Big Cases

By Marc Schlenoff, DDS

For the past 10 years, I have had the honor and privilege to be an instructor at the Aesthetic Advantage Hands-On Symposium at the NYU College of Dentistry in New York, as well as being an instructor at the General Practice Residency at Morristown Medical Center. During this time, the most-asked question from students and residents has been, "How can I do more of the big cases in my practice?" I think that in today's world of economic uncertainty, the answers to this question are significantly different than even several years ago.

There was a time not that long ago that I would have answered this question by using examples of advertising and marketing to draw patients to the office, specifically for esthetic treatment. There was a buzz about cosmetics, and the primary goal was to attract those people who had already made the decision to have these procedures done. But times have obviously changed, and the answers that I now give are different.

The keys to being able to attract the large restorative cases in today's world are communication and treatment planning. The number of patients coming in exclusively for esthetic dentistry has declined significantly in most practices, but the need for restorative care continues to grow as our baby boomer generation (myself included) continues to wear and break their dentition. This is the patient population that needs comprehensive, and thus esthetic, dental treatment.

Many of these patients are unaware of the options that are available to them in the modern dental practice. It is our obligation to open patients' eyes to the possibilities that exist for them. Recognition of declining dental health, particularly in long-standing hygiene patients, should not be ignored or glossed over. This can be a difficult conversation to have, and it must be presented in such a way that the patient does not feel that his or her health was overlooked in previous visits.

An example of a way to begin this discussion would be, "Mrs. Smith, we know that as time goes by, the teeth undergo a process of wear and tear. It eventually reaches a point at which we need to intervene to stop the process and restore your mouth to optimum health so that, going forward, you will not have to worry about continuing breakdown." In this way, there is an acknowledgement of a problem, and also of an available solution, and an opening for future conversations. Obviously, the ability to recognize occlusal instabilities, restoration breakdown, and other signs of chronic diseases of the dentition is essential.

I have also found that people are taking a longer time to make major financial decisions in all aspects of their lives. Certainly dentistry falls in this category. This creates a situation in which dentists must communicate with great precision regarding the needs and wants of patients. In Dr. Daniel Goleman's book, Emotional Intelligence, he discusses in great detail the different personality styles of people and the ways that they should be approached in order to connect with them.

As an example, the middle-aged woman whose daughter is getting married and wants to enhance her smile must be approached differently than a 65-year-old who is about to retire and wants his or her teeth fixed before retirement. Ironically, the treatment plans for these two patients might be exactly the same, but the communication techniques used with each must be very different. The awareness of patients' "EQ" is essential in getting them to appreciate the treatment that we have to offer them.

In 2014, it will not be the goal in our practice to "hit a home run" with each and every new patient who has entered the practice. More realistically, we will attempt to accurately diagnose all existing problems, discuss treatment options, create a priority list, and develop a relationship of caring and mutual trust. In this way the table is set for the "big cases," whether they are done at the beginning of the relationship with the patient or at a later time when that treatment fits in with the person's life more comfortably.

Marc Schlenoff, DDS, is president of MDS Dental Solutions, which helps young dentists successfully transition into the dental profession while also raising the level of execution in established practices. A practicing dentist, he is on staff at Morristown Medical Center. Reach him at (973) 886-7192 or at [email protected].