Thais Carter

Bien-Air Dental is a company with exceptional engineering in its very DNA. It was started in Switzerland’s “Watch Valley” by precision mechanic David Mosimann, who was motivated to bring his talents to dentistry after hearing a dentist complain about unreliable turbines in his office. More than 60 years after Mosimann founded Bien-Air Dental, the company is still listening to the needs of the dental professional and responding with quality.

Edgar Schönbächler is the CEO of Bien-Air Dental, but he is an engineer at heart, with a 

Fitted with an anti-retraction valve that stops fluid retraction from the oral cavity into nonsterilizable dental handpiece tubing and water lines. This valve in the body of the handpiece can be autoclaved to reduce cross-contamination

Accu-Chuck PreciPlus bur-locking and rotation drive mechanism assures a staunch clamping of the bur, eliminating all vibrations, and granting the handpiece stability and comfort

Bur-release is made quick and safe, thanks to a unique Soft Push system

Ph.D. in semiconductor technology. That kind of technical background is very common in Bien-Air’s senior leadership. Appreciation for technical excellence comes from the very top.

“‘Watch Valley’ is all about micromechanics, and the engineering schools in the area are dedicated to this, much to the benefit of watchmakers and, increasingly, medical device companies,” Schönbächler says. “What this means is that when we look for an operator for our assembly department, we don’t need to explain what it means to be precise, accurate, and rigorous. They know because this is the field they’ve trained for and often [they] have friends or family involved in some way. When you combine that skill with the values of listening to our clients to try to understand and anticipate their needs, that is special. These are the values we promote and try to live every day.”

Committing to that level of quality in process and product doesn’t come without great investment.

“We have a conscience about what our product should cost and, of course, we are in a competitive market where we have to make our case against other companies who are making good products,” Schönbächler says. “When it comes to engineering a new product, it is a process that not only involves materials or design, but is also very often an industrial process. It is easy to make a prototype that works perfectly well, down to the micrometer. It is difficult to bring that level of perfection and quality to 10,000 units, 20,000 units. This is where those initial choices on materials and design, the smallest details, end up making the difference.”

For dental handpieces, those details have a significant impact. Schönbächler uses the rotor, which rotates up to 200,000 rpm, as an example. If the rotor is even slightly unbalanced, it can create vibrations that not only wear out the instrument, but also can lead to discomfort for both the dentist and the patient, he says.

“We balance every single rotor individually, which takes an awful lot of time, but we do it because that individualized adjustment meets the standard we want to be known for,” Schönbächler says. “If a dentist is taking an approach where he or she wants to save money, this level of quality may seem like too much. But when you compare what happens when you don’t have that level of precision and what it can mean in terms of reliability, the true value of a Bien-Air handpiece is hard to estimate. There’s no secret to what we do; it is hard work and dedication every single day.”

This summer, many dental professionals found themselves assessing quality in a new way, eager to make choices that convey safety and build trust with both the team and patients. Technological advancements such as the sterilizable anti-retraction valve in a Bien-Air EVO.15 are more than a cool feature. Some electric handpieces on the market have anti-retraction valves, but they are located in the coupling, which isn’t sterilizable. Alternatively, Bien-Air locates the anti-retraction valve in the body of the handpiece so that it can be sterilized. Why doesn’t every manufacture do that? Simply put, it is technically a challenge.

“As a Swiss company, we are usually more expensive than some of our competitors, which means that when we do something, we have to do it better—we have no other choice. Sometimes we overoptimize our engineering, but in this particular case, with the sterilizable anti-retraction valve, it’s been entirely positive,” Schönbächler says. “We have a number of features related to maintenance and sterilization that have been ‘rediscovered.’ We’ve always seen the importance of those features, but now the dentists are seeing it with a new sense of importance. This crisis has made more people—patients and dentists alike—aware of the potential for cross-contamination in the dental practice. If a doctor can point out the sterilizable anti-retraction valve as a way of building trust, that is awareness and a good clinical practice that will benefit us all long after worries about [coronavirus disease 2019] have lessened.”

For Schönbächler, “innovation is something that also belongs in the industrialization process.”

“Imagine a guy who works on a milling machine and he comes up with an idea to make the process maybe 2 minutes faster—that’s innovation!” Schönbächler says. “It’s not just the anti-heat features, the push button, or the anti-retraction valve. Those are the things most visible, but they’re not always the most important. We’re a company that will always value the technical details. They make the big advancements possible.”

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How focusing on technical excellence made Bien-Air’s EVO.15 electric handpiece a safety standout. 


Precision isn't a buzzword, it's a promise

	If you’ve had reason to think about the “gig economy” recently, it might be thanks to the Lyft driver who took you to the airport or the Postmates delivery person who brought lunch to your office on a busy day last week.
	A close observer of the news might even have seen news in early September reporting that California passed a landmark gig economy rights bill, paving the way for approximately one million gig workers to have access to basic protections such as minimum wage and unemployment insurance. If “gig” is a concept that seems irrelevant to you, think again-think “freelancing.”
	Most dental practices are considered small businesses, employing fewer than 50 people and open an average of four days a week, creating a unique labor pool of part-time employees. The reality is, many dental team members-hygienists and assistants in particular-are gig economy workers.
	What does that mean for you? Joe Fogg, CEO of onDiem, a new nationwide dental staffing solution, sees this as an opportunity for dentists to embrace new solutions. We had the chance to talk with him about the burdens onDiem can lift from employers’ shoulders and the value it can create for employees including-no joke-providing healthcare coverage.

TC: Talk to me about the idea that became onDiem. What was going on in your world that brought the specific staffing challenges of the dental industry to your attention, and what made you think you were the guy to do something about it?

Right before I started this conversation with you, I was in the elevator with seven gig workers. We’re based in Portland, Ore., and actually share our building with Amazon Prime Delivery. A lot of the people who drive for Amazon also drive for Uber and Lyft. It is all about the gig economy around here.
	A couple days ago, I was reading the latest issue of Fast Company, which included an article about mobile dental clinics and pop-up dentistry intended to serve corporations and their employees who don’t have time to go to the dentist. I had that idea eight years ago.

	In my work, I’ve always been good at figuring out companies’ value propositions and how to differentiate, and I’d scaled a couple other businesses to successful exits.
	I always tried to take great care of my employees so that I could retain good talent, and at that time, my team was having a hard time making it to the dentist because we were so busy. In looking into options for our situation, I had an idea to create an app like OpenTable, where people could make reservations and a mobile dental clinic-a nice, semi-tractor trailer version-would roll-up.
	As I was working on forecasting and realizing the unique aspects of the business-open fewer days a month than traditional businesses, significant potential losses when staff is out-I saw two things that went on to shape onDiem: First, dental practices require reliable, qualified clinical staff to care for patients. When a team member calls in sick, it isn’t just inconvenient, it significantly reduces revenue. And second, there are thousands of part-time workers who want to work more and were using limited tools like social media to find available positions. There was no end-to-end option that managed that process. We started onDiem to fill that gap.
	Today, our app represents a true win-win for the dentist and the dental team, saving precious production dollars for the employer and helping part-time employees earn extra money and, most significantly, participate in a group healthcare plan not typically available to temporary staff.
	Both dental practices and dental professionals can post profiles in the app for free, both for permanent jobs and temporary work. Posting your needs doesn’t cost a thing. In the event that a position is filled and works, then we charge the employer a percentage of the labor. The employee is never charged.
	We’ve created software that removes the friction of hiring; we take care of vetting for state license verifications and background checks, we cover malpractice, workers’ comp and navigate state and federal labor laws, tax laws, and state dental practice acts so you don’t have to. We are designed for ease.

TC: One of the things I love about your app is how simple it is. Post jobs, see jobs, accept jobs, get compensated efficiently for a job well done. As you survey the market around staffing solutions, what do you think has prevented other companies from creating a model like yours sooner?

 A couple of things. Number one is that while the software is designed for ease, being registered to do business in every state in the country and establishing the back office infrastructure to manage millions of dollars in weekly payroll is actually a lot of work. We’ve set it up so that, on the dental professional’s end, these parts move seamlessly. The other significant challenge is getting all of that established while simultaneously funding app development, hiring developers and figuring out our market strategy.
	There are many platforms that exist to match people to work-from dog walking to photography and more. But we went a step further and did the non-easy parts that allow us to treat staff like people, not puzzle pieces, but managed to make it look easy.

TC: As you meet with dentists and encourage them to post jobs through onDiem, what is holding them back? Are there questions or concerns you hear consistently?

 I think the practices the most engaged with what onDiem offers are those who are utilizing things like Airbnb or Uber and get the gig economy; they love what we’re doing. They see the value in getting to select the dental professional who shows up, not just who they are, but what they’re familiar with in terms of technology or specialty procedures.
	

In some cases, dental practices are using our service to facilitate working interviews, assessing if the person would be a good long-term fit. The same goes for the staff, deciding if that practice is an environment they’d like to work in long-term.
	For smaller practices, older practices, there is some apprehension. Having to use a new service can be intimidating and inertia is powerful. For practices that want to grow or expand, onDiem can be a game-changer.
	For example, a doc has always wanted to add Thursdays to the schedule, but current team members aren’t available on that day and hiring a full-time new employee isn’t an option. With us, that practice can bring in the same temp every Thursday and do a meaningful trial on extended hours. The biggest expense is always payroll, and to try something new without that fixed expense is a huge opportunity.

TC: onDiem is a nationwide staffing solution, able to serve everyone from small neighborhood practices to large practices with operations across multiple states. What is remarkable is that you are also fully compliant within all those states. It is clear how this can benefit the dentist or the employer, but how does this scale change how you’re able to serve the dental hygienist or dental assistant?

 I want to say just one more thing about benefits to the practice itself! There are so many dollars spent on patient retention, SEO, and acquiring new patients. If you spend all that money and then have to reschedule those patients because of a staffing issue, you basically spent it all just to lose it, getting hit twice. We can help make sure that doesn’t happen!
	But to answer your question about scale and serving staff. This is where benefits really are the thing. There is so much anxiety and confusion-can I be an independent contractor or 1099? The answer is, they can’t. Even though it is the proper way to go, it can be a burden to add a temp to payroll, so often dentists will try to make it easier and just write a check, making them a 1099. There’s a lot at risk in that strategy, most serious being that the practice can get fined, but also, that as a 1099, the employee isn’t covered by workers’ comp and it is likely they didn’t set their rate expecting to cover the employer portion of taxes, so they make less money.
	With onDiem, staff are a W2 employee. We cover employer-paid taxes and no one is having to go through the hassle of adding a person to payroll or following up on payment. Staff can earn more money doing what they love.
	After working just one shift, dental professionals are eligible for our healthcare plan. The plan is set up to be as flexible as the workforce that needs it: Team members don’t need to work each week, but can remain covered so long as they work at least once a week every six weeks.
	The Fixed Indemnity medical plan does not have co-pays or deductibles (prescription, vision, and dental do). Fixed Indemnity medical also doesn’t have a pre-existing condition limitation. Those things, plus the fact that the Fixed Indemnity medical plan uses First Health Network-one of the nation’s largest PPO networks-are the aspects of this plan that we are really excited about.

TC: You could have just stopped with a good app. Why go the extra mile with workforce benefits?

 I believe that when you take care of employees, they take better care of customers, and customers take care of your business. I believe that if we could take care of this labor force, they’ll take better care of patients and the dental practices they represent, and those practices will take better care of our company. To get them excited about onDiem, we needed to make it valuable to them, and the peace of mind that comes from healthcare is no small thing.

Real-time staffing service onDiem delivers quality employees to dental practices, and health benefits to those employees.

A new standard in dental staffing

	We all know it: That sinking feeling you get when you learn something and, like a thread pulled in a sweater, it leads to an unraveling, realizing just how much you didn’t know about a topic. For too long, avoiding that feeling-whether they admit or not-has allowed many dental professionals to keep their heads in the sand about the meteoric shifts in how patients want to pay, and how much more dental practices pay for an outdated process.
	Dr. Ryan Hungate, CEO and Founder of Simplifeye, is building a business model on bettering workflow without changing behavior. We asked him about that bold promise and what it means for the future of payment in the dental practice.

TC: I’d like to start by talking a little bit about you and how your background informs your work with Simplifeye. You’re an orthodontist, but you’ve also worked for Apple, specifically focused on the customer workflow experience. How did this shape the way that you think about product development, and more precisely the user experience when it came to Simplifeye?


	RH: The experience completely changes how I look at dental practices. I think I’m more easily frustrated than the typical doctor by inefficiencies in the practice. With Simplifeye, our original product was Flow, basically an AppleWatch that told doctors where to go and why the patient was there. We had to teach everyone in the office how to use and, on a really basic level, change how they were acting. That didn’t fly. Behavioral change in a practice is challenging because it either doesn’t work or even if it works on 90 percent of the team, the 10 percent who don’t accept it ruin it for everyone else. That is a training issue compounded by a culture problem.
	Now, Simplifeye looks at how to better workflow in the practice, but not change behavior in the office.


	RH: It seems weird, I know, to say, “Apply my technology, but don’t worry, it won’t change a thing. You’ll just make more money.”

TC: Can you give me an example of how that plays out with one of Simplifeye’s tools?


	RH: Of course. Take Amplify, our live chat product. We chat for them. We can even schedule the patient for the front desk if they want. The same is true with our new Payments tool. We don’t ask front desk staff to make patient collection calls. Simplifeye automates that interaction. At the end of the day, these are the things we’re helping front desks with.

TC: Of all the different technologies they can invest in, how do you help a doctor get excited about a more streamlined front desk?


	RH: Doctors are fantastic in the back. More often than not, they’re knocking it out of the park, providing amazing service. However, in a market where most patients assume that all dentists are on an even playing field, today’s practitioners need to figure out how to compete with something like Smile Direct Club, available 24/7 and the patient doesn’t even have to leave his or her house. Even more intimidating? Smile Direct Club is reinforcing its message with lots of ad dollars. So, how do doctors compete? They start by recognizing that they already have the business, they just have to make the experience better and meet their patients where it is most convenient. That’s where Payments come in, using technology to make treatment affordable.

TC: There are so many different ways that technology is impacting the dental practice, from digital workflow in the operatory, to marketing and patient communication. What were some of the gaps you hoped to address with Simplifeye, and the company’s approach to Payments in particular?


	RH: In Silicon Valley, a concept that is often used is “hair on fire problems,” a dramatic name for the things that you will take care of no matter the circumstance. In the dental practice, the first and most significant “fire” is around getting new patients. A steady flow of new patients can lighten the impact of other business problems, so we start there, “Doctor, for your small investment, I’m going to help you get six to 10 new patients a month without any long-term contract.”

	Once we’ve started that conversation, I can talk about other products that are integral to the practice, like revenue cycle management. So many of the current payment rails built into the practice management software running today’s practices were actually built in early 2000. In 2019, we have Square-you walk into a coffee shop, tap your phone to pay, and walk out. This convenient experience is what most patients expect nowadays.
	One of the biggest issues with the old tech these office systems are built on is that they not only limit ease-of-pay for patients, but they don’t serve the best interest of the dental practice. With Payments, we focus on Card Present Transactions (CPT) and Card Not Present Transactions (CNPT). With CPT, you see my card, look at my face, confirm it is me and pay 3 percent in merchant fees to the bank every transaction. You could pay less 

with PayPal-as just one example-but most people don’t do it because they don’t know how much they are paying in the first place. The vendors they are working with are more inclined to remain silent as it protects their own pockets. That is taking advantage of doctors in one of the worst ways imaginable. Amazon and other online vendors are card not present transactions. Because of the risk that someone could steal your card and use it to pay for something over the phone or online, payment processors get away with charging an additional 0.5 percent to 1 percent every time.
	Let’s come back to how doctors run their businesses. Most still send bills in the mail, which cost $1 apiece to send, and the patient will either write a check to mail back, but more likely, they’ll call your front desk and give you their credit card number, a Card Not Present Transaction, which means a larger fee. That is money they could be saving.
	With Simplifeye Payments, we can help doctors save that extra 1 percent per transaction. We retail tokenize credit cards securely, which means that when a patient swipes in person, we can save that credit card number and when they later get a text or email invoice from the practice (that’s right, no more snail mail), then they can choose to use the credit card on file, ApplePay, or GooglePay, which are now all charged as Card Present Transactions, saving money. This is something all doctors should have, but they do not.
	Payments can also help dental practices facilitate recurring transactions. Some practices will take payment plans and some won’t. The truth is, when a patient is done being diagnosed, no one says they hope they can’t afford it. Maybe they can’t, or maybe they have to stretch it out to make it affordable. Macy’s will give you the option to pay for a designer purse over a 12-month period, yet medical and dental struggle to meet that challenge.

TC: Isn’t that where dental practices should direct patients to a service like CareCredit?


	RH: With this software release, we’re able to give dentists an option beyond CareCredit. If I send a patient to CareCredit to get approved, it is a “black box” process-the patient applies, but I don’t know why they did or did not get approved. If the patient isn’t approved, doctors can feel like they’ve exhausted every effort. If the patient is approved, CareCredit takes 10 to 12 percent of the procedure fee. They collect interest from the patient and fees from the practice- that is a model ripe for disruption.
	We take the CareCredit model and turn it inside out. Simplifeye Payments gives doctors the tools CareCredit has-running credit checks, control over standards for approval, FICO reports if they want them-and make them easy to understand. Once patients are approved, they can move onto a payment plan, working out how much they want to put down or how many payments they want to make. Simplifeye processes that every month as a Card Present Transaction, thus keeping costs down and making it easy for the front desk.
	This brings me back to how practices can compete with Smile Direct Club, offering braces for $99 per month. They are just the first of many companies who will try to offer dental work at a small rate over a long period of time. Backed by venture capitalists, they can afford to wait out the competition. We want to enable practices to offer braces at a competing price, creating the infrastructure for those payments so that dentists can actually compete.

CS Softdent v18 now includes ePayments Secure

TC: The benefits seem pretty straightforward, but I know you must get pushback. What are concerns dentists raise in conversations with you?


	RH: Many are scared that it will be a large change, like electronic health records. If I walked into a practice with the best electronic records system tomorrow, but it meant changing Dentrix-even if it saves them $50,000-they’d tell me to leave. They won’t put their team through a swap of something so integral to the practice.
	In contrast, with Simplifeye, we can have you up and running in a matter of moments because we have to ship you the sleek machine that allows you to accept payment wirelessly. We looked at companies like Venmo and Square, who didn’t get big chunks of the market because they are the same old payment services, but rather it was so simple to use that you could sign up with no training at all. That’s what I knew we needed to create for dentistry.
	Simplifeye will walk the team through from start to finish and the training for the front desk takes only 30 minutes. We don’t charge for training because we’re honored that you’d invest in our software in the first place. For too long, companies have gotten away with releasing complex software that is hard to implement, just because there weren’t better options available. Not anymore.

TC: Security is a primary concern in healthcare. Do you hear dentists' voice concerns about the topic?


	RH: Simplifeye is HIPAA and PCI compliant and today almost all credit card and debit card companies are more committed to security than ever before. But as I meet with doctors, they aren’t really worried about identity theft or credit card fraud; they’re more concerned about what they don’t know. When we start to talk with them about what their merchant fees are, they are shocked. They start to think about what else they don’t know and the different fees blow their mind.
	The technology I’m talking about may seem new to our industry, and healthcare in general, but Starbucks has used it for the last five years. It is time for dental practices to catch up.

TC: If a practice was to implement Simplifeye tools, what difference would you hope to see in that practice a year from now?


	RH: I’d love it if the first thing the team says is, “We didn’t even really notice it.” To me, that means there wasn’t pain caused by implementation. Secondly, I’d want to hear a front desk team talk about how their jobs were made easier by the software. Lastly, I’d love to have the dentist say they saved or made $50,000 more from using Simplifeye’s solutions.

Free payment tool from Simplifeye helps eliminate front desk stress and create significant savings for the dental practice.

Break away from the credit card transaction trap

	One of the most memorable anecdotes related to the Top 25 Women in Dentistry came just after the inaugural special feature was published.

	I was traveling with one of the [DPR] sales reps to visit a potential advertiser. The marketing manager was an older gentleman who had been involved in the dental industry for many years. I was walking him through DPR’s editorial mission and, because we had the Women in Dentistry issue in hand, proceeded to explain how it fit. Products are nothing without the clinicians who use them. Innovation is most powerful when used to not only amaze but also to actually make patients’ lives better. These honorees reflect a group with increasing influence in the profession whether it is in the dental practice, classroom or boardroom.

Related reading: Dental Products Report's Top 25 Women in Dentistry for 2015

	I went on and on and then paused, breathless, waiting for him to compliment our vision and tell me it was about time someone published a feature like this. Instead, he put the issue down and asked, “So when are you going to put out an issue recognizing the top men in dentistry?” I made a joke that every other issue year-round is dedicated to men. He didn’t laugh.

	It would be unfair to say things haven’t changed since then. There is fantastic, admirable work being done to train, support, mentor and recognize women across the dental industry. The number of women in dental practices continues to grow, and the number of dental manufacturers that recognize the power of the female clinician continues to increase. The people who serve the dental professional, as educators, sales reps, customer service specialists, etc., include more women today than ever. This is all in addition to the ongoing efforts of the American Association of Women in Dentistry.

Related reading: The significance of Dental Products Report's Top Women in Dentistry recognition

	To admit that things are changing, however, is not the same as saying we’ve reached any sort of parity. The biggest evidence of this is the way I hear “women in dentistry” discussed as some sort of monolithic demographic. Not all women in dental practices choose it for the same reasons or share the same professional goals, attitudes or concerns. When we can discuss the many different types of women in the field the same way we discuss the variety of male practitioners, that is, to say, naturally, then we will start to see the kind of change the industry we all love still needs.

 published the first Top 25 Women in Dentistry, each honoree was so wonderful, accomplished, inspirational and very surprised to hear she was being recognized. Each year since, there have been many reasons to think the feature might not return. I am so thankful, but in no way surprised, that year after year this industry has provided at least 25 reasons to do it again. Congratulations to all this year’s honorees, and here’s to another year of recognizing the incredible women in our corner of the profession wherever we may be.

Thais Carter is the former group editorial director for Advanstar Dental Media; she helped found the Top 25 Women in Dentistry in 2009. Today, she is senior manager, global PR/media relations, for KaVo Kerr Group.

The role of women in dentistry is still evolving and times are changing. But what still needs to happen - and why is recognition important?

Author | Thais Carter

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