Dental Case Presentation Formula

In this episode of Dental All-Stars, host Alex Nottingham welcomes guest Eric Vickery to discuss the case presentation formula. They emphasize the importance of understanding the reasons behind patients’ decisions and the need to avoid pressure sales tactics. The formula includes three steps: highlighting why the dental issue is important to the patient, expressing concern about the condition observed, and discussing the consequences of not addressing the problem. By testing the patient’s buy-in and addressing their concerns, dental professionals can create a sense of urgency and value before discussing treatment options. The goal is to ensure that patients believe they have a problem and are interested in a solution. The episode emphasizes the importance of integrity and ethical sales practices in dentistry.


About Eric Vickery

Eric holds a degree in business administration and brings a strong business and systems approach to his consulting. His initiation into the field of dentistry was in the area of office management. He managed dental practices for over ten years and has been consulting over 250 offices nationwide since 2001.

About Alex Nottingham JD MBA

Alex is the CEO and Founder of All-Star Dental Academy®. He is a former Tony Robbins top coach and consultant, having worked with companies upwards of $100 million. His passion is to help others create personal wealth and make a positive impact on the people around them. Alex received his Juris Doctor (JD) and Master of Business Administration (MBA) from Florida International University.

Episode Transcript

Transcript performed by A.I. Please excuse the typos.

This is Dental All-Stars, where we bring you the best in dentistry on marketing, management and training. Here’s your host, Alex Nottingham.

Welcome to dental all stars. The topic of this podcast is the case presentation formula. And we have our guest, it’s a guest, it’s Eric Vickery, man. He’s our president of coaching, superstar coach, superstar speaker. I mean, I can go through his bio, you’ve heard a bunch, but he’s coached over 300 offices. He’s got, wow, almost 70 personally now and well over a hundred combined with all of our coaches. Big fan of.

helping offices get off insurance. We’ll be talking about that soon. And we’re on this kick about case acceptance. And we had, this is kind of a three part series, if you will. The first was 95.5, finding the why, now case presentation formula. Welcome Eric, tell us about this. Thanks, All-Star Dental Academy. I appreciate you having me on Alex. Yes, you’re welcome. You guys are amazing, I love you. So I love that we’re putting all this together.

I know that it’s been, you know, broken apart, separated, but that’s important because you can’t get to this if you haven’t done that. So let’s do a quick, quick review. Two rules in sales, right? There’s that S word sell that we have to talk about. People don’t buy a solution to a problem they don’t perceive to have. That’s why we reviewed the 95-5 rule. Please go back and listen to that one. Number two, people buy for their reasons, not your reasons.

buying with emotion, justifying logic. So go find the podcast we did on finding the why. Now, if we’re going to talk about selling, we have to understand something. Nobody, in dentistry, nobody ever raises their hand and said, I love selling in dentistry. It’s like one person in our seminars will raise their hand and say, I love to sell. So we have to first understand why is that? I think the bottom line is pressure. Nobody likes the pressure sell. Is that fair?

It’s like, I don’t want somebody pressure selling me and I don’t want to feel like I’m pressure selling somebody else. And at the same time, I’ll sit in offices and we’ll do practice evaluations on site for clients and I’ll hear this phrase over and over and over again. You need a crown. You need four quads of scaling or root planning. You need four fillings. And that word need is pressure sales. You need to buy this car from me, Alex. You know.

And you can translate into questions and still come across as pressure focused things like, do you see any good reason why you wouldn’t want to go ahead and get this crown scheduled today? How do I answer that? It’s, it’s to me, it sounds like, do you see, do you see a good reason why you wouldn’t want to get this car today? Alex, what’s it going to take to get you in these leather seats today? And just, you know, I think people climb when they hear that. Yeah. It just comes across slimy. And so I get why we say we don’t like the S word cell.

But the sooner we get over the fact that we are in sales, just like any profession is, we’re all in sales, pick a profession, identify something that they have to sell, even a concept, even a pastor is in sales. He’s selling you on a concept. It’s just the belief of buying into something. So if we can just put that to rest and say, hey, you know what, I just want my patients to understand what’s going on, so they buy into a concept. Does that make sense? Well, sales is like a vehicle, if you will, a mechanism or channel.

The question is, do you put good fuel and good information through the channel or do you use it to manipulate people? So it’s a channel and service. I would service and sales are channels to express your passion and you can do it for good or for dark. So it depends again on but that goes back to the why we talked about in that. And by the way, I’ll put in the show notes links. Don’t worry everybody. We’ll give you links to the podcast. You can get.

it pretty easily. There’s a video version or an audio version, we’ll make sure you have that and transcript. For both of those previous recordings, right? Absolutely. Yes. Okay, gotcha. So I love that you’re talking about sales being a vehicle for light or dark. And you can absolutely use these skills that we teach and turn it into if you have lack of integrity, you can turn into manipulation if you so choose. And we ask that you don’t do that. Have integrity of this. There’s no

There’s no smoke and mirrors. And so when we lay this out for the patient, we remember they buy for their reasons, not your reasons. They don’t buy a solution to a problem they don’t perceive to have. And so we just go right with that right when we present. So I’m gonna give you some synonyms first to use in the formula so that you remember these keywords or coaching hacks that you know how to start this verbal skill. So people buy for their reasons, why? And if you remember the question we ask is, why is that so important to you?

So we’re gonna take that word important and we’re gonna plug that as the first thing we’re gonna target. If we remember the word important, we’re gonna get off on the right foot. So when we use the case presentation formula, step one, we’re gonna use why, the word we’re gonna use is important. Okay, step two, we’re gonna use the 95-5 rule, focusing on the condition. And every time we talk about the condition we see in the patient’s mouth, we use the same word. We look in their mouth and we say, you know what, when I see what’s going on, Alex, I am concerned.

And so throughout the exam and what they’ve experienced in the exam process and the system we use where the doctor’s talking to the assistant and the patient’s co-diagnosing with you, they’re hearing the word concern. So it’s not a surprise at the case presentation formula when they hear this word. They’ve seen internal photos, they’ve gone through the process, scanned, all of it. So one, why, we use the word important. Two, conditions, we use the word concerned. Now, in the 95, we talked about not only

letting them know what the condition is now, but what’s gonna happen if they don’t do anything about that? We call that the consequence step. So step three is consequences. And the phrase we use there is leads to, because you have this condition, this cavity, that’s going to lead to. The beautiful thing about dentistry is we only have two consequences that we have to, for the most part, be worried about. Sometimes aesthetics plays a role. We can set that aside for now. But simple, I’ll ask hygienist, hey, what’s the…

consequence of gum disease? They’ll say bone loss leads to tooth loss. Okay, so tooth loss is one of our consequences we deal with. Okay, number two, assistance. What is the consequence of decay? And they’ll often say root canal. So if you don’t do something that decay hits the nerve, you need a root canal. Well, we’re not talking treatment here. We’re talking about the condition consequence, and that would be a toothache. So in the consequence,

stage, we’re typically talking about either a toothache or tooth loss. Now, all we want to do in the 95-5 rule in this case presentation formula is say, here’s what you said you wanted and why, here’s the conditions and consequences that are going to prevent you from getting that. Test the buy-in. How concerned are you with this? And we’re going to check and see with the patient, do you really believe this is a big enough concern to move forward with? Because

I believe Alex, the number one objection is not money, not time, not fear. The number one objection is lack of urgency. This is why you see people say, I can’t afford it. And they go get in their brand new Cadillac and they go to Disney World, right? On vacation. So they have the money. They’re just choosing to put it somewhere else because they don’t believe in the value and the urgency of what you created 15 minutes ago. So we’re going to make sure they have urgency and value before we ever talk treatment.

So we’re in that 95-5 rule, we’re still in that 95 world. We’re not even talking about the 5% yet. We’re gonna put this line, 95 slash five. We’re gonna put this line, this barrier in between the fives. And we’re not gonna talk about the five until they tell us yes, they believe they have a problem. And yes, they would like us to tell them about a solution. Dentistry has this inherent problem. And we’ve talked about this before. You’re my patient, Alex, right? And you’re my new patient. And I say, Alex, you give me a…

$200, you give me $200 and we’re gonna do a new patient exam and x-rays, you pay me and I’m gonna tell you your problems. Right, okay, I put that in my pocket. Hey Alex, if you give me more money, I’m gonna fix said problems. You see the conflict of interest, right? And so because of that, we avoid a lot of what’s going on in this process, psychologically we say, I don’t wanna hear no, because I don’t wanna get into that.

An admin team can echo this for me. They hear all the time, patient walks out and goes, oh, now the real painful part. They say, oh, doctor must need to put his kid through college. Oh, doctor must got a new car. Oh, need to send the doctor on vacation. In other words, they’re just selling me something. And now I gotta pay money for this crown. They’ll make these comments. And that is a reflection of that unaddressed.

inherent problem that we have in dentistry. Not a lot of professions have that. Let me, you pay me, I’ll diagnose the problem solution. Even physicians, they’ll refer you out for the solution. They’ll prescribe you out. Here, we are all encompassing. We diagnose and then we get the benefit of what we diagnose. So in this 95.5, we’ve got to test the buy-in first. Do you believe you have a problem? Would you like us to talk about a solution to it? And how that sounds is,

We use the word concern. We just say, Alex, how concerned are you with what we discovered today? Now, Alex, if you were to say no to that, yeah, it’s not bothering me. If it ain’t broke, don’t fix it, right? It wouldn’t make sense for me to then say, well, let’s talk about those crowns then, right? If you’re not in on the problem, there’s no solution to even talk about.

Another reason why we don’t want to do this part psychologically, we avoid this because we want to talk about the solution. We have to give them the solution. Again, that’s back to pressure sales. So if I were to put just this first section together before we even get into the five, Alex, I would say, let’s create a scenario. Alex is the patient. So Alex, we did the, the, the emotional exam, right? I asked you some questions. I found your why. And I found out that.

your teeth are important to you because you present a lot. You don’t want to have a confident smile. You don’t want anything interfering with your busy work schedule. Does that sound about right? Yep. I got you pegged. You got me. I got you. You only know me for 10 years. So we find, and let’s just make something up. I know you have a healthy mouth, but let’s say we find gum disease, it goes undetected, and we find several cavities that you were completely unaware of, okay?

So if I were to lead with this, the word important is always first. I say, Alex, earlier you shared with me it was really important for you to have that confident smile and knowing that nothing was gonna really interfere with your ability to continue to work and present and be confident in that process, right? That’s right. And step two, I’m concerned. I’m concerned about two major issues going on. One is the foundation of your teeth, the gums.

We talked about this and how the infection that’s spreading underneath the gum line is the number one reason people lose their teeth.

I’m concerned about that because, uh, you know, you’ve probably seen people, Alex have really long teeth and the black spaces in between their teeth. Have you seen that before? I have. Okay. That’s the advanced stages of what you have right now. That’s what it progresses to. If you do nothing, you’re at a, yeah, that’s an eight, nine, 10 on the scale. And you’re a four or five right now, six. We can do something about that now. Okay. And number two, I’m concerned about the cavities that are going on.

Undetected because you’re not feeling anything right now. They haven’t hit the nerve of the tooth yet. And, and you’ve never had a toothache before, but we talked about it earlier. You’ve heard of someone who’s had to have a root canal, right? And that’s why I’m so concerned about these three teeth in the upper right that have the active decay because as soon as that hits the nerve of the tooth, toothache requires a root canal. So my question for you, Alex is how concerned are you with the infection in your gums that can cause you to lose your teeth and how.

Concerned are you with the decay in those three teeth in the upper right that can cause a toothache? Very concerned. Okay, and that’s what we’re looking for. Now if you say not concerned, I did a really poor job on all the systems we teach up to this point. Or I’m just dense. Could be. Low, low value. You’re just here because Heather sent you. Oh, my wife said I had to come get my teeth cleaned. Okay, so We’re looking for three yeses. She just said the doctor was good looking. So that’s why you know. Go, go. Yeah, you had to go check it out. So

Three yeses, I just got one yes, very concerned. So I say, how concerned are you with this? Now key point, I didn’t say, Alex, are you concerned with this? I said, Alex, how concerned are you with this? And I wanna show the difference between those two questions. Obviously, the former is a yes or no question. People lie in one word or less. They say, yeah. Oh yeah, yeah, sure, yeah.

Oh yeah, 5,000. Yeah, I’ll pay for that. Yeah, sure. Yeah. We call these the yesers. They just yes, yes, yes, till they get out and you think in your gut, I’m never going to see that person again. You know what I’m talking about? Yeah, yes, we want to. Yes, yes. There’s a yes or no question. You got me. So instead, we use the word how. How concerned are you with this? And if you guys heard what Alex said, when practice this, he just said, I’m very concerned. That’s what we’re looking for more than just the yes.

That’s getting a positive response to question number one. Now question number two, I would ask you then, do you want a solution for that? So I test the buy-in and then I confirm that we’re gonna move into the 5%. And this is a very assumptive question. So I just say, so how much sense, Alex, would it make for us to talk about a plan and how we can take care of these things before they become a bigger problem? It makes sense. Okay, and again, I didn’t get a yes. I got more words there. Using how, right. Using the word how.

how much sense would it make? And it is an assumptive. Yeah, of course. You’re gonna get this confirmation from the patient. And now I went from 95 slash five, I moved that line out of the way and now I’m diving into the five. This is a cautionary tale moment. Please avoid the desire to then blurt out the word crown. Alex, you know, I would consider you non-dental. I would consider myself non-dental, even though I’ve worked in dental offices. I don’t work in a dental office right now.

But when you hear that as a patient, when you hear the word crown, what do you think of immediately? Ooh, drilling, filling pain, expensive. Okay. Money. Survey says number one is money, right? Sounds expensive. Patient hears the word crown, they hear money. So why do I then immediately say, all right, well you need three crowns on those upper right teeth. You need four quads of scaling root planning. It just all went, it just crumbled right in front of us. Right. Right.

So if we’re gonna do this great setup, we have to have a really good finish in the 5%. And the best coaching hack I can give you is, put the term of the treatment at the end of the definition. So how that goes like this. So Alex, what we’re gonna do is we’re gonna clean beneath the gum line on your foundation of your teeth in areas that you can’t reach. We’re gonna get that infection out of there for you. We’re gonna do that in quadrant in areas of your mouth. So.

your lower right and your upper right will do that one visit and the opposite side on the next visit. Those are two hours of our hygienist Virginia. She’s going to take two separate two hour visits to get all of that taken care of. Now you’re going to hear us use technical terms called periodontal therapy. You’re going to hear that and your insurance is going to call it something. We just want you to know that the point of that is to get the infection out of there and then manage it and make sure it doesn’t come back and reinfect those areas. Okay. Does that make sense so far?

Oh yeah. Okay. So I define it and then I give the term. I don’t say, all right, so we’re going to do peritonal therapy for two, two hour visits, but that doesn’t mean anything to you. Right? True. Okay. Part two, those three teeth on the upper right, Alex, that we’re concerned about. I want you to imagine, let me ask you a question, Alex, have you ever seen an apple with a hole in the side of it? Okay, what’s going on there? A worm, a worm’s in there, right?

So that worm is in there doing what? Eating the apple. Eating the inside of the apple, eating all the good stuff. Would you buy that apple if you saw that apple? Only if it was on sale. No, I would not. You’re gonna pass over that one. So we see your tooth, this cavity, we see this hole on the side of it, we see a fracture, we see an access point and we see decay and we see the decay working its way around the inside of that. We have no idea when it’s gonna hit the core of the apple, the center of the tooth.

Once it does that, imagine that worm, if it were to, let’s say that the apple was on a tree, it was still on the vine, right? If that worm goes through and eats the core right away, it’s gonna kill that apple. All that goodness that apple’s gonna go away, it’s gonna cause a problem. Well, same thing with the decay. It’s working its way towards the nerve of the tooth. As soon as it reaches the center, that core, it causes a toothache. It doesn’t always send a symptom to you. You don’t always feel it right away. It wants to keep that tooth alive so it can keep doing its thing, okay? So…

To save that tooth, what we want to do is go in, remove the worm, remove the decay, get rid of it wherever it’s worked or where it’s around in the inside of that tooth. Okay, just like the apple, we’re going to get rid of all that. Then what we’re going to do is we’re going to put tooth colored filling material in. It’s actually bonds to your tooth. There’s fibers on a filling and there’s fibers like strands or teeth that interlock that we’re going to do on the inside of your tooth to bring your tooth together.

So it’s strong. So nothing can get in between there. Okay. Old fillings, they were just, yes, exactly. Yeah, like Lincoln logs. So in the olden days, those were metal fillings and they were just space savers. There was a gap. There was no connection between your tooth and your filling. That’s how decay got underneath there. Does that make sense? It does. So we’re gonna do a stronger filling inside your tooth that’s gonna protect it, get rid of all the fractures, all the decay.

So we protect that center, that nerve, that core of the tooth. Okay. Now, so that your tooth doesn’t split open, doesn’t sever, doesn’t break apart, we’re going to put a protective coat coating around the outside of cover that keeps it in cases and seals it. So nothing else can get in there and nothing else can break it. Does that make sense? That does. You’re going to hear us call that a foundation or a buildup. You’re going to hear us call that a crown over the top. You’ve probably heard that terminology before. Yeah. Okay. All right. I feel so much more intelligent now.

So now we’re gonna take care of the foundation, the gums, and then we’re gonna take care of those three teeth in the upper right so you don’t end up with a toothache or risk losing a tooth or having this infection cause you lose your teeth. And of course, invade the confidence that you’re looking for. So my question for you Alex is, okay, now I’m gonna pause right there. So we went 95 slash five. I’ve gotten two yeses. I’ve now described the five in the vivid terms that we wanna use. I use belief windows, I use word pictures to describe.

what was happening, right? I vividly described it. Now you feel like I understand what’s happening. It’s not just, hey, go up front and see Becky. She’ll get you scheduled for that crap. You took me on a journey through my mouth. Yeah. Well, and having you understand what you’re paying for is a huge part of this process. You, in your mind leaving, my hope is you don’t want the worm, the worm to get to the core of that apple. Because up front, here’s, go ahead. Well, as I’m listening to you, I’m thinking that even if I don’t buy that moment,

You just invaded my mind in a positive way. Like you educated me. I can now see it, what’s going on. And if I go home, I’m just gonna be like, the worm, what’s going on? I’m gonna need those linking logs and the protective coating. Like I feel like going home naked without getting treatment. It was very beautifully done the way you explained it in a way that I could understand. Yeah.

The thing that we hear upfront as administrators, managing two practices over five different years each, 10 years, six and four, the thing that I heard the most that frustrated me was after the clinical team left the patient upfront with me, they would say things to me like, you know, it’s not bothering me. I don’t really wanna spend $1,500, so I’m gonna go ahead and wait. Not knowing what’s going on and what’s going to happen, the consequence step was completely missed.

You have a cavity, go up front, you need a crown. This is what we have to avoid. So remember I said we’re looking for three S’s. The 95 slash, that slash represents two. Alex, how concerned are you with saving these teeth and preventing toothache, right? Oh, I’m very concerned. Okay, how much sense would it make then for us to talk about a plan and how we could take care of that? Yeah, let’s talk about it. Boom, I present the 5% to you, the treatment. That’s what everybody wants to talk about. At the end of that, now the drum roll, please. Now this is, this is,

the deciding factor. So once we get to the end of the 95-5 rule, I’ve now presented the 5%, drum roll, right? And then here’s the point. 64% of patients don’t get asked if they wanna schedule. We talk about this in the great call process. We become answering stations. We become information givers. And then there’s this awkward silence. And, or we say things like, you have any questions for me? No? All right, you’re all set, go up front, see Becky, she’ll get you scheduled.

These are the things we have to avoid. That’s first acknowledgement. Second is asking the right question. We don’t wanna say at this point, so Alex, do you see any good reason why you wouldn’t wanna go ahead and get this periodotherapy in these crowns scheduled? It just sounds icky. It’s a reverse negative. People don’t know how to answer that. No? Did I get a yes or not? Well, one of the concepts we teach in our programs is that if you, basically what you did is you built a ton of rapport, you addressed their needs, and you became the logical choice.

It’s logical. You don’t have to sell really because you’ve done those three, those three, what’d you call them? The three yeses, the three yeses. And it makes sense. You explained to me what was going on. Does it make, so the last question, does it make sense to move forward? So except that’s a yes or no, now we’re going to make it an open ended. So I just take that same thing and I say for a D personality type or a C I’ll be on the sense side. I’ll say, Alex, how much sense does it make to go ahead and move forward with this plan?

Oh, it makes a lot of sense. Now I’m not just getting a yes, I’m getting more. Now, if it’s an IS, I will say, Heather, Heather would be my IS, right? I’d say, Heather, how do you feel about moving forward with this plan? I just changed that into feel. So using the disc a little bit in the disc. Yep, absolutely. So I got to be ready to conform to that. Because if I ask you a field question, right, you’re going, why are we getting the feelings, Eric, you know, but as high C personality type, they want it to make sense.

How much sense does it make to move forward with this plan? And you can’t get just a yes or no in response to that. Now you’re really gonna get something that has some backing to it, why they’re not in it or why they are. You’re gonna hear things like, well, it’s not really bothering me. You need to decide as the presenter, treatment coordinator or dentist, are you willing to engage in that conversation now and do what you need to do to help this patient make a decision? Or are you gonna wave the white flag and give up?

Cause you’re not going to say, all right, we’ll go up front and see Becky. She’ll get you scheduled. Cause that’s not, no, that’s not what’s happening. Our obligation is to diagnose our obligation is the patient understand the consequence. We, they want a solution to that. We’re there for them. So I think Shelley did the podcast on permission statement. That’s a direct reflection of this. If we’re using the permission statement, this plays a role in that. So let me do this all at once. You can hear the steps. Okay. So

Alex earlier you shared with me, it was really important for you to have that confident smile knowing that you had the peace of mind knowing nothing was going to interfere with your work schedule, that you’re going to be confident in your presentations with how things look and feel. And taking that consideration during the exam is we reviewed, we had two major concerns, the infection in your gums, the active infection in your gums. And number two, the active decay in those three teeth in the upper right. Now, the reason I’m so concerned about those two things is the, the infection is going to

Number one reason people lose their teeth. If you know anybody who lost their teeth, that’s probably why. They didn’t do something sooner enough to stop it. And number two, the decay on those three teeth, that’s what causes a toothache. And it’ll wreak havoc until it’s toothache. And that’s why you hear people telling you they had to have a root canal done because they didn’t do something before the pain happened. So Alex, how concerned are you with taking care of both of these concerns? Very concerned. Okay.

Would it make sense then for us to talk about a plan and how we can take care of that? Yes, it would make sense. All right. So here’s the plan. We’re going to take care of the infection underneath the gums. First, we’re going to get you healthy there. That’s called periodontal therapy. Step two, we’re going to take care of the active decay that’s burrowing its way towards the nerve of your tooth. And we’re going to stop that. We’re going to put, replace it with white material that’s bonded to your tooth. And we’re going to put a strong protective coating over the top of the tooth to keep it from splitting. And that’s called a crown.

How do you feel about moving forward with this plan, Alex? Let’s do it. Okay, now I decide where to go from there. If he says, let’s do it, excellent job, I’m ready to go. And then we get into transfer of care, the next step in our process and our system. So I tried to really go through that sequentially so you could hear the steps and clarify. So this is taking the selling out of the cell, but we still got to sell. This is people buy for their reasons, not your reasons. And this is

focused on the condition, not the treatment. People wanna marinate and hear and understand what they’re solving, they don’t just wanna hear your solution. All right, sound good? It sounds great. All right, awesome. The case presentation formula with Eric Vickery, president of coaching at All Star Dental Academy. And in the show notes, I have part one, the 95-5 rule, part two, finding the why. I’ll even put a link to the permission statement podcast.

You’d like to get a little bonus training. And I’m thinking for the future, Eric, we could do a podcast on disc, a disc overview. Will be nice. That’d be great. That’d be a lot of fun. Yeah. Yeah, we’ll do a disc overview. Eric, thanks again for being on the podcast. And for those that are listening, watching, please remember to follow us on Apple podcasts and Spotify. Click that follow button. And if you’re watching us on YouTube, click that subscribe or whatever they call it button. And that gets you the content right away, straight away to your.

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