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Volume 5, Issue 6

Gaining Commitment from Patients That Were Labeled Inactive

This issue of Practice Prosperity is the 4th in a series that explores the concept of how a slight shift in the role of a dental hygienist could lead to increased effectiveness, productivity and job satisfaction. This issue will focus on how to establish a protocol for re-engaging patients whose charts have been labeled as ‘inactive’. Important steps of the protocol will be addressed, beginning with the initial phone call from a patient we will refer to as Mr. Morgan.

After a 5 year absence, Mr. Morgan has called to schedule ‘just a cleaning’. He is not complaining of pain, but has noticed that his lower front teeth feel rough to his tongue. The following protocol presents some strategies on how to effectively engage Mr. Morgan in renewing his commitment to oral health.

Phone Call

Picking up the phone is often a difficult decision for a patient who has not received any dental care for a number of years; Mr. Morgan should be acknowledged for taking the first step. It’s important that he feels welcome and is not chastised for his absence.

Key Points to Address in this Phone Call Include:

• What has prompted the call?
  
  
• How long has it been since his last appointment?
  
  
• What type of appointment should be scheduled to address his main concerns?
  
  
  

Engage Mr. Morgan in the conversation by welcoming his input and opinions. If he feels his needs have been heard, he will be more likely to consider future dental recommendations. Additionally, if he believes that the dental team has his best interest at heart he will be more committed to keep his appointments.

Specific Exam

If the patient is in pain, the first appointment will likely be a specific or emergency exam rather than a hygiene visit. Relieving pain is the first priority. A specific exam also provides the dental team with the opportunity to make suggestions about the next step in moving towards health. View each interaction with a patient as an opportunity to move the relationship forward.

This appointment presents a tremendous opportunity to show the client the condition of his teeth and tissues, opening the door to talk about the potential for improvement. Frequently a patient who has not been in for a number of years is unaware of the current condition of their mouth. Also, they may not know that advancements in dental technology will help them receive their required treatment in a more painless and expedient manner.

Hygiene Appointment

Since Mr. Morgan is not in pain and 'just wants a cleaning', schedule a hygiene appointment. The purpose of the initial hygiene appointment is similar to triage in a hospital. Act as the client’s advocate and help him receive the care and treatment that best serves his needs. Begin by helping him identify his goals for health and discuss potential treatment to help him reach them. This goes beyond the clinical aspect of dental hygiene and is arguably the most important part of the hygienist’s role.

Mr. Morgan is likely nervous about the condition of his teeth. He may fear judgment regarding his absence from the office and may be more comfortable seeing the hygienist first… which may be why he ‘just wants a cleaning’.

Steps of the Hygiene Appointment

• Health history update and review
  
  
• Take required diagnostic records
  
  
• Intraoral camera tour
  
  
• Co-discovery
  
  
• Periodontal assessment
  
  
• Dentist’s role
  
  
• Begin periodontal therapy
  
  
• Appointment wrap-up.
  
  
  

Health History Update and Review

As it has been 5 years since Mr. Morgan was in the office, he should complete a new health history form. Review his health history with him and identify any pertinent health concerns.

For patients that have been in the office within the last couple of years, you can have them update their health history form, initialing any deletions or additions.

Be sure to ask questions about both pharmaceutical and herbal medications so you are aware of potential complications.

Diagnostic Records

As Mr. Morgan has not seen a dentist in 5 years, it will be important to update his X-rays according to your office protocol. Explain to Mr. Morgan that the dentist has requested the X-rays to provide him with the benefit of a thorough examination and to aid in his diagnosis. The X-rays will also assist the hygienist in determining the height of the bone supporting the teeth. Additionally, get the other required diagnostic records.

Intraoral Camera Tour

Your goal for this appointment is to help Mr. Morgan realize the benefit of regular visits to help maintain his health. Non-judgmental questions, effective listening and the intraoral camera are three of the most effective tools to achieve this.

The intraoral camera allows Mr. Morgan to see what is going on, ask questions, and possibly inquire about possibilities for improvement. If the chair is equipped with an overhead monitor, he will be able to see his teeth as you tour around his mouth with the camera. Remember to capture images depicting both health and disease. Once the chair is upright, view the photos together, discussing what you both see.

Co-discovery Process

Many patients welcome and value their dental hygienists opinion.  Viewing the intraoral photos is a powerful opportunity to introduce restorative dentistry without the patient feeling pressured. Having an idea of what is currently in his mouth will also better prepare him for a recall or comprehensive exam with the dentist. Discussions about what is happening with his teeth will help him be better prepared for recommendations for restorative treatment.

Periodontal Assessment

There is a possibility that Mr. Morgan’s gingival tissues will be tender as it has been a few years since his last hygiene appointment. With the goal being to establish a plan for ongoing therapy, strive to minimize discomfort during this appointment so Mr. Morgan will be more likely to return. A spot probe or PSR will provide enough information to create a preliminary periodontal therapy plan. A complete periodontal assessment can be performed at a later date when discomfort is no longer an issue.

Periodontal Therapy

If time allows begin periodontal therapy during this appointment. To minimize discomfort for Mr. Morgan, start in an area that will show immediate change with little or no tenderness. Offer him anesthetic if the periodontal condition is too involved to treat without discomfort.

The mandibular anteriors are usually a good place to start as the improvement will be noticeable with the tongue. Anticipate areas that might be tender and verbalize them to him. Mr. Morgan will be better prepared if he has been forewarned and will be pleasantly surprised if an area that you suggested might be tender isn’t.

Dentist’s Role in The Potential Exam

At the morning team meeting, discuss the plan for Mr. Morgan’s hygiene appointment. The dentist’s primary role is to acknowledge Mr. Morgan for returning to the practice. This will involve briefly catching up socially and taking a quick look in his mouth to gain a general overview of what’s been happening. If more than a recall exam is required, discuss with Mr. Morgan the benefits of scheduling a comprehensive exam on another day to fully explore the current condition and the possibilities for improvement.

Appointment Wrap-up

At the end of Mr. Morgan’s appointment, return his chair to the upright position and discuss any further questions he has.

If this protocol for re-engaging patients is implemented effectively, Mr. Morgan will likely see the value of his treatment and find it easier to return to your office on a regular basis… for more than ‘just a cleaning’.  

Rather than constantly striving to increase your new patient flow, why not consider improving the standard of care you deliver to your patients of record?  By getting them excited about coming in on a regular basis and committed to their oral health, you may be able to begin doing the treatment that has been sitting in your charts for years! Might this impact your bottom line?

Points to Ponder

• Do your patients feel chastised by your practice if they don’t come in for a few years?
  
  
• How frequently do you ask patients to review or complete a new health history form?
  
  
• Does your office have a set protocol for the diagnostic records required given a variety of situations?
  
  
• Does your practice use an intraoral camera to assist with the co-discovery process?
  
  
• Does your hygienist anticipate and ask questions on behalf of your patients?
  
  
  

Learn more about creating effective hygiene appointments
by calling our office for a complimentary
30 minute phone consultation.

Co-authored by CoraMarie Clark and Mitch Peters

About the Author

CoraMarie Clark, BSDH MBA is recognized as a highly effective dental practice strategist. She works with dentists that want to optimize their potential both personally and professionally. Her collaborative approach has helped teams develop dynamic competitive strategies and achieve high impact sustainable results.

If you would like to explore the possibility of having CoraMarie work with your Dental Practice or speak for your Association or Group, contact us today.

Strategix
phone 403.686.6136
email coramarie@strategix-ltd.com
web strategix-ltd.com

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