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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


Advance Your Career

What If?
by Dr. Peter Evans
What if suddenly you found out something that would advance the course of your career, and this “something” fits right in with your philosophy?
What if you found that 30 to 40% of your existing patients were actually pursuing this very thing?
I want to reveal a secret on how to help patients buy into their own health.
Now, before you go on about how difficult it is to sell prevention … I’m not talking about selling prevention.  We all know just how tough that is!
We want patients to buy into their whole body health.  We want to influence patients in a positive way, do it in an ethical manner … to help them perceive the need for the care … accept what you’re saying and then move forward with it.
So, you can see it’s totally different than selling prevention.  We’re talking about total body dentistry here.  We’re talking about your dentistry and how it impacts whole body health, positively or negatively.
It’s not just being successful.  It’s doing something significant … to make a difference in an understandably unhealthy world.  If this is a philosophy that you can agree with … read on!
This secret will benefit your patients and benefit your practice.
The “status quo” is changing.
We are not “tooth and gum” dentists, anymore!
We believe in thinking differently.
The way we challenge the “status quo” is by making it easy for someone to select whole body BioCompatible dental care, impact and improve the bottom line of the business, enhance our profession and improve the quality of life for our patients.  It’s simple and direct.
Who are the patients who are looking for alternative healthcare possibilities?  They are the same people who are recycling.  They’re the same people who are going green.  These are the people who are looking for something other than “take two of these and call me in the morning”.
• They’re the people who’ve read about the safety concerns surrounding mercury and BPA and take them seriously for themselves and their children.
• They’re the people whose concern for the natural environment has grown steadily in recent years.
• They’re the people – as many as 40% of the population – who have considered, pursued and confidently used some form of alternative healthcare.
But, if they come to the conclusion that you’re not keeping up with the kinds of safe and environmentally sensitive dentistry they feel is appropriate, they’ll be out the door and gone for good.
In fact, if your physician/optometrist/oncologist was noticeably and arguably behind the curve, you’d leave too … WOULDN’T YOU?
But you can protect your practice and your lifestyle.
If you’re the kind of person who has been thinking of becoming more natural and healthy in your dental office, boy, do we have something for you!
This is the natural evolution of dentistry and it’s coming to a theater near you.
Answer to the questions above:
1. Diagnosis, treatment plan and treat the most prevalent chronic inflammatory disease on the planet … periodontal disease.
2. Go from being a mercury free office to become a mercury safe office.  We all know that mercury is something that you don’t want to fool around with.  Protect yourself and your staff with the proper masks, protect your patient from mercury vapors when removing mercury fillings with the proper protocol, and protect your local environment with a mercury retrieval system.  (By the way, the peer reviewed Journal of the Academy of General Dentistry this month has an article that assesses the release of mercury from silver mercury fillings exposed to different 10% carbamide peroxide bleaching agents.  Jan/Feb 2013, PP.33-35.)  The conclusion: the authors recommend avoiding the indiscriminate exposure of silver amalgam restorations to carbamide peroxide bleaching agents because of the increase in the quality of mercury released.
3. Diagnose and treatment plan for cosmetics, temporomandibular disorders, occlusal disease, sleep apnea, and other infections.
Everything we do … we believe it will make a difference in the health of our patients, and in the health of the country.
Together we do this.



Get Ready—Get Set New CDT Codes EVERY YEAR!


Get Ready—Get Set
New CDT Codes

by Roz Fulmer

Were you aware that in September 2011 the ADA replaced the Code Revision Committee (CRC) with the CAC (Code Advisory Committee)?  I am happy to share with you that this great change did happened and that the new 21-member committee is moving forward beginning with the codes and revisions January 2013.  The 21-members will consist of the following members:
Five representatives from the ADA.
One representative from the nine recognized dental specialty organizations.
One representative from each of the following third-party payer organizations: Blue Cross/Blue Shield Associations, Delta Dental Plans, Centers for Medicare and Medicaid Services, National Association of Dental Plans and America’s Health Insurance Plans.
One representative from the American Dental Education Association and
One representative from the Academy of General Dentistry.

Why the change to every year instead of every two years is due to the federal law of HIPAA that requires dentists and the third-party payers to only use current codes and we, the dental practices of America will need to be learning the CDT codes changes on a yearly basis.  Remember, we will need to know these changes prior to January of the New Year because that is when the codes will go into effect.

Here are a few of the many exciting revisions for January 2013:  Description for D2740 will include for Lava/CEREC crowns.  The descriptor will read; Porcelain/ceramic restorations will include “pressed, polished, or milled materials containing predominantly inorganic refractory compounds – including porcelains, glasses, ceramics and glass-ceramics”.   REMEMBER, this does not go into effect until January 2013.  If you are using this code right now for your CEREC/Lava crowns, you MUST include a narrative on the claim form in the Remarks box #35.

Another revision already in place pertains to code D9630 other drugs and/or medicaments by report.  When and what time of “drugs/medicaments” should this code be used for in your dental practice?  TODAY, this code should be used when dispensing for “home use only”, not within your office.  Example:  At times a patient was given in the office an oral antibiotic to prevent endocarditis and an office may have coded out D9630 for giving this medication to the patient within the office.  TODAY, that code could only be used if the patient were given the medication to use “at home, not in the office”.  Other medicaments patients may be given to use at home would be over-the-counter Fluoride (PreviDent, Fluoridex), oral analgesics, chlorhexidine mouth rinses (Peridex, PerioGard, etc.), MI Paste, etc.  This code is rarely reimbursed and should always have a narrative as to “why and what” was given for “take home usage”.

What code are you using for a “chipped” tooth, “smoothing teeth”, “reshape a root”, or “an orthodontist asked to you to reduce the mesial and distal surfaces of either primary or permanent teeth?  D9971 odontoplasty 1-2 teeth includes removal of enamel projections.  This code is used for adjusting up to 2 teeth and if more teeth were adjusted then you need to submit the code more than once stating which teeth were treated.  Typically, this code is only covered by plans due to accident related scenarios, not for cosmetic purposes.  You can charge out a D0140 Limited Evaluation if these teeth were not previously diagnosed along with D9971.

What is your plan for getting your entire team up-to-date on the newest CDT codes plus revisions in 2013?  Have you ever had an “Insurance Expert” present a Hands-On course right in your office?  That is exactly what I do on a weekly basis all across the United States, training right in your own office, training your team to be experts for your patients.  How well is your team trained in the areas of insurance coding?
Here are a few of the topics covered throughout my training session with you and your team:
The Real Wealth of Examination Codes
Self Funded Plans vs Fully Funded Plans
Coding Compliance – Dental vs Medical
Maximizing CDT codes for $$$ Benefits for your Practice
Narratives for Most Dental Procedures
Enduring and Passing an Audit

That is just the “tip of the iceberg” as they say to all the new changes that are coming your way very shortly in regards to CDT Insurance Codes.  Is your office ready for these changes?  If not, give me call 815-481-3851 to schedule a training day right NOW!
FREE downloads at my website: