Wednesday, July 29, 2015

Facial Enhancements

When dentists are thought of from an outside perspective, we’re often regarded as the men and women who know teeth. We’re generalized, minimized, and profiled as professionals who only known crowns, cuspids, and cavities, but this pigeonholing isn’t only performed by our patients—we often do it ourselves. We often exclude and limit the services that we offer based on these professional stereotypes, preventing us from not only offering a more expansive treatment regimen but from expanding our personal and professional breadth as well. So, if you’re not already offering facial enhancements to your patients, I anticipate that, by the end of this post, you’ll have found some irrefutable reasons to do so.

While the introduction of facial enhancement treatments in cosmetic dentistry has been slow and more and more dentists are picking up the practice, I’ve found that it is still a stigmatized practice amongst many industry professionals. “Leave the poking and prodding to the plastics,” we often think, and I’ve thought in the past, too. We may find ourselves unable, unqualified, or unprepared to present it as treatment option. In reality, with education, we are capable, we are qualified, we are prepared, and we are certainly more than talented enough. This post serves to remind us of those facts, and to offer up the motivation to act on them.

We certainly do spend a majority of our time looking at teeth, and regardless of our dental discipline or preference, the majority of our work does strictly involve the oral cavity. Our education, however, wasn’t strictly limited to teeth. We learned about the entire orofacial region: the muscles and the bones, the form and the function. The depth of our knowledge from our original learnings includes a strong foundation upon which we can structure facial enhancement treatments to our patients. At my practice, we often preach that the smile is the foundation and the buttress of a face’s youthful look. We practice that proclamation by extending our cosmetic reach through the use of facial enhancements.

One of the wonderful things about introducing facial enhancements to treatment plans is that the work is relatively easy. My practice performs facial injections on a consistent and most likely a daily basis, and we are certainly well-trained in their application. Picking up the administration of facial enhancements, especially for dentists experienced in the delivery of local anesthetics, does not have a steep learning curve. Many organizations offer courses to help dentists and physicians qualify and legitimize as administrators of facial enhancements. These organizations find us capable of the practice and agree that we should be able to administer, with many state boards siding with this argument. If the academies and organizations we identify ourselves by have faith in our competence as practitioners, why do we continue to exclude ourselves from offering these types of treatments?

Beyond excelling as a lateral treatment option in cosmetic dentistry, facial enhancements, specifically neurotoxins like BOTOX®, can be used as an alternative treatment for TMD, and while treatments are presently off-label, evidence strongly supports the notion that it is a viable treatment option. The comfort and care offered by using facial enhancements cannot be ignored and neither can the value it builds with the patients to whom we offer them.

While our relationships with our patients should come first and foremost, we simply can’t deny the cost benefit of offering facial enhancements to our patients. The profit margin can lean heavily in our favor, all while allowing us to offer the best treatments available to our patients at a reasonable price. The mandate to offer this treatment is in its math.

Exploring new avenues and methodologies of treatment not only improves the lives of our patients, but improves our lives as well. We stay active, we stay committed, and we keep to our Hippocratic Oath. We respect the hard-won scientific gains of our predecessors, and we apply, for the benefit of the patient, all measures which are required. Offering facial enhancements should no longer be a question or a cause, it should be a dental standard.

Whether you agree or disagree with my statements, I’d love to hear more from you. Sound off in the comments below and let me know what you think!  

Nicholas Navarro, DDS 

Monday, July 27, 2015

Celebrations and Trust

Dale, the leader of a noted local jazz trio, was in the living room playing live jazz on his bass, while Maria, a noted local personal chef was in the kitchen preparing a very special dinner.

Phyllis and Ernie had a good life, but their later years had not been very kind to them at all. Pillars of the community, they had ordinary working lives that were filled with volunteer work, and the love and admiration of many for all the good things they did selflessly through the decades. They could not have children of their own, so they adopted two great kids in the 1950s. Their oldest, Bob, was the child of an alcoholic mother and he overcame the mental disabilities he suffered to fall in love with a wonderful woman and get married himself, only to succumb to his mental illness in his 40s and take his own life. Barbara, their youngest, grew up, got married, and had children of her own, only to develop breast cancer and then pass away, leaving her husband and young children on their own. Phyllis and Ernie were stunned. All they now had were each other, and their 60th wedding anniversary was fast approaching.

For more than 50 years, Phyllis and Ernie were patients in our practice, seeing Dr. Roy Rasmussen for 30 years and me for the past 21 years. And now, all these years later, they were not just patients anymore. We laughed and we cried with them, and now we wanted to honour an amazing achievement—60 years of marriage. There was no way Ernie wanted to really celebrate, but we could tell Phyllis wanted to do something special. So we did it for them.

We called Dale and Maria, another married couple in our practice, and told them about Phyllis and Ernie. We asked if they might be able to go to their home, prepare a special anniversary meal for two, and top it off with romantic jazz music. They thought it was a great idea, so together we made it happen. And the evening, so we heard later, was as magical as we hoped it would be.

Phyllis, sadly, now has also left this earthly realm, and Ernie has not long to be with us either. But for one special evening, we made a profound difference for them that went beyond dentistry.

Sophia, age 2, came to our office for the first time. What a delightful little girl, in her purple Anna (from Disney’s “Frozen”) dress, she talked our ears off and had us all laughing. After she left, I sent a handwritten note to her, welcoming her again to our practice and letting her know how much fun we had meeting her. We stuck in a few “Frozen” stickers as a gift, too. Not only was she delighted, but her dad tweeted about it and we heard from many sources how much they enjoyed that simple show of gratitude.

John and Danni had been dating for awhile and now their wedding was just around the corner. John’s teeth were a little yellow, about an A3 shade. Danni had a beautiful smile. As a thank you for being patients, and as a wedding gift from us, we did a free in-office whitening for John, and a free supragingival biofilm removal (or “polish”) for Danni in the week before their wedding so the their smiles for pictures would be as best as they could be. We got a lovely thank-you card and a mention on Facebook from the newlyweds.

Aziz and Zara were expecting their first child. Early in the pregnancy, we asked Zara to increase the frequency of her hygiene visits during the pregnancy to lower the risk of a premature, low birthweight baby. On her final visit, we asked them to please put us on their notification list after the baby was born because they were so special to us. They sent us a beautiful picture via email with their announcement of the birth of their daughter, Sarai. We posted the picture on our Facebook page (with permission) and welcomed the new addition to our practice, too. We waited one month, and then sent a unique bouquet of flowers to their home, congratulating them on the birth of their daughter from our team. Aziz and Zara were delighted with the timing of the receipt of these beautiful flowers and shared the results on Instagram.

Dentistry is all about relationships. We practice comprehensive general dentistry, because we have taken the time to know our patients as people and, as a result, we earned their trust. We have carefully focused our efforts on major life events. We welcome new patients with handwritten cards, mentioning something specific about them, to show we paid attention. We send personal thank you notes to people who refer to us. We celebrate births, weddings, milestone anniversaries, and we send a handwritten note of condolences to family members when someone passes on.

What we don’t do is send birthday cards. Many patients have told us that birthday cards, although cute and nice to receive, just seems like a computer-driven, reminder-based action that does not seem genuine. So we stopped doing them a long time ago.

It’s the little things, in celebration of the big things, that have made a difference for our patients, for my team, and for me and my family.

What “little things” do you do that have made a difference? Please share your stories.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD


Friday, July 24, 2015

Made in the USA. Made in My Office. Maybe Even Made in the Same Day!

You know those seasons of work life when things seem to be flowing nicely—patients are steady, staff is happy and compliant, you get a lunch hour, and you’re able to leave on time. Maybe you even have time to read the paper or check your emails. (Man, does that sounds appetizing!)

Yea…that’s so not me right now.

We recently dove headfirst into the world of CAD/CAM dentistry. It’s addicting and fun, but I have to say that it’s so much more than I anticipated. I’m young and grew up on video games, so I can only imagine what the learning curve looks like for the generation before me. It’s not easy.

We did it not just for same-day restorative options, but for the control and the cost savings. What I didn’t have a grasp on was the added dimension of scanning and designing. It’s like stopping in the middle of your schedule and putting on your lab tech hat. And when the staff is learning the basics of the system, it’s really up to us as the docs to show them the way (aka mucho doctor chair time).

I’m sure some of you have been or are going into this same season, and it happens with the introduction of any new procedure, system, or piece of technology. If every day was easy and low stress, our jobs just wouldn’t be as fun as they are, right?!? Maybe it’s just me, but I thrive on the constant movement and unpredictability of daily general dentistry, and the overall thinking on my feet that we go through on an hourly/daily/weekly basis. It’s truly why I chose the profession and haven’t regretted it for a second.

Don’t get me wrong: The craziness of the last few weeks has surely cleared out any arterial plaque I’ve built up over the years (I really should get a FitBit to track this madness). It’s definitely a mental and emotional strain. I literally do not need a morning coffee anymore. And I’m sure my staff hates my guts with the outward portrayal of stress that’s seeping out of my pores.

But it’s worth it. It’s worth it for my patients, for my practice, and for me. Everyone needs a little spice in his or her work life. This CAD/CAM thing is here to stay, and I’m excited to get on board!

Donald Murry III, DMD 

Tuesday, July 21, 2015

But I Want to See a Real Dentist

Recently, I had an appointment with a long-time patient. At the conclusion of our visit, I said, “Well, now that your son-in-law is graduating from dental school, I guess I won’t be seeing you.”

She responded, “Are you kidding? I’m not going to see him. I want to see a real dentist!”

Wow. I can really relate to this. I’ve been on the receiving end of that sentiment. The reason is simple. The various friends and family members in our lives just see us differently. They see us in a more casual and familiar manner.

To my family and friends, I am “Andy.” As in, “What the heck does Andy know?”

To my patients, I am Dr. Alas. As in, “Dr. Alas says I need a crown.”

When Andy says you need a crown, it means that it’s time to ask your “regular dentist” what he or she thinks. 

When Dr. Alas says you need a crown, it’s time to schedule an appointment. 

There is a reason for all of this. You see, your family and friends were actually there when you took those photos—the ones that you now regret posting to social media. In fact, they are the ones who took those pictures of you during spring break. Don’t pretend you don’t know which photos I am talking about. 

So these days, when you express a health-related opinion, let’s just say it doesn’t always come across as authoritative. 

It’s all about context. Let’s try an experiment.

If THIS guy tells you that you need a crown, would you believe him?



Or would you believe this guy a little more?



See what I mean? (Yes, that is Dan Aykroyd in the first photo.)

Our family and friends just see us more casually, which is fine. I’m just glad to have friends that put up with me. I’ve learned not to take it personally when they tell me about their dental visits to another dentist’s office. It’s just something that I’ve learned to accept.

For the moment, though, I must stop writing. My wife has an appointment with a real dentist to see whether she does, in fact, need a crown on that tooth I told her about.

Andy Alas, DDS

Friday, July 10, 2015

Giving It Away

I don’t know how well you guys know me. 

If you’re an avid reader (I mean, if you’ve been reading this blog since 2008), then you know me. But for those of you who don’t...

I have a pretty average practice. I am a solo practitioner who works four days per week.  I am kind of a one-column dentist. I have two rooms, but I rarely use them at the same time.  

I have nine hygiene days. (I have three hygienists, but one is here for four days, one is here for three, and one is here for two.) Pretty average, right?!

I practice family general dentistry in a relatively small town. I am right down the middle. I don’t do any perio surgery, or implants, or crazy root canals. I stick with what I know and don’t really veer from that. 

I love kids, and I love families. I am very conservative, but I know how to do the full-mouth rehab (as a young dentist, I completed all the continuums at The Pankey Institute), and I do a couple of those cases each year.

I recently looked up the latest (2013) survey put out by the American Dental Association (ADA) about salaries. The survey talks about what dentists make. It talks about the average salary, and then it talks about what the top 25 percent are making. 

I am not going to tell you how much I make (because everything I write here always gets back to my staff). But I am very satisfied with where I lie in the range.  

So how does an average, small-town guy become successful? (Understand that successful to me means so much more than a dollar amount. It means being happy, it means getting satisfaction at work, it means making a profit, and it means liking what you do and the people whom you work with and for.)

I am going to tell you what I think, but I don’t think you are going to like it. 

You might know this, but I am VERY conservative. In 2009, which was the previous time the ADA did this survey, I was really surprised that I was in the top echelon of practices (money-wise), because I had only done—you are not going to believe this—58 crowns that year. Yes, I said 58. Now, I know some of you just fell off your chairs realizing that’s about one crown per week. 

Yep, I was able to be in the “top practices” line (at least, according to this survey) doing only one crown per week. (Since 2009, I have bought my father’s practice, which has come with a lot more mature clientele, and I have almost tripled the amount of crowns I did in 2009, but the same principles apply.)

And, I think I know why—and this is the part that might be hard for you.

Give it away.

I do a lot of free dentistry. It is kind of a theme in this office. It starts in February when my staff and I do a day we call Dentistry With a Heart. I started doing this 10 years ago. This is a day when I open up the office, filling every room with a different dentist or oral surgeon, and we do as much free dentistry as we can for 10 hours. And it just continues from there.

This has had an impact on the community. It kind of gets the word out about what kind of dentist you are.

Then a guy at church who you know, but who goes to another dentist, knows about this other guy who needs your help. Then it is his cousin, or a friend of a friend, or someone’s son. The answer is always yes. I say, “No problem, here is my cellphone number. Have them call me directly, and we will get them taken care of.” Sometimes, I don’t even know what I am saying yes to. It might be a filling, or a flipper, or it might mean a couple of root canals and a bunch of anterior restorations. I have even called in a favor to my orthodontist (an innocent bystander) and had him put braces on this one college-aged girl who wouldn’t smile because she hated her teeth.

And I know what you are thinking...word is going to spread, and you will have tons of folks banging on your door asking for free work.

This is what I say to you about that: “So what?”

Are you telling me that you don’t have holes in your schedule? Why not fill them with people whose lives you can really change? A single mom of two. A guy who just got out of prison and wants to turn his life around. A guy who just can’t find a job because his front teeth are a mess.

Now, it’s not always a perfect situation, and the receiver of the gift is not always as appreciative as your staff might desire, but it is about your heart. I am not going to get all Jesus on you but a couple of Bible verses come to mind.  One is the parable of the talents (Matthew 25:14-30), the one about God giving us talents and he expects us to use them and multiple them.

I don’t do this to get new patients, but it just happens. “I came here because you helped my friend.” “I came here because I know you do that day for the poor.” “I saw you in the paper.” And on and on.

Now you know that guy who goes to another dentist who sent this other guy. Guess where he is going to go to when his dentist ticks him off or dies? (I mean retires.)

So it goes both ways. The word that gets out can work in your favor.

I feel like I am in that top echelon of practices not because I do more crowns that you. I think I am up there because people start to know the kind of dentist you are. I am the guy who is pretty conservative and fair, and cares. I also am the guy who loves my job and can’t wait to come to work.

What do you think? Am I on an island on this one? Is anyone giving it away, too? How’s that going for you? Does anyone disagree with me?

I would like to hear from you.

John Gammichia, DMD, FAGD

Monday, July 6, 2015

Marketing Your Dental Practice in the Internet Age

In my 30 years of practicing dentistry, I’ve seen a lot of changes in the way we as dentists interact with our patients. For a time, my practice relied solely on expensive forms of outbound marketing—magazine advertisements; mass, community-wide mailers; and an endless number of calls—hoping to regenerate patients whose interactions with our office had, for lack of a better expression, expired. For a time, these methods of patient communication certainly did their job, but as the years have passed, larger and larger segments of our targeted population have become savvy to these efforts, and more often than not, they’ve become too expensive to justify their worth. Cutthroat as advertising already is in an industry like ours, we are finally, as a larger community, beginning to embrace the Internet age our industry has crawled into.

I say that we, as an industry, have crawled into the Internet age because, frankly, we are far behind the eight ball in comparison with other industries. The sales, services, and dining sectors all recognized the need to get their foot in the Internet door a long time ago, and it is truly astonishing to see that such a large portion of dental practices are just now embracing inbound and Internet-based forms of marketing. We have embraced advances in technology in how we operate our business; it is finally time we do the same when generating that business.

There is no time like the present to start taking advantage of these new avenues of marketing. At first, I myself was discouraged to reinvest in digital marketing because of the exorbitant costs of the pay-per-click era. The pay-per-click era brought many shoppers but very few buyers to my practice. This was a time when search engine optimization (SEO) was less dependent on the creation and promotion of rich content, but rather on how much money could be spent or how many keywords could be “stuffed” into a Web page. But that is no longer the case—through a comfortable blend of social media, Web design, and SEO, my practice is now able to digitally target potential patients who are looking for exactly what we provide and appreciate our unique approach to dental health and facial esthetics. My practice focuses on dental implants, cosmetic reconstructions, and facial enhancements using BOTOX® and dermal fillers. This new age of digital marketing allows us to focus our attention on these particular areas of profitability in ways that were not available years ago.

The ushering in of modern SEO techniques, responsive website design, digital live chat, and various social media outlets have provided an opportunity for my practice to grow in ways that I did not believe possible. These new tools redefine the patient experience. Prospective patients can speak with a live representative at our facility and be guided through our website, which is full of amazing and informative content. Our social media pages keep patients updated on what’s happening at our office and include photos of ongoing full-mouth restorations. We also use email as a resource for highlighting our practice, including announcements about new technology or procedures. One of the most important things that we have added to our patient emails are before-and-after cosmetic consultations, which include digital photos and key points discussed with our doctors, helping patients to see the real potential of the practice’s cosmetic treatment offerings.

We continue to look for new avenues to provide the greatest digital experience possible. If you haven’t already, I recommend exploring these new media options as they become more and more essential to growing the modern dental practice.

Nicholas Navarro, DDS 

Monday, June 29, 2015

Wedding Season, Part 2

“Larry, you have to have a booth at a wedding show. It’s a natural for the cosmetic side of our practice.”

Christy, my dental hygienist, was getting married in a few months and she had attended one of those bridal shows that brought everyone together: florists, dressmakers, wedding planners, caterers, hotels and other wedding locations, vacation people, makeup artists, photographers, and more. But she did not see one dentist! I had recently joined the American Academy of Cosmetic Dentistry (AACD) (now almost 20 years ago!) and my team and I had just discussed how we could get the word out about what we do and how we can do it. What an amazing team member; as she was busy planning for her wedding, she was thinking of our office and our goals as a team, too.

But it did seem like a natural opportunity. I just had recently purchased software that could import smiles, change them on the screen, superimpose other smiles, and give people a visual idea of what may be possible in a smile makeover.

So we contacted the organizers of the largest wedding show in Calgary and booked a booth. We got a corner booth for greater visibility, purchased tables, banners, lighting, and more to make it visually appealing and spent a weekend talking to a large number of women about their smiles and their upcoming big day. There was a lot of interest but, in the end, we did not garner a lot of business.  The message we got was that there was so much being spent on the wedding, there was little left to spend on a smile makeover, too.

We kept going back, and refined what we were doing and how we were doing it, and we did get some interest and some people following up in our practice. It was financially worthwhile, but just by a little bit. We did wedding shows and women’s shows. We were ahead of the curve and building our reputationone person at a time. But after three years of these shows, planning, buying supporting material, paying team members to give up some of their time to help out at the show (don’t get me wrong: I paid them for their time, but it was still family time that they were giving up to be there with me, although they did it with a smile and grace), and more, it just was not an effective use of my time and resources. After all, I was giving up family time to do this, too, and I was there every minute of every show!

One of the things that did come out of all of these shows, through research, contact with colleagues through the AACD, and my personal experience, is that we created a wedding timeline for planning a smile makeover and we posted it as a public service on our website. Over the years, many people had e-mailed me from all over the world, thanking me for providing the information, and it turned out to be a wonderful public information service. Here is what was on my website:

“Prior to your wedding day you will plan your clothing, jewelry, hair, and makeup in great detail. But the first thing people will look at on your wedding day, and the first thing you will see in all of your pictures forever after, is your smile.

“Who should be concerned with planning a fabulous smile for your wedding? Everyone who matters to you. The bride, groom, maid of honour, best man, parents of the bride and groom, bridesmaids, and groomsmen are the primary people who should consider a smile enhancement before the wedding day.

“The best cosmetic dentists in Calgary are all fairly busy, especially during wedding season, so here is a timing checklist to ensure every member of your bridal party will look their best:
3 months prior: Have a smile consult to determine what could be done. These consults are usually 30 to 45 minutes long, should be complimentary, or have a nominal fee.
2 months prior: Large smile makeovers should be started (usually completed in only 2 visits, about 2 weeks apart). This early date will ensure you will have lots of time for other last minute details. Your smile makeover will last for many years! Do it sooner than later.
1 month prior: For smiles that need minor changes only, consider home or laser whitening. The best cosmetic dental practices offer both services.
1 to 7 days prior: Go for a tooth polishing. Even if it is not time for a regularly scheduled dental visit, a thorough polishing will make your teeth shine, and should cost less than $100.”

Feel free to use any or all of this for your own website. I don’t mind. Unfortunately, the Complaints Director (CD) of the Alberta Dental Association and College told me I had to remove this from my website as it was a statement of superiority. No one complained about it, but the CD still found fault with everything I was doing and shut it down.

The happy ending to this, however, and as always, was the relationships that came out of these shows. At my first wedding show, I met this young woman and her mother. The young woman was getting married in a few months and had small peg laterals and was very conscious of her smile. We did photographs of her, analyzed her smile and offered a number of solutions from simple to complex. She chose something in the middle which consisted of two Empress restorations (this is the late 90s now) on her upper lateral incisors with some teeth whitening and she looked fabulous (I am a little biased).

But the best part is over the next 10 years I saw two of her sisters and I ended up enhancing all their smiles. They are incredibly beautiful women, inside and out. When it was all finished, I paid for a portrait session with a famous internationally renowned local photographer and they each got to pick photos that they could keep for themselves. Here is one of the images that came out of that session:


Now these three young women are all married and mothers to some amazing young kids. It’s so much fun to be part of something like this.

So enjoy wedding season. We really can make a difference for some people on a really important day in their lives.

Warm regards,

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD

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