Annemarie Mannion

	The first dental school to open in 40 years in Illinois recently welcomed its first class and is part of a trend toward opening new schools that is being seen nationwide.

	One hundred and thirty one students are in the inaugural class of the new College of Dental Medicine-Illinois in Downers Grove.

	According to a report by the American Dental Association, it is one eight institutions that have opened dental schools since 1997, and two others have announced their intentions to start schools.

	The new openings are in contrast to the period between 1986 and 2001 when seven dental programs were shuttered permanently.

	The ADA report “An In-Depth Look at New Dental Schools” attributes the start-ups of these schools to interest among young people in the dental profession, the perceived need to have more dentists to provide oral care and respond to an anticipated upswing in retiring dentists and because many of the universities starting the schools have a healthcare focus and want to have dentistry as one of the inter-disciplinary learning experiences they offer to students.

	After Northwestern and Loyola Universities closed their dental schools, the dental school at Midwestern is one of only three in the state. The high number of applicants to the first class-2,000-- reflects interest among young people in the dental profession, said Frank Licari, associate dean for academic affairs.

	The first class is a diverse group that ranges in age from 21 to 37 years-old, is 63 percent male and 37 percent female, and hails from 27 different states and three foreign countries including Canada, South Korea and Thailand.

	In order to be accepted, students must already have earned a U.S. degree in the sciences. They will graduate in 2015 with a doctor of dental medicine degree. They will provide needed dental care to their communities, said Licari, noting that demand for dental and oral care has fueled interest in the school.

	Richard Valachovic, executive director of the American Dental Education Association, said in the ADA report that other new dental schools also are focusing on the need in their communities for professionals to provide oral care.

	“Many of these universities have missions to serve their communities as part of their programs,” he said. “Many of them see the access to dental care challenge and believe that they are helping responds to that challenge by educating more dentists.”

	Students at Midwestern University will begin their first two-years of study on the Downers Grove Campus and complete their clinical education at the new Midwestern University Clinic which is under construction and scheduled to open in 2013.

	At the clinic, community members will receive comprehensive dental care from Midwestern students under the guidance of faculty mentors.

	“We have an integrated way in which we’re teaching, both in biomedical and dental sciences,” Licari said. “It’s very patient-based.”

	Though the opening of new dental schools may seem like a trend to applaud, the ADA report also cites concerns that dental professional associations are voicing such as high levels of debt for students. According to the HPRC Survey of Dental Education for 2009-10, students who graduate from public schools paid an average of $124,397 for their education while those in private schools paid $223,788.

	As students at Midwestern and other schools make their way through their educational programs, the ADA and other professional associations are committed to keeping an eye on the trend, and what it may mean for the profession.  

Articles

 The first dental school to open in 40 years in Illinois recently welcomed its first class and is part of a trend toward opening new schools that is being seen nationwide.  One hundred and thirty one students are in the inaugural class of the new College of Dental Medicine-Illinois in Downers Grove.  According to a report by the American Dental Association, it is one eight institutions that have opened dental schools since 1997, and two others have announced their intentions to start schools.

Dental students hit the books

It’s been said that death and taxes are certainties of life. Add change to that list. A new generation of dental lab operators are adapting to trends in the industry that include incorporating new technologies, using different methods of marketing, and coping with downward price pressures from overseas.

As they adapt to those changes, Dena Lanier, owner of The Lab 2000 in Columbus, GA, has noticed the new twists that younger people are bringing to their family-run businesses. Change is inevitable and a new generation that wants to have an impact on how business is done is responding.

“I call it, ‘This ain’t your Daddy’s dental lab anymore,’” said Lanier who also writes columns on marketing for dental labs. 

“Unlike previous generations, younger people are not as interested in spending their careers at the bench,” she said. 

“The next generation is not on the bench,” she said. “They’re managing the business. They look at it more as a business.”

While most younger operators still get their CDTs, Lanier said they may not devote as much time working hands-on in production as previous generations did because they are more involved in other tasks such as analyzing the value of new technologies.

Changes like that had been coming even before Zach Pittman, Vice President of Pittman Dental Lab in Gainsville, GA came into the family business eight years ago.

“With automation, production is changing and the way we manufacture is changing,” said Pittman.

Even starting a lab from scratch as his father, Rudy, did in 1974, would be much more difficult today, Zach said. Rudy launched the business in a detached garage at his parent’s house. It has grown from having one employee to about 100 employees.

“I think it’s much more costly to be a competitive, viable lab today,” Zach said. “Technology is a lot more expensive.”

Rather than spending time at the bench, both Zach and his father see their role as being responsible for ensuring that their product is up to snuff.

“We still do a lot of the quality control, but we’re not sitting there grinding the porcelain,” he said.

Adapting to advances in technology means that Zach has taken on the role of assessing what equipment is worth the company’s investment, a task his father did not have to be involved in simply because equipment and software did not change as much in previous decades.

“He (Rudy) didn’t have to have those thought processes involved in calculating a return on investment (on buying new technology),” said Zach, adding that his father has encouraged many of the changes and new technology that Zach has introduced to the lab.

“If I’ve got an idea on something he usually lets me run with it,” Zach said.

Zach proposed the idea of adding a night shift, an idea that took a while for his father to get used to, but has increased the company’s return on investment in the costly CAD/CAM and other tools the lab has purchased.

“The pieces of equipment are so expensive. To maximize them I felt we should run 24 hours rather than the 12- to 15-hour a day shift,” said Zach.

After some deliberation, they decided to try the night shift.

“We went back and forth on whether we wanted to do that,” said Zach. “It’s proved to be a good move for us.”

Being able to focus on innovation and technology has been something of a luxury for Zach whose father had to wear more hats, particularly in the early days of the business when, like most entrepreneurs, he had to be concerned with every aspect of the lab from whether water was running in sinks, to production, quality control, to increasing sales.

“He WAS the lab,” Zach said. “He was the one dealing with plumbers and worrying about other things like building infrastructure. I came into an already established business.”

Marketing is another area in which younger people are doing things differently than their parents did and it’s making an impact.

“We used to do a lot of trade shows and mass mailings,” Zach said. “We’ve cut back on the number of trade shows and we’ve definitely cut back on the mass mailings.”

Instead, the company is delving into marketing by email, social networking, and on its website. Rather than large trade shows, it focuses its efforts on networking at regional industry events such as local dental society study clubs.

Lanier applauds the way the Pittmans have melded the desires of different generations to have an impact on the lab business. As new generations of family members enter a business, Lanier said it’s important for family members to recognize that their family and business roles are separate.

“When they step over the threshold (of the business) you’ve got to think that’s not my sister, that’s another employee,” Lanier said.

Communication is key to how Zach and his father have made their business relationship work so well.

“Communication is critical to everything,” Zach said. “Especially when you’re trying to run a family business. And having mutual respect among family members is really important too.”

Zach and Rudy also try to set boundaries that keep their business and personal relationships separate. When they step outside of the business they try not to make the lab a topic of conversation. They like to spend time fishing together, but when they are casting lines they talk about the fish, not the lab.

“We try to leave the business at the office. When we go fishing, we enjoy the time together,” Zach said.

Legacy Labs: Pittman Dental Lab

Biting into a sugary chocolate bar may not be the best choice for 

. But a Louisiana-based company is taking the stand that not all cocoa-based products are equal.

 containing a cocoa extract and other minerals that developers say strengthens and hardens tooth enamel.

The toothpaste, which was unveiled in January, is called Theodent and it contains no fluoride. CEO Arman Sadeghpour said the cocoa extract-based product will revolutionize the way people think about toothpaste.

“We want people to value the experience of brushing their teeth more,” he said. “They should care more about what they put in their mouths. Up till now it’s all been sodium fluoride or fluoride-based. We’ve been brushing our teeth twice a day with one of the most toxic elements in the periodic table.”

Sadeghpour worked on the research behind the toothpaste while he was a doctoral student at Tulane University. His mentor Dr. Tetsuo Nakamoto, a co-founder of Theodent and a professor emeritus at Louisiana State University Health Sciences Center in New Orleans, first studied the concept. 

Nakamoto discovered the link between the cocoa extract and building tooth enamel in the 1980s when he was studying the effects of various nutritional ingredients on pre-natal teeth.

Nakamoto, with assistance from researchers at the University of New Orleans, found that the cocoa- extract helped fight cavities.

“It (cocoa) had the exact opposite effect (from what Nakamoto expected),” said Sadeghpour. “It makes these units of crystal (of teeth) larger. That works to strengthen the enamel of the teeth.”

Sadeghpour’s work verified the possibilities for the extract when he tested the findings on human teeth. He made a direct comparison between the cocoa extract and fluoride and found that the cocoa extract enlarges the crystals that form the teeth, resulting in a stronger enamel. Fluoride strengthens enamel by attaching to it and incorporating itself into the tooth.

According to Sadeghpour, Clifton Carey of the American Dental Association verified his results. Sadeghpour and Nakamoto, along with University of New Orleans professor William Simmons and Tulane School of Medicine assistant professor Joseph Fuselier, decided they could commercialize a product. They developed the proprietary mixture of cocoa and other minerals what are the active ingredients in the toothpaste, and founded Theodent.

The paste, which sells for $9.99 a tube, has been introduced in 171 Whole Foods stores and dental offices throughout the country. The first batch of 6,252 tubes sold out in the first three weeks, Sadeghpour said.

Unlike what one might expect, the paste has a mint, not chocolate taste. The company wants to develop a sugar-free paste with a chocolate flavor to appeal to children.

“Kids really want it to taste like chocolate,” Sadeghpour said. “We’re in a position to provide them with that.”

The company wants to expand its line in the future by also offering dental floss and mouthwash.

Part of the fun of introducing the product has been doing the marketing. The paste comes in chocolate brown or white packaging with ornate bronze lettering which Sadeghpour said they chose because they want the packaging to stand out against the blaring red, blue and white colors of standard toothpaste brands.

Though it’s possible to buy other toothpastes for as little as a $1 a tube, he said he thinks consumers will be willing to spend $9.99 for a package of Theodent.

He said he thinks consumers are ready to re-think what they think about toothpaste, and Theodent is ready to lead the way. 

“Toothpaste hasn’t changed in 100 years,” he said. “We’re the new kid on the block and we have a new technology. We have to change the mindset of how people view toothpaste. It’s more of an oral healthcare therapy.”

Biting into a sugary chocolate bar may not be the best choice for healthy teeth. But a Louisiana-based company is taking the stand that not all cocoa-based products are equal.

Toothpaste with chocolate fights cavities

Lisa Harper Mallonee, the mother of two children ages 2 and 3, wasn’t happy with the food being served at the preschool they attend.

She noticed that sugary snacks and fatty meats were the norm.

“They served Cheerios and apple juice at snack time,” she said. “I suggested using string cheese instead of Cheerios and turkey hotdogs instead of baloney hotdogs.”

It took some work, but Mallonee was able to convince the small school to make some healthy changes in the menu. Mallonee, it turns out, had some impressive credentials that she could cite when requesting the changes. She is a registered dental hygienist and a dietician and is employed as an associate professor at the Baylor College of Dentistry. However, even with such this background, change didn’t happen over night.

Mallonee, along with other experts in the dental and nutrition fields, say schools have generally made great strides in serving healthier foods, but parents still need to be advocates on behalf of their children. 

Those improvements were prompted by concerns over childhood obesity. But the well-acknowledged link between nutrition and oral health is another reason why parents need to be aware of what foods are being served to their children and push for changes when sugary foods and ones lacking in nutrition pose a threat to oral health.

The preschool’s first response to Mallonee’s request for menu changes was to ask her to submit a letter signed by either a physician or a dietician stating that her children could be served the foods she requested rather than those usually offered. Mallonee, of course, had no problem submitting the letter that she signed herself. She also discussed her desire for menu changes with other parents. Eventually, the school took heed of her concerns and changed the menu for all students.

Not every parent, of course, is a dental hygienist or dietician. Nonetheless, Mallonee and Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern and a spokesperson for the Academy of Nutrition and Dietetics, said there are steps parents can take to encourage schools to provide healthier foods.

Sandon said parents first need to be aware that the foods schools serve can vary widely.

“It can vary dramatically,” Sandon said. “It depends on how lunch is funded. It comes down to dollars.”

Public schools that receive federal funding from the National School Lunch program are required to follow the program’s dietary guidelines. Those lunches are often served to children who qualify for no or low-cost meals.

Private schools, however, are not part of the program.

“They’re not bound by anybody to go by any guidelines,” Sandon said.

In addition to the regular lunch line, both public and private schools may bring in other food service vendors that serve pizza, hot dogs, salads or other foods. These vendors may serve healthy foods, or not.

“If parents are concerned about vendor foods, they need to find out what’s offered,” Sandon said. “They need to go to the school during lunch hours and look at what’s being served and what students are purchasing.”

Though it might be contrary to what parents believe, having their children go through the regular lunch line, rather than giving them money to buy food from a vendor, might be a better option because, at least at public schools, there are nutritional guidelines in place for those lunch line menus. 

“The school lunch line is usually the better choice,” she said.

Parents also should ask if their schools have wellness policies in place. Schools that participate in the National School Lunch program are required to have them. The wellness policies are an important tool for parents and school districts that seek to promote student wellness, prevent and reduce childhood obesity, and providing assurance that school meal nutrition guidelines are met.

To really have an idea of what’s going into their children’s stomachs, parent also need to request the nutritional information for the foods being served.

“You could have a chicken nugget that’s baked not fried, but who would know by looking at it?” Sandon said. 

“There also is some “stealth nutrition” occurring,” she said. “That’s when a school boosts a dish’s nutritional quality by using fruit or vegetable purees instead of white flour or sugar or makes other changes to improve a dish’s nutritional value without letting the children in on the secret. That’s not necessarily a bad thing. But it doesn’t teach children about making good food choices,” Sandon said.

For parents who think their school needs to make changes, Sandon and Mallonee both advise reaching out to the director of food service or other school leader to make their concerns known.

Even before that, they said it’s also a good idea to connect with other parents or go to a Parent-Teacher Association meeting. Working as a group, rather than as an individual, will likely be more effective.

“A group of voices is usually stronger than a single voice,” Sandon said.

Mallonee, who was able to make changes in the menu at her school, said school officials generally want to do what’s best for children. Parents need to see their role as advocates for better health. 

“Showing parental concern is helpful,” she said. “We’re all looking out for the benefit of children.”

Lisa Harper Mallonee, the mother of two children ages 2 and 3, wasn’t happy with the food being served at the preschool they attend. She noticed that sugary snacks and fatty meats were the norm. “They served Cheerios and apple juice at snack time,” she said. “I suggested using string cheese instead of Cheerios and turkey hotdogs instead of baloney hotdogs.”

What's for lunch?

	Who hasn’t laughed politely at a joke that’s fallen flat or had to try to keep their eyelids open during a story that never seems to end? The question of whether it’s a good idea to indulge in a bit of humor or tell a long, drawn-out tale to distract a patient undergoing dental treatment is not just about relating to people, it’s about whether these conversations result in good customer service and appropriate patient care.

	Kendra Knowles, who has been a dental hygienist in the Chicago area for five years, said she has listened in on some cringe-worthy conversations with patients initiated by one dentist in particular with whom she has worked.

	Recalling the first time she assisted the dentist, Knowles said she was wondering if a TV crew was going to pop up in the office.

	“I can honestly say that I thought I was on “Candid Camera,” she said. “Because he was dropping the “F” bomb and he always had some story that’s over the top.”

	He also told patients a long story about how he had been called in the middle of the night to treat a dental problem for Hilary Clinton, a story that Knowles said grew more unlikely and outrageous every time he told it.

	Knowles, whose name was changed for this article to protect her privacy, said she doesn’t frequently work with the dentist, but when she does she has found a way to cope with his chairside manner.

	“Honestly, now I just tune him out,” she said. “It’s in one ear and out the other. I don’t listen anymore.”

	Despite his style, which she said makes her cringe, she said some of the dentist’s long-time patients seem to love his free and easy manner.

	“It’s just his personality,” she said. “That’s the guy he’s always been.”

	“I had a patient tell me she was not happy with the crown he put in, and she wasn’t happy with the F-word (he used),” Knowles said.

	Leaning how to relate to patients is a long-accepted part of the curriculum at dental schools, said Sheela Raja, a clinical psychologist and director of clinical behavioral science at the College of Dentistry at the University of Illinois at Chicago.

	“It’s such an important part of dental care,” she said. “Dentists have to be able to communicate with patients, talk about treatment plans and deal with anxious patients.”

	To help dental students develop a chairside manner, Raja said the school audiotapes some visits (with a patient’s permission) between dental students and patients.

	Afterward, students and teachers listen to those tapes in small group settings to brainstorm ways the students can better relate to and communicate with patients.

	The idea is to help dentists develop the skills that can put patients at ease, answer their questions and concerns, and provide them with the best possible care.

	“We talk about empathy and how to understand what a patient may be feeling, and reflective listening,” she said.

	Reflective listening involves re-stating the feelings and information another person is conveying. Raja said it is easy to do and helps patients know that what they are saying is received and understood.

	“It’s not all about you (the professional) talking,” she said. “It’s about giving the patient the opportunity to ask questions.”

	The communication between a patient and the dentist or hygienist often is not as simple an interaction as it may seem. There are goals that a health professional is seeking, such as providing information that can help a patient choose a better path to ensure his or her dental health.

	Learning how to encourage patients to adopt healthier habits is another aspect of the university’s curriculum.

	“We talk about how to motivate patients for behavioral change,” she said.

	As important as it is for dentists, dental hygienists and dental students to be able to communicate with their patients, Raja said it’s not always easy when a dentist or hygienist is focused on doing the technical job in front of them. Raja said it requires being able to multi-task.

	“The dental students are practicing their hand skills while they’re also practicing their people skills,” she said. “It’s like they’re walking a tight rope.”

	She said many dentists go into the field because they like to work with people.

	“They tend to be outgoing and they tend to like to work in teams,” she said.

	If there is doubt about how a joke or story or swear word will be received, Raja said it’s usually best to save it for another audience.

	“If you’re not certain how a joke is going to go over it’s probably best not to say it,” she said.

	Studies have shown that building a good rapport among patients and health providers can have many good results, such as reducing malpractice claims for physicians, she said.

	Knowles said she doesn’t feel comfortable telling this dentist to change his communication style. She does not think he would receive her feedback in a positive way. She said when patients are disturbed by a doctor’s style they usually speak with their feet, and then it’s too late.

	“Most likely they just go shopping for another dentist and you never see them again,” she said.

 Who hasn’t laughed politely at a joke that’s fallen flat or had to try to keep their eyelids open during a story that never seems to end? The question of whether it’s a good idea to indulge in a bit of humor or tell a long, drawn-out tale to distract a patient undergoing dental treatment is not just about relating to people, it’s about whether these conversations result in good customer service and appropriate patient care.

Communication gone wrong

Doctors Allen and Kelly Smudde of Valencia, CA-based 

The improvement in efficiency for the 6,000-patient practice has been noticeable. The same patient exam that used to take between one and a half hours to two hours now takes 45 minutes.

“If we had to go back to paper I don’t think we could,” said Melissa Forness, Marketing Manager for Smudde Dental.

Many dental practices still rely on pen, paper and file folders for tracking patient care and other tasks. According to Merry Cosgrove, a Senior Management Consultant at Pride Institute, these practices can greatly improve efficiency by adapting to electronic records.

Cosgrove says the reason why some practices still rely on paper records is simply because it is what they are used to. 

“Some people don’t like computers and they have a tendency to love the charts they learned on,” said Cosgrove.

At Smudde Dental, patients are greeted by a check-in kiosk furnished with a computer. They enter their basic medical and insurance information. Forness says incorporating this simple step is a big time-saver compared to handing patients paper forms and pens and having them enter their information by hand.

“It cuts down on the time patients are waiting,” said Forness. “We’re able to help patients much more quickly.”

While patients are in the chair, dental staffers enter doctor instructions, patient comments and other pertinent health information into desktop computers. These notes and other information are backed up every day before the office closes.

Retrieving patient information is easier than going to a metal file cabinet and hunting for it.

“It’s a couple clicks of a mouse and then you’re there,” said Forness. “It’s easy to find information about the patient and we can store digital X-rays in there, too.”

Like Forness, Cosgrove sees numerous benefits from electronic records including its easy to key-in insurance codes. Also, there is never the problem of trying to decipher someone else’s handwriting.

“One of the purposes of electronic records is for consistency,” said Cosgrove. “It’s also good for documentation of legal purposes and is a great communications tool.”

Cosgrove says electronic records can be used to educate patients about what further treatments may be needed. For instance, a treatment plan with teeth that are targeted for additional care circled or otherwise highlighted can be provided to patients.

“They have a copy to take home,” said Cosgrove. “It can have areas circled or pointed out in different colors. You’re using it as (an educational tool).”

Electronic records also can improve communication among the staff and specialists working on a case because less time is spent on asking and answering questions.

“The document can really be a guide for a specialist without a lot of additional questions or time,” Cosgrove says.

To find the software package that would be most useful to a particular dental practice, Cosgrove says visiting several vendors at a convention is a good way to get an idea of the different products available. It’s also a good idea to invite a potential vendor to the office for more in-depth analysis.

“Different software companies provide different solutions,” says Cosgrove.

Installing electronics record software is a step toward achieving efficiency, but Cosgrove says employees need to be trained on how to use the software and need to be allowed the time on a daily basis to enter information. Cosgrove recommends that practices set aside a short time daily that is solely for staff who can focus on updating patient charts.

At Smudde, new staffers are trained to input data into the software using a mock patient. Cosgrove says staff should  be trained to enter only information that is pertinent and purposeful, but Forness says the more information they have about the patient the better.

“There isn’t too much information that we can gather about a patient,” said Cosgrove. “We can note the bad experiences they had with past dentists so we can give them the TLC they need.”

Forness says patients appreciate the time-saving aspects of electronic records.

“We live in a world nowadays where time matters,” she says. “It’s a great way to provide customer service.”

Another benefit associated with going paperless is the interactivity that can be provided to patients who can reduce their claim on staff time by using a website to make appointments, cancel appointments or make online payments.

Forness said going paperless means Smudde no longer has to keep file cabinets stuffed with patient records to be in compliance with the legal requirement that they keep records for 10 years.

“Paper gets lost. Paper gets faded. Electronic records are more efficient and our office runs smoother,” Forness says.

Doctors Allen and Kelly Smudde of Valencia, CA-based Smudde Dental decided to go paperless in 2007. The improvement in efficiency for the 6,000-patient practice has been noticeable. The same patient exam that used to take between one and a half hours to two hours now takes 45 minutes.

Paperless makes for less stress

	Whether asked to hold a light, run to get cotton swabs or suction a patient’s mouth, Gina Durkin was happy to help in any way she could as a member of an American team of dental professionals and students that recently visited Nicaragua. 

	“We saw one patient after the next in the sweltering heat. But no one complained,” said Durkin who traveled as part of a 50-person group that went to impoverished neighborhoods of the country’s most populous city, Managua, as well as to a hospital to provide dental care to burn victims and into mountainous rural areas.

	“We went to the poorest of the poor areas in Managua,” Durkin said. “I just did whatever I could.”

	Durkin, a product manager for GC America, global dental product manufacturer, volunteered to go on the trip because her company provided most of the supplies for the mission including bonding agents, curing lights, sterilization products, composite materials and more.  

	The trip was organized by Foundation for Worldwide Health, a non-profit dedicated to solving the problem of endemic poverty and promoting total community health for communities it serves in underdeveloped countries.

	The foundation has sponsoring the Nicaraguan trip for the past 12 years. Dr. Brian Novy, an assistant professor of restorative dentistry at Loma Linda University in Loma Linda, CA has participated in the trip for the past six years.

	He said the group goes back again and again to Nicaragua because they want to build relationships and have a long-lasting impact.

	“It makes no sense to go in a pick up and leave and go to a new location,” he said.

	Upon arrival, the group split into teams with different assignments. One of the teams set up a clinic outside the city dump where people go to scavenge for food.

	“It’s like looking at the gates of hell,” Novy said. “There was black smoke from the plastic burning and a lot of flies.”

	Another clinic was set up in a church, which was where Durkin worked part of the time. From 7:30 a.m. to 4 p.m. she said the group, which included dental students from Loma Linda University, would see about 40 patients a day. The patients had already set up appointments via the church or some dropped in.

	“They came in their Sunday best,” said Durkin, noting that many of the people who were treated were having teeth extracted.

	In addition to the clinics at the church and city dump, members of the group treated children with special needs and others-mostly children-- who were hospitalized for burns.

	“People cook over open fires in one-room huts and children can roll over into the fires and get badly injured,” said Novy, adding that it makes sense to do full mouth dentistry while the patients are in the hospital.

	The dental mission trip provides experience for the American students who Novy said “work non-stop, 10-hours a day. They’re troopers.”

	Another goal of the mission is to provide training for Nicaraguan dentists and dental students so they can then use what they’ve learned when they treat patients. The idea is that by imparting their knowledge the mission’s impact will not end when the dentists and students return to the U.S. 

	Without the products provided by GC America, Novy said the trip would not be nearly as effective.

	“What they provide just blows me away,” he said. “Without their donation each year we wouldn’t be able to do the quality of dentistry that we do.”

	Novy said one of the more touching incidents involved a young boy who had had a chipped tooth repaired and then went to play soccer and chipped it again. The boy so happy when Novy fixed it again “that he got me a soda and gave me a big hug,” Novy said.

	Durkin said she would like to learn Spanish so that she can go again on a trip and be able to communicate effectively with patients. Novy said he will do more mission trips and possibly even set up a permanent clinic in Nicaragua.

	“These patients are so happy for anything you do,” he said. “They’re so grateful.”

 Whether asked to hold a light, run to get cotton swabs or suction a patient’s mouth, Gina Durkin was happy to help in any way she could as a member of an American team of dental professionals and students that recently visited Nicaragua. 

A long-lasting impact

	Where is it written that going to the dentist can’t be enjoyable? Or that a patient can’t sip a glass of beer or wine while waiting for an appointment or even borrow a laptop to surf the net?

	It’s not in any book that Dr. Clint Herzog, founder of 

, a practice with eight locations in Dallas and Houston, has ever read.

	After hearing time after time from patients about how they dreaded going to the dentist, Herzog, who has been in practice for 11 years, decided he needed to do something to change the experience.

	“I got tired of patients saying they don’t like going to the dentist,” he said. “I started asking patients to drive down to the core of what they want--without any preconceived notions.”

	Talking with patients and listening to their desires is how Herzog developed his approach to dentistry that he has dubbed his “FLOSSophy.” He maintains that quality dentistry can be provided in an upscale environment with the latest technology and at prices people can afford.

	A little bit of pampering and an attempt to make the experience more enjoyable means that patients at Floss Dental can choose to have a glass of wine or beer or water when they arrive for their appointments, get a tour of the office, and that every staffer knows their name.

	“It makes the experience feel high end and patients feel taken care of,” Herzog said. “But it’s not a spa.”

	He also provides other perks and incentives that patients appreciate such as a strong topical so that don’t feel injections and free, in-office teeth whitening for every patient once a year.

	“That (teeth whitening) is like your adult lollipop,” Herzog said.

	Herzog’s new FLOSSophy also means he provides in-network pricing, which was a high priority among the patients he talked to as he planned the transformation.

	“Most dentists make more money if they’re not in-network, but it’s not really what’s best for the patient,” Herzog said.

	Describing what his practice was like before he initiated these changes, he said it was pretty run of the mill.

	“It was fee-for-service,” he said. “It was what I thought a dentist office should be where the dentist wears a white lab coat and I’m the dentist and you’re the patient.”

	By putting patients in the driver’s seat and letting them tell him what they wanted and by running his business efficiently, Herzog said he has seen the company thrive. To counter the impact of going in-network, he has taken such measures as asking vendors to reduce their costs. 

	“We deal with a lot equipment companies and other suppliers,” he said. “We lean on vendors to drive their costs down.”

	The new formula, which he put in place in 2008, is working, according to Herzog, who has seen the business grow to have 60 employees, eight offices and four more under construction.

	“We’ve doubled in size every year for the last three years,” said Herzog.

 Where is it written that going to the dentist can’t be enjoyable? Or that a patient can’t sip a glass of beer or wine while waiting for an appointment or even borrow a laptop to surf the net?  It’s not in any book that Dr. Clint Herzog, founder of Floss Dental, a practice with eight locations in Dallas and Houston, has ever read.