Dr. Jim Clark, Benco Dental’s Head of Practice Transitions, has bought and sold multiple practices during his 30-year career. But only once did he buy a practice, and end up selling it back to the owner. 

The year was 1997, but the rustic log cabin housing a dental practice appeared to be out of the mid-19th century. Situated on the bank of a Montevallo, Alabama creek, it was owned by the chief of the fire department, the head of the Montevallo historical society, and the director of the state historical society—all the same person. In over his head, the busy practice was slipping from the dentist’s hands. 

Dr. Clark, by then savvy on streamlining systems and confident in his ability to whip it into shape, bought the practice with hopes of making lasting changes. His intention was to focus on the business side so the former owner, a beloved figure in the community, could keep doing dentistry. 

Kind—but eccentric

“He could have had an instrument in a patient’s mouth, but if that fire alarm went off, he would have jumped on the truck and left the patient in the chair,” Dr. Clark remembered. It’s also an understatement to say the doctor was flexible with patients who had trouble paying. “He graduated from The Pankey Institute, but he would have traded dentistry for just about anything…pigs, chickens, someone to paint his house.” 

Visits to the practice were spent encouraging the dentist to adopt better financial management. When Dr. Clark wasn’t there to oversee things, the office management team kept them in order. “This particular practice needed a lot of outside management,” Dr. Clark said. “He was pressuring the assistants to return to old ways when I wasn’t there. Even though I owned the practice, the dentist just could not give up control.” After four years, Dr. Clark sold the practice back to the former owner.

Saved from the brink

“This particular model I have of buying the practices and leaving them with the same person in charge has a downside,” said Dr. Clark.  “It’s hard to change the way they practice and get doctors out of bad habits. This practice was a unique experience.” 

Over time, Dr. Clark figured this doctor was always going to have trouble conforming to the new style of his management team. “After I saved his practice from the brink of bankruptcy and he bought it back, I heard he returned to a lot of his old ways. He was a great guy, but only wanted to be the employer, never the employee.”

But, on the bright side…

Despite the management battle, Dr. Clark says he never regrets a practice bought and sold.  “When you have doctors who are not willing to follow the basic protocols the management team put in place, you have to decide whether to fire them or give them more options. When owning practices, it’s never as easy as people think. There are pitfalls you’re responsible for and at some point, you have to solve the situation.” 

From his perspective, there is always something to be learned for the next transition—and this was one lesson he’d never forget.

Thinking about a transition of your own?

As Dr. Clark says, it’s never too early—or too late—to talk about it. You can contact him personally at jc8602@benco.com or leave a message at 1-800-GO-BENCO. Visit Benco Dental’s Transitions online to learn more about Dr. Clark and our team’s services.

In our third installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Betsy Carmack is one half of a husband-wife dental team along with Dr. Tyler Carmack. The dynamic duo from Bennington Dental Center (and three other office locations) in Vermont are also current members of Incisal Edge magazine’s 40 Under 40 spotlighting the best, most innovative, most interesting young dentists in America. She’s also a mother of three, champion bodybuilder, and former International Medical Missions Coordinator for Operation Smile.

Q: When did you reopen your practice?

A: Officially, we opened in June. We did see emergencies throughout the period, but we weren’t officially open until June 1.

Q: What has been the biggest challenge so far?

A: Educating ourselves on the new recommendations and protocols, figuring out how to implement them, and coming up with a new protocol manual was challenging for us. I wrote a whole new, 10-page manual that encompassed the new guidelines. Trying to ascertain and find supplies that were not counterfeit was extremely difficult. It took a lot of strategic networking to order things with the hope they would arrive on time. It almost felt like a game show. It took a lot of resources and reading and things are still changing. One week, a circumstance could be okay and then the next week things could change. It’s like ‘Survivor.’ Some situations would change and you have to adapt to the new situation.

Q: How have the changes in PPE affected your ability to practice?

A: It’s been a learning process and a learning curve with the new material. It’s like training for the army…you have to wear all the gear and the uniform and you start running the race. It’s very heavy and hard to breathe. You have a full headlamp, you have your loupes, you have your shield on top of that. We have air filtration units for each operatory as well so you’re shouting through the mask and the shield and the air filtration unit through the suction to the patients hoping they can hear you. We have started doing virtual consultations as an additive to patient communication. It’s more difficult now to have meaningful conversations when you can’t hear or understand or see the doctor. It can be challenging when you have all the PPE on to convey different options to patients.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: I have found that most patients are eager to come back to routine care. A lot of patients were hesitant to reach out earlier during Covid in fear that they were not in pain. It wasn’t a dental emergency, but it was still a bother to them. Things are going to ebb and flow, but the majority of patients are happy to be back. I don’t sense a huge fear factor. Being in rural Vermont, the caseload is extremely low, and the patient is very safe in terms of what we’ve put in place as protective for patients and staff.

Q: Have you encountered any challenges with staff members?

A: Honestly, I think there was an underlying anxiety everyone felt from what the news publicized. Going into any new challenge is going to be intimidating when you are not used to something, but our staff has really been fantastic. After the first week, they settled in very well. You get headaches, it’s hard to breathe, your personal comfort is not as high as it was prior to Covid but luckily, all of our staff really like what they do. They miss the patient and personal interaction and they’ve been excited to come back.

Q: Will dentistry ever return to what it was like pre-Covid? Should it? Or are the new precautions justified even in a world with a vaccine?

A: I don’t foresee this ending or the regulations changing in the near future. The standard of care in dentistry has always included advanced infection control regulations and if anything, COVID has given dentistry the opportunity to revisit those guidelines. We all joke “I feel safer at work than going to the grocery store” because we’re screening patients, we do temperature checks, we’re allowed to question them and we have full protective gear on. I think it might be the new normal. Dentists fall into this interesting category where we can’t make any other income. A lot of dentists have reached a certain point and they said, I’ve been building my practice my whole life and rather than lose my home and my whole life I would rather start working again. The risks for young dentists are much lower and we’re not going to lose our livelihoods over that.

In our second installment of this new series, we’ll be asking questions and getting first-person perspectives on what it’s like so far to practice amid the pandemic. Every region, every practice, every practitioner has unique stories so we’re chronicling them here to give you an up-close and personal look at challenges, solutions and inspiring moments across the country.

Dr. Dave Monokian, or “Dr. Dave” to his patients, has been surrounded by dentistry his entire life. In 2005, he became a partner and cosmetic dentist at Monokian Family & Cosmetic Dentistry with locations in Marlton and Haddonfield, New Jersey. Dr. Monokian graduated from New York University College of Dentistry and now serves as the President of the Southern Dental Society of New Jersey.

Q: When did you reopen your practice?

A: We officially closed down Monday, March 16th and we opened Tuesday, June 2nd.

Q: What has been the biggest challenge so far?

A: Prior to closing, we had a full schedule between dentists and hygienists. We had to cancel those appointments for the three months we were closed. When we opened again, there were emergency patients who called and the people who had appointments cancelled from March that wanted to reschedule on top of people who had scheduled six months before June. There just aren’t enough hours in the day or days in the week to see every patient. Making sure we’re staying equipped and have all of the right equipment for all of our employees despite the nationwide PPE shortage has been a huge challenge. And just coordinating the schedule — we can’t see nearly as many patients as we used to because of social distancing, trying to stagger appointment times and extending time for appointments to sterilize and disinfect the rooms. I would say those were some of the more significant challenges

Q: How have the changes in PPE affected your ability to practice?

A: It’s something that’s taking some time to get used to because we have to wear extra things and we’re changing things out more regularly now. It just affects the total number of patients we can see per day. It’s affected the overall production, revenue and number of patients we can treat.

Q: How has the experience been with patients? Has it been difficult to encourage patients to come into the office?

A: Even before the pandemic, we took a lot of pride in our infection control which has earned us a lot of loyal patients over the years. When all of this happened, we started on the process early. The day after we closed, I was on the phone trying to order things to stay ahead of the game. People definitely had questions but when we were closed we stayed in constant communication with our patients, sending emails and different types of correspondences. This was great to let them know the things we were doing and implementing in the practice to prepare them prior to coming into the office. The environment is definitely different with taking temperatures, asking various screening questions, things like that. Most of our patients trust that we’re doing the right thing because they’ve been with us for so long.

Q: Have you encountered any challenges with staff members?

A: They’re very supportive of what we’re doing and trying to lend a helping hand when they can. They had their questions about how we would do things and sometimes it’s a bit of trial and error as to how things go but they’ve been great. Our staff has really stepped up to help get everything reorganized and implement all of the new infection control. Dividing the team up to tackle certain areas helped a lot. We have team members that have been with us for a long time and they take pride in being a part of something special.

Q: Will dentistry ever return to what it was like pre-COVID? Should it? Or are the new precautions justified even in a world with a vaccine?

A: It’s probably always going to be how it is now. I remember when my father first started practicing and the AIDS epidemic hit. Before that, dentists weren’t wearing gloves or masks or much of anything; there was a new normal then. The biggest thing will be when we can finally get full PPE back in place and can get fully stocked with at least a month’s supply. Right now, we’re wearing two masks. Eventually, we’ll probably just go to one N95 mask. Our office put certain things in place that we intend on keeping. It’s all justified because you never know what else is around the corner. I don’t think you can ever be too cautious. You can screen and take medical histories, but there’s still a lot of hidden stuff out there. Vaccines give you more peace of mind but vaccines aren’t the be-all and end-all either. It’s difficult because it’s a complete unknown, but we’re in an industry working very close to people’s mouths with a lot of aerosols being created and a lot of potential to transmit something. The more caution, the better.

Seat, treat and complete with Onset to reduce PPE usage, the potential for cross contamination and treatment time.

Let’s start with the bad news we’re all painfully aware of: gone are the days of numbing a patient, checking on another one, coming back to that same patient, and so on. Today, that would require multiple changes of PPE that nobody’s going to be even contemplating. 

The good news: We can make anesthesia work faster, and that’s a win for doctors as much as patients who, now more than ever, may want to reduce their time spent indoors. 

The Onset Solution: Seat, Treat, Complete

With Onset, you can get to procedures faster in this new world of one patient at a time. Seat the patient, administer anesthetic with much less waiting for the patient to get numb, and get to treatment right away. There’s another benefit too: less time awkwardly hanging out and making small talk to pass the minutes while your regular anesthetic does its job.

A Practice Builder That’s Easy To Use

Buffering with Onset was a smart idea before Covid-19, and it’s an even smarter idea now. The product is a labor of love for Dr. Mic Falkel, Founder and Chief Medical Officer for Onpharma Inc. “I knew as far back as dental school that you could build a practice around more comfortable injections,” he said. “But for years, I wanted to accomplish even more. Onset not only makes the injection more comfortable, it allows doctors to achieve more profound numbness faster.”

It’s simple to use: buffer the anesthetic in the Onset Mixing Pen, remove and load into syringe, and inject within one minute. Onset can be used to buffer four of the five major local anesthetics used in dentistry: Lidocaine, Articane, Prilocaine and Mepevicaine. Plus, its useful life once opened is seven days.

It’s Also Cost Effective—Something Everyone’s Looking For Now

Onset couldn’t be more affordable, costing on average around 17¢ per injection. Factor in the time savings and improved patient experience, plus savings in PPE, and adding Onset to your practice is an investment that pays off daily.

Renowned educator and dental anesthesiologist Dr. Stanley F. Malamed literally wrote the book on local anesthesia, and he’s a believer. “I sound like I’m a salesman for Onpharma, but I’m not,” he said. “I’ve simply become enamored with the idea of buffering all local anesthetic injections, and specifically those injections given in the mandible where most problems arise when it comes to pain control. I’ve even come to the point where I conclude all of my lectures with it because it makes injection more comfortable, the onset is much more rapid and post-injection soreness is markedly reduced.”

Anesthetic buffering with Onset is something you can do right now to address the immediate Covid challenges, while enjoying its practice building benefits that will last well beyond the pandemic.

Dental Creations, the Texas-based, family-owned and operated manufacturing business, has released a brand-new line of zirconia products.

Stronger than porcelain, zirconia crowns have a five-year survival rate of 99%. Between the new Zir-Perfect zirconia disc, Z-tray, and Z-Beads, Dental Creations covers dentists with high-quality products that provide patients with long-lasting results.

The unique Z-Tray Vented Sintering Tray comes in two sizes and protects while sintering crowns, bridges, inlays, onlays, and veneers. Holes on the side provide better airflow and transfer of heat while sintering, which keeps restorations at the proper temperature. The dense, round, covered tray prevents unwanted condensation and discoloring of the zirconia by the heating elements. It can withstand high heat rates for zirconia in temperatures up to 1700° C, as well as slower heating rates for long-span bridgework.

Pair the Z-Tray with a jar of Z-Beads Zirconia Sintering Beads for the best results. Because the Z-Tray and the Z-Beads heat at different temperature rates, the beads absorb the heat and provide a controlled temperature to prevent shrinkage. Like the tray, the beads can endure temperatures up to 1700° C. Made of high purity zirconia, the beads produce clean, contamination-free restorations.

The last item needed to complete your zirconia system, the Zir-Perfect High Translucent CAD/CAM Zirconia Disc, uses a three-point flexural strength of 1200 Mpa and a natural translucency of 43%. Offered in nine different shades, including white to use with dip stains, the Zir-Perfect can help you deliver restorations that are natural, long-lasting restoration and functions like a real tooth.