Initial exam or interactive comprehensive evaluation?

Dec. 2, 2010
My previous column on "Getting to Yes" discussed the importance of discarding assumptions about patients and helping them experience a why moment regarding their dental health.

Frank M. Spear, DDS, MSD

For more on this topic, go to and search using the following key words: initial exam, well-referred, interactive comprehensive evaluation, Dr. Frank Spear.

My previous column on "Getting to Yes" discussed the importance of discarding assumptions about patients and helping them experience a why moment regarding their dental health. Eliminating preconceived beliefs about patients is the first step in opening yourself, team, and patients to new experiences in your practice. This month's focus is on evaluating the processes that need to be in place for both new and existing patients to experience a why moment.

A common question among students who attend Spear Education workshops is how to change their processes, and more specifically, how to determine when to do an interactive comprehensive evaluation as opposed to an initial exam. The students' primary concerns are doing something that might not be desired by the patient, or spending an inordinate amount of time on a patient who won't go forward.

Initial examination vs. interactive comprehensive evaluation

In essence, both of these tasks gather data through the examination process. The fundamental difference, however, is the intention of the practitioner with regard to the outcome. The objective of the initial examination is recognizing disease and offering treatment. The purpose of the interactive comprehensive evaluation is to create understanding, reach an agreement on desired outcome, and offer therapy that fulfills that outcome.

New and "no problem" patients

Insisting on an interactive comprehensive evaluation – which may entail an examination appointment, followed by a separate hygiene appointment – for every new patient who calls may be counterproductive. This is especially true during the growth phase when you have more time than people and many of the new patients who do call are primarily concerned with "cleaning." If the initial exchanges with your practice vary from what the patient expected (i.e., getting their teeth cleaned), they may decide to go elsewhere.

It is important, however, to assume some patients would want an interactive comprehensive evaluation, which leaves the question of how to differentiate those who would prefer a more involved, interactive process. This may be as easy as asking, "Do you have any significant dental issues you are dealing with right now?"

Most patients will answer "No" and an appointment for the initial examination and hygiene visit will be arranged. The practice has a new patient and you have a later opportunity to create an experience for them by making your initial exam different.

Referred and "story" patients.

Well-referred people and those with significant dental issues come with very different expectations. Well-referred patients come with a level of trust in you and the practice by the referrer.

They may have heard that your examination is different, that you are thorough, that you are highly skilled in the latest therapies, or that you are specially qualified to handle their problems. They arrive ready to partner with you differently than those for whom your practice is a complete unknown.

Similarly, patients who answer "Yes" to the question, "Do you have any significant dental issues you are dealing with right now?" come to the practice seeking answers. These two groups of patients already know you are different and can be welcomed to your practice through an interactive comprehensive evaluation.

Existing patients

With current patients, we have the most freedom, trust, and often the most opportunity. An example from one of our students: On his first day back in the practice after taking the Facially Generated Treatment Planning workshop, he challenged his thinking by performing muscle and joint exams, even on emergency patients.

To his surprise, the first two patients he saw were emergency patients who had previously declined complete exams. By performing the quick muscle and joint exams, even though they didn't request them, he found very painful muscles in both patients and created why moments for them. Both patients requested interactive comprehensive evaluations and both embraced regenerative dentistry.

As the founder and director of Spear Education, Dr. Frank Spear continues to be recognized as one of the premier educators in esthetic and restorative dentistry in the world today. He and long-time practice partner, Dr. Greggory Kinzer, maintain a private practice in Seattle limited to esthetics and fixed prosthodontics. Dr. Spear can be reached through

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