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18

AUGUST, 2018

Dentistry as a craft
Private insurance reducing fees and services
Concierge dentistry

What are the eight things you never knew about dentistry? This interview with independent clinic owner Warran Antoff reveals all.

Delia: Hi, I’d like to introduce Warren Antoff from Lifestyle Smiles. Warren, welcome to Wikihospitals.

Warren: I’m glad to be here.

Delia: What is your work history?

Warren: I’m a dentist. I graduated from the University of Melbourne in 2005. I’ve been working around Melbourne, in various clinics, for about five years, before I started up my own. I’ve been the principal of Lifestyle Smiles since 2010.

Delia: Have you got family connections to the health industry?

Warren: My parents were immigrants from China, and they were one of the first batch immigrants, back in the 80s. I lived in China for about ten years, and I came here when I was about nine or ten. None of my parents, or my ancestors, have any connection to health.

Delia: Why did you start your own company, Lifestyle Smiles?

Warren: After I graduated I worked at various clinics, I realised that dentistry is hard. It’s hard because people don’t usually understand what you’re talking about.

It’s as if you are talking a foreign language. I found difficult at other clinics because I was redistricted with what I could provide with my patients. In order to provide the quality of the service that I wanted, I was compelled to start my own company.

Delia: Most people that seek treatment in the health industry, don’t understand the language used and the scientific principles. This makes them vulnerable.

What does your company actually do?

Warren: We’re a general practise, that provides all types of dental services. Right down from examinations, your six monthly cleans. All the way to more complex treatment, such as, dental verniers, dental implants, dental make overs.

We like to be a one stop shop. You can come in and we will look after you, from A to Z.

Delia: Can you tell me, what particular problem that you solve?

Warren: That’s a good question, because obviously people come to me for various problems and issues. If you want me to summarise everything, I would like to provide an environment, where people feel comfortable, safe and they can trust that their dental needs are in good hands.

In this day and age, there’s still so many patients that are phobic to dentistry. Just yesterday, my very last patient, sat in the chair, and he was crying before I’d ever met him. He was nearly 30 years old.

I said, “What’s wrong?”, and the first thing he said is, “I feel really embarrassed to say this, but when it comes to my teeth, I’m just so nervous”. In the past he undergone brain surgery, while awake.

He told me that undergoing brain surgery, to remove his tumour, he had no issues with, but when it came to his teeth, he could not stop crying.

That hit me like a tonne of bricks.

Warren: When you run your own clinic, you’re able to take the time, and explain what the terminology means, and what the background is to improving the dental health.

1.  Dentists need to learn to speak a different language when they come out of Uni. Instead of ‘fixing problems’ they need to explain the basics of dental health and help people overcome their fear.

We have five years of training, to become a dentist, and doctors have six years training, to learn the whole body.

When it comes to the teeth, we a unique profession, where science meets medicine, meets art. Dentists are hands one. We are like tradesmen. If you provide one problem tooth to ten different dentists, they’ll give you ten different results.

People don’t understand that.

Having said that, a lot of people don’t care. As soon as it’s fixed, they’re out the door. Another interesting fact is, we’re one of the professions, where people are actually willing to pay more, to see us less.

When dentists graduate from the universities, all they think about is medical conditions, diseases, and the way they communicate is,

“How do you solve this?”

We tend to think like dentists, and we tend to communicate like dentists, which turns a lot of people off.

Firstly people don’t know what you’re talking about, when you give all those jargon, and they get confused, and secondly, it doesn’t make us very good communicators, in an industry where people are fearful of us.

Sometimes I’m a psychologist, sitting in the chair. I’m listening to all the patients concerns. They just want to be heard.

It’s a tough profession.

2. Dentists had the ‘highest suicide rate’ until recently. It’s a tough profession because people are afraid and don’t want to see you.

Warren: The history of dentistry doesn’t help at all, because there was always a shortage of dentists. So when people say dentist, people used to think, “Oh, they must be rich. They must be ripping you off.”

It’s a bit sad to hear that, but back in those days, there wasn’t a lot of dentists to provide the services to the community, and people were lining up, to see the dentist, because they just couldn’t get in.

I guess that’s why a lot of old fashioned dentists, they see a patient every 20 minutes, and they don’t need to have those communication skills, because they were so busy doing all these things.

I guess, that didn’t really build us a good reputation, because it wasn’t very personalised.

Delia: That’s the way medicine operates now. At high speed, but that’s not explaining things to people.

Warren: Exactly right, and I don’t know whether people realise this, but until recently, dentistry has the highest suicidal rate, out of all professions.

When I entered the dentist school, in the University of Melbourne, in the first lecture, in an auditorium with 60 other dentists, the first thing the dean, of the dental school, said to us was,

“Welcome to the profession that has the highest suicide rates”.

We all looked at each other, and we didn’t know what to expect, but it’s true. We’re dealing with people who don’t want to be here.

We hear it week after week. Day after day, and the first time the patient sits down, the first thing they say is, “No offence, but I don’t like you”, and that takes a toll.

Luck enough, I really love this job.

3. Dental disease is closely linked to ‘cardiac disease’ and ‘diabetes’.

Delia: You’re too young to know about the old days of dentistry.

I recall when pain was not of any concern, and equipment was much more primitive. It was very common for kids to scream until their parents stopped taking them to the dentist. It was also before fluoride was put in the water, and kids all had a lot of dental cavities.

There being a gap between what peoples emotions are, and what their understanding is, and what the health practitioner knows what needs to be done.

Warren: Absolutely.

Delia: The way that you’ve resolved that gap, is to go into your own private practise.

Warren: Yes.

Delia: So you can spend your own time. Make your own decisions, rather than be at the ten minute tick and flick.

Warren: Put it this way; the practises that I used to work with, for every new patient, I was given 30 minutes, to do a check up, do a clean, diagnose all their problems, come up with a treatment plan, and off we go. 30 minutes is not a long time.

In my current practise, for every new patient, I spend an hour, just on consultation. No treatment. Not cleans. Nothing.

From a business point of view, I’m actually losing money, but my consultation fee is $95, and if you add up all the wages, and all the running costs, it’s just not worth it. But I’m here for the long haul.

I want to make sure that my patients realise that, I have their best interest at heart. I want them to feel comfortable, choosing me to be their dentist.

I’m willing to spend that time, to understand them, to make sure that they’ve been looked after, and they’ve been heard, so that we can establish a life long relationship, together.

Some patients don’t want that. Some patients just want, in and out. They don’t want to hear you talk, and they just want to get the treatment done, and that’s fine as well.

That’s why, as a dentist, I need to decipher all that, and realise what type of person am I dealing with here? How should I proceed, so that I can make them comfortable, in their own ways, and that takes time too.

4. ‘Implants aren’t the cure all’ you previously thought, they fail for the same reason that teeth fail.

Delia: Dental disease is linked to other diseases in the body, is that correct?

Warren: Absolutely. There’s been ample evidence, dating all the way back into the 70s and 80s, there is a strong correlation between dental diseases, and the rest of the body. Especially the heart, and also other diseases, such as, diabetes. A lot of it is to do with your gum health.

A lot of people think that brushing and flossing, itself, is enough, but what they don’t realise, is that even if you clean well, say 98 percent of the time, for the other 2 percent, food stays on your teeth. The tarter hides and becomes a structure called calculus, which you can not clean off with a tooth brush, and floss.

Bacteria stays in that, and over time, it causes inflammation of your gums. A common term that people understand is gingivitis, where the gums bleed every time you brush and floss.

That’s a really early sign, that says something’s not right.

What a lot of people tend to do, is just avoid it. They think,

“Oh, it’s bleeding, so I shouldn’t brush here. I shouldn’t floss here”,

but if that’s not being cleaned away, by a dental professional, then it will lead to loss of gum, and loss of bone, and all the bacteria, that sits in there, it can travel to your heart, and cause cardiovascular diseases.

Gum disease is just one aspect of dentistry, and how I look at it is, the gums are the foundation of the architecture.

If the architecture of the buildings, the houses, the mansions, or whatever you call them, they’re your teeth. The gums are the foundation. You’ve got to get the foundation right, first. Then, you can start building, whatever house, that you want on top.

A lot of people think that, well, my teeth are crap. I’ve never looked after them, so they tend to avoid the dentist. They think that,

“I’m going to lose my teeth anyway, so I’m going to save up for these wonderful things called, dental implants, and they will last for the rest of my life.”

That is exactly why, within the industry, we have so many issues. People don’t realise that there’s nothing better, than your own teeth.

God has created teeth, for a reason. It doesn’t matter how great the technology is, it’s never going to be as good, as our own teeth.

The other thing is, if you’ve never looked after your teeth, in your whole life, and one day, you have them all out, and have all these dental implants placed in, those dental implants will undergo the same problem that you had with your teeth, because bacteria causes gum disease around teeth. Bacteria will also cause gum disease around those implants, and those implants will not last, if you don’t do the right things, and look after them properly.

Dental tourism is probably becoming a little bit more prevalent in this day and age, when Jet Star and all that are giving up fares, and people think

“Oh, I can go to Thailand for $500, and then I might as well just get my teeth done there, as well, and then come back.”

5. ‘People who avoid the dentist for years then go to Asia for extensive dental reconstruction might think they are saving money’. But they are at risk of having their implants failing within a couple of years.

Warren: There’s a few things here, that I would like to touch.

First thing is, we are living in a country that is more expensive, then a lot of Asian countries, so it is natural for people to go overseas, and purchase things, and bring them back, such as, clothes. But people don’t realised that dentistry is not quite the same.

They shouldn’t look at it as a commodity.

A lot of those people, they don’t know why their teeth became that way. They’ve been avoiding the dentist for 10, 15 years, and all of a sudden they want everything done.

They don’t know why their teeth are like that, and therefore, they don’t know how to maintain them, moving forward.

If you fly over to Thailand, and get all your teeth taken out, and have the implants put in within a week, the problem is, you will come back to Australia and they will not visit a dentist again. The implants may fail because you don’t have the right education, and know how to look after them.

That’s one thing.

The other thing is, as a practitioner, when we replace teeth, there’s a lot of biological concern, that we take into consideration. For example, when we’re placing the dental implant, it takes a good eight to twelve weeks, for the implant to integrate with your body. If we don’t wait for that time, there is a significantly increased chance, that the implant will fail. There are technologies, and ways, that we can overcome that, but it’s case dependent. I’ve seen people have implants and teeth straight away.

If you only have a week, and you pay the airfare, and you have this pressure, time wise, to get things done, the dentist overseas,  probably wouldn’t turn you away. Because to them, you’re a big case.

It gets done, you come home and if you start having problems it’s going to cost you more money to fix it. And you’ve lost a lot of biological architecture, for having treatment done, that’s failed.

That’s what I see sometimes. It’s not because the dentist wasn’t good, but because the patient didn’t understand what they were in for. The dentists have the pressure of getting things done within a certain period of time. They try to defy God, and get things done quickly, and things just done work out.

I have seen some good work overseas, as well, but a lot of failures because of those two reasons.

6. ‘Dentistry is not a consumable, it’s a craft’. Because most patients don’t understand the language or the science involved, they try to compare treatments by price. That doesn’t work.

Delia: What you’re saying, really, is that dentistry is not a commodity? Different from clothes, food, and cars.

Warren: Absolutely, because you know what? When you don’t understand what the dentist is talking about, when you don’t understand the industry, the only thing you can compare with, is price.

That’s not any fault of anybody, it’s just the lack of knowledge.

As a dental professional, I have the duty of care to provide my patients full knowledge, and also educate them, and increase their dental IQ, so they realise that, your teeth are a little bit more complicated, than that.

Delia: There is this push to make health care a commodity, from a range of groups.

Warren: Exactly. One prime example is probably health insurance. People think that private health insurance is the greatest thing, because they’re going to be covered, it’s going to save them money, and people buy it because everyone else has it.

They feel like if they don’t have health insurance, they’re not doing their family justice. They’re not looking after their children. I have no qualms about private health insurance, but people need to realise that, when I come to things like teeth, like dentistry, or optometrist, or physio, they’re called extras.

That’s where all the health insurance companies make their money. Why?

Warren: Because, the premiums for extras, and health coverage, for consumers, increase about eight percent, per year. That is huge. The growth of the economy, these days, is not even four percent. For an increase, in private coverage, and extras, is eight percent. People are buying extras, and not using them. That’s number one.

Secondly, I have patients, for example, they come to me, and they say,

“Oh, my health cover, only covers this much. Therefore, I can only get this much done.”

From a health professional point of view, if you’ve got a hole, you’ve got a hole. You’ve got to fix it. If you don’t fix it, the whole will turn into a painful tooth, which will lead to a root canal, or an extraction, and then an implant.

7. ‘Private insurance doesn’t always offer patients the best dental options’. For profit insurers work for their shareholders, raising extra’s prices by 8% a year, then pressuring dentists to restrict services to patients and on top of that, take a pay drop of 10%.”

Warren: People tend to think, “Oh well, my health cover is only gonna cover this much, so I can’t afford to have this done”. They don’t realised, that if they don’t buy health insurance extras, and just save all that money, in the long term, they can pay for their treatment, and still have surplus.

A lot of health companies are profit making organisations.

They have the share holders best interest at heart, and that why they can become so big, and they try to monopolise the market.

That’s not good for the industry.

I’m only a preferred provider for HCS, which is probably the biggest, non for profit, health insurer, out there. I like to support that.

I’ve got colleagues who work for profit making providers. A couple weeks ago they received a letter, from an insurance company saying,

“that to become, or maintain, as a platinum member, of this group, you need to lower all of your prices by ten percent.”

Quite bluntly, that’s what they said in the letter.

So, number one, they’re increasing consumers fees, by eight percent, per year, on average. And number two they’re asking their preferred providers to drop their fees. When your business has to fork out ten percent, to stay in this cult, what’s going to happen to the quality of service?

You may have to make some decisions that you would not have made in the past.

Warren: People tend to think, “Oh well, my health cover is only gonna cover this much, so I can’t afford to have this done”. They don’t realised, that if they don’t buy health insurance extras, and just save all that money, in the long term, they can pay for their treatment, and still have surplus.

A lot of health companies are profit making organisations.

They have the share holders best interest at heart, and that why they can become so big, and they try to monopolise the market.

That’s not good for the industry.

I’m only a preferred provider for HCS, which is probably the biggest, non for profit, health insurer, out there. I like to support that.

I’ve got colleagues who work for profit making providers. A couple weeks ago they received a letter, from an insurance company saying,

“that to become, or maintain, as a platinum member, of this group, you need to lower all of your prices by ten percent.”

Quite bluntly, that’s what they said in the letter.

So, number one, they’re increasing consumers fees, by eight percent, per year, on average. And number two they’re asking their preferred providers to drop their fees. When your business has to fork out ten percent, to stay in this cult, what’s going to happen to the quality of service?

You may have to make some decisions that you would not have made in the past.

Warren: That’s why I want to stay on my own. I want to run things my way and make sure that my patients get the best care.

Dentistry and medicine, is not a commodity, it’s not a consumer product.

It’s a complicated craft, that most people don’t understand.

Delia: That many people are intimidated by. That uses language that most people don’t really understand.

Warren: No. Take another example; there are codes that the private health insurance companies create, and they put a price. There are certain codes that, as a dentist, I can not actually perform. Why? Because, the lab costs, to do this properly, is more than what the fee is. For example, if it’s going to cost me more, then what I charge my patients, then I can’t provide that service. The patients won’t know that.

A porcelain crown, I could send it over to China, and guess what? The cheapest crown that I know of, that can be fabricated in China, is $10, Australian.

What happens if the product is being shipped off to another country, and get it made, and then put it in your mouth? How do we control the quality?

I use technicians locally, because I know them. I know they’re not going to shortcut me. I know that they provide excellent work, 99.9 percent of the time, and they’re just a phone call away.

Yes, they’re a little bit more expensive, but I have the peace of mind, that they know what they’re doing.

Delia: So you operate like a craftsman?

Warren: Yes.

Delia: You think that provides a much better service?

Warren: That’s right.

8. ‘Dentistry is a craft, not a consumer product like shoes’. Give ten dentists a problem they will all come up with a different solution, based on the individual patients needs.

Warren: For some people, they are always going to shop around for the cheapest quote.

I’m not going to sacrifice quality, to compete with others.

There’s always going to be someone who’s going to go a little bit lower, and I guess those are the patients that you don’t want, as well, because they might come to you, and might get one or two things done, and then they’ll disappear for ten years.

What’s going to happen, is your clinic is going to have all these emergencies. My clinic has a really, really low emergency rate. I don’t get a lot of my clients coming back with a lot of tooth aches.

Delia: Because you spend the time talking to them?

Warren: Yes. They do the right treatments and their okay.

Maybe that’s why my anxiety level is not that high, because I don’t have to worry that all of a sudden, I will have four or five emergencies, lined up, because everyone’s got a tooth ache.

That’s how some clinics are. They get emergencies, every day, and the patients might come in, and do something, and then they go away, and then you never see them again. That’s not the type of dentistry I want to do.

Delia: What you’re really describing is two separate models of care. One is the ten minute tick and flick, where there’s very little education, and people are likely to have big problems, because they don’t understand what needs to be done, on a daily basis.

Then you have, what you’re talking about, which is really a concierge dentistry, where you spend the time with people, and they’re regular patients, and you manage problems so far less emergencies result.

Delia: Where do you see your company in five years time?

Warren: I’ve got a family, and I’ve got a three year old son, so in five years time, he’ll be eight, and I will probably want to spend a little bit more time with him.

As much as I love doing what I do, I also like the challenge of running the dental clinic, as a CEO, mentoring younger dentists, and becoming really good technicians, that is a great service to the communities.

In five years, I like to think that, number one, I can cut my working hours, from five and a half days, to four days, so I can spend a bit of time with family. On the other hand, I see the practise thriving.

My motto for this clinic is, I want to build a place where my staff are proud of working in, other health professions would refer their patients to, and establishing a clinic where other dentists would love to work in, as well.

Delia: Thank you very much for talking to Wikihospitals, Warren. For pointing out that dentistry is really a craft, and it’s not about consumer products, and shopping around for the lowest price. It’s about the long term outcomes, and avoiding emergencies.

Warren Great. Lovely to speak to you, as well.

@ Wikihospitals August 2018