Louis Malcmacher, DDS, MAGD is a practicing general dentist and an internationally known lecturer and author. Dr. Malcmacher is president of the American Academy of Facial Esthetics (AAFE). You can contact him at 800-952-0521 or drlouis@FacialEsthetics.org , or visit FacialEsthetics.org.

Louis Malcmacher, DDS, MAGD

	I don’t know about you, but I’m pretty tired of reading doomsday articles about dentists and dentistry. Many times, dentists research articles about the future of dentistry and come to the wrong conclusions based on the data.

	Anyone who compiles data and conducts statistical research will tell you that’s the wrong way to look at a research paper. It’s up to you to understand the data and learn how you can improve your practice. Don’t let data become a self-fulfilling prophecy for you. The conclusions reached for any research study are the authors’ suggestions for lessons for you to decide how you want to move forward based on the data.

Related article: The top 5 ways cosmetic dentistry can benefit your practice

	Let me give you a good example. The American Dental Association Health Policy Institute (

) is an excellent resource for any thinking dentist. Marko Vujicic, PhD, who runs the HPI, conducts outstanding research on the state of dentistry, and it’s well worth your time to follow his research if you’re interested in the important global issues that impact your practice.

The HPI released a report on this year’s 

. I recently read an article by an author who used this data (and other research) to predict calamity for dental professionals saying, “The dental industry is broken.”

	Come on, let’s get real. Yes, we have challenges in dentistry and there’s no question that we have to confront these challenges head on. Let’s take a look at some of the takeaways reported in the State of the Dental Market: Outlook 2018:

		The supply of dentists continues to grow.

		Practice ownership rates are declining among all age groups. The share of dentists in DSOs increased in 2016.

		Dentist reimbursement (paid amount) has declined in the vast majority of states.

		Dentist busyness - 65 percent of all dentists reported this was the same or down compared to the previous year, while 35 percent of all dentists reported an increased patient volume from the previous year.

	Let me give you my interpretation of this research. First, more dentists means more competition, so you and I have to find more ways to differentiate our practices in a positive way and give patients a reason to choose our practice. Second, practice ownership rates are going down because dentists are finding it harder to compete, especially in the areas involving dental 

. Third, dental reimbursement rates are going down, which means that dentists who base their office income on dental insurance reimbursements, as the saying goes, need to work twice as hard for less money (and anecdotally, that may be pretty close to the truth). Dental insurance regulations and reimbursements are harder than ever to deal with, so why should dentists stay in private practice?

	Now, let’s go with the busyness data. Most people will focus on the 65 percent who were the same or down. Ask yourself this: Why were 35 percent of dentists busier? What are they doing that the other 65 percent weren’t doing?

	As president of the American Academy of Facial Esthetics (

) with more than 15,000 dentists trained over the last 10 years, I can venture a solid guess. The AAFE regularly does member surveys and our members are busier and more productive on average than previous years. The 35 percent of all dentists who were busier than the previous year were adding new elective services to their practices that patients want and will pay for. They’ve decreased their dependence on dental reimbursement and in the case of AAFE members, are providing the No. 1 and No. 2 most popular esthetic services - BOTOX and dermal fillers. These dentists want to stay in private practice because they’re busy and profitable.

Related article: Could Botox be the answer to your problems?

	It’s time for you to take a new look at your practice and decide: Are you going to use good research data on the future of dentistry as an excuse for why you’re not busy? Or are you going to use that research to propel your practice to success by adding new services to your practice that are insurance free and that patients are paying for elsewhere? It’s time for you to get trained in BOTOX and fillers today!

Articles

If your practice isn’t growing, maybe it’s time to stop blaming external circumstances and look at what you can change.

Why isn’t your practice growing?

	What if I told you there is a treatment for one of the most common destructive dental diseases that is easy to deliver once you have been trained, takes just a couple of minutes, can save your dentistry long term, relieve patients’ pain quickly, and make patients feel and look great?

	Would you believe this treatment has been around for over 20 years, thousands of dental professionals use it in their office every single day, there are new evidence-based studies and the general media is buzzing about it constantly?

Bruxism and TMJ syndrome are two words that makes dentists shudder - and with good reason. First, it has been estimated that one-third of the population exhibits some degree of bruxism. Heavy bruxism and teeth grinding can easily damage healthy or diseased teeth, dental implants, crowns, porcelain veneers and all types of restorations, and it can cause orthodontic relapse.

	How do you feel and how big is the knot in your stomach when you place 10 porcelain veneers or a dental implant and within the first few days, weeks or months, the patient has chipped, cracked or loosened restorations?

Even more frustrating for dentists is that TMJ and orofacial pain patient. According to an October 2015 JADA study, one in six patients visiting a general dentist had experienced orofacial pain in the past year. That’s right, one-sixth of your practice has some type of orofacial pain. Many other articles describe even higher percentages, with most of this pain coming from the head, neck and facial muscles.

	Treatment of both bruxism and TMJ-related syndromes by most dentists is really hit or miss, making both of these conditions the most frustrating diseases to treat. You know the patient - you have given them bruxism appliances they do not wear or they do wear and break; most of the time it does not even help and their pain stays the same or gets worse. You adjust the appliance so that you can show your patient and yourself that you are “doing something.” Three months later, you and the patient are frustrated and you are hoping the patient moves so they become someone else’s problem.

	So, where should dental practitioners turn when presented with bruxism and orofacial pain cases? Get trained in botulinum toxin (Botox) and trigger point therapy as frontline treatments for these dreaded conditions.

	As a lifelong ADA member, I find the daily ADA Morning Huddle email of tremendous value, as it brings relevant topics to my inbox every day. This ADA daily email reports continuing references to the use of Botox for bruxism and TMJ from the general media as well as evidence-based studies. Here is a recent item they reported:

	“The Daily Beast (4/23, Ross) discusses how Botox may help those with bruxism, which can damage teeth, cause headaches, jaw pain and more. The article states, ‘A report based off a small sample in the journal Neurology found that subjects given Botox versus a placebo for bruxism found their symptoms ‘very much improved’ or ‘much improved.’” The article explains that “Botox blocks nerve signals to the muscle where it is injected, so the muscle relaxes or, depending on how much Botox is used, stops contracting.”

	A study published previously in JADA February 2000 evaluated using “locally administered botulinum toxin” to treat bruxism. The study’s results suggested “Botulinum toxin administered by skilled practitioners is a safe and effective treatment for people with severe bruxism, particularly those with associated movement disorders.”

	Well over 10,000 American Academy of Facial Esthetics (

) members have been trained to deliver Botox for bruxism and TMJ. They are improving their patients’ lives every day by making them feel better and look better with Botox, dermal filler and PDO threadlift treatment. These dental professionals are also improving their practice production with added services that patients want and need.

	It is time for you to add these new services to your practice, give patients the treatments that are the most popular in the world ,and get the best esthetic and therapeutic treatment outcomes possible. You need to get trained in Botox, dermal filler, solid filler PDO threadlifts and trigger point therapy today!

Botox isn’t some magic snake oil - it’s a treatment grounded in good research that can alleviate common problems.

Could Botox be the answer to your problems?

	Every reader certainly knows what the suffix “dontist” means, as used in the words endodontist, periodontist and orthodontist.

	Imagine my amazement when I came to the 

 (AAFE) course on Botox Therapy for Every Dental Practice, which I led with outstanding AAFE faculty at this past American Dental Association Annual Meeting in Atlanta (the 2018 ADA Annual Meeting is in Hawaii - see you there!). The sign outside the designated room identifying the AAFE course took the opportunity to coin a brand-new phrase I had never seen before - facial estheticsodontist.

I am not sure how this came about, but this is the term as it was posted on the sign outside the room. At the start of the course, I congratulated the attendees of the course as being the first ever group of facial estheticsodontists being trained by the AAFE at an 

. This is just one of the dozens of AAFE live patient training courses gives each year and it is most certainly the first meeting to ever coin the phrase “facial estheticsodontist.”

Trending article: How to use injectable technology in the dental practice

	In truth, every dentist is a facial estheticsodontist, whether they realize it or not - and has always been. In over 40 years of taking and giving different dental continuing education courses, lip service (pun intended) has been given to how dental treatment affects facial esthetics. You and I have been to removable prosthodontics courses that have used the term “dental facelift” when the vertical is open on these cases. Orthodontists and general dentists who perform minor and comprehensive orthodontics can significantly alter the facial esthetics of a patient, which may or may not be entirely desirable to each individual patient. 

	Implant dentistry has made a huge impact in patients’ lives, not only with the function of teeth, but also with dental and facial esthetics. We have the opportunity to fully restore dentitions with fixed alternatives like never before. With implants, removable prosthodontics and orthodontics, there will be additional lip support and lower facial support. As practitioners, we can sometimes control the outcome, but sometimes it is a challenge - the final facial esthetic result may not be good enough for the patient. 

	In nearly every esthetic dentistry course that I have taken or given, we hear this concept of how to talk to patients about more comprehensive esthetic dental treatment: “You know, Mrs. Jones, if I treat these four teeth with porcelain veneers, you will have good-looking teeth but not a great-looking smile. If I treat 10-28 teeth with porcelain veneers, then you will have a great-looking smile!” It sounds like we have all been facial estheticsodontists for a long time. 

	Here is the truth - whether it is a case of a few simple tooth colored restorations, 10 porcelain veneers, restoring a single anterior tooth with an implant or a full-mouth implant reconstruction, the only thing accomplished is giving people great-looking teeth and not a great-looking smile. By only treating the hard tissues inside the mouth, even if you are changing the facial and lip support to some degree, that still does not translate alone into giving people a great-looking smile. A great-looking smile includes not only the teeth but also all of the soft tissue of the face. Dental esthetics is facial esthetics and facial esthetics is dental esthetics! 

More from the author: How to effectively integrate new technologies and skills in your practice

	To be a true facial estheticsodontist, you need all the skills and education to not only treat teeth but also to treat the oral and maxillofacial areas and really give patients great-looking smiles with non-surgical, minimally invasive treatments such as Botox, dermal fillers and PDO Threadlifts. This is exactly what dental professionals who attend AAFE live patient training courses are able to accomplish, once they have been properly trained in these skills that will last for the lifetime of their careers. The thousands of AAFE dental professional members are now able to achieve better treatment outcomes than ever before for dento-facial esthetics and also for TMJ and orofacial pain therapy.

	It is time for you to start your journey with the AAFE and get trained in the use of Botox, dermal fillers and PDO Threadlifts. These are the most popular esthetic services that patients want and are already getting somewhere else - why not at your office? Become an AAFE facial estheticsodontist today!

Trending article: Study finds Botox can relieve jaw muscle pain

It’s probably not a term you’ve heard before, but every dentist is also a facial estheticsodontist. 

Are you a facial estheticsodontist?

	It’s time to take a fresh look at dental technology. There are a lot of technology choices available to dentists today. Whether you’re in practice for the next 30 years or retiring within the next five years, you’re going to have to make a technology choice.

	The right choice of technology can rapidly improve your practice’s bottom line, provide better treatment and patient outcomes, and grow your practice. The wrong choice of technology can complicate clinical care, provide for poor treatment outcomes, waste your time and money, and bankrupt your practice.

Related article: The top 10 developments in dental technology in 2017

	I want to make one point very clear -  technology is not just a piece of capital equipment that you invest in. Every dental material and technique that you choose for your practice is also a result of new technology. Rapid dental innovation drives technology, which constantly improves patient care through new techniques and procedures that are able to be accomplished for better treatment outcomes than ever before. 

	When we look at new technology choices for our practices, I break it down into two categories of dental technology choices. 

	Integrative technology is any procedure, material or capital equipment that can be quickly and efficiently integrated into the present office structure and schedule. In other words, if I adopt something new for my practice, I don’t have to change the physical structure of my office or the personnel to adapt to the technology. There are two subsets of integrative technology:

	Capital equipment integrative technology includes dental lasers - like the 

  -  scalpels and high-speed handpieces. Most certainly, training for you and your team on using the actual technology is essential, but after that it fits into your present physical structure quickly and easily without any other disruptions. 

	Skills-based technology and procedures include BOTOX

, dermal fillers, solid filler PDO threadlifts, dental sleep medicine and trigger point therapy. Once learned, dental professionals will have the skills for the rest of their careers (Figs. 1-2). Pharmaceutical agents like BOTOX, dermal fillers and PDO threadlifts for esthetic and therapeutic uses in the oral and maxillofacial areas cause no disruption to the office team or physical structure, provide dental practices with more services that patients actually want and get elsewhere, and provide patients with better treatment outcomes than ever before. There are no constant hardware or software upgrades necessary because the skills are in your hands forever. 

	A good example of non-integrative technology is in-office CAD/CAM. In addition to buying and learning this technology, your office will significantly need to change the way it schedules patients, the physical structure of the office may need to adapt to the technology and intensive training is necessary to make this technology successful. For clinicians who commit to non-integrative technology, the results can be very rewarding.

	The other thing to look at is ROI on any technology choice. Most certainly, skills-based technology services like BOTOX, dermal fillers and PDO threadlifts are the easiest to integrate and by far have the highest ROI simply because there is no large capital investment up front, no monthly lease payment, and no need for constant software and hardware upgrades.

	The determining factor of any technology choice is you, the clinician. All technology, materials and procedures can be good for your practice. 

Related article: How to locate the pain points in your practice

	I often see examples of dental professionals who have invested hundreds of thousands of dollars in capital-intensive technology that sit in the corner of a treatment room and serve as expensive coat hangers. It is so important for you to do your due diligence and invest the time and effort to get trained and then start treating patients with the technology of your choice as quickly as possible. 

	Integration is very easy with skills-based technology choices because you can literally start the Monday morning after you have been trained. There is nothing to wait for - you have the skill in your hands! 

	Get your start like most of the thousands of American Academy of Facial Esthetics (AAFE) members by adding high ROI skill-based procedures like BOTOX and dermal fillers to your practice. This will dramatically increase your production and help fund the investment necessary for the capital investment technology of your dreams. Time for you to get trained today! 

Integrating new technology in your practice doesn’t have to be painful.

What technology is right for your practice?

	Most people relate technology with a piece of capital equipment such as a new computer, a CBCT, 3D printing, CAD/CAM, lasers and the like. Truth be told, technology goes much further than that as there is an incredible amount of technology that has evolved materials, products and techniques that are used every day in dental offices.

The technology evolution in injectable therapy has advanced quickly since dentists have been involved heavily with Botox, dermal fillers and PDO threadlift therapy over the last 10 years (

). Non-surgical, minimally invasive facial esthetics and facial pain therapy, like any area of dentistry, have evolved with new techniques and even with new injectables that can be used like never before. 

	This article will provide an overview of the different materials available based on the experience of more than 10,000 American Academy of Facial Esthetics (AAFE) member dentists and how they have worked to create better patient treatment outcomes today more than ever.

	Botox, Xeomin and Dysport are trade names for botulinum toxin, which comes in the form of a purified protein. The mechanism of action for botulinum toxin is quite simple: It is injected into the facial muscles. Botulinum toxin binds to and affects and blocks the neurotransmitters between the motor nerves that innervate the muscle that has been injected. There is no loss of sensory feeling in the muscles. Once the motor nerve endings are interrupted, the muscle cannot contract. When that muscle does not contract, the dynamic muscle contraction will be lessened or completely stop depending on the dosage applied. 

	Here is where this incredible technology has made it the most common esthetic and orofacial therapeutic treatment today. Skin’s natural state is smooth and without the underlying muscle contraction, the skin then starts to smooth out over the course of two to 10 days. The effects of botulinum toxin last for approximately three to four months, at which time the patient needs retreatment. This is how botulinum toxin is known for smoothing out wrinkles in the forehead, between the eyes (glabellar region), around the corners of the eyes (crow’s feet) and around the lips.

	The AAFE has taken this much further and applied the use of botulinum toxin in many new ways as a complement for esthetic dentistry cases, as a minimally invasive alternative to surgically treating high lip line cases, denture patients who have trouble adjusting to new dentures, lip flip techniques, and orthodontic cases where retraining of the facial muscles is necessary. 

	Many of the facial, head and neck muscles are also the cause of some or all bruxism, TMJ and orofacial pain and therefore botulinum toxin has become very effective in the treatment of these conditions as well as headaches and migraines. The AAFE protocols use this botulinum toxin technology in new ways for trigger point therapy for excellent therapeutic outcomes, which AAFE members deliver every single day to thousands of patients.

	One thing the AAFE has proven over the last 10 years is that no other health care provider has the capability to help patients with botulinum toxin in so many areas as do dentists.

Related reading: 4 things to remember about facial injectables

	Dermal fillers, such as hyaluronic acid (Juvederm, Restylane, Belotero) and calcium hydroxylapatite fillers (Radiesse), are commonly used to add volume to the face in the nasolabial folds, cheeks, oral commissures, lips and marionette lines. All of these areas support the upper and lower lips and directly affect the ability to smile, show more teeth, and create proper lip lines and smile lines. As we age, collagen and fat is naturally lost in these facial areas and these lines start to deepen. 

These dermal fillers are injected right under the skin to plump up these areas so that these lines are much less noticeable. Dermal fillers are also used for lip enhancement and are used by dentists for high lip line cases, uneven lips and to make the peri-oral area more esthetic. The face looks more youthful and is now a vital component of every anterior esthetic, implant and restorative dental treatment.

	 One of the more exciting dental uses for dermal fillers is in the area of deficient interdental papilla, otherwise known as the dreaded black triangle, eliminating one of the biggest esthetic challenges dentists face. Dermal fillers typically can last from six to 12 months. 

	New dermal filler technology introduced in the last few months has allowed improved cross linking of the dermal filler products, resulting in longer lasting fillers as well as creating a more natural filler that is more flexible. This allows the filler to look more natural in different facial contours. Both the Juvederm and Restylane family of fillers include different variations for different needs such as more lift for mid-face areas and thinner fillers for subtle lip enhancement.

Continue to the next page to read a case study.

	One of the newest and most exciting additions to the area of dental and facial esthetics is solid filler PDO threads. Polydiaxonone (PDO) suture threads have been used in neuro, cardiac, dental and other general surgeries for more than 30 years with an impeccable safety and efficacy profile. Smooth and lifting solid filler PDO threads placed in the dermis will add an immediate visible structure and lift in the placement area and as they break down, the body produces natural long-lasting collagen. 

	Essentially, these PDO threads are collagen builders and add volume to the face for up to two years. Lifting threads in particular can give a physical lift to the mid-face, which supports the upper lip showing more teeth and creating esthetic lip/smile lines. These can also create a defined jaw line and add support to the lateral aspects of the oral commissures allowing a patient to smile more broadly. Smooth PDO threads are used to create perfect vermilion lip borders as well as build collagen in the same areas as dermal fillers.

More from the author: How to make the right technology choices

	This case report demonstrates how the three technologies in the AAFE treatment circle are often used together. 

 shows a patient in her before photo with a descending sagging lower face, large masseter muscles as a result of heavy bruxism, downturned oral commissures, and mid-face volume loss resulting in loss of lip/smile line support as well as a masculinization of her face.

	 Botox was used to reduce the contraction intensity of the masseter muscles, which also improved her facial esthetics by slimming her face. Botox was also used for upper face esthetic improvement. Dermal fillers were used to replace volume in her mid-face to create upper lip support and better facial esthetics. Solid filler PDO threads were used to lift the sagging lower face, create a defined jawline and will build collagen for a long-term result. The patient was thrilled with her result.

Trending article: Nevada becomes first state to allow dental hygienists to use facial injectables

	It is a very exciting time for dental practitioners as we can now treat patients better than ever before. The AAFE has trained more than 15,000 dental professionals and provided post-course member support in the last few years who have significantly grown their practices with these evolving technologies, techniques and injectables. Botulinum toxin, dermal fillers and solid filler PDO threads offer new opportunities for dramatically increasing practice production while delivering the best esthetic and therapeutic treatment outcomes, eliminating some of the most challenging treatment frustrations for dentists. Get trained today! 

How new advances in injectable therapy are providing more options for patients.  

How to use injectable technology in the dental practice

	How many times over the years have you taken a course to learn a new skill or to use a new technology only to have either the skill/technology sit idle and never be used?

	Every dentist reading this article probably has a junk drawer, and if you have been in practice long enough, you most likely have a junk closet. This drawer or closet is filled with dental products or equipment that you have bought over the years that for some reason you didn’t like, thereby banishing it to the junk drawer or closet. 

	There is an equally large virtual closet of skills and concepts you have learned that have similarly been banished. We have all made poor purchasing decisions like that before in dentistry. This has cost you a whole lot of time and money over the years, but it has been a small loss to pay as opposed to poor treatment outcomes.

	In today’s era of dental technology, making a mistake when you purchase any kind of dental technology can be very costly indeed and may even bankrupt a dental practice. It’s amazing what some of the newer dental technology actually costs. The cost for some of the bigger ticket items can be $2-300,000. In the past, we used to be able to build an entire dental office for that same amount of money. 

	Here are some key questions to ask before you purchase any kind of dental technology or invest in skills-based education.

Is this technology or skill integrative or non-integrative?

	Integrative choices of technology or skills means that the way you practice and the way your dental office operates basically stays the same and the technology that you are buying can be integrated into the way you already practice dentistry. In other words, you don’t have to change your entire office to the technology/skill, but the technology/skill adapts to you. 

	Soft-tissue dental lasers are a perfect example of integrative technology. Every dental office should easily have a soft-tissue laser. These are basically an electrosurge replacement, which is much more precise, state of the art and attractive to patients. Nothing else in the office has to change. The cost of soft tissue dental lasers has really come down to make this an affordable reality for most dental practices. 

Botox and dermal fillers are good examples of integrative skills with the only investment being education. Once you learn these new skills, you will have these in your hands for the rest of your career. It is a new service that you can provide to your patients and completely integrates with most other dental treatment such as esthetic dentistry, implants, restorative dentistry, occlusion, bruxism and TMJ therapy. 

What are the continuing costs to this technology/skill?  

	Many dentists make this common business mistake-they only look at the initial cost of the technology without realizing that nearly everything has continuing cost whether it is related to support, maintenance, software and hardware updates, or parts that get used up and must be continually replaced. Take a realistic look at the entire package going out three or four years while shopping around for dental technology. 

	Let’s go back to our examples. Soft-tissue dental lasers have the continuing cost of tips as well as software upgrades that may be included in your initial price. There is also the realization with any technology that you will soon have yesterday’s technology. Skill-wise, the only cost of using Botox and dermal fillers is the cost of the actual product, which directly relates to what patients are paying for these services, similar to any other service delivered in the dental office.

How will patients perceive this new dental technology/skill? 

	From a practice management standpoint, this is an extremely important question. Will the patient experience change in the dental office because of a new technology/skill? Will patients now perceive your office as being a state-of-the-art office where they want to have their dentistry done and refer their friends? If you are going to invest in a new dental technology, will you need to constantly promote this to your patients so that they get the “wow” factor or will that “wow” factor be self-evident to patients?

	Soft-tissue lasers deliver the “wow” factor to patients once it is explained what it is and what it can do (bloodless surgery, faster healing, minimal trauma) if the patient needs it. As with most dental technology, it requires constant promotion to patients for them to get the “wow” out of it in terms of patients’ perceptions of your office.

	Botox and dermal fillers are self-evident to most patients as they are the No. 1 and 2 most commonly requested services in the world. From the experience of thousands of American Academy of Facial Esthetics (AAFE) dentists, providing these services puts your practice on a much higher level than other practices and has one of the highest referral rates of any other procedure in a dental office.

How difficult is the new technology/skill to learn and integrate into your dental practice?

	Learning curve is one of the most overlooked areas of investing into dental technology/skills. So many dentists I know have bought into a technology/skill and then either have never taken the time to learn to use it properly with their team or the learning curve is just so high on the technology that they have purchased that they then just give up on it. 

	In our technology example, soft-tissue lasers are among the easiest technologies to learn and integrate into any dental office. Learn how to operate the laser, what tips are available, unit maintenance, laser safety and clinical practice and you are ready to go. 

	In regards to skills, some of the skills necessary for proper application of Botox and dermal fillers every dentist already possesses. You know how to give injections in the face; this is just a different kind of injection. Once you learn the relevant anatomy and pharmacology, I can tell you from teaching thousands of dentists that dental professionals can be and are the most proficient professionals using Botox and dermal fillers, which can be instantly integrated into every dental practice.

	I have used soft tissue dental lasers (technology) and Botox/dermal fillers (skills) as the prime examples for this article as both are excellent examples of integrative technology and skills that make perfect additions for any dental office. Both are excellent investments for any practice that will add new services for your practice, provide better than ever patient treatment outcomes, and are instantly productive with a high ROI.

Four important questions that you should ask before investing in new technology of skills-based education.

How to effectively integrate new technologies and skills in your practice

	Look at all the incredible technology choices that we now have in dentistry which we have never had before. When I was starting dental practice nearly 40 years ago, I could build out two dental offices for the price of one piece of high-end technology. More importantly, technology will keep evolving and we are going to have some incredible dental technology advances in the very near future.

The same is equally true when it comes to new dental services that you can offer your patients. When I started dental practice, we had amalgam, gold foil and silver points, which were being eclipsed by new “technology” of dental materials in the form of tooth-colored composite resin and gutta percha. Today, dentists can now use botulinum toxin (Botox/Xeomin) and dermal fillers (Juvederm/Restylane) which have helped transform dentistry with better esthetic and therapeutic outcomes than ever before. Dentistry has expanded into an incredibly important role in sleep medicine that literally saves patient’s lives. We finally have predictable, simple step-by-step protocols for treating TMJ and orofacial pain patients which account for one out of every six patients that walk into your office.

Trending article: The huge technology mistake that could cripple your dental practice

	The bottom line is there has been an amazing explosion of technology-based and skills-based ways to expand your office and give patients better treatment than ever before.

	The challenge for every general dentist and dental specialist is, with so many excellent technology choices, where does a dentist start? How do we make the right choices for our individual practices? How do I know what will work for my patients? What are the smart choices in dental technology that can propel my practice to higher productivity while giving my patients better treatment outcomes? What are the wrong choices that may put my practice at financial risk?

I get this question all the time; with so many new services that dentists can now provide in dental esthetics, facial esthetics, orofacial pain treatment, bruxism and dental sleep medicine therapy, and dental implants, where should a dentist start? Dentists need a plan on how to add new services to their practice so that they can create a foundation on which to integrate these new services with comprehensive dental treatment which is now offered in the office. Finally, it is important to know what the initial and return on investment (ROI) of these different new services so we can make this affordable for the practice while being able to start using these skills so they can begin to pay for themselves and future investments.

	Make no mistake about one thing: These decisions apply to dentists of all ages, no matter if you are just starting out in private dental practice or you are going to transition and retire in the next one-to-10 years. If you are a young dentist, then you will build your practice on technology and skills that you will have for the rest of your career. If you are an older dentist, you will want to add as much value and production to your practice as soon as possible so that you will be able to transition it successfully and secure your retirement.

	What is important to know from the outset is there are no good or bad technology- or skills-based choices. The determining factor for every choice you will make will come down to only one thing – you. The services your office provides now, the kind of office you want to have and the kind of clinical care that you want to provide through technology or skill based choices only depends on you and your long-term goals for your professional career. 

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To get started and to greatly simplify the decision-making process, I want you to begin thinking about technology and skills based choices and put them in one of two categories: integrative and non-integrative.

	Integrative technology/skills are those in which you do not have to change your office or change the way that you practice dentistry after you have been trained in the technology or skill.

	Non-integrative technology/skills are those in which you will need to reconfigure your office in one or all these areas - work flow, scheduling, treatment space, clinical technique or employee responsibilities. 

	Let me be clear that these terms do not mean one type is better or worse than the other. Integrative and non-integrative technology can be great; it will depend on you. 

	Looking at technology and new procedures in this way helped our practice over the last 30 years get the most out of dental technology and skills, raise our production, and lower our overhead to under 50 percent. Once you learn how to properly choose technology and new procedure choices, your practice will run much more efficiently, your front office will be freed up to really engage patients while they are right in front of you and your office will live happily ever after.

Choosing the right technology can give your practice a big boost.