Ask Dr. Christensen

March 1, 2006
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers.

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].

Question ...

I hear constantly about the need to educate patients. What methods do you consider to be the most effective educational tools?

Answer from Dr. Christensen ...

Your question is among the best ones anyone could have asked! It is one I have considered my entire career, and one I have had to make determinations on from my experience. How often do you see patients who need significant dentistry, but they do not know they do? Further, many patients could benefit from numerous elective, appearance-enhancing treatments, but they do not know about them. Years ago, as I started a practice in an area that was already saturated with dentists, I had to decide what I could do to influence patients toward accepting the oral care I suggested for them. After long consideration, I arrived at an answer that has proven to be correct and successful. I decided to develop a highly effective patient-education program. Years later, after having to recruit several other dentists to support my ever-growing prosthodontic practice, I knew that the decision to emphasize patient education had been correct.

There are many ways to educate patients, and several different beliefs concerning which way is best. I prefer to determine patients’ needs and apparent wants on their first visit with the practice. It is easy to see and convince patients about their oral needs, but their wants must be encouraged by you or your staff. As an example, let’s say that the patient could use ceramic veneers. Most patients know nothing about tooth veneers. I prefer to briefly, but thoroughly, educate them about the concept of veneers during a dental hygiene or diagnostic appointment. While the dental hygiene or diagnostic data collection is being done, a staff member shows a video that describes the essential characteristics of veneers, their alternatives, advantages, disadvantages, risks, costs, and other related topics. The staff person follows up after the video with further information and answers any questions the patient may have. I come into the operatory for only a few minutes to complete the educational experience. The result is amazing! Most patients, after seeing and hearing this information about veneers, want to have them.

A variety of patient-education programs are available to dentists. Some are interactive and require the dentist to be present to compile and disseminate the data to the patient. Others are brief, concise, and self-explanatory, allowing the dentist to treat another patient while a video is shown. Some are expensive, and others are more moderate in price.

I suggest you obtain the program of your choice to educate patients, and that you educate your staff to follow up after the presentation. I know that you will have success in educating your patients, and that acceptance of both “need” and “want” dentistry will be high!

Recently, we made a new DVD series of 14, nine-minute, patient-education programs on the most accomplished procedures in dentistry. These videos will allow you to educate your patients with ease and thoroughness and - after a brief discussion with you or your staff - it satisfies informed-consent needs. For more information, contact Practical Clinical Courses at (800) 223-6569 or visit our Web site at

Question ...

I am confused about dentin bonding agents. It seems that every journal I pick up has another “generation” of dentin bonding promoted. I am satisfied with the bonding agent I am using currently. Is there a reason to change to another one and, if so, why and which one?

Answer from Dr. Christensen ...

You are not the only confused dentist! The continuing introduction of bonding agents and the attempts of manufacturers to convince you to change to a new one have been unfortunate. The “total-etch” concept, popular for many years, was effective when used on dentin if accomplished proficiently and correctly. It still is the technique of choice for surfaces that are all enamel. Many dentists are using total etch today on both dentin and enamel with success and patient satisfaction. However, some dentists report postoperative tooth sensitivity with the total-etch products used on dentin, and the change to the less sensitivity-producing “self-etch” bonding concept has been rapid and impressive.

The many self-etch products have provided minimal postoperative tooth sensitivity and more patient satisfaction than the total-etch products. At this time, Kuraray Clearfil SE Bond has achieved high popularity among dentists because of its obvious prevention of postoperative tooth sensitivity. That same company has produced two later products, Clearfil Protect Bond and Clearfil S3 Bond. But most of the users of Clearfil SE Bond continue to use it instead of the newer products. This observation is evidence of the obvious success of Clearfil SE Bond and the reluctance of practitioners to change when a product is working well. Numerous companies have made two-bottle, self-etch bonding products to compete with Clearfil SE Bond. Based on research from Clinical Research Associates, they are bonding to dentin in-vitro as well as SE Bond. But apparently, dentists prefer to stay with one product and are not convinced that the newer-generation products are better.

There is a current trend to one-bottle bonding agents, such as GC America’s G-Bond, Heraeus Kulzer’s ibond, Parkell’s Brush&Bond, Kuraray’s S3 Bond, and numerous others. All of these one-bottle products have thinner film thickness and relatively easy-use characteristics. In our in-vitro research, these products are producing bonding values similar to the previous thicker products. The proof of their success must be observed during the coming months as postoperative tooth sensitivity and long-term retention of restorations can be evaluated subjectively in clinical practice.

To summarize these observations, if you are satisfied with the overall clinical success of the bonding agent you are using - and you are not experiencing postoperative tooth sensitivity - keep using it! The minor changes and “advancements” of the newer products may be statistically significant compared to older products but probably have little or no major clinical significance. For most of my career, the bonding agents available were adequate and most of us had few clinical failures. Clinical success is the final test!

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known “CRA Newsletter.” He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

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