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11.21.08 Issue #350 Forward This Newsletter To A Colleague
Practice Stress
Dentist Coach-Conflict
Hygiene Consultant

Stress Boiling Over? Turn Down The Heat
by Sally McKenzie CEO
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Some dentists are utterly convinced that stress is an inherent part of dentistry, so much so that without significant quantities of it, they believe the practice must not be performing as it should be, the team must not be working as hard as they could be or the office must not be making as much money as it might be. In fact, just the opposite is true. Dentists and dental teams are paying the price personally and professionally for life in the pressure cooker.

Studies cited by the National Institute of Occupational Safety and Health show that stressful working conditions are associated with increased absenteeism, tardiness and intentions by workers to quit their jobs—all of which have negative effects on any business’s bottom line, particularly a small dental practice.

Although stress neither can nor should be eliminated, managing it is critical. Dentists and their teams need to identify those areas that cause negative stress and take concrete actions to reduce them. It all starts with changing the things you can. Staff can be changed, educated and properly directed; schedules can be changed; collections can be changed; treatment presentations can be changed; business procedures can be changed—all to yield improvements and reduce strain on the practice and team immediately. Take these steps:

  • List the stressors, starting with those issues that are most intense. Develop a plan of action to address the sources of stress through a procedure or system.
  • Meet regularly as a team to refine systems and procedures that continue to cause stress.
  • Clearly define staff roles and responsibilities.
  • Train your team to ensure that they are prepared to carry out their responsibilities and can succeed in their positions.
  • Establish work schedules that are compatible with demands and responsibilities of the job. If Julie is responsible for delinquent account calls but is never allowed time or a quiet space to make those calls, she cannot meet her job expectations. Make adjustments so employees can actually carry out the duties they are assigned.
  • Improve communications. If you are stressed out because cancellations and no-shows have occurred at record pace the last few months, rest assured your team is worried, too. Don’t just wring your hands and silently agonize over what will happen next—talk about the situation as a team and together develop strategies to address it.
  • Take time out for fun. Schedule an afternoon at the movies, a day at the zoo, a long lunch for everyone at a favorite restaurant. A little fun can go a long way towards reducing stress.

In addition, take a few pointers from “healthy” businesses. These companies have some key characteristics that keep office stress under control, thereby improving morale, increasing productivity and reducing absenteeism and attrition.

Recognize employees for a job well done not just once a year but routinely. Make an effort to acknowledge the good work of at least one employee in your practice every day. Provide opportunities for career development. Most quality employees want more than just a job; they want the chance to become truly proficient. Provide opportunities for professional growth to your staff and your practice will likely benefit every bit as much as your employees do.

Give your team a voice in the practice improvement process. Make them a valued part of the solutions. For example, if the new patient experience is lacking, create a subcommittee to identify ways in which it could be improved and present their recommendations to the group.

Make sure your actions as the leader of your practice are consistent with practice policies and values. In other words, if you have a collections policy that you expect your business team to follow consistently, don’t engage in your own financial negotiations with your favorite patients. If you expect your staff to be on time for the daily huddle, make sure you are punctual as well. If not, you are further fueling practice stress.

Remember, old habits die hard. Often it is essential to bring in a third party to help develop a plan of action and assist the doctor and team in implementing and maintaining systems that reduce stress.

Interested in speaking to Sally about your practice concerns? Email her at
Interested in having Sally speak to your dental society or study club? Click here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Don’t Let Your Office Become A Battleground

Ignoring employee conflicts puts you and your practice at risk. A “war” might be a lawsuit against you for a hostile work environment, but more likely “combat” starts when feuding staff fail to communicate vital information about scheduling or billing.

Bottom line: Ignoring conflict costs you money!

Do yourself—and your wallet—a favor. Address disagreements and problems as soon as they occur. Here are some recommended steps:

1. Adjust your belief about conflict.
Conflict itself isn’t the problem; it’s the way you respond to conflict that can escalate or resolve it. Certainly we know what bad conflict looks like: verbal, emotional or physical violence. But remember that conflict can result in positive change, too. Conflict in the United States resulted in freedom for the nation in 1776, abolished slavery in 1865 and gave women the right to vote in 1920. Accept that conflict is a natural part of life and deal with it up front.

2. Know your “hot buttons” and response to conflict.
In my last article, I listed five styles of conflict. If you are avoidant, competitive or accommodating more often than compromising or collaborative, take a class in assertiveness or mediation, or work with a coach to improve your ability to handle conflict constructively. Become more comfortable staying engaged and composed, regardless of how difficult a situation might be.

3. Communicate, communicate, communicate.
Nothing gets resolved if people stop talking. Rather than trying to stop conflict, meet it head on. Explore what’s behind the frustration or anger that people are expressing in their words or actions. Ask open-ended questions.

4. Listen, listen, listen.
It has been said that we have one mouth and two ears because we are supposed to listen twice as much as talk. The power and value of listening, especially in conflict situations, is monumental. When you are in a discussion about a conflict, rephrase what you hear to show that you are listening and to assure the speaker you heard correctly. Refrain from trying to fix the problem too quickly. Strive for understanding before resolution. Show empathy. Acknowledging employees’ feelings and motives is not the same as agreeing with them.

5. Be curious, not furious.
Our natural reaction to conflict, especially if we feel threatened, is to become defensive. Manage yourself. Stay calm. Use a neutral voice, even if the other person is heated up. Move the discussion to a private area, especially if there are patients within hearing range. Give the other person time to vent. Don’t interrupt or judge what they are saying. Thank them for letting you know how they are feeling and what they are experiencing. Rather than attempt a premature remedy, agree to talk about it after a cooling off period.

6. Work the issue, not the person.
When you are convinced that you fully understand the problem, acknowledge where you agree and disagree. Avoid blaming. Use “I,” not “you.” Talk in terms of the present as much as possible. Ask, “What can we do to make things better?” Identify at least one action that each person will do and get commitment for the plan. Set up a future meeting to discuss progress.

7. Develop a feedback-based culture in your office. Make frequent, two-way communication a natural part of your daily practice. Just as it’s important to praise and reward people when things are right, it’s essential to give feedback when you want something to change. Feedback is nothing more than data or information. Get individual ego out of this exchange; learn to de-personalize and help your staff to do the same. Ask them to give you feedback by answering three simple questions: What should I continue doing? What should I stop doing? What should I start doing? Keep the attitude that holding different views is both normal and healthy to a group. Use patience and persistence, and practice good people skills. Model open communication and feedback. Make your office a peace zone.

Dr. Haller offers basic training for interpersonal communication, conflict management and team building. If you would like information about any of her practice-building seminars, contact her at

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

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Angie Stone RDH, BS
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Periodontal Screening And Recording (PSR)

Although dental schools educate students about a screening system called Periodontal Screening and Recording (PSR), hygiene schools never give this education to their students. This is understandable because hygiene schools need to teach future hygiene clinicians the task of periodontal probing and recording of pocket depths, suppuration, clinical attachment loss, recession, furcation involvement, mobility, etc. In order to ensure that students are efficient in this task, it is a requirement to do a full periodontal assessment on all patients while in school. This is the gold standard in the world of dentistry, but it becomes difficult to take the time to assess and record all the information necessary for a full periodontal assessment. This is where the PSR Screening tool is helpful.

PSR was developed by the American Dental Association and the American Academy of Periodontology to provide a simple, standardized system to effectively screen and provide for detection of periodontal disease. Not only is it effective, it is quick and easy and can be easily incorporated into recall appointments. It is a tool that determines the need or absence of the necessity for a complete periodontal assessment. If the patient fails the screening, they can be brought back to look further into what their needs may be.

The medical community does such screenings on a routine basis with patients. For instance, let’s say I go to my MD for an annual physical and at that appointment he recommends a mammogram because of what he discovered during my breast screening. I schedule the mammogram and have the mammogram completed. The report from the radiologist states there is an area that is suspicious. I am encouraged to now have an ultrasound done of the suspicious area. I schedule an appointment. The ultrasound determines that the suspicious area needs surgical attention. I schedule surgery. The process is clearly defined: screen for the possibility of disease, further assess if there is evidence of disease, diagnose the disease if it is there and treat the disease as necessary. This is standard of care. Why then is this process so different in dentistry?

The scenario in dental hygiene schools is something like this: The patient arrives and is seated. Medical and dental histories are reviewed, necessary x-rays are taken, a complete periodontal assessment is done including (but not limited to) documentation of pocket depths, clinical attachment loss, bleeding points, drawing of the gingival margin, furcation involvements, etc. By the time students graduate, they may be able to complete the periodontal assessment in thirty to sixty minutes. An experienced hygienist documenting all the necessary parts of a periodontal assessment and educating the patient about the results will take at least thirty minutes. If this in-depth process is added to each recall appointment, every recall appointment is likely to top sixty minutes. Would it not be smarter and more time-efficient to perform this extensive screening on the patients who need it and not those that don’t?

Periodontal Screening and Recording. The periodontal screening procedure involves concepts that are different from traditional periodontal examinations.

  • The mouth is divided into sextants.
  • For each sextant, only the highest screening score is recorded.
  • The probe that is utilized during PSR is different than a traditional probe. It has a rounded tip. The color-coded band extends from 3.5 to 5.5 on the shank of the probe. (PSR probes can be ordered from several manufacturers.)
  • Pocket depths are not measured. Only relationship of the gingival margin to the colored band is assessed.
  • The codes determine the need or lack of need for a comprehensive periodontal exam.

A periodontal screening and recording (PSR) should be performed at every oral exam. This procedure is designed primarily for use with patients aged 18 and over, but valuable information may be obtained when screening younger patients. It is important to remember that screening does not replace a complete periodontal evaluation, but indicates to the clinician when a partial or full mouth comprehensive exam is needed. The PSR can be quickly implemented into every adult recall visit. If the screening determines there is no need for a complete periodontal examination, the patient will be screened again at the next recall visit. If, however, the screening results say there is cause to look further into the patient’s periodontal condition, then the patient will be rescheduled for a complete periodontal assessment at a future date. This protocol mimics that of the medical community—Screen, Assess, Diagnose, Treat if necessary. There is no need to accomplish all of these steps in one visit.

Data gathered to determine how much periodontal disease is being diagnosed reveals a startlingly low percentage because the hygienist doesn’t have enough time to accomplish a comprehensive periodontal assessment at each recall visit. Therefore, it gets put on hold for a future appointment. Most the time such an appointment never materializes and periodontal disease is not diagnosed. The system isn’t working and PSR offers a valid way to drastically improve the system so patients are treated for periodontal disease.

For more complete information regarding PSR, visit the ADA Web site.

Need help with implementing new systems in your hygiene department to ensure patient acceptance and compliance? Email

Interested in having Angie speak to your study group or at your next seminar? Click here.

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