Letting the comprehensive dental exam work for you
A five-minute comprehensive dental exam just doesn't cut it—not for the patient, not for the practice. What message does such a short exam send to the patient? This article discusses why you should reconsider the common procedures for the comprehensive exam, as well as the roles of both dental hygienists and dentists.
THE ATTENTION THE DENTAL HYGIENIST AND DENTIST give a new patient determines his or her longevity with your office. Understanding the intricacies that will allow you to establish a truly rewarding and successful relationship is essential. The care given to your new patients should be transformed from good to great, from inefficient to productive, and from limiting to valuable.
Consider this scenario. The dentist has just been introduced to Mrs. Smith as the first hygiene exam of the day. The dental hygienist informs the dentist that this is Mrs. Smith’s first visit to the office and she’s here for her comprehensive dental exam. Mrs. Smith’s last appointment was about seven months ago at a previous office, but her dentist has now retired, and she’s in search of a new dental home. She has good oral health overall, and after the five-minute exam, the dentist has treatment planned a prophy and a couple two-surface restorations. The dentist welcomes her to the practice and tells her that she’ll see her again soon for her fillings.
Upon walking to your next appointment, the dentist can’t help but think to herself that Mrs. Smith’s smile would improve dramatically if Nos. 8 and 9 weren’t so overlapped. Meanwhile, Mrs. Smith is sitting in the chair thinking that she wished her smile was as attractive as the hygienist’s next to her. Mrs. Smith’s previous dentist didn’t address her crowding, and neither did this one. She’s left knowing that she does a great job with her home care and thinks that because the crowding wasn’t addressed when she was a child, that there really isn’t anything that can be done now. If it was something that could be fixed, wouldn’t one of her dentists have mentioned it? She’s left feeling dissatisfied because she didn’t want to be that bothersome patient who asks too many questions, and the dentist seemed to be busy today with patients who had bigger problems than she did. Sadly, there is a breakdown of communication in this exchange, leading the patient to want more information, and setting the dentist up for the potential pitfall of nondisclosure of information.
As the dentist or hygienist in this situation, would you be afraid that you would lose credibility by sounding like a salesperson? Maybe you didn’t want to offend Mrs. Smith by using improper verbiage? Or it could be you assumed that Mrs. Smith had been this way for 20 years and didn’t want to fix it, or just couldn’t afford the treatment? All these reasons are understandable but nevertheless not acceptable. Most of these obstacles can be eliminated by communicating each step of the comprehensive dental exam to the patient—in other words: why you’re doing what you’re doing.
The word comprehensive means “all-inclusive”—this indicates that you, the provider, must evaluate all factors thoroughly. The dentist coming into the operatory, sitting down, and hurrying through the comprehensive dental exam, riddling off a list of to-dos will only leave the new patient feeling rushed and with limited understanding of the reasoning for the treatment plan. Patients typically will not accept dental treatment if they don’t think they have a problem. So, let’s change the “old way” of doing exams into a more successful, patient-oriented approach.
The process begins with proper communication from the front desk team when the patient makes their appointment. Mrs. Smith should be aware that her first appointment is ultimately designed to gather information and to discuss her concerns, and that it is not for a “cleaning.” Instead, it will be an experience centered entirely around her needs.
Keep in mind that the dental hygienist plays a key role in the process of delivering the treatment plan. The ability to show empathy with the patient while also gathering detailed information for the dentist is crucial. This allows for a smooth transition and it will reinforce the “we care about you” feeling, all the way from the moment Mrs. Smith books her appointment, to the moment she leaves the office. Hygienists have significant influence over case acceptance and have a responsibility to the standard of care delivered in practice. The following are key elements that make up a successful comprehensive dental exam:
Explaining to Mrs. Smith that today’s appointment may be more detailed than what she’s accustomed to and why. The front desk staff is the first line of communication. Relaying this information to Mrs. Jones when the appointment is made saves time and confusion:
- A thorough investigation of medical and dental history, and an intra-oral and extra-oral soft tissue exam. Many patients will thank you if they’re aware of what you’re doing.
- Periodontal charting. Accurate periodontal status cannot be obtained by pocket depths alone. Recession, mobility, furcations, and bleeding points must all be documented. This leads to increased patient acceptance of SRP and periodontal maintenance therapy.
- Exam of edentulous areas for future implants.
- Cosmetic exam. Mrs. Smith, is there anything about your smile you’re not happy with?
- Orthodontic/occlusal exam.
- Intra-oral photographs for accurate patient records and higher case acceptance.
This is a lot of information the dental team to obtain. A five-minute comprehensive exam followed by a prophy puts the patient and the practice at a clear disadvantage.
By performing an “all-inclusive” comprehensive exam, you’re establishing not only a long-term patient-provider relationship, but you’re creating future income for the practice. Your new patients will be impressed with the care and attentiveness you’ve given them. Giving the patient time to process recommendations sets the stage for future elective and multitooth treatment. You’re empowering your patients with information to make a decision as to what is important to them without sacrificing the importance of any immediate or need-based treatment. Taking a little more time and letting the comprehensive dental exam work for you will establish a trusting, patient-centered dental experience that will benefit your practice for the duration of your career.
Barbara Frost, RDH, BS, has over 13 years of experience in dental hygiene, in addition to an extensive business background. She currently excels in motivating hygiene departments and increasing overall practice revenue by maintaining a patient-oriented approach. Barbara is nearing completion of a dual degree for a master of Public Health and a master of Business Administration. She can be reached at firstname.lastname@example.org.
Editor's note: This article first appeared in RDH eVillage. Click here to subscribe.