Colossal Case Acceptance The Hygienist Plays a Vital Role in Encouraging Patients to Say Yes

Dentistry Today


As dentists, we think of ourselves as technicians, health professionals, scientists, artists…not salesmen. The good news is we don’t have to be salesmen. If the entire dental visit builds, stone upon stone, up to the case presentation, the patient can’t help but say yes to the treatment we know they need.

For patients to agree to needed treatment, they must understand the problem and value the solution. They must also believe in the dentist’s skills and abilities, have a sense of urgency, and be comfortable with the practice.
Enter the hygienist. She plays a vital role in case acceptance. Usually, she spends at least twice as much time with the patient as the dentist does. The patient refers to her by first name, and likewise, the hygienist knows details about the patient’s everyday life. A few simple, well-placed phrases by the hygienist can go a long way in helping the patient understand his needs and seek a solution.

In most cases, rapport develops naturally as the patient and hygienist spend time together. Even if she doesn’t consider herself a good conversationalist, the hygienist can easily develop conversational skills. It’s important to remember that developing a rapport with patients is more about being interested than being interesting.

The most important phrase when talking to patients is “Tell me more.” For example, Joanne mentions she just returned from a ski trip. “Tell me more.” Or, Mr. Shaw just sent his last son to college. “Tell me more.” 
One caveat: be friendly, but not familiar. The patient is sitting in a dental chair with problems of his own—he doesn’t want to hear about the problems of other people.

Respectful Language
The patient doesn’t miss much of what goes on around him in the dental office. What else is he going to do while he’s waiting in the chair? Respectful interactions between dentist and hygienist communicate to the patient that he’s in good hands. The patient sees that the dentist is thrilled with the staff he’s hired, and the staff feel privileged to work here. Must be a good place. Respectful language between these 2 professionals is the background against which the rest of the visit plays out.

The hygienist shows respect for both patient and dentist when she smoothes the transition to the dentist. For example, she might tell the dentist, “As I was cleaning Mary’s teeth, I noticed that some of her older fillings are breaking down. She mentioned to me that she is very concerned about preventing emergencies down the road. I said that you would be happy to discuss a long-term plan for her dental health.” The dentist, hygienist, and patient are now all on the same page. 
If he’s smart, the dentist will take advantage of the fact that the patient and hygienist have spent some time together and have a relationship. Questions directed toward the hygienist, such as “How does Mrs. Johnson’s periodontal evaluation look today?” and “What did you find in the charting?” go a long way toward establishing a respectful atmosphere.

Ownership of the Problem
Patients aren’t interested in the solution until they understand they have a problem. Don’t tell them to floss more—that’s a solution. They may not even be aware there’s a problem.

As master hygienist Deborah Hartley ( is scaling teeth, she might say, “I really want the doctor to see this today,” or “Things are breaking down.” Saying such remarks out loud, instead of simply making mental notes, gives the patient a chance to think about it and actively seek a solution. Once the patient takes ownership of the problem, he will want to know what he can do about it. If the patient’s dental situation is worsening, letting him know creates a sense of urgency. “If I don’t do something now, it will get progressively worse each time,” he thinks.
Other dental possibilities, such as cosmetic concerns, may not be urgent, but could benefit the patient greatly. The hygienist can approach any topic with the patient using careful phrasing. For example, if the patient’s teeth are discolored and could benefit from whitening, a general question like “Is there anything that concerns you about the appearance of your teeth?” could be to the point without being offensive.

Confidence in the Dentist
Have you ever recommended your favorite restaurant to friends, only to find out that they considered it mediocre? You might have been surprised that you felt a little offended. You were offended not because they were commenting negatively on the restaurant, but because they were commenting negatively on your decision making.

On the other hand, if this friend called you and thanked you for the recommendation, adding that he planned to take all his future clients there, you couldn’t help but feel a sense of pride. This same kind of reinforcement can be applied to the patient’s decision making, thereby enabling him to make further positive decisions for his dental health.
The hygienist can support the patient in his choices by letting him know that he picked the right dentist. For example, the hygienist might tell the patient, “Dr. Thompson is an expert at this treatment. She does beautiful work and uses only the best labs. She’s a great dentist because she’s so particular.” Not only does an affirmation like this instill confidence in the patient, but it also is a compliment on his excellent choice of dentists.

Comfort Level
Many times, a patient will listen in silence to the dentist’s recommendations. But that doesn’t mean he understands or is in agreement with the treatment plan. The hygienist can give him an opportunity to find out more by asking this all-important question after the dentist leaves the room: “How do you feel about all this? Do you have any questions or concerns?”

Perhaps the patient feels he can’t afford the recommended treatment, but he didn’t want to risk raising “petty concerns” to the dentist. By drawing this out of the patient, the hygienist can ease his fears by assuring him that financial plans are available to help him comfortably afford care. Or the patient may raise issues about terminology he doesn’t understand, or whether the treatment is really necessary. Whatever you do, don’t fail to give the patient a final chance to clear up misconceptions.
The bottom line is that sales techniques used in a dental office only leave the patient feeling “sold” and unlikely to accept treatment. (Let’s say the patient does accept treatment and it doesn’t feel exactly like it should, or he’s not 100% happy with it. He’s upset with you. After all, you “sold” it to him!) “Selling” in a dental office is really encouraging the patient to have confidence in his decision making to accept the very best.

The hygienist is in a unique position within the practice to play a vital role in informing patients about their dental problems, building rapport, increasing the patients’ comfort level, supporting the dentist, and thereby increasing case acceptance.

Dr. Wahl and Ms. Hollett of Office Magic are sought-after speakers and the developers of the Colossal Case Acceptance system. Sign up for their free newsletter at