How to Prosper in the New Economy

Bill Blatchford, DDS

Can you feel the “new economy?” We all want prosperity to return. However, the real “after” is the new economy. Americans are holding back on purchases and have learned to save more than ever. In addition, lay press is purporting ways to save money by encouraging gardening, vacationing close to home, and making your own fancy coffees. All this can hurt small businesses, and the dental office is no exception. What are we to do?

Recognizing what defines the new economy, and how Americans are currently thinking, is the first step. The second step is for you to do something about it. We have to be even better in what we do, how we do it, and how we are perceived in the community. We must differentiate ourselves from others. One way to make yourself stand out from other dentists is to broaden your offerings.

Our purpose in gaining new skills is two-fold. One is to attract a broader base of patients. It does take a larger numbers of patients who see your passion and meet your skill to have a great end result. Also, without adding new skills, dentistry can become routine and we can find ourselves in a rut. Adding new skills is a way for you to re-energize yourself emotionally and financially. Overall practice success and case acceptance increases when there is a transfer of enthusiasm. What is needed is a little more enthusiasm from the dentist, which trickles down to the team. Energy in creates energy out.

Clinical Tips for Retaining Single Unit Provisional Restorations

Jeff T. Blank, DMD

INTRODUCTION

There is possibly nothing more frustrating in the practice of dentistry than struggling with retaining single unit provisional restorations. It is both embarrassing for the dentist and a huge inconvenience for the patient to return to the office to recement a temporary. Most dentists will agree that aside from dental pain, many if not most of after-hours calls are related to dislodged temporary restorations.

CLINICAL TIPS

This short article will present a few clinical tips for ensuring that single unit provisional restorations not only stay put for the interim period prior to final crown delivery, but assist in reducing final restoration adjustments as well as ideal tissue health and patient comfort:

Clinical crown height and classic retention and resistance form are imperative for adequate provisional retention. Personally, I constantly feel the need for the double cord technique if for no other reason than to get as much apical migration of tissue to permit a decent prep height. This is particularly true with maxillary and mandibular second molars. Rarely is there enough clinical crown height above/below the retromolar pad and tuberosity area to get more than a few millimeters of prep height on the distal of these teeth. I certainly am cognizant of the fact that if you are using a bonded restoration, it is not always necessary to have much clinical prep height for the final ceramic restoration, but you are setting yourself up for problems when it comes to retaining the provisional restorations.

Retention and resistance form are both things we all know and appreciate, so I won’t expand on those concepts per se. However, I have found over my 21 years of practice that when I was not routinely replacing all previously existing amalgams/composites prior to or during the prep, pieces would fall out etc… during the prep and I would have the tendency to try to cut a box or basically “go with it” in terms of retention and resistance form. As I began using all ceramic crowns, especially those that must be bonded in rather than cemented, it became essential of course to remove all amalgam. When an adequate new core is placed, ideal prep form is easily achievable and along with packing cord or using a diode laser to increase prep height, these key issues were routinely addressed.

Lastly and probably most importantly, developing functional occlusion with no working or non-working interferences is a key factor in contributing to temporaries falling off. Most, if not all, of us delegate provisional fabrication to our assistants. I think it is essential that we really sit down and educate our assistants in not only how to make a good provisional index (several great methods exist), we must assist them in developing a working knowledge of dental morphology and occlusion. Several great books exist (the best are lab technician books) that do more than show basic primary posterior anatomy and illustrate the importance of developing proper cuspal inclines and the role these play in occlusion. Simply taking a preoperative dual-arch tray impression of the damaged tooth to be crowned is rarely sufficient in rendering a provisional that meets the demands of morphology and occlusion. More adept assistants are more than eager to learn techniques to correct the occlusion and morphology of the tooth prior to impressing for the index and this can be easily taught to them using a little bit of self-etching bonding resin and composite. Even if the assistant is sub par, we can certainly do it for them in minutes while the patient is getting numb. The key is for the whole clinical team to recognize those teeth that are occlusally unsound (working/non working interferences, lack of sufficient cusp contact etc…) by simply using articulating paper prior to impressing for the index. Once this becomes routine, then you will also see that in those cases where there is sound occlusion, you will want to replicate those contacts in the provisional. Failing to maintain healthy occlusal contacts lead to just as many problems as not recognizing occlusal interferences. How often have we had patients complain that the adjacent nonrepaired teeth were sore because we left our temps out of or light in occlusion, not to mention the potential of supereruption and the woes of excessive occlusal adjustment of the final crown as the result? I would go as far as to say that not checking working and nonworking interferences are probably the largest single contributor to temps coming off…so it is imperative that we teach this or check every temp ourselves.

I opened with the teaser that we rarely use temp cement. When the above factors are addressed, placing Gluma desensitizer on the tooth, drying and “shrink wrapping the provisional is often more than sufficient. The key there of course is assuring that excess acrylic doesn’t get below the gum line interproximally less we have a bloody mess at delivery. Small disposable interproximal brush sticks (ie, Soft-Picks [Sunstar]) should easily pass interproximally and the patient should be instructed to use them rather than floss while wearing the temp. The only time we use provisional cement is when frankly I have violated all or most of the above, or when the temp doesn’t “shrink wrap” comes off with the index or pre-op impression. Then we just add a light layer of flowable, reseat, clean excess with a brush, light cure and we’re done. Occasionally, we will use a temporary cement like TempSpan Translucent (Pentron Clinical Technologies) or an old favorite, calcium hydroxide paste (Dycal [DENTSPLY Caulk]). Of course, no one is perfect and we have had better luck using a resin-reinforced glass ionomer (such as Rely X [3M ESPE]) and prefer the click-it dispenser rather than mixing a polycarboxylate powder and liquid (such as Durelon [3M ESPE]), and my opinion, is easier to clean off. Nothing is more frustrating to the office and patient more than a temp coming off multiple times while waiting for a crown. I think simply paying attention to the above details pays off royally and sets up fast and efficient removal of the temp and excellent tissue health while minimizing occlusal adjustments.


Dr. Blank graduated from the Medical University of South Carolina, College of Dental Medicine in 1989, and maintains a full time private practice in Rock Hill, South Carolina where he emphasizes complex restorative reconstruction and cosmetic enhancement procedures. He holds an adjunct instructor post in the Department of General Dentistry at Medical University of South Carolina, College of Dental Medicine and has authored dozens of clinical manuscripts on a variety of clinical techniques and materials. He is a Fellow in the Academy of Comprehensive Esthetics, and an active member of the International Association for Dental Research, the Academy of Operative Dentistry, the American Academy of Cosmetic Dentistry, the Pierre Fauchard Academy, ADA, and AGD. Dr. Blank has lectured throughout the United States, Europe and in 9 countries in Asia, holds US Patent for a composite finishing instrument and is the creator of the C.E.B.L. Technique for direct veneer layering. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or visit carolinasmilecenter.com.

Why Most Practices Don’t Have a Dream Team

Roger P. Levin, DDS

Face it, most dental practices don’t have dream teams. Sure, dentists like to think of their “staff” as a “team,” and sometimes even as a “family.” However, the harsh truth is that most practices don’t have a team—they have a group of individuals who are doing the best they can to properly complete their individual duties and get through the day.
Creating a strong team is extremely challenging for a variety of reasons. Every dentist faces a time crunch: That’s just the nature of being both the practice’s main producer and its owner. Due to the hectic pace of many dental practices, team building often becomes a lower priority. A concerted focus on active team building can pay huge dividends in terms of increased productivity, improved morale, and lower stress.
Remember, your team is one of your practice’s greatest assets. During this difficult economy, you need to maximize all of your resources. Building a stronger team is one of the best investments dentists can make to ensure their future success.

FIVE ACTION STEPS FOR TEAM BUILDING
Here are 5 action steps that turn your staff—a group of individuals with various skills, talents and interests—into your dream team:

1. Communicate Your Vision
All employees want to be part of something bigger. This is true for large, multi-national corporations with 100,000 employees, as well as an 8-person dental office. That “something bigger” is your vision statement. It provides a road map of where you want the practice to go in the next 3 to 5 years. Whatever you do, don’t keep it to yourself. It’s not some secret document that should be locked away in a vault. In fact, the only way your practice vision becomes a reality is if it’s shared with your team members. So communicate your vision and communicate it often. The vision statement should be reinforced during weekly and monthly meetings. By creating a shared vision of the future, you have taken the first step to building your dream team.

2. Get Rid of the Stress
I recently asked approximately 100 dentists to rank their stress level between zero and 10. Zero meant almost no stress, and 10 meant you were ready to jump off a bridge. The average answer of these 100 queries was a 7. In further discussion, even doctors who rank their stress at a level of 3 conceded that their stress was caused by spending too much time on administrative work, rather than performing dentistry.
The No. 1 cause for practice stress is outdated systems. When was the last time you redesigned your systems? Has it been more than 3 years? 5 years? 10 years? The older your systems are, the higher the stress level will be in your practice. Without updated systems, it’s impossible to build a long-term, high-performance team.
Documented step-by-step systems eliminate misunderstanding and confusion that lead to unnecessary tension and stress. Step-by-step systems allow staff members to perform their jobs effectively and efficiently. For example at Levin Group, clients streamline their practices and reduce their stress by implementing the Levin Group Method, which includes systems such as scheduling, case presentation, and customer service, among others. Systems should include a series of checklists, so that each team member understands exactly what is expected every day. Make it easy for your team members to succeed—and you will have a low-stress, highly productive workplace.

3. Prepare, Train, and Support
Systems—updated or not—are really just ideas until they are implemented. The only way for that to happen is through training. Unfortunately, Levin Group has seen too many practices rush new employees into their positions after a day or 2 of haphazard training. Then, the dentists and office managers wonder why the new team member isn’t measuring up.
For training to be successful, it must be standardized and continual. When systems are documented in a step-by-step manner with accompanying scripts, it is easier to train and cross-train the entire dental team. This focused approach benefits new team members and those team members without an extensive dental background. Training also establishes a level of accountability when combined with job descriptions for each position on the team.
Training your staff is not something that can be effectively accomplished in the time dentists may have between patient appointments. To ensure that team members fully understand their roles, time must be set aside away from patients, so that the proper focus can be achieved. Fortunately, there are many learning opportunities for the dental office and clinical teams today, such as seminars, dental conferences, and one-day in-office training.
In addition, Levin Group recommends setting aside 30 minutes during monthly team meetings to focus strictly on training. Those training lessons should be reinforced during morning meetings as necessary. Even high-performance teams need regular training, which can occur in-office or outside the practice.

4. Give Every Team Member a Playbook
Every football player from junior high to the pros receives a playbook. This is the player’s guide to on-field performance. While no one on your team will be asked to run an end-around or a blitz, they should have a playbook, too—it’s their job description, which contains a comprehensive list of duties and responsibilities. Often in high-stress practices, team members do not completely understand their responsibilities. For example, if the practice expects the hygienist to educate patients about practice services, then that objective should be written in her/his job description. The hygienist should receive support, training, and appropriate communication tools to fulfill her duties.
Team members respond better when their roles in the practice’s success have been clearly defined. As the leader, the dentist must convey to team members their roles in achieving the practice vision. For an office to be a high-performance practice, every team member must have a clear focus of his or her role and responsibilities on moving the practice forward.

5.Coach the Team
To reach their potential, your team needs to be coached, supported, and encouraged. Helping individuals grow is critical to their satisfaction in the practice, as well as to their performance. One coaching technique is to ask questions, rather than give directions. While it is far easier to tell a front desk coordinator, “Schedule her on Tuesday at 3 p.m.,” it is more of a growth opportunity to ask the question, “Where do you think we could put this patient?” or “Do you think there is a time that would be suitable Tuesday afternoon?” Asking questions taps into the expertise of team members and allows them to take ownership in the practice. Gradually, they will make their own decisions.
Successful leaders understand that coaching is essential to turn a group of individuals together into a team. No dentist ever accomplishes the vision alone; it is only through the hard work and commitment of other people that the practice succeeds. As the practice leader and owner, the doctor needs to take a group of individuals, fuse them into a team, give them the game plan, and then monitor their progress. A good leader provides the guidance and coaching that leads to greater success, individually and collectively, for the entire team.
IN CLOSING
Will your dream team always remain just a dream? It doesn’t have to be that way! You probably have a good staff—now is the time to turn them into a great team. Be sure to start sharing your vision—this is the first step toward instilling a team mentality. Then, give them the tools and support necessary for success, and your dream team could soon become a reality!


Dr. Levin is chairman and chief executive officer of Levin Group, Inc. Dr. Levin is a third-generation dentist, who brings his Total Practice Success Seminars to thousands of dentists and dental professionals each year. Levin Group can be reached at (888) 973-0000, at This email address is being protected from spambots. You need JavaScript enabled to view it., or levingroupgp.com.



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