December 1, 2003
by Howard Farran, DDS, MBA, MAGD
1 — High-speed internet connection to get connected with your peers! Do you remember in school when you were lost? You knew your teacher knew the answer. You knew some of your classmates knew the answer. With the message boards at www.DentalTown.com, you can access information from other wet-gloved dentists from around the globe in addition to academicians and nationally recognized consultants. Experts such as Gordon Christensen, Karl Leinfelder, Bob Ibsen (Den-Mat), Stewart Rosenberg, Sally McKenzie and Linda Miles visit the website and share their advice. You also have more than 14,000 peers who can answer questions about anything from bonding, root canals, and implants, to staffing issues, marketing and legal advice. Log on today and let your online friends and colleagues revitalize your spirit, mind and soul.
2 — Start doing more endo today! Endodontics, composite fillings and implants are the three fastest-growing sectors of dentistry. You need to invest in an apex locator. Buy yourself a RootZX from J. Morita, the AFA (All Fluids Allowed) Apex Finder #7005 from SybronEndo, or the Formatron D-10 from Parkell. The most exciting advancement in endo is rotary files. Try either the .06 tapered ProFiles (sizes 15, 20, 25, 30, 35, 40 & 45) from Dentsply Tulsa or the new and exciting K3 files from SybronEndo. Rotary endo files work better with an electric engine as opposed to an air driven handpiece. Try an ATR Tecnika Torque Control Motor and Contra Angle from Dentsply Tulsa Dental or a Quantec-ETM electric torque control motor from SybronEndo, or the Endo-Mate from NSK America. Or take an entirely new and more conservative approach to endodontics with Endo-Eze AET by Ultradent.
3 — Buy a Diagnodent! It takes a very good bitewing radiograph at the perfect angle to diagnose a flossing cavity (interproximal decay from not flossing daily) but it takes a Diagnodent from KaVo to diagnose pit and fissure decay. We have two Diagnodent machines, one for the hygienist to use during recare appointments and another one for the dentists to use during new patient exams. I cannot tell you how much decay you are missing if you are still using a sharp explorer. A very typical Diagnodent story goes like this. You see a seemingly normal, dark brown, heavily stained pit and fissure. You look on your chart and the last time you saw the patient you had so little suspicions of this area that you did not even record a watch. You run your Diagnodent tip over the pits and fissures and it measures 50 to 75. You anesthetize with Septocaine, set a timer for eight minutes, and start to excavate the area. After drilling through the very hard enamel you fall into a pit of mush. By the time the area is completely excavated and cleaned, with the use of caries indicator dye such as Seek from Ultradent and a slow-speed bur, you nearly have a pulp exposure. You reflect to yourself embarrassingly that this patient has been in for a recare appointment every six months for the last 10 years.
4 — Start using a self-etch bonding system! Self-etch verses total-etch is the biggest buzz in bonding today. In a recent survey respondents said more than 52 percent of them use a self-etch while 47 percent use total-etch. The rapid advancement in self-etching is due to the fact it shuts down sensitivity. The reason is you cannot etch deeper than you can penetrate with resin. In addition, since the smear plugs are never removed, tubules are not opened; therefore there is no need to seal them. The best self-etching bonding systems are Clearfil SE Bond from Kuraray, Touch&Bond from Parkell and Simplicity, available through Apex Dental Products.
Another major difficulty with posterior composites is getting a tight contact. Two systems that solved this problem are the Composi-Tight System from Garrison Dental and/or the Palodent Sectional Matrix System with the BiTine ring sold by Dentsply Caulk.
A further major advancement in posterior composite placement is using a flowable composite on the floor of the prep followed by your regular composite on top. This two-layer technique is a must for fast, easy, predictable composites. I use Helioflow on the floor and Heliomolar on the ceiling. Both are made from Ivoclar Vivadent. 3M has combined these two steps, a flowable and a regular composite into one step with Filtek P60 posterior restorative. For anteriors try Palfique Estelite from J. Morita.
If you really want to make your posterior composites go faster, easier, and smoother buy yourself a Sapphire plasma arc curing light from Rembrandt. There is nothing more boring than sitting around slowly curing composites when you can cure 5mm deep in nine seconds. The Rembrandt Sapphire light can also be used for your in-office bleaching system, which is another practice builder. This dual purpose two in one curing light and bleaching light is a must have for your dental armamentarium.
5 — Go completely digital and paperless! There is absolutely no reason to start an old-fashioned paper chart on any new patient today. With digital radiographs, scanners, the Internet, electronic claims, are working online from home, why in the world are you still using paper and charts? When you are taking a working length film or a master apical cone fit film during endo, or taking a bitewing film on a crown before final cementation, why not have the films instantly appear on your computer. Why are you waiting around for a film to be processed? Do you really want to store your x-rays in a chart? When a patient calls you at home do you realize how awesome it is to pull up the patient’s digital chart? One percent of dental offices are completely digital and paperless today; within five years I predict it will be 10 to 20 percent. Don’t wait a second longer to join this new era in healthcare technology.
6 — Set a continuing education goal! L.D. Pankey said you can’t sell a product if it’s not on the shelf. Identify an area of dentistry that you routinely refer out or have major difficulty with, and then set a goal to master that area. I still think that earning my FAGD and MAGD accelerated my career more than anything else I have ever done. The FAGD and MAGD requirements are spread out over 16 areas of dentistry. This requirement forces you to take courses in areas outside your comfort zone. By the time you take the necessary hours to meet your requirements you find yourself proficient in that area. When you learn how to do more procedures, you diagnose, treat, and collect revenue from previously untapped areas. The other hidden phenomenon of continuing education is that you spend a lot of time with other dentists interested in dentistry. Practicing all by yourself means that only you can motivate and push yourself. Spending more time with fellow dentists and colleagues feeds and energizes your mind and career. Decide to go through the Misch Institute of Oral Implantology. Go through Brock Rondeau’s orthodontic program. For endo attend Kit Weathers’ Root Camp or see Steven Buchanan. Decide to attend all of Gordon’s Practical Clinical Courses in Provo, UT.
7 — Find a great lab! If you are having problems with your lab, or are stuck in a rut, find a new lab. When it comes to crown & bridge, removable, TMD, ortho appliances, sports dentistry, and implants, you can’t be any better than your lab. If your lab techs are not communicating with you, recommending and suggesting that you try new materials like Captek, Cercon from Dentsply Ceramco, or d.FM from Ivoclar Vivadent, then find a new lab that pushes you to grow and try new technologies. Your lab tech is an integral part of your dental professional team. And remember, your lab doesn’t have to be three blocks away from your office. With courier services, expand your horizons and try a lab a thousand miles from home. More often than not, a big lab far from home can be a wealth of knowledge, technology, and support. Sending in nearly perfect impressions will also impress your lab tech. You can do this better by utilizing a ligmaject with 1:50,000 epinephrine, ViscoStat from Ultradent, Expa-syl gingival retraction paste from
Kerr, or troughing around your prep with a DioLase Laser from ADT or a Waterlase hard and soft tissue laser from Biolase.
8 — Re-evaluate your dental insurance options! In March, 2000 the stock market bubble burst. Maybe it’s time to reconsider taking indemnity insurance and even a PPO or two. I know you won’t believe this, but if you lower your fees and take more dental insurance you will gross, and net, more money. The number one and two patient questions in every dental practice in America is still, 1) “How much is this going to cost?” and 2) “Do you know if my dental insurance will cover this?”
9 — It doesn’t matter how much you produce unless you collect it! Most doctors meticulously track their production numbers, but most unfortunately also ignore their collection numbers. Many doctors also just waive away any questions regarding their collections by saying they collect 98 percent and believe that is about as close as you are ever going to get. Those same doctors routinely have account receivables equal to two or more month’s average production! Your collection policy is the number one variable that determines your profitability. The average overhead is two thirds, or 66 percent. If your office collects 98 percent of production, you are still paying to produce the two percent your office didn’t collect. If you factor in your 66 percent overhead, the 98 percent collections figure actually turns into 94 percent. What is the solution? First truly make collecting 100 percent your office goal. After calculating the patient’s insurance benefit, their portion needs to be DUE on the DAY of TREATMENT! The easiest way to make this affordable for your patients is to use third party finance companies. Decide to sign up today! There are many good plans available.
10 — Order my 30-Day MBA! With a 30-day money back guarantee you will have nothing to lose. If you and your staff watch one tape during your lunch hour, one day a week, for 30 weeks, you will have enough new ideas to generate success for a long time.