Ed Rabinowitz

Jason Champagne, DDS, was only too happy to follow in his father’s footsteps. The elder Dr. Champagne practiced dentistry in Sparks, NV for nearly 40 years. He was an inspiration to his son, as well as a great mentor. But he never pressured his son to take over the family business.

“My dad certainly left it open,” Champagne says. “But it was definitely something that I zeroed in on right away. And I never really wavered during my high school and college years.”

 do, however, is take his father’s legacy of a solo practice and build it into 

, a thriving multi-doctor, multi-specialty practice of more than 70 employees.

Champagne says that his practice, as constituted today, evolved organically. Space constraints, brought about by an association with his brother, who is also a dentist in the practice, and his spouse, a pediatric dentist in the practice, forced a move into a new facility. Both were finishing their training and there was not enough room to effectively integrate them into the existing facility.

“We took a leap of faith and built a facility,” Champagne says. “And I built it bigger than what I needed at the time in anticipation that we would grow into it.”

That foresight was key to the practice’s growth. But Champagne says it wasn’t necessarily in his mind to grow the practice to the size it is today. It was more a matter of convenience.

“I built it to that size because I didn’t want to ever have to move again,” he admits. “I built it so there would never be an operatory or chair space issue again.”

Ironically, as the practice and patient base has grown, the conversation has already begun about available chair space. Champagne says the practice is already maximizing every square foot of available space. A good problem?

“It has its challenges at the moment, logistically and managing the schedule, but it certainly is better than the alternative.”

Champagne says the biggest challenge in being a privately owned or smaller dental practice is managing the ever-growing overhead. He says it should come as no surprise that an increasing challenge is collecting full fee for procedures performed. There are more PPO insurance plans, even more capitation systems moving into dentistry, and that’s affecting reimbursement rates.

“And the cost of doing business is certainly not going down,” Champagne adds.

He explains that dentistry has always had a pretty high price tag when it comes to overhead being able to deliver high quality, high technology dentistry. That magnifies the challenge of managing profit-loss statements effectively.

“Dentists have to be the CEO, the HR director, the CFO, the main operations person, and the person delivering the product each day,” Champagne says. “It’s very difficult to wear all of those hats and do any one of them effectively.”

That’s where building a solid staff comes into play. Champagne says the key is having a clear purpose and vision of what you want your practice to be, then finding the right people who will support that vision. And make sure that vision is communicated day in and day out, because the day-to-day operations can often overwhelm and take over.

“And when a team has lost its vision, it’s very difficult for any system, any process to stay on track.”

For years Champagne was involved in the Seattle Study Club, an organization started by a Seattle-based periodontist that helped dental practitioners form small study groups around the country where dentists could meet, present cases, and talk about new techniques. He has since moved on to the Spear Study Club, organized by Seattle-based prosthodontist Frank Spear.

Champagne and his colleagues meet on a monthly basis to review comprehensive dental cases. He believes it’s one of the most important things dentists can do when operating a group practice.

“It’s what I believe can make a good practice a model for the future as far as delivering high quality dental care,” Champagne explains. “I believe that patients ultimately get better service when dentists are continually being mentored, coached and evaluated by their peers, as opposed to only being evaluated when a problem arises.”

But it doesn’t stop there. Champagne says that when patients come in for various checkups in the examination process, the dentists at his practice have an opportunity to see each other’s work. It’s an open policy to regularly review where improvements can be made.

“My rule around the office is, all of our patients’ charts within the practice are open between clinicians,” Champagne says. “We keep them open for everyone’s evaluation and input.”

Champagne Family Dentistry participates in the 

, which is recognized and supported by the American Dental Association. It’s a free day of dentistry for youth in the community that takes place at least once a year.

Champagne himself is an active board member on the local Boys and Girls Club, and regularly works with the club to determine new ways to support members of the organization through dental opportunities for care they might not normally have access to.

But he’s also aware of creating opportunities for members of his practice.

“Dentistry gives me the opportunity to grow and develop the people in my organization,” Champagne says. “As we grow, and as we’re able to expand and offer our services to more patients, we’re also able to offer more opportunities to our team members. As the organization grows, different opportunities will arise.”

Articles

A Nevada dentist followed in his father's footsteps, then guided the family's dental practice to a major expansion. He says foresight and a solid team have helped bring success.

Dentist Builds on Father's Legacy in Northern Nevada

Jessica Gott, DDS, didn’t exactly shadowbox her way through a career-determining decision, but she did "shadow" multiple professions to help narrow down and eventually finalize her choice.

, shadowed a veterinarian, an emergency room physician, a plastic surgeon, and other specialty physicians before she landed in dentistry.

“I thought being a veterinarian was pretty good,” Gott says. “I went out and delivered a baby cow. That was pretty cool. I like the whole larger farm animal type of thing, so it was a close choice. But I just didn’t know if I wanted to smell manure all day.”

For Gott, who has been out of dental school for three years, that was a good consideration.

Gott, who received her DDS from The Ohio State College of Dentistry, believes that continuing education and experience are the fundamentals to creating a good dentist. Walking the walk, she’s done more than 150 credit hours of continuing education in the past year, six times the state requirement.

“There’s always new procedures being developed, better ways to do things,” she explains. “If you look at a TV, you used to have your old box TV and now you’ve got great 4K resolution. So you really don’t know what’s best if you’re not out there learning about it.”

How does Gott determine where to invest her educational time? She focuses first on areas that will impact patients the most. After that, she concentrates on what she likes.

“There’s so many different things in dentistry so you’ve got to know a little bit about everything,” Gott says. “But if you can focus in on one thing, you can really make that shine. For me, it’s about implants.”

Gott describes herself as a new dentist, and points out that there’s so much more to dentistry than she expected.

“I learn something new every day,” she says. “The more you practice, the more you learn. With people, not every situation is the same. So it always has my attention. It doesn’t get old. I’m very happy to be in this career.”

As are a growing number of women entering the field of dentistry. Statistics indicate approximately 50% of dental school students are women. Gott believes there are specific reasons for the attraction to the field.

“I think more females are going into dentistry because it’s something where you can sort of set your own hours, and run things the way you want,” she explains. “I think more women want to be home more with their families. So if they can build their hours around a child’s school schedule, it’s a good way they can also be professional.”

Gott enjoys an active lifestyle outside the practice. She has participated in half marathons, and even the 

, a series of hardcore 10-12 mile obstacle race designed by British Special Forces to challenge the toughest of the tough.

“I grew up with two older brothers who were very competitive in sports,” she explains. “I mean, we’re so competitive that every time we get together we play Monopoly, and we’re out for blood. We’ve got our own set of rules, so you’ve got to pay attention and be up on everything. That’s just kind of my family’s style.”

Even though competing in Tough Mudder events can mean plunging into a dumpster filled with ice water, or slogging through a field of mud with live wires hanging overhead, Gott says it’s all part of the challenge. It’s also about working as a team.

“No man left behind,” she says. “It’s just something fun to do to challenge yourself.”

To prepare, and to maintain overall health and fitness, Gott is active as a CrossFit member at a gym her brother owns. CrossFit is a program that combines a physical exercise philosophy with competitive fitness sport.

“It makes me a better, overall athlete,” she says.

The Tough Mudder events also help support the 

, a charity and veterans service organization for wounded veterans of military actions following the events of September 11, 2001. And that’s another important aspect to Gott’s life: giving back. She has been a national bone marrow donor for more than nine years.

“I had a friend … when she was 19 she was diagnosed with leukemia, so she had to get a bone marrow transplant,” Gott recalls. “It’s hard to find matches. She was on a long list of people looking for a donor, and she ended up having to get one from someone in Europe.”

The procedure, Gott admits, is very painful. A huge needle is inserted into the hip of the bone marrow donor, and there’s really no effective way to numb the area. But it’s not a long procedure, and Gott feels it’s worthwhile.

“I figure, if you put yourself out there, maybe you’ll be able to help someone else just by donating,” she says. “That’s life-changing for them, and it doesn’t really cost you a lot.”

She’s also a regular contributor to the Hope for Paws charity.

“I love animals,” Gott explains. “I’ve got two of my own. Anything I could do for them I would.”

And she also does anything she can for her patients.

“There are a lot of people who say, ‘I never smile,’ whether it’s from decay or overcrowding,” Gott says. “When people thank me for giving them back their smile, that’s the most rewarding thing.”

An Ohio dentist has centered her career on hard work, adventure, and giving back.

Young Dentist Proves to be One Tough Mudder

How much is your dental practice worth? It’s important to know, whether you plan on selling at some point in the near future, are considering merging with or acquiring another practice, or need to take out a loan. There are many factors that go into determining the value of a dental practice, including the dentist.

“When banks are looking at a dental practice loan, the collateral is usually the personal guarantee of the dentist and the practice itself,” explains Dan Croft, the head of healthcare practice solutions for 

. “They look at external expert appraisals that come from dental CPAs and dental transition consultant specialists.”

And, Croft points out, they look at global debt service coverage ratio, a measure of the cash flow available to pay current debt obligations.

Croft explains that among the many factors that impact global debt service coverage ratio is the dentist’s credit, the practice’s cash flow, net income margins, number of active patient records, and location of the practice. For example, is the practice in New York City, or upstate New York?

“How quickly is it possible to sell the practice?” Croft asks.

Banks also look closely at collection sources. Is the practice fee-for-service, or is it a PPO practice? Is it a Medicaid/Medicare practice? All of those elements impact a practice’s value.

“We don’t tell you a practice is worth A, B, or C,” Croft says. “But if you’re asking us, will we lend the $500,000 against this practice, it’s not just the profitability of the practice, it’s who’s buying it. How much money do they need to live on?”

For example, an individual buying a practice who has living expenses of $50,000 is in a different category than someone needing $100,000 to live on.

“That goes into the whole global debt service coverage ratio, which impacts the ability for banks to lend against,” Croft says.

Croft says that the current market environment for borrowing money, overall, is positive. Location, again, plays a key role. In northern Virginia or other major growth markets practices are selling in higher multiples. Those are seller’s markets because of supply and demand. Rural areas, however, are a different story.

“In a lot of rural areas, candidly, there are fewer people who want to buy a practice even though they may often be more profitable than practices in urban areas,” Croft says. “Usually they’re going to sell in lower multiples, and buyers can get unbelievable discounts buying that same practice. Sometimes they’re selling for 20%, 30%, or 40% less than in an urban area.”

There are also many entrepreneurial dentists who are grouping together and purchasing multiple practices, often owning a half-dozen or more practice within the same area. That trend, Croft says, also impacts the value of a practice.

“If someone wants to sell their practice to their associate, their price might be A, where corporate dentistry might say, we’ll offer you 20%, 30% more for the same practice,” he says. “They may not get a hundred percent cash; it may be a portion of it is cash, some of it is earnings, some of it is stock. But they’re usually offering higher prices to purchase practices that are from these larger groups than if they sold it privately.”

Croft acknowledges that, when it comes to lending money for a practice purchase, more emphasis can often be placed on the dentist making the purchase than the actual value of the practice. Most banks, he says, would like to see the purchaser have at least a year or two of experience after coming out of dental school.

“You can basically get a sense of what their clinical skills are, what their production levels are, what procedures they can do,” he says. “If the practice did a million dollars, and 33% of it was hygiene and then you have $700,000 in procedures, compare that to the person who wants to buy the practice. Can they produce $700,000? Can they fill the shoes of the seller?”

For established practices, Croft says that practice management consultants can offer sound advice for maximizing the value. For example, it’s important to “move the needle” and show that the practice is making money. That means optimizing your staff as far as your ability to sell more dentistry.

“What does your average patient make and, therefore, what kind of procedures can you do?” Croft says. “Can you do some more higher-end procedures? Can you grow your hygiene department, which is a profit center? So you take a look at sort of smart efficiencies. You look at productivity and you look at ways to really increase not only revenues, but obviously decrease overhead and take a look at the profitability.”

Your practice is your life's work and your workplace. But it's also a major investment. Just how much is that investment worth? We ask a banker.

How Banks Calculate a Practice's Value

The times are indeed changing where the face of dentistry is concerned.

According to The Henry J. Kaiser Family Foundation

, there were 58,632 professionally active female dentists in the US at the start of 2016, or 28% of the total.

If that doesn’t sound significant, consider that before the 1970s, 

according to the Sindecuse Museum at the University of Michigan School of Dentistry

, less than 3.3% of American dentists were women.

And, that 28% is likely to increase dramatically in the coming years. 

According to the ADA Health Policy Institute

, 15.9% of first-year dental students were women in 1978. By 2014 the percentage was 47.7%. In addition, the Sindecuse Museum reports that women currently make up nearly half of all dental students.

“Our school enrollment has been 50-50 for probably at least 15 years,” says Laurie McCauley, DDS, MS, PhD, dean of the University of Michigan School of Dentistry.

What has brought about this gender shift, and what does this mean for dentistry going forward?

 website indicates two main reasons for the gender shift: the women’s liberation and civil rights movements of the 1960s and 1970s which resulted in federal legislation to fund grants and encourage increasing enrollments of women in professional health schools; and the impact of birth control opening the doors for women to choose professional careers.

But McCauley says there’s another reason: lifestyle.

“There have been publications looking at the motivation to go into dentistry in general,” McCauley says. “And in the US, one of the top items that’s selected as a driver to choose a career in dentistry is that dentistry provides time for family life. And it could be that women may choose that as a motivation to select dentistry more than men do.”

The numbers tend to bear that out. The ADA’s “

Distribution of Dentists in the US by Region and State, 2009

” report, 5.1% of new private practice male dentists are part-time compared with 14% that are female—nearly three times the amount.

“There is also data out there that suggests that women are less likely to own their practice than men,” McCauley says. “It’s not a dramatic difference, but there is a tendency for [women] to be more likely to be in a team practice setting.”

The gender shift is also impacting dental practices both directly and indirectly, and in particular where patient perception is concerned.

Journal of the American Dental Association

 reveal that 31% of respondents believe that leadership is related to being a good leader in their own practices, and providing the best care for their patients.

But the study also found that women’s leadership aspiration responses were higher than those of male dentists. In fact, one of the study’s authors, Marita Rohr Inglehart, Dr. phil. Habil., professor of dentistry at the University of Michigan School of Dentistry, noted that, based on study results, women might be more committed and determined to take a leadership role and break down any perceived barriers.

One of those perceived barriers could be in the form of patient care. 

, has observed a trend where patients phone in for appointments and request women dentists.

“I have asked patients why they requested a woman, and their responses are consistent,” Outericka says. “They believe women are more gentle, compassionate, and have a better bedside manner. Of course, this is not the case. But this is what patients perceive.”

Outericka feels that the only challenge a woman dentist may face is within the relationship-building process. “Time off for family matters or working part-time could impair their ability to consistently see the same patients over and over again.”

But McCauley disagrees. She finds that there are more female physicians who are linking to their communities, developing more of a community presence, and giving back through organizing charity fundraisers.

“I don’t see women practicing less than 40 hours a week as a challenge,” she says.

McCauley says that patients are at the center of a dental practice, so if the growing ranks of female dentists want to succeed the focus should be on excellence in patient care.

“I think dentistry takes seriously its responsibility in providing patient-centered care,” she says. “And I think new graduates, if they focus on that, will be successful.”

Research shows female dentists still make up only a small percentage of the profession. But that's changing. 

Analyzing the Gender Shift in Dentistry

The shortest distance between two points is a straight line. But for Mike Dolby, DDS, the path to becoming a successful dentist was anything but straight or short. In fact, it was quite circuitous.

 in Eagle, ID in 2007, attended Boise State on a football scholarship with intentions on becoming an architect. When his coaches and advisors told him that the rigors of math would take too much time away from football and suggested business instead, Dolby agreed.

It was the start of what is likely one of the most unique routes anyone has ever taken into the field of dentistry.

Dolby graduated Boise State with a degree in business management, and almost immediately took a job with the company that today is known as GlaxoSmithKline. He began selling toothpaste and other related products, and his motivation to succeed—and subsequent success—earned him a rude awakening to corporate life when he attended his first district regional meeting in Denver.

“I remember my district guy pulling me aside and telling me that I was making his numbers look bad and he wanted me to work only three days a week and golf the other days,” Dolby recalls. “So I immediately had a bad taste of what corporate life was about, and I didn’t want to have anything to do with it.”

After briefly contemplating returning to school to get his MBA, his father, a college football coach, suggested he try dental school.

“And with about as much simplicity as that, I told my employer I was going to dental school,” Dolby says. “He said it was a waste of my time.”

But it wasn’t. After completing all the necessary science courses over an 18-month stretch, Dolby took the dental admissions test and was accepted by the school of his choice: the University of the Pacific in San Francisco.

“It’s a condensed program, three years of dental school versus the traditional four,” Dolby explains. “They take four academic years and cram it into three calendar years, and you work your butt off, but it’s a great education and it allowed me to get done quicker. Because at that point in my life I was getting a little bit older. And you know, it wasn’t school anymore; it was a distinct career path.”

Dolby recalls entering dental school and telling his wife, “I wasted four years going to school to get my business degree because I’m never going to use it. I’m a dentist now.” But that wasn’t the case. Instead, he learned quickly that there is a huge void in the model of training a dentist to enter life following dental school.

They do everything they can to get a young dentist essentially safe in the clinical aspects of their profession,” Dolby says. “And there virtually is no time to teach them that they will be running a private practice on their own.”

The result, he says, is that dentists find their way into a private practice and they know nothing about it. They struggle, and the staff ends up usually running the practice as best they know how with a limited business background. That was fine prior to 2000 because the model met dentists’ needs and helped them make a living. But times have changed.

“When I first started practicing you never heard of a dental practice going bankrupt,” Dolby says. “And now you that all the time. And it’s because the landscape is much more competitive than it ever has been. You need to run your practice efficiently, run it as a business, and you just can’t stumble your way through anymore.”

Dolby’s business acumen has served him well, and now he’s passing it on to colleagues in the form of a recently released book, “

Practice Made Perfect-Blueprint for a Successful Dental Business

” that has become a bestseller on Amazon.

“I basically took the 20 plus years I’ve been in practice and really focused on practice management and systems that are needed to run a high quality, low volume practice,” Dolby says. “I’m not the guy who’s teaching others how to run a corporate dental practice. I wrote it for the everyday guy who’s out there who wants to own his own brick and mortar building. Who wants to have a staff of four or five, and a four- to five-chair practice, and practice, three to four days a week, and have a great living.”

The secret to great dentistry, Dolby says, is doing a lot of little things great and consistently. There isn’t one magic bullet. Dentists can’t provide great dental services without a great team behind them. And a perfect example, he says, is Cottonwood Creek’s Care to Share program. When current patients refer a new patient to the practice they receive a $25 credit to their account. But that $25, Dolby points out, is only the icing on the cake.

“It’s a small token of appreciation,” he explains. “Nobody ever gets up in the morning and says, ‘God, I’m so glad I get to go to the dentist.’ The only way a patient is ever going to refer a patient to my practice is if I exceed their expectations. And when I do that, it naturally happens.”

Dolby says he works hard to stay in shape, and points out that people don’t often realize that dentistry is not only mentally demanding, it’s physically demanding as well.

“We’re working in a tiny hole,” he illustrates. “There’s a tongue moving and saliva moving, and people twitch and move at the last second. You’re hunched over, and it becomes very physically demanding.”

As such, Dolby uses his spare time to run triathlons, and has even participated in an Ironman. He has also competed in obstacle racing. The physically demanding activity helps improve his endurance, because he plans to continue practicing for the long haul.

“When a patient looks at me, and I see the joy in their eye in their cosmetic case that I did, or just the experience they had, and I know they’ve been filled with horrible experiences up to this point—it’s the greatest feeling in the world.”

An Idaho dentist never expected to join the dentistry profession. However, the detours he took on his way to the clinic helped prepare him to succeed not only on the clinical side of his work, but also on the business side.

Circuitous Route Pays Direct Benefits for Idaho Dentist

 This is the second in a two-part series. Read the first story 

When your dental patient tells you that he or she can get braces from a corporate-model dental practice, it’s time to look in the mirror and do some soul searching regarding your own dental practice.

That’s just one of the many challenges 

, a practicing orthodontist with more than 30 years of experience, was faced with. What did she do?

“We decided we needed to get out of the braces market to some degree,” Galante explains, “because it’s a hard thing sometimes for the consumer to be educated about the difference between braces here or braces there.”

In other words, you have to be willing to think outside the box and make some changes if your dental practice is going to compete and survive. And Galante discusses those strategies in Part 2 of this series.

The year was 2007, and Galante, looking to differentiate herself from others in the competitive braces marketplace, integrated Invisalign into her orthodontic practice. These removable, clear braces have exploded over the last five years, but Galante benefited because she was there first.

“The biggest area that Invisalign has targeted is the adult population,” Galante says. “And we went after that adult population with a vengeance, positioning ourselves as the Invisalign adult orthodontic specialist.”

Fast-forward to today after so many others have jumped on the bandwagon and Galante’s practice is still ahead of the curve because they were the first ones in and were able to build a reputation. People would say, “If you want Invisalign, you have to see these guys, because they really have it down.” That reputation is priceless.

“And because of that we’ve been able to hold fees to a much higher level and standard than anybody else in our environment,” Galante says. “Finding a niche and getting really good at that, and focusing all your collateral marketing materials in whatever you’ve decided to niche yourself as, will keep you somewhat isolated from some of the people who are offering everything with the cafeteria.”

Linked to finding a niche is offering your patients value. Galante says it has been a cornerstone of her practice.

“I hate to have patients come walking in and I feel like I’m at a used car lot as they’re trying to negotiate with me on fees,” Galante says. “We kind of stopped playing that game a long time ago. And now we offer value. We add value.”

Galante’s practice added value by offering accelerated orthodontics—new technology that cuts patient time wearing braces in half. And the practice offers extra sets of retainers for free—a savings to patients of $500 or more.

“I encourage any clients I work with not to think discount,” she says. “Think what can you add of extra value that the patient would have to pay for down the road but that you can provide either for free or maybe at a major discount. And you still keep your dental fees, your orthodontic fees. You’re not trying to compete with the corporate office down the streets that’s doing a crown for $99.”

Galante says that corporate dental practices benefit from group buying incentives pay about a quarter of what a private practice pays for braces. And Galante knows, because she worked in one.

“They’re saving 80% on the cost of supplies,” she adds. “That makes a big difference.”

But now there are buying groups that dentists can join to obtain similar discounts to those received by corporate practices.

“I’m seeing it in the general dental world rather than the ortho world right now,” she explains. “But that’s going to expand.”

It’s part of why Galante believes that the independent dentist is going to survive. But she also believes the spirit and desire to own a private practice is strong.

“Most dentists, if you would sit down in a room and took a poll, and let’s say 50% of them might be fresh out of school, and another 50% were out of school maybe 10 years or less, I would bet that the majority of the dentists in the room, maybe 80% of them, would want to have their own private practice at the end of the day.”

That’s why Galante shares many of her strategies 

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

“In dentistry we measure everything in millimeters,” Galante says. “It’s a small measurement, but it’s huge in our industry. So conversely, take a small millimeter approach to solving whatever issues you’re having in your office. And if [the issues] aren’t small, then build upon them, and by doing that it’s achievable.”

In part two of our series, we look at how dental practices can improve their bottom lines by focusing on value without cutting fees.

Survival Strategies for the Independent Dental Practice (Part 2)

When Kourosh Maddahi, DDS, was in dental school he performed more gum surgeries than anyone else in his class. He also did more mouth reconstructions, more extractions, and more work with multiple crowns.

So his response to chairpersons of various departments when they approached him about a career as a periodontist, or a root canal specialist, was most surprising.

“Why would I want to do that?” Maddahi recalls asking them. “That is not my interest. I cannot do [those types of procedures] all day. But what I can do are things where I am changing someone’s life because of their smile.”

Maddahi comes from a family of multiple doctors. His brother is a cardiologist, his uncle a general surgeon, and his brother-in-law is an internist. As such, healthcare is in his blood, as is thinking with his mind and working with his hands. But rather than pursue a career as a surgeon, the concept of being a dentist and the art that accompanies it was extremely appealing.

“By age 13 I had already decided that I wanted to become a dentist,” Maddahi says.

Having made that decision early in life, Maddahi was able to give much focus to the college he wanted to attend—he graduated from UCLA at the age of 20—but his projections didn’t stop there. He was already planning on the aspect of dentistry in which he would specialize, as well as how he wanted to run his practice.

“When you know that what you are bound to do is something you really enjoy, you become a happier person,” he explains. “And when you’re doing something that is actually changing someone’s life, that in itself is very rewarding.”

But Maddahi’s work took on an added dimension when he began pioneering the field of anti-aging dentistry. He was working with plastic surgeons doing makeover shows where the first step was the patient’s mouth and teeth.

“When I was looking at the teeth, I was looking at how is it relating to the smile, how is it relating to the left cheek and everything else,” Maddahi says. “I started to push the envelope little by little as to make the smile a little bit more beautiful, and make it more in the correct position.”

Today he works with many plastic surgeons, even some who perform rhinoplasty, in a collaborative fashion. He’s also written a book on the subject, 

Anti-Aging Dentistry: Restoring Youth, One Smile at a Time

Several years ago Maddahi began noticing that the mouthwash he was giving patients for maintenance following full mouth reconstructions was staining patients’ teeth and temporaries. He wondered, why isn’t there a clear mouthwash?

But there was more. He also noticed that when patients used mouthwash following gum or teeth surgeries they were experiencing discomfort and more of a burning sensation of their gums. That was due to the alcohol content in the mouthwash.

“I would tell our patients who had an extraction done by an oral surgeon or gum surgery by a periodontist not to drink any alcohol, because alcohol delays healing of the gum or oral tissue,” Maddahi explains. “So why would we have alcohol in mouthwash? And the percentage of alcohol was 21-26%, which is higher than wine and beer. Why should we be rinsing with it?”

He started to investigate alternatives that are chemical-free, preservative-free, dye-free, and contain no sodium saccharin. The problem was he couldn’t find any.

“I couldn’t find a clear mouthwash,” Maddahi says. “I couldn’t find one that had no preservatives, and no dyes or anything, and no chemicals. So I decided, you know what, I’ve had it, and I’m going to create my own.”

Maddahi partnered with a colleague, a periodontist, and they started with the concept that as children, every time they had a sore throat or a problem with their gums, the doctor, the dentist, or even their mother or grandmother would tell them to rinse their mouth with warm salt water.

They also found results of a 10-year study performed on homeless children in Manila. The children, all of whom had gum disease, were asked to rub sea salt on their teeth and gums. No flossing and no toothpaste. After 10 years, their children’s gum disease disappeared.

“And that’s just sea salt,” Maddahi says. “But the taste is not good.”

So Maddahi and his partner added some essential oils for fresher breath, as well as xylitol, an anti-cavity type of sugar substitute, and organic aloe vera juice. The end result is a mouthwash Maddahi says is very pure. And it’s the centerpiece to his line of hygiene products, 

, that includes toothpaste and floss, as well as variations on the original mouthwash formula for dry mouth and sensitive teeth.

By his own admission, Maddahi lives a vibrant life. He will fly into New York overnight to conduct interviews about his line of hygiene products, then fly back for hiking, bike riding, or even heading up to Canada for some zip-lining with his family. But as near and dear as those activities are to him, everything comes back to the change he feels his work brings to people’s lives.

“There are so many patients who come to me, and some will tell me that they haven’t left their home for a year or two because they’re so embarrassed about their smile,” Maddahi says. “They’ve always been dreaming of a nice smile. I get to put in something that’s never been there. It’s that change that I can bring about in their life that is the highest level of reward.”

A California cosmetic dentist pioneered the field of anti-aging dentistry and launched his own mouthwash line. But he's never forgotten the life-changing value of improving someone's smile.

Cosmetic Dentist Brings About a Sea of Change

 conducted by the American Dental Association indicates that 86% of all dentists work as independent practitioners.

That percentage has not changed in the last few years, and thus represents the overwhelming majority of dentists compared to those who have gone the corporate dentistry route.

So, why all the angst over the growth of corporate dental?

“The overall feeling about corporate dental among my clients, the independent dentists, is anywhere from it’s something to be feared to the unknown,” explains Wendy O’Donovan Phillips, part owner of 

, a membership organization dedicated to the ongoing success of independent dentistry and dental practices. “There’s definitely a sort of negative feeling.”

But Phillips, whose organization takes an objective stance on the issue, believes that in any industry, competition is good.

“I believe that corporate dentistry really provides the independent dentist with a big opportunity,” she says, “if they’re willing to take it.”

There’s no question about some of the benefits of corporate dentistry. Corporate dental practices are very well equipped on the business side of the practice. That includes unmatched marketing, guaranteed income for providers, and vast resources that are not available to most private practice owners.

But Phillips points out that the independent dentist can look to corporate dental and learn how best to raise his or her game to better compete in this new marketplace.

“Because corporate dental has encroached, it gives the independent dentist more of an opportunity to learn from them and to really raise their ‘A Game’ on the business side of the practice,” she says. “I think some dentists are still hoping that maybe it will go back to the way it was and they could just run a Yellow Pages ad and hang a shingle, as they say in the industry, put a sign out on the road front and that the patients will come. And it just simply isn’t that way any more.”

Part of the attraction or corporate dental for practitioners coming out of dental school is the ability to get their feet on the ground, get some experience under their belts, and pay off the great deal of the educational debt they have accumulated.

“It looks like a seriously daunting task to buy into a practice or start one on your own,” Phillips says. “Going directly from dental school to corporate dental can be a good move.”

She explains that doing so provides the dentist with an immediate way to enter the industry and begin practicing while paying back those student loans. But there are different challenges in corporate dental, and practitioners will have little to no control over how those challenges are addressed. That includes non-doctor management applying pressure for increased production.

“Some become disenchanted with that lack of control, and want more control around resolving the challenges and building the practices of their dreams,” Phillips says. And it’s a huge risk. Any business owner will tell you that leap of faith they take is always a scary thing. But we’ve got some real thought leaders in independent dentists today. And those are the ones who will thrive as independent dentists. Those are the ones who will not only make the leap of faith out of corporate dental, but they’re the ones who will do whatever it takes to learn or to outsource that business side to compete on a rigorous scale with, not only corporate dental, but other thriving dental practices.”

The majority of dentists remain independent, yet the world of corporate dentistry is making a bigger and bigger impact on the practice of dentistry. Rather than fearing the rise of corporate dentistry, one expert says independent dentists should learn from it.