Dental Practice Solutions

Optimize your dental hygiene department by taking an integrated, team approach

  • Do you feel like you are working hard and your production is not increasing?
  • Do you feel like your hygiene department is under performing?
  • Is your hygiene department producing 25-30% of your total production?
  • Are hygienists in your office treating bloody prophys?
  • Does your hygiene department help enroll implant cases and high-end treatment?
  • Do you have one or more holes in your schedule daily?

I am so happy that you are here because we have answers and solutions to your challenges.

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:



  1. CosmeticDentistry      Stateof      the Industry Report 2011. Accessed on Oct. 26. 2012