Clinical Corner: Information on Dental Procedures

Articles

What's Hot: Dr. Glazer on Jazz
Combating Hidden Decay with Early Detection
Atraumatic Removal of Defective Crowns
Balancing: The Art, Science and Business of Dentistry
Intra-Oral Preparation of Titanium Abutments in Order to Obtain Ideal Angulations and Contours
SS White Express Line High Speed Laboratory Metal Finishing Burs
Direct Preparation Of Preexisting Implant Abutments For Case Rehabilitation
Flextime Xtreme: The 80/20 Rule
Fast and Smooth - Efficient Crown Preparation With Carbide Instruments
When Advancing the Bur, One Can Feel the Presence of Dentinal Caries
Precision Trimming and Finishing of Current Dental Restorations Using the Safe End Bur System
Indirect Restorative Tooth Preparation: Extreme Efficiency and Accuracy
Creating Maximum Efficiency and Accuracy In Indirect Restorative Tooth Preparation
Preparation Protocol To Ensure Predictable Aesthetic Restorations
Tooth Preparation Mastering Quality and Efficiency
Fissurotomy: Proactive Treatment for Incipient Decay
Anatomically Adapted Carbide Finishing Burs - Creating Super-Smooth Composite Surfaces in Two Steps
Directions for Use: Dr. David Clark Kit
Placing Traditional Sealants with Enhanced Magnification: Methodology to Increase Both Short-term and Long-term Success - David Clark, DDS
How to Quickly and Conservatively Restore a Natural Shine after Orthodontic Bracket Removal
SS White Surgical Length Oral Surgery Burs: Atraumatic Removal of Teeth for Maximum Bone Preservation

"Balancing: The Art, Science and Business of Dentistry"

Dr. Jeffrey Hoos

How do we keep the "balance" while facing our top challenges? To be able to face any challenge in a proper manner, every office needs a vision, mission and resulting strategy to achieve it. Roger Levin says, "The future of any business depends upon the vision of its leader." It is the mission statement that gives us a guideline of how we want the office to be seen by the outside world. This statement should be a daily reminder for the staff and the doctor as to the direction of the office and how we want to treat our patients. The mission statement for our office is:

This mission is similar to what I have heard many of my colleagues state verbally. By gaining staff buy in and putting it on paper I have seen real results.

Roger Levin has clearly stated: "If a practice does not provide the financial resources for the dentist and family to enjoy a certain quality of life, satisfaction will be fleeting." Now dentists are discussing how to best fill their time with high quality, high fee for service paying patients, who want comprehensive and esthetic dentistry. These patients are the top 5% of the market.

Many dentists, therefore, ask how do we generate patients who want and need high-end work when they may represent perhaps only five percent of the dental population? Is the challenge to find the internal and external methods to generate these patients? Is it our ultimate desire to only do these type procedures and treat these patients? The wonderful thing about dentistry is that we all have a choice in the way we want to practice. However, it can be frustrating trying to look for and compete for such small % of the patient population base.

My mission and the practical nature of working on "Main Street" has made me embrace the fact that I will treat all patients in the most comfortable way while maintaining a balance. So how do I get balance?

I have come to realize that the success of our practice is not limiting it to the 5% of the patient base that all doctors including me seem to want, but to service all our patients with the highest quality care we can give them. That quality care is not just in the clinical skills we display. All patients assume that their dentist is clinically competent or they would not go into their offices. I believe that we must treat patients with what I call a "high perceived value" and within our large loyal patient base and the people that they refer, the high fee elective cases will be found. That "high perceived value" comes from utilizing good "people" skills as well as great clinical skills.

One new/old procedure I have found helps me with this tactic. Researchers and clinicians have documented the inadequacy of exams for dental caries detection using radiographs, explorer, and visual determination. However, these methods continue to be used because other methods are either not available or not trusted. Dr. Rella Christensen has documented that well over 94% (CRA Newsletter December 1999) of the stains in pits and grooves of non-smokers have undetected carious lesions. Many of these carious lesions can extend deep into the dentin and some have even invaded the pulp chamber.

The December 2000 CRA newsletter states that the Diagnodent by Kavo provides helpful diagnostic aid where radiographs are not useful. The Diagnodent will give instant feedback to both the clinician and the patient. A laser induces fluorescence, which is detected and converted to L.E.D. display and an audible signal. The touch of the probe and the audible signal help the patient follow the course of the exam and identify teeth with possible problems, thereby involving them in the treatment decision.

Once our suspicion is raised to a treatable level we have at our disposal a number of innovative ways to be conservative and reduce the need for anesthesia to restore these teeth. To reduce the need for anesthesia you could use air abrasion or one of the newer products, the Fissurotomy Bur system from SS White. I chose the Fissurotomy burs because they are more conservative and cleaner. SS White has devised a very simple, innovative, conservative technique to treat these teeth. This bur system has everything you need to very easily treat these areas of decay without the necessity of changing handpieces. The bur has been designed to be the smallest at its tip so as to minimize tubule activity and conserve healthy tooth structure.

We as dentists in the year 2001, need to use science for it is at our disposal. The amount of routine, "run of the mill", dentistry that goes undiagnosed in the dental office is probably enough to keep any dentist as busy as they want. Remember that part of the "balance" is the science of dentistry.

With the emergence of these simple new techniques, cutting devices and easy to use restorative materials, class one cavities can now be done 85 to 90% of the time without anesthesia. Dr. Charles Blair speaks of the unscheduled treatment room where patients can be seen as an adjunct to hygiene visits. When these lesions are discovered during the hygiene visit, multiple quadrants can be treated simultaneously and the teeth prepped in three minutes or less and then quickly restored. From a business standpoint, the chair time is reduced, and the production per hour rate has been increased to the point where it is similar to the top 5% of the work many of us target. I see this as very congruent with my mission to treat all patients. I get the same type of satisfaction and gratitude from these patients when they or their child experience a gentle, pain free, anesthesia-free cavity prep.

Listening to the Patients

The two questions that I always ask in all the courses I give are: "How are you serving your patient base in order to retain your patients and how are you generating your new patients?" It is important to understand a simple technique that we have used to help our office became successful. I believe that it is an easy method that can be used in any dental practice. I see this procedure helping me do this. In dental school, a very old doctor told me that if you listen to your patients, they would tell you the problem. These were very wise words. I would expand it further: the patient will tell us what they want or desire. My adult and child patients express fear of the needle. I listened and addressed this in many patients first experience with the handpiece. It is our job to fulfill that desire and give them what they want within the guidelines of good science and good business. With the "run of the mill" Class I, I now have patients and parents thanking me, and in some cases bragging about me for the "no shot cavity prep".

We want to respond to the patient’s desires. Once we have taken care of their immediate needs and built trust, we can build on this to help them understand the other undiagnosed dental needs they may have.

Benefits Versus Features

Once we have fulfilled their immediate desires, we as communicators need to demonstrate to them our view of other real dental needs. How we communicate and inform the patient is very important. Once the office has the patient understanding their needs, the doctor needs to provide the solution using methods that the patient can understand. Patients and people do not buy from someone that they do not believe and trust.

The key point to having patients understand their dental needs and agree to treatment is this concept: consumers buy because they trust you, not the features provided. What is a benefit versus a feature? When something is described, the simple word of "you" in the statement makes it a benefit statement.

"The car can go zero to sixty is six seconds." This is a feature statement. "You will be able to get into the flow of traffic because of this powerful engine." This is benefit statement.

It is extremely important that we really understand the difference between the "benefit" and "feature" statements. This concept can make the difference between our patients really understanding the importance of the services that the dental office can provide them.

Patients, as dental consumers, do not know how a procedure is done. How uncomfortable or comfortable will the treatment be? How many visits they should plan for the dentist to provide the service they desire? What great materials you are using, and how wonderful it will turn out in the end. By using the proper benefit statements, you can explain things to your existing patients and new patients in positive terms. It is the positive terms of the benefit statements and their emotional trust for you that will motivate the patient.

Gordon Christensen, in the recent article, The Credibility of Dentists talks about the Gallup Organization regarding the honesty and ethics in U.S. professions. The ranking of dentist has dropped over the years. Dr. Christensen has said that one of the reasons may be that the profession is planning and carrying out excessive treatment. When I describe the use of benefit statements as a "selling" tool; I want to provide patients who have grown to trust me via "run of the mill" work with treatment they desire and by using benefit statements that help them make the proper choices. I am not interested in overselling the patient; just providing a communication environment that is comfortable for the patient.

Summary

The purpose of this article was not how to do a simple Class I restorative procedure using tooth-colored materials, new devices and specially designed cutting instruments. The Science behind the techniques, the restorative materials and presence of hidden caries is well documented. The Business aspect of the equation is extremely important. We listened to our patients and understood their issues and had them understand the benefits we were going to provide for them. We validated their concerns and fulfilled their desires without compromising the science necessary to give a great result. The Patient and Practice won. We built trust and referring patients as a result. We set the stage for acceptance of more complicated cases (the top 5%). By following our mission and striving for balance, we can face the dental challenge of the years ahead and become as busy and successful as our clinical and communication skills will allow us.