- Email: [email protected]
Plan early for practice transitions
cussion. An area of exposed bone measuring 10 by 7 mm was found in the palate adjacent to teeth #2 through #4. The diagnosis was irreversible pulpitis with acute apical periodontitis originating from tooth #2. The patient underwent nonsurgical treatment of tooth #2 to reduce the number of factors contributing to the pain. The tooth was cleaned and shaped and the canal systems obturated with use of cold lateral compaction, then the tooth was temporized. Two days after the endodontic treatment the patient was no longer in pain. Case 3.—Man, 72, had pain of 7 days’ duration limited to the region of the maxillary right second molar. Cold increased the pain; heat and mastication had no effect. The patient’s history included prostate cancer with bone metastasis, cardiac insufficiency, and pulmonary edema. He had received bisphosphonate therapy for 1 year. His dental history included extraction of his maxillary left second molar followed by osteonecrosis, but that area was not painful at this point. Tooth #3 demonstrated extreme sensitivity to cold with a lingering effect and was diagnosed with irreversible pulpitis with normal periradicular tissue. The tooth had a poor prognosis because of the presence of extensive coronal caries. Tooth #2 also demonstrated a carious lesion. The dental plan formulated was conservative, including nonsurgical endodontic treatment of tooth #3. Tooth #3 was shaped and canal systems obturated by cold lateral compaction, then temporized. The carious lesion was removed from tooth #2 and a temporary filling placed. Immediately after endodontic therapy, the patient reported relief of pain that has continued for 6 months.
Discussion.—Patients with a history of bisphosphonate treatment can suffer endodontic complications. The best approach to such cases includes obtaining a careful medical history and being aware of the drug class identities; considering nonsurgical endodontic therapy that begins before the bisphosphonate treatments, if possible; and being aware that the pain of osteonecrosis resembles odontogenic pain. Once the osteonecrosis has developed, nonsurgical endodontic treatment or retreatment offers a better outcome than extraction or surgical approaches. Procedures must also be undertaken to minimize trauma from rubber dam clamps or instrumentation and obturation to the marginal and apical periodontal tissues. Because pain is the primary symptom that prompts patients to seek treatment, the patient’s comfort is an important consideration.
Clinical Significance.—How specifically to deal with patients requiring surgery who have been previously treated with bisphosphonates is a problem. For now, medical history to identify those patients at risk and use of nonsurgical endodontic treatment, with careful rubber dam placement, will help to minimize risk.
Katz H: Endodontic implications of bisphosphonate-associated osteonecrosis of the jaws: A report of three cases. J Endodont 31:831834, 2005 Reprints available from H Katz, 76 Livingston Ave, New Brunswick, NJ 08901; e-mail: [email protected]
Practice Management Plan early for practice transitions Background.—Experts in practice transition and succession counsel that the issues attending the sale of a practice should be addressed early in the dentist’s career to maximize financial benefit. The options available to a practice owner may be limited if he or she waits too long to examine them; it is never too early. Options.—The sale and/or transition options to be considered can suit practitioners at various stages of their
careers, but they do not offer the same financial rewards and benefits. Owners must examine each option, noting advantages, disadvantages, and objectives. Fitting the individual dentist’s financial and personal needs at a given time in his or her career is the goal. Timing.—For early planners, the primary objective should be receipt of a significant financial benefit from the developed or undeveloped value in the practice. Strategies
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include “buy-ins,” in which an associate is added, a copractice is formed, and then a final sale of the remaining interest is achieved. Group practices can also be considered, but only for practices in a growth mode where there are enough patients for all the dentists to treat. Mid to late career planners should aim at increasing the probability of a successful practice sale at retirement age. This strategy also helps to ensure the owner will receive a sale or purchase price consistent with the full, fair market value of the practice. An associate dentist may be added, then permitted to purchase the practice. At some point, the seller may work for the buyer. Options vary depending on whether these options are pursued 4 to 5 years before retirement or on the day of retirement. Contracts formalize the arrangement in terms of employment and final sale. The best time for initializing this approach is 3 to 5 years before retirement. Potential buy-out options decrease as retirement approaches. At the end of a dentist’s career, the goal is the immediate sale of the practice. This includes finding a buyer for the practice and selling it. This approach can put you at a disadvantage relative to the buyer’s needs, or, depending on how the practice may have diminished as you work fewer hours with perhaps fewer staff and older equipment, the value of the practice may decrease. You, as the seller, may have to step up the pace to make the practice more attractive to buyers. An option at this point is the equity earn-out alternative, in which the practice owner works for the period required to earn as much as would have been realized in a sale. Merging out or in may also be explored, where 2 colleagues who wish to retire join practices to achieve effi-
ciencies in staffing, equipment, or hours worked. Selling charts, records, and goodwill alone does not compare favorably to selling the intact practice. The recommended strategy is to begin in your early 40s to evaluate your practice in terms of how it is growing and whether it projects an attractive image. Then a strategy can be set up with enough time to achieve an attractive, growing practice that will appeal to buyers. Discussion.—School closures have limited the pool of potential dental practice buyers, but the pool of sellers is growing. As a result, it is wise to develop a strategy to build a marketable practice early so that there is time to achieve that goal and realize the best financial return on your investment.
Clinical Significance.—Most everyone hopes to someday retire. Approaching retirement has traditionally been the time dentists start thinking how they will sell their practice. Presented here are reasons to, and strategies for beginning the process some years ahead of time. Like most things, careful planning helps insure success.
Litch B: Selling your practice in 5, 10 or 20 years. AGD Impact December:24-25, 2005 Reprints available from the Academy of General Dentistry.Fax your request to Jo Posselt (312/440-4261) or e-mail [email protected]
Teamwork Background.—Teamwork has been studied, analyzed, and eulogized for years in many contexts, but the core idea remains elusive. Teams are made of imperfect human beings, which makes them inherently dysfunctional, yet solid teamwork produces outstanding results. Specific to dentistry, dental teams work well when individual team members focus on their own behaviors rather than the behaviors of others. Another key factor in success is having team members realize that difficulties will face them regularly,
218 Dental Abstracts
but then focusing on the growth that going through such struggles produces. Other factors contributing to a successful dental team are personality, environment, expectations and accountability, feedback, and conflict resolution. Types of People.—Zealots are intense about what they believe in and want everyone else to be as excited as they are. This enthusiasm can be too much for their teammates. Willing workers are ready to do whatever is needed and just
Discussion.—Patients with a history of bisphosphonate treatment can suffer endodontic complications. The best approach to such cases includes obtaining a careful medical history and being aware of the drug class identities; considering nonsurgical endodontic therapy that begins before the bisphosphonate treatments, if possible; and being aware that the pain of osteonecrosis resembles odontogenic pain. Once the osteonecrosis has developed, nonsurgical endodontic treatment or retreatment offers a better outcome than extraction or surgical approaches. Procedures must also be undertaken to minimize trauma from rubber dam clamps or instrumentation and obturation to the marginal and apical periodontal tissues. Because pain is the primary symptom that prompts patients to seek treatment, the patient’s comfort is an important consideration.
Clinical Significance.—How specifically to deal with patients requiring surgery who have been previously treated with bisphosphonates is a problem. For now, medical history to identify those patients at risk and use of nonsurgical endodontic treatment, with careful rubber dam placement, will help to minimize risk.
Katz H: Endodontic implications of bisphosphonate-associated osteonecrosis of the jaws: A report of three cases. J Endodont 31:831834, 2005 Reprints available from H Katz, 76 Livingston Ave, New Brunswick, NJ 08901; e-mail: [email protected]
Practice Management Plan early for practice transitions Background.—Experts in practice transition and succession counsel that the issues attending the sale of a practice should be addressed early in the dentist’s career to maximize financial benefit. The options available to a practice owner may be limited if he or she waits too long to examine them; it is never too early. Options.—The sale and/or transition options to be considered can suit practitioners at various stages of their
careers, but they do not offer the same financial rewards and benefits. Owners must examine each option, noting advantages, disadvantages, and objectives. Fitting the individual dentist’s financial and personal needs at a given time in his or her career is the goal. Timing.—For early planners, the primary objective should be receipt of a significant financial benefit from the developed or undeveloped value in the practice. Strategies
Volume 51 • Issue 4 • 2006 217
include “buy-ins,” in which an associate is added, a copractice is formed, and then a final sale of the remaining interest is achieved. Group practices can also be considered, but only for practices in a growth mode where there are enough patients for all the dentists to treat. Mid to late career planners should aim at increasing the probability of a successful practice sale at retirement age. This strategy also helps to ensure the owner will receive a sale or purchase price consistent with the full, fair market value of the practice. An associate dentist may be added, then permitted to purchase the practice. At some point, the seller may work for the buyer. Options vary depending on whether these options are pursued 4 to 5 years before retirement or on the day of retirement. Contracts formalize the arrangement in terms of employment and final sale. The best time for initializing this approach is 3 to 5 years before retirement. Potential buy-out options decrease as retirement approaches. At the end of a dentist’s career, the goal is the immediate sale of the practice. This includes finding a buyer for the practice and selling it. This approach can put you at a disadvantage relative to the buyer’s needs, or, depending on how the practice may have diminished as you work fewer hours with perhaps fewer staff and older equipment, the value of the practice may decrease. You, as the seller, may have to step up the pace to make the practice more attractive to buyers. An option at this point is the equity earn-out alternative, in which the practice owner works for the period required to earn as much as would have been realized in a sale. Merging out or in may also be explored, where 2 colleagues who wish to retire join practices to achieve effi-
ciencies in staffing, equipment, or hours worked. Selling charts, records, and goodwill alone does not compare favorably to selling the intact practice. The recommended strategy is to begin in your early 40s to evaluate your practice in terms of how it is growing and whether it projects an attractive image. Then a strategy can be set up with enough time to achieve an attractive, growing practice that will appeal to buyers. Discussion.—School closures have limited the pool of potential dental practice buyers, but the pool of sellers is growing. As a result, it is wise to develop a strategy to build a marketable practice early so that there is time to achieve that goal and realize the best financial return on your investment.
Clinical Significance.—Most everyone hopes to someday retire. Approaching retirement has traditionally been the time dentists start thinking how they will sell their practice. Presented here are reasons to, and strategies for beginning the process some years ahead of time. Like most things, careful planning helps insure success.
Litch B: Selling your practice in 5, 10 or 20 years. AGD Impact December:24-25, 2005 Reprints available from the Academy of General Dentistry.Fax your request to Jo Posselt (312/440-4261) or e-mail [email protected]
Teamwork Background.—Teamwork has been studied, analyzed, and eulogized for years in many contexts, but the core idea remains elusive. Teams are made of imperfect human beings, which makes them inherently dysfunctional, yet solid teamwork produces outstanding results. Specific to dentistry, dental teams work well when individual team members focus on their own behaviors rather than the behaviors of others. Another key factor in success is having team members realize that difficulties will face them regularly,
218 Dental Abstracts
but then focusing on the growth that going through such struggles produces. Other factors contributing to a successful dental team are personality, environment, expectations and accountability, feedback, and conflict resolution. Types of People.—Zealots are intense about what they believe in and want everyone else to be as excited as they are. This enthusiasm can be too much for their teammates. Willing workers are ready to do whatever is needed and just