Dale Carnegie wrote that "knowledge isn’t power until it is applied". With this in mind, the most powerful lesson taught by Dr. Peter Dawson must be the concept of the Complete Exam because it is through the Complete Exam that we begin to apply our knowledge to the benefit of our patients.
The Complete Exam is a framework on which to build a solid doctor-patient relationship.
It is the vehicle through which we identify signs and symptoms of occlusal instability, periodontal breakdown, and dental decay. When done properly, it also gives us the opportunity to understand our patients’ motivations, limitations, and dental IQ.
The 5 stage of the Complete Exam
Oral cancer/Airway screening
What can we discover if our minds are properly trained to perceive what our eyes can see?The Pre-Clinical Interview is our first opportunity to learn the patient’s motivation for coming to the office. I open with a simple question like, “What brought you in today?” Open ended questions let them tell their story. The careful listener will pick up clues about how to best manage the patient.
For example, I like to know if someone had a bad experience as a child. I once had a patient confide in me that she had not been to the dentist in years because she had been sexually assaulted. She panicked any time someone tried to put something in her mouth. That information influenced the way I approached her in the operatory. I would ask her permission before doing anything, and let her participate by having her help me place the x-ray sensor in her mouth. Thanks to this approach, we now have a strong relationship that allows me to complete her dentistry without anxiety or accommodation.
The interview sets the tone of the appointment and the doctor/patient relationship. By the time we leave the consult room (5-10 minutes), the patient knows that...
- Sharon runs our schedule and is our dental benefits expert.
- My assistant, Shannon, is my right hand, and she will start off by taking photos and x-rays.
- Ashley will gather data for the periodontal evaluation during the appointment. Her role is to work with me to formulate a plan to achieve and maintain periodontal health.
- Lastly, my exam will be different than any they have had before.
I tell them that before I look at their teeth, I am going to screen them for oral cancer and examine their muscles and joints. I am going to evaluate how their teeth come together, and by the time they leave, they will have a working understanding of their masticatory system. We set expectations high, then follow through to meet them.
Handoff to the Assistant
By setting the stage, my handoff to my assistant for imaging is smooth and easy. She gives the patient a tour of the office on the way to the photo room for six screening photos (full face, smile, retracted teeth together, retracted teeth apart, upper and lower occlusals) before coming to the operatory to expose an FMX. While she’s taking the photos, she explains that the pictures are often helpful to demonstrate what we can see during the exam.
They are also a great record for us to recognize changes over the years or as a guide to help me reconstruct a broken tooth. The photos are also critically important in helping us develop treatment plans for our specialty patients. This is how we determine incisal edge position, proportions, length to width ratios, etc.
Oral Cancer and Airway Screening
Once the images have been collected, we begin the clinical exam with an Oral Cancer and Airway Screening.This is a “soft touch” exam using fingers, mirror, and gauze only. We are deliberate in how we screen for oral cancer and take note of lesions or masses. At the same time, we look for a narrow, high vaulted palate, crowding, bicuspid extractions, Mallampati score, scalloped tongue, lingual frenum, and other indicators of potential restricted airway and/or mouth breathing. These findings will be a factor in the final diagnosis and treatment plan.
Functional and Biological Exams.
Most patients have never had a Functional Exam, and they are always impressed with the thoroughness of the exam as we palpate muscles, measure range of motion, and note mobility and wear on teeth. As we are collect these signs of occlusal instability, we can correlate them to the symptoms the patient told us about in the pre-clinical interview. This is a powerful application of the knowledge we possess.
By the time we get to the Biological Exam, our new patients know beyond a doubt that they are in a special practice, but it is important to remember to do the general dentistry too. This is the part of the Complete Exam that will feel more familiar to most patients as we chart caries, restorations, and a complete periodontal exam. The difference is that we do it within the context of a comprehensive understanding of the patient’s dental condition.
Eyes are useless when the mind is blind.
Before training with The Dawson Academy, I thought I was a good dentist, but I did not know what I did not know. Every single day in my practice there were signs of instability staring me in the face, but my mind was not trained to let my eyes see them.
Even when patients would ask for help, I had no idea that there were predictable ways to help solve their problems. My charts were filled with teeth that we were “watching”. To this day, I am not sure what we were watching them do, but we watched nonetheless. Now that I know better, implementing the Complete Exam has been the most critical step in taking our patient care, and our practice, to the next level.📷| @senivpetro