The Overwhelmed Practice
(December 2009) - Dr.Bhavana Doshi
Cure for the tooth ache -
Royal Gazatte & NewFoundland Adverise - Feb 14 1811
Dental Follicle Volume
4 Number 12 --- This is the end of 5th Year Of Dental Follicle. In
this issue you have two of the best papers published in the last
year. In the next 2 months will publish papers , which were some of
the best in the last 5 years.
Have nothing to say
more than " thankyou" everyone for making Dental Follicle a success
Patient: Doctor, what does the X-ray of my head show?
Doctor: Absolutely nothing!
-Breath Malodor - A review
By Dr.Ghazala Danish MDS
Oral Diagnostitian & Radiologist
Breath malodor means an
unpleasant odor of the expired air, whatever the origin may
be. Oral malodor specifically refers to such odor
originating from the oral cavity itself. A term like
halitosis is synonymous with breath malodor. There are
references to it in the Bible and in the Koran. Surprisingly
enough, until recently breath malodor has not been a matter
of much interest in periodontology, although its most
frequent causes are plaque-related gingivitis and
Breath malodor should not be
confused with the momentarily disturbing odor caused by food
intake (e.g., garlic) or smoking because these odors do not
reveal a health problem. The same is true for morning bad
breath: as habitually experienced on awakening.
A persistent breath malodor,
by definition, does reflect some pathology.
Imaginary breath odor or
halitophobia, well-established personality disorder
questionnaires allow the clinician to assess the patient's
tendency for illusional breath malodor.
Morning bad breath
Transient breath malodor is
noticed when waking up in the morning in more man half the
adult population. It does not deserve special attention
since it is due to the xerostomia developed during sleep,
i.e. when salivary flow is reduced to a minimum. This with
the ongoing intra-oral putrefaction explains the malodor
when waking up. Morning breath odor disappears soon after
the intake of food or fluid. The intra-oral placement of a
toothpaste containing zinc salts and triclosan has the
capacity to reduce the odor for several hours, even in the
absence of toothbrushing.
The real concern of the
population is the breath malodor which remains during the
day and which can cause social and/or relational problems.
Subjects who believe they produce malodor can adopt
avoidance patterns such as keeping a distance when speaking
to others or holding their hand in front of the mouth while
speaking. There is also a tendency to constantly use rinses,
sprays, chewing gums or pills to mask the breath odor,
although many such items have no effect whatsoever or at
least no lasting effect.
Even more disturbing is the
fact that a number of subjects imagine they have breath
malodor when they may not have. This imaginary breath odor,
also called halitophobia, has been associated with
obsessive-compulsive disorders or hypochondria. It has even
led to suicide. For such patients, the presence of a
psychologist/psychiatrist at the multidisciplinary malodor
consultation is essential.
Causes of halitosis
ØLack of flow of saliva during sleep
A.Disorders of oral cavity
ØPoor oral hygiene
B.Disorders of upper respiratory tract
ØAtrophic rhinitis (ozena)
ØWegener’s granulomatosis (Midline granuloma)
ØCarcinoma of larynx
C.Disorders of lower respiratory tract
ØCarcinoma of the lung
ØSalivary gland dysfunctions
ØCarcinoma of the tonsil or pharynx
ØCongenital bronchoesophageal fistula
E.Disorders of lower gastrointestinal tract
ØFebrile illness with dehydration
continued in next issue
VIDEO OF THE MONTH - CT
Applications in Dentistry
Overwhelmed Practice (December 2009)
Author: Dr. Bhavna Doshi B.D.S Lon.
Dr Bhavna Doshiis an international lecturer, who has worked
extensively with the National Media including
Extreme Makeover UK. She is the CEO of Dental
WEALTH Builder, which primarily focuses on Practice
Productivity, Cost-Effective Marketing and Growth
much to do, Too little time
most common form of stress that practice owners experience
is the feeling of being overwhelmed with far too much to do
and having little time to do it. In fact “TIME POVERTY” is
the biggest single problem facing our profession today!
simply do not have enough time to fulfil our
responsibilities. Because of budget limitations, staff
motivation and training, downsizing, patient care and time
needed with treatment planning, and then competitive
pressures, individual practice managers and principals are
forced to take on more and more work, all of which appears
to be indispensable to the smooth functioning of the dental
These pressures in turn often lead to unproductive
behaviours by both dentists and dental teams. Unproductive
behaviours include: procrastination, blaming anyone other
than yourself, poor standards, waiting for a better time to
do the work and generally never feeling that you are
progressing in any way. These behaviours lead to
unfulfilling work and lower profits, not to mention lower
standards of care.
This cannot be good for any business, especially in a
business like ours where a “service with a smile” is so
important to our ultimate practice growth.
Ask yourself the following questions:
How genuine is your smile when you are under stress?!!!
How effective and productive are you when you are pushed
How much do you dislike your job when you are under
In this mind set are you taking your business forward or
are you stagnant?
This tends to come to us in all forms and manner; and is
definitely not beneficial to our long term health. When we
are not achieving our goals in life we often tend to
procrastinate or just settle ourselves in our comfort zones
that are familiar and bearable. Going outside this zone
often leads to undesirable stress.
Stress often comes in three forms – the good, the bad and
ugly stress is the one which leads to verbal tension and
complete uncooperative behaviour. This is damaging to the
entire infrastructure of the business. You will instantly
recognise this because it will be the only thing playing on
your mind. Get rid of it now!
then come to the bad stress, this is often the one we
do not realise is creeping in on us. This is the stress
leading to job dissatisfaction, where we no longer enjoy the
practice of dentistry, yet don’t even stop to even think
about the cause of it. We often blame our patients and
unmotivated staff. We tend to end up feeling there is no way
out and this is the way it will remain. We go into an “if
What we need is the good stress, this is the one we
need, to keep us alert and motivated and is the one which
allows us to achieve goals. Good stress is created as a
result of reorganising the elements which give us the bad
a business owner we need to take a step back and re-
evaluate our situations. We need to ask ourselves – What are
we trying to achieve? We then need to figure out the steps
that will take us there.
need to take a good look at the bigger picture-of where we
The most common time wasters:
Drop-in visitors e.g. sales reps
Lack of clear and definite purpose, vision and goals
Attempting to do too much at once
Lack of prioritisation
Lack of practice systems
No definite system to monitor progress
Lacking the ability to say “No”
Having poor team members
Becoming an expert
Then all we need is to create solutions. One such solution
to the problem of work overload is for you to become an
expert in time management. There is probably no other skill
you can learn that will give you more value per pound spent
than to become extremely knowledgeable and experienced in
using time management practices.
is a case of giving more value to your time than your money.
In order for you to do this you need to take an “inventory”
of yourself and your practice needs. Then you need to
prioritize the steps which will lead to your “bigger
picture”. You need to develop sound leadership qualities in
order to redirect the team and their operative functions
within the practice.
art of leadership and delegation is what will eventually
save the day. As a business owner you need to be more
visionary in your role in order for you to take your
Time management is about doing your job in the most
efficient way possible to maximise profits and enjoyment.
two indispensable keys to the practice of time organisation
ability to set priorities
ability to concentrate single- minded on one thing at a time
TWELVE Tips For Effective Productivity
1.Write down a plan of key objectives for the
2.Focus on results ……not activities.
3.Prioritise the daily objectives by giving each
activity a 1-5 star priority.
4.Plan your daily activities the day before. Your
day will begin on a higher note.
5.Include personal time for yourself daily, to
reflect on your day ahead.
6.Good planners consistently get better results
7.Give start times and finish times per activity
for effective planning.
8.Make sure delegation is done effectively by
ensuring the job is explained clearly with help given
when required and more importantly a deadline for
9.Do not put off high productivity activities.
Follow the Pareto principle that 20% of your actions
will lead to 80% of your results and vice versa.
10.Regular, planned, and prepared meetings to
increase practice communication
11.Provide complete and effective training to the
12.Do not succumb to interruptions during a planned
activity e.g. telephone interruptions, internet use,
Since there is never enough time to do everything that needs
to be done, you must be continually setting priorities on
your activities. Perhaps the very best question that you can
memorize and repeat, over and over, is, “What is the most
valuable use of my time right now?”
This question will do more to keep you on track, hour by
hour, than any other single question in the list of time
Often we are so busy doing the LITTLE things that all we
achieve is LITTLE results!!!! The natural tendency for all
of us is to major in minors and to give in to the temptation
to clear up small things first. After all, small things are
easier and they are often more fun than the big, important
things that represent the most valuable use of your time.
However, the self – discipline of organizing your work and
focusing on your highest value tasks is the starting point
of getting your time under control and lowering your stress
This principal not only applies the dental business
management but also to your time allocation with your
patients and their treatment planning. Schedule your patient
diary to maximise income yet at the same time to lower your
stress levels by deploying the correct time allocation per
patient. There is nothing more stressful than a waiting room
full of WAITING patients!!!!
There are various techniques to scheduling your patients
with better efficiency. One such technique is to book long
higher income earning procedures in the morning (when you
are your at your optimum level of energy) and to book lower
income earning procedures in the afternoon. This way you
still have sufficient productivity each day yet you are not
stressing yourself all at one time.
other action point you can make use of is to create definite
practice systems for various jobs, then create a check list
for that system. Soon the systems within the practice will
become auto-run by the team as norm, hence freeing you up
for creative ventures to grow the business.
clear priorities each day, week, month and year and soon you
will be realising your potential for further growth and
productivity. This we can only do if we have taken the TIME
to work out where we want to steer our ship. We need to
understand the most valuable use of our time – deciding what
to eliminate, what to delegate and what to outsource. We
need to be creative in our procrastination of our
responsibilities. What should do we do now and what we can
leave for later are very important productive decisions. We
will ultimately have peak performance and enjoy the
benefits, if we manage our very valuable time to its
EFFICIENT TIME MANAGEMENT = OPTIMUM PRODUCTION & GROWTH
Correct and efficient time management skills are an
essential to any practice owner. Especially if you are
ambitious enough to want to enjoy the fruits of your labour,
and obtain enjoyment and fulfilment in the practice of
dentistry; not to mention increased productivity!