Case Presentation Strategies Lead to Success

February 1, 2021
Jo Donofrio

Getting dental patients to say yes to proposed treatment requires careful planning.

Effective case presentation in dentistry has evolved in recent years because of technological advancements, broader access to information, and patient acceptance of preventive dentistry as part of an overall health plan. Traditional case presentations, which usually consisted of the dentist informing the patient of the problem and then recommending the solution, are no longer effective in gaining widespread treatment acceptance. Today, successful case presentation is far more than citing research, providing a diagnosis, recommending a treatment, and discussing financial options. Thanks to the internet, patients are more educated and have more options, making case presentation even more important in treatment planning and acceptance.

A key to treatment acceptance is being able to build relationships and establish trust with patients. “Patients are better at doing research today,” says Jenn Janicki, executive director of Clinical Mastery Series, a national-based dental curriculum education program. “Whether it is dental work or medical work, people conduct their own research online and rely heavily on the referrals of their peers.” These referrals are no longer just from friends but from Facebook and private online groups, resulting in the sharing of misinformation. “Your dental team must be well trained to weed out the misinformation and help the patient make a good decision,” Janicki says. “It is more important than ever for a dental team to establish trust with the patient and become their trusted source of information.”

Successful case presentation focuses on 3 elements: listening carefully, communicating clearly, and, specifically, addressing patients’ questions in language they can understand. Presenting treatment from the patient’s perspective adds value and can be a motivating factor that leads to acceptance of the proposed treatment.

“Communication always was and still is the basis of everything we do in dentistry,” says Jason Goodchild, DMD, of Jenkintown Dental Medicine and vice president of clinical affairs at Premier Dental Products Company. “For a long time in dentistry, the patient just had to trust what the dentist or hygienist was telling them, so trust and rapport with the patient was the key to acceptance. But today with social media and the internet, people can do their own research on what dental treatments are, what they feel like, and even what they should be paying for them.”

One of the most important things in case presentation is knowing patients and what they value and paying attention to details that are important to them. “You have to determine the best way to communicate with each patient,” Dr Goodchild says. “Some patients want all the specific details, whereas others just want to know the bottom line.”

A patient’s decision to accept dental treatment is almost always emotional, not intellectual. Yet many dentists present a treatment plan from an educational and analytical perspective. “It is really vital that we do not use too much dental speak when speaking with a patient,” Dr Goodchild says. “You need to have emotional intelligence and empathy and talk with patients in a language they can understand. It is a skill that we must develop to effectively communicate with our patients.”

“One thing that is important to remember is that not every patient is the same,” says Jeff Lineberry, DDS, AAACD, and owner of Carolina Center for Comprehensive Dentistry. “I recommend having guided questions based on your knowledge of the patient. If you ask the correct questions, it guides you through the process while better understanding what the patient truly wants and supports them in making a good decision.”

Advancements in Technology

Technological advances have made a huge impact on how dental providers present to and communicate with patients. With so many tools to capture and share images, visual treatment planning has become an essential and persuasive tool in increasing acceptance. “So many people are visual learners,” Dr Goodchild says, “so being able to show patients what is happening in their own mouth is an excellent way to educate and facilitate codiagnosis.”

Codiagnosis helps the patient better understand the condition that needs to be treated and the importance of doing so. Codiagnosis makes the patient an active participant in the examination and in developing a customized treatment plan.

“The real value of a codiagnostic examination is that the patient sees what you see, the way you see it, in real time,” Dr Goodchild says. “During the codiagnosis, you can discuss the potential benefits of treatment and the consequences of leaving things untreated, from an oral and overall health standpoint.”

The sophistication of tools such as high-quality digital cameras, intraoral scanners, and cone beam computed tomography (CBCT) offer extraordinary detail and facilitate open, honest discussions. Patients can now fully participate during examinations and in customizing their treatment plans, which builds confidence and trust.

An intraoral scanner, also known as an optical scanner, uses images and stitches them into a 3D file. “We really have some incredible, amazing tools to show patients what is going on in their mouths,” Dr Goodchild says. “A lot of dental offices are using intraoral cameras, which they can integrate with their practice management software. We are sitting side by side with the patient and using quality images to discuss issues and options for successful treatment. Some images can be rotated so you can present from different angles to help the patient better understand what is going on in their mouth.”Knowing how to capture each image consistently and predictably helps the patient better visualize the current condition of their teeth as well as appreciate the result of treatment.

Dental CBCT is a special type of technology used to generate 3D images of dental structures, soft tissues, nerve pathways, and bone in a single scan, allowing for more precise treatment planning. CT provides detailed images of the bone and is performed to evaluate diseases of the jaw, dentition, and bony structures of the face, nasal cavity, and sinuses.

“A major advantage of CBCT is its ability to image bone and soft tissue at the same time,” says Brent Garvin, senior product manager for imaging at Planmeca. “What a 3D scan offers that is valuable for case presentations is … a wide variety of views and angles that can be manipulated to present a more complete evaluation and presentation to the patient. It is more accurate than 2-dimensional images and gives the dentist total control of the x-ray.”

With CBCT technology, the dentist can take the x-ray on the screen and use software to highlight issues the patient is facing and how they could possibly affect other areas in the mouth or neighboring teeth. It allows clinicians to gather more information than standard 2-dimensional panoramic images and provides the patient with a truer understanding of the treatment the doctor is recommending.

“The importance of imaging in case presentation cannot be understated,” Garvin says. “When the clinician is attempting to present a treatment plan to a patient, having an x-ray up on a screen for the patient to view helps them to better identify the source of the problem and the plan, rather than having it explained just in words. By using this approach, the clinician is assuring the patient that they are going to do a safe and effective procedure, which translates to competence for the patient. Now that the technology is more advanced and research shows 3D imaging to be a far superior, I don’t think there are any limitations on its clinical use in dentistry.”

Dental photography is also an important tool in treatment acceptance. You must be able to capture your work in quality images that will build confidence in the plan. A single-lens reflex camera, occlusal mirrors, and retractors are the basic package needed for photography that lends itself to a more emotional response. Keynote and PowerPoint are also essential tools in creating a visual treatment plan for patients.

Getting patients to say yes to needed treatment should be a team effort. To build trust and confidence with the patient, the entire dental team must be well informed of the recommended treatment and moving in the same direction. Every team member must be able to talk to patients about what they see in language the patient can understand. “All team members must be on board and have the same understanding of what we want to do for the patient and why,” Dr Lineberry says.

There can be a fair amount of dissension just from lack of communication among the team members. “The core of team training is understanding where comprehensive dentistry fits and creating awareness and a vision for the team so they can support their doctor,” says Janicki. “The team should have a common vision of how they are going to communicate with each other as well as with the patient.”

It is not uncommon for a patient to spend more time with dental hygienists or dental assistants and be more comfortable speaking with them. “Sometimes a patient speaking with a dental hygienist or dental assistant regarding their concerns is more successful than speaking with the doctor,” says Dr Lineberry. “They are more comfortable with this person and will confide in this person and ask questions, for example regarding financial concerns, that they are not comfortable asking me. This can be very helpful in terms of case acceptance rates.”

Common Objections

Asking the right questions can reduce objections by reassuring patients that the doctor is recommending the best treatment for them. “You have to be able to read the patient,” says Dr Lineberry. “If I am talking with a patient and I can see from their body language that they are overwhelmed, I will ask them about their concerns and may have to adapt my presentation. It is about being connected with the patient and then sharing your communication with the patient with all other team members in the office.”

There are many reasons why patients object to dental procedures. These include the time commitment, lack of insurance coverage, uncertainty regarding the immediacy of the problem, and, most commonly, price.

“It is really about value, and value is difficult to define,” Dr Goodchild says. “There is a value proposition in dentistry a lot of people consider, especially when they cannot see or feel a problem. We address the value of the procedure by educating the patient using all the tools at our disposal. For example, if a patient is objecting to the cost, we assure them that our office is going to do everything we can to make it affordable.”

Clinical Mastery Series and Janicki conducted a study of 13 practices over 8 years to track treatment plan acceptance. According to Janicki, findings showed that 25% of patients accepted complex treatment plans within 60 days of their visit. Another 30% of patients moved forward with some part of their treatment plan 24 months later. “My belief is that these patients had been in hygiene and continued to see the hygienist over the course of those 2 years,” says Janicki. “If the hygienist is well trained, they likely took photographs and were reporting to the patient on noticeable changes, resulting in partial acceptance of the treatment.”

Follow-Through

Providing a good customer experience including follow-through is important in ensuring a certain level of care. “The No. 1 failure I see in most practices is that they don’t ask for any commitment prior to them leaving their office,” says Janicki. “If you simply ask the patient if what you have discussed today is in line with their goals and they say yes, you now have a commitment and just need to work out the details.” Often patients want to discuss the treatment with a significant other before making a final decision. “Send the patient home empowered with all the information they need regarding their treatment plan, including observations, recommendations, photographs, and pricing, and then offer to bring them back for a second consultation.”

Although the patient may need time to consider the treatment plan, setting a time frame for follow-up is the second step in future case acceptance. “Ask the patient when they would like you to follow up, and then do so,” Janicki says. “When we open the door and put them in the driver’s seat, suddenly they start asking questions and are more receptive.”

The most effective case presentations are customized to what patients want and what fits their values. With all the new tools and technology, creating an environment in which patients feel comfortable and confident can significantly improve treatment acceptance. “Case presentation and treatment planning are taught in dental school, but there is an art to it that has to be developed,” says Dr Goodchild. “With all the new tools and technology, it is a continual learning process. One of the most important things a young dentist needs to know is unless you present it and patients accept it, you can’t do it. You have to have patient buy-in, and they have to understand what you are going to do and then show up to have it done.”

Providing effective presentation and excellent care can also lead to patient referrals. “Your photography has to be good, your documentation must be excellent, and your relationship with your patients strong in order for them to give you a referral, allow you to use their photograph, or write a beautiful story about their experience in a way that is impactful for someone who reads about it,” says Janicki. “If it is important what your patients say about you, foremost of all is that you have patients that speak on your behalf.”