San Diego Dentistry Blog

Developing a Paperless Practice P8

Dr Lavine:  Ok thank you. Next question, how do you recommend to convert loss and paper chart practise with digital imaging?  I guess it got cut out here but practise management software as well. As i said  i think the first  step  is  choosing the orates e management  software  because we find that pretty much any good practise  management  software  would be  good in that category  can ridge  with any  third  party image  program . So the  important decision here  is  the  practise  management  software and the best  thing that your can  do  is to get them a  copy of your  data , have them do a data  conversion and know  ahead of time what  to expect. Honestly, we have seen this with literally hundreds of offices sometimes the data just can’t be converted well. It’s the old garbage in, garbage out. If you got  data that  is not perfectly clean you are  going to find that it is really a challenge  to get that  clean the way  that you want it to be  so often times we  are recommend that  people  will keep the old  software  running on a   couple of  front desk  computers and as  patients come in you manually put in their name, you manually put in their  balances. Is it a pain in the rear? Yes but within 9 – 12 months you can get the bulk of your patient population in your software. Again if  you can convert it great  that always the first choice but when you do that  test  conversion that’s a way to find out  and  if there is problems what the test  conversations you are  probably going to have  problems with the  final version as well  and  at that point. I would never say don’t get a software just because that company cannot convert your data because it may be problem with the software.

Here’s a question for Sheryl, i don’t think we are balking up to the Maxident. How do we go about that? Is there a fee?

SHERYL: They would call me > that probably the easiest way of doing it. There is a minimal fee because they pay for the space that they use.

Dr Lavine:  We do online back up for a list of our clients as well and we use a data system as well and they don’t give away that space for free. Usually it’s not a major expense.

SHERYL: Well worth it.

Dr Lavine:  How much time would a new office need to get up and running? I work with a lot of practises that hare start up practises and it’s a process. We usually recommend that you start the process a good 2 – 3 months head of time. If you have ETA and when you plan to be in that space working with a practise all the time. Right now there is a good friend  of  mine up in Toronto right now and you ideally want to get  as much  free  time as you can because there is so  much  decision  that you have to make ,  not just the  practise management software , even  just the technology that we talked about  but everything  . The archetypal designs, the plumbing to the electrical. It just takes a long time. You’ve got the permit that has to be use. You have some state and provinces that are a lot better than others and you can get that together. Definitely start as early as you can.

I have medical companies that scan charts that cost very high, they charge per box.  Charts can be scanned in by third party. Our company found out what they do charge an armour. That why i wished that have the funds, the time to do something like this t make it low cost .What if someone can buck of a chart. A buck a chart would be a great idea for a business model.

Why is Debus a problem for Maxident? I can answer that  one because it’s not a problem with Maxident. It’s a problem with App Tricks. Sheryl in Canada can you use Dexus with Maxident scanner?

SHERYL: No and it’s a limitation of Dexus.

Dr Lavine:  Dexus is a very fine censor, please don’t get me   wrong. They are a great  censor .We’ve  got a lot of  people  using the  censor  but it tends to be a relatively i proprietary  system  so it’s  not going to work  with the Maxident software  directly or App Tricks or  pretty much any  third party software . It works really well with their software. It does work with the version of the Mac software in the States only in the military. I’m not sure I’m not sure if you are in the military. If you are not then that’s out of the question then you are out of luck.

We’ve got a couple of comments here. Any recommendations for a reasonable price digital panel? Absolutely, there’s a lot of good ones out there.  Probably my favourite right now j is the company that’s based into the US by 99%. You can get them out in Canada as well. It’s called Panoramic Corporation. What they have done is they have taken some of their used films and occasionally refurbished them and fit them with the censor. So the  image  quality  is as  good as  a  new Machine  because the censor  is  dictating image  quality . They also have get digitized existing pens as you already got that. The thing that I find most attractive about that is the prices. That most of the new digital pens out there are still in the $30 000- $35 000 range. The PC1000 requisite that we installed for a number of practises it comes with everything. The pen , the  computer, the software , shipping , installation , training , warranty , everything  for  $92 000.00 so  it’s a really great bargain . Certainly that my favourite system that we can recommend right now.

Other good ones that are out there. Gender 8500, the Plan Meca Pro 1, the instrument is a great unit. So ones are priced a little bit more but both of those are really good pieces. Any experience with I5 or reporting digital images to form your camera to your computer station. I played around with the I5 for those of you who aren’t familiar with it. Everyone cows with a digital camera you have like a little memory card and the way that you normally get that memory card to the computer is that you would put the mommy card into a reader and then copy that on. It’s basically seen as another hard drive   computer so you copy it over and then bring it to your software.

The I5 is memory card that would wirelessly transmit images right to your computer screen. Two reasons why I would not recommend is that it’s slow. You’re doing Wi-Fi___33 for some large image file. It’s going to be slow. They are probably not aware   of the I5 working with any dental image file. So you are going to have to put on your desktop first and then cut and paste it into the software. I think it’s just adding an extra step. So will not recommend something like that. Who knows what’s going to happen over the next few years.

Here’s another question. The dentist I work for say that all practises have to go paper less within a certain period of time. True there is a deadline. I know a number of you may not be on for the presentation for the first 5 minutes or so. In the US there is a schedule mandate that we need to be chartless or paperless by the end of the year 2014. Will that actually happen anyone can guess?  The reason that i am recommended it is two things. Number one I think insurance companies are probably ought to be the one that dictates what happens. At some point they are going to start taking film and stop taking paper claims.  I also think this is peer pressure. I mean more and more office are paperless and chartless and it’s an efficient standpoint. There a lot of reason to consider going towards a chartless or paperless environment. The reason why I would  be a lot more cautious  to this is if you have  sales  reps that comes in and say  you have to get  digital x rays  , you go to get  it And have to get it by 2014  that’s not 100% accurate. Don’t fall into some of these strong sale pitches.  I don’t necessarily believe in the case.

What’s a good imaging software and a good value for you money.  Certainly the one that Maxident sells with the app tricks software. It pretty much works with anyone out there. There is another one XDR. My god there is so many. I tend to be a  fan  of the  one that Maxident  uses , the  app tricks  , the XDR because  I really like  open ended image software. I think that people should have the ability to pick and choose their   censors, their cameras, their foster plate system, their scanners, their digital cameras and have them all working together.

So that’s why i tend to like those types of programs and that would be my recommendation.  Believe it or not we are out of time and pretty much out of question .We’ve got a few more here. What’s your   recommendation for your number and location of monitors to record in an operator?  I would say  probably  80%-85%  of the offices that we have set up in the  last  number of  years have gone  dual screen , two screens . One for the patient often time coming from the ceiling or a light bulb that   is going to show them images, show them patient education. If you want them to watch a DVD or TV fine. One that is going to be behind the patient. It’s for use by the dentist. I think you can pretty much do everything you want with   2 monitors.

We have more and more offices that we are working with that are going 3 monitors, 4 monitors. Honestly from an IT stand point they are a night mare. The quad carts that are out there that can handle three or four models are not easy to deal it. More often than that we get a call from the office on   regular basis that will say we can’t find out images on our monitor. I text them as say well do if you look on your other monitor’s get really confusing to kind of deal with multiple monitors. I typically recommend 2 monitors. I think that’s definitely fine.

What was the name of the Micro Tech? I think it was called the Media scanner. I am going to do a research on that and when I send the list I should have it on there. If I don’t for whatever reason and I’m going to put it on there to I will get to that. We are done. Sheryl is there anything else that you want to add at this point.

SHERYL: No not at this point.  If they have any questions on Maxi dents, conversion, it might be pricing option they can just give me a call directly. My number is … i don’t know if you are going to provide  that  but my number is 1800 -663-7199 and I’m extension 33 to  get my line direct .

Dr Lavine:  I don’t have that number. Do you want to go ahead and repeat that one more time?

SHERYL: 1800-633-7199 extension 33 or they can just email us at

Dr Lavine:  Ok. The other thing i should just mention to remind everybody as soon as you log out of the webinar you’re going to see a little skin that comes up. if you want me to  contact  youth any  additional question  or  just want to  set  up some time to talk . Again we don’t   change for that. if you definitely  want to hear  form Sheryl , for Maxident  sooner than later just  indicate that  on the  survey as well and  she will be in touch with you shortly . I want to thank everybody for joking. I think we had a great turn out, well over 100 people this evening. Some great question as well. We will send everybody more information about the upcoming webinars. The next one is in about 5 week on the infrastructure which i think is really critical. You can put computer software unless you got computer so that would be a god topic as well. Thank you everyone again for coming and the great questions and we will see you all again shortly.

Developing a Paperless Practice P7

SHERYL: For Ortho?

Dr Lavine:  Yes.

SHERYL: For Ortho contract filling or….

Dr Lavine:  Yes for imaging.

SHERYL: We penetrate orphan. Really any ortho imaging software that we can integrate with but for Ortha contracts and these other thing it’s already build in the software.

Dr Lavine:  Perfect. Thank you for that. I think I have already hint on this. What’s the best way to deal with people, charts and tons of data we have. It would take years to destroy them. It depends a little bit on your practise. Most of the practises that I work with really do not go into their progress notes on a regular basis. Maybe they want  to have the most recent  page of progress note but they the typically going back 5 or 6 years to remember what they did  or what their  progress  notes were. If you do practise like that then you are probably going to want to scan it in. As i said it’s not a fun job. I’ve always thought of great business model. I actually had a company that contacted me a couple of weeks ago.  Wouldn’t  it be great   if  you had  a company that had  like nan RV that went  around to the dental offices and come in on a Friday night and  would scan  all your charts for you over  the weekend, it would be an  hide  speed scanner and  by the time you came in  Monday morning it’s all done. I think you will see more and more companies doing that. What i would typically suggest is to scan in maybe the last page of progress notes. The other thing that you can do is to scan as patients are coming in. You don’t really want to scan an old chart from someone who hasn’t come in two years and you probably won’t see them for another 20 years. So what you can   do is the day before you can see the list of cases coming in and scanning those progress notes that you needed. It really just depends on your practise style. As  I said  you are going  to  find that it’s not just an  official  way to do things and  we’ve  had  people , office mangers tell them I would rather wait and do  something with that  so .

I got a recommendation here on another scanner that’s Xerox262 document. I’ve never even heard of that one so maybe you’ve got that. Thank you Doctor Bush for making that suggestions. Let’s go to the next one here.

Have I used any of the Anode smart pen system such as the deliria X paper or oxy paper? I’ve seen some of the trade shows. I have not used them yet. I think is an interesting concept. I don’t really want to comment on it at this point because i don’t know enough about them intelligently.

I think that purchasing iPad for patients so that they can vibe able to view their history forms prior to signature, do you know if iPad have it?  In Maxident Sheryl, do you guys work with the iPad yet?


Dr Lavine:  Actually where nay practise management software that can do that.  The  problem with an  iPad is that it’s basically like a iPhone on steroids because it  only  works with  applications that are  developed for an  apple  product . In our experience a number of practise management software companies are working on their iPad integration. I’m not even aware of any that have it yet.  Do you have anything else that you want to add Sheryl?

SHERYL: No, other than its coming. It’s been requested. So there is a plug in that apple has provided and that program is looking at integrating.

Dr Lavine:  Right. Ok here’s another question of you because we have one of your user on y here. I have Maxident already, shipped digital x-ray and [Inaudible] like a pen. How heard would it be to convert to completely paper?

SHERYL: Not hard at all. I guess that person can contact me directly.

Dr Lavine:  We have a 3 digital x-ray system with App Tricks but are not happy with the holes in the x-rays. What do you recommend as a replacement that works with App Tricks? There is a lot of good censors out there. One that we have had good luck with is one that is called E2V. Each of these are sold by a company called XDR and a few other companies. Many of you may not have heard of E2V because they in typically don’t sell directly to dentist, they sell it under other labels. So dentist in the past used to call it their image ray eye and Vere Tech used to call it their Accident Censors. Other companies like Mediadent haven’t sold that since. We’ve had really good luck with that one. There is another censor called the Amanda Censor that is available in Canada and the US. They have a brand new censor that is I believe they have one in Canada now called Vistio. It’s still going through FDA approval in the US so it’s not available yet but it has some promise as well. Again the beauty of the App Tricks system is that it works with every censor.  So really the best advice that I can  give you shopping for censors if  you already got the App Tricks software is have the rep come in and plug them in and take  all about  65 minutes of  both  drivers to get working and let your eyes help you to decide. Let them help you to tweak it and make sure that it’s you’re getting the best cost alignment. Have someone come in and if their censor can produce a better image quality then that may be the right cost for you.

If  i did  a start-up what’s  ball park I’m looking at in integrating the  various  technologies that  you have  presented  tonight ? Both initial cost and monthly. Now obviously this depends on number of factors. I can tell you that we work with a lot of start-up practises. The  typical practise that  we worked  with at getting practise management  software ,image  management , digital  x-ray , cameras, computers to grab all the apps, its not  a typical to have a  number  somewhere between  $40 000 kind  $ 55 000 .  That normal. We have some offices that are really going to be on as shoe string budget and that’s fine. We’ve also had large group practises that we’ve worked with that has gone beyond that. Solo practitioner if you budget for $50 000- $60 000 it probably won’t be a shock for you when you get the final deal. Obviously the ongoing monthly fees are going to depend on a number of factors. Whether  you  software  charges  a number of fees, whoever the  IT company is  going to offer  services as far  as maintenance and  networking monitoring and data  back up . All of that  have to  factored  in as well that’s why I would always recommend and  of Couse I am biased about this  but  i would  always  recommend working  with some  type  of technology consultant   that  you could  give you to the penny , here’s what  you are looking at  cost wise, the  initial cost is what you are looking at for a monthly cost  because that’s the way that you want to  go forward with  something like that .

Specific software for paediatric dentistry? Maxident can do mix dentistry cant it Sheryl?


Dr Lavine:  We found that there is not a lot out there that I would say is peso specific software.  We usually find that in most pedantic at least one that we are working with are getting their software in through general practise software and customise it for their patients.

So here’s another one. I recently purchased the Pedi scanner from MicroTech and i use it for dental x-rays. Well that’s great. I appreciate   giving me that feedback. There was a scanner from MicroTech years ago that we used to recommend called the MicroTech I800 and I900. One of the reasons why i loved that scanner is it was really inexpensive. It’s about $300 and the other ones we   are e looking at was   anywhere from $900 to $3000. MicroTech    the   less than North America market, a number of years but one of the attendees told me that they are back. That is another scanner that you can add. It’s called the Medi-Scanner and i will get more information about that as well.

There is another questions for Sheryl. How do your change incorrect default codes in Maxident chart? For ample MOD46 comes up as 2113.

SHERYL: I need to understand how old the charting program is. In the new charting program there is intelligence built not the system so it actually learns the dentistry that you do. If you do need to change a code there is one button called edit. Where you are able to go into there and edit the code. Once you set that it becomes your default all the time. Some are smart enough to reset itself based on the dentistry that your do in the office.

Dr Lavine:   So  if a program adds  features and  you already have a  third  party doing a separate data  base will that a problem? That’s really a challenge in decision. There is no easy answer here.  What  i understand the question to be is let’s  say that  you went out  and bought a third  party program because your current  management  software  didn’t have that feature and all of a sudden that software company now comes  up with  their  own module that’s integrated with  it . The questions is whether or not you should change. The answer is  in a lot  of  cases  I would  always  recommend  that there is  way to recommend it and  that’s  another reason why I am  a fan is that if there is a way to have the module  built  in, incorporated with the  practise management software its always going to be better. You don’t have to deal with bridges and it works fine .It just makes life a lot easier. The question is if you already had that information and third party program how easy will it be for the computer unit to get that stuff into the new module. In most cases it’s not that easy. What we normally suggest offices is just take a cut-off date. Here’s the day we are going to start using the model rather than the third party program. In some cases maybe you say that it can be converted in but in most cases it is not the case.

How many tablets do you recommend?  In most of your offices Sheryl how many tablets would you say to get. I assume they get them upfront and for sure but are people are putting in their operatory as well?

SHERYL: They are. If the dentistry is filling a prescriptions and he is using it to sign the prescription before he prints it or if he is electronically send it to a pharmacy he needs to have that. So the answer is it depends on that. Thetas not an easy answer I guess. But for sure reception. Sometimes you are planning a room and others in the operatory or the dentist office itself that’s always and issue with the prescription.

Developing a Paperless Practice P6

Really  every chart is different so what I recommend  if you are trying to figure out well how do I go chartless it’s  really not that hard. Go through your chart and take a list of every single system you got there. You’ve got your progress notes, your referral slips and patient in take forms. Less find a digital counterpart for them. I can help you with that, a lot of other people out there that do this for a living. As I said  it  sometimes can be a little bit overwhelming  especially when you are  dealing with some of these companies when they come and  say well if you are going to come in and get  our censors you got to get or practise name and   software  as well if you want to get an integrated solution.  You’re going to find that every system out there has pros and cons. What I normal recommend is that you take it one step at a time. There is always a way to get your image management software to work with your practise management software. We’ve not gotten any two systems that we couldn’t bridge one way or another. So make the decision based on that individual system and not try to do it all at once.

For the dentist on the webinar please involve your staff. Most of you do not have hands on day to day use of the software. They are  the ones who deal with it  every single day  so you are  if you are  going to look at a program like a Maxident,  if  your  are  going to  look at some other third  party program  that I talked about really make sure that the staff are part of that because  you want their  feedback because they hate  it. If they hate it you are just going to be miserable for years and it’s not worth it. Not that the staff should be the one to make the final  decision but they are a critical  part of the  practise and really should  be involve in that whole process as far  as I am concerned. As I said do things in stages. Sometimes it’s going to take a little bit of time. We work with offices all over the country who wants to go digital and get new practise management software and digital camera and all this stuff on day one and can’t figure out why their staff aren’t doing everything by day two. It’s really overwhelming. Do things in stages and everyone will be happy about that. As I said make sure you schedule in some time for this because it’s probably going to take you 12- 18 months to do something like this. So start doing it now, start the process whether it’s calling up a practise management software management company, whether it’s speaking with me or just doing it on your own. It’s available through email, You can got to my website  You can go to Facebook and search for me. You can go to twitter and search for me or you can go to LinkedIn probably about 2000 others. We have a toll free number that you can call if you want to set up a time. As I mentioned early up never charge a fee to talk to someone. If you just want my advice on a censor or practise management software I would never charge anyway. A lot of times it does require you to come into the office to do an in office evaluation. I am more than happy to do that. For new practise that wouldn’t be necessary because you have no building but I am happy to work with offices and if any capacity. We are going to open thing so up for questions right now.

What I’m going to do is give me second here. I’m going to open up my question pane. Start the questions as you think about them. Not a ton of questions yet which is great because usually what happens is people sort of fade more to the end. I’m not sure why. Let just get to the questions here. First, what’s the best standard to get rid of charts and x-ray? That is a really good question because aloft of times we are talking about 2 different scanners. The problem with  a scanner that you are  going to be using  for  film  is that for  most  part  they are pretty slow and they are  really not  designed for speed.  What my usual recommendation is to get 2 different scanners, one for paper, one for using for insurance forms.  One for film.

What do you use for paper?  The one that we normally recommend from paper are form a company called Fujitsu. They have two types of model, they have a lower cost one called the Snap Scan. I think S1500 is the model that i am currently recommend.  Like I said low cost, I’m saying relatively low cost. It’s still $4900 scanner. The probable with the Snap Scan is that it’s not  twain compatible .Twain is an  interface that  so used by  most software  programs  that allows the  to know how to interface with the  hardware . So  what that means is if you want to scan  the document that is not twain compatible you are  going to have to create a  PDF  file  first and then  import that into your  software. That’s fine, it’s an extra step. If you don’t want to do that then you are h probably going to want to get a twain compatible scanner.  Fujitsu has a model called the FI i think it’s the 6130. Now we are talking about $700-$900 scanner but it’s a great scanner for paper.

For film unfortunately your options are much smaller. The reason for that is in order for you to scan a film you are not going to want to take the PA and micro dental and so on. You are going to need something that has a large enough scanning surface and it also has what is called a CPU transparent unit. What that basically means is that there is a scanner or a light source in the lid. Usually when you are looking at X-rays if you want to see them you hold them up to the light and the light coming from behind the x-rays. That not the case with most scanners. Most scanners are like a copy machine where the light source is on the bottom. So a not a lot of great models for film.  The one that we normally recommend is the Epson V750M. They have one they called the V7000 but i heard that one is going to be discontinued.  The V750M is not an inexpensive scanner. About $800- $900 and the other limitation with that particular scanner is that it can only scan to about 10 inches maximum length which is fine for bite wing , which is fine for a  pan  but some  FMX mouths  are going to be a little bit longer  in here. Epson have another module called 10000XL which unfortunately is close to the price of it. You can scan the larger surface one beyond FMXD but that’s about a $3000 scanner. So  to  answer the  question I definitely recommend  getting both types of scanner because that’s  really what we do . I think there may be some questions about Maxident as well. I want to bring Sheryl on here so let me to just switch over to this for a second. Bear with me here.  I’ve got her muted which i am sure she is not opting to be happy about but I’m trying to get her to talk here. Sheryl can you hear me now?

SHERYL: I can.

Dr Lavine:  Perfect you’re great. So thanks for joining us and they are some Maxident questions here so great to have you on here. I’m going to go ahead and open up my questions again. So we got to the scanner questions. Does Egosoft software have all these criteria’s? In the states I’m not sure if Egosoft is available   in Canada or not. I think Egosoft is a very good program. You are going to find as you go through this   process there is a lot of good program out here. My goal is not to say well Maxident   is the only program you should look at and everything else is crap. I think Maxident is a great program… Egosoft has a number of features as well as they are going to  allow you to get close to the chartless and  paperless  but  as I said there is one  of many and I wouldn’t talk someone out of fi it fi they  are  sold on it but   certainly Maxident  is  one that  Would  definitely recommend.

What’s a good software for voice recognition that i can use to do period charting? There is not a lot of good stuff out there. I have been  telling people that  I believe  that  voice activated  software  is probably about  9- 12 months away from really being  state of the  art  and I have been saying that for  7  years .  The probably that I find is that if someone has an accent or if they have a cold that today of course you have to train it. It’s not as effective as i would like ti to be. The one that we have recommend for some offices is one that is called Perioral, its Again I will send the link to this. I believe it’s a web based  charting  which  is  kind of unique but  really nice system  that  is definitely   works  with  cove . That’s probably the only one that  have  seen  some of the practice management  programs  has it  built  in as  well and  I just haven’t found that its  really great  where i want  it to be  quite  yet.

Do you have any experience with Mogo? Yes i have experience with Mogo. I actually take was talking in my office last night. I wasn’t sure they were still in business. We have not heard much about Mogo in the last number of years. We had a number of offices that were on Mogo that used SQL database had a bunch of issues. Unfortunately a lot of users that we were working with jumped ship at that point. I don’t have a lot of current experiences with Mogo. I’ve worked with abou1600 offices over the years and i can count on one hand. That’s not necessarily a knock on them .I don’t know enough about their current software’s and the topic on them.

What are my thoughts on the future of online practise management software systems? I think web based is probably the future of all software. Not sure practise management   software, not just practise management software. We are heading in that direction. I think that you are  going to  find that  a lot  of companies and practise management  software companies are  going to  probably  head in that direction . I’m not sure Sheryl are you guys planning to do anything web based in a little while.

SHERYL: We are. It’s already in the plan. So its web based or computer based.

Dr Lavine:  Perfect. I think is great that you give people multiple options because they are so many practises out there who are living in east picking up a larger [Inaudible] or wherever. They have just no good consistent internet connection so I definitely think that for me is important. Which software for Orsoceptric is easy to use and easy to incorporate into Maxident? Do you guys have any specific software that you recommend Sheryl?

Developing a Paperless Practice P5

So a lot of reason why you should consider going chartless. The way that most of these systems work and in your practise management software you can clock on a little button and it’s going to take you right into the software and it will have. Of course you can customise it anyway you want  and you will  have read documents  that’s always need to  be signed and  if it hasn’t  been signed you  need to  make sure you got the  signature on there.  Customize the forms anyway you want. If you want that those to look like paper forms great if not you can use the ones come with their software.  They basically use sign and signature tabs like I showed you that basically you sign the signature tab that I showed you in the Maxident slide, your tablet PC. The dentist signs it and you now have a document that is perfectly legal and acceptable in every state every providence that I’ve ever been in.

The other cool thing about their software is that it’s online.  So  what a patient can do for example is  your patient calls up  in your practise you can  send it to your website where  there is link that they can go on to  a secure website, they fill out their paper work and that information gets uploaded to your  server a couple of time per day . So the whole premise behind this is that the information on the patient shows up long before they show up. The patent comes in for their first visit, they sign the signature tab and you are ready to go ahead and see them. That was always one of the things that I found annoying when I was in full time practise and send my patients the paper work, I would schedule in 10 or 15 minutes early just in case they forget it. They would forget it and come in on time and 35 minutes later they are still on their paperwork. So this should help to avoid a lot of the problems happening. This software is fully customizable. You can do all kinds of questions types, you can do statement things, and it can be done on a regular pc or a tablet or whatever you want. So that’s the Dent Form software. Depending  on the  package that you get you are  looking at  somewhere around  $3000  give or take  of the  software and  training and support and installation and the online and all that kind of  stuff as well.

What about online collaboration? This is an  area that really have not  taken off in dentistry  and  I’m surprised about that because as offices are becoming  more chartless, more paperless this is a  real hurdle . What do we do with those referral slips, how do we communicate another offices for using different to programs. How do we communicate with our labs? That’s important as well. If you are going to be chartless or paperless those forms are no longer going to be around. Is there a digital counterpart. There is not a lot of great options out there yet. The one that I’m most excited about. They are called Light Squid, they stared out in Calvary a few years ago. They are now in the US as well. They did their big coming out party in Chicago for the winter and February of this year. Expect to see a lot more about them. I’m just going  to show you a few slides of what they do  but basically it’s a  web based  online  platform for  multiple   people . The dentist, the lab, the referring office, the patient that you want them to have access to information and in real time.  Any of you who are  familiar with Facebook  are  probable  familiar with a screen  like the where  you can have a section for reading and  news blog,  this Facebook like  home page that  it keeps you updated on what’s  happening  with the cases. You’re got an area there where we can read comments for other people.

You basically have this online, ongoing dialogue with multiple offices. It   bridges to my knowledge with about 40 or 50 practise major programs. Pretty much every major one in Canada and the US so that’s not a problem. You can still enter in patients manually if you prefer as well. I think  there is this  really cool timeline feature as well that mouse over an area that you want ,  you mouse  over it and so you know when  something  happens or what’s  happening  at that particular  time . So really cool feature. You don’t have to use it if you want to just keep things chronologically as far as the other case that you have been working on.  Your can use a conventional system as well. You’ve got throw  online  lab prescription forms but  another really cool feature with this software you can take an  image on your  desktop , click and drag it to this white area and now your can upload it to  their  website. So really simple to click and drag and have access to images that your can share   with other offices. You’ve got this shipping check list, you have really nice view. You don’t need any special software. It’s all web based.

It also works with a lot of the cat canvases out there Catherine nitro and ND14 and Cirac. It actually has a built in 3D viewer as well.  So again someday who doesn’t have those machines can still take advantage of the products that you are sending to them. So great collaboration tools, security, manage your calling as far as who have access to what. You can certainly add calling as your feel you want to. That the Light Squid system. From my understanding  is  that the core system is going to run $129  ore  month  if you want  integration with the  Cad system  it’s going to be $199.

So keep your ears and eyes open for this. You are going to be hearing a lot more about it over the next few months. A few of the   things that i want to talk about in office communications. Certainly as you are going to have computers around the office does it really make sense especially for example for a  new office you really want to  go and  spend 5 or 6 thousand dollars on something that  is  older or light based , wired  systems. If you ‘vet got computers throughout the office why not use a software based system, software messaging systems. One that we recommended in the past is one called Soft Com a lot of practise management programs is built in as well. One we have recommended for a lot of practises is one that is called Bruno communicator. What I like about Bruno is that every person in the office has their own tone. So a lot of time you are trying to page someone you don’t know where they are. Are they in the staff lounge, in the operatory 3? As long as they can hear the page they can go to the nearest computer and reposed to that. So this is so really nice program. This m one runs around $800 for unlimited computers. So that’s one that i would recommend as well. We do get people who ask me about free programs like Yazd messenger and AOL messenger. I will be a little cautious about that. We are seeing more and more reports of spam and spyware and malware that affecting instant messaging programs. You wouldn’t necessarily want to put something like Ms Jones is here, sees a royal pain in the rear   that she usually is or something like this. Because when you are on this network Yazd messenger network you are on one that the whole world uses. So be a little careful about something like that. You tend to get what you pay off.

A  final program that I want to talk about and this is a n  area  that a lot of people  struggle with  as well is  progress note. If you are going to get chartless, get paperless how do you the progress note in there. The way  that  a lot of  practise  management progress notes  work is that u you will create h some type of  exploding code where you type this code  and  it’s  going to spit out the  procedure but then  you have to go back in there and  edit the tooth number and surfaces and the number of charpeals and anaesthetics . It’s just the pain. Often time you spend more time doing that then if you are typing from scratch. What if you can do the whole procedure with mouse click where all the setup is done ahead of time and you just click mouse, mouse, and mouse? We actually sat with offices that use this program and even to do a complex procedure takes them about 30 to 35 seconds.

So this is a program called Easy Notes Pro. It was created by a dentist, its Doctor David Burton in North Carolina. Just to show you some of their slides. This is the Easy Notes Pro software.  Works with pretty much any practise management rat software. I’m not going to spend too much time on this but basically this creates another tool bar for you can put on top of your practise management software.  Completely customizable. As I said most of the work that you do with this program is done ahead of time where you decide how you want the surface to be laid out in your software. For example most practises don’t have 30 different anaesthetics on a regular basis. It might be 3 or 4. Again I’m not going to spend too much time on the slides. If you have a really old practices management software that doesn’t have a place for progress note you can absolutely use something like this. It as standalone program. Most people don’t want that, they want the progress notes to go right in the software and that’s what this program can do. Again this is showing your how this works. Really slick software we have installed it in dozens of offices over the years. Works with pretty much any practise management software out there. Not an expensive program. Usually around $800- $1300 for everything. It just depends on what features you are adding to it. So you are trying to go chartless, you are trying to go paperless, what is the game plan? How do you go about if I could give you a summary of everything that we have gone through in the last 45 – 50 minutes? Really there is no magic bullet here. It’s not like I have information that no one on the planet has. I’ve done this for a number of years but the approach that I took is a systematic one. It’s a series of systems, look at it as a sequence of steps to take.  Try to do things in order.  You don’t necessarily want to go out and buy that really expensive digital pen if you don’t have digital software that it can work with or if your practise management software is outdated. So take the systematic approach to doing it.

Developing a Paperless Practice P4

As i mentioned a number of nice brochures and hand outs that you give to the patients as well. That’s Florida Pro system. Not an inexpensive system. You are looking at somewhere around $5,500 or so for single user system that’s going to be the hardware and the software and training and all of that. By the way the numbers that I am quoting here are retail prices. Usually companies like mine and other out there can probably get a better pricing. Around $5,500 for everything. I think that about $2,500 per operatory beyond that if you want   to do multiple operatory .Really nice system.  Not inexpensive.

What about patient education software? I think that’s really a great thing for people to be using. There is number of good systems out there. Most of you are probably familiar with Casey. Casey is the E hundred pound gorilla of patient education software. Unfortunately its $8000 patient education software. There are number of alternatives out there that are prices about third or a quarter of what Casey charge. There is nothing wrong with Casey, ‘m not trying to know them anyway. I just find that a number of offices that we work with say that we are looking for a little better   value for proposition or some think like this. One of the ones that I have recommend for lot of offices is called or sphere. You may have heard that it’s under a new name. Well i think they still sell the Orisphere but also Curbdental is now offering tips for free, it’s called Curb Ed. It’s completely free. It’s the exact software. I think its You can get more information about that. The Orisphere is the one that we have recommended for a lot of offices, very similar to what you would see with most patient education software’s. A series of libraries that you can stream together in a  playlist  For example if your want to show  patients something like an implant placement versus implant restoration that could be to a CD  or  DVD  to  take how with them. All the things that you would expect from modern software. Just to show you some their slides.  Really good graphics.

This is a thing we hear from some of our offices they don’t want to show patients anatomical things. For example something like an implant a verb going into the bone. They think that patients are going to be freaked out by it. I think you just have to gage with you patients. Some of them are not going to be comfortable with it and some of them couldn’t care less. So gage with your patients. The other thing with patients education software is that I always recommend to use it with a staff member hit a dentist chair site. Sticking that patient in chair and just having them listen to a little movie and then coming back and talking to them is a mistake. You have  to keep  in mind that the patient  is usually  not there to buy procedure, they are  there to  buy you  or  accurately  the  confidence that you can perform that  for them. So do a chair site don’t use the patient education software as a crotch. Again there are some of the slides that you would normally see with the Orisphere, they’ve got Cirac and all the latest and greatest stuff. Showing pocketing and build up. Again all the things that you would typically expect to see with   patient education software system. One that we have recommended for a number of offices is one that is called except. This is developed by a periodontist in Florida. What’s  unique  about  the Except system is that most  of the patient  education  software or programs  out there  is showing  you somebody wales  teeth , the patient  may  have a  little trouble  relating to  and  in my mind probably one of the most  effective ways that you can educate patient  is when  it  is   with their  own  images. So to call except a patient education software may be a bit of a miss nomer. I think it’s more accurate to call it a treatment playing software. So what i you want to be able to do is to take something like this where got the diasima, the central, and the latels could use a bit of crown lengthening. The cans can use a little tissue coverage there, perhaps cover things up. Ideally and under five minutes because truthfully I know the way dentist are. Its goings take  us more than 5 minutes we are  probably not  going to do  I but you can very easily simulate the  constitution graphs   on 6 and 11 or  Canadian  people  and 1-3 and 2-3,  crown lengthening  on the laterals, closing  up the black triangle with [Inaudible]and  of course doing some  whitening .

One [Inaudible] software like this. Be really sure that you can produce into his mouth what you are showing them in the screen. Usually they are going to want you to print this out for them, they are going to want to take it home and discuss with their response. When they come back  into that procedure  your know darn well that  they  probably have that with them  so what I always recommend doing is under promise and over deliver  and that way you’re going be a hero  in their eyes. For example don’t show them chicklet on the screen off you don’t know if product that. Show them maybe one or two shades lighter what they’ve got that way when you produces something better than they thought then you’re going to look golden in their eyes.

You can also do things with this program like numbering things or draining where are, showing how important would function. This is a really nice programs. I can’t give an example of what the cost is. Somewhere around $3000 give or take it.  We work with a number of companies using that one as well.

Confirmation and surveys. This is as I said a really hot area right now. I’m not sure if the market is really support  all the different ones that are out there but  Viewpoint want the first  one out there,  Smile Reminders is one that is  popular as well. My favourite one is one called the Man force. We installed it in a ton of offices. They are available in Canada and the US. Really great company, great product. There’s a lot of things that it can do. It was basically built initially as a way for confirming appointments but they went a lot beyond that. For example  lets say that you want to send out an  email  to every patient  that not  been in within  the last 6 months, offer them  some type of discount  on whitening or some kind of deal like that. The software does that automatically for you, just say go ahead and find everybody who hasn’t been in 6 months and send it automatically. You can track all this stuff which is critical because you want to know if it’s effective.

One of the things that i like about the Demand Force software is that they guarantee at least 3-1 return on investment or it’s free the next month. Most of these programs they cost somewhere around $200- $300 per month. So the  Demand Force is basically saying we can  track all this  stuff for  you  , you’re  going o see at least  $900  per month  in increased revenue or you  don’t pay within  the next  month . I am not aware of any other software program that does something like that. The core of the program  is that it sends out the confirmation  for the patient,  they click on that little confirm button that’s going to go back to the  dashboard that  the office manager has on their  screen  where you can keep a  running  total of whose coming in and who  is to be confirmed.

The other next  thing that they have  are these  surveys where you can customize this and  send the  survey out to  the patients after they have been into the office, try  to get  feedback  from hem and how you can a prove . Another really critical reason why I think the resurveys are important. This is just showing you that screen where you get that dashboard to the office manager where you they can monitor. The reason why those surveys are important demand force has a relationship with a little commonly called Google. To may have heard about them.  Basically no one is ever going to say that if you use a software you’re for sure going to get to the top of the list. When your do that, any of you who have familiar with what is called google local. You’re going to get get a little  map with 10 pins on it .You  are going to have  10 practises listed in the three, their website , their  phone number and you are  going to see reviews. Yes they are a number of companies that can give you reviews. At least for  San Francisco which is where the  Demand Force is based every single one of  those top ten if you click on the number of reviews it’s going to  review from Demand Force . So you are not necessarily guaranteed to get to the top. In our experience the more reviews that you have the more feedback that you have  from  patients  the higher you’re  going to rank with google searches and Demand Force definitely does that and that  including in that $300  per month fee that you are  paying them  besides the confirmation  and all that stuff. This is a great program, recommended for a lot of practise as well.

What about offices that are trying to go chartless and paperless that aren’t going to take my recommendations and look at a program like Maxident? How do you get those signatures into the practise management software? Probably my favourite program out there is Dent Form friend of mine and in the bay area. I’m just going to quickly go through some of their slides. I’m not here to sell you anything or to market anything like that. But the whole premise behind this and that and going chartless makes sense for a lot offices. You are going to save time, you are going to be a lot more effect as well. You are going to reduce the cost. I can’t think of anything that is more time consuming than scanning and charge. When lecture on this topic  people always  say  to me  what’s   your feeling on scanning and   charts and  whit I usually say  as the dentist in the group is that if you have  a staff member that you are  trying to get rid of  and you don’t want to fire them go ahead and give them  the  job of scanning and guaranteed h they  will portably  be gone  within a week . It’s a painful, time consuming job so. If there is a way that you can get all of that stuff electronically before paper. To  me  you are  going to  put  it on  paper and then scan  it in your are pretty much doubling your work  load. It so  way to get  you  digitally from  the get  go  and to me that is always the  best  way of  doing  it .

Developing a Paperless Practice P3

Here’s a mother key thing we don’t really seeing a lot of practise management programs. The ability to post treatment and payments per procedure. One of the things we hear a lot  of  offices is  that they  have associates  and they find  it  just almost  impossible  with their  software  to be able to handle those types of payments and look for software that can handle something like  this certainly Maxident that has  those kind  of features. They may not be the only one but they are the ones that I am aware of. You want something that has got a good image management module if you want. Certainly it’s  great to have a bridge solution  but if they  are  going to  support their image management,  a module  is part  of the software and  have it  be  open  ended and  you can pick and  choose  whatever  censors to whatever boxer plate why not look  for something  like that. Any of you that have used Patria or Clineview or Professor, you are familiar with this type of software, very similar in design and Patrix software. Both feature bridge that easily to their practise management software and its going to allow you pretty much use everything.

The only censor for example that I am aware that won’t work with Maxi viewer is Debus. I know that’s the case. I’m not sure in Canada but they are locked as well because they will work with the military installations in the US.  That’s really what I recommend.  It’s a module that allows you to do whatever you want and have all of that available. Obviously the electronic chart is critical for the practise management software. You want to  be  easy to  use whether you are  using a mouse or a touch  screen monitor we are seeing a lot of interest right now  and  the  possibility of using  IPad or tablet PCs in the operatory . So the software has been designed to use whatever input, whatever type of pc that you are using.  So you want it to be an easy, to be able to take that charting and get it up to the front desk electronically. Again this is a different type as of  features that  you are  looking forward , something that can work with his touch screen ready like IPad , like  tablet pc and certainly they come with  different  views, this is the one that I like with their software, the topical  , the  have the geometric view as well. This is easily my favourite one.  You want it to also be. Again this is another huge issue for a lot of  practises is that we’ve got all of these paper charts, were  used to  system the  way it is  how  do we transition? We want charting that is to understand, that it’s customisable. You want it to work with some of the hands free devices that are out there, dental rack. People on both countries I’m sure  are  familiar with dental  rack , voice activated and  it’s  all kinds of easy that you can get charting into  your  system that’s  a little  bit more modern an  make   it easier for  you and your  staff to  do that  . You want it to be customisable. Everyone likes their  screen to be  a certain way  sometimes  into he  practise the  front  office manager wants  her  screen one way and  people in the back wanted their own way . Again these are the types of features to look for in practise management software, that complete level of customization.

Signature test. That a big thing has well. People are going chartless and paperless. What do you do with all those forms that need signatures .The form consent, the medical history forms, dental history, US Hila forms? In the state and I’m sure this is the same with Canada, electronic signatures are perfectly valued, viable options. So why not look for something like this built into the software as oppose finding a way to kind of cobble it in. They have  got what  they’ve got the Maxi  sign and patients  get to sign their document ,they  sign their  questionnaires, when they go into treatment  of a pharmacy test words as well. It’s a perfectly authenticated patient digital record. Its date and time stamps everything so that no one can tamper with it. So that you have that security issue to deal with. Again it’s just all the type soft features that I recommend. Here’s another thing that is very rare to see with practise management software, their own built in online back up. Certainly many of  you who are on this call  are  clients  of  ours and  have some of the backup systems  that  we recommend which obviously  we  recommend  but  if  it’s so critical to back up your practise management software why don’t more practise  management program  built into  it  so that it goes  up automatically .  Truly a set it and forget it kind of system, you get an automated response from them, the backup skills that you know about it.  These are just really the types of features that you are looking for into his software.

Another final critical piece of the puzzle and we find so many practises making this mistake. We saw you know we spend so much time on this software and so much money and we’ve given you computers and all the things we need to do   but my staff are smart they are not going to need training. We can figure that out on our own and that’s basically like shooting yourself in the foot. Definitely not something that I would recommend. You definitely want to work with a company that’s going to get an instructor in there. We really recommend doing things in stages.  Some of the better practising management  programs out there Maxident is one of those will do things in  stages so you are not  going through 4 days nonstop of  training which we all know by 2  o’clock on day one people  eyes  are  glazing cover. You really want to try to do things in small bites, learn how to use the software properly. I always recommend as well. I already have a software that you want to think about switching then that’s also another key thing to look for in your practise management software. Can they do a conversion? A lot of companies will charge you for that.  To me that’s nuts and always for years said use that as a point of the sale. Say to the company I’m not going to buy your software and so you can   do a test conversion for me and show me that you can do what you say. I shouldn’t have to pay for that and Maxident certainly doesn’t charge for that and we certainly recommend   that’s the way the way to go when it comes to the paying for stuff.

You can do things in stages as i said that you don’t have to pay for it. These are the types of things that we recommend once you are looking for it. If you are not sure about software programs out there always look for some type of guarantee.  You have more than a couple of days if you think you made the wrong choice. Well I think 60 days is pretty generous. That way you will get a chance to play with the software and decide I like it or don’t like it and if not then time to move on. Any good software company will allow you to do demos in your office or over the internet. Usually most person  prefer online but however  you want to do  it  its  perfectly  fine  but  I will always recommend  getting the first . They  had  told me  that they are  planning to do  a special  for anyone who mentions my name , it’s  good for a  couple of month. I  actually do call them  up or they  get  in touch with you and  just say to you on the webinar  that i have no idea what the discussion is ,  I’m sure this is  pretty good.

So what about the offices  that aren’t  ready to make that switch  quite yet , they have  got a practise management  software , they are  kind of happy  with  it  but they realise that they are not really ready to move forward yet. As I said and almost in all cases you are going to need some type of 3rd party ad on software to get chartless or paperless? If the question is can my practise management software do it all? The basic answer is no. For most  programs  out there they really cannot  get you completely  chartless or  paperless  and  Maxident  comes pretty darn close in most cases you are  looking  at third party programs. That’s really what ware going to spend the next 20 minutes or so talking about. What are some of these, I’m not going to go through every single one of them but they are charting programs. What if you want something little but more advanced that what comes with the typical practise management program. How about patient education software. It really hasn’t  exploded the way up thought it  would but there is some  new stuff out there that I’m pretty excited about . We will talk about that. Again by the way I mentioned at the beginning for those of you who came on late. I’m  gigot be sending every  person who is on this webinar a set of PDFs that has all the slides that  I’m showing  you here this evening so your don’t have to  take  not as on all of this . I’m also going to send you a list of  every  single  product that we  have been talking about with their  contact information so that you can research it a little but  more on  your own .

Another area that is really huge right now is confirmation and survey. You have a number of companies right now in North America that are in this market, that Viewpoint, Demand Force, Smile Reminder. I don’t necessarily think the market is going to support of it but I will show you the one that is current favourite. Shade matching. We don’t have time to talk about that tonight but that’s another hot area right now. We are  going to talk about   a program called  Dent Form and  this is  really designed for companies that  don’t have a program like Maxident that say I need to get those  signatures in there its not built into my  practise  management software , how do I go about  doing that, Dent Form. Online collaboration.  I’m going to show you a new company, a new product that many of you may not have heard about, started in Calvary. They are coming down here in the states as well. Right Squid, probing systems, fee analysis. Again we are not going to have time to talk about that as well. In office communication systems, we will talk a little bit about that. So a lot of different things to touch on here. Probably one of my favourite charting programs out there is one called Florida Pro. Many of you may have heard on it. I’ve used it in my periodontist practice   in the early 90s. It was not a particularly great program then but significantly better now.

It’s basically a constant force probe where everything gets hooked into their software with a foot pedal. I can probably spend an hour just talking about Florida Pro and what it does. I remember as a periodontist whenever I would do surgery all of my patients seem to have 2mm pockets afterward. It wasn’t because they really had 2mm pockets it probably because I didn’t hold the probe with a whole amount of force that i should have. You eliminate that objectivity with the Florida Pro and the pro would be if you put it to the pocket and press down with it and all of that is going to be concurred electronically and put it into the computer. Really very little chance to get a number that’s not accurate. You can measure everything as far as digital marks and attachment levels, CVJ, all that. All the things that you want to do. One of the things I like about this program, this system is that your can print all this forms and brochures to get to patients. Charting is really, really sick, really high end time of chart. You should be able to pretty much, very practise management software out there that. That’s one of the reason I like it. If it doesn’t  work with  your practise management  software you can call them up and  it will very  quickly  so that’s a nice  feature so well.

Developing a Paperless Practice P2

Don’t put the chart before the horse. I’m going to give you the next  slide,  basically the game plan or  a treatment plan of  how you  should  go about  going chartless. The mistake that we see a lot of offices do is that as dentist we like things that we can touch and feel and that have hard numbers associated with it. We tend to forget about [Inaudible] stuff. You don’t necessarily want to go out and spend $20 000 on censors or spend $30 000 or $40 000 on digital pen and find out that it does to work with your software. So don’t put the cart before the horse, try to do things in order. That really what I consider to  be the  one of the best things  that I can give to you on this presentation today and you know in real estate they always talk about the  three most  important things are  location , location and location. For me it’s planning, planning, planning. There  is nothing wrong with  doing things in stages as long as you’ve got the game plan and  treatment plan of  how your are going to go about  it. Of all the slides that i have this is probably the most critical because this is the sequence that we talked about. This is really going to be the format that we used for this for a webinar series. The things that we are going be focusing on this evening  which I think is easily the most important decision  that you make , the practise management  software , its  third party  program ,  to get  your chartless. They are not a lot of software program out there that can really get your to the point where you are almost chartless or paperless. I’m definitely gaging to give you an example of one this evening that can but most of the program out there we cannot. You’re going to need to supplement   it.

Image management we talked about that. That’s going to be in a couple of webinar. This a critical decision for a lot of offices as well. Operatory design is also of ergonomic issues that we will need to be figured out when you are designing your operatory. Our next webinars will look at computers in your operatory versus the front desk versus the server. We will look at digital  technology that is  part  of the image management  as well and  finally  again which  think I so critical and that why I saved it for the end is going to be  data protection and  data  back up . By the way you all this covers a lot of stuff. We have plenty of time this evening to take questions. It don’t have to be on practise management software. So if you can’t wait for the other webinars and you have certain questions that you need to have  answered  I’m  certainly going to  do everything in my  power to answer those for you .

It’s kind of interesting to note how this specific webinar came about. Many of you know I was born and raised in Canada and I do a fair amount of my training and consulting it offices in Canada. About a year and a  half  ago I have visited some offices,  one in Winter peg , one in Calvary, Toronto and I was  kind of  surprised  that all of them were using the same  software  program. It   was called Maxident. I’ve never heard of it before.  I decided maybe I need to know little bit more about this. I was happy to hear when I spoke with them well they have started off in Canada, that they were available in the US as well. What really impressed me about their software  and I am going to show you some  examples of  that this  evening  is that  of  all the programs that I work with on a daily basis they really had a ton of features that  allow an office to be  completely  paperless without the need to  have  a  lot of these add on programs . So we definably are going to focus on that as well. I will show you some slides. This is an example of what I feel is a good practise easement software, what it should be able to do. On the call with me tonight is Sheryl Canhive who is Maxident GDM. She will be available at the end of the webinar I anyone has any specific questions about their software. Please understand as  I am  going through this  I don’t  work  for Maxident i don’t  sell it . Every single one of you went out and bought I would not make a penny off of that. I’m simply using that  as an  example of software  program  that  I think really does thing  the way  it’s  supposed to be.

How do you go about choosing a practise management software? About 10 years ago Gordon Christensen, clinical research associate they identified 200 different programs per year. Now I think some people had a different definition than I do of practise management software. I’m sure some people considered quick books, outlook to be management software I do not. That number is significantly smaller today. Probably around 30 – 40. I would guess there is about a half of that I have never heard of. I mean it’s probably about a dozen so that you never heard of. We should thank companies like Practise Works, Shine in the US. You know Shine has a company in Canada that has a lot of consolidations that we are receiving right now.  In this country, in the US there is really three major vendors, there is Kodak, Egosoft and Dentrix. Those account for about 75% of the market.

If you would have asked me a few years ago what are my feelings about using a Mac in a dental office I would have said absolutely not. If you ask me do today you have many more options? A number of practise management programs work with both Mac and PC software because of the fact that Mac can now run pc program using something called a boot camp, parallel to VM ware. You have more options available. So certainly of you are a Mac and you want to have Mac to the office I am a little bit more not as hesitant as I used to be about recommending it? I still feel that if you are running PC application you  probably shouldn’t  be  running that on pc most of the times but if you want a max it should not be out of the  question as it was few years ago .

So one of the things that I really recommend that your do is  keep in mind that when you talk to the sales  rep  form  practice management  software companies they are  going to show you all the  bells and whistles  and the things that’s really  unique to their program . For most offices in my estimation we are using maybe 5 – 10 % of that the program can do. So there are certain core functions that you’re always look for in a program because those are the things that you do every single day. It might be scheduling, it might be insurance estimation, billing, running perhaps practice reports, production collections reports or something like that. One of the things I suggest as a way to do this have when you are getting a demo of the software have them actually lock in an imaginary mutation through the office. You want to see how easy it is going to get them I the software. Now we put them in, we want to simulate them coming for their first visit, we want to charge them, we want to treat them, and we want to get them out of the week schedule.  As you go through that  process with multiple programs you are just going to get a  feel  that one of this felt better to me than the other or  just felt a little but  more intuitive to me than  there. That’s the one that probably right for your individual practise. As we mention you’re going to look for integration with third party programs we are definitely going to some time at the end of the presentation talking about that. What i really want to talk about is how you really find a good practise management software. What are the things that you really should   be looking for in your practise management software? We’ve talked about the fact that Maxident is one that I really think meets those criteria.   That really my goal here to show you what types of things Software Company and should be doing in 2010. I was actually a little bit surprised that when i got the supplies from them that they have been around for 30 years. I’m just kind of  embarrassed that I’ve been in the field  of  density since 1984 and doing  technology  full time for the last   8 years and have not heard  of  them and  off course  that has definitely change in the last  year and a  half or  so.

What are the things you look for in your practise management software? What are the features that should be part of it? Well certainly you want it to be able to run on any types of computers that you have. You want it  to  run on any window servers, on  XP or  7,  you want to be able  to use your  Mac , you want to be able to  32 or  64  bit platform  which I’m sure a lot of  programs can’t do. That’s one feature that I think you need to look for.  It would be nice if you ca all get them to work over a wide area of networking. Many of you would have certain web based program out there. There is something coming along that a lot of them in their early stages. That’s one of the  that you can deal with that but wouldn’t it be great if your can use the software you are already using in one  office over a wide area of network  so that  you can time multiple  office and don’t have to deal  with all the issues of  remote access and things  like that . That’s another feature that you look for in your practise and management software.

Look for something that is really designed properly or it’s come with multiple module, multiple ways to work with the program. All kinds of features. These are the types of thing that we recommend our offices do as we are going through the process of to choose your practise management software.  You want to something that is going to make it easy to deal with, to scan your existing images into the software.  You have something that can basically help you to develop some electronic medical or dental record.

The last point on here is digital integration with any imaging software.  That’s a really key feature as well. unfortunately a  number of practise management  software programs tend to of lock you in to their  specific  program  and you find that most  of the dentist that I am working with have  very good  idea of what they want right  but not necessarily what they want down the road. You wait to keep those doors that what we always recommend. Get a really good open ended a program to choose any image software that you want versus the one that the down supply company says you need to get.

Developing a Paperless Practice

see the vide0:

Dr Lavine: People are joining us right now but we are already a few minutes after 5:00. So thank you, welcome everyone. A pleasure to have everyone here on the webinar. As of this morning we had 276 people register for  this webinar and close to half of  you are  already here so  thank you very much for the  confidence you have given me throughout the years . It’s great to have some many people joining me this evening.

A little house keeping here I’m going to be speak for about 45- 55 minutes or so. I want to leave as much time as possible to answer questions. Every one of you should have a little box on your go to webinar control panel where you can ask the questions. So feel free to ask them throughout the webinar as you think about them but I won’t be able to get to any of the questions until after I’m done speaking. By tomorrow I will be sending you all a number of things. You will get a  short survey ask soon as you log out of this webinar and  please indicate  on that survey  if you want my office  to arrange a  personalised call with your office . I don’t charge for my time to speak to practises and give you one to one help.

You are  also  going  to get email with links  to download the lecture notes  from this evening which is basically a copy of  all the slides that  I’m going to show you . So do not worry if you have to take a phone call, if the kids are screaming or whatever. You are not going to miss anything. I will also have Amanda from my office email  everyone who attend this evening the CV form that is good for an  hour and half of CV reference.

So most of you already know who I am and what I do. I did  practise as a periodontist for 10  years and  over the last  8 years I have been exclusively  workign with  office to help them  basically get into 21 set century as  far  as technology is concerned. I travelled all over North America to give offices individualised  help , we work with offices to get their  computers up and running,  digital X-rays, cameras, basically try to help you avoid making any types of mistakes and you go through this process. If you want to keep up with the latest in technology I do have a blog .It’s I will put something on their every single day. I’ve done this for a little over 5 years actually. We would love to have as many people as you want. You can’t see on the screen here but there actually a place towards the bottom where you can sign up to the blog. So rather than you going to the blog every day it comes to you. There no charge for tat.

We have about 1000 people who subscribe and about another 200 or 300   who will come on a daily basis. I do write a tech guide every year. The latest one the 2011 guide is little bit delayed. We are negotiating with another company to publish it so that will be coming probably sometime by the Chicago Mid-Winter Medium, which is probably in February. So keep your eyes open for that. This webinar is actually the first of a series of webinars that we are we going to be doing.  They are all going to be about 5 or 6 weeks apart. We are going to spend some time in October looking at infrastructure, computers and networks and important things like that. Another hot  topic that was in December the  2nd  there will be image  management, digital x-rays  to  radiography and  the final one of the series which  to me so probably the most important and  really kicks  up a  lot  of practises is  data backup and data  protection .

All of you will get notification of that, this whole series will be free so we are more than happy to have as many people here as possible. One thing that is somewhat unique to this webinar series is that typically I lecture in Canada or the WE and I will normally adjust my presentation based on whatever country I am in at that time. What  I really wanted to  do for this webinar  is to  try to  create a series that has  value to the  dental  offices in both  countries at the same time  since many of the  products and  services are  really readily  available in both   countries.  You see the stakes here in 2014 and it’s certainly and in this county, in the states, not so much for Canada yet. Canadians still need to be aware of what’s going on out there. My understanding is there has been an exceptional [Inaudible] from the federal government which relates to allowing eligible computer software purchases to be 100% written off in the first year that it’s available for use. Very similar to what we into country on the schedule 179 reduction. So it really doesn’t make a difference if you’re in Canada or the USA. As  far has  going chartless and paperless I think there  is  ma lot  of reason  to  pitch the  move forward with that . Why in 2014 important besides the fact that according to the Mayans world we all would have been dead for 2 years already at that point.

The reason why it’s  important and many of  you may heard about this is that according to the federal government and  be aware  that it’s not a  law , it’s not a regulation . There is unfortunately some sales rep out there that will tell you that it’s mandatory. I think it’s  going to happen on way or the other whether  it’s  through the government , whether  an  insurance companies saying we are no longer taking  paper claims or film or just  peer  pressure  but then eventually we are all going to be at this point where all patient  records both  medical and  dental are supposed to be electronic by the end of the  year 2014 . This is actually a federal mandate  again its not a law, not a regulation but my whole premise his  behind this is  that you don’t necessarily want to wait till the middle  of  201  to  decide to do something about  it .

This was first  propose by  president Bush as a younger version in  2004 , president  Obama , the American  dental association is  a 100% behind it’s well. One of the thing to keep in mind is that really right now and if you have practise management software you are aware of this there really are not standards of being able to share information among multiple offices. You look at maybe what happen in the midterm elections and that may delay thing and hefty the government maybe just don’t know.  As I said really my premise in presenting this information to you is that you really don’t want to necessarily guess wrong on this one. In my experience of going chartless, going paperless it’s a fairly long process. Most of the practices that we have worked with its anywhere from about a 12- 18 month process. Again  you  don’t  want to  wait till the middle of 2014 and find that the federal  government saying  I got to do this  in  the next  6 months because you are really going to  be scrambling . If you don’t believe me on this there is ton of websites that you can get more information about it. If you just google  EHR  which stands for electronic  health record  or EMR, electric medical record or EDR for dental  record  in  year  2014 your will get  dozens  and dozens  of hits that  you can read more abut . Since you are all going to get a copy of the slides you can just go through the links and it will show you here as well.

So the federal government in all their represent recent states, in all their wisdom said we have the way that we can try to encourage people to move forward with this. We can give them the carrot, not necessarily the carrot but a carrot or the stick. What is that carrot? In the states many of you may have heard this. It’s called the steamers bill, the steamers package. It’s all a bunch of terms that you may have not heard about. The ARRA, the high tech act, the CC hit which is the body that licenses software as well. What you may be hearing about the fact is that there may be anywhere from $45, 000 – $44,000 per office available   for offices that have gone paperless, staring the year 2011. That is true as long as you are not a dentist. CC hit which is pretty much the licensing body had pretty much said that dental is not on their radar any point in the near future. The  key in all  of this is that the  software  has  to be certified in order  for you the  be  eligible  for the   funds. There’s a lot of other factors that comes into play as well. The key factors are that it has to be meaning full and certified and really there are very few programs out there that are going to fall for something, certainly in the dental realm. It  does start  in the States in  2011 and right  now  there each on dental software that is certified  and I would be choked if anything happens  in dentist in the next  few years. More are going paperless because you  are expecting to get this  $44,000  don’t  hold  your  breath , don’t  blame me   if you don’t  get it , don’t  call me  upon and send me a bill because I don’t have it  but be aware that  there are a number of things that are  being done  out there to  try and encourage  people to go paperless  one way or the other. Again there is  plenty  of  in formation out there that if you go to any  type  of website,  do google search on this you can find a lot that’s  out there.

When I’m working with offices or when I am lecturing on technology I’ve always felt that  I don’t have  to  be necessarily entertaining for the entire process.  If i can get a few nuggets or pearls wisdom that is going to help me in making my decision then it was worth wild. So instead of making you wait towards the  end  I will give it  to you  know and that way if you I can’t make it to the  end then don’t worry about it, you’ve got the  important stuff here. This  is a very common  question  that  I get  from a lot  of  offices . I’m looking a practise madman software. I’ve seen your lectures or  I’ve  seen  some of  your  articles but don’t  go through the whole process with me. Just tell me what the best one is. The problem is that there really is no right or wrong decision or best. It what’s its best for your individual practise but there is a lot of factors that can go into that. We are looking for software for example.  The one that has the most feature.  The one that’s the easiest to do for you and your staff.  One that’s the least expensive, the one that integrates best with your image management program. What I do as a consultant  is to work with an office that  says  we don’t  know what we want but  here’s what is important  to  us and then I can  help you to  narrow  down the choice.

The Importance of Perinatal Oral Health P6

Provide a relaxed, unhurried attention to the patient, a sense that you have time for her.  Talk about concerns and procedures before beginning the procedure.  Give her as much control and choice as possible about what happens and when.  Validate and concerns she might have as understandable and normal.

Now, I know that this is challenging because I know these rooms are small, but be flexible about her having a support person in the room.  Explain, of course, before the procedure, what’s going to happen and obtain her consent as you go along.  Ask if she’s ready for you to begin, and be clear that she can pause or end the exam or procedure at any time.  So, again, encourage questions, maintain a personable, friendly manner.  Be straightforward and generous with information.  Talk to her throughout and let her know what you are doing and why.

Here’s some ways that when we talked with some of our survivors, here are some techniques that dentists have used that women found particularly helpful.  One woman wore her coat.  Another woman asked to keep the x-ray apron on.  A couple of women wanted friends or allies available to them.  Bringing a pillow or a blanket, we’ve talked about.  My dentist, actually the dental assistant, puts lavender oil on the bib.  She also asks me if I want my hand held.  They put music on and ask me what kind of music during the procedure.

There are some times in order for women to stay in the dental chair need the dental chair upright as possible, and I appreciate how challenging that is at times.  Again, books on tape, visualization or meditation CD, and squeezing a ball.  There are these great squeeze balls, and then, if there is a television in the room, let the patient identify the channel.

Post-appointment procedure is make a follow-up call to determine the immediate outcomes.  The most important thing is developing a relationship with the woman.  It is a relationship that bring women from a place of fear that freezes to a place of relaxation to open their mouths and not clench up.  It’s all about relationship and safety.

So, we recommend staff development. Make trauma-informed practice training available to your staff through community resources, professional development resources.  Sheela Raj at the University of Illinois in Chicago has done some wonderful work and has a book that explores relationship between physical and psychological health and traumatic events, and it has a wonderful training tool.  You could have the staff read articles that might be helpful and then discuss that.  For example, there was an article in Community Dentistry called The Impact of Childhood Sexual Abuse on Dental Fear by Tiril WiIllumsen.  That’s something the staff could read and discuss.

Another thing is to make the staff aware of the prevalence of trauma in the lives of women and girls. In other words, discuss the centrality of trauma with the staff.  Make resources on trauma-informed practice available to staff for further reading and train staff to respond appropriately when a patient is distressed.

For more information on women’s dental experience, there is an article called The impact of childhood sexual abuse on women’s dental experiences in the Journal of Child Sexual Abuse.  There’s a brochure, and we’ve given you the website, Trauma Survivors in Medical and Dental Settings, and another brochure put up by the Sidran Board of Organization and Dentistry, Dental Tips for Trauma Survivors.  Now, both of these are more directed to survivors and can be very available for reading in your office.  Just as you have brochures from the ADA, these brochures can be made available for people in the waiting room.

Massachusetts Department of Public Health has done a bit of work also on dentistry and trauma.  All in all, what I want to say is that trauma is not in the event, it is in the reaction and the response.  So, what you observe when the woman is in the chair and she can’t open her mouth or if she’s rigid and she’s shallow-breathing is the reaction to her being retraumatized by the position she’s in at that point.  She feels powerless, unable to fight or flee, and the dental chair replicates that position.

So, relationship, relationship, relationship.  Continue to talk to make the woman feel comfortable.  I want to thank you so much, and I’m sorry for that break in the connection.  We missed those eight slides, but thank you.

I’m going to turn this over to Dr. DeFrancesco.


Dr. DeFrancesco:

And I’ll turn it over to Jennifer.



Well, thank you all very much.  I really do appreciate all these great presentations, and thank you all very much.  So, we do have a couple of questions that have come in through the presentation.  There was one specifically with regards to the safety of x-rays with pregnant women.  Perhaps, Dr. DeFrancesco, you might like to answer that question.


Dr. DeFrancesco:

Certainly.  I don’t have actual data in front of me, but what I know is we’ve always taught our patients from what we’ve been taught that between the proper usage of shielding and the relatively low radiation levels, there’s very little scatter, if any, during an oral x-ray.  They’re not contraindicated, generally speaking.  I think, in terms of radiation, in general, so much of this is time-dependent, where you are in the pregnancy, but for the most part, x-rays can technically be done anytime during pregnancy.


Dr. Hilton:

Hello?  Hi, this is Dr. Hilton.  I want to follow-up in what Dr. DeFrancesco.  He is correct.  If a pregnant woman presents to you in an emergency, abscess or caries, the proper amount of x-rays, the proper number of x-rays have to be taken in order to be able to arrive at the correct diagnosis.  This is an issue of the standard of care.

The ADA has guidelines on the proper number of x-rays that should be taken for an emergency and a comprehensive exam visit.  A pregnant woman should be treated any differently than any other patient.  That means the appropriate shielding, x-ray standard precautions that are always used, which is thyroid and a body shield and proper [1:21:55] on your cones, and the proper speed, high speed exposure.  In fact, the majority of dental offices are now using digital x-rays, which is much even lower dose of radiation.

So, really, in terms of the safety, same procedures and risks apply to pregnant women as with any other person.  Any human being wants to have the minimum amount of radiation exposure.  You never see articles about x-rays and getting as much exposure of your client.  If you’re lying on a plane, you get more exposure than you do if you’re using the standard four [1:22:40] and two [1:22:41].   So, it’s sort of a non-issue.



Thank you both of you.  I really appreciate that.  There is a question also about the safety of anesthesia with pregnancy.  I’m not sure who would like to tackle that one.


Dr. DeFrancesco:

This is Dr. DeFrancesco, again.  I don’t have statistics in front of me, but, again, we always go through the same risk versus benefit analysis.  Depending on which anesthesia agent you’d be using and why you’re using it, you’ve got to oftentimes forget the fact that someone is pregnant.  Many of these medications can be very safely during pregnancy at any time.

I think if somebody has appendicitis going on or some acute trauma, there’s absolutely no question they need to have anesthesia.  There’s no way to delay that.  So, we do know from enough cases where this had to be done in the past that there are a few things that you can do in pregnancy and still not endanger the pregnancy.  So, again, you, at that point, check the various agents that you have available.  Look for the ones that are least worrisome from the teratogenic point of view, but again, for most pregnancies, you’re not going to hit it at that time in the pregnancy as far as development goes.

I think we would never suggest that you need to delay something that’s must be done from a health point of view.  Most of these things are done, and most of these agents are used in pregnancy, judiciously, of course.


Dr. Hilton:

And to follow-up on that, if you look at the California Perinatal Health Guidelines, they had 250 references cited precisely in order to address concerns like this.  I’m going to assume that the question was related to standard dental anesthesia.  Again, for routine with the guidelines, we’ll tell you.  The guidelines were written by a group of expert physicians, dentists, OB GYN, family medicine, neonatologist, again, looking at the research on these very questions, and we’re not able to say.  Routine, standard, you have to present lidocaine with epinephrine.  In a routine pregnancy, there’s absolutely no contraindication, and, again, this is shown by the randomized clinical trial in the OTP and the anesthesia was used.

Again, routine anesthesia, standard anesthesia to do the scaling and planning and the fillings and extractions on the participants.  There was no difference in the outcomes relating to that.

Now, once you get into the other levels of anesthesia for dental treatment like nitrous or if you have to do sedation, then start getting into, as Dr. DeFrancesco said, the cost-benefit analysis on why you would need to use higher level management anesthesia and again the cost-benefit that is the condition that you’re trying to treat versus the potential effects on the mother and child.  Now, this is when you would have a consult with the perinatal health provider.



Great.  Thank you so much Drs. Hilton and DeFrancesco very much for answering those questions.  I am afraid that’s all we a have time for today.  I would just like to respond to a couple of questions about getting copies of the slides.  As I mentioned, the webinar itself and the PDF of the presentation on the National Healthy Mothers Healthy Babies Coalition website, and that website is, and you will receive a follow-up e-mail with the link to our website as well as the link to our Survey Monkey.

I would really appreciate it if you would all take a moment to share some feedback.  We would like to know your thoughts about the presentation today.  Would you like more of these kinds of presentations and just to hear a little bit more from all of you.  That was extremely helpful.

I would also like to say a very special thank you to today’s speakers, Mark DeFrancesco, Irene Hilton, Amy Gagliardi, and Rene Andersen.  I thank you all so much for your time today for putting this presentation together, and I also want to say a special thanks, once again, the Office of Women’s Health Region 1 for making today’s presentation possible.  We really do appreciate it.

Thank you all for attending, and we look forward to sharing all of these presentations on our website within the next day or so.  Thank you all so much.  Have a great day.

The Importance of Perinatal Oral Health P5


Thank you so much, Amy.  Now, I’d like to turn this over to Rene.


Rene Andersen:

Good morning or good afternoon.  This is Rene Andersen, and thank you Amy for such a wonderful lead in.  My task today is to talk about how do we get and keep women engaged in caring for their oral health.  The presentation’s going to offer concrete suggestions that help avoid common problems that prevent women form seeking dental care.

For women trauma survivors, pregnancy is a particularly challenging time.  Most women experience joy, fear, doubting, anxiety, a sense of connection and disconnection.  For women who have been previously victimized through childhood physical or sexual abuse, domestic violence, or sexual assault, this time of pregnancy is particularly fraught with either conscious or unconscious feelings.  It can trigger feelings of trauma, including physical pain by an authority person and unbearably intense emotions.

Let’s look at the scope of this issue, the scope of the issue of violence in America today.  Every 35 seconds, a child is abused or neglected in the United States.  In the past minute that I’ve been speaking, three children have been abused.  Every six hours, a child dies from abuse and neglect, and almost 500 women are raped or sexually assaulted each day.

Women and girls are most likely hurt by someone they know intimately.  Usually childhood physical or sexual abuse is perpetrated by a family member or a neighbor but someone that the family and the girls know well.  For an adolescent girl, the greatest risk of harm is from someone she loves.

I’m going to skip this slide on men since we’re going to be talking about pregnancy.  So, let’s get a look about violence and culture.  More than half of lesbians report at least one incident of sexual coercion by a same sex partner.  American-Indian, American native women are victims of violent crime including rape or sexual assault at more than double the rate of other racial groups.

Twenty one percent of Asian American women have a history of sexual abuse.  We suspect that is a low report, and a study of South Asian women found in heterosexual relationships that 40% of participants had been sexually or physically abused by their current male partner.

What we know is violence is the norm and not the exception in women’s lives.  It is universal, and we refer to this as the centrality of trauma.  In 1998, I heard about the ACE Study, the Adverse Childhood Experiences Study, which was a collaborative effort of Kaiser Permanent and the CDC, and it’s the largest study of its kind, over 17,000 participants, and it examined the health and social effects of childhood experiences throughout the life span.  Now, it’s interesting because the majority the participants were white, 77%.  They were 50 or older.  They had attended college.  They had health insurance.  They were at Kaiser Permanente.  So, this is a group that we typically think would not be of great risk for physical and sexual abuse.  The women, though, reported at least on childhood experience involving abuse or family strife, 66% of the women.

How did they define adverse childhood experience?  Well, they defined it as childhood abuse and neglect, physical and sexual abuse, and growing up in a home environment where the mother was treated violently.  There was substance in the family, a parent was institutionalized for criminal activity, a mental health diagnosis, or parental separation.

So, what happened?  This is the way they described the consequences of adverse childhood experiences.  When the experience occurs, there is a change in the body, which results in social, emotional, and cognitive impairment.  Then, there is adoption health-risk behaviors, which are coping strategies.  So, these are things such as when we begin to see kids drinking at early ages, doing drugs at early ages, promiscuity.  These are adaptive strategies.  This is how children begin to adapt to their lives and what happened to them.  That’s a result of these health-risk behaviors.  Let’s consider smoking one of those.  Disease, disability steps in.  So, people are most likely to develop lung cancer.  So, there is a correlation between adverse childhood experience and lung cancer.  We’ll look at a few examples of those correlative studies.

Social problems, if one of the health-risk behaviors is used to be sexually active at an early, this goes on, and one can become either as a street worker, or one goes on and gets STDs.  Also, you can end up in jail, in prison, as a result of this correlated childhood experience.  This all results in early death.

An ACE Score, we went over what those were before.  It is physical and sexual abuse.  It’s not how many times one was physically or sexually abused or how many times parents had psychiatric diagnosis or were in jail or prison, but each situation or condition is a score of 1.  So, the higher the ACE Score, the greater the likelihood of long term health consequences, extreme emotional responses, health risk behaviors (Those are those adaptive or coping strategies), serious social issues, adult disease and disability, high health care costs, and poor life expectancy.

This is an example of [inaudible 1:03:55].



So, I’ve seen a few questions.  While we’re trying to get Rene back, I just want to let everyone know that I’ve gotten a few questions about Q&A, and we’ll certainly get to that at the end of the presentation.  It seems there’s a possibility we may come to it sooner.  I’m not sure why we’re unable to hear Rene at this time, but hopefully, she’ll come back to us momentarily.

However, we’ll go through some of the questions.  This is, again.  Okay.  Rene?


Rene Andersen:

Yes, I’m back.  I’m sorry.  I lost connection.



Alright, welcome back.


Rene Andersen:

Thank you.  So, I’m going to go on and look at the ACE Score and intravenous drug use.   So, what we see here is the higher the ACE Score, the more likelihood there is intravenous drug us.  So, a male child with an ACE Score of 6 has a 4600% increase in the likelihood he’ll become an IV drug user later in life.  Up to 78% of drug injection by women can be attributed to ACE Score.

So, two important findings of the study.  The adverse childhood experiences are vastly more common than recognized or acknowledged, and adverse childhood experiences have a powerful relation to adult health a half-century later.

Amy referred to the necessity.  One of her recommendations is necessity for dental and medical offices to become trauma-informed.  In order for a survivor to have the best experience in the office, staff needs to be trauma-informed.  That is to better understand the emotional issues, the expectations, and the special needs that a person may have in a health care setting.

Now, I’m just going to be a little bit graphic.  An adult who has a history of being abused as a child, for example, may have experienced being pinned down, which replicates the position that one is in in a dental chair.  So, let’s look at Judith Herman’s definition of what it means to be trauma-informed.  Trauma-informed means for a trauma patient to have the best experience in the office, they need to understand the emotion issues.  We talked about that.  So, they will always seek out ways they can feel more comfortable in health care settings.

Let’s look at trauma-informed principles.  Trauma-informed principles are safety, trustworthiness, choice, collaboration, empowerment.  So, safety.  Safety and comfort are not the same thing.  We don’t expect that trauma survivors will be particularly comfortable in a dental, but we do expect that they can feel safe.  Safety is created by consistency and predictability.  What physical safety may look like is the dental chair position so that the woman’s back is to the door, and if it is, is there a mirror on the wall across from the dental chair?  So she can see who’s coming in.  Physical safety might also be is the chair able to go up and down, and can she control that?

Trustworthiness.  Do you do what you say you will do?  Let me give you an example.  I was in a dentist chair years ago, and the dentist and I, we agreed on a signal when the dentist would stop drilling when I was too uncomfortable.  I gave the signal, and the dentist said just a few more minutes.  That broke the trust between.  If you have an agreement with the woman to stop drilling when she indicates stop, do so.

Choice.  Do women have choice, a choice in terms of what the appointment is, which room they’ll be in, whether they have anesthesia or not, what kind of anesthesia they have. That is a conversation that you have in collaboration.  Is the dental care done in collaboration between the oral health provider and the woman?

Empowerment.  Is the women made to feel that she has power in this situation and can make those choices collaboratively, that she trusts you and feels safe?

These are the ways that you can help the woman feel safer and more comfortable prior to an appointment.  These are concrete examples to prevent retraumatization, and by retraumatization, we mean reactivating the body and mind events that replicate the original trauma.  Again, a little graphic, a woman on her back.  Her mouth is open.  She can’t talk.  These all frequently replicate the original that is sexual abuse.

So, prior to the appointment, a reminder call inviting the patient to bring anything that might add to her being comfortable during the procedure, any music or book on tape or pillow or blanket that she finds particularly comforting.  During the reminder call, encourage the patient to ask the staff any questions about upcoming procedure.  Make the dentist available to her.  Prior to the appointment, if a patient asks for sedatives for nerves, offer options and choice, meditation techniques.  Does your office have a handout on breathing techniques? Non-narcotic medication can be prescribe prior to the visit.  A CD on visualization or meditation on loan from the office.  Again, she could perhaps check out the CD on visualization or meditation prior to her appointment.

Ways you can help a woman feel safe and more comfortable in the waiting room.  Are the office chairs big enough and small enough to accommodate all sizes?  Literature available in language other than English.  Greet patients when they first arrive.  Greet patients by name and have someone bring the patient to the operatory room.

More comfortable in your office.  Offer a calming, soothing office environment.  I was in the dental office a few months ago, and one of the news networks was on.  It was covering a tragedy that had happened in the state, and there was a killing that had happened in the state.  I was noticing other people in the office sucked into that television screen and noticing body reactions.  People were getting more and more uncomfortable, twisting their body stiff.  So, if you have a television on, turn it on to something that is not so jarring.

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