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- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

Dental Practice Solutions - Debbie Bittke


By: Debbie Seidel-Bittke, RDH, BS

October 27, 2012

Many dentists expect that clinical training alone is enough to make comprehensive care a big part of their practice and they don’t pursue leadership training. This belief is contrary to the aspects of being a dentist and running a business. Most dentists pursue clinical education, and they slam headfirst into that wall that separates technical skills and running a business.

According to the 2011 report from the American Academy of Cosmetic Dentistry (AACD), 6% of practices reported average patient costs of less than $500—a 4‐point increase since 2007. The patient treatments most often completed – averaged  approximately $2,500 ‐ $4,999 (19%) and $5,000 ‐ $9,999 (15%), both down several points since 2007.As a result, many patients with more complex needs and higher treatment fees go home to “think about it” and never return, leaving the dentist to do nothing, become apathetic and wonder how the economy could do this to them. Some dentists may blame the patients, others blame their team, a few blame themselves but I hear many dentists blame this on the economy!

Try to grow a profitable dental practice without an awareness of leadership skills is like fighting a ghost. You can take a bat and swing at what you think is the problem, only to find that you are swinging into thin air and nothing is there to hit!

Leadership is the only way through this! Your ability to lead your practice affects the way you do dentistry, how much dentistry you will treat and it affects the entire team.

The end result is your prosperity and the legacy you will leave behind. It also determines if you can someday sell your practice or give it away!

“Your ability to lead your practice affects everything you do in your dental business, your prosperity and the legacy you will leave behind.”

Most dental schools today focus on the technical skills and after graduation there is still a focus on clinical skills.  There is little emphasis on leadership training in dentistry.


When you have great relationships around you and can do the dentistry you love, you will experience a life with greater fulfillment.

A sense of fulfillment creates happiness and happiness is contagious. Happiness spreads to those around you and those you influence. The people close to you, especially patients and team members, intuitively know that you are fulfilled. It becomes like a domino affect and spreads like a wild fire creating peace and harmony. The people around you also feel the peace and joy and they will begin feeling the same way. Everyone feels better about themselves.


The traditional form of case acceptance emphasizes an explanation of the disease etiology and the treatment process. The goal here is to raise the patients IQ and sell you dental services. Many times when you go into all of this explanation patients feel worse about themselves after they hear about their poor oral health, then when followed by all their personal and financial challenges laid out in front of them at their dental visit.  Patients may feel stressed when you tell them all the details and in addition the high ticket price to get their dentistry completed sooner than later.

I know and you know that you want to do the right thing by educating and explaining everything to your patients. You think you are motivating your patients to receive your stellar care.

But are you really?

Maybe not.

You’ve heard it a million times: “Patients don’t care how much you know, until they know how much you care.” Based on this thought, we jump high and perform all kinds of tricks with the goal of giving your patients a WOW experience. You are thorough; you spend unlimited time completing comprehensive examinations and bring patients back for lengthy case presentations. You offer excellent customer service, give them gift cards, spa treatments in the office, attempting to impress them with who you are and what you do! With the traditional type of case and when your emphasis is all about the disease and treatment process, your intention to help patients make the correct decision will be missed.

Food for thought:

Do your efforts to WOW patients distract or take away from the bigger picture of helping your patients feel better about who they are? It’s the stellar dental team that helps patients feel good about the team; it’s not the good team but the great dental team that helps patients feel good about themselves.

Leadership principles operate in all areas of life. If it works in the dental office, it will work in other aspects of your life as well. The dental office is a great place to learn about people skills and life skills. Use it or lose it. It’s a 24/ process.


The higher the level of care you offer your patients, the higher your level of leadership skills needs to be! Use the KISS method for successful case acceptance.

This is about Understanding vs. Educating the patient. Realize what emotionally and mentally this makes up each and every individual patient when in your office. What is their lifestyle like? What are their challenges and even their successes in life? What is their personality style? Do they speak to you slowly or quickly when they use their words? Do they speak softly or loudly to you? Match and mirror your patient styles. What type of words do they use? This is not manipulation I am talking about but a way of honestly getting to know your patient so you can COnnect.

I have coached dozens of dental teams and mentored thousands of dental professional and they have guided me in my approach to these concepts I will share about case acceptance.


The core of this process to get to that next level and increase your case acceptance is to identify your patient’s style. Discover what you patients want and what they expect of you and their appointment.

There are various types of personality assessments you can take to learn about the various personality types and how to communicate with each one differently.


Immediately following the patient exam will be your post-exam discussion. The purpose of this discussion is to discover your patient’s level of readiness for accepting their complete treatment plan.

The discussion will end with a question. The question will sound something like this: “Robin, today we talked about your oral health and this relationship to your total health. You heard me say earlier that there are ten teeth with areas of moderate gum disease and the old fillings on your six front teeth need to be replaced with the veneers. I understand from our conversation that you would like to live a healthier and longer life plus your family history of Diabetes is a concern to you. We can put a halt to that Diabetes concern by providing the scaling and root planing treatment around these ten teeth which are in all four areas of your mouth. We will have you return for scaling and root planing in these areas. I know that your daughter’ wedding is coming up in four months so after the hygiene appointments are complete and your gums are healthy, we can begin with the veneers on your upper front teeth. Would you like to begin the scaling and root planing treatment next week?” And always ask the patient; “Robin, what questions or comments do you have for me about your care?”

When communicating with your patients make sure to address their life circumstances and respect what is important in their life. Do what you can to avoid embarrassment, fears or anger. Do what you know is possible for them to say “Yes” to their treatment.


It is most likely that you patients will ask about the fees, duration of appointments, etc., at some point during the discussion. Do not offer to discuss this first! Never begin with the “your insurance will pay X” before they have accepted their necessary care.

Always provide written financial option forms to support your financial conversations.

When patients ask about fees, the financial coordinator needs to provide the patient:

  • The total fee (any specialists fees as applicable)
  • Time frame for each phase of treatment (or the complete treatment)
  • Flexible financial arrangements (offer options)


“Robin your total treatment fee is $4,500 and it will take about three months to complete your care. Most patients prefer to begin their care with no initial payment today but make 3 monthly payments during the months of treatment. We can do that for you, and I estimate your payments to be $1,500.00 a month. Another option for you would be to pay with a line of credit we offer. You will have no out of pocket for the next 12 months if you choose this payment option. Which option is best for you?”


Note that in this conversation the offering a flexible financial plan. Patient financing is critical

for patients who want and need comprehensive care. Without it, a significant number of patients will

not be able to fit comprehensive care into their lives.

Once the financial arrangements have been completed , the patient will need to sign the financial agreement and the next appointments will be scheduled. Only now is your patient is ready for the most technical aspects of case presentation.

In order for you to meet the ethical and legal responsibilities you will always discuss the benefits and risks with your patient and document the information and consent. When you are discussing a comprehensive treatment plan it is usually beneficial to the patient to communicate using visual aids, photographs, videos, clinical diagnostic records and radiographs. The difference when discussing comprehensive treatment from a tradition case presentation is that all this will occur after the patient has accepted the financial and time commitments for their care in your office.

The reason I suggest doing it this way is that the patient will no longer have any lingering fears about time, money or other personal challenges. You have overcome their potential stress and objections before they ever came to fruition.

Once the patient has acknowledged their understanding of the informed consent process (verbally and in

writing), they are now ready to follow through with their care in your office.


Many patients may still not be ready to complete treatment. Time constraints or financial challenges may exit. The biggest challenge most patients will have to accepting treatment is the time it takes to fit dental appointments into their schedule.

Check yourself:

Have you truly made an effort to understand your patient?

  • Their personality style?
  • Their tone?
  • Their pace?
  • Their personal life challenges?
  • Is your patient feeling frustrated about something? Anything?
  • Are you too rigid with your sequence of future or current patient appointments?

Some patients will still not accept treatment and their care in your office. The best solution I have is to ask if you can follow up with patients who leave without an appointment within 48 hours. If they say “Yes” to the follow up is something I can’t answer but continue to build relationship. Do you best to connect withj your patients whether they are in your office or outside the office. Technology and social media offer many ways to stay connected and continue to build the relationship.

DID YOU ENJOY THIS? Would you like more? Please join us on Oct 30th to learn 3 things your RDH can say to Increase Profits by 100k. I will share with you how to present more positive case acceptance plans. JOIN USE HERE: http://dentalpracticesolutions.com/products/case-acceptance-webinar/




  1. CosmeticDentistry      Stateof      the Industry Report 2011. Accessed on Oct. 26. 2012 http://www.aacd.com/proxy.php?filename=files/Footer%20Nav/Media%20Room/Surveys/AACD%20State%20of%20the%20Cosmetic%20Dentistry%20Industry%202011.pdf

Important Points to Understand and Increase Your Net Production

By: Debbie Seidel-Bittke, RDH, BS

October 20, 2012

Most Dentists today tell me their primary concern is to increase New Patient numbers. Do you know how much it costs you to market and then capture a new patient? What is the cost to you if you can reactivate a current patient of record?

Many dental offices are eager to spend money on external marketing efforts to capture new patients when in fact they are cutting back on dollars spent on building patient loyalty and getting patients back to the office. What makes you think that a new patient will be better than a patient you have not seen in the past year?

If you have limited dollars in your practice today, the best way to spend any money to raise patient numbers is spend any money available on your existing patient base. How much does it cost you to lose an employee? This is the same when you lose a patient of record. A lot of time and money is lost!

 Benefits of Retaining Patients

 Increasing your patient retention numbers will boost your profits and minimize other costs such as marketing for new patients.

Not only does retaining your current patients boost your profits just by having then visit the hygienist on a regular basis but imagine the dollars the current patients will spend when you offer various services such as:

  • Oral Cancer Screening technology/tests
  • CAMBRA (Caries Management by Risk Assessment)
  • Non-surgical periodontal services, adjuncts, lasers, etc.
  • Same-day services (Such as Whitening, fluoride, night guards, etc.)
  • Home-care products
  • Cosmetic dentistry
  • Implants
  • Six-month Smiles, Invisalign
  • Etc.

Your long term patients most likely have a great rapport with you and the team. Their trust factor is high. They are most likely to accept your treatment recommendations.

Do you know the average money spent from your current patients per visit? The longer the history for the patient of record the more comfortable they will be spending money in your office.

Statistics tell us that in dentistry we have a 70% chance that our patients will accept treatment but only 20-25% of patients schedule an appointment to complete treatment and pay for this.

The average dental practice loses 10-15% of their patient base annually due to patients moving, dying or just because they changed insurance providers. This means that if you have an active patient base of 1500 patients you will lose 150-180 patients annually. During this current economic climate case acceptance in general is low and with many practices gaining less than 20 New Patients per month, your revenue is very low!

The company New Patients, Inc. did a study in 2003 and found that the lifetime value of a patient is $1,502.27. When you adjust the rate of inflation you have a lifetime value of at least $2,000.00, as of 2011.

You can estimate the loss of value with the inactive patients by multiplying the total number of inactive patients by $2,000.00 –the current lifetime value of your patient.

Imagine that if you lose just 150 patients in 2012, your lost revenues will equal $300,000.00. Now that can hurt!

But let’s get to the bottom of this challenge and create solutions.

1. Count the active patients in the practice
    a. This is the # of patients who have been to the office in the past 12 months
    b. Not a surprise when you see this # is different that the number of patients in your database
    c. Review these numbers each month at the team meeting and
    d. Create systems to grow your patient post

2. Survey your patients
    a. Ask patients about their recent visit
    b. Did you meet their expectations?
        i. Did they enjoy their experience?
       ii. Did they have to wait?
      iii. Do they feel comfortable referring their friends and family?
      iv. Do they have frustrations? Any challenges?
       v. Are there services they wish to have but you did not offer?
    c. You can use www.surveymonkey and email to those patients who informed you that it is ok to contact them by email.
    d. Offer a gift, something of value from your office, in return for their response
    e. Once you have 75-100 responses discuss these at your next team meeting
        i. Any frustrated patients or needs you have not met, be sure to correct these and let the patients know you have addressed their frustration or need

3. Create a WOW experience. One like no other office in your area!
Many patients will come to your office because of your fees but there will be many who come to your office because of the team, their personal relationship and the specific culture of your dental office.

Each patient is different. Their needs vary and so do their personalities. Make sure that everyone on the team is able to effectively communicate with the various personality types. You can go here to update your skills and assessment of personality types: http://www.humanmetrics.com/cgi-win/JTypes2.asp

Treat your patients with honesty. If you say you will call them back, call them back at the time promised. If the fees change explain why and show them where this was projected to change. Be sincere in everything you do, say and stand for.

This is how you will continue to keep their trust and remain credible.

When you know your patients expectations and over deliver you will have them at WOW and create raving fans!

Meet with you team and discuss one thing that you can do now to create more fans and WOW them even more.

4. Communicate
    a. Your website is a great place to communicate with current and New Patients
    b. Does your website have an area to submit questions?
    c. Do you use social media to keep patients up-to-date with happenings in your office?
    d. How will you communicate special offers to your patients?
        i. And/or New Services?
    e. Email patients and/or post on social media about courses you and the team are completing
    f. Post and communicate about any changes in the office
        i. New employees
       ii. New equipment, chairs, services, etc
      iii. Tell them interesting health facts
    g. Find various communication methods to keep patients in the loop between their dental appointments
        i. Social media
      iii. Email
      iv. Educate, educate, educate
       v. Etc.

5. Reactivation tips
    a. Call patients who cancel an appointment and don’t reschedule within the next 48 hrs
        i. Ask when they cancel and don’t reschedule if you can call them to reschedule at X date at Y time
       ii.Make a point to call and reschedule at this scheduled time!
    b. Plan to have a reactivation system in place and use this every 3 months to send post cards, various letters at specific times, etc.
        i. Just like collections: the longer the person owes money, the less likely you will receive payment
          * Same thing with reactivating patients – don’t delay the process!
       ii. Run reports to reactivate overdue patients every month and send the various letters approximately every 90 days
      iii. Add the date of last appointment
      iv. Make the letter directly from the doctor showing concern
       v. Follow up with a  live phone call from the team when there is no response to the letter
          * Goal of call is to schedule the patient

The key factor to the success of every dental practice is reactivating patients. If your patients can experience a sense of loyalty you will experience higher profits and practice growth. You need to implement a strong reactivation system to prevent the loss of 10% or higher in your patient base.

Reactivation of patients can be complex but in the long run this will cost you less money than finding a new patient to replace a lost patient. Imgaine if you can cut back to losing 50 patients this year vs. 150 patients. This is worth it’s weight in gold!


Your Comprehensive Treatment Plan Part II: “Get Them to Say YES!”

By: Debbie Seidel-Bittke, RDH, BS

October 13, 2012

In part I of Your Comprehensive Treatment Plan we discussed the necessary fact that you need to build trust in your patients and understand their needs. It is also very important to understand their personality style before presenting treatment.

Case presentation is complex and involves numerous steps to get patients to say “YES”. These steps are:

  1. Coordination of the New Patient exam
  2. Communication to their patient of their needs
  3. Present the big picture
  4. Offer flexible financing

Continue reading “Your Comprehensive Treatment Plan Part II: “Get Them to Say YES!”” »

Your Comprehensive Treatment Plan: Patient Case Acceptance

By: Debbie Seidel-Bittke, RDH, BS

October 6, 2012

Every dental practice wants their patients to accept comprehensive treatment. Research states that at most, 25% of patients in a dental practice accept their treatment plan, and schedule an appointment.

What are some of the factors that will affect their decision? How can you change your current treatment plan case acceptance to be at 70% or higher?

Many factors play into your patients decision to accept and schedule treatment in your office. One of the most important factors that will get your patients to say “Yes” to case acceptance and schedule the appointment(s) is trust.

When patients feel good about your office, when the know they can entrust the care of their health to your dental office, it is because they trust you and now they are more likely to schedule for necessary treatment. You will find these are the patients who return for their appointments year after year, they are the people who trust you and the entire team. Your patients want to know and feel, deep inside, that you really care about them! How can you show a new patient that you really care about them and not just their pocket book?

Once patients trust you, they feel a sense of commitment and they are the patients who return for their appointments, no matter what is happening in their economy. These are also the patients most likely to make payment in full.

“It’s Complicated”

Case acceptance is a complex issue and requires a team approach. All decision making involves the understanding of human behavior.

Let’s break down case acceptance into 4 steps:

1. Developing a foundation for trust to occur

2. Understand your patients’ needs and their personality type

3. Effective communication

•           Be able to explain the why, what, how, etc.

4. Offer flexible financial arrangements

This month we will only discuss steps 1 and 2.


Step 1: Developing a Foundation for Trust to Occur

The first step to have patients accept your diagnosed/recommended treatment, and returning indefinitely for their appointments, is to gain trust. Trust is instinctive.

If patients have not established a trusting relationship they are not going to accept comprehensive treatment and they are less likely to become a long-term patient.

Building trust starts before patients even walk through the door of your office.  As you are reading this right now, millions of people are on the internet and hundreds of thousands are on the internet now, searching for a dentist.

When a patient lands on your website their mind begins the trust building factor. It continues when they first call your office and then as a patient in your office, your words and the manner in with you say your words build their ultimate trust or distrust.

The Important Trust Building Factors

When someone visits your website for the first time, they will want to easily find the information they came looking for. This may be a list of the services you provide, special programs you offer, insurance accepted, how they can schedule an appointment. Can a patient request an appointment through your website? Do you have photos of your beautiful cosmetic dentistry? Do you have photos of your team and a bio that talks about employee interests and their areas of expertise?

When a potential patient calls your office, will the person who answers your phone be friendly? Will they say their name? Imagine the first phone call as a phone call with your future spouse. If you don’t like the first conversation what are the chances you will be calling back to schedule a date?

People instinctively look for a specific comfort level when they are interacting with someone on the phone. The first person to speak with a caller must be courteous and reassuring. Understand the exact language and tone of the caller and mirror this during the phone conversations. This will put the caller at ease. Be able to give an answer to their questions whether it be financial or insurance driven.

How complicated is it to make an appointment in your office? Are people calling immediately put on hold? Can people visting your website make a request to schedule an appointment?

Many issues are important to discuss before a patient comes to your office but try to make the first call simple, succinct and one that is helpful to the patient. Try to not ask too many questions over the phone so you don’t complicate the process

What occurs during the patient’s first treatment appointment?

The first appointment when the patient is in your treatment room is when they will assess your “chair side manner,” your concern for their comfort, and how gentle you are during treatment.

Trust requires that the dentist and team keep their word. If the patient was quoted a fee, this fee can not change unless there is a change in the treatment plan and at this point, you will need to stop the procedure and explain the change. (The what and why, etc.) If your new patients and/or patients of record, expect to see a particular dentist or auxiliary, (RDH, etc.) they must be appointed with this dentist or auxiliary. If you tell a patient you will call them back within the hour, or the next day, they must receive this phone call.

Each time a patient visits your office for a scheduled appointment, they gain further confidence in your dental practice.

Step 2: Patient Priorities and Personality

The second step is to understand your patients’ needs, their priorities and their financial situation. To understand this means that you perceive what goes on inside their thought process. It will be helpful if you can identify the various personality traits of each individual patient and communicate effectively using these tools to help you understand the who, what and how, (etc.) they “see life”, through their own pair of glasses.

Depending upon the level of care and expense of the patients treatment plan, you may want to bring the patient back for a separate appointment to privately discuss in a consultant room or a private area. Always discuss treatment plans with patients, in a confidential area and without anyone feeling rushed or being interrupted.

A persons behavior patterns affect how they make a decision. Learning to understand these various personality types can result in positive communication, which results in building trust with the patient, retaining patients long-term and increased profits in your practice.

There are many different personality tests to evaluate personalities, how to respond and interact with each type. For this blog we will refer to the Meyers-Briggs Type Indicator® (MBTI) personality inventory. (http://www.personalitypathways.com/type_inventory.html) The MBTI uses factors such as introversion/extroversion, sensing/intuition, thinking/feeling, and judgment/perception to identify the various personality types. Every dental office needs a simple system that enables you to effectively communicate with your patients, as much as possible, to predict patient behaviors. The system that you choose to use must take into account not only patient behavior but also priorities and financial considerations.

The MBTI categorizes personalities into various types as mentioned above. You can take your own personality test and share with the entire team. It can make for a great team meeting and is a great resource to building a successful team. Here is where you can begin practicing how to get to know other people’s personality type and understand how they make decisions. Try it out within your team now! http://www.personalitypathways.com

When you can easily identify your patient’s personality type and learn how to communicate within their comfort level, you will turn objections into opportunities and create a huge TRUST factor with your patients! This is also a great way to build teamwork within your office! Try using this within the team.

At this point it is important to understand that having a specific methodology for case presentation is critical for your success and the best outcome of your patient(s).

When the entire team understands the process of getting your patients to “YES” for comprehensive treatment, you will begin building trust before a patient ever steps foot inside your office.

If your efforts are a desire to be helpful, reassuring, caring and understanding of your various patient personalities, and their mind-set. If you can eliminate their fears as well, your rate of success for comprehensive care will soar and your profits will take a LEAP– UP! Getting to “Yes” requires a commitment from the entire team which will benefit everyone!

Next week Part 2 will continue with this topic.

Do you want more of this? Be sure to check back in the next 30 days for the release of our 12 week program dedicated to CO-munnication to Increase Comprehensive Treatment.

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