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Inside Dentistry
January 2010
Volume 6, Issue 1

Hot Topics

Can dentistry embrace the expanded roles needed to treat their patients?

Clinical dentistry. Dental research and science. Dental practice building and business management. Within each of these three categories are trends that key opinion leaders are following and talking about.

This month, Inside Dentistry takes a look at the hot topics coming to bear on the dental profession in order to shed light on the exciting possibilities for the months—and years—ahead. But most importantly, we answer questions about the important challenges facing the profession and take a look at what’s ahead.

And, to help you prepare for what’s in store, we present practical advice so you can head into the New Year with an insider’s advantage. After all, you face a multitude of challenges every day—and not all of it involves dentistry. Therefore, our experts uncover the emerging trends that will affect how you practice clinically, apply new scientific advancements, and manage the business of your practice in response to, or in anticipation of, what’s on the horizon.

The Challenges Facing Clinical Practice

There are numerous clinical challenges facing the profession that need to be solved. Among them is the lack of ability to identify initial dental caries, explains Gordon J. Christensen, DDS, MSD, PhD, co-founder of Clinical Research Associates (now Clinicians Report). None of the radiographic devices currently on the market can effectively show initial caries, and analog films and digital sensors show about one half of the depth of the actual dissected carious lesion, he explains. Further, when it comes to caries, there has been an increase in difficult to restore dental caries in mature adults, Christensen says, and this age range of patients continues to demonstrate an increase in “wrap around” class V caries.

“The lack of treatment of periodontal disease in the United States is also a challenge,” Christensen asserts. “The few periodontists [currently practicing] are unable to treat the roughly 35% of the US population who have overt moderate or severe periodontal disease. Most periodontists are concentrating on implant dentistry, and most general dentists are not providing comprehensive periodontal therapy.”

Also, Christensen cites changes in the ethics of the profession which has contributed to significant overtreatment of unknowing patients among other challenges.

According to John Kois, DMD, MSD, director of the Kois Center and affiliate professor in the graduate restorative program at the University of Washington, one of the biggest challenges facing dentists in clinical practice is the inability to move toward precision medicine. Although evidence-based clinical decision-making certainly has reduced the often dogmatic and emotionally driven treatment options that continue to fuel many controversies, dentists still face challenging decisions due to a lack of metrics that provide clear, objective data for making a proper diagnosis (eg, biomarkers to predict future disease). As Inside Dentistry has reported in the past, developing such metrics in support of evidence-based protocol can bring clinicians closer to truly treating patients within a uniform standard of care.

“This creates a situation where one dentist determines treatment needs that another dentist would judge to be inappropriate,” Kois explains. “It’s not always clear when a dentist must replace existing restorative dentistry, remove a tooth, place an implant, or even provide dentures.”

Compounding the problem—and this is nothing new—is the fact that dentists work directly with patients and must therefore address patient expectations, believes Gerard Kugel, DMD, MS, PhD, associate dean for research at Tufts University School of Dental Medicine. However, this has become harder because the flow of information about oral health and restorative/cosmetic options is freer and uncensored. As a result, this challenge is exacerbated by misinformation that also is readily available to patients.

“Patients tend to feel they have the right to challenge the recommendations of their dentists, which is not necessarily bad, but in the old days, they didn’t have easy access to information, so they trusted you,” Kugel explains. “Now I find that patients who have searched the Web present to my office telling me what materials they think they should have in their mouths and why, and many times they base this assumption on information that’s erroneous and uncensored.”

And in terms of the materials that are used in clinical practice, Christensen cites continuing clinician confusion about the several all-ceramic crown and fixed prosthesis restorations—and the lack of long-term research about these materials—as another challenge. The increase in digital impressions, in-office milling, and the accompanying decrease in laboratory-made restorations is creating frustration among laboratory technicians, he says.

“I think that given the number of companies out there, the overflow of products from them challenges dentists clinically to really be able to select the best materials and procedures,” Kugel observes. “Being able to filter the information is a challenge for a clinical practitioner.”

That said, an important challenge remaining for dentists is obtaining accurate and unbiased education, particularly considering how rapidly materials, equipment, and products develop, explains David Garber, DMD, a member of “Team Atlanta.” Unfortunately, because people aren’t as willing to travel as readily as they used to, this is becoming more difficult, he says.

“As a result, internet education is very relevant today, and certain sites enable dentists to obtain multifactorial, cross-disciplinary education that is ‘nondenominational.’, or not really attributable to a single resource or in any way sponsored by a particular company,” Garber explains. “Dentists can obtain various guidelines and different perspectives on any given topic, which I think is incredibly important.”

But education in dentistry has other challenges. According to Christensen, the lack of time in the dental school curriculum to include many of the techniques and concepts required of new dentists is a challenge today. Additionally, there continues to be a need for more dental school teachers, he says.

There are other aspects of clinical practice with different challenges. For example, radiographic devices, including the cone beam devices, are so high in cost that in spite of their value to clinicians, it will be a significant time before they are incorporated into practice, Christensen says. Further, what affects the dental laboratory industry also comes to bear on clinical practice.

“Offshore laboratory involvement is eating into the US laboratory industry,” Christensen observes. “Estimates are that up to 20% of the crowns seated in the United States are not made in the United States, and there is almost no observation or critique of these restorations, and none appears to be coming.”

On the Horizon for Clinical Dentistry

For some, like Kugel, what truly lies ahead for dentistry is anyone’s guess. For example, he cites the “prophets” from 25 years ago who predicted that digital dentistry would already be in mainstream use, but notes that it is only recently that digital is becoming popular.

“My best guess is that the reality is that dentistry will continue to plug along doing the everyday stuff that it does,” Kugel says. “We know the future holds some major changes for technology that will improve the quality of the care delivered to patients, because it continues to get better.”

Specifically, CAD/CAM, digital impressioning, digital radiographs, oral cancer screening mechanisms, and other such technologies are improving, Kugel observes. But he again emphasizes that these types of “digital” devices have only recently begun to take off.

“I think dentistry is now ready for this technology, so we’re probably going to see a digital revolution at some level taking place over the next 10 to 20 years,” Kugel suggests. “Revolutions in dental practice are slow. They don’t occur in 2 or 3 days. They take a long time.”

For instance, Christensen envisions continued movement in dentistry to all digital radiography. However, this will require at least another 5 years, he says. Additionally, he sees increased but slow movement to cone-beam radiology on the horizon.

“These devices are too expensive for some to purchase, but that is changing,” Christensen explains. “Cone-beam images are the future.”

According to Kois, all the newer innovations or technologies have the potential to do wonderful things for clinical practice, but they also create a disruption in clinical practice because they force dentists to reconsider the way they practice. Dentists will be obligated to practice in different ways, he says.

“The challenge is now trying to determine how the practice can position itself to manage the clinical treatment toward the future, because it won’t be the same,” Kois elaborates. “For instance, practices may operate under two different business models. One encompasses the diagnostic aspects of the practice, which rely on some of the new technology for imaging. The second model encompasses the typical treatment aspects, which also have seen incredible changes in technologies, including ceramics and different procedures.”

However, Kois explains that what is most important in many of the treatment aspects is not just being able to provide the treatment, but also assessing the clinical survival and risk factors that patients present. Dentists will need to blend the best clinical technique within the confines of the risk management of the patient, he says.

“Patients are demanding minimally invasive procedures, and many are seeing the overt over-treatment proposed by some practitioners,” Christensen says. “On the horizon, we can look forward to more use of simple orthodontic procedures by both orthodontists and general dentists, but also more need for comprehensive, moderate cost therapies for mature patients.”

Right now, Garber sees two almost diametrically opposed aspects of dentistry developing. One encompasses the exciting era of virtual dentistry utilizing digital impressions, digital information, and CAD/CAM fabrication, as well as digital-guided surgeries. On the other hand, there is a very definite return to basics and minimally invasive techniques as materials have evolved.

“CAD/CAM fabrication can be used with a multitude of materials for crown and bridge, but now also for implants and veneers,” Garber says. “The technology is becoming much more accurate and predictable. When combined with digital impression making, this would change clinical practice dramatically in different ways, as well as how dental laboratories will develop—from a wet scene, hands-on to virtual.”

With CAD/CAM virtual centers, smaller laboratories that cannot afford their own equipment can receive these types of cases, send them to one of the new centralized facilities, such as Diadem Digital Solutions, to fabricate the essential substructure and morphology. The local laboratory can then complete the restoration. Such technology also enables the creation of digital models and occlusal relationships, as well as surgical guides for implant placement, Garber explains.

“On the horizon is rapid change to CAD/CAM-made laboratory-fixed restorations,” Christensen predicts. “Soon the traditional laboratory technician will begin to vanish, and a new type of technician will evolve who has computer skills and technical knowledge.”

But circling back to the “return to basics” to which Garber referred, he says that today, materials allow for thinner veneers which will help eliminate the need for aggressive tooth reduction—beyond enamel—to a much greater extent, while still ensuring predictable esthetic results.

Another apparent trend that Christensen has been watching is the continuing reduction in use of amalgam, as well as its replacement with resin-based composite. This is occurring in spite of organizational support of the viability of amalgam, he says.

Additionally, dentistry will witness a slow increase in implant use, with general dentists accomplishing more surgical placement, Christensen predicts. Further, the placement of small-diameter implants for restorative and prosthodontic use will also increase, he says.

“Implants are becoming more reliable, common, and easier to place, and I think their integration into bone will improve as manufacturers incorporate new technologies,” Kugel says. “Perhaps in 10 years, we’ll be placing implants that are coated with stem cells that can integrate more quickly.”

Stems cells are predicted to be a part of dentistry’s future, but not for several years, Kugel further emphasizes. Their role may involve incorporation into cements to help restorations integrate into dentin, as well as helping to grow a tooth in a socket, rather than place an implant.

Preparing for the Opportunities in Clinical Dentistry

It’s very easy for all of us in the profession to be lured by what I would call product seduction,” Kois cautions as he considers how dentists can best prepare for the opportunities ahead. “The product itself doesn’t provide all the solutions. It helps create understanding that will lead to better solutions.”

Therefore, Christensen stresses that clinicians will need to seek out and attend with staff members pragmatic, applied, and basic science-supported continuing education courses on the new techniques and concepts being introduced. Further, he emphasizes that the incorporation of new concepts into practice should be undertaken after appropriate continuing education.

Kois adds that because some of the newer technologies are very expensive, not every dentist needs to own the technology, but should at least have access to it (eg, scanning and milling machines). Decisions about when to bring these internal to the practice relate to the size of the practice, number of practitioners, and number of patients, among other considerations, so that the use of such equipment doesn’t become tied to a pure business strategy, he says.

“Dentists need to engage in deliberate and in-depth observation of new concepts to see if they will serve their patients faster, easier, and better,” Christensen advises.

The Challenges Facing Dental Research & Science

The challenges having an impact on dental research and science are many, not the least of which is the pipeline of dentists engaged in doing the research, points out Lawrence Tabak, DDS, PhD, director of the National Institute of Dental and Craniofacial Research (NIDCR). Much of the research can be conducted by people from various backgrounds, but there is a subset of the research, particularly clinical research, that really benefits enormously from investigators who have clinical training and experience, he explains.

“We are finding it increasingly very difficult to attract the numbers of researchers we need who are dentists. That’s one of our major challenges,” Tabak says.

According to Harold Slavkin, DDS, the former dean of the University of Southern California School of Dentistry, as well as the former (6th) director of the NIDCR, the profession has been aware for almost 15 years that dentistry has depleted its pool of research scientists educated and trained in dentistry (ie, DDS, DMD and dental specialty training) who also have advanced training in biomedical research (ie, MS, PhD, postdoctoral fellowships). One metric for this depletion is to observe the striking decline in dentally trained applicants to the various National Institutes of Health (NIH) program offerings, he says.

“In the late 1990s, we created a ‘Blue Ribbon Panel’ to assess the future challenges and opportunities for dental research and technology. They discovered that our nation, all dental schools, and related universities need to recruit 2% of all annual graduates to sustain academic dental schools with research; not to grow, but to just maintain. We have failed to achieve this,” Slavkin admits. “We are failing to recruit just two students out of every 100 dental graduates for careers in research and education!”

Science informs clinical practice. For more than 60 years, dentistry has enjoyed being positioned on major university campuses. This is now in great jeopardy due to the paucity of academically trained dental professionals, the costs of dental education, and the rewards to be gained in the private sector, Slavkin elaborates. Considering that science informs clinical practice, everyone in the public or private sectors needs to own this problem for their “enlightened self-interest,” he says.

“We need to recruit before dental school and offer full scholarships that cover DDS/DMD training and beyond in return for 5 to 6 years of full-time education and research activities,” Slavkin suggests. “We need to define for all dental schools that we need multiple tracks so that select students can individualize their programs to optimize the outcomes. If we continue to do nothing or very little, we jeopardize the future of academic dentistry.”

According to Tabak, the NIDCR supports a broad range of training opportunities for dentists interested in a research career that offer generous stipends and tuition. In addition, a loan repayment program is available that would provide trainees up to $105,000 to relieve their educational debt, he says.

Then, the next major challenge for dental research and science involves whether the profession is ready for the changes that are coming down the road in terms of how dentists will practice in the future, Tabak says. With new tools on the horizon, such as salivary diagnostics that can detect biomarkers for non-oral conditions, and stem cells that can be used in the care and restoration of form and function, he wonders if dentistry will be willing to embrace the expanded roles that would be required to counsel and refer patients.

“Is the profession ready to embrace the use of stem cells to either complement or one day supplant restorative procedures with nonbiological materials? Is the profession ready to take on therapeutic strategies that may include things such as gene transfers?” Tabak asks. “Obviously, there is an overlay of healthcare, but that overlay carries with it the question of how much a part of the future healthcare system dentistry will be. That’s certainly going to influence research directions of the future.”

However, from a practical, “in the trenches” perspective, the challenges facing dental research and science relate to getting the research done in the first place, such as obtaining adequate funding to managing the logistics; from conducting unbiased quality, long-term research to recruiting appropriate subjects. Contributing to such problems is the fact that many products change so quickly, which makes the likelihood of conducting a 1- or 2-year study impractical, explains Kugel.

Additionally, Kugel says the demands of conducting clinical research have gotten tougher (ie, recruiting patients and complying with investigation review boards [IRBs]). University and private IRBs are more demanding of researchers in terms of protecting the patient, ensuring there are no ill effects from anything that’s done, and ensuring they’re compensated at a significant level. He says this makes it harder for companies to afford the research.

“We have much more regulation, which is ultimately a good thing,” Kugel admits. “The other challenge is that companies are much less willing to fund research. They’re tighter with their money. Although the federal government funds research, much of it is not immediately practical to a dentist (eg, does this cement work). They are funding bigger studies on ceramics, stem cells, and biometrics.”

The Future of Dental Research & Science

Despite the challenges, Slavkin sees a bright future for dentistry and the biomedical sciences, arguably the brightest in the last 100 years. For example, he lists the following for consideration:

1. Advances in micro-imaging.
2. High resolution real-time MRI.
3. Saliva as an informative diagnostic fluid for many oral—as well as systemic—diseases and disorders.
4. “Customized” stem cells for the design and fabrication of cells, tissues, and organs.
5. Integration between dental and medical health records that can be reduced and stored on a credit card for easy access anywhere.
6. Advances in haptics (ie, sensory or touch-mediated computer-assisted technologies) that can revolutionize learning and practicing dentistry.
7. Numerous clinical research efforts to improve diagnosis, treatment, procedures, and outcomes.

“The use of stem cells—and finding better matrix systems for signaling these cells to differentiate to produce the tissue in the oral cavity that we want it to be—is part of the future of research,” Kugel predicts. “But we still need to improve our standard restorative materials and improve and make it much easier to do digital dentistry.”

Looking at the Opportunities Science & Research Will Present

Being prepared for what dental research and science have yet to bring will require an interest in learning new things. This begins in dental school and transfers throughout the profession via individuals who are already practicing in the community, Tabak explains. Dental professionals need to become more facile with things like genetics, more engaged in stem cell biology, and more knowledgeable about general medical diseases and conditions to be able to both inform patients who may test for various biomarkers of different diseases and conditions, and be sufficiently knowledgeable to make appropriate referrals to other healthcare professionals, he emphasizes.

“We have developed an elaborate ‘professional continuing education’ infrastructure in the United States, and beyond,” Slavkin explains. “Our shared challenge is to design a curriculum with learning experiences that enhance the oral health professions on all levels, including health promotion, risk assessment, disease prevention, human genetics and so much more. For me, ‘learning is living’ and ‘living is learning.’ Life-long learning programs are essential for the future of dentistry!”

The Challenges of Building & Managing the Dental Practice Business

The economy. Patients who don’t value dentistry as they should. Managing marketing messages. Financing improvements and technology purchases. When it comes to the business of building and managing the dental practices, the challenges are many—and varied.

“Clearly the economy has played a major part in creating challenges for dentists, and while the economy does seem to be improving, it’s happening at a very slow rate,” observes Roger P. Levin, DDS, chairman and CEO of Levin Group, Inc. “I think some of the big challenges coming up in 2010 will be getting credit to open an office or to build a new office, because banks are much more conservative in their lending practices, as well as getting credit for technology, remodeling, etc.”

According to Joe Lancellotti, the founder and chief information officer of, many dentists he’s spoken to have been severely affected by the country’s economic downturn, while others say that they are as busy as ever. The common thread seems to be that patients are not pursuing cosmetic dental procedures like veneers and whitening as much, and only agreeing to treatment that is absolutely necessary, he says.

“The number one challenge dentists face is that people don’t value dentistry the way they should. Sadly, most people do not see dentistry as a great investment—which it is,” observes Fred Joyal, CEO and co-founder of 1-800-DENTIST. “What’s worse is there is practically no one out there helping solve that problem. Dentists can help themselves by communicating that effectively and consistently to their patient base to help build their practice with loyal patients who value dentistry.”

The other trend Levin has seen with active patients is lower case acceptance; they are not necessarily agreeing to have the treatment recommended at the time it’s being recommended. Lancellotti observes a similar trend, noting that many patients are postponing larger, comprehensive reconstructive treatments until the economy picks up.

“However, there is still a huge need in the general population for routine dental checkups and restorative treatment. The downturn in treatment acceptance and busyness among dentists seems to be most affected by a geographic consequence,” Lancellotti says. “If the economy is very bad in a particular area and unemployment is high, this seems to be where the dentists are most affected.”

Levin says patients have been putting off treatment until they feel they can afford it, and he has seen a rise in the number of no-shows, last minute cancellations, and patients who simply are not scheduling appointments. Additionally, Levin has seen a slowdown in patient payments or collections, and as well as more people who can’t necessarily afford to pay their bills, which is resulting in decreased collections.

“Another issue is that most dentists have been thrown into the role of business owner without any training. They learned a lot of skills in dental school, but effectively marketing their practice wasn’t one of them,” Joyal has observed. “Getting new patients and keeping their current ones loyal; investing in new technology and promoting it to their patient base; creating a welcoming office environment; training front desk staff to answer the phone in a way that brings patients in their door—all of these things take a certain skill set that dentists don’t normally have, but are all crucial to building their practice. That’s an enormous challenge.”

Dedicating the time and resources to stay current and learn the advantages of new technological tools also is a challenge, believes Lancellotti. There is an enormous amount of technology available to dentists today, and much more on the horizon. However, he has observed a basic hesitancy on the part of dentists toward learning and utilizing these technologies to the fullest—whether clinical products (eg, Invisalign, implants, CAD/CAM, lasers) or practice management software and online marketing resources.

Predicting What’s in Store

As Lancellotti looks ahead to what’s in store for dental practices, he notes that the US population is continuing to grow while the supply of dentists is leveling off, if not declining. For example, he says that the number of dentists per 100,000 population increased from about 49 in 1960 to 60.2 in 1994, but has declined slightly almost every year since. Between 2010 and 2015, the dentist-to-population ratio is projected to begin a sharper decline until reaching 54 dentists per 100,000 by 2025, he says.

“Most dentists work full time, but there is a trend toward increased part-time work. By 2025, 18% or more of the dental workforce may practice fewer than 32 hours per week,” Lancellotti explains. “This part-time workforce will consist of both men and women, but the greatest increase in part-time dentists will come from the growing trend of women entering the dental profession.”

Lancellotti says that in 2007, women comprised 47.9% of the dental school graduates and tended to work part-time more often during their childbearing and child-rearing years. If dentistry follows the current pattern, then the gender distribution will continue to shift, with women dentists possibly out numbering male dentists in the future, he says. The percentage of the dental workforce then practicing part-time should continue to rise, requiring more dentists in the workforce to compensate for the increase in part-time dentists, Lancellotti predicts. Adding to the need for more dentists is the fact that the dental workforce is also aging.

“The downside of this is that within the next 17 years, up to 40% of the dental workforce could retire. Eighty-five percent of dentists retire between the ages of 55 and 65, with the average age of retirement being 62,” Lancellotti elaborates. “By 2011, 40% of the dental workforce in the United States will be 55 years or older, and by 2015, this percentage peaks at 43.4% and will remain fairly level through 2025.”

The upside of this, Lancellotti says, is that the retirement of America’s aging dental practitioners will provide almost unlimited opportunities for new dentists. Since 2001, the number of new dental graduates has remained in the neighborhood of 4,350 per year, with the present number of graduates being too low to keep pace with a growing U.S. population and the number of dentists retiring, he says. To avert a greater shortage of dentists in the future, dental school capacity must increase, Lancellotti says.

But for now, in terms of predicting what lies ahead for the business and management of dental practices, Levin believes that practices are not going to have much choice but to create highly efficient systems. In other words, they’re going to have to do more with what they have, he says. Specifically, they’ll want 98% of their patients to be scheduled at all times, the no-show rate to be less than 1%, and to collect their money at the time of the service so they have a 99% collection rate, Levin explains.

“More and more practices will have to develop systems so that they can offset the effects of the economy by maximizing the opportunities with the patients and the new patients that they do have,” Levin says. “For example, where the average production per new patient might decline, dentists can make up for that by putting in effective systems to increase overall practice production within the current patient base.”

Additionally, Levin notes that in the future, those dentists who participate with insurance will need to work more closely with those companies in order to maximize the patient’s insurance benefits. According to Lancellotti, reassessing fee-for-service vs. participating in various insurance plans is particularly important during times of economic stress, when consumers are comparing and evaluating every decision relating to monetary expenditures—even for health care.

“In 2007, a total of $68.8 billion was spent on dental care, and 61% of that was paid by dental insurance,” Lancellotti says. “Dental expenditures in the year 2012 are expected to exceed $75 billion, and the number in the population that currently has dental benefits will increase once again.”

“There are some wonderful technologies available, such as dental lasers. A dental laser can reinvigorate a practice with excitement, with messages to patients about the level of advanced care it provides,” explains Levin. “In other words, certain technologies, like a dental laser, could actually reinvigorate a practice, bringing a new perspective to older services.”

Finally, what is also on the horizon for dental practice building and business management is what’s huge right now in the social networking arena. According to Joyal, many dentists are still several steps behind in terms of social media in that they don’t even have a Web site. For those who do, the next step is making sure they are leveraging networking sites like Facebook, LinkedIn, and Twitter, blogging on their own site, and sending e-mail communications to their patients, he says.

“It may seem like a lot, but dentists need to realize that social media is how the new generation communicates and stays in touch. Regular tweets and status updates remind everyone that you’re out there and let them know what you’re up to—and they do this for you for free and in a way that is nonintrusive and fun,” Joyal explains. “You’re going to make a much better impression with the occasional well-written tweet than with a direct mail insert, no matter how well-crafted the mailer is. The new face of dentistry involves communicating with patients the way those patients communicate with everyone else. Right now, that’s through social media.”

Preparing for the Opportunities

To prepare for the opportunities ahead, Levin urges dentists to first ensure that they have highly efficient systems in the office. This will enable them to maximize opportunities as they are presented. For example, when new patients call the practice, it’s imperative that staff get them to schedule an appointment, not just have a pleasant conversation, hang up, and think about it, Levin says.

“Unfortunately, some dentists have slowed down, so they’re paying no attention to their systems because they view open capacity or appointments as a marker that there is no need to work on systems when, in fact, the opposite is true,” Levin emphasizes.

Additionally, while Levin advocates the incorporation of new technologies into the practice, he emphasizes the importance of paying attention to return on investment. Like all businesses, they can’t just spend freely, he says. For example, dental lasers might be viewed as a significant investment by many dentists, but lasers offer an excellent return when the doctor incorporates them into everyday use.

Among the recommendations that Levin offers dentists as they prepare for the opportunities and challenges that lie ahead is living a balanced life, as well as trying not to do everything by themselves. He admits that in the last 2 years he has seen many dentists become extremely stressed in practice, primarily as a result of the uncertainty of the economy.

“Being healthy, exercising, following good nutrition, and taking care of their medical health are all very important factors for dentists,” Levin emphasizes. “So that they don’t feel alone, there are wonderful advisors—from CPAs to attorneys, office design experts to management consultants—who can help the doctors and give them the confidence to know that they’re doing the right things.”

“The primary building blocks of the practice must be under the dentist’s control and supervision,” Lancellotti says. “He or she should be the initiator and the leader of the process, but relating to specific areas such as marketing, for example, no one expects the doctor to write copy, produce graphics, or create press releases.”

That said, dentists must also continue to train their staff, Levin says. A well-trained staff will make a huge difference in allowing efficient systems to be implemented properly, to hit the targeted numbers and goals, and to build a very strong practice, he says. Lancellotti adds that action plans must be developed to maximize the use and benefits of any high-tech clinical products or procedures that are integrated into the practice, as well as to effectively communicate these same benefits to the patients.

“Finally, doctors need to be good leaders as well from a management standpoint,” Levin adds. “When they don’t show confidence to the team, the team begins to function at a lower level, or some of them will leave.”

Therefore, Levin encourages dentists to spend more time studying practice management. They can attend courses, read relevant articles, or visit Web sites ( where there is a wealth of free information about what other people are doing, he says.

Once the internal components of the practice are set and prepared for the future, dentists can then turn their attention to marketing and capitalizing on the possibilities that await. Lancellotti says that although future changes in the supply and demand curve for dental services may reduce the need for external marketing to attract patients, the need for a solid branding strategy will always be a necessity.

“Branding is the representation of all the information connected with the dentist and the practice. It typically includes the practice name, logo, and other visual elements such as images, typefaces, color schemes, or symbols,” Lancellotti explains. “The perception of your brand in your patients’ minds encompasses the expectations associated with positive experiences at your office. Your brand is the story that people in your community tell when asked to recommend your practice to someone else.”

According to Joyal, communicating the practice brand should involve a Web site and social media, and for the dentists who don’t have a Web site, his first recommendation is that they get one. He further encourages them to seek a professional to create it to ensure that it’s user-friendly and optimized to come up in searches. Joyal also suggests taking pictures of the office and filming a virtual tour, being sure that the office is a welcoming place where patients actually like to visit so that the Web site can communicate that.

“Dentists should have not only their own personal Facebook page, but also a “fan page” that allows their patients to become fans and spread the word about the practice to their Facebook friends,” Joyal explains. “With Twitter, dentists can gain followers and tweet dental tips, advice and news about the office. A blog allows for these same things to be relayed to the non-Twitter crowd, and in much greater detail.”

With the practice’s social media marketing in place, the next steps are to collect e-mail addresses for every single patient, then use them, Joyal says. E-mails should be in the mix with traditional mail newsletters and reminder cards, he says. Business cards and e-mail to patients should include the link to the dentist’s Facebook page, Joyal notes, adding that the number one way dentists can seize all these new opportunities is to put themselves out there in every way possible.

Lastly, given the financial challenges that patients are facing, Lancellotti says that it can only help to be proactive by providing patient financing options, changing the insurance acceptance mix, and otherwise examining the offerings to see if they meet current needs. It then will be important to properly communicate relevant information to patients, he says, as well as ensure that the practice’s financial coordinator is up-to-date on the latest financial offers.


For the past two years, many practices have gone into a stall, with more than 75% of dental practices having either been flat or in decline in the last 12 months, Levin says.

“But now, I am starting to see some movement, and I’m optimistic,” Levin adds. “The key is to have systems that bring back your active patients and educate them about the range of the practice’s services. This will allow you to maximize treatment options. We have so many wonderful technologies and techniques today that the practices that put these systems in place are going to absolutely flourish.”

Among the new technologies and materials making in-roads into clinical practice now are higher strength pressable all-ceramic materials, which Garber notes may represent a significant change by bringing dentistry back to basics. For example, crowns may now be able to be cemented as opposed to bonded, so teeth can retain their underlying core strength, he says.

“We can now press new lithium disilicate materials to the zirconium, which gives restorations remarkable strength, and we can also use these materials without zirconium cores,” Garber elaborates. “We are constantly looking for easier and less expensive ways to go about restoring teeth, and obviously pressable ceramics is one of the materials that have improved the predictability factor.”

According to Tabak, if everybody becomes engaged in dental research at various levels, the scientific advances will really power the future to be remarkably bright and far greater than probably anyone can imagine. He says that as he surveys the horizon, he believes this is the most incredible time to be involved in research, and it’s research that really helps the profession invent what the future will look like.

“I hope we have more practitioners willing to get up-to-date on the latest advances in science and research opportunities, and I hope we have more clinicians willing to go into research activities,” Tabak says. “In order to get to the most exciting future that will enable the profession to keep people in great health, we need everybody to be engaged in the enterprise.”

And that enterprise, believes Kugel, is one that will lead the profession toward ever greater improvements in technology and, ultimately, prevention of oral diseases.

“Oral cancer screening technologies are improving, and there is new technology that we’re working on at Tufts [University School of Dental Medicine] that will make screenings more reliable, so the diagnosis and treatment of oral cancers will be improved,” Kugel explains. “Also, the technology for detecting and preventing cavities also is improving, and I think that will be something that will help us as a profession.”

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