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The Package: Diagnosis, Presentation, Case acceptance, Financing

Nov. 1, 2005
We live in a high-tech, “me-oriented” world. Consumers (our patients) are bombarded with temptation from all sides.

We live in a high-tech, “me-oriented” world. Consumers (our patients) are bombarded with temptation from all sides. Widescreen, high-definition televisions with digital video recorders, luxurious “all-inclusive” cruise vacations, and even automobiles that respond to our spoken commands populate a long list of life’s new “must haves.” Ultimately, discretionary dollars are doled out to the vendor that has made the most convincing case for the buyer taking ownership. As dentists, we find ourselves in line with all those vying for our patients’ elective spending dollars, particularly when we offer high-end items such as dental implant restorations and the porcelain veneer smile.

Practicing for more years than I can fathom, and in an area not populated by high rollers, it has become increasingly apparent that my cause is assisted by taking advantage of many digital items as well as finding patients access to the dollars needed to purchase what I am offering. This should not be surprising. We live in a visual society that is, for the most part, not afraid to spend money on itself so long as the dollars can be had. Why should dentistry be different than any other big ticket item? You can be sure that if the Circuit Cities of the world did not offer 12- to 18-month, interest-free budget plans, they would soon be out of business. In general, Americans must work life’s pleasures into their budgets. Inevitably, this dictates paying smaller amounts over time.

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With dentistry, before we ever get to speak of payment plans, we must first instill the all-important “desire to buy” in our patients. Let’s face it. “Mrs. Brokeanothercusp, you have three big amalgam-filled teeth that could benefit from being crowned” is just not that compelling. This is particularly true when it is compared to walking into a Best Buy, seeing a 62-inch Mitsubishi wide screen with high definition showing the latest Discovery Channel extravaganza, and being told that this unit can be in Mrs. Brokeanothercusp’s living room with simple, interest-free payments of $??? a month for 24 months - especially if she is not in any dental-related pain.

That’s where digital photography (and radiography), as well as digital smile simulations, come in handy. Here’s how I get my slice of the discretionary dollar pie in Wolcott, Conn., a town of approximately 25,000 hard-working, two jobs-per-family people.

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On a first visit, a new patient will likely see a hygienist for screening. This includes a full-mouth series of X-rays, periodontal probing, soft-tissue evaluation, and a prophylaxis. This does not preclude any further soft-tissue management but at least it starts the process. The patient is then scheduled with the doctor for a diagnosis of his or her present condition, and assessment of current and future needs. At this visit, after pleasantries are exchanged, the cheek retractors and mirrors ensue (Fig. 1). Along with my assistant, I take six to eight intraoral digital photographs of the entire dentition. I then immediately upload these photos into a program called Image FX by SciCan. In most instances, I take a portrait, too. This can be the beginning stages of a smile-rehab simulation (Fig. 2). But at the very least, it reminds me what the patient looks like when I see him or her for a return visit. In essence, I have recorded enough information to thoroughly examine that patient when they have departed the office. After getting an idea of what the patient’s priorities are, I use a chairside PC to guide the person through a brief slide tour of his or her dentition, making sure to orient the patient as to what is being seen. After making some mental notes, I tell a patient that - based upon our conversation and the digital information that I now have - I will formulate an appropriate treatment plan for his or her needs, and will present the plan at our follow-up consultation. The patient is charged $75 for this 45-minute process (and is told of this fee in advance of the visit). This also applies to patients of record who have been away from the practice for an extended (three years or longer) period.

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Prior to the patient’s return, I formulate a treatment plan on our SoftDent software, and normally submit the portrait to for a cosmetic simulation. In addition, I print the eight images of the patient, as well as the simulation, on three glossy photo sheets in groups of four, 3.5 x 5-inch images. I add the patient’s name across the top of each photo sheet (Fig. 3). I also print the treatment recommendations from SoftDent so that the patient is presented with a professional case presentation. (For more complex cases, models are included.)

There is no doubt that, at this point, a certain amount of patient “reading” must take place. An idea of whether the patient is a “section at a time” person, or a “let’s get it all done ASAP” person needs to be determined. The former type of patient is encountered more often. In addition, I must decide whether or not the case will include cosmetic enhancements. The crucial element, which is provided by viewing photos of the patient’s teeth on the glossy paper stock or PC monitor, is simply co-diagnosis. Even more provocative is concentrating on a single molar that might need obvious treatment (Fig. 4). The ability for patients to see the problem is - to quote the familiar MasterCard advertising slogan - “priceless.” The picture does overwhelm the argument. We are fortunate to be living and practicing in a time when this type of technology is affordable, attainable, and readily available. To not take advantage of this technology would seem unthinkable in this day and age!

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The last piece of the package for the patient is a method for paying any expenses not covered by insurance. In this country, the consumer needs a healthy credit history. If this is the case, the consumer can buy almost anything. Having an “outside the office” finance package is important. If you do not have this feature, and practice in a town the size of Wolcott, you will most likely do more talking about grandiose treatment plans than actually resolving them. Many of the patients who need our help live paycheck to paycheck, and must budget to afford both their needs and the wants you have created. At my practice, we have great success with CareCredit. The company offers multiple payment plans - some as short as six months and others up to 48 months. Some plans are even interest-free. As a dentist using CareCredit, you will need to pay the company a processing fee. When combining payments received via finance plans, along with any insurance benefits due patients, you now have some room with which to work.

If you carefully examine the methods and protocols of many of today’s most successful practitioners, you will find a similar “package” to what I have described. When all the pieces - diagnosis, presentation, case acceptance, and financing - are in place, your only limitation will be that related to your ability as a provider of dental care services.

Dr. Martin B. Goldstein practices general dentistry in Wolcott, Conn. He lectures and writes on topics including cosmetics, restorative dentistry, and integration of digital photography into the general practice. Dr. Goldstein can be contacted at [email protected], at, or by phone at (203) 879-4649.

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