In recent years, dentists, physicians, and the public have become highly aware of the interrelationships among occlusion, oral inflammation, airway problems, and systemic health. As dentists, we’ve stretched our care domain to coordinate patient care across all settings of care. Often, we are dismayed at the growing prevalence of chronic diseases among our aging patients. We want to help improve their lives. We know of ways to do this.

To do our best for our patients, it does matter if the patient has diabetes, cardiovascular disease, sleep apnea, gastric reflux, or poor nutrition. It does matter if we want to be master problem solvers in collaboration with our medical colleagues. Looking for oral and systemic health interrelationships every day with every patient is a basic element of many dental practices. Collaboration with physicians is a basic element of my practice.

Has your approach to patient care extended into at least the first phase of integrative dental medicine? This is the phase of sincerely asking the Why questions and searching for solutions. While I was in practice with Dr. Pete Dawson, for 40 years, I heard him say, “We’re going to ask why about problems until we don’t have to ask why anymore.” He called this “finding a better way.”

The 3 Pillars of Integrative Dental Medicine

In 2019, Dr. Shanley Lestini and I published a book titled The Shift: The Dramatic Movement Toward Health Centered Dentistry. In this endeavor, we were fortunate to have the support and input of two of the world’s most preeminent clinicians and educators, Dr. Peter E. Dawson and Dr. Bradly Bale. It was our goal to influence dentists and medical physicians toward fostering solutions together for their mutual patients in three pillar areas of integrative dental medicine:

1. TMD and Occlusion
2. Inflammation & Infection
3. Breathing and Sleep Disorders

Finding a Better Way Is Up to All of Us

My goal in this essay is to fuel your passion for operationalizing what we all know will make us better doctors – that which will enable us to be truly health-centered dentists. It comes down to relentless curiosity about the causes of diseases, the modalities for eliminating those causes, and how our best “individualized” efforts with a patient will have the greatest positive impact on the prevention, elimination, and management of health conditions that adversely affect their quality of life.

“We’re going to ask why about problems until we don’t have to ask why anymore.” – Peter E. Dawson, DDS

In this era of heightened awareness surrounding the intricate connections between oral health, overall wellness, and the growing prevalence of chronic diseases, we, as healthcare providers, find ourselves at a crossroads. It is our commitment to improve the lives of our patients that propels us forward. Embracing the principles of Integrative Dental Medicine (IDM) beckons us to explore the “Why” questions and seek innovative solutions. Don’t miss your chance to embark on a journey that redefines the boundaries of healthcare with the upcoming course “Integrative Dental Medicine: Creating Healthier Patients & Practices” – for more information visit the course page.

An essential technique in effective listening with new patients involves an interviewing discipline known as “bracketing.”

Psychiatrist and author M. Scott Peck described bracketing as “the temporary giving up or setting aside of one’s own prejudices, frames of reference, and desires so as to experience—as far as possible, the speaker’s world from the inside, stepping inside his or her shoes.”

True listening requires a setting aside of ourselves. It also requires acceptance of the person as they are in the moment.

In his book Ways of Being Unconditional, Carl Rogers defined “unconditional positive regard” as accepting and supporting another person exactly as they are, without evaluating or judging them. At the heart of this concept is the belief that every person has the personal resources within to help themselves. They simply need to be offered an environment of acceptance that can foster their own recognition of this.

The goal is to create a safe psychological space where the patient senses acceptance, and therefore feels less vulnerable and thus more inclined to open up to share their fears and concerns regarding dental issues. This is challenging, particularly in the middle of a busy schedule, as most of the time, we lack the capacity to truly listen while other responsibilities and distractions are present.

We need to set the environment with intention.

To do this well, uninterrupted times in the schedule must be established as well as a comfortable non-clinical location. The battle seems to always be between structuring our schedule for efficiency versus creating more open-ended opportunities for trust to develop and knowledge conveyed.

We need to truly listen.

Are you able to turn your focus to orchestrating an interview in which you actively listen? Yes, well, then good but how easy is it for you to maintain that focus?

Even though we may feel we are truly listening, what we are often doing is listening selectively, with a preset agenda in mind…thinking about what we want to happen next…procedurally or financially, wondering as we listen how we can achieve a certain desired result by redirecting the conversation in ways more satisfactory to us.

Even though we may feel we are truly listening, we often respond to what the patient is saying by assuming our interpretation of the question they ask or the concern they relate is actually what the patient is attempting to say. And this is why Mary Osborne’s Staying in the Question Part 3 blog is so on point that I recommend others read it. 

True listening, no matter how brief, requires effort and total concentration. This means we cannot truly listen to another person and do anything else at the same time. While in the middle of a busy day at the office, this is challenging—very challenging.

The first step is willingness.

Our willingness to truly listen is the most tangible form of esteem we can give to another person. And if we give a new acquaintance our esteem, they will feel less ashamed or embarrassed. Consequently, they will start to feel less threatened and more valuable. And it’s those who feel valuable to themselves, who are most likely to be interested in taking better care of themselves through fine dentistry.

Carl Rogers helped us see there is no better way for our patients to learn they are valuable (rather than deficient or flawed) than by our valuing them first through careful listening.

• When we offer no judgement, they feel less fearful, and they can share their thoughts and emotions more freely.
• As we accept them, they feel encouraged to find self-acceptance and think for themselves.
• As we invite them openly to share, instead of asking questions designed to illicit certain answers, we give them space to think for themselves, and with such space, they can begin to cultivate their inner resources and rise to our expectations for what is in their best health interest—on their own.

Tip 1: Develop the Habit of Clearing Your Mind as Your Move from Patient to Patient

One of the hardest challenges in dentistry is moving from room to room and being able to refocus and give each patient your full and undivided attention. Here’s a little trick I do to increase my presence as I move between rooms and patients.

As I move down the hall between operatories, I habitually self-talk. I silently say to myself, “The patient I just left will be fine with my dental assistant.” I intentionally turn off thoughts about the patient I left, and as I cross the threshold of the next operatory, I am interested in only that next patient. It is not easy, and the more intentional I am at bringing it into my consciousness, I believe the better my focus can become.

Interruptions of this type occur throughout the day as I need to stop what I am doing with one patient to check in on the patient in the Hygiene room. Fortunately, I have a long enough hall between my operatory and the Hygiene room to “practice” my little self-control meditation.

Tip 2: Identify an Analogy that Is Understandable for the Present Patient

I know I am not the only dentist who has patients who are not moving forward with the treatment I have recommended. Recently when interacting with a patient who was not moving forward with occlusal therapy I got to watch his understanding shift about the recommendation I had made. The difference was in explaining it in a language he understood. I credit Dr. Rich Green for mentoring me through this understanding. I related it to a real-life experience he already had.

The patient had been in my practice for a little while. We had identified that he had some occlusal disease. He had wear on teeth, some clinical attachment loss, abfractions, teeth that ran into each other, awareness that he brought his teeth together, and at times muscle tension.

One day I asked him, “Can you help me understand why you are not moving forward with occlusal therapy?”

He said, “You know, I just don’t know if it is going to benefit me.”

I happened to look down at his feet and notice he had good running shoes on. I said, “Those are fancy running shoes. They’re pretty cool. Do you wear them because you like how they look or because of another reason?”

He replied, “Actually I wear them because they are very supportive. I often have back muscle tension, and I need to wear really good shoes.”

I said, “You know, the dental orthotic that I’ve been calling an occlusal appliance is no different than wearing really good running shoes. Wearing a dental orthotic is like putting inserts in your shoes to create balance, decrease fatigue in the muscles, and provide me with the opportunity to learn what’s going on at the tooth level, the muscle level, and the joint level. Wearing the dental orthotic is likely to help you understand why you are experiencing discomfort at times, what those patterns are, and when they occur. And it just might be therapeutic in relieving muscle tension you have been experiencing and protect your teeth while we discover what is going on.”

He nodded and said, “Okay, I get it. I understand now. When can we start?”

Tip 3: Ask a Well-Crafted Question

Asking well-crafted questions allows us to better know the patient and get more complete information. Asking powerful questions also makes patients more aware that some of what they are experiencing is not healthy…is not normal.

For example, I often notice patients are not reporting pain as we do risk assessments on their muscles and joints. So, I ask the patient to rate the level of pain at which they take pain medication when they have a headache. “On a scale of 1 to 10, when would you pick up the bottle of Advil and take a pill to treat the pain?”

There are people who will take Advil when pain is at a 1 or 2 and others who will only take it when pain is at a 12. I’ve learned that there are people who have low pain tolerance who will call whenever they have pain in a tooth and other people who tolerate higher pain for months because they think it is normal.

By asking patients to rate their pain tolerance level, they become self-aware of symptoms they might be experiencing that align with the signs you observe and are discussing. They become more aware of what is normal and abnormal. If they have the tendency to not move forward with treatment until they are in acute pain, they become more aware that delaying treatment is not in their best interest. They realize the discomfort they have been experiencing is abnormal and they do not have to…should not tolerate it.

Occasionally we discover that we are not the right dental team for a particular patient or that the patient is not looking for what we offer. This doesn’t happen very often, but it can save a ton of time and help manage expectations if we find out before doing the comprehensive exam.

When new patients come into our practice, we always begin with a preclinical interview and then proceed to do a comprehensive exam. One new patient arrived and was seated in the consultation room. I came in and started the preclinical conversation. We started talking about her health history and dental history.

As we talked about her dental history, it becomes apparent that she had a history of “fixing things as they broke.” I explained that our exam process would allow us to find and treat issues early. I tried to help her understand that treating a cracked tooth as soon as the crack is observed could save the tooth and avoid the breakage she had experienced. I described to her what the exam would include, that I would describe and show her problems I saw, and that I would explain risk factors that could develop into future problems.

She said, “I don’t want you to do that. I just want you to make sure I don’t have any cavities and that’s it.”

I said, “Well, we can certainly do that. We can look for any teeth that have a cavity. Would you like me to tell you if I see anything else going on?”

“No,” she said, “I don’t want to know any more than that.”

We talked a little longer, and I tried to understand why she didn’t want to know. I said, “You know a tooth problem is a kind of like a tiny skin cancer they burn off instead of waiting until it grows and then you need a big Mohs procedure.”

She didn’t respond, so I said, “Let’s go to the dental chair, take a look, and see what we find, and we’ll take some x-rays.”

She said, “I don’t want x-rays.”

I explained that we couldn’t accurately diagnose cavities without x-rays. She then said, “I don’t think this is the right place for me.”

Fifteen minutes into our conversation, I heard myself say, “I think you may be right. We are here to help patients improve and maintain their oral health and to avoid having bigger problems.”

Before I could continue, she interrupted me, firmly saying, “No that’s not important to me.”

My response was, “Well then, it was nice to meet you,” and I stood up to walk her to the door.

I’ve known dentists who rush right into new patient exams without conversation in which they learn if the patient is motivated to improve and maintain their oral health. I told the team to not charge her for the appointment, and I told them, “That was the best preclinical interview we ever had because we stopped wasting her time and our time.”

Fortunately, most of the new patients who come to us have “Aha” moments during the preclinical interview and comprehensive exam. They immediately understand the value of what we are striving to do and are interested in the discoveries we make during the examination. They ask questions and want to know why conditions are the way they are. They want to know what can be done to lower risk factors. They may need nurturing over multiple appointments to accept treatment but we see them making progress with their emotions and decisions to move forward. The time we take with these patients is not wasted because it is quality time during which we build mutual trust.

All of you have heard me quote the famous proverb: “Guard your heart for it is the wellspring of life.” It is great wisdom. It is also very practical.

To remain healthy and safe, our “hearts” need to be protected. We need rest, downtime, and peace of mind. We need a life that gives energy as well as demands it. We need people around us to remind us of who we really are and what is important. We need to say yes to what is most essential and no to the things that aren’t essential.

In recent weeks I have heard a podcast interview of two people on the other side of burnout and a forced six-month sabbatical. I have had multiple conversations with dentists and dental teams that are overwhelmed and disillusioned. In addition, I have listened to a sad story of a friend who started behaving carelessly and out of character secondary to the fatigue and frustration of unrelenting pressure and career demands. He just wasn’t himself.

Many of you are running full speed, meeting the relentless demands of your practice as well as pursuing teaching and writing opportunities. The question I pose to each of you is “Which opportunities and demands are the most important—essential, to you and your unique life?”

We needlessly increase stress when we compare ourselves to others and think we should achieve what they are achieving. We create pressure on ourselves when we feel we should say yes to others’ requests for our energy and time. In contrast, we honor health when we pause to consider what is best for ourselves and recall our personal priorities.

Our purpose, capacity, energy, desires, loves, dislikes, and circumstances are unique to each of us and unlike those of anyone else.

I have listened to and read about people, who have been through periods when they struggled with their physical health, energy, and emotional state. To recover, they found that vacations were only a part of the solution. They had to find a community of peer support. They had to find ways to make each day healthier and more productive. They had to intentionally create “white space” in their life, place only the most important events on their schedule, and develop a respectful way to say “no” or “not now.”

Saying no is difficult for most of us but is required to live our one short life on purpose. In addition to living on purpose, there are other essentials for wellness. I’m thinking of:

• Resilience—Restoring physical, mental, and emotional strength often requires more rest, exercise, and recreative interaction outside of work with family and friends to reframe perspective.
• Meaningful work—Do what you love at least 50% of the time.
• Energy management—Pace yourself, take breaks, enjoy the “flow” that occurs when you are highly engaged in your work, and respectfully rely on your leadership team to help you maintain a schedule that prioritizes the most important activities.
• A peer-to-peer community of support—We have the human need to give and receive empathy, understanding, wise counsel, sparks of creativity, and encouragement.
• Dedicated time to recreate the self—Think in terms of daily, weekly, monthly, and seasonal-yearly rhythms. Create time to regularly relax, relate, and play outside of dental practice. Like a surfer running to the beach when the waves are perfect, allow yourself some flexibility to embrace spontaneous opportunities.
• Spiritual nourishment and expression—What nourishes the most foundational part of you? Seek the goodness that elevates your soul and feed on those nutrients. Celebrate that goodness with gratitude.

We talk a lot about balance at Pankey, and we do this because it is all too easy for healthcare providers to run out of steam…to run out of oxygen. Like the airline steward says, “Put on your emergency oxygen mask first before assisting others.”

Our positive thoughts, emotions, words, and actions—our joyful hearts, are what make it possible for us to be a wellspring of understanding, compassion, and love. We need to protect our hearts to enjoy our work and improve the wellness of everyone around us.

We had another interesting week at the dental office when a patient (I’ll call Ron) came in. Ron has been a patient of mine for over 20 years and is nearing 80. Whenever I saw him, we would have interesting conversations about what he was doing and thinking about doing next. He was the kind of person I love to be around, always positive with a “can-do” attitude.

This time was different. I hadn’t seen Ron in over three years, because he suffered a heart attack which led to some other complications. He came in using a cane.

When it was time for my hygiene check, Julie came to me and said, “I don’t know what’s going on with Ron, but he was really hard for me to work with today. I tried to get as much accomplished as I could. I’m sorry.”

Ron was previously very health-centered but now he was behaving like he wasn’t. Do values change in that short a period? No, but a person’s priorities might, particularly when they have developed a distorted perspective due to some traumatic events.

When I entered the room, Ron’s attitude perked up. He was positive and respectful — he was honoring our long history of mutual respect. He updated me on what happened and how he was doing. Not only were his physical disabilities frustrating, but he had rarely left the house for over a year.

Following my exam, we discussed an area of decay and several cracked teeth — all restorable with crowns. He responded that he was old and wasn’t sure how much longer he would be around. He asked, “Is there an inexpensive way to fix this? I don’t want to spend a lot of money on my mouth.”

Dentists hear this every day, but in this case, I knew the REAL Ron. I knew it was his depression speaking to me. I told him it would make sense for us to develop a Phase 1 plan, meaning, “Let’s remove the decay and get everything stabilized like they would do for you in the ER if you had an emergency, and then we can talk later about restoring things back to the way they need to be — strong and secure.”

“I don’t think I want any restoration work,” he replied.

Then, I said, “Ron, I know how much you love to eat fine food, and it would be tragic if, in your last decade, you were limited to eating only soft food or you had to fumble around with a partial denture that catches food around it all the time. Like I said, let’s focus on Phase 1 and then talk about restoration later. We have time on our side.”

“Ok,” he said, “I can go along with that.” He needed to feel like he was in control.

I finished by using words that would resonate with him, “You know Ron, despite these things that need to be addressed, you have great bone around your teeth and a great smile, so there are good reasons to restore things and finish out strongly. If you were an old, uninspiring ‘84 Oldsmobile, I’d say there is no point in restoring things, but you’re like a 1956 Corvette barn find that’s still in good condition. You’re worth it. Let’s save the conversation about restoration for another day when you are feeling better. I’m so glad that you came in, I miss talking to you.”

Ron’s eyes lit up. He smiled and said, “Yea, maybe you’re right. I can’t move like a Corvette any longer, but I understand what you are saying. I really appreciate it.”

One evening I was seated next to a new acquaintance at a dinner party. As we began the conversation, I learned Bob was a retired CFO of a manufacturing company with $250 million in sales. He had traveled extensively and had had many experiences in dental offices.

In our conversation, Bob discovered I was a dentist teaching at The Pankey Institute. I thought I would move the conversation off of dentistry and have the opportunity to climb into the mind of a CFO of a $250 million dollar company, so when he asked what I taught, I responded with “I teach Finance.” He looked surprised and a bit disinterested, but he said, “You know, the thing that impresses me most, about dentists, is how quickly they make decisions.”

Trying to find the compliment in the statement, he had just made and hoping he thought dentists to be of high intelligence, I queried, “Quick decisions?” He went on to tell me, and sometimes show me between bites of food, the crowns I had already noticed. He said, “It always impressed me, when I went into the dental office with a broken tooth, how the dentist would have a quick look around and then tell me I needed a crown. Sometimes he was ready to do it on the spot!”

Other things had come out in our conversation. He was an accomplished golfer with a six handicap. He had three homes, and each home had an identical set of golf clubs. All were recently updated, matched, swing-weighted custom sets. My mind was spinning as I thought about the gap between those matched sets of clubs and his unmatched set of teeth! How could I get his attention?

Doctor Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.” The light bulb came on, and I said, “Tell me about how you made decisions as a CFO in your business.”

“Well, I take a good look at the short and long term impact of the decisions, the cost of capital necessary – both short and long term, and the risk/reward potential to the bottom line of the company.”

Now I was in full swing, “Sounds like you study the problem and/or opportunity with reflection and quite a bit of detail. You slow down and take the necessary time to uncover the best decision.”

“Well, yes, of course, they would be important decisions, and they would take time!” Bob replied.

“Quite honestly, Bob, that is exactly what I and others are attempting to teach dentists at The Pankey Institute. We are asking dentists to intentionally slow down and become more reflective, affective, and effective with their patients.” I could see he was thinking about this.

“Bob, let’s compare you and your teeth to your sets of golf clubs.” He was intently listening. “It’s as if, when you were a young man, God gave you a set of new golf clubs. We, as dentists, call them teeth. You used them through the years as you refined your golf game and in time you broke the 9-iron. You went to the pro shop and tried to get a new one. It was a 9-iron, of course, but the grip, the shaft and the swing weight were not quite the same as your original set. It was okay, because you knew how to adjust if you remembered to accommodate for the differences.

“As time went on, you had the same experience with your 7-iron, the 4-iron, the pitching wedge, and your favorite wood. In time, you were adjusting your swing and muscles every time you swung a club. You noticed there were times when certain muscles would get sore and even the soreness would get in the way of your swing chewing. Finally, you decided to get refitted with a whole new set of clubs. You went to a professional who put you through a whole series of tests and thorough evaluations to diagnose and plan the best solution, which fit your uniqueness. And, you not only got one completely new set of golf clubs, you got three.

“Many dentists would see you as a very busy man who wants to get out of the dental office with dispatch. They respond in a crisis mode to your crisis events. But, like clubs, teeth need to be customized and “matched” to work together so you aren’t constantly accommodating as teeth break and are restored. What we are encouraging dentists to do is to slow down and be as thorough as you would be in your decision making in your business. It’s better for you—actually better for all concerned.”

Bob’s face lit up, “So that’s what you teach?” “That’s what I teach,” I responded

With that “aha” smile, Bob said, “Would you be so kind as to give me your business card with the name of a dentist who thinks like you do? In fact, I’d like three – one for each of the locations of my golf clubs!”

Doctor L.D. Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.”

Years ago, I had been asked by a young dentist to come to his office and help him with the implementation of his new learning with occlusion applied to bite splints and equilibration. I suggested he line up a few patients for us to work on together during my visit. When we arrived at his office early in the morning to talk about the patients we were going to see together over the next two days, I asked him to bring me up to speed on where he was in treatment with the patients and the conversations he had had with them. We also looked at full mouth models, models of bite splints, and radiographs. I asked him what he wanted me to do with the first patient who was coming in that morning.

He said, “I want to watch you sell him a bite splint!” A little surprised, I asked him to tell me about the patient. He said he was a new acquaintance. They played golf together and occasionally gambled as they played to keep their interest up in the game. They also gave each other a hard time about handicap ratings. He mentioned he felt a bit embarrassed because he thought he knew what was best for his new friend and had kind of hustled his friend on the golf course to be a patient. Now he was feeling a bit guilty about having his new friend come in as a patient, and he could not bring himself to a have conversation concerning the benefits of a bite splint.

Charlie (the friend) appeared, and the dentist introduced me. Charlie and I stood about the same height. We looked each other in the eye, and we smiled at each other – a good beginning. In my mind, I was repeating slowly to myself, “Find a relevant connection.”

I said, “Thanks for taking the time to come in and meet me on such a beautiful Spring day, as I pointed to a comfortable chair for him to sit in.”

He offered something about how golf could be a bit boring if you played it too much. Still looking for a relevant connection, since my “stated task” was to sell him a bite splint, I asked him about his work, and he said he was retired from directing filmed commercials. I asked him what he did with his new found time aside from golf. He smiled a big smile and said he ran about five to seven miles a day. I smiled as I remembered the years when I ran three to five miles a day during the week and seven to ten miles on weekends. A light bulb went on, in my head, and I knew a question I could ask to engage him and tweak his curiosity.

I asked, “How often do you buy new running shoes?” And without hesitation, he said, “Every four hundred miles.” I then asked, “How did you discover that interval?”

He reached down with his right hand and rubbed the lateral surface of his right leg from the mid-thigh, across the lateral surface of his knee, to the lateral surface of his calf, while telling me of the discomfort he would experience in his muscles when the bottoms of his running shoes became worn.

I made the statement, “You must run with the traffic!” Surprised, he asked, “How do you know that?”

I told him I experienced the same thing when I ran on a road with the traffic, especially when the road had a bit of a “crown” on its surface. I thought I had found a relevant connection, and I let it sink in a bit. Then, I told him his dentist friend wanted to offer him a new pair of shoes for the top of his teeth in the form of a removable bite splint. It would be like getting a new pair of running shoes. It would be professionally custom fitted to the tops of his teeth, which would please your chewing muscles and create greater comfort, just like a new pair of running shoes pleased his leg muscles and knee joint.

Charlie looked at his dentist friend and then at me before standing up. With a big smile he said, “I will make an appointment with the receptionist.” Hmmm… Isn’t that Interesting!

The art of helping our patients develop ownership of their present condition and their desires for their dental health is built on the foundation of listening. But much of the time, we do all the talking and provide all the information.

Several years ago, my friend and I were coaching a young hygienist when her patient asked how she could get her teenage son to spend more effort caring for his teeth. I was ready to dazzle them with all the tips I had learned over my 20+ years in Hygiene but my friend Linda cautioned us to “stay in the question.” She was curious to know what the mother in the chair was really asking. That was the first time I became aware of the concept of staying in the question.

The model I learned in my clinical training—the model of teach and tell, really isn’t enough to help patients make choices about their dental care. And over the years, I learned that when I assumed I knew what a patient meant by a question and gave information I thought they wanted… I was wrong. My assumptions got in the way of my ability to really help my patients.

Are our patients asking for help or for information?

When I learned to combine the ability to stay in the question with my knowledge about dental health and dental care, all my conversations became a bit easier. I have come to realize that that mother with a teenage son, like so many of our patients, was asking for HELP but not information.

Today I can think of several questions I might have asked that mom before I jumped in to giving her information. I might have asked, “Well, what have you tried so far?” Or I might have asked, “What motivates your son in other areas of his life?” I might have asked, “What is he doing to care for his teeth?” I might have asked all those questions but asking even one of those questions, might have enabled me to better help.

Sometimes asking just one question before offering information is enough to open the door to real learning.

Staying in the question is both a skill and an attitude.

We need to skillfully ask authentic questions that are not designed to manipulate people into doing what we want them to do. If the questions help us understand our patients better, they are authentic questions. If the questions help them talk through and move through any barriers they perceive, they are authentic questions. If the questions open their minds to possibilities, they are authentic questions.

But staying in the question is not just about asking questions. It’s about an attitude of curiosity, of coming to the conversation with a desire to know more. It’s about releasing the attitude that we know everything we need to know to help the patient move forward.

Staying the question requires a genuine belief that our patients have information that we need to help them better.

Both periodontal disease and TMD are inflammatory disorders.

We have lots of dental patients who are suffering from the effects of inflammation, and one of the things we can do is help them look at inflammation not from just a local perspective but also from a systemic perspective. Our goal is to help them reduce inflammation where it occurs in the mouth and, also, throughout their bodies in general.

In addition to the first line dental treatments, we can work with our patients at higher risk to manage their general inflammatory response by advocating and discussing dietary changes. I have had great success with some patients by giving them nutritional guidelines.

I know some of you are “rolling your eyes” when you read this because you have had little impact on dietary changes. But we can throw it out there, and some of our patients will latch on to that information and try hard between their dental appointments to make a visible difference when we next see them. These are patients who want to be proactive, and this is something over which they can take control, much like the percentage of patients who accept fluoride varnish and implement the Sonicare devices we recommend.

We don’t need to hold ourselves out there as nutrition experts. We can explain that periodontal disease and TMD are inflammatory processes and one of the things we are learning today is that the foods we eat can increase or decrease inflammation in general. We can suggest this is something they could become curious about, do some internet research, and use the anti-inflammatory foods information they find to affect positive changes in their total health and the oral health issues we are observing.

I tell patients there are great books on anti-inflammatory diet guides and anti-inflammatory cookbooks on Amazon. Dr. Joel Fuhrman and the Forks Over Knives publications are two I mention. If you delve into reading on this topic yourself, you will find you can easily converse about the impact this reading has had on your own diet and the health of other patients.

Be as general in the information you provide or as specific as you are comfortable, but by starting this conversation with patients, you are doing your best to help them.