We’ve Moved!

To the Loyal Readers of The Daily Grind,

The Academy of General Dentistry (AGD) unveils a bright new look at agd.org. As part of this new look, we’ve moved The Daily Grind onto agd.org, where you can now access all of your AGD news sources in one place.

You also will find the tools and resources you’ve come to rely on, as well as new features and a fresh, modern look fit for our thriving organization. The mobile-friendly website includes improved organization and search capabilities, a Find-an-AGD-Dentist tool for patients and content that is segmented for general dentists based on their career stage.

If you are currently a subscriber to The Daily Grind, you will see a lapse in the notifications of the new posts. We encourage you to follow AGD’s social media sites for notifications on the latest posts from our bloggers.

We encourage you to take some time to explore the new website and check out some of your colleagues — including some familiar faces from The Daily Grind — who have shared their stories.

The AGD Communications Team

Online Dental Information: Marvel or Myth?

No doubt we’ve all used or heard the phrase, “I read it on the internet.” But what this exactly means is unknown, not to mention risky. I’m certain that countless health care providers hear it all the time from their patients and clients. I gather information from the internet, too. Is an internet search a good thing or bad thing? It may be both. 

Naturally, being able to sort through the infinite amount of available information is no easy task and, just like the products at the eye level of grocery shelves that draw our attention, we focus on the first few search results. Those results are not there by accident. Their placement is the result of a highly sophisticated algorithm that is computed with utmost binary accuracy. That’s wonderful and “informative,” but it still may not give me the answer I’m looking for. And that’s just the point; it’s not supposed to. Rather, it gives you information. For those who can remember, that information used to come from a collection of thick, heavy books called “encyclopedias.” Just substitute “encyclo” for “Wiki,” and you have your 2017 version.

Where am I going with this? In comes my patient who tells me she read about a procedure online and then decided against it. How did she come to that conclusion? If we search via Google for “root canals,” for example, thankfully the American Association of Endodontists (AAE) has the upper hand on the information. But scroll a little more, and it’s stunning to see myths about root canals that are available by clicking just one search result below that of AAE’s.

When I was considering Lasik surgery on my eyes, I had a hard time not reaching for my computer and simply typing “Lasik surgery” into a Google search bar. Instead, I consulted with my optometrist, who gave me advice not only based on evidence-based research, but that also tied in to the particulars of my case. Decision made.

If the internet was to provide us with the answers to our medical and dental questions, I think health care providers would have easy careers. I’m not against being informed; on the contrary, that is the basis for our “informed consent” forms. If we’re not informed, we’re not making an educated decision about dental procedures.

However, that information must be credible, scientifically valid and accurately apply to a particular situation. I think dentists should give patients sources that are sound and ethical from which they can draw reliable information on their own time. Then they can tie it all together in an open discussion to reach a solution best suited for the patient.

Now, that advice should be available on the internet.




Zeynep Barakat, DMD, FAGD

Relationships Matter above Everything Else

As we know, dentistry has entered a new economic reality — a reality that is reshaping the way in which we do business, as part of an industry whose foundation is built upon the appreciation and realization that relationships matter, above everything else. Yes, everything! Stated another way, no longer are our clinical skills the differentiator between success and failure. Rather, it is the manner in which all team members commit to building relationships that has meaningful and lasting importance.

In 2017, dentists are no longer insulated from market forces. In many communities, the competition is fierce, employee engagement is abysmal, and the price shopper is alive and well. For the new dentist or seasoned practitioner, the ability to carve out a “niche” is seldom based upon clinical skills. Rather, building long-term relationships that lead to a following of lifetime customers is key to personal and professional satisfaction. Considering less than 1 percent of dentists file for bankruptcy, I don’t think we need to worry about going out of business. However, as an industry, we can do better. How much better? A lot! We are fortunate to have chosen a profession that by its mere existence is financially successful. Consider us wise from this perspective. Or maybe lucky? Who knows.

For most general dentists, their profit margins are shrinking and will continue to do so. Why? The competing forces are fierce; dental insurance reimbursements are continuing to decline as more dentists enroll (this is simple economics: supply and demand); corporate dentistry will grow (they want a piece of the profits); fewer dentists will retire (many because they didn’t prepare for retirement); and there will be more graduating dentists, not to mention poor business acumen and an employee-engagement profile that is frighteningly low. What does this mean?

According to Gallup, a worldwide strategic consulting firm whose focus is on “analytics and advice to help leaders and organizations solve their most pressing problems,” only 32.6 percent of employees are engaged in their place of business. Gallup defines engaged employees as those who are involved in, enthusiastic about and committed to their work and workplace. The remaining 67.4 percent were found to be not engaged or actively disengaged at their place of employment. In other words, they are underperforming and costing the business owner a substantial amount of money in wages and lost production. Suffice it to say, there is a production crisis and relationship disconnect in today’s workplace. Gallup’s employee engagement work is based upon more than 30 years of in-depth behavioral economic research involving more than 17 million employees.

A recent study by Deloitte, one of the four largest consulting firms in the world, reported a direct correlation between the patient experience and perceived quality of clinical care, noting that higher patient experience ratings are associated with higher profitability. Relationships were key. Not only was there an increase in profits, but there was also an increase in customer loyalty, reputation and brand while boosting utilization through increased referrals to family and friends. The Deloitte Center for Health Solutions’ outcomes mirrored the Gallup poll findings, stating, “A highly engaged staff likely boosts patient experience, translating into better performance.”

Are these new findings? No. According to the article, “Top 10 Online Patient Complaints – How Does Your Customer Service Stack Up?” published in September 2012 in the McGill & Hill Group LLC newsletter, McGill Advisory, nine out of every 10 dental patient complaints are relationship-based and continuing to rise. Our employees and teams can do better, and when they fail to do so, they are hurting our business. How are your relationships with your team and patients? Are they built upon a culture of “do no harm” or “do unto others as you would have done to you”?

While we may be facing big-box dentistry, miserable insurance reimbursements, and a marketing maze of well-intending individuals and companies, there is no substitute for a culture whose core is built upon developing rapport that leads to value, and value that leads to trust. When patients trust you, they will buy from you.

While we can’t be all things to all people, we can be all things to some. This includes our patients and team members who appreciate our services, education, and commitment to each of them and each other — a type of credo that nourishes relationships built upon rapport, value and trust, or what I refer to as “RVT,” an association between the services we provide and a relationship-driven culture that leads to brand loyalty for life.

Are your employees engaged, enthusiastic and committed to their work and workplace? Remember, a highly engaged workforce means the difference between a company that outperforms its competitors and one that fails to grow. Relationships matter, above everything else.

Duke Aldridge, DDS, MBA, MAGD, MICOI, DICOI

Extinguishing Fires — Literally

“Doctor, the radio keeps turning off!”

So began my morning. Little did I know that within the hour, an electrician, my dental equipment repair team and an electrician would be in my office. My staff also would be cancelling all of my appointments for the day.

“Why does the radio keep turning off?” I asked. No one knew.

“By the way,” I said, “who is smoking a cigarette in my office at 7:50 a.m.?”

Being a dentist and inhaling all of those chemicals over the years, my sense of smell is not the greatest. So I asked my assistant, “Do you smell anything?” She responded, “Oh yes!”

I quickly realized that we had an electrical fire. Somewhere in my office, an electrical wire was starting to burn. Where? It did not matter. My staff and I rushed to the circuit breaker box and turned off all of the switches for the operatories. We were finished for the day.

You’ve probably heard the saying, “Don’t sweat the small stuff.” Fair enough. The trick is to know when it is no longer the small stuff you are dealing with. A light bulb burns out in your private office? Small stuff. Smelling smoke each time you turn on a light switch? Not small stuff.

I learned this lesson a few years ago from a colleague. He got a call early in the morning informing him that there was a fire near his office. Within minutes, he drove up to realize that it was his entire office that was on fire. The cause? A water leak mixing with a power junction box inside his office. The total loss? His entire office.

This is not sweating the small stuff. This is knowing that things can go wrong — really, really wrong.

After my electrician checked things out, he gave me his report. The radio kept turning off because the circuit kept breaking. The circuit kept breaking because a fire was about to start. We were a few minutes away from ending up on the local news.

The electrician informed me that he would need to tear up the floor in our operatories in order to get to the wiring.

He tore up my flooring, dug a hole and located an outlet. This outlet had been buried for at least 15 years. It had given out. My electrician replaced it, and we were back in business.

Our patients were understanding about having to reschedule their appointments. As you well know, our patients are already nervous about having a filling placed. Now, having a filling placed inside a burning building? They’ll happily hold off until another day.

If you show up to your office and something keeps switching off, you may want to take it seriously.

Andy Alas, DDS

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

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.















Duke Aldridge, DDS, MBA, MAGD, DICOI, MICOI, FMISCH

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