The following is a guest post by Debbie Seidel-Bittke. If you are interested in guest posting for Dental Heroes, please sign up here.

In Part 1 of Communication Tips You Must Know to Improve Case Acceptance, we talked about the advances in technology and our knowledge of the current evidence-based science, regarding the oral health and systemic health link.

We understand that dental hygienists have a huge impact on communication and patients’ acceptance to a treatment plan. It is crucial to guide patients to have a healthy body and in return, we are adding value to the services we provide and this will in return increase the dental practice profits.

Critical components for patient case acceptance:

1. Rapport: The patient connection.
2. Visuals: Most people are visual learners. Have these ready to use at each appointment.
3. The words we use.
4. The questions we ask . (Open-ended questions.)
5. Review, repetition and closure with the patient.

Case acceptance is critical for clinical results and the success of all dental practices.
Without patients accepting the treatment plan we cannot provide optimal care and your dental business will not survive and thrive. When we communicate with our patients, it is valuable to ask open-ended questions. Without asking open-ended questions, our patients will be answering yes or no to our questions. We can learn a lot more about our patients needs when we ask questions that cannot be answered with just a yes or no.

Time is a big concern during the hygiene appointment and asking open-ended questions will allow us to communicate the important facts quickly. In Part 2 we will give examples of critical communication for patient case acceptance.

Example of an Open-Ended Conversation:

RDH: “Mr. Jones, Can you see the brown line and discoloration around this composite filling?”
Mr. Jones: “Yes, I can see this.”

RDH: “How do you feel about these dark discolored areas on your front tooth?”
Mr. Jones: “I have never noticed this before you mentioned it today. I don’t like my teeth not being white. What does the discolored area mean for my tooth?”

RDH: “This means there are open areas around this filling. I see from your chart, this restoration was preformed about 15 years ago. There are toxins, bacteria or poisons that will creep under the filling and cause destruction of the tooth. Do you see the small amounts of food trapped in this area?”
Mr. Jones: “Yes, I do see the food trapped there.”

RDH: “The bacteria that creep into this area on the tooth can also get into your blood stream and contribute to disease. This can affect your immune system.” Does this make sense to you?”
Mr. Jones: “Yes, that does make sense. I have never thought about it in this way.”

RDH: “What are your thoughts about restoring this tooth, returning it to a healthy status?”
Mr. Jones: “Well, yes, of course I want to be healthy. How can you do this?”

RDH: “Mr. Jones, the first thing I would like to talk about is your discolored tooth in the front of your mouth. I know you have never noticed this before today and with a new restoration, we can remove the bacteria, which causes oral disease and more destruction on your tooth. The bacteria will get into your blood stream if not removed. The way we fix this tooth for you is to very easily remove the darkened, stained enamel from the tooth and replace it with a new tooth colored material. Of course, all the recommendations for treatment I am going to make will be dependent on your budget. I know that the economy has also affected how you are spending money at this time. The doctor will look closely to make sure all the recommendations make sense for you and what is happening in your life at this time.”

This is the time to take out the brochure regarding restorative treatment. (Circle, highlight or underline the areas which pertain to the patient.)

RDH: “What are your thoughts about this treatment recommendation? Does this information make sense?”
Mr. Jones: “Yes, it does make sense. Although money is tight, I still want to have the healthiest mouth and body as possible. I would like to think about ways I can pay to have this treatment completed.”

RDH: “I can have Mary, our financial coordinator, discuss payment options with you. The second area I can help you with is your dry mouth. I noticed that you circled this on your medical history. This is most likely due to the medication you are taking for high blood pressure. Today, I will show you a few products, which will relieve this situation very easily.”
“Is this something that you will use at home?”
Mr. Jones: “Yes, I definitely want to know more about these products today.” “I don’t want to leave without asking Mary about the financial options you can offer.”

RDH: “I will show these products to you after the doctor completes your exam today. The other area I want to address is the bleeding gums and the areas, which measure 5mms. I completed a periodontal screening exam and I want to review my findings with you at this time.” (At this time if you have an electronic chart, put the perio chart up on the monitor and review with the patient. Also, bring out the periodontal brochures and outline, highlight or circle important areas that relate to the patient.)
“Your oral health is related to your overall health. We need to remove the bacteria causing the periodontal disease. You may have heard about gum disease before today. Some of the factors which can contribute to periodontal disease are stress and various systemic diseases such as your high blood pressure. I am recommending that you return for four appointments to scale and root plane these areas. I will place a chemotherapeutic agent called Arestin in the areas, which measure 5mms. This is similar to what you know as Tetracycline. This is a sub-dose of Tetracycline and will work only on the enzymes, which are causing the inflammation, bleeding and disease process. After the four appointments are complete, you will return four – six weeks later to re-evaluate these areas and make certain they are healthy. Usually with this treatment and the use of chemotherapeutics at this early stage, we can halt the progression of periodontal disease. I will also recommend that you return every three months for supportive therapy to prevent further disease. Does this make sense to you?”
Mr. Jones: “I think it does. I have been hit hard from the economy these past two years and it has caused a lot of stress. My daughter is getting married which adds to the financial problems and my stress. Are you telling me that if I don’t have this gum treatment for the periodontal disease, that I can lose my teeth?”

RDH: “Yes, that is correct. Usually this is a slow disease process but without the treatment, scaling and root planing, the disease process is likely to progress. The scaling and root planing will also help establish good health around that tooth before the doctor provides you with a new restoration or filling in that front tooth. The end result with a new filling is very positive once your gums are healthy. The doctor can add a much better restoration when the gums are healthy.” “I know you have your daughters wedding in a few months so maybe you want your smile to be the very best possible for this big event. Before doctor comes in to do the final examination and make the diagnosis, I want to show you some photos of patients with a similar situation as yours. In our computer, I have some photos of patients who had the same type of slight bleeding and redness around their gumline. (Now have photos of patients before and after scaling and root planing on the monitor) They completed the scaling and root planing and as you can see in this photo here, the patient now has gums that are a light coral pink color. How much difference do you see in the patients’ gums from the beginning to the end of treatment? Can you see a difference between these photos? Do you notice something is different?”
Mr. Jones: “Okay, I see, the teeth and gums look a lot better in this photo on the right. I understand what you mean about improving my oral health. That second photo doesn’t have any blood around the gumline. The front teeth on this patient are also much whiter. I have never even noticed this discoloration or bleeding before today. I never noticed those brown areas around that old filling and I definitely didn’t think anything about a little bleeding on my gums every once in awhile.”

RDH: “Our dental assistant Marcie had an old filling completed for the first time about twenty five years ago, before we had these great materials to restore teeth. The filling was redone few times over the past twenty-five years and last year doctor completed a veneer on this tooth. Doctor also whitened her teeth so they would all be much whiter. This is something very similar to what doctor can do for your teeth. Of course, this is only if you decide to have something more permanent completed on that tooth. It is very simple to complete and not much of your tooth will be taken away, contrary to having a crown placed.”
“I wanted to show you what we did to her tooth because we work for an amazing doctor who can make everyone’s teeth look better than ever. I wanted to show you this other type of treatment because it is longer lasting and all your teeth will look much whiter. Dr. Carter takes us to a lot of excellent educational courses and we just learned about a new procedure which can really make your smile look good for your daughters wedding!”
“Mr. Jones, we have talked about many things today. I want to make sure you are comfortable with your care. What questions do you have for me?”
Mr. Jones: The photo of the tooth after she had the veneer placed looks fantastic! I really like how natural it looks. How long will the restoration last?”

RDH: “With proper home care, the veneers can last over twenty-five years.”
I believe that doctor may want to discuss these various treatments with you at another consultation appointment. If you are interested in having all the teeth look great in the front of your mouth, doctor can talk to you about what you want your teeth to look like. We can make another appointment during your lunch hour next week so you don’t have to be so rushed today. You can take your time to decide on the type of treatment you want to make your smile look the very best. We will accomodate you so you don’t lose time from work. Is this something you would like to discuss with doctor further?”
Mr. Jones: “Yes, I think I would like to find out how all my teeth can look better. Let’s make a lunch time appointment for me to discuss this more.”

RDH: “I am looking at the schedule here on the computer and I see that we have a lunch time appointment next Thursday. Does 12:00pm on March 24th work for you?”
Mr. Jones: “Yes, I think that will work for me.”

RDH: “Before you leave today I will schedule the appointments for the scaling and root planing and a six week appointment to re-evaluate the outcome from the scaling and root planing. I will also review those products for your dry mouth. Here is doctor now.” Now the doctor will come into the hygiene room and complete the exam. Doctor will confirm the initial diagnosis and review the discussion between the hygienist and patient.

Recap for Critical Communication

At this point, the hygienist has talked about stress and the affects of this on the patient’s oral health. The hygienist has talked about something pleasant to continue with rapport building and the personal relationship between patient and practitioner. The hygienist has also used various types of visuals. In this scenario, the hygienist used brochures and individualized these by highlighting, underlining and/or circling important aspects. The hygienist also showed some real patient photos on the monitor. During the verbal communication, throughout the case presentation, the hygienist used open-ended questions. When possible, the hygienist engaged the patient in conversation.

The hygienist explained the purpose for good oral health and allowed the patient to choose the level of health they want. The hygienist allowed the patient to decide if they would like to hear other treatment options. This put the patient in charge of their oral health and options for treatment. The patient took responsibility.

During the case presentation, the hygienist suggested and asked the patient if they would like more time to discuss other options with the doctor. These other options were more permanent alternatives to treatment. The hygienist talked about a more complete treatment plan and asked leading questions to discover if this is the type of treatment the patient would be interested in. (RDH: “Is this something you would like to discuss with doctor further?”)

The Next Crucial Step For Patient Case Acceptance

The next step when doctor enters the room for the exam is for the hygienist to provide a verbal synopsis to the doctor about the discovery during the patient-hygiene appointment. The hygienist will begin with something personal about the patient. For example, Mr. Jones has a daughter who will be married in a few months. Then the hygienist will report to doctor what treatment options were discussed and what the patient felt about the treatment options and if Mr. Jones is interested in moving forward with any of the options discussed.

Another Crucial Step for Patient Case Acceptance

The next crucial step is to get closure before any financial arrangements are made. You need to know if the patient is ready to move forward with treatment. This one thing needs to occur before you will have an answer to this next step to discuss the financials. If the patient is not ready to move forward with treatment, discussing financials will become a losing option for your patient schedule.

If you do not proceed with this next step the patient can most likely make an appointment and then cancel. The patient may also follow through with financial arrangements but they will tell you they will call when they are ready to schedule their treatment. This is why it is crucial to have a commitment from the patient to move forward with treatment.

When presenting the treatment plan both doctor and the hygienist need to be on task. Neither of these two people can miss a step. If doctor misses a step, the hygienist needs to give a verbal cue for doctor to return on task and verbally communicate. Same thing occurs if the hygienist misses a step. There needs to be conversation and a buy in from the patient after explanation of the treatment.

Repetition. Repetition. Repetition.

In real estate, they say this phrase “Location. Location. Location.” When we discuss communication with our patients, we need to understand that, many times a patient needs to hear the information two or three times before, they will say “Yes” to a treatment plan.

When the hygienist and entire dental team understand the science behind communication for case acceptance, the hygienist and other members of the team can increase the chances a patient will move forward with their treatment plan.

It is the responsibility of the hygienist to continually review the periodontal, restorative and aesthetic treatments, regarding the structured process within the Science of Communication each time they see the patient. The time for communicating this will not always be as long; however it is still the responsibility of the hygienist to continue communicating as long as the patient says they are still interested in the information. The dental professionals are the experts and need to continually create a desire for patients to move forward with necessary treatment.

Conclusion

It is important to understand the science behind communication. We are all guilty of talking and not communicating.

Key components to understanding how to get a “YES” for patient case acceptance:

- Understand the patient’s personality style.
- The tone and speed or your words
- The words we use
- Stay away from “speaking in code.”
- Use visuals
- Seat patients upright in the chair and face each other eye to eye
- Focus on the patients concerns and not your own agenda

Once the dental team feels more confident explaining the treatment needs to patients, the patients’ confidence in scheduling their treatment will also increase. In order to improve our patient case acceptance we need to improve the patient experience. To improve the patient experience, we must first improve the dentist and team experience. The goal of communication is about changing what we do. Once we have mastered the Science of Communication, the patients will notice the value added to their appointment and the overall improvement of their experience. With the patient experience improving, so will the referral of the patient’s friends, family and colleagues. When we create a great patient experience, the dental practice will benefit with an increase in the bottom line.

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