March 1, 2004
Reaching out to fearful or dental-phobic patients can be richly rewarding for both patients and practitioners

by Jack Bynes, DMD

Today's new dentist operates under different circumstances than previous generations. In the past, it was not unusual for a dental school graduate to obtain bank financing for equipping a start-up office. Starting out solo in private practice was the norm. Most of us "old timers" hung out a sign and waited anxiously for patients to call. Almost all states had regulations as to the size and display of office signs and Yellow Pages ads. "Marketing" was a swear word and considered unethical. It was a wonder that patients ever found out about us with all the prohibitive regulations in effect. The most effective way to market our practices (we didn't call it marketing, of course), was to join civic organizations, church groups, and volunteer our time. By some miracle, most of us survived those anxious start-up days and went on to enjoy successful careers.

The most common way of starting a dental career today is to become an associate in an established practice. Many young dentists are saddled with heavy educational debt before they see their first patients. The banking industry no longer looks upon a solo start-up practice as a good risk. Today, marketing is no longer a question of ethics, it is a matter of survival. While there are obvious financial advantages in associating with an established practice and eventually purchasing it, there also are pitfalls to watch out for.

The major pitfall in buying into an existing practice is that the new dentist is molded by the nature of the practice instead of creating the type of practice he or she desires. An even worse situation exists when the new dentist hasn't thought about long-term professional goals. Frustration, professional disappointment, and burn-out occur all too frequently when these two factors are found together. Before buying into any practice, new dentists should have visions of how they want to spend their professional lives. Only then can they make decisions on the merits of buying into established practices.

Too often, the decision to purchase an existing practice is mainly determined by price. Quality does not come at a discount. Rather than counting the number of patients in a practice, it is more prudent to look at the quality of the patient list. Is it an elderly patient base or a good mix of age groups? Is the recall system effective or in disarray? Location, parking, patient demographics, insurance-plan participation, office staff, and equipment condition all enter into the decision-making process. The prospective buyer should look at the type of dentistry being performed. How many elective procedures are being performed? Does the practice provide a wide array of services such as implants and cosmetic dentistry?

Create a niche market

One of the more successful strategies is to create a niche market for your dental services. Just look at the success cosmetic, implant, and laser practices have enjoyed in recent years. We are now seeing the beginnings of a new niche dental market taking place — spa dentistry. More and more dentists are realizing they have to offer perks to their patients to avoid the trap of dental insurance-plan participation. These practices also generate a great deal of publicity and media attention that help expand patient bases.

An overlooked niche market is the practice devoted to fearful patients. This entails more than paying lip service to the problem by advertising that you "cater to cowards." Unfortunately, most dentists are not aware of the magnitude of the problem because most fearful patients avoid going to the dentist. There are many reasons why dental fear is still a problem in this age of painless dentistry. Despite the advances in our profession, we still have an image problem that is pervasive in the media. Tune into any late-night TV show and you are bound to hear at least one joke about a root canal, anesthetic needle, or extraction. According to the ADA and NIH, there are 40 million Americans who avoid dentistry because of their fear. That is a huge potential market. Not only is it a huge market, but it's one that's comprised of a population needing a tremendous amount of periodontal, endodontic, and restorative dentistry as opposed to elective dentistry. Not only are there millions of potential patients who avoid going to the dentist, there also are thousands of dentists who dread seeing phobic patients. There are misconceptions on both sides of the gulf.

Debunking myths and misconceptions

Let's look at some of the myths regarding dental-phobic patients.

• Myth 1: Very few patients fear dentistry any longer.
Fact: Fear of dentistry is pervasive. The numbers are deceptively small only because these potential patients avoid dental treatment.

• Myth 2: Fearful patients tend to be mentally unbalanced.
Fact: Because a phobia is an irrational fear, the actions of dental phobics may seem peculiar. Nevertheless, most dental phobics are normal in every other aspect of their lives.

• Myth 3: It is unproductive to treat fearful patients.
Fact: Nothing could be further from the truth. It does take more time initially to gain the confidence of a frightened patient. But once you do, you will find a tremendous backlog of dental work to do. Because these patients have let their mouths deteriorate, you will find a disproportionate amount of endodontic, periodontic, restorative, and prosthetic dentistry to do.

• Myth 4: Dental phobics are only interested in emergency dentistry.
Fact: This is a function of how they are treated during their first visits. Although most start out with specific problems, they will become your most devoted and reliable patients if handled properly.

• Myth 5: Treating dental phobics is not profitable.
Fact: Treating dental phobics will accelerate your practice growth more than any other means including cosmetic dentistry. You will avoid the hazards of managed care and insurance companies because phobic patients are willing to pay more out of pocket to be treated the way they should be treated � with kindness, patience, and compassion.

More advantages

Developing a practice centered on anxious and phobic patients has other advantages as well. In addition to making you less insurance-dependent, you will find less economic impact during times of recession. These patients initially are not getting elective dentistry. They are in need of basic restorative dentistry to save their teeth. Eventually, they will become candidates for elective dentistry as their fears subside and their self-images improve.

Another major advantage of the phobia-centered practice is the unusually high number of referrals these patients generate. When patients conquer their fear, they feel good about themselves — as opposed to the feelings of inadequacy and shame they may have had before discovering your practice. They attribute this to you, although they are the ones who should be getting the accolades. You have become a hero to them and they can't stop talking about you. One patient I have went on the Internet and extolled my virtues in cyberspace. I received several good referrals from that endorsement. In addition, as your reputation in this field increases, you will be getting referrals from psychiatrists, psychologists, social workers, therapists, and physicians.

Successful policies and positive attitudes

Having met many dentists across the United States, I have heard all of their objections to treating phobic patients. These include broken appointments, added stress on dentist and staff, and interference with normal office routine.

You control broken appointments by your office policies. A written policy statement is essential and should be distributed to every new patient during his or her initial visit. You must prevent broken appointments because they are too costly to the practice. Having an honest, up-front discussion with the patient at the initial visit leaves no room for misunderstanding. Explain that appointments can only be cancelled with a minimum of 24-hours notice and that a significant fee is charged otherwise. The only exceptions are sudden illness, accidents, and other such emergencies. If a patient doesn't keep an appointment twice in a row, a letter is sent removing the individual as a patient of record. Your manner in discussing this with patients is important to the success of this policy. You are not lecturing or admonishing them; you are simply stating the ground rules for your practice.

Attitude is the key to preventing undue stress on you and the staff. Phobic patients do take more time to treat, especially at the beginning. You have to charge adequately for your time. Many dentists are fixated on charging per procedure rather than for their time. It isn't fair to you or your patients to charge the same amount for a one-surface restoration that takes 20 minutes as opposed to one that takes 40 minutes to accomplish. Establishing more than one fee schedule and assigning patients to a particular schedule based on your estimate of the time needed is necessary. This will eliminate the frustration caused by time concerns. Patients will notice that you are calm in handling their fears.

The more time you have and the more you are compensated for your time does wonders for your attitude. If you sense frustration building up, take a break without any guilt. You are being paid for it.

In terms of professional satisfaction, the phobic-centered dental practice returns rewards to the dentist that cannot be measured in terms of numbers. Staff pride soars when they are part of a devoted team that is helping people to get the dental care they need. And, at the end of a long, hard, day, there is no reward greater than having a patient tell you that you made a significant difference in his or her life. It makes you want to come back tomorrow and do it all over again.

Sponsored Recommendations

Clinical Study: OraCare Reduced Probing Depths 4450% Better than Brushing Alone

Good oral hygiene is essential to preserving gum health. In this study the improvements seen were statistically superior at reducing pocket depth than brushing alone (control ...

Clincial Study: OraCare Proven to Improve Gingival Health by 604% in just a 6 Week Period

A new clinical study reveals how OraCare showed improvement in the whole mouth as bleeding, plaque reduction, interproximal sites, and probing depths were all evaluated. All areas...

Chlorine Dioxide Efficacy Against Pathogens and How it Compares to Chlorhexidine

Explore our library of studies to learn about the historical application of chlorine dioxide, efficacy against pathogens, how it compares to chlorhexidine and more.

Enhancing Your Practice Growth with Chairside Milling

When practice growth and predictability matter...Get more output with less input discover chairside milling.