Ed Rabinowitz

As implants have become more popular dentists have developed the mindset that they no longer need to maintain or save patients’ teeth.

What’s the fastest growing segment of the dental industry? It might be dental implants which, according to the 

, is expected to reach $4.2 billion for US and European markets in the next four years. And an estimated 500,000 people have implants placed each year.

, acknowledges that implants, used properly, are wonderful restorative options for patients. But, he cautions, are they for everyone?

“I came on board into periodontics in the early 1990s, and people were just starting to see how useful implants could be,” Honigman says. “But they weren’t pushed to the limit like they are now.”

And that “push” could be problematic for both oral practitioners and their patients.

Honigman recalls that implants used to be the purview of oral surgeons. Not anymore. Implant companies have tapped into this trend he calls an easy fix and started offering “weekend warrior seminars for general practitioners” who want to do dental implants. Practitioners line up for a chance to learn how to put implants into an artificial jaw. The problem is, it’s not that easy.

“Placing an implant isn’t very difficult, but it’s knowing how to handle complications, and where to place it properly and what other procedures need to be done that makes it more difficult,” Honigman says. “It’s more like an art and science as opposed to just drilling in a hole and putting in a screw.”

As implants have become more popular, Honigman says that dentists have developed the mindset that they no longer need to maintain or save patients’ teeth. They’re taught, and they pass this on to their patients, that implants will never have a cavity or need a root canal. However, they will break down just as the bone around a tooth would.

“Over the last five to 10 years, (the incidence of) perio-implantitis has progressed,” he explains. “And it’s easier to fix a tooth with periodontal treatment than it is to fix an implant with perio-implantitis, because one is natural and one is artificial. And there’s nothing better than your own teeth.”

Honigman believes that properly educated and given a choice, patients will want to save their teeth because implants can be an expensive proposition. Unfortunately, when companies market “teeth in a day,” patients may be inclined to say, “I’m tired of taking care of my teeth. I just want to get implants.” But they don’t realize the potential expense.

“Just because implants aren’t real doesn’t mean they’re not going to break down,” Honigman says. “And then you’re going to face $30,000 to $40,000 worth of work. Taking all your teeth out, unless they’re flapping in the breeze, to me is not a great option.”

But there’s the financial lure, at least on the surface, for oral practitioners. Honigman says that general dentists want to do implants because they’re high tech, sexy and easy money.

“You can charge $3,000 to $6,000 for one implant and one crown,” he says “And they’re easy to do; pretty straightforward as long as you understand where the complications can occur.”

“Perio programs have fallen down at the undergraduate level, where it’s not emphasized how periodontists can help general practitioners save patients’ teeth. I work in a group practice, I see new doctors come in, and it absolutely amazes me how they don’t understand perio.”

And they don’t understand the complications, which can be costly to a practice. For example, Honigman explains that if an implant fails to integrate and has to be removed, it will take three more successful implants to make up the money the practice loses by having to redo the original implant.

“A lot of the time you have to do it for free,” he says. “You have to stand behind your work.”

Honigman stresses the importance of practitioners educating their patients. Too many general practitioner offices, he says, shy away from emphasizing the aspect of hygiene following implant surgery.

“You have to treat patients who have implants as individuals with a severe periodontal disease,” he says. “You want to catch things before they become bigger problems.”

And, as the first periodontist in Phoenix to incorporate the 

 into his practice, he’s a strong believer in saving a patient’s teeth whenever possible.

“I love doing implants,” he concludes. “But I feel better about myself as a periodontist when I save a patient’s teeth, and they’re biting, smiling and chewing with their own teeth.”

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The dental implant market is booming. However, helping patients retain their natural teeth when possible cannot only improve their overall health and quality of life, it can have a positive financial impact on a dental practice. And it cuts to what Allen Honigman, DDS, MS says is the true reason for going into dentistry: saving teeth.


Weigh the Options of Dental Implants

 Why does tooth decay happens to people who do brush their teeth, and doesn’t happen to those who don’t brush?

Brushing and flossing are not as important as you think.

Sound strange? Perhaps, but it’s one of the many myths 

“Modern dental health is a disaster zone, and many of us are missing essential routines that could prevent further damage,” Lin says. “This harms your whole body.”

“This” is the connection between nutrition and dental health, and the recognition of the oral-systemic link: our mouths affect our body, and our bodies affect our mouths. It’s also the focus of Lin’s new book, 

, released this month, that he hopes will jump start the conversation.

Lin trained in dentistry at the University of Sydney in Australia, but had a previous background in biomedical science. The latter helped form the foundation for his passion as a whole-health advocate. But the more immersed he became in dentistry, the further he moved from the idea that the body and nutrition are crucial to overall health and lifestyle.

Once he began practicing, however, he found that dentistry wasn’t addressing the root causes of certain conditions. He began looking for answers for why tooth decay happens to people who do brush their teeth, and doesn’t happen to those who don’t brush.

“These are things that pop up in oral surgery that really aren’t explained in dental school,” Lin says. “The dental industry has been telling people for some time to brush and floss and look after your teeth, but we haven’t taken the nutritional approach.”

Lin’s search brought him to the work of 

, a Cleveland Dentist (1870-1948), who has been called the Isaac Newton of nutrition because of his theories on the relationship between nutrition, dental health and physical health. Initially, Lin was unimpressed.

“I felt like [Price] had something wrong, because I had my dental training, and I had my degrees, and none of this was talked about in my degree, so it can’t be right,” Lin recalls thinking. “So I went back to practicing, but it kept bugging me.”

Lin would return to Price’s work, and also delve deeply into material from medical practitioners about the link between nutrition and health. He began to recalibrate the way he approached his own nutritional intake, and eventually “stripped down” his own diet. He found he’d been consuming a lot of sugar every day but hadn’t noticed some of the related problems: getting sick several times a year; sports-related injuries not healing as quickly; low energy level; and poor sleeping habits.

“I changed all that, and it completely shifted my body,” Lin says. “It was difficult because I had to take myself off sugar. But I found that Price’s message of eating and understanding our body from a different angle and treating it the way it needs to be treated by trying to restrict calories and meal portions made a lot more sense to me.”

Today, Lin focuses on helping his patients prevent dental disease and thus avoid treatment — a preventative approach not unlike the growing philosophy within the medical community. He looks for the root cause of disease and is convinced that diet is the cause of many oral health problems, including crooked and rotten teeth, and inflamed gums.

“We have some big problems, and I think teeth hold a lot of the answers,” he says. “There is a real movement within the healthcare industry, and I think the dental industry needs to push this along.”

Lin, for one, is pushing. His new book, The Dental Diet, is described as a journey of ancestral medicine, the human microbiome, and epigenetics. It explains the foods for healthy teeth based on the Weston A. Price Diet that not only improve oral health but overall health as well.

, MD, a physician, scholar and New York Times best-selling author, that states, in part:

“Dr. Steven Lin’s book is instrumental in shifting our perspective to complete bodily health and getting to the root cause of disease. No longer will we see our teeth and oral health as merely comprising a warning system for issues with the rest of the body. Instead, we will recognize that our teeth and oral health are functional and essential contributors to our overall wellness.”

Lin also teaches a two-day Dental Nutrition course that is PACE accredited for continuing education that has run in Australia, the United Kingdom, the United States, and Canada. The goal, he says, is to help practitioners better understand how nutrition shapes the oral-systemic connection, and how to recalibrate the understanding of dental disease.

“We as dental practitioners need to be the leaders of this conversation,” Lin says. “Unfortunately, there’s so much bad information out there and patients are confused. The dental surgeon needs to be the hub of where they can get good information.”

Lin leads an active lifestyle — swimming, running and working out at the gym, which he says helps him unwind at the end of a day.

He also loves to travel and meet health professionals from different fields. That, in part, is how he hopes to spread the word about the connection between nutrition and dental health.

“I’ve found that when people have long-standing oral disease, they do tend to reach a level of hopelessness,” Lin says. “When they understand, when they learn that their food and lifestyle can influence and have a large impact on their future and also on their children’s oral health, there is a sense of hope in their eyes.”

That’s why Lin hopes his book, The Dental Diet, finds its way into dental practice waiting rooms as part of patients’ choice of reading material. Filled with more than 300 scientific references, the book is applicable to both patients and oral health professionals.

“It’s very much designed for patients to digest and easily take this information, enjoy it, and integrate it into their treatment plan with a dentist.”

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Steven Lin, DDS, is on a journey; a journey to help educate how whole body health begins with dental health and a dental health diet. It's an oral-systemic link that Lin says today is clearer than ever. And through a newly released book and a continuing education course, he's excited to help start this important conversation.

Cloud-based systems enable dentists to work how, when and where they want.

Is it really just a question of when, not if, all dental practices will migrate to a cloud-based system?

, a software development company that provides web-based management solutions for dentists and dental groups, chuckles as he recalls being asked a similar question in the mid-1990s. He was asked, is everyone going to move to Windows from DOS?

Jensen’s answer was a resounding, “Yes, because that’s what all the software vendors are designing for. They have maybe one or two people updating their DOS system, but at some point they’re going to look at those DOS guys and say, ‘Out of the pool.’ We’re done spending resources on DOS, and moving to Windows.”

It’s the same scenario today where client-server software systems and cloud-based systems are concerned.

Jensen sets up a hypothetical scenario. Imagine you’re going to start your own software company tomorrow. Are you going to develop that software for a client-server, or develop it for the web? The obvious answer is the web.

“Every software vendor out there should be looking at the cloud and saying, ‘If I’m spending less than 90 percent of my development resources on the cloud, then I’m in trouble,’” Jensen says. “It should be 90 percent spent on the cloud, and 10 percent spent to maintain what you have on the client-server side.”

That, Jensen says, is the way doctors coming out of dental school are thinking. They’re not going to put in a server because they recognize it’s not the current technology platform standard. They recognize that their entire life is on the cloud. So why would they want to be transported back to the mid-1990s when they enter their practice?

Beyond staying current, a cloud-based system helps ensure practice compliance with audits. For example, Jensen explains that the HIPAA security rule has 19 different requirements specific to having a server in a dental practice. Eliminate the server, and you have 19 fewer requirements to worry about.

“If you have a server in your practice, in the event of catastrophic loss, you have to be able to have everything back up within 24 hours,” Jensen says. “How do you do that if you just lost your server, and it’s buried in 5 feet of water?”

If you’re thinking of putting a client-server in your practice, you’d better be prepared to shut down the office for several days of training. That’s lost revenue. But who today isn’t familiar with Facebook, or Amazon or Twitter? Or shopping and banking online? Software user interface designers are primed in thinking interoperability, and intuitive interfaces. So when an end user jumps on Curve Dental’s cloud-based management system, it has a familiar look and feel to it.

“That’s what we take our inspiration from, is the new world of surfing the internet and shopping and socializing online,” Jensen says. “Everyone already understands that anything that is highlighted in blue is a clickable and actionable item. So that’s what we mimic. We design specifically for a browser.”

Want to stimulate practice growth? Or enhance your lifestyle? Practice management software contains all the information necessary to grow your practice. With a cloud-based system, all of that information is now accessible from anywhere. It enables dentists to work how, when and where they want.

Consider a full-time dentist who’s also a full-time parent. The sooner he or she can get away from the practice means increased family time. And when the kids are put to bed, it’s easy enough to finish up some charts or analyze patient data from the convenience of their own home.

“We’ve taken all that information and burst it out from the walls of the practice,” Jensen says. “It’s much more accessible.”

So, what do you need to consider when shopping for a cloud-based provider? Jensen says the most important element is experience. Because the hard part of a cloud-based system is not the front end, not the pretty interface. The hard part is providing service to customers 99.99 percent of the time.

“Dependability has nothing to do with software design,” he says. “It’s about infrastructure. We use Amazon, and we use them because we know they’re professionals at what they do.”

And the only way to obtain that experience, Jensen adds, is through trial and error. Every time you hit a bump in the road you learn from the experience.

“We’ve had those bumps,” he says. “The only way your software can become more durable is through experience. And it can only come with time.”

Is your practice still hosting data on servers in the back room? Still closing the office for several days when training is necessary? Andy Jensen of Curve Dental, Inc., says that's crazy. For reasons ranging from stimulating practice growth to ensuring HIPAA compliance, the time is now to migrate your practice to a cloud-based system.

There is something to be said for the excitement or “newness” that comes with an equipment purchase.

Did you treat yourself to the items on your holiday wish list? Perhaps a new digital intraoral scanner? Or maybe a 3-D cone beam imaging system?

Not unlike children on Christmas morning, unwrapping a new piece of technology for your practice is exciting, heightened by all the ways you might use this new tool. But investing in technology without a plan, just for the sake of having something shiny and new, can be counterproductive. And in the end, all you have to show is a large dust collector.

National Society of Certified Healthcare Business Consultants

 and owner of the Minnetonka, Minnesota-based Management Accounting Group, Ltd., cautions against investments in new technology thinking they’re an instant revenue generator.

“If [dentists] think buying a cone beam is going to automatically increase their productivity and bottom line, patients don’t differentiate,” says Renner. “Patients don’t say, ‘I’m only going to an office that has a cone beam.’ They’re not that astute.”

Renner believes it’s incumbent on the dentist to help his or her patient understand the benefits of a procedure using a particular piece of equipment, as well as the need for the service that equipment provides. And every dentist has a different set of sales skills and a different ability level when it comes to posing cases.

Plus, it’s likely procedures done with new technology will cost more. Are you comfortable presenting a service to a patient that carries a larger fee? And are you willing to spend the time and effort to get your staff on board with the new technology?

“If dentists are hesitant in charging their patients increased fees, then adding something that’s going to allow them to present more services but with increased fees is counterproductive,” Renner says. “It’s not a magic bullet.”

But there is something to be said for the excitement or “newness” that comes with an equipment purchase. Renner likens it to buying a new pair of jeans, albeit on a much larger scale. Clothing can be serviceable for a long time, but isn’t it nice to treat yourself to something new every now and then, and add enjoyment to your life?

“That may seem trite with an office,” she admits. “But when you spend all of your time there, doing business every day, a new procedure or some new ability to perform the same old procedure in a more enjoyable way is worth the investment for the mindset.”

Do dentists need to become adept marketers where new technology is concerned? Renner says a lot depends on the dentist and his or her patient base. For example, patients of any healthcare provider tend to put a lot of trust in that provider to provide the most beneficial service.

“When we get a colonoscopy, we as patients don’t really care if the equipment is two-years or 10-years old,” Renner says. “You just need it done. And the patient puts his or her trust in the provider.”

That doesn’t mean, however, that new technology shouldn’t find its way into the dentist-patient conversation. In discussing a procedure, a dentist might want to remind the patient that a specific piece of equipment sets them apart — differentiates them &mdash; from other dentists.

“Particularly if they’re in a very competitive market,” Renner says. “But like anything diagnostic that you present to your patients, you have to tailor it to your comfort level and the patient base you’re delivering it to.”

 you invest in? Renner says there isn’t one particular item that’s a “must have” for every dental practice — especially if you’re perhaps five years from retiring or bringing in an associate to eventually buy out the practice. That new associate might be used to a specific brand or system from training in dental school.

Additionally, Renner says, the technology isn’t likely to be a deal breaker where the purchase of a practice is concerned.

“Associates are buying a stream of income,” Renner says. “If this new technology is going to bring in more income, fine. But they’re really not buying hard assets.”

Renner doesn’t see leasing new equipment as a viable option. She explains that much of the new technology today has a software component. And once you bring home the software and open the package, it’s yours. That same type of return or exchange policy doesn’t exist.

Also, Renner advises her clients not to pay for equipment up front.

“Many times you may not get as good service from the supplier,” she says. “If they’re still waiting for the money, you might get their attention a little easier.”

A new piece of equipment, complete with all the bells and whistles, may seem like a great addition to your dental practice. But patients are not as discerning. Unless you like the challenge of working with new equipment and are equally comfortable presenting these new, and likely more expensive, procedures to patients, you might want to think twice before making the investment.

Key Considerations When Investing in New Technology

And while bringing in new patients is all well and good, it’s much easier and less expensive to get an existing patient to increase treatment than to find a new patient.

The New Year is upon us. How many have set goals for milestones they’d like to accomplish during 2018? Most people, I would imagine.

But perhaps more important is will you actually 

 a cloud-based platform that enables dentists to offer affordable, comprehensive dental care plans to their patients. He acknowledges that dental practices, like any business, need goals.

“Without goals, people basically drift,” Monahan says. “What I see … is that many practices will set broad goals without specifically indicating what they’re going to do to change the performance of the group.”

And a goal without a plan is just a wish.

Monahan says there are essentially two types or categories of goals that dental practices need to consider, and the two work hand-in-hand. Practice goals, and staff goals that support the practice goals.

As an example, Monahan illustrates that increasing practice revenue might be a larger overall goal, and a related staff goal might be to increase hygiene production. In other words, increasing utilization of the hygiene department to help drive the overall goal of increasing practice revenue. And staff appreciate that.

“Employees like goals,” Monahan says. “They like knowing that what they’re doing is going to improve the business.”

Having a specific goal and knowing how that goal impacts a practice’s bottom line also improves employee morale, Monahan explains.

“People want to improve,” he says. “Employees want to improve the performance of the practice, and they feel good when they’re doing that.”

In addition, Monahan says he hears from hygienists that they often work at multiple practices in order to achieve a full schedule. What they’d rather do is commit to one practice. Setting a goal to make the hygiene department more productive creates a situation where hygienists can commit to the practice. And in doing so, morale increases.

Monahan says he often hears dentists say they want to bring in new patients or improve the productivity of their hygiene department, but they don't implement anything new to achieve those goals. Or they develop Google ads, but those don’t move the needle toward the overall goal.

That, Monahan says, is when it’s time to try something different, such as a dental membership plan. He believes that fee-for-service patients will frequent the practice about 50 percent more often if they’ve bought into a membership plan because, in effect, they’ve bought into the practice.

“They’re paying a subscription, so they’ll come in to get their cleanings, and then they’re more likely to accept additional treatments,” Monahan explains. “Plus, you have your hygiene department busier and more productive as well.”

A key to achieving goals is understanding the data housed inside your practice management software. What’s sad, Monahan says, is that very few dentists understand their practice data. They may know the practice has approximately 1,200 patients, but when asked how many come in twice a year for cleanings, the response is a blank stare.

“What I’ve seen in the data is that U.S. patients come back once a year on average,” Monahan says. “But if you could move that up to 1.8, you’re going to increase your revenue by around 50 or 60 percent.”

Too often, Monahan points out, dentists believe that an increase in revenue will only come from finding new patients. And while bringing in new patients is all well and good, it’s much easier and less expensive to get an existing patient to increase treatment than to find a new patient.

“You can set and track goals easily inside practice management software,” he says. “And it’s all right there in front of you with your existing patients.”

Monahan says it doesn’t take a lot of manpower to set, measure and achieve goals. With a dental membership plan from Kleer, for example, all of the user interface is provided to allow for easy and seamless managing of the data. And anyone in the practice can easily log in and assess the data.

As for achieving overall practice goals, practice management software can accomplish that. All that’s necessary is assigning someone to be on point for tracking and managing the data.

“And then that person is responsible for reporting the data back to the group,” Monahan says. “It’s really pretty basic, but it’s something practices often miss.”

A set of specific dental practice goals is more than just a pie-in-the-sky wish list. Goals are critical to maintaining growth and financial security. And they're easy to set, just not so easy to fulfill. It starts with a plan that is clearly communicated and ties staff goals directly to overall practice goals. The result can be increased revenue, along with improved employee morale.

The Value of Setting and Achieving Dental Practice Goals

The success is that the patients really feel that they get to be part of the treatment, and the uniqueness is how we deliver that.

	He wasn’t exactly enamored with dentistry. His childhood experiences with visiting the dentist were “pretty traumatic.” So much so that when he was 15 and his dentist gave him a local anesthetic, he recalls saying, “Holy Moly, why didn’t you do that before?”

	Even his initial experiences in dental school left him thinking, “dentistry was pretty barbaric.”

	But his brother-in-law attended dental school, and even at a young age he was empathetic, and wanted to do something to help others.

	“I knew I could do a better job than my dentist did,” Ira Kamp, D.D.S., recalls thinking.

	Today, with more than 30 years of dental experience under his belt, Kamp, who runs Integrated 

 in Ithaca, New York, is doing just that, both in private practice and in teaching others.

	Kamp has been described as a practitioner who bridges scientific medicine with spiritual healing. But he’s quick to point out that he’s not a fan of the term ‘holistic.’ What he prefers, as it’s woven into the name of his practice, is ‘integrative,’ which he defines as taking what you have and bringing in other elements as a complement.

	“Holistic tends to make this boundary, where it either is or isn’t,” Kamp explains. “Holistic was interesting because I was fascinated by acupuncture and became certified in it, but the holistic part never fit in.”

 fit in was something Kamp discovered after years of searching that he says is common to all forms of healing: a connection of the souls between dentist/healer and patient. His book, “

Journey to Mudryi: The Wisdom That Underlies All Healing

,” is a primer for better understanding the relationship between the patient and the healer.

	Mudryi, Kamp explains, is the wisdom that resides within the patient; a reservoir of guidance that the healer accesses and uses for healing the patient. He illustrates by pointing to the different results, or opinions, he received from different practitioners when being tested for various medical issues.

	“I take walks in the woods, and I had this realization that there’s a communication between the healer and the patient that gives information to the healer,” Kamp says. “But what I got is that the healer can only hear what they know. So the wisdom that’s in the patient is given to the healer in the terms that the healer knows. And that was one of my explanations why people got different opinions (from different practitioners).”

	Kamp says the connection between healer and patient, what he calls the co-cognition, is unconscious for most individuals. However, it’s possible for both the healer and patient to become conscious of the connection, and to make use of it.

	“There are things that we cover up because we have really busy minds; a lot of worries that kind of vale the communication that could happen,” he says. “I think that as you become more peaceful in your mind, the more this possibility opens up.”

	When Kamp first began discussing this connection, people thought, well, you just talk to the patient and they’ll provide the information you need. He acknowledges the importance of listening but believes there’s something else in the patient communication. The communication is unconscious, but dentists can become more conscious of it, and it shows up as an inner voice or inner feeling rather than words coming out of the patient’s mouth.

	Toward that goal, Kamp offers patients massage therapy that he doesn’t charge for. The therapy comes in the form of a head and/or neck massage before or after treatment, or even a foot massage during treatment. Kamp says the benefits are two-fold.

	“It definitely helps the patient tolerate the procedure better, but it also makes it less stressful for me,” he explains. “The work is a lot less stressful when somebody is being cared for on another part of their body.”

	Kamp has always felt it was important to make a difference in people’s lives, so he began writing “Journey to Mudryi” with that goal in mind. He began by writing about alternative methods of healing, including acupuncture, homeopathy, herbal therapy and nutritional supplements.

	“Coming to the dentist can be very stressful, and I would use herbs and remedies to help patients with that,” he says.

	He wrote the book as a way to share these techniques as well as his personal experiences with other dentists. Along the way Kamp gained a better understanding that the relationship between the healer and the patient can be experienced in a way where both individuals are empowered and at peace.

	“I really feel that’s important,” he says, acknowledging that, to some extent, those feelings “have come out of my childhood experience of going to the dentist.”

	Kamp says he does not advertise his practice, believing that word of mouth is the best way for his practice to grow as patients help spread the word. He credits his staff and a collaborative culture for making that growth possible.

	“Everyone has a unique role, and they’re all cross-trained,” he says. “We have a surgeon who handles implants, and another individual who is heavily into sleep oral appliances. That’s what makes them passionate about their work. Everyone is empowered in their own work, as well as working as a team.”

	Patients are the other part of the equation. Kamp says his patients are “empowered in their own treatment.” When he first meets patients he does not recommend a lot of treatment, opting instead to have them feel as comfortable as possible with the practice. As they begin to develop trust, he says, they become more productive patients.

	“The antithesis is that the corporate dental practices push a lot of treatment, which I think for the most part is over treatment,” Kamp says. “We empower the patients to be involved in their treatment and the decisions they make. That’s what makes the practice unique and successful. The success is that the patients really feel that they get to be part of the treatment, and the uniqueness is how we deliver that.”

Foot, head and neck massage, both before and during treatment? Doesn't sound like your typical dental practice. And it's not. Ira Kamp, D.D.S., has journeyed in search of a connection between science and spirituality. What he discovered is a wisdom that underlies all healing. And now he's sharing it with other practitioners.


Dentist Bridges Scientific Medicine with Spiritual Healing

 If you like being your own boss and can’t imagine reporting to someone as part of a management structure, you might want to think twice before becoming part of a DSO.

Do you want to grow your dental practice? Do you want to provide a wider range of specialty type services? Do you still enjoy practicing clinical dentistry, but are tired of the business management side of the equation?

If you answered, “Yes” to any or all of the above questions, one consideration might be to solicit the management services of a dental service organization (DSO). But perhaps “solicit” isn’t the correct word.

“It’s not just management of independent practices,” explains Bill Kalogredis, chairman of 

 at Law’s Health Law Department, and a member of the 

. “They basically take over the practice.”

So if you’re not ready to let go of the reins, a DSO arrangement not be for you. But if being part what is certainly larger, but perhaps also a more efficient organization that might have increased purchasing power, a DSO might be worth considering.

According to Kalogredis, the typical DSO purchases a practice from a dentist. It might be a very successful solo practice, or one owned by multiple dentists. The DSO then owns the non-clinical side of the practice — the equipment, rental control of the property, and so on. The dentist still owns the clinical practice and employs the staff.

The DSO model certainly has its advantages. Often enabling smaller dental practices the opportunity to use modern technology to provide high quality care to patients. And while it’s a model that has been catching on, the American Dental Association Health Policy Institute indicates that 7.4 percent of all practicing U.S. dentists are affiliated with 

What’s drawing dental practices to DSOs?

“Some [dental practices] have decided to get bigger, and through a DSO concept they can do so under one big umbrella, even if they’re in different locations,” Kalogredis says. “In some cases the sellers might be getting a little more money when they sell to [a DSO]. Not every time, but in some cases, they do.”

If you’re just looking to do clinical dentistry and willing to give up aspects of management, a DSO might be in your best interest — especially if you’re at the end of your career and might be leaning toward working part-time. But, if you like being your own boss and can’t imagine reporting to someone as part of a management structure, you might want to think twice before becoming part of a DSO.

Beyond control, there’s the issue of money. Kalogredis explains that the DSO purchasing your dental practice wants to make money. How will you be paid? Will it be straight salary, or a percentage of collections?

“That’s what ownership is about,” he says. “They’re buying your practice because they want to make money on the deal, and you’re going to be paid as the worker bee versus a worker being an equity owner.”

And a drawback to that type of employment agreement might be the presence of a non-compete clause. Then, if three months or six months or two years down the road you decide you don’t like the working arrangement, you’re stuck because the non-compete indicates you cannot practice within a set amount of miles of your current location.

“You may now have a boss who may tell you what supplies they want you to use, or where they want you to work,” Kalogredis says. “And unless you build it into the contract, you’re not necessarily going to pick what dentists you’ll be working with, and who’s going to cover the patients you’ve served for the last 20 years.”

Can practices — one general dentist, an orthodontist and a periodontist — band together to form their own DSO to gain similar benefits to those of larger organizations? Kalogredis says they can, but he doesn't see it happening too often.

“A lot of people don’t want to get involved in the way of management and dealing with partners,” he says. “It can be good or bad, depending on who the partners are.”

However, Kalogredis has pulled groups together — he calls them mergers — and says the resulting entity is able to expand more easily and readily, and perhaps more efficiently, because it has more subspecialties covered, just as with the DSO model.

“There’s a lot to be said for the different approaches,” he says. “But if I was a dentist — unless I’m planning to retire shortly — I don't mind just selling out to a good organization that I’m happy with and getting a reasonable price for my practice. Because I’m not going to want to be that involved any more in the management side or the administrative side.”

There's a trend afoot particularly where new dentists are concerned. The American Dental Association says that 16.3 percent of all new dentists ages 21-34 are affiliated with dental service organizations—more than twice the overall percentage of 7.4. But when weighing the pros and cons, DSOs might be an appealing model for older, more established dentists as well.

Consider that 42 million Americans, or 15% of the entire U.S. population, listen to 

weekly. To put that in perspective, that’s five times more than those who go to the movies. And overall, 112 million Americans have listened to a podcast at some point in 2017 — an 11% increase over 2016.

And dental podcasts are part of this growth.

“Last time I looked, there are about 50 podcast stations just in the dental category,” says Jordon Comstock, the founder of 

, and co-host of a podcast about navigating dental insurance. “Just this year I’ve seen a dozen or so new podcasts pop up in the industry.”

Comstock and his co-host, Ben Tuinei, launched The Navigating Dental Insurance podcast about a year ago. They cover topics ranging from in-house membership programs to how to reduce dependence on dental insurance. They bring in industry experts who provide advice to dentists on various subjects.

But dental consultants like Comstock aren’t the only ones developing industry-specific podcasts. Many dentists are developing their own podcasts as well. For example, Mark Costes, D.D.S., founder of the 

, has built and sold several dental practices. His podcast, The Dentalpreneur 

, shares the strategies he used when building his own practices.

Some dentists develop podcasts, Comstock explains, simply to help out colleagues in the industry by sharing their experiences. Others take it to another level and create conferences such as the Voices of 

, considered the biggest dental podcasting event of the year.

“Some dentists want to have a voice in the industry,” Comstock says.

But dental podcasts don’t have to be serious. Some dentists doing their own podcasts share the humorous side of dentistry. Comstock says he and his co-host always have a good time recording their podcasts and sharing funny stories.

“It’s different content than dentist are used to consuming, and I think it can be more enjoyable if you add some humor,” he says. “That’s definitely the fun part of doing a podcast.”

So, how difficult is it to create and market a dental podcast? Comstock says it all depends on who you talk to. Most podcasters, he says, start off using programs like Skype. They purchase a USB microphone off Amazon, obtain a recording software that integrates with Skype, and publish the podcast on places like iTunes.

“Sound Cloud is a great free option to host your content,” Comstock says. “And every time you post a new episode it automatically updates in iTunes.”

It’s also not expensive, but it is time consuming. Comstock says that if dentists want to start and grow a podcast, there’s definitely a time commitment.

“My co-host and I, we’ve recorded podcasts every day this week,” he says. “That’s the hardest part of starting a podcast—having the commitment, and then creating the content.”

Comstock says there are dentists and dental consultants who record and publish podcasts on a daily basis. The key is being consistent.

“If anyone out there wants to start a podcast, they have to realize it’s going to take a good amount of time from their schedule, whether they’re a dentist or a consultant,” he says. “But it’s definitely a great help to the industry.”

Comstock says that most dental podcasts run from 30 minutes to an hour, though he has seen shorter ones that last only 15-20 minutes. That gives dentists a lot of flexibility, because they often listen during their commute to and from the practice, and for those with a shorter commute or less time to listen, they can still hear great content.

Podcasts also provide dentists with the added benefit of networking. They can serve as a platform for dentists to become influential within the industry, but also serve to bring in vendors who may want to offer discounts or advertise on podcasts, which can help generate revenue. Comstock says he has advertised his consulting business on podcasts hosted by dentists with whom he has become friends. He calls it a great benefit for him as a vendor, as well as for the podcast owner.

“There are a ton of benefits, and networking is one of the best benefits of doing a podcast,” Comstock says. “Networking is one of the best skills you can develop in growing your business relationships. I think that’s why podcasts have been so beneficial.”

If you're looking for a new and effective way to grow your dental practice, you might want to consider a podcast. Millions of Americans listen to podcasts every week, and dentists are no exception. There's definitely a time commitment if you want to start your own podcast. But even if you just listen, the networking opportunities are significant.


	 It’s really important to me that we continually build those interpersonal relationships so that we work better as a team.

David Wong is a periodontist, and what really sets his practice apart is its focus on team-building activities. From hot dog eating contests that attract the likes of Joey Chestnut to Periothons that run until midnight, the focus is on creating an atmosphere and building chemistry that results in a finely tuned operation.