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The Digital Diagnosis: A Business Plan for Turning Technology Into Smiles

Yikes! How will I ever be able to tell Mrs. Jones that I'll have to retake her x-ray? The film has turned out dark! That darn processor. The chemicals must have been too hot or is it too cold...or too old? Oh, I can never remember! Perhaps we have a light leak in the darkroom.

To make matters even worse, Mrs. Jones didn't initially want to have an x-ray. Although she presented to our office following an emergency call today (throbbing toothache on a mandibular first molar), her first concern was regarding the safety of dental x-ray radiation levels.

This is very likely to be a common scenario in your dental office, particularly if yours is one of the thousands of offices across the United States that is still using a film-based radiography system. Let's face it. Film-based radiography (especially when having to retake x-rays) can be a logistical nightmare. Working in a variety of dental practices for close to 15 years, I've been witness to, and admittedly sometimes a participant in, this travesty. Behind the scenes, the reading of poor-quality x-rays can bear more resemblance to a real estate negotiation than a reflection of co-diagnosis occurring among dentist, hygienist, and patient.

I remember how as a hygienist working in a traditional-modeled office, my team members and I had become somewhat proficient in attempted, but usually failed, pleas to our dentist to diagnose from botched films. Doctor, are you absolutely certain you can't see the interproximal decay through that horizontal overlap? We knew the answer to that request before he gave an answer, yet we really despised being the bearer of bad news to the patient, so it was worth the try. The bad news, as the team saw it, was not the diagnosis itself; it was that a retake of the x-ray would be necessary.

Fortunately, many of today's available digital dental technologies are making a dramatic impact on the diagnosis phase of dental care and cracking down on these logistical challenges that once plagued the profession. Going digital in terms of dental radiology means replacing the multitude of boxes of film that have amassed in dental offices around the world, stored in darkrooms, in refrigerators (often the same ones that are used for employee lunches), on shelves in stockrooms, and in drawers in operatories. Rid the profession of film packs (single, double, extraoral), roller transport cleaning, and best of all, the duplicating type! All is replaced with a single, portable, electronic item via implementation of a digital system. Gone is the necessity for a darkroom, messy chemicals, x-ray mounts, and the tedious process of waiting for films to develop.

Utilizing this technology, a sensor pad that is responsible for capturing the image is positioned inside the patients mouth. The sensor is analogous in size and shape to a size 2 dental film, is positioned similarly, and utilizes a holder that closely resembles a standard film holder. The process of dental tube-head positioning is also identical, however, radiation levels used in a digital system may be reduced up to 90%. Thats good policy from the point of view of our health-conscious patients. Rather than what often turns into a confrontation regarding the issue of radiation levels with our patients, we dental professionals are actually able to validate the patients concerns and assure the patients of a higher standard of care in the practice via the digital system.

Following sensor positioning and upon release of the exposure button, the image is displayed nearly instantaneously on a computer screen inside the operatory. Since the sensor is intraorally universal, retakes or exposing a series of x-rays are a breeze, rendering the previous film-based logistical nightmare a thing of the past. One simply repositions the sensor at the next appropriate location, without having to remove the sensor from the patients mouth, and the exposure process may then be repeated. Depending on the particular software, all images automatically appear on the screen precisely mounted and accurately spatially oriented. Average time for a FMX from the point of initial image capture to full development and mount is well under 10 minutes. Additionally, x-rays are stored on the computer system in a digital patient chart for future use, and when copies are needed, they can be quickly printed onto paper at any time.

An office that has implemented a networking multi-computer arrangement will realize the additional benefit of electronic image sharing, where the exposed image(s) may be projected onto any number of screens throughout the office. However, without doubt, the single greatest benefit of digital images projected onto a screen is the facilitation of patient understanding and ownership of particular conditions or pathologies. Patients having such improved diagnostic   insight (visual education) are much more highly motivated to accept the treatment recommendations of the dentist or dental hygienist.

Digital radiography is only one example among a wide range of other digital dental technologies commonly implemented to assist with the diagnostic patient education process that occurs in todays dental practices. Other examples in-clude digital caries detectors and calculus detectors, digital periodontal probes, endodontic apex locators, digital imaging fiber optic transillumination (Difoti), digital intraoral and extraoral cameras, endodontic microscopes, and digital imaging smile design software, just to name a few. These technologies, like digital x-rays, are also serving to narrow the gap in the diagnostic abyss: that is, the space and time in which dental problems commonly go undetected those existing below a threshold that can be recognized by naked eye or by conventional standards of diagnostic equipment or materials. It is easily recognizable how todays dental technology has influenced the diagnostic aspect of our profession, as evidenced by the capability to enlarge a size 2 film radiograph onto an entire computer screen, to adjust the contrasts manually for maximum clarity, and to create virtual notes or measurements on the images, indicating areas to watch or to record for future insurance or referral reference. Tricky incipient decay (for which teenagers are infamous) that once required squinting, perfect backlighting, and a satisfactory radiographic history in order to definitively diagnose now becomes the size of a babys fist with the zoom feature found in todays digital x-ray systems. Time-concerned patients are thrilled to be offered a more efficient and definitive process of care, and from a hygienists point of view (I am particularly concerned with diagnosis and prevention), what a benefit!

As dental professionals, we are fortunate to work within an industry that not only offers, but mandates, continuous opportunities to learn and grow. It is common that we experience periodic personal changes regarding our view of the profession. I remember undergoing a vision shift regarding the model by which I practiced dental hygiene as it relates to the available digital radiographic technology. For some time, fresh out of hygiene school, I had been perfectly content (except for those pesky retakes) with a film-based radiography system. In parallel custom, my mission for hygiene care was rather traditional. It encompassed the delivery of high-quality, long-lasting therapies.

Through continuing education and ongoing professional/patient interactions, I began to aspire toward a more sophisticated hygiene goal. My dental hygiene purpose evolved to one of learning the safe and effective use of the available digital x-ray technology in order to motivate my patients to accept and desire the superior level of excellent care that I was able to offer. My paradigm shift meant that I preferred to have my hygiene care be something that I performed for my patients rather than to my patients.

All well and good, but a hygienist is certainly not in the actual position to purchase and implement the technology to realize such a goal. Further, as you reflect on your own practices diagnostic needs and dental care delivery mission, you may be feeling about your office as I once did about mine. There is no way that my doctor would ever go for it make that kind of investment? It's just too expensive! Almost every dental team to whom I am introduced that has recently acquired a digital radiographic system shares a similar reminiscence with me. My advice to those who feel this way is not to be so quick to assume. Rather than allowing this inner voice of disbelief to suppress your desires and professional ideas, embrace it as a vehicle for change. Listen for the subtle, subconscious message as if this inner voice were a riddle; bear in mind the deeper meaning that is held for you.

I have had positive and action-oriented results  by following this simple strategy. Also, I have recommended it as a fantastic reparative technique to fellow hygienists afflicted with the quite common syndrome of hygiene burnout. Quite frankly, my motivation for writing this article has been based on my passionate belief in the universal, often-hidden ability possessed by dental hygienists to influence larger business changes than customarily are thought to be within the realm of the job description. Moreover, any office that incorporates digital technology upgrades such as a digital x-ray system without first having visualized a greater appreciation for the new practice model that is sure to ensue would not realize the full benefit of such an investment. As it has been said long before. Fail to plan and you plan to fail.

Any willing dental hygienist, by first granting the inner voice permission to power a professional philosophy evolution and second by thinking like a dentist-employer (careful consideration for the employer investment), will be appropriately empowered to devise a feasible, solid business plan. This plan supports technology adoption in lieu of the ever-changing patient care missions seen today. Once I had become concrete and tangible in my hygiene vision and was able to draw a relationship to my digital technology aspirations, my brain rather easily formulated the solution, which was a written business plan for gaining my dentists buy-in for this newly found religion of mine.

Dental hygienists, let me assure you, we are in a perfect position to partner with our dentist(s) in this regard. We, doctor and hygienist, who provide treatment services to mutual patients, are ideally suited to align our care beliefs, professional values, motivations, and overall dental business protocols. Only when performing as formidable allies collaborating on such decisions are we truly destined for successful long-term outcomes for ourselves, as well as for our patients.

Upon sharing my business plan for a digital radiographic system, I actually discovered that I had been incorrect in my previous assumptions that my dentist would never go for it. Rather, I uncovered clear financial evidence supportive of implementing digital radiology into our practice, which led to my dentists decision that he would not wait on it.


A business plan for any dental practice change must involve 5 basic components: introduction, summary, body, forecasting projections, and an appendix. The introduction should include background information regarding present treatment modalities and the reason(s) why a new system is under investigation. This addresses the strengths and weaknesses of the current approach, plus considers the threats of stagnant behavior and the realized opportunities expected via system change. In the summary, new system goals and objectives for both providers and patients are outlined. Overall, the components of the summary serve to provide the rationale for creating a well-documented business plan and an overall sense of the business focus and development direction. A strong, goal-oriented opening will act as the benchmark by which the end result can be evaluated and measured.

Graph. Cost Components Associated With Dental Radiography.
This graph represents summary data based on the authors study of radiographic costs. Actual cost comparisons between film and digital radiography may vary in individual dental practices.

As expected, the body of the plan acts as the meat of the document. In its bulk, financial factors for such a system are appraised. At this point, productivity of the system has already been established through a well-written introduction and summary. Therefore, one must concentrate this evidence on profitability. This may include a study of the associated costs of the current system against the desired, upgraded system. In the case of dental equipment, the following costs are attributed: fixed, variable, and operatory. Both film-based and digital radiology systems have associated fixed costs (initial equipment purchase price and/or space dedication) and variable costs (ongoing and/or product support). In my study, I discovered that a digital system is significantly lower in both these costs compared to a film-based system. You may find in your office, depending on your space configuration and technology needs, that only one of these cost types is lower for a digital system. Digital radiography is theoretically instantaneous in nature; there are no associated operatory costs at all. As such, operatory costs  exist only for a film-based system (Graph).

Operatory costs are those that are incurred when an operatory is allocated to a particular patient but no treatment can be performed (occurring during lag times while diagnostic film undergoes processing). These costs place a particularly heavy burden on the profitability of endodontic procedures and are often the sole factor in the profit margin of a digital system in this specialtys practice. The body of the business plan also encompasses other similar business development areas legal, marketing, case presentation, and treatment (sales) issues.

Concluding remarks of the business plan should provide forecasted results and references for the consideration of the specific available systems. Forecasting results for the complete business plan can facilitate the security that is required for an employer to obtain third-party financing or create a realistic internal funding strategy. This step must never be overlooked and must be realistic. Much of the required financial data may be gathered from dental technology articles, trade shows, and the Web sites of major dental technology manufacturers. Forecasting is crucial if the hygienist is to gain the dentist-employers consideration of the plan.



These are exciting times in our profession; traditional private dental practices are transforming to high-tech healthcare epicenters before our very eyes! In order to keep pace with the ever-changing patient demands and expectations presented to us in todays world, we hygienists have the chance to hone the planning skills that for years have been cultivated solely for the purpose of treatment planning and to sharpen these talents into business-planning acumen. Technological advances may arguably be the most influential driving force behind the evolving concept of the dental visit. Implementing some of todays digital technology options into the dental office means a new realization of the dental visit, from one that was once a dreaded patient encounter to one that is informative, painless, and quick, and therefore quite pleasant from our patients point of view.

From the providers perspective, the x-factor of co-diagnosis can readily be achieved. We know that our patients do place the greatest critical value on those emotions experienced while in a dental office as a way to judge the quality of a particular office or provider. Illustrating this fact is the determination that patients are most apt to measure the quality of care that they receive less by the clinical integrity of the service and more by the customer service skills of the dental provider. With these quickly transforming patient care values, dental hygienists must keep pace in our role as patient advocate and treatment plan facilitator; the time has come to add a new, business-planning  feather to our caps!



Well, Mrs. Jones, I'm glad you shared with me your concern for the radiation levels that are used today in dental x-rays. I can tell from your question that you are concerned with your overall health, as are we! We are pleased to be able to offer you digital technology in this office, which addresses that exact concern on all levels. Allow me to explain...

Now, let's go ahead, take a picture, and see whats going on with that tooth that is bothering you!

Who has the bigger smile at this point the patient, or me, the provider?

Ms. Close attributes her expertise regarding the business and technology aspects of dental hygiene to her diverse experiences for 15 years in the dental field, including dental assisting, practice management, and clinical dental hygiene. Currently, she functions as corporate hygiene administrator for Coast Dental, working with more than 100 dental teams across 4 states as well as serving as a Northeast/Southeast regional DEXIS instructor. She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

Disclosure: Ms. Close works as an independent contractor for DEXIS.

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