contemporary pediatric dentistry - ldha · associates in pediatric dentistry will become a...

Pearls and Lagniappe

Contemporary Pediatric Dentistry

Robert L. Delarosa, DDS

La. Dental Hygienists’ Association

April 12, 2013

Lafayette, La.

Topics:

Practice Management Concepts on systems analysis, recall programs, marketing strategies, AIPD business, associates/partnerships, common aspects of successful practices, etc.

Clinical Pearls with emphasis on materials, procedures and other “gems” accumulated over 25 years of practice.

Political and economic trends in dentistry—what is our future??

Ned Savide, Past President AAPD

“The passion, compassion,

empathy and purpose for

treating children frames the

rest of our activities both

personally and

professionally.”

AIPD Vision: Culture Day

Associates in Pediatric Dentistry will become a

world-class oral health care provider, committed to

excellence through passionate, accurate, and

consistent solution focused health care. We will

achieve our vision by building and sustaining high

quality relationships with those we serve: our

team, our patients, their families and our

community. We will provide patient experiences

that are fun and educational, and implement only

the finest scientifically proven technologies

available.


Mission Statement

Our mission is to truly care about our

patients. We work enthusiastically as a

team to provide the highest quality dental

care. Our practice is dedicated to the

prevention of dental disease because we

understand that prevention is the key to the

well being of our patients. It is our

responsibility to our patients and our

community as a whole to deliver our

message of dental health.

Ann Page Griffin-mentor,

colleague, friend

Practice Management

Consultant

CEO- Practicon

Dental Health Educator

12 Common Aspects of the Most Successful Practices

Benefactor

Information Transfer

Surveys

Evaluations

Questionnaires

Goals

Weekly Focus Reports


Overdue Recall Program

InformationTransfer:Surveys

Source of “focused” information from families, team and other stakeholders

Beginning and end points

Determined outcomes

Keep your promise

Be careful what you ask for

Information Transfer:

Practice Survey

Name 5 things about our practice that set us apart from anyone else: 1. Our attitude toward our patients is triple

TLC. We go overboard to make the child comfortable and happy. Our practice revolves around the patients and their feelings.

2. Our communication with the parents is excellent. We allow parents to be with the children at all times. We allow parents in the back. We are honest and upfront, we don’t try to hide anything.

3. We hold ourselves to a higher standard. We are not satisfied with what we have done in the past, we are always looking forward.


Practice Survey

4. A unique office with state of the art

equipment. Pleasant physical

surrounding with lots of windows and

open bays.

5. Our practice is always clean,

organized and well-run. We are

updated on all the new and latest

technology available. Always being the

first to try new products.


Boss Survey

Billy Arcement

President, The Results Group

“Searching for Success”

Retreat leader, speaker

Are You the Perfect Boss?

1. Keep the lines of communication open

2. Practice integrity in all you do

3. Be a straight shooter

4. Be an encourager of creative thinking

5. Be a positive thinker


6. Choose good people

7. Teach your employees to understand the bottom line

8. Provide positive strokes for positive folks

9. Demonstrate empathy for everyone

10. Coach


Your action steps:

1. Ask staff members to rate you on scale of 1 to 10

for each point (anonymously)

2. Use school grading system to rate your

performance; A=100-94, B=93-88, etc

3. Resolve to take every issue that surfaces and seek

improvement when necessary


Evaluations

Evaluations always have some style of

individual input

Provide a point of reference for past,

present and future behavior

Reminder of who you want to be

Evaluation Questions:

Six questions that have to be completed at

each evaluation, and at selected individual

times for non-performers.

These are purposely bi-directed to elicit the

most valuable information that will lead to

success for the team member and the team.

These are also used to generate new goals

and directives for the coming year.

Evaluation Questions 1. Have you attained your own professional/personal goals

here?

2. What are the biggest challenges we face in becoming

“world class”?

3. What changes do you/we need to make to attain our vision?

4. What are your world-class contributions to our practice?

5. What is your niche skill that when maximized we can’t be

world-class without?

6. What have been your less than world class contributions-

events, situations, staff relations- or any other area that is

getting in your way and not allowing you to reach your

world-class potential?


Annual Goals

Reference point from previous year’s

achievements in 1, 3, and 5 year goals

Measure of progress

Forward thinking exercise

Analysis and adaptation

“where are we now?”


Weekly Focus Report

Clinical positive performances

Clinic needs improvement ( this could consist of

anything from a situation with an employee,

parent/patient or equipment )

Administrative positive performances

Administration needs improvement ( this could

consist of anything from a situation with an

employee, parent/patient or equipment )

Weekly Focus Report

Week in review ( Positive and negative issues regarding any procedural, staff or other issues with positive solutions )

Positive performances of excellence ( Top 3 list per office which means you identify the top 3 people/performances that represent excellence )

Lack of Excellence ( Top 3 list that represent the lack of excellence. In this section, included should be a clear list of what you plan to do relative to specific coaching interventions with deadlines. Each manager is responsible for following up with Docs at the established deadline. )


“Community Voice” of the practice

Organizer for school programs, health fairs, and other public functions

Hygienist, PR Student, Marketing Coordinator

Year round activities with staff and doctor involvement

Invest, commit, give back

12 Common Aspects of the

Most Successful Practices

6. Recall system at least 80% effective

an effective recall system is

essential and vital in a busy

practice, and can be responsible for

as much as 80% of daily production

recall patients generate all other

services to the practice- restorative,

orthodontic and preventive


keeping the recall system current prevents

patients from falling through the cracks and

allows the inactivation of patients who have

transferred, moved or have elected to not

be in our practice

the overdue recall program must be kept

active and reviewed monthly for effective

recapture of patients


The goal of the overdue recall program is to successfully schedule and hold appointments for active patients at regular six month intervals who are overdue for recall appointments.

This allows both doctors and staff members to work efficiently as a team to increase production and provide routine oral hygiene instructions, up-to-date dental education, and optimal preventive oral health for our patients.

Overdue Recall Program Protocol

organized reports generated monthly reviewed by doctor

communication attempts by social media, written letter and phone calls to re-schedule patients

follow-up reports on effectiveness of activities

entire staff understands the importance of the project and demonstrates a willingness to be trained and participate in the project

appropriate “tweaking” of the system to ensure effectiveness and efficiency of efforts

Overdue Recall Program Protocol 2011

1st day of every month – put list of overdue patients on Dr’s desk for review

5th day of month – pick list up off of Dr’s desk

Email, text message or use other social media outlet to contact patient

10th day of month – letters should be mailed out to patients

2 weeks later, begin calling all patients

1st phone call – leave a brief message “Hi, this is Lacey at Associates in Pediatric Dentistry; I am calling in reference to Johnny. Please give me a call back at 924-6622.”

1 week after 1st phone call, call the patients that fell into the following categories again:

No Answer

Left Message

Will Call Back

Busy

2 weeks after 1st phone call, call No Answer and Busy patients again

Update Final Report

This protocol should give you a total of 4 reports:

Report #1 – response to letter, social media

Report #2 – response to 1st phone call

Report #3 – response to 2nd phone call

Report #4 – response to 3rd phone call

Clinical Pearls

Triple Antibiotic Paste

Mental Foramen Anesthesia

E-Arch

Xylitol

Circle “P”

Clinical Pearls

TAC

Varnishes

Diagnodent

ICON

Clinical Pearl

Triple Antibiotic Paste Endodontic Treatment of Primary Teeth using a

combination of antibacterial drugs

Lesion Sterilization and Tissue Repair (LSTR)

Clinical Pearl:Triple

Antibiotic Paste Endodontic treatment of primary teeth using a combination of

antibacterial drugs. Takushige T, Cruz EV, Asgor MA, Hoshino E. IEJ, Vol. 37, #2; Feb. 2004, 132-38.

Oral Health Program Using LSTR 3Mix-MP NIET Therapy. Hoshino MA, Asgor MA, Yagi M, Garcia MCG, Cruz EV, Oyanaga H, Kota K.

Lesion Sterilization and Tissue Repair (LSTR) Therapy- Non Instrumentation Directed Endodontic Treatment (NIET) Takushige T and Hoshino E.

Clinical Evaluation of Endodontic Re-Treatment Using LSTR 3Mix-MP. Takushige T, Hataoka H, Ando M, Hoshino E.

Clinical Pearl: Mental Foramen

Anesthesia

Easy to administer

Gentler to patient

Effective for most procedures on primary

teeth and some permanent teeth,

specifically from second primary

molars/premolars mesially

With TAC, rarely need lingual anesthesia

Clinical Pearl: E-Arch

Correcting crossbites in primary and

mixed dentition

Developing arch form

Used in conjunction with habit

appliance

Used in conjunction with other fixed

appliances

Materials used for E-Arch

Appliances: .040 Remanium Wire Spring-hard (Dentaurum #400-027-

40)

Stainless steel tube, inner diameter – 43mm (Dentaurum

#480-013-00)

Hi-T II Coil Spring .040 (3M Unitek #341-561)

Silver Solder – Cadmium Free (Great Lakes Orthodontics

#240-001)

Soldering flux (Great Lakes Orthodontics #240-002)

Clinical Pearl: Circle “P”

At all dental cleaning appointments, the hygienist/assistant is responsible for discussing a list of 7 recommendations ( with Xylitol ) with parents/patients to ensure that all preventative measures are taken at home to prevent dental decay. The symbol above (circle P) is used as a note in the chart that the recommendations below have been discussed.

P

Brushing – AIPD recommends brushing twice daily for two minutes each time. Although brushing morning and night is best, we do have patients that only brush once daily whether it be morning or night and we have some that may not even brush once a day. Instruct parents/patients to brush two minutes in the morning and two minutes at night, making sure they do not eat or drink anything but water after night time brushing. We encourage our parents to stay involved with brushing both morning and night until dexterity has fully developed (usually around 8 years old).

Flossing – AIPD recommends flossing once daily. Although flossing anytime during the day is helpful, night time flossing is best so that bacteria don’t harbor between the teeth while sleeping. Demonstrate the proper way to floss (along with brushing) and ask parents to help with flossing. Explain to them the importance of wrapping the floss around each side of each tooth to clean bacteria between the teeth that our toothbrush can not reach. Floss sticks are acceptable and fun for children to use but they can harbor bacteria. Snacking –Snacking is about choices. Choose water versus juice, ice cream versus sticky candy, and having discreet snacking times versus continuous “grazing”. Encourage parents to allow one or two snack times during the day. Our message is not only what but when.

Fluoride – We recommend all of our patients have some type of fluoride exposure whether a

prescription (Rx) fluoride tablet/drop or over the counter (otc) gel or rinse. Our doctors at AIPD make

these decisions. Children that are swallowing fluoridated toothpaste should use a smear to pea sized

amount of toothpaste so that they are not ingesting too much fluoride and generally will not be put on a

fluoride supplement. Children that are using training toothpaste ( without fluoride ) may be prescribed a

fluoride tablet/drop so that the exact dosage the patient is receiving can be monitored. Rinses are

recommended for children that are not swallowing toothpaste and will not swallow the rinse. Place pre-

measured rinse in mouth and swish for 1 minute, then expectorate. Rinses are most effective when

used at night after brushing and flossing. Fluoride should be the last thing placed on the teeth at night

time before bed.

Fluids – Water is the ideal fluid to drink. It does not contain any sugar or acid which greatly increases

the incidence of cavities. Juices, regular sodas, sports drinks and energy drinks are sugary and acidic,

and should be consumed in moderation. In addition, these types of fluids should be served at meal time

only because chewing increases saliva flow which helps to dilute the sugar and acid. We discourage

sipping on these fluids all throughout the day. Putting children to bed with a sippy cup or bottle with

anything other than water is also strongly discouraged. Giving children large amounts of juice is not recommended, we ask parents to dilute the juice, ½ water and ½ juice and increase the percentage of

water so that eventually the child will prefer water.

Sealants – Sealants are thin, white, protective coatings that are placed in the grooves of healthy

permanent first and second molars as well as other indicated teeth to help prevent cavities. We

recommend sealing teeth upon full eruption or when biting surfaces are easily accessible. Sealants

tend to chip and break away as time passes and will be touched up as needed. Avoiding hard candy and ice is recommended after sealants are placed as they can cause sealants to fail.

Xylitol

Xylitol is a five carbon sugar that is not

easily digested by oral flora, and

therefore reduces the acidic challenge

to the enamel surface. It has also

been shown to effect the integrity of

the plaque. The end result is a

reduction in decay.

Clinical Pearl: TAC Alternate Gel

20% Lidocaine, 4% Tetracaine, 2%

Phenylephrine Comparative Efficacy of 20% Benzocaine Versus TAC

Alternate Gel. This project is a study comparing the

effectiveness of two topical anesthetics for control of

pain associated with dental needle insertion in the

palatal mucosa. Clinical Trial at UTHSC, Houston. Art

Jeske and Femme Ambrosio Received Feb. 18, 2009.

Awesome for 3:00 “cliff hangers”, gingival tissue for

rubber dam clamps, mucosal tissue to reattach

buttons/chains.

Professional Arts Pharmacy, Lafayette, La.

Clinical Pearl: Varnishes

Alternative to other topical modalities with high risk and some moderate risk patients

Early adaptation in UK

5% Neutral NaF

No waiting period for drinking/eating after application

Easy to apply

Fluoride Varnish Indications:

a. arrest caries on young pre-cooperative patients until therapeutic treatment can be accomplished.

b. patients who have generalized decalcification and on all orthodontic patients at recalls. Teeth should be dried thoroughly before varnish is placed. Patients are allowed to eat and drink immediately after receiving a varnish application.

Clinical Pearl: Diagnodent

Bacterial activity measured by laser

fluorescence and calibrated

numerically

“relative” measures are valuable in

follow-up to remineralization program

Excellent for “prep check”

Cool for kids and parents

Clinical Pearl:ICON

Resin Infiltration of Incipient Caries: A

new treatment modality for caries

management

Conservative, non-invasive therapy for

incipient lesions

“case selection” is critical

ADA code D2990, specific code

released in January 2013

The Future???????

Dental Therapists- the Mid-level

Provider

Corporate Dentistry

Health Care Reform

Future Needs of Pediatric Dentistry

Research Directions

Dental Therapists

Deamonte Driver

History of political forces- “access to care”

Economics and the budget

Statistics from New Zealand Studies

AAPD positioning and recommendations

Research possibilities- Dr. Joel Berg

Corporate Dentistry

History of volume practices

“Going public”

Opportunities

Detractors

Where do you fit in?

Health Care Reform

Are you kidding me????

AAPD and the PAC

“Wraparound” legislation

Let’s talk about Medicaid

AIPD/Delarosa Model

Pediatric Dentistry and the

Future

AAPD and You

Leadership in all dimensions- private

practice, academia, organizational,

political

The “mouse that roars”

You can not afford to be passive!!!!!

Thank you!!!!!!!!!!!!!!!!


9000 Airline Hwy., Ste. 100, Baton

Rouge, La. 70815

(o) 225-924-6622, (c) 225-907-8801,

(f) 225-926-3384

[email protected]

Book List

As A Man Thinketh James Allen

Leadership and the New Science Margaret Wheatley

Flight of the Buffalo James Belasco, Ralph Stayer

The Art of Happiness Howard Cutler

Soar with Your Strengths Donald Clifton, Paula Nelson

Book List

Blink Malcolm Gladwell

The World is Flat Thomas Friedman

The Book of Positive Quotations John Cook

Dare to Win Jack Canfield, Mark Victor Hansen

The One Thing You Need to Know Marcus Buckingham

Book List

Success is a Choice Rick Pitino

Deming Management Method Mary Walton

Discovering the Soul of Service Leonard Berry

What Should I Do with My Life? Po Bronson

Poor Charlie’s Almanac Peter D. Kaufman

Book List

Don’t Retire, Rewire Jeri Sedler, Rick

Miners

Coming Back Stronger Drew Brees

The Intelligent Entrepreneur Bill Murphy

Steve Jobs Walter Isaacson

Socialnomics Erik Qualman

Book List

212o the extra degree Sam Parker, Mac Anderson

Blue Ocean Strategy W. Chan Kim, Renee Mauborgne

Start With Why Simon Sinek

The Emperor of All Maladies Siddhartha Mukherjee

Death by Meeting Patrick Lencioni

Book List

The Black Swan Nassim Nicholas Taleb

Showing Up For Life Bill Gates, Sr.

Outliers Malcolm Gladwell

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