Practice Management Toolkit Educating Patients that the Search for Cavities is only Part of the Dental Examination David Schwab, Ph.D Most patients think that their dentist is only interested in their teeth. That's not quite true, of course, but in dentistry, teeth are only part of the story. Patients often take dental examinations for granted, because they assume that the dentist is only looking for cavities. In fact, a recurring communication problem in dental offices is that the dental team is doing an excellent job of conducting a thorough examination, but a relatively poor job of communicating all the details of this process to the patient. You can lay a foundation for the patient's acceptance of a comprehensive treatment plan by educating patients about the scope of a new patient examination. The first step is to use the words "thorough" and "comprehensive examination" when describing the examination process. While you cannot control the words the patient uses to describe the experience, all members of the dental team should avoid the term "check up" when they are speaking of examinations. "Check up" implies a cursory check, while "comprehensive examination" connotes a detailed process of looking at a variety of factors that affect oral health. The receptionist or dental assistant should say something like this: "Mrs. Brown, Dr. Smile is very thorough. She will conduct a comprehensive examination and explain her findings and recommendations to you." The patient also needs to learn what you are looking for. Explain that in addition to looking for cavities, you are also concerned about loose or missing teeth. The patient should understand that you are also checking existing fillings to determine whether they are allowing bacteria to leak into the teeth and potentially cause decay. The doctor or the dental assistant should explain that cracked fillings may lead to a cracked tooth, and that some old fillings—particularly the larger ones—may need to be replaced at some point with new fillings or with a crown. If the practice uses an intraoral camera as part of the examination process, then these explanations need to precede the "show and tell" aspects of the examination, so that the patient can fully appreciate the significance of, for example, a cracked filling. The patient also needs a brief education about periodontal probing, and the significance of pocket depths. If the doctor is calling out pocket depths as she probes, the patient should already have a basic understanding of what the numbers mean. When patients are not afforded a prior explanation, the recitation of numbers is meaningless to them, so they take a mental break from the examination. An informed patient, on the other hand, is an interested patient. In addition to explaining periodontal probing to patients, the following sentences should always be used during new patient examinations. "Periodontal disease occurs when bacteria affect the gums. Periodontal disease is the number one cause of tooth loss in adults. The good news is that gum disease is preventable and treatable. We are going to examine your gums carefully through a process called periodontal probing." (The doctor or staff should then explain the significance of pocket depths measured in millimeters.) Note that these simple sentences provide essential information without giving the patient a lecture in microbiology, which would surely challenge the patient's interest level. If the patient asks questions about periodontal disease, then the doctor can address these questions in more depth. This short explanation also accomplishes the following:
The patient should also be made aware that the doctor will check for temporomandibular joint dysfunction (TMD). Explain to the patient the importance of a proper bite, and mention that TMD can lead to discomfort in the jaw as well as referred pain to other areas of the head and neck. It is important for patients to know that TMD has also been linked to headaches. There are still other components to an excellent dental examination that the patient may not fully appreciate. The doctor should explain that he is looking for abnormalities in the mouth, including mouth sores that may cause the patient discomfort, as well as more serious matters such as oral cancer that require early diagnosis and treatment. Doctors who are excellent communicators should also tell patients that they are looking for cosmetic problems in addition to clinical abnormalities. The doctor should explain to patients that most people desire to have teeth that function properly and also have a good appearance. It is the dentist's responsibility to point out not only functional problems, but esthetic concerns as well, and to suggest options for improving esthetics. In terms of diagnostic aids, the patient should be told that "necessary x-rays" will be taken. The x-rays that are needed for each patient are determined by the doctor on a case-by-case basis, of course, but the term "necessary x-rays" can be used with virtually every patient. Many doctors also elect to make study models for their patients, which not only provide an excellent record, but also serve as an effective teaching aid during the ensuing case presentation. Another simple but effective technique is for the doctor to dictate her key findings, overall impressions, and treatment plan after she has had a chance to review all the records. This dictation can be quite brief—only a few minutes per patient—but it provides an excellent and invaluable record. The narrative report that follows becomes part of the patient's permanent record and guarantees that the doctor will be well prepared with detailed notes at the time of the case presentation. Dictated notes can be sent to a local transcription service, since in-house typing may take the well trained front office staff away from some of their other important duties. Many physicians routinely dictate their findings after a patient examination, and they report that it is a time saver and important organizational tool. Many dentists are also conscientious about taking a patient's blood pressure and pulse at the time of the initial examination (and prior to performing invasive procedures at subsequent appointments). This level of care greatly impresses patients. When a dentist also takes it upon himself to call the patient's physician prior to starting a course of dental treatment, the practice should make sure that the patient knows that the call was made. The patient will appreciate the collaboration between the dentist and the physician. Many patients will remark, "I've never been to a dentist who is this thorough." That positive impression will certainly translate into higher case acceptance rates and increased patient referrals. There should be little concern about the time it takes to educate patients about the examination, because the explanation occurs at the same time as the examination itself. There are also patient education aids, such as CD-ROMs, that tell patients exactly what to expect during an examination. By telling patients what they are doing during each step of the process, doctors can lend new prominence to the dental examination and help the patient appreciate the doctor's knowledge, thoroughness, and commitment to excellence. In the final analysis, patients will not accept treatment they do not understand, and this understanding begins at the time of the examination. Excellent communication, then, is an integral part of excellent treatment. David Schwab, Ph.D. is a practice management consultant based in the Orlando, Florida area. He may be contacted at (407) 324-1333 or at the following e-mail address: davidschwab@compuserve.com 
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