Interrelation of Problems in Dental Practice PATIENTS Accept only emergency work Think of dentistry as a commodity, i.e.

, in terms of fees for different materials Will not accept reasonable fees Will not accept complete examination, including radiographs Want to bargain Will not accept payment plans Do not meet payments promptly Do not appreciate high standards of work done Break or cancel appointments Are late to appointments Drop out before work is completed Do not respond promptly to recall notices Do not refer others

FINANCIAL INSECURITY Lack of practice growth Low percentage of complete mouth rehabilitations Low percentage of response to recalls Low percentage of recommendations Insufficient income for effort made Poor collections High credit losses Low financial reserve Lack of funds to meet obligations Unfair competition Abnormal fluctuations in income Fear of future insecurity

PRACTICE MANAGEMENT PROBLEMS Too long hours Pressure due to more patients than dentist can handle Patients kept waiting No time to perform good dentistry Overlapping of appointments Time lost between appointments No time for vacation Lack of system in office procedure Unproductive time Inadequate records Slack periods High overhead Too low fee schedule Irregular fee schedule Poor arrangements for payments Inadequate down payments

The Story of Modern Dentistry 1. Indicate that dental practice has progressed. Fifteen or twenty years ago the average person paid little attention to his mouth until he had a toothache Or other annoyance. When a patient came into a dental office, the dentist would extract the tooth, relieve the pain, or perhaps fill the tooth. He gave little to avoiding toothache or the loss of teeth. Today we dentists are interested in trying to Prevent all these troubles. Do you know that, except for accidents or unusual illnesses a person need never lose a permanent tooth? Or never even have a toothache? That a child need not and should not lose any primary teeth prematurely? Most people do not know these facts. They do not realize that early and regular dental care will save a 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. But this is not all. Wouldnt it be harder for a person 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 on others! He is afraid to laugh heartily or even smile because he is so conscious of his faulty teeth. There are other troubles which can be avoided. Most people do not realize that many diseases of the Body can be traced directly to the mouth and teeth. For example, headaches, pains and aches in the joints, loss of weight, stomach trouble, etc., may be symptoms of more serious ailments, possibly due to unhealthy conditions of the mouth and teeth. Now, I dont know if you have any of these symptoms, and of course your mouth doesnt look look anything like this. But every one of these cases started with some small damage which would never Have reached this stage if cared for in time.

2. Express idea of prevention.

3. Suggest that neglect Causes trouble and expense.

4. Demonstrate importance of esthetics.

5. Suggest connection between oral and general health.

6. Relate to individual case and suggest that much can still be done to correct damage.

In your case, from what you tell me, it seems that some damage has already been done. While we cannot undo it, we can do a complete job in correcting it and thus help to prevent further damage. When the dentist has reached this point in the education of the patient, his next step will be to present to the patient the need for a complete examination. This can best be done by explaining that, in order to protect the mouth from further damage, two enemies must be fought: caries and periodontoclasia.

The first step is a thorough examination of your mouth to make sure that no condition is overlooked which might lead to toothaches and loss of teeth later on. If the examination should reveal that there are more unfavorable conditions than you expected and you feel you cannot afford to have all the work done now, at least the most serious conditions will be taken care of and we will be in a position to plan for your whole mouth in steps which will not be a financial hardship to you. I am glad you came back before having any serious discomfort. As You know, we dentists have always stressed the importance of checking the mouth regularly because in that way we can help prevent toothaches and loss of teeth. Of course, there are always new developments in dentistry that aid us even further in doing this. We try to keep up with these advances as they are made, so that our patients can receive the fullest benefits modern dentistry has to offer. In fact, fifteen or twenty years ago. (continue with the Story of Modern Dentistry) I am glad you noticed that. Progressive improvements are being made in dentistry, and dentists today try to keep up with them so that our patients will get all their benefits.

I. Series of radiographs to illustrate 1. Normal teeth 2. Enamel breaks 3. Caries a) caries of lesser degree b) advanced caries encroaching upon pulp c) caries advanced into pulp d) caries advanced into pulp with apical area 4. Old restorations showing recurrent decay, overhanging margins 5. Infections a) infected teeth (non-vital and devitalized) b) residual infections, retained roots, cysts, etc. 6. Condition of roots a) curved b) fused c) diverging d) exostosed 7. Impactions 8. Conditions of bone and peridental membrane a) resorption of bone b) peridental pockets c) thickening of peridental membrane, traumatic conditions d) edentulous area showing normal and abnormal ridges; for example, thin knife-edge alveolar process 9. Tarter 10. Childrens mouths a) 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 alignment b) 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 and closure 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

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., Chicago Ill., 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.

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 as quickly as possible. 2. Assure him that you understand and sympathize with his financial situation. 3. Show example of a case similar to that of patient. You know, Im glad you told me that you cant afford very much. Many people are in similar circumstances, particularly in these uncertain times. Yet these people want to save their teeth, just as you want to save this tooth you are complaining about. They want to prevent unnecessary loss of teeth. But they wonder how it can be done without spending too much money at one time. For example, these (study models) belong to a patient who was in recently. She could not afford much, either. She said she had a 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 the conditions which in all likelihood helped to bring it about. We found that some of her teeth were missing. Because they had not been replaced the remaining teeth moved out of their 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 between these 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 to continued food packing. This would have undermined the restoration and the patient would have had to undergo the same trouble and expense again.

4. Indicate cause and effect of damage.

5.Suggest Of course, at this time she couldnt afford to have the missing advantages of teeth replaced, but by finding out all the conditions in her mouth thorough 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 take necessary. Care of her mouth without spending too much money at this time. 6. Test patients understanding. Thats what you want to do isnt it, Mrs.__________?

7. Suggest suitable Now the fee for even the urgent work was more than this patient Payment plans. could afford at one time. We therefore discussed her budget with her and arranged suitable payments overa period of time. In that way,

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 your problem. If, on the other hand, the damage is considerable, this complete diagnosis of your mouth will help me determine not only what may have helped 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 patients Modern reach. Years ago, people didnt know this, and therefore neglected their Dentistry. mouths until they had a toothache or other annoyance. (Continue with Story 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 control of 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 treatment may 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.

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 spoiling them; secondly, the clasps on removable bridges wear out teeth.

1. Assure patient Ill be glad to examine your teeth. I can understand how you his complaint feel about bridgework, because occasionally people have had will be treated and trouble with it. However, we are now able to overcome many that 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 the teeth 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. We Modern 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, fixed With fixed bridges. Bridges can now be made to fit like this (show radiograph of satisfactory fixed bridge) Notice how the original shape of the teeth supporting 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 to prevent 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 it is 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 Bridge-work Has been Improved. Dentistry has developed new techniques for removable bridgework as well. Now removable bridges can be designed and constructed so that irritation of the gums is for the most part avoided. With newer 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 all instructions regarding the care and use of the appliance and if they return periodically for re-examinations. However, before considering different types of bridgework, it is even 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 along preventative lines. Fifteen or twenty years ago a patient paid little

attention to his teeth until he had a toothache. (continue with Story of Modern 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 good teeth 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, or perhaps 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 for controlling pain. d) By indicating the necessity for exploring the patients health and past dental history. e) By telling the Story of Modern Dentistry.