How to Get to YES with Geriatric Dental Implant Patients

Transcription

1 Earn 1 CE credit This course was written for dentists, dental hygienists, and assistants. How to Get to YES with Geriatric Dental Implant Patients A Peer-Reviewed Publication Written by Eric Shapira, DDS, MAGD, MA, MHA Abstract People are living longer and keeping their dentitions longer. Our healthcare capabilities are much better than the early 1900 s when the average lifespan was approximately 47 years of age. Although almost 25 % of the US population is edentulous, an even greater number of people over the age of 65 years will be prone to being partially edentulous in the future. This cohort of people will have the opportunity to receive one or more dental implants as tooth replacements. Dental implants were first recognized in the 1950 s as a source of alternative tooth replacement. Now they have evolved to being the first choice in restorative procedures to replace a missing tooth or teeth. In these strained economic times; however, it may be a difficult decision for our senior population to spend large amounts of money to replace missing teeth with dental implants. How to get to YES with potential geriatric dental implant patients is a discussion about the techniques of communication, salesmanship and empathic responses to important questions. Also discussed is the implant process itself which will enable patients to consider dental implants rather than a fixed bridge or removable appliance to restore edentulous areas. Among the most difficult parts of a dentist s job is getting our patients to want what our clinical judgment indicates they need. The ultimate decision about having dental treatment is the patient s. The ultimate decision about treatment lies with the practitioner. Learning Objectives: At the conclusion of this educational activity participants will be able to: 1. Present a treatment plan to a geriatric implant patient 2. Describe the factors that affect patient decisions about dental care 3. Discuss the differences between selling and educating patients Author Profile Eric Shapira, DDS, MAGD, MA, MHA, graduated of Temple University School of Dentistry. He holds Master s degrees in Clinical Gerontology and Health Administration. He is a Professor of Geriatric Medicine, Nursing and Stomatology in mainland China in various hospitals there. He has published over 100 professional articles as well as authored a book on healthy aging, A New Wrinkle: What I Learned from Older People Who Never Acted Their Age. He continues to practice clinical dentistry and teach Geriatric Dentistry and Geriatric Medicine. Dr. Shapira can be reached at eric@drshapira.com. Author Disclosure Dr. Eric Shapira has no potential conflicts of interest to disclose. Go Green, Go Online to take your course Publication date: April 2014 Expiration date: March 2017 Supplement to PennWell Publications PennWelldesignatesthisactivityfor1ContinuingEducationalCredit DentalBoardofCalifornia:Provider4527,courseregistrationnumber ThiscoursemeetstheDentalBoardofCalifornia srequirementsfor1unitofcontinuingeducation. ThePennWellCorporationisdesignatedasanApprovedPACEProgramProviderbythe AcademyofGeneralDentistry.Theformalcontinuingdentaleducationprogramsofthis programproviderareacceptedbytheagdforfellowship,mastershipandmembership maintenancecredit.approvaldoesnotimplyacceptancebyastateorprovincialboardof dentistryoragdendorsement.thecurrenttermofapprovalextendsfrom(11/1/2011)to (10/31/2015) Provider ID# This educational activity was developed by PennWell s Dental Group with no commercial support. This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content. Requirements for Successful Completion: To obtain 1 CE credit for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. Image Authenticity Statement: The images in this educational activity have not been altered. Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $20.00 for 1 CE credit. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

2 Course Objectives: At the conclusion of this educational activity participants will be able to: 1. Present a treatment plan to a geriatric implant patient 2. Describe the factors that affect patient decisions about dental care 3. Discuss the differences between selling and educating patients Abstract People are living longer and keeping their dentitions longer. Our healthcare capabilities are much better than the early 1900 s when the average lifespan was approximately 47 years of age. Although almost 25 % of the US population is edentulous, an even greater number of people over the age of 65 years will be prone to being partially edentulous in the future. This cohort of people will have the opportunity to receive one or more dental implants as tooth replacements. Dental implants were first recognized in the 1950 s as a source of alternative tooth replacement. Now they have evolved to being the first choice in restorative procedures to replace a missing tooth or teeth. In these strained economic times; however, it may be a difficult decision for our senior population to spend large amounts of money to replace missing teeth with dental implants. How to get to YES with potential geriatric dental implant patients is a discussion about the techniques of communication and empathic responses to important questions. Also discussed are strategies to enable patients to consider dental implants rather than a fixed bridge or removable appliance, where indicated. Among the most difficult parts of a dentist s job is getting our patients to accept what our clinical judgment indicates they need. The ultimate decision about having dental treatment is the patient s. The Importance of Knowing Your Patient Spending time with your patient is the greatest gift you can give yourself as their dentist. It is appreciated by most patients because of the fast paced medical system we have. Present day health care does not provide sufficient time to determine what it is that drives the patient to make decisions. The patient s priorities and preferences may not be in line with the practitioner s and vice versa. It behooves us as dental practitioners to take the time to actively listen to our patient s concerns and ask appropriate questions that will elicit personal responses of meaning and value. It is this value factor that controls the patient s willingness to be open to change. Gandhi once said: Our beliefs become our thoughts; our thoughts become our words; our words become our actions; our actions become our habits; our habits become our values and our values become our destiny. This is all about allowing ones values to be open to change. We cannot hope for a person to change how they think based upon habit until we know what their deepest values and concerns are. People s perceptions are their reality. Perceptions are based on knowledge and experience. Knowledge; however, may be skewed with information that is malformed; that is, information attained by hearsay and secondhand information that the person may have received from a friend who had a bad dental experience. We need to uncover the source of information that form the patient s beliefs and determine the validity of its content. An 84 year old patient of the author, who presented for some teeth to be extracted, balked at the suggestion of replacing her hopeless teeth with dental implants. She finally revealed that her friend had a terrible time with getting an implant and did not want them because of the friend s negative experience. The judgment that people make about dental care is connected with their perceptions. It is important for all dental professionals to look deeper into the values and concerns people have when they show resistance to even listening about something that may be beneficial for them. Acceptance of misinformation allows people the liberty of becoming firm with their convictions that something is not in their best interest. This thinking also can be based upon a person s family history such as; If dentures were good enough for my parents, why wouldn t they be good enough for me? If the parents wore dentures, why would I need dental implants is the deeper thought process here. This can also be coupled with financial concerns and thoughts about the ability to afford the implants. Deeper thoughts are present when the patient says, I ll have to think about it in response to an implant treatment plan proposal. At this point we can softly ask them, How long would you like to wait before we contact you again to discuss this subject? This can be a very revealing question, potentially indicating the patient s true intentions. Their response will likely indicate if they are seriously considering implant treatment. Letting the patient think about the information we have presented is a good thing, but we don t want to wait too long before we broach the topic again. Allowing one patient to describe the positive attributes of dental implants may also prove to be beneficial in certain situations. One can ask other patients of the same age group, who have had good experiences, if they would speak to other prospective patients about how good this decision has been for them. Good judgment is based on many factors including past experiences of the individual and others. It is very helpful to practitioners to know the patient s thoughts and experiences before presenting our findings. Pushing hard, like one might find on a used car lot, is not respectful of a person. We must inform before we perform, as the saying goes. The Meaning of Responses Aging patients have many years of accumulated judgment based upon their personal experiences and many things they have accomplished in their lifetimes, as well as the things they have observed and absorbed over time. When practitioners see patients exhibiting signs of emotion, it may be an indicator of resistance to information being presented to them. Internal anxiety can cause a deficit in ones ability to listen and absorb information. Being in a hyper-emotional state can interfere with anyone s ability to think clearly. Getting the geriatric patient to yes with respect to dental implants hinges upon uncovering the patient s thoughts. This includes the thoughts provoked by the presentation and questions

3 the practitioner asks; and what is conjured up inside the patient s mind that may prevent the patient from proceeding with the treatment being suggested. I Want to Think About it... Due to fear Risk Involved NO motive to buy Lack of trust Lack of understanding Price too high Get it cheaper elsewhere I can t afford it! Using I messages to tell the patient ones own thoughts and suggestions is recommended. You messages are commonly interpreted as blaming statements and will turn a person off. This may provoke defensive behavior and the discussion will be over before it starts. Asking direct, short, simple questions will provide some insight into what the patient is thinking. This can provide information for the dental professional, cultivate mutual respect and increase the likelihood of treatment plan acceptance. Positive Outcome Assessment Getting a patient to yes means that we need to think positively about what we are trying to accomplish, develop a plan that will increase the likelihood of treatment plan acceptance, and work backward from there to determine how to present our findings so they are understood. We also need to take into consideration all that we have learned about our patients and utilize our presentation skills in the process. One must proceed slowly in the discussion, speak clearly, ask for feedback to promote understanding and take the time necessary to get to yes with our older patients. The great American philosopher, Yogi Berra, once stated, If we don t know where we are going, any road will take us there! It is of paramount importance to be prepared. Many older individuals are compromised physically, mentally and financially. We must take into consideration that these factors will influence any decision-making abilities they have. Keeping our own expectations in check is a good thing to do as well. Having expectations that we do not communicate can lead to anxiety and negative thinking on our part. Being aware of our own values and how we think about having an implant in our own mouth is extremely important in the scheme of things. Educating the patient is the key to allowing them to make a well thought out, informed decision and prevent buyer s remorse afterwards. Not pushing the patient by hard selling but rather taking the time to answer all their questions, addressing their concerns and conveying the reasons why an implant is the preferred treatment will help the patient get to yes. Quality outcome assessments are a helpful framework because they help us see our plan, give us a roadmap to follow and put all the information at hand in an orderly format. Older individuals may have many challenges we need to consider including health and transportation issues, diminished balance and strength, difficulty walking, side effects of medications, xerostomia and tremors, among others. We can show respect and cultivate trust by sitting and facing them, speaking clearly and with sufficient volume to make it easier for them to hear and by listening carefully. We also need to address their concerns and determine what they want to accomplish with the dental care we provide. Connecting with our patients on an emotional level can be achieved by empathizing and establishing rapport. Empathy and rapport are important because people don t care how much you know, until they know how much you care. Quality Outcome Assessment Imagine it and then create it... Conceivable Doable Maintainable Sustainable Achievable Acceptable Postitive outcome for all concerned Work backwords from here... As practitioners we must be sincere in our concern and our communication with patients. We need to understand that people of advanced age may not hear as well as they did at one time. It may take them longer to process an idea being presented to them. It may take them a little longer to formulate a response. Advancing age is not accompanied by decreasing intelligence but perhaps by some extra effort to express themselves clearly and accurately. Getting to yes may be as simple as connecting with them on an emotional level. When we truly believe an implant is the best treatment option and the patient proceeds with our suggestions, it can make the relationship a win-win for all. Author profile Eric Shapira, DDS, MAGD, MA, MHA, graduated of Temple University School of Dentistry. He holds Master s degrees in Clinical Gerontology and Health Administration. He is a Professor of Geriatric Medicine, Nursing and Stomatology in mainland China in various hospitals there. He has published over 100 professional articles as well as authored a book on healthy aging, A New Wrinkle: What I Learned from Older People Who Never Acted Their Age. He continues to practice clinical dentistry and teach Geriatric Dentistry and Geriatric Medicine. Dr. Shapira can be reached at eric@drshapira.com. Author Disclosure Dr. Eric Shapira has no potential conflicts of interest to disclose

4 Notes Online Completion Use this page to review the questions and answers. Return to and sign in. If you have not previously purchased the program select it from the Online Courses listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the Take Exam link, complete all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your Verification Form will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page. Questions 1. Which of the following constitutes good judgment? a. Having the ability to make the right choices even though they may be wrong b. Making a mistake over and over again c. An action based on experience d. Neglecting to tell a patient they need an implant when they could use one 2. Quality outcome assessment encompasses something: a. Conceivable, doable, and expensive b. Achievable, maintainable and sustainable c. Acceptable, difficult and negative d. Doable, works when there is no plan 3. Spending time with your patient is: a. A gift you give yourself b. Not recommended if they are ill c. A process not recommended by most consultants d. A waste of time 4. Which of the following is a value-factor? a. Something that prevents the patient from changing b. An entity that does not allow acceptance of a treatment plan c. A thought process based on beliefs and hidden desires 5. Values are based on: a. Actions b. Beliefs c. Habits 6. Having expectations that are not communicated may lead to: a. Positive action b. Disappointment c. Increased patient referrals 7. A patient who wants to think about treatment may really be communicating: a. Resistance to change b. Lack of understanding c. Anxiety 8. Getting to yes means: a. A positive outcome with every patient encounter b. Thinking on your feet c. Working backwards 9. Clearing the thinking process for having dental implants is based on: a. What we know about dental implants b. Having an implant in our own mouth c. Our anxieties about doing or referring our patients for implants 10. Dental implants have been utilized as a tooth replacement modality since: a. The 1930 s b. The 1940 s c. The 1950 s 11. Many older individuals: a. Have vast experience to draw upon b. Medically compromised c. Mentally compromised 12. The dental treatment plan should: a. Uncover the patient s medical, dental, social, family and pharmacological history b. Uncover the patient s wants and desires only c. Only reveal the patient s feelings about dentistry 13. Empathic communication involves: a. Being non-judgmental b. Using You messages c. Talking while the patient is talking 14. Patient s with highly emotional states of being: a. Mean that you should back-off from talking to them b. Should be isolated from other patients c. May have difficulty thinking clearly 15. Asking direct, short, simple questions will provide: a. Short, simple responses b. Some insight into what the patient is thinking c. Lengthy responses

5 ANSWER SHEET How to Get to YES with Geriatric Dental Implant Patients Name: Title: Specialty: Address: City: State: ZIP: Country: Telephone: Home ( ) Office ( ) Lic. Renewal Date: AGD Member ID: Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 1 CE credit. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call Educational Objectives 1. Present a treatment plan to a geriatric implant patient 2. Describe the factors that affect patient decisions about dental care 3. Discuss the differences between selling and educating patients If not taking online, mail completed answer sheet to Academy of Dental Therapeutics and Stomatology, A Division of PennWell Corp. P.O. Box 116, Chesterland, OH or fax to: (440) Course Evaluation 1. Were the individual course objectives met? Objective #1: Yes No No Objective#3: Yes Objective #2: Yes No Pleaseevaluatethiscoursebyrespondingtothefollowingstatements,usingascaleofExcellent =5toPoor =0. 2. To what extent were the course objectives accomplished overall? Please rate your personal mastery of the course objectives How would you rate the objectives and educational methods? How do you rate the author s grasp of the topic? Please rate the instructor s effectiveness For IMMEDIATE results, go to to take tests online. Answer sheets can be faxed with credit card payment to (440) , (216) , or (216) Payment of $20.00 is enclosed. (Checks and credit cards are accepted.) If paying by credit card, please complete the following: MC Visa AmEx Discover Acct. Number: Exp. Date: Charges on your statement will show up as PennWell 7. Was the overall administration of the course effective? Please rate the usefulness and clinical applicability of this course Please rate the usefulness of the supplemental webliography Do you feel that the references were adequate? Yes on 11. Would you participate in a similar program on a different topic? Yes on 12. If any of the continuing education questions were unclear or ambiguous, please list them. 13. Was there any subject matter you found confusing? Please describe. 14. How long did it take you to complete this course? 15. What additional continuing dental education topics would you like to see? AGD Code 690, 752 PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. COURSE EVALUATION and PARTICIPANT FEEDBACK We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please all questions to: hhodges@pennwell.com. INSTRUCTIONS All questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination. COURSE CREDITS/COST All participants scoring at least 70% on the examination will receive a verification form verifying 1 CE credit. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is The cost for courses ranges from $20.00 to $ PROVIDER INFORMATION PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at org/cotocerp/. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# RECORD KEEPING PennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt. Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. CANCELLATION/REFUND POLICY Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing. IMAGE AUTHENTICITY The images provided and included in this course have not been altered by the Academy of Dental Therapeutics and Stomatology, a division of PennWell YESGI414DIG Customer Service