Lower Risk – Increase Prognosis

Episode #321 with Dr. Betsy Bakeman

Risk assessment is the most important tool for designing the best treatment. And to share the most effective way to lower risks and have a good prognosis for your patients’ teeth, Kirk Behrendt brings in Dr. Betsy Bakeman to talk about a new system of thinking, the four diagnostic parameters, for better outcomes in patients. Veneers are useless if you lose your teeth! To learn more about treating patients comprehensively for the long run, listen to Episode 321 of The Best Practices Show!

Main Takeaways:

It’s important to figure out why something is happening to patients’ teeth.

Always look to reduce risk in areas of perio, biomechanics, function, and esthetics.

You can reduce risk, but you can't always eliminate risk.

Risk is a moving target in patients — things change.

It’s important to help your patients understand their level of risk.

Treatment doesn’t need to be done all at once.

Continuing education is the best gift you can give yourself.

Quotes:

“The whole concept of lowering risk, of looking at a patient and making a complete diagnosis and looking at where their risk factors for breakdown are and really categorizing that in a very simple way: low, medium, high. Periodontally, biomechanically — which is the structural integrity of the teeth. So, that's the patient’s risk for caries, erosion. And then, functionally, load-based failure. And then, also looking at the patient for esthetics, do the teeth show, because that has an influence on where we put the teeth and everything. So, you categorize in those four areas, are they low risk, medium risk, high risk.” (04:40—05:24)

“You have to work to lower the risk. Now, that may be treating the decay. It may be saying the decay is too out of control, we need to remove the teeth and move toward implants. Load-based failures. Is this a parafunction patient? Is this just friction? Are the teeth rubbing together, and we can fix that, the way the teeth come together? So, we always are looking to lower risk. And the amazing thing that does when we really think about that and make a thorough diagnosis and we design our treatment plans to lower risk, we increase prognosis and predictability. And patients really get it.” (05:32—06:11)

“It’s just a different way of looking at things and looking at the whole patient and making some decisions about where to go with things. And people are so appreciative. You end up treating the patient for the long term and you create very happy, very pleased patients. And it doesn't mean you have to do it all at once. Sometimes, we stage treatment over time. But you're going in that direction to lower risk and increase prognosis. And it feels really good. It feels like you're serving the patient.” (07:32—08:06)

“You have to force yourself to think [in this way]. [John Kois], he has systems that go through that, that go through perio, biomechanics, structural integrity of the teeth, the function, and the esthetics. And you actually have to write down in those areas and think about it in that way. And in the beginning, you have to fill out the form. You have to start to get your brain to think that way. And you develop the risk assessment, and you say to yourself, ‘Okay. I know this patient wants veneers. But if I don't manage the function, the reason the teeth look this way, this whole thing is going to fail.’ Or if the patient doesn't treat the periodontal disease they have, I could do beautiful veneers, but they're going to lose their teeth. And so, you structure things that way.” (08:51—09:42)

“The patient that needs the most dentistry, they're coming with the highest level of risk. And sometimes, we can lower risk. But in some areas, we’re not able to. We just have to manage it, and to the...