a dentist examining a patients mouth.

This article was originally published in the Q3 2020 edition of CDOCS.com Magazine.

As part of the “3 Keys” to minimize time and maximize oral health, looking at the systems that support the results we're driving toward is essential.

During these challenging times, the most impacted system in the practice is the flow and protocols for the hygiene therapy visit. With infection control, the distancing protocols, and the PPE that must be worn by the hygienist(s) and doctor(s), the most difficult part of the new normal is creating an effective pre-exam and periodic exam that influences and inspires patients to say yes to comprehensive care.

An essential element of the messaging campaign is leaning into the concept of same day, quadrant, complete dentistry, delivered in a minimal number of visits. There is no better opportunity for a restorative doctor to celebrate the capability of accomplishing more in less time.

And the best time to educate and motivate a patient of record to commit to their ideal hygiene, restorative and cosmetic treatment solutions is at their hygiene therapy visit. Of course, the key to acceptance is a co-diagnostic partnership where the patient owns their problem, embraces the solution and is willing to pay (and schedule) for their care.

Relationships require a connection. Masks and guards make it hard to connect. It is vital the team re-assess their opportunities for diagnosing, treatment planning, and treatment conferencing to create new norms to establish that connection that leads to a “yes.”

The goal is to adjust to the obstacles with the intention of continuing to create co-diagnostic partnerships with patients that inspires loyalty, value, and commitment to long-term care.

How can the courtesy call and COVID-19 screening help?

While sheltering in place, we learned to use virtual meetings like Zoom, Skype, etc., to maintain connections and relationships. The need for prescreening provides the team an opportunity to use these new forms of communication, where you can see each other without masks.

Whether the COVID-19 prescreening is done by the hygienist treatment coordinator, clinical assistant, or a front desk team member (or even the dentist at times when appropriate screening indicates a significant treatment plan may be warranted) the elements that occur in the operatory pre-exam may be able to be completed through teledentistry, for example:

  • Learning the patient's recent motivators and concerns that may affect treatment decisions through a purposeful conversation. Use open-ended questions like, “Tell me your feelings about maintaining your oral health now.”
  • Documenting any life events or changes that may impact future treatment.
  • Reviewing the patient's medical and dental history, including COVID-19 screening questions. Use the questions as an opportunity to highlight any future needs that will be discussed during the hygiene therapy visit.

Once the patient is in the operatory, a data summary of what was discussed can easily roll into any needed assessments and X-rays. For these deeper calls to occur before the appointment, clarity about patient filters, timing of calls, and assigning the calls to specific team members will need to be brainstormed and an action plan will need to be created.

Making the periodic exam effective

The choreographed interplay between the doctor and the hygienist in the periodic exam is one of the most important factors in the patient experience and case acceptance. The goals of an excellent periodic exam are to:

  1. Provide a seamless hand-off (baton pass) from the hygienist to the dentist regarding motivators, concerns, any potential additional hygiene or restorative treatment, and any risk factors based on initial findings.
  2. Provide an opportunity for the patient to hear the message from two trusted health care professionals, influencing and inspiring the patient to commit to ideal hygiene, restorative or clinical treatment that benefits their overall health.

Based on infection control and distancing protocols, the approach to this vital patient interaction needs to be well thought out. Creative solutions including re-appointing for an exam in the dentist's chair, the use of virtual teledentistry, the dentist reviewing X-rays from a separate conference room via Zoom or Skype, and many more need to be discussed and implemented as options for each unique practice.

The key elements that need to be replicated in a virtual teledentistry environment are:

  1. During the pre-exam and prophy the hygienist shares their initial findings (not diagnoses) with the patient. Using the dentist's name and agreed upon language, which includes: URGENT – IMPORTANT – COSMETIC – ELECTIVE, the hygienist sets up the periodic exam.
    Based on what you and I just reviewed on the X-rays, I know Dr. DeWood will want to address this with you as this would be considered an urgent need.
  2. Post pictures of the area of concern so the dentist can review them with the patient, along with focused patient education videos.
  3. Alert the patient that the dentist will be doing an evaluation (live or virtual).
  4. Greet the dentist and the patient sitting in the room. Summarize the appointment up to that point focusing on any observations about needed restorative treatment, using the same language you had shared with the patient. Include any patient concerns or objections in the handoff to the dentist and alert the dentist to all relevant pictures and radiographs.
    Dr. DeWood, Amy and I reviewed ______________ and we knew you would want to address this if indeed it is urgent and requires treatment.
  5. Dentist delivers a quality statement about the hygienist and diagnose any needs based on initial findings, X-rays, and assessments.
    Thank you, Marcy. I always trust your professional guidance. Amy you continue to be in great hands.
  6. The doctor and the hygienist summarize anything the patient has said that might reveal their motivators and concerns.
  7. Gain patient agreement on next steps.
    It sounds like we agree that the next step to address this urgent need is an extraction, followed by an implant and restoration. And because we use the very latest in technology, this can be accomplished with minimal visits.
  8. Respond to any objections and pass the baton to the treatment coordinator to gain commitment and negotiate the financial agreement when appropriate.

It is vital for the team to brainstorm innovative techniques to accomplish these crucial steps to patient acceptance, so patients get the dentistry they deserve, and desire and the practice remains productive, efficient and effective.

A famous Chinese proverb states, “When the winds of change blow, some people build walls and others build windmills.” Use the hygiene pre-exam and periodic exam as your opportunity to build windmills. In times of chaos, come the most important innovations.

Amy Morgan is Vice President of Consulting Strategy, a member of Spear Resident Faculty, and former CEO of Pride Institute.