Review of Findings (ROF) Part 2: The How

In the first article in this three-part series, we looked at what a review of findings (ROF) is, who should get it (most new patients), and when it should be done (ideally, in a separate follow-up visit). Now, let’s get into the details of how to perform an effective review of findings.

The review of findings is an important consultation for both the patient and the practice, as you are building value and a compelling reason for potential dental treatment, as well as value for your expert dental care that will follow. The ROF is considered an extension of the new patient experience; as I discussed in Part 1, in our practice, it is scheduled and billed as a part of the comprehensive initial examination. No extra fee is associated with the review of findings, so insurance is not billed, but insurance can certainly be billed for the comprehensive examination. With that understanding, let’s move on to the details of the process.

The review of findings should be conducted in a consult room or area with access to screens and a computer. The ability to look at patient photos alongside the patient and show them what you see is a great service to yourself and the patient. I always bring an assistant into the ROF with me. They take notes and help build value for what I am seeing, as they will add to the conversation when they see an opportunity. This way, I can fully engage with the patient and don’t have to worry about missing anything the patient is saying. I listen intently to the patient, make eye contact, and have an interactive conversation. My assistant is writing what she hears from me and the patient, and she is also beginning to help formulate a treatment plan as we progress through the visit.

Begin the ROF by providing the patient with a checklist of observations you have made of their mouth. Once the patient has this checklist, begin by reviewing the photos taken during the exam. I always start with extraoral photos and work from the outside in. Review the full-face photo and smile photo with the patient. Ask them if there is anything they don’t like about their smile and point out variations from ideal that you see. The patient may not be cosmetically driven (at least at first). Still, when they begin to see that the esthetic concerns you identify are married with functional dental issues, as well as negatively impacting esthetics, they may change their mind.

After reviewing these photos and discussing what I see, and what the patient notices, I then move on to the intraoral photos. Buccal and occlusal photos can provide a patient with a lot of information. You can discuss all forms of wear that appear in these images, and the jaw and bite relationship. Intraoral up-close photos also work well with these photos and help explain the tooth condition observations. For example, looking at a tooth with a leaking amalgam and a Class 3 crack is compelling evidence for what might become an indirect restoration. How that failing amalgam may fit into the overall dental health prognosis for the patient also helps patients say yes to more comprehensive treatment. In that respect, the review of findings allows you to move past single-tooth dentistry and into the quadrant and full-mouth approach to patient care. When a patient can see full arch intraoral photos and receive an expert explanation as to the disease state and the etiology of their dental issues, they are more likely to want to move away from the single-tooth approach. The ROF should allow you to talk about the airway, esthetics, structure, function, and biology (AEFSB) observations for the patient.

Once I have reviewed all the information on the checklist provided, I often follow up with Spear patient education videos. This part of the review reiterates and legitimizes what was discussed minutes before. I then email the patient these videos so they can refer to them later. When I am done, I ask, “Are there more questions I can answer for you?”

Most of the time, they want to discuss treatment, how to execute it, and how much it will all cost. Remember, however — this is a review of findings; it is not necessarily a treatment plan proposal. If the patient has complex dental needs and concerns, I urge you not to present treatment at this visit. Let the information you have discussed marinate. Have the patient return for a treatment planning consultation and for further records if necessary. This visit is a terrific way to gauge if the patient wants comprehensive and elective care, or if they may want to phase treatment and address care more slowly over time. The review of findings visit is the visit to help you and the patient figure out what type of care they seek to receive. If the patient is eager to know what type of treatment you are proposing to treat their dental disease, this is a good sign. This is when you can tell them that you would like to develop an expertly crafted plan that is right for them, and that you are happy they see what you see and want to get healthy. Invite them back for a presentation of your treatment plan(s).

If the patient’s dental needs are not overly complex, I will follow the Frank Spear numbering method to illustrate what dental treatment can and should be accomplished and in what order. Frank has taught us to number the teeth using the occlusal photos and a 1, 2, or 3 numeric system. The numbers signify how immediately necessary dental treatment should be. A number 1 is more urgent (such as the amalgam with a Class 3 crack), 2 is less urgent (such as a PFM crown with a less ideal margin), and 3 is elective (cosmetic veneers).

Most of the time, I will do this prioritizing component at the end of the review of findings visit if I feel confident that I have a correct plan for the patient and that the patient wants to hear what I propose. Sometimes, I will have the numbered intraoral occlusal photos ready to show the patient. Other times, I will number the teeth alongside the patient, and we can develop the plan together. The way the visit is going influences how I proceed. It is always important to explain the pros of treatment, as well as the consequences of not treating the teeth you believe need dentistry (the 1s and 2s). After the treatment is described and explained, I have my financial coordinator speak with the patient and my staff. They go over the cost associated with the plan, and then the assistant and front desk schedule the patient accordingly.

I hope this provides a helpful overview of the how and all the details involved in a review of findings (ROF) visit. In the final article in this series, I will explain how to adapt approaches to this visit to help achieve optimal case acceptance and address one more big question: why do we do review of findings visits in the first place?

Dr. Margaret Frankel is a contributing author for Spear Digest.