Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
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Dental Practice Heroes
4 Case Acceptance Conversations That Make “Yes” Easy Next Time
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Most dentists push for a yes right now. We take a different path and show how planting a clear, respectful seed today leads to an easy yes at the next visit—no pressure, no awkward sales pitch, just a plan the patient helped shape. Using four common scenarios—SRP hesitation, x-ray refusal, cracked teeth without symptoms, and adult crowding—we walk through the exact words, visuals, and boundaries that turn doubt into acceptance.
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There are two types of case acceptance in dentistry. There is the today acceptance, which is what we normally do. We want the patient to say yes today. And then there's what I want to talk about with you in this episode, the next time case acceptance, where we have to approach something that the patient might be hesitant about. Maybe they're just not completely bought in. Maybe they're just not feeling that comfortable with what we're telling them. And it's easier to do the soft cell this time today. And then have the patient walking in at the next appointment already mentally prepared to say yes. And then when they come in, you barely have to do anything to make this work. Now, most dentists in certain situations, they're working way too hard for case acceptance because they try to close everything now instead of using what I think is one of the most powerful concepts in dentistry the next time. So when you plant that seed right today, the second conversation becomes effortless. The patients feel respected, informed, and most of all, they feel like they're in control. And ironically, they say yes much more often. So today I'm going to teach you the exact conversations that set up an easy yes at the next visit, four situations, four different scripts, and this will immediately increase your case acceptance without feeling pushy or salesy. Now you are listening to the Dental Practice Heroes podcast, where we teach practice owners how to create team-driven practices that run effortlessly without them. I'm your host, Dr. Paul Etchison, the author of two books on dental practice management, a dental coach, and the owner of a large multi-doctor practice in the south suburbs of Chicago. If you want a practice that's efficient, profitable, and able to generate income even when you're not in the building, you have come to the right place. All right, let's get into it. So here's our first scenario. The patient has inflamed gums. They have bleeding, they have pocketing, they've got the calculus, but they do not want to say yes to SRPs. They don't want it. Now, maybe it's someone who is a very borderline case, maybe it's someone who has already been scaled and you're thinking that it's time to rescale now, or maybe it's just someone that you feel that hesitation and you don't want to lose that patient as a patient of the practice, but you do want to do what's right for them and you know in your heart that they truly need the SRP. Now, what do dentists normally do? They try to convince harder, they start to overexplain, they pressure the patient, and often they have this feeling, this dis-ease in them that shows up in the way that they speak, like they're hesitant in the presentation, which can lead the patient to somewhat questioning why they even need the treatment at all. And think about this. Let's say this patient goes and gets a second opinion. You know that there is no shortage of other doctors in your area that will happily see this patient, tell them that you're over-treating, and give them the lesser treatment that they want, even though it's not the right thing for the patient. So what do you do? Because you know you're kind of in a lose-lose in these situations. That's where the next time method comes in, which is surprisingly a very useful method for when you acquire a practice from a watched dontist, that you're trying not to scare off all the patients that you just acquired. But there's a ton of things that have been watched and need to be diagnosed and need to be treated to your standard, but the patients have become very used to watching everything. So, what do you do to get over this situation, to get over this hump so that you can do the right thing for the patient and that you can sleep at night? So here's what you're gonna show visual evidence, you're gonna show photos of the bleeding, you're gonna show probe deaths, and you're gonna show photos or maybe point things out in the period chart. You'll show some images of the calculus, the tartar buildup, show the inflamed gums. Show the patient what you see. Seeing is believing. So here's what you're gonna say: say, hey, Mr. Jones, this is what I'm seeing today. And these pockets and this bleeding, this inflammation, it really concerns me. The gums are inflamed. I don't think this is gonna improve on its own. And I really think we should do some more active gum therapy, such as a deeper cleaning, and we can get these roots and these pockets all cleaned out so that they can be healthy. And then we're gonna shift the responsibility to the patient. And this is why it works, all right? But I want to give you the chance to improve this on your own first. Let's see if flossing and good home care can help. I want you to see if you can get this under control on your own. Floss and brush every single day. And when we see you in six months, if the gums are still looking all inflamed and bleeding and they're not doing better, we're gonna have to do that deeper cleaning. Does that sound fair to you? So, how do you think that'll work? You know, right, it's gonna work because this is non-confrontational. The patient feels respected. You're giving them a chance where they now have autonomy, they have control over their own destiny, and they know exactly what's coming next time. They will not be surprised. And let's face it, they're never gonna fix it on their own. They're not gonna floss. Patients don't floss. I mean, what does the study say? Like 98% of people don't floss every day. You know they're not gonna get under control. So they're gonna show up knowing what they did and being like, okay, I screwed up. Now I know what's next. I had a chance, I blew it. So these people they accept the treatment more easily when they believe that they personally have caused the outcome, when the cause is of their own volition, versus us just trying to sell them more expensive treatment when it might be perceived by them that we're just making things up, we're just trying to get more money. Maybe the trust isn't completely there, but this makes it easy. The trust is preserved and the autonomy is on the patient. So now we did this with one patient at our office, and his name was Ernie. And Ernie was a farmer, he wore overalls, and man, he wasn't the nicest dude in the world. And I remember he came in and we saw the perio. We told him that he needed SRPs and he about flipped his lid. He was pissed and we were nervous. So we let him go, we let him get by on it. Okay, and this just happened out of nowhere. We're like, you know what, Ernie? Fine, dude. You don't need it today. But if this looks like this next time, look at this. And we started showing him pictures and stuff. We were like, we really think you need this, but we will give you one chance to see if you can clean this up on your own. If this still looks like this next time, I think we know what's gonna happen. And he said, Yeah, I'm okay with that. I will do my best. I will get this under control. And wouldn't you know Mr. Ernie didn't? But what was the major change is we were so nervous for him to come back in six months when he was on the schedule. We're sitting there looking, we're like, crap, what are we gonna say to him? Oh my gosh, I don't want to deal with this today. I don't want to have somebody upset with me. And then Ernie came in and we had that conversation. I remember talking to him, and it was just like, oh, I just went in that room nervous, like heartbeating. And I sat down and I looked at him. We showed him the pictures and we said, Hey, we tried. I think we got to do the scaling. Are you okay with that? And he said, Yep, I knew it. I knew it. I didn't, I didn't do any of the flossing, I didn't do my part, so let's get it done. We need to get it done. And it was so simple. And it was like, oh my gosh, this is exactly what we need to do with certain patients like this. This is the easiest way to make it happen. So, what's our second scenario? Let's talk about x-rays where patients refuse the x-rays. We can explain to them why we need the x-rays, what is the radiation? We like ease their concerns about the radiation. Now, first, when you get somebody like this, ask them what is their problem with the x-rays. Sometimes it's financial, sometimes it's they have concerns over cancer and stuff like that. And we can respect where it is, but we want to figure out what is their objection so that we can address it directly. But we'll tell them something like, you know, we take x-rays because we needed them to diagnose accurately. We really don't want to take guesses with your health. And there's a number of things that we just can't see unless we don't have the x-rays. To us, it's not about money and billing things to you or your insurance, it's more about taking the best care of you, just like we would do with any members of our family. So today we can do your cleaning and we don't need to take x-rays today. You've just got to sign this form saying we explain the risks to you. But next time, we are going to have to take the x-rays that we need so that we can continue to treat you safely and not miss anything. And if next time you still don't want to take those x-rays, unfortunately, we're going to need you to find another dentist, which I really hope that you don't. I hope you stick with us. But if you're going to decline x-rays, it's not the way we do things here. And we're not going to be the right fit for you for your dentist. And it's very non-confrontational. You know, we keep the relationship, we preserve it today, we set a boundary for next time. And the patient can prepare mentally along, you know, over the months while we're coming up to this. Maybe they can do some research on the internet and find out that x-rays are really not such a big deal. And the compliance next time is almost 100%. People will either come back and let us take the x-rays, or they'll decide, you know what? It is so important for me not to take x-rays. I'm going to go somewhere else. Which you know how it is. The patients like this, we don't want them. We don't want those patients. They're a pain in the ass. So it's in their hands. You know, we're preserving the relationship. It's all in their hands. They get to decide what they want to do. We're just establishing a boundary. Versus sometimes when we get the patient in the chair and we're going to try to establish that boundary today, right? Or we just keep letting them sign the thing, sign the thing, sign the thing. I don't want to have that confrontation. I want it to be non-confrontational, super easy. I want the patient to say yes, or move along, go find somebody else to watch all your stuff. It ain't me. All right, third scenario. Let's talk about cracked teeth. Now, when I see a marginal ridge fracture on a tooth that has a large filling, that is a very easy thing for me to look the patients in the eyes and say, hey, this needs a crown. I don't want to let this break, right? But what about when you got a marginal ridge fracture and you've got a very small filling in that tooth, or maybe no filling in that tooth, and there's no pain on biting, like there's no crack tooth syndrome. So what do we do? Because the patient, of course, could find somebody else that's gonna say, no, you don't need a crown. And us sometimes we say, man, are we over treating? I don't really know. You know, it's hard to say. So I like to tell the patient, hey, this crack is small now. Eventually it's gonna get bigger and it has the potential to hurt the tooth. Now, I don't think that there's anything wrong with us preventatively taking care of it and putting a crown on it. I don't think that's aggressive one bit. But if you aren't ready for that for some reason, now if we keep an eye on it, there's always a chance that it's gonna break soon. And it can end up breaking into the nerve where it needs a root canal and it can end up breaking down the root where it has to come out, where we can't even fix it. But we don't know. If we let it break, we're never going to know. Sometimes it breaks good, sometimes it breaks bad. But next time I see you in six months, we can take a photo of it. And if we can compare it to the photo that we took today, and if it's looking any worse, well, we're gonna know what the next step is gonna be, right? So why is this so powerful? Again, same thing. We planted the seed, we took photographic evidence. You can't argue with the photograph. It is what it is. The patient feels like you're not overselling, you're giving them the opportunity to be more preventative or, you know, be more reactive. It's up to them. And a lot of the times when we present in this way, the patient will be more preventative. I would say 50% of the times they're just gonna say, Yeah, let's just take care of it. But if not, if they see progression, it's visual and they will quickly say yes and not think twice about it. All right, the last and fourth scenario, orthodontic needs for adults. Talking about like invisalign for lower anterior crowding. Do you have any patients that have lower anterior crowding? I'm sure you do. We have a lot of them. So it's very easy for us to take a picture of this, show them, show the inflammation on the gums that are between the teeth that are overlapping, that are crowded, and show them, like, man, see this picture of what's straight down on here? It's really hard to clean here. Look at all the tartar that's in here. Okay. So we like to tell the patient, have you ever thought of straightening these teeth out? And a lot of times I'll be like, oh, I can't afford that. I'm not gonna do that. No worries, don't care. And we just say, you know, I'm not saying that you need this today, but your crowding is really, we're starting to see that it's causing issues for your gum health around these teeth that are crowded down here. And long term, this can pose a big problem for the bone that supports the teeth in your mouth. So I want you to think about straightening these teeth before things get worse. But let's see if maybe you could really work on flossing these teeth, really work on getting the brush in there. And maybe next time the gums will be healthy and we won't ever have to cross that bridge. But let's see if you can do it. Unfortunately, if you can't do it, these teeth are set up in a position that's really hard to clean and it's gonna cause problems for the gums and the bone around these teeth. So, again, zero pressure. We are framing orthodontics as a preventative measure. And at the next visit, we're gonna take a picture and compare it. And even more so, like anytime that you're treatment planning in Visaline or ortho on adults, they're much more likely to say yes to it if you frame it as something for their health. All right, everybody wants straight teeth, everybody wants to look good, everybody wants to look young and beautiful, right? But people feel guilty spending money on themselves because of cosmetics and vanity. So anytime, even if it's not this time, even if somebody's considering it for cosmetics, always try to find a way to frame it for the health of their dentition. Because when you frame it for their health, and the cosmetics are now the side effect, you know, we're doing this because of your health of your teeth, but the side effect will be that they will look great, then the patient doesn't feel like they're being frivolous. They're not being vain, they're not wasting money on themselves. They could be spending on better things, they're doing what's right for their health. So, wrapping up, the fastest way to improve case acceptance with these tricky situations is not by pressuring them to do it today, but planting the seed for next time and being very non-confrontational, showing the patient what you see so that they can see what you see. And then next time we'll get them. So plant this seed today, get them to say yes in six months. And if you want help training you and your entire team on case acceptance principles like this, so that you don't need to see as many new patients to keep your schedule busy, please reach out to us at dental practiceheroes.com/slash strategy. Set up a free strategy call with me. I will have a no pressure conversation with you, give you some advice, hear about your practice, and if dental practice heroes can help you, I will share how we can do that. So thank you so much for listening. I really appreciate it. If you get a chance, please leave a five star review on Apple Podcasts. It would mean the world to me, and it gets this podcast to more people. Thank you so much for listening. We'll talk to you next time.
