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Take it easy

Nov. 1, 2006
A couple of months ago a dentist was lamenting online about the high cost of his digital radiography system - more than $50,000.

A couple of months ago a dentist was lamenting online about the high cost of his digital radiography system - more than $50,000. When asked what sort of golden sensors that included, it became clear that he did not already have computers in the treatment rooms and the inclusion of a computer system was bundled into this cost. I have to cry foul here. The computer infrastructure is not really part of the cost of the DR system. Rather it is the formation of the digital backbone.

The computer infrastructure allows a practice-management system to operate at full potential, allows in-room appointing, clinical notes, and other aspects that can free up the front desk. It also allows images to be shown and stored as well as offering education programs in the room and more. I realize this is old news to many of the readers of this column, but many offices have made the decision to “go digital” and dive in all at once.

This can lead to a multitude of problems, which are often dependent on the age of the practice and, unfortunately, also the age of the dentists, hygienists, and assistants. I am not necessarily looking at chronological age. Instead I refer to just how many years a person has been in dentistry. Most who have been practicing in the field for more than 10 years started taking X-rays with film. Going digital is a transition from “the old way.” Younger members may have started with digital. Thus, for them, there has been no real transition.

We now face a work pool of hygienists and assistants who have only known digital yet have had to adapt to film in dental practices that are directed by “older” practitioners. Anyone who has done an interview recently has seen the raised eyebrows of people when they respond, “We use film.” Funny how the worm has turned. It used to cause someone to sweat a little if you told a prospective employee that he or she would have to learn about digital X-rays.

Here is how the transition worked in one office, over time, but with a master plan in place. This was an older practice with long-term employees who wanted to modernize, but did so with some trepidation. The decision was made to introduce things slowly. The hygiene rooms were approached first, adding new computers and dual-monitor capability. Hygienists were taught how to call up a patient, and how to make an appointment. For a few months, they made only the next recall or perio appointment from the treatment room.

At first, there were a few grumblings about all the “extra time” this would take. The grumbling ended quickly, however, when this assumption was proven untrue. The hygienist also was able to have more control with a day’s schedule by not having to do three consecutive sealants or have a full day of “PIA” patients. In addition, future appointments could be made with a different hygienist if a patient’s visit did not go smoothly and you wanted to “let someone else deal with this person next time.” Some of you might be grinning while reading this since it is a common occurrence in many dental offices.

This process also allowed the front desk to merely check out a patient, give a walkout statement, and collect money if any is due. The time savings at the front desk was noticeable, and with front-desk personnel becoming cheerleaders to let “the back office” make its own appointments. Of course, this would lead to inputting treatment information, and - if the software allowed - treatment notes.

Now that hygienists were comfortable navigating the computer, an education system was implemented. Actually, one had been in this office all along, but the computers and monitors were never in the right place or working correctly. None of the staff was properly trained although the doctor thought it was a great idea, and had purchased the education system at a dental meeting.

Now that there were new computers and the availability of a second monitor, a new vista arrived. The schedule could be behind the patient, and the front screen could have the dental show. In addition, since the rooms were online, a news Web site could easily be displayed on that screen. Thus, the hygienist could look up information about anything from medications and diseases to the local school schedule. DVDs and entertainment during a hygiene visit didn’t seem to work since the hygienists liked to make the visit both intimate and social without interference. As we know, patients (almost) look forward to this time in the office. They tend to spill their innermost secrets to hygienists, who perhaps should be receiving therapist’s wages also.

Finally, it was time for digital sensors. The office chose to get only one, and it was to be used for recall bitewings. Keep in mind that, due to the diverse staff and typical slow implementation as well as procrastination of the “boss,” this process worked fine - one small step at a time. The program was installed, and hygienists were trained using only one holder, the bitewing.

In this case, all that is necessary for setup is one plastic sheath and one holder. All of these are set at the beginning of the visit. The same holder and sensor is used for all four. Thus, there was no switching of rings or sides. There was a standard bitewing holder and a vertical one. All the operator had to do was open up the patient’s record in the PM system, click on “X-ray,” then click on “bitewings.”

The software visually guided the operator to the proper sensor position. Then it was merely: “shoot, move, shoot, move, flip, shoot, move, shoot.” The images were taken and came up on the screen as fast as you are reading this column. Due to the speed, there was never an issue of having only one sensor. There was a short wait if just two hygienists were working.

While the novelty was still there, the patients, hygienists, and doctor marveled about the giant images on the screen. Using some of the software enhancements, it was easier not only to see pathology but also to show it to patients. The software was then installed by front desk personnel who now did not have to wait for an X-ray copy to send to an insurance company or a specialist. Images were pulled up at the front desk, printed, and could even be sent via e-mail.

Finally, it was time for real training of the digital sensors. All images could be taken with the sensor(s). It is interesting to note that this office chose DEXIS, partly because one sensor could be used for everything. The practitioner saw this as a cost-factor advantage.

Some offices want two or three sizes. Thus, the transition from bitewings only to the full series involves a couple of sensors. If an office has chosen one of these systems, there are incentives to purchasing all sizes in the beginning. In addition, options of using a smaller sensor for smaller mouths are available in the bitewing scenario. Each practitioner has to make that decision for his or her practice’s needs. There are many pages in this magazine and other journals to guide a doctor through the purchase process.

Since the software and the infrastructure were in place, the cost of adding the new sensor(s) for the dentist in my example was not overwhelming. In fact, the dentist and his assistant were anxious to start since they were still using film.

The reason I bring up this scenario is to show that it is possible to transition slowly. Some dentists think they have to shut down for a day for training, go through a chaotic transition, and spend the $50,000 - all at once. There are other methods but this one went particularly smoothly. Although this may not be an ideal method, it worked well for this office. It was slow, easy, and somewhat economical.

Also, a whole new “paradigm” was not thrust on the office all at once so there was little disruption. As always, I welcome comments from offices and manufacturers that I can reiterate here, in online forums, or in my lecture series.

Random notes

My friend, Jay Orlikoff - known to his Internet colleagues as drjay - sends out little gems about dentistry and the real world. Recently, he found a terrific solution to a common problem. We have all accumulated dozens of wires, transformer boxes, and other connectors to cell phones, MP3 players, and camera chargers. Suddenly, you don’t know which piece of equipment goes to what device. He noted that Sharpie now has a silver marker called “Metallic” that will write on the black boxes and wires. Thanks Jay.

Although I am entrenched in the digital world, my musical roots have brought a great appreciation of a cappella music. Before you start singing “Let Me Call You Sweetheart,” you should know that there are groups around the world - many on college campuses - that take popular songs, arrange and perform them without any instrumental backup. Drums and cymbal noises are done with hands and voices.

Rockapella, who does the Carmen San Diego theme, is one of this genre, but some can do complete jazz instrumentals like Rhapsody in Blue or Take 5. One of the best distributors of these CDs, MP3 downloads of individual songs (which you will not find on the large commercial sites) as well as sheet music arrangements for your group is near Bar Harbor, Maine. The site (www.a-cappella.com) also has some short preview clips available and should open a few eyes. You can hear some of this genre online at www.wers.org or if you are in Boston, check it out at WERS 88.9FM on Saturday and Sunday afternoons from 2-5 p.m. If you want some of my favorites, just drop me an e-mail.

Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He is a mainstay at technology sessions, including annual appearances at the Yankee Dental Congress, and he is an ADA seminar series speaker. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site at www.computersindentistry.com. He can be reached by e-mail at [email protected].

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