contemporary pediatric dentistry - ldha · associates in pediatric dentistry will become a...
TRANSCRIPT
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.
Robert L. Delarosa, DDS
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
Dental Health Educator
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.
Information Transfer:
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.
Information Transfer:
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
Are You the Perfect Boss?
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
Are You the Perfect Boss?
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
Information Transfer:
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?
Information Transfer:
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?”
Information Transfer:
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. )
Dental Health Educator
“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
Overdue Recall Program
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
Overdue Recall Program
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 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!!!!!!!!!!!!!!!!
Robert L. Delarosa, DDS
9000 Airline Hwy., Ste. 100, Baton
Rouge, La. 70815
(o) 225-924-6622, (c) 225-907-8801,
(f) 225-926-3384
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