Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

Renee Knight

The way you treat your patients is changing.

Gone are the days of simply fixing a cracked tooth and moving on to the next case. These days, you’re expected to look at your patients more comprehensively, to treat them as a whole rather than as components.

That shift in philosophy is just one of the reasons more general practitioners are branching out into specialty areas that enable them to treat their patients on a broader level, said Dr. Brian Gray, a GP who’s taken a special interest in orthodontics. Developments in technology have made it easier for GPs to take on cases they may have referred in the past, while more evidence-based science has given them the confidence they need to keep the work in-house. And the boost to the practice’s productivity and bottom line doesn’t hurt either.

The trend for GPs to offer specialty services really has taken off in the last five to eight years, said Penny Reed Limoli, owner of the 

, and it is an interest that likely will continue to grow. Almost 80% of GPs think they need to offer some type of specialty care in their practice to stay competitive, according to DPR’s January 2010 Specialty Care Survey. And of the 9% who don’t already offer such services, 72% would like to.

“We are seeing fewer dentists refer out procedures,” Limoli said. “They’re saying ‘OK, I have this active patient base, and the patients very often don’t want to go anywhere else.’ The patient looks at the general dentist and says ‘Can’t you do the root canal?’ or ‘Can’t you extract this tooth?’ It’s such a relationship business.”

Whether it’s orthodontics, endodontics or implants you’d like to add to your list of offerings, GPs and specialists agree it’s not something you can just jump into. Before you place that first implant or try that first Invisalign case, you have to take the proper steps to prepare. But once you’re ready, focusing on a specialty you’re interested in can help renew your passion for dentistry and make your job all the more rewarding.

Remember specialists spend extra time in school for a reason; there’s a lot to learn about the area they’re studying. So you can’t expect to take one CE course and be ready to go, said Dr. Olivia Palmer of the American Academy of Implant Dentistry, especially when it comes to implant work. If you want to reap the benefits that come with offering more specialty care in your practice, you have to put in the time. And many of our survey respondents listed implant work as a service they’d like to provide, with 52% indicating they already do.

Regardless of what area you’re interested in, there’s opportunity for learning. Start at association or manufacturer websites or check out institutions like the Dawson Academy and The Pankey Institute.

Researching the different technology options also is important, said Dr. Tony Soileau, a GP who has offered endodontic services to his patients since his practice first opened. Take courses that show you how to incorporate the technology and give you the hands-on experience necessary to make the right purchasing decisions.

“Technology can get really expensive if you’re not careful,” he said. “You need to know what you’re buying. Otherwise you’re going to spend a lot of money and not know what works best in your hands.”

And don’t feel like you have to buy everything at once, said Dr. Joyce Warwick, who recently earned a Fellowship from the International Congress of Oral Implantologists. The thought of making all those purchases at the same time can be overwhelming. Start slowly and bring on more tools as your skills advance.

“It’s definitely intimidating. I felt like I wasn’t sure I was going to be able to recoup my investment between education, time out of the office and the supplies I needed to buy,” Dr. Warwick said. “But if you do it slowly, it’s more manageable. And a lot of implant companies will work with you. They’ll give you the surgical kit if you buy a certain number of implants or work with you to discount your first purchase. Implant companies really want to get you started, and they will work with you to make the transition.”

Dentistry is based on relationships, whether it’s the relationship you have with your team, your patients or other practitioners. If you want your patients to benefit from the best treatment options and the best treatment plans, it is necessary to offer an array of specialty services. If you are not yet working with a specialist, you should develop a good relationship with someone in your area of interest. Find someone who’s willing to work with you and let you learn how to perform or-most importantly-correctly diagnose and treat a patient with several options. Many specialists are eager to teach and show off their work, and would enjoy spending the day with other dentists, orthodontist Dr. Jacqueline Fulop-Goodling (Dr. Jacquie) said.

“The most important thing for a GP in relation to orthodontics is to establish a good, comfortable relationship where they can approach an orthodontist in their area, whether it’s someone in their practice, down the block or someone they play golf or ski with,” she said.

Not sure of the best way to find a mentor? Dr. Soileau recommends taking a specialist to lunch. While most are willing to offer some guidance, there are others who would rather keep even the easiest cases for themselves. You’ll be able to tell in the first 15 minutes if the specialist you picked is someone you’d like to work with or if you’ll need to find someone else.

Study clubs, meetings and networking are other ways to find the right specialist. Some specialists, like Dr. Jacquie, even offer Webinars to help educate their GPs. Dentists usually e-mail patient photos and radiographs in advance, which are then uploaded into the Webinar presentation for discussion. Doctors can follow along from their offices or the comfort of their homes.

After you establish this relationship, you have to maintain it-meaning it can’t be one-sided. It’s important for you to refer your most difficult cases to the specialists who work closely with you, said Dr. John Shefferman, an orthodontist who works with Dr. Gray. If you don’t, that specialist is going to be less likely to help you navigate through the difficult cases you’d like to take on.

“It goes both ways. If you go to the orthodontists you refer to they know that you respect their abilities and you’re confident in their abilities to treat your patients,” Dr. Shefferman said. “If someone sends me a lot of patients I’m more than willing to sit down with that GP. They may not send me some of the really easy stuff, but I’d rather help them out than say sorry and then they don’t send me anything.”

When starting something new, it’s easy to get yourself in trouble. You may be excited to take on a case, but you have to think about the patient before you do, Dr. Gray said. It’s best to start off slow and build yourself up to the more difficult cases. The last thing you want to do is start a case and then realize halfway through that it’s way beyond your scope or that it’s going to take much longer than you originally thought.

“If you get to be four or five appointments in, you lose money, the patient loses confidence, everyone is frustrated, and no one is happy,” Dr. Soileau said. “Don’t start a case that’s going to take you a long time to do unless you’re comfortable talking to your patients about a higher fee.”

Talking it out with a specialist can help you determine if the case is something you should try or if it’s something you should pass on, Dr. Jacquie said. The education you’ve gained through your CE courses and your experience level factor in as well, but ultimately it comes down to what is best for the patient. If you don’t think your skill level is where it should be and patient care might suffer, you need to refer the case to a specialist.

 offers a case difficulty assessment form designed to help GPs know what’s beyond their scope. Each case is different, but these guidelines help with the decision process, AAE President Dr. Gerald Glickman said. And according to the survey results, 84% of GPs offer some form of endodontic treatment in their practice.

“The patient deserves the best possible care. The rule is never do harm,” he said. “If you think you’re in trouble doing a root canal, you likely are in trouble and the patient will have to be referred to an endodontist. To avoid problems, it is important to evaluate the case from the radiograph before the root canal is initiated. Clinicians should recognize difficult cases in advance and send them to an endodontist. If a patient has to be referred mid-way through a root canal, the procedure becomes much more complicated for us to handle than those that were never started at all.”

When it comes to orthodontics, Dr. Shefferman said it’s a case-by-case situation. There are simple cases, like closing a space in the two font teeth or pushing back a molar to make space for an implant or a bridge. But if you have a patient with a lot of crowding and you need to decide between taking the teeth out or just lining them up, that becomes more difficult. Remember, moving teeth can change a patient’s profile, and you really have to know what you’re doing before you can make such decisions.

“It’s just education. Some dentists might think they can do the movement, but they don’t think about what else can happen. The best thing to do is find an orthodontist who’s willing to let you bring a case and ask, ‘Should I do this,’” Dr. Shefferman said. “There’s no easy way to know what you can do and what you can’t do. Sometimes closing space between two teeth is not a problem at all, other times, unintended problems come up.”

Typically, your patients don’t want to be referred. That means extra time for them, and going to a doctor and an office they’re not familiar with, Dr. Gray said. They’d rather have whatever procedure they need done right then and there, in your office.
	Branching out in a specialty area gives you the opportunity to do this, Dr. Soileau said. As a GP who does a lot of endo, he has the ability to help get his patients out of pain immediately. Patients don’t schedule oral health problems, but when they come up they want them fixed. He’s able to do that, which makes his patients happy and boosts his practice’s productivity.

Knowing how to perform some of these procedures also puts the control back in your hands, Dr. Warwick said. Patients can find the referral process inconvenient or frightening, and the plan can become delayed or even lost in the process. By doing the implant surgery herself, she knows exactly what’s happening. She’s expedited the process and has control from start to finish.

Keeping more cases in-house is great, but don’t let fear of losing a patient take over when you’re looking at a difficult case you really should refer, Limoli said. Remember, keeping patients in your practice isn’t the only objective when it comes to specialty services.

“You have to provide the quality they would get elsewhere, or you’re not doing the patients any favors,” Limoli said. “There will always be some cases that need to be referred.”

You’ve taken the courses. You’ve established the relationships. You’re ready to go. Now all you have to do is let your patients know about it. And, according to our survey, only a little fewer than half of you are.

That’s where marketing comes in. The best place to start is internally, Limoli said. It doesn’t do any good to spend a lot of money on outside marketing if your staff members can’t answer questions about the new services you offer. You have to get your team excited and knowledgeable about what you have to offer and how it benefits the growth of the practice.

Once your staff is educated, begin marketing to your existing patient base first, said 

, President of Limoli and Associates. Send something in your newsletter, put a poster about your new offerings in the waiting area and encourage patients to ask you questions. Talk to patients during their appointments and give them educational materials about services that may apply to them. Simply put, communicate.

Dr. Palmer also recommends marketing via your website, your local newspaper, through civic organizations and via good old fashioned word of mouth. Let current and potential patients know you’re equipped to offer your specialty of choice. Go out into the community and offer public seminars about the benefits of certain procedures. If you are passionate about what you’re doing, people will see that and turn to you for their dental care.

“Patients are wanting these (implant) services, and when they realize their GPs are qualified, well-trained and credentialed, they will want to talk to them about the benefits of implant dentistry,” Dr. Palmer said.

Once you put all the pieces together, there’s much to be gained from branching out into new areas. You’ll feel rejuvenated and more passionate about what you do, and you’ll save your patients the time and stress that can come with being referred.
	And when you do have to refer, you’re referring to someone you’ve really come to know and trust through this process, someone who has become a mentor to you.

There’s no doubt the relationship between the GP and the specialist is changing, Tom Limoli said, and it’s changing in a way that benefits you and your patients.

You, the patient and the specialist all benefit from this relationship, Dr. Glickman said. And the bottom line is to ensure patients get quality care.

To that end, remember GPs can’t and don’t want to do every part of every specialty. If they did, they likely would have taken the extra schooling to become an endodontist or an orthodontist. There are specialists for a reason; now’s the time to work with them.
	
	Renee Knight is a senior editor for 

. She can be reached at rknight@advanstar.com.


	The January 2010 DPR Specialty Care Survey was sent via e-mail to 10,000 general practitioners in the United States. The link to the survey was also promoted on Facebook, where we currently have 3,688 followers. The survey was completed by 162 people.

Articles

The way you treat your patients is changing. Gone are the days of simply fixing a cracked tooth and moving on to the next case. These days, you’re expected to look at your patients more comprehensively, to treat them as a whole rather than as components.

Specialty Care Exclusive Survey: Working together

Many of your patients are visual people. They want to see results and have a feel for what certain cosmetic services can do for their smile.

Patient education and before and after photos are great ways to do this, but so are your team members’ own smiles.

If you have a team member who’s using Invisalign or who just finished some at-home whitening, make sure you’re talking about that with patients who are considering these cosmetic options. These team members should be ready and willing to talk to patients about their experiences-something that will help put patients at ease and give them an idea of what kind of results are possible.

If you’ve heard a team member talk about getting cosmetic work done, you may want to consider doing that work for free. It gives you another way to show off your work and will help make that team member even more confident when talking about the services you offer. Patients tend to trust your team members, and if your team members are happy with results from work you’ve done and can tell them about their experience first hand, patients are more likely to get excited about the possibilities and go forward with treatment.

Your patients are your practice. Without them, where would you be? You have to know the best ways to attract them to your practice, get them to accept treatment and make them happy, life-long patients.
	
	That’s where we can help. Check back regularly for tips on how to keep your patients happy, healthy and loyal.

Surround them with beautiful smiles

You want the best possible results for your 

. You want them to walk out of your office happy and singing your praises to family, friends and co-workers. But that won’t happen if you over commit on results.

, but you have to be honest with yourself and your patients about possible outcomes. It’s better for a patient to be pleasantly surprised than outright unhappy when they look in the mirror, or still in pain after treatment.

Patients put a lot of time into treatment, and they need to know exactly what to expect. If you over promise and don’t deliver, all you end up with is an 

Your patients are your practice. Without them, where would you be? You have to know the best ways to attract them to your practice, get them to 

 and make them happy, life-long patients.
	
	That’s where we can help. Check back regularly for tips on how to keep your patients happy, healthy and loyal.

You want the best possible results for your patients. You want them to walk out of your office happy and singing your praises to family, friends and co-workers. But that won’t happen if you over commit on results.

Set realistic expectations

The team at Harmony Dental Lab first heard about Zest Anchor’s LOCATOR Attachments through dental trade shows and clients who were excited about what it could offer their patients. They began using the LOCATOR not long after it was introduced to the market and have been happy with what it’s done for their lab, their dentist clients and of course the patients.

“I would say on CAD/CAM bars we really like it because it has the drill and tap option,” Hodson said.

“That allows the lab or even the dentist the ability to change out and replace the attachment if needed. This could save a restoration if wear occurs throughout time. And it works with all CAD/CAM bars. Any company that manufactures the bars offer the LOCATOR attachment as an option.”

Other benefits include different levels of retention, angulation versatility and its low profile. The different levels of retention is a huge patient benefit, Hodson said. Some patients require very little retention, such as an elderly patient who may not have the same dexterity and hand strength to insert and remove the attachment as a younger patient. Other patients simply prefer to have it locked in tightly so it takes a lot of effort to remove.

Not only does the LOCATOR offer retention options for the patient, it’s also easy to work with and predictable, which can save labs time and money.

“The system is pretty predictable,” Hodson said. “We’re not buying extra components. We buy what we need for the case and that’s it. There is no need for angled abutments because the extended range males correct the path of insertion up to 20 degrees. It’s very easy to process. I think we save time relative to other systems.”

The LOCATOR also is versatile, Hodson said. While his lab mainly uses the drill and tap option for CAD/CAM bars, the bar attachments offer many other options for technicians, including laser welding and a cast-to attachment.

Hodson and the team at Harmony Dental have been happy with the LOCATOR system and what it offers, and would encourage other labs to give it a try. It’s versatility makes it a great addition to any lab, whether you’re using it directly on implants, on CAD/CAM bars, cast bars or anything in between.

“I think it just comes down to the patented pivoting action and the self-aligning design of the LOCATOR,” Hodson said. “The different levels of retention really make a difference, too.”

The team at Harmony Dental Lab first heard about Zest Anchor’s LOCATOR Attachments through dental trade shows and clients who were excited about what it could offer their patients. They began using the LOCATOR not long after it was introduced to the market and have been happy with what it’s done for their lab, their dentist clients and of course the patients. “I would say on CAD/CAM bars we really like it because it has the drill and tap option,” Hodson said.

How Harmony Dental Lab benefits from Zest Anchors' LOCATOR attachments

It’s unavoidable. A patient won't be happy with a treatment outcome or maybe is looking at a bill that’s a littler larger than expected.  For whatever the reason, every now and then 

 and they want you and your team to know about it.

When a patient starts getting loud at the front desk, take that patient aside to talk about whatever the problem is. Let the 

 know you can see he or she is frustrated and you’d like to talk about the issue somewhere with less distractions. Stay calm and don’t react with anger; that will only make the situation worse. Let the patient know you understand his or her frustration and you want to come up with a solution.

 are likely the ones on the receiving end of a patient’s anger, make sure they know how to handle these types of situations. Take time to do some training in your team meetings and role play common situations. That way your team members will be prepared if and when they’re confronted with an angry patient.

It’s unavoidable. A patient won't be happy with a treatment outcome or maybe is looking at a bill that’s a littler larger than expected.  For whatever the reason, every now and then patients get angry and they want you and your team to know about it.

Don’t cause a scene

Patients look for reasons not to go to the dentist. They’re afraid of what you might find, or that any procedures they have to undergo might hurt or be too expensive. Don’t let unnecessary smells become another excuse for patients to avoid you.

And this doesn’t mean just the typical smells that come with a dental practice. If you or one of your staff members wears too much cologne, patients will notice and they won’t like it. Some might even have an allergy. Lingering 

 smoke and over powering air fresheners also can make patients want to leave your office before you even get started on their appointment.

 to a minimum, or consider not wearing any at all. Don’t go crazy with the air freshener and consider not smoking during the workday if you’re a smoker. If you’re telling your patients not to smoke and they smell it on you or a team member, they likely won’t take your advice very seriously.

Remember you have to make your office a warm, inviting place where patients feel as safe and as comfortable as possible. Don’t add unpleasant smells to the mix; look for ways to incorporate relaxing, soothing smells like lavender and your patients will thank you for it.

The DPR Patient Tip of the Day is sponsored by 

 high-end systems and solutions for dental and maxillofacial imaging. Visit 

 to learn about the company's full line of imaging solutions, including the 

Be aware of odors that may turn off your patients

 pounding away at the Northeast and leaving millions without power and massive amounts of flooding in its wake, it’s difficult to imagine all the damage that will be left behind.

Dental offices will no doubt be affected by the superstorm, whether it’s water damage or wind damage or a combination of the two. While it will be a struggle for everyone to get back on their feet, those offices that already use a paperless workflow won’t have to worry about if flood waters wiped their patients records away; their data is backed up.

This superstorm serves as a reminder of all the advantages a 

 can bring. For these practices, the practice data is backed up off site and is accessible to be restored during any type of disaster, 

Thomas Terronez, President of Medix Dental wrote in a recent DPR article

. In reality, the data could be accessed the same day to notify patients of the disaster, whether it’s a superstorm like Sandy, a fire or another disaster.

 can use the patient data to reach out and update patients on the progress of rebuilding as well as reopening, Terronez wrote in the article. Once the physical practice is rebuilt and you're ready to see patients again, all data is intact and the schedule is actually full because you were able to schedule patients based on having access to the data.

If your practice isn’t paperless, doing all these things becomes much more difficult, meaning you lose even more time and money than if you had backed up records for every 

With Sandy pounding away at the Northeast and leaving millions without power and massive amounts of flooding in its wake, it’s difficult to imagine all the damage that will be left behind.

Protect your patients’ information from natural disasters like superstorm Sandy

 throughout the course of the day, and most of those lies are harmless. The same is true in the dental practice.

You’ve likely heard more than one patient tell you they’re flossing every day, but you know for a fact that’s not true, or that they absolutely mailed payment in last week, when clearly they didn't.

It might be annoying to hear these lies over and over, but calling the patient out right there in the dental chair won’t do you or the patient any good. These patients are likely fibbing because they’re embarrassed to tell you the truth. Instead of making the patient feel bad or uncomfortable about the situation, take this as an opportunity to educate. Remind these patients how important home care is and that they need to continue to do their part to keep their mouth clean and healthy.

Your patients are your practice. Without them, where would you be? You have to know the best ways to attract them to your practice, get them to accept treatment, and make them happy, life-long patients.
	
That’s where we can help. Check back regularly for tips on how to keep your patients happy, healthy, and loyal.

Most of us tell little white lies throughout the course of the day, and most of those lies are harmless. The same is true in the dental practice.

Never call a patient a liar

You know your staff is talented and passionate about what they do. Why not give them a chance to show it?

Give each team member one month out of the year to be responsible for pride building throughout the practice, said Penny Reed Limoli, owner of the 

.  Establish a budget and let your team members use that money to promote their theme each month.

Not only is this a fun way to get your team more involved in the practice, it’s something your patients will notice. They’ll look forward to seeing the new theme when they come in for an appointment, and they won’t be able to miss the sense of pride it brings to your team. That’s something your patients will like being part of.

Spread the joy

Your patients are busy people. They’re likely working 9 to 5 jobs and may not have time to take an hour or two out of their day to spend in your practice.

Why not make it easier for them? Think about staying open into the evening a few days a week, or opening your practice a few hours early. Saturday morning hours are also a great alternative for busy working professionals.

If you can find a way to make extended hours work, you’ll attract patients who want to make their oral health a priority, but who just can’t fit dental appointments into their busy workday schedule. It will also give more options to current patients, who will be happy to tell their friends, family and co-workers about how great it is to have a dentist who’s flexible and willing to stay after hours or come in early. Market your new, more flexible hours and reap the benefits it can bring.