EXCLUSIVE! Stop giving it away!

Jan. 14, 2002
By Robert E. Hamric, DMD

Why do some dentists have a fear of dispensing products? What is so wrong with seeing the patient leave your office with the products you know they need? It just doesn't make sense to me. I have consulted with general dentists and orthodontists, and found many have a hard time rationalizing the true value of a product center.

Let's look at some facts and possibilities.

I developed a simple product center in the early 1980s. This started with an attractive display in an antique cabinet near our front desk area with only a few items. Patients at that time were able to purchase as many toothbrushes as they wanted, floss, fluoride, and toothpaste, and pay for it on the way out. (Yes, after a prophy we give them one manual brush, and floss) I suppose you know, patients think all those brushes, floss and every thing else you give them are samples that you did not have to purchase. Your local pharmaceutical rep just loves you so much they load you up with freebees, right? You know that's not the case and your patients should be aware that you purchase those items especially for them.

How much profit you desire is up to you, sell them for your cost or make a little profit. In our practice we charged more than cost and saved the profit for staff perks.

Over time we expanded our product center area to a remodeled coat closet, with indirect lighting and glass shelves. When we remodeled the entire office, we tore out a complete wall and built in a true product center, with glass shelves, mirrored walls, indirect lighting, and the whole thing. It was very professional and well received. The staff would decorate this area for the seasons or holiday. Displayed in the product center was EVERY product I would suggest for a patient to purchase. Some were prescription medications, such as fluoride gels and rinses or chlorhexidine . We did not keep antibiotics or narcotics in the office. I must tell you, patients loved the convenience of not having to make another stop to pick up these items. Many dentists visited our office and went back to their office to develop a similar product center; others would tell me it appeared unprofessional to sell out of the office. GET SERIOUS, when you do a crown, do you "sell" the patient on a crown instead of a MODBL-SOB amalgam, and do you do this procedure for just the lab bill or do you charge more than your cost. (By the way, your cost is far more than a lab bill). The difference between a product and a service is in the mind of the dentist, not the patient. I contend dentist?s dispense, sell and don't realize it, and many times simply give it away. STOP GIVING IT AWAY. One of the first professionals to dispense, and every one loved the convenience, was the vet. My vet dispenses everything our dogs need, and charges accordingly. You talk about a big business, talk to your vet about dispensing. Don't laugh, he probably charges more to clean your dogs teeth than you charge to clean his teeth. He is laughing at you.

An orthodontist friend of mine, when he sees gross plaque, and early periodontal disease, will fuss at the patient, usually a teenager, and write a prescription for a fluoride gel to help stop decalcification and hope for better plaque removal. What he found out was 50% of those prescriptions were never filled, and the patient was no better on the next visit. Why not dispense the proper fluoride gel, and develop a plaque control program for ALL patients and charge the proper fee or increase the monthly fee to include all these necessary products and instructions. Neglect is neglect, no matter where you see it. The reason I was given for not dispensing was; the general dentist is responsible for plaque control and the image of the orthodontist was at stake for dispensing. Whose image is at stake when the braces come off and there is decalcified enamel on every tooth? We tell ourselves it is the patients problem, they didn't keep their teeth clean?the patients tell you it is something you caused. They will never believe any different, no matter what your chart says. It is like blaming a cow for soggy cornflakes. But reality is perception. How is your image now?

I got into dispensing when I started my perio therapy program, Soft Tissue Management. What I found was, to be effective, this had to be a behavior modification program, and patients needed specific instruments and medications to improve and avoid surgery. I wanted to be certain they had the necessary tools for success, and the only way I would know they had what they needed, was to have them available in our office. No longer would the manual tooth brush work for these patients, they needed a Rota-Dent, the only powered appliance that has been clinically proven to remove plaque below the gum line and between teeth. Do I sell these, or include these in the therapy? At first we were giving the patient the option of purchasing the instrument. About half said yes, they were the ones who controlled their disease, got better and avoided surgery. The other half showed some improvement, but were always a problem to maintain and a great many were eventually referred to the periodontist. I finally made a commitment, every person going through the STM program, would automatically receive a Rota-Dent with proper instructions and the fee would be inclusive for the instrument? no exceptions. I adjusted my fee to offset the cost of providing the brush and the necessary medications the patient would need. This is dispensing?we properly charge for root planning, irrigation and any take home medicaments necessary, and have these products available and highly visible in our product center.

I also believed we needed some nutritional supplements in our product center. At one point we were doing the vitamin C lingual test (no longer available). All smokers were placed on Vitamin C therapy and every patient in our STM program were placed on 1000 mg of Vit C daily. The first bottle was included in the program, they purchased the others. We eventually added a complete nutritional/supplement line to our product center. My personal regimen included, anti oxidants, Vit E, multiples, niacin, Vit C, why not have these available for purchase in the office, I was ordering for family and myself. Why not have them for patients? The products I was using were reasonably priced and I felt a quality product.

Our practice did a great deal of tooth whitening. Patients would return for refills, a touch up kit or our special toothpaste we used for whiteners. We devoted a large area of our product center to whitening, with our own photos of smiles that we had actually completed in our office, not some posters from the beautiful people, who looked posed. So don't tell me you don't dispense.. if you are doing whiteners, and people pick up refill kits? you dispense. I do not feel it lowers your professional image at all. I suggest you ask your patients how they feel about you selling products, I bet they wonder why you are so far behind in the business world and haven?t done it long ago. Stop giving it away!