Terri Lively

What to Look for When Adding a Mill to Your Dental Practice. Photo courtesy of okrasuik/stock.adobe.com. 


When practices are looking to add a mill to their digital workflow, the process can be a lot to, well, process. Also, integrating an existing intraoral scanner can change the focus of the search. We look at what practices should consider when adding a mill to the workflow and how to avoid getting into trouble with this critical investment.

Practices should first set a goal and plan for what they want to accomplish by introducing a mill. Lisa Aguirre, Product Manager, Dental Solutions for Roland DGA, says that many of her conversations with clinicians start here.

"The first thing to understand is the why and what they're looking to do in their practice with a chairside milling solution," Aguirre says.

Gavin Sternberg, National Manager of CAD/CAM, Planmeca, agrees, adding that cost savings and new restorative opportunities have different effects on the bottom line. For example, a new practice that does fewer restorations may not have cost savings, but the mill's capabilities could boost word-of-mouth marketing about what's possible. On the other hand, established dental practices with many monthly restorations will reduce overhead.

"Once you hit a certain number of restorations—depending on what you are paying the lab—you are covering the cost of the machine. Everything above that is pure profit," Sternberg explains, estimating the break-even number for many practices at around 10-15 crowns a month.

Mohammed Soliman, CEO of vhf, Inc., adds that defining practice goals will help narrow the parameters for what the best solution may be regarding capabilities and sets the stage for implementation. Soliman sees a dental practice as a dental business, which requires attention to short- and long-term goals.

"Practices should evaluate both," Soliman says. "What can this mill do for me in the short term, and how will it pay back? In the long term, what could this do for my practice overall and, frankly, my life as a clinician?"

However, he warns against waiting for the perfect time to invest in new equipment. In his experience, most clinicians that invest in a mill as part of their chairside solution wish they would have done it sooner.

"Clinicians are always telling me, 'The effect it had on my practice, my patients, and ultimately my life was so great, and I saw such improvement, that I wish I would have done it sooner,'" Soliman says.

What Type of Architecture Does Your Mill Use?

After establishing goals, Aguirre says she turns the conversation to closed vs. open architecture systems. Aguirre favors open architecture because it allows clinicians to grow with the technology. While turnkey systems are great for when a clinician wants the whole workflow as a single piece, Aguirre says, it doesn't allow for room for digital workflow growth as technology advances.

In addition, open architecture systems allow clinicians to integrate existing equipment into their workflow. Aguirre says that getting into chairside milling with their existing scanner is often appealing to the practice as they are able make use of an existing asset.

"Open-architecture systems like the 42W [Roland DGA’s, DGSHAPE DWX-42W] allow a user to use their existing intraoral scanners," Aguirre explains, adding that it also lets you add different brand scanners to the workflow later. "With an open-architecture system, you could have 5 different brands of scanners if you wanted to, and you could integrate all of them into that same workflow. So, it provides a lot of flexibilityand versatility."

"As long as the practice can export that restoration file, we can import it and mill it. If they can only scan and don't have design software, we can bring it into our design software and design and mill that restoration," Sternberg says, regarding the Planmeca mills.

The integration of existing equipment is essential, Soliman agrees. Many offices do not consider a production workflow when purchasing acquisition software (scanner) or design software.Soliman says that vhf mills are designed to work with any open architecture scanners or software through STL export.EXOCAD and 3Shape users get an even bigger workflow advantage thanks to a trusted connection to the Z4 mill that streamlines the nesting process, he explains.The vhf line has several wet and dry milling machines, including the Z4 wet milling machine for same day dentistry applications, which are all open architecture. However, he thinks practices sometimes do not consider early enough in the process whether the mill they want to add to the workflow will fit in with this established system.

"You'd be surprised how far they go before they think about that," Soliman says.

Another important consideration is the price tag. Some mills decreased in price over the past decade, but some haven't and range from $150,000 to $160,000.

By contrast, Sternberg says the Planmeca FITÒ System which includes our PlanMill 35 for "bread-and-butter" restorations, e.g., crowns, inlays, inlays, veneers, and 3-unit bridges, starts at under $100,000. The more sophisticated mills cost more, but they do more, too, and reduce your costs per restoration, Sternberg explains. For example, at around $135,000, you can get the Planmeca FITÒ Plus which has our PlanMill 50 S allowing doctors to also mill splints, surgical guides, dentures, and full-roundhouse zirconia restorations.

"What kind of dentistry do you want to do: a general dentist who does crowns, inlays, onlays, and maybe a 3-unit bridge, or a general dentist who wants to expand the practice and do more in-house?" Sternberg says.

"Price is always a consideration," Soliman agrees, " Business decisions should always consider initial cost, operating cost, and ROI. Clinicians can get a plug and play, high quality vhf machine designed for same day dentistry for under $45,000.

“But that also goes back to the goals for your practice,” Soliman continues. “If you know your goals, you can determine what your mill requirements are.Machines such as our top-of-the-line R5, can produce almost any restoration you can think of and can even mill overnight thanks to a 10-disc changer.A $75,000 investment in an R5 can produce a massive return to the right practice.”

Aguirre agrees the ROI is a critical part of this decision process. Mills with a lower price point have an edge in this department, especially for practices with fewer milled restorations every month. Roland DGA’s DWX product line with a price tag of under $30,000 is a departure from their usual offering, which have been units exclusive to dental laboratory markets.

“Our products make same-day chairside restorative dentistry an affordable reality with ROI in less than 12-months of ownership,” Aguirre says.

Avoiding Common Pitfalls with Your Mill Investment

Some practices try to do too much too quickly. It is essential to have proper expectations for how long it will take to transition to the workflow. Sternberg recommends starting slow with a single unit crown. Then, graduate to more complex cases while getting used to the new workflow.

Training is essential, too. While most manufacturers have training that gets a practice started, additional training for the more complex restorations should follow.

Sternberg recommends investing time in a clinician-led advanced training course for smile design or denture classes. Planmeca partners with Modern Optimized Dentistry (MOD Institute) in South Carolina for its advanced training programs.

"There are reasons there are advanced classes so that clinicians can get the most out of their investment," Sternberg says. "The most successful docs take the time, do the classes, and work their way through the technology."

Aguirre agrees that change can't happen overnight, and most practices need about a month to be consistent in same-day restorative delivery. Gradually integrating the workflow in the office is essential.

"Start by scanning your patient and bring them back in a few days, or even the next day, instead of trying to do same-day dentistry right away," Aguirre says. "Then, little by little, start to integrate that same-day aspect as the clinician and team's technique gets better. Most practices that do that set themselves up for success."

Also, Aguirre says, pick your most easy-going patient with a straightforward posterior crown preparation for that first same-day case. Then, she recommends calling that patient beforehand and setting a proper time expectation for the appointment.

"You don't want your patient to expect that they'll be there for an hour and then be upset because it takes longer and they have somewhere else to be," Aguirre says.

Not having an implementation plan causes friction, too. For example, Soliman says, practices should consider which procedures they will produce in-house restorations for, who will design the case, who will operate the mill, and who will maintain the equipment.

“Even our chairside Z4 mill is capable of making inlays, onlays, temporary crowns, veneers, final crowns, short span bridges and titanium abutments.Implementing all of these workflows at once will create too much confusion in a practice,” Soliman says. “The business owners should decide which of these restorations they will bring in house first, train staff appropriately, and incorporate the workflow before expanding their capabilities.Some start with posterior crowns since they are less visible and then expand into more cosmetic anterior cases as they become confident and get better at making esthetic restorations.

“In the end, in-house milling is usually a good investment,” Soliman continues. "Most practices see reduced over-head, increased patient flow, reduced chair-time per patient, and a more profitable practice.”

Articles

If a practice already has an intraoral scanner, we look at what practices should consider when adding a mill to the workflow and how to avoid getting into trouble during implementation with this critical investment. 

What to Look for When Adding a Mill to Your Dental Practice

How Digital Do I Need to Be for the Dental Practice? Photo courtesy of Sergey Ryzhov/stock.adobe.com.


Dental technology has transformed many practice's workflows from analog to digital. However, not every practice has a digital workflow. Those considering the transition may wonder how digital do I need to be?

The answer is very—and not only in the practice workflow.

Anna Singh, DMD, Senior Vice President of Clinical Operations, Heartland Dental, says today and in the years to come, technology is the single most important factor that will influence patient care and patient acquisition as well as products and services offered in a dental practice. Technology has a massive effect on how dentists market—search engine optimization and social media platforms allow dentists and their teams to analyze both patient behaviors and market trends, ultimately allowing them to be more thoughtful in the way they engage with patients.

Technology influences patient interactions, too. For example, some dental practices utilize call centers and chatbots or use app-based services to create better patient experiences. Dr Singh says many of these technologies use artificial intelligence (AI) to understand the patient's experience, to create efficiency and accuracy in diagnosis. AI technology will be used to mark existing conditions, anatomical landmarks and quantify the disease process hence creative opportunities for predictive analytics which in turn can enhance preventative care and a proactive approach to treat dental disease.

Dr Singh shares that the ubiquity of technological innovation and the relentless pace of change require clinicians to choose the platform that brings these technologies together. However, while many vendors offer similar technology products, they are not the same.

"It is challenging for clinicians to find the right technology for both their practice’s and patients' needs," Dr Singh explains.

Dental practices might also question where to start. Is it shifting to 3D imaging, incorporating a scanner, or adding CAD/CAM workflows? Choosing the starting point can be overwhelming to some practices.

Many practices also experience stress related to buying too much technology. Lisa Thompson, CDA, RDA, Midmark® Clinical Service Manager, says to start with a purchase that helps you diagnose and treat patients confidently. However, recent research by Midmark discovered that 39% of dentists using advanced technology are overwhelmed by it. Therefore, considering the application and implementation of that purchase is also essential.

"Practice stakeholders need to think about who will be operating the tools and how easy it will be for them to adapt that technology into their daily routines," Thompson says.

Midmark's new EOIS digital imaging system.

Dr Singh agrees that dental practices should prioritize technology acquisitions that fit patients' needs and solve the practice's challenges, something not every new, shiny technology offers. However, when it comes to prioritizing, Dr Singh likes to be at the cutting edge, not the bleeding edge. The following questions determine the difference:

Is there room for efficiency in the area the technology addresses?

Are there opportunities for high-quality outcomes?

Does the technology provide consistency of care?

Is the technology reliable and well-supported by the manufacturer?

What is the science behind the technology, and is it repeatable in practice?

"These are some baseline thoughts I would pose for any practice considering new technology," Dr Singh says.

The practice's environment is another critical consideration. Dental practices with solid team leadership and the agility to adapt to changes in workflows and processes are on one end of the spectrum. On the other end are teams that struggle with change. When Dr Singh considers digital integration for Heartland Dental, she looks for technology with potential for practices in the middle of these extremes. 

As a doctor-led dental service organization (DSO), Dr Singh explains the partnership with supported doctors and their teams in making these decisions is essential. Noting, when the team is involved in the decision-making process, the implementation is more straightforward because you already have the team's buy-in.

"Do not underestimate the amount of change that technology will bring or fail to consider how well it will assimilate with the existing process and systems," Dr Singh advises. "We can get so excited about the potential benefits to the patient experience that we forget about the teams and whether it makes their lives any better." 

Thompson thinks everyone should train on new equipment. Without training, people do not get comfortable, leading to technology investments sitting around collecting dust. Moreover, cross-training, and continuous training are essential in today's “Great Resignation” environment to keep the office running.

"The doctors should work with consultants and team leads to establish peer-to-peer learning environments, which allows for training to continue after you get an onboarding session with a new piece of technology," Thompson explains.

Thompson also advises investing in onsite training with licensed clinical educators. Onsite training professionals can help with the specific workflow issues for the practice, mitigating the potential for sidelining new equipment because of integration issues or logistical concerns. For example, Midmark's clinical training program has a curriculum that trains assistants and hygienists in the morning, and the doctor over lunch. The afternoon is dedicated to training support for the practice’s clinicians while they use the technology with patients.

Thompson also advises knowing where the support center is.

"No one wants to get on the phone and discover support is in a different time zone on a different continent. Then, you're waiting a day or 2 for support," Thompson says.

Dr Singh agrees everyone should train, adding that a step-by-step way to use new technology in daily practice is an essential component. Patients are also a critical stakeholder, and the team should align on communicating the benefits to patients in a concise, non-technical manner to secure their buy-in. In addition, choose the type of training—in-person, online, self-paced, or web-based—that will work best.

"Different types of training might work for different people depending upon how quickly you want to scale," Dr Singh says. "Also, think about engaging champions, the early adopters, for that technology in the practice. Those champions will help others as people work through their stages of change."

Large practices with multiple locations might also need the flexibility to modify the manufacturer's training. Heartland Dental sometimes does a pilot program with a few practices before a larger rollout, allowing them to overcome internal friction points faster and adapt the script into Heartland Dental language. These modifications make it easier for the teams to integrate into their existing systems.

Gamifying the integration effort can help, too. For example, Dr Singh says they had a scan-time competition for the company-wide rollout a few years ago to help the clinical teams get comfortable and efficient with the sensors. The competition started at the regional level. The final round had the top 5 fastest clinicians across the nation scan a patient live at the annual company-wide event. The winning scan was under 2 minutes.

"You have to build excitement with training," Dr Singh says. "If you just do an ordinary training, it's hard for people to get excited about the change and buy in to the future potential.”

However, practices should never forget with new purchases of technology and software that the interruption to business-as-usual and the related learning curve is stressful for team members. Anything the practice stakeholder can do to mitigate that is essential.

"Keep the team stress-free and happy," Thompson says.

How Will This Investment Provide a Return to my Practice?

Thompson believes 3D CBCT should start the digital workflow. Midmark's Extraoral Imaging System recently released, and Thompson says 3D CBCT is a valuable tool in overall patient care by providing that additional information for routine care. Moreover, a DICOM file is a medical-grade file, making CBCT a universal tool in healthcare right now.

Moreover, the CBCT provides a better visual of conditions the clinical team wants to diagnose and treat early. She explains that it's less painful and expensive when patients get treatment earlier.

"When we take a 3D scan, we find many things that we never saw in a 2D image," Thompson says.

One of the most significant returns on investment is staying relevant, Dr Singh confirms. Also, using technology to make process improvements should improve chair-time efficiency and facilitate high-quality patient care experiences.

"All of this creates cost savings," Dr Singh explains. "On the front end, you have to invest a little bit. But if you pick the right technology and equipment, it will pay for itself in the long run."

However, the investment can also affect overhead costs, productivity, and patient acceptance rates. For example, the intraoral scanner integration by Heartland Dental made a significant difference in the remake rate for restorations. Before scanning, their remake rate was four percent; after the scanner integration, it dropped to 2.1%. Moreover, hygiene became more productive because the scanners helped connect visually for the patients the disease process and abnormalities and enhanced the communication of occlusal disease and periodontal disease for patients.

"Our overall case acceptance dramatically changed by offering scanners and technology to our supported practices," Dr Singh says.

Thompson agrees that when patients feel comfortable, they accept the dentistry the practice recommends. Patient acceptance is beneficial for patients and dental practices. The primary return on investment is the patient's perception that the dental practice is doing everything possible to keep the patient healthy, something patients like to talk about with friends and family.

"And we all know that word-of-mouth marketing is the best marketing," Thompson says. "I correlate this to, 'Happy patient, happy life.'"

For many practices, a digital workflow is inevitable. But how do you prioritize, implement, and benefit from a digital technology investment?

How Digital Do I Need to Be for the Dental Practice?

Doing things for others without regard for yourself is altruism. However, being altruistic often gives you as much as the others receive.

Harvard Business School research suggests that giving to others makes people happier, which isn't surprising. However, the researchers also say that happiness is cyclical. In other words, happier people give more and then get happier, which leads to them giving more—and getting even happier.

So, happiness and more altruism are benefits you can count on, which is excellent news. However, the even better news is that many dental professionals experience multiple benefits when demonstrating altruism at the dental practice—and some of them might surprise you.

Speaker and author Daniel Bobrow, MBA, president of 

, a healthcare consulting firm in the Chicago area, is also a Certified Dental Practice Consultant. He encourages dentists to remember the definition of altruism when committing to a charitable act, which is the practice of selfless concern for the well-being of others.

"I agree with and believe that concern for one's fellow human being should be and must be the overriding motivation behind the charitable act. I lean toward the adage ascribed to Ben Franklin to inform one's action in this regard, and that is, 'Do well by doing good,'" Bobrow says. "The more successful one is, the more charitable one can afford to be."

Bobrow and the team at AIM champion the concept of Cause Marketing. Cause Marketing refers to a partnership between a nonprofit and a business for the benefit of both. The idea behind Cause Marketing, Bobrow explains, is that it's a way to grow the practice that is both cost-effective and image conscious. The "cause" is the focus, but the "marketing" is the side benefit. In other words, when dental practices help others, their practice will benefit. Moreover, Bobrow says the power of Cause Marketing is limited only by the energy and creativity of the practices that choose to try it.

, in which these ideas of altruism and Cause Marketing serve as guiding principles. Supporting charitable causes is one way to grow the business through good acts.

"It comes back to you in many unexpected ways," Bobrow says.

Jonathan B. Levine, DMD, Associate Professor at the NYU School of Dentistry and Founder and President of 

, gives a lot of his time to charitable causes. He is on the board of Foundation Rwanda, the advisory board of Health Corps, and donates his professional services to Operation Smile. Along with his wife and business partner, Stacey Levine, the 

 provides free dentistry to people without access to care. Dr Levine commits time to charity because he believes in the concept of servant leadership.

"Servant leadership is all about how we make people the best versions of themselves so that you become the best version of yourself," Dr Levine says, adding that it drives his work with the foundation, his company, and also his private practice in New York City.

“At Dentsply Sirona, we believe altruism is part of being a sustainable dental practice,” Erania Brackett, Senior Vice President, Chief Marketing Officer at Dentsply Sirona. “This includes giving to others, providing access to underserved populations, and contributing to the community you serve.It’s about making a positive impact on society and the environment.”

Altruism makes the world a better place and creates positive change – not only for communities but for us as individuals, Brackett explains.

“In genuinely giving to others, we form new meaningful relationships that lead to a greater good. Studies have shown that altruism boosts well-being and resilience—both important in our hectic times,” Brackett says.

“Dental professionals do not just perform a needed service for their patients,” Brackett continues. “They have a huge impact on human lives, enhancing the overall well-being and health of patients across their lifetime, and increasing their self-confidence. Dentists have the power to extend their positive influence even further with sustainable, altruistic engagement.”

Doing Good Builds Teams That Do Good Together


Behind Dr Levine's desk is a large mission statement on the wall: "Everyone deserves to have a healthy, beautiful smile. And it all starts here." He says that drives his actions to provide his expertise wherever there is an access to care problem. For example, his efforts connected him to entertainer Lenny Kravitz, who asked Dr Levine if he could help his community on the island of Eleuthera in the Bahamas. Before COVID, Dr Levine and his team would travel there to help the people who live there. The last 2 trips before the pandemic brought more than 100 volunteers to the island to provide free dentistry and education.

"It's an amazing feeling to be able to help people," Dr Levine says. "And what happens when you help people? You find other people who want to help people, and like-minded people like to hang together, and you get filled up by each other. So, these missions are extraordinary because everybody is in it for everyone else. Everyone has that mindset."

Dr Levine recognizes that it can be daunting to think about taking time away from the practice to serve others who don't have access to care. However, in his experience, the rewards for doing so are excellent for the team's productivity. In addition, these super-charged good feelings from doing good are great for team morale.

"We have this amazing culture in our practice. We have each other's back, and it's very much like a family, but a very functional family," Dr Levine says. "I run an organization that is about learning and growing. But the fact that we have this higher purpose elevates what we do when we're practicing on our patients in New York City. The positive reinforcement that comes back to the culture of my team is nothing short of extraordinary."

Another benefit of altruism in the dental practice is your peace of mind. Giving to others is an antidote to burnout, Dr Levine says. If you are always going full throttle and working all the time, it's not good for the longevity of your career or your enthusiasm about it, he explains.

"Here I am in my sixth decade, and I'm more excited about dentistry than ever before," he says.

Dr Levine thinks the connection between dentistry with the medical community is a chance to elevate dentistry. As dental professionals join forces with their medical counterparts through salivary diagnostics and airway and sleep medicine, they innovate dentistry. However, dentists can't do it alone, so a happy and motivated team is essential to this future. The charitable work his practice engages in facilitates this atmosphere.

"You wake up in the morning, and everyone is excited to get to work, and you're building people's careers at the same time," Dr Levine says.

Dr Levine and his team are returning to Eleuthera for the first time since the pandemic in early December 2022. With the cooperation of Henry Schein CARES, they are building a freestanding clinic there. The foundation will host a fundraising event in early November for it, too. As a longtime lecturer worldwide, Dr Levine's connections from all over the world join in the projects with the same goal to help others.

"Nothing makes me happier than going down there, helping these people, and having my family, friends, and colleagues near me," he says. "It fills you up."

Can Your Practice Do Well By Doing Good?


Research shows that helping people is what most people want. Moreover, consumers want the companies they buy from and work for to help people. In June 2014, Nielsen published a report, "Doing Well By Doing Good," stating:

67% want to work for socially responsible companies

55% would pay extra for products and services from firms that demonstrate the positive social and environmental impact

52% made at least 1 purchase in the previous 6 months from at least 1 socially responsible company

52% care whether the product packaging has a sustainable impact

49% volunteer or donate to social and environmental programs

Moreover, these concerns took on a generational trend. Many of the respondents that emphasized these social responsibility goals were Millennials, whose responses in the positive for social responsibility were double that of Generation X and more than triple Baby Boomers.

Bobrow sees this as a positive change. For generations, businesses focused on maximizing stockholder value. He envisions a broader definition of shareholder value for the future.

"I'd rather take a little bit less capital gain in exchange for living in a healthy environment or knowing that the businesses we are funding aren't supporting undesirable activities worldwide," Bobrow says.

It can worry practice stakeholders to take time away from the business to perform altruistic service. Brackett says that altruism can feel like a big word, but small acts of giving can go a long way.

“If you bring your team and colleagues together, the culmination of small acts can make a very big impact,” Brackett says. “Altruistic engagement is extremely rewarding, as we hear again and again from the dental professionals who partner with us on the initiatives we support as part of our sustainability program called 

For example, in September 2021, thousands of dental professionals who participated with Dentsply Sirona World had the opportunity to support Smile Train, the world’s largest cleft organization, with their personal donations, which were then matched by Dentsply Sirona to increase their impact.

“In doing so,” Brackett explains, “They provided free access to cleft treatment to hundreds of children around the world, offering them the gift of a healthier, more fulfilled life. One that we at Dentsply Sirona support through a recently announced $5 Million donation and a true commitment to advance the future of cleft care. Because every 5 minutes a Smile Train cleft surgery helps a child in need.”

A life-changing action dental professionals took together with Dentsply Sirona, Smile Train and FDI World Dental Federation was to join the project task team and work on developing the first-ever set of standard cleft treatment protocols that integrate digital workflows, Brackett says, to genuinely advance the quality of and access to cleft care for countless patients.

“The rewards you reap extend further than yourself. You inspire others with your actions—colleagues and patients alike—and become an ambassador for sustainable dentistry, making your practice more attractive to many patients,” Brackett says.

We believe dentists who choose to integrate sustainability into their practice and do good will ultimately prosper—at a human level but also in their own practices,” Brackett continues. “Aside from personal gains these dentists reap, there is a business aspect to this as well—people are increasingly choosing services and employment based on their sustainability practices.”

Bobrow says Cause Marketing can take many forms. For example, you could offer a free dentistry day for veterans or have an event for a charity. Then, you promote the project to your current patients. The promotion increases awareness for the charity or event and lets your patients know that you do the right thing.

For example, AIM Dental Marketing has a health partner (client) who, as part of the new patient protocol, gives patients the option to pay for the initial consultation and X-rays or to match the practice's donation to the "Make-A-Wish" Foundation of $100 and the practice will comp the visit. Since the first-visit bill is more than $100, new patients save money and feel good about donating to such a worthy cause at the same time.

"Cause Marketing is one of the most effective ways to earn trust in a prospective patient's mind quickly. It's highly powerful," Bobrow explains. "It leverages your reputation."

“Each and every one of us can take action for a brighter world,” Brackett explains. “When choosing a project to support it’s very important that it’s an area that you truly connect with. At Dentsply Sirona, we offer you the possibility to take action for the environment, for communities, and even for your team.”

Brackett encourages dental professionals to contact 

Corporate.Communications@dentsplysirona.com

 if they would like to go beyond together with Dentsply Sirona. For example, Brackett says that dentists could:

Partner with Dentsply Sirona to develop and increase awareness around the first-ever Code of Good Practice for Sustainability in Dentistry, that Dentsply Sirona documents in partnership with FDI World Dental Federation

Volunteer to share knowledge and time to provide oral care services to people in need

Join hands with Dentsply Sirona as Dentsply Sirona strives to offer female dental professionals the opportunity to gain a stronger voice in dentistry.

“At Dentsply Sirona we have also supported a number of short-term projects, such as care missions in Uganda and Jamaica, where dentists treated a large number of patients during a set amount of time. To make your contribution truly count, choose a project where your unique expertise can make a real difference.”

Dr Levine encourages dental professionals wanting to start something altruistic for their practice to avoid "paralysis by analysis." First, determine what they want to do and where they want to do it. Then, using that as your motivation, talk to established foundations doing similar things in the area. Collaboration maximizes the amount of funding raised that goes to helping people.

"Finding a local organization or joining forces with a foundation that wants to help and has done this before will help you move in the right direction," Dr Levine says.

Bobrow agrees, adding that the team and patients should have input, too. He also recommends vetting the charity you want to support to prevent any bad public relations surprises. Also, determine how the charity will support your efforts.

"Any successful charity recognizes they can't take their donors for granted. So, if you're going to do something, they should provide you with in-office displays or a website that will enable you to reach out and market to your public to get them to make donations," Bobrow says.

For example, practices that support Climb for a Cause get free public relations support from AIM Dental Marketing, event organization and promotion, and in-office display materials. Participants in the climbs also get preferential consideration to go on a volunteer overseas oral health education and treatment project. Bobrow's organization has had assignments in Mexico, Guatemala, India, and Nepal. Smile Tree has a similar support program for practices, including social media content.

"The more we can encourage the dental public to recognize the power and value of doing this, the better we will do. Everyone will benefit from this," Bobrow says. "This tide will raise all boats."

Dr Levine agrees that altruism in the dental practice is an excellent way to empower the dental profession. Plus, dental professionals want to help people. He wants more dentists to embrace that part of their motivation and not get caught up in the details of how to get started.

 to do it is easy," Dr Levine says. "The important thing is 

 you do it. The answer for helping people falls right into place because that's what we do."

1. Anik L, Aknin L, Norton M, Dunn E. Feeling Good About Giving: The Benefits (and Costs) of Self-Interested Charitable Behavior. Hbs.edu. https://www.hbs.edu/ris/Publication%20Files/10-012_0350a55d-585b-419d-89e7-91833a612fb5.pdf. Published 2009. Accessed May 3, 2022.

2. Doing Well By Doing Good: Increasingly, Consumers Care About Corporate Social Responsibility, But Does Concern Convert to Consumption?. Nielsen.com. https://www.nielsen.com/wp-content/uploads/sites/3/2019/04/global-corporate-social-responsibility-report-june-2014.pdf. Published 2014. Accessed May 3, 2022.

There are multiple benefits to demonstrating altruism at the dental practice—and some of them might surprise you.

Giving and Receiving: The Benefits of an Altruistic Dental Practice

Rising to Their Expectations: How to Keep Patients Smiling in the Dental Chair. Photo courtesy of pressmaster/stock.adobe.com. 


We all have expectations. Sometimes they are based on experience, and other times, they come from comparison to something similar. And if we don't have anything personal to draw upon, we make it up based on stories we've heard or things we’ve watched on Netflix.

Your patients have expectations too. Do you know what they are and if you are delivering them? If not, maybe it's time you did. We take a closer look at why patient expectations are what they are and what you can do to keep them smiling in your dental chair.

First, it is essential to recognize that there has been a shift in information accessibility. Mark Hyman, DDS, MAGD, an Adjunct Full Professor and Special Assistant to the Office of the Dean at UNC Adams School of Dentistry, says in the "good ole' days," the dental team had proprietary information, and patients did what the team suggested. Now, with the internet and "Dr Google," patients see things without evidence and context and put their trust in that information.

"We can get angry and frustrated about this change, or we can use some fundamental principles of education that will win the day," Dr Hyman says.

When browsing for a "dentist near me," patients will see a wide range of dental content, from articles that describe sealants to videos demonstrating the benefits of implant dentistry to commercials about the wonders of clear aligners. So, patients know more about procedures when they walk through the door. The challenge occurs when patients develop expectations based on self-diagnosis.

"With dentistry, people come in with their expectations and research, and it can be hard to take the doctor's recommendation," Jeff Rohde, MS, DDS, says. "I am not offended by that. Instead, I see it as a chance to talk about this stuff, and I love talking about it."

With a misguided self-diagnosis, Dr Rohde prefers to have a conversation rather than tell patients they are wrong. So, he starts the conversation by asking where they read it. Then, he asks them why they were looking it up and what else they had learned.

Dr Hyman also believes in answering a question with a better question. When he has a patient that reads something on Google and objects to Dr Hyman's diagnosis or treatment plan, he asks, "What if Google is wrong?"

Dr Hyman also uses the “Feel, Felt, Found” objection handling technique with patients. For example, if a patient objects to fluoride treatment, Dr Hyman would say, "I understand how you feel. Many patients have sat right there and told me they felt the same way. However, research has found that fluoride cuts out cavities across the board." He finds that this approach puts his patients at ease.

"There is a temptation to be upset and feel challenged or demeaned, but I want us to stand our ground and smile while asking them to tell us more or how that makes them feel. Keep asking for information like why they came in or their goals for their smile. Be curious. Respectful. Then, reassure them from a professional that they are making the right decision," Dr Hyman says.

Sometimes the patient is looking for what they want to hear rather than what they need to hear. Dr Rohde says it can be challenging to disappoint patients. Still, by elevating the conversation and explaining why they need what you recommend, you can get patients on board with the diagnosis and treatment plan. While it might take longer than it used to, you can create a climate of trust in the operatory so that patients feel heard, even though you might push back and disagree.

"We need to flip our thinking around to remember that they are looking for the answer and are just disappointed with the outcome," Dr Rohde says when patients question his plans in the operatory. "It's all about matching those expectations."

Not Meeting Some Patient Expectations is Good, Too

There are some expectations you don't want to meet. Dental anxiety and dental fear are patient expectations that fall into this category.

Dr Rohde says dental anxiety was already accompanying many patients into the operatory. Add to it the pandemic, and now you have people afraid of dentistry and catching a disease. The war in Ukraine isn't helping with stress levels, either. Dr Rohde says he sees the effects of the rising levels of anxiety based on how many night guards he has made over the last 18 months.

Elevated anxiety and stress can result in short-tempered patients loaded with mental baggage. Dr Rohde says that he and the team remind themselves when the patient lashes out at them that it isn't about the team personally.

"Our job is to care about people and show them compassion even when they are not at their kindest," Dr Rohde says.

Dr Rohde says that initiating those conversations and making people feel accepted for who they are is essential. Since his team has many touchpoints with patients before he sees them, he raises the team's awareness about how they are delivering the elevated experience he wants at the practice. For example, he wants the team to let anxious patients know they are not alone, and if people feel scared, he encourages the team to respond to that in empathetic ways.

He also wants the team to meet patients where they are. If they are not consistent enough with their home care or do not floss often enough, he discourages the shaming approach to clinical diagnosis. Instead, aim for improvement and individualized goals, not perfection. He says that if a patient isn't flossing at all, try to get them to floss once or twice a week. It's not ideal or enough, but it's better than it was.

"What will we accomplish by making someone feel terrible for not flossing?" Dr Rohde says.

Dr Hyman uses photography, digital imaging, and digital printing. Also, Dr Hyman is excited about the new Artificial Intelligence (AI) products, like Pearl, that provide an automatic second opinion chairside. He believes that training the office on all these technologies is paramount. Training gets everyone on the same page with educating patients on their oral health. Seeing is believing and can help with treatment acceptance.

Another product he likes is PreVu Smile Simulation Software. He recommends using it as onboarding for new patients. First, you take a smiling photo, a panorex, and a cone-beam computed tomography (CBCT), and in 30 seconds, a simulation is complete. Then, you show it to them and ask the patient what they think and how soon they would like to be finished.

"An objection is not a 'no,' it's a request for more information," Dr Hyman says.

He also says you should dedicate time with the team to train on Digidoc cameras and role-play the patient conversations. The idea is to be curious but not authoritative. Once you have the photos on the monitor, Dr Hyman says the temptation is to lecture patients about what they should do. Instead, he wants the team to say, "Tell me what you see." Then, they should follow up with "how can I help you?"

He also likes hygienists to take a before and after photo for cleanings and show them to the patient. Then, he wants hygienists to ask the patient what they see. He describes a quality photo in front of the patient as liberation for dental teams.

"You have all this equipment. Well, any bozo can buy the equipment. It's how you use it and train on it," Dr Hyman says. "You want to exceed patient expectations and knock their socks off."

When You Can't Meet Patient Expectations Despite Your Best Efforts

But what about when a patient's expectations exceed your patience? Dr Rohde does not allow rude or verbally abusive people to stay patients. Dr Rohde expects the team to be there for patients and bend over backward to provide that elevated experience, but when that isn't enough, Dr Rohde will tell patients that the patient care at his practice isn't a good fit anymore. He thinks dentists should draw the line with these patients and support their teams.

"Even though people are coming in with all these fears and anxiety, and we have to be more patient and compassionate, it doesn't mean we have to be a doormat," Dr Rohde says. "You are not going to be the perfect fit for everyone."

If You Don't Know What Your Patients Want, Ask.

Perhaps most importantly, Dr Hyman says that you don't have to pine for the “good ole' days” when you were the authority and patients did what you said just because you said so. Instead, he encourages the dental team to rise to patient expectations, and if you don't know what they are, ask. Some of the questions that he trains the group to ask are:

What are your goals for your health, teeth, and smile?

Is it essential that you keep your teeth for the rest of your life?

Please help me understand why you don't want to move forward.

Another important consideration is where your patient is in their life. Generational differences affect how patients view dentistry. For example, Millennials do not have the same perception of dentistry as Baby Boomers. That means connecting with patients at different ages and life stages might require a varied approach. If you treat every patient the same way and assume they want the same things, you could miss out on many opportunities to connect with them and build a relationship. Asking questions and learning about the person in the chair is essential to meeting their expectations.

"It is a joyful way to work when you understand basic human relation principles," Dr Hyman says. "We in dentistry have the greatest thing going. We get to take colossal care of patients and make a profound difference in their life, and very few of them die when we're working on them. It's the greatest profession in the world. So, work hard on yourself and give the patient the courtesy of getting to know them by asking, 'Why did you walk in today?'"

Patients arrive in your operatory with an idea of what should happen. Do you know what they expect and whether you will deliver it? 

Rising to Their Expectations: How to Keep Patients Smiling in the Dental Chair

$11.5 Billion: The Future Looks Bright for Dental Restorative Materials—And Your Practice. Photo courtesy of New Africa/stock.adobe.com. 


$11.5 billion is a lot of money by anyone's standards. However, per market intelligence company Transparency Market Research's (TMR) report from early 2022, it is also the projected revenue of dental restorative materials product sales by 2030. So, what does that mean to your practice and clinical outcomes? We look at the benefits of a growing commercial market for materials and what that means to your practice and patients.

Before diving into the details of the TMR report, let's look at the report on the dental market as a whole, also released earlier this year. Precedence Research, a strategic market insight company from Canada/India, suggest in their analysis of the global dental market that a CAGR (compound annual growth rate) percentage of 6.4 or $698.8 billion by 2030. The US market for dental services will represent $196 billion by 2027. Precedence identifies the following in their report that are of note:

Cosmetic dentistry represents the most CAGR regarding procedure type, driven by younger patients concerned with esthetics.

Oral surgery was the dominant service in 2020 and will continue to grow as more general dentists are available worldwide.

End-users prefer dental clinics for dental services and treatment of disease (over hospitals, presumably).

North America was the leading dental services market in 2020, in part because of more disposable income, technology adoption in clinics, and high healthcare spending there.

Africa will be the fastest-growing market moving forward with the rising awareness about oral disease and increasing disposable income and access to dental clinics with advanced dental equipment.

Market intelligence firm indicates that the dental restoratives markets will grow to $11.5 Billion by 2030. What does that mean to your practice and patients? 