After practicing dental hygiene for more than twenty years, I went to work in the office of Dr. Doug Roth who was attending courses at The Pankey Institute. He had a copy of Dr. Bob Barkley’s book, Successful Preventive Dental Practices. Reading that book was a revelation for me. Although I never knew Bob Barkley, his work so resonated for me that I had the feeling he had read my thoughts about working with patients.

I had believed for some time that more was possible in dentistry. I had worked with good dentists and felt as though I took good care of my patients in the time I was allowed to spend with them. We were kind, thorough in our exams, and conscientious in treatment recommendations. Sometimes they took our recommendations, and sometimes they did not. I did not think there was much we could do to change that.

As a result of Bob Barkley’s book and the courses Doug was taking at the Pankey Institute, we incorporated a new model for bringing new patients into the office. Instead of moving patients quickly through an exam and treatment recommendations, we invested time and attention to get to know patients in a different way before we recommended significant treatment. I had no idea of the depth of connection we could have with patients, and the impact we could have on their health and well-being!

We spent “engaged” time with patients over a variety of appointments. We came to understand that the clinical tasks we had to accomplish were a small part of caring for patients. We began to see every interaction, with every patient, as an opportunity to get to know them and what was important to them to help them make healthy choices.

Over time we discovered with our patients:

• The status of the dental health
• The challenges of their current conditions
• The implications of these conditions if nothing was done to intervene
• Interventions they and we could do to change the trajectory of disease.
• A possible preferred future of choice
• Considerations involved in various treatment choices.

When we met patients where they were instead of where we thought they “should be” we found that some were ready sooner than others. We stopped giving patients solutions to problems they did not yet own. We came to understand that if we gave patients the time and attention they needed to own their existing conditions they were more curious about what Dr. Barkley called their “Probable Future” and more likely to pursue a “Possible Future.”

Without this spirit of collaboration and intentional patient development, we cannot do our best work.

Our influence develops throughout a process in which the patient is learning, in touch with their body, and engaged in thinking about the implications of the various aspects of their oral health. Because the conditions we discover today and our patient’s choices will impact their future health, we have a moral obligation to share what our experience tells us is likely to happen (the probable future) if they do nothing or if they choose a stop-gap treatment.

It is also our responsibility to help them see a preferred future that is possible for them when they are ready.

By engaging them in the exam process, creating opportunities for them to experience learning about their health, and welcoming them into collaboration, we enable them to partner with us in shaping their future. We must help them understand the implications of any choice they might make including its limitations, so they are fully informed to make true choices.

We have been trained to be efficient, and most dental clinicians have pride in their efficiency. But by prioritizing being “effective” over being efficient we make better use of our time and theirs. We experience an increase in trust, in our patient’s confidence in their decisions, and a more comprehensive view of treatment. Patients begin to see dentistry as a vehicle to create optimal health, function, and esthetics. Patients are more likely to keep their appointments, follow through on suggestions, and pay for our care with gratitude.

When we invest time in the early stages of our relationships, everything down the road flows more easily.

QuickSplint has many functions in general practice, but it is also a great resource overall in both diagnostics and restorative dentistry. It’s ideal for patients who grind, those with endodontic issues, and anyone needing a restoration.

QuickSplint to Improve the Patient Experience

Many dentists see patients who have wear on their teeth but don’t think they grind at all. They might have said that they used to grind their teeth, but they believe they don’t anymore. You can use the QuickSplint as a learning experience where the patient is able to recognize the cause of the attrition.

It’s nice to rely on this quick, easy, and inexpensive device. Go ahead and have the patient sleep in it for a little while. The QuickSplint will then reveal whether or not they are clenching and grinding. After the proof is clearly demonstrated, you can have an impactful conversation with your patient.

Another option for QuickSplint use is as a means for handling parafunction and restorative materials selection. Today, we talk a lot about posterior materials when we are doing crowns on first or second molars. Are we going to use high strength ceramics or traditional PFM restorations? Instead of guessing about the patient’s parafunctional risk and how much load they will place on the restoration, you can easily get that information with a QuickSplint.

Additionally, you can use the QuickSplint as a post-op device after an endodontic procedure. You can reduce a patient’s discomfort significantly in less than three minutes and also help the tooth heal without occlusal pressure. You then won’t have to take the entire occlusal table off the problem tooth. This can even work during pre-op for a patient whose tooth appears to need endodontic treatment.

In our Essentials One course at Pankey we use the Quicksplint as an overnight deprogrammer to allow us to capture very accurate diagnostic records.

Do you use QuickSplint in your dental practice? Tell us your best tips for using this handy little tool!

A comprehensive exam is the first step in a long line of decisions that can end in case success or failure. For this case, my patient presented with a litany of problems and dental concerns.

Failed Restoration: Patient History

When I first encountered the patient, she had a six unit anterior bridge with temporary cement. She came to my practice because she was unhappy with how her dental work looked and was interested in a permanent restoration that would truly suit her goals.

She had a checkered dental history beginning with orthodontic treatment for a diastema between the maxillary centrals and a left maxillary lateral that fractured down to the root and had to be removed. After a FPD was placed for the tooth removal, her diastema reopened and the right maxillary was also lost to fracture.

That wasn’t even it for the patient’s woes. She was given a bridge that made her very unhappy and also had to have endodontic therapy on the upper right canine. Despite multiple placements, the restoration was never to her liking.

Esthetically, the patient wanted to remedy her uneven gingival margin, the length of the upper right canine, the relative size of laterals and centrals, and the color match. The latter was difficult to remedy because of tetracycline staining from her childhood. Finally, she was also displeased with the thick feeling of the bridge.

All of this together painted a picture of a patient in need of serious help.

Failed Restoration: Evaluation & Exam

My esthetic evaluation confirmed many of her concerns. I completed it intraorally and with diagnostic photographs. The patient presented with tooth proportion asymmetries, inadequate tooth display at rest on one central, an uneven incisal plane, and gingival discrepancies.

Her comprehensive exam revealed normal TMD joints, but also showed posterior wear. She had muscle pain and headaches yet no muscle tenderness. I put her on six weeks of appliance therapy, which led to the discovery that she had a habit of ‘power wiggling.’ I was then able to obtain an accurate centric relation bite record.

I removed the anterior bridge for radiography of the abutments. It became clear that her maxillary right canine had a lot of decay and inadequate ferrule.

To be continued…

Like with any big purchase or expensive commitment, it’s not surprising patients would want to try on a new smile before going all in. You wouldn’t expect someone to purchase a sports car without first riding it around the dealership, would you?

Think of your cosmetic treatment as a high-end experience and your patients will too. Even the most hesitant spenders will be much more interested in moving forward if they’ve gotten a taste of how beautiful their smile really can be. This is where the ‘trial smile’ comes in.

Cosmetic Case Acceptance: Let Patients Try Their Smile

There’s no need to feel daunted by the process of creating a trial smile. Patients want to find a dentist who will offer them the kind of care they feel they deserve and who are willing to give them exactly what they want. You’d be surprised how hard it can be to find someone who will listen to a patient’s expectations instead of delivering what they personally feel is best.

With esthetics, the patient should have the primary say. Invite your patients who have given indications of wanting cosmetic treatments to communicate their preferences in a very tangible manner. All you have to do is first conduct a co-discovery appointment complete with high-quality digital images and an occlusal exam as well. Then, temporarily put composite on their unprepared teeth.

With this strong foundation already in place, your patient can see the potential outcome of smile design. When you pitch a trial smile to them, you can even call it a ‘demo.’ If the patient loves what they see, it’s no problem to move on to a diagnostic wax-up using a model of their demo smile.

What case acceptance techniques do you find most effective? We’d love to know your thoughts in the comments section below!

Photo courtesy of Matt Roberts CDT, CMR Laboratory.

The Aesthetics Course taught by Matt Roberts, CDT, Dr. Frankie Shull, Dr. Susan Hollar, Dr. JA Reynolds and Mr. Michael Roberts is just the place to learn to use digital technology to help patients want an aesthetic makeover.

There are three words on my business card that may seem obscure to patients at first. These words, which come to have important meaning later on in their relationship with my dental practice, are: Comprehensive, Restorative, and Esthetic.

Promising and Delivering a Luxury Patient Experience

Comprehensive

We look at the patient as a whole. We observe and diagnose globally. We intend to partner with our patients in a thorough individualized manner. The best dentistry does not happen when we just look at a tooth with a problem. In fact, it isn’t much better when a dentist has a look at ‘teeth’ plural.

Comprehensive dentistry considers the whole system and the individual. How are the muscles and joints that affect and are affected by the teeth and their use considered? How are the structures that support the teeth?

What are the factors unique to a patient’s habits, routines, and systemic health that relate to ideal dental health? What are a patient’s individual goals, desires, and expectations? Will the dentist take everything they can gather about the causes of problems and consider them in the solutions?

The list goes on. This is a highly intentional paradigm of patient care.

Restorative

The focus on restorative dentistry is just as it sounds. In our practice, we want to restore patients to an ideal state of health and function. We put tremendous effort toward continuing education, technology, and our approach to care beyond the average dental setting to achieve this ability.

Esthetic

Esthetic dentistry speaks to taking great care in the art and science of making dentistry beautiful. Yes, it is a nose thumbing at the overused term “Cosmetic Dentistry.”

We believe all good dental restoration is more beautiful if provided in the context of health and function. At the end of the day, we want to create smiles our patients can be proud of because they are beautiful, healthy, and durable.

We all have things we value enough to invest in. We all make choices that take effort because we want the result, just like my car that I enjoy and is reliable. I invite patients to consider that experience with their teeth through the approach of ‘Comprehensive, Esthetic, Restorative’ dentistry.

What do you do in your dental practice to make dental care a valued experience for patients?

When a car breaks down, the way we choose to have it repaired says a lot about how much we value our vehicle. A similar phenomenon occurs with dental care. 

In part 2 of this series about how we see a fix versus a valued service-based relationship, Dr. Kelly dives back into an experience that made him reflect on the dental profession. Keep reading for the rest of his story:

A Car Service Analogy: Obligation, Expense, or Experience

Coincidently, many days I use the analogy of cars to taking care of teeth with my patients. We wear away the surfaces of our teeth similarly to how tires age. We pay for maintenance and parts with an equal financial obligation and expense.

When we have to start over and restore our vehicle (or get a new one), sometimes it costs the same as major treatment we could have done for our teeth. Sometimes the auto investment is inconvenient and urgent. Often, if we choose, it is predictable and pleases us. We find ways to pay for it.

Individuals always seem to find ways to pay for the things they value. We choose our own experiences whether we know it or not. I invite my patients to consider experiencing dental care in my practice similarly to the good experience I have had with reliable and well-maintained cars.

The business card for my practice has three tag words on it: Restorative, Comprehensive, and Esthetic. I’ve been told that the meaning of these descriptors is too obscure for new patients to understand. Why not be like the dentist down the street and just say “Cosmetic” or “Family Dentistry”?

I believe every opportunity I have to help patients experience each of these focused goals for our patient care enriches the dentistry I can provide them. So many in our patient family have learned through these experiences exactly what these words mean.

To be continued …

What makes dental care a valued investment versus a fix patients choose begrudgingly? 

One morning I had an automobile breakdown in my “beater” weekend truck. We have all been there – filled with the inconvenience and anxiety of dealing with a problem that came up unexpectedly. I was hoping to find a place that could get me home that day.

I googled around until I found a reasonable looking repair shop close to the breakdown. They worked me into their schedule so I could get the old truck back on the road. It was pleasing to have the problem fixed, at least for that day, but I measured this against how I have experienced service at the shop that takes care of my daily driver car.

Dental Service Emergency vs Dental Relationship

There were many aspects of the breakdown with my old pickup truck that reminded me of a dental emergency. I found someone convenient and they had the best intentions to provide a fix.

It was a shop I didn’t have a relationship with. They were kind and helpful, but there were so many things missing that would have been unlikely to happen if I treated my old truck like I do the car I have been so much more diligent in taking care of.

The shop focused on the problem that was presented to them, not looking beyond a simple fix to get me back on the road. While I was appreciative, it is very unlikely that the next problem (or even the true cause of this one) was looked for. I did not leave with any feeling that I wouldn’t be in a similar situation as soon as the next problem arose.

I reflected on the years I have spent with the auto shop that takes care of my primary car. I have a valued relationship with them. They know me and know that I appreciate them taking the best care of the investment I have in the vehicle I drive every day.

When I take my car to an appointment, they look over everything. They tell me when to expect maintenance and repairs in the near future and throughout the life of the vehicle. I trust them and know that they have my best interest in mind. In return, I am very appreciative, expressing gratitude when I write them a check for their services. I have never broken down in the cars they take care of for me.

To be continued …

During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well.

A Hygiene + Occlusion Exam

What the hygienist should look for:

1. “Can you eat/drink cold things comfortably?”
2. Subtle wear facets – those shiny spots on the edges of teeth.
3. Chipping of the edges of teeth. Can you get the patient to line up an incisal “chip” with a sharp edge of a lower front tooth?
4. Fremitis – that subtle shimmying of an upper front tooth when you gently place your fingernail on the facial of a maxillary incisor and ask the patient to grind side-to-side and front-to-back.
5. NCCL – could that be from clenching or orthodontic expansion? Both/and?
6. Persistent marginal inflammation that could be a sign of clenching (or an imbalanced bite).

The hygienist’s role is to raise patient awareness –  to “discover” changes that can be brought to the doctor’s attention for long-term protection of the patient’s teeth.

The doctor’s arrival for an exam is the time that real skill and teamwork begins. The hygienist takes the lead and informs the doctor what they (hygienist and patient together) have been discovering/discussing.

Many times, the most significant questions come when I am behind and feeling rushed. Our goal, practiced for years, is for me to get in and out of the hygiene room in under 5 minutes. Therefore, our total goal together is to encourage the patient to schedule another appointment for a more thorough evaluation of any changes/discoveries.

The hygienist then supports and reassures the patient about the need for a more thorough understanding to protect their teeth and eating for a lifetime. They confirm the uniqueness of a full understanding of teeth, harmonizing bite forces, and oral-systemic health and well-being.

“This is what sets our office apart. Together we strive for the best in your total oral health prevention.”

A well-thought-out and choreographed hygiene appointment can truly establish you in the relationship-based sector of dental care.

Clarifying and fine-tuning a new patient system can be more challenging than you might think.

Five years ago, my partner Charlie and I bought a ‘Pankey practice.’ Soon after the transition, we started to recognize that our new patient system would need a little adjusting. The prior owners, who happened to also be my parents, had almost every new patient go through the same protocol.

Charlie and I noticed that the young adult patients who were drawn to our practice had two things in common. (1) They wanted cleanings at the first appointment and (2) they often had less dental needs. We concluded they may not need all the diagnostic records that someone with a lot of restorative needs would have to have.

Defining an Efficient Patient System

I am very systems oriented, and having worked with my parents for a few years, it wasn’t easy for me at first to switch up the new patient system. I liked having all patients funnel through the same protocol, but I began to realize that to get the younger generation into our practice we needed to cater to their desires and gain their trust.

When a patient calls our office, we have a great team that asks questions to understand what the patients’ needs are. I would say that because our referral is mostly word of mouth, we still have many new patients looking for comprehensive treatment. This means we have the traditional new patient appointment, which includes the new patient interview comprehensive exam and full diagnostic records.

But if a patient calls and says they want a cleaning and that there are no concerns, we flex and allow them to meet with the doctor first for a new patient interview, then they have their comprehensive exam and we finish with a cleaning with the hygienist.

If I find that diagnostic records are necessary, I will then have them come back for the records. Sometimes if I really think it would be in the patient’s best interest to not have the cleaning the same day, I will try and talk to the patient to help them understand why I think diagnostic records would be a better option that same day. Most times, if the patient understands the benefits, they are comfortable coming back for the cleaning with the hygienist on another day.

No matter whether the patient has the full new patient exam and diagnostic workup or has the exam and cleaning, the most important part to me is the first 30 minutes where I sit down with the patient and get to know them. I love this time because it allows me to learn about my patient. It also allows the patient to learn about me and my practice and ask any questions.

I believe those first minutes with my patients set our practice apart. It is the beginning of building trust so that whether they have a healthy mouth or need extensive treatment, they are confident that my practice will work with them to maintain optimal oral health.