Podcast: Excellence in Dentistry 2017 Conference highlights

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good evening. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions. This podcast is brought to you with the expertise and production management of Mr. Doug Foresta. His company, Stand Out and Be Heard, is responsible for the 50 or so podcasts that you’ve been listening to over the last year. Without his expertise and his training and background, none of this would be available.

Today, we have a specific topic. A little self-promotion, you might say. My name is Dr. Kevin Coughlin. I’m the creator of Ascent-Dental-Solutions, where the focus is on training, coaching, education and consultation. Today’s topic is about an upcoming continuing education event located in Destin, Florida, which is on the gulf coast.

I have a little backdrop to this particular story. Many years ago, a Dr. Woody Oakes contacted me almost on a cold call and said that he had read one of my books and was interested in some of my thoughts. From that conversation, we generated a friendship and he asked if I would participate in a radio show. He interviewed me for several hours and produced radio shows about my dental career, my background and my business acumen.

From that, he introduced me to a Mr. Steve Parker. And the combination of the Profitable Dentist and Excellence in Dentistry, I was introduced and asked to do some speaking and some training, some coaching and some education. I’m happy to say I’ve been pleased with their organization and I believe their organization has been pleased with me.

Coming in April, to be exact, 26th, 27th, 28th and 29th, will be the annual Destin, Florida Excellence in Dentistry Seminar, Meeting and Education. I hope for those that are available you’ll attend. We typically expect between 400 and 750 doctors and staff members from all over the country and actually, all over the world, to listen to presenters, educators, teachers, lecturers on a vast variety of subjects that relate to dental care today in the 21st century. Doug, do you have any questions?

Doug: I do. Thank you so much, Dr. Coughlin. One of the things that I was wondering about is first of all, I believe you’re speaking on Processes and Procedures to Improve Profitability. Is that correct?

Kevin:         Yes. I have a variety of different topics, but this particular presentation will be on Processes and Procedures to Improve Profitability. Basically, as most dentists and most people in health care in general feel the pressure, the strain of trying to meet excessively high overhead and significant reduction in fees and reimbursements, the profession, in my opinion, is forced and not necessarily in a negative way, to be more effective, to be more efficient.

And it’s incumbent upon us as a profession and as individuals of being small business owners to take a look at all of your processes and all of your procedures and how can we get rid of the fat. How can we make our procedures more profitable by being more efficient and more conscious of the bottom line?

I’m expecting to get, in my opinion, a very nice review from these particular processes and procedures which I’ve developed over 35 years and helped me develop my 14 practices here in Massachusetts. Keep in mind that I am a practicing dentist. I do practice full time. So I just don’t go out and lecture. Every day, today included, I worked almost all day long doing the things that most people in health care have to deal with. And that’s providing a high level of service, a high level of care. But being small business men and women, we also have to be conscious of our overhead and ways in which we can develop and provide better care and better service.

Doug: Dr. Coughlin, you mentioned and yes, you are a working dentist, and one of the things you mentioned was you said you’re cutting the fat. Can you give an example of things that you see that dentists do in their practice that cut into that profitability?

Kevin: That question we could spend the next couple of months on, but to summarize in this podcast, in most cases, my personal belief is that we as health care providers are not necessarily prepared to be as efficient as possible. I strongly recommend what I call a chichi. Some people call it a morning hurdle. But basically, it’s a review of all the scheduled patients so we know exactly what we’re expected to do, we know exactly how much time we anticipate to do it and our operatories are set up for those processes and procedures to provide care in the most efficient and effective manner.

The next thing that I see that I believe really affects profitability is the operatories or the areas in where we practice health care and dentistry in particular, they’re generally not set up to be efficient and effective. I cannot emphasize having cassettes available and those cassettes should be organized for restorative dentistry, separate cassettes for amalgams, separate cassettes for composites, separate cassettes for oral maxillofacial surgery, orthodontics, endodontics, periodontics and pathology.

If you don’t have the cassettes with the proper instrumentation and a staff that’s trained to provide this care and service in an effective and efficient way, you’re probably losing hundreds of thousands of dollars a year.

The ability to change from one particular treatment to another — in the dental sense, we begin to do a root canal and for a variety of reasons, the root canal may be failing and it may not be a successful treatment. To change gears within one to two minutes and make that a surgical extraction and then turn that into bone grafting and surgical placement of an implant really provides an enormous way for your patient base to receive not only excellent care, but efficient and effective care. So many times we consider doing things quickly and fast as being done cheaply or not as well or as effective.

I honestly think that our patient base is so busy and they have so many time constrictions that the more efficient and effective we can provide their care and treatment, the better they will like us, the more responsive they will be to our care and service, and the more likely they’ll be willing to keep their appointments. Those are just a few of the comments.

Doug, what I wanted to spend a few minutes with is to sort of just give the audience some of the speakers that you can expect to hear in Destin, Florida on April 27th, 28, 29th, 2017.

Doug:    There are some really great topics I was looking through that.

Kevin:  Oh yeah. The topics in this particular continuing education forum is varied. There’s practice management and there’s clinical. We have Gary Kadi who is talking about where are you taking your practice. Do you know the direction? Do you know what you want to accomplish in your dental practice? And it seems like an obvious question, but many times we’re not prepared to answer it. We just go in, work, do what we’re supposed to do and we really don’t have a clear cut direction.

We then have Dr. Mike Abernathy and his topic is how do you become that super specialist. You’re a general dentist, but in order to meet overhead, in order to stay engaged and excited about your profession, you have to introduce specialty into your care and treatment in my personal opinion. Obviously, others would disagree, but I think to be able to offer surgical implantology, prosthetic implantology, bend and bracket orthodontics, fixed and removable functional appliances, MTM which is Minor Tooth Movement orthodontics, Invisalign orthodontics, endodontics with rotary instruments, same day root canal procedures and treatments, CEREC restorations where crowns, bridges and veneers can all be constructed, designed and inserted in one visit, bone grafting procedures from extractions. The ability to have in-house laboratories to perform immediate prosthesis or full and partial dentures within a day or two days.

This offers an enormous amount of care and service to your patient base. Not only does it provide a better bottom line, but to me, more importantly, you’re offering your patients your most significant asset, a way to receive care and treatment in an efficient, effective manner.

Just take, for example, you went to a restaurant and you decided to order steak and they say, “Well, we don’t serve steak here, we only serve chicken.” And then you went to the chicken restaurant and they said, “We only serve chicken, not steak.” And then you decided that you wanted dessert, but they don’t offer dessert, you have to go to another restaurant.

Today, time, money, effectiveness is so critical that most people have double incomes. They have children, they have events, they have a busy schedule, offices and corporations are reducing time off for medical and health care and to be able to provide treatment in a very efficient, effective manner is an enormous service that you’re providing to your patient base. And I also believe as a subliminal advantage, your staff and team members will appreciate the excitement of being able to offer a variety of procedures and processes to your patient base.

We have other speakers too, Doug. We have Dennis Urban, a certified dental technician. Those of us that practice health care and in particular, dentistry know if you don’t have good laboratory support, you don’t have conscientious laboratory technicians and you’re not communicating well with them on a day to day basis, you’re having remakes, you’re wasting money and time and your products and services are suffering.

I cannot emphasize the importance of listening to Dennis Urban and how he expects to be communicated with and his tips to improve that communication. As many of you know listening to the 60 or so podcasts, I was a dental technician before I was a dentist and my heart goes out to these men and women in this profession. They really are artists and they’re experts in what they do.

We also have some dental hygienists. Wendy Briggs will be speaking about the five steps to increasing case acceptance. I think those of us who practice health care in the field of dentistry know that most of the care and service is going to come from your support members and your team members.

And it’s critical that your dental hygiene team and you as the practicing dentist be on the same page so you’re conveying the same message to Mr. and Mrs. Smith. And that message is clear, it’s concise, the finances are in order so that the treatment acceptance goes up not from five to ten percent, but to 75 and 85 percent.

We also have other speakers. We have Dr. Daniel Haghighi who’s going to talk about 3D Positioning of Dental Implants. I think those of us placing implants, myself since 1983, the ability to virtually place an implant reduces failure, increases speed and efficiency, and most importantly, provides a higher level of care.

We also have Dr. Thomas Nabors who will be speaking about why traditional hygiene programs in a typical dental office is no longer considered the standard of care. You have to look for better ways and more efficient ways to use your hygiene department.

We also have Mary Govoni who will be speaking as a registered dental hygienist and certified dental assistant and also has Master’s in Business Administration. Basically, her message is how do we work all day and go home feeling good and rested?

On top of that, we have Dr. Nathan Dallas who will be talking about how to improve the root canal or endodontic success in your practice by reducing time, increasing efficiency and improving the end results.

We also have Dr. Avi Weisfogel who will be talking about sleep apnea, obstructive sleep appliances, the advantages of these appliances over CPAP, how you can use combined therapy with obstructive sleep apnea appliances along with the conventional CPAP units. I think you’ll find his topics enlightening and I think it’s critical that all dental health care providers are knowledgeable in instructing their patients and staff in sleep apnea appliances and the advantages of those appliances.

We also have Mr. Charles Loretto, who is an expert in finance, business and helping dentists transition their practice to an associate or to some kind of DSO or MSO.

We also have several other lecturers such as Christine Taxin who will be working with insurances and explaining to the dental office and their staff members the quagmire of issues that dental insurances and medical insurances present to small and large dental offices.

I’m excited about the program, I’m promoting the program. I think it will be a benefit to those who can attend. We’ll be closing out the program with attorney Ali Oromchian, who is an attorney, and will speak to us about what all health care professionals just shriek about, and that is defensive medicine. What we need to do to prevent ourselves from getting in trouble. Not to save us money, but to provide a higher level of care and service and do it in the most efficient and effective way.

There’s an excellent program out there. My name is Dr. Kevin Coughlin. I am owner and producer of Ascent Dental Radio. In closing, I want to give my thanks to Mr. Doug Foresta. Without his expertise in podcasting, none of this would be available.

I know today’s podcast seemed more like a sales pitch for Excellence in Dentistry and The Profitable Dentist, but I believe your attendance or your ability to review it on CDs or video stream may be to your advantage. It’s an expensive way to get some significant continuing education in a vast array of subjects. I hope to see you in Destin, Florida on April 26th, 27th and 28th and I look forward to our next podcast.

Thanks for listening. My name is Dr. Kevin Coughlin. You’re listening to Ascent Dental Radio.

Podcast: TMD and what patients and dentists need to know

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Radio, where the focus is on knowledge, consultation, development and training. I believe this is the 40th podcast that we’ve been doing and it wouldn’t be possible without the special help of my production and consulting guru, Mr. Doug Foresta. His company, Stand Out and Be Heard is responsible for the webinars and the podcast and I always like to give a shout out to think him very much for his expertise and his talent in this regard.

Today, we have a topic of temporomandibular joint. For most of the listeners you’ve been hearing me and listening to me focus on the business of dentistry, but I want you to know that I am a clinician and have been practicing for 35 years as a general dentist in all areas of dentistry.

Over and over again I get questions and comments about Temporomandibular Joint disorders or TMJ and I thought today’s podcast might be valuable to the listeners on how do we treat TMD issues and what’s going on in the field. I’m proud to say that I’m going to have some questions asked to me today. Those are general questions and if you have specific questions, you can reach me on I’m very good about checking and getting back to you with specific questions. Doug, what’s your first question?

Doug: Thank you, Kevin. It’s a pleasure to be here. My first question for you is what is TMJ or TMD? Can you explain what that is?

Kevin: For the lay patients listening to this podcast, TMJ stands for Temporomandibular Joint. It’s the acronym for the most complicated joint in the human body and it’s located right in front of your ear canals on the right and left side. For the clinicians listening, we refer to the problems, the signs, the symptoms of temporomandibular joint as TMD or Temporomandibular Disorders or Dysfunction and there are a slew of them. Many times, the patient will come into the office and say, “Dr. Coughlin, I have a TMJ issue.” And my response is everyone has a TMJ, but not everyone has TMD issues. Hopefully, that answers that question.

Doug: Thank you. What are some of the patient signs and symptoms then of those TMD issues?

Kevin: I would say, in my 35-year career working pretty much five days a week, sometimes six days a week, a day has not transpired where a patient or an employee or team member hasn’t said, “Dr. Coughlin, I have pain, stiffness, popping or clicking in the joint region.” And when I say the joint region, I’m referring to the temporomandibular joint. Generally, the complaints are pain and discomfort and a limited range of motion.

I would say to the clinicians out there I have been doing expert evaluations for insurance companies for close to 30 years and the vast majority of the cases I review are TMD disorders and over and over again, I feel that the records that have been taken by the diagnosticians, the dentists in particular, are less than adequate and could be greatly improved by following some simple rules. I would strongly suggest to the clinician that on every single patient you document Range of Motion, ROM, not only vertically, laterally, but also protrusively.

This means, you have the patient open vertically as wide as possible without causing any pain or discomfort and for the average adult that should be close to 60 millimeters. If you want to save a lot of time and a lot of aggravation, generally, if you take your hand and use your forefingers and put them on top of each other and place them from the incisal edge of the upper anterior teeth to the incisal edge of the lower anterior teeth, you’re going to get about 60 millimeters. If you eliminate your baby finger, that will be about 50 millimeters and that would give you a good indication that the patient’s range of motion vertically is within normal limits.

Laterally, you have the patient bring their jaw all the way to the right and then all the way to the left and generally, that should be about four to six millimeters right and left to be an adequate range of motion laterally. Protusively, you’d like to see the patient move their lower jaw forward, at least, 6 to 10 millimeters anteriorly or protusively.

I would strongly recommend prior to the removal of wisdom teeth, prior to any orthodontic care or any extensive treatment where the patient’s jaw is going to be open for any significant length of time, let’s say more than 30 minutes, make sure your charts document range of motion.

The next item that I think is critical is during this range of motions, you want to document if the patient has any deflections or deviations. A deviation simply means when the patient is opening their mouth vertically, the jaw deviates either to the right or to the left and does not come back to the mid-line. This is an indication when the jaw deviates to the right that more than likely, the temporomandibular joint on the patient’s right side is not functioning properly.

Just going back to some basic anatomy and physiology, the first 25 millimeters of opening, the temporomandibular jaw rotates. After 25 millimeters, it translates down and forward. So when you see the patient’s jaw deviate to the right in this particular exercise, you know that the left TMJ is rotating and translating properly, but the right TMJ is not and it’s a pretty good indication that that joint is not healthy and is not in a correct position. And usually, the culprit is the meniscus or the disc that separates the temporal bone from the mandibula bone.

The next documentation would be a deflection. This simply means that the jaw upon maximum opening deflects either to the right or to the left, but comes back to the mid-line. So the opening is almost an S-shape. This means that the joints are not working properly. But in most cases, the disc has been recaptured and it allows the jaw to come back to the mid-line. Whereas in a deviation, that disc is not allowing proper translation and is most likely not being recaptured.

The critical thing here in this particular podcast is to give you a few simple inexpensive tips to improve your diagnostic records and your diagnosis and to help your patients and also to protect you since in my 35 years of experience, most patients have some temporomandibular joint signs and symptoms prior to dental treatment.

And then the dental treatment triggers the episode of pain and discomfort and the patient immediately associates it as a dental problem that was caused by a dentist when it actuality, the problem was predisposing. But because the records are inadequate in the documentation of range of motion, deviations and deflections have not been adequately documented. How about another question, Doug?

Doug: I was going to say, I know I was doing it as you were speaking, I could picture our listeners moving their jaws back and forth as you were talking about that. What are the treatment options for TMD?

Kevin: The first thing that I would tell our clinicians and for patients listening is you’ll never get success unless you have a proper diagnosis. And you’ll never get a proper diagnosis unless you have appropriate dental and medical records. The fundamentals and basics are a thorough medical history and a thorough dental history. To augment those two bits of information, I would strongly recommend that there be a complete clinical palpation and exam of the head and neck region, with emphasis on the medial and lateral pterygoids, the temporalis and masseter muscle, which are the four major muscles of mastication or the muscles responsible for chewing and function.

Palpation of these muscles, which start almost if you could just put your finger above your ear and move it forward in the shape of a question mark, you’ll be palpating the posterior middle and anterior temporalis muscles on the right and left side above the ear.

From there, you will go down and palpate the masseter muscles and if you clinch your teeth together, you’ll feel a bulge in front of your ear and those are typically the masseter muscles. Those are the two large muscles responsible for a large majority of the pain and discomfort.

During the palpation examination and the clinical examination, tenderness to these four muscles of mastication usually indicate that there’s a muscular problem and a muscular cause of the patient’s pain.

Also, you’ll find customarily, the patient will complain of tension and stress headaches, many times sometimes misdiagnosed as migraine headaches, and they’re really caused by the clenching and squeezing down of the upper and lower teeth together. And that constant aggravation causes spasm in these muscles which cause pain and that pain emanates from around the ear, in the head and neck region.

Next, you should have upper and lower diagnostic impressions so that we can see what your teeth look like and how they function. On top of that, I would suggest radiographic examination so we can determine the health and the condition of the temporomandibular joint. Typically, this would be a cephalometric view or a panoramic view and sometimes, we can even do a temporomandibular joint view. The more views, the greater the likelihood we’ll see damage and injury to the joint.

We can sometimes, depending on the severity of the problem, we may want to augment these diagnostics tools with an MRI or a CAT scan. But in most cases, for this particular type of podcast, I would function on the easy reversible treatments and diagnosis first to distinguish is the joint problem purely muscular or is it what we call internal derangement or intracapsular disease where there are some orthotic condition and the disc is not in its proper condition.

And there is sometimes, and actually many times, a combination of both problems, which makes the treatment in the diagnosis sometimes confusing and difficult.

After the proper diagnosis is done and records are done, generally, the treatment are broken into phase one and phase two types of treatment. The phase one treatment is simply to get the patient comfortable. And if it’s a muscular problem, we can many times test this by putting you on a pharmaceutical medication called Flexeril, generally, 10 milligrams, either in the morning or at night or a combination of both, to see if the patient’s signs and symptoms decrease. If they do, you’re pretty clear that you’re dealing with a muscular situation.

The next thing, in my 35 years of experience treating TMD disorders, is what we call Anterior Misguidance. You’ll find that your patient occludes or contacts the anterior teeth prematurely. Generally, these people tend to be very good looking in nature and generally, their teeth appear to be straight, but their upper anterior teeth are vertical. They have very little angulation and the angulation on the upper anterior teeth should be closer to 110 degrees.

And in most cases these upper teeth are up and down vertically so when the patient’s lower jaw goes into occlusion or opens and closes, the anterior teeth hit prematurely, causing the mandible to move backwards, irritating the ears, creating tinnitus, ear aches, neck, upper back pains and a tingling in the joint and just general discomfort.

A quick test for the patients and clinicians is to put your index finger lightly on teeth 7, 8, 9 and 10 or your upper anterior teeth and tap your lower teeth gently. If you feel a vibration or fremitus in that region, it’s a pretty good indication that the patient is suffering from anterior disclusion or malocclusion.

And a simple task would be to create some type of orthotic, sometimes referred to as a Night Guard, even those that’s inappropriate, to not allow the upper and lower anterior teeth to touch. Keep them out of occlusion and determine how the patient responds. If they immediately feel that they no longer are getting headaches or the headaches are reduced, the range of motion improves and their joints are no longer tender, then you know you’re dealing with some anterior misguidance. And you can correct this problem in phase two with some adult orthodontics.

Doug: Let me ask you this, Dr. Coughlin, the question that I think especially for patients would want to know, what is the cost generally of these treatments?

Kevin: I’d like to get as much as I possibly can, but that’s probably unprofessional and unethical. In fairness, it’s an excellent question. But generally, the diagnostic records will probably range somewhere between $175 and $650. As far as the actual treatment is concerned, the orthotics or the temporomandibular joint appliances and generally I would recommend one appliance for the lower jaw to be worn during the daytime and then an upper appliance to be worn at bedtime so you don’t wear both appliances simultaneously, what you’re trying to do is balance the jaw and keep in mind that this treatment approach is reversible.

It’s basically a phase one type of treatment to make sure your diagnosis is accurate and you’re providing value and care to your patient. Those orthotics can range from anywhere from about $850 to $2,250 per appliance and in most cases, the patient will need two appliances.

The course of care and treatment during this phase one is anywhere from three to six months and the patient is generally seen about every 14 to 21 days for adjustments and checks. Those visits are broken into short, medium and long, and the visit fees will range anywhere from $45 to $95 per visit. Please, keep in mind, I never hesitate to quote fees or recommend fees to give the audience some general guidelines, but the fees are general and they will be determined by the individual providing the care and treatment.

That is generally phase one type of treatment. If we find that the patient has responded and they’re doing quite well, their signs and symptoms have been eliminated or significantly reduced, a fair number of patients go into what we call a Phase Two type of treatment.

The phase two treatment is instead of wearing these orthotics day in and day out, we try to use a combination of orthodontics, prosthodontics to align, level and rotate the teeth to the new jaw position so that the orthotics or appliances are no longer necessary. That type of treatment can run into the several thousand dollar category. In most cases, the orthodontic care can run anywhere from about $3,850 to about $7,200 depending on how much and how we’re going to move these teeth.

In some cases, if the patient has a beautiful dentition with little to no dental disease, I will push the patient and guide them more towards and orthodontic type of treatment. If the patient has significant restorations, existing amalgams, composites, crowns or fillings on the teeth, I many times will suggest using a prosthetic type of treatment rather than orthodontics. The reason for that is the patient gets a double whammy. Not only does their jaw feel comfortable and their bite feel correct, but the cosmetics are improved significantly.

And in some severe cases, the patient will need a combination of both treatments. Keep in mind the physiology of the human body we cannot move the jaw indiscriminately as far as we want or as needed in some cases, and in those rare cases, a surgical approach is sometimes needed.

And that’s categorized as orthognathic maxillomandibular facial surgery. These are cases where positioning the jaw, even with the most up-to-date orthodontic care and prostatic care is not adequate. We actually have to surgically reposition the upper and lower jaw to the get the patient in that phase two success.

Doug: Would that be covered by insurance?

Kevin: In most cases, in my experience, once you’re going into the surgical phase, in most cases, that would be covered by your medical insurance because there would be a letter of medical necessity and no longer will your dental insurance be involved. I should comment a little bit on the fee structure for the dentist and for the patients listening to this podcast; my personal opinion is temporomandibular joint of TMD issues are medical issues.

The debate is the medical insurance feels that it should be billed through dental, the dental feels it should be billed through medical. But make no mistake about it. The temporomandibular joint is a joint and it is a medical procedure and a medical treatment, in my personal opinion, even though in many cases the individuals best suited to treat these most common problems are dentists.

Doug: That makes a lot of sense. I really appreciate it, Kevin. Thank you so much for sharing on this important topic of TMD and what people need to know.

Kevin: Thank you, Doug, very much. I just want to leave the listeners with what I call the 3 Ps. I would strongly recommend as you see your TMD patients, look for the 3 Ps. The first P is what was the patient’s precipitating event? It’s either going to be macro or micro trauma.

The second P is why are they predisposed? The patient usually will have a class two division one or a class two division two, malocclusion or a recessive mandibula or retrusive lower jaw. The third is what’s perpetuating the problem? So the three Ps are Precipitating, Predisposed and Perpetuating.

The perpetuating problem is TMD patients typically are clenchers. They’re constantly over exercising and irritating the muscles of mastication. When you can identify the three Ps and are comfortable with those 3 Ps, then you’ll probably have an excellent result in treatment and the patients will be happy and you will find that the treatment of TMD can be extremely rewarding and very cost-effective once you understand the basic principles.

You’ve been listening to Ascent Radio. My name is Dr. Kevin Coughlin. If you have particular questions, don’t hesitate to reach me through my website

My special thanks to Mr. Foresta, whose company is Stand Out and Be Heard and is responsible for the professional production of the webinars and podcasts that you’ve been listening to. Thank you very much and Doug, thank you for your questions.

Podcast: Lisa Norton on how dental hygienists can improve efficiency and effectiveness

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Solutions. This radio podcast is brought to you by VOCO Dental Supplies. As usual, we’re here to talk about different areas of the dental profession and today, I have a special guest. Her name is Ms. Lisa Norton. She represents VOCO Company, but she has a unique background. She graduated from Albany State University in New York and then went on and pursued dental education in dental hygiene at Forsyth University.

She practiced dental hygiene for many years and then for a variety of different reasons, got into the consulting business. And as all of us know in the field of dentistry, there is no more difficult department to manage and improve upon than the dental hygiene department.

All of our dental individuals struggle with some of these issues and we hope that with Lisa’s expertise and the background of her exceptional company, she’s going to offer values to today’s podcast.

Lisa, thank you so much for joining us on this podcast. We’re excited to have you here. If you were to tell us over the years of experience as a dental hygienist and a consultant for VOCO, what would you say are the top problems in most dental hygiene departments?

Lisa: I think hygienists are faced with multiple time constraints. There is a lot of expectation from the dentist that they’re going to be able to take radiographs, treat the patient, educate the patient, reschedule them, treatment plan for them in a very short period of time.

One thing that I feel helps to increase efficiency in this area is to streamline their systems or work with the hygienists to eliminate some of the extraneous conversation, use paperwork that can streamline the protocol and better communicate with the patients. So when the dentist does enter the treatment room, they’re ready with what needs to be addressed by the dentist and have the back-up of what they’ve already discussed with the patient.

Kevin: In your opinion, with your background and expertise, what do you think the ideal timeframe is for a hygiene patient, if there’s such a thing? Do you recommend 30 minutes, 40 minutes, 60 minutes, longer than 60 minutes? Do you recommend scheduling by procedure? We have almost 20 minutes so you should be able to answer this fully and completely for our listeners.

Lisa: That’s a loaded question and I’m sure there are a lot of people on the other end listening to this waiting with bated breath on what my response will be. I think it’s really different for every practice. I think that depending on what the expectation is from the dentist and how large the practice is, what is expected to be accomplished within the appointment time, all those things need to be taken into consideration. I think that depending on what the patient is appointed for will depend on the time that the hygienist needs.

I think the first thing the office needs to identify is what they’re trying to achieve within that appointed time. Once that’s identified, then the office should sit down as a team to evaluate how much time is going to be effective and efficient. And then able to achieve what the hygienist is trying to achieve, what the doctors are trying to achieve, what the administrative staff is trying to achieve.

Multiple systems are in place and each one has to be addressed. Because the hygienist may present treatment that then has to go out to the treatment coordinator who has to address what the costs are, what the fees are. All those times need to be taken into consideration.

I think it would be unfair for me not knowing what the practice is to throw out a time. I can only speak from my experience where I worked on a 10-minute increment. We had a lot of freedom to appoint what we felt was necessary.

If I had a perio maintenance patient that required only a deep cleaning for that day but wasn’t required an exam or radiographs or was due for periodontal probing, I could see them in 30 minutes. That was me having the autonomy to book that patient on my own, but all offices have very different systems in place.

Kevin: As a practicing general dentist myself for 35 years, some of the problems that we all face is Mrs. Smith and Mr. Jones have been given a 60 minute slot and, of course, their dog got hit by a car, their child came down with a fever, they cancel and now you’re trying to find the appropriate patient for that appropriate time. I think we all struggle with this. Some of the processes and procedures that I’ve put in place that may not be politically correct — it’s what I call profiling — is the patient a one, a two, a three, a four, or five?

One means they’re the gold card. They’re the American Express Gold card. They have no insurance. They actually have been pre-approved by a soft credit check and we know those patients are prior approved. So no matter how badly the periodontal need is, if the individual does not have the financial funds, they’re probably not going to fulfil the treatment plan that’s best for them. So we do a soft credit check to determine the financial situation which is generally done through either Wells Fargo or Care Credit.

The second is categorizing the groups of patients. In our particular practice, we have five groups. Group 1; they have no insurance. What we consider the Gold Card. Group 2; they’re over the age of 65. As a general rule of thumb, usually your home is paid for, your kids are out of college and generally you’re in a retirement mode and you can finally take care of your own needs.

Type 3; you have insurance, but that insurance allows you to balance bill. Which is almost a dinosaur in today’s dental market, but they’re still out there. Type 4 are government assisted plans. These plans the government usually reduce your fees by between 60 and 70 percent, but you’re guaranteed a fee. And generally if you fill out the forms correctly, you’re going to be paid within 45 days.

Type 5 are those groups of patients that have insurance, but do not allow us to balance bill that patient. Or if we do balance bill, we’re taking a reduced fee because the dental office has signed up on a contractual basis that they’re going to provide us with X amount of patients, but for that luxury they’re going to reduce a reasonable and customary fees.

This way here the hygiene department knows from a financial and didactic stand point the profile of Mr. and Mrs. Smith before they go in. What are your feelings on that? And I hope you say positive because we’re on air.

Lisa: I will say I worked in two different types of practices: one which we only participated with two insurances and one we participated with many insurances including GHI, which was all the government state workers were signed up for, which was very slow reimbursement.

We were faced with either only presenting what we felt the insurance would pay for or presenting to the patient their actual need and allowing them to accept or reject treatment. The way that we did it was we created a system where the fee was placed at the bottom with all of the therapies included. That included the fluoride varnish, that included each quad scale, that included oral irrigation.

During that visit where they were assessed based on their periodontal probing that they were a moderate periodontal case, if they were a GHI patient, they were shown what their payment was going to be in total, including the co-payment which were procedures that were not reimbursed by their insurance.

Which were out of pocket payment because they were not covered by GHI. Yes, it was a reduced rate, but it was — as far as time, we were able to achieve a very effective treatment within a shorter period of time, a 50 minute time where typically it might be 60 minutes or an hour and 10 minutes. Just because we had the protocol and the procedure in place. Sometimes even less because we used the paperwork to streamline the efficiency of that chair time. And then when patients returned, we could rebook at a lower time frame. I would say I’m probably in agreement with you in the sense that time was taken into consideration, but we were able to shorten the time by streamlining the process.

Kevin: You’re more efficient and more effective.

Lisa: Absolutely.

Kevin: I want to get into some nitty-gritty. It’s amazing to me the number of sealants that aren’t done on premolars and second molars and first molars. The amount of fluoride that’s not offered to our geriatric patients and to our adult patients. I’m amazed at the number of ancillary procedures that are so critical to overall dental health and care and the outcome of our prostheses that can be implemented by a well run hygiene department.

Can you go into some data, some procedures, some materials that you find that are extremely helpful for most hygiene programs?

Lisa: Absolutely. One thing when I enter an office and meet with the hygiene department for a lunch period, typically, I’m there to talk about some of the systems I’ve used in the past, but also materials that my company offers to implement into their protocol. I try to work with the ADA risk assessment forms to help the hygienist use a framework in which they’re able to present fluoride to their patients. Again, we go back to streamlining the protocol.

The ADA recommends about 80 percent of your practice should be receiving some type of fluoride adjunct therapy. Many practices aren’t even aware of what their baseline is. So when we start to ask or I start to ask the hygienist, “Typically, who are you offering fluoride to?” They’ll say, “All kids.” And they don’t necessarily take the risk into account. When we introduce or when I introduce the ADA risk assessment, they’re able then to see this is an objective opportunity for me to say to my patient that they’re presenting in my chair at a high risk. And I’m going to recommend an adjunct therapy.

Often, hygienists, I think, are faced with a struggle of selling product or selling procedure and not just administering care. This takes that subjective part of their presentation out of it. And now they’re using an objective form, which is the ADA, which almost everyone is aware of. And it’s add a little of validity. Not that it needs to, but it does.

Kevin: More importantly, it’s showing value.

Lisa: Absolutely.

Kevin: In the professional healthcare systems selling has a negative connotation.

Lisa: Absolutely.

Kevin: But value has a positive connotation. And over and over again in my 35 years, I’d be a hypocrite if I didn’t say I’m interested in bumping my revenue. I’m interested in improving my numbers, increasing my profit. I would be wrong if I said anything else, but it should never come before patient care and service.

So if you’re selling a product that isn’t delivering value, then I think you’re a charlatan. If you’re not selling a product and recommending a product that provides value, then I think you’re not doing your job as well as you should. And the profession needs that.

Can you talk specifically about some fluoride products that you’ve seen some phenomenal results with VOCO, in particular?

Lisa: Absolutely. Profluorid Varnish is a varnish that is very well received in hygiene practices. The application goes on clear, it’s very thin. The flavors are great. We have caramel, melon, mint, cherry and now bubblegum flavor so it offers a wide range of option for hygienists. Plus, it’s at a very competitive price point. You think about when you’re offering a fluoride varnish to a patient and you’re a little bit over a dollar application, it takes less than a minute to apply. And you’re offering your patient a service and improvement in their oral health. And you’re increasing your hygiene production, as you just talked about. So it’s a win-win.

Kevin: This fluoride product by VOCO, is it applied by a brush or is it applied by a swab or is it up to the hygienist and doctor to decide what works best?

Lisa: It actually comes with a brush. It’s packaged with the brush and has a little well so it’s very easy to use. It’s unit dose. And we also have tubes available. If doctors are concerned about the waste, there are tubes available with all the flavors.

Kevin:  Do you recommend that the area be isolated, such as an isolite or a dry shield?

Lisa: No. Actually it sets with the saliva. Sometimes it will go on a little bit easier if you take a 2 by 2 and wipe the teeth and then just you swipe the tooth. You do not have to cover every surface. It does become available in the saliva afterwards. So not every surface needs to be covered.

Kevin: And home care instructions; are the patients supposed to avoid eating or drinking for 15 or 20 mins or can they go immediately to resume their diet?

Lisa: They can eat and drink. We ask that they avoid anything hot liquids or anything hard and crunchy. If it in the geriatric population, at the end of the day, we ask that they avoid alcohol for four hours. And the recommended time for it to be left on is about four hours.

Kevin: As far as ADA codes, what would be the code that our listeners would be using?

Lisa: It would be the varnish code which is 01206.

Kevin: And that code that you’re talking about, does the ADA do it by quadrant or by individual tooth? Do you know how our listeners would build this? For example, if we’re going to isolate the lower right quadrant, 28, 29, 30 and 31, is that billed as four individual surfaces or is it billed as just one varnish treatment?

Lisa: There are more than one code you can use in this situation. If you’re doing localized areas, there is a desensitizing code. My apologies that I do not have that on me and I don’t want to mistaken the number for you. There is a code that I could do some research on and get back to you as far as desensitizing. So if you’re working in a specific area, there are per tooth codes that can be used. But the 1206 code is for the whole mouth for a varnish treatment.

Kevin: Okay, very good. As far as sealants, I know VOCO has some different sealants that are available. Could you speak to that?

Lisa: Right now, we just have the Grandio Seal. It’s a 70 percent filled sealant which is a great opportunity because that high filler allows for increased wear. It’s going to hold up longer. It goes on very easily. We have a non-drip technology. So in the syringe, you don’t pull back on the syringe to stop the material from flowing out. When you stop pressing, it stops flowing. Hygienists can really appreciate this type of application because they’re not required to pick up a explorer afterwards to tease the material through or have to call the dentist in to adjust it down because it’s too high.

Kevin: My name is Dr. Kevin Coughlin. We’ve been listening to Ascent Dental Solutions. This is about the 60th podcast that we’ve produced and I have to give thanks to Mr. Doug Foresta who his company, Stand Out and Be Heard, without his expertise and his knowledge in podcasting, I certainly couldn’t do this on my own. And I like, at the end of each episode, to thank Doug for his expertise.

Today, I wanted to introduce VOCO and their ability to provide value, not only because of their products, but their ability to bring people into your office, train those people and help them to add value to our care and our service that we’re already providing. I could tell you that our company Bay State Dental had a 115,000 patient visits in 2016. And I cannot tell you whether it’s large or small, you need proper processes and procedures and a well-trained team to support your organization.

What I particularly care about with VOCO is their ability to come in and do lunch and learns to provide expertise to the staff that many time we as dentists don’t have that expertise. We should, but many times we’re confused on the new products, we’re not sure how to use the new products, and many times we don’t have a baseline.

Experts like Lisa can come to our practice and help us improve, more importantly than our bottom line, but our care and service to our patients. Lisa, I can’t thank you enough and your company VOCO for being here today. I’m sure we’re going to be having you back. Thanks so much for your expertise.

This is Dr. Kevin Coughlin. You’ve been listening to Ascent Dental Solutions. Thank you all for listening and we look forward to talking to you in the next week.

Podcast: Mike Pedersen on improved dental SEO

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. You’re listening to Ascent Radio. My name is Dr. Kevin Coughlin, owner and operator of Ascent-Dental-Solutions, with an emphasis on knowledge, consultation, training and development. I’d like to give special thanks to Mr. Doug Foresta. He has produced all of my podcasts with Ascent Dental Radio and Ascent Dental Solutions. His company is Stand Out and Be Heard and I just always want to thank Doug for his excellent production.

Today, we have a special guest. His name is Mr. Mike Pedersen. Mike is the CEO of Dental Boost. It’s a cutting-edge dental SEO company for both solo and group practices with a focus on the dental market. Mike has been in this business for over 17 years with an emphasis on online marketing and six years, he’s been working exclusively with dentists.

His agency is able to help clients dominate all of their locations in Google organic searches. They’ve also provided custom high-converting dental websites. Most of the dentists out here listening and health care professionals realize that a website and a mobile app is part of our marketing program, but Mike takes it with his company, Dental Boost, to a whole new level.

Mike, thank you so much for taking time from your busy schedule. Can you give us a little bit of background about the particulars; why you saw this niche, why you decided to get involved with this particular aspect of the dental business?

Mike: Kevin, first off, thank you very much for having me on your show. I’m honored and it’s very much appreciated. Instead of going after the normal approach for dental SEO which is city dentist, city veneers, city Invisalign, city sedation dentistry, those are very general terms and the unfortunate thing is everybody else is going after those terms. And if you’re in a big city, you’re talking about hundreds of dentists going after that term.

Well, that chance of that one dentist, even when they hire an SEO company, the chance of that one dental practice ranking in the top three organically is pretty slim or none, even after one year, Kevin. One year of investing in SEO, the chances of ranking in the top three are very slim, depending on the competition.

So what we decided to do was, do our exhaustive research to find out what kind of what we call buyer-intent dental keyword phrases are people typing in Google for specific searches. And we came up with some staggering numbers, absolutely staggering. The first number we came up with from kind of a general standpoint was 577. The typical dentist when they hire an SEO company goes after all of their services and they tap on the city and then they’ll go after city dentist, city cosmetic dentist.

So we typically see that the approach with all dental SEO is about 20 keyword phrases. We’ve come up with what we call Phase 1 SEO. We’ve come up with over 500. And when we tell our dentists that, they’ve never even heard that number before. It’s kind of like, “What is that? I mean, 500?” And they don’t think we’re serious. And then when we give them our references and they talk to some of our dentists that we’ve done it for, then they start believing that we do what we say we can do.

The exciting stuff for us is the back end, we’ve got a proprietary system we use that’s Google friendly that makes it through all the updates. But the neat thing that we’re able to do is from a robust standpoint, we’re able to not only go after the city the dentist is in, but all the surrounding areas up to five. And so what we’ll tell our dentist is, “Hey, what are the areas you draw your patients from outside of your city?” And they’ll name a bunch of areas. And it could be neighborhoods, it could be outlying towns, things like that. So now we’re going after five to six locations per dental practice.

When we do that, now you’re talking about ranking for upwards of 2,500 keyword phrases for your dental business. And that’s called pure domination in dentistry. Pure domination.

Kevin: I can tell Mike, you’re quite an athlete. I don’t know if our listeners understand what your previous background was in athletes, but I can tell with your desire, your drive and just your overall excitement with your business, Dental Boost. For some of our listeners, even the word SEO, Search Engine Optimization, may be foreign.

For those dentists not as, let’s just say, digital savvy, my understanding is that there’s close to 13 billion Google searches very month. And out of those billions of searches, is it true that the majority, 50 to maybe 75 percent are coming on mobile devices and can you discuss with our audience how that’s changed?

A typical dentist like me who’s been practicing for 35 years, I used to think if I have a website, I’m doing online marketing and I’m free to go. But in reality, experts like yourself realize we’re probably throwing our money into the wind and not getting much of a return on our investment. Could you address that for us, Mike?

Mike: Exactly. And you said something that’s very important when it comes to Google search too is we call it Voice Activated Search or Voice Search. Where people are on a mobile device, and they will talk into their phone — they use SIRI a lot for Apple devices — but they’ll get on Google and they’ll type in “cost of veneers, Portland” or whatever it may be and they’ll start — voice activated search is exploding.

And when you think of voice activated search, which is what we optimize for in our SEO campaign, people don’t talk in general terms. They talk as if they’re talking to somebody right in front of them. And when they do that, you’re talking with three, four, five words so that they get a really defined search result.

And that’s another benefit of our approach, is that mobile search is exploding. And you’re exactly right, it’s over 50 percent on mobile now and growing.

So people are spending more and more time on their mobile devices, including shopping, which Kevin you and I, I don’t know about you, but I’ll speak for myself. I’m 53, tech savvy obviously, running my agency, but I’m old school. I’m not about to make a purchase on my phone. I’ll do it once in a great while, but I don’t think the user experience is very good on a little phone to make a shopping purchase. But a lot of the younger millennials, 25, 30, 35, 40 year olds, they’re doing everything on the phone now, everything.

So you make a very, very good point and it’s a great reminder for me to tell the audience that voice activated search is exploding as well. And that voice activated search is not somebody saying Portland dentist, you’re saying, “Looking for male dentist in Portland, Oregon.” They’re talking into their phone, is what I’m trying to get at. And if you don’t optimize your website for a mobile search, you are losing a huge percentage of people that are using mobile to search for a dentist.

Kevin: Mike, let me just follow up with another question. I know you’ve been doing this for a long time. I know that your clients have been over the top satisfied with the service that you and your company have been providing. But how do you track the results? At the end of the day, when you take on a client, how do you track so that we have objective data to determine the return on investment with your company?

Mike: Great question. First and foremost, we always send ranking reports every month. And that is just hard core data to show if we’re performing what we promised we would perform, which is ranking higher in organic search. Number one as an SEO company, we’re hired to rank our clients higher in Google organic. That’s number one. That’s right off the top. So every month we send a ranking report. We just sent one the other day to a client and this is pretty damn exciting. Kevin, honestly, this is unheard of in dental SEO. This particular client had 973 top three positions in Google. 973, can you imagine?

Kevin: Absolutely fantastic.

Mike: Yeah. So first off, we send a ranking report. Second, we’re going to look at the traffic boost that our services are bringing that particular website. So we’ll go into Google organic and we want to see an increase in traffic. The increase is going to be incremental each and every month because as we rank more and more buyer-intent keyword phrases, that traffic is going to keep going up.

Unfortunately with the old style of dental SEO, traffic hardly ever goes up because it takes so long to get those rankings for those general terms. We’re able, with our robust proprietary back-end system we use, what we’re seeing on average is the first month ranking report we send a client, they have over 200 top three positions in Google is our average right now, after only four weeks of working with us.

Kevin: Mike, if you don’t mind telling the audience, you talked about the organic search. What’s the inorganic search when it’s associated with Google?

Mike: Great question. It’s called Google AdWords. Google has continued to show us something. As SEO experts, we’ve seen this happen more and more, but they can always go so far and then people will stop using Google, which is this; you will see the first page of Google with more and more ads because that’s how Google makes their money. But if they sabotage that and they can’t, there’s no way.

There’s a lot of people that say SEO is dead. Well, they don’t quite understand SEO when they say SEO is dead because if Google littered the whole front page with ads, people won’t use them anymore and Google as big as they are will go away.

People hearing this might say, “That’s crazy, they’re a 50, 60, 80 billion dollar company,” there’s been many multibillion dollar companies that disappear and we can name them over and over and over again. If Google littered the first page of their website with ads, people would leave them. There’s no doubt about it. So people that say SEO is dead, they’re uninformed.

But when we talk about organic and then what’s left is called Google Ads and also the map section, and Google is even taking more of that away. The map section, that little box on the first page when you type like a city dentist, it used to be seven positions in that map. Well, good old Google didn’t like that that map took a big section of the page one for a search so they cut that down to three. Good old Google, rumor has it, it might cut that down to one and throw an ad in there.

So as you can see, Google constantly is trying to, without getting in trouble, put more ads in there. So Google ads typically are the four positions on page one and the top four positions on page one as well. So top and bottom, that’s eight positions of ads.

But let me tell you something, Kevin, about ads and especially with those dental support organization owners that are listening to this audio. If you want to play the Google ad game per location, you are talking about thousands and thousands of dollars per month to get an ROI because it takes a lot of investment to gain the trust with Google to lower the cost per click. But even when you lower the cost per click, you still might get a lot of clicks, but that doesn’t necessarily mean you’ll get a phone call or a new patient.

So we’ve done some research and we’ve found out a number that I want all the listeners to understand, and it’s this; we have found out through research and studies that Google AdWords only send 10 percent of all website traffic to a business. Hear what I just said again; Google ads only send 10 percent of website traffic to a business.

That means if that business, whether it’s a dental practice, a DSO with 50 locations, if you are not doing any kind of organic optimization, you are leaving 90 percent of the potential traffic on the table for all those locations. Ninety percent!

Kevin: That’s huge.

Mike: That’s a big number.

Kevin: Mike, I was wondering if you could share with the audience in your business experience Dental Boost, without getting too specific, whatever your comfort line is, but for the dentists out there, large groups, solo, corporate groups, what generally can they expect for an investment to get your expertise to help them grow their business, improve their position on Google? And at the bottom line, you want people calling the office and you want to convert this tracking to new patients for your business.

Mike: Are you asking what our fees are?

Kevin: Generally, how do you charge the dentists that are listening? Is there a set fee, a monthly fee, a start-up fee and then follow up fees? How exactly does your company run in that regards?

Mike: We’re pretty standard, but what we do, especially the offering that we have with this buyer-intent and hundreds of phrases we go after, we’re priced about right in the middle of what most credible dental SEOs charge. But remember, most dental SEO companies are using the old method that takes six months to a year to see any kind of result, any at all. That is true. That’s a fact. But what we don’t want to do is we don’t lock our clients into contracts.

We’ve heard horror stories and I dealt with a lot of clients. I’ve got one right now, a solo practitioner out of Seattle, no names mentioned because I love them to death. They brought us on and his previous company basically will not let him go and they’re trying to extort a bunch of money from him.  

We don’t want to do that. We don’t lock our clients into contracts. With a thirty day notice, they’re out. They give us a thirty day notice, they’re out. But we do have an agreement because we have a formal agreement that lets them know what they can expect from us and the investment per month and that kind of thing, but we do not lock clients into like a 12-month contract, 18-month contract. If clients aren’t happy with what we’re doing, they can leave within 30 days. So that’s one. Really we’re proud of for that one.

Secondly, we don’t have start-up fee, we don’t have this fee, we don’t have that fee. We typically have a monthly retainer that our clients hire us on. That monthly retainer never changes unless they want to add on more services. And Kevin, I didn’t even get into all the stuff that we’re doing that’s getting really exciting for a lot of our clients, what we call add-ons and keyword clusters.

And I can tell you that a little bit, but for the investment it’s basically just one fee per month for SEO and depending on how competitive the area is, if you’re a solo practitioner, we’ve got kind of a baseline we start with as far as investment. It’s definitely not in the low end. If you’re looking for hundreds of dollars a month, we’re not the company for you. That would be another company that you would want to call on. It depends on the competitiveness of the city or the investment for our services. But our services only fluctuate $300 to $500 from top to bottom. So it’s not a real massive increase, if somebody has got a city that’s 500,000 we don’t like triple the cost, we just incrementally go up.

For a DSO, we basically cut each location in half. For example, the ideal situation for a DSO, so if the DSO owners are listening, please listen to this; Google is looking more for brand recognition now. No longer do you need individual websites for each one of your location. And I would strongly recommend against that. Have a brand that has all your locations on one website. That makes it consolidated, that makes it more cost-effective. And for us, now we can treat it not as separate accounts, like we would have to with each website, now we can treat it as we’ve got an initial investment for location one and then location two through the rest of them, we cut in half basically.

So it becomes way more affordable when you look at the investment with each location as its own business, even in a DSO, it’s still its own business but in this umbrella of a DSO, we cut it in half. So we feel like we’re very accommodating for a DSO to cut that price in half for each and every location after the first one.

Kevin: I can’t tell you how much I’ve enjoyed and I’m sure our audience has enjoyed listening to your expertise as CEO of Dental Boost. Your particular interest and expertise to dentist is a credit to you and your company and it certainly will help us who struggle trying to find new patients and how to handle this new world of digital marketing. Can you tell our audience the best way to connect with you ; a website, an email, a phone number?

Mike: Sure, absolutely. One thing I want to say is there are a couple of dental practices on the east coast that have the name Dental Boost. Our company name is The Dental Boost. Because if the listeners just went to Google, they’re going to find a couple of dental practices back east so we want to make sure the word “the” is in front of that. The website is My email address is Our business number is 866-500-1414.

And Kevin, I want to say one last thing too that’s really important to the listeners, and I love doing this, by the way. Anybody that’s seriously interested in doing this, we really don’t want anybody just trying to just kind of pick our brains and not have an intent into possibly hire us. I do a personal thing we call a Digital Assessment.

That Digital Assessment is I will do a screen share of my computer with all of your online presence. If you’ve got ten locations, if you’ve got one location, I will pull up all your different web properties and I’ll analyze them right there in front of you on your computer screen. You’ll watch me click around. I did it with you, Kevin.

Kevin: You’re not kidding. And for those listening to us, it was an extraordinary eye-opener. The time and energy that Mike and his company put in to evaluate, in my opinion, is worth a pile of gold.

We’re not experts when it comes to marketing. We’re experts in the web. My personal opinion is talk to the experts like Mike. Have them get you straight and narrow so that you get the best results and you don’t waste money and time. Mike, is there anything in closing that you’d like to tell our audience?

Mike: When you make a decision to invest in your practices, you own a business. So it is an investment. A lot of dentists we talk to really kind of fret over I don’t want to spend this much money or I can’t spend that much money. It’s an investment in your business and because everything is online now, I would strongly recommend giving serious consideration to investing in a digital marketing program for sure, whether it’d be with our company or another company. But other than that, Kevin, I just want to thank you so much. I’m very honored to have been on this call with you and I thank you very much for that.

Kevin: Right back at you, Mike. We’ve been listening to Mike Pedersen, CEO of The Dental Boost, an expert in online marketing, but in particular, search engine optimization to get the best bang for your dollar.

My name is Dr. Kevin Coughlin. You’ve been listening to Ascent Dental; my company, Ascent-Dental-Solutions, with a focus on knowledge, development and training and education for the dental community.

I also would like to close with a thank you to Mr. Doug Foresta who produces each and every one of our podcast and his company Stand Out and Be Heard. If you’d like any additional information in how podcast can help your business, give me a contact at

Thank you everyone for listening. And I can assure you we’re going to get Mike Pedersen back from The Dental Boost to talk about the inorganic along with the organic portions of SEOs. Mike, thank you again and thanks to our listeners. I’ll talk to you soon.

Podcast: Jim Gaitan on the impact of mobile tech on dentistry

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. You’re listening to Ascent Radio, Ascent-Dental-Solutions, with a focus on education, knowledge, development and training. My name is Dr. Kevin Coughlin and I’d like to say thank you to Mr. Doug Foresta who has been producing this podcast. His company is Stand Out and Be Heard. Thank you very much, Doug, for another excellent podcast.

Today, we have a special guest. That guest is Mr. Jim Gaitan. Jim is a 25-year veteran in the dental industry. He has a broad career which includes knowledge of practice management systems, a variety of dental technologies, including the intraoral camera systems, digital radiography, CAD/CAM systems, 3D extra oral imaging and digital impression technology. He helped pave the way for the introduction of digital radiography in the dental marketplace and was an early sales executive at Schick Technology.

During its foundings in 1994, he spent 15 years at Schick. Jim then started a consulting company and provides sales and business development and consulting with several dental technologies and manufacturers. And is a leading distributor to offer help and further spread the use of technology as a platform in the dental industry.

In 2013, he co-founded Dentalfone. It’s a website, an app company that I’ve had personal experience with. And their service, their care to attention and detail has been absolutely over the top and I think our listeners will significantly enjoy what Jim and his company, Dentalfone, can bring to their businesses. Jim, thank you so much for taking your valuable time to be on today’s podcast. Give us a little synopsis of Dentalfone. What was the impetus? Why did you start the company and why did you see a need for it?

Jim: Thank you for having me on your podcast and I hope the listeners will enjoy the information that I’ll be sharing with you today. I started the company on this basic premise; and that was that having been in this industry for 25 years, I started in this industry really before the cell phone became common place.

So having this ability to look back in time and look at how we operated without cellular technology and then looked as things changed and then the introduction of the phone and its proliferation and its widespread use by patients, I think that perspective allowed me to have that one defining moment. That defining moment was really looking at dental practices and what happens as you come into a practice.

As an example, a practice will have some kind of brochure up its front desk with business cards, tri-fold brochure for patients to take with them. And then there’s typically a sign somewhere in the practice either at the front desk or on the door that says, “Hey, we really appreciate compliments and the best way you can compliment our practice is to refer a friend or a family member.”

So referrals are important to dentists. Then I would notice that these signs started to spring up in the waiting rooms and on the front counter or on the way into the operatory there would be a sign of a phone with a big red circle extra which says “turn off your phone”.

So I looked at this I said okay, so here’s a missing opportunity for dentists. Patients are not reading the magazines anymore, they’re not watching television. They’re sitting in the chairs consumed and buried in their smart phones.

So I’m thinking here a dentist wants these brochures to provide some kind of value to the practice. And that is for a patient to take one and when they leave, a couple of days later, they walk into a friend and someone says who’s your dentist or who’s your dental specialist? “Oh, I’ve got this brochure.” But the person’s never going to have that brochure, they’re never going to have your business cards at the opportune time when someone may ask for some information that your then patient could refer them to.

So I looked at this as everyone has their phone. They’re never going to lose their phone. It’s with them 24-7. So why don’t we make a brochure on a phone? If you’re going to have a brochure on a phone, you don’t want it to be menu-driven. You don’t want it to scroll endlessly where you can’t find the beginning or the end like typical websites are.

And so we designed a product called Dentalfone that allows a practice and for us to create for a practice a very visually engaging interaction with the practice via buttons and pictures and very image-oriented and it can convey and portray a practice in a beautiful way on a smart phone. So it’s kind of like an electronic business card or a brochure on a phone. That’s the foundation of the company’s beginnings, is that we wanted to help practices take advantage of these devices and leverage these devices for their patient because the phone is always with that patient.

Kevin: Jim, I can tell you that not only do I practice dentistry five days a week, but I also teach at Tufts Dental School of Medicine and today, I spoke to a practice management group of about 40 students. Before I started, I asked if anyone had a phone and out of 40, all 40 raised their hands with a phone.

What you’re saying, I just cannot emphasis that there isn’t a dentist listening to this podcast today or anyone in health care profession that hasn’t seen that patient on their phone in the dental chair or in the reception room. What struck me is not only did these individuals have phones, but they were actually checking and dissecting my presentation to make sure I was giving them accurate information. I actually had them video tape and I said, “If you video tape it and you do a good job, I’ll give you my three jobs that I’ve written on practice management.” But you hit the nail on the head.

Can you explain to me the significance of Google and the Search Engine Optimization or SEOs and how that relates to your company? Because ultimately, no matter how great the website or the app is, people have to be able to tune into it and ultimately find it. How does that relate to your company, Dentalfone?

Jim: Excellent question. There’s really two ways that I can answer that question. The first way is that today when patients are looking for a dentist, 70 percent of internet searches are on smart phones. I think about mid 2014 timeframe, the number of internet searches on smart phones exceeded that of desktop computers. For the last several years now, and it’s growing every year, people are using their smart phone to do internet search.

So if a patient is looking for a dentist or someone says go to Dr. Jones, the person is going to pick up their phone and they’re going to go to Google and they’re going to type in “dentist near me” or “specialist near me” or “dental implant near me” or the city, New York City, and Google is then going to yield a search result.

How Google’s algorithms produce these results has a lot of factors with the keywords that you put in your website. There’s a lot of things that go into how your website will be displayed and in what quarter.

But the way Google yields searches, and I invite your listeners to try this while they’re listening to this podcast, just type in, if you’re a specialist, “dental implant near me” or “wisdom teeth near me” or whatever service you feel like you want patients to find you through. When you enter that into your phone, into Google, Google will yield a result then the result will have ads at the top. There can be one to four ads on the phone. Sometimes there’s zero ads, sometimes there are four ads. And they’re all dependent on the time of day.

People bid for these ads and keywords so it’s a fluid situation, it changes almost minute by minute. But what you’ll see are ads first. And most people know that these are ads because they have a little thing that says ad, ad, ad. Most people don’t click the ads, but they are a way for practices to promote themselves. Some people do click these ads. If the information in the description is relevant enough, the potential patient may click it.

After that, you have what’s called a Google 3-Pack. This is a map package that shows a map location with your geosynclinal dot, that blue dot, and then it will show some red dots around that, those are the practices that meet the keyword search that are in your general local vicinity.

Below that, Google will display three practices below that. It used to be seven, it dropped to five, now it’s dropped to three. The reason it dropped to three is because we’re talking about mobile phones. Mobile phones only have so much real estate on them. So Google has oriented all of their search mechanics to be phone-friendly. So whether you look at this search on a computer or a phone, it’s only going to yield you a 3-Pack map.

If you’re local to that search and some other factors are met, your practice will be listed in that list of the map pack. Below the map pack is the organic search. These are people that have a history of their website being up for a while, have done some good things with the proper keywords, there’s a good amount of content in there. Some people pay for SEO to get them at these locations, some people have gotten just Google organic results because they keep their website fresh and updated with blogs. But that’s the organic search location.

What’s important is you have to keep in mind that a phone is a four by six screen. If the first screen are the ads and the second screen are the maps with the dentists that meet the map location, and then the next screen, the third screen is your organic search so there’s only going to be about three practices, three websites listed there.

So if you’re not in the first ten organic search locations, patients are not going to scroll seven, eight screens to find your practice. It’s a very valuable real estate on the screen and the Google search results would yield these results for you.

Just to elaborate on that real quickly, if someone does click a site, what they see on that four by six inch screen is really like the marketing of the practice. It’s your new billboard. If they come to something very generic, it doesn’t have your logo, it’s just kind of plain, it’s a very boring looking site, will you engage the patient?

Chances are the patient will say, “Okay, there’s one practice, let me click the next one, let me click the next one.” How your practice is conveyed on that mobile device is going to set that most valuable first impression.

What Dentalfone’s goal is is that when people are searching for you on a phone, we want your practice to be displayed in a very engaging, visually appealing, a very stylish way and also through images and pictures.

If someone is looking for a dentist that does implants and they land on a normal, traditional website on a phone, they’re going to see a logo, a phone number and maybe welcome to Bridge Dale Dentistry and maybe a picture or a stock photo of someone smiling. But on that first screen, there’s no indication that you do dental implants. With a Dentalfone implementation, we have your logo and some buttons, call us, directions, about the practice, meet the doctor, implants. So there would be a button or a picture of an implant. We’re going to make it very visual so if the patient is looking for implants, they don’t have to go through an endless menu system or a scrolling through several screens to know that you do implants.

That’s really the focus of the company, is we want to make sure that on a mobile device, a practice is displayed quickly and easily and visually so patients know what you do and are attracted to the design. Our product is kind of like an app-like design with buttons just like you would see mimicked on your phone. That’s the kind of interface patients like and that’s the interface that we’re providing.

Kevin: Am I correct to assume, Jim, that your company not only focuses on dental applications, but it also focuses on websites and you try to mirror or marry those two technologies to get the best bang for your dollar, is that correct?

Jim: That is correct. Dentalfone has a platform of offerings. Our most basic offering is what we call the Dentalfone App. It’s a web app, it’s cloud-based app so it has a URL, it has a website. It doesn’t have to be downloaded from the app store. When I first started the company three years ago, there were a number of companies selling apps in the dental space. I think many of them all just disappeared. They’re not really out there anymore. People don’t want to load a dental app through the app store and take two minutes and their Apple ID and use their passwords.

What we do is create a web app. You literally can create a URL,, whatever the available URL is that has some affinity to the practice and we will create a web app. So our basic product is a web app.

That means you can keep your existing website, you operate business as usual, but you get this web app because now it becomes kind of a tool. You’re able to put it on the patient’s phone for the post-op instructions, emergency information. That’s our basic product.

If the client wants to make this app the website, then we have several ways to do that. We can mimic the same design with the squares and all that on a computer. So when you go to a desktop or laptop computer and you type in the same URL as the app, you’ll see the app come up on the computer with the squares and there will be beautiful backgrounds, pictures of the city, pictures of landscape. Just very nice eye-appealing. So there’s a unique interface on the computer.

One thing that we do beyond that is we have something called a Hybrid Responsive Technology. This is a trademarked product from the company. What we do here is provide a responsive design. But instead of the way responsive designs work today in the marketplace where you have a traditional desktop website and when you go to a phone, what it does is it shrinks that information down into a submenu system of like a hamburger menu or a roller decks and then you have to scroll and scroll and scroll. What we do is we basically use the app-like interface on mobile to be the mobile version of the sites.

All within the same URL, our system measures the phone’s screen size, it determines the display size, in other words, of the device that you’re displaying on and if it’s big and wide, we’ll give you the desktop web appearance with very stylish video. We do very cutting edge desktop websites.

But if the display size is like a tablet or a phone, our software recognizes the shift in the geometry of the display size and will display the app-like interface. Because really since most people are using their phones for internet search, the phone is the most important platform. I can say this quickly, in that the way people have bought websites in the past is you go to a vendor, show them your websites and they spend two hours on a computer showing the websites. So before we end this, what does it look like on a phone? This is such a counter way to look at it today.

The very first thing a dentist should ask when they’re looking at website or any company is what does your website look like on phones? Because if 70 plus percent of the people are looking at the website from the phone, why would you spend 70 percent of the time evaluating the website on the desktop? It should be the exact opposite, the reverse.

Seventy percent of the conversation should be about how does your website look like on a phone and oh, by the way, before we end this conversation, what do you guys look like on a desktop? Because that’s really how people are using the devices to look at websites.

Kevin: There’s no question it’s a paradigm shift. Most of the listeners, I’d like to think all of the listeners know that I only endorse a product, a service that I fully believe in. And your company at this point has provided not just only excellent service, but your systems that are in place have been over the top.

If you don’t mind that I don’t put you on the spot, is there a way that you could give a general fee structure what you could expect the dentist and also a way for them to contact you? Not just dentists but any of the health care providers that are listening to this podcast, how they can reach out and get in touch with your company for a demonstration and additional information and knowledge.

Jim: Our product ranges in price from around $3,000 up to a high of $12,000. Depending on the options that the client is looking for, if you’re looking for the app or a high-end website, a desktop website, video-based systems, these are very, very high-end solution, you’re going to be closer to the $10,000 to $12,000 range.

If you’re looking just for a basic app for the phone and keep your existing website, then you’re down to the $3,000 to $4,000 and $5,000 range, depending on what options people are search for there.

Some of the key things that we’re also adding to the product, and this is something that’s very, very popular to some of our clients is like a translation option. You’re on a phone, you’ve got these buttons and there’s a good degree, depending on the city — I was just in Chicago recently, Polish, there’s a very big need in the City of Chicago. There’s like a big Polish community. You have your different ethnic communities. You have in some places Korean, Vietnamese.

So we offer a translation option so that if you’re sitting here and a patient is using this app, they can just literally move up a couple of inches and at the bottom it says “Select Language”. They can click the language that they want, Arabic, whatever, and everything in that app changes in a text basis via Google Translate. But it will change everything; all the buttons, names change and all the subsequent text behind all of these buttons and the subsequent pages will all change into that language.

So we offer some additional services that are part of kind of like that price structure I was laying out, but you can get started with the company as low as $3,000 and if you want to go to the full deluxe route, it’s close to $12,000.

I would just say to the listeners this, and that is that good things are seldom cheap, cheap things are seldom good. Our focus is on providing the best maximum value. If you buy a website for $5,000 and its mobile version of it, the scrolling and the menu-driven version of that website doesn’t portray your practice the way you’d like to portray it and if you looked at our product and said, “Wow! That’s a better way to portray my practice,” if I’m $2,000 more, the question is is it worth that additional amount?

If 70 percent of the people are looking at you from a mobile device, then I think I’m worth more. Because quite frankly, we’re focusing our work on helping you and the dental practice look amazing on a phone and to make the product more than just a website.

Most dentists would agree that websites are one and done. The patient will go to it one time and they’ll never go back again. Most patients are not revisiting dental websites. It’s one and done. With Dentalfone, we’re going to make your website kind of a tool. When the patient is leaving, “We have post-op instructions. Very easy with a button, just put this on your phone, it’s, just put it up on your phone, click the little post-op instructions and it’s available for you to use.

And oh, by the way, we love referrals. We have a little VIP program for our patients that refer their friends. You can literally share this app via text or you can share it via email and it’s a way for people to go out and pass our business card without having to collect paper in the pocket. Basically, you have your phone, you can help share our practice. We really appreciate it and we reward our patients with a little bit of a whitening discount,” or other ways that you can reward your patients for passing this along.

Kevin: Jim, your website is what?

Jim: My website is You can also reach us if you want to call our 800 number, we have 855-385-3663 or you can email us at and we will reply to your inquiry very quickly.

Kevin: Jim, I cannot thank you enough. I know how busy you are and I know you’ve devoted your life to the dental and healthcare profession and your excitement is evident in this podcast. I can tell our listeners that my experience with Dentalfone has been extraordinary. Their service and care to this point has been over the top and I’m strongly endorsing you to follow up with Jim and his company.

You’ve been listening to Dr. Kevin Coughlin and Ascent Radio. My website is I appreciate you taking the time to listen to this podcast and I strongly recommend that you consider reaching out to Dentalfone,

I think you’ll be very pleased with what they can do. With almost 13 billion searches a month in Google and 70 percent coming from a mobile phone, I think we’d be making a mistake not to take advantage of this opportunity.

Thank you again. And I want to give a special thanks to Mr. Doug Foresta, Stand Out and Be Heard. Once again, an excellent job in producing this podcast and I appreciate it greatly. Thank you to my listeners and I look forward to talking to you next week.

Dental implants growth tied to technology advancements

Although pioneering techniques have always been a part of dentistry, I must admit it’s been fascinating to watch how one in particular has evolved throughout my career.

I’m talking about dental implants. When I did my first implant back in 1983, it took three hours to get a single tooth in place. Back then the process included drilling into the bone to test for bone quality and quantity. The theory was that good bone density meant a good prognosis for a successful implant.

Since then I’ve done thousands of implants and the process has developed quite a bit.

Today, using cone beam technology we can plan the surgery in great detail. The cone beam allows us to check for quality and quantity of bone, height and width of bone without any invasive drilling.

Putting the technological advances in the procedure aside, it’s hard to overestimate how important an advance like implants are to the quality of life of patients. Even a patient with no teeth can have them all replaced.

It used to be a very time consuming and expensive process for a fully edentulous patient. Prior to cone beam technology, patients would wait weeks for treatment prep and planning to be completed. The prep has been since dramatically compressed over the years, resulting in a quicker and much less expensive procedure.

There are some companies such as Implant Concierge that are rather handy for dentists in that they handle all the post cone-beam scan work and create a plan for the dentist to work from. These are online processes that eliminate office work in terms of merging, segmenting and thresholding for the procedure.

What I like about such companies is how they allow dentists to integrate implant work easily into their practice without  stand-alone software, and the learning curve that it involved for everyone in the practice.

Outsourcing this type of work is a good strategy to increase your service offerings without impacting your current business. And because it expands the scope of your practice, it is good for client retention, referrals and your bottom line.  

So if you feel your practice is not growing as fast as it should, consider all the options.

Podcast: Bret Royal of Implant Concierge on benefits of implant surgery

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: This is Dr. Kevin Coughlin. Thank you for listening to Ascent Radio. My podcast is Ascent-Dental-Solutions. My name is Dr. Kevin Coughlin, a practicing dentist since 1983. I want to give congratulations to Doug Foresta, Standout and Be Heard. Doug has been helping me produce this podcast for the last several months and he can be reached at

Today, we have what I consider one of the leaders in the industry, Mr. Bret Royal, Founder and CEO of Implant Concierge. If you haven’t heard about it, you will hear about it in the near future. Bret is here to talk about the advantages of Implant Concierge, which I’ve learned firsthand.

He established seven businesses all related to the implementation and utilization of cone beam technology and guided implant surgical services into the dental market. As CEO of Implant Concierge, LLC, he’s built one of the largest CAD/CAM guided manufacturers in the world while focusing on service, simplicity and affordability.

With no further ado, I’d like to introduce to you Mr. Bret Royal, CEO of Implant Concierge. Bret, thank you so much for taking your valuable time to speak to us and the dentists all across the world about the advantages of guided implant surgery. Give me a little bit of a background about why you started your company and how your company is doing right now.

Bret: You bet. First of all, Dr. Coughlin, thank you so much for having me on Ascent Radio and on your podcast. It’s truly an honor. I really am excited to be here. My company was founded originally as a dental imaging center along with myself and 42 other dentists in San Antonio. And it was right when cone beam CT was coming out, it was pretty new and expenses of buying a cone beam CT unit, obviously, was not a smart economical decision at the time.

So myself and a few other dentists here in San Antonio went in as partners and opened a really nice state of the art dental imagining center focused on treatment planning and dental implants. Because of my network of surgeons across Texas, we went from one imaging center to ten relatively quickly in about three and a half years.

From the very beginning, the cone beam CT was fascinating, but what really got me excited because of my dental implant background was taking the cone beam CT images and creating a virtual surgery and presenting that to the doctor and as well to the patient to help improve the case acceptance and also just the quality and predictability of dental implant surgery. Over the years as the business grew and the services were becoming more and more popular, we really needed a way to take our business from local region dental imaging centers where we were provided really robust services to more of a national platform, even a global platform. That’s how Implant Concierge was created, is how can we take what we currently do but provide it to many more dentists across the United States and not just where we’re located.

Implant Concierge was founded on things that we had already been doing, but putting it online and making it much more simplified and taking all the time away from the doctor to free up the doctor from having to buy software and spend a ton of time sitting there working with DICOM files, merging, segmenting and also doing all the thresholding, and just simplifying the process and building a communication tool that will allow doctors to work together to make the process very multi-disciplinary and also very simple.

That’s my background and it’s been an amazing growth over the past ten years. Implant Concierge is averaging about 3.8 new dentists per day since October 2014. So it’s been a wild ride, but it really matters because I think the services are what many dentists need as they embark upon providing implants for their patients.

Kevin: I can just digress a little bit that I placed my first implant in 1983. At that time, I scheduled almost three hours to place that singe tooth implant. Over the next 34 years, I’ve put in literally thousands of dental implants. And only until the last five to seven years that I realized that — because this podcast goes out everywhere to non-clinical people, to clinical people, to the public in general, you may not realize this, but when we first started placing implants, we would drill a hole into the bone and check for the quality and quantity of bone. If it feels dense, if it felt strong, that was a good indication that the implant would be successful. Those pioneering days, I’m happy to say, are gone by the wayside.

Today, with cone beam technology and your company sophistication of software and guided surgery, we can now basically do the surgery virtually before we ever start the treatment on Mr. or Mrs. Smith. The cone beam allows us to check for quality and quantity of bone, height and width of bone. Why don’t you take a couple of minutes and explain to our audience some of the advantages and sophistications of using the virtual treatment plan before the actual treatment plan?

Bret: You bet. Many, many dentists go into a case with a lot of concerns about the anatomy and the amount of bone. As you said, the cone beam CT was powerful and fine giving us the bone quality and quantity upfront so at least now we know. But on top of that, now we can go ahead and we can place the implant. It allows us to avoid challenging outcome of situations, whether it’d be the sinus or the nerve, we can also place the implant in the ideal restorative position.

And really this is the key, I think, for many dentists whether you’re a specialist or you’re a general dentist placing the implants, you want to be able to plan and place the implant in the ideal restorative position so that at the end of the outcome you have a tooth. You don’t have a crown on top of an implant.

Using the software, we can place the implant in the ideal position. We’re using the crown-down philosophy, using that restorative crown as our guidelines and then maximizing the bone to the implant position and size, the length and the width. The software allows us to do that. Taking the diagnostic cast or the patient’s digital dental model and merging it also gives us the soft tissue and so many other parameters to consider while we’re placing the implants.

Once we have that virtual surgery completed, now we can take it to the next step and take the virtual surgery and utilize that to design a 3D surgical guide that utilizing CAD/CAM and 3D printers we can now print a medical grade surgical guide that can be used that takes our virtual plan and then it turns it into reality into a surgery.

Kevin: I know that we have a wide variety of listeners with a diverse degree of experience. Basically, if you walk us through, from my perspective, we have tooth-supported surgical guides and bone-supported surgical guides. In simple lay terms, some people have no teeth and we’re replacing all of their missing teeth with dental implants and other people have a wide variety of teeth still present and we’re replacing just a single tooth.

Can you explain the process, the procedures and how Implant Concierge works through the completely edentulous patient, the patient has no teeth at all, so that our listeners get a firm idea of the power of Implant Concierge and the tremendous success rate by following the correct process and procedures?

Bret: You bet. And I think if you go to our website, we have these protocols listed out to review and look at a step one through five process. But ultimately, the dentist would simply start the case at Implant Concierge and let us know which teeth are missing. In this situation, all teeth would be missing. And also on another chart, they let us know where they ideally would like to place the implants.

Once that’s completed, the Implant Concierge is going to get the dentist the exact specifications and rules, the workflow, so to speak, as far as exactly how to do it.

The number one step on a fully edentulous patient or someone with no teeth is to have a well-fitting hard reline denture. Once we have that denture, we can go ahead and use they call them X-ray markers, but it’s really a one millimeter lead ball that’s on a sticker and they’re actually for mammograms.

So we go ahead and we take six of these X-ray markers and just stick them randomly to the patient’s denture. At that point, utilizing the doctor’s cone beam CT scanner, we’ll go ahead and scan the denture with these X-ray markers on them and then we’ll very carefully take the denture and position it near the patient’s mouth. While the patient is wearing it, they’re also given a CBCT scan. Essentially, the patient was scanned one time with the cone beam CT unit and the denture was exposed twice.

Once those two scans were taken, it’s generate a file called DICOM. That’s what cone beam CT generates, is a DICOM files. Both those data sets or DICOM files are uploaded directed into Implant Concierge’s HIPAA compliant communication portal. So they’ll go and upload us the files. Once we have those, it’s a matter of utilizing software to match them back together and then using a tool called Thresholding, we can literally threshold the difference and create the soft tissue model.

From there, once we have that soft tissue model, we can pretty much do anything we would like to do. And we utilize the denture, the soft tissue model and the bone to meet with the dentist to finalize the final positioning during that virtual implant planning or VIP session.

It really is magical how simple it has become over the years. This used to be a very time consuming and also a very expensive process for a fully edentulous patient. Now, a fully edentulous patient is one of our easiest cases that we can do, believe it or not.

It’s come a long way in a matter of two, three years, saving that patient weeks of waiting for the diagnostic tools and treatment planning to be completed as well as a ton of costs that can now be minimized from not having to create really expensive scanning appliances. So this dual scan protocol, using the X-ray markers along with the patient’s denture is just a wonderful advancement for the patient and for the dentist.

Once that meeting is done, Dr. Coughlin, at that point we go ahead and we build a surgical guide that matches the intaglio surface or the denture so it fits just like the patient’s denture did. And then at that point, the dentist can go ahead and do a very efficient surgery.

Kevin: Just for our listeners out there, these little millimeter microdots or mammillary dots for radiopacities, you can order these through your local surgical supply house or I believe Implant Concierge can also order these radiopaque dots also. Another quick for individuals are make sure when Bret explained to you, you’re better off taking the denture with the diagnostic radiopaque dots and scan that first, then put it in the mouth rather than vice versa.

Because once that prosthesis is put in the mouth, sometimes the saliva and moisture can loosen up those radiopacities and you like to keep them in the same place. Am I correct on that, Bret?

Bret: Yeah, that’s a great tip. So step number one definitely would be to scan the denture out of mouth first with the markers and then carefully put it into the mouth. As far as the purchasing location, if you just type in “one millimeter X-ray markers” you’ll have a whole plethora of medical supply companies. Or if you buy from Implant Concierge, we have created a little package where you get a box of 110 of these markers for $40, that includes shipping, as well as the protocol sheet as well as a little sponge because you want to position the denture on top of a sponge or a form on top of your CBCT scanner.

So it’s almost like a little scanning kit for your dental assistants to follow along very precisely. It’s a little bit technique sensitive when it comes to taking the cone beam CT X-ray so having these protocol sheets right there for the dental assistants who will be taking the X-ray is very helpful to avoid any issues or poor scan quality.

Kevin: Bret, can you talk a little bit now about the patient who’s dentate, someone who has a multiple number of teeth but may need one, two, three or four additional teeth replaced and the sequence on that?

Bret: You bet, Dr. Coughlin. Providing a surgical guide for a patient who currently has teeth or what we consider a partially dentate patient is also extremely simple. The workload depends upon the technology that the dentist currently owns. Once again, you start the case at Implant Concierge and then follow the protocols.

The first thing that we’ll need is to take a cone beam CT scan of the patient. What’s nice about this is that no scanning appliance is necessary or a radiopaque template or a special bite guide. Nothing is really required. All we want is a simple separation using cotton rolls of the upper and lower maxilla and mandible teeth.

Once you have a simple separation, sometimes people will even use a bite stick and lay it across the occlusion table just to create a little bit of a separation. At that point, once you have the separation of the teeth, go ahead and take a CBCT scan so there now we have our DICOM.

You directly upload that into Implant Concierge and then if the dentist does not own a digital impression technology, then they’ll go ahead and take an alginate impression and then pull up a really nice accurate diagnostic cast and then ship us the diagnostic cast. Once we receive the diagnostic cast, we’re going to go ahead and digitize it using an optical scanner and create a digital file of that diagnostic cast. And then we turn that digital file into what we call a .stl (dot STL).  

If the dentist owns an intraoral scanning unit or a digital impression unit, that’s wonderful because the dentist can take a quick impression of the arch of interest and upload the STL file directly into Implant Concierge and within minutes, Implant Concierge will have the DICOM of the CBCT as well as the digital impression.

And then we’re off the races of merging and planning the case for the dentist. It’s either a cone beam CT plus a diagnostic cast, or if you have a digital impression, take a digital impression and upload that directly to Implant Concierge. So the workflow for partial is very simple.

Kevin: I know all of this information is on your exquisite website. But if the patient is partially edentulous and has a good fitting partial or removable partial prosthesis, do you want that partial in there when you do the cone beam or would you prefer that that be out of the mouth?

Bret: That is a great question and a lot of dentists they make the mistake. You do not want to have the partial in the mouth when taking a cone beam CT scan. The reason makes a lot of sense; cone beam CT scan does not like metal and most partials have some type of metal framework built within or the clasp.

So those clasps create all kinds of scatter or what people call noise on the cone beam CT. When you scan a patient, make sure everything is removed from the mouth. However, that RPD or the Removable Partial Denture, is so valuable for us for planning.

So whenever you send in your diagnostic cast, if the patient has an RPD, go ahead and take a second impression, what we call a pick-up impression of the patient wearing their RPD and send that in also. So now we have two diagnostic casts; one of the patient with their missing teeth and then one of the patient wearing their actual RPD. Because that gives us the actual reality or the actual positions of the restorative teeth and where you’d like to have them.

Once we know where the restorative teeth are at and we know the bone, we can do an amazing treatment planning that’s extremely accurate, once again, using that crown-down philosophy. So the RPD is a very useful tool.

Kevin: Am I correct if the patient doesn’t have a removable prosthesis if you’d advocate a diagnostic wax-up? So you’d send the impressions or I should say the pod accurate models of the edentulous area and then you would do a diagnostic wax-up so that we’re helping you where we want the occlusal plane, the path of insertion, the emergence profile, et cetera. Am I correct on that?

Bret: That is correct. This becomes a situation where you kind of have to make decisions. If we’re only missing one or two teeth, my team, they’re very well trained, they’re all dental assistants and also lab technicians, we know where teeth belong so we can virtually place a tooth in the right position to give us that crown-down philosophy.

However, if you’re missing a long span of bridge of teeth, maybe like say three plus teeth in a row, may four teeth in a row, then it’s really powerful if the dentist would send us I want the teeth to be in this exact position. So a lot of dentists what they’ll do is they’ll go ahead and do a quick wax-up in their lab or have their lab create a wax-up and send us that diagnostic cast with the wax-up on it as well.

If the dentist does not want to do a traditional wax-up, that’s not a problem. We have some very powerful software where you can send us the diagnostic cast as well as the upper and the lower end by registration and what we’ll do is we will virtually merge those files together and we’ll do a virtual articulation and then we’ll create a virtual wax-up that’s going to be extremely accurate, just like your lab would do on the bench with the articulator.

It is actually a huge advantage if the dentist does send us a wax-up because that way, we can make sure we use the crown-down philosophy. Having the doctor’s wax-up is always going to be superior versus someone else’s because you guys know exactly where you want that tooth.

Kevin: Mr. Royal, I cannot explain as our listeners know listening to me for several months now doing this podcast, I only endorse companies that I believe, like and trust in. My association with your company what has just been to me over the top is the care, the service and the ability to want to train us to provide a better care and better service for our patients.

Bret, can you tell us your website and how the doctors listening can get in touch with you to ask additional questions or order from your to get started with Implant Concierge?

Bret: You bet, Dr. Coughlin. I just want to say once again, thanks for having me. I also want to say my whole vision, my whole goal is to make guided surgery because I think it’s so powerful and so wonderful and as simple and affordable as possible. That’s what  I think we’re based upon.

I think we’re one of the few companies that actually provide this level of service and support. So I’d love to give you my contact information so that way your listeners if they want true service and a guided surgical company, I hope they give us a call. We can help them out to provide that predictable solution that they’re looking for as well as the confidence.

Our number is 866-977-2228 and the website address is The easiest way is to call us, someone will jump on your computer with you, give you all the protocols and we’ll even review your cone beam CT scans before you upload them to make sure that they’re of great quality and scan correctly. Whatever we can do to help out, we’d love to be there for you.

Kevin: Mr. Royal, thank you very much and I know your company is going to go nothing but straight up, the service, the care, the expertise over the top. I know how busy you are. I can’t thank you enough for taking the time.

You’ve been listening to Ascent Radio. Again, a shout out to Stand Out and Be Head by Mr. Doug Foresta who’s producing this podcast. A special thanks to him. That’s if you’re interested in podcast and the power that it can provide for education and knowledge.

My name is Dr. Kevin Coughlin and you can contact me at, with a focus on education, training, development and knowledge. Thanks again for listening and I look forward to talking to you in the near future.

Dentistry plays key role in sleep medicine

Feeling a little sleepy today? That’s okay, maybe you had a rough night. Not a big deal.

But what if you’re feeling sleepy a lot? Days or weeks at a time? You may be becoming dangerous.

Put another way, you may have a sleep disorder, putting you among the tens of millions who suffer with one. The dangerous part? It seems 20 percent of all motor vehicle accidents are associated with untreated sleep disorders. Do you remember the Challenger accident and the Three Mile Island danger? Both are connected with sleep disorder issues.

How does this relate to dentistry? First of all, the American Association of Sleep Medicine is considered the governing body. It provides the guidelines and the standard of care for dentists and physicians to follow in order to provide the public with the highest level of education and treatment options related to chronic, severe problems of sleep deprivation.

Most people consider going to a dentist for snoring only when their partner becomes disturbed and irritated. It’s a situation that is both uncomfortable and embarrassing for both parties.

So what can a dentist do to turn this problem into a profit center? Here are the proper process and procedures to provide excellent care in sleep medicine. Follow them and you will be able to increase your profitability by expanding your practices service offerings.

  • Get certified! Patients seek out dentists who have either a certification, designation or a minimum of 25 hours of training in the appropriate sleep medicine courses.
  • Learn to make the referral! A proper diagnosis requires the patient to get a polysomnogram (PSG), a level one sleep study done in a hospital setting where the individual stays overnight. Their eye movement, muscle movement and cardiac evaluation is constantly monitored along with their blood pressure, their inspiration, and expiration. A combination of all these factors will determine whether the correct diagnosis of obstructive sleep apnea is present or not.

Now for the solution. Most think a CPAP unit is the logical solution. You put on a mask when you sleep and it solves the problem, right? Well, maybe. As many as 80 to 85 percent of people are unable to tolerate the CPAP. Users can find it constricture, claustrophobic and ironically, find it difficult to sleep with it on. It’s also a bit pricey at about $2,000.

A good alternative is a Intraoral or Mandibular Advancement Device.These devices keep the lower jaw in place and stops snoring just as well as a CPAP machine.

Over 90 percent of all sleep apnea or obstructive sleep apnea is caused by occlusion of the oral cavity or back of the throat by the tongue. By bringing the lower jaw or mandible forward, the tongue is advanced forward and the airway is open.

We’ve been providing intraoral appliances for sleep disorders for many years now and it is amazing to me how much better patients say they feel. Whether is be a intraoral appliance or a CPAP unit, your practice can benefit greatly simply by offering the service.

So are your patients sleeping well? Are they snoring? Maybe these are two questions you should be asking at every checkup from now on.

Podcast: Andrew Olsen: How video can help dentists grow their practice

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome to Ascent Dental Solution Radio. This is Dr. Kevin Coughlin, owner of Ascent Dental Solutions. I want to give a thank you to Stand Out and Be Heard, Mr. Doug Foresta, who has produced this podcast for me for the last year or so. Without his expertise, this couldn’t be done.

Today, I’m fortunate enough to have owner and CEO Andrew Olsen, who owns and operates Loft Light Media. I’m extremely pleased to have Andy here as our guest.

Although most of our listeners are dentists and physicians, I know we have all kinds of different business owners listening to Ascent Dental Radio. In this particular case, in full disclosure, I do have a working relationship with Loft Light Media. I contacted several different venues to improve my mobile device and the message that that mobile device provides along with my website.

And over and over again, I came up with the same name and that was contact Andy Olsen of Loft Light Media. Basically, Andy, I can’t tell you, thank you so much for taking time to be on this podcast. Give us a little history about your business and how it came about.

Andy: Absolutely. Thanks so much for having me, Dr. Coughlin. It’s something I’ve been looking forward to doing with you. We started our business not necessarily planning to specialize in dental businesses, but that’s sort of how it worked out. I put together a video for an oral surgeon in southern New Hampshire and then kind of through him meeting some companies that were working on developing new smart phone apps. They sort of saw that video and asked if I wanted to do more like that. So actually at this point, about 90 percent of videos we produce are in the dental field, which we love. We’ve really had a good time learning about that and finding out how we can best help people who are in that particular field.

Kevin: Andy, how long has Loft Light Media been in business?

Andy: About four years now.

Kevin: And you’re primarily located in the New Hampshire area, but I believe you’re available to travel pretty much wherever is needed, is that correct?

Andy: Yeah, that’s right. We’re based in southern New Hampshire, but a majority of our clients range from New York, New Jersey, we have one we’re doing in Florida next week. So yeah, we travel depending on what the need is.

Kevin: I don’t know if our audience is aware, but Google has almost 13 billion searches every month and the vast majority, almost 80 percent of these searches today are done on mobile devices. And what Andy and his company, Loft Light Media, educated and showed me is how more and more people use their mobile device to do a search. And when you do a search, perhaps the best thing is to try to connect with our audience or patients in our case and the best way to connect is through a story. Andy, can you tell us how these videos help accomplish that goal?

Andy: Yeah, absolutely. That is exactly the main point of them, is most of your clients at this point, I would say, and every year the number grows, but I think last year to this year it’s about five times as many people are search on their smart phone or their mobile device. And as everyone who’s tried to do this can say from experience, when you have the patient zoom in on text, that’s a tedious process and most of your customers or your patients just won’t do that. They’ll just move on and they’ll skip back and miss a lot of the message that you really want to get across to them.

The advantage is they not only solve that problem instantly, that they can click a video and it’s interactive, it’s engaging, it’s beautiful. What we do are stories. Within 60 seconds we sort of give them a glimpse into who you are, what it is that drives your practice. You get to not only just tell them about it, but you get to show them as well. There’s a lot of power in that.

Kevin: It almost reminds me years ago when MTV came on to the scene and we were watching these videos and the entire world was taken by this. When I’ve seen the mobile devices in websites with videography in music, it’s quite moving. I can tell you it grabs my attention and it takes a lot to grab my attention. Do you have an artistic background, your education? How did you learn this? Where did this knowledge come from?

Andy: Absolutely. I appreciate that jumps out to you. When we put together a video, we really don’t have a cookie-cutter formula, we really try to customize it, not only the message, but the personality of each of our clients that we’re working for. I am a musician. I grew up very interested in music. Almost decided to go that direction professionally instead of video.

But I think video really, I’m love with the art of helping to communicate a story in a short amount of time that really leaves a lasting impact on somebody. And I think that a lot of businesses have a great story to tell, they just haven’t found a partner yet who can help them tell that. We love to do that for people.

Because I do have a background in music, we’re very picky with our music. We try not to use anything that sounds like it’s canned or just to be mass distributed, but we try to really actually license music by real artists and that makes a big difference. It really communicates the emotion, the feel of your practice, which, I think people can notice that difference.

Kevin: If you’re comfortable, Andy, let’s get into some of nitty-gritty. When you do a typical 30-second, 60-second or 2-minute videography, about how long do you need to film to get that story so that you’re comfortable and your clients are comfortable?

Andy: There’s a few variables. Sometimes the doctor could choose to actually speak in their video. So we’ll conduct a short interview with the doctor, try to get some candid responses about what it is they love about their work, what’s their philosophy of treating their patients, maybe what technology that they’re excited about and how that’s solving problems for their patients.

So we’ll have discussions like that and then we’ll intermix that with a professional voice actor that will then translate the rest of the message, kind of fill in the gaps, maybe where they’re located and a call to action or something. All of that put together really only ends up being 60 to 90 seconds, but when we’re there filming, the process takes about I would say safely four hours.

During that time, like I said, we customize it to each client, but I would say the majority of the time they’re actually treating real patients. So it’s a normal day, the front desk is running, the hygienists are treating patients, the doctors are treating patients. You get that real interaction. The doctors don’t have to worry about trying to be professional actors, too. They actually just go through their day. And I use a very small camera that’s not intrusive and I just capture things as they happen and we put it together later and edit it to be a video that really tells their story.

Kevin: And the great thing for health care professionals is the patients are still being serviced, the business is still up and operational. As small business owners, to take a half a day or a day off for filming can be quite expensive and disruptive to the normal flow. So the fact that you can do this while the doctors are still performing their day to day duties is, to me, just a huge, huge plus.

Another technical question; in your experience, these videographies, should they be updated semi-annually, quarterly, yearly? What’s your recommendation and suggestion for our listeners?

Andy: Normally, what we do is we begin with the story of the practice. That’s normally a 60 to 90 second video telling about who you are. That video, I would say usually has a lifetime of at least a couple of years. Within that time, maybe you’ve made some updates to your office, maybe you’ve added things, maybe personnel have changed. Usually, those are the reasons why we go back and say let’s update it, let’s add some new material and just make small revisions to what you had before.

But often, what will happen is we’ll actually add new material. So we’ll add patients’ testimonials. We’ll actually get some of the patients that have had an incredible experience at your office to come in and take 20 minutes of their time to tell their story. I’ll sit with them and we’ll have a conversation and we’ll edit that together.

And that becomes sort of like a living review for you that’s constantly promoting your practice. And that really gives what’s called social proof. So it’s not you talking about you, but it’s someone that the public can relate to just telling the truth about their experience. And that’s a really powerful addition.

So we do things like that and then we add other components. We sometimes highlight certain clinical procedures or for an orthodontic office, sometimes we do just fun things. We did like a mannequin challenge where they were able to put that on their social media and it just generated some fun or interactions with their patients.

Kevin: For our listeners who have different areas of expertise and knowledge in this particular area, the video that you film, can you use it both on the mobile device and on the website or is there something that you’d recommend different, one specific type of video for a mobile device and something specific for the website?

Andy: That’s a great question. I think there’s no difference at all. You can use the same video content on your mobile device as you would on a computer. The beauty is, you’ll own the video. We create a video, we turn it over to you and we actually recommend put it on your social media. Load it onto YouTube because that helps people find you.

The more video links you have tracing back to your practice’s website or your practice’s social media, that helps you rank higher in what’s called SEO, which is just what happens when someone Google searches a dentist or a specialist in your area.

Kevin: So no matter how great the content is, if they’re not searching and finding you, it could be less beneficial and those assets may not be used as well as possible, correct?

Andy: Absolutely. I do recommend, depending on who you’re working with to do your marketing, some practices do that in-house and some will bring in professional help to do that, but you do want to consider how are you going to release your video.

Because you can have a great video, but you don’t want it to just be silently released. You want to very strategically link it back in the right ways to give you the best response. And we certainly have partners that we highly recommend in that regard. But as long it’s done professionally, then you’ll get the best result possible.

Kevin: Andy, this next question I don’t mean to put you on the spot, but I know I find it awkward sometimes people always saying how much does this cost, how much does that cost, how long does this take. And there are so many variables, but ultimately if you could give our listeners, what can they expect as an investment to get what you would consider an acceptable story, an education about the practice that people watching will start to be engaged and understand that this is the type of practice I want to go to? This message, on average, what would you think it would cost the health care provider to have your expertise to create this story and this image?

Andy: As you mentioned, sometimes there are variables, but we have developed packages that we feel like have served clients pretty well and those include different levels of content. So to just create a basic video that is telling the story of your company, that first building block that we recommend, usually that starts at about $2,500 plus travel. We try to keep it in this mid range.

We’re certainly not a college graduate running it out of their basement, but we’re coming in well below what most ad agencies will start at. And we do that because we know what it’s like to be a small business and we want to empower them to get their story out there.

So we start there and then we have packages ranging from there to about $9,000. But that package will include several videos. You’ll be doing testimonials, you’ll be on an office tour, you’ll be doing all these components that it helps serve your patients well, even post operative instructions.

Basically, it can convert your whole website into a video hub. But there’s all tiers in between so that people can start at a place where they’re comfortable.

Kevin: Let me tell you, I have been practicing dentistry for almost 35 years and the one thing that I learned is always surround yourself with people who have excellent talent, excellent integrity and deliver on their promises. I’m flattered that you took the time today to talk to us, but I’m more impressed with the fact that you can educate, not just the dental community, not just the physician community and health care in general, but any business that’s interested in really connecting.

And as you have mentioned so clearly, basically, people don’t always remember the nuts and bolts. They remember the story, the connection, the emotion that was created. And viewing your work, I can tell you that every one that I personally viewed, I felt a compelling connection.

If the listeners out here want to contact you, if they want to get in touch with you, they want your expertise and service, what’s the best way for them to reach out to Loft Light Media?

Andy: They can reach me through There’s a contact page on there and that goes directly to my personal email. You can also send me an email which is I list my personal cell phone on all my emails and right there on the website which is 603-305-8133. I love what I do and I love helping practices connect with their clients in a more meaningful way. And I’m honored to be a part of this. Thanks so much, Dr. Coughlin.

Kevin: For those listening to my podcast now for the last year, I only have people on what I call BLT: I believe them, I like them and I trust them and you and your company certainly fall into that category. Andy, I can’t thank you enough and I hope the individuals listening today have enjoyed today’s podcast.

You’re listening to Ascent Radio. My name is Dr. Kevin Coughlin and again, special thanks to Stand Out and Be Heard, Mr. Doug Foresta, who has produced well over 40 of these podcasts for me over the last year and without his expertise, none of this would be possible.

Thank you for listening and I look forward to talking to you next week. My name is Dr. Kevin Coughlin and again, you’ve been listening to Ascent Dental Radio and our special guest today is owner and CEO of Loft Light Media, Mr. Andy Olsen. Thank you all very much and have a great evening.

Podcast: Jennifer de St. George on business options for dentists

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. You’re listening to Ascent Dental Radio. My name is Dr. Kevin Coughlin and I’d like to just give a notice of thanks to Mr. Doug Foresta. His company, Stand Out and Be Heard, has been producing and managing this podcast now for several months. I’m proud today to introduce to you Mrs. Jennifer de St. George. I’ve had the pleasure of chatting with Jennifer over the last several months, and in particular, a variety of subjects.

But mostly, the independence and the options that dentists now have. Perhaps one of the most significant changes is the advent of corporate dentistry, or what more properly would be referred to as managed service organizations and dental service organizations.

Anyone who has followed practice management, anyone who has been involved in the field of dentistry will be familiar with Jennifer de St. George’s background and accolades. She is one of the leading practice management speakers. And she is an authority in building teams and providing perhaps most importantly, education, team work and the development of a dental practice to suit the current goals and necessities that are available to today’s dental force.

Without any further ado, I’d like to introduce Jenny de St. George. And as always, these podcast are brought to provide the dental profession with the best in these areas and other areas. And I can’t thank you enough, Jenny, for taking the time to speak to me today about what’s new and what’s going on in the dental profession and how perhaps, between the both of us, we can shade some information to a variety of different topics. Jenny, thank you so much for joining me today.

Jenny: Kevin, it is absolutely my pleasure. I am going to, I’m afraid, date myself a little bit. When I first into dentistry almost four decades ago with my then current husband after he graduated from dental school, we opened our independent practice. And along with about 97 percent of graduating dentists at that time, which would be in the late 60s, about 97 percent of dentists graduating went into solo practice.

They took some money from the bank, in our case it was a whole whooping $25,000, to start four treatment rooms in 770 square feet. About three percent went to the military, postgraduate and once in a while, went into an associateship. So really the decisions that Edmond was making and the dentists at that time was not even a decision they had to make. It was a given.

When we went to crack a bank to get our loan to equip and open and finish the practice because the building was not completely finished, we had to do the last construction, the bank manager as he gave us $25,000 — and by the way, the only collateral we had, two wedding rings, a used VW that Edmond bought going through dental school and a DDS degree. And the bank manager looked at us and said, “We’ve never had a bankrupt dentist yet in the state of California, you will do nothing but succeed.”

Fast forward to today, 2017, and historically I think that has changed to maybe — and I’m going to exaggerate a little bit — perhaps 97 percent of graduating dentists are now looking for some sort of relationship where they don’t have to go out and start what we would call in England a scratch practice. And maybe three percent take that huge leap of faith, put their name on the door, open the door as we did, and just pray that somebody walks through the door.

I know it’s beginning to turn. I was at a meeting recently in San Francisco and I ran into a vendor from Wells Fargo who’s worked in dentistry for actually as long as I’ve been. He remembered me, I didn’t remember him. And we sat and chatted and he said that the market — and I can obviously only talk for California — he said is changing and he’s beginning to see more and more doctors graduating beginning to consider the potential of setting up an independent practice.

Either way, I think that Kevin your goal and my goal is to help in any way we can, the professional make an educated decision. So if they decide to join an organization or they make that commitment to go solo, they do it with, to the best of their ability, all the facts that they can get and not just make a blind emotional decision which I fear that many of them do.

Kevin: I can’t agree with you more, Jenny. I do teach at Tufts School of Dental Medicine in Boston, Massachusetts and the focus of my course is part of a practice management curriculum. Which now is mandated basically through almost all 60 dental schools in the United States to provide a business background and try to improve the business acumen of these young graduates so that they’ve been given the tools to make informed decisions about what works for their particular wants and needs.

So one of the reasons I was interested in bringing Jenny on to our podcast is dentists look for experts. They are looking for information and knowledge. Because unfortunately, most of us have a very strong science background, but we have a very weak background in business. And today, we’re surrounded by significant debt, significant challenges and it’s up to us to provide tools and information to guide these graduates or any particular part of your career whether you’re in mid career or in the twilight of your career, to make informed decisions.

Jenny, in your professional background, what would you consider would be the greatest opportunities, potentially the greatest threats to the profession as you see it? And you’ve traveled all over the world speaking and I believe you’ve been to five continents. What is your feedback from the people who are participating in your programs, reading your books, listening to your CDs? What do you see as their biggest opportunities and threats?

Jenny: I think it’s very important for your listeners to know I do not come from a clinical background. I came into dentistry through marrying Edmond, so I feel like I went through dental school. I feel I graduated as a dentist, but I did not.

When Edmond graduated out of the last year of what was known as P&S in San Francisco, College of Physicians and Surgeons, that was the last year before they moved the school and it became the University of the Pacific. Edmond and his class and the classes before him used to tell me that there was virtually nothing that would walk into their practice on the first day that they did not have the confidence to know how to handle.

Edmond told me he chose to be a GP because he liked the stimulation and the challenge of never knowing what kind of patient was walking through the door. He just didn’t want to go into a specialty practice where he was limited to a specific amount of procedures. So his confidence was so high that he could barely wait for the next patient to come through as an emergency.

Today, and this is just third party feedback, I am wondering if today’s graduating dentists have the same confidence and they have the same skills. I’m going into my memory bank, I think Edmond, I want to say, he made 35 dentures off the top of my head. I do know that when he delivered a new set of dentures, that the patient could not get it out. The fit was so good. He had so much confidence.

And so the most important it would seem to me to say as a non-clinician is to do whatever you need to do to get your clinical expertise to the level that you are confident and comfortable with yourself.

And I think as a number one, therefore, if you have that confidence, the second decision is where to take that confidence and expertise becomes a little easier. I sometimes wonder if the youngest dentists graduating lean towards going into a management service organization because they perceive that perhaps they still need to get more experience or more expertise.

Which in a way, he’s almost made the decisions for him or her. I don’t know how you feel about that comment because you and I have not discussed it and I appreciate I am a non-dentist making it, but it would seem to me that expertise is what the profession is all about.

Kevin: I can tell you that from my perspective, a number of factors are taking place today. One, many of the young graduates are limited in their exposure and in their clinical skills today, much different than it was 30 and 40 years ago and that’s because of the rise of specialization.

Today, that graduating student, that third or fourth year student is many times taking patients and these patients that require specific clinical care are referred to the post-grad departments, whether that’s endodontics, periodontics, pediatrics, oral and maxillofacial surgery, public health. The list goes on and on and the nine specific areas of specialization.

So unfortunately, and this is a generalization in my part based on 34 years of clinical experience, not only my own business but teaching, that many times these young men and women — and I shouldn’t use the term young, but recent graduates — may be lacking the experience that your husband had three and four decades ago.

I don’t see that changing and my feedback from my students are, “Dr. Coughlin, I just need a couple more years of working anywhere I can to get my skills and confidence levels up,” where your husband’s confidence levels are because of perhaps additional clinical training.

I always tell the students, and perhaps you can comment on this, I always say you would never marry someone just to be married. And I don’t think you should take a job just to take a job. I think you should take a job that you’re passionate about and a location with a support team that you’re enthusiastic about. And it’s up to you to get that additional training.

Because from a purely financial standpoint, since the bulk of our profession is still general dentist, I cannot emphasize what you mentioned earlier in this podcast, you have to get training in the nine areas of specialization.

And although you may not be a complete expert in all areas, with adequate training and mentoring, you should be able to do 80 or 90 percent of the treatment that walk through your doors to improve your bottom line, keep yourself technically and didactically stimulated, and also offer more services for your patients than just simply a radiograph and a referral path. What would be your comments on that, Jen?

Jenny: Number one, I could not agree more because if the graduating dentist does not follow your advice, they will end up by rather being like a traffic cop at an intersection. A patient comes into the GP practice and like the interns doing medical, they pass them on to somebody else. They’re just like the gatekeeper and I wouldn’t have thought most dentists would go to school to become a gatekeeper.

Kevin: I couldn’t agree more. One of the things, Jen, that I’ve actually seen and are part of my presentation, is it’s almost like a dating game. I have them fill out a series of 20 questions and those questions are basically personality questions that determine do you have the entrepreneurialship, do you have the drive and the desire to be a solo practitioner, to be in a group practice or to be guided towards corporate dentistry.

And it’s interesting over the last ten years, typically the groups that I’m speaking to are between 50 and 100 students. And more and more, each year, I see them gravitating towards corporate entities, sometimes because what we touched on is lack of clinical and business skills, but more and more, I see two incomes.

Many times one professional is marrying another professional and they say, “Dr. Coughlin, I’m looking for a different life balance. I’m interested in pursuing other aspirations and goals and I don’t know if I want the trials, the tribulations and the potential stresses of being a small business owner.”

And as I’ve said to you in private, I think our job as educators is not to necessarily put our views on people, but to explain to them the risks, the strengths, the opportunities, the threats and the decision-making process so that they don’t make a mistake.

Because personally, being independent, being in control of your clinical and business, to me is hugely important. But sometimes for other people, they’d rather have other people make those decisions and just focus on the clinical aspect. What would be your thoughts on that?

Jenny: Many years ago, I was interviewed and in fact, interviewed him, a psychologist on entrepreneurship and small businesses. He had worked in the dental field for quite some time and he told me that dentists’ group was the most individualistic of any of the professions. And in his opinion, there were dentists who were brilliant, they could have been heart surgeons or flown to the moon, whatever, but they choose to go into their own practice because they wanted to be in charge. But it takes a personality.

I think that what dentists today who have been practicing for many years, is they realize that 50 or 60 percent of the stress in their practice, maybe more, was not caused by their clinical area, it’s caused by staff and patients.

I joke when I speak from the stage, the ideal dentist if they could wave their magic wand, would let the patient drop off their teeth in the morning, pick up their teeth at the end of the day. The dentist at the dentistry never has to see the patient because it’s the patients and the money and the insurance and the staff that cause the stress, not the dentistry.

So I think that some of the dentists think that by going into a corporation that this stress, as I described it, will disappear, but that is absolutely not true.

And if there’s one practical suggestion I could share with you, Kevin, that I have said from the stage for years, when you are going to interview, whether it’s a DSO, an MSO, to be an associate in a private practice, whatever it is, call up and be a mystery shopper.

Call up and pretend to be a patient and make an appointment for an emergency. Get to the reception room two hours before the interview with the senior doctor or the manager of the group. Watch the staff, watch how they behave to each other, watch how they handle patients.

And if this is a mismanaged rude office where you will do nothing but learn how not to do it, I suggest you make your appointment five minutes and leave. You only want to go where you will be surrounded by the quality in management and communication.

Kevin: Jennifer, how do you feel, what’s the best way for the listeners of this podcast to improve that situation? What are some of the areas if a dentist listening to this podcast says, “You know what, I think I’m doing a good job, but really if I was to be critical of my team, myself, my office, I need improvement,” what would be the best way for them? How do they reach out to get better?

Jenny: The sad thing is we shouldn’t have to ask this question. The sad thing, Kevin, is that in dental schools, patient management, patient-doctor communication and human resources, how to hire and fire and manage, should be part of every program.

In England, a few years ago, they actually took the four-year dental program and made into five years so they could add all this stuff that was not being included in the four-year program.

When I talk to deans of dental schools as I have over the years and I got on my little soapbox about the kind of thing you and I are talking about, the deans tell me that the students are not ready for this kind of information. Yet when you go and talk to the students, they are more than ready and they want it. The deans will say there’s no time in the schedule, the students say you come in at 5:00 in the morning, we will come in.

At the moment, to answer your question, I don’t think there is a structured approach. It’s going to people like me going on to webinars, going to the conventions, but it’s not a systematical approach. I am hoping to get it finished this year, 2017, I would like to start a JdSG Learning Center online where I put up a very basic but the whole program. Because in my opinion, when you learn staff management or you learn how to communicate with patients or how to ask for money, you must always do it in the context of the whole program.

But dentists graduate from dental school and they maybe go to a convention and in theory they could have three speakers who actually say three opposing views on the very same subject. So it can be confusing. It should be part of the school curriculum and it’s not.

Kevin: I couldn’t have said it better myself. Hopefully, with experts in communication, in teaching, in education like yourself, we’ll see an improvement. And if I could give you a little prod, a little push, I will tell you get that program out running because our profession needs it. The better our business is, the better our communication skills are, the higher level of care and service we’ll perform. And I think understanding the independence and the luxury of being independent — I tell the students be careful what you wish for.

Nothing in this world is for nothing. And when someone tells you they’re going to take away all your stress and all your problems, sometimes you’re left with more stress and more problems.

Our goal out there in the practice management field, in the educational field is to provide data and information so that students, the seasoned practitioner, that practitioner getting ready to transition perhaps into a new area of their life, they need these tools and they need this information to make the most informed decision.

I  want to thank Jennifer de St. George so much for her expertise, her knowledge and her time. She’s been doing this for over two decades, actually over three decades, and it has been an actual honor and a privilege to have you on this podcast.

You’ve been listening to Dr. Kevin Coughlin, Ascent Radio, that’s Ascent Dental Radio. And again, my thanks to Mr. Doug Foresta for producing this podcast and it’s Stand Out and Be Heard. Doug, thank you so much for your expertise and I look forward to our next podcast. Thank you listeners very much.