Oral Health Group

Technology: Increasing Case Acceptance With Technology

June 1, 2003
by John Jameson

Many of these information systems were big, stand-alone units that could not share information or be integrated seamlessly into a complete system. Next came technologies that allowed us to practice with video dentistry. But these early forms of video dentistry and digital radiography were stand alone units as well, which were not able to network into the patient file to store the data. In dentistry the biggest change has been the ability to take all the variety of technologies out there, from computerized periodontal probing and voice activation, to the different types of video dentistry, including intra-oral to extra-oral digital cameras and digital radiography, and integrate it, through bridges and links or management software, into the patient record. This is a technology-based integration, where digital information and photographs become part of each and every patient record.

The Place to Start


For dentists looking to integrate technology into their practices, the best place to start is with video dentistry, specifically investing in a good extra-oral digital camera. With this technology, using ring flashers or flash diffusers, you can capture great intra-oral pictures in a photographic mirror or with direct vision. Then store these images, transfer the information into the patient file, and ultimately, use image capture software to enhance the image for patient and case presentation purposes.

Using these images during case presentations will allow you to better educate your patients on their existing conditions, the types of treatment that you recommend, the benefits of proceeding with the treatment, and the downside of declining or delaying treatment. This will ultimately result in higher case acceptance. Why? Well, studies have shown that during the communications process, only 11 percent of understanding is through the actual words spoken. So when you use the traditional approach to presenting dentistry, using radiographs or diagnostic casts and verbally communicating to the patient the condition that exists and the treatment options, the patient is able to comprehend and utilize about 11 percent of what the doctor says. However, when you begin to use a monitor to show them their existing condition and show them the potential through cosmetic enhancing software or with actual cases similar to theirs and the results you were able to achieve, then you increase understanding and utilization of the information up to 83 percent. That’s a significant difference.

It makes a significant difference in case acceptance also, especially when a patient has a diseased state yet dismisses the need for treatment because they are not experiencing pain. When a patient can see what is actually going on in their mouth, understand the breakdown of old restorative materials, and visualize the early, incipient stages of this breakdown, it will be much easier for them to agree that there are benefits to proceeding with treatment.

Establishing Systems for Success

After making an investment in technology, you have to proactively integrate it into the systems of your practice to be successful. It has to be a routine step for every new patient that comes into the practice for a comprehensive oral examination or any hygienic patient that returns to the practice that has diagnosed but incomplete treatment. Each one of these patients need to have a series of images captured so you can sit down in a consultative appointment and utilize that video tool to increase case acceptance.

A common mistake that practices make is investing in an intra-oral camera but never developing the systems in the practice to maximize its effectiveness. In such cases, instead of a routine step in the patient care process, technology is used randomly. If it is inconvenient to bring into a treatment room, team members may just avoid using the technology with that patient. Then, they would eventually bypass its use with almost all patients. The technology would sit in a corner gathering dust.

To optimize technology, systems must be developed in the new-patient or returning hygiene-patient experience where we capture and store those images for every patient. It becomes part of their overall record in the practice. The next step is, as we’ve discussed, using the data collected to educate the patient. And finally, you must eliminate any other barriers to treatment acceptance. Research has shown that one of the primary reasons people decline or delay treatment, even though they understand they need it, is cost. Offering patients a financial solution through a third-party financing company, can help. After you’ve made the decision to use technology to increase productivity, don’t let patients’ concerns over paying for treatment affect the success. Technology is of little value if patients can’t accept treatment.

Another key to success is training. For most of the different technologies, there is training available from the manufacturers or from the distributing companies. Make the team available to benefit from the training because it is the only way that they are going to maximize its utilization. With proper training the team will see how much it will make day-to-day operations easier. With technology, the images we need for diagnosis can be obtained almost immediately. There’s no down time. No time spent in the dark room. No preparation time. Within seconds the image is on the monitor in the treatment room. There is no need for retakes. What we now have available is an image that we can enhance and use not only as a diagnostic tool, but also as a great patient education tool.

Once the technology becomes part of the patient routine, monitor the impact by tracking the dentistry that is diagnosed, dollar-wise, and the dentistry that is accepted. Then determine your percentage of case acceptance and evaluate the change. When considering the cost of technology, categorize it as a fixed expense, not a variable expense. When you make a commitment to keep current with technology, it is a fixed monthly expense, just like rent and payroll. By monitoring the increase in case acceptance, you will see the incremental profit generated every month above and beyond what it costs to have that technology available.

Technology as the standard of care

Today, more than 50 percent of the dental population in North America has intra-oral cameras. The number of practices integrating digital radiography is rising at a steady pace. More and more practices now have clinical workstations in the treatment rooms. Technology is becoming the standard of care in many of the elevated practices. There are many reasons to embrace it including having better control of your information for storing patient information without loss of quality over greater periods of time, being able to digitally transmit information for insurance claims and, importantly, tracking outstanding claims.

In the future, technology will bring even more change. Maybe we will be able to control our lasers through our central processing units, our CPUs, in the clinical area. We may be able to store the recording of the settings that we used on that individual patient in their file as well; and a variety of other activities that will become a part of this integrated process. It’s already apparent that practices could be virtually paperless — if they desire.

Today, because case acceptance is so important, the primary benefit of technology such as digital radiography and intra-oral cameras is that it allows us to choreograph the patient presentation more effectively. We can sit down outside the clinical area and, with the visual assistance of a computer monitor, talk about the benefits of proceeding with treatment. Then once they understand and are receptive to treatment, we need to provide patients with a choice of payment options, including a convenient monthly payment plan through a third-party financing company. You need to make it as easy as possible for patients to say “yes” to treatment.

When utilizing video dentistry, I always think during the examinations, “What image
s do I need to capture and present to my patient that creates value for my treatment recommendation so the patient will go ahead and accept treatment.” Ultimately, it’s all about helping patients get the treatment they need.

John Jameson serves as Chairman of the Board for Jameson Management, Inc., an international dental lecture and consulting firm. He has been practicing general dentistry since 1974.

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