Missed Opportunities: Patients Lost to Lack of Understanding and Marketing

Dentistry Today


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.

This article discusses 3 patients who left their dentists, with whom they had long-standing relationships, and came to my office. Why did this happen, when their former dentists could have provided the same type of care? Two reasons: their dentists did not understand their patients’ “wants,” and my marketing. What qualities were the former dentists missing that created the loss? What skills could have been enhanced to provide those lost patients with treatment for their wants? These patients obviously sought answers to one or more of those wants by leaving their former dentists and coming to me in response to my external marketing. Their hope was that I would be better able to provide the care they wanted.
The skills the patients were looking for are communication, treatment planning, and clinical skills. Each of these skills is constantly in use with each patient encounter, yet they are poorly developed by many practitioners. The level of care offered to many patients is limited, often because of deficiencies in one or more of these skills, or the fear of rejection on the part of the treating dentist if the case fee is too high. The patient is thus robbed of having quality care of the magnitude desired.
Communication is the thread that holds a patient and dentist together. When the way information gets passed is careless, ineffective, or incomplete, case acceptance suffers. Patients are not feeling understood. Questions are not being asked to perceive the patient’s goals. Should those goals be shared with the dentist, the current dentist may not have the treatment-planning skills to present a course of action, or may be unable to clinically restore to the patient’s goals. 
It is possible to connect with all kinds of patients. Expressing yourself clearly the first time without overexplaining, repeating yourself, or having to answer unnecessary questions will convey that you are more influential, and more of your treatment plans will be accepted more often. You can convey warmth and caring, making it “safe” for people to open up to you. You will “hear” what people really mean, but do not always say. Polish your ability to speak the hidden languages of tone, inflection, and body position. The following 3 cases illustrate these issues. Each patient came to me with the desire for help in meeting their previously undiscovered goals.

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?)

In the consultation room, a treatment plan of 10 maxillary veneers was proposed, along with intruding her lower 4 incisors and veneering. She accepted the case and prepaid, a barometer of good communication skills. We then moved back to the operatory and polished the prototypes for her to wear home for one week. 
When she returned to the office, she was ready to continue. Ten veneers were prepared for teeth Nos. 4 through 13. Upon viewing the seated veneers 2 weeks later (Figures 4 and 5), Marylyn was “delighted.” She will continue with the lower teeth in the future. 
Marylyn was really very easy to please and a delightful person with whom to work. People of her age may not be taken seriously enough by our profession, yet, where are we told all the money resides? In her age group. Her desires were no less than anyone of any age, yet missed by her former dentist. His projection that she was not worthy of the change she wanted is a metaphor for all the other patients who are not presented care they may want, do not leave their dentist, and miss out on treatment that may be important to them.

“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.

Getting braces (Figure 9) was exciting for this lovely “senior” patient, evidenced by her comment of “being a kid again.” Once the anterior maxillary teeth were positioned, her bite was opened to the ideal, which the patient tolerated well. Her lower arch was restored first. Margery was very happy with the result of having replaced her lower partial denture and having “nice, white teeth.” After the removal of her brackets, the maxillary teeth were prepared for crowns and bridges. 

Take a look at Margery after receiving her full restoration (Figures 10 through 12) and marvel at the makeover. Wouldn’t it have been nicer for her dentist to have provided this same care years before? Could this denial of treatment have been the result of the same projection of a patient being too old for needed and wanted care?

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).

What prevented his previous dentist from providing the desired care? I called that office to inquire whether cosmetic dentistry was offered. It was. “My previous dentist never seemed interested in fixing my teeth,” was the patient’s comment. I found it difficult to understand why that dentist was not focused on providing a solution and receiving a $16,000 fee. Which skills were lacking? Again, as in the 2 previous cases, the patient had to seek help outside the original practice.

Patrick was superb to work for, as were the 2 ladies. His bite was opened in a trial with bonded occlusals of Triad rope material (DENTSPLY). The prototyping was accepted as the shape and length he desired. His restorations included an inlay-supported bridge and 14 veneers. He had no previous restorations or decay. Figures 15 and 16 show Patrick’s new CEO smile.

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.

Each of these cases exhibits the difference between needs-based and wants-based dentistry. More is being written about wants-based, but those dentists not prepared to provide such services could suffer the fate of losing the aforementioned type cases. All of the patients in these cases left their dentist of long standing. What a shame. It need not happen to any dentist if: (1) communication skills are of the highest magnitude, (2) treatment-planning skills are whole-mouth focused for comprehensive care, and (3) adequate clinical skills are available to carry out the treatment plan.
I have had occasion during numerous seminars I have facilitated over 3 years to speak with many attendees. If asked, “Do you do cosmetic dentistry?”, all answered yes. Yet, when queried about the cases completed, few had done even one 8-veneer case, and many of these same dentists had never placed a veneer. Few had opened bites or reconstructed a mouth. What happens to the patients in these practices who are ready, willing, and able to have such care rendered, but are never approached? Unfortunately, many mouths are never restored to the level the patient wants and is willing to accept. Dentistry lets down thousands of patients every year because of lack of skills or fear of rejection within our profession.
One of the major reasons patients do not receive the care they might is the fear of rejection on the part of the dentist. When I have asked countless attendees at the courses I have facilitated, “When quoting a fee to a patient, what price level makes you nervous?”, the majority said the insurance maximum or some specific price such as $2,000. Very few dentists would say no price level made them nervous.
The skills that are meaningful need to begin with you, the reader. If you fail to understand that patients come to you with the hope that you will be trustworthy, then not treatment planning to the level of their goals is untrustworthy. The fear of being rejected when quoting a fee you think is too high questions the value you place on your own dentistry. If you do not value it, how will your team value it? No matter what we do, we are communicating all the time.
Where does one acquire the needed skills to enable patients to receive the care they may want? Attending a 2-day course with clinicians such as Dr. Gordon Christensen (800-223-1230) or Dr. John Kois (800-457-9165) can enhance treatment-planning skills. Clinical skills can be mastered with live-patient hands-on courses offered by many facilitators around the country. Having provided these courses myself, I can without doubt assure you that such skills build confidence. Courses to improve communication skills are more difficult to find. Dental Boot Kamp (800-266-8526) and Sandy Roth’s Pro-Synergy (800-848-8326) do an admirable job. The Dental Learning Center (510-881-1924) offers a very focused workshop for 8 dentists learning supportive behavior skills dealing with the hopes and fears patients bring with them, enabling a patient to feel understood and accept care. These are just a few suggestions based on my recommendations. I encourage you to investigate these and other providers of such instruction.

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 cvdental@aol.com.

Disclosure: Dr. Whitehouse is founder of the Dental Learning Center, which provides communication skills workshops and cosmetic dentistry hands-on courses.