The Digital Age and Image of Dentistry

Dentistry Today


The second time is a charm, the old saying goes. After experiencing burnout and selling my business a few years ago, I wanted to make sure that my second practice, Andover Smiles, was the practice of my dreams. I accomplished this by including all the latest technologies (Figure), making it completely paperless, and attracting patients who wanted high-quality dentistry and were willing to pay for it. I needed it to be fun and exciting, as well as educational for me, my staff, and our patients.
We are hearing, seeing, and reading so much about electronic medical records in hospitals and physicians’ offices that a lot of the marketing and groundwork has been laid for us. Our patients’ expectations based on this information have raised the bar, meaning that a digital office should and will become the standard. Patients’ main concern is for their records to be available quickly and easily. Technology has improved diagnostic capabilities, and we can now better educate patients about their situation. They can understand more fully what treatment modalities are available and why they will benefit from these procedures. In recent months, several new patients have mentioned that they left their previous dentists not because of a bad experience, but because of a lack of technology.
I recently was at a meeting and was involved in lengthy and in-depth discussions with many doctors. I discovered firsthand how confusing it can be for doctors and their staff members to make a decision as it relates to technology integration. They frequently asked me, “What is the most logical process of implementation?” Cost obviously is a factor, as well as concerns about ease of use and staff acceptance.

Figure. The author is pictured using Voice Recognition Periodontal Probing.


I feel that the backbone of a digital/paperless office is the practice management software. I utilized Patterson EagleSoft (Patterson Dental) at my first practice in Rhode Island. I was very happy with it and continue to use it today. The second time around I also wanted Patterson EagleSoft clinical software in the treatment rooms to increase my efficiency, productivity, and profitability. It’s important to speak to a company that understands the hardware considerations such as speed, storage capacity, and proper integration with all the different components.
Chairside clinical software is gaining acceptance and being installed in dental practices across the United States. As the number of computers placed in treatment rooms increases, so does clinical software implementation. The driving force behind more practices placing computers in treatment rooms is digital radiography. Once the investment has been made and computers are in the room, the next logical step is clinical software.
The advantages of clinical software are many, and its implementation should not be dictated by the decision to purchase a digital radiography system. It creates so many efficiencies and provides so many benefits to a dental practice that the sooner practices adopt this technology, the better off they will be.
Let’s use the typical recare appointment as an example. The patient comes in for a usual 3-, 4-, or 6-month interval hygiene appointment. He or she has no restorative concerns, has dental insurance that pays 100% for preventive treatment, and has no outstanding balance. All that is needed is another recare appointment, which the hygienist can quickly schedule. In addition to scheduling the next appointment, the walkout can be completed at the same time from the treatment room. This eliminates the need for the patient to stop at the front desk, making him or her happy because there is no waiting. This also makes the front desk less stressful for staff members, who are busy dealing with other patients and the phone at the same time. Anything that lightens their load makes for a much happier front desk staff and a less stressed doctor.
Patients in need of restorative treatment have a different scenario. The doctor calls out a tooth number and procedure, and the hygienist clicks on the tooth and a quick-pick button to choose a procedure for that tooth. This process is replicated for additional work. The treatment plan is completed, printed at the front desk, and given to the patient, informing him or her of the financial responsibility for the next appointment. This virtually eliminates patients saying, “I wasn’t told I owed money today,” and the like. The procedures the hygienist completes are entered into the computer for the front desk person, eliminating procedure code entry by front desk staff. The restorative procedure is scheduled, and checkout and payment is quick and efficient.
Also, treatment plans entered are now easily available when reports are processed. As an example, the codes for all porcelain restorations can be entered, and in seconds you will have the names and procedures for all patients with work planned but not completed. This allows the staff to fill any open times in the doctor’s schedule and make that schedule more profitable.


I chose to integrate clinical software and digital radiography at the same time. Patients are blown away by digital x-rays and the speed with which they are viewed. It has been 2 years since this integration, and my own excitement, as well as that of the patients, has not faded. Patients are amazed when they see decay, open margins, calculus buildup, and periodontal disease instantly on a 17-inch monitor. For patients, seeing is believing, and as a result they accept ownership of their “problems.” The patients also realize that the doctor is able to access and view their clinical information before they enter the treatment room, allowing the doctor to spend more time formulating an appropriate plan for the patient than just the  2 minutes spent during the hygiene check.
We are a society of instant gratification, and technology definitely gives us advantages. Because of this, case acceptance increases dramatically, as does productivity, referrals, and, most importantly, profitability. It offers improved diagnostics, time savings, a quick return on investment, and is earth-friendly. No more wasted time cleaning processors, paying for repairs, purchasing film and chemicals, soiling clothes, or losing films and upsetting patients because of retakes.
My A-dec intraoral digital camera is the next piece of the puzzle. It is part of the delivery system, so no cables run from the countertop to the patient. It is used on every single patient in my office in 2 ways. It is first used at the hygiene appointment as part of my examination process to aid in my diagnosis and once again to show the patient his or her problems. It is hard for patients to say no to treatment when they see large open margins. Also, patients understand why we are recommending porcelain restorations when they see the size of existing restorations. Secondly, my patients are always shown the decay under old restorations before they are removed. I have found that patients experience no discomfort on most teeth that we advise need restoring. Patients are asked to spend their time and money, and I want them to see their problem once again so there is no buyer’s remorse. Before-and-after photos definitely guarantee that the patient is happy with the result, and they usually instigate the desire to replace other silver restorations.
Extraoral digital photos are taken on all patients interested in smile make-overs. Allowing patients to see their teeth closeup on a large monitor allows me to address all of their cosmetic concerns. A lot of patients come in with an expectation of what needs to be done to improve their situation, but, as we all know, much more is usually involved than that. Discussing golden proportion, tooth angulation, gingival contouring, tooth position, and occlusion with patients is much easier when they are looking at their teeth magnified on a monitor. Before-and-after cases of my patients go a long way in showing what is possible with current materials and techniques. As a photographic novice, I have used both the Kodak 690 and Canon Power Shot A620 with very nice results.
The final piece to my puzzle is utilizing CAESY patient education systems (CAESY,  A Patterson Company), which  educate patients on what is involved with the desired treatment. They can watch the procedure for veneers, all-porcelain crowns and onlays, as well as periodontal treatment and many other treatment modalities. Each video is about 2 minutes long, which is a perfect amount of time to hold patients’ interest. With the CAESY Enterprise system, patients can leave with a DVD of their complete presentation to view in the comfort of their home and share with family members and friends.


Clinical software, digital radiography, and the CAESY patient education system equip the dental office with outstanding tools that ensure smooth and efficient operating procedures. These tools help provide education and comfort to patients who are faced with questions and decisions regarding their dental health. Once these technologies are integrated into the practice and the patients are educated about them, it is a perfect time to improve your level of service and raise your fees. If you are looking to reach a different segment of the population, specifically patients who appreciate a high-tech practice, then I would advise instituting an external marketing campaign as well. Most importantly, articulate the benefits of these technologies to your staff and patients every day as you utilize them to improve your business. Creating the “wow” factor and hearing “I’ve never had an experience like this at a dental office!” makes it all worthwhile.

Dr. Rinaldi graduated from Tufts School of Dental Medicine in 1987 and practiced in Cumberland, RI, for 13 years before experiencing burnout. He sold his practice and worked in technology within the dental industry for a short period. He moved with his family to Andover,  Mass, and opened Andover Smiles, the practice of his dreams, in May 2004. His practice is paperless and incorporates digital x-rays, intraoral cameras, CAESY patient education software, chairside clinical software, CEREC, and a hygienist-driven profit center using PreViser Periodontal Disease and Risk Assessment Software. He can be reached at (978) 475-9141 or by visiting