Dental practice 2019

Oct. 1, 1998
The decade that will end in 1999 has been the most exciting in the history of dentistry! Intraoral cameras, dentin-bonding, reliably strong, beautiful porcelain veneers; predictable implants, caries finder, computer-assisted imaging, CAD-CAM, and more!

Tom Orent, DDS

The decade that will end in 1999 has been the most exciting in the history of dentistry! Intraoral cameras, dentin-bonding, reliably strong, beautiful porcelain veneers; predictable implants, caries finder, computer-assisted imaging, CAD-CAM, and more!

The advances the next 20 years could bring almost are inconceivable. Yet, our best of times may be the worst of times. How many of us will have the opportunity to choose to partake of the wonders of our future?

Before we explore the offerings of practice in 2019, we must ground ourselves in the realistic examination of our very existence. Dentistry likely will make strides we only previously could have dreamed of. Yet, the harsh business/economic reality is that few of us will ever experience the most exciting improvements. Along the journey to 2019, many predict that 90 to 95 percent of us will be "on the clock."

Who would we possibly be working for? Multimillion-dollar corporations that buy and sell practices (and doctors) like another Wall Street commodity. We also could be working for insurance giants. In 1998, I watched one Massachusetts DMO capture the central Massachusetts market with ease. The DMO`s first move was to just about give away the dental plan to corporations willing to sign on with medical. Dental benefits are merely a perk! To accommodate the enormous groundswell of dental enrollees, they signed large numbers of dentists into the participating ranks.

These dentists saw huge numbers of patients from the DMO ... yet didn`t always see a proportional influx of new patients! How is that possible? In many cases, existing patients merely moved onto the DMO roles. Net result? Same patient, same dentist, much lower fees. Worse, the numbers were so strong that some participating dentists, ears to the ground, are waiting for the other shoe to drop.

The rumor is that when the DMO captures a significant enough share of the market, it simply will build and run its own dental centers. For some plan dentists, the potentially catastrophic result would be a loss of 30 to 45 percent of their patients!

Position yourself now

The future may be less rosy for those who don`t proactively position themselves now. In many martial arts, when one is faced with an opponent of formidable size and strength, it is far better to leverage your strength against your opponent than resist with all your might. Tae Kwon Do suggests that you step out of the way altogether! I believe that our best hope for an economically healthy future is just that. Examine what the corporate- and/or insurance-owned practice can offer and what it cannot. Position your practice where these two entities cannot.

Certainly, there are ways to decrease the time needed to perform a given treatment. I`m amazed at the number of articles touting ways to cut minutes off doing this procedure or that! Perhaps Dr. Ken Blanchard should add to his collection of "One Minute" titles - e.g., The One-Minute Crown Prep. Time and motion studies can identify exactly where time is lost during treatment visits. Rather than visiting with patients, why don`t we have the assistant find out how patients and their families have been. The assistant can do any other small talk or relationship-building that is a waste of the doctor`s time.

In his seminars at the Center for Advanced Dental Studies, in St. Petersburg, Fla., Dr. Peter Dawson talks about the quality of the average level of dental care in the United States. His assessment is not a positive commentary - just the opposite!

To position your practice where the insurance and corporate moguls dare not go, consider ultra-high-quality dentistry and five-star VIP service. Though 90 percent of us already believe we deliver an ultra-high-quality product, ask yourself the following questions:

(1) Do I always wear loupes?

(2) Do I examine every impression under a microscope (not loupes)?

(3) If cord is needed for the impression, do I always pack cord at the placement?

(4) When placing a single posterior crown, do I eliminate all non-inclined surface, high-axis centric contacts and eccentric interferences?

(5) Do I ever see any space at the margins of crowns I cement?

(6) Do I periodontally screen (and treat as needed) every patient prior to prostho?

- Do I offer my patients a written warranty on all crowns, veneers, inlays, and onlays?

- Do I utilize a caries detector during all preps? (Dr. John Kanca`s research indicates that we miss caries over 40 percent of the time when not using a stain.)

" Would I be proud of my work?

This is the tip of the iceberg when it comes to ultra high-quality dentistry. Of course, quality alone is not sufficient to position your practice, since the public doesn`t perceive quality dentistry on its own merits. What is necessary is a significant dose of internal marketing to let patients know the trouble and care you take to deliver outstanding results.

Perception is everything

Position must sway public opinion. If you deliver extraordinarily high- quality dentistry, then be certain that your patients (and the public at large) perceive that. Your staff, your physical surroundings, and your demeanor all play a critical role in delivering the message. As Dr. Roger Levin says, marketing is not a magnet, a cute business card, or a special birthday greeting ... it is 40 or more consistent, simultaneous, positive messages delivered to your target audience.

Five-star VIP service is evident to your patients. In fact, you could "sell" all sorts of dentistry with extreme service alone. Of course, in short order it would come back to haunt you, if the quality of care weren`t in place as well. The Ritz Carlton, Nordstrom, The Four Seasons, and Lexus all bring images to mind of the ultimate in a quality service and product. They have worked very hard to earn this image. You can do the same thing. But, you`ve got to start now, not when you`re under the gun trying to dig out of the mess that "beyond 2000" might bring.

Predictions for 2019

Enough doom and gloom. I`m truly excited about the prospects for practice in the Year 2019. I want you to be able to enjoy the fruits of our future, as well. Only a very small percentage of us will have that opportunity. My predictions:

* Periodontics, as we know it, will be gone. Once periodontal infection is eliminated, only perio plastic surgeries - cosmetic in nature - will exist.

* Caries will have been solved as well. In one fell swoop, our raison d`être will evaporate!

* Endodontics and oral surgery will decline as well, as caries no longer creates pulpal infections or destruction of enamel and dentin.

* Orthodontics will be hotter than ever. We`ll have new techniques and appliances that will make it faster, cheaper, and easier than ever before. Every general dentist will be performing the hot, new orthodontic techniques! By default, there will be little room for Oorthodontic specialists.O

* Cosmetic dentistry will remain a hot topic for a long time to come. The decline of gum disease and tooth decay will significantly impact cosmetic dentistry. However, not until we can genetically engineer the shapes, color, and arrangement of teeth will the opportunities in cosmetic dentistry significantly decline.

If we?re in the dark and see the flash from the end of the gun barrel, it?s likely to be too late to do anything about it. 2019 really isn?t that far away. To be successful in our future, some radical changes must be addressed today. We can look forward to lasers that cut everything swiftly and silently; pink, healthy gums that are maintained with a pill; and materials that will surpass the strength and beauty of natural teeth. Incredible opportunities await our profession ... won?t you please plan now to enjoy it?!

Dr. Tom Orent practices esthetic dentistry in Framingham, Mass., and lectures internationally with "1000 Gem Seminars™." He created 1000 Gems™ in 1988, and has authored numerous articles and books on esthetic dentistry, practice management, and TMJ. He was a founding member of the American Academy of Cosmetic Dentistry.

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