Create a Thriving Dental Practice

by Peter E. Dawson, DDS

There is an almost magical triad of skills that, when learned and practiced, virtually guarantees the success of any dental practice. Excellent continuing education resources are readily available to any dentist who desires to become proficient in all three elements of this triad for success. The first two skills that are typically thought of as the keys to practice success are management skills and people skills.

While it is true that management skills and people skills are crucial factors to success, they can be lost without the third part of the triad, leading to frustration and overwork with minimum reward for efforts. The missing link in many offices and the part of the triad that is most important for fulfillment and practice success is the combination of skills that must be learned to produce clinical excellence. Concentration on clinical excellence can be particularly eye-opening for dentists who have been misled into believing that practice success can be assured by bringing large numbers of new patients into the practice each month. Certainly, new patients are essential to the success of any practice. However, trying to treat too many patients is counterproductive and unfair to your patients. What's more, too many patients is the most common obstacle to clinical excellence, which is the single most important factor that helps determine how successful a practice can become. Why this step is so often obscured by misconceptions about what really is meant by clinical excellence and how it affects every key monitor by which success is measured.

Why Clinical Excellence Pays Off

Clinical excellence is the best countermeasure for wasted time. Being busy does not equate with productivity, nor does "bigger" equate with better. If we look at the cost in time and dollars that are routinely wasted on remakes, reworks, adjustments, and , it would astound most dentists. Unfortunately, these time-wasters are so common that most dentists accept them as a normal part of practice. Understanding some of the basic clinical skills that are most commonly ignored can drastically reduce or eliminate many hours of wasted time and convert those hours to high productivity. Clinical excellence satisfies patient needs, which is the best way to build a practice. Today more than ever, patients expect quality. They seek out dentists who can make them look good and feel good. They put a high value on oral health and will most often be willing to pay for what they understand they need. The dentist who knows how to solve any masticatory system problem, and who does what is needed in a predictable time period at a fair fee will thrive.

What is Clinical Excellence

Clinical excellence cannot be explained in the limited context of teeth alone. Today's dentist must be physicians of the entire masticatory system, which in no way reduces the importance of teeth. In fact, it means we cannot isolate the teeth from the rest of the system. To be predictably successful, dental treatment must result in comfort, health, and equilibrium of all of the parts of the masticatory system. To reach that level of competence, dentists must understand and become proficient in the following skills: Diagnosis and treatment planning. The most important skills of all are typically shortchanged. The most successful dentists give a high priority to time spent on careful and complete examinations of the entire masticatory system. They know that a complete treatment plan must include whatever is needed to achieve optimum health of all the structures. They know it is also the blueprint for case presentation, effective scheduling, and increased production. Learning how to incorporate procedures for really thorough examinations is the first step to major practice improvement. Dentists are routinely amazed at how dramatically a complete exam policy can change a practice for the better. The incomplete exam probably is the most costly mistake a dentist can make. Any dentist can learn to become highly effective in presenting treatment plans, but this step depends on competence in the examination process so a comprehensive plan for treatment can be formulated. This is difficult to do unless the following clinical skills have been developed:

TMJ Analysis

Jaw relationships start with the temporomandibular joints (TMJs) because where the joints function determines how the lower teeth relate to the upper teeth. TMJ analysis has been confused by a variety of misconceptions, but if one understands the structural components and how they interrelate, there is no reason to be confused about the TMJs. Any dentist can be taught how to tell if the TMJs are healthy and can learn how to diagnose specific structural disorders. Occlusal treatment should never be started without examining TMJs first.

Occlusal Analysis

Almost every dental procedure has a direct or indirect effect on the occlusion, and occlusal disharmonies can be responsible for a wide range of complaints from sore teeth to headaches, wear, loose teeth, and many aspects of TMJ disorders. Yet, we find most dentists are so confused about occlusion that they do not even know how to evaluate or treat even the most common occlusal disorders. A tremendous amount of time is wasted and many problems are misdiagnosed if occlusal analysis and treatment are not understood. Occlusal concepts can all be taught on a structural basis that is so logical and learnable, dentists are typically upset that they had been practicing without this understanding.

Preliminary Mouth Preparation

The first goal of clinical excellence is to get the mouth healthy. Recognition of problems in the supporting structures is part of the complete exam, whichis too often shortchanged. Soft tissue management prior to restorative procedures is not only important, it is a practice-builder with many facets. A learnable program focused on getting mouths healthy invariably leads to an increase in total office productivity.

Esthetic Analysis

One of the major reasons patients seek dental care is because they want improved esthetics. It is appalling to see what is being so commonly passed off these days as cosmetic dentistry. The best esthetic dentistry is complete dentistry, which includes healthy tissues and beautiful teeth that are in equilibrium with all the other structures of the masticatory system. If tooth contour and position are related to total masticatory system harmony, it is exciting to see how predictably and beautifully esthetic results can be achieved. The concepts for doing this are so understandable that they eliminate the need for time-consuming guesswork or trial-and-error approaches.

Analysis of Anterior Teeth

The relationship of the anterior teeth is one of the most critical factors that affects not only the appearance, but also the stability of the entire dentition. Basic rules for determining correct relationships are very definitive and can eliminate the frustrating time waster of trying to talk patients into getting "used to" a result that does not quite feel right or look right. Problems of phonetics also can be prevented or predicted if concepts of anterior guidance and other determining factors are understood.

Quality Laboratory Work

Too often, dentists try to cut time or expense from the laboratory process and pay a premium in wasted adjustment time or compromised results. Quality laboratory work requires a very definite set of commitments. Most of these commitments take additional time up front, but save multiples of time at placement. A good doctor/technician relationship is one of the most beneficial factors a practice can have. It is dependent on precise communication of a number of technical guidelines for each laboratory case, but this communication method is easily learned and practically utilized.

Materials and Techniques

It is a tempting inclination to be the first one to use a new material or device, but it is a wiser approach to get independent factual information first. Staying accurately informed on new developments is expected of a quality dentist. A good rule of thumb is to always determine why a product is better before you use it.

Developing Clinical Excellence

While clinical excellence should be the first and most important priority, it is almost impossible to achieve in a disorganized office. And certainly enough new patients must be attracted to pay for the process. That is why the best approach is a combination of effort aimed at organizing the office team to help the dentist provide excellent care. But the doctor's definition of what is excellent care must be clarified first. Otherwise, time will not be reserved for adequate new patient exams and schedules will not be planned for optimum productivity.

The staff also must be trained to monitor and control the administrative process and develop the people skills for dealing effectively with patients. Fortunately, help is available for this kind of training, so the doctor can concentrate on improving the quality of care in the operatory, while the management skills are being developed or improved at the staff level.

I have had the opportunity to monitor a large number of dental practices from all parts of the country. Dentists who have committed to a high level of excellence reveal some consistent similarities, including the following:

1. They all made a conscious decision to practice superior quality dentistry.
2. Each one is a continuous student. They all take a large number of post-graduate courses in a variety of subjects.
3. Because they stay current, they reflect a high level of confidence when they examine or consult with patients.
4. They rarely advertise. It is unusual to find a Yellow Page Ad for a complete dentist. In fact, word of mouth from enthusiastic patients keeps their schedules full.
5. They see fewer patients, but produce more. Laboratory technicians verify that these dentists routinely produce several times the amount of restorative units compared with typical accounts at the lab.
6. Dentists that practice with a high level of competence work fewer hours, report lower stress levels, but have higher incomes.

If you make the decision for excellence, decide where you need the most help and start there. You must go for basics. Do not try to build a solid practice on fringe-type gadgetry or techniques. Be selective in your post-graduate course choices and do not block the process with self-limiting visions.

One thing is almost a certainty: The day you make the decision to have a truly superior practice focused on clinical excellence, your enjoyment of dentistry will go up. It will be a decision that only can be beneficial for both you and your patients.

Dr. Dawson is considered one of the most influential clinicians and teachers in the history of dentistry. Dr. Dawson is the founder of the Concept of Complete Dentistry^SM Series, as well as The Dawson Academy, which originated in 1979 ad the Dawson Center for Advanced Dental Study. In addition to numerous awards and special recognitions, Dr. Dawson is a past president and life member of the American Equilibration Society, and past president of the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry.

 

 

Comments

[peter bradley]

AHMEN!
Peter