Ed Rabinowitz

The dictionary defines “disparity” as a lack of similarity or equality. In other words, inequality.

A Google search drills even deeper, where vocabulary.com states “disparity usually refers to a difference that is unfair.”

It would seem “unfair” indeed that, according to Ralph Fuccillo, president of the 

, referencing the Surgeon General’s Report on Health for 2000, early childhood oral diseases are five times more prevalent than asthma in children.

And Hispanic children, Fuccillo emphasizes, are at even greater risk.

“Hispanic children suffer the burden of childhood diseases at a greater rate than other populations,” says Fuccillo, noting that close to 80% of Caucasian children reach age 5 without a cavity. “I believe Hispanic children are in the 40% range.”

Much of the reason for the disparity, Fuccillo says, is the makeup of the Hispanic community, which is composed of people from many countries and diverse cultural backgrounds. As such, the biggest barrier to oral health equity is often language.

“There’s a gap in the number of Spanish-speaking dental providers,” Fuccillo says. “But there are also other life conditions. Sometimes it’s a geographic barrier, or socioeconomic differences.”

And then there are family and cultural norms—traditions about how to stay healthy. Fuccillo tells the story of his grandmother being an immigrant from Italy, and how she always had pearly white teeth thanks to her use of baking soda.

“I don’t know what dentists think about baking soda, but that cultural tradition was one that she adhered to,” Fuccillo says. “When you get into all these new technologies, new products, all of those kinds of things—how are those introduced to the Hispanic community? Do they resonate with the cultural norms of the family? Those are the kinds of things that we have to look at if we’re thinking about raising the equity level.”

Lifestyle and work are also key issues. Fuccillo explains that in some areas in the western US there are large Hispanic communities of migrant workers where the lifestyle-work process doesn’t allow for families to go to one dentist.

“It becomes extremely difficult to have one dental home.”

Fuccillo says that when it comes to educating the Hispanic population, social learning theory must be considered. This theory states, in part, “learning is a cognitive process that takes place in a social context and can occur purely through observation.” That means peer groups, whether it’s a language peer or geographic peer, play a significant role in the way people learn.

In that regard, Fuccillo says that cross-cultural communication is an important component dentists and their practice staff need to consider.

“Does the dentist have any sense or background in how people want to be greeted at the office?” Fuccillo asks, rhetorically. “We know about the importance of eye contact or touch. All of those dynamics are part of the dentist being sensitized to cultural cognitive training. Not every patient is the same.”

Five years ago, the DentaQuest Foundation embarked on a national systems-changing strategy. It’s first two goals are that by 2020, 75% of all children will reach the age of 5 without a cavity; and that the 10 largest school districts will have incorporated oral health into their systems.

“We wish that number could be higher,” Fuccillo says. But with Hispanic children hovering around 40% and American Indian children at 23% compared to the 80% among Caucasian children, the goal is about closing that gap.

The Hispanic community has experienced the largest growth among the general US population over the last 15 years. 

, the Hispanic population reached a new high of 55.4 million in 2014, or 17.4% of the total U.S. population.

“We think it’s going to be 43% of the general population in 2020,” Fuccillo says.

As such, he believes that recognizing and addressing this population change is a business imperative.

“You have to think about who your patients are,” Fuccillo says. “And enabling patients to be able to interact with you. Certainly you should be concerned about whether there are economic disparities, be concerned about whether there are enough outlets for patients to access.”

That means, Fuccillo adds, that dental providers may need to change the way they practice.

“As new people come into your community, hopefully you’ll understand the way that those economics work and establish the right touch.”

Articles

As the Hispanic population grows, so too do disparities in oral health. One expert says dentists need to do more to reach out to Hispanics.

As Ethnic Disparities Persist, Dentists Urged to Grow Cultural Competencies

The patient-centered medical home model of care has been center stage in healthcare for the better part of a decade.

Historically, as the PCMH model has developed, the first component to be integrated was primary care, helping patients navigate the complexity of gaining access to care. Behavioral health was next, due in large part to its close connection to general healthcare. And then came oral health.

Mike Monopoli, DMD, MPH, MS, vice president of foundation programs for 

, says that oral healthcare and dentistry have often been siloed from general healthcare, and tend to be about 10 to 20 years behind the trend.

“But I think there is a more conscious effort now towards looking at oral health and the developing capacity for oral health to be integrated into healthcare,” Monopoli says. “And I think a lot of the impetus comes from a sense that with integrated care, with patient-centered models, you have better patient outcomes. You have a better patient experience.”

What has delayed the integration of oral health into the PCMH-type model? Monopoli says that while co-location is a factor, the bigger issue is that systems of care are separate. Separate electronic records and separate billing mechanisms mean that even if clinical entities are co-located, they often function as separate entities that might as well be across the street or across town.

“Co-location somewhat makes it easier, but it doesn’t either help a whole lot or inhibit a whole lot when the technological issues and the system integration issues are there,” Monopoli explains.

People are also a factor. Monopoli acknowledges that change is always difficult. It can bring opportunities, but it also brings with it a sense of uncertainty. To that latter point, oral health integration into patient-centered healthcare has been met with hesitancy across the board.

“Dentists are a bit wary because they have been a bit separated,” Monopoli says. “But I think as it becomes clearer what needs to happen, and it becomes clearer that all of this is happening, whether anyone likes it or not, to be at the table and be a participant in the change is much better than having the change happen to you.”

Monopoli says that DentaQuest’s goal, rather than focus specifically on PCMH, is to make sure that whatever patient-centered models are developed, that they define the best model for patient-centeredness. He explains that while the organization is participating in some PCMH activity, its goal is broader.

“We want to make sure that oral health is there from the beginning,” he says. “To be either the driver or be in the passenger seat, at least, but definitely not out in front of the bulldozer.”

To that end, the DentaQuest Foundation has been working with organizations such as the 

 to examine patient-centered care, integration of care, and how health disciplines can interact with each other in a productive way.

Within that initiative DentaQuest has been working with a large group of physicians to develop an online curriculum for the broadest range of healthcare providers to look at oral health; to be trained in aspects of oral health across the lifespan. The training modules start at childhood and extend to a geriatric module, giving information for all of the provider disciplines about how to address oral health.

“We want physicians and other medical providers, behavioral providers, to address oral health, but we also want dentists to be able to address issues of general health,” Monopoli says. “And to make sure that referrals and navigation for patients across both are equal and well developed.”

Monopoli believes that by engaging in patient-centered oral health integration efforts, dental practices can both directly and indirectly financial benefits through more developed referral mechanisms. For example, if dentists identify underlying health issues and can refer them to medical providers, that makes their patients healthier and more apt to complete care. Additionally, when health providers see patients and refer them back to dentists it results in the establishment of robust relationships.

“I think that as health payers start to look at value-based payments and look for improved outcomes as the way to incentivize payment among providers, I think it’s going to be more and more important for dentists to have a sense of their role in promoting improved outcomes that are beyond not having untreated dental decay,” Monopoli says. “For oral health people to be at the table to be able to define what those outcomes are and what it could look like makes financial sense.”

Oral health hasn't historically played a major role in discussions of so-called "Patient-Centered Medical Homes." That could soon change.

PCMH Model Takes on Important Role in Dentistry

To that end, DentaQuest has been working with organizations such as the 

, headquartered in Kansas City, KS to examine patient-centered care, integration of care, and how health disciplines can interact with each other in a productive way.

Oral health hasn't been a major part of the move toward so-called Patient-Centered Medical Homes. That could soon change.

PCMH Model Takes on Important Role in Dentistr

How important is a smile? To Edita Outericka, DDS, it’s everything. It’s what gives a person confidence to be the best they can be. And it’s a part of people that has fascinated her ever since she came to the US from the Czech Republic as a child.

“It’s the first thing I noticed on a person,” Outericka recalls. “Due to the economy, I noticed that some smiles were not that great. And I felt like helping to improve those smiles would make for a better and brighter person.”

It was then, at the age of 12, that Outericka knew she wanted to become a dentist.

“It’s one of the most interesting things to me,” she says of the artistic element associated with improving patients’ smiles. “And providing overall health to a patient is what I find particularly rewarding. It all leads to loving what you do in life.”

Outericka is so passionate about dentistry that she recently co-authored a book, “A Cup of Coffee with My Dentist,” (Rutherford Publishing House, 2015) in which she and 10 leading dental practitioners attempt to dispel some of the negative myths associated with the craft.

“The main reason I wanted to write the book is I wanted people to see through my eyes why dentistry is such a rewarding field,” she says. “I wanted them to understand the importance of how dentistry plays a role in patients’ overall health. And being treated in a comfortable, honest, and friendly environment.”

Outericka acknowledges that many patients are fearful about going to the dentist, but that fear is easy to overcome if relationships are built and trust is cultivated. It’s a message her fellow dentists were only too happy to share.

“Dentistry is one of the fields where if you ask most people they will tell you mostly negative things about it,” Outericka says. “We wanted to come together and say, ‘Hey, it’s not negative. It’s a great field; it’s a great place to be comfortable and be happy, and get rid of all that fear that people feel when they come in.”

The book also chronicles many of the hardships she experienced as a child coming to the US with nothing, the sacrifices she and her family made, and working hard to accomplish her dreams and goals. Today, she continues to see her dreams come to fruition.

“At this point we are expanding our practice to a multi-specialty practice,” she says of her Mansfield, MA-based 

 practice. “It will be a very large practice to accommodate patients; to be able to do all their treatment in one place.”

Building that practice was no small task. Outericka says the greatest challenge has been putting the right team together.

“I have a team that has to be with me on the same page, and treats people the way they want to be treated,” she explains. “Our practice is extremely honest, extremely energetic. Happy team is happy patients. And they work very hard to make that happen.”

That creates an atmosphere that is not lost on the patients.

“Every patient will tell you that the reason they come to our practice is because yes, we do a good job in dentistry, but they also come in to socialize with us and be comfortable,” Outericka says. “That’s so important.”

It’s also important that Outericka has surrounded herself with staff member who believe in and support her vision. Finding and bringing together people who have never met before and getting them to work to accomplish the same vision that she believes in is something she says she works at every day—especially since the practice is expanding.

“I’m increasing team members and growing,” she says. “I think the challenge is to get them trained, educated, and on the same page as me to make this a great practice.”

Despite working hard at her practice, Outericka recognizes the importance of taking time to stay active and take care of her overall health.

“If you can’t take care of yourself, how can you take care of other people?” she asks, rhetorically. “And that includes your team, your family and your friends.”

As such, Outericka sees herself as a role model. She is an avid athlete who regularly competes in triathlons and half-marathons. But she’s not alone. She will often involve the entire practice in working with members of the community, such as the local police department, to sponsor and raise money for charitable events.

“We come together and have a great day, and then have a barbecue afterward,” she says.  Just being able to take the money from events to donate to kids in need or school sports is a great feeling. And we do that often.”

But she also knows how to slow down, read a book, or sit on the beach and watch the sun set.

“I try to balance everything,” she explains, “take it all in and enjoy how life treats you.”

In the end, of course, it all comes back to her patients and their smiles. Outericka believes a person’s smile is a perception of their confidence. When a patient won’t smile, it hurts, because she believes it has a negative effect on their lifestyle. Her goal is to turn that around.

“Whatever it takes to make a smile come alive, and to increase their confidence — putting in veneers or putting on crowns or straightening their teeth,” she says. “Because when they walk in the room and they’re smiling, it’s so rewarding. We’re not just here to drill their teeth. We’re here to connect and help each other.”

And when she can accomplish that every day, then it has been a good day.

“When I go to bed at night, and put my head down on the pillow, I feel like I’ve made good decisions,” she says. “And the only way to accomplish that is to be true to yourself, and honest to others. No regrets.”

How important is a smile? To Edita Outericka, DDS, it's everything.

Changing Lives One Smile at a Time

Real estate decisions are crucial for dental practitioners. Why? For starters, medical office leases tend to belong-term deals, and have the potential to have a great impact on the future of the dental practice.

In addition, the logistics can be daunting. No one wants to pick up and move all that equipment and technology twice within a year or two.

“Just the plumbing component to a typical dental build-out is substantial,” says Phil Denny, co-owner of 

, a Chicago-based real estate investment and development company. “When dentists and doctors build out a space in your building, they’ve got to make such a substantial capital commitment to the premises that they end up staying for tremendously long periods of time.”

And as the saying goes, the three most important things to consider in real estate are location, location, and location.

Denny explains that over the last few years there’s been a trend by different segments of the population, from millennials to baby boomers, to move into downtown areas and create neighborhoods. In turn, that trend is driving development opportunities for commercial office buildings, restaurants, schools and medical office buildings.

“There’s a trend in Chicago, and I know it’s alive and well in other cities too, of people wanting to live closer to where they work,” Denny says. “And there’s a trend of companies moving back to the cities to try and attract the talent that’s in those areas.”

What happens is a domino effect. As neighborhoods begin to develop around restaurants, nightlife and office complexes, apartments, condos and schools will follow. Likewise, the need for services like medical and dental. All of those elements, Denny says, begin to play off one another.

“It’s just a common path that seems to occur.”

Denny explains that when it comes to real estate, it’s critical to any business to find the absolutely best location for the best price—and dental practices are no exception. One aspect to addressing that challenge is for dentists to work with a reputable real estate broker who can assist in finding neighborhoods with populations that will enable the practice to operate successfully.

For example, Denny’s firm recently signed three medical office leases for dental-related service providers, and the role of the real estate broker was invaluable.

“We worked with a broker who really specializes in assisting dentists and dental-related practices find the ideal location,” Denny says. “He was very knowledgeable about alternatives within different neighborhoods, as well as issues like parking, proximity to residential buildings and schools. It’s critically important that the broker understands the uniqueness of what a dental practice might require.”

Denny says dentists are so busy with their practices that they don’t have the time or the ability to conduct a search the way a knowledgeable broker might. For example, the availability of parking proved to be a key factor for all three of the dental practices that recently signed leases with Denny’s firm.

“Those decisions (made by the dental practices) were really based on almost a triangulation of schools that are new to the area and residential developments that are in the area as well,” Denny explains. “I guess the assumption is that somebody is picking up the kids at school—and on their way home or on their way to the grocery store there’s a dental practice that’s nearby that has parking. Parking seems like it’s a really critical part of the decision process.”

Denny says that when dental practices make a large capital investment in real estate, something that often gets overlooked from a strategic perspective is how the rent will increase over time.

“For somebody making a large investment in building out their space, you would like to see as long an initial term as possible,” he says. “Ten or 15 years, for example.”

Alternatively, however, it’s in the best interests of the developer or business owner to try to limit the length of the initial lease, thus providing an opportunity to increase the rent comparable to other real estate in the neighborhood. Often, there may be a provision in an initial 10-year lease allowing the landlord to increase the rent during the renewal option if the neighborhood has grown and/or improved.

“That could effectively double a dental practice’s rent,” Denny says.

That means it’s particularly important for dentists to be well advised in terms of legal counsel, but also with regard to their real estate broker.

“A good attorney or a good broker will help a dentist secure as long a lease as possible,” Denny says. “They’re critical to protecting dental practices from seeing their rents increase substantially through option periods. And they know how to drive the best possible bargain for their clients.”

Real estate trends could have a major impact on the long-term growth of your practice. When signing a new lease, follow these tips to ensure you're well-positioned, geographically and financially.

Maximizing Benefits of Dental Real Estate Trends

Maureen Perry, DDS, MPA, was a little confused as a child.

“I had a lot of dental work as a kid,” Perry recalls.

So, she and her mother frequented the dentist. And at the end of each visit, her mother would pay the dental assistant—who doubled as the receptionist in the small practice&mdash;at the front desk. That impressed Perry, who told her mother, “I think I want to become a dental assistant.”

Perplexed, her mother asked why, to which Perry replied, “Every time we go there you always give her money.”

Perry’s mother corrected her. “The money goes to the dentist, not to her.” Now fully informed, Perry changed her mind. “Oh, then I want to be a dentist.”

The irony, says Perry, the associate dean of 

A.T. Still University’s Arizona School of Dentistry & Oral Health

 in Mesa, AZ, and director of The Center for Advanced Oral Health, is that she wound up in academia and specialty care.

“It’s probably the least lucrative of all dental practices,” she laughs. “But I still have a lot of fun.”

Perry has seen first hand the changing demographics in the field of dentistry. She recalls attending dental school 25 years ago when approximately one-third of her colleagues were women.

“It was a big deal,” she says, adding that instructors often remarked that, “We’ve never had this many women in a class.”

Today the demographics are more 50-50. Perry says it’s because dentistry is a great job for women since they’re not usually on call, and they can have regular hours. She also thinks it’s a societal issue.

“There are more women and more minorities going into dentistry because that’s the makeup of our society,” Perry explains. “There’s still a glass ceiling, but we’re getting there.”

“When I was a younger dentist people would think I was the hygienist,” Perry recalls. “They would ask, ‘When is the doctor coming in?’ And I would say, ‘I’m already here.’ But I think that’s old school now.”

Perry has also served as president of the 

, a national organization promoting oral health for people with special needs. She defines people who need special care as falling into one of three or four groups. It includes people with educational or developmental disabilities; individuals with behavioral and cognitive disorders; geriatric patients who might be experiencing dementia or Alzheimer’s; and those patients with a complex medical history.

“We need to really look at the patient and say, ‘Well, does this patient need to be pre-medicated, or does the patient need to have laboratory work before it’s safe to treat them,’” Perry explains. “We need to touch base with their physician and work as a team.”

Perry’s attachment to these patients began when she was a young resident working at Jacoby Hospital in the Bronx, NY. Many of her patients were mentally disabled individuals who had recently been turned back into the community. But services for these individuals were sparse.

“The average dentist wasn’t trained for that,” Perry says. “So they would come to the hospital and I started seeing them. And I found that I really loved working with that population. It’s a really underserved population, and a very grateful population. And dentistry is certainly the most unmet need of patients with developmental and intellectual disabilities, from a healthcare standpoint.”

The Center for Advanced Oral Health that Perry oversees encompasses the 

—a general dentistry clinic for people who need special care dentistry. Perry is responsible for the residents’ training, all the treatment they render, as well as all the patients.

“We have students who have had a lot of community service,” Perry explains. “Not just the kids who say they want to do it. They actually have to show us that they’ve had community service in order to even be interviewed for a spot in our dental school.”

Taking that approach means not simply accepting the brightest students who want to become dentists and teaching them about the underserved populations. It means taking young students who already work with underserved populations and turning them into dentists. And after 10 years, the program has been extremely successful.

“More than 30% of our current students are either working in public facilities, in hospitals, or in the armed services,” Perry says. “It’s not an experiment any more. It’s working, and it’s pretty exciting.”

Perry laughs when asked about how she likes to spend her spare time.

“Yeah, I’ve heard that there are people who have spare time,” she says. “People ask, ‘What’s your hobby?’ And I say, ‘I don’t know. I work a lot.’”

Kidding aside, Perry describes herself as a “voracious reader” who feels that Kindle is the best invention ever.

She also likes to travel, most often for work, but her family will accompany her and they’ll tack on a few extra days. She’s done mission work with the US Navy in Jamaica, and also visited Qatar to work with the local government on developing a special needs program.

“It’s fascinating,” Perry says of her travel experiences. “It’s great to meet colleagues in different countries, and learn about what they’re doing.”

But the most rewarding aspect of her job, Perry says, is the hugs she receives from patients.

“Everyday we see patients who are so grateful, and they hug you, and they’re happy to see you,” Perry says. “That’s the most rewarding thing. It‘s like, the patients actually want to come to the dentist, and they love seeing you. That’s just great. I mean, that’s what it’s all about.”

Maureen Perry first became interested in dentistry as a child. As an adult, she found a calling in special care dentistry.

Arizona Dentist Builds Career Serving Underserved Populations

Quick trivia question: How long has digital dentistry been around?

Five years? Guess again. Ten? Not even close. How about 25. That’s right—25 years. The technology has been around for quite some time. And yet, according to Derek Diasti, CEO of 

, only 5% of dentists are taking advantage of it.

“About 95% of dentists still take traditional impressions,” Diasti says. “They put that silicon material in your mouth, you bite down on it to make an impression, and then they send it to a lab.”

That’s time and money not necessarily well spent.

Diasti says there are several reasons for the slow adoption of digital dentistry: cost, complexity, and consumers. But a lot has changed over the last few years, particularly in the area of cost and complexity.

“It’s a lot simpler to do teeth today than it was two years ago,” Diasti explains. “Previously, the technology was not user friendly.”

Dentists, Diasti says, would take a visual scan of the patient’s mouth, design the tooth, and mill the tooth in their office—virtually becoming a dentist in a lab. The work could be done the same day, but it was a cumbersome process that was also very expensive. In addition, consumer demand was non-existent.

“There’s a lack of consumer knowledge,” Diasti says. “They should not accept a traditional impression, because digital is here, it’s good, it’s high quality, and it’s efficient.”

Sun Dental Labs has developed a digital “workflow” that involves using an intraoral scan that creates a digital impression of the patient’s mouth. The dentist can check the image immediately on a laptop to make certain all is right with the impression. Then the image is sent electronically to the lab where dental technicians create the needed restoration.

Diasti says that the workflow, which the company calls digital solutions, is easy to work with. Dentists can purchase the digital scanner from Sun Dental or anyone else.

“We’re agnostic to the digital scanner,” he says. “You just download our user interface, and that’s it. You can see the design on your laptop, and approve it before it goes to machining. Basically, you’re taking a 3-D copy of the tooth.”

The digital solution is also cost effective. Diasti says that the scanner, software, warranties, and training cost $299 per month. So, if the cost of one impression is regularly $30 and the dentist does just 10 impressions a month, the digital solution pays for itself.

“And the data is stored in a cloud forever,” Diasti says. “If you have a broken tooth, if the patient needs to come back, you just go back into the cloud and order a new tooth. If the shade is different, you can just change the shade. It has really gone from analog to digital. You have access to all your data, and you don’t have to wait until the lab opens up on Monday morning. You can see everything.”

The one-day training can even be done online. For example, if a patient has a 10 o’clock appointment and the dentist contacts Sun Dental ahead of time, the technicians can log into the dentist’s scanner and computer and walk the dentist through the process.

Diasti says the digital solutions process is extremely efficient compared to traditional methods. With conventional methods, the dentist preps the tooth, and the dental assistant has to mix the putty in a tray to take the first impression—which then sits in the patient’s mouth for several minutes. Once the impression is completed, it must be shipped to the lab, which adds another day or two to the process.

“And then they have to pour a stone model in the impression to see if it’s a good impression,” Diasti says. “So that’s a second or third day. With [the digital workflow] you can tell that immediately.”

In addition, Diasti says that dental assistants can perform the scanning, making more productive use of their time, and freeing up the dentist to do other work.

“All the dentist has to do is make sure it looks good.”

Diasti says one of the more important benefits of digital dentistry is the improved patient experience.

“I really believe that in the next five to 10 years consumers are going to drive this change,” he says. “And this is smart business. It’s faster, cheaper, more efficient and more comfortable. If you want to stay in business, it’s a differentiator.”

Younger dentists, he says, will also drive the change.

“They’re the Apple generation,” Diasti says. “That’s what they’re used to. It’s not going to be difficult for them to adopt. They will demand it.”

Digital dentistry has been around longer than you think -- much longer. One industry executive says he believes wide adoption of the technology is finally on the horizon, with consumer demand driving the uptick.

Is the Era of Digital Dentistry Finally Here?

For Steve Lamberg, DDS, the apple truly did not fall far from the tree. The 

 followed in his father’s footsteps. He spent considerable time at his father’s practice as a child, and always enjoyed sculpting and science.

“Dentistry seemed to be the only profession where you could be involved in science and art at the same time,” Lamberg explains.

And that might have been all there was to tell were it not for a patient with a very specific problem in 2004. That patient—a physician, and friend from Lamberg’s book club—said he his wife complained that his snoring was keeping five people in the house awake every night.

“He begged me for an oral appliance to treat his snoring and apnea,” Lamberg recalls.

To be accurate, the appliance didn’t come about overnight. Lamberg went through several iterations of devices—six to be exact—in an attempt to cure the patient’s sno∏ring and sleep apnea problem. None of them worked, or were to the patient’s liking—mostly because they were too big and bulky. So Lamberg decided to come at the problem from a different angle—from the realm of dental sleep medicine.

“I began playing around with these little devices called de-programmers,” Lamberg says. “And it worked. An∏d he was happy.”

The physician was so happy that he referred many of his own patients to Lamberg. Some of these patients had reflux issues, others had endothelial dysfunction and a variety of other conditions that—in addition to their snoring—all seemed to disappear by using the Sleep Well Appliance.

American Academy of Dental Sleep Medicine

 and never looked back. At the time there were about 700 members; today there are approximately 4,000.

“I started taking courses everywhere I could, and have not missed an Academy meeting,” Lamberg says. “Four years ago I got boarded in dental sleep medicine. And after that they asked if I wouldn’t mind teaching their board review classes.”

Before long his sleep practice was equivalent to his dental practice.

“And that was without really trying,” he says. “I found it very gratifying because you’re helping people feel better, and helping them with conditions that have other negative impacts on their health.”

Lamberg went on to have the appliance patented, FDA approved, and approved for Medicare patients. He says it has been a long, fun journey, and very rewarding in more ways than financial. That latter aspect relates to helping other dentists integrate dental sleep into their practice.

“Taking impressions, there’s no learning curve,” Lamberg says. “Fitting the appliance, there’s no learning curve. It’s like so many things we do already. The big learning curve is how to implement it in your front desk and management areas.”

He explains that dental insurance is the same as medical insurance with respect to pre-authorizations to ensure which procedures are covered and which are not. In addition, a diagnosis often must first be made by a physician before Lamberg can treat them. So, if a patient comes to his office, says they snore and wants to use an appliance, Lamberg can not simply provide one because then he is making a diagnosis that the patient doesn’t have apnea.

“If they say they snore, then they have to see a physician and be diagnosed that it’s not sleep apnea,” he explains. “Then we can make the appliance.”

 to help teach dental sleep medicine to dentists.

“One of the things that I teach is how to screen a patient,” Lamberg says.

He explains that the average dental practice has approximately 1,000 patients, and about 20% of them—or 200 people—need the Sleep Well Appliance.

“This is something that’s huge and they don't realize it,” Lamberg says. “But they can build a business. And once they treat the first couple of hundred patients, they’ll be developing relationships with all the physicians in the area.”

Building relationships with all the specialists in the area takes time, but Lamberg says it’s time well spent.

“Ninety-five percent of my referrals are from the pulmonary guy,” he says. “And the rest I get from patients referring patients. It’s very low stress, because you’re taking impressions and adjusting appliances. But it’s a very profitable area.”

Lamberg lives a very active lifestyle away from his practice. He enjoys a wide range of activities including sailing, yoga, and cooking.

“Yoga can tie you into the spiritual side of yourself,” he says. “Everybody has some of that, and it’s nice to be in touch with it.”

But he also likes being in touch with nature, biking, and hiking through the mountains.

“It’s physical, but also aesthetic,” he says. “It’s nice to clear out your head and go for a long bike ride, run or swim.”

Lamberg believes it’s important for people to have balance in their lives. He uses his dental practice as an analogy.

“Treating sleep apnea patients is a nice balance from filling holes in teeth, and making veneers and crowns,” he explains. “You do all that stuff, but it’s nice to take off the magnifying hoops and just talk to the patient. Get to know them, and find out what their lives are really like.”

And he’s grateful for the impact he’s been able to have on people’s lives. Like the 70-year-old gentleman who told him, “Thank you doctor, I’m now sleeping with my wife again.” Or the patient who was on medication for reflux and couldn’t stand the side effects, but now doesn’t need to rely on the medication.

“You change people’s lives, and have an opportunity to make them feel better,” Lamberg says. “And that’s very rewarding.”

A patient's snoring problem led to a vast new career pathway for a New York dentist.

Dentist Grows Practice Through Dental Sleep Medicine

When you think of “metrics,” what comes to mind? Probably measurements like liters versus gallons, or kilometers versus miles. Or, if you’re into sports, you’re likely aware that Advanced Metrics is the term for the empirical analysis of sports, particularly statistics by which managers and coaches make important decisions that impact the outcome of a game.

Some sport franchise general managers will use metrics in an attempt to build a winning team. And now that philosophy can be used for hiring purposes at dental practices, thereby building your own personal winning team, through 

“It’s an online job site where people can find each other, they can connect, and then you can build a team using metrics,” explains Tonya Lanthier, RDH, founder of DentalPost. “You can actually pick a better hire by using metrics.”

Lanthier explains that metrics, such as the DiSC personality test, core values and work culture assessment can help dentists make better, more informed decisions when it comes to assessing potential employees.

“We all make decisions when we buy something,” Lanthier says. “We use data from reviews that people put on the Internet. That’s what [using metrics] is.”

More specifically, it’s data on people about their personalities, about their core values. If core values match, people are more likely to align, and more likely to “stick” in a practice.

“We tend to hire people that are a lot like us,” says Lanthier, noting that if you hire someone based on personality match, you’re more likely to get along and complement one another. “But if you hire two dominant people, you’re going to butt heads all day and not get anything done.”

Work culture assessment is another metric to consider. Is it a fast-paced office, or more slow-paced? Is it high technology or low technology? Answering those questions through an assessment will help determine if the person you’re considering hiring will be happy, which translates into increased productivity, in your office environment.

The film "Moneyball" tells of how a baseball team executive used data to build an optimal team. Now, similar metrics are being deployed to help dentists build a staff.