How Not to Fail

For this month’s column I found myself thinking about some of the dental technologies that never quite caught on. Some of those concepts were good ones, but just never gained traction. Others were not so good, and we are probably all better off that they were put out of their misery. In my dual role here as chief dental and technology editor, I get the chance to see and test a lot of products. I love the fact that our profession is always pushing forward with new technologies and new ideas.

Often in our profession, and in life for that matter, we see ideas that we inherently know just will not work. However, after we have determined they are hopeless, we then see other people using the idea or device with great success. I am sure you can think of something right now that you had doubts about that is now a mainstream success. How in the world does that happen?

Dentistry can be a closed-minded profession sometimes, and although that can be a good thing, it can also be a detriment. In a single-doctor practice, the doctor is the lord of the castle. The good news is that as more and more offices are becoming multidoctor, that means those offices are also multiopinion. There is more than one person who can make points from the doctor point of view and who can expand horizons and increase adoption of new technologies, techniques, and materials.

Expanding your horizons is a good thing, and I’m excited to see our profession opening up more and more to new procedures, new materials, and new thought processes. How do we do this the right way? How do we know what will work and what won’t? How does an office know when is the right time for change and what change to adopt? I have been a lucky guy in a lot of ways. I have made a career out of embracing change, and often I have had peers and patients ask me, “Why did you choose X?” or, “What made you decide on Y?” I am going to share some ideas that I have used (and some I’ve, ahem, borrowed) that have served me well over the years when it comes to integrating new ideas and new hardware into my workflows.

Analyze the Quality

Whenever I am presented with a new idea for the clinical aspect of dentistry, my first thought is always, “What is the end result?” It is a simple matter of looking at what the procedure provides. If it gives my patients the same outcome or a better outcome than I am delivering now, then I decide to give it a closer look.

I have learned that change always requires time and effort. If I get a better result in the long run, then I am willing to invest that time and effort. However, if I get lower quality, where is the upside?

This rule applies to either procedures I am currently performing or procedures that a new technology might allow me to perform that I don’t want to do the current way. Two examples that come to mind are crowns and soft tissue surgery.

The crown proposal comes from in-office milling. There are tons of advantages. Things like no temporaries, no second appointments, and no lab bills are clear advantages and a win-win for the doctor and patients. But if the restorations are of lower quality I cannot, with good conscience, place them in the mouths of my patients.

However, when I analyzed the restorations produced by the DGSHAPE DWX-42W, I found that they were of equal or better quality than what I was delivering “the old way.”

I did not do much soft tissue surgery before I purchased my first laser. Scalpels and sutures don’t conjure the best images for referrals, so I referred those cases to specialists. When I explored the possibilities that came with the use of soft tissue lasers, a whole new world opened up for me.

I began providing cosmetic recontouring, biopsies, and frenectomies in a bloodless environment. Lasers provide almost pain-free recoveries and rarely require sutures. Those cases I had been referring became routine procedures. When you factor in things like troughing for fixed prosthetics (which eliminates retraction cord) and periotherapies, lasers created a whole new way for me to help my patients.

Does It Save Time?

Quality is the most important factor, but time is next in line as far as I am concerned. No one wants dentistry to take longer. Certainly, our patients don’t want that. As we all know just from thinking about our own lives, the last thing we need is more things to do or less time to do our current tasks in.

I humorously tell people, although it is true, that in all my years of practice no one has ever asked for a procedure to take longer. Patients don’t want extra “drilling” or extra time in the rubber dam.

For the doctor and team, time savings is also a huge benefit. If a technology cuts minutes off a procedure, that is 10 minutes less the doctor and assistant spend in what I refer to as “the clinical posture.” Even with the best ergonomics, dentistry takes a physical toll on those of us who deliver it. The less time we spend in “the clinical posture” the better it is for us physically.

A few years ago, I learned that around 65% of doctors who file for physical disability do so because of neck and back injuries from practicing. That is a large number. Anything you can do to keep yourself out of that posture could very well save your career. Now, some of you reading this are probably thinking that if you can save time, you could see more patients and make more money. That is true, and if you are young and healthy that might work for you. For me, at this stage of my career, it is about staying healthy. And by the way, if you stay healthy and are not forced to retire early, that means more years of practice at a less hectic pace.

Does It Increase Cash Flow?

Like it or not, dentistry is a business. I dislike that fact probably as much as you do, but there is nothing we can do about it. As I have said plenty of times here, you can be the best operator in the world, but if you cannot make a profit and stay in business, your skills will not benefit very many people. Because of that, it is imperative that we make sure that any new things we incorporate also have positive cash flow.

There is one thing here I want to make perfectly clear: If you want to make a good living in dentistry, focus on your patients and not on dollars. If you do your very best and care about your patients, you will be just fine financially. My point here is that you need to make sure that what you buy helps your business and does not hurt it.

Using the examples I mentioned earlier of in-office milling and lasers, let’s explore the cash flow aspect. Milling crowns in the office reduces chair time, reduces lab bills, and can also reduce supply expenses. Those are all good reasons to consider a mill. It might not generate new revenues, but it cuts your costs and increases patient satisfaction, so the benefits are definitely there. When we incorporated our DGSHAPE DWX-42W into our workflow, not only did we get amazing clinical results and cut costs, we also got referrals from patients delighted and impressed with the services the mill delivers.

Lasers allow me to perform procedures that I had not been providing. When I referred patients to a specialist, that revenue went to another office. By keeping those procedures in house, I was able to increase revenue by doing procedures that I would not have done were it not for the investment in lasers. Considering the low costs associated with today’s diode lasers, the devices opened up an entirely new revenue stream for the office. Combining that fact with patient amazement and satisfaction meant we also increased referrals, which boosted the bottom line as well.

Simplicity and Repetition

Any time you do something for the first time, you are going to make mistakes and/or have unexpected problems. That is a well-known fact. No matter what the procedure, we become more proficient by making mistakes and then integrating course corrections as we learn. That little adage holds true for anything you can think of, whether it is a complicated dental procedure or even learning to ride a bicycle. No one ever learns without making mistakes.

Because of that, it is important to try to work out all the kinks ahead of time. Before we ever “go live” with a new procedure or device, I work the details out on the bench. I am a huge believer in the expression “failing to plan is planning to fail.” That is why I sometimes spend hours trying things out in a controlled, nonclinical environment before finally going live with patients. That also applies to staff. Before we went live with design and milling, my 2 designated milling assistants designed and milled about 10 crowns each. By doing this, many of the mistakes or problems you might otherwise face in front of the patient have been discovered and corrected beforehand.

I love history, and one of the best examples I can think of for the benefits of bench testing comes from the May 1, 2011, raid by Navy SEALS of the Abbottabad, Pakistan, compound. When asked by President Obama, “Can you do the mission, Bill?” Admiral William H. McRaven replied, “Sir, I don’t know. I really need to bring the guys in, and we need to rehearse this.” The president asked how long that would take and McRaven told him it would take 3 weeks, to which Obama replied, “OK, you’ve got 3 weeks; report back to me in 3 weeks.”

Navy SEALS had performed multiple raids such as the Bin Laden mission multiple times, yet they still needed 3 weeks to work out the bugs for this very specific objective.Hopefully that tells you something right there. Even experts practice.

Too many times I have seen doctors try to “run before they learn to walk” when it comes to integrating new things. When that is done, things tend to go sideways and then everyone blames the technology and they go back to doing things “the old way.” My advice is to bench test to the point of over preparedness and then, for the first few procedures, expand the appointment time to more than you will need. It is much easier to deal with unexpected problems when you are not stressed about the schedule. Simplicity and adequate time are critical when learning and trying new things.

It is also critical to make sure you have your team adequately trained on the new procedure. No one wants to look confused or lost in front of a patient, so making sure that everyone has a clear comfort level is incredibly important. The more relaxed your staff is, the better the experience for the patient. That comfort comes from practice and understanding.

It is also tremendously important to get staff buy-in when you make changes. When the staff believes in the change and is excited about it, they want to succeed as much as you do. That enthusiasm is infectious. The assistant will spend more time with the patient than the doctor and if the assistant is on board and excited about this, that will transfer over to the patient. When patient, assistant, and doctor are excited about it, that creates a kind of “circle of positive energy” that makes everything go more smoothly.

Wrapping Up

We must remember that change is inevitable. The important part of change is how we handle it. History is full of examples of individuals, companies, and even empires that failed to embrace change and were swept away because of it. I find it fascinating how change is such an inherent part of our universe and plays such a critical part in everything around us, yet our instinctual reaction when we are faced with change is to resist it.

We are living in a time where change has accelerated our lives. I think it is fair to say that things are changing faster now than they ever have before. What was cutting-edge 5 years ago is frequently passé or even forgotten about today. That is why I continue to be excited about what I do both in my office and with all of you in my columns and my lectures.

As a lot of you know, I am a big fan of quotes. I have a folder on my computer where I keep them, and sometimes, in a quiet moment, I open that folder and browse through them. It is amazing how profound our fellow human beings can be and how much guidance simple phrases can provide us with.

To end this month’s column, I would like to leave you with a quote from Charles F. Kettering. He was an incredibly bright engineer whom, for some reason, many people have never heard of.However, you have heard of some of his inventions. He held 186 US patents and probably his most famous invention was the electric starter for the automobile, which did away with hand cranking and brought mobility to the world. Before his invention, the problem had been called “unsolvable.”

One of my all-time favorite quotes is this:

“I am not pleading with you to make changes. I am telling you, you have got to make them—not because I say so, but because old Father Time will take care of you if you don’t change. Advancing waves of other people’s progress sweep over the unchanging man and wash him out. Consequently, you need to organize a department of systematic change-making.”

Now get out there and let’s change the world!