Promoting the doctor’s dentistry

Dear Dianne,

I graduated from hygiene school two years ago, and I have worked in my current practice for one year. (It took a whole year to find a job!) Recently, the doctor mentioned to me that he would like for me to talk to patients about dentistry that could be done, such as crowns and bridges. The problem is, I don’t know what to say. I’m kind of shy, and I don’t know how to get the discussion going. I also don’t want my boss to think I’m stupid, so that’s why I’m asking you. Can you help me? I really do want to meet the doctor’s expectations, but I don’t have the verbal skills that I need.

Timid RDH

Dear Timid,

It is unfortunate that your boss has asked you to do something without giving you the tools to accomplish the task. Doctors need to take into account that staff members who are less seasoned in the profession may not have the background or life experiences that would help them understand many of the restorative procedures that are performed today. One thing that helped me tremendously was that I got to work as a chairside assistant for a while before I went to hygiene school. I received firsthand, close-up experience in restorative dentistry from a “master” clinician who took much pride in his work. Those experiences helped to shape my understanding and appreciation for many advanced esthetic procedures. If you did not have any chairside opportunities before hygiene school, I would suggest you ask the doctor if you can observe him at chairside. You will be amazed at what you can learn!

Let’s say I have Joe in my chair today. His medical history is uneventful, his periodontal health is good, and his home care is adequate. He is missing teeth Nos. 19 and 30. The teeth on either side of the spaces have large amalgams. I know with the passing of time that the opposing molars in the maxillary arch will super-erupt, and the teeth adjacent to the spaces will drift in an effort to close the gap. This patient’s missing teeth cause his arch to be unstable, and if he doesn’t replace those missing teeth, he is likely to lose more teeth over time. The teeth with large amalgams will be made stronger and will be less likely to fracture if they are covered with crowns.

Before I open dialog about replacing his missing teeth, I would check his chart to see if any previous notes exist regarding discussions on this topic. If there are no previous notations, I would open the conversation like this: Joe, did you lose those two teeth a long time ago? Joe says, Yes, about eight years ago. I continue, I thought so. Actually, those particular teeth come in when a person is about 6 years old. But losing those teeth and not having them replaced leads to some other problems. Look at this.

Then I would hand him a mirror, or better, use my intraoral camera, and let him see for himself how his teeth are drifting. I would explain how the teeth support one other. The good news, Joe, is that we can replace those missing teeth with a couple of bridges and even make the teeth on the sides of the spaces stronger, since they have large fillings in them.

Then I would show him what a bridge looks like, using a visual or a model. The doctor comes in to do the exam, and I mention that we’ve been discussing how Joe’s teeth are drifting and what we can do to stop it. The doctor can take the conversation from there. I make sure to document the conversation in Joe’s chart. He might decide to do something now, or he may want to mull it over for a while. Either way, I planted the seed.

Talking with patients about elective procedures that can enhance their appearance and improve their ability to chew is appropriate if — and only if — the patient is interested. If Joe said something like, I’m doing fine without those teeth, or I’m really not interested, then the conversation would end with, OK, I just want you to be aware of the problem and know that there are good solutions. Then I drop the conversation. Again, be sure to record the patient’s thoughts in the chart.

Nobody likes the hard-sell technique. The hard sell is pushy and does not involve the patient in decision-making. It makes the patient feel uncomfortable. Hard-selling tactics ask loaded questions. Here are a few examples:

1. Do you like those bleeding gums
2. Would you like to keep your teeth for a lifetime
3. Would you like to wear dentures
4. Do you like those dingy/yellow teeth

Communication mistakes include:

1. 1. Failing to involve the patient in decision-making
   
2. Making false assumptions about patient desires
   
3. Ignoring the patient’s nonverbal communication
   
4. Implying that a patient’s smile is unattractive
   
5. Judging the patient’s ability to pay
   

Asking appropriate questions is a good way to initiate a conversation about elective procedures. Here’s an example: Seems like many people are interested in having whiter teeth these days. Is this something that interests you?

After talking about elective dentistry, try to find out your patient’s response by asking these questions:

1. Tell me, what are your impressions
2. How can I help you further
3. What are your thoughts on this
4. Does this sound like something you would like to do
5. Do NOT say, “Do you understand?” or “Does this make sense?”
   

Hygienists have a unique opportunity to plant seeds that guide patients’ thinking about options available to them for a variety of dental procedures. A hygienist who knows how to converse with patients effectively about dentistry and lead the patient to an understanding that results in additional production for the office is valuable far beyond his or her clinical ability. A hygienist should receive great personal satisfaction when the patient schedules additional dentistry after the hygienist opens the discussion. Promoting the doctor’s dentistry is a natural expression of confidence in his or her ability to help patients achieve attractive smiles and optimal masticatory function.

It seems obvious that your boss wants you to engage patients in discussions about more than just their periodontal health, when appropriate. I urge you to open discussions with the doctor about restorative procedures that he is interested in promoting. Certainly, you need to have a clear understanding of elective or advanced procedures in order to talk about those procedures confidently. You also need the tools to do the job in the form of pictures or models to aid your discussions with patients. I hope you have an intraoral camera and know how to use it. A good communicator with an intraoral camera becomes a GREAT communicator.

Dental hygienists must expand their view of the dental world beyond their own operatories and realize they are part of the big picture of a successful dental practice. Your conversations with your patients should be 75% dental and 25% social. Realize that your value to the practice is greatly increased if you are proficient at promoting the doctor’s dentistry. Always have your dental antenna raised, looking for options that help your patients have optimal esthetics and function. RDH

Always,
Dianne

Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne’s new book, “The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues,” is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at www.professionaldentalmgmt.com.