Team Meeting: Chronic Periodontitis Treatment Approach

Respect Permission Responsibility Recently I had the opportunity to speak to a dental team of nine people in their office at a lunch hour. Around the table sat the dentist/owner, a new dental associate, a dental hygienist, front office personnel and dental assistants. The dentist/owner wanted to know my opinion about treating periodontal disease and I am sure anticipated that I would talk about the disease. I did in a sense, but not in the normal way. Instead I wanted the team to see the problem as one involving all of them, not just a few, and that the best treatment for patients is a team effort requiring a great deal of cooperation and communication among all the team members. Years ago I remember my brother telling me about a neuroanatomy lecture he attended in his freshman year of medical school. In the hour allotted, the professor went through the material three times. His purpose in doing so was to help the students learn the most important material in the lecture through repetition. As he went back through it each time, he elaborated a little more in order to drive home some useful details that would help lock in the underlying information. That was the pattern I decided to use for this talk, so I put it in three rounds, like a prize fight. I explained to them, as they were eating, that this is what I was going to do and that they would hear the most important ideas I had to tell them three times. At the end of the presentation I provided them with a copy...

How to Succeed in Periodontal Therapy Part 5

Frankly, I have no illusion that I can single handedly change the quality and nature of periodontal therapy in every dental office in the world – at least not over night. There will come a day when dentists and dental hygienists train patients in ways very similar to how they perform clinical procedures today, because that is how they will be trained themselves. Even communication within dentistry is a trainable procedure. In time, the importance of effective communication within periodontal therapy will grow to the point where it will no longer be considered an esoteric topic. Instead it will be taught as a learned communication skill requiring memorization, rehearsals and performance. Critical conversations will be planned out behind the scenes and standardized into templates similar to composing musical compositions – and every member of the office team will learn how to read the music and perform their important role in patient support. Eventually more dentists will begin to grasp the overarching protection provided by proactively training patients and their teams. Informed consent will simply be subtly built into the everyday conversations office personnel have with patients because it has simply become a part of the story and culture of the office. When this happens friction between patients and dental offices will dramatically decline. Dental teams (not just a handful of dental hygienists) will no longer simply accept that patients never will floss or that they always do. Instead they will actually and automatically show them how to do it effectively and work with them when they have difficulty getting the hang of it. And patients will change their attitudes...

The Therapeutic Importance of Hope

Hope propels therapy forward. Despair stops it cold. Dentists rob patients of hope when they want to project an inflated level of certainty. When dentists “know” ahead of time how everything is going to turn out, whether good or bad, the candle of hope is snuffed out. Yes, even assuring patients that everything will be OK can be unkind. Should things not turn out as we had promised, our poor patients are then suddenly whiplashed into disappointments they were promised by our certainty would not occur. Here is a simple example. Never promise, or let anyone on your team promise, that something you will do won’t hurt. It might. And how do you know what “hurt” means to the other person? Instead, we can always promise to do our best and to be sensitive to how they are responding to what we are doing. Here’s an interesting thought. Our patients’ hopes are tied to our humility. In other words, to give them hope, we must admit we do not know everything and not everything we do works the way we want it to. This is not a slight on competence. It is simply acknowledging a fact of life. By being uncertain as to outcomes, we too express hope and become fellow travelers with our patients. Furthermore, unless we give patients the gift of uncertainty upfront, we cannot really celebrate with them in the end when everything works out just fine. May all our patients beat the odds, and may we not throw cold water on anyone’s desire to go for the Hail Mary pass. And should things not work...

Two Competing Business Models in Dentistry

I had an interesting experience yesterday. A former patient from years ago came to see me. As sometimes happens she did not stay the course and slipped on making sure she was seeing dentists regularly. Now over five years later she returns with one of her upper central incisors slowly avulsing. She knows it needs to come out. She has known this for some time now. But finally she has the courage to come back and see me. She came with a referral slip from a dental clinic nearby. I was in this facility earlier this month. It is owned by someone in another state and according to “the rules” I was not able to go back to the treatment area, which means that the dentists who work there are blocked from consultations with their patients and outside specialists chairside. Interesting… OK, fine. Now back to this particular patient. Her primary concern would be what? To make sure that when she loses the tooth, which will likely come out in the impression, that there is a replacement right away. There are two options to accomplish this. First the extracted tooth or an artificial tooth can be bonded back in. Secondly, a treatment partial can be fabricated within a day and delivered to the patient. I went back to this office and explained the issue, actually giving them the opportunity to make money today. According to “the rules,” however, they can only work with a particular lab out of state and the turn-around time is two weeks. The patient is horrified with this prospect. So I will take care of...

How to Succeed in Periodontal Therapy Part 4

Where Are We? It should be obvious by now that this presentation is not a “best practices” consensus on the subject of periodontal therapy. Rather it is my personal, but experienced advice on what I consider the best way for dentists to treat and manage chronic periodontitis. I also believe that reading and implementing some or all of my recommendations here will help your practice grow. The purpose of these blog posts, which will eventually be consolidated into a manual and used in training seminars on line or in person, is to explain in a comprehensive way how to establish and then operate a periodontal therapy program; one that provides the best care beginning in the general dental office that is working in concert with a periodontist colleague. In other words it is assumed that there will be patients who fall outside of the more predictable and routine, so for this reason, it is always smart to have a periodontist on your Periodontal Therapy Program team. This brings confidence to patients in your program and makes referrals, when indicated, easier to achieve. Remember, it is important that your referral recommendations are followed by your patients in order to make sure they return to you later. Patients who leave any office to find “somebody” to help them with “something” easily lose confidence in the practice that seems to have sent them away. On the other hand, when patients understand the story and how and when referrals are made, and to whom they are made, as simply a matter of fact in the early presentation, this builds greater trust in the...

How to Succeed in Periodontal Therapy Part 3

The Power of Story There are successful dental practices alongside unsuccessful dental practices. Each one of them provides similar services and has similar patients, yet some succeed and others do not. So what’s the difference? It’s really very simple. It’s explained in a story. Would you like to hear it? It’s every dentist’s story and it goes like this. A few years back every dentist was a dental student. And before this they were taking pre-dental classes, which were predominantly math and science courses. In fact most pre-dental students majored then, and still do even today, in biology or chemistry, not because they like these subjects, but because they want to be dentists and believe their chances are better if they obtain a degree in one of these fields. The science classes in colleges and universities that are prerequisites for dentistry, medicine and veterinary sciences are popular, not because most of the students taking them love these subjects.  It is because they are required courses in order to become doctors. So the class sizes are large and often are taught by graduate students. This is because professors prefer working with those who happen to enjoy their particular field. They do not enjoy dealing with people who are only there for the grade. So why isn’t there more of a stink about this? It is because the unwritten objective of these courses is not to teach toward comprehension anyway. These courses are for the most part filters designed to weed out professional school applicants.  So if lectures are complicated, possibly given by someone whose native language isn’t English, and the...