Inside Dentistry
April 2009
Volume 5, Issue 4

Moving Beyond Single-Tooth Treatment

Roger P. Levin, DDS

Dr. Brown had a problem. And he needed a solution—fast.

In October of 2008, he lost a substantial amount of money in the stock market, and needed to ramp up his practice production to offset his losses. Times had changed, and he needed to change with them, an increasingly common situation facing dentists that I discussed recently in my blog (www.levingroupgp.com).

Dr. Brown worked hard and kept his schedule full but practice revenue wasn’t where it needed to be to maintain his lifestyle. His situation was dire enough that he even contemplated the possibility of working a 5- or 6-day week to keep his head above water.

Finally, one day Dr. Brown looked at his schedule more closely and realized he needed to do something. Soon after, he decided to enlist Levin Group’s help. During an in-depth assessment of Dr. Brown’s practice, we helped him determine his #1 challenge—his schedule was dominated by single-tooth treatment.

Comprehensive Solutions

Levin Group finds that single-tooth treatment constitutes as much as 80% of patient appointments among practices starting out in its consulting programs. Obviously, a great deal of potential treatment is not being presented. We have always felt that the actual percentage of single-tooth treatment should be only 55% to 60% of all patient appointments.

Moving away from single-tooth treatment clearly presents innumerable opportunities for Dr. Brown. We helped him to understand that to really grow his practice, he would have to increase his average production per patient. That meant one thing had to happen—he had to promote comprehensive dentistry, especially cosmetic and elective procedures. This would also give Dr. Brown the opportunity to perform more of the procedures he thoroughly enjoyed doing.

To move beyond single-tooth treatment, Dr. Brown began providing every patient an annual comprehensive Five-Phase Exam™ that consists of the following:

  1. Periodontal Exam
  2. Tooth-by-tooth Exam
  3. Cosmetic Exam
  4. Implant Exam
  5. Occlusal Exam

Phase One—Periodontal Exam

A periodontal exam can lead to the discovery of a significant amount of necessary treatment, including scaling and root planing, the sale of the powered toothbrushes, and more frequent periodontal maintenance. All of these working together can create a significant production and profit center for the practice.

Phase Two—Tooth-By-Tooth Exam

Levin Group encourages clients to evaluate each tooth for all potential services. For example, there may be several different options for a restoration as well as a broken tooth. There also may be other areas that should be discussed, such as overfilled teeth that will eventually break, out-of-date restorations, and a host of other factors. All of these should be considered in the evaluation of the tooth-by-tooth exam.

Phase Three—Cosmetic Exam

During the cosmetic exam, each anterior tooth should be scored against a shade guide. Patients should be educated about the purpose of the shade guide, so that they understand what the potential for improvement is for their teeth. In many cases, the change could be significant, yet no one has presented cosmetic dentistry this way before.

The result of this heightened consciousness is that more Americans are interested in esthetic treatment. Unfortunately, many dentists are still assuming that the public will ask about cosmetic procedures, but most patients wait for the dental team to initiate conversations about practice services. Practices should educate patients about the available services, especially cosmetic ones.

Phase Four—Implant Exam

Dental implants are another enormous growth opportunity for practices. I am still surprised by the fact that more than half of general dentists do not restore a single implant case in a given year. Implant dentistry not only provides an incredible quality of life for patients, but also is extremely beneficial for practice productivity.

Think about it from this perspective. If a practice has 1,500 to 2,000 patients, how hard is it to identify a number of implant cases? Statistically, it should be easy. However, if patients are not diagnosed as potential implant candidates, there will be very little chance that implants will become part of the practice treatment protocol.

The implant exam is fairly simple. Dentists simply look for any areas of missing teeth and that becomes part of an implant diagnosis. With dental implant success rates of 95% or higher, there are very few edentulous patients today who cannot benefit from implant dentistry.

Phase Five—Occlusal Exam

During this exam, the doctor observes overall tooth function, wear, contact, and jaw alignment. This can often lead to the identification of potential problems, future wear issues, and/or fractures. Occlusal adjustments before restorative and cosmetic treatment can produce a dramatic long-term benefit for patients.

Highly Effective Case Presentations

In a single-tooth model, much of the patient motivation to accept treatment is there before you even speak with the patient. You’re usually working with people in pain, and they need little inducement to proceed with treatment.

Elective services, by contrast, are not essential—a fact that patients already know. Choosing whitening or veneers is not a logical or need-based decision, but rather an emotional one. Most patients are not interested in long explanations about the technical aspects of veneers or laminates.

With few exceptions, patients want to know exactly five things about an elective procedure:

  1. What is it?
  2. What will it do for me?
  3. How long will it take?
  4. How much will it hurt?
  5. How much will it cost?

How much time should you spend on each question? For successful elective case presentation, more time should be spent discussing how the patient will benefit from the treatment. This is the only way to build value for an elective procedure. Levin Group recommends that dentists allocate 60% of their time to explaining the benefits (“What will it do for me?”) with the rest evenly devoted to answering the other four questions mentioned above.

Staying true to this formula will result in increased case acceptance and allow your practice to grow and thrive the way you’ve always wanted.


Using a comprehensive treatment model, Dr. Brown is performing more elective dentistry than ever before while greatly reducing his reliance on single-tooth treatment. To best ensure success, you must take concrete steps to change your ways of thinking and operating. Transforming your office into a comprehensive practice is one of the best business decisions you can make.

Inside Dentistry readers are entitled to receive a 20% courtesy discount on the Levin Group’s Total Practice Success™ Seminar held for all general dentists on May 28-29 in Nashville. To register and receive your discount, call 888-973-0000 and mention “Inside Dentistry” or email customerservice@levingroup.com with “Inside Dentistry TPS” in the subject line.

About the Author
Roger P. Levin, DDS
CEO, Levin Group
Owings Mills, Maryland

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