Ask the teams that know

March 1, 2010
In the past eight years, I've picked the brains of over 100 dental teams who are experts at comprehensive case acceptance.

For more on this topic, go to and search using the following key words: ccomprehensive care path, foundational care path, alternatives, Dr. Nate Booth.

In the past eight years, I've picked the brains of over 100 dental teams who are experts at comprehensive case acceptance. I have made the following two discoveries:

Discovery 1These teams identify people who need comprehensive dentistry and treat them differently.

After the examination, the doctor selects which of three paths needs to be followed:

Routine care path — This path is for patients who need only routine care (two or three restorations, for example). The solutions to their problems are discussed at the end of the examination visit.

Foundational care path — This path is for patients who have serious foundational problems (periodontal, endodontic, or surgical) that require care before discussing comprehensive restorative, cosmetic, and/or tooth replacement dentistry. The solutions to their foundational problems are discussed at the end of the exam.

Comprehensive care path – This path is for patients who need comprehensive care. These patients usually have significant needs in two or more of the following areas: periodontal, restorative, replacement, and cosmetic.

Discovery 2They have one or more intermediate conversations with patients on the comprehensive care path before specific treatment plans are discussed.

Instead of just one treatment conference where specific care and fees are presented, these teams have one or more intermediate conversations where only possible care is discussed, nothing specific. No final decisions on treatment are made in these conversations.

These intermediate conversations can be at the end of examination visits or at second visits where additional records are taken. Patients typically return for separate visits where the final comprehensive treatment plans are agreed upon.

Fee ranges are also discussed at these intermediate conversations. When done correctly, patients think, “That's about what I thought it would be,” after treatment plan fees are presented.

Here's how a segment of the intermediate conversation might go: “The second area we need to address is restoring those five back teeth that have large metal fillings. You have three choices with these teeth.

Your first is to do nothing. The problem with that is the fillings will continue to leak and the decay will eventually reach the nerves. Your second choice is to have the metal fillings removed and have new metal or tooth–colored fillings placed. The problem with that is the new fillings will be even larger than the current ones. Your third choice is to have laboratory constructed, tooth–colored onlays and crowns put on the five teeth. I have these restorations in my mouth. The great advantage of onlays and crowns is their strength.

On this model, do you see how they hold teeth together instead of weakening them? They also look great, don't they? These restorations are typically about $1,000 per tooth. Would you like to explore the possibility of having these restorations? We will give you specifics at your next visit.”

What are the alternatives?

Think about it. What are your options for not having intermediate conversations with your patients on the comprehensive care path?

• Bad Option 1 — Don't give your patients treatment options; just discuss ideal care. Not only is this unethical, it can create doubt in people's minds. They may think, “Why didn't she say anything about replacing the metal fillings with bigger metal fillings? That's what I have had done in the past.” You want to remove doubt from people's minds because it can squash comprehensive case acceptance.

• Bad Option 2 — Give your patients all the clinical information, discuss treatment possibilities, dump a huge fee on them, present all your investment options, and ask them to make their final decision — all in 30 minutes! That's what most dental offices do and then wonder why their comprehensive case acceptance rate is so low.

Intermediate conversations help patients make big decisions in small steps. You don't overwhelm them with too much information delivered in too short of a time. Isn't this how you would like to be treated?

To receive a free, one–hour DVD of Dr. Booth's The “Yes” System: How to Make It Easy for People to Accept Comprehensive Dentistry, e–mail [email protected] or call (800) 917–0008.

Dr. Nate Booth is a speaker, consultant, and author who provides dentists with the information and systems they need to thrive in their dental practices. Dr. Booth teaches at the South Beach Dental Institute, and is a practice management advisor for ChaseHealthAdvance. He is the creator of the in–office, DVD–based program, The “Yes” System. For more information, go to, or call (800) 917–0008.

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