Archive for April, 2011

Becoming an Associate…Consideration #2

Friday, April 15th, 2011

Whether you just graduated from dental school, finished a residency program or specialty training, the majority of young dentists begin their careers as associates. The road to becoming an associate is full of variables, and knowing the “lay of the land” can help you make wise decisions. The journey begins with choosing the practice that is right for you.


Consideration #2 – Employment Relationship


Do not enter into a relationship without a written contract. A well-designed employment agreement will address many issues, including your role in the practice, non-competition agreement (if applicable), non-solicitation agreement, your compensation, and possible option to purchase. Additionally, realize that non-solicitation and non-compete clauses are common business practices, which protect the employer dentist from unscrupulous tactics. Non-solicitation means that you may not directly solicit any patients or staff for a specified period after you leave the practice.


Non-compete clauses may vary. Moreover, in some states they are not enforced. For those states that enforce non-compete clauses, they have to be crafted fairly. The geographic limitations in covenants are based on local convention in a specific area and must be considered to be reasonable. For example, a 10-mile covenant restriction in a major metropolitan area would probably not be enforceable for a general dentist, whereas one-to-two-miles would be considered reasonable. Restrictive covenants for specialties tend to have a larger geographic range since the number of specialists is fewer. The duration of a non- compete ranges between one-to-two years.


When you join a general dental practice, a non-compete clause stipulation should not take effect completely until you are employed for 12 months. A gradual approach, which allows the first 6 months of employment to be free of covenant and penalty, with subsequent periods of increasing restriction, is more appropriate. In cases of specialty practices where the employer is introducing the associate to the referral base, the graduated approach would be modified and have a shorter timeframe for increasing restriction.



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Carbon Fiber Posts

Friday, April 15th, 2011

There is a literature review in the March 2010 issue of The Journal of Evidence-Based Dental Practice regarding failures of posts. The writers examined multiple randomized control trials evaluating failures of endodontically-treated permanent teeth with different post types.  The trials compared metal posts to fiber posts. The results of the review showed fewer failures with carbon fiber posts as opposed to metal posts.


This seems to be concordant with the widely accepted thoughts about posts. Carbon fiber posts have a modulus of elasticity closer to natural tooth than do metal posts. In addition, carbon fiber posts are generally passive and tapered which decreases chances of perforation or root fracture when preparing. One disadvantage to carbon fiber posts is the necessity to “bond” them in with a self-etching resin. Bonding is very problematic at depths in the root and can create a point of weakness if the proper technique is not followed.


As an industry, we are doing less and less posts. I feel the literature supports this, however there are some teeth that just need posts no matter what. I find that these teeth are more often premolars and anterior teeth in my practice. Because of this, I general use the smallest posts available. Probably the biggest key to post success is amount of vertical tooth structure and ferrule remaining. In dire situations with little ferrule, no post system has a shot of success.

As far as my practice goes, I use 3M’s Rely-X post system. I find the system to be easy to use with few steps and yields good results. There are plenty of other good systems on the market. As with anything the key to success is your familiarity and comfort.

Small Changes…Improve Your Practice

Wednesday, April 6th, 2011

Certainly, the last year brought more change than most care to think about, as much of it was not easy.  If you don’t ever again want to face a year like you just did, I strongly suggest you commit to making economic change of your own in the coming months and ensure that regardless of the financial sector’s projections of  boom or bust, you practice is well positioned.


Start with the messages that you and your team regularly communicate to patients. Does your staff convey ordinary or outstanding, state of the art or status quo? Is the excellence of the team and the dentistry routinely conveyed to the patient? And, most importantly, have you even considered the messages you’re sending to your patients in every interaction, from the first phone call, to the emergency appointment, to the routine visit? If not, it’s time to listen up and script your success.


Use a well-crafted script to discourage patients from canceling appointments. When a patient calls to cancel, your business staff should ask for permission to put them on hold, access their file, and use the information to motivate them to keep the appointment. For example: “Mrs. Jones, I’m looking at the doctor’s notes and she emphasized that there is significant decay in that tooth. I know it is very important that you keep the appointment, would you reconsider?” The patient may still cancel, but in some cases, they will be convinced to keep it. Moreover, calling specific attention to the patient’s need for the appointment further underscores the value and importance of pursuing the recommended treatment, and emphasizing the need for care has never been more critical. Particularly since even in the best of economic times, many patients will put off certain procedures for as long as possible. Additionally, ensure that there is an established protocol to follow-up with patients who cancel. In many offices, it is months before anyone follows up on a cancellation.