HowardFarran.com

Start building your ideal dream dental office!

facebook twitter linkedin pinterest googleplus googleplus email

Best Practices, 2013

by Leave a Comment

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

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

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

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

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

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

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

Treatment Plans, Social Media Marketing and the Meaning of Life

by Leave a Comment

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

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

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

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

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

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

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

 

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

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

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

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

SUBMIT YOUR ARTICLE TO BE PUBLISHED IN DENTALTOWN MAGAZINE!

by Leave a Comment

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

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

 

 

Quit Rambling On

by Leave a Comment

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

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

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

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

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

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

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

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

Getting Poised for Growth

by Leave a Comment

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

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

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

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

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

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

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

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

Best Tips for Better Practice in 2013

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

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

Dentists are Still Doing Way Too Many Three-Unit Bridges

by Leave a Comment

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

Insurance Coverage?

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

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

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

Pricing and Presentation?

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

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

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

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

Specialists?

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

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

Implants Are Hard? Really? In 2013?

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

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

Remember the 4,000lb Gorilla in the Room

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

In Summary

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

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

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

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

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

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

Here’s What Really Happens When You Extend a Deadline

by Leave a Comment

Here’s a great blog post from the Harvard Business Review on deadline extension… check it out!

 

In June, the Obama administration pushed back the deadline for employers with fifty or more workers to provide health insurance for their employees by a full year — until Jan 1, 2015. Admittedly, the implementation of anything as complex as the Affordable Care Act is going to take time, and those involved have been working furiously to try to meet the government’s deadlines. So, at least with respect to this particular part of the ACA, everyone has an additional year to get everything just right. Sounds like a good thing, doesn’t it?

Only — how furiously do you think everyone with this new, extended deadline is working now? Are they still burning the midnight oil… or are they saying to themselves, Let’s take a breather. We’ve got plenty of time.

Read the rest of the article here: http://blogs.hbr.org/cs/2013/08/heres_what_really_happens_when.html?utm_source=dlvr.it&utm_medium=twitter

Parents sue Texas City man after boy’s teeth ripped out in dog attack

by Leave a Comment

A civil lawsuit accuses a Texas City man of failing to control his dog, which attacked a boy so severely in 2011 that it ripped out the child’s teeth. Read the rest of the article here: http://www.chron.com/news/houston-texas/houston/article/Parents-sue-Texas-City-man-after-boy-s-teeth-4744490.php

 

That’s one heckuva dog bite! Comment on this below!

Burglar Caught on Video Inside South Philly Dentist’s Office

by Leave a Comment

Hey gang… Check this out… What would YOU do in this situation??

 

Philadelphia police are on the hunt for a man who broke into a dentist’s office in the Pennsport section of the city over the weekend: http://philadelphia.cbslocal.com/2013/08/20/burglar-caught-on-video-inside-south-philly-dentists-office/

 

Comment below!!