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

Renee Knight

Now that their college days are behind them, recent graduates are ready to shift their focus to the job market. But interviewing can be stressful-especially in today’s economic climate-and these new grads need something to boost their confidence as they meet potential employers.

, alignment or a gum lift, can give them the boost they need to land that first job. But if you and your staff don’t market your practice’s cosmetic services to these young adults, they may not even realize how much a change in their smile, whether subtle or dramatic, can help.

The first step is getting these patients in your chair so you can have a conversation about whitening, veneers or any other cosmetics they might need. Chances are these patients aren’t going to come to you; you need to do some external marketing.

If a patient isn’t sure about going through with a procedure, Penny Reed Limoli, owner of the 

, suggests showing the patient what he or she can look like once the procedure is done. Take a photo of the patient and send it to smilevision.net, a dental lab that creates before and after cosmetic simulations. Patients can see what they’ll look like with veneers or a whiter smile, and they can take the photo home to show family and friends. And a lot of a lot of practices don’t charge for this service because its considered a marketing expense, which is another benefit for your patients.

Limoli suggests starting with radio and Internet ads. Find out what stations that age group listens to in your area and develop a commercial about beautiful smiles and job hunting. Put local ads on Google or post something on a local university’s Web site. Placing a classified ad in an area newspaper is another option, although Limoli recommends concentrating your efforts online. Make sure any ad you place focuses on improving smiles and confidence, and consider offering a free new patient exam.

“Once you get those patients in the chair, you have to think about what they are looking for,” Limoli said. “A healthy smile conveys hey, I’m healthy and I’m not going to miss a lot of work. There are all sorts of things that go through the employer’s mind as far as is this is somebody I want to have work for me. People get judged at different levels based on appearance. If you show up wrinkled or if you’re embarrassed of your smile and your hand is covering your mouth, those things really do count.”

If you find a recent college graduate in your office for a hygiene appointment, take the opportunity to have a conversation about smile-enhancing cosmetic procedures, Limoli said. Start by congratulating the patient and asking how the interview process is going. Ask about procedures such as whitening to see if there’s any interest, and talk about other patients who have opted to go that route.

Dr.Brian LeSage and Limoli agree that one of the main reasons a patient decides not to go forward with a cosmetic procedure is money. And if the patient isn’t working, cost becomes even more of a barrier. Talk to these patients about CareCredit and flexible payment plans. Concerns about pain and time commitment are other reasons these patients may decide to hold off on improving their smiles.

“Internal marketing with nice, friendly dialogue with the patients can make the difference,” Dr. Brian LeSage (cosmetic-dentistry.com) said. “Having photos of your patients throughout the office can make a difference.”

Have your team members ask these patients if they’d like to know about options that can enhance their smile, or if they’re happy with the way their teeth appear in pictures. Get them thinking about the possibilities.

If this sparks interest, bring out books with the practice’s before and afters of successful whitening, veneers, alignments and other cosmetic procedures. If the patient is ready to try whitening, bring out the shade guide, Limoli said. Let the patient hold the mirror and really see how white his or her smile can be.

It’s also a good idea for these patients to do some prepping for the interview on their own. Have them take a good look in the mirror or a close-up digital photo to check for obvious bleeding gums, stains and broken or chipped teeth, Dr. LeSage said.

With this age group, whitening is the most popular choice, Dr. LeSage said. It’s relatively inexpensive and patients see results right away. Alignment and veneer restorations are also on the list, but remind these patients to think about fresh breath before answering that first interview question.

Bad breath can be offensive, Dr. LeSage said, and is probably the first dental-related concern to consider when interviewing.

If a college grad is coming to you for cosmetic advice and you know that patient is a smoker, take the opportunity to talk about throwing out those cigarettes, said Penny Reed Limoli, owner of the Reed Limoli Group. Remind the patient is does cause stains and smelling like smoke during can interview can be off putting.

“Some people don’t realize their breath is not so great,” Limoli said. “Dental offices can do tests on whether breath is fresh. If somebody has bad breath, an employer usually doesn’t think I’m not going to hire that person because of it, but it doesn’t count as brownie points. Fresh breath can help build confidence.”

Whether it’s a porcelain veneer restoration or composite bonding the new grad wants, 

, Director of Esthetics at New York University College of Dentistry, said talking honestly with your patients and really addressing their needs is the best way to get them excited about cosmetic procedures.

“I listen very carefully to any patients who come in asking for those types of treatments and try to discern what it is they’re trying to accomplish,” Dr. Calamia said. “I give them the treatment that’s going to take care of their needs and be the least invasive. I’m truthful and honest with the individuals, and they know I’d be doing the same thing if it was my daughter or wife sitting in the chair. I have respect for what they’re trying to accomplish and I make sure we’re on the same wavelength.”

And that includes letting your patients know when their expectations aren’t realistic, Dr. Calamia said. Sometimes these patients want something that just can’t be done, and when that’s the case, it’s your job to let them know.

Dental offices are busy places, so it’s easy to forget your patients’ accomplishments whether it’s a college graduation, wedding or milestone anniversary, Limoli said. When these occasions come up, take the opportunity to send the patient a card and offer a free cleaning or whitening.

What a new smile can do for your patients

A study conducted by Beall Research & Training indicates that a new smile will make your patients appear more intelligent, interesting, successful and wealthy to others. Dr. Anne Beall, a social psychologist and market research specialist carried out the study on behalf of the American Academy of Cosmetic Dentistry.

If you’re acknowledging a college graduation, you may have given that patient a reason to stay with your practice after he or she does find a job and leaves mom and dad’s house. And it may remind the parents that it’s time to focus on their smile and go forward with those cosmetic services they’ve been thinking about.

“Giving a personal acknowledgement to the family can have many rewards,” Limoli said. “It’s a great opportunity to appeal to a once child patient as an adult. And when those patients do get jobs they’ll have co workers, which can begin a whole new crop of patients and referrals.”

And the confidence boost you’ve given that patient will extend well beyond their next job interview, Dr. Calamia said.

“It’s a tremendous difference. It’s fascinating to me how many patients almost seem to change in personality when they have that self confidence,” Dr. Calamia said. “I have individuals who are shrinking violets and don’t want to say anything and don’t want to smile without a hand in front of their mouth. Once they go through a procedure and see the results, they have a lot more confidence in their personal appeal.”

Articles

Help recent graduates nail a job interview with cosmetic dentistry services

The technologies you use in your personal life can benefit your professional life as well. We have talked with 

 who have already put the latest technologies to work in their practices.

At home, high tech is the norm. From online bill pay, to smartphones and wireless technology, our lives are connected, customizable and efficient. With so much obvious value and efficiency in our personal lives, it makes sense to incorporate some of the same trends and technology into the professional sphere. The question is: How?

No one wants to introduce new systems and products just for the sake of being on the cutting edge. There has to be value. Here, we outline the technology you recognize best-you’re using most of them everyday-and then provide 

, like you, making them work for them in a practice setting.

Here are the Products. To see what dental professionals are saying, 


	Carestream Dental’s Practice Expert and Reporting Library (PEARL) Module is a mobile tool that allows on-the-go practitioners to access their practice management software via their iPhone or Blackberry. Users can view patient records and images, check schedules, monitor practice finances, and more-remotely and in real time. The PEARL Module is available for Carestream Dental’s SoftDent, PracticeWorks, OrthoTrac, WinOMS CS and Windent Practice Management Software, supporting dentists, orthodontists and oral surgeon.

Dentrix Mobile provides fast, secure mobile access to patient information from a BlackBerry®, iPhone™, Palm Pre™ or Android™ Smartphone. It enables you to quickly access patient information anytime, even after hours; verify patient prescriptions and insurance eligibility on the go; quickly view appointments for you, your patients and other providers; and view detailed patient demographics, appointments, prescription histories, medical alerts and more.

The Dental R.A.T. is a simple, powerful tool for streamlining computerized periodontal charting. It works with dental software and is a simple foot-operated mouse that enables effective, consistent hands-free periodontal charting.

Curve Dental’s Web-based software gives clinicians access to patient data from anywhere at any time; from home, work or play. The software doesn’t require servers or IT services, saving practices money. The software makes it possible to schedule, invoice, manage recall, manage insurance, chart, and much more using only a browser and Internet connection. The software is clean and easy to use, with no confusing toolbars. The software is customizable to each practice, and will help make you and your staff more efficient.

The XLDent™ practice management system uses the latest in software development and design tools to provide an intuitive, robust, easy-to-use dental software. XLDent™ automates key business processes and ensures dental teams have the tools they need to manage the practice more profitably.

CAESY Cloud offers instant access to more than 280 multimedia presentations and access to patient education resources from multiple locations within the practice. New videos and features are posted frequently and seamlessly through the cloud. No installation and no network connections between participating computers are required. It is PC and Mac compatible, including iPads, iPods, iPhones and smartphones. The newest version, CAESY Cloud 1.2, gives practices the ability to embed CAESY presentations within their website(s), allowing professionals to better promote their services and demonstrate their commitment to educating patients. 

Officite’s mobile website solution creates a full version of your current site so that it will display and function optimally with the small screen dimensions on your patients’ smartphones and tablets. Visitors to your mobile site will be able to easily and instantly navigate the content-convenient click-to-call, appointment requesting, door-to-door directions, your full dental library and more-so your practice can connect, educate and communicate with patients in real-time.

Livescribe’s newest Smartpen, Echo, features a sleek design and enhanced features designed to make it the most powerful and easy to use smartpen yet. It allows users to transfers notes and audio to your computer and recharges your smartpen using a standard cable connection. Capture your meetings or lectures with crisp clear sound. Built-in speaker produces rich full sound to play back your recorded audio. The new ergonomic design and soft rubber grip provide comfort while writing (4GB and 8GB models available). Simply remove the ink cartridge with your fingers and insert a new one.

The Eye-Fi card is the first wireless memory card. It looks, stores media, and fits into cameras just like a regular SDHC card. On top of that, the Eye-Fi card has built-in Wi-Fi that effortlessly transfers photos and videos to your iPhone, iPad, Android device or computer.

Tyco Electronics’ Elo TouchSystems is a leader in touch products and technologies. Featuring a design that incorporates easy-to-read displays and responsive touchscreen interfaces, the touch equipment has a sealed casing that protects against liquid splashes. This allows the display to continue operating accurately even when subjected to water drops or other substances. Elo touchscreen products can be activated with a finger, rubber-gloved hand or stylus-all common in health care settings. Easy to use, reliable and stable, Elo touchscreens, touchmonitors and touchcomputers bring powerful simplicity to equipment, instrumentation and services, and improve the efficiency of devices used in a variety of health care settings.

 provides clinicians with a combination of outstanding image quality and diagnostic flexibility with an easy-to-use, modular technology that improves practice efficiency and enhances patient comfort. 

, which uses leading edge RFID technology, can be used with 

The technologies you use in your personal life can benefit your professional life as well. We have talked with dental professionals who have already put the latest technologies to work in their practices.

Save time and money by using your personal technologies in the dental office

IDOC Dental Lab is a full-service dental lab with 40 employees. It opened in Garden Grove, Calif. 12 years ago and specializes in smile design cases, implants and overdentures. Joey Hamernik is IDOC Dental Lab’s Vice President.

Compared to traditional all-ceramic materials, IPS e.max lithium disilicate affords optimal strength, durability, and esthetics. It has a flexural strength of 360-400 MPa and is up to three times more durable than other glass-ceramic systems. IPS e.max incorporates true-to-nature shades while demonstrating a low refractive index, providing optimal optical qualities (e.g., life-like translucency and high light transmission). Cutback-and-layer or stain-and-glaze techniques make it possible to further characterize IPS e.max restorations. Dental professionals can seat IPS e.max restorations using either conventional cementation or adhesive bonding methods.

Joey Hamernik needed something that would put an end to porcelain fracturing, especially porcelain 

. He found that in Ivoclar Vivadent’s IPS e.max.

That was three years ago, and since then not only has the fracturing problem been resolved, his lab has seen a 360% return on investment, a number that goes far beyond expectations. IDOC Dental Lab’s remakes have dropped to 0.8, and that of course saves the lab plenty of time and money.

“It’s one of our products with the lowest remake rates. I believe it’s because we “wax and press” here and that produces a very accurate fit,” Hamernik said. “I think for any lab that is after a low remake rate, e.max will achieve that. The doctors are happy all the way around and the patients are happy from the esthetics viewpoint, and you have very few shade changes.”

In the last three years since IDOC began using e.max, Hamernik has converted dental offices to using nothing but e.max. The lab even recently put on an e.max seminar for about 20 local dentists, where they outlined e.max’s benefits and went over manufacturer guidelines.

“We are a very customer-service-oriented lab,” Hamernik said. “We work with doctors in the beginning to troubleshoot prep and impression issues. Once they follow those guidelines and give us an all ceramic prep, they become loyal and very happy with the outcome of e.max-they love the esthetics and how it matches the natural surrounding teeth. They love the strength and they love the chair time-this is a 5-minute chair time product.” 

About 90 percent of IDOC’s all-ceramic cases are 

, so the strength e.max offers is probably the No. 1 benefit, Hamernik said, but the esthetics are a pretty great bonus too. With implant-supported crowns, you have the choice of so many high opacity ingots that can block out dark stumps and abutments for a more esthetic look, something that’s important to patients.

And with this product, you’re in control, Hamernik said. You’re 100 percent in control of the shade, and the technicians really get to know each e.max case they work on because they’re controlling the process from start to finish.

“It seems like you’re more intimate with these cases than when you use other products,” Hamernik said. “When you’re processing cases a lot of times you’re just making the coping or one part of the case, but with e.max the same technician is making that case from start to finish. You have fewer hands in the mix. It’s one person who starts and finishes the case.”

The strength, esthetics, and control e.max provides have made this product a great addition to IDOC Dental Lab, and is a  product that has performed beyond expectations. IPS e.max answers the porcelain fracturing problem that labs faced a few years ago, and shows Ivoclar Vivadent’s commitment to listening and providing solutions, Hamernik said, and that’s something the company proves time and time again.

“They really listened to the industry. They listened to the problems the doctors and the labs were having and came out with a solid concrete answer to solve those issues,” he said. “Porcelain chipping is the least of my problems now.“

The Lab IDOC Dental Lab is a full-service dental lab with 40 employees. It opened in Garden Grove, Calif. 12 years ago and specializes in smile design cases, implants and overdentures. Joey Hamernik is IDOC Dental Lab’s Vice President. The Product

Real Time ROI: Ivoclar Vivadent’s IPS e.max

Lisa Holzkopf was always indecisive when it came to making major changes to her 

. She had what she describes as “smaller than normal front teeth.” They had to be shaven down after she chipped her front tooth on the edge of a swimming pool during her high school years, and one tooth slightly overlapped the other one. When she first talked to 

 about her concerns with these teeth, he recommended going through the entire process of an expander for her back teeth and braces. This just didn’t seem worth the trouble for such a minor esthetic concern, Lisa said, especially because these teeth didn’t show when she smiled. But Dr. Engelberg offered Lisa another option that was much more attractive.


	When Dr. Engelberg suggested IPS e.max veneers, Lisa wasn’t convinced at first.
	“My first reaction was that they would be incredibly expensive and I didn’t want to lose (they shave it down to barely anything) my teeth (because they were healthy),” she said. “But the way the product is made and lasts, and the fact that they ended up being affordable and worth it, I went through with it.”

Lisa’s upcoming wedding was another factor that pushed her to make the decision, a decision she couldn’t be happier she made.

Before the procedure, Lisa’s teeth were chipped and worn, and much of what Dr. Engelberg did was to correct the wear in the incisal edges. Because of the material’s strength, Dr. Engelberg had to remove very little tooth structure, another benefit of using IPS e.max 

She’s had the veneers for about 8 months now and loves that her “front eight teeth are a good size and are straight.” Her smile is more attractive now, she said, and is something she’s noticed in pictures.

“I never had braces or anything done and only had minor problems, but loved the result of the veneers,” Lisa said. “I can’t imagine how happy someone with major cosmetic (or other) concerns would be if they got them. They also will never stain!”


	Lisa was so happy with her veneers that she even appeared in advertisements that promoted the benefits of the IPS e.max veneers and encouraged patients to check out Dr. Engelberg’s practice.

“I thought it would be a fun experience and they really worked around my schedule to make the shoots possible,” Lisa said. “The staff was very friendly and if it helps others who are considering the product, I figured why not?”


	Throughout the process, Dr. Engelberg took the time to explain all of the options to Lisa, and told her what to expect every step of the way. He told her what would happen during the procedure and talked about the benefits of the durable, esthetic veneers that would give her a more attractive smile. That helped Lisa make the decision to go through with treatment and enabled her to be confident that she was making the right choice.

“Dr. Engelberg did exactly what I wanted and I love the appearance of the veneers,” she said. “He was very helpful and is still patient if I have any concerns.”

Lisa Holzkopf was always indecisive when it came to making major changes to her smile. She had what she describes as “smaller than normal front teeth.” They had to be shaven down after she chipped her front tooth on the edge of a swimming pool during her high school years, and one tooth slightly overlapped the other one. When she first talked to Dr.

Patient Perspective: Using veneers to get to a more attractive smile

 walks out of your practice annoyed, that patient likely isn’t coming back.
	
	And these patients may not even tell you they’re irritated with you or one of your team members; they may smile and nod until they can finally leave, all the while thinking, “man, I need to find a new 

.”
	
	Of course this is the last thing you want to happen at the end of an appointment. The goal is for patients to walk out of your practice ready to sing your praises to family and friends, but that isn’t going to happen if you’re annoying patients during appointments. Here’s a breakdown of some common patient annoyances and what you and your team can do to avoid them.
	
	

 Too much cologne or the lingering smell of cigarette smoke on a team member’s hands are sure ways to annoy your patients, warns Penny Limoli, owner of the Reed Limoli Group. Limoli talked with patients about what irritates them most about their dentist and strong smells we definitely on the list. Nobody wants to deal with the taste of 

 in his or her mouth, and even though you think patients can’t smell it on you, they can. And if you’re telling your patients not to smoke, you and your team members probably shouldn’t be smoking either.
	
	Limoli points out that overpowering cologne or air fresheners also can be unpleasant. Cologne should be worn in moderation, if at all. Remember some patients may be allergic, and taking in your hygienist’s favorite perfume is the last thing they want to do during their visit to your office.
	
	

 Patients like to know what to expect, especially when it involves money. Limoli emphasizes that if your fees go up every time they come to your office, they’re not going to be happy. They’re also not going to be happy if you tell them their dentistry will cost X amount, only for them to find out later it’s going to cost them more because you forgot to factor something in.
	
	Kathleen O’Donnell, director of consulting for Jameson Management, says that before telling a patient how much the treatment is going to cost, take the time to figure out exactly what the final bill will be so there aren’t any surprises. Put together a formal financial agreement that takes everything into account, including what insurance will cover and what it won’t.
	
	“Also suggest the patient put down a deposit on the treatment if it’s significant,” O'Donnell said. “Tell the patient there will be an initial deposit of $500 and ask how they would like to take care of that. The patient has a commitment at that point and clearly understands everything he or she will be obligated to pay.”
	
	This is especially important with emergency patients. Make sure they have the time needed to complete the procedure, and that a written financial agreement has been put together so they know exactly what the treatment will cost.
	
	

 Your time is valuable, and so is your patients’ time. Patients aren’t going to be happy if they rush to get to their appointment on time, only to sit in your reception area or in the treatment room waiting and waiting for their appointment to finally begin.
	
	Don’t assume waiting is something patients expect as part of the deal when they go to the dentist. Take steps to let them know you understand their lives are busy and they don’t have time to waste sitting around.
	
	To avoid this, O'Donnell suggests timing procedures to be more accurate. Estimate average times and then literally time appointments with a stopwatch three to four times and use the averages. If you’re familiar with a patient and you know Mrs. Jones has difficulties and will most likely take extra time, add on a unit of time to be more accurate.
	
	

 Too many offices squeeze in unrealistic numbers of procedures, and that often includes using three or four treatment rooms to bank people. When that happens, everyone ends up waiting and getting more irritated by the minute.
	
	Instead of creating a stressful situation that leads to unhappy patients, O'Donnell recommends dovetail scheduling. Based on your averages, block a certain amount of time off for specific procedures, making it easier for you to schedule in smaller procedures throughout the day.
	
	“It may be a bit of an adjustment, but it’s a way of creating sanity for the doctor and the team for how they approach each day,” O'Donnell said.  “And it’s also so kind to patients because people don’t end up waiting unrealistic times.”
	
	

 Whether you’re talking to the patient or your assistant, too much chatting can put your patients on edge. Limoli cautions that patients don’t like it when you stop working in their mouth so you can talk to them or ask them questions while you have an instrument in their mouth.
	
	O’Donnell adds that even though you have a good rapport with your team members and want to chat with them during the workday, doing so while you have a patient in the chair isn’t the right time. This can often make them feel invisible. While you don’t want to work in silence, it’s important to remember the patient is there and may not be comfortable listening to your inside jokes.
	
	

 If you’re training a new graduate assistant, don’t just assume your patient is OK with that new assistant making their temporary crown, O'Donnell says. Because the assistant is learning, it’s going to take longer to make that temp, and the patient may not have an extra 45 minutes that day. The best way to handle this is to ask the patient if he or she is OK if the appointment takes a little longer because you’re training a new assistant. Some won’t have the time to spare but others will be happy to help, and even happier that you respected their time and asked rather than assuming they wouldn’t mind.
	
	

 Everyone loves coupons and saving money, but no one wants to see a promotion in their inbox for a treatment they’ve already started.  Make sure you know what treatments your patients are receiving, and if they’re already 3 months into their Invisalign treatment, don’t send them coupons for $1,000 off. But if you do, Limoli stresses that you better be prepared to honor it.
	
	

Disciplining your team in front of a patient.

 No matter what you may have discovered about a team member, never reprimand that team member in front of a patient, says Dr. Brad Guyton, Chief Operating Officer for Jameson Management. Your patients don’t want to hear about it; in fact it just makes them uncomfortable.
	
	“That’s difficult for patients to hear,” Dr. Guyton said. “We are advocates of always building your team up. If the patient hears the doctor complain that 'this is not the temp I was expecting or that is not a great impression, that’s an awkward thing for the patient to digest.’ The visit always goes smoother when the patient hears the doctor reward and appreciate a job well done. Constructive criticism must be addressed privately.”
	
	

 When you’re discussing diagnosis and treatment options, patients do not want to hear about all the technical aspects associated with their case. They just want to know what the problem is, how you’re going to fix it, if it’s going to hurt and if it’s within their budget, Dr. Guyton says. Too much technical information will often overwhelm them and may keep them from pursuing the treatment they need.
	
	“We often recommend dentists to stop talking and give patients only the necessary information they need to make an informed decision. Do not overload them with technical speak that isn’t necessary,” he said. “While we support all aspects of comprehensive informed consent, we must remember it does the patient no good if it isn't understandable.”
	
	“We ask dentists to be quiet and give patients the information they need to know to make an informed decision but not overload them with technical stuff that isn’t necessary,” he said. “We’re big fans of informed consent but it needs to be understandable.”
	
	

 You just broke down the treatment plan to the patient and talked with the patient about the cost. The patient is ready to go forward, but can’t afford the treatment without help third party financing. According to O’Donnell, having this option is key to helping patients afford the treatment they need, without your office turning into a bank. If you don’t offer this type of option, chances are patients are going to go elsewhere to get the treatment they need.
	
	

 Seems like a no brainer, but you have to remember you’re working in people’s mouths and you have to keep yourself presentable. Keep your nose clean and your nose hair trimmed, Limoli suggests, and dress appropriately for a dental practice. And if you or a team member has a cold, it may be a good idea to stay home. Patients don’t like the idea of someone who’s walking around with a cough and a runny nose working in their mouths.
	
	

 It’s important for you to educate your patients about what can happen to their mouths if they don’t take care of them, but Limoli advises that putting up diseased mouths in your waiting area isn’t the way to do it. Those are best suited for patient education presentations. Decorate your walls with pictures of beautiful smiles you’ve helped created to motivate your patients and show them what’s possible if you work as a team.
	
	The waiting area should be used to convey positive messages about density, O’Donnell recommends. Don’t let your waiting area fill up with outdated magazines. Instead supply it with entertaining as well as educational reading materials.
	
	Keeping your patients as happy as possible is a great way to not only improve your practice, but to improve your relationship with your patients and their treatment outcomes. So if you or your staff members are doing anything that might be annoying your patients, take a step back and make some changes. Everyone involved will benefit.  
	
	
	 

If a patient walks out of your practice annoyed, that patient likely isn’t coming back.  And these patients may not even tell you they’re irritated with you or one of your team members; they may smile and nod until they can finally leave, all the while thinking, “man, I need to find a new dentist.”

Are you annoying your patients?

The further you get into your career, the easier it is to become complacent, to make yourself believe there’s no point to invest in new technology or that the pains that come with practicing 

 are just part of the job. But no matter what your age or how close you think you are to retirement, you have to continue to grow. You have to stay curious and passionate about what you do, whether you’re planning to retire in 5 years or 20 years.

And of course, with the current economic climate, many dentists feel like they need to practice longer than originally planned. Maybe you lost money in your retirement portfolio or are just too uncertain about the future to go through with retirement plans. Or maybe you just love what you do so much you’re not ready to stop. Whatever your reasons for wanting to extend your career 

, there are plenty of ways to make practicing late into life much more rewarding, from keeping up-to-date on the latest and greatest in technology to making ergonomics a priority for you and your staff.

“You have to upgrade your clinical skills, your technology, your marketing, your staff management skills. You have to continuously grow,” said Amy Morgan, CEO of the 

. “Even if you don’t want to stay relevant for yourself, the day you try to sell your practice to a young dentist who’s been exposed to the best in 

 and knows what he wants, he’s going to find a huge discrepancy between having something new and special versus what you’re offering for sale. So until the day you lock the door and turn over the key, you have to grow in all aspects.”


	Dentistry is constantly changing. There’s always a new product you can add to your practice or a new technique you can learn, and they’re all designed to make your job easier and the patient experience more pleasant. But if you’re content to stay with the status quo, you’re never going to reap the benefits these new additions to dentistry can offer. To keep from burning out, you must have a deep rooted curiosity about “the next big thing,” Morgan said.  

No matter where you are in your career, you can’t ignore that the industry is changing around you. You have to read the dental publications, watch webinars, look at blogs, attend CE and spend time talking to manufacturers on tradeshow floors, said Laci Phillips, of Banta Consulting. Talk to colleagues and keep yourself abreast of the latest and greatest. If you don’t, you may find yourself losing interest as well as patients.

Patients are well educated these days, and can do their own research about what’s available to them. If they find through a Web search or a phone call that your practice doesn’t have the latest technology they’re looking for, they’ll move on to the next office. Even patients who have been loyal in the past may move on when they hear friends or family talking about their great experiences at the practice down the street.

“It’s frustrating. We want our doctors to be up-to-date and know what’s out there, no matter how old they are,” Phillips said. “We want them to have that knowledge. And not only in technology but what’s out there that can help me as a patient.”

Not only does updating your skills please your patients, it also keeps your day-to-day more interesting, said Dr. Michael Kokott of Associated Dentists in Wisconsin. That’s so important when it comes to career longevity. If you get bored you’ll lose your passion for what you do, and without that dentistry becomes just another job. And if you’re not updating and marketing your skills you’ll not only lose patients, you’ll stop attracting new ones. New patients are key to a thriving practice.

“If you have more patients coming in it will extend the life of your practice,” he said. “Once you stop getting new patients, it’s sort of the beginning of the end of your career. Having new patients come into your practice is an essential part of keeping your career going, and keeping it interesting as well.”


	While keeping up-to-date on the latest in dentistry and incorporating new technologies into your practice are great ways to add years to your career, you also need a plan for these products and techniques. All too often dentists buy that new piece of equipment only to find they never use it.

You have to think about what innovations most match your vision, values and strategy, Morgan said, and then you have to train yourself and your team on all aspects to get the most out of those innovations.

“Sometimes a long term dentist in peak performance will be willing to grow but only in one category. You can’t cheat physics. You grow in one area it affects all other areas,” she  said. “If you purchase a cone beam scanner but don’t take into consideration the practice management implications, the marketing implications and the clinical ramifications of that new innovation there’s a good chance that new technology purchase is going to fail. To have a growing practice you need to fire on all pistons.”


	If you’re going to have a long, successful career, you’re going to need a strong, energetic staff that wants to grow with you, not hold you back, said Dr. Bill Domb, who has a practice in Upland, Calif.  
	“Having a good staff is so important,” Dr. Domb said. “You need positive people and competent people. When you find someone who’s not a good fit don’t prolong the agony. Get them gone and find somebody else because they’re certainly out there.”

Once you find the right people, you have to invest in them. Training is such a crucial element to any successful dental practice, and Phillips recommends dentists offer team members a minimum of four hours of training a year. Getting your CE credits and keeping yourself up-to-date on the latest techniques and trends isn’t enough. Make sure every team member knows how to use the equipment and technology in your office.

Once you have your team trained and ready to go, Dr. Mark Hyman suggests you get out of their way.

“I have a magnificent group of women that I love to say I work for,” said Dr. Hyman, who has a practice in North Carolina. “They are highly trained and they are cross-trained. I focus on the procedures that only I can do, while the team manages almost everything else. This provides me, a single practitioner, with recuperative physical and mental breaks throughout the day.”

And don’t forget to surround yourself with good people beyond the dental practice, Dr. Domb said. It’s important to have a support group around you. That can come from a close circle of friends as well as your peers. If you’re not part of an online community, Dr. Domb recommends changing that. Groups like the Academy of Comprehensive Aesthetics (ACE), the International Dental Forum (IDF), the LVI Forum or Dental Town can provide you with support and a wealth of information, whether you’re going through a trying time at your office, thinking about adding a new technology to your office or going through personal issues that you need to talk about.


	Neck and back pain as well as hand fatigue are common problems that plague dentists. The pain can be so severe that it leads dentists to cut back on hours or force them to retire from practicing long before they’re ready. This pain isn’t something you can ignore, and if you can actually prevent it, all the better.

In fact, ? of dentists who retire early are forced to do so  because of a musculoskeletal disorder, Dental Ergonomics Expert Bethany Valachi said. Sitting for long hours in static positions is not good for the body, but that isn’t something that’s typically covered in most dental schools. Most schools don’t have a formal ergonomics curriculum, she said-they tell their students to sit up straight but don’t give them the tools to make it happen.

“There’s not a great awareness among dentists. They don’t know until they start to hurt, and structural damage happens long before we feel the pain,” Valachi said. “And this is what dentists teach day in and day out. Do you not brush your teeth until you’re in pain? No. It’s prevention. You take care of it so you don’t sustain the structural damage. So there’s a parallel between what they teach and the care of their own bodies.”

And when it comes to ergonomics, there’s so much to think about, from positioning the patient correctly for upper and lower arches, selecting the right ergonomic loupes, proper operator stool adjustment and proper positioning of the overhead light, to name a few. There’s so much to think about it can be a bit overwhelming, Valachi even wrote a 200-page book on the topic, but there are changes you can make to relieve or prevent pain, and that in turn will add years to your career.


	After only about nine years of practicing full time, Dr. Stephen Johansen was starting to think he might have to make a career change.

He was only in his late 30s, but the pain in his lower back was so severe he didn’t know how much more he could take. The thought of giving up his dental practice before he even turned 40 was a scary one, so he spent a lot of time looking for solutions. He came across a Dental Town thread about 

 and thought what did he have to lose, he’d give it a try. That decision helped to save his career. He noticed improvements in his back after only a few days.

“I was so scared. I was thinking I wanted to stay in dentistry but was trying to figure out what I could do to maybe teach,” said Dr. Johansen, who practices in Utah. “It was to the point where I knew if I was hurting at that level I didn’t think I could last 6-to-12 months. And so it was scary because I thought I’m not really qualified to do anything else. I didn’t know what I was going to do but I was contemplating that the end was near for me. I was worn out. With the tools I’m using now I feel like I can practice until I’m 75. I feel like I’m getting better and stronger. Long days aren’t as bad. I hurt less and I’m sore less.”

Adding the AnterioRest to one operatory, combined with adding a surgical operating microscope to a second operatory and taking up 

, has worked wonders in alleviating his back pain, Johansen said. The back pain started just three years into his career, and he said he wishes he would have been more prepared for the pain that came with dental practice and maybe even have prevented it. He encourages dentists who haven’t started experiencing pain yet to look into options like the AnterioRest, a product he said does a wonderful job of providing the necessary back support.

Proper seating is critical to a dentist, Career Extenders President Gregory Books said, because practicing in an unsupported seating position will expose muscles to a lot of unnecessary wear and tear over the years. Most physical problems dentists face are the result of unsupported seating, he said, and the static positions dentists must sit in to perform their work. Instead of attempting to move the dentist to another unsupported posture, the AnterioRest supports dentists in their chosen working position. The movable support means dentists don’t have to work in a static load position, and that is the key to pain relief. It can be installed onto about 300 different dental chairs.  

“If you can eliminate the unnecessary fatigue by introducing support into the preferred working position you can improve productivity, improve longevity and see a dramatic increase in quality of life and the ability to do what you love doing for a lot longer,” Books said. “But the key is support for the working position, not replacing one unsupported position for another.”

There are other ergonomic seating options you might want to look into, and when doing so Valachi recommends selecting a stool with a tilting seat pan (you don’t want it to tilt more than 15° forward). She also recommends to consider using a saddle stool, making sure the headrests on patient chairs are properly adjusted for upper & lower arches and also taking the time to correctly adjust the seating to meet your needs.

Among these options are the ErgoSure Stools from 

 that tilts from 0 to 15° for better blood flow, offers complete mobility and features easy height adjustment for relaxed positions, and 

 stools that feature seat tilt and lumbar support that relieves pressure on the back of the legs, increasing comfort.


	While proper seating is the foundation for good posture and alleviating pain, magnification helps as well. You need to practice with neutral neck posture to prevent chronic neck pain, said to create shadow-free images by adjusting the illumination direction of overhead lights or using a loupe-mounted headlight.

Creating this neutral neck posture without the right loupes is next to impossible. Dentists are constantly leaning in to get a better look at the patient’s mouth, and this leads to neck and back fatigue, said James Onderak, Orascoptic Director of New Product Development. Dentists are hunching over and moving their bodies in awkward positions so they can see. Magnification brings the teeth closer to your eyes, so you don’t have to move in to get a better look. You can see what you need to see while sitting in a comfortable position. Not only that, it helps you see problems you might normally miss, and it helps alleviate the eye strain so many doctors have to deal with after a long day chairside.

Dr. Kokott has used Orascoptic loupes for 25 years, and said he first bought the loupes for clarity of vision and better patient care. He had heard about the ergonomic benefits as well, and knew working with a more

 President Jin Chang, and that requires a head tilt of less than 25° and means the eyes need to rotate to see the target. Unless you take great effort to practice the neutral posture, there’s a great chance you’re tilting your head instead of rotating your eyes. You also need to avoid twisting your body upright posture would be beneficial to his health and his career. So using loupes has helped him prevent pain that so many other dentists experience.

When purchasing loupes, you need to look at the magnification, field size, declination angle and resolution, Onderak said. The right combination will improve your health as well as patient care. The declination angle is key to preventing pain, and Onderak said most dentists tend to work at angles between 30° and 35°.

And if you’re using loupes without the proper declination angle, you could actually be doing your body more harm than good, Chang said.

“Right loupes with proper declination angles will help dentists work with the neutral neck postures,” Chang said. “However loupes with improper declination angles will force dentists to work with the poor neck posture. The use of improper loupes is a major cause of chronic neck problems.”

Even with the right loupes you have to be willing to make the posture adjustments to get the full benefits, Onderak said, and to make sure you get the working distance that’s best for you. Often dentists sit up straight and try to have their best posture when the loupes manufacturer comes in to fit them, but then find they can’t maintain that posture throughout the working day. The manufacturer can always re-work that distance, but if you want the ergonomic benefits you have to commit to improving your posture, and realize it’s not an overnight cure.

“Gradually increase the working distance. If you’re currently lunging in and working at 12-to-14-inches all the time it’s going to be difficult to all of a sudden go to 22 inches,” Onderak said. “First get an ergonomic chair. That’s the foundation of support for your body. Then go ahead and get a loupe and take yourself up 4-to-6-inches. That’s usually something dentists can tolerate. That will help incrementally, and it’s something you should be able to sustain. At this point we’re talking about sustainability if you have neck and back pain. After 6 months to a year go up even higher and get to that 20 inches or 22 inches. It’s almost like a life-changing commitment to work on your posture. Like people who are overweight. It’s  a life-changing event you have to be committed to. Magnification is no different.”  


	Before he started using the MagnaVu dental procedure scope, Dr. Domb thought he was going to need shoulder surgery.

But that isn’t the only reason he invested in the MagnaVu. He wanted to see better, and had decided it was time to get rid of his operating microscope.  

“The upper right quadrant of my back was taking a lot of stress,” Dr. Domb said. “It had gotten to the point where muscles were pushing on nerves. I would be working and all of a sudden my right arm would drop. It had started to concern me and I could see the tenure of practicing getting limited quickly. As soon as I started being able to sit upright this all went away.”

So how does it help? This product allows doctors to sit up straight and work off a screen like medical surgeons have done for years, MagnaVu Vice President Bob Seawell said. The direct image enables them to see on screen what they would see in a mirror or if they were bending over to look directly in the mouth. They see it larger and without pain, and that means better patient care.

The product enhances what dentists do, Seawell said, giving them better lighting and improved ergonomics. The 24X magnification helps them see better and reduces eye strain, while they’re not contorting their bodies to see inside the patient’s mouth. Some dentists say this product has given them another 5-to-7-years to practice dentistry, Seawell said, and it’s given them their passion back. They’re not as beat up or worn out as they once were. They don’t have to go to physical therapy anymore or take medications every day for the pain. Overall, they have a better quality of life.

“This gives them a second shot at doing what they love best and practicing as long as they want,” Seawell said. “When they get home they’re not as fatigued as they used to be. Before they would get home and not do a whole lot or not do things on the weekend, because they were too sore, beat up and stiff. After a few months of using our product dentists find they can go out and enjoy free time again.”

Dr. to your body to make practicing even more comfortable. But the magnification and the more comfortable seating position aren’t the only benefits. It can be used as a teaching tool to show patients exactly what he sees, and it also enables his assistants to see what he sees, enabling them to know actually what he needs in any given procedure.

The MagnaVu systems start at about $22,000, so it’s a big investment but one that Dr. Domb said is well worth it. Without it shoulder surgery would have been inevitable, and that would have meant time away from the practice and lost revenue. Beyond that, if something went wrong with the surgery he may have lost his ability to practice. Instead, he’s gotten 10 years and is still going strong.


	Hand fatigue and carpal tunnel can both become problems if you’re not using the proper instruments. You have to find ergonomic instruments that are lightweight, comfortable to grip and easy to maneuver if you want to get through your day without hand fatigue, and the same goes for your staff.

Dr. Pat Allen, who practices in Texas, has used Hu-Friedy instruments for more than 30 years, and every instrument he has in his practice from perio probes to hand-held mirrors to surgical kits come from the company. These instruments have a very good balance and comfortable handles-which means round, large and hollow-which are both key elements for hand instruments if you want to avoid doing damage to your hand long-term. The large, round handles also give you better fingertip control, which means you don’t have to turn your wrist to make micromovements.
	
	Domb began noticing changes in a few days, and said the problem with his arm stopped in a few weeks. The system comes with an 

 that, with a push of a button, instantly adjusts.

“The expression I use is, if you wish to practice longer in procedures or longer in your career you need to pay attention to ergonomics,” Dr. Allen said. “That applies to auxiliary personal as well. In my practice every instrument in every area for every person has ergonomic handles. Mirror handles, probe handles, curet scalers. Everything.”

Dr. Hyman also knows the importance of ergonomic instruments and said he appreciates the touch and feel of his KaVo electric handpiece. He gets a smoother, more predictable and more precise cut and he doesn’t have to push as hard as he has with other handpieces.

“Dentists drill most of their day, so I’m in favor of anything that can deliver better quality care and a better physical experience for the doctor and the team. My team also use these handpieces,” Dr. Hyman said. “Before I tried the handpieces, I had convinced myself that I didn’t need them because I was set in my ways, and I didn’t want to spend the money on them and I didn’t want to change. The first time I tried one, I thought, “What in the world was I waiting for?” Immediately there was a dramatic change in how I prepped teeth and a huge improvement in my physical experience.”

When it comes to taking care of your hands, instrumentation isn’t all you should consider. Microflex 

 provide barrier protection, but a comfortable and ergonomic design targets the risk dentists face from hand fatigue and injury, said Michael Schoen, Dental Market Manager for Microflex.

This certified ergonomic exam glove uses an exclusive technology called Avantex™ to provide a comfortable, precise fitting nitrile formulation, Schoen said. Combining strength and protection with ergonomic comfort makes for an exam glove that helps keep dentists safe from biological hazards in the office while also caring for the health of their  hands.

“Dental professionals are in their gloves all day long,” Schoen said. “So wearing a glove that is less constricting on their hand and requires less muscle exertion to move in helps reduce their chances of suffering from hand fatigue, which over time may lessen their chances of developing more serious hand injuries such as carpel tunnel syndrome. Considering the use of ergonomic products may help lead to longer, healthier careers because they are designed to reduce the chances of ergonomic injury. ”


	Dentistry can be a stressful job, both mentally and physically; that’s why it’s so important to take care of yourself. If you don’t, you can forget about a long career.

Exercising regularly is a key component of a successful career, said Dr. Kokott, who follows an exercise program designed to strengthen his muscles.

Exercise is very important, but it’s also important that dentists are doing the correct 

, Valachi said. Dentists have to focus on exercises that target specific muscles for strength training and specific muscles for stretching, which is different than what someone who isn’t a dentist may take up. The wrong exercises can actually lead to more pain, Valachi said, who has a DVD that breaks down some of the best exercises for dentists.

Core strengthening exercises like Yoga can make a huge difference in your flexibility and how you feel day to day, Dr. Johansen said. As you know, the awkward positions you have to sit in every day don’t do your back or neck any favors, so anything you can do to strengthen those areas will go a long way to improving career longevity.

Dr. Johansen began using Yoga a few years ago after a colleague recommendation. He wasn’t sure about it at first, but was in so much pain so early in his career that he was ready to try just about anything.

“Out of desperation I thought I’m going to give it a try, it worked for him,” Dr. Johansen said. “I tried it and I was amazed. This should be a class in dental school. It restores flexibility and core strength. Unless you’re engaged in doing core strength exercises you’re not going to develop it, and as dentists our cores have to be bullet proof strong.”


	If a long, successful career is what you’re after, it all comes down to being happy in your professional life and your personal life. You have to find a work life balance and you have to stay passionate about what you’re doing. For this to happen, you need to staying healthy and curious.
	Not needing to retire also is key to longevity, Dr. Domb said. Have a retirement plan you feel comfortable with; don’t put yourself in a situation where you have to work to 75 to survive.

“If you can do what you do as a dentist knowing you could be somewhere else if you wanted, that says a lot about staying in your practice,” Dr. Domb said. “Not having to be in the practice but doing what you love.”

But if you find yourself in a situation where you have to work longer than planned, don’t just coast along because you know you only have five years or so left. Remember why you first started practicing and find ways to make it fun again. Seek out new technology, take care of any pains you’re having and find your passion again. Make it so you want to practice until you’re 75.

“If you have three or five years left that’s three or five years of dentistry or patients you have left,” consultant Phillips said. “Don’t you want to go out on top? You don’t want all the complaints from your dental career to come in the last five years that you practice.”

The further you get into your career, the easier it is to become complacent, to make yourself believe there’s no point to invest in new technology or that the pains that come with practicing dentistry are just part of the job. But no matter what your age or how close you think you are to retirement, you have to continue to grow. You have to stay curious and passionate about what you do, whether you’re planning to retire in 5 years or 20 years.

Practice dentistry until you're 75

If you choose the wrong lab management software, you may end up costing yourself a lot of time and money. That’s why when it’s time to buy lab management software, you have to look at all the options to determine what’s best for your lab, and that doesn’t necessarily mean the cheapest option. You need to take the time to look at what the software offers, how flexible the software is, are upgrades available and for how much, and the company’s reputation, among other things.

Seem a bit overwhelming? It doesn’t have to be. We recently talked with Alan Barnes, founder of Coaching For Service and the Barnes Group, for advice on what to consider when choosing lab management software. Here’s what he had to say.

 What should labs look for when choosing lab management software?

 A lab needs to look at what their present needs are and what their projected growth patterns are going to be. You want something you can grow into but not grow out of. Make a list of what you need: do you want bar coding, do you want to send out letters to your doctors, do you want something that’s easy to change if you have a fee increase and can you do that internally or do you have to go back to the company that wrote the software? Then look at maintenance fees. Is there a yearly maintenance fee as well as a monthly fee, and how much does it cost to upgrade? You could spend more money on upgrades than on the initial system.

Talk to friends and colleague and make sure the company is reputable and that their turnaround times on making changes are realistic, and that you’re not going to be stuck for a long time waiting for changes. How are the support services? Ask the company for three or four references and don’t be afraid to call each one of them.

 What do you mean by something you can grow in to?

 Look at what your capacity is today and project where you’re going to be three years from now. Will it be able to handle the amount of work you’re going to be doing? If you’re at 100 units a day and 3 years from now you plan to be at 175 units a day, make sure the software can handle it.

Implementation of new software is one of the most difficult periods. Make sure the company will give you enough tech support to help you get the software installed properly. You don’t want to spend months implementing your software. If the company gives you good technical support it will be to your advantage, so go with the company that offers the most support.

 How long should it take to implement the software?

 It should take four to 8 weeks to implement it into your lab. Remember, you need to make sure you have the right personnel that know how to enter data. Data entry is very important. Don’t try to take one of your best technicians and turn him or her into a software expert. Get someone well versed in computer technology and teach him or her what a dental lab does rather than trying to teach a lab person all about software and computers.

 What are some common mistakes labs make when choosing software?

 You can’t just look at the software with the lowest price. You want something that will function for your needs, not that has the lower price, to get started because you could spend a lot more money trying to tailor it to your needs or it might never meet your needs. Not buying enough of the services that you currently need is another common mistake.

I would go to a lab that currently is using the software. One of the nice things about our think tank is a member lab can go to another lab and look at their system and they’ll share everything. You want to network with people who will share things with you.

Software should be seen like a porcelain furnace. You change that every few years because of new technology, and it’s the same thing with computers and software. Don’t think your initial investment is your last investment. It’s important to keep up with the times. The needs change and the capabilities of the systems change. You need to have something that’s flexible. Make sure the company you’re buying from is well versed in the dental lab field because it’s a lot harder to tailor something to the lab field. You want something that’s already been designed for dental labs.

Another mistake labs make is they neglect to run two systems simultaneously. So the first few weeks run your new system and your old system as a back up. You don’t want to lose valuable data that you may find later that you wish you had. Run both systems parallel to one another until you’re positive that everything is there and functioning the way you want.

 Is there anything else you’d like to mention that we haven’t hit on?

 The thing I’d like to emphasis is make sure you get all the references you can and follow up on each one. Get in writing contractually everything they’re going to do for you, and at what cost so there aren’t any surprises later.

Finally, if you purchase new computers on which to run the software, keep in mind that more is always better: larger memory capacity can handle sophisticated programs, and more programs at one time without bogging down the system; check to see if that can be easily upgraded. Speed is important as well; get the fastest available. And be sure to back up your data regularly, at least once a week, to an external hard drive. It will save countless hours of frustration if you experience a crash.

The Build Up: Choose the right lab management software for your lab

Gus Diacoloukas opened Friendship Dental Laboratories in 1973 and worked alongside his sons, George and Nick, at the Maryland-based lab for many years. The brothers, who took over the family business 9 years ago and with support and mentoring from their father, have doubled the lab’s business in that time. The high production lab has more than 80 employees and between 80% to 90% of the lab’s fixed work is 

Ceramco 3 porcelain system provides a customized firing process that reduces remakes and increases laboratory profitability and productivity. This porcelain system is non-greening with out-of-the-bottle shade uniformity. It also features organic pigments in the porcelains. The colorants assist in restoration build-up by reducing training time and allowing technicians to clearly see the placement of each layer of porcelain.

Nick Diacoloukas describes Ceramco 3 as a reliable friend.

Starting with Ceramco 2, this porcelain system has been a staple at Friendship Dental Laboratories for decades, he said, and is a product they’ve come to rely on over the years.

“This is a fool proof system that works well in many different hands,” Diacoloukas said. “It enables technicians of all skill levels to produce porcelain esthetics that are very nice. There are other ceramics that are very esthetic but unless you treat them a certain way they can be technique sensitive. Friendship is a production lab, and when you’re doing a lot of volume, you have to have something that’s forgiving. Ceramco 3 is exactly that.”