I'm a general dentist. I worked for 20 years in downtown Manhattan and built a large Invisalign^® practice. I’m currently the president of the American Academy of Clear Aligners, which is responsible for over 100,000 Invisalign cases per year. I speak to about 4,000 offices on a monthly basis and listen to what doctors are talking about. I want to bring to light a major problem I see with dentistry that we’ve had for 100 years and — even better — recommend a solution. Let’s start with five facts.

1: Only 35% of Patients Accept Your Treatment Plan

If you’re doing really well, you might expect that your patients are accepting a significant percentage of your treatment plans. What do you think that percentage would be? 50%? 75%? The truth is, according to just about every consultant in dentistry, if you’re getting 35%, you’re doing great. You’re killing it. You’re a good dentist. You’re spending your time wisely, you’re learning, you’re buying technology, using the best stuff out there. You’re a master of your craft. Yet 65% of our patients do not follow our treatment recommendations.

2: Patients Don’t Trust the Dentist

As much as it pains me to say, patients do not trust us. It’s a little weird, right? I’m a dentist. I went to an Ivy League school. I’m not bragging, I’m just saying it. I slip it into the conversation a little bit. And yet, I have patients who doubt me in everything. I lived in New York, had a ton of friends. I lived in Chicago, had a ton of friends. I lived in Vancouver, had a ton of friends. Everybody who meets me says, “David’s a good guy. David’s an honest guy.” Everyone says, “David? You can trust him.” There’s only one group of people who thinks everything out of my mouth is a lie, or a trick, or a game. You know who that group of people is? My patients. How many of you reading this have ever said something to a patient and the patient has doubted you? You’ve experienced this. I tell a patient, “You have a cavity.” My patients say, “What? I have a cavity? Is it possible?” I reply, “Yeah, totally possible.” They say, “Are you sure?” I say, “Yeah, I went to school for a really long time.”

On a regular day, I say to a patient, “Sir, you need two crowns and a filling.” My patient looks me in the face and says, “And you need a Tesla.” How did this happen? Our patients doubt us. They doubt us more than any other health care provider. When I go to my ophthalmologist or my primary care doctor, I don’t doubt anything they say, but everybody doubts the dentist.

How did dentistry become the profession that you doubt? A recent study showed that 62% of patients have delayed, refused treatment, sought second opinions, or switched dentists because they didn’t trust the diagnosis.¹ How is this possible?

3: The Reason Patients Don’t Trust Us is the Dental Exam

Why do they not trust us? I believe it’s all about the dental exam. I think the way that we do the dental exam is broken. It’s been the same for 100 years, and I think it creates all the problems that we see. If I came to your office, here’s what it would look like: patient comes in, boom, you lean them back, grab a mirror and an explorer, boom, boom, you’re looking all around, call out a bunch of numbers to your staff. When a person is flat, it’s the most prone position they can be in. It’s scary to be totally flat. Then somebody’s all over you looking into your mouth and you’re thinking, “Did I brush last night? Do I have something in there?” Then they call out all these things you don’t understand.

The way we do the dental exam is broken. It’s thorough, but it’s broken. It’s not the correct way to do the exam when we have modern technology. If you do the exam that way, you’re setting yourself on a collision course with the patient. I was resistant to change, but I changed. And my case acceptance shot through the roof. The solution, the one that I’ve been employing and a lot of my followers have been employing for years, is using a scan.

I own five iTero scanners. Since 2018, I’ve been taking scans on every single patient. Then I use the scan as my exam. I don’t follow the rote review system anymore. I pull up the iTero viewer and look at the teeth the same time as the patient. When I see it, they see it, too. I can see everything in the mouth clearer and better than before. “If you have a black line in your tooth, you have a cavity. If you have a hole, you have a big cavity. If you’re missing a wall, you need a crown. If you’re missing a tooth, you need an implant.” Patients now look at me and say, “Do you have time to do it today?” It’s a whole different game. Now, I do all of my exams with the scanner. I don’t look in the mouth until the last minute. The moment you convert to intraoral scanning, the treatment acceptance in your office will skyrocket.

When a patient visualizes their teeth on a computer screen in front of their face, the entire game changes. When you change the way you do the exams, all the mistrust goes away. That 35% acceptance number can easily jump to 45% acceptance, which can translate to hundreds of thousands of dollars a year, maybe millions in some practices.

The moment you convert to intraoral scanning, the treatment acceptance in your office will skyrocket.

4: Scanning and Using Digital Technology is the Solution

Then there is software. For example, Overjet (Overjet Inc.; Claymont, Del.), which uses artificial intelligence to analyze X-rays and identify areas of concern. Simply put, it looks at your bite wings and tells you what’s there. Invisalign Outcome Simulator Pro analyzes the patient and determines if the teeth can be straightened. I use these software features during the exam. I often show the results to the patient and say, “I want you to know, you’re an orthodontic candidate. You don’t have to live with these crowded teeth.” The software is truly effective. And you show the patient what their smile could look like chairside, without picking up a handpiece or without putting wax on anything. You don’t have to spend money on digital smile design software.

Then there is Time-Lapse. What do you do if your patient of 5–10 years comes into the office — they’re male, 50 years old — and asks, “Is my grinding getting worse?” I would look at his chart, but in reality, I have no idea. With iTero, you can use the Time-Lapse software. Every time the patient comes in, you scan them and the software overlays the scans and shows changes over time. “Red: lots of change. Yellow: a little bit of change. Plus, you cracked that tooth.” You don’t need to open your chart and read the last five years of notes. Use technology. I can now tell my patient, “Your teeth are shifting.” And when they say, “Oh, and you need a Tesla,” I say “No, your teeth are really shifting. On this screen, look at how #8 and #9 are moving apart from each other. This is happening. This is when it happened. You need aligners now.” This is technology having the conversation for us. This is the future, and it is going to solve the problem of people not trusting us.

The iTero Element^™ 5D incorporates near infrared (NIRI), which allows you to analyze an intraoral scan using infrared wavelengths that are not visible to the naked eye. This aids in the detection and monitoring of interproximal caries above the gingiva. NIRI can save you time and money in terms of taking fewer X-rays and helps limit patient exposure to radiation.

I foresee a world where you’re going to come in to a patient and your scanner will be sitting there. You’ll push a button and a screen will pop up and provide a synopsis of what’s happening. “You have a crack on #3. It wasn’t there last time. You have recession on #24. It’s a millimeter worse than it was last year. You have a cavity detected by NIRI on #30 MO.” It’ll be consistent. That is a big problem; we’re not consistent in our diagnosis. This technology, this modern way to do exams, is consistent.

5: You Have to Scan Everybody

You have to set it up. Scanning is like bite wings for us. I will not walk into an operatory unless there’s a scan there. No exceptions. I don’t begin by looking in the mouth. I look at the scan. If there’s no scan, it’s a waste of time for me. If the patient says, “I don’t want orthodontics,” they’re still getting a scan. “I don’t want to pay for it.” It’s free. “I don’t want any radiation.” It’s a camera. You get the idea.