Is your dental team ready for the new face of general dentistry?

Aug. 1, 2008
The practice of general dentistry has become so much more complicated than it once was due to the number of different services that can be offered by clinicians.

by Stephanie S. Strong, RDH, BS

For more on this topic, go to and search using the following key words: ICOI, ADIA, Global Institute for Dental Education, Pride Management, team skills.

The practice of general dentistry has become so much more complicated than it once was due to the number of different services that can be offered by clinicians. As part of this dramatic change during the past 20 years, dentistry has progressed from routine partial dentures, full dentures, and amalgams to more technically demanding procedures such as veneers, all ceramic crowns, and implant dentistry.

What does this mean for the dental teamin today's general practice?

These new services require each member of the team to learn new technology and verbal skills that many of us have never been taught. We find that offering these services places an increased burden on the dentist to provide specific training for each of the departments of the dental office. The dentist must learn new skills and then translate to each department regarding educating the patient in order to gain treatment acceptance. Systems are more important than ever to accomplish these tasks. In order to mainstream implant dentistry into everyday practices, the needs of each department must be addressed.

What are the needs of the front desk?

Front desk personnel have very specific needs for guidance with scheduling and financial arrangements. All phases of dentistry have this need, but it's even more so with dental implants. Front desk personnel must be up to the task for more detailed information than ever before. Working with the dentist to understand the phases of implant dentistry from the first patient inquiry to the completed case requires a front desk team member to achieve a higher level of competency. For the first time in the history of dentistry, truly career minded team members are needed.

The front office team member must have excellent communication skills in order to schedule and discuss treatment needs. The first phone call to the dental office can make or break that big implant case. We have found that a telephone information form is invaluable in obtaining the information to correctly schedule patients inquiring about dental implants. (Pride Management, Novato, Calif.). This information is then shared with the dentist and entire team prior to the patient's first appointment. This protocol of obtaining and evaluating patient information puts the office team on notice that a potential implant patient is on the schedule so that proper preparations can be made.

The new implant patient is given a tour of the office by a team member to accentuate the positive aspects of the practice and reinforce the notion that the dentist and staff are helpful, competent, and intent on providing excellent care. Being "on time" is very important for all of our patients, but particularly critical for the first-time patient at the office. Much of the patient's impression of the office is predicated on being seen by the dentist in a timely manner, and by the appearance of the physical facility and staff.

This initial appointment should also include exposing the patient to visual aids, with models or brochures about the various options for implant treatment. If available, a DVD video that utilizes animated examples of all treatment options can be very helpful to the patient. Visualizing the choices in treatment is a key element in coordinating the patient's desires with treatment options.

Since financial arrangements are required in order to make implant dentistry successful, front desk team members must have some knowledge of math. Computer skills by today's front desk team are a must! In order to accept treatment, most patients have to determine how they will pay for it. The dentist and front office personnel should determine what payment options are to be offered. Third party financing plans such as CareCredit, Chase Health Advance, Capital One, HelpCard, and others allow payment options for patients. The front office member should be well versed in any of these plans in order to advise the patient of monthly payment requirements.

Prior to scheduling surgical appointments for extractions, grafting, and/or implant placement, the front office member should procure an informed consent document signed by the patient and witnessed by a staff member. An excellent consent form is available from the International Congress of Oral Implantologists as a member benefit ( Both surgical and prosthetic consent forms should be completed and signed before proceeding with the case.

Most implant cases will require a surgical index, or template, to guide the proper surgical positioning of the implant placement. Impressions and laboratory work are needed to fabricate this appliance. The front office member should coordinate with the dentist and assistant to schedule appointments for this procedure and make sure that the appliance is completed well in advance of the surgical date.

What are the needs of the hygienist?

The dental hygienist today must possess skills to market dental implants as well as maintain dental implants. The dental hygienist is responsible for designing a plan for home care maintenance and in-office maintenance of each implant patient. Effective communication skills are essential in order to assist the patient with his or her home care. In most cases of dental implant maintenance, some type of appliance is needed in order to simplify the home care. That need is very patient specific. Inventory for these appliances requires a team member to be responsible for ordering and organizing the appliances for distribution to patients.

We typically recommend use of a Rotadent brush, Sonicare, or Hydrofloss irrigation appliance for daily home care of the implant case. The appliance is illustrated to the patient and detailed instructions for operating and maintaining it are delivered in the office. A three to four month recare schedule is followed with all of our implant patients. This provides regular maintenance and evaluation procedures to reduce the progression of inflammation around implants, and for early solutions to implant prosthetic problems before they can become more difficult to remedy. The skilled hygienist becomes the front-line clinician in checking for gingival changes, bone loss, loosening of implant screws, occlusal changes, and damage or deterioration to either fixed or removable implant prostheses.

In our office, the hygiene operatory setup is determined by the type of implant case being maintained — either fixed or removable. All instruments and products needed are ready for the hygiene appointment. Our fixed implant hygiene maintenance kit contains scalers and rotary instruments for polishing porcelain. We find it efficient to have the hygiene operatory equipped with disinfecting products for removable implant appliances, and replacements for attachments accessible for the hygienist as needed. We use adjustment carbides and acrylic polishing rotary instruments for overdenture cases.

What are the dental assistant's needs?

The clinical assistant must also possess new knowledge to assist the dentist in preparing the patient for implant dentistry.

Depending on specific state regulations, well trained and competent assistants can assemble and disassemble some of the implant components and restorative appliances. Inventory of the various implant components, and coordinating with front office and surgical staff members of referring offices has also become an integral role of the assistant. By becoming more competent with implant procedures, the assistant becomes more conversant with the patient about implants. The "value-added" assistant can answer some technical questions about surgical and prosthetic aspects with confidence. This ability is invaluable to the dentist by having a team member who instills and reinforces confidence that the office is well versed with implants.

If the office is coordinating the implant dentistry with a surgical dentist, a good working relationship must be established with that office. Coordinating surgical templates as well as provisional restorations that are to be placed at the surgical office takes continual monitoring. No embarrassing moments are acceptable! Surgical templates must be ordered and delivered in a timely manner so that the implant placement can be done with precision, whether the surgery is done in the same office or with a surgical office.

In addition to upgrading the dental team's skill, attention to the overall facility impression and personal appearance produces a "professional" look by the team. The front office team should be in business attire and the clinical team should create a look that inspires confidence in all patients needing treatment. Clean, neat clothing and grooming of the dentist and staff creates a consistent message of attention to detail and a high standard of care.

Different types of continuing education are now accessible for the dental team. A prominent source of such information is available from the Academy of Dental Implant Auxiliaries (ADIA). This is a branch of the International Congress of Oral Implantologists. The ADIA is an organization committed to expanding the knowledge and expertise of dental office teams throughout the world. Online educational opportunities are also available to train dental team members conveniently at home. The Global Institute for Dental Education ( provides DVD's and online webcasts illustrating the technical and professional skills needed to enhance the growth of implants within any office.

The dentist and entire team will benefit professionally and financially by exhibiting an organized, skilled, and appearance-conscious approach to building the implant practice. Surgical and prosthetic completion of implant cases have proven to be our most productive and profitable procedures.

Implementing systems that focus the entire dental team on implant dentistry creates a win-win for the dental implant patient and the dental implant practice.

Stephanie Strong is a practicing dental hygienist and office manager in the practice of Dr. Sam Strong. She lectures with Dr. Strong to dental office team members on building the implant practice, in addition to publishing on this subject. She is the co-author of the booklet, "Team Training for the Dental Implant Practice." Reach her at [email protected].

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