Starting clinic soon! Advice?

[drkayz]

Hi friends!

I'm about to start clinic in the next few months and was hoping for some insight from those of you already there. At my school we have our initial treatment plan work-up appointment where we take x-rays, full perio charting, take impressions for models, intraoral photos, etc. I know this is all diagnostic and serves it's purpose but I'm just curious if anyone has any pro-tips on how to keep patients calm and content through all of this. Since we're so inexperienced and don't usually have an assistant it takes a solid 3 hours to do everything (if not longer) and I see a lot of patients getting antsy and frustrated even if they're informed ahead of time. In your experience, what is the best way to deal with this?

Aside from this, I would love to hear just any clinical experiences/pearls of wisdom from anyone!

Thank you all!

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[Vicviper]

The main thing is to explain the process before you get started. You need to address the negatives in a positive way as well. Use phrases like "Rome wasn't built in a day" and "We want to make sure this is the best it can be." If you put those positive spins on negatives, it makes patients more comfortable. The last thing you want is a patient who doesn't understand what's going on. So explain everything before you get started in a way that the patient understands. DO NOT USE DENTAL SPEAK, you'll only alienate your patient, and make them confused. You should never say the word "caries" to a patient, unless you're explaining the name of the disease - say cavity, that's something they understand. Be careful when you use the phrase "root canal" - patient are terrified of this word, so it always helps to explain what a root canal actually is, and stress that it's not nearly as bad as it sounds.

Back to my original point, here's an example of how to explain longer procedures / things that take a number of visits:

"Making a Denture / Partial is a bit of a process, because it takes a little bit to do things right, and we want this to fit as well as possible. Making the Denture / Partial is 5 visits.

Visit #1 we take initial impressions, we use a stock tray that is a few sizes fit all. With that, we make a custom tray that is perfectly fit to your mouth. Visit #2 we use that custom tray to take a final impression, where we use a different material to really capture how your mouth / teeth look. Visit #3 is what we call Jaw Relation - we've got blocks of wax that we use to tell how tall to make the teeth, and we also pick the color of the teeth. Visit #4 we have all the teeth set in wax, so you can make sure you like how it looks, and we can really change just about everything here if you don't like it. If you like how everything looks, Visit #5 they're done."

I use talks like this a few times a day, and it helps to structure things for the patient where they actually understand what's going on. That way, even if things are taking longer, they'll have some expectation of what is next. Sure, they probably won't remember everything you say, but its much better than things just taking forever, and them feeling like you haven't explained things to them.

Good luck, and the best piece of advice - don't stress!

 

[THS]

I haven't had too many issues with patients getting that antsy - they understand that everything takes longer at a dental school (for the most part). Just explain to them that everything at the dental school costs 1/3 of the price of a regular dentist (or whatever that discount may be at your school), but the downside is that the appointments take longer. Dental schools are for people with more time than money, so they need to understand this going in. I did have one lady that was very impatient and rude at her initial appointment, and I straight up told her "Look, we are doing our best to help you here, and if you don't think we are meeting your needs - you may need to find somewhere else to go." You can't sugarcoat it. It doesn't help anyone if you take the time to screen, accept, and treatment plan a patient that won't comply.

One tip for speeding things up is pre-filling out any forms on the computer (I'm assuming everyone uses Axium). I always fill out med hx ahead of time (since I can view the scanned paper form they filled out), and even dental findings. I put everything as "WNL" and change it if needed. I can also see a pan that was taken at their screening appt, so I fill out as much of charting as I can just from the pan. If you know that some teeth are just goners, or if they definitely need sc/rp - go ahead and add that to the tx plan. It's quicker to remove treatments that you don't need than it is to add them. It's nice if you an a classmate can help each other out taking the intraoral pictures - have the patient retract the lips/cheeks. Assistant hold the mirror and blows air on it to keep it from fogging, and you take the picture. Then you go help them out for a few minutes. For radiographs, the FMX series usually follows a specific pattern (our default is max anteriors, mand anteriors, max right PA, mand left PA, max left PA, mand right PA, BW). Know this pattern ahead of time so you can just flow through the FMX and you don't have to stop to wait and see what's next.

Once you develop a flow and you always know what step is next, you'll get faster and more efficient. Good luck

 

[ncide]

I haven't had too many issues with patients getting that antsy - they understand that everything takes longer at a dental school (for the most part). Just explain to them that everything at the dental school costs 1/3 of the price of a regular dentist (or whatever that discount may be at your school), but the downside is that the appointments take longer. Dental schools are for people with more time than money, so they need to understand this going in. I did have one lady that was very impatient and rude at her initial appointment, and I straight up told her "Look, we are doing our best to help you here, and if you don't think we are meeting your needs - you may need to find somewhere else to go." You can't sugarcoat it. It doesn't help anyone if you take the time to screen, accept, and treatment plan a patient that won't comply.

One tip for speeding things up is pre-filling out any forms on the computer (I'm assuming everyone uses Axium). I always fill out med hx ahead of time (since I can view the scanned paper form they filled out), and even dental findings. I put everything as "WNL" and change it if needed. I can also see a pan that was taken at their screening appt, so I fill out as much of charting as I can just from the pan. If you know that some teeth are just goners, or if they definitely need sc/rp - go ahead and add that to the tx plan. It's quicker to remove treatments that you don't need than it is to add them. It's nice if you an a classmate can help each other out taking the intraoral pictures - have the patient retract the lips/cheeks. Assistant hold the mirror and blows air on it to keep it from fogging, and you take the picture. Then you go help them out for a few minutes. For radiographs, the FMX series usually follows a specific pattern (our default is max anteriors, mand anteriors, max right PA, mand left PA, max left PA, mand right PA, BW). Know this pattern ahead of time so you can just flow through the FMX and you don't have to stop to wait and see what's next.

Once you develop a flow and you always know what step is next, you'll get faster and more efficient. Good luck

Just a little tidbit of advice. Heating the mirror is much more convenient than having to blow air on the mirror since using the air/water syringe to blow air takes an extra pair of hands. I took hundreds of intraoral photos by myself, and found out the easiest to do was to take a butane torch and lightly graze the mirror with the torch flame. It very quickly heats up the mirror so it doesn't fog inside of the mouth. You don't have to wait for water to warm up out of the faucet and you don't have to wipe off any excess water either if you ran it under water.

That's how I did all my initial ortho cases. Makes taking intraoral pictures go very quickly.

 

[deleted659902]

dont nick the pulp

 

[BluntForceTrauma]

Just a little tidbit of advice. Heating the mirror is much more convenient than having to blow air on the mirror since using the air/water syringe to blow air takes an extra pair of hands. I took hundreds of intraoral photos by myself, and found out the easiest to do was to take a butane torch and lightly graze the mirror with the torch flame. It very quickly heats up the mirror so it doesn't fog inside of the mouth. You don't have to wait for water to warm up out of the faucet and you don't have to wipe off any excess water either if you ran it under water.

That's how I did all my initial ortho cases. Makes taking intraoral pictures go very quickly.

I just use my hands and rub the mirror between them. Even with gloves on, takes about thirty seconds and I just use this time to talk with the patient. Never fogs, but I also have really warm hands.

Sent from my Pixel using Tapatalk

 

[THS]

Just a little tidbit of advice. Heating the mirror is much more convenient than having to blow air on the mirror since using the air/water syringe to blow air takes an extra pair of hands. I took hundreds of intraoral photos by myself, and found out the easiest to do was to take a butane torch and lightly graze the mirror with the torch flame. It very quickly heats up the mirror so it doesn't fog inside of the mouth. You don't have to wait for water to warm up out of the faucet and you don't have to wipe off any excess water either if you ran it under water.

That's how I did all my initial ortho cases. Makes taking intraoral pictures go very quickly.

Not sure why I never considered a torch. We don't have reliable hot faucet water, so warming up the mirrors usually involved soaking them in a hot water bath - which is a hassle. Good tip!

 

[TanMan]

Pro-Tip(s):
- Identify and work with only easy faculty when possible. If not possible, know preferences of each faculty and what they care about (or don't care for)
- Learn to multitask and learn when something's not important (i.e do you really need ABO quality study models for someone who has no problems with their teeth). The term "clinically acceptable" comes to mind to unimportant things.
- Learn from part-time faculty on how they work efficiently. Don't work with full-time faculty. Sometimes, this requires acquiring dental products not offered by the school. You are there to learn, you might as well experiment on different methods and materials as long as your faculty is cool. I remember buying my own stone since the stone at school took forever to set. I bought a box of snapstone and mixed with slurry water so that it would set in a minute. I used it for my study models. Fujirock is awesome for final casts. No need to wait a lot longer. Also bought lightcured base plates, tried the H&H impression technique, different bonding agents, etc...
- Work with confidence. Your patient senses and knows it. If they ask if you've done the procedure before, without hesitation, says, you've done it dozens of times
- Learn to work without looking. When you're cutting tooth or bone, you should be able to feel (with your handpiece or instruments), caries, gingiva, solid tooth structure, granulation tissue, solid bone, etc... That way, you are not so reliant on your vision. Eventually, you'll be able to cut a prep without looking the whole time.
- For removables, I'd recommend buying chairside hard reline material in case your dentures suck in the end. I wish I had this material in dschool.
- Where to get these materials without a dental license? Trade shows, dental association meetings, ebay, dental lab supply store, etc...
- Keep the patient informed as to why you're doing these things even if they have no relevance in the real world.
Xrays: tell them that looking only shows us the outside, the xrays show us everything in between and underneath. Otherwise, we're not seeing everything
Study models: Tell them you're analyzing their bite or something
- Full perio charting: Tell them that gums/bone are the foundation of their teeth, you're taking objective measurements to determine if their gums are healthy or not
- Intraoral photos: Tell them that you want them to see what you see so that they know why you're recommending what you recommend in terms of treatment. They respect that and drives patient case acceptance.

One additional tip: Analyze why you have to leave your workstation. Most often, it's because you might be missing materials (needles, lido/septo, composite compules, gauze, etc..). Stockpile and hoard materials for your own patient use so that you don't have to leave your workstation if you're missing items. Just make sure your admins are cool with it (do not ask them this question directly!) and don't make it too blatant. If your school doesn't have a ultrasonic scaler at every workstation, go buy a piezo scaler with independent water supply. You'll likely need it for the boards.