One of the biggest stumbling blocks to offering quality esthetic dentistry is the mistaken belief that your patients will not pay for it. I once had a patient who was a bricklayer and who was dissatisfied with his smile. I spent a considerable amount of time trying to educate him as to why the […]

Treatment planning is not complete until the patient makes a final decision about accepting treatment. However, follow-through by the treatment coordinator is necessary throughout your patient’s treatment. Any proposed changes to your treatment plan must involve your treatment coordinator. In fact, if your proposed changes affect your fee, then be certain to have the […]

There are several precautions to take if you elect to treat problem patients. One, be prepared to spend much more time in diagnosis. The best way to handle patients who have difficulty communicating what they want is to schedule several diagnostic sessions. Use different approaches to attempt to understand what your patient visualizes as […]

This is another potential problem patient that can be overlooked if your diagnostic time is too short. Frequently, this patient presents with poor dentistry or no restorative dentistry at all. Hygiene is either nonexistent or inadequate at best. They will vociferously complain about a previous dentist and staff. The major problem with these patients […]

There is nothing wrong with patients who are limited in the amount of money they can invest in their dental treatment. In fact, this may make up the majority of your patients. However, proceed cautiously with the budget-conscious patient who has extremely high esthetic expectations. Rather than having a dissatisfied patient, you are much […]

These are the patients who cannot communicate what they want because they do not themselves know what they want. They may show you a picture of exactly what they want, but when they eventually see it in their mouth, they may be terribly disappointed. Even study models with wax-ups may look good to these patients, […]

This patient has the highest standard of esthetic excellence. Unless you are willing to spend an inordinate amount of diagnostic and treatment time with this patient, you are much better off, emotionally and financially, making an early decision to refer this patient. Deciding to treat this type of patient may mean charging two, three, or […]

The final case presentation should be a carefully prepared, easily understood treatment plan. Visual aids, before and after photographs, slides, models, intra- and extraoral video and computer imaging, and examples of the procedures to be used assist in communicating the possibilities and limitations of esthetic treatment.
These are three basic methods for helping patients […]

Too often a dentist, impatient to begin treatment, fails to stress the importance of the patient consulting a specialist. For instance, dentists often do not emphasize the functional objectives of tooth repositioning, and consequently may not motivate patients to seek orthodontic treatment that might prevent bone loss later in life.
In most instances when […]

A preliminary treatment plan should definitely be formulated and it is also prudent to use an organized form on which to place these clinical recommendations. Although it may be revised considerably, different alternatives should be considered before the second appointment. A quadrant-by-quadrant outline of functional necessities with a separate list of esthetic options will […]

The dentist should be aware of any systemic physical or mental disease. Using a history chart, the dentist can learn if a patient has any of the various medical ailments that could compromise a successful esthetic result. It is important to know, for example, if the patient can tolerate sitting for extended periods during […]

Diagnostic models are an essential part of the treatment planning procedure. However, they must be accurate, well-made, and contain as much detail as possible. Arch relationships and tooth form, size, and arrangement should be studied. It may be necessary to consult a specialist with the diagnostic models before the patient’s second visit. Several questions […]

Preliminary reading of radiographs will reveal obvious caries, periodontal disease, and evidence of abscess or other pathology. Any teeth to be considered for crowning should be examined on the radiograph to see if the pulps are large or receded, because their condition can alter treatment expectations. Teeth that have deep caries or thickened apices may […]

Dentistry is fast heading toward a paperless office where every conceivable record can and will be computerized. The patient’s file, including all diagnostic and treatment records can already be stored, displayed, printed, and transported electronically. One of the major advantages of this trend is that it enables you to accumulate vast amounts of knowledge […]

This dual form of recording information will capture simultaneously the pretreatment full face and smile of the patient as well as the conversation relative to his or her perceived condition or problem. Both an audio and video recording are extremely helpful if there is any future question about the exact condition with which the […]

The more high-tech method of documenting the presence of microcracks is the use of an intraoral camera. It allows you to show patients their microcracks enlarged on a TV monitor, and also to record the finding on either a photograph or videotape. Thus, the patient involved in an accident claim has tangible evidence to […]

To accurately diagnose a patient’s problems and then create the best esthetic treatment plan, an esthetic evaluation chart is helpful. It can be a simple one-page form as developed by Goldstein or a more elaborate version. The comprehensive charts developed by Abrams and Dawson  incorporate both esthetics and function in their evaluation criteria. All […]

The first step in facial evaluation is to make sure you are viewing your patient at an appropriate angle. Have your patient stand or sit up in the chair with his or her gaze parallel to the floor. Then you can evaluate if a part of the face is out of proportion. Later, computer […]

Evaluation of bone support, tissue recession, tooth mobility, bleeding points, and periodontal pockets all have tremendous influence on your ability to achieve an esthetic as well as functional result. Presence or absence of appropriate ridge tissue also can change the treatment approach. A major reason for predestined esthetic failure is a failure to realize […]

Regardless of which chart you use, a tooth-by-tooth examination is essential to verify functional as well as esthetic limitations for the desired treatment. As basic as it may sound, there is no substitute for an extremely sharp explorer.
It is impossible to visually determine the soundness of each individual tooth. Saliva, plaque, and food […]

Every new patient receives a clinical examination. For the patient who is primarily interested in cosmetic dentistry, an esthetic clinical evaluation is mandated. This patient may have already received a prophylaxis, radiographs, examinations, and treatment plans from several other offices. Therefore, the initial appointment with you may be specifically for an esthetic evaluation, and […]

The hygienist may be either the second, third, or fourth member of the treatment team the patient meets. However, the hygienist usually is the first who actually performs treatment and therefore must be fully proficient in hygienic techniques and subtle investigation while maintaining a reassuring manner. Many times the hygienist will develop a special […]

Prehygiene: Look at the patient and observe the following:
1. Stains
What types and severity.
2. Calculus
How much and the length of time since the last prophylaxis.
3. Plaque
Most patients attempt to brush their teeth as well as possible before a dental appointment, so if your patient has a great deal of plaque present, this should give you […]

There is always the question of who should see the patient first—you or your hygienist. There are advantages and disadvantages to each being the first contact.
Even if the patient wishes an appointment only for a prophylaxis, it may be important for you to see and meet the patient first. Not only is it […]

This information can be quite helpful in determining what concerns your new patient has regarding his or her dental needs. One basic problem is that many individuals choose not to disclose the information, not wanting to prejudice you in rendering your opinion. The fear is that you may “slant” your treatment plan one way […]

There is no more important information than why the patient came to see you. This is not to be confused with your patient’s major complaint. Rather, why are they at your office instead of another? And why did they leave another office (or offices) for yours?
Frequently, this information can reveal valuable insight into your […]

A self-smile-analysis, or comparable index, should be explained and made available to the patient before the first visit.  The importance of such a self-evaluation cannot be overstated. Through this self-analysis, you can begin to recognize and understand the problems uppermost in the patient’s mind concerning his or her appearance, particularly as he or she […]

The dentist’s first priority should be to start educating the patient about the techniques and philosophy of the esthetic dental practice. The more understanding that patients have regarding their dental problems and potential solutions, the easier and more effective the first and future meetings with them will be.
Thus, a consumer book like “Change […]

Successful esthetic dentistry requires skills that involve more than the ability to diagnose and correct functional and pathologic irregularities. Each patient is an individual with an individual problem or concern and should be evaluated as a personality while considering the problem/solution diagnosis. The dentist who is able to master the art of understanding personalities […]

Most esthetically motivated patients who first appear for consultation are eager to begin corrective treatment. Nevertheless, their enthusiasm and, at times, their self-diagnosis should not influence the dentist’s esthetic diagnosis. Failure to attend to this caution could lead to treatment failure.
Although the functional aspect of every case should be the dentist’s primary consideration, esthetics […]