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Rethinking the denture mill

June 1, 2010
Dentures — the end of the dental road. Some reach this end through pure neglect. Others reach it as a result of ignorance, bad information, life circumstances, or poverty.

by Sandy Roth

For more on this topic, go to www.dentaleconomics.com and search using the following key words: dentures, removable prosthetics, denture mill, Dr. Doug Roth, Sandy Roth.

Dentures — the end of the dental road. Some reach this end through pure neglect. Others reach it as a result of ignorance, bad information, life circumstances, or poverty. Still others reach it only after battling unsuccessfully to retain what nature gave them. Whatever the reason, dentures are either the only or the most affordable answer for many adults.

While rates of edentulism have decreased with the advent of better prevention and greater awareness, it is estimated that 10% of adults over age 35 are completely edentulous. In addition to clinical conditions, risk factors for edentulism include socioeconomic status, income, education level, and smoking. Considering the increasing rate of home foreclosures, unemployment, homelessness, and general economic distress, there is reason to believe that this percentage may, if anything, increase. Based on U.S. census estimates, the simple math is that 10,450,000 adults older than age 45 are edentulous.

Yet at the mere mention of a “denture practice,” many practitioners bristle with negativity. Indeed, the image of a denture “mill” is not good. It harkens the image of low quality, revolving-door practitioners, and all the ambiance of the DMV. Ask members of any senior class at any dental school who wants to focus on removable prosthetics, and you’d better step aside to avoid the stampede to the door.

Indeed, dentures aren’t sexy in this age of veneers, implants, and popular cosmetic procedures. Yet who among us will care for the huge population of people whose dentistry has failed them — those 10.5 million adults?Perhaps you.

When my husband, Doug, and I moved from Seattle to rural Florida to care for my aging parents, he initially planned to continue substituting for dentists who had suffered unexpected illnesses, or care-taking practices until family members of a deceased dentist could find a buyer.

But as we got to know our new community, we realized there was a large underserved population of adults with serious dental needs and few options. While there were general dentists and family practices, most were understandably committed to saving teeth and restoring lost dentition with fixed options. For many patients in our area, however, these treatment plans were simply unaffordable. With a little research, we learned that our county was predominantly low to moderate income blue-collar retirees from the Northeast corridor, or relatively low-income indigenous Floridians.

When an opportunity presents itself, you either take it or pass it by. We chose to take it. The result, three years later, is a vibrant, thriving practice that is making an honest profit through real service to others. While this practice model isn't for everyone, it is one which might easily be replicated in many parts of the U.S. and Canada.

Denture Care Center

Is it possible to provide good quality basic care to people in need that is both affordable for patients and profitable for the practice? We were committed to answering that question and we began by outlining our purpose:

This practice was created with a specific purpose in mind: to provide services to people whose dentistry has failed. For many patients, we will provide the service of last resort. Some have tried to retain their teeth, and others were resigned to losing their teeth. But the past does not matter to us or to them. We accept them as we find them, and treat each person with total respect while creating a safe environment in which we attempt to restore function, appearance, and comfort. Our goal is to help each person leave better than they came and offer them the widest array of options given their unique circumstances.

For each member of the team, attitude is paramount. We serve many people who are older, those who have had unpleasant experiences with dentists in the past, many who have not had the benefit of consistent dental care, some who have fallen on hard times, and those who are retired but struggling to make ends meet. Each of these people will require great patience, tolerance, and gentle care. We believe we can help almost everyone and our goal is to win over those who are cynical, suspicious, angry, or otherwise just plain gretzy. If each patient leaves happy and restored to function, appearance, and comfort, they are bound to tell others. This will make our practice strong and grow.

Dr. Doug Roth visits with patients in his Florida "denture practice."

We chose a newly-built row office complex located near a prominent intersection of a state highway and county road. We wanted the physical plant to be open and impressive but not fancy or palatial. We created a comfortable reception area, a private business area, a place for patients to sit and speak privately with our reception staff, a surgical suite, and two denture-fitting and adjustment rooms, in addition to a completely equipped denture laboratory.

We also made space for Doug’s private office, a full staff kitchen and lounge, and a laundry. Eighteen months later, we took an additional suite to triple the laboratory space and make provisions for additional operatories. We outfitted our office with some new, but mostly refurbished equipment, and kept ourselves within a strict budget.

We believed from the beginning that if we could keep fees low by eliminating costs that were unrelated to direct patient care or service, we could make our model work.

We made specific, intentional choices in the following areas:

Staff

We needed strong, competent staff members who were aligned with the purpose of our new practice. We started small with one surgical assistant, one denture laboratory technician, Doug, and myself. We added new staff as we grew and recruited people with the skills we needed. We treat them fairly and pay them well. We have grown to a staff of eight — three laboratory techs, one surgical assistant, one denture assistant, one sterilization and physical plant manager, and two reception and patient coordinators — allowing me to return to consulting full time.

Advertising

Nine weeks before we officially opened, we began flooding our area with advertising. We placed the same carefully crafted ad in our county editions of the St. Petersburg Times and Tampa Tribune. We placed similar ads in a free advertising-driven publication that is delivered weekly to every household in our county and surrounding counties. We budgeted heavily for advertising from the beginning and have maintained that level. On the day we opened our doors to see our first patient, we had 95 new patient appointments scheduled in subsequent weeks. We continue our advertising on our cable system and continue to expand our target viewing audience. People are now driving two hours to get to our practice.

Fees

We initially set our fees based on instinct and with the idea of making them reasonable and affordable. We have occasionally tweaked them during the last three years, but we have been able to maintain a good profit without leaving our target market of low to moderate income people.

Free initial consultation

Getting people in the door is important in a startup practice. We never charged a fee for the initial examination and consultation, but patients do pay a $25 deposit to reserve an appointment time. That deposit is refunded when the patient attends and is forfeited if the patient fails to keep it. We have virtually zero no-shows.

Financing

We don’t do it. We created a true cash practice. Patients pay half of the fee at their first treatment appointment and the balance on the second-to-last appointment. We don’t even have a billing system on our computer. We have zero accounts receivable. When you aren’t chasing money you have already earned and are actually paid for what you do, you can afford to keep fees more reasonable.

Insurance

We don’t accept it in any form. We have a stack of standard ADA insurance claim forms and complete the provider sections by hand for the few patients who have dental insurance. Patients submit claims themselves and receive reimbursement at home. We have no insurance information on our computer either.

Fully paperless practice

We use laptops in the operatories and all information is entered on the computer. Health histories, informed consent documents, and all other written correspondence are scanned into the patient record.

Hygiene

We refer hygiene to general dentists in our area and they are happy for the referral stream. In exchange, they refer a large number of their removable prosthetic patients to us.

Laboratory

We have three full-time denture lab technicians who do everything except partial frameworks and a few other procedures. This model would not work if we had to rely on an outside lab for denture fabrication. Our lead lab technician has 30 years of experience and runs the lab like a tight ship.

So what services do we offer? Replacement, full, and partial dentures. Immediate full and partial dentures and ancillary services. Extractions. Mini-implants for denture retention. Full and partial denture repair. When patients request other services, Doug decides whether to provide them or refer to one of our general practice friends.

Three years of planning, trial and error, tweaking, deleting, and adding have confirmed our initial belief that there is a real need for this type of practice, and that it can be run profitably and joyfully. I believe this model can work for many other dentists in many parts of North America as a stand-alone venture. I also believe there is a great need for this type of practice — one that treats some of the most at-risk patients with respectful care in a personable and gentle manner while holding to high standards. Perhaps something like this is in your future as well.

For more information about this practice concept, contact Sandy Roth by telephone at (800) 848-8326 or by e-mail at [email protected]. Her Web site is www.prosynergy.com.

References available upon request.

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