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For Dental Sales Professionals October, 2012

For Dental Sales Professionals June, 2010A partnered publication with Dental Sales Pro • www.dentalsalespro.com

Healthcare Reform and

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www.firstimpressionsmag.com : First Impressions : October 2012 : 3

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Phone: 770/263-5257FAX: 770/236-8023

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First Impressions (ISSN 1548-4165) is published bi-monthly by Medical Distribution Solutions Inc., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2012 by Medical Distribution Solutions Inc. All rights reserved. Subscriptions: $48 per year. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Medical Distribution Solutions Inc., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

OctOber 12

Publisher’s LetterACA and Reform – a mixed bag ............p.4Ask the Expert............................................p.6Conference ConversationsHow reps can stand out at conferences and events ........................ p.10Infection control’s expanding role .....................................p.14Meeting planning at its bestYears of experience as a meeting planner enable Shannon McCarthy to pull off a successful Yankee Dental Congress meeting every year. .................................p.18Dental ChairsA few probing questions on the part of the service tech can guide dentists who wonder whether it’s time to repair – or replace – their dental chairs. ............p.20

From service tech to branch manager…and the White House in between .......p.22The Sand that Creates the PearlHands-on strategies to support your client’s success. .............................. p.26Electric handpiecesLighter motors and lower prices help drive interest in electric handpieces.. .......................... p.28QuickBytes ..........................................p.30Windshieldtime .................................p.31Healthcare Reform and the Dental Market. ....................p.32

Coverage QuestionsHealthcare reform’s impact on medical care seems clear, but its impact on dental care is less so ............p.34

Demand and SupplyWho will take care of all the patients seeking oral healthcare? ......... p.40

The Quality ConundrumThe Affordable Care Act could advance the profession’s quest to identify quality oral healthcare, but efforts had begun before the law was passed.. .................. p.46Brace, or Embrace?Healthcare reform and dentistry: Supply chain implications .................... p.52

Dental sleep managementWith some education from their sales reps, dentists can take advantage of treatment opportunities. ................. p.54

Dirty Little SecretsInfection control expert Nancy Andrews answers your questions. ....... p.58

Tech Talk: Curing Lights ..............p.64A Driving ForceBurkhart Dental’s Dennis McSweeney follows his passion for restoring antique cars.. ........................................... p.66News .............................................................p.69Products ......................................................p.73New Office Build-Out: Risks and Rewards ................................p.74

p.66p.14 p.32

4 : October 2012 : First Impressions : www.firstimpressionsmag.com

publisher’s letter

IBrian Taylor

I, like many of you, have been following the healthcare reform now for years. We have been through the partisanship of the debate, the enactment of the law and now have had a peek at the first implementations of parts of the law that guarantees access to healthcare insurance for millions of currently uninsured.

The triple aim of healthcare reform has been to increase access, improve quality through measurable outcomes, and control costs. Cer-tainly each of these goals is admirable, and I doubt anyone is opposed to the intent of the legislation. However, I find it difficult to see how they will be achieved in real life.

Take the first aim of providing access to insurance for the millions of uninsured. The Supreme Court’s upholding of the individual mandate was key as it provides insurance com-panies the volume of customers ($) they need in order to cover those with pre-existing condi-tions. They need the premiums from younger, healthier people to subsidize the expense of those with chronic and costly conditions. That part I get. Where I see a problem is in the ca-pacity of our healthcare provider system to handle an influx of millions of “new” custom-ers demanding services. In other words, we aren’t creating new dentists and doctors over-night. In fact, we have massive shortages.

It’s hard to imagine how providers will be able to serve all these new customers – there are only so many hours in a day. In Massachu-setts (which has universal coverage already) the average wait time to see a family physician is considerably longer than other states. More importantly only 50 percent of physicians are

taking new patients, which leaves newly in-sured patients without a lot of options.

On the second point, improving out-comes is certainly where we are headed re-gardless of politics or legislation. Preventive dentistry is key not only to better oral health, but also is a huge factor if we are ever going to get costs under control. Data will drive improved outcomes. Products that are de-monstrably better in enhancing outcomes and patient experience will win the day. Sup-pliers will need to provide evidentiary proof of their claims. That might take some time.

The third piece of controlling costs is the toughest one. The premise that we will add millions of customers demanding healthcare while reducing costs defies logic. Something has to give. Nowhere in the whole legislative process has tort reform been given anything other than lip service as something that needs to be dealt with down the road. It is a major driver of healthcare costs. Yes, the concept of preventive care versus fee for service is a noble one and is intended to control costs by keeping patients healthier and therefore not in need of more expensive treatments.

Healthcare is the nation’s largest indus-try and arguably its most complex. Costs are indeed out of control but this legislation while well intended may help in some ways, but I would caution to be aware of the unin-tended consequences it may produce.

ACA and Reform – a mixed bag

Michael Bocian, Darby Dental SupplyRick Cacciatore, Iowa Dental SupplySteve Desautel, Dental Health Products Inc.Paul Jackson, Benco Dental

Suzanne Kump, Patterson DentalDawn Metcalf, Midway Dental SupplyLori Paulson, NDCTim Sullivan, Henry Schein Dental

Clinical boardBrent Agran, DDS, Northbrook, Ill.Clayton Davis, DMD, Duluth, Ga.Sheri Doniger, DDS, Lincolnwood, Ill.Nicholas Hein, DDS, Billings, Mo.Roshan Parikh, DDS, Olympia Fields, Ill

First Impressions editorial advisory board


ask the expert

A: There is an old saying that “little things make a big difference.” When it comes to selling to dental offices, it’s crucial to understand that your customers are buy-ing you and not just your company or product. It’s not an option to work on strengthening ways that separate you from others, it is a necessity. To clarify these two

points, remember that if two people from the same den-tal company prospected Dr. Smith separately, it is entirely possible (and highly probable) that one of the two gets the account, but not both. So, if it were entirely about your product or company, that wouldn’t be the case right? And, with my new updated survey results showing the average general dental practice receives over 20+ regular mail solicitations, four to eight cold calls (phone), and three to five “unannounced” walk-in cold calls daily (not

to mention the print ads, emails and online marketing promotions they see), if you don’t do some little things, you just won’t get noticed, or will be fighting an uphill battle from the start. Just like dentists have to market their practices to show potential patients how they dif-fer from other practices, you must do the same. There-

fore, here are three areas to focus on that will significantly contribute to greater prospecting success!

1. Become a resource for them. Let’s keep this simple. There are a ton of purchasing decisions that dentists have to make that are totally “unrelated” to what you sell even if you represent many product lines or services. Time is the most pre-cious commodity to a dentist, so if a salesperson is well connected or

networked within the industry (or the community) and can refer them to someone else that can help them with a problem or decision without them having to do the re-search to figure it out, that salesperson becomes a huge asset to the dentist and therefore he/she is more apt to want to do business with them and buy their product. Do you know the local handyman (plumber, painter) or IT/computer expert? Do you know a rep from a good laser company? Do you know a solid practice

Ask the ExpertA former practicing dentist and current sales expert answers your questions

By Anthony Stefanou, DMD, Founder, Dental Sales Academy

Editor’s Note: Anthony Stefanou, DMD, will answer reps’ questions on their dental customers. E-mail him your questions at [email protected].

Q: What are some of the intangibles I can work on that can differentiate me from other dental salespeople when prospecting offices?

Let’s keep this simple. There are a ton of purchasing decisions that dentists have to make that are totally “unrelated” to what you sell even if you represent many product lines or services.

FA_HuFriedy_3Dad_FI_08222012.pdf 1 8/23/12 9:30 AM


ask the expert

Dr. Tony Stefanou is a 1987 graduate of Tufts University School of Dental Medicine. In addition to being in private practice until 2005, Tony has been the VP of Sales & Marketing for several dental companies, and has been a private sales consultant and trainer for many sales teams in the industry. He is the founder of the Dental Sales Academy, and developer of the “How to Sell to Dentists” workshops, which are live, interactive two-day events offered several times a year. He can be reached at [email protected]; (917) 796-4538; or visit www.howtoselltodentists.com.

management or transitions consultant? By keeping your eyes and ears open when prospecting an office, when you tell them something like “I heard that your server crashed and that you aren’t happy with your computer guy … I have someone who is terrific and is located nearby. Give him a call and tell him I sent you and he will take good care of you,” you will be looked upon as an indispensable resource!

2. Get back to them immediately. Things have changed dramatically in regards to when it’s OK to return

a call or answer a question a dentist may have. The gap between what a dental company/salesperson thinks and what a dentist wants is widening. If you know this, and work diligently to make it a priority for you, you will be ahead of your competition. What do I mean? Well, when asked “how quickly do you expect a return call when con-tacting a rep or a company with a question,” 84 percent of dentists say within 24 hours. Now, 5 years ago, answering that same question, only 42 percent of dentists expected a 24-hour call back. That’s probably why when I asked the question to salespeople, 78 percent said “as long as I get back to them within two to three days it is usually OK.”

See the problem here? Commit to getting back to them that day, and you will get more business!

3. Keep up to date. This goes way beyond just the basic necessary concept of “knowing something about them” before you pick up the phone or walk in to the of-fice for the first time (which is a huge part of my base program and philosophy). Let’s face it … even though it shouldn’t take four to six months for a dentist to decide to buy your product, sometimes it just does. And, a lot can happen in six months since you first communicated

with them! Did the dentist take a vacation to Asia? Did she write an article for Inside Dentistry? Did the practice implement a sleep apnea program in the office? If you want to be different, take a few seconds before every call or visit to a dentist when prospecting them to see if any-thing has changed (for the better) since the last conver-sation, and make a point of letting them know you no-ticed. Think how you would feel if others did that for you.

These three suggestions are simple for anyone to em-brace. Making the commitment to do so will result in a significant increase in your sales numbers! [FI]

The gap between what a dental company/salesperson thinks and what a dentist wants

is widening. If you know this, and work diligently to make it a priority for you, you will be ahead of your competition.

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office managers

Conference ConversationsHow reps can stand out at conferences and events

Prior to the convention we asked our members what their main goal was when they attended conventions (not just AADOM’s). The main intent seemed to be gathering material for evaluation and to meet their local company represen-

tative. The members enjoy that they can gather materials and literature all at one location. The majority of our respondents had attended a meeting within the last six months. Since our members are education-driven, this did not surprise us at all.

Sales behaviorWe asked questions about sales behavior in the booth. The most common response to the question “What sales representative behav-ior have you most appreciated at the booth?” was that the manager

was treated as if they had clinical knowledge and was also seen as someone with purchasing power. Robin N. liked the reps that “asked if I had a particular need for a product or was just gathering information.” We suspect the conversation is different if the rep realizes that this is a foundation-laying conversation versus a close-the-sale conversation. Both conversations are important, but if the rep can identify the intention of the manager, he or she can make the most of their time with the attendee.

Editor’s Note: The relationship between office managers and sales teams can be a beautiful thing when it works

well. The American Association of Dental Office Managers (AADOM)

would love for every manager to have great relationships with their reps. We’re thankful that First Impressions has

allowed us to strengthen this relationship by giving us a voice in this column. Office

managers will respond to questions in order to provide insight into the decisions

we’re faced with for our practices.

Heather Colicchio Teresa Duncan

In the wake of our 8th Annual Conference in Scottsdale, Ariz., we were struck by how important intention is to the purchas-ing process. If a manager attends a dental meeting with the intention of purchasing and information-gathering, the sales

process is already underway. AADOM has been consistent in its messaging that exhibitors are partners in their practice’s success – not vendors that must be dealt with during a convention.


The flip-side of the previous question was “what sales represen-tative behavior has driven you away from a booth?” The answers ranged from ignoring the manager because their badge doesn’t read dentist or hygienist to the commonly ex-pressed dislike of pushy sales behav-ior. As an organization that puts on a major convention, we understand that this is a fine line to walk for the representative. The goal is sales, but it’s important to identify where the attendee is in the sales process. We would love for all of our exhibitors to walk away with pages of sales as well. The truth is that attendees will be all over the map as to whether they are ready to pull the purchase trigger. Identifying intention would be a great skill for representatives.

We also asked if they had a preference for local versus state meetings. Our members were split down the middle on this. Janie B. mentioned that “there is more time to ask ques-tions” at the local level. Several members mentioned that a turn-off for them was waiting a long time to talk with a rep at the state meetings. We understand that this is hard as every-one has the same blocks of time to meet with the sales reps. Our members are not likely to leave the educational sessions to visit the sales floor, so they have to wait with everyone else.

Best practicesSome comments about representative behavior we thought were worth noting: Agnes H. related one story that we loved. One of her reps walked her over to another booth to meet the rep of a water filtration company. Rosi-land P. loves when reps can talk about their product with-out badmouthing their competitor. Alisa F. wants you to know that Monday morning after the show is not the time

to do your follow-up call (we com-pletely agree!). Several mentioned that they’ve been ignored by reps who sat and texted during attendee times. We’ve seen this ourselves – we wouldn’t like it in the dental of-fice and we don’t care for it on the convention floor. Natalie R. appreci-ates the rep who knows the product very well. She can spot a new sales-person a mile away, and doesn’t like it when they try to pretend to know everything about a product but she is more familiar with it than they are.

The last question we asked was if members were likely to par-ticipate in booth giveaways. Again our members were split down the middle. One anonymous member said she did not need any more let-ter openers or drink cozies. Oth-

ers mentioned that they would absolutely participate in giveaways if it was an iPad, Kindle or other technology gift. Several stated that actual product giveaways or draw-ings would be great. Only a couple members objected to being added to a mailing list so we hope that there is a disclaimer or opt-out for mailing list usage. From our experience at our Annual Conference, drawings and raffles are a huge incentive for our members. We believe in building your mailing list, but just be honest about the collection of attendee information.

The survey answers were surprising – especially the split between the local and state meeting preference. These tips are meant to help you make the most of your booth time and to have successful and productive meetings throughout the year. We hope you will join us for our 9th Annual Conference next fall in Orlando, Fla. We’d like to thank the vendors that participated in our sold-out session this year – we can’t educate our members without you! [FI]

Heather Colicchio is the President and Founder of the American Association of Dental Office Managers and Teresa Duncan serves as their Educational Content Adviser. For more information on AADOM please visit www.dentalmanagers.com.

Are you wondering what’s on our mind? Send an email to [email protected] with the subject line “First Impressions.”

From our experience at our

Annual Conference, drawings and

raffles are a huge incentive for our

members. We believe in building

your mailing list, but just be honest about the collection of attendee

information.


OSAP Symposium

Infection control’s expanding roleF

rom infection control to in-fection prevention, to patient safety, to quality. The grow-ing sophistication, scope and

mission of infection prevention pro-fessionals in oral health was evident at this summer’s OSAP 2012 Sym-posium, the annual symposium of the Organization for Safety, Asepsis and Prevention.

Two goals of the symposium, rein-forced throughout, reflected the growing mission of OSAP and its members, according to Executive Director Therese Long. Those goals were:

• Identify the recent changes and emerging issues impacting dental infection prevention and safety in the following areas: science, technology, guidelines, regulations, policies, practices and products.

• Identify connections and resources offering strate-gies to increase compliance with the safe delivery of oral healthcare.

The theme of the Symposium, “Connecting to Drive Compliance,” addressed the two goals, says Long. “[It also] just happened to echo and support the U.S. Centers for

Disease Control and Prevention’s ac-ronym,” she adds. In fact, the CDC – which is located in Atlanta – had a high profile at the Symposium. The agency kicked off the educational portion of the Symposium and spon-sored tours of its museum. Many CDC employees presented and/or participated in the Symposium.

Approximately 300 people at-tended the Symposium, including 66 corporate members and vendors. The

event featured 25 exhibit tables.

Patient safety“Practitioners, educators and policymakers can serve den-tistry and the patient populations best by taking a broad view of patient safety and borrowing tools for improvement from other disciplines and professions,” said Evelyn Cuny, responding to questions from First Impressions following the Symposium. Cuny, one of the event’s speakers, is director of environmental health and safety at the Arthur A. Dugoni School of Dentistry in San Francisco, Calif.

“Infection prevention has always been a major focus of OSAP, but now the focus of the organization has expanded

to include promotion of analysis and prevention of adverse events through the use of quality assurance tools, teaching patient safety at the academic level for professional schools, and oth-er efforts to promote awareness and a culture of patient safety in dentistry.”

Just a few years ago, people in infection control didn’t always make the connection between their work and patient safety, said Cuny. “I think they saw safety in silos of infection OSAP members

Keynote Speaker Dr. Marion Bergman


OSAP Symposium

prevention, worker safety, hazardous materials, patient safety, ergonomics, etc.”

But recent events have forced infection control pro-fessionals to look at how their work affects patient safety, said Cuny. And that is changing their view of the profes-sion. “I think there’s a move towards looking at safety from a program point of view, as something that requires a comprehensive approach and a focus on a strong safety culture with supporting procedures and policies.”

QualityIssues surrounding patient safety fit into the larger discus-sion of quality.

“Dentistry is a profession that has always prided itself on being progressive and patient-centered, and that mindset

is true among the majority of professionals who have cho-sen dentistry as their life’s work,” said Cuny. “Patient safety and infection prevention are measures of quality and as such, demonstrate that commitment to outstanding patient care.”

Quality assurance measures are primarily used in institu-tional settings, such as large clinics and schools, she pointed out. “Because adverse events are rare in a small dental office setting, applying the tools of QA is probably not reasonable.

“However, practitioners can benefit from the efforts made because improvements…can be shared with the pro-fession through publications and continuing education. In ad-dition, information gained from self-assessment may be use-ful in the development of evidence-based recommendations by government agencies such as the CDC. Some examples could be root cause analysis of adverse events, such as medi-cation errors, wrong tooth extractions, swallowed or aspirated foreign objects and others; and collection and analysis of data related to exposure incidents among workers.”

MisconceptionsKaren Gregory, RN, director of compliance and education for Total Medical Compliance, Charlotte, N.C., spoke to Symposium attendees about common misconceptions den-tal workers have of safe practice in the dental environment

“One big misconception is that OSHA will cite you [for poor infection control practices], or that OSHA is respon-sible for patient safety measures,” she told First Impressions. But in fact, OSHA is concerned about the safety of employ-ees, not patients. That said, dental offices with poor infec-tion control practices should be prepared for a visit from the state dental board or other regulatory agency.

A second misconception – perhaps not as widespread as in years past, but still out there – is that it’s OK to reuse something that has been marked “single use,” said

Gregory. Some hospitals and various third-party reproces-sors have mastered the practice of reprocessing high-cost, single-use devices, such as guidewires or biopsy forceps, she said. In fact, the Food and Drug Administration has OK’d the practice, so long as the hospital or third-party reprocessor complies with the same requirements that ap-ply to original equipment manufacturers.

But no items have been identified for reuse in the out-patient environment, pointed out Gregory. In addition, few dental offices have the expertise to do so. What’s more, the single-use items that dental offices tend to reprocess are usually insignificant in cost, such as impression trays or plastic syringes. “These products aren’t expensive,” she said. “Yet you’ll see [reprocessing].”

FutureThe key to high-quality infection prevention lies with the staff, said Gregory. “I’ve found that when most people understand,

Cheryl AwardHarte AwardPamela Norma award


‘This is what I’m supposed to do,’ they try to get it done.” Sometimes it’s just remembering the basics, and that gets back to education, she said. If prac-tices face another obstacle in achieving excellence in infection prevention, it’s time – or lack of it. “These practices are busy,” she said.

“I worked in the medical office. One of the things about working there is that you have to be a jack of all trades. That’s true in the dental office too.” Hospitals have dedicated sterile processing departments, with trained, knowledgeable people processing in-struments. Not so most dental offic-es. “You’re trying to do the back-end things, and providing care chairside too. That’s the challenge.” Successful practices have taken the time to orga-nize their processes, so everyone un-derstands what they’re supposed to do.

Despite the challenges, Gregory is optimistic about the status of in-fection prevention in dental prac-tices. “There’s more awareness; I see more people talking about it.” Part of that awareness is due to serious, highly publicized breaches in in-fection prevention in the past year. “They have made people pay atten-tion,” she said. “People are saying, ‘I need to make sure that couldn’t hap-pen in my environment.’”

To Gregory, the gold standard of infection prevention is the set of CDC recommendations, published in 2003. (See http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm.) Each dental practice should be fa-miliar with this guidance and strive to implement its rec-ommendations, she says.

She applauds OSAP for working hard to convey a consistent message to practices. “The word is getting out, and more and more people are on the same page. There’s less of, ‘One person told me this, and another

told me that.’” Vendor reps can be an asset to practices, as they too are more educated than ever on what’s needed to achieve excellence in infection prevention.

Infection control experts are in-creasingly playing another important role in oral healthcare – providing as-sistance to dentists who donate their services to underserved countries and underserved areas of the United States, said Cuny.

“Increasingly, members of the profession in the more developed world are reaching out to developing nations to assist them in providing oral healthcare services and educa-tion,” she said. Much of this work in the United States takes place in alternative settings, such as schools, mobile dental clinics and large sta-diums or other non-clinical settings using mobile dental equipment, she pointed out. “There is work to be done to help the people undertaking these huge efforts ensure that infec-tion control practices are not com-promised in these sometimes chal-lenging alternative settings.”

Ad campaignAt the Symposium, OSAP launched a new ad campaign with a clear mes-

sage: Dental safety is serious business. “OSAP’s mission is to advocate for the safe and infection-free delivery of oral healthcare,” said Long, in a statement. “This new ad cam-paign offers a concerted effort to raise brand awareness and position OSAP as a leader in preventing the spread of infection in traditional dental settings and for emerging models of care.” The ad campaign features the OSAP icon emphasizing its branding while clearly stating the organiza-tion’s benefits to dentistry.

The 2013 Symposium is scheduled for June 13-15 at the Hyatt Mission Bay in San Diego, Calif. [FI]

Hu-Friedy

Lecture

Executive Board


first person

For Shannon McCarthy, coordinating 800 volunteer dentists, 900+ booths and 500 companies is no easy task. But her hard work pays off annually, and the result – the annual Yankee Dental Congress dental

meeting in Boston, Mass. – is well worth her efforts, she points out. In a recent interview with First Impressions Magazine,

McCarthy sheds light on what it takes to pull off the Yan-kee Dental Congress dental meeting.

First Impressions Magazine: How long have you been doing this and how did you become involved in this role?McCarthy: I was actually an Eng-lish major in college and was hired to work on the journal the society publishes. When my current position opened up, the woman leaving had 25 years of experience. She came from the supermarket industry and was a great mentor – very hands on about explaining how to do everything. I learned a tremendous amount about the position from her.

FI: What are your basic responsibilities with regard to or-ganizing the annual meeting?McCarthy: I begin every year by creating a floor plan. We map out the floor layout – where the food court, exhibi-tors and everything else goes. Once the general chairper-son selects the show’s theme, I work with the service con-tractor to create the overall “look” of the show. Each year, we try to create a new look. I also work with the conven-tion center’s food service to plan meals. I oversee exhibit, sponsorship and advertising booth sales. And, I work with vendors around the show speakers. When new or special events arise, we have those covered as well.

FI: What are your greatest challenges organizing such a large-scale meeting and how have you addressed these challenges? McCarthy: We welcome vendors reaching out to us with their questions, rather than dealing with their frustration on their own. We can explain our decisions [such as hold-ing a meeting in the Northeast in January]. There are only a couple of open months when we can hold the meet-ing. With so many colleges located in Boston, we couldn’t get the hotel rooms we need in May. And, rates are lower in January. Also, some vendors have expressed a desire to limit the show to dental products aimed at the dentist. But,

our show is for the whole dental staff. So, [some attendees] are interested in new shoes and scrubs – as well as the funny little dental pin to wear on scrubs. It’s all about striking a balance and keeping everyone happy.

FI: How have you gotten better and smarter at planning meetings?McCarthy: Yes. The key is to keep an open mind about meeting planning. I attend as many non-dental meetings

as I can to see if there is a better way to lay out the show floor, or a way to improve the meeting and make it a great experience for both exhibitors and attendees. We are at the convention center throughout the year, and I continu-ally ask our service contractors to send us new and unique ideas they come across.

FI: What do you hope your attendees take away from the Yankee Dental meeting each year?McCarthy: This is a constantly changing industry, and these meeting are an opportunity for all of us to work and partner together. [FI]

Meeting planning at its bestYears of experience as a meeting planner enable Shannon McCarthy to pull off a successful Yankee Dental Congress meeting every year.

Editor’s Note: This is an abridged version of the Shannon McCarthy interview. For the full article, look for the November digital issue of First Impressions Magazine at www.firstimpressionsmag.com.

Shannon McCarthy

W e a r e p e o p l e p r o t e c t i o n.®


service techs

Dental chairs today are much improved over early models. New features, such as heat and massage, are designed to relax patients and enhance current procedures – particularly

longer procedures. Advanced hydraulic systems and struc-tural components support patients weighing up to 450 pounds and offer soft start/stop movement. Construction and engineering designs, such as cantilevered forward-lift mechanisms, help improve access for both the doctor and patient, including patients with special needs.

With careful troubleshooting, service technicians can help their dental customers determine when the time is right to repair – or replace – old equipment that no longer functions properly. Generally this involves technicians inspecting internal components of the chair and adjusting moving components, including the tension of headrests so they move well, the inter-nal components of the headrest clamp, rotation brakes, the arm rest swivel, checking hydraulic fittings, fluid levels, inspections of wiring, connectors and harnesses, etc. He or she also should remind dental customers to incorporate a standard cleaning protocol and remember to use barriers as much as possible.

Enhancing the life of the equipmentWhen dentists are aware of warning signs indicating a den-tal chair is failing or in need of a service call, they can take necessary steps to correct the problem and possibly preserve the equipment. Service techs should educate their customers to watch for the following problems:

• The chair doesn’t hold its position.• The power indicator light will not turn on. • The chair does not respond to input.• Trace signs indicate an oil leak, or oil seeps from un-

der covers or on the floor near the base of the chair.• Any unusual sounds or smells.• Any movement that either sounds like metal on

metal rubbing or has a grinding feel.

Service technicians should instruct dentists to respond accordingly:

• Use barriers to reduce direct contact with patients and harsh cleaners.

• Follow proper cleaning procedures referenced in the product’s user guide.

• Watch for accessories or attachments to the chair that might loosen up over time.

• Schedule routine maintenance and inspections by an authorized service company, because sometimes problems grow and are not noticed by the office.

Starting a discussionA conversation between the service tech and the dental customer can help the customer make the best decision regarding replacing old dental chairs or purchasing new ones. Some good probing questions, such as the following, can help launch a productive discussion:

• “Doctor, how old is the chair?” • “How much are you willing to pay for the repair?”• “If it isn’t under warranty, are you still interested in

proceeding with a repair?” • “How often is the chair used?”• “How much will a new chair cost?”• “What features would you like to see with a new chair?”

(The dental office needs to consider the message or image a chair sends to patients, so sales reps should also have this conversation with their customers.)

• “Has your patient profile changed over the years? Are many of your patients today older, larger or less agile than they once were?”

In the end, a brief discussion with dental customers can lead to a lot of value-added service on the part of the tech – and a trust-building relationship with his or her customers.[FI]

Dental ChairsA few probing questions on the part of the service tech can guide dentists who wonder whether it’s time to repair – or replace – their dental chairs.

Editor’s Note: First Impressions would like to thank Midmark Corp. for its assistance with this piece.


service tech profile

Few service techs can say they got into the profession because it gave them a chance to stay grounded. Literally. On land. But that’s what

led Midco Dental branch manager Tim Geller to dental equipment repair.

It was 1976, and Geller, a native of Anderson, Ind., had enlisted in the Navy. “Two things always fascinated me,” he says. “To be a pilot, and ar-chitecture.” His vision wasn’t 20/20, so he knew he couldn’t fly. He hoped that, in the Navy, he could train to be an air traffic controller. But he learned that candidates needed 20/20 vision to serve in that capacity.

Faced with a number of options, he chose to go to school to be a dental assistant. “I did it so I wouldn’t have to stay on a ship all the time,” he says, adding, “there are a lot more land bil-lets than ship billets.” Following three months of instruction, he was trans-ferred to Great Lakes Naval Station, just north of Chicago, in 1977, to work as a dental assistant. The work was OK, but he knew it wasn’t a long-term thing. “Sitting in a stool all day wasn’t my cup of tea,” he says.

C school“I had always been mechanically in-clined,” explains Geller, who built dragsters, including a Firebird, when he was young. So it’s not surprising that, while working as an assistant, he became interested in the work that the techs did in his office. “I got to know them pretty well,” he recalls. “And it got to the point where they said, ‘Maybe we could use your help.’” His first repair job wasn’t in the dental of-fice, but rather, building maintenance. Ultimately, he entered “C school” in San Diego, a nine-month course on dental repair, including three months in electricity and six months in dental equipment repair.

“I was happy to be using my hands and having to think,” says Geller. “And I had been in the dental field long enough to know there were opportuni-ties outside the Navy, so I could land a

From service tech to branch manager

…and the White House

in between


“I’d like to think it was because of my knowledge. I could fix things pretty well,

didn’t get many recalls.”– Tim Geller

job.” But before that was to happen, he had some pretty interesting oppor-tunities in the Navy.

“I got orders to go to Washing-ton, D.C., to work at the Navy Yard,” he recalls. One day, his chief called him in to his office and told him he was going to work on the White House dental equipment.

“I’d like to think it was because of my knowledge,” he says. “I could fix things pretty well, didn’t get many re-calls.” He also felt that he had a good way with people. “My mom and dad taught me manners,” he says. “I could talk to people, and listen to them.”

So, every six months, he’d go to the White House, and, with a Marine escort, go downstairs to work on the equip-ment in its one-chair operatory. “I did meet Amy Carter [daughter of President Jimmy Carter and his wife, Rosalynn Carter] once. And I met President Reagan. Friendly guy.”

In 1982, upon his discharge from the Navy, Geller returned to Anderson and took a job as a service tech with Ryker Dental. About a year and a half later, with a downturn in business and the economy, he lost his job. Rather than seek a similar position with another company, he decided to use his GI Bill benefits to take business courses at Ball State University in Mun-cie, Ind. But while studying there, he got a call from a manager at Healthco Dental about a service tech opening. “I thought, what the heck, I’ll go interview with them.” They gave him an offer he couldn’t refuse, and for two and a half years, Geller was a service tech in Indiana for Healthco.

His career path took another turn, however, when three doctors with whom he had become acquainted pooled their money and financed Geller Dental, an inde-pendent dental equipment repair company. “It was great,” he says. “I had my own company.”

Desert StormSo why did he close up shop suddenly in April 1990? “I got a knock on the door from a special carrier inform-ing me I had to report in 24 hours to Camp Pendleton in California for Desert Storm,” that is, the United Nations engagement to drive invading Iraqi forces out of Kuwait. Geller remained on active duty for 14 months, stationed in California, maintaining dental equipment stateside. “I was just a normal repairman, on active duty.” In July 1991, he returned to Anderson.

“I decided to try something outside the dental field,” he says. So, he became a quality control officer for a metal

Tim Geller with family.


service tech profile

stamping company. “I liked it. I wasn’t stuck in one place. I enjoyed talking to people, checking on things. But after awhile, I started missing dental.”

In January 1992, the Navy spon-sored an appreciation weekend in Dal-las, for reservists who had participated in Desert Storm. There, he met some-one who worked for Reeve Dental (now Burkhart Dental), who happened to mention his company was looking for a service manager to manage their service department. After he returned to Indiana, Geller got a phone call from a manager at Reeve, who asked him if he would be interested in relocating to Tulsa, Okla., to take the job. When the kids finished their school year, the fam-ily moved to Tulsa.

Like most of his professional ex-periences, Geller’s work with Reeve was rewarding. “I have had good ex-periences,” he says. Five years later, in 1997, he was transferred to Reeve’s Irving, Texas, branch, to become service manager. He stayed with Bur-khart for a number of years after the company acquired Reeve, then, went to work for Patterson Dental as in-stall manager in Dallas.

Branch managerAbout nine years ago, in 2003, he made the move to a smaller, family-owned company, Tuttle, Okla.-based Midco Dental. He was attracted by the opportunity to help owner Rick Owen build the business. He did ser-vice work in Midco’s newly opened Dallas branch, and two years later, in 2005, became branch manager when Owen decided to open a merchandise division. (Midco was recognized as the National Distribution & Contracting

Dental Member of the Year in Feb-ruary 2012, for exceeding goals in all categories in 2011 – sales, warehouse purchases and private brand support.)

Geller believes that his work in the field as a service tech prepared him well for his new job as branch manager. The years he spent honing his listening skills provided the great-est training of all, he says.

As branch manager, Geller has gained some new perspectives on the role of the service tech, and has rein-forced some old ones. Service techs have always been an important part of the dental distributor’s offering. “You have to have a service depart-ment to be a full-fledged distributor,” he says. Service techs also wield a lot of influence with the customer. That can be good, when the service tech is effective; but it can be harmful, if the service tech alienates the customer.

The demands on techs have changed. “When I first got into the business, you had to worry about pneumatics, hydraulics and electric-ity,” he says. “Today, it’s software, memory, computers.”

A good service tech knows the value of listening, particularly resist-ing the urge to come to conclusions before you hear exactly what the other person has to say. “It’s key,” he says.

Geller coached girls’ softball for 12 years, and boys’ football for eight years. He and his wife, Lisa, have seven children and 12 grandchildren. They live a couple of miles from Lewisville Lake, just north of Dallas, and enjoy boating and jet-skiing. He also enjoys woodworking, though he can’t seem to find the time to work that hobby as much as he’d like. [FI]

Granddaughter Kaylie Spring

Granddaughter Madison Spring

“When I first got into the business, you had to worry

about pneumatics, hydraulics and

electricity. Today, it’s software, memory,

computers.”– Tim Geller

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The fluoride varnish you have been selling might not have the fluoride release you think!


sales

The Sand that Creates the PearlHands-on strategies to support your client’s success.

By Ginny Hegarty, SPHR

Consider all the different hats that the average den-tist wears each day: A dentist is potentially the Owner, CEO, COO, CFO, HR Director, Market-ing Director, Doctor, Clinical Expert, Employer,

Manager, Teacher, Mentor and Confidant. It’s routine to be making a treatment recommendation to a patient one mo-ment, then making budgetary decisions regarding practice purchases, move onto counseling a team member to meet performance expectations and then review practice reports to evaluate productivity and profitability trends in prepa-ration for leading a team meeting. Sprinkle in phone calls from specialists, financial advisors, laboratories, colleagues, patients and family members and the full demands of this profession become pretty clear. Is it any wonder that your dentist clients may seem distracted when you visit?

Herein lies your greatest opportunity to support your clients and set yourself apart. Be the sand that creates the pearl.

When your client is stressed, the tempta-tion is to provide stress relief, to be the respite in a hectic day. Resist the urge to play it safe. In-stead, bypass temporary relief strategies and focus on game-changing strategies that will set you apart.

New way of thinkingChallenge the status quo and get your client thinking out-side the box. Here’s an example: Author T. Harv Eker calls out the naysayers who criticize people who wish to “have their cake and eat it too.” We’ve all heard this expression, most often used with a negative connotation to shame those who wish to have more than they should expect. Eker turns it around and asks “Why else would you want a cake if not to eat it?” Why shouldn’t we want to, and even deserve to,

enjoy our cake? Eker explains that when faced with the choice such as “Do you want a happy life or financial suc-cess?” there is no good reason not to choose to have both.

Apply this philosophy with your clients. For example, as I visit dental practices around the country, I routinely see doctors struggling with questions such as:

Should we…• see the emergency patient or finish up the day on time? • work less days this month to attend a continuing

education course or make goal?• avoid monthly patient billing or offer payment

plans to patients? • confront the drama in the practice or

keep the peace?• invest in new technology or keep

overhead in the desired range?

Rather than see these situations as either/or dilemmas, I challenge my doc-

tors to “choose both.” For example, they brainstorm solutions to triage an emergency

patient while staying on time with scheduled patients; it’s definitely possible. Even better, it’s a ter-

rific strategy for predictably meeting daily productivity and profitability goals.

Connect the dots to help your doctors see the correlation between new collaborative ventures with you and your part-ners and long-term financial success. Weigh in on the doctor’s stressors of the day. Listen well, step outside the box, reframe the choices and when two good options exist, encourage your clients to choose both. You’ll be rewarded by the opportunity to make a difference for your client, your company and your-self. Triple win solutions are always the best. [FI]

Owner and President of Dental Practice Development, Inc., Ginny Hegarty, SPHR is best known as a breakthrough expert specializing in business leadership, accountability and employee engagement. She works with leading dental teams and dental sales teams providing on-site communication workshops to support sustainable bottom-line success. Hegarty is a visiting faculty member at The Las Vegas Institute for Advanced Dental Studies (LVI), lectures at Temple University’s Kornberg School of Dentistry in Philadelphia, authors the HR411 column in The Progressive Dentist & The Progressive Orthodontist Magazines and is the President of the Academy of Dental Management Consultants. She can be reached at www.ginnyhegarty.com or (610) 873-8404


sales focus: handpieces

Electric handpiecesLighter motors and lower prices help drive interest in electric handpieces.

There was a time when dentists balked at electric handpieces. No more. Today’s models are lighter weight, easier to maneuver and lower-priced than their predecessors.

Today’s lighter motors and titanium body construction have moved the balance point toward the user’s wrist, mak-ing them easier to handle and mimicking the feel of air-driv-en handpieces, according to experts. Some models now cost as low as $3,650, including a micro-motor – which permits speed adjustments with the push of a button – and a couple of attachments. Attachments have also come down in price, from $950 to $1,350, and they generally are interchangeable from one brand of handpiece to the next.

Not that price should always drive a dentist’s purchasing decisions. Depending on the needs of a practice, higher-end models may offer such features as LED optics quarto-water spray for more efficient cooling, greater durability and easier maneuverability/accessibility for the user (e.g., a slimmer neck helps facili-tate easier access to difficult-to-reach areas in the patient’s mouth).

Conversation startersAdding electric handpieces to the operatory calls for little adjust-ment on the part of the dental practice, especially since there typically is an electric line avail-able under the dental chair. The handpiece can be installed on the chair or mounted nearby using a bracket. Depending on the size of the practice and the type of dental work performed, most practices require three to five electric hand-pieces per operatory. Sales reps can

ask several probing questions, such as the following, to gauge their customers’ needs:

• “Doctor, have you ever considered using electric handpieces?” (Some dental schools train students on electric, while others do not.)

• “Have you tried using electric handpieces in the past? If so, what did you like – or not like – about them?” (When dentists express their objections, sales reps can take advantage of the opportunity to address advances and improvements in the technology.)

• “Would you be interested in giving electric hand-pieces another try, now that they have become easier to use and more affordable?”

Many dentists today might be sur-prised to learn how lightweight and easy to use electric handpieces have become. By providing customers with concise, easy-to-understand informa-tion, sales reps can help ensure they realize the value this product can offer their practice. Particularly as 2012 tax breaks near their expiration, now may be the best time for dentists to add new electric handpieces or replace old ones. Devices that stall or provide too little power might not be usable in an-other six months. (Service technicians can determine whether a handpiece is in need of repair or replacement.)

But, whether or not dental custom-ers are ready to replace older units, sales reps can provide value to a practice by reminding dentists that regular lubing with a manufacturer-recommended spray – and regular maintenance before autoclaving – can help extend the life of their electric handpieces. [FI]

Micro-motors weigh less, offer more

The micro-motors being placed in many electric handpieces today may be small

in size. But, they have a lot to offer in value. Today’s micro-motors are brush-

less units (compared with previous brush models) and require less cleaning. A special drive on the brushless models

shut down the unit if it gets too hot, thereby helping to avoid overheating.

Additional features of micro-motors include:

• Enhanced torque.• Reduced noise.

• Conduction cooling.• Extended lifetime.

And, the compact size of the motor permits it to remain enclosed, there-by reducing the risk of dirt and other

foreign matter penetrating it.

Editor’s Note: First Impressions Magazine would like to thank NSK Dental LLC for its assistance with this piece.


Editor’s Note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, First Impressions will profile the latest developments in software and gadgets that reps can use for work and play.

Sports moms and dadsIf you’re coaching your kid’s sports team, or just the par-ent of a kid on a team, you might want to check out Team-Snap, a mobile and web service said to be used by almost a million and a half players, parents and coaches to man-age sports teams and leagues. Begun with a web-only plat-form, the company’s mobile app for iPhones and iPads was reportedly used 650,000 times in June. The app is said to make it easy to keep track of rosters, schedules, game and practice attendance and availability, team payments, statistics and more. A messaging function is included.

Life with SiriDery Books announced that Volume 2 of its “Life With Siri” eBook series is now available as an iBook on iTunes. This new volume joins the three earlier “Life With Siri” books. Volume 2 contains more than 100 pages, with 56 new Siri tips and 52 Siri questions that evoke funny answers. Priced at $1.99, the new volume is also available as a Kindle edition from Amazon and as a Nook edition from Barnes & Noble. While most eBooks are primarily text-based, “Life With Siri” is extensively illustrative, using original screen-shots to demonstrate how to most effectively use Siri.

Samsung Media HubPreloaded on the Galaxy S® III and other select Samsung smartphones, Samsung Media Hub is said to offer users

access to a broad collection of movies, as well as single ep-isodes or full seasons of TV shows, many available the day after original broadcast. Partners providing content for the service include CBS, Fox, MTV Networks, NBC Universal, Paramount and Warner Bros. Digital Distribution. Con-sumers select the content they want, confirm payment and start watching while the remainder of the show or movie downloads. All charges appear on their monthly AT&T bill. The Samsung Captivate™ and Samsung Galaxy Ex-hilarate™ from AT&T will also permit carrier billing op-tions for Media Hub content, according to Samsung. The

Samsung Galaxy Note™ and Galaxy S® II devices will receive carrier bill-ing capabilities through the upcoming software update to Android™ 4.0 Ice Cream Sandwich operating system.

The well-dressed sales repWant to look your best in the field? Feel like wearing a bow tie but don’t

know how to tie one? A recent edition of the New York Times looked at a variety of apps to help. Necktie Deluxe, for example, available through the Apple App Store, can show you how to tie your ties. Want to see how different hairstyles would look on you? Go to Hairstyle Salon. An-other hairstyle app, Men’s Hairstyles, is said to offer more than 240 hairstyle options for you to “try on.” BeardMe allows you to put facial hair on your photo, to see how you’d look in a variety of moustaches and beards. Cool Guy, which is free on iOS and Android, lets you mix and match clothes you already own after you’ve snapped pho-tos of them. And if you feel one of your friends or col-leagues needs your expert styling advice, the free Send A Tip app lets you send an anonymous e-mail to someone to point out a grooming slip-up. [FI]

Cool Guy, which is free on iOS and Android, lets you mix and match clothes you already own after you’ve snapped photos of them.


WindshieldtimeChances are you spend a lot of time in your car.

Here’s some automotive-related news that might help you appreciate your home-away-from-home a little more.

Personalized driving experienceHonda will unveil HondaLink™, an in-vehicle connectivity system, on the 2013 Honda Accord. Featuring the first au-tomotive OEM application of Aha™ by Harman, Honda-Link is said to provide a personalized experience connecting drivers to cloud-based news, information and entertainment feeds, using an intuitive, audio-system based interface. The HondaLink smartphone application allows owners to preset content on their phone. Once in the car, consumers will be able to listen to personalized content accessible via voice rec-ognition, steering-wheel mounted controls and in-dash audio system controls. HondaLink will also incorporate Pandora Internet radio and voice-to-text SMS text services with pre-programmed responses, which Honda introduced on the 2012 CR-V.

Dangers of sleep-deprived drivingYoung drivers don’t recognize the dan-gers of sleep-deprived driving, accord-ing to a recent study in the Journal of Safety Research from the National Safety Council. Sleep-deprived driving can be as dangerous as alcohol-impaired driv-ing, but attitudes about drowsy driving are less known, according to the Council. The study explains that: 1) sleep-related and alcohol-related car crashes occur predominantly among young drivers; 2) among drivers tak-ing long trips on the highway, drivers under the age of 30 are more sleep-deprived than other age groups, and 3) the driving errors displayed by drinking drivers are very similar to those of drowsy drivers

550 miles for Ford’s plug-in hybridFord’s first-ever plug-in hybrid – the C-MAX Energi utility – is projected to deliver 550 miles of total range, including more than 20 miles in electric-only mode – nearly double the elec-tric-only range of the Toyota Prius plug-in hybrid, according

to Ford. The C-MAX Energi – available this fall – will be Ford’s first production plug-in hybrid and part of Ford’s first hybrid-only dedicated line of vehicles. The vehicle is said to operate as a traditional hybrid, with two differences: Owners must plug in the vehicle using its charge port, and C-MAX Energi has a larger battery pack. Ford’s other electrified vehi-cles for 2013 are the Focus Electric, C-MAX Hybrid, Fusion Hybrid and Fusion Energi plug-in hybrid.

Carfax on AndroidCarfax announced that an Android version of the Carfax Reports mobile app is available to smartphone users. Carfax Ve-hicle History Reports can be viewed in a matter of seconds with

just a few screen taps. Used car shoppers needing Carfax information have three ways to access it – entering the vehicle identification number (VIN), license plate or scanning the barcode. Carfax created the Vehicle History Report in 1986 and maintains the largest vehicle history data-base ever assembled, comprising over 10 billion vehicle records from more than 34,000 sources across North America, according to the company.

The rise of the little SUVThe traditional SUV is going by the wayside, says Alexander Edwards, president of the automotive division of Strate-gic Vision, a San Diego, Calif.-based market research firm, as quoted in the Wall Street Journal. In its place is the small SUV, such as the Ford Escape, Honda CR-V, Toyota RAV 4, Kia Sorrento, Chevrolet Equinox and a raft of compact crossover wagons. In 2006, small SUVs – some with four-cylinder engines – accounted for just 9 percent of the mar-ket; now they represent about 14 percent of all vehicles sold in the United States. Why? They look good and they don’t guzzle as much gas as their predecessors. [FI]

In 2006, small SUVs – some with four-cylinder

engines – accounted for just 9 percent of

the market; now they represent about

14 percent of all vehicles sold in the United States.


cover storycover story


It’s full steam ahead for healthcare re-form. But chances are, reform would have moved forward regardless of how the Supreme Court had ruled on the Affordable Care Act, though the

pace might have been affected, according to those with whom First Impressions spoke. And reform will no doubt continue regardless of what happens in the November election, too, they say, adding there’s too much at stake for it to grind to a halt.

What will it mean moving forward for the dental market? First Impressions examines.

Healthcare Reform and the Dental Market


cover storycover story

The Affordable Care Act will expand health insurance coverage to millions of uninsured Americans. Its impact on medical care seems clear, but its impact on oral health remains to be seen. The healthcare reform law was largely

upheld by the U.S. Supreme Court on June 28.More than 15 million U.S. children, primarily from

low-income families, go without seeing a dentist each year, according to the Pew Center on the States in its recently re-leased report, “Expanding the Dental Safety Net.” Studies show this lack of care contributes to a significant number of missed school days, frequent trips to emergency rooms, and worsened job prospects as adults.

What’s more, 47 million Americans live in areas that are federally designated as having dentist shortages, cites Pew. A 2009 survey found that in 25 states, fewer than half of den-tists treated Medicaid-enrolled patients. Dentists frequently cite low reimbursement rates and cumbersome administrative requirements as reasons for not participating in Medicaid.

The Affordable Care Act attempts to address issues such as these.

Most notably, starting in 2014, consumers will be able to buy health insurance directly through what the govern-ment calls “Affordable Insurance Exchanges.” These ex-changes, which will be set up in each state, are intended to serve as competitive insurance marketplaces, where

individuals and small businesses can buy affordable and qualified health benefit plans, according to the Depart-ment of Health and Human Services. States have the op-portunity to set up their own exchanges, but if they are unable or unwilling to do so, the feds will do it for them.

Exchanges will offer consumers a choice of health plans that meet certain benefits and cost standards. And each must offer what the government calls “essential health benefits,” including items and services within at least 10 cat-egories, one of which is “pediatric oral care services.”

Millions of childrenFollowing the Supreme Court decision, the American Den-

tal Association noted that the law could expand dental coverage to “millions of additional children, many of whom have suffered with untreated dental disease.”

“The ADA advocated vigorously for increased children’s coverage, including how the ‘essential dental benefit’ for chil-dren is defined, in the months leading up to the law’s passage and is grateful that it remains intact,” said the Association.

But the association expressed dis-appointment with the Supreme Court’s decision to strike down a provision of the Affordable Care Act that would have withheld Medicaid funds to states that refused to ex-pand their programs to include more people.

“The ruling further diminishes the likelihood that tens of millions of low-income adults will gain better access to care,” said the ADA at the time. “Instead they will contin-ue to face such barriers as poverty, poor health literacy, cul-tural and language distinctions, geographic location, and lack of access to fluoridated drinking water that prevent them from achieving good oral health. Each of these bar-riers must be overcome if our communities are to attain an acceptable level of oral health.”

Coverage QuestionsHealthcare reform’s impact on medical care seems clear, but its impact on dental care is less so

“The ADA advocated vigorously for increased children’s

coverage, including how the ‘essential dental benefit’ for

children is defined, in the months leading up to the

law’s passage and is grateful that it remains intact.”

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cover story

‘An important benchmark’Responding to questions from First Impressions, the ADA ex-pressed relief that the Affordable Care Act emerged largely unscathed by the U.S Supreme Court. Had the entire law been overturned, “in the short term, there would likely be fewer people with dental coverage and it has been demon-strated that high-quality dental coverage reduces some of the barriers to oral health care,” the Association said.

“Including the pediatric oral benefit as part of the es-sential health benefit package is a very important bench-mark that will expand coverage to those currently without employer-provided coverage and who do not qualify for a government funded program.”

Many questions remain. For example, the Department of Health and Human Services had yet, at press time, to define exactly what is included in “pediatric oral services.”

“The agency has indicated that the state can select from several benchmark plans,” said the ADA, respond-ing to FI’s questions. “In federally facilitated exchanges the benefit package will in most cases be the most popu-lar small group plan in the affected state. If there is no dental coverage in the selected small market plan, the default dental coverage for children will be either the Children’s Health Insurance Program (CHIP) benefit package or the Federal Employees Dental and Vision In-surance Program (FEDVIP) dental plan with the largest national enrollment.”

The law should result in more adults receiving care as well, says the ADA. “The new benefit require-ment targets children, but we expect more adults will be covered as well. The challenge will be addressing the shortcomings with the current Medicaid program, such as inadequate reimbursement and administrative barriers. However, it has already been demonstrated in programs like ‘Healthy Kids Dental’ in Michigan (where more than 90 percent of dentists participate) that currently practicing dentists are able to provide the care needed.”

The Affordable Care Act contains other provisions that will affect dentists and their patients – some good, some not so good. According to the ADA, they include the following:

• Funding for health information technology in-frastructure and includes assistance for providers treating Medicaid patients, and some dentists may choose to take advantage of this funding.

• Enhanced funding under Title VII for training health professions and the National Health Service Corps, which improves access to care for under-served populations.

• Tax incentives to help offset the costs associated with providing health insurance to their employees through state exchanges or small business health options.

• A new cap on flexible spending accounts, which will affect patients who have used these funds to pay for coverage not included in dental plans or for patients without dental benefits.

• The medical device tax, which will add to the cost of providing care, says the ADA, which supports a repeal of this provision.

The Affordable Care Act ensures health plans of-fered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits must include items and services within at least the following 10 categories:• Ambulatory patient services.• Emergency services.• Hospitalization.• Maternity and newborn care.• Mental health and substance use disorder

services, including behavioral health treatment.• Prescription drugs.• Rehabilitative and habilitative services

and devices.• Laboratory services.• Preventive and wellness services and chronic

disease management.• Pediatric services, including oral and vision care.

Source: http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefit-s12162011a.html

Essential Health Benefits


Dental benefits addressedDelta Dental Plans Association sees pluses, minuses and question marks in the Affordable Care Act, as it emerged following the Supreme Court’s ruling, says Chris Pyle, di-rector, state government and public relations.

“In my view, the ACA made some real strides toward providing universal coverage to children, and that would have been lost if the law had been overturned,” he told First Impressions. “Now that the Court has determined its constitutionality, our aim is getting children and adults in this country meaningful and affordable coverage.”

In September 2011, the National Association of Den-tal Plans and Delta Dental Plans Association issued a white paper regarding dental benefits in health exchanges. At the time, Kim Volk, president and CEO of DDPA, said it was important that states address dental ben-efits as they put together exchange rules and shopping systems. That process is ongoing, says Pyle.

“The reality is that those states that are choosing to create their own exchang-es are so consumed with the enormity of the task that it still remains a challenge to get dental on their radar screens,” he says. “Washington State is one example where the legislature specifically addressed den-tal in relation to its exchange. The Washington law says that the pediatric dental benefits offered on the exchange must be offered and priced separately. How that plays out in terms of actual implementation is yet to be seen.”

When the Department of Health and Human Ser-vices issued its final exchange rule in March, it clarified in the preamble language that an exchange must allow stand-alone dental plans to be offered either independently from a Qualified Health Plan (QHP) or as a subcontractor of a QHP, but that it cannot limit participation of stand-alone dental plans in the exchange to only one of these options, he explains. “We are still finding it to be a challenge to com-municate this to states where exchanges are being created.”

A year ago, DDPA and the National Association of Den-tal Plans urged policymakers to “properly define state exchange processes to allow consumers to keep their dental coverage and the dentists they now use for themselves and their children.” But that’s not occurring, Pyle told First Impressions.

“Not only do the exchange rules need to be appro-priately created so as to allow transparency and competi-tion, but the actual online shopping experience needs to be designed to facilitate an up-front comparison of dental benefit plans,” he says. “Additionally, the online system needs to provide filters in the application phase that allow a person to search for their own dentist so that they are presented with the plans in which their dentist participates. This cannot be an afterthought, and we continue to urge legislators, regulators and exchange personnel to address these issues early in the development process.”

Consumers need to examine their options carefully, lest they inadvertently lose some dental coverage, warns Pyle. “There is nothing in the law that would preclude the offering of adult coverage or family coverage on exchanges. However,

the law only addresses pediatric dental benefits. We know that parents who have dental coverage tend to take their children to the dentist more often than those who do not have cover-age. There is a concern that if parents know their children are covered via a pediatric plan, they may choose to let their own coverage lapse, particularly if there is no option for them to purchase family coverage on an exchange.

“Another possible scenario is if a parent is forced to purchase a medical plan that has pediatric dental benefits embedded in it, they will be paying for duplicative cover-age if they already have a family dental plan. It is in no one’s best interest for family coverage to be broken up.

“While it is certainly good that additional children could gain access to coverage, if they do so at the expense of their parents’ coverage, or if dentist-patient relationships are bro-ken due to network issues with medical carriers, the gains made in the law are nullified. These are some of the un-intended consequences that must be guarded against.” [FI]

“ Not only do the exchange rules need to be appropriately created so as to allow transparency and competition, but the actual online shopping experience needs to be designed to facilitate an up-front comparison of dental benefit plans.”

– Chris Pyle, Delta Dental Plans Association


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• Pediatric dental benefit: Includes oral health care as part of the minimum services provided as part of essential benefits package for children under 21 years of age. Section 1302(b)(1)(J)

• Alternative dental healthcare provider demonstration project grants: Awards grants for up to 15 demonstration programs to establish programs to train or employ alternative dental health providers to increase access to dental care in underserved communities. Section 5304.

• Title VII provisions to expand and educate the oral health workforce: 1. Allocates federal monies to plan, develop and carry out professional training programs. 2. Offers financial assistance for students who will practice in general, pediatric or public

health dentistry or dental hygiene.3. Grants for programs that train providers who plan to teach in general, pediatric,

public health dentistry or dental hygiene. Section 5303.

• Alaskan Dental Health Aide Therapist Program. The Affordable Care Act does not extend the DHAT program beyond Alaska, but it does enable Indian tribes or tribal organizations located in a state where dental health aide therapist or mid-level-dental-provider services are authorized under state law to administer such services on tribal land. The bill prohibits tribes from filling any job vacancies for a dentist with a dental health aide therapist. Section 10221.

• Grants to support school-based health clinics, including those that provide oral health services. Section 4101.

• A five-year, national oral health prevention and education campaign led by the Centers for Disease Control and Prevention, targeting vulnerable populations. Section 4102(a).

• Establishes a grant program through the CDC for entities to demonstrate the effectiveness of research-based dental caries disease management activities. Section 4102(a)

• Expands existing grant program for school sealant programs to include all 50 states and territories. Section 4102(a)

• Establishes cooperative grants program overseen by the CDC to award grants to states, territories and Indian tribes and tribal organizations to establish oral health leadership and program guidance, oral health data collection and interpretation, a multi-dimensional oral health delivery system, and to implement science-based programs to improve oral health. Section 4102(a)

Directs the Secretary of Health and Human Services to carry out various programs and efforts to improve oral health monitoring and data collection. Section 4012(a).

Source: American Dental Hygienists’ Association, March 21, 2010, http://www.adha.org/governmental_affairs/downloads/Oral_Health_Provisions_in_Health_Reform_Legislation.pdf

Key oral health provisions of the Affordable Care Act


Though not strictly part of the Affordable Care Act, the Oral Health Initiative, announced in April 2010 by the

Department of Health and Human Services, is an attempt to expand dental coverage in uninsured areas.

“In the U.S., 53 million children and adults have untreated tooth decay in their permanent teeth,” said Dr.

Howard Koh, assistant secretary for health, U.S. Department of Health and Human Services, at the National

Oral Health Conference in St. Louis in 2010. “With this initiative, we plan to improve oral health by removing

barriers to care.”

The Oral Health Initiative was designed to use a systems approach to create programs that emphasize health

promotion and disease prevention, increase access to care, strengthen the oral health workforce, and elimi-

nate oral health disparities. Among its initiatives:

• The Administration for Children and Families will secure dental homes – ongoing sources of

comprehensive dental care – for Head Start children, and educate Head Start staff and parents about

the need to establish healthy habits to reduce tooth decay at an early age.

• The Centers for Disease Control and Prevention and National Institutes of Health will develop a long-

range plan to monitor oral diseases, conditions and oral health-related behaviors in the U.S. population.

• The Centers for Medicare & Medicaid Services are reviewing eight state Medicaid programs to

identify and highlight innovative service strategies to increase access to care.

• The Indian Health Service will expand its Early Childhood Caries Initiative through interdisciplinary

efforts including early childhood assessments by partners including Head Start, WIC, and community

health representatives, to include development of a national surveillance system for American

Indians/Alaskan Natives.

• The Health Resources and Services Administration (HRSA) is supporting two national studies that will

recommend short- and long-term strategies for HRSA and other HHS agency service programs.

• The Office of Minority Health will develop online cultural competency training modules for oral

health clinical providers.

• The Office on Women’s Health will incorporate enhanced oral health messages in its websites (www.

womenshealth.gov and www.girlshealth.gov) and its products and campaigns.

• The NIH National Center for Research Resources will fund the development of a Web-accessible

clinical research toolkit for researchers to facilitate the standardization of dental research and a

national dental research consortium infrastructure.

More information about the Oral Health Plan is available at Medicaid.gov: http://www.medicaid.gov/

Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/CMS-Oral-Health-Strategy.pdf.

Oral Health Initiative: Removing barriers to care


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The debate between organized dentistry and others is nothing new. But it heated up in July, after the Supreme Court upheld much of healthcare reform, when the Ameri-can Dental Association released studies performed by ECG Management Consultants, which concluded that of 45 dif-ferent staffing and reimbursement scenarios studied, only five would be willing to sustain themselves economically.

Mid-level models ‘not sustainable’The reports detail economic modeling of the dental health aide therapists who provide care in Alaska Na-tive territories; dental therapists currently working in

Minnesota; and the proposed but as yet unrealized advanced dental hygiene practitioner, reports the American Dental Association. The studies examine practice param-eters in five states whose legisla-tures or public health communities have been discussing adopting one or more of these models – Con-necticut, Kansas, Maine, New Hampshire and Washington.

ECG based its modeling on the length and cost of training each mid-level position, operating costs, likely salaries, academic debt and projected revenues, reports the ADA. Research-ers considered each model in the con-text of various combinations of public, sliding scale and private fee schedules

Of the 45 scenarios modeled (three payer mixes for each of three practice models in five states), only five indicated positive net revenues, ranging from $8,000 in Kansas to $38,000 in Connecticut, assuming a

50/50 mix of public and private fees, says the ADA. Four positive net revenue scenarios involved the dental health aide therapist model, and one involved the dental therapist model. The other 40 scenarios showed net losses ranging from $1,000 for a dental health aide therapist operating on a 50 public/50 private mix in Washington, to $176,000 for an advanced dental hygiene practitioner practicing in the same state, assuming a 75/25 public/sliding revenue mix.

“Certainly, this research is not all-encompassing,” said ADA President William Calnon, DDS, when the report was released. “But to our knowledge, no one has considered the question this comprehensively. The ADA encourages

Demand and SupplyWho will take care of all the patients seeking oral healthcare?

If the Affordable Care Act increases the number of peo-ple receiving dental care, the question is, Who will take care of them? Many dentists believe the current work-force, supplemented by dental hygienists and other allied staff, is adequate. But others believe that a new class of

provider, the so-called mid-level provider – e.g., the dental ther-apist, advanced dental therapist, advanced dental hygiene prac-titioner or community dental health coordinator – is necessary.


all stakeholders to study these models comprehensively, to avoid wasting constrained resources on programs that ul-timately are not sustainable.”

Different perspectiveIn the same month that ADA released its report, the Pew Children’s Dental Campaign presented a much different perspective in its white paper, “Expanding the Dental Safety Net: A First Look at How Dental Therapists Can Help.” The paper reported research from the University of Connecticut suggesting that adding dental therapists to Federally Qualified Health Clinics, that is, community health centers, could significantly expand the availability of care for millions of American children.

By including dental therapists as providers in school-based programs operated by FQHCs, the researchers es-timated states could provide access to care for 6.7 mil-lion Medicaid-eligible children nationwide, reported Pew. Moreover, the analysis also suggested that this significant increase in access could be realized for a cost of approxi-mately $1.8 billion – just one half of 1 percent of com-bined state and federal 2009 Medicaid spending.

“While the University of Connecticut study is the first of its kind, and further research is needed, these promis-ing, preliminary findings underscore the urgency of such additional analysis and, more broadly, for the expansion of the dental workforce throughout the dental safety-net system,” said Pew in a statement.

The report followed by two years another Pew report, “It Takes a Team: How New Dental Providers Can Benefit Patients and Practices,” which found that:

• In solo private dental practices – where most dentists work – adding new types of providers and dental hygienists produced gains in productivity and increased earnings by a range of 17 to 54 percent.

• Dentists who operate a practice by themselves can increase their pre-tax profits by 6 or 7 percent by accepting more Medicaid-enrolled children and hir-ing either a dental therapist or a hygienist-therapist.

Demonstration programsThe authors of the Affordable Care Act inserted themselves into the debate by providing up to $60 million in federal

demonstration grants to educate and test new oral health workforce models. Perhaps not surprisingly, the American Dental Hygienists’ Association supports the provision.

“There is widespread agreement that new types of dental providers are needed to address the nation’s dental access crisis,” says Ann Battrell, MSDH, executive direc-tor of the hygienists’ association, responding to questions from First Impressions.

The Health Resources and Services Administration [of the Department of Health and Human Services] es-timates that 10,000 new dental practitioners are needed to address the nation’s dental care shortages, she says. “ADHA champions dental hygiene-based workforce mod-els, and supports the Alternative Dental Health Care Pro-vider Demonstration Project grants.

“The [demonstration project grants program] is an opportunity for dental education programs, health cen-ters, public-private partnerships and other eligible entities to apply for funding that will allow for innovation, within the confines of state laws, to further develop the dental workforce and extend the reach of the oral health care system to rural and other underserved areas,” continues Battrell. “The grant program would fund workforce inno-vations, including building on the existing dental hygiene workforce; utilizing medical providers; and pilot testing new providers, like dental therapists and advanced prac-tice dental hygienists, who practice in accordance with state practice acts.

“These grants will yield valuable information to poli-cymakers about the dental workforce of the future.”

Alaska, Minnesota programsMid-level-provider programs are either being implement-ed, or being considered, in multiple states. The two most-talked-about programs, already up and running, are those in Minnesota and Alaska.

In Alaska, dental therapists perform both preventive and routine restorative procedures on children and adults, reports Pew. Minnesota permits dental therapists and ad-vanced dental therapists to perform a wider range of pro-cedures and to serve all age groups.

The Minnesota dental therapist provider is a graduate of an approved bachelor’s education program, according to the ADHA. The dental therapist is modeled after the


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physician’s assistant model, and requires on-site supervi-sion from a dentist for most services provided. This pro-gram does not require entering students to first be a li-censed dental hygienist.

The advanced dental therapist (ADT) provider in Min-nesota, meanwhile, is a graduate of a master’s level educa-tion program; entering students must have a dental hygiene license and a baccalaureate degree, explains Battrell. The first class of ADT students graduated from Metropolitan State University in St. Paul, Minn., in June 2011, and will need 2,000 hours of supervised practice as dental therapists before they can obtain their ADT certification. They will then practice with dual ADT and dental hygiene licensure.

By virtue of their dual licensure, advanced dental ther-apists are able to provide the full preventive skill set of dental hygienists in addition to the ADT restorative skill set, says Battrell. The advanced dental therapist is mod-eled after the nurse practitioner model and is designed to facilitate collaboration between the ADT and dentist, but does not require on-site supervision.

At press time, Kansas and Vermont reportedly were considering a licensed dental hygienist with one addition-al year of education. Washington State, meanwhile, has considered legislation, HB 2226, to establish two provid-ers – a two-year-educated dental practitioner; and a den-tal hygiene practitioner, who is a licensed dental hygienist who has completed a post-baccalaureate advanced dental hygiene therapy education program.

Currently, 20 dental hygiene programs offer a master’s degree in dental hygiene or related content, says Battrell.

Access problem“It has been acknowledged for over a decade that we’re facing an access problem,” says Julie Stitzel, senior staffer,

Pew Children’s Dental Campaign, Washington, D.C. The development of mid-level providers, such as dental thera-pists, is one solution to the problem.

“It’s important to acknowledge that more than 40 mil-lion Americans live in a dental shortage area,” she says. “One-third of the population lacks access to care and relies on the dental safety net, which is at capacity and only able to reach 10 percent of those patients.” Pew’s recent white pa-per suggests that adding a dental therapist to federally quali-fied health centers could expand access to care. By includ-ing them in school-based programs operated by community health centers, it is estimated that states could provide ac-cess to additional 6.7 million Medicaid-eligible children.

“The workforce issue is not an easy one to tackle, because you’re talking about scope of practice,” she says. Nevertheless, even though only two states have formal mid-level-provider programs, many more are having the conversation. International studies show that mid-level providers offer safe and quality care, but research findings aren’t clear as to the economic impact of mid-level pro-viders on dental practices. But answers may be forthcom-ing, as Minnesota and Alaska compile real numbers based on their experience. (In fact, the Alaska model of dental therapists, which is used in Britain, Canada and more than 50 other nations, performed the best of all mid-level pro-viders tested in the ADA study, Stitzel points out.)

“Because this is so new, people want more informa-tion before committing to anything,” says Stitzel. “There is a need to educate [dental professionals about] what these new types of providers do, and how they might impact private practices. That’s important, because dentists want the most information possible.”

An important piece of the puzzle is reimbursement. “At Pew, we advocate for adequate reimbursement rates

“Because this is so new, people want more information before committing to anything.There is a need to educate [dental professionals about] what these new types of providers do,

and how they might impact private practices. That’s important, because dentists want the most information possible.”

– Julie Stitzel, senior staffer, Pew Children’s Dental Campaign


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for all dental providers, so they are incentivized to ac-cept Medicaid patients,” says Stitzel. “The reimburse-ment rate alone won’t solve the problem, but it is an important part of it.”

Community health centersOn June 28, Tom Van Coverden, president and CEO of the National Association of Community Health Cen-ters, expressed support for the Supreme Court decision upholding much of the Affordable Care Act. That’s not surprising, given that the law appropriated $11 billion to expand the centers over the next five years, and $1.5

billion to expand the National Health Service Corps, which provides loan repayment for professionals, includ-ing dentists and hygienists, in exchange for service at a community health center.

“By upholding the constitutionality of the health re-form law, the Court has assured that millions of currently uninsured Americans will have the opportunity to gain insurance coverage over the next few years, and that con-sumers will have vital protections and benefits under the law,” Van Coverden said in a statement. “The only disap-pointment in the ruling for health centers and the patients they serve is the weakening of the Medicaid expansion. This potentially leaves some of the 16 million eligible low-income people with no affordable coverage alternative.”

Van Coverden was referring to the Supreme Court’s decision to strike down a provision of the Affordable Care Act that would have allowed the federal government to withhold Medicaid funds to states that refused to expand their programs to include more people.

First established in the 1960s, community health centers are clinics that receive federal funding to provide primary care, including dental services, to the under-served. To be eligible for funding, they must be located in underserved areas, charge patients based on their abil-ity to pay, and be governed by a community board that includes patients.

The number of community-health-center patients re-ceiving dental care grew 162 percent from 2000 to 2009, from 1.3 million to 3.4 million patients, according to the National Association of Community Health Centers. Vis-its to dentists increased 169 percent, from 2.6 million to

7.0 million, while those to dental hygienists increased 250 percent, from 402,000 to 1.4 million.

One community health center, the Family Health Center of Marshfield (Wisc.), has been particularly active in providing dental care, which may have been one reason Executive Director Greg Nycz was asked to serve on the advisory committee for the Pew Children’s Dental Cam-paign white paper.

Nycz is concerned about the maldistribution of den-tists in Wisconsin. While not as remote as some areas of Alaska, Wisconsin’s rural areas lack access to dental care providers, he says. That’s why the Family Health Center continues to establish dental clinics in areas of need. In fact, the center is planning its ninth dental clinic in north-ern Wisconsin. When it opens, the center will have 50 den-tists, coming from 12 different dental schools. In addition, Family Health Center is working with Marshfield Clinic to develop a dental school in an attempt to ensure an ad-equate workforce in the rural parts of the state.

“The only disappointment in the ruling for health centers and the patients they serve is the weakening

of the Medicaid expansion. This potentially leaves some of the 16 million eligible low-income people

with no affordable coverage alternative.”– Tom Van Coverden, president and CEO of the National Association of Community Health Centers


Wisconsin doesn’t recognize dental therapists. Nor does the Family Health Center have a school-based pro-gram, which formed the basis of many of the findings reported in the Pew white paper. But allied health pro-fessionals are an important part of the community health center’s delivery system, and that of the state, says Nycz. For example, the state of Wisconsin, with support from Delta Dental, has an active program that sends public health hygienists into schools to apply sealant.

The center also promotes closer relationships with medical doctors, and has developed an integrated medi-cal/dental electronic health record, so dentists can tell whether their patients have had neces-sary medical care (such as immuniza-tions, mammograms, blood pressure checks, etc.), and their medical coun-terparts can determine whether their patients have been getting their dental checkups. “The [dental] profession worries about auxiliaries taking work away from them,” says Nycz. “But we think there’s more work to be done in collaboration with medicine to get better outcomes.”

‘Primary oral health providers’Talk of mid-level-providers aside, dental hygienists got a boost from the authors of the Affordable Care Act, which recognized them as “primary oral health providers,” along with dentists. “[That] is a significant development for our profession, and ADHA has advocated for this public rec-ognition for many years,” says Battrell. “The concept of a primary care clinician can be considered as ‘an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health ser-vices to patients,’” she says. “So we were very pleased to see dental hygienists recognized as primary care providers in dentistry.

“Dental hygienists’ comprehensive education and clinical preparation make them uniquely suited for helping address the access to care crisis,” she says. “The only thing stopping them today is lack of authorization to provide services in more settings.”

But hygienists are looking ahead. The ADHA has developed a proposed master’s degree program to train a

new class of provider – the advanced dental hygiene prac-titioner – who would work collaboratively with dentists and refer patients with complex needs to dentists.

“In addition to the full range of dental hygiene clini-cal services, advanced dental hygiene practitioners will ad-minister restorative services within the scope of practice and will also have limited prescriptive authority,” explains Battrell. “They will be educated in health promotion and disease prevention, provision of primary care, case and practice management, quality assurance and ethics, which will provide a comprehensive approach to the delivery of oral health care services.”

It was never the intent of the hygienists’ association to recruit or educate these advanced practitioners, says Bat-trell. Rather, ADHA created the sample core competencies for the education curriculum and is working with individu-al states and key stakeholders to advocate for the creation of mid-level providers, she says. “ADHA policy supports alternative providers [who are] licensed, graduates of ac-credited dental hygiene programs, have expanded scopes of practice, and have direct access to the public.”

Talk – and debate – about mid-level providers is bound to continue. Introduced in June, the Comprehensive Dental Reform Act of 2012 (S. 3272), would, among other provi-sions, provide scholarships and education loans for dental therapists and oral health professional students. A compan-ion bill, HR 5909, was introduced in the U.S. House of Rep-resentatives by Congressman Elijah Cummings of Mary-land and referred to several committees in the House for consideration. Neither legislation was expected to advance this year, but could be re-introduced in 2013. [FI]

“ Dental hygienists’ comprehensive education and clinical preparation make them uniquely suited for helping address the access to care crisis. The only thing stopping them today is lack of authorization to provide services in more settings.”

– Ann Battrell, MSDH, executive director, hygienists’ association


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What constitutes good dental care? The federal government, dental pro-fessionals, payers and patients want to know. And, given the Supreme Court’s decision this summer to up-

hold key provisions of the Affordable Care Act, they just might find out.

Actually, the feds and others have been interested in identifying quality in healthcare for quite some time, even predating the Affordable Care Act. Their intent is three-fold – to improve patient outcomes, reduce disparities of care, and cut costs by identifying and then reimbursing only effective procedures.

It’s true that much of the feds’ attention has been fo-cused on medical, not dental, care. The American Recov-ery and Reinvestment Act of 2009, for example, allocated $1.1 billion for comparative effectiveness research, which compares treatments and strategies to improve health.

More recently, the Affordable Care Act created the Pa-tient Centered Outcomes Research Institute, that is, PCO-RI, which is intended to fund research that will provide patients, caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. In addition, the law authorized an initiative, called “value-based purchasing,” which will reward hos-pitals for the quality of care – rather than the volume of services – they provide to people with Medicare.

But the quality of oral healthcare has also been a con-cern of the government. The 2000 report from the Surgeon General of the U.S. Public Health Service, “Oral Health in America,” examined the relationship between oral health and general health and well-being, and pointed to the dis-parities that exist in oral healthcare across the country.

Last year, two reports on oral health from the Insti-tute of Medicine and the National Academies of Science “address[ed] the need for improved measurement of the results of oral health activities and for the development of systems to improve quality and accessibility of oral health services,” reported Paul Glassman DDS, MA, MBA, pro-fessor of dental practice, director of community oral

health and director of the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Den-tistry, in his December 2011 report, “Oral Health Quality Improvement in the Era of Accountability,” prepared for the W.K. Kellogg Foundation.

As part of the Affordable Care Act, the Department of Health and Human Services included quality measures within

accreditation standards for qualified health plans, that is, plans available through health insurance exchanges. Be-cause one of the “essential health benefits” that must be offered by the exchanges is pediatric oral care, it’s likely the feds will pursue some dental-specific quality measures.

Dental Quality AllianceAn important player in that effort will probably be the Dental Quality Alliance. In 2008, two years before the Affordable Care Act was signed into law, the Centers for Medicare & Medicaid Services asked the American Dental Association to be the lead agency in forming an alliance to create quality measures for children’s dental Medicaid plans.

The Quality ConundrumThe Affordable Care Act could advance the profession’s quest to identify quality oral healthcare, but efforts had begun before the law was passed.

As part of the Affordable Care Act, the Department of Health and Human Services included quality measures within accreditation standards for qualified health plans, that is, plans available through health insurance exchanges.

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Today, the Dental Quality Alliance is a multi-stakeholder organization, with representatives from the public, dental ben-efits companies, federal payers, dental specialties, the American Dental Association, and others, explains Christopher Smiley, DDS, chair of the Dental Quality Alliance. “The intent is to have a consensus organization of those who are impacted by measurement be the ones to develop them,” he says.

Smiley emphasizes that the DQA’s mission is not to generate and investigate the effectiveness of various treat-ment methods, but rather to develop measures to assess how well a health plan is actually delivering services ex-pected to improve oral health. Often, these measures evolve from evidence-based clinical guidelines, he explains. For

example, ADA Clinical Recommendations note that apply-ing sealant to individuals within a certain age range yields a certain outcome, such as reduced incidences of decay, he says. Quality measurement for delivery of sealants would then measure how many people within a certain plan actu-ally receive sealants. “You can assess, based on what you’ve measured, whether or not you’ve been successful in raising the bar of the oral health of that population.”

The Alliance’s initial charge was to address pediatric oral health measures that were mandated by the Affordable Care Act, says Smiley. As a result, the Alliance conducted an

environmental scan of all pediatric oral health measures, and developed a core set of measures “that we feel are based on what will advance oral health.” The Alliance has requested request-for-proposals from organizations that will test the measures for reliability and validity.

“As far as the future holds, DQA will look at measure development for other populations, including adults,” says Smiley. “We’ll look at other existing clinical guidelines and evidence-based recommendations to see what might be wise to develop measures for.”

The Alliance’s efforts are aimed at what Smiley calls the “programmatic level.” In other words, its findings will be used by the Centers for Medicare & Medicaid Services to measure how well individual Medicaid plans are per-forming. “Certainly, this information, at some point, can be mined down to the provider level,” he adds. “But I don’t see that happening in the immediate future.” That’s partly due to the lack of electronic health records, which would facilitate the gathering of information on care de-livery beyond claims data.

Regardless, dental providers shouldn’t fear the ad-vent of evidence-based dentistry, says Smiley. Pointing to the American Dental Association’s Center for Evidence-Based Dentistry, he says that evidence-based dentistry is based on three principles – the prevailing evidence in the literature, the doctor’s judgment, and the individual pa-tient’s needs and desires.

“So you have the input of patient, practitioner and evidence,” he says. “You blend it all to come up with a treatment decision that still basically allows for variation tailored to the unique needs of every patient.”

The Supreme Court decision in June to uphold most provisions of the Affordable Care Act certainly reinforced the industry’s efforts to identify and measure the quality of oral healthcare, says Smiley. “That said, a lot of this activ-ity was grounded in initiatives that were well-entrenched and moving forward [prior to healthcare reform]. Even had the Supreme Court overturned things, and the Af-fordable Care Act had gone away, we would still be on this track, though maybe we wouldn’t be as far ahead as we are.

“Measurement fits into dentistry’s goal – to improve oral health and decrease pain and suffering. The better we can under-stand the ways we can improve the oral health of a population, those are the things we, as a profession, have to support.” [FI]

There remain numerous challenges to develop and implement quality measurement in dentistry, ac-cording to the Dental Quality Alliance. These include:

• Few evidence-based guidelines.• Limited knowledge of outcomes.• Limited diagnostic data collection to establish

oral health benchmarks.• Limited information systems for capturing and

transmitting data from patient records.• Limited accessibility of claims data.

Source: Quality Measurement in Dentistry: A Guide-book, Dental Quality Alliance, http://www.ada.org/sections/dentalPracticeHub/pdfs/dqa_guidebook.pdf

Challenges for measurement in dentistry

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Editor’s Note: Following are some FAQs from the Dental Quality Alliance.

Q: What is “quality of care” and a “quality measure?”A: The Institute of Medicine (2000) defines “quality of care” as “the degree to which healthcare services for

individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The Institute of Medicine defines quality measures as “the mechanisms that enable the user to quantify the quality of a selected aspect of care by comparing it to an evidence-based criterion that specifies what better quality is.”

Q: What is “performance measurement?” Why should [a dentist’s] performance as a provider be measured? A: Performance measures help identify the areas that can be improved to achieve goals for optimum health.

Dentists often think measuring their performance is the same as determining the quality of the restora-tion’s margins or the technical excellence of the crown. However, as a measure, those qualities tell very little about the impact of the restoration or crown on the actual health of the patient. Instead, performance mea-sures are those supported by evidence that the subject of the measure has led to improved outcomes….

Q: What are the implications of measurement? A: The ultimate goal of measurement is to improve the quality of oral healthcare. Creating, measuring, and

analyzing the resultant data serves as a powerful tool to identify areas for quality improvement. Besides direct quality improvement, assessment upholds public trust and provides consumer information and accountability to policy makers, payers, and others who purchase care.

Q: What is the potential burden for introducing measurement into a practitioner’s day-to-day activities? A: Data for measurement can be obtained from administrative sources (encounters and claims), patient

records and surveys. In dentistry, data are already being collected through the claims process. Such data are currently proprietary to the payers who use it to make policy decisions, conduct research, and increasingly to provide performance and quality measures information to providers, employers, and consumers. In the future, dentists may be required to report diagnostic codes and other data elements required for specific measures, either on a claim form or through a medical record. Quality measurement does not place an additional burden beyond reporting these additional data elements.

Q: Why do we need to measure patient satisfaction? How does that reflect on [the dentist] as a provider?A: Measures of patient satisfaction, such as how often they had a good experience with their doctor or

how quickly they received care, are typically measured through patient surveys. Evidence suggests that patient satisfaction is associated with better oral health.

Q: What is still needed in dentistry to implement meaningful measurement and improve quality? A: Even today there remain very few evidence-based guidelines on which measures can be based. There

is a lack of knowledge of true health outcomes, which occurs in part because dentistry does not have a tradition of formally recording specific diagnoses or associating such diagnoses with specific services. Further, most dental practices and dental plans lack information systems capable of capturing the infor-mation necessary for measurement. Lastly, limited availability of freely accessible claims data is a signifi-cant limitation for health service researchers to track progress on oral health quality.

Source: Quality Measurement in Dentistry: A Guidebook, Dental Quality Alliance, http://www.ada.org/sections/dentalPracticeHub/pdfs/dqa_guidebook.pdf

FAQs regarding quality measurement

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Just as the Supreme Court decision regarding the Affordable Care Act will affect healthcare pro-viders, patients and payers, so too will it affect the dental products and equipment distributors.

“We’re excited about the Affordable Care Act’s potential impact on dentistry, especially access-to-care for those who are less fortunate,” says Chuck Cohen, managing director, Benco Dental. “We’re especially bullish on the expansion of the community health center network across the nation, because CHCs offer an affordable deliv-ery system for low-income individuals. As an industry, and a healthcare system, we need to improve access to dental care – and any reasonable effort to address this issue will benefit all of us.”

Cohen is more tentative about the Supreme Court’s decision to throw out that aspect of the Affordable Care Act that would have allowed the federal government to withhold Med-icaid funds to states that don’t expand their Medicaid programs.

“I don’t think that anyone can an-swer [how that will affect oral health-care],” he says. “We have to wait until we see how this provision is imple-mented by federal and state governments. Clearly, if fewer resources are dedicated to Medicaid, fewer resources will be dedicated to dental care that’s reimbursed through Medic-aid. We need to wait and see.”

Overall dental demandThe Supreme Court decision “will be beneficial, as it should grow overall dental demand,” says Lori Paulson, vice president, marketing and dental programs, National Distribution & Contracting, the Nashville, Tenn.-based member service organization that provides distribution, logistics and other services to 300 independent medical, rehabilitation and dental product distributors. Paulson ex-pects some broad trends to continue, such as the use of

auxiliaries for expanded procedures, and the integration of oral health with general health.

Care for allStanley Bergman, chairman and CEO of Henry Schein, points out that through the Affordable Care Act, “nearly 8 million children will be eligible for dental coverage through the state health insurance exchanges free of annual and life-time caps. The Act also includes nearly two dozen provi-sions that aim to improve the oral health of all Americans.

“The Act also represents an integrated and strate-gic plan to address oral health through prevention and health promotion, coverage and financing, workforce

and training, infrastructure and surveillance, and an improved oral health safety net,” he adds.

“From Henry Schein’s perspec-tive, it is essential that the Act passes guidelines to certify dental health re-cords, so the investment to incorpo-rate [electronic health records] in den-tistry is available to the profession. Although many of the public health provisions await funding, this is a clear recognition that dental disease

remains a silent epidemic in America, especially among children, and can only be eliminated by improving the en-tire oral health system.

“At Henry Schein, we believe everyone deserves ac-cess to basic health care, and we’re committed to doing our part to expand access. We also believe that society agrees on expanding access to care for all. The key question is how to pay for it. We don’t think there’s a single answer to this question, but we can suggest a process for getting to an answer. It has to be through public-private partner-ships. Government should not and cannot finance this alone, especially given the structure of American health care. All elements of society need to partner together to achieve this goal of providing access to basic care.” [FI]

Brace, or Embrace?Healthcare reform and dentistry: Supply chain implications

“At Henry Schein, we believe everyone

deserves access to basic health care,

and we’re committed to doing our part to

expand access.”– Stanley Bergman,

chairman and CEO of Henry Schein


trends

Let sleeping dogs lie? That advice may hold true in some cases, but not when it comes to dental patients. In fact, if dentists aren’t asking their patients about their sleep habits, sales reps can do them a service

by educating them on the value of doing so.Dental sleep management is a relatively new concept

in dentistry, and many dentists are uninformed and don’t know how to get started, according to experts. As such, this is an opportunity for sales reps to educate their customers about sleep apnea, oral appliances and home sleep tests – as well as guide their customers through the proper channels to ensure they bill properly for oral appliances they may prescribe.

Sleep apneaTraditionally, dentists don’t learn about sleep apnea in dental school. And, many likely wonder why they should. The answer is simple: Many people are at risk for obstructive sleep apnea (OSA), which can be life threatening, according to the American Academy of Dental Sleep Medicine (AADSM). In fact, over 18 million Americans are es-timated to have obstructive sleep apnea but are not being treated.

Obstructive sleep apnea occurs when an individual’s airway tempo-rarily collapses during sleep, pre-venting or restricting breathing for up to 10 seconds. Typically, patients who suffer from obstructive sleep apnea have a narrower-than-normal airway at the base of the tongue and palate. When lying flat, the palate

rests above the air passage. When the pharyngeal muscles relax, the palate can fall backwards, obstructing the airway.

Several other conditions can trigger OSA, including the following:

• A deviated septum (the middle wall of the nose separating the two nostrils) narrows the nasal air passages.

• Filters in the nose called turbinates obstruct airflow when they become swollen.

• The back of the tongue falls backwards, obstructing breathing.

• The side walls of the throat fall together, narrowing or closing the airway.

• A thick neck circumference greater than 16.5 inches may narrow the airway.

• Obesity or excess weight can lead to fat deposits around the upper airway, obstructing breathing.

Although patients with ob-structive sleep apnea may experi-ence disrupted sleep three or more nights each week, they generally do not report awakening during the middle of the night. Often, they merely move from a deep sleep stage to a shallower level of sleep. But, disrupted sleep can leave patients groggy during the day, interfering with their ability to concentrate and possibly lead-ing to accidents. Other common

By Laura Thill

Dental sleep managementWith some education from their sales reps, dentists can take advantage of treatment opportunities.

Patients with sleep apnea generally have a couple of

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AADSM: upper airway surgery

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symptoms include insomnia, fatigue, irritability, headaches and poor memory and attention. In addition, patients with an abnormally high apnea hypopnea index (AHI) – the ra-tio used to assess the severity of obstructive sleep apnea – are at risk for one or more major chronic diseases, as well as for heart failure, stroke or cerebral vascular accident, resistant hypertension and atrial fibrillation.

The dentist’s roleDentists are in a great position to discuss sleep apnea with their patients. Whereas patients typically visit their physi-cian to address a specific health issue, they see their dentist once or twice each year for a preventive checkup, making it easier for the dentist to raise other health topics. With

some gentle probing, the dentist can determine if a patient presents obstructive sleep apnea symptoms, such as the following, listed by the Mayo Clinic:

• Excessive daytime sleepiness (hypersomnia).• Loud snoring, which is usually more prominent in

obstructive sleep apnea.• Episodes of breathing cessation during sleep wit-

nessed by another person.• Abrupt awakenings accompanied by shortness of

breath, which likely indicates central sleep apnea.• Awakening with a dry mouth or sore throat.• Morning headache.• Difficulty staying asleep (insomnia).• Attention problems.

Patients with sleep apnea generally have a couple of treatment options, according to AADSM: upper airway surgery or oral appliance therapy. These techniques may be used alone or in combination with behavioral changes or continuous positive airway pressure (CPAP). A CPAP machine is comprised of a mask or device that fits over the nose, or nose and mouth; a tube that connects the mask to the machine’s motor; a motor that blows air into the tube. Mild pressure from CPAP helps prevent the airway from collapsing or becoming blocked.

Although considered the gold standard by many ex-perts, a good number of patients find it too uncomfort-able or claustrophobic to use a CPAC device. In some cas-es, patients can’t tolerate the constant stream of air being

blown into their nostrils or mouth. Either way, patient intolerance leads to a lack of compliance, and the issue remains unsolved.

For many patients, an oral appliance is more tolerable than CPAP, and The American Acade-my of Sleep Apnea has determined that an oral appliance is sufficient to treat milder cases of sleep apnea. No one oral appliance will work for all patients. Dentists must begin by taking an impression and x-rays of a patient’s mouth to measure the lower jaw protrusion. A custom-made oral appliance is then de-

signed to move the patient’s jaw forward in an effort to improve his or her nighttime breathing. Once the patient begins wearing the appliance, the dentist must adjust it as is necessary.

Once the patient has worn the oral appliance for two or three weeks, certain states permit the dentist to send him or her home with a home sleep test, which measures any progress toward improved nighttime breathing.

Helping your customers get paidBecause sleep apnea is a medical issue – not a dental one – dentists must work through a sleep physician or sleep lab to obtain a medical diagnosis before fitting their patients for an oral device. Then, they must bill

Because sleep apnea is a medical issue – not a dental one – dentists must work through a sleep physician or sleep lab to obtain a medical diagnosis before fitting their patients for an oral device.


for the device through the patient’s medical insurance. The process involves a new way of thinking (e.g., part-nering with a physician), not to mention a lot of extra documentation. At the very least, it can be daunting to dentists and deter many of them from pursuing dental sleep management.

Sales reps can do their dental customers a service by encouraging them to establish a relationship with local sleep physicians and/or sleep labs, which typi-cally are very open to working together, according to experts. When a dentist suspects a patient is at risk for – or has – sleep apnea, he or she should refer the patient to the local physician or lab. Once the sleep

physician/lab diagnoses the patient with sleep apnea, the patient can return to the dentist to be fitted for a custom oral appliance.

With a physician diagnosis in hand, dentists can proceed with the billing process through their patients’ medical insurance carrier. However, experts recom-mend that dentists rely on a software program designed to lead them through the right steps to ensure accurate reimbursement. Some sources in the industry recom-mend using the Dental Writer software package (www.dentalwriter.com), which guides dentists through neces-sary codes and documentation.

While the home sleep test is an important tool in treat-ing the patient, dentists should be aware that they cannot bill – or be reimbursed – for home sleep tests.

Working with your customersMany dentists are reluctant to come on board with dental sleep management. Some regard it as a physician issue. Some are concerned about liability issues. But, as long as they work with a physician and obtain a medical diagnosis, they essentially are making an oral appliance based on a medical recommendation.

Sales reps can initiate a discussion by asking several prob-ing questions, such as the following:

• “Doctor, are you currently treating any patients with sleep apnea?”

• “Are you aware that as much as 25 percent of your patients are at higher risk for sleep apnea?”

• “Do any of your patients have snoring issues? Do you discuss this – or other sleep apnea symptoms – with your patients?” (Snoring is a symptom of sleep apnea, but not all snorers have sleep apnea.)

• “Are you familiar with oral appliances available to treat patients with sleep apnea?”

• “Are you aware that you can get reimbursed for oral appliances by following the proper protocols?”

The mouth is a window to a patient’s total health. As such, dental sleep management is an opportunity for dentists to better service their patients – as well as an opportunity for sales reps to provide value to their customers. With some education from their reps, dentists can make informed decisions and proceed appropriately as they address sleep apnea in their patients. [FI]

While the home sleep test is an important tool in treating the

patient, dentists should be aware that they cannot bill – or be

reimbursed – for home sleep tests.


Dishwasher safe?How can I convince customers not to buy a standard home dishwasher to clean instru-ments before sterilization? I keep seeing them crop up in offices to save time, espe-cially when offices buy cassettes that require

more space than they have in their ultrasonics.

I am glad people are buying cassettes! This is a step forward in dental efficiency and asep-sis. Change often happens this way, a little at a time. Eventually, all dental offices will use

automated instrument processing equipment, and there will be better cleaning and sterilization results, fewer ac-cidents and exposures, and instruments will last longer. Meanwhile, here are the key points to tell customers about investing in home-use dishwashers:1. Standard domestic dishwashers

are designed for intermittent use on dishes. The manufactur-ers will void the service and replacement warranties if they are used as medical devices. Basically, these machines are not likely to hold up to the constant use required by dental facilities. Commercial dishwashers (for restaurants) may hold up in den-tal offices, but may cost as much as instrument washers, so there is no reason to select them over instrument washers.

2. Major instrument companies openly state they will void their instrument and cassette warran-ties if they are processed in

domestic or commercial dishwashers. They recom-mend instrument washers.

3. Domestic washers take more time to finish a cycle than instrument washers. Customers are tempted to skip the drying cycle to hurry up the process, resulting in wet instruments.

4. Dishwashers are designed to hold plates vertically. Instrument washers are designed to slant cassettes to allow optimal water flow from the top, middle and bottom sweeper arms into the openings of the cassettes. Many cassettes, especially the “vintage” models, have no openings on the lateral surfaces and will not allow water to hit the instruments if they are positioned vertically.

5. Instrument washers have a sequenced release of chemicals appropriate for precision dental instru-

ments. Dishwashers use dishwash-ing soap, which will dull and damage instruments.

A big whoopWe have a new 3 month-old baby and I’m learn-ing about vaccinations and childhood diseases. Recently on the news

there was a story about a dramatic increase in cases of Pertussis, or whooping cough, which can kill ba-bies. Since my baby is not old enough to get all the recommended doses, she is susceptible. I was told that adults can still get whooping cough, even if they have been vaccinated. I’m wor-ried that I might be exposed to Per-tussis in dental offices. I have three

Dirty Little SecretsEditor’s Note: Are your customers asking tough hygiene questions? Here is your chance to ask someone “In the Know.” Nancy Andrews, RDH, BS, will take your questions and tell your tales. Pulling from centuries of experience, endless education, lots of research, and occasional consultation with other experts, Nancy invites your e-mails at [email protected]. The best question or tale at the end of the year gets $100.

infection control: Q&A


infection control: Q&A

questions about this: First, how do you know it is Pertussis and not just a cold? Second, is there a risk of this disease being more prevalent in dental offices than anywhere else? Third, why be vaccinated if you can still get it?

Pertussis, or whooping cough, may start out like a cold, but will persist and become much worse. It is a highly contagious febrile (slightly raised temperature) respiratory dis-

ease caused by the bacterium Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria re-lease toxins, which damage the cilia and cause inflamma-tion (swelling).

Colds are typically caused by viruses, and a common symptom is a sub-normal temperature. Pertussis usually starts with cold-like symptoms with a mild cough or fever.

After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, Pertussis can cause a series of coughing fits that continue for weeks with uncontrollable, violent coughing, which often makes it hard to breathe and expels all the air from the lungs. After long fits of coughs, some-one with Pertussis often needs to take deep breathes which result in a “whooping” sound because of the swollen air passages. This extreme coughing can cause vomiting and exhaustion. You are also correct that Pertussis is a threat to adults, even those previously vaccinated. However, in teens and adults, the “whoop” is often not there and the infection is generally milder (less severe), especially those who have been vaccinated.

Your concerns for your daughter are well-founded. Pertussis most commonly affects infants and young

children and can be fatal, especially in babies less than 1 year of age. Diagnosis is difficult in the beginning: in infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. More than half of infants younger than 1 year of age who get the disease must be hospitalized.

Early symptoms can last for 1 to 2 weeks and usually include:• Runny nose. • Low-grade fever (generally minimal throughout

the course of the disease). • Mild, occasional cough. • Apnea – a pause in breathing (in infants).

To answer your question about the risk of encounter-ing Pertussis in a dental office, we should remember that

dental facilities should not be see-ing patients with febrile respiratory illnesses. If such patients are seen, the facility must have specific built-in air-handling systems that include negative pressure rooms, 6 to 12 air exchanges per hour, and filtered ex-haust air. The workers must wear spe-cific respiratory equipment including N-95 fit-tested respirators. Dental of-fices should either have all of these specialized accommodations or they

should screen patients for diseases such as influenza, Tu-berculosis, Pertussis, Meningitis, Vericella Zoster (chicken pox). In California there is an OSHA law requiring this screening be done prior to treating all patients. Other states may not have this exact law, but the CDC Guidelines say that patients with aerosol transmissible diseases (ATD’s) require the accommodations I mentioned.

Dental offices should be asking about symptoms of respiratory illnesses, and be able to take patients’ tempera-tures to detect febrile respiratory illnesses. The more cus-tomers you sell thermometers to and encourage to notice and screen patients with fevers and respiratory symptoms, the safer dentistry will be.

Remember, while patient medical histories are usu-ally reviewed at least once a year, this screening should be

Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. More than half of infants younger than 1 year of age who get the disease must be hospitalized.

www.firstimpressionsmag.com : First Impressions : December 2010 : 61

done at every appointment for active (symptomatic) dis-ease. Pertussis is a very contagious disease only found in humans and is spread from person to person. People with Pertussis usually spread the disease by coughing or sneez-ing while in close contact with others, who then breathe in the Pertussis bacteria. Many infants who get Pertussis are infected by older siblings, parents or caregivers who might not even know they have the disease. Symptoms of Pertus-sis usually develop within 7 to 10 days after being exposed, but sometimes may take as long as 6 weeks to show up. Bottom line: there should not be a risk of exposure to Pertussis in dental offices, but because symptoms may not be distinguishable from a common cold, or customers may not screen patients. Your best bet is to be vaccinated. Your last question: Why be vaccinated if you can still get Whooping Cough?

Pertussis vaccines are very effec-tive in protecting you from disease, but no vaccine is 100 percent effec-tive. If Pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious dis-ease. If you have been vaccinated, the infection is usually less severe. If you or your child develops a cold that includes a severe cough or a cough that lasts for a long time, it may be Pertussis. The best way to know is to contact your doctor. The important issue here is to protect the most vulnerable people in our population: babies, the elderly, and immunocompromised people. Even though the vaccines may not prevent every infection, they prevent most of them, and greatly reduce the severity of infections. A child like yours is much more protected if surrounded by vaccinated people than if caregivers are unvaccinated! Unfortunately, many people do not choose to be vaccinated, or forget about getting boosters. The CDC is attempting to counteract this trend by educating the public about the severity of Pertussis and the importance of getting vaccinated.

Here is some information about vaccines from the CDC: The childhood vaccine is called DTaP. The whoop-ing cough booster vaccine for adolescents and adults is

called Tdap. Both protect against whooping cough, teta-nus, and diphtheria. The first dose of DTaP vaccine is rec-ommended at 2 months of age but babies are not fully protected until they get all the recommended doses. Babies need the whooping cough vaccination on time, but there’s another important way to protect them. Family members and others who are around babies should be vaccinated – children should be up to date with DTaP, and everyone 11 years of age and older should get Tdap, the booster shot that prevents pertussis. All HCPs who have not or are unsure if they have previously received a dose of Tdap should receive a one-time dose of Tdap as soon as fea-sible, without regard to the interval since the previous dose of Tdap. Then, they should receive Tdap boosters every 10 years thereafter.

Last note: Make sure your customers use surface disin-fectants that are effective against this pathogen, and use them correctly, especially in clinical areas where aerosols are generated. They should use at least low-level disinfec-tants in public areas of the office such as the reception area and should be cleaning door knobs, the bathrooms, and counter tops with disinfectants, especially during this public outbreak and the upcoming flu season! Make sure your customers have well-fitted masks that meet ASTM standards appropriate to the procedures they perform. This topic creates a chance to educate yourself and help your customers be safer and protect patients.

For more information, visit CDC.gov [FI]

Pertussis vaccines are very effective in protecting you from disease, but no vaccine is 100 percent effective. If Pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious disease.

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tech talk

Curing LightsEditor’s Note: At The Dental Advisor, not a day goes by without our phone ringing from a customer asking for the “best.” As a dental publication that was designed after Consumer Reports, over the past 25 years we have learned one thing – the best changes from day to day. Providing relevant and timely information to customers is something we strive for. This series of Tech Talks focus on educating dental sales professionals on the products and technology they are selling so they can in turn educate their customer. Product evaluations are available at dentaladvisor.com.

By Mary Yakas

While the desired outcome of curing lights has remained the same (to polymerize restorations and resin cements), units have evolved over the past 30 years. Cli-nicians may choose a curing light with

merely “the basics,” or one with technological advantages. Not all options are mandatory for the curing process, and costs will vary depending upon the quality and added features. Ultimately, the choice should be based upon the needs of the dental practice and the parameters of the curing light.

With light curing units being one the most used devices in dental offices today, ergonomics play an important role. Ideally, curing lights will be cordless, provide a light-weight balanced grip, buttons for activation within easy reach, and have intuitive pro-grams that match the restorative materials being used. With the increase in popularity of Bulk Fill Composites, factors such as depth of cure, intensity of light, and speed of cure have become critical factors.

It is important to note that even the best curing lights on the market can indirectly contribute to the poor perfor-mance of a final restoration. If the resin material being used is insufficiently cured, the long-term success of the mate-rial is compromised. Unfortunately, once placed in vivo and cured, there is no way to test the resin to see if it is fully polymerized, because even an inadequately cured resin will provide a hard top surface. What really matters is the extent of the cure at the bottom surface of the composite. There-fore, it is imperative to not only use a light curing unit that has proven to be clinically superior, but more so to follow proper light curing guidelines to ensure a sufficient cure.

New featuresSince dentistry is becoming a resin world, more and more lights are offering multiple curing time features. A lot of dental cements

now have a “tack cure” phase, where they need to be exposed to LED light for 1 second for optimal cleanup. In addition, some clinicians like to “tack cure” their veneers for easier cement cleanup of resin cements. Therefore, some lights now have multiple time options of 1, 3, 5, 10, or 20 seconds. Paradigm and Elipar S10 (3M ESPE) actually have a setting for 120 seconds when curing an entire arch without having to repress the on/off button. One drawback of LED lights is the amount of heat they produce at the tip. Older LED lights had fans that cooled them and others simply shut off when they “overheated.”

Many newer LED lights now have metal heat sinks that draw the heat away from the tip. This additional weight actually makes the instrument feel more balanced in your hand.

A common error in utilizing curing lights is failure to cure the material thoroughly. As long as you are not overheating the tooth,

you cannot over-cure a restoration, but you can certainly under-cure a restoration. For optimal results, the tip should be perpendicular to the surface being cured and within 1 mm (but not touching) that surface. For each degree from perpendicular and each millimeter away from the restora-tion, curing efficiency decreases significantly. So, when in doubt, cure it again. Keep in mind that composites that are not fully cured may exhibit:

• Decreased physical properties• Increased post-op sensitivity• Decreased bond strength• Excessive wear• Marginal leakage.

As a sales representative, be aware of the types of pro-cedures your customers are doing, how well they are main-taining equipment, and how well trained assistants are on the proper use of a curing light with different materials. [FI]

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rep corner

It didn’t matter to Dennis McSweeney that he was only 9 years old. His heart was set on owning a 1966 Ford Mustang, and he wasted no time in realizing his dream. “I took up two paper routes, created flyers for odd

jobs and began marketing myself in my neighborhood,” he recalls, noting that his “love affair with cars started in the passenger seat of my folks’ 1965 VW Squareback.” It took

him four years, but by the time he turned 13, he had saved enough to purchase a 1966 Ford Mustang 289 V8 three-speed Coupe that he spotted in the newspaper classifieds.

“I had my paper route manager drive it home for me,” says McSweeney. “You should have seen the look on my dad’s face. “‘Nice car, Steve,’ my dad said [to my manag-er]. ‘It’s not mine – it’s his,’ [my manager] replied. There I stood with the pink slip and a mile-wide grin.” It was no surprise to the young McSweeney that his father immedi-ately questioned his plans for his new vehicle, seeing as it would be years before he could acquire his driver’s license. His response was immediate: “Restore it, of course.” Such was the start of what he calls an “incurable habit.”

“What is really interesting is that my grandfather, whom I never knew, was a master mechanic,” McSwee-ney points out. “After retiring from the railroad, he bought and operated a service station in New York. Folks would come in with the family Ford Model T or A, and he would buy them as fixers and ice-track race them with his friends on weekends. So, for my folks, watching me repeat history

was quite an adventure.”

Trailer queensBy the early 1980s, McSweeney had become a regular customer at the local auto parts shop, Mustang Ranch in Santa Clara, Calif. At some point, he recalls, he began working weekends at the shop, cleaning up in exchange for auto parts. The ex-perience enabled him to learn more about cars. “Soon, I was doing in-teriors, trim and basic mechanics,” he says. “The guys mentored me. It was heaven on earth!” It was also an opportunity to meet profession-als “who had the right tools and [spaces] for restoring old cars,” he

adds. “This ultimately led to my becoming a member of the Vintage Mustang Owners Association and – by default – an under-carriage judge.”

Eventually, McSweeney “burned out” on the rigorous requirements of participating in car shows. “This bolt had to be glossy black; that bolt had to be satin; that one had to be natural,” he recalls. “It became ridiculous. In my mind, cars were meant to be driven and enjoyed.” Those cars relegated to “art” were referred to as trailer queens, he ex-plains. “That’s not to say there’s a right or wrong way. But, I’ve preferred to drive all of the cars I’ve owned through the years.” Although he left the car show circuit, he has maintained many friendships from these early days, he says.

By Laura Thill • Photos by Rex Sellick

A Driving ForceBurkhart Dental’s Dennis McSweeney follows his passion for restoring antique cars.

From a young age, McSweeney has had a passion for restoring cars.


rep corner

Cars beget carsOnce he began restoring cars, there was no stopping for McSweeney. “Cars beget cars,” he jokes. “It never ends. “You buy one, fix it up, sell it, take the profit and [sink it] into the next car. Hey, Imelda Marcos [collected] shoes, and I [collect] rusty old cars,” he justifies.

And, to the true car restorer, it’s all about his or her rela-tionship with the cars, he continues, noting that his family and neighbors “think I’m crazy! I had to explain this to my wife when we married six years ago,” he says. “On the whole, [re-storing cars] is a 40/40/20 deal. Forty percent of the thrill is [getting the] lead, making the deal and driving the car home. Forty percent [of the thrill] is when you get the car running for the first time and drive it around the neigh-borhood. The [final] 20 percent is enjoying the car until it’s time to move on.”

Fortunately for McSweeney and his wife, their home in the country comes with ample space for storing his 12 antique cars, as well as two motorcycles and a couple of cars for daily use. His collection includes the following vehicles, all in varying stages of restoration or use:

• 1916 Ford Runabout/Speedster. • 1927 Ford Roadster pickup. • 1930 Ford pickup. • 1931 Ford Roadster pickup. • 1932 Ford B truck.• 1933 Ford pickup.• 1936 Ford pickup.• 1936 Ford coupe three-window.• 1936 Ford coupe five-window.• 1964 Ford Galaxie Z code convertible. • 1965 Ford GT Mustang Convertible.

• 1965 Ford Fastback.• 1986 BMW K100RS motorcycle. (“I have ridden these

bikes with my uncle cross county numerous times, coast to coast and as far north as Nova Scotia.”)

• 1991 BMW K1 motorcycle.

On a daily basis, he drives a 2008 Ford F150 Super-crew pickup, and his wife drives a 2010 Chevy Equinox.

If it’s possible for McSweeney to play favorites, his “ul-timate car” is the 1936 three-window Ford Coupe. “But, all of my cars have a story to tell and a special place in my heart,” he notes. That said, he has his eye on a friend’s 1932 Ford Coupe, he admits. “But, he’s not interested in selling

it,” he says. “Still, we help each other out from time to time, so who knows what the future holds.

“Here in Monterey, the climate is pretty good,” McSweeney continues. “So, my big-gest problems [with car restoration] are mice and the salt in the air.”

On the jobAs it turns out, the skills required to restore old cars translate to the dental world, says Mc-Sweeney. “I rely on my ranch-work mentality to fix dental equipment almost daily,” he says. “My clients seem to appreciate not having to call the service department for small issues.” In fact, the practical advice he is able to offer goes a long way in satisfying his customers, he

points out, noting that he makes frequent analogies between his cars and dental equipment.

“Our role at Burkhart is not just to sell equipment and supplies,” he continues. Rather, it’s to see the hidden poten-tial in our clients – and then encourage and support them in a long-term relationship. It’s a true win-win scenario. When our clients are successful, we are successful.” The same goes for his restoration projects, he points out. “In the beginning, the cars may be a rusty pile of sheet metal. But, I know there is a story to be shared, once they are back on the road.”

His customers respect and admire his hobby, says Mc-Sweeney. “Successful people recognize a need for downtime,” he explains. As much as he enjoys his sales career, “I love turn-ing a wrench,” he says. “And, yes, I have driven my restored cars to sales calls and meetings. Almost everyone enjoys an old car. It always puts a smile on a client’s face, as well as my own!” [FI]

McSweeney’s collection includes 12 antique cars and two motorcycles.


peopleSchein’s Healthy Lifestyles, Health Communities launched in 12 U.S. citiesMelville, N.Y.-based Henry Schein Inc announced that the 2012 Healthy Lifestyles, Healthy Communities program will provide free medical and dental services to more than 8,000 children and their caregivers. Events are being held in cities throughout the United States through the end of 2012. A flagship program for Henry Schein Cares, the company’s global corporate social responsibility program, Healthy Lifestyles, Healthy Communities is annually co-sponsored by state and local community health organiza-tions and supported by Henry Schein’s supplier partners. The Henry Schein Cares Foundation, a 501(c)(3) organiza-tion that supports and promotes dental, medical, and ani-mal health by helping to increase access to care globally, provided financial support for the program as well.

NDC appoints Mike Otten and Mark LaPointe as territory managersNashville, Tenn.-based National Distribution & Con-tracting Inc (NDC) appointed two new territory manag-ers; Mike Otten and Mark LaPointe. During the last four years, Otten worked closely with many NDC members as a regional corporate account manager with Edina, Minn.-based ARKRAY USA, a manufacturer of diabetic monitoring devices and lancets. Prior to Joining NDC, LaPointe found success in the field of medical sales as a territory manager for Clarksdale, Miss.-based Infolab Inc, a distributor of laboratory equipment. Both will re-port to Colleen Stern, managing director of NDC’s med-ical division and will work closely with NDC members to assist in the sales efforts and help them maximize partici-pation in NDC programs.

Aribex builds 10,000th NOMAD handheld X-rayOrem, Utah-based Aribex Inc completed production of its 10,000th NOMAD® handheld X-ray system. In cel-ebration of the 10,000th unit, Aribex participated in the Wasatch Wellness 10K/5K one-mile run held August 4, 2012 in Provo, Utah. Race proceeds helped benefit the Provo Canyon Behavioral Hospital and mental illness pa-tients who actively pursue increased behavioral wellness and seek the return to a normal routine in life. Eighty-six employees, family members and friends participated in the event, and the company won the Corporate Cup Challenge for the most participants.

AAPD joins Ad Council campaign on children’s oral healthThe American Academy of Pediatric Dentistry (AAPD) joined Healthy Mouths, Healthy Lives, a coalition of over 35 leading dental organizations who, together with the Ad Council, are launching the first ever joint national Children’s Oral Health campaign. Media partners include Sesame Street, DreamWorks and the Cartoon Network. Though largely preventable, dental decay is the single most common chronic disease of childhood with over 16.5 million children suffering from untreated tooth de-cay in the U.S. The new campaign, Kids’ Healthy Mouths, raises awareness about the importance of brushing for two minutes, twice a day. There are English and Span-ish-language TV, radio, print, outdoor and web ads to direct parents and caregivers to visit the new website, www.2min2x.org, which is also available in a mobile ver-sion, where they can watch entertaining videos and listen to music – all two minutes in length – while children are brushing their teeth.


people

James NakaTerritory RepresentativeThe newest member of Benco Dental’s SoCal region, Naka brings with him four years of experience in the dental industry.

Susan Ashley VolkTerritory RepresentativeA former dental hygienist, Volk has worked in the dental industry for eleven years. She will call on customers in the Carolinas region.

Carlie JacobsenTerritory RepresentativeJacobsen is a new member of Benco Dental’s Rocky Mountain region. Jacobsen has more than three years of sales experience.

Claudia NovoaTerritory RepresentativeBenco Dental welcomes Novoa to its SoCal region. She will call on customers in the Southbay area.

Jose VacaTerritory RepresentativeVaca has more than 20 years of experience in the dental industry. He will call on customers in Benco Dental’s SoCal region.

Derek DreyerTerritory RepresentativeBenco Dental welcomes Dreyer to its Metro region. He will aid customers in northern New Jersey.

Joseph BaladyTerritory RepresentativeBalady has more than six years of experience in the dental industry. He will call on Benco Dental customers in the Metro region.

David WrightTerritory RepresentativeWright is a new member of Benco Dental’s Dallas region. He will call on customers in northeast Texas and northwest Louisiana.

Cindy Coletti-ManningTerritory RepresentativeBenco Dental welcomes Manning to the company’s Empire region. With more than six years of experience in the dental industry, she will serve customers in the Albany area.

Steve HarencharTerritory RepresentativeHarenchar is the newest member of Benco Dental’s Allegheny region. He will focus on serving customers in the Pittsburgh area.

Benco Dental New Appointees


Chris Orlich - Field Sales Consultant - Orlich will represent Henry Schein Dental at its center in Boston, MA. He received his B.S. from the University of Connecticut.

Robert S. Kelly- Field Sales Consultant - Kelly will represent Henry Schein Dental at its center in Long Island, NY. He has over 20 years of experience in the dental industry and

was previously employed as a regional and territory manager. Kelly received his B.B.A. from Adelphi University.

Kevin Murrey - Equipment Sales Spe-cialist - Murrey will represent Henry Schein Dental at its center in Orange County, CA. He has over 10 years of experience in the

dental industry and was previously employed as a territory manager. He received his M.B.A. from the University of Phoenix and his B.A. from San Diego State University.

David Krout - Field Sales Specialist - Krout will represent Henry Schein Dental at its center in Indianapolis, IN. He has 30 years of experience in the dental industry

and was previously employed in territory sales. Krout received his B.S. from Purdue University.

Philip Koczwara - Digital Technology Specialist - Koczwara will represent Henry Schein Dental at its center in San Jose, CA. He has 10 years of experience in the dental indus-

try and was previously employed as an account executive. Koczwara received his B.S. from the University of Nevada.

Bart Hyche - Field Sales Consultant - Hyche will represent Henry Schein Dental at its center in Birmingham, AL. He has eight years of experience in the dental

industry and was previously employed as a territory rep. Hyche received his M.B.A. from Auburn University and his B.A. from Mississippi State University.

George Hummert - Digital Technology Specialist - Hummert will represent Henry Schein Dental at its center in Atlanta, GA. He has seven years of experience in the

dental industry and was previously employed in sales. Hummert received his B.A. from Clarion University.

Victoria Carnaghi - Field Sales Consultant - Carnaghi will represent Henry Schein Dental at its center in Los Angeles, CA. She received her B.A. from the University of Dayton.

Dave Daggett - Field Sales Consultant - Daggett will represent Henry Schein Dental at its center in Hartford, CT. He has eight years of experience in the dental industry and was

previously employed as a sales account manager. Daggett received his B.S. from University of Massachusetts.

Carley Moore - Field Sales Consultant - Moore will represent Henry Schein Dental at its center in Atlanta, GA. She received her B.A. from Kennesaw State University.

Joe Gober - Digital Technology Spe-cialist - Gober will represent Henry Schein Dental at its center in Wilkes-Barre, PA. He has five years of experience in the dental in-

dustry and was previously employed as a branch manager. He received his B.S. from Moravian College.

Samantha Dawson - Field Sales Consul-tant - Dawson will represent Henry Schein Dental at its center in Fresno, CA. She received her B.A. from California State University.

Anthony Miranda - Digital Technology Specialist - Miranda will represent Henry Schein Dental at its center in Pine Brook, NJ. He received his B.S. from Saint Joseph’s University.

Andrea Doria - Field Sales Consultant - Doria will represent Henry Schein Dental at its center in Hartford, CT. She has 20 years of experience in the dental industry and was

previously employed as a practice development specialist. Doria received her B.A. from Iona College.

Henry Schein New Appointees


people

Patterson Dental Sales GraduatesThe following Patterson dental reps met the sales training requirements at the Patterson Companies corporate office in St. Paul, Minn.

Dan Brookes Krissie Cole Doug Deryke Stephanie Dominguez

Johnny Favi Travis Fonnesbeck Simon Forest Dorian Harris

Scott Hoover Andrew Hopkins Nate Martinez Melisa Mast

Markus O’Leary Sarah Palacpac Cherise Picou Brian Pierce

Rob Stevenson Ned Swann Binh Trang


new products

Crosstex® introduces Advantage Mini-Towel Crosstex International introduced the newest addition to its line of towels, bibs and liners – the Advantage Mini-Towel. Designed for orthodontists and pedodon-tists concerned with protecting their patients cloth-ing, the mini-towel is smaller in size and will not shift around when used on smaller patients. Made with two layers of tissue and a poly back, the Mini-Towel is per-fect for short, non-evasive procedures where light to moderate amounts of fluid are present. “The Advan-tage Mini-Towel is an ideal alternative to have in the office” said Pamela Runge, Crosstex Vice President of Marketing. “The Mini-Towel is ideal for pedodontics, orthodontics and procedures with little or no fluids. It can also be used as a tray-cover due to its size and poly backing.” The Mini-Towel is an absorbent 2-ply tissue + 1-ply poly, 10” x 13” and is available in Blue, Dusty Rose, Lavender and White. www.crosstex.com

Keystone Industries launches centri-fuse fitKeystone Industries launched the centri-fuse kit, an innovated product that makes the application of de-cals to mouthguards quicker, easier and more cost effective. The typical lamina-

tion process for customized mouthguards can become expensive and time consuming, however with centri-fuse, customization has never been easier or more affordable. The centri-fuse system gives the advantage of applying the decal while eliminating the necessity of a second forming. The centri-fuse kit includes everything needed to start up an easy mouthguard customization system. It includes 20 centri-fuse strips, flameless torch, primer, brush, scissors, trimming and polishing brush, and pre-printed decals. For more information call (800) 333-3131 or fax (856) 663-0381. www.keystoneind.com/en/home

Hu-Friedy launches Steam Sterilization IntegratorHu-Friedy recently introduced a new solution to its Instrument Management System (IMS) Sterilization Product Line. The Hu-Friedy Steam Sterilization Integrator is a Class 5 steriliza-tion monitor designed to react to all critical variables in the ster-ilization cycle: time, temperature and presence of steam. Inte-grators are a multi-parameter chemical indicator and are a more stringent, reliable indication that sterilization parameters have been met compared to other classes of sterilization monitors. The Hu-Friedy Steam Sterilization Integrator is used to moni-tor the steam sterilization process and can be placed inside each pack or load. Features include: Moving Front Indicator Tech-nology that gives a better indication of acceptance; the strip is easily visible inside the pack (2-inches long); the product is lead free and does not contribute to environmental lead contamina-tion; and the integrators work with a variety of steam sterilizers – gravity, pre-vacuum and flash sterilizers.www.hu-friedy.com

Pulpdent Corporation launches Embrace VarnishPulpdent Corporation introduced Embrace Varnish, 5% Sodium Fluoride with CXP, a new generation of fluo-ride varnishes. By incor-porating Xylitol coated Calcium and Phosphate in a permeable resin matrix that does not separate and requires no mixing, Pulpdent has developed a sustained, time-release bioactive varnish with predictable, uniform dosage that delivers 10 times more fluoride than the leading varnish brand. Not only does Embrace Varnish re-lease more fluoride in four hours, it also releases bioavailable calcium and phosphate ions, the essential building blocks of teeth. The xylitol coating prevents the calcium and phos-phate salts from reacting until they come in contact with saliva. Saliva dissolves the xylitol and releases the calcium and phosphate ions, which react continuously in saliva with fluoride ions to form protective fluorapatite on the teeth. www.pulpdent.com


An Eye for Design” in September’s First Im-pressions equipment supplement. The article brought back memories of working in the field with dealer reps as they went over plans with

their customers to build a new office or expand an existing practice. There is a certain level of excitement and satisfac-tion when you can help your customer realize their dream of a new office, or even adding a few more operatories. As a field rep, you and your team have a huge responsibility to help keep the project on target and make sure it is suc-cessful, with as few bumps and delays as possible. The process almost always makes for an adventure.

It is a team effort. It takes the field rep, customer service rep, service install team, interior designer, equipment specialist, technology rep, architect, contractors, and various manufacturer reps (hopefully all working in har-mony), to get the office designed, built, and equipment installed in a reasonable amount of time. Timing of the project is important for a variety of reasons, including lim-iting or eliminating any downtime for the office.

Certainly a new office build-out, or even a small office expansion, can be challenging. As a field rep or equipment specialist you may think that you have everything covered, however the municipality that your customer is dealing with may have another opinion. Delays with permits and contractors, and even equipment orders, can throw a mon-key wrench into a successful new office build-out.

The stakes are high. You may have a six-figure technology and equipment sale with your new office build-out. Selling equipment is great, but unfortunately the nature of the sale is “one and done.” After a new office build or expansion it is more than likely that the office will not be making another large equipment investment in the near future. For every successful office build-out, there seems to another build-out that doesn’t

go so well. Whether it is your fault, or the city, or contractor, or architect, or something else, it still ends up being your problem. The chance of losing the sundry business after a subpar office build-out is high. And we all know the sundry business tends to pay the bills.

What can be done to ensure that you have a successful office build-out? Make sure that you, your equipment rep, the contractors, the dentist, and anyone else on the project, communicate well

with each other. With good team communication you can set reasonable goals and expectations for each person on the project, and ensure that when the office is complete your sundry business will grow as the new office does.

With thorough planning and excellent communica-tion, the cotton roll and bur sales will continue long after the office is complete. Move forward this equipment sell-ing season with an eye on the equipment business and a focus on retaining your sundry business.

Happy Q4,Bill Neumann

New Office Build-Out: Risks and Rewards

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Please send me your suggestions, comments or stories to [email protected].

By Bill Neumann

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