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Preventing ”No thanks” to optimal dentistry

Jan. 1, 2007
Dentistry, like medicine, has come a long way from the days when diseases were diagnosed and treated only after symptoms were so painful or uncomfortable they could no longer be ignored.
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Dentistry, like medicine, has come a long way from the days when diseases were diagnosed and treated only after symptoms were so painful or uncomfortable they could no longer be ignored.

Today, dental practitioners, like their medical colleagues, focus on preventing problems rather than waiting to correct them. They recognize that early detection and early intervention can mean more effective treatment and a greater chance of cure. They also recognize that some areas of oral health, specifically periodontal problems, require proactive maintenance that goes beyond the annual or semiannual PMV (Preventive Maintenance Visit). In other words, optimal dentistry in today’s practice means a healthy combination of prevention and maintenance and is a long-term partnership between the dentist and the patient.

Most dental patients know this, more or less. Those who know it more are easier to work with and benefit from better oral health. Those who know it less are harder to work with, and ignore small problems until they become big problems, which often require emergency attention or expensive corrective procedures. These are the patients who hem and haw about rescheduling PMVs or periodontal therapy re-care visits, complain about fees, and come up with all kinds of reasons for delaying or avoiding recommended treatment. They have different names and different faces, and dealing with them proactively means understanding what makes them tick. Most fall into the four groups outlined below.

Patient mentalities

Self-destructive patients live in a state of denial. Often irresponsible, they view all dentistry from the philosophy of“if it ain’t broke, don’t fix it.” If something goes wrong, they are surprised, annoyed, and expect you to fix it quickly, painlessly, and terminally. They don’t want to hear that the appropriate “fix” generally means routine follow-up visits to control an existing problem.

Phobic patients are afraid of pain and are often anxious about sights, sounds, or sensations associated with visits to a dental office. Quite often, their emotional barriers to optimal dentistry are the result of previous bad experiences in someone else’s practice. When you inherit this patient, you also inherit his or her baggage.

Bargain-hunting patients begrudge every dollar spent at your practice, pay bills reluctantly, and may even request “special” financial arrangements (i.e., discounted fees). The idea of paying for more than one visit a year (or even one visit a year) is anathema. Whether they come or not, these patients seldom feel they are getting their money’s worth.

The “world owes me a living” patients are egotistical nitpickers who will find fault with your practice, your staff, and any therapy you recommend on principle. They are never satisfied and are likely to reject your advice about optimal dentistry because it is simply too inconvenient, too expensive, too time-consuming, too painful, or too boring, and should be happening to someone else instead.

Your response to all four groups of patients may be: “I don’t need these people in my practice anyway, so who cares?” The problem with this is that most dental patients fall into one or more of these categories to some degree. If you ignore this, you may be cutting off your nose to spite your face. Ignore it long enough and often enough and you risk seeing your practice numbers dwindle rather than grow.

The good news is that all of these patients can be taught the error of their ways and can become the kind of patients you want to work with: those who understand the value of optimal dentistry and are willing to put their money where their mouths are - figuratively and literally!

Re-educating your patients - and you

The first of many facts you need to face is that patients don’t like to visit dentists. The good ones are usually diligent about showing up for their PMV and recare appointments but, like W.C. Fields, they would probably rather be in Philadelphia. Even your best and most compliant patients will occasionally have a bout with the flu or a funeral or an emergency business trip that comes up on the same day as a scheduled appointment. It should therefore come as no surprise to anyone that telling a patient he or she needs to come in every six, four, three, or two months means putting on the emotional flak jacket and being prepared to duck!

Any good military strategist will tell you that the best defense is a good offensive maneuver and that a preemptive strike is often the difference between victory and defeat. While this may sound “hawkish,” excellent dentistry cannot always be passive or pacifist. Any good financial advisor will tell you that the best way to improve your financial health is to learn to invest in things that will increase in value: blue chip stocks, real estate, cutting-edge technology that is certain to revolutionize some aspect of medicine, energy, manufacturing, or other field. The astute dentist can apply both of these philosophies to optimal dentistry by teaching even the most skeptical and dubious patients about the multiple benefits of investing in excellent oral health.

You cannot achieve this by compromising on re-care or by catering to denial, phobia, egoism, or tightfistedness. You do it by reeducating patients in a manner that prohibits denial, makes patients feel secure and comfortable, makes patients accept responsibility for their oral health, and makes investment in oral health attractive and desirable. Doing so means helping patients make the leap from “I can’t afford this” and “I don’t like this” and “I don’t need this” and “I’m terrified of this” to “This is a terrific investment that will pay off for me in the long run.”

And here it is time to interject something about educational experts and innovators who explore processes that improve teaching methodologies and make even the most onerous lessons learnable. Students (and patients) are far more willing to learn if they see a purpose for learning. And that purpose must extend far beyond a test grade or a year-end report card. The lesson must have a longer-term value and must contribute to some future well-being.

Teaching your patients to understand the difference between the dental junk bond and the dental blue chip stock works the same way. When they learn the difference and learn to see the long-term reasons for optimal dentistry, they are more likely to make the best investments that a dental practice can offer. In fact, you have made it impossible for them to avoid optimal dentistry.

Clinical excellence will take you part of the way, but it must be matched by excellent communication - before, during, and after treatment. Before any procedure begins, the dental professional should explain what is going to happen. The rule to follow here is to steer clear of anything that sounds like “dentalspeak.” The most effective presentations emphasize what treatment will do for the patient, both in the short term and long term. Before any procedure begins, confirm whether everything was understood and get the patient’s permission to begin. Leaving out any one of these components leaves you vulnerable to patients complaining that they did not know what they needed to know before you started treatment. See sidebar on page 76.

Make certain everyone in the practice adheres to a “customer comes first” philosophy and that no one in the practice is negligent about customer satisfaction. For most patients, optimal dentistry is not just something that happens in the operatory. It is a composite of experiences, which includes what happens during telephone conversations, while the patient is sitting in the reception area, the moment the patient is presented with a bill, all correspondence, and even post-treatment comfort or discomfort.

You have already learned to integrate preventive, restorative, and cosmetic dentistry into an indivisible whole. When you expand the parameters of this integration to include financial, educational, and attitudinal elements that make optimal dentistry a desirable investment, everybody wins.

Cynthia McKane-Wagester, RDH, MBA, a practicing hygienist, is president of McKane & Associates, a full-service management consulting firm. She is the author of “Dental Hygiene: The Pulse of the Practice,” a book on the business of hygiene. McKane-Wagester is co-founder and director of the Chesapeake Institute for Dental Studies, an educational enterprise that promotes teamwork through the integration of clinical excellence with business principles. She can be reached at [email protected], or at (800) 341-1244.


Keep patients involved -

  • Show radiographs and let the patient see what you see.
  • Use the intraoral camera and allow patients to take a virtual tour of their own mouths.
  • Balance bad news with good news. Patients who hear nothing but bad news become overwhelmed and discouraged.
  • Address problem areas specifically. Do not generalize and do not address six major problems at once.
  • Long-term commitment to excellent oral health care means pacing the patient. A patient who thinks “everything is wrong” is likely to give up before beginning.
  • If treatment requires multiple visits, say so up front. Patients do not want to be surprised after the fact.
  • During re-care visits, motivate patients by praising appropriatehome care and letting patients know of any improvements in the conditions being treated. Patients who know progress is being made will be relieved; patients who are encouraged rather than criticized will be more likely to stick with it.
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