Th 310814

Ask Dr. Christensen

Feb. 1, 2009
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers.

by Gordon J. Christensen, DDS, MSD, PhD

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an e-mail to [email protected].

For more on this topic, go to and search using the following key words: practice activity, proactive patient education, CLINICIANS REPORT, patient education activities, testimonial, Dr. Gordon J. Christensen.

Q During the last few months, I have experienced a significant reduction in new patients coming into my practice and a decreased acceptance of treatment plans. This is the first time this has happened in my 16 years of practice. What can I do to increase interest in my practice, and also increase acceptance of my treatment plans?A You are not alone! Due to the world's current economic issues, the majority of dentists have observed a reduction in patient acceptance of treatment plans and some reduction in new patients. CLINICIANS REPORT conducted a survey of practice activity recently (CLINICIANS REPORT, December 2008 supplemental issue (801 226-2121) and found that 91% of dentists reported that the recent economic crisis has negatively affected their practices. However, the same survey reported that only about 50% of the respondents were implementing changes to potentially remedy this situation. You are correct in being concerned, and I agree that you must do something! I have opinions and observations from many years of personal experience with increasing practice activity. These opinions and observations developed from the stressful experience of starting four practices in different geographic locations during my career as a prosthodontist.
Figure 1 — Diagnostic casts poured in fast-setting stone (for five minutes) on the patient's first encounter in the office offer important educational opportunities for the patient and increase the likelihood of patient acceptance of the potential treatment plan.
Click here to enlarge image

The singular most influential activity that dentists can implement into their practices to increase practice activity and patient acceptance of treatment plans is to implement proactive patient education, accomplished preferably by staff personnel.

Many patients are unaware of treatment options offered by modern dentistry. Educating patients about treatment availability in your practice will help increase acceptance of treatment. Many dentists rely on only reactive patient behavior, in which the patient asks for some type of treatment.

If the patient does not request a service, the practice personnel do not bother to tell the patient about what is available in the practice. In the following narrative, I will discuss the many patient-education activities that I have long provided for my patients, and discuss ways to implement them into a practice.

1. Panoramic radiographs. Panoramic radiographs are especially helpful for patient education, because the patient can easily orient the images to their own mouth. Digital panoramic radiographs are much better than analog panoramic radiographs for patient education. You can modify them in many ways (adding contrast, cropping, magnifying) to simplify the patient educational value.

2. Diagnostic casts. You may be making diagnostic casts to be shown to new patients on a second appointment, rather than at the initial encounter in the office. I suggest making diagnostic casts on the first appointment. Have your staff pour them in fast-setting stone, such as WhipMix Snap-Stone, which sets in five minutes (Figure 1). Showing the patient casts of their mouth on the first appointment is a major educational experience for the patient. Waiting until a second appointment to do this delays the patients' decision about dental therapy and reduces the chance of the patient accepting your treatment plan.

3. Digital radiography. I strongly suggest incorporating digital radiography into your practice as soon as you can afford it (Figures 2 to 5). Although the initial digital images are not better than analog images, they can be enlarged, colored, textured, and have contrast changed, thereby increasing patient education potential and your diagnostic ability.

4. Digital photography. The importance of making and storing digital photographs cannot be overestimated. Showing prospective patients the images of other patients you have treated is an excellent motivational technique to increase practice activity. The fact that you can say that you did the treatment is highly motivational for the prospective patient.

5. Intraoral television. Some dentists have retired this influential method to educate patients. I require my staff to obtain an intraoral video view of the patient's mouth, not only at the diagnostic appointment, but also on all subsequent recall appointments.

6. Educational visual programs DVDs and/or computer programs. If a picture is worth a thousand words, then a video is probably worth a million. Understanding is achieved much faster if visual material accompanies a treatment-planning appointment. CAESY from Patterson and Guru from Henry Schein are excellent programs to augment your educational activities. However, to complete “informed consent” information necessary for legal acceptability in the event of a lawsuit, Practical Clinical Courses' Patient Education DVD, including 14 major topics, can be loaded on your server or used in a desktop or laptop computer if desired. More information on this program follows later in this column.

Figure 2 — Preoperative digital panoramic radiographs are highly valuable to show patients the pathology that exists in their mouth. They are easy for the patient to understand; whereas, bitewing or periapical radiographs are difficult for patients to understand.
Click here to enlarge image

7. Pamphlets. American Dental Association pamphlets should be in your office for the procedures you routinely accomplish. You may get information and pamphlets from the ADA by contacting (800) 947-4746 or by visiting

Figure 3 — Postoperative digital panoramic radiographs can be used as an easily interpreted educational aid when patients are considering similar therapy.
Click here to enlarge image

8. Books. There are several books that provide motivating patient- education material for patients. Place these books in your reception room or operatories, and you will be surprised by how many patients ask about the procedures. Two examples are:

a. Change Your Smile, Goldstein, Quintessence
b. A Consumer's Guide to Dentistry, Christensen, Mosby

9. Models of potential treatment. Your office should have patient-education models that show the treatment you most commonly accomplish. An excellent source of these models is Kilgore International (800) 892-9999 or I suggest that the models should be in the dental hygiene operatories where you are likely presenting treatment plans, or wherever you do your presentations of treatment plans.

Figure 4 — This digital preoperative periapical radiograph shows questionable caries that may or may not be observable to the patient.
Click here to enlarge image

10. Pictures: before and after. Making and storing before and after photos of patients you are treating is very simple if you are making digital photographs of your patient treatment and filing the photos. I suggest filing the photos by type of treatment and by patient name. You can then find them easily and show patients before and after examples.

Figure 4 — This digital preoperative periapical radiograph shows questionable caries that may or may not be observable to the patient.
Click here to enlarge image

11. Patient testimonials. I am sure that you have many highly satisfied patients who would be pleased to speak with other patients considering the same therapy that they have had. I suggest having your staff ask a few selected patients, preferable mature patients who are at home most of the time, if they would occasionally speak to potential patients on the telephone. Most satisfied patients are pleased to do so. Be sure to give them a gift, such as movie tickets, each time they talk to a patient.

12. Educated, proactive, staff-accomplishing patient education. Can a busy dentist do all of the patient education I have described? No! Staff members should be educated to the level where they can carry out this essential service. I suggest having periodic staff in-service sessions to make sure your staff is knowledgeable in all of the subjects on which you want to educate patients.

I have given you my methods for patient education which have been highly successful for me. You may have others. In my opinion, there is no method more effective to stimulate practice growth and treatment-plan acceptance than tactful, well-presented patient education. Do it! PRACTICAL CLINICAL COURSES has a 14-topic (9 minutes each) patient-education DVD in both English and Spanish. The DVD features Dr. Gordon Christensen showing the alternatives, advantages, disadvantages, risks, costs, and the result of no treatment for each procedure.

Ask for Item DP 30, “Simple Patient Education for Every Practice.”

Dr. Christensen is a practicing prosthodontist in Provo, Utah, and Dean of the Scottsdale Center for Dentistry. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Rella) and senior consultant of CLINICIANS REPORT (formerly Clinical Research Associates), which since 1976 has conducted research in all areas of dentistry.

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