By Paul A. Henny, DDS, and Deborah E. Bush, MA 

The traditional rational economic model used in classical decision-making theory routinely fails to predict patient behavior because it fails to consider the psychology of decision-making and the inductive neuro process necessary to change one’s mind about what is best for oneself. 

Classic Decision Theory 

Classic Decision Theory (CDT) models a decision-making process that involves a fixed set of alternatives about which a person knows little. In response, they relate their limited knowledge to the situation at hand, use their beliefs and expectations associated with the options to project an outcome, and then use logic to make the final decision based on their goals. 

According to this theory, people primarily make decisions based on their desire to maximize gains and minimize losses, an objective. This deductive process is largely driven by a heuristic known as “scarcity bias.” However, anyone who has practiced dentistry for more than a day outside of a teaching institution knows that CDT fails to explain many of the decisions patients make when they’re confronted with a complex problem they don’t fully understand.  

Simple decisions such as “Should I get this filling replaced because it’s broken?” or “Should I allow Dr. Smith to help me make this tooth stop hurting?” are predictable. What’s much less predictable is whether a person will allow us to equilibrate their occlusion or leverage restorative dentistry to reestablish proper form, function, esthetics, and neuromuscular modulation. Why? Because these are complex issues that require an understanding of how the stomatognathic system works before the proposed solution makes sense and appears to be the logical best option to the patient. 

Neuroeconomics is an interdisciplinary field that aims to explain human decision-making. By integrating psychology and neuroscience, this discipline can help us better understand how humans process alternatives to make choices and follow through on a plan of action. Neuroscience affirms that re-evaluating perspectives is a right-brain activity and an inductive process. 

The Dentist’s Challenge  

In practice, we often see patients making decisions we think are unwise for their long-term oral health. A person’s values and belief system influence their decisions. Not only may the person’s understanding and belief system be underdeveloped in relation to the value of properly planned, designed, and executed health-centered restorative dentistry, but their memories may be distorted. In this case, the person makes what we perceive to be unwise decisions because their memories do not align well with our understanding of the situation. They don’t know what we know.  

Helping Patients Think and Feel Differently Through Inductive Reasoning 

Reassessment, modification, or outright replacement of beliefs is a right-brain process known as inductive reasoning. The purpose of Co-Discovery is to take the patient through an inductive reasoning process. Oral health providers who understand how and why Co-Discovery works have experienced how it can change the trajectory of a person’s decision-making process. 

Our challenge is to create an optimal learning environment in which people can safely reevaluate their beliefs, values, and priorities. Being patient with patients and taking our time to guide them through the inductive process of Co-Discovery will comfortably provoke new thinking, new beliefs, and new emotions. Through the process, a great many patients come to realize that their historical perspective is not serving them well, and they decide to have that equilibration or restorative dentistry that will serve them best in the long-term.  

They may not choose treatment the first time it is recommended but will subsequently realize it is in their best interest. We just have to stay in conversation with them in Co-Discovery mode and guide them through the inductive process to arrive at their new goals.  

Long-term, this is healthier for dentists and their care teams as well. The conversations we have with patients change the trajectory of our dental practices. Better conversations result in better decisions, which in turn result in better outcomes. Better outcomes result in lower stress and a thriving practice that is much more fulfilling for dentists and care team members.   

By Phillip Gold, Master CDT 

At a lecture in Atlanta a few years ago, Dr. John Cranham told us about a patient who had been in his practice for years and mostly came in for hygiene and emergency visits. She moved out of town for about a year and then returned to their dental practice. 

She made a hygiene appointment and when John walked in to greet her, he saw a woman with a beautiful smile. He was almost speechless. When he gained his composure, he remarked on the beautiful dentistry she had achieved while she was away. He asked her what got her excited enough to get the work done.  

She said, “I’ve always wanted to do something like this but I didn’t know who could do it.” When he explained that they do dentistry like this all the time she said, “I had no idea, I thought you only did emergencies and patch work.” 

How do you rebound from that? You make it a lesson learned and one you do not want to repeat! 

How do you spread the word?  

• Website Communication: 

Your practice website serves as a virtual front door. Make sure it clearly communicates all the services you provide. Consider creating separate pages or sections on your website dedicated to each service. Provide detailed information, FAQs, and before-and-after photos to show your expertise. 

Don’t fail to inform them of payment options that will make it easier for them to afford the dentistry they desire. 

• Smile Galleries and Visual Displays: 

Smile galleries in your office can be powerful tools. Display before-and-after photos of actual patients who have undergone various treatments. Seeing these transformations can inspire curiosity and interest. Also use photo books or digital displays in your reception area to showcase successful cases. Patients waiting for their appointments can browse through these visuals and learn about available services. 

• Social Media Engagement: 

Leverage social media platforms to highlight your services. Regularly post content related to different treatments, patient testimonials, and educational videos. Share success stories, patient experiences, and behind-the-scenes glimpses of your practice. Encourage patients to follow your social media accounts to stay informed. 

• Team Training and Communication: 

Train your team members to discuss services confidently. Encourage team members to engage in friendly conversations with patients. When patients ask questions, provide informative answers and emphasize the benefits of specific treatments. 

• Handouts and Placards: 

Create simple handouts or placards that outline your services. These can be placed in the waiting area, treatment rooms, or given to patients during their visits. Include brief descriptions of each service, along with any special features (e.g., same-day services).  

• Educational Events and Seminars: 

Host occasional events or seminars at your practice. Invite existing patients and potential new patients. Use these events to discuss different treatments, demonstrate procedures (if possible), and answer questions. It’s an excellent opportunity to engage directly with patients. 

Remember, patients often don’t realize the full scope of what a dental practice can offer. By proactively sharing information, you empower them to make informed decisions about their oral health. 

By Paul A. Henny, DDS 

In Part 1, we looked at personal boundaries in dental practice. I mentioned scarcity bias and how it is prevalent in undifferentiated dental practices but not so much in dental practices where providers and patients mutually share the values and agenda of the practice. Because scarcity bias is so human, so ingrained in us, I want to discuss two things in Part 2: healthy relationships and also how to address scarcity bias as it occurs in our differentiated dental practices. 

Insight Into Our Boundaries Leads to Healthy Relationships 

Healthy interdependent relationships are only possible through first understanding our personal boundaries (Who am I? What am I responsible for? What am I not responsible for?). That’s critical because psychologically speaking, boundaries are like fence lines with consciously regulated gates.  

The aphorism “Good fences make for good neighbors” prevails.  The same logic applies to the practice of dentistry and the nature of the relationships that we create—consciously or not, within it.  

And Now, We Circle Back to Differentiation  

Healthy interpersonal boundaries lead us toward more interpersonal authenticity, which leads us toward higher-quality communication of our values and purpose. Higher quality communication leads to a more sophisticated level of collaboration and healthy results, including healthy interdependent relationships, self-reflection, self-responsibility, improved oral and total body health, improved mental health, and a constantly growing reputation for your values. That’s differentiation. That’s personal authenticity. That’s success. 

Addressing Scarcity Bias 

Once we understand ourselves well and we communicate consistently with personal authenticity, we still have the challenge of “knee-jerk” scarcity bias in our patients. This is where patience comes in and empathy—understanding and recognizing their feelings. 

People are biased toward the here and now. The mind is naturally focused on meeting immediate needs at the expense of future ones. We procrastinate important things such as dental treatment unless we have an urgent need for it. We fail to make investments, even when the future benefits are significant or the costs of not doing so are substantial. 

When the dentist and patient participate equally in a co-discovery examination process and co-discovery consultations to discuss health history and current findings, and the patient is empowered and becomes comfortable mentioning everything on their mind, we have already begun the powerful process of leading each other through understanding what is happening in the body and what is happening in the mind (feelings and thoughts). We can start to talk about what the patient would like to achieve long term—the patient’s beyond-the-moment oral health goals. We can start to talk about what is possible to achieve together and introduce the notion that we can take steps at the speed that is mutually comfortable for us. 

Inspiration to do “the work” is often planted with just a few words that create a future desirable image in the patient’s mind. If we have the patience to let the inspiration grow, without overwhelming the patient, scarcity bias can dissipate. Often patients come back to the conversation the next time they visit us and say, “I was thinking about what we talked about, and I think I am ready to…”  

Negotiating health goals between two adults starts as an invitation to agree upon common goals. We can start early in the doctor-patient and hygienist-patient relationships by instilling the thought that preventive health care is a partnership. They can’t do it alone and you can’t do it for them. Everyone must play their part responsibly. 

By Paul A. Henny, DDS 

Today, I am revisiting the value of personal authenticity and its transformational power within truly helping relationships. We know can’t evolve into becoming more authentic with our patients until we first “know ourselves,” which is another way of saying “until we’ve developed a lot of personal insight.” 

Personal insight is the beginning point of understanding what tends to drive our behavior and thinking, therefore, it’s the beginning point of change. But there’s another key variable in the facilitation-of-change process that’s often overlooked: What is the level of personal insight within the person we are attempting to help?  

What happens when we and our patients share similar values? 

We’ve all had experiences with patients with whom we easily and almost automatically connect. The conversations flow smoothly, and there’s a lot of agreement regarding what needs to be addressed, how and when. It happens because these folks share similar values and priorities, and likely, they’ve had some personal experiences that strongly support those beliefs. 

But let’s be honest. Those moments are rare for most dentists who have undifferentiated practices. 

What happens in undifferentiated dental practices? 

When I use the adjective “undifferentiated,” I mean the practice has a lot of patients who come for reasons other than shared values, agendas, and purpose. A patient’s dental insurance is a prime reason patients go to a particular dentist. Nearly free new patient exams and limited x-rays offered by many dentists is another reason. Being accessible for emergency dentistry in the patient’s local neighborhood is yet another. 

PPOs are likely the most common reason a patient sticks with an undifferentiated dentist. Patients with “insurance” don’t really have insurance. They have a minimal and limiting benefit plan disguised AS IF it were insurance. Consequently, misconceptions occur due to the intentionally confusing language. 

Additionally, insurance causes people to naturally focus more on their benefits (a reductionistic concept) than on their health (a holistic concept). So, in a very twisted and often dysfunctional way, dental insurance can cause people to make bad decisions that negatively influence their health as they psychologically prioritize money over their health.  

The Scarcity Bias 

The human brain has a bias toward scarcity thinking unless it’s actively circumvented through more right-side prefrontal cortex involvement. This scarcity bias occurs as most dental patients make treatment choices, and when this happens, we have a choice. 

1. We can play along and rationalize it. “It is what it is.” We can take the checks and focus on economy-of-scale strategies and production. 

1. We can actively work to remove insurance carrier influence from the patient decision-making process while facilitating greater patient involvement and problem ownership. 

Put another way: We either accept the codependency relationships (and all the anger, confusion, disappointment, and frustration that it brings along with the insurance benefits), or we actively work at creating interdependent relationships with patients, wherein they become the co-creators of their health future and share responsibilities associated with that goal. 

The Violation of Personal Boundaries 

When we actively participate in dependency-centric relationships, we violate interpersonal boundaries.  

On this, Avrom King brilliantly commented, “Dependency is the word we use to identify an individual who, for whatever reason, cannot claim and develop their latent personal power; instead, they negotiate psychological contracts with other people whose ego needs are served by accepting responsibility for the dependent person’s outcomes.” 

The minute we start to take responsibility for other people’s responsibilities, we begin a journey down a road that commonly leads to dysfunction, conflict, and frustration. 

Heath-centered dentistry is only possible through interdependent relationships, which means that ALL codependent relationships aren’t health-centered. They are centered on other things that are often associated with insecurity.  

To be continued in Part 2… 

By Edwin “Mac” McDonald DDS  

Change isn’t just about external circumstances; it’s also an inner evolution. We go on a transformative journey, and our reflections as we go touch upon our intention and legacy, our personal identity amidst the change, and decisions we make as the change unfolds.  

Challenge 1: Intention and Legacy 

When facing change, having a clear intention is like setting the compass for your journey. What legacy do you aspire to leave behind? Aligning your actions with your deeply held beliefs ensures congruence between your intentions and outcomes. But stress may cause you to move away from your most deeply held beliefs. I’ve witnessed this happen, just as I’ve witnessed deeply held beliefs guide what happens. 

Challenge 2: Personal Identity Amidst Change 

The question “Who do I want to be during this transition?” is profound. It invites introspection. Consider how you want to show up for yourself and those around you, especially those who are most important to you. Authenticity matters. 

Challenge 3: Listening and Accountability 

Change often involves decisions. Whose voices matter? Listening deeply to trusted individuals—those who respect and understand you—can provide valuable perspectives. Forming a leadership team of diverse viewpoints helps guide you toward success. 

The Importance of Values During Dental Practice Mergers and Acquisitions 

Many private dental practices are being acquired by large partnerships in 2024. These transitions have tons of potential and profit associated with them. Associated with these transitions are complex changes for the practice owner and team members…expanded ownership, more complex organizational structure, new operational systems, and a distancing of some decision making. They also come with the unknown of who will be your future partners after the next sale of the organization. Are you prepared for all of that?  

Preparing yourself and your team is essential. On the front end, asking every possible question including questions about the partnership’s core values, how they are integrated into the day-to-day operations, and communicating the importance of that to you and your team is essential to long term success. These questions and expressions are an attempt to examine the congruence and compatibility between you, your team, and your new partners. 

I am witnessing several friends transition successfully to one of these new partnerships. The common factor I observe is that each dentist has great self-awareness and received very strong assurance that they would retain autonomy to continue to practice according to the most deeply rooted values. I also observed that the large partnership was very stable with excellent systems and had high quality leadership.  

My father often told me: “The person that you have an agreement with is more important than the agreement itself.” In other words, a person of strong character will find a way to honor the intent of the agreement regardless of the specific circumstances of the moment. Values have longevity. Circumstances come and go. 

I have also witnessed an abandonment of strongly held values as an organization was going through the painful changes of decline. In abandoning their values, stakeholders were hurt and distanced themselves. It intensified and accelerated the decline. Values matter. Character counts. Clinging to our core values in times of change or decline will increase and accelerate recovery. There are countless Fortune 500 case studies to support this idea. 

Another Example of Values in Transition from My Life 

Finally, I want to leave you with a case study from my church, The Village Church. We had become a multi-site church in response to the demand of many people attending our main campus. As it grew, our leadership became painfully aware that it was not fulfilling our mission and it was not consistent with our closely held values of community and individual relationships. Over a period of several years, each church was given the opportunity to vote on becoming independent. They all voted around 95% in favor of the change. We gave away around 40 million dollars of real estate, equipment, furniture, and other assets to all of the churches.  

Today, the new independent churches are thriving as is our main campus where we attend. The decision was in conflict with everything that is happening in our business and church worlds where there is constant consolidation and scaling. However, the decision was consistent with the values that drive the purpose of the church. The change created multiple thriving churches that are serving their specific communities and growing people and their impact on our world. 

By Clayton Davis, DDS 

About 15 years ago, my wife and I were on a trip to New York City. My laboratory had told me about two dentists there who practiced together and did an amazing amount of cosmetic and restorative dentistry. Their best month was about six or seven times more than my best month, so I was curious. I knew they had studied with some of the same mentors I had. They had gone to Pankey and Dawson. They have a a comprehensive approach. While I was in New York, one morning I told my wife I was going to visit their Manhattan office and see what I could learn. 

Their office had reasonable furnishings (nothing fancy) and a reasonable level of equipment. It was tidy with nice staff. It seemed similar to what I have in my office. I sat down with the dentist who was there that day, and he shared with me what they do in their practice. They do a fair amount of marketing in health and beauty magazines that are circulated in the New York City area but otherwise it all sounded very familiar to my practice.  

A few moments later, there was a knock at the door. It was the hygienist, and she said, “Doctor, ready when you get a chance for your examination. Mr. Anderson is in today, you may not recall, but he had said that he wanted to get his veneers done after his daughter graduated from college. That was a couple years ago when he said that, and his daughter is graduating in June, so it’s time to bring that up again. I mentioned it to him today, and he’s scheduled to start that in July. So, when you want to come on in and talk to him about it, that would be great.” 

She walked away, and I looked at the dentist. I said, “What just happened? The hygienist handled everything about moving that patient forward for treatment. I can’t get mine to do that. As a matter of fact, we’ve had conversations, and they don’t seem to feel comfortable doing that.” 

He said, “I don’t know. We talked to them about it, and they’re tremendous about it. They really help our practice move patients into treatment.” 

I went home wondering how I could move my hygienists in the same direction, and an old business concept came back to me. If you want to improve something, you need to come up with a way to measure it. So, I came up with a form for logging what I call “Hygiene Points” and presented it to my hygienists. We talked about how we want to improve our ability to move patients forward with their treatment through the hygiene department. I simply asked them to score themselves on how it went at each appointment in talking to patients about any kind of treatment that came up. 

As each patient passes through hygiene, they receive a score. The lowest score, a score of 1, is for when I come into the operatory, talk to the hygiene patient, bring up some previously recommended treatment, and they go ahead and schedule it. A score of 2 is for when the hygienist finds a problem like a cracked tooth and says that it needs to be monitored. A score of 3 is for when I’m in hygiene and diagnose something new and get the patient to commit to schedule treatment. A score of 4 is for when the hygienist gets previously recommended treatment scheduled at the front desk without my involvement. A score of 5 is for when the hygienist takes an intraoral picture and points out a problem to me and I get a commitment to schedule. In other words, they say, “Let’s take a picture of this. I want Dr. Davis’s opinion on it when he comes in the room.” And then because the hygienist was concerned and I confirm in front of the patient that this is an issue that needs to be addressed, the patient schedules treatment. The collaboration and communication go so well, this is worth 5 points. And then the ultimate score is 6 for when the hygienist gets a commitment to schedule treatment for an obvious problem before I come in to confirm the diagnosis.  

The first couple of months that we used this scoring, we recorded a baseline monthly total.  After that, the competitive instincts of the hygienists kicked in and they wanted to improve their total score each month. I did not give them a reward incentive, and over two years, more production was coming out of hygiene. The old saw “You can improve what you measure” has certainly increased restorative collaboration and revenue in our practice, and the pursuit of higher Hygiene Points has been fun. 

By Lee Ann Brady, DMD 

When you are managing the care of an older patient, I encourage you to take time to look up their medications and the medication you are considering prescribing, even something as simple as antibiotics or pain medication. 

A resource I use when I am writing prescriptions and also managing existing pharmaceuticals that my older patients are taking is the Beers Criteria published by the American Geriatric Society (AGS). The AGS Beers Criteria® lists the Potentially Inappropriate Medications (PIMs) that are typically best avoided by older adults in most circumstances or under specific diseases or conditions.  

Some listed PIMs should not be written for people over age 65 and some are okay with caution or in moderation. There is a long list of medications people can take until they are ages 65 to 70 without a problem. After that age, there are side effects. 

Some of the medications cause adverse reactions on their own or in interaction with other medications. Some of these PIMs are common over-the-counter antihistamines. 

By David R. Rice, DDS 

I’m guessing your practice is a whole lot like mine. People can be challenging. Patients are people. Ergo, yes, patients often bring us challenges. With that and 29 years into dentistry, there are a few challenges I’m willing to admit and, like you, work to overcome.  

Our great patients get great dentistry.
Our challenging patients get our best effort.
Our job is to understand who each is, what each wants,
and how we do our best to deliver it. 

As you and I learn the best techniques and technology, we have to understand that many of our patients see the world differently. They see it differently than each other, and they see it differently than we do. At first glance, yes, this is an obstacle. But for those of us willing to spend time focusing on their views, this is a massive opportunity.  

About 20 years ago, the treatment planning and presentation mantra our team developed was: Pizza by the slice or the whole pie? 

 A talented and curious team with character, plus a well-defined process,
always equals complete care and profitable production. 

 Here are the four keys: 

1. Understanding who of our patients wants complete care—the whole pie right now. 

1. Knowing who of our patients isn’t ready for the whole pie today and needs us to serve that complete care one prioritized slice at a time. 

1. Recognizing that some patients love pepperoni, some love veggies, some are all NY and thin crust, some love that Chicago deep dish, and so on. 

1. Delivering each individual patient’s pizza the way they want it without yielding on our quality. 

All our patients come with a story. Some are ready for a whole pie. They want complete care and they want it now. Other patients are overwhelmed by the whole pie. Right or wrong, some past experience makes their yes to the complete care we know they need challenging. We can push them, or we can appreciate where they are and work with them one slice at a time. 

I’m not proposing we compromise our care. I’m offering us all an opportunity to elevate it. Whether you’re scanning and milling, 3D printing, injection molding, direct bonding, or prepping and temping long-term, the materials and technology we have at our fingertips today afford us an incredible ability to segment care. 

Complete-care case acceptance at 90%+ is a reality when we add great communication skills to the clinical skills we’ve worked so diligently to achieve. Today, I challenge you to assess, calibrate, and elevate your ability to deliver pizza by the slice…or the whole pie. 

By Pina Johnson, Professional Certified Coach, and Edwin (Mac) McDonald, DDS 

B.F. Skinner, a noted 20th century behavioral psychologist, conducted an intriguing and provocative experiment using laboratory mice. Using behavioral conditioning he was able to condition one group of mice to believe that through their actions they were able to determine their fate. Using the same methodology, he also succeeded in conditioning another group of mice to believe that there was nothing they could do to alter their fate. 

He then placed the first group of mice, the ones that believed their actions mattered, into a large tub filled with water. As anticipated, this group of mice, when placed in a life-threatening situation, acted instinctively and began to swim to the side of the large water-filled tub. Upon reaching the edge of the tub the mice were able to crawl out to safety. 

The second group of mice, the ones that believed that their actions were meaningless, when placed in the tub of water, simply sank to the bottom and drowned. Appropriately, the lack of responsiveness displayed by the second group of mice was termed “learned helplessness.” 

Culture Lifts or Sinks Ambition 

Belief that our actions and choices matter is essential to “making things happen.” 

According to Edgar Schein, an icon of modern leadership thought, the primary function of leadership is to create an organizational culture. The culture that we choose to create will influence every aspect of our organization and ultimately determine our dental practice’s success or failure. 

Value-based leaders understand the power to alter the course of the organization does not reside with a few; it is shared by many. Organizations with cultures based on shared beliefs and purpose are higher performing. Leaders of the highest performing organizations foster cultures rich in collaborative decision making and a profound belief that everyone has influence. 

Counter Learned Helplessness by Empowering Self-Confidence 

We have come to recognize that good-old “self-confidence” is a learned competency, and effective leaders create organizational cultures that promote and teach self-confidence to each individual team member. This is accomplished by empowering teams through collaborative decision making and ensuring each team member has been given the knowledge, skill, support, resources, and appropriate authority to accomplish each task required to meet the shared goal. 

Unleash Teamwork and Creativity 

In organizations with shared leadership cultures, human self-confidence is unleashed beyond saving oneself to act in the best interest of the organization. Knowing that our individual actions will have some effect on our organization’s future (and thus on our own future and the future of others we value) compels us to want to take actions that have positive benefit for everyone. This is “meaningful” for the individuals within the organization. This raises their engagement in the work and simultaneously generates a sense of wellbeing.  

In our dental practices, “We are serving others with empathy and care to ultimately improve their wellbeing.” This is a form of love. It begets appreciation and reciprocity. When the slings and arrows of daily life initiate negative thoughts of being out of control of a situation, remembering our purpose and prior successes enables us to see disappointments and frustrations as opportunities to create a new type of approach and carry on. 

The goal for effective leaders is to allow all of this to happen in a psychologically safe environment in which our staff need not fear repercussions for their well-intended actions even if the outcome of these actions is less than ideal. By creating organizational cultures that are psychologically safe, we draw out our organizational creativity which is often stifled by the psychological repression found in command-and-control cultures. 

Creative thinking is considered to be one our highest-level cognitive functions and has been found to be a distinguishing characteristic of exceptional organizations. The wise leader understands that their organization is best served through shared power, collaboration, and utilization of their organization’s collective creativity. 

By Laura S. Harkin, DMD  

My dad and I were enjoying our favorite lunch spot years ago when he turned to me and said, “Laura, isn’t it amazing? There’s an incredible sense of trust that our patients have in us. Sometimes, we give our best recommendation for treatment, and it is declined as if it weren’t important or a priority. I’ve recognized that, more often than not, our patients eventually choose to move forward, proving that it was more a matter of timing and circumstance than lack of value.” 

Trust is the cornerstone of our practice. It was transferred from patients to Grandpa to Dad and to me. I do believe that every morsel is earned through guidance, thoughtfulness, and skill. Trust is an entity that requires constant nurturing. In private practice, one should recognize that a doctor’s trust in their patient is equally as important as a patient’s trust in their provider. With synergy there’s the opportunity for optimal health. Even as a child, I had a very clear understanding of the care my dad had for his patients. This feeling is innate and deeply imbedded in me. I imagine that he felt the same.  

I don’t consider myself “a writer,” but I’ve always enjoyed the art of letter writing. I grew up writing frequently to my grandparents and friends and always loved picking out stationary that reflected my personality. Recently, I reread the letters that my grandfather typed on his old typewriter and my oldest brother scribbled on his Grateful Dead CD inserts – crafted just for me. It seems fitting then that I enjoy writing personalized letters to my patients. In fact, I’m pretty sure I salvaged my mental health during COVID by writing “updates” to my patients during months of closure. I digress. 

The letters that I write to my patients are most often in reference to comprehensive treatment. They provide a bird’s eye glimpse of our most recent findings, diagnoses, and treatment recommendations. My older patients, especially, appreciate my thoroughness, organization, and systematic approach to recommended treatment. These letters certainly aren’t handwritten, but the hard copy renders a sense of care that’s transferred from my hands to theirs. We must remember that individuals comprehend and retain information differently. The one-on-one, verbal, treatment consultation can become lost in the shuffle of everyday. Add dental language and complicated procedures to the mix, and that’s simply a recipe for confusion.  

Whenever I present complex treatment to a patient, I write a letter in everyday language to support our conversation. It’s stored in their digital chart as part of their dental record. In my first paragraph, I state my patient’s chief complaint. A summary of clinical findings followed by bullet point. Next, I provide my best treatment recommendation, an appointment sequence, and the financial investment. Photographs are also a helpful insert to aid in explanation for family members who were unable to attend the consultation. I think there’s value in a tangible letter taken home to revisit.  

Treatment letters are also an irreplaceable resource for my team. When a patient calls to schedule treatment previously presented, my stored letter immediately becomes a reference for scheduling appointments, including time allotments and space in-between subsequent visits. In my office, we offer a courtesy for treatment paid in full. This amount is figured in the financial investment portion of my letter so that conversations regarding immediate payment or a payment plan can easily flow. Should a case not be accepted prior to a routine recare visit, this letter serves as an excellent reminder during team huddle. It’s inefficient to page through multiple chart notes and software-driven plans with no explanation of the diagnoses which caused a need for restoration in the first place.  

In my first few years of practice, it was hard for me to accept that I needed to view this document as fluid with a potential need for multiple modifications to suit my patient’s desires and limitations. For example, financial concerns often lead to the need for phased treatment or a compromise from the ideal. I’m committed to openly discussing what may occur if no treatment is rendered or if a compromised approach is chosen. Likewise, I believe in the importance of presenting the financial component of extensive treatment myself. As the dentist and business owner, I must “own” the fee that I’ve carefully determined to reflect indirect and direct time, the skill level and support to be provided by my team, the technical excellence of my laboratory technicians, and my own knowledge. The fee that I present is steadfast, barring an unanticipated need such as root canal therapy. Should there be a need for additional chair-time or visits, it’s included in the quoted fee.  

Finally, my letters include my expectations for post-treatment maintenance. For example, if we are to complete a hybrid case in conjunction with a surgeon, I’m careful to share the importance of periodontal health and frequent maintenance visits to prevent peri-implantitis. In patients who have pre-existing medical conditions that when uncontrolled can be contradictory, I stress the importance of regular monitoring. Ultimately, I strive to empower my patients to choose and achieve oral health, Undoubtedly, oral health positively impacts overall health. My personal letters are a distinguishing trait of my practice that convey the level of care to be carried from presentation through treatment and in maintenance. Consider the value in this extra step!