Th 123028

The single-tooth Syndrome

April 1, 2003
Treating patients one tooth at a time can be hazardous to the financial health of your practice. The cure? More quadrant, arch, and full-mouth dentistry.

by Nate Booth, DDS

Click here to enlarge image

How can dentists increase the quality of care they provide to patients? By doing less single-tooth dentistry and more quadrant, arch, and full-mouth dentistry. Want to build a team that enjoys delivering top-quality care? Do more dentistry on fewer people. Want to boost your income and enjoyment of your profession? Do an additional three or four comprehensive cases each month.

The "single-tooth syndrome" is a disease that infects most of the offices I coach. It robs your patients, your team, and you of the benefits of modern dentistry. Luckily, it can be cured.

However, to understand the cure, we must first understand the causes. Let's take a quick look at the two primary culprits: 1) Insurance: Patients who focus on yearly insurance maximum benefits. (We will discuss this one in a future issue.) 2) Iatrogenic: Dental teams that diagnose and treat individual teeth reinforce this concept with their patients. This is the primary cause of single-tooth syndrome; let's analyze it more thoroughly.

The cure for this problem is simple: Don't talk to patients about one-tooth problems and one-tooth solutions. Talk to them instead about problem areas and comprehensive solutions. A problem area is a collection of problems that can be solved with one type of treatment. For example, posterior teeth that are decayed, fractured, have broken or worn-out amalgams, or have faulty PFM crowns are one problem area. This problem can bsolved with a single, comprehensive solution: bonded, tooth-colored inlays, onlays, and/or crowns.

Discolored, worn, and crowded anteriors are another problem area. The problem can be solved with porcelain veneers. Generalized periodontal problems can be solved with comprehensive periodontal treatment. Lost teeth can be solved with implants or bridges.

In most dental offices, the creation of the Single Tooth Syndrome begins during the patient interview. The patient

In most dental offices, single-tooth syndrome begins during the patient interview. The patient might say, "I have a broken filling on the upper right side." The team member then answers, "I'm glad you brought that up. I'll make sure the doctor takes a look at it when she does your exam."

Do you see what I'm talking about? The patient discusses one tooth and the team member reinforces the one-tooth mentality.

Try the following conversation instead:

Patient: "I have a broken silver filling on the upper right side."

Team member: "I'll make a note of that. Have you ever broken mercury/silver fillings before?"

Patient: "Yes, it's happened quite a few times."

Team member: "Wow, I'll make a note of that. And every time this happened, the fillings got bigger?"

Patient: "Yeah, I guess they did."

Team member: "Have you ever had a time when the tooth around the filling fractured away?"

Patient: "Yes, that's happened too. The last time I had to have a root canal and crown."

Team member: "Oh, that's too bad. How did the root canal go?" (Any time you discover that patients have had root canals, ask them, "Why did that happen?" and "How did that go?" Their answers will give you valuable information you can use later. You can show your patients how your recommended treatment will prevent this experience from reoccurring.)

Patient: "It was pretty bad. They had to do the root canal twice."

Team member: "That's too bad. It sounds like you've had quite a few problems with your fillings. About how many of them do you have in your mouth now?"

Patient: "Oh, I don't know. They're on all my back teeth. I'd guess about eight."

Team member: "I'm glad you've told me all of this. When the doctor does your exam in a couple of minutes, I'll make sure she takes a look at all of them."

Do you see what just happened? The patient brought up one tooth, and the interviewer expanded it into a problem area.

In most dental offices, the single-tooth Syndrome builds steam during the examination and charting, then peaks at the treatment conference. Of course, a thorough examination must include a careful evaluation of each tooth. However, dentists too often will present the case one tooth at a time. This is a bad strategy for two reasons:

1 You completely lose patients after two or three teeth. You're not doing them a favor by doing it this way. You're confusing them.

2 You create the "menu effect." The patient says, "I'll have one of those, one of those, and one of those."

Dentists must approach treatment differently. They need to focus on problem areas and comprehensive solutions, and then give their patients several great reasons why single-tooth dentistry is not in their best interest.

For example, "Maria, you have eight teeth that have large fillings. Two of the teeth have broken fillings, while another has decay around the filling. One tooth has a big crack in the part of the tooth that supports the filling, and the rest are just worn out. The best way to restore these eight teeth is with tooth-colored restorations that are bonded right to the teeth.

"Now, we could do these eight restorations one at a time. However, this would require two visits to do each restoration. That means you'll be coming in 16 times. You'll have to take off work 16 times. Plus, it's very difficult to make the color and shape of the restorations match if we do them one at a time.

"It's much better to do them all at once. This approach would mean just two visits instead of 16. We can start next week and be completely finished in three weeks. You'll only have take off work and come in twice. Plus, the color and shape of the restorations will match perfectly. This is the type of treatment I would want for my wife should she require similar treatment.

"Your investment in your oral health will be $7,500. There are several payment options we can discuss that will help you fit this into your budget comfortably. We need to decide the quality of care you want, then talk about finances. If this works for your budget, and we can get you your maximum insurance benefit, is this treatment acceptable?"

Patients typically have one to four problem areas. Discuss them one at a time. Then, quote a fee for the entire case and ask them to proceed. If they can't, show them how they can do the care in two phases. If they can't handle that, move to three phases, and so on.

As you can see, the single-tooth syndrome has as much to do with your team's attitudes, actions, and choice of words as it does with your patients. From the very beginning, dentists should focus on problem areas and comprehensive solutions. And getting your whole team on board will cure the single-tooth syndrome in your office permanently.

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