Ask Dr. Christensen

I have recently attended continuing education courses that encourage me to significantly raise my fees and eliminate those patients who can't afford "complete treatment plans."

by Gordon J. Christensen, DDS, MSD, PhD

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an email to

Question ...

I have recently attended continuing education courses that encourage me to significantly raise my fees and eliminate those patients who can't afford "complete treatment plans." I was informed that this concept would increase my income and lower my stress level. How do you feel about this subject? Are there other ways to increase my income and lower my stress?

Answer from Dr. Christensen ...

Raising fees and eliminating patients who can't afford complete treatment plans will raise your income, but I feel there are more altruistic ways to accomplish the same financial result in a more professional manner. In my opinion, dentistry is a health profession dedicated to serving the public. With a few exceptions, I don't think we have the moral alternative to selectively eliminate patients from our practices because they have difficulty paying, or to raise our fees so high that they are not affordable to the public. What is a viable alternative?

In most states it is legal to use the skills of educated dental assistants, hygienists, and technicians on a clinical level. First, I suggest you obtain a copy of your state dental practice act and observe what procedures can be delegated. Most state practice acts are relatively liberal in allowing qualified staff persons to accomplish many of the clinical tasks commonly accomplished by only dentists.

Make a list of the procedures you want to delegate to staff persons. Identify the staff you feel are best suited to performing the tasks you have identified. Decide how you are going to educate them to accomplish the procedures. Interview them to determine their interest in learning these skills. Suggest that they will earn a higher income as they learn the new skills, and follow through when that happens. Most dental staff personnel are eager to learn more clinical skills.

When you have finished interviewing everyone individually, have a staff meeting to announce and discuss the new program. Starting slowly, educate the staff on the subjects that have been delegated to them. This education may be accomplished by numerous methods including: in-service education sessions before the clinical day begins, on-the-job training by other employees, or continuing-education courses. I prefer in-service education because the dentist has total control and can teach the procedures using the materials and devices perceived to be the best. When accomplishing this staff education, you will begin to solidify a "team" mentality with your staff, instead of several people going their own way and waiting for the day to be over. Although staff education requires time and patience, it creates a major, positive change in your practice. Your staff becomes a team!

In a few months, your staff can accomplish as much as one-half of the tasks you typically perform. What happens to productivity? I can testify that appropriate, legal, and controlled use of expanded-duty staff easily can double the productivity of a typical dental office. Additionally, the increased services you provide make you a more capable and knowledgeable practitioner. Staff members feel needed and important. Turnover is greatly reduced because your staff members feel productive, challenged, and rewarded. Your service to patients increases; your abilities increase; your staff becomes more skilled, happier, better paid, and more loyal to the practice; you feel like you have done something important each day; and, yes, you make more income.

What about treating some of the patients who have minimal income? You can keep most of them in the practice. Amazingly, many patients who come to know and like their dentists gradually will find the resources for comprehensive dental care.

Our Practical Clinical Courses course, "Faster, Easier, Higher Quality Dentistry" has helped thousands of dentists increase their productivity, service, and income while enjoying dentistry more than ever before. Contact PCC for information at (800) 223-6560, fax (801) 226-8637 or visit our Web site at

Question ...

I am completely frustrated by the many ads that promote all-ceramic crowns, especially fixed prostheses. I have tried some over the past and most have broken after a period of time. Are there actually all-ceramic materials that can be used for fixed prostheses? When would they be indicated?

Answer from Dr. Christensen ...

I also have an entire drawer with the remains of various all-ceramic crowns and fixed prostheses. I have kept them to remind me not to be too quick to jump on the next new all-ceramic "replacement" for porcelain-fused-to-metal (PFM). However, the profession actually has some all-ceramic crowns and fixed prostheses that look very promising. I will start my response by saying, "Have a reason for using all-ceramic restorations." Don't use them just because they are new. You already have an excellent, well-proven fixed prostheses material in PFM. When should we consider all-ceramic crowns? I suggest that all-ceramic restorations should be considered when patients state an overt allergy to metal; when suspected allergies to metal are indicated by skin rashes under watches, around rings, or around the earlobe; when the patient thinks he or she has allergies to metal; or when a superior aesthetic result is demanded. However, I feel patients should be offered information about all of the alternatives for treatment of their specific situations, and I also feel they should have an active role in selecting the type of crown or fixed prosthesis they prefer.

Currently, some of the all-ceramic fixed-prostheses that have shown good service performance are: Cercon from Dentsply Ceramco, Lava from 3M ESPE, Cerec inLab from Sirona, and others. All of these have zirconia as their understructures. Time is required to confirm the long-term acceptability of these restorations, but they appear to be very promising at this time.

Our newest video, V19-99— "Successful All-Ceramic Crowns & Fixed Prostheses," shows the many types of all-ceramic crowns and fixed prostheses, compares them, and makes recommendations for their use. Contact PCC for information at (800) 223-6560, fax (801) 226-8637 or visit our Web site at

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates, which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

Dr. Christensen's views do not necessarily reflect the opinions of the editorial staff at Dental Economics.

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