Day: November 23, 2021 (page 1 of 1)

Business side of dentistry: When to do a startup?

Editor’s note: This is the 11th article in a series exploring the business aspects of the dental profession, from starting a practice and marketing to hiring staff and finances.

Dr. Deshpande

Doing a startup may seem exciting, but as I’m going through it myself currently, I can say it is one scary endeavor. Probably scarier than anything else I’ve ever done.

There are a million things going in my mind right now as I write this in February of 2021:

1. I still need to tweak my business plan with location demographic and competition analysis

2. Write out monthly financial projections for years 1-3 and send it to three of my mentors for their input and advice.

3. Cold call offices in the area to analyze competition; how good are they at answering their phones? How easy was it to make an appointment? Were my financial options explained to me (posing as a prospective patient) with ease?

4. Completing my pre-qualification process with a lender. At the time of this writing, there are only 2 banks in Washington state that are offering a startup loan.

5. Taking a course on Facebook marketing, and another on in-house membership plans, because I want to have a fee for service practice that focuses on providing the very best hospitality to our patients. This is difficult to do in my location- an urban Seattle suburb, where insurance dependency typically runs quite high.

Do you now know what I mean? These are the things running in my head, or anyone who is planning a startup. Are you ready for this life? All of this with the uncertainty of patients actually calling your office and making appointments. However, all said and done, that doesn’t mean we don’t go ahead with our plans. Here’s when I think all of you should consider before undertaking a startup.

1. If you’ve looked at all the practice brokerage websites for at least a year and found no practice that comes close to your vision.

2. If you’ve reached out to every dentist in your chosen location, who is above 55 years in age and asked them about a possible transition.

3. If all the practices you’ve seen so far seem small in size. For example, my vision was to have a 7-op practice because I see myself having an associate and at least 3 hygienists one day. Most of the practices in my market have a max of 5 ops. It is very difficult to expand a 5-op practice, unless there’s a vacant space next door or you change the location.

This is why it is so important to know your future vision and reverse engineer from there! If after a year of searching, your vision of practice ownership remains the same, consider doing a startup.

Questions about doing a startup? Feel free to reach out and follow my personal journey @dr.deshpande.

Dr. Sampada Deshpande is a general dentist based in San Francisco. A foreign trained dentist from India, Sampada earned her DDS from the University of Washington in 2018 and is a 2020-2021 UW-LEND fellow. Outside of clinical dentistry, she enjoys teaching at the New Dentist Business Club and improving access to technology in healthcare via her involvement in Samsotech. You can reach her directly at @dr.deshpande on Instagram or visit her website for more information.

Editor’s note: We know that finding the right practice can be overwhelming and time consuming. That’s why the ADA created ADA Practice Transitions (ADAPT), a service that matches you with practices that fit your practice approach and lifestyle. We provide customized resources to ensure you feel confident in your decisions and an ADA Advisor supports you during each step of the journey. Learn more at

The medicine and dentistry divide in cancer care

We have a problem. There is a troubling gap between the medical and dental communities when it comes to cancer care. As a result, health care providers and their patients alike experience a great deal of frustration regarding the lack of dental care available to patients with cancer.

Dr. Alhajji

In my training, I met a middle-aged man who had been diagnosed with an adenoid cystic carcinoma of the left nasal cavity, for which he underwent surgery and electron beam radiation therapy.

The cancer recurred six years later, warranting another round of radiation therapy. As a result of his cancer treatment, he developed severe trismus to the extent that he was unable to remove his prosthesis. This limited our ability to perform an adequate head and neck exam and address the chronic intra-oral pain he initially came to our clinic complaining about. Despite a limited evaluation, we were able to note clinical evidence of osteoradionecrosis. The culmination of oral complications he acquired not only led him to suffer from chronic pain but also affected his speech and ability to eat.

Such catastrophic cases can be prevented or at least minimized with a simple dental assessment in anticipation of a patient’s cancer treatment, and with supportive oral care throughout the course of their cancer journey. If our team had been involved sooner, we could have facilitated a referral to a physical therapist to minimize progression of his trismus.

Dentists play an important role in enhancing the quality of life of their patients and instilling hope in their cancer journey. It’s hard enough going through cancer; it is one of the most trying experiences imaginable for our patients and their loved ones. Once a patient makes it through to the other side, the last thing they would want to deal with at that point is combatting major oral complications that can inevitably arise from cancer treatment, especially when those complications were totally avoidable

The reality is that this isn’t how things are working out. As Cancer Network observed, some cancer centers “let the patient take care of it” when it comes to dental care. Furthermore, a population-based study found only 35% of oral cancer patients have a regular dentist and routine dental care.1 In a survey of oral health supportive services for the National Cancer Institute-Designated Cancer Centers, 56% said they didn’t even have a dental department, nor did they have any sort of oral care protocol in place to address healthcare concerns that may arise during cancer treatment.2  This is a problem.

There are a few factors that can be attributed to this issue.

The first and perhaps most blaring reason is lack of access to care, mainly characterized by the fact that medical and dental insurance are based on separate insurance models; Medicare typically doesn’t cover dental procedures, and many dentists don’t accept Medicaid.

The second cause of this disconnect is a limited number of dental providers with a strong understanding of oncology. The current reality is that dental school curricula don’t emphasize dental oncology. For that reason, general dentists are not prepared to treat this patient population.

On the other hand, our medical counterparts are not adequately trained to consider the ramifications of cancer and its treatment on a patient’s mouth and overall health.

What makes matters worse, dental providers often have a lack of administrative support, or a lack of cross-trained billers (CDT vs. CPT coding), to support them with reimbursement.

Finally, a third explanation for our challenge might be described as “patient individual barriers.” They include lower socioeconomic status that impacts the ability to secure time off from work or to access transportation, language issues hindering effective communication, and patient education. After all, dental care is not the first thing that comes to mind upon a cancer diagnosis.

What is the solution?

There are a number of patient advocacy groups working on these conundrums, such as the Oral Cancer Foundation and the Santa Fe Group. Most recently this has been brought to the attention of the Lancet Series on Oral Health3, 4 and NYU Dentistry which has been designated as a WHO Collaborating Center for Quality Improvement and Evidence-Based Dentistry5.

There are also a limited number of facilities and programs attempting to bridge the medicine-dentistry gap.  I am grateful to be a part of one of them. The Oral Health Center for People with Disabilities (OHCPD) at NYU Dentistry, opened its doors in 2019 and is designed for patients with very prominent and visible physical disabilities, such as patients who use wheelchair transportation. Although society doesn’t often view cancer as a disability, it can surely affect one’s quality of life much like other disabilities. As a result, it deserves proper attention and care, which is why at the OHCPD, we are including the care of this patient population in our protocol as a mechanism to bridge this divide. Another way NYU Dentistry acts as a bridge is by waiving the cost of pre-cancer treatment dental care for those who don’t have insurance. We are also furthering the professional education of our students by modifying the protocol for the OHCPD to encompass comprehensive dental care for cancer patients, hence expanding the curriculum and educating the next generation of dentists.

In conclusion, at NYU Dentistry’s new Oral Health Center for People with Disabilities, we are leading the way to bridge the medicine and dentistry divide by helping to ensure dentists are available, visible, and accessible for this patient population. The goal is not just to survive and beat cancer, but to thrive afterwards. As Benjamin Franklin reminds us, “an ounce of prevention is worth a pound of cure.”

Dr. Dalal Alhajji, DMD, MSD, received her DMD from Boston University Henry M. Goldman School of Dental Medicine, a certificate in ‘Advanced Education in General Dentistry’ and a Master of Science in Dentistry, in Oral Medicine, degree from Case Western Reserve University School of Dental Medicine. She also completed a fellowship in Dental Oncology at Memorial Sloan Kettering Cancer Center and is now a Clinical Instructor at New York University College of Dentistry’s Department of Oral and Maxillofacial Pathology, Radiology, and Medicine.

1 Groome, Patti A., et al. “A population-based study of factors associated with early versus late stage oral cavity cancer diagnoses.” Oral oncology 47.7 (2011): 642-647.2  Epstein, Joel B., et al. “A survey of National Cancer Institute-designated comprehensive cancer centers’ oral health supportive care practices and resources in the USA.” Supportive care in cancer 15.4 (2007): 357-362.

3 Peres, Marco A., et al. “Oral diseases: a global public health challenge.” The Lancet 394.10194 (2019): 249-260.

4 Watt, Richard G., et al. “Ending the neglect of global oral health: time for radical action.” The Lancet 394.10194 (2019): 261-272.


Did you miss our previous article…

Connecting the dots

Dr. Patel managed to see places on her bucket list, including the Maldives this summer.

I remember watching Steve Jobs’ 2005 Stanford Commencement address as a dental school applicant who was hopeful (and a bit scared) about her future. In it, he spoke of three lessons he wanted to impart on the graduating class that year. The first, the one that resonated the most with me then, and continues to echo down the hallways of my life now, was about connecting the dots.

In his speech, Steve said, “You can’t connect the dots looking forward; you can only connect them looking backward. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.”

The last 20 months have brought about a season of change that many thought would never happen in their generations. A global change in not only the way we live our lives, but also how we look at each other, and the world. And yet, through the sometimes dark, but very often gray areas we’ve each lived through, light and love still break through.

I have made new friends around the country, reconnected with people I haven’t spoken to in years, and found a path for myself in “dental-land”(what I affectionately call organized dentistry). I’ve even managed to see places on my bucket list – the Maldives this summer was truly transcendental.  In the stillness of that beautiful place, I had my first opportunity to practice mindfulness. Wherever you are – be there. Be present. It is a gift, one that many don’t have the chance to experience.

As I reflect today — with the Thanksgiving holiday only a few days away — it seems that the dots which once floated aimlessly around the picturesque background in the story of my life are starting to connect. In our separation, we actually got to be closer to each other than ever before. Love shows up. I’ve always said this: to myself, to dental students and residents and new dentists I have the honor of working with, to friends, and family alike. Be present. Time (and your good health) are precious beyond measure. I look forward to continuing to grow, to learn, and to adventure – but most importantly, to do it together with so many of my loved ones.

Be well, and be present.

Dr. Amrita R. Patel grew up in Chappaqua, New York, and graduated from the New York University College of Dentistry in 2011 before completing a general practice residency at the Nassau University Medical Center. Dr. Patel is a general dentist in private practice with her father, Dr. Rohit Z. Patel, in Westchester County, New York. She chaired the New York State Dental Association New Dentist Committee, is the International College of Dentists – USA Section Fellow Ambassador of Social Media, and currently serves the new dentists on the American Dental Association Council on Dental Benefit Plans for the 2020-21 term. She is also among the recipients of the 2021 ADA 10 Under 10 Awards.

Did you miss our previous article…

How Does The Epstein-Barr Virus Affect Your Gums?


In today’s episode, Dr. B answers a listener’s question about whether the Epstein-Barr virus is responsible for her bleeding gums. EBV is a systemic infection with an oral manifestation meaning it acts as a great springboard to talk about the oral-systemic connection as well. EBV is more colloquially known as the ‘kissing disease’ and commonly flares up in patients who have contracted it when they are run down, causing symptoms such as bleeding gums. Dr. B takes us through the signs, symptoms, and manifestations of EBV and also gets into some of the other conditions it has been linked to. After covering the basic facts about the virus, we take a deep dive into the oral-systemic connection which EBV illustrates so well. Dr. B traces a chain of connections between outbreaks of EBV, inflammation, spikes in glucose, diet, and the immune system. We also hear tips and tricks for managing EBV involving periodontal treatments, eating to combat inflammation, and keeping a close eye on glucose levels. 

Key Points From This Episode:

Introducing today’s question revolving around bleeding gums and the Epstein-Barr virusThe typical situations that lead to EBV and related conditions it causesHow recent studies have implicated EBV in the pathogenesis of advanced periodontal diseaseDiscussing how EBV illustrates the oral-systemic connection Other places EBV can be found such as in the tips of the rootsSeeing a periodontist and getting regular cleanings to suppress the viral loadThe connection between inflammation and episodes of EBVTips for keeping EBV under control around bolstering the oral microbiomeWearing a glucose monitor in between sessions with the periodontistMaintaining a diet that does not flare up glucose levels and weaken the immune system

How to Submit Your Question:

Record your question for Dr. B at 

Links Mentioned in Today’s Episode:

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Did you miss our previous article…