Fall 2002 Presentation Summary:

"Coordinating Orthodontic, Implant and Restorative Treatment
A Coordinated Treatment Plan"

Presented by Dr. Randy K. Shoup on June 3, 2002, at the Central Region meeting
Summarized by Dr. Owen Nichols, Central Region Editor

According to Dr. Shoup, planning successful interdisciplinary treatment is all about communication, mutual understanding, organization and verbal skills.

Complex treatment plans require all members of the dental team to forge a working alliance that combines their individual and unique skills to achieve best patient care.

FACING OUR SHORTCOMINGS

Dentists take pride in their accomplishments, which have made our profession the leader in health care service. Misplaced modesty misleads an informed public that appreciates how good we are.

In almost every aspect of treatment and prevention, our profession is far ahead of the medical profession. Our innovation and the evolution of efficient treatment are unequaled in any other health care arena.

“No other field of health care can treat their specific area with the precision, quality of pain control and esthetics that dentists provide,” says Dr. Shoup.

Dentists are so accustomed to their excellent skills that they often fail to appreciate the complexity of what they do. They may shy from taking compliments or downplay their accomplishments.

The two most damaging words in our lexicon are “just” and “a little.” As in, “just a perfect shade and color match” or “a little patch on a badly broken incisor.”

As a result, the public sometimes takes our accomplishments for granted and fails to value our services. Dental professionals do better to take credit for how good they are and charge accordingly.

Another all-too-common problem in dental circles is a lack of verbal skills. We often find it difficult to discuss issues in a straightforward manner or avoid confrontations by playing with words.

Respect your patients and yourselves by being honest and direct. Be clear – the responsibility for treatment lies with the patient, not with you.

EDUCATE THE PATIENT

Dentists are not trained to compete, which can lead to a lack of candor, particularly when it involves finances. We tend to compromise our patient’s treatment because of presumed financial constraints when we are told, “I don’t have the money.”

Treatment is not about money. It is about choices. Help your patient value your treatment and its financial value.

To dispel financial concerns, the dentist must create value. State your case clearly and honestly so the patient can evaluate the situation.

Patients need to be educated to make informed, responsible decisions, including the concept of the value-added practice.

Patient education can provide value and create desire if the restorative dentist and his team are thorough, confident, competent and compensated. This doesn’t happen without planning and effort.

EDUCATE THE DENTIST

The weakest link in the treatment chain may be the referring general dentist who might have a limited working knowledge of orthodontics. He or she may fear that referrals slow the process of doing restorative dentistry because of the misconception that all orthodontic treatment is a two-year process.

Moreover, the referring dentist may not see any benefit for himself in the orthodontic referral—that the referral is only providing income for someone else.

There are a number of steps that the orthodontist can take to overcome these reservations, and make the referral process easier. Educating your referring dentist is the key.

Be sure he or she knows:

Not all orthodontic goals require two years to complete and there are options for limited treatment.

Orthodontic tooth movement can improve restorative results, by providing ideal pontic space, upright abutments, or more esthetic veneers. Orthodontics can enhance restorative profitability by simplifying procedures and reducing treatment failures.

The orthodontist can also refer back to the restorative dentist. A third of post-orthodontic patients need gingival recontouring (a simple procedure using electro-surgery).

Bleaching, bonding, and veneers will often enhance an orthodontic result. Spaces can be opened for implants.

COORDINATED TEAMWORK

Dr. Shoup recommends the restorative / implant / orthodontic team as a solution to our individual shortcomings and a synergistic outlet for our individual skills.

Enlist other specialists for complex treatment plans. He cautions that a complex treatment plan requires a formalized coordinated effort.

Experience has exposed numerous pitfalls, and mistakes have spawned solutions.

Diagnostic data can be digitized and made simultaneously available to all participants in a treatment group. Digital systems exist to manipulate data and predict outcomes so that all parties can visualize a clear end point of treatment.

Develop and follow treatment protocols with clear milestones and goals so that each team member can modify, accept and approve them. Everyone should know where the patient is in the process at any given time point in the treatment protocol.

The patient and each team member should sign off on their commitment to every aspect of the treatment plan. The patient is presented with a fee for each participating dentist, signs an agreement to the monetary obligations and confirms the means of payment.

Dr. Shoup recommends that dental financing plans be made available.

A PROTOCOL FOR COMPLEX COORDINATED TREATMENT

Dr. Shoup’s “Coordinated Treatment Plan” is a four-phase protocol to which each team member and patient agree.

• The first phase involves the initial consultations. The restorative, orthodontic and implant providers examine the patient, evaluate the problem, objectives of treatment and desires of the patient.
  
  Each practitioner develops tentative treatment options, and obtains the essential diagnostic records. To avoid duplications, each doctor receives copies.
• The second phase is an in-depth case analysis by each of the dentists involved using shared diagnostic data.
  
  Treatment plans and recommendations are passed on to the next participant, including a description of methods and materials. The last person to review the material and make recommendations convenes the group as a whole for the third phase of the process.
• The third phase is a group collaboration, the “Coordinated Treatment Conference.” This is a face-to-face meeting to coordinate treatment options into a cohesive treatment plan.
  
  The group agrees on the goals, methods, sequences, and timetables, and sets fees for each stage. They set temporal mileposts for the completion of each step. Signatures are affixed to this third phase document, as in the previous two steps.
• In the fourth and final phase, one of the participating dentists presents the treatment plan to the patient who signifies his acceptance and commits to payment.

By this point all dentists involved have signed their intent to provide specific treatment for specified costs and at specific time points.

To keep confusion and misunderstandings to a minimum, no doctor completes his part of the treatment without written approval by the other participants.

For the orthodontist, this means that appliances are not removed before the others sign off on completion. Dr. Shoup recommends placing any implants before removing the orthodontic appliances.

Management of complex dental treatment requires a uniform agreement on goals, techniques, materials and timetables. Dr. Shoup insists that formal, written agreements can facilitate successful completion of interdisciplinary treatment.

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