Stephen D. Poss, DDS
In the last 15 years, dentistry has undergone revolutionary changes. This is especially true with adhesive dentistry, which has been fueled by an aging baby boomer generation.
Some clinicians embraced this whole-heartedly, while others were more skeptical. I embraced this revolution as a last-ditch effort to stay in dentistry. I was burned out and ready to quit, but the aesthetic aspect of adhesive dentistry was very appealing. Since 1995, I have explored nearly every aspect of adhesive dentistry and what it has to offer. This includes something as simple as a direct composite to the more difficult full-mouth reconstruction.
For many dentists, the emotional rewards of adhesive dentistry are priceless. I have many stories to tell about how someone's life was changed with a new smile. But for me, it was even simpler than a set of veneers. Placing a direct composite instead of an amalgam is very gratifying. When I hand patients a mirror to inspect their completed direct composites, they frequently ask which tooth I worked on because it looks so natural. This is always a "pat on the back" for me and very rewarding. It creates pride in my work, as well as pride in my team members.
The first step in doing adhesive dentistry is to learn everything you can about it. I began by reading anything on the subject that I could get my hands on, and then trying some of the things that I learned. Articles are published regularly about all types of adhesive dentistry — especially cosmetic procedures — but I was too impatient to learn that way! I attended some all-day technique lectures and found that they helped, but they still did not provide all the answers. Finally, I discovered the hands-on programs offered by the various "institutes." The hands-on experience can propel you ahead of most dentists in your area. Placing direct or indirect restorations on a live patient can be a huge confidence-builder! I took my team members with me and we learned together. It was a great experience for all of us!
Even though there are a variety of ways to achieve this, I believe that Dr. William Dickerson of the Las Vegas Institute for Advanced Dental Studies has created an environment for dentists to advance their skills in all areas of adhesive, aesthetic, and reconstructive dentistry. This is where I not only rapidly improved my clinical skills, but also dramatically increased my level of confidence and enthusiasm during case presentation.
Next I set up a new office dedicated to serving patients who wanted this type of dentistry. Having read many times in Dental Economics that the first three rules of establishing a practice are "location, location, location," I decided to establish my office in a Nashville suburb that was affluent and growing. I designed the office to appeal to the type of patient I was trying to attract. The reception area is small and elegant. I do not expect to have a number of people waiting for me, since I do more procedures on fewer people during longer appointments. I do not need a large number of treatment rooms or staff for the same reason.
I worked hard to establish this new practice. It is very rewarding to have patients excited to be at my office having aesthetic dentistry done. This was truly a career-saving change for me! If your office has not experienced the excitement this type of dentistry can create, it is time for you to begin.
How to get started
The simplest place to begin is with direct composites. There is a great deal of concern and negative publicity about amalgam restorations. Many patients exhibit a certain amount of fear about the biocompatibility of amalgam. Others do not like amalgam for no other reason than it does not look good.
Manufacturers are making the switch to adhesive dentistry easier with the development of self-etch adhesives. The lack of phosphoric acid will eliminate the post-operative sensitivity that has plagued some patients for years. Start with your team members, and then have your own teeth restored as well. It is hard to enroll your patients in this service when your smile tells them that you do not value the service yourself. My hygienist and I both have veneers. We can show patients the wonderful results in our own smiles and talk to them about the positive experience we have had. In my office, we took one Friday a month to replace each team member's worn-out amalgams with direct and indirect restorations. If your team members believe in you and your skills, they will be your best missionaries.
This would also be an excellent time to incorporate photography into your practice if you have not already done so. Showing patients "before" and "after" photographs of your work can be invaluable in your case presentation. If your office wants to do more veneer cases, then a digital-imaging system can be a big help in motivating patients to accept treatment. However, do not rely on these tools alone. The major key to treatment acceptance is good communication. Nothing can replace good verbal skills.
Since adhesive restorations are more time-consuming than an amalgam, your fees must justify the time you spend doing these procedures. Your enthusiasm and passion in presenting treatment are essential to gaining acceptance from your patients. For those of you who are just beginning this process, you may find that your patients are more receptive than you think they will be. Most consumer magazines are publishing articles on these cosmetic procedures on an ongoing basis.
Help your patients finance treatment
Have alternative financing in place, because most insurance companies are not very receptive to providing benefits for adhesive dentistry. The insurance companies prefer to pay a benefit on amalgams rather than composites. My office not only accepts numerous credit cards as payment, but we have sources of outside financing for dental work. We work with one local financing company that offers 12-month, interest-free financing. The company charges dental offices that use this plan a negotiable rate of 6 to 10 percent of the total amount charged. We have found patients to be very excited and receptive to having 12 months to pay for their dental treatment with no interest charges. Think about all of the furniture and electronics stores that do the same thing. For the larger cosmetic cases, we recommend CareCredit, Dental Fee Plan™, and The HELPcard. These companies will finance up to $25,000 with an interest rate that is much less than most credit cards offer. We also offers a 5 percent discount (investment reduction) for patients who pay with cash, check, or a debit card.
Invest in yourself!
Most clinicians invest a tremendous amount of time, energy, and money into their facilities, but rarely do they invest in themselves with advanced continuing education. I discovered that the more you invest in your education, the more confidence you will have, and the higher your case-acceptance rate will be. I can give you numerous examples of missed opportunities as a result of a lack of knowledge or skills. You simply don't know what you don't know!
Patients will come to our office and tell us that they expressed an interest in improving their smiles to their previous dentist, but were put off or told that adhesive dentistry does not work. A large portion of my practice is made up of patients who wanted cosmetic work, but could not get their previous dentists to do these procedures. If your practice could add even one veneer case per month, the effect on your bottom line would be significant.
Manufacturers are making the materials for this process better and better. Patients are expecting more aesthetic options from their general dental office. Your office could be missing a big opportunity in this area. It is time to get on board. Remember: If you are not riding the wave of change, you will find yourself beneath it!
