Making It Easy for Patients to Say Yes to Implant Dentistry. A Peer-Reviewed Publication Written by Dr. Paul Homoly, CSP

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1 Earn 3 CE credits This course was written for dentists, dental hygienists, and assistants. Making It Easy for Patients to Say Yes to Implant Dentistry A Peer-Reviewed Publication Written by Dr. Paul Homoly, CSP PennWell is an ADA CERP recognized provider ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. PennWell is an ADA CERP Recognized Provider Concerns of complaints about a CE provider may be directed to the provider or to ADA CERP at Go Green, Go Online to take your course This course has been made possible through an unrestricted educational grant. The cost of this CE course is $49.00 for 3 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

2 Educational Objectives Upon completion of this course, the clinician will be able to do the following: 1. Understand patient readiness and how to assess the issues in a patient s life that affect his acceptance to dental care 2. Understand the importance of encouragement and planning for the patient, to result in continuing care at your office 3. Understand the different methods of approaching a patient regarding treatment plans (e.g., Inside-Out vs. Outside-In) 4. Understand the role of the dentist as an advocate in promoting case acceptance Budget INSIDE-OUT Outside the Inside the Schedule Abstract Case acceptance, especially for those patients facing complex procedures such as implant dentistry, is a major factor for many dental health professionals. However, the failure of patients to carry through with a recommended course of treatment is not an insurmountable problem. Through a discussion of the various issues involved in case acceptance, this course addresses how the dentist can increase the odds of patient retention over time. This course includes analyses of patient readiness, psychological contributors from the patient s point of view, and ways in which the dentist s perception of the patient can positively or negatively influence case acceptance. Introduction Why do some patients accept implant dentistry at their initial appointment, while others take many months, and sometimes years, to say Yes? Two key concepts lie at the heart of case acceptance for implant dentistry: readiness and advocacy. Without understanding both of these, it s easy to overwhelm your patients with the complexity and fees of implant dentistry and lose them forever as a consequence. This course will help you keep potential implant patients in your practice who, when they are ready, will choose you to treat them. Readiness To understand patient readiness is to understand what considerations your patient has when deciding the best time for them to receive care. Knowing how your recommendations for implant dentistry fit into the current (or foreseeable) circumstances of your patient s life is a key case-acceptance skill. Major fit issues include stressors such as finances, work schedules, special events, travel, health factors, and any significant emotional issues in short, any issues that dominate the patient s energy or attention affect their readiness for care. Time Life Family Inside-Out vs. Outside-In Most of the literature on case acceptance for implant dentistry describes an inside-out process; that is, it begins by studying the inside of the patient s (examination, diagnosis, treatment plan). Only after consultation and show-and-tell do we learn about what s outside the patient s : his budget, work schedule, time constraints, and so on. Usually it s these issues that determine the course of your treatment plan. Although an effective approach for simple dental care, an insideout process may not be an ideal method when it comes to high-fee, complex-care dentistry. Does an inside-out approach offer predictable case acceptance for implant dentistry? Do thoroughly examining the, explaining the details of care, and illustrating your treatment with sophisticated multimedia typically result in patients saying Yes? Most dentists say No. In fact, the dentists interviewed for this article assert that over ninety percent of patients whose treatment plans exceed $10,000 are not ready for care following their initial consultation. Additionally, the largest cases these same dentists treat have been in their practice for a year or more. Therefore, a sensible process for case acceptance of implant dentistry is one that Discovers and acknowledges those issues in the patient s life that affects his readiness for care Encourages patients who are not ready to undergo implant dentistry to remain in your practice, and to choose you to provide their care when they are An approach to case acceptance for implant dentistry (and all complex dentistry) that makes the most sense is 2

3 Budget OUTSIDE-IN Outside the Inside the Schedule Discovering Readiness The quickest way to discover a patient s readiness is to ask him. This means a greater focus on understanding patients as opposed to educating them. Educating a patient is about telling him what he doesn t know about his dental health, including the consequences of his dental conditions, if left untreated, and the best forms of treatment. Conversations intended to educate patients are typically one-way; we do the talking while the patient does the listening. Traditionally, dentists have relied on patient education to sell implant dentistry. If patients are ready for care, educating them does no harm but if they re not, too much education feels like a sales pitch. Time Life Family an outside-in process. This starts with an understanding of what s happening on the outside of the first: how dental conditions are affecting and interacting with the patient s budget, time management, work, and family issues. It is only after we have an understanding of how complex dentistry may fit into the patient s life (that is, his readiness) that we proceed to conversations about the details of the inside of his. An excellent example of an outside-in sales process is the purchase of a home. Imagine you decide to buy a new house. You go to your favorite real estate agent and within a few minutes you are discussing price range, financing, down payment, location, neighborhood, and schools. These are all outside-the-home issues. Once you ve settled on the outside-the-home issues, then, and only then, does it make sense for you to start a conversation about inside-the-home issues such as carpet and tile selection, bathroom lighting, size of rooms, and so on. Now what if your real estate agent were a former dentist? You sit down and the first thing she does is start a conversation about inside-the-home issues and shows you photographs of tile samples. What would you think? You d think about finding another agent. How many of your patients, who after they have experienced your inside-out process, have found another dentist? Predictable case acceptance of implant and complex dentistry is an outside-in process. Get the big picture of what makes sense for your patients before getting into the appropriate details. You and your patient will save an incredible amount of time, and more importantly, you won t blow patients out of the water or your practice anymore. Understanding a patient means gaining an awareness of the patient s lifestyle requirements and limitations, including budget, work, and family issues. Often the single greatest issue that impacts a patient s decision to accept complete care is how it fits into his lifestyle. Understanding a patient involves having a two-way conversation, which will ultimately lead to the best solution for your patient. Choice Dialogue: The Choice Dialogue starts with a question asked early during a patient s initial visit, either as part of the interview or immediately following the examination. For example, your patient Kevin is concerned about a dark front tooth, but during the interview he mentions that he has many missing teeth. A Choice Dialogue for Kevin that will help you understand how much dentistry he is ready for could sound like this: Kevin, I understand why you re concerned about your dark front tooth. Before we make any decisions I want you to know that you have a choice. I m glad to help you with that front tooth today, or in addition to that I can look at all your teeth and help you develop a plan for a lifetime of dental health. What s going to be the best for you today? Kevin s response to this choice reveals his level of readiness today. If Kevin is ready for complex care, then offer to do a complete examination in addition to helping him with his dark front tooth. If Kevin is not ready, make him happy by fixing his front tooth, and when he becomes ready, he s likely to choose you. Advocacy Advocacy is the opposite of making patients ready. Advocacy recognizes that patients become ready on their own, and the advocate s role is to acknowledge their life circumstances and make them welcome in your practice regardless of their readiness. When you and your team 3

4 adopt an attitude of advocacy, it communicates to your patient that treatment acceptance is not a condition of your continuing good relationship, and that treatment can proceed whenever he is ready. Advocacy and readiness are linked, in that advocacy is the glue that binds your patients to your practice. Considering that ninety percent of patients aren t ready for high-cost treatment, it makes sense to have a case-acceptance process that accommodates these patients, keeps them in your practice, and increases the chances that they will choose you to provide their care when the time comes. The great flaw in the traditional approach to educating patients is the focus on making them ready for further treatment, by raising their dental IQ. The likely outcome is that, despite the dentist s best efforts to educate, many patients are not ready for complex treatment, and leave the practice forever. Whenever you exceed the patient s level of readiness, you create stress for the patient, for you, and for your team. The fact is that readiness does not occur in the dental office. Readiness occurs in everyday life: an embarrassment with dentures at an intimate moment, or the frustration of not being able to chew a juicy steak. Your goal should be to accumulate several hundred implant and complex-care patients in your practice who aren t yet ready to decide on further treatment, but sense that you re their advocate and are happy in your practice. In these circumstances, you can expect at least one patient per month to independently decide to start further treatment. Add the new implant patients who are ready at the initial appointment and you ll enjoy the more predictable success for case acceptance for implant and complexcare dentistry. Your role as advocate is to help your patients make smart dental health care decisions and help them understand how they can fit complete dentistry into their lives. You guide them to find a way to make it happen either now or later, or you recommend alternate treatment plans. The more you keep your advocate role clear in your own mind, and obvious to the patient, the more your patient will trust your clinical recommendations. Advocacy Dialogue: The Advocacy Dialogue makes your advocate role obvious to the patient and links what s going on in the patient s to what s going on in the patient s life. This dialogue typically occurs immediately after a complete examination but can be delivered at any time during the initial appointment by the dentist or any team member. Through telephone conversations, interviews, examinations, and post-examination discussions, the Advocacy Dialogue links circumstantial issues, such as time, budget, and schedule, with disability issues, or the ways in which the dental conditions in question affect your patient s life (embarrassment, worry, etc.). For example, during your team s conversations with Kevin, he mentions he s remodeling his house and his boys are starting college. From your examination and clinical conversation, you learn that food becomes impacted beneath his partial dentures, and that this is becoming an embarrassment during business conversations. This is Kevin s disability. Kevin s advocacy dialogue links his fit and disability issues to his life. Kevin, I know from our conversations that you have a lot on your plate right now with your boys starting college and your home renovations. I also know that it s embarrassing for you when food packs under your partials during business meals, and you d like to do something about it. Let s talk about your choices and find the best way to fit fixing your teeth into what s going on in your life. Is now a good time to talk about this? This dialogue, like the readiness dialogues, leads to a conversation about how Kevin s dentistry can fit into his life and clearly communicates that your role is to help him find the best way for him to get his teeth fixed. In other words, you re his advocate. Ultimately, the conversation that results from the Advocacy Dialogue answers the patient s questions, such as the following: What is the big picture of my clinical needs? What is the ballpark fee? What is the total time for treatment? How can I pay for it? How much does my insurance help? How much do this dentist and team care about me? The Advocacy Dialogue and the resulting conversation also answers your questions: Is this patient interested in the overall treatment recommendations? Is this patient comfortable with the ballpark fees, time estimates, and financial/ insurance arrangements? Is this patient ready for complete care now? In the absence of the Advocacy Dialogue, the above questions are usually answered only after you ve presented the treatment at the consultation appointment. Too often, after the patient learns about the fee and other details, the dentist or the treatment coordinator has to pick apart the dentistry plan and figure out which parts fit, which parts don t, or if anything fits at all. This 4

5 process can be highly stressful and embarrassing. It can create anger, waste time, and devalue your relationship, and it is regarded as the low point by most dentists, team members, and patients. To avoid this, use the Advocacy Dialogue and get the fit/readiness issues out in the open before you present your care and treatment plan. Taking No for an Answer You will have patients who aren t ready for care. In the absence of a time-sensitive condition, the strongest position you can have with them is one of advocacy; that is, their immediate acceptance of treatment is not a condition of your continuing good relationship. For example, Kevin tells you that he likes what you re saying about implant dentistry, but with the college tuition and the home expenses, it s just too much for him. When patients can t go through with care and are still hesitant even after you ve offered segmented treatment and installment payment plans, acknowledge and support their lack of readiness, and keep them in your practice. Kevin, it sounds like this is not a good time for you to consider this care. Why don t we keep you in our recall system, take care of any needs that come up, and when you re ready, we ll be here. It s not about the teeth Case acceptance for implant and complex dentistry is not about the teeth. Tooth- and treatment-centered presentations can be overwhelming and incomprehensible, and when the smoke clears, the financial obligations can be embarrassing and angering. Save your technical show-and-tell for informed consent. Center your caseacceptance process for implant dentistry on readiness ( Is now a good time for you to get your teeth fixed? ) and advocacy ( How can we best fit fixing your teeth into your life? ). Do this well, and you ll make it easy for patients to say Yes. References Homoly, Dr. Paul. Making it Easy for Patients to Say Yes. Sheraton Books, Homoly, Dr. Paul. Isn t It Wonderful When Patients Say Yes. PennWell Publishing, Homoly, Dr. Paul. Dentist: An Endangered Species. Knova Press, Dr. Homoly s resources for this course material have culminated over years of experience as a dentist, a consultant, and an author. The issues addressed are based on personal experiences in the practice as well as faceto-face encounters and discussions with colleagues. He is the first in his field to address this topic in writing. Author Profile Dr. Paul Homoly, CSP Dr. Paul Homoly is regarded as one of the top practice and personal development coaches in dentistry. Paul practiced for twenty years and is known for his innovative and practical approach to dentistry. Paul is a consultant to private practitioners and corporations, and is a world-class trainer in the dental industry. Paul holds the highest earned designation in professional speaking Certified Speaking Professional (CSP) from the National Speakers Association. Fewer than ten percent of professional speakers are distinguished at the CSP level. He is the first and only dentist in the world to earn this designation. Disclaimer The author of this course has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. Reader Feedback We encourage your comments on this or any PennWell course. For your convenience, an online feedback form is available at 5

6 1. The keys to case acceptance are: a. Readiness and Urgency b. Readiness and Advocacy c. Education and Understanding d. Understanding and Advocacy 2. Patient readiness is defined as: a. A long-term state of mind in which the patient is ready to begin treatment at your convenience b. The point at which the dentist feels the patient is ready to begin treatment c. The point in time which the patient considers to be the best to begin treatment d. None of these 3. Major fit issues for the implant patient include: a. Health factors and financial concerns b. The dentist s schedule and recommendations c. Knowledge of implant dentistry d. b and c 4. Providing a potential implant patient with all the details of the implant procedure in the initial visit is: a. Recommended; most patients want to be as informed as possible b. A surefire way to overwhelm him with an excess of information c. A good way to determine the patient s level of readiness d. A moral obligation 5. The author recommends a process for case acceptance which: a. Encourages patients to remain in your practice b. Begins treatment immediately c. Acknowledges issues of patient readiness d. a and c 6. The Outside-in process begins with: a. The details of the patient s dental needs b. The patient s work, family, and financial issues c. A thorough explanation of the implant process d. a and c 7. An inside-out approach to case acceptance is recommended for complex-care dentistry. a. True b. False 8. Which of these is the quickest way to determine patient readiness? a. An examination of his medical history b. Asking the patient if he feels ready c. Observing his reactions to educational materials d. Daily phone calls 9. Overall an emphasis on is stressed: a. Education over understanding b. Understanding over advocacy c. Understanding over education d. Readiness over advocacy Questions 10. Educating the patient involves: a. A one-way conversation intended to inform the patient about dental health b. A one-way conversation in which the patient describes his dental health routine c. A two-way conversation about the patient s lifestyle requirements and limitations d. A two-way conversation focusing on the patient s questions about implants 11. Understanding the patient involves: a. A one-way conversation intended to inform the patient about dental health b. A one-way conversation in which the patient describes his dental health routine c. A two-way conversation about the patient s lifestyle requirements and limitations d. A two-way conversation focusing on the patient s questions about implants 12. The Choice Dialogue is intended to: a. Put the patient at ease b. Determine the patient s level of readiness for complex care c. Subtly encourage the patient to choose you for future dental care d. All of the above 13. Which of the following is NOT true of advocacy? a. It communicates to the patient that treatment acceptance is not a condition of your continuing good relationship b. It is linked with readiness c. It is intended to make patients ready d. It recognizes that patient readiness does not occur in the dental office 14. The great flaw in the traditional approach to educating patients is the focus on making them ready for further treatment, by raising their dental IQ. a. True b. False 15. When the patient s level of readiness is exceeded, stress is created for: a. The patient b. You c. Your team d. All of the above 16. The advocate s role in patient readiness includes: a. Acknowledging the patient s life circumstances b. Making the patient feel welcome regardless of his readiness c. Hastening the readiness process d. a and b 17. Which of the following is true of the Advocacy Dialogue? a. It is usually conducted during the initial visit b. It links circumstantial issues with disability issues c. It directly follows treatment d. It focuses on the details of the implant procedure 18. The article s definition of disability issues includes: a. The effect of obesity on dental health b. Financial concerns which could affect case acceptance c. The ways in which a patient s dental conditions affect his life d. None of these 19. The Choice Dialogue and the Advocacy Dialogue are alike in which of the following ways? a. Both address the issue of total time in treatment b. Both encourage patient readiness c. Both explore how dentistry can fit into the patient s life d. Both explore ways in which the patient can change his lifestyle to accommodate the dentist 20. Which of the following statements that is true of the Advocacy Dialogue is also true of the Choice Dialogue? a. It generally takes place during the patient s initial visit b. It commonly deals with ways in which the patient can pay for treatment c. It determines the patient s degree of comfort with fees d. It links circumstantial issues with disability issues 21. Without an Advocacy Dialogue, possible results include: a. You and your patient will amicably discuss the details of the procedure and its effect on the patient s life without incident b. After expressing some concerns, the patient will consent to the procedure c. You, your patient, and your staff may suffer aggravation and frustration when the fee and other details of care are presented to the patient for the first time d. You will be forced to explain to the patient that he has no other choice but to go forward with the treatment schedule you have planned 22. When a patient without a timesensitive issue isn t ready for care, the practitioner should: a. Refer him to another dentist b. Take a position of advocacy c. Pressure him until he relents d. b and c 23. Case acceptance for implant dentistry is primarily about the procedure involved. a. True b. False 24. Where the patient is concerned, tooth- and treatment-centered presentations to patients are frequently: a. Accessible and informative b. Overwhelming and incomprehensible c. Difficult but necessary d. An important part of an initial consultation 25. The proper time for technical details is: a. When discussing informed consent b. During the initial consultation c. After the procedure d. Never 6

7 ANSWER SHEET Making It Easy for Patients to Say Yes to Implant Dentistry Name: Title: Specialty: Address: City: State: ZIP: Telephone: Home ( ) Office ( ) Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 3 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. Educational Objectives 1. Understand patient readiness and how to assess the issues in a patient s life that affect his acceptance to dental care 2. Understand the importance of encouragement and planning for the patient, to result in continuing care at your office 3. Understand the different methods of approaching a patient regarding treatment plans (e.g., Inside-Out vs. Outside-In) 4. Understand the role of the dentist as an advocate in promoting case acceptance Course Evaluation Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No Objective #2: Yes No Objective #4: Yes No 2. To what extent were the course objectives accomplished overall? Please rate your personal mastery of the course objectives Mail completed answer sheet to Academy of Dental Therapeutics and Stomatology, A Division of PennWell Corp. P.O. Box 116, Chesterland, OH or fax to: (440) For immediate results, go to and click on the button Take Tests Online. Answer sheets can be faxed with credit card payment to (440) , (216) , or (216) Payment of $49.00 is enclosed. (Checks and credit cards are accepted.) If paying by credit card, please complete the following: MC Visa AmEx Discover Acct. Number: Exp. Date: Charges on your statement will show up as PennWell 4. How would you rate the objectives and educational methods? How do you rate the author s grasp of the topic? Please rate the instructor s effectiveness Was the overall administration of the course effective? Do you feel that the references were adequate? Yes No 9. Would you participate in a similar program on a different topic? Yes No 10. If any of the continuing education questions were unclear or ambiguous, please list them. 11. Was there any subject matter you found confusing? Please describe. 12. What additional continuing dental education topics would you like to see? AGD Code 557 PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. AUTHOR DISCLAIMER The author of this course has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. SPONSOR/PROVIDER This course was made possible through an unrestricted educational grant. No manufacturer or third party has had any input into the development of course content. All content has been derived from references listed, and or the opinions of clinicians. Please direct all questions pertaining to PennWell or the administration of this course to Machele Galloway, 1421 S. Sheridan Rd., Tulsa, OK or macheleg@pennwell.com. COURSE EVALUATION and PARTICIPANT FEEDBACK We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please all questions to: macheleg@pennwell.com. INSTRUCTIONS All questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification forms will be mailed within two weeks after taking an examination. EDUCATIONAL DISCLAIMER The opinions of efficacy or perceived value of any products or companies mentioned in this course and expressed herein are those of the author(s) of the course and do not necessarily reflect those of PennWell. Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. COURSE CREDITS/COST All participants scoring at least 70% (answering 14 or more questions correctly) on the examination will receive a verification form verifying 3 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is The cost for courses ranges from $49.00 to $ Many PennWell self-study courses have been approved by the Dental Assisting National Board, Inc. 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