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Howard Speaks Howard Farran, DDS MBA, MAGD, Publisher, Dentaltown Magazine

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Greed and Fear

Howard Farran, DDS
MBA, MAGD
Publisher,
Dentaltown Magazine
 If you were to enter any dental practice in America, I bet you’d find at least 60 to 80 percent of the treatment plans in that practice are unfinished. Why? Because we learned dentistry in Latin and we still have a hard time explaining to patients what is going on in their mouths in layman’s terms. This has huge outcomes, guys. For instance, 30 percent of America has zero teeth by age 65, yet 99 percent of this country’s dentists don’t wear dentures at 65. Why is there such a big gap between dentists who get optimum oral health care and patients who’d rather opt for nice cars, nice vacations and other luxury goods? In essence, the big question is: Why are we all still having a hard time selling dentistry?

The answer might just be as easy as appealing to our patients’ senses of greed and fear.
Greed is your patient thinking, “I want to keep my teeth. I want sexier, whiter teeth. I want to chew up my bacon cheeseburger and french fries when I’m 80.” Fear is, “I am going to have to spend a lot of money. I am going to lose my teeth. I am going to have root canals and I’m going to have to have exotic, costly treatment.” The best dentists in the world convince their patients to value and pay for treatment. This is all done by teaching.

When we have the patient in the chair, the first thing we do is probe all the tissues where the toothbrush goes, which should normally be threes and twos all the way around the mouth inside and outside. Then we explain to the patient that everywhere the toothbrush goes there is oxygen, and bad bugs cannot live where there is oxygen. Then we go back and probe the gums in between the teeth where the floss goes. There is where you pick up fours, fives and sixes. It’s at this point when the patient knows he has been busted for not flossing.

Then we take the digital flossing X-rays (don’t call X-rays “bitewings,” your patients don’t know what a bitewing is). You need to sell the fact that these people don’t floss their teeth and the far overwhelming majority of cavities are in between the teeth. So we pull the X-rays up on our screen, print them out on an 8x10, put them on a clipboard, pull out a red pen and circle the existing flossing fillings (Fig. 1). We show the patient the cavities growing right where the two teeth touch because where they touch there is no air. We tell the patient, “The floss carries out the food, sugar and the sweets but it also carries air in between the teeth, which kills all the ‘bad bugs’ on contact.”

Then when we trace where the nerve is (Fig. 2), we can show him that the flossing filling was a good 2mm from the nerve, thus avoiding the root canal. Then we’ll show the patient that not only does he have an existing flossing filling between those two teeth, he has an existing flossing cavity. So what we’ll do is trace out the nerve, then we’ll trace out the filling. We’ll say, “You weren’t flossing when you got that filling and you’re obviously still not flossing because you have another flossing cavity right here. We need to get that cavity filled pronto, because it is about 2mm from the nerve. Right now a flossing filling on the backside of that tooth costs about $250. If that cavity gets into the nerve then you’ll have pain and then you are looking at a root canal and a crown, which costs $2,000. Let’s say you don’t have insurance or $2,000 when you’re hurting. By then you’re going to be in so much pain your only option will be to pull the tooth, which costs $250. So either you give me $250 today, we do a filling and you keep the tooth or wait a couple years and you’ll still give me $250, but I pull the tooth and I keep it.”

Now compare that with the dentist who reads the bitewings and says to his assistant, “He needs a DO on #4,” then turns to the patient and says, “OK?” The patient says, “OK” only because he doesn’t know what a “DO on #4” means. He doesn’t know he’s been busted. He doesn’t understand that his diet and behavior caused this. Then he checks out up front and they ask if he wants to be scheduled for these fillings. He says, “Let me check my schedule and I’ll call you back.” He won’t call back. Guaranteed. Then two years later this poor guy is in dire need of a root canal.

You have got to get these people thinking on the same level as you are!

We bust the non-flossers two ways, with X-rays showing existing flossing fillings and brand new flossing cavities, and on the probing of the gums, which we do every six months on recall. Between X-rays and probing depths, you should be able to create enough fear in a person that he knows he needs to start flossing.

Pit and fissure cavities are also best explained (and sold) via X-rays. Again we explain to the patient that these bugs can’t grow in oxygen. The bugs get up in between the teeth, where only the floss can go, and they also get up in those pits and fissures on the tops of the teeth where the enamel formed. So we show them the X-ray and show them their existing pit and fissure cavities (Fig. 3). Then we’ll trace out the nerve, trace out a pit and fissure filling and say, “Look how close that filling is to the nerve; you were spared a toothache and a root canal. Then we’ll show them other pit and fissure fillings that were very small. Then after we have explained it, we get out the Diagnodent (Fig. 4) and check all the remaining pits and fissures in their mouth. A lot of dentists say, “I don’t need a Diagnodent to diagnose cavities.” Once again, you shouldn’t need a Diagnodent to locate pit and fissure cavities. That’s not the point.

The point is you need to teach. Let your patients hold the Diagnodent while you scan their pit and fissures and write down the numbers on the chart. Think about when they are holding on to the Diagnodent and they hear that low tone going, “rrrrrrr,” and then all of a sudden it comes across a deep hole and it goes, “RRRRRR!” The patient hears that and sees the readings. Then you take out your intraoral camera and show them the black dot – their cavity – on the top of the tooth (Fig. 5). Then you try to give them an estimate as to how close it is to the nerve. Then you say, “We need to do a filling today or you will need a root canal tomorrow.”

My favorite picture, which we have in every operatory, is Fig. 6. I love it because in one picture you can say to your patients, “Look, the cavities only grow in two places – and both have no air!” Look at the existing flossing filling and then check out the pits and fissures where the bugs live. We tell them, “When you eat sugar, the bugs only feed where there is no air and everywhere the air hits the teeth and where the toothbrush goes is usually not a problem. The problem is in those pits and fissures and flossing in between the teeth.” We show them what’s going on with X-rays and probing. Then when they get those pit and fissures measured, they can decide when they want to have those cleaned out. Then you remind them, “The later you do it, the bigger the hole, the closer it is to the nerve, the greater chance that you could end up needing a root canal or an extraction.” Then the patient decides when they want to clean these out and then place a filling.

Another important point: Your hygienist is in the room with that patient for almost an hour. Your exam at the end of the appointment is maybe five minutes. You have to allow your hygienist to teach dentistry. So many dentists don’t want their hygienists to teach with X-rays or intraoral cameras. This is wrong. Your hygienists need to spend that hour imparting knowledge they gained from their four years of college into your patients’ minds. Not allowing hygienists to teach is a real detriment to the patient.

If you want to be a great doctor, you have to be a great teacher. That involves getting the whole team involved. This also means using plain simple language for everyday people. Being a great doctor doesn’t mean your margins on your crowns are 50 microns or less. Being a great doctor means teaching your patients skills and knowledge now so they never need a crown later.
Howard Live

Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, email colleen@farranmedia.com.

Dr. Farran’s next speaking engagement is March 12, 2010, at the Sarasota County Dental Society in Sarasota, FL. For more information, please call Colleen at 480-718-9914.

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