FAQs – Teeth Whitening and Employee Tools for New Dentists

Burkhart’s Practice Support Team provides support to doctors throughout the year by answering hundreds of questions that come through our toll-free number and email. It is our pleasure to provide answers and resources, at no fee, to all our Burkhart clients. We want to share some of this year’s most frequently asked questions and answers.

 

Q: We offer several types of whitening services, how can we increase our patient acceptance?
A: Creating a protocol that includes evaluating each patient’s smile promoting additional whitening services. Dental teams spend hours improving their clinical skills through CE courses and hands-on training. Increasing whitening, or any other esthetic treatment, involves improving your listening and patient interview skills. This includes ascertaining the patient’s desire to whiten his or her smile as well as recording initial shades during the hygiene visit. Showing your patient his or her initial shade on the shade guide will elevate the patient’s oral health awareness and open possibilities for discussion. Display whitening options and associated fees in the hygiene ops and check-out area.
Patients are often unaware of how reasonably priced whitening services have become so they hesitate to initiate the conversation. If you offer chairside whitening, include the phrasing, “Would you also like to whiten your teeth at that appointment?” each time a hygiene visit is scheduled. Whitening options should be included in all comprehensive treatment plans. If the ultimate goal is to provide an exceptional, referral-worthy patient experience, focus on increasing the team’s ability to actively listen while also challenging your patients by weaving thought-provoking questions into your conversations.

Q: My case acceptance rate could be higher. Do you have any tips I can pass on to my employees to increase the number of patients accepting treatment?
A: Your case acceptance is reliant on several things working well:
1. The transition of information from the RDH—Doctor should engage the patient and include a synopsis of the patient’s periodontal and restorative status as well as aesthetic desires. The doctor’s exam should occur mid-way through the appointment, allowing the patient time to process options discussed and the front office staff time to put together the financial part of the treatment plan.
2. For larger cases, a “ball park estimate” given by the dentist will help the patient understand the amount of investment and potentially open further discussion about treatment options.
3. The clinician should engage the patient again during the transition to the front desk team. Verbally stating the prioritized treatment plan in front of the patient and the treatment coordinator helps to summarize and solidify the plan for both the front desk and the patient.
4. The front desk staff make the plan affordable and get it scheduled. They should be armed with phrases to use when patients don’t schedule, such as, “Are there any challenges I can help you with to get the needed treatment started?” All too often, patients have some type of challenge—usually financial—and aren’t comfortable bringing up the topic. Knowing they can make a payment, or use an outside funding option, may be all they need. Display outside funding options to make them more accessible.

Q: How can we effectively build reasonable patient expectations for whitening results?
A: Teeth whitening can provide stunning results that make your patients proud of their smile. It can also provide less-than-desired results leaving your patients frustrated. The less-than-desired results are often a product of reduced compliance to the whitening program. Sensitivity is the leading cause of reduced compliance. Offer a toothpaste with a prescription level of fluoride and potassium nitrate to reduce sensitivity and give patients the opportunity to continue to whiten.

Start with an initial shade and be realistic with the results the patient could expect, generally 2-3 shades lighter. Discuss difficult cases, such as tetracycline staining, and let your patients be prepared to whiten for an extended period to achieve the results they want. A good rule of thumb is to make every effort to eliminate surprises for your patients. Let them know what to expect about results and sensitivity to reduce frustration for both patients and the practice.

Q: As a new practice owner, what should I provide my employees?
A: An employee manual, job descriptions, accountability measurements and regular feedback are important ways to make sure your employees will be successful and the practice will thrive. Employee manuals not only provide information on how your practice operates, they set policies to manage employees in a fair and consistent manner. The manual serves as a communication link to reference benefit questions, operating policies and the practice vision. It also serves to keep the dentist in compliance with federal and state regulations.

Job descriptions, tailored to each position, provide clarity and accountability for employees. Regular feedback in the form of performance reviews and goal setting tell your employees you care about their success and their impact on the growth of the practice. A written format for reviews provides documentation for the employee and the employer. In the case of employee termination, these documents become a valuable part of the employee record.

Q: Do you have sample job descriptions?
A: Yes, we do. We provide resources and consulting advice, on a complimentary basis, to all our Burkhart clients.

 

How can we help you? The Practice Support Team has years of combined business and dental expertise. Call or email us to see how we can help you.
1.800.665.5323 | practicesupportteam@burkhartdental.com

Heart Centered Dentistry

By Anne Baer
Photo by Jeff Hobson

 

 

Patient-focused. A family of friends. Warm and inviting. Relationship-centered. It’s hard to know where to start describing Silverdale Dental Center, its crew and clinic. Situated at the end of Sinclair Inlet in Old Town Silverdale, Washington, Silverdale Dental has been in the same location for over 40 years, and until recently, in a converted home. Jeff Phillips is at the center of its beating heart, mentoring and leading the expansion, and nurturing a culture of patient-first philosophy.

At 70, Dr. Phillips radiates energy and enthusiasm, embodying the definition of a health care provider who emphasizes “care.” A lifelong runner, outdoorsman, and self-described project guy, Dr. Phillips is an ardent supporter of team dentistry. “I have never been in a truly solo setting. I’m used to having someone who could cover and give me the freedom of an independent life.” As Dr. Phillips tells it, Dr. Bruce Craswell, the founder of Silverdale Dental, was an entrepreneur ahead of his time. Originally started in 1968 by Drs. Herb Shinn and Bruce Craswell, the practice grew to include Jeff Phillips and Mike Morton in 1976. With only seven operatories (one dedicated to hygiene), out of necessity the four doctors were trend-setters in offering evening and Saturday appointments. Each doctor was an independent practitioner, rotating time in the office with a week off every two weeks. As Dr. Phillips points out, “With four of us seeing patients in such a tight space, we learned to be flexible. But there were great benefits. You always had someone to cover for you, ensuring your patients got emergency care regardless of your own schedule. It allowed for time away giving me a chance to be a healthy dentist.”

Providing a Greater Circle of Care
With retirements and other changes in the group, Dr. Phillips became the building owner in 1990 and subsequently purchased an empty lot behind the original practice. At first, the lot was just a garden of high density blackberries, but it factored heavily in Dr. Phillips’ dream of providing a greater circle of care in the future.

Fast forward to 2008 when, fresh out of dental school, Dr. Jason Niemeyer responded to an ad for an associate at Silverdale Dental. Dr. Phillips welcomed the energy and new perspective Dr. Niemeyer brought to the practice. The team was complete when Office Manager Monica Duchemin joined the staff. She brought exceptional management and people skills to the office, as well as her broad palette of talents. When Dr. Niemeyer transitioned from Associate to Partner, the doctors hired Dr. Marc Cooper of Mastery Company as their “Future-Guiding” dental consultant. Time had come to push ahead with plans to expand into Dr. Phillips’ backyard blackberry lot. The stage was set for change.

Final Push Takes Shape
It all started with a casual conversation not long after Dr. Niemeyer purchased half the practice in 2013: “Why not expand into the lot behind the office?” On an invitation from their long-time Burkhart Account Manager, Bill Melius, the doctors attended a seminar offered by Burkhart and co-hosted by A-dec and Bob Kramer, a dental CPA. At the seminar, the team was inspired to consider purchasing equipment in stages and employ the IRS’ Section 179 tax deduction. With low interest rates available, the final push toward building a new space took shape.

A Perfect Construction Team
The project concept was clearly aligned with Dr. Cooper’s strong feeling that the future of dentistry is group practice. Dr. Cooper continues to coach Drs. Niemeyer and Phillips about operating as a Dental Entrepreneurial Organization (DEO).

All of Dr. Phillips’ connections throughout the years helped build the perfect construction team before any ground was broken. The role of architect was filled with a long-time running club friend, Charlie Wenzlau, while another friend introduced them to Mike Brown of FPH Construction. Steve Stimson, Burkhart Equipment Specialist, referred them to Office Wraps, a Kirkland, Washington dental office interior design firm. One last team member, Maggie Boyle of The Dental Group (CPAs), was instrumental in keeping the project on budget and helping financially plan each step.

As office manager, Monica was at the helm of the project, allowing both Dr. Niemeyer and Dr. Phillips a truly exceptional experience throughout the process. “I felt it was their job to do the dentistry and my job was to keep the project moving along,” says Monica. “We continue that same model with me taking care of the staff and doctors so they can pour their energy into patient care.”

The Largest Infection Control Center A-dec Has Manufactured
Burkhart’s Bill Melius was instrumental in setting up their initial A-dec visits. Bill introduced Andy Hayes, A-dec Manager, who was extremely helpful. “Two trips to A-dec were very informative and the ability to try out different options really helped,” says Dr. Niemeyer. Bill also set up tours of offices nearby to get ideas and see what succeeded elsewhere. As Monica states, “The team we had made the difference. We just couldn’t have done this without a trusted team. I could call Steve, and if he didn’t know the answer, he would point me in the right direction.” Since he knew the office flow so thoroughly, Bill also helped shape the design and set-up, knowing how the staff organized each area. “The sterilization area boasts the largest ICC (Infection Control Center) A-dec has ever manufactured,” says Bill. “Knowing how Silverdale Dental’s team works went a long way toward guiding their choices for cabinetry, delivery systems, and chairs.”

Goal to Keep Warm, Family Feel
When envisioning a new space for his growing practice, Dr. Phillips’ main goal was to keep the warm, family feel of their old space. That proved to be a challenge for Monica. She recounts, “It wasn’t merely to fit as many ops as we could in the new building. We needed to marry Dr. Phillips’ vision of a warm, family feel with Dr. Niemeyer’s more high-tech style. It required a lot of compromise, but the final result delights our patients and staff.” After a few construction and financing hiccups, the crew moved to the new building in late February 2016. The practice includes 17 operatories, including five dedicated to hygiene and three open ops for pedo. Flexibility and consistency are built in to the design: endo carts can wheel in to any op; an endodontic operatory with microscope and surgical suite are available; and each operatory cabinetry is the same, providing efficient use of time when seeing patients, restocking supplies or training a new assistant. The space has none of the large, cold clinic feel, but offers a comfortable and comforting blend of warmth and top-flight design.

Long-Held Belief in Good Systems
A central idea maintained throughout the practice is a long-held belief in good systems. For patients to experience the highest level of care, Dr. Phillips long ago created standardized references for each area of the practice. Using three-ring binders with pictures and step-by-step descriptions of how to do tray set-ups, make a retainer, and check-in a patient provide consistent and thorough training for the staff. For their current team of 30 to work smoothly and assist with eight different providers ranging from general dentistry to endo, they provide detailed instructions. Monica explains, “Each doctor has a main or lead assistant. Their second assistant sometimes floats due to our rotating schedule of doctors. Just like our doctors have specialties or areas of interest, the dental assistants also want to do more in each area. Any assistant can step in; that’s where our manuals come in to play. It helps them learn specifics for each provider.” The secret to both attracting and retaining that high level of assistant is selective hiring up-front. “Then because we are a large practice and are open a wide range of hours, we try to be very accommodating with their schedules and family lives,” says Monica. “We take care to nurture our staff and have fun while working hard.”

Getting Patients in to See Specialists Without Leaving the Building
All the new space and trained staff are already well-utilized, welcoming an average of over 100 new patients per month. One of Dr. Phillips’ goals was to provide comprehensive general and specialty care to his patients. Dr. Niemeyer explains the philosophy. “We can offer them everything here within our walls. So often, in the past, when we would recommend our patient see someone down the street, they didn’t follow through. Now, we can get a patient in to see a specialist quickly, without having to leave our building. Our entire staff has been elevated through exposure to all specialties. We have higher quality assistants because they have to be flexible and learn many different styles and procedures.”

Today, Silverdale Dental’s providers include general dentists Dr. Jason Niemeyer, Dr. Jeff Phillips, Dr. Sherrill Conner, Dr. Corinne Reschenthaler, Dr. Grant Reschenthaler; pedodontist, Dr. Kaitlin Neste; periodontist, Dr. Tracy Scott; and endodontist, Dr. Tina Olsson.

The entire team adheres to a set of values set long ago by Dr. Phillips: Inform before you perform, no surprises. Create happy patients. Stay on time. Exceed our patient’s service expectations. People before things. Offer treatment options. “These are the team values that have served us well. It’s the way we treat our patients, ethically and honestly,” says Monica.

Practice Includes Pediatric Care
The practice’s “family orientation” is exemplified by the story of their pedodontist, Dr. Kaitlin Neste. Dr. Neste first came to the practice as a young patient then worked as a sterilization tech during college. After attending dental school, Dr. Neste elected to pursue pediatric dentistry. Although it was never a given, the team was thrilled when Dr. Neste joined the practice and now offers pediatric care. “(Silverdale Dental) is so patient-centered. We care about our patients as if they were family. Now, the fun is being on the other side and seeing all the things that go in to making that happen,” relates Dr. Neste.

In reflecting on the unique professional environment at Silverdale Dental, Dr. Niemeyer describes, “Once in a while, there’s a day when I’m by myself. It makes me realize how there’s more stress on me with no one around for collaboration. I will have a longer career in dentistry because I have lower stress and have a great group of doctors around me.”

Dr. Phillips sums it up as he looks around this dental home to so many patients and a welcoming space for the community. “This place is pretty unique and more of a ‘heart thing’. I love the legacy of this place, the slow ethical growth that got us here, and the terrific partners I share it with. I am truly blessed.”

It’s Never too Early to Develop a Retirement Plan

By Doug Fettig, CPA, MBA

I met with a client recently who asked for advice regarding the sale of his dental practice. He has served patients faithfully for over 40 years, but would like to retire and spend more time with his family. He also has hobbies and dream vacations he’d like to pursue.

I’d like to tell him the road ahead will be easy. If he had a long-standing corporate or government job, he might have had the flexibility to set a retirement date and then sit back and wait for his gold watch, going away party, and retirement benefits. Unfortunately, he isn’t guaranteed a successful sale of his practice, nor a firm timeline for ending his life’s work. Even if he finds a suitable buyer, the net proceeds from the sale may not meet his expectations.
For dentists, the difference between a smooth and bumpy road to retirement is advanced planning. Whether you are just starting out or preparing for your “encore years,” the sooner you get a handle on your long-term financial picture and the keys to building a saleable practice, the better off you’ll be.

Three Common “Speed Bumps” on the Road to Retirement
Between 2001-2013, the average retirement age for dentists increased from 64 to 69. While a variety of factors contributed to this five-year extension, the following “speed bumps” played a role for many practitioners.

1. Unrealistic Assessment of the Practice’s Market Value
Purchase prices for dental practices generally range between 60-80 percent of annual collections. This figure includes the present value of the tangible assets (e.g., building, equipment, receivables) as well as “goodwill.” The latter equals the estimated future value of patient revenue streams and comprises the overwhelming majority of the valuation. A drag on valuation occurs when:

• The operatories and front office use dated technology that is inconsistent with modern dentistry and practice management
• The building and/or office space needs substantial repair to function appropriately and attract the desired clientele
• The number of active patients has dwindled and/or reflects a healthy share of “loyalists” who may defect when ownership transfers

2. Insufficient Wealth Accumulation Outside the Dental Practice
While dentists count themselves among the upper echelon of wage earners, many labor under the weight of an immense amount of debt. Student loans for recent graduates can tip the scale at $300,000. They may need to come up with $700,000 or more to buy into a practice. Hefty home mortgages, car loans, and tuition payments for their offspring add to the debt load. Add in the country club membership and annual family vacations and there’s little cash to sock away for retirement, let alone the “rainy day” fund.

3. Poor Experience with Dental Associates
A popular exit strategy calls for adding a younger associate to whom the practice could be transitioned at the appropriate time. Some dentists opt for candidates with impressive technical credentials without giving due consideration to the cultural “fit” with existing patients and staff. Others strike it rich on technical and interpersonal competency, but fail to craft a mutually beneficial business arrangement. A parting of the ways robs the practitioner of valuable time to groom a replacement.

Three Steps to a Successful (and Timely) Transition
With advanced planning and attentive implementation of your retirement strategy, you can avoid the “speed bumps” and enjoy a smooth road to retirement. The following three steps help you prepare for a successful transition.

STEP 1: Get Real About What You’ll Need to Support Your Retirement Years
Whether you are starting out or closing in on the final years of your dental career, a clear picture of the “end game” will inform the life decisions you’ll make along the way. This “end game” considers where you hope to live, the lifestyle you intend to support, the places and activities you want to explore, the enduring financial commitments you’ll have, and the legacy you’ll leave behind. With these aspirations in mind, your financial planner can develop a snapshot of what it takes to fund your vision and help you explore options for realizing it.

If you are an established practitioner, your dental advisor can assess the value of your practice while taking a close look at other retirement savings and social security benefits. In consultation with a tax specialist, you can identify future tax liabilities and make determinations on the optimal timing for realizing gains. A close inspection of outstanding debt may reveal opportunities for refinancing that could improve your cash flow.

If you are decades away from retirement, you can take action now to increase the likelihood you’ll retire comfortably in a time frame of your choosing. As noted in the chart above, every year you wait to start saving ups the ante on how much you’ll need to set aside to reach your goals. Armed with these facts, you’re in a position to make informed choices on a variety of lifestyle choices—e.g., from the size of the house (and mortgage) you’ll support to the leisure activities and vacations you’ll pursue. You’ll also devise a strategy for retiring your outstanding education and practice debt while considering the obligations you’ll want to absorb on behalf of your children.


STEP 2: Make Your Practice Attractive to Prospective Buyers
Just like selling your home, a team of skilled experts can take a close look at your practice and help you develop strategies to maximize its value. Best-in-class dental practices demonstrate mastery in seven key areas:
• They have a strong support team that operates at peak efficiency
• They’ve instituted effective patient management processes that ensure a stellar customer experience in all aspects of their engagement
• They make sure their patients come in for routine hygiene appointments and work with them to take appropriate action on recommended treatment plans
• They have the right equipment and software applications to manage the practice, and staff leverages these tools to good effect
• They manage staff time expertly by setting realistic time allotments for all procedures, encouraging strong communication between clinical and scheduling staff, and developing back-up plans to address the unexpected
• They cultivate patient referrals and make effective use of their marketing dollars
• Their financial management provides guidance on fee structures, budgets, cash flow, collections, daily deposits, and bank reconciliations on which the owners and staff take action

If any of these areas prove undesirable, your dental advisor can provide the roadmap and associated support tools to make the necessary improvements. These enhancements will sweeten your bottom line while you continue to own and operate your practice as well as increase its appeal to prospective buyers.

Your dental advisor can also provide guidance on whether to sell or lease your property and equipment when you close up shop. This assessment could include input from a commercial real estate broker on the strength of the local market as well as recommended improvements to make the building attractive to a prospective buyer or tenant. Tax incentives may be available to lower the threshold at which incremental investment makes economic sense. Your dental advisor can point you toward dental-specific lenders who can provide practice loans, working capital, and building loans to fit your particular situation.

STEP 3: Develop a Transition Plan for Your Practice
If you’ve had the good fortune to build up a loyal collective of patients and talented staffers, you need to consider how you’ll care for them once you ride off into the sunset. Perhaps you’ll choose to add an associate and lighten your workload gradually as you make the transition. Or you may prefer to have a “flash cut” after which you’ll simply launch the next chapter in your life story. Either scenario presents considerable impact on others as well as implications for the lead time necessary to implement your strategy.

Your dental advisor can share “best case” and “worst case” scenarios based on experience with similar transactions and help you devise the tactical plans to place your name in the “win column.” In addition to maximizing the potential for staff and patient retention, your advisor can provide guidance on employment/non-compete agreements for prospective associates and navigate the contractual arrangements for selling your practice, leaving open the possibility of continued participation in the field should you choose to do so.

Get Started Today
As noted in the introduction, the sooner you get a handle on your long-term financial picture and the keys to building a saleable practice, the better off you’ll be. If retirement plans are on your near-term horizon, give yourself a five-year lead time to map out a strategy and take action. If retirement is a distant reality, use the plan to make intelligent decisions today that give you the greatest degree of flexibility in the future.

 

Doug Fettig, CPA, MBA, Dental Business Consultant
Doug has over two decades of experience as a CPA and a finance professional, providing him the unique ability to understand dentists’ needs and help them grow efficient and profitable practices. His insight allows him to effectively communicate business concepts to dental practices while strategically addressing tax, investment, and retirement planning needs. Doug has spoken at numerous dental seminars, academies, study groups, and vendor forums around the country and he is known for his energetic, engaging, and entertaining speaking style. As a dental business advisor, he is adept at collaborating with dental practices and incorporating Aldrich’s expertise to help dentists grow their practices and increase their profitability.

Crimson Thread of Connections – Jeff Phillips and SmileHigh North America

By Anne Baer
photos by Dr. Jeff Phillips

 

Some people have an extraordinary capacity for making connections, weaving together experiences and the people they meet into a fabric that provides far-flung comfort for others. When Dr. Jeff Phillips first visited Nepal in 2007 to compete in the Mt. Everest Base Camp Marathon, he did not know his connections from summers in Canada would shape his next adventure. “I knew I wanted to volunteer in either Nepal or Africa. Then one spring, our Rotary Group was invited to Nepal by a long-time friend from Vancouver Island (British Columbia, Canada), and I was hooked.” A lifelong outdoorsman, he was attracted by both the incredible mountains and the simple joy found in the Nepali people.

In the past four years, Dr. Phillips has made five, month-long volunteer dental trips to Nepal. For two years he worked with the Nepal Education Fund of Canada, a small charity that sponsors extremely poor children to attend school. Dr. Phillips self-funded these trips and created an extensive cache of surgical instruments, supplies, and equipment.

Desperate for Dentistry
The need for dental care in Nepal is staggering. With a population of 30 million, the country is served by just 500 dentists. Most citizens will not see a dentist in their lifetime. Dental caries and periodontal disease are rampant throughout the population with untreated pain and infection affecting nearly everyone.

In April 2015, an avalanche above Mt. Everest base camp rocked the area, killing 16 Sherpas who were preparing the climbing route for their Western clients. That day, Dr. Phillips emailed a climbing friend at base camp and offered to bring his dental care to the Khumbu region of Mt. Everest in support of the Sherpa community. With the help of his climbing friends, Dr. Phillips met members of the Sherpa community living in the Seattle area and started preparations to bring a dental camp to the Khumbu.

History of Humanitarian Efforts in The Khumbu
In 1953 after summiting Mt. Everest with Tensing Norgay Sherpa, Sir Edmund Hillary dedicated his life to enriching the lives of the Sherpa community. He helped build schools and hospitals throughout the Khumbu. The first school “Sir Ed” established was in Khumjung at 12,500 feet where Dr. Phillips arranged the dental camp. In a most serendipitous encounter, Dr. Phillips and his Nepali assistant/translator/dental student, Ngima Mendewa Sherpa, arrived in Khumjung on the last day of a dental camp conducted by SmileHigh of New Zealand. “Sir Ed” had supported and inspired Dr. Julian Haszard of New Zealand and Dr. Mingma Sherpa of Nepal to create SmileHigh in 2003 to bring dental health and education to the Sherpa communities of the Khumbu.

A Partnership for Good
Upon meeting, Drs. Haszard and Phillips immediately realized how beneficial they could be to each other. Dr. Phillips could learn from the decade-long experience of SmileHigh, and SmileHigh could benefit from exposure to the enormous dental market of North America.

Back in the U.S. in October 2015, Dr. Julian Haszard, Dr. Mingma Sherpa and SmileHigh’s administrator, Trevor Moyle, met at Dr. Phillips’ home to discuss their collaboration. The result was the creation of SmileHigh North America, led by Dr. Phillips as well as a mutual plan to develop a sustainable year-round dental clinic in Kathmandu. The three operatory clinic, complete with dormitories and kitchen, would allow Western dentists an opportunity to spend a week in Kathmandu. They would volunteer their dental services, pay rent for lodging, get a donor receipt for their good work, and have an opportunity to venture into the exciting countryside of Nepal for a trek, climb, or jungle adventure. The vision: the lodging fee would pay the rent for the clinic while the true winners would be the desperately poor of Nepal struggling with the ravages of dental decay, pain and infection.

Adding A-dec Expertise
The next part of the adventure was when the SmileHigh/SmileHigh North America team flew to Washington D.C. to attend the American Dental Association (ADA) annual meeting. There they met with the ADA Foundation and another serendipitous encounter occurred, this time with Mariah Kraner, PhD, Professional Relations Manager of the A-dec Foundation.

Dr. Phillips was very familiar with A-dec Dental Manufacturing of Newberg, OR as he selected A-dec equipment for his new 17 operatory dental center in Silverdale, WA. Meanwhile, Dr. Haszard had sketched out an architectural plan for the three operatory dental facility envisioned as the SmileHigh Kathmandu Dental Center. Dr. Kraner was very interested in the SmileHigh Kathmandu project for a variety of reasons: SmileHigh had operated in Nepal for a decade; the Kathmandu clinic would be utilized full-time and managed by a Nepali dentist; it would provide free dental services from a Western volunteer dentist; and it would be nearly self-supporting due to the lodge fees charged to guest dentists.

All the threads of connection were coming together. Dr. Phillips spent most of January 2017 in Nepal visiting the Khumbu villages of Khumjung and Phortse, home of the Khumbu Climbing Center. While there, he provided treatment to needy villagers. Newly graduated from dental school in the Philippines, Dr. Ngima Mendewa Sherpa plans on taking the Nepal dental boards this spring. She is delighted about the possibility of managing the SmileHigh Kathmandu Dental Center. Dr. Phillips and his pro bono lawyer friend, Brian Lawler, are busy completing the SmileHigh North America 501(c)3 non-profit application. Dr. Phillips plans to spend a month in Nepal this autumn, working in the Khumbu and finalizing plans for the SmileHigh Kathmandu Dental Center.

Where Luck and Purpose Collide
Dr. Phillips feels blessed by the serendipitous events that have occurred in his life journey, providing adventure, good health, and purpose. His message to other dentists interested in sharing their skills is “stay healthy and be an asset!”

Small Changes for a Big Difference

By Rhys Spoor, DDS, FAGD, Accredited Member of the American Academy of Cosmetic Dentistry

 

This case involved a pleasant young woman who wanted to improve her smile. In her history she noted a traumatic injury where #9 was partially avulsed and subsequently had ankylosed (Figures 01, 02). She also wanted her teeth to be a more uniform color and lighter (Figure 03). Teeth #7 and #10 had prominent horizontal fractures that were likely from the same accident and had been and still were vital and asymptomatic (Figure 04). Tooth #8 was also facially placed in the arch (Figure 05).

    

We gathered records to treatment plan the case and decided a direct mock-up of the desired result would be appropriate. A diagnostic wax-up was done and then transferred to the mouth using B1 Luxatemp. The patient’s father, a retired dentist, was present to see the mock-up (Figure 06). Having a friend or family member present at the mock-up reveal is often helpful to support a decision made by the patient.

The treatment plan included periodontal evaluation and oral prophylaxis, whitening, osseous crown lengthening #9, mesio-incisal composites #6 and #11, ceramic veneers #7-#10 and a post-treatment maxillary full occlusal night guard.

Cord was packed in the facial gingival sulcus on tooth #9 and a direct composite veneer was placed before surgical crown lengthening (Figure 07). The gingival contour was left over contoured until after the flap was made for the surgical access (Figure 08). The intra-sulcular flap was incised with an ophthalmic micro crescent blade and the attached tissue blunt dissected and stretched to allow slow speed round bur access for osseous reduction. The gingival aspect of the composite veneer was then recontoured to place the facial height of contour more apical than the original tooth shape. This would allow for more symmetric healing of the gingival form compared with #8. The site was stabilized with one 6-0 Ethicon Prolene horizontal mattress suture (Figures 09 and 10).

   

After eight weeks of healing, teeth #7-#10 were prepared for ceramic (Ivoclar eMax) veneers. To keep the preparations as conservative as possible, a stent with Luxatemp (Figure 11) was placed over the teeth and depth cuts were made through the material with a 0.5mm wheel diamond (Figure 12). The Luxatemp material was then removed leaving depth marks where reduction was necessary, but other areas required none (Figure 13). This technique allows for maximum conservation of enamel that is good for strength, bonding and reduces possible sensitivity. Excellent aesthetic provisionals were made to most importantly test the function and psychological acceptance of the patient (Figures 14 and 15).

    

Often, the final restorations are custom characterized (Figure 16) at the delivery appointment. The final results have symmetry in shape, texture and color (Figures 17 and 18), and blend into the envelope of function. Excellent marginal integrity, contours that are biologically compatible, along with good oral hygiene are the reasons for the excellent gingival health (Figure 19).

   

Even though these are small individual changes, the sum total is apparent in the final photograph—a pleasing smile and a happy patient (Figure 20).

 

Dr. Rhys Spoor is a 1983 graduate of the University of Washington where he was an Affiliate Assistant Professor in the Department of Restorative Dentistry for 10 years. He is an Accredited Member of the American Academy of Cosmetic Dentistry, a Fellow of the Academy of General Dentistry, the International Dental Implant Association and the Pierre Fauchard Society. He is also an Editorial Reviewer for the Journal of Cosmetic Dentistry. Dr. Spoor maintains a private practice in Seattle in aesthetic, implant and restorative dentistry. Dr. Spoor also is currently offering hands-on live patient treatment programs in aesthetics through The Center for Exceptional Practices (www.exceptionalpractices.com). He may be contacted at spoordds@msn.com.

SSG Helps Oklahoma Practice Be More Profitable and Efficient

Lauren Engles, Janelle Lott and Casey Kennedy, Burkhart Account Manager

This Supply Savings Guarantee outlines the perspectives of Lauren Engles and Janelle Lott regarding the positive effects the SSG has had on them and their office. Lauren and Janelle work for Dr. Terry Reavis in Bixby, Oklahoma. Lauren is the office manager/lead assistant. Janelle recently took over the responsibility of ordering supplies when Lauren was on maternity leave.

Dr. Reavis just completed his third quarter working with Casey Kennedy and Burkhart Dental on the Supply Savings Guarantee and the results have been impressive. In the last nine months, the percentage of gross production Dr. Reavis’s office spent on supplies dropped from 5.52% to 4.36%—a savings of more than $15,000.

WHAT WAS IT THAT MADE YOU WANT TO WORK WITH BURKHART?
Lauren: “The Burkhart team came in and did a ‘What a Great Supply Rep Does’ presentation. I was impressed with the presentation and it came at a great time. I was about to go on maternity leave and needed a system of ordering that I could transition to Janelle who would be taking over that responsibility. I was doing most of my ordering from catalogs and thought I was saving money, but I was spending about three hours every Wednesday morning putting an order together.”

Janelle: “I had worked with Burkhart in the past, so I already knew what they could do for our practice. I had a positive experience with them at another office.”

WHAT WAS IT ABOUT THE GUARANTEE THAT ORIGINALLY CAUGHT YOUR ATTENTION?
Lauren: “We like to be as thrifty as possible. Margins are tighter and reimbursement seems to be going down. We are always looking to save wherever we can. We figured with the guarantee, we had nothing to lose by trying it for a year to see what happened.”

WHAT PART OF THE SSG DO YOU FIND MOST VALUABLE TO YOU AND YOUR PRACTICE?
Janelle: “Costs have gone down and it saves us a lot of time. I know Casey is going to take care of the order and I don’t have to worry about it. I don’t have to spend a half day putting an order together like Lauren used to do.”

HOW DOES YOUR BURKHART ACCOUNT MANAGER HELP YOU REACH YOUR GOALS?
Lauren: “Casey does a good job of describing alternate products that offer a better value. He researches products for us and keeps our costs down. I also really like the return policy and process. We feel comfortable trying his recommendations knowing we won’t be stuck with a product if we don’t like it. All of these things help us be more profitable and more efficient.

We also appreciate the free goods. Free goods are really important and we get them quickly.

We recently finished three quarters of doing business with Burkhart and Casey showed us that we have saved more than $15,000.”

HOW HAS THE SSG HELPED YOUR BUSINESS?
Lauren: “Before the SSG, we didn’t feel like we had a reliable service technician who we could depend on. It was frustrating not always knowing how long it would take a service tech to get to our practice. By agreeing to the SSG, we found out we would receive a 25% discount on service, so we gave Burkhart a try and met Tim Williamson. Tim has been great to work with. He knows what he is doing. We can rely on him being here when we are told he will be here. Tim and the Burkhart service team have really helped our business.”

IN WHAT WAYS DOES YOUR BURKHART ACCOUNT MANAGER HELP YOU AND YOUR TEAM?
Janelle: “Casey helps us spend less time ordering. He has helped us be more efficient. He has helped our bottom line. We are a very busy practice and we are growing. I don’t need to worry as much about the supply order, and I can focus on other things that are more productive than ordering.”

WHAT WOULD YOU SAY TO A DOCTOR CONSIDERING THE SSG PROGRAM?
Lauren: “We went into the SSG thinking, ‘We’ll give it a shot. We can’t lose anything.’ I was looking for an ordering system I could transition when I was on maternity leave. The SSG and Casey provided that system. Burkhart has been great to work with and the SSG has gone better than expected. We have saved a lot of money and become more efficient. I would tell other offices considering the SSG to give it a try. You can’t lose.”

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