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Practice dentistry until you're 75

Dental Products ReportDental Products Report-2012-03-01
Issue 3

The further you get into your career, the easier it is to become complacent, to make yourself believe there’s no point to invest in new technology or that the pains that come with practicing dentistry are just part of the job. But no matter what your age or how close you think you are to retirement, you have to continue to grow. You have to stay curious and passionate about what you do, whether you’re planning to retire in 5 years or 20 years.

The further you get into your career, the easier it is to become complacent, to make yourself believe there’s no point to invest in new technology or that the pains that come with practicing dentistry are just part of the job. But no matter what your age or how close you think you are to retirement, you have to continue to grow. You have to stay curious and passionate about what you do, whether you’re planning to retire in 5 years or 20 years.

And of course, with the current economic climate, many dentists feel like they need to practice longer than originally planned. Maybe you lost money in your retirement portfolio or are just too uncertain about the future to go through with retirement plans. Or maybe you just love what you do so much you’re not ready to stop. Whatever your reasons for wanting to extend your career longevity, there are plenty of ways to make practicing late into life much more rewarding, from keeping up-to-date on the latest and greatest in technology to making ergonomics a priority for you and your staff.

“You have to upgrade your clinical skills, your technology, your marketing, your staff management skills. You have to continuously grow,” said Amy Morgan, CEO of the Pride Institute. “Even if you don’t want to stay relevant for yourself, the day you try to sell your practice to a young dentist who’s been exposed to the best in technology and knows what he wants, he’s going to find a huge discrepancy between having something new and special versus what you’re offering for sale. So until the day you lock the door and turn over the key, you have to grow in all aspects.”

Stay curious
Dentistry is constantly changing. There’s always a new product you can add to your practice or a new technique you can learn, and they’re all designed to make your job easier and the patient experience more pleasant. But if you’re content to stay with the status quo, you’re never going to reap the benefits these new additions to dentistry can offer. To keep from burning out, you must have a deep rooted curiosity about “the next big thing,” Morgan said.  

No matter where you are in your career, you can’t ignore that the industry is changing around you. You have to read the dental publications, watch webinars, look at blogs, attend CE and spend time talking to manufacturers on tradeshow floors, said Laci Phillips, of Banta Consulting. Talk to colleagues and keep yourself abreast of the latest and greatest. If you don’t, you may find yourself losing interest as well as patients.

Patients are well educated these days, and can do their own research about what’s available to them. If they find through a Web search or a phone call that your practice doesn’t have the latest technology they’re looking for, they’ll move on to the next office. Even patients who have been loyal in the past may move on when they hear friends or family talking about their great experiences at the practice down the street.

“It’s frustrating. We want our doctors to be up-to-date and know what’s out there, no matter how old they are,” Phillips said. “We want them to have that knowledge. And not only in technology but what’s out there that can help me as a patient.”

Not only does updating your skills please your patients, it also keeps your day-to-day more interesting, said Dr. Michael Kokott of Associated Dentists in Wisconsin. That’s so important when it comes to career longevity. If you get bored you’ll lose your passion for what you do, and without that dentistry becomes just another job. And if you’re not updating and marketing your skills you’ll not only lose patients, you’ll stop attracting new ones. New patients are key to a thriving practice.

“If you have more patients coming in it will extend the life of your practice,” he said. “Once you stop getting new patients, it’s sort of the beginning of the end of your career. Having new patients come into your practice is an essential part of keeping your career going, and keeping it interesting as well.”

Have a vision
While keeping up-to-date on the latest in dentistry and incorporating new technologies into your practice are great ways to add years to your career, you also need a plan for these products and techniques. All too often dentists buy that new piece of equipment only to find they never use it.

You have to think about what innovations most match your vision, values and strategy, Morgan said, and then you have to train yourself and your team on all aspects to get the most out of those innovations.

“Sometimes a long term dentist in peak performance will be willing to grow but only in one category. You can’t cheat physics. You grow in one area it affects all other areas,” she  said. “If you purchase a cone beam scanner but don’t take into consideration the practice management implications, the marketing implications and the clinical ramifications of that new innovation there’s a good chance that new technology purchase is going to fail. To have a growing practice you need to fire on all pistons.”

Surround yourself with good people
If you’re going to have a long, successful career, you’re going to need a strong, energetic staff that wants to grow with you, not hold you back, said Dr. Bill Domb, who has a practice in Upland, Calif.  
“Having a good staff is so important,” Dr. Domb said. “You need positive people and competent people. When you find someone who’s not a good fit don’t prolong the agony. Get them gone and find somebody else because they’re certainly out there.”

Once you find the right people, you have to invest in them. Training is such a crucial element to any successful dental practice, and Phillips recommends dentists offer team members a minimum of four hours of training a year. Getting your CE credits and keeping yourself up-to-date on the latest techniques and trends isn’t enough. Make sure every team member knows how to use the equipment and technology in your office.

Once you have your team trained and ready to go, Dr. Mark Hyman suggests you get out of their way.

“I have a magnificent group of women that I love to say I work for,” said Dr. Hyman, who has a practice in North Carolina. “They are highly trained and they are cross-trained. I focus on the procedures that only I can do, while the team manages almost everything else. This provides me, a single practitioner, with recuperative physical and mental breaks throughout the day.”

And don’t forget to surround yourself with good people beyond the dental practice, Dr. Domb said. It’s important to have a support group around you. That can come from a close circle of friends as well as your peers. If you’re not part of an online community, Dr. Domb recommends changing that. Groups like the Academy of Comprehensive Aesthetics (ACE), the International Dental Forum (IDF), the LVI Forum or Dental Town can provide you with support and a wealth of information, whether you’re going through a trying time at your office, thinking about adding a new technology to your office or going through personal issues that you need to talk about.

Pay attention to pain
Neck and back pain as well as hand fatigue are common problems that plague dentists. The pain can be so severe that it leads dentists to cut back on hours or force them to retire from practicing long before they’re ready. This pain isn’t something you can ignore, and if you can actually prevent it, all the better.

In fact, ? of dentists who retire early are forced to do so  because of a musculoskeletal disorder, Dental Ergonomics Expert Bethany Valachi said. Sitting for long hours in static positions is not good for the body, but that isn’t something that’s typically covered in most dental schools. Most schools don’t have a formal ergonomics curriculum, she said-they tell their students to sit up straight but don’t give them the tools to make it happen.

“There’s not a great awareness among dentists. They don’t know until they start to hurt, and structural damage happens long before we feel the pain,” Valachi said. “And this is what dentists teach day in and day out. Do you not brush your teeth until you’re in pain? No. It’s prevention. You take care of it so you don’t sustain the structural damage. So there’s a parallel between what they teach and the care of their own bodies.”

And when it comes to ergonomics, there’s so much to think about, from positioning the patient correctly for upper and lower arches, selecting the right ergonomic loupes, proper operator stool adjustment and proper positioning of the overhead light, to name a few. There’s so much to think about it can be a bit overwhelming, Valachi even wrote a 200-page book on the topic, but there are changes you can make to relieve or prevent pain, and that in turn will add years to your career.

After only about nine years of practicing full time, Dr. Stephen Johansen was starting to think he might have to make a career change.

He was only in his late 30s, but the pain in his lower back was so severe he didn’t know how much more he could take. The thought of giving up his dental practice before he even turned 40 was a scary one, so he spent a lot of time looking for solutions. He came across a Dental Town thread about Career Extender’s AnterioRest and thought what did he have to lose, he’d give it a try. That decision helped to save his career. He noticed improvements in his back after only a few days.

“I was so scared. I was thinking I wanted to stay in dentistry but was trying to figure out what I could do to maybe teach,” said Dr. Johansen, who practices in Utah. “It was to the point where I knew if I was hurting at that level I didn’t think I could last 6-to-12 months. And so it was scary because I thought I’m not really qualified to do anything else. I didn’t know what I was going to do but I was contemplating that the end was near for me. I was worn out. With the tools I’m using now I feel like I can practice until I’m 75. I feel like I’m getting better and stronger. Long days aren’t as bad. I hurt less and I’m sore less.”

Adding the AnterioRest to one operatory, combined with adding a surgical operating microscope to a second operatory and taking up Yoga, has worked wonders in alleviating his back pain, Johansen said. The back pain started just three years into his career, and he said he wishes he would have been more prepared for the pain that came with dental practice and maybe even have prevented it. He encourages dentists who haven’t started experiencing pain yet to look into options like the AnterioRest, a product he said does a wonderful job of providing the necessary back support.

Proper seating is critical to a dentist, Career Extenders President Gregory Books said, because practicing in an unsupported seating position will expose muscles to a lot of unnecessary wear and tear over the years. Most physical problems dentists face are the result of unsupported seating, he said, and the static positions dentists must sit in to perform their work. Instead of attempting to move the dentist to another unsupported posture, the AnterioRest supports dentists in their chosen working position. The movable support means dentists don’t have to work in a static load position, and that is the key to pain relief. It can be installed onto about 300 different dental chairs.  

“If you can eliminate the unnecessary fatigue by introducing support into the preferred working position you can improve productivity, improve longevity and see a dramatic increase in quality of life and the ability to do what you love doing for a lot longer,” Books said. “But the key is support for the working position, not replacing one unsupported position for another.”

There are other ergonomic seating options you might want to look into, and when doing so Valachi recommends selecting a stool with a tilting seat pan (you don’t want it to tilt more than 15° forward). She also recommends to consider using a saddle stool, making sure the headrests on patient chairs are properly adjusted for upper & lower arches and also taking the time to correctly adjust the seating to meet your needs.

Among these options are the ErgoSure Stools from DentalEZ that tilts from 0 to 15° for better blood flow, offers complete mobility and features easy height adjustment for relaxed positions, and Pelton & Crane stools that feature seat tilt and lumbar support that relieves pressure on the back of the legs, increasing comfort.

While proper seating is the foundation for good posture and alleviating pain, magnification helps as well. You need to practice with neutral neck posture to prevent chronic neck pain, said to create shadow-free images by adjusting the illumination direction of overhead lights or using a loupe-mounted headlight.

Creating this neutral neck posture without the right loupes is next to impossible. Dentists are constantly leaning in to get a better look at the patient’s mouth, and this leads to neck and back fatigue, said James Onderak, Orascoptic Director of New Product Development. Dentists are hunching over and moving their bodies in awkward positions so they can see. Magnification brings the teeth closer to your eyes, so you don’t have to move in to get a better look. You can see what you need to see while sitting in a comfortable position. Not only that, it helps you see problems you might normally miss, and it helps alleviate the eye strain so many doctors have to deal with after a long day chairside.

Dr. Kokott has used Orascoptic loupes for 25 years, and said he first bought the loupes for clarity of vision and better patient care. He had heard about the ergonomic benefits as well, and knew working with a more

SurgiTel President Jin Chang, and that requires a head tilt of less than 25° and means the eyes need to rotate to see the target. Unless you take great effort to practice the neutral posture, there’s a great chance you’re tilting your head instead of rotating your eyes. You also need to avoid twisting your body upright posture would be beneficial to his health and his career. So using loupes has helped him prevent pain that so many other dentists experience.

When purchasing loupes, you need to look at the magnification, field size, declination angle and resolution, Onderak said. The right combination will improve your health as well as patient care. The declination angle is key to preventing pain, and Onderak said most dentists tend to work at angles between 30° and 35°.

And if you’re using loupes without the proper declination angle, you could actually be doing your body more harm than good, Chang said.

“Right loupes with proper declination angles will help dentists work with the neutral neck postures,” Chang said. “However loupes with improper declination angles will force dentists to work with the poor neck posture. The use of improper loupes is a major cause of chronic neck problems.”

Even with the right loupes you have to be willing to make the posture adjustments to get the full benefits, Onderak said, and to make sure you get the working distance that’s best for you. Often dentists sit up straight and try to have their best posture when the loupes manufacturer comes in to fit them, but then find they can’t maintain that posture throughout the working day. The manufacturer can always re-work that distance, but if you want the ergonomic benefits you have to commit to improving your posture, and realize it’s not an overnight cure.

“Gradually increase the working distance. If you’re currently lunging in and working at 12-to-14-inches all the time it’s going to be difficult to all of a sudden go to 22 inches,” Onderak said. “First get an ergonomic chair. That’s the foundation of support for your body. Then go ahead and get a loupe and take yourself up 4-to-6-inches. That’s usually something dentists can tolerate. That will help incrementally, and it’s something you should be able to sustain. At this point we’re talking about sustainability if you have neck and back pain. After 6 months to a year go up even higher and get to that 20 inches or 22 inches. It’s almost like a life-changing commitment to work on your posture. Like people who are overweight. It’s  a life-changing event you have to be committed to. Magnification is no different.”  

Practice like a surgeon
Before he started using the MagnaVu dental procedure scope, Dr. Domb thought he was going to need shoulder surgery.

But that isn’t the only reason he invested in the MagnaVu. He wanted to see better, and had decided it was time to get rid of his operating microscope.  

“The upper right quadrant of my back was taking a lot of stress,” Dr. Domb said. “It had gotten to the point where muscles were pushing on nerves. I would be working and all of a sudden my right arm would drop. It had started to concern me and I could see the tenure of practicing getting limited quickly. As soon as I started being able to sit upright this all went away.”

So how does it help? This product allows doctors to sit up straight and work off a screen like medical surgeons have done for years, MagnaVu Vice President Bob Seawell said. The direct image enables them to see on screen what they would see in a mirror or if they were bending over to look directly in the mouth. They see it larger and without pain, and that means better patient care.

The product enhances what dentists do, Seawell said, giving them better lighting and improved ergonomics. The 24X magnification helps them see better and reduces eye strain, while they’re not contorting their bodies to see inside the patient’s mouth. Some dentists say this product has given them another 5-to-7-years to practice dentistry, Seawell said, and it’s given them their passion back. They’re not as beat up or worn out as they once were. They don’t have to go to physical therapy anymore or take medications every day for the pain. Overall, they have a better quality of life.

“This gives them a second shot at doing what they love best and practicing as long as they want,” Seawell said. “When they get home they’re not as fatigued as they used to be. Before they would get home and not do a whole lot or not do things on the weekend, because they were too sore, beat up and stiff. After a few months of using our product dentists find they can go out and enjoy free time again.”

Dr. to your body to make practicing even more comfortable. But the magnification and the more comfortable seating position aren’t the only benefits. It can be used as a teaching tool to show patients exactly what he sees, and it also enables his assistants to see what he sees, enabling them to know actually what he needs in any given procedure.

The MagnaVu systems start at about $22,000, so it’s a big investment but one that Dr. Domb said is well worth it. Without it shoulder surgery would have been inevitable, and that would have meant time away from the practice and lost revenue. Beyond that, if something went wrong with the surgery he may have lost his ability to practice. Instead, he’s gotten 10 years and is still going strong.

Take care of your hands
Hand fatigue and carpal tunnel can both become problems if you’re not using the proper instruments. You have to find ergonomic instruments that are lightweight, comfortable to grip and easy to maneuver if you want to get through your day without hand fatigue, and the same goes for your staff.

Dr. Pat Allen, who practices in Texas, has used Hu-Friedy instruments for more than 30 years, and every instrument he has in his practice from perio probes to hand-held mirrors to surgical kits come from the company. These instruments have a very good balance and comfortable handles-which means round, large and hollow-which are both key elements for hand instruments if you want to avoid doing damage to your hand long-term. The large, round handles also give you better fingertip control, which means you don’t have to turn your wrist to make micromovements.

Domb began noticing changes in a few days, and said the problem with his arm stopped in a few weeks. The system comes with an ergonomic chair that, with a push of a button, instantly adjusts.

“The expression I use is, if you wish to practice longer in procedures or longer in your career you need to pay attention to ergonomics,” Dr. Allen said. “That applies to auxiliary personal as well. In my practice every instrument in every area for every person has ergonomic handles. Mirror handles, probe handles, curet scalers. Everything.”

Dr. Hyman also knows the importance of ergonomic instruments and said he appreciates the touch and feel of his KaVo electric handpiece. He gets a smoother, more predictable and more precise cut and he doesn’t have to push as hard as he has with other handpieces.

“Dentists drill most of their day, so I’m in favor of anything that can deliver better quality care and a better physical experience for the doctor and the team. My team also use these handpieces,” Dr. Hyman said. “Before I tried the handpieces, I had convinced myself that I didn’t need them because I was set in my ways, and I didn’t want to spend the money on them and I didn’t want to change. The first time I tried one, I thought, “What in the world was I waiting for?” Immediately there was a dramatic change in how I prepped teeth and a huge improvement in my physical experience.”

When it comes to taking care of your hands, instrumentation isn’t all you should consider. Microflex XCEED® gloves provide barrier protection, but a comfortable and ergonomic design targets the risk dentists face from hand fatigue and injury, said Michael Schoen, Dental Market Manager for Microflex.

This certified ergonomic exam glove uses an exclusive technology called Avantex™ to provide a comfortable, precise fitting nitrile formulation, Schoen said. Combining strength and protection with ergonomic comfort makes for an exam glove that helps keep dentists safe from biological hazards in the office while also caring for the health of their  hands.

“Dental professionals are in their gloves all day long,” Schoen said. “So wearing a glove that is less constricting on their hand and requires less muscle exertion to move in helps reduce their chances of suffering from hand fatigue, which over time may lessen their chances of developing more serious hand injuries such as carpel tunnel syndrome. Considering the use of ergonomic products may help lead to longer, healthier careers because they are designed to reduce the chances of ergonomic injury. ”

Stay healthy
Dentistry can be a stressful job, both mentally and physically; that’s why it’s so important to take care of yourself. If you don’t, you can forget about a long career.

Exercising regularly is a key component of a successful career, said Dr. Kokott, who follows an exercise program designed to strengthen his muscles.

Exercise is very important, but it’s also important that dentists are doing the correct exercises, Valachi said. Dentists have to focus on exercises that target specific muscles for strength training and specific muscles for stretching, which is different than what someone who isn’t a dentist may take up. The wrong exercises can actually lead to more pain, Valachi said, who has a DVD that breaks down some of the best exercises for dentists.

Core strengthening exercises like Yoga can make a huge difference in your flexibility and how you feel day to day, Dr. Johansen said. As you know, the awkward positions you have to sit in every day don’t do your back or neck any favors, so anything you can do to strengthen those areas will go a long way to improving career longevity.

Dr. Johansen began using Yoga a few years ago after a colleague recommendation. He wasn’t sure about it at first, but was in so much pain so early in his career that he was ready to try just about anything.

“Out of desperation I thought I’m going to give it a try, it worked for him,” Dr. Johansen said. “I tried it and I was amazed. This should be a class in dental school. It restores flexibility and core strength. Unless you’re engaged in doing core strength exercises you’re not going to develop it, and as dentists our cores have to be bullet proof strong.”

Be happy
If a long, successful career is what you’re after, it all comes down to being happy in your professional life and your personal life. You have to find a work life balance and you have to stay passionate about what you’re doing. For this to happen, you need to staying healthy and curious.
Not needing to retire also is key to longevity, Dr. Domb said. Have a retirement plan you feel comfortable with; don’t put yourself in a situation where you have to work to 75 to survive.

“If you can do what you do as a dentist knowing you could be somewhere else if you wanted, that says a lot about staying in your practice,” Dr. Domb said. “Not having to be in the practice but doing what you love.”

But if you find yourself in a situation where you have to work longer than planned, don’t just coast along because you know you only have five years or so left. Remember why you first started practicing and find ways to make it fun again. Seek out new technology, take care of any pains you’re having and find your passion again. Make it so you want to practice until you’re 75.

“If you have three or five years left that’s three or five years of dentistry or patients you have left,” consultant Phillips said. “Don’t you want to go out on top? You don’t want all the complaints from your dental career to come in the last five years that you practice.”

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