Archive for the ‘Practice Management’ Category

It’s a Two-Way Street! Dental Practices and Patient Working Together For The Best Outcome

Tuesday, July 7th, 2015


By: Virginia Moore, Moore Practice Success

We’ve probably all been in the position of being a patient and been kept waiting past our appointed time. Frustrating, isn’t it? We’ve all had that experience of having to pay for something necessary when we’d really like to spend our money on something “fun”.  In both those situations, whether you are the provider of the service, or the recipient, you can work to make it as pleasant an experience as possible.

 Staying on Schedule

Dental Practice:

  • As a dental team, agree on appropriate amount of time to allocate to different procedures. This gives you the best approach to staying on time.
  • Start your day on time. After the morning meeting, make sure patients are seated in the dental chair at their appointed time, not 5-10 minutes later.
  • If you routinely have 3 or more emergency patients each day, consider blocking time in the schedule. If less than, in the morning huddle have the clinical team determine best time for emergencies to be seen.


  • Honor your appointed time. Barring an emergency situation, keep your appointments. Your good oral health depends on it!
  • If you need to make an appointment change, give at least 48 hours notice. This allows the practice to accommodate another patient who has treatment needs.
  • Arriving early can give you the time to relax, check emails, and in many practices, have a refreshment. Relaxed is a great way to start your appointment!

Financial Agreements

Dental Practice:

  • Always discuss the financial aspect of treatment before providing treatment. No one likes a surprise, especially a financial surprise!
  • Consider partnering with a third-party finance company that can offer your patients a longer period of time to pay (and sometimes, for a very low/or no-interest rate).
  • Whenever possible, discuss financial matters in the most private setting. None of us like having to share our financial concerns with more people than necessary.


  •  Be upfront. Let the financial person know what you can commit to when discussing finances. None of us want to commit to something we can’t fulfill.  Ask about payment plans, savings for payment in full before treatment, or how treatment may be phased.
  •  Nothing’s for free! In over 25 years of consulting I’ve never seen a dentist’s fees that aren’t in keeping with their overhead. Most dental practices have significant overhead when you consider they are essentially a self-contained hospital; expenses of personnel, supplies, equipment, facility, lab, etc.
  •  If you are fortunate enough to have dental insurance, remember that it is not designed to cover all your dental needs. In fact, most annual dental benefit amounts are provided to maintain an already healthy situation. In other words, if you have dental needs that have been delayed, you will most likely have expense beyond your dental benefits.  When you think about it, it will be some of the best money you ever invest.  Your teeth and mouth work 24/7!

Working together is the key to the best outcome for all involved.

Here’s to the outcome of great dental health for all!


MooreMs. Moore has been bringing greater productivity and profitability to general dental and periodontal practices thru her consulting practice for the past 20 years. As a speaker, she has presented at the top dental meetings in the U.S. and has spoken at meetings in Canada, the Middle East and Asia. Ms. Moore is a contributor to ADA’s newest publication Expert Business Strategies, is a regular contributor to ADA’s Dental Practice Success, as well as authoring 2 books and co-authoring 8 books on practice management. Her passion is getting results that further the success of dental practices. Ms. Moore is a graduate of the ADA KEMP for dentists. She holds membership in the National Speaker’s Association and is a member and Past-President of Academy of Dental Management Consultants.


Dental Practice Employment Law Update: After Measure 91, is Marijuana Just Another Legal Drug?

Monday, April 6th, 2015

By Randall Sutton, Saalfeld Griggs PC

Reliable and productive staff is the backbone of every dental practice. It is well known that substance abuse problems can interfere with work. Unreliable attendance, lack of focus, and poor decision making are common outcomes of staff substance abuse. For these reasons, many dental practices find it critical to maintain a drug-free workplace.

With that in mind, it should come as no surprise that the legalization of marijuana for recreational use poses new challenges for dental employers. If the experiences of Colorado and Washington are any indication, Oregon is likely to see a significant increase in the number of employees testing positive for marijuana.  In the year following legalization in both states, positive tests increased by over 20% according to a recent study by a national testing lab.  Moreover, the decriminalization of marijuana and resulting drop in prices, combined with tightened controls on prescription drugs, has led to a surge in the manufacture and importation of heroin into the United States from Mexico.  Given the level of dependability, skill and professionalism required of dental staff, these developments make an enforceable drug and alcohol policy and testing program more important than ever.

The recent change in the law has also brought changes to perceptions and expectations about marijuana use, particularly on the question of whether the drug should be subject to looser regulation by Oregon employers. As of July 1 of this year, marijuana will join alcohol as the only legal intoxicants that can be used recreationally. Given the significant change in the you’re your staff may erroneously anticipate that marijuana use will be treated the same as alcohol use. Under Oregon law, a dental practice cannot test for alcohol use unless a trained individual determines that the staff member is presently (and visibly) under the influence. Similarly, staff may believe that after July 1, 2015, they may use recreational marijuana away from work so long as they do not appear to be under its influence while at work.

However, testing protocols and Oregon employment laws treat marijuana very differently than alcohol, and the new law allowing recreational use does nothing to change that.  Marijuana is fairly unique among the drugs typically included in an employment-related test panel.  Unlike other drugs, which leave one’s system in a matter of hours or days, THC (the active ingredient in marijuana) is stored in fat cells in the body and tests may be positive even weeks or months after the staff member’s last use.  Second-hand smoke can also trigger positive results, but testing cutoff protocols are intended to screen out results that arise solely from spending time around pot-smoking friends or colleagues.  In any event, marijuana is unlike alcohol because there is no recognized test to determine whether your staff member is presently impaired by marijuana.

Not only are testing protocols different for alcohol and marijuana use, but Oregon laws treat them differently—even after legalization of recreational marijuana. Since Prohibition ended in the 1930s, alcohol has been legal at the federal level.  In contrast, marijuana continues to be illegal under federal law.  For employers, this distinction is critical.  Given that federal law continues to identify marijuana as a Schedule I controlled substance with no accepted medical use, the Oregon Supreme Court held in a 2010 decision that Oregon employers can enforce zero tolerance policies, even against authorized medical marijuana users. Measure 91 does little to change that holding, as the new law specifically does not “amend or affect in any way any state or federal law pertaining to employment matters.”

In other words, Measure 91 does not require that you abandon zero tolerance drug and alcohol policies or make significant changes to testing protocols. But, in light of changing perceptions about the drug, we recommend that our dental clients update their policies to address the issue of recreational marijuana use and make it clear that the drug is still illegal under federal law and prohibited under the practice’s drug and alcohol policy.

This is also a good time to ensure that your drug and alcohol policy strictly complies with the myriad of complex drug testing legal requirements.  In Oregon, there are restrictive regulations governing whether or not a termination resulting from a positive drug test affects the staff member’s ability to collect unemployment benefits, and it can be challenging to win unemployment appeals if the practice’s policy is not sound and all regulations are not followed. For these reasons, dental practices should work with employment counsel to review and update their drug and alcohol policies before recreational marijuana is decriminalized on July 1st.


Randall Sutton_Saalfeld GriggsSaalfeld Griggs PC is a law firm serving dental practices throughout Oregon and Washington. Randall Sutton is the partner in charge of the firm’s Employment Law and Litigation Practice Group.  He advises dentists on a wide variety of employment matters and represents dental practices in litigation.

Global Diagnosis In Dentistry

Monday, January 12th, 2015

By William Robbins, DDS, MA

With the increased emphasis on interdisciplinary treatment in recent years, the deficiencies associated with traditional methods of diagnosis and treatment planning have become more evident and problematic. Many years ago when I was in dental school, I learned to gather a lot of information about the patient and then sit down and make a treatment plan. Dentistry was much simpler in those days. In a complex patient, the treatment plan was primarily dictated by information provided by study casts which were mounted on a sophisticated articulator in centric relation. At that time in history, the primary tools available for treating the complex restorative patient were functional crown lengthening surgery and increasing the vertical dimension of occlusion. The treatment plan was simply based on restorative space, anterior tooth coupling and resistance and retention form of the final preparations, with no focus on placing the teeth in the correct position in the face.  Practitioners did not have access to advanced periodontal, orthodontic, orthognathic surgery and plastic surgery tools that are currently available. With the advent and common usage of these new treatment modalities, the historical method of diagnosis and treatment planning is no longer adequately serving our profession. This style of treatment planning is only effective when prescribing single tooth dentistry. When the case becomes more complex, the old style of treatment planning doesn’t tell the dentist where the teeth and supporting structures fit into the patient’s face.

Global Diagnosis is a treatment planning strategy that guides the dentist through the process of diagnosing and sequencing an interdisciplinary treatment plan. It provides a systematic approach to diagnosis and treatment planning the complex interdisciplinary dental patient with a common language that may be used by the orthodontist, periodontist, and oral and maxillofacial surgeon, as well as the restorative dentist.


Robbins photoDr.  Robbins maintains a full-time private practice and is Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School.  He graduated from the University of Tennessee Dental School in 1973.  He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas and a 2-year General Practice Residency at the V.A. Hospital in San Diego, California.  Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects. He coauthored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach.  He is a diplomat of the Federal Services Board of General Dentistry and the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and is currently president of the American Academy of Restorative Dentistry.

How To Rank High on Google

Monday, October 7th, 2013

By Ian McNickle, MBA


Have you ever wondered why some websites rank higher than others? It’s a really common question. The world of online marketing can be very confusing and hard to understand. The goal of this commentary is to explain how it works, and what you can do to improve your website ranking.

How Do Search Engines Work?

Google and other search engines rely on very complicated and frequently changing algorithms to sift through millions of websites to determine which websites should rank higher than others for given search terms. Amazingly this happens in a fraction of a second.

Since Google is by far the largest search engine with about 65% of all search volume we’ll focus on them for our understanding. Google’s search algorithm has over 200 variables that it looks at to determine where a website should rank. Fortunately many of these variables are somewhat understood, although the algorithm changes often.

Search engines read a website like we read a book. As it reads your website the algorithm is looking for dozens of specific items in the code and content to help it understand what the website is about, what each webpage is about, and how important the website is compared to other websites.

In addition, search engines look at incoming links to help determine how important your website is. An incoming link is a link from another website that links back to your website. For example, if the ADA had a link on their website that linked back to your website that would be considered an incoming link for your website.

What Can You Do?

With the experience of optimizing hundreds of dental websites we have learned what works, and what doesn’t. The following items should help your website improve its search engine ranking. It is worth noting that densely populated areas like Seattle and Portland are very competitive, but these strategies should improve any website’s ranking for search terms.

  1. Unique Content – If your website was purchased through a high-volume website company then most likely it is template based, and has duplicate content. The problem with duplicate content is that search engines penalize websites with content that is the same as other websites. If you rewrite all your content to make it unique your rankings will improve.
  2.  Individual Pages – Most dental websites have an overview page with dental services such as a Cosmetic Dentistry page with a list of those services. This is ok for website readers, but bad for search engines. When Google looks at a webpage it attempts to determine what the topic of that page is about. If a page lists two or more topics then they basically cancel each other out, and the page ranks poorly for all terms. Make sure your website has individual pages with unique content for each dental service topic and your website rankings will improve.
  3. Site Map – A site map tells the search engines where all your webpages are located. About half of all dental websites do not have a site map which definitely degrades the website’s ability to rank well. If your website does not have a site map, then have your webmaster add one immediately.
  4. Incoming Links – One of the most difficult things to do is build incoming links to a website. When it comes to incoming links the more the better. Links from other dental websites are better than non-dental links. Links from high traffic websites are better than low traffic websites. Most dental websites have fewer than 10 incoming links, but ideally you should have at least 50 to 100 (or more depending on your competition). Take some time each month to ask other websites to link back to your website.
  5. Code Issues – Search engines look at website code to understand everything about your website. If your code is not properly optimized (title tag, meta keyword tags, meta description tag, alt tags, header tags, etc), then your website has little chance of ranking well. A web developer well versed in code optimization is critical when constructing a dental website.



Ian McNickle is a Partner at WEO Media where he leads their sales, marketing and business development activities. Ian has developed significant expertise in online marketing, search engine optimization (SEO), search engine marketing (SEM), social media, and online reputation management. Ian speaks nationally to dental societies, study clubs, and conducts numerous seminars and webinars on these topics. Ian brings over 17 years combined experience in technology, sales & marketing, business development and operations. Ian has a BS in Mechanical Engineering from Washington State University and an MBA from the University of Washington.

If you have questions or would like a free analysis of your website, please contact Ian McNickle at WEO Media. Email:  |  Phone: (503) 708-6327  |


Stress Relief: I’m Outta my Mind, So Feel Free to Leave a Message

Tuesday, September 3rd, 2013

By Kelli S. Vrla 


Never fails: after I tell a passenger seated next to me I teach stress-relief seminars, my luggage is lost when we land. She smiles at me and asks, “What are you gonna do now, Stress Lady?” I do what I always do: smile and breathe deeply- several times.

Some folks are convinced that stress is still good for you. Here are a few reasons I’ve heard on why you should stay stressed

  • It helps you seem important.
  • It helps you keep your personal space and avoid intimacy.
  • It help you avoid responsibilities.
  • It gives you an adrenalin rush.
  • It helps you avoid success.
  • It help you keep that authoritarian style you love so much.

If you buy into this theory, here are a few ways to stay stressed:

  • Eat anything you want.
  • Gain weight.
  • Take lots of stimulants.
  • Personalize all criticisms.
  • Toss your sense of humor.
  • Become a workaholic.
  • Toss food time management skills.
  • Procrastinate.
  • Ask stupid questions…repeatedly.
  • Worry about things you can’t control.

Granted, some stress is good – if it kicks you into high gear. Yet, if you want more stress-free days, you have to create a new set of habits. Not all your days will be perfect, yet it’s a good start to a more balanced life with better health.

Here are a few stress-busting habits to try:

  1. Expect the unexpected and be ready to roll with it. Most of us are married to a certain outcome: how a person will act of react, whether our plane arrives on time, or when we will receive that report we requested. If we are ready for any outcome, we can quickly roll to Plan B in the event that our original wish list did not come true, So, instead of being married to an outcome, think of it as a “prenuptial agreement” with flexibility.
  2. Mentally rehearse a Plan B. Adopt an adaptable mindset. Make adaptability a part of your daily routine. Think of yourself as a Ninja Warrior in a video game with obstacle whizzing at you. To win the game, you have to quickly fend off and move onto the next level, always moving forward, getting ever closer to finishing the transaction at hand. Entertain different scenarios, much like an airline pilot would in the event you lose an engine. Visualize what you would do if the day completely fell apart. You will be more ready to take on scenarios you have previously thought about, rather than avoiding them altogether.
  3. Neutralize any situation with these magic words: “That’s interesting.” This evokes a mindset of curiosity, not of position. Instead of polarizing your thoughts into good or bad, it allows the neutral frame of reference. When times are tough, you need to get out of your emotional, knee-jerk response mode and immediately go into a problem solving flow. Your body will follow the mindset you initiate.
  4. Accept the rhythms of your business. All days cannot be perfect, nor cal all days be the absolute worst. To quote one of my favorite bumper stickers, “Some days you’re the windshield; some does you’re the bug.: Relish the good times and treat the challenging times as moments for growth. If you’re not uncomfortable, you’re not growing- and may be coasting. Don’t let your mind get stagnate.
  5. Hang out with adaptable, less-stressed folks. Know people who seem well adjusted and non-plussed by life’s curve balls. Watch them and see how they handle little surprises. If you were to write a short report on their observable actions, what verbs would you use? This is a  key to understanding good modeling survival behavior.
  6. Practice Stress-Busting Phrases. If you face a potentially stressful situation, try on of these forward thinking phrases:
    1. What’s Plan B?
    2. 100 years from now, all new people.
    3. At least we don’t work for Enron (or Martha Stewart, Inc…fill in your fave)
    4. Things could be even worse!

What will you do differently this year to make a difference in your professional and personal growth?

Some stress is good. Harness your good stress and work on getting rid of the bad stress. You’ll soon be on the road to stress relief, and no one will have a clue why you’re smiling the next time you’ve lost your luggage.


VrlaKelly Vrla is a Rockies-based Leadership Consultant and Keynote Speaker and a Road Warrior for Humor in the Workplace. Her festive deliveries help you people have more fun and get more done. She can be reached for keynotes and workshops at or email 214-987-HAHA(4242). Stay light and practice, practice, practice!


Avoiding Organized Dentistry to Save Money on Dues—Think again!

Monday, August 5th, 2013

By: Vanessa Browne, DDS

ODA logo (color)

With the continued rise of educational debt, many dental students are graduating with difficult financial decisions to make. The job market is saturated, many are getting married and starting families, high monthly loan payments are around the corner, and many also are craving delayed gratification for eight or more years of very hard work. It is natural, then, for some to make the decision to delay all unnecessary costs. For some recent graduates, the choice has been to forgo membership in the American Dental Association, the Oregon Dental Association, and their local dental society as a means to save money as they are establishing themselves in the dental community. However, I believe this is the worst choice that a new dentist can make. The benefits of being a member of our dental societies far outweigh the cost.

Dental societies function as a tripartite membership. This means when you become a member, you hold membership at three levels: the national level (American Dental Society), the state level (Oregon Dental Association), and the local level (Oregon has 17 local dental societies). More than 71% of Oregon’s dentists belong to the ODA. While this is an impressive number, the opposite number is staggering. 29% of dentists in Oregon are practicing without the support, network, protection, community, and education that being a dental society member provides. I believe that joining your dental society is a commitment to continued growth as a professional.  Here are just a few ways that organized dentistry can help you:

Peer Relationships

Upon graduation, many new dentists begin working and sometimes lose connections with classmates and the dental community. This is understandable as starting a practice, joining a practice, or becoming an associate is a time-consuming process. However, this is a missed opportunity to seek advice from mentors, learn practice management and clinical techniques from peers, empathize or share experiences among colleagues, and network for leadership, professional, or career opportunities. There are over 2,100 dentist members in the ODA, and 9 staff at ODA working to help provide information, answer questions, and support the profession.


 A portion of the dues paid to the dental societies goes to supporting and protecting the profession. This includes lobbying for specific dental issues. A few of the recent issues facing dentistry include eliminating national license testing with a push toward portfolio licensure for dentists, educating legislators about the negative effect the new medical device tax will have on the cost of oral health care, impeding insurance companies from dictating rates for treatment that insurance does not cover, and providing alternative solutions to the proposed mid-level provider model.

Serving the Community

Being a part of the dental society gives dentists many opportunities to give back to the community. Not only does organized dentistry help educate the public about oral health and the importance of seeking dental care, but it also serves to advocate for changes such as water fluoridation, increased funding for research, dental care for underserved populations and public health initiatives, and increased insurance coverage for dental services. Beyond this, there are opportunities for dental professionals to volunteer in the community through events like Mission of Mercy (November 24-27, 2013) and Give Kids a Smile (February).


Every dental society hosts at least one conference a year with a collection of continuing education courses and a vendor showcase with member discounts. Also available throughout the rest of the year are additional continuing education courses, leadership training, and numerous publications. The Oregon Dental Association publishes its newsletter “Membership Matters” and this blog “The Tooth of the Matter.” The American Dental Association has its own journal “Journal of the American Dental Association” and newsletter “ADA News”. Beyond education for members, these dental societies also provide numerous public health resources and patient education tools that can be used in your office.

Career Protection

Dental societies offer three specific resources for career protection: Insurance for your personal and practice needs, peer review, and a well-being committee. The ADA sponsors life and disability insurance plans at a reduced rate for members. Other dental societies also endorse malpractice insurance companies and other necessary insurance providers. Peer Review is a process by which patients and third party payers can voice concerns or disputes that are resolved by a collection of your colleagues. This allows the dentist and patient to have dental care evaluated in a non-combative environment at a local level. These issues are often resolved at this level and do not have a need to progress to a lawsuit. The Well Being Committee offers dentists who struggle with alcohol and controlled substances an opportunity to get back on track without losing his or her license.

Practice Support:

The ADA and ODA have endorsed programs of products or services and often offer discounts to members. All of the dental societies also have several opportunities to seek employment or place classified ads. These are sometimes the first place individuals will look. Both the ADA and ODA help with patient referrals by listing your practice information on their websites and when patients seek dental care in a certain area, the staff will refer to its members. Additionally, the ADA has a professional product review that provides unbiased dental product information that is scientifically sound, clinically relevant, and user friendly. The ADA also has a center for Evidenced Based dentistry that provides research and gives you access to systematic reviews. Using both of these resources, organized dentistry allows dental professionals to make informed decisions about their practice.


So How Much Will This Cost You?

The dental societies realize that new dentists are graduating with enormous debt loans.  To decrease the burden of membership dues, the American Dental Association and most dental societies structure their dues on a graduated scale over 5 years. Usually, membership in the first year in practice is free. This means that even if you don’t know where you are going to practice, it is beneficial to join to have access to this wealth of resources. At the national level, dues are 25% of full national dues your 2nd year in practice, 50% your 3rd year in practice, 75% your fourth year in practice, and 100% your fifth year in practice. State and local dental societies have a similar system. There are also member get a member discounts to encourage dentists to invite their colleagues to join. Depending on your location, full dues for tripartite membership by your fifth year vary from $900 to $1,800. Students who pursue graduate training also have a reduced rate of $30 for national dues and begin the reduced dues five-year program when their graduate education is complete.

Convinced Yet?

Being a member of organized dentistry can lead to career opportunities, referral connections, educational opportunities, practice management support, risk management answers, reduced rates on endorsed products, unbiased and scientific information on clinical products, support at the legislative level, license protection with peer review, social opportunities, and more. The small cost of membership is worth a lifetime of benefits.

How Do I Get Involved?

The best way to get involved in your dental society is to visit the websites and read the newsletters for upcoming events. It is best to start with your local dental society. Look for New Dentist events, Continuing Education courses, opportunities to be a mentor/mentee, or upcoming conferences such as the Oregon Dental Conference or the American Dental Association New Dentist Conference. There are also numerous opportunities to volunteer with events like the ODA Mission of Mercy (November 24-27, 2013) and Give Kids a Smile (held annually in February).

Check out the following website for more information:


IMG_6409Vanessa Browne, D.D.S, is a 2012 Loma Linda University Dental Graduate who is currently in her orthodontic residency at Oregon Health and Sciences University in Portland, OR. She is a member of the California Dental Association, the Oregon Dental Association, the American Dental Association, the American Association of Orthodontists, and the Pacific Coast Society of Orthodontists. As a dental student, Vanessa held numerous roles as a leader in organized dentistry including the chair of the California Dental Association student delegation. She is passionate about encouraging dental students and new dentists to join organized dentistry. You can contact her at

It’s Really Just a Conversation! 5 Easy Steps to Help Your Team Resolve Conflict!

Monday, May 6th, 2013

Head in the sand

By Judy Kay Mausolf

Unless you live in some remote jungle or under a rock and only work with plants you will probably interact with lots of other people during your lifetime.  The people I am talking about are not the strangers you make brief eye contact with for a second or pass in a hallway.  I am referring to the people you consistently interact with on a daily basis.  Your success depends greatly on these relationships!  Life would also be much more enjoyable if conflict did not exist between you and them.  But that isn’t real life!

The problem is that many of us go thru life trying to avoid dealing with conflict out of fear!  We hope it will just go away!  But the more we try to avoid it the more it builds until eventually it escalates to a point to where there is serious damage to the relationship.

Our fear of conflict is the problem, and it seems bigger the more we dwell on it.   Here is the funny thing… fear is really only a negative prediction about the future and not reality.  Whether or not we take action is governed by a simple ratio: our perception of danger versus our confidence in our ability to handle the conflict.

If we believe we can resolve the conflict, the amount of fear we feel is minimized and we will take action.  This is why it is so important to teach our teams the mindsets and skill sets they need to give them confidence that they can handle conflict.

The first step is to start with our mindset about conflict!  If we tear it apart; conflict is really just conversation where there is a disagreement because of a difference of opinion or expectation!  So what is so scary about talking about a difference of opinion or expectation?  We can eliminate the negative emotional energy from the conversation by coming from a place of care and concern instead of judgment and criticism.

Next step is the skill sets!  The following 5 step process will give our team the skill sets they need to successfully resolve conflict.  It will change the focus of the conflict conversation from who did what wrong to what we can do in the future!

Here are 5 easy steps to help your team resolve conflict!

  • Set up time to meet with the person you have a concern or conflict (they may not have time right at the moment) and don’t tell anyone else!
  • Be open and listen; don’t come to the table with the solution, you don’t know the why behind their reasons.
  • Don’t personalize; instead of saying you did this, say I am not sure what you meant by…or can we talk about what happened today?  Talk about the situation and not the person.
  • Focus on the solution, what can be done to prevent in the future versus who did what wrong.  It will not be perfect for anyone, but can be good for everyone.
  • If you can’t resolve; all team members involved meet together with whoever handles conflict resolution and agree on a solution.

It is so important to teach our teams the mindsets and skill sets they need to give them confidence that they can handle conflict.

Ta-dah!  Conflict resolved now onto more enjoyable relationships!

Mslf_006 - Copy

Judy Kay Mausolf owner and president of Practice Solutions Inc, is a dental practice management coach, speaker and author.  She coaches dentists and managers who want to grow their practice by becoming better leaders, getting their teams to work together better, communicating more effectively and creating a practice environment they enjoy coming to! She is President of National Speakers Association Minnesota Chapter, member of the National Speakers Association, Academy of Dental Management Consultants, Speaking Consulting Network.  She is author of Rise & Shine; An Evolutionary Journey to Get Out of Your Way and On Your Way to Success, and a contributing author for many dental magazines.  She also publishes a monthly newsletter entitled “Show Your Shine”.

The Ethical Case for Confidentiality

Wednesday, March 6th, 2013

By Gary T. Chiodo, DMD, FACD and Phyllis Beemsterboer, EdD


All health care providers are well-aware of the legal protections extended to patient information via the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.  With few exceptions, all information that patients provide to us in the form of their medical history and all data related to the care we deliver to them are protected by the HIPAA rules and may not be released to any third party without patient consent and authorization.  While HIPAA may impose strict legal parameters on how patient information must be protected and how it may be released, there are ethical obligations that provide even more persuasive arguments for the bond of doctor-patient confidentiality.  These ethical obligations are based in the ethical principles of respect for autonomy and nonmaleficence.

Respect for autonomy is the ethical principle that allows, with few limitations, patients to determine what will and will not be done to their bodies.  In normal health care practice, patient autonomy is facilitated and respected through the process of informed consent.  The well-informed patient who has capacity to consent has the right to select from various treatment options, the treatment or treatment plan that is most concordant with his/her values and wishes.  Because the informed consent process is essential in this dynamic, health care professionals must collect and analyze complete information about the patient.  For example, surgical options for repair of a periodontal defect may very well change if the dentist knows that the patient has a bleeding problem.  Plans to remove teeth may be mitigated by a history of bisphosphonate therapy.  In cases like these, patient autonomy cannot be truly facilitated and respected unless the dentist has complete and accurate information about the patient’s medical conditions and history.  If the patient is not entirely comfortable with complete disclosure because he/she doubts that confidentiality will be respected, then important information may be withheld.  When this happens, not only will the patient’s autonomy be compromised, but the dentist’s obligation of nonmaleficence, or avoiding harm to the patient, will be in jeopardy.  While most patients would not be reluctant to reveal a bleeding problem or a history of bisphosphonate therapy, some may hesitate to reveal things they consider to be embarrassing or intensely personal.  For instance, the patient who is receiving treatment for mental health issues or chemical dependency may opt to omit that from the medical history out of concern that it will not be treated with strict confidentiality.  The male patient who is using a phosphodiesterase-5 inhibitor on occasion, may decide to leave that out of his medical history so he does not need to worry about who may have access to that information.  A young woman who takes a hormonal contraceptive may decide that her dentist simply does not need to know that.  While we are well-aware of the potential harms that may come to patients when we do not have complete medical information, patients are less likely to appreciate those harms or, if they are aware of them, may simply decide to keep the information private and accept the risk.

Part of the challenge in obtaining complete and accurate medical information from our patients comes from making sure they understand why we need this information and this process takes chairside time.  However, another important part of the challenge is in ensuring that they trust us to keep it strictly confidential.  If we are not successful in creating that trust, critical information may be withheld and we will not be able to meet our ethical obligations of respect for autonomy and nonmaleficence.  In the best case scenario, breaching confidentiality will result in a patient who feels betrayed and goes elsewhere for care.  In the worst case scenario, the patient will develop a lack of trust in other health care providers, will withhold vital information, and will be seriously harmed.  If we emphasize the protections that we afford their personal information and assure them that they may trust us to keep it strictly confidential we are honoring our ethical principles and serving our patients best.



Gary Chiodo, DMD, FACD is currently the interim dean at OHSU School of Dentistry. Most recently, he served as the Chief integrity Officer for OHSU, a position he held for 10 years. He is a professor of Community Dentistry and Association Director of the Center for Ethics in Health Care. Dr. Chiodo received his Certificate in Health Care Ethics form the University of Washington School of Medicine in 1992.




Phyllis L. Beemsterboer, MS EpD, FACD is a Professor and Associate Dean for Academic Affairs in the School of Dentistry at OHSU in Portland. She is and associate director in the Center for Ethics in Health Care at OHSU and co-chairs the inter-professional ethics education program. Her research interest is in bioethics education and she is currently president of the American Society For Dental Ethics, a special section of the American College of Dentists.

Does Botox Have a Role in Dentistry? Yes!

Wednesday, August 22nd, 2012

By Dr. James Catt

Does Botox have a role in dentistry?  This was what I was determined to discover when I registered for my first introductory Botox course.  The course was instructed by Dr. Warren Roberts from the Pacific Training Institute for Facial Esthetics (PTIFA) in Vancouver B. C. .  I was drawn here because of its recognition by both ADG PACE and ADA CERP as well as this being the most thoroughprogram that I could find. I was in search of answers, not a diluted course that spoon fed material and handedout a flowchart of “how to’s”.  I needed both a didactic and clinical perspective in order to arrive at a sound judgment on the practicality and safety of the possible utilization of Botox in my practice if Oregon were to allow dental professionals access to this therapy.  PTIFA fulfilled this requirement for me.

Admittedly, prior to attending the training I had some pre-existing bias on two levels.  Apprehension of the drug’s effects and unwanted clinical outcomes made up the bulk of my bias.  In addition, understanding the psyche of the patients who seek this type of therapy also added to my unease.  The latter was less of an issue since I learned multipleclose acquaintances evidently received Botox therapyregularly provided by individuals who at first glance appeared to have fewer head and neck anatomy credentials then I.Also, all of these acquaintances seemed like normal people and their outcomes were as expected.  In reality, it was only due to my close relationship with them and their voluntary divulging of this informationthat I had any idea they had received treatment at all.  So the question lingers; how does Botox apply to dentistry?

In short, the education that I received allayed my misgivings concerning Botox.  Let me repeat that.  The educationallayed my misgivings concerning the safety and utilization of Botox.  I’ve since taken an additional 16 hours of continuing education from PTIFA (totaling  32 hours) which focused on specific dental applications and hands on exercises.  There is absolutely no question in my mind that this treatment can provide dental advantages.  The next question would pertain to who specifically should be providing the therapy for dental applications.

In making my assessment and attempting to answer this question, I began to systematically review what my particular “job” as a dentist currently entails.  My “job”, as I would describe it, may be quite different then my dental colleague’s “job” who practices next door if he were to describe his own duties.  We are both D.M.D.’s, obtained our degrees from the same dental school and we are both required to meet the same standard of care.  However, he may state that his “job”entails extensive endodontic and pediatric treatment.  Theoretically, in these cases, I may state that my “job” is to schedule these patients with a great specialist.  My colleague has taken additional training and provides a high level of care in these cases that I don’t necessarily feel comfortable becoming involved in.  The converse may also be true.  After dental school I chose to pursue a greater level of understanding of occlusion.  I began a four year post graduate path that ultimately provided a competence in treating complex occlusion cases.  Coincidently, often times, this therapy helps with head and neck pain.  My colleague may not report this as one of his “job” objectives.  We are both working within our scope but our focuses differ.  I believe that it is well established that while working within our scope the discretion of what services we provide is based on our education.  Likewise, one practioner’s voluntary dispassion for a type of dental procedure does not, nor should it ever, preclude other practioners from focusing on this said procedure as long as it’s within the scope of dentistry.   Which dental professionals should be allowed to administer Botox for dental purposes?  The answer is the dental professionals who have taken advanced Botox training for dental purposes.   Dental purposes include, but are not limited to, muscle/frenum pulls leading to gingival recession and other periodontal concerns, bruxism and hypertrophic facial muscles, excessive gingival display, and muscle related TMD symptoms.

Some may say that the general dentist should stick with treating teeth and gums.  Some may say that facial musculature isn’t something that the general dentist should involve themselves with.   At this point I am going to use my own training as an example of how the general dentists in our state, who have had the proper advanced training, currently involve themselves with facial musculature every day.   The application of Botox by the general dentist is not an expansion of scope.  On the contrary, Botox is simply a potentially powerful new tool in our armamentarium of treatment options.    The question at hand is,which dental professionals can use Botox in a comprehensive manor and safely maximize the benefits of this therapy?By no means is this example to imply a specialty on my part.  Like many of my dental colleagues, this is simply one aspect of my “job” as I’ve defined it through advanced education and is what I’ve chosen to study and implement in my practice.

 All of us dentits have seen severely worn dentitions.  We as dental professionals know that severe dental attrition is only one sign of a systemic problem.

After ruling out other biological etiologies such as medications, eating disorders and gastric problems, it is inherent that we address the facial musculature system which attaches to and controls the grossly worn hard tissues.  It is impossible to predictably treat the teeth alone since the hard tissues and the soft tissues are reliant on one another.  Without superfluous explanation since the methods vary, the facial muscles need to be relaxed, the jaw joint needs to be passively stabilized, a diagnosis made and treatment options proposed.Botox therapy could often times be useful atmany of these junctures.After consent is given, irreversible procedures are performed on the hard tissues.  The treatment objective is to provide therapy which will lead to permanent stabilization of the occlusion and therefore provide a state of musculature stability which coincides with this new stable occlusion.    As I mentioned earlier, the consequence of this treatment is often times a reduction in myofacial pain.  Below are several photos of one of my own cases.  These photos document the muscular changes that occur when advance occlusal therapy is performed.   There is no refuting that there are permanent changes to this individual’s facial musculature.  This is an irreversible and, might I say, quite an invasive procedure.  However, the results are predictable and successful due to advanced education.  This treatment falls within today’s scope of practice for our state’s general dentists.  Not all dentists perform this type of invasive, advanced, irreversible procedures whichaffect the hard AND soft muscular tissues.  This is a voluntary choice made through the practitioner’s involvement in advanced education.  Botox therapy, even though reversible, should have similar educational requirements.

 Before and After Occlusal Therapy and Muscle Stabilization

So, should a general dental professional be allowed to provide Botox Therapy?  The answer is a resounding, YES!  The caveat being, the general dental professional should be required to meet a standard of competency based on educational requirements.  It is obvious that there are well trained general dentist who treat facial musculature every day and we do this with irreversible procedures.  Botox therapy can be used as an adjunct to such treatment as well as others. Not only is Botox proven safe to use in the right circumstances, it is completely reversible.  The real question is, who better to provide dental Botox to our patients?  Logic requires that the treating doctor has the knowledge of the masticatory system, complex occlusion, head and neck anatomy, as well as possesses the dexterity for specific injection techniques.  Certainly this treatment option isn’t for every dental practitioner, but let’s not withhold this from those general dentists who have the ability, desire, and education to serve their deserving patients.


Dr. Jim Catt  practices health centered comprehensive cosmetic restorative dentistry in Medford, Oregon. He received his Bachelor of  Science from  Oregon State University and was Magna Cum Laude from Oregon Health and Sciences University with his Doctorate in Dental Medicine.  Dr. Catt is  a past president of the ODA and has served as an  Trustee for 13 years, participating on many Boards and Committees. He is a member of the International College of Dentists, American College of Dentists, and Pierre Fauchard Academy. In addition, he facilitates dental health in children through dental health awareness in Medford schools, volunteering at Jackson County Children’s Dental Clinic, and acting as the Project Lead for the Southern Oregon Mission of Mercy.


ODA Dental Health and Wellness Committee

Monday, July 16th, 2012

By Dr. Todd Beck


As dentists we manage the stress and anxiety of our patients every day.  We have developed a rich and complex skill set that allows us to provide much needed treatment to people who are not always appreciative and most often fearful, anxious and even sometimes angry.  We do all of this with the self imposed need for perfection and under the backdrop of a troubled economy; a combination which, as best, makes owning and running a small business a daunting task.  Add to all of that the unique challenges of managing employees and it is no wonder why most of us choose to work only four days a week.

We have CE courses and study clubs for everything from practice management to placing gold restorations.  But where do we turn for help with the emotional and personal issues we face?  Where do we go to get tips on how to better cope with our fear, anxiety and depression?  How do we get help when our coping mechanisms include drugs and alcohol?  Who do we turn to if we are suffering the anxiety of a board complaint or a lawsuit?  This is where the Dentist Health and Wellness Committee might be able to help.

I have been involved with the DHWC for over 12 years now.  In 2000 I reached out to the committee for help.  I was struggling with an addiction to narcotic pain medicine and my world was falling apart.  What I received was an ear to listen, a shoulder to cry on and excellent advice and direction.  It was a phone call to this committee that started the process of getting my life back on track.  At that moment I decided the rest of my career would involve “paying it forward”.

The work we do is most often anonymous; and for good reason.  We are dealing with very sensitive and personal issues.  We get referrals from the Board of Dentistry, concerned staff and family members, attorneys and dentists themselves.  The issues range from general stress to suicidal thoughts.  The ages range from dental students to retirees.  The request is always the same; “I just need someone to listen, I don’t know what to do”.  The response is always the same; “I’m glad you called; let’s see how we can help you”.

I need to be clear.  None of us on this committee have the training nor are we able to solve these problems by ourselves.  What we do have are the resources to point people in the right direction.  We are often the first step in the journey to healing and a better life.  We are an ear and a shoulder, and sometimes that is all that is needed.

If you or someone you know might need our help, please don’t hesitate to call our anonymous hotline at 503-550-0190


Dr. Beck graduated from OHSU in ’94 and completed a two year GPR at St. Anthony Hospital in Oklahoma City, OK in ’96.  After practicing and teaching for a few years in Oklahoma, Dr. Beck returned to Portland in 1999 and purchased Mt. Tabor Dental.  Dr. Beck opened a second location at South Waterfront in 2010 and for the past decade has been an Assistant Professor at OHSU in the departments of Community Dentistry, Restorative Dentistry and Urgent Care.  Dr. Beck has served as Chair of the Dentist Health and Wellness Committee for the past seven years, is on the Board of Directors for the OAGD and is currently President of the Multnomah County Dental Association.