Lee Ann Brady

Practice Profitability Levers

 Practice of Dentistry  3 Responses »
May 202013
 

11430606-music-mixer-slidersA week ago in Connecticut while lecturing I was asked how to make anterior esthetic dentistry work if you are a provider for dental insurance fees with set fee schedules. This is a complex question at many levels, and each of us has to determine based on our preferred business model whether being an insurance in network provider is workable. This decision and many others on the business side of dentistry depend on understanding the finances of your office and being in control of them.

When I think about the financial side of my practice what I have come to understand is that I only have three financial “levers” to adjust. The profitability levers in a dental office are fees, time and expenses. As part of a specific business model we may have more or less control over each of these levers, and sometimes we give up our control completely. Our ability to set fees allows us to adjust gross earnings to adjust for increases in expenses that might include lab fees, clinical supplies or technology purchases. When we become a provider for insurance plans we make a choice to give up our ability to use this lever to manage the financial health of our practices.

We can also control profitability by using the lever of expenses. Expenses may include anything from salaries to clinical supplies and lab fees, as well as rent and insurance. Many of the choices we make on the expense side have to be balanced so that we do not diminish the quality of the care we provide or the level of customer service that fits our chosen business model.

The last lever is time. In dental practice time is really a representation of the number of patients or procedures we can complete in a given workday. One limitation on our ability to complete more procedures is having enough patients, the next is the physical limitation of the provider and the last is not compromising care due to speed.

Each of us gets to chose for our office how we want to use the levers of fees, time and expenses to create the practice we envision and deliver the care that fits our personal philosophy. Success is any chosen model is dependent on skillfully using the levers to create profitability

 

Direct Composite for Repairing Worn Incisal Edges

 Occlusion/TMD, Restorative Dentistry  No Responses »
May 092013
 

Incisal edge Matrix Lower webIt is routine to see patients with lower incisal edges that are worn into the dentin. The wear can be from attrition or from erosion, and is often a combination of the two. When dentin is exposed and the wear is progressing at a rate that is not age appropriate I want to do something to protect these teeth and slow the progression of the damage. When I think about possible restorative options I want to do what is appropriate, stay conservative if possible and manage the restorative challenges that are present with lower incisors due to their size and shape. These factors combined with the fabulous properties of our new composites have me using direct composite more and more in these situations. Continue reading »

When is Appliance Therapy Complete

 Occlusion/TMD  1 Response »
May 082013
 

Anterior Bite Plane Lateral View WebLast week teaching a hands on equilibration course one of the participants told a story about a new patient to his office who was in active appliance therapy and frustrated because the former dentist wouldn’t move to the next step of the treatment plan and the patient felt “stuck” in the appliance. His question to me was whether it was wise to move ahead with definitive restorative therapy. So when is appliance therapy complete? The answer to that question hinges on your reasons for placing a patient in an appliance. Continue reading »

When Patient’s & Dentist’s Concerns Don’t Align

 Practice of Dentistry  2 Responses »
May 012013
 

BW EarToday I had the privilege of seeing a new patient who came in concerned about an area of gingival recession that appeared to her to have been getting worse. She shared with me a story about having recently seen a general dentist, to whom she had been going routinely, who told her she didn’t need to be worried about her gums. As the rest of the story unfolded she shared that she was looking for a new dentist because she had felt her concern was dismissed, even assumed to have been silly. I have been practicing dentistry for long enough that I can imagine in my mind’s eye what happened at the other office. I can even see and hear myself doing something similar over the years.

The challenge is that as dental professionals we become very comfortable with both dental disease and with common dental issues that are not problematic. This comfort often gets in the way of our ability to remember that for each patient their concern is real, it is their mouth or teeth, and they do not have years of experience to tell them something is routine or easily treatable. From things like amalgam tattoos to recession, craze lines and decalcification spots patients get curious and worried over things they notice in their mouths. Often a misplaced smile, or lighthearted attempt to dismiss concern can be inappropriate in response to a patient.

The most important thing I have learned over the years it to first listen fully. The second step is to acknowledge what you heard including the emotional subtext, and ask for verification. I will always take the time to examine the area in question making sure to be thorough. Lastly I will share with the patient my beliefs about what is happening and the information necessary for them to move from fear or concern to comfort. Whether the patient today decides to move forward with grafting or to simply allow us to monitor the area of recession, what I know is she left feeling heard and respected for being proactive about her health.

Are You Recommending Xylitol for Caries Control?

 Preventive Dentistry  2 Responses »
Apr 292013
 

gum and mintsThere are numerous artificial sweeteners on the market that report to be zero calorie and are added to “sugarless” gums, mints, candies and foods. Xylitol not only fulfills the diet requirement but helps prevent cavities. Xylitol has 9.6 calories per teaspoon compared to 15 for sugar, however it has 0 net carbs as it is a sugar alcohol and does not alter glycemic index. It has been understood for many years that xylitol is beneficial for patients at risk of getting cavities. This fact has made it very popular in the dental hygiene community. It is estimated that 80% of all hygienists discuss xylitol with patients and over 50% use xylitol products themselves on a daily basis. Continue reading »

Are You Using Checklists?

 Practice of Dentistry  8 Responses »
Apr 242013
 

checklistmanifestoThe concept of checklists has become very popular over the last few years. I first became familiar with it when the book “Checklist Manifesto” by Atul Gawande was recommended by a fellow dentist and friend. It struck home with me as I have always been a fan of lists. Over the last few years more and more of the dentists I have spoken with have begun implementing checklists as a way to improve efficiency and successful execution of complex tasks in the dental office. Recently my friend Kirk Behrendt posted a video on the use of checklists which is worth a few minutes to watch.

Continue reading »

Air Abrasion For Margin Repair

 Esthetic Dentistry, Restorative Dentistry  No Responses »
Apr 172013
 

e.max WebFrom time to time we can help our patients extend the lifespan of an indirect restoration. Today was one of those days. On a lower left first molar all ceramic crown a patient presented with a marginal discrepancy on the buccal. The gap had begun to pick up stain and a very minor amount of decay. Fortunately for the patient the lesion did not extend under the all ceramic material and was confined to the buccal and did not go past the MB line angle so was easy to access. Based on the clinical situation I shared with the patient the ultimate need to replace the restoration and the option for :extending” it’s lifespan a short amount by repairing the margin. Continue reading »

“Permanent” Restoration

 Practice of Dentistry, Restorative Dentistry  3 Responses »
Apr 152013
 

communicationOver the last few months in lectures and articles I have discussed the concept of managing patient expectations about the longevity of restorative dentistry. Multiple times during these conversations a dentist has pointed out that we have coined the phrase “permanent” crown or restoration or filling. What does the use of the word “permanent” communicate to our patients, and is this misleading. These are great points and something worth addressing. I am clear that words are powerful and I pay close attention to their impact. In truth it is not just our patients that are impacted and create beliefs because of the words we use, but our teams and our own behavior. Continue reading »

Improved Anterior Esthetics Using Microfill Composite

 Dental Materials  1 Response »
Apr 112013
 

HeliomolarOften when I lecture on composite dentistry I get asked about improving the final surface texture, polish and sculptability when doing anterior teeth. In a previous blog I looked at the categories of composites and understanding their physical and handling properties based on composition. Microfill composites are an older material formulation that is still on the market for precisely the reason of it’s esthetic qualities. These materials have a lower filler percentage which means there are compromises in the areas of material strength, wear and durability under load. However, microfills to date still have the highest polishability of any composites. Not only are the easy and beautiful to polish in your office, but they maintain that polish over time due to normal hygiene with a toothbrush. Packshot Heraeus Durafill Continue reading »

Spot Etching & Cementing Provisionals

 Esthetic Dentistry, Restorative Dentistry  7 Responses »
Apr 092013
 

Lower Onlay Preps WebMore and more in my practice my preparations are partial coverage. Our ability to use all ceramic restorative solutions and adhesive bonding to seat have allowed this increased conservation of tooth structure. This trend has also brought with it more and more preps that lack traditional retention and resistance form. One of the inherent challenges with partial coverage preparations is temporizing and cementing these interim restorations in a way they stay put. I often joke with my patients that I expect one of two things from their professionals, they will either come loose all the time and drive us both crazy, or they will have to be cut off the day we have them back to get the final restoration. Continue reading »

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