Track for an Associate?
Avoid the Train Wreck
I, Dr. Jones, take you, Dr.
Smith, to be my associate from this day forward until we can no
longer stand each other and you storm off to set up your own practice
or I send you packing. Now shake hands and everybody smile for the
ok, not all associate relationships are destined
for disaster, but a sizeable percentage of these arrangements do
not succeed, and the falling out can resemble some of the messier
divorces. So what’s the problem? From personalities, to systems,
to staff, to patients, to
to patient load, to unclear expectations, there are any number of
potential minefields buried beneath the surface
just waiting to make a royal mess of what both parties hoped would
be a beautiful, lasting relationship.
of the most common associate disaster traps is the busy
office. Oftentimes the doctor on the hunt for an associate
is desperate for someone to help with this “too busy”
practice. “I’ve got to bring in someone who can help
me establish order from chaos.” The senior dentist often wants
to offload the emergency and problem patients on the junior doctor.
Senior believes this will calm the perpetual storm. The unknowing
associate trots in only to be swept up into the swirling mayhem.
too often the too busy practice suffers from poor scheduling habits
and numerous management inefficiencies that an
associate cannot possibly overcome. In fact, their presence will,
in many cases, only further compound the problems brought on by
dysfunctional systems. And while we’re talking “too
busy” what exactly does that mean?
example, does the office schedule appointments to meet production
goals or is the objective simply to fill the units with names to
keep the doctor busy? Is the doctor too busy because he/she will
not delegate duties to other appropriate staff members? Is the doctor
wasting valuable production time on patient education and procedures
that should be delegated to the assistant? Is the doctor engaging
in financial discussions that should be handled
by a staff member serving as the financial coordinator? Is the doctor
performing oral hygiene? Busyness can be a convincing illusion,
but until the practice takes a close look at what is causing that
busyness throwing another body into the mix, especially an associate,
is not the answer.
an associate is ever considered, practices must carefully examine
their management systems to determine if, indeed, the addition
will enable the practice to grow and thrive or if this is just a
last ditch effort to keep the place from sinking under the weight
of poor organization and sloppy systems.
week, objectively determining the need for an associate.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
Ultrasonic, and Air Abrasive Power Instrumentation
Dr. Allan Monack
Hygiene Clinical Director
Does hand instrumentation or power scaling have an advantage in
the removal of subgingival calculus, biofilm, and its by-products?
Most studies indicate there does not seem to be a clinically significant
difference. However, the application of ultrasonic instrumentation
helps to decrease operator fatigue, provides lavage for periodontal
pockets, and requires less time than hand scaling. This creates
more time for education and promotion of patient needs. There are
many sonic, ultrasonic, magnetorestrictive
piezo-electric devices available. Currently, scaling involves the
employment of both hand and power driven instruments. Research indicates
that exercising the use of automated instrumentation
on narrow pockets and difficult furcation access is more effective
than hand instrumentation alone. (Hodges, 1998)
devices were introduced in the 1950’s and have become
the most popular power instrument in the dental office. The goal
of ultrasonic periodontal debridement is to remove
subgingival calculus, biofilm and its by-products. The result is
to create a root surface that is biologically acceptable for tissue
healing and regeneration. The difference between sonic and ultrasonic
devices is the vibration frequency at which they operate. Sonic
scalers operate within the audible range and ultrasonics at a frequency
above the audible range.
Devices - Sonic scalers operate similar to the ultrasonic
types. The vibration frequency is much lower, ranging from 2300
to 6300 cycles per second. Sonics are much smaller in size and attach
directly to the air hose on the dental unit. The direction of the
tip is orbital. The insert tips are screw-on with an autoclavable
advantage is the relative low cost and ease in sterilization. They
do not interfere with pacemakers. They are best utilized as deplaquing
instruments. Their disadvantage is the limited power and
effectiveness. No tuning or power alternatives are available with
sonic scalers. They are not effective for deep scaling and debridement.
Devices - Ultrasonic devices operate at 20,000 cycles per
second and above. Manually tuned ultrasonic devices are more efficient
than auto-tuned ones because they can be adjusted to the specific
needs of the operator. Auto-tuned instruments tune to the maximum
power setting you put it on.
Cavitron® is the most recognized brand of magnetorestrictive
devices. There are many tip designs. The manufacturer recommends
that the tip be replaced every six months with everyday utilization.
Indications are for the removal of heavy and tenacious calculus
and stain. The device can be used for the removal of overhanging
restorations and cements around crowns and orthodontic
bands. It should not be used in the presence of pacemakers. It can
cause surface alterations of composite restorations and microscopic
rippling of the root surface. It is not recommended to be used on
These instruments do not produce heat but still use water spray
for lavage. Piezo-electric devices operate at 45,000 cycles per
second and seem to produce less discomfort for the patient. The
tips have two edges and move in a linear direction. This is very
similar to a hand curette making it more difficult to adapt to the
root surface than the magnetorestrictive devices. Because of its
higher frequency it does not cause microscopic rippling of the root
surface. It is not recommended for implant surfaces.
an automatic scaling device can enhance therapy and treatment options.
With the availability of so many devices in the marketplace, take
the time to review your choices and preferences prior to purchase.
Micro-etchers range in power from removing stain to cavitating teeth.
The Prophyjet® uses sodium bicarbonate slurry to remove stain,
plaque, and light calculus. They are also useful in removing stain
from occlusal fissures prior to sealant placement and cleaning around
orthodontic brackets. The more powerful micro-etchers use aluminum
oxide powder to remove tooth structure and composite restorations.
They also can etch porcelain and metal surfaces for repairs and
bonding. At very low power and with extreme care the aluminum oxide
devices can be used to remove heavy stain with minimal tooth structure
patients need to medicate against bacterial endocarditis.
Exposed cementum and dentin can become sensitive if the dentinal
tubules are opened.
Patients with respiratory and communicable disease are more susceptible
to infection with aspirated particles.
Avoid sodium bicarbonate in patients with salt restricted diet.
Acute gingival inflammation is susceptible to powder penetration
below the gingival epithelial layer.
Avoid contact with restorations especially composite and gold.
Patients should wear eye protective shields during micro etching
Micro-etching devices are becoming more popular as new ways are
being adapted for their use in periodontal and restorative procedures.
The dramatic increase in utilization of these power instruments
have given the dental community better and more effective ways to
help the patient. The hygienist and dentist can treat the patient
more comfortably, more quickly, and with less fatigue
of the operator.
you have any questions concerning your hygiene program submit them
to me at email@example.com
and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
DOES YOUR OVERHEAD
Trust Between Patient and Doctor - Part 2
Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development
trust is a many-leveled process starting with the first
phone call and ending with dismissal. The main factors
in establishing trust with a patient are as follows:
A patient seeking your care is confident that you are licensed,
authoritative, can make an accurate diagnosis and deliver the care
with little or no discomfort. It is up to you to instill confidence
in your patients by displaying your credentials and that of your
staff in a prominent location or printing them in your brochure.
When discussing treatment with a patient, making
to a current course you attended or a new skill
you have acquired can show that you keep up with current trends
in dentistry that are relevant to the care you are about to deliver.
Recently I overheard a conversation between a scheduling coordinator
and a potential patient. The caller had asked about the CEREC™
crowns and whether the doctor was doing them. She had read a recent
article and wanted more information. The scheduling coordinator
said, “ I have never heard of that, it must be something new,
we don’t do that here.” The caller did not schedule.
How much better it would have been if she had known about this new
technique even if it were not performed in her office. Being active
in your local dental society, speaking to groups about dentistry
or being active in a charitable dental delivery system demonstrates
competence and commitment to your profession. Enrolling
your staff in advanced business courses such as the training offered
Center for Dental Career Development will instill competence
and confidence in their role as patient and treatment coordinators.
Showing personal commitment to your recommended course of treatment
is most important if the patient is to proceed. A personal
testimonial about recent work for another patient and the
results obtained shows that you are confident that you will get
a good result for this patient also. Saying, “If you were
my mom, I would recommend this treatment” instills confidence
in patients. Have a “before and after” book
showing completed cases like the treatment you have recommended
is beneficial in creating confidence and builds a sense of excitement
and anticipation for the patient.
Most patients are aware of some general risks in treatment so they
are waiting for you to be honest about what if anything they might
be faced with as a result of the treatment. By giving advantages
and disadvantages research shows that patients are more
willing to trust you to deliver their care. A one sided, advantage
only picture can unravel easily if anything unexpected should go
wrong during treatment. Always speak at the patient’s level
of understanding. Trying to look “smart” by using jargon
and “ten dollar” words can only cause the patient to
distrust or want a second opinion elsewhere. Patients
always feel better when they know the benefits and risks
of proposed treatment. Always keep eye contact with the patient
and sit at the same level that he is sitting, to make the patient
feel that he is involved in the treatment decisions.
In my experience, many issues having to do with trust are linked
to the patient’s perception of the value
they are receiving versus the cost. The right communication skills
to discuss fees are mandatory. Studies show that patients avoid
dental treatment due to cost more than pain. Yet
if they feel that the costs measure up to the service received there
is no complaint. Many patients will not question fees if the practice
has demonstrated that they can deliver “superior” service.
From the first phone call to dismissal establishes the “value”
for services that the patient is receiving. Communication skills
for presenting payment options and treatment presentations are part
of the course work offered at The
Center for Dental Career Development. For more information on
how The Center can improve your team’s communication skills,
or call 1-877-777-6151.
M. DuCharme, RDA, CDPMA
YOU LIKE TO HAVE
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A Guide to Checking References
good through 10/7/04
Missed Past Issues of Our e-Management Newsletter?
I enjoy reading your weekly e-newsletter and find the tips and advice
very helpful in running my practice. One issue that I have not seen
addressed is the matter of references for former employees. Over
the last couple of years, we have seen employees come and go. Some
we have terminated, others have quit and moved on. One thing that
remains unclear to me is how much negative information can we devulge
to our former employees' prospective employers when they call for
You can give a candidate a negative but “honest” reference,
because the dentist providing the information cannot be held liable
because truth is considered a defense in cases where defamation
is alleged. However, documentation regarding the employee’s
performance must be in their personnel file, and it must have been
shared with the employee during their tenure. Supervisors cannot
share suspicions they may have, that the employee engaged in illegal
or unethical activities while employed by the office.
Hope this helps.
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Center for Dental Career Development
Business Education for Dental Professionals
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