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11th Annual Mega’Gen International Symposium – New York, NY

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For more information on seeing Howard speak at this event:

11th Annual Mega’Gen International Symposium
267-291-1150
http://vizstara-professional.cdeworld.com/events/130

5/1/2015
New York, New York

Grand Hyatt Hotel
109 E. 42nd Street
New York, NY 10017

MegaGen jpg

Dr. Farran’s Seminar Coordinator is:
Rebecca Parent
rebecca@farranmedia.com

How to Successfully Integrate CAD/CAM

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I had active Townie Dr. Sameer Puri come to my practice to train my staff on a new CAD/CAM software last month. Why? Because I wanted my assistants to know how to use the system just as well, if not better, than I do. I know that 90 percent of the questions asked by patients are fielded by the front desk and the assistants, not me or the other doctors. And because of this, I want all my staff to know what they’re doing!

So many doctors go to CE courses or conferences alone. They’ll do in-office training alone. They’ll never teach their staff the software or systems or procedures. This doesn’t make any sense. You don’t work alone. You don’t run your practice alone. Why would you attend a conference to learn how to better your practice and then not bring your staff along? That just doesn’t make sense.

I sat down with Sam to ask him about CAD/CAM implementation. Our office has it already, but not all offices do. I wanted to see what he had to say about the technology and how he helps doctors successfully implement the machine into their offices. Here are some of his tips:

Train Your Team

The key with any office utilizing CAD/CAM is getting your team on board. At one point, there was a lot of debate about whether the technology worked or was worth it. I think that’s over. There have been offices—single doctor, one assistant, one front desk—that have been successful and there have been multi-doctor, multi-staff offices that have integrated it efficiently.

Once you get your team trained with how to use CAD/CAM properly, the dentist really just needs to do what he or she has been doing with a lab. The dentist should numb the patient, prep the tooth and then leave. With CAD/CAM, the team can take over (depending on the laws of the state) and nearly the entire process can be done without the supervision of the dentist. The dentist can be in the other room being productive. And when the restoration is done, come back in to check the work and cement it. If the team member takes the impression, designs the restoration, mills it and either polishes or glazes it, it saves the doctor a lot of time he or she can spend in another operatory. The key is that you have to have your team trained. You have to help them learn how to utilize the machine.

Don’t Let it Be Disruptive

Introducing a new piece of equipment into the office can be huge. Change doesn’t have to be overwhelming. I hear from dentists all the time, “We’re really busy. I don’t know if we have the time for it.” Well, it’s no different whether you have a well-functioning office using CAD/CAM or if you’re sending your restorations to a lab. The doctor does not have to be heavily involved in the design of the restoration…if you train your team.

Integrating CAD/CAM doesn’t have to be disruptive. You should adapt the system to your practice, not adapt your practice to the system. No matter how big or small your practice, you have a certain flow in your office that obviously works for you. Make the machine accommodate the flow of your office. Things don’t have to change drastically.

Yes, you’ll have to learn how to take a good digital impression. But that’s easy with the current generation of CAD/CAM systems. The impression gives you a lot of feedback. You instantly know whether you have a good prep or not, whether you’ve reduced enough, whether you need to do a reduction coping or spot the opposing. You know instantly whether you’ve captured the margins and whether you’ve prepared the tooth properly.

If the team member is doing all that work for you and they say, “I can’t quite see the margins.” He or she simply calls the dentist back, the dentist makes the appropriate modifications and you proceed.

Recognize the Need for Same-day Dentistry

When it comes to implementing the technology, the biggest mistake that offices make is they forget that there is a person attached to those teeth. They’ll say, “My lab is great. My temporaries fit well. My patients don’t mind coming back for a second visit.” This is utter nonsense. I have never met a patient who would prefer to have a restoration done in two visits instead of one. It’s crazy to believe that your patients have all this free time and can come back for multiple appointments.

Discover CAD/CAM’s Potential

When CAD/CAM first entered the mainstream market, many offices bought a CAD/CAM but they didn’t know how to use it to its full potential. This was common because the learning curve was significant. Twenty years ago you had to spend time doing 50 to 100 restorations just to learn how to do a simple inlay. You had 2D software. You had to manipulate a bunch of lines on the screen and imagine that would be a restoration. Today, with proper training, a dentist can do 30 restorations his first month. The learning curve is significantly reduced. The return rate (those who buy the machine and say it doesn’t work out) has dropped exponentially too, because the machine, the software and the results are so good.

In the past, dentists were limited by the materials they could use. We only had one material: feldspathic porcelain, which is a relatively weak porcelain. We had to use that everywhere. Today, a dentist has anywhere from six to ten different types of blocks they can mill—from composite to zirconia to lithium disilicate to feldspathic porcelain. We can do inlays, onlays, implant abutments, bridges…we’re not talking about just a simple little machine anymore. We’re talking about a robust piece of equipment that can serve as a center of the practice doing many different types of restorations.

What’s your experience with CAD/CAM? Have you integrated it? Are you ready to do so? Let’s continue to talk about this massive evolution of technology at Dentaltown.com. – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2680&t=233712#sthash.teltjuS7.dpuf

Howard Speaks: And the Band Played On…Again

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Howard Speaks: And the Band Played On…Again
Dentaltown Magazine
August 2014
by Howard Farran, DDS, MBA

When you’re young, everything is black and white. When you’re half a century old, everything is 50 shades of gray. And as you get older, you see patterns.

I remember my senior year of high school when two men were dying of something called Kaposi’s Sarcoma in a hospital in California. This was strange because the two men were young and the cancer was something typically only found in the older population.

Then researchers found out both men were gay. When they crunched the odds of this, it caught the attention of the Center for Disease Control and Prevention (CDC). Soon the numbers grew to prompt a medical investigation.

A New York Times article dated July 1981, reported: In the United States, [Kaposi’s Sarcoma] has primarily affected men older than 50 years. But in the recent cases, doctors at nine medical centers in New York and seven hospitals in California have been diagnosing the condition among younger men, all of whom said in the course of standard diagnostic interviews that they were homosexual. Although the ages of the patients have ranged from 26 to 51 years, many have been under 40, with the mean at 39.
This was, of course, the start of the AIDS epidemic of the 1980s. The CDC just hadn’t quite realized yet how widespread and destructive it would be.

In 1987 Randy Shilts published a book titled And the Band Played On: Politics, People and the AIDS Epidemic. A movie stemmed from the book, which premiered in 1993.

The synopsis: Don Francis, epidemiologist and main character, questions the escalating number of unexplained deaths among gay males, particularly in large cities like New York and San Francisco. He starts to investigate the possible causes and keeps tally of those affected by the disease. This list is nicknamed “The Butcher’s Bill.” He talks with politicians, professionals within the medical community and activists and eventually theorizes that AIDS might be sexually transmitted.

Now, we’re more than 30 years beyond this public health nightmare. And hindsight is 20/20. We might have high awareness now but at the time, it flew under the radar for years. And part of the problem was that people refused to talk about it.

In the past, oral and oropharyngeal cancer—or “mouth cancer,” as they call it in the U.K.—have most often been linked to drinking and smoking. And even more specifically, the cancer has been linear—someone who had smoked two packs a day for four decades was more likely to get cancer than someone who had smoked one pack a day for one decade. Chewing tobacco didn’t follow this model. It was less predictable and didn’t get a lot of attention, though still a cancer risk.

Now, the tides have turned. Today we’re seeing an explosion of oral cancer in young girls! Girls who have never had a cigarette in their lives and don’t have a drinking problem. They’re showing up at the doctor with lesions and screening positive for cancer. It’s HPV and it’s hitting us all by surprise. But nobody is talking about it.

You can’t talk about HPV without talking about oral sex… so let’s just get that out of the way. It’s awkward, but you’re an adult, so buck up. Last year the U.K.-based newspaper The Guardian published an article about Michael Douglas, who opened up the conversation about HPV’s ties to oral sex, attributing his own cancer to it.

I get it; you’re not a sex ed teacher, but if we’re going to call ourselves doctors, we need to be asking some tough questions. When I lecture I ask dentists if they talk to their patients about HPV. It’s not even on dentists’ radar.

You should be asking every patient who comes in if they’ve been vaccinated for HPV. Many dentists give excuses. “That’s not my area. Their family physician should do that.” No! We are all on the frontlines of health. If we’re not talking about this, let’s just say we’re not doctors. We’re just molar mechanics.

We have a serious biological problem here: a virus. We’re knowledgeable about AIDS—possibly one of the only positive outcomes of the epidemic—but we’re missing the new problem right in front of us.

I talked to a mother of a patient in my office who refused to talk to her daughter about HPV. And the mother thought that vaccinating her daughter against the virus would be the same as sending her off to college with a box of condoms. She didn’t want her daughter to feel protected. These are huge moral, ethical, religious questions. We need to talk about this stuff, even if it is uncomfortable or controversial.

In 2007, Texas Governor Rick Perry worked to mandate the HPV vaccine among middle-school girls. Though it was controversial and was overridden in the months after, it was one of the only big-time public actions taken against the virus. All 50 states in the U.S. have a Department of Health and Human Services, and nearly every state has a dental division. Have you ever called yours to talk about HPV? Ask for resources. See what the division is doing in your state.

HPV is a topic that makes people squirm in their seats. We don’t want to talk about it. No one wanted to talk about AIDS either. It made people uncomfortable. But the epidemic happened right in front of us anyway. And in a way, we were blindsided! This is what’s going on right now with HPV. The fact is, we don’t know how serious it is or isn’t. And it’s our job— as dentists—to talk to patients and parents about the risks of the disease.

Not only are we not talking to patients, but we’re not talking to each other about it either. I’m on Dentaltown all the time and there is hardly any discussion at all about HPV. Let’s talk about how to educate patients and parents! Let’s converse about the public health risk and our part in the big picture. Americans see a dentist twice as often as they see a physician. We have 125,000 dental offices in America. That’s manpower! We have a massive ability to get out in front of this.

We don’t want to look back at an HPV Butcher’s Bill and ask ourselves what we could have done about it. I’d love for dentists to stand up and become physicians of the mouth. We’ve got a problem on our hands right now.

References

  1. Rare cancer seen in 41 Homosexuals: by Lawrence K Altman; July 3, 1981; The New York Times http://www.nytimes.com/1981/07/03/us/rare-cancer-seen-in-41-homosexuals.html
  2. National Conference of State Legislatures http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
  3. Michael Douglas: oral sex caused my cancer”; June 2, 2013; The Guardian http://www.theguardian.com/film/2013/jun/02/michael-douglas-oral-sex-cancer?CMP=twtgu

– See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=365&aid=4974#sthash.utdmJeBH.dpuf

Why Two Out of Three Cavities Go Untreated

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Every year, since 1991, there have been more cavities diagnosed than the year before. That’s a terrible statistic.

What would happen if the fire chief of a city reported that in the 23 years he had been in the position, more houses had burned down each year than the year before?

Legendary, successful mayors are the ones who substantially lower the crime rate while they’re in office. “I’m so proud of the fact that there were more murders than last year! We’re hoping and expecting even more next year!” said no one ever.

On average, for every three cavities a dentist diagnoses, he only removes the decay on one. One! He doesn’t remove the decay two out of three times! That’s below average dentistry! We all claim to be good dentists, but on average, we can’t all be.

I always hear clinicians say they’re 20/20/20 dentists—“My fillings are bonded with greater than 20 megapascals.” “All my indirects fit within 20 microns.” “All the materials I use wear less than 20 microns a year.” They use their fancy adhesive bonding agents and their fancy CAD/CAM machines on one-third and do squat on the other two-thirds.

You are a dentist because you got A’s in science and math, and because you (hopefully) genuinely care about removing decay and disease. But part of the problem is that dentists typically aren’t good at sales. And to fix patients’ cavities, and in turn, prevent the spread of disease and decay, you’ve got to convince them they have a problem that needs fixing.

Say you have a patient in the dental chair and you are presenting treatment after an exam. You might say something really technical and clinical. “You have an interproximal legion on the distal of three. It’s causing irreversible pulpitis. You’ll need endodontic therapy, a post-build up and a full-cast restoration.” The patient just stares at you like a deer in headlights. She doesn’t understand what you just told her, doesn’t realize the importance of fixing the issue and because she, like most people, doesn’t buy based on information, she walks out to the front desk, says she’ll call later to schedule her treatment and then leaves. Two out of three cavities are walking right out your front door!

Let’s look at this same situation by putting ourselves in different shoes. Say a dentist was selling real estate. He’d walk in the house with the client and say something like: “The altitude of this house is 368 meters above sea level. This side of the street gets direct sunlight in the morning. The climate of the area is mostly rainy…” Boring! It would be all technical information.

A good real estate agent, on the other hand, would present a house much differently. She would walk you into the living room and help you imagine the big parties with family and friends that you could have. She’d sit with you around the fire pit and talk about how fun it would be to BBQ on the patio during the summer. She’d make it relatable. She’d make it an emotional decision rather than an informational one.

There is a biological science to selling. There are only two things humans can love. It’s not ice cream or cookies or dogs or cats or family. It’s dopamine and serotonin.

Your dog sees you walk in the front door from work. His tail wags and he jumps up, excited to see you. You think you love each other but you actually love the two chemicals. The real estate agent is secreting dopamine and serotonin too.

What on your résumé makes you think you’ll be good at sales? Sometimes dentists are their own worst enemies. Patients are already on edge when they visit the dentist, so it doesn’t take much to (even unintentionally) put them in fight or flight mode. Looking back to the patient in the dental office, it’s no wonder she wasn’t compelled to schedule her treatment. You weren’t giving off any dopamine or serotonin. In fact, you were secreting norepinephrine and adrenaline, which have the opposite effect.

We’re putting patients in fight or flight mode because of the clinical information we’re spouting off and because many dentists feel compelled to comment on previous dental work. If you’re not impressed, keep it to yourself. In 1997, William Ecenbarger published an article in Reader’s Digest called “How Dentists Rip Us Off.” The investigative journalist went to 50 different dentists for consultations. He received 50 different treatment plans. Dentistry is as much an art as it is a science. It’s inexact. So unless you see shoddy dentistry worthy of malpractice accusations, don’t badmouth! What if the patient was a family friend with her previous dentist? What if their kids played sports together? If you’re badmouthing her previous dentistry, you’re telling the patient that her decision to have treatment years ago was a bad one, but now you’re asking her to make the decision for treatment again with you.

The point is we need help selling treatment. Most of us are just not biologically good at it. I’ve had the same dental assistant for 25 years. She is great at presenting treatment because she gives off serotonin and dopamine. She’ll present treatment like this: “You have two cavities, but I wouldn’t fix them just yet because if the doctor puts those fillings in there, he’s going to match them to the existing teeth. So, what I would do is bleach them first. But before you do that you need to have them cleaned. So let’s get you in the hygiene department and we’ll get all the plaque and tartar off your teeth, then we’ll bleach them in the office and send you home with bleaching trays. Then we’ll remove those cavities and match the fillings to the pretty white teeth. It’s going to look great.” The patient gets excited about what her new smile will look like!

I lucked out having an assistant who is so good at selling dentistry. But the fact is, I still have a treatment coordinator. This is something that orthodontists figure out two years into practicing and nine out of ten dentists never figure out. Treatment coordinators have been known to triple treatment production! By hiring a TC we can lower the rates of decay and disease, and maybe clean out two of three or three of three cavities that come into our offices! – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2669&t=230414#sthash.47OLzMj8.dpuf