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Are you talking with patients or to patients?

May 12, 2022
Listening skills and mutual respect go a long way toward case acceptance. Shelly VanEpps explains.

“You have an abscessed tooth that will need a root canal and then a crown.”


“I know you want to save this tooth, and you are in a lot of pain. In order to treat the infection, first we need to treat the root. Once that is taken care of and you are out of pain, I can cover the tooth up to ensure the tooth is stable and functional long-term. How does that sound?”

Do you see the difference? To you as a provider, I’m sure it is subtle, but to a patient, it is astronomical. It’s the difference between confusing them and including them. It is the difference between declaring what they need and knowing what they want. And most of the time, it’s the difference between scaring them away or caring for their individual dental health. The bottom line: it’s the difference between case rejection and case acceptance.

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As dental professionals we get so excited about all the cool information we have learned, and can easily get caught up in our own dentalese. For the hygienists, it’s the prophy, gingival pockets, or the scaling and root planing needed to treat periodontal disease. For the doctors, it could be the posterior second molar that has a breaking down amalgam and a fracture at the mesial. The administrative and assisting teams have their own fun lingo. I think you see where this is going.

My point is, absolutely no patient wants to be scaled, probed, or drilled. The only things on the patient’s mind when you say crown, infection, root canal, etc. are the pain and cost associated. You may be thinking “Well then, what are we supposed to do? We have to tell them what they need!”

You are absolutely correct. It is our duty as dental health professionals to let them know about any and all conditions present. It is then the patient’s decision as to whether they want to treat those conditions, and the best way to turn those “shoulds” into “wills” is to talk with them before performing your exam. Identify their desires and objections. By having a genuine, gentle discussion about their goals and concerns for their oral health prior to identifying the conditions present, you are setting the stage for your case presentation. 

For example, if you hear your patient express that she doesn’t want dentures because she saw her mom struggle with hers for years, then you identify that there is perio present, you are able to set your patient up to have a conversation similar to this:

Dental pro: “Mary, when we were talking earlier, you mentioned your mom and how she struggled with her dentures.” 

Patient: “Yes. It was horrible.”

Dental pro: “I also asked permission to share with you if I identify any areas of concern, and you said that you want to know everything I see.” 

Patient: “Yes, I do want to know, but now I’m scared.”

Dental pro: “There is some bad news, but I also have good news. The bad news is that there is gum disease present, which left untreated could put you in a position similar to your mom. The good news is, if you want, we can help you to avoid getting to that point. How do you feel about that? Do you want to discuss your options?”

Patient: “Yes! What can we do?”

The truth is, you can’t give away something that people don’t want, but they will find a way to pay for something they do want. If you are not taking the time to talk with your patients, your case acceptance will always be hit and miss. Listen to the objections you receive when patients choose not to proceed; are they legitimate? Again, most people will find a way to afford what they want, and people don’t like to be told that they need or have to do something!

We need to remember, people all over the world live without teeth. What we provide in dentistry is a choice that each patient is responsible to make (or not make) regarding their own quality of life. Offering them the opportunity to be heard and providing options based on what they communicate is the best treatment we can possibly provide. Respecting and honoring those decisions is how we can go above and beyond their expectations and to see our case acceptance rates rise as well.