Dentistry management essentials: leading specialty practices to success

Ali Oromchian, JD, LLM, offers guidance on creating a less stressful and more productive environment in the dental practice

Whether a clinician is placing implants, straightening teeth, or performing root canals, the way the office runs behind the scenes can be as important as the clinical care. Patients expect top-tier clinical expertise, but they also want a smooth, stress-free experience — from the moment they walk in to the time they leave. When applied consistently, good leadership and smart practice management can turn a busy office into a thriving one.

The strategies discussed in this article focus on the everyday realities of managing a specialty dental office. From hiring the right people to coaching your team and staying on top of compliance, these core principles help create a well-run, positive environment for patients and employees.

Laying the foundation: understanding practice management in specialized dentistry

The unique challenges of specialty practices

According to the American Dental Association, more than 1 in 5 dentists are specialists.¹ Unlike many general dental clinics, specialty practices often see a narrower range of patients who have specific conditions or needs requiring advanced procedures. For example, an endodontic practice may handle fewer but more complex root canal treatments, whereas an orthodontic clinic must manage lengthy patient relationships throughout multi-year treatment plans.

In addition, since specialists depend on regular referrals to grow their practices, effective communication with referring doctors, clear treatment protocols, and well-coordinated follow-up are crucial for fostering trust and ensuring ongoing patient inflow. This reliance on professional networks shows the importance of establishing and maintaining a reputation for clinical excellence and organizational efficiency.

Defining clear goals and vision for the specialty practice

Every practice benefits from clarity of purpose. A straightforward mission statement keeps everyone on the same page, whether that mission emphasizes best-in-class orthodontic care for adolescents or cutting-edge implant procedures for adult patients. Translating this overarching mission into concrete, measurable targets helps team members align daily tasks with broader practice goals.

For instance, a pediatric dental practice might set a goal to reduce patient anxiety by a specified percentage over a 6-month period. To achieve this, leadership might implement new behavioral management training or invest in child-friendly operatory designs. The same is true for other specialty practices that may see patients who may have increased anxiety because of their upcoming treatment. By defining specific goals and mapping out the steps required to achieve them, specialty practices ensure that their vision is a central guiding force in clinical and administrative decision-making.

Leadership 101: key principles for specialty dentists

Establishing a leadership style

In any dental setting, leadership style directly influences the workplace atmosphere. Common leadership approaches include:

• Authoritative: Centralized decision-making, well-suited for high-stakes or urgent scenarios (e.g., a complex implant surgery needing immediate clarity on procedural steps).
• Coaching: Leaders guide employees through questions and feedback, encouraging professional growth (beneficial for new team members in a practices learning advanced technology).
• Democratic: Encourages collective input and consensus-building, useful when team buy-in is essential (e.g., reorganizing patient flow in a busy office).

A one-size-fits-all leadership approach rarely works. Instead, effective leaders adapt their style to the practice’s current stage of growth and the specific makeup of their team. Periodic self-evaluation and employee feedback can pinpoint which leadership tactics are working and where adjustments are needed.

Creating a culture of accountability

Accountability begins at the top. When leaders model punctuality, thorough recordkeeping, and patient-centered care, team members are more likely to follow suit. Clinicians should regularly review assigned tasks to confirm they are being completed on time and properly and encourage employees to take ownership of their responsibilities by clearly delineating roles and establishing transparent expectations in an employee handbook.

To embed accountability into daily routines, consider implementing:

• Task checklists: For example, implement a sterilization protocol checklist that must be completed before each shift ends.
• Progress updates: Brief daily or weekly huddles that help the group track ongoing initiatives and resolve potential bottlenecks.
• Open-door policies: Employees can discuss concerns, mistakes, or feedback without fear of repercussion, promoting a supportive learning environment.

Hiring and onboarding strategies for a high-performing team

Despite offering wage increases to both hygienists and dental assistants over the past year, specialty practices — like their general dentistry counterparts — continue to face major hiring challenges.

According to a June 2023 poll from the ADA Health Policy Institute of about 1,100 dentists, 94.5% of those recruiting dental hygienists found it “very” or “extremely” difficult to fill vacancies, while 83.7% reported the same for dental assistants. Notably, 4 in 5 responding practice owners increased wages for these roles, with most wage hikes ranging from 4% to 6%, yet the staffing gap persists.²

A May 2021 poll likewise showed that 35.8% of surveyed dentists were seeking assistants, 28.8% were seeking hygienists, and more than 80% found recruitment for both positions to be very or extremely challenging. These shortages, which predated COVID-19, have been further intensified by early retirements, safety concerns, and higher salary expectations, leaving many specialty practices struggling to attract and retain the skilled team members necessary for efficient operations.³

Effective recruitment for specialized skill sets

Specialty dental practices often require team members with a deeper or more nuanced skill set than general dental offices. When writing job descriptions, highlight the core clinical and administrative abilities needed for that specialty. This clarity helps candidates self-select based on their experience and also ensures you attract the right talent. During the interview process, ask scenario-based questions that reveal how a candidate might handle specialty-specific tasks, such as managing sedation protocols in a pediatric practice or tracking inventory for implant, endodontic, or orthodontic components.

Comprehensive orientation and training

A strong onboarding process does more than educate new hires on practice policies; it helps them feel confident and part of the team from day one. Try to pair each newcomer with a seasoned employee who can act as a mentor during the initial weeks. This allows new employees to quickly learn the nuances of daily operations, from patient check-in procedures to specialized clinical workflows.

Orientation should cover:

• Clinical guidelines: Specialty-specific protocols, infection control measures, and charting processes.
• Administrative overview: Patient scheduling systems, insurance verification, and billing workflows.
• Communication standards: Preferred channels for interoffice messaging, meeting cadences, and conflict-resolution procedures.

When well executed, comprehensive orientation and training set a tone of professionalism and structure that bolsters both employee retention and patient satisfaction. Employee retention is incredibly important, as the cost of hiring a new dental employee can be three to four times that position’s overall salary.⁴

Coaching, mentorship, and ongoing development

Building a coaching culture

Continuous improvement is at the heart of high-performing dental teams. Coaching is better than traditional top-down instruction by fostering a two-way dialogue that benefits both the instructor and the learner. In a coaching culture, senior team members regularly share best practices with junior employees, and open communication channels allow everyone to contribute ideas for refining processes or enhancing patient care.

Encourage short, focused feedback sessions to address issues as they arise. Rather than waiting for an annual review, a quick “check-in” after a challenging case or a complex surgery can solidify learning and reinforce positive behavior. This supportive, real-time feedback model keeps employees engaged, motivated, and aligned with the practice’s mission.

“Continuous improvement is at the heart of high-performing dental teams.”

Performance reviews and professional growth plans

While informal feedback is valuable, structured performance reviews remain a cornerstone of comprehensive team development. These reviews typically occur semi-annually or annually and offer an opportunity for leaders and employees to jointly assess progress, celebrate successes, and set new benchmarks.

When preparing for a performance evaluation, gather data on key metrics like:

• Treatment acceptance rates for front-office employees or patient coordinators.
• Quality of clinical notes and adherence to safety protocols.
• Patient satisfaction scores or feedback directly tied to an employee’s responsibilities.

Following the review, collaborate with each team member to create an individualized professional growth plan. This plan might include attending relevant continuing education courses, cross-training in other specialty services, or participating in leadership workshops.

Team dynamics and communication

Establishing clear roles and responsibilities

A specialty practice often employs team members with overlapping skill sets. For instance, an orthodontic practice may have multiple treatment coordinators, each handling digital impressions, bracket changes, and patient education. To avoid confusion and duplicate effort, explicitly define each individual’s duties, authority level, and accountability.

Job descriptions should be updated regularly as the practice grows or introduces new technologies. Clear boundaries and well-communicated responsibilities minimize task redundancy, reduce mistakes, and improve efficiency. For instance, if a treatment coordinator’s primary role is to educate patients (or their parents) on sedation options and post-op care, that information must be spelled out so other team members understand to whom they should direct relevant questions.

Conflict resolution and collaboration tools

Even well-managed practices encounter interpersonal tension. Whether it’s a disagreement about employee scheduling or a miscommunication on clinical protocols, conflicts can escalate if not addressed promptly. Adopting a step-by-step approach to conflict resolution can keep issues from harming team morale or patient care: 

• Acknowledge the conflict: Encourage team members to speak openly and respectfully about the issue.
• Clarify the underlying problem: Determine if the tension arises from miscommunication, differing priorities, or misunderstandings of role boundaries.
• Develop a solution: Work collaboratively to find common ground, focusing on how resolving the conflict benefits the patient and the practice.
• Monitor outcomes: Check back in after a set period to ensure the resolution remains effective.

Modern collaboration tools, such as compliant messaging apps or shared project management boards, also streamline communication and help avert potential misunderstandings. Daily or weekly team huddles can reinforce clarity and ensure everyone has up-to-date information about protocols, appointments, and treatment plans.

Measuring success: key performance indicators (KPIs) for specialty practices

Clinical versus business metrics

Balancing patient care with business finances is a constant juggling act for specialty dentists. Tracking both clinical and financial metrics can reveal hidden inefficiencies or highlight effective strategies. Examples of KPIs relevant to specialty practices include: 

• Treatment acceptance rate: This is especially crucial for practices where high-value procedures often require detailed patient education and financing.
• Patient retention and recall: For offices that typically rely on recurring visits, tracking retention rates helps gauge satisfaction and loyalty.
• Average production per patient: Offers insights into how effectively the team communicates and provides bundled or adjunctive treatments.
• Net Promoter Score (NPS): Reflects how likely patients are to recommend the practice to peers in their community, often correlating with overall patient experience.

Tracking progress and refining strategies

Data interpretation is just as important as data collection. Holding monthly or quarterly KPI reviews provides a structured opportunity to celebrate achievements and identify areas needing course correction. For instance, if a specialty practice notices a decline in patient referrals from general dentists, leadership can investigate whether the issue stems from longer patient wait times, communication breakdown, or external market factors.

After analyzing data, scheduling protocols can be adjusted, employee training refined, or new marketing efforts deployed. This continuous improvement cycle — assess, adjust, and advance — keeps a practice agile in a competitive and evolving healthcare environment. According to the Bureau of Labor and Statistics, the dental industry is projected to grow at 5 percent per year between 2023 and 2033, highlighting the need for versatile, responsive dental practices.⁶

Maintaining a positive practice culture

Stress management and burnout prevention

Long appointments, anxious patients, and complex treatments can heighten stress levels in a specialty dental setting. Whether it’s a busy clinic with intricate surgical schedules or a practice balancing dozens of active treatment plans, employee burnout remains an ongoing concern. A stressed-out team not only affects office morale but can also compromise patient safety and satisfaction.

In one study investigating psychological health among dentists, 63% of respondents reported feeling burned out.⁵ These findings underscore how chronic workplace stress not only diminishes office morale but can also compromise patient safety and satisfaction.

Practical strategies include:

• Streamlined workflow: Use technology to automate routine tasks like appointment reminders or supply ordering, reducing clerical burdens.
• Wellness initiatives: Provide access to stress-management resources (e.g., seminars on mindfulness, short meditation breaks, or Employee Assistance Programs).
• Time off and flexibility: Offer flexible scheduling or adequate time off to recuperate between busy patient

Risk management and legal considerations

Employment law basics for specialty practices

Specialty practices often face the same employment laws as general dental offices but with unique twists, such as employing specialized assistants with additional licensure requirements. To stay compliant:

• Stay informed: Follow state and federal guidelines for wage-and-hour regulations, breaks, overtime, and licensure requirements.
• Create clear policies: Document attendance expectations, disciplinary procedures, and confidentiality standards in your employee handbook.
• Seek professional guidance: Complex matters, such as handling workplace harassment complaints or ensuring Americans with Disabilities Act (ADA) compliance, often require legal counsel or specialized HR services.

Failure to comply can lead to legal penalties, reputational damage, and diminished employee morale, so proactive risk management is a must.

Documentation and compliance essentials

Thorough documentation is a non-negotiable aspect of practice management, from medical record-keeping to employee files. Detailed charting is critical for patient care and insurance claims while also protecting against possible legal issues. Specialty offices, which frequently involve multi-visit treatment plans, should maintain clear records of patient progress, informed consent, and any modifications to the planned procedure.

Investing in HR software, like that of HR for Health, can streamline these processes, ensuring that HR files are easy to access, properly backed up, and compliant with privacy regulations like HIPAA. With all employee records stored in one secure, digital location, practice owners and managers can quickly retrieve essential documents when needed — whether for audits, legal compliance, or internal reviews.

In the staffing domain, consistent paperwork around credentials, performance reviews, and continuing education fosters transparency and accountability. A well-organized HR system also reduces the risk of misplaced or incomplete files, helping avoid compliance issues that could lead to costly penalties or operational disruptions. HR compliance is key, and investing in advanced software to streamline processes and limit opportunities for human error can help make these goals a reality.

Additional resources

• Take your handbooks from helpful to heroic: https://bit.ly/4joNI05
• How to Write Job Descriptions for Your Healthcare Employees: https://bit.ly/4i8fUmZ
• Onboarding Best Practices in Healthcare: https://bit.ly/42aUjFO
• Don’t just manage your team. Make it better: https://bit.ly/3EiCmfk

Key takeaways

Leading a specialty dental practice requires seamlessly merging clinical expertise with adept management. From defining clear goals and leadership styles to establishing robust hiring and onboarding protocols, every aspect of operations influences patient experiences and internal team well-being. By embracing a coaching culture, measuring progress through KPIs, and diligently managing legal and compliance risks, specialists set the stage for sustainable growth and a positive work environment.