The new-patient experience: a cosmetic focus

March 1, 2008
What happens when a new patient enters a dental practice? What experiences will tell a person that he or she has found a new dental home...

What happens when a new patient enters a dental practice? What experiences will tell a person that he or she has found a new dental home and which experiences will tell the new patient to keep looking? While each person is unique, rest assured that new patients want to find a dental team that is genuinely interested in them, and one that is able to develop a relationship and meet their needs. This is especially true when addressing cosmetic considerations since patients have their own ideas about esthetics.

To be successful with comprehensive care, including cosmetic dentistry, developing a relationship-based practice is a key factor. As with all relationships, the beginning phase is an introduction. This begins with a patient’s first phone call to the dental practice, followed by the first visit. The second phase is an interview process in which the dental team learns about the patient through active listening and questioning. Understanding a patient’s desires and concerns is the most critical element of the entire process. The interview is followed by the third phase — an educational process that requires the dentist and team to build value and trust, while motivating and inspiring a patient to pursue comprehensive esthetic care. The fourth and final phase is a patient’s decision to maximize his or her dental health and esthetics with the most appropriate plan considering the patient’s unique life circumstances, needs, and desires.

Phase 1: The Introduction

The initial phone call is a patient’s first impression of the dental practice. When a patient has cosmetic concerns, he or she often has an increased sensitivity for the quality of care and concern expressed by the receptionist during the phone call. Therefore, it is critical that there is plenty of time for the call so it is unrushed, and informative, in a friendly and caring manner.

Similarly, upon arrival, a patient experiences other important first impressions about the dental team and facility. The staff’s and dentist’s appearance and manners during this stage can impress a new patient positively or negatively. Therefore, awareness of the environment of the practice is important.

Since the phases of developing the relationship overlap, the dental team can learn important facts about a patient during the first phone call and during the office tour and staff introductions. In my practice, the receptionist gives the new patient an office tour upon arrival. During this time and the initial phone call, she notes important concerns, desires, and life circumstances that the patient has shared with her. The receptionist then relays this information to me before I meet the patient.

Phase 2: The Interview

Understanding a patient is the most important aspect in developing a relationship. This is accomplished by listening to the person’s concerns and asking questions to help him or her explain further.

To better understand a patient’s desires and circumstances, the interview should begin with questions about any problems, then progress to needs-benefit questions. For example, if the problem is that the patient has gaps between his or her teeth, then follow-up questions would be:

“How do the spaces between your teeth affect you in social situations? How much do you need or desire treatment due to the problem? What would change for you if the gaps were closed? What are the benefits of treatment?”

Most clinicians routinely ask problem questions; however, many fail to proceed to a deeper level of interviewing that comes through the use of needs-benefit questions. When the dentist understands the degree and importance of the dental problems, and how a patient’s life is affected by these issues, he or she can address the problems more appropriately.

My friend and colleague, Dr. Lynn Jones, an Accredited member of the American Academy of Cosmetic Dentistry who practices in Bellevue, Wash., also begins her initial exam with problem questions followed by needs-benefit questions. She then arranges the examination in the sequence that is most effective for a patient. She has found this approach significantly helpful in deciding whether to emphasize esthetics in initial discussions with a patient. Once we know the degree of concern associated with the problem and understand a patient’s desires, we can move into a third phase.

Phase 3: Educate and motivate

In this phase, we offer the patient options so that we can co-discover the most appropriate solution. But it is important to fully develop the problems before presenting solutions.

For example, a patient’s chief complaint might be that he or she wants a more attractive smile. Thus, you note in your exam that the anterior teeth are extremely worn, creating posterior interferences.

A patient should understand that there are dental health benefits, as well as esthetic rewards to be gained from comprehensive, restorative care. Digital images of retracted views that reveal wear and abfractions are effective communication tools to educate a patient about his or her condition.

Presenting the problems before the solutions is important. When a patient understands all the benefits, more value is built. In other words, the bite will be rejuvenated along with the smile makeover. This creates twice the value because the patient’s present bite is causing serious problems to his or her dentition and masticatory system.

Once a patient fully understands the dental health and esthetic problems, there are a variety of methods and techniques that help the patient visualize the solution and understand the benefits. These methods are educating and motivating. Dr. Nils Olson, an Accredited AACD Fellow who practices in Fredericksburg, Md., shows his patients digital images of completed cases with similar clinical issues. In this way, patients learn about treatment options as they develop an appreciation for Dr. Olson’s clinical ability.

Another effective way of educating and motivating patients is having a well-designed Web site that shows a range of clinical cases and informs visitors about special interests and credentials. Moreover, a well-informed and enthusiastic staff with a passion for dentistry and a genuine sense of caring similarly can reflect the capability of the team.

I routinely offer my patients a trial smile where I temporarily place a composite over unprepared teeth. This method allows patients to actually see and feel the results of the proposed treatment plan, as well as experience the clinician’s touch.

After viewing their trial smile on a chairside monitor, most patients become more enthusiastic about esthetic restorative treatment. Each of these ideas demonstrates the capability of the cosmetic dentist and can instill hope and confidence, build value, and eliminate the fear of the unknown. These factors lead to the final phase of a patient’s decision to proceed with treatment.

Phase 4: The patient’s decision to proceed with treatment

At this point, Dr. Betsy Bakeman, an Accredited AACD Fellow who practices in Grand Rapids, Mich., adds a confirmation question. Once a patient understands the time and cost involved in the proposed treatment, Dr. Bakeman specifically asks, “Is there anything that would prevent you from obtaining the treatment that we have planned?” In other words, does the treatment work with the patient’s schedule, lifestyle, and financial situation? This confirms that Dr. Bakeman has properly understood her patient’s needs and concerns. If there is a problem, she can make appropriate adjustments to help the patient overcome these hurdles.

The final decision happens once the dental team has successfully completed its interview, and has educated and motivated the patient. When a patient’s life circumstances are aligned with the financial commitment and time involved for esthetic, comprehensive, restorative dentistry, the patient and clinician are ready to proceed. Be prepared, however, for smaller commitments to be necessary from the beginning of the relationship. Early on, the patient may be asked to commit to an array of records to explore the options of comprehensive care or further examination and bite analysis. This might be followed by a consultation or initial splint therapy. In essence, each appointment may require a journey through each of the four phases.


One of the most important principles of the four phases — introduction, interview, education and motivation, and decision — is that each phase must be accomplished in order. The old adage, “They don’t care how much you know until they know how much you care,” is reflected in these ideas. Therefore, the interview, which involves listening and questioning at a deeper level, must precede education and motivation. Also, the data gained during an interview enables the dental team to understand not only a patient’s prioritized needs and desires, but also his or her life circumstances. With this knowledge, the dental team can help a patient understand options and potential. Then the patient and the dentist can work together to create the most appropriate treatment plan. This approach builds trust and creates a relationship-based atmosphere that is necessary for comprehensive, restorative dentistry.

Susan Hollar, DDS, has maintained a private practice in Arlington, Texas, since graduating from Baylor College of Dentistry in 1980. She was accredited by the American Academy of Cosmetic Dentistry in 1999. In addition, she is a visiting faculty member for the L.D. Pankey Institute, an AACD examiner, and serves as a contributing editor for the Journal of Cosmetic Dentistry.

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