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In this article from Dental Products Report, a team of dental experts describes the challenges of incorporating technology into the dental practice, and provide solutions to help overcome these obstacles.

6 challenges in adopting dental technology

	Many dental experts, even those who are most adamant about making dentistry digital, admit there are challenges with incorporating dental technology into a practice.

 to several dental experts about how technology is impacting every part of the dental process, and they raised some challenges that every professional needs to consider. Happily, these experts also share the opinion that these difficulties are neither insurmountable nor should they be a reason to avoid technology.

Must read: 10 tips and tricks for adopting technology

	Here are six common challenges our experts identified regarding incorporating new technology into a dental practice and how to tackle them.

	Many offices have concerns about adoption of new technology because they are afraid of what could go wrong. For example, Tija Hunter, Dental Assistant and Vice President of the American Dental Assistants Association explains some offices suffer intense apprehension if they let go of how it’s always been done. For example, she sees offices every day that still use paper charts, which she finds surprising from both a technological and infection control standpoint. However, the doctors in these practices worry what will happen if the computers go offline.

Related: How technology is REALLY impacting the dental practice

	“That happens very rarely. We back up every night. You know, it’s not that computers have been out for two weeks; they’ve been out for years, so we’ve learned how to back up!” she says. “But there’s that fear.”

	Hunter advises her dental assistants to train on the technology, research it and become the champion of it in the practice to help doctors make the transition. Not only does it make her assistants more valuable to the practice, but also it increases the fun factor in the job.

	“Gone are the days when we just stood next to the doctor and assisted them. Doctors now need us for so many more things. And technology has made dentistry fun and exciting again for dental assistants,” Hunter notes.

Challenge #2: Lacking compatibility with integral partners.

	If you spend tens of thousands of dollars on a new technology for your practice, how thrilled will you be to discover that the lab you have worked with for years can’t work with it? However, according to Mark Ferguson, General Manager at Vulcan Custom Dental, it happens more often than you think.

	“As a clinician, the last thing I want to do is spend $20,000, $30,000, $40,000 or more dollars to find out, ‘oh, I can’t work with the lab that I’ve been working with for 15 or 20 years that I’m comfortable with,’” Ferguson explains.

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	Dr. Kris Mendoza, a resident at UCLA and past president of the American Student Dental Association also believes compatibility is a challenge within the office as well when it comes to integrating the various systems.

	“You have all these different companies making all these different types of technology, and even some with the same function, but using different coding. They don’t always integrate well,” Dr. Mendoza says.

How to overcome it? Discuss or research before you buy.

	Consider the workflows when you invest in technology. Ferguson suggests you discuss your plans with important partners before the purchase to ensure you won’t disrupt the system you have established. Dr. Mendoza said to research the technology specifications to make sure it is compatible with what you already have.

	“If you have an electronic charting system, you need to make sure it integrates well with your system to take radiographs and your scheduling system. You have to make sure that they’re all on the same platform,” Dr. Mendoza says.

Challenge #3: Navigating the pain of change.

	Most people fear change because sometimes the learning curve is long. It can be longer still if you lack a general comfort with computers. Our tech-savvy experts describe a learning curve that can be tough, but only for a couple of days or a week. However, for some people it’s important to recognize the transition could take longer to realize.

How to overcome it? Face it all at once with a plan and the buy-in of the team.

	Either way, the experts agree that the best way to get through the pain of change is to go all in for your technology product transition. Kara Vavrosky, RDH in Beaverton, Oregon, and Editorial Director of Modern Hygienist explains.

Plan ahead: Planning your technology purchases

	“It’s a fast learning curve if you dive in,” she says. “In my experience, the learning curve is quick. With digital charts software, going paperless only takes a couple of days to get used to, and once you do, you wonder how you ever worked without it because you save so much time.”

	Dr. Mendoza agrees that the all-in approach to a new process is best: “It’s about having all that hassle up front. If you do that, you’re going to save so much time down the road. Otherwise, you’re not going to be as efficient as you would like.”

Challenge #4: Not knowing where to start with technology.

	New advances in dental technology never cease. On the one hand, it’s excellent, because technology advances the science and the ability to practice efficiently. However, it’s also daunting because you don’t know where to start. Dr. Jason Watts, DMD and general dentist in Coral Gables, Florida, acknowledges it could be overwhelming, but he also emphasizes that those in the dental profession need to learn to adapt and continue to grow and educate themselves to best serve their patients.

	“It’s just like anything else: If you’re not growing, you’re dying,” Dr. Watts says. “If you’re not utilizing technology and advances, then you’re not adequately and properly treating your patients. You limit the ability of your treatment to provide the best care.”

Related: How chairside CAD/CAM can provide better patient care

	Dr. Leah Capozzi, DDS, a new dentist in Buffalo, New York agrees. “Technology is no longer just a luxury; it can provide us with a more efficient and effective way to practice,” she says.

How to overcome it? Consider your practice goals, ask your colleagues, and start a little at a time.

	Dr. Capozzi’s strategy is to carefully evaluate how she would integrate any new technology into her practice and how that coincides with her practice goals.  First, she ensures that it enhances her ability to provide excellent patient care and then, earns a return on investment.  She recommends doing your homework and checking out technology you are interested in at a hands-on course. Also, she advises doctors to talk to their colleagues that are using it to see what their experience has been.

	“Mentorship is a great thing.  Connect with a mentor that shares your vision in dentistry. Then you have someone with more experience whose opinion you can ask for,” Dr. Capozzi says.

	When it comes to technology, Dr. John Flucke, DDS, in private practice in Lee’s Summit, Missouri says you don’t do it all at once, but piece by piece. He compared it to eating an elephant.

	“You don’t eat the elephant in one bite. You eat the elephant one bite at a time,” Dr. Flucke says, recalling one his favorite expressions. “Dentists are great clinical planners and they need to do the same thing with technology. Make yourself a plan and pick out a piece that you want to accomplish this quarter or this year. Then sit down and talk to your team and figure out their opinions on it and where they think there might be problems and get everybody on board before you start.”

Challenge #5: Paying increasing overhead costs while reimbursement decreases.

	Most new technology comes with a hefty price tag.  With cost in dentistry on the rise and insurance payments on the decline, margins for dentists are squeezed from both sides. Add to it that many new dentists enter the practice with substantial debt, and it’s clear why the price of technology can be daunting for many clinicians.

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How to overcome it? Research, research, research.

	Dr. Erinne Kennedy says that it’s easy for a doctor to become tech-happy, meaning a clinician who wants to purchase every item that comes to market. She believes that an honest evaluation of the pros and cons before making a purchase will help avoid making an unnecessary purchase that doesn’t pay you back.

	“Cost is a big factor, but not a deterrent,” Dr. Kennedy says. “Take it to heart, look at the new development and research. Then you’ll be able to purchase items when the cost is appropriate and when you know that it will give you a good return on investment.”

Challenge #6: Technology doesn’t always work.

	Few things are more stressful than when you need your technology to work, and it doesn’t. Even the most tech-savvy practices lament this situation. Dr. Flucke incorporates multiple technologies in his practice and doesn’t find technology too much of a challenge in most instances.

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	“When something has a problem, when something doesn’t work right or whatever the case may be, that’s when it’s more challenging for us,” Dr. Flucke notes.

How to overcome it? Have a support team in place.

	Dr. Capozzi also voiced her concerns about when things go wrong. However, no matter what business you are in, technology having a glitch is an inherent risk. Her strategy is to choose those organizations that have tech support in place to help troubleshoot those frustrating moments.

	“Even the most innovative businesses have to make sure their technology is up and running, so choosing an excellent support team is crucial for success,” Dr. Capozzi observes. “Make a plan to get comfortable and engage your team to do the same.  Know who you will call if you get stuck or need advice.”

6 Challenges in Adopting Dental Technology

	Dr. Jason Watts, DMD, just bought a new car. Not long ago when you bought a car, GPS was optional. Today, it comes standard. In fact, his new car came with Google Chrome. As a young general dentist practicing in Coral Coral, Florida, his car’s features serve as metaphor for technology in the dental practice: technology isn’t an option for today’s dentist; it’s the standard.

	“For me, technology is almost my bloodline of dentistry,” Dr. Watts says. “If I didn’t have technology, I wouldn’t be as efficient or as effective as a dentist to my patients and my community as I could be.”

	A little over 1,200 miles and more than three decades of experience away, Tija Hunter, dental assistant and vice president of the American Dental Assistants Association, believes technology has changed the way dentistry is done.

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	“I’ve been doing this 35 years, and it’s totally changed the way we do dentistry from every standpoint,” she says. “The patients love technology. They appreciate that their healthcare provider has invested in this technology for them.”

, a general dentist in Lee’s Summit, Missouri, marvels at how different his practice is today. He does not do anything the same way he was trained 29 years ago.

	“You can see how much the world has changed in such a relatively short amount of time. Technology has completely streamlined, simplified and made my life a zillion times easier-and my patients’ lives as well,” Dr. Flucke notes.

	Another 1,200 miles away on a trail in Phoenix, Arizona, new general dentist Dr. Emily Hobart, DMD, hikes Camelback mountain while reflecting on her next career move. After attending Midwestern, a dental school steeped in technology, her first job in a corporate practice lacked adequate tools for her to practice the way she wanted. She described the transition after school as returning to the Dark Ages.

	“I was an assistant before I went to dental school and then when I went to dental school, it was very technologically advanced. There were a lot of different technologies that we learned. So it’s hard to revert to the Dark Ages,” she observes. Dr. Hobart is currently looking for a new practice.

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	Just a little over 350 miles away, a resident at UCLA Dental Anesthesiology, Dr. Kris Mendoza, DDS, appreciates how technology has streamlined communication and patient experience in the practice. From enjoying accurate remote scheduling to modifying treatment plans to notifying the dentist the patient is ready for an exam, technology has improved the workflow for practices, especially the large ones.

	“I’ve seen it as a tool that can increase efficiency. It helps for expansion. A few years ago, you probably wouldn’t have seen all these big group practices running efficiently and that’s because of technology,” he explains.

	Nearly 1,000 miles north in Beaverton, Oregon, dental hygienist 

 loves the efficiency technology affords today’s clinician and staff.

	“Whether it is voice-activated perio charting, digital radiographs, dental software with digital patient recall systems, messaging in the office with that digital software or the doctors fabricating crowns in-house, technology has not only added to the efficiency of the office, but also the efficiency of dental treatment for the patient,” Vavrosky explains.

	From sea to shining sea, dentists know the value of technology. However, they don’t think it’s the future. Dr. Watts sums it up best:

	“Technology is not the future. It’s the now.”

	Next page: Improving patient care with technology ...

	Advances in technology are the bread and butter of the several-billion-dollar global dental equipment and supplies manufacturing industry. The industry, fueled in part by the spirit of capitalism combined with altruistic desires to improve patient care, works to provide the best possible products to transform and enhance the dental practice for its customers.

, is part of the supplier side of the dental industry. As a milling center for one of the largest implant companies, he finds the reduction in timelines and remakes for milling remarkable. Ferguson estimates that since the introduction of technology, the remake rate industry-wide has decreased from four percent to 0.4 percent.

	Not only that, technology is improving communication and leading to a higher level of treatment, with less hassle and better health for the patient than in the past. From determining where to place implants according to the bone position to making better decisions about the amount of pressure to put on the tissue, technology makes everything measurable and leads to better placement of implants.

	“Everything that we’re doing is for the benefit of the patient, whether it be faster turnaround time or more accurate impressions,” Ferguson says. “It’s all benefiting the patient.”

	Dr. Tara Griffin, DMD and dental sleep professional in Florida, appreciates how technology improves her patients’ quality of life by providing better and more varied treatment options for her patients. As a provider of nonsurgical treatments for temporomandibular disorders (TMD) and dental sleep medicine as well as other areas, she finds 

cone beam computed tomography (CBCT) imaging

 for joints and airways shows the specifics of her patients’ conditions. Other technology enhanced the predictability of how the devices she prescribes will work. By using a trial appliance in a lab setting, she can tell the patient with more accuracy how the appliance will work for them.

	“I can set treatment expectations. I can help them fully understand what can and can’t be done. That’s huge,” Dr. Griffin explains.

	Dr. Erinne Kennedy, DMD and GPR resident in a VA hospital, has worked with technology and without. Coming from Nova Southeastern University College of Dental Medicine, she was trained in CAD/CAM dentistry. However, her experience at the VA was with traditional impression techniques. Contrasting the two environments, she finds that patient care is more efficient as a result of technology, resulting in a better patient experience.

 to see a root canal very quickly without having to develop the X-ray or crowns where you can do same-day dentistry, technology has really increased the efficiency of patient care. We are valuing a patient’s time, something patients appreciate,” she says. “We want people to show up on time and to come to their appointments ready and have everything ready to go. But from a provider’s perspective, I also think that we need to respect their valuable time. Technology has let us do that.”

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	Technology enabling same-day dentistry has one of the biggest impacts on how dentists practice today. CAD/CAM enables doctors to create dental restorations and cement them the same day. Dr. Leah Capozzi, DDS, a general dentist practicing in Buffalo, New York, believes it has created fabulous results for her practice.

	“Patients are busy and a broken tooth can be a major inconvenience. Patients who come in expecting bad news get to learn that we can fix their teeth in one appointment AND with a restoration that conserves natural tooth structure,” she says. “We achieve excellent patient care and very happy patients who refer their friends and family.”

How-to: How chairside CAD/CAM can provide the care patients deserve

	Hunter agrees that same-day crowns have enhanced the patient experience in her office. She said some patients think it sounds too good to be true. However, once they experience it for themselves, patients tell everyone they know.

	“They tell other people. ‘I got my crowns the same day.’ Their friends say, ‘What do you mean you got them the same day? Don’t you have to go back in two weeks? ‘No, I don’t have to go back in two weeks. They’re permanently cemented on and I got to see them make it,’ ” she notes, laughing.

	CAD/CAM helps Dr. Griffin with patient experience as well. The appliances she can produce with her technology are smaller than the other options available. “They are much more durable and comfortable for patients versus the other options we have available,” she says.

	Aside from the convenience and saved chair time for the patient, CAD/CAM can also help fill the schedule. Vavrosky often checks patients’ paperless chart to see if their cleaning is due. Then, she recommends patients due for hygiene have it while waiting for their crown to be fabricated.

	“Even though CAD/CAM is a technology for the doctor, it can also help fill the schedule,” she says.

	Next page: How digital radiography helps acceptance rates ...

	Digital radiograph technology improves patient acceptance rates

 have far-reaching benefits from better diagnosis to higher patient acceptance rates. Dr. Watts finds that he can educate patients with digital X-rays. He blows up the digital image on a screen and shows them the problem. Patients diagnose it themselves. It not only increased his patient acceptance rate, but digital radiographs also alleviate the anxiety that many patients have while sitting in the dentist’s chair.

	“It’s helped with patients understanding the importance of their oral health, accepting our treatment, as well as them being more receptive to dentistry and what we do within our profession,” Dr. Watts says. “Most patients have a phobia of dentistry. It’s imperative they understand that it’s not our fault that they’re coming to us for their discomfort. We’re just trying to help them.”

The lab perspective: What going digital means for the lab-dentist workflow

	“With digital radiographs it’s easier to show the patient, ‘Hey, you have decay right here,’ ” Vavrosky explains. “Instead of looking at this tiny film, you can blow it up on a TV screen and they can see it. They can see the bone loss and why we need to do perio treatment. It has led to a much higher acceptance of treatment plans for patients when you can show them what’s going on in their own mouth.”

	Vavrosky also likes having them almost instantaneously and chemical-free, a benefit not lost on her. “The old chemicals can be a danger to the clinician and the environment. Simply put, they are gross,” she says.

	Many of the doctors like how digital radiographs afford them the opportunity to be more prepared for patient exams. Dr. Flucke and Dr. Capozzi both review the images the hygienist collects before they do the exam. “It streamlines the process for the patient because they get their teeth completely cleaned and everything is done with our hygiene visits,” Dr. Flucke notes.

	Reducing stress and improving communication by going paperless

	Dr. Flucke remembers a time when he used to color in charts with red and blue colored pencil. All the work that was done or existing in the patient’s chart, he colored in blue. Any work that was pending, he colored in red. When you completed a pending treatment, he had to color all the red areas blue to indicate it was done.

	“You would look and say, ‘Did I do that? Is that red on top of blue? Or is it blue on top of red?’ ” he remembers.

 much simpler than the paper charts of the past. Follow-up coordination is easier because the administrative team has all that information in the system about when the patient needs to come back. Also, there is no more time lost while the front-office team deciphers whether the doctor wrote a “five” or a “three.” In addition, his patients get in and out easier. The whole team is less stressed because it’s more organized, and running on time, he explains.

	“When an office is running behind, people only think about the clinical team. ‘Oh my! They’re probably stressing back there,’ ” he says. “But the admin people are looking patients in the face up front and if the patient is tapping his foot and looking at his watch, that can be really stressful.”

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	Dr. Mendoza agrees that paperless charts improve the practice organization. He likes how technology allows the treatment plan to be online. It is easier to use and modify online instead of tracking down the original document in the paper chart. “It’s allowed integration and communication with everyone within the dental team without actually having to be together, which can be very helpful,” he notes.

	Another feature he enjoys is knowing which part of the process the patient is in by the touch of a button. “To be honest, it makes life easier for the dentist. If three or four steps are already taken care of before he or she is asked to see the patient, it just helps things flow a lot better,” Dr. Mendoza explains.

	Vavrosky likes paperless charting as well, but cautions offices to do the training that comes with the product even if you feel like it’s fairly intuitive. While she understands it’s a time commitment, it’s worth it.

	“Yes, you can learn it on your own by pushing buttons but if you aren’t trained, you don’t see all the features of what it can do. And if you aren’t going to use the features, what’s the point of having the technology?” she asks.

	Creating a team approach-in the practice, in surgery and beyond

	Imagine you are taking a digital pano when you see an abnormality, one that could indicate another condition is affecting the patient’s health. With the technology you are using, it’s simple to email it to the physician.

	This goes for sharing chart notes from a general dentist to a specialist, such as an endodontist or periodontist. With digital technology, it’s seamless and as simple as hitting send.

	Suppose you have a patient that you haven’t seen for some time. You don’t remember their history as well as you would like. Refresh your memory by reviewing the notes in the system before his or her exam.

	“It leads to comprehensive patient care, which I would think should be everyone’s goal,” Vavrosky says. “Everyone can access the information wherever they are. It has encouraged a team approach not only with outside specialists but also collaboration within the office.”

Technique: Using imaging data for better surgical results

	Dr. Kennedy agrees that technology has encouraged the team approach, especially with other specialists. “It’s amazing what three-to-four specialists and a few lab technicians can do over a conference call online,” she notes.

	General dentists can work with the periodontist, orthodontist, oral surgeon and other specialists to not only offer the best treatment for the patient, but also prepare in advance for any obstacles that might occur during surgery. Best of all, the team can create a precise, step-by-step game plan.

	“In the past, a lot of times you’d get in on surgery and you would just have to react to something that comes your way that might be new or surprising,” Dr. Kennedy explains. “Whereas now with our 3D technology and virtual planning, there’s not much that comes as a surprise. That is great for us as a team of specialists, but it’s even better for our patients.”

	Precision is one of the biggest benefits the technology affords. Treating a recent case of osteomyelitis, Dr. Kennedy located a draining fistula that led to a necrotic bone fragment near the sinus. She could get an exact measurement of where this fragment was located through her cone beam technology. “I was able to get the exact picture of where it was going to be so that when I went in and removed it, not only was it exactly where I thought it was going to be and the exact size that I thought it was going to be, but this knowledge allowed a more conservative treatment to be performed,” Dr. Kennedy says.

	But Dr. Kennedy also thinks technology creates an interactive team approach and improves trust between the doctor and patient, especially when the patient sees for themselves that there is a problem. “It creates an open dialogue. So instead of me telling the patient, they can discover their health for themselves,” she observes.

	Ferguson notes when all the partners of a restorative team-labs, restoring doctor, surgeon-work together, you get optimal results. He believes the earlier in the process the team can collaborate the better. Moreover, with digital technology, the team has a lot more data to compare. For an implant abutment, Ferguson can measure how much tissue he is going to be pushing away from a socket site because he can see where the tissue exists. Before, with analog, this was guesswork. The ability to see and obtain a precise measurement removes the guesswork and allows him to communicate with the doctor what he needs to do his best work.

	“If I can show the doctor what I can do restoratively, then he or she can prep the teeth to give me room. And then I can do what I said I was going to do,” he explains.

Step-by-step: Creating an immediate-load denture using digital tools

	“There hasn’t been a moment where technology hasn’t benefited communication, whether it’s other healthcare providers or specialists, to be more effective for our patients,” Dr. Watts says. “Whether it’s physicians with electronic health records or specialists communicating and increasing the predictability of success while decreasing the variables through more advanced treatment, and even teaching while not in the exact location of the students, we have opened the doors of communication.”

	Dr. Mendoza agrees that technology opens the lines of communication, making sharing information easy. “You can exchange pictures if you’re a dentist and you’re referring to a specialist,” he says. “You can send radiographs or X-rays, which allows them to a have lot of information without having to see the patient. By the time the patient gets to the specialist, a plan is already in place or at least a few options are in place. That can be very helpful because with that, the general practice dentists can not only send the information, but also communicate the end goal they want to see.”

	Next page: Why technology is not the future ...

	Technology is not the future … it’s the present

	Whether you already have technology or are just starting to make the transition, our experts agree that it’s time to get serious about incorporating it into your practice. It is true whether you are just starting out or getting ready to retire. Dr. Flucke, who admits his retirement isn’t as far off as it once was, encourages all practices to get the technology basics in place, especially if they are considering selling the practice.

	“All of the younger doctors probably 40 and under and definitely 35 and under have been raised on technology,” he says. “They know this stuff. When you go to break somebody into your practice or to sell something to somebody and just walk away, if you don’t have at least the tech basics, like digital X-rays and computerized operatory and that sort of thing, you’re behind the eight-ball or behind the curve.”

Must-read: Tech planning in this quarter and beyond

	“My boss is 40 years old,” Hunter notes, “but he’s a video kid and he loves the technology. Our patients appreciate it because they know they’re getting better quality care and I believe that.”

	Dr. Watts encourages today’s clinician to welcome technology in the dental practice: “It’s a new way to better treat our patients. It’s going to constantly change but people shouldn’t be scared of that. Embrace it. Know that it’s more efficient and more effective and it’s going to lead to a better result for the patient and the provider. It’s never going to be perfect and it’s never going to stop changing, but you need to be willing to grow with the times.”

	“It’s better patient care all the way around,” Hunter notes. “We’re here to take care of that patient. If we can do it with the technology and make it that much better, then that’s what it’s all about.

It’s obvious to any observer that technology has drastically impacted the way dentists practice-and the way they work with the dental team and specialists and how they interact with patients. we asked professionals from around the country: how is technology really changing dentistry? Here’s what they told us.

How technology is REALLY changing the dental workflow

	DPR Spoke to Dr. Jason Goodchild, DMD, about how to provide excellent patient care and run a successful practice. For Dr. Goodchild, it’s all comes down to rapport-building skills and putting the patient experience first.

	He believes that when the patient believes that you are there to help them achieve their best possible oral health, you have a culture of trust that builds a foundation for a successful practice. 

Why do you think your practice has been successful?

	I have a practice; I work in education, and I work in industry. So I have all three perspectives. But I’ll put on my business owner hat for you today and talk about the things that have made me successful in my dental practice. Doing dentistry might not be the most important aspect to running a successful dental business. Of course we should know how to do dentistry effectively, but we’re not technicians; we’re doctors and business owners. Balancing those two things is difficult sometimes, but is the key.

	My practice has been successful because I’ve tried hard to develop a culture of communication, trust and rapport. I encourage patients to call me by my first name. They have my cell phone number. The secret of my success has been creating a culture where patients feel like I’m always working to make their lives and oral health better. They trust me and hopefully feel that I’m not just another doctor. They can talk to me or reach out to me or just get advice from me. It’s a culture thing in my office.

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What comprises practice management and why is it important? 

	When I think of practice management, I think about the tools that you can give a young dentist who has very little or no business training to help them be successful. Because if they believe that doing good dentistry is the only thing that matters, they’re unfortunately mistaken.

	Why do patients come to you? Do they come to you because you do excellent dentistry? Maybe. But do they also come to you because you have a nice person answering the phone? Or a nice hygienist? Or a welcoming office? Or easy parking? Or you give painless injections? There are so many answers out there for why people come to you. It’s all these peripheral things that can make or break your business, and differentiate it from competitors.

	The overarching theme for all of practice management is that dentists have to remember that we are in a service business. We have to work toward better patient experience and by doing that, we will be able to attract new patients and take care of them better. We are taking care of people, not only taking care of teeth.

	People have a lot of choices when it comes to dentistry. What differentiates you isn’t necessarily your dentistry. It’s all those other things.

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What do you think is the number-one practice management tip every clinician should remember?

	It’s the idea of trust and rapport.  The philosophy of building a practice is that patients believe you are there to help them. They trust you and that they can’t envision themselves going anywhere else.

	Dentistry is an interesting business. When you tell people they have a cavity or have something wrong with their mouth, sometimes they feel it. They can feel a sharp edge or a broken tooth, or they’re in pain. But in a lot of cases, if we're proactive, we’re telling them that they need to fix things that they can’t see or feel. So there needs to be some level of trust that I’m not just making something up out or out to treat their wallet. There needs to be effective and open communication, and this sometimes involves visual aids.

	So trust, empathy and education are my three big factors. If I’ve done those things correctly, patients will be able to have an open and honest conversation with me, and I’ll feel like I’m looking out for their best interests.

Continue to page two for the most vital practice management tips...

What other practice management tips do you think are vital?

 Get out of your comfort zone if you have to, but work toward treating the patients. There’s a saying, “It’s not about you. It’s about the person in front of you,” or “They don’t know how much you know until they know how much you care.” It’s the idea of getting to know your patients and breaking down that doctor-patient relationship until it’s just two people working toward a common goal, which is making the mouth healthier and looking better.

Your success in dentistry is in large part due to the people around you.

 I mean your front desk people, your assistant, your hygienists and all of your team members. Because the time patients see the dentist during their whole dental visit could be small, but they spend more time with those other people. Your team members can make or break the entire patient experience. 

Trending article: The biggest mistakes dentists make: Not providing adequate team training

Remember these three things: empathy, confidence and education

. Some people call that the trust triangle: empathy, confidence and education.  By doing these things, displaying empathy and confidence, and educating patients on what is going on their mouth and what they can do to treat it, you can develop rapport and trust with your patients. I’ll give you one crazy example of this:

	One particular patient came in for a simple filling. We started chatting like two friends who hadn’t seen each other in a long time. My dental assistant gave me this sideways glance, and so I said: “Alright, we’ll put you back in the chair, and we’ll get started.” Five minutes in, she looks up at me and says “Jason, do you think I need Novocain today or do I need local anesthesia for this?” I was horrified. I sat her up and said, “I’m so sorry. We were just chatting away, and I completely forgot.” And she said “No big deal. That’s fine. Don’t worry about it. I trust you, so I just figured you didn’t think I needed it.”

	I always tell that story because in most cases, if a dentist starts working without local anesthesia, that can be a deal breaker. But she just laughed it off. That could have been the last time I saw that patient, but I see her and her husband all the time. When you screw up, having that trust and rapport saves you and can help preserve the relationship.

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Have a great team who shares your philosophy.

The whole team, not just the dentist, should believe that dentistry changes lives. If everybody is on board with that, then you have a working team.

The first contact is important. You want someone who is warm and helpful on the telephone. Also, a lot of patients make their judgments very quickly, so I insist on a clean and spotless office. It doesn’t have to be the most up-to-date and modern office, but if it’s sparkly clean, that makes a huge difference.  One of the things I encourage each of my team members to do – hygienist, assistant, front-desk people – I ask them to sit in all the dental chairs and look around as if they were a patient. Do we have too much clutter in an area? Under one of our light shades, do we have some dust and dirt? Just look around from the patient’s perspective just to make sure that we are putting our best foot forward.

Systems are important, but they have to be sincere. 

I just don’t want my team members acting like robots. Systems are good because everybody knows what to do, but, at the end of the day, systems only work when they’re sincere.

Continue to page three for the most common practice management mistakes...

Is there a common area that clinicians make mistakes as it pertains to practice management?

	It’s all about customer service. It’s doing the little things. It’s taking the bib off of the patient. It’s about sitting them up and thanking them for being there that day and saying ‘You did great.’ Little personal touches that can make that patient experience better. Those little touches are what differentiate your office and make people want to come back.

	I had an associate who was just out of dental school, and when he was done with the procedure, he’d hang up the handpiece and walk out of the room. He wouldn’t even sit the patient up. He wouldn’t take the bib off. He wouldn’t say thanks. He wouldn’t say “This is what to expect after the procedure.” He would just walk out. His feeling was “I’m there to do dentistry. That’s why I’m there.” But that’s just a small part of it. It’s the patient management side of things, the soft skills as I call them, that can make or break your practice.

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What can someone do to get better at that? How do they train themselves on soft skills?

	Some dentists have those soft skills inherently. They have the gift of gab. They’re personable and warm. And others not so much. The truth of a service business is you have to put on your game face when you walk into the office. Patients don’t want to hear about my bad day. Patients are paying for my best hour of the day, so I need to give them my best hour of the day. Because that’s what I would want if I were the patient.

	Unfortunately, these soft skills don’t get much attention in dental school. I’m trying to change that. In my role as department chair of diagnostic sciences at Creighton University School of Dentistry, I’m in charge of treatment planning and soft skills. Yes, it’s important to get all the other aspects of dentistry right, but those soft skills are so important. Develop those trusting relationships and the rapport so that patients will want to follow you. Communicate with them. Educate them. Motivate them to come back and see you. Unfortunately, some young dentists fail at that. Those are important skills, just as much as giving a good injection or doing a nice filling or crown.

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Any other advice for young clinicians just starting out?

 Watch what they do so you learn how to do it. Along the way, you’ll find things that work for you, but you cannot work in a vacuum. The idea of a dentist graduating from dental school and jumping in to start a new practice is concerning. The best way to do it after your training is to associate. Find someone that will be helpful in showing you what’s worked and what hasn’t worked, pitfalls to stay away from and that sort of thing.

Keep your eyes open in this profession because things are moving so quickly. From practice management to software to equipment to materials to the roles of the team members to insurances to technology, it’s unbelievable. Once you finish dental school, your training is not finished. There are so many other things to learn in the profession. The end of dental school is just the beginning of your experience. Now it’s about learning how to make it a business and keep it profitable. 

It’s not all about money; it’s about the patients.

 Coming out of dental school with $350,000 in student loans should not impact your treatment plan. Does a young dentist with $350,000 in student loans suggest treatments that are more expensive to make more money or do the best thing for the patient? I don’t want dentists to think that way. Treat your patients how you would want to be treated. If you do that, the money will come-and you’ll be able to sleep at night because you have upheld the nobility of our fantastic profession!

Find the tools that work the way you want to practice.

 There’s just so much out there. And because all those things cost money, and you have to be careful about what you buy. You can end up with a drawer of stuff you thought you needed, but end up not using.

Efficiency is about working fast but also getting it right the first time.

Find the procedures, materials, and technology that work for you. Because if you do a filling fast, but the patient is having problems and they have to come back so you can fix it, you haven’t really done anything. The patient experience was poor, you didn’t make any money, and your profit margin was erased. So if you can make people happy, work quickly and get it right the first time, then everybody stands to gain.

DPR Spoke to Dr. Jason Goodchild, DMD, about how to provide excellent patient care and run a successful practice.

Practice management: A balancing act between being a doctor and business owner

	Maybe he had a dental implant placed. She might have had her periodontal surgery. He could have had four impacted wisdom teeth removed. Whatever the dental treatment, you know the patient will likely have pain after the anesthesia wears off. You should write them a prescription for a strong analgesic medication… or should you?

	According to the experts we spoke with, the answer is no-at least for the majority of dental patients. For most post-operative pain management best practices, you need not look further than your average medicine cabinet: ibuprofen and acetaminophen, a.k.a, Advil and Tylenol.

	Dr. Paul Moore, dentist, pharmacologist and professor at the University of Pittsburgh School of Dental Medicine, believes that nonsteroidal anti-inflammatory drugs (NSAIDs) should be the first-line drugs for the overwhelming majority of acute dental post-operative pain management cases.

	“One of the things I have been advocating is combining Advil with acetaminophen, which is Tylenol.

 You get even more pain relief than with either of those drugs alone. I’ve always suspected that, but it wasn’t until recently that we saw 

 that were convincing that the combination is something we can use instead of Vicodin. It’s an alternative that doesn’t require using opioids.”

	Dr. Kenneth L. Reed, retired periodontist, currently practicing dentist anesthesiologist and Associate Program Director of the Dental Anesthesia Residency, as well as attending for the Advanced Education in General Dentistry and graduate pediatric dental residency programs for NYU Langone Health Center agrees that NSAIDs should be the first-line choice for post-operative analgesics in dentistry. The rare exception would be patients with allergies or other health conditions that prohibit their use.

	“NSAIDs should be the first line in every other case, though. Acetaminophen (Tylenol

) should be the second line. A combination of a NSAID and acetaminophen is far superior to any opioid available, orally, IM or IV,” he explained. “Opioids may be added as a third agent in those very rare cases that do not respond to a combination of a NSAID and acetaminophen. That is the proper use of opioids as post-operative analgesics in dentistry. Opioids are tremendously over-prescribed.”

	Dr. Moore believes that a combination of patient expectations and routinely using post-operative pain management strategies that should be reserved for severe/hard to manage cases (around 20 percent in his estimation) contribute to clinicians prescribing opioid medication. He published a commentary 

Journal for the American Dental Association 

	Dr. Jason Goodchild, a general practice owner in Havertown, Pennsylvania, and Associate Professor and Chair of the Department of Diagnostic Sciences at Creighton University School of Dentistry, also supports the combination of ibuprofen and acetaminophen regimen. The combination has shown better results in the literature than using ibuprofen alone after treatment and addressed the source of the pain, inflammation.

	“All the opioids will do is cloud your sense of pain, taking you out of that feeling rather than addressing the actual underlying cause of the pain, which is inflammation. That’s why the idea of anti-inflammatory agents, the nonsteroidal anti-inflammatory agents like ibuprofen, become the best pain medications because they affect the etiology or underlying cause of pain,” Dr. Goodchild explained.

	Dr. Mark Donaldson, Director of Clinical Pharmacy Performance Services for Vizient, has spent the last 18 years focusing on dental pharmacology and dental therapeutics. He believes based on evidence from dental literature clinicians have the road map to do the right thing and use the right drug with the right dose for the right patient and the right procedure.

	“But because universities, because older prescribers, and ultimately because patients continue to say ‘I like my Percocet. I like my Vicodin,’ dentists prescribe the opioids,” he said. “I just have to remind dentists of the power of the pen. I tell them ‘Look, you cannot be bullied by your peers or patients. If you get to be known as a dental prescriber of opioids, that’s probably a good practice builder, but definitely not the kind of practice you want to build and the kind of patients you want to attract.’”

Whatever the dental treatment, you know the patient will likely have pain after the anesthesia wears off. You should write them a prescription for a strong analgesic medication… or should you?