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6.6.08 Issue #326 Forward This Newsletter To A Colleague

When the Patient Is Ready the Doctor Appears
Seize the Teaching Moments
by Sally McKenzie CEO
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Turn on the television or the radio. Open a newspaper or a magazine. Visit a few online sites. What do you find? Ads. We’re inundated with recommendations to purchase a particular car, consider a new cosmetic and install a new appliance. We are flooded with information that we quickly cast off or never even see because we’re not ready to consider it.

But when our car begins showing the wear and tear of many miles, or we’re noticing the little lines curl around our smile or the fridge is no longer adequate for our wants and needs, then we are open to learning more about products designed to address them.

Such is the case when the emergency patients sit in your chair. Up until this moment, those people may not have been interested in what you have to offer. But their situation has prompted them to consider not only immediate treatment but, quite possibly, comprehensive care as well. Yet dental teams miss this opportunity time and again.

A good rule is that 85% of all emergency patients should be converted to comprehensive exams. If your rate is lower, it’s time to develop a plan to seize the “teaching moments” that emergency cases present. For starters, pay attention to cues the patient is giving. The conversation that the assistant has with the individual can be particularly useful in identifying those issues that will need to be addressed in order for the patient to consider further care.

Does the patient appear anxious or fearful? Does he/she express concern about the cost of the treatment, the possible pain or the time the procedure is going to require? Is he/she apologizing because it’s been such a long time since the last appointment? Was there a negative dental experience in the past? Is he/she angry or frustrated? While talking to the patient, the assistant should be able to identify the most likely obstacles the dental team will encounter when encouraging this patient to pursue comprehensive care.

Track the most common reasons why emergency patients wait until there is a problem before coming into the practice. From there, the team can develop a patient communication strategy through the use of scripts and educational materials to overcome those barriers.

Just as scripts are essential at the front desk when answering phones, they are critical when educating patients about the value of ongoing dental care. Moreover, they are a safety net that prepares the staff to know what to say, how to say it and when to say it. If a patient is highly anxious, the team should have a specific script and protocol that they follow to put the patient at ease. If the patient doesn’t understand why a specific procedure is needed, the staff should be prepared to respond through educational videos, printed materials, dental models, etc. Anticipating patient concerns and being prepared to address them enables staff to educate patients confidently and consistently, to seize the teaching moments effectively.

Set aside time during the weekly or monthly staff meetings to develop scripts. Don’t get bogged down in addressing every possible scenario immediately. Pick a couple of key barriers and address those initially. The doctor and team should work together to fine-tune the documents over time and to develop an easy and natural flow. Once you feel confident in using those, create a few more.

Be sure to take time to “close the deal.” After the treatment, escort the patient to the front desk, and gently stress once again the importance of ongoing care. Explain to the Scheduling Coordinator that the patient needs an appointment for a comprehensive exam. Time should be set aside in the schedule to allow emergency patients to be scheduled for comprehensive exams within the next week.

That evening or the next, the doctor follows up with a phone call to check on the patient and express appreciation for the opportunity to take care of them. Shorty thereafter, the patient should receive a new patient packet in the mail with printed information about your practice and your services, along with a handwritten note from the doctor’s assistant that expresses concern for the patient’s well-being and indicates that the staff is looking forward to seeing the patient again for a comprehensive exam on the designated date.

Seize the teaching moments and watch your conversion rate increase significantly.

Interested in speaking to Sally about your practice concerns? Email her at
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Angie Stone RDH, BS
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Fluoride - It's Not Just for Kids

Fluoride remains one of the most amazing developments in the dental profession. The general population experienced a sharp decline in dental decay when community water supplies became fluoridated. When some folks balked at what they perceived to be involuntary use of a chemical, some communities removed fluoride from the water source only to see a quick increase in dental caries. As a result, many communities made the decision to place fluoride back in the water supply. So, since 1945, people have been reaping the benefits of fluoridated water.

The main use of fluoride in the past has been to protect teeth during development and eruption, but research has now shown that fluoride helps protect erupted teeth in the battle against tooth decay. Although clinicians preach about the use of fluoridated toothpaste and fluoride rinses, in-office fluoride treatments are often overlooked, especially if patients are over the magical age of 18. The evidence is clear that professional topical fluoride applications provide an additional benefit (beyond fluoridated water and toothpaste) for all adult patients with a moderate to high caries risk.

The following information should be considered when deciding which adult patients would benefit from fluoride:

  • Is the patient taking medications that cause a dry mouth? A decrease in saliva can increase the risk for decay. Fluoride treatments can help reduce the risk of decay in this population.
  • Does the patient have exposed root surfaces? Root surfaces are extremely susceptible to decay and decay can travel quickly through the root. Professional fluoride treatments help make roots stronger and resistant to decay.
  • Has the patient needed a restoration due to decay in the last year? If so, the patient is at risk for decay and delivering a fluoride treatment will reduce this risk.
  • Does the patient have crowns and/or bridges? Fluoride can help protect the margins of these restorations and potentially eliminate decay around the margins.
  • Is the patient wearing bonded brackets or bands? High concentration of fluoride can help keep teeth caries free during orthodontic treatment.
  • Is the patient undergoing or going to be receiving head and neck radiation? Radiation damages salivary glands, which causes an extreme reduction in salivary flow. Saliva is an important component in the fight against tooth decay. Without it, the risk for decay is extreme. This patient will benefit from fluoride treatments.
  • Is the patient experiencing sensitivity? Fluoride can help reduce the pain and discomfort caused by exposed root surfaces. Regular fluoride applications can help eliminate this sensitivity.
  • Does the patient have poor oral hygiene? Plaque on the teeth increases the risk of decay. Fluoride helps fight the decay process caused by high levels of plaque.

When considering these reasons for applying fluoride to adult patients, it becomes easy to see that a high percentage of adults fall into at least one of these categories and would benefit from in-office fluoride treatments.

The question thus becomes what fluoride is the most effective. The American Dental Association report, Evidence-Based Clinical Recommendations: Professionally Applied Topical Fluoride, is a great resource when making this decision. The following information is taken from this report.

  • There is considerable data on caries reduction for professionally applied topical fluoride gel treatments of four minutes or more. In contrast, there is laboratory (but no clinical equivalency) data on the effectiveness of one-minute fluoride gel applications.
  • Two or more applications of fluoride varnish per year are effective in preventing caries in high-risk populations.
  • Fluoride varnish applications take less time, create less patient discomfort and achieve greater patient acceptability than do fluoride gel treatments, especially in preschool-aged children.
  • Moderate-risk patients should receive fluoride varnish or gel applications at six-month intervals.
  • Higher-risk patients should receive fluoride varnish or gel applications at three- to six-month intervals.
  • Application time for fluoride gel and foam should be four minutes. A one-minute fluoride application is not endorsed.
  • Other considerations: Foam commonly is used in dental practice; however, the weight of the clinical evidence of its effectiveness is not as strong as that for fluoride gel and varnish.
Another aspect to consider is that of revenue for the hygiene department. If hygienists make decisions about in-office fluoride treatments based upon patients’ caries risk factors, it is easy to see why more adult patients would be receiving these treatments. This would directly increase hygiene productivity. Let us say that the hygienist sees eight adult patients per day and half of them receive a fluoride treatment at a cost of approximately $25 per treatment. That would be an increase of $100 per day per hygienist. If the hygienist works 16 days per month, that would mean $1600 per month and $19,200 per year. This revenue can come easily by simply assessing the need for adult patients who can benefit from fluoride. It is a win/win situation for both the patient and the office.

Interested in knowing more about how to improve your hygiene department?

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Growing Your Team

Just like humans go through stages of development, teams go through phases of growth. Effective dental leaders know how to move their employees through these stages with a minimum of fuss and stress.

Stages of Team Development
The Forming–Storming–Norming–Performing model of team development was first proposed by Bruce Tuckman in 1965. His theory has been studied for more than 40 years and is still the preeminent team model today. He maintained that these four group stages are all necessary and inevitable in order for the team to grow.

FORMING is the “getting-to-know-you” stage. Individuals come together for the first time. Team members are usually on their best behavior but very focused on self. Individuals try to understand their own roles, the roles of the other team members and their purpose in the group. This is entirely natural and to be expected. People are unsure, suspicious and nervous.

Leadership Goal: Clearly define expectations.
Give the team time to get comfortable with one another. Be sure that employees understand processes and procedures. Take time to bring new members up to speed with all the rules, roles and goals. Encourage mature team members to model appropriate behavior even at this early phase. Take a supportive but directive approach in this stage of team development.

STORMING occurs when the members within the team start to “jockey” for position. Control struggles take place. Members of the team realize that they have different ideas and they compete for power. In some cases, storming can be resolved quickly. In others, the team never leaves this stage.

Leadership Goal: Be supportive and direct in guiding decisions and behavior.
This phase can become destructive to the team and will lower motivation if allowed to get out of control. Therefore, accessibility and responsiveness of the leader is high until the team learns to guide itself.

Disagreements can be either very obvious or subtle. Control often becomes the primary issue although team members may focus on minutiae as an evasive tactic. The team needs direction at this stage and perhaps people need to hear things that they don’t want to hear. Get things out in the open. As the leader, demonstrate tolerance for everyone. Actively listen to team members and manage the conflict. Encourage ideas and explain decisions. Help the team recover from destructive conflict. Formal agreement on the practice vision, values and code of conduct enables teams to heal. With a common system of beliefs, behaviors and processes, your team can rise above conflict and establish more constructive actions.

NORMING happens when the team adheres to the rules it agreed to follow. Team members adjust their behavior to each other as they develop work habits that make teamwork seem more natural and fluid.

Leadership Goal: Act as a team member and help develop agreement and buy-in.
Norming is characterized by acceptance. Leadership during this phase needs to be more participative than in the two earlier stages. The “norming” team really wants to accomplish its mission. Therefore, remind them of their tasks, be more diligent in adhering to the road maps and provide consistent encouragement.

PERFORMING is the stage in which the team starts to produce through effective and efficient working practices. A performing team is just that: a highly effective, problem-solving unit that can reach solutions quickly and can even head off issues before they become problems.

Leadership Goal: Facilitate communication of the team’s success and reward success accordingly.
Leadership at this stage requires a non-directive role. Take a step back and let the team become self-directing. Concentrate on strategy to plan the next step for the practice. To help your team advance to this stage of development, focus the team on shared accountability. Bonus systems that are based on overall practice productivity generally work best to maintain an esprit de corps.

Some teams will go through the four stages rapidly and move from forming to performing in a relatively short space of time. The outcome depends on the composition of the team, the capabilities of the individuals, the tasks at hand and, of course, the leadership you demonstrate. The advantages of growing your team are worth the investment of your time and energy. Instead of constantly urging your people along and having to solve all the problems yourself, you'll be the leader of a high-performing team. They’ll be more productive. You’ll have more freedom to do the things you really love to do. And you’ll be more profitable in the process.

Dr. Haller helps teams move smoothly through the forming-storming-norming-performing phases of development. Dr. Haller is available for team building and dental leadership coaching. She can be reached at

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

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