Comprehensive Care

July 1, 2004
The creation of a 'dental health and wellness' system leads to an organized, concerted effort to rid charts of incomplete treatment and enhance the art of dentistry.

by Kimberly Miller, RDH, BS

Hygienists can be incredibly effective at promoting dentistry from the hygiene chair. However, most hygienists are challenged by how to discuss full-mouth comprehensive care during a recare visit. We know the doctor expects it; however, it is not expected by the patient, and often comes across as a sales pitch. In fact, most patients have a difficult time considering thousands of dollars in dentistry when presented by the hygienist during a one-hour, $65 cleaning. Implementing and creating a "Dental Health and Wellness" system will help alleviate the various problems inherent in encouraging patients to plan for comprehensive care through state-of-the-art dentistry.

Consider this ... how many thousands of dollars in previously diagnosed — yet still incomplete — treatment plans are sitting in your filing cabinet? When will you see those patients again to discuss their recommended treatment? Most likely, at their next hygiene visit. In fact, some patients faithfully see the hygienist (many as frequently as four times a year), and still have incomplete treatment.

Let's take a look at why this occurs. In the morning meeting, we review patients' charts. We identify those who have outstanding treatment. The hygienist reviews the treatment with the patient, uses visual aids, discusses benefits, and tries to build the value of the needed treatment. Remember, the patient is here for a cleaning, not a comprehensive diagnosis. When the doctor arrives for the exam, he supports the hygienist and repeats the diagnosis for what's previously been treatment planned. We believe the patient needs the treatment. In fact, we may even get the impression that the patient is ready to start the treatment, commit to a financial arrangement, and leave today with an appointment.

This same patient gets to the desk and says, "I need to talk to my husband before I do this," or "You know, these teeth really aren't bothering me. I think I'll wait," or better yet, "I can't do this until I know how much my insurance is going to pay. Can you file a predetermination for me?" One way or another, the administrator finds herself trying to bring the patient back to clinical value, while the patient is trying to get out the door. The end result is charts full of incomplete treatment.

So, instead, let's take a different approach. The hygienist still reviews treatment, uses visuals, discusses benefits, and builds the value of the comprehensive treatment. Many patients, though, need additional time with the doctor to solidify the acceptance of proposed treatment. However, don't underestimate the value of a team approach to comprehensive care! Case acceptance for comprehensive care is a process. Every value statement, every testimonial from a team member, and every ounce of five-star service a patient receives is another step toward closure. So, if the patient is not ready to move forward with the care from the hygiene chair, the next step for interested patients is additional patient mentoring by the doctor in the doctor's chair.

First, ask yourself when was the last time this patient had a full series of diagnostic films and some quality time (something other than a periodic exam) with the doctor? Depending on how long this patient has been in your practice, this could have been many years ago.

Second, consider setting aside one or two hours per week (pre-blocked on the doctor's schedule) for a "Dental Health and Wellness Visit." This time is specifically designed for the doctor and the interested patient to discuss the health and wellness benefits available to patients and their families through today's dentistry.

OK, so how do we get there from here? How can we generate excitement and interest in full- mouth comprehensive care? How do we change the patient's mindset toward comprehensive dentistry? Let's take a look at one option.

In the morning huddle, select a patient (or two) from the hygiene schedule who is due for a full series of films, and has incomplete dentistry on their treatment plan. At the beginning of the hygiene visit, take a few moments to discuss the five "E's" with those patients:

Excitement over the advances in dentistry, which can provide additional health benefits (share a personal or another patient's experience).

Examples of two or three of these advances and how they can be health-related (use the intraoral camera to show the patient their areas of need, avoiding single tooth remarks).

Extend a "special invitation" from the doctor to take advantage of an opportunity to come back and explore the options of how these advances could provide another level of health and wellness for them (use other visual aids, photos, models, Surgeon General's Report, AAP fact sheets, CAESY system, etc.).

Explain what will happen during the visit. Incorporate "knock-their-socks-off" customer service. Use a list of procedures to build value. (The charge is for the FMX only, so set it high enough for your comfort level.)

Expect a positive response from the patient. If the patient is not interested at this time, ask if you can discuss it again during their next visit.

During the periodic exam, the hygienist informs the doctor that she or he has given the invitation to the patient, and tells the doctor the patient's response. When the patient is going to come back, the doctor expresses excitement over the opportunity to spend more time with them, and briefly reviews restorative/esthetic options available today. If you have imaging, the doctor should ask the hygienist to take a digital photo before the patient leaves. That way, the imaging will be completed prior to their "Dental Health and Wellness Visit."

If the patient isn't interested, it is a very clear signal for the doctor not to spend extended time trying to re-enroll the patient in comprehensive treatment. At that point, the doctor would simply re-diagnose the need for the incomplete treatment. Either way, valuable time is not being taken away from the patient who is waiting in the doctor's treatment room.

Upon completion of the hygiene appointment and the handoff to the administrator, the patient is scheduled for the extended visit with the doctor. Each office must design a template that works for the culture of their practice. However, here are a few suggestions to assist you in developing your own template:

• Have a clear understanding of each team member's role in the appointment.

• Have a previously imaged photo of the patient up on the monitor before they are seated in the treatment room.

• Schedule the patient with an assistant 30 minutes prior to seating the patient in the doctor's chair for an FMX and overview of what is included. Use the intraoral camera or show CAESY while waiting for films.

• The doctor should introduce the patient to the philosophical changes that have occurred for him personally and in his practice, as well as the technical advances currently available.

• Provide the patient with a "comprehensive exam," as you would with a new patient.

• Make it affordable, through third-party financing, for the patient to move forward with comprehensive care.

This becomes a very exciting opportunity for your existing patients to explore dental health and wellness through state-of-the-art dentistry! Many of them will discover that they have the desire to improve their health and extend the life of their teeth. All that remains is for us to help them achieve their desires.

Kim Miller, RDH, BS, graduated in 1981 from Loma Linda University with a bachelor of science degree in dental hygiene. She has since continued in practice with periodontal and general dentists. Kim has balanced the practice of clinical hygiene with her role as an instructor and senior consultant with JP Consultants Institute since 1992. She is also the co-director and instructor for JP Consultants Institute's Dynamic Team Concepts and Evolutionary Hygiene in Support of Aesthetic Dentistry courses. Kim has coached more than 135 individual practices for JP Consultants Institute, teaching a six-day hands-on curriculum, as well as workshops and seminars throughout the United States and Canada. She can be contacted at (800) 946-4944 or visit