by Dr. Lynn Jones, Accredited Member, AACD
Interdisciplinary coordination for clinical success
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Most general dentists see themselves as the overall case coordinator when specialists are brought into the diagnostic, treatment planning, and execution process. Having a single clinician responsible for oversight ensures that the individual providers' efforts are well planned, well timed, and well executed. The general dentist must, of course, have a thorough grasp of comprehensive treatment modalities to ensure that the team of dentists is working collaboratively and effectively.
As the general dentist becomes more clinically sophisticated, he or she looks for more opportunities to work collaboratively on cases that pose greater challenges and present more stimulating approaches. At these times, communication and relationship skills are rigorously tested, and these skills — as well as style — must be at peak performance.
My experience in developing better relationships with specialists and laboratory technicians took a turn for the better as I embarked on a path to accreditation with the American Academy of Cosmetic Dentistry. To be successful in this pursuit, even the best general dentist must learn how to work collaboratively with virtually every specialist, as well as his or her laboratory technician. This accreditation process is an excellent training ground for developing the skills to handle sophisticated interdisciplinary cases.
Because accreditation is so rigorous, the successfully accredited dentist will always be more knowledgeable and confident than prior to undertaking the commitment. And for good reason. To ensure more predictable results, the general dentist must coordinate with specialists when undertaking complex cases.
The general dentist cannot successfully coordinate complex treatment plans without a sound understanding of comprehensive, interdisciplinary treatment planning, and the skills to work with a wide range of styles and disciplines.
Dr. Fred Arnold, AACD Accreditation chairman, said this about accredited dentists: “Accreditation success requires a level of excellence that often necessitates an interdisciplinary treatment approach. The philosophy of comprehensive treatment that allows for predictable outcomes with the maximum preservation of healthy tooth structure often requires orthodontics, oral surgery, and/or periodontics, including implant placement before restorative dentistry. I'm proud that the AACD and the accreditation process promote these ideals that help our patients maintain the proper health and function of their teeth for their lifetimes.”
Nothing kills credibility and trust more quickly than conflicting messages. Thus, referring dentists and specialists must thoroughly discuss a patient's goals, their approach to a case, how they will share responsibility, and how they will communicate. The accreditation process allows the dentist to learn these skills through direct application since many accreditation cases are best approached collaboratively.
As the accreditation candidate moves through the process, he or she is able to build clinical knowledge and learn how to communicate effectively with colleagues. Accreditation requires the general dentist to master sophisticated skills and be informed and organized when working with others. For this reason, communication is clear and trust is strong.
The best specialists have well-developed communication systems. This starts with an initial letter acknowledging the referral. Once the patient is seen, the specialist will generally send a review of findings and an overview of the proposed treatment to the general dentist.
As treatment progresses, the specialist will continue to communicate via a series of treatment reports and tracking letters for every follow-up visit. This correspondence usually indicates when the patient can return to the referring dentist.
As referring dentists, general dentists can learn from this. Creating a tight communication system to follow interdisciplinary cases achieves better results for the patient, shows respect for the specialist, and in turn, earns respect.
AACD accreditation requires the dentist to develop strong intra and extra oral photography skills and to critically evaluate his or her work. As part of the accreditation process, dentists must submit standard photographs using the same settings on the same camera from the same angle for each view.
Accredited dentists are also expected to systematically document and keep accurate records of findings, diagnoses, treatment planning, and techniques and materials. They must also be prepared to document the rationale for each treatment plan.
In my opinion, a colleague — Dr. Franco Audia, a board certified oral and maxillofacial surgeon who practices in Bellevue, Wash. — is exceptionally skilled at placing implants for the best esthetic and restorative results. Dr. Audia's success, in part, is a result of his commitment to routinely reviewing potential risks and problem-solving with me and his referring dentists to achieve optimal results. When asked about his experience with AACD accredited dentists, he said:
“I work with several (AACD) accredited dentists, and it is fun and interesting to work with them. They communicate at a high level. When an implant referral comes to me from an accredited dentist, we often address questions about where to place the implant, and whether to add bone in face-to-face communications. Together, we look at models and X-rays. When we meet like this, we have a better perspective that allows us to be more creative and precise. This ensures that the outcome is more predictable. I also have a better idea what the total treatment plan is going to be.”
Dr. Audia added: “Something else I like is the ongoing communication. When treating a case I like to get feedback, and the accredited dentists keep me informed about what is happening with the patient. In all fairness, there are other very sophisticated dentists who take a lot of continuing education, but I think accredited dentists have personalities similar to specialists. They want to perform at the highest levels and are more interested in what the specialist is doing.”
When a treatment plan is particularly complex, the treatment team, involving several specialties, may meet and collaborate on the plan. This makes it even more imperative for the plan to be organized and for everyone to know his or her part.
As the coordinating dentist, I need to know the limitations of a procedure before it has been performed. Moreover, the patient needs to know what to expect. By discussing these issues in a planning meeting, we can coordinate esthetic goals, as well as restorative and functional considerations.
I know Dr. Cheryl Townsend, a board certified periodontist and key member of my specialty team, has a great eye and skilled hands for setting gingival margins exactly where I want them. With skillful lifts and connective tissue grafts, she establishes the gingival architecture to coordinate with my porcelain restorations. We have worked and grown together to the point that I can trust that she will place the tissue after I have set the margins in the provisional.
Once I have completed my preparation appointment and placed the prototype restorations, the patient sees Dr. Townsend to establish biologic width and cover roots to match the architecture of the provisionals with highly predictable results.
Dr. Townsend has much to say about her experience of working with AACD accredited dentists.
“I really enjoy working with accredited dentists because I have discovered that when dentists better understand what the periodontist can do, they become better referrers,” she said.
Dr. Townsend has noticed an increase in the number of referrals, as well as better quality referrals when the referring doctor understands what she can do for them. She reports having better dialogue and clearer communications with accredited dentists. Moreover, the goals and treatment outcomes are more clear.
“This,” she said, “makes treatment planning much easier.”
While dentists often complain about referred patients getting lost in the system, a referral to your preferred specialist can ensure that cases remain coordinated and well-managed. When the patient knows the referral specialist is part of your team, he or she is assured there will be continuity of care. We recommend that the referring dentist and his or her staff make the initial contact to introduce the patient to the specialist and make the first appointment.
Accreditation leads to increased skill and confidence in cosmetic dentistry. This leads to increased client demand for higher quality service. A team approach leads to performing more complex cases, and more complex cases lead to more interdisciplinary dentistry. My experience as a practicing accredited dentist is that the more I learn, the more demanding my clientele becomes. I can't quite explain this phenomenon, but I have spoken with other professionals who have noticed the same pattern. It may simply reflect the increasing consumerism in our society, or it may be the type of referrals that are attracted to a dentist with a reputation for esthetic excellence.
The bottom line is that, if this is the kind of practice you wish to have, then the best thing to do is give patients the quality and esthetics they demand. This often means mastering new techniques to improve the esthetic and functional outcomes of your cases. The ability to coordinate with specialists on interdisciplinary treatment plans is necessary to achieve this level of excellence.
Dr. Lynn A. Jones maintains a full-time general and cosmetic dental practice in Bellevue, Wash. She is an accredited member of the American Academy of Cosmetic Dentistry, has served on the board of directors, and is currently an accreditation examiner. You may reach Dr. Jones by e-mail at [email protected].