The hygiene exam can be a dreaded topic in the dental practice, especially if you’ve been dodging the issue for a while. Depending on your state, there may be specific rules or regulations about how the hygiene exam should be conducted. After meeting these rules though, it’s up to you to determine what style of hygiene exam best suits your goals.

Hygiene exams can complicate your relationship with hygienists if you don’t have an open dialogue about why you conduct them the way you do. There isn’t one right or wrong way to do things. That’s what makes it such a challenge for clinicians.

Conducting a More Effective Hygiene Exam

Commitment to your purpose should help you decide on how you want a hygiene exam to go. Most importantly, don’t do something you dislike simply because you think it’s the only option. Your obligation is to meet your patients’ needs while fulfilling your ethical or moral responsibility.

Patient expectations are where things get tricky. It doesn’t necessarily matter if your style is to put most of the responsibility in your hygienist’s hands or if you prefer to enact a thorough exam yourself. What does matter is that your patient knows what to expect and that you meet that expectation.

If you want to meet with patients for an in-depth exam, then schedule that time. If your hygienist will handle the majority of the exam, give them the tools and the training they need to feel confident. By the same token, if you want to check in on patients, but don’t want to do more than visit, then don’t even put on your gloves.

In the end, you can choose a combination of hygiene exam processes. Just keep your patients and your team informed.

How do you conduct hygiene exams in your practice and why? We’d love to hear from you!

Every patient has a story that makes their case unique. When we embrace their path to treatment and make an effort to understand their motivations, we can provide even more excellent care.

A great example of this simple lesson came in the form of my patient Anne. I knew Anne well, as she ‘grew up’ in our practice and had been a regular patient for many years. This fact added an unexpectedly challenging element to her case. I knew I needed to re-familiarize myself with her interests and background instead of taking our past relationship for granted.

Restorative Case For a Future Hygienist

Anne is nineteen and currently training to become a dental hygienist. Her personal dental experiences spurred her interest in the field. She’s excited to provide patient care that improves both oral health and self-image.

All of these details about Anne informed how I approached her treatment. Her primary esthetic concerns were a peg lateral #7 and a congenitally missing #10. She also had canted axial alignment, mottled enamel, and uneven gingival zeniths with a high smile line.

We decided on comprehensive restorative treatment approach that would correct these problems and provide her with a result she could readily show off. The treatment consisted of orthodontics, an implant for #10, and periodontal surgery to reposition gingival levels. We also moved ahead with occlusal equilibration and a diagnostic wax up.

To round out the case, we did tissue sculpting on #10 in addition to esthetic/functional testing and refinement via provisionals. Anne got beautiful e.max veneers on #5, 6, 7, 8, 9, 11 and 12. Finally, she got an implant supported e.max crown on #10.

Matt Roberts CDT handled the lab side of Anne’s case and did a stellar job. She can now go forth confidently into her career and help others embrace treatment that can change their lives.

What case put a smile on your face recently? We’d love to hear what you think in the comments! 

It’s time to start thinking of smartphones as an asset rather than a detriment to dental practices. Yes, they can be distracting, but they can also pose great opportunities for connecting to a younger generation of patients. Ultimately, they can directly contribute to case acceptance and smoother communication with specialists. 

How to Use a Smartphone for Better Case Communication

Videotaping patients with an iPhone has changed how I practice, especially with interdisciplinary care. Here is how that often takes place in an exam:

“You know Mrs. Jones, we are so blessed to have Dr. Periodontist, Dr. Orthodontist, and my Lab Tech, Mr. Awesome, working together with us on this case. I think we learned some things today that are important to share with them, wouldn’t you agree? I’ve got an idea … would you mind if I recorded a short video to text to them? I think this will keep them up to speed and enable them to give any input as we move forward.”

I state the patient’s name and date, then start describing the situation. We show things from exam findings while the patient experiences them again, usually nodding their head in agreement. With the right patient, I get them to state what we found while recording the video. The whole time, I imagine the patient feels like they are holding the attention of all the members of the interdisciplinary team at once.

These videos are an awesome way to communicate with specialists and other members of the case team. With care and knowing your patient, the behavioral learning opportunity is priceless for them. Sometimes the behavioral pieces can even guide a team member.

As we grow, we must embrace the possibilities of our current reality. We experience and process the world differently now that it is through the filter of a little device in our pocket that connects our mind to the world.

Do you love or hate smartphones in your dental practice? 

In my last blog, I discussed the possible scenarios that could occur when your patient answers their phone during an appointment. Now, I’ll explore how you can leverage smartphones to your advantage in your dental practice.

Leveraging Smartphones in the Dental Practice

Which scenario would you hope might happen with you the most? Are these all valuable experiences? Do you KNOW YOUR PATIENT more by observing each behavior? Do you KNOW YOURSELF more from your level of engagement and influence on the outcome? How will you modify your future interactions for each patient from what you have learned?

Let’s face it, for the past couple of decades we’ve had it easy. If we chose, a whole wall could be filled with charts of Baby Boomer patients. Boomers are everywhere in great numbers, most have comprehensive needs, most have the means to care for themselves, most have a high level of trust. It was an ideal patient population and still is.

Now we have Millennials. Frankly, they are initially a tough personality for more seasoned practitioners to relate with (we look at them like spoiled kids). The stark reality is that they outnumber Boomers and have plenty of dental needs. They are the future of our workload.

To relate with Millennials, they need information fast. They need to see to believe and establish trust. Fortunately, they have a camera in their pocket. Sure, I still take my full photo series and we keep the intra-oral cameras in our rooms, but when I see the slightest glimmer of doubt in a Millennial, I ask if they can open the camera on their phone. Then I pull out a photo mirror.

It’s almost as if saving the image in their device’s storage is connecting to their memory bank. They look at it several times. They text the picture to friends and post on social media. They seek validation. From cracked teeth to gingival needs to caries – for my millennials, seeing is believing. (Now if I can keep them off social media while I’m prepping their teeth.)

Here are two photos of a tooth that a skeptical patient refused to crown because there were no symptoms. The “just fill it Doc” attitude changed with two simple snaps on their phone using a mouth mirror.

To be continued …

One of the keys to delivering meaningful patient care is upholding the power of relationships in all aspects of your work life. For example, clear communication in the patient referrals process can either make a patient feel doubly supported or leave them feeling insignificant.

So how do you foster good relationships with the specialists you refer to that improve patient trust?

Patient Referrals: Communication, Relationships, and Trust

It’s not uncommon for a dentist to refer their patient to a specialist, only for the patient to realize the specialist hasn’t been told anything about their unique case. This clumsy pass between health care professionals starts the patient off with a heightened level of distrust.

Then, the situation can be made even worse if what the patient learns from the specialist is very different from what their dentist told them. They can become frustrated by the inconsistency or angry that they are being given conflicting information.

The solution to this problem is as simple as it is difficult to enact consistently. Patients will develop increased trust with their general dentists if they are led to believe the general dentist is skilled at referring them to specialists.

Additionally, they should feel that their case is handled with great care in the transition period. Their general dentist should make the process smooth for everyone involved and communicate expectations with the specialist.

Patient trust is everything. They will not follow you on the path to more advanced or complex treatment, or even come to think of you as their long-term dentist, if they feel the relationship is built on shaky ground. Who you refer to and how you do it can either strengthen that relationship or do the exact opposite.

More than anything, you must show the patient you are very familiar with the specialist and advise the specialist about the patient in turn. The specialist’s office should then be able to affirm your relationship with the patient by providing complementary care and information.

When you and the specialists you refer to provide conflicting treatment plans or explanations, doubt inevitably creeps in.

How do you communicate effectively in the referrals process? 

In life, there are few things that are truly a ‘guarantee.’ This word has been thrown around in sales speak for eons, but it’s also an empowering tool by which to build your dental practice. You may not be able to control the outcome of every aspect of your patient care. On the other hand, you can definitely commit to always going the extra mile to secure complete satisfaction.

What is a Guarantee in Dentistry?

Your practice culture should be defined verbally or in writing through your vision and mission. It should also be held as the unspoken, consistent values you communicate to staff and patients on a daily basis. You don’t need a cheesy catchphrase beneath your practice logo saying, ‘100% satisfaction or we’ll completely redo your dental work’ to make your service a guarantee.

But what does a guarantee look like in dentistry and why is it beneficial? Think of a guarantee as the powerful conviction that you stand behind your work and will continuously strive for exceptional service. If your motto is to exceed expectations and you make that clear to your patients, then you will go to any lengths to do exactly that.

Commit to Complete Satisfaction

A guarantee is an ethic of personal responsibility. It is your integrity and it will speak for itself in a hundred ways if you follow through. It means you will take the time to determine what satisfaction looks like for your patients. The main benefit of this is the development of a rock solid service reputation. You won’t have to go to the yellow pages for explicit ‘we guarantee it’ marketing. Word of mouth will snowball as your confidence in what you offer translates to how comfortable your staff and patients feel recommending you.

Excellence is a rarity fueled by integrity. Develop your patients’ and team members’ pride in your work by incorporating a guarantee into your dental practice culture.

How do you go above and beyond in your clinical care? 

After building my dental practice from scratch, my work life began to get more and more intense. I knew I had to slow down, but I didn’t know how until I decided to take a leap of faith and visit the Pankey Institute.

Creating a Work Life Vision at Pankey

At Essentials One, I was blown away by the faculty to student ratio. It was almost 1:1! The quality of the education was outstanding, but what I found most impressive was the encouragement, mentorship, and passion from all the faculty and staff.

Pankey taught me how to help my patients value dentistry, develop communication skills, and learn co-diagnosis. Most importantly, Pankey helped me create a vision of what I always knew I wanted — a low volume fee for service practice that allowed me to have a good family-work life balance.  

Returning to My Dental Practice Recharged

When I came back home from Essentials 1, I immediately stopped working six days a week. I started some training exercises with my team to show them what my vision was.

One month later, I went out of network with my first insurance plan. This plan was one of my biggest — it made up 25% of my patient base, but I was determined. Six months later, I evaluated our progress. We did not lose a single patient and our revenues had actually doubled. When I saw this, I went out of network with six more plans immediately. We were on a mission.

Today, two years after Essentials 1, I am only in network with one remaining plan. Our practice has continued to grow. We have worked less hours, seen almost half as many patients per day, and our practice revenues have increased.

Additionally, I have also taken more time off every year and taken more continuing education than I have in the past. My team continues to be excited in our journey together to achieving our professional and personal goals.  

My story is nothing special. I truly believe anybody can develop the clinical, leadership, and communication skills to create a successful relationship-based practice. For me, the Pankey Institute provided all the resources I needed. Pankey has changed my life. I hope to give back one day. 

What’s your dental practice story? Join the conversation in the comments! 

A key tenant of Pankey philosophy is to know your patient before you treat them. It’s one of the most important lessons learned in our Essentials 1 course, Aesthetic & Functional Treatment Planning You begin to develop a self-awareness that you can cultivate throughout your professional life.

The concept of ‘knowing’ is worthy of much exploration, especially because what counts as knowing your patient is subjective to each individual. It’s about more than simply gathering data on their past dental history and current concerns in a pre-clinical interview.

To know your patient, you must be fully present with them. Then you must listen, truly listen. It’s difficult to remain quiet as your mind jumps from different solutions and possibilities to potential responses. That’s what makes listening a skill worth cultivating.

How to Listen More Effectively in a Pre-Clinical Interview

Start by taking stock of the moment before you even enter the room and acknowledge the patient. Pause. Evaluate your own mental space. Become curious about the unique individual who seeks your guidance and expertise.

Once you’ve transitioned to the interview, remind yourself that the patient should be doing 80% of the talking. It requires practice to stifle the urge to interrupt or re-direct, especially if you’re naturally talkative. On the other hand, during extremely busy days it can be a relief to settle back and focus on someone else’s thoughts.

Create a More Comfortable Environment for the Patient

One thing that helps you begin to know your patient is creating the right environment. Focus on them exclusively so that in the moment they genuinely feel like the most important person in the world. Hold eye contact, but also learn to take conversational cues from the patient. If they seem reticent, give them the space and freedom to be at ease.

During the interview process, ask open-ended questions capable of uncovering their values around health, fears or anxieties, and more. By providing them with answers to their questions and listening closely, you are already performing a service that is likely a rare experience in their daily life.

How do you cultivate understanding and trust in your pre-clinical interviews? Share your tips or advice with the Pankey community! 

Many dentist-patient interactions operate under the assumption of limited time on our part and limited ability to accurately explain on theirs. After engaging in hundreds of pre-clinical interviews and conversations during appointments, you will have naturally developed your own preferred style for questioning. But how well does it really serve you?

If you feel something is lacking in your patient care, yet your clinical skills and execution seem immaculate, the problem might be about language. When you communicate with your patients, do you get the sense that they feel limited, misunderstood, or unsatisfied? This could be a direct result of using language to discuss ‘disease’ rather than ‘health.’

Use the Language of Health to Connect With Your Patients

Getting out of the rut of a traditional hygiene appointment starts with how you communicate. Even minor shifts in your word choice can have a profound effect on the patient’s sense of comfort. Open up a discussion about their health to connect with their needs.

A great way to follow this path is to abandon the typical impersonal medical jargon. Instead of asking if there have been changes to the patient’s medical history, pose a question about how their health has been since you last saw them.

Right out of the gate, you are presenting yourself as empathetic rather than turning into the classic brusque medical professional. Ask about how they are feeling, whether they have been taking care of themselves, and what changes they have made in their lifestyle.

These types of questions capitalize on expressive language to make the most of your time. Having the patient rattle off changes in their medical history without knowing how they feel about those changes isn’t as useful. People will generally open up when they are given a safe, non-judgmental space to discuss their health. After all, it is often one of the central preoccupations of our interior lives.

What questions do you think are most productive during appointments? 

Okay teams, here I go again talking about basic phone skills. It might seem as though this is a pretty old horse that has been beaten to death one too many times. The reality, though, is that your phone continues to be the single most important tool in your office.

Why Phone Call Communication Skills Still Matter

The other reality is that all too often, this valuable instrument is under-functioning due to the lack of intention, precision, and focus of the people answering it. I love referring to your phone as an ‘instrument’ as it takes a skilled musician willing to put in time and energy for it to sound magical.

And yes, there is a very sweet recipe made up of having a talented individual that LOVES answering the phone combined with appropriate training in facilitation. Only this can create a truly extraordinary experience for the patients that are calling your office.

How to Improve Calls Through Coaching

Not sure if this is happening in your practice? I have one simple suggestion: record your calls and make time on a regular basis to listen to them. Learn for yourself exactly what is occurring.

After listening to hundreds of calls this past year alone, I can tell you without a doubt there are always opportunities for improvement on basic (and of course advanced) phone skills.

As you listen to calls, I invite you to become and stay interested in a number of things:

• Does your team member have a warm and welcoming spirit?
• How quickly is a caller asked for their name?
• Do they sound genuinely interested in the person on the other end?
• Are they inviting the patient’s story? Responding appropriately?
• How much value building is there for your practice?
• In what ways is the patient assured that they called the right place?
• Are potential patients being asked to schedule?

Listening to calls with individual team members can be a wonderful coaching opportunity! Although it may take some time and energy to create a safe environment in which to do this, I find the process engaging, enlightening, and potentially transformational. What do you say? Is it time to see if your phone is making magical music?