Oh Great, I’ve Got This Kid with Oral Pathology … What Do I Do with That?!

By Dr. Ben Curtis

Has this ever happened to you? I know I am not the only one! As a pediatric dentist, this is one area where I use to be nervous and concerned, but I know is an opportunity for my office to shine. I integrated an all-tissue laser into my pediatric practice five years ago and it has been a game changer for my patients and my office.

This case is of a 5-year-old child who has a mucocele, a ruptured salivary gland that has formed a cyst of saliva that persists or gets larger. Fig. 1 is before treatment and Fig. 2 is two weeks post-treatment. These lesions are almost always caused by trauma and are quite common in early childhood. Kids of this age are not known for leaving things alone and they tend to bite and suck on these swellings, which makes them worse. The traditional surgical treatment involves a scalpel, lots of gauze to control hemorrhage and sutures to close the surgical site. Well, that sounds terrifying on a 5-year-old child! Not fun, right?

Fig. 1
Fig. 2
Fig. 3

Then comes the all-tissue laser and changes everything! With an all-tissue laser, we can provide a more minimally invasive surgical approach with minimal bleeding, no sutures and excellent healing … and dare I say, fun for me as the doctor! Could this be a win-win situation for both the patient and the doctor? Yes! I have been able to help countless patients who have these oral pathology lesions with the all-tissue laser in a simple in-office procedure that takes me less than 10 minutes. This procedure has become my most favorite pediatric procedure to preform, and it is all do to the all-tissue lasers help!

Dr. Ben Curtis is an FDC2022 speaker and will be presenting two courses on Thursday, June 23. “Integrating Laser Dentistry into Your Pediatric Care” will be at 9 a.m. and “Lumps and Bumps, Oh My! Successful Removal of Pediatric Soft-tissue Pathology with an All-tissue Laser” will be later that day at 2 p.m. For more information and to register, visit floridadentalconvention.com.

Market Appraisal: Transitions & Valuations

By Greg Auerbach, , MBA, Henry Schein Dental Practice Transitions

Leading up to early March 2020, practice values and sale prices in Florida were among the highest they had been in years, if not decades. This was driven by solo practicing dentists, smaller multi-dentist groups and DSOs in the marketplace hungry for acquisition. Smaller, local lenders had access to money that was readily available from reputable national lenders. There simply were more purchasers in the market than there were sellers. Aided by practices continuing to strengthen after the economic challenges of prior years and increasing net income, the market could not have been better. Then the clock stopped as we saw practices close abruptly early 2020. We all know what happened, but what was the result? Where did things go and what can we learn? 

After reopening, we saw a very strong recovery with many practices increasing their average monthly collections over 2019, despite the shutdown. For many, this continued into 2021 where, after accounting for the time of forced inactivity, it was almost as if 2020 was just another data point in continued year-over-year growth. This created a “first” amongst evaluators and transitions specialists — specifically, how is 2020 accounted for and how is the continued viability and sustainability of the practice made evident?  What has that meant going forward? Value has remained high and practice sale prices have similarly remained high. We note that investments made in the practices, whether by way of equipment/technology, team training, patient communications or personal education, proved a strong positive return on investment.    

In all, the timeless question continues to be top of mind: Where does value come from? How is the real value, the intangible of a practice quantified and how does value get protected and transferred in a transition? Even now, it is not uncommon to hear a doctor firmly state that practice value is 60-70% (of something). That “something” may be collections, production, an average of three years’ of collections or some other “methodology.“ While we, and many others, have published articles locally, regionally and nationally, and presented casework to demonstrate how this is incorrect, the myth persists. If you are looking to purchase an existing practice, it could mean that you miss out on stellar opportunities because your mental “evaluation“ of an asking price is not consistent with the current market. If you are considering a sale, it could mean that you agree to sell at a lesser price that could have been otherwise obtained. There is no magic formula that can be applied to all practices.

Once the hurdle of pricing is conquered, though, the pitfalls of the process abound. Transition is not about two people making an agreement, it’s two (or more) doctors — often, it’s two spouses, two accountants, two attorneys — at least one banker and their team (if not more), not to mention any other advisors, all whom are vital to crossing the goal line. Who are these other participants, though, and what should they do? 

We often come across “experts“ who stray from their experience or knowledge to try to do more, with real-life scenarios resulting in a deal that is not consummated or made very difficult from start to finish. We are seeing more out-of-state advisors who are evaluating and providing advice for practices in Florida with no local knowledge. In a lot of cases, their credentials are internet-based and there is no real personal relationship, let alone hometown or “on the ground” knowledge.

Having advisors is important; the goal is for everyone to work in concert while properly representing their client. How is this done? Further, what are the best practices for evaluating the practice and transition, working with the staff, retaining the patient base and setting the table for success? The stories of the “bad” are numerous and can be a point of education, but so can the successes. 

Experience and expertise matter in every aspect of dentistry, and this does not exclude practice transitions and evaluations. Learning how to best ready yourself, whether as owner looking to transition or non-owner looking to take the next step in your career, understanding the ins and outs of the methodologies and processes and the members of the team around you is vital. 

Mr. Auerbach is an FDC2022 speaker and will be presenting “Transitioning Transitions and Valuing Value: The Good, the Bad and the Ugly” on Thursday, June 23 at 9 a.m. Visit floridadentalconvention.com for more information.

Safety in the Dental Office

This week, Beyond the Bite is featuring not one but TWO speakers for the 2022 Florida Dental Convention (FDC)! There’s a similar thread between the two — both blogs refer to safety, but in different ways. Ms. Keri Higby addresses personal safety, while Dr. Larry Williams discusses safety in a medical emergency.

Make plans to attend FDC2022, “Dentistry & Systemic Health: Mouth, Mind & Body Connection,” June 23-25 at the Gaylord Palms Resort & Convention Center in Orlando. For more information, or to search by speaker or course, visit floridadentalconvention.com.

S.T.A.R. (Safety Tactics and Awareness Response) in the Dental Office
By Kerry Higby, certified self-defense instructor

In 2012, the Seminole County Sheriff’s Office created a Women’s Self-defense Program, now called S.T.A.R. (Safety Tactics and Awareness Response). This program has been tremendously successful in the community, as we try to educate women on how to maximize their personal safety.

We’ve built strong partnerships in the community through this program and have worked with a wide variety of organizations, including Publix, Hospice of the Comforter and Seminole State College, among others.

Our mission is to reduce the opportunity of violent crimes through teaching women how to increase their situational awareness, reducing the risk of becoming a victim and how to avoid confrontations. It’s important to realize that self-defense is 90% mental preparedness and 10% physical. The techniques and knowledge we share with participants gives them a sense of empowerment to help them become their own best defense.

It’s important for everyone, especially those professionals who have close contact with the public to remember these three concepts:

  1. Create a plan of action.
  2. Remove the risks of becoming a victim/target.
  3. Increase your situational awareness

Practicing and thinking about “what if” situations allow workers to have a plan in case they need to defend themselves. It is similar to the Run, Fight, Hide concept that is used with armed attackers and mass shootings. Designing your environment for optimal safety and security, when possible, helps to significantly lower the risk of becoming a victim or target. This can be done through crime prevention through environmental design. Securing/limiting office access, cameras and lighting are all examples that can help create safer business settings. Overall, the most significant defense one has is to increase their situational awareness skills everywhere.

Two self-defense techniques you can use to help in a situation is your voice by yelling. Attackers don’t want attention. By using your voice, you not only draw attention and may get potential help from bystanders, but you stay breathing instead of freezing or panicking. Another basic technique is to maintain your distance, if possible, from a potential attacker. Quickly scan the area that you find yourself in and be ready to run/escape.

Remember, if you think about what you would do in a dangerous situation, you will be more likely to react and survive, instead of being caught off-guard and panicking.

Ms. Higby is an FDC2022 speaker and will be presenting, “S.T.A.R. Women’s Self-defense Deep Dive” on Thursday, June 23 at 9 a.m.

Stop the Bleed: Safety in the Dental Office
By Dr. Larry Williams

Imagine coming out of your favorite downtown store and the security guard at the door is looking up. You notice other people around the entrance looking up. You look up and realize that a crane across the street has become unstable and is likely to fall. Before you and others can move to safety, the crane falls and sends debris everywhere. A piece strikes the security guard in the leg, and he immediately falls to the ground bleeding severely. The crash is over but everyone, except you and the guard, flees to safety and you are left standing and staring at the fast-expanding pool of blood next to the security guard.

What are your options?

  • Run away to safety like everyone else.
  • Call 911 and wait for help to arrive.
  • Call 911, realize you are the help until help arrives, make sure it is safe, and then work to stop/slow the bleeding.

Blood delivers oxygen to the organs, and a sudden significant loss of blood can lead to shock and eventually death. Experts agree that severe bleeding can lead to death in as little as 5 minutes. You need to figure out how to keep the blood in the body.

Techniques can include using pressure at the site of bleeding, pack the wound and apply pressure, using a tourniquet on the heart-side of the wound, and arterial pressure if possible. The “Stop the Bleed” course was created to address the above scenario, and to date, more than 1.5 million people have been trained to address bleeding. Do you want to learn more? Take my course at FDC2022, where I’ll be speaking on this topic and more!

Dr. Williams is an FDC2022 speaker and will be presenting several courses. “You Are the Help Until Help Arrives Deep Dive: Hands-on First Aid and STOP THE BLEED® Training” will be on Thursday, Jun. 23 at 9 a.m., and later that day, “Pharmacology and Your Dental Patient: An Update!” will be at 2 p.m. On Friday, June 24, “Geriatric Dentistry: Treatment Planning, Treatment Concerns and Communications” will be at 9 a.m. and “Tobacco, Vaping and Cannabis — What do you know?” will be at 2 p.m. 

The Prevention of Musculoskeletal Disorders in Dentistry  

By Rick Williamson, CPT, Body Praxis, LLC

More than 80% of dental professionals suffer from pain associated with musculoskeletal disorders caused by the demands of their profession. Years of hunching over patients, reaching and stretching in awkward positions, fighting with equipment, and coping with the physical redundancy of the occupation leaves the professional with daily pain and chronic discomfort. Dentists commonly suffer from tingling and numbness in fingers and hands, and deal with shoulder, back, neck and hip pain.

These regularly occurring conditions, if ignored, can cause cumulative physiological damage that may lead to a career-ending injury. Like a professional athlete, the dental professional needs to understand how rigorous physical strains and repetitive movements lead to muscle imbalances, postural dysfunction and compensatory movement patterns. Overused muscles fatigue while underused muscles fail to properly support the spine and extremities. Fortunately, the pain and discomfort of dentistry is avoidable. Like an athlete, the dental professional needs to physically train to prevent and reduce pain. Unfortunately, if muscle imbalances and compensatory movement patterns already exist, general exercises can be detrimental. They tend to only reinforce faulty movements and imbalances. Without focused and specific movement reeducation, the strong and overused muscles and systems will be further strengthened while the neglected musculature will remain weak.

Biomechanical reeducation must be introduced and consider the occupational, recreational and daily activities. Oppositional movement patterns must be created to counteract imbalances and common repetitive positions. The importance of muscle recruitment, balance, spine segmental mobility, stabilization, and breathing techniques need to be properly learned to restore function and alleviate pain. We advocate the introduction of these specific programs as early as dental school. A strong emphasis on a daily commitment to the program will provide career sustainability and contribute to overall wellness.

“The dental professional needs to learn to break out of the habitual posture any time they are not engaged with the patient.”

One specific concept that is valuable to many dental professionals is the concept of engage-disengage. This is a concept that anyone can easily incorporate into the workday. Often, procedural work places the dental professional into a postural position of forward flexion and rotation of the spine and hips in one direction. This creates imbalances that the engage-disengage technique can address. The dental professional needs to learn to break out of the habitual posture any time they are not engaged with the patient. They need to learn to come into a neutral postural position to retrain the body to know where proper alignment is. They learn to incorporate it throughout the day and even outside of the office in other activities, reducing the cumulative trauma of repetitive faulty positions.

Another common problem is hip and pelvic pain. Sitting in the dental stool forces the pelvic bones into a rotation, which is held for long periods of time. Over time, the cumulative effect can lead to a fixed rotation of the pelvis, causing misalignment and pain.

A common movement or exercise used to reeducate pelvic alignment is pelvic rolls on a stability ball. While seated on a stability ball, movement is initiated by the coccyx (tail bone) as the pelvis is rolled forward and back. This creates a nutation and counternutation of the pelvis, which reeducates and realigns the pelvis to eliminate pain.

These techniques are demonstrated and further explored in my “Body Praxis” seminar at the 2022 Florida Dental Convention (FDC).

Mr. Williamson is the creator of the Body Praxis System and can be reached at bodypraxis@aol.com. He will be presenting his course, Body Praxis: Physical Rehabilitation for Dental Professionals  — “The Prevention and Reversal of Musculoskeletal Disorders in Dentistry,” on Saturday, June 25 at 9 a.m.-12 p.m. and again at 2-5 p.m.

View all FDC2022 speaker and course offerings today. Registration opens in March 2022.

Reprinted from Today’s FDA, Jan/Feb 2021. Visit floridadental.org/publications to view Today’s FDA archives.