Long story short: I'm attempting to turn around a full FFS practice. I objectively believe the doctor/owner is an excellent clinician. But her practice, which has stood for decades, is going down the tubes. The OM has been there 18 months, and came from managing a DSO location. I think the OM really kept a DSO style. I also think most of the OM's hires (which would now be the entire staff except me) are her friends, 2 of which were pregnant. Which is what prompted the doctor to approached me to help sort it out. Staff went from 3 to 8 (1 Dr, 1 Hyg, 2 DA, 4 Admin), while the schedule has been in steady decline. Payroll is 57% of overhead. I know that's an issue, but our hands are kind of tied it feels. I think the first thing to focus on is getting more bodies in the shop. I'm open to all input. Below is my current plan of attack.

My main effort right now is setting up a reactivation campaign for anyone that has been in the practice in the past 4 to 5 years. Patients will be categorized and it should be relatively personalized to each patient. I'm thinking of following that with a referral system, review farming system, strategic positioning campaign for the Dr, and a loyalty/membership program for the office. There are literally no systems implemented in the office, so eventually I want to focus on systematizing and tracking metrics on everything I can. The Dr is putting effort into communication in an effort to increase case acceptance. She usually does the consult on the tail end of exams, but we've discussed changing to consolts being more of a stand alone appointment, when appropriate. The next 6 weeks will be critical. The OM has grown the top line, but never brought profit and now the practice is burning through cash faster than ever.

Guys/gals, I can’t be alone here. My scrubs have my name on them, call it “Dr. Jones”.
Once every month or so I’ll be walking around in public (grocery store, to my car, etc), and someone will look over and slowly, quietly say “Doctor Jones”- and then just walk away. I think they’re reading it aloud, slowly, but it’s happened for 10 years.

Does this happen to anyone else?! I’ve told my girlfriend about it in the past and today she got to witness it first hand.

Anyone with any opinions on a product that is ready made for a patient to get some sort of TMJ pain relief same day. I’d love everyone to be custom fit, but I also don’t want to let people suffer for the build time if there’s a really good “this will do in a pinch” option

I’ve looked at a company called AquaLizer that’s I think the best representation of what I’m picturing. Anyone work with them before?

I’m open to any and all best TMJ practices you’ve found. If a brace or splint or bite guard sounds stupid then what company does have that ultimate device you like?

I am leaving my practice soon (first job, newish grad) and starting a new job. My split from the clinic is amicable and we have agreed on an end date. How does one go about scheduling patients? Less than 10 weeks from agreed end date. Do I try to finish up in-progress treatment? Do I still see new patients? Do I do recalls for patients I’ve done work on to see how things are holding up? Thanks!

Hi guys,I recently bought a flexible periotome.im doing my extraction of 14 starting with a periosteal elevator to reflect the gingiva,and then I use the periotome to cut the pdl.Then the tooth gets mobile.however the issue is when I get the forceps to pull it out it takes forever to take it out.is there anything I'm doing wrong or missing?

I'm in dental school and it seems people use different techniques when they send impressions for crowns. I would take final impression in a full arch stock tray with heavy and light body. I then would take a counter arch impression with alginate. Lastly, I get the bite registration with blu-moussee.

I noticed other students would take a triple tray and simply send that to the lab for a crown. I never knew you could do this for a final impression; I mostly just used triple trays for making a provisional.

What would you say is the better method? Which method would a lab prefer? I want to do things right and never want to look like I'm cutting corners. I appreciate any tips and advice.

About to finish my GPR in a few months and live alone for the first time. I lived at home during college and dental school so that I can graduate with minimum amount of loans (~165k). I have the luxury of living at home again so that I can pay off my loans faster. Should I do it? I have a great relationship with my parents but also love my independence. Also like to add that I'm 28 and single.

I’m talking about brown and dark yellow discolored class V incipient lesions. Can someone please describe their protocol when dealing with such lesions in detail? They’re so common. I’m a student and we never formally discussed this in uni but a few patients have asked me about possible treatments and I always tell them resin infiltration. But I’m curious to know the specifics as I’ve never seen this procedure performed in a clinical environment.

I assume we have to remove the stain first? I once tried using a white stone polishing bur as a quick aesthetic relief for a perio patient and it removed the brown discoloration revealing a white demineralized lesion underneath. But I don’t know if that step is necessary or if there are better more conservative ways to remove the stain.

Also can resin infiltration be done using flowable composites, or is it necessary to use the specific infiltration resins? I have never learned about this procedure in an organized manner, so please excuse my ignorance.

Hello,

This is one of my first few crown insert cases since dental school and I was hoping for some advice :)

I prepped the tooth 26 for a zirconia crown and took a pre-op BW prior to cementation- I noticed this gap on the distal and ended up placing retraction cord/trying to get a better impression/sending to lab for a remake.

Is that cement space or an open margin on the distal? I've never taken a pre-op prior to cementation so I am curious to know everyone's thoughts.

26 Pre-Op BW- https://drive.google.com/file/d/1Nv7uTJRrNS3w_QiYPNiYbPYXR_nMrB8R/view?usp=sharing

In dentistry from the moment I walk into the office to the moment I leave I’m taking to people. Sometimes I’m even taking about dentistry on my drive home.

When I finally get home in just exhausted from taking all day. Yet that’s when my gf wants to talk to me about her day and wants to hear a about mine.

Yet I’m just exhausted and don’t want to talk to anyone but don’t want to hurt her feelings

Does this happen to anyone else ? How do you deal with it ?

Does anyone know if this makes sense?

Recently, there has been an ownership change at my dental office (they are partner dentist). One is officially here at the office and have been meeting our patients. He greeted the staff and informed us of his experiences. He has about 6yrs of experience, does the general dentistry treatments, goes up to the pre-molar for rct treatments. before the patient came in he wanted to change the schedule a bit to give him more time to do the treatment, however he wants 1.5hrs to do a crown (replacement) {we have already given him a 1hr slot to do it}. Mind you this treatment has been approved by insurance as a post/pfm (the pt has done an rct before) . he said the post wasn't necessary because there were only caries under the crown- it seemed like he just didnt want to do it.
Later in the afternoon, there was a patient that needed to do a rct/post/pfm bc her tooth was exposed and there were cavities, but he just did it as a bu/pfm.

Also, he took about 10minutes to numb the patient. during that time the assistants usually do the impression, bite registration, make the impression for temp crowns, etc. but he told them to not do it. after 10minutes pass, then to make the assistants start doing it. Because the previous dentist, numbed the patient (both topical and the needle), while he was waiting for it to take effect then he would make the assistants do the impressions and everything. then begin the treatment and finish within the hour- not too long.
And he informed us in the morning before patient began coming in that at his other office he sees 30 patients a day.
(ik he's new and needs to get used to the office, greet the patients,etc., but does it make sense that a dentist with 6yrs of experience takes 1.5 hrs to do 1 crown.)

what is your option on EMOTIONAL SUPPORT dogs being in the dental office with a patient (not service dog)? I personally think it's disgusting and today a patient brought in their blind "emotional support" dog for a denture delivery appointment and the dog would not sit down and almost tripped the doctor walking around in the room. after the room smelled awful. this is the second time someone has brought in an "emotional support" dog into our office. I think it's extremely unsanitary... I understand it can help some people with their anxiety but I think it's pretty unsafe because these dogs are not usually trained.

Hello Reddit dental community! What are your recommendations for the best children's picture books about oral health? I've found a few online, but it's hard to validate whether they are good messages or even accurate. I'd like to find some books that also aren't just scare tactics and make teeth/oral hygiene fun. Thank you!

Can someone walk me through the basics of how to elevate more effectively? I was watching my local surgeon do a case, and I swear he got every tooth basically popping out of the socket with a 301 elevator alone. I did ask him for tips but he gave me the basic "I find a purchase point and lever off the bone. Comes with experience." I feel like that's what I try to do with far less effectiveness.

I only extracted like 10 teeth in dental school and frankly I didn't get much concrete instruction. I've done a lot more since I graduated, but when it comes to non-perio molars and some premolars, I can barely get movement with my elevator. I tend to have to go surgical a lot and section/trough.

Here's what I would do for say, #30.

1. Periosteal elevation to sever the PDL.
2. Insert elevator at the MB line angle and try to shimmy it as apically as I can with little twist motions. Then, I turn the upper edge of the elevator towards the tooth and push. Repeat at the other line angle.
3. If I'm lucky and it gets mobile, I'll then start trying to "scoop" it out of the socket, trying to find a purchase point. I have a lot of issues finding purchase points to be honest.
4. Get the forceps.

I feel like I rarely have much luck getting multi-rooted teeth very mobile. I also struggle a lot to elevate effectively for teeth on the left, my non-dominant side.

Do I need to apply more pressure to get leverage on the purchase point? Should I hold the elevator more parallel to plane of occlusion? Right now I hold it at about 45 degrees. I just feel like I am not understanding fully the way to use an elevator properly.

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If you have a good panoramic image is that enough for an extraction or would you always get a PA of a tooth that is going to be taken out? I’ve been a stickler about PAs but wanted to see other opinions

Having endo come in once a week or every other for the cases you wouldn't wanna deal with. Perio for the grafting, soft tissue procedures, advanced perio cases, and an orthodontist because patients all want straight teeth.

The way I see it an owner has to obviously pay specialists a higher % which would amount to nearly 0% profit after overhead. In the name of keeping patients "in the same place", because let's face it, patients don't give a shit if they need a specialist, they just want it done "here."

Medicolegal-wise, it's cumbersome to be equipped for OMFS, or something to that effect?

Obviously we run our offices how we want, but what are the pros and cons of having a specialist in-house?

I'm a noob prospective owner, please render unto me direction and wisdom. I like to see people's responses on top of the podcasts and books.

Hi guys! I have been practicing my crown preps but the one place I am struggling in is my occlusal reduction. I align my bur along the cusps to allow for occlusal anatomy but for some or the other reason everytime I finish reducing it there is a wide flat central fissure. Can you give me tips on how to avoid this and preserve the anatomy of the cusps?

Optibond, scotchbond, all-bond, whatever the fuq bond. There's obviously price to consider, but at what point does one decide that a product is so inferior that it does not justify purchase, even at a lower price? Are there manufacturers/brands to avoid? Hu-friedy, Schein, Benco I feel like implants are a little easier to sift through, but restorative materials are as plentiful as paper clips in a hoarders den.

Obviously when performing any bonding procedure it's recommended for a surface to be dry, but not TOO dry. Some bonding system instructions even go so far as to say to have the prepped surface be "slightly wet."

Over-drying IIRC can cause post-op sensitivity indefinitely, so how do you fine professionals go about drying a tooth to allow for maximal bonding without desiccating it?

Edit: glad I'm not crazy lol

I can't remember exactly where I heard or saw it. Say you dropped all insurances and only did FFS at reasonable rates, e.g. $1000-1200 a crown, idk. You spend an hour prepping, scanning/impressing, temping (hypothetically by you, not assistant), and it's $1200. Versus taking shit insurances and doing two $600 crowns, or three $400 crowns, or twelve $100 crowns (jk but "insurance" companies probably talk about this being their ultimate goal).

What's the math that displays how less efficient it gets as you do work that gets contracted at lower and lower fees?

I get that depending on the situation, quite oftrn it can be very hard to make FFS work, and the role accepting insurances play in simply getting patients to walk in the door, just wondering if anyone here had the math, because I feel that a LOT of dentists don't seriously think about it. Fuck these dental DISCOUNT PLANS pretending to be "insurance". Patients have no idea what their plans even do, and are surprised when half or more of their needs aren't even covered lol.

unfortunately I barely open them never mind read them and they're just taking up too much storage space. I feel bad throwing them away. feel free to DM

What do you do with these people? I have one that I knew in the consult and try-ins that she was going to be brutal… Delivered C/C and she immediately started complaining. “This upper doesn’t fit as well as my last one,” “this is not my natural bite,” etc… What do I? Sometimes I’ll remake if I actually think I can fix something like esthetics. Sometimes I’ll reline if I actually think I can fix the fit slightly. But in this case I really don’t think I will ever be able to match this person’s expectations. I mean, it’s a denture it’s not AllOnX; I am not the lord.

Dent3 here

Quick background, I am in the military so “the grind” is a foreign concept to me, unless its in regards to endless computer based trainings, infection control red tape, and wartime exercises.

But I am curious about ortho on the outside and have a hard time finding people’s firsthand experience with the realities it.

I am on the fence about staying in or trying to get into a civilian ortho program and separating. I have decided I would not be interested in separating and doing general dentistry. I admit, I like the slower pace of the military and living overseas, and I just don’t like doing general dentistry enough to bust my tush off in the “real world.”

I am genuinely interested in ortho. I like not only the type of work, but also (please correct me if I’m wrong) the lower stress work life. I love seeing patients, teaching and talking, but hate large amounts if admin (biggest reservation of staying military). I would not do it just for the money, so the lower pay for ortho doesn’t bother me so much, if true. I would ideally like to get out and settle and live in one spot, but not if its going to still be as much of a grind and life suck as gen den. I am not interested in having my work consume me completely, or not having financial security.

So what is the current reality with ortho? With all the changes ortho has had to go through lately, is the grass really any greener anymore compared to general dentistry? I know that it would still be very busy, but I sometimes hear of upwards of 100 patients a day if in a DSO or successful practice, or alternatively, a really difficult competitive scene if wanting to live in a reasonable area. I have had a good experience with the military, going well past my initial commitment, and just want to hear more personal accounts on the risk/benefit of taking the leap of faith (assuming I actually get accepted into a residency)

To stir the pot, somewhere semi-rural California would be the dream spot. I do not know if I would own a practice or stay associate

Our office switched from Protaper Next to WaveOne Gold files. I’ve hated doing endo since the switch. I feel like the Protaper next files would pull their way down the canal to the apex after hand filing to a size #20 hand file. With WaveOne Gold I feel like I have to really push to get the file to advance and it seems like the WaveOne files want to ledge rather than advance around the curves near the apex. Can’t really pre bend the WaveOne files either. I thought WaveOne would be great. What am I doing wrong? Any advice?

To all….yes I do have the proper endo motor with Wave One Gold reciprocating settings.

Made me chuckle

General dentist who wants to start placing my own implants. Looking for course recommendations please.

New grad here. So I currently have an offer from a DSO (I haven’t signed yet), but I just got an interview scheduled at a private practice (for which I applied to a month ago). How do I tell the DSO office that I might actually consider this other place?

SIDE NOTE: im supposed to meet with the DSO to discuss my contract a few days before my scheduled interview with the private office. I was preparing myself to sign with the DSO that day but I want to put that off now and see what the private practice has to offer. What’s the best way to communicate that without losing my spot with the DSO?

I started an associateship at a practice around a year ago as my first gig after graduating. Things have been going really well for me there. My boss is chill and my schedule is full. The only drawback is my boss has an assistant who is really insecure and views anything that I do differently than how she’s done things in the past (she has like twenty years of experience) as an indictment against her competency. My gripe is that she’s telling people things that are objectively wrong and that I don’t know what I’m doing. She tells people I “do root canals wrong” because I use an apex locator. I wrote up a template for post op instructions for EXTs and she told my assistant not to tell patients they could take ibuprofen and Tylenol together because “it doesn’t work”. She told another employee (who was pregnant) that lidocaine is dangerous during pregnancy and shouldn’t be used after I had told her that was what was approved by the ADA and OBs. I’m obviously not infallible but it’s so frustrating being undermined at every turn by someone who is both wrong and massively less educated than me. Does anybody have experience with this? I want to pull her aside and tell her to cut it out but I strongly doubt she will listen, and would be super pissed and probably create a headache for my boss and assistant. What should I do?

Hey there!

I’m having a hard time with deep class Vs that are >1.5mm sub-g.

I’ve tried teflon and different sized cords, but I’m still having an issue getting a good gingival seal with composite, especially on molars. I’ve also tried just removing the gingiva with a bur, but then I’m not able to pack cord after and there’s a ton of bleeding (and often still bleeding even after we’ve used a hemostatic agent).

And don’t get me started on the topic of when the cord gets stuck under the composite after curing…

Sometimes if I feel it’s necessary, I talk to pts about amalgam as a better longterm alternative, but not many of them go for it.

I don’t have a laser but I do have an electrosurge. Should I be removing the gingiva with this?

Thanks in advance!