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How to keep today's recommendation off tomorrow's pending treatment list

Oct. 20, 2021
Pending treatment is a constant struggle in dentistry, and often results in more extensive, expensive treatment down the road. What can we do to prevent this?

What’s a good definition of pending treatment? Perhaps this is one: Treatment for a diagnosis the patient doesn’t take seriously enough to schedule. Wow…have you thought about those implications?

And what about patients who simply can’t afford the recommended treatment? What if patients have pressing emotional reasons for postponing treatment? Granted, those reasons account for a small percentage of patients’ decision not to proceed with diagnosed treatment. It’s fair to say that the majority of patients delay scheduling because they’d prefer to do something else with their time and money. Worse yet, they often use the reasoning, “If it’s not broke, don’t fix it.” How often do patients state something like this: “If it starts to bother me, I’ll let you know.” When you hear such a response, you know the value of recommended treatment is at an all-time low!

At face value, it may seem reasonable for patients to wait until there’s a glaring problem to schedule treatment. Here’s the problem with that line of thinking: Almost always, by the time a patient feels symptoms, the treatment itself is likely more extensive and more expensive. We see the evidence of this over and over in dentistry. Take, for example, the patient with interproximal caries diagnosed on the distal surface of tooth no. 5. It doesn’t hurt. They wouldn’t even be aware of it had bitewings not been updated. The hygienist and dentist both recognize the carious lesion just into the dentin, and the dentist makes a diagnosis for a two-surface restoration. Dialogue often follows the same pattern. We make a diagnosis, we provide a treatment recommendation, and we give a cost estimate and insurance benefit as applies. We ask if the patient has any questions, and we recommend they schedule treatment before they leave the office. Unfortunately, patients often leave without scheduling, and that treatment recommendation ends up on the pending treatment list. Eventually, we receive a call from the patient, and they are now in discomfort. Desire to schedule is high. Instead of a single two-surface resin, now the tooth has cracked and requires a root canal and full-coverage crown, or at least, a larger restoration. More extensive; more expensive.

How can we minimize the chance of today’s treatment recommendation landing on tomorrow’s pending treatment list?

What if we approached treatment recommendations differently? If we know delayed treatment often leads to more costly treatment, why not shift what and how we communicate? Upon showing the patient the evidence of caries, making a diagnosis, and providing a treatment plan, try communication such as this: “Cindy, I’m aware that your tooth doesn’t currently cause discomfort. How long would you like to wait before scheduling?” Pause. Let the patient answer. If they indicate they’d like to “wait until there’s a problem,” say, “Okay. So, how long do you think that might be? A month? A year?” You can ask this follow-up question with a twinkle in your eye, because the goal isn’t to be sarcastic. The goal is to help the patient consider the value of treatment prior to symptoms. If they ask, “Well, how long do you think I can wait?” they’ve just opened the door for you to educate them on the value of treating conditions before they become more expensive and more extensive.

This may seem silly. But, the truth of the matter is, if the patient doesn’t value treatment, their plan will be to wait. We know that waiting increases the risk for extensive and expensive outcomes, so the desired next step is for the patient to take ownership of their condition as quickly as possible. My experience is that value follows ownership.

Also by Karen Davis:

3 strategies for fostering connections with dental patients
When patients refuse recommended services or screenings

A revealing exercise in any dental practice is to run a report on how much pending treatment there is monthly. That number multiplied per month becomes a substantial number annually. What are the risks for patients who delay treating gingivitis? Periodontitis? Peri-implant disease? Dental caries? Replacing missing teeth? In some cases, the risk of adverse events doesn’t stop in the oral cavity.

With optimal diagnostics such as digital radiographs, automated periodontal charting, salivary diagnostics, and the use of intraoral technologies, so many conditions are diagnosed early and prior to symptoms. We owe it to our patients to implement strategies that help create a sense of ownership regarding their own oral health.

Recently, I saw a patient who had returned for preventive care following an extended period of absence after the COVID shutdown. He was diagnosed with gingivitis the last time he was in the office, and chart notes reflected that he was not ready to schedule. Upon screening him when he returned, it was apparent that his gingivitis had not only progressed to periodontitis, but he had also developed several areas of decay due to inadequate hydration while wearing a mask for work and his penchant for sucking on sugary peppermints. Sadly, a much more extensive and expensive treatment plan was delivered.

There are a million scenarios that negatively influence dental conditions to progress once the patient leaves our practice, so perhaps our role is more about creating value at the time of diagnosis than simply making and delivering an accurate diagnosis. Examine your own pending treatment list. Review charts each day prior to treatment and formulate strategies to engage patients differently than you have in the past; then track progress. If treatment remains on a pending list month after month, you have confirmation that patients would rather spend their time and money elsewhere, and practice value remains at an all-time low. Those outcomes can be very costly. 

Editor's note: This article appeared in the October 2021 print edition of RDH magazine. 

Karen Davis, BSDH, RDH, is the founder of Cutting Edge Concepts, an international continuing education company. She practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corporation, Periosciences, and Hu-Friedy/EMS. She can be reached at [email protected].