Written by Joseph Whitehouse, DDS, MS Friday, 28 February 2003 19:00
You are seeing a patient who has been in your practice for years. Her mouth looks as it always has. You see no decay or periodontal disease. You carry on a comfortable conversation and then say good-bye. However, she has other ideas. Because you did not present her with any new opportunities, such as using the new technology she has been reading about on the Internet, nor did you ask her about her now darkened front teeth, she leaves your practice. Perhaps she assumed you were not interested in proposing “wanted” care.
75-Year-Old Woman Wants New Smile
Marylyn came to me with a desire for an enhanced smile (Figures 1 and 2). Her previous dentist showed no interest in fulfilling her desire and actually caused her to feel “too old.” (I assure you she is not too old.) His assumption was obviously wrong. His listening skills were lacking. He failed to understand. On the other hand, when Marylyn was asked what her goals for her mouth were, she was very clear. She wanted a nicer smile. Was there anything that would keep her from going ahead with the treatment that would meet her goals? No. I had positioned myself on a bay-window seat, leaned forward slightly, and I listened. I paraphrased as she spoke and summarized at the end. She felt understood.
|Figures 1 and 2. This 75-year-old patient presented with a desire for an enhanced smile.|
|Figure 3. Composite is used to lengthen the teeth as a “prototype” for the final aesthetic effect.|
|Figure 4 and 5. The patient’s new smile after seating 10 veneers.|
During the examination, I used a digital camera to place her smile from various angles on DICOM, a digital imaging program, and we viewed her mouth in several poses. An intraoral camera at 28x magnification exposed the severe bruxism damage of her lower incisors. She was concerned about those teeth and was shown a finished case that used orthodontic intrusion and veneering. She remarked about the technology. I then placed composite to prototype her maxillary teeth by simply adding length (Figure 3). She was pleasantly surprised and liked what she saw. (Couldn’t her previous dentist have done this?)
“Her Dentist Can’t Do What She Wants”
Margery’s daughter brought her to the office believing that Margery’s mouth was in need of more care. The previous dentist was of a long-standing relationship, the patient liked him, and would return to him for continuing care. However, he was obviously missing an understanding of what Margery wanted. He never sought out her goals and may have felt unable to address her clinical needs. Was he missing all 3 needed skills? If he could not treat Margery clinically, was he responsible for referring her to someone who could help her?
|Figures 6 through 8. This 71-year-old patient wanted to improve her oral health and appearance.|
|Figure 9. Placing orthodontic appliances on this senior patient made her “feel young again.”|
|Figures 10 through 12. The patient after completion of treatment.The patient after completion of treatment.|
Figures 6 through 8 show the patient’s oral condition. There was no question that she required me to understand her goals, which were (1) nicer smile, (2) teeth together, (3) solid feel, and (4) long-lasting care. Margery is 71 and sees a future for her mouth’s enhanced condition. The treatment proposed, which included opening the bite, bridges, crowns, and orthodontics, met her goals. She had no objection to the approximately $20,000 fee, which her own dentist could have earned.
CEO Knows He Needs Something Done
|Figures 13 and 14. This corporate CEO wanted to improve the appearance of his “worn out” teeth.|
|Figures 15 and 16. The patient’s new “CEO” smile.|
Patrick, the CEO of the Better Business Bureau of Northern California, was not being heard by his dentist. After reviewing a Chris Ad marketing mailer, he discovered I might be able to provide him with a solution for a more presentable smile for his working environment. According to Patrick, his bruxed teeth “are just so worn out” (Figures 13 and 14).
Some readers may have lost and will continue to lose interesting and rewarding cases to those dentists who become known through referrals or external marketing to satisfy patient wants. The wants are not just clinical in nature, but are often the most basic of needs. Feeling understood, supported during decision making and care, left in control, not “put down,” and having positive perceptions are but a few of the hopes for which patients yearn. The case examples described are but a few of the opportunities I have received from patients arriving with the hope that I can satisfy their goals. There are many dentists who do provide the same understanding and care.
All patients deserve to feel understood and get what they want. Ask them and you may be surprised, but be ready to treatment plan and complete the often complicated cases. Then rejoice in having helped a fellow human being reach a higher level of dental health, confidence, and satisfaction.
Dr. Whitehouse practices in Castro Valley, Calif. He is currently treasurer of the World Congress of MicroDentistry. He holds fellowships with the International Congress of Oral Implantology and the World Congress of MicroDentistry. He is one of very few dentists with a master’s degree in counseling. He can be reached at (510) 881-1924 or
Disclosure: Dr. Whitehouse is founder of the Dental Learning Center, which provides communication skills workshops and cosmetic dentistry hands-on courses.
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