Ed Rabinowitz

Text messaging is simple. It’s quick, easy, and portable. But when applies to dentistry, “simple” isn’t enough. It also must be secure.

, a Boston-based tech startup, comes in. The company has launched a HIPAA-compliant texting application it hopes will streamline the workflow of America’s dental offices.

“We provide the opportunity for a very simple and cost effective method to communicate between sectors, and with laboratories,” says Arnold Rosen, DDS, MBA, Awrel and CEO. “If Tom Brady had used our texting application instead of using his phone system, this issue of them wanting and needing his phone would not have been important because there is no information that resides on the phone in a HIPAA compliant application.”

Rosen explains that the Awrel solution provides functionality to intuitively create custom platforms for individuals and groups to exchange and store information, images, and documents. As such, a dentist can benefit from specialty consultation at the point of patient care, or from real-time interaction with a technician creating an implant or cosmetic prosthesis.

“We’re increasing productivity from a quantitative and qualitative standpoint,” Rosen says.

For example, from a quantitative standpoint, texting is a method for communicating rapidly and in a simple manner. Rosen says the Awrel app combines this technology in an environment where groups can be formed and documents can be shared and stored.

“I might have a restorative dentist,” Rosen says. “Or I might have, as part of a multidisciplinary team, an orthodontist preparing something for implants. I may even engage a specialist from a dental device company, like an implant company. By having a texting environment to work in, there’s no delay in the speed of communication, which is something that people are anticipating these days. So from a quantitative standpoint you can compress time and increase access to information.”

From a qualitative perspective, Rosen points to the increase in digital dentistry that often requires dentists to view work in progress. He says that currently the majority of this work is being done in a non-HIPAA compliant manner through normal text messaging.

“For that reason, we have received a lot of interest from the laboratory industry, as well as dentists who communicate with labs,” he says. “Labs can work rapidly and not have interruptions in workflow.”

In addition to avoiding workflow interruptions, Rosen says the new application simplifies practice workflow. He recalls speaking with an oral surgeon who is part of a large surgical group. The group has been using a HIPAA-compliant email system, which lacks the simplicity of text messaging, to send x-rays and to communicate. As a result, staff is resistant to using the system because of its complexity.

But the new mobile and web app is not just a texting application. Rosen explains that it’s built on a business platform, and the plan going forward is to provide business solutions. This could come in the form of “smart forms” that facilitate the inputting of information that has to be sent to a lab.

“These will be resident and accessible as part of this texting environment,” he says.

Rosen points out that the platform the new application is built on includes connectivity to the internet, and the company plans to customize the application for use in a wide range of environments.

“This will provide an opportunity for a patient to have a tele-dental experience with their office,” he says. “That’s going to have significant value to the dental industry.”

Rosen further illustrates the benefits to dentists as well as patients. If a patient has an emergency because he or she breaks a tooth, they can use the application to take a photo with their phone and communicate how they’ve been compromised, both functionally and aesthetically, to the dentist—who in turn can be more efficient and productive by having that information in advance.

Rosen says he lectures frequently, and when he does, he talks about opportunity cost. And it amazes him that his colleagues have no idea what opportunity cost is.

“Opportunity cost is something that applies to the clinician and it applies to the patient” Rosen says. “When the patient comes in, if we did not communicate rapidly, and work in progress with the lab doesn’t show up, I lose productivity, and the patient has lost productivity. So there’s this opportunity cost that is seldom recognized, but probably is the most erosive aspect of the economics of a dental practice.”

The Awrel application, which was developed by dental professionals for use across the dental industry, is available from the App Store for iPhone users, and from the Google Play Store for Android users.

Articles

Smartphones have penetrated just about every aspect of our lives, except when it comes to patient care, where HIPAA regulations make the technology problematic. Now, a new secure texting application is helping to change that.

Texting App Fosters Dental Effectiveness and Efficiencies

 from the Office of the National Coordinator for Health IT, 83% of physicians nationwide have adopted electronic health record systems. Meaningful use incentive programs are considered one of the main factors for the increased adoption.

But when it comes to dentists, meaningful use has not had the same impact. Why?

“My understanding is that meaningful use had some restrictions on the patient population that a dentist had to serve in order to be eligible,” explains Terry O’Toole, DDS, vice chair of the American Dental Association Council on Dental Practice. “And frankly, I don’t think that requirement met the patient profile of most dental practices, and therefore, it didn't have lot of applicability in the case of the average dental practice.”

However, O’Toole believes the tide is beginning to turn.

O’Toole says the ADA feels strongly that EHRs are a good investment for dental practices, and has invested resources in standards development, enabling vendors to put forward an electronic health record that meets dentists’ needs.

“One thing I think a lot of the dental EHR vendors have done is partnered in some way with a component of the medical EHR,” O’Toole says. “I think industry has tried to respond in that way, to try and create a greater use of a combined dental and medical EHR.”

One of the greatest challenges EHRs have faced is the issue of interoperability between one medical practice and another. That same challenge exists, to a certain extent, with interoperability between a medical practice and a dental practice. Addressing that challenge becomes increasingly important given the growing recognition of the connection between oral health and medical health.

“You can’t have good general health if you don’t have good oral health,” O’Toole says. “The ADA is doing a lot of things to bring awareness to oral health issues, and making sure people understand the correlations that exist between poor oral health and other medical conditions. And I do see those things improving over time.”

One of the hurdles to overcome with increasing EHR adoption is the cost factor. While the growth of dental group practices has been a developing trend, there are still many dental providers operating as smaller, family-run practices. However, the benefits of EHR adoption, including increased efficiency and productivity, more efficient patient billing, and improved reimbursement, are clear.

, located in Manchester, IA, understands the importance of those benefits. Connie Behnken, RDA, practice manager, was responsible for the overall integration of the XLDent EDR (electronic dental records) system, and more recently, 

, which provides secure information transport services, into the practice.

The practice is progressive, and has been using the XLDent EDR system for the past 29 years. The DataMotion companion was brought on board three years ago. And the benefits, Behnken says, have been significant.

“If we need to send a digital x-ray to a specialist to look at, we can actually create a PDF right off of our XLDent system and import it into an e-mail and send it securely,” Behnken explains. “It’s super simple to use. It’s just like using your regular Gmail account.”

Behnken says one of the keys to successful integration is having everyone on the same page.

“Going from paper to electronic records was hard,” she admits. “But we came up with a plan, and XLDent helped us so that when we rolled it out it made sense. They were an integral part of making that happen, including helping us create the templates for our progress notes which made us much more efficient. We’re able to make sure that everybody is getting the exact same information, and the standard of care has improved.”

Twelve months after flipping the switch on the XLDent EDR system the practice was able to virtually forgo pulling a paper chart.

Though it’s only speculation, O’Toole believes that dentists’ use of electronic health records will continue to grow—particularly given the increasing correlation between poor oral health and other medical conditions.

“I think dentists realize that anything they can do to improve oral health will certainly improve the overall health of the patient,” O’Toole says. “Just as physicians are looking at certain issues, dentists are looking at issues such as tobacco cessation. I see those things improving over time, as we need to work together to improve general health of the individual.”

Dental offices have been slow to adopt electronic health records, in part because they haven't had the same regulatory incentives as physicians. But the software can bring benefits to dental practices, even if they're not required.

Weighing the Challenges and Benefits of Dental EHRs

, was preparing for college she had designs on becoming a pharmacist. Why not? Her father was a pharmacist in Philadelphia, working for a large pharmaceutical company.

But he had other ideas in mind for his daughter.

“He told me I can go to college but I can’t become a pharmacist,” Galante recalls.

When she asked why, he told her that one day there wouldn’t be independent pharmacists; that they will all be working for companies. He wanted her to be her own boss. That meant a career either in medicine or dentistry.

During an eight-week winter break externship with a female pediatric resident at Reading Memorial Hospital in her sophomore year, Galante made a decision: she would focus on dentistry.

“I literally spent eight weeks with her from 7 in the morning until 7 at night, and I decided I didn’t want to be a doctor after that,” Galante explains. “I didn’t think I could handle my patients all having these illnesses. And I know that sounds like a very shallow reason, but my goal was to a career that had a lifestyle attached to it.”

While in dental school Galante worked two part-time jobs. She worked two nights each week for a general dentist, and on Saturdays worked for an orthodontist. It was the latter job that most caught her interest.

“I loved the orthodontic part,” she says. “It was a lot of kids, and it was really fun.”

Encouraged by the orthodontist, she applied for and was accepted into the orthodontics program at the University of Pennsylvania. That’s where she met her future husband, Paul Cater. And after eight years practicing in King of Prussia, PA, they moved to northern California where they’ve run 

The benefits of working together, Galante says, far outweigh the challenges.

“We have four locations, and if I’m in one office and I’m like, it was crazy, this and this happened, he totally gets it,” Galante says. “It’s not like you come home talking about how bad your day was, because you’re an attorney and your husband is an accountant, and it’s like, oh no, my day was much worse. Or you just don’t understand what I have to go through during tax season. We understand exactly what’s going on, and I think that helps.”

Their patients, she explains, like the family approach. Galante tells patients that because she and her husband were trained at the same school, they’re getting two sets of eyes; paying for one orthodontist but getting two.

“There’s stuff that doesn’t get missed,” she adds. “We’re on top of things.”

In 2008, with their practice growing, Galante and her husband purchased a large office building to house their expanding practice. And almost simultaneously, the economy tanked.

“And it went south in a hurry,” Galante recalls. “We went from a full schedule of patients to half schedule. We lost about 30% of our income in one year.”

It also came at a time when Galante, who had been practicing for 22 years, was ready to back off and perform more of an administrative role. Those plans changed overnight, and she and her husband recognized they had to make some dramatic changes or they could find themselves out of business.

“Everybody was struggling and saying, ‘I’ll sell you braces for half price,’” she says. “The price points were becoming so ridiculous that you might as well close up shop. We thought there had to be something we could do that would set us apart.”

, aligners that are a clear alternative to metal braces. They used their limited resources that remained to market to adults who always wanted better teeth or a better smile, but had never been offered a clear alternative like Invisalign. They also took some risks.

“People would come in, and they didn’t have all the money for a down payment,” Galante says. “They only had a limited amount to put down, and we’d say okay, fine, and put them on a payment plan.”

“We became the Invisalign orthodontist,” Galante says. “It took us 18 months to regain our lost income, and we’ve been on the upstroke ever since.”

The work Galante and her husband were doing did not go unnoticed.

“[People at Invisalign] saw this little office that was doing so many cases a year, and it was like, what are these people doing?” she recalls.

Galante became a key opinion leader for the company. She travels frequently—most recently to China and Australia&mdash;giving workshops and instructional seminars on Invisalign. And she makes these trips because she recognizes the big picture.

“I know how much Invisalign has helped our practice,” she explains. “But the bigger picture is that it’s a great thing for patients. I know that if I go to Australia and I lecture to a bunch of orthodontists, there may be 20 percent of the audience that gets the passion like we got, for whatever reason. Eventually those doctors are going to be treating thousands of patients and giving them the smiles they’ve always dreamed of.”

That’s a life-changing experience for a lot of people, Galante says—patients, as well as orthodontists and their staff, who are excited to go back to their offices and begin working with the clear alternative.

It’s All About Millimeters: How Small Changes Can Make a Big Impact in Your Business and Life

.” She recognized that in dentistry as in life small things can have a huge impact.

“When we were making the changes in our practice we thought, what can we do a millimeter at a time to make these changes?” Galante says. “It mushroomed into this entire book.”

And became part it the practice’s tagline: Changing smiles, changing lives.

“And that’s what it’s all about.”

A California orthodontist had a thriving practice -- then the recession hit.

Orthodontist Makes Big Changes a Millimeter at a Time

report from the Office of the National Coordinator for Health IT

 reveals that 83% of physicians countrywide have adopted electronic health record systems. So while the adoption rate has been slow over the past few years, it is progressing.

It’s a different story, however, among dental practices, where EHR adoption has been low. Andy Nieto, director of healthcare solutions at 

, which provides secure information transport services and products to businesses, says EHR adoption is a multifold problem in the dental industry.

“Dental practices have an established documentation process which does not lend itself to what I would call clinical or ambulatory medicine EHRs. It’s very specific and unique,” Nieto explains. “Most EHRs are not designed for dentists.”

Nieto says that dental EHRs themselves are only advisable or necessary for dentists if they really want to comply with certain billing terms, whether it be a meaningful use compliance issue or something similar. To that end, there’s been no singular driving force to really push dentists to use EHRs, unlike the ambulatory EHRs or hospital EHRs that had money associated with meaningful use.

“There’s been a kind of disconnect,” Nieto says. “Why would a dentist spend the money to deploy an EHR if there’s no stick or carrot really associated with it.”

But aren’t there similar benefits to a dental practice—benefits that medical practices are beginning to realize, such as increased productivity and workflow efficiency? Nieto agrees that there’s always value to having better management access to, and delivery of, information.

“Having said that, the reason I don’t drive a Cadillac right now and I drive a Jeep is because my need is not comfort and style,” he points out. “My need is transport.”

Nieto explains that EHRs have been around for years, and their current structure is closed-ended questioning for the purpose of documentation. Dentists, however, do most of their own diagnoses and typically ask open-ended questions, and EHRs typically remove that dialogue.

For example, an EHR has to improve the efficiency of an office. If the dentist has to click on every tooth in order to document each one, and a paper chart allows them to just use a pencil to circle or place a mark on the tooth, which one is more efficient? And which one keeps them facing the patient?

“I don’t think we’re quite there yet when it comes to the ease of use technology at the point of care,” Nieto says. “It’s improving, but I don’t think we’re quite there yet.”

But dentists are a very eager group of professionals, Nieto says. Last fall, DataMotion was selected for the second consecutive year as the technology backbone for demonstrations during ADA 2015 on the secure exchange of digital images and patient records between dentists, dental specialists, other healthcare entities and patients themselves.

“[Dentists] typically are more technology savvy,” Nieto says. “One of the things about dentists is they like the tools, they like the technology, and they like the resources. They’re constantly saying, ‘Teach me. I want to learn more.’”

Nieto points out that in the last five years “it’s been really cool” to see the recognition of dental health and clinical or medical health coming closer together. There is more recognition of the relationship between oral infections and heart disease, and a clear relationship between oral infections and sinus issues.

“There’s a direct brain-mouth connection when it comes to infection,” he explains. “And all of a sudden there’s been this recognition that oral health is a component of your overall clinical health.”

The other component, Nieto says, is that Medicare and Medicaid are recognizing that with diabetes and with certain chronic conditions, oral health needs to be audited at a more direct level. As a result Medicare and Medicaid are paying for dental services that they never used to, as part of patients’ chronic care management for certain conditions like diabetes.

“So now you’re having this interesting crossover in expectations,” Nieto says. “These things are driving the adoption rates forward, especially for providers who remain cutting edge, or who want to extend what they do in their practices. They don't want to just fill cavities. They want to be kind of a wellness partner.”

Those efforts are underway. The Improving Oral Health Measurement Project, a collaborative effort of the 

Association of State and Territorial Dental Directors

, seeks to strengthen the quality, collection and use of data to improve the nation’s oral health. A 

 examines the barriers and explores the challenges of better collection of health data.

Does this mean more of a need and desire for dentists to connect and interact with the medical world, particularly through expanded adoption of EHRs?

“I would certainly hope so,” Nieto says. “I’m not going to cross my fingers on that, but I do think that they’re coming closer together.”

Electronic Health Records are billed as a way to streamline processes and paperwork. So why haven't they take off in America's dental practices? 

Digital Divide: Why Don't More Dentists Use EHRs?

In 2015 the average dental school graduate carried student loan debt totaling $255,567, according to the American Dental Education Association’s 

. That’s an increase of more than $8,000 from the year before.

Christian Piers is no stranger to those numbers. Piers is a recent graduate from the 

University of Colorado School of Dental Medicine

, and served as American Student Dental Association’s national president for the past year. He saw annual tuition and fees “slowly creep up” from approximately $61,371 at the start of his four-year stint to nearly $67,514 by the time he graduated.

“I had the fortune to have a lot of scholarships as an undergrad that really covered most of my education, so I thought there has to be some sort of merit-based scholarship system for dental school,” Piers reasoned. “And it turns out those are extraordinarily rare.”

When Piers decided to attend dental school he found himself in a unique situation. He was living in Hawaii, and since the state does not have a dental school, an exchange program pays the difference between in-state and out-of-state tuition costs for any resident to attend a dental school on the mainland. The caveat is you must have lived in Hawaii for five years to be eligible for the program. Piers fell short of the criteria.

“Private and public schools were all going to be quite expensive for me,” he says. “Even state-funded universities can be up to twice as much for out-of-state residents. It has been a journey fraught with a lot of financial worry.”

But that hasn’t dampened Piers’ passion for a career in dentistry and, more specifically, orthodontics (which means he’s bucking a trend that has seen more dental school graduates forgo specializing due to concerns over increasing debt).

“Plenty of my classmates who became interested maybe a little later in the process in specializing, ended up dismissing the prospect outright simply because of cost,” he says.

But Piers, with an uncle and a cousin who are both orthodontists and a determination prior to entering dental school to pursue that specialty, was undeterred.

“I was really passionate about orthodontics, and I think that has let me be willing to take on any kind of financial burden that goes with it,” says Piers, whose wife has been the family’s single earner throughout dental school. “But it doesn’t make it any less scary.”

Piers says that one of the best things the ASDA does for dental students with regard to helping them deal with student debt is encouraging congress and state legislatures to introduce and pass measures to alleviate the burden. For example, on April 12, 58 of ASDA’s chapters scheduled more than 300 appointments with lawmakers and their staff to lobby specifically on behalf of dental loan refinancing and student loan reform.

“That’s an annual thing we do,” he explains. “Because ASDA represents 22,000 members, and basically 90% of dental students, we can really actively channel the voice of dental students through those meetings.”

There’s also assistance from the American Dental Association, which in September 2015 

 an exclusive student loan-refinancing program with Darien Rowayton Bank, more commonly known as DRB. The program allows ADA members an opportunity to refinance existing federal and private student loans at a lower rate that, according to the ADA, could save members tens of thousands of dollars on average.

All of those initiatives are helpful, Piers acknowledges. But he reminds that tuition rates continue to soar, rising exponentially every year.

“The concern is that without addressing that base problem, are we just applying band aids and allowing the problem to continue to grow?”

Piers says one of the plusses of specializing is the increased earning potential it affords. He’s hoping to buy into a practice as soon as possible following residency so he can use that additional earnings potential to pay down his debt.

“Whether or not the market and lenders allow me to do so remains to be seen,” he admits.

reports that the number of dental school applicants in 2010 was 12,001

, an increase of 55% from the 7,700 who applied a decade earlier. Is the field still attractive despite rising tuition costs?

Perhaps, but Piers says the important question to ask is, at what point does the cost of dental school begin to turn away those bright young minds?

“I think a lot of students who are pre-health and traditionally may have gone on to become physicians are wary of a lot of changes in the healthcare system, so they turn to dentistry as kind of a safe alternative,” Piers says. “I feel like we’re getting these amazing applicants right now, and it’s just a question of how long those very smart students are going to consider the risk-reward of taking on $256,000 of debt a good idea.”

As tuition continues to rise at the nation's dental schools, the former president of the nation's largest dental student organization worries it could soon cause would-be dentists to choose another field or opt against specialization.

Dental School Tuition: Will Rising Costs Deter the Next Generation of Dentists

The Merriam-Webster online dictionary defines “commonalities” as the “possession of common features or attributes.” And sometimes, that’s not a good thing.

One thing you don’t want to share in common with your fellow dentists is a penchant for poor financial habits that lead to lack of success. Unfortunately, too many dentists do ascribe to this commonality.

“I will tell you that your financially unsuccessful dentists do not have their financials in order,” says Scott Mortier, executive vice president of business development for 

, a leading dental practice acquisition specialist. “They’re not current on their tax returns. That’s the commonality as we look across the country for practices to acquire.”

And from there the domino effect takes over.

Mortier acknowledges that dentists are very busy. Their passion is “putting their hands in people’s mouths and fixing teeth.” But the reality is that a dental practice is a small business. And just as with most small businesses, once up and running, the principals tend to stop marketing, and no longer keep up with their financial statements.

“They have a lot on their plate, and it’s the easiest thing to push aside,” Mortier says.

And when the financials are pushed aside, they’re often delegated to the practice office manager. That, Mortier points out, is a key mistake.

“Office managers are great at managing people, and they’re a huge asset to the dentist, but it’s not their business,” he says. “And keeping up to date financials—it’s not what they do, it’s not what they like to do. It’s tedious, and that’s why it usually falls by the wayside.”

And as a result, not only do dentists not know where their money should go, they often are unaware of where it 

 going. They’re unable to, at a glance, compare expenditures for salary, labs, supplies, and equipment purchases. How can you know what you have if you don’t know what it’s costing you to get there?

“Dentists are passionate about what they do, and they’re great at what they do, but the reality is a dental office is a small business,” Mortier says.

Financially unsuccessful dentists also don’t do a good job of setting goals. They neglect to establish a long-range retirement goal, and even more short-term annual savings goals.

“They look at their bank account every month, and if there’s more there than there was the month before, the average dentist says, ‘Things are great,’” Mortier says.

But the reality is they’re not great. Mortier says dentists should be focused on building their practice, and developing an exit and retirement strategy for down the road. Failure to do so, and failure to maintain accurate financials along the way, could prove costly.

“The typical sale of an office or business takes six months,” Mortier explains. “If dentists had their financial records in order, it would take only three months. That’s the reality of the industry. It’s a seller’s market right now, and dentists should be looking at a long-term financial strategy, no question.”

Another reality is that too often dentists attempt to make their own decisions rather than rely on or enlist the advice of financial professionals. They get so bogged down with the day-to-day of running their practice that they forget to look at what’s down the road. Yet, when offered, they are receptive to receiving advice.

“They know that their [financial records] are not current or accurate, or that they have documents to file,” Mortier says. “They’re very forthcoming, and will typically connect us with their account and give us carte blanche to compile the necessary information.”

Mortier says that the first conversation he has with dental practice clients is expressing the importance of accurate financial documents and tax returns.

“That’s really what we beat them over the head with,” he says. “We’re not going to be able to sell their practice or acquire another practice and deal with banks if they don’t have accurate financial information about the practice they currently have.”

As advice, Mortier recommends that dentists make certain they are working with the right financial broker.

“There are big companies that have been doing dental practice acquisition in the U.S. for a long time,” Mortier says. “If you’ve had a practice for 20 or 30 years, let’s face it, it’s your baby. And you need to make sure you hire a broker or consultant who understands that and is willing to work with you and be flexible.”

Like it or not, a dental practice is a business. Here's a look at key signs you're neglecting the business side of your practice.

The Commonalities of Financially Unsuccessful Dentists

In the age of "selfies," everyone seems eager to let everyone else know exactly what they’re doing at that exact moment. But our Facebook feeds are also full of a different kind of selfie — the old “before and after” standby. And when it comes to patient experience, the “before and after” is just as important as the time the patient spends in the office.

, a professor at Western Michigan University, when he talks about the 

. And it has particular relevance where dentistry and the patient experience are concerned.

, CSP, author of “Business Charisma — How Great Organizations Engage and Win Customers Again and Again,” explains the model.

“Brinkerhoff’s research shows that only 20% of the impact occurs when the teacher is in front of the students,” Norton says, equating the teacher-student relationship to that of the dentist and patient. “Forty percent of the potential impact occurs before the student even shows up, and 40 percent occurs after they leave.”

In other words, dentists looking to maximize a patient’s experience should take a closer look at what happens before and after the patient encounter.

Norton recalls have a bone graft done for a dental implant. When he arrived at home late that night, around 9:30 p.m., his phone rang. It was the oral surgeon herself calling to check up and make sure he was doing well.

“When’s the last time a dentist ever called to follow up on a patient?” Norton asks rhetorically. “There’s a huge opportunity for dentists to impact the lives of their patients before and after they sit down in the chair.”

An orthodontist Norton worked with had an iPad with each patient’s name on it when they walked in the front door. Written on the iPad was, “Welcome, we’ve been waiting for you to arrive …” followed by the patient’s name. Then when the patient’s braces come off, they’re given a magic marker and told to write a testimonial on the wall.

“The walls of this orthodontist’s office are covered with, ‘Thank you Dr. Zach. I love my new teeth, and my new smile,’” Norton says. “Then they take a photo of the patient and the orthodontist, and the dentist signs it. The patient takes home an autographed photo of his orthodontist.

What those actions are saying, Norton explains, is that the orthodontist recognizes the importance of giving the patient a great experience when in the chair. But he also recognizes the importance of involving the entire family in the experience.

“I went to another dentist’s office and they had a jar of Chapstick with the dentist’s logo on it,” Norton explains. “When kids come in they ask, ‘Can I have a Chapstick?’ And they’re told, ‘Only if you take two and give one to a friend.’ Dentists live and die on referrals, and the best referrals are not from other doctors, but from other patients.”

Norton says the research he has conducted indicates that the value of a dentist’s chair-side manner is worth 50% more in the marketplace. In other words, patients are willing to pay up to 50% more for an engaged, charismatic, fascinating experience. And employees at the practice are less likely to call out sick and are more promotable.

“The staff experiences less turnover, which is a cost savings,” Norton says. “They refer more patients, which is a cost savings. In a very real sense there are multiple ways that this approach is hugely profitable for a dental practice.”

Norton recommends that dentists reconsider their competition in today’s marketplace. He says that it’s not another dentist down the street, or another healthcare professional. The dentist’s competition, he says, is Disney, and Apple, and Trader Joe’s and Cirque du Soleil—because that’s what patient experiences should be like.

“When the dentist is the sole creator of value, then that stifles creativity and the application of that creativity, which is called innovation,” Norton explains. “If a dentist says, ‘I’m a professional,’ but doesn’t turn loose the creativity of their own staff, then it’s just a matter of time before they’re going to get run over by somebody with more personality, warmth and charisma.”

Customer satisfaction is critical, Norton says. He points to the HCAHPS Hospital Survey already in place as an instrument for measuring patients’ perceptions of their hospital experience.

“That’s coming to dentists whether they like it or not,” he says. “It’s just a matter of time before malpractice insurance is assigned to the level of patient experience. Why? Because everybody is already doing it.”

The best way to improve patient experience is to build a relationship that extends beyond the brief appointment time. 

To Maximize Patient Experience, Focus on Before and After

It was more than 50 years ago, but Stephen Litton, DDS, PhD, remembers it well. He was finishing high school and feeling lost; didn’t know what he wanted to do. So, when his best friend, who had always wanted to be a dentist, registered for college, Litton thought the strategy made sense.

“I decided to put down pre-dentistry as my major,” he says. “Turns out I ended up going to dental school, and my friend graduated in business.”

Life has a funny way of working out sometimes. And Litton wouldn’t have wanted it any other way.

“I loved dental school,” he explains. “I loved graduate school. I loved my 40-plus years of practice. And now I’ve moved on to another phase of dentistry and it’s very, very rewarding for me.”

Litton says he was fortunate in dental school to secure summer research fellowships. Today, most dental schools are 12 months a year, but there was no summer school back in the day. So for two summers Litton worked in orthodontics, and one summer he worked in oral pathology. He was fascinated by both specialties, and it set the stage for a decision that impacted his entire career.

“I ended up picking orthodontics,” he says. “I liked working with my hands, and I liked the idea of being able to practice a bit.”

Along the way he picked up a PhD in anatomy, and taught the subject to medical and dental students for several years at the University of Minnesota. But he acknowledges that the doctoral designation hasn’t much affected his career.

“It may look good after my name,” he admits. “Not many dentists have a PhD.”

And not many survive in private orthodontic practice for more than 40 years. But truth be told, Litton actually had two different practices over the years—one on his own, and one with two other individuals. He says it gave him “the best of both worlds,” and found running his own practice to be a good learning experience.

“Aside from doing orthodontics, which is the part all orthodontists enjoy doing, the business part of dentistry is a whole separate issue,” Litton says. But I think I was relatively successful. I ended up retiring and selling my practice five years ago. And I’m still unemployed and not running out of money yet.”

Litton says that dentistry is the greatest profession around, and that he never felt like he was going to work. He was just going to the office. But six years ago he found himself asking, “Do I really have to go to the office today?” That’s when the light bulb went off.

“I thought I’d die sitting in a chair working on a patient,” he recalls. “I really did love orthodontics. But things change. I was much older, and I needed something else to do.”

That “something else” became serving on four different dental boards, the most time-consuming of which is that of the 

, of which he is the current president. He says it’s been a great challenge, and very rewarding knowing that they’re making a difference providing dental care for the underserved in Minnesota.

“There was a finite number of people who I saw while I was practicing,” Litton explains. “At this stage I am affecting thousands of patients every year and it’s not me personally doing the dentistry, but it’s like an orchestra I’m kind of orchestrating it.”

Litton also serves as fundraising lead for the 

. Since 1994, the Mission of Mercy has been providing free healthcare, free dental care, and free prescription medications to the uninsured, underinsured, and individuals who fall through the cracks of the nation’s healthcare system. It functions in approximately 25 states, including Minnesota.

Each year the Minnesota chapter sets up a two-day temporary dental clinic with about 120 chairs, and volunteers see in the neighborhood of 1,000 people each day.

“We hope to do about $1 million worth of dentistry in the two days,” Litton says. “And it’s all free.”

It’s also long and arduous for the volunteers, about one-third of whom work in the dentistry field. But it’s also extremely rewarding.

“In Minnesota it costs about $200,000 to put on one of these clinics,” Litton explains. “We raise the money by writing grants in order to obtain donations.”

Litton says the introduction of technology has been the most positive change in dentistry during his 40-plus years of practice.

“Whether it’s computers for tracking the management of the office, or the computers used to generate restorations or figure out where you’re going to put an implant rather than figuring it out manually, technology has really made dentistry so much more efficient,” he says. “And in my estimation so much more precise.”

But there’s still much work to be done. Litton says that the advent of fluoride has had a huge impact on decay rates, but there are still many issues people can have besides dental decay. Periodontal problems are the most prominent.

“So just because you don’t get decay and you don’t have to brush your teeth doesn’t mean you won’t have dental problems,” he explains. “And I think that’s part of the education process of the dental office in educating our patients.”

Away from the dental boards and the time he spends aiding the underserved, Litton loves to travel—though he doubts he’ll ever get to visit all the places he’d like.

“I’m going to New Mexico in a couple of weeks,” he says. “That’s one of the three states left on my bucket list that I have not visited.”

The other two are Delaware and Oklahoma, but he’s confident he’ll check those off the list some time soon.

That will give him more time to spend with his four grandchildren.

“Being involved in their lives is still a lot of fun for me,” he says. “As well as just enjoying life.”

After four decades as an orthodontist, a Minnesota dentist is expanding his reach by helping organize free care for underserved and uninsured patients.