It’s enjoyable to watch the light come on in physician’s eyes when they learn about what dentistry can offer that can help them. I just got back from a “Lunch-n-Learn” In-service with a M.D. who is

a Pain and Rehabilitation specialist. This is basically the doctor who is at the end of the line for people in chronic pain. In my state, family physicians and other doctors can’t manage chronic pain with medication. They must be referred to these Pain/Rehab specialists. So when all the other doctors can’t figure out the pain problems in their patients, this specialist is where they wind up.

After some pizza and small talk, I fired up my notebook computer and PowerPoint presentation and went through a short presentation showing what caused facial pain and migraines from a neuromuscular perspective. It was like watching a kid with a new toy. The new ideas this nice lady physician processed answered a lot of puzzling questions that she didn’t even know were questions yet in her mind. When she connected the dots on the relationshp between the neurology of the trigeminal nerve and the mandible, along with all the other proprioceptive input coming from ascending postural areas, and realized how this affected the CNS sensitivity, facial pain, etc, and how we could help with many of these patients – it got exciting! She finally realized the “upstream” cause of much of the pain and she “got it” why neuologists would be stumped and impotent in their ability to deal with migraines and facial pain – IF the mandibular posture and TMD related issues weren’t ruled out or dealt with first. I gave a quick demo on how to use a gloved finger in the mouth to palpate the lateral pterygoid area, and gave pointers on what to observe in the mouth for signs of dental problems and bruxing, etc. One of their staff members had me palpate her intraoral muscles as she went on about her history – saying that she now knew that she needed to make an appointment for herself with me.

I made sure to instruct them on how to refer patients, what we did with them at our initial FREE consult, and how we gave feedback to their office and any other treating physicians connected to patient care. All in all – not bad for the price of a pizza! – Lee Ostler DDS

One of the payoffs for establishing a healthy professional relationship with physicians offices comes when the medical office calls your office and asks for more referral forms because they have run out!

While it would be wonderful if these physicians would just call us up out of the blue and initiate these kinds of requests, this isn’t how it happens in the real world. Physicians seek me out like this when I have first established a relationship with them, and have continued to nurture it by repetitive contacts, literature review newsletters, and the like.

Today at lunch, I’m going to personally drop off a packet of referral forms to replenish their supply. Since I haven’t yet had a chance to do an inservice presentation to his office, I’ll see if I can’t get that scheduled sometime as well. When these opportunities drop into your lap like this, you MUST take advantage of them right away, and make it look like business as usual – which it should be! Always remember that “luck” is when preparation meets opportunity. Wish me luck!
Lee Ostler DDS

Today was another bright day for physician referrals in my practice. A couple weeks ago I stopped by a physician’s office because I heard he was treating spinal pain and back problems in his practice. I was intrigued so I stopped by and presented him with the Physicians Resource Manual (PRM) we’d made for him on the topic of TMD and headaches.

When I arrived there his staff told me to hang around and that I could probably speak with him for a few minutes. Within about ten minutes I was invited into his private office and we spent the next

20 minutes talking about what he did, what I did, and how we could maybe help each other. I left him with the binder and some referral forms, and he seemed to act very impressed!

As I hadn’t ever met him previously, the purpose for my drop-by visit was mostly about just getting acquainted and starting a relationship and leaving him with some information. Upon leaving, I casually mentioned that maybe it would be a good idea for us to get together again, and that perhaps we could come do a staff in-service training for him and his medical team and bring him up to speed with the ways that dentistry can medicine are becoming connected. He agreed that this would be a good idea and we said our goodbyes, agreeing to have our office managers talk to work out a convenient time for this to happen. Today was that meeting!

I had my dental assistant pick up some sandwiches, chips and cookies from the local deli and we arrived at noon for the in-service presentation. He gave us the lunch hour until 1:00, and at twenty after we were done munching on food and began talking about dentistry. It was a small group – the physician, a PA and a nurse, and their office manager, so I just showed a PowerPoint presentation on my notebook computer on the coffee table in their front reception area. I gave a complete (but very quick) presentation addressing sleep apnea oral appliances, TMD-headaches, and the perio-oral/systemic connection.

We were extremely well received and they tracked right along all the way. I even found myself having to stop periodically while they started talking with each other about the names of patients who fit these conditions as we brought them up. I made sure they knew the clinical aspects of these issues from their medical perspective – i.e. how to identify perio or TMD problems, and what to do about it.

I discussed setting up a co-management arrangement for Perio Host Modulation using Tetracycline, and asked if they would be willing to accept patients we might refer to them for this co-management. He said he would be thrilled to see these patients and manage the pharmaceutical aspect of this therapy. I also told him that he could and should consider prescribing Doxycycline for his own medical patients AND making sure that they get to a dentist for the other aspect of therapy – the hands-on antimicrobial periodontal therapy that only a dentist can provide (in addition to the “official” diagnosis)!

I also made it clear that for their own patients in need of dental services, that if they couldn’t get their patient’s dentist to respond, that we would be more than willing to step in to assist them. They really liked the idea that perhaps they could begin taking a more active role in co-managing perio patients with me. Even thougth perhaps could and might do this myself, I think this is a brilliant way to involve the physician directly in the process adn get them excited about looking for oral-systemic disease problems and referring patients.

Of course we left them with additional referral forms. I gave them to the office manager directly and spoke straight at her about being the “boss” in the office and the one who would likely keep track of where the referral forms were located.

All in all – not a bad outing! Now the follow-up and ongoing “drip” support program! – Lee Ostler DDS

This letter of thanks came after having an in-service presentation with one of our favorite physical therapy offices. This is really great feedback and confirms that we are making an impact when we do in-service “lunch-and-learn” presentations. – Lee Ostler DDS

Dear Dr. Ostler,

I want to take the time to thank you for your time to visit our clinic to share with us your treatment of TMD. We all enjoyed the pizza, too. I received many positive comments from my staff about

your visit. They all were glad to gather the new knowledge and are looking forward to putting it to use with their patients.

I was very happy to learn that you take a whole body approach with assessing your patients. Most referring doctors I’ve worked with don’t look at it that way. We will definitely be referring any TMD patients that come to us without a TMD specialist already working with them. It seems to us that we share the same passion to help relieve our patient’s pain and educate them throughout the process.

I am excited to begin treating your patients and building a lasting relationship between you and Oasis Physical Therapy. Pease feel free to call me at any time with any questions you may have. I am always available to you.

Sincerely,

Mindi Irvine, MPT
Oasis Physical Therapy
Pasco, WA

When I was in to my chiropractor for my regular working over and adjustment, I mentioned to him that it would be nice perhaps to get together sometime for me to show him what I do to help headache patients. Actually, we’ve been talking about this for some time now, but the degree of interest he showed was always generally low in the dental side of this equation. For some reason, this visit was

different and he agreed it was time and that he would like to learn more about the TMJ and how I deal with headaches.

He is also my dental patient, and we made an arrangement to spend a half hour together after his next cleaning coming up in a couple of weeks. His cleaning was today, and when he finished in hygiene we had a nice chat. It was a bit hurried as I had a surprise patient to see – but that’s real life!

I showed him a sample orthotic and we discussed the nature of the dental bite and how it is so tied in with the neck, shoulders and back. In particular I discussed the neuromuscular aspects and explained how because of the trigeminal nucleus and the co-morbidity factors due to ascending postural distortions and instability – that we needed to work together with our mutual patients. I then did a quick muscle palpation exam on him (lateral pterygoid) and he about came unglued! He is a closet TMD patient! I would have never guessed!

The bottom line was that I took advantage of an opportunity I was already having with another health professional, and turned it into a productive bit of relationship marketing. Even as we were talking and the lights were coming on for him, he mentioned about half a dozen patients he had that he now suspected might have TMD problems and which would explain why he was struggling so hard to help them.

We may be able to move him into an orthotic as well, but at least he now understands much better what I’ve been talking to him about for the past year or so in our meetings together. This was an improvised in-service training, and one that was very informal, but potentially very productive.

Today the lead nurse at a local ENT medical office called to refer yet another patient to our office. While she was giving us the patient’s information, she said she wanted us to know the reason for the referrals was because of information her doctor received from our office. She said he was very impressed! – Lee Ostler DDS

MDReferrals is modern dentistry´s leading authority for physician referrals! Here you will find resources and marketing tools that will help you position yourself to get referrals from physicians and to become the leading dental authority in your medical community. MDReferrals will show you how to use the Oral-Systemic Connection, Oral Appliances for Obstructive Sleep Apnea, and TMD-Headache Therapies to create strong professional referral relationships and to become part of the referral network of physicians in your community.

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As I and my office team were getting ready to launch the TMD-Headaches part of our physicain referral marketing program to area physicians, chiropractors, and dental colleagues, we experienced a minor office fire that put us out of business for a few days while restoration contractors did cleaning and repairs. While I was busy working with the contractors and insurance adjustors, I directed my team members to

use their down-time to deliver our Physician Resource Manuals (PRM) and referral forms to area physicians we wanted to work with and get referrals from.

My team went to the bakery and cleaned them out of brownies and then made several deliveries of the brownies and PRMs. They met with some wonderful medical office managers and staff, and created some great new relationships with medical offices in the community.

Unbeknownst to us, one of the medical office team members at one office had an unresolved ear complaint of ear pain and ear congestion, for which her boss-physician had previously referred her to an ENT for evaluation. She had spent several months in tests trying to get a diagnosis for her unresolved problem and both she and her boss-physician were becoming very frustrated. After my team member left their office, the physician handed her the referral form from inside the binder and said emphatically “go see this guy”.

As it turned out, later that same day at a follow-up appointment with her ENT, her ENT physician mentioned that my office team had also stopped by her office with this same information and that she was now suspicious that her unresolved ear complaints were jaw joint related. She also gave her one of our referral forms and advised her to call us and make an appointment, which she promptly did.

Our evaluation found that she did indeed have a TMD problem along with considerable dental pathology and occlusal breakdown. Appropriate recommendations were made and treatment soon began for what will ultimately work out to be a full reconstruction before it’s over.

The moral of this experience is that using down time can be very productive if used wisely and you are prepared at any moment to execute what you are already prepared to do.

Oh – and as it turned – the fire/water damage was contained and limited – but we did get a rather nice insurance-paid renovation out of it.