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There’s no ‘I’ in case acceptance

Jan. 1, 2021
Dr. Pamela Maragliano-Muniz says case acceptance is a group effort. She explains how an educated and empowered team, as well as educated patients, will lead to improved patient experience, patient retention, referrals, and case acceptance.

Practice ownership inspired me to focus on the art of improved case acceptance and treatment outcomes. I pursued various forms of education, including multiple courses in case presentation and countless books. I would implement some of the strategies that I learned, but much to my dismay, my practice management software reports did not reflect my efforts. As a result, I would continue the disappointing cycle of further educating myself and attempting to implement the tools I learned, only to have case acceptance that could at best be described as hit or miss.

One very important concept that I was missing is this: There is no “I” in case acceptance. If I was the only one in the practice endeavoring to motivate patients to accept treatment, it would be the same as being a really fancy boat with a large, heavy anchor. The boat might be ready, but it isn’t going anywhere. Likewise, I was ready to perform exceptional care, but without great case acceptance, my practice couldn’t thrive. 

In my experience, excellent case acceptance is most successfully accomplished as a group effort. If patients and the dental team are properly educated, the dentist’s role in case acceptance becomes substantially less arduous. The sky is the limit when you have an educated and empowered dental team. Once their education is in place, as well as patient education and empowerment, improved case acceptance will ultimately follow. 

An exceptional dental team = improved case acceptance

Each member of the dental team is extremely valuable, as each person contributes to the patient experience and ultimately to case acceptance. Providing team members with the education and tools they need to successfully accomplish their daily tasks will lead to an improved patient experience, patient retention, patient referrals, and case acceptance. 

Front office

Patients appreciate a warm, accommodating person to greet them, whether it is on the phone, via email or social media, or in person. The role of the front office staff is essential to ensure patients schedule and keep their appointments. After all, if a patient doesn’t show up for an appointment, the office has lost revenue and doesn’t even have an opportunity to identify treatment needs.

Engaging the front office team in scheduling and production goals will help provide specific daily, weekly, and monthly objectives. Implementing various software solutions may aid the team in accomplishing these goals by encouraging patient engagement, keeping track of referrals, and scheduling recommendations to improve revenue. 

In addition, it is essential that the front office team has a general understanding of how dental procedures are carried out, including treatment times and cost of care. When misunderstandings are communicated to patients, patients tend to lose confidence in the capabilities of the dental team. 

Dental assistants

The role of the dental assistant is incredibly important. The patient often communicates with the dental assistant before the dentist enters the operatory and when the dentist leaves. It is essential that the assistant understands and can effectively explain the benefits and process of recommended treatment. Moreover, this dental team member has the unique opportunity to praise the work of the dentist. The assistant observes and participates in every aspect of patient care; there is nobody better to commend the skills of the dentist and reassure patients that they are in excellent hands. Many dentists do not like to toot their own horn, so have someone else do it! 

The dental assistant can also be exceptionally useful in assessing the patient’s value system and facilitating treatment discussions. Assistants often take photographs that can be displayed on a computer in front of the patient. The use of photography to improve case acceptance is critical. Patients often have an initial reaction to seeing large photographs of their dentition, and dental assistants can support the patient to pursue necessary care. 

There are times when the dental assistant acts as a patient concierge, often accompanying the patient from the waiting area to the treatment room and vice versa. The assistant must effectively communicate essential information from the front office to the treatment room, and then treatment-related information or next steps back to the front office team after treatment is rendered. When this communication is accomplished successfully, the dental team demonstrates preparedness for that patient, and the coordination and continuity of care is improved. 

Dental hygienists

Dental hygienists are invaluable for exceptional case acceptance. When equipped with the proper technology, a dental hygienist can educate patients and motivate them to pursue recommended treatment. Utilizing a system for dental and periodontal charting that allows the patient to hear the findings of the hygienist tends to ignite the patient’s curiosity. This gives the hygienist an opportunity to discuss findings and highlight areas of concern.

Caries detection technology can provide an objective perspective when identifying dental disease. Moreover, the use of intraoral cameras is instrumental for patient education and disease acceptance. Patients often have difficulty understanding our verbal explanations of various dental conditions and treatment recommendations, and they often won’t pursue care if they are not experiencing pain or don’t understand why treatment is being suggested. 

It is essential that dental hygienists work as a second set of eyes for the dentist. Dental hygienists who understand (and ideally share) the core dental care philosophy of the practice can be extremely valuable when educating patients. When dental hygienists and dentists share a similar treatment perspective, there is a reciprocal reinforcement of care recommendations. When the two parties offer conflicting suggestions, patients often find treatment recommendations confusing, which may lead to diminished trust in their dental health-care providers. 

Hygienists have a unique opportunity to assure patients about the quality of dental work that is being performed in the practice. The hygienist visualizes and maintains these restorations, so where else can a practice find a better advocate for the dentist’s skills? 

The role of the patient

If the need for dental care is effectively communicated to patients and mindfully reinforced by the dental team, case acceptance and patient care improve. Furnishing the practice with tools to aid in patient communication and comprehension of care is essential. The use of photography and diagnostic technology is valuable. Sharing before-and-after photos or digital case renderings can help patients visualize their outcomes. When patients understand why care is being recommended and how it can be successfully accomplished, patient care and treatment acceptance will improve. 

Demonstrating preparedness for case presentations, including the financial aspects of care, is essential. Any delays in information can result in poor case acceptance. Frequent team meetings and communication can prevent delays or miscommunications in appointment scheduling and coordination of care. When patients are escorted through the entire patient experience, whether physically or educationally, they will accept necessary care. 


The role of every member of the dental team is invaluable for identifying, communicating, and ultimately recommending necessary dental care. When patients are properly educated by an empowered dental team, case acceptance is significantly enhanced.  

PAMELA MARAGLIANO-MUNIZ, DMD, is the chief editor of DentistryIQ and editorial codirector of Through the Loupes. Based in Salem, Massachusetts, Dr. Maragliano-Muniz began her clinical career as a dental hygienist. She went on to attend Tufts University School of Dental Medicine, where she earned her doctorate in dental medicine. She then attended the University of California, Los Angeles, School of Dental Medicine, where she became board-certified in prosthodontics. Dr. Maragliano-Muniz owns a private practice, Salem Dental Arts, and lectures on a variety of clinical topics. You may contact her at [email protected].

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