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Archive for February, 2013


The Dental Rat Race in 2013

I gave my kids a gift for Christmas this year that I enjoyed WAY more than they did. It’s a board game called Cashflow by Robert Kiyosaki. I loved it, because I am determined to teach my kids that money does not, in fact, grow on anything, including trees. The game has a starting point and a smaller inner circle on the board called the Rat Race. To escape the portion of the board known as the Rat Race, a player must achieve a passive income that exceeds their monthly expenses. Simple, right? Just create investments, income properties or other interests that create more monthly cash flow than you spend every month. This leads to playing a much bigger, more lucrative part of the game.

So, what if you could create a dental practice that did the same thing? What if your two hands were not necessary to have the practice cash flow? OR, what if you could create enough cash flow to have the practice succeed with your production only a few days every month? What if you could structure your practice to be able to do a few chosen procedures that you truly love, rather than being “Jack of all trades”? Or you could choose to work less hours IN the practice and more time working ON the practice. The real question is what if you had the power to create whatever your dream practice looks like to you?

What would the picture-perfect practice be for you?

I will venture a guess that the practice picture would appear differently for every single one of us. For me, it’s no general dentistry anymore – I just don’t enjoy it as much as I once did. I also don’t check hygiene patients, so I am not tied to an every day schedule in the practice. Clinical dentistry for me is one to one and a half days per week. For me, it is Invisalign and placing and restoring dental implants, and Trudenta TMD/headache therapy. It can be life-changing dentistry for many patients.

I also love improving the business systems of the practice in order to maximize the patient experience and overall happiness, while increasing hourly production for all care providers. I spend a lot of time marketing the practice in order to maintain a healthy patient flow. I truly enjoy the business and clinical sides of dentistry, although I do realize this is not the case for many dentists.

For me, it is my dream way to practice. I love my role as the leader, marketer and clinician in the practice, on my own terms. The funny thing is that when I practiced dentistry the way that it has “been done” for decades, I was miserable. When I customized my practice to my needs, my family’s needs and our patients’ needs, everything fits. Patients know if you are passionate about them and the dentistry you provide every visit for them.

It took a ton of work, humbly learning my weaknesses as well as improving my strengths, a clear strategy and a great desire to love my profession as much as I thought I would when I graduated from dental school. Is your goal to escape the rat race or are you just doing what you’ve always done to get what you’ve always received? Practicing dentistry in 2013 is a puzzle, but when you focus on the right pieces, it can become a beautiful picture.




1. Reason for visit:
a. Initial Exam
b. Emergency visit
c. Referral from another Doctor
d. Patient referral
e. Second Opinion
f. Consultation
g. Walk-in

2. Thorough review of health and dental history:
a. Discuss all “Yes” answers, make appropriate
notes,, and affix necessary warning stickers to
chart (inside chart).
b. Proactively ask, regardless of a “No” answer on
the Health history from, if the patient is allergic
to any medication or if he/she has been told he/
she has been told he/she needs to take antibiotics
before dental treatment.
c. Review the Health history and document the
Dental history of a new patient.

3. Patient’s chief complaint in his/her own words:
a. “The last tooth on the bottom right throbs all
night long and keeps me awake.”
b. “When I drink something cold it hurts on the
upper right.”
c. “I don’t like the color of my teeth”.
d. “Everything’s fine. I’m just here for a check-
e. “The tooth that doctor just did feel great”.

4. Symptoms (symptomatic or asymptomic)
a. How long
b. Location
c. Chronic or acute
d. Taking medication-what, when, how much, and
is it working?
e. Keeping patient awake at night
f. Interfering with eating or drinking
g. Throbbing (constant/intermittent)
h. Aching (sharp or dull)
i. Sensitive to heat, cold or air
j. Other

5. Clinician’s visual findings:
a. Location
b. No visual symptoms
c. Appears normal
d. Swollen
e. Broken lingual cusp
f. Inflames
g. Abscessed
h. Red and puffy
i. Cracked filling
j. Bleeds upon probing
k. Other

6. Diagnostic records:
a. Date of last x-rays/models/photos
b. Brought ______ from Dr. _____
c. At doctor’s request:
1. Took pa of # ______
2. Took panorex
3. Took maxillary occlusal
4. Took bitewings of _____
5. Took impression

7. Doctor’s examination:
a. Charted existing restorations and missing teeth
b. Completed full mouth periodontal probing and
c. Soft and hard tissue examination
d. Charted necessary restorative treatment
e. Occlusion
f. Oral Cancer screening
g. TMJ

8. Doctor’s diagnosis:
a. No active caries
b. New caries # ____________________
c. Recurrent caries # ________________
d. Acute apical abscess #9
e. Periodontal abscess #30
f. Type II, III, IV, or V periodontal disease
(or AAP’s new dx. System)
g. Full bony impaction # 1, 16, asymptomatic, but
some cystic development around #16

9. Doctor’s Treatment recommendations: (Example
a. RCT #9 ASAP-good prognosis if treated
b. Porcelain Crown #9
c. Referral to periodontist Dr. ____________,
regarding periodontal abscess #30 and Type III
periodontal disease. Stressed to patient the need
to see the specialist Dr. ____________ within
the next week or risk losing tooth #30. Gave
patient the option that we call for her/him for an
appointment or they can call, patient chose to
call specialist.
d. Optional treatment of #30 if patient refuses to
see specialist; emergency periodontal scaling of
#30 with irrigation using antibiotic medications
ad prescription for oral antibiotics. Prognosis
poor including possible loss of tooth #30
without immediate treatment and subsequent
comprehensive periodontal treatment. “I
understand” stated the patient today.
e. Referral to oral surgeon, Dr.
________________, for assessment of #1 and
possible cyst involving #16.

10. Discussions with patient and his/her choice of
treatment; (Example of conversations):
a. Patient accepts RCT and crown recommendation
for tooth #9 and is scheduled for Monday June
6th at 8:00 am. FA is completed and patient will
pay in full at time of treatment to receive his
courtesy of 5%.
b. Discussed periodontal disease at length.
Patient was surprised/upset with diagnosis of
periodontal condition, stating the following: “No
one ever told me that before.” “I was getting
my teeth cleaned every 6 months”. Patient “will
think about it” and will “let you know after we
complete her/his treatment for #9”.
c. Discussed periodontal abscess of #30. Patient
accepted optional treatment to be done today.
She/He understands the poor prognosis but is
not willing to consider comprehensive treatment
at this time.
d. Patient not concerned about wisdom teeth
because “they are not giving her/him any
trouble at this time”. Dr shared with patient the
importance of having the cyst checked by the
oral surgeon, patient still refuses. Patient did
agree to have us recheck with another panorex in
6 months.

11. Treatment rendered:
a. Details regarding administration of local
anesthesia and other medicaments – exactly
what, when and how much.
b. Correctly document which procedure was done.
c. Document how the patient responded to
treatment, the prognosis and any other
recommendations or discussions with the

12. Items given to patient:
a. Prescription (in detail)
b. Special instructions to the patient
c. Post-op instructions
d. Informed consent
e. Signed refusal of treatment
f. Referral slips to other specialists
g. Other educational literature (e.g., brochures
relating to periodontal disease, endo, impacted
wisdom teeth, etc.)
h. Appointment card
i. Financial arrangement agreement

Why go to all this trouble?

Although this may seem like a lot of
documentation, thorough chart notes are the
cornerstone to providing quality dental care and
protecting your dental practice in the process.

Dental records are admissible in a court of law
because they are felt to be an accurate depiction
of what actually happened. Jurors tend to place
greater credibility on the written record rather than
the testimony of the doctor or the patient.

In essence, if it is NOT written down, it did
not happen, was not said and was not

By: Roz Fulmer



27 Ways to Get Quality New Patients, Keep the Patients You Already Have and Grow Your Practice

I want to let you know first and foremost the reason there are 27 Ways. You are probably thinking that there is no way you can do 27 things at once. I realize this. While your successes will be quicker and greater if you do implement all 27, sometimes other things take precedence, and for that reason I have prioritized the listing.

I have tested each of these 27 ways in my practice, and I can personally attest to the fact that they work. Certainly, in different areas of the country markets are saturated in different ways, so there will be some small differences from practice to practice, but I believe this system also accounts for that.

It is really my goal to help you avoid some of the common pitfalls that people tend to run into when they launch a concentrated marketing effort. One of the things I hear all the time from our clients is, “I ran this and I didn’t get anything, or I did that and I didn’t get anything.” I get it. It’s incredibly frustrating. That is one of the primary reasons I am doing this. So sit back and learn.
1. Making Your Website Relevant
2. Google AdWords
3. Articles
4. Creating a linking strategy
5. Creating a Referral Program
6. Adding more niche services
7. Flyers
8. Freestanding Newspaper Inserts
9. Using testimonials
10. Direct Mail
11. Targeting new movers in your area
12. Using a Val Pak or Money Mailer coupon mailer
13. Press releases
14. Media pitches
15. More newspaper options
16. Join a business networking group
17. Find a Niche
18. Measuring results using tracking tools
19. Newspaper advertising
20. Partnering with other businesses through joint ventures
21. Communicating with your patients through e-mail
22. Email Marketing
23. Another use for email marketing
24. Social networking
25. Collaborate with your colleagues in the medical field
26. Community involvement
27. Billboards