“Only do what insurance covers.”
This is a phrase I have heard uttered in the operatory more times than I can count, along with “I'm here for my free cleaning.” Well . . . there is bleeding upon probing and those 6mm pockets, not to mention the radiographic calculus present. How do we convert this “free cleaning” patient into the patient who will see the value in treatment that insurance may not cover?
Through many years of dentistry, I have learned ways to communicate the importance of oral treatment and to encourage the patient to see the same value. Using our arsenal of diagnostic tools in addition to effective communication not only establishes value, it also can help build a relationship of trust with the patient.
The impact of images
When we see a patient who is new, returning, or even one who seems to have changes in treatment needs, it all boils down to one thing—communication. Most people are visual learners. I can tell a patient that they need a crown, but showing the patient an intraoral image can have the biggest impact.
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Most people don’t want to have the large amounts of calculus, biofilm, bleeding, or a decayed hole in their mouth. The fear of fracturing a tooth to the degree it requires a root canal or extraction is often enough of a motivator to complete treatment. There are intraoral cameras that are now reasonably priced and plug into a USB port and are ready to go. Showing the patient the multiple fracture lines, decay, or the amount of calculus present will have the biggest selling point. I often will tell the patient that I am going to show them “what I see,” and the treatment plan sells itself.
Plant the seed
In my experience, a crown for a fractured tooth is much easier to show and explain to a patient than making a patient understand and accept treatment for periodontal disease. For most people affected by periodontal disease, it's often a silent disease process until it is in its advanced stages, which are often marked by mobility and pain. The adage “if it doesn’t hurt, don’t fix it” comes to mind for many patients. I have often had patients initially decline the treatment due to lack of pain or discomfort; however, the discussion plants the seed of disease progression in their minds.
As a hygiene professional, you must be comfortable planning and discussing the value of treatment, including the risks of not treating the disease. Having the ability to read the patient’s disposition and discuss the proposed treatment recommendations without being condescending or pushy is key in any treatment presentation. We are all human: when we feel attacked, we shut down and become defensive. Explaining the treatment in a friendly manner goes a long way.
Money and fear
Reasons for declining treatment can range from money to fear. Everyone has a different financial situation, and for many patients, treatment may not be a possibility in the near future. Financial discussions should be a responsibility of the office manager or treatment coordinator—the responsibility to recommend the best treatment options comes belongs to the hygienist and dentist. Communication and placing value on treatment for overall systemic health rather than just “cleaning teeth” can help the patient see the long-term, overall health benefits. Many times, once the patient sees the value and desires the recommended plan, they are willing and able to find the money to complete the needed treatment.
Fear is a driving force keeping patients out of the dental practice. The fear of pain and needles will often keep patients away for years at a time. When they finally show up and find that the recommended treatment is not fully covered by insurance, this situation may provide them with another excuse to stay away for many more years if they don’t understand the benefits of treatment. For some patients, it takes everything they have to sit in the dental chair for the first time, trusting their care to a stranger. Understanding that these patients have fear as a driving force and encouraging the patient that there are treatments to help alleviate the anxiety and discomfort associated with dental care can provide the reassurance to accept the proposed treatment. Whether it is nitrous oxide, oral sedatives, or conscious sedation, it may be enough to put the anxiety to rest.
Periodontal charting is a key tool in every element of patient care in dental hygiene. I use Voiceworks, which perio charts in a colorful and easy-to-read graph, and provides patient risk factors for periodontal disease related to systemic and oral factors. By allowing the patient to hear the probe depths through the computer and showing him or her the chart in comparison to x-rays, in addition to intraoral photos, can provide a trifecta of data to show the disease process. The benefit of Voiceworks is that it provides patient education videos in addition to the periodontal charting system. I will often play these videos as a part of my periodontal treatment planning, showing a video with graphics will aid in patient understanding of the disease process.
Talk and listen
Confidence, confidence, confidence! Knowing and discussing the oral-systemic link of periodontal disease is imperative to relaying the importance of care. When you are discussing treatment needs, sit the patient up and talk eye to eye. Talk and listen, allow your patient to ask questions, and don’t forget to ask them if they have questions about the proposed treatment. Presenting in a personable, professional, and approachable manner will gain the trust of the patient, and in turn will transition into treatment plan acceptance.
Editor's note: Originally posted in 2017 and updated regularly