Values are a powerful tool that can be quantified. Once you know your four to six business values, you can strengthen your practice and build a high-powered team. Once you have completed this exercise, you may want to repeat the process for your personal values. It can be insightful and fun.
Thriving dental practices are excellent at providing a warm personal experience or are efficient, fast and cost-effective. Those that that attempt to do both end up being mediocre at just about everything.
Introducing ideas from dramaturgy and service simultaneity in the services marketing literature, the authors provide a model for the conceptualization and redesign of the dental practice.
Successful dental practices will be those that concentrate on low customization of activities in the back office or high customization of activities in the front office.
The majority of treatment room configurations typically revolve around the dentist. However, a design based on the relationships among the dentist, patient, staff members and dental equipment results in a more functionally appropriate design.
As the dental practice's primary production space, the treatment room should be designed as efficiently as possible. Ideally planned operatories will benefit your practice by allowing you to produce as much as you choose, while decreasing your stress level.
Make no mistake: dental practices are businesses. Dentists as CEOs need to focus on key performance indicators and statistical tracking in order to understand what is happening in the practice over its life span. Average production per new patient is a key factor to be tracked because it is an essential driver of the financial performance of any dental practice. The health of this factor will have a dramatic effect on the financial well-being of the dentist, and on the timing and character of his or her retirement. At the same time, it is essential to balance financial factors with exceptional quality of care for every patient. Without both, neither will be successful in the long-term.
Approximately 3,900 elementary schoolchildren rinsed once a week with a 0.2% neutral NaF solution. After four school years, 109 rinses had been scheduled. The effect on caries prevalence in the permanent dentition is evaluated.
A school-based fluoride rinsing program was instituted in 1975 in the Three Village Central School District, Long Island, NY. The children rinsed once a week with a 0.2% neutral NaF solution under supervision of the homeroom teachers. After three years, the participants had rinsed an average of 77 times. Children in grades 3 through 7 who had participated during all three years of rinsing had a reduction in caries prevalence of 30.9% for DMFS and 28.5% for DMFT. The greatest reduction occurred on proximal surfaces (48.7%), followed by buccolingual surfaces (30.0%) and occlusal surfaces (28.2%). The benefits of fluoride rinsing increased with the duration of the program.
The implementation of a school-based mouth-rinsing program in a Long Island, NY, community was described. In this program, children rinse once a week with a neutral 0.2% sodium fluoride solution under the supervision of homeroom teachers. Although the children reside in a fluoride-deficient community (F less than or equal to 0.1 ppm), the baseline dental caries prevalence of a subsample of the group (11 to 13 years old) was similar to that of comparably aged children who were residents of a fluoridated community and from approximately a third to a half lower than that of other fluoride-deficient communities. Despite the initially low caries activity in the study population, there was a 19.9% difference in mean DMFT prevalence scores between the baseline and two-year examination and a 20.3% difference in DMFS scores after two years of rinsing (average of 49 rinses). The greatest difference, 40.0%, was found between proximal surfaces; differences for occlusal and buccolingual surfaces were 19.6% and 15.6%, respectively.
This study determined the effect of brushing with 0.4% stannous fluoride (SnF2) or 0.22% sodium fluoride (NaF) on clinical and microbial parameters associated with gingivitis. The study included three groups of 281 subjects. Subjects in all three groups were instructed to brush twice daily with an ADA-accepted fluoride dentifrice, rinse their mouths with water, and subsequently brush with 0.4% SnF2, 0.22% NaF, or a fluoridefree placebo gel. More stain was detected in the SnF2 group than in the other two groups at all periods except at baseline. However, no differences were observed in gingivitis, bleeding, or mean proportions of microbial forms in the SnF2 or NaF groups when compared with the placebo group at 18 months. Results indicate that 0.4% SnF2, or 0.22% NaF is no more effective than a placebo in reducing gingivitis.
Research does not support the concept that 0.4% stannous fluoride gels are the preferred preventive or treatment agents for hypersensitivity, plaque, gingivitis, or periodontitis. The only clinically proved, cost-beneficial indications for use of these materials are for the prevention of enamel decalcification in patients wearing banded orthodontic appliances and for the prevention of dental caries in patients who have had head and neck radiation therapy. Even for these applications, other fluoride products may have equal effectiveness.
The 3-year DMFS increments of 2,509 children were compared. Group 1 used a conventional Na2PO3F dentifrice (1,000 ppm F) and served as the active control. Groups 2 and 3 used mixed-fluoride dentifrices containing equimolar amounts of NaF and Na2PO3F, providing total fluoride concentrations of 1,000 and 2,500 ppm F, respectively. Dentifrice use was unsupervised in the subjects' homes. There were no statistically significant differences (F-test) between the 3-year DMFS increments of the dentifrice groups, nor were there any significant differences between the dentifrice groups when the analysis included subject compliance and caries risk.
The safety and efficacy of various sedative techniques was studied. Inhalation sedation provided the mainstay of anxiety control, whereas intravenous and combination techniques were reserved for more difficult patients or procedures. Pooled data from all techniques yielded an 87% effectiveness rate and 93% patient acceptance rate. Sedation was less often effective in persons with poorer health status than in healthy persons. Complications encountered were few, rarely of serious potential, and easily managed. Nitrous oxide sedation was effective 88.5% of the time and usually at concentrations of 50% or less. The safety and efficacy of intravenous, oral, combination, and especially inhalation sedation given by individuals not formally trained in general anesthesia appears to be confirmed. No correlation of side effects to a specific technique of administration or to patients suffering significant medical disorders could be established. However, more data need to be obtained in this area before firm conclusions can be made.
To statistically associate specific factors of surgical extraction of third molars with mandibular nerve dysesthesia, records of patients were reviewed for preoperative panoramic radiographs, complete operative and anesthetic records, preoperative and postoperative notes, and histories. Data were then tabulated and the cases of altered sensation were compared with cases of unaltered sensation.
No changes were found in the epithelial cells from the buccal mucosa of dentists with the use of the light microscope, electron microscope, or electron probe that could be correlated with mercury exposure under the conditions of this test. In a normal population it can be expected that at least 0.01% of the population will show class 2 atypical smears. Patients with class 2 smears have fewer highly matured epithelial cells (tendency toward keratinization) of the buccal mucosa and hence a thinner epithelium.
To assess the precision of cytology in the diagnosis of oral cancer, the medical records of 1,801 patients seen for follow-up were reviewed. Eleven of these patients developed mouth cancers subsequent to a negative or indeterminate cytologic finding. Some of the weaknesses of cytology may be attributed to faulty clinical technics.
Probably the most common procedure in dentistry is the administration of local anesthetic, or LA. Immediate complications of LA administration include positive blood aspiration, blanching of the tissue and burning sensation on impingement of the nerve. Because studies about the immediate complications of LA administration were conducted before 1980, more recent data regarding this procedure are needed.
In this prospective study, an experienced dentist administered, 2,528 LA injections to 1,007 consecutive patients with 1-inch 27-gauge needles, using a solution of 2 percent lidocaine and 1:100,000 nordefrine hydrochloride.
The authors observed positive blood aspiration in 73 injections (2.9 percent) without any further complications. The most severe immediate complication-syncope-occurred only in one case. In 63 injections (2.5 percent), the dentist touched the nerve, and the patient reported feeling an electric current sensation (40 times with inferior alveolar nerve blocks, 18 times with lingual nerve blocks, four times with mental nerve blocks and one time with a second injection to the same site) without any further complications.
The results confirm that LA injections that are properly carried out appear to be safer today than they were in the past.
LA is a safe procedure when the appropriate technique is used. It is even safer when an inferior alveolar nerve block is administered.
A clinical comparison of 28 patients was done in a double-blind fashion to evaluate the effectiveness of 1.5 etidocaine with epinephrine 1:200,000 and 2% lidocaine with epinephrine 1:100,000 in oral surgery. The patients selected had no medical problems, but required the extraction of bilaterally impacted third molars. Each subject served as his or her own control with etidocaine being used to produce local anesthesia on one side of the face, and lidocaine on the opposite side. The results were evaluated to allow a comparison of the onset and quality of anesthesia; the duration of lip numbness and the onset of postoperative pain; and the incidence, type, and severity of adverse reactions. Both lidocaine and etidocaine were similar in onset and quality of anesthesia. No adverse reactions were observed with either agent. The two anesthetics differed mainly in their durations of action. Etidocaine proved 2.16 times longer acting than lidocaine with respect to recovery from lower lip numbness and 1.75 times longer acting than lidocaine with respect to the onset of postoperative pain. Therefore, the conclusion was reached that 1.5% etidocaine with epinephrine 1:200,000 is an effective local anesthetic for use in oral surgery because it has a rapid onset, provides profound anesthesia, and possesses a longer duration of action than 2% lidocaine with epinephrine 1:100,000. The final characteristic is of particular value as the onset of postoperative pain is significantly delayed.
Because a number of patients have reported an increase in heart rate with the intraosseous, or i.o., injection, it is important to evaluate changes in the cardiovascular system with this injection technique. The purpose of this study was to determine the cardiovascular effects of an i.o. injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine.
With the use of a repeated-measures design, the authors randomly assigned 42 subjects to receive i.o. injections of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine or 1.8 mL of 3 percent mepivacaine in a double-blinded manner at two appointments. At each appointment the authors monitored electrocardiographic findings, cardiac rate, systolic and diastolic blood pressure, and mean arterial pressure before, during and after administration of anesthetic solutions.
With the 2 percent lidocaine with 1:100,000 epinephrine solution, 28 (67 percent) of 42 subjects experienced an increase in heart rate that might be attributed to the effect of the epinephrine. In 22 (79 percent) of these subjects, the heart rate returned to within 5 beats of baseline values within four minutes after solution deposition. The authors found no significant increase in heart rate in subjects receiving the 3 percent mepivacaine. No significant differences (P > .05) were found in mean diastolic, mean systolic or mean arterial blood pressure values between the subjects receiving 2 percent lidocaine with 1:100,000 epinephrine and those receiving 3 percent mepivacaine.
The majority of subjects receiving the i.o. injection of the 2 percent lidocaine-epinephrine solution experienced a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine.
While patients would likely notice the heart rate increase with the lidocaine-epinephrine solution, it would not be clinically significant in most healthy patients. In patients whose medical condition, drug therapies or epinephrine sensitivity suggests caution, 3 percent mepivacaine is a good alternative for i.o. injections.
The authors conducted a randomized, double-blind, two-way crossover clinical trial to compare the pharmacokinetics and cardiovascular effects of 11.9 milliliters of 4 percent articaine hydrochloride (HCl) plus 1:100,000 epinephrine (A100) with those of 11.9 mL of 4 percent articaine HCl plus 1:200,000 epinephrine (A200).
During two testing sessions, the authors administered injections of A100 and A200 over a seven-minute period (in one-cartridge doses unless otherwise noted): maxillary right first molar infiltration, maxillary left first molar infiltration, maxillary right first premolar infiltration, maxillary left first premolar infiltration, right inferior alveolar injection, left inferior alveolar injection, right long buccal infiltration (one-half cartridge) and left long buccal infiltration (one-half cartridge). They analyzed venous blood samples for articaine levels. They used noninvasive acoustic tonometry to measure a variety of cardiovascular parameters over a two-hour period.
Plasma concentration curves of articaine over time were similar for both solutions, with peak concentrations and times to maximum concentration being 2,037 nanograms per milliliter and 22 minutes for A100 and 2,145 ng/mL and 22 minutes for A200. At the 10-minute point, the mean systolic blood pressure and heart rate were significantly elevated (P < .05) with A100 versus A200.
Maximum dose recommendations for the A100 solution also can be applied to the A200 solution. A200 produces less cardiovascular stimulation than does A100.
A200 is as safe as A100, and may be preferable to A100 in patients with cardiovascular disease and in those taking drugs that reportedly enhance the systemic effects of epinephrine.
A follow-up study of 118 patients was performed to determine the effect of various conservative treatments for MPD after six months to 12 years. Of the patients, 82% were females; 62 were females younger than 40 years old. During treatment, patients were made aware of muscle spasm, and consciousness of the role of muscles in MPD was raised. Of 105 patients who were contacted, 65 had no further problems, 26 thought the problem was improved and under control, and 14 had not improved or had sought treatment elsewhere. Musculature and psychological factors play major roles in the MPD syndrome.
The free physiologic eruption of impacted canines requires the cooperation of the general dentist, the oral surgeon, and the orthodontist. The techniques which have successfully brought impacted canines into the arch in 2,000 instances are described.
The American people and our profession have been dealt a traumatic blow. The short-term effects of this incident are obvious: all aspects of our economy have slowed; travel and dental CE attendance are down; dentists are seeking other modes of CE that do not require travel. As the country recovers, I predict that dental CE will have a temporary lull, but that the desire for dental CE will continue to expand, and that the destination and local courses to which we have been accustomed will flourish again.
In 1972, a school-based fluoride program was initiated in elementary schools in Nelson County, VA, a fluoride-deficient area. For 11 years, participating children ingested daily in school a 1-mgm fluoride tablet and rinsed weekly with a .2% sodium fluoride solution. They also received fluoride dentifrice and toothbrushes for home use. The program was extended into junior high school in 1978 and into high school in 1980. In 1983, dental examinations of children aged 6 to 17 years, who had continuously participated in the program for 1 to 11 years depending on school grade, showed a mean prevalence of 3.12 DMFS, which was 65% lower than the corresponding score of 9.02 DMFS for children of the same ages at the baseline examinations. The preventive program inhibited decay in all types of surfaces: 54% in occlusal surfaces; 59% in buccolingual surfaces; and 90% in mesiodistal surfaces.