How to treatment plan

Treatment planning is the key step to achieving a successful outcome for your patients. If you get your plan wrong at the start, you’ve set yourself up to fail. No matter how amazing your clinical skills are, no matter how beautiful your dentistry is, if you are providing the wrong treatment it is not going to work. So why do so many dentists rush their treatment plan?

I think that some dentists feel embarrassed if they don’t know what to do. We feel that we should be able to pluck a treatment plan out of the air in an instant, no matter how complex the case. Most of the time, we can do this. When a patient presents with a problem, we often know what to do before the patient has hung up their coat. (This is quite a skill by the way. Don’t forget how you are able to solve most of your patient’s problems with effortless skill.)

When a patient comes in with a problem that stumps us, we are afraid of showing it. We are afraid of being human rather than dental gods. Oh crikey, I’m not sure what to do here. Can we bridge this gap? Can we even restore this one? I don’t know. Nuts!

We start to treatment plan out loud. ‘Well, Mrs Smith, we could root canal treat that tooth but it’s quite wobbly and I’m not sure if we have enough tooth left to work with. We could try whitening this tooth afterwards but that’s less predictable than a veneer. If this one breaks then there’s no point in the whitening because we need to do a bridge. That’s going to be the most expensive option but it might work.’

We’re desperately scratching around for the correct treatment plan or worse, we are asking the patient to treatment plan it themselves. This simply won’t do. There’s nothing wrong with not knowing the best treatment plan straight away but there is a lot wrong with cobbling together an inappropriate treatment plan on the spot.

So lets work out what we need to do when we next meet that patient who poses us a conundrum.

Mr Peters

Complex dental patients take time to treatment plan.

Mr Peters is a new patient. He’s in the chair. You’ve been staring into his mouth for the last 8 minutes thinking ‘Oh sausages, I don’t know where to start’. What do you do?

You need to give yourself some time. If there are any immediate problems such as pain, you do what you can to address those but if there are no immediate problems then do not be rushed. You tell the patient that their case is complex and you want to give it the attention it deserves to plan it appropriately.

Patients always understand. They don’t want you to dive in with an ill-considered treatment plan. They want you to get it right even more than you do. Tell them that you need to gather some information to address the complexities of their case and take time to find the most appropriate plan.

Then you need to gather that info. Take your x-rays. Make sure you’ve got all of the gingival scores you need. Get as much info as you can. You might need a set of clinical photos or study models. Don’t let the patient out of your site until you have what you’re going to need to make a treatment plan.

The most important bit of information

The most important bit of info you need is what the patient wants to achieve. The patient may have already told you this but make sure that you know what they want before they leave. They may want their dream smile. They may want all of their teeth out. They may just want to secure the health of their teeth without any care for the appearance. Now, the patient’s expectations may be unrealistic or inappropriate. At this stage, that is not important. However, it is of vital importance that you know what your patient wants before you try to plan their treatment. Ask the patient to come back in around 2 weeks when you will be better prepared to discuss their options.

WARNING!

Please note, if the patient is unwilling to give you the chance to consider their case, they are not a patient that you want to be treating. Don’t be bullied into discussing treatment or costs before you are prepared. You’ll talk yourself into a corner that you may struggle to get out of.

Planning

When you give yourself time to plan a complex case, it will often appear much simpler than you first thought. In the moment, so many options appear in your head that you are swamped. But after the patient has gone and you consider their teeth, the best way forward starts to appear.

You also have time to consider how long this treatment is going to take and what you need to charge. When you try to treatment plan on the spot, you often miss something which leads to an unexpected problem popping up in the middle of treatment. This means you’ve undercharged for the case at the start and either fix the unexpected problem for free, cut corners or hand the patient an extra bill that damages good will. Nobody wins.

Take your time on planning. Think about what might go wrong and what might be required to put it right. This means that you are then prepared for a full and frank conversation about the benefits and risks of any plan.

There’s no such thing as a perfect treatment plan. There are benefits and risks to any dental treatment and the risks have to be weighed up. Sometimes there may be elements of the plan that you think could fail in the short to medium term but are worth a try to avoid a more radical option. As long as you make the patient aware of this at the start, I have no problem with a treatment plan with compromises. Sometimes you have to be an imperfectionist.

The sales coaches and quick fix ortho companies

‘Never let a patient leave without getting their commitment.’ That is the mantra of ever sales coach and every company with a short term ortho system to flog. They want you to give the hard sell and make sure that the patient is signed up before they leave your sight. The problem with this approach is that if the patient is committed then so are you.

So you go on your weekend ortho course, you’re back in work the next week and your new patient, Susan, wants straight teeth. You do what you were taught at the weekend and get her signed up, impressions taken and deposit winging its way to your bank account.

You get home that night and look through Susan’s photos and notice that she has a posterior cross-bite. Now you’re panicking, thinking ‘How the heck do I treat that? I’ve never even fitted a bracket before.’ The case is suddenly a lot trickier than you realised. You’re now in the position where you have a patient expecting treatment (that you sold to them) beyond your competency.

The sales coach or short term ortho company don’t care about your predicament by the way. They’ve already been paid. They’ve turned you into a sales rep for their company, flogging units. They don’t care when you get yourself into a sticky situation that causes a complaint or even risks your registration.

You should never sell to your patients.

I’m not saying don’t try your hand at new things. It’s great to learn new clinical skills and learning to use simple orthodontic systems is a valuable string to your bow. However, having done several courses with these types of companies, you quickly realise that they are more keen on teaching you sales than orthodontics. Please don’t be indoctrinated. Think for yourself and pick the cases that allow you to learn without getting you into hot water. Don’t act like a sales rep.

Failing to plan is planning to fail

You must have heard that before? It applies to pretty much anything and it certainly applies when planning complex dental treatments for your patients. So the next time you see a complex patient and you do not know what to do, buy yourself some time. Tell them that their case is complex and requires detailed planning. Gather the information and find out what the patient wants from treatment. Give yourself a couple of weeks to mull things over so that when you next see the patient, you can have a full and frank discussion with the patient and decide on a treatment plan that is best for them.

Follow Andrew via email

Enter your email address to hear about Andrew's latest posts by email.