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The Exceptional Patient Experience T h e Va l u e s B a s e d D e n t a l P r a c t i c e
William T. Brown, D.D.S.
Friday, February 22, 13
Introductions
2Friday, February 22, 13
Introductions
Introduce yourself and
2Friday, February 22, 13
Introductions
Introduce yourself and
What influenced you to go into the Dental Profession?
2Friday, February 22, 13
Bill Brown
3Friday, February 22, 13
Bill BrownWho am I?
3Friday, February 22, 13
Bill BrownWho am I?
3Friday, February 22, 13
Bill BrownWho am I?
3Friday, February 22, 13
Steps in achieving workshop goals:
4Friday, February 22, 13
Steps in achieving workshop goals:
“IS”
4Friday, February 22, 13
Steps in achieving workshop goals:
“IS”
“WAS”
4Friday, February 22, 13
Steps in achieving workshop goals:
“IS”
“WAS”
“MIGHT BE”
4Friday, February 22, 13
My Goal is that Each of You Will:
5Friday, February 22, 13
My Goal is that Each of You Will:
5Friday, February 22, 13
My Goal is that Each of You Will:
Identify some change you want to make
5Friday, February 22, 13
My Goal is that Each of You Will:
Identify some change you want to make
Understand COHC
5Friday, February 22, 13
My Goal is that Each of You Will:
Identify some change you want to make
Understand COHC
Develop & use your philosophy as a communication tool.
5Friday, February 22, 13
My Goal is that Each of You Will:
Identify some change you want to make
Understand COHC
Develop & use your philosophy as a communication tool.
Conduct exams that influence attitudes & monitor oral health.
5Friday, February 22, 13
My Goal is that Each of You Will:
Identify some change you want to make
Understand COHC
Develop & use your philosophy as a communication tool.
Conduct exams that influence attitudes & monitor oral health.
Have you leave with an idea of your next step.
5Friday, February 22, 13
BRAINSTORMING
6Friday, February 22, 13
BRAINSTORMING
For Change:
6Friday, February 22, 13
Change
7Friday, February 22, 13
Change
“Everyone thinks of changing the world, but no one thinks of changing himself.” - Leo Tolstoy.
7Friday, February 22, 13
8Friday, February 22, 13
An EXPERIMENTAL ATTITUDE
8Friday, February 22, 13
Key Elements:
9Friday, February 22, 13
Key Elements:
Core Beliefs that are understandable & repeatable by staff & patients.
9Friday, February 22, 13
Key Elements:
Core Beliefs that are understandable & repeatable by staff & patients.
Establishing Effective Doctor-Patient Relationship.
9Friday, February 22, 13
Key Elements:
Core Beliefs that are understandable & repeatable by staff & patients.
Establishing Effective Doctor-Patient Relationship.
Involving Patients in a Health Story.
9Friday, February 22, 13
Key Elements:
Core Beliefs that are understandable & repeatable by staff & patients.
Establishing Effective Doctor-Patient Relationship.
Involving Patients in a Health Story.
Dental Metrics to Monitor Patient Progress.
9Friday, February 22, 13
10
A Personal Story
Friday, February 22, 13
10
A Personal Story
Diagnosed with gingivitis at age 28
Friday, February 22, 13
11
A Personal Story
Diagnosed with gingivitis at age 28
Friday, February 22, 13
11
A Personal Story
Diagnosed with gingivitis at age 28
I was shocked!
Friday, February 22, 13
I thought I had a healthy mouth
12
A Personal Story
Friday, February 22, 13
I thought I had a healthy mouthThis revelation caused me to change
12
A Personal Story
Friday, February 22, 13
I thought I had a healthy mouthThis revelation caused me to change I needed to find the cause
12
A Personal Story
Friday, February 22, 13
13
From My Own Life,My Conclusions:
Friday, February 22, 13
13
From My Own Life,My Conclusions:
Interruption of a disease process
Friday, February 22, 13
13
From My Own Life,My Conclusions:
Interruption of a disease process
Patients were responsible for their oral health
Friday, February 22, 13
13
From My Own Life,My Conclusions:
Interruption of a disease process
Patients were responsible for their oral health
And not “Objects of Treatment”
Friday, February 22, 13
13
From My Own Life,My Conclusions:
Interruption of a disease process
Patients were responsible for their oral health
And not “Objects of Treatment”
NEW SYSTEMS NEEDED
Friday, February 22, 13
14
The Result of My Learning & Influences”
Friday, February 22, 13
14
The Result of My Learning & Influences”
c o m p r e h e n s i v e o r a l h e a l t h c a r e
Friday, February 22, 13
Knowledge is Empowering
Critical Issue
15Friday, February 22, 13
16
Studied causes of my problem
Friday, February 22, 13
16
Studied causes of my problem
Bacterial plaques
Friday, February 22, 13
16
Studied causes of my problem
Bacterial plaques
Mechanical removal
Friday, February 22, 13
16
Studied causes of my problem
Bacterial plaques
Mechanical removal
Unmanageable areas manageable
Friday, February 22, 13
16
Studied causes of my problem
Bacterial plaques
Mechanical removal
Unmanageable areas manageable
The cause of man’s most common disease was bacterial plaques
Friday, February 22, 13
17
Dr. C.C. Bass
Dr. C.C. Bass in his dental laboratory
Friday, February 22, 13
Bacteria settle on the teeth and organizes to cause disease
18
What He Found Out:
Dr. C.C. Bass in his dental laboratory
Friday, February 22, 13
I incorporated the Bass techniques personally, and my periodontal disease was controlled in less than a month
19
Dr. C.C. Bass
Friday, February 22, 13
I incorporated the Bass techniques personally, and my periodontal disease was controlled in less than a month
This personal experience and epiphany was a revelation that I knew I had to share with my patients
19
Dr. C.C. Bass
Friday, February 22, 13
20
Comprehensive Oral Health Care
Friday, February 22, 13
20
Comprehensive Oral Health Care
Resulted from experience & influences
Friday, February 22, 13
20
Comprehensive Oral Health Care
Resulted from experience & influences
Dentistry is a dynamic evolving science
Friday, February 22, 13
20
Comprehensive Oral Health Care
Resulted from experience & influences
Dentistry is a dynamic evolving science
Shift from techniques to dental team
Friday, February 22, 13
The Five Components of COHC
21Friday, February 22, 13
The Five Components of COHC
21
humanistic
Friday, February 22, 13
The Five Components of COHC
Humanistic
Friday, February 22, 13
The Five Components of COHC
Humanistic- Importance of patient involvement in oral health care
Friday, February 22, 13
The Five Components of COHC
Humanistic- Importance of patient involvement in oral health care
- What a patient does every day is more important than what is done in the dental office two or more times a year
Friday, February 22, 13
The Five Components of COHC
Humanistic- Importance of patient involvement in oral health care
- What a patient does every day is more important than what is done in the dental office two or more times a year
- Avoid treating patients as objects
Friday, February 22, 13
The Five Components of COHC
23
humanistic
Friday, February 22, 13
The Five Components of COHC
23
humanistic
biologic
Friday, February 22, 13
The Five Components of COHC
24
Biologic
Friday, February 22, 13
The Five Components of COHC
24
Biologic- Understand basic biology
Friday, February 22, 13
The Five Components of COHC
24
Biologic- Understand basic biology
- Oral Cavity-Organ System
Friday, February 22, 13
The Five Components of COHC
25
Health Plans Expand Dental BenefitsStudies Linking Gum Disease To Health Problems Spur New Focus on Preventive Treatments
Friday, February 22, 13
The Future
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
Relationships between Perio Disease and :
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
Relationships between Perio Disease and :
• CV Disease
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
Relationships between Perio Disease and :
• CV Disease
• Diabetes
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
Relationships between Perio Disease and :
• CV Disease
• Diabetes
• Pre-Term and/or Low Birth Weight Babies
26Friday, February 22, 13
The Future
Picture a world where dentists are the entry point in the health care system.
Relationships between Perio Disease and :
• CV Disease
• Diabetes
• Pre-Term and/or Low Birth Weight Babies
• Salivary Diagnosis
26Friday, February 22, 13
The Five Components of COHC
27
humanistic
biologic
Friday, February 22, 13
The Five Components of COHC
27
humanistic
biologic
diagnostic
Friday, February 22, 13
Diagnosis
28Friday, February 22, 13
Diagnosis
28
Diagnosis is the reason for professional education
Friday, February 22, 13
Diagnosis
28
Diagnosis is the reason for professional education
Diagnosis is based upon COE
Friday, February 22, 13
Diagnosis
28
Diagnosis is the reason for professional education
Diagnosis is based upon COE
Friday, February 22, 13
The Five Components of COHC
29
humanistic
biologic
diagnostic
Friday, February 22, 13
The Five Components of COHC
29
humanistic
biologic
diagnostic
therapeutic
Friday, February 22, 13
The Five Components of COHC
30
Therapeutic
Friday, February 22, 13
The Five Components of COHC
30
Therapeutic
- Importance of providing the patient with comfort, function and a good appearance
Friday, February 22, 13
The Five Components of COHC
30
Therapeutic
- Importance of providing the patient with comfort, function and a good appearance
- Therapy is based on the information gathered in the examination/diagnostic phase.
Friday, February 22, 13
The Five Components of COHC
31
humanistic
biologic
diagnostic
therapeutic
Friday, February 22, 13
The Five Components of COHC
31
humanistic
biologic
diagnostic
therapeutic PHILOSOPHY
Friday, February 22, 13
Philosophy:
32Friday, February 22, 13
Philosophy:
32
The “glue” that holds the components of COHC together
Friday, February 22, 13
Philosophy:
32
The “glue” that holds the components of COHC together
Used as a communication & management tool with staff and patients
Friday, February 22, 13
Philosophy:
32
The “glue” that holds the components of COHC together
Used as a communication & management tool with staff and patients
- Should be easy to explain & repeatable by patients & staff.
Friday, February 22, 13
Philosophy:
32
The “glue” that holds the components of COHC together
Used as a communication & management tool with staff and patients
- Should be easy to explain & repeatable by patients & staff.
- Can be a roadmap.
Friday, February 22, 13
Comprehensive Oral Examination
PHILOSOPHY
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
34
This is NORMAL
The Gold Standard!
Friday, February 22, 13
35
Bleeding Is Not Normal
This is average, but not normal
Friday, February 22, 13
36
Comprehensive Oral Examination
System development
Friday, February 22, 13
36
Comprehensive Oral Examination
System development
- COE
Friday, February 22, 13
36
Comprehensive Oral Examination
System development
- COE
- Baseline data
Friday, February 22, 13
36
Comprehensive Oral Examination
System development
- COE
- Baseline data
- Quantify monitoring progress
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
- Involves patient in a HEALTH STORY
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
- Involves patient in a HEALTH STORY
- COE is what’s best for your patients
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
- Involves patient in a HEALTH STORY
- COE is what’s best for your patients
- COE is a powerful non-verbal communication tool you’re thorough
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
- Involves patient in a HEALTH STORY
- COE is what’s best for your patients
- COE is a powerful non-verbal communication tool you’re thorough
- Co-Dx can break the “preoccupation barrier”
Friday, February 22, 13
37
Comprehensive Oral Examination
Benefits
- Involves patient in a HEALTH STORY
- COE is what’s best for your patients
- COE is a powerful non-verbal communication tool you’re thorough
- Co-Dx can break the “preoccupation barrier”
- Check list - Don’t land with wheels up! Friday, February 22, 13
38
Comprehensive Oral Examination
Friday, February 22, 13
Additional benefit: what’s best for the patient
38
Comprehensive Oral Examination
Friday, February 22, 13
Additional benefit: what’s best for the patient
What would you do for a member of your family?
38
Comprehensive Oral Examination
Friday, February 22, 13
39
Comprehensive Oral Examination
Friday, February 22, 13
Additional benefit
39
Comprehensive Oral Examination
Friday, February 22, 13
Additional benefit
- Change in dentist’s image
39
Comprehensive Oral Examination
Friday, February 22, 13
40
Comprehensive Oral Examination
Yields benefits to patient and practitioner
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
40
Comprehensive Oral Examination
Yields benefits to patient and practitioner
A powerful nonverbal communication of your sincere desire to be thorough and complete in your procedures
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
41
Comprehensive Oral Examination
Instantly communicates to your patient that your practice is exceptional
Friday, February 22, 13
41
Comprehensive Oral Examination
Instantly communicates to your patient that your practice is exceptional
Establishes a new rapport
Friday, February 22, 13
42
Comprehensive Oral Examination
Is the only method:
Friday, February 22, 13
42
Comprehensive Oral Examination
Is the only method:
- To find all the patient’s needs
Friday, February 22, 13
42
Comprehensive Oral Examination
Is the only method:
- To find all the patient’s needs
- Dentist’s moral, legal obligation, and responsibility
Friday, February 22, 13
43
Comprehensive Oral Examination
Can you imagine a physician’s Physical Exam:
Friday, February 22, 13
43
Comprehensive Oral Examination
Can you imagine a physician’s Physical Exam:
Without measuring blood pressure
Friday, February 22, 13
43
Comprehensive Oral Examination
Can you imagine a physician’s Physical Exam:
Without measuring blood pressure
- Without weighing you
Friday, February 22, 13
43
Comprehensive Oral Examination
Can you imagine a physician’s Physical Exam:
Without measuring blood pressure
- Without weighing you
- Or listening to your heart and lungs
Friday, February 22, 13
43
Comprehensive Oral Examination
Can you imagine a physician’s Physical Exam:
Without measuring blood pressure
- Without weighing you
- Or listening to your heart and lungs
Preposterous for “RD” to perform the above procedures, but not record them
Friday, February 22, 13
44
Comprehensive Oral Examination
As many procedures as there are dentists
Friday, February 22, 13
44
Comprehensive Oral Examination
As many procedures as there are dentists
- My procedure evolved over many years
Friday, February 22, 13
44
Comprehensive Oral Examination
As many procedures as there are dentists
- My procedure evolved over many years
- You decide what might work for you
Friday, February 22, 13
44
Comprehensive Oral Examination
As many procedures as there are dentists
- My procedure evolved over many years
- You decide what might work for you
- My COE can serve as a matrix or outline
Friday, February 22, 13
44
Comprehensive Oral Examination
As many procedures as there are dentists
- My procedure evolved over many years
- You decide what might work for you
- My COE can serve as a matrix or outline
- COE is culmination of many different sources
Friday, February 22, 13
With COE:
Baseline data allows us to determine patient progress.
45Friday, February 22, 13
46
Comprehensive Oral Examination
Barkley, Kohn, and Burns
Dr. Robert Barkley, DDS
Friday, February 22, 13
47
Elements of COE
Friday, February 22, 13
47
Elements of COE
Orientation
Friday, February 22, 13
47
Elements of COE
Orientation
Clinical
Friday, February 22, 13
47
Elements of COE
Orientation
Clinical
Radiographic/Digital (CBCT?)
Friday, February 22, 13
47
Elements of COE
Orientation
Clinical
Radiographic/Digital (CBCT?)
Treatment planning
Friday, February 22, 13
47
Elements of COE
Orientation
Clinical
Radiographic/Digital (CBCT?)
Treatment planning
Consultation
Friday, February 22, 13
Elements of COE - Orientation
48
Medical / DentalHistory
Friday, February 22, 13
Elements of COE - Orientation
49
Non-ThreateningEnvironment
Friday, February 22, 13
Elements of COE - Orientation
49
You are what the patient experiences
Non-ThreateningEnvironment
Friday, February 22, 13
Elements of COE - Orientation
50
Interview
Friday, February 22, 13
Elements of COE - Orientation
51
Philosophical Agreement
- not byacquiescence
Friday, February 22, 13
Elements of COE - Orientation
52
PatternedInterview
How can I help you? _______________________________________________________Review medical history. ___________________________________________________Age of first dental appointment. ___________________________________________Any history of bad experiences. ___________________________________________Was care regular? __________ How much care was needed?__________________Are parents living? _______________________________________________________What is parents’ dental condition and care habits? Edentulous? _____________What is / was brothers’ / sisters’ dental condition and care habits? Edentulous? ________________________What is / was spouse’s dental condition and care habits? Edentulous? ______________________________What is / was children’s dental condition and care habits? Edentulous? __________________________________How would you describe your present dental health? Good Fair PoorWhat has the past five years’ care been? ____________________________________Do you think your dental disease is active or controlled? ____________________Have you been taught to control it? ________________________________________How do you feel about ever losing your teeth? ______________________________Two main goals of practice? _______________________________________________Any problems to handle today? ____________________________________________
Orientation - Dental History
Friday, February 22, 13
Elements of COE - Orientation
53
Mantra for new patients
Friday, February 22, 13
Elements of COE - Orientation
53
Mantra for new patients
“We have unconditional amnesty for dentist evaders.”
Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
- Review medical history.
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
- Review medical history.
- Age of first dental appointment.
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
- Review medical history.
- Age of first dental appointment.
- Any history of bad experiences?
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
- Review medical history.
- Age of first dental appointment.
- Any history of bad experiences?
- Was your care regular? How much was needed?
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How can I help you?
- Review medical history.
- Age of first dental appointment.
- Any history of bad experiences?
- Was your care regular? How much was needed?
- Are your parents living? Parents dental conditions & habits? Edentulous?
54Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- What is/was your brother’/sisters’ dental condition & care habits? Edentulous?
55Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- What is/was your brother’/sisters’ dental condition & care habits? Edentulous?
- What is/was your spouses’ dental condition & care habits? Edentulous?
55Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- What is/was your brother’/sisters’ dental condition & care habits? Edentulous?
- What is/was your spouses’ dental condition & care habits? Edentulous?
- What are your children’s dental condition & care habits? Edentulous?
55Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How would you describe your present dental health? Good, Fair, Poor?
56Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How would you describe your present dental health? Good, Fair, Poor?
- What has the last five years’ care been?
56Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How would you describe your present dental health? Good, Fair, Poor?
- What has the last five years’ care been?
- Do you think your dental disease is active or controlled?
56Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How would you describe your present dental health? Good, Fair, Poor?
- What has the last five years’ care been?
- Do you think your dental disease is active or controlled?
- Have you ever been taught to control it?
56Friday, February 22, 13
Elements of COE - Orientation
Specific comments:
- How would you describe your present dental health? Good, Fair, Poor?
- What has the last five years’ care been?
- Do you think your dental disease is active or controlled?
- Have you ever been taught to control it?
- How do you feel about ever losing your teeth?
56Friday, February 22, 13
Elements of COE - Orientation
57Friday, February 22, 13
Elements of COE - Orientation
57
CRITICAL POINT
Friday, February 22, 13
Elements of COE - Orientation
57
Two main goals of practice:
CRITICAL POINT
Friday, February 22, 13
Elements of COE - Orientation
57
Two main goals of practice:1. Never lose your teeth.
CRITICAL POINT
Friday, February 22, 13
Elements of COE - Orientation
57
Two main goals of practice:1. Never lose your teeth.2. Ultimately lower the incidence
of dental repair
CRITICAL POINT
Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
58Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
- Agreement on the basics before proceeding - not by acquiescence
58Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
- Agreement on the basics before proceeding - not by acquiescence
- Establish common reference point - agree philosophically
58Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
- Agreement on the basics before proceeding - not by acquiescence
- Establish common reference point - agree philosophically
- New doctor patient relationship
58Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
- Agreement on the basics before proceeding - not by acquiescence
- Establish common reference point - agree philosophically
- New doctor patient relationship
- Personal dental health awareness
58Friday, February 22, 13
Elements of COE - Orientation
Orientation accomplishes:
- Agreement on the basics before proceeding - not by acquiescence
- Establish common reference point - agree philosophically
- New doctor patient relationship
- Personal dental health awareness
- New insight and understanding
58Friday, February 22, 13
Elements of COE - Orientation
59
Establish a Relationship
Friday, February 22, 13
Elements of COE - Radiographic/Digital
60
Digital Radiographs, Digital Images
and Models
Friday, February 22, 13
Co-Discovery
61
Digital Imaging for Co-diagnosis
Friday, February 22, 13
Clinical
62
Co-diagnosis
Friday, February 22, 13
Elements of COE - Clinical
63
Exam Form
Dental
Record on the tooth chart.
Missing teeth, why lost, position of remaining teeth and replacements No. ________________________________________________
Chart all other variations from normal, (see symbol sheet)
Palpation over the gingiva and roots of the teeth to determine bone form _______________________________________________________
Extension of the lips and cheeks for the observation of frena and muscle attachments, position of the gingival margin, and width of the attached gingiva.
Probe for pocket depth and furcation involvement.
Friday, February 22, 13
Elements of COE - Clinical
64
Son of a Dentist
Friday, February 22, 13
Elements of COE - Clinical
65
Attached Gingiva
Friday, February 22, 13
Elements of COE - Clinical
66
Attached Gingiva
Friday, February 22, 13
Elements of COE - Clinical
67
Dental Form
Friday, February 22, 13
Elements of COE - Clinical
68
Soft Tissue
Friday, February 22, 13
Elements of COE - Clinical
69
Buccal Mucosa
Friday, February 22, 13
Elements of COE - Clinical
70
Examination Form
Friday, February 22, 13
Elements of COE - Clinical
71
TMJ (Temporo- mandibular Joint)
Friday, February 22, 13
Elements of COE - Clinical
72
Exam Form
Occlusion 0 - none 1 - slight 2 - moderate 3 - extensive
___ Premature centric contacts No. __________________________
___ Biting stress mobility No. _______________________________
___ Right working contacts No. ______________________________
___ Right (left) non-working No. _____________________________
___ Left working contacts No. _______________________________
___ Left (right) non-working No. _____________________________
___ Protrusive contacts No. ________________________________
___ Right dec. chewing efficiency ____________________________
___ Left dec. chewing efficiency _____________________________
Friday, February 22, 13
Elements of COE - Clinical
73
Non-Working Interferences
Friday, February 22, 13
Elements of COE - Clinical
74
Occlusion
Friday, February 22, 13
Elements of COE - Clinical
75
Exam Form
Habit Signs 0 - none 1 - slight 2 - moderate 3 - extensive
Tongue ThrustTongue ThrustReverse swallowingLateral indentationsFungifuorm enlarge
BruxismBruxismFacetingOcclusal wearHyper masseter
MouthbreathingMouthbreathingLack of nasal flareGingival changesNail biting
TemporomandibularTemporomandibularRight painRight crepitusLeft painLeft crepitus
Friday, February 22, 13
Elements of COE - Clinical
76
AmelogenesisImperfecta
Friday, February 22, 13
Elements of COE - Clinical
77
Tooth Mobility
Friday, February 22, 13
Elements of COE - Clinical
78
Periodontal Pocket Depth
Probing
Friday, February 22, 13
Elements of COE - Clinical
79
Periodontal Pocket Depth
Probing
Friday, February 22, 13
Elements of COE - Clinical
80
Probing in Six Places
Friday, February 22, 13
Elements of COE - Clinical
81
Why periodontal disease can’t be diagnosed with x-ray only
Cadaver
Friday, February 22, 13
Elements of COE - Clinical
82
Cadaver Lingual View
Friday, February 22, 13
Enamel Projection
83Friday, February 22, 13
Enamel projection
84Friday, February 22, 13
Elements of COE - Treatment Planning
85
Exam Form
Complete the remainder of the form after the patient is dismissed.
General condition of mouth ___________________________________
State of active disease
Caries _____________________________________________________
Perio _____________________________________________________
State of bacterial control _____________________________________
State of manageability _______________________________________
Pt’s attitude during exam - Interested Casual Disinterested
Fears and dislikes of potential treatment possibilities _____________________________________________________________
Hope and desires about future dentistry ______________________
_____________________________________________________________
Friday, February 22, 13
Elements of COE - Treatment Planning
86
Initial Status
FacialFacialFacial
1-5 6-11 12-16TEETH NO.
CALCULUS
BLEEDING
SUPPURATION
GINGIVAL TEXTURE
GINGIVAL FORM
EXTOSTOSES
PLAQUE (DEBRIS)
PalatalPalatalPalatal
16-12 11-6 5-1
FacialFacialFacial
17-21 22-27 28-32
LingualLingualLingual
32-28 27-22 21-17
Mean
Date TM Occl Sul Ging Perio Calc Debris Irritant
INITIAL
RE-EVALUATION
SIX MONTH
ONE YEAR
TWO YEAR
THREE YEAR
Etiology ______________________________________________________________________________
Diagnosis _________________________________________________________________________
Prognosis __________________________________________________________________________
Treat Plan _________________________________________________________________________
__________________________________________________________________________________
Initial Status
Patient Status
Friday, February 22, 13
Section 1. First appointment. (Orientation)Observations about patient.
Section 2. Second appointment. (Examination)Summarize medical history (questions 1-55)Additional dental history information obtained during examinationSummarize dental history (questions 56-105)Basic physical findingsSummarize diet history (questions 106-115)Synopsis of historical findings
Section 3. Oral ExaminationComplete soft tissue examination (quanitate changes 0-3)Complete occlusal examination (quanitate)Habit evaluationReview of radiograph findingsDental examination (complete charting of all restorative and periodontal needs - absolutely must probe all pockets)
Section 4. Review of findingsQuantitation of the periodontal condition at initial examination. Quantitation of periodontal findings with progression of treatmentTM - Tooth Mobility; Occl - Occlusion; Sul-Pocket Depths; Ging - Gingival Status; Perio is average of means of TM, Occl, Sul, GingCalc - Calculus; Debris - plaque; irritant is average of calc, debris
Elements of COE - Treatment Planning
87
Explanation of Examination
Forms
Friday, February 22, 13
Elements of COE - Treatment Planning
88
Initial Status with Numbers
from Exam
FacialFacialFacial
1-5 6-11 12-16
2 1 23 2 21 0 12 2 22 2 20 0 02-3 3 3
TEETH NO.
CALCULUS
BLEEDING
SUPPURATION
GINGIVAL TEXTURE
GINGIVAL FORM
EXTOSTOSES
PLAQUE (DEBRIS)
PalatalPalatalPalatal
16-12 11-6 5-1
2 1 22 2 21 0 11 2 11 2 11 0 13 3 3
FacialFacialFacial
17-21 22-27 28-32
1 2 12 3 20 1 02 3 22 3 20 0 03 2 3
LingualLingualLingual
32-28 27-22 21-17
2 2-3 23 2 31 0 12 2 22 2 20 0 03 3 3
Mean
Date TM Occl Sul Ging Perio Calc Debris Irritant
1 2 2.6 2 1.9 1.7 2.9 1.8INITIAL
RE-EVALUATION
SIX MONTH
ONE YEAR
TWO YEAR
THREE YEAR
Etiology ______________________________________________________________________________
Diagnosis _________________________________________________________________________
Prognosis __________________________________________________________________________
Treat Plan _________________________________________________________________________
__________________________________________________________________________________
Initial Status
Patient Status
Friday, February 22, 13
Elements of COE - Treatment Planning
89
Explanation of Assessing Periodontal
Status: Quantization of
Periodontal Condition at
Initial Examination
SCORING CALCULUS
Score 3Score 2Score 1Score 0
heavy calculus (supra sub)moderate calculus (mainly sub)slight calculus (mainly supra)none
SCORING BLEEDING
Score 3Score 2Score 1Score 0
bleeds easily with probingbleeds moderately with probingbleeds slightly with probingnone
SCORING SUPPURATION
Score 3Score 2Score 1Score 0
pus readily appears with probingpus moderately appears with probingpus slightly appears with probingnone
SCORING GINGIVAL TEXTURE
Score 3Score 2Score 1Score 0
considerable swellingmoderate swellingslight swellingnormal
SCORING GINGIVAL FORM
Score 3Score 2Score 1Score 0
considerable enlargement alterationmoderate enlargement alterationslight enlargement alterationnormal
SCORING EXOSTOSIS
Score 3Score 2Score 1Score 0
considerable exostosismoderate exostosisslight exostosisnone
SCORING PLAQUE (DEBRIS)
Score 3Score 2Score 1Score 0
most of tooth coveredabout 1/3/ of tooth coveredless that 1/3 of tooth coverednone
Friday, February 22, 13
90
Elements of COE - Treatment Planning
Simple or complex
Friday, February 22, 13
90
Elements of COE - Treatment Planning
Simple or complex
Departure from normal
Friday, February 22, 13
90
Elements of COE - Treatment Planning
Simple or complex
Departure from normal
We see mostly “average” not normal
Friday, February 22, 13
90
Elements of COE - Treatment Planning
Simple or complex
Departure from normal
We see mostly “average” not normal
Complex may require “team approach”
Friday, February 22, 13
Patients comment:
“Do you do this for everyone?”
91Friday, February 22, 13
Elements of COE - Treatment Planning
92
Radiographic Exam
Friday, February 22, 13
Elements of COE - Treatment Planning
93
Case Planning
Friday, February 22, 13
Friday, February 22, 13
Friday, February 22, 13
Digital Metrics for COHC
Friday, February 22, 13
DentMet Excel Spreadsheet
Friday, February 22, 13
Digitizing Dental Metrics
Friday, February 22, 13
Digitizing Dental Metrics
• Code can be written in Microsoft Visual Basic
Friday, February 22, 13
Digitizing Dental Metrics
• Code can be written in Microsoft Visual Basic
• Metrics can be coded with oral commands through voice activation module
Friday, February 22, 13
Digitizing Dental Metrics
• Code can be written in Microsoft Visual Basic
• Metrics can be coded with oral commands through voice activation module
• Dental metrics can be statistically analyzed for an overall sum of patient’s health
Friday, February 22, 13
Digitizing Dental Metrics
• Code can be written in Microsoft Visual Basic
• Metrics can be coded with oral commands through voice activation module
• Dental metrics can be statistically analyzed for an overall sum of patient’s health
• Dental metrics can be linked to existing practice management software
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Potential Digital Metric Partners
Friday, February 22, 13
Elements of COE - Treatment Planning
98
Digital Images and Models
Friday, February 22, 13
Elements of COE - Consultation
99Friday, February 22, 13
Consultation Can:
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
Help you find out what the person wants in a dentist
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
Help you find out what the person wants in a dentist
Find out what the person dreads about dentistry.
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
Help you find out what the person wants in a dentist
Find out what the person dreads about dentistry.
Help you replace resistance with collaboration.
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
Help you find out what the person wants in a dentist
Find out what the person dreads about dentistry.
Help you replace resistance with collaboration.
Keep you from feeling like a salesman.
100Friday, February 22, 13
Consultation Can:
Allow you to stop feeling you have to badger people into accepting treatment.
Help you find out what the person wants in a dentist
Find out what the person dreads about dentistry.
Help you replace resistance with collaboration.
Keep you from feeling like a salesman.
Allow you to have a productive conversation about the patient’s wants and needs.
100Friday, February 22, 13
Consultation IS:
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
The highest productivity of the Dentist
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
The highest productivity of the Dentist
A critical issue for the patient
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
The highest productivity of the Dentist
A critical issue for the patient
Variable (Simple, Complex, etc.)
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
The highest productivity of the Dentist
A critical issue for the patient
Variable (Simple, Complex, etc.)
Not a “batting average”
101Friday, February 22, 13
Consultation IS:
Based upon COE & Diagnosis
The highest productivity of the Dentist
A critical issue for the patient
Variable (Simple, Complex, etc.)
Not a “batting average”
The embodiment of your practice philosophy
101Friday, February 22, 13
102
Summary of COE
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
102
Summary of COE
How COE can solve problems
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
102
Summary of COE
How COE can solve problems
Make money (can only treat what you know to look for and find)
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
102
Summary of COE
How COE can solve problems
Make money (can only treat what you know to look for and find)
Stay out of trouble
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
102
Summary of COE
How COE can solve problems
Make money (can only treat what you know to look for and find)
Stay out of trouble
Do what’s best for your patients
c o m p r e h e n s i v e o r a l e x a m i n a t i o n
Friday, February 22, 13
Patient Who Did Her Own Surgery”
103Friday, February 22, 13
After Meticulous Home Care:
104Friday, February 22, 13
Before Plaque Control
105Friday, February 22, 13
Two Weeks Later
106Friday, February 22, 13
Disease Processes Differ
107Friday, February 22, 13
The Mount Rushmore of Dentistry
108Friday, February 22, 13
The Mount Rushmore of Dentistry
108Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
• Robt. Barkley
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
• Robt. Barkley
• Sumter Arnim
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
• Robt. Barkley
• Sumter Arnim
• Per Branemark
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
• Robt. Barkley
• Sumter Arnim
• Per Branemark
• Michael Buoncore
Friday, February 22, 13
The Mount Rushmore of Dentistry
108
• G.V. Black
• C.C. Bass
• Robt. Barkley
• Sumter Arnim
• Per Branemark
• Michael Buoncore
• Dr. Bob Margeas
Friday, February 22, 13
109
What changes do I want to make?
How do I make them?
Friday, February 22, 13
What You Want:
110Friday, February 22, 13
What You Want:
LIST FOUR THINGS YOU WANT YOUR PATIENTS
& STAFF TO SAY, BELIEVE, FEEL ABOUT YOU AS
A DENTIST AND YOUR DENTAL PRACTICE.
110Friday, February 22, 13
111
Extensions for successful change
Friday, February 22, 13
111
Extensions for successful change
Control your own oral disease, if you haven’t already.
Friday, February 22, 13
111
Extensions for successful change
Control your own oral disease, if you haven’t already.
Require your office staff to have their oral disease under control.
Friday, February 22, 13
111
Extensions for successful change
Control your own oral disease, if you haven’t already.
Require your office staff to have their oral disease under control.
Develop an examination form which includes components that you feel are necessary to accomplish COHC.
Friday, February 22, 13
111
Extensions for successful change
Control your own oral disease, if you haven’t already.
Require your office staff to have their oral disease under control.
Develop an examination form which includes components that you feel are necessary to accomplish COHC.
With a colleague, conduct a thorough examination on one another.
Friday, February 22, 13
112
Extensions for successful change
Conduct a thorough exam on a few selected patients (family, staff, patients) and solicit their reaction.
Friday, February 22, 13
112
Extensions for successful change
Conduct a thorough exam on a few selected patients (family, staff, patients) and solicit their reaction.
Write your philosophy of oral health care and share it verbally with your staff. Solicit their reaction.
Friday, February 22, 13
112
Extensions for successful change
Conduct a thorough exam on a few selected patients (family, staff, patients) and solicit their reaction.
Write your philosophy of oral health care and share it verbally with your staff. Solicit their reaction.
Solicit the oral health care philosophy of your staff. Is it the same as yours?
Friday, February 22, 13
112
Extensions for successful change
Conduct a thorough exam on a few selected patients (family, staff, patients) and solicit their reaction.
Write your philosophy of oral health care and share it verbally with your staff. Solicit their reaction.
Solicit the oral health care philosophy of your staff. Is it the same as yours?
Review patient records to see if you can make specific observations on patient progress.
Friday, February 22, 13
113
Extensions for successful change
Provide a small, select number of patients with a written and (or) verbal diagnosis. Solicit their reaction.
Friday, February 22, 13
113
Extensions for successful change
Provide a small, select number of patients with a written and (or) verbal diagnosis. Solicit their reaction.
Analyze with your staff the ways that your office and dental practices contribute to changing the dental behaviors of patients.
Friday, February 22, 13
113
Extensions for successful change
Provide a small, select number of patients with a written and (or) verbal diagnosis. Solicit their reaction.
Analyze with your staff the ways that your office and dental practices contribute to changing the dental behaviors of patients.
Discuss the ideas shared here, and get their reactions.
Friday, February 22, 13
114
You’ve Been Shown:
Friday, February 22, 13
114
You’ve Been Shown:
How systems were developed.
Friday, February 22, 13
114
You’ve Been Shown:
How systems were developed.
And how you can develop you own unique program.
Friday, February 22, 13
114
You’ve Been Shown:
How systems were developed.
And how you can develop you own unique program.
My system isn’t perfect.
Friday, February 22, 13
114
You’ve Been Shown:
How systems were developed.
And how you can develop you own unique program.
My system isn’t perfect.
Your system will have shortcomings.
Friday, February 22, 13
114
You’ve Been Shown:
How systems were developed.
And how you can develop you own unique program.
My system isn’t perfect.
Your system will have shortcomings.
The process will enhance your goal
Friday, February 22, 13
Comprehensive Oral Health CareT H E G O A L O F D E N T I S T RY
Q & A
Friday, February 22, 13
Patient Communications
need a section on pt. relations: Green Notes, office satisfaction surveys, mystery patient, staff feedback, focus groups, cleanliness (office, staff, Doctor) e.g. spots on glasses, blood spatters on gowns, breath odor, personal grooming.
The car you drive and How you drive it.
The way you dress.
116Friday, February 22, 13