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Practice ManagementPractice Management
In DentistryIn Dentistry
 Recognize the basic concepts of quality assurance andRecognize the basic concepts of quality assurance and
practice mana...
 Recognize and effectively utilize all sources forRecognize and effectively utilize all sources for
continuing profession...
Successful DentistSuccessful Dentist
1.1. Establish a practice in a desirable conditionsEstablish a practice in a desirabl...
Making The ChoiceMaking The Choice
&&
Planning The CareerPlanning The Career
 It is important to love & enjoy the pattern ofIt is important to love & enjoy the pattern of
workwork
 Typical dentist ...
Dentist may be employed in:Dentist may be employed in:
 Academic ( full time or part-time)Academic ( full time or part-ti...
 Technique of part-time option to aid in decisionTechnique of part-time option to aid in decision
making.making.
 The op...
Planning The PracticePlanning The Practice
CareerCareer
 There are two kinds of doctors; those who areThere are two kinds of doctors; those who are
primarily interested in disea...
For Private PracticeFor Private Practice
CHOOSING A PLACE DEPENDS ON:CHOOSING A PLACE DEPENDS ON:
 AgeAge
 RaceRace
 So...
 The question of how far away the place of workThe question of how far away the place of work
will be from home is import...
Special Consideration OfSpecial Consideration Of
The Woman DentistThe Woman Dentist
 Prejudice against women dentists both on thePrejudice against women dentists both on the
public & dentists themselves DO...
 Women dentists can do all dental procedureWomen dentists can do all dental procedure
which were once considered to be ex...
 Another point is the instability or interruptionAnother point is the instability or interruption
in women's career:in wo...
 Another prejudice from female ancillary staff,Another prejudice from female ancillary staff,
secretaries, chairside assi...
 To overcome this prejudice, educating the publicTo overcome this prejudice, educating the public
is important .is import...
Building up aBuilding up a
sufficient list ofsufficient list of
patientspatients
Entering an existingEntering an existing
practicepractice
For a new graduate dentist in private clinic, thereFor a new graduate dentist in private clinic, there
are two main situat...
Working at another's clinicWorking at another's clinic
 It affords a reasonable numbers of patients.It affords a reasonab...
 It may need the existing practice team to get theIt may need the existing practice team to get the
patient's initial app...
 For a new comer younger dentist to start anFor a new comer younger dentist to start an
established practice busy enough ...
 His personality & relationship with patientsHis personality & relationship with patients
must be pleasing, he must show ...
 The next problem is being short of patientsThe next problem is being short of patients
 Being pleasant, skilful, friend...
 The dentist who spend a little time discussingThe dentist who spend a little time discussing
the procedures to be advise...
The influence of chargesThe influence of charges
 A free system of payment in Sudan and otherA free system of payment in ...
 Because of the accelerated inflation, the dentistBecause of the accelerated inflation, the dentist
is finding it necessa...
 Generally, older patient tend to refuse payingGenerally, older patient tend to refuse paying
much for procedure in compa...
 Other aspect that is the quality of patients whoOther aspect that is the quality of patients who
present to the new dent...
How the patient will pay ?How the patient will pay ?
 Pay in advancePay in advance
 Having an accountHaving an account
...
 Dentist must be clear, and definite about feesDentist must be clear, and definite about fees
otherwise he will loose hon...
Starting your ownStarting your own
practicepractice
Making oneself knownMaking oneself known
 The dentist has find his own patientsThe dentist has find his own patients
 Wh...
 Being pleasant, skilful, friendly, compassionate,Being pleasant, skilful, friendly, compassionate,
definitely will attra...
Patient sourcesPatient sources
 FamilyFamily
 FriendsFriends
 Referral of emergenciesReferral of emergencies
 Referral...
Appointment bookAppointment book
 Filling the appointment bookFilling the appointment book
 Never saying there is nothin...
Basic Furnishing &Basic Furnishing &
EquipmentEquipment
 Buy only what is needed in the immediateBuy only what is needed in the immediate
foreseeable futureforeseeable future
 ...
ErgonomicsErgonomics
 The study that concerns the relation betweenThe study that concerns the relation between
workers an...
 Standing for a long period of time will cause varicose,Standing for a long period of time will cause varicose,
strain in...
DesignersDesigners
 A satisfactory practical workable apparentlyA satisfactory practical workable apparently
clean design...
EquipmentEquipment
 Specialist dentist will know what items required,Specialist dentist will know what items required,
th...
Dental chairsDental chairs
Most patients do not likeMost patients do not like
 one arm chairone arm chair
 Flat head res...
 Recent chairs are computerized, but they guaranteedRecent chairs are computerized, but they guaranteed
from companies un...
Dental stoolDental stool
Requirement are:Requirement are:
 Comfort at all positionsComfort at all positions
 Support for...
The suction/ spittoonThe suction/ spittoon
 Some clinics are supplied central suction, toSome clinics are supplied centra...
CompressorCompressor
The compressor needs to be:The compressor needs to be:
 Powerful in performing the desired pressureP...
AutoclaveAutoclave
 An essential item in the dental clinic, may assureAn essential item in the dental clinic, may assure
...
Other itemsOther items
 Sphygmomanometer, stethoscopeSphygmomanometer, stethoscope
 Amalgam mixerAmalgam mixer
 Digital...
Laboratory equipmentLaboratory equipment
 Although the dentist is sending dentures andAlthough the dentist is sending den...
Water distillationWater distillation
 Dirty water may damage the water circuit in theDirty water may damage the water cir...
Installation & servicesInstallation & services
 Air, water, electricity and drainage will beAir, water, electricity and d...
Clinical photographyClinical photography
Why the camera ?Why the camera ?
 Before and after photographs to demonstrateBefore and after photographs to demonstrate
...
The waiting roomThe waiting room
 It is better to call it the reception roomIt is better to call it the reception room
 You need to implement your own pe...
The business officeThe business office
ComputerComputer
 It is advisable to acquire computer in the clinicIt is advisable to acquire computer in the clinic
to s...
Copying machineCopying machine
It is used in our practice for:It is used in our practice for:
 Daily appointment schedule...
TelephoneTelephone
&&
answering machineanswering machine
 It is useful aid in good patient relationshipIt is useful aid i...
Dictating machineDictating machine
 Micro cassette to help the dentist leaving aMicro cassette to help the dentist leavin...
The appointment bookThe appointment book
 Appointment book is a planning system forAppointment book is a planning system for
dentist and for the other operating s...
A general plan of appointmentA general plan of appointment
makingmaking
 Extractions are better done earlier in the day s...
 Emergencies should ideally be seen in twoEmergencies should ideally be seen in two
selected periods during the day, the ...
A short notice list of patientsA short notice list of patients
 Is a list of patients that can be used to fill in lateIs ...
General considerations in caring forGeneral considerations in caring for
the new patientsthe new patients
 First impressi...
StaffStaff
 The dental team may be consist of: the seniorThe dental team may be consist of: the senior
dentist, a partner...
Redundancy & firingRedundancy & firing
 A staff who have been employed continuouslyA staff who have been employed continu...
Redundancy paymentRedundancy payment
 These are made for members who have beenThese are made for members who have been
em...
Health care in theHealth care in the
practicepractice
Hazards to the dental teamHazards to the dental team
 MercuryMercury
 Posture problemPosture problem
 ElectricalElectri...
Continuing educationContinuing education
Keeping with contemporary dentistryKeeping with contemporary dentistry
 Regular reading of dental journalsRegular reading...
Evidence-based DentistryEvidence-based Dentistry
 The concept of using current evidence to guideThe concept of using curr...
 The new concept of EBM utilizes a systematicThe new concept of EBM utilizes a systematic
process to incorporate current ...
The evidence-based process requiresThe evidence-based process requires
the development of five key skills:the development ...
Levels of evidenceLevels of evidence
 When deciding whether to implement evidenceWhen deciding whether to implement evide...
The 5 levels of evidenceThe 5 levels of evidence
1a. Systematic review of multiple randomized controlled1a. Systematic rev...
AA randomized controlled trial (RCT)randomized controlled trial (RCT)
 is a type of scientificis a type of scientific exp...
AA systematic reviewsystematic review
 Is a literature review focused on a singleIs a literature review focused on a sing...
 AA cohort studycohort study is a form of longitudinal study (a typeis a form of longitudinal study (a type
of observatio...
Case-control studyCase-control study
 is a type of retrospective, epidemiological, clinical studyis a type of retrospecti...
AA case seriescase series
 (also known as a(also known as a clinical seriesclinical series) is a medical) is a medical
re...
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Practice management in dentistry

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  1. 1. Practice ManagementPractice Management In DentistryIn Dentistry
  2. 2.  Recognize the basic concepts of quality assurance andRecognize the basic concepts of quality assurance and practice management.practice management.  Prioritize workload and manage personal stress in thePrioritize workload and manage personal stress in the frame work of proper performance and management.frame work of proper performance and management.  Work in collaboration as a member of anWork in collaboration as a member of an interdisciplinary teaminterdisciplinary team  share information and professional knowledge withshare information and professional knowledge with both the patient and other professionals, verbally and inboth the patient and other professionals, verbally and in writing, including being able to negotiate and give andwriting, including being able to negotiate and give and receive constructive criticism.receive constructive criticism.
  3. 3.  Recognize and effectively utilize all sources forRecognize and effectively utilize all sources for continuing professional development and life-longcontinuing professional development and life-long learning.learning.  Adopt a creative attitude in an ethical and scientificAdopt a creative attitude in an ethical and scientific approach.approach.  Self evaluate professional abilities, performance, andSelf evaluate professional abilities, performance, and progress.progress.  use contemporary information technology foruse contemporary information technology for communication, management of information andcommunication, management of information and applications related to health care.applications related to health care.
  4. 4. Successful DentistSuccessful Dentist 1.1. Establish a practice in a desirable conditionsEstablish a practice in a desirable conditions 2.2. Good relationship with the patientsGood relationship with the patients 3.3. A happy practice teamA happy practice team 4.4. Reasonable income to maintain reasonable livingReasonable income to maintain reasonable living standardstandard 5.5. Abilities & facilities to keep abreast of modernAbilities & facilities to keep abreast of modern dentistry, both educationally & in equipmentdentistry, both educationally & in equipment 6.6. Technically Skilful in dental proceduresTechnically Skilful in dental procedures 7.7. Respect timeRespect time 8.8. Three As are important in making a successful dentistThree As are important in making a successful dentist Availability, Affability and Ability.Availability, Affability and Ability. ** Devote his time to caring of patient as a human being without the pressure ofDevote his time to caring of patient as a human being without the pressure of thinking every minute without the drill in his hand is lost income.thinking every minute without the drill in his hand is lost income.
  5. 5. Making The ChoiceMaking The Choice && Planning The CareerPlanning The Career
  6. 6.  It is important to love & enjoy the pattern ofIt is important to love & enjoy the pattern of workwork  Typical dentist works at the dental chairside,Typical dentist works at the dental chairside, operate on patients restoring teeth, fillings etc..operate on patients restoring teeth, fillings etc..  Students must be asked if they good with theirStudents must be asked if they good with their handshands  All dentist must be able to do adequateAll dentist must be able to do adequate treatment at final examination leveltreatment at final examination level  There are different areas of dentistry we can gainThere are different areas of dentistry we can gain experiences in, and we decide which would beexperiences in, and we decide which would be suitable to our temperamentsuitable to our temperament
  7. 7. Dentist may be employed in:Dentist may be employed in:  Academic ( full time or part-time)Academic ( full time or part-time) 1.1. TeachingTeaching 2.2. ResearchResearch  Hospital (full time or part-time)Hospital (full time or part-time)  General dental practiceGeneral dental practice  Specialist dental practiceSpecialist dental practice  Participant in commercial promotionParticipant in commercial promotion  Writing (journalism)Writing (journalism)  Organizations & management ( WHO)Organizations & management ( WHO)  Public relationPublic relation  Armed servicesArmed services
  8. 8.  Technique of part-time option to aid in decisionTechnique of part-time option to aid in decision making.making.  The option of military services is almost a one-The option of military services is almost a one- way option.way option.  Possible ladder of promotion depending onPossible ladder of promotion depending on further trainingfurther training
  9. 9. Planning The PracticePlanning The Practice CareerCareer
  10. 10.  There are two kinds of doctors; those who areThere are two kinds of doctors; those who are primarily interested in disease and those who areprimarily interested in disease and those who are primarily interested in peopleprimarily interested in people  There are two kinds of dentists; those who areThere are two kinds of dentists; those who are primarily interested in the mechanics ofprimarily interested in the mechanics of treatment and those who are interested in peopletreatment and those who are interested in people
  11. 11. For Private PracticeFor Private Practice CHOOSING A PLACE DEPENDS ON:CHOOSING A PLACE DEPENDS ON:  AgeAge  RaceRace  Social classSocial class  CustomCustom  Town OR countryTown OR country * Remember, you can practice at home !* Remember, you can practice at home !
  12. 12.  The question of how far away the place of workThe question of how far away the place of work will be from home is important in term ofwill be from home is important in term of travelling time and emergencies that necessitatetravelling time and emergencies that necessitate attendance even at weekends.attendance even at weekends.  Malpractice cover is sought, especially as aMalpractice cover is sought, especially as a beginner.beginner.  Payment issues ( fixed salary, percentage basis)Payment issues ( fixed salary, percentage basis)
  13. 13. Special Consideration OfSpecial Consideration Of The Woman DentistThe Woman Dentist
  14. 14.  Prejudice against women dentists both on thePrejudice against women dentists both on the public & dentists themselves DOES exist.public & dentists themselves DOES exist.  In Sudan intake of new dental studentIn Sudan intake of new dental student approaches equality in examination resultsapproaches equality in examination results indicating no superiority in skills of one genderindicating no superiority in skills of one gender over another.over another.
  15. 15.  Women dentists can do all dental procedureWomen dentists can do all dental procedure which were once considered to be exclusivelywhich were once considered to be exclusively carried out by male dentistcarried out by male dentist  Many patients, however, question the ability ofMany patients, however, question the ability of women to extract a tooth, this coincide with thewomen to extract a tooth, this coincide with the view that dentistry is a manual skills in whichview that dentistry is a manual skills in which dentist is always operating, while generaldentist is always operating, while general medicine (for women) is merely examination andmedicine (for women) is merely examination and advice.advice.
  16. 16.  Another point is the instability or interruptionAnother point is the instability or interruption in women's career:in women's career: 1.1. She may have to take more days for sicknessShe may have to take more days for sickness 2.2. She may leave to have childrenShe may leave to have children 3.3. If married, might find it necessary toIf married, might find it necessary to accompany her husband should he beaccompany her husband should he be transferred in his job to another area.transferred in his job to another area.
  17. 17.  Another prejudice from female ancillary staff,Another prejudice from female ancillary staff, secretaries, chairside assistant etc who prefer asecretaries, chairside assistant etc who prefer a male ‘boss’.male ‘boss’.  Some women solve this problem by taking upSome women solve this problem by taking up dental practice seriously after child bearing anddental practice seriously after child bearing and rearing is over, although it may be a sacrifice torearing is over, although it may be a sacrifice to wait too long before contributing to the home,wait too long before contributing to the home, learning late become difficult.learning late become difficult.
  18. 18.  To overcome this prejudice, educating the publicTo overcome this prejudice, educating the public is important .is important .  Another means of decreasing this trend is whenAnother means of decreasing this trend is when the male gender is becoming a minoritythe male gender is becoming a minority
  19. 19. Building up aBuilding up a sufficient list ofsufficient list of patientspatients
  20. 20. Entering an existingEntering an existing practicepractice
  21. 21. For a new graduate dentist in private clinic, thereFor a new graduate dentist in private clinic, there are two main situations:are two main situations:  Working at another's clinicWorking at another's clinic  Beginning on his own clinicBeginning on his own clinic
  22. 22. Working at another's clinicWorking at another's clinic  It affords a reasonable numbers of patients.It affords a reasonable numbers of patients.  It necessitates a support from the owner’s andIt necessitates a support from the owner’s and put them in the embarrassment of getting rid ofput them in the embarrassment of getting rid of their patients to an unknown dentisttheir patients to an unknown dentist  You must be patient and understanding to thisYou must be patient and understanding to this situationsituation
  23. 23.  It may need the existing practice team to get theIt may need the existing practice team to get the patient's initial approval for the changepatient's initial approval for the change  Once the referral has taken place the contest isOnce the referral has taken place the contest is within the hand of the new dentist, to provewithin the hand of the new dentist, to prove himself.himself.
  24. 24.  For a new comer younger dentist to start anFor a new comer younger dentist to start an established practice busy enough to reliveestablished practice busy enough to relive him/her of the worry of acquiring a new patienthim/her of the worry of acquiring a new patient  The condition at which it may occur, is having aThe condition at which it may occur, is having a new patient.new patient.  Old patients may protest and claim being rid ofOld patients may protest and claim being rid of by the owner of the clinic to unknown dentistby the owner of the clinic to unknown dentist
  25. 25.  His personality & relationship with patientsHis personality & relationship with patients must be pleasing, he must show compassion, bemust be pleasing, he must show compassion, be gentlegentle  He must not compete or degrade his bossHe must not compete or degrade his boss  He must show the advantage of his youthfulHe must show the advantage of his youthful appearance of the new& latest methods &appearance of the new& latest methods & techniques in dentistrytechniques in dentistry
  26. 26.  The next problem is being short of patientsThe next problem is being short of patients  Being pleasant, skilful, friendly, compassionate,Being pleasant, skilful, friendly, compassionate, definitely will attract more patients.definitely will attract more patients.  A common failing is the use of language theA common failing is the use of language the patient does not understandpatient does not understand  One has to explain each procedure to the patientOne has to explain each procedure to the patient language & general comprehensionlanguage & general comprehension
  27. 27.  The dentist who spend a little time discussingThe dentist who spend a little time discussing the procedures to be advised and does this inthe procedures to be advised and does this in simple everyday language will often find ansimple everyday language will often find an appreciative and co-operative patient.appreciative and co-operative patient.
  28. 28. The influence of chargesThe influence of charges  A free system of payment in Sudan and otherA free system of payment in Sudan and other countries, although in others the fees of eachcountries, although in others the fees of each procedure performed by GP or specialist isprocedure performed by GP or specialist is governed and established.governed and established.  The first system allow any dentist whatever hisThe first system allow any dentist whatever his standards to make a living.standards to make a living.  Often the lower standards the better incomeOften the lower standards the better income
  29. 29.  Because of the accelerated inflation, the dentistBecause of the accelerated inflation, the dentist is finding it necessary to compete with care andis finding it necessary to compete with care and service and has to give value he is giving to theservice and has to give value he is giving to the patient for the fees he is demanding.patient for the fees he is demanding.  The patient himself is comparing between theThe patient himself is comparing between the service he is getting to the fees he is paying.service he is getting to the fees he is paying.  An advice from a senior colleague, accountantAn advice from a senior colleague, accountant receptionist is recommended, with due respectreceptionist is recommended, with due respect for socioeconomic status for the patients of thefor socioeconomic status for the patients of the areaarea
  30. 30.  Generally, older patient tend to refuse payingGenerally, older patient tend to refuse paying much for procedure in comparison to youngermuch for procedure in comparison to younger ones.ones.  A patient who is regular visitor an older dentistA patient who is regular visitor an older dentist also will find the fees unexplainably high.also will find the fees unexplainably high.  A differential charges between dentists for theA differential charges between dentists for the same practice gives the impression to patientssame practice gives the impression to patients there is a lower charge because the dentist isthere is a lower charge because the dentist is somewhat inferior in his standardssomewhat inferior in his standards
  31. 31.  Other aspect that is the quality of patients whoOther aspect that is the quality of patients who present to the new dentist with lower chargespresent to the new dentist with lower charges are those of problematic in nature, although it isare those of problematic in nature, although it is an opportunity to test your kindness, coldan opportunity to test your kindness, cold nerves, controlling pattern.nerves, controlling pattern.  There are two schools, one is discussing the feesThere are two schools, one is discussing the fees with the patients the other does notwith the patients the other does not
  32. 32. How the patient will pay ?How the patient will pay ?  Pay in advancePay in advance  Having an accountHaving an account  Young dentist should suspect who looks smartYoung dentist should suspect who looks smart and honest because of thier financial inabilityand honest because of thier financial inability
  33. 33.  Dentist must be clear, and definite about feesDentist must be clear, and definite about fees otherwise he will loose honest who will pay evenotherwise he will loose honest who will pay even if under protestif under protest
  34. 34. Starting your ownStarting your own practicepractice
  35. 35. Making oneself knownMaking oneself known  The dentist has find his own patientsThe dentist has find his own patients  Where do they come fromWhere do they come from
  36. 36.  Being pleasant, skilful, friendly, compassionate,Being pleasant, skilful, friendly, compassionate, definitely will attract more patients.definitely will attract more patients.  A common failing is the use of language theA common failing is the use of language the patient does not understandpatient does not understand  One has to explain each procedure to the patientOne has to explain each procedure to the patient language & general comprehensionlanguage & general comprehension
  37. 37. Patient sourcesPatient sources  FamilyFamily  FriendsFriends  Referral of emergenciesReferral of emergencies  Referral by doctors & dentistsReferral by doctors & dentists  Recommendations by those patients already seenRecommendations by those patients already seen
  38. 38. Appointment bookAppointment book  Filling the appointment bookFilling the appointment book  Never saying there is nothing to do if I cameNever saying there is nothing to do if I came waiting for patients to comewaiting for patients to come
  39. 39. Basic Furnishing &Basic Furnishing & EquipmentEquipment
  40. 40.  Buy only what is needed in the immediateBuy only what is needed in the immediate foreseeable futureforeseeable future  If offered some new gadget a carful appraisalIf offered some new gadget a carful appraisal should be made of its properties, and reportsshould be made of its properties, and reports and evaluation by other dentists in practiceand evaluation by other dentists in practice conditionsconditions
  41. 41. ErgonomicsErgonomics  The study that concerns the relation betweenThe study that concerns the relation between workers and their energy and environmentworkers and their energy and environment  In dentistry, it is concerned with the study ofIn dentistry, it is concerned with the study of unnecessary movement and wasted energy,unnecessary movement and wasted energy, saving time, lessening fatigue.saving time, lessening fatigue.  Dentistry is physically demanding profession,Dentistry is physically demanding profession, long hours is spent in one positionlong hours is spent in one position
  42. 42.  Standing for a long period of time will cause varicose,Standing for a long period of time will cause varicose, strain in musculoskeletal systemstrain in musculoskeletal system  Consideration should start with the positioning of theConsideration should start with the positioning of the dental chair in relation to the door & patient path.dental chair in relation to the door & patient path.  Another parameter is the entrance of light positionAnother parameter is the entrance of light position  Once the chair position is established, plumbing for theOnce the chair position is established, plumbing for the wash basin is arranged, near to the dentist.wash basin is arranged, near to the dentist.  Base cabinet should have tops at comfortable height forBase cabinet should have tops at comfortable height for dentist to workdentist to work
  43. 43. DesignersDesigners  A satisfactory practical workable apparentlyA satisfactory practical workable apparently clean design is preferableclean design is preferable  A conference between designer, plumber,A conference between designer, plumber, electrician and those wishing to supplyelectrician and those wishing to supply equipmentequipment  Those people should work under supervision ofThose people should work under supervision of the dentist who guide toward his objectivesthe dentist who guide toward his objectives  Never hesitate of asking any stupid question!Never hesitate of asking any stupid question!
  44. 44. EquipmentEquipment  Specialist dentist will know what items required,Specialist dentist will know what items required, the followings are concerned with the generalthe followings are concerned with the general practitioners.practitioners.  Planning for the future can take place whenPlanning for the future can take place when economic factor improves.economic factor improves.  Some of the equipment is bought as a secondSome of the equipment is bought as a second hand so you need to take care ( the poor can nothand so you need to take care ( the poor can not afford the cheap.afford the cheap.
  45. 45. Dental chairsDental chairs Most patients do not likeMost patients do not like  one arm chairone arm chair  Flat head restFlat head rest  Chairs with noisy mechanisms or with type ofChairs with noisy mechanisms or with type of stimulated leather that make noises as patientsstimulated leather that make noises as patients movemove  The more complicated, the more difficult to fixThe more complicated, the more difficult to fix if it goes wrongif it goes wrong
  46. 46.  Recent chairs are computerized, but they guaranteedRecent chairs are computerized, but they guaranteed from companies unless there is misuse of dentist.from companies unless there is misuse of dentist.  They supplied with new accessories that you need (nonThey supplied with new accessories that you need (non touchable light, suction, high hand piece, air dispensertouchable light, suction, high hand piece, air dispenser light cure applicator, ultrasonic scaler, intraoral camera,light cure applicator, ultrasonic scaler, intraoral camera, X-ray viewer etc…).X-ray viewer etc…).  A programmed position is set even an emergencyA programmed position is set even an emergency positionposition
  47. 47. Dental stoolDental stool Requirement are:Requirement are:  Comfort at all positionsComfort at all positions  Support for the backSupport for the back  Easily adjustable for heightEasily adjustable for height  Should be stableShould be stable  Should be movable when requiredShould be movable when required
  48. 48. The suction/ spittoonThe suction/ spittoon  Some clinics are supplied central suction, toSome clinics are supplied central suction, to place the motor in distance from the clinic.place the motor in distance from the clinic.  Most today's clinics the suction & spittoon areMost today's clinics the suction & spittoon are built within the dental unit, the difference is thebuilt within the dental unit, the difference is the quality in companies.quality in companies.
  49. 49. CompressorCompressor The compressor needs to be:The compressor needs to be:  Powerful in performing the desired pressurePowerful in performing the desired pressure with either low speed or high speed hand pieces.with either low speed or high speed hand pieces.  Quite & friendly with much noisesQuite & friendly with much noises  Time of regular check ups is important for theTime of regular check ups is important for the air and oilair and oil
  50. 50. AutoclaveAutoclave  An essential item in the dental clinic, may assureAn essential item in the dental clinic, may assure the quality of standards the dentist aiming at.the quality of standards the dentist aiming at.  If expensive its cost is wastedIf expensive its cost is wasted  It should be big enough to accommodate clinic'sIt should be big enough to accommodate clinic's items.items.  In the contract at least 2 years maintenance isIn the contract at least 2 years maintenance is advised.advised.
  51. 51. Other itemsOther items  Sphygmomanometer, stethoscopeSphygmomanometer, stethoscope  Amalgam mixerAmalgam mixer  Digital timerDigital timer  Pulp testerPulp tester  Root canal depth indicatorRoot canal depth indicator  Panoramic X-rayPanoramic X-ray  Oxygen unitOxygen unit  General anaesthesia equipmentGeneral anaesthesia equipment
  52. 52. Laboratory equipmentLaboratory equipment  Although the dentist is sending dentures andAlthough the dentist is sending dentures and bridges to a commercial lab, sometimes somebridges to a commercial lab, sometimes some preliminary technician job & corrections neededpreliminary technician job & corrections needed to be made at the clinicto be made at the clinic
  53. 53. Water distillationWater distillation  Dirty water may damage the water circuit in theDirty water may damage the water circuit in the dental unit, filter or water distiller is important atdental unit, filter or water distiller is important at the contextthe context
  54. 54. Installation & servicesInstallation & services  Air, water, electricity and drainage will beAir, water, electricity and drainage will be requiredrequired  The installation of waste pipes is the mostThe installation of waste pipes is the most difficult task of all.difficult task of all.  Plumbing is vital in cross infection issuesPlumbing is vital in cross infection issues
  55. 55. Clinical photographyClinical photography
  56. 56. Why the camera ?Why the camera ?  Before and after photographs to demonstrateBefore and after photographs to demonstrate improvement in oral conditionimprovement in oral condition  To demonstrate the merit of different materialsTo demonstrate the merit of different materials  Recording of unusual & interesting oralRecording of unusual & interesting oral conditionsconditions  The provision of teaching materialThe provision of teaching material
  57. 57. The waiting roomThe waiting room
  58. 58.  It is better to call it the reception roomIt is better to call it the reception room  You need to implement your own personality in itYou need to implement your own personality in it  You do not need to give education because they areYou do not need to give education because they are quite anxious .quite anxious .  The waiting time should be briefThe waiting time should be brief  Receptionist should welcome the patient and make itReceptionist should welcome the patient and make it clear that we know his arrivalclear that we know his arrival  The question of music or other entertaining material isThe question of music or other entertaining material is becoming mandatorybecoming mandatory  Furniture of the waiting room to be cleansableFurniture of the waiting room to be cleansable  The bathroom must be kept clean all the time.The bathroom must be kept clean all the time.
  59. 59. The business officeThe business office
  60. 60. ComputerComputer  It is advisable to acquire computer in the clinicIt is advisable to acquire computer in the clinic to save, organize datato save, organize data  New software for dental practice management isNew software for dental practice management is designed for clinics according to their needs.designed for clinics according to their needs.  This software is easily trained for theThis software is easily trained for the receptionistreceptionist
  61. 61. Copying machineCopying machine It is used in our practice for:It is used in our practice for:  Daily appointment schedule, one copy to eachDaily appointment schedule, one copy to each dentistdentist  Information to be given to patients eg.Information to be given to patients eg. instructionsinstructions
  62. 62. TelephoneTelephone && answering machineanswering machine  It is useful aid in good patient relationshipIt is useful aid in good patient relationship  It is used to make patient able to cancel or toIt is used to make patient able to cancel or to change his appointmentchange his appointment  Their message should be shortTheir message should be short
  63. 63. Dictating machineDictating machine  Micro cassette to help the dentist leaving aMicro cassette to help the dentist leaving a message, written material for copying, medicalmessage, written material for copying, medical report etc…report etc…
  64. 64. The appointment bookThe appointment book
  65. 65.  Appointment book is a planning system forAppointment book is a planning system for dentist and for the other operating staffdentist and for the other operating staff members and should be a method of planningmembers and should be a method of planning free time as well as chairside time.free time as well as chairside time.  It should be stressed that the only earning powerIt should be stressed that the only earning power is in the time given to patientsis in the time given to patients
  66. 66. A general plan of appointmentA general plan of appointment makingmaking  Extractions are better done earlier in the day soExtractions are better done earlier in the day so that by the end of the day freedom fromthat by the end of the day freedom from excessive discomfort or haemorrhage can beexcessive discomfort or haemorrhage can be assured.assured.  It is often recommended that children be seenIt is often recommended that children be seen early in the day, obviously not school time!early in the day, obviously not school time!  It is good idea to leave new patients requiringIt is good idea to leave new patients requiring examination, consultation, X-rays, etc.. , to theexamination, consultation, X-rays, etc.. , to the end of the dayend of the day
  67. 67.  Emergencies should ideally be seen in twoEmergencies should ideally be seen in two selected periods during the day, the 1st half hourselected periods during the day, the 1st half hour is left openis left open  Ensure open communication with patient duringEnsure open communication with patient during the daytime hours of openingthe daytime hours of opening
  68. 68. A short notice list of patientsA short notice list of patients  Is a list of patients that can be used to fill in lateIs a list of patients that can be used to fill in late cancellations or blanks in the day .cancellations or blanks in the day .  This is a list of patients a secretary should keepThis is a list of patients a secretary should keep at reach & consist of patients who live or workat reach & consist of patients who live or work nearby and come at short notice for treatmentnearby and come at short notice for treatment  Could be classified into 1 hour, 3 hours, 24Could be classified into 1 hour, 3 hours, 24 hours according to the time required to attend.hours according to the time required to attend.
  69. 69. General considerations in caring forGeneral considerations in caring for the new patientsthe new patients  First impressionFirst impression  The approachThe approach  Introduce yourself to the patientIntroduce yourself to the patient  Shake handsShake hands  Careful general & dental history is takenCareful general & dental history is taken  Attentive listening with interest is important.Attentive listening with interest is important.  Match question & instruction with the pace of &Match question & instruction with the pace of & comprehension of the patientcomprehension of the patient
  70. 70. StaffStaff  The dental team may be consist of: the seniorThe dental team may be consist of: the senior dentist, a partner (if any), dentist assistant, dentaldentist, a partner (if any), dentist assistant, dental hygienist, secretary/receptionist, dental chairsidehygienist, secretary/receptionist, dental chairside assistant, dental technician, (and often) theassistant, dental technician, (and often) the patient.patient.  A four to six weeks period of testing a staff isA four to six weeks period of testing a staff is satisfactorysatisfactory
  71. 71. Redundancy & firingRedundancy & firing  A staff who have been employed continuouslyA staff who have been employed continuously for more than 2 years can not be fired without afor more than 2 years can not be fired without a very good reasonvery good reason  Tell employee formally that their conduct isTell employee formally that their conduct is unsatisfactory, giving a timetable forunsatisfactory, giving a timetable for improvement, advice, and help.improvement, advice, and help.  Give written warning that if there is noGive written warning that if there is no improvement, dismissal will follow.improvement, dismissal will follow.  Give written notice as per contract.Give written notice as per contract.
  72. 72. Redundancy paymentRedundancy payment  These are made for members who have beenThese are made for members who have been employed for the minimum legal periodemployed for the minimum legal period  Payment do not have to be made to employee:Payment do not have to be made to employee: 1.1. Who work less than 2 years (104 weeks)Who work less than 2 years (104 weeks) 2.2. Who workless than 21 hour per weekWho workless than 21 hour per week 3.3. Who are or will be over 65 yrs at the theWho are or will be over 65 yrs at the the termination of the service.termination of the service. Of continuous serviceOf continuous service
  73. 73. Health care in theHealth care in the practicepractice
  74. 74. Hazards to the dental teamHazards to the dental team  MercuryMercury  Posture problemPosture problem  ElectricalElectrical  Injuries from instrumentsInjuries from instruments  X-raysX-rays  Infection- hepatitis BInfection- hepatitis B  Anaesthetic gasesAnaesthetic gases  Allergies- skin reactionAllergies- skin reaction  Inhalation of aerosolsInhalation of aerosols
  75. 75. Continuing educationContinuing education
  76. 76. Keeping with contemporary dentistryKeeping with contemporary dentistry  Regular reading of dental journalsRegular reading of dental journals  Joining a learned societyJoining a learned society  Enrolling in coursesEnrolling in courses  Attending dental meetingsAttending dental meetings  Part-time teaching at dental schoolPart-time teaching at dental school  The pankey continuumThe pankey continuum  Internet or www.Internet or www.
  77. 77. Evidence-based DentistryEvidence-based Dentistry  The concept of using current evidence to guideThe concept of using current evidence to guide decision-making was first introduced by Gordondecision-making was first introduced by Gordon Guyatt and the Evidence-Based Medicine WorkingGuyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada inGroup at McMaster University in Ontario, Canada in the 1990s. A new concept for medical educationthe 1990s. A new concept for medical education designed to incorporate current research into educationdesigned to incorporate current research into education and practice was developed to help practitionersand practice was developed to help practitioners provide the best care for their patients.provide the best care for their patients.  The term evidence-based medicine (EBM)is defined asThe term evidence-based medicine (EBM)is defined as "the integration of best research evidence with clinical"the integration of best research evidence with clinical expertise and patient values."expertise and patient values."
  78. 78.  The new concept of EBM utilizes a systematicThe new concept of EBM utilizes a systematic process to incorporate current research intoprocess to incorporate current research into practice.practice.
  79. 79. The evidence-based process requiresThe evidence-based process requires the development of five key skills:the development of five key skills: 1.1. Formulate information needs/questions into four partFormulate information needs/questions into four part questions. These questions identify thequestions. These questions identify the patient/problem (P), intervention (I), comparison (C),patient/problem (P), intervention (I), comparison (C), and outcomes (O) also known as PICO questions.and outcomes (O) also known as PICO questions. 2.2. Conduct an efficient computerized search of theConduct an efficient computerized search of the literature for the appropriate type and level ofliterature for the appropriate type and level of evidence.evidence. 3.3. Critically appraise the evidence for validity with anCritically appraise the evidence for validity with an understanding of research methods.understanding of research methods. 4.4. Apply the results of the evidence to patient care orApply the results of the evidence to patient care or practice in consideration for the patient's preferences,practice in consideration for the patient's preferences, values and circumstances.values and circumstances. 5.5. Evaluate the process and your performance throughEvaluate the process and your performance through self-evaluation.self-evaluation.
  80. 80. Levels of evidenceLevels of evidence  When deciding whether to implement evidenceWhen deciding whether to implement evidence from a study, it is important to look at the typefrom a study, it is important to look at the type of study design employed, which determines theof study design employed, which determines the “strength” of evidence on which to base the“strength” of evidence on which to base the clinical decision.clinical decision.
  81. 81. The 5 levels of evidenceThe 5 levels of evidence 1a. Systematic review of multiple randomized controlled1a. Systematic review of multiple randomized controlled trials (RCTs)trials (RCTs) 1b. Individual well-designed RCT1b. Individual well-designed RCT 2a. Systematic review of cohort studies2a. Systematic review of cohort studies 2b. Individual cohort study, or low quality RCT2b. Individual cohort study, or low quality RCT 3a. Systematic review of case control studies3a. Systematic review of case control studies 3b. Individual case control study3b. Individual case control study 4. Non-analytical studies (case series)4. Non-analytical studies (case series) 5. Opinions of expert committees or respected authorities5. Opinions of expert committees or respected authorities
  82. 82. AA randomized controlled trial (RCT)randomized controlled trial (RCT)  is a type of scientificis a type of scientific experimentexperiment most commonly usedmost commonly used in testing thein testing the efficacyefficacy oror effectivenesseffectiveness ofof healthcarehealthcare services or clinical research . The key distinguishingservices or clinical research . The key distinguishing feature of the usual RCT is that study subjects, afterfeature of the usual RCT is that study subjects, after assessment of eligibility and recruitment, but before theassessment of eligibility and recruitment, but before the intervention to be studied begins, are randomlyintervention to be studied begins, are randomly allocated to receive one or other of the alternativeallocated to receive one or other of the alternative treatments under study. Random allocation in real trialstreatments under study. Random allocation in real trials is complex, but conceptually, the process is like tossingis complex, but conceptually, the process is like tossing a coin. After randomization, the two (or more) groupsa coin. After randomization, the two (or more) groups of subjects are followed up in exactly the same way, andof subjects are followed up in exactly the same way, and the only differences between the care they receivethe only differences between the care they receive
  83. 83. AA systematic reviewsystematic review  Is a literature review focused on a singleIs a literature review focused on a single question that tries to identify, appraise, selectquestion that tries to identify, appraise, select and synthesize all high quality research evidenceand synthesize all high quality research evidence relevant to that question. Systematic reviews ofrelevant to that question. Systematic reviews of high-quality randomized controlled trials arehigh-quality randomized controlled trials are crucial to evidence-based medicine.crucial to evidence-based medicine.
  84. 84.  AA cohort studycohort study is a form of longitudinal study (a typeis a form of longitudinal study (a type of observational study) used in medicine, dentistry. It isof observational study) used in medicine, dentistry. It is an analysis of risk factors and follows a group of peoplean analysis of risk factors and follows a group of people who do not have the disease, and uses correlations towho do not have the disease, and uses correlations to determine the absolute risk of subject contraction. It isdetermine the absolute risk of subject contraction. It is one type of clinical study design and should beone type of clinical study design and should be compared with a cross-sectional study.compared with a cross-sectional study.  A cohort is a group of people who share a commonA cohort is a group of people who share a common characteristic or experience within a defined periodcharacteristic or experience within a defined period (e.g., are born, are exposed to a drug or a vaccine, etc.).(e.g., are born, are exposed to a drug or a vaccine, etc.).
  85. 85. Case-control studyCase-control study  is a type of retrospective, epidemiological, clinical studyis a type of retrospective, epidemiological, clinical study design. In a case-control study, people with a diseasedesign. In a case-control study, people with a disease (often, a specific diagnosis, perhaps lung cancer) are(often, a specific diagnosis, perhaps lung cancer) are matched with people who do not have the disease (thematched with people who do not have the disease (the 'controls').'controls').  Further data are then collected on those individuals andFurther data are then collected on those individuals and the groups are compared to find out if otherthe groups are compared to find out if other characteristics (perhaps a history of smoking) are alsocharacteristics (perhaps a history of smoking) are also different between the two groups.different between the two groups.
  86. 86. AA case seriescase series  (also known as a(also known as a clinical seriesclinical series) is a medical) is a medical research observational study that tracks patientsresearch observational study that tracks patients with a known exposure given similar treatmentwith a known exposure given similar treatment or examines their medical records for exposureor examines their medical records for exposure and outcome.and outcome.  It can be retrospective or prospective .It can be retrospective or prospective .
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