C101A / C101B GROW OR DIE DAVID AHEARN, DDS, AND WENDY BRIGGS, RDH THURSDAY, FEBRUARY 20

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1 C101A / C101B DAVID AHEARN, DDS, AND WENDY BRIGGS, RDH THURSDAY, FEBRUARY 20 DISCLAIMER: This work, audio recordings and the accompanying handout, are the intellectual property of the clinician, and permission has been granted to the Chicago Dental Society, its members, successors and assigns, for the unrestricted, absolute, perpetual, worldwide right to distribute solely as an educational material at the scientific program being presented at the 2011 Midwinter Meeting. Permission has been granted for this work to be shared for non-commercial education purposes only. No other use, including reproduction, retransmission in any form or by any means or editing of the information may be made without the written permission of the author. The Chicago Dental Society does not assume any responsibility or liability for the content, accuracy, or compliance with applicable laws, and the Chicago Dental Society shall not be sued for any claim involving the distribution of this work.

2 Chicago Dental Society MWM & REGIONAL MEETING COURSE EVALUATION Speaker: Subject: Date: Number of attendees: PLEASE RATE YOUR SPEAKER AS TO: Excellent Good Fair Poor N/A Subject selected Timeliness of subject Comprehensiveness Meeting your expectations Content level Delivery Voice quality Holding your interest Appropriate audiovisuals Effective audiovisuals Overall evaluation of speaker Overall evaluation of program Should this speaker be invited for future meetings? Yes q No q What topics of interest would you like to see covered in the future? Comments (use reverse if you need additional space): Name (requested but not required please print): RETURN EVALUATION CARD TO: Chicago Dental Society Aloysius F. Kleszynski, DDS 401 N. Michigan Ave., Suite 200, Chicago, IL DO NOT FOLD CARD. FOR CDS PERMANENT FILES.

3 Choices we make (consciously or not) that set the stage for practice success Intro Productivity Structural Elements Principles Putting it all Together THE GREAT DIVIDE The Great Divide Niche Growth Simplified Rules and Checklists David J. Ahearn, DDS 2 Ways Out 1.Go Niche...It Is Risky 2.Get Efficient

4 So what s the problem with growth? Expanded offices have reduced profit margins New offices are unprofitable for some time period The further the additional office is from the first, the longer the delay to profitability. David J. Ahearn, DDS So What s The Problem if you do this in a tougher economy? Case average is down Number of new patients down So you have to work harder and longer to get the same result...and most people won t David J. Ahearn, DDS Measurement I think that the biggest challenge in creating high growth is in creating a manageable data set that reflects the practice game plan. David J. Ahearn, DDS Of All The Things That Hold Back Practice, Bottlenecks Are The Most Damaging Because They Rob You Of Your Greatest Resource... Time

5 3PRODUCTIVITY BOTTLENECKS Sterilization Front Desk Treatment David J. Ahearn, DDS 3PRODUCTIVITY BOTTLENECKS Sterilization Front Desk Treatment David J. Ahearn, DDS Front Desk Essentials The Plan...Who are you? A Design...What are your structural needs? Communications...What tools might you apply? Scheduling...The heart of success Systems...How you scale David J. Ahearn, DDS 3 PRODUCTIVITY BOTTLENECKS - FRONT DESK

6 Scheduling Front Desk Essentials 1. Doctor and assistant time 2. Collapsing time schedules...which is not the same as going faster! David J. Ahearn, DDS

7 Growing Hygiene Wendy Briggs, RDH Hygiene Diamonds and The Team Training Institute A tale of two companies... What do these Companies Have in Common? Hung on to an obsolete business model, and failed to develop a new plan They did NOT think differently! Here's to the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes... the ones who see things differently -- they're not fond of rules, and they have no respect for the status quo.... You can quote them, disagree with them, glorify or vilify them, but the only thing you can't do is ignore them because they change things.... -Steve Jobs

8 World s Largest Rope Swing Arches National Park 130 Foot Drop 5 Different Anchors Created a business, so others can pay for the thrill WE MUST ADAPT! Dentistry is changing! Our patients are changing! Many practices that are failing to adapt to these changes are becoming irrelevant. Adaptation It is not the strongest of the species that survives, nor the most intelligent that survives, It is the one that is the most adaptable to change. - Darwin The Current Draft - Dr John Meis

9 Adaptive strategies in dentistry Dentistry is changing... That was then. This is now! Role of Hygiene Maximizing 3 Roles Preventive Therapist Periodontal Therapist Patient Treatment Advocate 3 Roles for the World Class Dental Hygienist Preventive Therapist Treating the Infection of Decay Risk Assessment Fluoride Topical, Take-home, Varnish

10 Collectively, these studies showed conclusively that it was the low ph generated from sugar metabolism rather than sugar availability that led to the breakdown of microbial homeostasis in dental plaque. Marsh PD. Dental plaque as a biofilm and microbial community implications for health and disease. BMC Oral Health Suppl:S14. Fluoride When is Fluoride typically offered? What is the fee for this service? Who should have fluoride? What constitutes High Risk for Adult patients? 3 or more lesions in the last 3 years Suboptimal fluoride exposure Xerostomia or Dry Mouth Have multiple factors that may increase caries risk American Dental Association Factors that may increase caries risk High titers of cariogenic bacteria Poor oral hygiene Prolonged nursing (bottle or breast) Poor family dental health Developmental or acquired enamel defects Genetic abnormality of teeth Multi-surface restorations Restoration overhangs and open margins Chemo/radiation therapy Eating disorders Drug/alcohol abuse Irregular dental care Cariogenic diet Active orthodontic treatment Presence of exposed root surfaces Physical or mental disability with inability of performing proper oral health care

11 Get your copy of the Risk Assessment Brochure Text right now to THE TEAM, or Name, address and Name of Event You will receive a copy of this powerful tool before this conference is over! Fluoride Benefits Recent CRA studies show up to 75% reduction in new decay Helps prevent cervical decay Reduces sensitivity Prolongs life of crowns and other restorations Patients recognize the value of investing in Fluoride..even in a crazy economy What does this mean for hygiene profitability? Average office- 8 patients Average fee for fluoride 25 Increase to the practice?

12 80% Acceptance of In-office Fluoride treatments 34,600 increase per year Per Full Time Hygienist! Fluoride Acceptance: Kayla Ginn 100% Kim Orick 71% Sandra Mills 85% Jodie Welch 73% Emily Spencer 71% Paige Shouse 71% Darbi Zuccato 82% Melissa Hodges 78% Donna Satterly 88% Sealants How interested are your patients in prevention? Who should have Sealants? Everyone has a 95 percent chance of eventually experiencing caries in the pits an fissures of their teeth, if sealants are not used in those areas. ADA council on Dental therapeutics accepted sealants in 1971

13 ADA states: The application of dental sealants is an extremely simple procedure to perform and does not cause any discomfort for the patient. Because of their simplicity and effectiveness, from a health standpoint, sealants make excellent sense for both children and adults. Sealants Goal: Recommend sealants on all posterior teeth NOT only on those that Insurance will pay for Pre-Screen adults with CAVITY DETECTING LASER We have two choices... If we add 4 sealants per day in hygiene on average this means an increase of 34,560 per year Record number of sealants done in one day by a single hygienist is 82!

14 Desensitizing Agents 80% of adults suffer from sensitive teeth Hypersensitivity affects 45 million adults in the United States 10 million are chronically affected with sensitive teeth Dental Abstracts by Jaeggi and Lussi as summarized in Dental Abstracts Dentistry Today, pg 46, September 2002 Desensitizing Agents Brush and Bond techniques, Parkell Fee is between $22-39 Covered benefit with many insurance companies under desensitizing treatment per tooth If we add 4 teeth treated per day in hygiene on average this means an increase of 34,560 per year Add this to the potential with fluoride and sealants, we have a total of 103,720 increase! Periodontal Therapist Have you run any audits lately to analyze how well things are going with Periodontal Services in your practice? What is your acceptance rate for Periodontal Services? Are you treating Periodontal Disease the same old, same old way, or have you made

15 Periodontal Disease and stillborn babies January The first documented link reported between a mother with pregnancy associated Gum disease to the death of her fetus There is an old wives tale that you lose a tooth for each baby. This is due to the underlying changes during pregnancy, but if there is an underlying condition in the background then you may lose your baby. - Yiping Ham, Case Western Reserve University School of Dental Medicine During the 35 year old woman s pregnancy, she experienced excessive gum bleeding: (75% of pregnant women experience this) Periodontal Disease and stillborn babies Bleeding associated with the gingivitis allowed the bacteria that is normally contained to the mouth (body s own defense system) to enter the blood and work its way to the placenta Bacteria enters the amniotic fluid, and is ingested by the baby In this case, the mother had an upper respiratory infection a few days before delivery with a fever Periodontal Disease and stillborn babies Postmortem microbial studies of the baby found the prescence of Fusobacterium nucleatum in the lungs and the stomach The baby had died from a septic infection and inflammation caused by bacteria Researchers had the mother visit Periodontist, who collected samples from her teeth DNA cloning technologies were used, and a match was found in the mother s mouth with the bacterium in the baby Periodontal Disease and stillborn babies The testing strongly suggested the bacteria were delivered through the blood - Dr Yiping Han With Periodontal treatment, and preventive Oral Care the mother has since given birth to a healthy baby -Term Stillbirth caused by Oral F. nucleatum: Journal of Obstetrics and Gynecology, 2010

16 Periodontal disease and conception August Report presented to the Society of Human Reproduction and Embryology The negative affect of Periodontal Disease on conception was the same order of magnitude as the effect of obesity. Until now there have been no published studies that investigate whether gum disease can affect a woman s chance of conceiving Periodontal disease and conception 3737 Pregnant Women studied; results analyzed for 3416 Out of the 3416 Women, 1014 of them had Periodontal Disease... 26%! Women with Gum Disease took just over 7 months to become pregnant...2 Months longer than average Findings: Periodontal Disease can increase the time it takes to become pregnant. -Study conducted by Medical Director of Fertility Specialists of Western Australia, published by the European Society of Human Reproduction and Embryology Periodontal disease and AIDS Butryic acid, produced by the bacteria in the mouth with periodontal infection, has been proven to invigorate the HIV virus. The acid hinders an enzyme called HDAC that blocks HIV from proliferating Serious Periodontal Disease could lead to the development of AIDS in HIV positive people March 2009 Study, Journal of Immunology Pancreatic and Prostate Cancer Recent research has established a significant connection between periodontal disease and prostatitis - Journal of Periodontology Men with periodontal disease have a 60% higher risk of being diagnosed with Pancreatic cancer -National Cancer Institute

17 Periodontal Productivity audits Practice Analysis Classification of Periodontal Disease Periodontal Classification worksheet Use these on every patient! takes decision out of your hands...confidence! Customized Perio Brochure Make this yours!

18 We need more focus on our role as an advocate for the long term health of our patients Patient Retention Providing Excellent Care Pre-scheduling for Hygiene Visits, building value Helping to administer Patient Retention programs How are patients being served? How wide open is your Back Door? Recall Audit patients not enrolled in Continuing Care Patients for Life!!!

19 Acceptance of proposed treatment begins in hygiene To Maximize your role as Treatment Advocate, there are vital steps that must happen during the appointment What is the New Paradigm? Build Value Simplify...more on this in a bit WIIFM What are the specific benefits to the patient with that particular service? Keys to Building Value... It s not the customers job to know what they want

20 Build Value by using: Cavity Detecting Laser Intra-Oral Camera When they see it, they believe it. -Dr Gordon Christensen 1991 Keep it simple! Avoid over-complication at all times Even when explaining simple procedures we have a natural inclination to use words our patients aren t familiar with How much do you get out of a complicated explanation? Dr Braga... Using these tools saves us valuable time! They also add a whole new level of WOW to the patients overall experience

21 Using these tools are vital! Build Value-trying to do this without Diagnodent readings and/or photos is difficult Simplify-We tend to overcomplicate things, and let s face it, our patients often just don t get it How can we Motivate and Inspire our Hygiene Team to change? I have tried to get my hygienist to do this for years This won t work for me because my doctor. Motivating Hygiene Production Based Compensation is critical! Several transition formulas that are win-win Our team of mentors and coaches are incredibly motivating...we are all hygienists We have been where they are now, and can help inspire change because we have done it ourselves. Does it make a difference?

22 Success is the sum of small efforts, repeated day in and day out -Robert Collier Hygiene Explosion In Office Consult The Team Training Institute

23 3STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE What the Patient Sees How to Make a Treatment Room Surviving the Process David J. Ahearn, DDS 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - WHAT THE PATIENT SEES 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - HOW TO MAKE A TREATMENT ROOM How To Make A Treatment Room 1. More is Less 2. What s the Plan? 3. Only Two Ways Out 4. What if I can t Grow? David J. Ahearn, DDS 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - HOW TO MAKE A TREATMENT ROOM You can t use what you can t reach

24 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - HOW TO MAKE A TREATMENT ROOM There are only 2 great ways to fully equip an operatory. Room centric or Office Centric. 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - HOW TO MAKE A TREATMENT ROOM How To Grow Your Office Without Making It Bigger 1. Go digital. 2. Go chartless. 3. Outsource non-critical elements. 4. Combine functions carefully! 5. Stagger your schedule. 6. Compress treatment schedules. 7. Process data (payment) at the point of service. 8. Reduce treatment room volume. David J. Ahearn, DDS 3 STRUCTURAL ELEMENTS TO CREATE A SUCCESSFUL PRACTICE - HOW TO MAKE A TREATMENT ROOM Most environments are perfectly designed to get the results that they get. 6PRINCIPLES FOR PRODUCTIVE TREATMENT Condense Products in Tubs Organize Consumables In Bins Use Vertical Space Replace Trays With Cassettes Compact Mobile Deployment A Small Room...Is Better Than No Room At All David J. Ahearn, DDS