By Paul A. Henny, DDS 

The word “prescriptive” recently got stuck in my head. It made me think about the important distinction between a relationship that’s primarily focused around “giving directions or injunctions” versus mutually goal-oriented and collaborative. It’s all too easy in the middle of a busy day to reduce our patients’ complex problems down to prescriptive responses so we can move on to the next problem or obligation on our schedule.  

The reality of dentistry was brilliantly stated long ago by Bob Barkley, “Our goal is to design dentistry that will fail at the slowest possible rate.” This humble statement should always sit at the center of our practice philosophy: We aren’t gods; hence we aren’t perfect, and we can’t control the future. The best we can do is learn, practice, and do our best with the best of intentions. The rest will be up to the patient and fate.  

If our patients choose to not assertively take charge of their oral microbiome through appropriate oral hygiene and diet management, then all of our skills and good intentions will be undercut, and the failures sometimes blame-shifted onto us. That thought brings me around to the central reason behind why I’m writing today: We can’t be successful unless we are also good teachers and leaders. We have to want our patients to be successful on a very deep level. 

Last year my daughter Allison graduated at the top of her high school class, and it was easy to think “Wow! Look at what she did!” Yet it wasn’t just her efforts that made it happen, so the thought should be “Wow! Look at what WE did!” as the effort was communal and very philosophically-driven. It’s clear that Allison’s Principal and teachers LOVED her enough to invest a significant part of themselves in her development. You could feel it, see it, and hear it in their words. 

Are we similarly invested in our patients success? Are we doing a whole lot more than just being prescriptive? Are we investing a significant part of ourselves in our patients’ lives because we want to see them succeed? Can they feel it, see it, and hear it?  

By Paul A. Henny, DDS 

Effective leadership in dentistry requires open-mindedness and empathy, while at the same time, assertiveness, consistency, adaptableness, and resilience.  

That’s a tall order! 

Many of us struggle to be assertive and empathetic at the same time, particularly when we are under pressure. All too often, we lean into our positional power and superior knowledge and don’t stop to ask ourselves: 

• How does the patient feel about my message? 

• Does the patient understand the long-term implications of the information I have presented? 

It’s important to remind ourselves that decision-making is a two-step process: 

Step 1: The recognition of accurate, relevant, timely, and important new information 

Step 2: Reasoning to make choices that align with values and goals 

Few people fully understand the nature of their problems, needs, and the complex processes necessary to realize their goals when they first come into our dental offices. Patients often behave dogmatically or too emotionally, which leads them to choices that result in more failure and frustration. 

Our ability to facilitate learning in others and lead them to decisions with predictably better outcomes can be developed. This is good news! With understanding, practice, and reinforcement through successful experiences, we can all learn how to become more effective leaders and develop a more successful practice. 

The 6 Key Steps to Effectively Guiding Our Patients 

1. Slow down and manage your time more strategically to spend more time with each patient.
2. Demonstrate empathy. Stay in conversation and ask questions to understand what they know and how they feel about the information you are giving them. 
3. Create a safe and effective environment for learning. This entails slowing down your delivery of information into the bite sizes that are appropriate for the patient and pausing often for their minds to catch up and for them to experience self-discoveries.  
4. Show deference for the fact that each person is the best expert regarding themselves, their feelings, values, and goals. Let them know you will support them in their process and invite them to learn more and weigh their new knowledge against their values, priorities, and long-term goals.
5. Give each person enough time to make complex decisions as well as work through the logistics necessary to make their decisions fit into their life.
6. 6. Remain clear and assertive about what is in the patient’s best health interests and consistent with your values. Only proceed with treatment decisions that are mutually agreed upon as appropriate.

By Mary Osborne, RDH 

Developing a partnership begins with an attitude of curiosity. It stems from a belief in the possibility that by working together we can achieve more than either of us can accomplish alone. With an attitude of curiosity we can develop the skill of listening and asking questions before going too quickly to teaching and telling. 

How do we help our patients see the part they can play in improving their health?  

We can begin by inviting the patient to share with us what they know about their health. They come to us with attitudes, beliefs, biases, and concerns about their health, as well as specific knowledge of their history. The more we know about where they have been the better able we will be to help them plan their future. We will have information to share about what we find and recommendations for how to proceed, but if we listen first we honor their perspective. We can also begin to hear their aspirations for their health in general and their dental health in particular. 

When dentists discover plaque or bleeding in an initial exam, they can tell the patient that the hygienist will help them with home care. But if we ask the patient if they would like help with home care and they say yes, we now have an invitation to give them information. The difference is subtle, but important.  

You can also ask the patient if a solution they have thought of or a recommendation you have made is something they would like to try. A yes is a commitment on some level to share in the oral hygiene process with you. Inviting and asking means moving the locus of control from you to the patient. I recognize that that is not our default mechanism, so doing this takes intention.  

How can we help patients to see us as a trusted advisor and seek our guidance? 

One of the things that I have learned over the years is that, when I remember who is really in control of the patients’ health, I am better able to partner with them. This process may take a little longer initially, but I would like to suggest we have all the time we need. We have the lifetime of our relationships with our patients.  

Once you agree that you have the mutual goal of moving toward improved health, you can invite them to deeper levels of conversation and understanding around health. You can avoid assuming what is best for them and help the physician inside each patient go to work. As they share their thoughts, they often become clearer about what they hope for.  

When you are genuinely interested in your patient, you earn a level of trust that opens the patient to hear more about their existing conditions and your concerns for them. By making connections with them over what is possible to achieve and what they want to achieve, you create a bond that opens the patient to your expert perspectives. When you ask for and respect their input on solutions, they are more likely to commit to a solution. 

When a new patient needs urgent treatment, how can we meet those treatment needs and still commence a lifetime journey toward health with the patient? 

Of course, we want to help our patients with immediate treatment when disease conditions are acute, but we want to do so in a way that inspires the patient to see the bigger, more comprehensive health picture. We want to help them see health as a journey and see us as empathetic fellow travelers who understand their suffering. As we facilitate dialogue about the health outcomes of treatment, we uncover their broader health aspirations. 

We intentionally deliver the message that we are here for them. We are interested in them and care about them as a person, and we let them know they can count on us to help them become healthier and maintain achieved levels of health. We do not allow the fact that the patient needed immediate relief to get in the way of a long-term commitment to their overall health.  

How do we engage our patients in being curious about their total health? 

At every visit, we can invite them into conversation about their health. The questions you ask will shape the conversation. Instead of “Any changes in your health history?” you might begin with, “How has your health been since the last time we were together?” Pause and listen to learn about your patient’s experiences, opinions, and feelings.  

In my experience, this process respects the physician that lives within each patient and leads to continuous co-discovery and collaboration toward health. Every conversation can empower the patient a little bit more to become clearer about their knowledge, attitudes, beliefs, biases, and barriers. The insights developed over the lifetime of your relationship enable you to become a trusted advisor to your patients.  

By exposing your interest about a range of health issues (diabetes, heart disease, obstructive sleep apnea, weight loss, smoking cessation, stress reduction, etc.), they will see you as a professional with broad knowledge and a worthwhile perspective. They will see you as a valuable resource. They will see you as someone who knows about health and ¾ more important ¾ someone who knows them.  

By Paul A. Henny, DDS, and Deborah E. Bush, MA 

The traditional rational economic model used in classical decision-making theory routinely fails to predict patient behavior because it fails to consider the psychology of decision-making and the inductive neuro process necessary to change one’s mind about what is best for oneself. 

Classic Decision Theory 

Classic Decision Theory (CDT) models a decision-making process that involves a fixed set of alternatives about which a person knows little. In response, they relate their limited knowledge to the situation at hand, use their beliefs and expectations associated with the options to project an outcome, and then use logic to make the final decision based on their goals. 

According to this theory, people primarily make decisions based on their desire to maximize gains and minimize losses, an objective. This deductive process is largely driven by a heuristic known as “scarcity bias.” However, anyone who has practiced dentistry for more than a day outside of a teaching institution knows that CDT fails to explain many of the decisions patients make when they’re confronted with a complex problem they don’t fully understand.  

Simple decisions such as “Should I get this filling replaced because it’s broken?” or “Should I allow Dr. Smith to help me make this tooth stop hurting?” are predictable. What’s much less predictable is whether a person will allow us to equilibrate their occlusion or leverage restorative dentistry to reestablish proper form, function, esthetics, and neuromuscular modulation. Why? Because these are complex issues that require an understanding of how the stomatognathic system works before the proposed solution makes sense and appears to be the logical best option to the patient. 

Neuroeconomics is an interdisciplinary field that aims to explain human decision-making. By integrating psychology and neuroscience, this discipline can help us better understand how humans process alternatives to make choices and follow through on a plan of action. Neuroscience affirms that re-evaluating perspectives is a right-brain activity and an inductive process. 

The Dentist’s Challenge  

In practice, we often see patients making decisions we think are unwise for their long-term oral health. A person’s values and belief system influence their decisions. Not only may the person’s understanding and belief system be underdeveloped in relation to the value of properly planned, designed, and executed health-centered restorative dentistry, but their memories may be distorted. In this case, the person makes what we perceive to be unwise decisions because their memories do not align well with our understanding of the situation. They don’t know what we know.  

Helping Patients Think and Feel Differently Through Inductive Reasoning 

Reassessment, modification, or outright replacement of beliefs is a right-brain process known as inductive reasoning. The purpose of Co-Discovery is to take the patient through an inductive reasoning process. Oral health providers who understand how and why Co-Discovery works have experienced how it can change the trajectory of a person’s decision-making process. 

Our challenge is to create an optimal learning environment in which people can safely reevaluate their beliefs, values, and priorities. Being patient with patients and taking our time to guide them through the inductive process of Co-Discovery will comfortably provoke new thinking, new beliefs, and new emotions. Through the process, a great many patients come to realize that their historical perspective is not serving them well, and they decide to have that equilibration or restorative dentistry that will serve them best in the long-term.  

They may not choose treatment the first time it is recommended but will subsequently realize it is in their best interest. We just have to stay in conversation with them in Co-Discovery mode and guide them through the inductive process to arrive at their new goals.  

Long-term, this is healthier for dentists and their care teams as well. The conversations we have with patients change the trajectory of our dental practices. Better conversations result in better decisions, which in turn result in better outcomes. Better outcomes result in lower stress and a thriving practice that is much more fulfilling for dentists and care team members.   

By Mary Osborne, RDH 

Dr. Rachel Naomi Remin says, “Doctor, you may know what’s best for the disease the patient has but that’s not the same as knowing what’s best for the patient.”  

It’s difficult to let go of our own assumptions about what we’re supposed to do, how healthy this person should be based on our criteria, and what is the best path forward in every situation. Our clinical training leads us to believe that we’re supposed to know what’s best for our patient. 

There is another quote, from Dr. Albert Schweitzer, which has challenged my thinking about patient care for a long time:  

“Patients carry their own doctor inside.”  

I believe that every one of us has opinions, ideas, and knowledge about our own health. That is the doctor inside. Dr. Schweitzer said patients come to us knowing we have expertise, but “we are at our best when we give the physician who resides within each patient a chance to go to work.” When we do that, we help people become healthier. 

There is a place for our solutions. There is a place for our expertise to show up. But if we slow ourselves down a half step, we are often amazed at the answers patients come up with. They can be downright creative and elegant. The reason they are elegant is because they are their solutions, and patients are more likely to follow through with solutions they conceive. I’m not saying we shouldn’t guide them to understanding the advantages and disadvantages of their solutions and other possibilities that you we know are out there, but we should be open to allowing them to think about solutions and not prejudge their choices. 

For example, if a patient says she or he doesn’t have time to floss, I was trained to say, “Well, don’t you watch the evening news? You can do it while you’re watching the news. Right?” That’s about me having the solution. But now I sit back and say to the patient, “Well, it sounds like you’re very busy. Is there any time at all during the day when you’re sitting, and you feel that you could floss easily?” When I ask the question, they usually have a better answer than the nightly news. It’s a better solution because it’s their solution. They have bought into it at some level.  

In many cases, we see the “treatment” for a problem as we’re seeing the problem. That’s something that we take a great deal of pride in. But when we come together with our patient, sitting eye to eye, we can often come to a much more elegant treatment plan, one that moves us more comprehensively toward our goal of improved health. In between what is and what is possible, we encourage the patient to discover the level of health to which they aspire. We come to mutual agreement about going forward in a certain way to accomplish some things that are bigger and better than just solving “a problem.” 

By Paul A. Henny, DDS 

In Part 1, we looked at personal boundaries in dental practice. I mentioned scarcity bias and how it is prevalent in undifferentiated dental practices but not so much in dental practices where providers and patients mutually share the values and agenda of the practice. Because scarcity bias is so human, so ingrained in us, I want to discuss two things in Part 2: healthy relationships and also how to address scarcity bias as it occurs in our differentiated dental practices. 

Insight Into Our Boundaries Leads to Healthy Relationships 

Healthy interdependent relationships are only possible through first understanding our personal boundaries (Who am I? What am I responsible for? What am I not responsible for?). That’s critical because psychologically speaking, boundaries are like fence lines with consciously regulated gates.  

The aphorism “Good fences make for good neighbors” prevails.  The same logic applies to the practice of dentistry and the nature of the relationships that we create—consciously or not, within it.  

And Now, We Circle Back to Differentiation  

Healthy interpersonal boundaries lead us toward more interpersonal authenticity, which leads us toward higher-quality communication of our values and purpose. Higher quality communication leads to a more sophisticated level of collaboration and healthy results, including healthy interdependent relationships, self-reflection, self-responsibility, improved oral and total body health, improved mental health, and a constantly growing reputation for your values. That’s differentiation. That’s personal authenticity. That’s success. 

Addressing Scarcity Bias 

Once we understand ourselves well and we communicate consistently with personal authenticity, we still have the challenge of “knee-jerk” scarcity bias in our patients. This is where patience comes in and empathy—understanding and recognizing their feelings. 

People are biased toward the here and now. The mind is naturally focused on meeting immediate needs at the expense of future ones. We procrastinate important things such as dental treatment unless we have an urgent need for it. We fail to make investments, even when the future benefits are significant or the costs of not doing so are substantial. 

When the dentist and patient participate equally in a co-discovery examination process and co-discovery consultations to discuss health history and current findings, and the patient is empowered and becomes comfortable mentioning everything on their mind, we have already begun the powerful process of leading each other through understanding what is happening in the body and what is happening in the mind (feelings and thoughts). We can start to talk about what the patient would like to achieve long term—the patient’s beyond-the-moment oral health goals. We can start to talk about what is possible to achieve together and introduce the notion that we can take steps at the speed that is mutually comfortable for us. 

Inspiration to do “the work” is often planted with just a few words that create a future desirable image in the patient’s mind. If we have the patience to let the inspiration grow, without overwhelming the patient, scarcity bias can dissipate. Often patients come back to the conversation the next time they visit us and say, “I was thinking about what we talked about, and I think I am ready to…”  

Negotiating health goals between two adults starts as an invitation to agree upon common goals. We can start early in the doctor-patient and hygienist-patient relationships by instilling the thought that preventive health care is a partnership. They can’t do it alone and you can’t do it for them. Everyone must play their part responsibly. 

Explaining Dentistry in a Way Patients Understand 

Clayton Davis, DMD 

Here are some of the ways I communicate with patients to help them understand dentistry. I hope some of these will be helpful to you in enabling your patients to make good decisions about their treatment.  

Occlusal Disease: In helping patients understand occlusal disease and the destruction it can cause, I have long said to them, “The human masticatory system is designed to chew things up. When it is out of alignment, it will chew itself up.” I tell them, “Your teeth are aging at an accelerated rate. We need to see if we can find a way to slow down the aging process of your teeth.” The idea of slowing down aging is very attractive to patients, and if you relate it to their teeth, they get it.  

Occlusal Equilibration: Typically, I come at this from the standpoint of helping them understand that teeth are sensors for the muscles, and when the brain becomes aware our back teeth are rubbing against each other, it sends the same response to the muscles as when there’s food between our teeth. In other words, the brain tells the muscles it’s time to chew, and this accelerates wear rates on the teeth. Equilibration is really a conservative treatment to reduce force and destruction of the teeth.  

Diseases of the Jaw Joints: Regarding jaw joints and adaptive changes and breakdown, patients understand that joints have cartilage associated with them. Saying there has been cartilage damage in your jaw joint gets the message across simply. 

Treatment Presentation: When patients say, “I know you want to do a crown on that tooth,” I jokingly say, “Oh, don’t do it for me. Do it for yourself.” I never say, “You need to get this work done.” Instead, I say, “I think you are going to want to have this work done.” 

Conservative Treatment: I have always enjoyed John Kois’s saying that no dentistry is better than no dentistry, so when talking about conservative dentistry, I’ll tell patients, “No dentistry is better than no dentistry. We certainly don’t intend to do any dentistry that doesn’t need to be done.” Another way I speak about conservative dentistry is to say, “Conservative dentistry is dentistry that minimizes treatment. In the case of a cracked tooth, a crown is actually more conservative than a filling because it minimizes risk.” 

Moving Forward with Treatment: I love Mary Osborne’s leading question for patients after they’ve been shown their issues and treatment possibilities have been discussed. The question is “Where would you like to go from here?” With amazing regularity, the patients choose a really good starting point for their next steps toward improved health, steps that feel right to them. Always remember, people tend to support that which they help create. 

Dental Insurance: I typically speak of dental insurance as a coupon that can be applied to their dental bills. I’ll say, “Every plan sets limits on how much it pays. The way dental insurance works, it’s as if your employer has provided a coupon to go toward your dental bills.” 

Presenting Optimal Care: If I want to present optimal care to a patient who is ready to hear it, I ask permission by saying, “Mrs. Jones, if I were the patient and a doctor did not tell me what optimal treatment would be for my problems because the doctor was concerned that I couldn’t afford it or that I would not want it, I would think, ‘How dare you make that judgment for me. You tell me what optimal care would be, and I’ll decide for myself if I want it.’ So, with that in mind, Mrs. Jones, would it be okay with you if I presented you with the optimal solutions for your problems?” 

Give patients opportunities to discover what lies beneath their smile

Ewelina is part of my office team. She’s from Poland. She’s beautiful but early in our doctor-patient relationship, I realized she had a closed-smile grin. One day, I asked her if she was aware that she was guarding her smile. She wasn’t but the question made her curious. Later, she came by and said, “I realize it now.”

So, I raised another question, “Now that you notice this, what do you think about your teeth? Were you guarding them subconsciously?”

She thought momentarily and said, “I wasn’t happy with their appearance. I think I unconsciously I do guard my smile.”

So, I raised one more question, “At what point in your life did you say to yourself, I wish my teeth were more attractive?”

Her answer surprised me: “I thought about it when I got married and bleached them, and after I had kids, I thought my teeth looked more unattractive than they did years ago.”

I spoke to Laura Harkin, a dentist I admire, about this. She said that it’s common for women to become more critical of their appearance after having children. Their bodies have gone through so many changes. Ewelina seemed to guard her smile long before she had children so I wondered if there may be cultural differences between her old and new adopted home. I asked her if she became more self-conscious about her teeth after coming to the United States. She answered in the affirmative, “People’s teeth generally look better here than in Poland.”

I loved that there was a long thoughtful pause before her answer. I intentionally gave her time to think between questions. I offered to give her a smile makeover, which she readily agreed to. In doing my case workup, we found she had a two-step occlusion that needed to be corrected. When I got to my wax-up, the anterior changes were minimal and I did an equilibration on the wax-up to try out the results. This set the stage for the changes we would try out in provisional.

Provisional restorations are something I always do to test if the speech will be affected, whether the new occlusion is comfortable, and if the patient feels “good” psychologically about all the changes — not just the aesthetics.

While wearing the provisionals, she began to smile with a Duchenne smile. In photos, I could see a postural difference, too.

My ceramist did an amazing job duplicating in ceramic the provisionals that I created. When the case was completed, I asked Ewelina how she felt. She said, “Great, happy, healthier, cleaner, brighter, very happy.” Cleaner, brighter, healthier, happy – that was a huge learning moment for me! Not once did she mention her teeth, just the feelings around her treatment outcome. It began to dawn on me how much we not only change teeth, but we can change lives!

“I’m happy,” she said. “I think I smile more and I feel like they’re my natural teeth. It’s hard to explain, but I feel like these are the teeth I’ve had all along.”

“How does your bite feel?” I asked. “Were you surprised how the small adjustments made big differences?”

“Before, I felt a little muscle soreness and dull pain back here, but after a day or two of the adjustment, I felt nothing. I feel great,” she said with a big, broad smile.

I think if we spend a lot of time with our patients and develop relationships, it’s ideally like psychological therapy. We give patients opportunities to discover what lies beneath their smile, show them a vision of what could be, and lastly, help them to reach their full potential, as described in Part 1, with a beautiful, confident Duchenne smile.

We have a unique opportunity to not only restore teeth but also change lives through our efforts.

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.