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  10.15.04 Issue #136

Measure Your Minutes
Gain Hours

Sally Mckenzie, CEO
McKenzie Management

       “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

treatment. Time is, indeed, money – money lost or money gained.

When 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 center.

If 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.

What’s 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?

As 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 weeks.

Delegate 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.

Review 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.

Reserve 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 performed.

Allocate 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.

Make the most of your time and you’ll make the most of your dentistry, your team, your patients, your schedule, and your money.

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

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Periodontal Diagnosis Criteria

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

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 procedures.

Although, 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 professional cleaning.

Here are the criteria guidelines recommended to ascertain the need for periodontal therapy.

  1. Generalized bleeding on probing
  2. Total depth of pockets add up to 15 or more
  3. Two or more 5mm pockets
  4. One pocket 6mm or greater
  5. Evidence of progressive loss of bone on comparing previous radiographs with new ones
  6. Increased mobility
  7. Gingival recession with soft tissue defects or frenum pulls

Once 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.

Case 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.

Case 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.

Case 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.

Case 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.

Case 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.

There is a new method of complete diagnosis proposed and approved by the American Academy of Periodontology. The diagnosis is determined by multiple criteria.

  1. Localized 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.
  2. Amount of attachment loss determines severity. Amount of attachment loss is defined as the sum of the recession and pocket depth.
    1. Slight- 1-2mm of attachment loss
    2. Moderate- 3-4mm of attachment loss
    3. Severe- 5mm or greater of attachment loss

The 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.

Once 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.

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


Office Design

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

         When 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 of computer

terminals 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.

Ergonomics 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.

An 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 this practice.

There 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 more information.

Belle M. DuCharme, RDA, CDPMA

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Personal Life

Have You Increased Your Hygiene Days Per Week In The Past Year?

How To Have A Sucessful Recall System
By Sally McKenzie

Unfortunately, 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.

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Sally's Mail Bag

Hi Sally,

In 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.

Dr. Mark

Hi Dr. Mark,

The 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 sustain growth.

For 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 helps.

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

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McKenzie Management Upcoming Events
Date Location Sponsor Speaker
Oct 22 San Antonio, TX American Orthodontics Society Sally McKenzie
Nov. 6-7 Warsaw, Poland Uno-Dental Sally McKenzie
Nov. 19-20 Griffin, GA Endo Magic Root Camp Sally McKenzie
Dec 3-4 TBA Endo Magic Root Camp Sally McKenzie

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