By Vincent Meng, DDSMaintaining a successful dental practice requires that both general dentists and specialists stay current on the latest technologies and treatment options. As the landscape of treatment options continues to expand and dental implants become more and more commonplace, patient education and expectation setting becomes more complicated. The Internet has raised awareness of treatment options and possibilities, but in some instances has created false expectations about treatment options and outcomes. As a result, it is important that the general dentist and his/her office staff provide accurate and timely information to their patients about a myriad of issues surrounding dental implant procedures.Education must happen on two fronts. First, it is important for the practitioner to make sure that the patient understands the benefits of a dental implant vs. a traditional crown and bridge restoration, in terms of quality, cost, and durability. The practitioner must also ensure that the patient understands how the implant process will unfold. How many appointments will be needed? How many specialists will be involved? It is also important to find out if the patient has concerns about dental insurance coverage and has a clear understanding of the out-of-pocket costs that will be incurred. Second, hygienists, administrative staff, and implant coordinators may all field questions from patients. Properly educating your staff to answer these questions and know when to refer a patient back to you is an important part of streamlining the implant process. As always, offering treatment in the patient’s best interests is everyone’s professional responsibility.In this article, I provide advice based on more than 15 years of building an implant practice, outlining some best practices for educating these two important groups, for improved patient satisfaction. Educating the patientEvery patient experience starts with a comprehensive examination, but once the examination is complete, it is important that the practitioner begin discussing the risks and benefits of the applicable treatment options. In my office we use photos, examples, and cost analysis to educate patients about their options. It is also important to set realistic expectations about treatment options and outcomes while guiding patients to make informed treatment decisions about their oral health. As we know, in some instances the dental implant option can be twice the cost of a conventional bridge, depending on the surgical requirements. This can be an obstacle for both the dentist and the patient, therefore it is important to explain the cost differences clearly in terms of the risks and benefits of each procedure. In an instance in which an implant is the most appropriate treatment, I outline why that option will lead to the best outcome from a clinical and an esthetic standpoint. When this value is thoroughly explained, patient acceptance of the treatment is usually higher than when it is not.For example, if a patient is losing a central incisor with very healthy adjacent teeth, treatment choices include: no treatment, a transitional appliance like a flipper, a bonded retainer, a fixed bridge, or a dental implant. During the consultation, I will explain that a conventional bridge in a young individual may require replacement at least twice during the patient’s lifetime and could result in significantly more complex and costly treatment should it fail. I will also explain the advantages and disadvantages of the other options. I typically explain to my patients that an implant is the treatment of choice if they do not need restorations on adjacent teeth. While an implant requires routine daily care, a bridge requires more meticulous daily cleaning maintenance. A bridge, however, can still be the treatment of choice if there will be structural benefits to adjacent teeth and if the occlusal changes help solve multiple problems. A bonded retainer can be a treatment option if insufficient space exists for an implant. However, these can de-bond from undue force or bruxism, which increases the potential for increased long-term maintenance. The bonded retainer materials can now be made out of reasonably esthetic material and may qualify as a permanent option but are best for short-term solutions in younger individuals who are still growing.The last option I will discuss, if appropriate, is a flipper, a removable plastic, which is designed more for esthetics but is a nuisance for food entrapment. Flippers are difficult to use in deep bite cases, but if properly made are reasonable replacements to act as both a post-orthodontic retainer and tooth replacement until growth and development is complete for implant therapy. I would rather a person wear a flipper long term than follow the path of a compromised option and will clearly explain this.Educating your staffThe hardest questions are often asked when the doctor leaves the treatment room. Whether they realize it or not, hygienists and administrative staff can influence a patient’s treatment decision. The more that staff members are educated about this process, the better able they are to reinforce the value of any particular treatment plan that the dentist has outlined. A well-educated staff member can clearly explain treatment options and provide the patient with a recommendation that is consistent with the practice’s standard of care.So, how do we all get on the same page? In my office, we hold regular staff meetings and periodically involve the staff in the study club group I belong to that focuses on treatment issues. My staff is now better able to understand implant procedures and possible complications. They can exchange ideas with other staff members about various office situations and, in particular, insurance issues. There may also be times when it is not appropriate or advisable for a staff member to be discussing treatment choices with a patient, so staff should likewise be educated on the signs of when a doctor’s input is necessary. When your staff is educated on the costs and considerations involved in implant treatment, they can work with you to make the process more manageable for patients in terms of time and cost. One important way to help patients understand and receive the best care available is to provide a treatment plan that is phased over a longer period of time, so that they are able to pay for the treatment as it happens. We have always developed ideal treatment plans and then tried to find ways for patients to achieve appropriate care with phased treatment. Even patients with complex reconstructive needs can transition treatment over many years without compromising the end result. In addition, many of these cases end up being the most rewarding, since the patient who has persevered through this process has an even greater appreciation for the result and the care they have received. Committing to an investment of time and effort to educate both your staff and your patients pays big dividends that are rewarding to both the practitioner and the patient.
Vincent Meng, DDS, is a native of Illinois and has maintained a general dentistry practice in Missoula, Mont., for 30 years. He graduated from the University of Illinois, College of Dentistry, in 1977 and completed a residency program in general dentistry at Illinois Research Hospital in Chicago. Dr. Meng started his private practice in Missoula in 1979. He dedicates extensive time to continuing education with much emphasis on esthetic dentistry and utilization of dental implants.