2. The Business of Dentistry From Employee to Entrepreneur The Future of Dentistry….by design

6. Take Home Points 1. The population is getting older and more diverse, leading to different disease patterns, care giving behavior and ability to pay 2. Consumers are becoming more astute purchasers of health care and seeking value for their spending 3. An increasing number of dentists are being trained, but mounting debt and changing demographics are altering the practice choices for new dentists

7. 4. Pressures are growing for an expanded dental team to provide preventive and restorative services 5. Care is being integrated within “Patient centered medical homes “ in medicine but inclusion of dental care servicers has been slow.

8. Conclusion Given the link between oral health and overall health, there is much promise for integrating dental services into overall health services. However, there is little evidence to suggest that the integration of dental services is little more than a possibility at this time.

9. Anthony Van Leewenhoeck 1673 Developed a microscope and described “many little living animalcules very prettily a moving ”

10. Dr WD Miller 1853-1907 “ The mouth is a focus of infection where microorganisms or their waste products obtain entrance to parts of the body adjacent to or remote from the mouth”

11. Dr Thomas Hartzell At the 1916 National Dental Association meeting, Dr Hartzell described how “neglected teeth act as a gateway for deadly germs into the system”.

12. Dr Weston Price

13. Authored Dental Infections Oral & Systemic Dental Infections and the Degenerative Diseases Fundamentals of Oral Expressions of Dental Infections

14. Dr Bob Barkley

15. Dr Barkley spoke of the necessity of treating patients as total beings. “The new information on disease control has made patients responsible for their oral health and therefore it is our responsibility and obligation to involve patients in a health story. My office needs to be primarily a place of oral health education. Shifting offices from case centered to patient centered connecting with patients through empathy, patience and compassion. Coined the term “co-diagnosis”

16. DR Paul Keyes NIH researcher 1955-1981

17. Paul Keyes DDS First to use the term dental plaque First to show a direct relationship between microbial dental plague and periodontitis First to show microbial specificity in dental caries development First to document infectious spread of dental caries First to document the infectious spread of periodontal pathogens Formulated 1% sodium fluoride Invented vinyl tray applicators for topical fluoride

18. The 4 Eras of Dentistry

19. ERA 1 40’s 50’s 60’s Very much problem focused Patients went to the dentist when they had a problem…when they were in pain If you have this type of patients in your patient, who can still meet them where they are and help move them toward total care

20. ERA 2 Late 60’s and 70’s Dr Bob Barkley A philosophy of comprehensive care that focused on diagnosis,prevention, education, and relationship building. People were beginning to get the message that you needed to have your teeth “cleaned” on a regular basis in order to be healthy

21. “Complete dentistry is giving the patient the opportunity to do all of the work that you have diagnosed at their own pace within their financial and psychological comfort zone even if it takes years to accomplish” Thomas Larkin DDS The Dental Entrepreneur

22. ERA 3 The Golden Age of Dentistry Where technology meets demographics Focus was on aesthetics 45 y o was determined to look good for a variety of reasons Money was FLUSH Cosmetic training exploded – Dr’s Dickerson,Rosenthal,Hornbrook

23. ERA 3 1988- 2008

24. September 2008

25. 2009 Predictions “This is not a momentary correction, nor a down cycle – it’s the end of the world as we know it. A Premium will be placed on Doctors and offices that demonstrate “empathy”; an understanding of the consumer plight.

26. The Marketplace Today (mavericky) In February of 2009,putting continuing education resources, i.e. time and $$$$$$$ into elective, vanity based dental services is fraught with EXTREME RISK Dr Tom Larkin *

27. Wants Vs Needs We are entering a prolonged period in our Country’s economic history where individuals are redefining what their Needs Are I Want Pretty White Teeth I Need To Be Able To Eat Do not position yourself on the wrong side of this equation

28. The Ultimate NICHE 2009 Lecture UKCD The Biological, Health Oriented, Dental Practice is the LARGEST EMERGING MARKET opportunity in modern History 1. Biological Caries and Perio Risk Assessment 2. Minimally Invasive Dentistry 3. Remineralization and Antimicrobial Therapies 4. Advanced Non-Surgical Perio Therapy

29. ERA 4 2010 - ? The shift from aesthetics to health and wellness The 4 th generation patients want a dentist who will listen and work with them and not just on them.

30. AAOSH

31. ERA 4 2010

32. What Concerns Boomers Today Brain Health Event…heart attack, stroke Mobility

33. Where Do They Spend Dollars Hormone Replacement Anything Anti-aging Anything related to mobility and brain health These are not covered by Delta Dental

34. What Boomers Want Do boomers want to go to a clinic and get a one size fits all solution They are looking for quality of life solutions

36. The Opportunity 1. To address the connection of what is going on in my patient’s mouth and how it relates to their overall health 2. Identify their risk factors associated with oral disease 3. Diagnose and treating disease in its very earliest stages until waiting for physical damage 4. Provide patients with an individualized plan that meets them where they are

37. The Business of Dental Hygiene 1/3 to 2/3 ratio

38. The Language of Era 4 Biofilm Bacterial Load Oral Disinfection

40. The Conversation The conversation must change from removing the “stuff on your teeth” to the bacterial environment in your mouth and the consequences to your overall health

41. The Ultimate NICHE 2009 Lecture UKCD The Biological, Health Oriented, Dental Practice is the LARGEST EMERGING MARKET opportunity in modern History 1. Biological Caries and Perio Risk Assessment 2. Minimally Invasive Dentistry 3. Remineralization and Antimicrobial Therapies 4. Advanced Non-Surgical Perio Therapy

42. Dr Bradley Bale/Amy Doneen

43. Bale Doneen Method

44. Bale Donneen Method Periodontal Disease is an independent predictor of CV risk and oral infection may trigger a heart attack Patients with known CVD should have regular visits with a hygienist and dentist If there is a puzzling inflammatory level, consider oral disease. Periodontal Treatment Improves Glycemic Control Periodontal Wellness Reduces Risk of Stroke ALL cardiovascular prevention programs must include an oral/systemic component

46. The Technology of Era 4 Video Microscopy

47. Perio Path

48. The New Paradym

50. Relationship between longitudinal change in periodontal status and change in common carotid artery intima ‐ media thickness. Desvarieux M et al. J Am Heart Assoc 2013;2:e000254

52. Health Care Costs

55. Tomlarkin.com tom@tomlarkin.com