By survey, the overwhelming number of new patients expect a cleaning as part of their first new patient appointment.
1. Unless the new patient is an emergency, has a broken tooth or toothache assume all new patients will get a prophy but, do not guarantee a prophy when scheduling.
2. The doctor always does an exam first however, many doctors do not like doing the comprehensive exam in uncleaned patients as caries can be missed if a lot of buildup is present. For that reason, many practices schedule the patient through hygiene but, of course, the doctor must still perform an exam.
3. When scheduling patients through hygiene the hygienist greets and seats the patient. Then the doctor, having reviewed the health history medications to verify and ensure no contraindications to hygiene scaling, says hello to the patient, goes over the chief complaint and gives the OK to take x-rays and do a prophy (if called for) after which the doctor does a comprehensive exam at the end of the appointment.
4. If too much build up, many do just probing and comprehensive perio evaluation. No cleaning but, patient is scheduled for SRP as soon as possible. You can also start on a single quad of SRP as a single quad takes the same or less time than a prophy in most cases. If the patient is disappointed that you cannot do a cleaning, consider delivering a coronal polish and quick calculus debridement (do not charge as a prophy!).
5. If accurate probing can’t be done, many will do FMD and then have the patient come back for comprehensive exam, probing & prophy.
6. New patient appointment with hygiene should take no longer than ninety minutes. Depending on the medical history or complexity it might just be x-rays, photos and exam, leaving time for a more in depth conversation.
7. Never rush exams. Doing so is “stepping over dollars to pick up pennies”. You will miss opportunities, especially perio, if you’re in a rush.8.
8. If the new patient has a lot of previous dental work or neglect, many doctor’s prefer to do FMX and pano. If insurance does not cover it, many still order whatever radiographs are needed but, charge only what the insurance covers as it doesn't take an assistant that much longer to take the FMX. That being said, if you do a pano and BW same day, you can get less reimbursement because it often gets mapped to an FMX. A pano can be done later when it is warranted. Many practices will do four BWs and three anterior PAs. Then additional PA for any severe perio, symptomatic tooth, broken tooth, or existing root canal.
9. Emergencies, broken teeth and toothaches are scheduled with the doctor. For emergencies, ask the patient, “Would you like me to focus on this one problem you are having, or let you know everything that is going on?”. For cash patients, many practices charge for a full exam. This takes money out of the equation. Then just give the patient what they want. See extraction or RCT patients a week later as post op so you can see how they are doing. With the patient out of pain they may be interested in taking the next step so they do not have to schedule another emergency appointment.
10. Same day dentistry: A new patient is receiving a cleaning and it’s discovered the patient needs a filling or two:
Wrong: “Let’s go up front and see if we can get you scheduled for treatment sometime in the future.”
Right: "Ms. Patient we might be able to save you a visit. If we can work this into our schedule and you have the time and finances, would you like to get this completed today?"
11. Coordination with front desk :
Call out treatment to assistant or hygienist who enters into the computer.
Next, the front desk employee who handles financial arrangements comes into the operatory.
Explain the needed treatment to the patient in the presence of the front desk employee.
If there is more work than can be done in one appointment, highlight the priority items to be fixed first. State exactly what you are treating first.
The front desk employee leaves the operatory and enters treatment plan as the doctor further explains the treatment plan to the patient.
The front desk employee returns 5-10 minutes later with the treatment plan.
The front desk employee says to the patient, "Your estimated portion is XYZ. Would you like to get started today?”.
Ensure patient signs the treatment plan and understands they will need to make their co-pay that day. For FFS patients payment is always due at time of service.
12. Financial arrangements: One of the biggest management errors that can be made in a dental practice is discussing finances with patients at the front desk where other patients might be able to overhear the conversation. Not only could it be a HIPPA violation but, most patients are not comfortable discussing finances where other patients might be able to overhear the conversation.