. In twenty one years, we have NEVER experienced ONE dentist with pristine referral source tracking not one. So, dentists everywhere make ill informed business decisions with (at best) partial information to guide them. It doesn t have to be that way. What you want to do is set up a unique telephone number and call tracking system with each of your major outbound promotions. What you get in return is astounding. You will have quantified evidence of every inquiry from each promotion. You will get to listen to each phone call to determine the training level of your team (or share it with your management consultant/staff training specialist). You will KNOW when your phone rings during business hours and nobody answers it. Basically, you will know and be certain of everything related to your promotions, if the inquiries are being handled, and how inquiries are being handled. For goodness sake, don t ever call your new patients the day they call to make their first appointment. All new patients have a level of nervousness before visiting a new dental practice for the first time. Some new patients are 10% nervous, some are 100% nervous. All you have to do to get your cancelled new patient appointments down to zero is simply call the new patient on the same day they call to make their first appointment. Yes, the dentist should make the call. Call them, ask them if they are currently experiencing any dental pain of any kind (they won t be or they d be in your emergency schedule), ask them if they have any questions at all about their appointment on [day] at [time]. Remind them of exactly where you are located and exactly where there is ample parking. Communicate that you are very much looking forward to meet them on [day] at [time]. BINGO! You will see an immediate decrease in new patient appointment cancellations. Make sure you totally ignore the back door of your practice. Are you of the mindset that enough new patients will solve all of your problems? Well, a good number of great new patients will solve a few of your problems but not all of them. In order for an effective promotion circle to be truly successful, patient retention and patient advocacy must be nurtured and measured. If you bring in 25 new patients a month and 25 existing patients are falling through the cracks, is your practice growing? Well, temporarily it might. Maybe if all you do is full mouth rehabs. But, for the vast majority of dental practices out there, the ultimate goal is to bring in more new patients than the attrition through the back door. This is really the only way a dental practice will grow revenues consistently. We want you to go do this exercise right now to determine if you indeed need to spend some time and energy working on your patient retention and patient advocacy. 1. Go run a new patient report from through Tally the total number of new patients between those two dates. This is your front door. 2. Go run an overdue recall report from through Tally the total number of existing patients that have or are in the process of walking out your back door. 3. Compare the two numbers. Best scenario is that your incoming number is about twice as high as the outgoing number. Unfortunately, only about 10% of you reading this will get that result. Most of you will get almost even numbers. Some of you saw fewer new patients than those leaving your practice. This is a simple measurement that should be run monthly and logged onto a spreadsheet. Summary: If you really want all you can get from your marketing dollars, commit yourself to making some internal changes. Long term successful promotion of a dental practice requires change. Some of that change may certainly be your promotion, design, message, targeting, deployment progression, etc. These can be handled by a reputable firm. But many times, the dental practice needs to change a bit as well. If you do need to make some changes, make them. You will be a happier dentist in the long run. Howie Horrocks is the Founder and CEO of New Patients, Inc., the ad agency exclusively for dentists. Mark Dilatush is the Vice President of New Patients, Inc. For more information: call or visit the web at SPRING

17 PRACTICE MANAGEMENT Discounting Your Fees Is NOT the Answer by Robert H. Maccario, MBA Yes, these economic times are unique. Practice growth and profitability goals can seem difficult to reach. Making sure your current patients/guests accept care and/or actually show up for appointments can be a challenge. And attracting new patients/guests can be expensive and daunting. How is a practice to thrive in these times? Some dentists assume that scaling back discounting fees and cutting cost is the answer. But beware: these tactics have serious ramifications. Not only can they negatively impact your commitment to clinical excellence, but they can also damage your practice s reputation in the community. You have invested considerable time, effort and money to develop your skills and your brand/image. Don t devalue this investment with shortsighted tactics. Discounting Your Fees Impacting Your Brand First of all let s establish a very basic definition of brand. A brand is your identity, distinguishing you from all the other options available to consumers. More than just a logo, which is the graphic representation of your business, a brand communicates everything about you. A brand characterizes your business, encompassing what you do and how you do it. Everything you do must reinforce your brand. In his article Discounting Prices Discounts your Brand in Marketing Profits ( discounting_ret.html.), Paul Williams states, The problem with discounts is that customers don t see the price drop the same way you do. As a business person, you clearly understand you are temporarily cutting into your own profit to give a little more to the customer and keep their business. As customers we see it different. The moment you discount, it re-calibrates the perceived value of your products/services. Selling something for $200 today and discounting for $150 tomorrow tells us you are making more money on the $200 version and you re still making money on the $150 version so the $200 version was over-priced. The new perceived value is $150. As a consumer buying something, we get this. As a marketer selling something, we tend to ignore this fact. Another downside to discounting; it is the easiest competitive move to counter. It is just as easy for your competitor, be it another dentist or any other consumer product, to lower prices as it is for you. Therefore, if your practice is based on quality, you will probably never be the lowest cost. The anticipated increase in production from discounting will probably never materialize you ll just end up doing the same care at a lower fee and dramatically lower profit. Differentiation vs. Discounting Businesses with a consistent track record of success, competing in the quality/service marketplace (rather than the low-cost producer marketplace) understand they need to continually enhance their brand by providing more value. By providing more value they differentiate themselves from their competitors in the marketplace. 18 SPRING

18 Raising the Value of Your Brand In the consumers eyes quality relative to price determines value (Q/P=V). If your price is too high relative to quality, you will have a low value. If your price is too low, you may actually detract from your value and be perceived as poor quality. Your fees (pricing) are part of your branding. This is where discounting can negatively impact your brand. Understanding Quality In every business quality is comprised of two components, conformance quality and perceived quality. Conformance quality is the technical aspect, in dentistry it would be the margins, occlusion etc. Perceived quality has to do with the perceptions of your patient/guest; the ambience of the reception area, were they seen on time, etc. You are the expert on conformance quality and in the consumers eyes the mere fact you have a dental license implies some acceptable degree conformance quality. Perceived quality is based on the opinions and experiences of your patient/guest. The patient/ guest is the expert on perceived quality, therefore perceived quality becomes the significant determining factor in their buying decisions. Boosting Perceived Quality You build your practice on conformance quality (clinical excellence) but you market the perceived quality: listening, caring and a variety of services beyond just doing a crown. This important concept dramatically influences treatment acceptance and practice growth. To be successful in today s competitive environment, a practice must offer state-of-the-art services consistent with their quality of clinical care. Together, the entire package creates a higher value to the consumer. Rewards That Really Do Motivate Rewards programs have been proven to influence purchasing decisions and engender loyalty. Utilizing similar technology as automated appointment reminders and consistent with a value-added approach to guest s services, is Loyal Patient Rewards. It is derived from a marketing/software program many Fortune 500 companies have used successfully for years. It automatically promotes tracks and delivers valuable rewards. Just as healthcare credit cards and automated patient communications have become the standard of care, implementing a rewards program is a consistent step in the evolution of a well-run practice. A rewards program will enhance your practice s brand and increase your bottom line. Robert H. Maccario, MBA is president of Dental Management Sciences, LLC, a business management firm for dental practices. Bob earned his MBA. from Pepperdine University. He is a veteran of the dental field, with over 40 years of experience. He teaches the Dental Concierge Turn your patients into guests, a complete system to teach practices how to evolve out of sending statements, eliminate accounts receivable, and to minimize insurance dependency. He also teaches the Dental MBA Leading practices into the new era of dentistry. This program utilizes proven business systems to highlight clinical excellence. Bob owned and operated a large commercial dental laboratory in Oakland, California for 18 years prior to managing dental practices. Bob is a popular speaker to the major national meetings and has had articles published in numerous dental publications. He participates in various business/dental organizations and a member of AACD and ACE. He can be reached at ext 2# or Grow Your Practice How do you increase the value of the brand and motivate your current patient/guest to keep appointments, reactivate the ones that are overdue, attract new patients and get them all to accept treatment? How do you avoid discounting your fees and possibly being forced into using a cut rate lab, switching to cheaper materials or laying off a key employee? Tactics Consistent With Long-Term Success The key is value-added services make it easy for guests to communicate with your practice and make them feel appreciated. Automated Guests Services Most practices have been using healthcare credit cards with their easy-to-use technology for many years, and more recently over the last few years automated patient communications with their technology have made significant inroads into practices SPRING

19 PRACTICE MANAGEMENT Protect Yourself! by Ralph Laurie We re in a financial crisis in the United States featured by widespread foreclosures, bank failures, high unemployment, and a slump in manufacturing, which marked the end of the economic expansion. You might think that I was just describing our current economic calamity. Instead those words marked, The Panic of 1819, which lasted five devastating years. While we declared our independence in 1776, we did not become an operating country until approximately Over the last 222 years, the United States has endured 4 economic depressions, 16 major recessions, and 9 major wars, totaling 156 years. Another way of putting it, is that 70 percent of our time as a country has been spent in turmoil. That means as a business owner, manager, or employee who plans on working for 30 years, you need to be prepared for 21 years of hard times. Interestingly, every boom or growth cycle, has been followed by a severe downturn.. and, the bigger the boom, the bigger the bust! So then, business as usual, at least over the past 222 years, has been short booms, followed by busts, interspersed with wars that were usually caused by some type of economic calamity. As a dentist or a dental vendor, how should you conduct business to cover yourself during the good and the bad times? The answer is quite simple. During the booms be frugal and position your business for the inevitable bust, and during the busts be even more frugal and prepare your business for the eventual boom. You should always assume the worst and be prepared for turmoil no matter whether you re making money or not. I call it healthy paranoia. What then should you be doing regardless of the economic times? At the very least, you should start by questioning everything. Your business needs an operating protocol designed to keep you efficient, effective, and profitable regardless of the economic scenario. Here are some tips to follow. Expense Management Expense Management is an imperative for a successful business. It is vital for you to continue to question where your money is being spent. The most difficult time to watch the outflow of dollars is when the business is making money, usually characterized by a boom economy. What s a few thousand here or there? After all we re flush with cash. I suggest the following to keep your business on track. Make Rules for Spending (Awareness) It s important to establish a protocol for how money is spent in the practice and it should be good for everyone including the owner of the practice. Awareness in good times is essential during tough times. When you follow this, during the boom times you will have excess cash which will give you a great fall back position when the cycle reverses itself, which it most certainly will. Set a cash reserve limit and decide, in advance, how it is to be disbursed. Negotiate Everything We have a tendency to be lax when things are going great for us and we sometimes forget that in a free economy, everything s negotiable. This is extremely important in the down times, but shouldn t be forgotten when things swing back to booms. The most important part of negotiation is the ability to walk away. If you can walk and go to another vendor, you have the upper hand. You don t need to throw that in the face of the person with whom you re negotiating, they already know you can walk. I have a doctor friend who renegotiated virtually all of his expenses categories including lab and supply fees. Just from asking he saved $40,000 a month from his operating expenses. This is no bull, he actually saved this much money. Times are tough for most, but for him, he s flush. When things turn around, he ll be swimming in dough. He told me that he wished he would have done this years ago. That s $480,000 a year without hurting how his practice operates. Credit Card Processing Fees How much are you paying for processing credit card transactions? Why would you not want to shop around and ARTPUPPY 20 SPRING

20 get the absolute best rates? This should be an ongoing part of your expense management protocol. You can contact Leo Townsend (International Payment Solutions) at Leo will review your credit card merchant statement and let you know how much money he can save you! Electronic Claims Processing If you re creating electronic insurance claims and you re spending between $.40 to $.50 per claim, you should be asking why? ClaimEx, a very reputable firm, charges approximately half that. It will save you so much money, it s just good business. Lab and Supplies These two categories are huge areas where you can save money, but you have to ask. My friend called his lab and asked for a 10 percent reduction in his costs. He was shocked when the lab reduced the expense by 10 percent without negotiation. Even if you re using Patterson Dental or other full-service supplier, you need to ask for a reduction in the costs. You might be pleasantly surprised. And, if they won t negotiate, you need to seriously consider moving on to a company who will. Watch Capital Purchases There are definitely times to buy and times not to buy new capital equipment. The most important thing to look at is the return on investment. Of course, every vendor is going to give you a story about how their piece of equipment will not only save you money, but will make you money. Still, beware of the following traps. Beware of Impulse Purchases Even if you have a need to purchase an item, beware of plopping down money without following your protocol. Ensure that you follow the rules below: Have you gotten the absolute best price for the equipment? Remember if you can walk you have the negotiation edge. A tactic to use is making the sales representative put time into the sale. The more of the rep s time that is put into making the sale, the less he will be willing to walk away. Avoid Long-Term Contracts Many of us are willing to sign long-term contracts with vendors for the use of their products and services. Contracts are compelling and if times get bad, your income can drop, but your contracts live on. If you over commit to contracted payments for a time period, you d better have fall back money to make those payments throughout the life of the contract. is the interest you are paying on your loans. While, your accountant or tax adviser should direct you, I think you ll find that the peace of mind from having zero debt will go a long way to offset any tax advantage you receive from throwing yourself into debt. Plus, if you are truly getting a return on investment, you will restore your cash position because of the effectiveness of the new purchase. What is the True ROI? Establishing the true ROI should include the following as part of the calculation. What is the mean-time between failure rate (MTF)? Most sales folks don t have a clue what this means let alone what it is. The MTF is the amount of time the piece of equipment will perform before it has a tendency to fail or need a major service. If you re paying added costs for repair, loss, or damage, it should be part of the ROI calculation. What are the hidden costs? (Shipping & handling, conversions, training fees.) Ensure that all the hidden costs are included in the calculation. While this rarely is discussed in an ROI calculation, you need to take into consideration two very important pieces that can cause any ROI to fly completely out of the window. 1) Does the dental team have the ability to meet the capabilities of the equipment you re purchasing? 2) Are there any psychological mindsets or fears that can create subconscious sabotage among the team members? Incorporate Practice Management Extended Tools During the good times, areas of the practice that need attention such as recalling patients, chart audits, external and internal marketing, and ongoing practice analysis tracking have a tendency to slip. Why? Because the practice is making money, and the dental team is focused on other things. It s common for confirmation calls, recall postcards, overdue recall processing, practice newsletters, surveys, and reactivation letters, to take a back seat. When in actuality, it s during the booms when you need to be keeping up with the practice building routines. You need to understand the ratio of new patients to patients who are leaving the practice. You need to continually monitor, the results of your ongoing external marketing campaigns. Practice management extended software does all these things and more and it does it automatically. You ve got to see it to believe it. It s just a part of a good plan to incorporate this type of software in to your practice. Business operates in predictable cycles. In order to operate your practice effectively, efficiently, and profitably, you need to incorporate a protocol which includes expense management, capital equipment purchases, and practice management extended software. If you would like information on vendors that can help you achieve these goals, write me an and I will forward you a list. Pay Cash if You Can Ralph Laurie co-owns Lighthouse Practice Management Group. He has If you re following an expense management protocol, you lectured throughout the United States, and the world. Ralph is also the author will begin to accumulate cash. Part of your money expenses of Winning the Interaction Game, and co-authored The Magic of Business Charisma with his son Jason. Ralph can be reached at or by phone at ext SPRING

21 PRACTICE MANAGEMENT Top Five Employee/Employer Myths of 2009! by Paul Edwards Myth #1 I don t have to worry about the 6000 upcoming IRS Audits and how I classify my employees. We are a small office and we might not have it all completely right but, it s the big companies they are after, not us. We ll be fine. Myth #2 My attorney/buddy told me not to have an employee handbook because they will use it against me. He told me not to worry because if I get into trouble, he can get me out of damn near anything. Myth #3 I don t want to do job descriptions because I know that sooner or later I m going to have to listen to an employee tell me, That ain t in my job description. Myth #4 We took several good employee handbooks and put them together to sort of make our own, we are covered. Myth #5 I don t need an employee handbook because I m in a right to work state and I m At Will. I can fire anyone anytime and because of my right to work, there is nothing they can do about it. Let s work our way through these, starting from Myth #1. As if being an employer and making ends meet and keeping patients and employees happy isn t a large enough challenge, I ve got additional news. Beginning in February 2010, the IRS will start a much heralded and three year long research project. (They ll be extracting hundreds of thousands of dollars along the way in recovered taxes and penalties.) The research project is to randomly audit 6000 employers for compliance with the IRS employment tax codes. They are looking to establish a base which shows how well or not well we employers are paying our employment taxes. In other words they are about to go looking for the missing money. They will also be looking at how we classify our employees when it comes to being on salary or not, which I know from experience many don t have this right. This mean you need to know what exempt vs. non exempt and independent contractor vs. employee means and if you have it correct. For those of you thinking your payroll company or accountant has this covered for you, think again! The IRS will also want to know exactly how well you pay overtime because more OT means more taxes to collect. And as we all know, the IRS can expand its investigation as they see fit. IF you ve made a mistake, you ll be made to fix it and pay penalties. If it s clear that you don t understand the tax code, they ll go deeper in their audit. What the IRS is doing is research on how we as employers classify our employees and then pay employee taxes. This is an area that I know most of you are fuzzy on and I also know that many of you are not getting it correct. What this means is that you are not only vulnerable to an IRS audit, you are also vulnerable if an employee makes 22 SPRING

22 a complaint. Typically you fire someone for a good reason and they turn around and make a complaint with a government or an attorney that you have to answer. All because you simply decided you had enough and got a bad apple employee out of your office. Finally, how can you avoid the audit? I ll be offering a solution to resolving all five myths in a moment, including myth this one. Myth #2 Debunked If you don t make up the rules in the workplace and communicate them through your handbook to your employees: your employees, the government, and the attorney suing you will make up the rules for you. Do you really want them to make up the rules? If you understand that many of the same laws that protect your employees can be addressed in a way so as to protect you too, then you know that letting them make up the rules is not a good idea! The average cost to defend yourself in court against a legitimate claim is reported to easily exceed $90K! The difference between a contingency fee attorney taking a case or the EEOC issuing a right to sue letter, often lies in what they find before they decide to take action. So, ask your buddy if he is willing to get you out of damn near anything for free. I ll bet you notice a distinct pause before he changes the subject. Myth #3 Debunked (sort of) What the heck people? Really? You think that the reason not to create one of the most valuable tools you can have in your office, job descriptions, is because someone might point out that it s not in my job description, so it s not my job? Job descriptions, done well are easily distributed, maintained and updated. They not only, in most instances, create a huge legal barrier to charges of discrimination, I know for a fact they help to create accountability and profits. What about the employee that throws it s not in my job description in your face. First of all your job description isn t an agreement. (DO NOT CREATE AN AGREEMENT and please get additional assistance on this subject this is not a place to start from scratch and a do it yourself project.) But more important, your job description can and should contain language that says anything you ask an employee to do is a part of their job and continued employment. Like all the other components we are discussing, the modern employer needs ongoing guidance and support. More to come on that in a moment. Myth #4 Debunked Even though I am not a dentist and have never attended dental school, since I attend a lot of conferences where things are being taught about sedation and dentistry in general, I have decided that I am qualified and it would be a good idea if I start my own little dental practice here in Arizona. For instance, I know the contra indicators for giving out antibiotics and that I need to ask if the patient has had any kind of joint replacement. I m not exactly sure why, other than I know the antibiotics might cause the joint to reject an implant. But I figure since I ve been to several of these conferences and even though I m not an expert, me and my new patients will be fine! Right? I d like to make the same point about employee handbooks and you do-it-yourselfers out there. Yes, you are intelligent and if all you did was study and keep yourself up-to-date on all things employment law/regulation related, you would be able to cobble together and maintain a high quality employee handbook that protects you. But I submit that you have less knowledge in what is actually OK to do in your employee handbook than I do about dentistry. How many of you attended more than 20 Human Resource Conferences like I did dental conferences last year? And yet I am still not qualified to do dentistry. What this leads me to and hopefully you, is your self made, downloaded, borrowed, cobbled together 3-year-old handbook is NOT what you want to put between you and an investigation or employee lawsuit? I would submit you have about as much chance of surviving in tact as my new patients. Myth #5 Debunked Let s start with a general description of what right to work means. It has little to do with 99% of you out there. It is most often applied in instances where a union agreement might cause an employer to have to fire an employee that will not participate and/or pay union dues in your unionized shop. Therefore, being in a right to work state indicates that there is some kind of law that says, no union agreement shall compel an employer to terminate or take adverse action against an employee as punishment for not paying their dues, because they have a right to work. So what protection does right to work afford you? Not really applicable is it? About At Will It s a two-way street between you and your employee. You may fire an employee and an employee may quit for no reason, a good reason, or even a bad reason. That is where the two way street ends on your at will status with your employee. That is because the important distinction, which is worth billions of dollars in settlements, legal fees, and fines to the attorneys that make their money in the employment industry know: you may not fire someone for an unlawful reason. If you do, then AT Will does not apply! So to put this as blunt as possible: Their job is to profit by proving you had an UNLAWFUL reason like age, religion, Continued on page SPRING

23 practice management You re Going to be Spending $50,000+ SO DON T BLOW IT!...continued RESULT CONTROL by Bill Rossi As you may recall, the last time I wrote about Cost Control. Most of you have, or will be, within the next 2-3 years making investments of $50,000 more in technology; digital x-rays, Diagnodent, lasers, clinical charting software, monitors, patient education software, Cerec, electric handpieces, endo equipment and so on. This can easily come out to over $12,000 per treatment room. For starters, you want to make sure that you don t pay too much. That s where specing out what needs to be done and comparative bidding come in. Many of these items are bought together (especially digital x-rays, monitors, intra-oral cameras and clinical charting software). Get competitive bids. Moreover, and probably more importantly, get expert help in planning your technological upgrades to make sure they work well for you. When your hygienists time is worth over $120/hr. and your time is worth over $500/hr. you don t need glitches. Interrupting your work flow can be very expensive! Today I m focusing on Result Control. As an owner you want to get a return on every investment you make. In fact, the whole idea of good management is to get the biggest return on the resources you have; your time, your money and your skills. What organization would spend thousands of dollars without having a clear idea of the outcome they want in return? Upgrading just for the sake of upgrading is insanity. So, as you make these investments what outcomes are you planning on? My favorite example of this is intra-oral cameras. Over 50% of dentists now have intra-oral cameras and half of those cameras are used fewer than five times per week. Very poor result control. If you purchase intra-oral cameras, you are presumably doing this so you can better inform the patient so the patient will make better choices which results in more case acceptance. Better case acceptance means more production. This should show up in increased crown and bridge (for example). Therefore if you buy intra-oral cameras and your crown and bridge doesn t go up, you didn t get result control. It s a pretty good bet they aren t being used. So, to get them used! Do the following: 1) Do Clinical Calibration with staff so they know to what end you want this educational tool used. Have a meeting in your practice to talk about when you feel it s in the patients best interest to crown a tooth and when you don t. When is a composite indicated vs. a crown or vs. an amalgam? Who are good candidates for implants and who aren t? When are x-rays really needed? How about fluorides? If you haven t worked through these issues with the staff, they ll be pointing the intra-oral camera around but only vaguely knowing what they are trying to do. Check out the article on Clinical Calibration posted on our website. www. 2) Be very sure your cameras and monitors are ergonomically set up. And, don t ask the hygienists to share a camera. You ll do far better paying for two cameras that are actually used than one shared camera sitting in the hallway or lab. 3) Track how many times your intraoral camera is used per day or per week. If you re not measuring this, it s probably not being used enough. When you first get the intra-oral cameras, ask the hygienists to keep a tally of when they ve used it. Over 2/3 of the adult patients should be shown something. It doesn t always have to be something bad. Showing patients what s good is helpful too. You like it when you go to the doctor and hear good things too, right? Anyway, the more the patient knows (and people learn through what they see) the more they appreciate what you can do for them. 4) Put this all together in a set of goals: As a result of this Patient Education Technology (e.g., intra-oral cameras) we will see an increase in patient acceptance by two crowns per week. Therefore, we believe that there will be $8,000 more per month in production (that s great result control). We will use the intra-oral camera on 70% of our adult patients. This will be tracked on the daily schedules by each hygienist. The exceptions would be patients who have other problems that are not easily visualized by the camera, a patient due for full-mouth x-rays, the patient arrives late or there is some other mitigating circumstance. DIGITAL X-RAYS: When digital x-rays are installed in your treatment 24 SPRING

24 room there will likely also be capability such that your hygienist can set up her own appointments, enter treatment plans, enter progress notes, enter today s charges, use the intra-oral camera and use patient education software. In most practices that have paid for these technological capabilities, only two or three of the above are performed regularly. What is the plan for your office? Entering treatment plans, setting up the next appointment, entering today s charges, all take your hygienists time. However, digital x-rays help save the hygienists time. No running to the processor, no mounting, etc. What are the expectations of how the team will use the extra time? Your hygienist simply must have the training so that she is completely comfortable with the software so she can perform these functions. Then it s likely the patient will arrive at the front desk with all the information already available to your administrative staff. Then the administrative team can do what they do best-work with the patient to make their dentistry as comfortable and affordable as possible (financial options) and commit them to treatment. That should result in more treatment done, right? Measure it! A Subtle Change That s Very Expensive: Many offices reserve 45 or 50 minutes for standard adult recall hygiene appointments. Often when all of this new technology is introduced, the hygienist will feel they need more time. It doesn t seem like a big deal to increase hygiene appointment lengths to 60 minutes, but that results in one fewer patient seen per day on average. Not only does this reduce the hygienists production by over $120 per day it reduces demand for the doctor s services by over $300 per day (Many dental offices produce $400+ per exam so any decrease in hygiene flow can really take the wind out of your sails.) Fifteen fewer hygiene visits per month all of a sudden can mean $6,000 less treatment per month. That s a very negative bang for the buck for your investment in technology! Another solution is to add more technology! For example, automated or voice activated perio charting. Or, a digital pano. It takes just 8 seconds even less than digital full-mouth x-rays (in situations where it s clinically acceptable). These technologies can help your hygienists maintain their visit per day capacity even while increasing their productivity per visit. However, it s clear that hour-long hygiene appointments are becoming increasingly common. You may be fighting a losing battle if you keep these Start a New Patients Epidemic Your new website could be the source! Catering Exclusively to Dentists since 1998! connect with fans Rule the Search Engines... Dominate Your Market with your New Custom Website! "Talk about return on investment - WOW! I literally could not imagine not having the website that I have, my practice would not be the same. I am always ranked on the first page of all of the major search engines with organic search, not paid ads. Thanks a million, (or two!) Greg and Mary. You are the best around!" Steffany Mohan, D.D.S. Receive a FREE Flip Digital Camcorder with website purchase. Call (888) SPRING

25 lengths so tight that the hygienists won t buy in to or really employ the technology you paid for. So, what do you do? In a larger office a possibility is to hire a hygiene assistant so they can keep appointment lengths to 50 minutes. However, I ve seen offices hire this assistant and still have appointment lengths go to an hour and so the bottom line is hurt. Again, if you add a hygiene coordinator/assistant, you have to have result control. For many of you the best course of action would be to allow the hygienist the additional time but make sure they use the technology. That s your quid pro quo. We now provide digital x-rays to save you time. I really need you to use the intra-oral camera, the Diagnodent, etc. Then, since you ve subtly cut into your hygiene capacity, you have to add additional hygiene time to counteract that. It will all work out if your hygienists are presenting the treatment. Your case acceptance will go up and that will more than counter the reduced patient flow per day per hygienist. If you added hygiene time then you ll keep your flow up and allow room for growth. I ve seen mistakes in the above that cost offices thousands of dollars directly and many thousands more indirectly. CAD/CAM-CEREC: I ve never been able to talk a client into or out of buying a Cerec machine! I feel that most of the time this decision is made at a gut level. That s fine. That s your business. However, it s my business to make sure that if you buy a Cerec you get bang for your buck. First of all, before you make this very expensive investment, ask yourself, Is there somewhere else I can get a bigger return on my dollar? I ll argue that there are many smaller investments you should make first as you ramp the practice up such as; Diagnodent, automated endo, intra-oral cameras and perhaps non-technology items such as better signage, advertising, training a treatment coordinator, and getting you and your team significant continuing education. Before you buy the Cerec, Count Crowns. That is, for a month or two keep tally of how many patients for which you feel the Cerec would have been the right solution. Most of my clients tell me that there are some cases that are better suited to Cerec than others. I m not a clinician, it s up to you to make your own judgments about that based on discussions with your colleagues or authorities you respect. Then, once you buy the Cerec, make sure that you are employing it as much as you planned on and see that your lab expenses really do decrease. Another subtle cost of a Cerec machine is that at least initially, it takes longer to do crowns. Many doctors I ve observed with Cerec will initially have to spend 2 2 ½ hours per unit. Obviously, if your time is worth $500 per hour, you don t save enough on the lab cost to justify that extra hour (or even ½ hr) in getting a crown completed (most doctors take an hour for a conventional prep and a half hour for seating- 1 ½ hour total). So if you do 20 units per month and the Cerec machine takes you an extra half hour, that still costs you $5,000 per month in capacity. Now hold on Patterson folks, before you call me, hear me out. The answer here is additional training. There are excellent post purchase sources for training on Cerec to bring the procedure time down. If you buy a Cerec machine and don t plan on training your staff to help you use it, well, you re going to have poor result control. With the correct experience and training, I ve seen many doctors bring their single unit Cerec times down to 1 1 ½ hours. I am simply astonished to see that a doctor will spend $100,000+ on a piece of equipment but flinch at the idea of an extra couple thousand dollars in training to really come into song with it. Speaking of training, that s also very true for all the technology that you re going to put in your and the hygienists room. After an initial 3-4 days of training, arrange for follow up training in three months. In a larger clinic, I think it makes sense to have a trainer on board for a day or two as everyone is using the clinical charting and other matters. It really helps that there is someone right in the building who can show you how to do things. Also, just as in paper charting, you have to decide as a group how you are going to chart. There are a lot of choices and you have to pick the configuration for your office. This takes some time and focus. So, as with so many things, it s best to begin with the end in mind. What are the outcomes you intend to get? And, how are you going to measure them? Before you go out to purchase the technology, make it absolutely clear to the staff that you need their commitment to use it! Prioritize your expenditures and tackle them in order of where you can get the biggest bang per buck. In this way your practice builds up more and more profits and momentum. Don t buy technology because everyone else has it or even if, no one else has it! Buy it because you know the outcome you want for your office. And, by the way, just an up-to-date image is not enough if you are serious about your bottom line. It has to be for go, not just show. IN SUMMARY, IF YOU SPEND $$$$ ON TECHNOLOGY: 1. Define the outcomes you expect (and increased revenues or decreased expenses have to be part of that). 2. Get staff s understanding and commitment (e.g., clinical calibration). 3. Get additional training. The built in amount is not usually enough. 4. Measure activity (e.g., time used per day) and results (dollars brought in or saved). 5. Celebrate your successes. Recognize and reward your staff accordingly. Bill Rossi is president of Advanced Practice Management. He and his associates are actively involved in the nvolved in the ongoing management of over 250 upper midwest dental offices. You may contact Bill at or through www. 26 SPRING

26 Danni Doctor We Know It s A Jungle Out There Join Us April Along With Danni Boatwright, Winner of Survivor Guatemala, In Sunny Orlando, Florida To Learn How You Can Be A Dental Survivor In Today s Treacherous Economic Climate! Mark your calendars and get on the phone EID has BIG news we ve moved our 19 th Annual Spring Break Seminar to sunny Orlando, Florida! Come join us as we celebrate this exciting, new, world-class venue at the Hilton Orlando just minutes away from all that Orlando has to offer. You and your staff will band together to discover TONS of cool new things to help make your practice more PROFITABLE like never before! Call I LUV ORLANDO Or Visit to register TODAY! So if you have previously been with us in Destin OR have been out there looking for the perfect seminar experience Come Check Us Out You Haven t Seen Anything Yet! The ULTIMATE in Dental Education Courses: ONLY $1,497 (Doctor) ONLY $447 (Staff) ONLY $397 (6+ Staff) ONLY $97 (Student) Keynote Speaker: Dr. Steve Rasner Dr. Alvin Arzt Dr. Mike Abernathy Dr. Lorin Berland Dr. Craig Callen Tina Calloway, CDA Dr. Joe Capista Dr. Brady Frank Dr. Chris Griffin Cindy McKane-Wagester, RDH, MBA Ralph Laurie Douglass Lodmell, JD Dr. Louis Malcmacher Dr. James McAnally John Plisky Howie Horrocks and Mark Dilatush Dr. Steffany Mohan Dr. Vincent Monticciolo Dr. Woody Oakes David Stone Dr. Ryan Swain Jimmy Vee & Travis Miller Garrett Gunderson (New York Times Best-Selling Author of Killing Sacred Cows ) And special uncensored guest: Dr. Howard Farran SPRING

27 practice management AMERICA S MOST PRODUCTIVE DENTIST An Exclusive Interview with Dr. Woody Oakes & Dr. Bruce Baird He s nicknamed America s most productive dentist and with good reason. Dr. Bruce Baird works only two days a week yet he produces $2M annually. How does he do it? The quick answer, I learned, is that he schedules to productivity not time like most dentists. Intrigued, I talked with Bruce to find out more. 28 SPRING

28 Woody: They say that any goal is attainable if first a dream. Was there a lightening rod moment when you said, Wow, I can double or triple my personal production? and then set about to do it? Bruce: Yes, I remember the moment well It was 10 years ago and I was driving to Chicago with a dentist friend named Russell Knight. We had just stopped at a Wendy s on the freeway. I had the fries between my legs, a burger in one hand and the steering wheel in the other when I turned to Russell and asked, How does Dr. Mark Morin personally produce $800 an hour? He replied, It s easy. He only books $800 per hour procedures. My brain started spinning like a break-dancer on steroids. I didn t say a word until we got to Chicago. Like all life-changing ideas, this one was deceptively simple. To produce $800 per hour, only schedule $800 per hour procedures. When I returned home, I immediately took action. I created enough Excel spreadsheets to cover the state of Texas. I furiously scribbled my ideas on yellow note pads. Most importantly, I began implementing that simple idea in my practice the next day. The result has been a dramatic increase in the quality and quantity of care I provide our patients and a corresponding increase in my net profit. Woody: So what you re saying is, don t leave productivity to chance? Bruce: Yes, productivity must be an intentional activity. If you leave it to chance, it will vary widely from month to month and will be lower than it could be. Make productivity a deliberate activity by only scheduling procedures that fit within your hourly production goal. All procedures can be productive. As an example, let s say your hourly production goal is $900 and that your three-surface composite fee is $200. If it takes you 30 minutes to do one, your productivity is $400 per hour. To raise the hourly production to $900, you have four choices: 1. Raise your fee to $450 (this is probably a little high for most practices). 2. Reduce the time it takes to complete the restoration to 12 minutes (this is probably too fast for most dentists). 3. Do a combination of 1 and 2 above. Increase your fee to $300 and decrease the time to 20 minutes (this is doable for most dental offices). 4. Don t do three surface composites. Do $900 Cerec restorations instead. Woody: Is scheduling to production a standard, across-theboard procedure in your office? Bruce: Yes, with one exception: patient exams. It s important to make your exam fees competitive and take whatever time you need to do a thorough exam, communicate with the patient, and gain treatment acceptance. Woody: Okay, this sounds almost too easy; if it is, why aren t more practices scheduling to productivity? Bruce: Scheduling to productivity is a difficult concept to communicate to dentists because they have been trained to think only of time. Here s a common example: Maria starts her day at 8:00 a.m. in treatment room one doing a 45-minute restorative procedure. When she gets done at about 8:45, she goes into treatment room two to do a 75-minute endodontic procedure. Then, at 10:00 a.m. it s back to room one for a 30-minute appointment to seat a crown. Maria spends her time hopping back and forth between treatment rooms doing carefully timed procedures. If she gets behind with one patient, she s behind for the rest of the morning. Sound familiar? Woody: All too familiar what then? Bruce: Instead of chair hopping based on time, schedule to your hourly productivity goal. Here s an example: You have a patient who needs two crowns at $900 each and two build-ups at $100 each. That s a total fee of $2,000. Your hourly production goal is $500. So you would schedule the patient in room one for four hours (2,000 divided by 500 equals 4). Is it going to take you four hours? Of course not. That s why you can intelligently schedule crown seats, occlusal composites, new patients and emergencies in rooms two and three. If you find yourself sitting around too much, just raise your hourly production goal to $550. This will decrease the amount of time you schedule a $2,000 appointment to 3.6 hours. If you don t have enough of the $2,000 appointments, you need to enhance your marketing, diagnosis and/or case presentation skills. Woody: Lastly, who should do scheduling and where should they do it? Bruce: Clinical assistant in the treatment room. When we started scheduling this way, our productivity went up 27 percent! Woody: Any closing thoughts? Bruce: I hope the reader s head is spinning like mine was that day in the car. Every once in a while, a spinning head is good. It interrupts your habitual pattern of thinking and points you down the path to being a more productive dentist. Dr. Bruce Baird is a practicing dentist in Granbury, Texas and is CEO of the Productive Dentist Academy. For more information on seminars and coaching, call or visit SPRING

29 practice management Ten Actions You Must Take To Increase Hygiene Profits by Rachel Wall, RDH, BS Have you ever wondered how you could build a hygiene department that is not only profitable but supports the overall health of your patients and the financial health of your practice? If so, you re not alone. Every week, I encounter doctors and dental teams that have the same questions. How can we cut the open-time in hygiene? How can we enroll more high-care, high-production procedures in hygiene? How can hygiene be more profitable? There are a multitude of specific systems, skills, and strategies for each of these challenges and every coach and consultant has their own formula. But what they might not teach you are the underlying factors that affect profitability; some are more obvious than others. Here are the 10 not-so-obvious actions you must take to increase hygiene profits. 1 Identify and clear the obstacles When helping our clients set new performance goals for hygiene, one of the very first actions we take is to identify what s held them back from reaching those goals in the past. Hidden obstacles can sabotage the success of the most well-intentioned teams. Often these obstacles are quiet but insidious and can undermine your efforts to create a more profitable hygiene department. Examining all aspects of your hygiene department including how the schedule is created, fee structures, coding, doctor and team mindset, and hygiene supply and demand will often uncover what s been in your way and allow you to address it. It s not unusual to find that even slight adjustments in systems will create better flow and increased production before making major changes. One of the most common obstacles I see is a hygiene schedule that is out of balance. A schedule that is jam-packed with prophies leaves little time for high-production hygiene procedures and so often a cycle of undiagnosed perio begins. A day full of prophies is rarely an ideal day. 2 Create a strong Why for taking care to the next level It s important to create a why for your team that goes beyond increasing profits. Team members must know and embrace your treatment philosophies 3 Implement 4 Understand and believe that a sincere desire to serve your patients best interest is at the core of your practice. Intentionally share your philosophies and expectations with your team. Be very clear as to which diagnostic tests you expect to be performed on every patient and how you would like the results to be communicated to you during the doctor exam and to the patient. Carefully selected continuing education courses create a strong foundation of knowledge of the periodontal disease process and help you uncover the prevalence of disease in your own practice. When your team realizes the impact undiagnosed perio disease has on your patients overall health and why a progressive treatment philosophy is essential to delivering highquality care, they ll be more likely to be on board with increasing perio care and productivity. clear systems for diagnosis, treatment and enrollment Success comes from having a clear step-by-step system for identifying disease, planning treatment, enrolling and performing the therapy. So often I see teams doing everything right but the fact that there is no system in place creates confusion for the hygienist and the patient. This often results in failure to present the best care and a low level of treatment acceptance. the business behind a successful hygiene department Beyond the science of hygiene care, it takes a well planned business approach to make a hygiene department successful. This includes setting goals for growth and reaching them, creating accountability for implementation, time management, systems for keeping patients in the recare loop and engineering the ideal hygiene day. And the only way to know if your efforts are successful is to track your progress. Frequent analysis of the business of your hygiene department requires daily, weekly and monthly tracking. Knowing where you stand every day allows you to quickly adjust your course of action if goals are not being met. This eliminates the common realization at year-end that hygiene didn t meet their first level of productivity. 30 SPRING

30 5 Empower A few hygiene business statistics to gather are: Profitability ratio of the hygiene team Recare effectiveness Enrollment success rates Open time percentage your hygiene team to build the practice Being responsible for enrolling all or most of the dentistry that goes on your books is a big load to carry alone. That s why empowering your team to enroll perio AND restorative care is a huge step toward building a successful practice. The time you spend educating your team on your personal treatment philosophy will pay off many times over. Proper training creates the confidence the team needs to actively co-diagnose and create preliminary treatment plans so when you enter the hygiene room, the enrollment is 90% complete. On our free CD 3 Steps to Increase Hygiene Co-Diagnosis I give you a step-by-step system for empowering your team to enroll more restorative care. Get your copy at www. 6 Develop 7 Master leaders on your team I ve been asked by many doctors, How do I get my hygiene department to run itself? I ve found what s behind that question is really a desire to have hygienists that are excited about their opportunities for service, career building and financial success as part of your practice. And what I know is that it starts with you the doctor. One of my favorite leadership experts, John Maxwell, said To lead, start with yourself. In order to develop leaders on your team, you must step into that leadership position first. In his book, The 21 Irrefutable Laws of Leadership Maxwell says the most valuable gift a leader can give is being a good example. He goes on to say that leadership is more caught than taught and that one catches leadership by watching good leaders in action! That s you! Your team is watching. So when you expect them to be at morning huddle at 7:45, be sure you are there, prepared and present. the mindset of presenting the best treatment, every time Holding onto old beliefs, information and judgments about patients is one obstacle that may keep you from Nearly every Whitehall client has protected their practice with Dental Justice. Greg Stanley, President, Whitehall Management Tired of dealing with disgruntled patients? Run by dentists for dentists, Dental Justice, a Division of Medical Justice Services, Inc. is an economical, patented, counterclaim service that protects dentists from the impact of frivolous lawsuits, web defamation, and unwarranted refund requests. Practice dentistry stress-free again! Call today: / SPRING

31 PRACTICE MANAGEMENT 8 Identify 9 Set reaching your goals. When I work with my private coaching clients, we get real about how you and your team perceive the value of your services. It s important to make sure everyone understands that it s their ethical duty to present the best treatment to your patients and give them the opportunity to say yes or no. It might be necessary to uncover what s at the heart of the mindset. Is it a fear of rejection? Is it a perception that the patient doesn t have the money for the treatment? It s not uncommon for us to project our own limiting beliefs onto our patients. That not only hinders performance but may rob the patient of the power to make their own health care decisions. your unique hygiene service mix A hygiene service mix that s prophy heavy will never reach the same level of success as one that thrives on a variety of services including periodontal care, professional products and high-level diagnostics. Take a close look at last year s production-byprocedure report to determine which services are actually being performed and at what frequency. Then create goals for your perio percentage and identify which services you can add now to increase the level of care and production that occurs in hygiene. your course for future growth In addition to setting short term performance goals, brainstorm where you want to see yourself in 12 months and two years. Set your sights on always striving for the next level and celebrate your success along the way. Setting a course for growth may include planning future production goals, team incentives and rewards, new clinical services, technology and how you ll increase your visibility and value in your community. 10 Inspire and nurture the development of true healthcare professionals As dental professionals, we re often the first to minimize the impact we can make on our patients overall health. I know you d rather have a preventive professional on your team than a mouth maid. No one likes that term but when hygienists limit themselves to doing one prophy after another and fail to complete a thorough oral health assessment, that s just what they become. Frankly, it s a waste of their talent and education. Dentists, hygienists, dental assistants and administrators all have the potential to become a powerful part of your patients healthcare team. Especially when caring for patients with systemic health issues, it s important to step into this role by communicating fully with patients and their physicians. This includes completing a thorough clinical exam and presenting the best treatment options. Incorporating complete medical history reviews and medical testing demonstrates your team s awareness of whole body wellness. As owner of Inspired Hygiene, Rachel Wall helps dentists tap into the productive potential of their hygiene team. Inspired Hygiene is the preferred hygiene coaching group for the Productive Dentist Academy and a strategic partner with The Profitable Dentist. To contact Rachel, her at or call FREE BONUS WORTH UP TO $570 Now You Can GET New Fee-For-Service Patients and DOUBLE your Patient Referrals...even in THESE TIMES!!! When you mail either or both of our PROVEN New Fee-For-Service Patient program or our Retention, Reactivation and DOUBLE Your Referrals system. Our PROVEN SYSTEMS will get you a steady stream of New Fee-For-Service Patients and increase your Referrals! Thousands of dentists over the years have increased their practices $30,000 to $80,000 a month, or more, with our PROVEN marketing systems FOR: General Dentistry Cosmetic Sedation Dentistry Invisalign Cerec Dentistry Orthodontic New and Transfer Patients Implants Your call for a FREE information packet will qualify you for the Free Bonus of $570. Stoneybrook PUBLISHING, INC. 1 (800) PD3 Valid for 30 days from issue date. For new clients only. 32 SPRING

32 PRACTICE MANAGEMENT How Do I Find Office Space? by George Vaill Here s a question I get every week: How do I find office space when there is absolutely nothing out there? The answer is that there really are spaces out there. You just need to know how to go about finding them. Searching for space can be a daunting task. For those who are frustrated and about ready to give up, take heart. You just might have to formalize your search effort. Spaces come and go every day. Be on the lookout and employ some aggressive search methods. Here is a suggested approach. 1. Determine exactly where in the market you are willing to locate in order to: (a) maintain your existing patient base without too much loss; and, (b) continue capturing new market share right down to what streets are IN and what streets are OUT. Do NOT waste time driving any streets that are OUT. 2. Determine exactly what type of property you ARE willing to go into and what type you are NOT willing to go into. If you ve ruled out medical high rises or houses or airport lobbies then, do NOT waste time even looking in their direction. 3. Once you have done #1 and #2 above, then drive those specific streets that DO work for you and ONLY look for and at buildings that you ARE willing to go into whether they have a For Lease sign on them or not. We all see the top retail chains located in the AAA spaces around town. That s NOT by accident. They don t wait for a For Lease sign to go up. In fact, we rarely see a For Lease sign on those AAA locations, because those companies are proactive. They pay people to camp out on those the AAA locations and establish a rapport with the landlord or management company so they can be the first in line to lease them. 4. Make a list of each of those buildings that may work for you and plot them on a map. 5. Pull into the parking lot at each of those buildings and sit there for a while and establish a preliminary conclusion about whether or not there may be sufficient parking and large enough lighted signage and whether or not the property is attractively maintained and whether or not the ingress and egress to and from the street appears to feel safe and unintimidating and whether or not the co-tenancies and the neighboring properties are conducive to your business. (You don t want to be next to a smelting plant or tattoo parlor, do you?) for about X amount of usable square feet for a long-term lease and that your timing is flexible. Ask if he/she anticipates any impending vacancies in that size range. Get his/her fax number and fax your criteria sheet to that person EVERY SINGLE WEEK until you have a signed lease somewhere. Otherwise, out of sight is out of mind. 8. Do the same with equipment company reps, dental lenders and dental CPAs in your area. Then repeat, repeat, repeat for every building that is on the possible YES list. By now you probably get the pattern; spread your search requirements far and wide and keep after all of these players until you have landed a suitable location. And keep looking even after you think negotiations are going smoothly. You ll want to have a fallback plan in case the negotiations go south for any reason. Remember, your absolute number one priority must be that you protect the practice you have developed by ensuring that you are never out on the street without a place from which to serve your patient base. Leasing Space? Negotiate Once. Negotiate Right. GEORGE VAILL To level the playing field in your next negotiation, call or visit In today s economy... don t even think about building, going into a new location, or signing a lease BEFORE you speak with George Vaill. George will save you a ton of money and a lot of headaches. Dr. Woody Oakes, DDS Editor-in-Chief, The Profitable Dentist 6. For every one of these buildings that still feels OK after you ve done #5 above, walk in the door any door every door if necessary and ask to speak to someone in charge. Your goal is to get someone in the building to give you the name and telephone number of the landlord. 7. Call the landlord and tell them you are an established dentist with a mature practice in the community and you are looking SPRING

33 Clinical Tips for Better Dentistry & More Profit! by Dr. Michael Curtis How can you provide better dental care with less stress and more profit? Some tips: 1. Emergencies, Sedation & Hot Teeth: How can you get fast sedation for an emergency patient you ve squeezed in? Try the following: Hot Rinse: Have patient rinse with very warm (not scalding) water to dilate oral blood vessels. Place 0.25mg-0.5mg of Halcion (Triazolam) into an x-ray packet and crush it into a powder with your mirror handle. Pour the powder under the patient s tongue. Rapid sublingual absorption will produce sedation in minutes. The sublingual route may also yield deeper sedation since drugs reach the brain before any elimination occurs in the liver. Nitrous Push: To temporarily deepen sedation, add nitrous oxide at 70% for seconds before you inject anesthetic. Turn the Nitrous down immediately afterwards to prevent nausea. Is this safe? With 70% nitrous oxide you are still providing 30% oxygen, which is higher than the 20% oxygen in normal air. Avoid Nitrous with: Middle Ear Infections, Sinus inflammation or blocked Eustachian tubes. Nitrogen diffusion can cause pressure buildup and damage the tympanic membrane. Obstructed Bowel: Severe gas pain can develop. Detached Retina: Eye surgeons sometimes inject a gas during retinal surgery. This can expand with nitrogen diffusion. In rare cases, blindness can result. Congestive heart failure, Pregnancy, COPD, Tuberculosis and Multiple Sclerosis are all contraindications for nitrous. A Pulse Oximeter is a must to monitor sedation. There are many on the market. Which should you buy? Why do blocks fail and what can you do to never miss again? How can you numb hot teeth? What are intra-osseous and intra-furcal injections? Do they work? How do you give them? For answers, consider our Anesthesia guide. 2. Endo Pearls: Would you like to do faster root canals? How can you reduce your inventory? Some tips: Cut Inventory: The Gutta Guage is a plastic bar with 17 precise holes that correspond to ISO sizes If you place a size 20 point in the size 40 hole and cut off the excess, you ll create a perfect size 40 point. Limit your stock of paper points and gutta percha points to only a few sizes in 02,.04, tapers! Cost: $28 Dentsply-Maillefer. Any dealer. 34 SPRING

34 Boost Speed: The FileMate is a measuring block that accurately measures instrument lengths every half millimeter. Establish your working length. Then drop each file, paper or gutta percha point in the appropriate length-guide. You ll get fast, exact reproducible measurements every time. Cost: $32 Dentsply- Maillefer. Prevent Breakage: Subtract 1-2mm from working length when using rotary files, but recapitulate to length each time with a #15 or #20 hand file. Go even shorter for larger rotary files. For how this excellent technique stops fractured instruments once and for all, see our Endo guide. Quick Irrigation: Pre-load syringes of Hypochlorite, EDTA and Chlohexidene during downtime, so you don t lose time during procedures. Heat Hypochlorite in a hot water bath to double its efficacy. Fast Dams: Stop setting up and sterilizing dam frames and punches. Disposable Inti-Dams ( come pre-set on frames with your hole already punched. They work well for premolars and anteriors. For molars, keep a dozen dams pre-set-up on frames, with holes punched in the center, ready to prevent molar dams from tearing: Use heavy-weight dam material and the larger 6 size. Punch extra-large holes (interlock 3 of the largest hole size) Lube around the hole with topical so the dam slips on easily. Seal any leakage with liquid dam (whatever you use for whitening-i.e. Ultraseal). Calcified curved canals: What special instruments are made for calcified and curved canals? Which root canal systems are best? Why do apex locators get quirky sometimes and how can you fix them? For answers, consider our Endodontics guide. 3. Better Night Guards: How can you adjust night guards for better results? When delivering an appliance, paint the biting surface with a sharpie marker. Have patients back after a few days and check where color has worn off. This will give you a dynamic record of the patient s movements. Adjust accordingly. Do you prescribe updated meds like Dysport, Lyrica, Voltaren and Savella? Do you prescribe TMJ exercises? For new methods for TMD therapy, see our Anesthesia guide. 4. Faster Dental Assistants: Does your assistant ever run out of the room for items she forgot to setup? Some tips: Super Setups: Create a perfect setup, in the correct order, for every procedure you do. Label each item. Then photograph, enlarge and laminate the photos. (Kinkos, Staples) Use these images as your tray covers. Have assistants place instruments and supplies directly on their photo for ideal setups every time. This is excellent for new employees, part-timers and cross-training staff. Fast Disposables: During downtime, place typically used disposables (suction tips, dry angles, burs, anesthetic, packing cord etc.) in Ziploc bags. Color code bags with colored tape or magic marker to match your color-coded procedure tubs and trays. Rx s: Pre-write common prescriptions for fast dispensing. (I.e. Motrin 800mg x12, Z-Pak, CHX, Prevident 5000PPM etc.) Quick Collating: Avoid wasted time collating instruments. If you do not use cassettes, consider rubber Proties (Zila) to keep instruments together during sterilization. Rapid Records: Xerox an ideal chart entry so assistants can fill-out paperwork for you. Make a list of common abbreviations such as RD (rubber dam), POI (post op instructions), 1.8A (1.8cc Articaine) or CA-LF (Crown advised to prevent leakage or fracture). Express Timer: Purchase a simple digital timer (Target) and set it for everything you do. Know exactly when impressions or cements are set. Stop waiting longer than necessary for anesthesia. Track time spent on chit-chat. You ll be surprised at the efficiencies this simple item will create. 5. Insurance Alert! Are you overly dependent on any dental PPO? Be careful. Insurance companies may be tracking every claim you submit to any insurer. If you submit certain codes more than average they can red-flag you and drop you from the plan; even if your treatments have been completely appropriate. Codes to watch: Root planing, Full-mouth x-rays, Surgical extractions, Crown- lengthening and Buildups. Fees: Do you know exactly what other dentists in your area charge? You can find out! Do you know how you can create your own insurance plan to attract tons of new patients? For answers, see our Collections or Fees & Case Acceptance guides. 6. FREE Pearls E-Newsletter! Sign up for our FREE E-Newsletter at Get fast, bottom-lined pearls delivered right to your door! Dr. Michael Curtis practices in Connecticut and is the author and founder of the 100s of Pearls series. For questions or to order, call or visit This article is excerpted from several 100s of Pearls guides and is copyrighted and reprinted with permission. To contact Dr. Curtis, please him at SPRING

35 Clinical SECOND MOLAR MISERY by Dr. Michael Kinsley If you learn by mistakes, I ought to be a genius! Charlie Waters, former NFL defensive back Oksancia I just may scream if another patient returns to my office with broken porcelain on a second molar. More than half of my crown failures are second molars, probably a lot more than half. Only 13% of the teeth in the mouth are second molars and yet they comprise well over 50% of the crowns that I have to remake! And we re talking free here. This isn t counting the crowns that you made that I remake. (I m just kidding. I know your crowns would never break!) A PFM is a rare thing in my practice. I don t use much metal at all to restore or replace teeth. I average ninety crowns a month and I do less than one PFM per month. I started working toward a metal free practice in 1990 with the advent of OPTEC crowns. I loved those things. To me, a PFM doesn t look much like a tooth but those OPTEC crowns looked so realistic. Of course the literature back then preached that you could only use bonded porcelain on front teeth, but little by little I kept creeping my OPTEC crowns from first bicuspid to second bicuspid and on to the molars with great success. By 2000, I was sailing toward all allporcelain restorations. I was listening to a Frank Spear presentation in Orlando, Florida, part of a restorative continuum I was participating in. I remember Frank giving his blessing on all-porcelain restorations for all teeth except second molars. I thought that was kind of wimpy. If we were going to go all-porcelain why leave out 13% of the teeth? Several years later and several generations of porcelain later, I began to notice something. As my volume of crown and bridge increased dramatically it became more and more inconvenient, annoying and unprofitable to have to do remakes. And the more I observed, the more I realized it was always the second molars that people were breaking. Some I could smooth down, some I patched. Inevitably, I was stuck remaking these things. We remade Wol-ceram, Empress, Eris, Lava, Cercon, E-max, and Procera. If you ve never cut off a Procera crown you haven t really worked. Restorative lecturer Bill Strupp says he hopes to retire before it s time to start replacing Procera crowns. My question is: if they are that hard to cut off with a dental handpiece, how can people break them? WHY 2 ND MOLARS? My next question is, Why second molars? There are some obvious answers. Most of us aren t making much money restoring wisdom teeth so these seconds are the least visible teeth in the mouth getting crowns, therefore our crown preps may not be as ideal. It s also a bit more challenging to keep spit out of the working area, so that makes getting the impression and bonding the crown more difficult. There are also anatomical difficulties with second molars. The clinical crowns are short and a thick gingiva from the retromolar pad makes them even shorter. So every time we reduce the occlusion for proper thickness of porcelain we are losing some retentive properties. This affects me especially because I am a huge advocate for supragingival margins, particularly way back in the mouth. Margins above the gumline are easier to capture on an impression, better maintained by the patient, and better examined by the dentist or hygienist. Of course, for all you physics lovers, no discussion of this sort would be complete without mentioning the second molars proximity to the fulcrum of the jaw. The closer a tooth is to the lever s pivot, the higher the forces that cause teeth to break. THE MYSTERIOUS PROPERTIES OF 2 ND MOLARS Orthodontic lecturer, John Witzig advocated the removal of second molars prior to orthodontic therapy on children with crowding. Witzig said that it was not the eruption of wisdom teeth that forced the other teeth to overlap but the mesial force of second molars. In his lectures, he would illustrate that once the seconds were out, the rest of the teeth would ZOOM distally and make the elimination of crowding all but automatic. The second molars exerted pressure mesially. Whenever I restore vertical dimension on an arch with severely worn enamel, I find my best results take place when I place crowns on all of the teeth except the second molars. I usually get a call from the laboratory complaining that my occlusal registration and scheme has the seconds out of occlusion. I cannot think of a single case where the patient returned for their cleaning and the second molars were not in full occlusion. So my theory is that the second molars exert pressure and movement occlusally. My point is further demonstrated by a few patients with inexplicable second 36 SPRING

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37 molar behavior. More than once I have cemented second molar castings that fit the models yet required much more than expected occlusal adjustments in the mouth. Having been arduously equilibrated until the new crown no longer touched, they returned the next day with that tooth as the point of first occlusal contact! Second molars can be mysterious. WHAT DID I DO WITH THE LESSON I LEARNED? Okay, so its unprofitable, unpopular and unsettling to have to remake crowns, and the lion s share of mine were coming from the posterior 13%. Armed with that information, what could I do to become a better restorative dentist? My first reaction was to give in to my human nature and quit diagnosing the need for crowns on second molars during periods when I d seen several broken crowns. Patients were having to request crowns on their seconds. My hygienists were bringing me back my treatment plans asking me if I d missed something. That wasn t good. We had an office meeting where I pointed out to the staff that most of our remakes were on seconds. I painfully changed my stance from metal-free to pro-gold on second molars. From that point in time, I decreed, we would tell our patients that we would stand by our remake policy and remake any broken porcelain crown. But if they, the patient, wanted to ensure that a remake wasn t necessary, they should pick gold. Half of our patients picked gold. Our remakes decreased by half. More of our patients would have selected gold if our staff would have believed in it themselves. But we had positioned ourselves as an office that believes in ultra-white Vita shades and preaches against the sins of black metal margins. So, in the beginning, it was difficult to sell. I would sit down to do a crown and ask the assistant what material we were using. You would have thought I was asking our staff to sell snake oil. But as we increased in our shift toward gold, the misery of second molars started easing up. The embarrassment and irritation of remakes began to decrease and that felt good. More and more patients were being happily recommended gold and more and more were accepting. By using gold we were also able to employ an onlay design when it was indicated which was often more harmonious with the patient s occlusion. GOLD ISN T FOR EVERYONE But some patients don t want gold. A friend from church came to my office with the need for crowns on all second molars. Three of the teeth had huge fillings and worn down occlusion and some crown length had been lost. Number eighteen had a PFM that was uncemented with exposed metal on the occlusal. To help him receive maximum insurance benefits the right side was restored several months before the left side. Wrong he returned to our office a few months after the crowns were seated with the complaint of a rough edge on the inside of the lower crown. Clinical inspection revealed that he had sheared off some porcelain on the lingual cusp and unbeknownst to him had done the same to the upper! The crowns were removed and additional occlusal reduction done to make a porcelain fused to zirconia crown on each of the teeth. This would be our material of choice for the left side, also. When he broke two of these crowns by chewing the porcelain off of the core, I more strongly recommended gold for his teeth. His shoulders slumped. He just couldn t see himself with a gold tooth. So I called the lab and asked if they could make a crown out of the coping material. After all, the coping had not fractured, just the bond between it and the porcelain. The lab said that solid zirconia would abrade and wear down the opposing dentition catastrophically. They recommended a solid lithium disilicate crown. I still couldn t help but wonder about a solid zirconia restoration. Then I saw an ad from Glidewell Laboratory advertising a crown called Bruxir. This is a solid zirconia crown (Why didn t I think of that?) highly finished to avoid abrading the opposing dentition. I called an office meeting to tell our staffers that this is what we would put on lab slips for any second molar where the patient refused gold. The laboratory instructed us to prep the tooth as we would gold. On the lab prescription we wrote for them to take the crowns out of occlusion. The first crowns we received back were definitely in occlusion. I tried adjusting this Kryptonite with finishing burs, carbide burs, course diamonds and diamond wheels! The sparks in the patient s mouth looked like a welder s bench but not much material was being reduced. It took me forever to get the bite adjusted so I m not sure if I saved any more time than if I had to do a remake! As this was a new offering from the lab, one of their representatives called asking how my first few units had gone. I explained about the amount of time it took to adjust the bite and described the sparks in great detail. I also told them I was worried about the black scuff marks that my adjustments left on the crown surface and whether or not the unpolishable crowns would abrade the opposing dentition. Since it was a new offering, not much advice was available but I was told a Bruxir adjusting and finishing kit was available. In the mean time I asked them to make sure all of my second molars were out of occlusion. (They will erupt back into function very quickly.) So, I may have found the cure for second molar misery. As long as I don t have to spend too much time adjusting the occlusion, it might work out as a great economic solution. Unlike gold, these restorations are tooth-colored and will appeal to the patients sense of esthetics. Annnnnd I haven t seen one break yet! Michael Kinsley is a general dentist in rural Georgia. A self-proclaimed Profitable Dentist junkie, Michael is also a big fan of the Golden Era of Movies. In his office, he combines autographed photos of golden-age stars with signed portraits of his patients in an environment he calls, Everyone Can Be A Star. You can contact Dr. Kinsley at SPRING

38 Clinical EZ Stent by Dr. Craig Callen Placing an implant without a stent can be risky business. Having a specialist place the implant for you and hoping the implant comes back in the right position is like playing Russian roulette. Unfortunately, some specialists are not tuned into the restorative end of the procedure and seem to almost randomly place implants and leave you with a mess to correct. These problems are often unnecessary with the use of a stent to guide in the placement of the implant body. Having a lab make a splint can cost you as much as a crown in price, so what do you charge the patient? This already expensive procedure just got more expensive. Sometimes you forget to add in the cost of the stent and you end up eating the lab bill. 1) 2) 3) EZ Stent is now sold through Stauman Implants at or go to Your Marketing Minute by Dr. Chris Bowman 3 Quick Ways To Convert New Clinical Skills Into Profit! One of the best ways to increase revenues and grow your practice during challenging economic conditions is to add new procedures and services to your practice menu. That said, few things are more frustrating than to invest time, energy, and money in clinical continuing education courses, and then not start any new cases or procedures for weeks, months, or heaven forbid ever. So what steps should you take to virtually guarantee that you ll come out of the gate strong after completing your training to provide new procedures and services? 1. Tell patients about it before you go. Whenever I schedule training for new procedures, I instruct my team to let our patients know right away! It may be several months before we re able to provide the services, but we can literally create demand before the training begins! 2. Use newsletters and press releases. Staying in touch with your patients is THE most important internal marketing action you can perform. Informing your patients about the great continuing education courses you are taking is front page news. Be sure to include stories about your training before and after, so your patients will know when they ll be able to schedule a consultation or get started. Similarly, press releases are a little used strategy you can employ to inform the public about new advances in your practice through the media. Properly written, they can give you free advertising when published! For best results make them informational, not salesy. 3. Make a killer limited offer now! Do you really want to get started on day one? Well, if you don t have any patients who are on go yet, announce a limited offer that they can t refuse: treat the first 3-5 at steep savings. Alternatively, find a team or family member who wants the procedure you just learned, and treat them for free or at your cost. Go for it! You ll quickly find that by taking the three steps listed above, you ll build momentum (and revenues) faster. Dr. Chris Bowman is a full-time practicing dentist, speaker, author, and founder of Dental Insiders Alliance. For more practice building information, visit SPRING

39 Clinical Preformed Guidance Appliance Technique The Sensible Solution for Adult Orthodontics by Dr. Earl O. Bergersen Acceptable orthodontic treatment at any age requires the correction of all the various problems present in a malocclusion. This preformed guidance appliance * is recommended for use in the adult dentition, and is specifically designed to do this in an efficient and simplified manner. Only one appliance is required to correct all aspects of most malocclusions and the same appliance is also used as the sole retainer to maintain the correction. It is a prefabricated rubbery appliance (Fig 1) and comes in thirteen exactly evenly-proportioned sizes to fit 95% of the variations in tooth and arch sizes. Most malocclusions consist of three basic problems; namely excessive overbite and overjet as well as anterior crowding. When a patient has an unacceptable overjet, the intercuspation of the posterior teeth usually involve cuspal interferences, which often lead to or are associated with TMJ problems. An excessive overbite is also often associated with TMJ problems and eventual looseness and loss of lower incisors. Incisal crowding contributes to gingival problems as well as to increased susceptibility to decay and loss of teeth. Often, due to the inherent design of most removable appliances, all of the problems of a malocclusion are not corrected, and when used by a novice or one with minimal training in orthodontics, certain problems that are critical to a well-functioning dentition are frequently left untreated. The most neglected problems in many commonly used appliance systems are the overbite, overjet and proper posterior intercuspation. This guidance appliance was designed by a board-certified orthodontist and functions in exactly the same way that ideal fixed orthodontics treats a case. The appliance is a combination of a positioner that has individual sockets arranged in a perfect super Class I arrangement, and also resembles the activator in function by advancing the mandible to correct excessive overjets and is activated by muscular activity. As a result of these varied movements of the teeth and jaws, the overbite, overjet, crowding, rotations, and molar relations are simultaneously corrected in about 4 to 10 months. This appliance has been shown to successfully correct 83% of TMJ problems and can treat malocclusions to a successful result so that 80% of the finished cases do not require any further orthodontic treatment. The appliances can also be used in combination with almost any other form of appliance therapies to enhance the results. A simple measurement is taken with a specially-designed ruler to determine the proper size. Few if any adjustments are required. Patients are instructed to wear the appliance at least one hour actively each day and also while sleeping. Active wear consists of biting and holding the teeth in occlusion for at least five minutes and relaxing for one minute for periods of at least 20-minutes at a time. The total chair-time required is between one and two hours. The usual fee for this service is about ¼ to ½ of a usual standard fixed appliance fee. The most frequently used orthodontic appliances in combination with this guidance technique are bumpers and headgears to provide sufficient room for crowded teeth which avoids the removal of enamel by stripping or adversely labial *This preformed guidance appliance is called Ortho-T and is manufactured and distributed by Ortho-Tain, Inc., tipping of incisors. Once the correction is complete, the same appliance is then used as a retainer until the patient is dismissed after about two years of retention. The following adult dentition case is a typical example of what the guidance appliance can accomplish: Fig 1. The preformed guidance appliance is shown in the mouth of a patient 40 SPRING Initial Final Fig 2. Adult dentition with a deep overbite and a lingually-locked canine, treated in 4 months with the preformed guidance appliance in combination with a lower labial bumper. Initial Final Fig 3. Same adult dentition as in Fig 2 showing lower crowding corrected with the preformed guidance appliance in combination with a lower labial bumper in 4 months. Recommended references: 1. Bergersen, E.O., The eruption guidance myofunctional appliance: How it works, how to use it, The Funct. Orthod.., 1: 28-35, Bergersen, E.O., The eruption guidance myofunctional appliance: Case selection, timing, motivation, indications and contraindications in its use, The Funct. Orthod., 2: 17-33, Bergersen, E.O., The eruption guidance myofunctional appliance in the consecutive treatment of malocclusion, Gen. Dent., 34: 24-29, 1986.

40 OrThO-T brings profitability back TO your practice The Originator of Adult Orthodontic Treatment Without braces efficient Offers These AppliAnces: n Ortho-T n Occlus-o-Guide n Nite-Guide n Snore Cure affordable proven free! case DiAgnOsis Ortho-T provides: Superior Alternative to Invisalign No Quotas, No Lab Fees, No Certification Fees Only One Appliance Worn 1-2 Hours per Day Corrects Crowding, Spacing, Overbite and Overjet Can Treat Younger Children Over 2 Million Patients Treated Developed by Orthodontist Mention Offer: PD Winter phone: fax: Call to receive your FREE case diagnosis

41 Clinical Shade Taking Just Got Simple by Dr. Woody Oakes The following is a great article from the folks at VIDENT who made the VITA shade guide. But be sure to read the info at the end of this article to find out why Shade taking just got simple! As you know, eye fatigue, improper or poor lighting, the patient s clothing, make-up or even the color of your operatories can affect shade-taking accuracy. Here are some tips: STEP 1 STEP 3 Determine the lightness level (value) Hold shade guide to patient s mouth at arm s length Start with the darkest group moving right to left Select value group 1,2,3,4 or 5 ALTERNATIVE STEP 1 Determine the hue Check whether the natural tooth is more yellowish or more reddish than the shade sample selected FINAL SHADE STEP 2 Remove all tabs except the middle M tabs Select Value group (pictured with bleach 0 tabs) Select the Chroma From your selected Value group, remove the middle tab (M) and spread the samples out like a fan Select one of the three shades to determine the Chroma But, now there is an even better way with the VITA Easyshade. With this chairside assistant you simply place the top of the device on the tooth to be prepped, click and you ll get a perfect shade match despite lighting or other untoward conditions. The device is on sale now for only $2,995. If that sounds like too much money, consider how much you are currently losing when the shades off and you have to send the crown back to the lab and reappoint the patient. To order call VIDENT at or visit Be sure to mention TPD when you call! 42 SPRING


43 Five Myths continued from page23. pregnancy, race, sex, and a host of other protected classes that influenced your decision to fire. Your job is to be able to show that when you fired the employee for being late for the third time and a generally poor attitude it had nothing to do with the fact that they are in whatever protected class they might be in. By the way virtually everyone reading this article is in some sort of protected class! So those are my top five myths of 2009 that came from employers just like you, and I know for a fact that because of the limited space I have here, many of you are left with questions and concerns, that is why CEDR The Center for Employment Dispute Resolution is hosting our Spring 2010 summit online and it s free for every employer that decides to attend. It s titled, Everything you need to know about your employee handbook. Busting the myths of In the webinar we are going to give you real solutions to the myths, guide you on classifying your employees properly, and we ll advance your knowledge about your own employee handbook. To sign up please go to our website at www. and click on the Webinars tab. There, you will find the event listed and you can sign up for free. We will also provide additional materials and links to all sorts of valuable resources during and after the event. It s time to get this right! Finally I know many of you are excited about my new dental practice and for those of you that created your own handbook and don t need any of this, I ll be offering you special discounts to my sedation dentistry practice. I encourage you to call and set up an appointment, you ll probably be fine but if things don t go great, don t worry, I have even less knowledge about what to do when things go wrong while you are under sedation than I have about dentistry in general. Together we ll get through it because I have a buddy I can call if things go bad on us while you are under. Paul Edwards is the Managing Director for The Center for Employment Dispute Resolution, LLC (CEDR). Find out more information at or contact Paul at or Tooth Desensitizer An Electrical Device For Desensitizing Teeth Purchase a metal penlight flashlight and remove the cap, spring and bulb. In the cap, insert a 1 inch length of aquarium tubing (an insulator) with a small 1.5 inch metal wood screw. Screw a metal paintbrush tip onto the wood screw. Insert 3 N sized batteries with the positive pole (top) pointed to the bottom of the penlight. Wet the brush with a fluoride solution. Make a positive contact of the metal flashlight with the skin of the patient while you paint the area on the tooth to be desensitized with the brush. The flashlight will be charged positive, the brush will be negative. Fluoride ions will flow from the brush to the tooth. Treatment For Primary Herpes Rx for Acyclovir 200 mg 1 tab 5 x per day Rx Pen Vk 500 mg, Take 2 caps right away and then 1 cap every eight hours until all caps are gone. Magic Swizzle Rinse and swallow 5 cc before meals. Peridex Rinse with one capful after brushing. What s the best dental resource on the Internet? Dental products, seminars, coaching, continuing education, great links to the best dental resources out there and so much more! It s up-to-date and get s better all the time. If you haven t been visiting The Profitable Dentist website, you re missing out! Profitable 44 SPRING

44 News Release ChaseHealthAdvance and nationally renowned dentist, Woody Oakes, team up to offer patient financing options There are many variables that should be taken into consideration with choosing a patient financing company to partner up with. Dr. Woody Oakes weighed each variable, impact to overall practice, ease of use and patient friendliness, and chose one of the nation s leading healthcare financial service providers, ChaseHealthAdvance, to stand out amongst the rest. ChaseHealthAdvance is a division of JP Morgan Chase a bank with over 200 years of lending experience and a brand patients already know and trust. ChaseHealthAdvance offers generous credit lines, affordable no interest and extended payments plan options as well as practice management tools at no additional cost to the practice. These tools from ChaseHealthAdvance help practices like Dr. Woody Oakes, Excellence in Dentistry, offer the best care possible to their patients. ChaseHeathAdvance offers your patients: $0 down payment required 3, 6, 12, 18 and 24 Months No Interest plans with equal monthly payments Extended payment plans up to 48 months Instant online credit decisions Generous revolving credit lines starting at $5,000 ChaseHealthAdvance s goal is to bring more unprecedented access to the world s best finance tools for the healthcare market. Chase is dedicated to continually developing and providing products that dentists and practice managers need to optimize their office s efficiency and profitability, states Barry Trexler, SR VP of Sales and Marketing for ChaseHealthAdvance. About JPMorgan Chase & Co JPMorgan Chase & Co. (NYSE: JPM) is a leading global financial services firm with assets of $2.1 trillion and operations in more than 60 countries, and the company has issued about 159 million credit cards in the United States and Canada. The firm is a leader in investment banking, financial services for consumers, small business and commercial banking, financial transaction processing, asset management and private equity. A component of the Dow Jones Industrial Average, JPMorgan Chase & Co. serves millions of consumers and businesses in the United States and many of the world s most prominent corporate, institutional and government clients under its J.P. Morgan, Chase, and WaMu brands. Information about JPMorgan Chase & Co. is available at www. About Dr. Woody Oakes, Excellence of Dentistry Dr. Woody Oakes is a nationally renowned dentist who has been in private practice since He built one of the largest and most successful practices in Indiana, a practice that was written up and studied by several dental publications. He is also the publisher of The Profitable Dentist newsletter. In 1990, he founded Oral-Vision, Inc., the manufacturer and distributor of the intra-oral camera. In the Spotlight continued from page 8. When you are at work be at work doing dentistry! At PDA, we teach how to consistently condense the schedule. Initially, it took me four days/week to produce $2M/year; now, I can accomplish that in two days/ week. There s a great book called The 4-Hour Workweek by Timothy Ferriss. It presents a roadmap to an entirely new world. I suggest you pick it up. Invest in yourself: Protect your practice and your livelihood. That s what I tell dentists all the time. I used to buy every new gadget out there and from time to time, I still do. But I m not impulsive and looking for the magic bullet anymore. (I m smarter than that!) Okay, this is a wrap as they say in Hollywood. Hope to see you at one of our upcoming seminars; attending the course will be like putting a few zeros on your income. We guarantee it SPRING

45 Clinical Cenegenics Profitable Dentist A.pdf 3/19/2009 9:31:33 AM SnoWhite for Dentures by Dr. Joe Steven, Jr. Many of you are familiar with SnoWhite that is used in the H&H cordless impression technique. There s another great use for SnoWhite that many of you may not be aware of and that is for removable prosthetics. I discuss its use in my Efficient-prosthetics meetings. It is our primary product to use when we need to send a denture in for a laboratory reline. After cleaning the inside of the denture, we inject 90 second-set SnoWhite, and seat the denture in the patient s mouth, border mold, and let it C set for about 90 seconds. You ll notice a M much tighter fit when you try to remove the denture. Send it off, and you ll have Y a perfectly relined denture when it comes CM back from the lab. MY Another great use of SnoWhite is to CY use it with Silkline soft reline material. I love this new soft reline material and CMY use it routinely following an immediate K denture procedure while waiting for adequate healing before sending it to the lab for a hard reline. As much as I love this injectable self-cured silicone reline material, the only disadvantage of these materials is that you can t add new material to old material. It won t stick. So, unfortunately, it s necessary to remove all of the original Silkline material which is never a fun job. Now, with SnoWhite, you don t have to remove the silicone material you simply add to it. Clean the inside of the patient s denture, dry, and inject 90 second-set SnoWhite wash material, insert, border mold, and let it set. It saves time and the mess of removing the old material, plus you get a much-improved fit (Lucky Winner: Dr. Judith Benjamin, Bowling Green, KY). SnoWhite has come through again! Give it a try on your next reline case. 46 SPRING

46 PUMP UP YOUR PRODUCTION IN 2010 BY $300/HOUR GUARANTEED! Vicki McManus, COO Dr. Bruce Baird, CEO Rated Excellent by 99 % of Attendees Up 100% in 12 months. Like propane to my practice. Unbelievable surge in our production. Course Location: Dallas, Texas SAVE $400 WHEN YOU REGISTER 30 DAYS BEFORE PROGRAM DATE. Are you frustrated by working harder without any real gains in productivity? Has your practice plateaued, yet your team says, We're doing all we can? Do you get a sense that something is missing, but not sure what? PROMO CODE: PDA2010 Have you been working too hard for too long? Are you ready to cut back time without sacrificing income? SPRING

47 Puzzle Piece Automatic Referral Generator by Dr. Woody Oakes Part #195 of the $100,000 Puzzle Here s a great idea that I wanted to share with all of our readers. As you know, your best patients usually come to you via referrals from existing dental patients. But even though you stress the value of this to your team and even practice various scripts after awhile team members forget to ask for referrals. Here s a solution that we have found very helpful. Most dental offices have background music playing throughout the office. Hopefully you are NOT using music piped in from a local radio station. What we find best is an ipod connected to the speakers throughout your office. If you don t know how to connect an ipod to your system, visit your local Radio Shack or Best Buy. If you don t have speakers, purchase an ipod tower - which works very well. After you have loaded appropriate music into the ipod, add an automatic referral generator audio track that goes something like this. Thanks for choosing Plaza Dental Group. Rest assured that we are doing everything to make your visit safe, comfortable and enjoyable. We are using the latest in dental technology, stress infection control, and always strive to keep our office clean and up to date. We want you to leave with a confident, whiter smile that you can be proud of. If you are pleased with our services, we appreciate your referral to us of family, friends and co-workers. Again, thanks for choosing Plaza Dental Group. This little audio commercial lasts for about 30 seconds, but you ll be surprised how patients comment about it and refer their friends because of it. Once you have this audio personalized and professionally recorded simply add it to your ipod. Place the ipod in the shuffle mode and the commercial will play approximately every 15 minutes. We have made special arrangements for a local studio to produce this product for you. They will professionally record it, put it on an audio CD and also it to you in a wave file format. For more information, please call Johnny at Audiocom ( ) and he ll discuss the process and the low pricing that we ve negotiated for our members. Try it you ll love it! A Word From Our Readers Hi Woody I m sorry we couldn t connect last week but I would welcome the chance to speak with you this week if you are not too busy. Last week alone I saw 4 Lumineer patients for remakes. It s become routine to see a couple of these patients a week. I ve tried to get the Den-Mat people to work with me but all they are willing to do is remake the Lumineer. I have contacted an attorney to get their attention. His name is *** *****, a long-time close friend. *** was the lead attorney on the Exxon Valdez case and has won several big awards going after unscrupulous companies. I do believe that what is happening to me is just the tip of the iceberg. The instructor who taught the course I took and whose office I attended for a hands-on course no longer is associated with Den-Mat and cannot speak about what the issue was that he had with them. But I m fairly certain the circumstances were similar. I hope you would be willing to speak with me as I would really value your input and if you are hearing similar stories from other dentists. This month, I need your assistance in helping a couple of our readers. If you have any input on these issues, please contact me at Editors Note We have forwarded a copy of this to Den-Mat for comments. We invite any other readers who do Lumineers to comment on this by ing Woody at Woody, I am planning to open a practice soon and I received a flyer for web-based software called Curve Hero by Curve Dental. 1) Have you heard of this software? They claim its $297 per month, no server, no upfront costs for the software. 2) What are the disadvantages of going with dental software for the web? 3) Does this software have full functionality (like Eaglesoft), or is it a lite software like EZ Dental? Signed, 4) Can you recommend a source that will help me pick the best software for my startup? Dr. X Help! 48 SPRING 2010 Tara Perry, DMD

48 Business Cards/Yearly Calendars The name of the game is keeping in touch with all your patients as often as you can throughout the year. As we all have heard so many times, Your patient may not stay your patient unless you stay in contact throughout the year. Laminated, credit card size yearly calendars are very inexpensive. Insurance agents have used these cards for years with fabulous results. We ve taken it one step further and are giving you a direct source for the cards. On one side is a standard 2010 calendar. Then on the other side is an abbreviated version of your business card. For those of you that have attended my 10 Best seminar, you know the keys to a great business card. For those of you that haven t here s a tidbit. The target patient for cosmetic dentistry is a 40+-year-old female with a household income of $50,000. Most 40+ women can no longer read fine print without glasses or the best selling OWL device. Unfortunately, the telephone number on most cards is so small that your target audience can t read it without magnification! So we would recommend the telephone number be as large (or larger) than the practice name. Above is an example, of the killer design our graphic artist can create for you (call , ext. 13). We joke about the word killer because a lot of dentists say they have a killer sign, killer ad, or whatever and there is NO telephone number on the piece, so yes, it is killing them. To order call Oral DNA Tests Oral DNA Labs is officially launching two revolutionary molecular tests to help dental professionals identify patients with existing periodontal disease as well as to identify patients with the genetic predisposition for developing periodontal disease well before physical symptoms occur. Specifically, MyPerioPathsm detects the presence and quantity of specific bacteria associated with periodontal disease, while MyPerioIDsm PST, which the company licenses from Interleukin Genetics, provides a means of quickly and accurately assessing an individual s genetic risk for periodontal disease. This launch not only marks a major advance in the science of oral diagnosis, it is widely introducing the clinical lab business model that has long been a fixture in medicine to the dental profession. For more information, please go to or call Once again, these salivary DNA diagnostic tests represent a major scientific advance as well as a potential business model shift for the dental profession. Note from Editor: We regret any confusion our article New Super Crown Survives Even the Strongest Bruxers! The correct name on this product is BruxZir and pricing runs at $99 per unit. Give them a try on your next bruxism case! Hi Tara, Sorry... but I don t know anything about this software. But I ll ask our readers and see if we get any feedback. Question for Woody, What do you think of the Heartland Dental Care Group? I am looking at options for a struggling dental practice and feel a well-managed system may be a good choice but am worried about the group instituting a factory atmosphere. Sincerely, Dr. Z Dr. Z Heartland is a great choice for dentists who don t want the hassle of managing a dental practice. Several of my friends are very comfortable working for them! Regards, Dear Doctor Woody, First of all, I d like to thank you for taking the time to answer me. The American is really the greatest man on this earth. You also confirmed that. Last week all the time I was thinking about how to thank you for your gesture. I ve visited your Internet site for quite a while now and I ve learned a lot from it and your magazine. The site is wonderful and rarely does a person see such a great and neatly done Internet page. Your offer is very generous thank you. If there is a possibility, I would like to pay for the mailing for this 2 DVDs: Dr. John Lyons 20-Minute Denture and 11-Minute Partial System DVD and Dr. Omer Reed s 90-Second Crown Prep DVD. Maybe sometimes we will l have a chance to see each other personally so I can thank you again. In the end I will wish you a great time during the upcoming Christmas Holidays and I want to wish you a Happy New Year. Jasmin Fidoski Republic of Macedonia SPRING

49 This year, US dental practices will spend over $6.3 Billion on dental products. Most of them will overpay. Will you? Save 15% Off Catalogue Pricing When You Call The Profitable Dentist Buyers Club at and you won t be one of them! SPRING

50 $1 Trial Membership Driving Dentist Series (The Easy Way to Get Your CE Credit) YES, sign me up for my $1 Trial Membership in the Driving Dentist Series Audio CD Program! I understand that my first month s membership is only one dollar since I m sending this in before March 1, I authorize the additional monthly charge of $46.97 to my credit card for my monthly membership fee as long as I want to continue in the DDS program. I will receive a monthly audio CD, complete written transcript, CE credits and other FREEBIES from time to time. I can cancel anytime just by contacting Christy. Upcoming interviews include: Dr. Howard Farran, Dr. Bruce Baird, Dr. Jimmy Eubanks, Dr. Gary Cameron, Dr. Wes Blakeslee, Dr. Ryan Swain & Dr. Matt Bynum Just to name a few! Please Print Neatly Name Address Excellence In Dentistry Feature Product & Services City State Zip Phone Fax Visa MC Amex Discover CC# Exp. Date: Signature FAX to , Attn: Lisa No Later Than March 1, 2010 OR Mail to: 3211 Grantline Road, Ste 20, New Albany, IN Code: NEWS SPRING

51 What Do You Do When There s 134 Pizza Orders On A Friday Night? OR = $$$$ (The answer s simple when you have a protocol.) Excellence In Dentistry Feature Product & Services Most of you reading this letter have heard about Papa John s Pizza it s the second largest pizza company in the United States (maybe the world?). Anyway what you may not know is that the founder, John Schnatter was an occasional patient in my infant dental practice. But for the real story keep reading! As a teenager, John had two loves: making pizza at his father s store and his prized car a 1972 Z28 Camero. Her knew he could make a great pizza, but he also knew that marketing and systems (protocols) were the secrets to a successful business. He then made a great, profitable decision an all or more decision that most dentists are unable or unwilling to make. He sold his prized Camero, bought a used (gosh, he used pre-owned equipment?) oven with the proceeds and then started his pizza empire in a refurbished broom closet in Jeffersonville, Indiana. And now, 25 years later, he s a multi-multi-millionaire. Hard work and the protocol book is his secret. What if there was a similar book for dentists? Dr. Steven Rasner Well, the great news is that Dr. Steven Rasner who runs a $4M practice is offering just that in his amazing Dental Office Protocol book on sale at an unbelievable, unheard of price. WARNING: This life-changing book will tell you exactly how to run your business and how to handle every situation that occurs? If you think you cannot handle the simple, simple ease of it all, STOP READING NOW put down this flyer and continue to muddle through the everyday fiascos in your office! If you re ready to simplify things for your staff, yourself, and your patients CONTINUE ON If you ve read this far, you may be wondering about the unusual headline on this sales letter. Well, it s paraphrased from the Papa John s Protocol Book. When they have 134 pizza orders on a Friday night, they take all of the telephones off the hook because they ve reached capacity. Then, when they catch up, the phones go back on and they start taking orders again. If a customer complains about their pizza being delivered late, they turn to page X and there s also a protocol for that. Get the idea? WARNING: This Book Will Change Your Expectations, Your Profitability, and Your Stress Level You Must Act Now To Claim Your Copy ONLY 77 AVAILABLE Don t Miss Out! (The book is now out of print.) Call Right Now to Claim Your The Protocol Book What To Do When for ONLY $197 It s difficult to put a price on something as valuable as a dental protocol book, but your investment is only $197. Plus you can get the entire book on Audio CD (add $37) or a Computer Disc (add $37) that you can customize to fit the needs of your practice (Audio CD and Computer Disc only available with book purchase). ORDER NOW CODE: NEWS-BKPB 52 SPRING

52 Book Shows How To NET $1 Million A Year In Your Dental Practice Even In A Recession! After 13 years of being stuck at $500K, Dr. Mike Kesner discovered that the practice model, he was desperately trying to implement, just wasn t going to cut it.) Dear Doctor Did you know that the average dentist is 54-years-old, nets $127,780 before taxes and does not enjoy his/her career choice? Did you also know that most dentists cannot afford to retire? Also, more dentists are un-retiring than ever before. I think these are statistics that need to change for our profession. Dr. Mike Kesner 13 years of Desperation before he found the correct model! Dr. Mike Kesner was there! After years of trying and failing to build a successful practice, he decided to call it quits. So he sold his practice and embarked on a journey that allowed him to discover the secrets to building a Multi-Million Dollar Dental Practice. In this product, he will share with you some of the secrets that have allowed him to net $1,000,000+ a year in his general dental practice for the last five years and how he continues to do so today even in a recession! This book could change your life and the life of your family. Read it and make the choice to become wealthy in dentistry and enjoy the profession like never before! But don t take my word for it, read this: Greg Stanley and I started Whitehall Management over 28 years ago. Throughout those years I have associated and consulted with the best of the best in our industry, however I must admit that I was blown away when I met Dr. Kesner (and saw what he had developed) in his practice. What really caught me off guard was how big the production was without stress. I was shocked at the end of the day when I saw how much dentistry was done and Dr. Kesner never looked like he broke a sweat. He is, without a doubt, the most efficient doctor I have encountered in my 28-year career. Not only is he the best producer I have met, but he is so willing to share with others and inspire them to accomplish greatness in dentistry. - Gregory Jack Dental Coach and Consultant Co-Founder of Whitehall Management Before he discovered the correct model, Dr. K was netting only $120K/year. This was far too much work and far too much risk for only $120K. Maybe this sounds familiar? You want success, but the harder you work the harder it is to find success? Are you tired and frustrated? The late, great Will Rogers once said The only difference between a rut and a grave is that the grave has sides at both ends. Climb out of the dental rut forever with Dr. Kesner s amazing practice model! Excellence In Dentistry Feature Product & Services This product includes the entire 157-page book, plus a special DVD that Dr. K put together that helps explain everything. If you are unhappy with your current net income (and lifestyle) then this product is perfect for you. Don t let your rut turn into a grave. I invite you to order Dr. Mike Kerner s book and DVD Multi-Million Dollar Dental Practice for ONLY $ by calling Regards, William W. Oakes, DDS CODE: NEWS-MKBK - If you have weak heart or a hip replacement this book is NOT for you. But, if you are ready to rock and net $1M/year, then Dr. K s candid advice will be solid gold for your practice and your life! SPRING

53 Who Else Wants To Learn From Ripley s Believe It Or Not Dentist? (The secrets of a 36-year-old dentist who does the impossible everyday!) Excellence In Dentistry Feature Product & Services One of the challenges of running an information/marketing company like EID is finding new dental talent and then finding a way to present it to the profession. Oftentimes, it s a gamble someone you think will do well bombs and oftentimes you find a diamond in the rough! Well, this time we found a true diamond in Dr. Chris Griffin! To refresh your memory, Dr. Griffin practices in the economic sinkhole of Ripley, Mississippi. He takes four days of vacation every week, and does about $1.5M/year working ONLY 3 DAYS PER WEEK! Of course, the most amazing part of this is that he works in $7,500 of unscheduled/emergency dentistry nearly every day. So, to recap, he only works 12 days/month, has a daily goal of $12,000 and ends up doing about $1.5M/year with overhead lower than a snake s belly! Now don t think this is due to the fact that Ripley, MS is a thriving city with lots of industry. It s not and most of his patients are blue collar and no collar factory workers. The secret s not a Taj Mahal office building featured on the cover of Dental Economics. Nope, it s a renovated house close to the local McDonalds. Maybe it s his great website? Nope his website is decent but it s certainly not a patient producing machine like that of - say - Dr. Stephanie Mohan s. So What Is It? In a nutshell, Dr. Griffin has created a consumer-oriented practice that s efficient, affordable and can get most folk s dentistry started or done TODAY! Even though I ve interviewed Chris and read or reviewed all of his products, I took about 10 pages of notes at the actual seminar. And get this, of the 150+ folks in the audience only four people didn t stay until the end and that s only because they had to catch a 5:30 PM flight out of Louisville s Standiford field airport. Best Way To Learn? Study after study has shown that most people learn in three different ways: visual, audio or combinations. So to ensure that you get the absolute best value from Chris information, we ve put together a Ripley s Believe It Or Not Package that includes: DVDs of the entire day s event Audio CDs of the entire day s event A complete written transcript of the event A binder of the complete lecture PowerPoints/handouts A personal invitation to visit Dr. Chris Griffin s office to learn from him (and his staff) over the shoulder. Doctors who attended the 3-Day Dentist Seminar in Louisville, Kentucky lost a day s production in their office, had the expense of travel for themselves and several staff people, and two nights lodging and food. So maybe the only fair thing to do would be to match their investment on this product? Even at that it would still be a bargain! But since we know that a lot of you are struggling and need help in the New Economy we are pleased to offer Ripley s Believe It Or Not package at only $497! Call or visit to order your copy today! Regards, William W. Oakes, DDS CODE: NEWS D951 You and your staff will be BLOWN AWAY by the 100 s of gems that you can implement into your office INSTANTLY to boost production and work less! 54 SPRING


55 Request a FREE sample* of SpeedCEM today! PRSRT STD U.S. Postage Paid Louisville, KY Permit No. 354 Log on to Shift up to SpeedCEM SpeedCEM For the fast, efficient cementation of IPS e.max. SpeedCEM S e l f - A d h e s i v e R e s i n C e m e n t Developed specifically for high-strength ceramic restorations such as IPS e.max lithium disilicate, as well as metal, metal-ceramic and zirconia restorations, SpeedCEM features patented adhesion promoters eliminating the need for additional dentin/enamel primers or bonding agents. 100% CUSTOMER SATISFACTION G U A R A N T E E D! Call us toll free at in the U.S., in Canada Ivoclar Vivadent, Inc. SpeedCEM and IPS e.max are trademarks of Ivoclar Vivadent, Inc. *Offer valid in the USA and Canada only, while supplies last. Requests must be received by 5/31/10. Limit one per office. Ivoclar Vivadent reserves the right to cancel this promotion at any time.

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