Inside Dentistry
March 2008
Volume 4, Issue 3

Initial Exam or Comprehensive Evaluation?

Gary M. DeWood, DDS, MS

New patients are the life force of every dental practice. They bring needs and wants that provide opportunities for us to do what we do. How we interact with them throughout the process of becoming acquainted will shape their expectations of our new relationship. If you wish patients to accept comprehensive dentistry you must start every relationship with a comprehensive evaluation, right? Maybe not.

Our profession has created a public that calls the office asking for what we have taught them they need. “Hello, my name is Gary Smith and I need to get my teeth cleaned.” What happens next depends on where your practice is right now. If you have more time than people and you wish to expand your patient base, I hope what happens is an appointment for a cleaning and an initial exam. If you have more people than time, I hope you begin the process of self-selection with this person as you assist them in determining whether or not your office is the place they want to be. If it is, the patient may decide the comprehensive evaluation is an appropriate selection for their first visit.

Initial examination is a disease-oriented task. It is designed to find and note the things that are wrong with teeth and their supporting structures in an efficient, effective manner. It is about the dentist knowing what the patient has and telling them how it must be fixed. Most patients do not need your input to claim ownership of cavities, bad breath, bad taste, and bleeding gums: “I know they’re bad Doc, cantcha’ just fix ‘em?”

Comprehensive evaluation is a health-oriented process. It is about the patient knowing and experiencing their present condition. It is about allowing them to claim ownership of the disease they know while introducing them to the disease they do not—often the disease you see in the signs that herald occlusal breakdown. It is about walking with them for as long as it takes for them to develop ownership while continuing to offer understanding, support, and, when they ask, answers.

In a well-managed practice trying to grow itself, the initial examination can serve as a pipeline to the comprehensive evaluation while keeping the dentist and the team productive. If you want to see more people, remove all of the obstacles a new person might see to becoming a patient in your office. When they call wanting their teeth cleaned, clean their teeth. Use your time with them to listen and observe carefully. As you clean their teeth, find a question that is not answered with an initial exam, and offer them an op-portunity to experience something different. Wonder about something with them and invite them to discover it with you, at that first visit and at every one that follows.

Some will accept your invitation and experience a comprehensive, co-discovery exploration of their oral health condition. Many of those who do will invite friends and family to that experience, and they will come to you seeking that difference. This growing group will form the core of your practice and, ultimately, the people with whom you choose to spend most of your time.

Some will decline your invitation. They will ask about the problems that they can claim and ask you to fix them. As your time allows, fix them. In this you will be provided new opportunities to create excellent experiences and to create curiosity about the problems you see but they do not yet claim. At every contact keep wondering with them and keep inviting them to discover with you. They will tell you when the time is right. It might be at that first visit.

The difference between the initial exam and the comprehensive evaluation is not in what the dentist sees and knows. Some will arrive ready to go there with you, some will develop the questions that take you there, and some will never choose your best stuff. Leading the patient to discovering with you and coming to ownership of what they discover can take time. If you offer solutions to problems that patients have not yet come to own, they are likely to feel pressured to do things they are not sure they need. That pressure gets in the way of establishing the trust necessary to become a partner in health rather than a fixer of teeth.

In spite of all that you have been told, it is not about educating patients. If that were true, nobody would smoke. The answer is in the questions—those you ask and those asked of you. If your practice-building goal is partnering in lifelong collaborative relationships, making comprehensive care more than a buzz phrase, then make haste, slowly. The practice of your dreams will develop right before your eyes.

About the Author

Gary M. DeWood, DDS, MS
Director of Marketing and Publications
Clinical and Business Instructor
The Pankey Institute
Key Biscayne, Florida

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