The breadth of the dental field is astounding. Dentists are simultaneously the doctors, teachers, CEOs, managers, artists…and the list goes on and on. With so many roles to play, dentists who do not embrace technologies that save time and resources are doing a great disservice to their patients, their dental team, and themselves. If you haven’t embraced technolog, if you haven’t developed an efficient system for success, if you haven’t spent the time and the resources investing in the technology it takes to provide the most efficient and effective care possible, then you are leaving revenue on the table. Worse yet, you are imprisoning your patients in a decades-old model of slower, less comfortable, and probably less effective dental care. Technologies that make care more efficient and comfortable can play a major role in patient satisfaction, treatment acceptance, and profitability, as the following case demonstrates.
GETTING UP TO SPEED
A busy businessman with a looming business trip contacted me through our Web site one evening, indicating that he needed an immediate appointment. A 20-year-old amalgam filling in his mandibular right first molar (tooth No. 30) had fractured, with the tooth also fracturing in the process (Before Image). As is the case with all successful businesspeople, time is a valuable commodity. The onus is on our team to make him a priority; otherwise, we not only lose the opportunity to care for him, we also lose the invaluable marketing opportunity that comes from befriending and successfully treating an influential individual in a manner which is truly appreciated and valued. If our team cannot solve his urgent request within our schedule, another practice surely will. We appointed him at 8 o’clock, on Monday morning.
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| Before Image. Pre-op: When an old amalgam filling loosened and fractured, the patient needed relief and a restoration as soon as possible. | After Image. Post-op: Our patient was pleased with his gorgeous new restoration. His total treatment time, from entering the office to diagnosis to completion, totaled just a little more than 60 minutes. |
Care for the patient began before he even walked through our doors. Each morning, our dental team gathers for a brief daily huddle. This is an important team meeting to discuss points of emphasis for patient care, as well as any unique cases on the schedule. Even though this particular patient would be our first of the day, our huddle allowed us to plan how to effectively integrate him into our busy schedule in a manner that would not make other confirmed patients wait.
EVIDENCE DEFEATS DOUBT
When the patient was seated in the treatment chair (after virtually no wait due to our system), we began his visit by codiagnosing his entire mouth with a Digital Doc intraoral camera (Figure 1). Our intraoral cameras (there is one in each of our 8 treatment rooms) allow us to take before, during, and after digital photographs of a patient’s mouth. We never neglect this step; the ability to show patients their own teeth while describing a unique condition and/or treatment options has a dramatic impact on treatment acceptance. Furthermore, we have visual documentation for insurance purposes, thus ensuring (or at least increasing) the chances that the patients will receive all the benefits that their coverage allows.
Our next step was to take digital radiographs, which are a vast improvement over traditional film-based radiographs. In addition to lower radiation requirements and the electronic storability of the digital images, the digital radiographs save nearly 10 minutes of chair time for the patient. This is another way we increase comfort and efficiency for our busy patients.
Using these technologies, we were able to show our patient exactly how his tooth was damaged and, in addition, other areas that had gone through some changes since his last visit. This is evidence that defeats the doubt that can cloud our patients’ judgment when it comes to the reality of their condition. Patients are much more willing to accept their recommended treatment plans when their own teeth are used as visual aids. As a result, the return on investment for an intraoral camera is swift.
IT PAYS TO PREPARE
A well-planned patient care system has 2 noteworthy, and seemingly contradictory, influences on patients. First, it comforts our patients by decreasing treatment times, and due to so much information being immediately available via the chairside video monitor, it helps them feel completely informed with regard to any condition and treatment. Secondly, it creates a sense of urgency with regard to accepting a treatment plan.
If we are going to encourage the patient to act immediately, we must be prepared to provide detailed information and a sense of comfort when it comes to the patient’s financial arrangements. In this case, when our case study patient accepted the proposed treatment, we readily provided an estimated fee for our services.
We are always pleased for our patients who receive any benefits as a result of dental insurance coverage. However, the annual value of most patients’ insurance benefits has remained static during all the years that I have practiced, generally covering about $1,000 in dental care. Sometimes, patients choose to limit the quantity and, often, the quality of care, to match their dental benefits coverage. Those who value their oral health are faced with making an investment in the difference between what their dental insurance covers, and the current costs associated with optimal dental care.
Along with our estimated fees, we offer a payment plan (Care Credit) that can make patients’ investment in their dental health easier to budget. Care Credit offers a flexible program that allows patients to choose no-interest plans of 6, 12, or 18 months; or, at higher treatment levels, 24-, 36-, 48-, or even 60-month low-interest extended-payment plans are available. Many of our patients have chosen one of these plans to make the investment in their families oral health easier to manage through low monthly payments. Our case study patient chose a Care Credit plan due to the unanticipated expense of his care and because of an interest-free option that he was able to secure. He was very pleased with this portion of his care, and his satisfaction only led to a more pleasant overall experience with our team.
TECHNOLOGY: MANY HAPPY RETURNS ON INVESTMENTS
As clinicians, when we consider the advantages that dental technology provides to us, the overarching objective is that any new piece of equipment should improve our patients’ experiences. Ask any highly successful practitioners and you will see common threads for success woven into their treatment philosophies, and in the implementation of proven technologies into their practices.
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| Figure 1. An intraoral camera (Digital Doc) can play a vital role in diagnosis, patient education, and treatment acceptance. | Figure 2. Tiffine prepares to buffer the anesthetic using Onset (Onpharma). |
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| Figure 3. The isolation and illumination system (Isolite Systems) being used here, at a cost of just $2 per patient, returns the investment many times over in reduced treatment time and increased patient comfort. | Figure 4. All operatories are fully stocked with every applicable tool; shown here are our electric handpieces (KaVo) and our intraoral camera. Placing advanced equipment in every operatory is another investment that pays for itself many times over. |
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| Figure 5. A highly skilled certified dental assistant can perform many phases of treatment. Here, Tiffine is shown in the operatory in front of our CEREC system (Sirona Dental Systems) that was used to scan the tooth, and then to design and mill the restoration. Next, she took a precementation digital radiograph. All this was done without the doctor present in the operatory. | Figure 6. Today’s in-office CEREC systems mill custom porcelain restorations in 4 to 8 minutes, eliminating the need for a temporary restoration and a second office visit. |
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| Figure 7. After the doctor placed the restoration, the dental assistant cured the resin cement using 2 curing lights (FLASHlite Magna [DenMat]). This ensures a higher-quality cure of the resin cement, in less time. |
Onset (Onpharma) is one such example of a new technology that improves the quality of our patients’ visits. Injections are perhaps the most loathed part of a patient’s dental care experience. Typically, an attempt at a mandibular block takes 10 to 15 minutes to work and it is (statistically) only 65% effective. This waiting time is one of the main reasons dentists get “behind” in their busy schedules. Additionally, since the pH of lidocaine is approximately that of lemon juice (pH = 3.5), patients complain of a burning sensation. Onset is a precision buffering technology that adds liquid sodium bicarbonate to the anesthetic before it is injected, greatly improving patient comfort by neutralizing the pH of the injection (Figure 2). Furthermore, our patients are now fully anesthetized in 2 minutes, not 15, so we can begin treatment without ever leaving the patient. This not only saves time, the doctor-patient relationship gets stronger and patient satisfaction skyrockets!
Another impressive technological advancement in isolation instruments is Isolite (Isolite Systems). In this case, we utilized the Isolite system in almost every step of our patient’s treatment (Figure 3). This versatile isolation and illumination tool protects the tongue and the cheek. It holds the patient’s mouth open comfortably and it suctions to eliminate saliva. It helps reduce taste and smell during the procedure, and has a fiber-optic light to help illuminate the area being treated. It also allows our talented teammates to focus on running the case with maximum efficiency, instead of fighting the tongue. In our office, using the Isolite isolation and illumination system reduces treatment time by 30% to 50% (Figure 4). It is so important in our overall efficiency that we have 8 treatment rooms with 8 Isolite systems. Each operatory is equipped for success, predictability, and comfort.
Today’s technology also allows dentists to maximize their efficiency by performing just the “doctor-only” phase of the operative/restorative procedure. In this case, a highly skilled dental assistant performed the 3-dimensional (3-D) scan of the tooth, designed the CEREC restoration, milled the restoration, tried it in, and took the pre-cementation radiograph (Figure 5). Then, utilizing an in-ear intercom (Kisco), she called me in to confirm the fit and cement the restoration. For a procedure that took just more than an hour (already a respectable time), the actual chairside time for the doctor totaled approximately 20 minutes. This was due to the implementation of proven technologies, all utilized within an efficient care system.
When I began practicing, I never imagined we would fabricate porcelain inlays, crowns, and veneers right in the office. However, 14 years ago, when we bought our first CEREC system (Sirona Dental Systems), the convenience that it immediately provided, to both our patients and us, made it an easy investment to make. Today’s improved CEREC system offers same-visit service to our busy patients, while giving our practice a competitive advantage that is well worth the initial cost.
For our case study patient, we utilized the CEREC Omnicam, recently introduced as the most advanced chairside system for designing, milling and fitting porcelain crowns (Figure 6). The advantages of the new Omnicam CEREC system include a powder-free 3-D virtual image in full natural color, allowing us to create a high precision image of the new crown; and then, manufacture the restoration in about 5 minutes and to immediately try it in and deliver it. We completed our patient’s restoration, curing the resin cement by utilizing 2 curing lights (FLASHlite Magna [DenMat]). Our patient was surprised and very pleased with the minimal amount of time spent in the chair, and he also appreciated the high-quality restoration that he had received (Figure 7).
NOT FINISHED YET!
Providing superior and personalized service requires more than a “you’re done” after completing treatment. While our dental team observed the patient, we offered him a frozen fruit smoothie to soothe his mouth. We also gave him an opportunity to provide us with a review of our care using an iPad. Online reviews are a form of modern day word-of-mouth that should not be underestimated as a marketing tool. As a part of our standard procedure, we had already taken before photographs; now, with his permission, we took several after photographs to display on our social media channels (After Image). We would later follow up with a personal phone call and a final opportunity to candidly chat about his personal experience with our team. Is there any doubt that this gentleman will call us first, should he require any future care?
CLOSING COMMENTS
One of the benefits of being in practice for more than a quarter of a century is having the opportunity to marvel, through the multitude of innovations and advancements in dental technology, at just how far we have come! When I first started my practice, I never dreamed how quickly we would be able to complete complex procedures while virtually eliminating patient discomfort. When you add that to the accuracy of today’s diagnostic tools, and the sheer scope of cosmetic procedures available, dentistry has become a very different experience from what we knew in dental school. For the sake of our patients, our dental teams, and ourselves, we must embrace the future. Rest assured though, while technologies have dramatically changed the practice landscape, the emphasis on quality care is as steadfast as ever.
Dr. Hyman is a graduate of the University of North Carolina (UNC) at Chapel Hill and the UNC School of Dentistry, and holds a Mastership Award granted by the AGD. He is an active faculty member at Pankey Institute for Advanced Education in Biscayne, Fla. He also serves as adjunct associate professor at the UNC School of Dentistry in Chapel Hill, NC, and he has served on the surgical staff of Moses Cone Health System (Greensboro) for the past 2 decades. Dr. Hyman is an international speaker. He has been named a Leader in Continuing Education by Dentistry Today magazine for the past 11 years, and was named “Young Dentist of the Year” by the North Carolina Dental Society in 1995. He can be reached at smile@tarheeldentist.com.
Disclosure: Dr. Hyman is an investor in Onpharma.
