Acute Versus Chronic Dental Pain During COVID-19

August 31, 2020 Lee Ann Brady DMD

During this time, while we are working through COVID-19 in our dental practices, some of you are helping patients in need of emergency dental care. One of the “urgent care” challenges we all cope with during normal practice applies during Coronavirus…and maybe in a new way. This challenge is helping patients understand the dental pain they are experiencing and what we can do to address it.

Acute Pain

In dentistry, we are accustomed to dealing with patients who have pain. The majority of the time it is acute odontogenic pain. With acute pain, patients seek diagnosis and treatment promptly, reporting that the pain is intolerable and getting in the way of their normal function. When patients seek diagnosis and treatment promptly, standard treatment modalities more predictably eliminate the pain.

Chronic Pain

However, in the case of chronic pain, when patients are not experiencing an intolerable level of pain and have found ways to function around it, or when the pain is intermittent coming and going over a period of months and patients have not promptly sought help, we have a greater challenge. This is because, when pain occurs constantly or intermittently in the same location for more than 90 days, the neurological system tends to rewire itself. Now, when we treat the original source of the pain with standard modalities, we may not get a satisfactory pain elimination result. The pain has become the diagnosis itself. It has become a pain disorder.

Listening to what the patient tells us, helps us understand whether the pain is acute or chronic. In the case of chronic pain, patients have suffered with it for months and typically report attempting to figure out the source themselves and holding on to the ope that it would just go away. They may have been to more than one clinician seeking a diagnosis. Perhaps, they have had treatment and pain has persisted.

Communication is Key

We need to communicate to our patients that we want to diagnose and treat pain before it becomes chronic and that, once the pain has persisted for more than 90 days, it becomes a diagnostic and therapeutic challenge. As we enter the second phase of COVID-19, I have communicated with my own patients that I can see them for urgent care and to please call me if they are in acute pain. We can perform standard treatments for emergency dental needs at this time.

The message for chronic pain sufferers is more challenging. If their lives have become so disrupted that they cannot normally function, I want to help them and can do a teleconference consultation during which we talk about the history of the pain, I help them understand the nature of chronic pain, and we discuss how we can partner now remotely in finding a pain management strategy and later partner in my normal clinical setting.

The relationship we create with our patients, during this time, may be more binding than ever before. Treat these relationships like the most prized jewels.

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About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Visit Your Dental Lab

August 26, 2020 Kelley Brummett DMD
Recently I went and spent time at the lab of my dental lab technician. I had heard that this was a good thing to do, but the value I got was far more than I expected when I scheduled the visit.

One of my labs is out of state and one is close by. I don’t frequently visit my labs, even the one that is close by, as I find many reasons not to go. However, whenever I have visited the local lab, I experienced them differently than when speaking with them over the phone. Early this year I set aside some time to visit my local lab.

Chairside Challenges With Patients

We have challenges chairside with our patients… It could be the size of their tongue, how they open, the frequency of how little they open, and just like us, our labs run into problems. Oftentimes, they don’t have the whole picture. The patient isn’t sitting in front of them. They only have an impression, a scan, or a model. So, I went around to each person in the lab and asked them what they are looking for when working with a dentist, their concerns, and the roadblocks they come up against. How easy is it for them to pick up the phone and call us about some of the challenges they are experiencing while working with a case?

The visit accomplished a few things. One, we established a more open relationship. This means I’m going to call them as frequently as I need, and they are going to call me as frequently as they need. Two, we reviewed the case and they assisted me with my wax-up. We had an open and honest conversation in which they helped me understand how I can improve my work. We also got to know each other. This is important to me because I strive to have a relationship based practice. I want to be able to speak honestly with my patients and lab, to laugh, and to celebrate the things that are going well.

Conversations With Your Lab Technician

What you do chairside with your patient can be enhanced by conversations with your lab technician. I know that sounds obvious, but what I heard from my lab is that dentists are so busy, they don’t pick up the phone and reach out. And when the lab calls dentists about the challenges of a case, these busy clinicians frequently don’t want to be interrupted by the call. Typically, they don’t want to redo something.

The reality is that we are not perfect, and it is challenging for the lab to make decisions when they don’t have all the information. In my relationship-based practice, it is important for me to freely exchange feedback with my lab. We get feedback forms from labs so we can tell them how well they did. I want feedback from my lab, so I can learn how to improve what I do and understand the challenges they had. I’ve never had a lab willing to give me written feedback, but by developing relationships with the employees of my lab, I have learned some things that improved what I do. And it has made phone conversations with them easier to do.

Regular Laboratory Visits

When was the last time you stepped into the laboratory you use? Have you ever asked them how they can help you improve what you do? I urge you to visit your dental laboratory technician and open the conversation.

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About Author

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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Chew Test to Discover Functional Interference

August 24, 2020 Kelley Brummett DMD

I had a patient in a provisional on tooth #7, and he called to tell me he ate the crown. When he came in, I checked his occlusal marks in MIP, and there was a nice coupling with the opposing tooth. He was not hitting the tooth at all in protrusive, in right and left, and in crossover. He had not used floss and had not chewed on something sticky that would pull the provisional off. So, I put articulating paper between his teeth and used my iPhone to video him as he chewed like he was chewing food. What I discovered in the video is that he had a functional interference. He had broad strokes on the provisional whenever he was in his chew stroke.

I sent the video to the lab with the hope that the new information could be used to make a crown that would protect the tooth from breaking or becoming loose. This patient was adamant about not wanting orthodontics. I was able to show him why equilibrating his opposing tooth would be beneficial and he accepted equilibration.

Having run into this problem once, I am now checking for functional interferences with more patients by having them do “the chew test.”

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About Author

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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The Four Universal Promises of Leadership – Part 5

August 5, 2020 Edwin "Mac" McDonald DDS

In previous parts of this series, we looked at leadership, the commitment it requires, and the first three of four universal promises of leadership. The first promise was the promise to set a clear direction and create meaningful work for the organization you lead. The second was the promise to engage all stakeholders and hold them accountable for performance. The third was the promise to ensure your strategies, systems and processes facilitate focus and execution.

Now we will look at promise four.

The Fourth Universal Promise

You will lead effectively by maintaining relationships of trust to achieve and sustain results.

Why would someone want to follow you? The answer is trust. In order to keep the first three promises of leadership, you must value the priceless currency of relationships built upon trust.

Trust is one of the most difficult concepts for sociologists to describe and define. Two exceptional thought leaders on trust in our culture said this:

Steven M. R. Covey: “Trust lives at the intersection of character and competence.”

Rachel Botsman: “Trust is a confident relationship with the unknown.”

Becoming Trustworthy

Because trust builds confidence and frees up hearts and minds to commit, it forms the basis for a thriving practice culture and draws out the inherent potential of your team (their individual talents, energy and passion). Traditionally, I focused my energy on building trust.

Rachel Botsman proposed that in creating a culture built on trust, we would be served better by focusing on becoming more trustworthy. Rachel’s idea hit me hard. It was spot on. Trust demands the best that we have to offer. Perhaps, it demands all that we have to offer. It is the secret sauce of why people decide to surrender themselves to the great vision you offer.

If you take one thing away from this, take away a renewed devotion to becoming a more trustworthy person. You will likely find that your aspirational identity shows up with more clarity, courage, conviction and compassion.

And So, Back to Clarity

People follow leaders they trust by surrendering to a compelling vision that engages their hearts and minds. Others will trust your vision if you are clear, courageous, have conviction, and are compassionate. These are the building blocks of a shared (collective) style of operation and leadership in which each individual in the organization contributes, benefits and leads. This is relevant to your patients (clients) as well as the team you lead.

As I end this series, I leave you with my belief that developing and elevating your leadership competencies is the best investment you can make. Effective leaders who deliver on the four universal promises of leadership create strong cultures that outperform average cultures by multiples, not percentages, in every measurable dimension over time.

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Edwin "Mac" McDonald DDS

Dr. Edwin A. McDonald III received his Bachelor of Science degree in Chemistry and Economics from Midwestern State University. He earned his DDS degree from the University of Texas Dental Branch at Houston. Dr. McDonald has completed extensive training in dental implant dentistry through the University of Florida Center for Implant Dentistry. He has also completed extensive aesthetic dentistry training through various programs including the Seattle Institute, The Pankey Institute and Spear Education. Mac is a general dentist in Plano Texas. His practice is focused on esthetic and restorative dentistry. He is a visiting faculty member at the Pankey Institute. Mac also lectures at meetings around the country and has been very active with both the Dallas County Dental Association and the Texas Dental Association. Currently, he is a student in the Naveen Jindal School of Business at the University of Texas at Dallas pursuing a graduate certificate in Executive and Professional Coaching. With Dr. Joel Small, he is co-founder of Line of Sight Coaching, dedicated to helping healthcare professionals develop leadership and coaching skills that improve the effectiveness, morale and productivity of their teams.

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