Selling Smiles in a downturn

Selling smiles in a downturn


Dr. Charles Crane, left to right, his dental assistant, Janeen Murray, and certified dental assistant Susie Woods work on Mary Jane Raber of Sarasota at his office in Sarasota last month.

By David Gulliver


Published: Monday, January 5, 2009 at 1:00 a.m.
Last Modified: Monday, January 5, 2009 at 8:28 a.m.
A recent Tuesday for Dr. Charles Crane began with an emergency patient around 8 a.m. and ended with a 5 p.m. trip to the Save Our Seabirds refuge to examine the broken beak of a young sandhill crane.

So when the cosmetic and restorative dentist spent two and a half hours on a single patient the next day, it was almost a relief.

“I’m fast, but I don’t like to be rushed,” Crane said. “That’s one of the reasons I got into this specialty, after 20 years of general dentistry. I don’t want to skip between six treatment rooms.”

The decision is paying off. Crane recently won two gold medals in the Florida Academy of Cosmetic Dentistry’s 2008 Smile Gallery Competition.

As the slowing economy makes people reconsider spending money on anything but necessities, he is finding new ways to pitch his expertise and make his work affordable.

Cosmetic and restorative dentistry is complex work.

The dentist is in essence a quarterback, calling plays and leading the attack for a team of professionals, including oral surgeons, periodontists and dental lab technicians, who makes the crowns, or replacement teeth.

It also is expensive work. Restoring a single tooth can run $4,000, and some patients’ cases involve restoring virtually the entire mouth.

One such patient is Mary Jane Raber, a Sarasota resident with an appointment one Tuesday morning.

In the past 18 months, Crane has replaced all her upper teeth — a few of them twice, in fact.

The morning he bonded her new upper crowns, Raber slipped and fell at home, shattering the front teeth and slicing open her lip. She called Crane, who had just sat down for dinner at Outback Steakhouse. He met her at the office, stitched her lip and created temporary teeth to replace the ruined, hours-old work.

That Tuesday, Crane’s task was to create temporary teeth to stand in for Raber’s long-departed lower molars on each side, and to take the impression that would be used to create her final lower teeth.

Shortly after her 11 a.m. appointment begins, Raber is almost unidentifiable, thanks to a suite of measures intended to keep her comfortable. A sleep-style blindfold covers her eyes. Headphones pipe Christian music — her choice — into her ears. A breathing mask delivers a nitrous oxide mix, a mild sedative. Blankets drape her body, and beneath them, the team says, warmed booties encase her feet.

The procedure starts minutes later with two shots of Xylocaine.

Recalling concierge


The pampering and all-hours service recall the precepts of concierge medicine, where patients pay a large annual fee for unlimited access to a doctor.

Ann White, the practice’s coordinator, educator and pitchmaker, sees the similarities but says the practice is not for the elite.

For one, Crane has about 2,000 patients, many inherited when he took over the practice from Dr. Steven Krause. That is far more than the typical concierge physician. Many days, Crane and his team see eight patients for cleanings and routine care.

“We probably are hurting ourselves by saying we’re cosmetic dentistry,” White said.

In the struggling economy, many people are buying only what they see as essentials, potentially a killer if your business is seen only as creating a prettier smile.

So Crane’s practice lately has emphasized the quality of its materials — porcelain, not plastics, metals or mercury — and health.

“This economic environment is giving us the opportunity to say what we always wanted to — this is about health,” White said.

For some patients, restorative work is a necessity because of dental health problems that ruined teeth. The process starts by treating those problems.

For most, though, better teeth means better health, Crane said, such as allowing people to eat a healthier, more appealing diet.

But the practice also is pitching the angle of patients getting what you pay for. Crane’s patients may pay more out of pocket, because insurance companies typically pay full value only for lesser materials, White said.

But they claim their materials mean reduced long-term costs. “If you think you can only afford to do it once, you can’t afford to do it two or three times,” she said.

Lately, price has been more of an issue, especially for people who live off investment income, White said.

More of them are using the practice’s financing option, installment loans from Capital One at interest rates of 1.99 percent to 23.99 percent.

But nothing sells better than telling people the work will last 25 years or more. That is what Raber is counting on.

Crane at work


Crane wears glasses with 4x magnifying lenses, or loupes, as he examines the tiny hardware in Raber’s mouth.

Where her lower molars would be are what look like the tops of three screws. They are the caps atop implants, screw-like devices that anchor into the jaw. Eventually they will join to the crowns via another screwlike middleman, called an abutment.

With a hex tool, he unscrews the caps, handing them to Janeen Murray, the chairside assistant.

By 11:30 a.m., Susie Wood, his other assistant, is filling a mold with quick-hardening acrylic. Crane fits it to the lower left gumline, then removes it when Murray calls time, less than a minute later.

He extracts what looks like a set of four normal teeth, then begins smoothing the set with a sandpaper disc on a high-speed drill.

He moves to the other side of Raber’s mouth, and the team repeats the process. Over and over, they ask her to tap the teeth together, checking alignment. By 11:55 a.m. Raber has a set of temporary teeth. But Crane still has to take an impression to make a set of permanent teeth.

Crane next removes her temporary four front teeth, revealing her original teeth, now trimmed and polished to nubs. He smooths them again with a drill, 15 minutes of finishing touches. At a previous appointment he already spent more than an hour working them into their current form.

From there, he shuttles different bits of hardware in and out of Raber’s mouth, so the impression will reflect the pieces that eventually will link the crowns to the implants.

Gum tissue has grown over one of the caps, and he zaps it away in seconds with a handheld laser.

The team takes X-rays of both sides to make sure the implants are in proper place. The images come up seconds later on the office’s computerized system.

By 12:45 p.m. Crane is coating Raber’s teeth and gumline in blue goo to make the impression, then presses a mold into place and holds it tight.

After that, the team takes a break, then inserts the proper hardware and replaces the new temporary teeth. There is more teeth-tapping and checking, and by 1:30 p.m. they are wrapping up.

“She came in with 6 bottom teeth,” Crane said. “She’s leaving with 14.”


The Harley Street Smile Clinic are able to offer 0% finance (subject to status)over 10 months or 2-5 years at 9.9% to clients seeking cosmetic dentistry. These days more and more clients are asking to finance their cosmetic dental treatment - especially the offer of 0% finance. Cosmetic dentistry can be costly, especially if you are having a smile makeover of around 8-10 veneers. In the current economic climate clients are seeking the easiest ways of paying for their cosmetic dentistry, and taking advantage of the finance on offer.