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June 11th, 2019

Not Your Problem: How to Talk to Patients About Risk Factors

By Bren Barbour, Business Development Coach & Kathryn Gilliam, RDH, BA, FAAOSH, Hygiene Coach

We are passionate about teaching dentists and their teams how to present risk factors to patients. Our ultimate goal is to help doctors educate and serve their patients so they can minimize risks and maintain healthier lives.

Let’s set the foundation: the risk factor conversation should be one of education and illumination, not sales. While increased case acceptance is often the result of discussing risk factors, it is not the primary focus.

When patients know that their dental health practitioner is focused on their wellness, it elevates the relationship to a partnership based on mutual trust. And as you probably know, dentistry is all about the trust between a doctor and a patient.

Why Talk About Risk Factors?

While it takes more effort and more education for your team to present risk factors to patients, the benefits – to your patients and practice – can be enormous. Here are just a few examples:

  • As our Co-Founder Dr. Bruce B. Baird eloquently says, “It’s not my problem!” A lot of dentists feel responsible for patients’ problems. But, repeat after us, their problems are not your responsibility. By educating patients about their risk factors, you place the responsibility of the patient’s conditions where it belongs – with the patient. By educating patients about risk factors you help them own their problems or conditions.
  • Education on risk factors is also important as it helps patients understand how they got to the point of having problems with their oral health.
  • By understanding and owning their conditions, the patient then feels empowered to “correct” their risk factors; they are in control of the solution and their own health.
  • Discussion of risk factors elevates the level of service your office provides and makes you stand out from the crowd. Other offices present only “findings and treatment needed.” Discussing Risk Factors (how/why; levels now/after) provides patients with a more thorough dental, or oral wellness, experience and gives your practice differentiation from other local offices.

5 Key Distinctions for Implementing Risk Factor Conversations

An effective conversation about risk factors has five components: current risk level, risk linking, consequences of not doing treatment, benefits of treatment, and level of risk after treatment.

  1. Current risk level: The risk factor conversation begins as you start the conversation and build rapport with the patient. During this time you can review the patient’s health history and inform the patient of his/her current risk levels.
  2. Risk linking. This is where you discuss the how and why the risk exists: prescription medications, health conditions (HPB; Diabetes; Heart conditions, etc.), genetics, nutrition, lifestyle, self-care habits, immune system status (antibiotic exposure, bacterial biofilm stability, probiotics and prebiotics), etc. Remember: this is the patient’s problem, not yours!
  3. Consequences of not doing treatment. Here is where you overview the patient’s current level of risk and future level of risk. Here are two examples of how that conversation might go.
  • “Well, Mr. Smith, you are a pretty high risk for heart attack or stroke due to the bacteria that are present in your oral biofilm. Once we treat the gum disease and target the bacteria with antimicrobial products, your risk will be reduced. Now I know you already know this, but if you get re-infected, or if you don’t keep the biofilm in balance, your risk will be elevated again.”
  • “So, Mrs. Jones, because of your diabetes, you may always have a challenge keeping your gums healthy. If, however, you are able to get the bacterial biofilm in balance with your self-care habits, you may find it easier to control your blood sugar. Now, as long as you have diabetes, your periodontal health will always be a high risk and you really need to maintain an impeccable self-care routine. We also suggest you come in every 3-4 months so we can help support you in keeping your gums healthy.”
  1. Benefits of doing treatment, and consequences of not doing treatment. Discussing the benefits is key because almost all dental professionals discuss “consequences” of not doing treatment. Focus on the benefits, as well, so the patient hears and sees a positive future.
  2. Level of risk after treatment. The patient needs to know their risk level even after any recommend treatment is completed. If the patient’s level of risk is going to remain high after treatment is completed – tell them that now.  You may say something along these lines to a patient:
  • “Now remember, Mr. Jones, your high blood pressure medicine, your allergy medication, and that anxiety medication you’re taking, all cause dry mouth. We talked about the acid/alkaline balance being off due to the bacteria sitting on your teeth. We know you can’t go off those medications. And that dentistry we just did for you I want it to last the rest of your life and I don’t want you to waste money so if you’ll follow these things you’ll have a good chance at this dentistry lasting. You need to use the products we give you consistently, choose your foods and beverages carefully, and do the self-care we discussed: use that electric brush and water pick. Is that something you can agree to do?”

The Dangers of Missing Protocol 2

One of the most important steps in the risk factor conversation is step two; linking the risk. This is a vital step in patient communication because it shows the patient how they got that way. While all pieces of the risk factor discussion are important, showing the link is vital to the patient’s understanding of their risks and of them taking ownership of their health.

We often use the example of an oil change when coaching teams and doctors about the importance of linking:

Imagine you’re taking your car in for an oil change. You walk in and state, “I want my oil and oil filter changed.” One of 3 scenarios happen:

  1. You get your oil changed and pay when it’s done.
  2. You sit in the waiting room and a after a few minutes a mechanic walks in and says: “You need your front end aligned; your tires rotated and balanced; your antifreeze changed; your brake fluid changed; your air filter changed….”What’s the result of him telling you all that if all you want is an oil change? You feel pressured into buying something you don’t want and don’t understand.
  3. You sit in the waiting room and a after a few minutes the mechanic walks in and says, “Could you please come with me? I’d like to show you how you’re wearing out your tires. They are wearing very unevenly. See, right here. If we align your front end; rotate and balance your tires, they will last.  If you continue like this… well, you see this wear – new tires are in your future way earlier than they should be. Also, see this dark gray fluid here – it’s supposed to be yellow not grey… what this means to your engine is it’s not being able to function optimally. Oh, and see here – this is your manual – it says right here this, this and this should have been done at 30K miles.  You have 52K miles on the car… all these things have not been done.” You then chose to leave the garage with your oil changed and additional maintenance. Why? Because the mechanic gave you THE LINK – the HOW and WHY it got that way. You no longer feel you’re being sold something you don’t need or want. You understand the value and the benefits of what you’re doing, the risks of things going uncared for, and you want the services done.


In order to ensure that the patients understand their risk factors, all five risk factor protocols must be in place. Once the patient understands “how” they achieved their present condition and the consequences of not doing treatment they more easily commit to treatment plans and behavior changes that will positively impact their health. In addition, you and your team will experience increased treatment acceptance and the satisfaction of making a difference in patients lives.  

For more information about the entire team’s role in risk factor conversations, or with help implementing risk factor discussions in your practice, contact Productive Dentist Academy at (800) 757-6077 or fill out the form below to claim your complimentary practice discovery to see what opportunities are available within your practice.

Get Your Complimentary Practice Discovery Today!

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