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  10.01.04 Issue #134

On Track for an Associate?
Avoid the Train Wreck

Sally Mckenzie, CEO
McKenzie Management

       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 picture.

Ok, 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

philosophy, 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.

One 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.

Unfortunately, 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?

For 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.

Before 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.

Next week, objectively determining the need for an associate.

If you have any questions or comments, please email Sally McKenzie at

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Sonic, Ultrasonic, and Air Abrasive Power Instrumentation

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

        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

and 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)

Ultrasonic 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.

Sonic 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 tightening wrench.

Their 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.

Ultrasonic 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.

Magnetorestrictive Devices
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 implant surfaces.

Piezo-Electric Ultrasonic Devices
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.

Choosing 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-etching Devices
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 loss.

Contraindications and Precautions:

  • Susceptible 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 procedures.

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.

If you have any questions concerning your hygiene program submit them to me at and I will answer them in future articles.

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


Building Trust Between Patient and Doctor - Part 2

Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development

         Building 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:

COMPETENCE: 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

reference 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 at The Center for Dental Career Development will instill competence and confidence in their role as patient and treatment coordinators.

CONFIDENCE: 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.

FRANKNESS: 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.

FAIRNESS: 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,
Email or call 1-877-777-6151.

Belle M. DuCharme, RDA, CDPMA

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Sally's Mail Bag

Dear Sally,
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 a reference?
Dr. Watters

Dear Dr.
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.

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

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This issue is sponsored
in part by:
Dr. Bill Dickerson Dr. Bill Dorfman Dr. Bill Strupp
Dr. Kit Weathers
Dr. Louis Malcmacher
Dr. Del Webb
Dr. Eric Mandelbaum
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Gary Coxe
Kathleen Collins
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Nov. 19-20 Griffin, GA Endo Magic Root Camp Sally McKenzie

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