Wendy Briggs

Over the years, we have seen many practices struggle to navigate difficult waters. In fact, it seems that lately, there are an alarming number of dental practices having serious challenges staying on course. 

There have been so many recent changes in our profession, we often see dentists struggling to adapt as they begin to sail into uncharted waters.

. Others are struggling to attract new patients. Competing with the “corporate rollup” is both challenging and even frightening for some. Your frustrations may stem from open time in the schedule or just difficulty achieving continuous improvement. Whatever your current storm may be, rest assured it doesn’t have to end badly. It is disheartening to hear stories about dentists who decide to give up or no longer enjoy life as a practicing dentist. Our passion for what we do in the field of dentistry is what drives us! It is an exciting time to be in dentistry.

We would like to share three practice survival strategies with you in this article. These concepts have helped countless other dentists in similar circumstances turn things around or break through their plateau and realize tremendous success. When you realize success in your professional life, the satisfaction you derive can make all aspects of life more enjoyable.


If you think of your practice as a box, the majority of your time, effort and resources should go toward the patients, team and procedure mix you currently have in your box. Do the things your patients expect in a more extraordinary way.

 to attract new patients, you need to become attractive to new patients. One simple exercise to become more attractive is the "No Transformer". When we tell our patients “no,” we are denying them what they want. Have your team identify every situation where they need to say “no” to a patient. Lead the team in discussing how they can transform as many of those nos to yeses as possible. Your patient referrals will soar as you become more attractive.

Video: How to grow your practice with patient referrals

The "No Transformer" is one of the many tools we use to help our clients become more attractive to patients. Becoming more attractive overcomes two marketplace challenges: The return on external marketing in some markets has evaporated, and the old paradigm of patients conforming to the wishes and preferences of dentists and their teams is failing. Dental consumers are becoming more demanding, and those practices that adapt and find a way to say "yes" will realize great return on their effort.

in 2013, a survey was done of patients who were looking for a dentist. These people were asked what was important to them in selecting a new dental provider. The No. 2 issue they stated was convenience. This proves there has been a major change in our marketplace, and expecting patients to conform to what we want is no longer a winning strategy.

Becoming more attractive is the first step in creating hyper patient demand. The next step is to master internal marketing. We teach 21 internal marketing steps any practice can use to increase patient demand quickly, easily and inexpensively. Once you have mastered these skills, your success with external marketing will be multiplied many times over.

Strategy #2: Maximize potential from hygiene

In today’s dental practice, realizing success in 

 is not out of reach. Although it may seem that achieving high productivity consistently from your hygiene department is a fantasy, we have found a formula for success. The incredible thing is, we have taught practices all over the country how to convert lackluster hygiene productivity into an incredible revenue stream.

To realize potential in hygiene, we must be sure that we are maximizing the three roles of a modern-day dental hygienist.

Webinar: 7 steps to improve your modern marketing skills

The first role is that of a preventive therapist. Dental hygienists have a significant responsibility to be focused on the prevention of disease. We are the only health professional who is given the primary role of prevention. The truth is, many patients of today are considered high risk by the ADA. Those who consistently struggle with chronic decay have a very high level of frustration. They do not want cavities, they are tired of always having problems with their teeth and they are very interested in preventive options.

 doesn’t cover a certain preventive procedure, the patient will not want it. When we present the opportunity the right way, patients jump at the chance to prevent future problems. Preventive services like fluoride, sealants, desensitizing agents, radiographs, advanced oral cancer screening, and many others become commonplace procedures happening daily in hygiene. If we are truly maximizing preventive therapy in hygiene, a nice thing happens to productivity. It goes up drastically.

Study: Saliva plays key role in caries prevention

We should also note that with more markets seeing the influence of insurance and 

, maximizing the preventive role can help our profitability even when on a “discounted” insurance plan. Having patients choose a higher level of care, and more services at their hygiene appointments, benefits the patient and practice.

 therapist. Many consultants and hygiene educators focus heavily on periodontal therapy, as it is a critical component in the life of a dental hygienist. However, it is not uncommon to see a practice that is still treating periodontal infection today with the same strategies and technology it was using five or even 10 years ago. This is truly alarming! Many things have changed. We have better tools and better science about what causes periodontal infection and how to drastically reduce it. We know so much more about the 

 link and serious health risks that exist with the presence of inflammation in the body.

We have laser techniques, oral DNA testing methods, home care products, additional resources like Arestin, and other adjunctive options for patients. If we are truly maximizing potential in our role as periodontal therapists, we are seeing periodontal disease, talking about it, and treating it. We have extremely high acceptance rates for these advanced services; supervised neglect is not an option. We discuss periodontal disease with existing patients, as well as new patients, and we are treating it with every available weapon in our arsenal.

Related reading: Why oral-systemic health and dental EHRs make for a great marriage

The third role is that of a patient treatment advocate. Hygiene often underestimates what a critical role we have in helping our patients make choices about the dentistry they need. How many times have they turned to the hygienist, or another clinical team member, to ask, “Do I really need to have this done?” or “How long can I wait before I get this taken care of?” The reality is patients want the team’s opinions and recommendations when it comes to the choices they have about treatment.

We also teach providers how to embrace and incorporate technology that aids us in better maximizing this role. Having the time and skills necessary to use the 

 on every patient is vital. Other incredible devices like cavity-detecting lasers and enhanced imaging tools can help us facilitate treatment being accepted. Verbal skills, knowing which questions to ask and helping the patient decide which option best accomplishes their goals, are what we are aiming for in developing this role. Presenting treatment and having the patient choose better dentistry can be incredibly rewarding. 

Related reading: Top must-have prevention technologies for dentists

Strategy #No. 3: Eliminate production blockers

We have observed dentists who produce $200K per month easily. We have also observed dentists who struggle to produce 20 percent of that. What is the difference? The myth would tell you the $200K dentists are doing lots of big cases. The reality is that these hyper producers mainly do bread and butter dentistry and have simply eliminated blockages to production. Some common blockages: inadequate investment in technology, inadequate number of equally equipped treatment rooms, too few chairside assistants, room turnover inefficiency and lack of standard clinical protocols.

Quite simply, practices that become attractive to patients generate a great deal of patient demand and become blocked to future growth quite quickly. These blockages are often too subtle to be detected by a busy practitioner. The super producers know the early symptoms of these blockages and address them aggressively. One early symptom is the inability to accept emergency patients immediately. If you have existing or new patients with a 

 you cannot see them today, you have a production block.

The usual dentist response to a production blockage is to misidentify the problem. Commonly, the blocked dentist tries to fix the blockage by trying to attract more new patients. These new patients only exacerbate the blockage. Like a dam full to capacity, more water causes a spillover. In a practice, spillover includes the patients who no longer return to your practice. As you add more patients in the front door of a blocked practice, you increase the patients slipping away through the back door.

Eliminating production blockages can be scary. It almost always involves investment in people, technology, equipment, supplies and/or facility. If the blockage is correctly identified and the correct strategy is used to solve it, the investment pays off very rapidly. If the blockage diagnosis is incorrect, the treatment is less likely to be effective and the payoff negligible or none. Having expert help identifying and addressing blockages is extremely beneficial.

To overcome blockages we teach an 11-step process, "The Productive Practice Mindset", to improve 

 and maximize clinical accuracy and efficiency.

Practices that utilize these strategies are not worried about survival. Instead, they are thriving! Despite economic challenges, they realize record productivity. Their practices are growing and their teams are engaged and excited about serving their patients. This provides a tremendous benefit for the doctor. Productivity brings profitability. Profitability often produces peace of mind.

Our unique approach, providing expertise from a practicing dentist, a practicing hygienist, and practicing team administrative leaders, has helped many dental professionals not just navigate challenging waters but rise above them.

Articles

 Over the years, we have seen many practices struggle to navigate difficult waters. In fact, it seems that lately, there are an alarming number of dental practices having serious challenges staying on course. 

Navigating uncharted waters for your dental practice in 2015

For the last several years, I have been fortunate to work with many of the top dental practices in the country. As I review their vital statistics and study procedures done, I am often alarmed at how often we struggle to provide periodontal services.

I often see that our challenges in providing periodontal care are not in performing the procedures themselves. Rather, it’s having patients ready and willing to have the services done.

Many dentists think they should be providing periodontal care to 25-40% of their patients. Yet, when we evaluate where they really are, it’s often far below that. Some are stunned to find out that less than 5% of their patients are currently enrolled in a periodontal maintenance program. Practices that have studied this extensively and worked diligently with their teams might be a bit higher than that, but the reality is we are often underperforming in this area.

Again, in my experience, the problem is not in our clinical abilities to scale and root plane when heavy calculus exists, but rather gaining acceptance from our patients on these procedures that are costlier than the “regular cleaning” and may or may not be covered by their insurance policy.

10 questions on genetic testing, periodontal disease and the role of the dental professional

Hygienists face real obstacles in discussing periodontal disease. We all know that periodontal disease is a complex, bacterial condition that presents a real threat to the patient’s oral health. In studying the oral-systemic link, it is widely accepted that having periodontal infection also represents a serious threat to the patient’s systemic health. So why is it so difficult to have the patient complete all four quadrants of therapy and return for recommended maintenance?

Here are some simple steps that we teach to hygienists that have proven to help improve acceptance for periodontal procedures.

This may seem basic but it’s an important step. I am not talking about proper insertion and angulation of the actual probe, but rather how we present what we are doing to our patients. If we do this correctly, we help patients understand why we are recommending they have the services done.

Setting the stage is critical. The moment you see warning signs of periodontal disease (even before you start probing), it’s important to tell patients that you are concerned about some warning signs of infection you see in their mouth. Then explain that you’re going to take some measurements in order to do a more thorough assessment. Tell the patient in advance what the numbers mean to help him or her understand what’s going on.

We have found success when we explain the numbers in the following way:

If you hear a three or under, it’s considered healthy.

Anything higher than a three means there is infection.

If you hear anything higher than a five, this means the infection has already spread to the bone.

Just by listening to us call out the numbers, the patient already knows there is a problem. It is not uncommon to have patients react immediately when they hear us calling out 6-5-6, 7-5-7. When you do it this way, you don’t have to tell the patient there is an issue. They often will look at you and say, “We have a problem!”

Trending article: Anastasia Turchetta's five hot dental hygiene topics for 2015

Step #2: Helping the patient see their disease for themselves

There are several ways we can do this. Some hygienists will have the patient watch a suitable educational module so that they understand the issues fully. Choose your module carefully as some give way too much information and actually turn patients away from treatment rather than educate them as to why they need treatment.

To introduce the module, you can say, “As you could tell from the numbers, we do have some infection in there. I am going to have you watch a short video that will help you know what we are talking about.”

The reason this is important is that it’s not enough just to talk about options and solutions. We need a format that presents the information visually. It is said that 87% of patients are visual learners and will not truly understand it until they see it. Patient understanding and retention is much greater with visual information. This also helps us with efficiency because while the patient is watching the video, the provider can step away and make notes on the chart or enter information on the computer.

Another exciting way to do this is with a Soprocare camera by 

. I love being a hygienist in today’s world! We have such incredible technology with which to work. The Soprocare camera utilizes varying wavelengths of light to help us educate our patients. This tool actually has a “Perio Mode” setting that is unlike anything else I have ever seen. With this setting, I am able to have my patients see for themselves the inflammation and deposits that we see. As trained dental professionals, we can easily see plaque and calculus in our patients’ mouths. Now with the Perio Mode setting, plaque and calculus become visible to our patients’ untrained eyes. They also can see areas of tissue inflammation and redness for themselves. When they see their mouth and can recognize these concerns, they are more likely to accept periodontal treatment. We have seen the visualization of their current conditions help to motivate and inspire patients to move forward with recommended periodontal treatment.

Step #3: Review findings with the patient utilizing simplified terminology

In the next step, it’s important to review the findings with the patient and review the health assessment form. Note: The health assessment form is available to our members in the resources area of our member-only website, but I have included a link to a free PDF of this tool at the end of this article.

When a practice has multiple providers and/or multiple locations, it can be a challenge to get all the hygiene providers and dentists on the same page. This tool is an example of a system that can help everyone get on the same page when it comes to determining the level of infection, and what should be done. This resource is especially helpful if we are dealing with a patient who is borderline.+

The importance of collaboration for today's dental hygienist

The form is not a final diagnosis. Rather, it’s meant to be a guide to help providers make an assessment. The doctor always makes the final diagnosis.

After the patient has watched the educational module, the hygienist could say,

“Let’s review where you are. Do you have any questions about the video? Let’s talk about what level of infection is present and about how we can help control and maintain this infection that’s in your mouth.”

If we have used the camera to show the patient the obvious infection and calculus present, they often can see for themselves and will ask about solutions. We then go on to explain the three steps needed to clear up the infection, being careful to use simplified language that the patient can understand.

 is to do a deep, more aggressive treatment than you’ve had in the past.” And then I stop. At this point, the patient is probably thinking this is going to involve pain and discomfort. We need to reassure patients we will do everything possible to keep them comfortable. If they have a fear of pain, they will not come back. We have a tremendous advantage with state-of-the-art technology and power scalers.

An analogy that we often use when talking about a deeper cleaning is making a comparison with a splinter. You can explain it’s like having a splinter under the skin.

If we don’t get rid of the splinter, the area is never going to heal. In the same way, we need to do the cleaning to get the buildup out and to clear the area of bacteria.

We often will utilize lasers with our periodontal therapy, and will introduce that concept here as a way to keep them comfortable while providing a thorough “detox” of their mouth.

A dental hygienist's perspective: Fighting caries with customized care

 we need to do is to change a few things that you are doing at home.” We have to be very careful here. Patients don’t appreciate the lecture on what they are not doing. We try to have a guilt-free, lecture-free discussion. We don’t focus on what they are NOT doing. Instead, we discuss getting them better tools.

When we have this level of infection present, it is time to focus on helping our patients be more effective in their daily battle against the bacteria. We often recommend using a power toothbrush. When it comes to recommending the power brush, we love the analogy of a screwdriver – a basic job can be done with a manual screwdriver but a big job will need a power screwdriver. With the level of infection they have in their mouth, it requires a tool that will do more for them.

We also may suggest that they get a prescription mouthwash and recommend they use something every day to keep the bacteria under control. They are open to this and people are willing to follow our recommendations … if that’s what gets the job done.

Whatever products you are recommending to help minimize infection can be introduced here.

The six things every dental hygienist should be doing to grow professionally

 is to see you more frequently than we have in the past.”

We know how important it is for the patients to come in for three- or four-month recall visits but patients don’t realize how critical it is. In 2012, the Journal of Periodontology stated that after scaling and root planing alone, the bacteria returns to pre-treatment levels in just 21-60 days. We need to evaluate and attack the bacteria again within the first four to eight weeks. Patients need to understand that this is not a one-time fix. Just like any other bacterial infection, they can have re-infection and progression of the disease.

We need to explain that after the initial therapy, if they don’t come back for maintenance visits more often, they can end up back where they started. The disease will continue to progress and the infection can continue to cause damage.

We have overwhelming scientific proof that dental health affects overall health. Infection in the mouth often means the patient is at risk for other serious medical illnesses. In a 2012 consensus published by the 

, they stated that evidence exists that indicates a connection between periodontitis and other systemic diseases, such as chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome, and cancer.

We know this, but patients do not. We need to help them understand the serious nature of their diagnosis and what is required to keep them smiling for many years to come. 

www.theteamtraininginstitute.com / www.hygienediamonds.com 