Dental Patient Management

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Dental Patient Management: 

D ental P atient M anagement

First Clinical Experience: 

First Clinical Experience The

What are we dealing with ?!: 

What are we dealing with ?!

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We are not dealing with an object or a tooth, we are dealing with a Humans .

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So, Try to put yourself as a dental patient. What will you feel when you are going to the dental clinic ?

Dental Patient’s Fears ?: 

Dental Patient’s Fears ? Fear from pain and the treatment procedure. Fear from unknown. Fear from the past dental history. Fear from the financial cost. Fear from the treatment outcome.

The common determinants of a patient's presenting behavior: : 

The patient's perception and interpretation of the present situation (the reality or view of the present illness). The patient's past experiences or personal history. The patient's personality. The patient’s fears about his case, the future treatment, and the final result after the treatment. The common determinants of a patient's presenting behavior:

Strategies for the Initial Patient Interview : 

Strategies for the Initial Patient Interview

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Only few words can translate “ The strategies of IPI “ Be Impressive for a While

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The patient’s will take an impression about you in the 1 st few minutes of the initial interview.

Strategies for the Initial Patient Interview :: 

I- Verbal Exchange. II- Non-verbal Exchange. Strategies for the Initial Patient Interview :

Verbal Exchange: 

Verbal Exchange

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You can use this strategy while taking your dental and medical history after asking your questions (Opened & Closed), and reassurance of your patient by discussing the case and the treatment plan. Make your patient to feel that you are interested and care about him/her.

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Opened Questions : Questions that do not have specific yes or no answers give patients more latitude to express themselves. More information allows a better understanding of patients and their problems. The dentist is basically saying, “Tell me more about it." Throughout the interview the clinician listens to any cues that indicate the need to pursue further questioning for more information about expressed fears or concerns. Typical questions of the open-ended format include the following: "What brings you here today?" "Are you having any problems?" or "Please tell me more about it .“ Closed Questions : Questions that have a specific yes or no answers. This type of questions may be useful when the patient can’t tell you what you need in your diagnosis. Typical questions of the closed-ended format include: “Do you feel a pulsating pain with this tooth?” or “Does the pain appear during eating?”

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Non-verbal Exchange

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Eye contact : Looking at the patient without overt staring establishes rapport ( Change your eye position every 3 to 4 seconds ). Facial expression : A smile or nod of the head to affirm shows warmth, concern, and interest.

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Vocal characteristics : The voice is modulated to express meaning and to help the patient to understand important issues.

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Body orientation : Facing patients as you stand or sit signals attentiveness. Turning away may seem like rejection. Forward lean and proximity : Leaning forward tells a patient that you are interested and want to hear more, thus facilitating the patient's comments. Proximity infers intimacy, whereas distance signals less attentiveness. In general, 4 - 6 feet is considered a social, consultative zone.

Trust Building: 

Trust Building

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Making your patient to trust you as a dentist is one of the most important keys of your success. You need a wide range of skills to build this trust such as leadership, management and communication skills .

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You should make your patients feel that you are their friendly leader and as much as possible make your steps managed well starting from the first interview ending with the treatment and follow up . Also, you should improve your communication skills to build a good doctor/patient relationship that will make your patients trust you more.

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To improve your communication skills you should know how to do better conversations with your patients, and to do this you should know that there are three elements to any conversation : 1- Words account for only 7% of the message . 2- The tone of the voice accounts for a full 38% of the message. Women are much more sensitive to tiny changes in tone than are men . 3- Body language accounts for 55% of communication.

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Listening skills one of communication skills that build trust. The more you listen, the more people trust you. The more they trust you, the more they like you. The more they like you, the more they'll open up to you . Listening skills 1- Listen by leaning forward, and don't say a word . 2- Pause before replying. When you pause, it raises the self–esteem of the other person . 3- Question for clarification, “What do you mean?” Feed it back; show you've really been listening.

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Patient’s satisfaction and reducing anxiety one of the important tools that can build the trust, and you can do this through many behaviors that you can do: - Explain procedures before starting. - Give specific information during procedures. - Instruct the patient to be calm. - Verbally support the patient: give reassurance . - Give the patient some control over procedures and pain. - Attempt to teach the patient to cope with distress. - Provide distraction and tension relief . - Show personal warmth to the patient.

Dentist’s Commands & Its Outcome: 

Dentist’s Commands & Its Outcome

Positive Commands ( Direct Commands ): 

Positive Commands ( Direct Commands ) Negatives should be avoided in commands. Positive commands are more easily experienced, and compliance is usually greater. Example : Negative Command : Don't close Positive Command : Rest open widely, please.

Indirect Commands: 

A permissive approach and indirect commands also create less resistance and enhance compliance. One may say, " If you stay open widely, I can do my procedure faster and better ," or " By flossing daily, you will experience a fresher breath and a healthier smile. " This style of suggestion is usually better received than a direct command. Indirect Commands

Linking Phrases: 

For example, " as" " while" or "when" to join a suggestion with something that is happening in the patient's immediate experience provides an easier pathway for a patient to follow and further enhances compliance . Examples include the following: “As you lie in the chair, allow your mouth to rest open .” or “While you take another deep breath, allow your body to relax further .” Linking Phrases

Providing Pathways: 

Providing pathways to achieve a desired end may help patients to accomplish something that they do not know how to do on their own. Patients may not know how to relax on command; it may be more helpful to suggest that while they take in each breath slowly and see a drop of rain rolling off a leaf, they can let their whole body become loose and at ease. Providing Pathways

Relaxation Script: 

Relaxation Script

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Relaxation is important for both dentist and patient if they feel tired or tensed during the dental procedure. This relaxation script using deep breathing can be done in your clinic; you can do it or your patient . Deep breathing not only helps to cure anxiety and stress, it also triggers relaxation. Here's how to breathe deeply . Here is a way to slow down your breathing while keeping it deep and exhaling fully : Inhale slowly to the count of four, Pause to the count of three. Exhale slowly to the count of five . The breathing process goes like this : Inhale... two, three, four...pause...two, three....exhale...two, three, four five.... Inhale... two, three, four...pause...two, three....exhale...two, three, four five.... Repeat for a minute or two.

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Pause your dental procedure at least every 15 minutes, give the patient time to relax and give yourself time to relax your muscles; make some movements and change your body orientation then continue.

Operator and Patient Positioning: 

Operator and Patient Positioning

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Operator Positions in Oral surgery is a very important aspect in the success of your Dental treatment. The correct positioning of the operator is very important to help the Operator or Doctor to have good Visibility and Accessibility of the Oral cavity.

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The Universal Seated Position for the Clinician/Operator: Forearm parallel to the floor. Thighs parallel to the floor. Hip angle of 90 degrees. Seat height positioned low enough so that the heels of your feet touch the floor. Back of the operator should be always straight. Head erect and should not be bent of drooping.

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The 2 main things which we have to consider are the Operator Position , Chair Height and Patient Position : 1- Chair height 2- Operator Position 3- Patient Position

Chair Height : 

For Maxillary Teeth: The Chair height should be 8cm or 3 inches below the shoulder level of the operator. For Mandibular Teeth: The Chair height should be 16cm or 6 inches below the level of the operators elbow. Chair Height

Operator Position: 

Operator Position Based on the operator’s working hand: Right Handed Operator or Clinician: 7 o’ clock position to the front of the patients head 9 o’ clock position to the side of the patients head 10 to 11 o’ clock, to the back of the patient’s head 12 o’ clock position, directly  behind the patient’s head Left Handed Operator or Clinician: 5 o’ clock position, to the front of the patient’s head 3 o’ clock position, to the side of the patient’s head 2 to 10 o’ clock position, to the back of the patient’s head 12 o’ clock position, directly behind the patients head

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Based On Maxillary and Mandibular Arches: For Maxillary Teeth: Right Front of the patient for anteriors , and 11 to 12 o’clock for posteriors. For Mandibular Teeth: All Left Mandibular Teeth – Right Front of the patient Mandibular Teeth on the Right Side: Central incisor, Lateral incisor and Canine – Right front of the patient 1st and 2nd Premolar – Right of the patient 1st and 2nd Molar – Exact Right side of the patient 3rd Molar – Just behind the patient on Right Side

Patient Position: 

Patient Position The patient should mostly be in Supine Position. The Mouth of the patient should be close to the resting elbow of the Operator. Patient’s Body : For Maxillary Teeth – The back of the chair should be slightly at a 45 Degree position from the floor For Mandibular Teeth – according to working area. Head and Chin Position: The patients head should be positioned at the edge of the head rest Chin Position of the Patient: For Mandibular teeth – Chin Down position For Maxillary teeth – Chin Up position

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Basic Patient Positions (A) Upright. (B) Semi-Supine, Semi-Upright. (C) Supine or Horizontal. (D) Trendelenburg.

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Dr. M. Arnous