Using Technology to Impact Patients and Enhance Practice Productivity

Douglas W. Voiers, DDS Private Practice Avon, Ohio Phone: 440.937.5432 Email: Web site: www.cosmeticfamilydental.com

Abstract

The 21st century has ushered in a new era of dental technology that has the potential to increase diagnostic capabilities, control disease, reconstruct the dentition, and enhance physical appearance. Such changes within the dental profession have paralleled societal attitudinal changes in human lifespan, health, and appearance. Dental practitioners are faced with a multitude of decisions that can affect the direction of their dental practice from both practice management and clinical perspectives. This article examines the traditional family practice model and its relevance to these issues. An emerging practice model will be discussed that takes into consideration the dynamic relationship between advanced dental technologies, increased patient expectations, and new directions in dentistry.

Like never before, dental practitioners are faced with a multitude of choices. Whether considering new diagnostic tools, treatment technologies, or communication ad­vance­­ments, dentists must make im­portant decisions that serve the best interest of their patients, their dental practice as a business, and their personal lifestyle preferences. How the choices are implemented is critical to establishing a profitable and ethical practice that is positioned to grow and prosper as societal demands on dentists transform.

The Family Practice

It is time for dentists to examine the changing landscape of our profession and explore the relevance of the traditional family practice model. Dentists can no longer rely on methods of the past to meet the needs of today's savvy dental consumers. Since the 1960s, traditional family dental practices have operated in a fairly consistent and predictable pattern. Starting in the 1980s, variations in this practice model arose. Multiple-provider clinics cropped up all across America. Then, cosmetic boutique-style dental practices emerged as esthetic dental techniques and materials developed and society be­came more health- and beauty-driven. At the same time, the adult-only reconstructive practice came to fruition as postgraduate institutes provided dentists with the knowledge and techniques required to deliver care to an aging population who increasingly longed to retain their natural teeth for a lifetime.

In recent years, though, a shift has developed in the way dental practices are operated that requires a change in the philosophy of those who wish to retain their family practice identity. Dental insurance, increased competition in metropolitan areas, surging overhead expenses, and ever-increasing expectations for esthetics and quality on the part of the general public all are placing increased burdens on family practice dentists. Patients will inevitably pigeonhole dental practices into one of the categories previously described and make decisions as to which type of practice best meets their needs.

In the 21st century the family practice will incorporate multiple new technologies and offer cosmetic dental services for patients of all ages and socioeconomic levels. This model can enhance practice productivity while maximizing the total patient experience as well as increasing the potential for greater acceptance of both needed and elective services. Further, the dentist and the dental team can experience a greater sense of job satisfaction.

Creating the WOW Factor with Technology

Figure 1—When designing a new office space, I considered how the outside of the building sets the initial tone for our patients’ visits.

Figure 2—I concentrated on the office entryway, believing that first impressions are indelible.

Figure 3—Trying to imagine a space unlike those of traditional dental offices, I had creature comforts installed in our lobby.

Using advanced technology creates a true WOW factor, which has the potential to stimulate word-of-mouth referrals to quality-conscious people in your community who are looking for this type of practice, regardless of their economic status. People from all walks of life now actively seek cosmetic procedures from practitioners who exhibit technological knowledge and expertise. Such a comprehensive dental practice model can be implemented in the traditional family dental practice. The dentist will need to evaluate the various technologies in an objective manner, weighing the pros and cons and studying the return on investment for each.¹

The 21st-century dentist should use technology not only as an extension of his or her diagnostic and clinical skills, but also as a patient motivator for moving forward with treatment. Demonstrating a high level of capability helps build patient confidence, thereby generating a higher rate of case acceptance. I have found that the ability to properly treat patients and get them to a healthy oral condition is directly related to the dentist's motivational skills and those of the dental support staff.

Practice Philosophy

Your core practice philosophy is where your mission is developed. You will need a vision for both your practice as a business and your clinical care. When carried out in everyday practice, each aspect of daily life in your office should be congruent with your practice vision and your philosophy of care. With the media's attention on make­overs, people of all socioeconomic levels and age groups have developed a focus on esthetic services. People who just a few years ago would have never thought of enhancing their image and appearance with cosmetic or restorative dentistry are now searching the Internet for dental offices that can provide elective services. Therefore, to remain successful, you will need to develop a vision for your practice that takes into consideration your patients' current mind-set.

Your ideal dental practice is created by you. As the practice owner, you decide what kind of dentistry will be performed as well as in what kind of environment it will be performed (Figure 1).

When developing my practice, I visualized myself as a patient walking in through the front door (Figure 2). Behaviorists have found that when people experience something new for the first time, the first few seconds of that new experience leave a powerful and indelible impression on the subconscious mind.² I wanted a strict departure from all of the negative stereotypes that patients thrust upon dentists, so I imagined the colors, shapes, smells, and textures that would be most unlike those of traditional dental offices (Figure 3). I wanted to ensure that from the moment patients first walk into my office to the time they leave at the end of an appointment, every sensory cue they experience is consistent with my vision of a modern, advanced technology, cosmetic dental practice. In addition, my philosophy of complete dental care and customer service satisfaction is consistent with my dental methodology. One does not fight against the other in the subconscious mind of my patients.

There are of course, many ways to design a dental practice and I am not suggesting that my model is a one-size-fits-all solution. But having graduated in 1985 at a time when dramatic changes were occurring in our profession and in our society, I have been forced through the years to make many major adjustments to my practice vision and infrastructure. Having gone from rubber-based impressions to infrared camera im­pressions in the past 20 years, I think it is safe to say that change is the order of the day and must be embraced to continue to prosper and serve our patients' dental needs. I believe that modern dental practices should offer the most advanced diagnostic and treatment modalities available, combined with a broad range of elective cosmetic dental services, within the family practice setting. Today's dental practice must strive to cultivate an image that clearly challenges the patients' preconceived notions of dentistry while dispelling the negative stereotypical images that are still pervasive among the general population.

Through my teaching experiences, I have had the privilege of getting to know thousands of dentists across America. I have found dentists to be conscientious and sincere. Dentists want their patients to understand that the clinical dentistry they deliver is exceptional and performed to the very best of their abilities. However, dentists simply cannot assume that patients fully understand what constitutes quality dentistry and how to identify it. Dentists often believe that if they simply work hard to provide quality dentistry, the quality will speak for itself. Unfortunately, the average dental consumer is not armed with enough dental knowledge to differentiate the varying philosophies and technical skills dentists provide. Sadly, clinical excellence is not enough to succeed. All too often, from our patients' points of view, a crown is a crown and a dentist is a dentist. That is, unless we show them otherwise.

How, then, can dentists best distinguish their practices and themselves to achieve their objectives? This is best done, I believe, by exceeding patient expectations in dental office appearance, design, atmosphere, the services provided and, most of all, the technology used as an extension of capabilities. Excelling in these areas will break down those tired old stereotypes of the drill-n-fill dentist/mechanic who primarily removes teeth or places fillings to repair teeth. We must motivate our patients by showing them that we are aware of the past and conscious of their need for a new approach to dentistry and patient care.

Technology Integration

Figure 4—Our 21st-century treatment rooms integrate our many technologies.

Figure 5—Our cabinetry was designed for computer integration.

Today, dentists are acquiring new technologies for their dental offices like never before, trying to integrate a wide variety of technologies that were not in existence 10 years ago. Therefore, dentists must perpetually gain the necessary knowledge through reading the literature, attending professional and technology meetings, participating in continuing education, and studying changes in consumer attitudes and business practices. Being profitable directly correlates to the ability to deliver quality care. Integrating technology enables clinicians to extend their diagnostic capability and deliver clinical care at a highly sophisticated level.

Most family dental practices have one or more of the newest technologies. However, quite often these technologies were not purchased with an overarching vision or integration strategy. Fortunately, it is never too late to adopt a comprehensive vision for your practice and for technology integration. It is not necessary to put all available technologies in place at once and, in fact, in many cases it is counterproductive to do so. Every practice is unique and every practitioner has his or her level of comfort. Focus should be given to purchasing technologies that are congruent with your practice philosophy and will move your practice sequentially closer to your goal.

Team training for each technology is extremely important and should be done gradually over spaced intervals so that employees can assimilate properly without being overwhelmed. Every Tuesday, our office has a 90-minute extended lunch period so that on any given week, we can have in-service training when needed. Having the entire team attend continuing education seminars is also a critical element of 21st-century dental practice.

Evaluating Technologies

When making a technology purchase, I expect it to meet one or more of my personal and professional expectations. To determine this, I ask myself the following questions.

• Will it elevate the quality of my clinical dentistry?
• Will it increase my diagnostic skills?
• Will it enable me to communicate better and patients to understand better?
• Will it maximize operational efficiency as well as dentist and staff time?
• Will it streamline my business op­erations?
• Will it allow me to spend less time in the office by making me more productive per hour?
• Is it congruent with my practice vision and objectives?
• Will it make my daily office life more enjoyable?
• Will it ultimately enhance my lifestyle?

Infrastructure and Operatory Design

Another, often overlooked aspect of technology integration has to do with office design. Today, many new offices are being built or older offices remodeled in an effort to upgrade the operational capability of the practice. I am continually amazed, however, at how many dentists will undertake construction of a new dental office without proper consideration to the physical placement of technologies they are considering now or that could be considered in the future. The infrastructure for various technologies should be built into any new or remodeled office. The practice does not have to be brand new, but it may be difficult to incorporate some technologies into existing dental offices. Careful planning, with total technology integration in mind from the beginning, is critical for a successful outcome. Any dental practice can be transformed into what you want, it just takes planning.

In my practice, we have 15 computers that operate almost everything—scheduling, insurance filing, financing plans, treatment plans, patient files, intraoral camera images, periodontal charting, digital radio­graphs, patient communication, and practice management parameters (Figure 4). The foundation for this level of technological integration is the computer hardware and software systems, which are the lifeblood of the dental office's technology. Almost all digital technologies must seamlessly integrate with the software platform. Today, photo imaging, digital radiography, and practice management software can be linked together digitally without separate software programs. Setting up integrated systems requires careful consideration and planning. The computer tower, keyboard, and monitor will need to be placed in the operatories and throughout the office so that they are easily accessible and do not create clutter, reduce clinical workspaces, or compromise infection control protocols. Such issues as power supply, ventilation, cooling, and ease of service access also must be addressed during the planning stage.

Careful consideration must be given to operatory design during office construction or remodeling. The double rear-entry treatment room typically allows for maximum use of space and technology integration. By having patients enter from the rear, facing a window if possible, provides a sense of privacy and space. Each treatment room in my office has 3 video screens. The first, dedicated to entertainment, is mounted near the ceiling to maximize viewing capacity for the patient during typical treatment chair positions. The second, dedicated to scheduling and practice management functions, is mounted behind the patient's view on a rear delivery unit arm. The third, our diagnostic and communication portal, is positioned physically to be a third "person" in the room. Both the dentist and the patient can see the screen to discuss treatment during codiagnostic or consultation appointments. Our intraoral camera, digital radiographs, and patient education system all run through that readily accessible monitor.

For those who may not be able to physically change the configuration of their dental operatory, there are a variety of ways to technologically enhance and upgrade. New dental cabinetry is designed for greater efficiency and technology integration with specific areas dedicated to computers, wiring, and communication portals (Figure 5). New chair and delivery systems allow for computer monitors and integrated intraoral cameras, ultrasonic scalers, and electric handpieces.

Figure 6 and 7—Digital radiographs and intraoral camera images can help dentists get patients to graphically visualize their dental conditions firsthand.		Figure 8—Using the CEREC 3D system, our office can provide single-visit crown-and-bridge procedures.

Impact of Technology on the Patient

Several new technologies can significantly impact the dentist's ability to render high-quality care. Dentists often experience frustration trying to get patients to realize that painless dental problems actually exist, not to mention the problems faced in motivating patients to act before symptoms arise. Often dentists believe money is a real obstacle to treatment plan acceptance. However, my experiences have led me to believe that one of the keys to treatment acceptance lies in the ability to get patients to graphically visualize their dental condition firsthand. This is one reason I believe digital radiography and intraoral cameras combine to make an incredible impression on our patients (Figures 6 and 7). It is not unusual to hear phrases of incredulity uttered by patients who have never seen their own teeth up close, much less seen their own carious lesions and gingival inflammation. These pictures, along with caries-detecting devices that register an audible tone of varying frequencies when caries is detected, allow patients to gain a sense of control and ownership of their dental problems. No longer does it have to be your word against theirs in that all too familiar tug-of-war of doubts. Seeing is believing, and there is no denying the power of images.

Patient education systems, such as Caesy Enterprise (Caesy Edu­cation Systems) can help you con­cisely and visually explain conditions and treatment options to patients. Digital radiography uses less radiation, allows for enhanced image quality, and is far more efficient and practical than standard film techniques.³ Digital radiographs can be easily integrated with your electronic records, facilitating faster insurance submission with electronic claims processing and improving archival quality with less storage requirements. Plus, you no longer will experience broken film processors or need to purchase processing chemicals.

Chairside CAD/CAM systems provide dentists with total control over the final outcome of their restoration in terms of fit, morphology, and esthetics. With these systems, traditional impressions and 2-appointment protocols are no longer required, reducing crown-and-bridge treatment to a single visit, which meets the needs of today's busy patients (Figure 8). CEREC 3D software (Sirona Dental Systems, LLC) comes with a biogeneric database that simplifies the delivery of restorations by proposing a final tooth anatomy based on the variance from the residual tooth structure to the average-shaped tooth. Everything from inlays to full crowns and veneers can be quickly fabricated with accuracy and strength. Patients often enjoy watching the computer-design process and are highly impressed. Chairside CAD/CAM systems provide a high return on investment because they can eliminate many dental laboratory bills and dramatically increase your production of onlays and three-quarter crown procedures, which are in increasing demand.

Dental lasers now are used for a variety of procedures, including cavity preparation, caries removal, tooth whitening, tooth etching, and soft-tissue procedures. Unlike lasers of the past, many of the newest generation diode lasers are extremely compact and easily transported from operatory to operatory.

Figure 9—The photo gallery subtly emphasizes our practice’s esthetic focus.	Figure 10—The SIROLaser (Sirona Dental Systems, LLC) demonstrates that our practice uses advanced technologies.	Figure 11—Placing our sterilization unit open to the hallway shows our diligence for infection control.

Power of Technology

Do not underestimate the power that technology has to create the practice of your dreams. Patients today are enamored with technology and often equate it with a higher level of quality of care. The days of the dental patient believing that "because the dentist said it, it must be true" are over. Armed with access to unlimited information, many patients research products, procedures, and dentists online. They come into the office armed with information and they ask insightful questions about procedures. Many expect to see digital radiography, intraoral imaging, lasers, and other advanced technologies.

Patients intuitively rely on subtle sensory cues as well as their previous personal experiences to judge quality (Figure 9). In my office, new patients are taken on a guided tour when they arrive for their first dental visit. The new patient tour is a visual illustration of the practice philosophies of care and customer service. As patients are guided through the lobby and into the patient areas, they get the impression that we are detail and customer- service oriented. They get the sense that we are acutely aware of their needs for comfort and a relaxing environment. The tour highlights the elements of the practice that we want to emphasize, such as the degree of dental education, esthetic focus, advanced technology, and health and wellness orientation. As the tour progresses to the clinical treatment areas, the staff points to and discusses the key, high-impact technologies (Figure 10). Patients are encouraged to ask questions at any point along the tour. We built our sterilization center among our operatories, open to the hallway where our patients can see our concern for proper infection control and sterilization protocols to ensure their safety (Figure 11).

The very last thing patients are shown before being seated in the operatory is our CEREC 3D system. We have carefully positioned it in a nook at the end of the hallway in full view. Patients are given a thorough explanation of the many benefits the system can provide. Then, patients are seated in the operatory where our concierge introduces the dental assistant, who then continues to orient the patient to the technologies found within the treatment room. Finally, I enter the room and become engaged with the new patient, who is now fully indoctrinated as to the wonders of our 21st-century practice.

Conclusion

Whatever you want for your practice can happen, provided you have a clear vision and carefully plan your future. Technological developments in dentistry make it possible to create a unique environment for your patients to experience all the wonderful things dentistry has to offer for them and their families. I have developed what I believe to be a 21st-century practice that reflects my personal and professional beliefs, a practice that serves as an outward demonstration of my values. Incorporating cosmetic services and advanced technologies into the family practice setting can help you define your position in the highly competitive dental marketplace where pa­tient-centered orientation is a prime factor in success.

Disclosure

Dr. Voiers is a CEREC 3D trainer for Patterson Dental Supply, Inc.

References

1. Owen RD, Owen K. Weigh the digital "WOW" factor. Int J Orthod Milwaukee. Fall 2005; 16;32.
2. Gifford R. Environmental Psychology: Principles and Practice. Boston, Mass: Allyn & Bacon Publishers; 1996:16-45.
3. Samaras C. Technology and money in dentistry. Dentist's Money Digest. Sept/Oct 2002;22.