Dental Practice Management [PDF]

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Dental Practice Management CM Marya



Since the time evolved, Dental practice has existed in one or the other form. But it is not so long that it has attained the status of a profession. Webster’s dictionary defines a profession as “a calling requiring specialized knowledge and often long and intensive academic preparation”. The dentist provides preventive, therapeutic and educational services, supporting total health for the control of oral diseases and the promotion of oral health.



Preventive Methods employed to prevent oral disease and promote health (e.g. application of pit and fissure sealants, topical fluoride to teeth).



Therapeutic Methods employed to arrest or control oral disease (e.g. restoration of carious teeth, scaling and root planning periodontally involved teeth).



Educational Methods employed in both preventive and therapeutic aspects to explain concepts regarding oral disease and health, to demonstrate self-care techniques (e.g. teaching toothbrushing and flossing, diet counseling).



DEFINITION Practice management can be defined as the organization, administration, and direction of a professional practice in a style that facilitates quality client care, efficient use of time and personnel, reduced stress to staff, and financial profitability. To establish a good dental practice, first step is to establish a dental office and secondly managing the dental office, which includes personnel management, patient management and record management.



ESTABLISHMENT OF DENTAL OFFICE Factors to be considered before establishing dental practice: • Selection of place • Selection of location • Selection of building • Financial assistance • Selection of equipments and instruments • Designing of dental office.



SELECTION OF PLACE • Personal choice of dentist • Depends on the population demography of the area; population density, age distribution and average salaries of the residents • Depends on number of dentist practicing in a place • Whether dentist knows local language or not • Place which is well linked by road, rail, air is good for practice • Good facilities for living • Hobbies and interests of dentist • Place where dental college are present for employment • Depends on profession or job of spouse.



SELECTION OF LOCATION • Depends on scope, style of practice and convenience • In the heart of city as it is accessible for people from all the areas of city • Location with a good public transport facility • Location close to government commercial offices, corporate and business houses • In residential areas it is good to practice in morning and evening time as office goers can get treatment done before going to office or after office time. Also, it is convenient for old people and housewives.



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SELECTION OF BUILDING • Building should be well ventilated, have proper water and drainage system as well as power connection • Building should preferably be on ground floor and have parking facility for both dentist and patients • Select place where more area is available than present requirement so that it can be expanded if required • It is also possible to practice at home by making some alterations • It is better to own dental office rather than taking it on rent.



FINANCIAL ASSISTANCE • Many nationalized banks, private sector banks and state financial corporations give help to establish professional career for a new graduate. SELECTION OF EQUIPMENTS AND INSTRUMENTS • • •



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Should have basic equipments and instruments to run dental office and can keep on adding instruments as per need Selection of equipments depend on finance available During selection of equipments importance should be given to reputation of company and after sale services provided by company It is better to have autoclavable instruments especially hand pieces, scaler handle and tips Sterilized or pre-autoclaved materials should be preferred when one buys consumable materials like blades, suture materials, gloves, syringes, needles, etc.



DESIGNING OF DENTAL OFFICE • While designing dental office consider functional, esthetic and utility value of available space • Design should incorporate a spacious waiting area, work area with dental chair and dental unit, X-ray room, laboratory, resting place, toilets, etc. • Placement of each electrical equipment, gadget which will be used by dentist presently and also in future should be considered while designing electrical connections • It is better to have concealed electrical connection keeping in mind the lighting, fan, exhaust, compressor, X-ray unit, computer, dental chair, chair unit, music system and speakers, etc. and also have few additional electric points for future additional gadgets • Know the exact position of dental chair and dental unit, washbasin, and laboratory to design inlets and outlets for water and drainage connections • Floors and walls should be designed considering esthetics and whether they can be cleaned easily. Instead of having joints and grooves in tiled flooring, choose rubberized vinyl flooring which is easy to keep clean



• Waiting area should be spacious considering future number of patients also • Design work area in such a way that even after placing dental chair in supine position there is enough space all around chair for operating stool and assistant • Have separate X-ray room, autoclaving and sterilization chambers near work place • Keep generators and compressors as much away as possible from workplace • Visit many dental clinics before designing your own clinic, consult dentists for shortcoming and faults in their clinic • Have insurance coverage against fire, burglary and riots.



MANAGEMENT OF DENTAL OFFICE Types of Practice Three ways of private practice are: 1. Solo dentist practice–dentist alone manages all types of cases according to his/her capacity (Fig. 45.1). 2. Group practice–dentists specialized in various specialities work together in the same office 3. Single dentist with call facility for specialist–in this type, dentist alone manages the clinical work but calls for a specialist when required. Whatever be the type of practice, dentist should be able to manage the practice well.



PERSONNEL MANAGEMENT • Daily communication and regular staff meetings to encourage the participation of all the personnel • Appoint a full time receptionist, dental assistant and a person to clean dental office • The clinic should open much before the scheduled appointment of the patient and the assistant should keep the required instruments autoclaved and ready.



Fig. 45.1: Dentist practicing solo



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• Have sufficient amount of stock of materials and dental staff should know how to make economical use of materials • Should have business association with a good dental laboratory which delivers work in time.



PATIENT MANAGEMENT • Dentist should have good communication with patients to ensure quality oral health care services and patient motivation • Appointments should be scheduled for patients for effective time management in the practice • Dentist should explain about diagnosis, investigation, different treatment plans available, cost of treatment and mode of payment • Instructions regarding care after extractions, maintenance of artificial dentures, oral health education, etc. may be given in written.



Fig. 45.2: Computerized dental charting



RECORD MANAGEMENT • Record should be systematically maintained • Written records include the dental and periodontal charts; case history, record of examinations, diagnosis, informed consent and treatment rendered • Non-written records include photographs, radiographs, models and cephalometric tracings • Receptionist should maintain book of accounts by keeping all bills of purchase of equipments, instruments, materials, stationary items and subscription for journals, travel expenses, fees for registration of seminars, conferences, receipt of water, electricity, telephone bills and record for salaries for staff, any donation given, etc. • Many dental software programs are available for documenting patient record; spreadsheets with automatic accounting functions, data management, graphics, scheduling, communications and education (Figs 45.2 and 45.3).



Fig. 45.3: Computerized patient record keeping including radiographs



Table 45.1: Ten fundamentals of dental practice management Bruce J Lowy I. II.



Communication: Dentist should have good communication with patients to ensure quality oral healthcare services and patient motivation. New patient management: The primary objective is to make new patients feel important by exceeding their expectations. This impresses people, and impressed patients accept higher levels of care and tend to refer more of their friends and relatives. III. Treatment presentation: Dentist should explain about diagnosis, investigation, different treatment plans available, cost of treatment and mode of payment. IV. Financial arrangements: Effective means to help patients make financial decisions that affect acceptance. V. Collections: Effective over-the-counter collection prevents many accounts from becoming delinquent and helps to preserve positive patient relationships. VI. Treatment planning and scheduling: Appointments should be scheduled for patients for effective time management in the practice. VII. Continuing care and recall: Provide patients with a specific diagnostic reason to return for their next appointment. VIII. Internal marketing: Many offices have found exceptional success using advertising via cable television, radio, mail, magazine, newspaper advertising, billboards, telephone directories and other traditional business avenues to stimulate new patient flow. IX. Managing the team: Daily communication and regular staff meetings to encourage the participation of all the personnel. X. Financial analysis and control: Maintain patient record along with fees charged on day to day basis Approach a C.A at initial stage of setting up the profession. Maintain book of accounts by keeping all bills of purchase of equipments, instruments, materials, stationary items and subscription for journals, travel expenses, fees for registration of seminars, conferences, receipt of water, electricity, telephone bills and record for salaries for staff, any donation given, etc.



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ACCOUNTING AND OTHER FINANCIAL ASPECTS OF DENTAL PRACTICE (TABLE 45.1) • Maintain patient record along with fees charged on day to day basis • Approach a C.A at initial stage of setting up the profession • Maintain records of all expenses on a day to day basis • Start tax planning by investing in approved schemes as life insurance, public provident fund, N.S.C, tax saving bonds, etc. • Start filling tax returns from 1st year of practice itself as it would help in being law compliant and also in obtaining loans in future and avoiding enquiries from tax authorities.



FACTORS INFLUENCING DENTAL PRACTICE I. LEGAL: Each dentist must respect and be well aware of the law. Frequent review of the practice acts and/or regulations is recommended to keep the dentist up to date. II. ETHICAL: Dentists are ethically and morally responsible for providing dental care to all patients, including those who have been or may have been exposed to infectious diseases. III. PERSONAL: Factors such as general physical health, oral health and mental health should be given consideration. Dentist should go for routine physical examinations at least annually. Adequate physical health, vacation from work, recreation and participation in social activities ensures good mental health.



THE WAYS OF INITIATING A DENTAL PRACTICE • Starting an own practice • Buying an old practice and/or working with an associate dentist.



STARTING AN OWN PRACTICE Advantages of starting a new practice: • The geographic location of the practice is a self decision. • One may incorporate any ideas, concepts, philosophies of practice or techniques according to his/her preference.



• One may plan, build or remodel a new facility or old facility to meet the needs. • Employees are the people of own choice. • He/she is the only decisive authority in the practice. Disadvantages of starting a new practice: • One needs a major amount of money or a large loan. • Building a patient base requires several years and diligent effort in the practice. • There is no assurance that the initial practice income will keep up with the financial outgo need.



BUYING AN OLD PRACTICE AND/OR WORKING WITH AN ASSOCIATE DENTIST Advantages: • One can start with an immediate income. • The facility and the equipment are functional. • No need to plan an office or be creative at the beginning of the practice experience. • Patients are immediately available to treat. • The change from previous professional activities (school or another practice) is not a major shock. Disadvantages: • The patients are devoted to the previous owner of the practice, and one must make a positive impression with them to gain their confidence and keep them in the practice. • The previous owner may continue to treat the desirable patients while he or she is still in the practice, limiting the income and productivity. • The employees are devoted to the previous owner. • The equipment may be old and out of date, requiring an outlay of money. • The building may be old and in need of repair, or in a geographic location that is not your choice. • The previous dentist’s work may have been of a different level of quality than desired in the practice, and the staff will have to be re-educated. • The previous owner may want to stay longer than originally planned, and it may be difficult to take over the practice at the agreed time.