The Dentist's Network #88

The Golden Question for Case Presentation

There is a simple yet powerful question that can instantly and dramatically improve your case acceptance rate... I call it "The Golden Question." I will tell you what The Golden Question is shortly but please allow me to set it up. The Golden Question is something that seems too basic upon first inspection. However, I promise you that when you start using it you will have one of those "a-ha!" moments that we all crave.

We all get frustrated when we spend time discussing treatment with patients, only to have the patient decline. It can sometimes feel like we are beating our heads against a wall. All dentists have a different propensity for eliciting treatment acceptance from patients. Some dentists seem to have a knack for "selling" dentistry while other dentists can barely "sell" a root canal to a person in pain. Regardless of your current level of success with case acceptance, The Golden Question will undoubtedly make your conversations with patients smoother, shorter and more fruitful.

Are you ready for The Golden Question? Well, here it is! The Golden Question is this - "When you think about proceeding with treatment, what are your main concerns?" I know, I know, it seems too basic. I told you it would! Allow me to explain how it works.

The Golden Question must be asked before you present the recommended treatment to your patient. The answers that the patient provides to us after we ask the question give us the ability to powerfully tailor our case presentation so that it fits that patient. This ability to customize the discussion is absolutely paramount for regular success with case presentations.

Imagine that you are presenting a treatment plan that consists of some fillings and a few crowns. Now, imagine that as you begin your presentation, you falsely assume that the patient's primary concerns revolve around cost. As you discuss your recommendations with the patient, you repeatedly tell them how reasonable the costs will be and how you will be using the most cost-effective materials. Well, what if this patient's primary concern is about how long the recommended work will last? You missed the boat! While you were blabbing about cost-effectiveness, you missed your chance to connect with patient in terms of what is most important to them. This is the kiss of death and a surefire way to send a potential case directly down to Davey Jones' locker, never to return.

In my practice, I focus almost exclusively on Short Term Ortho for adults. Every consultation begins with The Golden Question. Asking "when you think about proceeding with cosmetic orthodontic treatment, what are your main concerns?" allows me to understand clearly how I can best present treatment to this patient in a manner that will hit the right buttons. My acceptance rate is fantastic, but it hasn't always been like this - I learned the hard way. I did hundreds of consultations before I started asking The Golden Question and most of the conversations were laughable.

I used to feel as though I needed to address every concern that the patient might have during the discussion. So, I rambled on and on about everything under the sun. Then, after I was done with my monologue I would then ask the patient if they had any questions or concerns. Well, by that time I had overwhelmed them with so much information and brought up so many topics that they never even considered, their heads were spinning! I think most of us have been guilty of "blabber mouth syndrome" during our presentations. The beauty of The Golden Question is that it allows us to cure ourselves of this nasty syndrome and move on into fresh new territory. If we understand our patients' concerns clearly and address them succinctly as we discuss treatment, our case presentation conversations become amazingly effective.

When we take the time to understand the plight of the patient, we begin to see trends in the way that our patients think. There are really just a handful of concerns that are typically expressed by our patients. Very quickly we can learn how to effectively address each of these concerns and how to cater to the types of patients that typically have a particular concern. It feels like cheating, but trust me, it's not. As long as the treatment we are presenting is truly going to benefit the patient, everyone wins when the case is accepted. So, next time you sit down to discuss treatment with a patient, remember The Golden Question and never look back. You, your staff and your patients will be glad you did!

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.

Dr. Swain can be reached at Drswain@thedentistsnetwork.net

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Louis Malcmacher
DDS MAGD
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Do You Sell Flowers?

When I walk into many dental offices, sometimes I feel that they are selling big bouquets of flowers. Other times I am sure that they are selling a condo or a house on the beach. Other dental offices I’ve been in, I could swear they are either an art gallery or are trying to sell paintings or knock-off of famous art pieces. I was sure that one dentist I went to visit was a farmer, because in his waiting room he had beautiful pictures of fruit.

Why would I think that dentists are selling flowers, condos, homes on the beach, art, and fruit? Because when I, and their patients, walk into their offices there are big pictures of these items on the walls. They are on the walls of the waiting room and treatment rooms. Well, here is my big question to those dentists that have such artwork on their walls - if you are not selling flowers or fruit, then why in the world do you have these things on your walls? Most businesses that you go into that actually sell something have beautiful pictures of whatever they are selling up on the walls. Dentists for some strange reason all of a sudden want to hide from their patients what they can do and may be more comfortable selling flowers to their patients.

Like it or not, we are all selling something. What is your core business? It is delivering dental services to your patients and creating health, wellness and beautiful smiles. What you should have on your walls are big pictures of happy people with beautiful smiles, because that is exactly what will help motivate your patients to accept treatment. Before and after pictures of smiles with Aurum Ceramics Cristal Veneers www.aurumgroup.com and total facial esthetics with Botox and dermal fillers that you have done in your office should immediately take the place of anything else on your office walls, because that is what you are looking to provide to your patients, and indeed, that is what they are looking to receive from you.

The strong effect of before and after pictures cannot be discounted when it comes to showing patients what you can do for them. For as long as I can remember, we have had before and after pictures of smiles in our offices in albums and up on the walls. What I want to hear from the patient when I walk into the room is for them to point to a picture on the wall and say, “hey, can you do that for me?” The answer obviously is: “sure, I can do that for you!” That is basically my treatment presentation. You need to plant seeds in patients minds as to what you can accomplish. With elective esthetic dentistry, a beautiful smile on the wall is much more effective than flowers and fruit.

One of the most important lessons that I have learned from being a long time member of 1-800-DENTIST (www.1800dentist.com) is that you need to market the services that you perform specifically in your office, not promote dental services that you refer out. If you don’t do implants, then having that as a headline in your practice newsletter probably is not prudent. If you don’t sell flowers, then either stop promoting them in your office, or start selling flowers.

We can certainly learn a lot from other healthcare practitioners in the health and facial esthetic industry. Now that we are providing Botox and dermal fillers in our office and training dentists how to do these procedures, we have gotten very involved with other esthetic physicians who have taught us how to truly inspire and motivate our patients who are looking for these treatments to go ahead with a combination of soft tissue and hard tissue esthetics. If you go into any plastic surgeon’s office, you will not see flowers on the wall!

The walls in your office tell the story of what you are trying to sell, and it is the best way to help motivate people to accept whatever services you provide. You sell health, wellness, oral hygiene prevention, esthetics, implants, laser procedures with a Powerlase AT laser (www.laresdental.com) and life changing treatment for people. The walls in your office, if they could talk, would tell some incredible stories about what you have accomplished for people over your career as a dentist. Now let your walls publicize and tell people the great treatment options we now have in dentistry to make them look good, feel good, and improve the quality of their lives.

Louis Malcmacher DDS MAGD is a practicing general dentist and an internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for Clinicians Reports, Dr. Malcmacher is a consultant to the Council on Dental Practice of the ADA.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here. To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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Chris J. Lampert, DMD
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Endodontic Questions and Answers

The following represents a sample of questions I am often asked during continuing education courses. I think they are good to share because they cover a variety of endodontic topics and they demonstrate what other clinicians are thinking. Please feel free to e-mail me your own endodontic questions at DrLampert@thedentistsnetwork.net

Question: Do you pulp test teeth with radiographic lesions associated with their apices?
Answer: Great question! The answer is: absolutely every single time. The only teeth that do not get pulp tested in my office are teeth with previous endodontic treatment and previously accessed teeth. Confirming pulpal necrosis is the only way to diagnose that the lesion is of endodontic origin. Other pathology sources and anatomical structures should be considered when a tooth has a vital pulp response and an apical lesion.

Question: What strength of sodium hypochlorite do you use and do you irrigate the chamber or into the canal?
Answer: I use full strength Clorox bleach (5.25% NaOCl) straight out of the bottle with a closed-tip side vent irrigation needle. To effectively irrigate the entire canal you must irrigate into the canal. Remember to keep the irrigation needle passive (loose) within the canal to avoid generating back pressure, which may force NaOCl out the apex and into the periapical tissues. The scented Clorox products do have a more pleasant, less “bleachy” odor but they are NOT 5.25% NaOCl. The scented Clorox product MSDS list the NaOCl strength as 3.5%.

On this same topic, 17% EDTA irrigation is also required to remove the inorganic component of the smear layer which is produced by rotary instrumentation. When the smear layer is completely removed, the NaOCL can more effectively penetrate into the dentin tubules and lateral canal spaces.

Question: What are the signs and symptoms you look for when making the diagnosis of a vertical root fracture?
Answer: Three common clinical signs of a vertical root fracture are a narrow isolated probing defect, a classic “J” shaped radiolucent lesion, and biting pain on release. A less common sign of a vertical root fracture is a sinus tract located near the gingival margin (rather than near the apex). The operating microscope is a valuable aid and often a necessity for diagnosing many vertical root fractures.

Question: When using rotary instruments, what taper do you use for shaping the apex?
Answer: The most important thing to remember about canal shape is that an under shaped (prepared) canal does not allow for adequate irrigation of the apex. It is irrigation in the apical 3 mm that ultimately cleans the canal and in large part determines success or failure of the endodontic treatment. As the old saying goes, “files shape and irrigants clean.” For most canals, an apical taper of 6% is needed for adequate irrigation (a .06 tapered rotary instrument). Apical shape or taper is also important when obturating the canal with a warm gutta-percha technique. With a warm gutta-percha technique, the apical taper allows for vertical compaction of the warm gutta-percha and prevents the gutta-percha from being pushed out the apex. Therefore, using a size 20/.04 tapered rotary file to shape the apical region is usually not enough.

Question: How much hand filing do you do before using rotary instruments?
Answer: On most canals I determine working length with hand files and an electronic apex locator. This is followed by creating a glide path with hand files to at least a size 15 hand file. On larger canals such as a palatal canal of an upper molar, a distal canal of a lower molar, or most maxillary anterior teeth, I frequently hand file to a size 30 or 35. It has become a recent trend to utilize small .02 tapered rotary files to create a glide path and reduce hand file use. Rotary file manufacturers are in the process of developing rotary instruments designed for this specific task and I believe this trend will continue.

Question: How do you manage post-operative pain for your patients?
Answer: I inform every patient that biting sensitivity and a general ache will last for 3 to 4 days and possibly up to a week following treatment. The amount of pain the patient was experiencing prior to endodontic treatment is also a good indicator of what the level of post-operative pain will be. Inflamed or infected teeth will take longer to settle down and these patients will experience a greater level of post-operative pain. Because most post-operative endodontic pain is inflammatory in origin I always recommend an anti-inflammatory such as Ibuprofen for 3 to 4 days. I routinely prescribe 600 mg Ibuprofen every 6 hours for 3 to 4 days.

Chris J. Lampert, DMD maintains a fulltime Endodontic practice in Portland, Oregon, and is involved with research, testing, and development of new endodontic products. Dr. Lampert received his DMD from Oregon Health and Sciences University and his Endodontic post-graduate degree from Boston University.
Dr. Lampert can be reached at drlampert@thedentistsnetwork.net

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