STO by Six Month Smiles

by Ryan Swain, DMD

Early in my career I grasped on to a certain mindset that I have since learned was erroneous. I thought that I needed to convince each patient to proceed with the dental work that I believe they needed. I viewed case presentation as though I was the attorney and the patient was the jury; my job was to win the case. I believed that if I won the case and convinced the patient, they would proceed with the treatment that I was recommending for them.

How many times have you presented a treatment plan and hoped that you showed the right photos and used the right verbal skills in order to get the patient to “say yes?” Some of us even create fancy PowerPoint presentations with spinning letters and flying photographs… all in an attempt to get the patient to “say yes” to our recommendations.

I had an epiphany a few years ago after I took my car to a local mechanic. I usually despise taking my car to a mechanic because it is hard for me to know if the recommendations that he gives me are trustworthy. I’m sure many of you feel the same way. You take your car in and they tell you things like, “You need a new transmission” or “Your brakes are shot and you need completely new brakes.” In my experience, most mechanics aren’t like dentists. They don’t take out a small camera and take pictures of the existing problems with the car. They don’t put together clever PowerPoint presentations to convince us that the problems really do exist. Most mechanics tell us what we “need” and stare blankly at us until we say something… but they are expecting us to submit to their “automotive authority” and proceed with their recommendations.

When I took my car to a local mechanic a few years ago, I had a different experience that really resonated with me. After diagnosing my car problems, this particular mechanic, whom I had never worked with before, came into the waiting room and told me what he thought was wrong with my car and explained his recommendations. But, he didn’t stare blankly at me after this. He said something bold and clear that has stuck with me.

He said, “Dr. Swain, I’m assuming that you want your car to run properly and function safely but you want to spend as little money as possible to accomplish those goals. Is that correct?” In awe I responded, “Yes, that’s right.” He continued, “Dr. Swain, you have my word that I will only make recommendations that will allow you to obtain your goals and I will always make my recommendations based on the knowledge that you want to spend your money wisely.” I was blown away by his simple and effective approach. I proceeded with his recommendations and he quickly earned my trust as the months went by. We reached “the sweet spot” where he could be honest with me and I could trust him as the automotive expert.

Through this experience I realized that my patients want the same thing from me… the ability to trust me as the expert. With the PowerPoint presentations and photos that I had been using to “convince” patients to say yes, I had essentially been trying to educate patients to the point where they became “the expert” and would agree that my recommendations were appropriate. Even with great patient education, patients still aren’t able to make an expert decision about whether or not they need an implant or a root canal. They come to us because we are the experts. When I take my car to the mechanic, I don’t want to be responsible for making the decisions because I don’t have enough knowledge of automobiles to make good decisions. I want to trust my mechanic and our patients want to trust us.

I’ve discovered that the best way to implement this idea is to be very candid with patients, just like the mechanic had been open and candid with me. We should tell patients that they can trust us because we have their best interests (and their wallets) in mind when we make our treatment recommendations. Some patients will never meet us in “the sweet spot” but many will. It is our responsibility to communicate to patients that they should trust us, and then it is our duty to make ethical and accurate recommendations.

This approach has saved me and my team a tremendous amount of time and it reduces stress for everyone – including the patient. We still understand the importance of patient education, but we use it as a tool to inform them about the treatment they will be receiving rather than as a tool to convince them to “say yes.” Ultimately, I realized that patients want to put their trust in the hands of a reliable expert and I needed to own that role. If you can grasp the attitude shift that I’m recommending, I hope that you too are able to move into “the sweet spot” with your patients.

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.

By Dr. Ryan Swain

“Value” is a word that we hear so often, I think many of us have lost sight of what it really means. Dictionary.com defines value as “worth, merit or importance.” Value is subjective. We all apply different amounts of value to different items. A great piece of sushi may be extremely valuable to me (a sushi lover) but essentially worthless to someone with a strong aversion to raw fish. During this recession, we as dentists and business owners must think hard about the amount of value that we are creating for our patients. We must also clearly understand what aspects of our practices provide the most value to our patients. Is it the convenient location of our office? Is it our ability to provide painless dentistry? Is it the quality of our dental restorations? To be successful, we need to create significant value for the people in our communities or we are destined for mediocrity or in the worst-case scenario, failure.

A recession is an interesting phenomenon. Billions of dollars of wealth literally disappears in a very short period of time. Although they can be very painful, recessions do a great job of separating the wheat from the chaff and exposing businesses that aren’t bringing sufficient value to their customers. When money becomes scarce, consumers start treating each dollar with more care and spending their money with more scrutiny. Whether we like it or not, our job as business owners is to provide products and services that are worth more to our patients than the money they have in their pockets. When we do this, they will decide to give us some of their money in exchange for our services. Garrett Gunderson, author of Killing Sacred Cows, sums this up by saying “We only give up something in an exchange when we value what we’re receiving more than we value what we’re giving up.” It sounds simple, right? Let’s investigate this a bit further.

Why is it that during this recession, some practices continue to thrive while other practices are hurting badly? Why do some dentists increase their marketing budgets during the recession while others make cuts? It all boils down to value creation. The dentists that continue to provide services and experiences that are truly valuable to their patients will always have cash flowing into their practices. These dentists realize that when times are tough and consumers are clinging more tightly to their dollars, an increase in marketing will help convince more people to come into their offices for dental services. However, an increase in marketing will only yield results if there are aspects of the practice that are truly marketable. In other words, we must have something valuable to market to our patients!

The common myth is that cosmetic dentistry should be “put on the backburner” during a recession. The misconception is that cosmetic dentistry is “elective” and therefore is not something that people will purchase when money is tight. This brings us back to our concept of value creation. What do you think is more valuable to a patient – having a crown placed on their cracked but asymptomatic second molar or having the unsightly diastema closed between their upper centrals? Which will provide a more tangible result for the patient? Which procedure will help improve self-confidence and self-esteem and therefore create a significant amount of value for the patient?

The unavoidable truth is that most people care a lot more about their appearance than they do about their health. This is especially true when it comes to dental health. As dental professionals, we understand how important dental health is but sometimes the most frustrating part for us is trying to convince our patients to feel the same way. The trend towards insurance-based practices is a symptom of the discrepancy between the consumers’ perceived value of restorative dental work and the costs that are associated with these services. Many practices simply aren’t able to convince enough patients to spend the fruits of their labor (their money) on dental services, and therefore these practices opt to participate with insurance plans. When participating with an insurance plan, a practice can generate more patients and no longer has to work as hard to create value for the patients. Value for these patients exists because the dental office participates with their plan and they don’t have to spend as much of their own money in exchange for the dental services provided. Since they are spending less of their own money they don’t require as much value during the exchange.

Don’t get me wrong. I am neither praising nor denigrating dental practices that participate with insurance companies. There is nothing wrong with dental insurance participation and for many dentists it is a smart move. I’m highlighting the idea that there are various ways that dentists can appeal to patients and when times are tough it doesn’t have to be by signing up for more insurance plans.

We have to fully understand what patients want, and then provide it. In my office I’ve seen that affordable cosmetic dentistry can be an enormous boon to a practice. There is tremendous value in conservative dentistry that dramatically improves the smiles of our patients. Sure, those big $30,000 porcelain cases become rarer during a recession, but more practical forms of cosmetic dentistry can be very attractive to patients. Many dentists that I speak with on a weekly basis are actually growing their practices by ensuring that they are offering services that patients will say yes to and then creating the exposure needed to make patients aware of these services (both internally and externally). Many of these services are conservative cosmetic procedures such as: botox and dermal fillers ( www.FacialEsthetics.org), strategic cosmetic bonding (www.BioclearMatrix.com), short term orthodontics (www.6MonthSmiles.com), teeth whitening (www.KorWhitening.com) and ‘minimal prep’ veneers such as Cristal veneers from Aurum Laboratories.

Along with great restorative dentistry it is important to have a vast service mix available to our patients. The products and procedures I’ve mentioned here can all be added to a practice with minimal amounts of time and money, but with significant return on investment. Allow me to conclude by stating very clearly what my “take home” message is. Businesses succeed in any economic environment when they continue to create value for their customers. As dentists, we must be honest about what our patients want and be willing to cater to them on their terms. We are highly trained dental professionals and we must be able to diagnose and treat dental disease at a high level. But, as business owners we should also recognize that it is our responsibility to understand our customers and cater to them. We must create value for our patients.

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.

By Dr. Ryan Swain

I was eating lunch with some dentists a few years ago and a very interesting conversation took place. I’ve spent a lot of time thinking about that conversation because it raised some important concepts that I believe all dentists should consider. The conversation began when one of the dentists said: “When a patient asks me if they need cosmetic dentistry, I just tell them that it is totally up to them.” Another dentist at the table jumped in and responded by saying: “It’s your job to tell your patients about their cosmetic options and whether or not you think they could benefit from cosmetic dentistry.”

The conversation continued and turned into a fiery exchange between these two colleagues. They had very different opinions about what a dentist’s duty is in regard to cosmetic dentistry and cosmetic recommendations. I’ve thought about that conversation many times over the last few years and some important ideas have crystallized for me during that time. I’ve realized that there are essentially two types of dentists when it comes to cosmetic treatment recommendations:

Dentist #1 believes that his/her duty as a dental professional is to diagnose and treat disease and structural issues but does not believe that he/she can or should diagnose cosmetic discrepancies unless the patient inquires about them. Dentist #2 believes that his/her duty as a dental professional is to diagnose and treat disease, structural and cosmetic discrepancies because these are all important aspects of complete dental health. If you fall into the category of Dentist #1, this article is an attempt to shake you up a bit and perhaps even persuade you to become a Dentist #2. In other words, get with the program!

As dentists, we are teeth people. We know how much a person’s smile affects their overall appearance. In fact, we spend most of our time during conversations staring at teeth and diagnosing all of the cosmetic discrepancies that we see. When we look through a magazine, we stare at the smiles on the page, when we walk through the mall, we consciously think about the models’ smiles on the banners – especially if there are cosmetic problems! We are the experts. We can identify the aspects of a smile that can and should be changed in order to drastically improve the symmetry and esthetic appeal. There is a tremendous amount of value in this expertise we have all developed during our years as clinicians. I believe that if we hide this expert ability away, only drawing from it when patients ask us for our opinion, we do a tremendous disservice to our patients and our practices. Health and beauty go hand in hand and we owe it to our patients to educate them about both aspects of their smiles.

This idea was conveyed to me in a very poignant way when I was fresh out of dental school. I was a new associate and had just started working in a dental practice. I was performing a hygiene exam on a man in his late forties and noticed that he had a stainless steel crown on #8. I had never seen an anterior stainless steel crown on an adult before. The crown was contoured properly, the margins were good but boy was it ugly! I asked the patient how long he had had the crown and he told me that it had been placed when he was about eight years old. I asked him “Do you have any interest in replacing that steel crown with a porcelain crown?” He asked a simple and concise question that I can still hear in my head to this day…”WHY?” I was dumbfounded. I didn’t know what to say. I had all kinds of thoughts racing through my head but I was a good boy and resisted the urge to say something like “Because silver teeth are ugly!” or “Because you look like a cyborg!”

After further discussion with the patient, I realized that he honestly had never thought about the cosmetic appearance of the steel crown on #8. It had been in his mouth since he was eight years old and was fundamentally a part of him. He didn’t question it. He simply didn’t have the dental IQ or cosmetic awareness needed to recognize the impact that the crown had on his overall appearance. But, even as a new dentist with little experience, it wasn’t hard for me to clearly see the cosmetic gravity of the situation (in other words, he had “metal mouth!”). I knew that the steel crown was a serious detriment to his appearance and was a social hindrance for him. I knew that the steel crown negatively affected the manner in which others perceived this gentleman. Since I cared about the well being of this man, I felt responsible for educating him. I spent some time with him over the next few months and explained to him the characteristics of a nice smile. I asked him to pay attention to other people’s teeth during conversations and while watching TV.

After a few weeks, he called the office and set up an appointment. We removed the steel crown and replaced it with a nice porcelain restoration. The difference was amazing. When he returned to the office for his next hygiene appointment, I asked him how the crown was working for him. He shared some amazing stories about the great comments he had received. The patient thanked me profusely and then said something that has stuck with me. He said “If you hadn’t told me that I should have that crown replaced, I probably would have lived with that darn silver tooth for the rest of my life!” This extreme case made me realize firmly that I had a duty to my patients to inform them about cosmetic discrepancies and corresponding treatment options. Their social health and well being could depend on it!

Since that time, I started a practice that focuses almost exclusively on Short Term Ortho (www.6MonthSmiles.com) and other cosmetic dental procedures. I realize now more than ever the dramatic improvement that cosmetic dentistry can provide for our patients. Improving the overall symmetry of a smile is paramount in creating a pleasing look. The stories of improved self esteem, self confidence and social status that my patients report continue to bolster my belief in the importance of the services I provide. So, if you’re a dentist who feels that cosmetic dentistry should only be discussed when a patient brings up the topic, please consider a paradigm shift. Our patients depend on us for our expertise – ALL of our expertise. They want us to have their best interest in mind. If we turn a blind eye to the appearance of their smiles, we are doing a disservice. We can and should tactfully and respectfully educate our patients about their cosmetic discrepancies. I believe that a cosmetic exam should be a regular part of our comprehensive examinations and all offices should have a chief cosmetic complaint form as part of their new patient/recall paperwork.

People desire to look and feel their best and we can do a lot to help them achieve this. I encourage you to utilize all of the abilities you’ve acquired throughout the years to the benefit of your patients. We’re not just tooth mechanics; we are highly trained clinicians and oral esthetic experts. Everyone benefits when we understand these roles and play them appropriately. If you’re not a Dentist #2, please join the club. It’s a good one!

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.

By Dr. Ryan Swain

There is a simple yet powerful question that can instantly and dramatically improve your case acceptance rate… I call it “The Golden Question.” I will tell you what The Golden Question is shortly but please allow me to set it up. The Golden Question is something that seems too basic upon first inspection. However, I promise you that when you start using it you will have one of those “a-ha!” moments that we all crave.

We all get frustrated when we spend time discussing treatment with patients, only to have the patient decline. It can sometimes feel like we are beating our heads against a wall. All dentists have a different propensity for eliciting treatment acceptance from patients. Some dentists seem to have a knack for “selling” dentistry while other dentists can barely “sell” a root canal to a person in pain. Regardless of your current level of success with case acceptance, The Golden Question will undoubtedly make your conversations with patients smoother, shorter and more fruitful.

Are you ready for The Golden Question? Well, here it is! The Golden Question is this – “When you think about proceeding with treatment, what are your main concerns?” I know, I know, it seems too basic. I told you it would! Allow me to explain how it works.

The Golden Question must be asked before you present the recommended treatment to your patient. The answers that the patient provides to us after we ask the question give us the ability to powerfully tailor our case presentation so that it fits that patient. This ability to customize the discussion is absolutely paramount for regular success with case presentations.

Imagine that you are presenting a treatment plan that consists of some fillings and a few crowns. Now, imagine that as you begin your presentation, you falsely assume that the patient’s primary concerns revolve around cost. As you discuss your recommendations with the patient, you repeatedly tell them how reasonable the costs will be and how you will be using the most cost-effective materials. Well, what if this patient’s primary concern is about how long the recommended work will last? You missed the boat! While you were blabbing about cost-effectiveness, you missed your chance to connect with patient in terms of what is most important to them. This is the kiss of death and a surefire way to send a potential case directly down to Davey Jones’ locker, never to return.

In my practice, I focus almost exclusively on Short Term Ortho for adults. Every consultation begins with The Golden Question. Asking “when you think about proceeding with cosmetic orthodontic treatment, what are your main concerns?” allows me to understand clearly how I can best present treatment to this patient in a manner that will hit the right buttons. My acceptance rate is fantastic, but it hasn’t always been like this – I learned the hard way. I did hundreds of consultations before I started asking The Golden Question and most of the conversations were laughable.

I used to feel as though I needed to address every concern that the patient might have during the discussion. So, I rambled on and on about everything under the sun. Then, after I was done with my monologue I would then ask the patient if they had any questions or concerns. Well, by that time I had overwhelmed them with so much information and brought up so many topics that they never even considered, their heads were spinning! I think most of us have been guilty of “blabber mouth syndrome” during our presentations. The beauty of The Golden Question is that it allows us to cure ourselves of this nasty syndrome and move on into fresh new territory. If we understand our patients’ concerns clearly and address them succinctly as we discuss treatment, our case presentation conversations become amazingly effective.

When we take the time to understand the plight of the patient, we begin to see trends in the way that our patients think. There are really just a handful of concerns that are typically expressed by our patients. Very quickly we can learn how to effectively address each of these concerns and how to cater to the types of patients that typically have a particular concern. It feels like cheating, but trust me, it’s not. As long as the treatment we are presenting is truly going to benefit the patient, everyone wins when the case is accepted. So, next time you sit down to discuss treatment with a patient, remember The Golden Question and never look back. You, your staff and your patients will be glad you did!

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.