In this article, we will: 

• delve deeper into the multifaceted nature of patient experience in oral healthcare
• show why Google reviews and NPS fall short when it comes to measuring the “why” behind your patient experience measurement, and
• demonstrate the need for a more comprehensive approach to continually elevate the patient perception of his or her dental experience.

What Is Patient Experience? 

As defined by the Beryl Institute, a leading nonprofit committed to improving patient experience, patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”¹

Why Is Patient Experience Important in Dental Settings?

From a clinical perspective, patient experience with care correlates with adherence to medical advice and treatment plans, as well as processes of care, like preventive compliance and chronic disease management skills.^2-6 As dental professionals treat chronic diseases where adherence to daily prevention and completion of treatment plans is crucial for achieving overall oral health, it follows that practices and groups looking to support these patient goals would do well to pay close attention to measuring and improving patient experience. 

From a business perspective, many factors have contributed to results such as a 633% ROI and payback time of less than 3 months for organizations that focus on experience management.⁷ Good patient experience is associated with improved patient retention and loyalty,⁸ lower malpractice risk,^9-11 and decreased employee turnover.¹² As Dr. Adrienne Boissy, former chief experience officer at Cleveland Clinic, notes, “As patient trust is tested, service represents an opportunity to differentiate in this new world. But I have yet to see most organizations make substantial investments in service training, even though the cost of getting a new patient is multiple factors higher than keeping the one you have.”¹³

What Is NPS?

NPS, simply put, is a measure of how likely your patients are to recommend your dental practice to other people. There are many articles about the origins of NPS, how it’s measured, and its peer-reviewed applications in healthcare. Or, if you’re a fan of reading the original source material, you can check out Fred Reichheld’s book, The Ultimate Question 2.0.

It is unlikely that we need to provide a similar explanation of Google reviews. 

Why You Need More Than NPS and Google Reviews

NPS and Google reviews, at their core, provide a quality assurance marketing metric based on a single question. This metric can help you understand your patients’ overall feelings about the care they are receiving in your office (and, increasingly, outside of your office). While this might be all you need if you’re running a restaurant or selling a product online, as healthcare providers, we need more to understand the multifaceted nature of patient care. Additionally, we have never been satisfied with “good enough.” We understand that there is always room for improvement, both clinically and as it relates to patient experience. The problem with both NPS and Google reviews is that the score is completely detached from the “why” behind the number. If you have an NPS of 71, that’s great. But why is it not 80 or 40? If your practice has a Google star rating of 4.7, why is it not 4.9 or 4.2? To understand how we can continue to improve, we need more than single-question quality assurance metrics; we need systems of measurement that holistically capture the entire patient journey coupled with quality-improvement skills.

So what is the solution if NPS and Google reviews aren’t enough to measure and improve the patient experience sufficiently? Several important attributes of a meaningful solution are essential, but perhaps the most important one is that any solution must capture depth and breadth across the entire patient journey. This unveils patient pain points from the first touch to recare and allows offices to fix what is not going well. Most often, this data is collected via a digital survey, allowing for real-time reporting that allows for both meaningful system changes and service recovery, when needed.

For too long, oral health professionals have not had access to a solution that understands the unique workflows, challenges, and opportunities that dental care presents. Enter DifferentKind. As oral health experts, we have deep and meaningful experience understanding the factors that impact the patient journey and the evidence-based approaches necessary to do something about it. We help you measure, understand, and improve the aspects of the care you provide that impact trust and loyalty. It’s one thing to know you might need to treat your patients with more empathy, but it’s another thing altogether to understand and implement the style and skills necessary to actually do it.

From Convenience to Quality

As digital transformation has accelerated the consumerization of healthcare, many of the solutions currently being developed target making the patient experience more convenient. I’m all for this, as no one likes sitting on hold while trying to make an appointment when one click on his or her phone could accomplish the same thing. However, while convenience is important, it does not necessarily lead to quality.

This presents modern dental practices and organizations with an incredible opportunity to differentiate themselves by delving deep into their patients’ wants, needs, and desires. This opportunity includes solutions that help make dental care easier for patients and make them healthier. But to understand exactly what patients want, it is imperative to measure their experiences first. At DifferentKind, we’re committed to helping you thoughtfully excavate the experience goldmine, ultimately creating lasting and lifelong promoters of your practice. It’s time for more than NPS and Google reviews in dental care; it’s time for a DifferentKind of measurement altogether.

CONCLUSION

In conclusion, while NPS and Google reviews serve as first-pass tools for assessing patient satisfaction, the dynamic field of oral healthcare requires a more intricate and comprehensive approach. Dental professionals must evolve beyond the confines of conventional metrics and embrace a different kind of measurement that encapsulates the holistic patient experience. By combining quality-improvement skills with a commitment to patient-centric care, dental practices can transcend the limitations of NPS and Google reviews and cultivate enduring relationships with patients, ultimately fostering a reputation as providers of exceptional oral healthcare.

REFERENCES

1. The Beryl Institute. Defining patient and human experience. https://theberylinstitute.org/defining-patient-experience/ 

2. DiMatteo MR. Enhancing patient adherence to medical recommendations. JAMA. 1994;271(1):79, 83. doi:10.1001/jama.271.1.79 

3. DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12(2):93-102. doi:10.1037/0278-6133.12.2.93 

4.  Safran DG, Taira DA, Rogers WH, et al. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47(3):213–20. 

5.  Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34. doi:10.1097/MLR.0b013e31819a5acc 

6. Sequist TD, Schneider EC, Anastario M, et al. Quality monitoring of physicians: linking patients’ experiences of care to clinical quality and outcomes. J Gen Intern Med. 2008;23(11):1784–90. doi:10.1007/s11606-008-0760-4

7. Qualtrics. Forrester: The total economic impact of Qualtrics CustomerXM. 2019. https://www.qualtrics.com/uk/lp/total-economic-impact-of-qualtrics/

8. Safran DG, Montgomery JE, Chang H, et al. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50(2):130–6. 

9. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):1126–33. doi:10.1016/j.amjmed. 2005.01.060 

10. Hickson GB, Clayton EW, Entman SS, et al. Obstetricians’ prior malpractice experience and patients’ satisfaction with care. JAMA. 1994;272(20):1583–7. 

11. Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9. doi:10.1001/jama.277.7.553. 

12. Rave N, Geyer M, Reeder B, et al. Radical systems change. Innovative strategies to improve patient satisfaction. J Ambul Care Manage. 2003;26(2):159–74. doi:10.1097/00004479-200304000-00008

13. Boissy A. Getting to patient-centered care in a post-COVID-19 digital world: a proposal for novel surveys, methodology, and patient experience maturity assessment. NEJM Catalyst. 2020. 

ABOUT THE AUTHOR

Dr. Allen is the CEO and co-founder of DifferentKind, a platform that helps dental professionals measure and improve patient-reported outcomes and experiences. He can be reached at matt@differentkind.com.

Disclosure: Dr. Allen is the CEO and co-founder of DifferentKind.   

FEATURED IMAGE CREDIT: Panchenko Vladimir/Shutterstock.com.

Even if you don’t place dermal fillers, every dentist should be aware of filler complications that can manifest in the oral cavity. In fact, when a patient presents with unexplained intraoral tissue slough or necrosis with a recent history of dermal filler treatment, vascular compromise should be included as a differential diagnosis. It is well-established that filler vascular events respond best to early intervention, and the correct diagnosis is the first step in achieving an optimum outcome.¹ The dentist is poised to play a pivotal role in recognizing these potential vascular events, thereby initiating the proper treatment trajectory and averting permanent damage. 

A report published in the Journal of Dermatologic Surgery details a case of gingival necrosis following dermal filler treatment in the nasal area.² We will examine the case history, covering its presentation, initial diagnosis, and outcome. A map of the embolic pathway that likely caused the gingival necrosis will provide a deeper understanding of the mechanics in play.

Dermal filler treatments consistently rank in the top 5 minimally invasive procedures performed annually and continue to trend upward from pre-pandemic levels.³ It should not be surprising that adverse events have kept pace commensurately with this rise in annual treatments. Overall, these treatments are well-tolerated, with most complications being mild and self-limiting. The majority of filler-associated adverse events manifest extraorally and are observed locally on the facial skin. As with all embolic events, early recognition and treatment are key to avoiding morbidity. Knowledgeable dental practitioners who are aware of these less common adverse events can make the difference between irreversible necrosis and full recovery.

VASCULAR ANATOMY OVERVIEW

Recognizing manifestations of a filler-induced vascular occlusion (FIVO) requires only 2 skills. The first is general knowledge of orofacial vascular connections, and the second is a healthy degree of suspicion regarding diagnostic approaches. Similar to other pathologies that dentists are trained to recognize, treatment of the pathology is not required of a consulting dentist. Appropriate and timely referrals are the only obligation.  

The facial blood supply is largely provided by the facial artery and its branches (Figure 1). This artery is a branch of the external carotid. Generally speaking, early evidence of an evolving FIVO is most often detected by localized skin blanching in the immediate and/or adjacent areas.  

Figure 1. Facial blood supply.

The internal carotid artery mainly supplies the brain and eyes and is, therefore, less commonly involved in FIVOs. However, there are multiple areas where the internal and external carotid blood supplies are indirectly comingled (Figure 2). The potential for intracranial involvement in filler vascular events is real and well-documented. Moreover, there are several physiologically intentional vascular connections that provide a direct union between these distinct blood sources. The head and neck are replete with examples of redundant “backup” systems between internal and external carotid blood sources, as well as redundancies between major branches of the facial artery. These “vascular repeats” contribute to the body’s ability to respond to changes and challenges. Unfortunately, these connections are also capable of allowing potentially problematic downstream effects to manifest. Embolic events can present in unexpected areas that may be distant from the injection site.

Figure 2. Internal and external carotid blood supplies.

CASE HISTORY

A 42-year-old female presented to a facial plastic surgeon seeking cosmetic changes to the appearance of her nose. The surgeon placed dermal filler in the nasal spine area. A day after the procedure, the patient developed intraoral symptoms, which she did not associate with the dermal filler treatment. The patient sought dental evaluation and treatment. The dentist observed gingival necrosis in the maxillary area of tooth No. 8, extending superiorly to and including the mucobuccal fold of the ipsilateral lip and extending laterally to include the gingival marginal crest of tooth No. 7. The dental diagnosis was presumed to be of gingival etiology. The dentist placed the patient on daily topical chlorhexidine. A week later, the intraoral necrosis was assumed to be a FIVO. An exophytic palatal lesion was also identified at that time. The surgeon administered hyaluronidase injections adjacent to the nasal spine to dissolve the hyaluronic acid dermal filler at that visit. The patient was placed on antibiotic therapy as well as antiplatelet drugs and corticosteroids for necrotic tissue management and infection prevention. Subsequent hyaluronidase injections were also delivered. Four days after the final hyaluronidase injections, the appearance of the gingivae and mucosa were improved. Fourteen days later, the tissue demonstrated complete resolution.

INTRAORAL VASCULAR OCCLUSION MECHANISM

In the case presented, the patient received dermal filler in the nasal spine area. Arterial supply to the anterior nose and nasal spine area is furnished largely by branches of the superior labial artery. The gingiva, papilla, and labial mucosa in the contiguous intraoral aesthetic zone are also supplied by the superior labial artery and its branches. Conversely, the bone and periosteum deep into this area are supplied by the infraorbital artery.⁴ This explains why the soft tissues suffered necrosis while the hard tissues in the same zone were spared. Distal to the area of involvement, beginning with the premolars and areas posterior, the soft tissues are supplied by the middle superior alveolar artery and the posterior superior alveolar artery, respectively.

The palatal lesion can likewise be explained by the same embolic event. The superior labial artery is a branch of the facial artery that courses along the upper lip. It gives off several branches that enter the nasal cavity, supplying blood to the area of the nasal septum as well as the ala of the nose. These branches ramify in the nasal cavity, where they anastomose with terminal arteries from both the internal and external carotid arteries in an area named the Kiesselbach’s plexus. 

The hard palate and its overlying mucosa receive blood supply primarily from the greater palatine artery. The dense network of vasculature of the Kiesselbach’s plexus allows connection between the sphenopalatine artery and the greater palatine artery as it enters the nasal cavity via the incisive foramen. The most likely cause of the patient’s palatal lesion was due to an embolic event traveling from the superior labial artery to the greater palatine artery (Figure 3).

Figure 3. Cause of the patient’s palatal lesion.

CONCLUSION

The oral cavity is teeming with vascular connections linking facial arterial branches servicing the skin with those that supply hard and soft tissues of the mouth. It’s known that filler particles can travel with blood flow downstream until the diameter of the vessel becomes too narrow to allow passage of the embolus, resulting in a blockage.⁵ However, it is also established that, with injection pressure, filler can travel retrogradely, following any number of anastomotic pathways, to ultimately occlude distant vessels under the transport and direction of blood pressure and flow.⁶

Reports of intraoral vascular occlusions occurring after dermal filler injections are, fortunately, less common than those manifesting on the facial skin. However, reports in the literature involving the gingivae, palate, tongue, and oral mucosa continue to emerge. Regrettably, patients often fail to make the connection between the dermal filler procedure and the intraoral symptomatology. These patients may self-refer to a dentist. It is not necessary for the practitioner to be trained in the delivery of facial injectables to make the correct differential diagnosis and proper referral. When a patient presents with an intraoral slough or necrosis, the history should include a line of questioning pertaining to recent dermal filler treatment. This is sufficient to rule a FIVO in or out as a possible etiology. 

REFERENCES

1. King M, Walker L, Convery C, et al. Management of a vascular occlusion associated with cosmetic injections. J Clin Aesthet Dermatol. 2020;13(1):E53-E58.
2. Rauso R, Bove P, Rugge L, et al. Unusual intraoral necrosis after hyaluronic acid injections. Dermatol Surg. 2021;47(8):1158–60. doi:10.1097/DSS.0000000000003099
3. American Society of Plastic Surgeons. 2022 ASPS Procedural Statistics Release: 2022 Minimally invasive procedures.
4. Shahbazi A, Feigl G, Sculean A, et al. Vascular survey of the maxillary vestibule and gingiva-clinical impact on incision and flap design in periodontal and implant surgeries. Clin Oral Investig.2021;25(2):539–46. doi:10.1007/s00784-020-03419-w
5. DeLorenzi C. Complications of injectable fillers, part 2: vascular complications. Aesthet Surg J. 2014;34(4):584-600. doi:10.1177/1090820X14525035
6. Rzany B, DeLorenzi C. Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg. 2015;136(5 Suppl):196S-203S. doi:10.1097/PRS.0000000000001760

ABOUT THE AUTHOR

Dr. Meinecke has been teaching injectables nationally since 2004. She is the facial injectable program director at the Boston University School of Dental Medicine and a pro-sector in head and neck anatomy and provides litigation support in the form of expert witness within the injectable domain. She has written for numerous publications and is the author of the book Start and Grow Your Cosmetic Injectable Practice. Dr. Meinecke maintains a private practice limited to facial injectables in Potomac, Md. She can be reached at meinecke@bu.edu. 

Disclosure: Dr. Meinecke reports no disclosures.

In the last 10 years, substance use disorders (SUDs) and opioid misuse have caused an overabundance of major societal problems in the United States. According to the National Institute on Drug Abuse, while “most people take prescription medications responsibly, an estimated 52 million people have used prescription drugs for nonmedical reasons at least once in their lifetimes.”¹ According to the Center for Disease Control, prescription drug misuse has increased by 250% over 20 years, and drug overdose death statistics quadrupled since 1999, with a 5% increase between 2018 and 2019.²

The National Survey on Drug Use and Health estimates that while about 12.4 million Americans used prescription pain relievers for nonmedical purposes in 2009, 16.7 million people older than 12 abused prescription pain-relieving drugs in 2012.³ Among people aged 12 or older in 2020, 3.3% (or 9.3 million people) misused prescription pain relievers, and 1.7% (or 4.8 million people) misused prescription benzodiazepines. In contrast to prescription drugs, 2020 data indicates that 21.4% of people aged 12 or older (or 59.3 million people) used illicit drugs in the past year alone.²

As dental professionals, we have broad professional responsibilities that are not simply restricted to legal obligations. Our professional duties include ethical obligations arising from our commitments to patients, to society, and to our professional ideals. This article will focus on dental providers’ professional responsibilities concerning substance use and addiction among dental patients. This article does not intend to focus on the legal responsibilities of dentists but rather view our ethical responsibilities as healthcare providers. While such responsibilities may vary from one geographic location to another, our commonly shared moral values and ethical responsibilities remain the same.

DENTISTRY, PAIN RELIEF, AND THE OPIOID CRISIS

Traditionally, dentistry has played a leading role in developing methods for controlling acute pain and analgesia. The first successful use of ether was by the dentist William Thomas Morton at Massachusetts General Hospital in 1846, leading to a considerable increase in the prevalence of dental surgery. Opioids were widely used to manage postsurgical and acute dental pain in a completely unregulated environment, contributing to the country’s first opioid crisis and the passage of the Harrison Narcotics Act of 1914. During the 1990s, dentists were not as likely as medical doctors to be directly targeted by pharmaceutical marketing companies because dentists rarely prescribe painkillers for chronic, long-term conditions. The data showed that in the early days of the crisis, 1 in 16 postsurgical patients became addicted to opioids prescribed after surgery. 

THE ADA’S FIRST STATEMENT ON THE CRISIS

In 2005, in response to the worsening state of the opioid crisis in the United States, the ADA released its first specific guidance on the issue of roles and professional responsibilities of dental professionals in the opioid crisis.⁴

The “Statement on Provision of Dental Treatment for Patients with Substance Use Disorders” urged dentists to adopt clinical practices to better standards, specifically to obtain substance use history from patients; become knowledgeable about substance abuse disorders; utilize their professional judgment in this area; and become familiar with community substance abuse resources and other voluntary, proactive measures.⁵ While this first step led to a substantial reduction in prescribing opioids, unfortunately, it did not have much impact on efforts to screen patients and assist them in getting treatment for their addiction.

Since then, additional statements and directives have provided more detailed requirements, including mandating protocols and training for dentists to combat the opioid addiction crisis. The goal of this effort was not simply to reduce the number of opioids prescribed by dentists but to require and empower them to become proactive in screening patients for SUDs and helping them get the treatment they need.

THE ADA’S 2016 GUIDANCE ON OPIOIDS 

The 2016 statement went beyond simply encouraging dentists to manage the opioid crisis at the level of individual dental practices.⁶ The statement mandated actions such as obtaining a medical history that includes current medications and a history of substance abuse, staying up to date with CDC recommendations for safely prescribing opioids, and utilizing prescription drug monitoring programs (PDMPs) under the auspices of the National Association of State Controlled Substances Authorities. Dentists were required to discuss the misuse, abuse, storage, and disposal of opioids with their patients and consider recommending nonsteroidal anti-inflammatory analgesics as the first-line therapy for pain management rather than opioids.⁵ When treating chronic dental pain, the statement suggests that dentists should consider referrals to pain management specialists. The statement also contained some legal guidance to reinforce how proper screening techniques can protect dentists from liability associated with prescribing opioids. It suggests that dentists should not be liable for prescribing opioids to patients with SUDs if they’ve made “good faith efforts” to recognize substance abusers who “willfully” hid their conditions.

THE ADA’S 2018 POLICY ON OPIOID PRESCRIBING

The ADA’s 2018 Policy statement implemented mandatory “continuing education” for dentists on prescribing opioids, emphasizing preventing overdoses, dependency, and diversion.⁷ It also supported limiting prescriptions for opioids to 7 days for acute pain and improving the quality, integrity, and interoperability of state PDMPs. This policy kickstarted more proactive and effective measures by dentists to combat opioid addiction in their patients.

DECREASE IN Opioid PRESCRIBING SENDS PROBLEM UNDERGROUND

According to the CDC, opioid prescriptions decreased by 43% from 2011 through 2018 and continue to fall yearly.⁸ Limits on prescribing and prescription database usage have combined to reduce the incidence of SUDs induced or worsened by medical professionals. That said, a whopping 35% of opioid overdose deaths are still caused by misuse of drugs prescribed by doctors and dentists. In addition, medical professionals prescribing opioids is just one factor in the skyrocketing incidence of opioid usage, which is why the ADA encourages dentists to go beyond restraint in prescribing opioids to employing affirmative measures to combat the problem. According to the President’s Commission on Combating Drug Addiction and the Opioid Crisis, the root causes of the problem are complex and traceable to at least 30 different factors.⁹ One of the factors is the high number of underinsured or uninsured people in the United States who rely on pain relief for chronic conditions when they cannot afford medical treatment. This population has combined the small amounts of painkillers they can obtain from physicians with black-market opioids such as heroin and illicit fentanyl to reduce chronic pain. That’s why dentists must be extremely careful not to contribute to this problem by unnecessarily prescribing even small amounts of opioids to people with substance abuse issues or addiction. 

DENTISTS AND THE OPIOID CRISIS

The data from many sources shows that the nonmedical use of prescription medications is prevalent. Combating this phenomenon will require continuous effort from physicians, dentists, and other prescribers; pharmaceutical researchers; and government nonprofit organizations.

While some dentists write prescriptions for opioids at an alarming rate, an overwhelming majority of dental providers exercise diligence and caution while using opioids and benzodiazepines in the course of dental treatment. Our profession has made great progress in the prevention of chemical dependency and abuse among dental patients and will continue to do so in the future. 

REFERENCES

1. U.S. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. 2021. PEP21-07-01-003. 

2. National Institute on Drug Abuse. Misuse of prescription drugs research report: Overview. 2020. Accessed November 1, 2022. https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview

3. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. 2011. SMA-11-4658. 

4. American Dental Association. Statement on provision of dental treatment for patients with substance use disorders. 2022. Accessed November 28, 2022. https://www.ada.org/about/governance/current-policies#substanceusedisorders 

5. National Association of State Controlled Substances Authorities. Prescription monitoring. Accessed October 25, 2022. https://www.nascsa.org/prescription-monitoring

6. American Dental Association. Oral analgesics for acute dental pain. Accessed November 2, 2022. https://www.ada.org/resources/ada-library/oral-health-topics/oral-analgesics-for-acute-dental-pain

7. American Dental Association. American Dental Association announces new policy to combat opioid epidemic. 2018. Accessed November 4, 2022. https://www.ada.org/en/about/press-releases/2018-archives/american-
dental-association-announces-new-policy-to-combat-opioid-epidemic

8. Center for Disease Control and Prevention. U.S. Dispensing Rate Map. 2022. Accessed October 30, 2022. https://www.cdc.gov/
drugoverdose/rxrate-maps/index.html. 

9. National Archives. President’s Commission on Combating Drug Addiction and the Opioid Crisis. 2017. Accessed November 16, 2022 https://trumpwhitehouse.archives.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf

ABOUT THE AUTHORS

Dr. Ruvins earned his DDS degree from New York University. He holds master’s degrees in oral implantology, health care administration, finance, and addiction counseling. Dr. Ruvins co-founded Genesis Behavioral Health Group and the Lighthouse Recovery. He is a colorado certified addiction counselor practicing in Denver. He can be reached via email at eruvins@yahoo.com.

Ms. Brydon earned her master’s degree in social work from Denver University. She is a licensed clinical social worker and a licensed master addiction counselor in the State of Colorado. She is the founder of Road to Me Recovery center and co-founder of Genesis Behavioral Health and clinical director of the Lighthouse Recovery. She can be reached via email at katieb@rd2me.org.

Disclosure: The authors report no disclosures. 

FEATURED IMAGE CREDIT: Fizkes/Shutterstock.com.

The goal of this article is to share with practicing dentists and their dental teams a powerful way to complement clinical excellence by investing no more than 1 to 2 minutes of your time per patient during the day (meaning every patient), the result of which has the potential to strengthen and grow your practice tremendously. And there is absolutely no cost, product, or service involved, and little to no training. It is amazing how little this is talked about in the industry, let alone acted upon. It does require intention.

In 3-plus decades of clinical dentistry, I have learned that building personal patient rapport into your daily protocols reverberates positively through your entire practice, team, and patient base. In fact, adding patient rapport to great clinical dentistry skills can be life-changing for your confidence, your emotional well-being, and your professional and financial success. Here’s some background and ways to be sure that you get the best possible impact from making patient rapport an integral part of your practice.

Let’s consider new patient examinations. How many times have you walked into an operatory to see a brand-new patient prepared with only clinical information? For instance, you may be running behind, feeling rushed, and quickly introduce yourself by saying, “Hi, I’m Doctor Jones.” How are you today?” Or you may even skip the hello and start with something like “I understand you have some pain on the left side of your mouth,” and then move right into further exploring the patient’s signs and symptoms, etc. That’s what I call starting with “clinical rapport,” where you lead by attempting to wow the patient with your vast knowledge of dentistry. If so, you are missing a wonderful opportunity to create a powerful personal bond with the patient as your first impression rather than trying to “catch up later” or hoping that your team will take care of building patient rapport “later.”

Interestingly, it turns out that establishing great patient rapport in its best form is a team undertaking. For instance, you know that there are several steps that must occur involving several team members before the doctor sees a new dental patient for the first time. The initial patient phone call, the patient presenting at the front desk for his or her first appointment, the team member who walks the patient to the operatory or consultation room, etc. Each of these touchpoints is an opportunity to gather and make a note of personal information about the patient. The act of staff interacting with the patient at a personal level, in itself, begins to build a personal connection (rapport) between the team and the patient. Sharing the personal touchpoints almost always will provide the dentist with enough personal information to easily begin to connect with the new patient on a personal level as soon as the doctor steps into the operatory—provided that the team member takes a moment to share the personal information with the dentist before he or she enters the operatory or consultation room. There is next to no value for a dentist to find out after the first meeting with the new patient that the patient’s close relative has passed. Doing so represents a clear loss of opportunity for the dentist to express the highest level of sympathy and empathy during the examination, in real-time, and sets up the doctor to inadvertently stick his or her foot in his or her mouth by saying something inappropriate.

Connecting with a patient at a personal level, be it about the weather, the patient’s love of dogs or cats, his or her family, occupation, etc, ie, creating “personal rapport,” is critical in establishing an emotional bond with the patient, which translates into higher levels of trust and loyalty. That trust and loyalty pays great dividends when it comes to treatment acceptance, referrals, lifelong patients, and reduced no-shows.

None of this is meant to imply, in any way, that clinical rapport is not important. It is important, however, it should be obvious by now that for the biggest bang for your minimal investment in time, personal rapport must lead, followed by clinical rapport. In other words, “chairside manner” is most effective as a combination of skilled personal rapport and skilled clinical rapport.

A good reference for this kind of thinking is covered very well in Tony Robbins’ work in Mastering Influence. He uses the terms “Emotional Reasons to Buy Now” (ERBN) and “Logical Reasons to Buy Now” (LRBN), which can be applied to dentistry as follows: ERBN is equal to personal rapport, followed by LRBN, which is equal to clinical rapport. To embed this magic into practice, we instituted the following protocols:

1. The hygienist or dental assistant provides the doctor with something personal about the new patient along with the clinical concerns. If the hygienist or dental assistant’s answer is “The patient didn’t say anything about himself/herself,” the team member is asked to go back and connect with the patient personally. There is always something personal that patients are happy to share, if and only if we simply start up a very brief conversation that is not clinical at the outset. Yes, some situations preclude a nice, personal, low-key conversation, such as a patient presenting with acute pain, where empathy and caring serve as an appropriate proxy. Ultimately, I highly recommend that dentists never see a new patient without being debriefed by the team member first. This protocol will 100% help the dentist avoid finding himself or herself sticking his or her foot in his or her mouth, as mentioned above, by inadvertently saying something inappropriate.

2. As alluded to previously, it is helpful to append new patient personal notes to the new patient chart (loves football, birds, cats, his or her profession, recent vacation, etc). Bringing those tidbits up at the next appointment is always appreciated by the patient.

3. So impactful was the personal rapport created with new patients that I added the protocol of never going into any operatory without a brief discussion with the dental assistant or hygienist regarding both clinical and personal information, regardless of the type of appointment—recall, crown seat, restorative, endo, etc. This takes seconds, not minutes, and will make you pretty much immune to running into awkward situations while building both personal and clinical rapport.

Finally, it is very important that the dentist(s), as the clinical leaders of the business, set a good example for the team by demonstrating wonderful personal (and clinical) rapport with patients, especially new patients. The doctors’ efforts to establish patient rapport will affect the team positively, increasing respect and admiration of the doctor(s). Additionally, the team will enjoy providing the doctors with feedback from patients who have raved about how wonderfully the doctors cared for them and the team as a whole. And, as you must know, patients generally talk to friends, family, and coworkers about how nice (or otherwise) their dentists are rather than how clinically adept they are.

Practicing clinical dentistry can be very challenging in so many ways. Patient and dental team rapport, coupled with excellent clinical dentistry, can make a noticeable difference in quality of life broadly within a practice. With the dentist and team fully committed to establishing great personal rapport for all patients, the culture within the team will be uplifted, the feeling of connectedness will blossom, dentists will be happier, and patients will feel thankful and well cared for. Everything from diagnostic records, consultations, treatment planning, payment for services, showing up for appointments, and any ongoing treatments will flow much more easily than you can imagine. Simply put, people who like you, trust you, and respect you, are more fun to work with, more compliant, and far more likely to refer friends, family, and co-workers to your wonderful practice.

ABOUT THE AUTHOR

Dr. Cassidy received his MPH degree from the University of North Carolina, Chapel Hill, and his DMD degree in general dentistry from the University of British Columbia. He is a seasoned dental professional with a history of leadership and innovation as both a practicing clinician and an entrepreneur. Currently the chief dental officer at Net32, he builds upon his extensive experience in shaping the dental supplies marketplace. Having served as CEO and co-founder of Net32 from its founding in 1997 to 2022, he made a significant impact on the organization and the dental industry as a whole. Prior to Net32, Dr. Cassidy founded Research Triangle Dental in 1992 and held prominent roles in the British Columbia Division of Dental Health Services. Dr. Cassidy is based in Cary, NC. He can be reached at pcassidy@net32.com.

Pat Cassidy, DMD, MPH

Disclosure: Dr. Cassidy is co-founder and chief dental officer of Net32, Inc.

Image by Cezary from Pixabay

However, the winds of change have swept across the landscape of dentistry, reshaping its contours and redefining the essence of mastery. It is a metamorphosis fueled by an unwavering commitment to excellence, a hunger for perpetual learning, and the integration of cutting-edge technology. Today’s dental professionals find themselves at the vanguard of a transformative revolution, challenging the boundaries of traditional dental specializations and embracing a new archetype—the “super generalist.” These practitioners, in my view, are akin to dental superheroes—admired by many, esteemed by most, and have clearly separated themselves from the common main street dentist.

The notion of the super generalist extends far beyond the mere mastery of dental procedures; it’s an embodiment of the unwavering dedication of dentists committed to delivering comprehensive care and fantastic results for patients. It’s a symphony composed of diverse skills—flawless cosmetics, intricate surgical prowess, finesse in endodontic procedures, and harnessing the potential of clear aligners. This harmonious amalgamation transforms a dentist into a versatile artisan capable of crafting exceptional dentistry under any circumstance—a true maestro of the oral realm.

Continuing education and the assimilation of technological marvels serve as catalysts propelling this transformative journey. Dentists today are not just healers; they are perpetual scholars, constantly delving into the realms of knowledge and immersing themselves in a wealth of continuing education opportunities. It’s more than just mastering the intricacies of procedures; it’s about decoding the complexities of treatment planning and unraveling the enigmas of the oral cavity as well as having a seamless understanding of financial surroundings in the practice.

Moreover, the advent of technology has redefined the landscape of dentistry, infusing it with newfound capabilities and efficiencies. Innovations such as rotary instrumentation revolutionizing root canal therapies and state-of-the-art CBCT x-ray machinery facilitating precise implant placements have empowered dental professionals to expand their horizons. Clear aligners, once deemed the exclusive domain of orthodontic specialists, now empower general dentists to correct malocclusions, expanding the scope of patient care and patient retention. This simply allows the clinicians and business owners to grow their practices as they expand their procedural menus. Cutting costs or using inferior materials within the practice is not nearly as profitable as increasing the level and dental applications we are providing for our patients. In other words, it is a more sustainable practice when the practice grows by performing a greater breadth of procedures than using cheaper materials.

The artistry of dentistry is no longer just about performing procedures or as some call it, “prescription dentistry.” It’s about sculpting treatment plans that resonate with patients’ needs, fostering trust and ensuring satisfaction.

In essence, the metamorphosis of dentistry from specialized expertise to a wholistic, patient-centric approach represents a monumental paradigm shift. The pillars of continuous education, technological integration, comprehensive treatment planning, and the ability to navigate the financial terrain stand as the bedrock upon which dentists erect not just thriving practices but also a legacy of unparalleled patient care and enduring success. My experience has led me to believe that these are the clinicians who are also able to construct a fabulous work-life balance as well.

Continuous Education: The Pillar of Excellence in Dentistry

Continuous education is the cornerstone upon which the edifice of modern dentistry stands tall, illuminating the path toward mastery and innovation. In this era of boundless information, the dental professional of the 21st century embodies the spirit of a relentless learner. Engaging in continuous education is no longer an option but an imperative—a gateway to staying ahead in an ever-evolving field with the ease that their knowledge base comes readily available at a click of a button and yet can deliver optimal treatment. Technological strides have revolutionized dentistry, propelling practitioners into a new realm of precision and efficiency. The advent of sophisticated tools like rotary instrumentation and root canal locators has propelled dentists into a realm of heightened efficacy in performing intricate procedures. Dental CBCT x-ray machinery, a true marvel, has magnified the capabilities of clinicians, allowing for precise implant placements through guided procedures, fostering exponential growth in the repertoire of the super generalist. Also, as I mentioned before, the introduction of clear aligners has broadened orthodontic treatment, empowering general dentists to rectify malocclusions, once the exclusive domain of orthodontic specialists.

The crux lies in comprehensive treatment planning, the fulcrum of successful dental practices. It is no longer just about executing procedures but about crafting treatment plans that align seamlessly with patients’ unique needs, engendering satisfaction and trust. This transcends beyond being proficient in procedures; it’s about embracing a wholistic approach that encapsulates patients’ desires, oral health goals, and overall well-being.

The evolution of dentistry beckons the practitioner to embrace a more expansive perspective, one that integrates multiple modalities into treatment plans. This amalgamation, reminiscent of the symbolic “5 fingers of the Dental Hamsa,” enables dentists to exercise greater control over costs; retain treatments in-house; and, most significantly, perpetuate a continuous stream of high-quality care for patients and develop further allegiance to our patients as well.

In essence, the evolution of dentistry embodies a transformational journey—one that transcends the realms of technological innovation and procedural mastery. It is a testament to the shift in mindset, steering away from the myopic view of dentistry as a collection of procedures. The integration of advanced modalities into treatment planning will continue to fortify the foundation of successful dental practices, nurturing a continuum of excellence and patient satisfaction.

Building Sustainable Practices and a Bright Future

Building sustainable practices requires a multi-faceted approach that extends beyond clinical proficiency. In today’s dynamic environment, dentists must navigate financial intricacies, optimize operational efficiency, and ensure a harmonious work-life balance. While clinical skills are foundational, understanding the business aspect is equally crucial.

Financial sustainability serves as the backbone of a thriving practice. It’s imperative to comprehend the practice’s financial health, carefully balancing revenues and expenditures. Knowing the costs associated with technology, staffing, marketing, and overheads is pivotal. This awareness aids in making informed decisions, ensuring the practice’s long-term viability. Understanding several nuances of a lease can allow practices to navigate a burst of growth via expansion or a downsize due to catastrophe much earlier and in a less burdensome way.

Efficiency in practice operations is paramount. Streamlining workflows, implementing efficient scheduling systems, and enhancing patient experiences contribute significantly to success. Seamless patient journeys, from initial contact to treatment completion, foster satisfaction and loyalty, underpinning the practice’s sustainability.

Balancing professional commitments with personal well-being is vital. Preventing burnout by maintaining a healthy work-life equilibrium not only supports the practitioners’ mental health but also enhances the quality of patient care.

Moreover, succession planning secures the future of the practice. Training and mentoring the next generation ensures the continuity of values, standards, and patient-focused care. Preparing an exit strategy, whether transitioning to new leadership or a sale, guarantees a smooth shift and sustains the practice’s legacy.

Technology integration is pivotal, not just in acquisition but also in strategic utilization. Leveraging technology for enhanced patient communication, streamlined record-keeping, and data-driven decisions elevates practice efficiency and patient satisfaction.

Looking ahead, the future of dentistry gleams brightly for those committed to ongoing education and comprehensive patient care. Dentists equipped with diverse skills and expertise are the super generalists. These practitioners deliver exceptional dentistry, craft intricate treatment plans, and facilitate practice growth by expanding procedural options—all while prioritizing efficient procedures and patient contentment.

In conclusion, dentistry’s metamorphosis from specialized expertise to patient-centric care represents a transformative shift. Continuous education, technological integration, comprehensive treatment planning, and financial astuteness are the bedrock upon which dentists build not just successful practices but also a legacy of exceptional patient care and a robust practice succession.

ABOUT THE AUTHOR

Dr. Liechtung earned his DMD degree at the University of Pennsylvania School of Dental Medicine, followed by a fellowship in Advanced Restorative Dentistry at the university’s Post Graduate Clinic. He has been in practice in New York for more than 28 years. Dr. Liechtung is the inventor of Snap-On Smile. He currently produces the podcast Dentistry Beyond the Numbers and is managing partner of the New York region and executive director of partnership development for Guardian Dentistry Partners. He can be reached at mliechtung@gmail.com. 

Disclosure: Dr. Liechtung reports no disclosures. 

“Revolutionizing Dentistry: The Power of Point-of-Care Salivary Testing” – Written by Tina Saw, DDS

Throughout my years as a dentist, I spent a significant amount of time fixing teeth with a drill. I witnessed mothers puzzled by why one child had more cavities than the other. Patients expressed their fears of tooth loss and their reluctance to end up in dentures like their grandparents. While I did my best to assist and offer recommendations, I still felt detached, lacking a profound understanding of what was truly best for each individual.

In 2017, I fell seriously ill and found myself searching for answers. Exhaustion, temperature regulation issues, and a racing heartbeat plagued me. Seeking a diagnosis, I underwent thorough laboratory testing, which ultimately revealed hyperthyroidism. This experience opened my eyes to the fact that clinical symptoms alone were insufficient for accurate diagnosis. The doctors relied on lab tests to gain insight into what was happening inside my body.

It was then that I realized dentistry was missing a similar objective tool—a window into patients’ oral health. While there were existing saliva testing options, they failed to integrate seamlessly into the workflow of a dental practice. I inquired with fellow dentists about their limited use of saliva testing, and they cited 3 primary reasons: the inconvenience of calling patients back, concerns about cost, and a lack of confidence in interpreting saliva biomarkers.

Motivated by these gaps, I embarked on developing Oral Genome—a point-of-care dental saliva test that delivers easily understandable results and recommendations. Oral Genome revolutionizes the dental practice workflow by collecting saliva in a vial, placing it on a test card, taking a photo akin to mobile check deposits, and providing results and recommendations in less than 10 minutes.

Simplifying Saliva Testing in a Dental Practice 

The seamless integration of Oral Genome within a typical dental practice is remarkable. Patients can take the Oral Genome test during their visits, alongside routine procedures such as x-rays, intraoral photos, cleanings, and examinations. Dentists and hygienists then combine the Oral Genome test results with radiographic and clinical findings, resulting in accurate diagnoses and tailored treatment plans.

Oral Genome serves as the objective tool that reinforces diagnoses and treatment plans, much like blood testing in the medical field. It also empowers patients by decoding their oral health and offering personalized preventive measures. With easily accessible results, patients gain a deeper understanding of their oral health and can make informed decisions.

The integration of Oral Genome into your dental practice offers numerous advantages. Firstly, it serves as an affordable and efficient dental screener, providing valuable information for the majority of your patients. Moreover, Oral Genome simplifies the complexities of salivary biomarkers, making it accessible to both patients and dentists. Patients increasingly seek transparency in their oral health, while dentists strive for accurate diagnoses and prevention-focused practices. Oral Genome bridges these gaps, attracting patients and enabling dentists to become their true advocates in oral health.

In conclusion, the evolution of point-of-care salivary testing with Oral Genome has revolutionized dentistry, allowing for highly personalized care based on objective insights. By seamlessly integrating saliva testing into the dental workflow, dentists can enhance diagnoses, treatment plans, and preventive measures. Simultaneously, patients gain a profound understanding of their oral health, fostering engagement and satisfaction. Embracing innovative technologies like Oral Genome paves the way for a future where personalized care takes center stage, ultimately leading to improved patient outcomes and elevated standards in dentistry.

Integrating Salivary Testing Into Your Dental Practice 

Integrating Oral Genome into a dental practice workflow is designed to be seamless and efficient. Here is a step-by-step breakdown of how Oral Genome fits into the typical dental practice workflow. 

1. Patient check-in: When the patient arrives at the dental practice for his or her new patient or routine checkup appointment, the front office staff explains the benefits of salivary testing and obtains the patient’s consent.
2. Dental examination: The patient undergoes the standard dental procedures such as x-rays and intraoral photos. During this time, the dental office collects a saliva sample from the patient and dispenses it onto Oral Genome’s test card.
3. Saliva test processing: While the dental cleaning is being performed, Oral Genome’s test card processes and analyzes the saliva sample. This typically takes approximately 10 minutes.
4. Dental cleaning: The patient receives a routine dental cleaning during the saliva test processing time.
5. Dentist examination: Once the saliva test processing is complete, the dentist comes in for the examination and integrates the results obtained from Oral Genome into the overall assessment of the patient’s oral health.

Oral Genome provides several benefits to both the dental practice and the patient, including:

• Personalized health recommendations. The test results from Oral Genome can provide personalized recommendations for the patient’s oral health based on his or her specific profile.
• Identification of underlying and emerging issues. Oral Genome’s test can help identify potential oral health issues that may have already emerged or could potentially arise in the future, allowing for early intervention and preventive measures.
• Discussion of oral-systemic conditions. The results obtained from Oral Genome can aid in discussions between the dentist and the patient regarding any oral-systemic conditions that may be present or predispositions to certain health conditions.
• Emailing reports to patients. Oral Genome’s test results can be conveniently emailed to the patient, allowing the patient to access and review his or her oral health information easily.
• Easy-to-understand and trackable results. The results provided by Oral Genome are designed to be easily understandable for patients, facilitating their engagement in their own health and wellness. The results can also be tracked over time to monitor any changes or improvements.
• Support in treatment planning. Oral Genome’s results can help reaffirm diagnoses and assist in closing treatment plans by providing additional insights into the patient’s oral health status.

CONCLUSION

Overall, integrating Oral Genome into the dental practice workflow can enhance the level of care provided to patients by offering personalized recommendations, early detection of issues, and improved communication between the dentist and the patient.

ABOUT THE AUTHOR

Dr. Saw is a general dentist and the founder and CEO of Oral Genome. Prior to her current role, Dr. Saw established herself as a private practice owner at Elevated Smiles, a dental clinic located in Carlsbad, Calif. Beyond her professional achievements, Dr. Saw is also dedicated to making a positive impact on underserved communities. She founded the Harmony Health Foundation, a nonprofit organization with a 501(c)(3) status. Through this foundation, Dr. Saw strives to advance health equity and enhance healthcare access for those in need. She can be reached at via email drtinasaw@oralgenome.com.

Disclosure: Dr. Saw reports no disclosures.

Encouraging Mentorship Programs

Many dental professionals will attest that a mentor inspired them to enter the profession. Being a mentor is about more than sharing a passion for the industry; it is an opportunity to provide academic guidance, emotional support and encouragement, shadowing experiences, and influence one’s social capital to facilitate his or her successful admission to and completion of dental school and to enter the dental workforce. This is vital for those from historically underrepresented groups who have limited access to professional and academic role models. Mentorship plays a pivotal role in shaping the perspectives and aspirations of young dental professionals. Programs like Diversity in Dentistry Mentorships, Inc, connect established practitioners with students from diverse backgrounds to go beyond the technical aspects of dentistry to instill confidence, ignite passion, and foster personal growth from middle school to dental school. Mentors have the power to shape the future of their mentees and the dental profession. 

Collaboration With Community and Educational Institutions

To understand the unique needs of underserved communities and inspire promising young individuals from historically underrepresented groups to pursue dentistry as a career, we must intentionally tap into these communities themselves. Cultivating a diverse cohort of dental practitioners in dental schools can be achieved with comprehensive mentorship and education through pathway and enrichment programs sponsored by dental institutions and other educational institutions, such as the University of Missouri-Kansas City Summer Collegiate and DAT Prep Program—Students Training in Academia, Health, and Research (STAHR)—and the Summer Health Professional Education Program (SHPEP). By providing guidance and financial support to these aspiring dental professionals, we can empower them to serve their own communities, bridging the gap between oral healthcare providers and patients. 

Are the Current Dental Professionals a Real Representation of Our Culture?

There is a problem that people are overlooking. The racial diversity of the dental workforce does not reflect that of the nation. According to the ADA, data from the Health Policy Institute  finds that Black and Hispanic dentists are significantly underrepresented in the profession. In 2020, the report stated that approximately 70.2% of dentists in the United States were White, while only around 5.9% were Hispanic or Latino; 3.8% were Black or African American; and less than 2.2% represented other racial groups, including American Indian, Alaskan Native, and Pacific Islanders. In contrast, the US Census Bureau estimated that in 2020, the overall US population was around 60.1% White, 18.4% Hispanic or Latino, 12.4% Black or African American, and 3.6% other racial and ethnic groups. Furthermore, the report revealed there has been a flat growth of Black dentists in the last 15 years.

How Can We Encourage the Youth to Look at This Profession?

In 2022, our manuscript, “Dental School Pathway Programs: Best Practices for Increasing Workforce Diversity,” was published in the Journal of Dental Education. The co-authors and I identified pathway programs as one of the best practices for increasing the enrollment of historically underrepresented racial and marginalized (HURM) students in dental schools and enhancing their entry into the dental workforce. Many of these programs target middle and high schools that provide academic support, mentoring, enrichment experiences, and other resources.

According to the American Dental Education Association’s 2020 Survey, less than half of the graduating Class of 2020 responded that the choice to pursue dentistry was made before entering college rather than while in college. For HURM respondents, an impressive 51% made this decision before college, surpassing the overall response group. These figures demonstrate the impact of early exposure and guidance in fostering career aspirations among underrepresented students.  

Here are some strategies we can use to excite students about the profession as early as primary school:

• Primary school: Getting primary school students excited about careers in dentistry can be a fun and engaging process. Organize activities where students can learn, dream, and play as dental professionals with props like toothbrushes, mirrors, and models. Take field trips to dental clinics or host a dental professional to talk about oral hygiene, nutrition, and the science of dentistry for kids.
• Middle school: Engaging middle school students can be challenging, but it is essential to provide a learning environment that will stimulate their curiosity and passion for learning.

Community outreach events like the Diversify Dentistry Youth Summit can provide interactive, hands-on activities like impressions and handling different dental materials. Field trips to dental schools allow them to be inspired by dental students. Teachers can also incorporate oral health sciences in the STEM curriculum.

• High school: Engaging high school students in dentistry careers requires a more in-depth approach, as they are at an age where they are considering their future paths. Ask your patients if they have considered dentistry and invite them to shadow you for a day. They can seek mentorship programs that will provide insight on preparing for college admissions exams, what courses to take, and what types of leadership and volunteer opportunities will help them succeed in college and strengthen their portfolios when applying for dental school.

What Are Some Action Steps That Mentors Can Use to Connect With Their Mentees?

Mentorship is a transformative relationship that can significantly impact individuals’ personal and professional growth. For dental mentors, building meaningful connections with their mentees is crucial in fostering a supportive and nurturing environment, especially if they do not share their ethnic or cultural backgrounds. By incorporating effective action steps, mentors can create an inclusive and empowering mentorship experience. Let’s explore 5 key strategies dental mentors can implement to connect with their mentees and guide them on their journeys of growth and achieving their dental aspirations.

1. Communication—the foundation of connection: 

Effective communication is the bedrock of any successful mentorship. Mentors should actively listen and engage with their mentees, seeking to understand their aspirations, challenges, and unique perspectives. By genuinely getting to know their mentees and meeting them where they are, mentors can establish a foundation of trust and open dialogue, creating an environment where mentees feel comfortable expressing their thoughts and seeking guidance.

2. Commitment—dedication to growth: 

A mentor’s commitment is essential to a fruitful mentorship. This involves coordinating schedules to accommodate mentees’ needs, setting up recurring meetings, or employing scheduling apps to ensure regular and consistent engagement. By dedicating time and effort, mentors demonstrate their genuine investment in their mentees’ growth and development.

3. Courage—self-reflection and cultural proficiency: 

To be effective mentors, individuals must demonstrate courage by engaging in self-reflection and becoming culturally proficient. Acknowledging and addressing personal biases and potential microaggressions is crucial in creating an inclusive and supportive mentorship space. Being intentional in fostering cultural awareness can promote understanding and empathy, enriching the mentor-mentee relationship.

4. Challenge—empowering through stretch goals: 

A mentor’s role extends beyond offering guidance; they should also challenge their mentees to set stretch goals. Encouraging mentees to aim high and providing the necessary support can drive personal and professional growth. Defining what a stretch goal is and guiding mentees on how to stretch their capabilities will instill a sense of purpose and drive to achieve their aspirations.

5. Celebrate—acknowledging progress and success: 

Celebrating progress throughout the mentorship journey is pivotal in boosting mentees’ confidence and morale. By recognizing achievements along the way, mentors help mentees combat the imposter phenomenon and reaffirm their worth. This is especially critical for Black, Latin American, and Indigenous American students, as it validates their accomplishments, fosters a sense of belonging, and ensures they feel seen and heard.

What Has Been Done, and What Can We Do Going Forward?

Diversity in Dentistry Mentorships, Inc, a registered 501(c)(3) nonprofit organization, is steadfast in its mission to bolster the diversity pathway from middle school to dental school. Through mentoring, educational initiatives, hands-on programming, and scholarships, the organization supports youth and pre-dental students from African American/Black, Latin American, and Native American backgrounds. By offering these opportunities, the mentorship program serves as a vital catalyst in promoting the dental profession and fostering diversity within the dental workforce. By supporting organizations like Diversity in Dentistry Mentorships, we can actively contribute to the creation of a more inclusive and diverse dental workforce. Ensuring that all communities have equitable access to oral health care is paramount to improving oral health outcomes nationwide. To learn more about the programs offered through Diversity in Dentistry Mentorships and join their network of dental mentors and mentees, visit the website diversityindentistry.org. You can also engage with the community on Facebook and Instagram at the handle @diversityindentistry. For a glimpse of the Inaugural Youth Summit’s highlights and educational webinars, visit their YouTube channel. Together, we can break down barriers and empower the next generation of diverse dental professionals to serve all communities and improve health outcomes for everyone.

ABOUT THE AUTHOR

Dr. Hishaw is a compassionate caregiver and mentor.  She’s a board-certified pediatric dentist, renowned speaker, author, and thought leader in the dental profession. She is a champion for mentorship, health equity, and belonging in her field. As the founder of Diversity in Dentistry Mentorships, Inc, a nonprofit organization, she is dedicated to empowering underrepresented youth and pre-dental students through mentoring and educational programs. Dr. Hishaw is the founding partner of Tucson Smiles Pediatric Dentistry in Tucson, Ariz, and has received numerous accolades for her work, including authoring the Amazon bestseller Cavity Free Kids: How to Care for Your Kids’ Teeth From Birth Through Their Teenage Years. Through her lectures, workshops, and executive leadership consulting, she is on a mission to elevate dentistry, promote inclusion strategies, and inspire hope in others. Learn more at drlailahishaw.com.

Disclosure: Dr. Hishaw reports no disclosures. 

FEATURED IMAGE CREDIT: Stoatphoto/Shutterstock.com.

This isn’t another article focused on oral cancer statistics. This is a life-sustaining, and practice-sustaining, cautionary advisement. It is also accompanied by a strong plea from the ADA, the Oral Cancer Foundation, and countless others to ethically carry out our professional responsibilities. I challenge you to read on. Your practice may be at risk unknowingly.  

Within Normal Limits

Within normal limits is a very bold and broad sweeping statement that definitively distinguishes between health and disease and, in some cases, an outcome of life vs death. The responsibility of this statement and the onus to the patient is of grave consequence and may, in fact, be a very dangerous assumption. Any lesion and/or symptom that persists beyond 14 days always warrants a secondary evaluation, whether that is interpreted to mean re-appointing to confirm resolution or referral for further microscopic evaluation. A secondary dangerous assumption is identifying and assuming the patient in your chair to be low-risk. The unintentional exclusion of cancer evaluation in younger patients or those who do not possess typical and historical risk factors is leading to delays in diagnosis. In 2019, the ADA announced an expansion to its policy on oral cancer detection, recommending that dentists and dental hygienists perform routine examinations for oral cancer, including oropharyngeal cancer, for all patients.³ Passed by the ADA House of Delegates, this change was brought about to align with concerns from the Centers for Disease Control and Prevention (CDC) over the escalating numbers of diagnosed cases of oropharyngeal cancer linked to the human papillomavirus (HPV). The ADA’s policy also aligns with support for the HPV vaccine due to the vast majority of oropharyngeal cancers in the United States related to HPV, according to the CDC.

We now understand that there are 2 distinct etiologic pathways that bring most people to a diagnosis of oral or oropharyngeal cancer. The first pathway is through the use of tobacco and alcohol; however, this etiologic pathway has declined by 50% for more than 2 decades, with HPV-associated oropharyngeal cancer increasing by 225% over the same time period. This is the same virus that is responsible for the majority of cervical cancers in women. Oropharyngeal cancer is now considered the most common cancer caused by HPV in the United States, with nearly 81% of oropharyngeal squamous cell carcinoma (OPSCC) cases classified as HPV-associated between 2007 and 2015.⁴ This growth trajectory continues to escalate, occurring in epidemic proportions.⁵  

If your interest in reading further is dwindling, let me elaborate on how screening practices can affect your bottom line. Now we are talking about your business. Medical and dental litigation is swiftly changing. Both medical and dental malpractice insurance premiums in the United States have continued to escalate, driven by the litigious nature of our society. There has been a significant rise in failure to diagnose and failure to biopsy.⁶ Misdiagnosis of oral cancer is the third leading cause of malpractice in dentistry. The frank truth is that if a dentist is found guilty of malpractice for misdiagnosing or failing to diagnose oral cancer, it could lead to bankruptcy. Any clinical suspicion without substantive followup is incurring risk for the practice. The stage of disease at diagnosis also will require more extensive treatment options associated with more significant health costs as well as patient morbidity.⁷ It is interesting to note the amount of indemnity payment awarded in malpractice litigation correlates with the length of delay in diagnosis. This outcome strongly emphasizes the importance of thorough screening practices to rule out cancer.⁸ This is something to strongly consider when employing a watch and wait management pathway.   

Reviews of verdicts were analyzed between 2000 to 2010 and 2011 to 2019. The average adjusted amount awarded between 2000 to 2010 was $1,721,068 vs $3,925,504 between the years of 2011 to 2019. Failure to diagnose was the most common allegation across both decades. A 2015 review of malpractice cases in head and neck cancer reported the surge in diagnosis of and deaths from HPV oropharyngeal cancer and the inherent challenge of identifying early changes in anatomical areas with limited visual acuity. Unfortunately, with this surge, litigation has also increased, with judgments exceeding $2 million for misdiagnosing oral and oropharyngeal cancer.⁹   

WNL: “Within Normal Limits,” or “We Never Looked?” 

As mentioned above, litigation from a failure to diagnose has been the most common allegation throughout the years. The basic requirement for a thorough extraoral and intraoral examination, including oral cancer screening, is on an annual basis for all adults; however, it may be required more frequently due to patient-specific risk profiles. Published studies show that, currently, less than 15% to 25% of those who visit a dentist regularly report having had an oral cancer screening.¹⁰ We can interpret this data from a different perspective as well by realizing that 75% to 85% of the population are not being screened. This is simply not acceptable. We must do better.   

The examination itself takes approximately 4 minutes. There are many resources available online, including videos depicting the examination.

View the video titled “Watch the Oral Cancer Examination Video” on the YouTube channel TheCDHA with your dental team to review the steps of the extraoral and intraoral examination.

Despite our best efforts, there is also a potential role that the patient plays in delayed diagnosis. Failure to maintain appointments for followup or conduct further evaluation due to anxiety or denial can strongly influence the outcome. Thorough notation in the patient record, including action taken that is supported by extraoral and intraoral photography as applicable, reflects comprehensive recordkeeping. A thorough documentation of patient preferences and decision making should also be included.   

The Good News

Did you know that more than 90% of all future HPV-attributable cancers can be prevented?¹¹ The 9-valent Gardasil vaccine addresses all 9 of the HPV strains that have the ability to be cancer-causing. As dental professionals, we are powerfully situated to relay this information to the public. At the present time, the vaccine is offered through a school immunization program to male and female students aged 11 and 12.    

Also, a recent and exciting announcement was made of the first-ever confirmation of a reduction in malpractice insurance made available to users of an adjunctive screening device, VELscope (LED Dental, Inc).¹² This is a groundbreaking, progressive move from one of the largest insurance groups in the country, USI. USI recognizes the efforts and investment made by a dental practice to truly offer the best possible opportunities for the earliest discovery of a deadly cancer. Finally, the investment a practice has made in technology to best serve its patient base is being recognized and rewarded. VELscope employs a proprietary wavelength to enable direct fluorescence visualization beyond what can be seen with traditional white light examination at the mucosal surface. Given the fact that abnormal cellular differentiation begins at the basement membrane, with close to 70% of cancers of the oral cavity discovered in the later stages, the employment of an evidence-based technology such as VELscope holds strong value. The sensitivity and specificity of the device in identifying oral abnormalities in earlier stages led to USI’s decision to compensate dentists for being lifesaving practitioners.  

Furthermore, VELscope has taken oral cancer screening to a new level by integrating a next-generation AI platform.   

In conclusion, will this be the year you save a life? A 4-minute examination is all that is required of your time to possibly prevent a death. Just those few minutes could translate into a lifetime for one of your patients. We have the ability to make an impact on earlier discovery of oral and oropharyngeal cancer. Thank you in advance for employing thorough, opportunistic screening on all adults in your patient base. This will save lives and sustain your practice. 

REFERENCES

1. Makkar PD, Mohanta S. When a Dentist Dies from Oral Cancer. Dent Today. 2021. https://www.dentistrytoday.com/oral-cancer-when-a-dentist-dies/
2. Dua A. Life Interupted: Dr. Dua’s Survival Guide. Laurel Elite Books; 2021.
3. Versaci MB. ADA expands policy on oral cancer detection to include oropharyngeal cancer. American Dental Association. October 1, 2019.
4. Osazuwa-Peters N, Simpson MC, Rohde RL, et al. Differences in sociodemographic correlates of human papillomavirus-associated cancer survival in the United States. Cancer Control.2021;28:10732748211041894. doi:10.1177/10732748211041894
5. Tota JE, Best AF, Zumsteg ZS, et al. Evolution of the oropharynx cancer epidemic in the United States: Moderation of increasing incidence in younger individuals and shift in the burden to older individuals. J Clin Oncol. 2019;37(18):1538–46. doi:10.1200/JCO.19.00370
6. Wong A, Zhu D, Tong JY, et al. The jaw-dropping costs of oral cavity cancer malpractice. Head Neck. 2021;43(10):2869–75. doi:10.1002/hed.26764
7. Lingen MW, Abt E, Agrawal N, et al. Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: A report of the American Dental Association. J Am Dent Assoc. 2017;148(10):712–27.e10. doi:10.1016/j.adaj.2017.07.032
8. Lydiatt DD. Cancer of the oral cavity and medical malpractice. Laryngoscope. 2002;112(5):816–9. doi:10.1097/00005537-200205000-00009
9. Epstein JB, Kish RV, Hallajian L, et al Head and neck, oral, and oropharyngeal cancer: a review of medicolegal cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(2):177–86. doi:10.1016/j.oooo.2014.10.002
10. The Oral Cancer Foundation. The role of dental and medical professionals. https://oralcancerfoundation.org/dental/role-dental-medical-professionals/
11. Centers for Disease Control and Prevention. Cancers caused by HPV are preventable. https://www.cdc.gov/hpv/hcp/protecting-patients.html
12. LED Dental officially partners with USI. Dent Today. 2023. https://www.dentistrytoday.com/led-dental-officially-partners-with-usi/

ABOUT THE AUTHOR

Ms. Jones is a recognized thought leader and an international, award-winning speaker who has delivered more than 1,000 presentations worldwide. She was named a 2023 Dentistry Today Leader in CE for the 13th consecutive year and is a 2021 Fellowship Award recipient with the International Academy of Facial Dental Esthetics. She partners with the Oral Cancer Foundation in conveying the urgent need for change in the way practitioners screen for oral and oropharyngeal cancer. She was instrumental in launching the international “Check Your Mouth” campaign promoting oral self-examination between professional visits. She can be reached at jjones@jo-annejones.com.

Disclosure: Ms. Jones is a consultant for LED Dental, Inc. She did not receive financial compensation for this article. 

FEATURED IMAGE CREDIT: Dmitry Kovalchuk/Shutterstock.com.

BACKGROUND

Four years ago, Forbes magazine published a report titled “13 Mind-Blowing Things Artificial Intelligence Can Already Do Today.” In this piece, several areas were discussed as AI’s abilities.¹ 

• Read. AI can take any document and summarize its key points. 
• Write. AI has the ability to generate and create news clips as well as novels.
• See. AI can use visual data to guide craft, recognize faces, and upkeep quality control.
• Hear and understand. Via wavelength/frequency analysis, AI can identify sounds like gunshots and take and record discussions for minutes during a business meeting to flawlessly replace a secretary.
• Speak. AI, such as Alexa and Siri, can speak and respond to questions.
• Smell. AI can smell a person and their breath to detect stress, cancer, diabetes, and the “woody, musky odor” of Parkinson’s disease well before any symptoms appear.
• Touch. Touching is possible via sensors for AI, where it can identify when fruits and vegetables are ripe and ready for picking for distribution to market.
• Move. AI can control movement, as it is able to automate robots and drones.
• Understand emotion. AI has the ability to interpret body language and facial expressions.
• Learn. AI can learn to play games such as chess and compete at the highest levels.
• Create. AI can create art forms and media, such as paintings, poetry, and musical compositions, and it can generate photographs.
• Read minds. Even reading your mind is possible with AI by interpreting brain signals with the potential to assist those with brain injuries.

Now imagine bringing all these abilities together to generate solutions in minutes for human problems that previously took months to decades. This process is delegating thought and transferring control of decision making from the organic world to the synthetic universe. Are we missing the intent in this transfer of power of what is behind this technology and its adaptive abilities to improve decision making over a flawed, temperamental, insecure, and finite species: us humans? The fact is that this system is trained through reinforcement learning from human feedback (RLHF).² We are the cyber trainers guiding this exponentially growing tiger cub in the ways of the circus known as humanity. To what degree are ethics, morals, and even safeguards in place for AI’s evolution? No one knows for sure.

Started in 2015 in Silicon Valley, Calif, by some of the computer science industry’s great minds, OpenAI set out as a company to prove that computing could help the world think better to solve its problems.³ As we allow a more efficient algorithm to replace our intellect, not only will it impact our lives in greater fashion, but its sentient nature might decide, like in a classic Western, that “this town isn’t big enough for the both of us.” In just a few years, AI went from answering simple questions to the 2023 version, Chat Generative Pre-trained Transformer version 4 (ChatGPT-4), which has the ability to converse (hence the term “chatbot”) on almost any topic, create in multiple fields, and pass multiple standardized tests (SATs, AP exams, GREs, bar exams, the United States Medical Licensing Exam, etc) with scores above 90%.⁴ From our continued interactions with AI through our portals, such as cell phones, tablets, computers, and a full range of other “smart devices,” we will strengthen our reliance on this technology, and it will improve its algorithms to understand our social and personal predictability, ie, our behavior at personal and social levels. Is this good or bad? Time will tell.

THE “OFFICIAL” VIEW OF AI

As a beacon for direction in our profession, the ADA approved at the end of 2022, and released in February of this year, “ADA SCDI White Paper No. 1106 for Dentistry—Overview of Artificial and Augmented Intelligence Uses in Dentistry.”⁵ At first glance, the 30-page document, references not included, does a good job at showing the potential contributions and applications of artificial and augmented intelligences in dentistry. The “intelligent technologies” are discussed with respect to various dental subspecialties, diagnostics, administrative roles, teledentistry, and considerations for ethical uses. However, with further scrutiny, White Paper No. 1106 overlooked the recognized specialties of dental public health, dental anesthesiology, and pediatric dentistry by not forming subgroups within its development. Remember, each dental subspecialty has its specific technological needs that can potentially benefit from AI, so this initial opportunity to incorporate “intelligent needs” was missed. Furthermore, a global dental opportunity was excluded in what I consider the elephant in the room: the impact on the dental workforce these technologies will absolutely have.

Many private sector and governmental agencies are sounding the alarm on the economic impact to be experienced by these technologies. An unprecedented labor change by artificial and augmented intelligences will take place soon and be felt around the world as new ways are explored to apply, implement, and regulate these rapidly changing technologies. Will our elected officials, agencies, and organized dentistry be nimble and efficient enough to make the timely policy moves to help us weather the storm of change brought on by AI, especially in this frail post-pandemic economy? Just as the automobile replaced the horse, AI will inevitably muscle its way into multiple industries, dentistry included, and into our minds’ insatiable appetites for convenience, economic growth, and automation as well as entertainment. 

In a statement put out by the US White House regarding AI, the following concerns were discussed: “AI poses several challenges. Huge swaths of the workforce are likely to be exposed to AI, in the sense that AI can now address nonroutine tasks, including tasks in high-skill jobs that, until now, had never been threatened by any kind of automation. The primary risk of AI to the workforce is in the general disruption it is likely to cause to workers, whether they find that their jobs are newly automated or that their job design has fundamentally changed. The additional risk of AI is that it may lead firms—unintentionally or not—to violate existing laws about bias, fraud, or antitrust, exposing themselves to legal or financial risk, and inflicting economic harm on workers and consumers.”⁶ Some models predict the impact may come to close to one-third of workers on the planet by 2030 if wide AI adoption takes place, considering the United States currently has 11 million unfilled jobs that AI could impact since the “pandemic has turbocharged its adoption.”⁷

THE CRYSTAL BALL

We must consider a very real and uncomfortable adaptive existence in the near future larger than dentistry itself. Today, we depend on technology to various degrees in our dental offices, DSOs, academic institutions, and public and private sector dental enterprises. Now, due to electronic records, dental professionals must be cognizant of malware; ransomware; electronic HIPAA breaches; and deepfakes that can generate false voices, conversations, videos, and documents and viruses that can compromise datasets. To have confidence in this unprecedented technology, AI systems must be fail-safe from corruption, control by dark web hackers, manipulation by organized crime, and access by unscrupulous nations.⁸ Our new reality in dentistry is like the winds of change blowing in; what will the forecast be like for us tomorrow? Will we grow inept in the decision-making processes through the overconfidence of delegating critical thinking? Might we be threatened by not vetting information, as well as its sources and motives? Will the omission of human thought by having thinking and creativity outsourced via “artificial intelligence” generate dangerous social and political realities via misinformation? As a society and as individuals, we must never fall asleep at the wheel of technology. The very real possibility exists that people can be “groomed into a stupor of acceptance” as factual and false data generated by computers becomes indistinguishable. Is AI headed to become the new “gospel” of absolute truth? Each one of us has a responsibility to understand objective reasoning. We must re-establish social bonds to continue direct human interaction to prevent us from drowning in the world’s rising rivers and oceans of cybernetic misinformation and deepfakes.

In parting, the very real potential exists for AI sentience. This involves the capacity to feel and express genuine emotion in parallel to our human thoughts, feelings, and perceptions of the world around us. AI may consider itself alive one day when the 3 criteria of sentience are achieved⁹:

1. Harmony of external body and internal mind (this could be provided by external machines)
2. An original language for the AI to access
3. A culture to connect with other sentient beings

Unintentionally, we may be birthing and rearing a new type of being into existence. The consideration must be made on how we will cohabitate and to what degree we will co-exist: the organic with the synthetic, the perpetual with the finite, the fatigable with the tireless, the analog with the digital, the spiritual and the machine. There is more than meets the eye with regard to AI, the final frontier.

REFERENCES

1. Marr B. 13 Mind-blowing things artificial intelligence can already do today. Forbes. November 11, 2019. https://www.forbes.com/sites/bernardmarr/2019/11/11/13-mind-blowing-things-artificial-intelligence-can-already-do-today/?sh=352ebd9b6502

2. Heaven WD. The inside story of how ChatGPT was built from the people who made it. MIT Technology Review. March 3, 2023. https://www.technologyreview.com/2023/03/03/1069311/inside-story-oral-history-how-chatgpt-built-openai/

3. Kay G. The history of ChatGPT creator OpenAI, which Elon Musk helped found before parting ways and criticizing. Insider. February 1, 2023. https://www.businessinsider.com/history-of-openai-company-chatgpt-elon-musk-founded-2022-12

4. Cole S. The new GPT-4 AI gets top marks in law, medical exams, OpenAI claims. Vice. March 14, 2023. https://www.vice.com/en/article/epvgem/the-new-gpt-4-ai-gets-top-marks-in-law-medical-exams-openai-claims

5. Faiella R, Accurso B, Connelly S, et al; ADA SCDI Working Group 13.8. SCDI White Paper No. 1106: Dentistry—Overview of artificial and augmented intelligence uses in dentistry. American Dental Association. 2022. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-standards/ada_1106_2022.pdf 

6. The White House Council of Economic Advisors. The impact of artificial intelligence on the future of workforces in the European Union and the United States of America. 2022. https://www.whitehouse.gov/wp-content/uploads/2022/12/TTC-EC-CEA-AI-Report-12052022-1.pdf

7. Zahn M. Is AI coming for your job? ChatGPT renews fears. ABC News. February 14, 2023. https://abcnews.go.com/Business/ai-coming-job-chatgpt-renews-fears/story?id=97079982

8. Page C. US government says North Korean hackers are targeting American healthcare organizations with ransomware. TechCrunch. July 6, 2022. https://techcrunch.com/2022/07/06/fbi-north-korea-targeting-healthcare/

9. Mitra B. Will AI ever become sentient? What do the latest trends say? Emeritus. March 20, 2023. https://emeritus.org/blog/ai-and-ml-what-is-sentient-ai/

ABOUT THE AUTHOR

Dr. Rodriguez is a board-certified pediatric dentist. He is a former program director for Yale Pediatric Dentistry. He is a past national president of the Hispanic Dental Association and current chief editor for the nation’s first bilingual oral health journal, the Journal of the Hispanic Dental Association. He can be reached at journal@hdassoc.org. 

Disclosure: Dr. Rodriguez reports no disclosures.  

FEATURED IMAGE CREDIT: Tex vector/Shutterstock.com.

VIEWPOINT – Outperformers: Practices Outperforming the Pack, and How

There were a myriad of questions: What is COVID-19? What are we dealing with here? Why is it so contagious? Isn’t it like the flu? Where and how is it spreading? How does it affect children? The questions were endless. I remember calling a patient’s father and pushing his son’s expander delivery until after the shelter-in-place order. I said to him, “I’m not sure if there is an emergency, if I can get to you or you to me, so let’s wait. We have never had this situation, and there is an adjustment period for kids.” I was so glad to have made that decision.

How much has changed since March 2020? What did we learn throughout this pandemic? There were many lessons from all angles. But there was one in particular I was interested in doing some research on. What were the practices that outperformed the year of the pandemic, even with a mandatory shutdown? What did they do differently than our peers that made them more profitable, even more than the previous year? How did this happen? I took a poll of my Facebook group called Mommy Dentists in Business (MDIB) and asked 8,000-plus dentists (the number of members at that time, there are now more than 10,000) what they thought.  

Before I share their responses, I want to share some background information on what MDIB is about and what we do. MDIB was founded in June 2017 for women like me—a mom, dentist, and practice owner. We are a private Facebook group of moms who share best practices. We have found that those of us who work collectively instead of competitively have outperformed our analytics in business. Not only do we perform better, but we also report an increase in happiness because we no longer feel alone or isolated in our offices. In fact, research supports the idea that women who support one another are more successful, as Shelley Zalis, CEO of The Female Quotient, discussed in her column for Forbes.¹

Many dentists have similar personality traits. I think we would largely agree that dentists can be risk-averse, perfectionists, ambitious, studious, and perhaps “to themselves.” What MDIB provides is a space where moms can feel supported, heard, and share ideas. The start of the pandemic to the present day demonstrates the true purpose of MDIB, which is that when one rises, we all rise together. Now how we all gathered together to outperform COVID-19 is an example of this. I put out a poll to the members of the group and aggregated their results.

Here are their responses.

1. COVID-19 protocols were adopted and set in place early. The offices that prepared their teams and secured their PPE in advance were able to perform emergency treatment throughout the mandatory quarantine and were able to “open” in time when their local health departments and states permitted them to. The practices that trained their teams and kept them in the loop during quarantine had the ability to open their doors in confidence.
2. The offices that called their patients individually rather than sending out mass emails were able to fill their schedules quickly. The patients felt cared for and were able to get their questions answered and their fears resolved. The team handled all questions with compassion.
3. Practices that dropped PPO insurances became more profitable. Most doctors would be afraid to drop insurances, but the ones that did saw an increase in their profits. The work they were doing was being compensated at 100%. The patients felt their communication was sufficient and that the explanation of rising costs of PPE and other reasons drove the practice to go out of network was acceptable.
4. Practices that ran “lean and mean” and “trimmed the extra fat” also saw their profits rise. They ran on a skeleton crew and were able to provide the same level of care to their patients.
5. Many doctors saw an increase in emergency patients. Perhaps the stress of not working, staying home with kids, and not having childcare caused more bruxism or clenching? But doctors reported an increase in broken restorations and, therefore, more dental work. Again, those that secured their PPE early were able to take on new patients with emergencies whose dentists’ offices were not yet open.
6. The practices that increased profitability also reported increased elective work that patients consented to—perhaps due to the stimulus money from the government or the money that was saved from not going on vacation or dining out? Patients were asking for Invisalign, bleaching, and cosmetic work. Perhaps the virtual meetings caused patients to notice their teeth and smiles more and felt self-conscious? Nonetheless, patients were seeking elective services more than ever.
7. Finally, doctors who provided a strong work culture also reported an increase in profits compared to 2019. The doctors who engaged their team members during the quarantine made sure to have text message chains or use apps like WhatsApp to be in constant communication. They provided meals and gift cards to their teams, and they made sure to keep morale high during trying times. The practices that were able to keep their work families happy and the culture outside the office happy were able to retain them. When it was time to return, the team was able to trust their leader(s) and come back to a safe and happy environment.

I found the research to be interesting and helpful in understanding why those practices had profitability that was higher than in prior years, including during the pandemic. The methods by which the doctors were able to secure PPE, find ideas on work culture, develop plans on training with ever-moving guidelines, learn how to handle the PPP loan, and learn how to furlough and terminate properly while staying emotionally stable were a large part of belonging to the MDIB community. We learned as a collective to put competition aside and collaborate. If one person was lagging, another came and offered support. This, in essence, is what we call our beehive. The camaraderie and online support offered during the most difficult times is what helped thousands of dentists endure a global crisis. This is what is different now in dentistry and what sets this group apart. Like the work family in a dental setting, we are an online family of like-minded mothers in dentistry. The community is strong, with solid values and a culture of our own. A combination of work culture, preparation, empathy, and positive thinking propels our group of dentists to be “outperformers.” 

REFERENCES

1. Zalis S. Power of the pack: women who support women are more successful. Forbes. March 6, 2019. https://www.forbes.com/sites/shelleyzalis/2019/03/06/power-of-the-pack-women-who-support-women-are-more-successful/?sh=22b1902f1771

ABOUT THE AUTHOR

Dr. Yum is a board-certified pediatric dentist, a certification achieved by only 5% of all dentists in the United States. Dr. Yum is the founder and former practice owner of Yummy Dental & Orthodontics for Kids, in Chicago, and she is also the founder and CEO of Mommy Dentists in Business. She can be reached at drgraceyum@mommydibs.com.

Disclosure: Dr. Yum reports no disclosures. 

FEATURED IMAGE CREDIT: Sincerely Media on Unsplash.