GOT STRESS? How to Sail Through Your Day and Increase Profits as well

Many dentists are embracing bartering as a marketing strategy to bring in more patients by exchanging goods and services rather than charging a fee. Bartering also appeals to patients who need costly procedures for their families but don’t have dental insurance.

Trade International Exchange (TIE) is a barter exchange network that allows members to buy and sell products and services using TIE Dollars rather than cash. Businesses in certain areas use TIE to trade with physicians, dentists, and pharmacies in exchange for medical services for their employees.

To get medical services for its employees, a business sets up the TIE Healthcare Program, activating a barter arrangement with TIE. Agreeing to buy and sell specific company goods and services, these commodities are exchanged for healthcare and other needs such as plumbers, electricians, painters, ad agencies, and printers. Upon a firm’s request, TIE will pursue healthcare providers in areas that have no formal arrangements in place.

In trade exchange networks, everyone trades with everyone, even if they do not want what the other person is offering, according to TIE. Trade dollars are credited to a trade account in the exchange, which can then be spent on goods or service from within the network.

"Bartering makes sense, especially because today many people don’t have good health insurance and most people are underinsured," Stuart Kay, TIE marketing officer, told DrBicuspid.com. "Dentists have taken the opportunity to barter for years because it’s easy for them to do as small-business owners."

Bartering can also help dentists with collections, Kay added.

Besides medical services such as dental care, TIE offers bartering for a range of services, including car rentals, travel, restaurants, clothes, jewelry, landscaping, spas, vacations, and even real estate.

For example, while many children need braces, their parents can’t always afford it, Kay noted.

"If the parents are business owners, they can provide services like graphic design" in exchange for orthodontic services, he explained.

Marc Frankel, DDS, who has a practice in Hallandale Beach, FL, has provided oral surgery and preventive procedures for four patients in a family that owns a Latin restaurant in town. In exchange, his practice is being marketed in the restaurant.

"It’s a restaurant that I like," Dr. Frankel told DrBicuspid.com. "I think it’s a good idea."

More dentists are getting involved in bartering exchanges, according to Kay.

"People today need to be more creative because so many have lost dental coverage," he said.

He cited a manager of a high-end restaurant whose wife needed $20,000 worth of dental work. The manager traded exchange credits with an orthodontist who could then use the credits for whatever he wanted.

"Anything you can do with cash, you can do with trade, including healthcare," Kay said.

His brother, Marc Kay, DDS, uses the exchange to help market his Phoenix practice. Dr. Kay is one of 20 dentists who are TIE members.

The company charges a lifetime membership fee and a monthly maintenance fee. TIE also collects a percentage of the transaction when the goods are bought and sold, which range from 5% to 7.5% for both the buyer and seller.

Exchange credits are based on the retail price of goods or services, and dental procedures have set rates. Members can save their credits, and the company also offers lines of credit.

TIE has 1,000 members, including businesses and consumers. Some 65% of the Fortune 500 companies barter, Kay said, including charities that barter for millions of dollars.

"It’s a way to market, get people in, and have fun," Dr. Frankel said.

 

Educating adolescent patients with diabetes about oral hygiene can go a long way toward improving their overall health, according to a study presented at the recent International Association for Dental Research (IADR) meeting in Seattle.

The researchers found that less than half of the adolescents with type 1 diabetes in their study strongly agreed that taking care of their gums is as important as taking care of their medical health.

The subanalysis of people enrolled in a study of the epidemiology of cardiovascular risk factors in adolescents with type 1 diabetes was conducted by Anne Wilson, DDS, MS, of the Children’s Hospital Colorado and an associate professor of pediatric dentistry at the University of Colorado School of Dental Medicine, and Elaine Morrato, DrPH, MPH, an associate professor at the Colorado School of Public Health. They analyzed responses from 182 subjects to a 40-item oral health questionnaire. The youths first completed the questionnaire and then underwent a dental evaluation.

The 120 young people with diabetes and 62 without diabetes had an average age of 15 years and were equally split between boys and girls; 80% were non-Hispanic whites. Their average body mass index Z score — a measure of relative weight adjusted for each child’s age and sex — was 0.44, indicating their average weight was very close to average for their age group. Furthermore, 73% were late- or postpubertal.

Of the total group, 84% had dental insurance, and 80% had a dental checkup in the previous six months and 55% had previous orthodontic treatment.

The survey results also revealed that the subjects who did not have diabetes had brushed their teeth an average of 11.6 times in the previous week, compared with an average of 9.7 times among the children with diabetes (p = 0.008). They had flossed an average of 3.1 and 2.3 times, respectively, in the previous week (p = 0.17).

Adolescents with or without diabetes both had bleeding on probing at more than half of their teeth. However, the percentages of teeth and sites/subject that bled on probing increased in a stepwise fashion with hemoglobin A1c levels, rising from 40% among those with normal levels (< 7.5%), to 56% among those with early-stage diabetes (7.5% to 9.5%), and to 70% with severe diabetes (>9 .5%, p < 0.001). The investigators noted this is consistent with increased risk for vascular complications from suboptimal glucose control.

Furthermore, the average periodontal pocket depth was 2.02 mm in the diabetes group, compared with 1.93 in the nondiabetes group (p = 0.01). The average clinical attachment loss was 0.73 mm and 0.62 mm, respectively (p = 0.005).

In contrast to their somewhat lax brushing and flossing habits, 43% of the adoloscents with diabetes indicated they knew diabetes confers an increased risk of periodontal disease. Just 8% in the nondiabetes group were aware of this fact. But — perhaps indicating why they are keen flossers — only 44% of those with diabetes agreed that taking care of their gums is as important as taking care of their medical health.

This is a red flag in an era when more and more evidence links diabetes and periodontal disease, Dr. Wilson noted. The relationship is probably bidirectional, she suggested, with individuals with diabetes possibly experiencing an exacerbated systemic response to periodontal pathogens and pro-inflammatory cytokines associated with chronic periodontitis increasing insulin resistance and contributing to poor glycemic control.

"Therefore, as dental practitioners, we have an opportunity to contribute in a meaningful way to health promotion for children and adolescents with diabetes through early disease detection, vigilant dental maintenance, monitoring of blood glucose levels, nutritional counseling, and ongoing collaboration with medical providers for the optimal health of patients," said Dr. Wilson, who presented the findings at the IADR meeting.

 

The alarm sounds and you hit the snooze button — multiple times. Finally, looking at the clock, you realize you have exactly 23 minutes to get dressed, brush your teeth, grab a quick breakfast, get to the office, have your operatory set up, and enter the reception room to call back your first patient of the day.

Anxiety and stress start to set in as soon as you realize your patient is late — 15 minutes, to be exact, and they are scheduled for BWX, full perio charting, and an exam. Even though you’ve worked into your lunch to make up for the lost time, you smile and provide every patient optimal treatment throughout the day. Of course, with this type of day-to-day activity comes stress and anxiety, along with hand, arm, neck, shoulder, and upper back pain.

I have always made a conscience effort to follow the rules of proper ergonomics, but nonetheless, I began to feel the effects of repetitive movement after only five years of working in a clinical setting. I realized if I wanted to last, I needed to make a change. The following chronicles my journey of realization — both personally and in the office — when it comes to finding alternatives. You’ll see how exercise helps me and how alternative oral healthcare methods help my patients.

 

Looking for stress relief

Yoga, associated with benefits such as stress reduction and lower blood pressure, has been a main focus with individuals afflicted with musculoskeletal disorders. Dental professionals certainly fit into this category with disorders that can develop from repetitive movements and awkward postures, so I decided to give it a try.

When I first attempted the "easy" downward dog pose, the instructor properly aligned me and stood there for the full five minutes we were to hold the pose. Holding any pose for this amount of time is not easy, and I quickly began to realize the challenge yoga provided. I was determined to get this down and be the model student, no matter how difficult.

My grandmother always said, "Practice makes perfect." I kept that in mind, and soon enough I was a downward dog extraordinaire. My next goal was to master the headstand. I adopted Grandmother’s advice once again and continued to practice. After about three months, I was able to successfully hold a headstand pose and basked in the feeling of triumph.

My next goal: the side crane pose (I’d recommend you refer to Google for a visual!). It had been roughly one year that I tried to conquer this particular pose when I realized Grandmother wasn’t always right. There was no amount of practice that could result in being able to successfully stay in this pose. I decided to not let this get the best of me and adopted a different way of holding a similar pose. The new pose offered the same flexibility and strengthening benefits. Finding an alternative helped me achieve the same success.

 

In-office communications change

Even if you are not one to join in the yoga craze, think about something we deal with every day as clinicians, where practice doesn’t always make perfect: flossing. I started my dental career as a surgical assistant for a top periodontal practice, and my primary goal was to teach patients how to properly floss around their newly placed implants.

We all know the drill and could teach it in our sleep. So why is it that most of our patients do not adapt to this habit, and, better yet, why do they make it look so difficult? A very good friend and I were discussing the topic one day, and she said, "I often wonder if my patients are bad students or if I’m a bad teacher." It hit me for the first time that it wasn’t my patients who weren’t getting it; it was me. I was teaching every patient the same technique every time they were in the office and expecting the same results. Just like me and my frustration with the side crane pose, I needed an alternate practice to recommend for my patients who just couldn’t grasp the practice of flossing. The use of string floss may be the gold standard for interproximal cleaning, but if a patient will not adapt to flossing, why not have a backup plan?

Compliance is ultimately the key factor, but people tend to adapt to practices that are easy or at least attainable. I am not going to continue to recommend string floss to my patient who says, "I find it difficult to get my fingers in the back of my mouth." This type of patient would benefit much more from a product such as Philips Sonicare AirFloss, where the only thing the user needs to concentrate on is placing the guidance tip between their teeth, in the embrasure space, and pressing one button to achieve a quick and effective 60-second clean. The device can be filled with either water or mouthwash for an extra burst of freshness, an appealing draw for many patients.

Changing my approach to the side crane pose was needed to accomplish goals in my yoga practice, just as changing my approach and identifying alternatives to oral health instruction are needed to help my patients achieve their goals to have healthier mouths.