Tuesday, May 30, 2017

Sleep Apnea: Our Journey to Be Recognized as Physicians of the Oral Region

We dentists started as barber surgeons, with teeth as disposable as hair. The oral region was glossed over as unimportant by the medical community for thousands of years. A good friend of mine, a physiatrist (physical medicine and rehabilitation specialist), admitted to me that his education stopped at the temporomandibular (TM) joints and anything beyond that was a total mystery to him. In my orofacial pain and TM joint dysfunction practice, we naturally are working closer together than ever before.

With increasing evidence that diabetes affects the progression of oral infections — particularly, periodontal disease and how periodontal infections can affect the stability of diabetic management; and the growing links between oral infections and premature, low birthweight babies; as well as the links between premature atherosclerosis and periodontal infections and higher levels of c-reactive proteins in the presence of chronic inflammation from infections — the medical community is starting to pay attention to the orofacial region and dentistry as an integral part of the assessment and treatment of the entire human body.

When I was in dental school, many of our courses were identical in the first two years as the medical students’ courses. Basic information about the human body must and should be understood by all members of the health care community. Only in later years do we emphasize the subject areas of our particular field of study.

About 20 years ago, I became aware of the work of James F. Garry, DDS, a pediatric dentist who understood the critical link between breastfeeding and the development of the oral region, including the development of the airway. He was instrumental in the development of the NUK® and Sauger nipple and pacifier, along with Dr. Wilhelm Balters, a leading health expert from Germany.

Now, orofacial development, airway development and airway issues are affecting such a large part of our population that it is a serious general medical issue, and our role as physicians of the oral region continues to grow in importance. Steven Y. Park, MD, an otolaryngologist (ear, nose and throat specialist) in New York has a great website, blog, podcast, book and more, which are focused on airway and sleep issues, and he regularly interviews dentists, as he has recognized our role in this issue.

It is gratifying to see that our medical colleagues slowly recognize that our role in early childhood development and possible prevention of future airway and sleep apnea issues is critically important to the long-term well-being of the general population. Indeed, obstructive sleep apnea and sleep disorders are part of the Fellowship Exam of the Academy of General Dentistry.

It is time for all of us to study this field more, and to continue to collaborate, positively and collegially, with our medical colleagues, for the betterment of the members of the public whom we humbly serve.

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

Monday, May 22, 2017

What Do You Sell?

Today’s dental economy is rapidly changing, and the dentist owner is challenged to remain current in every facet of his or her business, both clinically and operationally. There is a continuous wave of new materials, techniques and technology inundating us, begging for our attention 24 hours a day, seven days a week.

With the arrival of discount dentistry, social media, poor dental insurance reimbursement and the “price shopper,” many dentists have had to postpone their retirement five to 10 years or more. The seeking of excellent dental service is slowly being replaced by questions such as, “How much is your crown?”; or, “How much is an implant?” In the eyes of too many consumers, the dental industry has become a commodity-driven industry where “tangible products are replacing intangible services.” Aren’t all crowns equal? Look at your insurance reimbursement fee schedule. Do you charge the same for an anterior crown as a posterior crown? Maybe the anterior crown should be more expensive? I think so.

Photo caption: A 28-year-old female patient whose chief complaint was, “This is what my insurance covered, and the doctor said it was the best he could do.” 

A tangible product is an object that satisfies a need or want and can be perceived by touch or feel (clothing, groceries, automobile, etc.). A service is intangible and cannot be touched or felt and is derived through the application of skills and expertise that fulfills an identified need. Dentists sell services, not products. Services are more about selling a relationship and the value of the relationship. As a result, they can be more difficult to sell. The key component to selling dental services and establishing long-term relationships is trust.

With the advent of Amazon.com and big-box superstores (Costco, Sam’s Club and 24-hour grocery stores), the consumer is demanding more. “One-stop” shopping and many dentists’ decisions to “compete on price” have shifted the dental industry toward a commodity-based market where emphasis is placed on product instead of service. This is a dangerous proposition for the small business owner. Much of this has been introduced through dental service organizations (DSOs) and the dental insurance industry, which is growing exponentially through acquisitions and marketing, while appealing to patients on numerous levels. Examples include: brand, national name recognition, being more cost-effective, etc. Considering the average student debt in 2015 was $247,000, many new graduates have decided to join a DSO to hone their clinical skills, be paid well, and not have to worry about managing or operating a business.

Dental insurance is another facet of business that dentists have had a difficult time keeping up with. For example, in 1972, the cap on dental insurance reimbursement was $1,000, and for many carriers, it hasn’t changed since then. Today, $1,000 would only pay for 177 dollars’ worth of dentistry in 1972. Conversely, it would require $5,660 dollars in 2015 to cover the purchasing power of $1,000 in 1972.

In 2016, it is worth noting that the No. 1 reason that dentists contract to become “in-network” providers is to grow their patient base. In other words, adding potential new insurance-dependent patients who, in most instances, don’t determine their own dental plans. Their employers do.

Unfortunately, many business owners do not realize that both the dentist and the insurance company are competing for the patient’s business. As a result, the dentist’s profit margins have dramatically shrunk, with more than 90 percent of dentists participating in one or more dental insurance discount programs. Prior to signing a contract to become an “in-network” provider, the business owner should evaluate the potential return on investment, with a clear knowledge of their breakeven point (BEP).

In my evaluation of hundreds of dental offices, I have found that more than 78 percent of all business managers and dental owners have contracted with insurance companies as “participating providers,” only to realize later that the insurance reimbursement is less than their cost of doing business. In other words, they are losing money while at the same time decreasing their cash flow. As an aside, it is important to note that insurance contracts are prepared and written by attorneys, not dentists.

In summary, an increase in patient flow that results in reimbursement for your services that are less than your cost of doing business is a recipe for disaster. Have you read your dental contracts, and do you know what your BEP is?

As dentists, we are considered physicians of the oral cavity, and we should focus on selling our services and expertise, not products and insurance affiliations. For the price shoppers and insurance-driven consumer, in most instances, they can go elsewhere.


Monday, May 15, 2017

Lend an Ear to a Fellow Dentist

It’s midweek, and you have a schedule that somehow just went way south. A staff member just informed you of a situation that will affect your schedule. An insurance claim denial waits on your desk to be appealed. Oh, and you just remembered you’re up for CPR renewal, and darn it, that model trimmer is still leaking. You know, it’s a typical day in our field. Needless to say, the drive home can sometimes be pretty serene despite the Google traffic GPS map showing dense red lines everywhere. 

But what happens when you get through the door at home? It must be nice to have a spouse or partner or parent who is a dentist and “gets it” when we narrate the ups and downs of our day. (Though, I’ll admit it’s refreshing to delve into the day of someone far removed from my tooth world.) What if we don’t have dentists waiting at home to hear us out? Do they find our stories boring? Repetitive? My favorite response to my own animated description of dental practice was, “Well, you wanted to be a dentist,” when I used to have my mother as my audience. And that was if my day was bad; when I was ecstatic about a case outcome or felt good that day, my joy might have only been my own. She always smiled and, with good intention, replied with nice comments, but did she get it?

As dentists, we carry a plethora of burdens. We must be mini-specialists (my coined phrase) in business administration, law and ethics, staff management, insurance policies, human resources, risk management, and on and on. Almost all of these things, I might add, we had to learn on our own. We are not only responsible for our own work and income, but that of our staff as well. That is a hefty burden on our shoulders. Who would empathize with us better than other dentists?

This is why camaraderie is so important in this profession. It provides us with constructive support that our loved ones or staff members may not be able to provide. I find that study clubs, dental meetings, board meetings and courses are venues where we can vent about our highs and lows and seek genuine empathy alongside sincere praise. Call me naive; perhaps dentists are more competitive with one another. But the most beloved listeners to my good and bad have been those who have walked in my shoes — because they get it.

Zeynep Barakat, DMD, FAGD

Monday, May 8, 2017

Cross-Train for Dental Success

Cross-training is a way of life for the modern athlete, and no one in Chicago’s professional sports scene more illustrates that than Jake Arrieta, pitcher for the World Champion Chicago Cubs. His training regimen received quite a bit of press over the past baseball season for being so multidimensional. Yoga, Pilates, Olympics-style weight training, visualization and sports psychology were all incorporated by Arrieta to help him reach his highest potential.

Are you unfamiliar with the term “cross-training”? Runnersworld.com defines the term nicely: “In reference to running, cross-training is when a runner trains by doing another kind of fitness workout such as cycling, swimming, a fitness class or strength training, to supplement their running. It builds strength and flexibility in muscles that running doesn’t utilize.”

How does cross-training in sports apply to the field of dentistry? In my opinion, the best all-around dental offices are the ones that consistently provide excellent patient care and do so daily with ease.

While there are numerous aspects that must come together to create an office of this caliber, in my opinion, one of these aspects is invariably cross-training of the dental team. Cross-trained offices thrive in the same way Jake Arrieta does: They build strength and flexibility in individual dental departments by doing another kind of work. These offices exhibit increased fluidity and typically operate at a lower level of daily stress regardless of what obstacles present on a day-to-day basis. Additionally, employees of cross-trained offices always seem to work better together. Being knowledgeable about a coworker’s job fosters increased understanding, empathy and appreciation for the daily tasks among the dental team (comprised of dentists and dental assistants), the hygiene team and the administrative team. Cross-training your dental practice will inevitably help yield stellar patient care and patient office experiences.

The beauty of cross-training a dental office is that there’s no wrong way to do it. While certainly impossible to completely achieve, the cross-training goal should be that everyone knows how to do everyone’s job. In actuality, simply having all staff members possess a basic understanding of all of the jobs is a monumental undertaking (and achievement). It might be challenging, but it’s worth it. Think of how much more effective your administrative team would be if they possessed firsthand knowledge of common dental procedures. Similarly, think about how much more effective the dental team would be if team members could execute common administrative tasks such as making appointments and answering incoming phone calls. Add the dental hygiene team into the equation, and the positive benefits are even greater.

The following are just a few ideas to get you started down the cross-training path:

1. Cross-train within a specific position (i.e., ensure that all dental assistants are fluent in all procedures for day-to-day operations, and that your team is not just comprised of a highly trained and experienced lead assistant with lesser trained and experienced coworkers).

2. Rotate in members of both the dental hygiene team and the administrative team to witness a variety of dental procedures firsthand.
a. Educate staff members (and the patient) during the procedure about as much as possible to create standardized informational scripts, and so that they will be able to more completely and effectively discuss the procedure on their own.
3. Rotate in members of both the dental hygiene team, as well as the dental team (yes … dentists, too!) to learn and review basic administrative skills and tasks.
a. Review predetermined scripts to ensure phone calls are answered within two rings even when the office is overwhelmed.
b. Schedule a patient’s next appointment.
c. Take payment.
d. Find charts and properly print/email X-rays and photos.
4. All staff members from all teams should be knowledgeable about how rooms are stocked and where extra supplies are kept.
a. Staff members should be knowledgeable about the names of dental equipment and their locations (i.e., a hygienist is asked to get a highspeed handpiece, burs and articulating paper for a chairside occlusal adjustment of a filling on a patient in a hygiene room).
5. Do you have an overflow dental chair? What about an “overflow dental assistant” from the hygiene or administrative teams who can help when all dental assistants are busy? Cross-train the overflow dental assistant to not only be able to help out, but also to thrive when called upon. Keep their skills sharp by periodically asking them to assist.

Learn from Arrieta’s success and cross-train your dental practice. It will certainly take time, determination and a lot of effort, but in the end, the office and your patients will undoubtedly benefit from it!


Friday, May 5, 2017

Put on Your Thinking Caps!

One of the biggest struggles most dentists have is hiring the right people to be on their teams. For me, the ability to think through, understand and resolve tasks is a must-have trait for an applicant to be considered. I have found that the struggle is that people are not used to thinking anymore. The thinking-process concept is becoming obsolete. 

In today’s younger generations, I feel that they are taught to listen, memorize and do rather than to slow down, understand and think through a process. This type of learning seems to be further continued and reinforced in most business settings. In fact, I have attended continuing education seminars where this same approach was being used to teach doctors and their team members.

It is faster and easier to just tell people what to do, and for the learner, it is quicker to only memorize; it takes a lot less energy. People robotically proceed through the day, and then they’re confused when things go wrong. There is little understanding and no connection to what it is they are doing. This teaching model is detrimental to our youth and to our workforce because it does not inspire people to be more and creates no sense of loyalty.

For example, when I used to conduct hiring-process interviews with dental assistant applicants, I found that the majority of them thought their responsibilities finished with suctioning and successfully passing instruments. They were quiet and timid, and most of them had no understanding of how to use the materials they potentially would be handling. When I asked them why they were searching for a new job, the answer given rarely was about money. The most common response was: “I want a job where I can learn and continue to grow.” They had little connection with their patients, and most came from offices with a lot of internal conflicts amongst the staff members.

If we teach people to interpret and process tasks, it will better equip them to handle the next task they are presented with. In my office, I train my assistants to function as clinicians. I am clear about my practice vision and my expectations of them. Each task is broken down, reviewed and reassessed until the trainee feels he or she has mastered the concept and is ready to move on to the next. You see, it’s when people understand why they are doing something that they really get how to do it and it sticks with them. Aside from that, they value the time spent in developing their skillset. Team members who are continuously well-trained feel confident and are present in their encounters throughout the day.

If we have a team of “doers” rather than “thinkers,” we set up a work environment where the mind-set becomes, “well, that’s not my job” or, “no ever told me.” However, if we cultivate “thinkers,” the entire team has a unified vision of the practice philosophy and a clear understanding of what the collaborative goals are. What type of team would you rather work with? 

Pamela Marzban, DDS, FAGD

Monday, May 1, 2017

Love What You Do

His name was Percy Faith. The eldest of eight children, born to Abraham and Minnie Faith in Toronto, he was a gifted violinist. Greatness was within him, and a vibrant future was his to command until one day he used his hands to put out a fire that was engulfing his youngest sister. She was badly burned and scarred, but he saved her life. Unfortunately, his hands were also badly burned and scarred, and his career as a violinist ended before it began.

But Faith loved music. He turned from performing it to composing and arranging it. After reaching a pinnacle of success with CBC in Canada in the 1940s, he moved to New York and continued his career there. Eventually, the industry encouraged him to settle in Los Angeles, and there, he raised his family while becoming a prolific recording artist, with more than 60 albums, not to mention film scores and more. In 2012, he was inducted into the Canadian Songwriters Hall of Fame for his song “My Heart Cries for You.”

He loved to take popular songs and arrange them for an orchestra, allowing him to introduce Caribbean and Central and South American sounds to North America in the 1950s. It was his life’s passion (other than his family, whom he dearly adored). It is what stood out for me, that he loved what he did for his career.

I grew up listening to classical music and Faith (because he was my mother’s eldest brother), and now, as an adult, attending performances by the Calgary Philharmonic Orchestra is a regular part of my life.

It was a Friday night, and my wife and I went to the Oak Room in the Palliser Hotel after enjoying a performance by the orchestra. We sat to enjoy a drink and quiet conversation when a beautiful young woman walked to the center of the room, lifted a microphone and started to sing. Her name was Ellen Doty, and she had this sultry, breathy, beautiful voice as she sang some jazz standards. She had the room totally captivated. As she sang, a keyboardist suddenly appeared to accompany her, and it was magic.

After a few songs, another musician joined her. He played some saxophone and drummed on a box. And he had joy written all over his face. Creating and playing music that others can enjoy was what they were passionate about. I don’t remember the keyboardist’s name from that evening, but the other musician was Oliver Miguel. These are artists who love what they do, like my uncle did.

I have to admit, I love being a dentist. I love what we get to do every day. I love that what I do changes people’s lives. And I laugh when patients tell me that they could never be a dentist and do what I do. I tell them that is a good thing because if everyone was a dentist, I would not have any work to do.

With springtime now firmly staring us in our faces, as we strive to emerge from our winter homes and enjoy the outdoors again, remember to engage that passion and love what you do.

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


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.