“Time is money.”
You’ve heard that phrase before. Perhaps you’ve even
used it. In fact, you and your team may go ripping through each
day chanting quietly to yourselves, “time is money, time is
money.” But have you ever actually measured the use of time
in your practice and its effects on your day, your team, your stress,
your patients, and your money? Consider this “time
is money” reality. The patient who is stuck twiddling
their thumbs in the waiting room, sitting in the operatory, and
stewing at the front desk is far less interested in returning to
your practice to waste their valuable time and money on your valuable
Time is, indeed, money – money lost or money gained.
was the last time you measured how much time was spent processing
X-ray films? Do you ever consider what your patients are
doing while they must sit and wait? Maybe they are reading a magazine.
Perhaps they’re checking in at the office on their cell phone,
but within just a few minutes they are antsy. They are peering at
the door to see if anyone is coming, studying the floor, examining
the ceiling, waiting, wondering, and wishing they had said they
didn’t have time to get the X-rays done at this appointment.
Finally someone returns to rescue them from this time wasting detention
you discovered you were losing 2-5 hours of production time a day
would you take steps to reclaim it? If you could significantly reduce
the amount of time that a patient has to sit waiting would you?
If your answer is yes, digital
radiography is one of the smartest investments you can make.
The doctor that invests in a digital radiography system says to
the patient “excellent care, highly efficient, state-of-the-art
technology, and I’m no longer going to waste your precious
time,” without ever uttering a word.
more, digital radiography gives practices the one thing they are
most desperate for: time. Consider the time it takes to process
film. That is time that could be used to discuss optimal treatment
options with a patient that can now clearly see the problem
and is ready to invest in their oral health. That time could be
spent learning about the patient’s dental wants
and educating them on the latest cosmetic and aesthetic opportunities
available. With an additional 2-5 hours of time every day, how many
more new patient consults could be scheduled? How far could you
reduce the backlog patients? How much would you enjoy a full hour
for lunch? What could you and your team do to increase production,
improve the schedule, and enhance the total patient experience?
you begin to realize the benefits of a highly efficient digital
radiography system, take a few more steps to increase the time and
reduce the stress in your day:
Avoid booking entire treatment plans. Scheduling
all the appointments up front makes your schedule appear clogged
and overwhelming, and it does nothing to guarantee that the patient
won’t change or cancel appointments. What’s worse, overbooking
typically forces loyal patients to wait several weeks for routine
procedures. The doctor should never be scheduled out more than three
procedures to the assistant. Many states have expanded
functions for dental assistants. Provide necessary training to prepare
your staff to perform procedures that they are legally allowed to
carry out in your practice.
the schedule as a team first thing. The clinical staff
can then advise the scheduling coordinator where to place any emergency
patients. The dental assistant also can review specifically what
procedures are scheduled and set up the treatment rooms accordingly.
time for crown and bridge appointments based upon actual
historical patient activity. Calculate the number of crown and bridge
units over the last six months, divide by the number of days worked.
Reserve time in the schedule based on the number of units actually
necessary time for new patients. Look at new patient activity
over the last six months. If you saw 60 new patients, that would
be 10 per month and 2.5 per week. Reserve at least that much time
in your schedule to handle immediate new patient demand. Remember,
new patient slots should always be reserved during prime time.
the most of your time and you’ll make the most of your dentistry,
your team, your patients, your schedule, and your money.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
Dr. Allan Monack
Hygiene Clinical Director
In assessing for periodontal disease, the hygienist is not responsible
for the diagnosis. The doctor is the only one that can make the
diagnosis even though the hygienist gathers the majority of the
diagnosis of the disease. While in most states, the dentist makes
the actual diagnosis, the hygienist can be held liable
if these issues are not disclosed with the patient. Hence, it is
imperative that the hygienist utilizes certain diagnostic screening
the numbers vary slightly depending on the study, 70-80%
of the population has some form of periodontal disease.
This information is alarming because through our Hygiene
on-site Consulting Services we typically find only 10% on average
of the active patients have been treated or undergoing therapy for
periodontal disease. Only 15% of the total dental services rendered
in the United States is related to periodontal therapy. This amount
has doubled since 1995, but is still too low! In light of the evidence
linking periodontal disease to heart disease, stroke, diabetes and
low birth weight of newborn babies, more effective intervention
of periodontal disease needs to be done!
Gathering Information for Proper Diagnosis
In order to determine whether your patient needs a comprehensive
periodontal evaluation it is recommended that the initial screening
can be done with PSR probe or your probe of choice. Establish written
protocol to determine when a patient needs more than a
are the criteria guidelines recommended to ascertain the need for
bleeding on probing
Total depth of pockets add up to 15 or more
Two or more 5mm pockets
One pocket 6mm or greater
Evidence of progressive loss of bone on comparing previous radiographs
with new ones
Gingival recession with soft tissue defects or frenum pulls
your protocol recognizes there is a need for interceptive
periodontal therapy, perform a comprehensive examination
which includes six point probing, radiographic survey, abnormal
gingival color and form, presence of bleeding, exudates, and mobility,
missing teeth malodors, furcation involvement, attachment loss,
gingival recession mucosal defects, and bone loss.
Classification of Periodontal Disease
Based on the information that has been gathered at the clinical
examination, we must now classify the periodontal disease. These
classifications were developed as guidelines for universal treatment
and billing modalities.
Type I Gingivitis- Diagnosis Code 4500-
Inflammation of the gingiva characterized clinically by changes
in color and gingival form with the presence of bleeding and/or
exudates without attachment or bone loss. Light plaque and subgingival
calculus can be present.
Type II Early Periodontitis- Diagnosis Code 4600-
Progression of the gingival inflammation in the deeper periodontal
structures with evidence of some attachment and bone loss Probing
depth is generalized 4mm with isolated 5mm pockets possible.
Type III Moderate Periodontitis-Diagnosis Code 4700-
Moderate stage of periodontitis exhibiting increased destruction
of the periodontal apparatus with noticeable loss of bone. Probing
depth is 4-5mm with localized 6 and 7mm pockets possible in no more
than four areas.
Type IV Advanced Periodontitis-Diagnosis Code 4800-Major
loss of alveolar bone support usually accompanied by an increase
in tooth mobility with possible furcation involvement. Probing depth
are generalized 6mm and above.
Type V Refractory Progressive Periodontitis-Diagnosis
Code 4900-Is characterized by rapid attachment and
bone loss. There is usually a progression of the periodontal breakdown
even after aggressive intervention.
is a new method of complete diagnosis proposed and approved by the
American Academy of Periodontology. The diagnosis is determined
by multiple criteria.
definition is determined if less than 30% of all possible sites
are involved. Generalized definition is determined if more than
30% of all possible sites are involved.
of attachment loss determines severity. Amount of attachment loss
is defined as the sum of the recession and pocket depth.
Slight- 1-2mm of attachment loss
Moderate- 3-4mm of attachment loss
Severe- 5mm or greater of attachment loss
new codes would include a combination of localized or generalized
with slight, moderate, or severe. Note that the dental insurance
companies have not yet incorporated the new definitions
into their insurance codes.
the diagnosis is made comes the hard part. You must get your patient
to understand how serious their periodontal problem is if left
untreated. Take the time to communicate and listen to your
patients’ desires and fears. Overcome their barriers to therapy
and make your patients healthier.
you have any questions concerning your hygiene program submit them
to me at firstname.lastname@example.org
and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
DOES YOUR OVERHEAD
Belle M. DuCharme
RDA, CDPMA, Director
The Center for
Dental Career Development
a doctor attends our Practice
Start-up Program, they are near completing the purchase of an
existing practice or the building of a new facility. The considerations
necessary for a successful practice have all ready
been put in motion. We ask that the doctor bring the blue print
design of the interior of the office. The parking area and types
of businesses near the office location are also important to see.
Our purpose is to help the new dentist make the best first
impression when patients enter the office for the first
time. We can determine the proper flow of patients and the positioning
for proper check-in and check-out of patients and we can make suggestions
for the design of the reception room. It is important to consider
privacy in the placement of computer monitors.
Areas where treatment plans and financial arrangements will be discussed
must be designed so that conversation is not easily heard. It is
common to put more emphasis on the design of treatment rooms and
not on the business area of the office. Maximizing
profitability in the space provided is a main concern.
Planning of the business office workspace is equally important.
The area should be ergonomically designed so that the office staff
can perform their job tasks with the greatest efficiency and comfort.
is the study of the effects of the work environment on the health
and well being of the worker. Physiological factors include color,
lighting, acoustics, heating and air conditioning, space, furniture
and equipment. An attractive, cheerful and efficient office
inspires confidence in the staff and comfort in the patient. The
Americans with Disabilities Act, passed in 1990, has affected the
design of dental offices for patient treatment. The office design
needs to comply with state and federal guidelines.
The Justice Department issues accessibility specifications for offices.
Some states have stricter guidelines. Staff productivity and longevity
is greatly affected by the work environment. Patients
are more comfortable and agree to more treatment in a comfortable,
clean, attractive office.
easily accessible location for now and the future are important.
Take into consideration the possibility of growth in the immediate
area of the practice that may affect the availability of
parking or visibility of the office. Seating in a reception room
should be comfortable, attractive and well lit for reading. A general
rule is to provide two seats per dental chair in
a general practice and three or four seats in a pediatric or orthodontic
practice. For endodontics, one seat per dental chair is adequate.
Consider comfortable armchairs that are not too low and with a sturdy
base so that patients can easily get in and out of them. Working
in dental offices for the last thirty-five years I have seen examples
of poor design that have limited the growth of
potentially thriving practices. For instance, a dentist purchased
an office with five treatment rooms and within six years had all
rooms booked solid each day. There were only four assigned parking
spots and one handicapped parking stall. The reception
room had space for only five chairs. A sixth chair was added giving
a crowded look to the room. The general practice evolved into a
family practice with many children patients. The afternoons became
chaotic as parents brought siblings in with the scheduled child
and tried to find seats in the reception room. A bench had to be
installed outside the office for adult patients. This was fine for
the summer but not the winter. Scheduling had to be controlled to
limit the number of children seen at any time. Complaints
were common about the parking and often patients had to park a block
from the office and walk. The business area of the office was small
and cramped with no area designed to discuss treatment and payment
options without being overheard in the reception area. The design
of the front office area was not considered when purchasing
are many factors that affect the success of a dental practice. The
Practice Start-up Program is an excellent way to learn the skills
to create the practice of your dreams. Please give us a call for
M. DuCharme, RDA, CDPMA
YOU LIKE TO HAVE
Exceptional Front Office Employees?
You Increased Your Hygiene Days Per Week In The Past Year?
To Have A Sucessful Recall System
By Sally McKenzie
patient retention is not guaranteed by preappointing, sending
postcards, letters, or even phone calls. But an effective use
of an integrated retention system can significantly improve your
ability to keep patients returning. This step-by-step guide to
the systems used by today's most progressive practices includes:
letters that get responses, telephone monitoring techniques to
ensure patient retention, tools to monitor your success, and scheduling
tips for a productive hygiene department.
*Good through 10/22/04
Missed Past Issues of Our e-Management Newsletter?
your latest news letter you gave industry data for the number of
new patients per month for a healthy practice (16-25). Do you have
any numbers for a pediatric dental
practice? Thanks for your time.
point to keep in mind when determining a “healthy” new
patient number is you have to consider how much business is going
out the back door. And while practice’s don’t like to
think they lose patients….they do. That’s why the majority
of solo practitioners are still solo after many years in practice.
So the answer to your question is that ideally you would treat 2
x the patients going out the back door in comprehensive exams to
example: Year to date this year (9 months) you had 1200 patients
due to return on the recall system. You actually treated 975 which
225 were not retained through the system or 25 patients a month
and you treated an average of 12 comprehensive exams per month.
You lost 2 x out the back door. Your new patient numbers per month
should have been 2x the loss or 50 new patients a month. Hope this
US TRAIN YOUR
Center for Dental Career Development
Business Education for Dental Professionals
Pearl Street, Suite 201
La Jolla, CA 92037
OUT OF YOUR
Center for Dental Career Development
Business Education for Dental Professionals
Pearl Street, Suite 201
La Jolla, CA 92037
issue is sponsored
in part by: