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Dental Practice Management: State task force dentist, reopening advice

Dental Practice Management: State task force dentist, reopening advice

Note: I was in the process of putting together re-opening tips and recommendations from dentists around  the country when I stumbled on this Facebook post from a dentist from Indiana. The post is full of excellent insights, knowledge and recommendations. 

First time poster, long time reader 😉 I am a dentist from around Fort Wayne, CHAIR of the IDA communications committee, member of the IDA Task Force for COVID-19 Response, and soon to be IKDDS Treasurer. I recently posted this on the Fort Wayne Dental Peeps page and was asked to share it here as well.

It is a long post so please bear with me. What follows is my professional opinion and should not be construed as the opinion of the CDC, ADA, IDA, IKDDS or any other person or professional entity. If you get through it all, I’m impressed 😊. 

First of all, this is a scary and challenging time for us all. I completely understand the fear and uncertainty that many of you are feeling since the recent announcement by the Governor earlier this week. There is an inherent risk that is present for all of us catching COVID-19. Unfortunately, there is nothing anyone can do to provide you with 100% certainty that you will not get sick. This is true in the dental office, grocery store, Starbucks, or even sitting at your home. All of the recommendations that have been presented by the CDC, OSHA, ADA, and even IDA are strategies to DECREASE risk, but NOTHING will eliminate the risk. That being said, each and every person has varying degrees of risk tolerance. If your individual risk tolerance is different from your dentist or anyone else in your office, it will create a significant strain in your offices’ work environment. Therefore, I strongly suggest you communicate this and see if a mutually acceptable plan can be created. If this isn’t possible perhaps the best move would be to separate yourself now. That means different things based on your situation, but it may mean you take an extended leave of absence and stay home, you retire, or you find a new place of employment.

Secondly, I wanted to address some of the misinformation I have been reading specifically related to Indiana’s return to work and the dental office recommendations. OSHA has released categories: very high risk, high risk, moderate risk, and low risk to describe patient encounters and susceptibility to transmitting COVID-19. Very high and high are procedures completed on suspected or known COVID-19 patients. Moderate and low categories are for patients that do not have COVID-19. Since we have no way of effectively discerning exactly who has it and who doesn’t then we must assume everyone is at minimum a carrier for the disease.

PPE - I want to make one thing clear regarding PPE. Most of us are all scientific minded that like to see things in black and white, right and wrong, YES and NO. Unfortunately, the topic of PPE involves 50,000 shades of grey. Everything provided by the CDC, ADA, and IDA in terms of “best practices” are currently recommendations, NOT mandates. Mandates are laws which are established by the state or federal government. And, up to this point, there are no specific mandates regarding appropriate PPE. N95 masks with face shields are considered “ideal”. However, wearing surgical masks with goggles is considered “acceptable”. Disposable gowns for each patient are “ideal”. However, wearing scrubs which are removed and laundered at the office is considered “acceptable”.

• Does a N95 provide better filtration/fit than a surgical mask? ---- Yes.
• Does better filtration and fit mean that you won’t get sick? ---- NO!

So, until we know more, PPE is a good-better-best debate. Each dental office and practitioner must determine what PPE is most appropriate for the procedures they will be completing. Higher risk procedures (ones which result in more aerosol and/or more time spent in front of the patient) should be appropriately treated using higher levels of PPE. Lower risk procedures (with less time in front of the patient and no aerosol) could be completed using our standard precautions.

CHAIRSIDE COVID-19 TESTING – In order for a chairside test to be appropriate for use in a dental office it must accomplish a few things.

• Rapid – it must provide results quickly –preferably under 10-minutes.
• Appropriate– it must answer the question - IS THIS PERSON CONTAGIOUS?
• Accurate – it must give us certainty that the results are true and consistent
• Inexpensive – it must be cheap enough that we can do it on every person, every day

Unfortunately, there are no tests available that check all of these boxes. Current viral-activity tests are taking 3-5 days to have results back, they are 70-85% accurate and dentists are not approved providers. Abbot Labs’ new rapid viral-activity test requires very expensive equipment which isn’t practical for most dental offices. Antibody testing evaluates the body’s immune response which may occur several days after a person catches the disease and becomes contagious. Hopefully this will change, and there will be a test developed that is as simple as chairside glucose screening. Unfortunately, we are not there yet.

Finally, I want you all to know the reason most of your bosses are wanting to get back to work. And, believe it or not, it has NOTHING to do with making money. We have all taken an ethical and moral obligation when we entered this profession to do no harm and to do what is in the best interest of the health and wellness of our patients. We have now gone a full month completely neglecting the dental health of our patients.

We are experts in the oral/systemic connection and educate patients every day on how the health of the mouth is connected to the health of the rest of the body. This viral outbreak has not eliminated the oral-systemic connection. We all have patients suffering from high blood pressure, diabetes, congestive heart failure, etc. which we know are tied to periodontal disease. These patients need to be on regular periodontal maintenance in order to stay healthy and keep their systemic inflammatory markers low. We also have patients with active tooth decay and oral infections which will only get worse with time. How would you feel as a patient if you had a deep cavity or restoration which needed completed right now? If these rather routine procedures are put off too long our patients will become dental cripples or worse yet, die. Now, I understand this is a bit of an exaggeration for most patients. However, if you don’t believe that maintaining dental health is important and that we have a role to play in ensuring the long-term systemic health of our patients then perhaps you are in the wrong profession.

My final question for everyone to ponder… If not now, then what time would be appropriate for you to return to work?

This virus is not going away. It will be here one week from now, one month from now, six months from now, and likely even a year from now. The risk of getting sick will be present from now until the time we have a reliable vaccine. So, if you are uncomfortable returning to work because you don’t want to be sick and/or don’t want to risk getting anyone else sick, then stay home (and know, it could be a long wait). If you are uncomfortable returning to work because you don’t feel like your boss is taking things seriously, then I suggest you have an open and honest conversation with them. If they are unwilling to listen, leave. It’s not worth the stress and risk to work for some one who won’t listen to you. However, most of you will find the exact opposite happens. They will listen to you! The truth is that, as business owners, we are just as scared. We have families and loved ones that are at risk. We are worried about making them sick. We are worried about making you (our team members) sick! We are doing the best we can to prevent this disease from spreading while at the same time fulfilling our professional obligations. Please help us, we can’t do it without you!!

Dental Consultants Best Reopening Tips
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What Does A Dental Consultant Do? Charge?

Many dentists will tell you dental consulting works. If dental practice management firms had no worth or benefit they could not stand up to harsh economic realities for long. What a veteran dental consultant brings to the table are systems and protocols successfully implemented in other practices that have been improved and tweaked over many years. Top dental consultants talk and network with each other. They pay attention to what works and what doesn't work across all dental practices.

Marketing & New Patients

Practice management consultants generally have little marketing training or background. 

Note: Cambridge'a consultants are Certified SEO and Ad Words Specialists

Dental Office Systems

Key systems dental consultants implement:

  1. New Patient Phone Call
  2. Insurance Processing
  3. New Patient Experience and Patient Education
  4. Financial Arrangements
  5. Scheduling
  6. Confirmation
  7. Unscheduled Treatment Followup
  8. Reactivation
  9. Huddle
  10. Stat Monitoring
  11. Daily and Weekly Checklists
  12. General Policy Manual

Your Staff

You will not get much ROI from your dental consulting if your staff do not have your back. You do not beed a team of cheer leaders jumping up and down with enthusiasm, but you do need staff who are smart and take some pride and ownership in what they do. If there is more than the usual drama in your practice that needs to be sorted out before you will get any real results.

Staff Accountability 

What gets monitored gets done.

The "big" obvious numbers are important to monitor, but when you look at them they are typically already "in the books". You want your team to concentrate and be accountable daily on the "small" stats that bring about the "big" stats. How many practice owners know how many calls were made to unscheduled patients each day or overdue re-care or inactive patients? Many dentists vastly underestimate how much daily "outflow" is needed to keep a schedule full. How may dentists know what % of slots were open in their hygiene schedule each day? How many know how many NP calls there were yesterday, who scheduled and if they end up showing up? More importantly how many staff know considering it's their job to do?

The only way to monitor what gets done is with daily stats especially for your weak areas. For example, one employee should be specifically responsible for calls to patients who are unscheduled, overdue re-care or need reactivation. Other staff can and should help in coordination with the accountable employee, but that employee accountable reports daily on a spreadsheet like this: 1. # of calls or personal texts sent 2. # of contact
3. # of appointments with name and date 4. # of arrivals

It is the employee who is either making themselves valuable to you or not. If they are doing so, dismissing them will never enter your mind. On the other hand, if they are not making themselves valuable, you will be doing them and yourself a favor by giving them the opportunity to find a practice or other employment that is a better fit for them.  


What most practice owners are missing is not how to book an appointment but how to be effective leaders. The best systems in the world are useless if the staff do not comply. Good leaders know how to get staff to willingly follow through and comply. Agreement among all team members is key. Your written office policies should contain those agreements and should answer most questions staff come up with. Doing so will save you much time and simplify the management of your practice. Staff non compliance is a sure sign of poor leadership. The primary reason practices underperform is staff non compliance.  Key traits of leaders. All it takes is discipline: 

  1. Always keep a cool head especially when "under fire"
  2. Realize that all mistakes are an opportunity for you and your staff to learn.
  3. Set a good example.
  4. Always be learning.
  5. Take care of yourself.
  6. Fight the impulse to address multiple issue at the same time. Frantic activity creates spotty results.


$35.000.00 is the average fee for a one year program with dental practice management companies you are likely familiar with. For those companies that require you and your staff to travel to their facility or seminar you also need to add in the cost of travel, staff pay and lost production from time away from your practice. 

Questions You Should Ask

  1. Do you and/or your staff have to travel or does the consultant come to you?
  2. Is the program mostly one on one consulting versus seminars or courses with multiple clients in attendance? There are advantages to both.
  3. If the dental consulting is one on one who will actually deliver the consulting? I recommend knowing who your specific dental consultant will be prior to signing on the dotted line.
  4. Is program based on a specific dental practice management system? You want to avoid cookie-cutter programs. Ensure the program will be tailor-made to fit your practice's specific needs.
  5. The cost (including travel expenses and downtime) is certainly not the only factor, everything else being equal, it is still a major factor to consider. It's unwise to pay too much, but it's worse to pay too little.

If you do a little homework it should be fairly easy to pick a reputable consultant that is a good fit for you and your practice.