Why do dentists with excellent technical skills have trouble getting patients to say yes to complete dental treatment?
Mike Schuster, DDS
People who do not have a picture of health in their minds do not make healthy decisions. Dentists have the same problem getting a patient to say yes as they did 28 years ago when I began. In fact, because we have more advanced technical materials and methods, there is more junk being delivered today than years ago. I see dentists thinking that occlusion is everything and doing little or nothing with the periodontium. It blows my mind. We all see the ravages of orthodontists straightening front teeth but missing the mark completely on how the teeth fit together. You have a big task at hand. There is a simple question that each of us has to answer. Do I want to be part of problem or the solution?
 It takes less time to deliver quality care than it does to deliver poor care. Once you set your process and systems in place, doing the highest quality of care you can deliver will actually take you less time. 
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It takes less time to deliver quality care than it does to deliver poor care. Once you set your process and systems in place, doing the highest quality of care you can deliver will actually take you less time. Do the ground work now. Excellence is a step by step process. It starts with the first moment of truth and moves forward. Excellence is imbedded in the willingness to do the little things. Processes and systems needed to deliver high quality restorative care. • New patient interview: Commit yourself to an interview with all new patients. This will be the most important decision you make for your present and future success. Get a video recorder and video tape your interview and ROF’S. You will learn so much from this that you won’t believe it. You will advance geometrically in your communication effectiveness when you watch and hear yourself. • Treatment planning: Remember: Optimum health is first --------------- optimum repair is second. 1. Plan first. 2. Perio health second. 3. Tooth health. 4. Occlusion, Stable Joints, proper occlusion form. • Review of Findings appointment: Remember to use: 1. The dreadful story, the impact of it as it relates to this patient. 2. Pankey’s Youth-Adult-Elder story as it relates to this patient. 3. The slides before the exam are critical to lay the base or foundation with your patients. • Models and slides: Commit yourself to the finest records you can create, including slides. Slides can easily be converted to prints later. A Caromate can be purchased for $200 to show slides. Get a system to take a certain set of x-rays on all patients. Portrait x-rays as well as intra-oral photographs. Alginate should be vacuum mixed and stone vacuum poured within minutes after taking them. No sense taking models if they aren’t absolutely accurate. Bite records should be highly accurate and complete and put in appliance cases so they won’t distort. Dentists are anxious to get digital photography, but a vaccum investor for alginate and stone is far less costly, and will improve your dentistry immensely. Yes, digital is great, but slides work. Invest in a good camera, the best you can find. Learn to make pictures a regular part of your exam. I see a great deal on my slides that I didn’t see in the mouth. I also see things on models that I didn’t see in the mouth, if the SLIDES and MODELS are excellent. • Radiographs: Creating X-Rays with no flaws is critical. Radiographs should be the excellent and your developed x-rays should be read with magnification. (8 power or better) Digital can be blown up and accuracy of digital is getting better. • Facebows: When you take facebows, why not set your facebow up so that you can take a FPO (functional plane of occlusion) as well as EPO ( an esthetic plane of occlusion) at the same time. I mentioned to a student one time that I can take a hinge axis in 15 minutes. Why, because I have simplified how I do it and have done it hundreds of times. • Preps, dies and impressions: Creating excellent preps and models with no flaws is critical. For 10 years I worked with three full time technicians only doing my work. Our mandate was no remakes. We were determined not to bring castings or crowns to the mouth that didn’t fit. I went seven years without a cast remake. Did I make mistakes? Yes. But the technicians would catch it and I learned more about preps and impressions from them because I worked with them. If a wax up didn’t pull, we didn’t cast it. It didn’t take me long to do excellent preps and impressions. • Magnification: The better you see, the better you do. Today we use 2.5 Power for gross preparation, and 6 Power magnification for finish. Trim your own dies. See your own margins. Trim your dies with 10-20 power so you can really look at your preps. Seeing your work you will improve your work. This all takes time, but it all saves time and enables you to deliver quality care. A lab microscope for $800 will improve your dentistry even more.
Once you find something that works, stick with it.
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