Ask Dr. Christensen

June 1, 2007
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].

Q What is the easiest and best way to educate unknowing patients about new concepts and techniques in the profession? Should I take the time to do it personally, or is it a staff function? If it is best as a staff task, how can I educate staff members enough about the subject to provide effective education for patients?A I hear this question many times. I have often said, and firmly believe, that the difference between a practice with patients wanting treatment and an office with inadequate numbers of patients doing only pain-oriented dentistry is patient education. Your question about who in the office should be responsible for educating the patient is especially important. If you personally take the time to educate patients, that time must come from your active clinical day. The cost to the practice is significant. You could easily prepare a three-unit fi xed prosthesis or complete endodontic therapy in the same time that is required to educate a patient about, as an example, the cracked tooth syndrome.

The obvious answer is to have someone on your staff provide the education. Who does it depends on which employee has the interest and ability. This task may not have been in the person"s original job description. I have had dental assistants, dental hygienists, front desk staff, and people who knew almost nothing about dentistry become educated to the level that they could provide comprehensive and convincing patient education. I have not hired staff for just that purpose. We have watched staff members mature in their knowledge and ability, and asked them to assist with education at the appropriate time in their careers. I suggest several steps to put your office in a proactive mode relative to patient education:

• With the help of your staff in a regular meeting, determine which areas of dentistry you want to emphasize in your practice. Usually, these are areas in which you are competent and want to expand. I suggest selecting areas in which there is a need in your geographic location for more activity. There may also be new areas, such as implant placement or laser dentistry, in which you want to be involved. If it is a new area for you, seek, find, and take continuing education courses to get yourself up to the level so that you can promote that new concept in your practice.

• Find the best tools to help with patient education. I will suggest a few, although there are many more than those I will discuss in this column.

Pamphlets -- Pamphlets explaining the various dental procedures are especially useful. They can be used in not only in the offi ce, but also can be taken home. This provides a later reminder of the visit with the educator in your office. Such pamphlets are readily available from the ADA, the companies that make products for the concept you are promoting, or you can make pamphlets to meet your specific needs. I personally developed many of the forms I use in my practice.

Photographs of completed treatment -- I suggest you get a good digital camera and take photographs of treatment you have completed. If you don't want to do that, you can buy before-and-after photos from many sources. Rather than using an album fi lled with hard-copy photos, I prefer to have the photos of completed treatment on my computers. This way they can be located any time by anyone on staff. You can place them on your main server for access by all of the offi ce computers, or you can put them on a small laptop to be carried remotely. When you have loaded treatment photos into the computers, you can show prospective patients what can be done at any time.

Intraoral video camera -- While their resolution leaves much to be desired, intraoral video cameras are mandatory for your practice. Of major importance is the ability to show on live television the concept about which you are attempting to educate the patient.

Patient education video series or program -- Various patient education systems are available today. They range from the relatively complex and interactive to the short and simple. I prefer the simple ones. Our own Practical Clinical Courses series shows 14 of the most commonly used concepts in nine-minute segments. By using a video series or program, you can work elsewhere in the practice while patients watch the program. On your return, you can answer patients' questions and recommend treatment based on their individual needs. With adequate education, a patient usually requests the treatment you recommend.

Models -- Models are an excellent way to show the treatment you intend to accomplish. As an example, it is helpful in the decision-making process for a patient to see an actual gold crown versus a ceramic crown. There are models available for almost every area of dental therapy. An excellent company from which to purchase models is Kilgore International (800) 892-9999. Also, you may have your dental laboratory construct models showing treatment that you want to promote.

Patient testimonials -- Satisfied patients who have completed dental therapy can offer great patient testimonials. Many patients are willing to speak to prospective patients on the phone about the therapy they have had and which you are suggesting to a new patient. Just ask previously treated patients if it is okay to call them occasionally. Then thank them from time to time with a gift.

• Select the employees who are going to be the designated educators. In my experience, these people are usually dental hygienists. These staff members are seeing patients for relatively pain-free treatment. They have 30 to 60 minutes in either a prophy appointment or a diagnostic data-collection appointment to provide instruction while they are completing their own hygiene treatment or data collection. If you have television monitors close to the dental chair, the patient can watch an educational DVD while the dental hygiene procedures or data collection tasks are being completed. Many patients will sit up after the hygiene or data collection has been completed and comment, "That implant (or whatever) looks like something I would like to have in my mouth. Can I talk to the dentist about it?" This simple act is one of the most influential patienteducation tasks you can do.

• How do the designated patient educators become knowledgeable about the procedures you are going to emphasize? In my opinion, you need to have a series of in-service education sessions for your entire staff. I prefer one-hour sessions held before the practice day starts. Soon, your staff members will become competent and convincing as patient educators.

The positive results produced by the development of patient education in your office will amaze you and your staff and help your patients.

Practical Clinical Courses has some excellent patient education aids. The Dental Documents Booklet and CD-ROM contain all the pretreatment, post-treatment, and informed consent forms that I have developed for my practice. We also have released the third edition of our patient education DVD series, "Simple Patient Education for Every Practice." For more information, call Practical Clinical Courses at (800) 223-6569, or visit our Web site at

Q What is the best cement for routine cementation of porcelain-fused-to-metal crowns or zirconia-based all-ceramic crowns, such as Lava"! from 3M"! ESPE"!?A Either of the crown types you identified can be cemented with any form of cement that you prefer. Both PFM and zirconia-based crowns are strong. I prefer resin-modifi ed glass ionomer for routine cementation because of its strength, bond to tooth structure, low or no postoperative tooth sensitivity, and especially its fluoride release. As you will remember, the most popular cements in this category are RelyX"! Luting Cement from 3M ESPE or FujiCEM from GC America.

Many dentists are changing to self-etching resin cements, such as Unicem from 3M ESPE or MaxCem from Kerr. The popularity of these cements has been high in the last several months. The reason for their popularity is clear. The cements are easy to use, do not irritate the pulp, dualcured, and strong. You may certainly use them for routine cementation; however, this is not my choice. Usually, I do not need the extra strength of resin cement for routine cementation. Resin cements are more difficult to remove when a crown has to be taken off the tooth preparation. The self-etching resin cements also do not have fluoride release. I consider fluoride release to be very important.

Resin-modified glass ionomer is still my personal choice for routine cementation of zirconia-based crowns and fixed prostheses. Self-etching resin cements are my choice for moderate strength ceramic crowns or restorations needing additional retention.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. 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 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 fi ndings 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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