Do You Have a Specific Protocol for New Patients?

Do you have a specific protocol that you follow with all of your new patients, or do you just look for the low-hanging fruit?
You know, 75% of all patients are referred into the hygiene room. So, when they meet the doctor for the first time, they’re getting their teeth cleaned. The doctor comes in, says, “Oh, that tooth needs a crown,” schedules them for a crown, and that’s it — no comprehensive care.

In our practice, patients can’t come to see the hygienist at their initial visit unless they’ve had a comprehensive exam first. Sometimes they do get a cleaning at their first visit, but I’ll see them for an hour before then.

If they just need a prophy, we can do that. But if they need scaling and root planing, they’ll be scheduled for that — the first of four one-hour visits.

The Four Phases and Five Protocols of Treatment

Let me talk to you very quickly about the four phases and five protocols of treatment.

The four phases, which we’ve discussed in previous videos, are:

1. Exam

2. Diagnosis

3. Treatment Planning

4. Treatment

Those phases are completed for all patients. Once those phases are completed — or even during the process — I explain to the patient what the five protocols are.

Setting the Tone at the Initial Visit

Here’s a little practice management tip.
At the initial visit, I say to a patient, “You’re very lucky that you’re here because you’re in the right place.”

They don’t know what that means, but people like declarative sentences. If you declare something — “I’m a good athlete,” “I’m a good cook,” or “I’m not very good at that” — people tend to believe you.

When you say something positive to someone, the mind is such that they’re not going to deny it. They may act like they deny it, but deep down — in the amygdala — they’re thinking, “Hmm, I feel pretty good about that.”

When a patient comes into our practice, they’re often scared. So, I say, “I’m glad you’re here because you’re in the right place.”
They already feel a wave of relief.

Then I say, “Here’s what we’re going to do today: an exam and a diagnosis. I’ll give you some treatment plans. We’re probably not going to do treatment unless you’re in pain. Are you in any pain?”

If they’re in pain, we take care of it. If they’re not, then we move on to the second phase of care — the five protocols.

The Five Protocols of Treatment

1. Eliminate Pain

You only do this at the first visit if the patient is in pain.

2. Eliminate Infection

You begin eliminating infection before doing comprehensive treatment.
You don’t do implants, bridges, or ortho if there’s active periodontal infection or caries. Those are the two main infections in the mouth.

There are billions of people on the planet with active periodontal and caries infections — it’s a massive issue.

3 & 4. Functional Rehabilitation and Aesthetics

These are often combined because they’re done at the same time.

Usually, we begin with functional rehabilitation — moving teeth into the right place, placing implants, and provisionals — before doing aesthetics such as veneers, bleaching, or final crowns in the front of the mouth.

These steps occur in the last phase of treatment.

5. Maintenance

This is the most important phase of care.
If I don’t tell my patients at their initial visit that maintenance is the most important phase, no matter how good my treatment is, it won’t last.

Why Most Practices Don’t Do Comprehensive Dentistry

Here’s a statistic: 75% of all practices do not do comprehensive dentistry because they don’t do comprehensive examinations.

No periodontal probing.
No occlusal photographs.
No oral cancer exam.

They might look at one or two teeth that need to be fixed, but that’s it. They see one tooth, send the patient to the endodontist for a root canal — but that tooth might be tipped, have a 9mm pocket, or a collapsed bite.

Then I’ll see the patient afterward — and the tooth is hopeless — all because it wasn’t treated comprehensively.

Always Plan Before You Build

I try not to do any treatment before I have a restorative treatment plan, a periodontal treatment plan, an aesthetic treatment plan, and an orthodontic treatment plan, if necessary.

All of that is done before treatment — not during treatment.
I don’t figure this out as I go, just like you wouldn’t start building a house without a plan.

When this house was built, they didn’t just start putting up walls and windows at random — they had a blueprint.

Most dentists, unfortunately, are not planners. We just do what we see because patients say, “I just want this one tooth fixed. I don’t want a full-mouth rehabilitation.”

Well, guess what? It’s our responsibility to have the hard conversations.

Having the Hard Conversations

Just as a parent must have tough conversations with their kids — “It’s 5:00, dinner’s at 5:30, no ice cream now” — we have to do the same with our patients.

If a patient says, “Hey, I just want this tooth fixed,” I say, “I can’t treat that tooth because you have periodontal disease, decay, your bite is off, and there’s an abscess here.”

Those conversations must happen.

The “Textbook Says” Approach

Sometimes I’ll pull out a book — any book — and say, “You know what the textbook says?”
One of my friends, Dr. Bill Becker, a famous periodontist, used to do this. He’d wrap a book in a brown paper bag labeled “TEXTBOOK” and say, “The textbook says…” and then share his message.

So I’ll say, “The textbook says I have to do a comprehensive exam, give you a diagnosis and treatment plan before we begin treatment, and follow these five protocols:

• Eliminate pain

• Eliminate infection

• Functional rehabilitation

• Aesthetics

• Maintenance”

If I don’t tell my patients those things, I’m not doing my job — and I’m not being a gift to my patients.

Be the Gift

Be the gift to your patients and follow that protocol. Here’s why:
You’ll be a better dentist.
Your patients will be better cared for.
You’ll be busier.
Your team will be happier.
Everybody wins.

Have a great day, everyone — and remember, be the gift.