by Kevin Winters, DDS
By far the most prevalent dentistry involves handling urgent problems. Whether it is teeth that are creating pain or teeth that have broken in some way, dentists are involved in handling immediate problems on a daily basis.
Because the focus of many of these patients is their immediate problems, we dentists get brought into this mindset of just handling problems. We offer to fix the tooth that has broken and then the patient is happy. Unfortunately, we may not ever see that patient again until the next time something breaks.
There are several things I think can help dentists to break out of this cycle and increase the success of their practice as well as provide a much better and higher level of service for their patients. The first thing that must occur is diagnosis and communication. It is not really hard to diagnose a broken tooth. Our minds cannot be so closed to only seeing the one tooth. Even if this “emergency” has to be handled, there are ways to turn this appointment into one that is better for our patients.
For so long, dentists have suffered from the disease “non-confrontation-itis.” They question and doubt themselves: “What happens if I mention this other problem and they say no? If I tell them about this problem, they might get mad at me and not do the other tooth. Since the other tooth has not broken yet, maybe they will not believe me.”
These are all questions dentists pose to themselves when they deal with patients. Stemming from undeserved low self-esteem issues, many dentists will not confront their patients to tell them about their problems. Read that again: Their problems. The fact that Mrs. Jones has not taken care of her teeth is not our fault. The fact that Mrs. Jones has decay around her failing 20-year-old amalgams is not our fault. The fact that Mrs. Jones has MODBLXYZ fillings that need crowns is not our fault.
Therefore, we must provide our patients with a thorough and accurate diagnosis of their conditions. Now, the fun part is how to comfortably relay this information to the patient. This is where most dentists fail, and it happens at many levels. If the dentist presents the treatment, it often goes downhill.
Don’t get me wrong, there are certainly some very accomplished linguists among us, but for the most part, dentists love to talk about dentistry. The problem is that our patients do not. Even though Mrs. Jones may be shaking her head yes to the dental master’s thesis you have just proposed to her, as soon as you leave the room she asks your assistant, “What did he just say?”
Mrs. Jones is worried about picking her kids up from school in time to get them to practice, getting to the dry cleaners before they close, and handling the next board meeting she is in charge of, not anything about the bond strength of PQ1 (Ultradent) or the compressive strength of Empress (Ivoclar).
Mrs. Jones is concerned about WIIFM (What’s in it for me?). She wants to know how dentistry is going to make her life simpler and benefit her. Also, Mrs. Jones wants to hear about it in words that make sense to her and from someone she trusts. So, what’s the answer to help Mrs. Jones?
Your assistant or treatment coordinator is the ideal person to present treatment. First, Mrs. Jones usually trusts her much more than you. She is more her equal. She can relate to the assistant much more easily. As long as the assistant is properly trained, the relationship between the assistant and patient is as important if not more so than the doctor/patient relationship.
So let’s go back to this scenario of a broken tooth on Mrs. Jones. She has a broken mesial buccal cusp on tooth No. 30. This tooth has a large MOD amalgam that was placed a long time ago. Mrs. Jones does not have any pain in the tooth, but she’s very scared and concerned that her tooth has broken. In this same quadrant, tooth No. 28 has an occlusal amalgam with leaking and decayed margins. Tooth No. 29 has a large DO amalgam that has left a very thin buccal cusp. Tooth No. 31 has a MODBL amalgam that shows a radiolucency on the mesial root that you picked up on the periapical radiograph of the broken No. 30.
So, where do we go with this? There are many approaches, none of them necessarily right or wrong, just different. Let me propose a way in which I have had success handling this and see if it might work for you.
After gathering the information detailed above, my treatment plan consists of an occlusal composite on No. 28, and indirect restorations on Nos. 29, 30, and 31 along with endodontic therapy on No. 31.
Now, knowing that Mrs. Jones has come to see me just for her broken tooth, how is this quadrant treatment plan presented to her? How do we get Mrs. Jones to accept treatment that will give her a healthy and strong quadrant of teeth instead of just one tooth? It really boils down to the treatment coordinator.
Dentist: Mrs. Jones, it is very fortunate that this tooth broke.
Mrs. Jones: What do you mean, Doctor? I am very concerned about it.
Dentist: Well, Mrs. Jones, I want you to know everything is going to be OK with this tooth. I can make this a strong, nice-looking tooth for you once again. What is also fortunate, is that I have been able to see a couple of your other teeth right next to this one that have some very significant problems as well. These teeth are weakened and need attention before they break or create even more serious problems for you.
Mrs. Jones: More serious problems? But nothing else hurts.
Dentist: I’m glad to hear nothing else is bothering you. That means we have caught these problems at just the right time. I have spoken with Susan, our treatment coordinator, about what we need to do to prevent you from having further problems. Susan is going to go through some treatment options for you and answer any other questions you may have. She is very knowledgeable and I know you will like her.
Mrs. Jones: Wow, Doctor! What is all this going to cost?
Dentist: Mrs. Jones, after Susan goes over your options with you, she can let you know the costs involved depending upon what you decide to do. The great news is we can take care of this for you all in one visit. I know you are probably a very busy person and time is important to you. That’s why, if you would like, we can take care of this area for you all at the same time to make sure you don’t have any other emergencies like this broken tooth.
Mrs. Jones: OK, thank you, Doctor.
Now it’s the treatment coordinator’s turn. Because she has been trained properly, Susan knows what to say, what not to say, and how to say it. Dental words are not allowed, only patient-friendly dental talk.
Mrs. Jones’ treatment is presented in a way that is very relaxed and a report of what HER teeth have shown. It is always done in a benefits manner — WIIFM. How will this prevent future problems? How will this save her time and money?
Susan: OK, Mrs. Jones, Doctor Best Dentist has a plan that will work very well for you. Like he said, it is good that we are seeing you now. There are several teeth right next to this one that already have some pretty big problems.
Mrs. Jones: Yes, that’s what the Doctor said. What else is going on?
Susan: Well, you have a couple of fillings that have worn out and have decayed. One of them is very weak and looks like it might break just like this one. The other problem is the nerve has died in one tooth and has become infected.
Mrs. Jones: Nothing hurts, though. Shouldn’t I just wait until they break, too?
Susan: Mrs. Jones, I know just how you feel. Many of our patients have felt like you. What they have found, though, is that once these problems are taken care of, they can go about their lives with confidence and not worry about any unwanted tooth pain. The best news is that we can handle all of this for you in just one visit. You can leave with four teeth that will be strong and healthy and you won’t have to worry about them breaking or being infected any more. Isn’t it great that you can have this done and only have to get numb once and only have to be here away from your busy day one time?
Mrs. Jones: That does sound good. I’m sure my insurance will take care of this, won’t it?
Susan: Mrs. Jones, it is great that you have insurance and I want you to know we will do all we can to maximize your coverage. Most insurance policies allow a maximum payment of $1,000 to $1,500 per year for procedures. I would not be surprised to see you get your maximum coverage.
Mrs. Jones: So can I just pay out the rest?
Susan: We have several payment options available. Are finances a concern for you?
Mrs. Jones: Yes, they are.
Susan: Well, Mrs. Jones, if budget is a concern for you, we offer Mastercard, Visa, American Express, and Discover. We also have additional programs available if you need them.
Mrs. Jones: That sounds great. Can I find out about these?
Susan: Certainly. It sounds like you’re ready to get started. Let’s go get a time reserved to make these teeth healthy. Does that make sense?
Let’s look at what has happened. A broken tooth has turned from another “crown of the year club” crown into a bonded composite filling, three indirect restorations, and a root canal. This happened with just a proper diagnosis, and then the dentist stepping out of the way to allow his well-trained auxiliaries to take over. The dentist never had to have the sometimes uncomfortable discussion about fees, he didn’t have to give his master thesis on root canals, and he has turned an emergency patient into a potentially great new patient because of the care and attention she has received. Very little of the appointment even involved the dentist. So now you can see how easy it is to turn a single broken tooth into a very productive appointment that is great for the practice, but more important, provides the patient with treatment that will serve her well for many years.
No matter what the situation, start diagnosing mouths — not teeth. If there is a problem in a quadrant, give the patient reasons why it would be in his or her best interest to take care of all the teeth that need work and not just one. It is better service for your patients and much more productive for you.
Dr. Kevin Winters graduated from the University of Missouri-Kansas City in 1989. After completing a GPR at the University of Louisville-Humana Hospital, he opened a general practice in Claremore, Okla. After developing a successful general practice and being awarded the Young Dentist of the Year Award in 1995, Dr. Winters transitioned his general practice into one that concentrates on esthetics and reconstruction. He is one of the original clinical instructors at the Las Vegas Institute. He also lectures and conducts seminars across the nation. Reach Dr. Winters at (918) 341-4403 or by e-mail at firstname.lastname@example.org.