Running a practice on MI principles
Dr Elmar Reich serves on the FDI Education Committee, has a dental practice in Biberach, Germany, and is the scientific coordinator of the GC MI Advisory Board. He opened his dental practice in 2004 with a clear goal of practising according to the Minimum Intervention philosophy. We asked him a few questions about how he achieves this goal.
Briefly explain why you chose to adopt the MI principles in your practice.
ER: My practice is not limited to MI dentistry but prevention forms the basis of everything we do here because I want to help my patients in the long run. I don’t only want to do restorations on their teeth, I want to give them advice and support, by myself and my team, in order to maintain their teeth and prevent caries from progressing.
How are dentists reimbursed for work in Germany?
ER: Unfortunately in Germany we are still based on a ‘fee per service’ system. This means the government health service will pay, for example, for a basic restoration. For a ceramo-metal restoration, the patient will have to pay an amount towards the cost. Preventive care is only paid for with children up to the age of 18. They will receive individual preventive treatment in the practice, such as advice on diet, tooth cleaning, plaque removal and brushing, as well as having fissure sealants on permanent molars. The government feels that adults should have learnt all they need to know about prevention by the time they are 18. This is wrong in my understanding. This is why I have managed my practice in such a way in that we do not only treat the disease but also prevent it and do that in a way which is helping my patients. But adults have to pay for preventive treatments.
What feedback do you get from patients when you introduce MI treatment concepts to them?
ER: Most patients are very glad to be informed about the causes of the disease. Most people think that as children they will get fillings, as adults they will need crowns or bridgework and removable dentures as seniors. And most of them are quite happy and grateful when they hear from me or anyone on my team that this does not have to be the case and that they do not have to follow that route. We can stop caries progression at any age. This is why my patients come back when I give them individually tailored recall programmes. They are really grateful for the information beyond the treatment.
How did you introduce the MI concept to your team?
ER: When I started my practice I had a very young dental team and they had not experienced the problems of caries lesions, pulpal pain and periodontal diseases themselves. So I made sure they all received information and training, so they became qualified in this area. After their training they are very enthusiastic about how good it is and they received positive patient feedback. I could not do preventive dentistry without my assistants. I always talk to my patients in a way they can understand the new concepts, but many still have questions and they find it easier to ask my assistants or my receptionist on the phone. So my team has to be on an equally trained level and they have to be well informed. It is also a great motivational factor for the dental team as well.
What needs to happen for the MI concept to be used more widely by dentists in Germany?
ER: I would say that the ‘fee for service’ system will continue in Germany but I think we will see, because of the evidence that is accumulating, that patients directly benefit from this kind of preventive approach (oral and general health). In the long term they have less dental problems and this is a convincing factor. Change of the system could happen if we can prove to the government that it is also cost effective, but this is not easily done. I think there will be increased patient demand for this kind of preventive treatment. This will be pushed by patients, which could in turn influence the government. Patients asking for change may have more power than a group of dentists. So we hope the population will soon begin see the benefits of this type of approach.
Above: Views of Dr Reich's dental practice in Biberach, Germany.
Visit Dr Reich’s practice website at www.zahnprofilaxe.de
Send your comments and questions to editorial@dental-learninghub.com
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Dr Elmar Reich serves on the FDI Education Committee, has a dental practice in Biberach, Germany, and is the scientific coordinator of the GC MI Advisory Board. He opened his dental practice in 2004 with a clear goal of practising according to the Minimum Intervention philosophy. We asked him a few questions about how he achieves this goal.
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