TBU #028: How To Make Money Doing Biomimetics In A Pediatric Medicaid Office
Nov 19, 2022
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"Ok! I love biomimetics but I cant do it in my office right now. I'm an associate and I can't always pick my materials, what procedures I do, and all that stuff. I'm stuck in this position for another few years until my contract is up. C'Mon man, you know how it is!"
Actually, I do. I've been there. Well, never had a contract or anything like that, but I did have that pressure to preform like 4 crowns a day, 3 root canals, and place like 5 implants at the same time. Sometimes that pressure that comes from working for someone is overwhelming. They want high production and speed at the same time, and oh... while doing it as fast as you can.
My first job out of school was at a group practice that was attached to a hygiene school. We were responsible for doing the hygiene checks for the school but also had to balance what the front office was bringing to us.
One day it was slow with not much going on, I decided to get up and walk around the clinic. I looked back and see the neighboring clinician was legit doing an exam, molar Endo and placing an implant on three separate people at the SAME TIME! Call that efficient, call it questionable quality, call it whatever you want. For me, I call it impossible.
It was impossible for me to preform at that level right out of school. But it was also impossible for me to get any of those patients. It was also impossible for me to WANT to do that. Implants were new for me at the time, but I'm 100% capable of molar Endo or definitely an exam. It was obvious I wasn't the office's first choice.
So that was a big wake up call. I was super excited about biomimetics at the time and was eager to put into practice all the things I had learned the few years prior. I realized that I had to expand my thought process and adapt. I realized I had to do at least one of three things. 1) I had to acquire new skills 2) work faster 3) and/or learn to not care too much about quality and the end result.
While I know you can learn to go faster, I never considered myself slow. I always finish my appointments on time. But being able to jump from room to room AND finish on time? That was next level. However, its not the next level I want tho. I just know it takes time and certain steps in order to delver what I think is quality. Maybe thats a bit over zealous of me, idk. So after some reflection, number 3 was something I could not do. That left me with number 1 and 2 as my focus.
Ok, so the new skill. I just wanted to do biomimetics. What new skill is there that could be related to that?
Kids!
What? Kids?
Yes. Kids need work too. Kids' teeth are teeth. Biomimetics still applies right? Of course it does!
It wasn't until I took a course with J. Tim Rainey that I realized what exactly that meant.
His course was about medicaid, or government sponsored, pediatrics, minimally invasive, and air abrasion.
For those that know me, know I love air abrasion. This course is part of the reasons why. Air abrasion has the ability to offer so many benefits. Biomimetics or not. One of them is the ability to work without having to get the person numb. Thats amazing! Literally half the people in world hate going to the dentist because they dont want a shot. Well...not sure on the stat... but you get the idea. But this is a huge benefit to out patients.
So in my practice, I NEVER get kids numb. Its just not what we do. Here's how I do that.
Side note*** This has been a huge resource for referrals. I acquired an older practice and this has helped me make a huge shift to seeing younger families.
Ok so back to the protocol for working on kids.
So if a younger person, or even adult, has a need for an occlusal restoration, or even a small two surface, odds are, I'm using air abrasion to do the prep.
Crystalmark Dental says on their site...
Once the prep is done, you have two main options for how to restore the tooth. I'm either using composite and going with the classic biomimetic protocols or I'm going to use Glass Ionomer.
I like to use Fuji Triage for my 'go to' choice. Its fantastic for kids and preventing caries, especially when were working in moist environment of a kid's mouth. With Fuji Triage, you typically don't need a bonding agent, but if the woking field is good, I'll place SE Protect, or even QuickBond from Kuraray, to further seal and protect the tooth. From there, you just place the Fuji Triage in the prep, do some needed shaping and you're done! Its a quick procedure that takes about 15 minutes.
To fully adapt this concept in your office, you can block off a pure pediatric restorative day. This type of scheduling can be a benefit in a high patient volume office that takes medicaid or lots of insurances. These appointments are fast, no crying, and have an easy room turnover process as there aren't a lot materials being used. These days can be high production days because you are doing so many appointments at once. These can be scheduled every 15-30 minutes depending on the child. Depending on how the office is setup, these can really boost the practices production. This is something that I have implemented in two of the offices I worked at before purchasing my own and they have been a success.
This is an easy way to increase production without adding extra stress. The main hurdles are getting an adequate air abrasion unit and making sure there are enough kids to justify the full day. Plus, as mentioned before, this has been a huge practice builder.
There you have it! Learning a new skill and working faster. At the end of this, I could feel good knowing that I was offering quality care and as well as helping kids not hate going to the dentist!
So for the recap and actionable tips?
- Get air abrasion if you dont have it. Its worth the investment. I recommend CrystalMark or AquaCare. The other units typically don't have enough power or efficiency to cut enamel.
- Start restoring pediatric teeth with Fuji Triage
- Schedule pediatric restorative days when the numbers allow it.
Whenever you're ready, here are the ways I can help you:
- If you're looking for better application in your practice, take a look at our online courses and guides
- The Foundations Of Biomimetic Dentistry
- How To Do Biomimetic Posterior Direct Composites.
- Get our 53 page biomimetic protocols guide for posterior direct restorations.
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