Quadrant Dentistry

Dec. 1, 2006
Maria Lopez is with your hygienist for her regular recare visit. She has a fractured amalgam on her first molar and three other worn-out amalgams surrounding it.

How to make it easy for patients to say ‘yes’ to quadrant dentistry

Nate Booth, DDS

Maria Lopez is with your hygienist for her regular recare visit. She has a fractured amalgam on her first molar and three other worn-out amalgams surrounding it. She could have only the first molar restored with your cosmetic restoration of choice, or she could have all four teeth restored.

Who wins if she decides to restore only the one tooth? Maria does not. When she makes that decision, she increases her chances of having an emergency situation in the future. She also will have four times as many restorative dental visits when she has one done at a time. Your dental office also loses because doing quadrant dentistry is more emotionally and financially rewarding to everyone in the office.

Here are five steps that will make it easy for your patients to say “yes” to quadrant dentistry:

  1. Understand before you seek to be understood.
  2. Don’t push. Guide.
  3. Use emotion and logic.
  4. Use a story or simile to get your point across.
  5. Ask.

Step 1 - Understand before you seek to be understood.

If you want Maria to understand what you have to offer, she must first think that you understand her. This is especially true with big decisions.

Step 2 - Don’t push. Guide.

Four things will happen if you push Maria into doing quadrant dentistry. She will feel the pressure and:

  1. push back with an emphatic “no!”
  2. put up a wall that blocks effective communication.
  3. walk out the door saying, “I’ll think about it.”
  4. say “yes” when she is in the office. After she gets home, she will change her mind, cancel her appointment, and be upset with the hygienist and you.

Instead of pushing Maria, guide her. Have her take small steps to say “yes” and give her options.

Step 3 - Use emotion and logic.

I have observed hundreds of treatment conversations between dental team members and patients. The majority of them are way too logical. This is sad because most people make decisions based on emotion, then justify their decisions with logic. In order to know where and how to use emotion, you must understand each patient’s unique emotional make-up. You learned this in Step 1.

Step 4 - Use a story or simile to get your point across.

A simile is a figure of speech in which two unlike things are explicitly compared. People love stories and can easily relate to similes. Great communicators use stories and similes extensively. Every team member should have a toolbox of stories and similes. At the appropriate time, a team member selects the one with the most impact in order to communicate effectively. Later in this article, in a sample conversation, you will learn how to use The Flat Tire simile.

Step 5 - Ask.

When it comes to doing more quadrant dentistry, if you do not like the answers you are getting from your patients, then perhaps you need to ask better questions.

A conversation with Maria

Now let’s put these five steps into action. In the dialogue to follow, I have inserted the step numbers to indicate where you are at each part of the five-step process.

Let’s assume that, because of decay under an amalgam restoration, Maria had emergency endo done on a molar three years ago. In addition, you learn she is extremely busy at work and home, and she has a difficult time squeezing dental visits into her hectic schedule. (Step 1)

At her recare visit, Maria mentions her broken amalgam. Your hygienist, Susan, sees the three worn out amalgams around the broken one. Susan does not push Maria by telling her she needs to do all four restorations now. (Step 2) Instead, Susan displays the four faulty restorations on a monitor and has the following conversation with Maria:

“Maria, as you can see on the screen, the metal filling on your lower left molar is fractured. This tooth should be restored as soon as possible. I think the doctor will recommend ____________. Here is a model showing _______________ restoration and here is why they are so good. Take a look at these before-and-after photos of people who have had their metal restorations replaced with _____________. They look great, don’t they? (Step 2) These are the same restorations I have. I love how they look and feel.

“Now, look at the monitor again and notice the three teeth around the fractured one. Do you see how the edges of these fillings are crumbling? (Step 2) I know the doctor is worried when he sees worn-out metal fillings like these. Sometimes there is decay underneath the fillings we cannot detect. Three years ago you had an emergency root canal done on a tooth that had decay under a metal filling. I am sure you do not want that to happen again. (Step 3) These three other teeth also can break at any time just like the one that is broken now. (Step 3) In addition, if we do the four restorations one at a time, you will need to take off work eight times, come to our office eight times, and we will need to numb your mouth eight times. (Step 3)

“If you choose, we can replace all four of the metal fillings at once. By doing this, we can minimize the chances of emergency situations in the future. If we do all four at once, you will need only to come in twice. I know your time is extremely valuable.

“Here is another way to look at it. The four old restorations are like old tires. Some people who buy 30,000-mile tires replace all of them at 30,000 miles so they do not have any problems. Some people replace their tires when the tread is almost gone, while others replace them when a tire blows out. (Step 4)

“I do not know how you judge this, so let me know. One of your four metal fillings has had a ‘blowout’ and the other three are at 30,000 miles. I have no idea when or where you might have another blowout. Most of our patients never want to be stranded with a dental blowout.

“Would you like to explore the possibility of doing all four restorations at one time? We can talk to the doctor when he examines you.” (Step 2)

When you enter the room, Susan recaps her conversation with Maria. You make a diagnosis and reinforce what Susan has said. After you leave, Susan quotes the fee for the four restorations, and asks Maria if she would like to proceed by saying, “Maria, would you like to have all of your tires replaced at once?” (Step 5) Susan also can have Maria meet with your financial coordinator.

To make this five-step process work, hold a team meeting at which everyone (including you) role plays the various situations in which you might talk to patients about quadrant dentistry. Then expect your team to do its part. If a team member does not, have a conversation with the person about why this is important to you, what may or will happen if he or she does not take action, and what will happen when the person does use the five-step process.

When it comes to change in your office, remember that successful people do the things that unsuccessful people do not like to do. Many dental team members do not like doing anything new. It is up to you to lead the way with your example. Expect your team to do the same. This is called leadership! When you do, everyone wins.

Dr. Nate Booth provides dentists with the information and systems needed to thrive in their dental practices. A frequent speaker to dental groups, he is the author of the books “Thriving on Change” and “The Diamond Touch,” and is co-author of “555 Ways to Reward Your Dental Team,” “How to Create an Exceptional Aesthetic Practice,” and “Unleashing the Power of Dentistry.” Reach him at (800) 917-0008, or on the Web at natebooth.com.

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