Status quo dentistry today stifles practice growth tomorrow! Your practice can leave the doldrums of status quo and enjoy future success by seizing missed opportunities with a proactive dental hygiene experience as outlined in this article.

The Problem

Let's look at a typical situation that daily repeats itself in dental offices across the country… Forty-five year old "Baby Boomer Betty" is in to see the hygienist for her "cleaning and check-up".

The day before her appointment a front office administrator called and left a message saying, "Betty, this is Sally at Dr. Super's office, I'm just calling to confirm your appointment at 9:00 tomorrow for you cleaning and check-up. Please call back as soon as possible to confirm this appointment." Naturally, Betty did not call back, and arrives at the appointment 10 minutes late.

Betty is in a hurry and tells the hygienist she needs to be finished on time because she has another appointment across town. The hygienist feels the pressure and hurriedly begins the cleaning. At the end of the appointment the hygienist notes moderate bleeding around the posterior teeth as well as the same two molars needing crowns diagnosed 2 years ago. She says to Betty, "I noticed a little bit of bleeding today especially around your back teeth so really work on your flossing and we'll take a look at it next time." Betty murmurs her sincere agreement to floss more. The hygienist hastily adds, "Have any of those molars been sensitive that Dr. Super recommended you have crowned?" Betty shakes her head no, and impatiently looks at her watch.

On her way out of the office Betty stops by the restroom, looks in the mirror, and wistfully she says to herself, "Hum, I wonder why having your teeth cleaned never really whitens them! I sure wish my parents had sent me to the orthodontist when I was 16!" Betty leaves the office only marginally better off than when she entered.

Can you spot the missed opportunities in Betty's appointment? Let's examine how to seize the opportunities Betty presented!

Creating Value Over The Phone and Setting Expectations

Two days prior to her appointment a front office administrator leaves the following message on Betty's recorder: "Betty, this is Sally at Dr. Super's office. This is your courtesy call to verify that our hygienist, Mary has 9:00 on September 5th reserved for your hygiene appointment, periodontal screening and oral cancer exam. We look forward to seeing you on Thursday and sharing some new information with you!" Verification of a patient's commitment to an appointment should be personalized, and, when expressed with enthusiasm, can to heighten the interest of the appointment itself.

When Betty rushes in 10 minutes late, the hygienist greets her and says, "Betty, I am so glad you are here! I know what a busy schedule you have. Let's get going right away and discover what the priorities are today." This sets the stage at the beginning of the appointment to do discovery and begin to prioritize today's treatment."

Screenings Determine Priorities

Following an update of the health history the hygienist asks an important question: "Betty as I do your screenings today, do you have any concerns about your mouth?" Betty says everything feels fine now but recently has experienced discomfort along the right side of her jaw, pointing to her TMJ.

In the restorative / aesthetic screening the hygienist hands Betty the mirror and says, "Betty there are a couple of things I want to bring to your attention. First, I see numerous places where your teeth are showing permanent wear, probably from clenching. I have captured a couple of close-up pictures from inside your mouth that we'll examine in a moment on the monitor. Secondly, the teeth Dr. Super diagnosed for more secure restorations have numerous fractures and it appears you are trapping food between these two molars that need crowns." Betty nods agreement. The hygienist continues, "I have two intraoral pictures of those teeth we can look at together in a moment. I also wanted to tell you about a new service many of our patients are taking advantage of that is quite fun! It is an aesthetic consultation with the doctor to look at some of the incredible possibilities now available to even further enhance a person's smile! We can computer image a person's smile to see what it would look like to whiten, straighten, or even change the shape of a person's teeth. Often this can be done very simply and without orthodontics. How does that sound to you?"

Betty reveals she does wish her teeth were whiter, and always notices her front teeth look too crowded when she sees a picture of herself. She agrees she would like to set up an aesthetic consultation with the doctor as soon as possible.

The last screening the hygienist does prior to the prophylaxis is a screening to determine periodontal health. The hygienist prepares the patient by saying, "Recently, new information has been published that examines a correlation between a person's periodontal health, and their overall health. We now know that bleeding tendency can be the earliest warning sign of gum disease that not only affects the gums and jawbone, but can also affect your overall health!" As the hygienist does the periodontal screening she captures two intraoral pictures of areas with moderate bleeding, then sits the patient upright to review the restorative and periodontal findings.

Co-discovery and Diagnosis

The hygienist and Betty examine the monitor together to see pictures of two molars with fractures, failing restorations, significant wear facets, as well as the areas indicating periodontal infection. For the next five minutes the hygienist explains what the doctor generally recommends to treat the early stages of periodontal disease and shows Betty how the teeth needing restorations can be a contributing factor to the unhealthy conditions in that area. She uses a 60 second CD Rom to help describe non-surgical periodontal therapy and shows Betty an example of a bite splint and the indications for both. The hygienist uses open-ended questions to find out how Betty feels about moving forward with treatment and discovers that maintaining a healthy mouth and keeping her teeth for a lifetime are very important to her!

When the doctor enters the hygienist informs the doctor of today's findings and Betty's interest in an aesthetic consultation. The doctor confirms the diagnosis of early periodontitis, the need for a bite splint, or occlusal therapy, and sequences the restorative treatment following the periodontal therapy. He also invites Betty to come back for an aesthetic consultation. Where more time is needed for treatment planning or diagnostic data, a returning comprehensive dental examination should be scheduled with the doctor.

Mission Possible

Most readers may be thinking, "There is no time left to clean Betty's teeth!" The key is to begin with screenings, and co-discovery that dramatically affects how much treatment takes place in one appointment. For areas that are healthy, a preventive prophylaxis is all that is required and should take minimal time with the use of power-driven instrumentation. For sites needing periodontal therapy additional appointments will provide the necessary scaling, root planing, co-therapy and education to achieve optimal tissue response. Effective enrollment into optimal treatment begins with a realistic plan, and is built on creating value and communication.

With the use of appropriate visuals and verbal skills the hygienist is able to collect data, sit the patient up to discuss treatment possibilities, and still perform a prophylaxis. In cases where data indicates active disease, prophylaxis should be only the beginning of treatment, and not the therapeutic treatment itself. Unfortunately, the reality in too many practices is that emphasis is put on performing a prophylaxis at the expense of collecting enough data to have appropriate diagnosis, and conversations with the patients related to ideal treatment enrollment.

Steps For Implementation

An opportunity exists TODAY to change the status quo! You can seize opportunities, rather than miss them by doing the following:

• 1. Establish clear distinctions and indications in the various hygiene procedures so the entire team understands when to provide preventive treatment, versus additional therapy. (ADA's CDT 3 /2000 defines dental procedures by insurance codes.)
  
• 2. Begin every hygiene appointment with intentional screenings to discover periodontal and restorative health, and aesthetic possibilities.
  
• 3. Use visuals to assist patients in understanding available services and outcomes.
  
• 4. Build relationships with patients with an exchange of information and "telling the truth".
  
• 5. Collect appropriate data and prioritize today's treatment as well as an appropriate treatment plan.
  
• 6. Let go of pre-judging the interests of the patient. Instead, invest time in communication and education to help create value for ideal treatment.
  
• 7. Enthusiastically enroll patients into aesthetic consultations and existing patient comprehensive re-examinations.
  
• 8. Practice the art of using open-ended questions and active listening.
  
• 9. Refine your skills, knowledge and the services you offer your patients.
  
• 10. Remember, you are serving consumers that are health conscious and interested in appearance.

Why not seize the opportunities you have to convert routine visits into proactive appointments? The decision to do so will create a more rewarding experience for the practice, the hygienist and the patient!

Karen is founder of Cutting Edge Concepts®, and a consultant for JP Consultants, Institute. She lectures nationally and can be reached at Cutting Edge Concepts® 646 Goodwin Drive, Richardson, TX 75081, or contacted by phone: 972-669-1555, fax: 972-470-0353, e-mail, or web site @ www.karendavis.net.
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