Figure 1: Impression for a single anterior crown and an upper partial

What does patient comfort mean?

June 27, 2022
Dr. Jeffrey Hoos says the business of dentistry can be successful only when patients are comfortable and want to return to the practice. He illustrates with an analog impression.

Are you working toward your goal of building a better practice using Practice Building 101 ideas? Remember, it is the implementation of these concepts in total that really help. Like any team sport, it is not one member of the team or one single play that ultimately wins the game. Creating your mission statement, offering exceptional services, providing yes as the answer, focusing on patient comfort, and climbing the ladder toward success require commitment to the process. If I can do it, then anyone can.

All patients have had previous dental experiences—except someone who has never been in a dental office—but do you think they’ve all been positive experiences and that all of them were “comfortable”? One’s experiences in any situation lead to an assumption about how future experiences will be. Think about your own experiences. If every time you went into a store you had a bad shopping experience, you would stop going unless you had no choice. If it were the only clothing store that would accept your form of payment, for example, then you would have no choice. “I owe my soul to the company store.”

Dental insurance plans require that I only see a dentist who is in my network. I am not bashing dental insurance plans, but I am saying they limit the patient’s choice of treatment options. Can you create a comfortable environment and perform dental procedures that are comfortable for someone who is willing to be a fee-for-service patient? I believe you can, because if anyone can...

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I am a fee-for-service dentist. Creating a comfortable environment is relatively easy, but doing procedures that are comfortable requires a different way of thinking. This is an easy way to reframe your thinking: think about your own experiences. This will help you put yourself in your patients’ shoes as you seek to understand their perceptions of the dental experience. As I have said many times, patient comfort is one of the most important things that you can do. I want to hear “I feel so comfortable in your care” from my patients, because then I know we’re doing great things. It makes my heart sing.

Let’s look at a simple dental procedure that’s done every day in dental offices—taking an analog impression for a crown. Yes, I am using the word analog, not digital. Digital impressions are the “latest and greatest” but not everyone can afford or wants to invest in the technology. We have four intraoral scanners (we have embraced digital technology), but every day we still take conventional impressions because sometimes it’s just easier.

Let’s go through the process. While we do this procedure almost every day, it could be the first time for the patient. Keep in mind that ensuring the patient’s comfort in number one. Placing the impression tray in the patient’s mouth can be a challenge because one size does not fit all. We’ve all been there. When you find that the tray doesn’t fit and that it’s not comfortable for the patient, sometimes you have to use a single-sided tray. Yes, I know—it’s not ideal, but there are ways to get this to work perfectly. How about packing cord around the tooth? It’s always comfortable for the patient (you know I’m kidding). The patient may be numb (because you did a “painless injection”) but the tissue can be sore afterward. Let’s try to avoid packing cord and still get a great impression. Did you remember to take the counter model, or maybe you can take the counter model at the same time you do the crown impression.

Many people know that I innovated the Hydraulic and Hydrophobic (H&H) Technique many years ago, and dentists have had great success with it. Some dentists complain that the crowns are too tight or too high or just do not fit. Some claim that the H&H impression method doesn’t work. Well, if it’s not working for you, don’t do it. But know that the H&H was created with the patient’s comfort as the first thought.

Here is a simple combination case (figure 1) of an upper anterior single crown (the easiest thing in dentistry to do, matching a single crown...NOT) and a removable partial denture. The crown’s margins need to be done with a master impression for the partial denture framework. What seems hard is actually easy; the hard part is keeping the patient comfortable.

The “triple tray” is placed in the patient’s mouth, making sure they can bite down in full bite. Load the tray with the heavy body impression material one side at a time, keep it in the patient’s mouth, and have them close and wait for the material to set. Without removing the tray, have the patient open, then rinse and dry the preliminary impression and put the light body impression material in place. Have the patient close and wait for the material to set. There you have it!

I use Honigum (DMG) material because of its properties. Using the heavy body and light body together allows the dentist to get the impression required—but more importantly, the patient is comfortable. The heavy body (Honigum) is used first and the light body is placed inside the impression. When the patient closes and clenches, the hydraulic pressure captures all the details including the subgingival margin.

I realize that this is not a technique column, but my purpose is to illustrate that the impression procedure can be very comfortable for the patient. From the beginning of Practice Building 101, I have spoken about balancing the art, science, and business of dentistry. In other words, doing beautiful dentistry based on great science within a business model that works. Some dentists say, “I don’t care how long it takes to make a great impression.” My response is always, “I know someone who cares and it’s the patient.” The business of dentistry can only work if things are done efficiently and patients want to return because the practice and procedures are comfortable.

Whenever someone complains—either verbally or through body language or wincing or moaning—about being uncomfortable, pay attention. Think about what you can do to improve the procedure for your patient. Remember your mission statement: Providing the highest quality care for the most people, while maintaining the balance. Businesses will only grow and be successful when patients are comfortable. 

Editor's note: This article appeared in the June 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

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