Digital imaging enhances whitening case acceptance

March 1, 2003
Seed the patient's imagination ... Use 'before' and simulated 'after' pictures to help patients understand how whitening will improve their smiles.

by Justin Lee Altshuler, DMD, FICD

Seed the patient's imagination ... Use 'before' and simulated 'after' pictures to help patients understand how whitening will improve their smiles.

What percentage of your patients accept your treatment recommendations? Do you track this information in your practice? Is a case defined as the time when clinical treatment is initiated?.

Whitening is a relatively inexpensive elective treatment. Its appeal is nearly universal. As study after study shows, people associate whiter teeth with youth, sexuality, attractiveness, and good health. And with today's digital cameras and software-simulation programs, explaining whitening recommendations is easier than ever before.

Case acceptance: foundation for success

As far back as the 1960s, the American Academy of Dental Practice Administration defined "success in life" according to L. D. Pankey's concept of balancing professional, family, and religious commitments. These observations continue to have merit today.

The Academy further suggested that practice success was particularly important, because it establishes a foundation for other areas of a dentist's life — i.e., dentists who are financially successful in their practices can establish stability in their private lives as well.

So what factors ensure that a practice will be successful? The most important factor is a higher percentage of case acceptance. When a practitioner — often with the help of the staff — finds a way to help the majority of patients agree with proposed plans of treatment, the practice will flourish. Not only should most patients say "yes" to treatment; they also should add, "When can we get started?" Without this agreement, there is no production, no income, no added staff, no upgraded equipment, and no take-home profits to support the dentist's lifestyle.

Dentists use many techniques to improve case acceptance. Perhaps the simplest is to just talk. Dentists face the patient and convey a passionate belief in their "product," including oral health and attractive smiles. As a result, the patient becomes excited and agrees to treatment.

As an adjunct to verbal presentations, dentists also can choose from a variety of case-presentation aids. These range from the simple to the sophisticated. As Dr. Dave Gane has noted, the very first imaging instrument was the mirror! For whitening, today's options include: the CAESY Education Systems (available on DVD) which prepares patients to understand the whitening process; books such as Goldstein's Change Your Smile; and literature from manufacturers of whitening products. Any of these materials can be used to facilitate pre- and/or post-case presentation discussions.

While these aids are useful, it's even more important to refine the entire presentation. Effective case presentation draws on psychological principles, the patient's individual attitudes and responses, and current state-of-the-art communication tools — namely, digital photography.

Elements of a good presentation

For any case presentation, it's important to begin by gathering the right information and individually tailoring the presentation.

Get to know the patient. The doctor always should perform the initial patient interview personally. During the interview, listen to and observe the patient closely. What does the patient's body language tell you? Does the patient act relaxed, anxious, hurried, or stressed? What kind of previous experiences has the patient had with dentistry? When was the patient's last dental treatment, and was it completed? Are there any dental issues that the patient feels are a top priority? Are there any dental treatments that the patient is curious about, but may not consider critical? By gleaning answers to these questions, you can begin to make educated decisions about how receptive the patient will be to your treatment recommendations, including recommendations for elective procedures.

Make sure you can gather the necessary data. After the interview, the patient should be introduced to the hygienist. As you introduce the patient, ask the hygienist to please make "the necessary records" for Mrs. Jones. For this step, semantics become critical. No need to mention X-rays, photography, or impressions by name. Never say, "This is Mrs. Jones, would you please take her in for her X-rays?" If you do, you give the patient an opportunity to raise questions. For example, the patient may say, "I'd rather not have X-rays today" or "Why would I need photographs? I'm just here to get my teeth cleaned."

If, on the other hand, you manage the visit as a pre-arranged exchange between professionals, the patient will accept what the hygienist does. After all, the hygienist is clearly following procedure. The majority of patients accept being guided when procedures are managed professionally.

Because whitening and other aesthetic procedures are a potential treatment option for so many patients, the hygienist should take at least two or more digital photographs of the patient. At a minimum these should include a portrait of the patient smiling and relaxed smile close-ups. Additional views should be taken depending on the practice's standard procedures and the results of the patient interview. Some practices may want to capture a series of standard close-up views for every patient. Others may take additional views depending on what is discovered during the clinical exam. For example, if a patient has a cracked bicuspid or crooked incisor, that finding may trigger the hygienist to take additional photographs.

The images should be captured using a high-resolution camera capable of accurate color reproduction. One option, the Kodak™ DX4900 Dental Digital Camera Kit, includes a camera with these capabilities, plus helpful tools like built-in distance and framing guides to help ensure consistent, properly framed shots.

Later, these images will be used to create communication aids to support the case presentation. One way to aid in this communication is to use high-quality inkjet paper to produce excellent prints on a dye-sublimation or inkjet printer.

Seed the patient's imagination. During an exam, your hygienist should begin to identify opportunities for further treatment. For whitening, the hygienist should note any discoloration, staining, or dark tooth color. The hygienist should then mention that the practice offeres whitening services. Once again, semantics are important. The hygienist should say something like, "I've noticed your front teeth are a little darker on top than on the bottom. The doctor can tell you about a way to lighten them." This helps the patient start imagining how nice it would be to have a whiter smile. At the same time, it avoids making the patient feel pressured. It also places the final diagnosis and treatment recommendations in the hands of the dentist.

Schedule a follow-up visit. Some dentists advocate delivering the case presentation during the patient's initial visit. I'm not one of them. First, in my experience, careful preparation is essential. Second, if you propose an elective procedure to a married patient without having the spouse present, your chances of treatment acceptance are always lower. Many married patients simply won't agree to elective treatment until they discuss it with a spouse — and you can't leave that discussion in the patient's hands! You may justify your treatment recommendation eloquently, but when the patient goes home, the spouse's first question will be, "How much is this going to cost?" At that point, your entire case presentation is reduced to the matter of expense.

Have the staff schedule a return visit, explaining that the doctor recommends the patient's spouse or a close friend come along as well. The staff can explain that sometimes another person can see things or ask questions that would otherwise be overlooked.

Then, prepare! Before the patient's second visit, review all X-rays, models, and photographs. Determine the best possible treatment for this patient. But don't stop there; pick an alternative treatment option as well. When it's time to have the consultation, you need to give your patient choices. Why? Because if you don't offer the patient a choice, your patient may come up with one anyway. The patient may decide that the best option is no treatment at all. If you offer two different treatment options, the patient hopefully will choose between two treatment options. It will be a decision to accept treatment, not reject it.

Develop communication materials. Today, a critical component of any whitening presentation is personalized "before and after" prints to help patients visualize how the treatment will improve their smiles. These are best created using specialized dental-simulation software, such as that offered by DICOM Imaging™, Image FX or TigerView™. All of these programs simply call up the image of a patient's smile. With a few mouse-clicks, you can lighten the patient's teeth on the electronic image, then print out the before and after images so patients can see what whitening can do for their teeth. Use a photographic-quality paper, such as Kodak Desktop Medical Imaging Paper, to produce glossy, professional-looking prints. These can be mounted in a die-cut folder with the doctor's name, office address and phone number on it or they can be framed for added impact.

Deliver the presentation. For the presentation itself, simplicity is key. My observations of dental students suggest that one of the most detrimental tendencies of the inexperienced is to make presentations too complicated. The successful dentist makes presentations simple by keeping them both short and free of jargon. No case presentation should last more than 20 minutes, nor should it use terminology that is unfamiliar to patients. Simply explain, in lay terms, what treatment you recommend, what alternative the patient has, and how much treatment will cost.

Patients who are candidates for whitening may have teeth that are otherwise in perfect condition. If the only treatment offered to patients is a whitening process, an alternative might be to commence treatment immediately or to postpone treatment for a subsequent visit. Many whitening products offer a wide range of approaches, including treatment performed entirely in the office, partly in the office and partly at home, or completely at home. Plasma lights and similar tools that produce results in an hour or less are another option that appeals to patients who like "instant results." Here is where your initial data-gathering is important. If, during your first interview, your patient was relaxed and asked questions about tooth-whitening, you might decide to offer different options than you would for a patient who is focused primarily on what treatments might cost.

Regardless of how you frame the alternatives, use the "before and simulated after" images to help patients understand how whitening can and will improve their smiles. The images form a powerful incentive to patients to accept treatment, helping to ensure that when they do make a decision, it will include whitening.

It's easy, at times, to underestimate the importance of effective case presentation. However, case acceptance is the foundation of a successful practice. By gathering good information, and preparing and developing effective communication materials, you can raise your acceptance percentage. You'll be helping more patients achieve brighter, whiter smiles, and these improved smiles will be reflected in your practice's bottom line.

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