Pediatric Dentistry Dental Economics

High-performing pediatric staff—the best asset a practice has!

March 22, 2016
The best asset a dentist and a dental practice has is its staff, particularly in a practice that treats children. Here, AAPD past-president Rhea Haugseth, DMD, discusses pediatric dentistry best practices.

Picture this: You walk into your office on a Monday morning. Your staff has already arrived, and every operatory is organized and ready for patients. The daily appointment schedule is full—in fact, it's filled three to four months in advance—and there's a waiting list of people who are hoping to get in earlier if there's a cancellation. Your staff is reviewing the day's schedule; they're looking through the records to understand the unique needs of each child and family so you and your staff can provide the best possible care. You begin your day with a morning huddle. Practice is over—now it's time to perform!

Then, after each child's visit, the staff masterfully communicates to the parent with enthusiasm, confidence, a sense of ease, and expertise. The parent knows exactly what the staff is talking about, which puts the parent at ease and makes him or her eager to comply with all recommendations. If restorative care was performed, the staff confidently explains to the parent what was done, and gives the parent the postoperative instructions in a comprehensive and easy-to-understand way.

This is what it is like to practice with a high-performing pediatric staff. The staff works together as a team, with each person playing her or his part, just as a musician in an orchestra does. With an orchestra, the conductor brings out the best of each individual musician. They perform both independently and simultaneously to produce a previously written, learned, and rehearsed composition in beautiful harmony. The audience may not notice small slips or slightly off-key notes on an individual level, but they definitely can tell if the entire orchestra does not play the piece in harmony.

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This is also true in our offices. We can have minor blips in the day, but in order to be an efficient, profitable, professional practice, the entire staff must be playing the same composition and able to repeat it hour after hour, day after day. It takes preparation and a well-written, well-rehearsed script to do it right every time. It begins with the doctor and transfers to every member of the team. Administrative staff members are just as involved in the execution of a great visit as are the clinical staff. The result is a high-functioning, high-performing team.

Administrative responsibilities are similar in any dental office. The real difference in a practice that treats children is that the administrative team most often communicates not with the patient, but with the parent. It is sometimes difficult to convey the necessity of treatment to the parent if they can't see this need, or the child-patient hasn't complained that something hurts or is uncomfortable. The parent knows how they feel when they have their own dental issues, but isn't necessarily able to fully comprehend how his or her child feels. This is where well-written scripts for the administrative team are essential. Intraoral cameras and diagnostic radiographs can help, but ultimately it comes down to trust between the parent and the dental provider. A well-trained team praises its doctor and teammates as being the best, gives examples as evidence, and instills confidence in the parent that his or her child is in great hands.

The clinical team is of course also crucial. The dental assistants and hygienists must know exactly what their roles are in various situations so that the entire team functions smoothly. Since most pediatric offices see a high volume of patients, systems must be in place to prevent chaos. Everyone's functions must look smooth and controlled to give patients and parents a sense of calm. The team members provide the care as efficiently as possible, both when working independently and directly assisting the doctor.

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Different state dental practice acts have different levels of duties that dental assistants and hygienists are able to perform. The most successful pediatric offices utilize their teams to the fullest extent of the law, such as having team members apply fluoride varnish, sealants, rubber dams, matrix bands and wedges, and etch-and-bond systems. Some states allow the hygienist to perform injections, while others allow the expanded-function assistant to carve and polish restorations. Whatever is allowed in your state, train your clinical team to use its capabilities to the fullest extent of the law.

Utilizing single team members instead of four-handed, two-person teams in procedures makes the office much more efficient and profitable, as twice as many patients can be seen. For example, utilizing fluoride varnish, which takes the assistant just seconds to apply, saves more time than the older method that places fluoride foam in trays in the mouth for four minutes. Fluoride varnish also provides better fluoride uptake by the enamel, and it continues to release fluoride and possibly calcium and phosphates while on the teeth. Asking the patient to delay brushing for many hours allows the fluoride to have the greatest effect on the teeth. Another team member can place sealants on teeth efficiently, greatly increasing the practice's production without utilizing any of the doctor's time.

There are also many ways to attain good isolation for effective sealant placement. One of the newest ways is the Isolite system, which enables complete isolation of half of a patient's mouth and greatly increases the team's efficiency. Some sealants need completely dry teeth while others need the teeth to be slightly damp, which can help with recently erupted permanent molars or even primary molars with deep pits and fissures. Having both in your armamentarium greatly enhances your team's ability to do it right the first time, and reduces failures and replacements. Having your office staff be proficient (i.e., doing it better) and efficient (i.e., doing it faster) by incorporating the new game changers in pediatric dentistry is the key to your profitability.

The best asset a dental practice has is the staff, particularly in a practice that treats children. Because the staff must communicate with both the parent and the child, verbal and nonverbal communication must be well designed and well executed in order to provide the best care and best visit possible. The practice that budgets the time and expense for training will see not only the financial rewards of increased referrals and case acceptance rates, but a harmonious, highly functioning team figuratively playing a beautiful concerto.

Rhea Haugseth, DMD, a past president of the American Academy of Pediatric Dentistry, has 38 years of clinical experience. She is a diplomate of the American Board of Pediatric Dentistry, a faculty member of the Institute for the Clinical Practice of Pediatric Dentistry, and founder of the Pediatric Dental Assistants Association.

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