Dentist

The Profitable

FEBRUARy 2014

News & Information to Increase the Profitabilit y of Your Practice

Dr. Taylor Clarks Assist To Succeed Dental Assisting School:

DRIVER OF WEEKEND RICHES

How Many HIPAA Compliance Gaps are Happening Daily in Your Practice? Office Sharing: Practice Equity Suicide Tackling the Causes of Periodontal Disease Head On!
Plus a FREE Tear-out Educational Tool for Patients

Will You Be the Oldest Practicing Dentist in Your State?

You are Invited to the Spring Break Seminar 2014 featuring... The Godfathers of Dentistry

xcellence in Dentistry

Quatum Leap???

Stoneybrook manages the entire process and has proven many times that they really care about us and our results. And we DO get results ! We have more than doubled our New Patient numbers every month. We get New Patients from Stoneybrook pretty much every day, and on many occasions, more than one a day. Their service has enhanced our practice so much.
Our Hallmark Style Special Occasion cards are mailed to your patients by their first name with a note to let them know you are thinking about them during the holidays as well as on their birthday.

Our highly personalized, full color Patient Education Publications are filled with interesting, current articles about dental health as well as your personal letter addressing them by their first name.

PUBLISHING, INC.

DPD
1718

BruxZir restorations, a more lifelike emergence profile

After

Before

This endodontically treated molar had a large amalgam and a fracture, necessitating a full-coverage crown. I selected BruxZir Solid Zirconia for its conservative nature (as thin as 0.5 mm) and the fact that I will get a great fit in the gingival third due to its natural emergence profile. Im not sure my patient is going to floss as much as he should, and I want to make sure I do my part to help his gingival health.
Michael C. DiTolla, DDS, FAGD

$ 99* per unit

Another BruxZir Award

vs.
PFM
This image represents the typical PFM prep we receive with a conservative feather-edge margin. When a PFM is fabricated for this prep, there is a bulky 1 mm margin on the PFM that catches on the explorer. Even if the margin is sealed, the emergence profile is unacceptable.

BruxZir Crown
This image represents the typical PFM prep we receive with a BruxZir crown in place. Because it is a monolithic crown and can be milled to a feather edge, there is no bulk of material, or speed bump, at the margin. Dentists tell us their explorer cannot detect where the tooth ends and the BruxZir crown begins.

*Price does not include shipping or applicable taxes.

Call for case pickup

www.glidewelldental.com

877-708-7972

Premium Products - Outstanding Value

GLIDEWELL LABORATORIES

FEBRUARY 2014 | I s s u e 2 4 7

PRACTICE MANAGEMENT
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CONTACT US
Phone: 800-337-8467 or 812-949-9043 Fax: 812-949-8535 Mail: The Profitable Dentist 3211 Grantline Rd, Ste 20 New Albany, IN 47150 Email: info@theprofitabledentist.com

From the Editor

10

8 9

A Word from Woody In The Spotlight Dr. Taylor Clarks Assist To Succeed Woody: Up Close and Personal

www.theprofitabledentist.com

Practice Management

STAFF
Editor-in-Chief William W. Oakes, DDS Associate Editor CRAIG CALLEN, DDS Executive Vice President of Operations/Finance DELAINE STEWART Seminar Coordinator JENNIFER JONES Front Office Coordinator/Marketing Director CHRISTY CLAYWELL Seminar Coordinator Assistant HOLLY SWITZER Administrative Assistant Ashley Scharlow Client Support Coordinator Shelia Allender TPD Designer Leah Conder Taylor Taylor & Associates

12 14 16 18 20 22 24 26 28 30 32

Women Rule: And Why Thats Great News for Dentistry! by Ginny Hegarty, SPHR How Many HIPAA Compliance Gaps are Happening Daily in Your Practice? by Roz Fulmer What You Dont Know Can Hurt You: Employee Working Interviews by Paul Edwards 24 Secrets to Coach Your Team To Be Winners by Chris Mullins When Your Marketing Has No Pulse by Dr. Mike Abernathy Why it is Important to be Different by Dr. Steven Katz Office Sharing: Practice Equity Suicide by David Woods Making the Most of the Doctor-Hygiene Exam by Rachel Wall, RDH, BS Four Moves to Revitalize an Ailing Practice by Dr. Steve Rasner Whats Your Return on Investment? by Dr. Mike Kesner DRIVER OF WEEKEND RICHES Why Every Dentist Should Consider Running an In-Office Dental Assisting School by Dr. Taylor Clark The Advertising Trap by Dr. Joe Steven, Jr.

EDITORIAL ADVISORY BOARD

DR. MICHAEL ABERNATHY Dr. Keith Dobracki DR. DAVID HORNBROOK DR. MARK HYMAN CATHY JAMESON DR. BILL KIMBALL DR. ROGER LEVIN DR. TOM ORENT DR. STEVE RASNER DR. LARRY ROSENTHAL DR. ROY SMITH DR. BILL STRUPP Dr. Joe Steven, Jr McKinney, TX Madison, WI La Mesa, CA Greensboro, NC Davis, OK Encinitas, CA Baltimore, MD Framingham, MA Bridgeton, NJ New York, NY Tyler, TX Clearwater, FL Wichita, KS

The content of this publication may not be reproduced either in part or full without the written consent of The Profitable Dentist .

34

2014 Excellence in Dentistry, Inc., Publisher. Copyright enforced no part of this publication may be reproduced without written permission. This publication is designed to provide reliable information in regard to the subject matter covered. However, it is distributed with the understanding that it does not replace the need for advice from your personal, competent professional advisors.

F EBB AyR Y FE RR UU AR 2 02 10 414

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GUARANTEED Media Appearances For Dentists

4 Ways to Receive Media Credentials You Can Use For The Rest of Your Life to Build Expert Credibility Over Your Competitors
1

Become a Best-Selling Author

Produce Your Documentary Film on Your Business that Airs on Major Broadcast Networks
Your business, profession, franchise, nonprofit, or legacy film will be produced by Emmy Award winning director Nick Nanton. We will script, film in true HD, and edit a 30 minute movie. We will GUARANTEE airing on a Major Broadcast Network and can even help you set up a theater red carpet premiere! We will show you how to use this documentary in all your marketing and position you as the go to Expert in your field.
Right after we did our T.V. Show in L.A., Fox 40 News in Sacramento called us two days later, came in to our office and did a live interview. So The [Ultimate] Celebrity Branding Experience is amazing, its great for your business...I highly recommend it! Donna Galante, Cater Galante Orthodontic Specialists I didnt now what to expect when I decided to proceed with this venture and pleasantly surprised by everything. The organization was phenomenal. Very professional, very courteous, very friendly made you feel as though you are the expert in the field that you do even though you may not feel that you are, and the confidence that they build, I m ready to go conquer the world. So thanks guys, it was great and I cant wait to keep proceeding with this. Dr. Vesna Sutter, D.D.S., CEO, Sunrise Dental Partners A big thanks to DNAgency for all they have done to catapult me into being Americas Premiere Cosmetic and Sedation Dentist. The masterminds and training are the biggest secrets to the success! Scott Schumann, Grove City Dental

Write one chapter for a collaborative book we are publishing with other clients of ours, and we will market it to become an Amazon or BarnesAndNoble.com Best-Seller GUARANTEED! You will be inducted into The National Academy of Best-Selling Authors and will be able to use the prestigious title of Best-Selling Author for the rest of your career and life!
2

Get a Guest Appearance on Affiliate Stations Around the Country and Be Seen On One of Our TV Shows
We GUARANTEE to get you placed on one of our television shows: The New American Dream, The Brain Tracy Show, Consumers Advocate, Americas PremierExperts or another show we produce and is directed by Emmy Award winner, Nick Nanton. We will help you use the appearance with your target audiences to attract more clients.

Appear in or Over 100 Others in our Big Print Publications, and Be Quoted with Your Photo
These are special edition, GUARANTEED appearances we arrange for our Expert clients. You will be in a full or half page spread and be recognized as a Game-Changer in your field.

We have more than 1900 clients in programs like the ones mentioned here and represent clients in more than 36 countries. Media appearances are guaranteed in writing. Agency representation fees start as low as $497 a month.

Visit www.celebritybrandingagency.com/dentist or call and ask for a no obligation Brand review with a Business Agent at (888) 578-0574

CLINICAL
Anastasia_vish@bigstockphoto.com

Advertiser Quick Guide

Stoneybrook Direct mail & custom projects.............. 2 Glidewell Laboratories BruxZir restorations............................ 3 DN Agency Celebrity branding................................ 5 Dental Website Websitedesign..................................... 7 Quantum Leap Dental consulting. ............................... 11 X-Ray Support X-ray film and imaging provider......... 19 Summit Practice management strategies. .......... 25 DDS Test Drive Dr. Steven Rasner. .............................. 29 HigherDentalFees.com Insurance Profit Recovery Kit......... 31 Kisco Dental efficiency products. ................. 35 Spring Break Seminar 2014 The Godfathers of Dentistry............................ Centerfold Bank On Yourself Wealth building strategies.................. 43 Sleep Optima Dental sleep medicine ....................... 49 Cenegenics Healthy Aging Program...................... 51 Hygiene Diamonds Team Training Institute. ....................... 53 Masters of Dentistry Coaching Program............................. 61 Paragon Dental practice transitions. ................. 66 TPD Product Offer Dr. Joe Steven DVD............................ 69 TPD Product Offer Painless Anesthesia........................... 71

Clinical

38 40 42 44 46

New Pearls for 2014 by Dr. Michael Curtis Simplifying Dentures in the New Economy! by Dr. Ara Nazarian Cracked Teeth: Treatment and Patient Management by Dr. Craig Callen The Million Dollar Smile by Dr. Johnny Savage Tackling the Causes of Periodontal Disease Head On! by Patricia Worcester RDH, BS by Dr. Michael DiTolla

50 Updating and Improving Endo Technique 52 54

How to Sell Sealants by Dr. Woody Oakes The Truth About Dental Sleep Medicine: An inside look at medical insurance billing in dental practices by Nick Carlone

Profitable Practices

56 58

Doctor Beware by Dr. Craig Callen Will You Be the Oldest Practicing Dentist in Your State? by Pamela Yellen

Getting to Your Greatness

60
Coaching Office of the Month by Sasha Burau, MBA You and Your Sleep Deprived Patient by Dr. U.P. Odiatu

63

Good Stuff
67 68 70
How to Fix Slow Time FAST New Products and Services From Our Readers
zagart@bigstockphoto.com

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DDS Dental Lab Dental Buying Program....... Back Cover

FEBRUARy 2014

Let the Forces of Our Destiny Websites

Bring You Quality New Patients!
g!
Our custom Destiny Websites are like no other in the world. Created by engineers, they attract and deliver quality new patients based on the specic services you want to promote!

Created for Desktop, iPad/Tablet and Smartphone devices, our Destiny Websites are like having multiple websites within your main website on a single domain name which uniquely features:

Destination Dental Service Landing Website Dental Service Specic Call-to-Action features that have online forms, automatic rotating expiration dates Dental Service Specic Isolated Navigation

Am

gE n i z a

ng

rin e e in

In other words, when potential patients nd your website on the rst page of Google, because they where searching for dental implants, they are delivered dental implants content, dental implants call-toaction, and dental implants isolated navigation. Everything about our strategy reduces complexity and pulls the potential patients IN, then prompts them to contact your ofce.

Your Destiny Website will record the landing page and morph your main website such that the potential patients will think your entire website is focused on the service they searched for.

Call us at 888-906-1667 x12 or visit us online at www.DentalWebsites.com to learn more about this incredibly successful Internet marketing strategy!

Dr. Woody Oakes www.TheProtableDentist.com

"Of all the website design and Internet marketing companies that I have worked with over the years ... Mary and Greg Rahall at DentalWebsites.com, produce the BEST RESULTS! "

Dr. Tom Orent www.1000Gems.com

"DentalWebsites.com is the SECRET WEB WEAPON behind every website I own. The owners, Greg and Mary Rahall, are 2 of the nest people I have had the pleasure of working with for over 15 years. Their work is top quality. Their integrity is beyond question, and their programming team is the BEST on the web today (dental or otherwise)."

Dr. Steve Rasner www.PearlSmiles.com

"At a time when too many companies overpromise and under deliver, Mary and Greg Rahall from DentalWebsites.com are the REAL deal! I can tell you they will give incredible value and detail for your project. They walk you through every step, provide great ideas, and are on the cutting edge of what your web site should be doing for you. I guarantee you won't be disappointed."

888.906.1667
Attracting Quality New Patients Since 1998!

See Us in Destin!

A Word From Woody

Welcome to the February issue of The Profitable Dentist magazine. Youll find this issue loaded with some terrific clinical articles and several great practice management articles as well. Roz Fulmer & Chris Mullins. Roz discusses ways to make sure that you are HIPPA compliant and Chris gives more tips on handling the phone properly. Next, Id like to remind everyone about our 23rd annual Spring Break seminar to be held April 10-12, 2014 in Destin, Florida. This years theme will be The Godfathers Of Dentistry and our keynote speaker will be the boss of all bosses Dr. Gordon Christensen. Call 1-800-DESTIN-7 or 1-800-337-8467 or visit www. theprofitabledentist.com to register or for more information about the event.
l i g h t p o e t@bigstock.com

Lastly, a large number of our readers have called to inquire about our coaching program. The next class will start the end of April 2014 and we limit the program to 20 dentists. The program usually sells out at the Spring Break seminar, so please apply now if you are interested before it sells out again. For more information about the coaching program, contact Ashley at Ashley@theprofitabledentist.com or call her at 1-800-337-8467. Well thats all for now have a great month!

Wed like you to meet our newest team member!

Shelia Allender is the new Client Support Coordinator for The Profitable Dentist. She is focused on expanding TPD approved dental product and service companies and bringing that information to our readers through customized advertising and promotional packages. Im very excited to join the TPD team. Were developing some really exciting programs and packages that will benefit advertisers and readers alike, said Allender. To reach Shelia, email her at shelia@theprofitabledentist.com or call 800-337-8467.

allegro7@bigstock.com

FEBRUARy

2014

In The Spotlight
Dr. Taylor Clarks Assist To Succeed:
A Powerful Weekend Revenue Generating Machine
by Dr. Woody Oakes
A few years ago I came across a fascinating book called Beating All Odds, by Dr. Taylor Clark. As I sat on a plane reading it, I was excited at how well it fit what I was looking for. I really enjoyed reading that book and have profited much from the ideas Ive implemented from it. Its no surprise to me that this book is well on its way to becoming a national best seller. Taylors story is similar to what I went through in 1996. I had a stroke and could no longer practice dentistry the way I was used to doing. I had to come up with some other way to build wealth, bringing me to what I do today. Taylor encountered an untreatable skin irritation early on in his career that limited his ability to practice dentistry full time. He very easily could have rolled over and claimed disability. Instead, he claimed more ability and found another way to grow his dental business. While reading his book, I was amazed at his accomplishments and how many high profile people have endorsed him. Even Rudy Ruettiger, the inspiration behind the TriStar hit movie RUDY, had provided the Foreword to his book. I was determined to call Taylor so I could find out how he was accomplishing so much, so fast. I was interested in the many things Dr. Clark is doing in his dental practice. In particular, his Assist To Succeed (ATS) dental assisting school business grabbed my attention. He has mastered the ability to empower dentists throughout the country to profit highly from running a dental assisting school in their office. Now, I had been doing a school for years, but I couldnt imagine how Taylor was doing so well with his. I had to find out. I purchased a $40,000 program many years ago and enjoyed great profitability for a number of years. However, my school business had died recently. I was struggling to fill my classes, and had to cancel two courses in a row. Something had to change! I called Taylor last year and asked him if my area was available for his program. We discussed his dental assisting school business model in detail and why it has become so successful in so many different locations. I bought his Assist To Succeed program and gained access to his support team. My stress levels have dropped because one of their excellent support doctors... is now working with my wife Georgia to fill our classes again. Our school is back on the rise and that powerful income stream is back! Im fortunate my area was available. In fact, Dr. Clark just turned down another dentist wanting my area. He has to turn away a growing number of dentists because he will only accept one dentist per geographical area. Dr. Clarks ATS School goes far beyond simply teaching students a trade and making money for dentists. Self-confidence and an optimistic attitude have become common results for all students who give their best effort. His personal growth and development emphasis combined with his unique business approach set his Assist To Succeed dental assisting school model apart from all the rest. Ive maintained for years that every dentist should consider running a highly profitable dental assisting school from their office. Its such a no-brainer in my mind to have that recurring income stream! I am convinced there is no better way to start a dental assisting school in your office than what Dr. Taylor Clarks Assist To Succeed opportunity offers. Give them a call today, find out if your area is available and get started! How Do You Get Started? First, find out if your area is available. Go to www. AssistToSucceed.com and submit your office address for area availability. They will notify you if your area is open and determine if your office qualifies for running a school. You may reach the Assist To Succeed office at (208) 353-5301. The first 27 online inquiries will receive a FREE personally signed copy of Dr. Taylor Clarks book Beating All Odds, with foreword by Rudy Ruettiger and endorsed by Dr. Stephen Covey, Brian Tracy, T. Harv Eker and many other best selling authors, speakers and trainers.

silvae@bigstockphoto.com

Current and Pending ATS Locations

Woody:

Up Close and Personal

hanks to everyone for all the positive feedback on the Woody Does B-Town article in the last issue of the magazine. Therefore, weve decided to keep running this series of articles.

I love living in Indiana, the change of seasons is something you really dont get living in parts of California or even Destin, Florida, where my wife Georgia was born and raised. However, in Indiana November to the end of February can be very unpredictable. As Im writing this article, we were enjoying upper 60 weather yesterday and tonight theres a possibility of 1-3 inches of snow. So what do we do during the bad weather months? Well, we follow college basketball! Last Friday I was back in Bloomington, Indiana, for another game. As many games as Ive attended there I have never not enjoyed it. As I mentioned last time, my favorite movie is Hoosiers starring Gene Hackman, Barbara Hershey and the late Dennis Hopper. A couple of years ago at our Spring Break seminar our keynote speaker was Bobby Plump, the guy who hit the final shot in real life. In the movie the team was called Hickory, but in real life, it was the story of tiny Milan, Indiana. Late last month, I made a visit to the Milan 54 Museum to visit my friend, Roselyn, who is the curator. I was curious to see their new location that was made possible, in part, to the money we raised for them at our Spring Break seminar. It was a fascinating day talking with her and Jamie about their new building and all of the new donations of memorabilia they have received the last couple of years. Now, if you have seen the movie, Hickorys gym (in the movie) was not filmed in Milan, Indiana. In fact, when the film crew arrived at the gym they had selected for filming, it had been torn down due to a miscommunication. So right away Hollywood had to find a new location to shoot the gym scenes. They finally located a gym they could use in Knightstown, Indiana, which is almost two hours away from Milan. Anyway, my friend John and I decided we had to see the gym as well as the museum. Honestly, we didnt know if it would be worth driving an extra two hours. Im sure that many of you reading this have had the experience of visiting a place and it wasnt up to your expectations and you were under whelmed? When I visited the Alamo in San Antonio, Texas I thought... Its so small, I thought there would be a lot more here to see. Same thing with Mount Rushmore not what I expected. But going to the Hoosier Gym in Knightstown, Indiana, was more than I expected. We were met by an elderly gentleman who gave us a tour of the place and gave us full access to every nook and cranny that was filmed in the movie. Of course I asked him if I could shoot some hoops and he said, Okay! It was quite a thrill for me and a day Ill never forget! Next issue, Ill tell you about another trip to B-town that ended up having a very funny ending. Please stay tuned

10

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F EBRUAR Y 2 0 1 4

PRaCTICE MaNaGEmENT MaNaGEmENT PRaCTICE

Women Rule!
And Why Thats Great News for Dentistry!
by Ginny Hegarty, SPHR

THE WAY IT WAS

Remember when the team at a dental practice was referred to as The Girls? About the same time it was assumed that all-female teams were synonymous with cattiness, drama and high stress. This wasnt particular to dentistry; it was a socially accepted norm that was played out in real life as well as books, television and the movies. Tina Fay grew up about fifteen minutes from my childhood home in Southeastern Pennsylvania, just outside of Philadelphia. While I attended an all-girls Catholic high school, Tina attended the local public school. I remember hearing all kinds of stories about how unruly the kids in the public school were. Of course, compared to the strict discipline handed out by the nuns at my school, unruly was an easy target. However, those stories didnt prepare me for the screenplay that Tina Fey would write in-part based on her experiences in that high school. You may have seen it it was called Mean Girls and stared Lindsay Lohan as a wannabe and the eventual leader of The Plastics. Entertainment Weekly called Mean Girls one of the sharpest high school satires ever in part because its depiction of girl-on-girl cattiness stings incredibly true. Remember this classic line? Evil takes a human form in Regina George. Dont be fooled because she may seem like your typical selfish, back-stabbing, slut-faced, ho-bag, but in reality, shes so much more than that. Regina George, a classic female villain if there ever was one! Yes, you remember Regina George, right? She worked in your dental practice. Well, she may have gone by a different name. She may have been a brunette instead of a blond. But chances are you worked with either Regina George or one of her clones. The stories are legendary and the stress is still palpable when coworkers speak of the havoc she wreaked in the office. Thankfully, that was then and lessons were learned. As Mean Girls the movie ends Lohans character sums up the lessons learned this way, Calling someone else fat wont make you any skinnier. Calling someone stupid doesnt make you any smarter. And ruining Regina Georges life definitely didnt make me any happier. All you can do is try to solve the problem in front of you.

VENUS IS RISING
The Economist reported back in 2009 when brute strength mattered more than brains, men had an inherent advantage. Now that brainpower has triumphed, the two sexes are more evenly matched. The feminization of the workforce has been driven by the relentless rise of the
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F EBRUAR E B R U A RY y 2 20 01 14 4

service sector where women can compete as well as men. It would seem that women were ready for that message and women in large numbers have embraced their sisterhood. As I visit dental practices Ive seen a marked difference over the past decade and I believe weve all been reaping the benefits of a kinder, smarter, more collaborative female perspective. It would seem women have realized the power and influence we have to create a healthier workplace and we are stepping up to the opportunities at hand. The world has changed dramatically over the past few decades as we evolved from the Industrial Revolution to the Digital Revolution. It has taken some time to recognize the shift and adjust accordingly. Depression-era parents who embraced tenacity and superior work ethic as the recipe for success raised the baby boomer generation. Traditional masculine strengths such as hard work, self-reliance and independence were taught and celebrated. As one of eight siblings born over a ten-year span in the 60s, I grew up in such a household. The chore-chart was posted on the ice-box and each of us had a list of weekly responsibilities that had to be met before we could go out to play. One night a week I washed the dishes and I was up bright and early on Saturday morning to clean the bathroom so I could make it to the football game in time to cheer on the team. While we did our fair share of whining about the chores, we did them nonetheless. Our parents and eventually our employers could count on our steadfastness; we were hard workers, we got the job done.

let it define us or limit us. Dentistry is a most challenging profession requiring clinical precision, emotional sensitivity and business acumen. This combination of aptitude and skill is not intuitive for most people regardless of gender. Ive always believed that fathers of daughters would be the difference-makers who would take the lead to redefine an appreciation for the feminine perspective. In their new book, The Athena Doctrine, authors John Gerzema and Michael DAntonio make the case that business has progressed: from command-andcontrol (roughly through the 1980s) to empower-andtrack (the 1990s to mid-2000s) to connect-andnurture (today) Feminine traits and values are a new form of innovation. They are an untapped form of competitive advantage. Continued on page 66

WORK ETHIC IS NO LONGER ENOUGH

Hard work is no longer an appropriate measure of success. Advances in technology have business moving at the speed of light as what used to take weeks can now be accomplished in seconds. As a result, expectations are higher than ever. Weve all heard the clich of working smarter, not harder as the business world focuses on creative, innovate, collaborative, timely results. The differentiators today are more traditional feminine virtues such as responsiveness, sensibility, interdependence and creativity. Its clear we must engage hearts and heads to create growth and success. This is great news for dentistry, an industry traditionally dominated by female employees. Its even better news as the profession now boasts over 50% of graduating dental students are female. Were well positioned to make a meaningful difference. While our gender may identify us, we must not

800-337-8467

The Profitable Dentist.com

13

PRaCTICE MaNaGEmENT

How Many

HIPAA Compliance Gaps are Happening Daily in Your Practice?

by Roz Fulmer
ou may be asking yourself, Why does my dental office have to comply with the new 2014 HIPAA Security Rules? Here is just one of the many reasons your office needs to get the office secured: If you are submitting Eclaims to a clearinghouse and then the clearinghouse submits the electronic format of the claim to a health plan on behalf of your office, you MUST now comply to the new Privacy, Security and Breach Notification Rules of HIPAA 2014. Does your business area of the practice store credit card information on the computer, in a patient chart, on any removable media or even off-site? If so, you must now get trained in the Privacy and Security Rules required within the workplace. Who is your Security Official who will hold the responsibility of documentation should a breach occur within your office? HIPAA requires that dental offices must

safeguard and protect health information for their patients as well as their payment information. When was the last time that you held a fire drill at the office? Do you know where the back up of patient information is being held should a fire destroy your place of business? Is that back-up of information protected? HIPAA compliance does not have to be difficult! You dont have to be techie to understand what is important of HIPAA. Many offices are well on their way to being compliant and need to know more of what they dont know in regard to getting all the Ts crossed correctly. There are ten immediate action items that will help you through the process of getting compliant and staying compliant.

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FEBRUARy 2014

1. Identify your Team Has each

of your team members signed a Confidentiality and Non-Disclosure Agreement? Who is your HIPAA Privacy Official and the Security Official for the practice?

by all team members at any given time. These documents should be kept in a 3-ring binder like your OSHA procedure manual.

6. Implement your HIPAA Security Policies and Procedures

Dont just get them created, you MUST implement them as soon the policies and procedures are created. Schedule reviews of your HIPAA compliance program quarterly, document who attended the meeting and what was discussed and action items created from the meeting. This should be a mandatory meeting as everyone on the team MUST be HIPAA compliant.

2. Develop and Implement your HIPAA Privacy Program The

Privacy Official is responsible to develop and implement the Privacy practices of the office as well as the annual updates of documents. Many offices have the Notice of Privacy Procedures already in their offices and the Acknowledgement of Receipt of Notice of Privacy Procedures but did you know that these must be presented every two years, not just once in a patients lifetime?

possible patient information. Use encrypting and a HIPAA disclaimer on all e-mails sent out via office computers. Post reminders at all workstations to never leave the computer unsecured, sign out at all times and prohibit sharing password information with fellow co-workers.

10. Protect Patient Health Information - Any vendor,

dental laboratory, consultant(s) or subcontractors, who want to view, review, create, transmit or maintain Patient Health Information (PHI) must sign a business associate agreement. Remember, there is no one size fits all when it comes to your HIPAA security compliance plan. Should your office be subjected to a compliance audit or a complaint filed, you want your systems, policies and procedures documented and your HIPAA Security Manual up-to-date. Word of Caution: Do not keep doing what you are currently doing in regard to HIPAA as there are many changes that are being implemented since the 2014 Final Rule became effective this year. Get information on how your office can become HIPAA compliant.
Roz Fulmer, Founder and CEO of Making a DifferenceToday has owned several private businesses and managed a dental office for a combination of over 25 years of business experience. Roz is renowned for her knowledge with Insurance Coding, Legal Chart documentation, Protecting your Practice Assets, Dental Software Training and Hiring Right the first time! All of the HIPAA documents mentioned within this article will be supplied to your office free of charge as part of any inoffice HIPAA compliance training session completed by Roz with you and your team members. Feel free to either email her at roz@rozfulmer.com or call 815-481-3851 to schedule your HIPAA 2013 Final Rule Compliant training.

7. Provide Employee Training At

your initial training session, a recommendation is to hire a HIPAA compliance officer that will get you and your team started with all the right documents, get you compliant and will help to keep you compliant throughout the year.

3. Evaluate your Practice for Security Risk How safe is the

computer system that contains your patients information? What are the safeguards in place to protect this information from hackers? When was the last time you had a qualified security tech in the practice to help you identify risks and vulnerabilities involving patient information, especially now that most offices are using electronic transmission messaging like Demand Force, Smile Reminder, Lighthouse 360 and others?

8. Develop Processes to Monitor your Policies Ongoing maintenance

is critical to continued compliance with HIPAA. Review your dental offices risks, policies and procedures to determine if changes should be made to your program. New computers, new team members, new business associates happen at dental practices over time and when these changes happen, a review team meeting should be implemented immediately to ensure that everyone is current and compliant.

4. Make a Plan for Getting HIPAA Security Compliant Is your

software HIPAA Compliant? Are the emails being sent out daily by your office encrypted and protected? Are you using a disclaimer on the signature of ALL emails being sent out by the office?

9. Security Awareness Create

systems to guard your computers, detect and report malicious software, monitor log-in attempts and create passwords to safeguard all practice and patient information. Prohibit internet usage for personal e-mails and social media with any

5. Develop Written HIPAA Security Policies and Procedures Formally

create your HIPAA Security Policies and Procedures according to your State Laws and these must be in writing and available to be viewed
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PRaCTICE MaNaGEmENT

What You Dont Know Can Hurt You:

by Paul Edwards

Employee Working Interviews

Shes answering your job ad for a Dental Assistant position. On paper, she seems perfect. She has the education, the skills and the experience youre looking for. She should be a great fit for the position, but youre leery about hiring her based solely off of her resume and an initial interview. To get a better understanding of her skills, you decide to use a tool you picked up called a working interview. You ask Jane to come in for a few hours and have her work alongside you as an assistant. Shell work through the morning so you can test her skills and chair-side manner with patients. During this couple of hours, she agrees to not be paid because its a working interview and she wants to show you what she can do. At the end of the interview, you feel like you have a good handle on her skills and personality, but youre not sure shes the best fit for your office. You tell her youll be in touch with your final decision in a few days. She leaves without pay, or perhaps you write her a check for $100 for her time. You go back to work no worse for wear. But what if I told you that you just did something that is considered tax fraud?

Meet Jane.

Working Interviews: Legal or Not?

Working interviews were originally invented by temporary employment (temp) agencies as a try before you buy option. The agencies would send job candidates out to their clients offices to work for a few hours, days or even weeks, to give the client time to test out the candidates skills. If the client liked the candidate, they could hire him or her as an employee. If that candidate did not impress, the agency would send another until their client was happy. Today, most working interviews are done without the temp agency as a middle man. Employers contact job candidates directly and invite them to work in the office for a few hours or days to test their skills before hiring them directly. Many employers get either a verbal or written acknowledgement that the candidate waives their rights to be paid while interviewing, while other employers simply compensate the candidate as a 1099 and pay them a fixed amount for the day. Unfortunately, in the eyes of the IRS and Department of Labor (DOL), if you do not pay an employee for

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time worked, you are seen as attempting to avoid your obligations as an employer. The employer obligations Im referring to, of course, include withholding taxes, paying matching taxes, wage notice requirements, I-9s and more. Similarly, classifying the candidate an independent contractor doesnt work. If the candidate performs duties usually done in your office by employees and does so under your control, using your equipment, in your office, and at the hours you request, they are an employee. If you call them a contractor to avoid payroll taxes or other employment benefits, you have misclassified them, and you are subject to penalties from both the IRS and DOL. So what is the difference between a temp agencys working interview and yours? To put it simply, the candidate is employed by the temp agency. The temp agency fulfills all of the employer obligations because they hire the candidates and temp them out to you. However, when you do a working interview yourself (sans a temp agency), none of the employer obligations are fulfilled, thereby violating a myriad of labor and tax laws. If that wasnt enough to give you pause, you are also missing key protections for you and your business. This includes workers compensation coverage for the candidate in the event that they are injured in your office. Moreover, if you hold a working interview and then decide against hiring the candidate, they will have the upper hand if they file for unemployment or a complaint against you. In other words, working interviews are dangerous and not worth the risk.

theyre seeing. For someone whose job would include billing insurance, set up a fake patient file and test them on coding or answering a patients questions. This skill testing method is not only legal, but will grant you that same inside look at the candidates skills and personality. REMEMBER: A ship builder can send a prospective welder to the scrapyard to weld scrap so they can see the skill level of the welder and legally pay him nothing. But they cant send the prospective welder to a ship under construction to weld a few panels in place for the same purpose and not pay him for his work.

How to Hire Right Every Time

Taking care during the entire hiring phase before, during and after the interview is the best way to ensure a candidate has all the right skills and is a good fit for your office. Make sure to do the following each and every time you hire: 1. Interview better. A great technique to utilize is the behavioral interview. By rephrasing questions to elicit a situational answer (as opposed to a yes/no or hypothetical one), you can gain immense insight into a candidates inner thought process. To learn more about behavioral interviewing, Profitable Dentist readers can download a complimentary copy of our Hiring Guide at www.cedrsolutions.com/PDHG. 2. Follow the golden rule: Hire Slow and Fire Fast. Take your time interviewing, skill testing and picking the candidate you think is right for the job. If they do not work out, however, dont waste your time or theirs waiting for them to improve let them go and move forward. 3. Make any offer of employment contingent upon the candidate passing a background check. If they cannot pass the professional background check, you are free to offer the next person on your short list the job, providing they are able to pass the background check. In summary, hiring doesnt have to be scary. By combining skill testing with the interview technique and hiring methods mentioned above, you will gain all the benefits of a working interview without the risks. Happy Hiring!
Paul Edwards is the CEO and Co-Founder of CEDR HR Solutions (www.cedrsolutions.com), which provides individually customized employee handbooks and HR solutions to dental offices of all sizes across the United States. He has over 25 years experience as a manager and owner and specializes in helping dental offices solve employee issues. Paul is a featured writer for The Profitable Dentist and Dental Economics magazines and speaks at employment education seminars, conferences and CE courses across the country. He can be reached at paul@cedrsolutions.com or (866) 414-6056.
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The Solution to Working Interviews: Skill Testing.

After reading the above, you may be asking, Okay, I cant do working interviews and I cant call candidates independent contractors, so what CAN I do? The answer is skill testing. The difference between working interviews and skill testing is the environment in which they occur. During a working interview, you ask the candidate to work alongside you during a regular workday and have them perform their skills on patients to demonstrate. In contrast, skill testing is when you set up a work scenario and ask the candidate to walk you through it, as they understand it. For example, you might take a dental assistant candidate into a room and show them your setup. Then ask them to reproduce the setup in another operatory. For a hygienist candidate, create a chart for a fake patient and then have the candidate look in the mouth of one of your employees and tell you how the chart differs from what
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Part 2

Get MullinSIZED

by Chris Mullins, The Phone Sales Doctor

1)

Teach your team how to focus on one call at time. Visualizing is a great tool for staying focused on the next call. Think about Mary, the next prospect in line to call. What does she look like; how can you be of service to Mary? Create a voice message script. Create an outline for the messages your team members will leave. Again, hold them accountable for using the script. Provide headsets that work for your team members. Its faster and easier for them to navigate, and it cuts down on fatigue. Observe your team members as they make and take calls. Listen carefully to the tone of voice. How are they doing, really? Watch their body language. Should they be in this position? Do they need a break? Do they need water? Teach your team to use good listening techniques by paying attention to the tone, the voice and the breathing of the patients, as well as the background noise. Teach your team to keep detailed notes on each call, especially documenting the exact language and vocabulary of your prospects. Remember that without the telephone, youre out of business. Pay close attention to how your phone (leads you paid for) is being answered and monitor those calls to be sure youre capturing all sales opportunities. Give your team all the important ongoing coaching, training and information they need to be successful. Set them up to win, not fail. Decide that the First Impressions Director (front desk, reception position), is critically important to your business. Roll out the red carpet! Stop dealing with turnover. Sell with integrity. Monitor all team members that use the phone, chat, text, email, fax, etc. You must Inspect What You Expect. However, you must go at this from a positive point of view. Share with your team that the purpose of

I hope you have been practicing the first 12 secrets from the last issue of TPD. Here are 12 more

2)

monitoring calls is to identify all the great things they do so you can repeat them and all the areas that need to be tweaked fast. This technique is the quickest way you can grow your business. 10) Teach self-critiquing. Your team members should know how to critique their own calls and then provide you with feedback. 11) Implement a bonus plan (commission works best) that promotes MORE business for your practice, which will make even more money for your team members. 12) Have fun! Dont give up! You can do this!

3)

4)

5)

6)

Chris Mullins (aka The REAL Phone Sales Doctor) is president and founder of Mullins Media Group, a communications and consulting firm for dental practices. For TPD readers, Chris is offering a FREE Conversion Consult for the doctor. Email: tanya@ mullinsmediagroup.com to request your FREE Mystery Call and confidential Doctor Telephone Consultation with Chris Mullins. The doctor will hear the mystery call; Chris will tell you exactly what to do to fix the problem areas. Limited time offer. To get our FREE FAMOUS Monday Morning Email Stimulator opt-in at www.GreatBottomLine.com. g

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24 Secrets to Coach Your Team To Be Winners

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PRaCTICE MaNaGEmENT

When Your Marketing Has No Pulse

by Dr. Mike Abernathy
f your practice is like most, you shouldnt spend another dime on marketing. Ever try to diet? Statistically you will weigh 3-6 pounds more after finishing the diet than you did before. Why? Diets, by themselves, do not work. You need one more thing to make a diet work. If you add exercise, you can literally change your metabolic set point so that as your muscles grow, you will literally burn more calories than you take in. Diet and exercise along with the consistency and persistence to work your plan always achieves great results. Marketing works much the same way. Marketing alone will not cure your ills. A lack of patients is a symptom, not the problem. The problem is that you are failing to inspire your clients to come in and refer everyone they know. If you are not growing, you are not giving patients what they want. Failure to give patients what they want means you no longer have a viable business. The problem is that many of us look externally (marketing) for a solution to an internal problem. This external solution results in you contacting a marketing firm that may be ill equipped to really diagnose the true problems. They deal with the symptoms. Most of the time you end up spending a lot of money, getting a few more patients that eventually stop coming and tell everyone they know not to visit your practice.

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to see what type of marketing would work or bothered to look at your practice overhead and discuss the merits of an actual budget for your marketing efforts. They never take their eyes off the symptom. You need someone to fix the problem and then all of the symptoms will go away. Good practices (the ones with all of the patients) are doing everything right. They have consumerized their outreach, systems, hours, services and staff. They give patients what they want while helping them to understand what they need. They listen and come off as caring, compassionate, competent and consumer-oriented. Their best referral sources, after their own patients, are the two or three dentists down the street who are donor practices. The donor doctors down the street do have 100% case acceptance. Their problem is that this good practice is actually doing the work that they diagnosed. If this good practice did market, it would keep every new patient. Their front door is wide open and their back door is solidly closed. Marketing only brings them in. If we dont deliver, they wont return. Marketing could be thought of as delivering and everything you do is marketing. Growth in a practice occurs when a message (marketing or things we do) and our methods are balanced. Like it or not, practice growth is the natural result of total practice health. The bad practice leaves their back door wide open by not recognizing what patients want or by trying to give them something they dont want. They fail to listen to their patients and their perceived needs. If they marketed, they would only run off more patients who would tell everybody they know not to go there. Marketing for them would only speed up their predictable demise. Marketing is everything you do, so always be marketing (ABM). It includes: 1. Consumerism: Giving patients what they want, when they want it, at a price they can afford. 2. Internal Marketing: The measure of the number of

When it comes to marketing, good practices dont need to

market, but they should, and but they shouldnt.

poor practices need to market

When it comes to marketing, good (recipient) practices dont need to market, but they should and poor (donor) practices need to market but they shouldnt. Bet you never heard that from a company that wanted to sell you some marketing they have beta site tested, done marketing samplings to fine tune the message and custom-designed a brochure or direct response marketing piece just for you (even though hundreds of other doctors were told the same thing and sold the same design). Bet they never took the time to sit down and explain the demographics of the population and competition. Bet they never took the time to look at your numbers and branding

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direct referrals you receive. Serving the patients in such a way that they perceive the value of what you do, not what you charge. 3. External Marketing: Print media, web sites, social media, signage, community involvement, radio, TV, billboards, etc. 4. Negotiated Marketing: The insurance plans that you accept, promote and embrace the use of by patients while still achieving a 50-60% overhead. 5. Word-of-Mouth-Promotion (WOMP): No amount of money can buy the positive marketing that comes from existing happy patients. Those who know from firsthand experience that you do what you do so well that they cant help telling everyone they know about you. There are secrets that seem only to be known by a few. Once you understand them, they will seem like commonsense. Somehow there is a cognitive disconnect for most doctors. Its almost like they want to be taken advantage of by high prices, ridiculous promises and a blind faith in speakers and business owners with the slickest use of Infusionsoft drip marketing campaigns, rather than taking the time to actually learn and understand how to reach out to the consumer. Extremely rare are those practices that seem to get their share of the new patients and more. The practice of the future, The Super General Dental Practice, incorporates every angle of marketing to ensure a faucet-like flow of new patients that they can literally turn on or off to supply as many patients as they need each month. Ill close with these eight common marketing myths that too many doctors throw out as excuses for not getting enough new patients: MYTH - I tried marketing. It doesnt work. (or: It doesnt work in my area.) REALITY - Everything you do IS marketing and it IS working. You just dont like the results. Learn the why, what and how of tapping into sources of unlimited new patients. MYTH - Marketing brings in the wrong kind of patients. REALITY - There are no wrong kind of patients, only poor systems or misplaced expectations. Learn why your practice is no longer inspiring new patients to seek you out. MYTH - Marketing will make me appear desperate. REALITY - There is not one thing you own that has not been marketed to you prior to a purchase. Marketing has become the information highway for seeking out and qualifying a purchase. Like it or not, you are a small, consumer-driven business that operates within very
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specific guidelines dictated by the consumer. Learn how to use consumer speak, without which we all may become desperate. No patients = No income = No practice. MYTH - Marketing costs too much. I cant afford to market. REALITY - Marketing is just a great story, well told. Listen to your potential patients and learn how to give them more of what they want and less of what they dont want. Great marketing taps into the consumers spending habits and directs them to you. Marketing that works isnt expensive, its priceless. MYTH - Discounts and write-offs hurt production. We cant reach our goals. REALITY - Marketing doesnt necessarily mean discounting your fees. Empty chairs, out of control overhead, poor systems and marginal staff keep you from meeting your goals and hurting your production. Our practices operate on the philosophy of Produce More, Collect All and Keep Half. MYTH - My current patients will see it and want the same deal. REALITY - Most marketing is directed toward new patients only. There are specific ways to handle any situation that arises. The trouble is that most dentists are exceptional thinkers. They think of the one exception to any rule or scenario and live their lives in fear that they may have to resolve an anomaly. MYTH - Marketing isnt legal in my state. REALITY NOT TRUE! Going bankrupt should be illegal in your state. Marketing is legal and necessary. MYTH - Marketing, especially with discounts, cheapens the value of my dentistry. REALITY - The value of your dentistry is in the mind and actions of your patients. Let them, not you, decide how they consider your practice. As we said, everything is marketing. You get to decide on the message and response to it. So, what will it be for you? Continue to believe in myths? Or face reality, adopt a whatever it takes attitude and get busy attracting and keeping more new patients than you ever dreamed possible. If I can help in any way, my contact info is below.
You may contact Dr. Mike Abernathy at 972-523-4660 or at abernathy2004@yahoo.com.

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PRaCTICE MaNaGEmENT

It Is Important To Be

hy is there always a cloud at the top of the mountain? Why do the sand crabs dig holes? Why do the birds dive into the water? Why cant we stay on vacation longer? Why are the dentists back home frustrated and unhappy? Why am I thinking about this on vacation? I still have no idea about the answers to the first three questions. I leave the answers to these questions to the meteorologists, the marine biologists and the ornithologists. The reason we cant stay longer is that I have three daughters, two of them still in college and grad school and someday I will have three weddings. The answer to the fourth question is because, as Bob Dylan said, These times, they are changing. And like the dinosaurs, we are not adequately accommodating to the changes. The answer to the fifth question is because I truly care and my vision, or belief, is that I can make a difference in the lives of the people around me, in my practice and in my profession. What is your belief? What is your vision? Why do you practice dentistry? Why is it harder now? It is harder because as a profession we are not innovative. Sure, we adopt technologies and we develop new techniques, but these are merely changes in what we do and how we do it. The greatest challenge that we are facing is the commoditization of our profession. Insurance companies know it. Walmart knows it. That is why these entities are so hell-bent on making our consumers think that our care is indistinguishable. A crown is a crown, isnt it? A filling is a filling, isnt it? A cleaning is a cleaning, isnt it? If all we are concerned with is what we do or how we do it, then the failure to differentiate will enable the proponents of commoditization to win.

Whenever I ask the doctor to tell me about their practice. Ive had a successful practice. We do quality work. We have a gorgeous office. We have the latest technology. Every member of the team has 25 years of experience. We do a lot of cosmetic dentistry. We do implants. We do Invisalign. We have treated some celebrities. If practicing dentistry were like dating, would this work at a party? New Acquaintance: So youre a dentist? What is that like? Dentist: Ive been very successful because I do quality work and have a beautiful office, the latest technology and a staff with each member having over 25 years of experience. I do a lot of cosmetic dentistry, implants and Invisalign and I have treated numerous celebrities. Would you like to make a date to come to my office? How do you think the dentist fared? Unfortunately, many in our profession work very hard to prove their value without ever saying why they exist in the first place. They provide potential patients with a list of their experience, what they do and how they do it in the hope that the prospects will drop whatever they are doing and come to their practice. When you try to cultivate patients by defining what you do and how you do it, you are falling into the commoditization trap because it encourages those we serve into making their decisions based on intellect. They begin to weigh quality, service and cost like they do in

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clothing, groceries and appliances. Lets try the dating scenario with a different approach. New Acquaintance: So youre a dentist? What is that like? Dentist: I love what I do. As a dentist, I love going to my office and working with an amazing group of experienced team members and wonderful patients whose lives we improve each and every day. Of course we have a beautiful office and the latest technology, but what excites me each and every day is that we make a difference in peoples lives with cosmetic dentistry, implants and Invisalign. Weve even had the opportunity to care for some celebrities and improve their lives, as well. May I invite you to come visit our wonderful office? Do you think this approach might have been more successful? Why? Exactly! People have less of an affinity for what we do than why we do it. People are inspired by beliefs, not by facts. When we have a greater sense of purpose in our practices we become less concerned with the aspects that may tend to make dentistry more of a commodity. This approach automatically makes you different than most and patients are inspired by this difference. When we promote dentistry by describing what we do or how we do it, a patient may think that coming to us is the right decision. Thats what happens when we sift through the pros and cons of making a decision. Inevitably, there always remains some doubt because most people tend to second-guess the intellectual thought process. When a

decision feels right we make gut decisions that seem to have a much greater level of confidence. We trust our gut because these decisions are usually based on congruence of beliefs. These beliefs are expressed to the patients when we emphasize why we do what we do instead of describing what we do or how we do it. I understand that to differentiate your practice this way may seem like a difficult paradigm shift for the way most of you view dentistry. I also understand that this philosophy may need much greater clarification than can be achieved in this format. The basic premise is that we must clearly define the reasons we have entered into this wonderful profession and communicate that sense of purpose to the people we serve. Why do you enjoy doing what you do? Why do you feel fulfilled by caring for others? Why are you inspired to seek new and better ways to care for your patients? For those of you who have detected some level of stagnation in your offices, you may be wondering why you should consider making such a drastic change in the way you differentiate your practices. My answer to those who feel this way is WHY NOT?
Dr. Katzs practice was destroyed by a series of life tragedies 12-14 years ago. He systematically rebuilt it to become a multimillion-dollar practice with an emphasis on relationships and customized care. Dr. Katz is a Master in the Academy of General Dentistry and a Fellow in the International College of Dentists. He has been the Team Dentist for the New York Jets Football Team and a Dental Consultant to Channel 5 Fox News in New York. He is the Senior Partner in Smiles On Broadway Dental Care in Malverne, NY and the Founder of Smile Potential Dental Practice Coaching. Contact him at SmilePotential@aol.com or 516-599-0883.

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OFFICE SHARING: Practice Equity Suicide

by David Woods

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he office sharing arrangement has historically been a very popular option for dentists. There are two main reasons that prompt the creation of most office share arrangements. Both represent an attempt to reduce overhead expense. A common occurrence is for two or more dentists to enter into a real estate venture that will accommodate multiple practices with plans to share certain common spaces and equipment. Secondly, office sharing arrangements are often initiated because a dentist has built a facility much larger than he or she really needed in anticipation of future expansion. At some point it becomes evident that the expansion will not occur, so the doctor begins exploring ways to utilize the unused office space. What begins as a seemingly innocent attempt at saving a few dollars in overhead can easily end up costing office sharing doctors hundreds of thousands of dollars in practice equity!

Office sharing doctors remain solo economically dependent in that the bulk of their personal income is directly tied to their own individual production. An office sharing arrangement is not a substitute for a true co-owner relationship such as a practice merger or practice consolidation, both of which are structured to provide the practice owner with significant passive income from their practice. Office sharing doctors often continue to experience the same negative cash flow as they continue to pay their share of the fixed overhead expenses while away from the office. Again, an office sharing arrangement is NOT a viable substitute for a true co-owner relationship. While there are a vast number of negatives, arguably the most critical is the potential loss of practice equity. An office sharing arrangement often ends up costing the doctors hundreds of thousands of dollars in practice equity. Why? In essence, the only logical buyer is one of the office sharing partners. But, the office sharing partners often have no reason (or desire) to purchase the practice. If the practice does not sell to a third-party (and quite often it does not), the partners will get the patients they want for free! Why is an office sharing practice difficult to sell? Two reasons. First, the office sharing practice is a very risky venture for a purchaser! The patients generally do not understand that the practices at this one location are individual practices. Patients naturally assume the doctors are partners and thus share everything. To a purchaser, it is both logical and reasonable to assume that every patient has some existing relationship with the other doctors in the office. The purchasers fear is that many of the patients will migrate to the office sharing partners since the doctors have been practicing together for so long. Frankly, history

DEFINITE DISADVANTAGES OF OFFICE SHARING

Personal liability exposure is a major issue. The public assumes a partnership between the dentists. The courts also frequently determine that a partnership exists (implied partnership between the parties). One doctor can easily incur personal liability resulting from the adverse actions of the other doctors. Each doctors practice equity value is almost always severely compromised and, in some instances, can be totally diminished. In a profession where virtually every doctor is seeking more quality patients, does it make sense that YOUR quality patients are walking through the front door of another doctors practice? Regardless of the relationship you have with your office sharing partners, you are still competitors.

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proves this to be true regardless of the partners indication that they already have enough patients. We see patients flow to the other doctors often. So, understandably, the majority of purchasers would much rather invest in a true solo practice environment so there is no risk of significant patient loss! Those very few purchasers who are willing to take a risk on the acquisition of an office sharing practice are certainly not willing to pay full market value. They demand a significant price reduction to offset the risk of patient loss. Second, due to the history of poor patient retention, the majority of lenders are extremely leery about providing loans for the purchase of office share practices. In fact, most lenders refrain from offering office share loans entirely. Unfortunately, this significant negative impact on practice equity is not fully understood by office sharing doctors until one of the doctors puts his or her practice on the market. This is generally many years into the relationship. The longer office sharing partners have been

together, the greater the fear to any purchaser or lender that patient retention will be unsuccessful. In summary, dentists need to realize that an office sharing arrangement can easily cost each doctor a significant amount of practice equity and, in some situations, can end up costing the doctors 100% of their practice equity. Protect your practice equity. You and your family deserve a better fate!
David Woods academic background is in Business with an emphasis on Marketing. He is a graduate of Mississippi College. David has managed and acquired multiple businesses in the Mid South prior to joining PARAGON. Over the past ten years he has assisted many PARAGON clients across the nation with their transition needs. He has been involved in the development of many of PARAGONs current transition programs including presales, mergers, consolidations as well as co-ownership arrangements. David currently serves as PARAGONs Vice President overseeing operations in the Southern United States. His primary duties with PARAGON include the recruitment, training and daily transition support of PARAGON consultants.

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Making the Most of the Doctor-Hygiene Exam

by Rachel Wall, RDH, BS

ouve spent good time and money training your hygienist. They have a good amount of time working with the patient and have a lot of good information at their fingertips, but it sometimes takes you, the doctor, clearly setting the tone and communicating some simple guidlines to significantly enhance the productivitiy and efficiency of the doctor-hygiene exam. Here are 5 simple things that you can say to your hygienst to get started.

those awkward exams where you feel like youre walking in cold to try and figure out the patients needs in 10 minutes or less. Giving your hygienists permission to openly discuss their patients treatment needs and share them with you during the exam is a critical step in building trust and treatment acceptance. To build your hygienists confidence in codiagnosis, tell him/her that you are confident in their dental knowledge and skills. Then set out your specific expectations regarding co-diagnosis. It may sound something like this. I respect you as a highly skilled dental professional. To effectively support our patients in staying healthy, I need your help. Patients trust you and your opinions. To work as a team, we must all have the same beliefs in what is best for our patients. I would like to spend time reviewing my personal treatment philosophy and why I make certain treatment recommendations. This will allow us to discuss areas in which we may have different opinions on treatment and resolve them. Although it is your job, as the dentist, to make a final diagnosis and treatment plan for your patients, it is perfectly acceptable to expect your team to contribute to that diagnosis process with thorough observation and education of our patients. Give your hygienists permission to observe restorative needs and to begin educating patients on those conditions. Permission to participate in diagnosis, not only for perio disease but for restorative needs is critical. Give your hygienists permission to think beyond calculus and gingival health and begin to think about what might have caused that abfraction on #11. To think about what you might recommend to strengthen that 2nd molar that is broken. To look at x-rays and analyze the root tips as well as the bone level. Clearly communicate your treatment philosophy. Often, dentists assume that since their team works with

1) Youve just spent anywhere from 20-50 minutes with this patient. Im walking in cold. Please, bring me up to speed.
Imagine youre at a cocktail party and you see someone that youve wanted to meet for a long time perhaps a potential new client or someone you really admire. Your friend just had a 20-minute conversation with that person and so you hope this is your chance. You walk up and theyre both quiet. Your friend introduces you but beyond that you just stand there in awkward silence. Youve got to leave the party in about 10 minutes and you want to find out everything you can about this person but your friend is offering no help. So you ask a million questions and talk real fast and then take off. Sound familiar? Do your hygiene checks ever feel like youre walking into an already established conversation and youre the 3rd wheel? You fumble through an awkward conversation and then you leave. Or you try to tell them everything about you and find out everything about them while talking really fast and its all overwhelming. Now think of the opposite scenario. You walk up to the pair at the cocktail party and your friend introduces you and brings you right into the conversation telling you all about this person youve been wanting to meet. The new friend feels special and you all feel connected right away. Developing an empowered hygiene team prevents

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them each day, they are familiar with their treatment philosophy. This may be true but there may be some specific aspects of treatment that the staff is unfamiliar with. Reviewing cases together will build confidence in your treatment recommendations and get everyone on the same page.

Even better, there are two non-verbal cues that your hygienist can give you that will help you immediately know you should connect quickly with the patient and then get down to business: 1 Intra-oral photo of a treatment need up on the monitor or printed out 2 Perio chart printed in color and handed to the doc upon entering the room

2)

Im ok with you taking charge of the exam.

So many times hygienists are timid about directing the doctor in the hygiene exam. At the same time, approximately 95% of the hundreds of dentists weve worked with WANT the hygienist to guide them through the exam. This presents a great opportunity for learning and open communication. Again, be very clear with your expectations on how youd like the information delivered. Map out the flow of the dialogue and practice. Heres an example: 1) Greet patient and connect 2) Discuss patients concerns 3) Present medical/dental history: risk factors and changes 4) Present perio/restorative status 5) Discuss treatment 6) Patients readiness to move forward

4) Please give me a hint as to how much information the patient needs from me.
Dentists and hygienists can get frustrated with each other when it comes to the balance of patient education. If the hygienist has already talked with the patient about the benefits of a crown and then the doc comes in and does the same thing, someone is going to be annoyed. Especially if it means the appointment runs long. Have you ever felt that you talked a patient out of treatment that is in their best interest? Perhaps with too much information or too many options? What if your hygiene team let you know what was discussed and the patients readiness to move forward? That would give you a cue as to how much you need to educate. It can be something as simple as Dr. Brown, Jane has a few more questions for you about the bite guard we discussed. Or, Dr. Brown, Jane is ready to schedule a time to take impressions for the bite guard. Thats your cue to confirm the plan and move on.

Not only is this helpful in hygiene but the same format can be used by your assistants for emergency or new patient exams. Many of our clients have a checklist in the op next to the computer to remind them of this sequence. This helps calibrate the entire team so the doctor is getting information in the same way from each team member. Can you imagine how receiving this information in a very similar way from every clinical team member can free you up to be more effective at treatment planning and enrollment?

5) I appreciate you.
Its that simple. Bonuses and benefits are wonderful AND just as important are these simple words. When interviewing our client team members many of them are yearning for a good job today or any words of sincere appreciation. It costs nothing, goes a long way and reinforces the actions youre looking for.

3) If I talk too much about personal stuff; its ok to redirect me.

Ok, no one wants to be rudely interrupted but Ive found that some hygienists are reluctant to jump in to move you along in the exam. The first step is to give them permission to do so. The next step is to share with your hygienists exactly HOW youd like them to redirect you. It could be something like So Dr. Smith, Im really concerned about Sues old metal fillings.
800-337-8467

As owner of Inspired Hygiene, Rachel Wall helps dentists tap into the productive potential of their hygiene team. Inspired Hygiene is the preferred hygiene coaching group for the Productive Dentist Academy and a strategic partner with The Profitable Dentist. If you would like more information on how to unlock the untapped potential in your hygiene department, Rachel is pleased to offer you their popular CD, 10 Essentials to Increasing Hygiene Service, Systems and Profits absolutely FREE. Please visit www. inspiredhygiene.com to order your free CD and to register for her free weekly e-zine where they share weekly tips on building a thriving hygiene department. Rachel can be reached at: rachel@ inspiredhygiene.com.

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PRaCTICE MaNaGEmENT

Four Moves to
by Dr. Steve Rasner

Revitalize an Ailing Practice

bill. Your knee jerk response during a slump is to cut cost randomly. You begin the fix by knowing the facts.

ny seasoned clinician would know that the past four years have been the most challenging times to maintain prior levels of success. To be clear, the enemy is not just the lingering recession. It comes in the form of the PPO dominance or the emergence of corporate care. The time when you can thrive because of a great skill set and team are over. Or are they? After 30 consecutive years of increased growth and profitability, I experienced my first turndown years in 2011 and 2012. The present year will result in an approximate 14.9% upswing. The practice remains an independent fee for service office. This article is dedicated to helping you perhaps reverse your own slump with the four principals I employed.

2) Revitalize your monthly and weekly meetings.

When productivity crashes, morale is not far behind. When the morale of an office has tanked, it is not uncommon to abandon protocols that dont seem to add to revenues. The AM and monthly meetings are two of these protocols. It happened in our office during the 2011 & 2012 down years. Lets review why we instituted them in the first place. The morning meeting takes a mere 10 minutes, yet laser focuses your team into that day. The result is greater productivity, better flow and definitely improved camaraderie. It is the time to see if this schedule will really work. Are we set up today to fail (in terms of being on time)? Does the hygiene department know what recall patients have a history of scaling and root planning? How long ago was it? Does the insurance department know the patients out of pocket cost if recare is needed? Most offices leave untreated soft tissue care on the table because there is no fluid system to retreat the patients with need. The outcome is that your hygienist informs a patient that their perio is not looking so great and the patient and office make a joint decision to embrace watchful neglect. The result: poor care and a wasted opportunity. The AM meeting is also an opportunity to evaluate patients on the schedule that had prior treatment plans declined. The point is NOT to badger the patients over and over with unwanted care but to be PREPARED when it comes up. When patients sit in an operatory 30 minutes while your office scrambles around to see what their insurance covers, your possibility of case acceptance just went down. Be prepared! Monthly meetings are where you make bigger decisions regarding the direction of the practice. This is where you move ideas into action. It may be the time when you drop a PPO because you recognize from due diligence

1) Its not going to get fixed overnight.

I include this because you need to begin with realistic expectations. Your number one job is to sit down and figure out how you can budget your way through until productivity and cash flow begin to increase, which they will! Begin by being completely in touch with key office numbers. Run a report to see where you stack up against national trends. Find out where you stand on your major expenses like: Salaries (30% not including doctor salary) Lab fees (8%) Supplies (5-6%) The national averages on the aforementioned are in the parenthesis. It is my opinion that it is worth the approximate $2,000 to hire a forensic accountant to give you a reliable, objective analysis of where your money is going. When I exercised this very task, I discovered $240,000 of uncollectable balances on the street. So ask yourself: How in touch are you with your billing department? What is your check and balance system for unpaid fees? I assure you that no office reading this will go unscathed. You will discover flawed insurance estimates; patients who lost insurance during treatment and forgot to tell you or those patients that somehow never got a

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Get This $67 CD For ONLY $1! Dr. Steven Rasner

its costing you money. This time might be used to implement change in your new patient exam or hygiene recare visits with the intent of improving care and productivity. Lastly, it is very much an opportunity for a reality check for the team. The team needs to know where the office stands and what is needed to maintain the office as an independent fee for service entity. Maybe that means front desk team members become more active in the recall process and the clinic becomes a force in seeking referrals from the patients they are treating. In our office we implemented the Four Recall Per Week Protocol. It mandated that front desk personnel recall four patients per week who were overdue. It was natural for the front desk to help the office with this protocol because of the nature of the job. Checking patients in and out; confirming and rescheduling appointments, this part of the team can easily assess who is over due. I am rather aware that this is adding work to their present job role. If you are going to exist with some independence, it is simply going to require more from everyone. Another protocol we initiated was an aside having team members hand out a $25 Visa Thank You referral card. This was particularly effective coming from the clinic since that is where most of the patients time is spent. The patients initial the bottom of the card and if a patient refers, the staff member gets a point. We track the points on an easel in our kitchen. The individual with the most points gets a not so shabby cash gift at the end of the month.

Dr. Woody Oakes Interviews...

(Thriving in a Challenged Economy)

The #1 service you need to add to your practice now! Dr. Rasners 3-pill Rx sedation cocktail How to select the right team for todays times How to compete with PPOs and corporate dentistry The front desk apology How you can avoid IV sedation
Dear Friend Each month, hundreds of your colleagues receive 2 units of CE credits and stay up-to-date on the latest clinical procedures, practice management info, etc... without even leaving their office or home. Their secret is that they receive our monthly Driving Dentist Series audio CDs. Members pay $67/month for this valuable information... but for a limited time only, we are offering non-members a $1Test Drive. After your test drive, you will continue at receive valuable CDs at $67/month or simply contact us to end the subscription. 1. Simply complete the information on this form and FAX this form to our 24/7 secure FAX line at 812-949-8535. 2. You may also call the office at 1-800-337-8467 3. Return this form by mail to: 3211 Grantline Rd, Ste 20, New Albany, IN 47150.

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TPDs monthly CD series is the most valuable CE investment that I have made in 20 years of practice and over 2,000 documented CE hours! Woody delivers month-aftermonth, new and exciting ideas that re-energize my passion and improve my bottom line! - Dana Brockington, DMD, PC, Acworth, GA As I have a 45-minute commute each way, each day to my office, I look forward to listening to your CDs and have benefited greatly from them over the years and have learned much about running a business that I did not learn in dental school. - Dr. Charles Cooper, Alpharetta, GA Not only are the interviews excellent, but your service is equally excellent. Getting CE credits is enjoyable... thanks to you! - Dr. Thomas Kachorek, Clinton, MI I look forward to your monthly visits to my car. You make commuting to work educational and less a waste of time. - Dr. Martin Zase, Colchester, CT

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3) Up your clinical game.

There is little doubt that the offices best equipped to sustain independence are those that provide more services. There has never been an easier time to add endo, ortho and oral surgical services to the general dentist skill set. There are abundant venues to acquire an array of skills you are presently referring out. Be clear that the arena of CE is NOT the place to skimp or take short cuts. A poor endo, ortho result and especially an implant failure can have a devastating impact to the practice. My suggestion: ask around. Take a highly reputable and complete program; preferably a continuum spaced out over six months or a year. Continued on page 65

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PRaCTICE MaNaGEmENT

Whats Your Return on Investment?

by Dr. Mike Kesner

ow much income did you make in 2013? What part of that income came from your return on your investment for the risk of owning and operating your business? If you are like most dentists, all of your income was salary and there wasnt any income from ROI. How much did you spend on marketing in 2013? What was your month-to-month return on investment on that marketing? Most dentists dont know the answer to this question because they dont track their marketing ROI. How much did you spend on a practice management consultant in 2013? What percentage did your income increase over 2012 as a result? The key to almost every decision in your practice should be based upon ROI. The key decision should usually NOT be based on how much something costs. Most dentists make business decisions based on cost exclusively and not ROI. I hear dentists make statements like: Marketing costs too much; or a consultant is too expensive or hiring another assistant and adding another treatment room is more than I want to spend. These statements are often made with no regard to ROI. The increase in your revenue as a result of the expenditure should be the key factor in your decision-making process, not the cost. In order for your practice to grow year over year, you must stop thinking like a dentist and start thinking like a businessman. If you make decisions based upon ROI as opposed to cost alone, then your business can experience breakthrough growth as opposed to gradual growth or even a decline. You should get an ROI on your business that is payment for the risk you take as a business owner. Owning a business is a risk. Your name is on the bank loan. You not only provide the dentistry to your patients, but you also run the business. You should be paid for that risk and responsibility. You hire and fire. You discipline employees. You are responsible for payroll, accounts payable and accounts receivable. There are P&Ls and balance sheets to watch and understand. There are capital expenditure decisions. There are marketing decisions. You have people delegated to help you with these responsibilities, but you should get a monthly return on your investment of money, time, energy and risk that you have as a business owner. If you owned a car wash, you would not be the one washing the cars. You would hire other people to do that for you so you can run the business. As an owner-practicing dentist, you not only run the business, but you also provide the services. The vast majority of dentists get paid to provide the services and not to run the business. You are probably thinking That sounds great Mike, but there is not enough money left over at the end of the month to pay me a return for running the business. You can change that. Earlier I referred to the ROI from marketing and consulting. These are the two primary ways to increase your total revenue and supply you with the income you should be receiving. The right kind of marketing can provide you with a good ROI from the new patients generated. I receive a 4:1 ROI in the first month on my marketing. When you consider the lifetime value of a patient from future dentistry and referrals, then the ROI is much, much higher. There are several factors that make marketing effective. There is size, colors, headline, offers, demographics, Continued on page 52

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Advertisement

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f someone told you that tens or even hundreds of thousands of dollars were being stolen from your dental practice, what would you do? You might scoff at such a claim. Or dismiss that person as yet another consultant trying to sell you something. You would probably be too busy for them. But what if that person could produce indisputable evidence to prove their claim? What if they identified your stolen profits, put them in writing -- then guaranteed to recover them for you? Would you still be too busy? Heres what this is about: A new, comprehensive Insurance Profit Recovery Kit for Dentists has been prepared, with confidential facts about the secret PPO rip-offs and reduced reimbursements that are bleeding your bottom line. To receive your Kit, pick up your phone and call 715-598-2577 or visit www. HigherDentalFees.com

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by Michael Patrick

You Dont Need Another Expensive Guru. But Could You Use $20,000 In Extra Profits?
Frankly, whats happening to dentists in America today qualifies as fraud. Here are the facts First, not every dentist gets equal PPO reimbursements, even in the same Zip code. Example: Dr. Smith, in suburban Cleveland, OH (who wishes to remain anonymous) uses the same C&B lab as another dentist down the road. Yet, Dr. Smith got reimbursed $150.00 less per crown than the other dentist 3 blocks away. Of course, the insurance company would never tell him that How many crowns do you perform every year? Multiply each of them by $150.00. Thats the kind of money you may be losing out on to the insurance companies, who are keeping it to line their pockets or pay your competitors. And thats just one procedure. Imagine how many ways you can increase your income, with no additional dentistry performed by you. Example #1: If you get just $5 more per prophy and do only 5 insurance

prophies a day thats $5 x 5 x 200 days worked = $5,000 extra profits every year (enough to fund your IRA or enjoy an extra vacation). Example #2: If your crown fee is increased by $200 and you do 100 insurance crowns a year, thats $200 x 100 = $20,000 extra profits every year (which other dentists may be getting -- money thats rightfully yours). And those examples dont include bigger cases with bigger fees, like implants, root canals, bridges, etc. Youre bleeding money and profits every day your reimbursements are less than what other dentists are getting -- for the same work. Meanwhile, the PPOs are laughing at your expense, all the way to the bank. Second, you dont have to accept the fees that PPOs offer. Its true. Instead of taking huge write-offs every month, you can negotiate higher fees and rake in more profits with no extra chair time. This is, quite literally, found money for your practice. The only problem? That word, negotiate. Even if your insurance person were handed ninja-level negotiating skills on a silver platter, she couldnt find time to call every carrier and sweet-talk them into giving you better fees. And you certainly dont have time to endure the frustration of negotiating with every one of your carriers. Which brings us to the third fact

nothing, you pay nothing. The big insurance companies have a team of negotiators who are paid to hammer you for the lowest fees possible. Now the game is finally fair. Because you have a team of professional negotiators on your side. There are reasons you cannot negotiate with PPOs on your own. Among them, the Dental Fee Negotiator team has spent years building relationships with national carriers that are unavailable to you they audit more than 30 different holes in your practice through which profits escape via under-reimbursements they fight back when PPOs try to intimidate you (and they will). Unless you have renegotiated higher reimbursements in the last 12 months, significant profits are being denied to you, right now -- this minute. The complimentary Insurance Profit Recovery Kit for Dentists reveals opportunities to stop your loss of profits and dramatically improve your income -with zero out-of-pocket investment and no risk.

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You may have heard about certain companies that claim they can negotiate higher fees for you. The only catch? They may charge you $3,000 to $5,000 upfront, with no guarantee of results later. Thats like putting thousand-dollar bills in a slot machine. Why risk it? Dental Fee Negotiator LLC was created by a dentist, for dentists. Theyve built an A Team of 22 legal, dental, insurance, and administrative experts to handle every aspect of negotiating on your behalf with major PPOs. The typical dentist can expect gains of 10% to 40% on insurance fees. If they find

COVER STORY

DRIVER OF WEEKEND RICHES

by Dr. Taylor Clark

Why Every Dentist Should Consider Running an In-Office Dental Assisting School

everal of years ago, Dr. Woody Oakes called me. He told me about his weekend dental assisting school and what a great thing that has been for him and his practice over the years. He had heard about my dental assisting school model and the success weve helped many doctors experience in recent years. He said many of his clients are running their own schools and asked if I would be willing to do a recorded interview with him. We discussed many of the benefits our dental teams can have by leveraging our offices. I couldnt agree with Woody more when he indicated that running a dental assisting school is such a no-brainer for dentists. While there is a long list of benefits to running a school, I decided to share what I think are the top nine, in no particular order of importance.

into dentistry if it wasnt for an excellent low-cost alternative.

Third: You can have a bigger pool of prospective

assistants to hire from at any given time. Lets face it. The only real constant about a dental practice is the doctor. You may have a great staff today but it can change oh, so quickly. Your assistants spouse takes a job in another state. Perhaps your assistant leaves for hygiene school, to raise a family, take on another career or any endless number of reasons. We all know the turn-over bug can hit anytime, without warning. Lets not forget the dreadful one. Ever had a bad apple? A negative attitude and selfish pessimism by one person can quickly turn into the cancer that takes the whole practice down. Though we never want that to happen with our staff, it can eventually become a reality for any of us. When it happens, replace them fast. You get to cherrypick the very best ones right from your class! You have a pool of assistants doing working interviews with your head assistants year round. Imagine never having to run an expensive ad for a dental assistant ever again.

First: Todays economy heavily supports it. People are less willing than ever to shell out $10,000-$18,000 plus for dental assisting training. Furthermore, theres a huge opportunity cost of lost wages for the nine-plus months of going to school full time and not bringing in a salary from a job. Factor the two together and it could end up costing a student $30,000 to become a dental assistant through a traditional full-time program. Second: A lower cost alternative to dental assisting training lowers the barrier for many great ones to get into the field of dentistry. The barriers of expensive long-term traditional programs are too much sacrifice for many potential rock stars. Too many great ones have been shut out of the field of dentistry because of this one major obstacle. Gone are the days of having to quit the full-time job for dental assisting training.
Let me tell you about my head assistant that has been with me for 6 years now. Alicia was a full time project manager with Micron Technologies, serving as supervisor to a team of employees in Singapore. She has exceptional organizational and leadership skills. She is a very quick learner and says her career today is the most enjoyable that its ever been. Needless to say, Alicia and our six other full time staff members hired from my school, make my life so much easier. Alicia says she never would have been able to get

Fourth: You gain some control over the quality of

available dental assistant prospects in your town. I had some frustrating times in my first four years in practice. Id catch myself thinking something like this: Are you kidding me? These externs from the local traditional schools are all I have to choose from? At times I was able to pick talent off the street and train them quicker and faster than I could with any of the available trained prospects in my area. I mean no disrespect for any program, long or short. We all know there are people in our dental school class, hygiene class or assisting class that we would never let near our mouths. Every type of training program has their bottom 10% of graduates. But, let me tell you about a comment that I hear over and over again from MANY dentists around the country. It goes something like this: Theres this expensive full-time dental assisting school down the street thats a year long. The graduates come into our office to volunteer and I wonder what they were doing all year long. They dont know anything!

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Fifth: You get to leverage your hundreds of thousands

of dollars in equipment and physical plant that sits idle part of the week. Your facility makes you nothing when its closed. I used to get that all too familiar pit in my stomach when Id think about the weekends and my empty office that I still had to pay rent for. It was just the other day that a doctor from Hawaii called me saying he was sick and tired of wasting money on rent for so many days that his dental office is closed. That all changes when you have a dental assisting school! You get to experience multiple streams of income. If your dental office has a bad month, you dont have to worry so much because there is another income stream to compensate.

it, or they dont. Many are willing to take a well calculated risk, with a high probability for success on something they are experts in: dentistry. Others might simply prefer to keep doing more of those DOBs on #2 or #15, upside-down, under water and through a mirror. Thats perfectly fine either way. Heres one more thought Id like to leave with you. We always hear about how we need to think outside the box. But, what if the big answers are already inside the box? With a dental assisting school, they are. Sticking with the devil you know is often better than messing around with the one you dont.

Sixth: You have a powerful retention tool for super star staff. Your highly qualified assistants love teaching and being in an authority position. They get to enjoy being the mentor that students look up to. Due to the low overhead of running a school, you can easily pay your head instructor 1 to twice what they make during the week. Who doesnt like to earn more? If they are ever tempted to leave your office, they have to think twice about it because they lose these strong benefits in addition to the other benefits you may provide. Seventh: Many dentists believe their dental assisting school is the most lucrative niche in their practice. We can choose to do dental implants, veneers, Invisalign, crown and bridge..why not dental assisting training? Operating overhead for a full class is far lower than the average dental practice overhead. You are already paying for the major expenses required whether you run a school or not. Your equipment, physical plant and highly trained staff give you a huge advantage over would-be vocational school competition.
Lets face the facts. Its perfectly fine to make a great profit. You provide a strong value to more people. The more value you can provide, the more people you can help and the sky is the limit for profitability. Having a significant chunk of money go into your bank account each quarter, separate and aside from your dental practice revenue is an exciting thing to experience. Hiring your staff to help you run a dental assisting school can be very profitable in many ways. The monetary and non-monetary benefits are numerous. With this business, a dentist is sticking with their own expertise: dentistry. You are not buying a car wash, a deli shop, or investing in some diamond mine in Belgium. You are leveraging the knowledge and expertise you paid the price to gain for eight long years of your life. Ive come to find that there are two main types of dentists with respect to exploring the possibility of starting their own dental assisting school business. They either get
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Eighth: Residual money is different money. Let me ask you as question. Would you rather make $200,000 in a year and do all the work or make $100,000 and do little to none of the work? Ill take the latter every time! Youll have a sizable chunk of money plus lots of time to leverage further into other income producing activities or personal pursuits. With your school, you dont have to do all the work if you dont want to. You can delegate work to your staff. Ninth: No retirement? No problem. A dental assisting school can be your retirement. After you have long since put down the drill, you can still retain your school business if you want to. I have a 75-year-old dentist friend who got beat up with the business of dentistry in his practicing days. He burned out of running his dental practice and had to get out. He had nothing but debt after many years of long hard dental practice labor. However, he saw the potential with owning and directing his own dental assisting school. He took action and as a result, has not skipped an income beat since he quit practicing dentistry years ago. He enjoys a healthy six figure income stream year after year because of the highly efficient dental assisting training he is able to provide for many, many people each year.
I hope by now you are able to see your dental practice in a new light. In my opinion, our potential in the business of dentistry is second to none! The more creative we can be with our business minds, the more possibilities we will see. I wish you the best as you move forward in pursuit of a more profitable business that provides more value to an increasingly large number of people. Your reward will be proportional to the value you can provide. To find out what type dental assisting school opportunity is available in your area, go to www.AssistToSucceed.com.
Dr. Taylor Clark is an author, speaker, dentist, dental assisting school mentor and entrepreneur whose passion is making life better for people. His accomplishments have been recognized in newspapers, radio and television in many cities throughout the United States. He was named the 2009 Young Entrepreneur of the Year by the Boise Metro Chamber of Commerce. For questions or more information, you may visit www.AssistToSucceed.com or call 208-353-5301.
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PRaCTICE MaNaGEmENT

The Advertising Trap

by Dr. Joe Steven, Jr.

imes have certainly changed! When I graduated from Creighton Dental School back in 1978, there was no way any dentist would attempt to advertise. Why of course, that would be unprofessional! Fast forward 35 years and its obvious that things have changed. Dentists are slowly gaining on lawyers when it comes to advertising on TV, radio, etc. Even though I have been fortunate enough not to have the need to advertise, Im not against it. Id jump on that band wagon also if I really felt the need to gain new patients and it meant keeping food on the table. I give great credit to our staff for generating an average of 75 new patients per month at Riverside Dental which makes it unnecessary for us to do any external marketing. Of course, I do my share of internal marketing right along with Dr. Jasmin Rupp, my daughter, and Dr. Terra Pauly who recently joined us. Everyone has to go that extra mile to win patients over so patients stay in our practice and refer their friends and family to our office.

marketing budget. But, I have seen too many dentists abandon the PR part and focus more on the advertising aspect of getting new patients. I hear repeatedly that we should allocate about 5% of our gross revenues to marketing, and there are many dentists who do that. I know of many offices that spend anywhere from $10,000 to $20,000 per month on marketing. They get good results doing that so they keep doing it. But, if you treat people right while they are in your office, is it necessary to keep spending that much money in advertising? For some offices they fall into that advertising trap because they start depending on marketing to get new patients and they dont make the effort to develop a great dynamic team that will help build the practice with great services that result in patients referring their friends and family into their practice. Increasing external marketing before improving internal marketing is like turning on the faucet and leaving the drain open! Thats what Im seeing done in way too many offices. They need new patients so they start a marketing budget and they get them, but they lose them out the back door because they dont have great internal marketing working for them. Advertising is great for jump-starting a practice, but the end game should be to phase out of it after a good patient base is established which will continue the flow of new patients with referrals from those existing patients. There are some who believe that word-of-mouth referrals are a thing of the past, and that you cannot depend on that. I totally disagree! It has worked extremely well for us for 35 years, and it is still absolutely the best way to build a practice.

The day may be gone when you can hang up your shingle and the patients will be beating down your door. But, with the proper PRskills, I wouldnt rule out that concept entirely. Sure, a massive external marketing campaign will jump-start many practices as we are now seeing with many of the corporate dental offices that are going up all around us in the cities. Unfortunately though, there lies the trap that befalls many dentists! What Ive been observing over the past 10 years or so is that many dentists are depending on advertising to get new patients while slowly disregarding the concepts that the great Dr. Earl Estep and others espoused 30 some years ago about providing excellent customer service by becoming genuinely interested in our patients and truly winning them over. The most rapidly successful dentists are the ones that combine this concept with a large external

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Ask yourself this question would you rather have a new patient come to you because one of your current patients referred them to your office, or one that comes in from a direct mail ad that they may have received from you? We should always prefer the one that was referred because they are already partially presold on the practice because their friend or co-worker recommended your office. Ive heard from many dentists and their staff members that marketing works, but many times the quality of patients that come in arent ideal patients and they are shoppers. They may take advantage of the free exam or free x-rays or free cleaning or free whitening, but then many of them move on. Of course the goal with marketing is to get these shoppers to come in and then win them over so that they become long term patients. Some offices are very good at doing that, but unfortunately too many offices are not. Then, they depend on continuing to spend money on advertising to keep the flow of new patients coming in. That was one of the good things about becoming a professional - we didnt have to deal with advertisers as other businesses do. It can get rather confusing, time-

consuming and expensive constantly making decisions on direct mail marketing ideas, TV ads, radio ads, yellow page ads and then always designing new marketing campaigns which is an ongoing office overhead. Focus first on internal marketing which encompasses so many things related to patient care and genuinely make the effort to win over your patients. Something to consider in lieu of spending money in advertising and riding that marketing merry-go-round, would be to go ahead and participate in one or two of the better PPO plans. Monitor it closely and you may realize that you prefer to gain a large group of patients with these plans and only write off about the same amount of money as you would if you were to advertise for new patients. You may find this more preferential than always searching for the right external marketing concept. For years I have said that more dentists need to rearrange their priorities for their practice and focus on building a great team that does the marketing for you. Yet, so many dentists have other priorities such as being a great implant dentist, or a great Cerec dentist, or the best Continued on page 66

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All articles from Staff MeMoS: for Dental Personnel are contained within Section B of Staff MeMoS: for Doctors. Staff MeMoS: for Doctors...$49.97 Staff MeMoS: for Dental Personnel 1 book...$19.97 5 or more books...$15.97 ea.
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These 2 books contain various articles and short stories written by Dr. Joe Steven, Jr. that were originally published in several leading dental publications. The Doctors book will help dentists develop, build, and maintain a dynamic, winning team for developing a more successful practice. Plus, it will help dentists enjoy their practice more on a daily basis when working with loyal, appreciative, enthusiastic team members! The Book for Dental Personnel should be mandatory reading for all team members so they will learn the important business principles that many dentists have been trying to instill in their staff. This book will motivate and inspire every member of a dental team to excel in their performance which benefits the entire office! 800-325-8649 For more information, go to: www.kiscodental.com
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Dr. Woody Da Brain Oakes Politely Requests Your Attendance At The Family Meeting With The Godfather of Dentistry...

Dr. Gordon Christensen.

20 Of The Top Bosses

In The Industry All Gathered In Beautiful Destin, FL

Strategies For Success In A Challenging Economy, HR Issues, Oral Surgery, Insurance Problems, Financial Freedom & MORE!

The Most Worthwhile and Entertaining Credits That You Cannot Refuse!

16+ CE Credits

ANNOUNCING

Dont fugetaboutit!

l a u n n A d r 3 2 The r a n i m e S k a Spring Bre

entistry aka The Godfathers Of D

Time

7:50 am

Room Speaker
Magnolia Dr. Woody Oakes

TITLE
Orientation

CE

Thursday, 4/10/14
8:00 - 10:00 am Magnolia Dr. Gordon Christensen 10:00 - 10:30 am BREAK Surgical Extractions: Faster And More Predictable 1.5 The Bosses Books For Survival 2 In A Still Recovering Economy

This presentation not available on DVD.

10:30 - 12:00 pm Magnolia Dr. Karl Koerner 10:30 - 12:00 pm Azalea Ginny Hegarty, SPHR 12:00 - 1:30 pm LUNCH Douglass Lodmell, JD & Paul Edwards

Alright... Start Talking: 1.5 Breakthrough Communication Success (BCS)

1:30 - 3:00 pm Magnolia

The Devils In The Details: How The Little Things Can Cost You BIG! How To Dominate The Internet Like a Boss

1.5 1.5

1:30 - 3:00 pm Azalea Colin Receveur 3:00 - 3:30 pm BREAK

3:30 - 5:00 pm Magnolia Shelly Ryan, RDA

Collections Made Comfortable: The Team Approach

1.5

3:30 - 5:00 pm Azalea Dr. Jeffrey Hoos How To Change A Denture Patient 1.5 Into A Dental Implant Patient Friday, 4/11/14 8:00 - 9:30 am Magnolia Dr. Nathan Dallas Transforming The GP From A Referral 1.5 Rat To An Endo Boss 8:00 - 9:30 am Azalea Wendie DeLoach, RDH 9:30 - 10:00 am BREAK Hot Seats The Shortcut To Accomplishing All Your Goals Within 12 Months 1.5 Reviving a Numb Practice With Extreme Teamwork 1.5

10:00 - 11:30am Magnolia Dr. Woody Oakes 11:30 - 1:00 pm 1:00 - 2:30 pm Magnolia LUNCH Dr. Bruce Baird

Productivity: Its Not By Chance Order A HIT On Running Over: A Mob Approach To Hygiene Time Management

1.5 1.5

1:00 - 2:30 pm Azalea Rachel Wall, RDH, BS 2:30 - 3:00 pm BREAK

3:00 - 4:30 pm Magnolia Dr. Steve Katz & Kelly Fox-Galvagni, CDA 3:00 - 4:30 pm Azalea Bill Rossi

Pump Up Your Practice: Strategies For Practice Success In A Challenging Economy PPO Plays 2014: Make The Right Moves And Make Many More $10,000s!

1.5

Happy Hour with Woody Friday: 4:45 pm 6:15

Hammerheds in The Village

pm

1.5

Saturday, 4/12/14

8:00 - 9:30 am Magnolia

Dr. David Ahearn & Grow Or Die 1.5 Wendy Briggs, RDH Ratting Out The Empty Suits Icing The Contract On Your Freedom 1.5

8:00 - 9:30 am Azalea Dr. David Phelps 9:30 - 9:45 am BREAK Dr. David Ahearn Wendy Briggs, RDH

9:45 - 11:15 am Magnolia

Grow Or Die Hormone Replacement Therapy: Breaking The Code Of Silence Out Of The Darkness

1.5 1.5

9:45 - 11:15 am Azalea Dr. Mickey Barber 11:15 - 11:30 am 11:30 - 12:30 pm Magnolia BREAK Dr. Woody Oakes

CLINICAL

New Pearls for 2014

by Dr. Michael Curtis
on 100s of Pearls
most nces for the Amazing adva dure you do! important proce

Anesthesiaf& Pain Relie

totally Fast, easy and the busy practical for t. general dentis of dollars Saves 1000s hours in C.E. and countless from 100s 100s of Pearls you know of sources...Do them all?
For The General Dentist

Avoid sugar, caffeine, nicotine and other stimulants that over-sensitize the nervous system for at least an hour before hygiene or other treatment. Consider Chlorhexidine (Peridex etc.) pre-op to reduce bleeding and inflammation, lessen patient discomfort and reduce treatment time. New Recall Message: If patients prepare for their visit they are less likely to cancel or break their appointment. Prescribe Peridex with the following message: To make your cleaning more comfortable and effective, we ask that you to use a medicated rinse twice per day for a week prior to your hygiene visit. Please call us to confirm your visit and your pharmacy information so we may call in your prescription. Other Practice Builders: Topical: Routinely apply topical before scaling interproximally and into the sulcus for greater comfort. Load any traditional benzocaine into a 3ml Monject syringe with an Ultradent mini-tip (#514) as shown. For new more effective topical anesthetics that are pre-packaged in syringes, please see our Anesthesia guide. Apply Vaseline on the lips to keep them supple as you stretch them. Patients appreciate the gesture and it helps avoid uncomfortable tissue splits.

1. Broken Hygiene Appointments:

Are you getting too many broken hygiene appointments? One reason may be that cleanings can be quite uncomfortable. First, the hygienist places hard x-rays that dig into tissues or gag patients. Then she scrapes razor-sharp blades against ultra-sensitive root surfaces. Some tips to create a more positive experience: Softer & Kinder: In school, we were taught to remove a layer of cementum to properly eliminate endotoxin from root surfaces. New information has disproved this theory. Use lighter pressure on root surfaces can lessen the shock of metal-on-root and reduce iatrogenic post-op root sensitivity. Ultrasonics: Consider utrasonics over hand-scaling whenever possible. Studies show cavitrons yield results that are as effective, or better than hand scaling. Look at Parkells Turbo-Sensor unit. At $500, its a bargain. Parkell.com 800-243-7446 Change Ultrasonic Tips: As tips age, they deliver less energy. To compensate, operators tend to turn the power up which makes the tips hot. So they turn up the water. Before long, were burning, drowning and hurting the patient and not removing calculus efficiently. You cannot see wear on older tips. Consider new tips every year or two. Pre-op Prescriptions: Consider Aleve with Tylenol pre-op to diminish discomfort during and after hygiene.

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FEBRUARy 2014

 Safety glasses Sun glasses protect patients vision and allow them to relax without the bright light in their eyes... another nice touch patients notice.

the mirror, so you retract and suction simultaneously. www. TheBlueBoa.com, 801-6458881. Cost $65 Suction Ejector Mirrors are disposable. Suction goes through the hollow handle and out the holes behind the mirror. Optics are excellent. www.practicon.com 800-959-9505 Cost $27. Dry Tips are flat triangles filled with the same gel that diapers contain, so they absorb as much as 30 times their weight of fluid. The cheek side sticks to mucosa, while the side facing the tooth is polyethelyne, so no absorbed fluid gets through. Throw away your cotton rolls that only wick moisture onto the teeth! Any dealer. (I only use size small). Cost: $12 for 50. Endo Isolation: Are you using a rubber dam for easier Endo? Hypochlorite is a must-use irrigant and you cannot prevent tissue burns, horrid taste or potential legal liability without the dam. Plus, your apex locator may not work reliably without it. Seal the dam with the same liquid dam you use for whitening (Ultradents UltraSeal XT) or similar. Technique: Apply rubber dam. Inject liquid dam between dam and tooth to complete the seal against all moisture. Extend into clamp holes to lock material in. Then cure for 10 seconds. Drill material out of rubber dam clamp holes prior to removal. www.Ultraseal.com

2. New Loupes-More Profit:

Would you like to do belter dentistry-faster? Consider new loupes. The better you see, the quicker you can work and the more details you notice for superior results. I recently upgraded to 4.5x magnification for all my general dentistry and have been astounded at my new speed and excellence. A headlight is an absolute must! Please do not even consider working without one! Look into inexpensive loupes for hygienists, so they diagnose and advise patients before you arrive, to echo their findings. Case acceptance will skyrocket. Loupes also assist expanded-duty assistants so you can delegate more. Check out the big four loupe companies Orascoptic, Designs for Vision, SurgiTel and DenLight.

3. Americas Best Dentists: FREE

Have you applied to Americas Best Dentists for your 2014 online listing and office plaque? If not, youre missing a powerful marketing opportunity. Patients are impressed when they see you were selected. Inclusion can also raise your websites SEO and give you the Americas Best Dentists logos for your website & marketing. Referrals and case acceptance can soar. Basic listings are FREE. www.TodaysBestDentists.com.

5. Latex Allergy Better Gloves:

Are you still using nitrile or vinyl gloves for patients and staff with latex allergies? Please look into Polypropylene instead. The fit, dexterity, elasticity and feel are much better, with comfort as good as latex. They are no more expensive than alternates and have no nasty latex taste. Check out Posi-Prene textured, by Clinical Supply Co., or LeSoothe by Smart Practice.

4. Moisture Control & Isolation:

Maintaining isolation from saliva is one of the most stressful aspects of dentistry. Try the Blue Boa/Suction mirror/ DryTip technique for posterior composites, impressions and crown inserts. The Blue Boa is a hose that connects to the high speed line on one end, and to a hollow plastic mirror on the other. Suction pulls saliva through the back of

Dr. Michael Curtis practices in Connecticut and is the author of the 100s of Pearls books on Anesthesia, Endodontics, Collections & Case Acceptance; each with over 400 Pearls in 80 categories. For questions or to order, visit www. HundredsofPearls.com or call 800-427-2830.
The Profitable Dentist.com

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CLINICAL

Simplifying Dentures
in the New Economy!
by Dr. Ara Nazarian

oday, the number of patients who will require removable prosthodontic services is increasing at an exponential rate because of the growing number of baby boomers. Their increased attention to appearance and function has created much higher denture expectations than in the past. More importantly, these patients do not want to go through multiple appointments for the fabrication of a new set of teeth. Removable prosthodontics can be a very rewarding component of our practice if we understand and implement certain developments, techniques and materials in our profession. A patient presented to the office with an existing set of dentures that were about 18 years of age (Figure 1). He complained that his maxillary and mandibular dentures were loose, painful and unaesthetic (Figure 2). He wanted to have a new set of dentures fabricated before a big overseas business trip that was already scheduled within a week. In order to save time and reduce the number of appointments, I would bypass having record bases with wax rims fabricated going through the traditional 4-5 visit technique. Instead, I would utilize the patients existing dentures as custom impression trays. Using a medium body impression material, I would take

reline impressions using their existing dentures. In addition, I would take a bite relationship. These molds would be taken in the morning and forwarded to a local lab where they could be poured up and mounted with the patients relations. The dental lab would have all the information needed in regard to tooth shape, size and color. Any alterations to these characterizations of the existing denture would be instructed in the lab Rx. By that afternoon, the patients existing dentures would be returned to the patient while the dental laboratory would work on the new set of dentures. However, in this particular situation the patient refused to leave his dentures with us because he had meetings throughout the week for several hours a day. Because of this, I figured we could create a duplicate denture using a Lang Duplicator (or something similar to it) and go through the same impression and relations steps mentioned earlier. It seemed like a plan until I carefully looked at the malocclusion and setting of his existing dentures. Did I really want to use these dentures as a guide for the final prosthesis especially ones that would be fabricated in such a short amount of time? It was at that time I remembered seeing a presentation at the IDS (International Dental Show) in Cologne, Germany, from a company named Goodfit on a product called the All-in-One Denture Tray. This product was an adjustable impression tray made of dental PMMA (poly-methyl methacrylate) in the form of a complete denture that was thermoplastic when heated in boiling water (Figure 3). The All-in-One Denture Trays could be adapted and fitted within the mouth in minutes, serving as custom impression trays

Figure 2 Pre-Operative Retracted View

Figure 3 All-in-One Denture Tray

Figure 4 Internal View of Tray

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FEBRUARy 2014

and providing all the data required for complete denture fabrication in just one clinical visit (Figure 4). I quickly relocated the samples I had received at the IDS and started my water heater so that I could heat the All-in-One Denture Trays. Within a couple minutes, the water was boiling and the materials softened (Figure 5). At that point I removed the upper All-in-One Denture Tray and allowed it to cool at a temperature that was comfortable on my wrist before placing it in the patients mouth. While the material was still moldable, I placed it in the patients mouth and pressed up onto the palate so that the material was flush. The midline of the All-in-One Denture Tray was easily lined up beneath the nose and the incisal edges brought to an area where they were slightly showing at rest. The patient was asked to smile, so that the midline and the high lip line (smile line) were confirmed. This is much easier than trying to imagine where the teeth would be in a wax-rim. Once the teeth were in an appropriate position and the All-in-One Denture Tray seated comfortably in the patients mouth, an adhesive for a polyvinylsiloxane impression material was placed on the internal aspect of the tray and allowed to dry. Once dry, a medium body impression material (Take One Advance, Kerr) was placed within the All-in-One Denture Tray. While the material was setting it was important to border mold by asking the patient to make specific movements while using my hand to massage the areas of the extensions. Once set, the impression was inspected to make sure there was good vestibular extension without bubbles and all the anatomic landmarks from that arch (Figure 6). The same techniques for molding the Allin-One Denture Tray were reproduced for the lower arch. However, while still in its moldable stage, we had the patient bite down until the appropriate vertical dimension was achieved. Once shaped and formed, the reline impression was taken using the same type of impression material. Any alterations in tooth size, gingival height or midline could be identified using a Sharpie marker on the All-in-One Denture Trays and instructed to the dental laboratory.

Within a few days the dental lab had already fabricated a wax try-in of the maxillary and mandibular dentures by using the impressions and relations from the All-in-One Denture Tray. When tried in the mouth, the patient was very pleased with the wax try-in (Figure 7) and signed off for fabrication of the final prosthesis. Two days later, the dentures were delivered to the office and tried in for fit and function. Phonetics was checked as well as occlusion. The patient stated he was very pleased with the aesthetics and fit of his new teeth (Figure 8)! As the population in the United States ages, there is an increased demand for removable prosthetics. It is estimated that nearly 3.45 million people undergo denture replacement/ fabrication each year with a yearly expenditure of approximately $9 billion. By providing removable prosthodontics effectively and efficiently with the use of new materials and methods, dentists can provide comprehensive dentistry for their patients and increase the revenue in their practices. For more information log on to www.goodfit.com.
Dr. Nazarian maintains a private practice in Troy, Michigan, with an emphasis on comprehensive and restorative care. He is a Diplomate in the International Congress of Oral Implantologists (ICOI). His articles have been published in many of todays popular dental publications. Dr. Nazarian is the director of the Reconstructive Dentistry Institute. He has conducted lectures and hands-on workshops on aesthetic materials and dental implants throughout the United States, Europe, New Zealand and Australia. Dr. Nazarian is also the creator of the DemoDent patient education model system. He can be reached at (248) 4570500 or at the website www.aranazariandds. com.

Figure 5 Tray being moulded

Figure 6 Reline Impression

Figure 7 Wax Try-In of Teeth

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41

CLINICAL

Treatment and Patient Management

by Dr. Craig Callen
s it just me or is everyone seeing more cracked teeth in their practice these days? Maybe it is that patients are retaining teeth longer, or maybe it is a commentary on the economy and the stress patients find themselves under. Some of the teeth are more obvious than others and have large fillings, while some are virgin teeth and hard to see any cracks at all. We often need to rely on process of elimination and our diagnostic skills to make a proper diagnosis. All the while you have that angst you are dealing with because of the fear of the unknown. What will you find when you treat the tooth? Will it respond to treatment? How will the patient react to treatment that has a high incidence of failure? All of this pretty much comes down to how you educate and inform the patient of the treatment, prognosis and options. So lets look at this one step at a time:

Cracked Teeth
I

patient. They need to have a clear understanding of the treatment options, progression of treatment and the high possibility of failure. Maybe given all the options they elect to remove the tooth. You will need to have a clear policy on fees and communicate that up front and it may change from case to case. Are you going to credit them for a new crown if you place a crown and 3 months later you end up doing a root canal? What will you do if you perform a root canal and crown and the tooth fails and requires an implant and crown. Are you assuming the financial risk, the patient, or are you sharing it? Regardless of your policy, the patient should know this up front. (See patient hand out on next page).

1.) Diagnosis: The first thing you want is a good history on the tooth. If the tooth is sensitive to biting pressure with the pain lingering after release of pressure that is a positive sign of a cracked tooth. Next I bring out my Tooth SleuthTM, which is a plastic instrument for the patient to bite on that will isolate the cusps. I try to reproduce the pain the patient is experiencing. Sometimes I will place caries detector dye on the tooth to highlight a crack. This also comes in handy if you have prepared the tooth. Obviously I am looking with loops and an LED head light. Trans illumination will occasionally make the crack visible. An X-ray is a must, but often not much help. We may take a picture with our intra oral camera and put it up on our large monitor to look for a crack. If the crack is visible, I will stain it and take a picture for documentation. A new option is to refer it for a 3D scan to my friendly Oral surgeon which has proven at times to be a life saver and saved me the aggravation of trying to treat a hopeless tooth. 2.) Patient Management: Arguably the most important part of this process is how you handle the 42

3.) Treatment: Once you have made your diagnosis and informed your patient, treatment is pretty straight forward. The first step would be to place a full temporary crown and permanently cement it. I would leave them in a temporary for 2-3 months to make sure the tooth is symptom free before I would place a permanent crown. Sometimes when preparing the tooth it becomes obvious that you need to proceed to root canal or tooth removal. Sometimes things look good and the tooth settles down. If not, then root canal is the next step. Even though the root canal may look easy, these are teeth I tend to refer out. I dont like to see my root canals fail and have that doubt in the patients mind that I did not do something correctly. For me, this is a case of spreading the responsibility around a little bit. It never hurts to have a specialist give the patient a concurring second opinion. If the patient does not want to share in the financial risk or drawn out unpredictable treatment, then an implant or bridge becomes a viable option.
Cracked teeth, while difficult to manage, can be dealt with in a logical fashion with no hard feelings on the part of the patient if you have your management procedures in place. Your staff also needs to clearly understand the process and be able to communicate that to the patient to minimize misunderstandings.
Olivier/bigstock.com

F EBRUAR E B R U A RY y 2 20 01 14 4

FREE Special Report Reveals...

The Ultimate Wealth-Building and Equipment Financing Strategy for Dentists

Cracked Tooth Syndrome

One of the most difficult things we sometimes have to do as dentists is to diagnose and treat cracked teeth. Teeth will crack from a variety of causes from large old fillings to trauma. Occasionally we will even see a cracked tooth where there has never even been a filling placed in the tooth. One of the big problems for us is that the cracks are not always visible to the human eye and cannot be seen on an X-ray film. We have some tests we can perform and we listen closely to the problems or symptoms you describe to us, such as pain upon chewing to determine our course of action. Once a tooth is prepared the crack often becomes more visible. Sometimes when preparing a tooth a cusp will fall right off. Sometimes preparing the tooth becomes part of determining the long term chances for success. So what are the treatments for cracked teeth? 1.) If the pain is moderate, we will first try to crown or cap the tooth. If the tooth is comfortable in the temporary crown after a few months we will cement the permanent crown and hope that takes care of the problem. 2.) If the pain is more severe, or the temporary crown does not alleviate the pain, then it becomes necessary to do root canal treatment to deaden the nerve. Then we place the crown. 3.) It is possible that the crack is too severe and even root canal treatment will not work. Then the only options are removal of the tooth and replacement with an implant, bridge or removable partial. Because of the difficulty in treating cracked teeth, we may elect to complete the root canal treatment here, or refer you to a root canal specialist with a microscope to evaluate and treat the tooth. Be aware that this is hard to diagnose and treating the problem could escalate from a simple crown to the loss of a tooth. There is no way to predict the success of this procedure. There is some financial risk in progressing with treatment and we will discuss that with you during our financial arrangements.
Dr. Callen can be reached at craigcallendds@gmail.com.

Have you ever sat down and totaled how much youve spent on financing costs for your practice? Whether you finance or lease your equipment, its going to cost you hundreds of thousands of dollars in interest payments youre never going to see again! But it doesnt have to be that way. You can bypass banks and financing institutions altogether, become your own source of financing and recapture all the interest you now pay to finance companies. Imagine being able to get your hands on the capital you need to build a cutting-edge practice and gain an almost unfair advantage over every other dentist in your area by answering only one Pamela Yellen question: How much do you want? Financial Security Expert 2012, 2013 Spring Break Best of all, the money you Seminar Presenter withdraw to finance your practice continues to earn interest and dividends just as if you never took it out! Youll discover exactly how this works on page 12 of my FREE Special Report, available at: www.BankOnYourself.com/dentists Ive spoken twice at the Excellence in Dentistry Spring Break Seminar, and this is what Dr. Woody Oakes said about my presentation: You simply CANNOT afford to not have this information for you, your family, and your friends and team! - Woody Oakes, DDS In my FREE Report, I also reveal... The wealth-building strategy that has never had a losing year for the past 160 years! How to access the money in your plan with no taxes or penalties or restrictions when you want and for whatever you want How to have the peace of mind that comes from steady, predictable growth of your money, year in and year out. Youll know the guaranteed value of your retirement account on the day youll want to tap into it... and every point along the way (on page 7) Dont you owe it to yourself, your practice and your family to at least check it out by getting your FREE Report here right away? www.BankOnYourself.com/dentists

CLINICAL

The Million Dollar Smile

by Dr. Johnny Savage
e all have created the million dollar smile for patients who have a million dollars by crowning 28 teeth with porcelain. I have had the privilege of doing this for many patients who are wealthy, but in this article I want to share with you the techniques I have learned to create a million dollar smile for patients with little or no money. To accomplish this, I have had to learn how to use and be very creative with composites and I would love to share with you some of my suggestions. Before I start on my idea for composites, allow me to share a little of my background. My office may be the most isolated office in America located in the river swamps of Northwest Florida. Yes, swamps with alligators, snakes and turtles! My age is 80 and Ive been in practice for 54 years and truly cannot wait to get back to my office having the privilege of serving people as a dentist. One thought of philosophy here: If you become deeply interested in anything it will become interesting to you. I am still studying and learning how to be a better dentist so I have never had any thoughts of burn out. And, I believe that the relationships I have with myself, Pat and Faye (the two wonderful women I work with) and my patients is the most important goal in my practice. Now, lets discuss techniques for a beautiful low-cost smile. First I bleach! Bleach! Bleach! Sometimes for months until we get that white color that everyone seems to be looking for. In our office, models and trays work best and if we get sensitive teeth, I suggest they put Sensodyne tooth paste in the trays and wear them for about 30 minutes each day. This seems to help. When the color is what they want, then we can begin to use our composite to rotate teeth, close spaces, add length, or replace decay or old discolored restorations. One important suggestion here dont leave your

operatory light focused on your composites before you cure them. Any that you select seem to be good. But, for me one of the best investments I ever made was the light that had a light option that did not cure composites. I bought it the minute I saw it and very much like the fast curing lights. Now lets discuss composites. In 1984, a very close friend had spaces between his six upper teeth and I asked his approval to use six different composites to close the spaces. He takes outstanding care of his mouth and they still do not need replacing 29 years later. So it may be more important how a person cleans their teeth and the technique we use to place composites than which composite we use. You cant go wrong with any of Gordons recommendations. My present favorite is estilite. I have used just about every bonding agent on the market and most seem to work well but in every case where I am in deep dentin or close to the nerve, I use amalgam bond by Parkell. It is a self cure so you dont have to get your light into a difficult place. It comes with a powder you can add for nerve capping or if you want an extra strong bond to composite. I have used it in difficult cases for over 20 years and it is my all-time favorite. Please try it on an extracted tooth, bond composites to it and you will be impressed. Many years ago, when Maryland bridges became popular, I, of course, tried them. I could never get them to stay in for any length of time. A patient came in with a #10 Maryland bridge out and with a very important event that night. The enamel was very good on teeth #9 and 11. So I wondered, Could I bond in a replacement tooth? I spent several hours trying to be creative and when I finished, it looked better than the Maryland Bridge. The patient and I were thrilled! I was practicing in Atlanta then, so I named it the Georgia Bridge. Since then, I have done over 1,100 Georgia Bridges and followed

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FEBRUARy 2014

some for over 30 years. In some cases, they are my bridge of choice. For example, a patient who has too loose a lower central or lateral, I can replace it that day and if they have perio problems, bond all six lowers and get great long time results. I have written an article on my technique and if you want a copy, call me at 850-535-2257. The Georgia Bridge has allowed me to help many people with limited income. The most difficult bonding I do is when I bond 28 teeth and open the vertical relationship 3 mm or more. Lets discuss this. How do I determine vertical when I can open vertical without causing problems? Over 40 years ago, I attended a lecture with Dr. Earl Pound, a gifted prosthodontist from California, who was teaching how to determine vertical for dentures when all teeth were lost and all vertical relationships were gone. His suggestion put the anterior teeth on the base plates, have the patient stand up and have the patient count from 60 to 70. If the anterior teeth just touch, you have a good vertical. If the teeth touch too hard, you have opened too much. If there is too much space, then you have not opened enough. Please stop now! Stand up, look In the mirror and count from 60 to 70 and you will have an immediate answer as to whether you could be opened or not. With this information, let me start a complex case bonding 28 teeth and opening the vertical 3 mm. This patient was night grinding and had worn over half the surface off his upper and lower teeth. I added composite to #8 and #25 and adjusted the composite to a light touch when he counted 60 to 70. Then I began the process of establishing ideal anatomy of the 12 anterior teeth. Again, I ask the patient to stand up and check and adjust vertical to ideal. Two things I work hard to accomplish at this time are group function and cuspid rise. Then I work on ideal anatomy for the lower posterior teeth leaving room for good anatomy on the upper posteriors. Most important, make certain you have cuspid rise to disclude all posterior cuspids when the patient moves into a working relationship on both sides. When I completed this case, the 32 year old, 62 tall, 220 pound male was only in composite contact on all teeth. Ten years later, what has happened? Three gold crowns on 2nd molars and no wear yes, no wear on the 12 anterior teeth. He stopped night grinding. I believe the reason he has no wear on the anterior teeth is group function and again cuspid rise on the working side. Was this easy for me? No. I started his case on Monday at 9 a.m. and finished Wednesday at 3 p.m.
800-337-8467

The results he had a beautiful and confident smile, ideal vertical which we worked out in composite and a good position to replace any crowns in the future. There are so many things in our profession I am deeply grateful for bonding and composites are two of them.
Johnny has both dental and law degrees from Emory University in Atlanta. While in dental school, he was elected President of the student body. After graduation, he was a dentist in the Navy on an icebreaker for two trips to Antarctica and upon return served in the Georgia Legislature. He currently practices dentistry in the river swamps of northwest Florida, thirty miles from the closest town. You may contact Johnny at 850-535-2257.

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CLINICAL

Tackling the Causes of Periodontal Disease, Head On!

by Patricia Worcester RDH, BS

e fix it after we find it. Lets try to eliminate periodontal disease before we even have it; instead of waiting until we have periodontal disease, we need to work diligently to prevent it. Periodontal disease is on the rise and increasing because of poor host immunity factors. I will discuss how to use these risk factors to help regulate and improve our patients health standards in order to prevent periodontal diseases. We need to help our patients understand the importance of their total health to maintain and improve their dental health. The new model of periodontal disease consists of environmental and acquired risk factors and host immuno inflammatory responses. Below are lists of factors that contribute to the cause of gingival and periodontal diseases. I created and use the pie chart on the next page to explain all these factors to our patients. The pie chart is easy for the patient to understand and a great visual tool to educate patients to all the factors that are giving them oral diseases.

have gum and periodontal diseases. Only SRP/RDTs will treat periodontal diseases. Improving oral hygiene will not treat the condition. Our patients must fully understand that increasing their oral hygiene is a very small piece of the pie that is causing them to break down and attract diseases. This discussion is going to describe risk factors for periodontal diseases and make suggestions to help our patients build their host resistance. The following 12 risk factors, which are many times overlooked when assessing our patients periodontal risk factors, will be discussed in this article. The following information will help you and your patients have a better understanding as to why with excellent oral hygiene gum and periodontal diseases can be present.

Until recently, I did not have a full understanding of how critical the HOST factors are to suppressing our immune system and cause us to suffer from gum and periodontal diseases. By using my pie chart, my patients soon understood the entire model of host resistance and I use an erasable marker to check off all the factors periodontal diseases. We need to be talking about all of the patient possesses to help them understand why they the factors and how they contribute to the patient having oral diseases. Of course I want our patients to practice good oral hygiene. The important point, however, is that The most common risk factors the presence of periodontal diseases can for periodontal diseases be found even in people with excellent oral Male gender Other contributing risk factors hygiene. It is not just a low socio-economic Older than 30 for periodontal diseases disease. By fully understanding this, we IL-1 genetic polymorphism Dry Mouth can begin a full assessment of our patients Metabolic syndrome Aging and recommend total health care to boost Diabetes Grinding the host resistance. We must review all the other factors to help the patient understand Obesity Nutrition their susceptibility to gum and periodontal Smoking Sugars diseases. Osteopenia/osteoporosis Medications DRY MOUTH: There are over 3,000 Low calcium intake Herbal supplements prescriptions and over the counter products Low intake of vitamins C and D Lack of sleep that cause dry mouth. Dry mouth is a Consume more than 5 alcoholic Communicable causative factor for gingival and periodontal beverages per week Illegal Drugs diseases and tooth decay. Full discussion Stress, distress, depression of dry mouth products and plenty of water Hormones

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Laminate this chart as a visual to help educate patients in your office

e rie fg ft

Factors Contributing to Periodontal Disease

Factors Contributing to Periodontal Disease

Sugars Host Resistance Nutrition Herbs

Grinding

Sleep

Dry Mouth

Communicable

Oral Hygiene

Stress

Medications

Drugs

Diseases

Genetics

Smoking Hormones Gender

Age

How many do you have?

CLINICAL

is advisable for help with lubrication and hydration. I recommend Biotene, Perio Sciences, fluoride at home rinses and office fluoride varnish treatments. GRINDING: Grinding puts forces on the fibers that hold the teeth and stress on the jawbone. During the day when you clench and grind, you put 200 lbs. per square inch on your teeth, periodontal ligaments, fibers and alveolar bone. Nighttime grinding and clenching creates 900 lbs. per square inch on your teeth, periodontal ligaments, fibers and alveolar bone. This is very detrimental to periodontal health and necessitates a night guard. NUTRITION: Nutrition is crucial to a strong host resistance. The daily requirement was 4-6 servings of fruits and vegetables per day. Due to the soil being depleted of nutrients, our food does not have the same nutritional value as it once did. Now the recommendation is 8-12 servings per day. Most of my patients say they are hard pressed to get 4-6 servings per day, let alone 8-12 servings. Bone loss is caused by high cholesterol in the diet, eating fatty foods, low calcium, low vitamin C and D, menopause and stress. Recommending daily multiple vitamins will help us receive the required daily nutrients. Along with a multiple vitamin, I also recommend CoQ 10, Calcium, Vitamin C and D, daily for improved oral health. Stressing minimizing the in-take of fatty foods and keeping cholesterol maintained in a healthy manner will help prevent bone loss. HERBAL SUPPLEMENTS: Herbs have many health benefits; unfortunately, they also have side effects. One of which is a mild blood thinner. The side effect of any herb that starts with the letter G is bleeding. Garlic, ginger and genko are a few that cause an increase in bleeding gingiva. These herbs are great for heart patients, and many physicians recommend their use. We need to be aware of the herbs our patients are taking and talk about the side effects. I share with my patients that the herbs are helping their general health and we will deal with the side effects of increased bleeding. Many people need to stay on these herbal supplements, so we will need to shorten their time between hygiene maintenance visits or perform more frequent SRPs to maintain their oral health along with their general health. SLEEP: If you get 6 or less hours of sleep per night, you are more susceptible to health problems including being more prone to infections. Lack of sleep increases the susceptibility to gingival and periodontal diseases threefold. I recommend my patients get at least 7 hours of sleep per night, 8 hours if possible. STRESS: Stress is very harmful to our general health.

When we are under stress, our bodies produce cortisol, which is a hormone that affects inflammation. Stress makes a person 2-7 times more susceptible to gingival and periodontal diseases. When my patient has more bleeding and an increase in their periodontal pockets, the first question I ask is how is their stress level. The patient usually responds their stress is up. When stress is elevated, we dont sleep well, eat properly, or exercise. Stress affects us in a multitude of ways to break down our host resistance and make us more prone to many illnesses. I recommend we all take 10 minutes per day for meditation to help alleviate stresses. DRUGS: This includes alcohol and illegal drugs. A 30% increase risk for periodontal disease is seen in people who drink more than five alcoholic beverages per week. Consuming 10 or more alcoholic beverages per week, increases your risk for periodontal diseases by 40%. Illegal drug use can increase the risk factors to gingival and periodontal diseases more than twenty times. GENETICS: The genetic gene for periodontal disease is found in about 30% of the population. Your risk to develop periodontal diseases increases by 7-19 times by having the genetic gene. A person with the genetic gene has four times the amount of bacteria in their mouth and will present with severe bleeding even if their pockets are shallow. The signs of gingival and periodontal diseases will appear twenty years earlier if the genetic gene is present. HORMONES: Studies have shown relationships between estrogen deficiency and increased gingival inflammation, including bleeding on probing. Estrogen deficient women have a higher incidence of clinical attachment loss and less alveolar bone density. Estrogen deficient women have been shown to have higher gingival crevicular fluid levels of IL-1B. The relationship of IL-1B to bleeding has also been shown to be independent of biofilm. In other words, our patients can have excellent oral hygiene and no biofilm and still have periodontal breakdown. AGING: As we age, we are more prone to periodontal diseases. 75%-85% of people 60 years old and older have periodontal diseases. In males, at age 50 and older, periodontal disease hits hard and fast to cause severe periodontal destruction in a short amount of time. COMMUNICABLE: Periodontal disease is communicable. The bacteria can be passed between parent and child, spouses, siblings, etc. If your patient does not respond to SRP and maintenance, they might be getting re-infected from their spouse or significant other. Explain to your patient that they can pass on their infection to others.

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Periodontal disease consists of bacteria, viruses, yeasts and molds, which can all be communicable. SYSTEMIC DISEASES AND CONDITIONS: If you are 45 years old or older and have diabetes, you are at 3 times the risk for periodontal diseases. Plus, a diabetic has a much harder time controlling their condition if they have periodontal diseases. A post-menopausal female who has osteoporosis is 86% more likely to have gingival and periodontal diseases. Compromised immune system diseases make you 3-5 times more likely to have gingival and periodontal diseases. Depression is being studied by the Archives of Internal Medicine, because less bone density is seen in people suffering from depression. Research is studying if it is the anti-depressant medications affecting the bone density, or is it the disease of depression that is affecting the bone density. When our host resistance is lowered, we are 2-7 times more susceptible to oral infections. We help our patients by performing SRP/RDTs along with diligent re-care visits. We must enlarge the patients scope of health by teaching nutrition, vitamins, stress reduction, herbal supplements, sleep habits, genetics, hormones, smoking and systemic

diseases. When you add all the patients pie slices together, this equals a very compromised host resistance and we need to help fortify our patients HOST. PLEASE research current information and realize that oral hygiene is a very small piece of the pie. Feel free to cut out and lamiate the chart on page 47 to help educate your patients and your team. Most of our patients have numerous slices that are making them susceptible to periodontal diseases and we must be aware of what to look for because it is not just about plaque control anymore!
Pat is an international speaker, published author, practiced fulltime hygiene for over three decades, and is a trainer to dental practices across the United States, Canada and the United Kingdom. She is an Instrument and Product Analyst for DENTSPLY International and Thought Leader for Hu-Friedy Dental Instruments. Pat is founder and clinical director of Mission PossibleBest Hygiene seminars and clinical hands-on training programs. Combining working on your patients, your team and your practice for RESULTS! Healthy Patients = Healthy Profits You may contact Pat at: 954-536-0700. Call today for a free analysis of your hygiene department, patworcester@comcast.net, wwwmissionpossiblehygiene.com.

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CLINICAL

Updating and Improving Endo Technique

by Dr. Michael DiTolla
have known for a while that I needed to update my endo technique. Like the vast majority of you, in dental school I was taught to shape canals with Hedstrom hand files, irrigate with sodium hypochlorite in a disposable syringe and obturate with gutta percha using lateral condensation: not the picture of efficiency. After a few weeks of investigation I settled on Axis|Sybron Endo and their TF Adaptive system with the Elements motor for instrumentation, their EndoVac system for irrigation and their Elements Obturation system. The good news is you can get better results with less effort for the same fee: thats what technology is supposed to do. When set on TF Adaptive, the Elements motor (fig.1) rotates clockwise and depending on the load on the file, adapts and reverses counter-clockwise by coasting in a reciprocal motion. This keeps excessive stress off the file and avoids the screw-in effect of pure rotary systems. I am able to treat almost all teeth with just two files: one to create the desired taper and one to enlarge the apical portion of the canal. Three files are provided and are color coded to a traffic signal, which my assistants love. Shaping has never been simpler. EndoVac (fig.2) is a negative pressure irrigation system. The MicroCannula is able to reach the canal working length and provides suction through small openings around its tip while the sodium hypochlorite is introduced from the top of the canal. Irrigant can finally get to the apical 3 to 4 mm of the canal, with no fear of extruding past the apex. Search EndoVac Animation on YouTube to see it in action.
Figure 2

Figure 1

The Elements Obturation unit (fig.3) is two instruments in one: the System B handpiece that is used for downpack, backfill and as a heat source for vitality testing. The System B pluggers match the canal shape and maximize condensation forces, moving gutta percha and sealer into all areas of the canal, including lateral canals. The other instrument is the extruder that uses disposable cartridges to deliver gutta percha. Filling the entire coronal two-thirds of the canal with dense, void-free gutta percha in 3 seconds is an amazing feeling! If you have ever wished that endo could be done with three or less files, or wished you could safely get irrigant to the apex, or wished you could fill lateral canals like in the magazines; then you owe it to yourself to go to www.sybronendo.com and get a demo.
Dr. DiTolla is the Director of Clinical Research and Education at Glidewell Laboratory. Dr. DiTolla is Editor in Chief for Chairside Magazine, has a monthly column on restorative dentistry in Dental Economics. He has been lecturing on restorative dentistry topics since 1995.

Figure 3

Dr. DiTolla can be reached at: mcditolla@mac.com or www.drditolla.com.

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Serving The Profitable Dentist subscribers for over a decade.

We serve patients nationwide with offices in Charleston, SC and Charlotte, NC.

Dr. Mickey Barber, President of Cenegenics Carolinas, recently received the top honor in her field from the Age Management Medicine Group the Alan P. Mintz, MD Award. The award honors Dr. Barbers years of superior patient care, dedication and entrepreneurship in the medical specialty. You deserve the best... choose Cenegenics Carolinas. Cenegenics Carolinas patients begin experiencing a new definition of aging in less than 60 days:

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877-317-LIFE (5433)

CLINICAL

How to Sell Sealants

by Dr. Woody Oakes
1) In the operatory is a sign that reads... A tooth without a sealant is like a car without a seatbelt. The sign is a conversation starter for both pedo and adult sealants.

2) The dialogue goes something like this Hey John, you have a couple of small cavities we found today that need to be fixed. Id recommend that we also place sealants on the rest of your teeth so they dont get cavities. 3) Then we use a visual model that we hand to the patient. We take a plastic drinking cup and fill it with white plaster. Before the plaster sets, we place a virgin biscup and a bombed out biscupid. Once the plaster sets, we peel away the cups to leave a block of plaster with two teeth. 4) John heres a tooth that was protected by a sealant and heres a tooth that wasnt protected. Here are some photos of my mouth that shows my teeth that have been sealed. So what do you think? We can do them today if you want! 5) We offer a special fee for full mouth sealants. In other words, rather than charge $30/sealant just go ahead and offer to do everything for say $500.

Return on Investment - continued from page 30

frequency, etc. When everything is done right, then you get a high ROI. Marketing must also be tracked. If it is not properly tracked, then you have no data to make intelligent decisions about your marketing. You must know the response rate, the number of phone calls, the conversion rate of calls to appointments, the number of new patients per marketing campaign, the case average per marketing campaign and the return on investment in that month per marketing campaign. You need to hire someone to do this tracking by putting together a marketing dashboard. You dont have the time to do this yourself. I have dentists tell me that they tried direct mail, or radio, or whatever and it didnt work for them. Yet, they have no data from which to know why that particular campaign didnt work. Many times the marketing does work in generating phone calls to the office, but the people answering the phone did not know how to covert the caller to a new patient appointment. You can track this by using an Internet call tracking service that records every marketing inbound phone call. Marketing done right is very profitable. Marketing done wrong is very expensive. The key to increase your revenue and receive the business owner ROI you deserve is to hire a practice management consultant. Dentists using consultants statistically make more revenue than dentists that dont. Hire a good consultant because this is the best way to rapidly grow your practice. You probably went to dental school because you like helping people. You probably did not go to dental school because you are entrepreneurial. If you found an employee that could turn your practice around and double or triple your revenue, would you hire them? Of course you would. This is what a consultant is. For about the same cost as another employee, you can hire a practice management consultant. You should expect a large ROI on a consultant. The cost, time, energy and effort are high, so the ROI should also be high. The right consultant can deliver this for you. Seize the opportunity and make 2014 your best year ever! Focus on ROI over cost and practice the business of dentistry in a way that produces rapid growth in your practice.
Dr. Mike Kesner is a practicing dentist and author of MultiMillion-Dollar Dental Practice. He is founder and CEO of Quantum Leap Success in Dentistry, a consulting company that helps dentists build the practices of their dreams in 24 months or less Guaranteed! Dr. Kesner speaks nationally on topics related to mastering the business of dentistry. You may contact Dr. Kesner at 480-282-8989 or drkesner@QLSuccess.com. His website is: www.QLSuccess.com.

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Tired of Roadblocks In Your Practice?

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John J. Meis, DDS, FAGD, DICOI Wendy Briggs, RDH

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CLINICAL

The Truth About Dental Sleep Medicine:

An inside look at medical insurance billing in dental practices
by Nick Carlone

he Implementation of dental sleep medicine programs has grown in dental practices across the country over the last few years. Many of these programs promote Sleep Medicine as a standalone revenue generator for practices everywhere, and with an exception to select dentists; this is not exactly a realistic expectation. The purpose of this article is not to deter dentists from implementing sleep medicine into their practice, but I hope this serves to educate on the realities of the industry and help manage expectations. This can be a very solid revenue stream, but the idea that your practice can rely on dental sleep medicine as its only offering is a misconception for the vast majority of practices. Like anything else, it ultimately is what you make of it, but there are limiting issues for every practice to think about before implementation. For this article I want to focus on the main realities of this industry when it comes to medical insurance billing. Our company, Sleep Optima, serves as a third party billing entity and we have 7 years experience billing medical insurance. We pride ourselves, on our industry knowledge and experience. We work directly with medical insurance companies, while being pioneers when it comes to other procedures in a dental practice that may also be billed medically. We specialize in billing for home sleep testing, oral appliance therapy, and TMD, with successful experience billing for extended procedure that may be deemed a medical necessity and are a covered benefit by the patients medical insurance plan. A few examples of extended medical billing procedure are implants, bone grafting, ruptured tooth, radiographs including cone beam images, botox etc.

VectorHere/bigstock.com

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Each insurance claim has multiple hoops to jump through, and each case will be handled differently. Each case will generally be broken down in these steps (though each is not always necessary); verification of patient benefits, pre-authorizations, claim submission and denial management. I will not spend much time discussing the actual process, most practices that have tried medical billing know the extensive work and time medical insurance takes vs dental. I would rather take this time to cover what each of you would like to know, how much will the insurance companies pay? The short answer is, unless you are in network with the medical insurance company, you wont know. I know, very helpful right? Unfortunately because you are out of network the insurance companies will not disclose the allowed amount which leads to much frustration in this industry. What all of you must understand is there are so many variables such as state regulations, what specific insurance company we are dealing with and the patients individual plan. With all of these factors how could any sleep medicine program guarantee what revenue you can add to your practice? What I hope you all take away from this article is not a definitive answer but rather a better understanding of what to expect. When we verify benefits the main information we obtain is the following; is the procedure a covered benefit, what is the percentage of the allowable that will be covered once the deductible has been met, the out of network deductible, what has been met of that deductible, what is the out of pocket, how much of the out of pocket has been met, are any pre-authorizations necessary? Having these questions answered will give you a better idea of what percentage the insurance company will pay, but you will never know the exact amount the patient will be reimbursed. Each insurance company and insurance plan has a different allowed amount for each specific medical procedure which they think of as usual and customary that is billed for, so even if they tell you it is covered at seventy percent, the question still remains, seventy percent of what? Note: This allowable will not be told to an out of network provider. Lets get to the point: We generally see allowed amounts for oral appliance

therapy in the $800-$2,500 range. Again this is not an absolute; it can be more, it can be less. We normally see the out of network coverage at 50%-80% of the allowed amount, with the more common coverage at 60% or 70%. Note: these percentages are only covered once the out of network deductible has been met, which is another variable to account for. If the insurance specialists tell you the procedure is covered at 90% with a $250 deductible, double check that they are looking at the out of network benefits (happens all of the time). To sum this section up I will point out that the general ranges for oral appliance therapy code E0486 will be 50%-80% of $800-$2,500. There are ways to leverage the insurance companies by including the consultations, radiographs follow up visits etc. because all of those procedures have their own allowed amounts. Again, this is not to deter you from implementing sleep medicine into your practice but to put a realistic spin on the industry. The profit margins are still very much in your favor, a general range of lab fees for oral appliance therapy will run $230-$610, while your total claim should generally average $2,800-$5,500. We have had claims pay much higher, but again, I am speaking in generalizations, of that $2,800$5,500, only about $1,500-$3,500 should be billed for the oral appliance itself. Many dentists make the mistake of saying, Since the insurance company pays on percentages, shouldnt we jack up the price? NO! Bottom line, the insurance companies allowable will be what they deem as reasonable and customary. The entire medical insurance process is very complicated and there is much more than what I have written about in this article. This is why a billing specialist or third party billing entity is needed to maximize your practices reimbursement. For the few who can make this a standalone business, I can guarantee they have a strong understanding and thorough education on the medical billing side. For the rest of you, understand this can be a very lucrative revenue stream while truly improving your patients quality of life. We understand treating the patient comes first, but understanding this is a business is crucial to your practices successful implementation of dental sleep medicine and medical insurance billing.
For more information please contact us at Sleep Optima at 877.643.1613 or on the web at www.sleepoptima.com.

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DoCtOr BeWaRe
by Dr. Craig Callen

o you ever feel like you have a target taped on the back of your clinic coat? Between malpractice lawyers, State and Federal Agencies you really do.

Many of you may or may not know that I have been fighting an IRS audit for the last 3.5 yrs. It was probably triggered by an accounting error my now EX-accountant made. But a major reason I was audited was because I am a doctor. How do I know this? The agent who spent half a day at my office, 2 full days at my accountants office and half a day at my farm divulged this to me in a conversation. When only 47% of the country pays income tax and we are running at huge deficits, who are they going to go after for more money? You got it. YOU have a target on your back. So what happened? The IRS did a full audit on my practice, rental properties and alpaca farm. For the practice, they primarily looked at my huge advertising budget and patient refunds. They asked for proof of both which I readily provided. They did not believe that I spent as much as I do on advertising. I asked the agent, How did you find my phone number? He said, The Yellow Pages. I said, Well there is about 2/3 (at the time) of my advertising budget. For the rentals, they had questions on interest deductions which my accountant cleared up for them. The big sticking point was the alpaca farm. While I went to the IRS website to learn what constitutes a farm as a business before I started the farm and used their guidelines to set it up, apparently this was not enough. I formed an LLC, took classes, got a yellow pages ad, website, logo, sign, phone number, sold alpaca products, had promotional events, became an employer with all taxes deducted, etc. It was again, not enough. They audited me 3 years into the farm, even though you are allowed 7 years with a breeding operation to show a profit. Consequently they disallowed all my deductions over those years. The animals alone cost $90,000. I have several friends who were in the business and made a good profit on the animals. Well, this was right before the housing crisis and the economy tanked and the value of the animals dropped. All factors out of my control. They did not care. They were going after me for $335,000 including penalties and interest because the farm did not show a profit!

mast3r/bigstock.com

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Initially my accountant tried to handle it on his own. On the advice of a consultant, I retained another accountant to help with the audit and we hired an attorney out of Maine who specialized in alpaca farm operations. She was on the committee that helped to pass a bill in Congress designating alpaca as livestock. A fact the IRS chose to discount. To make a long story short, they did not believe I had the farm as a business, but as a hobby, which makes a huge difference in how you take your deductions. I guess I was up bottle feeding baby alpacas in the middle of the winter nights for fun?? My attorney requested we retain local counsel, so we hired a tax attorney from Columbus who was familiar with the local agents and we went into the appeals process. They would drag their feet for months, yet if they wanted a decision (or information) I was always on a tight deadline. They took so long the first attorney retired from practice and the local counsel took over the case. This really disrupts your entire life. I spent about $50,000 in legal and accounting bills. The attorney basically said that they were not treating me fairly and the way I conducted my business was perfectly within the guidelines set by the IRS. All that does not matter. With the IRS you are guilty until proven innocent. Just last week after we denied them another yearlong extension (we already gave them one), we finally got them to act and negotiate. I conceded a few expenses. Realistically, I should have paid them under $10,000 with interest and penalties. The attorney got them down to me owing about $75,000. At this point they know that you will settle, because to go to court will cost another $50,000, two more years of your life and interest runs on any settlement you make. So I basically paid them to go away. Absolutely ridiculous! While I was tempted to keep fighting on principal, it becomes too much of an unnecessary drain on your life, emotionally and financially. It makes it hard to focus on the important things like family and your practice. So we settled. So what did I learn from this expensive lesson that may help you? 1.) You, as a high income earner, are in fact a target and, I think, will become more so in the future. With 15,000 new IRS agents and all the computerized auditing, if you make a decent income you will be audited. 2.) Make sure you have a really good accountant. Mine was way over his head on the audit and caused more problems than he helped. 3.) According to my attorney, Terrance A. Grady, You need to have a real good understanding from your CPA tax preparer of the IRS delinquency rules and penalties

for late filings and payment of taxes. Make sure your CPA and his or her staff does not let you miss these deadlines. The penalties for late filing of returns are very punitive. It is based upon what amount of taxes are owed on the return due date, including extensions and is 5% of that amount per month for any part of the month the return is late, up to a maximum of 25%, or five months late. The penalty can be completely avoided if the return is filed timely, even though full payment cannot be made. 4.) Always give power of attorney to your accountant/ lawyer. Do not contact or deal with them yourself. You may know dentistry, but you do not know the IRS and if you say or do the wrong thing, you will compound your problems. If there is a significant audit taking place, hire a good tax attorney. Bite the bullet and spend the money. Heck, its tax deductible and they will more than earn their pay if they are any good. Had I had the attorney involved sooner, this probably would have been settled sooner for less money. Although I have never met my attorney face-to-face, I owe him a drink or two and would not hesitate to refer others to him: Terrance A. Grady, Atty. Terrence A. Grady & Associates 100 East Broad Street, Suite 2310 Columbus, OH 43215 Phone: 614.849.0378 Fax: 614.849.0379 Email: tgrady@tgradylaw.com Website: www.tgradylaw.com 5.) Respond to requests from the IRS promptly. If you delay (or stall) they will tend to think you are stonewalling and will come at you even harder. 6.) Remember, the IRS is not your friend. They may smile and act nice, but lets just say that they are not always completely truthful. They will try to trap you if they can. To them, you are the enemy. They could care less about you or the consequences of their actions. 7.) Above all else, maintain proper and meticulous records. Above all else this is what will make or break you. Everything I had was on the computer and helped me tremendously. So I hope that none of you will face the hardships I endured, but I am sure that many of you will. So be prepared. Keep great records and if it happens and you need a shoulder to cry on, drop me a line.
Dr. Callen can be reached at craigcallendds@gmail.com.

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Oldest Practicing Dentist

the in Your State?
by Pamela Yellen
Dr. Bill Harris of Carlsbad, New Mexico, is still practicing dentistry at age 91. A couple of years ago, Dr. Paul Kincaid claimed to be the oldest practicing dentist in Kansas at age 90, with no plans to retire any time soon. Dr. J Dean Robertson of Oklahoma finally did retire at age 92 after 63 years of practice.
As laudable as these long careers are, Im guessing that you didnt enter dentistry with the idea that youd still be donning your scrubs to earn your daily bread in your 90s! Nope, not you. So you put together a plan and socked away 10%-20% of your annual income (except in those lean starting years, and maybe that year you had to replace your equipment and the year recession hit your community, and... ). Then you took all your hard-earned cash, threw it in a zip lock baggie, hopped a plane to Vegas and slammed it down on the nearest craps table and promptly lost 50% of what you had. No, wait! You wouldnt do that! Who in their right mind would do something so irresponsible?!? Instead, you took the coaching of your accountant and financial advisor and advice of your neighbor, and plunked all your hard-earned cash down in the Wall Street Casino and promptly lost 50% of all you had. Hey, youre not alone... Many people saw their investment accounts plunge by 50% or more when the dot-com bubble burst. NASDAQ technology stocks plunged 78% from March 10, 2000, to October 9, 2002. More than a decade later, the NASDAQ is still well below its 2000 high. What about investors who were more diversified? The S&P 500, a broader measure of the market, lost 49% in that same two-and-a-half-year period. After the S&P 500 peaked at 1565 in October 2007, it proceeded to lose 57% by March 2009. Thats two heartstopping losses over 49% in one decade! Honestly, folks, you cant make this stuff up. When the market began to pick up steam again in March 2009, Wall Street pundits (who just might have a vested interest?) urged us to jump back in. By the spring of 2013, they were boasting that both the S&P 500 and the Dow had hit new all-time highs! Yippee! Uh, but theres a tiny detail Wall Street forgot to mention: That 36% inflation rate from 2000 to 2013? It took an enormous bite out of the purchasing power of our dollars. When you look at the total return of the S&P 500 (including reinvested dividends), the real inflation-adjusted purchasing power of your investment remains negative after thirteen years. (Deep breath. Now is definitely the time to practice those stress reduction techniques... ) I have no idea what will be happening in the market as you read this article. It could be crashing, recovering, or doing the samba sideways. I cant predict what it will do one month from now, ten years from now, or even tomorrow. And neither can you. And neither can anybody else! And THATS the point! Too many of us have pinned our hopes for retirement on things we cant predict or count onand we never could and never will be able to. So the big question to ask yourself is (in the immortal words of Dirty Harry): Are ya feelin lucky? Since 1929 weve had three market crashes where the Dow took between 16 and 25 years to return to pre-crash levels. Even if the market looks rosy today, it might bottom out tomorrow. Can you even imagine the impact on your retirement plan if you have to wait twenty-five years for the market to recover? Do you really want to become the oldest practicing dentist in your state?

Will You Be

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Actually, given that an American Dental Association study of 1,000 dentists shows that a full 32% report symptoms of carpal tunnel syndrome, working until youre even 60 may not be an option! But enough doom and gloom! I wouldnt shove all those dismal statistics down your throat if I didnt have a better option for you. But I gotta tell you, it wasnt easy to find it! My husband Larry and I invested in all sorts of financial products and vehicles starting in 1987, but we never came close to getting the returns we were told we should get. And the three oh-so-pricey experts we hired lost us money during the longest-running bull market in history! We picked ourselves up and dusted ourselves off. Since Ive coached tens of thousands of financial advisors on building their businesses, I had access to a kazillion financial vehicles. I investigated more than 450 different financial products, strategies and vehicles. No go. Finally, one of my clients said, Have you ever heard about this? This turned out to be a little-known twist on a financial asset thats increased in value every single year for more than 160 years through depressions, recessions and good times too! (Check with your Wall Street guy and ask if hes got anything that can make that claim.) Its dividend-paying whole life insurance. No, not the whole life insurance policies Suze Orman and Dave Ramsey diss (without doing their homework, I might add). The policies Im talking about are specifically designed to supercharge guaranteed growth. Too good to be true? Ask Dan Proskauer, a VP of a major health care firm and sophisticated investor, who shares his net worth chart above. The Bank On Yourself method offers something you truly deserve, but may not havefinancial security and peace of mind. With Bank On Yourself, you can sleep well knowing your savings can only grow, never shrink. With Bank On Yourself, you know, rather than hope. Look, if you really want to continue practicing dentistry in your 90s, go for it! But do it because you choose to, not because the Wall Street Casino is forcing you to!

Increase Your Profitability!

Okay, I think Ive battered you enough about the instability of your market-based retirement account, whether its in a 401(k), IRA, SEP-IRA, or Keogh Plan. But what about the downsides of these plans themselves? In most of these plans, its like your money is locked up in a maximum-security prison where someone else calls the shotsand you barely get visitation! You will be told how much you may put in your plan, what you can and cannot invest in, how much you can borrow and how you must pay it back, how long you must wait before you can access your money, when you must access your money and how much you must withdraw (and pay taxes on) at that time. Penalties for running afoul of these regulations can be huge. And withdrawal rules are very restrictive: Youll pay penalties for taking most distributions before youre 59, and youre forced to start taking distributions when you reach 70whether or not you want to or need to. Wait! Whose money is this anyway?!? Bank On Yourself gives you complete control over the equity (cash value) in your policy. You can access your equity whenever you want, for whatever you want, with no government restrictions. There are no penalties for early withdrawals, late withdrawals, or no withdrawals. Its still your money. Just sayin.
Pamela Yellen, financial security expert and two time speaker at our Spring Break Seminar, is also the New York Times bestselling author of Bank on Yourself: The Life-Changing Secret to Growing and Protecting Your Financial Future. For a FREE report, The Ultimate Wealth Building and Retirement Strategy, go to www. BankOnYourself.com/EID

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Coaching Office of the Month

by Sasha Burau, MBA
3308 Platt Springs Rd. West Columbia, SC 29170

e often find a correlation between a doctors stress and their offices success. So, when we arrived in West Columbia, South Carolina at the office of Dr. Deno Chrysostom we were astonished to find out that he actually takes naps during his lunch hour! From the outside, this office appears to be a high stress office. Dr. Deno works out of four operatories that are almost always booked (with an overflow, 5th operatory!). He also has three other associate doctors, two of whom are in the office when he is practicing. But, he has systems in place and is very comfortable delegating, so that he can be focused on dentistry. When Dr. Deno first approached us about coaching, we were very surprised. He already had a very successful, multidoctor practice and he had some good systems in place. In addition, his son Alexander has an MBA and is his general manager, and his office manager, Lisa, is a fantastic leader and is very knowledgeable. Alexander and Lisa are great implementers and have procedures for everything from checking a patient in to leaving at the end of the day. BUT even the best are looking to be better! We began the program with a forensic, in-office visit where we spent a day in the office. This gave us insight into the systems, staff personalities and allowed us to understand the area around the practice. While in the office, Woody even checked out his lab work, crown preps and denture impressions they were excellent!!! We discovered that they just needed to tweak some of the existing systems and implement a better recall system.

Our 2-Day Mastermind Meeting in Louisville, Kentucky, is a time for our doctors to learn from one another. One of the best ideas from our meeting in August was to hold a Crown Day. Dr. Chrysostom and his team actually made plans to put this in place within the first week after leaving Kentucky. They actually marketed and held two Crown Days (which were days when they offered crowns at a discounted price) and produced over $23,000 EACH DAY. But, they took that same idea to another level and hosted two Denture Days and produced another $10,000-$15,000. At this time, they are also looking at hosting two Extraction Days. Since we have started working with them, they have added Friday hours, added another associate and they are already up over $230,000*. They are also looking at instituting a new, short-term Invisalign program and are working on implementing a stop-cancellations protocol. Their largest obstacle to overcome was their very high overhead, which was due to their large staff (over 20 employees!!). Now, with our help, they have overhead down to 60%! We still have half of the program left to implement and are looking forward to their continued success! So, where does your practice lie on the scale from: VERY STRESSED.............................NAPPING AT LUNCH 1 2 3 4 5 6 7 8 9 10 *Dr. Deno and his team still have almost a half year of coaching left. Our average client last year increased revenue over $276,000 but Dr. Deno is on track to increase almost $500,000 in one year. Wow!

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There is Only One Man on The Planet Who Can Turn Your Dental Practice into a Cash-Generating Profit- Building Springboard For Your Financial Freedom!
Dr. Woody Oakes
aka The Profitable Dentist

dental practice is a big yellow rubber raft. With enough foresight and the right strategies, you can identify and get around nearly any obstacle that comes your way before it becomes a problem. However, if youre not willing to focus on whats most important, you may be upended by a log while youre watching the scenery go by. Or, maybe youll be busy trying to fix a leak in the boat, and you wont notice the waterfall? Even if youre focusing on something important, if its not the most important thing, youre sunk! It helps to have another pair of eyes watching the river. Especially if they belong to someone whos navigated the waters many times before.
My practice was doing fairly well. We had deposited $2.2 million each of the last two years. But we had flat-lined and could not get to the next level. I knew we could do better, but didnt know how. I found out about Woodys coaching program and decided to hire him as my coach. WOW! Woody looked at EVERY aspect of my practice and with his help we will produce $3,000,000+ this year. I made $956,000 extra in 12 months on a $25,000 investment. What an ROI! And, Im excited about stayiing on with Woody in his alumnicoaching program. I would highly recommend Woody and his coaching program. Woody provides the best and the brighteest people for all aspects of your practice management. And the staff at Excellence in Dentistry is the nicest you will ever encounter.

The marketplace is like a quickly moving river, and your

a very good lifestyle. Many of his former clients have already achieved that earnings goal and are prepared to retire within 2 years. Others, present and prior, are in the process. One will net $1M/year for the next 10 years due to the exit strategy Woody created for him. Woody is truly a seasoned world-class navigator. And, he makes dental offices fly. How does he do it? With a unique combination of strategic marketing and management principles and ideas- so totally outstanding - they create quantum leaps in production and quality. He uses his Total Success Blueprint, based on over 37 years of research and application. Specifically, as a coach to over 500 dentists, and his unique ability to turn around every one of them and make them super successful in as little as 12 months! Woody also knows the secret to circumventing and outflanking the third-payment fiasco. In fact hell show you: How to develop additional profits from those formerlyunprofitable third-party payers How to create new profit centers How to get new profitable patients for your high ticket dentistry How to make your dental practice succeed- really flyregardless of the economy

Thanks for everything Woody! Youre the best! - Dr. Richard Boatman Troy, Illinois

Whos watching your boat? You are, of course. Are you too busy doing dentistry, taking more CE or managing your staff to navigate? Is your practice drifting? Will your big yellow rubber raft make it another year? Another two years? Another five? Now, close your eyes for a minute, and imagine: what if your big yellow rubber raft of a practice could fly? It can. *Dr. Woody Oakes, a dental consultant for the past 15 years, has already guided hundreds of dentists and helped them devleop an exit strategy. He decidedly maintains that any practice - with the burning desire to do so - can earn $1,000,000+ a year, or more, and only work 30 hours a week plus retire on their own terms with enough continuing annual income to maintain
*Dr. Oakes is the CEO of Excellence in Dentistry, has created 3 multi-million dollar companies and has been a dental consultant for the past 15 years.

I went from producing $42K/ month (w/outrageous overhead), to nearly $1.7M/year with real overhead of 43%. Im speechless! We tripled our net income in just 12 months! The best move we ever made professionally.

Dr. Jim Whatley, Mobile, AL

- Dr. Staci Blaha, Platte City, MO - Drs. Jim and Jennifer Rice

I was a slow starter, but we doubled monthly production and Im staying on for next years program.

- Dr. Frank Rios, Jacksonville, FL

Now, Heres Your Amazing FREE GIFT - Its worth $500, but its value can be immeasurable if you put it to good use!
Give us 30 minutes and myself and Sasha will personally give you a FREE marketing and business analysis that identifies exactly what you have to do to explode your profits and cash flow NOW!

xcellence in Dentistry

Call Our 24/7 Toll FREE Hotline at 641-715-3800 (Access Code 87777#) To Learn More!

Sasha Burau, MBA

This is not a prerecorded message. This is not a sales call. This is a personal, 30-minute one-on-one consult with the most knowledgeable turnaround expert for dental practices todayDr. Woody Oakes. Some people pay $997 for this marketing/consulting analysis. But because you came specially referred, all you need is 30 minutes of uninterrupted, quality time to receive a very unique and outstanding business analysis, personally, by phone, from none other than Dr. Woody Oakes and Sasha Burau, MBA.

Dont miss out on this once-in-a-lifetime opportunity. We promise you that by the end of the 30 minute analysis youll come away with these two benefits. A comprehension of what constitutes proper strategic marketing for your independent dental practice- marketing that gets you immediate and measurable results without discounting fees. A quick education regarding some successful management principles and practices they never taught you in dental school, which nevertheless should be applied to your dental business.

Make sure you shut the door, have all other calls held,and have pen and paper to write down notes, because in that 30 minutes youll specifically learn how to
...Get 20-to-50 new patients per month Keep those patients, and many others like them, coming back each month- and turn them into customers for life WOW your profitable patients and turn them into RAVING FANS Launch, or significantly increase, your fee-for-services income stream Double your production/collection in 12 to 18 months Think differently about your staff so that you focus on creating your A-Team Ultimately be able to take more time off as you develop a truly hassle-free independent dental practice

Congratulations!

COACHING ALSO OFFERSTHE POWER OF MULTIPLIED TESTING If you test one idea a month = 12 in a year If each member of a group of 20 tests one a month = 20 a month = 240 a year
It would take you YEARS to get the same testing done as you can get via the benefit of ONE YEAR in coaching!

How much faster can you achieve your goals by compressing 20 years of experimentation into one... test 240 ideas in only one year.

Others have spent nearly $1000 to learn: Namely, how the right strategies and strategic marketing (together with management principles and practices), can take your business to new heights. This FREE analysis is only available to you through March 15, 2014 so phone Woodys Office Admin, Ashley, right now at 1-800-337-8467. You can make your appointment for after March 15, 2014, but you must call before then to take advantage of your free gift. Call Ashley right now at 1-800-337-8467 and make your appointment before you forget! Code: NEWS

GETTING TO YOUR GREaTNEss

You and Your Sleep Deprived Patient

by Dr. U.P. Odiatu
ou thought you had it all figured out during your new patient exam health history section you ask patients what meds they take; if they have ever been in a motor vehicle accident; and some dentists ask about specific supplements their patients are taking. Well, that is only part of the equation when it comes to your patients health history. Current sleep research has shown if you are regularly sleeping less than 7 hours a night you are more likely to suffer from cardiovascular disease, stroke, cancer, diabetes and any number of other inflammatory conditions. Think gingivitis and periodontitis. Most dental professionals are aware of sleep apnea and its grave consequences on the heart and brain. If sleep apnea is severe a CPAP machine is prescribed by the patients health care professional. If the diagnosis is mild a MAD or Mandibular Advancement Device can be made by the dentist. This article is not about obstructive breathing issues but about patients who simply do not get to bed on time, work shift work or have evening habits that disturb their sleep quality and quantity. If you read this article you will receive insights that will help you expand your new patient exam questions or it will support your own healthy living goals.

There is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you live, perhaps more important than whether you smoke, exercise or have high blood pressure or cholesterol levels ~ Dr. William Dement, one of the worlds most prominent sleep researcher and founder of the Stanford University Sleep Disorder Clinic. 1. Current sleep research has shown that 4 out of 10 people reported they sleep poorly. 2. 20-40% of Americans work some type of evening or overnight shift. Michael Howard PhD has reported that people who do shift work spend most of their waking time in a jet lag state. 3. There is an important part of your brain SUPRACHIASMATIC NUCLEUS that is your brains circadian clock which does not function well with cross country travel / time zone changes, poor sleep habits, night shifts, sleep apnea, etc. 4. When working into the wee hours of the night, crossing time zones with cross country air travel to four on four off shifts the bodys reserves do not get replenished.

Willee Cole/bigstock.com

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From wound healing to trying to recover from a cold or a flu, a sleep debt can bankrupt your good intentions. 5. Cumulative sleep debt costs you and your patients. People with disrupted sleep from rotating shifts have 3 times as many GI problems such as constipation, abdominal pain, heartburn and reflux (think acid erosion of lower molars) than those who have regular day time work hours 6. REM (rapid eye movement) sleep is a vitally important part of your night. For optimal emotional health, adults need approximately 100 minutes of REM a night. (This can only be measured in a formal sleep study called POLYSOMNOGRAPHY). REM sleep has also be shown by UC Berkeley experts to help process stressful memories and experiences and bring enhanced well-being into your life. Are you thinking of certain patients with bruxism habits? 7. Research has shown that visual learning, especially learning to do NEW things gets consolidated while you are asleep - especially during REM sleep. A 2010 Harvard study on memory had their 100 volunteers do a test on finding their way around a maze on a computer. During a five hour break some stayed awake another group napped before taking the test again. The group who napped did the maze 162 seconds faster than the ones who stayed awake when doing the test again. Those who actually dreamed while napping did their second test maze 225 seconds faster. TAKEAWAY for dentists on three day intense implant courses or leadership training? Take a nap midday after an 8 hour workshop to internalize, consolidate the information and make it your own. 8. A prominent Canadian dental journal Oral Health had a cover story demonstrating a relationship between obesity and periodontitis. This relationship was based on the inflammatory mediators released from visceral fat. CDC reported that 30% of Americans are overweight or obese (BMI over 30). Whats the link between lack of sleep and developing an overweight condition? Case Western University research showed that women who sleep less than 7 hours a night were 15% more likely to become overweight; women who had less than 5 hours were 30% more likely to develop obesity. A 2010 JADA article reported that dentists are interested in giving wellness guidance but felt they needed more evidence that losing weight would make for a healthy oral environment. If you are reading current periodicals the evidence is arriving. 9. Sleep is a critical time enabling the body to heal, repair, restore and regenerate itself reports Mary OBrien MD author of The Healing Power of Sleep. Next time when giving post op instructions after an extraction or periodontal surgery tell your patient to get 7-9 hours sleep

for the next week for optimal healing and recovery. 10. Alcohol is the most common drug people use to get to sleep. Admittedly it does get you to sleep quickly. Downside, your sleep is lighter you dont get enough of the DEEP SLEEP where your pituitary gland releases growth hormone (the youth hormone for fat burning and maintaining muscle mass). With a single glass of wine before bed it spikes your insulin which also takes you out of fat burning mode. Alcohol before bed encourages snoring and sleep experts report even snoring reduces valuable oxygen flow to your brain 11. As dentists we are aware of the link between inflammation in the mouth and a diabetic condition. Did you realize that poor sleep disrupts good blood sugar management? Four nights of shift work has been shown in scientific studies to bring about pre-diabetic blood glucose levels in those workers during their shifts. If someone is not responding favorably to your soft tissue management therapy, you need to question those patients about their sleeping habits. 12. Contrary to the belief, older people still require 8 hours sleep if they want to age gracefully. Sleep architecture changes with age (they spend less time in DEEP SLEEP and more time in LIGHT SLEEP) and with slower wound healing people over 60 need quality shut eye.

RECOMMENDATONS:
1. Sleep in a cool (65-68F) bedroom for deeper sleep. 2. Create a pitch black environment so your melatonin levels remain high during the night. 3. Dont eat before bed as it subtracts from the rejuvenating role sleep plays as your body is trying to digest a meal that should have been eaten at supper time. 4. If you have to cross multiple time zones and want to perform well in business or a sporting event, give yourself an extra day for each hour off your regular time zone. 5. Sleep scientists say if you are going to work out, 4-7pm is the ideal time in terms of supporting muscle adaptation and also to take advantage of the post exercise body temperature adaptation that sets the mood for sleep in the following 3-4 hours. Early morning workouts are still very productive and they are the best strategy to make time for exercise in a busy life. Its just that current research by Michael Howard PhD has shown that late afternoon or evening exercise sets the tone for a healthy sleep later that night. 6. If you are not sleeping well it is almost impossible to heal well - NATIONAL SLEEP FOUNDATION.

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7. Guided visualization and relaxation exercises are two of the best ways to support healthy rejuvenating sleep. 8. A clear conscious and a peaceful mind make for a short sleep latency (the time it takes to get to sleep ideally 5-15 minutes). 9. If you want to support healthy REM sleep and utilize its ability to process emotion and consolidate memory, give yourself a mental suggestion right before you sleep to focus on a specific subject or challenge you are currently undergoing. 10. Napping for 20-30 min. in the mid afternoon has been shown in numerous studies to enhance emotional wellbeing and productivity. As long as the naps dont go longer than 30 minutes, night time sleep is not impacted. 11. Find the right mattress for your body type. There is no one best type. Studies have shown that medium to firm is most likely to fit most peoples needs 12. If you get up in the morning earlier than you wanted to, stay up. After a long continuous sleep, expose yourself to bright full spectrum light or sunlight and get your Sleep-Wake routine formalized. 13. Dont do anything else in bed except for the two Ss (sleep and ____). Watching TV, doing your taxes or eating will distract you from one of the most important health habits you might have. The brain loves cues that it is preparing to

sleep. Lugging your laptop onto your lap to answer emails is highly distracting for your night-time brain. 14. Develop a bedtime ritual which cues your brain for slumber. Following the same steps before bed gets your brain ready for zzzzz. 15. Many over-the-counter sleep aids are meant only for short term challenges with sleep. Prescription meds work wonders but they too have a number of side effects and many are not designed for long term use. There are herbal supplements but they too pale in comparison to learning relaxation techniques and developing good sleep hygiene rituals (evening/ pre-night time sleep habits). This subject is new for the dental industry and I hope to share with you further information in the future. In the meantime sleep well tonight and dont let the bed bugs bite.
Dr. Uche Phillip Odiatu BA, DMD is the author of The Miracle of Health and Fit for the LOVE of IT! This busy practicing dentist is also a NSCA Certified Personal Trainer and a professional member of the American College of Sports Medicine (ACSM). He lectures at most of the major dental conferences in the USA, Canada, the Caribbean and England.
REFERENCES: Wamsley & Stickgold, Current Biology, 2010, 20(23) National Sleep Foundation CDC Obesity and Periodntal Health: Whats the link? Should I be concernded? W. Ward et al. OralHealth October 2012 Sleep and Your Memory by Michael Howard PhD 2010 Biomed The Healing Power of Sleep by Mary OBrien MD Biomed 2012 Dentists Attitudes About Their Role in Addressing Obesity in Patients Curran et al. JADA 2010 Geyer, Talachi & Carney, Introduction to Sleep and Polysomnography, 2005

Revitalize an Ailing Practice - continued from page 29

4) Brand yourself in your community.
Those of you who havent discovered the power of treating phobic patients need to read this carefully. If there was one magic pill that could treat an ailing practice it would be enteral sedation. There simply is no easier and more powerful skill set. In most states, it requires 24 CE hours every other year. In return you get to administer a combination of medications that induce conscious sedation of your patients. Here is the caveat: The market for treatment of phobic patients remains huge. The fearful dental patient is not unlike a plastic surgery or infertility patient. They are emotionally charged and if they perceive you can solve their problem they will go to great lengths to afford that care. Further, you will find many of these patients havent visited a dentist in years and have significant needs. The best part is if you are successful (and you will be), they tell everyone! Through the use of the Internet and social media, it isnt unrealistic to brand your office within six to twelve months as the place to go for the fearful patient. Maintaining your status as a predominantly independent fee-for-service practice is going to require an epic effort by the entire team. Offices unburdened from total PPO dentistry likely provide a work environment superior to the higher volume demands of the PPO office. I have offered a recipe for a 2014 turnaround. It is literally what was used to reverse a 24-month downturn. It requires abundant energy, hard work and perseverance. The payoff is to maintain the independent fee for service environment that most of us once enjoyed. The choice to stay steadfast and hope for a better outcome is simply no longer a choice.
Dr. Rasner is a general dentist who has nurtured a private practice in Southern New Jersey for the past 33 years. He has accumulated close to 5,000 CE hours and was awarded his MAGD from the Academy of General Dentistry in 1998. In 1998 he founded Realizing the Dream, a company focused on practice management enhancing products including books, DVDs and CDs. Dr. Rasner has received multiple speaking awards and has spoken in several countries abroad and most of the continental U.S. His topics include Practice Management, Simplified Oral Surgical Principles for the G.P. and Implant Dentistry. He may be reached at drrasner@aol.com.

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Women Rule continued from page 13

Their work cites a study conducted by BAV consulting in 13 countries with over 64,000 people that concluded that two-thirds of those surveyed said the world would be a better place if men thought more like women. This doesnt spell the demise of traditional masculine strength, but it does shine the light on an opportunity that dentistry should embrace wholeheartedly to support our teams to greater influence, happiness and success in the changing face of dentistry. happen until people engage. Its in the emotional connection that we have an opportunity to work together to advocate and support our patients to choose a higher level of health resulting in both dental and overall physical well being. Well also reap the benefits of a happier, more relaxed and enjoyable workplace, as well as greater bottom-line success. Weve moved beyond the Mars/ Venus conversation of the 90s that focused on our differences to a new understanding of our capacity for synergy. Breakthrough Communication Success is both my passion and the title of my presentation at the 2014 Excellence in Dentistry Annual Spring Break Seminar. Please join me as its now up to us as leaders to embrace this new perspective and recognize the opportunities at hand. Forget Follow the Leader lets Be the Jones and lead our teams on purpose.
Ginny Hegarty is the President of Dental Practice Development, Inc. and the current President of The Academy of Dental Management Consultants. With over 25 years experience in dentistry and certification as a Senior Professional in Human Resources (SPHR), Ginny is best known as a turnaround expert specializing in practice leadership, accountability and employee engagement. Ginnys book Powerful Practice is available at www.ginnyhegarty.com Contact Ginny at 610-873-8404
profitable-dentist2.pdf 1 12/11/13 11:42 AM

BEYOND MARS VS VENUS

Without a doubt, communication is the biggest obstacle to success we face in life and business. We face it every day in our dental practices. When visiting with teams across North America and the United Kingdom, I see disconnects from one team member to another, from one department to another, from team to patients and team to supporting vendors. The Mean Girls of years ago may be gone, but communication remains a universal challenge. Soft skills, people skills are the keys to that elusive next level of success. Once all the cutting edge education and sexy technology is in place, the magic doesnt

The Advertising Trap - continued from page 35

cosmetic dentist. Or, they spend tens of thousands of dollars on new technology in hopes of satisfying their patients needs. These are all good things, but the best investment of all and the number one priority that we all should have is to spend the time and effort and money for building a dynamic team who patients love and as a result refer others to your practice. I certainly understand how much easier it is for some doctors to simply write a check to bring in new patients that hopefully will give them immediate results. You cannot transform your office team overnight so that they become your best marketing tool, but you can start immediately on that quest. There are plenty of seminars and great information out there to help you attain that goal. Make a dedicated effort to achieve that and you wont fall into that revolving door marketing trap!
C M Y CM MY CY CMY K

Dr. Joe Steven was a solo practioner in Wichita, KS until June 2007 at which time his daughter joined him. His 15 member team works out of 9 treatment rooms providing all facets of dentistry. He is a member of the ADA, the Kansas Dental Association and the Mid America Dental Study Group. He is also president of KISCO, a dental products marketing company. You can contact Dr. Steven at 800-325-8649, or go to www. kiscodental.com to sign up for their free KISCO Email Network to learn and share ideas with other dentists.

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Puzzle Piece

How to Fix Slow Times FAST

by Dr. Woody Oakes
I often get calls from dentists (nationwide) who say they are experiencing slow times. Usually these calls come in April, May, June and July... but sometimes they come in January and February which should be the busiest times of the year. Other businesses have discovered how to handle this, so let me cite two examples: 1) Sun Tan City is a large group of suntan franchises with headquarters in Louisville, Kentucky. In fact, my ex-wife lives in the same condo building as the owner. So what does Sun Tan City do to stay busy in the Summer? Well, actually they do a lot! They offer special pricing on suntan products like lotion, spray, etc. They also sell memberships at different levels. The net result is that they dont really have slow times. 2) A former patient of mine, Gary LaDuke, has a landscaping business... what does he do in the winter? You probably wont guess this, but he uses his landscape equipment for snow removal. Plus, Gary has expanded his menu to offer way more than just landscaping services. In fact, below youll see the three other businesses hes created plus 5 other ways that he can get paid during the off-season or get paid in advance. Its not a stretch for you as a dentist to take a clue from Gary or Sun Tan City. What services could/should you be offering? Could you create a Thank You program on a prepay bonus program? Of course you can do all of the above and then some. Oh yes, one more thing, Gary is probably the most expensive landscape person in our area (with one possible exception). Why does he charge more? Well, he feels he deserves it and his customers pay him what he asks. He almost never loses a customer because of his fees... hmmmm!

jgroup@bigstock.com

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Pink Band The Band Becomes The DamTM

Heres a new product you need to check out... a matrix band that also serves as a rubber dam. Heres the pitch... Pink Band is the only silicone coated matrix band that provides an additional seal against contamination and improved moisture control. What if the band becomes the damTM? Pink Band was evaluated by the Dental Advisor and 27 dental consultants that placed 479 composite restorations. Pink Band received a 98% clinical rating and 100% of the dental consultants said they would switch to Pink Band. Pink Band received Dental Advisor Editors Choice Award and Dentistry Todays 2013 Top 100 Products. Pink Band coatings are FDA approved and patented in 24 countries. Pink Band is now available in a starter kit ($81.47). Pink Band comes in universal, pedo and subgingival sizes, and the bands are offered in Regular and Ultra-Thin thickness. The Ultra Thin 0.001 band maintains its form when loading into the matrix band holder, unlike other thin band products on the market. Pink Band saves time, frustration and money in composite materials. During the placement of the composite into a tooth, if the preparation becomes contaminated with blood or saliva, the filling must be removed and the procedure repeated, wasting composite, adhesive, etch and time, therefore, costing the office approximately $17 each event. This innovation technology will change the dental industry! Why? Contamination is the number one cause of bond strength reduction in adhesive properties of composite material, causing recurrent decay and post operative sensitivity. For more information visit www.pinkband.org.

Bibo-LED Lite Block

Inexpesive autoclavable bite blocks Illuminates the entire mouth An intra oral light system which simultaneously, relaxes the patients jaws as a mouth prop and illuminates the working area in the oral cavity. Bibo is extremely simple to use with rechargeable power for the LED light of about 50,000 life hours given light power of 22,000 LUX. Bite blocks are autoclavable and have disposable infection control sleeves. Comes with: 1 Lighting Unit 2 small bite blocks 2 large bite blocks 1 Charger 50 Infection Control Sleeves The Bibo-LED Lite Block is available at Kiscodental.com 800-325-8649.

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I Was Shocked to Hear 4 Tips (On Denture Fabrication) I Had Never Learned In 39 Years Of Fabricating Dentures!
(Watch a clip from the new lecture by Dr. Joe Steven the King of Efficient Prosthetics)
Dear Doctor,

was hooked. Joes presentation was one of the best of the Destin 2013 presentationsin fact it should be mandatory for recent dental school graduates or seasoned veterans. I believe that dentures are going to be the next big thing in dentistry due to the aging population and the demographics Ive read. Unfortunately, most dentists (maybe you?) dont enjoy doing dentures because you have not done enough to make them profitable, or you feel they are not as sexy as cosmetic dentistry. The reality is that dentures can be cosmetic dentistry on steroids, and can be the ultimate full mouth reconstruction! Thats why you need to watch Joes presentation. heres just some of what you will learn: The secrets of 2-appointment immediate dentures Shade taking tips 3-appointment new dentures The alameter reading 3-appointment replacement/duplicate dentures Be sure to take the bite at the estimated vertical position and The latest in crown and bridge impression techniques mark the mid-line The H&H cordless impression technique Determine freeway space by 77 or Mississippi Thixotropic? Check these 3 things at the try-in, and have patient sign off The 9 vital steps to a great H&H impression on them! Why many doctors have switched from yellow Flexi-Velvet The best tissue treatment material to stabilize dentures for to Sno-White duplication The 6 steps for lab procedure for H&H Triple Tray impressions Why you MUST relieve the palatal area of all dentures The H&H technique without a Triple Tray The ultimate way to create the perfect post dam The H&S Technique slightly different than H&H 12 common denture problemsand how to fix them Use of the Accu-Gel-System for the 3-appointment denture The 5th hand impression aide The amazing cant do without- Papillameter The incredible Hedgehog burs and where/why you need them The Profile scale reading Hydent dentures indicator spray better than PIP? Red or green occlude indicator? 10 Crown candy? 60- 0% And much, much more! DA

I had planned to sit in for just a few minutes of Dr. Joe Stevens Efficient Prosthetics lecture, but after 10 minutes, I

This product consists of a DVD of Dr. Stevens Destin 2013 lecture, his complete lecture handouts and a resource list for all of the products mentioned in his lecture.

xcellence in Dentistry

MO Y NE Y G U BAC K AR AN TEE

ORDER FORM
YES, send me Dr. Joe Stevens Efficient-Prosthetics DVD for ONLY........................................... $177
(Please include $9.95 for shipping/handling.)

To order Dr. Joe Stevens DVD Efficient-Prosthetics call 1-800-337-8467, visit www.theprofitabledentist.com or complete and return this order form TODAY!

Regards, William W. Oakes, DDS PS - If you are currently doing dentures, the information in this course will cure the common denture problems and the chair time you are currently using. PPS - Average full denture fees in the USA are $3000 to $15,000 for cosmetic or FaceLift Dentures. You can easily see how dentures can be the #1 profit center in your dental practice. Are you ready to get started?

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For Faster Service: Call: 1.800.337.8467 Visit: www.theprofitabledentist.com Or Fax: 812-949-8535
To Order By Mail Return Completed Form To: Excellence In Dentistry 3211 Grantline Road, Suite 20 New Albany, IN 47150 COPYRIGHT EID 2013 CODE: NEWS- D1313

From Our Readers

Dr. Oakes,

e Sheraton ur lecture at th yo nd te at to and was able fast as I could Im glad that I tried to write as I . , like er TN ev in r ow te H at was said. th Music City Cen ng hi s yt er er full of note ted about ev ve a ring bind ha was very exci I e, er m th t other ite E course ou more than an ever y other C ns nothering ea m e . I would nc st ta du bs thered with ga that without su d an n te ot ur lecture, n to be forg ve a copy of yo ha in my collectio d ul co I if ation on any to ask you way and inform y graciously like m w ro w. th to e then and no u may want eciated the tim pr any pearls yo ap tly ea gr I ing events. . of your upcom LT Geoffrey W Yuma, A Z
Dr. Ward, We contacted Dr. Griffin (who hosted the event) about the video he shot at my presentation in Nashville... I havent heard back yet. Wha t Id like to do is create an audio file from the video and then create a written transcript. However, the video is Dr. Griffins property and I cant do anything with it unless he gives me permission. Regards,

Dear Doc, Dr. Mike Abernathy says you MUST pro duce 12% more than you did the pre vious 12 months jus t to sta y even. Its true but with this ec onomy how r u gonn a pro du ce more UN LESS U sell agressiv ely... like sell crowns instead of MOD... do the unnecessary dentistr y and we ha ve so many of our dentists doing that ... RIGHT???

(2008) casaalmare@bigstockphoto.com

Dear Doctor, Actually, selling more dentist ry (case presentation) is only one of the 10 things you must do to increase production/collec tions. I just did a lecture on this at our San Diego, CA seminar. We should hav e a DVD of that presentation for sale in a cou ple of weeks as soon as we edit the video. But for now... Delaine has scanned the 10 keys and attached to this email. Regards,

10 Keys To Productivity
1. Overhead/Scheduling 2. Quadrant Dentistr y 3. MMP acit 4. Work In Emergencies Cap 5. Delegation 6. Combining Of Procedures 7. The Magic 6 intra-Oral 8. Technology: Filmless X-Ray, etc. Camera, Diagnodent, ents 9. Flow Charts... Fewer Instrum 10. Strategic Treatment Planning y

The 10 Keys Wood referred to in this response are presented below:

Send me your questions, comments or interesting observations! Email them to info@theprofitabledentist.com with TPD Reader in the subject line.

70 70

FB EB UA AR RY y 2 20 01 14 4 FE RR U

xcellence in Dentistry

Okay heres an exciting breakthrough!

(Painless Injections a video by Jeffrey Hoos, DMD, FAGD)

Dear Friend, The video Im about to describe to you will absolutely change the way you give injections in your dental office. Its information so profound that a 70-year-old dentist at the event said, This will truly change the way I practice dentistry from this day forward. So, what is this technique? Well, listen up The ability to give truly painless injections is the #1 practice builder there is, but to give painless injections, most dentists rely on topical, The Wand, VIBRA JET, N2O, or even sedating drugs. Well, thats about to change once you hear about Dr. Hoos breakthrough techniques. In this hands-on course, Dr. Hoos selects a volunteer from the audience and then demonstrates his techniques on three different types of injections: block, infiltration, and palatal injections. Yes, painless palatal injections with no topical.

Now You Can Get Painless, Profound, Predictable Anesthesia Without Topical, The Wand, or VIBRA JET

Heres whats covered in this video:

Why you may want to rethink the use of epi in local anesthetics. What really causes the epi rush that may lead to syncope The real problem with dental phobias The best brand and least expensive needle on the market and the importance of sharpness Why and how the tissue should be pulled toward the needle... this concept is HUGE! The three components you must master: Anatomy, Pharmacology and Psychology An anatomy lesson on the 5th nerve Why a nasal cannula works better than a N20 nosepiece Why you need an adult/adult relationship with your patients Understanding the ANS The real reason why anxious patients dont get numb Why and how to keep the sympathetic nervous system from kicking in Why painless injections require some showmanship The magic of distraction and crossover Split second hypnosis you wont believe how easy this is How to get the brain to take in too much information at the right moment The amazing INTERFLOW device Why you should never use epi in intra osseous injections The five rules of truly painless injections The importance of a complete setup How to get informed consent and relax the patient with one magic sentence Problems with Septicaine and why it should not be used for block injections When Septicaine wears off do you re-inject with Septicaine? I hope not! What anesthetic you must use when Septicaine fades What gauge of needle works best for all injections How to tell if an injection is truly painless... the eyes have it!

ORDER FORM YES, send me the Dr. Jeffrey Hoos Painless Injections DVD for ONLY... $77

To Order By Mail Return Completed Form To: Excellence In Dentistry 3211 Grantline Road, Suite 20 New Albany, IN 47150

For Faster Service: Call: 1.800.337.8467 Visit: www.theprofitabledentist.com Or Fax: 812-949-8535

(Please include $9.95 for shipping/handling.)

And much, much more!

Wow! Like I said at the start the information on this video will completely change the way you practice forever. Your patients will absolutely love you once you master this technique! To order this exciting Painless Injections DVD by Dr. Jeffrey Hoos, for ONLY $77 call 1-800-337-8467, visit www.theprofitabledentist.com or complete and return the order form. Regards, William W. Oakes, DDS
100% 60-DAY MONEY BACK GUAR ANTEE

PS Just added to this protocol is an incredible new topical anesthetic so powerful that you can even do SRP and minor oral surgery (frenectomies) with it!

Signature: ___________________________

Name: ________________________________ Address: ______________________________ City: _____________State: _____Zip: _______ Phone: (____) __________ Fax: (____) ______ E-mail: _______________________________ Visa MC Amex Discover Check CC# ______________________Exp. Date: ____

COPYRIGHT EID 2013

CODE: NEWS-D364

Does

xcellence in Dentistry
3211 Grantline Rd, Ste 20 New Albany, IN 47150

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Service
Dear Doctor,

Matter?
When you call you will speak to a person NOT an answering
machine!
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