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Dental Implants

Dental implants

Definition

Dental implants are surgically fixed substitutes for roots of missing teeth. Embedded in the jawbone, they act as anchors for a replacement tooth, also known as a crown, or a full set of replacement teeth.


Purpose

The purpose of dental implant surgery is to fix metallic anchors in the jaw bone so that they can receive the replacement teeth and hold them in place. Dental implants should be considered as an option for replacing failing or missing teeth and often provide more predictable results than bridgework, resin bonded bridges, or endodontic treatment.


Demographics

In 2000, the estimated number of dental implants placed in the United States was 910,000 and this number is expected to increase at a rate of about 18% per year through 2005.


Description

By replacing a lost tooth with a dental implant, the overall health and function of the surrounding teeth is maintained. The implant can prevent tooth migration and loss of structure and will help avoid loss of bone from the jaw in that area. Further, implants reduce the impact of the lost tooth on surrounding teeth, as traditional bridge structures often require reduction (filing down) of the two flanking teeth to hold the bridge in place with a crown. Implanting avoids such alterations to the surrounding teeth when replacing a lost tooth.

When replacing dentures, implants can provide even more benefits. Implants do not slip nor do they have the potential of limiting the diet to easily chewed foods as can happen with poorly fitting dentures. If appropriate, implants are the method most able to surgically restore one or more missing teeth to their original conditions.

The actual procedure occurs as follows. Under local anesthesia, the first step for many implant procedures is the exposure of the bone where the implant is to be made. This is followed by placement of the implant into the exposed jawbone. Implants that are placed in the bone are called endosteal implants and are made of titanium or a titanium alloy because this metal does not adversely interact with biological tissue. After placement of the implant a cover screw is put in and the wound is closed with stitches and allowed to heal. In general, placements in the lower jaw need to heal about three months, while placements in the upper jaw need to heal about six months.

After healing, in a second surgical procedure, the implant is uncovered, the cover screw is removed, and a healing abutment or a temporary crown is placed in the implant. Temporary crowns are generally used for esthetic reasons, when the implant is in a place that is visible. Both healing abutments and temporary crowns allow the tissue around the implant to be trained to grow around the final prosthetic tooth.

After about two months the soft tissue will be healed to receive the final prosthetic tooth. Impressions are used to make custom abutments that take into account the neck morphology of the implant. The prosthetic tooth is sometimes attached to a gold cylinder that can be screwed into the abutment or it can be directly cemented onto the abutment. This multi-stage process, where the two surgical procedures are separated by a lengthy healing time, has proven to provide excellent stability in the final implant. Single step surgical implants are available, but some stability of the final implant is often lost by eliminating the healing step.


Preparation/Diagnosis

At the first appointment, the dentist or oral surgeon performs a thorough examination to determine whether implants are appropriate to replace the missing teeth. Often, x rays are necessary to discover the state of the jawbone, particularly if the teeth have been lost for some time. This information is used to determine if implants are appropriate and, if so, what particular type of implant would be best for the clinical situation.

There are two solutions commonly used if the initial examination indicates that the bone in the area where the implant is to occur is too resorbed to support the implant. The first is bone grafting . This involves undergoing a procedure that moves bone from one place in the body to another to enlarge the bone structure at the implant site. Often, bone can be moved from one place in the mouth to another. Sometimes a graft from a donor or an animal or artificial bone can be used if bone from the patient is not available. Grafting usually is done four to eight months before the implant procedure, to allow the graft a chance to heal before it is disturbed with the implant process.

A second solution is the use of subperiosteal implants that ride above the bone but beneath the gum. These types of implants are not placed in the bone. A CT scan is commonly used to obtain a model of the bone structure and then the implant fixture is molded to precisely fit the bone model.


Risks

The greatest risk following the surgical procedures is that the implant will fail. For implants placed within the bone, most failures occur within the first year and then occur at a rate of less than 1% per year thereafter. Recent research has indicated that tobacco use by the patient and use of a single-stage implant procedure are two risk factors that increase failure rate.


Normal results

Overall, the success rate for all implants runs from 90% to 95%. Most failed implants can be replaced with a second attempt.

Resources

books

Balshi, Tom, William Becker, Edmond Bedrossian, and Peter Wohrle. A Patient's Guide to Dental Implants. Omaha, NE: Addicus Books, 2003.

Wiland, Michael R., Michael Mastromarino, and Joseph N. Pipolo. Smile: How Dental Implants can Transform Your Life. Boca Raton, FL: CRC Press-Parthenon Publishers. 2001.

periodicals

Vehemente, V. A., et al. "Risk Factors Affecting Dental Implant Survival." Journal of Oral Implantology 28 (2002): 7481.

organizations

American Academy of Implant Dentistry. 211 E. Chicago Avenue, Suite 750, Chicago, IL 60611. (312) 335-1550, Fax: (312) 335-9090. <http://www.aaid-implant.org>.

American Dental Association. 211 E. Chicago Ave. Chicago, IL 60611. (312) 440-2500, Fax: (312) 440-7494. <http://www.ada.org>.


Michelle Johnson, M.S., J.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Implants can be done by dentists, periodontists, or oral surgeons. The procedure is done in the dental professional's office.

QUESTIONS TO ASK THE DOCTOR


  • What are the expected benefits of dental implants and what are the chances of receiving these benefits?
  • What are the expected risks of dental implants and what are the chances of suffering from these risks?
  • How many procedures like this have you done previously and can I talk to any of these patients?

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Dentist

Dentist

A dentist is a medical professional who cares for the oral health of his patients. Dentists administer both prophylactic (preventative) care and corrective treatments for teeth and gums. Dentists in a general practice perform procedures such as cavity filling, root canals, gingivitis (gum disease) correction, and much more. Specialties in dentistry include orthodontics (structural correction), oral surgery, pediatric dentistry, endodontics (complex root canals and dental implants), oral surgery, periodontics (advanced gum care), and prosthodontics (reconstructive dentistry).

The most familiar work setting for a dentist is private practice. Traditionally, dentists in private practice provide oral health services for families. However, dentists are also employed in a variety of other situations. For example, many hospitals (especially those that specialize in long-term care, such as geriatric and psychiatric hospitals) employ dentists to attend to the oral health of their patients. Additionally, public health agencies that organize relief efforts for inner cities, the rural poor, or developing nations employ dentists to provide dental care to people groups that cannot normally afford it. Many insurance companies also employ dentists as consultants that help review and process dental claims.

In order to become a dentist, one must attend four years of dental school after obtaining a bachelor's degree from an undergraduate college. To gain admittance into dental school, a strong high school and college background in biology, chemistry, math, and physics is required.

see also Doctor, Family Practice; Medical Assistant

Susan T. Rouse

Bibliography

American Dental Student Dental Association. <http://www.asdanet.org/>.

Cox/Bond Dental Group. "So You Want to Become a Dentist?" <http://www.vvm.com/~bond/home.htm>.

List of Dental Schools. <http://dir.yahoo.com/Health/Medicine/Dentistry/Schools__Departments__and_Programs/>.

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Dentist

Dentist

BUSINESS PLAN     STANLEY M. KRAMER, DDS, LLC


43110 Gillette Street
Omaha, Nebraska 68110


The goal of this business is to provide high quality general dentistry with a moderate to high price using the highest technology possible. Prices will be justified by the advanced technology used and the lifestyle conveniences that the dental practice will offer. The dental practice will be positioned as a place one can get high quality dental work in an environment of convenience and technology.


  • executive summary
  • marketing plan
  • operational & organizational plan
  • financial policy
  • financial plan
  • financial statements
  • possible pitfalls
  • positive points
  • appendix

EXECUTIVE SUMMARY

I am preparing this business plan to discuss the dental practice that I am planning to purchase upon my graduation from dental school. Upon graduating, I will do an associateship with the potential for buyout, in a practice in Nebraska. This will allow me to spend one year determining if Nebraska is where I want to live long-term and will familiarize me with the practice that I could possibly buy. After the year is over, if I am pleased with what the practice has to offer, I will buy it. If I am not satisfied with its performance, I will have spent time researching other practices that are or will be going up for sale. After approximately a year of my building up the current client base, my father, who is also a dentist, is planning to move to Nebraska to work with me as an associate. He will sell his current home and practice and work for me until he decides to retire. This arrangement works in both my father's and my favor. This allows me to work with a dentist who has over 25 years of experience in the practice and business of dentistry. This gives my father an opportunity to make a comparable living to what he is currently making without the responsibilities of an entrepreneur. As he nears retirement (he is currently 52 years old), he will reduce his hours and patients.

In evaluating a location for a dental practice we are looking for an area of growth and culture, namely an affluent, western suburb of Omaha, Nebraska. We have chosen this general area for various reasons. The main reason being that we love all that this area has to offer in raising a family. Further we feel strongly about living in a location that you would also desire to spend your retirement in. The suburbs of Omaha are growing rapidly and do not have enough dentists to meet the needs of the people. I plan to buy a practice in a highly traveled, suburban area of Omaha that has the patient and facility capacity for two active dentists. In 1995, almost 20 percent of all private dental practices were two-dentist practices, so this should not be too difficult to find ("Key Dental Facts," p. 17). Working with the retiring dentist will allow me to learn his practice management style and to foster a relationship with the client base. This is very important, as with many businesses, the client list and work force is the most valuable asset of a dental practice. Also this affords me the opportunity to understand the management philosophy of the past dentist, so I will be able to make gradual changes that do not cause too much dissension from the staff. If a dental practice with capacity for two dentists cannot be found, I will buy a single practice office and expand it to suit two dentists. I will use savings accumulated during my year as an associate to pay for the down payment of the business loan and finance the business through a bank, the Small Business Administration, or through a broker.

My father should not have great difficulty selling his practice, as his is the largest practice in the area. Also, there are dental brokers that buy practices to sell them at a higher price. In the worst-case scenario, my father could sell his practice to one of these brokers.

Company Description
Purpose of the Service

My goal is to provide high quality general dentistry with a moderate to high price using the highest technology possible. My prices will be justified by the advanced technology used and the lifestyle conveniences that the dental practice will offer. The dental practice will be positioned as a place one can get high quality dental work in an environment of convenience and technology. Due to the increase in two-income families, many service-oriented professions are leaning toward differentiating themselves on the basis of convenience. This is what I intend to do when I have completely taken over this business from its previous owner and have hired an associate, namely my father. For instance, we plan to have two shifts, an early morning shift and an evening shift in which the practice will be fully functional from 7 a.m. to 7 p.m. or later on various days of the week. We also plan to work rotating weekends to offer Saturday service twice a month. We feel that the main beneficiaries to these services are professional, high-income individuals that do not feel that they can take time out from work to go to the dentist. We are also considering hiring part-time help to do filing and various other work during the day and to act as a sitter so that parents can leave their kids while they are receiving dental care.

Related Services and Spin-offs

Possible related services include:

  • Tooth Whitening
  • Smoking Abstainment Treatments
  • Practice Management Seminars
  • Dental School Instruction
  • Tempromanibular Joint Disorder Treatment
  • Implant services
  • Free screenings for children in severely/profoundly retarded care centers and schools
  • Having a yearly "Sealant Day" and "Dental Awareness Day" at local grade schools
  • Nursing home screenings

Stage of Development

Stanley M. Kramer, DDS, LLC is still in the idea stage as I will not have my dental license until August 2001 and my father has not actively looked for a purchaser for his practice. Between now and when I graduate, I plan to accept a position with a retiring dentist with a contract giving me first option to buy the practice.

Service Limitations

A restrictive covenant will be included in my contract with the former dentist. This non-competitive clause will ensure that the dentist does not sell me the practice and then set up a practice next door. It also ensures that I do not work with the dentist and then set up a practice down the street using the patient base I have seen while working with him. Further, we will not participate in any HMOs or Managed Care Insurance, as it is my belief that these cost dentists more than it makes them and reduces their treatment alternatives (see Appendix).

Government Approvals

In June 2001, after passing the Central Regional Dental Test required by the American Dental Association, I will receive a license to practice dentistry in the central region of the United States, which includes Nebraska. My father has already applied for and received his Nebraska license. The practice will apply for any applicable city, county, or township licenses that apply, a Drug Enforcement Agency permit to prescribe controlled substances, and any applicable licenses for such items as administration of general anesthesia or conscious sedation. Compliance with the Occupational Safety and Health Association (OSHA) standards set by the previous owner must be maintained.

Service Liability

I will purchase malpractice insurance to protect myself against any malpractice suits raised. Even the best, most conscientious dentist can be sued; therefore, malpractice insurance is an essential part of dentistry. The type of malpractice or professional liability insurance I will buy is an occurrence policy. If the policy would expire before a claim arises, the insurance company will still defend the dentist and pay any settlement or court-awarded judgement that occurred while the policy was in force that does not exceed the limits of the policy. Disability insurance provides continuing income in the event that an injury or illness prevents me from practicing. Adequate amounts of disability income and medical expense insurance will be maintained to cover the costs of treatment and ongoing family expenses until re-entry into active practice is possible. The insurer will require proof that you are in good health, as no company will cover potentially disabling conditions present prior to the date coverage is issued. It is essential that I purchase as much non-term type disability insurance as possible while I am young and healthywaiting until I am older could cause me to be uninsurable or cause my premiums to be astronomical. I will also carry business liability and property insurance and any other insurance we deem necessary after receiving counsel from my lawyer and insurance agent. Health insurance and workers' compensation will be provided for our employees and myself as part of their benefit package. We feel that this is mandatory to ensure that they do not leave the practice for one that does offer these benefits.

MARKETING PLAN

Current Market Size & Growth Potential

The dental profession is one with a very low failure rate and a high propensity for profit. These were two areas I examined before selecting a profession. According to the American Dental Association (ADA), dental offices are the third highest-ranking category of start-up business most likely to survive. The average income of a dentist is in the highest 8 percent of U.S. family income. As the growing population becomes better educated and more wealthy, people demand better dental care ("Starting Your Dental Practice," p. 4). Annual spending for dental services has risen from $13.3 to $45.8 billion, an increase of 244.4 percent, from 1980 to 1995 ("Key Dental Facts," p. 8). The advancements in cosmetic dentistry provide new venues of service for the general dentist to offer. Also, with the increase in non-capitation dental insurance, many people who could not previously afford dental work are now part of the patient pool. Of the total population over the age of 2, 40.5 percent are covered by private dental insurance. Sixty percent of those with dental insurance have an annual income of $35,000 or more and 51.4 percent have an education level of 13 or more years. Also, 45.4 percent of all American children ages 5-17 are covered by dental insurance ("Key Dental Facts," p. 9).

The average dentist to patient ratio is 1 to 1,600-1,700 ("Starting Your Dental Practice," 9). Nebraska as a state has a ratio of 1 to 2050 and an expected population growth of 11 percent by the year 2001. Further, 21 percent of the general dentists in Nebraska are over 55 years old and many are looking to sell their practices and retire. Nebraska is a very educated state with24.9 percent of its residents having a college degree and over 75 percent of its residents working in white-collar positions. The average household income in Nebraska was $34,938 in 1996 and is projected to increase by 10.8 percent by the year 2001 to $41,328 (ADA County Reports).

Various demographic profiles in Nebraska:

Nebraska Douglas Washington Cass Saunders Sarpy
County County County County County
Population in 1996 3,833,144 459,920 499,680 18,021 493,656 310,568
1990 to 1996 Population Growth Rate 16.4 17.5 6.9 39.9 12.6 17.2
Projected Population by 2001 4,251,171 513,189 522,617 22,141 535,764 345,977
1996 to 2001 Projected Population
Growth Rate 10.9 11.6 4.6 22.8 8.5 11.4
Median Household Income 1996 28,087 42,033 28,409 39,450 43,330 33,045
Average Household Income 1996 34,938 53,177 38,343 45,372 50,797 38,409
% Change in Number of Active
Dentists in area 3.9 1.6 -2.1 37.5 -2.8 37
Total Number of General Dentists 1,869 251 322 10 256 105
General Dentists Under 35 224 33 36 2 29 17
General Dentists 35 to 44 644 115 108 2 85 41
General Dentists 45 to 54 611 69 85 4 83 29
General Dentists 55 to 64 267 21 60 2 36 13
General Dentists over 65 123 13 33 0 23 5
Patients per Dentist ratio 1996 2051 1832 1552 1802 1928 2958
Number of dentists that will be in
retiring age within next 10 years 1001 103 178 6 142 47
% of dentists that will be in retiring
age within next 10 years 54 41 55 60 55 45

Customer Profile

  • Middle to high income
  • College educated
  • White collar
  • Married with children
  • All ages
  • Two-income families

Target Market

  • Current patients of the practice we purchase (2,500 to 3,000 patients)
  • Professionals that need the convenience factors we will offer
  • Stay-at-home mothers that need a place to keep their children while they receive dental work
  • All other dental patients who will pay a premium for convenience

Customer Benefits

Various customer benefits include:

  • Two highly skilled dentists to be treated by, one with over 25 years of experience and the other with the boundless energy and enthusiasm of a recent graduate
  • Extended hours on various nights of the week
  • Saturday hours two times a month
  • Childcare while receiving dental work
  • Use of advanced technology in treatment and patient education
  • Discounts for referrals

Market Penetration

Current patients of the practice purchased will receive letters of notification of the change in practice ownership and management. I will give my background and experience information and tell the patient that I hope to maintain their business. I will set up a "Meet the Doctor" picnic, where all patients will be invited. We will also offer free family consultations to discuss any concerns the patient might have. We will also advertise our benefits in the local papers and telephone books and send out direct-mail information advertising our practice. Current patients will be given referral cards that give both the current patient and patient referred a discount for services after the new patient has received a cleaning and consultation. Advertisements will be taken out in the local paper promoting discounts on whitening procedures. Once the patient comes in for whitening, I will sit down with the patient and discuss other ways to improve the aesthetics of their teeth. If they like the service that they are given, they may become patients or at least give good word-of-mouth advertisement. Other incentives will be given to attract new patients and maintain current ones.

Internal Marketing

The goal of Internal Marketing is to make current patients continue their patronage and to encourage them to refer our services. This can be done by first and foremost treating them with respect. This office will also give each patient the highest quality dental treatment possible, while offering competitive prices. Treatment is to be presented to patients by the doctor only. Treatment will be presented by encouraging the patient to ask questions and asking open-ended questions to prompt discussion. Visual aids will be used when necessary and intraoral pictures will also be utilized. A benefit for the patient will be given to help them see the need for treatment (i.e. "So that tooth doesn't fracture further and cause you more expense and pain, I recommend we start a crown on that tooth as soon as possible.").

To stimulate referrals from existing patients at the end of the dental appointment we stress to them their importance in our dental office and request that they refer family and friends to our office. In order to maintain a strong patient base and retain active patients, a patient should have either a restorative appointment and recall appointment or be in the recall system to call on a specific month for a specific procedure. Various other ways to promote our office to already active clients and induce them to refer our practice to others include:

  • Be on time and if you cannot, personally apologize to the patient for any inconveniences this has caused him or her
  • Greet patients by name (both dentist and staff)
  • Install a music system
  • Have multiple telephone lines
  • Call patients at home after significant treatment to ensure patient is doing well
  • Install a "good-bye" mirror so patients can check their appearance before leaving the office
  • Offer coffee or other beverages
  • Keep reading material current
  • Provide referral cards which offers both the referring current patient and the new patient a discount of certain services
  • Have personal information written on a notecard attached to chart to give dentist conversational topics
  • Send a special note for occasions such as weddings, graduations, birthdays, etc.
  • Decorate office internally and externally for holidays
  • Have toys for children to play with
  • Give patients magnets, toothbrushes, etc. with dental practice name and logo
  • Give a picnic, barbecue, or other outdoor event during the summer for your patients

External Marketing

External Marketing deals with promoting the dental practice to potential patients. This can take the form of referrals, free publicity, or advertising. Examples of each of these are:

  • Yellow page listing
  • Send a welcome letter to new residents in community
  • Run newspaper advertisements
  • Become involved with local Chamber of Commerce
  • Hold an open house event to show off new office, meet new staff, or celebrate the practice's anniversary
  • Participate in career days for area students
  • Get acquainted with community leaders
  • Join civic, religious, and community organizations
  • Patronize your patients' businesses
  • Offer to write a monthly column on dental health issues or a Question/Answer column

Industry Trends

For a detailed summary of industry trends, refer to the industry analysis included in the Appendix.

  • Decrease in dentists participating in managed care organizations
  • Increase in consolidation or networking of practices
  • Retirement of baby boomer dentists causing a future shortage in dentists
  • Increase in gross profits for dental practices
  • Globalization of the dental industry
  • Advancements in technology and invention of products that aid in treatment

OPERATIONAL & ORGANIZATIONAL PLAN

Philosophy of the Dental Practice

The philosophy of my dental practice will be to provide high quality general dentistry in a comfortable setting, with a moderate to high price using the highest technology possible. Prices will be justified by the advanced technology used and the lifestyle conveniences that the dental practice will offer. With use of an interactive, multi-media educational system, I will present my patients with multiple treatment alternatives and let them choose the alternative that best suits their lifestyle and budget. I will emphasize preventative dentistry and continually suggest cosmetic procedures. Any dental work that is too complex to be treated at my practice will be referred out to a specialist. I will foster a relationship with various specialists in the area, so they will refer patients in need of general dentistry to me as well. Further, I will not participate in any capitation insurance, as it is my feeling that these plans cost dentists more than it makes them.

The dental practice will be positioned as a place to get high quality dental work in an environment of convenience and technology. Due to the increase in two-income families, many service-oriented professions are leaning toward differentiating themselves on the basis of convenience. This is what I intend to do. For instance, I plan to have flexible, "people" hours on various days of the week so that not all patients have to leave work to have their dental work done. I also plan to work rotating weekends to offer Saturday service twice a month. I feel that the main beneficiaries to these services are professional, high-income individuals that do not feel that they can take time out from work to go to the dentist. We are also considering hiring part-time help to do filing and various other work during the day and to act as a sitter so that parents can leave their kids while they are receiving dental care.

The office will be run as a team, with each employee playing an integral part in the success or failure of the business. Employees will be given whatever tools and training is deemed necessary to carry out their assignments. An emphasis on process improvement will be instilled in each of the "teammates" by offering bonuses or special privileges. Teammates will be rewarded both monetarily and non-monetarily for jobs well done. Effective communication will be stressed in the office. This will cut down on misunderstandings and miscommunications among patients, employees, and doctor. Weekly meetings will be held to discuss the weekly agenda, and to give a report of last week's happenings. Teammates will be given the opportunity to add input at these meetings in the form of suggestions, comments, and complaints. Teammates will have defined tasks, but are to be open to doing whatever requests outside of their set guidelines need to be done to bring success to the practice. Finally, I plan to offer many perks to my employees to keep them satisfied and willing to give the practice 100 percent.

Job Description Dentist

  1. The Dentist is responsible for all procedures that are covered by his license and not those of the hygienist and assistant.
  2. The Dentist is responsible for all human resource aspects of the practice.
  3. The Dentist is responsible for the management aspects of the practice.
  4. The Dentist will form a relationship with both the clients and staff.
  5. All major purchases or decisions must receive final authorization from the doctor.
  6. The Dentist will sign all checks.
  7. The Dentist will be punctual to all appointments. Should the case arise where he cannot see the patient on time, he will personally apologize to the patient for any inconvenience.
  8. The Dentist will call all patients receiving significant treatment the night of the appointment to ensure that the patient is doing well.
  9. The Dentist will join civic and religious organizations to be of benefit to the community.
  10. The Dentist will actively, yet with taste, market the practice.
  11. The Dentist will treat employees and patients in a fair and unbiased manner.
  12. The Dentist will provide high quality dental work with an emphasis on technology and education for himself, his staff, and his customers.
  13. The Dentist will work to make the practice an enjoyable environment in which to work

Job Description Assistant

  1. Study and become familiar with Office Philosophy and agreements in the office.
  2. Be observant, and considerate, friendly and generally in good humor. Make patients feel at ease and welcome as a guest in your facility.
  3. Upon arriving in the morning, get prepared for the day prior to the morning meeting.
  4. Set up trays
  5. Check treatment room drawers, stock as needed.
  6. Go through charts and review the treatment patients are scheduled for today and treatment pending. At this time always check what type of anesthesia each patient will need. Be prepared to discuss charts at morning meeting.
  7. Greet patient in reception room and escort to proper treatment room.
  8. Seat patients, desensitize areas of treatment, take necessary study models, prepare Rx blanks, select shades for composites and PFMs, take impressions for temps, mark and adjust temps, remove cement from temps, orthodontic bands and crown and bridges; place matrix bands, and perform other procedures to prepare patient for doctor as instructed by the doctor.
  9. Be with the doctor to assist with all treatment.
  10. Give patients POST treatment instructions as needed (orally and/or written).
  11. Complement the dentistry procedures performed by the doctor. Show the patients their case before and after the insertion in the mouth.
  12. Dismiss patient and escort them to the front desk with chart. If the business office is busy ask the patient to have a seat in the reception room. The business coordinator will be with them ASAP.
  13. Compliment the behavior of a child to the child and the parent. This helps to child be more confident.
  14. Spray and clean room after each patient; change headrest cover, light handles, etc. Follow all sterilization procedures as mandated by OSHA.
  15. Prepare all instruments and handpieces for sterilization by autoclave or cold sterilization.
  16. Close all treatment rooms at the end of the day. Make sure all equipment is shut off.
  17. Have a general knowledge of the business office and be familiar with business office verbal skills.
  18. Know how to schedule appointments.
  19. Do a bi-weekly inventory and order necessary items.
  20. Prepare and participate in weekly staff meeting.
  21. Study and become familiar with all OSHA requirements. Take all precautions as trained and have a completed HBV vaccination series. Wear protective equipment as required.

Duties to Perform As Needed

  • Take, develop, and mount x-rays
  • Record any x-rays taken in chart, type name and date on label
  • Prepare Rx blanks of Meds
  • Take diagnostic cast and pour in proper stone
  • Trim models and label
  • Keep lab cases labeled and organized
  • Clean cement from newly cemented PFM, FGC, temps, etc.
  • Place matrix bands and wedges
  • Make vacuforms
  • Make customtrays
  • Make temp crown
  • Remove and place orthodontic elastics
  • Calm apprehensive patients
  • Keep current with up-to-date dentistry
  • Check supplies and keep inventory current
  • Help business office when time permits
  • Empty the trash
  • Stock drawers
  • Run cleaner through the vacuum system each night.
  • Lubricate drills
  • All other reasonable requests by the doctor

Daily Duties

  1. Check level of water in autoclave and add, if needed
  2. Run autoclave during day as needed
  3. Oil and autoclave handpieces after each patient
  4. Oil prophy handpieces daily
  5. Check trash at the end of the day and empty if needed
  6. General operatory cleaning
  7. Take intraoral pictures as needed
  8. Prepare charts for morning meeting
  9. Check developer reservoir tanks and refill
  10. Prepare trays for procedures and assist doctor

Weekly Duties

  1. Change solutions in ultrasonic cleaner
  2. Autoclave lab burs
  3. Clean autoclave per manufacturer's instructions for weekly maintenance
  4. Restock all drawers and check inventory

Job Description Dental Hygienist

  1. Study and become familiar with Office Philosophy and Agreements in the office.
  2. Organize yourself physically, mentally, and emotionally, always dress in a professional manner, leave your private and family concerns at home, and make a mental check of your day.
  3. Be observant, considerate, friendly, and generally in good humor. Make patients feel at ease and welcome as a guest in your facility.
  4. Upon arriving in the morning, get prepared for the day prior to the morning meeting.
  5. Go through charts, review the treatment patients are scheduled for today and treatment pending. At this time always check what type of anesthesia each patient will need. Be prepared to discuss charts at morning meeting.
  6. Greet patient in reception room and escort to proper treatment room.
  7. Use correct verbal skills.
  8. Dismiss patient; escort to front desk with chart. If business coordinator is busy ask patient to have a seat in reception room. Business coordinator will be with ASAP.
  9. Spray and clean room after each patient, change headrest cover, light handles, etc. Follow all sterilization procedures as mandated by OSHA.
  10. Prepare all your instruments and handpieces for sterilization by autoclave or cold sterilization.
  11. Close your treatment room at the end of the day, making sure all equipment is shut off.
  12. Have a general knowledge of the business office and be familiar with business office procedures.
  13. Know how to schedule an appointment on the computer.
  14. Prepare and participate in weekly staff meetings.
  15. Take all OSHA precautions as trained, have a completed HBV vaccination series. Wear protective equipment as required.
  16. The dental hygienist may not perform any of the clinical duties without the dentist in the facility.
  17. Help to maintain and keep the recall system current.

Clinical Duties

  1. Polish restoration.
  2. Perform root planing and soft tipsier curettage.
  3. Apply topical anesthetics and topical medicaments.
  4. Record existing conditions through the use of radiographs.
  5. Perform intraoral dental laboratory tests, including but not limited to, oral cytology smears, pulp vitality test, and caries tests.
  6. Apply pit and fissure sealant to teeth, as prescribed by the dentist.
  7. Do intraoral irrigation and sulcular irrigation.
  8. Remove overhanging margins without the use of rotary instruments.
  9. Oral prophylaxis with slow speed handpiece.
  10. Give topical fluoride application.
  11. Complete all other reasonable requests from doctor.

Job Description Receptionist/Office Manager

  1. Organize yourself physically, mentally, and emotionally; always dress in a professional manner; leave your private and family concerns at home, and make a mental check of your day.
  2. Study and become familiar with office philosophy and agreements in the office.
  3. Be observant, considerate, friendly, and generally in good humor. Make patients feel at ease and welcome as guest in our facility.

Appointment Scheduling

  1. Set appointment hours in accordance with appointment scheduling guidelines and daily goals.
  2. See that the dental hygiene schedule is completely filled.
  3. Follow up on all broken appointments.
  4. Keep a short call list.
  5. Fill broken and canceled appointments.
  6. Confirm patient's appointments at least 2 days prior to appointment date.
  7. Copy the daily schedule and post it in each treatment room.
  8. Greet all patients courteously when arriving and make sure the charts are in the proper place.
  9. Promptly indicate to the staff when the next patient has arrived.
  10. See that the phone is answered before the third ring at all times.
  11. See that the desk is covered at all times.
  12. Complete all other reasonable requests from doctor.

Financial Control

  1. Check records each day to approach any patients who owe a balance.
  2. Take responsibility for requesting and collecting money "over the counter" daily.
  3. See that each record is posted and filed as it comes through. Be responsible for the accuracy of the day sheet and records.
  4. Print and submit insurance for patients when appropriate.
  5. Make financial arrangements with patients in accordance with the financial policy
  6. Follow up on all insurance not paid within 6 weeks. Maintain the insurance system.
  7. Send monthly statements.
  8. Follow up on past due accounts; set arrangements for past due balances. Make collection calls and send accounts to collections with doctor's approval.
  9. See that each payment received in the mail is posted to the accounts receivable system. Be responsible for the accuracy of the accounts receivable system.
  10. See that the bank deposit slip matches the daysheet total.
  11. Make definite financial arrangements with all new patients and patients requiring extensive treatment in accordance with the financial policy of the office.
  12. Work the delinquent payment record.
  13. Be in charge of all correspondence regarding collections, insurance, etc.
  14. Determine approximate patient portion of insurance procedures.
  15. Notify patients of overpayments and send refunds.

Marketing

  1. Keep the new patient book current
  2. Prepare new patient letters for Dr. Kramer
  3. Tank referral sources, letters, etc.

Office Procedures

  1. Be responsible for the preventive maintenance system (recall system).
  2. Be responsible for preventive maintenance follow-up.
  3. Organize and maintain file systems for quick retrieval of information.
  4. See that all backlog paperwork is completed before closing the office on Friday.
  5. Maintain the supply system and inventory for business office items.
  6. Keep Dr. Kramer informed and current on all aspects of the office, patient status, recommendations, etc.
  7. Be responsible for own desk appearance.
  8. Put together new patients' records and charts. Coordinate patient flow.
  9. As changes occur in schedule, change schedules in the treatment rooms.
  10. Check and straighten the reception area.

Job Description Janitorial Staff

The janitorial staff is an outside agency that comes in one day per week and cleans the office. They are responsible for:

  • Vacuuming the entire office
  • Mopping floors
  • Cleaning the bathroom (sink and toilet)
  • Washing exterior and interior windows, mirrors, etc.
  • Emptying trash
  • Dusting shelves and countertops
  • Cleaning out operatory sinks and lab sinks

All other maintenance of the dental equipment is the responsibility of the office staff.

Infrastructure Members

Accountant: to prepare tax returns and advise on various practice financial decisions. $50 to $100/hour.

Lawyer: to help with start up legalities and incorporation, to act as representation in case of litigation and to advise on various business decisions. $75 to $150/hour depending on experience with dental practices.

Insurance Agent: for malpractice and liability insurance. Commissions only.

FINANCIAL POLICY

Third-Party Insurance Policies

This office does not and never will participate in capitation and/or reduced fee-for-service programs. Any phone calls, mail, or solicitors for such plans are to be turned away. Patients who have non-capitation insurance will be required to have an insurance card and the insurance company must be called and verified before they are considered for assignment of benefits. Once a patient has been verified, the following information needs to be retrieved from the insurance company: address to mail claims to; deductibles, if any, and what they apply to; excluded treatments (i.e. crowns are not covered); if the payments are usual and customary or fee schedule; and if prophys are limited per year. All this information can be provided to the patients as needed.

Assignment of benefits will be taken again, only if verification has been approved. Otherwise, the patient is considered "cash paying" until verification can be established.

Patients who receive treatment with insurance will be told up front (before treatment begins) as to their estimated portion of the bill. That portion is due on the date of service; no exceptions are to be given. Patients need to be aware that the amount they are paying is an estimated portion based on what their insurance has told us, and if insurance does not pay or pays less, they are responsible for the balance. We gladly process insurance forms for patients. Insurance claims are to be submitted each day as the charges are posted. Narratives and X-rays need to be mailed with larger claims and all crown and bridge cases. Periodontal charting should be sent with all periodontal cases.

Claims are to be filed in duplicate. One copy goes to the insurance company and one is filed by month and in ABC order. As claims are paid, the EOB (explanation of benefits) is to be attached to our copy and filed in a separate file under "paid claims" for that month. Claims not paid within 5 weeks must be called on and proper steps taken to expedite payment. Also, Visa and Mastercard will be accepted. For treatment plans of considerable amounts, we will help the patient file for financing through a bank.

Financial Arrangements

  • A 5 percent discount is given to patients whose treatment plan is over $250 and pay cash up front.
  • If a patient needs to come back 5 times to complete a $1,000 treatment plan, then payments would be $200 each visit.
  • Treatment plans under $250 are expected on the day of service.
  • Any other arrangements must be made directly through Dr. Kramer.

Appointment Philosophy and Procedures

The appointment book is the map of our day and is to be used in a specific manner. All procedures have been timed and a schedule of times is attached to the schedule book. Only in instances that Dr. Kramer or the hygienist request additional time are these guidelines to be changed.

  1. Always try and fill the schedule to capacity and keep a short call list.
  2. The schedule is also to be filled to our daily production goals.
  3. Patients that cancel less than 24 hours in advance or no-show are to be warned the first time and charged a $25 fee the second time.

FINANCIAL PLAN

The practice will be set up as a Limited Liability Company (LLC). This will be done to receive the limited liability of a corporation with the option of selecting taxation as either a partnership or as a corporation. Upon counsel with my lawyer and accountant, I will decide which setup offers me the best result in regards to taxes.

I am looking at a practice worth approximately $250,000. One shortcut method to determine the selling price of a practice is to take the average of the last three years gross sales and divide it by two. To purchase the practice I will take out a $300,000 ten-year loan at a negotiable rate (I used 15 percent in my financials) that gives me the opportunity of renewal every three years and has no penalty for early repayment. I am estimating that $250,000 will go for the practice, $30,000 will be used for any start-up costs (such as updates to building or equipment), and the remaining $20,000 will be used to maintain positive cash flows at start-up and to be used in case of any unforeseen problems. I don't foresee any problems attaining a loan, as there are many brokerage companies that will fully finance your dental practice with no down payment if you can prove that there will be no significant decline in gross sales resulting from the purchase of the practice. Another financing possibility is that the current owner of the practice could seller-finance some or the entire sales price. This would allow 100 percent financing without titled collateral, but would preclude a higher than market rate. Similarly, a dental broker could finance the project with the same general benefits and drawbacks of the seller-finance option. Also, we could approach a bank for the loan, which will generally ask for a 20 percent down payment, titled collateral, and an aggressive amortization rate, but a lower interest rate than the other options.

In doing my financial statements, I have had to make many assumptions and use many numbers, averages, and percentages given by the American Dental Association (ADA). Some of the numbers seem either too high or too low, but I used them to maintain consistency. For instance, in the first five years of business, marketing and legal/professional costs will probably be higher than the national average. I think that insurance will be much higher than the amount attained by using the percentage given by the ADA. Also, the average patient charge per patient includes dentists who do all of their own hygiene work, dentists who accept capitation insurance, and dentists who do public health dentistry only. Therefore, the $183.56 national average as stated by the ADA seems very low.

The number of total employees the practice will have upon my purchase is dependent on the structure prior to my buyout. My first year in practice, I will need one full-time assistant and one full-time bookkeeper/receptionist. Until I feel I have a sufficient client base, I will do much of my hygiene work. One hygienist will work one or two days a week dependent upon need and on a percent of work completed basis. This will give the hygienist greater incentive to see more patients and to insure the recall system works efficiently. Building the patient base to have enough patients to allow for two dentists will take about a year and a half. Optimal full-time employment upon my father joining the practice is two full-time assistants, one full-time bookkeeper/receptionist, and one hygienist with the same conditions. After the larger client base has been established, which will probably take about a year of working with my father, another hygienist will be added so that there will be a hygienist in the office four days a week and my father and I will not need to see any hygiene patients which will make our per patient charge increase. If need arises, one part-time office helper will be employed.

As we will be living in the central region of the United States, I have used the wage rates quoted in the Journal of the American Dental Association for dental employees in that region. Median hourly salary for a receptionist/bookkeeper is $11.65/hour. The average hourly wage for an experienced chairside assistant is $11.00. Finally, a hygienist in the central area will make around $200 a day. This sounds like a lot, but hygienists often rotate between practices as to support a broader client base.

My father and I will discuss a contract whereby he receives a certain percentage of his gross production, probably 40 percent the first year. With working the same hours per week that he currently does and seeing fewer patients, he will make a comparable salary to what he pays himself in Lincoln. Lincoln is a farming and industrial community that does not see the benefits of the highly profitable aesthetic dentistry. Although my father has the largest practice in the area, he does not make as much money as comparable practices in more educated areas due to the demand for restorative dentistry only. Working for Stanley allows his father, Jeremiah, to make as much money as he wants, while only working the amount of hours that suits his lifestyle. Also, he will not have the risk or responsibility associated with running a business, but will have significant input, as he has so many years of practice experience. The money he will make by selling his practice can be invested to use in his retirement.

We will establish written bylaws that address issues such as how the relationship between my father and I will be handled. As my parents will probably help with a small portion of the down payment on the loan, both my mother and father will receive a percentage of profits based on their contribution. The other portion of ownership will be divided between my wife and myself. We will have guidelines on buying back and selling ownership shares. This is to ensure the business does not suffer from problems within the family.

My family is a very close one that is intent on building our futures together. We have held many discussions concerning the control and management of the practice and are in agreement to this point. Before my father actually decides to move and sell his practice, we will sit down and write up an agreement about practice management. We will have a lawyer that is familiar with dental practices and family businesses look it over and add suggestions. Me and my wife will have the final say in matters pertaining to the practice, as we will have a greater share of ownership. As I have not had as much experience managing a practice, my parents' input will be greatly appreciated and sought. A policy of mutual respect between the four of us and documented policies will make our working relationship as positive as our personal one.

My first year after buying the practice, I will be able to see about seven patients per day and will work five days a week. The average cost per patient visit is $183.56 for a normal solo practice. Using these numbers, I should have an average monthly gross income of $25,000 and first-year gross income of approximately $275,000 based on having four weeks' vacation. My client base should be somewhere around 2,000 to 2,500 (a small drop from initial patient base) active patients, and I expect to exceed the average growth rate of 32 new patients per month for new dentists. I should have patient capacity for my father within two years. My financial statements assume that Dr. Jeremiah Kramer will join the practice after two years. I have also included income statements that show the practice's standings if my father and my dream of working together does not become a reality. Note: the practice still garners a reasonable profit, but not nearly as significant as the one earned with both dentists practicing. An exit strategy has not yet been planned, as this business will be the main source of income for my father for many years. When my father decides to retire, I will either hire another associate or rent out his facility to another doctor or specialist.

Price List

Customers will be charged the going industry price for the geographic area of practice plus a premium for the convenience-based value-added services. An example of a price list for services from the May 1996 issue of Dental Economics for the central region is as follows. We will use prices similar to these plus a premium for some treatments.

Initial oral exam, adultexcluding radiographs $27 Inlay, porcelain, 1 surface $344
Comprehensive oral exam, adult 38 Full-cast, high-noble metal crown 511
Emergency oral exam 31 Porcelain fused to high-noble metal crown 514
Panoramic film 48 Porcelain fused to noble metal crown 491
Intraoral X-rays, complete series including BWX 59 Prefabricated stainless-steel crown, permanent 129
BWXfour films 28 Cast post and core, in addition to crown 159
Intraoral, periapical, first film 11 Crown buildup, including any pins 110
Intraoral, periapical, each additional film 9 Replacement crown 45
Prophylaxis, adult 44 Labial veneer-laminate 232
Limited oral exam, problem-focused 25 Labial veneer (porcelain laminate)lab 415
Initial oral exam, child 24 Complete upper denture 694
Prophylaxis, child 30 Complete lower denture 696
Fluoride, child-excluding prophylaxis 17 Upper denture reline, chairside 146
Periodic oral exam, child 19 Lower denture reline, chairside 148
Pit and fissure sealant, per tooth 23 Extraction, single tooth 61
Periodic oral exam, adult 20 One root canal, exclusive of restoration 283
BWXtwo films 19 Two root canals, exclusive of restoration 345
Amalgam restoration, 1 surface, permanent 55 Three root canals, exclusive of restoration 438
Amalgam restoration, 2 surfaces, permanent 72 Periodontal scaling with gingival inflammation 80
Amalgam restoration, 3 surfaces, permanent 89 Gingival curettage, per quadrant 119
Composite resin restoration, 1 surface, anterior 65 Periodontal root planing, per quadrant 111
Composite resin restoration, 1 surface, posterior 75 Teeth-whitening, per arch 161
Inlay, metallic, 1 surface 323 Infection-control fee 18

FINANCIAL STATEMENTS

  • Percentages given by "Building a Financial Foundation for your Practice," an article from ADA Dental Practice Library.
  • Sales estimate based on a 48-week year with benefits paid for 52 weeks.
  • Years 3-5 are shown both including and excluding Dr. Jeremiah Kramer, DDS.

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Income StatementYear 1, June 2002-May 2003

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 22,917 22,917 22,917 22,917 22,917 22,917
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 29,637 29,637 29,637 29,637 29,637 29,637
Cash Receipts (90%) 26,673 26,673 26,673 26,673 26,673 26,673
Accounts Receivable (10%) 2,964 2,964 2,964 2,964 2,964 2,964
Cost of Goods Sold
Lab Fees (9%) -2,667 -2,667 -2,667 -2,667 -2,667 -2,667
Dental Supplies (6%) -1,778 -1,778 -1,778 -1,778 -1,778 -1,778
GROSS INCOME: 25,191 25,191 25,191 25,191 25,191 25,191
EXPENSES:
Advertising (3%) 889 889 889 889 889 889
Insurance (3%) 889 889 889 889 889 889
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 1,778 1,778 1,778 1,778 1,778 1,778
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 417 417 417 417 417 417
Utilities (2%) 593 593 593 593 593 593
Wages
Professional (F) 4,167 4,167 4,167 4,167 4,167 4,167
Hygienist (.25 of production) 1,680 1,680 1,680 1,680 1,680 1,680
Salaried & Benefits (21%) 4,813 4,813 4,813 4,813 4,813 4,813
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 22, 725 22,725 22,725 22,725 22,725 22,725
NET PROFIT (LOSS): 2,466 2,466 2,466 2,466 2,466 2,466
Stanley at 7 patients a day at an average of $183.56/patient
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient $80,640
1 Assistant 40 hours/week at $11.00/hour for 52 weeks 22,880
1 Receptionist/bookkeeper 40 hours/week at $11.65/hour at 52 weeks 24,232
Weekly wage of Assistant and Receptionist before benefits 47,112
Dec Jan Feb Mar Apr May Total
22,917 22,917 22,917 22,917 22,917 22,917 275,000
6,720 6,720 6,720 6,720 6,720 6,720 80,640
29,637 29,637 29,637 29,637 29,637 29,637 355,640
26,673 26,673 26,673 26,673 26,673 26,673 320,076
2,964 2,964 2,964 2,964 2,964 2,964 35,564
-2,667 -2,667 -2,667 -2,667 -2,667 -2,667 -32,008
-1,778 -1,778 -1,778 -1,778 -1,778 -1,778 -21,338
25,191 25,191 25,191 25,191 25,191 25,191 302,294
889 889 889 889 889 889 10,669
889 889 889 889 889 889 10,669
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
1,778 1,778 1,778 1,778 1,778 1,778 21,338
2,500 2,500 2,500 2,500 2,500 2,500 30,000
417 417 417 417 417 417 5,000
593 593 593 593 593 593 7,113
4,167 4,167 4,167 4,167 4,167 4,167 50,000
1,680 1,680 1,680 1,680 1,680 1,680 20,160
4,813 4,813 4,813 4,813 4,813 4,813 57,750
417 417 417 417 417 417 5,000
22,725 22,725 22,725 22,725 22,725 22,725 272,700
2,466 2,466 2,466 2,466 2,466 2,466 29,594

Statement of Cash FlowsYear 1, June 2002-May 2003

Jun Jul Aug Sep Oct Nov
Cash Inflows
Beginning Cash Balance 20,000 19,503 19,005 18,508 18,010 17,513
Loan for Start-up costs 30,000
Cash Receipts 26,673 26,673 26,673 26,673 26,673 26,673
Total Cash Inflows 76,673 46,176 45,678 45,181 44,683 44,186
Cash Disbursements
Start-up costs 30,000
Lab Fees (9%) 2,667 2,667 2,667 2,667 2,667 2,667
Dental Supplies (6%) 1,778 1,778 1,778 1,778 1,778 1,778
Advertising (3%) 889 889 889 889 889 889
Insurance (3%) 889 889 889 889 889 889
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 1,778 1,778 1,778 1,778 1,778 1,778
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 417 417 417 417 417 417
Utilities (2%) 593 593 593 593 593 593
Wages
Professional (F) 4,167 4,167 4,167 4,167 4,167 4,167
Hygienist 1,680 1,680 1,680 1,680 1,680 1,680
Salaried & Benefits 4,813 4,813 4,813 4,813 4,813 4,813
Other Expenses (F) 417 417 417 417 417 417
Total Disbursements 57,170 27,170 27,170 27,170 27,170 27,170
Remaining Cash at Month End 19,503 19,005 18,508 18,010 17,513 17,015
Dec Jan Feb Mar Apr May
17,015 16,518 16,020 15,523 15,025 14,528
26,673 26,673 26,673 26,673 26,673 26,673
43,688 43,191 42,693 42,196 41,698 41,201
2,667 2,667 2,667 2,667 2,667 2,667
1,778 1,778 1,778 1,778 1,778 1,778
889 889 889 889 889 889
889 889 889 889 889 889
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
1,778 1,778 1,778 1,778 1,778 1,778
2,500 2,500 2,500 2,500 2,500 2,500
417 417 417 417 417 417
593 593 593 593 593 593
4,167 4,167 4,167 4,167 4,167 4,167
1,680 1,680 1,680 1,680 1,680 1,680
4,813 4,813 4,813 4,813 4,813 4,813
417 417 417 417 417 417
27,170 27,170 27,170 27,170 27,170 27,170
16,518 16,020 15,523 15,025 14,528 14,030

Balance Sheet Year 1-5

Year 1 Year 2 Year 3 Year 4 Year 5
Assets:
Cash 14,030 27,228 53,494 39,471 55,598
Accounts Receivable 35,564 48,872 75,908 79,432 91,902
Building and Equipment 250,000 250,000 250,000 250,000 250,000
Total Assets 299,594 326,100 379,402 368,903 397,500
Liabilities and Owners Equity:
Note Payable 270,000 240,000 210,000 180,000 150,000
Owners Equity 29,594 56,505 102,174 65,409 108,029
Retained Earnings 0 29,594 56,505 102,174 65,409
0 0 10,723 21,321 74,062
Total Liabilities 299,594 326,100 379,402 368,903 397,500
Difference 0 0 0 0 0

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Income StatementYear 2, June 2003-May 2004

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 29,370 29,370 29,370 29,370 29,370 29,370
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 36,090 36,090 36,090 36,090 36,090 36,090
Cash Receipts (90%) 32,481 32,481 32,481 32,481 32,481 32,481
Accounts Receivable (10%) 3,609 3,609 3,609 3,609 3,609 3,609
Cost of Goods Sold
Lab Fees (9%) (3,248) (3,248) (3,248) (3,248) (3,248) (3,248)
Dental Supplies (6%) (2,165) (2,165) (2,165) (2,165) (2,165) (2,165)
GROSS INCOME: 30,676 30,676 30,676 30,676 30,676 30,676
EXPENSES:
Advertising (3%) 1,083 1,083 1,083 1,083 1,083 1,083
Insurance (3%) 1,083 1,083 1,083 1,083 1,083 1,083
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 2,165 2,165 2,165 2,165 2,165 2,165
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 500 500 500 500 500 500
Utilities (2%) 722 722 722 722 722 722
Wages
Professional (F) 5,000 5,000 5,000 5,000 5,000 5,000
Hygienist (.26 of production) 1,747 1,747 1,747 1,747 1,747 1,747
Salaried & Benefits (21%) 6,168 6,168 6,168 6,168 6,168 6,168
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 25,967 25,967 25,967 25,967 25,967 25,967
NET PROFIT (LOSS): 4,709 4,709 4,709 4,709 4,709 4,709
Dec Jan Feb Mar Apr May Total
29,370 29,370 29,370 29,370 29,370 29,370 352,435
6,720 6,720 6,720 6,720 6,720 6,720 80,640
36,090 36,090 36,090 36,090 36,090 36,090 433,075
32,481 32,481 32,481 32,481 32,481 32,481 389,768
3,609 3,609 3,609 3,609 3,609 3,609 43,308
(3,248) (3,248) (3,248) (3,248) (3,248) (3,248) (38,977)
(2,165) (2,165) (2,165) (2,165) (2,165) (2,165) (25,985)
30,676 30,676 30,676 30,676 30,676 30,676 368,114
1,083 1,083 1,083 1,083 1,083 1,083 12,992
1,083 1,083 1,083 1,083 1,083 1,083 12,992
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
2,165 2,165 2,165 2,165 2,165 2,165 25,985
2,500 2,500 2,500 2,500 2,500 2,500 30,000
500 500 500 500 500 500 6,000
722 722 722 722 722 722 8,662
5,000 5,000 5,000 5,000 5,000 5,000 60,000
1,747 1,747 1,747 1,747 1,747 1,747 20,966
6,168 6,168 6,168 6,168 6,168 6,168 74,011
417 417 417 417 417 417 5,000
25,967 25,967 25,967 25,967 25,967 25,967 311,608
4,709 4,709 4,709 4,709 4,709 4,709 56,505

Statement of Cash FlowsYear 2, June 2003-May 2004

Jun Jul Aug Sep Oct Nov
Cash Inflows
Beginning Cash Balance 14,030 15,130 16,230 17,330 18,430 19,530
Cash Receipts 32,481 32,481 32,481 32,481 32,481 32,481
Total Cash Inflows 46,511 47,611 48,711 49,811 50,910 52,010
Cash Disbursements
Lab Fees (9%) 3,248 3,248 3,248 3,248 3,248 3,248
Dental Supplies (6%) 2,165 2,165 2,165 2,165 2,165 2,165
Advertising (3%) 1,083 1,083 1,083 1,083 1,083 1,083
Insurance (3%) 1,083 1,083 1,083 1,083 1,083 1,083
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 2,165 2,165 2,165 2,165 2,165 2,165
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 500 500 500 500 500 500
Utilities (2%) 722 722 722 722 722 722
Wages
Professional (F) 5,000 5,000 5,000 5,000 5,000 5,000
Hygienist 1,747 1,747 1,747 1,747 1,747 1,747
Salaried & Benefits 6,168 6,168 6,168 6,168 6,168 6,168
Other Expenses (F) 417 417 417 417 417 417
Total Disbursements 31,381 31,381 31,381 31,381 31,381 31,381
Remaining Cash at Month End 15,130 16,230 17,330 18,430 19,530 20,629
Dec Jan Feb Mar Apr May
20,629 21,729 22,829 23,929 25,029 26,129
32,481 32,481 32,481 32,481 32,481 32,481
53,110 54,210 55,310 56,410 57,509 58,609
3,248 3,248 3,248 3,248 3,248 3,248
2,165 2,165 2,165 2,165 2,165 2,165
1,083 1,083 1,083 1,083 1,083 1,083
1,083 1,083 1,083 1,083 1,083 1,083
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
2,165 2,165 2,165 2,165 2,165 2,165
2,500 2,500 2,500 2,500 2,500 2,500
500 500 500 500 500 500
722 722 722 722 722 722
5,000 5,000 5,000 5,000 5,000 5,000
1,747 1,747 1,747 1,747 1,747 1,747
6,168 6,168 6,168 6,168 6,168 6,168
417 417 417 417 417 417
31,381 31,381 31,381 31,381 31,381 31,381
21,729 22,829 23,929 25,029 26,129 27,228

Income StatementYear 3 with Dr. Jeremiah Kramer, DDS
June 2004-May 2005

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 33,041 33,041 33,041 33,041 33,041 33,041
Dr. Jeremiah Kramer 23,496 23,496 23,496 23,496 23,496 23,496
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 63,257 63,257 63,257 63,257 63,257 63,257
Cash Receipts (90%) 56,931 56,931 56,931 56,931 56,931 56,931
Accounts Receivable (10%) 6,326 6,326 6,326 6,326 6,326 6,326
Cost of Goods Sold
Lab Fees (9%) (5,693) (5,693) (5,693) (5,693) (5,693) (5,693)
Dental Supplies (6%) (3,795) (3,795) (3,795) (3,795) (3,795) (3,795)
GROSS INCOME: 53,768 53,768 53,768 53,768 53,768 53,768
EXPENSES:
Advertising (3%) 1,898 1,898 1,898 1,898 1,898 1,898
Insurance (3%) 1,898 1,898 1,898 1,898 1,898 1,898
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 3,795 3,795 3,795 3,795 3,795 3,795
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 750 750 750 750 750 750
Utilities (2%) 1,265 1,265 1,265 1,265 1,265 1,265
Wages
Dr. Stanley Kramer (F) 7,500 7,500 7,500 7,500 7,500 7,500
Dr. Jeremiah Kramer (.45 of production) 11,895 11,895 11,895 1,895 11,895 11,895
Hygienist (.27 of production) 1,814 1,814 1,814 1,814 1,814 1,814
Salaried & Benefits (21%) 6,939 6,939 6,939 6,939 6,939 6,939
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 45,254 45,254 45,254 45,254 45,254 45,254
NET PROFIT (LOSS): 8,514 8,514 8,514 8,514 8,514 8,514
Stanley at 9 patients a day at an average of $183.56/per patient 396,490
Jeremiah at 8 patients a day, 4 days a week for 48 weeks at $183.56/patient 281,948
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
2 assistants 40 hours a week at $11.00/hour for 52 weeks 45,760
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
Weekly wage of assistant and receptionist before benefits 69,992
Dec Jan Feb Mar Apr May Total
33,041 33,041 33,041 33,041 33,041 33,041 396,490
23,496 23,496 23,496 23,496 23,496 23,496 281,948
6,720 6,720 6,720 6,720 6,720 6,720 80,640
63,257 63,257 63,257 63,257 63,257 63,257 759,078
56,931 56,931 56,931 56,931 56,931 56,931 683,170
6,326 6,326 6,326 6,326 6,326 6,326 75,908
(5,693) (5,693) (5,693) (5,693) (5,693) (5,693) (68,317)
(3,795) (3,795) (3,795) (3,795) (3,795) (3,795) (45,545)
53,768 53,768 53,768 53,768 53,768 53,768 645,216
1,898 1,898 1,898 1,898 1,898 1,898 22,772
1,898 1,898 1,898 1,898 1,898 1,898 22,772
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
3,795 3,795 3,795 3,795 3,795 3,795 45,545
2,500 2,500 2,500 2,500 2,500 2,500 30,000
750 750 750 750 750 750 9,000
1,265 1,265 1,265 1,265 1,265 1,265 15,182
7,500 7,500 7,500 7,500 7,500 7,500 90,000
11,895 11,895 11,895 11,895 11,895 11,895 142,736
1,814 1,814 1,814 1,814 1,814 1,814 21,773
6,939 6,939 6,939 6,939 6,939 6,939 83,263
417 417 417 417 417 417 5,000
45,254 45,254 45,254 45,254 45,254 45,254 543,043
8,514 8,514 8,514 8,514 8,514 8,514 102,174

Income StatementYear 3 without Dr. Jeremiah Kramer, DDS
June 2004-May 2005

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 33,041 33,041 33,041 33,041 33,041 33,041
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 39,761 39,761 39,761 39,761 39,761 39,761
Cash Receipts (90%) 35,785 35,785 35,785 35,785 35,785 35,785
Accounts Receivable (10%) 3,976 3,976 3,976 3,976 3,976 3,976
Cost of Goods Sold
Lab Fees (9%) (3,578) (3,578) (3,578) (3,578) (3,578) (3,578)
Dental Supplies (6%) (2,386) (2,386) (2,386) (2,386) (2,386) (2,386)
GROSS INCOME: 33,797 33,797 33,797 33,797 33,797 33,797
EXPENSES:
Advertising (3%) 1,193 1,193 1,193 1,193 1,193 1,193
Insurance (3%) 1,193 1,193 1,193 1,193 1,193 1,193
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 2,386 2,386 2,386 2,386 2,386 2,386
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 500 500 500 500 500 500
Utilities (2%) 795 795 795 795 795 795
Wages
Dr. Stanley Kramer (F) 5,000 5,000 5,000 5,000 5,000 5,000
Hygienist (.27 of production) 1,814 1,814 1,814 1,814 1,814 1,814
Salaried & Benefits (21%) 6,939 6,939 6,939 6,939 6,939 6,939
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 27,319 27,319 27,319 27,319 27,319 27,319
NET PROFIT (LOSS): 6,477 6,477 6,477 6,477 6,477 6,477
Stanley at 9 patients a day at an average of $183.56/patient 396,490
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
1 assistant 40 hours a week at $11.00/hour for 52 weeks 22,880
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
Weekly wage of assistant and receptionist before benefits 47,112
Dec Jan Feb Mar Apr May Total
33,041 33,041 33,041 33,041 33,041 33,041 396,490
6,720 6,720 6,720 6,720 6,720 6,720 80,640
39,761 39,761 39,761 39,761 39,761 39,761 477,130
35,785 35,785 35,785 35,785 35,785 35,785 429,417
3,976 3,976 3,976 3,976 3,976 3,976 47,713
(3,578) (3,578) (3,578) (3,578) (3,578) (3,578) (42,942)
(2,386) (2,386) (2,386) (2,386) (2,386) (2,386) (28,628)
33,797 33,797 33,797 33,797 33,797 33,797 405,561
1,193 1,193 1,193 1,193 1,193 1,193 14,314
1,193 1,193 1,193 1,193 1,193 1,193 14,314
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
2,386 2,386 2,386 2,386 2,386 2,386 28,628
2,500 2,500 2,500 2,500 2,500 2,500 30,000
500 500 500 500 500 500 6,000
795 795 795 795 795 795 9,543
5,000 5,000 5,000 5,000 5,000 5,000 60,000
1,814 1,814 1,814 1,814 1,814 1,814 21,773
6,939 6,939 6,939 6,939 6,939 6,939 83,263
417 417 417 417 417 417 5,000
27,319 27,319 27,319 27,319 27,319 27,319 327,834
6,477 6,477 6,477 6,477 6,477 6,477 77,727

Statement of Cash FlowsYear 3, June 2004-May 2005

Jun Jul Aug Sep Oct Nov
Cash Inflows
Beginning Cash Balance 27,228 29,417 31,606 33,795 35,984 38,173
Cash Receipts 56,931 56,931 56,931 56,931 56,931 56,931
Total Cash Inflows 84,159 86,348 88,537 90,726 92,915 95,103
Cash Disbursements
Lab Fees (9%) 5,693 5,693 5,693 5,693 5,693 5,693
Dental Supplies (6%) 3,795 3,795 3,795 3,795 3,795 3,795
Advertising (3%) 1,898 1,898 1,898 1,898 1,898 1,898
Insurance (3%) 1,898 1,898 1,898 1,898 1,898 1,898
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 3,795 3,795 3,795 3,795 3,795 3,795
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 750 750 750 750 750 750
Utilities (2%) 1,265 1,265 1,265 1,265 1,265 1,265
Wages
Dr. Stanley Kramer (F) 7,500 7,500 7,500 7,500 7,500 7,500
Dr. Jeremiah Kramer 11,895 11,895 11,895 11,895 11,895 11,895
Hygienist 1,814 1,814 1,814 1,814 1,814 1,814
Salaried & Benefits 6,939 6,939 6,939 6,939 6,939 6,939
Other Expenses (F) 417 417 417 417 417 417
Total Disbursements 54,742 54,742 54,742 54,742 54,742 54,742
Remaining Cash at Month End 29,417 31,606 33,795 35,984 38,173 40,361
Dec Jan Feb Mar Apr May
40,361 42,550 44,739 46,928 49,117 51,306
56,931 56,931 56,931 56,931 56,931 56,931
97,292 99,481 101,670 103,859 106,048 108,236
5,693 5,693 5,693 5,693 5,693 5,693
3,795 3,795 3,795 3,795 3,795 3,795
1,898 1,898 1,898 1,898 1,898 1,898
1,898 1,898 1,898 1,898 1,898 1,898
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
3,795 3,795 3,795 3,795 3,795 3,795
2,500 2,500 2,500 2,500 2,500 2,500
750 750 750 750 750 750
1,265 1,265 1,265 1,265 1,265 1,265
7,500 7,500 7,500 7,500 7,500 7,500
11,895 11,895 11,895 11,895 11,895 11,895
1,814 1,814 1,814 1,814 1,814 1,814
6,939 6,939 6,939 6,939 6,939 6,939
417 417 417 417 417 417
54,742 54,742 54,742 54,742 54,742 54,742
42,550 44,739 46,928 49,117 51,306 53,494

Income StatementYear 4 with Dr. Jeremiah Kramer, DDS
June 2005-May 2006

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 33,041 33,041 33,041 33,041 33,041 33,041
Dr. Jeremiah Kramer 26,433 26,433 26,433 26,433 26,433 26,433
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 66,194 66,194 66,194 66,194 66,194 66,194
Cash Receipts (90%) 59,574 59,574 59,574 59,574 59,574 59,574
Accounts Receivable (10%) 6,619 6,619 6,619 6,619 6,619 6,619
Cost of Goods Sold
Lab Fees (9%) (5,957) (5,957) (5,957) (5,957) (5,957) (5,957)
Dental Supplies (6%) (3,972) (3,972) (3,972) (3,972) (3,972) (3,972)
GROSS INCOME: 56,264 56,264 56,264 56,264 56,264 56,264
EXPENSES:
Advertising (3%) 1,986 1,986 1,986 1,986 1,986 1,986
Insurance (3%) 1,986 1,986 1,986 1,986 1,986 1,986
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 3,972 3,972 3,972 3,972 3,972 3,972
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 958 958 958 958 958 958
Utilities (2%) 1,324 1,324 1,324 1,324 1,324 1,324
Wages
Dr. Stanley Kramer (F) 9,583 9,583 9,583 9,583 9,583 9,583
Dr. Jeremiah Kramer (.5 of production) 14,685 14,685 14,685 14,685 14,685 14,685
Hygienist (.28 of production) 1,882 1,882 1,882 1,882 1,882 1,882
Salaried & Benefits (21%) 6,939 6,939 6,939 6,939 6,939 6,939
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 50,814 50,814 50,814 50,814 50,814 50,814
NET PROFIT (LOSS): 5,451 5,451 5,451 5,451 5,451 5,451
Stanley at 9 patients a day at an average of $183.56/patient 396,490
Jeremiah at 9 patients a day, 4 days a week for 48 weeks at $183.56/patient 317,192
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
2 assistants 40 hours a week at $11.00/hour for 52 weeks 45,760
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
1 receptionist/ bookkeeper 20 hours a week at $11.65/hour at 52 weeks 12,116
Weekly wage of assistant and receptionist before benefits 82,108
Dec Jan Feb Mar Apr May Total
33,041 33,041 33,041 33,041 33,041 33,041 396,490
26,433 26,433 26,433 26,433 26,433 26,433 317,192
6,720 6,720 6,720 6,720 6,720 6,720 80,640
66,194 66,194 66,194 66,194 66,194 66,194 794,322
59,574 59,574 59,574 59,574 59,574 59,574 714,890
6,619 6,619 6,619 6,619 6,619 6,619 79,432
(5,957) (5,957) (5,957) (5,957) (5,957) (5,957) (71,489)
(3,972) (3,972) (3,972) (3,972) (3,972) (3,972) (47,659)
56,264 56,264 56,264 56,264 56,264 56,264 675,174
1,986 1,986 1,986 1,986 1,986 1,986 23,830
1,986 1,986 1,986 1,986 1,986 1,986 23,830
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
3,972 3,972 3,972 3,972 3,972 3,972 47,659
2,500 2,500 2,500 2,500 2,500 2,500 30,000
958 958 958 958 958 958 11,500
1,324 1,324 1,324 1,324 1,324 1,324 15,886
9,583 9,583 9,583 9,583 9,583 9,583 115,000
14,685 14,685 14,685 14,685 14,685 14,685 176,218
1,882 1,882 1,882 1,882 1,882 1,882 22,579
6,939 6,939 6,939 6,939 6,939 6,939 83,263
417 417 417 417 417 417 5,000
50,814 50,814 50,814 50,814 50,814 50,814 609,765
5,451 5,451 5,451 5,451 5,451 5,451 65,409

Income StatementYear 4 without Dr. Jeremiah Kramer, DDS
June 2005-May 2006

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 36,712 36,712 36,712 36,712 36,712 36,712
Hygienist 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 43,432 43,432 43,432 43,432 43,432 43,432
Cash Receipts (90%) 39,089 39,089 39,089 39,089 39,089 39,089
Accounts Receivable (10%) 4,343 4,343 4,343 4,343 4,343 4,343
Cost of Goods Sold
Lab Fees (9%) (3,909) (3,909) (3,909) (3,909) (3,909) (3,909)
Dental Supplies (6%) (2,606) (2,606) (2,606) (2,606) (2,606) (2,606)
GROSS INCOME: 36,917 36,917 36,917 36,917 36,917 36,917
EXPENSES:
Advertising (3%) 1,303 1,303 1,303 1,303 1,303 1,303
Insurance (3%) 1,303 1,303 1,303 1,303 1,303 1,303
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 2,606 2,606 2,606 2,606 2,606 2,606
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 500 500 500 500 500 500
Utilities (2%) 869 869 869 869 869 869
Wages
Dr. Stanley Kramer (F) 5,000 5,000 5,000 5,000 5,000 5,000
Hygienist (.28 of production) 1,882 1,882 1,882 1,882 1,882 1,882
Salaried & Benefits (21%) 7,710 7,710 7,710 7,710 7,710 7,710
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 28,672 28,672 28,672 28,672 28,672 28,672
NET PROFIT (LOSS): 8,246 8,246 8,246 8,246 8,246 8,246
Stanley at 10 patients a day at an average of $183.56/patient 440,544
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
1 assistant 40 hours a week at $11.00/hour for 52 weeks 22,880
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
Weekly wage of assistant and receptionist before benefits 47,112
Dec Jan Feb Mar Apr May Total
36,712 36,712 36,712 36,712 36,712 36,712 440,544
6,720 6,720 6,720 6,720 6,720 6,720 80,640
43,432 43,432 43,432 43,432 43,432 43,432 521,184
39,089 39,089 39,089 39,089 39,089 39,089 469,066
4,343 4,343 4,343 4,343 4,343 4,343 52,118
(3,909) (3,909) (3,909) (3,909) (3,909) (3,909) (46,907)
(2,606) (2,606) (2,606) (2,606) (2,606) (2,606) (31,271)
36,917 36,917 36,917 36,917 36,917 36,917 443,006
1,303 1,303 1,303 1,303 1,303 1,303 15,636
1,303 1,303 1,303 1,303 1,303 1,303 15,636
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
2,606 2,606 2,606 2,606 2,606 2,606 31,271
2,500 2,500 2,500 2,500 2,500 2,500 30,000
500 500 500 500 500 500 6,000
869 869 869 869 869 869 10,424
5,000 5,000 5,000 5,000 5,000 5,000 60,000
1,882 1,882 1,882 1,882 1,882 1,882 22,579
7,710 7,710 7,710 7,710 7,710 7,710 92,514
417 417 417 417 417 417 5,000
28,672 28,672 28,672 28,672 28,672 28,672 344,059
8,246 8,246 8,246 8,246 8,246 8,246 98,947

Statement of Cash FlowsYear 4, June 2005-May 2006

Jun Jul Aug Sep Oct Nov
Cash Inflows
Beginning Cash Balance 53,494 52,326 51,157 49,988 48,820 47,651
Cash Receipts 59,574 59,574 59,574 59,574 59,574 59,574
Total Cash Inflows 113,069 111,900 110,731 109,563 108,394 107,225
Cash Disbursements
Lab Fees (9%) 5,957 5,957 5,957 5,957 5,957 5,957
Dental Supplies (6%) 3,972 3,972 3,972 3,972 3,972 3,972
Advertising (3%) 1,986 1,986 1,986 1,986 1,986 1,986
Insurance (3%) 1,986 1,986 1,986 1,986 1,986 1,986
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 3,972 3,972 3,972 3,972 3,972 3,972
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 958 958 958 958 958 958
Utilities (2%) 1,324 1,324 1,324 1,324 1,324 1,324
Wages
Dr. Stanley Kramer (F) 9,583 9,583 9,583 9,583 9,583 9,583
Dr. Jeremiah Kramer 14,685 14,685 14,685 14,685 14,685 14,685
Hygienist 1,882 1,882 1,882 1,882 1,882 1,882
Salaried & Benefits 6,939 6,939 6,939 6,939 6,939 6,939
Other Expenses (F) 417 417 417 417 417 417
Total Disbursements 60,743 60,743 60,743 60,743 60,743 60,743
Remaining Cash at Month End 52,326 51,157 49,988 48,820 47,651 46,483
Dec Jan Feb Mar Apr May
46,483 45,314 44,145 42,977 41,808 40,639
59,574 59,574 59,574 59,574 59,574 59,574
106,057 104,888 103,719 102,551 101,382 100,213
5,957 5,957 5,957 5,957 5,957 5,957
3,972 3,972 3,972 3,972 3,972 3,972
1,986 1,986 1,986 1,986 1,986 1,986
1,986 1,986 1,986 1,986 1,986 1,986
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
3,972 3,972 3,972 3,972 3,972 3,972
2,500 2,500 2,500 2,500 2,500 2,500
958 958 958 958 958 958
1,324 1,324 1,324 1,324 1,324 1,324
9,583 9,583 9,583 9,583 9,583 9,583
14,685 14,685 14,685 14,685 14,685 14,685
1,882 1,882 1,882 1,882 1,882 1,882
6,939 6,939 6,939 6,939 6,939 6,939
417 417 417 417 417 417
60,743 60,743 60,743 60,743 60,743 60,743
45,314 44,145 42,977 41,808 40,639 39,471

Income StatementYear 5, June 2006-May 2007

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 36,712 36,712 36,712 36,712 36,712 36,712
Dr. Jeremiah Kramer 26,433 26,433 26,433 26,433 26,433 26,433
Hygienist #1 6,720 6,720 6,720 6,720 6,720 6,720
Hygienist #2 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 76,585 76,585 76,585 76,585 76,585 76,585
Cash Receipts (90%) 68,926 68,926 68,926 68,926 68,926 68,926
Accounts Receivable (10%) 7,658 7,658 7,658 7,658 7,658 7,658
Cost of Goods Sold
Lab Fees (9%) (6,893) (6,893) (6,893) (6,893) (6,893) (6,893)
Dental Supplies (6%) (4,595) (4,595) (4,595) (4,595) (4,595) (4,595)
GROSS INCOME: 65,097 65,097 65,097 65,097 65,097 65,097
EXPENSES:
Advertising (3%) 2,298 2,298 2,298 2,298 2,298 2,298
Insurance (3%) 2,298 2,298 2,298 2,298 2,298 2,298
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 4,595 4,595 4,595 4,595 4,595 4,595
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 1,083 1,083 1,083 1,083 1,083 1,083
Utilities (2%) 1,532 1,532 1,532 1,532 1,532 1,532
Wages
Dr. Stanley Kramer (F) 10,833 10,833 10,833 10,833 10,833 10,833
Dr. Jeremiah Kramer (.5 of production) 14,685 14,685 14,685 14,685 14,685 14,685
Hygienist #1 (.28 of production) 1,882 1,882 1,882 1,882 1,882 1,882
Hygienist #2 (.25 of production) 1,680 1,680 1,680 1,680 1,680 1,680
Salaried & Benefits (21%) 7,710 7,710 7,710 7,710 7,710 7,710
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 56,094 56,094 56,094 56,094 56,094 56,094
NET PROFIT (LOSS): 9,002 9,002 9,002 9,002 9,002 9,002
Stanley at 10 patients a day at an average of $183.56/patient 440,544
Jeremiah at 9 patients a day, 4 days a week for 48 weeks at $183.56/patient 317,192
2 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 161,280
2 assistants 40 hours a week at $11.00/hour for 52 weeks 45,760
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
1 receptionist/ bookkeeper 20 hours a week at $11.65/hour at 52 weeks 12,116
Weekly wage of assistant and receptionist before benefits 82,108
Dec Jan Feb Mar Apr May
36,712 36,712 36,712 36,712 36,712 36,712
26,433 26,433 26,433 26,433 26,433 26,433
6,720 6,720 6,720 6,720 6,720 6,720
6,720 6,720 6,720 6,720 6,720 6,720
76,585 76,585 76,585 76,585 76,585 76,585
68,926 68,926 68,926 68,926 68,926 68,926
7,658 7,658 7,658 7,658 7,658 7,658
(6,893) (6,893) (6,893) (6,893) (6,893) (6,893)
(4,595) (4,595) (4,595) (4,595) (4,595) (4,595)
65,097 65,097 65,097 65,097 65,097 65,097
2,298 2,298 2,298 2,298 2,298 2,298
2,298 2,298 2,298 2,298 2,298 2,298
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
4,595 4,595 4,595 4,595 4,595 4,595
2,500 2,500 2,500 2,500 2,500 2,500
1,083 1,083 1,083 1,083 1,083 1,083
1,532 1,532 1,532 1,532 1,532 1,532
10,833 10,833 10,833 10,833 10,833 10,833
14,685 14,685 14,685 14,685 14,685 14,685
1,882 1,882 1,882 1,882 1,882 1,882
1,680 1,680 1,680 1,680 1,680 1,680
7,710 7,710 7,710 7,710 7,710 7,710
417 417 417 417 417 417
56,094 56,094 56,094 56,094 56,094 56,094
9,002 9,002 9,002 9,002 9,002 9,002

Income StatementYear 5 without Dr. Jeremiah Kramer, DDS
June 2006-May 2007

INCOME: Jun Jul Aug Sep Oct Nov
Dr. Stanley Kramer 36,712 36,712 36,712 36,712 36,712 36,712
Hygienist #1 6,720 6,720 6,720 6,720 6,720 6,720
Hygienist #2 6,720 6,720 6,720 6,720 6,720 6,720
Gross Sales 50,152 50,152 50,152 50,152 50,152 50,152
Cash Receipts (90%) 45,137 45,137 45,137 45,137 45,137 45,137
Accounts Receivable (10%) 5,015 5,015 5,015 5,015 5,015 5,015
Cost of Goods Sold
Lab Fees (9%) (4,514) (4,514) (4,514) (4,514) (4,514) (4,514)
Dental Supplies (6%) (3,009) (3,009) (3,009) (3,009) (3,009) (3,009)
GROSS INCOME: 42,629 42,629 42,629 42,629 42,629 42,629
EXPENSES:
Advertising (3%) 1,505 1,505 1,505 1,505 1,505 1,505
Insurance (3%) 1,505 1,505 1,505 1,505 1,505 1,505
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 3,009 3,009 3,009 3,009 3,009 3,009
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 500 500 500 500 500 500
Utilities (2%) 1,003 1,003 1,003 1,003 1,003 1,003
Wages
Dr. Stanley Kramer (F) 5,000 5,000 5,000 5,000 5,000 5,000
Hygienist #1 (.28 of production) 1,882 1,882 1,882 1,882 1,882 1,882
Hygienist #2 (.25 of production) 1,680 1,680 1,680 1,680 1,680 1,680
Salaried & Benefits (21%) 7,710 7,710 7,710 7,710 7,710 7,710
Other Expenses (F) 417 417 417 417 417 417
TOTAL EXPENSES: 31,292 31,292 31,292 31,292 31,292 31,292
NET PROFIT (LOSS): 11,337 11,337 11,337 11,337 11,337 11,337
Stanley at 10 patients a day at an average of $183.56/patient 440,544
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
1 Hygienist at 7 patients a day for 2 days a week averaging $120/patient 80,640
1 assistant 40 hours a week at $11.00/hour for 52 weeks 22,880
1 receptionist/ bookkeeper 40 hours a week at $11.65/hour at 52 weeks 24,232
1 receptionist/ bookkeeper 20 hours a week at $11.65/hour at 52 weeks 12,116
Weekly wage of assistant and receptionist before benefits 59,228
Dec Jan Feb Mar Apr May Total
36,712 36,712 36,712 36,712 36,712 36,712 440,544
6,720 6,720 6,720 6,720 6,720 6,720 80,640
6,720 6,720 6,720 6,720 6,720 6,720 80,640
50,152 50,152 50,152 50,152 50,152 50,152 601,824
45,137 45,137 45,137 45,137 45,137 45,137 541,642
5,015 5,015 5,015 5,015 5,015 5,015 60,182
(4,514) (4,514) (4,514) (4,514) (4,514) (4,514) (54,164)
(3,009) (3,009) (3,009) (3,009) (3,009) (3,009) (36,109)
42,629 42,629 42,629 42,629 42,629 42,629 511,550
1,505 1,505 1,505 1,505 1,505 1,505 18,055
1,505 1,505 1,505 1,505 1,505 1,505 18,055
3,750 3,750 3,750 3,750 3,750 3,750 45,000
833 833 833 833 833 833 10,000
3,009 3,009 3,009 3,009 3,009 3,009 36,109
2,500 2,500 2,500 2,500 2,500 2,500 30,000
500 500 500 500 500 500 6,000
1,003 1,003 1,003 1,003 1,003 1,003 12,036
5,000 5,000 5,000 5,000 5,000 5,000 60,000
1,882 1,882 1,882 1,882 1,882 1,882 22,579
1,680 1,680 1,680 1,680 1,680 1,680 20,160
7,710 7,710 7,710 7,710 7,710 7,710 92,514
417 417 417 417 417 417 5,000
31,292 31,292 31,292 31,292 31,292 31,292 375,509
11,337 11,337 11,337 11,337 11,337 11,337 136,042

Statement of Cash FlowsYear 5, June 2006-May 2007

Jun Jul Aug Sep Oct Nov
Cash Inflows
Beginning Cash Balance 39,471 40,815 42,159 43,503 44,847 46,191
Cash Receipts 68,926 68,926 68,926 68,926 68,926 68,926
Total Cash Inflows 108,397 109,741 111,085 112,429 113,773 115,117
Cash Disbursements
Lab Fees (9%) 6,893 6,893 6,893 6,893 6,893 6,893
Dental Supplies (6%) 4,595 4,595 4,595 4,595 4,595 4,595
Advertising (3%) 2,298 2,298 2,298 2,298 2,298 2,298
Insurance (3%) 2,298 2,298 2,298 2,298 2,298 2,298
Interest Expense (F) 3,750 3,750 3,750 3,750 3,750 3,750
Legal & Professional Services (F) 833 833 833 833 833 833
Office Supplies (6%) 4,595 4,595 4,595 4,595 4,595 4,595
Mortgage (F) 2,500 2,500 2,500 2,500 2,500 2,500
Taxes & Licenses (10% of salary) 1,083 1,083 1,083 1,083 1,083 1,083
Utilities (2%) 1,532 1,532 1,532 1,532 1,532 1,532
Wages
Dr. Stanley Kramer (F) 10,833 10,833 10,833 10,833 10,833 10,833
Dr. Jeremiah Kramer 14,685 14,685 14,685 14,685 14,685 14,685
Hygienist #1 1,882 1,882 1,882 1,882 1,882 1,882
Hygienist #2 1,680 1,680 1,680 1,680 1,680 1,680
Salaried & Benefits 7,710 7,710 7,710 7,710 7,710 7,710
Other Expenses (F) 417 417 417 417 417 417
Total Disbursements 67,582 67,582 67,582 67,582 67,582 67,582
Remaining Cash at Month End 40,815 42,159 43,503 44,847 46,191 47,535
Dec Jan Feb Mar Apr May
47,535 48,879 50,223 51,566 52,910 54,254
68,926 68,926 68,926 68,926 68,926 68,926
116,461 117,805 119,149 120,493 121,837 123,181
6,893 6,893 6,893 6,893 6,893 6,893
4,595 4,595 4,595 4,595 4,595 4,595
2,298 2,298 2,298 2,298 2,298 2,298
2,298 2,298 2,298 2,298 2,298 2,298
3,750 3,750 3,750 3,750 3,750 3,750
833 833 833 833 833 833
4,595 4,595 4,595 4,595 4,595 4,595
2,500 2,500 2,500 2,500 2,500 2,500
1,083 1,083 1,083 1,083 1,083 1,083
1,532 1,532 1,532 1,532 1,532 1,532
10,833 10,833 10,833 10,833 10,833 10,833
14,685 14,685 14,685 14,685 14,685 14,685
1,882 1,882 1,882 1,882 1,882 1,882
1,680 1,680 1,680 1,680 1,680 1,680
7,710 7,710 7,710 7,710 7,710 7,710
417 417 417 417 417 417
67,582 67,582 67,582 67,582 67,582 67,582
48,879 50,223 51,566 52,910 54,254 55,598

Possible Pitfalls

Locating a suitable practice There is the possibility that the perfect practice does not exist in our desired location. Further, the practice that I do the associateship with may not be optimal for purchase. In that case I will survey the area for a practice to buy or a location to build. Living in the area will give me latitude to do this.

Not being asked to buy the practice from the present owner If the owner does not like my work or decides not to retire, I will weigh my options. I could buy another practice, build a practice or possibly do a partial buyout of the current practice. Fortunately, this decision will be made after I have had a year's experience with the owner to assess his practice, the area, and my goals for the future without any capital outlay.

Not having a "quality" client base I feel that it is optimal to buy a practice with a good client base. Sometimes the goodwill of the client base is overstated. By working in a practice, I will have the opportunity to assess the quality of the clients. If I decide not to buy the practice that I am doing an associateship in, I will have built up a client pool of my own that will hopefully follow me to my new practice.

Not having large enough initial client base We will select a practice only after intense study of its active patient base, collection percentage, etc.

Possibility of clashing management styles between previous owners and new owners We feel that patients will adapt to our style provided we make it a policy to show sincere concern for our patients' well being. Also, we realize that it is likely that the practice will lose a percentage of its original patients in the beginning.

Possibility of clashing management styles of new owners An office manual will be constructed prior to purchase of the practice to determine whether management philosophies are compatible. Any discrepancies will be discussed and documented with employees having say in outcome.

Positive Aspects

  • Market conditions are right for location selected
  • Pre-existing client base
  • A business agreement that meets both my father's and my personal and professional goals
  • Industry trends are favorable (see Appendix)

APPENDIX

Managed Care

As in the medical profession, over the past couple of years, the dental industry has been bombarded with Preferred Provider Organizations (PPO) and Dental Health Maintenance Organizations (DHMO). Not surprising, after a couple years' trial of these services, many dentists are going back to traditional, independent practices. In 1995, 44 percent of dentists surveyed participated in at least one PPO and 19 percent participated in a DHMO as compared to 37.1 percent and 15.5 percent respectively in 1996 (Kehoe, pp. 28-29). Dr. Gordon Christensen, a leading researcher, clinician, and lecturer in dentistry, feels that the move to managed care has "degenerated the quality of dentistry, particularly the dentistry delivered by less-mature dentists" and that it has only proven beneficial for those patients that might not have had access to dentistry previously (Bonner, p.74). He predicts a movement away from managed care in the next 15 years as the American public becomes disgruntled with the poor quality and reduced alternatives offered by managed care much like it has in the medical profession. "We will see free-enterprise dentistry finally win, and therefore, the American public wins because quality will remain. This will happen because of the elective nature of many dental services, and the lack of most managed care programs to provide care in the elective area" (Bonner, p. 78).

Consolidation

One current trend in the dental industry is the linking together or networking of separate dental practices. This is called consolidation and is normally instigated by nondentist entrepreneurs who have recognized a potential income source in uniting dentists with managed care organizations (MCO). The dentists either act as salaried employees to the MCO or get paid a percentage of the collections or production. Obviously this is not the scenario that the dentist hoped for when attending eight years of school. This is only an alternative that the dentist will consider when faced with the choice of staying in private practice and losing a large percentage of the patient base to managed care or joining managed care and losing money. Consolidators act as brokers that see to it that the MCO gets the much needed managed care dental providers and that the dentists get a fair contract. This is done by networking dental practices. The consolidator is called a network administrator and he/she "evaluates the proposed contract, negotiates the terms and sets up the agreement." These consolidations are very similar to the activity taking place in the physician managed-care networks.

There are various benefits derived from the use of consolidation networks. Dentists in the managed care network receive an increase in patients. Although most consolidations that have been made include already practicing dentists, many recent graduates see it as an appealing alternative. The main benefit that they see is the elimination of the expenses associated with setting up a practice. Also it greatly reduces the necessity of making business decisions. As many dental students have had little or no business experience or instruction, and have had an education based almost entirely in science, the prospect of running a business is frightening. Speculators expect a trend toward recent graduates joining MCO networks right out of school. One other benefit of the networks is that consolidators focus on using "economies of scale" to save money. Network dental offices within a given location will see reduced lab expenses, supplies and equipment costs by volume purchasing.

Consolidation also has many obstacles. Neither dentists nor patients of managed care have as much freedom of choice in the dental care given or received. As dentistry is becoming more elective and is offering more alternatives for each diagnosis, both the patient and dentist want more freedom of choice. There is also the question of legal liability for treatment. If the dentist is merely acting as an employee of a MCO, who is liable in a case of malpractice? "Managed care companies usually cannot be directly sued for malpractice because they do not practice dentistry, but rather 'arrange' for treatment or pay for services. Consolidation companies may work with network dentists as independent contractors or employees. If a dentist is an employee or 'agent' of a company, that company may be held liable." Finally, some states have laws stating that only a dentist can own a dental practice. "Challenges to the law are expected to be made by consolidators in 'dentist-ownership only' states."

Baby Boomer Dentists Retiring

As the baby boomers are starting to turn 50, there is much interest in the effect that this will have on dentistry. Many dentists retire between the ages of 55 and 65 and as the baby boomers near these ages, there are many questions that need to be answered about the competitive factors involved. For instance, will there be a surplus of dental practices for sale in the next 10 years, making a shift to a buyer's market? Imtiaz Manji, president of ExperDent Consultants, Inc. says that eventually the dental practice market will be a buyer's market. He speculates that the only practices that will sell at close to what their value is today are those that have "exceptionally well-managed patient bases and goodwill assets" (Manji, p. 12).

Another question concerning the retirement of baby boomer dentists is whether there will be a shortage of dentists in 10 years. This question can be looked at by discussing the number of active dentists that will be over 50 in 10 years and the number of dental students graduating in the next few years. In 1996, there were 152,575 professionally active dentists in the United States. Of the active dentists, only 45,580 or 30 percent were under age 40. That means that within 10 years, 70 percent of the current active dentists will either be retired or preparing for retirement. Will this number be offset by an abnormally high market influx of recent graduates? Currently there are 55 dental schools in the United States and the current trend is that it is more likely for a school to close down that for a new school to be instituted. In 1996, there were 16,570 undergraduate dental students of which 3,810 graduated. Applications to dental schools have increased from 5,123 to 8,872 between 1990 and 1996; however, class sizes have remained relatively the same size ("Key Dental Facts, pp. 14-16).

Bigger Bottom Line

The current trend in dentistry is increased wealth. Between 1995 and 1996, 73.2 percent of dentists noted increased take home pay, 76.8 percent reported their gross personal income increased by a median of 10 percent, and more than 50 percent of respondents claimed unchanged or decreased overhead costs. When the dentists surveyed were asked the reason for this increase in wealth, they typically diagnosed it as a "combination of working harder, working smarter, and increasing fees" (Kehoe, p. 28).

Globalization

As we enter a new millennium, we are forced to expand our viewpoint to include the international perspective. "Globalization can be defined as a process of change stemming from a combination of increasing cross-border activity and information technology enabling virtually instantaneous communication worldwide." There is a greater global immigration among dentists, and countries are becoming more lenient with their accreditation of immigrant dentists. Furthermore, many students are receiving their education internationally. The Internet has become an integral part of international communication among dentists. The more developed nations claim to be becoming more "Americanized" in dentistry. This is important since American dentistry has led the way in most dental advancements in the last several decades. There is also a push for the developed nations to make dental practices and education available to underdeveloped countries due to a great feeling of international social responsibility among the dental profession. This push toward globalization is opening vistas worldwide in such avenues as business opportunities, education and training, and social conscious.

Technology

More and more dentists are embracing the new innovations that have reached the industry. Nearly 93 percent of respondents to a survey done by Dental Practice and Finance magazine use computers in the daily operations of their practice. As the doctor's income level increased, so did the spending on new technologies. A listing of percentages of high-tech instrumentation used by respondents is as follows ("Examining Incomes," p. 32):

Intraoral video camera 37.1%
Air abrasion cavity preparation systems 5.0%
Digital radiography 2.8%
Cosmetic imaging software 5.5%

New Products

In an interview conducted with Dr. Gordon Christensen, he addressed the most important changes in dentistry in the last 15 years and how they will affect the next 15 years. In his discussion, he talks of an abundance of new product innovation and dental procedure improvements that are shaping dentistry of the future. For instance, the vast use of fluoride in community water and by direct application to teeth by means of toothpaste and rinses has greatly controlled the cases of gross caries that have been seen in past generations. This has promoted dentistry to a point of being largely preventative rather than restorative. With the new preventative stance taken, doctors can spend more time doing some form of aesthetic or cosmetic dentistry, which is where the true profit comes into play. For example, due to preventative measures, the average person retains his or her teeth longer. Since people age 50 and older have more discretionary money, they are more prone to take advantage of new products and processes, such as tooth whitening and implants. As the baby boomers hit this age, dentists will see an even bigger trend toward aesthetic and cosmetic services. Dr. Christensen gives a listing of the areas that have seen the most change in dentistry over the last 15 years. This list includes (Bonner, p. 74):

20 Areas That Have Changed Dentistry Over the Last 15 Years

  1. Infection control
  2. Orthognathic surgery
  3. Adult orthodontics
  4. Lighted handpieces
  5. Magnifying Loupes
  6. Aesthetic Dentistry
  7. Bleaching teeth
  8. Composite resin restoration
  9. Controlling caries among children
  10. The maturation of dental implants
  11. Intraoral cameras
  12. Digital radiography
  13. Ceramic restorations in fixed prosthodontics
  14. Polymer-based fixed prosthodontic restorations
  15. The maturation of class II resins
  16. Microscopic endodontics
  17. Air abrasion
  18. Resin-reinforced glass ionomers
  19. The refinement of impression materials
  20. Managed Care

Bibliography

Bonner, Phillip. "A Look at the Past and Future: Interview with Gordon Christensen, DDS, Ph.D." Dentistry Today, December 1997.

Dental County Reports. American Dental Association.

"Examining the Incomes of High-tech Dentists." Dental Practice and Finance, Nov./Dec. 1997, pp. 32-33.

Kehoe, Bob. "Building a Bigger Bottom Line." Dental Practice and Finance, Nov./Dec. 1997, pp. 28-36.

"Key Dental Facts." American Dental Association, Survey Center, September 1997.

Manji, Imtiaz. "Practically Speaking: Solving Management Challenges." Dental Practice and Finance, Nov./Dec. 1997, p. 12.

"Starting Your Dental Practice: A Complete Guide." American Dental Association, Practice Management, Series, 1996.

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dentist

den·tist / ˈdentist/ (abbr.: dent.) • n. a person qualified to treat the diseases and conditions that affect the teeth and gums, esp. the repair and extraction of teeth and the insertion of artificial ones. DERIVATIVES: den·tist·ry / -strē/ n.

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dentist

dentist •fattist •unpractised (US unpracticed) •Esperantist, obscurantist •Anabaptist, Baptistartist, Chartist •clarinettist (US clarinetist), cornetist, duettist, librettist, vignettist •leftist • dentist • transvestist • statist •completist, defeatist, Docetist, élitist, graffitist •pietist, quietist, varietist •Semitist • Sanskritist • spiritist •syncretist • portraitist •anaesthetist (US anesthetist) •rightist • finitist • orthodontist •synoptist • flautist •protist, unnoticed •chutist, flutist, therapeutist •absolutist • parachutist • cultist •contrapuntist • occultist • scientist •egotist •dramatist, epigrammatist, melodramatist •pragmatist • stigmatist • numismatist •systematist • dogmatist • diplomatist •hypnotist • immanentist • nepotist •comparatist • indifferentist •separatist • corporatist • Adventist •Baathist • amethyst • telepathist •homeopathist • farthest • furthest

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