The Power of Trust: Transforming Your Dental Practice

In dentistry, clinical excellence is often considered the ultimate goal. Perfect margins, ideal occlusion, and flawless aesthetics dominate our professional conversations and continuing education. Yet there's another factor that will have a far greater impact on your practice’s commercial success: patient trust.

High trust is the foundation upon which successful dental practices are built. When patients trust you and your team, treatment acceptance increases, referrals flourish, and patient retention soars. Let's explore why trust matters so much in dentistry and how you can intentionally cultivate it in your practice.

The Science Behind Trust in Healthcare Settings

Trust in healthcare isn't just a feel-good concept—it's backed by substantial clinical research. Studies show that patients who trust their healthcare providers are more likely to follow treatment recommendations (Adekunle, 2023) (Thom, 2001) and more satisfied with their care. Even though there is consensus as to the importance of trust, there is more work needed in the field of defining how to reliably measure, define or quantify trust. (Yuan, 2023)

Trust is particularly critical in dentistry because of the significant information asymmetry between dentists and patients (Muirhead, 2013; Moore, 2022). Most patients can't personally evaluate the quality of a crown margin or the completeness of a root canal. Instead, they rely on proxies to assess quality, with trust being the most significant of these proxies.

Trust Accelerators: Building Patient Confidence

Certain behaviors and practices consistently build trust with patients. I call these "trust accelerators," and implementing them can rapidly impact your patient relationships:

Demonstrating Genuine Empathy

Patients can sense whether you truly care about their concerns. Take time to listen actively, acknowledge their feelings, and respond compassionately. Simple phrases like "I can see why that would concern you" or "Many people feel that way" validate patient experiences and build connection.

Similarly, the way you treat team members and even colleagues says much to those observing your behavior and manner of interacting with people. Think about how you speak to staff members in front of patients—both when things are going smoothly and also when things are more challenging. Your manner of speaking and interaction with the team you surround yourself with constantly broadcasts to the wider audience your values around teamwork, inclusion, diversity, and people. Demonstrated empathy says tenfold more than the words you use.

Maintaining Absolute Transparency

Be forthright about costs, treatment options, and potential outcomes. When patients sense you're holding back information, trust erodes quickly. Present all reasonable treatment options, even if some might result in less production for your practice.

Don’t make the amateur mistake of being vague or evasive about costs. Equally, don’t leave it to the reception staff to solely have the challenging conversations about money. I am not saying don’t involve reception staff and office managers in money and finance discussions with the patients, but don’t be a coward and suggest to the patient that “the front desk will cover all the cost and scheduling details'“.

Part of being clear about the What and Who, is being proud of your work, and quality costs money, every day of the week. Dentistry is an investment that won’t resonate with everyone, every time. Don’t shy away from this discussion. 

Matching Treatment Recommendations to Trust Maturity

Trust develops over time. Proposing extensive, expensive treatment in the initial appointments almost always feels premature to patients, no matter how clinically indicated it might be. Instead, stage treatment to match the level of trust you've established — begin with addressing immediate concerns before presenting comprehensive care plans.

Apart from trauma, fractures and acute infection, very little in dentistry is really an acute emergency. Most things can be planned and therefore effectively staged. And the stages, should reflect the clinician-patient relationship that has developed, as well as the oral hygiene and patient understanding level developed. Trying to run before you can walk is a perfect recipe for scaring off new patients, roasting your treatment plan conversion ratio, and creating lingering negative branding about the practice that will last for months or years in today’s digital media world.

Prioritizing Patient Education

Educated patients make confident decisions. Use visual aids, intraoral cameras, and clear explanations to help patients understand their oral conditions and treatment options. When patients understand "why," they're more likely to trust your recommendations.

And accept that some may never reach a level of appreciation that would be required for very involved comprehensive treatment undertakings. Don’t prejudge what people can understand and make an effective judgment for themselves about, but equally, be responsible about how options are presented. We all know there is considerable nuance to how options are presented and explained.   

Trust Dissolvers: Common Mistakes That Erode Patient Confidence

Just as certain actions build trust, others can rapidly diminish it. Here are common "trust dissolvers" to avoid:

Rushing Treatment Decisions

Patients feel pressured when asked to make significant financial decisions quickly. Give patients time to consider options, ask questions, and consult with family members when appropriate. The complexity and the investment involved in the proposed treatment, should be proportionate to the depth of relationship developed to date. 

If we as practitioners allow other considerations (e.g. production targets) to dictate treatment presented, it will likely be very evident to our customer patients.  Furthermore, it will certainly be evident to our staff. And our staff, (like it or not) consciously or unconsciously transmit either trust or wariness to patients. 

This is where having a mission and purpose beyond just being in the business of dentistry is so important. We need to engage and win over the staff team into what we are doing, and who we are doing it for. If staff sense the treatment presented is more about this month’s production target, than about the right treatment presented at the appropriate time, we will come unstuck. 

This is especially so if this perceived desperation comes as a result of clinician’s lack of understanding of effective marketing strategies to attract the right (read ideal) customer profile patients, or poor communication competence on their part. 

Inconsistency in Communication

When different team members provide conflicting information about treatments, costs, or procedures, patients lose confidence in the entire practice. Ensure your team communicates consistently through regular training and clear protocols.

Again, this is a case of developing a sense of mission and purpose that your staff can get excited about, so that they are willing to discuss and reinforce treatment suggestions. Many clinicians are unaware that their staff (the DSA particularly) often have higher credibility when asked questions about the necessity and timing treatment when the dentist is out of earshot. The auxiliary staff are perceived to have less (or no) skin in the game with regard to large treatment plan investments, compared to the treating dentist.

Displaying Defensiveness

When patients question treatment recommendations or express dissatisfaction, responding defensively immediately erodes trust. Instead, try to listen openly, acknowledge concerns, and respond thoughtfully—even when criticism, or perceived criticism feels unwarranted.

This is challenging. Most of us are very comfortable being the ‘expert in the room’ when it comes to treatment planning. This is where the language used to describe the person you are talking with, (the customer-patient) is so critical.

In private practice, the customer is customer first, and patient second. Academics on taxpayer-funded salaries will often object to this, and respond with an ivory tower aphorism about everyone in the world being entitled to theoretically perfect dentistry, often for free. Those of us in competitive private businesses all wish we had their luxury.

Focusing on Production Over Patient Needs

Patients can sense when recommendations are driven more by practice production goals than their individual needs. Ensure every treatment recommendation is genuinely in the patient's best interest.

As mentioned above, staff also sense this. Dentists need to consider their clinical staff an essential part of their marketing team. If the staff around you transmit a vibe to the customers that they aren’t fully aligned with what the clinicians are proposing, you will never reach excellent levels of treatment plan conversion—the deck is stacked against you.  

The solution to the latter, is back to working out your mission and purpose, and trying to get your staff engaged with it. What is it (you are offering - and not) and Who is it for – and by inference, who is it not for.

The Financial Impact of High-Trust Practices

Building a high-trust practice isn't just good ethics—it's good business. Practitioners who focus on building trust (either consciously or subconsciously) often see:

• Higher treatment plan acceptance rates 

• Higher patient retention rates

• More of the new patients are coming from direct referrals

• Higher case values as patients accept more comprehensive treatment

• Less dependence on insurance plans and fee discounting

Over time, these advantages compound significantly. A practice with high trust levels can often outperform competitors with technically superior clinicians but lower patient trust.

Building Trust in Your Practice: Next Steps

Cultivating trust requires intentional effort from every team member. Here are three actions you can take this week to begin strengthening trust in your practice:

1. Conduct a trust audit: Anonymously survey staff about their trust level in your practice and areas for improvement with a ‘mystery shopper’. Ask some friends or relatives to visit the practice for a new patient exam, and get them to quiz the staff (when you are not in the room), about the necessity of proposed treatment and what the staff member would do if in a similar situation. It will quickly become clear if staff are on the same page as you or not with what is proposed. This works better if the treatment plan has a substantial cost attached to it, so the set-up with the mystery shopper is ideally a dental situation that would not unreasonably involve considerable comprehensive dentistry in the medium term.

2. Review the practice mission and purpose: Becoming crystal clear about ‘What’ it is you offer, and for ‘Who’, is foundational. Only then can you assess which staff seem to resonate and buy into the mission, and which team members probably don’t buy into the vision of what you want to provide. Address this as soon as you can. Just as it is possible through poor marketing to attract the ‘wrong patients, you can also attract the ‘wrong’ staff members. This is a disruptive mistake to rectify, but is a worthwhile correction. Grasp the nettle.

3. Review your treatment presentation process: Ensure the treatment planning and discussion/presentation process allows adequate time for patient questions and reflection before decisions are requested. For more complex and intermediate stage treatment, it can be helpful to separate examination and treatment presentation appointments. For the latter, it is important to be transparent and clear why these are being separated into separate appointments. This requires high trust to see patients return for the in-depth discussion. 

Trust is neither accidental nor automatic—it results from consistent, intentional behaviors that demonstrate your commitment to patients' best interests comes first. By focusing on trust as a core practice value, you can create an environment where patients feel confident, respected, and valued.

This foundation of trust not only transforms the patient experience but also drives the key operational metrics (referral rate, customer acquisition cost, customer lifetime value, treatment plan conversion rate) which ultimately produce the financial outcomes of your practice.

Dr. Phil Smith is a dental practice management consultant with experience as both a practicing dentist and marketing professional. His book "From Stress to Smile: 15 Levers for Practice Growth" provides dental professionals with practical strategies for practice success.

Bibliography

Adekunle, T. E. (2023). A qualitative analysis of trust and distrust within patient-clinician interactions. Patient Education and Counseling Innovation, 1-4. Retrieved from https://www.sciencedirect.com/science/article/pii/S2772628223000675?via%3Dihub

Moore, R. (2022). Trusting the Dentist—Expecting a Leap of Faith vs. a Well-Defined Strategy for Anxious Patients. J Dentistry, 1-15.

Muirhead. (2013). Do health provider–patient relationships matter? Exploring dentist-patient relationships and oral health-related quality of life in older people. Age and Ageing, 399-405.

Thom, D. (2001, Apr;50). Physician behaviors that predict patient trust. J Fam Pract((4):), 323-8.

Yuan, e. a. (2023). A scoping review to explore patient trust in dentistry: the definition, assessment and dental professionals' perception. British Dental Journal, 106.

5 Steps to Boost Your Practice’s Bottom Line: Part 1 - Understanding Key Metrics

In the ever-changing landscape of dental practice management, one thing remains constant: a financially healthy practice provides the foundation for everything else. Whether you're fresh out of dental school or managing an established practice, understanding the key financial metrics that drive your business is essential for long-term success.

This article begins a five-part series exploring crucial steps to improve your dental practice's financial health. Today, we'll focus on the cornerstone of practice management: understanding and tracking four key financial metrics that reveal the true health of your practice.

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EBITDA: The Big Picture of Your Practice's Health

EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) might sound like accountant jargon, but it's actually one of the clearest indicators of your practice's operational performance.

Think of EBITDA as your practice's vital signs – it tells you how healthy your core operations are by showing what you earn from day-to-day activities before accounting for financing decisions, tax environments, and non-cash expenses.

Calculating EBITDA is straightforward:

1. Start with your practice's net income

2. Add back interest expenses

3. Add back taxes paid

4. Add back depreciation and amortization expenses

For dental practices, a healthy EBITDA typically ranges from 15% to 20% of revenue. If you're below 10%, there's significant room for improvement. If you're above 25%, you're performing exceptionally well compared to industry standards.

To improve your EBITDA, focus on increasing production while controlling overhead costs. Even small changes, like reducing supply costs by 2% or increasing production by 5%, can significantly impact your EBITDA over time.

ARPU: Knowing Your Patient's Worth

ARPU (Average Revenue Per User/Patient) tells you, on average, how much revenue each active patient generates for your practice annually. This metric helps you understand the efficiency of your patient relationships and service mix.

The calculation is simple:

ARPU = Total Annual Revenue ÷ Number of Active Patients

For general dental practices, ARPU typically ranges from $500 to $1,200 annually, though this varies widely based on your practice's service mix, location, and patient demographics.

A low ARPU might indicate opportunities to:

• Enhance your treatment presentation skills

• Expand your service offerings

• Improve recall effectiveness

• Refine your fee structure

Remember that increasing ARPU should come from providing proper, needed care – not from overtreatment. The goal is to ensure patients are receiving comprehensive care that addresses their needs while supporting your practice's financial health.

LTV: The Long-Term Value of Your Patients

LTV (Lifetime Value) estimates the total revenue a patient will generate during their entire relationship with your practice. This metric helps you make informed decisions about marketing investments and patient acquisition costs.

Calculate LTV using this formula:

LTV = ARPU × Average Patient Longevity (in years)

Industry data suggests the average patient stays with a dental practice for approximately 8-10 years, making the typical patient worth $8,000-$15,000 over their lifetime relationship with your practice.

Understanding LTV changes how you view patient relationships. When you recognise that a new patient represents potentially $10,000+ in lifetime revenue, investing in excellent service, a comfortable environment, and effective communication becomes an obvious business decision, not just good patient care.

CAC: The Cost of Growing Your Practice

CAC (Customer Acquisition Cost) measures how much you spend, on average, to acquire one new patient. This includes all marketing and advertising expenses divided by the number of new patients who joined your practice in the same period.

CAC = Total Marketing Expenses ÷ Number of New Patients Acquired

Many practices significantly underestimate their CAC, often thinking it's around $25-$50 per patient when it's actually $150-$300 or higher, especially for practices in competitive markets using digital marketing channels.

The relationship between LTV and CAC is critical:

• Ideally, your LTV should be at least 3x your CAC for a healthy marketing ROI

• If CAC is too high relative to LTV, your marketing strategy needs adjustment

• If CAC is very low relative to LTV, you might actually be under-investing in growth

Bringing It All Together

These four metrics—EBITDA, ARPU, LTV, and CAC—provide a comprehensive picture of your practice's financial health. By tracking them regularly (at least quarterly), you'll gain insights that typical profit and loss statements simply don't provide.

Consider creating a simple dashboard in your practice management software or even a basic spreadsheet to monitor these metrics over time. Looking for trends and patterns will help you identify opportunities for improvement and measure the impact of changes you implement.

In next week's article, we'll explore the second step to boosting your practice's bottom line: optimizing your patient mix. We'll discuss how to define your ideal patient profile, strategies for attracting ideal patients, and the ethical ways to transition your practice toward a more profitable patient base.

Until then, take some time to calculate your current EBITDA, ARPU, LTV, and CAC. Understanding where you stand today is the first step toward creating a more profitable tomorrow.

Dr. Phil Smith is a dental practice management consultant with experience as both a practicing dentist and marketing professional. His book "From Stress to Smile: 15 Levers for Practice Growth" provides dental professionals with practical strategies for practice success.

SmileWerk Blog: The Science of Smiles & Art of Connection

This is the SmileWerk blog page.

It will be largely about dental marketing and innovation in dentistry.

I will try to regularly produce content on how to grow your practice in a stress-free manner without the hard sell, but via judicious application of dental marketing insights and strategic business choices.

I’ll also occasionally review new clinical research as it is published if I think it is meaningful for the intersection of clinical research and practice economics.

Additionally, I’ll be looking at some new technologies if there are products and services that come to market that are more than just updates and minor modifications of existing technology approaches.

My goal, is to help you have fun and grow a more profitable, successful and low-stress business.