This week was a demonstration in our office of several patients saying to me, “I’ve never had an exam like that.” In a couple of cases, it was even more significant than that. “Thank you, Doctor. Now I see why they say you’re the best,” was one of the quotes.
What’s interesting is that patients won’t pay for diagnosis (willingly), but they will get treatment from the doctor who diagnoses beyond the norm. And those patients will tell their friends. You are on the way to independent practice, whether you are there are not, now. It is your patients who assist you to that level even if you are now in a referral practice. Whether your patients tell the referring doctor or tell their friends and family, the result is the same. So let’s give you some inexpensive tools to give you a diagnostic edge. (And yes, I know that long-time members have read some of this before. But even you will get some new ideas to use.)
1. Get yourself some pH paper (Amazon Link)
Why is a person getting caries? Sugar or dry mouth. We know that dry mouth is acidic. But even “wet mouths” can be acidic as well. If a patient shows evidence of caries, wouldn’t it be nice to know that the caries is likely to continue unless the patient makes concerted changes? Let the patient know that. It may make the difference for you in determining whether the implant may be a better choice than crown lengthening, biologic reshaping, endo, and a build-up and crown. A pH of 5.5 or below is indicative of continual demineralization of the tooth.
2. Measure the patient’s maximum maxillomandibular opening (Link)
Do you want to know the patient’s TMJ status before you start treatment? I do. This simple device allows you to do so.
3. Determine the Mallampati score. (Link)
The Mallampati score is predictive of difficulty of intubation. Many feel that it is also an indicator of sleep disorders. It takes less than five seconds to do it. It helps your anesthesiologist and even yourself if you are doing IV sedation.
4. Use Shimstock on nearly every patient. (Link)
You are trying to help the patient determine predictability of restoration. One of the keys to restoration is having the teeth meet. Wouldn’t it be great to know in advance whether your implant is going to be overloaded because no other teeth are meeting on the side you’re placing the implant? How about making recommendations to the patient for restorative dentistry. The first goal of restorative therapy is having the teeth meet. If you check every occlusal contact to see if the teeth are meeting or not, you’ll have a diagnostic edge that others may not have found.
5. Learn how to apply cervical traction to diagnose the origin of bite problems. Watch this portion of the video: 2:36-3:30
a. Have the patient tap his or her teeth together
b. Then apply light cervical traction and ask the patient to tap once again.
c. Ask the patient if the bite has changed.
d. Repeat the process if necessary.
If the bite changes when applying cervical traction, you know that the bite is not the primary problem. Refer to a chiropractor or physical therapist of your choice. Don’t adjust the bite.
6. Learn how to apply lumbar traction to diagnose the origin of bite problems. Okay, I know. I’ve told you this before. It’s a little weird. Here’s what happened twice this week, now four times this month. The patient has a bite problem that has worsened since an accident. In the once case I’m thinking about, a 23 year old female is in the office with her mom. I do the occlusion check with Shimstock. The teeth aren’t meeting evenly. I apply cervical traction. The bite improves a little. I then ask the mom to pull on the patient’s right leg. The patient says, “My jaw has come forward. My bite is better.” Make the appropriate referral as in 5 before you touch the bite.
7. Before you make a nightguard, have the patient bite on a tongue depressor. Have you ever made a nightguard for a patient and the patient says that he or she can’t wear it because it makes the jaw worse. If you have the patient bite down on a tongue depressor for a minute or so, often the patient will tell you in that short a period of time whether the jaw feels worse. If it feels worse with the tongue depressor, it won’t feel any better with the nightguard. (Hint: I almost never make a full occlusal guard. They take a lot of time and don’t produce as good a result as an anterior bite plane. Anterior bite planes are a lot easier to fit.)
8. Start doing an Oral DNA MyPerioPath test on your perio patients. (Link)
Of course you use a periodontal probe, take x-rays, CT scans, etc. Periodontitis is a bacterial (and/or viral) disease. You can determine the presence and quantity of periodontal disease- (and systemic disease) causing bacteria. You’ll know the correct antibiotic regimen to use as an adjunct to your treatment. And you can make the patient aware of systemic health risks associated with the bacteria that shows up in the test. That is a diagnostic edge. It’s also a treatment edge for the patient.
Other than the Oral DNA test, the other tests cost nothing or nearly nothing. I easily get these done within the 30 minute examination period. Add these to your diagnostic regimen. See what the response is from your patients. See how much more information you have to help you develop a diagnosis.