Exam

patient view

Instead of jumping into your examination steps, absolutely astound your patient by just sitting across from them and simply asking, “Mrs Smith, tell me what we can do for you today” (And don’t interrupt!) The may respond with “Just a checkup” or go into a particular problem that they have a real concern about (and that no previous dentist has allowed them to fully explain.) Once they have given you areas of their concern, you will be able to custom fit your approach and solutions in a far more acceptable way than if you just dictated to the patient their objective dental needs. And be mindful to offer alternatives and how staging of treatment can accomplish comprehensive care.
Go over benefits and risks of various treatment approaches as you see them but try to avoid the “take it or leave it” treatment plan ultimatum that too many patients have been presented with in the past as unmanageable and unaffordable for them. Little steps can accomplish great things…

The Exam
“Why is he feeling my neck?!  I just wanted my teeth looked at!” Many of your patients will have never experienced a comprehensive oral examination and palpating a patient’s neck or grasping their tongue with a gauze can raise eyebrows and lower comfort levels unless you are informing the patient in advance of your movements. A little explaining beforehand will impress the patient with your thoroughness and permit you to gather the best diagnostic information in a permissible and logical manner.

“Mrs. Jones, as dentists we are interested in your total oral health and that includes your whole mouth and all the structures around it. I will of course examine each and every one of your teeth but I want to be careful and thorough and I will tell you everything I am doing as we proceed.”

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The first time you actually touch a patient is your absolutely very best opportunity to establish a life-long confidence in your skill and gentleness. Don’t be a “QuickJerk” lip and tongue tugger or you will be labeled “Rough” by the patient from then on.
Patients can also read hesitant or unsure movements in your fingertips. Practice a “slow-motion confidence” with your finger and hand movements and your patient will award you the priceless “My Dentist is So Gentle” title.

Sample Dialogs:

Soft Tissue:
I would like to begin our exam by looking for any abnormalities around your head and neck and under your jaw (skin lesions, masses, nodes, orthognathic profile). Now I am going to check your jaw joint (TMJ) and I want you to yawn in slow motion for me. Alright.  Next if you will open slightly I am going to check your lips and cheek areas. Good. Now I would like to carefully examine your tongue and I will lift it side to side (gauze, palpation). Now I would like to feel under the tongue and the roof of your mouth. OK, that all seems fine.

Periodontal:
Next I am going to carefully measure the bone and gum support of your teeth and I will be calling out some numbers to my assistant which I will explain to you after we are done (mobility, perio probing, attachment levels, occlusion, etc.).

Dental:
And now I want to examine each tooth and filling for any cavities or other problems. (An intraoral camera is extremely impressive to the patient at this point and will improve your diagnosis.)

Radiographic:
Alright, we are finished and now I need to to carefully compare your x-rays with this information…(digitally, chairside is ideal)

Diagnosis and Treatment Planning:

…and then completely go over my findings with you. For routine cases, most patients will expect you to review your findings and recommendation at this same visit. For more complex cases, you might say:

“To do this properly, I would like to have a separate appointment where we can sit and discuss your oral health, my recommendations, fees, appointment time involved, and answer any questions you may have. Will that be ok?”

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