Practice management1 /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Practice management1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. PRACTICE MANAGEMENT INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. METAMORPHOSIS OF DENTISTRY  Traditional dentistry has changed dramatically over past 25 years. More challenges face a dentist today than even before. Now dental practice management has got great impact by the following factors.
  4. 4. These factors are;--------     The greatly increased consumer awareness The impact of insurance carriers New dental delivery system The prevalence of extensive advertising The dental malpractice crisis
  7. 7. The first phone call  It is the first physical contact ,the patient has with our personnel and our office and therefore an aura of pleasantness and concern must be established. Can be of two types in nature Typical phone call Emergency phone call e.g.. Fracture of teeth, traumatic injury
  8. 8. Receptionist is the person who makes the first office contact on phone, so these most important auxillaries should have following qualifications;-----------   Dental auxillaries experience Good telephone voice Physical appearance - according to what our patient will accept and be pleased with.
  9. 9. Therefore a receptionist should be trained for the following;--------      Phone must be answered promptly. Answer with pleasant and concerned voice. A monotone should be used. Listen carefully and obtain all the information before closing the conversation. Never discuss fee or financial arrangements over the phone. Always close the conversation in a pleasant and concerned manner.
  10. 10. IMPROVING TELEPHONE MANAGEMENT  No of telephone lines sets or an answering machine will depend on the following factors No of outgoing calls Size of our practice No of patient seen per day No of phone call received per day
  11. 11. THE ART OF DENTAL EXAMINATION    This simply means being through. A complete and thorough examination will not only enable us to deliver the best possible treatment but will also help to prevent the practice of malpractice suits. Before going to actual art of examination following things should be performed.
  12. 12.     Actual examination should follow after the consultation which should be extra oral and intra oral. Consider every aspect of dentistry when examining the patient. Expertly record the results of the consultation and examination. Inform before you perform.
  13. 13. Medical consultation patient identification medical and dental history Consult with other dentist in case of referral
  14. 14. ANXIETY AND PAIN CONTROL  Pain control of the dental patient is still one of the pressing needs of our profession. APPROACHES Spoken words (hypnosis,biofeed back) Drugs Pharmacological and verbal
  15. 15.   Verbal techniques capable of altering body functions when used by skilled dentist. They can induce state of relaxation ,sedation, analgesia, amnesia and are very helpful in post operative pain control LIMITATION TIME CONSUMING LEVEL OF PATIENT CONTROL NOT PREDICTABLE
  16. 16. PHARMACOLOGICAL MEANS   Widely used through different routes We are a pill oriented society so oral medication probably will be the most acceptable form of premedication.
  17. 17. ORAL PREMEDICATION Relaxation of patient before his arrival to dental clinics More dentistry can be performed at one visit. Diazepam is most commonly used.
  18. 18. MAXIMUM DENTISTRY IN MINIMUM VISITS  Generally the patient would like the treatment to be completed as painless and comfortably as possible and quickly and efficiently and with the least expenditure of time effort and money.
  19. 19. Followings should included in the practice    A complete examination, detailed diagnosis, and treatment plan and time for each appointment as well as in between the appointments should be established before the starting of the treatment. Plan , present ,and schedule the case. Separate the treatment visits completely from the payment arrangements.
  20. 20. Orthodontic management of medically compromised patients  Orthodontic procedures generally perceived to be among the least invasive and physiological benign of any in the dentistry. However it must be evaluated for potential risk for medically compromised patients and orthodontists must be comfortable with being able to identify patients at risk and to treat them appropriately.
  21. 21. Major risk for medically compromised orthodontic patients associated with bacteremias, are caused by    Band placement and band removal. Bleeding and infection cause by mucosal and gingival irritation. Ability of patients with some conditions to tolerate treatment.
  22. 22. management      Communication with patients physicians. Aggressive pretreatment and intratreatment oral hygiene maintenance. Prudent use of prophylactic antibiotic therapy. If diagnosis of leukemia or aplastic anemia is made, removal of existing orthodontic appliance is mandatory to minimize the risk of gingival or mucosal irritation ,bleeding or infection. Elastomeric modules are preferred to wire ligatures.
  23. 23.   It has been suggested that orthodontic induced external root resorption occurs with greater frequency in patients with asthma than in nonasthma population. Therefore it would seem prudent for orthodontist to disclose the increase risk of root resorption to patients before initiating the treatment.
  25. 25.  Legal ramifications of the some of the clinical situations that arise in the dental practice of dentistry and practical approaches and solutions to these problems should be familiar to dentists LEGAL CONSIDERATION CONTRACTS AND GUARANTEES ABANDONMENT AND TERMINATION OF TREATMENT FRAUD AND MISREPRESENTATION INFORMED CONSENT
  26. 26. ABANDONMENT AND TERMINATION OF TREATMENT   Dental abandonment is somewhat similar to abandonment of a child by a parent. Once a dentist undertakes the treatment it is important to complete the treatment to a point at which patient is not left in a precarious position e.g.. Not placing a permanent restoration after caries removal on the tooth.
  27. 27.  Termination of treatment can be done in case of chronically complain about their perception of out come, uncoperation or constantly break appointments, by sending a letter by certified mail with return receipt requested.
  28. 28. CONTRACTS AND GUARANTEES   Many dental malpractice suits are brought against a practitioner based on contract, so some knowledge of the general concepts of contract law is essential to avoid these situations. Generally a contract is considered as an written document , however in many situations a legal contract is formed orally.
  29. 29.    On this basis practitioners are advised to be very careful in conversation to their patients They should not promise or guarantee any thing . Try not to admit fault when problem occur and think carefully before not charging a patient for an additional procedure that might become necessary.
  30. 30.     When performing orthodontic treatment stress the need for co-operation in determining the final result. We should speak about improvement not perfection. Discussing the need for patient cooperation for home care and keeping appointments Staff should also be instructed to be very careful about importance of not making promises or statements that may provide a basis for future liability.
  31. 31. INFORM CONSENT  SHOULD CONTAIN---- Procedure explained in simple terms Information of any and all risks Treatment alternatives with their associated risk and risk of non treatment
  32. 32.  In case of minors a legal ,valid consent should be taken from parents before treatment. However in case of extreme emergency, dental care can be rendered. The children with certain level of financial success and are capable of decision making can give their consent themselves.
  33. 33. FRAUD AND MISREPRESENTATION   A dentist should be honest in filling out forms and making insurance reports which represent an affidavit of truthfulness by us. It is necessary to resist temptation to alter treatment reports just to take advantage of insurance policy provisions , because once caught it costs more to defend ourselves, our reputation and our livelihood.
  34. 34. Sexual harassment :an issue in orthodontic office     According to Nolo Press of Berkeley,California sexual harassment results from a misuse of power rather than from sexual attraction. Unwelcome sexual advances ,request for such favors considered as harassment when:-Submission to or rejection of such conduct by an individual is used as the basis of employment decisions affecting such individual. Such conduct has the purpose of or effect of un reasonably interfering with an individual work performance or creating a hostile or offensive work environment.
  35. 35.   The orthodontist or staff members should be very careful about being with a patient in the office alone or even in a part of office out of sight and out of ear shot. Always make sure that another adult is in the office when you are with the patient or parent to avoid such circumstances.
  36. 36.    A more worrisome situation in the orthodontic practice is an allegation of sexual harassment against the orthodontist by a young or adult patient of opposite sex. If such complaint were made such an allegation would go to the state dental licensing board for review . A written office policy may be good way to put these issues out for everyone in the office.
  38. 38. FINANCIAL CONSIDERATION    It is important to ascertain who, is responsible for treatment. In a situation involving long term treatment ,such as orthodontic care in which the fee is paid periodically over a long period of time, it is essential that every specific financial agreements be made. Consent should contain
  39. 39. Consent of either competent parent or wise to have signs of both ORTHODONTIC CONSENT Mode of payments Total cost
  40. 40. Determination of orthodontic fee    Establishing a fee that both orthodontist and the parent feel good about, can be difficult. A fair fee is what the doctor and the patient agrees is fair. The price of almost any product or the fee for almost any service depends upon a no of considerations other than the cost to produce it. Ultimately the price is determined by a sufficient number of people who are willing to pay and by the desired profit of the producer.
  41. 41.    The orthodontist who invests years and large sums in education and in establishing and building a practice, starts a career years later and dollars behind. It is strange fact that experience is not highly valued in determining the orthodontic fee and the fee of most experienced orthodontists are only10% higher than the fee of brand new orthodontist. As patient have no real way of judging competence in advance, so they judge us by peripheral factors. e.g. Recommendation by dentist and First impressions of the office, doctor and staff.
  42. 42.   Orthodontic fees must be increased regularly to at least equal the increase in orthodontic price index, in terms of increased costs of material, staff, and a host of other overhead items. Some patients value the service more than the fee while people who do not know the value of service can only concentrate on the size on the fee.
  43. 43.  Earlier (before 1950) when no of orthodontists were few. The orthodontic economic equation: fee x case load – expenses = profit .  which emphasis on more cases starts at low fees. As the no of orthodontists increased there after, supply caught up with the demand and so fees need to be raised.
  44. 44. PAYMENT ARRANGEMENTS  A financial arrangement is an agreement between two parties in which one party will perform a given treatment for a specific fee and other party (patient) will accept this obligation and will pay in prescribed manner.
  45. 45. No arrangement at all Pay as you go TYPES OF FINANCIAL ARRANGEMENT Bank loans In office budget installation plan Patient payment booklet
  46. 46. THIRD PARTY AND YOU   The payment of dental fee by the patient through health insurance organization—is known as third party. A knowledge of insurance policies is necessary To alert the dentist to the potential problems with the procedures and the terminology being used To offer specific basic guidelines as to how to proceed with third party Plans
  47. 47.         TERMINOLOGY Generally insurance and terms are defined by the insurance carrier The most important terms used now these days include Prior authorization UCR fee concept Participating contracts Fee itemization 90th percentile Peer review
  48. 48. PRIOR AUTHORISATION   It is basically a listing of procedures, item by item with procedure code as sanctioned by ADA. A general policy of an insurance company is that they usually do not dictate the care but rather offer payment for a lesser service which lead to following difficulties
  49. 49. •Moral and ethical dilemma of doing or not doing his best for patient Health. •Places a dental subscriber in a doubt if his or her dentist is telling the truth about best care available. •Patient may think that service might be detrimental to his own health.
  50. 50. PARTICIPATING CONTRACTS  It is legal contracts between a dentist and a insurance carrier. In this type of agreement insurance carrier decide to pay appropriate payment in full for certain plans and gets the right to enter dentist office and review the records.
  51. 51.  Basically the purpose of such type of contracts is to allow insurance company to take list of contracted dentist to the purchaser and to sell both you and your care skill and judgment. So before indulging in such type of agreement a lawyer consultation is necessary.
  52. 52. UCR CONCEPT OF FEE    Usual fee— means that usual fee charged to most patients by a given dentist for a given procedure. Customary— fee charged by dentists of similar experience and background in a given geographical area . Reasonable— a fee is reasonable if it meets the above two criteria or if it is justifiable considering the special circumstances or the particular patient in question.
  53. 53.  Each dentist should carefully examine the strength and weakness of UCR before signing a contract with insurance companies and to decide who will get benefit, the patient ,the dentist or the insurance company.
  54. 54. Reimbursement of dentist by insurance companies Participating and non participating dentist A participating dentist is defined as any duly licensed dentist with whom insurance company has a contractual agreement to render care to covered subscribers.
  55. 55. Participating dentist   According to this concept the insurance company gives 90th percentile of fee as payment in full, and only fee of the high priced top 10% will be cut. This concept sounds fare but in case of inflation a request of new filing should be made to the insurance company. Company will have the right for post treatment inspection of randomly chosen patients to monitor the quality of care.
  56. 56. Non- participating dentists   They are paid considerably lower percentile often 50th percentile. However they do not need to prefile their fees and are not subject to fee audits.
  57. 57. MARKETING
  58. 58.   Marketing is a process that enables us to better understand the needs and wants of our patients. It is about listening and learning from our patients as a way to improve the care we provide.
  59. 59.   The word marketing has caused discomfort and alarm among some dentists due to the stigma attached to dental advertising. Here it is important to draw a distinct line between advertising and marketing which are quite different and require a different approach in patient education.
  60. 60. Offering or promoting a service or product usually new or out of the ordinary that we want our consumer to receive. ADVERTISING MARKETING Offering or promoting a service or product that consumer already perceive as desirable. It is giving them some thing they already want or enjoy.
  61. 61. Before we introduce our marketing plan ,we should understand the following:-  The strength of practice —market those services we deliver best with an eye for those services that are unique and special to differentiate our practice from others. The weakness of your practice -we can use our dental staff team, third party aides, to assist ,find, and correcting the weakness.
  62. 62. Some other factors which should also be taken into consideration are      Geographical area Demographic area Psychographic area Budget Ideally 5% of the collected revenue should be put back into our marketing program.
  63. 63.   Due to increased dental manpower, changing disease patterns (most important a major decreased in the dental caries incidence in the young population), cost containment policies by business and government and the rise of consumerism have placed more emphasis on the field of marketing Marketing techniques INTERNAL MARKETING EXTERNAL MARKETING
  64. 64. INTERNAL MARKETING  These are the marketing techniques used within the practice to keep established and new patients active and to motivate them to become enthusiastic referral sources, before employing internal marketing technique three important trends of the society should be well known to the dentist Self help movement Information based society High tech/high touch
  65. 65. Teaming up patients to teach them preventive techniques and maintenance of good oral hygiene at home Stressing personal service and caring attitude in addition to latest dental technology INTERNAL MARKETING TRENDS Provide accurate information on dental health to the patient
  66. 66. The first step –our staff Patient perception The first impression INTERNAL MARKETING Case presentation Knowing our patients
  67. 67.      Learn all the methods of pain control and utilize the most advantageous to make patient comfortable during the long appointments. Organize the procedures, set up staffs and office to cut down on all make ready and put away procedures. Four handed dentistry should be practiced Plan the entire course of treatment to completion. Deliver what you promise, use appointment book to plan treatment and to complete the treatment in the shortest possible visits.
  70. 70.   Any business may reach a saturation point beyond which productivity can not increase without additional capitalization. In a dental practice the expansion may be directed towards the purchase of equipment ,the addition of personnel ,or both.. PATIENT ACTIVITY IN CLINICS FINANCIAL CONSIDERATIONS PRACTICE EXPANSION
  71. 71. Transitional office design    A orthodontic office should be designed to allow some flexibility for secondary working chairs for expansion of the practice. A new office may be ideal for a particular stage in a practice but no one should expect a design to hold up for 30 years. Due to changing nature of our profession and its technology, more than one office may be required during an orthodontic career.
  72. 72. Grading of an orthodontic office based on external and internal feature.     External feature(1)—community demographics -moderate to high income level, proximity to high growth areas, shopping centers, hospitals and referring dentists. (2)attractiveness of office building —includes inviting curb appeal, visibility to drive by traffic, adequate convenient parking. (3)signage —personal sign instead of common marquee, high quality design and easy observed at right angle to the traffic.
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  75. 75. Internal feature   Reception area —warm ,friendly décor, generous seating, fully visible to secretary, at reasonable distance from appointment desk. Office design that creates a feeling of space – wide hallways, abundance of windows and skylights ,and liberal use of glass panels and windows between work zones.
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  78. 78. features of excellent Operatory    Exceptional atmosphere in open bay. exciting exterior view if possible or interesting wall treatments. Should be equipped with well organized and up to date equipment. Digital patient records that allow convenient access to treatment history without paper charts.
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  82. 82.   It is difficult for dentists to practice dentistry and handle the administrative issues at the same time. Doing so leads to decreased production and increased stress. Any practice will reach a certain point at which the dentist no longer can continue to monitor ,control and watch everything.
  83. 83. Leverage in dentistry    Leverage is the ability to grow the business or practice through other people. It is not the same as delegation. Delegation is having other people perform specific tasks. with delegation a dentist might assign a specific task to a dental assistant. A dentist should spend approximately 98% of their time in direct patient treatment to be productive , based on the model of dental practice. this leaves a little time to act like as company (DENTAL CLINICS) CEO who is focused on strategy and direction.
  84. 84.  this is the point at which a legitimate office manager (front desk staff members) needs to be put in place who handles all human resources and staff management functions, controlling all financial parameters of the practice and setting policy for practice often with the approval of the dentist.
  85. 85. MOTIVATING THE DENTAL STAFF    It has been said many times that the greatest frustration that we face in running our office is managing tension with and among our staffs. We need to discuss not just the dental office but business in general in order to prepare ourselves for successful practices in the year ahead. Motivation of dental staff can be brought about by OVERVIEW AND SELF ASSESSMENT MOTIVATING TOOLS
  86. 86. Bonus system Continuing education MOTIVATING TOOLS Retreat Staff meetings
  87. 87. EMPLOYER—EMPLOYEE CONSIDERATIONS   Hiring in general is regulated by various laws on both the national and state level. If not followed dentist may be leaving himself open to law suit or regulatory hearing. Although rule varies from state to state generally it is unlawful to discriminate in hiring employees based upon race, religion, national origin, sex, age ,or disability.
  88. 88.  Discharge of employee—written attendance, punctuality ,records of probationary periods job assessment and evaluations should be made. One should also record the all warnings, disciplinary actions ,and negative evaluations to justify our discharge.
  90. 90.    Improper design and shortage of chairs can limit the options for association. So the floor plan for a new office can be designed to allow some flexibility for secondary working chairs in case a associate is added later. By taking advantage of modern time and motion concepts we can easily increase the no of patients by 10 per day and still reduce stress in the office.
  91. 91. Effects of square footage on practice expansion    Smaller office (2000square feet or less)—not profitable for two orthodontists, new growth will require expansion. Medium size office(2500-3500 square feet)— minimum 5 to 6 chairs, profitable practice for 2 doctors Larger offices(4000 square feet or more) -minimum 6-8 operatory chairs, provide greater flexibility for remodeling to accommodate new associate.
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  94. 94. INTERNET     This new era of computer technology will be an enormous part of our practice in the coming years. In the relatively near future the internet will grow in its starring role as an interactive television/audio medium, allowing dentistry some great opportunities to raise awareness. These technologies will be helpful for Computerization of scheduling, progress notes, insurance claims, telemarketing, radiography and other form of communication.
  95. 95. 3D IMAGING IN ORTHODONTICS  It is a set of anatomical data that is collected using diagnostic imaging equipment, processed by an computer and then displayed on a 2D monitor to give the illusion of depth. The depth perception causes the image to appear in 3d.
  96. 96.     APPLICATION IN ORTHODONTICS Pre and post orthodontic treatment assessment of dentoskeletal relationship and facial aesthetics 3D treatment planning and 3d soft and hard tissue prediction. 3D fabricated custome made archwires,3d facial skeletal and dental records can be used for in treatment planning, research and medico legal purposes .
  97. 97. MODEL CONSTRUCTIO N VISUALIZATION 3d imaging,mand.motion. facial animation, functional information Image and data refinement,registration,int egration. DIAGNOSIS AND TREATMENT PLANNING ANALYSIS finite element analysis, material selection TREATMENT Treatment option, definitive treatment, computer assisted therapy, treatment results. BOUNDARY CONDITION
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  103. 103. References:---   Roger levin---Leverage in dentistry—Journal of American Dental Association—2005 January, vol-136,page—87—88. Christian B.Sager—Balancing team development in four directions--- Journal of American Dental association— 2005,December,vol-136,page-1730-1731. Ronald Inge—The ins and out of dental insurance-- Journal of American Dental association—2005 February—vol-136,page-204209.
  104. 104.    Stephen T. Sonis—Orthodontic management of selected medically compromised patients: cardiac disease, bleeding disorders and asthma. —Seminars in orthodontics-vol.10,page-277280. Redmond et al—one pathway to successful orthodontic practice-JCO 2005 July,vol.XXXIX.No.7,page,415-419. Gerald Nelson—Sexual harassment: An issue in the orthodontic office—Am J Orthod.1993,october,vol-104,no-4,page-417418.
  105. 105.    Murlidhar Mupparapu et al—Use of a wireless local area network in an orthodontic clinic- Am J Orthod 2005 June,vol,127,no-6,page-756-759. Robert G.Keim et al----Practice success—JCO 2005,December,vol-XXXIX,no-12,page-687— 695. Donald Poulton et al—Treatment outcomes in 4 modes of orthodontic practice-- Am J Orthod 2005 March,vol-127,page-351-354.
  106. 106. Larry Wintersteen—Marketing with patient focus-- Journal of American Dental Association —1997 December –vol-128-page-1657-1659.  Roger P.Levin —Are you operating at OPC-Journal of American Dental Association—1997 December –vol-128-page-1649-1651.  Roger P.Levin—Measuring patient satisfaction-Journal of American Dental Association— 2005,march,vol.136,page,362-363. 
  107. 107.    James Mah—Predictive orthodontics:A new paradigm in computer assisted treatment planning and therapy.—Seminars in Orthodontics,2002,March,,2-5. The dental clinics of North America—Practice management-1988,jan,vol-32,no-1. Rbert A.W.Fuhrmann—3D evaluation of periodontal remodelling during orthodontic treatment-- Seminars in Orthodontics,2002,March,vol-8,page,23—28.
  108. 108.    David Schwab—Today’s impatient patient-Journal of American Dental Association—1997 December –vol-128-page-1646-1648. Ben Bissell---The challenge of change- Journal of American Dental Association—1997 December –vol-128-page-1651-1653. Barry Freydberg—Get with the Net--Journal of American Dental Association—1997 December –vol-128-page-1654-1656.
  109. 109.   Warren Hamula—Transitional Office design: attracting an associate.— JCO,2002,December.VOL-XXXVI,no12,page-701-706. Vicki Venn ,Sheila Scott—Insight into the business of orthodontics— BJO,1996.August,vol-23,no-3, page,288— 291.
  110. 110. Thank you For more details please visit