Brazilian Project: missing link found!

Feb. 1, 2006
Here is my “Gem” which converts new patients into new-patient exams.

Here is my “Gem” which converts new patients into new-patient exams. During the first appointment, proceed with your screening and oral cancer exam, check for open carious lesions, soft-tissue problems, etc. In most adults, you’ll find a number of carious pits, fissures, and grooves. Visually identify the darkest, deepest, ugliest pits, grab the DIAGNOdent, and explain that you found a questionable area of concern. Tell the patient you will use the “laser cavity finder” on just that quadrant of pits, fissures, and grooves.

Prior to using DIAGNOdent, explain to the patient what the numbers mean and how the increased tone correlates with deeper cavities. You’ve got to properly preframe expectations for maximum acceptance!

When you’ve completed the exam, recommend that the patient return as soon as possible to restore these new cavities before they end up deeper and requiring anesthesia or a routine drill. Suggest they complete the full DIAGNOdent examination. (Make it clear to the patient that since you are not doing a complete new-patient examination today, you only have time to check areas of concern.)

Of course you don’t want to complete an examination at this time. You want the patient to feel the urgency to come back to your office.

Once you have made your recommendations, say, “Mrs. Jones, if you don’t currently have a dentist and you would like to have the full exam and take care of these cavities, I’d love to have you come back here for a complete new-patient examination.”

It would also be a good time to explain to your new client that when cavities are found in their earliest stages, you can treat them ultra conservatively using (insert your favorite conservative modality here - air abrasion, hard tissue laser, or fissurotomy bur).

Periodontal screening

Just as we hope to find undiagnosed, asymptomatic new pit or groove caries, it also would be a good idea to check for previously unidentified, asymptomatic periodontal disease. Remember, the vast majority of adult Americans have some level of undiagnosed periodontal disease.

Again, I wouldn’t do a complete perio exam here. You want to leave the new patient curious to learn more about his or her condition. For example, you might say to the patient, “Mrs. Jones, there is an area of your gums that concerns me. I am going to do some measurements. It will just take a moment.” Then do only the quadrant that, on the surface, appears to be the most edematous, with loss of stippling, etc. Of course, if you identify an area of five- or six-millimeter pocketing with bleeding, you are on your way.

Conclusion and conversion

The above are examples of two ways to “agitate” and emotionally motivate a new patient to want to return quickly to your office. Of course, if the patient has come to your office to take advantage of a discounted or free brief routine exam - and already has a dentist he or she knows, loves, and trusts - then this person is welcome to return to that office to report your diagnosis of previously undiscovered maladies! However, it’s likely the patient would not come to your office in the first place if he or she had a solid relationship with another dentist. And, if you are wondering whether my technique is ethical, what you should really be concerned about is whether or not it would be ethical not to diagnose and explain the patient’s as-of-yet undiscovered maladies.

Your first step, today, should be to look back over the last year and determine your conversion ratio. In the last 12 months, how many new adult patients have you seen and how many returned for a complete new-patient examination? Then put the above strategy (Gem!) into action, and watch your practice numbers jump.

Here’s the math: If you converted two more nonexamination new patients per month to follow through with a complete new-patient examination, you would “save” (earn) two new patients. The average lifetime value of a dental patient in the average office is $2,500. Thus, two patients per month x 12 = 24 additional new patients per year x $2,500 = $60,000. Convert three or four new patients a month with this technique and you are up more than $100,000! It’s a great way to breathe new life into your practice.

Dr. Tom Orent, the “Gems Guy,” is a founding member and past president of the New England Academy of Cosmetic Dentistry. His “1000 Gems Seminars” span five countries and 48 states. He is the author of five books and hundreds of articles on practice management, TMJ, and “Extreme Customer Service.” To receive three free issues of his “Independent Dentist,” “Mastermind of the Month” CDs, and other special offers, go to, and type “DentalEcon” in the yellow “Special Code” box at the top. You also may call (888) 880-4367.

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