Janice Janssen, RDH, CFE, combines her years of clinical expertise and well-rounded management experience to position herself to provide high-quality consulting services. She has earned the designation of “Certified Fraud Examiner,” which finds her investigating misappropriation of funds in dental office and, just as diligently, working to rebuild the practice. Janice is a co-founder of Global Team Solutions, a practice management consulting firm, a professional speaker, and published author. You may reach her at Janice@GTSgurus.com.

Janice Janssen, RDH, CFE

	On August 2, 2016 the dental world was turned upside down when Jeff Donn released an article titled 

Medical benefits of dental floss unproven

 was published, you could hear a collective sound across America of people digging deep in their bathroom drawers and throwing out the years of floss that had been put into their hygiene bags. People were now given permission to not do what so many claimed they did, but didn’t actually do anyway. No more having to make that embarrassing confession to the hygienist every six months when asked, “How often are you flossing?”

Related reading: Is the Associated Press right? Response to the AP regarding the benefits of flossing

	Donn’s article cited several reasons that flossing does not help avoid gum disease and that this is nothing more than a marketing ploy by big businesses like Proctor & Gamble to sell this useless piece of string and the American Dental Association (ADA) to charge for the seal of approval to these companies. He continues by saying that the ADA and the AAP (American Academy of Periodontology) cite studies to prove their claim that flossing prevents buildup, plague, gingivitis and tooth decay; however, these studies used outdated methods and tested few people.

	‘Outdated methods’ is an interesting statement because the method of flossing has not changed, in any dramatic way, since Levi Spear Parmly invented it in 1819. There have been slight adjustments with the wrap around method vs sawing and/or snapping the thread but no major changes in the methodology.

 is where I have to take an extreme exception to the theory in his article. Let’s look at this in a logical manner. How do you prove that floss does not prevent gum disease?

	In order to have a valued study you need to have two groups of people; Group A and Group B. All participants must possess the exact same oral and medical health, since we know that things like chemo, tobacco, diabetes, pregnancy, etc., affect the health of the gums. This study is already dead in the water because we know that is it virtually impossible to find two people that meet this requirement, much less enough to exceed Donn’s definition of “few.” However, since we are working on theoretical information anyway, let’s continue with the discussion.

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	Next we need to set the parameters – Group A will be the flossers and Group B will be the non-flossers. This is where the study must stop. We are trying to prove that flossing does not prevent gum disease – that means that if we ask a group of people to stop flossing and they acquire periodontal disease, an irreversible disease that has been linked to other medical issues like heart disease, we have performed a study that is completely unethical. This would be similar to getting a group of people to begin smoking to prove that it doesn’t cause lung cancer.

	How do you prove that flossing does or does not prevent gum disease? The simple answer is that you really can’t and remain ethical in your studies; however, I have seen first-hand that patients who floss have less bleeding, inflammation and plaque than those who do not. Therefore, they have less gum disease. As a hygienist I could tell those people who actually flossed and those that didn’t merely by the health of their gums. I realize that some people like to think that hygienists are just saying that to get you to floss, but I will tell you if you bring me five people who floss and five that don’t, I will be able to pick them out without a problem. For me, I say irrefutably that flossing is an important part of a patient’s daily hygiene routine. Sorry folks, unfortunately you are going to have to keep flossing. I hope you didn’t throw away all of your floss!

Articles

A response to the recent article that stated flossing did not help gum health.

To floss or not to floss?

, we talked about the emotional toll embezzlement can create in your practice. The good news is that you can get past this. It doesn’t seem like it at times, but you will move on.

How are you going to do that, you ask? Well, how do you eat an elephant? That’s right â¦ one conversation at a time. That is the key! You have to talk about it. Get it out in the open. The more we whisper about it and not have the conversation, the bigger that elephant becomes. You need to break it down piece by piece.

. Even if you start your meetings for the lunch hour and bring lunch in, that’s OK. You need to start. Topics for the meetings should include each of the following:

This is not comfortable for a lot of people, but there should be a discussion of how each person feels about what happened and how it has affected them. Everyone should be open and honest in addition to feeling safe enough to do so. Tensions are running high and everyone needs to be able to express their feelings with the “family” or “team” with which they are in the trenches. This is not an easy thing to do, but is necessary for recovery.

Another topic of discussion needs to be what the “company line” is going to be to patients. You have to be very careful what you say about an employee who has left because he or she was stealing, especially if that person has not been convicted yet. It’s also important to tread lightly because you do not want your patients to lose confidence in you. The other piece to talk about is explaining to patients if their balance is incorrect or they say they made a payment that is not reflected on their account. Everyone needs to be on the same page with what is said and how these questions are answered.

It is time to start rebuilding trust and get everyone rowing in the same direction again. You will either want to find some team-building activities to do with the team, or have a consultant or trainer come in with some activities. Focus on rebuilding trust and increasing the communication within the practice.

Interesting read: 3 things your practice can learn from Starbucks

Always remember, it’s OK to ask for help. Your practice has just been through a very difficult event. Seek advice and help from others. There are many people out there who have been in your shoes and are happy to help you.

The other thing to remember is that you have discovered this wrong that has been bestowed on you â¦ and it has stopped. Your money is “yours” again. Let’s rejoice in that. You can now put processes and safeguards in place to minimize your chances of this ever happening again. It is a time to rebuild.

Rebuilding hope and trust after embezzlement in the dental practice

It happens all over the country, every day, to two-thirds of all businesses. Some business owners are aware of it â¦ others will probably discover it soon. What is happening? There is a rogue employee who has decided to pull a bit of extra funds out of the office’s bank account and into his or her own account. Let’s take it out and give it a name â it’s called fraud, misappropriation of funds, or by its more common name ... embezzlement!

Has embezzlement occurred in your dental practice? If it has, chances are there is a lot of confusion and discord happening in the office and no one knows what to do. When something like this occurs, it has a profound effect on the entire practice. Most people do not know what to do or even where to start.

Depending on how the embezzlement was found and where you are in the process, there are many steps that will need to be taken:

All kinds of craziness begins happening within the practice walls.

What is not addressed (and quite often never talked about) is how this awful event affects the dynamics of the team. The systems in the office will need to be reviewed and refined. There are many emotions occurring that no one knows how to handle, nor has anyone taken the time to consider.

It’s high time we pulled the elephant out from under the rug and begin the conversation. What emotions are associated with the embezzlement?

- It is right and natural to feel this way. If you are the doctor, someone just stole your money. For the doctor and/or team members, you just found out a trusted friend has stolen money from your place of business. This is very disconcerting; something you do not want to believe is possible. No one trusts anyone nor does anyone feel trusted.

- There is a sense of loss in the practice. Someone that has been a co-worker and quite possibly a friend is now gone. More than likely, it was the office go-to person, so the feeling of loss is prevalent.

- What do you do now? How will you find out how much money was taken? How it was taken? How will you prevent it from happening again? Which patient accounts were affected? How will you correct the errors?

- Could this happen again? What if someone else is stealing or starts stealing? How will I know? It is the fear of the unknown because you never thought this would happen in the first place.

- You are mad â¦ and rightfully so! Someone stole your hard-earned money. Everyone thinks this just pertains to the doctor, but it really affects everyone. For the team members, you may have had a bonus or bigger bonus if not for this embezzler. There may have been more money for a raise. You may have been able to get that new equipment you all would like to have in the office. It truly affects everyone!

- You really do not want anyone to know because it looks like you were not taking care of your business. Could you have done something to prevent it? Remember, this is happening in three out of five dental offices across the country. You are not alone. Don’t be embarrassed.

- You never thought this person would be capable of committing a crime. How could you not see it? What else is happening that you do not know about?

The embezzlement has happened. This is the time for the entire team to lock arms and tackle the fear, sadness, confusion, and anger together. There will be more questions than answers at first and the team needs to know how to explain to patients where the missing employee went and why patients have a balance when they swear that they paid on their accounts. The elephant needs to be front and center in all team meetings. Together, you can handle all the craziness that is about to take place, while you still focus on patient care.

In the next article, we will discuss that there is hope and you can rebuild. Stay tuned!