The Gargler

Tend Logo

2 jKiLae-nkh9Ixj3kt9aVzQ

MorningVsNight Horizontal

Seltzer Horizontal

01 Welcome Bar

0 ootGL4k38DTycw4T

Grinding_Horizontal

OutOfNetwork Horizontal

Tend

Doug Hudson

It’s hard to crack open your third (or fourth, or fifth…) can of the day and not feel a little worried that seltzer drinking could be damaging your teeth. What’s actually in seltzer? And does it matter for your oral health?

To find out just how bad—or not—a sparkling water bent can be, we sat down with Dr. Marc Schlenoff, Tend’s Head of Clinical Development.

__Seltzer drinking isn’t something to lose sleep over__

Compared to drinking soda and other not-so-great-for-you beverages, drinking seltzer “isn’t really something to worry about,” says Dr. Schlenoff.

__Unless your seltzer contains citric acid__

When it comes to your teeth, the danger of many canned and bottled drinks, even the sugar-free ones, is mostly centered on a single ingredient: citric acid. Citric acid is naturally found in citrus fruits, and an artificial version is commonly used as a preservative and flavor-enhancer in some of America’s favorite bevvies.

__Citric acid erodes enamel__ 

By lowering the pH of your mouth, citric acid can [erode your enamel](https://www.ada.org/en/member-center/oral-health-topics/erosive-tooth-wear). Combine that with another popular ingredient—sugar—as many soft drinks do, and, according to Dr. Schlenoff, you’ve got the “perfect conditions for tooth decay.”

__Seltzer is more acidic than water__

“Part of the seltzer-making process involves mixing water with something called carbonic acid,” explains Dr. Schlenoff. (That’s the “carbon” in “carbonation.”) “So there’s a little bit of acidity that’s brought into the mix,” which is one reason seltzer tastes good.

__But only slightly__

The acidity “isn’t dramatic,” says Dr. Schlenoff, though he cautions that seltzer companies don’t share the exact pH levels of their products with the public, so it’s [hard to know what the long-term effects of drinking them will be](https://cspinet.org/tip/your-seltzer-habit-harming-your-teeth).

__To play it safe, swish with water__

“All it takes is a swish of water to rebalance the pH of your mouth,” says Dr. Schlenoff. So after you get your seltzer fix, swish with water for a few seconds to bring your mouth’s pH level back to normal. But before you do anything else, check your favorite brand’s ingredient list. And if you see citric acid or sugar, take out a water glass instead.

That’s why we call ourselves a dental wellness company. We help you form healthy habits with personalized nutritional tips, product recommendations, and more.

We believe dentists shouldn’t just solve problems. They should prevent them.

*In our “How Bad Is It?” series, we answer your cringing questions about whether something you’ve done, or do everyday, is bad for your oral health (or completely harmless).*

Seltzer: How Bad Is It?

“If you had to choose, __brushing at night is more important__,” says Dr. Marc Schlenoff, Tend’s Head of Clinical Development.

At night, you’re brushing away “the accumulation of sugary and acidic things we all eat and drink throughout the day.” In the morning—unless you’re a midnight snacker (which, fair)—your teeth are still pretty clean, since they haven’t really been used. Brushing in the morning is more about freshening your breath and getting rid of any plaque you missed the night before. 

That said, __Dr. Schlenoff definitely does not recommend skipping your morning brush.__ Long-term it will affect your oral health, and short-term people may “stand a little further away from you.” But let’s say you’re a parent negotiating with a particularly brushing-averse kid: if you have to give up something at the bargaining table (just once), now you know what to do.


No matter when you brush, our dentists will make you feel completely and utterly care for.

No judgment ever

Brushing twice per day is standard practice. But are the two brushing moments equally important? The answer, it turns out, is no. 

Is Brushing at Night More Important Than in the Morning?

When you’re looking for a dentist, you’re probably aiming to check a few different boxes: you want your dentist to be close to where you live or work, you want them to have good reviews, and you want them to take your dental insurance (if you have coverage). 

On this last point, you’re probably looking specifically for someone who’s “in network” with your insurer. “Out of network” feels like something to avoid: we associate it with more expensive care, specifically big surprise bills that show up in the mail months later.

And these associations are often justified. If a dentist is “in network,” it means they’ve negotiated set rates with your insurer. So you’ll just owe your normal deductible and coinsurance. If a dentist is “out of network,” they may bill you for more than your insurance will pay. Thus the surprise bills.

However,  if Tend is out of network with your insurer (we can’t speak for the other guys), it can actually be a good thing. 

For 80% of our out-of-network guests, checkups are *fully covered*. By checkups, we mean your twice-per-year cleanings, with x-rays, an oral exam, and a polish. We also include a free oral cancer screening ($60 value), so you get more thorough care than you might elsewhere, without paying anything extra.

Summed up, if you’re coming in for a checkup, there’s only a 1 in 5 chance that being out of network will be any different than being in network. And if you’re in that 20%, we’ll make sure you know ahead of time and allow you to cancel, no questions asked.

If you have more questions about being out of network, give us a call at (212) 686-3686. We’ll talk you through it. 

See exactly what you’ll owe for your checkup with our real-time insurance checker.


See if your checkup is covered

With Tend, being out of network can actually be a good thing.

Why Being Out of Network Can Be a Good Thing

We’re often simply told we do it, recommended an expensive mouthguard, and sent on our way with little to no more information. But *why* do we grind our teeth in the first place? Do I *have* to wear my night guard? And is grinding *really* such a big deal? Tend’s Head of Clinical Development, Dr. Marc Schlenoff, has these answers and more. (Spoiler: yes, grinding is, in fact, a *very big deal*.)

__Grinding can be caused by stress, but it’s also genetic__

While a lot of us grind due to stress, “some people who are seemingly under no stress grind because that’s just the way they’re hardwired,” says Dr. Schlenoff. 

__Grinding produces a huge amount of force__

“Grinding can generate up to 1,100 pounds per square inch of pressure on your teeth.” To put that in perspective, that’s [3-6 times](https://www.chicagotribune.com/lifestyles/health/sns-health-teeth-stress-story.html) the pressure you use to eat.

__Evidence of grinding is easy to spot__

When people grind, the cusps of their teeth gradually become flatter, and shinier, then shorter. “I always show my patients a picture of the wear to show them exactly what’s happening,” says Dr. Schlenoff.

__Grinders typically grind for an hour or so per night__

“We grind and clench and then we stop and then we do it again...all night long,” says Dr. Schlenoff, adding up to about 60 minutes total.

__You’re more likely to grind if you snore__

Some snorers assume they couldn’t possibly grind their teeth while snoring, but sadly they’re wrong. In reality, “grinding is just momentary, and there’s almost a 100% correlation between snoring and grinding.”

__Grinding wears away at enamel, then at dentin__

Now for some dental anatomy: a tooth has layers that grinding destroys bit by bit. The first layer is the enamel, which coats the outside of the tooth and is “the hardest substance in the body.” Once you grind through this, you’re in trouble. Underneath the enamel is “dentin,” a yellowish substance that’s 11 times weaker than enamel. As a result, it will erode 11 times more quickly.

__Grinding affects multiple teeth at a time__

Grinding doesn’t just happen to one tooth: it occurs in a sliding motion that wears down many of your teeth simultaneously in a fairly symmetrical way. 

__There’s a point of no return when it comes to tooth damage__

Because the tooth gets softer the deeper you go, over time the damage grinding causes begins to accelerate. At a certain point, the damage is beyond repair and your teeth will require crowns. Dr. Schlenoff recalls, “I’ve had cases where I had to do crowns on every tooth in the mouth to rebuild them to their original height because people have worn them down so dramatically.”

__Repairing this damage can be incredibly expensive__

A single crown can cost up to $2500, depending on where you live. If your case is really extreme and you need crowns on every single tooth like Dr. Schlenoff’s patient, that could result in a whopping cost of $80,000. 

__There’s a way, way cheaper alternative__

Since there’s no way to consciously stop grinding (especially in our dreams), our best mode of defense is a night guard, or a simple piece of plastic custom-molded to your mouth that you wear just when you sleep. A night guard typically costs less than a thousand dollars. We charge $599 if you don't have dental insurance, and if you do, it could cost significantly less than that. That’s a savings of $79,401 or more if things were to really go awry.

Here’s to strong enamel, and grind-free teeth!

Book a Checkup at your nearest Tend studio, and one of our top-rated dentist will examine your teeth for signs of wear. 

Think you're grinding?

[8% of adults](http://sleepdisorders.sleepfoundation.org/chapter-7-sleep-related-movement-disorders/sleep-related-bruxism/p/) grind their teeth, but most have no idea about the long-term consequences.


80,000 Reasons to Stop Grinding Your Teeth

![01 Welcome Bar](//images.ctfassets.net/otz9p93fkvjx/6pnmWl2TTFWHR39xGsjXSO/40e6b1a4b0362cd6ab33e02a29107081/01_Welcome_Bar.jpg)

__The Welcome Bar__
*0-10 minutes*

As you enter the studio, you’ll find yourself in a beautiful, modern space with soothing lighting and a friendly face behind our Welcome Bar. We’ll greet you and gather your insurance info. (To save time, enter it online when you book or call ahead.) If you don’t have insurance, a checkup is $350, and you can pay by credit card.

![02 Brushery](//images.ctfassets.net/otz9p93fkvjx/4pdCCRk5njg3vZojfIRfbi/3a24024cb87144003e4268a14f82593e/02_Brushery.jpg)

__The Brushery__
*5 minutes*

After getting insurance out of the way, we’ll offer you a Tend toothbrush and a curated, seasonal toothpaste. We’ll also give you a complimentary Brush Bag from Baggu to carry everything in. Then we’ll show you into The Brushery, a swishy, swirly room just for freshening up. (No more awkwardly brushing in the bathroom at work before your visit.) 

![03 Suite](//images.ctfassets.net/otz9p93fkvjx/2uDI5G8qM0sCOsq3mu1c3W/e3c1dd6763625e77a2015d70c950e719/03_Suite.jpg)

__The Suite__
*30 seconds*

When you’re done at The Brushery, we'll guide you to your suite, prepared just for you. It has personal space where you can hang your coat, leave your bag, and charge your phone. If you chose a Netflix show to watch when you booked, it will be queued up on a ceiling-mounted TV over your chair. (If you didn’t choose one, you can do so now.) Before getting started, we'll take your blood pressure, since we consider your oral health in the context of your overall health.


__The Imaging Bay__
*30 seconds*

If you need any imaging, we’ll show you to our Imaging Bay. We use a state-of-the-art Planmeca Promax 3D imaging machine. This machine, which moves around your jaw as you stand in place instead of poking the roof of your mouth or making you gag, turns x-ray imaging into a comfortable 30-second process. It also uses 80% less radiation.

![05 Cleaning](//images.ctfassets.net/otz9p93fkvjx/1gsRXiJ7joFMx58WtYa6qH/c794b7440fed58396e96467cf2a7c69d/05_Cleaning.jpg)

__Cleaning__ 
*40 minutes*

After you’ve wrapped up at the Imaging Bay, your hygienist will show you back to your suite and give you a thorough, comfortable cleaning, using a topical numbing gel so you won’t feel a thing. The tools we use are quieter, gentler, and less intrusive, so you can focus on the Netflix show you’re watching overhead.

![07 Polish](//images.ctfassets.net/otz9p93fkvjx/2ucUvRdhuELSzdwHC680zC/7e75b37edab440434aa4edaad52f8d11/07_Polish.jpg)

__Polish__
*20 minutes*

When your cleaning is finished, your hygienist will give you a polish to remove any cosmetic staining on your teeth. You’ll get to choose between mint polishing paste or a fun flavor like vanilla and keep watching Netflix. 

![06 Oral Exam](//images.ctfassets.net/otz9p93fkvjx/3SjC41J4L7PvjVYzcoDTxq/8620dde0f5428125e7fcb8912f8633e2/06_Oral_Exam.jpg)

__Oral Exam__
*15 minutes*

When your polish is finished, your dentist will come in, say hi, sit down, and answer every question you have. Then they’ll examine your mouth and talk to you about your oral health with zero judgment. As part of your exam, you’ll get a complementary oral cancer screening. Since the mouth can be a front-line indicator of many diseases, dentists can identify early symptoms before they become more serious.

If your doctor recommends additional care, like a filling, they’ll show you exactly why by showing you a picture of your mouth on a screen. You’ll have all the time you need to think about how you want to proceed, and you can  make your decision confident that your doctor’s interests and yours are truly aligned. Our doctors aren’t paid a commission on procedures, so they only offer the care you actually need. 

![08 Goodies](//images.ctfassets.net/otz9p93fkvjx/1s84uU4hyOm4b4DOzLZb2Y/7051e4fb5ceecbe223365859c06e6b0a/08_Goodies.jpg)

__Goodies__
*Up to you*

That’s it! Your checkup is finished. If you owe anything for your visit, we’ll take care of it in your suite. Also, if you receive an Explanation of Benefits letter from your insurer later on, don’t worry: you don’t owe anything. We cover the difference in price between what we typically charge and what your insurer pays.

Before you leave, you can freshen up at your personal space in the suite and add some extra goodies to your Brush Bag. We’ll see you in six months! (Can’t wait.)


Haven’t given us your insurance info yet? Save time at the studio by getting it out the way right now.

Wrap up your paperwork

So you’ve booked a checkup. Amazing. We can’t wait to Tend to you. When you arrive at the studio, here’s what to expect. 

Your First Tend Visit

Maybe you’ve walked by our Flatiron Studio. Maybe you’ve seen “Look forward to the dentist” or “A new kind of dental office” in the windows of our upcoming FiDi and Midtown Studios. Or in an ad online. Maybe you’ve visited our website. Maybe you’re intrigued.
*Who are these Tend people? They’re hiring. Do I want to work for them? Do they want to hire me?*

In my last post, I talked about how Tend is innovating for our guests. We want to be the first dental experience they actually look forward to. Dear dentists, today I want to talk about how we’re innovating for you. We haven’t just rethought dental care from the patient’s perspective. We’ve rethought it from yours.

# A beautiful place to work

Our studios are designed to soothe. Gorgeous tube lighting. Warming wooden paneling. A custom fragrance in the air. They’re also designed to earn trust. Simple, encouraging hues. Framed diplomas on the walls. Screens in front of each chair so guests and dentists can discuss treatment with imaging as a common reference point. And they’re designed to reframe expectations. A room just for freshening up with swishy, swirly walls. Super-friendly front desk staff. Netflix on ceiling-mounted TVs.

For you, this means calmer, more trusting patients, who are actually enjoying their experience. It also means working in a gorgeous, elegant office, equipped with a lounge where you can eat, meet, and relax.

![1 SpQ75pu5tXdnXg4Ew9bV5Q](//images.ctfassets.net/otz9p93fkvjx/5oUKnYsgFJCPMqCZPF5i3s/6efe97e3bb82f80732e46bcb0217a3f3/1_SpQ75pu5tXdnXg4Ew9bV5Q.jpeg)

# State-of-the-art tech

Like many forward-thinking dental practices, we’ve invested in the latest technology. Extra-oral x-rays with 80% less radiation. Quieter handpieces. Scalers that don’t require a spit bowl. We see faster, more comfortable care as key to reframing our guests’ expectations about what dental can be. That means state-of-the-art tools at your fingertips.

Our investment in tech extends beyond hardware. When our guests book visits online, for example, we ask them for their insurance info and their medical history. This streamlines in-studio operations and reduces wait time, which makes our guests happier and more relaxed when you see them.

![1 2BatcABlJgvuNpa 8xY9NA](//images.ctfassets.net/otz9p93fkvjx/55EWV2dIc5GUBoMSzNrqKQ/9ef5fb0d7a46c8ed3cbadf7d130da9ed/1_2BatcABlJgvuNpa_8xY9NA.jpeg)

# A culture of collaboration

If you’re a Tend dentist with a complex case and you want input from a colleague, you have an array of resources available to you. You can consult with another dentist in the studio where you’re based. You can call on the broader network of Tend dentists. Or you can turn to Dr. Marc Schlenoff, our Head of Clinical Development. Until he joined Tend this year, Dr. Schlenoff was Director of Advanced Education in General Dentistry and Assistant Professor of Prosthodontics at Columbia University’s College of Dental Medicine. Before Columbia, Dr. Schlenoff was in private practice for more than 30 years with a specialization in aesthetic dentistry. He collaborates with our clinical team as a whole to make sure each of our dentists feels 100% supported.

![1 52UwH2sfzwwH2A5sHqrAVQ](//images.ctfassets.net/otz9p93fkvjx/6zbd5B1jg4NHpV9eQruK0u/c3632853e1761595788dbac56b7e7e43/1_52UwH2sfzwwH2A5sHqrAVQ.jpeg)

# Continuing education

Dr. Schlenoff’s role includes continuing education. He’s created a program, called Tend University, that keeps our clinical team up to date on all of the latest developments in science-based care. It also delves into the business side of dental. You may be the world’s most incredible clinician, but you may still be able to learn something about hospitality: how to talk to guests in different consumer segments at different points in their journeys, for example. Or you may still be able to learn something about leadership: how to run a huddle, how to hold people accountable, how to do talent reviews. Combine skills like these with your existing clinical abilities, and you’ll be a powerful operator.

# A new win-win approach to compensation

If you’re a dentist who earns a commission on procedures, your pay month-to-month may be unpredictable. You may also detect a sense of distrust in your patients that, for the vast majority of clinicians, is totally unfair. Are your treatment recommendations really in their best interests, your patients may wonder, or are they in yours?

This perceived conflict of interest can make things awkward fast. Let’s say you’re seeing a brand-new patient who needs work done, but they’re asymptomatic. Now you have to do an internal calculation: should I bring my diagnosis up now and risk making my patient feel suspicious? Or should I wait to gain their trust, potentially delaying care to their detriment?

We’re eliminating this problem with a new win-win approach to compensation. We pay you a competitive base salary with an additional bonus based on several key metrics, including Net Promoter Score (a common experience metric that measures guest satisfaction). This provides stability for you, aligns your interests with your guests’, puts your guests at ease, and ultimately makes them more likely to accept the care they need. It also takes productivity out of the equation.

![0 4EEThGxoSoIbVDVF](//images.ctfassets.net/otz9p93fkvjx/1KdZ2mizyT636kIxuiw5Kd/42ad8183c8a1a6d656d927a543274436/0_4EEThGxoSoIbVDVF.gif)

# Three common career paths

Many dentists choose between three common career paths: 1) starting their own practice, 2) working for another practice or practices, or 3) joining a dental support organization.

Starting your own practice allows you to build something from scratch, which is an extremely rewarding experience. But it will put you (on average) $475,000 in debt. And that’s on top of the debt you likely already have. In 2018, the average dental school graduate owed $285,184 (a 400% increase since 1990), according to the ADA. Starting a practice also requires skills you might not have acquired in dental school: how to market, hire, manage an office, look great on social media and third-party booking sites, and so on. If you’re like most dentists, you got into the field because you love taking care of people. You don’t necessarily love marketing performance metrics or training front desk staff.

Working for another practice is an option. You can pay down some of your debt and hone your clinical chops. But unfortunately you’re at the whim of the practice or practices you contract with, and that may mean irregular hours, or shifts at different practices on different days of the week. This route keeps your options open, but without a partnership track, it won’t help you build a long-term, sustainable practice of your own. It also doesn’t necessarily provide mentorship.

Joining a dental support organization can provide stability. You know you’re part of a larger parent company that can do the heavy lifting when it comes to marketing and operations. But most DSOs are fully staffed in the major markets you most likely want to live in. They also tend to operate their practices as silos, so there isn’t a strong culture of collaboration.

![1 Vg2hh7NXlBPhCNIOz3o3aA](//images.ctfassets.net/otz9p93fkvjx/wO2JQFnsK6zbHlQTX3TvM/9c14979cb7a0d3fb2b6e928a40775419/1_Vg2hh7NXlBPhCNIOz3o3aA.jpeg)

# A fourth option: Tend

I want to personally offer you a fourth option. Tend is currently opening studios in Manhattan and Brooklyn, and we need outstanding dentists to build them into thriving practices. Most of all, we’re looking for dentists who want to change the way dentistry is perceived. To shift the conversation from fear to anticipation. Lack of trust to confidence. Pain to comfort. So-so to out of this world. We want our guests to look forward to seeing you.

Sound like something you want to be a part of? Drop us a line.

*A letter from our CEO, Doug Hudson, to dentists everywhere.*

Seltzer: How Bad Is It?

Is Brushing at Night More Important Than in the Morning?

Why Being Out of Network Can Be a Good Thing

80,000 Reasons to Stop Grinding Your Teeth

Your First Tend Visit

Dear Dentists