In my career, I've had the opportunity to own both a private practice and a dental laboratory. Much of my career was spent as a private practitioner, but for the last 17 years, I owned and was affiliated with a dental laboratory concurrently with my private practice. It wasn't until I understood the nature of the dental laboratory business that I realized how poorly I communicated with my labs, and this situation adversely affected the patient experience. Through this experience, I became aware that many labs do not fully understand the daily dynamics that occur in a modern private dental practice. Conversely, many dental offices generally lack the same awareness when it comes to understanding effective dentist lab communication as it applies to our workflow and case understanding.

Dentist clients are sincere in their approach to restoring patients to dental health
Dentist clients are sincere in their approach to restoring patients to dental health.

However, all is not lost, and there is a lot of good news about both professions. It is evident that our dentist clients are sincere in their approach to restoring patients to dental health, treating their patients respectfully in all ways. Keeping that in mind, sincerity needs to be backed up with the communication required to successfully complete the case.

Let me give you five examples of how communication lapses by otherwise excellent dental practices can lead to unfavorable experiences for our patients:

1. Margin Marking: When Dentists Redact Retractions

We usually see this with dentists who have recently bought a scanner. When we call the dental office to tell them we cannot identify the margin and ask them about retraction, their reply usually is, "Uh... the sales rep told us we did not need retraction anymore." When we ask them to re-scan with a better view of the margin for marking, some will acknowledge the problem and re-scan, but for others, the response is usually, "no, just do the best you can." In this case, the trusting patient is receiving a case where there is uncertainty about the prognosis.

2. When Cases Go MIA Through Lack of Communication

Dental practices generally work hard to provide the best experiences for their patients. This includes having to delegate tasks to auxiliaries. Early in my practice, I would hire auxiliaries and assume that they would know what their job entailed through osmosis. After a succession of failures, I finally understood that the dentist-owner needed to spend time communicating with their auxiliaries about what is expected of them. Dentist lab communication became a point of emphasis, where the situation as described above can be prevented. Here’s the scenario: Our lab receives a case, and during our preparation of the case, we find something is inadequate or missing, which will not allow us to proceed. We call and email the office to alert them that we cannot proceed. We pulled the case from our production schedule awaiting a reply. The reply finally comes the day of the appointment with the patient in the chair. It goes like this: “Where is our case? The patient is in the chair.” This was actually my conversation with my lab before I emphasized the importance of lab communication.

3. Where Is the Post?

We are proud of the accomplishments of our dentist customers on behalf of our patients. However, as we know, a day in the life of a private practice can sometimes be chaotic. We receive an open tray impression for an anterior implant with only the impression post screw without the post. We call and ask them, "Where is the impression post that is used with the screw?" They reply, "Well, it is right here." As a result, the patient is once again inconvenienced, resulting in a need for an unnecessary appointment. Thankfully, this talented dental practice has implemented systems to prevent this from happening again.

4. Lost in Translation: Keeping Your Labs and Specialists Informed

An edentulous patient presents to the dental office requesting a Locator-type of implant-supported prosthesis. He said that he did not want a fixed solution because he wanted the ability to retrieve it at will. We received the case from the dental office with a well-written prescription for a Locator-supported prosthesis in the maxillary arch.

Upon inspection of the implant cast, we observed that All on Four-type implants were placed by the surgeon, ostensibly if what the dentist prescribed was for a fixed-detachable case.

Our lab was not part of the referral process between the surgeon and the restoring dentist, so we do not know the circumstances that led to this situation. We were able to finish the case as requested with specialized components, but the lab fee increased significantly. This confusion always causes anxious moments for the dental office and reduced profitability because the patient was already quoted his fee for the Locator type of prosthesis.

5. A Backwards Tale of Coordination, Communication, and Dental Care

Mrs. Jones resides in a nursing home with limited mobility but is still relatively healthy with a sharp mind. She is really excited today because she is receiving her new implant crown on her upper left second molar. The nursing home staff is aware of her appointment, and they take all necessary measures to ensure that her transportation is coordinated. The staff wakes her at 5:30 AM, performs their hygiene services for her, helps her dress, and gets her to breakfast by 7:00.

After breakfast, she is led to the door to wait for transportation. She is picked up at 8 because the driver has other stops. She is finally dropped off at the dental office at 9:15 and waits until 10 when she is courteously led to the operatory.

After a struggle to get her out of her wheelchair and into the dental chair, the assistant screws in the implant crown, but she feels that the contours, occlusion, and contact point appear to all be wrong. When the assistant reports this to the dentist, the dentist says, "Oh, OK. Take some pictures and send it back to the lab." The assistant passes on the news to Mrs. Jones, telling her "that the lab did something wrong. We will correct it and have you back again."

After the appointment, the exhausted Mrs. Jones is returned to the waiting area to wait for her ride back to the nursing home. She is aware that she will have to endure this experience again.

We received the case back with the photos. When we looked at the photos, it was obvious that the assistant tried in the case backward.

The point is that it not only takes good clinical skills but coordinated dentist-lab communication to provide a better patient experience in all these instances described. What could have been positive experiences turned into negative experiences and cast the dental offices in a bad light.

I found when I practiced that a little time communicating with your staff and emphasizing the importance of what you say can have a profound and lasting effect on the patient experience.

We have talented resident faculty who share the same philosophy on the importance of staff communication with labs and specialists. Dr. Steve Ratcliff has a four-part series in Spear Online about lab communication for auxiliaries that can help immensely with this topic in your offices. Martin Mendelson has a great article on delegation in Spear Digest that can provide immediate benefits when his thoughts are used in your offices.

The message is clear, Dr. Frank Spear taught us that the patient’s experience should exceed their expectations. It is obvious from these examples that much can be done to improve our patient experience if we take the time to improve dentist lab communication.

Edward J. Roman, D.D.S. is a dental laboratory owner who maintained a private practice in Washington, Pennsylvania. His educational emphasis is improving dentist-lab communication. He is a member of Spear Visiting Faculty and a contributor to Spear Digest.