The five-star emergency

June 1, 2002
A patient recently called a dental office with an emergency, saying, "My front cap came off. It just needs to be re-cemented. Can you squeeze me in this morning?" This dental team is ultra-aware of VIP 5-Star service.

A patient recently called a dental office with an emergency, saying, "My front cap came off. It just needs to be re-cemented. Can you squeeze me in this morning?" This dental team is ultra-aware of VIP 5-Star service. They would never think of letting an emergency patient suffer. A quick response to emergency patients is a critical part of the office philosophy.

Several errors resulted in an extraordinarily messed up day!

•The patient's expectations for the "emergency remedy" were never managed. Nothing was mentioned to this patient regarding the possibility that it could become more than a "re-cement"... and what to expect if that were the case.

•No time is set aside for daily emergencies. Their "A" patients had to wait. Many patients were inconvenienced this dark day. When asked how many "emergencies" they get on an average day, team members confessed that a routine day normally meant at least two or three unexpected emergency visitors!

•The patient's past history was not reviewed for a "pattern." Sometimes, emergencies happen to the nicest, most compliant patients. However, more often than not, if you will review the patient's history, it may help guide your response.

If he chipped a micrometer off of the enamel on a cusp of his third molar, and never has accepted any prior treatment recommendations ... it may "shade" your handling of his "emergency." Maybe he can be scheduled after your "A" patients of the day.

What really did happen

Of course, it couldn't have been just a simple "re-cement." Nope. The patient presented with crown in hand ... and tooth in crown! Unfortunately, because of improperly managed expectations, the patient assumed that he would leave there "fixed." "Re-cemented." And that he did. In the middle of a hectic schedule - and after a root canal, post and retrofit core were performed, followed by re-cementation of the crown. He was in the office (being served on the side in a spare room) for the better part of the day. Every other patient waited excessive amounts of time for their regularly scheduled appointments. The stress was unbelievable ... and nobody was happy.

Critique the Possibilities

During interviews with individual team members, I determined that this was not an isolated incident. Often, multiple unexpected additions - something of "emergency" nature - ruined their days.

My answer? Get the patient in right away. Satisfy his emergency in the fastest, most simple way possible, and get him rescheduled for definitive treatment at the next available routine appointment. In this particular case, the simplest solution would have been a hunk of acrylic fashioned into a "wing pontic." Wedge or temporarily bond it into place. No root canal (unless in pain, which he was not), no post, no retrofit core, and no final cementation. Just make him look good. It's the reason he called you in the first place.

What if a filling fell out right smack in the middle of his maxillary central incisor? Don't get into extensive caries removal, isolation, preparation, bonding, placement of the composite, finishing and polishing. Place a temporary restoration solely to eliminate the cosmetic embarrassment. Carefully explain the need for additional treatment and reappoint.

Most emergency situations can be satisfied fairly quickly. It's truly a win-win situation for all involved. Your other patients will appreciate your maintaining their promised times. Your staff will enjoy keeping to the schedule. Sit down with your team and discuss similar cases. Even a minor improvement can work major miracles in stress reduction, patient satisfaction, and overall peace of mind.

Dr. Tom Orent, the GEMS GUY, is a management consultant and practicing dentist. He is a founding member and past president of the New England Chapter of the AACD. He has presented his "1,000 Gems SeminarsTM" in four countries and at state and national meetings in 46 states. He has lectured at numerous dental schools and is the author of four books and numerous articles on aesthetic dentistry, practice management, TMJ, and "Extreme Customer Service." Dr. Orent may be reached by phone at (888) 880-4367, by fax at (508) 879-4811, by email at [email protected], or visit

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