Redefining the General Dentist

Dental Products ReportDental Products Report-2011-10-01
Issue 10

Having a focus for the practice doesn’t have to mean going all-in on a specialty such as endodontics or oral surgery. Nor does it mean playing up cosmetics or selling take-home products, but either of those are valid choices if they are the type of dentistry you believe in. General and family practices can really stand out by just embracing the reasons they’re involved with dentistry.

Having a focus for the practice doesn’t have to mean going all-in on a specialty such as endodontics or oral surgery. Nor does it mean playing up cosmetics or selling take-home products, but either of those are valid choices if they are the type of dentistry you believe in. General and family practices can really stand out by just embracing the reasons they’re involved with dentistry.
Whether it’s using the latest technology, approaching cases with the idea of being minimally invasive or any other guiding principle, figure out what drives you and pursue it in your practice. Your patients will notice when there is passion behind the care they’re receiving.

Why not now?
For Dr. Marvin Berlin and his practice,, in McKinney, Texas, the drive to provide same day care as often as possible came after realizing how good it felt when he had to take his daughter to the doctor and she was seen and treated right away. He realized his patients rarely felt this way because if they came in for a hygiene appointment and needed further treatment, they’d leave with another appointment and maybe a prescription.

“They would kind of slump their shoulders and say, ‘Is there any way you can do it today?’ and I’d say, ‘No, we have to reschedule you.’ Not really knowing why we were doing it that way other than that was how we were taught,” Dr. Berlin said.

To change this, Dr. Berlin realized he’d need to hire at least one more assistant and get his staff on board with being flexible. But once those adjustments were made and everyone got the hang of simply working in extra treatments throughout the day, he discovered his patients were far happier.

Patients no longer had to worry about getting another afternoon off work or finding another baby sitter, and whether it was a root canal or a crown, they went home with their dental issue addressed. Those patients told their families and friends, bringing in new referrals, and the practice promoted this same day care attitude everywhere it could, bringing in more patients.

“It’s kind of what we call a ‘Yes’ philosophy, where we try to say ‘yes’ to whatever the patients want and make it happen today. That in itself has kind of set our practice apart,” Dr. Berlin said. “There’s really no more convenient time than right now. We don’t mind working through lunch or staying late if we have to. Then it’s taken care of, and that’s what it’s all about.”

A lighter touch

A different passion has guided the career of Dr. Mark Malterud, whose St. Paul, Minn., practice has honed its minimally invasive approach to care throughout the past 28 years. His drive to focus on minimal preps and save healthy tooth structure has been with him from the time he finished dental school.

“It’s a philosophy of practice. You really have to look at things differently. Rather than just going in and cutting a prep here and cutting a prep there, and thinking about classic preps, you’re always thinking about what can I save,” he said.

Before the term minimally invasive was a part of the dental conversation, Dr. Malterud was using pediatric-sized burs to create less aggressively designed preps than those he’d been taught in school. He adopted early generations of bonded composites, and today still sees patients with those restorations that have been functioning for 25 years. He has even greater confidence today thanks to the improved results from easier to use newer generations of these materials.

Still, even the newest materials might eventually fail, and Dr. Malterud believes his approach to protecting the patient’s natural dentition will be beneficial in the future. This led him to focus his practice on prevention, detection and minimally invasive care, and he makes sure his patients understand why he is taking this approach.

“My restoration isn’t going to be the last one that will be in there. It’s going to last a long time, but it’s going to have to be restored again down the road if something fails,” he said. “Five, 10, 15 years down the road we’re going to have better materials and better ways of dealing with tooth structure. The more that I leave, the better chance I’m going to have to restore effectively the next time.”

Benefits of focus
Having a practice identity patients can understand and relate to can definitely help a practice stand out, which is important in the current economic climate, said practice consultant Penny Reed Limoli who added that the industry is as competitive as she’s seen it during the 20 years she’s been involved. Anything that distinguishes a practice in a positive way can be helpful, she said while noting that just staying up to speed with the practice down the street can be an important baseline.

“I think you’ve got to stay up to date and involved with these products and services or you will give the patient or potential patient that you’re practicing decades old dentistry,” she said.

A practice needs to keep up to date on what is happening in terms of new technologies and treatment options, and at the very least a practice should be aware of options patients may find elsewhere, said dental technology consultant Dr. Lorne Lavine. Having a guiding philosophy of care also will drive technology and other product decisions for the practice.

This was certainly true for Dr. Berlin’s practice, which found D4D Technologies’ E4D Dentist CAD/CAM system to be a natural fit when it came to providing immediate care. The ability to provide a definitive crown, inlay or onlay in one appointment was an exact match with the practice philosophy and added a capability competitors couldn’t match.

“The practice has grown and I think a lot of that is because we’ve tried to separate ourselves,” Dr. Berlin said. “You can’t get better than a same day crown, in my opinion. There’s not anything out there that has changed the practice like the E4D has.”

Dr. Berlin said adding CAD/CAM took the practice’s care to a new level. And because they have enough business to keep the system in use regularly, the costs per crown have shrunk while patient satisfaction has increased. The practice strives to use the technology as efficiently as possible. For endo cases, Dr. Berlin will prep the tooth and scan it prior to performing the root canal, so that the crown is ready to be seated when treatment is concluded so what once required four appointments is completed in one.

The system is in use even for cases that aren’t completed in one day, and all of the assistants in the practice know how to use it. But while the scanner and the mill stay busy, the practice’s biggest return on its CAD/CAM investment is the ability to promote same day crowns. That concept has resonated with patients and it brings them in for all types of dental work.

“I love it, it’s part of our day,” Dr. Berlin said. “We’re kind of known in the area now that if you need a crown today just give us a call. It’s kind of a cool reputation to have.”

Products that fit
The purchase decisions at Dr. Malterud’s practice have followed a similar path, but for him the decisions to adopt a new product, technology or material is always based on whether that product will allow him to be less invasive with the care he provides. He said the philosophy of minimally invasive care really does require the use of certain technologies for patients to experience its benefits.

At his practice he is always looking for new ways to improve the care he provides, while lessening its impact on healthy tissue. Core technologies for him include air abrasion, which he uses on every restoration he places; DIAGNOdent, which allows for early caries detection; and the bands, brackets and rings required to create contacts on his minimal preps. Still none of that has helped him provide the care he believes in as much as the 6X magnification loupes he wears to see every detail of the surfaces he works on.

“That’s been a crucial part to my journey through minimally invasive dentistry,” he said.

The development of restorative materials has been another part of his journey. Dr. Malterud said he tries to stay up to date on the latest materials because as their properties improve, it gets easier to provide care in a minimally invasive way. Today’s composites are far better than the first generation materials he started with, and he’s intrigued by the possibilities of the newest flowables.

“That’s starting to actually pique my interest for the restorative aspects of dentistry, especially with minimally invasive preps,” he said.

A team that works
Having a staff with a true understanding of and commitment to a practice’s goals is an absolute necessity. The staff members interact with patients before the dentist ever meets them, and if a practice is going to live up to the philosophy it wants to present, team members need to embody that spirit during those interactions.

Even in the Internet era where patients may discover a practice via its website, Limoli said the phone is still the primary way new patients make contact, and thus staff members answering the phone need to be prepared to present the practice in the way it wants to be seen. They need to be able to answer questions about what sets a practice apart without hesitation. If they can share personal experiences with the benefits of the care and products the practice provides, that’s even better, she added.

Dr. Malterud said his staff has been a big part of his success as a minimally invasive practice. His hygienist has been with him for 24 years and has experienced the practice’s evolution from its early days as part of a production-focused practice following a practice management consultant, to its current status as an independent practice dedicated to minimally invasive care.

“I always felt uncomfortable selling crowns, but she was great at selling crowns,” he said. “Now that she understands my philosophy, she’s great at selling minimally invasive dentistry.”

Team buy-in is just as critical to the success at Dr. Berlin’s practice where he needs to know his hygienists, assistants and front office team will be ready to shift priorities as needed. His staff all know they are working hard to do the best they can for their patients, and he feels lucky to work with such a dedicated team.

The practice is set up with an assistant assigned to every operatory, whether there is a patient seated or not. This way if there’s an open operatory for a patient, Dr. Berlin knows he’ll have a team member ready to help get treatment started right away. Having the facility and staff to handle the workload is important, but the dentists have to set the tone for everyone by hustling as much as the team members, if not more.

“If you’re lazy then this probably isn’t going to work for you,” he said.

Ready for everything
Making sure the staff is properly trained on all aspects of the practice is important. While the administrative personnel won’t need to know every detail of the CAD/CAM software, Dr. Lavine said they need to know enough about the technology to help patients grasp what it can do for them.

“If they’re not going to believe in that new technology, then they’re not going to be expressing that belief to your patients,” he said.

Limoli agreed, and said a practice should regularly review questions it receives from patients to make sure staff are providing consistent responses that present the practice in the right light. It’s important for the team to be able to discuss the services a practice provides, but it can be just as important to know how to respond when patients ask about something the practice doesn’t offer.

Patients have greater awareness of some dental products, such as Zoom! Whitening and Invisalign appliances, and if the practice doesn’t provide something, Limoli said the team should be ready to offer an alternative the practice can provide while explaining why the practice made that product decision.

“Those are the conversations that you need to practice,” she said.

Offering a viable alternative is precisely the route Dr. Malterud and his practice have taken when patients inquire about same day crowns. Even in a minimally invasive practice, there are plenty of cases where a crown is required, and while he doesn’t do enough crowns to support investing in a CAD/CAM system, Dr. Malterud said he understands the patient appeal and the clinical sense of being able to offer something definitive in one appointment.

To accomplish this he places Natural 1 preformed composite resin crowns from DirectCrown, which can serve as a long term temporary that allows a patient to either save up for a definitive crown later, or replace the temporary with another sometime in the future.

Operating with efficiency similar to a CAD/CAM system, Dr. Malterud has his assistant fabricate the Natural 1 crown while he is free to see another patient, and then he can return to seat the crown. It might not be a permanent solution for the patient, but Dr. Malterud is able to offer these crowns at a lower price, and they fit perfectly with his philosophy of helping his patients stay healthy until a more definitive option is available in the future.

“It’s a transition, and during these economic times I think it’s positioned perfectly to take off,” he said.

Selling the idea
Once a practice has honed the business to follow a philosophy of care, successfully integrated the products and technologies that match that outlook and brought the staff on board with enthusiasm, it is important to make sure that message is reaching patients in a way they can understand.

While putting the practice’s focus front and center is a good thing, Limoli said it is important for patients to see and understand the practice provides general dental care. Otherwise, if all they see is crown in a day or minimally invasive care, they might not be interested in coming in for a hygiene appointment. This is something that’s especially true for a minimally invasive practice, such as Dr. Malterud’s, because not every case can be treated that way.

“Whether it’s dental caries, endodontics, restorative, implantology or periodontics, we focus on the minimally invasive aspect of all of those. But that being said, my foundation is strong enough that I have no problem jumping into full-mouth reconstructions and taking care of people who are severely broken down and you can’t perform minimally invasive dentistry on,” he said.

However, once that focus is completely integrated into the fabric of the practice’s day-to-day operation, it is important to make sure your message about the care you provide is out there for patients to find. Limoli recommends putting the dentist front and center online via the practice website and beyond that via videos that can be posted to YouTube and even shown in the reception area.

“We’ve got more technology at our disposal, not just in dentistry but in marketing, than we’ve ever had. Why not have the messenger be the doctor himself or herself? It connects them visually with that brand,” she said. “The doctor, whether they like it or not, is the rock star of the practice. The team is important, but the brand of the practice really winds up being, ‘Do I like the doctor?’”

Marketing is a multi-faceted and wide-reaching effort for Dr. Berlin’s practice takes out magazine ads, billboards, radio and online ads, and everything they put out encourages patients to “Ask us about same day crowns.”

Spreading the word
Once patients do arrive, they aren’t likely to leave Dr. Berlin’s practice without being introduced to the E4D system. The staff knows to make sure patients see the technology on the way to the operatory, especially if a crown is being designed or milled. When patients are in for a same day crown, Dr. Berlin said they are always in the room while it is designed because once they see the technology in action they want to talk about it.

Both Limoli and Dr. Lavine said this should be the norm for any practice with CAD/CAM. Patients may not be familiar with the technology, but once they’ve seen it they can quickly grasp its cutting edge nature. With or without CAD/CAM, Limoli said it’s a good idea to note in a patient’s record if he or she has toured the practice. The tour should be repeated when there’s a new capability the practice wants to highlight.

Once patients see the CAD/CAM at Dr. Berlin’s practice, or even better experience its benefits firsthand, they almost always become advocates for what his practice can offer. Making sure good patients leave with an understanding of his practice’s guiding principle of same day care can turn them into ambassadors for other good patients.

“The best marketing for sure, 100% is word of mouth marketing. People tend to refer good people and good patients. You’re not going to get any better in my opinion,” Dr. Berlin said.

This is something also experienced by Dr. Malterud’s practice. While he admits, minimally invasive dentistry can be a difficult concept for patients to understand, he and his team always explain how the concept of saving natural tooth structure and treating with as little impact as possible guides the clinical decisions. Then patients who feel the benefits personally are likely to tell their friends about their positive dental experience.

Pitfalls to avoid
Regardless of how many products a practice adopts to fit the philosophy behind the care it provides, if it doesn’t fit with the patient population around the practice, things probably won’t work.

Dr. Lavine said a practice dedicated to same day crowns and immediate care will likely do well in an urban environment, but no matter how dedicated and ready, the same team may struggle in a slower-paced locale.  

“If you’ve got a high number of busy professionals in the practice, then something like that may see more benefits than a practice that might be in a rural setting or have a lot of elderly patients,” he said.

Another potential problem can come from moving too fast to turn the dentist’s philosophy into the basis of the care the practice provides. It starts prior to purchase with a plan for how any new technologies or products adopted will be integrated into the practice operations and how it will be promoted. Without such a plan, the investment might sit gathering dust, Dr. Lavine said.

“The fact of the matter remains that with these technologies, they are not for every patient,” he said. “Practices can spend more time choosing the technology than answering the correct questions, which is can I use the technology.”

The next step is knowing when to implement and promote new capabilities of the practice. Dr. Lavine said every practice will have a different comfort level and learning curve with new technologies and protocols. Attaining that comfort level is critical because a practice must be sure it can deliver on any promises made in marketing around the new systems, Limoli added.

“I’d be sure you can prepare what’s on the menu before you start marketing it to the general public. Be prepared to deliver and be prepared to answer some questions,” she said.

Care you believe in
In the end, it will all come back to believing in the care you provide, because your patients will notice. Dr. Berlin said this has certainly been the case with his practice’s same-day care approach, and he expects the concept to catch on elsewhere.

“I think you’re going to see more and more patients demand same day dentistry. I think the word is going to get out, or at least I’m going to try to get it out,” he said.

Dr. Malterud also sees his approach to dentistry as one that could be successful for others. While it might be more difficult to pitch with an elevator speech, he believes minimally invasive care is something patients respond to once they’ve experienced it first hand, and just as importantly, it is something that strikes a chord with the reason many people got into dentistry in the first place.

“It can work for a lot of practices,” he said. “I don’t think there’s a single maximally invasive dentist. I just don’t think some of them understand how little they can do to a tooth and still restore it.”

Knowing and embracing the principles that led you to dentistry can unlock the potential of your practice, and when those ideals are integrated into the practice’s day-to-day activities it shows in the care patients receive.


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