Harvey N. Silverman, DMD, FASDA, FABAD

Every dentist wants to provide their patients with caring, quality service that can restore form, function and a natural looking, pleasing smile. When we take on the responsibility of providing patients with cosmetic dentistry we directly impact their self-image. Consequently, before providing that service, we need to know as much as possible to determine if we can fulfill their expectations. Fortunately, this is easy to do if you use the following simple techniques:
	
	1. Don’t assume you know what the patient needs. For example, your patient may have a small space between the central and lateral incisors. Don’t assume that is the patient’s chief complaint. Have the patient fill out the Silverman Institute’s Smile Analysis Form. You might discover the patient has other concerns such as some small chips or uneven teeth.  
	        
	This is a valuable lesson. When it comes to cosmetic dentistry NEVER assume you know your patient’s chief complaint. Find out what it is. Hand your patient a mirror and try saying something like this:  
	
	”I reviewed your Health History and Smile Analysis Form and I noticed that there are some things you would like to change about the appearance of your teeth. Please take this mirror. Now look into the mirror and give me a big smile. Now, in your own words, please show me which teeth you would like to change.”
	
	2. Rethink case presentations. In the past your first instinct might have been that a patient needed 8 or 10 veneers to solve their cosmetic dental problem. That was then. Today, I want you to change your mind set. Don’t necessarily think of large case presentations. Not in today’s economy.  
	
	Doing an entire Smile Makeover is now more the exception than it is the rule. Instead, transform a patient’s smile with 1-2 LifeLike Veneers™ in combination with in-office whitening. If needed, do additional veneers later. Simply inform your patient PRIOR to beginning work and document that in the patient’s chart. If your patient only wants to invest in 1-2 veneers and whitening, then do it if you can achieve excellent results.
	
	3. Perform a Smile Preview prior to beginning. Some dentists prefer computer-imaging systems for demonstration purposes. Others like to do a direct mock-up, while others have their laboratory do a wax mock-up. Whatever you choose to do, use a system that allows you to accurately predict the final outcome. Share that with your patients and have them sign off on the color, size and shape they have agreed to. Having your patient sign off helps minimize any potential issues or misunderstandings. It also helps you achieve outstanding cosmetic dentistry results.

4. Use the 80% Rule. Find out as much as you can about the patient’s expectations. The Silverman Institute has found that works best when you have team members talk to Patient X while you are in another treatment room working with Patient Y. Using the Silverman Institute’s principles, 80% of the time when you are with Patient Y, someone or something is happening in your office that informs and educates Patient X about your cosmetic dental service. For example, while your receptionist is showing Patient X before/after photos of your cosmetic work, have her ask the patient what she likes or doesn’t like about the transformation. The receptionist should write that down on a piece of paper and share it with you. Now you know what potential issues need to be addressed that might not have been readily apparent. The same is true when the hygienist or assistant is talking to a patient. By the time you see the patient, the 80% rule has helped you understand potential expectation problems before discussing the case with the patient.

5. Discover and uncover. After demonstrating the Smile Preview, have your patient rate that transformation on a scale of 1 to 10. If the rating is below a 7, chances are you will not be able to meet your patient’s expectations. After discovering how enthusiastic your patient is to have work done, uncover everything your patient would like to have changed to achieve the smile he or she has always wanted. That’s easy. Simply ask.

6. Review bruxism and excursion movements to determine if your patient is a candidate. Check for wear patterns and also have your patient go into protrusive and lateral excursion movements. Look for areas that will represent stress. If you can effectively deal with these issues, go ahead and take on the case. If you anticipate that these interferences will cause ongoing chipping problems and a patient who will never be satisfied, consider advising the patient that cosmetic dentistry might not be appropriate and document in the chart that you had that conversation. Consider nightguard therapy to minimize this. Factor in compliance considerations as well.
	
	7. Under promise, over deliver. When describing how much improvement you might be able to achieve when closing a large diastema, consider recommending less improvement than you think possible. Why? Because if your patient is satisfied with 50% improvement, than anything above that (70%, etc.) will make your patient that much happier. Keep expectations reasonable. Wouldn’t you prefer to be surprised by even better results than you expected than to have greater expectations that aren’t met?
	
	8. Create natural looking veneers. Have you ever noticed someone walking in public with teeth that look “fixed?” We all have. Try to work with a dental laboratory that allows your patient to have a natural looking smile when the veneers are placed. Or consider LifeLike Veneers™ when you want to have in-office control of size, shape, color and illusion effects.
	
	9. Are fees an issue? They always are-especially in today’s economy. However, it does not have to be. Offering combination treatment that maximizes 1-2 (or more if needed) veneers with in-office whitening will help eliminate fees as an objection. Excellent cosmetic dentistry does not have to be synonymous with expensive cosmetic dentistry.

10. Take CE courses but don’t watch as the parade goes by. Don’t just sit in on CE courses and let knowledge percolate in your head. Better yet, work on becoming a leader. Share your before/after cases with the Silverman Institute and we will share them with other dentists. Excellence requires experience and experience leads to your developing expertise. Start with some simple cases that you will discover by having patients fill out the Silverman Institute’s Smile Analysis Form. Build up your own album of before and after photos. And photo document every case you do. It leads to excellence.  

Cosmetic dentistry is going to change your practice and bring more happiness to your life, your team members’ lives and most importantly, your patients’ lives. When excellence is your goal, you will enjoy every case you do. If you want to find easy ways to achieve excellence in technique or management/marketing for cosmetic dentistry, contact me and I will be happy to let you know if you are a candidate for our ONE DAY transformation program. You will be able to achieve excellence and have joy while doing it. Contact me at incrediblesmiles@aol.com with any questions and I will do my best to get back to you ASAP-and I might even answer your question in a forthcoming article.

Dr. Harvey Silverman has been inventing simplified cosmetic dentistry systems and coaching dentists/team members on how to expand their cosmetic dentistry practice since 1984. Dr. Silverman was involved in developing the original porcelain veneer system in 1983, pioneering Extreme MakeOvers in 1987, opening the country’s first dental spa in 1988, patenting one of the first OTC tooth whiteners in 1989 and developing numerous tooth whiteners and same day veneer technologies since 1990. If you want to do more cosmetic dentistry or want more information about the Silverman Institute Of Cosmetic Dentistry’s 14 Day Cosmetic Transformation Program or on the Institute’s Program on How To Double Your Cosmetic Dentistry Practice, please contact Dr. Silverman at 216-256-4599 or e-mail incrediblesmiles@aol.com.   

Articles

Every dentist wants to provide their patients with caring, quality service that can restore form, function and a natural looking, pleasing smile. When we take on the responsibility of providing patients with cosmetic dentistry we directly impact their self-image. Consequently, before providing that service, we need to know as much as possible to determine if we can fulfill their expectations. Fortunately, this is easy to do if you use the following simple techniques: