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Published by Viva Concepts, 2018-01-29 22:09:34

Case Acceptance New

The Most Powerful Asset
To Increase Case Acceptance Is Summed Up In One Word
Copyright © 2017 by Gregory Hughes, Viva Concepts, LLC. All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Printed in the United States of America. First Printing, 2016

Overview of the Viva System
Every Viva course begins with an overview of the Viva System and its four business laws. The fundamental growth of any business is dependent upon application of the four business laws illustrated below.
4 Business Laws:
1) 2) 3)
Consumer Acquisition: Every business will always have to acquire new consumers to continue to expand. Why? Because existing consumers are lost every month from the company’s database.
Consumer Sales: Once a business acquires a consumer the business has to sell its service(s) or product(s).
Consumer Retention: Once the consumer has purchased something then that same consumer is entered into the company’s database for future purchases. This law is at the core of any business’ growth potential.
Consumer Experience: A positive experience with the service or product generates reviews and referrals. This is far more powerful than it appears as referrals are a source of new consumers that cost the business virtually nothing to acquire.
1) Consumer Acquisition
3) Consumer Retention
2) Consumer Sales
4) Positive Experience

The Secret to Increasing Case Acceptance Growing the Active Patient Database
Definition of Database: A list of all patients that have received services. E.g. The loss of patients from your database is damaging to the overall expansion. The key factor for any business expansion is returning consumer (retention) which is called “recall or recare” in the dental industry.
The most important aspect to improve case acceptance in any practice is through an understanding of the four business laws and how they interrelate. Specifically, when a patient enters a practice and receives his or her diagnosis, much of the diagnosed work is done at a future date due to patient limitation of finance, ceilings on their insurance, fear of doing the procedure and so on.
To fully grasp how the four business laws are interrelated let us cover some basic metrics (measurements) about the dental industry. The first metric, published by Dental IQ, the American Dental Association and Dental Economics, reveals the incomplete treatment in dental offices (sitting in the patient files) across the country to be between 60 and 65 percent.
All of a sudden the importance of consumer retention becomes extremely important.
Definition of retention: Customer retention refers to the ability of a company to retain its customers over some specified period. Patient retention is vital for long term practice growth. There are several reasons for this:
1) Retention becomes a critical factor in raising case acceptance as the work is done in subsequent visits. The important fact to remember is that CONSUMER RETENTION always increases CASE ACCEPTANCE.
2) The patients, who are in a hygiene retention program where they visit twice a year have a higher case completion due to the education and dialogue from the dental hygienist and staff.
3) The practice has already paid for the acquisition of the patient and the existing patient is always more likely to accept treatment due to improved trust with the doctor and staff.
4) Returning patients improve consumer acquisition as they begin referring family and friends

Growing the Active Patient Count
The diagram below illustrates what the four business laws accomplish. As seen by the arrows of each business law, the application of each law increases the size of the active database. Any business owner can be in control of the growth of their business by focusing on increasing the size of the active consumer database.
Definition of Active Database: The business definition for Active Database is when a returning customer pays the company a fee within a specified time period. An example, would be your mobile phone carrier, such as Verizon or T-Mobile. You pay a company (T-Mobile) a specified dollar amount within a specified time period (30 days).
For the dental industry, the Active Patient Count (also called the Active Database) is when a returning patient pays the office a fee for a service within a specified time period. The specified time period is based on the fact that patients know they should go twice a year for cleanings and an exam. For example, if your practice has a hygienist 5 days a week, he/she will see about 8 patients a day, or 40 patients per week. With 50 working weeks in a year, this means there are 2,000 hygiene visits. Divide this by 2 and the active patient base is approximately 1,000.
Consumer Acquisition Consumer Retention
Consumer Sales Positive Experience (Case Acceptance)

Case Acceptance
Begins With a Mission Statement
Why is a mission statement so crucial to a business? Let us first define the meaning of the phrase “Mission Statement” as its importance to any business is paramount to its success.
Mission Statement, Definition of:
“A written declaration of an organization’s core purpose and focus that remains unchanged over time.” Properly crafted mission statements:
(1) Serve to separate what is important from what is not
(2) Clearly state WHY the business is there...
(3) Communicate a sense of intended direction to the entire organization.
The Mission Statement
The Mission Statement is an education step for every patient and is repeated many times. The Mission Statement is posted at reception, in every operatory, the hallway and even the bathroom. It is handed to patients in printed form on practice stationery and every patient is instructed to share the mission statement with their friends and family.
At the first appointment of each new patient hygiene visit, the hygienist uses the following dialogue as a guideline as a Mission Statement for the office:
Hello my name is _________. I want to foremost thank you for landing in our offi ce. I want to begin with a bit of an orientati on on the overall purpose we have for every pati ent we service in our practi \ce.
Our practi ce is locate here in _________, and quite honestly, 90 to 95% of our pati ents live within 2 to 2 1/2 miles from our office.
That being said, if you look out into the community within that 2 1/2 miles, it is simply composed of neighborhood homes. If you go inside those homes what you’ll fi nd is simply people—people like you and people like me...and inside those homes are husbands and wives as well as children and

grandparents, some ti mes nephews, nieces, aunts and uncles....many of them live in the same community or within a close distance. Those neighborhood homes are composed of families.
The reason we bring this up is because the family is the most important component of’s why everyone goes to work, its the important thing people care about, and in fact, it is the fabric that keeps society together.
The reason this is important is because our practi ce is a family-based practice. That being said you’re probably about the age of my sister (or brother, father, mother, grandparent)... and the diagnosis and treatment you receive from our office, would be as if you were a sister, no more and no less, in other words, as if you were a family member.
For an elderly person, they would be treated as if they were a grandfather or grandmother...and it would be no different if it were a young the treatment would be the care we would give to our own children.
But there is an important goal we have for you, as well as every pati ent...and that purpose is to educate each person to level of reducing and eliminating your dentistry in the future.
We call this “A Wellness Program1.”
This purpose came about from a bit of research—which came from the derivati on of the word doctor. The word “doctor” comes from the Lati n word “docere”... which means, toteach, to know, or to teach to know. I’m the person in charge of our hygiene educati on center.
The way we achieve this goal is by scheduling your hygiene visits twice a year...and every ti me you come for a hygiene visit, we always schedule your next visit 6-months in advance.... and as we progress on this program it means no future gum disease, no extracti ons, no root canals and if anything
does occur, we’ll catch it when it’s very minor.
We have a mott o that we hope you like...and that motto is:
“Partners in your dental health.”
As a final note, if you ever have questions about any incorrect bill, an incorrect way you were treated, or a question about a dental concern for anyone in your family, or a dental emergency.... we would be privileged if you give us call so we can resolve the problem ... and our purpose for resolving it is very honestly because we plan on having you for a lifetime!
1 Wellness De nition: e concept of a practice assisting your patient to elimate future dental work through patient education and regular recall visits.

= Mission Statement Hung on the Wall
Operative #1
Operative #2
Finance Coordinator Dr. Office
Hygiene #1
Hygiene #2
Hygiene #3
Staff Lounge
Bath Room
Sterilization, Instrument Preps, Supplies

Case Acceptance System (CONSUMER SALES)

Case Acceptance: A Team Activity
Improving case acceptance is a team activity. The practices with the highest case acceptance in the nation have a skilled team with precise systems in place. The case acceptance System described in this workshop is based on years of market research and thousands of practices with the highest case acceptance in the nation.
Eliminate Just One Team Member And Case Acceptance Declines
Dental Assistant
Office Manager Finance Coordinator

The Laws of Case Acceptance
The 3 Laws of Case Acceptance
All team members should be fully educated on the 3 laws of case acceptance:
Case Acceptance Triangle
LAW: Case Acceptance is always proportional to patient’s education with use of images and
Images Finance financial arrangements.
The only way to change a patient’s behavior regarding his oral hygiene is through education.
Example: A new patient comes in for a cleaning and after doing the exam and x-rays, the doctor discovers that the patient has deep pockets and bone loss. Through education on how to properly care for the gums, the patient becomes a partner in controlling the disease. With the use of images, the patient can be shown the exact areas to focus attention on, and he is looking at his own images and x-rays, so the problem is more real to him. Then with proper assistance from the treatment coordinator, the patient can be assisted to afford the treatment needed.
The Law of Gradient Scales
LAW: Too steep a gradient of treatment planing or financing will loose the patient.
If the amount of treatment needed is overwhelming to the patient he may decide not to get any treatment done at all. So the right way to approach this would be to choose the priority issues for completion first. Likewise if the price of the treatment is more that the patient can confront he may choose to put off the treatment for later. Between the doctor and the treatment coordinator helping the patient to fit in his treatment plan to his budget will increase case acceptance.
The Law of Consequences
LAW: Always educate the patient that nearly all dental conditions untreated will worsen. You must “paint a picture” to illustrate what happens with non-treatment.
Office staff need to explain to the patient that there are major consequences to not accepting treatment and these consequences all add up to a greatly worsened condition.

The Case Acceptance System The Case Acceptance Flow Chart
The case acceptance flow chart is a PRODUCTION LINE. The concept of a production line originated in manufacturing. It is defined as: “a repetitive process in which each step necessary to complete a product passes through the same sequence of operations.”
Profiling the Patient and Patient Forms
X-Rays & Oral Photos
Mission Statement Hygiene Cleaning
Finance Coordinator Arranges Finance
Education With Images On Exact Procedures
Dr. Exam & Consult
Patient is Handed Treatment Plan & Images
Patient is Always Appointed for 1st Procedure

The Production-Line Approach to Service
The production-line approach has been incorporated into the service industry leading to greater results in many cases due to the addition of a repetitive and unalterable system. As a “system” was put in place that was repetitive and unalterable. Many examples exist in business research journals at Universities such as Harvard, Pepperdine, UCLA, Loyola, etc. Businesses that first adopted the production-line Approach to Service were organizations such as McDonald’s, Sub-Way and Starbucks. Many dental chains have employed this same approach to extraordinary results.
The Case Acceptance System
A Repetitive Process
or System of Predictable Steps that Yield a Higher Quality Product: An Increase In Case Acceptance

1. Profiling the Patient & Forms
The Importance of Your Office Forms
Profiling is the first step in assessing the consumer’s finance information. Profiling is done through filling out a form with the proper information that obtains a profile so you, as the finance coordinator, can direct the finances to close the new person. The purpose of profiling the patient is to have enough information about their finances so one can treatment plan accordingly, know how many children they have because their children and other family relatives can be referred as future patients.
Sample Profiling Questions
Please fill out the information for the questions provided below:
a) Name (first) ________________________ (last) ____________________
d) Address: City _____________________________ State ________ZIP ____________ c) How long have you lived in the area? 0-2 years 2-5 years 5+ years
d) Occupation _________________________________________________
e) Name of spouse _____________________________________________
f) Spouse’s occupation _________________________________________
g) Children:
name _____________________________________ Age _______________ Name _____________________________________Age _______________ Name _____________________________________Age _______________ Name _____________________________________Age _______________
h) Relatives who live in the area? parents? grandparents? siblings? nephew/niece(s)?
(check boxes that apply)
i) Do you have insurance? No Yes Name of carrier? __________________________ j) Is a monthly payment plan important for assisting in your treatment? No Yes
Our office provides patient funding for services in an effort to assist families to obtain needed treatment. Our financial coordinator is there to assist patients and their families to accommodate your financial needs.
Please let us know how we can best service and assist you and your family!

2. X-Rays & Oral Photographs
The Patient’s Own Images
Images: Use pictures, drawings and images to educate the patient. The best images are DIGITAL photos of the patient’s upper arch, lower arch, and a straight on shot with cheek retractors. This step precipitates “co-diagnosis” from the patient and causes them to be engaged. Images of the patient’s mouth are without question the single largest educational step that facilitates an increase in case acceptance.
The Proper Set Up—Large Monitors the Patient Can Touch
A large monitor within reach of the patient precipitates involvement and co-diagnosis with the patient.

Sample Monitors in Operatories
The Oral Images and X-Rays are always done at Step 3. Each step is an unalterable procedure. Upon entry into the operatory, the doctor now has a full profile , x-rays, a monitor set up and oral images. The doctor, assistant, hygienist and finance coordinator are now prepared for far better case acceptance.
Sample Operatory Monitors
Below illustrates the simplicity of the equipment needed to take intra-oral photographs. If you do not have an
Optical Stabilizing Lens, it is suggested to purchase one as with new technology, it eliminates “blurred” images and “re-takes.”
Digital SLR Camera
Macro Lens
Sample Operatory Monitors
Macro Flash

3. The Mission Statement
The retention of patients begins with the Mission Statement of the office. The most important factor in achieving the strategy for a residual-based practice is to drive home a strong mission statement. Your mission statement is the focal point of all activities in the office... as this is the goal being achieved.
The mission statement is an education step for every patient and is repeated many times. The mission statement is posted in reception, every operatory, the hygiene operatories, the hallway and even the bathroom. It is handed to patients in printed form on your stationery with the end result of every patient wanting to share their positive experience with family and friends.
Our Commitment To New Patients & Their Family
Our office is here to service you and your family members with excellent service and to answer any questions you may have concerning your dental health!
Our doctor has oriented our entire staff to educate every patient on how to achieve excellent oral hygiene. Our wish for every patient is to achieve the goal of never needing dental work in the future.
The purpose of my office and staff comes from the derivation of the word “doctor.” It comes from Latin: “teacher,” from docere which means “to show, teach, cause to know.”
The most important aspect of achieving optimal dental health is availing yourself of cleanings and periodontal evaluation with the hygienist twice a year. We always schedule your next cleaning visit upon completion of each cleaning, which puts in an excellent program to assist you in achieving the best possible result.
Our final goal for every patient is to achieve optimum oral hygiene with an excellent relationship to eliminate future dental problems.
If you have immediate dental work that is needed, we make every effort to assist you in completing your work and once complete, to service you in our hygiene center to prevent future dental work and maintenance of a healthy mouth! We have a motto we hope you will like:
“Partners in Your Dental Health”
We are completely approachable on any questions of concern you may have. Always feel free to ask about anything: something you don’t understand, finance or insurance questions, or the smallest thing about your smile or any procedure that is being performed.
Our Warmest Regards,
Doctor & Staff
*Note: See full Mission Statement on Page 6 & 7.

4. The Exam & Consultation
Using The Laws of Case Acceptance
The exam and consultation is a team activity. This is where the LAWS OF CASE ACCEPTANCE are put to use. The following pages illustrate the use of the 3 fundamental laws of achieving superlative case acceptance.
The Case Acceptance Triangle EDUCATION
LAW: Case Acceptance is always proportional to patient education.

5. Education & Images
The Case Acceptance Triangle is inter-connected. Education comes about through dialogue but primarily through use of IMAGES and DIAGRAMS. These two corners of the triangle go “hand-in-glove” and well executed, will readily yield far higher case acceptance.
Images & Diagrams Create an Emotional Response
A picture says 1,000 words. You can never “show this” with dialogue.
Conversion after seeing silver fillings to cerec inlays or composite.

(5. Education & images Continued)
Use the patient’s own images to explain to the treatment plan and why they should do the treatment now. The patient can walk in to your practice without pain and have a mouth that looks like below image. If you don’t show them what is really going on inside their mouth, you would have a hard time getting them to accept treatment, especially with new patients, as they don’t have a trust built with you.
Oral Images Graphically Illustrate The Patient’s Problem
Patients Can Be Shown Perio Situations Impossible To Describe With Dialogue

(5. Education & images Continued)
For example, in the x-ray below, you can see that the patient has 6 cavities. This patient came in to the office as a new patient to get a new patient cleaning. However after taking the x-rays the office realized that the patient has
6 cavities. One can make an error and tell the patient that they have 6 cavities, its going to cost $2,000 and if they don’t take care of it they will need a root canal. A new patient then would think you are trying to “sell” her treatment and would leave without accepting treatment. They might even write you a bad review.
However, another approach would be to educate the patient on how to read her own x-rays. The assistant can show them the difference from healthy teeth and the ones with cavities and then have the patient find the rest herself. By doing so one is co-diagnosing with the patient and the patient can see the problem herself. Then getting the patient to accept treatment will be easy.
A Patient Shown Cavities Never Goes For A Second Opinion
Again, A Picture Of Impacted Wisdom Teeth Is Worth A Thousands Words

6. Finance Coordinator Arranges Finance
The Finance Coordinator and/or Office Manager finalizes the cost with use of patient funding services (Care Creditor Lending Club) and sees that the patient is scheduled for their first procedure (if they do not begin the same day).
Using Case Acceptance Laws to Gain Acceptance
The Case Acceptance Triangle:
Case Acceptance is Always Proportional To Patient Education.
The Law of Gradient Scale:
Too Steep a Gradient Loses the Patient.
The Law of Consequences:
Always Educate the Patient that Nearly All Dental Conditions not Treated will Worsen.
The Law of Case Acceptance Triangle EDUCATION
LAW: Case Acceptance is always proportional to patient education.
The Law of Gradient Scale
LAW: Too steep a gradient loses the patient.
The Law of Consequences
LAW: Always educate the patient that nearly all dental conditions not treated will worsen. You must “paint a picture” to illustrate what happens.

“Finance” Belongs to the Finance Coordinator
The “Finance” part of the Triangle belongs to the Finance Coordinator/Office Manager, as the skill to achieve high case acceptance is learned through experience and constitutes a key factor in overall growth. It is important to have different types of financing available for the patient just in case they don’t get accepted for one. For example, if your patient did not get accepted for Care Credit, you can apply for Lending Club. It it ideal to have more than one financing available so the financial coordinator can use multiple sources to help the patient pay for the treatment.

(6. Finance Coordinator Arranges Finance)
Using Case Acceptance Laws
It requires skill to assess each patient for the finance and dental work needed. The Law of Gradient Scale is assessing “how much” and “when” in terms of the patient’s ability to pay.
Too much cost and/or too many procedures often causes the patient to “fall” off or cancel their appointment. The canceled appointments are extremely frustrating as the doctor is left with “down time.” A common solution is to have “Stage 1 Treatment” and “Stage 2 Treatment,” when the amount of dental work is overwhelming and/or if the cost is overwhelming. Too steep a gradient unrecognized by a finance coordinator will lose the patient.
When a patient cancels or “goes for a 2nd opinion,” the gradient was too steep!
The Law of Gradient Scale
LAW: Too steep a gradient loses the patient.

(6. Finance Coordinator Arranges Finance)
This Law is KEY for the Finance Coordinator. Used correctly with experience and the other Case Acceptance Laws, your case acceptance should easily increase. It requires OBSERVATION of people and knowing them.
The Law of Consequences
LAW: Always educate the patient that nearly all dental conditions not treated will worsen. You must “paint a picture” to illustrate what happens.
The Law of Consequences is vital for use by the entire TEAM. Often the patient is educated about the various dental procedures, but most people do not know the consequences of non-treatment, both financially or the worsening of the condition the patient currently has.
Always spend sufficient time to gain understanding from the patient that their dental situation almost ALWAYS WORSENS. Paint a picture, use diagrams and financial cost so they are well informed if they do not proceed. Example, if the cavity is not fixed the consequence is a root canal and crown or an extraction. If a patient needs a crown, the consequences of not doing the procedure may result in
a fractured tooth and root canal which doubles the cost, not to mention there is also the potential of
losing the tooth.

The Law of Emotion
Defintion of Law of Emotion: All positive experiences are brough about through an emotional connection.
The Law of Emotion is what creates a Positive Experience (the 4th Business Law). This law is brought about through a commitment of care through education of the patient. All such education and time spent to give understanding is the highest method of creating a positive experience. Obtaining new patients, case acceptance, patient retention and loyalty are greatly enhanced by the doctor and staffs, attitude and emotional connection to each and every patient. In other words, treating him or her as if they were a member of your own family!
The Patient Profile is ued to assist the staff and doctor to “spark up” a conversation with the patient. For example, if the patient has 2 kids and you have 2 kids you can talk about your experience and build emotional attachment.
Building emotional attachment is key to higher case acceptance.
The umbrella that exists over all aspects of any case acceptance is emotions. Emotions are the SINGLE largest reason people buy!

Case Acceptance: By Gordon Christensen, DDS
As I travel around the country providing continuing education for the dental profession, I see significant pessimism on the part of many dentists about their ability to influence patients to accept treatment plans that are beyond the most urgent or painful level of need. I contend that you and I can do better in our presentation of treatment plans and, thus, better serve our patients. I do not see patient education being accomplished thoroughly in many of the dental practices I visit.
This article includes suggestions for increasing patients acceptance of treatment plans and for changes in practitioners behavior in presenting treatment plans. Such change has the potential to better aid patients in understanding the desirability of treatment plans and in accepting the most appropriate oral care.
How is the “Best” Treatment Plan Defined?
Most mature dentists know the best treatment plans for routinely occurring dental needs, except in the most difficult and extreme cases. Dentists recognition of the best treatment plan is not the issue in terms of treatment plan acceptance; in my opinion, the most significant problem for dentists lies in making needed oral care seem important enough to patients that they will use their discretionary money to obtain it. We must realize that much of dental care competes with sometimes more attractive consumer products. This is especially true if the dental treatment is not mandatory. However, some oral treatment is mandatory, including therapy for oral cancer, fractured bones or teeth,infected painful teeth and various tumors. Most patients accept treatment of these conditions as necessary and accept it in spite of financial limitations. The best treatment plan often is not the most expensive plan. I suggest that when providing alternative treatment plans to patients, the dentist explain all logical plans thoroughly.
After the patient has had the opportunity to hear all of the options, the dentist should offer his or her opinion about the treatment he or she would choose if he or she had the same condition as the patient and could afford the treatment. Assuming the patient trusts the dentist and the dentist is an experienced practitioner, information about the treatment that the dentist would choose to undergo himself or herself is significant educational input for uninformed patients. How can we educate patients to make the best and most appropriate decisions about treatment plans? It is my strong belief that only by means of adequate education do patients come to accept oral treatment plans.
27 39

Collecting the Diagnostic Data
The first important requirement in educating patients is to help them learn about and understand their oral condition. This requires significant clinical time and comprehensive diagnostic data collection and therefore, I believe, is best and most economically accomplished by a qualified, experienced, trained and educated staff member.
The importance of delegation. Many dentists feel that they themselves must complete the entirety of a diagnostic appointment, including all of the diagnostic data collection. Often, this is not financially feasible
in a busy multioperatory practice. Assuming the dentist has met the patient and observed the patients oral condition, he or she can delegate many of the diagnostic data collection tasks before making the overall diagnosis and creating the treatment plan. I have long suggested, taught and practiced having dental staff be heavily involved with the diagnostic appointment. Competent trained and educated dental hygienists or dental assistants are well able to collect diagnostic data and perform patient education. Thereby, this procedure becomes less difficult and time consuming for the dentist.
On the patients first visit to the practice, the dentist should briefly introduce himself or herself to the patient and explain that a staff member will collect as much information as possible about the patient and educate him or her about the potential treatment alternatives. The patient should be informed that the dentist will return at the end of the data collection period for further discussion. With needed help from the staff member in charge, the patient fills out informational forms. This requires up to 10 minutes. Most experienced staff members
can accomplish adequate data collection and educate a typical patient in about 50 minutes. An additional 20 minutes or so are required for the dentist and staff member to accomplish the preparation and presentation of the treatment plan. The majority of this 20 minutes is staff time only. Data collection tasks delegated to or supervised by the staff member. These tasks involve data gathering only.
They should not be considered as diagnosis and treatment planning, which in most geographic areas are illegal for staff members to carry out. Additionally, some of the following specific data collection tasks may not be legal in your geographic area (please check your state dental laws if you have questions):
• •
completing routine patient information forms with data such as health history and personal data, which should be simple, fast and self explanatory;
obtaining panoramic images, which are prescribed for most patients, depending on the patients condition; tomographic or cone-beam computed tomographic (CT) radio graphs may be desirable for some situations (cone-beam CT radio-graphs rapidly are becoming the norm in some states for some conditions, and I predict that this trend will continue, but the cost of such radio-graphs often is prohibitive for many patients);

• obtaining bite wing radio-graphs, which usually are desirable for interpretation of initial inter proximal caries; the newer forms of extra-oral bite wing radio-graphs are now my favorite, because of their ease of use and increased patient comfort have made available extra-oral bite wing radio-graphs that greatly reduce patient discomfort and enhance patient education; other companies soon will have such software, and it appears that dentistry has moved completely to the extra-oral concept);- obtaining periapical radio-graphs, which are not always
Perspective Observations
The first important requirement in educating patients is to help them learn about and understand their oral condition. Needed, especially for patients with only a few remaining teeth;
• obtaining alginate impressions and stone casts poured in fast five-minute-setting stone;
• charting periodontal pocket depth (in which all periodontal pockets of a depth of 3 millimeters or more should be identified) and recording of all other periodontal defects;- recording blood pressure, pulse and pain level;
• charting previous restorations and endodontic therapy; - charting obvious carious lesions;
• conducting vitalometer testing of suspect teeth;- charting soft-tissue lesions;- notating apparent occlusal disease conditions, including primary and secondary occlusal trauma, bruxism, clenching, and temporomandibular joint dysfunction;
• charting missing teeth;- charting any other oral pathosis.
Patient Education
The patient education portion of the diagnostic appointment is critical for optimum acceptance of treatment plans. Education sessions are necessary to educate dental staff members to the level at which they are competent in educating patients about all areas of dentistry. At the dentist’s request, staff members can conduct patient education about the potential alternative types of treatment needed. This education is intended to provide pretreatment planning information for the patient. The following modes of education are suggested:
• Show educational video programs to the patient while the casts are being poured and are setting. Commercial programs for this purpose are readily available from numerous sources.
• Using a monitor, show and explain the digital radio-graphs to the patient. If the radio-graphs are analog, display

them to the patient on a lighted view box.
• Use the diagnostic casts to show specific aspects of the patients oral condition.
• Use an intra-oral camera to display all aspects of the patients oral cavity.
• If appropriate, show anonymous digital images of completed treatment accomplished on other patients.
• Use other helpful educational tools, such as consumer-oriented dental education books, models showing dental disease and treatment potentials, and educational pamphlets.
• For treatment relatively unknown to the patient, such as dental implants, veneers or periodontal surgery,
an informative and successful educational technique is to have the patient speak on the telephone with another patient who has undergone similar treatment. Obviously, it is necessary to prearrange the call with the patient who has completed treatment. After collecting all of the necessary diagnostic data and educating the patient, the staff member should meet with the dentist in a private location for a brief overview of the patients needs for and interest in treatment.
During these few minutes, the staff member informs the dentist about the patients expressed interest in treatment, apparent preferences for treatment, potential for payment by means of benefit plan, time availability, desire for patchwork or complete treatment, and any other information that will help the dentist when preparing alternative treatment plans. The dentist then goes into the treatment planning room (I prefer an operatory) to confirm and review all the data the staff member has collected and to develop brief descriptive treatment plans for all of the logical treatment alternatives. The dentist answers the patients questions and further educates the patient. After this is completed, the dentist stays with the patient for a few minutes to communicate the details of the most desired plan and to provide a rough estimate of the treatment cost. If the cost is too high for the patient, the dentist should discuss other segmented or different treatment plans. It is my conclusion, after accomplishing this data collection/education appointment concept for many years, that most patients accept at least a part of the proposed treatment plan. This eventually leads to additional treatment, and in many situations, to completion of the entire plan.
The aim is to have the patient accept the most appropriate plan, to be accomplished either in one concerted period or in a planned sequential number of appointments across a longer period. Sequential treatment plans spread over several years often are the result of the complete data collection, patient education, and diagnostic and treatment planning appointment method I have described. Sequential treatment allows patients to receive the cumulative maximum annual amount from their third-party benefit plans and to accumulate personal
funds to complete the treatment during a reasonable period. It has been my experience that after receiving this thorough education about their oral health care needs or wants and being presented with moderate and justified

fees, few people refuse treatment. Assuming the patient desires the treatment and commits to it, the treatment coordinator (who usually is the business staff member) finalizes the appointments and fees schedules the patient to begin treatment.
The global recession has brought a significant reduction in the number of patients seeking dental treatment. Dentists have reported anecdotally that many patients are not accepting treatment plans in spite of needing or wanting the treatment and being able to afford it. With proper education, patients who can afford treatment can be motivated to accept it. Education generally is necessary to stimulate behavior change, which in the context of this article is acceptance of treatment plans. Avoiding patient education leads only to patients requests for minimal, urgent treatment.
In-depth patient education usually leads to acceptance of at least a portion of the proposed treatment plan. It is suggested that dentists and their staff members plan and carry out diagnostic data collection together; that dentists present honest, thorough treatment plans or, if necessary, develop sequential treatment plans; and importantly, that dentists charge moderate, reasonable fees that they would pay themselves for the suggested treatment. Such activities will increase treatment plan acceptance, motivate new patients to stay in practices, and help ensure a practice’s financial viability and success.
Dr. Christensen is the director, Practical Clinical Courses, and a co-founder and senior consultant, CR Foundation, Provo, Utah. He also is an adjunct professor, Brigham Young University, Provo; and an adjunct professor, University of Utah Salt Lake City. He is a diplomat of the American Board of Prosthodontics.
Address reprint requests to Dr. Christensen at:
CR Foundation, 3707 N. Canyon Road, Suite 3D, Provo, Utah 84604.
The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the American Dental Association.
1. Christensen GJ. Restorative dentistry for times of economic distress. JADA 2009; 140(2):239-242.
2. U.S. Department of Labor, Bureau of Labor Statistics. Labor force statistics from the Current Population Survey. www.bls. gov/cps/. Accessed Jan. 12, 2011.
76 JADA, Vol. 4 / Issue 1 / March 2011

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