07.17.09 Issue #384 Forward This Newsletter To A Colleague
Periodontal Assessments
Purchasing a Dental Practice
Practice Management

Making the Case for Perio
by Sally McKenzie CEO
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Let’s face it, most of us don’t care much for change. Dental teams typically don’t like to change their protocols and patients may be resistant to shifts in practice procedures. Change can feel like a lot of work with an uncertain payoff. Worst of all, it’s scary.

But the fact is that in the dental practice, when it comes to changing certain procedures in the patient exam, the change can have a significant positive impact on the overall health of the patient. Such is the case when it comes to perio assessment.

One third of hygiene production should be in interceptive periodontal therapy. That is the industry standard. As a healthcare provider, you have a medical responsibility to integrate interceptive periodontal therapy into the hygiene protocols. There is now strong evidence indicating that the toxins released by the gum cells in response to bacteria can get into the bloodstream daily. These toxins can then go anywhere the blood flows.  

Moreover, it has been clearly documented that eliminating gum inflammation can reduce the risk for heart disease. For diabetics, gum disease makes controlling blood sugar even more difficult. A study in The Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.

Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar level. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

These are potentially life altering health concerns. Clearly, you can no longer sit back and say to the patient, “Well if it doesn’t hurt, let’s just keep an eye on it.” Since dental health professionals now know that the patient’s overall health is affected, it is more critical than ever to address periodontal health with patients.

Educating and teaching new patients about the office protocol is easy. Introducing existing patients to this change, however, will likely require a little more time and patient education, but it is imperative not just to the practice, but, most importantly, to the patient.

When asked by the existing patient, “Why hasn’t this procedure been done before?” you have an excellent opportunity to emphasize the advances in research and the development of new procedures that have emerged in dental medicine establishing a much clearer understanding of the link between oral health and its impact on our overall health.Consider this approach with the patient: 

Gum disease is caused by bacteria. This leads to an increased risk for more serious health problems. For example, bacteria from the mouth can get into the bloodstream when the gums are inflamed. These bacteria can attach to platelets. These clumps of platelets and bacteria can lodge inside the walls of blood vessels causing heart stopping clots to form. These clots are what lead to heart disease. Keeping your gums healthy can reduce your risk for a heart attack.

In addition, studies show that people with long-standing gum disease are more likely to have strokes. For diabetics, the presence of any gum inflammation can make it much more difficult for a diabetic to control their blood sugar. Elimination of any gum inflammation can directly improve diabetic control.

For women who are pregnant or considering having children, those with gum disease are seven to eight times more likely to give birth prematurely to low birth weight babies. Researchers believe that gum disease causes the body to release inflammatory chemicals, which are linked to pre-term birth.

One of the most beneficial procedures in dentistry is the screening process that enables us to detect gum disease in the earliest stages. As a result, a conservative therapy can be performed before the disease and infection are allowed to progress.

There is plenty of evidence linking healthy gums with overall health. The case is so compelling that one would have to ask, are you really fulfilling your responsibilities as a healthcare provider if you aren’t routinely providing periodontal assessments? Only you can answer that.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click here.

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Managin Your Practice and Your Future Growth is NOT just a roll of the dice.


Thomas L. Snyder, DMD, MBA
Managing Partner
The Snyder Group, LLC
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Buying A Dental Practice? Buyer, Be Aware

The prospect of establishing your own dental practice is about as big a decision - in terms of its long term impact - as your decision to go to dental school was. If you’ve decided to purchase a dental practice as opposed to starting a practice, there are several key factors to consider to ensure that you make the very best investment for both your current needs and your future opportunities

Location, Location, Location! From the community as a whole, to the actual site of the office, to the type of dentistry you wish to provide, location is key. Take a look at the demographics.  Is it a diversified economy? Is it a growing community in terms of new housing, condo and apartment complex construction? Does it offer a quality school system?  Take time to tour the area you are considering. Look at the shopping malls and the types of stores in the area. The retail establishments give you an indication of the population that surrounds the area you are considering. 

Is the office under consideration conveniently located?  Is it on a busy thoroughfare?  Is there adequate parking that is free and convenient?  Is the facility handicapped accessible? If not, OSHA laws will likely require you to make it accessible. If the practice is located on a second or third floor, is there an elevator? Is there prominent signage? 

Consider the type of the location. If the practice is in a mixed professional office, for example, it may include a dental practice and other primary care providers such as internists, cardiologists, dermatologists, etc. Downtown high-rise practices often are in commercial properties with many dentists in the building, and parking can become an issue, while a converted residence typically will house an older practice that requires updating.

Consider the type of practice and the clinical services you want to provide. Purchasing an insurance-based practice requires that you study the plans and contracts carefully to clearly understand the economics of the arrangements you’ll be taking on. If you seek a fee for service practice, a suburban area may offer greater opportunity to develop this model, particularly if the residents in the area are white collar professionals. In addition, consider if you want to establish a family practice that serves a broad age range or if you want to focus on restorative dentistry and aesthetics, which tends to attract more mature patients.

Examine the fees. Fee structure is important to determine where fees may be relative to other dentists in the area. Purchasing a practice with a lower fee structure allows you to gradually increase fees.  Conversely, if you purchase a fee for service practice and fees are considered highest in the area, you may have difficulty charging the same fees as your predecessor who could command that level based on his/her skills and experience.

Evaluate the infrastructure. Many practices need substantial financial investments in new equipment, leasehold improvements, and technology.  While the market price may be lower, consider the additional investment required. Be careful not to restrict your ability to grow the practice. If there are only three operatories and no room for expansion, you may force yourself into a costly move down the road. Practices with unused space, plumbed operatories, as well as plenty of workspace in the business area may make better long-term financial investments.

Conduct a chart audit to determine the number of active patients – those individuals that have visited the practice for at least one recare appointment in the last 12 months. The number of new patients per month is also a key indicator of patient activity, and looking at age distribution of the patients will give you a snapshot of the type of dentistry you will be providing.  In addition, the zip code analysis can reveal how many patients are driving long distances to see the selling dentist. Once the previous dentist is gone, those patients may switch to a more conveniently located practice. 

Consider the staff. Although you may not want to keep the employees long-term, if the seller departs shortly after the sale it can be beneficial for the hygienist, in particular, to remain, since she/he has a relationship with the patients. If the staff members are well trained and likeable, they will be an asset, even though the market value may be higher in terms of their salary rates. 

Purchasing a dental practice is the foundation for your professional future. Doing so effectively will ensure your long-term financial freedom.

Dr. Thomas L. Snyder is Managing Partner of The Snyder Group, LLC, a nationwide practice transition and financial management consulting firm.

With more than 75 years of experience in the field, The Snyder Group can provide you a full range of services relating to practice transition matters and retirement planning. They can be reached directly at 1.800.988.5674 or email tsnyder@snydergoup.net

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Who's the "Pack Leader" in Your Practice?

I recently watched a particularly interesting episode of The Dog Whisperer. For those of you who aren’t familiar with this very educational and entertaining program, the host is Cesar Millan, a dog behavioral specialist. His mission is to rehabilitate dogs and retrain people. He has an uncanny ability to keep dogs balanced, calm and compliant. I think of Cesar as a dog psychologist.

On this particular episode, the focus was on Riley the Mastiff, a 125 pound handful for her owners, Jessica and Shawn. This hefty canine was in control of the household! Although Shawn was a fitness expert capable of lifting hundreds of pounds, his size was insignificant when it came to stopping Riley’s bad behavior. Jessica was frustrated and vacillated between pleading to punishing the dog. They truly needed Cesar’s help.

If you’ve ever viewed The Dog Whisperer you know that Cesar teaches dog owners that they are the problem, not their pets. As I observed him show this couple how to restore order in their household, I saw many parallels for dental leaders.

My belief is that people, like dogs, are inherently good. I doubt that anyone on your payroll gets up in the morning thinking about how to make life difficult for you. If you’ve got problem employees, maybe you’re not being a good pack leader. Being successful requires you to influence people just about all of the time. You need to persuade your patients and your employees to take action based on what you say. Here are some principles to re-establish yourself as the alpha dog in your office.

1. Start thinking like your employees and your patients. Make the effort to get to know the people around you. Find out what’s important to them. This creates a positive atmosphere that motivates, encourages and gives confidence. Best of all, the information you gain will help you to know what each person needs from you to be a good follower.

2. Be direct and consistent in your communication. In the absence of clear expectations, your employees and patients will assume what they think you meant, and it might not be accurate. If job performance is not up to your standards, it’s your responsibility to provide feedback and training. If treatment compliance isn’t up to your satisfaction, emphasize the seriousness of the problem and/or the positive benefits that will be gained.

3. Be calm and assertive. If your employees and patients see you as frustrated, angry or fearful they are unlikely to follow you.

4. Match employees to the right jobs. Top performers want and need to feel challenged. Explore what new opportunities they see in their work with you. Provide your staff with opportunities to expand their skills. Show them that you are interested in them as people not just as employees.

5. Be benevolent but tough. This means you are fair and respectful. If you want employees to be productive, you have to create a disciplined teaching environment. Discipline is really a part of overall performance management.

6. Acknowledge your employees each and every day. People need to feel that they matter; it’s a human need. We all have a basic and natural desire to be valued and appreciated.

7. Reward appropriately. Avoid giving bonuses with the hope that problem employees will “get the message.” If you use money as the primary motivator, your staff will see you as a push-over – they weren’t performing well before the raise and they sure as heck won’t improve when they get reinforced for doing poorly. Praise needs to be linked to specific behaviors in order to contribute to the overall practice mission.

8. Choose your battles. There are some employee behaviors that just aren’t worth hassling. If you’re quiet but your chairside is talkative and friendly, learn to live with it. Manage your energy by focusing on the things that really matter.

Like our canine friends, your employees need challenge, discipline and support…in that order. This is the foundation for a balanced leader-follower relationship. Calm-assertive energy will create a positive and lasting connection with your employees and patients. And the rules, boundaries and limits you set and maintain consistently will establish you as the pack leader in your practice. 

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like information about any of her practice-building seminars, contact her at coach@mckenziemgmt.com

Interested in having Dr. Haller speak to your dental society or study club? Click here.

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