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Becoming an MVP Endodontist

Helen Yang, D.M.D.By Dr. Helen Yang Meyer

The “Most Valuable Player” honor is given to a team member who is a tremendous asset and who consistently goes above and beyond. As endodontists, we are on the patient’s dental team, spearheaded by the restorative dentist. In this article, I share my approaches to go above and beyond the technical endodontics and help you become your referring dentist’s MVP.

Co-pilot through patient education – A copilot is a qualified pilot who assists the pilot but is not in command. As specialists, our opinions carry weight, even if it’s outside our immediate area of expertise. During the consultation, I ask patients to summarize their overall treatment plan; this gives me an idea of their understanding and acceptance of it (or if there even is one). They will share candid statements such as “the dentist keeps wanting to crown my perfectly fine teeth,” “I don’t see why I need the expensive gum treatment,” “the tooth was fine before the dentist crowned it,” and “I don’t know why all my teeth are suddenly going bad.”

If I sense a lack of understanding or doubt, I will devote a few extra minutes to ask follow up questions, do a quick whole mouth exam, and try to support the referring dentist’s reasoning. I explain how different treatment philosophies can impact two dentists’ recommendations, especially on asymptomatic conditions such as cracked teeth, third molars, and periodontal disease. Often, patients need to hear a recommendation more than once, from more than one source, for it to stick. So, I take the time to review the value of periodontal treatment, nightguards, or referral to perio/TMD experts in increasing the longevity of their dentition. Finally, I encourage the patient to return to their dentist to address any remaining questions or doubts so they can be informed and seek timely dental care.

See something, say something– Nearly all of my referring offices do not have their own CBCT machine, so frequently my 5×5 scans pick up additional findings. It’s our duty to inform the patient, and equally importantly, the referring dentist. The findings may impact treatment outside of the referred area, and I try to gently work this new information into the patient’s existing treatment plan (e.g. finding an apical lesion on a tooth that is scheduled to have a crown replaced–> recommending a retreatment beforehand).

Last week, I saw a patient to evaluate #4. In the mandible, she only has first premolar to first premolar occlusion. She mentioned her dentist (who is a fairly recent grad) just took impressions for a lower RPD. The scan shows #28 has a fairly short, conical root, questionable canal obturation, normal periapex, and moderate mesial cervical bone loss. I informed her that #28 is sound for now but may not hold up against the torquing forces of a metal clasp and that I’ll share the CBCT findings with her dentist. After our phone call, the dentist decided to have the RPD clasp the canine instead. We can provide information to improve treatment, or at least, warn patients of potential shortcomings.

Be accessible-  Establish regular rapport by being available and in close communication with your referring doctors. On any given day, I may receive texts with images asking if a tooth looks cracked, my thoughts on a working length x-ray, how to handle a patient who’s experiencing post-treatment symptoms, if they should refer a patient with unusual orofacial pain my way, if I can squeeze in an emergency patient the same day, etc. The doctors know they can text or call me personally and receive a response almost always within the hour. I want to be the endodontic teammate they reach out to and rely on first.

Ensure the patient’s seamless transition back to the referring office with prompt, detailed email reports, and occasionally direct communication. The report includes discussions I have with patients and ancillary recommendations (e.g. if a patient may benefit from nitrous oxide, or keeping a tooth in a temporary crown for a prolonged time) are documented, along with relevant CBCT slices. My office manager too will go the extra mile by helping patients schedule their crown appointment while they are still at my clinic.

Relay patient feedback– When patients express sentiments about their referring dentist’s office, I remember to share it with them. Bearing praise is always a pleasure. Nonetheless, delivering helpful and constructive feedback, to the right audience, can also be appreciated. 

A recent case comes to mind. Middle aged, inquisitive, friendly, the patient presented in February with pulpitis that developed after #19 was placed in a temporary crown, which needed to be recemented and bite adjusted within a week. She was frustrated, believing the pulpitis was caused by the dentist delegating most of the tasks to his EFDA, who was somewhat rough and had large hands. She stated that she was thinking of switching offices over this. I encouraged her to give the office a second chance, or at least return to complete the two crowns that were already started. The same day, I called her dentist to relay the story and recommend perhaps he personally oversee the crown deliveries with white glove service.

Last week, she returned to me with a temporary crown on #31 and an almost identical chief complaint. This time, she was adamant about leaving. I recommended another great general dentist office near her workplace, one without EFDAs and is helmed by a doctor whose personality I thought the patient would find agreeable. I personally called both doctors. The first expected this outcome and was actually relieved, and the second was happy about the referral and appreciated the heads up.

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An MVP plays many roles. In addition to delivering endodontic treatment to the best of our abilities (which is challenging enough!), we are also a trusted second opinion, co-pilot, messenger, and conflict mediator. While not all doctors may appreciate the hard work and good intentions behind this philosophy, the vast majority value the endodontist who goes above and beyond and has their patients’ best interests at heart.

Dr. Helen Yang Meyer is a former chair of the Resident and New Practitioner Committee and currently practices endodontics in Colorado.