Dr Phillip Palmer, June 2007 - Recently when I was speaking to a non-dental industry friend of mine he told me that he thought the six-monthly checkup concept was a big con that dentists were perpetrating on the public. When I asked him what he meant by this he said “Of course dentists are going to tell you that you have to come in every 6 months for a check-up. It means more business for them. It’s like a car salesman telling you that you definitely need a new car… All I ever get from going in for my regular dental check-up is a good cleaning. I have my own toothbrush, I can do that myself”.

Unfortunately this point of view is all too common among non-dental people. I have even heard it occasionally from some dentists! So what is missing? I can think of two very good reasons that every dentist would be aware of why people should visit them for regular checkups:

1. There is no longer any question in the general medical world over the direct links between periodontal disease and systemic diseases such as strokes, heart disease, Alzheimer’s disease, diabetes, low birth weight children, etc. Good oral hygiene and regular checkups is not just about oral hygiene. It is about the patients overall health and well-being.
2. Every dentist will be aware of many cases when a patient has come in to see them for a regular checkup and they have been able to fix a small problem that was about to get much worse. Indeed our research at Prime with dentists from all around Australia has repeatedly shown that practices with high rates of patient participation in regular check-ups and maintenance have low rates of emergency treatments.

So, what can dentists do to explain the definite preventive and overall health value of regular dental visits? During the regular checkup visits we can make a point of explaining what we are doing. All patients know is that they leave the practice feeling almost the same way they walked in. The only changes they can discern is that their teeth feel a little cleaner and their wallet is a little lighter. How many of your patients truly know:

• What the fluoride application is doing to their teeth.
• That you are doing an oral cancer screening
• The potential consequences of no maintenance
• The links between general health and periodontal disease
• What you are checking for with respect to their teeth and gums

There is no doubt that communication skills can be learned and honed and the better we get at our communication/ rapport building skills the more successful we will be at getting the necessary messages across. At the end of the day though, no matter how we communicate, the more cynical patients will still choose to see us as having ulterior/ profit motives for having them visiting regularly. The only solution to this would come if an external body (without a profit motive in dental treatment) were to say that it needed to be done. An example of this in another industry in Australia is the system of car registration. If it were only the mechanics in NSW that were recommending an annual motor vehicle check, not many would participate. There would be a cynical percentage of the population who would think that the mechanics just want to line their pockets.  However, the state government and the RTA will not register your car unless you have had a clean bill of health from an RTA certified mechanic each year. This takes the profit motive away from the mechanic and sends a clear signal from the government that the checkup once a year is the price we have to pay in order to maintain the safety of everyone on the road.

In the health industry however, I have only ever come across one solution that I can recall. Last year while I was in South Africa, some dentists told me about an insurance system that had begun a few years earlier. Just as car insurers offer no-claim bonuses to people that haven’t had an accident, a health insurance company in South Africa has started recognising that healthy people make fewer claims and are therefore a lower risk for them as insurers.

Lower insurance payments (among other rewards) were applied if patients lived a healthier lifestyle. For example, with proof of regular gym visits/ sport participation, and if you get the recommended health tests for age and gender, (Glaucoma screenings, Prostate screenings, pap smears, Mammograms, HIV testing, completed vaccinations) you become entitled to rewards including having your premium reduced.

More interesting for dentists though, was that patients who had participated in regular dental check-ups also qualified for these rewards.

What this means is that the insurance companies In South Africa acknowledged the benefit of regular dental checkups not being “just a cleaning” but being actually a way of preventing small health problems from becoming large problems (with obviously larger insurance claim). Most importantly, (in the opinion of the dentists I spoke to) it has put that value judgment into the eyes of the consumer.

The public knows that the insurance company would only be offering these rewards if it made business sense for them to do so. The only way it would make business sense is if people were healthier as a result of those visits.

Regular dental check-ups in South Africa are now being accurately presented (by a third party) to the consumer as a necessary and reasonable preventive health measure.
The South African dentist now has a more convincing answer to people who say that the six-monthly dental checkup is a “big con that dentists were perpetrating on the public to line their pockets. “

Now if only there was a third party in Australia telling the Australian consumers the same thing…

{Published in Australasian Dental Practice, Vol 18, No 4, July/August 2007}