What’s happening out there?

June 1, 2005
Most dentists are trained in intellectually challenging, highly stimulating, and intensely competitive environments.

Most dentists are trained in intellectually challenging, highly stimulating, and intensely competitive environments. My dental school was embedded in a vast medical center surrounded by literally thousands of people training, teaching, or practicing all disciplines of health care. As overwhelming as it was at times, we still found plenty of time for important pursuits. We would make the case to anyone who would listen about how much more difficult the first two years of dental school were as opposed to attending medical school. As proof, we often cited a murky and not well-documented study that showed the first year of dental school required a world-record vocabulary expansion of 13,000 words.

The sense we were making with this Herculean leap in retained jargon helped to alleviate some of the nerd-factor sting of walking to dental school each day in a mustard-colored smock with a tan and yellow fishing-tackle box swinging from one hand, and a blue articulator case swinging from the other. From a distance, the blue Denar articulator case appeared eerily similar to something that should contain a pair of two-toned shoes and a bowling ball. Contrast the typical dental student image to our medical student counterparts across the street, who waltzed to school each day in crisp, white lab coats with shiny silver and black stethoscopes draped across their shoulders. Those were the days. Our young lives were full of personal and intellectual growth, emotional outbursts, and fellowship.

As the years pass after dental school and the camaraderie of dental school years fades, many of you might experience the isolation of private practice. Only a dentist can understand the loneliness experienced in a practice, even though you are constantly surrounded by staff and patients. Many dentists join study clubs, attend CE courses, and go to meetings to continue growing as practitioners as well as to see what’s happening out there, and to feel connected to dentistry. I am always surprised when speaking with our design clients to find out how curious they are about what other practitioners are doing.

If you feel out of the loop at times, here are some trends we have encountered in our design work with practitioners across the country:

  • The CEREC3 CAD/CAM restorative device by Sirona is having a major impact in dentistry, especially with midcareer to slightly younger practitioners. The newest generation of CEREC is much easier to program than previous models. In many offices, auxiliaries can manage much of the CAD/CAM process. Regardless of what you think of the quality of these restorations, single-visit crowns are very appealing to many patients - especially to those who just want white teeth. The subtle nuances of tooth shading and coloration are probably lost on the generations accustomed to bleaching trays and Crest Whitestrips.

    Recently, we designed operatory corridor niches in several different offices to display the CEREC milling unit. Practitioners report patients are fascinated by the milling process, and enjoy watching their restoration fabricated. It does take a little creativity to design and construct a glass-enclosed display area for the milling unit, yet still muffle the considerable sound generated. Sirona also is developing cabinetry to house and display the milling unit, as well as store all associated materials.
  • As popular as the one-visit CEREC crown has become, the one-visit, laser-bleaching treatments - as far as we can tell - are not having the same impact in the marketplace. There has been considerable discussion as to what these systems do and don’t do to tooth structure, and how long the bleaching results are acceptable. The wide availability of other types of bleaching products may have cooled the demand for one-visit bleaching makeovers. We have yet to work with any clients requesting design modifications to accommodate a laser-bleaching unit.
  • The entire dental profession is not utilizing digital radiography. We often encounter anxious doctors who feel obligated to make the switch from film to digital because they think everyone else is doing it. I know of no current data on the percentage of digital vs. film usage, but I would be shocked if more than 25 percent of dental practices rely exclusively on digital radiography. Scan-X, the reusable phosphor-plate scanning system by Air Techniques, has made tremendous gains in the marketplace as an alternative to the wired and wireless sensors. Scan-X is especially popular in larger practices with high volumes that also utilize large-format digital films. There is still no broad consensus on which CCD sensor is the most reliable, and produces the highest-quality image. Dexis and Schick sensors seem to be the most prevalent at this time.
  • The success of a front deskless dental office, boutique-style dental office or concierge-style dental office is wholly dependent on strategic implementation of specific practice-management concepts and philosophies - not trendy or faddish design outcomes. Front deskless, boutique-style, and concierge-style - in most respects - are different names for the same practice approach. As we enter an era of fewer dentists providing care for an increasing population base, it is difficult to envision a high percentage of practitioners delivering only high-end comprehensive care to a handful of patients a day. We are currently designing a front deskless/concierge-style facility. Our team has created many unique design outcomes that augment this doctor’s practice approach in the new facility. But, if you were to examine this doctor’s current facility floor plan, it would appear generic and typical of most dental offices from 10 or 15 years ago. Yet, the doctor is successfully practicing front deskless, concierge-style dentistry.

For those dentists considering the removal of the front desk in their new facility, here is one example of the types of practice-management dynamics that are congruent with this design outcome:

  1. New patients are only scheduled at 9 a.m. and 1 p.m. during the practice day.
  2. A concierge awaits all new patients near the entrance to the facility.
  3. Upon entry, the new patient immediately is welcomed by the concierge, and taken on a tour of the facility, including all clinical areas.
  4. The tour ends at a unique multifunctional space that combines a staff area, consult room, kitchenette with coffee, water, and juice available plus seating for this nontraditional waiting area. Doctor, staff, and patients mingle and interact in this space as they watch entertainment or educational programming on a large LCD flat-panel screen. From this area, most patients are retrieved by dental assistants and escorted to the clinical area. On future appointments, patients typically enter the facility then proceed directly to this multifunctional space to await treatment.
  5. Established patients of record have credit cards on file, and are aware of the sequence of charges associated with their respective treatment plans. There is a minimal amount of financial transactions at the end of appointments after a payment sequence is established. If a new appointment is needed, it may be scheduled at one of five cubicles scattered throughout the facility. The cubicles also are available to patients, doctor, and staff to access the Internet, check e-mail, and make phone calls.
  6. This facility does not take insurance nor does it participate in managed-care plans.

I hope you have enjoyed hearing about just a few of the things happening out there. If you are feeling isolated in your practice, get out there and attend a couple meetings, join a study club, or call your dentist buddy down the street and take him or her to lunch to reconnect. Nobody understands better what it is like to be a dentist than another dentist.

Dr. Jeff Carter is co-owner of the Practice Design Group, based in Austin, Texas. PDG specializes in providing architectural, interior design and equipment, and technology integration services to dentists nationwide. Dr. Carter may be reached at (512) 295-2224 or by e-mail at [email protected].