Going elective in the family practice

May 1, 1998
With many areas of the country under virtual siege by insurance companies and managed-care plans, dentists have learned that, to thrive, they must run a more efficient operation. Basically, there are two ways to be financially successful in dentistry.

Families accept inlays and onlays options, but you still have to ask.

Craig C. Callen, DDS

With many areas of the country under virtual siege by insurance companies and managed-care plans, dentists have learned that, to thrive, they must run a more efficient operation. Basically, there are two ways to be financially successful in dentistry.

One way is to be a high-volume, low-fee model. Typically, this would be known as a clinic-type practice, usually in a group-practice setting. These practices are geared for and embrace managed care. Unfortunately, the only one who usually is happy and profitable is the owner/dentist, not the employee/dentist.

The second profitable model is the low-volume and high-fee practice. These are the cosmetic or reconstruction-style practices. They become somewhat immune to the attacks of managed care. There always will be people willing to pay for quality care.

There is a third model - a family practice with moderate fees and moderate volume. This model is the most vulnerable to erosion of profits brought on by managed-care plans. Its price-sensitive patients will be more likely to leave when a low-cost insurance plan comes along. Generally, there is less loyalty to a family practice than a cosmetic/reconstruction practice.

Upgrading a family practice

How can a family practice be upgraded to more of a cosmetic/reconstruction-style of practice? One way would be to upgrade patients` treatment from basic fillings to inlays and onlays. Not only are inlays/onlays more durable and esthetic, but they also are more profitable for the dentist. It really is a win/win situation for the patient and the dentist.

Dentists are not always the best communicators when it comes to explaining the need for, and motivating patients toward, elective treatment. A cosmetic/reconstruction practice relies on elective procedures to survive, so its case acceptance must be better than average.

Today, there are a number of aids that you can use in your office to increase case acceptance of inlays and onlays:

* Intraoral TV - Using the intraoral TV camera, you will be able to better demonstrate the need for the replacement of old, worn fillings. If a patient already has a nice inlay/onlay, you can show him or her how nice it looks and how durable it has been.

* Interactive CD/CD ROM - We use the CASEY system (800-505-4430) for patient education and motivation. There is a wonderful section comparing different materials for fillings that will motivate patients toward lab-fabricated restorations.

* "Before" and "after" photos - In every operatory, the consultation room and the reception room, we have "before" and "after" pictures mounted on the wall. Our photos came from Dr. Tom Hughes` company, High Impact Image (714-488-0808). I keep a laser pointer in my lab-coat pocket and will point out the difference between the "before" and "after" pictures on the wall. It is faster than getting out our photo albums.

* Dental diary - Every new patient is given a customized dental diary, which is a small book that explains all of the phases of dentistry, including inlays and onlays. We order them from KISCO (800-325-8649).

* Handouts - I created a handout for patients describing the basic difference between restorations and the advantages of inlays/onlays. We have them framed and mounted in the reception room and also pass them out to patients. The handout is written in simple, easy-to-understand terms (see related article at left). It is meant to motivate patients to upgrade their treatment.

* Cosmetic surveys - Every new patient and recall patient is given a short questionnaire to fill out and check off things that they don`t like about their smile. Almost all of them don`t like their dark, silver fillings. This gives you a great opening for cosmetic dentistry.

* Warranties - We provide a written treatment warranty for our patients that is dependent upon them maintaining regularly scheduled recall appointments. The warranty for lab-fabricated restorations is better than the one for direct-placed restorations. If you remove the risk for patients, your acceptance rate will rise.

* Flexible financial arrangements - It doesn`t matter how badly a patient wants the treatment, if he or she can`t pay for it. Studies have shown that, generally, patients can`t afford our cosmetic treatment unless a payment plan is offered. We use outside finance companies, as we do not carry accounts long term.

Not every patient is going to elect to have a lab-fabricated restoration placed over a direct-placed restoration, but that`s OK. If even one out of 10 patients elects to have the inlays/onlays placed, your profitability will skyrocket. Why do you think McDonald`s always asks if you want fries with that burger? They are asking you to upgrade your order. They know that a certain percentage of customers will elect to increase their orders if they are just asked.

I can guarantee that if you never ask patients if they would like the superior restorations, they will never ask you. Using the various tools and ideas in this article, you will increase your case acceptance of elective procedures dramatically.

Fillings: Good, Better and Best

You need to have a new filling or replace an old one. In the world of modern dentistry, you have several choices as to materials to use. So that you can make a more informed decision, we have put together this information sheet for your review. The materials that we use today are much more esthetic (more natural) than some of the older materials. We do not place silver fillings because the new materials bond to the tooth and look so much nicer. We have listed choices in materials in order of strength, longevity and investment. Keep in mind that the stronger materials last longer (and come with a longer warranty) and, while the initial investment is more, they won`t have to be replaced nearly as often (if at all). So in the long run, they actually cost you less. How long any tooth lasts depends upon how good of a job you do with your home care and keep up with regular professional visits.

Good: Composite, direct tooth-colored fillings - These direct-placed, one-appointment fillings are shaded to match the tooth and are bonded to the tooth for added strength. For small fillings and front fillings, this may be your best choice. For larger fillings, they are not as strong.

Better: Lab-fabricated tooth-colored fillings - These two-appointment fillings involve making a mold of your teeth and placing a temporary filling. A dental laboratory then will custom-make this durable filling to fit the mold of your teeth. These fillings generally are heat- and/or pressure-cured for added strength. Usually, they are made of porcelain or a porcelain-like material. The fillings then are bonded to your tooth at the second visit. These fillings tend to be more natural-looking than direct-placed fillings, resist staining better and are much stronger.

Best: Lab-fabricated gold fillings -The strongest and most durable material available to us today to place in a filling is gold. Like the other lab-fabricated fillings, gold fillings require two appointments, a mold of your tooth and a temporary. Gold is much more esthetic than old, silver fillings because gold fillings do not stain the teeth. Some people may not care for the looks of gold fillings, while others want the added strength. If the filling is in an area that does not show when you smile, gold is by far your best choice.

As you can see, you have several good choices of materials to restore your teeth. All of them work, but the lab-fabricated fillings work better and last longer. If you have any questions or concerns, please don`t hesitate to ask. We are here to help. Craig C. Callen, DDS & Associates

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