Exceptional Dental Practice Management

Dental Implants

Our hygienists were saying they wished they knew more about dental implants.  My boss, Dr. Jeff Price made up a great implant outline that he has given me permission to reprint here:

• Five critical factors related to dental implant      therapy
  • An implant is like a tooth….
    • Substitute for the root of a tooth
    • Preserves alveolar bone
    • Most ‘natural-like’ method for tooth replacement & restoration of function and esthetics
    • Requires proper oral hygiene to maintain health
    • Don’t “do” anything to an implant that you wouldn’t “do” to a natural tooth
  • An implant is different from a tooth….
    • Implants only move a few microns within the bone since there is no peri-implant ligament; therefore, it is extremely        important to manage forces properly. Forces on an implant include occlusal forces as well as the fit of the abutment or crown or prosthesis onto the implant.
    • Implants require at least 1.5 mm of distance from  a natural tooth root and 3 mm of distance from another implant to maintain healthy bone. It has been shown that there is a 1.5 mm circumferential zone of bone around the implant that can be affected even in ‘healthy’ implants.
    • Periodontal gingival fibers are different than peri-implant gingival fibers. Periodontal gingival fibers are horizontal, vertical, transverse, etc. since they attach to the bone as well as the cementum of the natural tooth roots. Peri-implant gingival fibers attach to the bone with very little, if any, attachment to the implant surface. The fibers run pretty much in one direction – horizontally. This is why tissue collapses into the space vacated by healing or restorative abutments when removed. Example: A patient who had a bar overdenture prosthesis needed healing abutments placed on the implants when her prosthesis was removed.
    • Implants are made of titanium which can be scratched with conventional stainless steel instruments. Use plastic or graphite scalers to avoid scratching the surface of implants.
    • Implants do not need ‘routine’ peri-implant probing like teeth. Only probe implants when there is clinically evident inflammation such as red or swollen gingiva or exudate present.
  • Advantages
    • Preserves alveolar bone
    • Most natural-like form of tooth replacement
    • Fixed tooth replacement options instead of removable partial or full dentures. This offers not only increased social confidence but directly affects overall health. People        with fixed teeth chew much better than people with removable appliances. Since they chew better, they have better nutrition which results in improved health and a longer life expectancy.
  • Disadvantages & limitations
    • Medical contraindications such as uncontrolled diabetes, autoimmune disorders, previous head & neck radiation or        bisphosphonate therapy.
    • Inadequate bone for implants can be managed with bone grafting in mild to moderate cases. Severe loss of alveolar bone requires ‘block’ bone grafting. The larger the amount of bone to be grafted, the higher the risk of complications.
    • Time for healing and osseointegration.
    • Certain esthetic compromises may be required.
  • Cost in single tooth areas
    • For 3 unit bridge – extraction and fixed bridge = $2,900
    • For single tooth implant – extraction, surgical placement of implant, abutment and crown = $3,900
  • Disclaimer from Linda ~ these are Hendersonville,NC fees.  If you live in Los Angeles they are probably a little higher.

Understanding implants better and having the information they need helps our hygienists feel more comfortable discussing implants as a option for tooth replacement.  Many dentists comment that their staff doesn't discuss treatment options with their patients or that they don't educate the patients enough.  Maybe they just need a little more information from you.  At your next staff meeting or morning huddle ask each employee what they'd like to learn a little more about.  You can call in the specialists you refer to and have them give an overview at a lunch and learn.  Ask product reps to come to your office and give a presentation.  There are a lot of resources who would be happy to help.  When people really know their subject matter, they feel much more comfortable discussing it with others.  Make your staff knowledgeable about the services and treatments you offer and you'll hear them telling your patients all about it. 

What Are You Waiting For?

    What are you waiting for?  When will you be where you want to be in your life?  When will you be happy, feel satisfied, or get where you're going?  It's easy.  You can have all that right now.  You can accept things as they are right at this moment.  That doesn't mean you don't look forward and try to make yourself and the other people and events around you better.  It means you appreciate this.  What you have, where you are, who you are and who you're with at this moment in time. 
    As usual, if you haven't noticed by now, something in my own life prompted this realization.  I keep thinking I'll be happy when everything and everyone is just the way I want it.  So I'll either change my expectations or decide never to be happy.  Nothing will ever be exactly as I think it should be.  So, I've decided to look at everything as having two sides.  Positive and negative.  If I can fix the negative, I will.  If I can't I'll decide to live with it and appreciate the positive.  Sometimes the positive may only be the opportunity that the negative gives me to grow.  Sometimes we're lucky when we think we have it so bad.  Bad gives us something to hold good up to for comparison.  It makes good look even better when we get it. 
    Many times when I've been unhappy or unsatisfied in life the answer lay inside myself.  Often I've been the cause of my problem  I've said it before, you can't control what happens outside yourself, you can only control your reaction.  Better yet, you can only control what goes on inside yourself and how much of it you allow to hit the atmosphere.  How many times have you given voice to a thought that would have been so much better off remaining just an unuttered thought.  Next time, hold on to it for a while.  Give yourself time to consider the wisdom of releasing it onto the unsuspecting public.  You may be glad you did.  In the light of calm, some thoughts really don't seem to be as valid as they did in the darkness of anger or aggravation.  It's hard to erase bitter words completely once they've been heard.  So give it a try.  Enjoy this right now.  And whatever happens next.  Be grateful that you have the breath to make your brain function enough to recognize positive and negative.  Look at everyone as just trying.  That's really what we all do.  Rich or poor, lucky or unlucky, beautiful or homely, funny or sad, we all just try to get it right.  Maybe, it already is.

Are You Ruminating Or Contemplating

    What's the difference?  It's a big one.  When you contemplate about a problem or decision you think it through and come up with what you will do next.  You sort out the good and bad and decide which weighs heavier and plan your response.  Then you're done with it for a while.
    When you ruminate you drive yourself, and perhaps everyone around you with functioning ears, crazy.  You chew your problem like a cow chews a cud.  You just can't let go of it.  You turn it round and round in your mind, looking for new angles, trying to make sense of the non-sensical, until you exhaust every brain cell you possess.  And you likely get nowhere.  You just intensify your frustration and stalemate your brain.  You can't find answers because you're too busy identifying new aspects to the problem.  How can you stop?
    Give yourself a time limit.  Think about the problem or situation for that amount of time and then do something else.  If you set it aside you may find new awareness's and answers popping up out of seemingly nowhere.  That is because your brain needs a break.  It needs time to process and sort the information you're giving it.  If you keep it busy with the same information about the same problem, you'll never give it a chance to come up with answers. 
    The big difference is this: contemplation is relaxing and calming, rumination is frustrating and anger provoking.  So knock it off already.  Take a break and be patient.  The answers will come in their own time.  The universe is unfolding exactly as it is meant to. And you can't rush the universe.

Patterns Are Made Of Wax

     I've been writing about patterns lately and Galba Bright made a comment that got me thinking.  He was saying that remembering times when he felt unmotivated gave him patience for others when they were lacking motivation.  He made me realize that many times we don't recognize the pattern we are exhibiting when we are in the grip of it.  I went through a time in the recent past when I kept approaching problems in basically the same way and expecting a different result.  Remember the definition of insanity?  I can tell you, it's on the money.  My pattern was that I was so single-minded and obsessed with having the outcome I wanted, that I was ignoring the fact that I was actually getting an outcome that was repeatedly making me, and probably others, very unhappy.  My pattern was being out of touch with the reality that I didn't want to see and overly committed to only believing that one end result would be satisfactory and that there was only one way of attaining what I wanted.  I didn't step out of my box enough to see any other possibilities.  I didn't even consider that what I thought I wanted wouldn't be good for me.
     What made me recognize my pattern, believe that it existed and admit that it was not working?  It finally hurt to much to maintain it.  I finally believed that if I persisted, I would lose.  I understood that what I was calling perseverance was actually stubborn refusal to consider that there might be a better way.  I loosened my grip, floated on a wave of what if, and I trusted something different.  I looked around me at the people that believe in me,  that give me enormous opportunity, that care about and for me and I knew how lucky I am.  I decided that I would make it my new pattern to think about that and express it in a non-smarmy way at least once a day.  OK, so sometimes I'm smarmy about it.  So what?  I'm not cool, and I don't care.  I have tons of patterns, both good and bad.  I talk too loud when I shouldn't, I laugh in church, I cry when I'm happy sometimes, heck, I'm 49, I just plain cry sometimes.  I butt in when I should butt out, I learn my lessons the hard way, I talk way too much for some people, I tell everybody how much I love my husband, my kids, my dog, my job and my co-workers, I'm dramatic, I'm effusive, I'm obviously long-winded.  I could go on and on.  Oh yeah, I did.  But, do you get my meaning?  We are all made up of our patterns.  The whole ball of wax is who we are.  Wax is mold-able.  So are your patterns.  If there is something that feels like it could be better, that's great!  You can change it.  It's just a pattern.  You just have to be willing to be honest about the results you're getting, and decide if they're the results you want.  If they're not, figure out what to do.  It can be as easy as paying attention.  When you change a pattern you have to stick with it.  You must have the self discipline to live with control over your emotions and urges.  A new pattern requires self analysis.  If you stop lying to yourself so that you can give in to quick responses you can find long term satisfaction and contentment.  It's work, but it's worth it.

Pattern Matters

    The other day I wrote something about negative patterns.  Tonight, my 16 year old son was studying and reviewing for his end of semester exams.  He's a bit of a dilemma.  Smart as can be, but sees no reason to study, despite the fact that the results of this pattern have been dismal, causing him to lose privileges and listen to endless lectures about why he needs to study.  Last week he finally started to actually prepare for some tests and he came home and proudly told me he had gotten a 98 in Chemistry and a 90 in Social Studies.  I asked him if he thought studying may have made a difference.  He readily agreed that it did.  I said, "Isn't it nicer to have me congratulate you than remind you that if you studied you'd have done better?"  Again, yes, that was right.  "Well do you think that you'll study from now on?", I asked hopefully.  "I guess so." 
    Now, why would he guess so?  Why wouldn't he be happy to have found the answer to good grades?  The key to getting us off his back?  Getting the car keys back in his hands?  Because we want it for him more than he wants it for himself.  So, what would make him want success in school for himself.  Looking ahead to where that success, or lack of it, would lead him.  Identifying the outcome he wants and then deciding whether his patterns were leading him closer to it or farther from it.  Getting good grades to make us happy didn't cut it. I kept wondering why his teachers didn't get on him more.  They had already figured it out.  Getting good grades to get what he wants has more impact.  We'll see what that report card looks like next week. 
    Now, think about yourself and your staff.  If you're a leader, you're probably pretty motivated, that's what got you there.  You understand the pattern.  But, if you're like me, you probably have a hard time relating to the pattern of the unmotivated employee.  That's OK, you don't have to be like someone else to help them learn a new pattern.  Find out what's important to them.  Now, show them how developing positive work patterns can help them achieve what they want.  It's not easy, sometimes they don't know what's important enough to them to make them change.  Change is safe and comfortable.  The chance of making a mistake is low and the effort required is less.  Wrong. It's an illusion. The mistake is in staying stagnant. The effort to resist moving forward is much harder than going with the flow of progress.  Getting left behind is the hardest of all because it's too late then to realize how much better it would have been to have kept progressing when you had the chance.  Catching up is not easy, if you even get the chance. 
    You would think that the payoff from developing positive patterns would make it easy to ensure permanent change.  It's not that easy.  People get used to feeling a certain way.  It's a comfort or maybe a discomfort zone that is familiar to them.  One good response isn't enough to cement change.  The response has to occur many times and be consistent for it to become the new familiar feeling and replace the old.  That is why, as a manager, you have to reinforce what you want to keep.  You will know when it's enough and when you can let it become a pattern that has a life of it's own.  It's when the benefits from establishing it sow seeds for other positive patterns in that person.  Then you can go on to the next thing knowing that you did a good job.  That's your positive pattern.

Oh Yes, I See It Now

    Patterns.  They're not always so easy to see.  Especially when they are yours.  I'm not talking about a fashion statement here.  I'm talking about behavioral patterns.  We all have them.  We all hate to see them when they're bad.  But, nobody conquers them unless we take a good hard look at our patterns and what impact they have on our relationships, both personal and professional. 
    Not all patterns are bad, so leave those alone.  I'm talking about the ones that you find yourself repeating despite the fact that what you're doing results in the same negative consequence.  That's the definition of insanity.  Doing the same thing and expecting a different result.  Don't feel too bad, we all do it to some degree.  What counts is what you do once you decide this pattern isn't working.  If you keep persisting in repeating it, read that definition of insanity again.  If you want to make your life, and the lives of people you interact with better, figure out a way to break your bad pattern.  You could keep talking it to death but that would just give rise to another time wasting pattern.  Instead, figure out a way to recognize that you are beginning the patterned behavior and have a way to stop yourself all figured out.  Now do it.  Just stop it.  Even just for a minute.  Next time, stop it for 5 minutes.  Then just stop it altogether.  Once you do, you'll be amazed at the freedom you give yourself.  Just don't use that freedom to develop another negative pattern.  Keep marveling at how much better your life is without that obstacle in it. Pretty soon you'll be thumping yourself on the forehead for driving yourself nuts with that stupid pattern.  (Don't get into the pattern of thumping yourself on the forehead either, that could hurt.)  It really all comes down to living life with a certain amount of awareness of the cause and effect of what we do.  Most of the problems I face in life are a direct result of either my action or my response to someone else's action.  I have control over both.  So do you.  Do you see that now?

Dedicated to JS the magnificent!

People Are Funny

    If you really think about it, people are funny.  Some people are hysterically funny and bring lots of light and laughter wherever they go.  They're fun to be around and everyone looks forward to seeing them.  Co-workers like that make the day go by easier and patients who are funny are a joy to have in the office.  Sometimes people aren't quite so "ha-ha" funny.  Sometimes you have to find the humor in what they do.  It's there if you look hard enough and want to find it. 
    Think about the eternally grumpy patient.  He gives dirty looks, makes cutting remarks and is generally a curmudgeon.  They can really make a visit unpleasant, can't they?  If you let them they can.  OK, so try something different.  When he gets to the office tell him how glad you are to see him.  He'll probably respond that he's not glad to see you.  Laugh and tell him how funny he is and tell him that's what you love about him, his sense of humor.  Kill him with kindness, lavish him with love.  It beats seething and getting all uptight yourself.  Maybe he'll live up to the opinion you tell him you have of him.  You have nothing to lose.
    How about the patient that likes to tell you how to do everything?  That's annoying, isn't it?  Think about it.  What would make somebody do that?  Probably insecurity.  So let her tell you what she will.  Thank her for the advice and get on with your life.  Don't hate her because she's low on self-esteem.  Be happy that you are confident enough not to be threatened by that. 
    Do you get my drift?  You have choices.  You can laugh off annoyances or you can wallow in despair.  Come to think of it, wallowers are kind of funny in a pitiful way, too. All that drama and not a movie camera in sight.  What a waste!  A waste of time, energy, and waste of a chance to be happy.  Now, that's a poor choice.  You can determine the course of most encounters with other people.  At least you can determine how you will act.  Try this, when you are dealing with someone who is difficult, unpleasant or just plain mean, look in their eyes.  The eyes tell you more about who is in there than the attitude they're showing you.  It may even explain things a little.  If you see hurt, fear or insecurity, it might be easier to let what they're putting out there slide.  Find something to compliment about them.  And don't forget to be thankful for the joy inside you. So smile, people are funny.

Oh, You Poor Thing!

    We had a mess at our house this week.  On Wednesday night I started the washing machine before I went to bed.  I wanted to make sure my son had some clean pants for the next day.  About four hours later I got up when nature called and heard water running.  I asked my husband if he had left the hose on.  We soon discovered that it was much worse than that.  Our washer had broken and had been overflowing all that time.  Our lower level was a mess.  Water was flowing from the ceiling like a waterfall.  I wish it was a nightmare but, it's real.  We are now dealing with ripped out ceilings, ripped up carpet, possessions that are ruined and things stacked all over the house.  The heating and air conditioning is destroyed as well as ductwork and floors and the walls are in danger of growing mold.  The smell is unpleasant and we have massive dehumidifiers and fans droning night and day.  They produce a lot of heat so the temperature in the house reaches about 85 degrees.
    So, why am I talking about this on a dental weblog?  Because it made me realize something and you can use this in dealing with patients.  I know that my problem isn't monumental in light of other problems in the world.  I know that the victims of hurricane Katrina had it much worse than we do.  I know I'm lucky to have possessions and a nice house to be ruined and that I can count on insurance to help pay to restore everything.  But, that doesn't make this feel better right now.  Right now I just need a little sympathy.  Our receptionist, upon hearing about it just looked at me and said "Oh, you poor thing."  She didn't try to make it seem light in the face of someone else's problem.  She didn't try to one up it with a worse problem of her own.  She just expressed the sentiment that fit the situation.  I didn't need anything more than that.  I wasn't wallowing in my problem.  I didn't use it as an excuse to get out of doing anything.  I got up the next morning after sopping up water most of the night and went to work and did my job. Then I went home and attacked the mess.  I was just glad someone understood what I was facing and felt sorry for me.
    When patients come in and tell you their problems, remember, even if it seems like nothing to you, it is important to them. Don't say "Oh, if you think that's bad let me tell you about what happened to me."  This is their problem now, you had your time.  Don't downplay it, just give them what they need.  Maybe they just need someone to listen or encourage.  Maybe they need to hear how you handled a similar situation.  This is one of those times when you get to turn the dental chair into a therapist's couch.  Listen, empathize and give them what they need.  It may be as simple as "Oh, you poor thing."  It made me feel better.  Oh, and let me serve as a warning to you, don't run your washing machine when you're not awake or when you're out of the house. 

Experience. The Most Brutal Teacher

    But you learn, by God, you learn.  Yes, there's a quote that goes like that, I didn't think it up myself.  But...it's true.  Yes, even those of us who think we are smart enough to write weblogs can, and need to, learn a thing or two.  And, if our egos allow it, we might just share what we learned, through trial by fire, with you.  And hopefully, you'll be smart enough to sit up and take notice.  So, what is this monumental thing I've learned?
     Don't keep bringing up the past.  Let it go already.  What's done is done.  No sense beating a dead horse.  Let the past be in the past.  MOVE ON.  Where did I learn this?  In this great article by Michael McKinney on the leadership blog.  In his article Case Closed, Michael discusses all the misconceptions about discussing a wrongful situation and achieving forgiveness or resolution.  It rarely happens.  Instead he suggests dismissing the matter once there is nothing more to say.  No more talking about it or referring back to it.  Move ahead and move on.  Sometimes, if we're lucky, we learn our lessons before a situation becomes irreparable.  I hope reading Michael's message will help someone else learn what I have learned.  There is nothing to be gained by rehashing past grievances. You won't find the magical phrase to make it all make sense or make everyone feel all warm and understood.  Sometimes, you have to face the fact that you just can't fix it.  As a leader you have to determine whether you will see others as doing the best they can at any given time or if you see them trying to get one over on everyone.  The mature thing to do is decide that enough is enough and to move around and past the boulder in the road.  If you don't, you might as well dig a little space under the boulder and hunker down and live there.  Because you are not allowing yourself the opportunity to see what may be waiting further along the way.  And you'll have only yourself to blame.  In this, as in all other situations in life, you had the power all along.  That is, you have the power to decide how you will react to the rocks and potholes that you find in your path.  And that is all the power you really need.

Don't Judge a Book By It's Cover

     You've heard that before.  Well, don't judge a patient by their age or appearance, either.  How many times do you look at a patient who needs teeth replaced and think "she's a removable partial?"  Why?  Well, she's not dressed so great, she's missing a lot of teeth and the rest aren't in great shape, she's over 65, etc. 

     Well, think again, she may just be interested in multiple implants to replace those missing teeth.  Or a crown instead of patching up an old, huge amalgam.  She might just agree to scaling and root planing and placing Arestin.  You just never know.  Just because someone doesn't look the way you think someone interested in optimal treatment would look doesn't mean they aren't. 

     Learn to lose those preconceived ideas and you will do yourself and your patients a big favor.  My boss has a great approach.  He thinks about what he would want for himself or his family and at least offers that option.  If he feels that is the only viable option, he's not afraid to say it.  Patients have the right to know and understand all their choices.  It's up to us to educate them and help them.  There will always be patients that will leave your practice to find a dentist that will do what they want, even if it's not in their best interest.  That's also their right.  At least you won't be the one providing sub-standard care. 

     Make sure you offer all your patients all the choices that are right for them.  There is so much information available from many different sources now.  Patients that a few years ago may not have heard of many dental procedures are now much more well-informed.  Keep that in mind and don't underestimate them.  They may just surprise you!

There Is Nothing Wrong With You

    There is nothing wrong with me either.  There is nothing wrong with anyone just because they don't agree with me or feel the way I feel.  Have you ever had a hard time having a good, respectful relationship with someone that you really admired because you had such different personalities and thought patterns?  That doesn't mean you can't have a good relationship with them.  It just means you have to work harder for it.  And you have to pay attention and maintain it more.  Whew!  Is it worth it?  Maybe.
    It's worth it if it has the potential to make you better and add something good to your life.  You can develop great strength through dealing with adversity and not quitting when things get tough. Sometimes the things we have to fight for the hardest are the most rewarding.  Think of the flexibility you can acquire by learning to dance to another's lead, to give when they need to take or to be understanding of what you can't comprehend..  There is satisfaction to be found in finding a way to co-exist peacefully together.   
    Only you can decide if it's worth it, but remember while you are involved in a difficult relationship that there's nothing wrong with you just because someone else doesn't value what you offer.  See what Pamela Slim has to say about that here . 
    I realized today as I was speaking with someone at work that I admire greatly but have a challenging relationship with that 1.  We will always struggle to understand each other to some extent.  2.  We value each other but also drive each other crazy.  3.  The way to keep from exploding our relationship is to stop thinking that there is something wrong with the other person.  It's that simple.  I think.  I guess I'll try it and find out.  I'll let you know if it works.

It's All Right To Be Wrong Sometimes

    Do you learn something new everyday?  You probably don't even realize it but you I bet you do.  You just weren't paying attention.  Today I learned that sometimes people will go to amazing lengths to be able to hold on to the fantasy that they are always right, no matter what it costs them.  You can actually see a person who has the need to be right thinking of ways to turn any conversation or statement around until they think they've convinced another person of it.  It's a pitiful sight.
    The reason it is pitiful is because the need to be right supercedes honest communication and growth of inner self and relationships with others.  That is because in a conversation that includes different points of view, insisting on being right requires one to have a closed mind.  That person is cheating themselves.  They will never know what they missed out on.  They will lose face with the other person.  They will not increase their own scope of awareness.  Unfortunately, they are becoming a prisoner on the island of their own self-righteousness and insecurity.  And though they will never realize it, it shows.  If you've ever dealt with someone like this you know what I mean.
    There is hope, though.  If you persevere with them, you may hit the right chord once in a while and get to witness the wonder of a dawning awareness that there might be more than one right idea.  If you persist, you may even convince them that different points of view can be equally valid.  You may actually help them see that exchanging and listening to other opinions and beliefs can help them solve problems and see a bigger picture than the one they see through the tiny peephole of their own reality. 
    There is a lot of satisfaction to helping someone see a bigger picture.  For starters, you get to have more interesting conversations with them.  If they are someone you work with you will definitely be more productive together.  It also saves a lot of time.  When you are dealing with someone who has to be right, you spend a lot of time chasing their tail with them until you are both exhausted and frustrated and wind up in the same place you started.  I'm pretty sure I'm right about all this, but if I'm not I hope someone will let me know.