Dental Myth One...Bigger cases are the quick way to bigger dollars.

The one true thing about a big case, is that it is big and usually expensive.

Now the motivation for doing any dentistry should always be, what does the patient want, and how does that fit with their existing dental disease.  We cannot, and must not, treat a patient for any other reason than  to help them reach their dental goals.  To treat a patient for our own goals or to fulfil our own requirements is unethical, and in the long run, unprofitable.

Notice I did not mention what the patient needs.  The truth is that dentistry is very elective and unless the patient has pain or swelling, they do not need it.  It may be more healthy and have better quality of life, but they don’t need it.  You need a heart, you do not need a tooth.  You need a liver, you do not need a nice smile. 

Now the great thing is, if you free yourself from trying to make people feel they need dentistry, you can learn how to communicate that dentistry is something they want.  People do what they want.  People only do what they need with self discipline.

Helping people get the dentistry they want, can lead to doing cases that involve many teeth and that are more expensive.  It is a mistake however to think that this will necessarily result in more profit.

There are two main issues with larger cases.  They take practice to get them right efficiently and you can get stage fright staring at the big number and underquote the case.

That they take practice is a no brainer.  If you ever are masochistic enough to take on full mouth rehabs on a regular basis, the first several will likely not flow entirely smoothly.   There might be little adjustments.  There might be teeth that start aching.  There might be temporaries that chip and have to be remade.  You might drop a veneer or crown on the floor and chip it.

Certainly there are efficiencies with multiple teeth cases.  It doesn’t take much longer to anaesthetize ten teeth as to anaesthetize one.  It certainly doesn’t take ten times as long to prep ten teeth as one.  So at certain stages of treatment, the hourly rate can be enormous.

However, there is also the time spent working up the treatment plan, which usually takes quite a long time when you are starting out.  There are the impressions, records and diagnostic waxup.  There is the large lab fee.  There is time spent refining temporaries.  There is time spent repairing temporaries.  If there is anything that you have forgotten to put in the quote or warn the patient about, like a core build up, you will have to do it for free (charging the patient for extra’s that they don’t expect is a good way to fall out with the patient).

Now if anything goes even slightly wrong, like a crown not fitting, or a contact not being correct, you can add remakes to the list of unforseen costs.  Trying to do a case too fast is also a very good way to increase costs.  The temptation is to do too many teeth too quick.  This all goes swimmingly until we strike a disaster or remake something.  With time, we find that it is better to do things a little slower, and do it right first time, than to rush something, and then take the time to redo it.

The second main issue with the larger case is underquoting.

Since it is such a large amount compared to our normal treatment plans, there is a temptation to not charge for everything correctly.  Perhaps we start to get a fright once the treatment plan is at twenty thousand dollars, and forget to charge for that those incidentals that add up to a further five thousand.  On a case with a four thousand dollar lab fee, that last five thousand can be the difference between getting paid to work extremely hard, and getting paid less than usual to work extremely hard.

The reality is, that only a small percentage of dentistry can ever be large cases.  However if you do want to get into this area for professional fulfilment, or because your patients demand it, then it is common to make very little profit on your first few cases.

The solution, of course, is training and practice.  With training, you can learn to be methodical, so that you can avoid many common mistakes and pitfalls.  And then you will have to practice.  So if you going to do this sort of dentistry, it will be much easier if you learn how to do it well, and do it more than once a year.

Dr lincoln Harris's latest article published by Australasian Dental Practice Magazine

Why you were taught to treatment plan upside down. 

At dental school, we were taught to treatment plan single teeth. That is fair enough since the majority of dentistry is single tooth bread and butter dentistry. In most cases, dental students are taught to treatment plan in this order. 

Emergencies and toothaches were dealt with first. Caries control and periodontal control followed.  Missing teeth, occlusion and aesthetics were dealt with last. 

Money was never discussed. Of course, money should be discussed first.  In a profession where elective treatment can range from $10 to $100,000, it is not only prudent, but also ethical and compassionate (and more successful) to discuss the patient’s budget before you embark on designing a dental Dubai in their mouth. 

However that is a topic for another article. 

While this approach seems to make sense by dealing with important things like caries and periodontal problems before trivial issues like aesthetics, the weakness of this approach can be seen as soon as a more complicated case comes along.  With no strong framework to see the end point of the case, a dentist can become bogged down in deciding which teeth can be saved, which need perio and agonising over whether that central should have root canal therapy.