A Secret Most Dentists Don’t Know

I'm going to share with you a secret — one that not many dentists know. Well, 25% of you might, but 75% of you don’t. Most of you do not perform a comprehensive examination on your patients.

An article titled Periodontal Treatment for the General Practitioner by Curry Martins and Bonaker, published in the American Journal of Dentistry back in 2006, looked at over 235 practices. They asked several questions: Do you perform a comprehensive examination? Do you complete a periodontal chart? Do you take a full set of X-rays?

The results were surprising — less than 25% of the 235 offices did a comprehensive examination and took a full set of X-rays. This included specialists, periodontists, and prosthodontists as well.

The Bias in Treatment

What does that mean? It means most people receive the treatment that the dentist sees — and that’s a bias.

If a practice focuses on extractions, implants, or Invisalign, patients tend to receive those same treatments, regardless of their actual needs. Some periodontists perform flap or laser surgery on nearly every patient with recession. It becomes a knee-jerk response — dentists treat what they see instead of what’s truly there.

Returning to What We Were Taught

It’s important to do what we were taught in dental school — even if most of us never really did it.

Throughout my career, I’ve had about seven or eight associates. When I ask them if they practiced in their residency programs the way we do in our office — which I believe is ideal — the answer is usually no.

We do a comprehensive examination. We provide every patient with a proper diagnosis — or multiple diagnoses — because there can only be one accurate diagnosis per issue. We learned that long ago from the masters in our field, including Morton Amsterdam at the University of Pennsylvania and others.

Giving Patients Options

Once we complete a diagnosis, we present patients with treatment options so they can choose what’s best for them.

When I teach residents, students, or associates, I often ask, “What do you think we should do?” Their answers are usually immediate — “Oh, denture,” or something similar. But when you take the time to perform a comprehensive exam, it removes the stress of guessing.

You become data-driven. You don’t have to rely on assumptions or quick judgments. Our job is to gather information — that’s the examination. Then we create a diagnosis, and it must be comprehensive: periodontal, endodontic, occlusal, caries, aesthetics, orthodontic, oral cancer, and more.

We collect all the necessary data — cone beam CT scans, full-mouth radiographs, digital scans, and other information — all during the initial visit. That process takes about an hour.

From Diagnosis to Solutions

Once I’ve gathered all the data, I present it to the patient. I explain their diagnosis, but I call it their problem list.

I tell patients, “I’m going to make an assessment, look around your mouth, and give you a problem list.” Then, I provide solutions — multiple ones. I don’t leave them hanging.

Usually, there isn’t just one solution. There may be several: extract, maintain, or do nothing. Each option has its own cost, risks, and benefits. Once I explain all of this, the patient can make an informed decision based on knowledge — not fear, money, or my authority as the doctor.

Becoming a Dental Guide

I tell my patients: I am your dental guide, not your dental father.

I don’t tell them what to do. I give them their options, the pros and cons, and let them decide what’s best for them.

When you go to a restaurant, the waiter doesn’t say, “Eat the steak.” They show you the menu and might make recommendations, but they let you choose. The same should apply to dentistry. Patients deserve the ability to understand and choose their treatment from an informed perspective.

Why a Comprehensive Exam Matters

How can 75% of dentists claim they’re doing the best for their patients if they’re not performing a comprehensive, one-hour exam on every new patient?

The only time I skip it is during an emergency visit — when a patient is in acute pain and needs immediate relief. Otherwise, every patient deserves a full exam, diagnosis, treatment plan, and treatment sequence.

When you follow this process, your practice will thrive because you’ll have well-informed patients making the best decisions for themselves.

Educating the Patient

A long time ago, there was a department store called Sims. Their tagline was “Name Brand Clothing for Less.” You could buy designer items like Armani suits or Ferragamo shoes at a fraction of the cost.

Their slogan was: An educated consumer is our best customer.

I say the same thing about dentistry: An educated patient is our best consumer.

Educated patients choose dentistry that’s in their best interest once they understand their options. The power of the initial comprehensive exam, diagnosis, and treatment plan cannot be overstated — it’s the foundation of everything we do.

The True Gift in Dentistry

Some people say, “Mike, all you do is talk.” And yes, I talk a lot — but I also do a lot of treatment after my patients understand their choices.

That’s why our practice is routinely booked three to four months in advance — because we take the time to truly understand and educate each patient. Could I work faster and do more dentistry? Maybe. But it wouldn’t be as good, and it wouldn’t reflect my commitment to Be the Gift for my patients.

If you’re not performing a comprehensive examination — and most of you aren’t — it’s time to start. You’ll not only improve your patients’ outcomes, but you’ll also elevate your practice and the care you provide.

Because when you empower your patients with knowledge, you truly are the gift.