As competition among dental groups grows more intense, practices often struggle to keep up with their busy, mobile, and technologically attuned patients who like to make and break appointments with the push of a button. But unfortunately, even the best scheduling software doesn’t always cut it.
That’s what we learned a few years ago when we saw more of our patients using smartphones in the waiting room of our dental practice in Dyer, Ind. Patients were becoming more tech savvy right under our nose, and if we missed a chance to reach out to them in an impactful way, we worried they would change providers.
Unfortunately, when we tried to leverage our previous scheduling software to help us engage, we quickly learned that the software wasn’t as smart as the technology our patients were using. Frequently we tried setting up digital appointment reminders, but things continuously went awry. In one particular incident, a patient received a text reminder for her appointment while she was already sitting in the chair with her hygienist. How embarrassing!
In October 2016, we decided it was time for a change—and for better technology—that would make a more meaningful impact on our patient relationships. The only issue was how to do this affordably, given that we aren’t a large corporate dental practice brimming with resources.
Improving Relationships With Our Patients
We opted to implement a cloud-based, patient relationship management (PRM) tool instead of a simple scheduling app because we wanted an all-encompassing solution that understood the needs and limitations of a smaller, independent practice. The PRM tool is designed to enhance patient relationships in multiple ways, from scheduling and sending targeted texts and email blasts to offering personalized communications, including birthday messages, so our patients know we are always thinking of them.
We also wanted to ease our staff’s workload. We see more than 2,000 patients per year, and up until we implemented our PRM tool, it wasn’t uncommon for our hygienists to have to answer the phone or make calls between appointments because the administrative staff was tied up with other tasks or responsibilities.
Because we had an extensive “reschedule” list, back then we had a culture of, “anytime you’ve got downtime, you’ve got to be on the phone.” Today, our PRM tool takes care of sending out reminders, about 200 per day, for those who need to schedule follow-up appointments, saving our staff hundreds of hours on the phone and freeing them up to engage with our patients in the office or waiting room.
Once we got our PRM tool up and running, our first order of business was to set up an appointment reminder system that would dispatch 2 or more notifications prior to a patient’s appointment. Patients have the option to create their own account and determine how and how often they want to be contacted by answering questions such as “do you want a reminder an hour before your appointment?” Our patients have been much more responsive to this communications system, whereas before, they just ignored seemingly random, and far too frequent, text and email alerts. Because our PRM tool allows patients to choose their preferred digital medium (eg, text or email) and at their preferred frequency (eg, one week in advance of an appointment, or 2 alerts at weekly intervals), they’re more likely to confirm or reschedule their appointment and less likely to skip out on visits.
Within the first 2 weeks of implementation, we also started using the PRM’s digital marketing tool to offset some of the marketing work that often falls on the staff. Our PRM solution offers a robust reputation-management application, which moderates online patient feedback and helps us ensure our patient satisfaction surveys are delivered in a timely manner. It also nudges us to acknowledge issues that arise, such as when a patient has a less than stellar experience at our practice, requiring us to reach out and address the situation. The PRM tool is also equipped with templates for newsletters and targeted email blasts, which we can send to specific demographics, such as those adult patients who would benefit from Invisalign, fillings, or a general checkup.
As a result of our success in just 3 short months, we’ve been able to condense the number of outside vendors we use down to one, which has saved us quite a bit of money in the process.
Already, we’ve seen a number of benefits since implementing our PRM solution.
So far, we’ve had 279 appointment confirmations, further explaining why we also have fewer missed visits. We’ve also benefitted from sending out 6 group messages—for example, “we have an open appointment at 4:30 pm for oral hygiene; we will schedule the first person who responds”—which encourages patients to take advantage of last-minute appointment opportunities. In December 2016, we made a little more than $8,000 in revenue based on this feature.
Thanks to our online reputation tool, our Healthgrades rating is now at 5 stars, so anyone searching for a dental practice in our part of the country is likely to see we have many satisfied patients. In addition, our Net Promoter Score (+100 to –100 score) is +90.
Though it’s still early, we’re excited about seeing a rise all of these metrics.
Some dental offices worry that the staff will become nonessential if technology is adopted to lighten administrative burdens, but that couldn’t be further from the truth. Our front office staff stays busy, especially since the addition of our PRM solution. We’re just happy that instead of spending hours on the phone trying to reach patients, we’re now actually able to spend time with them, in person, while they visit. Getting to know patients on a more personal level helps us forge real relationships that they’ll take with them even after they leave the office.
Ms. Gambetta, CEO of Advanced Dental in Dyer, Ind, has worn many hats since graduating from DePauw University including classroom teacher, independent consultant, National Geographic educator, Lincoln Park Zoo educator, full-time parent, bookkeeper, volunteer, and small business entrepreneur. Each of these positions has shaped her and she counts herself blessed to have earned so many friends along the way. She feels fortunate to be making a difference in patients’ lives every day. She can be reached at (219) 365-5420.
This February, dentistrytoday.com celebrates National Children's Dental Health Month with news stories, interviews, and blogs all about safeguarding pediatric oral health. #NCDHM
Samantha Dreyer, sophomore at William Fremd High School in Palatine, Ill, is a competitive figure skater and Team USA athlete. When not busy traveling for competitions or participating in service projects through her high school’s Service Over Self Club, she dreams of one day helping underserved communities as a dentist or orthodontist. Motivated to decrease dental health disparities, Samantha was looking for a way to help address some of these needs within her own community. Hosting an America’s ToothFairy Smile Drive was the perfect opportunity.
America’s ToothFairy: National Children’s Oral Health Foundation launched the Smile Drive in 2014 as a national campaign to raise awareness of the importance of children’s dental health and collect toothbrushes, toothpaste, and other oral care products for children in need throughout February, National Children’s Dental Health Month. Thanks to the enthusiastic participation of volunteers like Samantha, to date more than one million oral care products have been distributed to nonprofit clinics and organizations reaching underserved children.
Brown Paper Bag Day
With inspiration from Brown Paper Bag Day at her mother’s pharmacy, a day in which elderly patients bring in medications they don’t remember how or when to take, Samantha and her mother devised an innovative way to make her Smile Drive a success—Samantha created a Brown Paper Bag Day of her own.
Samantha bought enough brown paper bags to distribute to every house in her neighborhood and affixed a short letter explaining who she was, what the Smile Drive is, and why oral care products are so desperately needed. The letter also included pickup instructions indicating the date and time she would collect the bags from the front door of each home. By the end of her Smile Drive, Samantha had collected more than 300 products for children in her community.
Smile Drive is a national campaign. However, the purpose is to spark both local participation and local impact. Smile Drive hosts select a local shelter, food bank, school, or other nonprofit organization of their choice to receive their donations, allowing volunteers to address the needs of children right in their own community.
The charity Samantha chose to receive her donations was the Northwest Community Healthcare Mobile Dental Clinic. This mobile clinic provides preventive and restorative oral health services to individuals and families who are without dental insurance and who live at less than 200% of the federal poverty level. Samantha’s hope was that by equipping the clinic with additional oral care products, more families would be able to enjoy healthy, pain-free smiles.
“The Smile Drive was a fun and easy project to do,” Samantha said, proud of her community’s support for her first Smile Drive. “I hope to do an even larger Smile Drive next year with my Service Over Self Club.”
America’s ToothFairy volunteers like Samantha have used all kinds of creative ways to expand the impact of their Smile Drives. Girl Scouts of Orange County Junior Troop #4581 hosted Christmas caroling events where they “caroled for smiles,” collecting oral care products from house to house. A group of high school students with HOSA: Future Health Professionals in South Dakota visited all of their local dental practices, requesting and collecting donations. By the end of their Smile Drive, they had collected more than 26,000 products, many of which were distributed to children on the Pine Ridge Indian Reservation.
Volunteers and businesses in the Charlotte, NC, community, where America’s ToothFairy is headquartered, have been especially supportive. The Charlotte Mecklenburg Police Department, Coca-Cola Consolidated, the American Burger Company, Wells Fargo, and many other businesses participated as collection sites. Community members pitched in by dropping off oral care products at the “Smile Drive Thru.”
When Smile Drive Charlotte concludes, more than 50,000 toothbrushes will be distributed to local schools and nonprofit organizations serving children in need. More than 40,000 of them will be distributed to the 78 Title 1 Schools in the Charlotte area. By stocking the schools’ hygiene closets and equipping teachers with products for their students, the Smile Drive is helping ensure every child has access to a primary tool for tooth decay prevention—a new toothbrush.
Though the Smile Drive is emphasized during February, National Children’s Dental Health Month, Smile Drives can be held at any time throughout the year. America’s ToothFairy provides a free toolkit with free resources and tips for promotion. Learn more about how you can participate at smiledrive.org.
Ms. Malmgren, executive director of America’s ToothFairy: National Children’s Oral Health Foundation, has more than 15 years of leadership experience across a variety of industries. She began her career in dentistry in 2006, serving as director of operations for the Sheets & Paquette Dental Practice and the Newport Coast Oral Facial Institute. In 2011, she relocated to Charlotte, NC, where she joined the America’s ToothFairy team and later assumed the role of chief operating officer. As executive director, she aims to continue to expand the organization’s role as a valued resource provider for nonprofit clinics and community partners delivering oral health education, preventive services, and treatment for underserved children.
Estrogen therapy helps women in menopause reduce hot flashes, improve heart health and bone density, and maintain levels of sexual satisfaction. Plus, the same therapy that treats osteoporosis may lead to healthier teeth and gums as well, reports the North American Menopause Society (NAMS).
As estrogen levels fall during menopause, women become vulnerable to numerous health issues including loss of bone mineral density, which can lead to osteoporosis. Around the same time, changes in oral health also are common as teeth and gums become more susceptible to disease, which can lead to inflammation, pain, bleeding, and loose or missing teeth.
Researchers have found an association between osteoporosis treatment and severe periodontitis in postmenopausal women. They evaluated 492 postmenopausal Brazilian women between the ages of 50 and 87 years, with 113 in osteoporosis treatment and 379 not treated, to determine whether osteoporosis treatment could help increase the bone mineral density in their jaws and improve overall oral health.
According to the study, the rate of occurrence of severe periodontitis was 44% lower in the postmenopausal osteoporosis treatment group than in the untreated group. The treatment comprised systemic estrogen alone or estrogen plus progestin, in addition to calcium and vitamin D supplements, for at least 6 months.
“Osteoporosis can occur throughout the body, including the jaw, and lead to an increased risk of periodontal disease,” said Dr. JoAnn Pinkerton, NAMS executive director. “This study demonstrates that estrogen therapy, which has proven to be effective in preventing bone loss, may also prevent the worsening of tooth and gum disease. All women, but especially those with low estrogen or on bisphosphonate treatment for osteoporosis, should make good dental care a part of their healthy lifestyles.”
While dentists play a key role in encouraging oral health, friends and family can be influential too, according to Brenda Heaton, PhD, MPH, an assistant professor of health policy and health services research at Boston University’s Henry M. Goldman School of Dental Medicine. She and her colleagues at the university’s Center for Research to Evaluate & Eliminate Dental Disparities have been investigating oral health and disease among residents of Boston’s public housing.
Most of their work has focused on whether or not “motivational interviewing” can influence how women care for their children’s diet and oral health—specifically, their impact on kids with dental caries. Mounting evidence suggests that one-on-one behavioral interventions, like motivational interviewing, may change short-term behavior, but their effects don’t last long.
“We started to get a sense that there may be more influences that we need to acknowledge beyond just the individual,” said Heaton, who also found that social networks—not Facebook and Twitter but networks of friends, family, and acquaintances—may play an overlooked role in oral healthcare.
Some of the women who were interviewed had been born and raised in the family unit they were living in and were now raising their own children in that unit, meaning grandmothers, mothers, and children all living together. Those close connections influenced how people behaved, Heaton said, and the researcher had to tap into those networks herself to make significant progress against diseases like tooth decay.
That is not easy, but it is important, said Thomas Valente, PhD, a professor of preventive medicine at the University of Southern California and an expert in social networks in healthcare. People believe information more when it comes from someone they know or respect, and evidence indicates that people are more willing to trust people who are like them, Valente said. All too often, he added, health information is handed to a community by people on the outside, and it is less impactful.
“It’s like West Side Story,” said Valente, who was not involved in Heaton’s study. “It’s like being a Shark and having a Jet come up to you and tell you to do something. It is just not going to happen.”
Heaton wants to spread resources about good oral health, not only to combat tooth decay but also because oral health in intertwined with other health concerns. For example, she is interested in sugar-sweetened beverage consumption not just because it is a risk factor in oral health outcomes but also because it can lead to obesity and obesity-related health conditions.
To understand the connections that existed in the community, the researchers needed to draw a social map. Since 2008, they have interviewed close to 200 women living in Boston public housing and have identified nearly 1,000 influential individuals. Heaton is using those network maps to find similarities about how information flows through these communities. The ultimate goal is to use the map to introduce health information and resources into a community in ways that change long-term behaviors.
“You can’t design those interventions until you actually have a really strong grasp of the network structure,” said Heaton.
For instance, she said, if you want to make an impact, should you look for community members with the most personal connections or for people with large influence but with fewer personal ties? Or, should you take advantage of existing connections or seed new ones? The power of this approach, Heaton said, is that it focuses on prevention rather than cures since tooth decay is entirely preventable.
We all know that Facebook and other social networking sites are a marketing goldmine. But without knowing the terminology used on these sites, do we really know what we’re getting ourselves into? Those of us who have only used Facebook for our personal pages are entering a whole new world when we start using it for our practice. The terms below just might help to demystify the Facebook lingo, whether you are just now setting up your practice page or trying to decipher the page metrics reports.
- Impressions: Impressions are the number of times a post from your practice’s page is displayed, regardless of how many clicks, likes, or shares it has. This is not to be confused with the number of views, as the same person may see a post immediately after you share it and then again after a common “friend” shares it again.
- Pageviews: Pageviews are the total number of times your Facebook page was viewed during the time period you select in Page Insights, which is the Facebook metrics reporting tool. A visit to your practice’s Facebook page indicates a higher level of engagement than those who simply like your post when it shows up in their news feed.
- Reach: Reach is the number of people who received impressions (see above) of a page post, whether they follow you or not. By analyzing reach, you can assess positive responses (such as likes and shares) as well as negative (such as posts being hidden or reported as spam). Knowing how people respond to your posts can help you determine what people like and want to see more or less of.
- Boost post: Boosted posts appear higher in your audience’s news feed, making it more likely that they will be seen. You can boost any post you create, from status updates to videos, and Facebook determines the cost for boosting by the number of people you want to reach. Boosted posts are marked as “sponsored” and appear directly in the news feed, not in the righthand column with ads and trends.
Facebook has truly mastered the art of marketing through social networking. While the terminology might be puzzling at first blush, taking the time to familiarize yourself with it will allow you to utilize Facebook to its full capacity.
Intraoral scanners and other imaging devices are replacing impression materials and other older analog techniques in today’s dentistry. But the next wave of innovation is coming from an unexpected source—Disney Research. Working with ETH Zurich and the Max Planck Institute, this division of the global entertainment giant has produced an algorithm that noninvasively reconstructs teeth and gums from digital photos, with no scanner necessary.
Sophisticated image-based digital reconstruction methods for modeling the human face have been available for some time, capturing detailed images of the face or of specific areas such as the hair, eyes, or eyelids for creating digital models for both scientific and entertainment applications. Yet little attention has been given to the oral cavity in general and teeth in particular.
Image-based approaches capable of modeling teeth in a natural way are in the early stages of development. Yet accurate rending of teeth is essential for realistically displaying facial expressions, prompting researchers to rely on handmade plaster casts of teeth. The new algorithm, though, can create a complete reconstruction of the teeth and roots from some digital photos of a face, even if they are partly or fully occluded.
The researchers also have produced reconstructions from short video clips of a face recorded with a smartphone. Primarily developed for the entertainment industry, the new approach can be integrated into existing photogrammetric multicamera reconstruction setups for entire faces as well.
First, the researchers taught the software the basic features of tooth positions, shapes, and rows by feeding it high-resolution 3-D scans of oral cavities. The software then used this data to learn how to recognize sets of teeth, assess their shape, and synthesize the missing elements not discernible in the images, including their positioning. Also, the software now can account for any tooth discoloration and matched the gum pigmentation. The result is a natural-looking reconstruction of the teeth and gums, according to the researchers.
“This approach opens up new avenues for high-quality tooth reconstruction,” said project coordinator Thabo Beeler of Disney Research.
The technology can be used in dentistry, as dentists look for the simplest method possible to produce the most natural model of their patients’ teeth so they can provide their patients with a visual impression of how replacement teeth would look, for example. They wouldn’t need to put intraoral scanners in the mouths of their patients to build these digital models. Instead, they would take standard digital photos for the software to analyze.
“We have received very positive feedback from dentists,” said Beeler. “This shows this method is not only suitable for modeling digital characters in films or games, but also for practical applications in the real world.”
When patients present with a cavity in between their teeth, dentists typically have to numb the area and drill away the tooth structure to get to it. Resin infiltration, under development at the University of Alabama at Birmingham (UAB), offers a less painful treatment option via a plastic perforated sheet placed in between the affected teeth.
“When we develop cavities between teeth, sometimes we have to go through the tooth, and we end up damaging healthy tooth structure,” said Augusto Robles, DDS, assistant professor and director of the operative dentistry curriculum. “This new system allows us to skip the drilling and helps us preserve that structure.”
The cavity is first cleaned by pushing a gel that prepares the surface to accept the resin infiltrant through the perforated sheet. The tooth then is filled by pushing a liquid resin through the perforated sheet. A dental curing light is applied to the tooth to cure the resin, and the treatment is complete. No drilling is necessary, and anesthesia typically isn’t required.
“Since this is a no-shot and no-drill treatment, it is popular with patients,” said Nathaniel Lawson, DMD, the division director of biomaterials at the university’s school of dentistry. “And since no tooth is removed, it is a very conservative procedure.”
The one-of-a-kind resin infiltration has been approved by the Food and Drug Administration and commercially available in Germany, though it is only used in clinical trials in the United States. The UAB Clinical Research Center is now conducting the largest US clinical trial of the product, enrolling 150 patients in the study.
“I never thought this would be possible for dentistry,” said Robles, who agrees with Lawson that it could be a game-changer for the profession if adopted nationally. “In my 24 years of practicing, this changes everything we’ve done so far. It’s marvelous.”
There are prerequisites for treatment, though. It only works in between teeth or on smooth surfaces where there are small cavities. Some cavities that are large or on top of teeth aren’t suited for this kind of system because the liquid resin used cannot build up shapes.
“The resin has to be liquid to be able to be absorbed into the cavities in between teeth,” Robles said. “So at this point, the application is pretty specific.”
This February, dentistrytoday.com celebrates National Children's Dental Health Month with news stories, interviews, and blogs all about safeguarding pediatric oral health. #NCDHM
Tooth decay remains the most prevalent childhood disease, even though it is entirely preventable. Access to care is a chief roadblock in ensuring pediatric oral health. That’s why the American Academy of Pediatric Dentistry (AAPD) works to enact change on a national level to better connect families and dentists.
When meeting with policymakers, the AAPD always emphasizes the following:
- The AAPD is committed to optimal oral healthcare for all children. This means establishing a dental home for a child by the age of one year.
- Pediatric dental practices are the backbone of oral healthcare for our nation’s children.
- On average, 70% of pediatric dentists participate in Medicaid or the Children’s Health Insurance Program (CHIP), comprising 25% of their patients.
- Pediatric dentists also provide significant amounts of free or discounted care.
The AAPD has a robust legislative and regulatory agenda for 2017, which is available online. The 2 highest AAPD priorities at the federal level are healthcare reform and funding for health professionals’ training.
In 2017, healthcare reform essentially means how Congress will handle the Affordable Care Act (ACA) in terms of repeal, replacement, or repair. To ensure that children receive the oral healthcare they need, and based on experience to date under the ACA, the AAPD is making 4 recommendations.
First, any required health insurance coverage for children should include pediatric oral health coverage, either through an appropriately structured standalone dental plan (SADP) or embedded medical plan—that is, a health insurance plan that includes pediatric dental coverage.
While pediatric oral health was defined as an essential benefit in the ACA, federal regulators determined that the actual legislative language did not require purchase of such coverage. This has resulted in an odd outcome that while more than one million adults nationwide have purchased private standalone dental insurance plans under the ACA, only slightly more than 100,000 children have gained such coverage.
Second, preventive dental services should have first dollar coverage, meaning they should be exempt from cost sharing (deductibles or copays) in embedded medical plans and SADPs. Embedded plans should have separate dental deductibles. AAPD member pediatric dentists have reported problems with families not realizing their ACA medical plans with dental coverage embedded had a high combined deductible, such as $5,000. This resulted in the families cancelling or delaying preventive dental appointments for their children.
Third, CHIP, which has required pediatric dental coverage, should be reauthorized.
Fourth, any changes to Medicaid should preserve the existing requirement for oral health services for children up to age 21 while lessening financial and administrative burdens in the program. The AAPD is pleased that the percentage of children lacking dental benefits continued to fall in 2014 and is now at its lowest level since 1999 (the first year that data became available).
However, much of this expansion of coverage for children’s dental insurance has been via Medicaid, a program fraught with low reimbursement and high administrative burdens for providers. For example, providers should expect fair and reasonable audits, based on peer review and accepted clinical practice guidelines of the AAPD.
Progress So Far
A modest amount of money for pediatric dentistry training provided by the federal Health Resources and Services Administration (HRSA) under Title VII of the Public Health Service Act has made a tremendous difference for children. Since the year 2000, Title VII has spurred the creation of more than 250 new first year pediatric dentistry residency positions. This has helped grow the overall pediatric dentist workforce in the United States from under 4,000 to almost 7,000.
These grants have also supported enhanced training initiatives focused on underserved children in urban and rural areas, children with special healthcare needs, and inter-professional collaboration with primary care medical providers. Additionally, the grants have supported the recruitment and retention of pediatric dental faculty.
The AAPD is requesting fiscal year (FY) 2018 funding of $35.873 million for the HRSA Title VII Primary Care Dental Training Cluster and related oral health programs, with not less than $10 million for pediatric dentistry training programs. This is the same level provided in the FY 2016 federal budget and FY 2017 continuing resolution, and it will support grants for dental faculty development and loan repayment, predoctoral (dental school) training, and postdoctoral (residency) training. The AAPD also supports retention of authorizing language for this program as provided in the ACA.
Mr. Litch is chief operating officer and general counsel for the American Academy of Pediatric Dentistry (AAPD). He coordinates AAPD’s internal operations and planning, including human resources; directs the AAPD’s government relations and public policy agenda; and manages legal issues affecting the AAPD and pediatric dentistry. He serves as secretary to the AAPD Political Action Committee, member of the AAPD Constitution and Bylaws Committee, and staff liaison to the AAPD Council on Government Affairs. He received a law degree from University of Maryland Francis King Carey School of Law and a master’s degree from the Sanford School of Public Policy at Duke University. And, he is a licensed attorney in 3 jurisdictions and a Certified Association Executive.