Thomas Larkin DDS

Thomas Larkin DDSThe Business of DentistryFrom Employee to Entrepreneur

The Future of Dentistry.by design

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Take Home PointsThe population is getting older and more diverse, leading to different disease patterns, care giving behavior and ability to pay

Consumers are becoming more astute purchasers of health care and seeking value for their spending

An increasing number of dentists are being trained, but mounting debt and changing demographics are altering the practice choices for new dentistsPressures are growing for an expanded dental team to provide preventive and restorative services

Care is being integrated within Patient centered medical homes in medicine but inclusion of dental care servicers has been slow.

ConclusionGiven the link between oral health and overall health, there is much promise for integrating dental services into overall health services. However, there is little evidence to suggest that the integration of dental services is little more than a possibility at this time.Anthony Van Leewenhoeck 1673

Developed a microscope and described many little living animalcules very prettily a movingDr WD Miller 1853-1907

The mouth is a focus of infection where microorganisms or their waste products obtain entrance to parts of the body adjacent to or remote from the mouthDr Thomas Hartzell

At the 1916 National Dental Association meeting, Dr Hartzell described how neglected teeth act as a gateway for deadly germs into the system.Dr Weston Price

AuthoredDental Infections Oral & SystemicDental Infections and the Degenerative DiseasesFundamentals of Oral Expressions of Dental InfectionsDr Bob Barkley

Dr Barkley spoke of the necessity of treating patients as total beings. The new information on disease control has made patients responsible for their oral health and therefore it is our responsibility and obligation to involve patients in a health story. My office needs to be primarily a place of oral health education. Shifting offices from case centered to patient centered connecting with patients through empathy, patience and compassion.Coined the term co-diagnosisDR Paul Keyes

NIH researcher 1955-1981

Paul Keyes DDSFirst to use the term dental plaqueFirst to show a direct relationship between microbial dental plague and periodontitisFirst to show microbial specificity in dental caries developmentFirst to document infectious spread of dental cariesFirst to document the infectious spread of periodontal pathogensFormulated 1% sodium fluorideInvented vinyl tray applicators for topical fluorideThe 4 Eras of DentistryERA 140s 50s 60sVery much problem focusedPatients went to the dentist when they had a problemwhen they were in pain

If you have this type of patients in your patient, who can still meet them where they are and help move them toward total careERA 2Late 60s and 70s Dr Bob BarkleyA philosophy of comprehensive care that focused on diagnosis ,prevention, education, and relationship building.

People were beginning to get the message that you needed to have your teeth cleaned on a regular basis in order to be healthyComplete dentistry is giving the patient the opportunity to do all of the work that you have diagnosed at their own pace within their financial and psychological comfort zone even if it takes years to accomplish

Thomas Larkin DDS The Dental Entrepreneur ERA 3 The Golden Age of DentistryWhere technology meets demographics

Focus was on aesthetics45 y o was determined to look good for a variety of reasonsMoney was FLUSHCosmetic training exploded Drs Dickerson,Rosenthal,Hornbrook

ERA 3 1988- 2008

September 2008

2009 PredictionsThis is not a momentary correction, nor a down cycle its the end of the world as we know it.A Premium will be placed on Doctors and offices that demonstrate empathy; an understanding of the consumer plight.

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The Marketplace Today (mavericky) In February of 2009,putting continuing education resources, i.e. time and $$$$$$$ into elective, vanity based dental services is fraught with EXTREME RISK Dr Tom Larkin*

26Wants Vs NeedsWe are entering a prolonged period in our Countrys economic history where individuals are redefining what their Needs Are

I Want Pretty White TeethI Need To Be Able To Eat

Do not position yourself on the wrong side of this equation27The Ultimate NICHE 2009 Lecture UKCDThe Biological, Health Oriented, Dental Practice is the LARGEST EMERGING MARKET opportunity in modern History

Biological Caries and Perio Risk AssessmentMinimally Invasive DentistryRemineralization and Antimicrobial TherapiesAdvanced Non-Surgical Perio Therapy28ERA 4 2010 - ?The shift from aesthetics to health and wellness

The 4th generation patients want a dentist who will listen and work with them and not just on them.AAOSH

ERA 4 2010

What Concerns Boomers TodayBrain HealthEventheart attack, strokeMobilityWhere Do They Spend DollarsHormone ReplacementAnything Anti-agingAnything related to mobility and brain health

These are not covered by Delta Dental What Boomers WantDo boomers want to go to a clinic and get a one size fits all solutionThey are looking for quality of life solutions

The OpportunityTo address the connection of what is going on in my patients mouth and how it relates to their overall healthIdentify their risk factors associated with oral diseaseDiagnose and treating disease in its very earliest stages until waiting for physical damageProvide patients with an individualized plan that meets them where they areThe Business of Dental Hygiene1/3 to 2/3 ratioThe Language of Era 4 BiofilmBacterial LoadOral Disinfection

The ConversationThe conversation must change from removing the stuff on your teeth to the bacterial environment in your mouth and the consequences to your overall health40The Ultimate NICHE 2009 Lecture UKCDThe Biological, Health Oriented, Dental Practice is the LARGEST EMERGING MARKET opportunity in modern History

Biological Caries and Perio Risk AssessmentMinimally Invasive DentistryRemineralization and Antimicrobial TherapiesAdvanced Non-Surgical Perio Therapy41Dr Bradley Bale/Amy Doneen

Bale Doneen Method

Bale Donneen MethodPeriodontal Disease is an independent predictor of CV risk and oral infection may trigger a heart attackPatients with known CVD should have regular visits with a hygienist and dentistIf there is a puzzling inflammatory level, consider oral disease.Periodontal Treatment Improves Glycemic ControlPeriodontal Wellness Reduces Risk of Stroke

ALL cardiovascular prevention programs must include an oral/systemic component

The Technology of Era 4 Video Microscopy

46Perio Path

47The New Paradym

Relationship between longitudinal change in periodontal status and change in common carotid artery intimamedia thickness.

Desvarieux M et al. J Am Heart Assoc 2013;2:e000254Relationship between longitudinal change in periodontal status and change in common carotid artery intimamedia thickness. Periodontal status (A) defined clinically, according to percentage of sites with 3mm probing depth (P for linear trend