Ask Me Anything about being the CEO of the most popular dental practice in Liverpool, a UK city of 2.2M. We've grown from £0-1.5M revenue in less than three years and are doubling in size again this year. Ask Me Anything about how we've achieved this unprecedented success.

Ed Challinor
May 13, 2018

Gaining financial clarity is how businesses get from 0-1

Finding the right people is how they scale quickly 

Running integrated and efficient marketing campaigns is how we dominate the local space

An in-depth understanding of the competitive landscape allows us to squeeze our competitors out of our markets 

Caring about people, practicing brutal honesty and managing effectively is how you stay sane.

Ask me anything about this lot.  Here at Smileworks, we love helping small businesses with their problems that (almost always fall into one of the above categories) and have become number one in a very short period of time.  Take a look at our practice here: Smileworks Dentist Liverpool.

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Who were some of your influences that you looked up to who may have been the dentist of your day?
May 18, 9:27PM EDT0

The dentist I look up to the most is my fiancee Dr MJ Rowland-Warmann BSc BDS (Manc) MSc Aes.Med. (Lond) MJDF RCS (Eng).  She is a genius of dentistry and loves facial aesthetics. 

Her creativity is limitless and she loves her patients almost as much as she loves being the best at her job.  She does more continuing professional development in a year than most people do in their entire careers and is so committed that nobody can compete with her. 

She is the reason I gave up my job in the City of London and she is the reason I'm here.  People ask me 'what's your 'why' and the answer is always MJ.   She's my 'why'.  And nobody can compete with the dedication that I put into making sure her practice is the best in the UK. 

May 19, 12:22PM EDT0
What have you learned about leadership, entrepreneurship and mentoring others?
May 18, 6:52PM EDT0

Leadership and mentoring are similar but entraprenurship kind of covers everything we do.

As far as leadship goes, it's difficult.  When I first started my business I didn't really deserve the title of CEO or leader but as time goes by and I put in the work and learning and constant demands required of a business owner, I've earned that title and can lead the business and feel comfortable being 100% responsible for our sucess. 

There's two elements to leadership for me.  Leading people and teams and leading the strategic direction of the company.  Leading people and teams is challenging for me but I learned a huge amount from the  Netflix culture and the book 'Powerful' by Patty Mccord. 

As far as leading the strategic direction of the business that's about the numbers and financial clarity.  Estimating demand and marketing efficiency and what your teams can acheive. 

I love mentoring but am trying to adopt a 'coaching habit'.  I like to solve problems but mentoring is about facilitating team members to solve their own problems.  That's challenging.  Especially when it's so obvious to me what the answers are. But it's so important they develop and you give your teams the opportunity to exercise their innate talents. 

The limitations of an individual is what they can acheive in a day, the limitations of a manager are how many individuals she can manage and initiate to perform and the limitations of a leader are how many managers they can get to share their vision. 

- I think it was Michael Gerber who said that but I can't remember. 

May 19, 12:16PM EDT0
Where do you see the future of dentistry headed?
May 18, 10:56AM EDT0

It’s a growing industry.  Adult braces and medical aesthetics are ‘breakout’ on google trends so we’re in a strongly growing industry. 

We are not likely to be threatened with technological disruption. Robots cannot do dentistry and the technology’s is really helping us get better results for patients. 

I look forward to tighter regulations to stop to diy dentistry going on like illegal whitening and clip on teeth. 

I run lots of risk assessments and the future is bright.

May 19, 4:30AM EDT0
How were you able to balance a busy dental practice and do dentistry with an entrepreneurial pursuit such as a growing company like Smiles works?
May 18, 8:46AM EDT0
Is there one patient who most stood out from the “Extreme Makeover” period?
May 18, 8:24AM EDT0

I canlt tell you about individual patients and we don;t really engafe with the 'extreme makeover' type stuff becsuse it's great for TV but becsuse the work is so aggressive it is often not clinically advisable and will not last long.  It;s like thsoe peopel who have 'home makeovers' after a few years they start falling apart lol.  We don't do quick fixes.  Good dentistry and making a real imact on the way you look and feel tskes time and the types of peopel who want everythingn now are often troublesome patinets.  Also the moiths of the 'extreme makeover patients' are often in a bad state and that is because of neglect.  We would be reticent to put work on if there was a chance the neglect was going to continue.  So it's a difficult one.  Great question though.  Shows the difference between what you see in the media and real life. 

May 19, 4:16AM EDT0
What has been the role of luck in your success?
May 18, 6:00AM EDT0

We've had a lot of bad luck.  We've been really slamed with some body-blows that have almost finished us off.  Most of it I can trace back to bad decisions I've made though.  Good and bad luck is not a real thing.  It's a way people try to jutify failures or criticise the successes of their competitors or people they dont like.  There is no place for luck in business.  We manage risk.  They are similar but not the same. 

May 19, 4:11AM EDT0
Who has been your role model when it comes to business management?
May 17, 10:05PM EDT0

i've read so many different books but the people who influenced me the most were Elon Musk (becsuse of his giant vision and how he does what he says she's going to do) ans also I like Patty McCord or Netflix and Ryan Deiss, John Loomer and a load of digital marketing people too numerous to mention. 

Don;t follow one person.  Your busienss is unique and you need to learn about ALL of th eleaders and their styles and analyse the facts and results and tske the parts you like and dum the parts you don't. 

ALso bsuiness leaders write books for publicity - not neccesarily to help you.  So you need to assess the provenance of the messages and find out whose real and who has agendas and is banging the drum of their product. 

So don't pick one person to follow, choose the most relevant parts of everyone's ideas and formulate your own 'role model' in your mind - the person you want to be. 

Also manageent by managers is now becomign replaced by integration with systems and metrics and self-management.  Traditional people management is a dying discipline in my mind.  It's being disrupted at every opportunity with software, automation and better ways. 

May 19, 4:08AM EDT0
Did you go through any failures when you were building your practice? What were they and how did you turn them around?
May 16, 6:37PM EDT0

Wow.  Failure.  There was a lot of that. Although I hate these business owners who wear failure like a badge of honour.  They have an idea and get seed funding and then waste it and their investors all suffer and they just move on as though nothing happened.  To me they are just failures. 

But business is about small wins and small failures all the time.  It;s highs and lows. Once I mis-read a contract and almost cost us our lease and ruined the entire buisness.  You can imagine - being a lawyer - how that affected me.  I fasiled to secure funding I failed to learn marketing quickly ewnough and I always feel like I'm failing to help my employees enough or drive the business hard enough. 

We've faced down bankruptcy and still make big mistakes.  But failure is a funy word.  You make mistakes and learn from them.  Failinng to me is really giving up.  I'd never do that.   And the hardest thing is that when you are small the odds are so heavily stacked against you sometimes it;s overwhelming and you feel like giving up.  Luckily I beleived my fiancee was the worlds best dentist and she beleived I was the world's best lawyer and business leader.  So we always found peace and solace in one another.  I don't think I could have done it alone. I'd say get a business partner or two.  That way you have support from people who understand you. 

May 16, 6:59PM EDT0
Did you hesitate before switching from your previous career to dentistry?
May 16, 6:23PM EDT0

THat's a pretty difficult one becasuse my brother got sick and I kind of had to give up my job anyway.  I had 'emotionally handed in my notice' and was not happy and it provided a reason to quit london and come home to look after him. 

I saw a poster on the underground at Green Park one day and it said, 'If you don't like your life then change it'.   So I did.  It wasn't easy.  I didn't really change career I just had time away from the rat-race to think and get fit and think about my future.  I decided it was business I wanted and then I met my Fiancee (a Dentist) and that sealed the deal.  

They say half of life is chance.  And I beleive that.  But you can certainly load the dice in your favour and I made a real effort to go out and meet people, and started reading about how I could start a business. 

If I'm going to get really personal my family kind of always wanted me to go into the law.  And I had a big falling out over the correct treatment of my brother and moved out of the house.  That feeling of cutting ties with my past really solidified my resolve to make something new for myself that I wanted to do - not what others wanted me to do. 

Remember the Movie 'Fight Club'.  Sometimes yoyu need to lose everythign to gain anything'  Often the people around you are holding you back.  not because they don;t love you but because they want you to be a certain type of person.  It;s very difficult to let go and become your own person.  I guess it took a tradgedy to do that for me. My brother was an alcoholic.  He's better now.  His girlfriend is pregnant and he's been dry for over 18 moths and loving life. 

May 16, 6:52PM EDT0
What would you say is the best thing about your job?
May 16, 11:09AM EDT0

I love SEO.  It's perfect for my skillset.  I have to take a load of information like a really complex factual matrix and apply the rules of SEO and optimise it so that google and people can both understand it.  It's like a mixture of a crossword and sudoku puzzle. 

Then you have to make is understandable for normal people and talk to them in a way that they can understand that goes to their desired positive end result for treatment. 

I also like thinking up creative ways to solve problems.  Like looking outside of dentistry to other industries where they do things really well and seeing how that can help us and help our patients. 

Also I never worked very well in a structured environment.  I am very bad at admin and have quite poor attention to detail.  But marketing is all about big data and estimations and working with ranges so you don't need to be 100% accurate all the time.  It's more absorbing the data and making determinations based on ambiguity.  I'm really good at that.  And can work well with incomplete figures. 

May 16, 11:56AM EDT0
What is the competition like in your field? With the kind of success you are having, would you say that you dominate it?
May 16, 6:28AM EDT0

Competition in Liverpool is Fierce.  There are well-funded cosmetic dental practices on every street.  When we initially went to the bank they said 'the market is saturated' and wouldn't lend us money.  

But we saw that although there was competiton it was all - in our view - sub standard.  We held an honest belief that we could do better - and we did. 

The practices we saw were all glitzy and expansive with fish tanks and comfy chairs but that's not what dentistry is about - it's about caring for patients. 

When we opened up a competitor sued us for £99,999.00.  That's the maximum you can sue someone for without going to the high court.  That's how frightened they were.  

Snce opening our doors one practice has gone bust, another (the one that sued us) has moved away fro the town centre and now hardly does any dentistry and two practices have put their businesses up for sale. 

But we didnt do that.  They just were greedy, didn't care about their patients and didn;t hire the right dentists or the right staff. 

I compete extremely aggressively online and use my digital marketing skills to starve our competition of their patients.  But we never go head to head with a competitor. 

I don't see myself as a lion or a woolf or shark like so many arrogant dentists and marketers do.  Big campaigns and starting price wars or fighting is inefficient.  I see myself as a squirrel or a dog.  I'll scavenge market share a tiny piece at a time until the competitor demonstrates a mistake to me in their marketing or what I hear on the grape vine.  

This indicates to me where we're hurting them and I'll go for those profit centres and cause them to make more silly decisions. 

It sounds like a nasty way to do business but when you see the way some patients get treated by other dentists in Liverpool you'd know why I'm so passionate about wanting to help ALL the patients in the city and take 100% of the market share. 

But the simple fact is that nobody can compete with us because we've creaated our own rules and our own competitive landscape with creativity and panache and they simply cannot copy us.  Sometimes I wish a really great competitor would show up so I could learn something from them.  Competition is good..  But I dont see myself in competition I see myself providing a service that patients deserve and have been denied up until now.

We get lots of nasty letters, threats and someone (a friend) came to see the practice recently and said 'where have all my patients gone'.  My buisness partner replied, 'they're here, of course?'  That made me laugh.  I'd never be that bold. 

May 16, 6:47AM EDT0
How do the materials used in a dental practice vary? If one was to go for a cheaper service, should they expect cheaper materials and so lower quality or the materials are all the same but the cost of work is different across practices? How to know what to ask as a patient when making a choice?
May 14, 2:04PM EDT0

The materials differ greatly but the real difference-maker is the quality of the dentist.  I often say to patients who say they want it cheaper;

'how would you feel going into a surgical procedure in hospital knowing that the surgeons were the lowest paid around, the materials had no CE marks or were not FDA approved and everything was the cheapest we could possibly find?  Would that make you feel safe?' 

The answer is no.  Material science has come on a great deal in the last decade and there are some really stellar materials that we use to get beautiful outcomes.  Do you want veneers that look like your toilet bowl or do you want them to be painstakingly painted and layered with translucent EMAX and renamel composite materials?  Do you want a Dental Implant for £800 that is just a titanium screw the same as used in a motorbike or do you want one created in a state of the art laboratory with acid etched, laser surfacing that creates microscopic grooves precisely the same dimensions as a bone-producing osteoblast for maximum integration with your jawbone?  All these things cost money. 

The idea that expensive dentists make more money because they are greedy is misguided.  If anything the cheap dentists are making more money.  Our costs are absolutely enormous.  

I recently purchased a Cone Beam Scanner that helps find blood vessles and nerves for implant surgeries.  It won't make us a penny.  It is simply there so we can be 100% sure to never have an adverse reaction while palcing an implant.  It cost £98,000.  I googled 'what costs 98k' and up came a brand new Audi R8 supercar.  So the dentist witht the supercar is not the dentist you want.  It's the one with the CBCT scanner in the back room to keep you safe and ensure a great outcome. 

But as I said the difference-maker is the dentist. Are you seeing Dr MJ, a 33 year old with these postnominals BSc BDS (Manc) MSc Aes.Med. (Lond) MJDF RCS (Eng) or are you seeing Dr Pinar, who has a pHD or a specialist oral surgeon or are you seeing Jo Bloggs DDS, who's not bothered to get one single qualification in 30 years?   That's the difference.  Some dentists just love dentistry and they want to create the best result as a matter of perfection and clinical science.  That's ok.  Others want to care for you and get you the best outcome for you as a person - that's also ok. And others just don't give a damn and want to go home and spend your money.  It's your choice but choose wisely. :-)  If you email me I can help you choose a good dentist wherever you are in the world.  I'd be happy to help you with that.  I'll ask around the office too. 

Last edited @ May 14, 2:23PM EDT.
May 14, 2:19PM EDT0
What do you feel about dental insurance and PPO's?
May 14, 1:44PM EDT0

I think that's only in America.  We have insurance patients but it's not like in the US.  A similar problem here in the UK is the NHS, where patients can get discounted or free treatment.  But they are not our people.  If there are problems on the horizon or if you see markets failing then you should get out as fast as possible and seek out new and more fertile opportunities.  Agility is the key.  If tomorrow they made dentistry illegal I would have another business model set up and running in a few months in another business.  

Lots of dentists in the UK complain about the demise of the NHS and lots of dentists in the USA complain about insurance. but they are making excuses.  They dined out on easy street for years and now they've been disrupted and instead of moving on they are clinging on and it's going to lead to their demise or them losing their minds!  there's a great book called 'who moved my cheese' I think that's what it's called.  It's about agility and seeking out new opportunities.   

The world has changed so much just in the last few years.  I dread to think the new dentists with new ideas who are going to start disruptng our model in a few years.  But I'll be ready to adapt. 

May 14, 2:01PM EDT0
When you talk about financial clarity, how do you decide what is to be shown and what not?
May 14, 1:43PM EDT0

Financials are the language of business.  I want my staff to understand that.  So everyone knows what everyone else gets paid because it's on the board.  I even give our team members lines on the P&L to look at as little projects to see whether they can improve contracts or get us better deals.  I am constaantly amazed how business owners think that financials are some private thing like medical records.  They're not.  I am happy to discuss how much money I make because I earn every penny of it and I am happy to discuss with any employee why X gets more than Y because they do a different role with more or less responsibility, have more or less qualifications or are getting better results. 

But by financial clarity I really mean the business owner understanding how the financials in the business works.  Numbers are like magic to me. They are often counter-intuitive and will always surprise you.  

To give you an example.  We were in a situation at one point where we could have raised our prices by 10% and afforded to lose 25% of our customers and still make a higher profit margin.  It's insights like that that can drive a pricing strategy. 

I also know what my competitors are doing and how I can attack their profit centres and squeeze them.  It's like tennis.  You cannot go head to head with an opponent you need to instead force them to make errors.  For example, I worked hard on gaining a number one position in the search engines that forced my competitor onto adwords.  their camaign is a disaster and is losing them money.  They are also telling me precisely what their biggest profit making categories are so I can squeeze them harder. 

We do a better job than our competiton locally so I have no ethical problems running greedy or inauthentic or poorly managed businesses out of town.  That's better for the health of the patients in the long run. 

I see each patient lost to a competitor as a sad loss because I know they won;t get the treatment they deserve. 

May 14, 1:56PM EDT1
What do you think works for your dental business? The right treatment or the right marketing or both?
May 14, 12:03PM EDT0

Marketing is everything.  So as a marketer I truly beleive that every aspect of what we do is marketing.  And when patinets get treated there are touchpoints that have been designed by the marketing team to make patents as hapy as possible.  

If you look at our reviews people talk about the silly glasses we make them wear to shield their eyes from the dental lamp or the smell of the mouthrinse that's like bubblegum.  

Then there's the consultation process and the way that the nurses and dentists interact to produce a feeling of total control and safety so thatthe patient feels they can relax and that they are in good hands. 

I am in a lot of EO's and organisations where I learn marketing and lots of people sell really bad products andn they use good marketing to basically hard sell or make people buy stuff they don't want. 

But with us everything we sell is tried and tested and works to improve the lives of patients so I can;t really tell you what it would be like to market bad dentistry.  People certainly do it though but I actually think that the dentists 'feel they are doing a good job' because they don;t know any better and the patients 'think they are getting a good service' because they don't know any better.  So it's a tough question. 

I've never had a patient come back and say they don't like what we did for them.  Ever.   We get the odd complian but it's usually that we won;t treat them (because they're not suitable or it's not safe to do so) or that they have to wait too long to get treatment. 

Why settle for anything less than the best. Marketing is just explaining the process of getting from a before state of unhappiness, no confidence, self-consciousness or ill health to a happy place of health, confidence, and cuccess.  So all we do is say precisely the steps involved in getting from A to B. 

I wanted to start a dental agency but didn't feel I could do the best job because everyone wanted the service for cheap.  So I wasn't comfortable marketing services I know won't really advance the interests of the dentists or make their businesses better.  To do the marketing we do and to have it literally in the DNA of the place takes an enormus committment and a lot of capital.  So when some dentist comes to me and says, 'can you do my marketing for £1,000 a month' I just say no.  It's not going to work.  So I suppose the answer is both.  You need a brilliant product and brilliant marketing and then it becomes easy.  If i could only have one it would be a brilliant product though.  Because at least you'd get word of mouth marketing and it would take lots of time but you'd build a good buisness eventually. 

May 14, 1:48PM EDT1
What are some of the complications one might encounter when using an automated billing system?
May 14, 5:36AM EDT0

We dont use an automated billing system.  People pay a deposit to secure their treatment.  Usually after their diagnostic appointments they'll pay some morey up front for their main appointment and pay the balance when it's over. 

Automated billing systems are more for ecommerce and scalable businesses that serve thousands of customers.  We typically have 20-100 patents in the practice a day and they all pay on finance or by using card machines or cash deposits. 

It can get tricky managing it all and we have a bookkeeper and an accountant and XERO that produces monthly management accounts for the buisness including cash reconciliations. 

The language of business is numbers.  To understand a buisness and how it works people often look to people or processes or all sorts of places but at the end of the day it's the hard numbers that tell you  the score.  I beleive it was Warren Buffet who said you need to know the score to determine the winners from the losers.  And the score is to be found on the cash flow statement P&L and Balance sheet. 

Paying associates is a nightmare because we need to factor in lab fees, failed work (occasionally) discounts and materials costs.  But we're getting good at it and I put all the data into a spreadsheet and am actually pretty accurately able to forecast our monthly Net profit margins using just a few important datapoints. 

May 14, 5:56AM EDT0
What are the most common dental treatments people come for? What makes them choose your dental practice over others?
May 14, 1:49AM EDT0

We're getting loads of composite and resin veneers at the moment. And braces for adults.  We offer whitening with pretty much everything here for free so whitening is EXTREMELY popular but we often give it away with braces or veneer treatment.  Younger patients want less invasive dentistry and our dentists can create really beautiful resin veneers (not made in a lab but made by the dentist in the chair by sculpting them onto the tooth) 

Our chinese patients have a lot of Invisalign treatment and the arabic patients (we have lots of both because of the university) come in for hygiene and braces mainly.  Arabic women also like it that we're an all female practice and they have facial aesthetics like botox and filler done. 

Local people have composite veneers, braces and hygiene and older patients come in for implants and bridges and things to replace lost teeth.  So where patients are from and their age strongly correlates with the  most popular treatments.  So use this demograsphic information in our marketing and it works really well.  Also word gets around because peope who are here studying all live and work together so the referrals are MUCH higher in these groups.  Also teachers are a demographic who have lots of facial aesthetics.  Not sure why.  Maybe they don;t want ot be teased by nasty kids in class! 

They choose us because we're head and shoulders above the rest and we care.  Most dentists only care about money but we care about our patients and doing a great job.  Nobody can compete with that.  There are actually practices in the city selling up because all their patients decided to come to us.  I don't ever like to see businesses fail but I thought what we did was just doing right by patients but it turns out what we do is extremely rare in dentistry.  So patients will choose us unless they want it cheaper and other practices drop their prices below +ve margin.  But I don;t mind that either because I know that other practice is losing money so we wil eventually be able to look after their patients and do a better job of it. 

Last edited @ May 14, 3:18AM EDT.
May 14, 3:15AM EDT0
What payment or financing options does your practice offer patients?
May 13, 8:04PM EDT0

We have a dental plan where you can pay as you go for your hygiene appointments and get money off major treatment. We also have designed our own plans for people who want a dental plan focussing on gum disease, whitening, low cost etc.  

Then we have aesthetics plans so you can pay in to have a years worth of Botox and Fillers or whatever facial aesthetics you need and then for big cases you can pay on finance which is interest bearing or 0%.

We can get you a credit score instantly in the office and decide which is the best plan for you and the liklihood of acceptance. 

Most people pay on finance.  Even for small stuff.  Our average is probably a £3,500 braces treatment and they'll typically pay 500 up front deposit and then anything from 150-60 / month dependign on the terms. 

The best part is we ge thte full amount and their agreement is with the finance company so they do all the chasing for payments and we are free to do the dentistry and if they can;t recover the money from the patient that's their problem.  They are a good company and we've never had complaints.  It's called practiceplan. 

May 14, 3:09AM EDT0

How do you cater for kids? This is something as a mother of four I have noticed to be not addressed at all and given the fear (usually inflicted by adults but still) kids have of dentists would be a massive advantage to any dental practice. The best I have ever got has been dentists who have a way with kids or some professional training and experience so they can handle those little patients better but you can imagine for a kid that is not enough, same as you have kiddy doctor cabinets with drawings and toys and costumes etc. you can have in a dental practice not to mention there is so much to learn and address about oral hygiene, how teeth grow and fall, what is normal, what not, regular checks etc etc. Also, parents rarely think about taking their kid to the dentist until they are in pain, so prompting them to do that beforehand would help both, the parent and the kid. So yes, what do you do in that direction?

May 13, 7:34PM EDT0

Hey Tatiana, 

Great question - this is a long one because I want to help you find the right dentist and explain some of the things going on in your kids heads. and your head when you go to the dentist.  So please bear with me. You can also call on 07761009320 because I'm happy to help in any way I can and tell you if you've chosen the right place or not.  Four kids is a lot of teeth and you've a big job there - but you know this already!

We are not a specialist paediatric dentist and actually have very few kids in the office.  We do have young teenagers for braces and Dr Laurence is great with them and likes to mess about and put them at ease - but that's more because of his personality than anything else.  He does the same with adults.  We have a polaroid camera that we give to the kids to play with and when their moms have done their medical histories we can unlock their personal iPads and the kids can play games.  We have headphones so they can sit on a beanbag and not even look at what's happening in the chair.  Sometimes our receptionsts will take them out into the park outside if it's sunny and they have time.  That's rare though.  And we can do this because it's so infrequent we see children in the office. 

We have chosen adult dentistry because it started with aesthetics treatments (Botox and Fillers) and we also have lots of sharp things, acids, x-rays and many of or mums coming for aestheitcs with their dentistry and don't want the kids asking questions!  I wouldn't really want my little ones asking about botox and fillers and body enhancements - but also I dont see why not either.  Depends how you want to bring your kids up.  Some parents like to protect and others like to tell them about things and let them make their own minds up.  But when teenagers ask about lip fillers I just tell them  we eouldn;t do it because their lips are perfect and we couldn't improve them if we tried (not, we don't treat under 18's) Also sometimes their partners and boyfriends don't even know about mums Botox and the kids listen to everything and want to know what things are.  I think that's the other reason we're not a childrens practice. 

Also you need to create special systems and processes to keep young kids safe and even have a different set up (like you can have brother and sister side by side in two chairs in the same room with one nurse caring for both and use special tools and instruments that don't look scary.  We have bibs with dinosaurs on them because we like dinosaurs.  And our mouthrinse tastes like bubblegum because we like it.  Things like that appeal to kids and adults. 

What I do know though is that you should take your kids to the dentist when they are very young and start brushing with them from 3 upwards.  It should always be fun and not a chore and having four kids I know that's easier said than done.  They should associate the experience - as you rightly say - with positive things not negative ones. Donmt mention dental disease or teeth falling out (their milk-teeth are going to fall out remember)

The fear response is generated by a part of the brain called the amigdyla.  it's ancient and impossible to control with rational thoughts.  When it gets frightened it just gets frightened and you hyperventelate, are reactive to bright lights and start to shake.  All bad in the dental chair.  ALso we use articane/lidocaine that has ephinedrine in it (to help control local bleeding) and this can make people nervous because ephinedrine is adrenaline. 

Recent research shows the amigdyla has a 'memory' and can 'remember' bad experiences.  Not like a movie or photo but you'll just smell or touch something and feel frightened and not know why. This is because it's not connected to your memories.  This is also why feeling frightened for no reason often is more frightening because you are confused and trying to think of reasons. 

So one nasty dental appointment could make someone afraid for life.  And talking them around will not help because when the amigdyla is activated you can't think your way out of the fear because it uses up all the blood and oxygen in the rational parts of your brain. 

I love neuroscience - can you tell?

Also the amigdyla (because it protected our ancestors from harm) is in the centre of the brain and can cause a 'hostile takeover' of higher brain functions.  So you literally cannot reason with a frightened person. Especially a child.  As a mum of four I'll bet you've experienced this. 

Saying 'ths won't hurt' won't help!  You hve to make it not hurt.  Saying 'there's no monsters under the bed' won't make the child less frightened.  The amigdyla has to learn over time that there are no monsters by not being threatened by real monsters. 

It's also about the dentist.  A talented dentist can get an entire cartridge of lidocaine into someone without them feeling a thing.  It's all about knowing where the nerves are and using a very special technique where you spritz some of the lidocaine on the injection site, then make a tiny hole (that people cannot feel) and then inject when the superficial area is numb.  I've had it done and it's like magic. 

An entire injecton up into my gum with no feeling of it even happening.  Also the dentist pulls the lip up quite hard and this detracts from the injection sensation becasuse your brain can't tell the two feeliings apart and get's confused. 

Even the smell of the place could set the child off with an unpleasent frightened feeling.  Deep breathing and positive associations is the best way to calm the amygdyla and restore blood flow and oxygen levels tothe rest of the brain.

So practice fun breathing exerciese and cound to ten taking a big breath each time.  This will really help.  I see so many moms doing the 'count to ten thing' but you need to take a big breath with each count to make it work.

It's important you find a good paeds dentist but also it's up to you to make it a fun and positive experience.  Words are also important.  Imagine the difference telling a small kid

"you're going to see a wonderful woman who cares about you very much and she's going to polish your teeth and make sure their healthy so you can smile for the school play'


'you're going to the dental office where you're having and Xray, high pressure water and air squirted under your gums, and they'll be using sharp metal tools to scrape off bits of plaque and make your mouth bleed. 

Everything is marketing :-) 

May 14, 3:04AM EDT1
To what extent has communication and customer attention played a role in your practice's success?
May 13, 6:26PM EDT0

We are present for every customer and give them 100% from the moment they walk in to the moment they leave (and then afterwards by phoning them the next day).  Our receptionists are very good at this and patients feel like they are the centre of attention. 

It's funny because we have the odd bad review and they are almost always because someone has been kept waiting.  And It's because reception had some emergency and couldn't look after the patient while they were waiting or entertain them or inform them in some way. 

But I also say that the person in the dental chair is at the centre of everyone's world and if they have to be there for longer than expecte we might run late and that might make people have to wait.  

The guy who complained actually waited 22 minutes (2 times).  Which shows you how high our standards are.  I've waited 90 minutes for a doctors appointment in the past and didn't bat an eyelid. 

But we're all great communicators and I gave this example because it rarely breaks but when it does bad things happen.  Also (and we don't ever get sued by patients) dentists who do get sued are statistically bad communicators.  They've done research on that.   It has nothing to do with the work or the price but the levels of communication between patient and dentist. 

Rapport is everythign and from a marketing perspective you'd say 'know', 'like' and 'trust' as the aims of the communication. 

Good question. 

May 14, 2:20AM EDT0
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