Is dentistry moving in reverse?

April 1, 2019

How to drive patient recommendations forward.

When I was in third grade, I became a junior Girl Scout. As a wildly driven scout who had just received her bright green sash, I was determined to bedizen my sash with every patch available. With ease I received my badge for animal care, fitness and even gardening - a badge that, given my inability to keep a cactus alive in the desert, should have been withheld from my sash. Despite my gumption to receive every badge possible, I gave two green thumbs down for anything having to do with auto mechanics or auto repair. I’d rather make friendship bracelets, sell lemonade on the corner, or play checkers at the local senior living facility.

Nevertheless, I was determined to receive every badge I could. I patiently watched as my dad showed me how to perform an oil change on his 1985 Oldsmobile Cutlass Sierra. I memorized appropriate tire pressures and independently filled up my mom’s 1989 Plymouth Voyager with a full tank of gas. I hated every minute of it, but I proudly earned my auto mechanics badge.

More than two decades later, I’d still rather make friendship bracelets or sell lemonade or kill a cactus in the backyard than deal with my vehicle. While taking my vehicle in for an oil change recently, I went through the all-too-familiar motions of pretending I knew what the technician was talking about. Through “mhmms” and “I sees,” I pretended I knew what was going on when really I just needed to know what my bottom line and next steps were. While I felt like a dipstick (pun intended) around understanding vehicles, I believe many patients feel just as confused about their dental needs and, in turn, rely on dental professionals to deliver the bottom line.

I soon realized that in many ways, the automobile industry has unique aspects about it that can teach us so much about how to deliver our recommendations and bottom line in a respectful and streamlined way. In some ways, one could argue that people treat their vehicles with more care and financial investment than they do their dental health.

So here it is: an unpopular opinion about how the automobile industry is driving forward while dentistry is stuck in reverse.

We maintain our vehicles

Research has clearly defined the importance of customizing our treatment plan recommendations based on the unique needs of our patients.

As such, our dental protocols continue to stress the importance of understanding risk assessment in our patients. Patients who present with familial history, certain systemic diseases, advanced grades of periodontitis, poor oral hygiene, xerostomia, or other contributory factors are considered to be at an elevated risk for dental disease. We’re taught to educate patients on ways to manage this risk, whether through shorter hygiene recalls, integration of remineralization therapies, investment in oral hygiene tools or products, or implementation of active therapy.

Similarly, I bring my vehicle in for oil changes. The frequency with which I bring in my vehicle has nothing to do with the amount of time between oil changes but rather the mileage and wear I’ve put on my engine. I’d imagine I bring my vehicle in more frequently for oil changes because I drive quite a bit for work. The understanding that my vehicle requires more frequent maintenance work due to the wear and tear I put on it makes sense, yet I believe many patients struggle to understand the customized maintenance their oral conditions require due to the wear and tear inflicted by their presenting risk factors.

Now more than ever, patient education is imperative; however, not all patient education is the same. The ability for the dental provider to relate his or her educational delivery back to the patient is of upmost importance. This requires a deep understanding of our patients’ familial history, genetic predispositions, comprehensive dental history, thorough medical history, list of medications, nutritional status and oral hygiene habits. Only then can we thoroughly and comprehensively evaluate, educate and deliver customized care based on our patients’ unique needs.

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We’re insured

Most, if not all, states require some form of insurance in order to safely operate a motor vehicle. Within the spectrum of auto insurance, premiums vary depending on a multitude of factors. A 20-year-old male with poor credit and a wreck less driving history will pay a significant higher premium than a 40-year-old female with stable credit and impeccable driving history. One speeding ticket or fender bender will significantly drive up insurance premiums because insurance companies have taken the time to evaluate their risk of insuring their clients.

In fact, in many ways, health insurance has followed suit. A healthy woman of child-bearing age will pay a higher premium over a healthy male of the same age. Smoking risk factors may play a role, and the ongoing concerns with pre-existing conditions have become significant factors in the overall premium a client will pay to ensure coverage.

In contrast, dental insurance premiums continually increase without consideration for risk factors. Rather, exclusions, waiting periods, missing tooth clauses and uncovered benefits plague the dental industry, leaving patients (and many dental offices) with a poor understanding of how - or if - their insurance works for them.

It’s time that dentistry change the culture and understanding we provide when it comes to maximizing insurance benefits. Clarifying for patients that your recommendations are made in their best interest and that there’s an entire team dedicated to maximizing their insurance benefits often clarifies for patients that while their insurance is accepted, it certainly will not be the driver (pun intended) in your clinical decision making.

We don’t expect our insurance to cover maintenance or cosmetic procedures

As I concluded my oil change appointment, I found myself paying for the premium oil, the oil change and an air filter change. It didn’t occur to me to ask the mechanic if my automobile insurance would cover this maintenance procedure. Nevertheless, I know that if I don’t maintain my vehicle with these services, I’m likely looking at a larger bill and an incredible inconvenience when my engine explodes. (That’s what happens when you don’t change your oil, right?) Because of this, I recognize the importance of maintaining my vehicle now to prevent future problems down the road (pun intended … sort of).

Also, living in Phoenix, Arizona, means you automatically have your car windows tinted before you roll it off the lot. In addition, headlights, adding a moon roof, sporting a spoiler, new tire rims, and unique paint or seat covers are ways to cosmetically enhance a vehicle. No one would ever expect to bill his or her automobile insurance for adding a spoiler to his or her car, yet dental patients continually ask why their dental insurance doesn’t cover cosmetic veneers or whitening procedures.

Have we simplified dentistry so much for our patients that they no longer understand or value the work we do to diagnose, prevent, arrest, or treat their ongoing dental disease?

I’ll give an example: my boyfriend pays less than $15 per month for dental insurance. For this, he receives his two “free cleanings” (goosebumps, anyone?), radiographs and examinations covered at 100 percent as well as a $1,500 annual maximum on dental work. For less than $200 per year, he receives nearly 10 times that in dental benefits. I’m confident that patients must think there’s a magical tree that wires invisible money to their dental office, otherwise this should make no sense. Conversely, my boyfriend pays less than $200 per month for automobile insurance that covers none of his vehicle maintenance and, quite frankly, hasn’t been used in years due to his “good” driving record (sometimes I think he drives too slowly, but that’s a topic for another article perhaps).

We understand how important it is to ensure our vehicle drives with four tires, yet patients “thrive” for years without posterior molar occlusion. We upgrade the stereos in our vehicles, but patients complain when their 20-year-old amalgams need to be replaced. We pay to take our vehicles through a car wash, yet patients decline fluoride varnish therapy.

I believe the financial recession of 2008 led so many dental professionals to the belief that patient refusal is largely based on finances, or the lack thereof. I beg to differ. I believe it’s based on value, or the lack thereof.

Conclusion

Whether in a fee-for-service office or one in which the patient population is highly insurance driven, one thing remains the same: we have a responsibility to ethically address and treat the dental needs of our patients to the greatest of our ability. I believe that all too often insurance has a greater influence on the dental provider’s recommendations and, in turn, dictates our own standards of excellence rather than supporting patients in seeking and completing necessary dental care.

During my time as a junior Girl Scout, I learned one of the most important mantras of Girl Scouts: always leave something better than when you found it. Whether it was cleaning a classroom space we used or raking leaves for the elderly, we were taught that we have a beautiful opportunity to make a positive and lasting impact on our community.

My advice to you is make sure your patients leave your operatory better than when you found them. Keep your standards high and remain unwavering in your recommendations based on excellence. This, my friends, is the only way we’ll collectively move our industry into the future.