Posts Tagged ‘Dentistry’

Larry Silver

Letter to the Editor

Posted by Larry Silver

Letter to the Editor
By David E Lawler, DDS, D. ABDSM
Bloomington, IN


Hello,

This week, I had the pleasure of being interviewed for an article in The Practice Solution Magazine by one of your research staff. As a result of this interview, I want to encourage you to step back and look at a different topic with a broader perspective.

You are a practice management magazine whose perspective should clearly be focused on that topic. However, there are opportunities in dentistry that are rarely looked at that, especially in these troubling economic times, should be more widely discussed.

The addition of sleep medicine to my practice of dentistry has been, not only the most rewarding professional thing that I have ever done, it has been a wonderful cushion in a time of economic down-turn. If the absence of pain, bleeding or swelling, a great deal of dental services are highly discretionary and can be delayed. However, people always need air and those people with sleep-breathing disorders have their air supply greatly reduced during the night as well as their quality of life during the day and their overall health. All they need is the proper information and a therapy that they can tolerate to accept treatment.

Last week I was asked to speak to the annual meeting of the Indiana Self-Insurers Association on the management of these sleep-breathing disorders with oral appliance therapy. This was a room full of people who are intimately aware of the cost of medical care. They were wide-eyed as I showed statistics showing the dramatic drop in medical costs associated with the proper management of these disorders. In addition, there were quite a few present that now know that the annoying sound coming from their bed partners as they sleep is the sound of these people fighting for their next breath.

Similarly, yesterday I spoke to a state-wide respiratory therapy conference at our local hospital on sleep-related breathing disorders like snoring, upper airway resistance syndrome and sleep apnea and their management with oral appliances. At the break following my discussion, I was surrounded by attendees at this conference who wanted to tell me that they now recognized in themselves or their spouses, the conditions that I had just talked about. These are people who are intimately and professionally familiar with the process of breathing but who were unaware of the many forms these disorders take that allow them to remain unrecognized. Similarly, there was a sizable number who knew they or a family member had a problem but were unaware that there was an alternative, patient friendly, therapy as a substitute to the traditional CPAP therapy that they could not tolerate.

These sleep-related breathing disorders are epidemic in our society, with as many as one in five adults having a sleep breathing problem significant enough to affect their health. Since these occur only during sleep, the vast percentage of people suffering from these disorders have no clue that they are affected. Occasionally a bed-partner will say something, but usually that is only to complain about the noise disturbing their own sleep. Even those people seeking regular medical care usually are undiagnosed, since only a very small number of physicians question their patients about sleep quality. Those people who are fortunate to get a diagnosis are routinely prescribed a therapy that as many as 50% refuse or fail within the first six months of use. Those who remain undiagnosed, or who are diagnosed and yet unmanaged because they cannot tolerate their prescribed therapy, go on to live shortened lives of diminished quality with medical expenses easily doubling those who are diagnosed and able to tolerate therapy.

Oral appliance therapy can offer life saving treatment to untold thousands of people if they only knew about it. Dentists would gladly add this therapy to their existing practice model if they knew how easy it was for them to recognize these problems in their existing patient base.

Sleep medicine is a very young field of medicine. Because of that, physicians are only now starting to connect the dots between these disorders and many of the problems that they commonly treat. What is necessary is more public recognition of these disorders and this is where I believe strongly you can play a role.

I was very impressed by the amount of time and the intensity in which researcher focused on his interview this week. I am fully convinced that he is more than qualified to develop this topic in order to give it the attention your readers deserve.

Thanks, in advance, for your consideration.

David E. Lawler DDS, D. ABDSM
Diplomate American Board of Dental Sleep Medicine
The Center for Sound Sleep
www.thecenterforsoundsleep.com
2909 Buick Cadillac Blvd.
Bloomington, IN 47401
812-339-4499
812-339-6013 fax
Better health through restful sleep


Larry Silver

Economic Fears Can Affect Dental Care

Posted by Larry Silver

Newswise – Regular checkups and cleaning can save money in the end by heading off problems early. Nevertheless, when times get tough and people start losing their jobs, preventive dental care can be one of the first things to go.

However, the correlation between rising unemployment and a drop in preventive dental care is not necessarily due to people being short of cash, according to a new study appearing in the online edition of Health Services Research.

“We see that high community-level unemployment exacts a psychological toll on individuals,” said lead study author Brian Quinn. “Even for people who are working, or who have a working partner or spouse, there might be an impact if they’re stressed about themselves or their significant others losing their jobs.”

Quinn, a program officer for the Robert Wood Johnson Foundation, said the distraction of worrying about not having a job could make dental care drop off a person’s radar. “During stressful periods, those things that don’t seem as urgent may be ignored,” he said.

The researchers analyzed 10 years of information about visits to dentists’ offices in metropolitan Seattle and Spokane from Washington Dental Services, the largest dental insurer in the state, which covers roughly one-third of its residents. They compared this information to unemployment data from the Bureau of Labor Statistics and Washington’s Employment Security Department, and ruled out other possible explanations for a correlation.

In the Seattle area, for every 10,000 people who lost their jobs, there was a 1.2 percent decrease in visits to dentists for checkups. The drop was higher in the Spokane area, where the same increase in unemployment was associated with a 5.95 percent decrease in preventive visits. This is notable as the study looked at people who had dental insurance that covered routine care.

Dental care is way down at the bottom of the list of essentials for many people, said Gene Sekiguchi, associate dean of legislative affairs for the University of Southern California School of Dentistry. “When the economy gets tough, you’ll start eliminating the last items on the list and work your way up,” said Sekiguchi, who had no affiliation with the study.

Sekiguchi said that oral hygiene is important for overall health; for example, gum disease can lead to heart disease and diabetes.
Because preventive care is usually cheaper than tooth repairs, dental plan administrators and public health policy makers might want to promote cleaning and checkups during periods of high unemployment, the study authors say.

Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or jshaw@aha.org. HSR is available online at http://www.blackwell-synergy.com/loi/hesr.

Quinn BC, Catalano RA, Felber E. The effect of community-level unemployment on preventive oral health care utilization. Health Services Research online, 2008.

Interviews: Susan Rosenthal at slrosent@utmb.edu

Source: Health Behavior News Service Released: Thu 28-Aug-2008, 15:15 ET Embargo expired: Fri 19-Sep-2008, 00:00 ET

Contact Information

Health Behavior News Service: Lisa Esposito at (202) 387-2829 or hbns-editor@cfah.org.

© 2008 Newswise. All Rights Reserved.


Larry Silver

Researchers Use A Patient’s Own Bone

Posted by Larry Silver

Researchers Use A Patient’s Own Bone To Accelerate Orthodontics

Newswise – Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as “Wilckodontics.”

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.

As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.

Nowzari says that his team believed they could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explains. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

Contact Information
Angelica Urquijo (213) 740-6568 office (213) 271-4189 cell


Larry Silver

Cannabis Indicated as Possible Risk for Gum Disease

Posted by Larry Silver

Cannabis Indicated as Possible Risk for Gum Disease in Young People

Newswise – Young people who are heavy smokers of cannabis may be putting themselves at significant risk for periodontal disease, according to new research.

The study, published in the Feb. 6 issue of the Journal of the American Medical Association, is believed to be the first to explore whether or not smoking a substance other than tobacco – in this case, marijuana more than other cannabis products – may be a risk factor for gum disease.
After controlling for tobacco smoking, gender, socioeconomic status and infrequent trips to the dentist by one-third of the participants, the study reported a “strong association between cannabis use and periodontitis experience by age 32.”
Study participants who reported the highest use of cannabis were 1.6 times more likely to have at least one gum site with mild periodontal disease – compared to those who had never smoked cannabis.

This group’s risk of having at least one site with more severe gum disease was estimated to be more than three times higher than the group who never used the substance.

Researchers defined the group of heavy cannabis users as participants who reported an average of 41 or more occasions of substance use per year between ages 18 and 32, equivalent to smoking the substance almost once a week through that period.
But people who reported even some cannabis (fewer than 41 times a year) were more likely to have mild and severe gum disease than people who never used the drug.

“In the United States, we think about periodontal disease as being a problem after the age of 35,” said James D. Beck, Ph.D., Kenan professor of dental ecology at the University of North Carolina at Chapel Hill School of Dentistry. “These findings, that almost 30 percent of individuals at age 32 had periodontal disease, indicate that this younger group may need more attention.”
The 903 participants are part of a longitudinal study of a group of children born at Queen Mary Hospital in Dunedin, New Zealand, between 1972 and 1973. The recent study’s senior author is W. Murray Thomson, Ph.D., a professor of dental public health at the Sir John Walsh Research Institute at the University of Otago’s School of Dentistry, in Dunedin.

Study participants received dental examinations at age 26 and a similar examination at age 32, and they gave self-assessments at ages 18, 21, 26 and 32 on their cannabis use during the previous year. In an effort to control for tobacco use, participants reported their tobacco use during four periods: up to age 18, ages 18 through 21, ages 21 through 26 and ages 26 to 32.
The study suggests that the benefits of public health measures to reduce the prevalence of cannabis use may carry over to gum disease. Additionally, researchers wrote, studying a possible association between cannabis use and periodontal disease in other populations “should be a priority for periodontal epidemiological research.”

Other study authors were Richie Poulton, Ph.D., David Welch, Ph.D., and Dr. Robert J. Hancox, all of the department of preventive and social medicine, Dunedin School of Medicine, the University of Otago; Jonathan M. Broadbent, the department of oral sciences, University of Otago; and Terrie E. Moffitt, Ph.D., and Avshalom Caspi, Ph.D., with the Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, and with the departments of psychology and neuroscience, psychiatry and behavioral sciences and the Institute for Genome Sciences and Policy, Duke University.

Funding was provided by the National Institute of Dental and Craniofacial Research and the National Institute of Mental Health, both components of the National Institutes of Health; the Medical Research Council of the United Kingdom; and the Health Research Council of New Zealand, which supports the Dunedin Multidisciplinary Health and Development Research Unit.

Contact Information

School of Dentistry contact: Deb Saine, (919) 966-8512 or deborah_saine@dentistry.unc.edu

News Services contact: Clinton Colmenares, (919) 843-1991 or clinton_colmenares@unc.edu

© 2008 Newswise. All Rights Reserved.


Larry Silver

Discussing Finances with the Patient/Client

Posted by Larry Silver

Strategies for Obtaining Payment

When discussing financial matters with a patient/client, always assume that the patient/client can afford the service or product. Do not be shy, embarrassed or apologetic when discussing these matters. You MUST let the patient/client know how much your services are going to cost. You should feel comfortable and be able to speak with conviction. If it is at all uncomfortable for you, have another staff member practice with you until you do feel comfortable.

ASKING FOR PAYMENT

The goal when making financial arrangements should be to obtain the entire fee as soon as possible. It is important that the Accounts Manager avoid giving the patient/client the opportunity to say “No”. Never say, “Would you like to take care of that today?” Instead, give the patient/client options that are compatible with office policy. For example:

“Mrs. Smith, the fees for today are $50. Will you be paying cash or using your credit card?”

“No” is not one of the choices. Remember that if you make clear financial arrangements in the first place, you won’t have any trouble collecting the amount due.

Let us say that there is a misunderstanding and they can’t afford to pay the entire balance. You could say:

“Could you tell me how much you are able to pay?”

The idea here is to get the largest payment possible. Now you need to get the balance.

“Mrs. Smith, that will leave a balance of $560. When might I expect to receive payment on that balance?”

When they agree to a definite date for the payment of the balance, put the information on a financial agreement form and have the patient sign it.

EXTENDING PAYMENT PLANS

If it appears necessary to extend a monthly payment plan to the patient/client, adhere to the payment schedule as governed by office policy. Do not stray from established policies.

Although it may not occur commonly, you may experience a patient who cannot afford monthly payments but does want care. You might consider implementing a “lay-away” plan. This works by having the patient agree to set up an account where they will send a small amount to you each month (to be credited to their account), and when they have accumulated enough in the account to cover service, you would call them to schedule an appointment. This system would certainly require approval from the doctor prior to implementation.

DISCUSSING INSURANCE PAYMENTS

When a person has insurance, address payment such as:

“Mrs. Smith, your insurance will cover approximately 80% of this bill. Your portion will be approximately (20% of the total). Would you like to pay cash or write a check today?”

If they say, “I’ll just wait until the insurance pays, then I will pay you”, you might respond:

“Well, Mrs. Smith, I know from having worked with this insurance carrier in the past that they will cover about 80% of this service. Your portion will amount to $120. If your portion turns out to be less, we will certainly refund any overpayment due”.

If the patient/client ever becomes upset about insurance or appears unhappy, it would be advisable to explain to them how insurance companies operate, including how they can delay payments, challenge the service, etc. You can also remind them that their insurance is an agreement between them and their insurance company (or employer), and not with the doctor’s office.

Most likely, once you have clarified this with the patient/client, and they truly understand, you will not have to deal with it again. The best time to discuss this issue of insurance coverage is when the new patient/client first arrives.


Larry Silver

Extending Credit

Posted by Larry Silver

Tips to Control Your Accounts Receivable

Following are some guidelines to assist you in determining to whom you wish to extend credit and how to go about collecting on those accounts.

* Assess the patient/client’s credit worthiness before extending any sort of credit. Have them fill out a “credit application” (see sample in the Form section,) and verify the information supplied.

* Always charge for any credit extended, using a monthly percentage or a flat service fee.

* When extending credit of any kind, have the patient/client sign an agreement covering the terms of the credit. Ensure that they fully understand and agree to the terms of payment.

* Monitor all accounts monthly so that you know who may be delinquent. Take immediate action on any account over 30 days past due. The older an account gets, the more difficult it will be to collect. Call the patient/client right away and make arrangements to bring the account current.

* Flag past due accounts by putting a red self-adhesive dot on the upper right corner of the patient/client’s chart folder. In this way it is easier for any staff person to see that the patient/client has a past due account and it will be more likely to get addressed.

* Each day review the schedule for the next day so that you will be prepared to see any patients/clients whose accounts need addressing. Confer with the receptionist on anyone who will need to be seen after their appointment, or from whom the receptionist would collect over-the counter.

* If a patient/client you had planned to collect from has forgotten his/her checkbook or does not have the agreed upon amount, the receptionist should contact the accounts manager or the office manager so that the matter can be addressed.

* Patients/clients with delinquent accounts, who are not making an attempt to handle it, should be sent to a collection agency. Again, this should be done as soon as possible before the account gets too old to realistically expect payment.

* Ensure that statements are accurate and are being mailed out every month on time and without fail. Utilize appropriate labels on the statements such as: Thank you for your payment.”


Larry Silver

THE GOVERNMENT HELPS OUT ON NEW EQUIPMENT PURCHASES

Posted by Larry Silver

Taking Advantage of the IRS Section 179 Write-Off

Written by Brad Beck, Vice President Bank of America Practice Solutions

What did you think the chances were that a banker would not start anything that is printed on paper without a disclaimer? Well if you took the safe bet you were right and here it is: I am not a CPA and therefore not certified to give tax advice. What you will read in this article are my thoughts based upon my experience in the equipment and practice finance industry. Any decisions you make about equipment purchase, and the tax benefits associated with those purchases, should be made only after careful consideration with your tax advisors. With that disclaimer out of the way, let me proceed with some information that may be helpful for you.

State-of-the-art technology and equipment has become more important than ever in a modern, competitive Health Care Office, whether you are a Dentist, Veterinarian, Optometrist, M.D., etc. The cost of technology has increased, and continues to increase, in the economic environment in which we live. Purchasing equipment is a difficult decision for many reasons but, somewhat fortunately, the government has decided to make the decision making process a little easier by giving large incentives to encourage purchases over the next few years. These incentives also help on many levels to stimulate the economy. Unlike most complicated tax legislation we see, in this case the government has gone out of their way to make the tax benefits to purchasing equipment very easy to understand.

Let’s clarify the language first. What is IRS Section 179? This refers to a small business tax incentive bill that Congress passed this year that allows small business owners a significant tax break on purchases of equipment. A taxpayer can elect to expense up to $125,000 in equipment purchases in 2007. This legislation, passed on May 24, 2007 is retroactive to purchases made since January 1st of this year. This is up from $112,000 that was previously set for this year and up from the $25,000 that it was previous to that! So this is a significant change in a tax advantage. The equipment must be used in the active conduct of a trade or business, which is just a fancy way of saying you must use the purchase in your practice. (A boat may be a valid tax deductible purchase for a fisherman but not for a Dentist!).

The dollar amount allowable to expense from Section 179 changes yearly according to inflation. The equipment purchase becomes a direct savings on your taxes due based upon your marginal tax rate. Any purchase amount that exceeds the 179 deduction amount of $125,000 for 2007 will go to normal depreciation schedules. That may sound complicated, but it is actually very simple. Below are two real world examples of the math which should explain it better.

I hope the above real world examples give you a grasp of the concept of the Section 179 tax benefits. If equipment purchases are in your near future, and you have not already used your “179″ benefit this year, you should give thought to purchasing and installing the equipment before the end of the year.

Before you all run to your sales reps and place equipment orders, there are a few points and limitations you should be aware of:

* This tax benefit is available from January 1, 2007 through December 31, 2010.

* As noted above, the “179″ write off is limited to $125,000 yearly (adjusted to inflation yearly).

* There is a phase out provision for 2007: If you purchase over $500,000 worth of equipment there is a dollar for dollar reduction of the $125,000 write off. As an example, if a Doctor purchases $550,000 worth of equipment, $50,000 of the $125,000 potential write-off would be lost and only $75,000 would be able to be directly written off and the rest would be depreciated as normal. Or, as another example, if a doctor purchases $625,000 in business assets this year, the Section 179 is completely phased out and there is no benefit.

* The practice must have taxable income to qualify and be used, but any write off not able to be used can be carried over and used in the following year.

* Business asset purchases (equipment) must be “Placed into Service”

In order for an equipment purchase to qualify as “Placed in Service”, the equipment must be delivered and installed and ready to perform its function. It must be available and capable to perform its function. It does NOT have to be paid for in full. The purchaser must be obligated to pay, which means they must have executed a contract to pay, or created a liability (loan) to pay, or actually paid for it.

This tax deduction will be in effect through 2010, so you should be planning accordingly. What happens January 1st, 2011? Section 179 reverts back to $25,000 and the phase out starts after $200,000. So at $225,000 in equipment purchases there will no benefit to the Section 179 write off. Using one of the examples above, a $300,000 equipment purchase in 2007 will give a savings of $56,000 (with a 35% tax rate), but that same $300,000 purchased in 2011 gives a savings of only $28,000. That’s a difference of $28,000. I’m sure you all can think of something to do with $28,000 other than give it to Uncle Sam (maybe that boat that the fisherman was able to write off under Section 179!).

Now as I say to my two sons, you have to make your own decisions in life and in business. In the end, if you have no need for new equipment this year, then this information may be irrelevant right now. But, if you do have a need for new equipment and don’t take advantage of this, you could be wasting money. The world will not stop turning but, like I said, we all have things we can do with some extra tax savings.

I hope this information is helpful and gives you some food for thought that you should discuss with your CPA.

Brad Beck Vice President Bank of America Practice Solutions

brad.beck@bankofamerica.com

800-214-6087


Larry Silver

Motivating Employees at Your Practice

Posted by Larry Silver

By Dr. Amy Shroff, VMDDr. Amy Shroff, VMD

The success of any business depends on its employees. Figuring out what motivates them is the tricky part. Motivation, like employees, is highly individualized – what drives one person may not mean nearly as much to someone else. While some people excel with a pat on the back, others look for financial rewards and others still seek power or equity in a company.

In our fifty-person practice, I have learned there are seven key elements which motivate employees. Recognizing which employees fall into which categories is what makes for a happy and productive staff.

Fulfillment: Employees who fall into this category are motivated by the successful completion of a project. They are often self-motivated, if the job is challenging enough;

Power: These employees receive satisfaction when they can lead and direct;

Affiliation: People who enjoy interacting with coworkers like social aspects of the workplace and do well on teams;

Autonomy: This group wants independence and freedom. Setting their own schedules is the key to harmony;

Recognition: This is universal. Positive feedback on specific tasks is essential for everyone. No matter how busy the day seems, taking a few minutes to praise someone for a job well done makes an enormous difference in overall staff morale;

Safety and Security: A predictable work schedule, job stability and benefits drive this cluster;

Equity: Across the board, an environment that encourages interaction and feedback will help employees communicate their needs. For instance, an organized office system with a written policies and procedures manual, compensation guidelines and access to information ensures compliance and equity for all.

Whether the practice is large or small, strong leadership is critical. The ideal person is someone with patience and insight that can shape and guide the practice. In the high- stress world of veterinary medicine, this is a tough role. The leader must be in charge but approachable, respect each employee, and know their names and their position.

The majority of the employees in the veterinary practice setting usually fall into the Generation X (30s) or Generation Y (20s) age groups. When surveyed, I found these employees seek a work environment that’s fun, offers opportunities for growth, and provides competitive salaries, interesting new projects and excellent benefits as well as the chance to learn and develop new skills. They also wish to travel and attend conferences. And yes, they really want flexible work schedules.

Both these groups have grown up with computers and are more receptive to information found online. That can have its drawbacks. Because our hospital is open round the clock, we all work different shifts. I can go for weeks without seeing some of our staff. Often those questions that would be asked and answered in person need to be addressed via email. As valuable a tool as this may be, it is essential not to lose sight of the impact of face-to-face conversations. Important information is conveyed through voice and body language. Learn to read your employees so you can react and motivate them appropriately.

The P Word

Recognition was addressed above, but is worth taking a closer look at effective ways to use praise.

Be specific when praising an employee. For instance, take some time with the person to cite a certain task. It could be one that made the practice more efficient or helped a client or patient. Make it a point to do this in front of the employee’s peers whenever possible. Sometimes, we buy lunch for the office and make an announcement about a job well done.

Supervisors can easily keep track of good deeds if they always have a list of employees. They can check off the names of those recognized each day. Leaving a voicemail message for a job well done is another effective way to send someone a high five. Or, deliver hand-written notes on special occasions to make everyone stand out.

A supervisor or team leader can also use praise to improve poor performance. If an employee is handling the majority of their tasks well but lacking in one or two areas, sit down with the person and have a conversation. Praise them for what works and discuss changes to smooth out the rough spots.

Moving On Up

A raise isn’t necessarily always the answer. Providing opportunities for advancement stimulates many of us. Employees wear many hats in veterinary practices and quickly find out what they like best and can move in that direction. By offering staff training, opportunities to sharpen skills and career guidance, employees will work harder and smarter.

Show You Care

Make sure your employees have the tools they need to do their job. A functional and emotionally supportive work environment including appropriate lighting, ergonomic workstations, and Internet access with use of VIN or VSPN makes everyone’s job easier. Insure all diagnostic equipment is serviced regularly and fixed immediately if something malfunctions. Have enough supplies on hand to conduct training sessions. The small things do make a difference: quiet meeting rooms, interoffice e-mail, voicemail and even business cards say you value everyone’s role.

It is important for all employees to be part of the decision-making processes whenever possible. Our practice has grown and evolved since it began. To better define our hospital, employees were asked to review our collective and write individual mission statements for each department. Then, a new one was developed based on everyone’s input. This exercise was an excellent team builder.

We reward employees who generate ideas that can be implemented. Audio CDs, gift certificates, contributions to a person’s favorite charity are typical. We have even sponsored baby and wedding showers.

Along with the usual Christmas bonus, we also provide bonuses and appreciation for Veterinary Technician week as well as birthday bonuses.

Each department receives a monthly cash incentive if they gross above their target number. Bonuses are given to full as well as part-time employees and allocated based on number of hours worked.

It is important to reward hourly workers for taking a shift on a non-scheduled day, coming in early or staying late. If someone is called in for an additional shift in my hospital, they receive a monetary bonus. All employees working holiday shifts are provided lunch or dinner as well as double time pay. The goodwill and increased productivity this policy fosters more than makes up for the expense incurred.

Share Information

Employees need to understand where company dollars are spent if they are going to help a practice grow. By distributing cost information at regular meetings, our staff is always aware of what is going on and often makes suggestions to cut expenses.

Employees are the single most important investment any veterinary hospital can make to ensure profitability and success. Before you ask them what they want, understand what motivates you. If you know the answer, setting an example for your staff to follow will be easy.

Dr. Amy Shroff is owner and chief of staff at the Veterinary Emergency & Specialty Center of New England (VESCONE) in Waltham, MA. www.vescone.com.


Larry Silver

Search Engine Marketing for Doctors

Posted by Larry Silver

Article 1 of 4 part series

By Lisa Thayer,

GoldfishNetwork.com

Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.

Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com


Larry Silver

Root Canals Just as Effective as Dental Implants

Posted by Larry Silver

Dentists Emphasize Saving Natural Teeth and Patient-Specific Considerations

For patients torn between the best way to treat a compromised tooth, the choice just got clearer. A recent systematic review comparing two of the most common treatment options – root canals and dental implants – found virtually equal success, or survival rates, between both treatments. However, despite this similarity, it was concluded that the priority should always be to preserve the natural tooth before extracting and replacing with an implant. Root canal treatment saves more than 17 million teeth a year.

The results of the treatment analysis were published by The International Journal of Oral and Maxillofacial Implants, the official publication of the Academy of Osseointegration, an organization committed to advancing dental implants. The Academy also published a consensus statement developed by experts from several dental disciplines that supports the comparison’s findings and stresses the importance of patient-specific considerations.

There are several notable differences between the two procedures. Dental implants require extracting the tooth followed by multiple surgeries to insert a metal post in the jaw and affix a porcelain crown to the post. These surgeries often can take three or more visits to complete, and can be timely and costly. During root canal treatment, the source of tooth pain – inflamed pulp – is removed and the inside of the tooth is then cleaned, filled and sealed. Today, most root canals can be completed in one visit and are virtually painless.

Since the comparative analysis uncovered no significant differences in the success rates between the two options, the researchers emphasize that treatment decisions must be based on factors other than outcome, such as case complexity or the patient’s individual health and preferences. To assist dental professionals and their patients in determining the most appropriate treatment, the American Association of Endodontists (AAE), the national association representing root canal specialists, released a position statement on treatment planning when considering a root canal or dental implant.

According to Dr. Shepard S. Goldstein, AAE president and Framingham, Mass. endodontist, the position statement is meant to be used as a guide when deciding how to best treat a compromised tooth. For example, when a patient has diabetes, there are certain factors that the dental professional must consider when determining treatment.

“The recommended treatment must be safe, mindful of the patient’s wishes, and should aim at preserving the natural tooth when possible,” said Dr. Goldstein. “The AAE hopes that this guidance can help ensure that each patient receives the best treatment based on his or her unique case.”

Dr. James A. Abbott, an endodontist from Santa Rosa, Calif., says many of his patients have had to choose between a root canal and a dental implant. “Most patients want to keep their natural tooth,” says Dr. Abbott. “When I explain the details of both treatments and how the tooth can be saved with a root canal, the choice is simple.”

The AAE position statement also is intended to assist dental professionals in evaluating the various risk factors and other implications associated with each of the treatment choices. Risk factors can include smoking, bone quality and estrogen level – for example, women with lower estrogen levels may encounter more treatment failures with implants. According to the AAE statement, it is crucial that the patient’s health and specific oral care needs be the most important considerations when weighing treatment options.

The American Association of Endodontists, headquartered in Chicago, represents more than 6,900 members worldwide, including approximately 95 percent of all eligible endodontists in the United States.

SOURCE: American Association of Endodontists


Larry Silver

Periodontal Diseases Are Blind to Age

Posted by Larry Silver

Two studies suggest that periodontal diseases should be a concern to women of all ages

Two studies in a recent issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives. One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.

“Younger women often think that periodontal disease is a condition associated with old age,” explained study author Brian Mullally, PhD. “Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners about any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy.”

Another study in the Journal examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.

“Our study’s findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years,” said study author Renee Brennan, PhD. “We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis-including smoking, age, medications, and overall general health-are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women.”

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

SOURCE: American Academy of Periodontology


Larry Silver

Scientists Discover How Maternal Smoking

Posted by Larry Silver

Can Cause Cleft Lip and Palate

Scientists supported by the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, report that women who smoke during pregnancy and carry a fetus whose DNA lacks both copies of a gene involved in detoxifying cigarette smoke substantially increase their baby’s chances of being born with a cleft lip and/or palate.

According to the scientists, about a quarter of babies of European ancestry and possibly up to 60 percent of those of Asian ancestry lack both copies of the gene called GSTT1. Based on their data, published in the January issue of the American Journal of Human Genetics, the scientists calculated that if a pregnant woman smokes 15 cigarettes or more per day, the chances of her GSTT1-lacking fetus developing a cleft increase nearly 20 fold. Globally, about 12 million women each year smoke through their pregnancies.

Dr. Jeff Murray, a scientist at the University of Iowa and senior author of the study, noted that parents who are considering having a child and need added motivation for the mother to quit smoking might one day be tested to determine their GSTT1 status. Because the fetus inherits its genes from both mother and father, the test would determine the likelihood of the baby developing without the GSTT1 gene to detoxify the cigarette smoke.

“A test that indicates the GSTT1 gene is present certainly would not eliminate a baby’s risk of a cleft because many other genetic and environmental factors can be involved,” said Murray. “But the opposite result would give the mother one more compelling reason to quit smoking for her own health and for the sake of her child.”

In the United States, about one in every 750 babies is born with isolated, also called nonsyndromic, cleft lip and/or palate. The condition is correctable but typically requires several surgeries. Families often undergo tremendous emotional and economic hardship during the process, and children frequently require many other services, including complex dental care and speech therapy.

According to Murray, researchers have built a strong statistical case over the past several years that pregnant women who smoke put their unborn babies at greater risk of developing a cleft. The data raised two related questions. “Do genetic variations in the mother influence her own metabolism of the cigarette smoke and its byproducts, thus setting in motion developmental changes that cause the cleft in the fetus? Or do genetic variations in the fetus itself compromise its ability to metabolize the cigarette smoke and cause the cleft?” said Dr. Min Shi, now a scientist at NIH’s National Institute of Environmental Health Sciences and a lead author of the paper.

To find the answers, Murray’s group teamed with colleagues in Denmark to perform a large, complex, and possibly first-of-its-kind international study. The group first assembled a list of 16 genes of interest, each of which encode proteins that plug into various pathways in the body involved in detoxifying dangerous chemicals. “We picked genes that previous evidence shows either are directly involved in cigarette smoke toxicity or are major players in general toxicity management in people,” said Dr. Kaare Christensen, a scientist at the University of Southern Denmark in Odense and an author on the paper.

“These genes tend to be quite variable from person to person in their precise DNA structure, or spelling,” Christensen added. “We wanted to see if any of these variations might adversely affect a person’s ability to break down the toxic products of cigarette smoke.”

Christiansen and his colleagues then turned to their existing database of kids with clefts, their parents, and siblings. In all, the scientists analyzed 5,000 DNA samples from both continents – including 1,244 from children born with clefts. Importantly, the families in Denmark and Iowa provided the opportunity to independently confirm the findings in two distinct populations.

In addition, they had free public access to the NIDCR-funded COGENE project, a comprehensive online database of genes expressed throughout the various stages of development. Working closely with Dr. Mike Lovett at Washington University in St. Louis, one of COGENE’s founders, the database proved especially helpful because cleft lip and/or palate occurs during the first 5-to-12 weeks of development. This meant the scientists had to be sure not only that their genes of interest are expressed during this vital period but are switched on in fetal craniofacial structures. If the genes met both criteria, the investigators said they hoped their subsequent data might point them to a gene-environment interaction.

As reported, the scientists determined from their analyses that the mother provides the toxic environmental exposure, which then can be greatly amplified by the genetics of the fetus to produce the cleft. This marks the first time a gene-environment interaction in clefting has been documented at a molecular level. The data also point the way for future studies to define the specific molecular chain of events that lead to the cleft, vital information to understand and hopefully one day prevent the process.

While sifting through the data, the researchers took particular note of the GSTT gene and its contribution to clefting. The gene encodes one of the body’s approximately 20 different glutathione S-transferase enzymes. These enzymes collectively play roles in common detoxification processes, ranging from chemically altering drugs and industrial chemicals to detoxifying polycyclic aromatic hydrocarbons, a key component of cigarette smoke.

The scientists found that pregnant women who smoked and also carried fetuses that lacked the GSTT1 enzyme were much more likely to give birth to a baby with a cleft. This finding was true in Iowa and Denmark, and they noted in the COGENE database that the gene is highly expressed in developing craniofacial structures. “It may be that the lip and palate can form normally without GSTT1,” said Murray. “But if the chemicals in cigarette smoke challenge the normal development of these structures, fetuses that lack the gene are at a distinct disadvantage.”

Murray and his collaborators continue their genetic analyses. “We now have data from about 350 genes on this cohort of families,” he said. “It’s certainly a more complicated analysis to perform, but we’re working our way through it and hope to have some very interesting data in the months ahead.”

The article is titled “Orofacial Cleft Risk is Increased with Maternal Smoking and Specific Detoxification-Gene Variants,” and is published in the January 2007 issue of the American Journal of Human Genetics. The authors are Min Shi, Kaare Christensen, Clarice R. Weinberg, Paul Romitti, Lise Bathum, Anthony Lozada, Richard W. Morris, Michael Lovett, and Jeffrey C. Murray.

The NIDCR (www.nidcr.nih.gov) is the nation’s leading funder of research on oral, dental, and craniofacial health.

SOURCE: National Institute of Dental and Craniofacial Research


Larry Silver

Baltimore Dental Study Offers Model Program to Reduce Tooth Decay in Urban Children

Posted by Larry Silver

Description

University of Maryland, Baltimore study shows early preventive dental care to toddlers may significantly reduce cavities and cavity-causing bacteria levels in children.


© 2009 Newswise — A new study by researchers at the University of Maryland, Baltimore recommends a model program for urban pediatric clinics that can significantly reduce dental cavities in low socioeconomic infants and toddlers.

The researchers at the University of Maryland Dental School conducted the 26-month study of 219 children, ages six to 27 months, at the University’s Pediatric Ambulatory Care Center, a pediatric primary care clinic serving mostly low-income residents. Oral conditions of very young children were compared with those of older children at their first visit.

A “prevention group” of 109 children, ages six to 15 months, showed more than eight times less cavity-causing oral bacteria and significantly less cavities at their final dental visit, than did a control group of 110 children, ages 18 to 27 months at their first visit who had not received previous preventive care. Each child in the younger group received assessments of dental caries, monitoring of oral bacteria levels, fluoride varnishing, dental health counseling, periodic recalls, and referral to a dentist.

The study showed that if infants and toddlers can be provided with some preventive care, their oral health will be much better at the age of two years old than if they did not receive preventive care, says study leader and Dental School professor Glenn Minah, DDS, PhD.

Outcome measures included number of decayed tooth surfaces, oral counts of cavity-causing bacteria, and caregiver responses to a questionnaire about the child’s diet and home care.

Children who needed immediate treatment for caries were referred for treatment and those with high microbial counts were considered high risk and recalled for additional prevention.

Tooth decay can begin as soon as the first teeth emerge in toddlers, Minah says. And the study confirmed that children with early childhood dental caries are at higher risk for developing new carious lesions at a later age. Early childhood caries is a $3 billion problem annually, according to the researchers.

The desired improvements in dental care for young urban children can happen “by working with the physicians to assess children for caries-risk, screening them for early caries, referring them to dentists, and applying topical fluoride varnish,” says Minah.

He said that the success of the study was largely possible by placing a full-time nurse or dentist with pediatric experience at the clinic who was solely dedicated to oral care, and the use of microbial screenings as a primary caries-risk indicator for the study. The risk assessments and screenings helped the staff identify low-risk subjects and children who were experiencing caries-promoting conditions.

Norman Tinanoff, DDS, MS, program director of the School’s Department of Pediatric Dentistry, says that dental caries in preschool is a big program now and a “rather ignored” program until 10 years ago. The problem was referenced in only two separate sentences in the 2000 report of the U.S. Health and Human Services Department (HHS) Surgeon General’s report on the nation’s health. “Now it has bloomed as a public health problem and a research problem,” said Tinanoff. Dental caries is now recognized by HHS as the most widespread chronic disease and most common unmet health care need of childhood.

The study identified potential drawbacks of the model, such as added costs for laboratory equipment for analysis of the microbial screenings and recalling the young children for follow-up preventive measures.

A more cost-efficient model suggested by the study may be one that assumes every enrolled child is at high risk for tooth decay, providing fluoride varnish at the first visit and at six-month intervals, referring each child for dental treatment when cavities appear, re-examining them for oral problems at each or most medical visits, and emphasizing dental education at each visit. The study is published in the journal Pediatric Dentistry, vol. 30, no. 6.

© 2009 Newswise. All Rights Reserved.


Larry Silver

Streamlining Your Collections

Posted by Larry Silver

Tips to Improve Your Performance

Patient/Client Billing

Those patients/clients who do not pay cash at the end of their appointment must be billed through the mail. Most offices receive a large portion of their monthly earnings in response to these billing statements. A person who receives a billing statement in the mail may or may not pay it fully or promptly, though. The Accounts Manager can increase the percentage of patients/clients who promptly pay their bills through the following:

* Send all bills out promptly. Most people tend to pay bills that come in closest to the beginning of the month and postpone those bills received later in the month. Determine exactly when you are going to send your bills out, and get them prepared a couple of days prior to sending.

* Make sure that bills are neat and professional in appearance. A neatly written or typed bill carries more authority than a sloppy one. Computer billing offers the most efficient and neat method of billing.

* Accuracy of your bills is very important. Itemize the services performed. Avoid repeating a charge on the bill that has already been paid. Ensure that the spelling of the name and address is correct.

* Indicate a due date on your billings. Any amounts that were previously billed, but not paid should be listed separately and the balance carried forward.

Collecting From Insurance Companies

While there is not really one best way to streamline claim processing, the following are some suggestions to avoid unnecessary delays:

* Use electronic filing wherever possible.

* Use approved insurance claim forms. Some other forms are easier to complete, but may not be processed as quickly.

* Pre-print your identification information on the forms.

* Pre-print your most frequently performed procedures on the forms. This helps to avoid typographical errors.

* Submit your findings for predetermination of benefits any time extensive service is needed.

* Have patients/clients bring their claim form with them to the first visit and have them fill out their section first.

* Mail all claims from your office if not filing electronically.

* Remind patients/clients that insurance plans are intended to help them pay for care, not to pay the entire cost for them.

* Explain clearly and concisely, prior to service, what the patients/client’s financial obligation is.

* Come to a mutual agreement about the assignment of benefits.

Working Patient/client Accounts

The Collections position involves more than just sending out bills. Often the accounts involve some work. Therefore an accurate records and a tracking system must be developed which will keep the Accounts Manager informed on when to expect payment and how much to expect.

Maintaining Accurate Patient/client Records

Your office should maintain a separate financial record for each family or individual patient/client. Financial records can take the form of a computerized account or a patient/client ledger card. In either case, the name on the account should be that of the person responsible for payment of bills.

Every financial transaction should be recorded in the correct account or ledger card. Every charge and every payment received should be recorded. This is done regardless of whether the payment is received at the time of service or not, in response to a bill sent by mail, or from an insurance company. The more details in an account, the better. This card or account becomes the source for the patient/client’s monthly statement showing charges and payments.

Using a Tickler

Since the Accounts Manager must “work” the accounts, it is advisable for her to develop a tickler system that she will use to track the accounts. There are a variety of software programs that can be used for a reminder/tickler system. What is explained below is a system that was originally designed for a non-computerized system. It is presented here to give you the basics of what you need, whether doing it with software or not.

This tickler system can be as simple as using a 5 x 7 file box. The file box should have 31 dividers, labeled 1-31, one for each day of the month. When you begin “working” an account (using the aging information that follows,) make up a tickler card with the patient/client’s name, account number, phone number, insurance information if applicable, and the date.

You will then note on the card every date and time that you have any correspondence with the patient/client and/or insurance company. You will also note exactly what was said and promised. If you have placed a call to an insurance company to find out exactly when you will receive payment on an account, note on the card whom you spoke with and when the money is to arrive. You would then place the card behind that date in your tickler file. When that date rolls around, you simply pull the card, see that money was to arrive that day, and if it doesn’t you place another call.

Each day when the Accounts Manager comes into the office, she should pull the cards behind the current day and “work” those accounts. As the day comes to an end, she would take the current tabbed date card and move it to the back of the box (the days then are constantly moving forward in the box). Any card that she was not able to get to that day must be placed behind the slot for the following day so that any necessary calls or follow-up can be made.

Monitoring Your Accounts Receivable

All accounts should be monitored using an accounts receivable aging sheet, whether this is done with a software program designed for such or not This acts as a valuable collection tool because the status of an account can be assessed along with an immediate determination of which patients/clients are not complying with the terms of payments. The accounts receivable sheet should be analyzed ten days after each billing period. Patients/clients who have not made their payments should be sent a second billing (31-60 days) with a reminder that their payment is past due. (A handwritten one, such as “your payment is beyond the time established by you to pay your account,” is most effective).

Patients/clients receiving a third billing (61-90 days) should receive a statement with a stronger memo. If payment is not made within ten days, this patient/client should receive a call and a firm arrangement must be established.

If still no payment occurs, it is advisable to create a “third party credibility” in the collection of this account. You could send a letter such as “We have been informed by our accounting firm that because your account is considerably overdue, it will be turned over to an attorney for immediate legal action if complete payment of your balance is not made immediately”. This correspondence creates the image of the account now being controlled by an outside, stronger source. The account then appears to no longer be in the hands of just the Doctor and staff, and may create greater credibility and enhance the collection process.

The most important factor in keeping your collection percentage high is maintaining continual communication between the office and the patient/client (and insurance companies). By really staying in communication, you will remain in control of your accounts, and you will enjoy greater success in receiving prompt payment for services rendered.


Larry Silver

Acupuncture Eases Radiation-Induced Dry Mouth in Cancer Patients

Posted by Larry Silver

Description

Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia – severe dry mouth – among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.

© 2009 Newswise — Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia – severe dry mouth – among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.

Xerostomia develops after the salivary glands have been exposed to repeated doses of therapeutic radiation. People who have cancers of the head and neck typically receive large cumulative doses, rendering the salivary glands incapable of producing adequate saliva, said Mark S. Chambers, M.S., D.M.D., a professor in the Department of Dental Oncology. Saliva substitutes, lozenges and chewing gum bring only temporary relief, and the commonly prescribed medication, pilocarpine, has short-lived benefits and bothersome side effects of its own.

“The quality of life in patients with radiation-induced xerostomia is profoundly impaired,” said Chambers, the study’s senior author. “Symptoms can include altered taste acuity, dental decay, infections of the tissues of the mouth, and difficulty with speaking, eating and swallowing. Conventional treatments have been less than optimal, providing short-term response at best.”

M. Kay Garcia, LAc, Dr.P.H., a clinical nurse specialist and acupuncturist in M. D. Anderson’s Integrative Medicine Program and the study’s first author, noted that patients with xerostomia may also develop nutritional deficits that can become irreversible.

Garcia, Chambers and their team of researchers conducted a pilot study to determine whether acupuncture could reverse xerostomia. Acupuncture therapy is based on the ancient Chinese practice of inserting and manipulating very thin needles at precise points on the body to relieve pain or otherwise restore health. In traditional Chinese medicine, stimulating these points is believed to improve the flow of vital energy through the body. Contemporary theories about acupuncture’s benefits include the suggestion that needle manipulation stimulates natural substances that dilate blood vessels and increase blood flow to different areas of the body.

The M. D. Anderson study included 19 patients with xerostomia who had completed radiation therapy at least four weeks earlier. The patients were given two acupuncture treatments each week for four weeks. The acupuncture points used in the treatment were located on the ears, chin, index finger, forearm and lateral surface of the leg. All patients were tested for saliva flow and asked to complete self-assessments and questionnaires related to their symptoms and quality of life before the first treatment, after completion of four weeks of acupuncture, and again four weeks later.

The twice weekly acupuncture treatments produced highly statistically significant improvements in symptoms. Measurement tools included: the Xerostomia Inventory, asking patients to rate the dryness of their mouth and other related symptoms; and the Patient Benefit Questionnaire, inquiring about issues such as mouth and tongue discomfort; difficulties in speaking, eating and sleeping; and use of oral comfort aids. A quality-of-life assessment conducted at weeks five and eight showed significant improvements over quality-of-life scores recorded at the outset of the study.

“In this pilot study, patients with severe xerostomia who underwent acupuncture showed improvements in physical well-being and in subjective symptoms,” Dr. Chambers said. “Although the patient population was small, the positive results are encouraging and warrant a larger trial to assess patients over a longer period of time.”

Garcia said that a phase III, placebo-controlled trial is planned and is currently under review. She also noted that in other studies, the M. D. Anderson researchers are examining whether acupuncture can prevent xerostomia in patients treated for head and neck cancer, not just treat it.

“Recently, we completed a study at Fudan University Cancer Hospital in Shanghai, China that compared acupuncture to usual care to prevent xerostomia. We have now started a two-arm placebo-controlled pilot trial in Shanghai. In the prevention trials, acupuncture is performed on the same day as the radiation treatments,” Garcia said.

In addition to Chambers and Garcia, other authors on the all-M. D. Anderson study include: Joseph S. Chiang, M.D. and Thomas Rahlfs, M.D., Department of Anesthesiology and Pain Medicine; Lorenzo Cohen, Ph.D. and Qi Wei, M.S., Department of Behavioral Science/Integrative Medicine; Meide Liu, LAc, Place of Wellness; J. Lynn Palmer, Ph.D., Department of Palliative Care and Rehabilitation Medicine Research; David I. Rosenthal, M.D., Department of Radiation Oncology; and Samuel Tung, M.S. and Congjun Wang, Ph.D., Department of Radiation Physics.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News & World Report.

© 2009 Newswise. All Rights Reserved.


Larry Silver

Cracking the Root of Tooth Strength

Posted by Larry Silver

Description

After years of biting and chewing, how are human teeth able to remain intact and functional? A team of researchers from The George Washington University and other international scholars have discovered several features in enamel—the outermost tooth tissue—that contribute to the resiliency of human teeth.

Newswise April 2009— Human enamel is brittle. Like glass, it cracks easily; but unlike glass, enamel is able to contain cracks and remain intact for most individuals’ lifetimes. The research team discovered that the major reason why teeth do not break apart is due to the presence of tufts—small, crack-like defects found deep in the enamel. Tufts arise during tooth development, and all human teeth contain multiple tufts before the tooth has even erupted into the mouth. Many cracks in teeth do not start at the outer surface of the tooth, as has always been assumed. Instead cracks arise from tufts located deep inside the enamel. From here, cracks can grow towards the outer tooth surface. Once reaching the surface, these cracks can potentially act as sites for dental decay. Acting together like a forest of small flaws, tufts suppress the growth of these cracks by distributing the stress amongst themselves.

This is the first time that enigmatic developmental features, such as enamel tufts, have been shown to have any significance in tooth function” said GW researcher Paul Constantino. “Crack growth is also hampered by the “basket weave” microstructure of enamel, and by a ‘self-healing’ process whereby organic material fills cracks extended from the tufts, which themselves also become closed by organic matter. This type of infilling bonds the opposing crack walls, which increases the amount of force required to extend the crack later on.”

This research evolved as part of an interdisciplinary collaboration between anthropologists from The George Washington University and physical scientists from the National Institute of Standards and Technology in Gaithersburg, Md. The team studied tooth enamel in humans and also sea otters, mammals with teeth showing remarkable resemblances to those of humans.

The article, “Remarkable resilience of teeth” appears in the April 2009 edition of Proceedings of the National Academy of Sciences.

Located four blocks from the White House, The George Washington University was created by an Act of Congress in 1821. Today, GW is the largest institution of higher education in the nation’s capital. The university offers comprehensive programs of undergraduate and graduate liberal arts study, as well as degree programs in medicine, public health, law, engineering, education, business and international affairs. Each year, GW enrolls a diverse population of undergraduate, graduate and professional students from all 50 states, the District of Columbia and more than 130 countries.


Larry Silver

Employers Pay High Price for Vision Disorders

Posted by Larry Silver

Uncorrected Vision Problems Contribute to Decreased Employee Performance

Vision disorders carry a hefty price tag for employers and result in a marked decrease in productivity costing businesses an estimated $8 billion annually, according to a new report released by the Vision Council of America (VCA). The Vision in Business report shows the staggering financial impact of vision problems on the economy, individual states and the workplace.

“Uncorrected vision problems are costing employers billions of dollars,” said Ed Greene, CEO of VCA. “Direct medical costs associated with vision disorders exceed similar medical expenditures for breast cancer, lung cancer and HIV, yet few Americans get regular eye exams or have vision coverage in their health plans.”

Both the private and public sectors of the economy are affected. VCA’s state-by-state analysis of the economic burden associated with vision disorders finds:

1. In 17 states the annual financial burden of vision disorders exceeds $1 billion, and in 15 additional states, that burden exceeds $500 million;

2. States representing the largest cost burden are: California ($5.5 billion), Florida ($3.9 billion), New York ($3.6 billion), Texas ($3.1 billion), Pennsylvania ($2.7 billion), Illinois ($2.2 billion), Ohio ($2.1 billion), Michigan ($1.8 billion), New Jersey ($1.6 billion) and North Carolina ($1.4 billion).

Vision in Business examines the prevalence and cost of vision problems as well as the role of preventive vision care in improving the productivity and efficiency of the American workplace. It also shows that job-related eye injuries, computer eyestrain and other vision problems are costly for employers and employees in a wide range of industries and occupations. Employees in professions ranging from engineers, construction workers, stockbrokers, software developers, to accountants and administrative assistants are among those most at risk for developing vision problems that affect their work performance.

Specific findings from the report include:

1. Vision problems are the second most prevalent health problem in the country, affecting more than 120 million people.

2. An estimated 11 million Americans have uncorrected vision problems, ranging from refractive errors (near- or far-sightedness) to sight-threatening diseases such as glaucoma or age-related macular degeneration.

3. There are nearly 800,000 work-related eye injuries each year, 90 percent of which are preventable.

4. Nearly 90 percent of those who use a computer at least three hours a day suffer vision problems associated with computer related eye strain.

5. Employers gain as much as $7 for every $1 spent on vision coverage.

“I see patients everyday with vision problems that could impact their work performance if not corrected,” said ophthalmologist Elaine G. Hathaway, M.D. “In addition to refractive errors, eye injuries and computer eye strain, eye diseases such as glaucoma and diabetic retinopathy can impair vision if not detected and treated early.”

VCA’s report also highlights recent research that finds the annual financial burden of major adult vision disorders exceeds $50 billion. Specifically, there is a $35.4 billion drain on the U.S. economy with an additional $15.9 billion borne by individuals with vision problems and their caregivers.

“The good news is that because of these high costs, healthy vision is increasingly being recognized as an important health issue in the workplace,” said Greene. In fact, the federal government has set a precedent by adding vision coverage to its new health plan that launched in November 2006.

“Regular eye exams are the best way to maintain employee vision health,” continued Greene. “Increased productivity and accuracy as well as higher job satisfaction are just a few of the payoffs one receives from healthy vision. Therefore, it is crucial that both employers and employees make healthy vision a priority through preventive vision care and offering effective vision benefits in the workplace.”

Tips for Employers:

1. Offer vision coverage as part of a health care package.

2. Ensure a safe working environment with mandatory eye protection as needed.

3. Encourage regular eye exams for employees.

Tips for Employees:

1. When working on a computer take a 20 second break every 20 minutes and look at something at least 20 feet away.

2. Those who wear glasses should talk to their eyecare professional about anti-reflective lenses to reduce glare, eye strain and fatigue.

3. Wear protective eyewear that meets the approval of the American National Standards Institute (ANSI), which will be clearly marked “ANSI Z87.”

VCA urges employees to take an active part in maintaining healthy vision by scheduling regular eye exams. Permanent vision loss is not a normal part of aging, and many vision threatening conditions have no early warning signs. Eye exams can also detect other serious health problems including diabetes and glaucoma.

SOURCE: Vision Council of America


Larry Silver

Guest Column: The Business Sense of Dentistry

Posted by Larry Silver

dr-dolce2Profile of Dr. Vincent Dolce, DMD

By Charles Friedman

Dr. Vincent DolceAs a National Geographic documentary producer, I have had the opportunity to see the world, weave between cultures, and meet many extraordinary individuals. Currently I am working on a documentary for the Florida Department of Education which will be shown to high school students throughout the state. This particular presentation is career oriented with a heavy focus on leadership skills and innovation. Eleven careers were chosen and Dentistry was one of them.

The essence of leadership, which is the core of the documentary, is the combination of personality, integrity, setting a consistent standard, and the ability to motivate and inspire your staff. Yet it is important to convey to these future leaders that an individual who exhibits these traits is still not guaranteed that the end results will be positive. We had to find a common thread among leaders that wasn’t just success.

The common thread between all eleven leaders chosen for the documentary was vision, which takes courage and there are still no guarantees. Vision means thinking outside the box, it means change, and it means taking chances and that’s why our dentist of choice was Dr. Vincent Dolce of Palm Beach County.

But beyond just a documentary, I thought that his own profession would be interested in knowing more about him. I found him to be exceptional. My first indication that Dr. Dolce was unique was when I learned he hosted a weekly radio show throughout southern Florida. He actually brings on other dentists to educate the public about the future of dentistry and the health risks if you do not take care of your oral health. He pays for the show out of his own pocket and he does not take any sponsorship, nor does he run any commercials. This humane gesture revealed to me the caliber of his character. It’s the manner in which he thinks, the manner in the way he acts, the manner in the way he talks, and the manner in which people respond to him. He is a man of dignity, and substance. But dignity and substance are still no guarantees of success.

As I was proceeding with my documentary I was also being introduced to the Dolce philosophy of Dentistry. It was most reassuring that Dr. Dolce turned out to be who I thought he was. When I asked him if I could write this article knowing that I would be giving away certain business techniques, I was fully expecting to receive his approval but not really sure. He was not protective of his techniques in the least and there was no hesitation, he wants every dentist to get the most joy, satisfaction, and financial gain out of the profession that can be achieved. A great deal of his personality is his passion for people to succeed, as well as his lightning quick sense of humor. What made a significant impact on me was his ability to captivate other dentists during a lecture. Although Dr. Dolce is only 51 years old, other dentists approach him with the awe of approaching an ancient Zen dentistry master. These other dentists are curious about his approach because Dr. Dolce has noticeably doubled his income and is expanding his business while many are trying to keep theirs alive. He developed training programs that improve the efficiency of the hygienist, treatment coordinator, dental assistant, and receptionist. After a few of his industry friends saw his numbers start to increase he developed a series of training modules so that dentists could be smarter and better business people.

Dr. Dolce’s business sense of dentistry can be broken down into roles which even include the environment. The roles are divided between the staff and the atmosphere.

The Office of Dr. Vincent Dolce

dr-dolce1When you walk into Dr. Dolce’s West Palm Beach, Fl office it appears like any other dental office. However, beyond the reception area, sequestered yet not obtrusive, is a room that felt more like an elegant showroom than a dental office. This room would make George Lucas envious, and it was done at very little expense.

That is another aspect of Dr. Dolce’s business sense. It is part photography gallery, part exhibit hall, part high technology – with all the elegance of a museum setting.

“This room has more than paid for itself,” Dr. Dolce explained. “As I’m explaining how each patient (whose before and after pictures appear) benefited from taking their oral health seriously, I’m also educating the patient on how their oral health is integrated into their overall health.”

When someone is in the consulting room, they can be taken on a pathway to possible consequences of neglecting their oral health. This one room opens up a whole new line of dialog with his patients. Instead of reacting to the dentist’s office in a negative way, they now begin to understand the dentist and his office as a proactive approach to their health.

“That is the beginning of a new form of relationship between a dentist and his patients.” Dr. Dolce told me.

How is that new relationship best defined? Dr. Dolce and his staff continually educate a patient of the correlation between their overall health and their oral health. This is accomplished in a genuine and sincere matter-of-fact nature that the patients are 100% attentive to. Dr. Dolce’s training initiates the patient to inquire and investigate what they need to be healthier and happier. Empowering the patient is a major first step; a dentist’s office has to make money to prosper.

Dr. Dolce reminded me of a typical visit to the dentist – put the patient in the chair, take x-rays, and diagnose what they need. What they don’t do is energize and inspire the patient to be proactive in taking care of their oral health. “That’s not what they teach you in college. They don’t teach you the psychology of dentistry, they teach you the mechanics. There is a psychology of dentistry, there is a philosophy of dentistry, and there is a business of dentistry,” he said.

The next phase is the human element phase. This is where teamwork and training comes into play. Dr. Dolce assembled a team of training specialists which included curriculum developers from the United States Navy, Harvard University, and the Department of Justice. He wanted to develop interactive training modules that challenged and educated every one of his employees to meet the individual needs of every patient. These interactive training modules are the basis for his expansion initiative. His goal was to increase his gross amount considerably without depending on new patients as his only source of growth. To Dr. Dolce’s satisfaction, the training method worked.

An x-ray machine is an x-ray machine is an x-ray machine, but the dialog between the person taking the x-rays and the patient does not have to be the typical conversation. Dr. Dolce’s training teaches his staff a new way to communicate with the patients. Basically Dr. Dolce believes that the lifeline of successful dentistry is education in communication with the patients. Dr. Dolce also believes that every patient should be secure in the fact that his staff has listened to them.

Since I was producing a documentary, his patients that participated had all agreed to be on camera. My original thoughts were to observe the doctor and his leadership skills and the patients were just props. However, as I was seeing and experiencing his philosophy I really became curious about what the patients thought of their interaction with him. So before he even started working with them I started asking patients what they thought about their introduction to the doctor.

Everyone felt that this was a person who could be trusted. I did not know exactly what that meant until the next phase. The next phase as you probably know is the reviewing of the treatment plan. I did not even really realize what was happening or the impact that the doctor training modules had had. I learned through a conversation at lunch with his treatment coordinator.

The treatment coordinator said, “I have worked for three other dentists before Dr. Dolce. I have never experienced patients so willing to pay for their dental health and so willing to be proactive about their dental health as here in Dr. Dolce’s office. Usually there is a wall of resistance as soon as you explain the costs of dental work. People are not usually proactive about oral health, but the way Dr. Dolce has trained us in explaining their dental needs has them lower their resistance.”

Dr. Dolce invited me to attend a lecture that was being given for dentists in his region. It focused on the restorative phase of implants. I went because I wanted to talk to other dentists and see how they interacted with their patients. What I learned and overheard was that most of these dentists were there to learn how to make more money.

I asked him about this as we were heading back to his office. He said, “Most dentists don’t look at their office or their office procedures as a combination of trained staff and bedside manner. They expect their staff to bill properly and know the techniques as well as the sterile parts of dentistry, but really they expect their staff to be already trained to be business oriented.” The most unique difference being that Dr. Dolce inadvertently reaps the rewards of a high volume of the most expensive and most productive dental procedures such as veneers, implants, and total reconstruction through a highly trained staff, an aesthetic environment, and personal attitude.

I would like to leave you with an excerpt from one of Dr. Dolce’s speaking engagements to a local group of high school students:

“The future of dentistry could never be brighter. With the aging of the baby boomers, and the population in general, plus the cosmetic revolution, not to mention the direct health connection between the mouth and the body, the business of dentistry is perfectly positioned to make any dentist a millionaire. However, if you do not have passion, if you do not consider the patient an individual and a treasure, and you only enter the field of dentistry to make money you will be disappointed. Dentistry is a competitive field. The business sense of dentistry is not a course that is offered in college. The business sense of dentistry is developing a highly trained staff, providing an education and vision to the patient, and nourishing and maintaining the patients trust.”

Chuck Friedman is a former executive producer for National Geographic Television. Mr. Friedman has worked as a video producer/director for a long list of companies and government agencies that include the United States Army and Navy, State of Florida, U.S.D.A., St. John’s University, Michelin, Minolta, Pony Shoes, United Way, the Air Force, Drug Free America, Major League Baseball, DuPont and many others. Mr. Friedman is also well known for developing effective multimedia training programs, and for providing marketing and strategy consultation for a wide variety of clients.


Larry Silver

Search Engine Marketing for Practices

Posted by Larry Silver

(Article 2 of 4 Part Series)

By Lisa Thayer, GoldfishNetwork.com

“Spiders and crawlers and bots…oh my!” – Two views of the same website

One of the most challenging aspects of optimizing a website is that there are two audiences to appeal to: 1) standard website users (like you and me) and 2) search engines. There are many similarities in attraction but also some very important differences.

First, let’s take a look at the top four usability issues from a human/standard user’s viewpoint:

* Ease of navigation – This is no time to be overly “creative” and make visitors guess where to find pertinent information. Sounds like a deceptively simple piece of advice but you only have an average of 8 seconds to capture your audience’s attention. After you have spent time and effort driving traffic to your website, don’t lose them by frustrating them! One navigational tool users appreciate is the addition of a “site map” or hierarchal list of the pages of your website.

* Visually attractive – If it looks like a high school student created your website, it will adversely affect your business’ public profile. If you don’t care about your professional image, the customer might also think you don’t care about the quality of your work. Keep in mind that the internet allows individuals the chance to anonymously pre-screen your business. You may truly have a solid, reputable business but if your website doesn’t have a good design with the proper aesthetics and technical capabilities, you’ll present a poor image of yourself. Unless you know how to design a website with these attributes, you should retain the services of a web designer and developer.

* Content-rich – Studies show that website visitors read websites like billboards not novels. Make sure that whoever writes the copy for your website is familiar with this very important difference in writing for the web. Place your most important content “above the fold” so that the user doesn’t have to scroll down unless they need more details. Make your website more relevant to the user by providing a set of Frequently Asked Questions (FAQ). Don’t be afraid of having a page of categorized links to other website resources but, of course, ask that they in turn link back to your website. Also, be sure to update your content as information in your industry changes as this will garner more frequent, repeat traffic.

Speed – In our increasingly fast paced society we have little tolerance for time wasters such as watching someone’s fancy animated intro or waiting for a picture to download. Use animation sparingly for maximum impact and to respect visitor’s time.

Not every website on the Internet gets the majority of its traffic from the major search engines, but you can’t afford to ignore them. Search engines processes and methodologies are quite complex and are updated all the time. The simple explanation of how search engines work is: the user types a query into a search engine which quickly sorts through literally millions (sometimes billions) of pages in its database and produces matches /results ranked in order of relevancy.

A search engine’s database is culled from a variety of sources.* Many of the larger search engines use things called web “spiders”,” crawlers” or “bot” programs that search the Internet in a methodical way to index and find new or updated data.

The most important thing for a website owner to know is that due to the use of these automated spiders some content and links displayed on a web page may not actually be visible to the search engines.

Now, let’s take another look at the top four usability issues – this time from a spider’s viewpoint:

* Ease of navigation – A spider isn’t concerned about getting lost – either you provide an easy roadmap to and through your website or it simply doesn’t exist in the spider’s mind; metaphorically speaking of course. The best way to do this is by adding a site map.

* Visually attractive – Web spiders don’t have eyes therefore even an actual picture of Bigfoot would have no effect on relevance. Search engines don’t index images; they won’t index any text your web site presents in image format. To fix this problem, you can use what are called “ALT tags” or image descriptions in your website coding.

* Content-rich – Content is also king when it comes to web spiders but beware… search engine methodologies have evolved to identify redundant text and the overuse of keywords. This means some of the tactics ethically challenged web designers used a few years back no longer fool the search engines and can actually harm your standings if overused. Search engine methodologies these days even go so far as to calculate the ratio of actual text (content) to the amount of coding. Web spiders also consider the information within three clicks of the home page to be most relevant to a search. Spiders, as well as human users, appreciate fresh content. (I will address the important issue of updating content in the next article.)

* Speed – Although search engines generally won’t penalize for the use of frames, dynamic content and multimedia files, they will have difficulty indexing them. They also don’t index pages that require registration, “cookies” or passwords.

I have seen many business owners make the mistake of designing an elaborate website and then seek out a professional SEO (Search Engine Optimization) expert. This can lead to disastrous results such as poor performance, missing your target market, and a potentially costly redesign. Before you begin your website project, make sure you clearly express your business vision, current and future marketing plan, and expectations with your web designer. (BTW- If the web designer isn’t asking you about these vital areas perhaps you should keep looking.)

*Other search engine sources include search engine advertisements, human based search engines or web directories and topical search engines.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 9 states across the U.S. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com