Feeling Guilty About Not Flossing? Maybe There’s No Need

SOURCE: http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0

  • You guys can stop flossing but I am not buying into it!


For decades, the federal government — not to mention your dentist — has insisted that daily flossing is necessary to prevent cavities and gums so diseased that your teeth fall out.

Turns out, all that flossing may be overrated.

The latest dietary guidelines for Americans, issued by the Departments of Agriculture and Health and Human Services, quietly dropped any mention of flossing without notice. This week, The Associated Press reported that officials had never researched the effectiveness of regular flossing, as required, before cajoling Americans to do it.

In a statement issued on Tuesday, the American Academy of Periodontology acknowledged that most of the current evidence fell short because researchers had not been able to include enough participants or “examine gum health over a significant amount of time.”

The revelation has caused a stir among guilt-ridden citizens who strive to floss daily but fall short of that lofty goal. Among experts, however, it has been something of an open secret that flossing has not been shown to prevent cavities or severe periodontal disease.

A review of 12 randomized controlled trials published in The Cochrane Database of Systematic Reviews in 2011 found only “very unreliable” evidence that flossing might reduce plaque after one and three months. Researchers could not find any studies on the effectiveness of flossing combined with brushing for cavity prevention.

“It is very surprising that you have two habits, flossing and toothbrushing without fluoride, which are widely believed to prevent cavities and tooth loss, and yet we don’t have the randomized clinical trials to show they are effective,” said Dr. Philippe Hujoel, a professor of oral health sciences at the University of Washington in Seattle.

The American Dental Association’s website says flossing “is an essential part of taking care of your teeth and gums.” Last year, Dr. Edmond R. Hewlett, a spokesman for the group and a professor of restorative dentistryat the University of California, Los Angeles, said, “We’re confident that disturbing the bacteria in plaque with brushing and flossing is, indeed, beneficial.”

Actually, that is only half proved: Brushing with fluoride does prevent dental decay. That flossing has the same benefit is a hunch that has never been proved.

If it is any consolation, there is some mediocre evidence that flossing does reduce bloody gums and inflammation known as gingivitis. That Cochrane review found that regular brushers and flossers had less gum bleeding than people who only brushed, although the authors cautioned that the quality of the evidence was “very low.”

Early gingivitis is a long way from severe periodontal disease. Still, some dentists argue that despite a lack of rigorous study, flossing matters if it can reverse initial gum problems.

“Gum inflammation progresses to periodontitis, which is bone loss, so the logic is if we can reduce gingivitis, we’ll reduce the progression to bone loss,” said Dr. Sebastian G. Ciancio, the chairman of the department of periodontology at the University at Buffalo.

Severe periodontal disease may take five to 20 years to develop.

“It’s a very insidious, slow, bone-melting disease,” said Dr. Wayne Aldredge, the president of the American Academy of Periodontology, who practices in Holmdel, N.J.

Even without rigorous evidence that flossing prevents late-stage periodontal disease, Dr. Aldredge urges his patients to floss. Those who quit are “rolling the dice,” he said.

“You don’t know if you’ll develop periodontal disease, and you can find out too late,” he said.

Maybe the evidence that flossing reduces tooth decay or gum disease does not hold up because we are all such poor flossers. Superflossers, like the zealous hygienist at your dentist’s office, aim to “hug the neck of the tooth” and get below the gum line, Dr. Hujoel said.

But we common folk, staring woefully at our bathroom mirrors, tend to lightly give it the once-over.

A review of six trials found that when professionals flossed the teeth of children on school days for almost two years, they saw a 40 percent reduction in the risk of cavities.

So maybe perfect flossing is effective. But scientists would be hard put to find anyone to test that theory.

New Listing – Tampa, FL

South of Brooksville, North of Tampa. Fantastic opportunity for someone who likes to place implants (mostly mini) and do dentures. Well established high end practice dong about 1.2 million on 4 days and is all FFS. Building available with about 3000 SF with a lab and with possibly even more  room for expansion. Paperless, laser, digital pano, this one has it all with much referred out. Call for more details!

Listing ID: MS1618

Morcie Smith 727-544-4385

Are You Ready for an Associate?

By Larry Chatterley and Randon Jenson, CTC Associates

The goal of any associate-type arrangement is to create and maintain a mutually rewarding personal and professional relationship between two or more doctors. Unfortunately, many associate arrangements do not address one of the most fundamental elements for a successful relationship, that is, does the dental practice have the capacity to sustain both doctors?

With that in mind, here are some key areas related to the dental practice financial capacity that need to be addressed before entering into an associate arrangement. The key questions are as follows:

  1. How far is the current practice booked out? If the current practice is booked out only a week or two and has holes in the operative schedule, then the practice will likely struggle to fill in the gaps for a new associate. If the practice is seeing 15-20 new patients per month, which usually is just enough to keep one doctor busy, then it’s going to be difficult to keep an associate busy enough for him or her to want to stick around.
  2. Does the dental practice have the sustaining power to subsidize the new doctor to up to $8,000 per month for the first six to twelve months while building the practice?
    If the answer is no, then the practice may not be in the position to bring on another doctor.
  3. Does the dental practice have a lot of debt and/or is the overhead exceeding 65%?Practice debt can polarize the relationship by making it difficult for both parties to meet their financial obligations on a timely basis.
  4. What form of marketing is in place to help increase patient flow? Unless this is addressed and in place before the associate starts, there might be difficulties having a successful associateship.

Most associates are paid a percentage of their respective gross production. In most markets and situations, this percentage for general practitioners is about thirty percent. (Specialty practices/specialist associates are often paid a higher percentage.) It is not uncommon, however, to see a flat wage or salary paid as well, or a variation of the two. In other words, the associate is paid a flat rate per day (i.e. $500) or 30% percentage of production, whichever is higher. This method is particularly effective in situations where it may take the associate several months to “ramp up.”

However, the host doctor should expect to see a consequential decline in income over the short term as he/she subsidizes the associate’s income via the draw. This will last until the associate’s percentage wage is sufficient enough to cover the minimum, at which point the host should expect to begin earning an override on the associate’s production. The question here is if the dental practice is in a financial position to subsidize the associate wages over a 6 to 12 month period. If not, then maybe step back and reassess the situation.

Years ago this was not the case. One could just add another doctor and more new patients would flow through the door. This has not been the case in the more popular and competitive areas of the country for more than a decade.

If you or your practice are experiencing greater patient flow than you can comfortably handle, then you might be good candidate to hire another pair of committed hands to handle the load. If not, and you still want to hire an associate, you must assess the dental practice transition potential and create an effective game plan to increase patients or reduce overhead.

Practice for Sale: West Coast, FL – Pinellas County

High end practice that did about $935,000 in 2015 on 3.5 days. 5 ops with room for more, about 3000 SF, stand-alone building available, all endo and most ext. referred out, PPO & FFS, Digital Pano, Itero, paperless and chartless, laser, Isolite, microabrasion, and electric handpieces. Beautiful practice in a great location with lots of walk-ins.  This is a nice one that has it all and will not last! Call Morcie to get more details 727-544-4385.

Listing ID: QW88407

How to Negotiate Dental Practice Transitions Like a Pro

For a NAPB dental practice transition broker, negotiation is part of the job. From partnership buy-in agreements to space sharing agreements and everything in between, our days are spent dealing with contracts and covenants. Most of the time, negotiations go smoothly, but if one derails, it can cause a tremendous amount of stress, frustration and holdup for all parties.

The ultimate goal when buying or selling a dental practice is for all parties to walk away from the table feeling like they got a “good deal.” Tensions can run high when making such a big transition. The seller may be embarking on a new phase of life and they want to capitalize on years of hard work. The buyer may be just starting out or making a shift in their career and they don’t want to bet on the wrong horse, if you will.

Trusting in the process and having a sense of humor can really help your dental practice transition.

Here are a few tactics to negotiate like a pro:

  • Be knowledgeable: Get a sense of who is sitting across the table. Humanize the person(s) you’re dealing with during the transaction. That aids your ability to stay steady and negotiate from a place of calm.
  • Be flexible: The best solutions often come from unexpected places. If you’re locked into an outcome, there’s no room for those creative possibilities.
  • Be optimistic: You’re receiving guidance from a dental practice transition specialist. There are no enemies here. Everyone wants the transition to go well so approach the experience from a place of confidence that you will find workable solutions for all parties.
  • Be fair: If you ask for something for your benefit, be prepared to give up something to the other party in order to close the deal. Quid-pro-quo. Again, not with an attitude of score keeping, but from a perspective of: How can we ensure this is a genuine win-win?
  • Be realistic: Along the same lines, operate from a place of reality. If you are selling a dental practice with antiquated equipment and a less-than-ideal location, you may have to lower your asking price. Go in with a clear understanding of what’s most important to you, but not in the vein of “let’s make a big stack of cash without improving the practice in any way prior to listing it.” This would be considered unrealistic and counterproductive. You do have to consider the buyer’s viewpoint as well.
  • Be polite: You’d be surprised what can be accomplished simply by being courteous and asking nicely. If you find yourself getting heated or frustrated, take a breath or even take a break. A walk around the building can often alter my outlook in a significant way.
  • Be respectful: Stay right-sized. In other words, don’t operate from a place of inferiority or superiority. Neither will ultimately help you arrive at a consensus.

As we’ve discussed in previous articles, because there is so much intrinsic and intangible value within a dental practice, it’s important to uphold goodwill throughout the dental practice transition process. There is more than just a building, equipment and money changing hands. There’s a history, patient relationships and a presence in the community. All these factors require some fluidity and sensitivity.

Call your Doctor’s Choice today for a free consultation.

Tip of the Day

We can not stress time and time again how important your lease situation is. Whether you are setting yourself up to sell in the near future or plan to drill for 20 more years. As a dental practice owner your two biggest expenses are payroll and your rent / mortgage payment and you have to manage this overhead to make your business as profitable and safe as possible.

Your typical lease term for commercial deals are 5 years with an option to renew period of “X” years. When you sign a 5 year lease or more, it is vital that you as a tenant get something in return. Whether it be new ceiling tiles, flooring, paint, or cabinets – the landlord should keeping your space modern for you! As a tenant, you could invest thousands of dollars but get nothing out of it when you leave and this is every landlords dream. Every lease situation is different and if you are in a competitive market with no vacancies in your plaza or building then the landlord may have more leverage to not do these tenant improvements. Every situation is case by case however in most situations the tenant has the upper hand. On top of this, every time your lease is up for renewal you should be paying fair market rent for that time period unless your rent is cheaper than fair market value. Many doctor has a 3 to 5% rental increase per year that compounds. After 10, 15, or even 20 years it can add it fast. If you are paying less than what is market value, clearly do not bring it up to the landlord however this again is rarely the case with the market on the rise.

We have run into various situations where a doctor is going month to month and does not even have a lease. PLEASE do not get caught in this trap as if your landlord isn’t pestering you to sign a new lease then something is off. You could get kicked out with 30 days notice and be scrambling to find a new location. It is essentially more risk for you, the tenant.

If your have further questions, reach out to us for help.