A week ago I wrote about preparing a patient for a second visit consultation. At that second visit, here are some tips to keep in mind.

1. Treatment presentation is done in a dental operatory and not in a separate consultation room. The patient is seated in the dental chair in the upright position- not lying down in what I would call a defenseless position. Eye to eye contact with the doctor sitting in his/her chair. I like the treatment room as opposed to a consult room because just in case you need to confirm something clinically, you can tilt the patient back to see something – and then return the patient to the upright position for your communication.

2. Your job prior to the consult visit is to design and price out three treatment options – the total cost along with the estimated insurance coverage if applicable for all three choices.

3. Don’t show the patient any x-rays. They have absolutely no idea what they are looking at. It took you two years of dental school to be able to interpret films.

4. Don’t draw squiggly lines on the bracket table cover. I don’t know why so many doctors do this, but it is a very ineffective way to describe or illustrate a procedure.

5. Instead, use photographs of perfectly shaded posterior and anterior crowns along with photographs of poor quality color crowns with gold margins showing in order to illustrate what “your” crowns will look like. When you talk about crowns, patients might have a negative perception based on what they have seen in other peoples mouths.

6. I love using an iPad to show clinical examples. The color is amazing and the experience is very interactive. (link to blog post)

7. Let the patient hold the study casts. Obviously the casts should be properly trimmed and cleaned and polished.

8. Use language that a 10 year old can understand. Do not use clinical words like margins, occlusion, etc. Talk about “cavities” and not “decay”. From the time kids are 3 years old, they know that cavities are a bad thing.

9. Present the three options for treatment. The sequence is to present the best option first – but we don’t call it the best. We say “one way, a second way and a third way.”

Now listen to how I present the three treatment options for a typical scenario of a precipitating event. Tooth #30 had a large amalgam restoration. The precipitating event was that the lingual cusp sheared off. Tooth #31 and tooth #29 are also restored with large amalgam restorations that are suspect but still intact. The patient qualifies for this 2nd visit because there is the possibility or potential to perform 2 or more indirect restorations in the quadrant where the precipitating event has occurred.

click here to listen

In my next blog post I will teach you how to close this case effectively.

There are two kinds of precipitating events that are seen in your practice all the time. The first would be classified as an emergency – a patient calls because something is broken or is painful. The second would be a new or existing patient seen in the Hygiene room and the examination reveals decay or a periodontal problem. In both of these cases, treatment is required. There are negative and significant consequences to not performing treatment. Something must be done.

If the problem is isolated to a single tooth, the diagnosis is made when you see the patient, and the patient will be appointed for treatment. Usually there would be no need for a second visit to present treatment choices. BUT – If there is the possibility or potential for doing two or more indirect restorations within the quadrant or the arch where the precipitating event occurs – I recommend a no charge second visit for the patient to return to the office so that you have the opportunity to present choices. In dollars, that would be a minimum of usually $2500-$3000.

In preparation for that visit, take some diagnostic study casts, necessary x-rays and a few digital pictures – all at no charge – to help you prepare for the treatment choices you offer. You say to the patient “ Mrs. Jones – I want you to come back next week so that I can discuss your treatment options with you.” Now to the patient who has that broken tooth, or decay under an existing filling, they usually say “But Doctor – what are we going to talk about? I need you to fix my tooth.” DON’T say that we are going to discuss fixing those two other heavily restored teeth that are right next to the one that is broken. That NEVER works! And it does not work because the patient is distracted and concerned about only the tooth that is damaged. So they say “no doctor – let’s just fix the one that is broken.We can worry about those others later.”  Because you try to present treatment choices at this initial visit, you fail and you end up being a one tooth at a time dentist – over and over again.

Instead, your answer to the patient when asked “what are we going to talk about”  should be  “you know, I am not sure. I want to study these x-rays and models and photographs to see why this happened – and when you come back, I will know your case by heart.” Those are the magic words! I learned them 25 years ago from the great Dr. Paul Homoly who was masterful at getting patients to say yes to treatment. I promise you those words are just as effective today as they were back then.

The only thing you do at this initial visit is palliative treatment – smooth a rough edge or put in a temporary sedative filling material. Take your photographs and study casts and re-appoint the patient for a 25 to 30 minute visit. Next week, I plan to send you a recording of a typical three choices of treatment presentation for a precipitating event. When you hear this, I hope you will be able to see the many positives of presenting treatment in this fashion.