Boost Your Practice to the Next Level

You may be the greatest salesperson when it comes to case acceptance, but if you if you are going to talk the talk, then you have to walk the walk. A good place to start is by taking lots of continuing education courses, especially those that include hands-on learning, and practicing on extracted teeth can help to further hone your skills.

With the currently low reimbursement rates from insurance plans, there is a great temptation to cut costs by using cheaper, inferior materials. Do not fall into that trap. Always use quality materials that you can trust to be in your patients' mouths not only years but also decades later. Restorations that fail because the dentist was trying to pinch pennies can cost more in the long run because the re-treatment is done on his or her dime.

Another result of the terribly low insurance compensation is that one must work extremely efficiently in order to make a reasonable profit. However, that doesn't mean that clinicians should rush through treatment. Set up a system so that all of the instruments and materials needed for a particular procedure are readily at hand and ensure that your assistants are well trained in order to help things go as smoothly as possible. Incorporate quadrant dentistry (or even multiple quadrant dentistry) into your standard operating procedure. This is more efficient, and patients really appreciate not having to return to the office for multiple visits. Think of all of the time saved from not having to set up, seat, and anesthetize a patient for multiple visits as well as the time required for the cleanup and disinfection of the operatory.

As a basic rule of thumb, do not hurt your patients. You could be the best technical dentist in the world, but if your patients are extremely uncomfortable, then they will be less likely to return for future treatment. In this regard, it is imperative to develop a good technique for the administration of local anesthesia.

Use potent topical anesthetics and give them enough time to produce a reasonably deep level of preinjection numbness. Prior to administration, waving the needle around in front of a patient is not a very good idea. Make sure that your assistant hands you the syringe outside of the patient's peripheral vision. During administration, inject extra slowly to allow the tissue to become numb ahead of the needle tip. Use of a computerized injection system can help, especially with palatal injections. Employing 4% Articaine, which is extremely potent, can help maintain profound anesthesia throughout a procedure. For scaling and root planing, the use of a potent topical anesthetic, such as lidocaine and prilocaine periodontal gel (Oraqix^®, Dentsly Sirona), can be a huge blessing. Gone are the days of having to administer what seemed like endless injections for minor periodontal procedures.

At the completion of treatment, consider including your phone number in postoperative instructions. This can give patients peace of mind that they will have someone to turn to if they have problems. Most patients are extremely respectful of my time away from the office, and thus, it is a rare occasion when I do receive an after-hours call. Also, make sure that your patients are supplied with adequate pain medication if you think that their treatment warrants it. Given the state of the current opioid crisis, the majority of our patients should be managing their pain with ibuprofen and acetaminophen. However, if an opioid prescription is justified, then we should only prescribe enough to get the patient through the most painful postoperative period.

Stay on time. One of the biggest pet peeves that patients have is enduring extended waiting times. This is the generation of instant gratification, in which everyone expects everything right away. I usually take my staff out to lunch once a week, and there are occasional times when we sit for a few minutes without anyone acknowledging that we are there waiting. If I ask the staff how they feel about it, they always respond that it is downright irritating, and then I ask them, "How do you think our patients feel when this situation occurs at the office?" All it would take to ease my staff's frustration is for a server to stop by for a second and let us know that they will be with us as soon as they can. At your practice, have the front desk keep each patient in the waiting room apprised of the amount of time in which they can expect to be seen. For all patients waiting in treatment rooms, have an assistant check in with them no less than every 15 minutes to let them know when they can expect to see the doctor.

Patients who present for emergency treatment can be divided into three categories: episodic, lukewarm, and lifelong. You will not see the episodic patient until the next time that he or she is in pain. The lukewarm patient can often be reactivated once he or she sees the need for continuous dental care. It is seeing the lifelong patient that really makes it worthwhile to deliver same-day emergency treatment. I have had these types of emergency patients literally wait for hours and still be extremely appreciative that we went the extra mile to get them out of pain. These patients can also be your best source of referrals.

Whenever possible, see emergency patients the same day, but make them wait until you are available so that it does not interfere with your scheduled patients' time. Make sure that emergency patients are aware of this potential wait before they come to the office. If they are willing to wait for an extended amount of time, then they are likely experiencing a true emergency.

Set aside time in your schedule for emergencies. If you have an extra treatment room, first thing in the morning or after lunch are good times. This will allow you time to assess emergency patients' needs and anesthetize them, then they can wait comfortably and pain-free until you finally have time to properly treat them. It can also help to set some buffer time aside right before lunch or at the end of the day to allow you to get caught up.

Richard P. Gangwisch, DDS, a master of the Academy of General Dentistry and a diplomate of the American Board of General Dentistry, is a clinical assistant professor at the Dental College of Georgia at Augusta University and maintains a private practice in Lilburn, Georgia.