Lesson #1: CORE lesson #1 – Working up the Wellness Pyramid

About This Lesson

Instructions coming soon..


Action Items

  1. Review my office manual and make sure that you have a logical flow to your guided tour.
  2. Make sure that the patient can understand and follow along your guided tour/exam process.
  3. If you are not taking Intra and Extraoral Photographs, this is essential.

Full Video Transcript / MP3

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What's up, everybody? How are you? This is Dr. Steve Schluentz. I want to welcome you back to module number five, which is the guided discovery process. And I have to admit that out of all 10 modules, this is actually one of the hardest to teach without doing live Q&A's because everybody's guided discovery process is different. Everybody's exam process is different. It's not as standardized as maybe some of the other modules are. You have to understand that as I'm trying to teach this, there's a couple core things that I want you to understand. One is, through the guided discovery process, this is basically code name for the exam itself. When you bring somebody back to the clinical exam, you want two things, actually three major things, so as you're going through all of module five just think of these three core elements. These are absolute essentials in the exam process.

One, you need visual aids so that patients understand where they're at in that health disease spectrum. That's number one. Okay, so any visual aid you can use, that is going to be a huge benefit for you. Number two is you have to get them into goal setting mode as quick as possible. Whether they're small goals, large goals, it doesn't matter. I always lead with small goals because I feel if patients can get on board with small goals, they'll have bigger goals down the road. It's how most people set goals to begin with. That is absolutely essential. We have a visual aid or visual aids, we have some type of goal setting mode, and third is just getting the patients involved in the process, helping them actually understand what it is that you're looking for.

Just keep those three core things in mind as you go through the exam process. And as you're developing your own exam process, just be aware that everybody has different sheets, everybody has different things, everybody has different training. If you went to Spear, it's different than Pankey. If you went to Pankey, it's different than Dawson, and Dawson and Spear, on and on and on. If you go to OBI, you go to The Stewart Center, you go to dentistry's optimal model, things of that nature, they're all gonna have their own style and you're going to have your own style. And my exam processes change in terms of the sheets that I've used, but the three core tenets that I talk to you about, those are always there. So these are the five basic tenets of the guided discovery process. So building up the pyramid of wellness, visuals for engagement, simple goals first, larger goals later, invitation of the possibilities appointment and the post-appointment call and gift.

Understand that these five should be touched on at some level in any exam process. And if you can do these, you can make it as cool as you want, but understand these five tenets. So for me it's all about building up the pyramid of wellness. And this is very synonymous with actually number three, which is simple goals first, larger goals later. If you remember what we talked about, we talked about this pyramid of wellness, and this is one of the things that I think has really simplified the process for most of the dentists that I work with. If you're having a patient that's cosmetically driven, for example, you can go up the rungs of the pyramid and start to talk about longterm aesthetic dentistry, but you also have to understand that these patients have to get down to that first level and start to adjust perio disease first.

When I'm building up the pyramid of wellness, I use this as a way for the patient to understand our process. So I use that risk assessment pyramid as a way to structure my exam. It's very important. I actually go through my exam process the way the pyramid is laid out. I start with perio first, then I go to tooth decay, then I go to bite, then I go to longterm dentistry, then I go to general health. And at the first appointment, I'm really not even thinking about general overall health and trying to get them to chiropractors and specialists and things of that nature. All I'm trying to do is get them started up that pyramid, and I even tell patients when we go through the guided discovery process, the reality is I probably will not be able to do the complete exam that I'll have to do if they're going to go through longterm therapy.

I usually don't even get to an occlusal analysis or any type of model work that first appointment. I just don't. I take photos. So I want you to start with perio, move to decay by work your way up the pyramid during the exam. And for me, this is what I personally do. For the initial guided tour, I focus on photos, perio charting and initial bite assessment, and decay. I didn't put decay on there, but it's literally photos, perio charting, decay and some type of initial bite assessment. And for me, that's just literally looking at tooth wear. I have those ideal pictures of health that I look at. That's the model in my head that even when I'm looking at patients for the first time, I'm comparing it to those pictures of health to see what they would need to get them to an optimal level of health.

So I don't get too deep in the woods here. I don't spend 45 minutes charting at this exam. I want a 30,000 foot view. I want patients to understand the generalities of where they might fall in this disease and health spectrum, and I found that photos are the best way to do that. So as you go on, what you're going to see at the possibility session, which is module number six, you really do this guided tour. You get them some level of understanding, and then if they have high risks at multiple levels, they're coming back for an initial review of findings for me. I'm trying to break all these things into steps. I don't want to throw too much at them at once. I know that can work for some dentists where you do an exam and then all of a sudden you're immediately giving them a treatment plan.

But I do believe that overall, for patients that are unaware of the disease in their mouth, that's a behaviorally unsound model. You're going too fast and the second you go too fast, they will say no. They can't say yes if they don't completely understand the problem. They own the problem and then they want a solution to the problem. So I want you to refer to my sheets and manual for more details. Listen, that exam manual that I give you, all this stuff is in there and I encourage you to dig through this over and over and start to develop your own process. Hop on the Q&A calls and make sure, hey, I have a question about this. I have a question about this. This is how I'm working this, and I'm going to be able to help you. Now there's just some things that I can't discuss in detail on these little intro videos that I can discuss in detail in the the Q&A session.

So I encourage you to go. I encourage you to help your team understand that this is how we move through a guided discovery process. There's a very systematic reason we do this. And so your action steps at the end of this video is review the office manual that I gave you and make sure that you have a logical flow to your guided tour. If you're all over the place with your tour and you're going to do this and then you do this, "Oh, I forgot," you go do this and you put this in the chart, the patient's lost. This exam, you have to understand, the exam is designed for the patient. The exam is not designed for the doctor. You have to understand that. If the patient gets lost through any part of this process, it's going to take a lot longer for you to get them to say yes.

Okay? You got to make sure that the patient can understand and follow along with your guided tour exam process. And if you're not taking intraoral and extraoral photos, you absolutely have to do this. I have a camera that's a wand, one from, I don't get sponsored by them, but mouth, what is it, Mouth Watch. Best Camera I ever had for an intraoral camera to just snap photos. I got one in every room now. They're incredibly inexpensive. If you're watching this, this might be dated. They might not even be around anymore by the time you see this. I have no idea. But cameras are so amazing now that you can buy inexpensive ones, put them in your room and always have those available. And then a good extraoral photographic series is a must, and I take some initial shots just to be able to have a discussion with the patient if they're moving forward with occlusal therapy and they're going to full time appliance wear and they're getting restored.

I have 36 photos that I take of these patients. I don't do all that at the first visit. But you know what's interesting? When I take extraoral photos, I love it because it's an icebreaker. It's really incredible. I say it's like taking glamor shots for your teeth, right? It gets the patients laughing. It really builds some bond and rapport between you and your patients. I love that session. That's one of the reasons I do it. I know some dentists like to delegate that to the assistants, and that's totally fine. If your office is humming along and you don't have the time to do it, delegate, have somebody else do it. I have found that that is one of the best ways for me to engage with my patients, so that's a hidden secret for you. I will always do that process because I love to be able to discuss and talk with my patients as I'm going through this and what I'm looking for and why I'm looking for it. So hopefully you got value out of this video. I'll see at the next one. And keep digging into module number five. This is going to be a great, great module.