Presenting crown and bridge

Nov. 1, 2003
I recently consulted in a successful, 20-year practice. A report that I always generate and review with the doctor and team is the "Unscheduled Dentistry Report."

Annette Ashley Linder, BS, RDH

I recently consulted in a successful, 20-year practice. A report that I always generate and review with the doctor and team is the "Unscheduled Dentistry Report." In this particular practice, that amount of unscheduled dentistry was valued at over $500,000! While this amount might seem staggering, it is not at all unusual. I see varying levels in every practice where I consult.

There is a multitude of reasons that contribute to why patients are not scheduled for treatment. We could fill several books and many lectures on this topic. For the purpose of this column, allow me to present some thoughts on the hygienist's role in presenting crown and bridge.

The hygienist is in a very unique position to set the stage for and present the benefits of crown and bridge. Patients often look to the hygienist for help in decision-making. Ideally, seeing the patient on a continuum — every three, four, or six months — allows the hygienist to develop personal and professional relationships. (Many hygienists report that it is these relationships that make their work rewarding.) With that in mind, here are five ideas that we incorporated into this practice's hygiene procedures to boost crown and bridge acceptance.

1) Morning huddle and auditing patient records
The hygienist reviews patient history, identifying "undone" dentistry, prior conversations, and discussions. There is a brief discussion to give the doctor a "heads up" reminder and to solicit feedback about the patient from other team members. Because this office was entering treatment into the computer, we decided to print and use the Route Slips and to highlight the proposed treatment (as a physical reminder for us). Now the hygienist is prepared for each patient with appropriate visual, audio, and written patient-education materials.

2) Intraoral camera and facts and findings
The hygienist performs an intraoral examination so that the patient can see the screen and ask questions. Using a laser pointer, she identifies the areas being discussed. The hygienist can "show" the patient that the fractured tooth has not improved — and possibly the fracture is larger — since the last visit. Pictures are captured on the screen for both the patient and the doctor to see.

Many of my consulting clients have established general guidelines for camera utilization:

• The doctor expects to see at least one image (if not several) on the monitor when entering the hygiene room.
• When the doctor arrives for the examination, the hygienist reports the treatment discussed and the patient's current status.

By following this protocol, the doctor knows exactly what has occurred and can continue the dialogue in a timely fashion.

Note: Now is the time to review or create a protocol for camera utilization. Hold a staff meeting in which all team members have the opportunity to "be the patient." Once comfortable with utilization, most hygienists (and the entire staff) will not part with the camera. It's the best tool for educating, motivating, and case presentation, and it builds compliance at the same time.

3) New patient recall exam — status update
Because of time constraints at the hygiene (recall) appointment, many patients are maintained for years with periodic oral exams. This does not leave time for appropriate case presentation. When auditing patient records, identify patients whose last comprehensive exam was more than three-to-five years ago. Whenever there is an opening in the hygiene schedule (an appointment cancellation or failure), maximize the time efficiently by proceeding with an updated status exam. This can and should be part of every day's work with identified members of the team who are skilled at case presentation. Some practices have assigned a treatment coordinator to assume this role.

4) Use the camera to tour the mouth at the periodontal evaluation appointment, commenting on how well the tissues have healed. While doing this, the hygienist might say, "The active infection is gone and the tissues are stable. I know that Dr. Jones can continue to restore the function of your teeth by placing the crowns (or the bridge) to replace the missing teeth now that we have achieved a strong foundation."

5) Make sure that your hygienist is aware of your practice philosophy and your expectations. Does the hygienist know your parameters for placing a crown and how you want this presented to the patient? This is easily accomplished through regularly scheduled hygiene and doctor meetings in which initiative and responsibility are encouraged. Happy Thanksgiving to all!

Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. Since 1989, she has presented more than 350 seminars and consulted in dental practices throughout the world. She is a featured speaker at dental meetings and provides in--office consulting services with her team of business and clinical consultants. She may be reached at her Web site at, via email at [email protected], or by phone at (804) 745-6015.

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