The Group Dentistry Now Show: The Voice Of The DSO Industry

Dr. Lou Graham, CEO of Catapult Education, and Charissa Wood, RDH, Hygiene Lead of Atlanta Dental Spa & Mastermind Leader of Bulletproof Hygiene, discuss hygiene as the engine of practice growth. They share their thoughts regarding:

Growing hygiene departments with technology such as Perio Protect
Discovering new sources of hygiene revenue
Solutions for perio maintenance, gingivitis, implants, restoratives
Much more

To learn more about Perio Protect visit – http://perioprotect.com/DSO

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Full Transcript:

Bill Neumann:

Welcome everyone to the Group Dentistry Now Show, I’m Bill Neumann. And as always, we appreciate you listening in or you may be watching us on YouTube. But without a great audience like yourselves, we wouldn’t have great guests like the next two guests we have on the show. So our focus is going to be a little bit different than in podcasts of the past. We’re going to really focus on hygiene with this podcast. And I know a lot of DSOs and group practices that we work with have been focused in the past year, year and a half, on same store growth. So instead of acquisitional growth, it’s how do we do more with what we have. And it’s a bigger shift for some groups than others, but we’re going to focus on that today.

So we have with us Charissa Wood. And she is the hygiene lead at a group practice in Atlanta, Atlanta Dental Spa. She also is the mastermind leader of Bulletproof Hygiene at Bulletproof Dentistry. So we’re going to find out about Bulletproof Dentistry, we’re also going to find out about Atlanta Dental Spa and what she does there. So Charissa, welcome to the Group Dentistry Now Show.

Charissa Wood, RDH:

Well, thank you so much for having me. I really appreciate this opportunity. I love what I do. I’ve been a practicing and I’m still a current full-time hygienist for the past 28 years, and I love it so much that I really love to connect with other hygienists and help coach them along and help us all really be fulfilled in our profession. Because what we get to do in our chair every day really can be exciting and amazing and healing. And so I’m excited to be here today to join in and share. You mentioned Bulletproof Dentistry, it’s Bulletproof Dental Practice. And we’ve got a teams contingent and a hygiene contingent because we always say that dentistry is a team sport. The whole team has to come together to be really profitable and successful for patient care. And so our goal from the Bulletproof standpoint is to help practices, whether it’s a private practice or a DSO practice, really get focused on bringing the team together, looking at all the different opportunities that we have within our practices and really strategize and be as effective as possible.

Bill Neumann:

Thanks, Charissa. And then we also have Dr. Lou Graham with us. He is the co-founder and president of Catapult Education. So Dr. Graham, thanks for joining us today.

Dr. Lou Graham:

Bill, my pleasure. Just a little brief background, I’ve been in practice 40 years, which is crazy. And last year, I did sell my practice, which was a group practice with multiple associates and specialists, to an MSO/DSO. So I can totally understand both worlds of individual practice now and the MSO/DSO world. For Catapult, we’ve celebrated our 20th year, 36,000 subscribers, and we just have so much excitement going on. And as we briefly talked about this morning, which we’ll touch on, we’re launching our own group purchasing organization that’s based on education. And we see really the future of dentistry going to small and medium and large DSOs and group purchasing just like other professions. So my pleasure to be here today.

Bill Neumann:

Thanks, Lou. And so you’ve got the GPO that you’re launching or you’ve launched, so you have that. And then on the education side of things, we were talking about this prior to recording this session, that you’re launching a DSO group practice focused educational component as well. So that’s not for a little while, but you’re rolling that out as well this year?

Dr. Lou Graham:

We’re going to roll that out Q2. So we believe, like Charissa does, education guides everything, and that’s what we’ll be talking about a little bit today. But we have individual learning as far as modular learning and live learning and we’re going to combine that. And this goes into hygiene and obviously other clinical care. And that’s what we’re going to be rolling out to DSOs of all sizes, definitely all sizes.

Bill Neumann:

And then before we start to talk about hygiene, and really the topic for today is hygiene as the engine of practice growth, I like that. Charissa, at Bulletproof, you do a lot of work with group practices there.

Charissa Wood, RDH:

Correct, yes.

Bill Neumann:

Great. And we’re going to make sure that at the end, if anybody, whether you have a single practice or whether you’re an emerging group practice, you can find out more about what Charissa is doing and of course what Lou and Catapult are doing.

So let’s talk a little bit about hygiene and maybe kind of set the stage for this. I’d say over the past couple of years there’s been a huge focus on technology in the dental industry. So AI has been a huge topic of conversation, whether it’s image 3D imaging, digital scanning, things that tend to might have a higher price tag. So we’re going to talk about something that’s technology focused, and it’s focused on hygiene, but I think it might be not really focused on a lot because there’s just not a lot of marketing around it, but it’s so important. We have hygiene, hygienists are spending more time than the dentists are in a lot of cases, especially if you’ve got a relatively good dentition. So your hygienist is spending all this time. So how can we make the most out of those appointments? Let’s talk a little bit about Perio Protect. I don’t know who’d like to start things off, but how do we make more with the time that we have? And we do have a lot of time with our patients on the hygiene side.

Charissa Wood, RDH:

Well, I’ll kick that off. As a hygienist, as a practicing hygienist, I think for so long, hygiene was viewed almost as a loss-leader. It’s kind of one of those necessities that we have to have in the practice. And I know there’s a lot of dentists and a lot of conversation out there about hygiene being a loss-leader, hygienist being divas. And I hate that because hygiene can be such a huge part of the production of the practice from so many aspects. Obviously, if we’re taking the best care of the patients and the patients are seeing that and feeling that, they’re referring more patients, that’s building practice growth, they’re telling everyone they know about it, and that’s so, so important. But also, what we do in our hygiene chair is so, so important not just for oral health, but for systemic health. We are understanding more and more now, the research is showing more and more these connections between what’s happening in the mouth and what’s happening in the rest of the body.

And I think you touched on technology and sometimes I think we put the cart before the horse and we get really excited about these new technologies, but we’ve got to stop and look at what the science is showing and understand what our responsibilities are in really treating these diseases and what’s coming in through the oral front. So I’m really excited to talk about Perio Protect. I have been using it in my practice for the last 11 years. And basically, let me, let’s talk about what is Perio Protect. That’s probably the best place to start, right? So Perio Protect are trays, customized trays, that are made to force the medicament. And there’s many different options on that front we can talk about as well. But force the medicament down below subgingivally into the sulcus and hold that in place. And it’s super easy to use. It’s very easy for patients to be compliant with.

But the reason that it makes sense to me is because as a hygienist, all day long, I’m looking at patients who are coming in with inflammation and bleeding gums. And I always say to my patients, what happens in your mouth is happening everywhere. This is the gateway to our body. We’re breathing into our lungs, we’re swallowing into our gut. When you’re telling me you’re seeing bleeding when you brush and floss, now there’s access to the circulatory system and this is two inches from our brain. So what’s happening here is happening everywhere and it’s really important that we get this inflammation under control. We address the bacteria that are driving that inflammation. And what we know is when we go in and do what we’ve always done in hygiene, whether that’s scaling and root planning, using ultrasonics, maybe lasers, what we know is we are making a big impact on that biofilm and those bacteria that are driving that. But the studies show that within two to seven days, those bacteria have completely rebuilt.

So we need some more strategies and we need science that’s going to help us really manage that biofilm for more than a week out. And that’s where Perio Protect comes in. Because if you are driving an oxidative medicament below that gumline, you are targeting those anaerobes on a daily basis in every nook and cranny. So it’s a really smart way to get our patients off that hamster wheel of having to do scaling and root planning or laser over and over again and really taking control of their own health at home and seeing those benefits. And I will say, patients do see the benefits and that’s what keeps that compliance going.

Bill Neumann:

Dr. Graham, your thoughts?

Dr. Lou Graham:

A hundred percent supportive of everything Charissa just said. So I’ve been a user now eight years. And as Bill, in your introduction, we use 2D AI in our practice now for over a year with Pearl. We digitally scan every patient. Again, not a necessity. We do it in initial exams. Our hygienists are trained. Our assistants are trained. But to the point of how you started this, there is no investment in Perio Protect beyond a team training. And when our team was trained initially, our periodontist really was the skeptical one. He is now pretty much our biggest proponent of Perio Protect. So I’m going to compliment and not repeat what Charissa said.

There are so many patients in our practice who come back with bleeding and bleeding and bleeding. So our rule of thumb is that if you have ten bleeding points in your mouth, [inaudible 00:11:19] probing, and you’ve gone through debridement, scaling and planing, laser therapy, all my hygienists are trained, patients, not all, but a certain percent will regress. And so why don’t you change? And so in many ways what we’ll do is we’ll utilize the scans we have or take a new scan and or traditional impressions and have the trays fabricated. And again, complimenting what Charissa said, our results for the last eight years for patients who are compliant are amazing. And we actually know when they’re not compliant because we see them go back downhill. So compliance is key. It’s only 10 minutes a day. And patients who learn that 10 minutes a day, it becomes part of their daily oral healthcare.

Bill Neumann:

So it’s interesting that we’re looking at hygiene and Perio as a focus, and this is, I don’t want to say low tech, but it’s not thought of as a technology. This is a clinical solution. How does it relate to revenue? Because we’ve got a lot of business people that listen to this podcast as well. So we have the clinical side. It makes a lot of sense, I’m sure, to the RDHs listening. The periodontist, this might be intriguing. But what about the business side? How is this going to increase revenue? Where do we see this fitting in? And then also, is this in place of another solution, potentially just trading dollars?

Dr. Lou Graham:

Well, I’ll kick it off and then I’ll hand it to Charissa. So this is a total practice by practice opportunity. And by that, the trays generally will cost the practice, let’s just call it $100. When we deliver the trays, we generally put two tubes of the perio gel, hydrogen peroxide, 1.7%, with the delivery. The doctor does nothing. Let me be clear on this. The hygienist routinely is the one who co-diagnosis, I believe they do, with the doctor. The assistant or the hygienist take the scans, images and deliver. And what I will say, if you know your costs, it’s up to you what you want to charge. In our office, we charge between routinely $400 to $425 an arch, these trays last five years plus routinely. If a patient has to have new treatment, like restorative treatment like an implant, et cetera, and we make a new tray, we just charge the cost of the tray.

So I would say very, very profitable. And if you look, it can be one arch or two arches, that’s how we do it, but if it’s two arches and your costs are, let’s say $250 all in and you’re charging $650, $750, $800 or more for your trays, then I will tell you it’s a very profitable center. Two more key points. We offer it in our in-office dental plant. So it is discounted in our in-office dental plants 12%. And you’re going to ask about insurance. And most insurance companies to date, most do not reimburse. So back to Charissa’s point, you really have to engage the patient and show them why they need this because this is not a financial killer and it will save them money in the long run and have utmost profound effects on their oral health. Charissa?

Charissa Wood, RDH:

Yeah, you asked if this replaces anything you’re doing and I would say no, it’s an adjunct to what you’re doing. When you see a patient who presents and they’ve got that subgingival calculus, they’ve got the bone loss, they’ve got active periodontal disease, you’re still going to do your therapy, you’re scaling and root planning, your laser, you’re still going to do all those things. This is an adjunct from a maintenance standpoint of helping these patients maintain this so that they don’t continue to need those rounds of laser therapy and scaling and replanning. In our practice, I’ll say, Lou just said, you charge what you determine is the value.

And in our practice, we charge $1,100 for the trays. And the patients see a great benefit. Like Lou said earlier, you can tell when patients aren’t using them. My patients will tell me, “Hey, I took a vacation. I didn’t take them with me. My mouth didn’t feel as clean. I couldn’t wait to get back to using them.” And I find that you will see added revenue from a standpoint of when a patient feels like their gums are very healthy, they’re not seeing bleeding, we didn’t mention this, but your teeth get whiter as you use it because it is a peroxide based product.

So when the patients start seeing all of that, they’re feeling better about their smile, they’re feeling better about their health, they start asking us, “Hey, what else do I need in here? What else is going on in here?” You have built that trust between your provider and your patients that when a provider now says, “Hey, we’ve got your gums under control, but now we’ve got some restorative things we need to address,” or “We’ve got some occlusion issues we need to address,” the patient is more open to moving forward with those because they’ve seen what you have done for them and they now trust you as a provider. And I think that’s a really important thing when we’re thinking about practice growth and revenue as well.

Bill Neumann:

So Charissa, you talked about a couple different use cases, but let’s make sure because it seems to me that it’s not just perio maintenance and gingivitis, but there’s a lot of different things that a hygienist should be looking for where Perio Protect can come in and really help out. So would you mind kind of going down that list so we make sure we cover everything?

Charissa Wood, RDH:

Absolutely. So let me just say I’m a big cheerleader for Perio Protect. I honestly think everybody is a candidate for Perio Protect. I wear them myself. As a hygienist, obviously I don’t have periodontal disease, but I don’t ever want to get it. So it’s really important to me to maintain a good healthy oral flora. But when we’re looking at our candidates, you’ve got those patients now who are very, very entrenched in health and wellness. We’ve got those patients coming saying, “Hey, I’m seeing a functional medicine doctor. I want to prevent having any issues. I want to prevent Alzheimer’s.” Those are great patients because what a great way from a preventative standpoint to keep things healthy. Obviously we’ve got our patients who have gingivitis and active periodontal disease, we’ve got to consider our patients who have systemic issues going on. There are some great studies, and I’ve seen for myself, patients who are diabetic that have been able to really lower their A1C levels because we are reducing those inflammatory markers and conditions going on in their body.

So anyone where you’ve got arthritis patients, diabetic patients, patients with history of heart attack or stroke, cancer patients, all of these patients are great patients to think about from a standpoint of keeping those inflammatory markers low. Obviously implant patients, what a great way to protect your implants. I always say to patients, “Hey, the great thing about an implant is obviously we can’t get a cavity, but bone loss will take out an implant.” So Perio Protect is a great way to keep that bone healthy and stabilized around those implants. And if you are a practice doing implants, I recommend building Perio Protect into their case so that once everything is done, they’ve got that automatic way to protect.

Another great use is patients who have a higher decay risk because the beauty of these trays is, like I said, you can use different medicaments and it will drive them down below that gumline. So if you’ve got your elderly population that tends to have more root caries going on, you can use a fluoride based gel and it will drive its subgingivally around those roots and help remineralize in those areas and protect there. So there’s really not a patient out there that couldn’t benefit from it in all honesty.

Bill Neumann:

You touched on at Atlanta Dental Spa that you’re charging $1,100 for the trays. Dr. Graham talked a little, that not be everywhere. So give the audience a little bit of an idea, and maybe Lou, you can touch on this, what kind of revenue you should expect from this and maybe how many patients. You, Charissa, talked about just about every patient it could be applicable to, but realistically, especially when you’re starting off, what are some realistic expectations on revenue and maybe how many patients in a given day would be interested in this?

Dr. Lou Graham:

You want to start?

Charissa Wood, RDH:

Sure. So like Lou said, you’re looking at your lab costs, it’s around about $200, $250. So anything that you are charging above that, that is your profit. If you think about your patients that come in and sit in your chair every day, how many patients do you have that you see that are bleeding when you see them at the top of the appointment when you’re doing your perio evaluation? Or they’re telling you, “Hey, I’m getting bleeding when I’m brushing or flossing.” I would say at least one would be a very small percentage. But if you were to implement Perio Protect on at least one patient per day, that is increasing your revenue, again, depending on what you’re charging for your trays, by a significant amount. So I think that’s one place to start thinking about it from that aspect. But if we really delve into how much bleeding we’re seeing and how much inflammation we’re seeing, there’s a lot of opportunity there.

Bill Neumann:

So it sounds good to people in the audience, but one of the biggest concerns is, “Sounds great. I have 50 hygienists that we’re going to have to train and educate,” it could be more than that. So how easy is it? What’s the next step? And how easy is it for whether it’s onboarding, whether it’s the education, what does that process look like and how long does it really take practices and hygienists to become comfortable presenting this to the patients? Yeah, so let’s start there. That’s probably one of the bigger concerns, “Sounds good. We’re going to make more money. We’re going to really provide better care to our patients. But how do we onboard this?” That’s where the challenge can lie, especially when it’s not one hygienist or two, it’s multiple and it’s over multiple locations.

Dr. Lou Graham:

So let me tackle that. I’ll go back to our initial training. Everybody must participate in the initial online training. It’s an hour, hour and a half. And you have to understand there are some basic core understandings of this FDA approved device. So once the team buys into this, I would recommend one or two people actually trying the trays who have bleeding on probing. And I’ll just show you, I was one of them. And I will tell you, once you’re a user in the office, you’re a believer. So team training’s easy. I think, and what Charissa will absolutely say is, the doctor has to be supportive of the hygienist recommendations and the hygienist has to be supportive of the doctor’s recommendations. And I would say this is pretty much a no-brainer to learn how to do. And for me, implementation is about consistency. And you want the same consistency, Bill. So if you have two or three hygienists in a practice like we have three, all the hygienists should be delivering the same quality of care diagnostically and clinically, and this adds to the components of such.

Charissa Wood, RDH:

And I want to hop in on that. As far as you asked, because you’re right, there’s always a fear when there’s something new. Anytime we’re offering something new, the practitioners start thinking, “Oh my gosh, how do I talk about this?” I say a lot of hygienists get uncomfortable when we’re talking about something that we deem expensive, but if we stop and think about what a patient is investing when they are doing scaling and root planning or laser therapy, this is yes, another investment, but this is a long-term investment towards maintaining health. And we have to think about it from that aspect. When we first start onboarding Perio Protect, I always recommend, I love Lou’s idea and I think that’s brilliant, is start with your team, let your team try it out. But then when you’re starting to shift towards patient focus, start with your perio maintenance patients that are still bleeding every time you see them. Because the reality is we have not gotten them healthy, we have not kept them healthy.

And that’s an easy conversation of, “Mr. Jones, I know that we have been seeing you for X, Y, and Z years. We’ve done multiple rounds of scaling and root planning or laser therapy, but when you come to see us, we’re still seeing active bleeding, and that means we’re not really achieving health like we want to for you. We know that this still is putting you at risk. We have a new technology here in our practice that we are really excited about because we’re seeing great results with patients with the bleeding and the inflammation stopping. And I think this would be a wise investment for you in light of everything that you’ve already put in. Let’s try this and see if we can’t truly get this infection under control.” And once you as a practitioner treat three or four of those perio maintenance patients and you see for yourself that they’re coming back without the bleeding and the inflammation and they’re actually excited about it, now it’s easier to start talking to more and more patients about it. But I always recommend starting with those perio maintenance patients first.

Dr. Lou Graham:

And Bill, to that point, about 15% of your patient load will have refractory perio. In other words, bleeding on probing after treatment. And to Charissa’s thoughts on that, I am a hundred percent supportive. You will see those patients literally, so if you’ve got a thousand patients, 150 of them are sitting in your practice right now, go after them. And I’d say have an approach. This is easy. So let’s say you’re going, “Wow, a thousand bucks is a lot of money to a lot of people.” Great. So we work with a company, in Catapult, one of our financing partners, is called Cherry. And we can do 12 months interest free minimum cost to the practice and minimum cost to the patient, costs them nothing extra. And this way if the money is an issue, and it will be to many people, we can go 0% financing for 12 months and, boom, increase case acceptance. I want to take money out of the resistance because what we all want is oral health. And as a team, just come up with an approach, standardize it and you’ll be fine.

Bill Neumann:

Great insight there, Lou. As we start to wrap things up here, just any final thoughts on Perio Protect? And then I want to make sure that the audience knows how to get in touch with both of you. So email addresses, website information, we’ll make sure we drop all that in the show notes. But is there anything that you think could tie this podcast up nicely and convince people to at least find out more about Perio Protect? So maybe we’ll start with you, Lou, and then finish up with you, Charissa.

Dr. Lou Graham:

So couple things. First off, we tell our patients every hygiene visit, bring your trays. They’re not effective if they don’t fit well, things can happen. So routinely, what we’ll do in our practice, just an FYI for everybody out there, if someone comes in with a lot of calculus and tartar, new patient, we’ll do an overall super gingival debridement then scan, because we don’t want to really scan on calculus. So we ask the patients always to bring them in. We like to clean them in the office. We don’t charge for it, it’s a value add. And they should be purchasing the gel at least two or three tubes every three to four months from the office. And again, it’s additional revenue. It’s not that costly to a patient.

And I just want to go back to one thing Charissa said, and it’s so important, peri mucositis occurs in almost half of all implants. Peri implantitis occurs years later on almost a third of all implants. So we make it mandatory that patients get Perio Protect if there’s any perio at all in their mouth, and if you don’t have ideal gingival tissue around it, these are all mandatory essentials in our practice. So I would say you will continue to evolve once you fall into the Perio Protect thinking and it will continue to evolve in your practice.

Bill Neumann:

Charissa?

Charissa Wood, RDH:

And I just think, as being a user for 11 years, I could not recommend it more. It is easy. It’s easy for everyone involved. It’s easy for you as a provider. You asked about how hard is it to get this going, like Lou said, it’s about an hour and a half of training for your team, you get the information. Perio Protect is really fabulous at supporting you in the beginning and really helping you understand and getting you what you need to get everything rolling. It’s easy for the patient to be compliant. They wear the trays 10 to 15 minutes a day. Everything about it is easy.

It’s one of those things, I think so many people have maybe not really looked in because they think, “Oh, that sounds too good to be true,” I feel like it is almost, but it’s effective and it is easy and it is efficient. And I will say as a hygienist personally, it makes your job so much easier when you’re seeing those patients for their recare visits because they have been doing the work for you. And my doctor says all the time when we’re talking to patients about them, it’s like having your teeth professionally cleaned on a daily basis. So it’s just a super, super smart, scientific way of managing inflammation and infection in our mouths. And why would we not do that?

Bill Neumann:

So if anyone in the audience wants to find out more about Perio Protect, you can go to perioprotect.com/dso. It’s perioprotect.com/dso. We’ll drop that link in the show notes. Dr. Graham, if people want to find out more about Catapult, how do they do so?

Dr. Lou Graham:

Well, we have two websites. One is catapulteducation.com. And we host a lot of complimentary CE. And we’re so happy to be launching our GPO and it’s called Catapult Grow, and go to catapultgrow.com. And Perio Protect is one of our clients, so you actually save money by joining our GPO. And we’re bringing only educationally driven products to all of you. And so I think both are winners. Thank you, Bill.

Bill Neumann:

Thank you, Lou. Charissa, how do they get in touch with you or find out more about your organization?

Charissa Wood, RDH:

So you can find me at bulletproofhygiene.com. I will give you my email to put in the show notes as well, I’m open to that. I’ve got a podcast out there called Bulletproof Hygiene, so that’s a great way to kind of look in and see what we’re doing for hygienists and how we’re connecting. But yeah, come check us out.

Bill Neumann:

Excellent. Well, thanks. We’ll make sure we drop all those URLs and the email address in the show notes. Thank you, Dr. Graham. Thank you, Charissa, for joining us today. And thanks everybody for watching us or listening in. Until next time, this is the Group Dentistry Now Show.