A New Way to Look at the Comprehensive Exam

Episode #328 with Dr. Kevin Groth

You might get by cramming five-minute exams at the end of your appointments. But it isn’t the best way to learn about your patients. It’ll also get you quickly overwhelmed. To show you a better way, Kirk Behrendt brings back Dr. Kevin Groth to share his protocol process so you can help diagnose and solve your patients’ issues. His first step is to start slow to build relationships with your patients. For more tips you can merge into your practice, listen to Episode 328 of The Best Practices Show!

Main Takeaways:

Five minutes is not enough time to discover anything about your patients.

Structure your office based on relationships and care. 

Slow things down and get to know your patients. Build rapport.

Don't get sucked into the capital aspects of dentistry.

Believe that what you're doing is beneficial for your patients.

Co-discover issues with your patients.

Don't assume that patients can't afford a service.

Don't take offense if patients refuse the exam. It may not be the best time for them.

Quotes:

“It’s so easy to get bogged down into the doldrums of general dental life. And I was working 220 days in 2018 and running around with my head cut off, type of feeling, and doing examinations at the last five minutes of each appointment. And new patients would come in for a hygiene appointment, and then they'd see me for five minutes. And I just felt very overwhelmed and drowning in what we consider general dentistry. And you start really becoming resentful of the profession — and it’s an amazing profession. There could be a better way.” (04:48—05:24)

“My comprehensive exam comes from my current patient pool. I do a comprehensive examination on new patients as well, and we oftentimes discover a lot more. But a lot of times, these things come from the practice within. Like you've said time and time again, you can form a practice within a practice.” (06:44—07:04)

“Five, seven years ago, I would have new patients coming to my dad’s practice, and we’d see them. Right off the bat, they get their teeth cleaned. I would meet them after their cleaning and I would see them for about five minutes, 10 minutes, or whatever it may be. And it’s really difficult to really discover anything with the patient and build a rapport and trust with them, let alone say, ‘Hey, you need all this work done.’ So, you kind of get in that grind like you would in dental school where you're just looking for caries, looking for periodontal disease, looking for oral cancer — the things that you were trained upon. But, quite frankly, like they say in Dawson Academy, about 70% to 80% of the patient population all have some type of functional disease or issue going on.” (08:01—08:42)

“Unfortunately, you have a lot of people in the industry preaching that if you do this technique, or you do this procedure, or if you buy this technology, it’s going to make you productive and you're going to have a more fulfilled life, and you're going to have a better practice, and your patients are going to be better off. And you get sucked into that. And I think I was a product of that right out of dental school because I heard placing implants would do a lot of those things. So, I spent the $20,000 and did an implant course. And I don't place implants, to this day. And I think it’s just because I didn't really have a clear understanding of why I was doing something, and it’s because I didn't know who I was to begin with. And that's really what it’s all about in anything in life, is that you need to know who you are, which then flows into why you do something.” (10:38—11:26)

“I want to impact people. I want to change their lives. And from a dental aspect, I want to have a relationship with every single patient I have. So, if I treat people with the regard as if you are my brother, my sister, my wife, my mother, however it is, I have to give you what I would do on them. And so, I wanted to learn more complete care. To me, running around all day long with four patients in the operatories and spreading myself thin is not the way I would treat those people in my life.” (11:45—12:15)

“I structure my office based on relationships and caring. I care about these people. I'm concerned for their well-being. If someone was going to a cardiologist and they said, ‘Hey, there's something going on with your heart. I want to do additional tests,’ you don't question that. And I think it’s the same regard for us. I think that dentistry, we get so bogged down in terms of, ‘Well, is insurance going to cover it?’ or, ‘They're not going to pay the $350 to do a thorough analysis of things,’ whatever it may be. Well, now, you don't believe in the process that you're doing yourself. I believe that what I'm doing is a benefit for the patient, and I'm going to put that first and let the rest of the details figure themselves out.” (15:58—16:39)

“I don't base my well-being on the patients’ decision of what I do. So, if they say no [to the comprehensive exam] and I've given them every option or educated them in this capacity and they say, ‘This is just not the right time for me,’ maybe there's something else going on within their life that's going to make things difficult for them. And then, they come back two years later and say, ‘Okay, I'm ready. I broke three teeth now. I broke another tooth.’ Or, ‘I am starting to see the shifting and moving of teeth,’ or, ‘You were talking about those headaches. I can't get rid of them now. It’s on my mind. So, what can we do about it?’ So, they may say no at the time, but they’ll come back. And I'm okay with that. You don't take offense to it because people, if they're educated appropriately, will make the decision that's best for them.” (16:47—17:30)

“If I had to give any advice, that's one thing I learned, is you want to take the photos first before you start using your articulating paper or impressions. Because there’re so many times you take these photos after all that, and now there's gunk in between their teeth, or you could see the markings on the paper. So, I always like to do the photos first.” (19:02—19:17)

“I [tell patients], ‘I'm gathering a bunch of data. And, for me, I don't really know what's happening right now, but I'm going to do the same protocol I do on every single patient I do this with because it’s consistent.’ And with that, it builds a lot of trust in them because it’s like, ‘This guy has done this before. This is normal. He does this with a lot of patients.’ They're not concerned about any of this stuff because it builds confidence.” (19:34—19:56)

“I very well will ask or repeat myself based on previous exam discussions that we’ve had. It’s not to be insulting, it’s just something that I'm going through in this protocol because I don't want to miss anything. And there's also stuff that we may have covered in the past that they talk about, and then they take it a week later, and they think things differently and say, ‘You know what? I know you mentioned this last week at our hygiene appointment, but I was thinking things through a little bit deeper, and I do actually do X, Y, Z.’ So, you end up having more appropriate dialogues or more accurate dialogues based on a little bit of time in between too, which I appreciate.” (19:59—20:35)

“The issue that I'm having is that by doing these complete examination type of protocols, I'm identifying that a lot of people have sleep issues and are having airway obstructions and all those different things. Now, I'm not privy to know everything. But at the same point, if I'm screening for it, now I'm saying, ‘Okay, I'm seeing some signs and things that really would reflect that you have something going on.’ Their next question is, ‘Okay. What do I do?’ And then I'm stuck because I'm like, ‘I really don't know.’” (29:05—29:34)

“Oftentimes, [after the exam, patients] say, ‘No one’s ever done it this way. [Other dentists] always just looked at cavities that I was trying to get filled, and I always felt like I was running back and forth with needing new crowns replaced because they're breaking left and right. And I always thought it was the material. I didn't realize it was a dysfunction of my occlusion.” (36:01—36:21)

“That's another thing I don't like about dentistry, is the fact that we’re here to be so critical of these people. All the time, we’re trained from school that we need to come in and say, ‘These are all the findings that are wrong with you.’ And yet, we never talk about all the good things that they have going on, ‘You're a really good brusher. You really take good care of your teeth, it’s just you're functionally a mess. But we can solve those issues if we go through this protocol.’” (42:45—43:09)

“There are certain people that are, ‘Shoot it to me straight,’ and there’re other people that want to have more supportive energy. So, you kind of have to read these people too, because not all people are the same.” (43:26—43:37)

“[Some misconceptions dentists have is], ‘I don't have time. I'm too busy.’ Or, ‘Patients can't afford this. It’s not covered by insurance.’ I think it goes back to how you want to structure your way of your day. If you don't have time, that's great. Don't do this type of stuff. You can continue to keep doing what you want to do. And that's the beauty of dentistry, if you find that you're doing what you want to do. This is my way, and it’s not going to be great for anybody else but me. And that's the beauty of things. This works for me, and it might work for other people in some facet. But I hope someone takes this and then tweaks it to merge into their protocol of what they do.” (46:37—47:16)

Snippets:

Dr. Groth’s background. (03:34—06:13)

Slow things down and work less. (06:44—07:36)

His journey and evolution of this process. (07:59—10:21)

The who and why that drives his process. (10:36—11:37)

You need a team to implement the process. (11:45—14:23)

Details of his protocol process. (14:51—16:39)

Responding to resistance from patients. (16:44—17:31)

When to do exams and pre-photos. (17:54—19:19)

How to set expectations for patients. (19:33—20:39)

After photography and the articulating papers. (20:48—22:46)

Forming his own system and the occlusal analysis sheet. (23:00—28:44)

Where airway fits into the future vision of his practice. (29:04—30:42)

Slow down and get to know each patient. (31:16—32:16)

Taking patients’ measurements. (32:28—35:12)

Co-discovering issues with patients. (35:28—39:27)

The perio part of the exam. (39:50—41:16)

True or false? “There's only one true diagnosis.” (41:49—43:15)

Ask patients how they feel after the exam. (43:15—43:37)

Closing dialogue with patients. (43:45—46:25)

Myths and misconceptions from dentists. (46:37—47:16)

Advice for young dentists. (47:46—48:59)

Dr. Groth’s contact information. (49:25—50:00)

Q&A for Dr. Groth. (50:38—59:10)

Reach Out to Dr. Groth:

Dr. Groth’s email: kevingroth@gmail.com 

Dr. Groth’s Facebook: https://www.facebook.com/grothdental/

Dr. Groth’s Instagram: @drkevingroth https://www.instagram.com/drkevingroth/?hl=en

Dr. Kevin Groth Bio:

Dr. Kevin Groth’s primary goal is for every person to walk out of his office knowing that they received the highest-quality, most personalized care possible. Dentistry is more than just a profession for Dr. Groth. He sees every patient as an extension of his own family, and when you are in his chair, you’ll always be treated well.

Dr. Groth’s favorite part of being a dentist is that every day and every patient is different. He loves the variety of people he gets to meet and procedures he performs to help patients maintain their smiles.

Since graduating from the University of Michigan School of Dentistry, Dr. Groth has been recognized locally by Hour Detroit Magazine as a Top Dentist, and nationally as a Top Doc. As a passionate dentist who wants to provide the best care for his patients, Dr. Groth pursues continuing education through The Dawson Academy, serves on the executive board of the Periodontal Bunting Society, and is the Assistant Clinical Director of the Society of Comprehensive Dentists. He has also served as an adjunct clinical faculty member at the University of Michigan School of Dentistry.