Gem Publishing October 2018

Gem Publishing October 2018

Blow the Roof off ‘Usual and Customary’ Dentistry, Part I By Dr. Tom “The Gems Guy” Orent

need $20,000 in dental care — you’d send new patients running to the hills. More often than not, dentists choose one or two teeth to treat cuz it’s easier than trying to convince an asymptomatic patient they need five figures’ worth of care. The patients seem happy, the practice still has recurring revenue, and you can keep the doors open another month. In the last issue, we discussed Gems’ mission: “Together we are dedicated to improving the health and longevity of 3,000,000 people, one smile at a time.” If we were to treat one tooth at a time rather than focusing on the overall best possible care for our patients, we would never accomplish our mission. BLAME THE ABSENCE OF SYMPTOMS Compromised care isn’t your fault. In addition to the meddling from managed care insurance, we also have to overcome a significant challenge every time we plan and discuss treatment… the fact that 95 percent of the care our patients truly need is CARE NEEDED in the ABSENCE of SYMPTOMS. Common issues indicative of stomatognathic deterioration often go untreated. Pathologic occlusion, muscle tenderness, excessive anterior wear facets, and posterior enamel wear are frequently missed. Many patients have even worn through their enamel into dentin. We must intervene. The good news is that you have proven-effective Gems at your fingertips to help you help patients… asymptomatic patients... perceive the immediate need for care. Accept recommended care. Site map GG12 Monthly Team Training Toolkit: “058 & 059 Worn Enamel Recognize and Treat Pathologic Occlusion, Add $50,000 to $100,000 Per Year, Part I & II” These two episodes offer you a gold mine of opportunity. My longtime friend and colleague, Dr. Buddy Mopper, InsidersCircle.com | 1-888-880-GEMS (4367) 1 Continued on page 2...

It’s time we REJECT “usual and customary” dentistry as “good enough.” The state of care in our profession is deteriorating because we’ve allowed it to be contingent upon (our perception of) our patients’ financial capabilities. Insurance companies set what they deem “usual, customary, and reasonable (UCR) fees” based on some FICTICIOUS number they pick out of a hat and then tell our patients it’s the norm in your zip code. Employers choose to pay for dental insurance plans with maximum limits capable of covering next to nothing. Meanwhile, we have real patients with real problems. It’s our obligation to rise above the usual and customary and deliver the extraordinary. We can only do that if we stop approaching dentistry from a reactive position and re- establish a doctor-patient relationship that fosters the level of trust necessary to help patients achieve optimal health. OBSTACLES TO RENDERING BEST-OPTION CARE What are some of the most common reasons patients don’t accept (reject) recommendations for care? Lack of money, insufficient time, fear of treatment. The absence of symptoms, and of course… the insurance quagmire. But what if insurance considerations, time, money, and fear were magically removed from the equation? What would be the best possible care for your patients’ long- term health? While this sounds great in theory, putting this into practice is more difficult in the real world. Many dentists are still delivering “one-tooth dentistry”… in the face of the (perceived) stranglehold of “Doc, just do what my insurance covers.” When a patient comes in for a checkup or cleaning, it’s much easier for them to accept that one tooth is a problem because insurance usually only covers $1,000–$1,500 a year. No one wants to hear that they

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2 InsidersCircle.com | 1-888-880-GEMS (4367) THE NEW PATIENT CASE PLANNING PARADOX If one-tooth dentistry doesn’t address the patient’s actual needs and telling the new patient about everything they need just scares them out the back door… then what can we do to RETAIN and actually HELP patients achieve the best possible long-term health? shared some of the very best Gems on this topic at “GICW 057 Mopper How to Perform and Get Paid for More Cosmetic Dentistry” and “GICW 095 Mopper How to Prep and Place Invisible Long-Lasting Cervical Restorations.” Pankey, Dawson, Kois, and Spear, all highly respected clinicians, taught us superior clinical methodologies that changed the course of dentistry. They addressed rehabilitative care in great depth. But a funny (not so much) thing happened between taking those courses and trying to get our patients to accept such high-level care. WHY NEW PATIENTS RUN OUT OUR BACK DOORS After completing some of the top rehabilitative continuum in our profession, I introduced a far more extensive new patient exam than I’d ever performed. Every new adult patient was scheduled for 90 minutes. I performed a TMJ ultrasound, not one but three DeLar bites, impressions, casts mounted in centric relation, Centri-Check to confirm centric on a Denar Articulator… a TMJ exam, measurements, muscle palpations, pterygoids check… Every single step of what the continuum told us to do, I did it. And at the end of the new patient exam, I’d ask them to come back in a week and to bring a spouse or loved one because (we were coached to tell them that). “Four ears are better than two.” If they came back, I presented them with recommended care for their whole mouth. More often than not, their response was often shock, disbelief, and something to the effect of, “My last doctor said I only need a filling, not $20,000 worth of work done.” One day, my office manager, Izabel, came to me with what I initially thought was a compliment. “Doc, since taking all these advanced continuums, you’ve become a much better clinical dentist.” This was a classic case of a woman speaking and the man having absolutely no clue what she actually said! I thanked her, to which she replied, “Not so fast. Look at this.” She handed me a piece of paper. On it was quite a long list of names. Izabel asked me, “How many of these names do you recognize?” Truth be told, some were familiar, but I didn’t recognize most of them. She continued, “This is a list of our new patients over the last year. Almost all of them have left the practice!” The continuums were terrific (clinically), but if you weren’t one of the superhuman doctors who taught them, deploying their suggested method of new patient exam and case presentation often caused patients to run out the back door. Of course, if you’re in the 1 percent who have the communication gift to consistently convince BRAND NEW ASYMPTOMATIC PATIENTS to get a full-mouth reconstruction (the moment you meet them)… then ignore everything from here on out. The other 99 percent should keep reading.

This conundrum reminds me of a time I was in the Midwest speaking at a seminar. That year, Reader’s Digest ran a scathing article about modern dentistry on their front page. The cover said “RIP OFF” in big, bold letters. The article cast a long, dark shadow on dentists, stating that we were routinely overtreating patients, by recommending and performing unnecessary care. They essentially secret shopped dozens of dentists across the country. Pretending to have just moved into the area, the writer asked each doctor to perform an exam and recommend a plan of treatment. Unbeknownst to these dentists, the writer says that his dentist at home told him he only needed two teeth treated. Meanwhile he got treatment plans across the country ranging from a few thousand up to $40,000. “60 Minutes” performed a similar hack job on our profession. I happened to have mentioned this during the seminar. During the lunch break, one of the attendees approached me and said, “Tom, about the Reader’s Digest story... I am that dentist featured in the article! I was the writer’s dentist.” I asked the doc what he had really diagnosed. “The whole thing is a lie,” he told me. “Sure, at his most recent exam, I told the writer he only needed one crown and a filling. But for the longest time, I told him he was going to lose teeth. What he really needed was a full-mouth reconstruction. He had refused treatment for years. The minimal treatment he said was the plan recommended by his real dentist was nothing more than emergency recommendations to put out the worst couple of fires.” HOW TO KEEP THE NEW PATIENT AND DELIVER BEST- OPTION CARE You may have heard me speak about the Mercedes study. Mercedes-Benz wanted to know how many positive interactions with a new client, customer, or patient it takes before they are ready to hand over a significant amount of money. The result? They found it takes 5–7 positive interactions with a new client, customer, or patient for them to consider a big purchase. The bottom line? When meeting most new patients, especially those who haven’t experienced symptoms and have NO CLUE regarding their true dental needs… it’s JUST TOO SOON to tell them all about what they need. During most asymptomatic new patients’ first few visits to your practice, there is INSUFFICIENT RELATIONSHIP AND TRUST for you to consistently achieve high levels of acceptance of high-dollar recommendations for care. IS IT ETHICAL (EVEN CREDIBLE?) TO NOT TELL THEMWHAT WE SEE? This is truly a (multi) million-dollar question. In our next issue of “New Frontiers in Dental Practice Success,” in Part II of this article, I’ll not only answer this question… I’ll also reveal in explicit detail exactly how you can RETAIN the highest possible number of new patients and achieve consistently high acceptance of your very best possible recommendations for care.

“Together we are dedicated to improving the health and longevity of 3,000,000 people, one smile at a time.”

Minimally Invasive Maximum Profit Dentistry

The Artful Genius of Dr. Buddy Mopper

Imagine being so adept at what you do and loving it so much that after 50 years at it… you’re still practicing! Dr. Buddy Mopper is one of the most gifted, talented, hard-working clinicians and mentors in our profession. I had the good fortune of meeting Buddy nearly 30 years ago through the American Academy of Cosmetic Dentistry. Buddy was one of the founding members of the AACD and one of the earliest members to achieve AACD accreditation. As one of my first mentors in esthetic dentistry, Buddy played a large part in inspiring me to devote more than two years to becoming accredited by the AACD, and to subsequently devote six years as an accreditation examiner. Dr. Buddy Mopper doesn’t need to be practicing dentistry into his 80s. In addition to being one of the most successful esthetic and restorative dentists in the world, Buddy co-founded Cosmedent Corporation. Buddy continues to see patients and mentor us through webinars and seminars solely because of his passion for his artful deployment of our science. 50 YEARS OF EXPERIENCE EXTENDING THE LIFE AND BEAUTY OF DENTITIONS One of the most commonly overlooked (neglected), insidious problems contributing to the demise of patients’ dentitions is pathologic enamel wear secondary to diminished or lost anterior guidance. The problem with which this patient presents in Buddy’s case below is all too common. The patient’s mandibular incisors have worn through the incisal enamel, exposing dentin. The remaining incisal enamel, “cupped” and unsupported, is subject to ever rapidly increasing deterioration. Left untreated, this patient would potentially be facing root canals and most likely four anterior mandibular crowns. As Buddy says, nobody wants to prep a mandibular incisor for a crown!

Before and after photos and dentistry by Dr. Buddy Mopper

Put yourself in the place of this patient. If these were your teeth, which of the following would you want your doctor to do?

A. Wait and do nothing until the only alternative is massively more expensive, extensive, and destructive

B. Remove all the labial enamel and a couple millimeters of the incisal enamel… prepping for and placing porcelain veneers; or… C. Minimally invasively remove as little remaining tooth structure as possible, and then prep, etch, and rebuild the incisal edges with direct resin bonding (as shown in the photos) The answer is obvious, and yet cases just like this — some not quite as advanced, others far worse — present to dental practices every day, often leaving the visit with no recommendations for care. We (here on Planet Gems!) can and should take a stand. It’s not happening at our practices on our watch. Show these photos to your entire team and alert them to the fact that this is NOT NORMAL — when enamel wears like this, it’s the sign of a PATHOLOGICAL OCCLUSION. We need to restore the worn enamel and rebuild the anterior guidance in order to protect the patient from further loss. Remember our mission: “Together we are dedicated to improving the health and longevity of 3,000,000 people, one smile at a time!” EXACTLY HOW SHOULD YOU RESTORE THIS CASE? As members of our Gems Family, you and your team have the opportunity to watch Buddy restore this case. You’ll get to listen to Buddy as he talks about the rationale for treatment,

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InsidersCircle.com | 1-888-880-GEMS (4367)

FROM LEAD MAGNET TO CONVERSION If online marketing is your vehicle for new patients, then your website is the garage. A patient’s journey with your practice starts and ends with your website. Even with this understanding, many dental practitioners can’t tell you anything regarding their web presence. They don’t know their demographic, how many leads they are getting from it, or how to use it for marketing. Which brings us to our first Gem. Hiring someone to manage your website is a great place to start if you feel intimidated by the mechanics or time investment required. From there, you can have that team member set up what we call a lead magnet. I like to start with a free giveaway, such as an e-book, brochure, checklist, or cheat sheet — some marketing material that adds value to their lives. For example, when a potential patient logs on to your website, you can have a “10 Things You Should Know Before Implant Treatments” article. From that article, you can capture that person’s email address and add them to your >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10

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