by William Vitale, DMD
The past decade has been marked by countless technological breakthroughs in dentistry. Lasers stand out as a truly revolutionary technology that has helped to advance the standard of care of many hard- and soft-tissue procedures that dentists perform on a day-to-day basis. Patients are aware of laser uses in cosmetic procedures and ophthalmology; now, they are seeking dentists who use lasers. As laser technology becomes more and more patient-driven, dentists need to overcome the concern, "What will this laser cost me?" They must regard the laser as an investment that will increase revenue and profitability, as well as provide better patient comfort and superior clinical results.
Many common links make the implementation of the laser into a dental practice profitable. Laser use brings intangible benefits, such as a "high-tech: image and the referrals that his reputationgenerates. This results in positive patient experiences of more comfortable procedures done quickly and with less stress for the patient. For example, most hard-tissue procedures can be done without anesthetic.
There also are very tangible financial benefits of using lasers for hard- and soft-tissue procedures that are more easily quantified. You can perform restorations in multiple quadrants without anesthesia, without multiple appointments, and without the inconvenience to the patient of having a numb mouth. "Add-in" procedures from the hygienist or the exam schedule are more easily accommodated and directly contribute to profitability.
Lasers also provide practice-expanding opportunities for the dental practitioner. Soft-tissue procedures that most dentists learned in school — but tend either not to do or to refer out — can be done noninvasively for the patient with a minimum of postoperative discomfort. These include excisional biopsies of fibromas, gingivectomies, and frenectomies. Preprosthetic surgery becomes much less invasive and easier for both the dentist and the patient; it now can become part of the prosthetic treatment plan.
Most dentists who have a hard- and soft-tissue laser in their practices have found that they are excellent marketing tools. While the common perception is that only big practices in large metropolitan areas can benefit from marketing a laser, many "small-town" practices also are increasing their revenue and profitability with this advanced technology.
Dr. Daniel Howard, of Eagle, Idaho (near Boise), started a new practice with a mission to provide his patients with the latest in technology and the highest quality care. Dr. Howard explains: "A hard- and soft-tissue laser was exactly what I wanted in my practice. Within one week of acquiring the laser, we appeared on a local news channel's 'Health Headlines.' This exposure helped to expand the area that I drew patients from to many surrounding counties. The responses that we got from this and a subsequent newspaper article have been phenomenal. Lasers market themselves! We have done no paid advertising and have continued to have three to five new patients per day due to the laser."
Dr. Harold Biller, a general dentist in Forest Hills, N.Y., found that the laser has helped change the focus and direction of his practice and has generated a lot of interest in the community. "Initially, we used the purchase of the laser — combined with changing our practice name to The Center for Laser Dentistry — as part of an external marketing program to reshape our image in the community," stated Dr. Biller. "It has helped to cement our image as a high-tech, cutting-edge practice. Internal referrals from our existing patients have been phenomenal, and those in the community who are aware of our laser are calling us and becoming new patients."
Dr. William Greider, a general dentist practicing in Ft. Meyers, Fla., quickly discovered that the news media is attracted to new technology that reduces the need for needles, anesthesia, and drills. According to Dr. Greider, "When the media found out that I had this laser, they called me seeking an interview. They literally 'tracked me down' looking for something positive and new in dentistry. A radio interview that I did three years ago is still played throughout Florida and still brings me patients who are looking for a 'laser' dentist. I also have been on television several times and have been the subject of a number of newspaper and magazine interviews, all because of the laser."
Dr. Greider believes the marketing benefits of the laser are less important than the better and minimally invasive dentistry he can perform with the laser. He adds, "The word 'laser' is what attracts them to my office, and they stay with me because I offer this technology. I have had patients travel over 100 miles from their homes just because I have a laser. Some of them weren't even candidates for its use, but they continued to come to me because of the laser."
Quantifying production increases
Lasers have been contributing to the profitability of medical practices in ophthalmology, cosmetic surgery, dermatology, and other specialties for well over a decade. In the last few years, many dentists also have reaped the rewards of investing in laser technology. A small number of elite dental laser "gurus" have been using lasers for soft-tissue procedures, periodontal work, and curing for 10 years. More recently, however, a growing number of general practitioners are discovering the financial and clinical benefits of lasers.
Increased satisfaction and renewed interest in dentistry due to lasers also has contributed to profitability for many dentists. Dr. Larry Kurzweil, from Bellrose, N.Y., reports: "I have a very busy practice and see about 40 to 50 patients a day. This laser has helped my bottom line dramatically and has actually made me re-think the way I practice dentistry. I have had my laser for three months and have seen my gross revenues increase $10,000 per month since I started using it for hard- and soft-tissue procedures. It has put so much satisfaction back into my practice."
Dr. Greider has been tracking laser procedures for three years. He has substantiated that his gross revenue went up $110,000 the first year he started using the laser — and he did it without raising fees or increasing hours. He found that he was treating a minimum of two to three patients per day for unplanned dentistry with the laser. "These were procedures that came off my hygienist's schedule, off my exam schedule, or from people walking in with various dental emergencies that I normally would have rescheduled. Because of the laser, I was able to fit them into my schedule without disrupting my day, since, in most cases, anesthesia is not necessary."
Dr. Biller notes, "With the laser, I am offering less- invasive dentistry for my patients, and its use has helped me shift the scope of my operative practice toward doing 90 percent composite restorations. The positive clinical effects for patients are obvious in terms of preserving tooth structure, aesthetics, and performing restorations that impart strength to the tooth. Our bottom line — in terms of hard-tissue usage with this laser — has dramatically increased in terms of the fees that composites generate over amalgams. Taking into account the increased flexibility that I have doing dentistry without anesthesia — as well as the increased opportunity to work on multiple quadrants and to be able to work patients into my schedule for simple procedures at diagnosis — the laser also has had a dramatic effect on my bottom line. The addition of this laser in my office has truly been an incredible investment for my practice."
While lasers allow dentists to prepare cavities without needles, anesthesia, and drills in most cases, it also gives them a tool to easily expand their practices into the profitable world of soft-tissue surgery. Most general dentists refer their patients to specialists for their obvious soft-tissue needs, while many less noticeable procedures are ignored. Lasers give them a tool to perform bloodless soft-tissue work quickly and efficiently, often without anesthesia.
For years, Dr. Greider has tracked soft-tissue procedures that he has performed with the laser. "I would never dream of doing these procedures with a scalpel or even an electrosurge. With the laser, I do at least seven excisional biopsies per month and probably an equal number of frenectomies. Factoring in a few crown- lengthening procedures and gingivectomies for cosmetic purposes and for removing hyperplastic tissue, I calculate that I exceed my monthly lease payment with this laser within the first two or three working days of each month."
Dr. Greider's gross revenues increased an additional $110,000 the second year, and he projects a similar increase in subsequent years. "Here is a tool that makes my life easier, makes dentistry fun again, and is earning me in excess of $100,000 per year. I could never go back to practicing dentistry without a laser."
"The soft-tissue procedures that I do now — and never did before — have become real and tangible sources of increased revenue for my practice," Dr. Biller emphasizes. "I used to refer out many procedures that I was once uncomfortable doing. Procedures such as biopsies, frenectomies, and fibroma removals, which were once monitored or referred out, have become routine procedures for me. There is no bleeding, no need for sutures, and very little postoperative discomfort with these procedures. They are easily done and usually billed out in the neighborhood of $200."
According to Dr. Kurzweil, "The soft-tissue applications of this laser have truly amazed me and have added significantly to office production. They have made the practice of dentistry easier and more exciting for me. I now perform several gingivoplasties per week. I rarely performed frenectomies prior to getting the laser (perhaps one or two per year), but now do four to five per week. I do six to seven biopsies per week now, versus one to two per week prior to the laser. I use it on most of my crown preparations in lieu of placing retraction cords and get excellent impressions with the laser."
Dr. Kurt Froehlich, of Cairo, N.Y., comments on the multiple uses of his laser. "I use my laser so often — all day long — and am regularly finding more uses for it. One application that I find the laser helpful for is to etch crown, inlay, and veneer preparations to remove the smear layer for better bonding and less postcementation sensitivity. I have found that the laser works well as a palliative treatment for aphthous ulcers and to desensitize teeth. In the past, I used electrosurgery for soft-tissue surgical procedures. However, the laser, as far as my experience with it, is safer, has more predictable margins, no tissue necrosis, and less postop sensitivity. I use it routinely for gingival recontouring in aesthetic cases instead of retraction cord for crown impressions."
Does a laser make sense?
Thousands of dentists in the United States and internationally have implemented lasers successfully into their practices. During the next five to 10 years, tens of thousands more are expected to purchase lasers. Dentists are using lasers for a wide range of clinical procedures, including fast, effective curing of composites, teeth-whitening, hygiene, soft-tissue surgery, and, most recently, hard-tissue work. While there are exceptions, most dentists who use lasers find they are excellent marketing tools and can significantly increase revenue and profitability while providing patients with the most advanced dental care available.
The dentists interviewed for this article have purchased the Waterlase™ hard- and soft-tissue laser from Biolase Technology, Inc., in San Clemente, Calif. It uses a specialized, patented process to energize water with the laser to cut hard tissue, in most cases without the need for anesthetic. On the other hand, in soft-tissue applications, direct laser energy is the cutting agent, cutting and coagulating soft tissue precisely and predictably.