Dr. Todd Franklin
Well here we are full swing into the year. The spring semester for the PAC has been very busy all across the country. Many are taking advantage of the PAC course opportunities and seeing positive change in their practice and themselves. Have you and your team set down some goals for the year? Where do you want to see your practice at the end of the year? Now is the time for action!
Having just finished the Northern California hands-on program with my fellow Director Dr. Samir Ayoub, we both commented about having a very similar question asked of us. Usually these questions happen at the meeting ‘after’ the meeting. “How do you get to the point where you are able to do these types of cases on a regular basis?” Well if we remember what one of the core values of the PAC, then we know we are talking about Comprehensive Restorative Dentistry. These types of cases involve Smile Design, Full Mouth Reconstruction and Advanced Occlusion based restorative schemes.
In order to do these types of cases, you and your team need to have the training and knowledge to be able to identify these types of cases. To do more, you need to be able to diagnose the signs and symptoms of occlusal disease, design opportunities in the smile and have the know how to educate the patient to the point of getting them to say ‘yes’.
Well the answer lies in the New Patient Comprehensive Exam. To do more, you need to see more and in order to see more you need the proper amount of time. How much time do you reserve for your New Patient Comprehensive Exam? We routinely schedule 90 minutes from start to finish. You will need to sit down with your team and determine what is appropriate for your office. We will outline the items that we go gather in our exam with the patient.
We could spend an entire article just talking about relationship building with our patients. So to keep it brief there are a number of items we gather from the patient that help us determine the best course of treatment for the patient. The initial contact form has many questions that will help the front office determine how to properly schedule the patient and creates a checklist for follow up before the new patient appointment. A new patient packet is sent to the patient along with a questionnaire that helps to narrow in on the patient wants and desires. When you are able to identify the patients ‘hot button(s)’, the ability to customize an approach with the patient becomes so much easier.
We have found that the most important five minutes of any new patient exam is the first five. We don’t want to talk dentistry. We just want to build rapport. We then gather the typical records, medical history, radiographs, and a brief Q & A session. As we head into the quick look exam this is where the process of identification begins. Many of these items we review in our Occlusion course.
- Gather the following information:
TMJ review noting clicks, shifts, crepitus, history of trauma or pain, posterior ligament check, right and left lateral movement - Identify intraoral signs of occlusal loading: Tori, linea alba, scalloping of the lateral border of the tongue, occlusal and buccal abfractions, occlusal wear, fractures and broken restorations, periodontal defects, and periodontal ligament changes.
- Reality views: Remember patients learn more by visual than verbal. Whether you have an intraoral camera or a digital 35mm, take some quick pictures of intraoral items you identified above. With these pictures up on a patient monitor
a discussion can begin. With enough practice and experience, you will have a good idea what type of patient they are.
Traditionally dentistry is provided to address a few present issues. This is a reactionary approach to maintaining optimum oral health. We term this repair dentistry. This approach leads to a lifetime of dentistry being done, not addressing the underlying causes, and ultimately results in time and resources being exhausted trying to stay ahead of the disease process.
When we identify a patient who in our opinion would benefit from a comprehensive approach, the next step is to have a conversation to determine which direction the patient would like to go. We call this the ‘fork in the road’ moment. This next question from us has helped guide patients into saying yes to comprehensive dentistry. “Mrs. Jones we know that most patients spend their lifetime going to the dentist and having things repaired. Many times the underlying reasons for a failure in dental health are not fully addressed. This leads to an excess of monetary resources and time being devoted to try and keep optimum dental health. We call this type of dentistry repair dentistry. On the other hand we can address all the underlying problems and reasons now. We are then able to move you quickly into a maintenance program where you can experience optimal oral health. We call this complete dentistry. Which type of care would you like to receive?”
For those that choose to receive repair dentistry we will continue to provide the best care possible taking into account any barriers that may prohibit them from choosing comprehensive care. Many patients have later come to us asking for complete care.
For those who choose complete dentistry we discuss the records process after which we are able to present them with a comprehensive treatment plan, timeline and what their investment will be.
We have found this approach to providing care very beneficial to our patients. As you continue this approach the ability to identify comprehensive cases will rise and the number of patients who say yes will also rise. Remember our job is to inform the patient and give them the tools to make an educated decision regarding their optimal dental health. Many of the details to this approach we cover in our local PAC Study Groups. For more resources or questions regarding this process please feel free to contact me at [email protected].
