John Bitting, Esq, is legal counsel for DOCS Education. Here, he answers this question: “What regulatory issues does dental Botox present?"

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“Botox is another part of the dentist’s armamentarium that’s growing very fast,” says John. “It’s growing much faster than the states’ regulations can keep up with it, and it’s another situation where it’s not quite as diverse regulatorily speaking as sedation dentistry regulations are, but it is a situation where the boards—no board has promulgated a Botox regulation. The boards have only been issuing policies regarding Botox administration in their state. And these policies, while providing some guidance, do not provide a method by which the dentist can really be held accountable under the regulations and the laws of the state. Most of them basically are allowing the general dentists to administer Botox to their patients as long as they have had some formal training.

“And if anything goes wrong, they will look to the training, and nothing seems to go wrong with Botox. It seems they have a very wide margin for error, but some states say that only oral surgeons can do it, but the boards are—there’s nothing really with any teeth for them to enforce it. It’s a situation that is going to continue to evolve, and you may see some regulations regarding it, but right now, there aren’t any. The board will just look towards the dentist having training.”

John Bitting, Esq., is legal counsel for DOCS Education. He is an expert on legal issues surrounding sedation dentistry and dental marketing. Learn more at SedationRegulations.com.

John Bitting, Esq, is legal counsel for DOCS Education. Here, he answers this question: “How can I learn more about my state requirements?"

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“I’m sensing a real theme in your answers that everything does seem to be very state by state,” says Julie Frey. “So whether it’s dental hygienists or sedation dentistry, how can I find out what my state requires?”

John replies, “You can call your state board, and hopefully, you’ll get someone on the phone, and if you do get someone on the phone, hopefully they’ll be able to provide you with that information. However, here at DOCS, we’ve put together a website called SedationRegulations.com which, as it says, only deals with dental sedation right now. It provides a clickable map, and you can click on your state, and you can see an overview of your state’s oral and intravenous – and pediatric soon – regulations. It’s a good one-stop place to look up at least a brief overview of your state’s sedation regulation. Sometimes the state boards, they’re pretty busy, and they may or may not answer the phone, and they may or may not give you the information you want. They may just hand you a copy of the state’s regulations, which could be anywhere from ten to 60 pages long, and it’s kind of hard to find the model answer you’re looking for when you hand out a document that big.

“So it helps keep me in business too. I get a lot of phone calls every day regarding these things.”

John Bitting, Esq., is legal counsel for DOCS Education. He is an expert on legal issues surrounding sedation dentistry and dental marketing. Learn more at SedationRegulations.com.

John Bitting, Esq, is legal counsel for DOCS Education. Here, he answers this question: “What about the increase in autonomy of dental hygienists?"

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John replies, “This is a great question because when I go in front of dental boards to ask them to promulgate sensible sedation regulations, I inevitably overhear them discussing new dental hygienist regulations because hygienists are gaining more and more autonomy. They’re allowed to do more and more procedures. For instance, they are more increasingly allowed to do local anesthesia and in some states, they’re allowed to administer local anesthesia even outside the presence of the dentist.

“The State of California, in fact, has its own hygienist board now. It’s the first state, and so far the only one, to do that, and it won’t be the last either. I think here in the State of Washington, you’ll see the hygienists eventually have their own board and it will start popping up in state dental boards around the country. You’ll have separate hygienist boards. They’re very well organized and they’re getting more autonomy. They’re allowed to do more and more procedures, sometimes without the dentist even being in the office. It’s one of the fastest growing parts of the healthcare profession along with nursing, and you’ll see more hygienists out there. As they say, the dentist is only as good as his team, so they will have a positive future, I see."

John Bitting, Esq., is legal counsel for DOCS Education. He is an expert on legal issues surrounding sedation dentistry and dental marketing. Learn more at SedationRegulations.com.

John Bitting, Esq, is legal counsel for DOCS Education. Here, he answers this sedation dentistry question: “Can you give us a brief overview of the oral and IV sedation regulations in the US?”

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John begins by explaining his professional role. “I am DOCS’ regulatory counsel, which means I help our members and the attendees of our courses comply with the regulations – the sedation regulations and advertising for that matter – of each of their states, because every state is different. I like to say that the sedation regulations anyway, advertising too – they’re like snowflakes. Every state is different, and that’s what I do for DOCS.

“I can imagine there’s an awful lot of information in your head,” says Julie Frey. “Let’s see if we can get some of it out right now. Can you give us a brief overview of the oral sedation regulations in the US?”

“I sure can,” John replies. “If I could make it brief, I would, but like I said, every state is different. Whereas with general anesthesia and intravenous sedation, where dental regulations are more or less uniform throughout the United States, the state-by-state requirements for oral sedation are that every state is different. Like I said, they’re like snowflakes. The majority of US states now require some combination of formal training and standard of care equipment, plus a permit issued by the state dental board, before dentists can provide oral sedation dentistry to their patients.

“For instance, these regulated states may require anywhere between zero and 75 hours of training for minimal and moderate oral sedation. Some of these states may also require certification and advanced cardiac life support or ACLS or even pediatric events life support, which is known by the moniker PALS. Every state requires a dentist to be certified in basic life support or BLS, which is CPR for healthcare providers, and is a requirement for licensure already.

“And every one of these regulated states requires some modicum of standard of care monitoring and emergency equipment for sedation. Many of the states have linked their dental sedation requirements to the recommendations of the American Dental Association, Anesthesia Sedation Guidelines. Those are revised from time to time, and the most recent version of the guidelines was released in October of 2007 after a great deal of input from interested stakeholders. And those ADA guidelines recommend special training for minimal and moderate sedation ranging anywhere from 16 hours for minimal sedation to 24 hours for moderate oral sedation and – I’ll get into this a little bit later – 60 hours for intravenous moderate sedation.

“This would be didactic construction, like I said IV sedation also has—we’ll talk about that later as a clinical requirement that goes beyond the 60 hours of didactic. A little overview there. I could go state by state, but we would be here all night.”

“Okay, well let’s move on to IV sedation then,” says Julie. “Can you give us a brief overview of the IV sedation regulations in the US?”

John replies, “IV sedation is much more uniform regulation across the country. Most states – in fact, I can’t think of any that don’t – so every state requires at least a 60-hour intravenous sedation didactic course plus 20 clinical patient experiences. This was culled from the ADA sedation dentistry guidelines that I referred to earlier. And most of the states also require advance cardiac life support.

“Answering the intravenous question is much easier than the oral sedation one, but the oral sedation—some states have no regulations, and some states have very minimal regulations. Others have heavier regulations, and others require an intravenous sedation permit in order to do oral sedation of any kind, but those are very few and far between.”

John Bitting, Esq., is legal counsel for DOCS Education. He is an expert on legal issues surrounding sedation dentistry and dental marketing. Learn more at SedationRegulations.com.

Jim Du Molin answers the following dental management question: “What’s the biggest dental marketing problem for sedation patients?”

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“Quite honestly, the biggest problem with sedation dentistry patients,” replies Jim, “is the front desk.

“I’ll tell a brief story. Dr. Michael Silverman will know exactly who this doctor is, and I’ll keep everybody’s names quiet here so I won’t let anybody be embarrassed, but we had a very professional doctor in Southern California who was big in cosmetics. I mean, just major in cosmetic dentistry, and he went through all the training for sedation, and he was quite good. Clinically, I think he had it pretty well done. We did an outrageously great dental marketing program for him for radio and in 30 days, we generated 49 new patient inquiries.

“Forty-nine new patient inquiries on sedation on the radio in Southern California – and according to the doctor, it was a total failure. He only got one new patient from it. Now, I watched this progression, and so did Michael, and we just can’t believe this. Out of 49 at-bats, as we called them – when a patient calls, you’re at bat. You get to get up there and just take a swing at it, bring them into the practice and make it work for them. Out of 49, they got one!

“So I did a call. I think Michael did one as a consumer too. And the bottom line is, the front desk blew it every time. They didn’t know how to sell cosmetics. They didn’t even try to sell sedation to a dental phobic patient. They just took the entirely wrong position and attitude for it.

“And that’s one of the best things about the DOCS program, is that it trains your team on how to deal with that patient, because it is totally different from dealing with a normal patient who is not fearful. And when you have a fearful patient, it’s a different experience entirely, and I will not even begin to try to explain it on the phone on the webinar.

“But the issue is, your front desk will make it or break it for you. One of the best things we ever did is, on all of our dental marketing programs for sedation, I think Michael does this too, we record the incoming phone calls for quality control so the doctor can hear exactly what the patient is saying. You can go online 24 hours, seven days a week and listen to it. You can find out exactly what your patients are hearing from your front desk and whether they are imparting the right information.

“This is probably one of the most powerful training tools at your fingertips in today’s modern marketing. So you hook it up so just your new patients come in through your marketing. You’ll get a sample of what your practice is putting out there to get patients, but that is the number one barrier and the biggest problem not just for sedation dentistry, but for all marketing. It’s the front desk.”

Jim Du Molin founded dental marketing company Internet Dental Alliance and dental continuing education resource The Wealthy Dentist University. Du Molin encourages dentists to target high-value braces, cosmetic dentistry, and dental implant patients without alienating their general dental patients.

Jim Du Molin answers the following question: “What do you think is the best return on investment for sedation dental marketing?”

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“Well, you know, I’m an internet fan,” replies Jim, “and we see and handle about 800 marketing campaigns for sedation dentistry on the internet right now for doctors all across North America. And we see a tremendous income of new patients just from the internet – and not just dentist websites, but directory listings, dental newsletters and all of the things that go hand in hand. Right now, with the Internet Dental Alliance, we deliver over a quarter of a million requests for a doctor every year, and about 60% of that is sedation. It’s a way for the patient to learn about sedation without having to be confronted with talking to someone – as Dr. Michael Silverman will tell you, it takes a while for a patient, a phobic patient especially, to get used to the concept. There may be help out there, and they want to research it beforehand. And the internet provides that capability. Through the services we offer around the internet for dental websites and directories with the Internet Dental Alliance, it works! And we generate those calls.

“So we usually suggest, in conjunction with radio and television – not as a replacement, but in conjunction with it – a great internet experience, a great position on the internet especially with your positioning for your practice with a specific internet website for sedation dentistry, because that will rank well with the search engines.”

Julie Frey asks another question. “So where is the money at? Does marketing for sedation patients have as good of a return on investment as cosmetic or implant patients?”

“Well,” Jim responds, “the first thing you’ve got to remember is that cosmetic and implant patients are going to come in for sedation. So you’re going to get those naturally out of that. So that’s the first thing you have to remember, especially with dental implants, because as I said earlier, when Michael and I started developing the concept of marketing around sedation dentistry 12 to 14 years ago, it was mainly because of implants, and Michael’s desire to really find a better way to place implants with his patients in a less frightful manner. As everybody knows who’s done dental implants, patients can get a little nervous when you tell them that you’re going to be drilling into their jaw… and it’s going to be an interesting process.

“Sedation was the major motivator, and I think implants were the major motivator to put Michael into sedation – with great benefit not just for himself and his practice, but for I think dentistry in general.

“So you’ll get the implant patients, you’ll get the cosmetic dentistry patients, and the ROI is really interesting. During this recession, we’ve all seen that certain things are discretionary, like cosmetics or implants are discretionary services. Sedation has held up pretty well, and you’ll get more sedation patients in this kind of an economy with the unemployment that we have, because people will see it as a way to solve a long-term problem. Then you will get cosmetic dentistry and implant patients.

“So while the cosmetic patients by themselves may be a more profitable patient – and so well may be an implant patient – you’re not going to get as many of those as you are sedation dentistry patients. Currently, it’s a very interesting thing that we’ve watched develop over the last three years, because we’ve watched cosmetic and implant inquiries on the internet especially drop dramatically, while we watched sedation stay relatively the same and stable.

“So your ROI is still good, not a problem.”

Jim Du Molin has over 26 years of experience in dental management consulting and dental website marketing. He founded marketing website TheWealthyDentist.com and continuing dental education resource The Wealthy Dentist University. Du Molin encourages dentists to target high-value braces, dental implant, denture and sleep dentistry patients without alienating their family and general dentistry patients.

Jim Du Molin answers the following dental marketing question: “When marketing sedation dentistry outside of the practice, what’s the best strategy?”

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“One of the top ones is radio marketing,” replies Jim. “We’ve had a tremendous experience in radio dental marketing. When Dr. Michael Silverman first started advertising sedation dentistry, we went to the radio as a way to reach out. Because what will happen, you will use up the patients in your practice fairly quickly, I would say within three to six months. And the vast majority of your patients out there today are people that aren’t in your practice, and they’re not in any practice.

“And one of the most cost-effective ways, especially today, is radio – and coming up (and I’m going to ask Michael to comment on this briefly), television. Radio is a very low-cost media, especially if you’re in a suburban or rural area, and it has great return on investment. I can’t tell you the number of doctors who’ve gone on the radio for sedation, and they actually had to dial back their marketing to some extent because they were getting so many calls.

“It’s just an amazing thing if it’s properly done. And you have to have the right script, the right tone. It’s important that the doctor communicated his best as possible and put it out there. And you don’t have to be a radio star. That’s the thing. I do real well on radio because I’ve got a face for radio, as many people have told me. But the issue is, you have a great, warm, caring demeanor on the ad, and you’ll come across just fine, and people will relate to that.

“Now, television is another thing. Television is traditionally much more expensive, but again, it’s a powerful medium, and video is becoming more important now – not just broadcast video, but internet video. We’re adding a lot of video to the internet to doctors’ dental websites and special marketing campaigns on YouTube and other places. So it’s become a major area for explaining your treatment care and so forth. It has to be done very carefully, and it has to be done with extreme care and it has to be done professionally.

“Michael, can you update us on what television is doing right now relative to radio, especially in the pricing area?” asks Jim. “I think you’re probably more up to speed on that than I am.”

Dr. Michael Silverman replies, “Yeah, you know, Jim, we have a lot of clients with RAMP, the Dentist’s Advertising Agency, that are on television now. Television has been really an excellent, excellent medium that’s gotten better and better. It’s amazing to find out how good it is, even with all of these DVRs and Tivos and things like that. And you know, we’ve broken the barrier with RAMP, with getting people onto television at an affordable level. Especially with these fearful patients, if they’re going to make a call to the dental office, you have got to have somebody who answers the phone who is really good!

“So we would only put on television advertisements during times that the office was open, when they had that superstar to answer the telephone. But what we’ve done is, we’ve expanded it to getting very inexpensive late-night advertising buys and using a very good telephone answering company with a lot of really great people that answer the phone. I mean, they don’t go into a lot of details, but they just get enough to get the patient’s name and telephone number and email address, really gentle and careful about it. And it’s become more affordable. This way, the patients get to see the doctor and see that they don’t have horns, and they’re not dripping blood from their fangs, and they get a chance to experience a little bit of something about that, and then they can make a call and actually talk to somebody, even at four o’clock in the morning.”

“That’s great,” concludes Jim. “That’s a really needed thing.”

Jim Du Molin has over 26 years of experience in dental management and internet dental marketing. He founded dental website TheWealthyDentist.com and dental CE resource The Wealthy Dentist University. Du Molin encourages dentists to target high-value dental implants, braces, dentures and tooth whitening patients without alienating their general dental patients.

Practicing Dr. Dan Garza answers this dental marketing question: “How do you market sedation dentistry in a rural area?”

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“I don’t think it’s that different from dental marketing in an urban area,” says Dr. Garza. “Sometimes, it might be a little easier in a rural area. We found – again, Dr. Silverman’s suggestion – we went right to the radio with it, and that’s just been spectacular in terms of return on investment. We do spend some money on the radio, but it just brings people from miles around. In fact, one of the interstate highways passes through our town, and it’s not unusual for us to have somebody traveling through Texas, maybe on the way to New Mexico or Colorado from maybe as far away as Louisiana or Mississippi. They’ll happen to hear our ad and for some reason, I guess they think that we’re the only dentist in the United States doing sedation dentistry. And they may return to us from Louisiana or Oklahoma or New Mexico or Colorado just for us to do their sedation dentistry.

“So the radio has been an incredible source of good potential patients. The newspaper is also good. A little more expensive. I think the radio is good, especially if they can hear your voice, and the dialogue is good, and you hopefully can come across as a good and caring person. I think it’s important that the radio be able to communicate the warmness and caringness that your office provides. So again, I would have to say the radio has really, really been a good way to market.”

Dr. Dan Garza, DDS, has been practicing dentistry for over 30 years. At his Texas dental practice, Dr. Garza offers sedation dentistry, Oral Systemic Balance Therapy, and general dentistry.

Practicing Dr. Dan Garza answers this dental marketing question: “What is your biggest challenge in sedation dentistry?”

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“I don’t really see it as a challenge,” answers Dr. Garza, “but you have to be well organized and I think it’s critical that you spend time with a potential sedation dentistry patient. These patients are very, very alarmed and frightened, and a typical phone call to the administrative area may involve – and I think Dr. Silverman has elaborated on this numerous times – you can’t get in a hurry when you’re visiting a sedation patient. The hardest thing for them to do is to pick up that phone and call. That’s just a monumental task for them.

“So once they get on the phone, you want to have trained people to talk them down, if you will, off the wall and let them know that you’re caring and loving people. You’re concerned about their dental fear, you respect their fear, and explain everything that’s involved. They want to know a lot of details. They want to know how things are done, how safe things are. And so I think one of the biggest challenges is to not get in a hurry with these patients, to spend the necessary time. And that’s a challenge sometimes in a busy practice where you have two or three phones ringing and patients checking out, patients wanting dental insurance information, and so spending the time with them is critical, and I think another challenge. Again, this is why DOCS is so great, is getting the whole team involved, and having the assistants well trained, so that they can do proper assessments, explanations, going over consent forms, and having the hygienist feel comfortable in an oral sedation environment where they’re working.

“I think the other challenge is getting everyone on the team on the same page, speaking the same language, and feeling comfortable with a procedure that’s really extremely safe. And we just have to be able to communicate that to everyone involved.”

Dr. Dan Garza, DDS, has been practicing dentistry for over 30 years. At his Texas dental practice, Dr. Garza offers sedation dentistry, Oral Systemic Balance Therapy, and general dentistry.

Practicing Dr. Dan Garza answers this question: “How long have you been practicing sedation dentistry?”

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Dr. Garza first gives his professional background. “I’m in a small town in Texas, and I have been doing sedation dentistry. Actually, I was at Michael Silverman’s first course in 1998 in Oklahoma City. I knew this would be an area that would be really exciting, but I had no idea how many people were concerned about dental fear, and it’s turned out really, really well. We kind of do all areas of dentistry. That way, we don’t ever get bored. We have a lot of fun doing a lot of different things.”

“How long have you been doing sedation dentistry?” asks Julie Frey.

Dr. Garza replies. “Again, I went to Dr. Silverman’s first course (that I’m aware of anyway) on sedation dentistry in 1998, and I immediately came back home and got everything I needed. And really, we started in the latter part of 1998, so we’re coming up on about 12 years now. It’s been very, very rewarding for our patients as well as the practice.”

Julie then asks, “Are there any advantages to being a sedation dentist in a rural area like the one where you practice?”

“Well, you know, everyone likes to distinguish between urban and rural areas,” says Dr. Garza, “and what we have to remember is that people are people. No matter where they live, no matter what they do, they have the same wants and needs. In some respects, I think there’s an advantage to being a sedation dentist in a rural area in that there aren’t that many dentists doing sedation dentistry in a rural area. And so, you certainly have an advantage in terms of what you can offer your patients. And another interesting thing that I’ve noticed, we have a city about 25 miles away where there are dentists who do sedation dentistry, but for whatever reason, patients choose to come 25 miles to see us.

“Sometimes, you’re not that well thought of in your own town in some respects, so people think if they go to another area that perhaps you have all the answers. And in some respects, we’re able to use that to our advantage. But I think the main advantage is you don’t have that many dentists doing sedation dentistry, especially in a rural environment.”

Dr. Dan Garza, DDS, has been practicing dentistry for over 30 years. At his Texas dental practice, Dr. Garza offers sedation dentistry, Oral Systemic Balance Therapy, and general dentistry.