How technology is REALLY changing the dental workflow

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.”

Dr. John Flucke, DDS, 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 Kara Vavrosky 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 ...

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.

Mark Ferguson, general manager of Vulcan Custom Dental, 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.

“Whether it’s digital X-rays 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.”

Next page: The appeal of same-day dentistry ...

The wow-factor with same-day dentistry

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.”

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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

For other doctors, digital radiographs 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.”

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“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.

Dr. Flucke finds paperless charting 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.

Next page: A truly team approach ...

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.”

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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.

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“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.”

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“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.