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  06.17.05 Issue #171

Douse the Fires of Discontent

Sally McKenzie, CEO
The McKenzie Company

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Like a smoldering fire, conflict often begins with a minor spark of disgruntlement. No big deal, right? Everyone has disagreements. And so it is dismissed as inconsequential or not worth the trouble. Slowly the smoke begins to rise, but it is still much easier to disregard than address, after all if you ignore it long enough it will go away . or so you think. Then one day, seemingly without warning, the blaze goes ripping through the practice, and what should have been a minor spat has turned into a firestorm of rage and discontent.

Conflict often is allowed to quietly burn in dental practices. That hushed anger beneath the surface can be sparked by any number of exchanges. It may start with frustration over the employee who consistently fails to provide necessary production reports maintaining that she/he is just too busy with other responsibilities to get to it. The doctor walks away seething, but doesn't call the staff member on it because he/she doesn't know how to challenge the claim.

Or perhaps the schedule is regularly booked incorrectly. The doctor mentions the problem in passing during a staff meeting, but doesn't take the time to explain directly to the employee why proper scheduling is so critical to the practice or provide training to ensure that the problem is resolved. The doctor quietly fumes and is stressed because production is slipping. Or maybe an employee consistently shows up late, and after watching the office manager look the other way time and again, team members implement their own system of progressive discipline in the form of snide remarks and open hostility.

Conflict typically is rooted in system breakdowns and a general lack of communication - employees do not know who is responsible and accountable for which systems. For example, the hygienist may become frustrated with the business staff because she/he is consistently missing his/her production goals. Yet no one on the business staff has been designated as the person responsible for ensuring that the hygiene schedule is kept full.

Conflict can be minimized significantly when individual team members are given clear information, defined responsibilities, and are held accountable for specific outcomes. Employees must know what is expected of them individually and as a team. They cannot be expected to function effectively or cohesively without clear job descriptions and performance objectives. In addition, they must receive regular ongoing feedback in order to make corrections in systems and continuously improve and grow as contributing members of the team.

Take these steps to manage conflict constructively day-to-day before it burns both the doctor and staff:

  • Set aside time to address matters that are causing conflict.
  • Focus on systems and what is or is not working in the systems rather than on the people. For example, what steps does the practice need to take to ensure that the schedule is booked correctly to achieve specific production goals.
  • Address sources of day-to-day conflict during the daily huddle . For example, if the clinical team wants emergency patients placed at certain times they must tell the scheduling coordinator so that the coordinator is not picking and choosing based on what she/he thinks will work.
  • Avoid the urge to react emotionally and judge, criticize, or attack.
  • Focus on addressing the issue rather than proving who is right or wrong.
  • Focus on the desired outcome for the practice as a whole.
  • Establish clear standards for professional office behavior. Do not tolerate destructive personal attacks among team members.
  • Establish clear office policies and follow them.
  • Take time to better understand each other's personalities and how different personality types communicate.

Certainly, as long as there are people working together there will be conflict. As destructive as conflict can be, if it is managed, it can become a constructive tool in moving the practice and the team that much closer to achieving overall goals and objectives.

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

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Six Simple Systems for Everyday, Practical Endodontics

Arthur "Kit" Weathers, Jr., D.D.S.

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One of the greatest frustrations for a busy dentist is to begin a scheduled root canal treatment and find surprises as to the difficulty or the amount of time required to complete the treatment. At my two-day, hands-on Practical Endodontics Root Camps, we spend a lot of time helping a doctor attain the knowledge and skills required to avoid treatment surprises. In this article, I break down six critical considerations for assuring your endo treatment will be efficient, predictable, and of high quality.

1. Careful Case Selection

Efficient endo must begin with proper case selection. You must know your limitations and select cases based on these limitations. For simplicity, I've listed on the chart below a comparison to help you more accurately select the cases you choose to treat in your office.

Endo Case Selection Chart

Better Worse
Vital Necrotic
Anterior Posterior
Maxillary anterior Mandibular anterior
Mandibular molar Maxillary molar
First molar Second molar
Gradual canal curve Sharp canal curve
Large pulp Calcification
Average length roots Long roots
No crown in place Crown in place
No swelling Swelling
First endo treatment Retreatment
Non-strategic tooth Abutment

If you don't have a high confidence level in your endo skills, you should definitely limit your cases to those listed in the "Better" column. You'll find that you will still have plenty of endo to do, even if you limit yourself to only those cases. The last thing you want to happen in a busy dental practice is to get "bogged down" with a root canal that takes much longer than anticipated. Worse, you don't want to begin a root canal treatment that you later discover you can't complete.

2. Proper Access

I cannot over-emphasize the importance of proper, straight-line access for safe and efficient endodontics. You should be able to see the openings of every root canal with one eye closed and without moving your head or the mirror. If you can't find 'em, you can't fill 'em. Not establishing straight-line access (which means the rotary file is bending as it enters the canal) is one of the leading causes of rotary file breakage.

3. The Rubber Dam

The rubber dam is one of the most low-tech tools we have in our office. It's also one of the most important for the safety of our patients. I've found that I can place a rubber dam on any tooth in the mouth using one of only three clamps. The 12A is appropriate for the lower right and upper left molars; the 13A is designed for the lower left and upper right molars; and the 9M works great for all anterior teeth. Also, you'll find the Aseptico Handidam (available from EndoSolutions 800-215-4245) to be a real time saver, since the rubber dam and the frame are made as one disposable unit.

4. The Electronic Apex Locator

The apex locators currently on the market show remarkable accuracy. They can improve your speed and precision in determining the correct root canal length. Two great units that have withstood the test of time are the J. Morita Root ZX, and my personal favorite, the Elements Apex Locator by Sybron Endo.

5. Digital Radiography

Without question, digital radiography can easily trim 7 to 21 minutes from the total treatment time. Once you've had this valuable efficiency tool in your practice, you wonder how you ever practiced without it. With the quality now equaling that of film, and the return-on-investment to be less than one year, it no longer makes sense to put off implementing digital radiography in your office, especially if you do endo. Dexis is the unit we're currently using at our Endo Root Camps.

6. Efficient Instrumentation

The introduction of rotary instrumentation in endo 13 years ago revolutionized the way we perform endo. Besides allowing us to increase our speed of treatment, rotary instrumentation has made it significantly easier to thoroughly clean and shape canals. Often, cases that we used to dread treating with hand instrumentation are now fast and fun.

The chart below, illustrates the impact of incorporating rotary instrumentation with your root canal techniques. The "Time Before" column indicates the endo treatment times that our "Root Camp" attendees reported prior to attending Root Camp. The "Time After" column is an average of the times they reported just months after finishing their two-day training.

Average Root Canal Treatment Times Before and After Root Camp Training

Tooth Time Before (min) Time After (min)
Anterior 56 40.7
Bicuspid 72 54
Molar 106 77.6

It's amazing how rapidly such improvement can be accomplished using these new techniques. In fact, we see an increase in endo production, on average, between $184/hr to $242/hr, depending upon which tooth is being treated. The greatest increase in efficiency occurs in treating anterior teeth. Following training, our doctors are producing $787 per hour performing anterior endodontics.

Certainly, many factors can affect the efficiency of your root canal treatment. The tips I've outlined here are not all-inclusive, but they should serve as a guide to improving your efficiency when doing endodontics.

To Order Dr. Kit Weather's Practical Endodontics Root Camp Home Study Course click here.

Dr. Weather's can be reached at 770-227-3636 or

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Communication Skills to Increase Patient Compliance

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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Look into a dental operatory, watch and listen to the operator communicating with the patient. What do you see? I am talking about the nonverbal communication going on. I know there are a lot of fantastic clinicians out there: Hygienist, Dentist, and Assistants. However, if they are not equally talented in the skill of communication they will not be performing as much dentistry as they would like.

Communication involves the sender, the receiver, the message, the environment, attitudes, emotions, socio-cultural background, and values of both the sender and receiver. There is both verbal and nonverbal communication happening every minute of our existence.

Some of these factors the dental professional does not have any control over. If you sit and talk with your back to the patient, looking at x-rays, and avoiding eye contact while going over the treatment plan, you are less likely to gain the amount of trust that you will need in order to have that patient return to your practice . Interpersonal communication skills are truly central to the dental hygiene process.

The environment is easily controlled. It needs to be comfortable not too hot, too cold, too plush, or too untidy. The music needs to be at an appropriate level and appropriate style for the majority of the clients that you see. The office should smell clean and fresh. Even too much cologne on the operator could be a diversion to the patient. It is better to have an environment that is private. Particularly, when going over health needs or financials. The position of the chair is very important. Most people like to feel they have some control, when lying back in the chair some of that control is relinquished. It is better to have the patient sitting in the up position and with the patient bib removed. This will enable them to feel more in control and in a more natural position. The feelings and camaraderie the patient senses within the office workings will even have an effect. They want to feel that the people surrounding them are happy to be there and enjoy working with each other.

When it comes to attitudes and emotions the operator really does not have control over any preconceived attitudes or emotions. However, they do effect what the patient may feel or think about them by the actions and words they use. The hygienist should be compassionate but must act professionally . He or she needs to be sure to leave their own emotions that are rooted in their own personal life at the front door when they enter the office. The hygienist's own personal life should not interfere with patient care.

Values are beliefs that may have moral and ethical implications. Not all patients will value oral health at the same level. These values can and may change, but it is a very slow process. The best thing you can do is to know what you value and how it affects the choices you make. You need to also be aware of your patient's values. This can be done by observation, analysis of behavior, and good listening skills. The hardest thing to do is to avoid imposing your values on your patients. Educating your patient about oral health is the best method to help promote change.

America has a diverse population consisting of many multicultural beliefs and value systems. A dental hygienist that has a broad understanding of cultural diversity will be better prepared to communicate with patients from varying backgrounds. Improving ones cultural competence and sensitivity to the differences will be a huge step in overcoming many communication problems that may occur because of socio-cultural backgrounds. Seeking to better understand the cultures within your community will help you to understand their orientation toward health, disease, acculturation levels, and other related assessment items. This way, you will be better able to talk Western concepts of health, prevention, disease, and treatment in terms that are culturally understandable and relevant to the multicultural population in your area.

When it comes to verbal communication, no matter what population you are dealing with, just keep the word CARE in mind. This mnemonic was developed by Myerscough in order to help health professionals to remember the skills they should develop. Comfort, Acceptance, Responsiveness, Empathy .

The CARE principle can also be implemented with nonverbal communication. The factor with nonverbal communication is that it is essential for you to be able to read different aspects of kinesic behavior. You must also be aware of the nonverbal communication you are sending. This includes, posture, facial expressions, eye behavior, and overall body movement. The way a person gestures or the posture they maintain will tell us a lot about how they feel. The body movement may tell us they are uncomfortable or comfortable, bold, or timid. Shifting their posture may be an indication of an emotional change. Shifting towards a person indicates trust and liking. Movement away from a person indicates a negative message. Eye contact is a must in order to convey trust, interest, or attention. When eye contact is avoided it is a sign that one feels uncomfortable. When maintained steadily we are taking an offensive approach to someone. There are many nonverbal movements that may happen while you are working with your patients. Always keep in mind what they are saying to you and what you are saying to them. Be a good active listener . Make sure you have educated yourself about different cultures and what different body motions may mean in that particular culture. The same movement may mean two totally different things in different cultures. Be aware of your patient's acculturation level.

Communication also includes listening to the patient. This is the single most important part of the communication process with your patients. No matter what, the patient should always remain the center of attention. A good listener should have good eye contact, shoulder and legs toward the speaker, slight forward lean, and above all, be silent. Do not interrupt. To make sure you understand their wants and concerns, paraphrase back what they say. The patient is not going to want to hear what you are concerned about until you have answered their wants and concerns.

Utilizing these communication skills and knowledge will make your patients much more compliant and accepting of treatment plans.

Jean conducts 2 day Hygiene Performance Enrichment Programs for The Center for Dental Career Development and McKenzie Management in La Jolla/San Diego, CA. Contact her at or 1-877-777-6151 Ext. 23

Interested in having Jean speak to your dental group? Email us at or call 1-877-777-6151

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Sally's Mail Bag

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Dear Sally,

My office manager is about to have her 1 year anniversary with me. I know she will look for a raise!! We are still on the upside of a huge learning curve and my numbers, production and collection haven't increased so how do I not give her that expected raise most employees feel they deserve with an anniversary date? I will be paying her medical in full, which I consider a big raise of $4,000 to $5,000 per year.

Thank you.

Dr. Mississippi

Dear Doctor,

Consider this a learning curve. Any employee on the day they are hired are told that raises are dependent on their performance and the performance of the business. She's an office manager for 1 year so she knows your production hasn't increased and it doesn't sound like she's been real instrumental in making that happen. I suggest you go to my web-site and purchase this downloadable form: Employee Salary Review. This form will help to justify why you can't have your payroll over 19-22% of your collections. If she doesn't understand business then she's not the right office manager for you.


Dr. Kit Weather's presents...

The Practical Endodontics
Root Camp
Home Study Course

Now on DVD, you can own Dr. Kit Weather's entire Root Camp Didactic Program. In this comprehensive Endo course, you will learn the secrets of practical, predictable and profitable Endodontic procedures and immediately BOOST your hourly Endo production.

The Root Camp Study Course Includes:
• 7 DVD's
• 24 Hours of CE Credit
• Reference Manuals
• Step by Step Technique Guide
• Telephone Support

You will learn:
• Making multiple-canals easier
• Systems that work on every tooth
• Instant and painless anesthesia
• A 5 minute emergency solution
• Obturating root canal techniques

Boost Your Production!

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McKenzie Management's Seminar Schedule
2005 Location Sponsor Information Topic Speaker
July 21-24 San Diego, CA IA of Comprehensive Aesthe 702-341-7978 Peak Performer Sally McKenzie
July 28 La Jolla, CA Southern CA Ortho. Symposium 619-656-4646 Top Issues Sally McKenzie
August 13 Topeka, KS Delta Dental Plan of Kansas 800-733-5623 Breakdown Sally McKenzie
Sept. 9-11 San Francisco, CA California Dental Association 916-443-0505 Successes Sally McKenzie
Sept. 22 El Paso, TX El Paso Dental Society 877-777-6151 Breakdown Sally McKenzie
Sept. 23-24 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Oct. 14 Riverside, CA Riverside Implant Study Group 951-279-7847 TBA Sally McKenzie
Nov. 18-19 Griffin, GA Endo Magic Root Camp 877-478-9748 Top Issues Sally McKenzie
Dec. 1 Cincinnati, OH Cincinnati Dental Society 513-984-3443 Breakdown Sally McKenzie
Dec. 9 Minneapolis, MN Minneapolis District Dental 877-777-6151 TBA Sally McKenzie

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