The 5-Step System I Use with Every New Dental Patient

When patients come into our office for emergency treatment or with a severe problem, most of them think it just happened overnight. That’s usually not the case. It’s typically something that’s developed over a period of time.

A Pattern of Avoidance and Disappointment

Many of our patients have had a long dental journey. They’ve seen dentists, stopped seeing dentists, taken five years off, and repeated the cycle. In my practice, the average new patient is around 64 years old. They often come in after having seen a series of dentists over the course of their lives.

Sometimes, they’ve had $5,000 to $10,000 worth of dental work done, only to stop going due to fear, inconvenience, or dissatisfaction. They may have had a bad experience and then gone elsewhere. By the time they reach us, many are broken—physically and emotionally—and they don’t trust anyone.

The “Sonick Curve” – A Downward Spiral

This mistrust and ongoing decline remind me of something I call the “Sonick Curve.” People are usually born with relatively good teeth, but over time things get worse.

It starts with a two-surface amalgam or bonded restoration. Then it progresses to a crown. Eventually, it becomes an extraction, followed by a bridge, more bridges, additional extractions, implants, and sometimes peri-implantitis and periodontal disease.

While this isn’t the case for every patient, it’s a common path I see in my practice. Their experience with dentistry—and their own teeth—has often been negative.

Dentistry and Addiction: A Surprising Parallel

When I describe this to patients, I often compare their situation to addiction. Over time, whether the addiction is food, drugs, alcohol, sex, gambling—or in my case, the "respectable addiction" of work—it gets worse until people hit rock bottom.

There’s a well-known curve developed by Dr. E.M. Jellinek, a professor at Yale in the early 1900s, that describes this decline. Addicts spiral downward until they hit the bottom of the curve. At that point, they either remain in that state, live a miserable life, go to jail, die, or end up in a hospital.

When I first saw that curve, I realized it mirrors what happens with many of our dental patients. They come in with three or four teeth left, a broken partial denture, and a sense of hopelessness. And many of them are not without means—they just never received the care they truly needed.

Reaching the Bottom and Taking the First Step

These patients often don’t trust anyone. But when they walk into our office, they’ve taken an important step: they’re asking for help. They may not trust me yet, but they’ve driven to the office and walked through the door. That’s huge.

I tell them, “I realize the hardest thing you did was get in the car, drive here, and walk up the steps.”

For every six or seven patients referred, only one actually makes an appointment. By the time someone comes to see me, they’ve likely been referred by friends, their dentist, their primary care physician—multiple sources. When they finally show up, they’re ready to begin.

Moving Up the Curve – A Step-by-Step Approach

I tell patients, “We can move you back up the curve.” And here’s how we do it—with education and baby steps.

First, I focus on controlling the infection and getting them out of pain. That’s the priority. Then we begin rebuilding.

The Four Phases of Care

There are four phases of care I always walk patients through. And there are five ways we treat every patient, which I’ll explain in a moment.

We learned this in dental school, but I’m constantly surprised by how few dentists actually follow this process.

Phase 1: Examination

Every case starts with an exam. I explain to the patient, “We’re going to do an examination, and then I’ll give you a diagnosis.”

There’s only one correct diagnosis—whether it’s caries, periodontal disease, or pneumonia. Everyone should agree on the diagnosis.

Phase 2: Diagnosis and Treatment Options

Where things differ is in treatment options. There are many different ways to treat the same diagnosis. I give the patient their options clearly and thoroughly.

Phase 3: Treatment

Once they understand their choices, we move into treatment. I let them know this plan before we begin any care. Unless they’re in acute pain, we typically won’t do any treatment on the first day.

Phase 4: Maintenance

The most important phase—and often the most overlooked—is maintenance. This is where long-term success is built.

The Five Ways I Treat Every Patient

Here’s the exact breakdown I give every patient before we start care:

1. Get you out of pain. (If you’re not in pain, we skip this step.)

2. Control infection.

3. Functional rehabilitation. (Crowns, surgery, implants, ortho, etc.)

4. Aesthetics.

5. Maintenance.

This conversation inspires trust. Most dentists jump right to treatment: “You need an implant,” or “You need Invisalign.” That doesn’t build trust, especially for patients who already feel betrayed by past dental experiences.

The Reality of Patient Experience

Many patients feel that dentistry has only ever brought them pain and suffering. And it’s not always their fault. Sometimes it’s the dentist’s fault. Sometimes it’s a combination. And sometimes, it’s just genetics and bad luck.

The Good News: There’s a Way Forward

The good news is that we now have the technology and knowledge to help every patient get healthy—if we take the time to educate them and build trust.

I believe it’s both a privilege and a responsibility to walk patients through this journey.

So next time a patient walks in looking hopeless, don’t blame them. Empathize with them. Offer hope. Offer a way out. Because they’ve already taken the hardest step—getting into your chair.

Be the gift your patients need.

Have a great day, everyone.