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February 2014
Volume 35, Issue 2

7 Keys to Crafting a Vibrant Periodontal Practice

Jennifer Hirsch Doobrow, DMD

A recent Centers for Disease Control (CDC) study shows 47.2% of adults 30 years and older have some form of periodontal disease, with the number jumping to 70.1% for adults 65 and older. Dentists and dental specialists are in the unique position of being at the forefront of evaluating, treating, and eliminating this rampant disease.

To treat these ailments, most patients have many options from which to choose; there may be numerous providers in their geographical area. Therefore, what can dental clinicians do to establish their practices as premier providers in this vital area of dentistry while remaining profitable? It is important to balance both patient care and business acumen. In virtually any economic climate—and particularly in a difficult one—there are strategies dentists can implement to grow their maintenance/recall programs, bolster their implant practices, and enhance and cultivate their relationships with referrals. Clinicians can strive to seek out opportunities to regularly educate themselves and their team, and they can make a conscious effort to establish a particular “brand” to distinguish their practice. The following suggestions can be used to achieve these goals.

1. Oral Hygiene Program, Including a Periodontal Regimen

For periodontists, the core of a practice should be the business of prevention. A strong dental hygiene program provides prophylactic care in a timely fashion and permits a vehicle to address patients’ current needs. The dental hygiene department is the heartbeat of a practice.

Clinicians should work with dental hygienists to establish a defined retention program using a 3-, 4-, or 6-month recall, or 1-year implant maintenance program specific to each patient. It is imperative that patients are on alternating recall programs between a periodontal practice and the referring dental office. Alternating recall programs are extremely important to provide comprehensive care for patients, ensuring they do not “fall through the cracks” and aiding in continual communication between the dental specialists and their referrals.

By focusing on this fundamental aspect of a practice, clinicians will not only continue to provide the best care for their patients, but they will also promote steady contact with their referring teams, leading to sustained financial success within a practice.

2. Implants: An Alternative for Endodontic and Crown and Bridge Procedures

There are significant benefits to dental implants as a treatment option for tooth replacement without compromising healthy teeth. While not all patients are candidates for dental implants, clinicians need to include this treatment modality when discussing replacing missing teeth versus conventional endodontic and crown and bridge procedures. By neglecting to do so, the clinician is failing to provide the patient all credible options—and risks losing the patient to another practice.

When patients ask, “What would you do if this was your mother, father, etc?” it is imperative to not only discuss all treatment options, but also emphasize why these options are being presented. For example, depending on the case, simply replacing one single tooth with a dental implant may be more reasonable than grinding down perfectly healthy teeth, which could lead to greater risk for cavities and eventual tooth loss. Many articles, including a systematic literature review published in 2013,1 have confirmed that for single-tooth replacement, an implant is as cost-effective of a treatment option as a traditional three-unit dental prosthesis.

3. Incorporating Implants and Overdentures Into the Practice

According to the American College of Prosthodontics, more than 35 million Americans are fully edentulous: 23 million are completely edentulous, and 12 million are edentulous in one arch. Ninety percent of those who suffer from edentulism have dentures, and the number of partially edentulous patients will swell in the next 15 years to more than 200 million individuals. Periodontists are uniquely positioned to help improve the quality of life for these individuals.

Millions of people around the world wear conventional dentures without support and struggle to retain them in the mouth. While not all denture wearers are candidates for implants, it is the dental professional’s duty to properly educate these edentulated individuals on their options for treatment, including but not limited to fixed dental implant-supported overdentures, removable dental implant-supported overdentures, or dental implant-stabilized overdentures.

Patients treated with implant-supported or -stabilized overdentures will need more treatment and time in the dental chair than a patient with conventional dentures. The same systematic literature review mentioned previously1 supports this process, discussing how replacing multiple teeth with dental implants (fixed or removable prostheses) is associated with higher initial costs but also improved oral health-related quality of life compared with other treatment options.

4. Learning the Latest Periodontal Procedures and Products

Individual sales representatives walk into offices daily selling the newest products and processes, and in many instances these options would be great additions to most practices’ armamentariums. However, before purchasing anything, clinicians should do adequate due diligence. While this may seem self-explanatory, doing homework up front will save time, money, and aggravation over the long run. For instance, introducing digital x-ray and 3-dimensional (3-D) CBCT technologies has been a “game changer” for many practices; but this decision should not be made hastily. It can take months to review copious amounts of literature, discuss with references currently using these products, and complete adequate hands-on training before agreeing to make such a sizable investment. Not all decisions will require such intense scrutiny, but by taking time and doing homework, clinicians can help ensure that they are acquiring the most efficient and effective product option(s) that will provide the greatest return on investment.

5. Investing in Periodontal Technologies

New technologies are intended to make work (and life) easier and help create a more marketable practice. Investing in the right practice management software that explicitly meets the needs of the dental practice will enable a clinician to be more efficient and productive with scheduling, communication, and billing. For example, the addition of periodontal-specific practice management software can be instrumental in the growth and maturation of many periodontal practices.

Incorporating dental patient education software into a practice is also essential. For tech savvy clinicians there are a variety of iPad® or iPhone® apps that can add significant value as well. Using this software is invaluable to help explain the benefits of treatment and the consequences of non-treatment to patients. While clinicians would like to think that patients leave the office with a full understanding of everything that has been discussed, unfortunately this is not always the case. To enhance case acceptance, give patients the opportunity to also visualize what is being explained to them. Make sure referrals are aware that not only does the practice have these products but outline how it will benefit their offices and the patients they refer.

6. Developing Relationships with Other Dentists (GPs and Specialists)

Cultivating relationships with referrals is fundamental to a dental specialty practice. One must foster these relationships with the entire referring office, not just the doctor, and there are a variety of ways to do so. Certainly, everyone enjoys being recognized and receiving tokens of appreciation from time to time. When warranted, periodontists should not discount the value of sending a random gift to those at the referring office, just to remind them that they are only a phone call or email away.

Education is an extremely beneficial way to foster these relationships. Coordinate and commence, or get involved with, an existing study club with referring doctors. Providing continuing education (CE) courses for referring doctors and their offices can be extremely lucrative and serve as a significant practice builder. For example, start an annual hygiene symposium, a new doctor study club, lunch-and-learns, or offer CPR courses through the dental office. There are a variety of ways to educate referring offices and develop relationships with the dental community.

7. Post-Graduate Education for Periodontists

Dentists and dental specialists are charged with the task of staying up to date with the constantly evolving dentistry profession. Endless learning opportunities are available. Local and national dental societies and dental associations constantly produce quality research that is easy to digest. In today’s cyber world it has never been easier to attend a meeting or webinar, receive an e-newsletter or journal, or participate in blogs and forums. There are infinite opportunities to attend meetings in person to improve techniques on hard- and soft-tissue regeneration, implant site development, implant placement, and the like. It is important to give back to the community; if the opportunity and time is available, get involved with a dental school in the area. This will not only be rewarding to the students but an invaluable experience for all, as students often pose questions that the instructor may not have heard yet. Moreover, the students’ thought patterns will likely be similar to those of the patients who sit in dental chairs.

The term “practicing” is not used arbitrarily when it comes to dental clinicians. Practitioners must constantly strive to have the most productive and efficient practice possible, and seek out opportunities that will afford their practice the best return on their investment while providing the best quality of care for their patients. There is certainly no panacea, or one way, on how to run a dental practice as a business. However, it is imperative to occasionally take stock, evaluate the practice, and, after thorough investigation and trial and error, try something new and different to expand the practice’s horizons.

About the Author

Jennifer Hirsch Doobrow, DMD
Private Practice, specializing in periodontics and implant dentistry, Cullman, Alabama


1. Vogel R, Smith-Palmer J, Valentine W. Evaluating the health economic implications and cost-effectiveness of dental implants: a literature review. Int J Oral Maxillofac Implants. 2013;28(2):343-356.

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