45 Dental Practice Management

CM Marya

Since the time evolved, Dental practice has existed in one or ESTABLISHMENT OF DENTAL OFFICE
the other form. But it is not so long that it has attained the
status of a profession. Factors to be considered before establishing dental practice:
Webster’s dictionary defines a profession as “a calling • Selection of place
requiring specialized knowledge and often long and intensive • Selection of location
academic preparation”. • Selection of building
The dentist provides preventive, therapeutic and • Financial assistance
educational services, supporting total health for the control of • Selection of equipments and instruments
oral diseases and the promotion of oral health. • Designing of dental office.

Preventive SELECTION OF PLACE

Methods employed to prevent oral disease and promote health
(e.g. application of pit and fissure sealants, topical fluoride to teeth).
Therapeutic
Methods employed to arrest or control oral disease (e.g.
restoration of carious teeth, scaling and root planning
periodontally involved teeth).
Educational
Methods employed in both preventive and therapeutic aspects
to explain concepts regarding oral disease and health, to
demonstrate self-care techniques (e.g. teaching toothbrushing
and flossing, diet counseling).
DEFINITION
Practice management can be defined as the organization,
administration, and direction of a professional practice in a
style that facilitates quality client care, efficient use of time and
personnel, reduced stress to staff, and financial profitability.
To establish a good dental practice, first step is to establish
a dental office and secondly managing the dental office, which
includes personnel management, patient management and
record management.
• Personal choice of dentist
• Depends on the population demography of the area;
population density, age distribution and average salaries
of the residents
• Depends on number of dentist practicing in a place
• Whether dentist knows local language or not
• Place which is well linked by road, rail, air is good for
practice
• Good facilities for living
• Hobbies and interests of dentist
• Place where dental college are present for employment
• Depends on profession or job of spouse.
SELECTION OF LOCATION
• Depends on scope, style of practice and convenience
• In the heart of city as it is accessible for people from all the
areas of city
• Location with a good public transport facility
• Location close to government commercial offices, corporate
and business houses
• In residential areas it is good to practice in morning and
evening time as office goers can get treatment done before
going to office or after office time. Also, it is convenient for
old people and housewives.
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SELECTION OF BUILDING • Waiting area should be spacious considering future number

of patients also
• Building should be well ventilated, have proper water and • Design work area in such a way that even after placing
drainage system as well as power connection dental chair in supine position there is enough space all
• Building should preferably be on ground floor and have around chair for operating stool and assistant
parking facility for both dentist and patients • Have separate X-ray room, autoclaving and sterilization
• Select place where more area is available than present chambers near work place
requirement so that it can be expanded if required • Keep generators and compressors as much away as possible
• It is also possible to practice at home by making some from workplace
alterations • Visit many dental clinics before designing your own clinic,
• It is better to own dental office rather than taking it on rent. consult dentists for shortcoming and faults in their clinic
• Have insurance coverage against fire, burglary and riots.
FINANCIAL ASSISTANCE
• Many nationalized banks, private sector banks and state MANAGEMENT OF DENTAL OFFICE
financial corporations give help to establish professional
career for a new graduate. Types of Practice
Three ways of private practice are:
SELECTION OF EQUIPMENTS AND INSTRUMENTS 1. Solo dentist practice–dentist alone manages all types of
cases according to his/her capacity (Fig. 45.1).
• Should have basic equipments and instruments to run dental 2. Group practice–dentists specialized in various specialities
office and can keep on adding instruments as per need work together in the same office
• Selection of equipments depend on finance available 3. Single dentist with call facility for specialist–in this type,
• During selection of equipments importance should be given to dentist alone manages the clinical work but calls for a
reputation of company and after sale services provided by
specialist when required.
company
• It is better to have autoclavable instruments especially hand pieces, Whatever be the type of practice, dentist should be able to
scaler handle and tips manage the practice well.
• Sterilized or pre-autoclaved materials should be preferred when
one buys consumable materials like blades, suture materials,
PERSONNEL MANAGEMENT
gloves, syringes, needles, etc.
• Daily communication and regular staff meetings to
encourage the participation of all the personnel
DESIGNING OF DENTAL OFFICE • Appoint a full time receptionist, dental assistant and a
person to clean dental office
• While designing dental office consider functional, esthetic • The clinic should open much before the scheduled
and utility value of available space appointment of the patient and the assistant should keep
• Design should incorporate a spacious waiting area, work the required instruments autoclaved and ready.
area with dental chair and dental unit, X-ray room,
laboratory, resting place, toilets, etc.
• Placement of each electrical equipment, gadget which will be
used by dentist presently and also in future should be
considered while designing electrical connections
• It is better to have concealed electrical connection keeping
in mind the lighting, fan, exhaust, compressor, X-ray unit,
computer, dental chair, chair unit, music system and
speakers, etc. and also have few additional electric points
for future additional gadgets
• Know the exact position of dental chair and dental unit,
washbasin, and laboratory to design inlets and outlets for
water and drainage connections
• Floors and walls should be designed considering esthetics
and whether they can be cleaned easily. Instead of having
joints and grooves in tiled flooring, choose rubberized vinyl
flooring which is easy to keep clean Fig. 45.1: Dentist practicing solo
 Chapter 45 N Dental Practice Management 499
• Have sufficient amount of stock of materials and dental
staff should know how to make economical use of materials
• Should have business association with a good dental
laboratory which delivers work in time.

PATIENT MANAGEMENT
• Dentist should have good communication with patients to
ensure quality oral health care services and patient motivation
• Appointments should be scheduled for patients for effective
time management in the practice
• Dentist should explain about diagnosis, investigation,
different treatment plans available, cost of treatment and
mode of payment
• Instructions regarding care after extractions, maintenance
of artificial dentures, oral health education, etc. may be
Fig. 45.2: Computerized dental charting
given in written.

RECORD MANAGEMENT
• Record should be systematically maintained
• Written records include the dental and periodontal charts;
case history, record of examinations, diagnosis, informed
consent and treatment rendered
• Non-written records include photographs, radiographs,
models and cephalometric tracings
• Receptionist should maintain book of accounts by keeping
all bills of purchase of equipments, instruments, materials,
stationary items and subscription for journals, travel expenses,
fees for registration of seminars, conferences, receipt of water,
electricity, telephone bills and record for salaries for staff,
any donation given, etc.
• Many dental software programs are available for document-
ing patient record; spreadsheets with automatic accounting
functions, data management, graphics, scheduling, commu-
nications and education (Figs 45.2 and 45.3). Fig. 45.3: Computerized patient record keeping including radiographs

Table 45.1: Ten fundamentals of dental practice management

Bruce J Lowy

I. Communication: Dentist should have good communication with patients to ensure quality oral healthcare services and patient motivation.
II. New patient management: The primary objective is to make new patients feel important by exceeding their expectations. This impresses
people, and impressed patients accept higher levels of care and tend to refer more of their friends and relatives.
III. Treatment presentation: Dentist should explain about diagnosis, investigation, different treatment plans available, cost of treatment and
mode of payment.
IV. Financial arrangements: Effective means to help patients make financial decisions that affect acceptance.
V. Collections: Effective over-the-counter collection prevents many accounts from becoming delinquent and helps to preserve positive
patient relationships.
VI. Treatment planning and scheduling: Appointments should be scheduled for patients for effective time management in the practice.
VII. Continuing care and recall: Provide patients with a specific diagnostic reason to return for their next appointment.
VIII. Internal marketing: Many offices have found exceptional success using advertising via cable television, radio, mail, magazine, newspaper
advertising, billboards, telephone directories and other traditional business avenues to stimulate new patient flow.
IX. Managing the team: Daily communication and regular staff meetings to encourage the participation of all the personnel.
X. Financial analysis and control: Maintain patient record along with fees charged on day to day basis
Approach a C.A at initial stage of setting up the profession. Maintain book of accounts by keeping all bills of purchase of equipments,
instruments, materials, stationary items and subscription for journals, travel expenses, fees for registration of seminars, conferences,
receipt of water, electricity, telephone bills and record for salaries for staff, any donation given, etc.
500 Section 5 N Dental Practice
ACCOUNTING AND OTHER FINANCIAL
ASPECTS OF DENTAL PRACTICE (TABLE 45.1)
• Maintain patient record along with fees charged on day to
day basis
• Approach a C.A at initial stage of setting up the profession
• Maintain records of all expenses on a day to day basis
• Start tax planning by investing in approved schemes as life
insurance, public provident fund, N.S.C, tax saving bonds,
etc.
• Start filling tax returns from 1st year of practice itself as it
would help in being law compliant and also in obtaining
loans in future and avoiding enquiries from tax authorities.
FACTORS INFLUENCING DENTAL PRACTICE
I. LEGAL: Each dentist must respect and be well aware of
the law. Frequent review of the practice acts and/or
regulations is recommended to keep the dentist up to date.
II. ETHICAL: Dentists are ethically and morally responsible for
providing dental care to all patients, including those who
have been or may have been exposed to infectious diseases.
III. PERSONAL: Factors such as general physical health, oral
health and mental health should be given consideration.
Dentist should go for routine physical examinations at
least annually. Adequate physical health, vacation from
work, recreation and participation in social activities
ensures good mental health.
THE WAYS OF INITIATING A DENTAL PRACTICE
• Starting an own practice
• Buying an old practice and/or working with an associate
dentist.
STARTING AN OWN PRACTICE
Advantages of starting a new practice:
• The geographic location of the practice is a self decision.
• One may incorporate any ideas, concepts, philosophies of
practice or techniques according to his/her preference.
• One may plan, build or remodel a new facility or old facility
to meet the needs.
• Employees are the people of own choice.
• He/she is the only decisive authority in the practice.
Disadvantages of starting a new practice:
• One needs a major amount of money or a large loan.
• Building a patient base requires several years and diligent
effort in the practice.
• There is no assurance that the initial practice income will
keep up with the financial outgo need.
BUYING AN OLD PRACTICE AND/OR WORKING
WITH AN ASSOCIATE DENTIST
Advantages:
• One can start with an immediate income.
• The facility and the equipment are functional.
• No need to plan an office or be creative at the beginning of
the practice experience.
• Patients are immediately available to treat.
• The change from previous professional activities (school
or another practice) is not a major shock.
Disadvantages:
• The patients are devoted to the previous owner of the
practice, and one must make a positive impression with
them to gain their confidence and keep them in the practice.
• The previous owner may continue to treat the desirable
patients while he or she is still in the practice, limiting the
income and productivity.
• The employees are devoted to the previous owner.
• The equipment may be old and out of date, requiring an
outlay of money.
• The building may be old and in need of repair, or in a
geographic location that is not your choice.
• The previous dentist’s work may have been of a different
level of quality than desired in the practice, and the staff
will have to be re-educated.
• The previous owner may want to stay longer than originally
planned, and it may be difficult to take over the practice at
the agreed time.