The Bio-Engineering Co.

Is your Tx mechanotherapy giving you the ideal Tx results you desire?  Are your cases being completed in the least amount of chairtime?  Are your cases are being completed by their ECD (Estimated Completion Date)?  If you need to get your cases under better control, maybe this pearl can help.

Lets face it, making system changes in your practice isn’t typically met with great staff zeal.  But if your team is a part of the entire process, your success is more probable.

Sooo...Analyze the attachments below to see how the A~D~D~I~C~T straightforward approach works, Decide how you want to improve your case control,  Decide on and Design the Tx mechanotherapy that will best fit your needs, Implement that design, Critique the effectiveness of your design, and Tweak what needs to be improved.

Obtain your "Scheduling & Tx Quality Control Management Kit" to install your Tx Quality Control programs (see the attached PDF).

Use the suggested Management Pearls to create your QualityControl sub-systems that enhance your Tx Quality Control (see attached PDF for listing).

Refer to the attached PDF to learn about the nine A~D~D~I~C~T MAJOR practice systems and their dozens of supporting sub-systems.

Obtain your A~D~D~I~C~T straightforward guide to "Self-Optimize Your Entire Practice"

Do you suffer from chronic lower back pain?  Do you suffer from occasional or chronic hip pain?  Or are there other pains (i.e., shoulder, leg, foot, etc.)?  Do you want to get rid of or ease that pain?  If so, maybe this pearl can help.

We all suffer from pain in our lives, especially as we get older—and being a dentist doesn’t help; quite the opposite.  Non-traumatic pain (injury, etc.) comes from muscles and bone joints.  Pain can come from over-use of some muscles and under-use of others, throwing your entire musculo-skeletal system out of balance.

When we over-use a muscle it becomes fatigued and creates “trigger points”.  A trigger point is a small part of the muscle that is permanently contracted until resolved.  This contraction pulls on the tendons attached to that muscle.  The tendon pulls on the bones it is attached to, pulling the joint out of its natural position and causing your pain.  If these trigger points are not resolved the contraction can cause joint damage (as is evident in the knees), which leads to chronic pain.

The most common pain for dentists is back and hip pain that stems from working in an unnatural twisted position.  This affects the entire spine, but mostly the lower back and hips.  At the recent AAO meeting in Orlando, I noticed that the younger dentists walked upright and the older dentists listed to one side—and the older they were the more they listed.  Many doctors I spoke to were in pain, some obvious (limping or bent over) and some not (trying to ignore their pain)—most of their pain was unnecessary.

Pain, even chronic debilitating pain can be resolved or avoided.  Simple daily exercises can help you avoid pain by strengthening your muscles to keep them from becoming fatigued.  Unfortunately, most people would rather live with occasional pain and not do the exercises until the pain becomes chronic.  I asked one client at the AAO meeting how his decades of chronic back pain was doing and he said that he is doing well now that he does my daily “Back Wellness Program” exercises.  Another client limped up to my booth with obvious right hip pain he had been suffering for days.  I showed him where the trigger point was and how to massage it, which relieved the pain.  His comment was “this may just be the best reason to came to this meeting”.

If you have chronic lower center back pain, you may want to learn simple daily exercises to avoid painful episodes—get the “Back Wellness Kit”.

If you have chronic or occasional hip, leg or foot pain, you may want to learn how to remove the trigger points that cause that pain—get the “Trigger Point Therapy Workbook, 3rd Edition”.  This workbook may just be the best reference you ever bought—it was for me!

You do NOT have to live with chronic or even occasional pain.  I use to have gout episodes that lasted for months, causing excruciating pain.  I now use Trigger Point Therapy at the first sign of pain and eliminate the episode altogether (I lived with it for two years before I figured it out—Trigger Point Therapy was the key).

Is your receptionist a strong relator who establishes rapport (trust) with all patients?  Is your receptionist a weak director who finds it difficult to follow your schedule?  Typically, this is a package deal, but this pearl can help you to reconcile this dilemma.

It is not easy to create a great schedule that is smooth and productive, but it can be done.

It is not easy finding a receptionist (scheduling coordinator) who can control that schedule without messing it up, but it can be done.

Unfortunately, the kind of receptionist that establishes rapport (who the patient's trust to give them the right appointment) is typically not the best personality to control the schedule.  But, this can be resolved if she learns why she acts the way she does and then establishes procedures to overcome her weaknesses.

See the attached PDF for an understanding of the problem and what you can do to resolve it.

If you want to hire the best receptionist...

If you want to create the ideal schedule...

Have you ever hired a consultant?  If so, were you satisfied with the outcome?  Was the outcome worth your time and expense?  If not, maybe this pearl can help you to better select your next consultant.

What is a consultant?  He/she is an expert—knowledgeable and highly experienced—in the systems you want, but find difficult to create and implement on your own.  Lets face it, any consultant can help a disorganized practice somewhat, but it takes an expert to provide lasting results.

What can a consultant help you with?  A consultant may have expertise in one or in many areas, to help you to:

1.  Organize & Hire your team (if your staffing is not optimal)

2.  Schedule your team (if your days are not smooth, productive, and low stress)

3.  Create a TC Program (if you are not attracting or converting exam patients effectively)

4.  Create a Team Training Program (if staff training is incomplete or takes too long)

5.  Access your Entire Market (if you don’t have enough DDS or patient referrals)

6.  Practice Transition (if you want a partnership or to retire)

7.  Create a better Office Layout (if your practice is outgrowing your facility or it isn’t attracting patients)

8.  Other areas such as: Goal Attaining, Inventory Control, OSHA & HIPAA, computer utilization, etc.

If you need help in numerous areas, make sure that your consultant can help in all desired areas or can at least refer you to someone who can help you where they lack expertise.

When considering a consultant, account for the following: 

1.  Whether they have the required expertise (they should be able to give you a call list of previous clients)

2.  Exactly what they will provide you with, according to what schedule, and for what price.

3.  The written or electronic materials (systems) they will provide your team members with and train them in.

4.  Their follow-up after a visit to make sure that what they provide you with, lasts.

5.  A report after each visit indicating what was accomplished with whom, what each must do to make sure the install systems last, and what still needs to be accomplished.

6.  A payment plan that coincides with the services provided; be wary of consultants who want it all up front…and make sure that the fee is a reasonable investment in your future!

Refer to the attached PDF “Minimal Standards for Orthodontic Consultants” for a better understanding of what services you should get for your investment in time and money.

Have you tried using Indirect Bonding?  Do you think that it might be a good Idea?  Do you think that it saves DR-Tx-Time in your schedule?  If not sure, maybe this pearl can help.

Indirect bonding isn’t for everybody—some do very well with it and some can't seem to make it work.  So let's look into what might make it work or not.  Most people get into indirect bonding because they feel it will save them chairtime and Dr-Tx-Time in their daily schedule—you may be surprised at what actually is the case.

The average doctor can direct bond one arch in 8 to 15 minutes.  I can take up to 15 minutes if the doctor does every step after the surface prep to the selection of archwires.  It will take less Dr-Tx-Time if the DA places the brackets and the doctor finalizes the positions and gives a light tack before leaving the chair.  It is important to keep ambient light from setting the bonding agent while working on the patient.  Some doctors (where it is legal) allow an experienced DA to bond and light tack or light cure the arches and then the doctor re-bonds any brackets needing it.

The average doctor can indirect bond one arch in 3 to 7 minutes.  I can take up to 7 minutes if the doctor inserts the tray and holds it until ready to light cure.  It will take less Dr-Tx-Time if the DA holds the tray in place until ready to light cure.  It takes even less overall time if the doctor does both U&L arches with one trip to the chair.

Another key is to have a tray stiff enough to hold the brackets in place, yet flexible enough to allow for removal of the tray without tearing the brackets off or shifting their positions.  This is where an excellent lab comes into place.  Frankly, I find that most doctors are not that thrilled with outside lab setups, especially those companies that offer a "system" for indirect bracketing and archwires.

So, to save yourself chairtime and Dr-Tx-Time you need a great lab doing your indirect trays and an effective procedure for delivering those trays at the initial appliance insertion visit.  And an in-house lab with an experiences lab tech seems to be the way to achieve this.  But this is not easy to accomplish and the minor savings of 10-15 minutes of DrTx-Time at the initial appliance visit can cost you a great deal in lost chairtime, Dr-Tx-Time and extended Tx time for your starts.

Most doctors don't consider the consequences of a "non-ideal" bracket placement from indirect bonding or inaccurate direct bonding.  Every practice I work with either does one re-bonding of 1-4 brackets during treatment (usually when bonding/banding the 7's) on at least 50% of their full starts.  Some practices schedule it on all of their full starts just to be sure.  And some practices do it more than once, especially if they have not perfected their indirect bonding technique.  Of course, not all brackets can be perfectly placed with crowded cases and need to be re-bonded later.

Unfortunately, whether doing direct or indirect bonding, too many of today's ortho-graduates have not been sufficiently taught how to bend wire and end up doing many re-bondings...this a waste of Dr-Time, chair-time and extends treatment time.  My advice for these graduates is to learn how to bend wire so that numerous 10- to 20-minute appointments don't turn into 40- to 60-minute appointments.  Or, they can learn how to bond perfectly on the initial appliance insertion; a good philosophy for all practitioners.

Bottom line, unless you bond perfectly, the chairtime saved (20-40 minutes) and Dr-Tx-Time saved (10-15 minutes) with indirect bonding may turn into hours of lost chairtime, much more Dr-Tx-Time and the extension of overall treatment time.

Are all of your SDS (Safety Data Sheets) and Labeling up to date as of June 2015?  Have your team members been trained on the new SDS and labeling elements?  If not, maybe this pearl can help.

Even though the revised SDS and Labeling formats were suppose to be in place on June 1, 2015, I still get inquiries about it.  The attached "OSHA SDS & LABEL Changes" PDF describes the SDS and Label formats, along with a sample of a label and the new SDS at the end.

This team training management pearl was also created to update your OSHA training to account for the new SDS and Labeling formats and to make you aware that this training must be completed before new employees can be exposed to hazards.

If you already have a copy of "The Environmental Safety Handbook" (ESH) for installing your OSHA programs and instantly teaching new team members, download the "Revised Environmental Safety Handbook Pages for OSHA SDSs & Labeling" pdf, print the revised pages, and insert them into your ESH binder, replacing outdated pages.    If you like, you can request a pdf of the revised "OSHA Training Workbook" to print out as many workbooks as you need for your ESH (send your request to This email address is being protected from spambots. You need JavaScript enabled to view it.).

If you would like a copy of  "The Environmental Safety Handbook" to enhance your OSHA training, clich HERE.  Use the Coupon Code: ESH-65 by April 30th to get a $65 discount on your ESH purchase.

Is your New Patient Exam all that it could be?  Are your new patients singing your praises and sending you referrals?  Are your exam conversion rates as high as they should be?  If not, this pearl may help.

Lets face it, making system changes in your practice isn’t typically met with great staff zeal.  But if your team is a part of the entire process, your success is more probable.

Sooo...Analyze the attachments below to see how the A~D~D~I~C~T straightforward approach works, Decide how you want to improve your TC Programs, Design your TC Programs to fit your needs, Implement your TC Program designs, Critique the effectiveness of your TC Programs, and Tweak what needs to be improved.

Obtain your "New Patient Experience Management Kit" to install your MAJOR TC programs.

Use the TC Management Pearls to create your TC sub-systems that support your major TC programs (see attached PDF for listing).

Refer to the attached PDF to learn about the nine A~D~D~I~C~T MAJOR practice systems and their dozens of supporting sub-systems.

Obtain your A~D~D~I~C~T straightforward guide to "Self-Optimize Your Entire Practice"

Do you have balance problems from an acoustic neuroma?

Are you less “athletically graceful” nowadays than you were in the past?  Do you have more “senior moments” than you would like?  If so, your 6th sense (somatosensory system) may be out of wack and needs resetting.  This pearl can help you to reset it.

Your somatosensory system coordinates your entire neuromuscular system, allowing you to do your daily tasks as accurately and efficiently as possible.  It also has an affect on your memory.  With injury or as a consequence of aging, your somatosensory system tends to falter, causing imbalance or injury and unnecessary “senior moments".  The cerebellum mainly controls this system—if the cerebellum is out of wack so is your entire body, including your memory,  since the cerebellar static in your brain makes it more difficult to access memories.

After an acoustic neuroma destroyed my balance 17 years ago, my somatosensory system was a mess.  My cerebellum worked overtime to regain my balance, but was getting nowhere.  It also caused a lot of “static” in my brain, messing up my memory (which is common in people with acoustic neuromas).  Research other than my own, also shows that one's memory after doing balance exercises is better than it was before.

A simple set of exercises (see the attached) done once a month can create a healthier 6th sense and improve your memory.  These exercises independently reset the three planes (your semi-circular canals) that activate your cerebellum allowing it to reset.  Once all three planes are independently reset, they work together interdependently to improve your coordination and memory.  When I am not as agile as I was as a gymnast, I do these exercises to regain my coordination and as a bonus, my memory is immediately improved, there is no reason why yours can't be.

The PDF attachment details the exercises; the video gives an example of doing half of the exercises.

Does your TC establish rapport and provide a great exam that new patients like.  But, does she seem to have difficulty "closing the sale" (i.e., she has too many Will-Call-Back patients)?  If so, it may be you and/or the TC's personality dilemma that is reducing your starts.  This pearl can help you clear that up.

The first thing that may need cleaning up is the doctor’s comments to the patient/family at the exam.  I can’t count how many times a TC has told me “I had them all set to start and the doctor came in and told them to "go home and think about it'”.  Bad idea doc; they want to start...now…not go home and think about it.  To tell them to go home basically tells them "we don't want to treat you".

The next thing that gets in the way of new patients starting is the typical TC personality.  A TC must be able to inspire the patient/family and get them excited about treatment.  This is automatically accomplished if she has a strong socializer style.  A TC also has to be able to establish rapport (have the patient/family trust her).  This is automatically accomplished if she has a strong relator style.

And finally, the TC must be able to “close the sale” (get them into records or starting appointments).  This is accomplished if her “get-it-done” director style is not too weak.  Here lies the rub—most TC’s with strong socializer and relator styles have a weak to very weak director style.  But there is a way to get around this—see the attached PDF. 

If you need to hire the best TC for your practice, you might find the "Organization & Hiring Management Kit" will get you there quicker and cheaper.

If you want to have the best TC program possible, you might fine the "New Pt. Experience TC Programs Management Kit" very helpful.

Do your SOS & Emergencies Failures seem high (more than 5/day)?  Do your Missed and Cancelled appointments seem high (more than 8/day)?  Are you, or are your patients the cause of this?  Maybe this pearl can help you figure it out.

SOS patients (who show up to their appointment with a problem) and Emergency patients (who have a problem, but no appointment) not only wastes time and resources, it messes up a smooth, productive treatment day.  There is no way to eliminate these occurrences—neither your patients nor your team are perfect—but there is a way to reduce the daily number of SOS and Emergency appointments.  Refer to the attached PDF.

Failure patients (who miss their appointments that treatment day) and Cancellation patients (who change their appointments before that treatment day) creates holes in your treatment day, again wasting time and resources and extending patient treatment time (run-ons).  Again, there is no way to eliminate these occurrences, but there is a way to reduce the daily number of failed and cancelled appointments.  Refer to the attached PDF.