In the Middle of the Greatest Need - Burkhart Dental...Greg Biersack, Vice President of Operations A...

A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 4 2008

Offi ce DesignInvest in Your Practice, In Good Times and Bad

Wealth ManagementSaving is the Key but What is the Key to Savings?

In the Middle of the Greatest NeedDr. Charles Keithline

A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 3 2010A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 3 2010

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Contents

In the Middle of the Greatest NeedPediatric Dental Group ............................................28Contributing Writer: Paige MeadExecutive Assistant to the PresidentContributing Photographer: Scott Miller

Practice ManagementA Treatment Plan For Your Practice .........................4Contributing Writer: Margaret Boyce-Cooley Director, Practice Leadership, Burkhart Consulting

Increasing New Patients: What Do Starbucks and Your Practice Have In Common? ...............................7Contributing Writer: Karen Burnett, RDH Consultant, Practice Leadership, Burkhart Consulting

Burkhart Office Manager Superstar .........................9Burkhart Office Manager Superstar .......................11

Office DesignInvest In Your Practice, In Good Times And Bad .. 12Contributing Writer: Andy Hutson, Branch Manager, Burkhart EugeneContributing Photographer: Joanna Herr-Hanks

Assistant SuccessSupply Savings Guarantee: Great Service and Controlled Supply Overhead, The Perfect Combination ...................16Contributing Writer: Jerry Ritsema, Branch Manager, Burkhart Western Washington

Burkhart Assistant Superstar .................................17Get Organized! ......................................................... 18Contributing Writer: Hollie Wise-Bryant

Environmental Surface Disinfection ........................23Contributing Writer: Sheldon Fisher, Vice President Crosstex International

ClinicalConservative Anterior Composite Art.....................25Contributing Writer: Rys Spoor, DDS, FAGD, Photos courtesy of Rys Spoor, DDS, FAGD

TechnologyOn The Road to Cone Beam Imaging — The Journey And The Destination: Part II — The Destination .............36Contributing Writer: Sudip Ghosh, DDSImages Courtesy of Gendex

Managing the Information In Your Practice to Maximize Your Profitability .....................................39Contributing Writer: Dawn Christodoulou, President, PEB/XLDentImages Courtesy of Dawn Christodoulou

Business of DentistryWhat’s Your Number? ...............................................44Contributing Writer: Bob Creamer, CPA

Wealth ManagementSavings is the Key but What is the Key to Savings? ............................................48Contributing Writer: Sam Martin, CPA, CFP®

Hygiene SuccessSubgingival Air Polishing for Periodontal Maintenance ..................................52Burkhart Hygiene Superstar ....................................54

Index of Advertisers: A-Dec: Proven ...............................................................................15

Air Techniques, Inc.: Polaris™ and Spectra™ ............................47

Belmont®: Bel-Cypher ................................................................43

Belmont®: Bel 20+ ...................................................Back Cover

Bien Air: 2010 Specials ..............................................................51

Bosworth Company: Super Values ..........................................21

Creamer & Associates: Powerful Tax & Business Solutions ...45

Crosstex: Sanitex Plus® Wipes ...................................................24

DentalEZ: everlight™ ...................................................................58

DentalGroup LLC: Is Your CPA a Dental Specialist? ............50

Dentsply Professional: Cavitron ................................. 55

Digital Doc: IRIS ........................................................................57

EMS: Air-Flow Kills Biofilm ...........................................................53

J. Morita: Vera View Epocs 3De ................................................35

KaVo, Pelton & Craneand Marus: Better. Together. ....................Inside Back Cover

Matsco®: What are Your Practice Goals? ...................................24

Midmark: ElevanceTM ..................................................................34

Pelton & Crane: Embrace your Surroundings. ......................22

Practice Leadership, Burkhart Consulting: Practice View .....6

ProDrive Systems: Pro Drive ..................................................................2

Progeny: Vantage™ ..................................................................................38

SciCan: E-STATIS .......................................................................................43

Soredex: Orthopantomograph® OP 30 ........... Inside Front Cover

Summit Dental Study Group: 2010 Speakers ..........................56

Sunstar : GUM™ Soft-Picks® .......................................................10

XLDent™: Bringing Your Whole Practice Together ...................41

Zirc: A Big Problem With A Simple Solution ................................20

Cover Photo: Dr. Charles Keithline of Pediatric Dental Group in Tulsa, OK. Photo by Scott Miller. Story on Page 28

CATALYST MAGAZINE Issue 3 2010 1.

In This Issue:

ProDrive, the Logical Evolution in Dentistry.Unlike traditional friction grip design, ProDrive’s revolutionary upgrade turbine and triangular bur system lock together for noticeably improved cut performance, superior control and improved precision.

You can experience ProDrive two ways, the ProDrive Upgrade Turbine for leading brand handpieces, or the ProDrive High-Speed Handpiece (standard or mini head). The ProDrive High-Speed Handpiece is the only handpiece to incorporate the ProDrive Turbine. Both options work with the triangular shank ProDrive Bur which is specifically designed to engage with ProDrive Upgrade Turbines and ProDrive High-Speed Handpieces. Experience faster cutting, superior control & improved precision.

Evolve your practice. Contact us today to experience the ProDrive diff erence.www.prodrivesystems.com | 1.866.937.8882

Triangular Bur Shank- Locks into turbine for superior cut speed, control and precision.

3mm Bur Lengthening Feature- Safe bur extension for diff icult to reach areas.

540 Carbide & Diamond Burs

InTouch

Greg Biersack, Burkhart Vice President of Operations


Do y o u s e e y o u r s u p p l y representative as someone who is trying to sell you things. Or do

you see them as part of your team who is serving as a “purchasing agent,” working for you? It is our goal that you see your Burkhart Account Manager as the latter. This is someone that is looking out for your best interest, a person who tries to bring you the products that meet your clinical needs and tries to do it at the lowest possible cost. This has been the heart of our Supply Savings Guarantee for more than 30 years.

What are the specific practices of a good purchasing agent?

1. Helps provide the information to you on which products help you accomplish your goals

2. Looks for and suggests products that will get the job done at a lower per-use cost

3 . B r ing s in t h e m anu f a c t u re r representative for support to ensure that products are being utilized most effectively

4. Works with you to schedule regular training /information meetings so that your of f ice knows what advanc e s are be ing made in material development

5. Works with the manufacturer to secure samples of new products

6. Processes your coupons and free goods for you

7. Helps manage your inventory so that you do not run out of product or have too many dollars tied up in inventory

8. Evaluates themselves based on their ability to control your costs

A Burkhart Account Manager says, “I have access to all of these products. I will seek to understand what you need and buy the things for your office that fit these needs.”

If you are working with Burkhar t, thanks for allowing your Account Manager to serve as your purchasing agent. If you are not working with Burkhart, please ask yourself whether you are getting the level of service you deserve from your purchasing agent.

Greg Biersack, Vice President of Operations

A special apology to Dr. Darwin Lum and his staff in Fairfield, California. We edited Maribel Wilson’s responses in the Assistant Superstar feature which drastically altered the meaning of some of her statements that ran in the Q2 2010 issue. We are reprinting the Assistant Superstar on page 17 in its entirety, as her answers were submitted to us.

Serving the DentalProfession since 1888...

Catalyst Magazine is published byBurkhart Dental Supply2502 South 78th St.Tacoma, WA 98409Tel. (253) 474-7761Fax (253) 472-4773

PublisherGreg Biersack

Principal EditorHolly Kean

Graphic DesignersBrittany StatenSara Wisely

AdvertisingJamie Bragazzi

All rights reserved. Reproduction of any part of thispublication without written permission from the Publisher is strictly forbidden. Images are not necessarily to scale.

Customer Service:

800.562.8176

At Burkhart we realize that our clients are both dental professionals and business owners. It is our goal to help them be successful at both aspects of their careers . Catalyst is fully dedicated to that success. The articles in this publication vary from product use and selection to business management topics and provide information and guidance that can lead to a more successful practice. Throughout the publication are stories of Burkhart clients who have succeeded in the areas that are highlighted. We hope that you enjoy.

If you have a request for a topic that you would like for us to cover in Catalyst, p lease cont ac t Hol ly Kean a t :

[email protected]

4. Issue 3 2010 CATALYST MAGAZINE

If asked whether their patients have treatment plans, most dentists will provide you a

resounding “Yes!” In the past two decades, treatment planning has become a more clearly defined process that is critical to case presentation success. Just as everyone’s smile is different, no single treatment is going to work perfectly for all dental patients. The treatment plan allows you to employ a variety of techniques, products, and procedures in order to create a customized dental treatment plan for each of your patients. Whether the treatment plan includes an operative procedure or a cosmetic procedure, it serves to inform the patient about what the dentist is providing them. It provides a road map of sorts for the patient, keep ing them in formed and allowing treatment to be prioritized in a clear way to the patient, with their options outlined. As many dentists have learned at seminars on case presentation, the practice o f c o - d iag no s ing emp ower s patients; they become aware of their options and are better able to choose the treatment that best meets their dental desires. You wouldn’t think about not having a treatment plan for your patients. Doesn’t it make sense that the dentist should have a treatment plan for their practice?

When you are deciding on what steps to take next in your dental practice, many questions can arise, and there are several options that must be taken into consideration. Just as you ask your patients what

long-term results they wish to see, the dentist should consider what long-term results he or she wishes to see with regard to the business.

• What is your vision for your practice?

• Have you achieved it yet?

• What needs to change in your practice in order for this to happen?

• How do you begin to create an action plan?

We recommend that you start with the same first steps as you do with your patients, with an interview and a comprehensive exam with diagnostics, leading to a treatment plan for your practice — a Practice View. The Practice View process begins with an in-depth interview. Similar to a health history for your patient, along with the questions

regarding how the patient feels about his or her smile, you need to assess if you’re happy with the following with regard to your practice:

• Production• Collections• Location• Patient Base• Schedule• Leisure time

Next, a support team with various areas of exper t ise regarding business systems, equipment, technology, and service arrives at your pract ice to complete comprehens ive d iagno s t ic s , i n c lu d ing re p o r t g a t h e r ing , equipment testing, photographs, an aesthetic review, and an ergonomic assessment. We will notice things you may never have noticed, and we chart what we discover and share it with you. Talk about a comprehensive exam! Dr. Neil

By Margaret Boyce-Cooley, MSDirector, Practice Leadership, Burkhart Consulting

Practice View: A Treatment Plan for Your Practice

Practice Management

Practice Leadership, Burkhart Consulting, i s a f u l l - s e r v i c e c o n s u l t i n g t e a m specializing in developing leaders and teams in dent istr y. For more than a decade, Practice Leadership has helped hundreds of practices achieve new levels of success. Contact your Burkhart Account Manager or Practice Leadership directly at 800.665.5323 for more information.


Gehred said, “The Practice View process exceeded my expectations. When the team arrived, they got to know me, my practice, and my goals. I knew what I was going to get from Burkhart was an in-depth, valuable view of my practice.”

Once we’ve analyzed al l the diagnostics, we will present our findings, just as you do with your patients. Starting with what’s going well, we’ll work through suggested recommendations so you are aware of your options in order to achieve your practice goals. Treatment for the practice can be prioritized in light of the results you’d like to see in your practice (sound familiar?). Just as a patient responds with raves for the most thorough exam they’ve ever had, our doctors are responding similarly.

“It helped me as a business owner to know what things to look for when I’m evaluating my practice every day. The process provided an overall view and a framework of what I should be doing and need to be doing.” — Dr. Rick Horacek.

It can certainly be a little nerve-racking to have the Burkhar t team turn the intraoral camera on your practice, just as it can be for patients when they see a view of their mouth they’ve never seen before. Some patients have fears allayed when they see the images, while some realize that they better fix that back molar with the large silver filling with the crack next to it before the tooth breaks, and others may even think you are trying to sell them dentistry. Our doctors have felt the same way about Practice View. Many are encouraged to f ind they have several things going well in their practice. Some recent observations include:

• The image of the front office and clinical team is polished and appropriate.

• The f ront o f f i ce team is collecting estimated co-pays at the time of the visit.

• The team and doctor are able to get out of the office on time for lunch and at the end of the day the majority of the time.

We all need to hear what we’re d o i n g w e l l a n d h a v e i t b e recognized by others! I know the last time I was at the dentist and heard that one of my pocket depths went from four to two, I was pretty excited! On the other end of the spectrum, we say to patients, “Wouldn’t you want to know about the cracked tooth now, before it gets worse, breaks under added stress, and causes pain and lack of productivity?” Practice View provides you with that information as well . Are we using that intraoral camera to “sell you something?” We’re using it for the same reason you do—as a partner in your patient’s oral health, you provide them with information, options, and success. No hidden agendas. Period.

We feel confident that once your Practice View is completed, you will be better informed to make the important decisions that concern you and your practice, armed with recommendations that generate a working treatment plan for your practice. As we all know, treatment plans are living documents that must be followed and reviewed regularly to achieve the desired resul t s . Burkhar t is honored to provide this service that will further enhance your knowledge and ul t imately your prac t ice success. Contact your Burkhart Account Manager for information on how to get started.

“This process was much more valuable than I anticipated it would be.” — Dr. Minou Chau

Burkhart and Practice Leadership’s team of experts can help you assess your current practice by:

� Performing a comprehensive analysis of the business systems in your practice to discover strengths and identify areas that may need more focus.

� Assessing your facility and dental equipment’s ability to refl ect your desired practice image.

� Identifying technologies that could improve effi ciency or quality of care for your patients.

� Exploring ways to achieve the vision and goals for your practice.

www.burkhartdental.com www.practiceleadership.com

Contact your Burkhart Account Manager for a complimentary comprehensive PracticeView Analysis to get started today!

Practice Management


Connection — it ’s the way both Starbucks and your practice can maintain loyal

customers, even in a challenging economy! That line of customers getting their early morning coffee hasn’t seemed to decrease, even in recent years. Regular customers at Starbucks have their drinks made for them by the barista while they’re in line. There is the cheerful expectation of custom orders — so many choices, and you don’t have to drink coffee to be a customer!

People enjoy being a part of a community and having options. Is this evident in your practice? Clues that you successfully connect with your patients are shown through patient comments such as, “You guys make it fun to come here!” or “How’s my favorite hygienist?” When was the last time you overheard or were given a compliment by one of your patients? If it’s been too long, evaluate what you can do to build that level of care.

Even if you feel that you’ve found the right blend of customer service and dental care for your patients, plan

to continually evaluate how to keep your approach fresh. In response to the trend for healthier eating, Starbucks changed its menu items. Brew your own ideas for continuing education, technology, or patient comfort that demonstrates how much you care for your patients!

Growth or Grief?Many factors contribute to the growth, plateau, or decline of your patient base. These include your staff, your facility, your scheduling, your communications, and your service. Referral conversations between your patients and potential

Increasing New Patients: What do Starbucks and Your Practice have in Common? By Karen Burnett, RDH, Consultant, Practice Leadership, Burkhart Consulting

Practice Management

Practice Leadership, Burkhart Consulting, i s a f u l l - s e r v i c e c o n s u l t i n g t e a m specializing in developing leaders and teams in dent istr y. For more than a decade, Practice Leadership has helped hundreds of practices achieve new levels of success. Contact your Burkhart Account Manager or Practice Leadership directly at 800.665.5323 for more information.


new patients rarely focus on your clinical skills. Mentally run through the checklist of factors. Which factors contribute to patient growth, and which restrict your practice?

Quality or Quantity?Review your tracking of new patient referral sources. Do your marketing tools contribute to your established patient base? A recent evaluation of one practice’s new patient sources

revealed a number of new patients referred by a phone book ad; yet 52% of these patients were seen only once and never returned for treatment. What can protect your practice from one-time visits? Continually review the factors from the checklist to evaluate what your new patient might experience during a typical visit to your practice. Strive to personally serve each of your patients rather than adopting a drive-through mentality. Make a genuine effort to care for your patient, and their loyalty, along with their referrals, will be the reward.

Camaraderie or Conflict?What makes your practice a place that your patients want to be? The people on your team that serve your patients create the environment for those patients — whether positive or negative. Select and coach your team with this in mind. Consider the patients in your practice; are there some that have been allowed to negatively affect how your other patients experience your practice? One of your greatest practice building decisions could be to limit those who create challenges for you, your team, and your other patients. Help your patients use their smile — make it your priority during their visits.

When your most loyal patients refer you to others, you benefit by working with new patients who not only come with confidence in the practice, but are also almost ‘pre-qualified’ to be a good fit. Identify what makes people recommend you, and keep it up. Highlight these features rather than just procedures in your new patient brochure, on your website, and in other marketing materials. Help those who want what your practice offers find you.

Now, are you ready for your double tall latte?

BENEFITS:• Friendly, warm telephone skills

• Availability of appointments

• Staff longevity

• Appropriate number of staff to provide your standard of care

• Quality facility with updated equipment

• Financial arrangement options

• Comprehensive, detailed exams

• Appreciation of patients’ time

• Respect for patient confidentiality

DETRIMENTS:• Abrupt or impersonal phone skills

• Too long a wait for available appointments

• Staff turnover

• Insufficient staff

• Dated facility and equipment

• Lack of financing options

• Rushed exams

• Consistent running over of appointment times

• Lack of patient confidentiality

VS.


Hobbies:

What I like about my job:

My Greatest challenge is:

Success at our office means:

What Burkhart means to me:

Enjoy spending time with my family and being in my garden.

Building a lasting relationship with my patients.

Finding enough hours in a day.

That each patient’s needs are met and a lasting relationship is made.

Matt is an asset to our office by keeping inventory and making ordering a breeze. Burkhart has always been professional in building our practice and developing our office.

Office Manager, Riverbend Dental - Springfield, Oregon

Pepper Wedmore

Superstar

Office Manager


I love spending time with family and friends, watching movies, reading, and attending weekend church

activities. This is more of a calling than a hobby but I’ve always been involved in some type of

non –profit community development. My life is so blessed that I like to give back by working with other

ministries and organizations in helping underprivileged families in the inner city of Austin, Texas. I also

sponsor a memorial scholarship for high school students each year.

This is my dream job! There are lots of things that I like about my job: I live close to our office and

the drive to work is gorgeous—Steiner Ranch is one of the most beautiful areas of Austin. I am so

fortunate to work with a great team of people including two great dentists-- Dr. Julia Hawthorne and Dr.

Dan Devine. I feel fortunate to be a part of a progressive office where quality, excellence and superior

customer care is a priority. I like people so I love the interactions with patients and making sure that I

am doing my part to see that they feel special and have a great experience from the moment they walk

through the front doors to the time they leave our office. I wear a lot of hats in the course of a day but

the icing on the cake for me is when I have the opportunity to listen to our patients and hear what’s going

on in their lives. Sometimes I get to pray for them or just take a moment to encourage them.

...accurately identifying patient needs and responding to them appropriately. Scheduling can be

challenging at times when I am trying to keep things flowing and productive but I like the challenge!

Satisfied customers--success is achieved when the patients are happy when they leave our office—

when we have exceeded their expectations and everyone has enjoyed the journey. Many of our online

patient surveys come back saying that we have provided outstanding service. Word of mouth referrals

are a given when this happens.

Bill brings in a high level of integrity and excellence to our office and we consider him part of our team.

Putting Bill in charge of ordering our dental supplies has benefited our office tremendously. No matter

what he is doing for us, he seems to always have our best interest at heart. Plus, he is such an

awesome person that we just love having him around.

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Hobbies:

What I like

about my job:

My greatest

challenge is:

Success at our

office means:

What Burkhart

means to me:

Office Manager, Steiner Dental - Austin, Texas

Doris Lang

Superstar

Office Manager

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Office DesignInvest in Your Practice, In Good Times and BadBy Andy Hutson, Eugene Branch Manager, Photography by Joanna Herr-Hanks

Dr. Wolff was doing well in his San Diego practice since opening in 1995, but he felt

restrained. Always pushing himself to higher competency levels in his restorative and cosmetic practice with ongoing CE, he wanted to offer more expertise and service to his patients, but he needed more room. As 2008 came to a close and 2009 forecasted very rough economic weather ahead, it seemed as though Dr. Wolf f would be forced to continue to wait. Suddenly, the adjoining office

space next to his three-story office building became vacant, presenting the perfect opportunity to knock out a wall and double the number of opertories. Dr. Wolff reflects, “I was a bit concerned about a costly expansion project in the middle of a rough economy, but decided all my reasons to do the project just made too much sense, so I went for it.”

Brief BioDr. Wolff is passionate about his work and his patients. He loves his profession and is deeply committed to being the best dentist he can be. His strong commitment to his patients, whom he often refers to as "his other family," is obvious from your ver y f i r s t meet ing with him. Developing a personal relationship with each and every patient is his main priority — care and dedication at this level are what brings patients and their families and friends back through the generations.

After graduating from high school, Dr. Wolff began his pursuit of a career in dentistry. He attended the University of California at Riverside (UCR) for his pre-dental s tudies, and while there, Dr. Wolff served as Treasurer of Phi Gamma Delta Fraternity (Chi Chi Chapter). Dr. Wolff graduated with Honors and completed his dental degree at Loma Linda University in 1988. Dr. Wolff scored highest in his class on both of his National Boards. Dr. Wolf f was invited and accepted into the residency program at Loma Linda Veterans Administration Hospital. In 1994 Dr. Wolff met and began working with Dr. Norman D. Sperber. A relationship formed, and Dr. Wolff purchased the practice from Dr. Sperber in 1995. At that time, Dr. Wolf f brought specialized dentistry practices into the field of general dentistry. Dr. Wolf f holds numerous educat ional cer t i f icates and continues to spend his spare time away from the practice, pursuing a higher

Left: Creating a more streamlined patient check in area created additional space for treatment presentation. Above: Lisa steril izers were installed to improve instrument turn-around.


Office Design

degree of dental education while learning the newest dental techniques in order to take better care of his patients’ individual needs.

Dr. Wolff is the proud father of two beautiful daughters, ages 10 and 3; enjoys worldwide travel; and is passionate about music and photography. He is a huge NFL fan and enjoys following the San Diego Chargers. Locally, Dr. Wolff is a member of the Pacific Beach Town Council and the San Diego Chapter of the Better Business Bureau.

Getting it DoneUpon starting his practice, Dr. Wolff and his staff had to move quickly and assemble the right team. Working at first with a major Burkhart competitor, something didn’t feel right about moving forward. Office Manager Teresa McInerney comments, “They would show up for our merchandise order and schedule equipment meetings for our project, but we felt like just another client.” That all changed when Burkhart’s Mario DeAngelis began tracking their expenditures via the Supply Savings Guarantee. “Now,” adds Teresa, “I can accurately follow how much I am spending monthly and manage the budget. It is really helpful. Based on the attention to detail they exhibited with dental supplies, it made perfect sense to move the entire equipment and design needs of the project over to Burkhart as well.”

Above: Integrating technology has not only increased efficiency but also has helped the office handle more complex treatment plans.


Clinical Support AreaClinical AreaBusiness AreaStaff/Private AreaPublic Area

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BUSINESS

STERILIZATION

RECEPTION

STORAGE

STAFF LAV.

PATIENT LAV.

LAB

REF.

STAFF ROOM

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X-RAY

6/9

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PRIVATE OFFICE

CHARTS

CONSULT

MANAGER

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Office Design

Upper Right: Delivery systems were changed to reduce clutter and create more efficient, ergonomic workflow. Above (left to right): Bertha Stancovich, RDA; Denise Dow, RDH; Pat Ryan, Scheduling Coordinator; Teresa McInerney, Practice Administrator; Dr. Randy Wolff; Dora Parra, RDA; Alan Haynie, RDH; Tonya Howard, Financial Coordinator; Patrice Gill, RDA; Mario De Angelis, Burkhart Rep. Not pictured: Lynda Wagner, Administrative Assistant

Lee Palmer, Equipment Specialist in the San Diego Branch, acted promptly and organized a trip to Newberg, Oregon, to visit Adec and showed them how to work smarter, using better chairs, units, lights, and casework. Lee also introduced the office to Steve Utgard with Utgard Construction Incorporated (UCI) and put together a plan that allowed the office to stay open for 14 of the 16 weeks during two different phases of construction. Designer Patti Rague worked closely throughout the process to make sure the look and feel of the new space met everyone’s expectations.

Office Changes• Dual Class B sterilizers were

added to improve turnaround t im e o f in s t r um e n t s an d handpieces. The Adec Lisa is a pre- and post-vacuum tabletop steam sterilizer that allows all contents to completely dry, thus avoiding re-contamination.

• A H u - F r i e d y I n s t r u m e n t Management System (IMS) was introduced to replace tray set-ups and increase staff safety.

• A separate mechanical room was built to house the office’s vacuum and c ompre s s or ; previously, this was a ‘shared’ system in the building, which presented obvious drawbacks.

• Dental unit delivery systems were changed from a mixture of car ts and chair-mounted radii to 12 o’clock positions in order to achieve a cleaner, less intimidating look and to limit class 4 and 5 movements.

• The reception area and business of f ice were redesigned for better patient flow at check-in and checkout. This allowed for an additional of f ice for treatment presentation.

• A new staff lounge was added for group lunches and staf f m e e t ing s . T he o l d o f f i c e had only a counter to stand around, which was awkward and uncomfortable.

• Operatories increased from f o u r t o s e v e n , e n a b l i n g more productive scheduling and room for an additional associate in the future.

Dramatic ResultsWhen both phases were complete by the end of the first quarter in 2009, the of f ice atmosphere and mood changed immediately. Teresa goes on to explain, “It is kind of hard to put a finger on, but I think our team reacted so positively to the new office that

patients picked up on it. Everyone was simply happier to be working in a beautiful and highly functional environment, and that helped lead to even higher case acceptance.”

Dr. Wolff’s practice grew by 18-20 new patients per month before the buildout, and interestingly, that number remained the same after the new construction. Production, however, grew 10-12%. These results came because of the exact reasons Dr. Wolff decided to move ahead with the expansion in the first place, regardless of the current economic downturn. He now had the extra space and the right image, training, and technology to offer more extensive treatment plans to his patients, especially in the areas of implants, bone grafts, and Invisalign®. He has been performing bigger cases in conjunction with higher acceptance.

Teresa more fully explains, “The of f ice transformation began a kind of big upward spiral. We have a great staff, and now, coupled with this beautiful new office and attitude, we showcase our patient care and professionalism. We have never looked back.”


Proven.Unrivaled innovation, thoughtful design, lasting integrity: A-dec 500®

is based on decades of collaboration with dentists worldwide.

Such cooperation has led to pressure-mapped patient comfort,

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©2010 A-dec® Inc. All rights reserved.

Assistant Success

A g r a du a t e f r o m O re g o n H e a l t h A n d S c i e n c e s University (OHSU) in 2000,

Dr. Kelsey Ullsmith has lived and worked in Bellingham ever since. She met her husband in dental school, they married in 1999 and moved to Bellingham, Washington so her husband could accept a job offer at ICHC, the local community health clinic. The city matched their criteria for livability and the small-town feel they craved. It was in this charming town where she started her dental practice from scratch.

Originally Dr. Ullsmith attended college to become a veterinarian, but upon beginning her studies, she found she did not enjoy the field. After college, she worked for her father as a dental assistant. In this posi t ion she became interested in the field of dentistry, and she applied to dental school. The rest is history.

She began using Burkhar t in 2004 due to the great customer service some of her peers were receiving from the local Burkhart representative.

What was it that made you want to work with Burkhart?

I heard about your great customer service from my peers who were u s ing Burkhar t . I had b e en exper iencing order ing errors while working with Patterson, and my staff members were spending too much of their time completing order s and other tasks that should have been handled by the account manager.

What was it about the guarantee that or ig inal l y caught your attention?

I liked the concept of working with a budget each month and knowing about where my supply bill would end up.

What part of the SSG do you find most valuable to you and your practice?

Again, I like the budgeting aspect of the program. Each month, my office establishes a supply budget based on a percentage of the prior month’s production. The SSG matches this concept perfectly. It keeps us on track with this process automatically. The entire staff sees and tracks its progress daily.

How does your Burkhart account manager help you reach your goals as a dentist and business owner? How does he help you and your team?

Marlon is very important in this area. He manages the expense side of my supply purchases, allowing my staff and me to concentrate on patient care. He is constantly looking out for the best-value products on the market, and any special offers or coupons we might take advantage of. He manages our inventory to make sure we have just the right amount of what we need, when we need it. He gets us free samples when we want to try a new product, and will go to any length to solve a problem. Finally, he acts as a point person to coordinate any equipment installation or service issues that arise. He does a simply amazing job.

How has the SSG helped your staff be more efficient?

My staff doesn’t have to spend time ordering supplies, researching products, or shopping around for the best price. Marlon does all of this for us and keeps us under our monthly budget.

What would you say to a doctor considering the SSG program?

If you would like to know for certain that your supply bill will not exceed a pre-set monthly amount, it is a great program. On top of that, Burkhart customer service is simply the best.

Any final thoughts?

We have been very pleased with the SSG program, the service from the Burkhart team, and particularly the service from Marlon.

Supply Savings Guarantee: Great Service and Controlled Supply OverheadThe Perfect CombinationBy Jerry Ritsema, Branch Manager Western Washington

Dr. Kelsey Ullsmith with her Burkhart Account Manager, Marlon Jack. Photo courtesy of Marlon Jack.


Hobbies:

What I like

about my job:

My greatest

challenge is:

Success at our

office means:

What Burkhart

means to me:

My hobbies revolve around the activities of my 4 year old and my 19 month old. Whenever possible, I do try to make time for myself, and the things I enjoy doing the most are spending time with friends and family, shopping, reading, and watching movies.

I consider myself a people person. I love being able to interact with our patients. I enjoy supporting the patient through complex restorative cases involving many offices. My job has allowed me to grow as a person and also build great working relationships with my co-workers and patients.

My greatest challenge is keeping up with all the changes in dental materials and technologies. I’m fortunate to work in a practice that values continuing education.

Success in our practice can be measured in many ways. In our practice we educate our patients so they can make an informed decision about their dental health. I think a successful practice is one that enjoys their work and that can laugh with their patients, while treating them with respect and offering them quality dental services. A successful practice grows from patient referrals because a satisfied patient will always refer their family and friends.

Burkhart is not only the dental supply company that we order from. They play a very important role in our practice’s success. Our patients always get quality dental products. Along with great communication we have developed exceptional rapport.

Dental Assistant, Darwin Lum, DDS - Fairfield, California

Maribel Wilson

SuperstarAssistant


Assistant Success

We use organization every day, week, month, and year without even thinking

about it. It becomes routine in our way of life and how things are executed and accomplished. The biggest problem with organization is knowing when and how to use it. With excuses like “I don’t have time to sit down and strategize,” “I can’t afford to start over,” or “I don’t think it could benefit me enough” makes the process of organization leave a bad taste in the mouth.

How would we get up every morning, put on clothes, drive in our vehicles, purchase a caffeinated beverage, park our vehicle at work, and clock in without organization? If we didn’t have it, at 9 o’ clock in the morning there would be a lot of half-dressed, half-asleep people driving endlessly with no idea about what they were supposed to do for the day. Organization is everywhere.

During the economic downturn, o u r d o c t o r s h a v e p r o b a b l y delivered “a call to action” to save materials, maximize chair time, get organized, and create new strategies. Now is the time!

Placing tub bins and ut i l izing instrument and bur holders in the practice may be your answer. Saving time, saving products, bu t even more imp or t an t l y, getting organized.

How does this pertain to you? In the dental office there are many ins t rument s , mater ia ls , and procedures that are utilized on a daily basis. These items can easily be misplaced or forgotten, and that can create a problem with the procedure, the appointment, and even the schedule for the doctor during a dental procedure. This can lead to frustrat ion,

disappointment, and even less organization, which costs money and t ime fo r your p r ac t i c e . Fortunately, there’s a solution: color-coding your procedures is the solution for increasing your efficiency and productivity. Each procedure in your pract ice is assigned a color.

The next time you get ready to perform a procedure, you will have everything in one place and in one portable container, and you will be all for the procedure. You have saved the time it would take to gather all of the necessary items. It may not seem like much time, but if performed for each daily procedure, the spared minutes will add up quickly. Af ter the procedure is over or at the end of the day, restock that tub with the appropriate tools and materials again and place it back in that central area.

No more stocking each operatory! You now have portable bins of materials that can be used in any room.

You have now taken the f irst step to organizing; take it one step further. Buy an instrument c a s s e t te to ho ld your hand

Get Organized!By Hollie Wise-Bryant, Photos Courtesy of Zivic

Here are some ideas that make

organization seem uncontestable.

1. Start by purchasing a tub for one of your procedures.

2. Place all the materials necessary for the procedure in the tub.

3. Store it in a centralized location designated for procedure materials (e.g., central sterilization).

4. Start watching the savings on materials add up and the doctor’s frustration decrease.

Procedure tray sealed and ready for use.


i n s t r u m e n t s a n d B u r/ E n d o Holders to organize your burs and f i les. This wil l keep your i tems separate and easy to locate dur ing the procedure, and they will be protected during the sterilization process. Now you are saving setup t ime for your procedure and being more ef f icient during the procedure with everything organized.

Need more t ips? If you add a t ray to your procedure along with the tub, cassette, and Bur/Endo Holders, you now have the ability to keep the consumables in the tub to hand to the doctor, a n d t h e t r a y m a y b e u s e d strictly for instrumentation. This creates less confusion when looking in the tub, and the tray wi th the ins t rument ho lder s displays your instruments in an orderly and uniform setup for easy recognition. The best tray solution is to look for one that offers a cover that can lock onto the t ray. A locking cover wi l l keep your instruments safe prior to the procedure and after the procedure during transportation to sterilization.

Once you have an organized setup for one procedure and want to continue to maintain that system for others, then you need to utilize color-coding further into your routine. By now, you should

have established an assigned color for each procedure in your practice. Be sure to use color-code rings and tape to identify your instruments and tools so they do not get mixed in with other procedures. Color-code tape can even be used on other items such as cassettes, tubs, and drawers. With color-coded procedures, it is easy to locate and retrieve the needed materials for a specific p rocedure bec ause o f co lor recognition. All it takes is a sheet of paper with the procedure name and the assigned color next to it, and that way everyone in the office is aware of what the color-coding system is and what to look for. This saves large amounts of time, because there are fewer people wandering around trying to find and gather items, and it allows for a faster patient turnaround, which will reduce the time frame of your procedure processes. I t a l so s ave s on spac e and inventory. I recommend utilizing your steril izat ion area as the headquarters to your pre-prepared procedures and the closet in the back as your supply room.

Organization also facilitates more ef f ic ient ster i l izat ion. With a color-code system implemented into your procedures, sterilization becomes that much easier. Having color-coded rings or tape on your instruments makes it simple to

put the blue-labeled instruments into the blue cassette with the blue tray and blue tub.

Organize it first, benefit from it second. There are many ways that you can organize your dental supplies. Saving money during these tight economic times is important to the success of the practice. This is a great way to save money, maximize your product supply, get organized, and become more efficient during daily procedures.

Ms. Hollie Wise-Bryant is

a meticulous, organized,

a r t i c u l a t e p r o fe s s i o n a l

skilled in numerous aspects

o f c l i n i c a l a s s i s t i n g ,

teaching, practice management, product

development, and private consulting.

She is a highly acclaimed motivational

speaker, team coach, and mentor, and she

has over nine years of experience in all

aspects of dentistry. A distinguished author

of numerous professional publications

and pioneer of new dental assist ing

techniques and products, she also serves

on the advisory boards for numerous dental

manufacturers. Ms. Wise-Bryant currently

serves on the editorial review board for

multiple dental publications and has several

active internet-based blog forums. She is

especially passionate about the importance

of educating the entire clinical team and

achieving the ultimate dental practice

through a total team experience.

Assistant Success

Endodontic procedure tray. Sealant procedure tray.


www.zirc.com

Need help getting organized?Try Zirc’s Procedure Planner. It’s an interactive tool that helps you organize your instruments and materials...for each procedure...utilizing color. Go to www.zirc.com to start organizing now!

A big problem... with a simple solution.

FREE $10 Target GiftCard!*When you spend $100 or more on Zirc’s

color code products.

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800.562.8176www.burkhartdental.com

Let Burkhart show you how our unique Supply Savings Guarantee can help you keep your supply overhead low!

Do you need to control

SUPPLY overhead in your practice?

Your Burkhart Account Manager can:

> Allow your staff to focus on patient care - not spend time researching or ordering supplies

> Identify & recommend products that deliver the best value

> Carefully manage inventory

> Take advantage of manufacturer coupons & specials

Contact your Burkhart Account Manager to learn more today!


Your intuition and hard work have gotten you this far. Ours will

take your practice to the next level. Indulge your senses with

the perfect combination of our Spirit family of dental chairs &

delivery units, Helios LED dental lights, Renaissance Collection

of dental cabinetry and genuine KaVo handpieces. Surround

yourself in a dental environment unlike any other.

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For more information, contact your local Burkhart sales consultant at 1-800-562-8176.

We a l l k n o w t h a t t h e cleaning and disinfecting environmental surfaces

constitutes a significant portion of an effective asepsis program. O p er ator y sur fac e s b e c ome c ont aminated dur ing dent a l treatments, creating the potential for the transfer of pathogens due to the spatter of blood and saliva as well as airborne aerosols.

In this buyer-beware world and in light of the multitude of products available, let’s take a deep breath and ask ourselves what the best chemicals to use are, and how we can use them properly. The current choices include many different chemistries, including chlorine (said to be extremely caustic to tissue and needs to be used in a well-ventilated area), complex

phenols (which may degrade plastics and leave a residual film on surfaces); Iodophors (which combine iodine and may cause discoloration), and high alcohol exc e e d in g 70 % (w h i c h m ay actually melt plastics). While these products differ in many aspects, they all have one thing in common — they are spray-on liquids that create the potential for inhalation of airborne aerosols by you, the user of the product.

The inhalation of these aerosols has actually become a major concern in recent years, leading to the c rea t ion o f the te rm occupat ional as thma, which h a s ap p e are d in num e r o u s articles and has been reviewed in s eminar s wor ldw ide . The opportunity to rid the environment of disinfectant sprays is certainly a step in the right direction. The alternative — the use of an EPA-approved pre-impregnated wipe. Use of these wipes eliminates dangerous aerosols and allows the user to target areas more effectively and eliminate waste through over spraying.

One of the most effective chemistries available in the family of wipes is the synergized dual-chain quaternary compound, which has outstanding efficacy and low toxicity while providing impressive cleaning ability.

There are several brands of wipes available in this category; however, in our buyer-beware culture, you want to select a product that eliminates TB in five minutes or less, with a rapid Hepatitis B and C kill time, preferably two minutes or less, and is effective against a broad range of bacteria and viruses. There are wipes with low alcohol (20% or less) that are effective cleaners as well as disinfectants, and there are wipes with high alcohol (55% or more), which offer quicker kill times, but are not effective cleaners — remember, the higher the alcohol, the less effective the product is as a cleaner. There are also alcohol-free wipes; however, this choice may compromise kill times on some organisms. Packaging is also a factor. Make sure your wipe of choice

is packaged in a thick container with a “deep well,” or recessed top, to avoid drying out of wipes and has an airtight seal affixed prior to opening of the product. Wipes are normally available in two convenient sizes — large and extra large. Wipes themselves should be constructed of a strong, lint-free, non-woven material that will not shred or come apart when cleaning and disinfecting surfaces.

Wipes are the disinfecting product of choice. They are easy to use, fast, extremely effective, and safe. If you are not using wipes, consider switching for your protection as well as the protection of the entire office team.

Don’t worry, breathe easy, knowing you are using the best concept available today!

Environmental Surface Disinfection Wipes are here, don’t worry, breathe easyBy Sheldon Fisher, Vice President-Crosstex International

HERE’S A TIP!

Whenever switching from one chemistry to another, always clean the area with mild soap and warm water to prevent potential chemical reactions

C r o s s t e x – m anu f a c tu r e r s o f t h e Sanicloth and Sanitex Plus family of high-end disinfectant wipes.

Assistant Success


Financing for your practice. And so much more.

EQUIPMENT FINANCING

PRACTICE EXPANSION

PRACTICE ACQUISITION

PRACTICE EQUITY LOAN

COMMERCIAL REAL ESTATE

PRACTICE START-UP

BUSINESS REFINANCE

www.matsco.com

Whether you’re just getting started or already established in practice, Matsco’s customized financing and expert support can help you achieve them.

What are your

practice goals?

All practice financing is subject to credit approval.Matsco is a division of Wells Fargo Bank, N.A.

©2010 Wells Fargo Bank, N.A. All rights reserved.ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.

Matsco is the only practice lender endorsed by:

Find out about the financing solutions available to you and receive your FREE copy of the new issue of Strategies for Success!

www.matsco.com/BC110

Fac

w

Immediate financing needs? Contact your Regional Manager at 800.326.0376 or apply online at www.matsco.com

Do you need to control

overhead in your practice?SUPPLY

Contact your Burkhart Account Manager to learn more today!

Let Burkhart show you how our unique Supply Savings Guarantee can help you keep your supply overhead low!

800.562.8176www.burkhartdental.com

Clinical Success

Conservative Anterior Composite ArtBy Rhys Spoor, DDS, FAGD, Accredited Member of the American Academy of Cosmetic Dentistry


T he true medium for aesthetic a r t i s c o m p o s i t e , a n d with the new formulations

from a variety of manufactures, t h e c h o i c e s a v a i l a b l e t o t h e c l i n i c i a n a r e b r o a d . Improvements in polishability, f l o r e s c e n c e , s t r e n g t h , a n d adhesive properties, the current generation of composites is the best we have ever had to create

life-like and durable restorations. A d d i t i o n a l l y , t h e r e i s t h e advantage of placing aesthetic anterior restorations in one visit without the higher cost of CAD/CAM technology and makes the medium acce s s ib le to ever y dentist. There is a learning curve in using the materials to gain maximum ef fec t iveness, and the following case provides an

example of some simplification of the multiple steps needed for creating beautiful and durable composite art.

This teenage girl expressed a desire to have a more attractive smile and had been bothered by the white spots on her maxillary central incisors. She also had some significant yellow brown tones to her

1 2 3

4 5 6

Fig 1 Before treatment, hypocalcified white spots and excessive yellow chroma led this teen age girl to seek treatment to change both on her maxillary central incisors. Fig 2 Before treatment, retracted view. Fig 3 Close-up view showing surface texture. Fig 4 Various shades of composite were placed on the unprepared teeth surfaces and light cured. This technique can be used to accurately assess shade matches before the teeth dehydrate and change shade. Fig 5 The bulk of the hypocalcified areas were removed with a rotary diamond bur with just air cooling. This allowed for better visualization of the border of the hypocalcified area. Fig 6 A rubber dam was placed and the remaining preparation was completed with air abrasion (27μm aluminum oxide) which cleaned the tooth structure and increased adhesion.

Clinical Success


teeth (approximately A2 on a Vita shade guide) that made the white areas stand out more prominently (Figures 1, 2 and 3). These and the rest of her teeth were healthy, with no caries or restorations.

After discussing treatment options with the patient and her mother, we obtained informed consent and started with vital in-office bleaching followed by tray-delivered 16% Carbamide perox ide for approximately two weeks. Our experience has shown that the combination of the two techniques gives the best and most long-lasting results for vital bleaching.

B e f o r e p r o c e e d i n g w i t h restoration, the shades of the c o m p o s i t e m a t e r i a l s t o b e used was placed on the teeth and cured without etching the underlying tooth structure (Figure 4). This technique allows the clinician the ability to view the f inal shade before the teeth have dehydrated and allows for accurate shade matching. Once the appropriate shades were selected, anesthesia was given, and the bulk of the hypocalcified white areas was removed with a course diamond bur (Figure 5). A rubber dam was then placed, and the areas were micro -abraded

with 27μm aluminum oxide (Figure 6). This cleans the preparation and increases adhesion.

The prepar at ions (F igure 7) were then ac id e tched w i th 35% phosphor ic ac id for 30 seconds (Figure 8). Adhesive was applied and agitated for 30 seconds (Opt ibond Solo Plus Kerr Corporation), and the first layer of composite was applied to mimic the dentinal internal charac ter is t ic s (F igure 9) . A more opacious composite was used (Venus AO2), and this layer was light cured. Because this patient’s teeth exhibited some

7

13 14 15

8 9

Fig 7 Prepared teeth. Fig 8 The preps were acid etched with 35% phosphoric acid for 30 seconds. Fig 9 A dentin opacified and shaded composite (Hereaus Venus AO2) was added to the body of tooth, condensed, sculpted and light cured. Fig 10 Kerr Kolor Plus composite tints. Fig 11 A thin layer of white tint (Kerr Kolor Plus) was added to mimic the horizontal lined pattern of the adjacent natural dentition. Fig 12 Incisal view showed the restorations being purposely under contoured at this point to allow for the final layer of

Clinical Success


horizontal white lines, a layer of white t int (Kolor Plus Kerr Corporation) was applied in the same pat tern and light cured (Figure 10 and 11). To allow room for the final, more translucent composite layer, the restoration at this point was lef t sl ight ly undercontoured on the facial aspect (Figure 12). A final layer of a microfill composite (Hereaus Durafill B1) was layered with a brush, sculpted, and light cured.

T he re s to r a t ion s were t hen f in ished wi th a f ine - tapered diamond (Figure 14) and polished with polishing cups (Hi -Luster

polishing cups Kerr Corporation). The f inal sur face lus ter was placed by using a polishing brush on a s low - sp e e d handp ie c e (Occlubrush Kerr Corporation) (Figure 15). This technique allows the clinician the ability to give a very high shine but maintain a sur face tex ture similar to the adjacent dentition.

The final results (Figure 16, 17, 18) show that the chameleon e f f e c t t h a t t h e c o m p o s i t e restorations have when applied in a specif ic sequence is truly art. The technique does not need to be overly complex, but layering

of the composite gives the truly life-like characteristic of natural teeth. Plus, it gives the added pleasure of helping a patient enjoy his or her own smile and new found confidence.

Rhys Spoor, DDS, is a

1983 graduate of the

University of Washington

School of Dentistry and is

an Accredited Member of

the American Academy of

Cosmetic Dentistry and a

Fellow of the Academy of General Dentistry

and the Pierre Fauchard Society. He

welcomes contact at [email protected].

16 17 18

10 11 12

a translucent composite. Fig 13 Final layer of a microfill composite (Hereaus Durafill B1) was sculpted with a sable brush (filbert shaped tip). Fig 14 The surface was shaped with a fine tapered finishing diamond (Axis #859-014F). Fig 15 Final polish with attained with a Kerr Occlubrush. Fig 16 The final restorations exhibited a chroma and value that blended with adjacent natural dentition. Fig 17 The treated teeth have been finished to a similar surface texture. Fig 18 All the teeth in the smile were now harmonious and pleasing to this happy young patient.

By Paige Mead, Assistant to the President, Photos by Scott Miler

IN THE MIDDLE OF THEBy Paige Mead, Assistant to the President, Photos by Scott Miler

Greatest Need

Feature


W hen it comes to the subject of success in the business of dentistry,

many believe there is only one real formula to achieve it . In truth, doctors who are financially successful in dentistry do share some commonalities: leadership skills, technical expertise, and an excellent office manager, to name a few. Certainly, Dr. Charles Keithline, of Tulsa, Oklahoma, can count these traits among his assets, but commonalities aside, his practice looks like none I’ve ever seen. From the street, Pediatric Dental Group reminds me of a bag of Skittles, spread around the corner of 6th and Utica, in the heart of an area of Tulsa that is considered prime for redevelopment. It stands like a promise of better things to come, setting an example for business owners in the community and

developers alike. The architecture is award-winning, aesthetically pleasing, and environmentally friendly. But the real story of this unique practice can be found inside the building. Dr. Charles Keithline has steadily built a thriving pediatric practice around a community of people who really need him, a largely Medicaid-served population. He does what he loves and feels passionate about, alongside people who share his convictions and mission, and his practice is very successful.

In business, one doesn’t f ind success just by practicing good customer service. Likewise, it isn’t enough, alone, to ensure the financial success of your practice long-term, especially as a dentist. Dentists who own their practices must be excellent doctors and business managers. Truthfully,

when I asked Dr. Keithline why he thought his pract ice was successful, he answered, “I do the best I can for my patients. The money follows.” While true, part of his efforts to do his best has included specific and logical business decisions, like staffing his practice over time with the most qual i f ied and capable team he can find. In addition, Dr. Keithline is a tremendous leader; the evidence can be found in every part of his practice. He is resolutely clear about why he is a dentist in the community and about the importance of what he brings into his patients’ lives. To accomplish his goals , Dr. Kei thl ine has surrounded himself with a team

From Left Phil Hamburger, Construction Supervisor, Jack Powers,

Burkhart Dental Equipment Specialist, Dr. Charles Keithline, John

Cowan, General Contractor Buck Davies, Architect.W re ly l From Left Phil Hamburger, Construction Supervisor, Jack Powers,

i ent Specialist, Dr. Charles Keithline, John

t

Ground Breaking Ceremony


of energetic professionals who are doing exactly what they want to be doing. He is whole-heartedly supported and buoyed by his wife, Nancy. He has a practice manager with a magic touch, and the practice environment cheers patients all the way through treatment.

Having made up his mind at the age of twelve to become a dentist, Dr. Keithline earned his undergraduate degree from Oklahoma State University and graduated from Emery University School of Dentistry in 1976. He stated that he began his career thinking he wanted to be “a crown and bridge man,” enjoying the privilege of being “last in the mouth.” By 1978, he’d finished his pedo training and opened his first practice in Tulsa. However, during the two years between graduation and the opening of his practice, he learned the value of truly being “first in the mouth” as a pediatric dentist. His views and goals evolved. As a pedo dentist, he realized that he could reach his patients and their parents much

sooner in life, potentially affecting their dental health for generations to come. “I used to think, ‘Why see a kid before age three?’ Now I think that by age three, it’s too late!” Where he once thought he would enjoy being the “crown and bridge man,” he became aware and excited by the idea that he could affect children’s dental health early on and possibly avoid crowns and bridges altogether. Of course, he is a fix-it man when it comes to dental caries, but he has zeroed-in on a community of people who really need him to serve in that role for them. In order to feel satisfied by his work, Dr. Keithline likes to feel needed — it’s a perfect relationship. The community of people who have made up his clientele for the last 30 years is largely served by Medicaid, although some have private insurance. This creates an unusual patient load for such a successful practice as his. The first office he opened in the area in 1978 was 900 sq. ft. By 1982, he needed more space to serve his patients, and he moved his practice to a location in the same

community that offered 1500 sq. ft. In 1995, he moved again to occupy a 3000 sq. ft. office. But in October of 2009, he made a quantum leap, moving to a 10,000 sq. ft. space described in a recent article in the Tulsa World as, “the East Anchor of the Sixth Street Redevelopment project.” There are aspects about this doctor that have changed over the last 30 years of practice, but

Top: Dr. Keithline and his deep sedation team treat a young patient. Above: Dr. Keithline and his practice manager, Kathleen Holleman, discuss the day’s details.

FeatureFeature


his clarity regarding his purpose in serving the working poor has only heightened. Now, with an office with such intense curb appeal, he gets the kind of “drive-by” business that professionals desire; people stop in and become patients because the practice looks as inviting on the outside as it really is on the inside.

In addi t ion to ser v ing young patients, as young as two months old, with their first tooth breaking through, Pediatric Dental Group (PDG) now boasts a separate adult practice, specializing in pregnant women. OB Dental is located on the west end of the building, with a separate entrance. This separate business, also owned by Dr. Keithline, serves moms-to-be with babies in utero, a situation the doctor finds very advantageous to capturing the attention of his audience. “This is when we can teach mothers about how they can

positively and negatively affect their babies,” said Dr. Keithline. Mommies can t ransfer s t rep mutans to their babies’ mouths and unknowingly deliver them into a life of cavities. This incredibly valuable and l i t t le -known information is cer tainly something all new mothers should hear, but perhaps only a few do. Along with his wife Nancy, Dr. Keithline has founded Dentovative Service Foundation, a non-profit foundation dedicated to education for prevention of dental caries. He is passionate about getting this very practical information into the minds of the general public so that people are truly aware of the roles they play in their children’s cavity prevention.

W i t h a n e n o r m o u s office decorated like a rainbow; a patient load growing on average by 80 new children a week (yes, 80) and a staff of

assistants, hygienists, and doctors who never seem to stop moving, how does Dr. Keithline achieve cohesion in a team of 35+ people? His staff is united by shared vision and passion for the patients, and according to Dr. Keithline, they are “paid fairly, treated well, and never bored. Plus, they like the way we treat the patients regardless of their financial background.” Says Dr. Keithline about his team, “They love kids, play with them, and get them to do x-rays and treatment. They get it done!” Due to the large,

Feature


overall footprint of the practice, and the high production activity on a daily basis, the team stays connected to each other by wearing wireless headsets, navigating the practice space with precision. Kathleen Holleman, the practice’s business manager, describes the staff thus, “They often volunteer their time at Baby Boot camp, a

Saturday morning dental class offered for free to the public. If they need to stay late to accomplish treatment, they do it.” The patients become family, and the sincerity of this passion for them from the doctor and this dedicated team is evidenced by long-term patient retention. I had the opportunity to speak with a mom and former patient, Mindy Morgan, who now brings her children to PDG. “When I found out that Dr. Keithline was still practicing, I just couldn’t take my kids anywhere else.” Mindy drives 30 minutes each way to the

practice for her sons’ orthodontic appointments, twice a month. Justin Morgan, age 11, told me, “Dr. Keithline is a good person. I get to be around people who are nice and know how it feels to be in braces.” The team at PDG is so skilled at holding onto their patients that the patients don’t want to graduate to general dentistry practice as

adults. Kathleen remarked, “’The trouble is, they outgrow our chairs!”

The doctors who choose to practice under Dr. Keithline’s tutelage benefit from his vision, purpose, and experience, but they are also exposed to ground-breaking practices in the dental field. For example, PDG is part of a study at Baylor University on deep sedation technique. Dr. Keithline employs a Cer tif ied Nurse Anesthetist, Pam Wilson, who specializes in office-based anesthesia. Baylor is studying her specific intra-muscular technique,

analyzing the safety and efficacy of intra-muscular Ketamine and Versed. Pam told me, “This technique keeps over 95% of patients needing extensive dental treatment with sedation from having to go to the hospital, which is where they would otherwise have to go.” This practice saves patients the unnecessary stress of the hospital environment and also saves the doctors’ time that is better spent serving their patients, which is exactly what Pam wants to be doing. “I have a passion for serving the indigent population, the underserved. I love it!”

If Dr. Keithline is the heart of PDG, Kathleen is the backbone. Dr. Keithline’s wife Nancy confided in me how precious Kathleen is to the practice, as she brings a consulting background and 30 years of her own personal experience in the field of dentistry as a foundation of expertise. Nancy said, “Kathleen wouldn’t waste a penny. She’s a great person to have in practice management.” With the books in Kathleen’s capable hands, Dr. Keithline is free to focus on taking care of his patients without the burden of watching business details, although he does take a peek at Kathleen’s urging from time to time. According to both Kathleen and Nancy, Dr. Keithline doesn’t focus on the money from his practice. “He’s in it for the heart,” explained Nancy. “He has good business management, and Kathleen is the best in the business.”

Dr. Keithline is a leader, a talented practitioner, a crusader, and a “Grandpa Dentist.” He told me, “When I get patients who grow up and bring their kids to me, I say I’m a Grandpa Dentist. I bet I have hundreds of ‘em.” As his practice continues to evolve and grow, Dr. Keithline has plans to bring on a par tner who can eventually take responsibility for production levels. This would allow Dr. Keithline to start to focus on the more difficult procedures that he enjoys doing for his patients but that are time consuming when

Above: For Dr. Keithline and his wife, Nancy, serving people is their life passion.

Feature

When I found out that Dr. Keithline was still practicing, I just couldn’t take my kids anywhere else.


the pace of the practice is always at high speed. Of course, says Nancy, the doctor’s involvement in Dentovative can expand at that time, too. The mantra “It’s the right thing to do” seems to be at this dentist’s core. He serves his community of patients very purposefully and has for over 30 years. Ask him why he chose to build his new practice according to s t r i c t LEED C er t i f i c a t ion requirements (a green building certification program encouraging s u s t a i n ab l e g r e e n b u i l d i n g practices), and he’ll offer up some logical reasons, “better long-term value, lower operating expenses,” but those reasons don’t drive his commitment . U l t imate ly, he built his practice where and

how he did because it was the right thing to do. PDG is Tulsa’s first LEED Certified healthcare facility, and it is the beginning of a major revitalization effort. “I chose to move my practice to an area of town with a large Medicaid population to help real kids with real needs.” According to Burkhart Equipment Specialist and collaborator on this award-winning building, Jack Powers, “Dr. Keithline is one of the kindest individuals I’ve ever run into. The children recognize this fact quickly and a trusting bond forms almost immediately.” Though Dr. Keithline won’t toot his own horn, his true character is readily apparent to his team, patients, and colleagues.

“I’m trying to produce a healthy m o u t h , ” s a y s t h e d o c t o r , summarizing his mission. By way of advice on running a successful practice, he said, “Pay attention to taking the best care you can of your patients, and try to stay out of debt.” That is logical and palatable advice, and it works for him. He’s content to let his experts do their jobs, confident that they will, and he does his, building lasting relationships with his patients in the process. Dr. Keithline is a man with a purpose and a mission. In an area known for its storms, the Grandpa Dentist and his team at Pediatric Dental Group are a beacon in an area of great need — a symbol of care, connection, and hope for a better life.

Front Row Nancy Keithline, Autumn Adams, Marisol Cortez, Barbara Bryant, Dr. Miranda Ruleford, Dr. Charles Keithline, Latoya Smith, Kellie Southard, Latwana Lewis. Middle Row Cady Spratt, Jordon Smith, Ruth Dennis, Waiica Hollis, Jennifer Lahran, Amanda English, Tracey Mulkey, Megan Ashline, Citlally Baggiani, Laura Proffitt, Moray Ephraim. Back Row Pamala Wilson, Jesica Vanzandt, Ashlee Lemonds, Stephanie Brunner, Brittany Mcguire, Lisa Smith. Not Pictured Dr. Siriporn Webb, Becky Brugman, Cathy VanMatre, Chasty Flynn, Jennifer Farrar, Jennifer Langham, Kathleen Holleman, Kris English, Michael Hood, Sherry Dorris

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Clinical Case Study

Technology

On the Road to Cone Beam Imaging—

The Journey and the Destination

Part II—The Destination

By Sudip Ghosh, DDS


At the end o f las t year, I e m b a r k e d o n a n e w adventure in imaging when

I invested in a Gendex GXCB-500 (CBCT 3D scanner). Part I of this series discussed my journey — the path of research and discoveries that led me to choose the right type and model of machine to help me achieve my pract ice goals. In Par t 2, I promised to share my dest inat ion — how my GXCB-500 brought greater efficiency, increased treatment acceptance, and above all better patient care to my office. Now, the 500 has become an important part of my practice, benefitting me as the practitioner and also my patients. Last time, I said, “It’s all about the smiles,” and that has become true on many levels.

During the first few months, I took many steps to educate myself on how to use the Cone Beam to its best advantage. Before choosing the 500, I looked into the various fields of views available. I chose the medium field-of-view machine that offered an image from the nose to the chin, and now that I actually have the machine in operation, this decision makes even more sense to my general dentistry practice. I took classes and, of course, experimented with the many anatomical views that I could achieve within the scan software on my own machine.

Armed with all of the knowledge that I could obtain, I introduced the machine to the people who would be af fected the most —

my pat ients . They have been very responsive and receptive and are amazed that our dental office can offer this technology to them. They are pleased that a CBCT emits lower radiation than medical CT scans, and they are also grateful that they do not have to make multiple trips to my office and an imaging center before star ting treatment. The s o oner t re a t ment i s b e gun , the sooner the procedure is completed and pat ient s can regain their dental health.

In addition to the well-being of the patient, the information that a 3D scan provides gives me much more data for diagnosis and increases productivity. With my machine’s extended scan, I have a 3D view of the TMJ and the whole condy le sec t ion. I can determine bone dens i t y

and see bone loss and boney pockets , making per iodontal surgery a breeze. On third molar ex tractions, I also have more confidence, since the roots are so clear and visible. Because I can work within a more precise area, patients experience very little discomfort during treatment and postoperatively.

Patients also notice that I have invested in equipment that allows me to diagnose more efficiently and treat them more effectively. Because of the precise, non-distor ted views that the scan provides, I am more confident in the successful outcome of an implant procedure. Once I cross-section the jaw, I can see the landmarks that may otherwise impede my successful treatment i f I were using 2-dimensional x-rays. I can see exactly how the

Figure 1: Protruding implant.

Technology


jaw curves and how to place the implant so that it is centered in the bone and not tilting sideways or per forat ing the bone. For example , rec ent l y a pat ient visited my of f ice af ter having had an implant several years ago, complaining of pain in a lower molar. On a 2D x-ray, his implant appeared to be perfectly straight . However, a 3D scan solved the mystery, showing that the previous dentist had actually dr i l led the implant along the lingual border and perforated the jaw. (Figure 1)

When preparing for an apicoectomy, I can see exactly whether a cyst is located on the buccal or lingual side or if a canal is blocked. I have also been able to increase the scope of my practice by adding procedures such as implants. This system reduces the time for such procedures by hal f. Everyone involved in the process appreciates this, including my patients and assistants.

In another case, having a 3D scan prevented me from starting an apicoec tomy wi th hidden complications. I was examining a cyst in preparat ion for the procedure. The infection didn’t look very extensive. When I cross-sectioned the area on the scan, (f igure 2) I found that the cyst was actually huge, hidden behind the tooth, and running right up to her sinus. Without the 3D scan, I would have started the procedure and halfway through discovered this unwelcome fact. I would then have had to stop mid-treatment and send the patient to my oral surgeon. This would have turned into a stressful experience for both of us and possibly caused the patient to lose confidence in me. Since I was able to see

the large scope of the infection before using my scalpel, I sent the patient directly to the oral surgeon with the scan, and she received the appropriate treatment.

S inc e I have purchas e d my GXCB-500, my referrals have also increased from orthodontists and oral surgeons. These specialties ask us to send the CBCT scan along with the patient. It makes their work a lot easier. The scan can easily be burned to a CD, along with the same imaging sof t ware I am us ing and be delivered to my colleague.

Eve n t h o u g h I h ave a r r i ve d at my destination, which was implement at ion of the C one Beam scanner, I am far from f in i she d le arn ing ab ou t t he many ways that Cone Beam can improve my scope of practice. O n e t h ing I h ave d e f in i t e l y discovered; the investment was a good decision. When I take

into account the number of new patients, expanded treatments, a n d g o o d w o r d - o f - m o u t h adver tising, the 500 gives me more than I bargained for on so many levels and in several dimensions.

Af ter graduating dental

school from The University

o f B o mb ay in Ind i a in

1983, Dr. Ghosh earned a

Master of Science (MS) in

Endodontics & Restorative

Dentistry in 1987. In 1999, he completed

a Master of Science (MS) program and a

certificate degree in Operative Dentistry

from the University of Iowa. Since 1996,

he has been in private practice with his

wife, Manisha Ghosh, who graduated from

dental school in 1985 from the University

of Bombay, India. She also has Master’s

Degree in Health Care Administration (MHA)

and a MBA from the University of Houston,

Texas. Both dentists are members of the

ADA, CDA, and Santa Clara Dental Society.

Figure 2: Endodotic lesion located on palate.

Technology

Information is available to us in many forms and in increasing volume. In fact, the emergence

of the digital age has provided us with so much information with such prevalence and speed that sometimes it’s difficult to identify exactly what informational elements are the most important in order to make effective decisions. In addition, at times it can be difficult to discern truth within inconsistent information and missing or incomplete data. In your dental practice, it’s critical to get a handle on your information mechanisms and even more critical to keep your data in check.

I met recently with a young doctor, Dr. Jones (names have been changed), who had just opened his first practice with high hopes of opening satellite offices in the surrounding communities. This energetic new business owner sat down with me to discuss a problem he was having regarding case presentation, specifically how to present the value of his dentistry and the associated reduced (PPO) fee. His goal was to show patients that, by coming to his practice, they would receive the best quality dentistry at a significantly reduced price. He was also struggling with the identification of his net production. Dr. Jones uses digital technologies including the XLDent practice management system and Gendex sensors with a panoramic unit from Instrumentarium.

I began collecting the necessary information to assess Dr. Jones’ concerns. My questions and his responses are as follows:

Are you presenting treatment plans to all of your patients?

Yes.

Are you doing so wi th your digital technologies and visual presentations?

Yes. I use my intraoral camera on every patient and show them pictures on the screen. When I present a dif ficult case, I also show them the digital x-rays and the chart so they can see exactly which teeth I’m talking about.

Are you attempting to maintain a fee-for-service practice, or are you contracted with PPOs?

I’m working with PPOs, and this is how I’m going to proceed with my satellite offices, at least at first to get started.

H o w m a n y P P O s a r e y o u currently contracted with?

10.

Have you entered the PPO fee

schedules into your XLDent system?

Yes, I think so, but sometimes my numbers don’t come out right, so I’m not sure.

Are you processing secondary insurances, and does your front desk staff know how to handle coordination of benefits?

No, we tell patients they have to process their own secondary insurance. What do you mean by coordination of benefits?

I’ll explain COBs in a minute. First , can you tell me i f you record each PPO payment and each PPO adjustment with a unique tracking code?

No, why is that important?

Dr. Jones was already utilizing the XLDent and ImageXL systems

Managing the Information in Your Practice to Maximize Your Profitability By Dawn Christodoulou, President PEB/XLDent, Screenshots Courtesy of XLDent

Display tools render all patient demographic data at a glance and accessible. Panels allow users to customize screen layout for optimal display and access to mission-critical information.


Technology

to involve his patients in their care and to visually present the cases and need for treatment. However, he was having difficulty presenting the financial aspect of the process. We discussed XLDent’s treatment plan report and how he wanted to show his patients his fees, the contracted PPO fees, and the est imated patient portion. I explained that all of this was possible to show using XLDent and that i t was really quite easy to implement. We just needed to make sure his staf f was consistently and accurately entering the benefit structures for each PPO plan. After explaining the mechanisms in XLDent that would help him achieve his desired result, we set up some time to train his staff. I went on to suggest that this was a perfect opportunity to establish a Standard Operating Procedure (SOP) for creat ing benefit plans in the system and presenting treatment plans to patients so that, as his practice

g rew in pat ient vo lume and staff, consistent results could be expected.

The next problem to tackle was getting a handle on gross versus net produc t ion. Because Dr. Jones was already contracted wi th 10 PPOs and was l ikely going to contract with more, it was very impor tant for him to see his estimated net production on a daily basis . In addit ion, anal y z ing ac tual co l lec t ions a n d a d j u s t m e n t s w o u l d b e increasing ly impor tant as he grew his practice around the PPO framework. Again, we discussed t h e m e c h an i s m s w i t h in h i s XLDent software that would help him manage his prac t ice for profitability and success.

Dr. Jones had been looking at his Estimated Net Production Report on a daily basis, but was not analyzing his actual collections and adjustments. He was not tracking this information divided

by contracted PPO and was not in tune with patient composition as it related to the PPOs. The daily gross and estimated net production reports were providing lots of information, but it was generalized information. What he needed to do was capture the data so that he could analyze the details. We immediately set up payment and adjustment codes that would allow him to track these details and also pointed out repor ts and data capture mechanisms within XLDent that would allow him to further identify PPO patient composition. No one likes to write of f money, so by star ting to record and analyze the details, he could start getting a better handle on which PPOs were profitable and which were not . In addi t ion , proce s s ing secondary insurance on behalf of his patients and instituting a coordination of benefits SOP could potentially increase his bottom line by thousands, if not tens of thousands of dollars a year.

During my conversation with Dr. Jones, we also discussed his reviewing the audit reports on a regular basis and establishing certain policies for making bank deposits and paying credit cards b i l l s . In addi t ion, we t a lked about performing random spot

Patient composition by insurance carrier.

Present a treatment plan that shows the true value of your services so you can put the patient’s portion in proper perspective.


checks of patient history, patient s tatements, and outstanding claims reports. It is crucial for dentists to establish and enforce the policies and expect staf f members to be accountable. If Dr. Jones reviews the key indicators presented by his XLDent practice management reports on a regular basis, he will be able to keep things in check and on target.

Data is meaning ful only when it brings valuable information –in fo r m a t i o n n e c e s s ar y fo r management . T he key i s to make sure you are capturing and consistently inputting the data necessar y to produce quali t y information and then to focus on the mission-critical elements that will help you manage your dental practice for success.

Technology

Grid technology offers instantaneous data sorting and grouping capabilities. Sub-group and filter to drill data down to simplest form in seconds.

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Business of Dentistry


What’s Your Number?

By Bob Creamer, CPA

What’s Your Number?” We of ten hear this catchy phrase during commercials

or among investors today. The answer to the question, of course, is the amount of money you need to be able to retire comfortably.

Based upon a recent survey, if you know your number, you are in the minority. It appears that only 44% of workers report that they have actually tried to calculate how much they will need to save in order to live comfortably during retirement. Therefore, 56% have not even attempted to identify their number. My question is, of the 44% who attempted to identify their number, how many felt they had accurately identified it? Another similar survey showed that only 13% felt “very

confident” in having enough money to live securely throughout their retirement years, while 22% of respondents said they were “not at all confident.”

Why is it that the majority of people have not even attempted to identif y their number? The number is different for everyone, and everyone has the responsibility to make sure they have made the correct arrangements. For the younger generation of workers,

it may simply be that the word “retirement” has no practical meaning. Retirement could be a phase of their life that is too far out in the future to think about. Another group may have accepted the fact that they will reach the point of retirement; however, not knowing how they will deal with this phase of life, they simply choose to ignore planning for retirement.

I believe there is a larger group who would attempt to identify their number if only they knew how to do it. In my work as a Dental CPA, many dentists I consult have told me they really do want to know their number so they can begin planning for it. However, they just do not know how to go about the process of coming up with their number.

When I hear this sentiment, I tell them to start with what they presently know. You know your current lifestyle. What changes to your current situation do you want to make, and what would it cost to make those changes? Most often, this is where the calculations present a challenge. You probably have a vision of what retirement will be like. What you do not know is the cost of that vision. To a large degree, your uncer tainty is a result of really not knowing

the details of what your current lifestyle costs. The majority of the dentists I consult do not track their personal spending or work with a budget. As a result, they do not know the cost of their current lifestyle, and consequently, they have little idea of what they will need for retirement.

To solve this problem, you need to star t with the basics. This includes tracking and identifying where and how you currently spend your money. The solution, while very simple, requires some disciplined effort. Start with a list. Use a pad and pencil or create a spreadsheet on your computer. On a daily, weekly, or even monthly basis, identify the areas where you and your family both receive and spend your money. Be prepared to take from one to four months to gather and record the necessary informat ion to real l y get an accurate account of your spending.

The great part about gathering your spending information is that you become informed. Once you’ve gathered this information, you are prepared to create a budget. Here are some simple tips to keep in mind when creating your budget: keep it flexible, keep it easy, make it fun, include all categories separately, start with a six-month plan, and if the money runs short, cut expenses from several categories.

A budget will help you achieve “your number” much earlier. We have found that those who discipline themselves to live within a budget

“

You know your current lifestyle. What changes to your current situation do you want to make, and what would it cost to make those changes?


Beginning Age20304050

5% Return$346,956$194,516$101,960$45,764

8% Return$917,648$399,082$165,457$60,203

11% Return$2,642,331$871,142$278,603$80,372

Beginning Age304050

5% Return$5,017,190$2,836,919$1,364,007

8% Return$7,736,917$3,809,243$1,616,051

11% Return$12,189,691$5,171,514$1,920,741

BUILD YOUR NUMBERIf you invest $2,000 each year in a 401(k) How much will you have at age 65?

If you invest $65,000 each year in a 401(k) How much will you have at age 65?

Figure 1. Build your Number

do achieve their number much earlier. The amount of money you make is important, but what you spend and save is just as important.

Putting money in your retirement fund is an important part of your budget decis ion -making that directly impacts “your number.” Figure 1 illustrates how the choice to star t investing early verses putting it off until later will affect how quickly you achieve the amount you need for retirement. It is all up to you. This applies to saving on a pre-tax basis and taking advantage of the time value of money. This is the practice of paying yourself FIRST!

Two more calculations are necessary to help you determine “your number.” First, list all your assets.

Include items such as stocks, bonds, and savings accounts. Be sure to include your personal residence, a second or vacation home, rental and investment

property, the dental practice, the dental office (if you own it), and dental equipment. Finally, add your personal property, including automobiles, jewelry, coin and art collections, etc. Identify the fair market values of all your

assets. The total of these market values is your Total Asset Value.

Second, list all of the debts you owe. Include the debts of your dental practice as well as all personal debts. List who you owe

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to, how much is owed, the monthly payment amount, and the interest rate. The total of this list of debts is your Total Liability Value.

Now, compare the Total Asset Value to the Total Liability Value. Hopeful l y, the total value of assets exceeds the total value of liabilities. The excess value of assets over liabilities is referred to as your net worth. As your net worth increases, the length of time to achieve “your number” and the age of retirement will decrease.

By following the process above, you will have the foundation of the financial data needed to get started in identif y ing your retirement numb e r. B e c au s e y o u h ave identified what it costs you to live today, you are better prepared to answer the question of what it will cost you to live during retirement.

Armed with your financial data, let’s go back to the question of your preferred lifestyle for retirement. If you are single, you only need consult with yourself to answer this question. If married, both partners must identify how they picture their retirement. You may find your visions of retirement are very different. If so, it is better to recognize this today rather than once retirement begins. Knowing your differences in ideas today gives you the opportunity to put your heads together and work out a middle ground that both of you can look forward to achieving.

Now that you have gathered your f inancial information and identified your goals, it is time to

meet with a professional who can help identify impor tant issues you may not have considered and who can assist you in fine-tuning your ul t imate number. The professional person might be your Dental CPA or a financial planner. Select someone who has specific experience in retirement p lanning . Mo s t imp or t ant l y, i t must be someone you are comfor t ab le d i scus s ing th i s matter with and someone whose abilities you feel confident with to help you achieve your goals.

As a Dental CPA , I f ind I am armed with specific information and details regarding a dentist’s practice, which I can utilize to help them achieve their goals. I have found that , among al l of my clients, those who keep their office up to date with new equipment and technology are among our mo s t p ro f i t ab le . Through proper planning, the purchase o f new equipment and technology has been a key c omponent to he lp ing many clients achieve their number.

When assisting our clients with this important planning, we use a tool referred to as a Monte Carlo Analysis. The Monte Carlo Re t i r e m e n t S imu l a t i o n i s a method to help clients visualize the effect of the unpredictable financial market volatility on your ret irement plan. We consider cer tain assumptions relat ing to inf lat ion, rates of re turn, retirement funding, retirement spending, tax rates, etc. The ana l y s i s r un s t hou s and s o f

simulations, producing trends, patterns, and possible ranges that will af fect your f inancial plans. While it can’t predict your financial future, it does illustrate visually and numerically several different possible outcomes.

The Monte Car lo Ret i rement Simulation is very ef fective in helping you identify the potential risk of out-living your money. For many of us, the idea of out-living our money is a terrifying thought. Without proper planning, you might have to depend on others to provide for your needs until death. For those who desire to be self-reliant in your golden years, proper planning and knowing your number is a must.

The earlier you know your number, the longer you have to plan and to take active steps to achieve it. It is better to build your number ten years too soon than one day too late. Why wai t? Take the necessar y s teps to s tar t the identification process today.

Bob Creamer is a CPA

a n d P r e s i d e n t o f

Creamer & Associates,

PC, an accounting firm

i n S a l e m , O r e . I n

addition, he is an owner

w i th par tner Joanne

Humphrey, CPA /PFS in Salem Asset

Management, LLC. For the past 34 years,

his firm has emphasized financial and

retirement planning, dental transitions,

practice enhancement, wealth creation,

tax savings and related accounting and

consulting services for maintaining an

efficient and profitable dental practice. He

is a founding member of the Academy of

Dental CPA’s. Bob can be reached at 800-

248-1120 or [email protected].

Through proper planning, the purchase of new equipment and technology has been a key component to helping many clients achieve their number.

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Saving is the Key but What is the Key to Savings?By Sam Martin, MBA, CFP®, CPA

There are a few successful d e n t i s t s w h o a r e j u s t n a t u r a l l y p r u d e n t a n d

consequently are and have been great savers through their entire career. This of course is not the most common personality (cer tainly not with me), as we f ind the vast major i t y of our dentists and specialists need some help to accomplish the level of savings that is necessary to achieve their goals.

In the last issue of Catalyst, I talked about the value of putting your f inancial and investment plans in writing in the context of effective risk management. In this article, we continue along that vein; only here the emphasis is on planning in support of adequate savings to reach your goal.

Why the focus on savings? Those who read this column regularly already know the answer to this. The fact is that savings is the number one influencer in terms of long-term financial success. You can have the best portfolio design in the world, but if you do not fund it (with savings), it is wor thless. Conversely, you can have a pretty basic or even a pretty poor design (OK, we’re not talking Bernie Madoff here), but with heavy savings you can overcome such hurdles.

Of course, it makes more sense to have an extremely ef f icient and effective portfolio design and just the right amount of savings.

Saving too little will leave you with poor alternatives in retirement, whereas over-saving can rob you of some well-deserved lifestyle benefits during your working years.

What is the right amount?In the last issue, we discussed some of the important reasons to have a written financial plan. Specifically discussed was the concept that the design and level of exposure to risk in your investment portfolio should be a function of and serve your (written) financial plan. In turn, the financial plan should serve you and your goals, desires, and concerns.

We also find that recording your goals and concerns in writing, developing a financial plan that a d dre s s e s t ho s e g o a l s and concerns and in turn developing a wr i t ten inve s tment p o l i c y s tatement (por t fol io design), and putting in place processes and protocols to monitor and communicate progress helps many dentists and specialists to f ind a way to save at the appropriate level. In turn, this leads to greater peace of mind for the dentist and his or her s p o u s e , k n o w i n g t h a t t h e y have a plan, they are on track, and someone is watching over and communicating progress. This peace of mind can greatly enhance your quality of life.

What if I am unable to save

enough to achieve my goals?The s t ar t ing po int would be to prove that and to develop a f inancial plan that addresses your family ’s long- term goals a n d c o n c e r n s . I f t h e p l a n suggests that annual savings should be $100,000 and your best savings year was $25,000, then yes, there is some work to do. But feel ver y lucky, as m o s t A m e r i c a n s h a v e v e r y little control over their income, whereas professional practice

owners such as dentists have the ability to change our income.

Personal development guru and author Steven Covey states, “what you measure you can monitor and what you monitor you tend to improve.” If that is true (and I believe vehemently that it is), should we not use this concept to our advantage?

The starting point for measuring and moni tor ing s tar ts wi th a wr i t ten p lan. V i r tual l y ever y mid - s ized or large bus ine s s in this countr y maintains and regularly updates their business plans and the many sub-par ts thereof. The plan becomes the measuring stick. Processes and procedures for measuring and monitoring are put in place as is the assignment of responsibility, accountability, and the process for communicating thereon.

Based on my 29 years of working with dentists, I believe that less than 1% of dental practices have writ ten business plans or the various sub-parts, which would include, at a minimum, short-, mid- and long-term goals; a cash flow plan; and a marketing plan. On the personal side, I have met very few dentists who have a written financial plan, let alone a systematic process for monitoring, communicating, and updating. Yet it is crystal clear to me that having written plans and a systematic set of protocols for measuring, monitoring, and adjusting improve the odds of creating a secure future for the doctor and his or her family.

As mentioned above, the single l a r g e s t f a c t o r in l o ng - t e r m investment success is savings. Without savings, there is no inve s t ment . In i t s s imp le s t definition, savings comes from establishing a lifestyle that requires some amount that is less than the after-tax and after-debt service (loan and mortgage payments) income.

Wealth Management


For vir tually every dentist, the key prac t ice f inanc ia l goals are income and quality of life. The amount of income and the definition of quality of life are very personal and vary greatly. Bigger or more profit isn’t necessarily better, unless bigger and more profitable also suits your quality-of- li fe goals. There is nothing wrong with a three-day-a-week practice if you are able to achieve the level of income that will in turn allow you to save at a rate that fulfils your plans and you enjoy having four days of f per week to spend on personal pursuits. The point is, at any practice size, the goal ought to be to optimize income and quality of life, and if you also have a well-thought personal financial plan, then the income goal becomes known.

To optimize this process, one t ies together the pract ice of f in an c i a l p l ann ing w i t h t h e personal financial planning, since the former fuels the latter. We accomplish this by dovetailing the bottom line cash flow of the practice to the cash flow needs of the personal financial plan.

Initially, there may currently be tension between the income needs

of the personal financial plan and the income results of the practice. However, by working with both sides of the equation, you can come to an achievable and sustainable result that serves both the personal financial plan and quality of life.

The Irony of Patient Service and Profitability: We interrupt our regular broadcast for a Blinding Flash of the Obvious (BFO). Some dentists have

a hard time embracing the financial side of their practice. After all, this is healthcare, and patient care should always come first. You will get no disagreement from me on this point; however, there is no doubt in my mind that those dentists who spend the time and effort to address the business side of their practice create an atmosphere in which the doctor and staff can spend more time focusing on patient care and customer service, because they have effective and efficient systems in place to deal with the financial side of the practice.

It has been my observation that those dentists who avoid the business side have less t ime and resources to provide great patient and customer service. Furthermore, can you imagine how having all of your financial ducks in a row could add tremendous value to your quality of life? You practice dentistry the way you want to and because you enjoy it, not because you have to. The most unhappy dentists I know are on the “have to” treadmill. So, if you have avoided the financial side of your practice in the past, it’s time to develop a new paradigm: creating great and elegant systems for the financial side of your practice is in

fact patient friendly and will also reduce your stress (and the stress of those around you) and increase your quality of life.” Keep in mind that a stressed dentist on the table for multiple bypass surgery is of no help to anyone — not patients, staff, spouse, or family.

I hope that al l dent is t s and specialists who own their practice have some sense of what an

Income Statement or Profit and Loss evaluation looks like. It starts with patient receipts and then lists all of the various expenses of the practice, and deducting the latter from the former would leave some definition of net income or profit.

An income statement tailored to dentistry would likely have a subtotal called the operating income. This would represent patient receipts minus those expenses required to run the practice on a day-to-day basis. These expenses would include such expenses as staff, rent, lab, supplies, professional services, office, marketing, etc. These operating expenses would not include any compensation or benefits of the owner-dentist, loan payments, depreciation or other arbitrary expenses (donations, continuing education, etc.).

Operating income then represents the cash flow available to fund the rest of your life. Let’s look at a typical list of the uses of practice operating profit:

• Debt service of the practice

• Federal (and state if applicable) income and FICA taxes

• Your lifestyle and personal loan/mortgage payments

• Funding for retirement

• Funding for education and/or other funding goals

Typically, we develop the lifestyle requirements, retirement funding, and any other funding goals through the process of creating the personal financial plan. We then deduct these cash flow expenses along with the others noted above from the operating profit (or cash flow) of the practice. If we produce anything north of zero, we are off and running.

If we produce a negative result in the exercise above, we then

The starting point would be to prove that and to develop a financial plan that addresses your family’s long-term goals and concerns.

Wealth Management


roll up our sleeves and determine what needs to change in order to be successful. For example, with the practice cash flow tool, we could work backwards and determine just how much of an increase in production would result in the desired income level. If that increase is achievable and sustainable and does not violate the quali t y of l i fe goals, then the solution may be to develop practice plans to achieve that higher production goal.

Alternatively, if the production goal developed is not desirable, then other parts of the plan can be altered. This is a process of (informed) self-negotiation. We could reduce personal spending and increase savings. We could plan to work longer. We could plan to live on less during retirement. We could expose ourselves to additional investment

risk if appropriate, or we could adjust a little bit of each of these elements. The point here is that, with these powerful and integrated planning tools, we can make informed and strategic decisions about how to proceed to achieve our long-term financial goals.

How Does All of This Planning

Relate to Savings? Our observations have convinced us that the majority of dentists and specialists become much better savers once they have a coherent plan that demonstrates the proper savings amount. The act of perhaps trading or deferring a few luxuries for the peace of mind that your plan is in place, there is a process for monitoring it, and you have optimized your potential to achieve f inancial security is of immense value to

most dentists and their families. As Winston Churchill said, “Let our advance worrying become advance thinking and planning.” Creating your plan and putting it into action isn’t hard if you just take the steps to get started.

Sam Martin is Director of Weal th Management Services and Advanced Tax Planning for the Dental Group, LLC / Martin Boyle PLLC / Dental Wealth Advisors, LLC, a CPA, practice advisory, financial p lanning and Wealth

Management services group exclusively serving dentists and their practices. Sam is a Certified Public Accountant (CPA), a Certified Financial Planner (CFP®), and holds a Masters Degree in Federal Income Taxation. Located in Kirkland, WA – Sam can be reached at 425.216.1612 or [email protected].

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Should subgingival air polishing be used for periodontal maintenance? Absolutely. Here’s why: it’s safe and effective, it can access areas all the way to the bottom of the pocket for biofilm removal, and patients find it more comfortable.

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Subgingival Air Polishing for Periodontal Maintenance

Interested in learning more?Ask us about the Swiss Dental Academy and the continuing education course, “New Concepts in Periodontal Therapy: A Hands-on Approach” if you would like to learn how to:

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ReferencesMoëne, R., Décaillet, F., Andersen, E., Mombelli, A.; Subgingival plaque removal using a new air-polishing device. J Periodontol. 2010;81:79-88.


Three horizontal nozzle apertures for the air-powder mixture, a separate vertical water nozzle aperture for rins-ing: what used to be off limits is now easily reachable, through gentle action and without any risk of emphysema. And since the Air-Flow Powder Perio is particularly f ine, the tooth surface is not damaged.

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A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 4 2008

Offi ce DesignInvest in Your Practice, In Good Times and Bad

Wealth ManagementSaving is the Key but What is the Key to Savings?

In the Middle of the Greatest NeedDr. Charles Keithline

A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 3 2010A MAGAZINE DEDICATED TO THE SUCCESS OF DENTISTRY ISSUE 3 2010

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