How to Profit From...handpieces — Clinical and management methods for your practice

How do we keep the "balance" while facing our top challenges? To be able to face any challenge properly, every office needs a vision, mission, and resulting strategy to achieve it. Dr. Roger Levin says, "The future of any business depends upon the vision of its leader."

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by Jeffrey C. Hoos, DMD, FAGD

How do we keep the "balance" while facing our top challenges? To be able to face any challenge properly, every office needs a vision, mission, and resulting strategy to achieve it. Dr. Roger Levin says, "The future of any business depends upon the vision of its leader." The mission statement gives us a guideline of how we want to be seen by the outside world. This statement should serve as a daily reminder for the staff and the doctor — reminding them of the direction for the office and how we want to treat our patients. The mission statement for our office is:

"To provide the highest quality care, to the most number of patients, in the most comfortable way, while maintaining a balance between our personal and professional lives."

This mission is similar to what I have heard many of my colleagues state verbally. By gaining staff "buy-in" and putting it on paper, I have seen real results.

What is the challenge?
Dr. Roger Levin clearly states, "If a practice does not provide the financial resources for the dentist and family to enjoy a certain quality of life, satisfaction will be fleeting." Now, dentists are discussing how to best fill their time with high quality, high fee-for-service patients who want comprehensive and aesthetic dentistry. These patients are in the top 5 percent of the market.

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Occlusal caries in distal pit
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Many dentists, therefore, ask, "How do we generate patients who want and need high-end work when they represent perhaps only 5 percent of the dental population?" Is the challenge to find the internal and external methods to generate these patients, and is it our ultimate desire to only do these types of procedures and treat only these patients? The wonderful thing about dentistry is that we all have a choice in the way we want to practice. However, it can be frustrating trying to look for and compete for a small percentage of the patient population.

My mission and the practical nature of working on "Main Street" has made me embrace the fact that I will treat all patients in the most comfortable way while maintaining a balance. So how do I get balance?

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Fissurotomy bur
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I have come to realize that the success of our practice can be attributed to not limiting it to the 5 percent of the patient base that all doctors (including me) want, but to service all of our patients. They receive the highest quality care that we can give them. This is not just in the clinical skills we display. All patients assume that their dentist is clinically competent or they would not go into their offices. I believe that we must treat patients who have a higher perceived value of modern dentistry and its capabilities. Within our large, loyal patient base and the people whom they refer, the high-fee elective cases will be found. That high perceived value comes from utilizing good "people skills" as well as great clinical skills.

One new/old procedure I have found helps me with this tactic. Researchers and clinicians have documented the inadequacy of exams for caries detection using the traditional radiographs, explorer, and visual determination.

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Conservative prep at right
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However, these methods continue to be used because other methods are either not available or are not trusted. Dr. Rella Christensen has documented that well over 94 percent of the stains in pits and grooves of nonsmokers have undetected carious lesions. Many of these carious lesions extend deep into the dentin and some have even invaded the pulp chamber.

The December 2000 CRA newsletter states that the DIAGNOdent by KaVo provides helpful diagnostic aid where radiographs are not useful. The DIAGNOdent will give instant feedback to both the clinician and the patient. A laser induces fluorescence, which is detected and converted to an LED display and an audible signal.

The touch of the probe and the audible signal help the patient follow the course of the exam and identify teeth with possible problems, thereby involving them in the treatment decision.

Once our suspicion is raised to a treatable level, we have at our disposal a number of innovative ways to be conservative and reduce the need for anesthesia to restore these teeth. To reduce the need for anesthesia, you could use air abrasion or one of the newer products — the Fissurotomy Bur System from SS White.

I chose the Fissurotomy burs because they are more conservative and cleaner. SS White devised a very simple, innovative, and conservative technique. This bur system has everything you need to very easily treat these areas of decay without the necessity of changing handpieces. The bur has been designed to be the smallest at its tip to minimize tubule activity and conserve healthy tooth structure.

As dentists working in 2001, we need to use the science at our disposal. The amount of routine, "run-of-the-mill" dentistry that goes undiagnosed is probably enough to keep dentists as busy as they want to be. Remember that part of the "balance" is the science of dentistry.

With the emergence of these simple new techniques, cutting devices, and easy-to-use materials, Class I cavities now can be done without anesthesia 85 to 90 percent of the time.

Dr. Charles Blair speaks of the unscheduled treatment room where patients can be seen as an adjunct to hygiene visits. When these lesions are discovered during the hygiene visit, multiple quadrants can be treated simultaneously. The teeth can be prepped in three minutes or less and then quickly restored.

From a business standpoint, the chairtime is reduced, and the production-per-hour rate has been increased to the point where it is similar to the top five percent of the work many of us target. I see this as congruent with my mission to treat all patients. I get the same type of satisfaction and gratitude from these patients when they or their children experience a gentle, pain-free, and anesthesia-free cavity prep.

Listening to the patients
The two questions that I always ask in seminars are: 1) "How are you serving your patient base in order to retain your patients? 2) How are you generating your new patients?" It is important to understand a simple technique that we have used to help our office become successful. I believe that it's an easy method that can be used in any dental practice. That method is: Listen to your patients. In dental school, a veteran doctor told me that if you listen to your patients, they will tell you the problem. These were very wise words. I would expand it further: The patients will tell us what they want or desire. My adult and child patients express fear of the needle. I listened and addressed this issue in many patients' first experience with the handpiece. It is our job to fulfill that desire and give them what they want within the guidelines of good science and good business. With the "run of the mill" Class I, I now have patients and parents thanking me — and in some cases bragging about me — for the "no shot cavity prep."

We want to respond to the patient's desires. Once we have taken care of their immediate needs and have built trust, we can build on this to help them understand their other undiagnosed dental needs.

Benefits vs. features
Once we have fulfilled their immediate desires, we need to demonstrate to them our view of other real dental needs. The way we inform the patient is very important. Once you and your team help your patients understand their needs, the doctor needs to provide the solution using methods that the patient can understand. Patients do not buy from someone whom they do not believe and trust.

The key point to having patients understand their dental needs is the concept that consumers buy because they trust you, not the features provided. What is a benefit vs. a feature? When something is described, the simple word "you" in the statement makes it a benefit statement.

"The car can go zero to 60 mph in six seconds." This is a feature statement.

"You will be able to get into the flow of traffic faster because of this powerful engine." This is benefit statement.

It is extremely important that we really understand the difference between the "benefit" and "feature" statements. This concept can make the difference in helping our patients understand the importance of the services we can provide for them.

Patients, as dental consumers, do not know how a procedure is done or how uncomfortable or comfortable the treatment will be. They also don't know how many visits will be required for you to provide the services they desire. They don't understand what great materials you use or how wonderful it will turn out in the end. By using effective benefit statements, you can explain things to both your existing and new patients in positive terms. Positive terms in your benefit statements and their emotional trust in you will motivate the patient to move ahead with your recommended treatment plan.

Dr. Gordon Christensen, in the recent article, "The Credibility of Dentists," talks about the Gallup Organization's research regarding the honesty and ethics of professionals in the United States. The ranking of dentists has dropped over the years. Dr. Christensen said that one of the reasons may be that the profession is planning and carrying out "excessive treatment."

I want to provide patients with treatment they desire. When I describe the use of benefit statements as "selling" tools, I mean that I want to provide patients (who have grown to trust me via "run-of-the-mill" work) with treatment they desire. I use benefit statements that will help them make the proper choices. I am not interested in overselling the patient, just providing a communication environment that is comfortable for the patient.

Balancing art, science, and business
The purpose of this article was not how to do a Class I restoration using tooth-colored materials, new devices, or specially designed cutting instruments. The science behind the techniques, restorative materials, and presence of hidden caries is well documented. The business aspect of the equation is extremely important. We listened to our patients, understood their issues, and helped them understand the benefits we were going to provide for them. We validated their concerns and fulfilled their desires without compromising the science necessary to give a great result. The patient and practice won. We build trust and referring patients as a result. We set the stage for acceptance of more complicated cases — the top five percent. By following our mission and striving for balance, we can face the dental challenges in the years ahead and become as busy and as successful as our clinical and communication skills will allow us to be.

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