After preparing a crown and filling a cavity, you direct your patient to the front desk, where the receptionist asks for "the total for today." The patient replies, "But I thought that I was only getting a filling!" Or worse yet, your patient is seated in the chair and you are planning to seat tooth no. 3 and prepare tooth no. 30 for a crown. The patient remarks, "I thought that we were only putting the crown in today," and now you have 1
hours of open chair time that is virtually impossible to fill.
WARM-UP
The scenarios described above can be eliminated for the most part by using what I call the "warm-up" and the "wrap-up." After the case presentation, most dentists simply assume that patients know what will be done at each visit, but they do not. Each appointment should begin with the dentist seated at the 3 o’clock or 9 o’clock position (9 o’clock for left-handed people), looking the patient straight in the eye while he or she sits upright. The dentist then should discuss the plan for that day’s appointment.
For example, "Today, we are going to be doing a crown on the upper right side and a tooth-colored filling in front of that. You will be here for about one or 1 hours; when we are done, you will have a beautiful new filling and a nice provisional crown that will be replaced at the next visit. At that appointment, I will be placing the permanent laboratory-manufactured crown, and starting some more work on the lower teeth on the same side. Do you have any questions?"
This clarifies the nature of the visit in the patient’s mind and reduces anxiety by answering any questions that he or she has about the visit. As Estep1 teaches, when we can reduce the patients’ fears by reducing their sense of mystery and allowing them some sense of control, they will relax as much as with any dose of nitrous oxide. Informed consent also is reinforced, since patients know exactly what is to be performed.1
WRAP-UP
At the end of the appointment, the dentist can say, "Today, we strengthened and prepared that upper tooth for a crown. Everything went beautifully. While there was decay, we were able to remove it with no significant problems. We then strengthened the tooth with a filling that goes under the crown. I am very pleased about the results that have been achieved. The impression is perfect. This provisional restoration will be comfortable, and, of course, I replaced the old filling just in front of it with a new tooth-colored filling, which you probably will never even know you have.
"Again, this went well and I expect you to have absolutely no discomfort at all. At our next visit, I am going to cement the permanent crown, which the laboratory will make to match your other teeth. I then will place another crown on the lower right side below it and two fillings on the same side, also tooth-colored. Everything should go as smoothly as it did today. You will be here a bit longer than today, but it should be a comfortable and easy visit. Do you have any questions?"
CONCLUSION
By doing this warm-up and wrap-up at every appointment, patients’ informed consent is reinforced. They know that their cooperation is vital, and they know what to expect today and what is going to happen at the next visit. This technique evens out a multitude of rough spots and makes for smoother sailing throughout our practice days.
