Category Archives: Dr. Dorfman Says

An interview with NYU Magazine about Dental Phobia

1. Dental phobia describes a fear of dentistry. It may also be called dental anxiety of simply “fear of the dentist.”

2. People develop dental phobia for a variety of reasons. The majority of dental phobic people have experienced one or a series of really bad and/or painful in-office experiences with one or more dentists. Some have had really bad results in the actual dentistry – rather than in-office experiences – that have resulted in severe pain and/or failure of their dentistry. Physically strong men are frequently more fearful of dentistry as are Masters of the Financial Universe. In addition men don’t experience the vulnerability of seeing a gynecologist so they tend to frequently fear dentistry than women. People who have habituated to drugs and/or alcohol are frequently afraid of dentistry because they need higher amounts and different chemistry of novocaine. Patient experiences in higher volume dental practices are also associated with a higher incidence of dental phobia. Our YouTube channel, The Center for Special Dentistry, has a twelve part discussion on this topic.

3. Dental phobic people are frequently most afraid of the injection, then the sound of the drill, then pain during and/or after the actual dentistry. The first and most important thing for me to demonstrate to a patient is that I give really gentle injections.

4. We offer all therapy in-office via dental phobia behavioral modification, many different anesthetic techniques including published methods for painless injections, atypical novocaine chemistries, allowing longer times for novocaine to take effect, nitrous oxide (laughing) gas, anti-anxiety medication pills, intravenous (IV) sedation and of course, excellent dentistry. Many of these things are not possible to offer in high-volume dental practices. A low percentage of our patients may also need help with alcohol and/or other drug dependency and we offer near-complete overall medical & psychiatric coverage with affiliated MD’s in our office building.

5. I personally always liked my dentist when I was a child so it helped me consider it as a career.

6. I studied Biochemistry at UPenn and had many career interests besides dentistry and including psychology. I studied with Dr. Martin Seligman who is an expert on helplessness and depression and I incorporated his teachings early on in my practice of dentistry. I remained at UPenn for dental school.

7. Our practice draws patients from around the world seeking what I trademarked “Creative Solutions for Complex Dentistry.” That is frequently not dental phobia and instead may just be difficult dentistry. However many people who suffer dental phobia have complex dental needs. We also treat many patients who love the highly personalized level of care, attention to detail and having all sixteen cosmetic dentists, specialists and lab techs in one office. Over thirty years in practice we have built a significant reputation and offer the biggest private practice predental training program in the U.S. We receive students (and patients) from around the world. Students and patients hear of our practice from our patients and students and also from the 4,400 page website I wrote, NYCdentist.com, that is read in more than 200 countries plus other writing and lectures. I’ve been writing online since 1998. I also held pro bono professorships at both Columbia and NYU dental schools for over 20 combined years so a lot of students have been locally exposed to my teaching.

8. A lot of our patients are from the greater NY metro area but we frequently receive patients who visit from many exotic places around the world. These people will visit for one or two weeks over one or more occasions. Regardless I personally prefer long-term patient relationships that I have had with many of our patients for decades. The average age of our patients is older, e.g. 30+, because our practice is most attractive – and valued – by people who are old enough to recognize bad life-experiences with other dentists and are therefore willing to pay the higher fees our type of dentistry demands.

9. I teach Dental Philosophy which involves personally catering the entire dental experience for each patient. There is a very positive energy one can feel when entering our office because it is an academically oriented, high end private practice filled with a lot of staff and students who share a genuine interest in providing the highest level of dentistry. I view myself as a member of the Board of Directors giving advice to my patients who are CEO’s of their own bodies. Therefore I see my role as an academic to teach the nature of a problem and then offer as many creative solutions how to solve that problem including various treatment options, duration of treatment, aesthetic options, possibility of pain and/or aesthetic limitations based upon treatment options and cost. I can spend hours discussing this information over several visits depending upon the needs and desires of each patient. Some people want to get to work quite quickly and I am also hope to oblige them.

10. IV sedation is usually safe if performed by medically qualified people in a healthy person. We offer it as an option to all of our dental phobic patients so that they (not me) can make choices as to their treatment however we always recommend more conservative methods of comfort if at all possible. IV sedation does involve risks.

11. IV sedation is only offered by an Oral Surgeon or an MD-anesthesiologist for dental procedures that I personally perform that require it.

12. Our office fees are the same regardless of whether we treat someone who suffers from dental phobia or they are just seeking excellent dentistry and an amazing overall experience. Our office fees are high and we do not participate as in-network with any insurance plan. We cannot offer our level of dental care at standard insurance fee schedules. In fact I think the high volume dentistry dictated by managed care insurance plans is one reason for the high incidence of dental phobia.

13. Many patients do overcome dental phobia. I can’t honestly say that they will ever enjoy dentistry more than a walk on a Caribbean beach during sunset but we are very successful with our patients.

14. Sensitivity to dental phobia is the basis for creating an office environment conducive to successfully treating these patients.

15. The worst cases of dental phobia that I have successfully treated include: 1) a woman who was raped by a dentist in a dental chair as a teenager, 2) another whose well-intentioned neighbors extracted her painful, bad teeth with a pliers while holding down her arms and legs while living in France during WWII where access to medical care was difficult, and 3) a woman who was so afraid that her non-patient husband came to the first visit without her to see that it would be safe for her.

16. The majority of our practice is focused on treating people who do not have dental phobia but who are seeking a very high level of dentistry.

17. I like getting to really know my patients and in turn sharing my life with them. A lot of my patients become social friends over time so basically my daily work involves seeing my friends all day long. My dental visits start at 60-90 minutes so there is plenty of time for patients to get really numb before we begin treatment and this allows a lot of time to just talk and get to know each other.

18. Yes a lot of patients send gifts of infinite variety. None are necessary but all are most sincerely appreciated.

19. Our practice performs low volume dentistry in a 3,000 square office space on Madison Avenue and 49th Street that only has five dental treatment rooms. In comparison a typical dental office would likely have ten treatment rooms in that size of a space. Accordingly, on average we only see about 15 patients a day across all treatment rooms. My favorite days are frequently when I only see two or three people for much longer than average visits.

Check your bank account for unexpected Quicken charges

I recommend that all my students avoid using Quicken when they are seeking financial software to run their dental practices. I had used Quicken and Quicken Bill Pay for many years and sadly discovered that Quicken was using the bank account access I provided to pay my bills to also pay itself a monthly fee without my knowledge or permission.

If you use Quicken Bill Pay then you should check your historical bank statements to see if this is also happening to you. New dentists may Google “Quicken alternatives” to discover more suitable, and hopefully more ethical, financial software.

Why I left Dentrix dental practice management software from Henry Schein

Dental practice management software (DPMS) is typically divided into two parts:  1) the database, which includes all patient data, the ledger and clinical records, and 2) imaging, which includes x-rays and photography.

When I built my current office around 2005 I upgraded from Henry Schein’s EZ Dental DPMS to Dentrix because I understood it was more sophisticated.  I paid approximately $20,000 at that time for Dentrix, which included the database and imaging components.

Approximately five years later I received a notice that Dentrix had sold it’s imaging division to Danaher Corporation’s Dexis Imaging subsidiary.  I was also informed that I would have to pay Dexis to use the imaging part of Dentrix that they now controlled – even though I had recently paid Dentrix for it.

The price Dexis demanded for the use of their imaging software varied over several years starting at about $12,500 to a low of about $5,000 if I promised to buy a certain amount of dental supplies from Henry Schein.  I never took the offer because I felt it was morally wrong — and a really bad business decision for Henry Schein.

I was therefore forced to remain using Dentrix G4 because it was the last version of Dentrix that did not switch to Dexis imaging.  For about the past five years I could not perform annual upgrades to Dentrix.  I was really annoyed but trapped.  Customer support at Dentrix and Henry Schein got nowhere.

Other weaknesses in Dentrix also bothered me.  For one, I didn’t need all the complexity the software offered and wanted to be able to completely turn off sections in the root directory but could not.  As a dental school professor for twenty years I also found the medical history and treatment planning sections quite weak.  In December 2015 I made the decision to leave Dentrix and thereby Henry Schein after nearly 30 years.

Next week our practice will begin using Patterson Dental’s Eaglesoft DPMS.  Eaglesoft offers both the database and imaging components for one reasonable price.  My own research on Eaglesoft showed it to be well-liked and my brilliant DPMS IT consultant, Josh Noskow, also thought highly of it.

I have grown to really admire Patterson over the past ten years – and really liked that I could directly reach their CEO when I had a problem a few years ago because he provides his personal email on their corporate website.  He personally solved a problem in 48 hours.

I plan to write about my personal experience with Eaglesoft at a later time.

Dr. Jeffrey Dorfman
The Center for Special Dentistry®
New York

Placement of a Fixed (not Removable) Temporary Crown over a Future Dental Implant Site.

Placement of a Fixed (not Removable) Temporary Crown over a Future Dental Implant Site.

Placement of a Fixed (not Removable) Temporary Crown over a Future Dental Implant Site.

I had lunch with a group of friends last month and I noticed a friend was missing a tooth!  I asked him why and he said he was getting a bone graft and then a dental implant so his dentist and oral surgeon thought to leave him like that for the nearly twelve months the bone graft and then dental implant would take to heal.  I told him to visit my office and I would give him a custom-shaded “fixed” temporary crown that is not removable.  Total treatment time was less than one hour.  Note this is NOT a flipper which is a “removable” temporary tooth.  Avoid lazy dentists.

#dentalImplants   #dentalImplantCrown   #dentalImplantTemporaryCrown   #dentalImplantFlipper   #NYdentalImplantDentist

The Center for Special Dentistry® is a teaching dental practice.

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The Center for Special Dentistry® is a teaching dental practice.  Dental students and young dentists from all over the world apply to our academic programs to study with us.  In this photo students are learning about the cementation of Porcelain Veneers under the direction of Dr. Jeffrey Dorfman (foreground left) — and a Master Porcelain Ceramist (background center) who is personally present in case any modifications are needed.  Note:  all patients may opt for privacy but they rarely do because most are personally interested in learning.  #PorcelainVeneers   #MadisonAvenueDentistry    #NYCosmeticDentist    #dentalSchool   #dentalInternship   #dentalIntern

Introduction to Dental Medicine – Online Video Course

from The University of Pennsylvania School of Dental Medicine

I personally recommend this course to all predental students.” — Dr. Jeffrey Dorfman

About the Course
In this course, you will learn basic dental anatomy, how to evaluate a patient and the causes and impact of oral diseases.  We will use case examples and live demonstrations with patients.

The course will focus on four areas:
1 Review of modern aspects of dental medicine
2 Introduction of basic oral and dental anatomy and techniques of clinical examination of the oral and per-oral structures
3 Discussion of common disease processes affecting the oral cavity and peri-oral structures including a) dental and periodontal diseases, b) oral mucosal diseases, c) orofacial pain conditions
4 Demonstration of clinical cases, ranging from basic to complex, reflective of the common disease processes affecting the oral cavity and perioral structures

Eligible for Verified Certificate Statement of Accomplishment

7 weeks of study
1-2 hours/week
English

Course Syllabus
WEEK ONE: Introduction to dental medicine including oral health related to general health, sources of infection, modern technology in dentistry and public health impact.

WEEK TWO: Basic dental anatomy including embryology of the oral cavity, oral functions, basic tooth structure and clinical implications of disease.

WEEK THREE: Comprehensive evaluation of the patient including medical history, with live demonstrations with patients.

WEEK FOUR: Dental and periodontal disease – their causes and contributing factors.

WEEK FIVE: Oral and mucosal disease focusing on anomalies, ulcers, cancer and other diseases.

WEEK SIX: Oral and facial pain from common conditions to rare ones including an exploration of psychological aspects of oral and facial pain.

WEEK SEVEN: Selected cases in dental medicine ranging from oral surgery to prosthetic reconstruction.

Course Format
You will have the opportunity to learn from three of Penn’s respected dental medicine faculty. Each of the three professors will share his particular area of expertise. Live demonstrations with patients will help you see the techniques in practice.

https://www.coursera.org/course/dentmedpenn?action=enroll&sessionId=972963

HIPAA compliant medical and dental document shredding or disposal

HIPAA and the New York State Public Health Law require only that medical and dental records be destroyed in a secure manner, one of which is shredding or using a reputable shredding service to perform that function. Typically, the shredding company picks up the material at your office.  However, it is permissible to deposit material in a secure receptacle that is not accessible to the general public, but only to the qualified shredding company personnel. You should have what is called a “HIPAA business associate contract” with the disposal company that spells out their responsibilities to maintain the security of the receptacles and the protection of the records from any disclosure prior to final destruction. You cannot just deposit records in a dumpster or a recycling box of some kind.  You need to be confident that the particular company will keep the material secure and their deposit boxes are not accessible to any unauthorized persons. All of that should be in the HIPAA business associate contract. If they are familiar with HIPAA as they state, they should have a HIPAA business associate agreement on file that they can readily use.  Otherwise, even if their box is secure, but somehow the records get out in the public view due to any negligence on their part, you will bear the entire burden for that event.

Acknowledgement: a very knowledgeable General Counsel friend

 

Associate dentist liability regarding insurance and medicaid billing in a high volume practice

The most basic rule of tort law is that you are only responsible for that which you do personally and for what your employees do in the scope of their employment. Thus, if you put your name on something as an employee, but your employer alters it fraudulently without your knowledge, you are not responsible for that just because your name is on the item – but of course proving that you didn’t know about any change is not always easy (a good idea is to make a copy of the item before it leaves your hands and you never see it again until the authorities come calling). Where employer fraud is rampant, it sometimes becomes incredible for an employee to reasonably assert he or she was unaware of things in the absence of clear evidence otherwise. You can seek indemnification clauses in an employment contract so that an employer will have to pay for any damages, attorney fees, or civil penalties imposed on you as a result of the employer’s own actions – but few employers would agree to do that even if the employee insisted (who would want to start off on that foot with any employee paranoid over fraud?). Also, nothing can save anyone from government authorities who seek criminal fines or other criminal sanctions for something like Medicaid or insurance fraud. No indemnification or other contractual agreement will be enforced where it seeks to shield someone from criminal behavior. You are already shielded by the law from an employer committing fraud that you were completely unaware of and had no reason to be aware of. All you need to do is make sure that you can establish your unawareness credibly. Making copies of claims you sign is the easiest way. Randomly doing your own review of submitted claims is another way to monitor things. Carefully charting your work in the patient record is another check and even keeping your own separate claims ledger is an idea. Those things make it harder for an employer to take liberties by altering items because the back-up documentation clearly wouldn’t make it easy to argue pretend justifications for the alterations. But, and this is a matter of common sense, if you really think your employer is engaging in that kind of fraud, find another employer as quickly as possible.

Acknowledgement: a very knowledgeable General Counsel friend

Senior Associate Dean of Penn Dental Medicine Elizabeth Ketterlinus visited The Center for Special Dentistry® today for lunch.

Senior Associate Dean of The University of Pennsylvania School of Dental Medicine, Elizabeth Ketterlinus, visited The Center for Special Dentistry® today for lunch.

Penn Dental Medicine, University of Pennsylvania School of Dental Medicine

Senior Associate Dean of Penn Dental Medicine Elizabeth Ketterlinus with Dr. Jeffrey Dorfman, Director of The Center for Special Dentistry®.