Production, Products, and Your Bottom Line

Dentistry Today


By now, you have attended several years’ worth of periodontal diagnosis/treatment courses and have implemented a successful conversion program to move your patients from routine prophy appointments to more comprehensive, nonsurgical periodontal treatment (where many should have been long ago). You can be forgiven for the delay in a more aggressive treatment philosophy, because change is difficult. However, if you have been effective, it’s because your staff members have been with you long enough for them to trust you, and for you to understand and trust them. The patients are accepting of your care and are good about returning for appointments. Your front desk staff members are capable and effective. So what’s the problem? As always, there is both good and bad news.

The good news is that your schedule is full with referrals from the hygiene department and with patients who finally realized that when you said “that tooth needs a crown,” it actually needed a crown. And, believe it or not, they are ready to pay! You are scheduled far enough in advance to keep your accountant happy and to pay the bills for your daughter’s college tuition. However, the bad news is that the additional revenue that began when patients were converted to periodontal treatment has flattened. Your hygienist has converted many of your long-time patients, and they are in maintenance phase. Your new-patient population still needs aggressive diagnosis and treatment, but the lucrative and long SRP appointments that were filling the schedule are now few and far between. On occasion, a 4342 will appear on a “healthy” patient, confusing you, the patient, and the insurance company, and forcing you to take time with everyone for another updated periodontal chart.

It is probably time for a meeting to discuss the possible next steps in your office evolution. Once you decide that you don’t have the time or the space to add providers, or the desire to add another “technological advance,” what can you look into for your patients, your practice, and your income stream? What about products?


Photograph by Nathan Zak

With the overwhelming number of dental products available in stores today, and the confusion about their use and efficacy, it is becoming more common for dental offices to have a selection of products that patients can purchase while in the office. An additional bonus is that your knowledgeable staff members (not a store clerk) can answer patients’ questions. I’m not suggesting that shelves of differing toothpastes, fluoride rinses, breath products, floss, electric toothbrushes, and whitening aids are necessary…I’m simply pointing out that when you work hard to educate your patients about their needs, some patients would rather purchase the recommended product from you, and some, when enamored with and confused by a product buffet, will pester you to death until you make the selection for them. Either way, it’s a win for the office, the patient, and your bottom line.

It’s not such a reach, after all. Haven’t you spent hours answering questions about toothpaste, toothbrushes, mouthwash, whitening, amalgams, composites, orthodontics, and veneers? Patients have come to trust your judgment. Relax, you aren’t selling. They are buying. Big difference!

“Recommending products based on a patient’s wants or needs is providing the ultimate in comprehensive dental care,” reports Lauren Key, vice president of marketing for Coast Dental Services, a dental service group with more than 100 offices based in Tampa, Fla. Our doctors and hygienists want to “help patients achieve a beautiful and a healthy smile.” Do you want anything different for your patients?

While it might have been a struggle at first to educate your patients about periodontal disease and its links to systemic illnesses, low-birthweight babies, possible issues with fertility, etc, if you’ve done it, then you have mastered a better communication style. More importantly, you believe in what you say. When you believe it, you can help patients make the link between what you do and what they need to do to stay healthy. Readying patients for product purchases has to be easier than telling them they have disease!

When I thought about products and patient care, the key for me was to adjust my philosophy to a wider focus. It’s not just scaling, polishing, and filling any more. There is so much more to attaining health. The focus is now on prevention, restoration, and a healthy mouth.

Let’s face it, your patients are going to buy healthcare aids from you or someone else. They are going to spend the money at your office or at a grocery store or pharmacy. If what you have to offer can make a difference in their lives, why not do it? You know them best. Their needs and wants are not in a vacuum.


It’s only fair to warn you that there is a significant difference between recommending products and recommending services. Treating a patient with locally applied antibiotics as a part of SRP is not the same as recommending a toothbrush or whitening system. However, the skills used to communicate the need for an antimicrobial treatment in a 6-mm pocket, or a better toothbrush, are similar.

 First, the patient has to trust you. Second, you and the rest of the staff have to believe totally in your recommendations. There is one office I work with where patients scheduled for placement of antibiotic therapy during scaling and root planing automatically receive the latest information downloaded from the American Academy of Periodontology  Web site ( The office manager prints it out daily and places it with the appropriate chart. The patients can read it while waiting or in the chair, or they can take it home. (The articles used to be laminated for patients to read while in the office, but they kept disappearing, like the recipe pages from Good Housekeeping magazine.) In this office, the whole staff has been educated and trained in the need for antibiotic therapy during SRP. They believe it, it works, and the patients know it. After SRP, the patients are placed on an antimicrobial rinse for 14 days, then fluoride until their next visit. It’s all a part of patient care in this practice.

Speaking of staff, it’s vital that all staff members are educated repeatedly during their employment. I was in an office recently where a new dental assistant was attempting to convince a patient that he should complete a chemoluminescent screening for oral cancer. She said something like this: “You don’t want to have this done today, do you?” Needless to say, the patient declined. It’s important that your staff understand that the focus is on the needs of the patient, not a product “sale.” Gaining the trust of the patient is the first step. Communicating the urgency is the second step. Understanding the “why” is vital.


How do you start with products in your office? Whitening systems are an easy way to link cosmetics and patient care. They come in every style and price range: strips, painton systems, tray systems, and in-office 1- to 2-hour whitening programs. For some patients, this is the beginning of a whole new view of dental care. They might entertain comprehensive restorative treatment once they begin to see themselves in a new way. Patients could start paying more attention to their smile with brighter, whiter teeth, which, in turn, might lead them to better home care, decreased risk of periodontal disease, and an understanding of why dental appointments are an important part of their overall health.

Whitening systems are the best way for patients to experience the beginning of comprehensive care. Once they are aware of their smile and its impact on others, they become sponges for treatment: misaligned teeth need veneers or orthodontics, old fillings need replacement, recall appointments are kept, and patients start to see what a healthy mouth looks and feels like. Besides, whitening is not hard to “sell.” It’s more likely to be “purchased,” and that makes it easier on everyone. It is quite honestly the easiest system to “sell,” because many hygienists, assistants, and doctors have tried it.

The popularity of “make-over” programs has raised the bar for dental awareness. That’s both good and bad news. The bad news about “makeover” programs is the disconnect between the actual time for treatment and the need for an immediate result for the sake of television. The need to collapse time for programming can be disillusioning for patients who think they can show up 24 hours in advance of their 20th high school reunion and be transformed overnight. However, since whitening is usually the start, it does get the ball rolling. By the way, why not whiten the teeth of all staff members, especially the front desk? That way, when the patients ask if it works, all your staff has to do is smile! No selling there!

Speaking of trying it, some of the success of the invisible braces occurs when patients see doctors, hygienists, or other staff members actually working and talking with the trays in their mouths. Last year, I spent time with an Atlanta general practitioner who had added this orthodontic treatment to his practice. On several occasions, I saw him remove his gloves and pull the orthodontic trays out of his mouth to show a potential patient. Now, while I don’t necessarily condone that, it was effective! If you piggyback the potential of that enthusiasm onto a whitening patient, can you imagine the effect on your present patients, your referral base, and your bottom line? Once again, you are the messenger. The patient is the buyer.


In-office availability of therapeutic products makes it easier for patients to comply with your treatment recommendations. If a better brushing system is important for healthy patients, it’s easy to have major electric/sonic toothbrush companies educate you on the value of their products. Confusion reigns between the popularity of sonic systems with their claims of biofilm disruption  and those of others with various “spin” technologies. Many patients will ask you which is the best system to buy, much like they did years ago with manual brushes. Since this is a personal decision for many practitioners, I will not speculate on the “best” for you and your patients. What I will say, however, is that right at that moment, the patient is willing to listen to your opinion on the product and make a rational choice. Clearly, any brush that induces patients to take better care of their teeth and oral health is the best one for them. It’s like exercise: run, swim, walk…it doesn’t matter, as long as you do it. If your patient uses a manual brush, flosses, and has great home care, the only inducement to purchase a power brush is that it might help make the teeth whiter or keep them white longer (manufacturer’s claims, not mine). Who knows, they might have been thinking about it for awhile and are ready to make a change!

Sometimes, the easiest way to conceptualize a sales technique is to understand that you have been doing it all along. When you review your charts daily before the morning huddle, you automatically decide who is in need of a new perio chart, x-rays, premedication prescriptions, special considerations, etc. If medical issues or medications contraindicate treatment of some kind, you are automatically thinking about the best care for your patient. You and your hygienist work hard to raise the awareness of your patients to improve their home care regimen. You remembered and prescribed fluoride treatments for adults with sensitivity and recession, sealants for children, bite guards for those who brux, clench, and grind, fluoride trays for patients undergoing radiation for head and neck cancers. Why not view products as an extension of your high level of care?

So what products can be offered? High-fluoride toothpastes and rinses, breath products, toothbrushes, at-home full and touch-up whitening kits, tongue scrapers, floss impregnated with fluoride, specific vitamin therapy, and much more. When you think of your patients and their care, which of these products is not connected? A patient who complains of bad breath may be in need of periodontal treatment and/or mouthwash. A child needing sealants, or one experiencing interproximal decay whose water supply is not fluoridated, would be well-served by a high-fluoride paste and/or rinse. There is no problem with a specific product when you tie it to specific needs.


Offering products ties back to the relationship you have established with your patients. If it is one of genuine care and concern, they will look to you to tell them what they need, and they will believe what you say. Your connection to products is an extension of your treatment and your treatment philosophy. Your patients are consumers with a broad knowledge of the marketplace. Products within your practice can be therapeutic, cosmetic, or both. By offering them, you are giving your patients an opportunity to choose and be educated by people who care.

Ms. Cary lives in Atlanta, where she works with more than 30 dental practices in the Georgia and Virginia area coaching, training, and mentoring hygienists to meet their clinical and professional goals. She can be reached for comment at