Letters from Readers

"Success is counted sweetest ..."
I was elated to see Dr. Neiburger question the definition of success as a result of my article, "Building Your Practice With Professionalism" in September Dental Economics. Most dentists in my seminars have never given it serious time, effort, or thought. Most will dedicate more resources to a week's vacation than to what brings them happiness in their entire lives. Yes, success may have many definitions, but only because it means different things to different people. Each of us defines what success means specifically to us. One person's treasure may be another's trash.

Earl Nightingale said, "Success is the progressive realization of a worthy ideal." Success has to do with our aspirations. We each get to choose what is worthy and what is ideal. I can certainly agree with Dr. Neiburger that individuals often pay a very heavy price for what they mistakenly think is success. That is why it is so crucial that we ponder the question seriously. As the expression says, "Be careful what you wish for, you might get it!"

On a positive note, let's not get trapped into "either/or" thinking. Let's think of "and/also" concepts. One can practice fine dentistry, without, as Dr. Neigburger suggests, traumatizing patients. We can earn an excellent income while contributing to our profession. We can pass the baton and share with our colleagues while having some of life's modern material possessions, and still have time for a happy family life. The real question is: What is your vision, your goals, and your personal definition of success? What is important to you, doctor?

Once pondered, it is interesting that it really begins with things and thoughts that cannot be measured or quantified such as happiness and prosperity. As Dan Milam says, "How happy can you stand it?" What do you really want more of in your life? The answers and thinking process must begin on the right, emotionalside of the brain in nonquantifiable concepts that many of us have called "vision." Once the list of concepts is established, the switch can be made to the logical, left side of the brain to create measurable objectives that will, in turn, produce the aspirations we define as our personal success. It's important to note, however, that only after the nonquantifiable concepts have been established can one define measurable terms. Following this sequence, allocations can be made for office hours, continuing education, family, vacation, dental organizations, politics, and personal growth. Now we can decide on our desired net income, our production, number of staff, etc. Your definition of success determines the allocation of your resources — time, energy, money, thought, and talent.

Success for most people is an elusive target, primarily because it is more about "feeling" than about "thinking." Like the Supreme Court Justice who noted about pornography, "It is difficult to define, but I know it when I see it." Recognize that your success is an "inside" job.

Albert L. Ousborne, Jr., DDS
Towson, MD

A case for direct reimbursement plans
I read Dr. Mark Trollo's letter in the October issue of Dental Economics, and I could not agree more completely with the sentiments he expressed. First and foremost, we as dentists and dentistry as a profession should not be engaged in hand-wringing when it comes to advocating fee-for-service dental practice. This model provides patients with the most comprehensive, and therefore the most cost-effective, mode of treatment. It also promotes the strongest doctor/patient relationship, which best serves our patients and enriches our lives professionally.

Managed care can only undermine the doctor/patient relationship and detract from the high standard of care that fee-for-service dentistry has established. We have already witnessed the devastation of the practice of medicine from managed care, and seen the pharmaceutical industry attempt to dictate the course of medical care through advertising. In dentistry, we cannot throw a pill at most of the problems; we must actually treat them.

This is why I have served on the board of directors of the New Hampshire Dental Society's direct reimbursement entity (Priority Dental Health, Inc.; www.priorit ydental.com) for the last four years. We have been showing employers across New Hampshire how to self-fund their employees' dental benefits. Typically, 95 percent of funds in a DR plan are utilized directly for patient care, while 15 percent or more of the premiums paid to a traditional insurer are used to cover administrative costs. A DR plan is a true benefit, dollars that an employer can give employees to cover some or most of the cost of their dental care each year. There are no restrictions or exclusions; therefore, treatment decisions are made between the patient and his or her doctor as they should be. This enhances the doctor/patient relationship and so improves the quality of care delivered.

While DR may never become the dominant approach to providing dental benefits (as it really should be), Dr. Trollo's point that we must never rest on our laurels and expect someone else to pursue this cause is well taken. This has allowed us to make a real impact on the dental benefit marketplace in this state, even beyond the clients we serve. There is no doubt that our presence has minimized the premium increases of other plans and forced them to be more flexible in response to our concept.

DR offers more for patients, employers, and dentists than any other method of financing dental care. Dr. James Pride once said to the dentists of New Hampshire, "Invest in DR; it's your future." If we are to advance the cause of fee-for-service dentistry in the United States, there is no alternative.

Barry McArdle, DMD
Portsmouth, New Hampshire

Periodontists are experts
We frequently read Ms. Beverly Maguire's columns concerning periodontics. We applaud her attempts to encourage dentistry to focus on the often-ignored periodontal needs of all our patients. As a periodontal group that has given nonsurgical periodontal seminars to general dentists and hygienists in 36 states for the last 18 years, we do take strong exception to a recent column, "Partners in Productivity." In this article, she states, "Periodontists are certainly an option; however, most practitioners are focused solely on surgery ... few are experts in nonsurgical therapy."

We believe that this statement demonstrates a misunderstanding of the structure of the profession of dentistry and the scope of the specialty of periodontics. The dental profession defines several specialty areas, periodontics being one. Periodontics is the only specialty in dentistry with specific, accredited, university-based, post-dental school training in the treatment of periodontal disease. Periodontists are not specialists in only "gum surgery." They are specialists — experts — in all the treatments of periodontal disease.

We have never seen in the dental profession any official recognition of the self-appointed title "practicing periodontal therapist" as the hygienist, Ms. Maguire, claims. While hygienists are certainly an extremely valuable member of the periodontal treatment team, at this time periodontists remain the only university trained, post-graduate specialists in all of the modes of treatment for all forms of periodontal disease.

Susan C. Neuman, RDH
Cheryl Pearce, RDH
Douglas Neuman, DMD, MS

Ms. Maguire responds:
I am pleased to hear that periodontists as well as general dentists are reading my column regarding the value of incorporating diagnosis-driven hygiene protocols into their practices. Indeed, periodontists are the specialists in the treatment of all forms of periodontal disease and I highly advocate the periodontal referral process. My point concerning the treatment of periodontal disease in the general practice related to the management of early periodontal disease for patients with pocket depths of 4 and 5 mm. My experience has been that of the periodontists treating patients with more advanced needs than he general dentists can manage. All three professionals — the hygienist, general dentist, and periodontist have important roles to play in managing disease in our patients.

Based on my 30 years of experience, I believe that the periodontist cannot and should not be expected to treat periodontal disease alone. Early recognition and management of the disease process determines successful long-term outcomes. Conversely, not acknowledging our nonsurgical limitations or failing to refer promptly will also affect long-term outcomes for patients.

To address your comment regarding the role and designation of "the periodontal therapist," I believe that "periodontal therapist" truly defines the level of care that qualified dental hygienists are expected to provide today. The term "hygienist" means "someone who cleans." My goal is to halt the "cleaning of disease" and move toward consistent protocols that reflect our current level of knowledge and research.

My intent is not to divide the three key professionals or minimize anyone's role, but to illuminate concerns I have seen in our profession as they relate ultimately to the appropriate care for patients.

I feel that we are interested in similar outcomes for our patients — the prevention, treatment, and control of periodontal disease at all levels.

Beverly Maguire, RDH
Littleton, CO

A thank-you from New York
We at the Greater New York Dental Meeting would like to take this opportunity to thank our colleagues, clinicians, friends, and exhibitors who participated in our recent meeting and who lent their support during those trying days following the September 11th tragedy. Over 30,000 individuals attended our meeting, demonstrating that the spirit of New York City is strong and vibrant and has survived this horrible period.

Many of our colleagues, families, and staff had the opportunity to partake in our wonderful educational programs and visit our exhibition floor, displaying the latest in dental products and technology. In addition, New York City was alive with cultural, social, and dining opportunities for those who attended the meeting and took the opportunity to sample our great city.

Words cannot express the feeling that the organization committee had when we saw the multitudes of dental professionals once again supporting our meeting, our city, and our country. Thank you all.

David I. Kratenstein, D.D.S.
General Chairman
Greater New York Dental Meeting

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