the patient and dentist

8/6/2019 The Patient and Dentist

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Interrelation of Problems in Dental Practice

PATIENTS

Accept only emergency workThink of dentistry as a

commodity, i.e., in terms offees for different materials

Will not accept reasonablefees

Will not accept complete

examination, includingradiographs

Want to bargain

Will not accept payment plansDo not meet payments promptly

Do not appreciate high standards

of work doneBreak or cancel appointmentsAre late to appointments

Drop out before work is

completedDo not respond promptly to

recall notices

Do not refer others

FINANCIAL INSECURITY

Lack of practice growth

Low percentage of complete mouthrehabilitations

Low percentage of response to

recallsLow percentage of recommendations

Insufficient income for effort made

Poor collectionsHigh credit losses

Low financial reserve

Lack of funds to meet obligations

Unfair competitionAbnormal fluctuations in income

Fear of future insecurity

PRACTICE MANAGEMENTPROBLEMS

Too long hours

Pressure due to more patients thandentist can handle

Patients kept waiting

No time to perform good dentistryOverlapping of appointments

Time lost between appointments

No time for vacation

Lack of system in office procedureUnproductive time

Inadequate records

Slack periodsHigh overhead

Too low fee schedule

Irregular fee schedulePoor arrangements for payments

Inadequate down payments


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The Story of Modern Dentistry

1. Indicate that dental Fifteen or twenty years ago the average personpractice has paid little attention to his mouth until he had a toothache

progressed. Or other annoyance.

When a patient came into a dental office, thedentist would extract the tooth, relieve the pain, or

perhaps fill the tooth. He gave little to avoiding

toothache or the loss of teeth.

2.Express idea of Today we dentists are interested in trying toprevention. Prevent all these troubles. Do you know that, except

for accidents or unusual illnesses a person need neverlose a permanent tooth? Or never even have a

toothache? That a child need not and should not lose

any primary teeth prematurely?

3.Suggest that neglect Most people do not know these facts. They doCauses trouble and not realize that early and regular dental care will save aexpense. great deal of trouble. As a result, many mouths have

fallen into a state which involves not only a good deal

of time and difficulty to correct but also considerable

expense.

4. Demonstrate im-

portance of esthetics. But this is not all. Wouldnt it be harder for aperson like this (show illustrations on page 6,7 and 8 of

teeth, Health and Appearance) to get a job, a wife (or

husband)? Think of the effect of his appearance onothers! He is afraid to laugh heartily or even smile

because he is so conscious of his faulty teeth.

5. Suggest connection There are other troubles which can be avoided.

between oral and Most people do not realize that many diseases of thegeneral health. Body can be traced directly to the mouth and teeth. For

example, headaches, pains and aches in the joints, lossof weight, stomach trouble, etc., may be symptoms of

more serious ailments, possibly due to unhealthy

conditions of the mouth and teeth.

6. Relate to individual Now, I dont know if you have any of thesecase and suggest symptoms, and of course your mouth doesnt lookthat much can still look anything like this. But every one of these cases

be done to correct started with some small damage which would neverdamage. Have reached this stage if cared for in time.


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I. Series of radiographs to illustrate

1. Normal teeth

2. Enamel breaks3. Caries

a) caries of lesser degree

b) advanced caries encroaching upon pulpc) caries advanced into pulp

d) caries advanced into pulp with apical area

4. Old restorations showing recurrent decay, overhanging margins5. Infections

a) infected teeth (non-vital and devitalized)

b) residual infections, retained roots, cysts, etc.

6. Condition of rootsa) curved

b) fused

c) diverging

d) exostosed7. Impactions

8. Conditions of bone and peridental membranea) resorption of bone

b) peridental pockets

c) thickening of peridental membrane, traumatic conditions

d) edentulous area showing normal and abnormal ridges; for example, thinknife-edge alveolar process

9. Tarter

10. Childrens mouthsa) primary and unerupted teeth

b) mixed dentition, normal and abnormal

II. Study models to illustrate

1. All teeth in position, showing in both child and adult

a) regular alignmentb) crowded, irregular alignment

c) closed bite

2. Mixed dentition with malocclusion present due to prematurely lost deciduous

tooth or teeth.3. One missing tooth, preferably posterior, with space partially closed, with

shifting, drifting, extrusion, loss of contacts, plunger points

4. Several teeth missing with extensive disarrangement of remaining teeth andclosure of bite; and, if possible, a similar case corrected to normal relationship

5. Many teeth missing, also indicating types of ridges resulting from resorption

6. Edentulous mouth, several, showing:a) thin knife-like ridges

b) concave ridges

c) fairly well rounded ridges


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In illustrating a condition by means of study models, the dentist should have at hand

radiographs of the same case if possible and use them to reinforce the demonstration.

III. Books

1. Teeth, Health and Appearance, Bureau of Public Relations, A.D.A., ChicagoIll., 1940.

2. Atlas of the Mouth, Maury Massler and Isaac Schour. Bureau of Public

Relations, A.D.A., Chicago Ill.3. Visual Education of Dentistry, Dental Digest Publishing Co., Pittsburgh, PA.


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Patients statement. I think I have a cavity and I would like you to take care of

just this one tooth. I probably have a lot of other work, but I

cannot afford very much.1. Reassure patient Very well, let me look at it. Is this the tooth? Im sure I

that his complaint can take care of it today.

will be treated asquickly as possible.

2. Assure him that You know, Im glad you told me that you cant afford veryyou understand much. Many people are in similar circumstances, particularly in

and sympathize these uncertain times. Yet these people want to save their teeth,with his financial just as you want to save this tooth you are complaining about.situation. They want to prevent unnecessary loss of teeth. But they wonder

how it can be done without spending too much money at one time.

3. Show example For example, these (study models)belong to a patient who was

of a case similar in recently. She could not afford much, either. She said she had ato that of patient. a cavity in this tooth (point out tooth on models). Not only did we

find the cavity (point out on radiographs)but we also found theconditions which in all likelihood helped to bring it about.

4. Indicate cause We found that some of her teeth were missing. Because theyand effect of had not been replaced the remaining teeth moved out of theirdamage. normal position ( point out on models).

As a result of that, several things happened. This tooth moved

out of position so that this point, or cusp, was packing food betweenthese two teeth and probably helped cause this cavity that she had

felt. We could have filled the tooth, but if we had not found this

point and rounded it off, new decay might have set in, due tocontinued food packing.

This would have undermined the restoration and the patient

would have had to undergo the same trouble and expense again.

5.Suggest Of course, at this time she couldnt afford to have the missingadvantages of teeth replaced, but by finding out all the conditions in her mouththorough exam- through these and other means (point to radiographs and study

ination; division models) she knew which conditions were so urgent that they

of treatment, if required immediate attention. In this way she was able to takenecessary. Care of her mouth without spending too much money at this time.

6. Test patients Thats what you want to do isnt it, Mrs.__________?understanding.

7. Suggest suitable Now the fee for even the urgent work was more than this patientPayment plans. could afford at one time. We therefore discussed her budget with her

and arranged suitable payments overa period of time. In that way,


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when the treatment was completed her payments were finished, too, so

that she didnt have to worry about going into debt. Later she is going to

have the rest of her work done.Thats how we helped this patient. However, we dont know the

extent of the damage in your mouth. It mat be very slight. In which

case, making suitable payment arrangements may be the solution to yourproblem.

If, on the other hand, the damage is considerable, this complete

diagnosis of your mouth will help me determine not only what may havehelped cause the cavity but also which other conditions urgently need

treatment, to avoid as far as possible still more serious trouble.

8. Tel Story of You see, we are interested in putting dentistry within a patientsModern reach. Years ago, people didnt know this, and therefore neglected their

Dentistry. mouths until they had a toothache or other annoyance. (Continue withStory of Modern Dentistry, Chapter 6)

To summarize, the reader will note that relaxation of the patient is accomplished by

assuring him:

a) that his complaint will be treated quickly as possible

b) that you understand and sympathize with him in his financial position

Through these steps the patient is put in a state of mind receptive to further education.

The education itself is then continued thus:

c) by showing an example of a case similar to that of the patient:

(1) illustrating cause and effect of damage

(2) indicating advantages of thorough examination.(3) Ascertaining whether the patient understands the need for a complete

diagnosis as the first step toward determining which conditions most

urgently need attention.d) by controlling the financial problem:

(1) dividing the treatment needed

(2) arranging suitable payment plan.

e) by showing the desirability of comprehensive dentistry leading to optimum controlof dental disease

(1) Story of Modern Dentistry

Mr. ________, in view of all these conditions now apparent,

resulting from missing teeth, etc., we can already conclude that considerable treatmentmay be necessary. Even though I do not yet know the specific treatment which will be

best for you, I can see that the fee will be rather large. But whatever it is, I am sure we

can arrange payments so that it will be no hardship to you.


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Patients statement Id like you to examine my teeth, but dont talk to me about

bridge work. I dont want any false teeth. In the first place,

fixed bridges require cutting into sound teeth, thereby spoilingthem; secondly, the clasps on removable bridges wear out teeth.

1. Assure patient Ill be glad to examine your teeth. I can understand how youhis complaint feel about bridgework, because occasionally people have had

will be treated and trouble with it. However, we are now able to overcome manythat you understand of the difficulties patients have had.

his attitude. For example, it used to be difficult to fit bridges properly

down near the gums (show unsatisfactory bridge on radiograph) As

a result, food collected under the bridge and around the teeth

supporting it. Then the gum became irritated and sore, and theteeth began to decay. People wearing such bridges experienced bad

tastes and odors. They had the bridge-work removed and in some

cases refused to have any further bridge-work.

2. Indicate that Today we have new ways of meeting these difficulties. WeModern dentistry examine more thoroughly, have new techniques for making

Has resolved impressions, and have better materials.

Many difficulties As a result of the progress that dentistry has made, fixedWith fixed bridges. Bridges can now be made to fit like this (show radiograph of

satisfactory fixed bridge)Notice how the original shape of the teethsupporting the bridge has been restored, so that they no longer push

food between the opposite teeth. Observe the space left between the

teeth on the bridge, which allows for easier cleaning. This helps toprevent decay from stagnating food particles.

Of course, it is always possible for cavities to start in these

supporting teeth just as in any other part of the mouth. That is why itis important for the patient to be extremely cooperative and return for

periodic examination, so that if they occur they can be taken care of as

soon as possible and thus prevent the breakdown of the bridge.

3. Removable Dentistry has developed new techniques for removable bridge-Bridge-work work as well. Now removable bridges can be designed and constructed

Has been so that irritation of the gums is for the most part avoided. With newerImproved. Materials, clasps can be made thinner, lighter in weight, and less

noticeable. Thus patients no longer have the difficulties they used to

complain about, especially if they cooperate by following carefully allinstructions regarding the care and use of the appliance and if they

return periodically for re-examinations.

However, before considering different types of bridgework, it iseven more important to determine whether or not it is needed.

Just as dentistry has made progress along these technical lines,

which are, of course, corrective, so also it has progressed alongpreventative lines. Fifteen or twenty years ago a patient paid little


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attention to his teeth until he had a toothache. (continue with Story ofModern Dentistry, Chapter 6)

To summarize, the reader will note that relaxation of the patient is here accomplished

by assuring the patient:

a) that his complaint will be treated as quickly as possible.b) that you understand and sympathize with his attitude toward bridge-work

Once the patient is relaxed he is in a receptive state of mind to further education, which

is accomplished as follows:c) by indicating the progress that the dental profession has made in solving the

difficulties that may be on the patients mind:

(1) Examples of satisfactory and unsatisfactory bridge-work are shown

(2) Explanation of precautionary measures taken during construction, i.e.,radiographs of castings, etc.

d) by indicating the patients responsibility

(1) to follow instructions carefully concerning care and use of the

appliance.(2) To return promptly for re-examination.

More complete techniques for meeting the statements You have to cut into goodteeth and Bridge-work makes a person feel old are given in Chapter 31.

I dont like to go to the dentist; they always hurt me.

Im glad you told me about that, because the dental profession has developed a

number of new methods for controlling pain.By exploring into your health and past dental experiences, we will be able to

determine the method best suited to your needs. Whatever method is used, we shall be

very careful to test the effectiveness of the anesthesia as you are treated.Years ago we didnt know about these things, and therefore a persons fear of pain

often kept him away from the dentist until he had a severe toothache. Then he had to go,

and what did the dentist do? Usually he had to remove the tooth, relieve the pain, orperhaps fill the tooth. (continue with Story of Modern Dentistry, Chapter 6)

The reader will observe that relaxation is accomplished by assuring the patient:

a) that you understand and sympathize with his fear of pain.b) That you will be extremely careful to test the effectiveness of the anesthetic as

you proceed.

The education, then, is carried on as follows:

c) by pointing out that the dental profession has developed new methods forcontrolling pain.

d) By indicating the necessity for exploring the patients health and past dental

history.

e) By telling the Story of Modern Dentistry.

the patient and dentist

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