Engaging the Overdenture Patient Starts in the Front Office
Nita Weissman Okamoto
It is surprising to hear from dentists and their staff that many practices do not have denture patients in their chairs, given that an estimated 37 to 50 million Americans wear dentures. One likely reason is that, until recently, there have been few solutions to the day-to-day problems and discomforts of the average denture wearer. It is not uncommon to hear stories of suffering from loose dentures, dentures that hurt, sore spots, and the displeasure of denture adhesives.
Until now, the standard of care for edentulous mandibular patients was a two-implant overdenture. However, the existence of such a treatment does not guarantee that patients know about it, can afford it, or will accept it. Of the global population who might benefit from implants, approximately 5% actually receive them; in the United States close to 18% receive them.1 This is of great significance to the dental community, because it indicates that in the United States alone, approximately 82% of edentulous Americans are not receiving the recommended dental healthcare they should.
Let us analyze the three primary reasons. First, many patients do not have adequate bone for most of the larger, conventional implants. Second, the patient may not be physically or psychologically able to undergo the lengthy dental procedures associated with implant placement. Third, many denture patients may not be able to afford the traditional two-implant overdenture treatment. If we consider that in the United States 50% of potential implant candidates earn less than $40,000 annually, it is evident that financial considerations represent a significant obstacle to garnering patient acceptance of implant-supported overdentures.2
In 2001, the US Food and Drug Administration (FDA) approved the use of small-diameter dental implants (eg, Atlas™ Den-ture Comfort™, Dentatus USA, Ltd, New York, NY). These small implants may be the breakthrough solution for the underserved denture patient population who has experienced discomfort for almost as long as they have been wearing dentures.
The narrow diameter (1.8 mm to 2.8 mm) of small implants enables their placement into a far greater number of narrow ridges associated with long-term denture wearers. Not only is there a greater application potential for small-diameter implants, the insertion procedures are less invasive because they do not require a surgical flap, and they are generally completed within an hour. Finally, the small implants are typically two to three times less expensive than their larger, conventional-diameter implant counterparts.
With FDA approval and prominent thought leaders, such as Gordon J. Christensen, DDS, MSD, PhD, advocating the use of narrow-diameter implants with mandibular overdentures, the message about the useful indications for this treatment alternative is getting out.3 Evidence is suggesting that denture comfort is having an impact on the “whole” patient. When conventional dentures are replaced with implant-retained overdentures, patients enjoy a higher quality of life, greater self-confidence, and a better nutritional state.4
Other studies indicate additional benefits: improved facial appearance with greater support of the cheeks and lips and easier and simpler oral home care.5
Fortunately, evidence suggests that increasing numbers of general practitioners accept the fact that placing narrow-diameter implants is within their level of expertise. Given the sheer number of edentulous patients experiencing pain, discomfort, and an otherwise limited quality of life as a consequence of their lower dentures, general practitioners who can offer the narrow-diameter implant option to suitable denture patients will be providing a new standard of healthcare to their patients.
Given that the two-implant overdenture is the standard of care, how do you reach those patients who could most benefit from this minimally invasive, affordable, and comfort-providing procedure?
EMPOWERING YOUR STAFF TO EDUCATE YOUR PATIENTS
Until now, the perception among the general patient population has been that implants are for the “very rich,” they “take a long time,” and they involve a “surgical procedure.” By diminishing these prohibitive parameters, dentistry now has an implant solution to motivate denture patients to embrace the recommended dental treatment they deserve. The key tools in this process are information and education. Most important is a dialogue with the patient about narrow-diameter implant-supported overdentures. A comprehensive ap-proach will eventually lead to acceptance.
The dentist’s office staff is an excellent resource and can serve as the “friendly advisor” to the prospective denture patient. The office staff can engage in marketing activities and inform prospective patients of this important new service. It has been proven that an effective approach to building a practice from within is informing current patients about the full range of available services.6 To market narrow-diameter implant placement services directly in the office, place display brochures or posters in the waiting room area. Encourage the front office staff to talk to your denture patients in ways that open the door for explaining the benefits of newer, simplified techniques recommended by the dental profession.7 This will enable your staff to speak candidly about the narrow-diameter implant option in ways that the patient can relate to and appreciate:
• “You’ll have more confidence.”
• “My friend’s grandmother had it done, and she smiles all the time and eats most foods now!”
• “The price of this option may be something you can afford.”
• “This procedure only takes an hour. There’s no traditional surgery or waiting period involved.”
Considering that people generally like to stay in their comfort zone, denture patients may feel most at ease speaking to those who they perceive as peers and colleagues, rather than the house professional—meaning the dentist. For reasons relating to modesty, shyness, and the fear of sounding silly, doctors of all medical disciplines are often the last people to whom patients want to address their questions. These questions may involve cost, length of time for the procedure, whether or not the patient’s age is a consideration, whether or not the procedure will really work, etc. However, once patients have the answers and information they need from people who they consider to be impartial, and more likely “one of them,” there is a greater chance they will consider and accept what the dentist has to say.
However, many patients do not even visit the office because they are unaware of convenient and affordable options that may enhance their quality of life with dentures. In this situation, the outreach needs a different approach. Office staff can add information to the on-hold telephone messages. Statement stuffers, postcards, and free press releases given to local newspapers can all be used to announce your new service. A few simple and concise statements that will be quickly understood can be communicated from one patient to another. Keep in mind that loyal and satisfied patients who might not themselves need narrow-diameter implants or dentures may know someone who does.
CONCLUSION
With an estimated eight out of 10 denture wearers having problems with their dentures, chances are some of your own patients would benefit from the narrow-diameter implant option. Almost all denture wearers are perfect candidates for placement of small-diameter implants to secure their dentures, regardless of age, whether or not they have a thin ridge, or their medical/dental history. However, if they are unaware that a treatment is available, or if they are afraid to engage in a discussion about it, they may never realize a more comfortable quality of life. Manufacturers and practice management consultants have gone to great lengths to provide general dental practices with the knowledge they need to teach and inform their staff and patients about the benefits of narrow-diameter implant placement. Ultimately, it is the dentist who must take the lead in his or her own practice. Provide more information to the staff, give them tools to disseminate information to patients, and encourage a more comfortable communication environment. All of these tools will help to identify willing and accepting candidates for this standard of care.
References
1. Millennium Research Group and Dentatus estimates.2. 2004 National Health and Nutrition Examination Survey. Centers for Disease Control and Prevention. Available at: www.cdc.gov. Accessed April 7, 2008.
3. Christensen GJ. The ‘mini’-implant has arrived. J Am Dent Assoc. 2006;137(3):387-390.
4. Henry K. Q&A on the future of implants. Dental Equipment & Materials. September/October 2006.
5. Rossein KD. Alternative treatment plans: implant supported mandibular dentures. Inside Dentistry. 2006;2(6):42-43.
6. DiMatteo AM. Why, When & How to Market Your Practice. Inside Dentistry. 2007;3(9): 51-62.
7. Carpentieri J, Tarnow D. The Mandibular Two Implant Overdenture First-Choice Standard of Care for the Edentulous Denture Patient. New Jersey: Montage Media Corporation; 2007:77-82.
