Last month, we spoke on the topic of the new patient experience and how to create a memorable experience by making it interesting and involving not excluding the patient in a co-discovery process. We also talked about paving the way to help the patient understand that you will be investing time on their behalf to customize a plan. Our goal is to build value for what we have done and what we will be doing.

The goal of a comprehensive care, relationship based practice is to achieve and maintain optimal health, function and comfort of all the components of the masticatory system. That means we must do a step by step systematic assessment of the TMJs, muscles, teeth, periodontium, esthetics and occlusal function on all our patients and not just the one reporting symptoms in a particular area. Once we have collected the data, assessed the status, we need to take some intellectual time to reflect, study, contemplate so we can make a diagnosis and develop a plan and sequence. One of the biggest mistakes I see dentists make is trying to talk to the patient about treatment either during or immediately after the exam. I feel this is inappropriate, for a number of reasons. It is not fair to you to try to shot-gun a treatment plan. There are too many things to think about, too many implications to consider. If you are just about "fixing teeth", then you probably could simply note the teeth in obvious need of structural or esthetic improvement, and calculate a fee based on number of units multiplied by fee per unit. If a dentist is about masticatory system health, then this approach falls short. And for many patients, all this occurring during the first visit is too overwhelming. Even a simple restorative case will most likely involve a rather significant fee and this approach does not allow enough time to build value and trust.

I hear and read that many consultants say that you need to proceed in a timely, quick manner while the patient is interested. You don't want that enthusiasm to fade and if you make the patient wait a week or so to return for the consult, that you may just lose them. If our goal was to "sell" a patient whatever "commodity" we have ready "on our shelf" I would agree. But that is not what a comprehensive-care, relationship-based practice is all about. If the exam was interesting to the patient, if it was focused on them, if they began to understand the implications, if they see that it is about THEM, and that you listened to and understood their concerns and they see how the findings relate to THEIR concerns, then I would have to emphatically DISAGREE. I find them anxious to come back. There are totally flabbergasted that you are going to invest time on their behalf to customize a plan for them. They appreciate your honesty in telling them that you DON'T know the answers just yet, but you WILL after your intellectual time for them. It is RARE that a patient leaves the practice not to return for the consultation. It becomes obvious to them that you are not the "usual and customary" practice and that they have been lucky enough to find something very special.

At this point, to NOT take the time to study the data, the radiographs, the photographs, the articulated casts and to PERSONALLY be involved in a diagnostic wax-up is a big mistake. How else can you develop a lifetime master plan for health, proper function and esthetics with stability and longevity? This is especially true for inter-disciplinary types of cases. You need the input of your specialty team. I sincerely believe that it will be difficult for you to counsel your patient in an understandable way about what is in their best interest and to do so with ENTHUSIASM, BELIEVABILITY AND CONVICTION, if you shortcut this step. Then one resorts to what they know and what is easier and that is "tooth" dentistry. I know from personal experience and from speaking with many dentists who have made this commitment, that the benefits are enormous. The result is a patient who understands their problems and responsibilities, is moving forward for the RIGHT REASONS and not out of obligation and will be a happy, appreciative client.

We need to communicate an often times complex, multiple phase plan and sequence that involve appointments with specialists. It is easy to get too technical and give so much detail that it confuses the person. The following template has been helpful in thinking through the case in a systematic manner and communicating effectively to the patient.

The first thing I do at the consult is to review the photographs. The patient and I sit side by side in front of a computer monitor, the patient has a laser pointer and we converse (and I try to mainly listen). We then review the following report.

Your Concerns Summarize their concerns that you learned about in the pre-clinical

Summary of Examination and Diagnosis for This should not be new information for the patient but rather a summary of what they discovered in the exam. Be sure to include positive results as well as areas of concern
Teeth Summarize the status of the dentition, i.e., decay, fractures, periapical pathology, esthetic concerns, ortho concerns etc. Include causes which may be occlusion.
Gums Summarize the status of the periodontium. Include causes which may be occlusion.
TMJs Summarize the status of the TMJs. Include causes which may be occlusion.
Jaw Muscles Summarize the status of the muscles. Include causes which may be occlusion.
Bite From a bite engineering perspective, all teeth should touch equally when the jaw is relaxed (like a door closing in its frame), and when the jaw moves side to side, the front teeth should smoothly glide (like the front wheel of a tricycle) and the back teeth should not interfere. Signs of bite "interferences" were detected when examining. This is a factor in (include the relevant information here) and a very important factor to consider when planning definitive dentistry.

After reviewing this section, the patient and I will look at the diagnostic casts. Then we will review this part of the report.

Summary of Treatment Plan

Teeth }
Gums } Summarize what treatment you feel is appropriate in these major areas.
TMJs } This will include areas of specialist treatments.
Jaw Muscles }
Bite Correct bite engineering is important for longevity and stability of all components of the "masticatory system". The goal is all teeth touching equally when the jaw is relaxed, and when the jaw moves side to side, the front teeth smoothly guiding and the back teeth not interfering with smooth jaw movements. The guideline will be the diagnostic blueprint.

At this point I will discuss the diagnostic wax-up. If it is a case where I may have done computer imaging to preview esthetic improvements, we will review that too.

Summary of Treatment Sequence

Lay out an overall sequence which includes visits to the specialist, healing times, time intervals etc. Get their input, invite questions and discussion, discuss fees.

I have found this approach to be relaxed and fun. You know the case because of your intellectual reflection time so you can invite questions and discussion confidently. The patient can see, hear and sense that your have THEIR best interest at heart.