Tom Orent, DMD

Accredited by the AACD in 1990, Dr. Orent has served on the Ethics Committee and currently serves as an Accreditation Examiner. He also writes a column for The Journal of the AACD, and served as Editor from 1994-1995. Dr. Orent lectures internationally with "1000 Gems SeminarsTM", which he created in 1988, and has authored numerous articles and books on topics ranging from Esthetic Dentistry and Practice Management to TMJ. He originated Non-Orthodontic Alignment of Malposed Teeth (NOAT). Dr. Orent practices Esthetic Dentistry in Framingham, Massachusetts.

Dr. Orent: "A true gem is a valuable byte-sized idea which can be put into practice Monday morning. Gems are the "meat" of the books, lectures, and tapes we all partake of on a routine basis. Perhaps you are looking for a certain gem, or have one from which others might benefit. If so, please contact me at: 1000 Gems Seminars, 12 Walnut Street, Framingham, MA, 01702; phone 888-880-GEMS; e-mail orent@1000gems.com; fax: 508-879-4811. Or visit our web site at www.1000gems.com."

The decade ending 1999 has been the most exciting in the history of dentistry! Intraoral cameras, dentin bonding, reliably strong beautiful porcelain veneers, predictable implants, caries finder, computer assisted imaging, CAD-CAM and more. The advances the next twenty years could bring are almost inconceivable. Yet, our best of times may be the worst of times. How many of us will have the opportunity to choose to partake of the wonders of our future?

Before we explore the offerings of practice 2019, we must ground ourselves in the realistic examination of our very existence. Dentistry will likely make strides we could previously only dream of. Yet the harsh business/economic reality is that few of us will ever experience the most exciting improvements. Along the journey to 2019, many predict that 90 to 95% of us will be "on the clock."

Who would we possibly be working for? Multimillion-dollar corporations who buy and sell practices like another Wall Street commodity. Insurance giants. In 1998, I watched one Massachusetts DMO capture the central Massachusetts market with ease. Their first move was to just about give away their dental plan to corporations willing to sign on with medical. Dental benefits were merely a perk! In order to accommodate the enormous groundswell of dental enrollees, they signed large numbers of dentists into the participating ranks.

These dentists saw huge numbers of patients from the DMO, yet didn't always see a proportionate influx of new patients! How is that possible? Existing patients, in many cases, merely moved onto the DMO roles. Net result? Same patient, same dentist, much lower fees. Worse, the numbers are so strong that some participating dentists, ears to the ground, are waiting for the other shoe to drop. Rumor is that when the DMO captures a significant enough share of the market, they'll simply build and run their own dental centers. For some plan dentists the potentially catastrophic result would be a loss of 30 to 45% of their patients!

The future may be less than rosy for those who don't pro-actively position themselves, now. In many martial arts, when one is faced with an opponent of formidable size and strength, it is far better to leverage their strength against them than to resist will all your might. In Tae Kwon Do, they suggest stepping out of the way altogether! I believe that our best hope for an economically healthy future is just that. Examine what the corporate and/or insurance owned practice can offer, and what they cannot. Position your practice where they cannot.

Certainly there are ways to decrease the time needed to perform a given treatment. I'm amazed at the number of articles touting ways to cut minutes off of this procedure and that. Perhaps Dr. Ken Blanchard should add to his collection of One-Minute... titles, e.g., "The One Minute Crown Prep." Time and motion studies can identify exactly where time is lost during treatment visits. Rather than speaking to the patient at all, why don't we have the assistant find out how they and their family have been -- and any other small talk, relationship building, wastes of doctor time? In his seminars at the Center for Advanced Dental Studies in St. Petersburg, Dr. Peter Dawson talks about the quality of the average level of dental care in the United States. His assessment was not a positive commentary. Just the opposite.

To position your practice where the insurance and corporate moguls dare not go, consider ultra-high quality dentistry, and five-star VIP service. Though 90% of us already believe we deliver an ultra-high quality product, ask yourself the following questions:

1. Do I always wear loupes?
2. Do I examine every impression under a microscope (not loupes)?
3. If cord is needed for the impression, do I always pack cord at the placement?
4. When placing a single posterior crown, do I eliminate all non-inclined surface hinge-axis centric contacts, and eccentric interferences?
5. Do I ever see any space at the margins of crowns I cement?
6. Do I periodontally screen (and treat as needed) every patient prior to prostho?
7. Do I offer my patients a written warranty on all crowns, veneers, inlays and onlays?
8. Do I utilize caries detector during all preps? (Dr. John Kanca's research indicates that we miss caries over 40% of the time, when not using a stain.)
9. If Dr. Dawson or Dr. Christensen watched over my shoulder, would they be proud?
10. Would I be proud?

This is the tip of the iceberg when it comes to ultra-high quality dentistry. If you haven't been to Dr. Dawson's continuum, and would like to expand your mind, call the Center for Advanced Dental Studies at 813-823-7047. Of course, quality alone is not sufficient to position your practice, since the public doesn't perceive quality dentistry on its own merits. Necessary is a significant dose of internal marketing, to let patients know the trouble and care you take to deliver outstanding results.

Positioning must sway public opinion. If you deliver extraordinarily high quality dentistry, then be certain that your patients (and the public at large) perceive that. Your staff, your physical surrounds, and your demeanor all play a critical role in delivering the message. As Dr. Roger Levin says, marketing is not a magnet, a cute business card, or a special birthday greeting... it is forty or more consistent, simultaneous, positive messages delivered to your target audience.

Five-star VIP service is evident to your patients. In fact, you could "sell" all sorts of dentistry with extreme service alone. Of course, it would come back to haunt you, on short order, if the quality of care weren't in place as well. The Ritz Carlton, Nordstrom, The Four Seasons, and Lexus all bring to mind the ultimate in quality service and product. They've worked very hard to earn this image. You can do the same. But you've got to start now, not when you're under the gun to dig out of the mess that "beyond 2000" may offer.

Enough doom and gloom. I'm truly excited about the prospects for practice in the year 2019. I want you to be able to enjoy the fruits of our future as well. Only a very small percentage of us will have that opportunity. My predictions:

Periodontics, as we know it, will be gone. Once periodontal infection is eliminated, only perio plastic surgeries, cosmetic in nature, will exist.

Caries will have been solved, as well. In one fell swoop, our raison d'etre will evaporate!

Endodontics and oral surgery will decline as well, as caries no longer creates pulpal infections or destruction of enamel and dentin.

Orthodontics will be hotter than ever. We'll have new techniques and appliances that will make it faster, cheaper, and easier than ever before. Every general dentist will be performing the hot new orthodontic techniques! By default, there will be little room for "orthodontic specialists."

Cosmetic Dentistry will remain a hot topic for a long time to come. The decline of gum disease and tooth decay will significantly impact cosmetic dentistry. However, not until we can genetically engineer the shapes, color, and arrangement of teeth, will the opportunities in cosmetic dentistry significantly decline.

If we're in the dark and see the flash from the end of the gun barrel, it's likely too late to do anything about it. 2019 really isn't that far away. To be successful in our future, there are some radical changes that should be addressed, today. We can look forward to lasers that cut everything, swiftly and silently. Pink healthy gums maintained with a pill. Materials that surpass the strength and beauty of natural teeth. Incredible opportunities await our profession. Won't you please plan now, to enjoy it?