By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

Kelley Brummett, DMD 

Recently, I completed growth conferences with everyone on my team. The beauty of a growth conference is that it’s all about growth. It’s all about effort. It’s all about meeting each other and becoming more aligned with the mission of the practice. If I have something I want to share with a team member that’s a concern or something new I would like them to achieve such as mastery of a new skill, I think about how I’m going to communicate it. And as I do growth conferences with the individuals on my dental team, I am cognizant that they are likely to want to receive feedback differently as individuals.  

I’ve discovered that if I ask my employee upfront how they like to receive feedback, they pause to think before responding. I wait patiently for their response because I know the response will save both of us time and energy. For example, there are some team members who want the short and skinny of it—“Give it to me straight now.” They don’t want you to hold back. There are some team members who need to be gently warmed up before they can hear the message and require thorough explanations of why. 

I’ve discovered it helps to frequently ask the “how do you like feedback” question of my team to get their buy-in of my feedback. The beauty of “feedback” is that even criticism can be framed in a positive way as the next identified step in working towards a goal.  

Those of us in dentistry know that sometimes we move fast, but there are times that we need to sit back, think through what somebody gave us information about, and then come back and have a conversation. Mary Osborne has guided us to have conversations with patients that allow us to slow down and learn more about them so they can think, hear themselves speak, and learn about themselves. I’ve decided the feedback question is also a good question to ask patients. “How do you like to receive information? Would you like to know all the details or for me to summarize?” 

I’ve learned from Mary and experiences with patients that “staying in questions” helps them grow. Staying in questions also helps team members grow. Staying in questions helps us providers grow. So, feedback—how do you give it? How do you like to receive it? How do you handle it? I encourage you to think about this. 

By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Laura Harkin, DMD, MAGD 

Let’s delve deeper into the preclinical interview! 

It’s helpful to understand a patient’s perception of their overall health and oral health, as well as what type of restorative dentistry they’re hoping to have and why they feel the way they currently do.  

Sometimes, an integral family member has influenced the timing of care. For instance, you may hear, “My grandchildren are making fun of my teeth” or “My wife asked me to get my teeth fixed.” From this response, I know that I will need to be sure my patient personally desires treatment before rendering it. I’m also anxious to understand what type of restorative dentistry a patient is considering. For example, are they open to removable prosthetics, fixed crown and bridgework, or implantology? 

Recently a new patient came to my office with an emergency. Tooth #5 presented with the buccal wall broken to the gumline and a moderate-sized, retained, amalgam filling. He immediately said, “I do not want bridgework.” I listened quietly until he elaborated by saying, “When I had this front tooth replaced by my other dentist, I had to take it in and out, and I just found that so irritating.”  

I finally understood that he was referring to a flipper but calling it bridgework. So, it’s important to listen and ask questions when someone seems close-minded about having a certain modality of treatment. Delve deeper into the conversation because it may simply be confusion surrounding dental terminology. 

For the grandparents who ask for a better smile, I’d like to understand their thoughts on the scope of treatment and their expectations. Are they looking for a white, straight, Hollywood smile or a more natural appearance with a little bit of play in the lateral incisors? Are they mainly concerned about stains, gaps, or a missing tooth? Are there other problems they’re aware of such as tooth sensitivity, inflamed gums, or the need for a crown? This input is very important as we continue conversation with co-discovery throughout the clinical exam, diagnostic records, and treatment planning phase. 

Learn to count on your chairside for pertinent information. 

I’m fortunate to always have my assistant, Cindy, beside me for preclinical conversations, comprehensive examinations, and restorative procedures. Sometimes, Cindy interprets a patient’s statement or component of conversation differently than me. She may hear a message that I missed or read body language of which I wasn’t aware. Sometimes, auxiliary conversations between patient and assistant take place after I’ve left the room to complete a hygiene check.  

At the end of the day or in the morning huddle, we always take time to discuss interactions with our patients. Together as a team, we’re more efficient at acquiring accurate information so that we may approach the road to health most effectively for each individual. 

Determine if trust is present. 

As I’m getting to know a patient and before I choose to begin restorative treatment, I seek to understand if trust is present in our doctor/patient relationship. New patients often share past dental experiences, and, unfortunately, some have lost trust in dentistry itself. This may be warranted due to improper care, but it may also be due to a lack of understanding or unclarified expectations regarding a given procedure or material choice.  

It’s not unusual, particularly when a patient is considering a large scope of treatment, to serve as a second or third opinion. Building trust and waiting to be asked for our skills are key necessities before moving forward in irreversible therapy.  

The comprehensive examination, periodontal therapy, splint therapy, and gathering of records are all appointments during which opportunities exist to get to know our patients. True trust often takes time to establish, but the reward reaped is frequently one of empathy, friendship, and the ability to do our best work. 

Explaining Dentistry in a Way Patients Understand 

Clayton Davis, DMD 

Here are some of the ways I communicate with patients to help them understand dentistry. I hope some of these will be helpful to you in enabling your patients to make good decisions about their treatment.  

Occlusal Disease: In helping patients understand occlusal disease and the destruction it can cause, I have long said to them, “The human masticatory system is designed to chew things up. When it is out of alignment, it will chew itself up.” I tell them, “Your teeth are aging at an accelerated rate. We need to see if we can find a way to slow down the aging process of your teeth.” The idea of slowing down aging is very attractive to patients, and if you relate it to their teeth, they get it.  

Occlusal Equilibration: Typically, I come at this from the standpoint of helping them understand that teeth are sensors for the muscles, and when the brain becomes aware our back teeth are rubbing against each other, it sends the same response to the muscles as when there’s food between our teeth. In other words, the brain tells the muscles it’s time to chew, and this accelerates wear rates on the teeth. Equilibration is really a conservative treatment to reduce force and destruction of the teeth.  

Diseases of the Jaw Joints: Regarding jaw joints and adaptive changes and breakdown, patients understand that joints have cartilage associated with them. Saying there has been cartilage damage in your jaw joint gets the message across simply. 

Treatment Presentation: When patients say, “I know you want to do a crown on that tooth,” I jokingly say, “Oh, don’t do it for me. Do it for yourself.” I never say, “You need to get this work done.” Instead, I say, “I think you are going to want to have this work done.” 

Conservative Treatment: I have always enjoyed John Kois’s saying that no dentistry is better than no dentistry, so when talking about conservative dentistry, I’ll tell patients, “No dentistry is better than no dentistry. We certainly don’t intend to do any dentistry that doesn’t need to be done.” Another way I speak about conservative dentistry is to say, “Conservative dentistry is dentistry that minimizes treatment. In the case of a cracked tooth, a crown is actually more conservative than a filling because it minimizes risk.” 

Moving Forward with Treatment: I love Mary Osborne’s leading question for patients after they’ve been shown their issues and treatment possibilities have been discussed. The question is “Where would you like to go from here?” With amazing regularity, the patients choose a really good starting point for their next steps toward improved health, steps that feel right to them. Always remember, people tend to support that which they help create. 

Dental Insurance: I typically speak of dental insurance as a coupon that can be applied to their dental bills. I’ll say, “Every plan sets limits on how much it pays. The way dental insurance works, it’s as if your employer has provided a coupon to go toward your dental bills.” 

Presenting Optimal Care: If I want to present optimal care to a patient who is ready to hear it, I ask permission by saying, “Mrs. Jones, if I were the patient and a doctor did not tell me what optimal treatment would be for my problems because the doctor was concerned that I couldn’t afford it or that I would not want it, I would think, ‘How dare you make that judgment for me. You tell me what optimal care would be, and I’ll decide for myself if I want it.’ So, with that in mind, Mrs. Jones, would it be okay with you if I presented you with the optimal solutions for your problems?” 

As a maximizer, I’m always tweaking processes to try to make things a little better. A few years back on the advice of a wise mentor, I made a small change to the last question I ask of patients in my Pre-Clinical Conversation. This change required a dramatic difference in how I view my “job” for patients.  

A Powerful Pre-Clinical Conversation Question

For years, I thought I was so unique to finish my time in the consult room with the question: “Is there anything else I should know about you to take good care of you?” Patients genuinely seemed to appreciate that question. I felt great about the responses I got, almost always along the lines of, “Nobody has ever asked me these types of questions!”  

A few years back, I was diving deeper on Locus of Control of Oral Health with my small growth group, The Sinking Stones. I was hoping to help my patients increase ownership of their condition and shift the “locus of control” from the doctor/expert (tell me what to do, when, and how) toward a true partnership (I can be the expert of the technical pieces, but you are the expert of you).  

The elegance of this transfer relies on our ability to do so without the patient feeling abandoned and unguided. I was gently reminded by Dr. Rich Green that a small change to that question could help frame the relationship differently right off the bat.

My new question is: “Is there anything I should know about you to work well with you?” Rather than facilitating a dependent/top-down/expert doctor relationship, I now have a much better chance of a patient understanding how important it is for me to be in partnership with them.

I can look them in the eye and tell them my healthiest patients are those that view me as their partner. This is better than looking for “experts” to tell them when it is appropriate to take on a particular procedure or make a decision for them without knowing their temperament, circumstances, and objectives.  

Though I love taking care of people, a change in those four words has allowed me to do so in a partnership according to the context of the patient’s life.

Amidst all the details that must be managed day in and day out at a dental practice, I’d like to bring to light something I find super important that is often neglected. Let me begin by asking a question: When is the last time you took a good look at your perio probes? I mean a really good look!

My guess is you will find different shapes, sizes, colors, materials, ages, and markings. Maybe this doesn’t seem like the worst tragedy in the grand scope of the world, and yet, having even two different probes in the office can set the stage for lack of continuity in your patient diagnoses. 

Why Perio Probes Matter

It does seem like there are as many choices in probes these days as there are stars in the sky, so how can you make the best decision when it comes down to buying?

Although I do recognize the need and desire to have options, at the end of the day I encourage you to consider which probe provides the LEAST probable chance of creating error. Although I have used (and observe people using) a huge variety of probes, my favorite by far is the UNC-15. Due to markings at every mm up to 15, there is virtually no guesswork in capturing and documenting data with a high level of accuracy.

As you make the decision of exactly which probe you will use exclusively in your practice, please also consider calibrating all dentists and hygienists on an ongoing basis. It is typically easy to notice that probing techniques will vary from person to person. Watching and learning from each other with the ultimate goal of having everyone in agreement about how you will probe is invaluable.

Lastly, remember that an accurate periodontal diagnosis can only be made when a comprehensive periodontal assessment is completed and documented. Your probe is designed to be used for measuring pocket depths, recession, bleeding, pus, and attached gingiva. Oh, and don’t forget to check for mobility and furcations while you’re at it.

Here’s to a future of more accurate and calibrated perio probing in your office!

Growth should be the primary goal of every dental practice. No matter how well things are going, planning for and promoting growth ensures that any setbacks do not completely derail you. Growth is also valuable because it keeps your practice lively with new patient energy and ensures your team stays engaged.

In Part 1 of this series, I discussed my first two tips for 2018 that encouraged developing a marketing plan and increasing whitening services. Keep reading for my final two pieces of advice:

Thrive in 2018: Patient Education and Experience

Use Digital Photos for Patient Education

Take the following series of six digital photos on all new patients:

1. Natural smile
2. Close up retracted view
3. Upper occlusal view
4. Lower occlusal view
5. Left buccal corridor
6. Right buccal corridor

Load the photos onto an iPad or tablet for patient viewing. This will convert the process from passive to active for the patient. Be prepared to hear two frequent comments from patients: (1) “Wow, I have never seen my teeth like this before!” and (2) “Yuck!”

Provide a Remarkable New Patient Experience

The first visit to your practice should be an awesome experience that helps new patients become more interested in their oral health. Take some time with your team and design a new patient experience that is more ideal.

Consider beginning with a simple office tour that shows the patient some services that are available. Include a new patient interview where a team member takes the time to get to know your patient and understand their ‘dental story.’ Make it a ‘wow’ experience where patients leave saying, “I have never been treated so thoroughly before!”

The four tips presented in Part 1 and 2 of this series are an excellent way to develop a thriving practice in 2018 and beyond.

As you begin to implement these recommendations, think of the following axiom: To achieve what you have never achieved, you must do what you have never done. Here’s to your success!

It’s my strong opinion that dental practices are either growing or they are in decline. A case could be made that there is a third option, staying the same, but with ever-rising overhead, staying the same is just another form of decline.  

In Part 1 and Part 2 of this series, I’ll share 4 specific tips that will help you thrive in 2018 and beyond.

Thrive in 2018: Marketing and Whitening

Develop a Comprehensive Marketing Plan

New patients are necessary for a growing practice. Oftentimes the difference between a good practice and a thriving practice is the volume of quality new patients.

Spend some time crafting a comprehensive marketing plan that includes internal, external, and digital marketing activities. In my own practice, our most effective internal marketing strategy is the dentist calling all new patients and any patient who receives an injection on the evening of treatment.

An effective external marketing strategy for us is making NFL-quality mouth guards for our local high school football team. Also, one very effective digital marketing strategy has been getting online patient reviews. An appropriate marketing budget for a growing practice is 4-5% of revenue.

Embrace Whitening

Growing your whitening business is a great way to attract patients. Here are 3 simple things you can do to increase the amount of whitening treatments you perform:

1. Take a shade match at the beginning of the hygiene appointment. Then show the patient their current tooth shade on a shade guide organized chromatically from dark to light.
2. Value-price whitening. Consider value-pricing as a means of making it more affordable and accessible for your patients. The real economic benefit is the restorative and elective treatment that results from increasing your whitening.
3. Offer lifetime whitening. Consider offering free gel to your whitening patients, provided they keep their recommended hygiene appointments. This is a win/win strategy that patients love!

To be continued …

Throughout my dental hygiene, dental school, and residency programs, I was blessed to have exceptional instructors and role models. All of them encouraged me, believed in me, and most importantly, impressed upon me the importance of lifelong learning. Many of them recommended Pankey, telling me to go there as soon as I could.

A Journey to Deeper Patient Relationships

That journey began in 1994. I will never forget sitting in Dr. Irwin Becker’s philosophy class as he talked about the Crosses of Dentistry. He discussed “Knowing Your Patient” and I remember becoming very emotional.

As a young hygienist, it would bother me when I would see a re-care patient and not remember what we talked about the previous time. I started jotting things down on index cards about each patient and keeping them in a private file. Not the things you would typically see in chart notes, but personal things they felt comfortable sharing.

Each time they came in, I would refer to the personal card file and refresh my memory as to where we left off. There was no way I would have been able to remember all those special discussions, so I had to write them down. Each time they came in, the next chapter began.

I also started sharing more information about myself. I found the more I shared, the deeper the conversations went. I really wanted to know my patients on a much deeper level and that is what happened over time.  

When I came back to the Pankey Institute for the second continuum, I was pleasantly surprised to be greeted by name by Dr. Ernie Anderson, one of the course instructors, as I stepped into the elevator of the condos. Obviously, he had taken time to look at the roster to see who was in the class and that was very impactful. The kindness, thoughtfulness, and encouragement shown to me at the Institute were instrumental in demonstrating how I wanted to make my patients feel during my care.

Time spent getting to know my patients has resulted in lifelong relationships. Of all the things I’ve learned, this is one of the most important keys to a meaningful and enjoyable career.