Figs. 1, 2, and 3 — Facial, upper occlusal, and lower occlusal views of a patient who could not afford crowns on his anterior teeth. Another dentist had presented a high–cost treatment plan, and he wanted all of his teeth extracted. After significant education, followed by treatment of the most affected posterior teeth, the anterior teeth were restored with smooth surface–retaining, resin–based composite restorations during the first year of therapy. This sequence provided a significant esthetic improvement for the patient, and he continued with quadrant therapy spread across several years until all of the work was completed.
Click here to enlarge imageThe following information will tell you how to perform complex comprehensive therapy in segments:
1) Diagnosis and treatment plan: Accomplish a complete diagnosis and treatment plan. Not doing this results in the dentist making a less–than–adequate plan which compromises the eventual treatment. I usually have a staff person perform these tasks after I have introduced myself to the patient and before I discuss the alternative treatment plans. Educated, motivated staff members can easily collect this data. Dental hygienists or dental assistants can be trained and educated to legally do the diagnostic data collection.
The tasks included in this staff–oriented diagnostic appointment are:
- Filling out informational forms
- Taking panoramic radiographs
- Taking bitewing radiographs
- Taking periapical radiographs
- Making diagnostic casts on the first appointment
- Providing education about all aspects of the patient's needs
- Using an intraoral TV demonstration to show all areas of the patient's mouth
- Charting all periodontal pockets of 3 mm or more
- Recording blood pressure
- Charting of previous restorations or endodontic therapy
- Charting of obvious carious lesions
- Vitalometer testing of suspect teeth
- Performing examination for soft–tissue lesions
- Determination of the presence of any occlusal disease
- Charting missing teeth
- Observing and noting any other oral pathosis
- Determining patient's desires for treatment
After completing the data collection and discussing it with the staff person who collected it, I usually spend about 10 or 15 minutes analyzing the data and explaining the treatment plans to the patient.
2) Discussion of the patient's ability to pay — I suggest being candid, yet empathetic, about the cost of oral therapy and the need to have adequate financial ability to pay for extensive oral care.
3) Discussion of the patient's dental benefit plan — About 70% of American dental patients have at least some dental benefits provided by their employers. The amount these third–party companies pay for oral therapy is low and does not approach our standard and customary fees; however, these benefits do represent a token amount toward the total payment for therapy. They also can be spread across a period of years to maximize their effect.
4) Determination of the patient's ability to get a loan for the services — Some patients with good credit ratings are willing to get a loan, pay the interest on it, and have the treatment performed as soon as possible. This is the ideal situation, but let's assume the patient cannot or will not get a loan. Such a patient is shown in Figs. 1, 2, and 3.
5) Help the patient decide which treatment plan he or she prefers. I usually say something like, "If I were you and had the financial ability to pay for these services, I would probably do this plan." At this point — after considering all aspects of the agreed–upon plan — I suggest segmenting the treatment into several logical categories such as:
Year one: Removal of any condemned teeth, periodontal therapy, placement of provisional restorations in any deeply carious teeth, bleaching teeth if desired, placement of temporary removable partial dentures (flippers) to replace any esthetically compromised areas, endodontic therapy as needed anywhere in the mouth, treatment of at least the six upper anterior teeth, and placement of the patient on an appropriate preventive regimen.