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Rule 5: 6 E’s

Posted By Stephanie Wilhelm, Wednesday, July 25, 2018
The Basic Rules of.....

Basic Rule 5: 6 E's

When I first started to read about Dr. Earl Pound’s removable prosthodontic technique what immediately became apparent was how organized he was with his patient care. His organizational skills were such that he made removable prosthodontics a predictable procedure or at least as predictable as one could make such a discipline. He did this by having multiple steps and appointments with each one obviously being a precursor to the next but also involving the patient in the process along the way. This had the effect of doing two things. Firstly, the patient was apart of the process and could put their input in as required or desired. If they were agreeing with each step along the way then a successful outcome for treatment was more or less assured. What a relief to know we are on the right track, isn’t it! Secondly, and most important, if the patient was not satisfied with the process no matter what the cause, the services could then be terminated. Wow. Imagine, your half way threw treatment and you leave on pleasant terms. Why was this possible? Because before treatment commenced he followed the 4 E rule (I have added two more “E”‘s to make it the 6 E rule).
 
The E’s are:
1. Evaluate
2. Educate
3. Empower (my “E”)
4. Estimate
5/ 6. Enter or Exit (Pound had Eliminate)
 
The process of the E’s means that we are thorough with our patient interviews, case work-up, and case treatment planning and execution. By making the patient an equal partner in the process, ie. co-discovering, with us we are working towards a common goal like a team.2-4 We are up front with our patients with regards to treatment options, treatment length of time, costs, and efficacy. There are no surprises. And we expect to get renumerated at each appointment, just as Dr. Pound did. Dr. Pound received a fee at each appointment so that if services were terminated he was not out of pocket, the patient paid for what was done to that point, and the patient left the practice knowing full well that the pre-treatment contract had been honoured. Pretty smart. This concept can be applied to 21st century dentistry be it comprehensive fixed or removable prosthodontics, or just the routine everyday basics.

In my practice I follow the 6E’s. We thoroughly evaluate. There are no exceptions to this rule. Then we educate. Remember Basic Rule 2. Empowering of the patient results whereby they become a participant in their own care. Furthermore, this education process is not only about our diagnosis, treatment options, and empowering but also about fees and termination of services. We make each step of the way sequential and progressive such that records and treatment to date can be picked-up and continued at another practice of choice if in the unlikely event that “E” #6 (exit) occurs. We insure also that our fees have been looked after as well to this point.

A good example of our approach to comprehensive oral rehabilitation is the common way we provisionalize. In generalized moderate wear, erosive cases we frequently directly bond with hybrid composite; we like to call this the “prototype phase”. We do our thorough examination and evaluation followed by a thorough education of etiology, risk factors, treatment options, and efficacy. Costs are estimated and agreed too. We then perform our diagnostic provisional “prototype” phase (i.e. we have entered (“E” #5) into the treatment phase; in this example we bond establishing form, function, and vertical dimension re-establishment (Figures 1-3).

Figure 1

Figure 2

Figure 3

Figures 1-3: Composite bonding done in one appointment reestablishing form and function to the stomatognathic system.

This can usually be done in maximum one appointment per arch. At this point we have accomplished the first 5 E’s and have been renumerated. We can then proceed to the definitive restorative phase with the material of choice (gold or porcelain) at our leisure (ie. reenter (“E” #5) the relationship again) or services can be terminated depending on the circumstances (ie. exit (“E” #6) the relationship). Therefore, treatment has been predictable and stress free.

The 6 E’s offer another vehicle to optimize patient communication and interaction. The 6 E’s also just make good business sense. As oral healthcare providers we dance a fine line between professionalism and business. Nevertheless, a high regard for professionalism coupled with business acumen will ensure that we keep the busyness that us top professionals deserve.

Further Suggested Reading and References:
1. Pound E. Personalized denture procedures: dentist manual. Anaheim: Denar Corp.; 1973.
2. Roth SR. ProSpective volume one. Reclaiming the passion of dentistry. Seattle: ProSynergy Press; 1993.
3. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
4. Roth SR. ProSpective volume three. Advancing the profession of dentistry. Seattle: ProSynergy Press; 1996.

Tags:  Basic Rules  Racich  Rehabilitation  Treatment 

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The Basic Rules of......

Posted By Michael J. Racich, Thursday, March 2, 2017

The Basic Rules of …..


The solution to complex puzzles is often quite simple. When something that has perplexed us for a long time is finally solved it can be very gratifying to put our minds at rest. Sometimes it can be exasperating too as we might wonder why we did not think of the simple solution first. This applies not only to all walks of life but also dentistry. When it comes to dentistry and performing any restorative or prosthodontic task we are often confronted with this conundrum. Such questions as: “Is it really this difficult?” or “Is there an easier way?” immediately come to mind. The simplification of the art and science of oral care, specifically oral rehabilitation, is what I wish to share with you over the ensuing months via a series of short essays. 

Like most of my colleagues I attend numerous programs and congresses throughout the year. As I attend these meetings a common thread appears to run through them as I tend to hear the same messages over and over. Instinctively, I want to distill down what was really important from these messages for our profession and what is on the periphery so to speak. I have spent a considerable amount of time reflecting on and reviewing what is essential for an oral rehabilitation and what our profession has recommended over the last six decades and it appears to me that there are some basic fundamentals that optimize success; basic rules if you like. Yes, being a meticulous single tooth dentist and paying attention to all the details for an oral rehabilitation is important but it is essential to know the overall basic rules and what the end points are. This series of essays will be a tribute to this concept.

As such, I plan to be as transparent in my writing as possible. These essays will be written as an overview of the complex topic of oral rehabilitation. They will be also written to be concise and entertaining, food-for-thought if you like, that can be easily read on an overseas flight or poolside. In no way will these essays be assembled as a definitive source or to minimize the heroic efforts of the countless published academics and master clinicians that have made dentistry the wonderful profession that it is today. We all owe an immense amount of gratitude to these individuals. My intention, therefore, is to be synergistic and complimentary to the works of others. Evidence-based dentistry affords the practitioner the tools to rate the information that is presented to them and blend this information with patient values and professional beliefs and experiences; this is the key thought behind the motivation for these essays.

The Basic Rules of Oral Rehabilitation essay series will create and simplify for the reader a practical approach for the diagnostic, treatment, and maintenance phases of patient care by providing Basic Rules which are memorable, sequential, and gratifying. Appropriate references are included with each Basic Rule for further study by the reader. The Basic Rules will be divided into 4 major sections: The Patient, The Plan, The Process, The Payoff. Each major section of the Basic Rules essay will sequentially lead the reader through the steps necessary for an oral rehabilitation. 

I hope you enjoy these informative essays as much as I will enjoy putting my thoughts into words.  Depending on the feedback from this first essay series foray, a second Basic Rules essay series (The Basic Rules of Occlusion) will follow. I enjoy the art, science, and practice of dentistry and I particularly enjoy sharing it with my colleagues. Please feel free to contact me at your convenience, preferably via media such as Skype (mikeracich1). I wish you good health and continued success in your dental journey, no matter how lofty or humble you choose it to be.

 

Tags:  Basic Rules  Racich  Rehabilitation 

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Dr. Michael Racich introduction

Posted By Stephanie Wilhelm, Wednesday, March 1, 2017
Updated: Thursday, March 9, 2017

ADI is proud to have one of our Fellows offer his writings to ADI Fellows.  Dr. Michael Racich of West Vancouver, British Columbia will share his series. ADI is extremely grateful Dr. Racich ~ Thank you!

 

Dr. Racich, a 1982 graduate ofthe University of British Columbia, has a general dental practice emphasizing comprehensive restorative dentistry, prosthodontics and TMD/ orofacial pain. Dr. Racich is a member of many professional organizations and has lectured nationally and internationally on subjects relating to patient comfort, function and appearance. He is a Fellow of the Academy of General Dentistry and the American College of Dentists as well as a Diplomate of the American Board of Orofacial Pain and the International Congress of Oral Implantologists. Dr. Racich has published in peer-reviewed scientific journals such as the Journal of Prosthetic Dentistry and the International Journal of Periodontics and Restorative Dentistry and has authored the books: The Basic Rules of Oral Rehabilitation (2010), The Basic Rules of Occlusion (2012), The Basic Rules of Facially Generated Treatment Planning (2013), and The Basic Rules of Being a Dental Patient (2016). Currently he mentors the didactic/clinical FOCUS Dental Education Continuum (study clubs, proprietary programs, coaching, 2nd opinions only).

Tags:  Basic Rules  Racich  Rehabilitation 

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