- Email: [email protected]
Overcoming mid-career slump
individualized application. This approach does not emphasize demandingness, which may tilt the style toward an indulgent type. Parenting Stress.—Behaviors associated with general parenting stress include inconsistency, increased negative communication, decreased monitoring and/or supervision, setting vague rules or limits on behavior, being more reactive and less proactive, and engaging in increasingly harsh disciplinary behaviors. Effects Relevant to Dentistry.—Relationships have been established between diet and caries risk. Breast-feeding is more common, which has nutritive benefits and conveys passive immunity to the infant. Breast-feeding is also a way to connect with and soothe the infant. Feeding on demand well past the first few months when the infant needs frequent feedings to thrive also is becoming more common. Demand feeding until the child wants to quit is integral to attachment parenting. Co-sleeping and nocturnal breastfeeding also are behaviors designed to increase the attachment level between parent and child. However, early childhood caries (formerly termed baby bottle tooth decay) is associated with nighttime breast-feeding or breast-feeding children past age 12 months. Early childhood caries also are linked to bottle-feeding at night substituted for use of a pacifier and daytime on-demand use. Obesity is another adverse effect related to poor eating habits. When demand-feeding and prolonged breast- or bottle-feeding behaviors are present, children may no longer see food as simply for satisfying hunger or nutritional needs, but may use it to meet emotional needs. With increased consumption is increased exposure to potentially cariogenic foods. The ability of dental professionals to deliver oral health care services is altered by parenting changes. Overly protective parents tend to hover in the operatory and hinder communication between doctor and child. When parents are afraid their child may be traumatized, they can overly
prepare their child for the dental visit, giving it a significance beyond what is reasonable. Behavior management may not be as effective, depending on the parenting style in place. Many children are never told what to do but rather are offered choices and permitted to play a significant role in making important decisions. Thus dental professionals who exercise authority may be less effective in achieving the desired behaviors in children than was previously seen. The preventive strategies designed to advance oral health by diminishing the risk of caries and periodontal disease may also be affected by parenting style. For these strategies to be effective, the family must be committed to increasing oral hygiene and monitoring the children’s diet. This commitment requires active parental involvement. Uninvolved parents usually are not committed to a home-care regimen. Parents also are more often approaching health care as consumers. This can undermine the dental professional’s authority to request the family make changes in lifestyle to promote oral health.
Clinical Significance.—As dentistry’s model changes from surgical to medical, the emphasis of practice shifts toward prevention from correction. This shift requires greater attention to controlling lifestyle issues such as diet and oral hygiene—items where understanding parenting philosophies is essential. Understanding parental attitudes is essential to affecting the child’s behavior.
Law CS: The impact of changing parenting styles on the advancement of pediatric oral health. Calif Dent Assoc J 35:192-197, 2007 Reprints available from CS Law, Univ of California, Los Angeles, School of Dentistry, 23-011 CHS, 10933 Le Conte Ave, Los Angeles, CA 90095-1668
Practice Management Overcoming mid-career slump Background.—At mid-career, a dentist would like to be well established, with a growing practice and feeling that the investment has been worthwhile. What if you don’t feel that way? What if you feel like giving up, like you are in a slump? It’s important to look at the areas that are causing your practice to be less than ideal: patient retention, staff recruitment and training, and customer service.
Patient Retention.—‘‘Busyness’’ does not necessarily mean that patient retention is fine. The perception that being busy means you are retaining patients can be deceiving and costly. Statistically 80% of dental practices are losing more patients than they are adding each year. You won’t know if you are in that 80% or in the lucky 20% unless you analyze certain areas. Among the questions you should
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ask are: How many inactive patient files are you storing? Have you increased the number of days devoted to hygiene over the past year? Is the hygienist taking home more than 33% of what he or she produces? Have you been able to convert 85% of the patients who came as emergencies into staying for comprehensive examinations? It is not good to have enough inactive records to open a second practice, to see no increased hygiene days, to have your hygienist’s salary more than a third of what is produced, or to see fewer than 85% of your emergency cases fail to become loyal patients. The usual suspect in patient retention issues is a poor recall system. You need to reconnect with all the patients past due for recall appointments in the previous 12 months. Use a definite strategy so you can set goals and track the results of your recall efforts. Then you need to assign the recall duties to a staff member, making him or her the coordinator, and monitor progress. Use a specific script to guide the discussion in the calls. Set a goal of having a specific number of appointments scheduled and following up to ensure that a specific number of patients complete their treatment. Schedule the hygienist to achieve daily or monthly goals. Have the coordinator monitor and report on recall efforts at staff meetings. Hiring and Training.—Many practices have no recruitment or hiring strategy in place. When a staff member is leaving, the focus is on filling that vacancy as quickly as possible, so dentists often hire the first person who seems qualified. Dental practices in general, and a struggling midcareer practice in particular, cannot leave hiring decisions to chance. You need to establish an ongoing employee recruitment program. Even when you are not hiring, you should be looking. Notice who gives you excellent service and give that person your business card and an invitation to send you a resume, which you can keep on file. Use your connections and ask for employee referrals. Contact business schools, hygiene programs, and assistant programs in the area and request the faculty to send along candidates who will effectively represent their programs. When the hiring opportunity arises, use computerized testing tools to assess individuals being considered. This can help to avoid hiring a collections coordinator who secretly hates to ask people for money and will eventually quit in frustration or lead you into a financial dilemma. Training is not accomplished simply by staff members sharing information. Sadly, a pet store may invest more time and energy training their high school employees how to sell pets than most dental practices invest in training employees who will be responsible for hundreds of thousands of dollars in practice revenue. Dentists often believe they will spend exorbitant amounts of money training an
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Dental Abstracts
employee who will then leave the practice. We must learn to look beyond such fears and realize that training contributes significantly to developing employee loyalty, and the investment in training pays off handsomely in terms of improved staff efficiency. In addition, we now have a less-expensive option in ‘‘cybertraining.’’ Online courses can be completed at each individual staff member’s own pace without leaving the office or costing the dentist enormous amounts of money. Customer Service.—Study has shown that many patients will remain with your dental practice only until they find a reason to leave. The reasons can be remarkably diverse, such as inconvenient practice hours, poor parking, pain during treatment, difficulty understanding bills, insurance issues, changes in practice policy, not answering the phone or arranging for a message to be left, charges for a missed appointment, feeling fees are too high, having staffing changes, being referred to a specialist, feeling the patient is not being listened to, or even a lack of contact between appointments. Dental staff may consider some of these to be insignificant, but they can cost a mid-career practice significant income through lost loyalty. To encourage long-term loyal patients, evaluate your systems and service. Seventy percent of customers say poor customer service is why they defect. Too often dental employees view managing patient concerns as less important than their other duties. Find out what your patients think. Use a survey to see if some seemingly minor concerns voiced by a few patients are much larger issues than you thought. Use ‘‘action listening’’ strategies, rather than active listening, in which the dental team commits to bring concerns and issues patients express to the staff meeting where they can be discussed and actions determined. The obvious cannot be ignored. Have your staff welcome each patient as a guest. Be prepared to answer basic questions immediately. Make sure the patient is not ignored when he or she comes to the counter. Train your reception staff to acknowledge the patient’s presence right away and let the patient know they will be right with him or her. Don’t let them pretend the patient isn’t there, which is like telling the individual that he or she is an annoyance and not worthwhile. Discussion.—All mid-career practices have room to grow and improve, but growth and improvement require action. Dental practices must invest in analyzing their patient-retention strategies, in hiring and training quality employees, and in establishing excellent customer service practices. These areas will require continual surveillance, but they are key in helping you achieve your individual and practice goals.
Clinical Significance.—Dental practices, like any other business, don’t grow and stay healthy by magic. Like a garden, they require attention and evaluation or else they become a weed patch. Excellent dentistry is expected. We don’t get extra points for providing good care. Service is what a successful practice is all about.
McKenzie S: Feel like giving up and getting out . from beneath the mid-career squeeze? Calif Dent Assoc J 35:126-129, 2007 Reprints available from S McKenzie, McKenzie Management, 3252 Holiday Ct, Suite 110, La Jolla, CA 92037
Preventive Dentistry Glass ionomer sealant for emerging molars Background.—Resin-based pit-and-fissure sealants are exceptionally well suited to their calling. However, it is hard to handle the resin sealant in a moist environment. The retention of resin-based sealants exceeds that of glass ionomer sealants under conditions of good isolation and moisture control. When the conditions are not right for resin sealants, glass ionomer offers an alternative. In particular, glass ionomer is a good sealant for children whose primary molars are deeply pitted or fissured and in whom isolation may be difficult. They are also useful in treating first or second molars that are not fully erupted (Fig 1) and when a ‘‘transitional’’ sealant is needed before the ‘‘permanent’’ resin sealer is used. The advantages of glass ionomer include its hydrophilic nature, making it compatible with the mouth’s changing environment; its ability to set rapidly; and its release of fluoride, permitting remineralization of enamel and adding an antimicrobial effect. Calcium, aluminum, and other ions can also be released, all promoting tooth remineralization. Hicks and Flaitz reported on the use of light-cured resin-modified glass ionomer sealants relative to the formation of caries-like lesions in adjacent occlusal enamel. They compared the effects with those achieved using conventional light-cured fluoride-releasing sealant. Caries involvement was less with the resin-modified glass ionomer sealant than with the conventional resin sealant. Other studies also have noted that even though glass ionomer sealants may have lower retention rates than resin-based sealants, small amounts of sealant remain in the fissures and release fluoride, even after the sealant is apparently gone. Glass ionomer sealants were applied to a newly erupting tooth, a use for which resin-based sealants may be contraindicated. Method.—A GC Fuji Triage kit is used, which contains glass ionomer capsules, an applier, a conditioner, and a coating agent. The usual prophylactic preparation using pumice
is completed, making sure to avoid aggravating the operculum. Next, the tooth is rinsed thoroughly with water. A drop of the conditioner is dispensed into a well, then applied using a microbrush for 10 seconds. An air syringe is used to gently dry the tooth, leaving the surface with a moist, glistening appearance. The glass ionomer capsule is tapped 2 or 3 times on a hard surface to loosen the powder, then activated. A plunger is pushed in until flush with the main body, then the capsule is positioned in the capsule applier. The lever is clicked once. After removing the capsule from the applier, it is placed in an amalgamator and triturated for 10 seconds at high speed before being loaded back into the applier. The lever is clicked twice, priming the capsule, then the glass ionomer is extruded onto the tooth, making sure to
Fig 1.—Glass ionomer can be used to treat emerging permanent molars. (Courtesy of Lindemeyer RG: The use of glass ionomer sealants on newly erupting permanent molars. J Can Dent Assoc 73:131-134, 2007.)
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prepare their child for the dental visit, giving it a significance beyond what is reasonable. Behavior management may not be as effective, depending on the parenting style in place. Many children are never told what to do but rather are offered choices and permitted to play a significant role in making important decisions. Thus dental professionals who exercise authority may be less effective in achieving the desired behaviors in children than was previously seen. The preventive strategies designed to advance oral health by diminishing the risk of caries and periodontal disease may also be affected by parenting style. For these strategies to be effective, the family must be committed to increasing oral hygiene and monitoring the children’s diet. This commitment requires active parental involvement. Uninvolved parents usually are not committed to a home-care regimen. Parents also are more often approaching health care as consumers. This can undermine the dental professional’s authority to request the family make changes in lifestyle to promote oral health.
Clinical Significance.—As dentistry’s model changes from surgical to medical, the emphasis of practice shifts toward prevention from correction. This shift requires greater attention to controlling lifestyle issues such as diet and oral hygiene—items where understanding parenting philosophies is essential. Understanding parental attitudes is essential to affecting the child’s behavior.
Law CS: The impact of changing parenting styles on the advancement of pediatric oral health. Calif Dent Assoc J 35:192-197, 2007 Reprints available from CS Law, Univ of California, Los Angeles, School of Dentistry, 23-011 CHS, 10933 Le Conte Ave, Los Angeles, CA 90095-1668
Practice Management Overcoming mid-career slump Background.—At mid-career, a dentist would like to be well established, with a growing practice and feeling that the investment has been worthwhile. What if you don’t feel that way? What if you feel like giving up, like you are in a slump? It’s important to look at the areas that are causing your practice to be less than ideal: patient retention, staff recruitment and training, and customer service.
Patient Retention.—‘‘Busyness’’ does not necessarily mean that patient retention is fine. The perception that being busy means you are retaining patients can be deceiving and costly. Statistically 80% of dental practices are losing more patients than they are adding each year. You won’t know if you are in that 80% or in the lucky 20% unless you analyze certain areas. Among the questions you should
Volume 53
Issue 1
2008
31
ask are: How many inactive patient files are you storing? Have you increased the number of days devoted to hygiene over the past year? Is the hygienist taking home more than 33% of what he or she produces? Have you been able to convert 85% of the patients who came as emergencies into staying for comprehensive examinations? It is not good to have enough inactive records to open a second practice, to see no increased hygiene days, to have your hygienist’s salary more than a third of what is produced, or to see fewer than 85% of your emergency cases fail to become loyal patients. The usual suspect in patient retention issues is a poor recall system. You need to reconnect with all the patients past due for recall appointments in the previous 12 months. Use a definite strategy so you can set goals and track the results of your recall efforts. Then you need to assign the recall duties to a staff member, making him or her the coordinator, and monitor progress. Use a specific script to guide the discussion in the calls. Set a goal of having a specific number of appointments scheduled and following up to ensure that a specific number of patients complete their treatment. Schedule the hygienist to achieve daily or monthly goals. Have the coordinator monitor and report on recall efforts at staff meetings. Hiring and Training.—Many practices have no recruitment or hiring strategy in place. When a staff member is leaving, the focus is on filling that vacancy as quickly as possible, so dentists often hire the first person who seems qualified. Dental practices in general, and a struggling midcareer practice in particular, cannot leave hiring decisions to chance. You need to establish an ongoing employee recruitment program. Even when you are not hiring, you should be looking. Notice who gives you excellent service and give that person your business card and an invitation to send you a resume, which you can keep on file. Use your connections and ask for employee referrals. Contact business schools, hygiene programs, and assistant programs in the area and request the faculty to send along candidates who will effectively represent their programs. When the hiring opportunity arises, use computerized testing tools to assess individuals being considered. This can help to avoid hiring a collections coordinator who secretly hates to ask people for money and will eventually quit in frustration or lead you into a financial dilemma. Training is not accomplished simply by staff members sharing information. Sadly, a pet store may invest more time and energy training their high school employees how to sell pets than most dental practices invest in training employees who will be responsible for hundreds of thousands of dollars in practice revenue. Dentists often believe they will spend exorbitant amounts of money training an
32
Dental Abstracts
employee who will then leave the practice. We must learn to look beyond such fears and realize that training contributes significantly to developing employee loyalty, and the investment in training pays off handsomely in terms of improved staff efficiency. In addition, we now have a less-expensive option in ‘‘cybertraining.’’ Online courses can be completed at each individual staff member’s own pace without leaving the office or costing the dentist enormous amounts of money. Customer Service.—Study has shown that many patients will remain with your dental practice only until they find a reason to leave. The reasons can be remarkably diverse, such as inconvenient practice hours, poor parking, pain during treatment, difficulty understanding bills, insurance issues, changes in practice policy, not answering the phone or arranging for a message to be left, charges for a missed appointment, feeling fees are too high, having staffing changes, being referred to a specialist, feeling the patient is not being listened to, or even a lack of contact between appointments. Dental staff may consider some of these to be insignificant, but they can cost a mid-career practice significant income through lost loyalty. To encourage long-term loyal patients, evaluate your systems and service. Seventy percent of customers say poor customer service is why they defect. Too often dental employees view managing patient concerns as less important than their other duties. Find out what your patients think. Use a survey to see if some seemingly minor concerns voiced by a few patients are much larger issues than you thought. Use ‘‘action listening’’ strategies, rather than active listening, in which the dental team commits to bring concerns and issues patients express to the staff meeting where they can be discussed and actions determined. The obvious cannot be ignored. Have your staff welcome each patient as a guest. Be prepared to answer basic questions immediately. Make sure the patient is not ignored when he or she comes to the counter. Train your reception staff to acknowledge the patient’s presence right away and let the patient know they will be right with him or her. Don’t let them pretend the patient isn’t there, which is like telling the individual that he or she is an annoyance and not worthwhile. Discussion.—All mid-career practices have room to grow and improve, but growth and improvement require action. Dental practices must invest in analyzing their patient-retention strategies, in hiring and training quality employees, and in establishing excellent customer service practices. These areas will require continual surveillance, but they are key in helping you achieve your individual and practice goals.
Clinical Significance.—Dental practices, like any other business, don’t grow and stay healthy by magic. Like a garden, they require attention and evaluation or else they become a weed patch. Excellent dentistry is expected. We don’t get extra points for providing good care. Service is what a successful practice is all about.
McKenzie S: Feel like giving up and getting out . from beneath the mid-career squeeze? Calif Dent Assoc J 35:126-129, 2007 Reprints available from S McKenzie, McKenzie Management, 3252 Holiday Ct, Suite 110, La Jolla, CA 92037
Preventive Dentistry Glass ionomer sealant for emerging molars Background.—Resin-based pit-and-fissure sealants are exceptionally well suited to their calling. However, it is hard to handle the resin sealant in a moist environment. The retention of resin-based sealants exceeds that of glass ionomer sealants under conditions of good isolation and moisture control. When the conditions are not right for resin sealants, glass ionomer offers an alternative. In particular, glass ionomer is a good sealant for children whose primary molars are deeply pitted or fissured and in whom isolation may be difficult. They are also useful in treating first or second molars that are not fully erupted (Fig 1) and when a ‘‘transitional’’ sealant is needed before the ‘‘permanent’’ resin sealer is used. The advantages of glass ionomer include its hydrophilic nature, making it compatible with the mouth’s changing environment; its ability to set rapidly; and its release of fluoride, permitting remineralization of enamel and adding an antimicrobial effect. Calcium, aluminum, and other ions can also be released, all promoting tooth remineralization. Hicks and Flaitz reported on the use of light-cured resin-modified glass ionomer sealants relative to the formation of caries-like lesions in adjacent occlusal enamel. They compared the effects with those achieved using conventional light-cured fluoride-releasing sealant. Caries involvement was less with the resin-modified glass ionomer sealant than with the conventional resin sealant. Other studies also have noted that even though glass ionomer sealants may have lower retention rates than resin-based sealants, small amounts of sealant remain in the fissures and release fluoride, even after the sealant is apparently gone. Glass ionomer sealants were applied to a newly erupting tooth, a use for which resin-based sealants may be contraindicated. Method.—A GC Fuji Triage kit is used, which contains glass ionomer capsules, an applier, a conditioner, and a coating agent. The usual prophylactic preparation using pumice
is completed, making sure to avoid aggravating the operculum. Next, the tooth is rinsed thoroughly with water. A drop of the conditioner is dispensed into a well, then applied using a microbrush for 10 seconds. An air syringe is used to gently dry the tooth, leaving the surface with a moist, glistening appearance. The glass ionomer capsule is tapped 2 or 3 times on a hard surface to loosen the powder, then activated. A plunger is pushed in until flush with the main body, then the capsule is positioned in the capsule applier. The lever is clicked once. After removing the capsule from the applier, it is placed in an amalgamator and triturated for 10 seconds at high speed before being loaded back into the applier. The lever is clicked twice, priming the capsule, then the glass ionomer is extruded onto the tooth, making sure to
Fig 1.—Glass ionomer can be used to treat emerging permanent molars. (Courtesy of Lindemeyer RG: The use of glass ionomer sealants on newly erupting permanent molars. J Can Dent Assoc 73:131-134, 2007.)
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Issue 1
2008
33