Featured Q&A: Interview with Dr. Darshan Patel

DR. NEIL PARK: It’s great to visit your beautiful office and meet you and your dental partner, Dr. Sandeep Patel. Let’s start with some background. Where did you grow up?

DR. DARSHAN PATEL: I was born and raised in Daytona Beach, Florida, not too far from the office, actually. The original office that Sandeep had was right next door to my home. Fast forward 30 years, and I’m a partner in that office.

NP: Did you always plan on being a dentist?

DP: Not always. My parents are in the hospitality business, so I thought I would follow in my father’s footsteps. But the more I started exploring different majors in college like biology, the more I found myself asking, “What can I do with biology that is still in the people business?” Interacting with people is my number one joy in life. I figured I would shadow a couple of careers. Medicine wasn’t really for me. I liked optometry — it was something I was interested in. Then, in 2014, I shadowed Dr. Sandeep Patel. That really hit the nail on the head for me. He’s the coolest guy. He loves what he does. He comes to work each day and has no regrets. I knew right away dentistry was what I wanted to do. Not only are patients gratified, but it also makes you feel happy. When you take a tooth out that’s infected and causing the patient pain, it makes you feel like you’ve done something good.

NP: Excellent. Where did you go to dental school?

DP: I went to dental school at University of Florida. I did four years of undergrad there. I came out with three degrees for undergrad because I never wanted to leave. If you need help on construction or business, I’m your guy. Then, my fourth and final degree was dentistry. I graduated in 2019.

NP: Then you did a GPR?

DP: I did a GPR in New York City, the same program that my partner Sandeep went to. I figured I might as well follow in his footsteps. He really enjoyed his program. He loved the director, and we got a great experience in the day-to-day life as a general dentist.

NP: That’s a pretty fortuitous situation. You came into a well- established practice in a brand-new building. How did you work that out?

DP: Honestly, it was a lot of dumb luck as Sandeep calls it! The timing was great. I was fortunate. I couldn’t be happier. I’m thankful for him and everybody around me.

NP: We talk a lot about mentorship in dentistry. That’s one of the most important ways for a young professional to develop. Can you talk a little bit about how Sandeep has mentored you over the years?

DP: Oh, this is weird with him sitting right behind me. From day one, he’s always told me to just practice to the best of my ability and always think of the patient first. That’s the biggest thing. Treatment plan for the patient, and then let the rest continue. His advice is if you’ve done something that you regret and you have to go to sleep with it, it’s not going to help you. Just do the best you can. If you can’t do your best, find the best for the patient, whether it’s a referral or somebody else in town. Treat the patient to the best of your ability, and then everything else will fall into place.

NP: I speak to a lot of practice management gurus, and they always say, “Dentistry is a people business.” A lot of successful people seem to make that their mantra. But here, I see it is how you both actually practice.

DP: The ideal patient relationship involves figuring out where they want to go with their dental health and what they want us to accomplish. Ideally, every patient would love us and not be terrified. But you and I both know that is not how it is. Patients may have had a negative experience or trauma in the past. Get to know where they’re from, what their experiences are, what they’re looking for in a provider — just as you would if you were to go to any other provider. We’re human, they’re human. Treat them with the same respect. And then they can trust you when you say, “Okay, you have a problem. We have multiple solutions. Which solution works best for you?” But you can’t present solutions without gaining their trust. You have to get to know them and get to know what they’re looking for first.

NP: That’s great. How big is this practice? There are two doctors, right? You don’t have any additional associates?

DP: No. We have nine staff members: two front desk people, four hygienists and three assistants.

NP: The assistants work for both of you?

DP: Yes. The assistants work for both of us. Sandeep has his primary assistant, Wendy, who’s been with him for 11 years. We have Deanna, who’s been with me for three years. Zoe has been with us for more than two years. We like having three assistants because, while a crown is milling, we have a free agent on the sideline. It works out for us because we’re going to have one assistant each, but the third assistant can fill in where needed. It works really well.

NP: You mentioned milling. How did you first get into digital dentistry?

DP: I was first exposed to digital dentistry in dental school. Back then, it didn’t live up to our expectations because the technology was not ready: the scanning and milling took a long time. But now, we have the glidewell.io^™ In-Office Solution. Since we started using the fastmill.io^™ In-Office Mill in 2021, we have been amazed at how quickly you can scan, design and mill a crown.

NP: Buying a mill is a big decision for a practice. What caused you to make that decision?

DP: What is going to make our patients happier? It all comes down to convenience, comfort and time. Patients don’t like temporaries. Lesser-quality temporary crowns can break, be swallowed, and sometimes break your buildup. Then, you have to restart or restructure the treatment plan. Milling would solve that issue. If the patient is here and they only have two hours to spare, I’ll say, “John, I got you. Give me an hour and 40 minutes. We’ll have 20 minutes left over to grab a coffee.” They really laugh at me. They don’t think I can finish the appointment that fast, but I can. It’s because of the intraoral scanner and milling unit that we have. The fastscan.io^™ scanner has only gotten better and better. We started with the original, and now the new software is quicker.

NP: There are several good mills on the market. What made you decide on the fastmill.io In-Office Mill?

DP: The support’s been great. When I do my four-unit or six-unit cases, I rely on the design team at Glidewell. The design team is great. They make the designs flawless. They make it look like you had a wax-up. In about 45 minutes, we can get a custom, hand-touched design created from a lab tech in California. I tell the patient, “Hey, we’re getting this design hand touched and you’re going to love it.” Our customer service manager, Victoria, knows how much fun we have as two boys practicing dentistry on the East Coast, and she knows what we expect out of these products. I have no complaints.

NP: How do you make your decision as to whether you’re going to design a restoration yourself or send it to Glidewell to be designed?

DP: I design 100% of single-unit crowns. I’m confident in the system. I’m confident in my margins. I know where I want my contacts. I know how broad I want them and how narrow I want them. I can finish that within two to three minutes now. Don’t get me wrong, when we first started in 2021, it took 10–15 minutes. That’s because we were hesitant at first. We discovered some of the complications that labs run into. But now we are the lab. We’re doing everything, so it makes us feel more confident in our work. The cases that I send off to the lab are highly esthetic cases — like #7–10 or #6–11 — something that I really want another pair of eyes on.

NP: You mentioned that this has made you and Sandeep better dentists. Tell me about that.

DP: If you’re planning on using an in-office mill to fabricate a #30 — a right-handed dentist’s favorite site for a crown prep — you’ve got to make sure it’s the best impression ever because then you have to design a crown for it. From a lab tech’s perspective, you want to make sure your margins are clean. Your gums are not in the way of the prep. Your contacts are nice and broad. You don’t want your contacts to be narrow or sharp. When you’re designing it in your office, you as a dentist are thinking five steps ahead. You’re thinking, “I already know my reductions there, but how are my contacts going to look?” Then, you go back and take a look at the prep. “Hold on, I can make that better. I can improve it.” You stay in that room an extra five minutes, which pays dividends because your final product is far superior.

NP: So, you’re seeing things from the viewpoint of a technician.

DP: Correct. We have a second mill. That was a no-brainer. With our first mill, after two or three weeks of using it, Sandeep and I were playing rock, paper, scissors for who would get the mill. I’m the younger partner and Sandeep is the more established partner in the office — but by no means the better-looking partner, of course — I used to let him use the mill first. After two or three weeks, I said, “Sandeep, this is not fair. I need a mill.” He was waiting for this conversation. We ordered another mill and put them both to use. If it’s four or fewer crowns, I’m milling them the same day. I might have a Glidewell tech design them if it’s #7–10, and my assistant will let me know when the design is ready to mill while I’m doing hygiene checks or a filling. After I’ve approved the design, I’ll send it to the mill. Within two hours after the intraoral scan, the permanent crowns are cemented on, and the patient can go home without worrying about anything falling out.

NP: How do patients react when you tell them that they’re going to get their crowns the same day?

DP: They won’t. I’ll tell you the truth: This in-office mill has given us so much more — I hate to use this word — business. Patients realize that their one crown was so easy and fast that they’ll point out a porcelain tooth that’s chipped and shows metal and ask, “Can you replace this one just as easily?” The tooth isn’t uncomfortable or bothering them in any other way; they just don’t like the way it looks. I’ll tell the patient that, yes, it is that easy, and we can do it right now because I have a second mill. It’s internal growth. The patient didn’t need to replace the crown, but they saw how easy it was to do right then and there. Our business has increased.

NP: Can you quantify the increase in production from the first mill and then from getting the second mill? Can you see that in your overall production?

DP: Yes. In terms of percentage, it’s about 42% in gross numbers because of that second mill. The number of crowns we mill is up about 230%. Our numbers went up by that much.

NP: How long would you say it took to recapture your investment from the first mill and the second mill?

DP: The first mill probably took about eight months to recapture, and the second mill took maybe six months. That’s the crazy part because Sandeep and I did the math. We thought it would probably take two years, realistically, at the number of crowns we were doing. But, when you have an in-office mill, you’re able to produce a lot more than you initially anticipate, and that return-on-investment number explodes. We looked at each other and thought, “How did this happen?” We haven’t changed the way we practice dentistry. We haven’t worked extra hours. If anything, we are working fewer. We are taking more Thursdays off. We are doing more traveling. It is just the internal growth of the practice due to the mills.

NP: When you started doing same-day crowns, it did change your workflow, right? You have patients who are spending an hour here instead of a half hour. How did that affect the office?

DP: The first week was a little chaotic, but it was a good chaotic. We were so used to prepping in an hour, temping for 30 minutes, patients out the door in under two hours. Then, we figured out about two weeks after that, we should schedule patients for about 140 minutes to give us plenty of time to design and mill the crown. Now, we have it down to a science. We hear many dentists only schedule 90 minutes for a crown prep, but I still don’t think that’s enough time for the patient. You need to communicate with the patient what you’re doing and how you’re doing it — that takes time. We can mill a crown and get it cemented in two hours flat from the point of anesthetic.

NP: What’s your advice to the dentist who says, “I like the idea of same-day crowns, but I just don’t want to become a technician.”?

DP: If anything, I spend more time with patients now. While a crown is milling, I have 30 minutes of time that I can utilize in between hygiene checks where I can talk to patients and actually show them their crown that’s being milled. This is a huge marketing tactic as well. Patients take pictures of the mill and send them to their friends or post them online. It’s free marketing. When doctors say they don’t want to be a technician, I feel like that’s a cop-out. This career is a technical career, and we should be good with our hands.

NP: How about you, Sandeep? What would you say to someone who believes milling is not a good thing for their practice?

DR. SANDEEP PATEL: Most of the reasons are around fear of adapting to technology. That’s a real thing. Some people just don’t want to do it. If you’re at the end of your career and you’ve been riding the same bike for 25 years, why switch if it’s working for you? I’m not going to convince that person. For anyone that has another decade or more on the horizon of dentistry, you have to make the change. There’s no reason not to. New technology will revitalize them. If they’re getting bored of doing the same stuff every day, there’s a different way to do things.

DP: Plus, I would say it’s the biggest attractor to a new associate or new partner. As a younger dentist coming into an office, I would want to work with the doctor who has the technology, because that means he’s invested the time and the money to become better.

SP: If you’re looking to bring somebody new in, showing them all the new bells and whistles will make them more excited to work there. If you have the goop and putty and border molding from dental school, they’re not going to be excited.

DP: I think that’s the biggest thing that we really love about the glidewell.io In-Office Solution suite of products. It’s an ecosystem. We call it “the Apple of dentistry” because the products all sync together, like my iPhone, AirPods, Mac, and Apple Watch. There’s no huge learning curve. It works really well. It’s fluid. I think that’s what makes us great practitioners and makes us love Glidewell even more. It’s easy to use. You don’t need to spend five hours on a CE course just to learn how to design a crown, but you can if you want to get better. A lot of other companies make their products harder to use because they expect users to navigate complicated software. The fastdesign.io^™ Software and Design Station uses cutting-edge technology to simplify and streamline design creation by harnessing artificial intelligence. AI can design your crowns faster and better. AI is going to continue advancing, and soon you won’t even need to spend two minutes on the design.

NP: Well, Dr. Darshan Patel and Dr. Sandeep Patel, it’s been a pleasure to chat with you. Thanks for taking the time out of your busy practice to share your experiences with Chairside^® magazine readers.