Trends in Dental Practice Sales and Associateships in the Current Economy.
Recent experiences would suggest that there is a significant discrepancy in the number of doctors retiring and transitioning their practices and the number of younger practitioners wishing to assume ownership and build a career. Peaks and valleys in dental school enrollment over the last forty years should have produced an abundance of retirement aged doctors wishing to place their practices on the market to a smaller pool of buyers. Such is currently not the case. Doctors in their sixties have experienced recent stock market downturns in 2000 and 2008, the “9-11” tragedy and a drop in both the value and liquidity of the housing market. The ready access to refinance or second mortgage funds may even find some doctors upside down on personal, vacation and investment real estate. All of this combined has had considerable negative impact on their net worth. Health care costs continue to increase and most dentists are personally responsible for their premiums. Combine all of this with the current low level of secure returns on invested capital along with a significant increase in life expectancy over the last two generations and many decide they are simply unable to retire as planned. The fear of running out of money is stronger than their will to pursue retirement. This article examines in some detail the reasons for this imbalance and the effects they are having on practice transitions, practice values and the market for associate employment. We will also explore what the future may hold for both retiring and new career doctors.
Key words: Practice transition; Practice value; the Great Recession; Diminished retirement portfolios; Life expectancy; Associateships, Dental management companies.
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The “Wal-Martization” of Dental Practice.
The economic environment of dental practices is undergoing rapid change. Franchise and network practices are increasing in number because of many underlying economic factors, including supply and demand for services, banking requirements, student debt, proliferation of managed care plans, and healthcare reform. These franchise practices compete very effectively with traditional solo dental practices, leading to the “Wal-Martization“ of dental practice, in which dental services are bought and sold more as a commodity than as an individually unique service. These chains compete with private practices on efficiency, convenience, insurance plan participation, and aggressive marketing. There are advantages and disadvantages for both the patients and dental practitioners for participating in this practice mode. This paper explores the reasons that these entities are growing, and offers suggestions for independent solo practitioners to compete with them.
Key words: Dental management companies; Dental networks; Franchises; Practice management.
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Introduction to the Special Issue on Practice Management.
This special issue on practice management represents a labor of love from some of the key thinkers/leaders in the field of dental practice management in the United States. The topics covered in the articles are current and, in some cases, somewhat controversial. I hope the readers find the articles both stimulating and insightful.
Key words: Dental practice management; Risk management; Associateships; Practice valuations; Dental education; Mid-level providers; Dental therapists; Economics; Dental management companies; Dental service organizations.
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Clinical Applications of Reverse Panoramic Radiography.
The essence of oral and maxillofacial radiology is not only to be an important tool in the diagnostic assessment of dental patients but also to equip the clinician with the ability to interpret images of certain maxillocraniofacial structures of importance to dental, medical and surgical practices. Although combinations of several conventional x-ray projections can be adequate in a number of clinical situations, radiographic assessment of certain craniofacial structures sometimes needs to be facilitated by other imaging modalities. A not-so-recent development called reverse panoramic radiography may be a useful adjuvant to such a situation, at least in the near future. It is essentially a technique where the patient is placed backwards in the panoramic machine in a reverse position in such a way that x-ray beam is directed through the patient’s face and the exit beam then passes through the patient’s head on the opposite side where it is captured on the receptor. The following manuscript is an attempt to throw light on this technique and the impact it may have on dental, medical and surgical practices. The advantages and disadvantages of reverse panoramic radiography and it’s comparison to conventional panoramic radiographs and other skull views are also discussed.
Key words: Reverse panoramic radiography; Mastoid air cells; Occipital protuberance; Lambdoid suture; Temporo mandibular joint.
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Innovative Method for Fabrication of Microwavable Denture Flasks.
Introduction: Microwavable denture flasks for polymerization of acrylic resin are commercially available. However they are expensive and smaller in size, large maxillofacial prosthesis cannot be fabricated in them. The objective of this report is to showcase a simple technique for the fabrication of microwavable denture flasks which is economical and larger in size.
Clinical innovation: A method of making dental stone flask pattern and a latex rubber mold was used to produce microwavable denture flasks. These flasks are made from the fiberglass liquid resin that is strengthened by the addition of chopped fiberglass strands.
Discussion: Microwavable denture flasks can be made that will be simple, economical and large enough to accommodate the maxillofacial prosthesis. These flasks are strong enough for compression molding and allow successful microwave polymerization of acrylic resin denture bases.
Key words: Fiberglass liquid resin; Fiberglass strands; Microwavable denture flask; Liquid latex rubber.
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Evidence-Based Clinical Significance in Health Care: Toward a Inferential Analysis of Clinical Relevance.
Evidence-based dental practice requires the developmment and evaluation of protocols that ensure translational effectiveness: that is, the efficient incorporation of the best available efficacy and effectiveness findings in specific clinical dentistry settings and environments.
Evidence-based dentistry predicates the synthesis of research for obtaining the best available evidence in a validated, stringent, systematic and unbiased fashion. Research synthesis is now established as a science in its own right, precisely because it adheres to the scientific process that is driven by a research question and a hypothesis, follows through clearly defined methodology and design, yielding quantifiable data that are analyzed statistically, and from which stringent statistical inferences are drawn. The conclusions from the protocol of research synthesis define the best available evidence, which is used in the process of evidence-based revision of clinical practice guidelines. One important hurdle of the process of applying research synthesis in evidence-based dentistry lies in the fact that the statistical inferences produced by research must be translated into clinical relevance. Here, we present a model to circumvent this limitation by means of text analysis/mining protocols, which could lead the path toward a novel, valid and reliable approach for the inferential analysis of clinical relevance.
Key words: Research synthesis; Statistical significance; Clinical relevance; Evidence-based revision of clinical practice guidelines; Number-need to treat; Preventive fraction; Intention-to-treat; Sufficiently important difference; Text analysis & mining.
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The possible role of dentin as a piezoelectric signal generator by determining the electromechanical coupling factor of dentin.
Introduction: This article aimed at calculation of the electromechanical coupling factor of dentin which is an indicator of the effectiveness with which a piezoelectric material converts electrical energy into mechanical energy, or vice versa.
The hypothesis: The electromechanical coupling factor of dentin was determined in mode 11 and 33 by calculating the ratio of the produced electrical energy to the stored elastic energy in dentin under applied pressure. This study showed that the electromechanical coupling factor of dentin was affected by the direction of the applied force and the moisture content of dentin. Also dentin was a weak electromechanical energy converter which might be categorized as a piezoelectric pressure sensor.
Evaluation of the hypothesis: Determination of the electromechanical coupling factor of dentin and its other piezoelectric constants is essential to investigate the biologic role of piezoelectricity in tooth.
Key words: Dentin; Piezoelectric signal; Electromechanical coupling factor.
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