A comprehensive approach to case presentation

Feb. 1, 2010
When dentists finish dental school, there is a sense of excitement. They are glad they gained outstanding clinical skills and look forward to entering private practice.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: practice facelift, continuing education, Botox, no prep veneers, Dr. Louis Malcmacher.

When dentists finish dental school, there is a sense of excitement. They are glad they gained outstanding clinical skills and look forward to entering private practice. However, most new dentists do not realize that another equally complex skill must still be learned to succeed in dentistry — the art of case presentation. This skill is a critical aspect of the practice's success in increasing production.

Case presentation is probably one of the most difficult skills for any dentist to master. Some reasons for this incluDE:

  • Having more of a scientific mindset, most dentists do not typically have a gift for persuasion, which is key to successful case presentations.
  • Dentists tend to focus on the technical and clinical features of cases, while patients are more interested in lifestyle benefits.
  • Given the pace of many practices today, it is often challenging for dentists to talk patients through all aspects of medium to large cases, answer questions, and motivate patients to make decisions.
  • Many dentists tend to focus only on smaller, need–based cases because patients are predisposed for this type of treatment. Treatment for a single–tooth restoration is much easier to present than a case for a three–unit bridge or six veneers.
  • Dentists often lack confidence when it comes to presenting larger elective cases. Past rejections do not seem to warrant the time and effort the presentation takes.

Practices succeed by educating their patients. Case presentations are a dentist's chance to inform and motivate patients in more than just clinical terms. When patients truly understand the benefits of the care they require or desire, a practice can deliver higher quality of treatment and increase practice production.

Systemizing the process

One case–presentation strategy that Levin Group clients find successful is to provide every patient with a comprehensive Five Phase Exam™ at least once a year. This approach builds on a dentist's often analytical nature, turning case presentation into a step–by–step process. Each phase is explained through value–added scripting, allowing the doctor to focus on comprehensive dentistry. I have seen clients double the average production per new patient using this technique!

The Five Phase Exam™ is an effective method to engage patients in positive conversations about their oral health and the wide range of treatment options offered by the practice. Greater patient awareness leads to increased case acceptance. We also recommend that dentists and staff members improve their communication skills in conjunction with improving the case–presentation process. Scripting is the key to excellent practice communication.

For many practices, the majority of dental appointments are still single–tooth treatment. For example, a patient with a broken tooth might also be interested in cosmetic treatment, such as whitening or veneers. While treating the broken tooth should be the top priority, dentists must learn to look beyond a patient's immediate problems to provide the most thorough care over the long term. Comprehensive dentistry is a mindset that not only enhances patient care, but can also increase production by 10%, 20%, 30%, or more.

A stronger emphasis on all possible treatment options will have a significant impact on practice production. Instituting the Five Phase Exam™ will help doctors upgrade their case presentation skills, which is critical in the current economy. The Five Phase Exam™ includes:

1. Periodontal exam

Periodontal disease is often perceived as an “invisible” disease by patients because it is relatively painless, especially in its early stages. But tooth loss is only one of many possible consequences of forgoing treatment. Recent research has linked the disease to other serious conditions, including diabetes, pregnancy complications, and cardiovascular disease.

As the connections between oral and general health become clearer, dentists have an excellent opportunity to provide a higher level of information and care to all patients.

Performing a periodontal exam educates patients about their oral health condition and any treatment options, such as scaling and root–planing, antibiotic therapy, and frequent periodontal maintenance. Educating patients about periodontal disease and its impact on overall health can only help dentists close more cases. When patients better understand these broad benefits of dental care, they are also more likely to keep appointments and remain with the practice for the long term.

If referring patients to a periodontal practice, dentists should keep in mind that a periodontist who works in a true team approach will reinforce the other phases of comprehensive treatment. This creates a third–party interdisciplinary endorsement for the treatment recommended by the dentist, which increases the likelihood of greater case acceptance for other procedures.

2. Tooth–by–tooth exam

This is the phase where dentists excel the most. Few dentists tend to miss caries, fractured teeth, or other obvious tooth problems. I believe that most dentists are tuned in to identifying tooth problems more than any other intraoral issues, which may be reflective of the doctor's original training.

The tooth–by–tooth exam is usually expertly handled and should be used as an educational opportunity. Be sure to speak in plain English and not dental terms. Instead of using terms such as maxillary, facial, or No. 30, it makes more sense to discuss upper teeth, front teeth, and bottom–right first molar.

This allows the patient to be part of the educational process, to appreciate the level of care the practice is providing, and to gain a better understanding of the quality of his or her oral health.

3. Cosmetic exam

During the cosmetic exam, each anterior tooth should be scored against a shade guide. Patients should be educated about the purpose of the shade guide so they understand what the potential for improvement is for their teeth. Based on the popularity of over–the–counter whitening products, there has been a shift in the public consciousness about the benefits of cosmetic dentistry.

Many Americans are paying more attention to the brightness of their smiles than ever before. Even television shows that focus on makeovers regularly include dentistry as part of the makeover process. The message is clear: an attractive appearance requires a beautiful smile.

The result of this heightened consciousness is that more Americans are interested in esthetic treatment. Unfortunately, some dentists still assume that patients will ask about cosmetic procedures when they are interested, but most patients wait for the dental team to initiate conversations about practice services.

Practices should educate patients about available treatments, including esthetic services. After all, most patients want to know how they can significantly improve their smiles simply by undergoing basic cosmetic dentistry.

The cosmetic exam opens the door for patients to have a better understanding of their current esthetic condition, resulting in diagnosis, and ultimately, treatment options. Levin Group recommends that at least 20% of all practice production be in elective services. This lessens dependence on insurance–related services and allows practices to grow significantly in the new economy.

4. Implant exam

Dental implants are another enormous growth opportunity, yet many general dentists do not restore a single implant case in a given year. Think about it from this perspective. If a practice has 1,500 to 2,000 patients, there are likely dozens of patients who could benefit from implant treatment.

But if patients are not diagnosed as potential implant candidates, how could implants ever become part of the treatment protocol? As with cosmetic dentistry, implant treatment is not dependent on dental insurance and should be viewed as an opportunity to increase the elective portion of the practice.

With dental implant success rates 95% or higher, there are few edentulous patients who cannot benefit from implant dentistry. Educating patients about the high success rate of implants and their quality–of–life benefits sets the stage for more patients moving forward with implant treatment.

Full and partial edentulism is expected to increase in the coming years as the U.S. population continues to grow older. This means that practices can expect to see more potential implant patients. Practices that include an implant exam as part of an annual patient assessment will be the ones to experience strong implant growth in the next few years.

5. Occlusal exam

The occlusal exam requires using articulating paper to mark the teeth and allowing patients to see the different markings on the occlusal surfaces of teeth. This may be the first time that patients have the opportunity to understand how teeth actually fit together and what the bite is really all about.

Whether or not the doctor feels that any occlusal intervention is necessary, this exam is another way of differentiating the practice and builds value for its services, quality, and fees. The occlusal exam often reveals issues that need to be addressed in combination with other types of treatment.

Want to know how you can upgrade your case–presentation skills? Dental Economics® readers are entitled to receive a 50% courtesy on a Levin Group Total Success Practice Potential Analysis™, an in–office analysis and report of your unique situation conducted by a senior practice analyst. To schedule an appointment, call (888) 973–0000 and mention “Dental Economics” or send an e–mail to [email protected] with “Dental Economics” in the subject line.

Roger P. Levin, DDS, is founder and CEO of Levin Group, a leading dental management consulting firm that is dedicated to improving the lives of dentists through a diverse portfolio of lifetime services and solutions. Since the company's inception in 1985, Dr. Levin has worked to bring the business world to dentistry. Reach Levin Group at (888) 973–0000, or at www.levingroupbp.com.i>

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