Tag Archive for: leadership

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. You’re listening to Dr. Kevin Coughlin and Ascent Dental Radio. Today, I have another super guest for the next 20 minutes for another amazing podcast. Ascent Dental Solutions is focused on helping the dental community market themselves, improve patient relations and just improve their bottom line.

I would be remiss if I didn’t mention Mr. Doug Foresta. He has helped produce over 50 podcasts for me and without his intellect, his expertise and his stick-to-itiveness, we wouldn’t be here today.

As important, if not more important today, we’re dealing with communication issues which to me, are the fundamentals of success in any business, but in particular, my area of expertise: dentistry.

Today’s guest is Mr. David Wolf. He’s been creative director and producer of content for radio, TV, film, podcast, audio books and multimedia. His clients are Amblin, Universal, Disney, Discovery Channel, South West Airlines, children’s medical centers, Kidney Care, Miller Brewing, Budget Rent a Car, Frito-Lay, Pepsi, McDonalds, Texaco and the list goes on and on.

You may be asking yourself, why would the dental profession be interested in having an expert like David speak? I can only tell you with 35 years of practicing dentistry, owning 14 dental offices, 160 employees that the single most significant thing that I’ve seen over the years is the ability to communicate with your team members and your patients.

And without any further ado, David’s going to introduce himself and tell us what he’s seen over his number of years in this field and how he can, perhaps, improve our ability to communicate with team members and patients.

David, thank you so much for taking time from your busy schedule to speak to our audience today.

David: You are most welcome, Kevin. Thank you.

Kevin: Give us a little bit of background about what you’ve sensed and what you see as far as communication in health care, but in dentistry in particular.

David: That’s a fascinating subject because it’s infused by years of producing talent, singers, speakers, musicians in the context of pure communication which is music and audio for advertising and communications and training films so my perspective is somewhat skewed to the entertainment preparation or production side of the business.

As an observer of those who I’ve encountered in the medical profession and also in dentistry, and we were talking offline about this is as well, I think that because of the nature of the work and the nature of the type of minds that enter those fields, I think from a personality perspective they tend to be very scientific.

And I would check this with you to see if you agree, I know you’ve been in the industry for more than 35 years. Would you agree that most of the folks, it seems to me, tend to be more, let’s call them introverted. They’re really measured by their grasp of technology and emerging technology in dentistry. And then with that emersement, they are then almost tasked to come up for air and talk to mere mortals as they’re sitting in the chair ready for a procedure. Do I have this right?

Kevin: I think you hit the nail right on the head. We’re all somewhat prone to these idiosyncrasies. We focus on the minutia. We focus on infinitesimally small areas of the human anatomy and many times we lose sight of the actual patient. We’re not actually listening to what they’re telling us or what they actually want.

And I think in today’s competitive market in medicine, in dentistry, the ability to be able to connect, what I call BLT; you want your team and your patients to believe in you, you want them to like you and you want them to trust you. And in order to accomplish that task, there are certain areas of expertise that you bring to the table that maybe you can help our listeners learn from your teaching standpoint.

David: Absolutely, and I appreciate that. You hit it on the head with BLT because at the end of the day, what I’ve learned, if I’ve learned anything in my 30 or so years in the communication space, is that for the most part we’re emotional beings. And the communications and this connection that we make, the belief, the like and T was trust, forming that foundation in a relationship, it’s all about emotion.

So how do we communicate emotion in a world that is somewhat technical and there is sometimes a clock running and there is a procedure to be done and there is a lot of preparation?

It almost, from my perspective, might require that the practitioner almost compartmentalize a bit, and as I said earlier, come up for air and understand that okay, now I’m going to speak to this patient in emotional terms. I’m going to use my voice in ways, almost the tone — one of the things I do is I coach people around the use of their voice. I call this program The Power of Voice.

There are some fascinating things about the voice that despite the fact that we use it for 80 percent of everything we do, no matter what business we’re in or vocation or avocation we’re in, we rarely think about it. We just assume, oh, this is my voice, this is what I’ve been given and born with and I’ll just use it however I can use it. But very few people really think or exam or even practice simple aspects of their vocal mechanism. And I think some of this could apply to the practitioners that are listening here to better understand how their voice affects the emotions of the patient in the chair.

Kevin: I would tell you that some of the things that I’ve seen is in my particular organization, we see over 938 new patients a month. And over and over again I hear the same thing; how come no one ever explained this before? How come no one ever told me this before? And when you’re talking about the inflections in the tones, in your voice, I would tell you that over and over again I hear the same thing and that is, “I didn’t notice any empathy. The practitioner explained the A, the B and the C, but there was no inflection, no empathy, no real concern. It was a matter of fact. They need A, they need B, they need C and the cost is D.”

I think many times we as clinicians miss that connection that people, as you mentioned, they want that emotion. They want to know that you care. They assume that you already know how to do the A, the B and the C, that you’re clinically astute, but what they really want to pay for, what they really want is you to connect with them emotionally and understand why they want what they want and how come they need what they need.

And that’s been my 35 years of experience and sometimes, myself included in this, we miss that because we’re on the clock or because we’ve done it so many times.

Are there specific tips or training drills that you can suggest for the whole health care? But I believe it applies to anyone who deals with people.

David: I think you’re right. I’m glad you asked because I have a lot of notes ready for us today around some specifics. We’ve been kind of nibbling at the edge of this.

We’ve established that it’s an emotional connection we need to make, but how do you do that with your voice in the context of a practice? And by the way, I would say also Dr. Coughlin, that this applies to speaking too in public, it even applies to guys like you and I that do podcasts and Doug that are on mic technique. It really applies to a lot. And I’m a student of this stuff. I’m working on it all the time even though I help others accomplish it.

So here it goes. I have a list of things I like to call the Elements of Voice and that includes breathing and tone, melody and pitch modulation, word formation, rhythm, pacing, phrasing. And then this thing we call filler words which may not as much relate to this emotional content that we’re talking about with respect to empathy, some of these traits or some of these elements of voice absolutely do inform the emotional content of our voice.

If I may, maybe I’ll demonstrate a few of these things. What’s amazing and again, I’m a student of this as well, as you pointed out here after even 35 years we’re always students, so few of us have really thought about how we breathe. Unless you’ve played trombone or some wind instrument in a band when you were in grammar school or high school, no one ever taught us that we really need to breathe from our abdomens.

And almost think of the abdomen as a balloon and the first step in breathing is not the inhale, but the exhale. So what we’re doing is we’re clearing [exhales], we’re exhaling out as much as we can — there will always be some air in our lungs because that’s what is required to keep them inflated — but to clear the lungs out to a comfortable level and then allow them organically or naturally to re-inflate.

What I’ve been practicing lately as I’ve got more and more into studying this is putting my hand sort of right around my navel and really feeling the expansion of my abdomen in a way that may feel a little silly. And many of us are weight conscious so if you’ve got a little belly you’re like, “I’ve been taught and conditioned socially to hold in my stomach all the time.” So for me that was a little bit of a I work on my weight, but push the stomach out as you exhale and really pull it in so it’s lower than your chest.

What happens when we, so much of us project or create the stream of air that our vocal folds use to create sound, we tend to focus in our neck area and in our chest area. And so where this folds into what we’re talking about with empathy is that if there’s enough sufficient breathe to support the stream of air as you talk to a patient or as you’re talking to someone in public, I believe that that support that you’re providing, your vocal tone, will feel more soothing to the recipient. So that’s just one example of breathing.

Kevin: I could tell you David also another thing that I saw is the physical presence of a dentist or any health care provider in their cubicle or operatory. I’ve been a student, not as astute as yourself, but I videotape a lot of the presentations that occur in a medical setting. And one of the things that I noticed is often the practitioner is standing and the patient is sitting and immediately you’re creating a dominance. I strongly recommend that you take a look at not just the tone and the breathing, but the physical space that you’re in and try not to impinge by being too close or too far away.

I talk to my students, my staff, my team members and say, “Try to be eye-to-eye contact. Try to stay within an arm’s length or three or four feet from the individual and talk eye-to-eye rather than looking down or looking up at them.” Would you agree with some of those comments?

David: Absolutely. We can’t ignore the fact that communication is multidimensional. And so in a room with a patient, or with anyone for that matter, a very high degree of adaptivity to what they’re comfortable with is called for here. And so in a world that is very procedurally driven, which is the world most of you live in, I think, in the medical space, you almost have to step out of that and suddenly become highly adaptive.

Now, I may have that wrong. It may be that even though you’re dealing with known anatomy, you go into a mouth or a cavity or a gum periodontal situation, you may have a whole lot of adaptiveness that’s required in order to treat. I may have misspoken on this, but these levels of sensitivity about hierarchy and body language are all a part of the communications process.

Of course, I’m focusing on the voice, which is only one component. The visual, yes. Bottom line is I absolutely agree with that premise. It’s a total communications process.

Kevin: David, are there actual courses out there that you teach that can give more instrumental techniques? Is there ways that people can touch base with you to learn some of these tactics that really, I hate to say, we try to sell to people? But in the world that I live in, we’re all selling something and in my opinion, selling is good providing it’s done ethically and honestly. I’ve never looked at selling as bad. I think I’m selling myself on this podcast.

You’re selling your techniques to people. But so long as they’re done with the idea of providing value and a service and to improve the way we connect with people, I look that as something very good and I appreciate the expertise. How do they get in touch with you? How do they reach out to learn more about these techniques to improve their accepting the patient and the patient accepting them?

David: Thank you very much. I appreciate that, Dr. Coughlin. By the way, I listen to your podcast regularly and I know that really you’re sharing great and valuable information that you believe in. That’s what I’m trying to get to there. So thank you for including me in the fold there. The way folks can get a hold of me and learn more about this program I call The Power of Voice is they can reach me at www.podcastandradio.com.

There is a contact me area or page on that site. There is also a little bit of an explanation about The Power of Voice. I do coaching. I’m developing a course that will be ultimately sold online as well and a lot of exciting developments around all of this is as an adjunct to my background. So thank you for inviting me in.

Kevin: No David, thank you. For our listeners here, sometimes I like to digress from the technical aspects because I think sometimes more important than the technical aspects of health care is the people aspects of health care. And I think we take with a grain of salt what we should probably spend more time on. And that’s patients come to us to listen to explanations, options, the risk, the benefits and the alternatives.

And unfortunately, if we’re going to provide the highest level of care and service, the ability to communicate, the ability to connect and the techniques to make us better at it are many times completely overlooked in the health and medical profession. And bringing experts like David wolf and his programs to our listeners, I think, is a great boon to our profession and to our patients.

David, with your expertise in the creative director and producer, we need people like you in our health care profession to make us connect better and more efficiently with our patients and I can’t thank you enough. Please, don’t hesitate to reach out and get to David at smallbizamerica@gmail.com.

You’ve been listening to Dr. Kevin Coughlin, Ascent Dental Solutions, where the focus is on knowledge, consultation, training and development. And in closing, my great thanks to Mr. Doug Foresta, Stand Out and Be Heard. Without his expertise, this podcast would not take place. Thanks again and I look forward to speaking to everyone soon.

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. This is Dr. Kevin Coughlin. You’re listening to Ascent Dental Radio, where the focus is on knowledge, consultation, development and training. I believe this is the 40th podcast that we’ve been doing and it wouldn’t be possible without the special help of my production and consulting guru, Mr. Doug Foresta. His company, Stand Out and Be Heard is responsible for the webinars and the podcast and I always like to give a shout out to think him very much for his expertise and his talent in this regard.

Today, we have a topic of temporomandibular joint. For most of the listeners you’ve been hearing me and listening to me focus on the business of dentistry, but I want you to know that I am a clinician and have been practicing for 35 years as a general dentist in all areas of dentistry.

Over and over again I get questions and comments about Temporomandibular Joint disorders or TMJ and I thought today’s podcast might be valuable to the listeners on how do we treat TMD issues and what’s going on in the field. I’m proud to say that I’m going to have some questions asked to me today. Those are general questions and if you have specific questions, you can reach me on www.ascent-dental-solutions.com. I’m very good about checking and getting back to you with specific questions. Doug, what’s your first question?

Doug: Thank you, Kevin. It’s a pleasure to be here. My first question for you is what is TMJ or TMD? Can you explain what that is?

Kevin: For the lay patients listening to this podcast, TMJ stands for Temporomandibular Joint. It’s the acronym for the most complicated joint in the human body and it’s located right in front of your ear canals on the right and left side. For the clinicians listening, we refer to the problems, the signs, the symptoms of temporomandibular joint as TMD or Temporomandibular Disorders or Dysfunction and there are a slew of them. Many times, the patient will come into the office and say, “Dr. Coughlin, I have a TMJ issue.” And my response is everyone has a TMJ, but not everyone has TMD issues. Hopefully, that answers that question.

Doug: Thank you. What are some of the patient signs and symptoms then of those TMD issues?

Kevin: I would say, in my 35-year career working pretty much five days a week, sometimes six days a week, a day has not transpired where a patient or an employee or team member hasn’t said, “Dr. Coughlin, I have pain, stiffness, popping or clicking in the joint region.” And when I say the joint region, I’m referring to the temporomandibular joint. Generally, the complaints are pain and discomfort and a limited range of motion.

I would say to the clinicians out there I have been doing expert evaluations for insurance companies for close to 30 years and the vast majority of the cases I review are TMD disorders and over and over again, I feel that the records that have been taken by the diagnosticians, the dentists in particular, are less than adequate and could be greatly improved by following some simple rules. I would strongly suggest to the clinician that on every single patient you document Range of Motion, ROM, not only vertically, laterally, but also protrusively.

This means, you have the patient open vertically as wide as possible without causing any pain or discomfort and for the average adult that should be close to 60 millimeters. If you want to save a lot of time and a lot of aggravation, generally, if you take your hand and use your forefingers and put them on top of each other and place them from the incisal edge of the upper anterior teeth to the incisal edge of the lower anterior teeth, you’re going to get about 60 millimeters. If you eliminate your baby finger, that will be about 50 millimeters and that would give you a good indication that the patient’s range of motion vertically is within normal limits.

Laterally, you have the patient bring their jaw all the way to the right and then all the way to the left and generally, that should be about four to six millimeters right and left to be an adequate range of motion laterally. Protusively, you’d like to see the patient move their lower jaw forward, at least, 6 to 10 millimeters anteriorly or protusively.

I would strongly recommend prior to the removal of wisdom teeth, prior to any orthodontic care or any extensive treatment where the patient’s jaw is going to be open for any significant length of time, let’s say more than 30 minutes, make sure your charts document range of motion.

The next item that I think is critical is during this range of motions, you want to document if the patient has any deflections or deviations. A deviation simply means when the patient is opening their mouth vertically, the jaw deviates either to the right or to the left and does not come back to the mid-line. This is an indication when the jaw deviates to the right that more than likely, the temporomandibular joint on the patient’s right side is not functioning properly.

Just going back to some basic anatomy and physiology, the first 25 millimeters of opening, the temporomandibular jaw rotates. After 25 millimeters, it translates down and forward. So when you see the patient’s jaw deviate to the right in this particular exercise, you know that the left TMJ is rotating and translating properly, but the right TMJ is not and it’s a pretty good indication that that joint is not healthy and is not in a correct position. And usually, the culprit is the meniscus or the disc that separates the temporal bone from the mandibula bone.

The next documentation would be a deflection. This simply means that the jaw upon maximum opening deflects either to the right or to the left, but comes back to the mid-line. So the opening is almost an S-shape. This means that the joints are not working properly. But in most cases, the disc has been recaptured and it allows the jaw to come back to the mid-line. Whereas in a deviation, that disc is not allowing proper translation and is most likely not being recaptured.

The critical thing here in this particular podcast is to give you a few simple inexpensive tips to improve your diagnostic records and your diagnosis and to help your patients and also to protect you since in my 35 years of experience, most patients have some temporomandibular joint signs and symptoms prior to dental treatment.

And then the dental treatment triggers the episode of pain and discomfort and the patient immediately associates it as a dental problem that was caused by a dentist when it actuality, the problem was predisposing. But because the records are inadequate in the documentation of range of motion, deviations and deflections have not been adequately documented. How about another question, Doug?

Doug: I was going to say, I know I was doing it as you were speaking, I could picture our listeners moving their jaws back and forth as you were talking about that. What are the treatment options for TMD?

Kevin: The first thing that I would tell our clinicians and for patients listening is you’ll never get success unless you have a proper diagnosis. And you’ll never get a proper diagnosis unless you have appropriate dental and medical records. The fundamentals and basics are a thorough medical history and a thorough dental history. To augment those two bits of information, I would strongly recommend that there be a complete clinical palpation and exam of the head and neck region, with emphasis on the medial and lateral pterygoids, the temporalis and masseter muscle, which are the four major muscles of mastication or the muscles responsible for chewing and function.

Palpation of these muscles, which start almost if you could just put your finger above your ear and move it forward in the shape of a question mark, you’ll be palpating the posterior middle and anterior temporalis muscles on the right and left side above the ear.

From there, you will go down and palpate the masseter muscles and if you clinch your teeth together, you’ll feel a bulge in front of your ear and those are typically the masseter muscles. Those are the two large muscles responsible for a large majority of the pain and discomfort.

During the palpation examination and the clinical examination, tenderness to these four muscles of mastication usually indicate that there’s a muscular problem and a muscular cause of the patient’s pain.

Also, you’ll find customarily, the patient will complain of tension and stress headaches, many times sometimes misdiagnosed as migraine headaches, and they’re really caused by the clenching and squeezing down of the upper and lower teeth together. And that constant aggravation causes spasm in these muscles which cause pain and that pain emanates from around the ear, in the head and neck region.

Next, you should have upper and lower diagnostic impressions so that we can see what your teeth look like and how they function. On top of that, I would suggest radiographic examination so we can determine the health and the condition of the temporomandibular joint. Typically, this would be a cephalometric view or a panoramic view and sometimes, we can even do a temporomandibular joint view. The more views, the greater the likelihood we’ll see damage and injury to the joint.

We can sometimes, depending on the severity of the problem, we may want to augment these diagnostics tools with an MRI or a CAT scan. But in most cases, for this particular type of podcast, I would function on the easy reversible treatments and diagnosis first to distinguish is the joint problem purely muscular or is it what we call internal derangement or intracapsular disease where there are some orthotic condition and the disc is not in its proper condition.

And there is sometimes, and actually many times, a combination of both problems, which makes the treatment in the diagnosis sometimes confusing and difficult.

After the proper diagnosis is done and records are done, generally, the treatment are broken into phase one and phase two types of treatment. The phase one treatment is simply to get the patient comfortable. And if it’s a muscular problem, we can many times test this by putting you on a pharmaceutical medication called Flexeril, generally, 10 milligrams, either in the morning or at night or a combination of both, to see if the patient’s signs and symptoms decrease. If they do, you’re pretty clear that you’re dealing with a muscular situation.

The next thing, in my 35 years of experience treating TMD disorders, is what we call Anterior Misguidance. You’ll find that your patient occludes or contacts the anterior teeth prematurely. Generally, these people tend to be very good looking in nature and generally, their teeth appear to be straight, but their upper anterior teeth are vertical. They have very little angulation and the angulation on the upper anterior teeth should be closer to 110 degrees.

And in most cases these upper teeth are up and down vertically so when the patient’s lower jaw goes into occlusion or opens and closes, the anterior teeth hit prematurely, causing the mandible to move backwards, irritating the ears, creating tinnitus, ear aches, neck, upper back pains and a tingling in the joint and just general discomfort.

A quick test for the patients and clinicians is to put your index finger lightly on teeth 7, 8, 9 and 10 or your upper anterior teeth and tap your lower teeth gently. If you feel a vibration or fremitus in that region, it’s a pretty good indication that the patient is suffering from anterior disclusion or malocclusion.

And a simple task would be to create some type of orthotic, sometimes referred to as a Night Guard, even those that’s inappropriate, to not allow the upper and lower anterior teeth to touch. Keep them out of occlusion and determine how the patient responds. If they immediately feel that they no longer are getting headaches or the headaches are reduced, the range of motion improves and their joints are no longer tender, then you know you’re dealing with some anterior misguidance. And you can correct this problem in phase two with some adult orthodontics.

Doug: Let me ask you this, Dr. Coughlin, the question that I think especially for patients would want to know, what is the cost generally of these treatments?

Kevin: I’d like to get as much as I possibly can, but that’s probably unprofessional and unethical. In fairness, it’s an excellent question. But generally, the diagnostic records will probably range somewhere between $175 and $650. As far as the actual treatment is concerned, the orthotics or the temporomandibular joint appliances and generally I would recommend one appliance for the lower jaw to be worn during the daytime and then an upper appliance to be worn at bedtime so you don’t wear both appliances simultaneously, what you’re trying to do is balance the jaw and keep in mind that this treatment approach is reversible.

It’s basically a phase one type of treatment to make sure your diagnosis is accurate and you’re providing value and care to your patient. Those orthotics can range from anywhere from about $850 to $2,250 per appliance and in most cases, the patient will need two appliances.

The course of care and treatment during this phase one is anywhere from three to six months and the patient is generally seen about every 14 to 21 days for adjustments and checks. Those visits are broken into short, medium and long, and the visit fees will range anywhere from $45 to $95 per visit. Please, keep in mind, I never hesitate to quote fees or recommend fees to give the audience some general guidelines, but the fees are general and they will be determined by the individual providing the care and treatment.

That is generally phase one type of treatment. If we find that the patient has responded and they’re doing quite well, their signs and symptoms have been eliminated or significantly reduced, a fair number of patients go into what we call a Phase Two type of treatment.

The phase two treatment is instead of wearing these orthotics day in and day out, we try to use a combination of orthodontics, prosthodontics to align, level and rotate the teeth to the new jaw position so that the orthotics or appliances are no longer necessary. That type of treatment can run into the several thousand dollar category. In most cases, the orthodontic care can run anywhere from about $3,850 to about $7,200 depending on how much and how we’re going to move these teeth.

In some cases, if the patient has a beautiful dentition with little to no dental disease, I will push the patient and guide them more towards and orthodontic type of treatment. If the patient has significant restorations, existing amalgams, composites, crowns or fillings on the teeth, I many times will suggest using a prosthetic type of treatment rather than orthodontics. The reason for that is the patient gets a double whammy. Not only does their jaw feel comfortable and their bite feel correct, but the cosmetics are improved significantly.

And in some severe cases, the patient will need a combination of both treatments. Keep in mind the physiology of the human body we cannot move the jaw indiscriminately as far as we want or as needed in some cases, and in those rare cases, a surgical approach is sometimes needed.

And that’s categorized as orthognathic maxillomandibular facial surgery. These are cases where positioning the jaw, even with the most up-to-date orthodontic care and prostatic care is not adequate. We actually have to surgically reposition the upper and lower jaw to the get the patient in that phase two success.

Doug: Would that be covered by insurance?

Kevin: In most cases, in my experience, once you’re going into the surgical phase, in most cases, that would be covered by your medical insurance because there would be a letter of medical necessity and no longer will your dental insurance be involved. I should comment a little bit on the fee structure for the dentist and for the patients listening to this podcast; my personal opinion is temporomandibular joint of TMD issues are medical issues.

The debate is the medical insurance feels that it should be billed through dental, the dental feels it should be billed through medical. But make no mistake about it. The temporomandibular joint is a joint and it is a medical procedure and a medical treatment, in my personal opinion, even though in many cases the individuals best suited to treat these most common problems are dentists.

Doug: That makes a lot of sense. I really appreciate it, Kevin. Thank you so much for sharing on this important topic of TMD and what people need to know.

Kevin: Thank you, Doug, very much. I just want to leave the listeners with what I call the 3 Ps. I would strongly recommend as you see your TMD patients, look for the 3 Ps. The first P is what was the patient’s precipitating event? It’s either going to be macro or micro trauma.

The second P is why are they predisposed? The patient usually will have a class two division one or a class two division two, malocclusion or a recessive mandibula or retrusive lower jaw. The third is what’s perpetuating the problem? So the three Ps are Precipitating, Predisposed and Perpetuating.

The perpetuating problem is TMD patients typically are clenchers. They’re constantly over exercising and irritating the muscles of mastication. When you can identify the three Ps and are comfortable with those 3 Ps, then you’ll probably have an excellent result in treatment and the patients will be happy and you will find that the treatment of TMD can be extremely rewarding and very cost-effective once you understand the basic principles.

You’ve been listening to Ascent Radio. My name is Dr. Kevin Coughlin. If you have particular questions, don’t hesitate to reach me through my website www.ascent-dental-solutions.com.

My special thanks to Mr. Foresta, whose company is Stand Out and Be Heard and is responsible for the professional production of the webinars and podcasts that you’ve been listening to. Thank you very much and Doug, thank you for your questions.

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Good afternoon. You’re listening to Ascent Radio. My name is Dr. Kevin Coughlin, owner and operator of Ascent-Dental-Solutions, with an emphasis on knowledge, consultation, training and development. I’d like to give special thanks to Mr. Doug Foresta. He has produced all of my podcasts with Ascent Dental Radio and Ascent Dental Solutions. His company is Stand Out and Be Heard and I just always want to thank Doug for his excellent production.

Today, we have a special guest. His name is Mr. Mike Pedersen. Mike is the CEO of Dental Boost. It’s a cutting-edge dental SEO company for both solo and group practices with a focus on the dental market. Mike has been in this business for over 17 years with an emphasis on online marketing and six years, he’s been working exclusively with dentists.

His agency is able to help clients dominate all of their locations in Google organic searches. They’ve also provided custom high-converting dental websites. Most of the dentists out here listening and health care professionals realize that a website and a mobile app is part of our marketing program, but Mike takes it with his company, Dental Boost, to a whole new level.

Mike, thank you so much for taking time from your busy schedule. Can you give us a little bit of background about the particulars; why you saw this niche, why you decided to get involved with this particular aspect of the dental business?

Mike: Kevin, first off, thank you very much for having me on your show. I’m honored and it’s very much appreciated. Instead of going after the normal approach for dental SEO which is city dentist, city veneers, city Invisalign, city sedation dentistry, those are very general terms and the unfortunate thing is everybody else is going after those terms. And if you’re in a big city, you’re talking about hundreds of dentists going after that term.

Well, that chance of that one dentist, even when they hire an SEO company, the chance of that one dental practice ranking in the top three organically is pretty slim or none, even after one year, Kevin. One year of investing in SEO, the chances of ranking in the top three are very slim, depending on the competition.

So what we decided to do was, do our exhaustive research to find out what kind of what we call buyer-intent dental keyword phrases are people typing in Google for specific searches. And we came up with some staggering numbers, absolutely staggering. The first number we came up with from kind of a general standpoint was 577. The typical dentist when they hire an SEO company goes after all of their services and they tap on the city and then they’ll go after city dentist, city cosmetic dentist.

So we typically see that the approach with all dental SEO is about 20 keyword phrases. We’ve come up with what we call Phase 1 SEO. We’ve come up with over 500. And when we tell our dentists that, they’ve never even heard that number before. It’s kind of like, “What is that? I mean, 500?” And they don’t think we’re serious. And then when we give them our references and they talk to some of our dentists that we’ve done it for, then they start believing that we do what we say we can do.

The exciting stuff for us is the back end, we’ve got a proprietary system we use that’s Google friendly that makes it through all the updates. But the neat thing that we’re able to do is from a robust standpoint, we’re able to not only go after the city the dentist is in, but all the surrounding areas up to five. And so what we’ll tell our dentist is, “Hey, what are the areas you draw your patients from outside of your city?” And they’ll name a bunch of areas. And it could be neighborhoods, it could be outlying towns, things like that. So now we’re going after five to six locations per dental practice.

When we do that, now you’re talking about ranking for upwards of 2,500 keyword phrases for your dental business. And that’s called pure domination in dentistry. Pure domination.

Kevin: I can tell Mike, you’re quite an athlete. I don’t know if our listeners understand what your previous background was in athletes, but I can tell with your desire, your drive and just your overall excitement with your business, Dental Boost. For some of our listeners, even the word SEO, Search Engine Optimization, may be foreign.

For those dentists not as, let’s just say, digital savvy, my understanding is that there’s close to 13 billion Google searches very month. And out of those billions of searches, is it true that the majority, 50 to maybe 75 percent are coming on mobile devices and can you discuss with our audience how that’s changed?

A typical dentist like me who’s been practicing for 35 years, I used to think if I have a website, I’m doing online marketing and I’m free to go. But in reality, experts like yourself realize we’re probably throwing our money into the wind and not getting much of a return on our investment. Could you address that for us, Mike?

Mike: Exactly. And you said something that’s very important when it comes to Google search too is we call it Voice Activated Search or Voice Search. Where people are on a mobile device, and they will talk into their phone — they use SIRI a lot for Apple devices — but they’ll get on Google and they’ll type in “cost of veneers, Portland” or whatever it may be and they’ll start — voice activated search is exploding.

And when you think of voice activated search, which is what we optimize for in our SEO campaign, people don’t talk in general terms. They talk as if they’re talking to somebody right in front of them. And when they do that, you’re talking with three, four, five words so that they get a really defined search result.

And that’s another benefit of our approach, is that mobile search is exploding. And you’re exactly right, it’s over 50 percent on mobile now and growing.

So people are spending more and more time on their mobile devices, including shopping, which Kevin you and I, I don’t know about you, but I’ll speak for myself. I’m 53, tech savvy obviously, running my agency, but I’m old school. I’m not about to make a purchase on my phone. I’ll do it once in a great while, but I don’t think the user experience is very good on a little phone to make a shopping purchase. But a lot of the younger millennials, 25, 30, 35, 40 year olds, they’re doing everything on the phone now, everything.

So you make a very, very good point and it’s a great reminder for me to tell the audience that voice activated search is exploding as well. And that voice activated search is not somebody saying Portland dentist, you’re saying, “Looking for male dentist in Portland, Oregon.” They’re talking into their phone, is what I’m trying to get at. And if you don’t optimize your website for a mobile search, you are losing a huge percentage of people that are using mobile to search for a dentist.

Kevin: Mike, let me just follow up with another question. I know you’ve been doing this for a long time. I know that your clients have been over the top satisfied with the service that you and your company have been providing. But how do you track the results? At the end of the day, when you take on a client, how do you track so that we have objective data to determine the return on investment with your company?

Mike: Great question. First and foremost, we always send ranking reports every month. And that is just hard core data to show if we’re performing what we promised we would perform, which is ranking higher in organic search. Number one as an SEO company, we’re hired to rank our clients higher in Google organic. That’s number one. That’s right off the top. So every month we send a ranking report. We just sent one the other day to a client and this is pretty damn exciting. Kevin, honestly, this is unheard of in dental SEO. This particular client had 973 top three positions in Google. 973, can you imagine?

Kevin: Absolutely fantastic.

Mike: Yeah. So first off, we send a ranking report. Second, we’re going to look at the traffic boost that our services are bringing that particular website. So we’ll go into Google organic and we want to see an increase in traffic. The increase is going to be incremental each and every month because as we rank more and more buyer-intent keyword phrases, that traffic is going to keep going up.

Unfortunately with the old style of dental SEO, traffic hardly ever goes up because it takes so long to get those rankings for those general terms. We’re able, with our robust proprietary back-end system we use, what we’re seeing on average is the first month ranking report we send a client, they have over 200 top three positions in Google is our average right now, after only four weeks of working with us.

Kevin: Mike, if you don’t mind telling the audience, you talked about the organic search. What’s the inorganic search when it’s associated with Google?

Mike: Great question. It’s called Google AdWords. Google has continued to show us something. As SEO experts, we’ve seen this happen more and more, but they can always go so far and then people will stop using Google, which is this; you will see the first page of Google with more and more ads because that’s how Google makes their money. But if they sabotage that and they can’t, there’s no way.

There’s a lot of people that say SEO is dead. Well, they don’t quite understand SEO when they say SEO is dead because if Google littered the whole front page with ads, people won’t use them anymore and Google as big as they are will go away.

People hearing this might say, “That’s crazy, they’re a 50, 60, 80 billion dollar company,” there’s been many multibillion dollar companies that disappear and we can name them over and over and over again. If Google littered the first page of their website with ads, people would leave them. There’s no doubt about it. So people that say SEO is dead, they’re uninformed.

But when we talk about organic and then what’s left is called Google Ads and also the map section, and Google is even taking more of that away. The map section, that little box on the first page when you type like a city dentist, it used to be seven positions in that map. Well, good old Google didn’t like that that map took a big section of the page one for a search so they cut that down to three. Good old Google, rumor has it, it might cut that down to one and throw an ad in there.

So as you can see, Google constantly is trying to, without getting in trouble, put more ads in there. So Google ads typically are the four positions on page one and the top four positions on page one as well. So top and bottom, that’s eight positions of ads.

But let me tell you something, Kevin, about ads and especially with those dental support organization owners that are listening to this audio. If you want to play the Google ad game per location, you are talking about thousands and thousands of dollars per month to get an ROI because it takes a lot of investment to gain the trust with Google to lower the cost per click. But even when you lower the cost per click, you still might get a lot of clicks, but that doesn’t necessarily mean you’ll get a phone call or a new patient.

So we’ve done some research and we’ve found out a number that I want all the listeners to understand, and it’s this; we have found out through research and studies that Google AdWords only send 10 percent of all website traffic to a business. Hear what I just said again; Google ads only send 10 percent of website traffic to a business.

That means if that business, whether it’s a dental practice, a DSO with 50 locations, if you are not doing any kind of organic optimization, you are leaving 90 percent of the potential traffic on the table for all those locations. Ninety percent!

Kevin: That’s huge.

Mike: That’s a big number.

Kevin: Mike, I was wondering if you could share with the audience in your business experience Dental Boost, without getting too specific, whatever your comfort line is, but for the dentists out there, large groups, solo, corporate groups, what generally can they expect for an investment to get your expertise to help them grow their business, improve their position on Google? And at the bottom line, you want people calling the office and you want to convert this tracking to new patients for your business.

Mike: Are you asking what our fees are?

Kevin: Generally, how do you charge the dentists that are listening? Is there a set fee, a monthly fee, a start-up fee and then follow up fees? How exactly does your company run in that regards?

Mike: We’re pretty standard, but what we do, especially the offering that we have with this buyer-intent and hundreds of phrases we go after, we’re priced about right in the middle of what most credible dental SEOs charge. But remember, most dental SEO companies are using the old method that takes six months to a year to see any kind of result, any at all. That is true. That’s a fact. But what we don’t want to do is we don’t lock our clients into contracts.

We’ve heard horror stories and I dealt with a lot of clients. I’ve got one right now, a solo practitioner out of Seattle, no names mentioned because I love them to death. They brought us on and his previous company basically will not let him go and they’re trying to extort a bunch of money from him.  

We don’t want to do that. We don’t lock our clients into contracts. With a thirty day notice, they’re out. They give us a thirty day notice, they’re out. But we do have an agreement because we have a formal agreement that lets them know what they can expect from us and the investment per month and that kind of thing, but we do not lock clients into like a 12-month contract, 18-month contract. If clients aren’t happy with what we’re doing, they can leave within 30 days. So that’s one. Really we’re proud of for that one.

Secondly, we don’t have start-up fee, we don’t have this fee, we don’t have that fee. We typically have a monthly retainer that our clients hire us on. That monthly retainer never changes unless they want to add on more services. And Kevin, I didn’t even get into all the stuff that we’re doing that’s getting really exciting for a lot of our clients, what we call add-ons and keyword clusters.

And I can tell you that a little bit, but for the investment it’s basically just one fee per month for SEO and depending on how competitive the area is, if you’re a solo practitioner, we’ve got kind of a baseline we start with as far as investment. It’s definitely not in the low end. If you’re looking for hundreds of dollars a month, we’re not the company for you. That would be another company that you would want to call on. It depends on the competitiveness of the city or the investment for our services. But our services only fluctuate $300 to $500 from top to bottom. So it’s not a real massive increase, if somebody has got a city that’s 500,000 we don’t like triple the cost, we just incrementally go up.

For a DSO, we basically cut each location in half. For example, the ideal situation for a DSO, so if the DSO owners are listening, please listen to this; Google is looking more for brand recognition now. No longer do you need individual websites for each one of your location. And I would strongly recommend against that. Have a brand that has all your locations on one website. That makes it consolidated, that makes it more cost-effective. And for us, now we can treat it not as separate accounts, like we would have to with each website, now we can treat it as we’ve got an initial investment for location one and then location two through the rest of them, we cut in half basically.

So it becomes way more affordable when you look at the investment with each location as its own business, even in a DSO, it’s still its own business but in this umbrella of a DSO, we cut it in half. So we feel like we’re very accommodating for a DSO to cut that price in half for each and every location after the first one.

Kevin: I can’t tell you how much I’ve enjoyed and I’m sure our audience has enjoyed listening to your expertise as CEO of Dental Boost. Your particular interest and expertise to dentist is a credit to you and your company and it certainly will help us who struggle trying to find new patients and how to handle this new world of digital marketing. Can you tell our audience the best way to connect with you ; a website, an email, a phone number?

Mike: Sure, absolutely. One thing I want to say is there are a couple of dental practices on the east coast that have the name Dental Boost. Our company name is The Dental Boost. Because if the listeners just went to Google, they’re going to find a couple of dental practices back east so we want to make sure the word “the” is in front of that. The website is www.thedentalboost.com. My email address is mike@thedentalboost.com. Our business number is 866-500-1414.

And Kevin, I want to say one last thing too that’s really important to the listeners, and I love doing this, by the way. Anybody that’s seriously interested in doing this, we really don’t want anybody just trying to just kind of pick our brains and not have an intent into possibly hire us. I do a personal thing we call a Digital Assessment.

That Digital Assessment is I will do a screen share of my computer with all of your online presence. If you’ve got ten locations, if you’ve got one location, I will pull up all your different web properties and I’ll analyze them right there in front of you on your computer screen. You’ll watch me click around. I did it with you, Kevin.

Kevin: You’re not kidding. And for those listening to us, it was an extraordinary eye-opener. The time and energy that Mike and his company put in to evaluate, in my opinion, is worth a pile of gold.

We’re not experts when it comes to marketing. We’re experts in the web. My personal opinion is talk to the experts like Mike. Have them get you straight and narrow so that you get the best results and you don’t waste money and time. Mike, is there anything in closing that you’d like to tell our audience?

Mike: When you make a decision to invest in your practices, you own a business. So it is an investment. A lot of dentists we talk to really kind of fret over I don’t want to spend this much money or I can’t spend that much money. It’s an investment in your business and because everything is online now, I would strongly recommend giving serious consideration to investing in a digital marketing program for sure, whether it’d be with our company or another company. But other than that, Kevin, I just want to thank you so much. I’m very honored to have been on this call with you and I thank you very much for that.

Kevin: Right back at you, Mike. We’ve been listening to Mike Pedersen, CEO of The Dental Boost, an expert in online marketing, but in particular, search engine optimization to get the best bang for your dollar.

My name is Dr. Kevin Coughlin. You’ve been listening to Ascent Dental; my company, Ascent-Dental-Solutions, with a focus on knowledge, development and training and education for the dental community.

I also would like to close with a thank you to Mr. Doug Foresta who produces each and every one of our podcast and his company Stand Out and Be Heard. If you’d like any additional information in how podcast can help your business, give me a contact at www.ascent-dental-solutions.com.

Thank you everyone for listening. And I can assure you we’re going to get Mike Pedersen back from The Dental Boost to talk about the inorganic along with the organic portions of SEOs. Mike, thank you again and thanks to our listeners. I’ll talk to you soon.