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How to Communicate the Need for a Complete Exam to Patients

This video is an excerpt from the April 2015 Dawson Faculty Office Hours with Drs. Leonard Hess and Rajeev Upadya. To watch the full office hours and to sign up for future office hours, visit the Videos and Webinars page

The following is a transcription of this video excerpt. 

Question from Devin:

Most patients at my practice expect quick fix dentistry: quick checkups and x-rays. 

I feel overwhelmed by all the signs of instability I see and feel like I need to do complete exams for everyone, but it's hard to convince them of the need for it when they just want a cleaning and fillings.

I try splitting the exam and doing photos to show them why we need a complete exam, and then book a second visit for the full thing. Any suggesions?


First of all, I will say once you've learn what to look for, you see so much more. It's absolutely true. I'd say that far more than 50% of the patients, if not 60-70% of patients have signs of occlusal instability. The nice thing is that it is not a race. We don't have to get all our patients through a complete exam by a certain point. 

As I was saying earlier, we started the evening by talking about how we plant seeds. When I first started seeing all these patients in my practice, I did feel kind of the same way for the first week or so - thinking, "oh my gosh, there's so much." But then you realize you aren't going to solve everybody within the next few weeks - you don't have time to do it.

You just start talking about it with your patients. There will be at least one patient in the course an entire day that is interested in having more information. You don't have to force them into anything. There's naturally going to be people that want to go into the exam and records process.

In my office, we used to say, "they went over the rainbow." Over the rainbow concept is that it takes them a while to get to the "ah ha moment" that finally gets them to say, "oh my gosh, I understand what you're talking about. What can we do about it?" For some patients that's 5 minutes into a hygiene visit, for some people it's a couple of years, or they may have to have some sort of debilitating event. We talk about it, show them the signs of problems and when they're willing to go further, we get them schedule for an exam.


The other thing to think about this is that most patients just don't know any better. That standard of care is their standard of care because that's all they have been subjected to their entire career as a patient.

The way to really change that is to start asking our patients questions. When you have a patient that has 4 crowns in there, needs another one and 3 of those crowns already have broken porcelain on them - just ask them, "Does it concern you that you had 4 crowns put in your mouth and 3 of them are already broken?" And they're probably going to say yes because no one likes to have stuff break in their mouth. That opens the door - you can say, "Well is now a good time to talk about why that happens?" And if they say no, then stop. If they say yes, they just gave you permission to open up that dialog about what is going on in there. 

You'll start to see patients that have signs of instability in their dentition; when they have wear, migration or mobility. These patients invariably have occluso-muscular problems. They have headaches, the back of their necks are sore, you start to palpate their muscles and they have big knots in their masseter, you palpate the temporalis muscle and you have to pull them back from the ceiling because it's so tender. Those are moments you can say, "Wow, geez, those are really sensitive. You know those aren't supposed to be that tender, right?" And that opens to door once again, for you to explain a higher level of care to them. 

The good news is that I've never seen anyone die from not being in Centric Relation. We don't have to save the world in one day, or even in one year.

If you have a busy practice that has kind of been setup to be that quick-fix type of dentistry, it's going to take a little bit of time to transition that. Do you have time to give everyone a complete examination, then? You don't. You have to start with the patients that are movitated and interested. From there you'll start to build progess and motivation, add nice before & afters on your wall, get testimonials from patients, and people will start to get it. If all they've been subjected to is a quick standard of care, it is your job to start building those bridges for them to cross over to the other side. 

This was a very great and common question. Again, Raj and I still have a lot of general dentistry patients in our practice. It's a battle with them too. Rome wasn't built in a day; it just takes time.

Why Porcelain Breaks