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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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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How to Have Meaningful Discussions

February 3, 2019 Bill Gregg DDS

It’s critical to have discussions with team members about what behavioral influence entails.

Behavioral conversations are efforts with patients to encourage health. They involve discovering current perceptions and encouraging choices for improved health – especially dental health. Considering today’s understanding of the oral-systemic connection to overall well being, we owe it to our patients to continually offer them the opportunity for health.

Avoiding the BS Trap

As such, it is essential to consider that social conversation is not behavior conversation. I call it the BS trap. Yes, there is a social component to behavioral. Connecting on a personal level is critical.

As Robert Cialdini says in his book “Influence,” people like doing business with people they like. In a relationship-based practice, full engagement with patients is critical. Engagement increases the likelihood of being listened to and influencing healthy behavior.

AND, we must avoid the BS trap. Conversations need to be about them, not us. Conversations to influence values and behaviors need to be about patients. So, how do you know when social conversation has slipped into BS?

Encouraging Meaningful Discussion With Patients

The key is to realize when you are interjecting yourself into the conversation. Avoid personal words: I, me, my, mine, us, we, our, etc. It is not about us – our story – but about the patient, the patient’s story, the patient’s health values, and their objectives.

Avoid:

  • “I went there …”
  • “When I did that …”
  • “My experience …”

How do you shift from social (the starting point in conversations) to behavioral? Have one or two powerful questions to shift the conversation:

  • “How are you feeling about your health?” (Perhaps more powerful than: “What has changed in your health?”)
  • “What are you doing to enhance your health?”
  • “How are you taking good care of yourself?”

Then “Stay in the Question.” Continue to follow the thread they share. Remember …

Their first response is not the answer. It is their first response.

Questions are NOT the key. Listening is. Go below the surface.

  • “What else?”
  • “What do you feel?”
  • “Say more about that.”
  • “Do you have any ideas?”
  • “Tell me more about …”
  • “Yes, I understand.”
  • “I’m glad to know that.”
  • “Thank you for sharing that.”
  • “Is there anything else?”
  • “What is your suggestion?”

These questions work both ways. Teaching you to turn the focus onto the patient and teaching the patient to communicate their needs more clearly.

Have you read this article from team behavior expert Mary Osborne on understanding a hygienist’s true expertise?

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Bill Gregg DDS

I attended South Hills High School in Covina, Denison University in Granville, Ohio and the University of Redlands in Redlands, California prior to dental school at UCLA. My post-graduate education has included an intensive residency at UCLA Hospital, completion of a graduate program at The L.D. Pankey Institute for Advanced Dental Education ; acceptance for Fellowship in the Academy of General Dentistry (FAGD); and in 2006 I earned the prestegious Pankey Scholar. Continuing education has always been essential in the preparation to be the best professional I am capable of becoming and to my ongoing commitment to excellence in dental care and personal leadership. I am a member of several dental associations and study groups and am involved in over 100 hours of continuing education each year. The journey to become one of the best dentists in the world often starts at the Pankey Institute. I am thrilled that I am at a point in my professional life that I can give back. I am honored that I can be a mentor to others beginning on their path. As such, I have discovered a new passion; teaching. I am currently on faculty at The L.D. Pankey Institute for Advanced Dental Education devoting 2-3 weeks each year to teaching post-graduate dental programs. In other presentations my focus is on Leadership and includes lifestyle, balance and motivation as much as dentistry.

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Becoming More Trustworthy

August 31, 2018 Edwin "Mac" McDonald DDS

Trust is a central facet of human interaction, one that cannot be ignored in a dental or business setting. This blog reviews some interesting concepts on trust from Oxford professor Rachel Botsman

Trust: Known and Unknown

Botsman is a thought leader and significant contributor to the current conversation surrounding the role of trust in our personal and business relationships as well as our culture. She says that trust lives in the unique tension between our hopes and fears. It is about vulnerability and expectations.

Trust acts as the bridge between the known, where we are comfortable, and the unknown, where we are fearful. She defines trust as, “a confident relationship to the unknown.”

Similarly, when we enter into a relationship with a patient, there is a great deal unknown to them concerning their dental condition. They don’t necessarily sense what is required to establish good health, function, and esthetics.

A Relationship Strategy

According to Botsman, in developing our strategy of building high trust relationships, our goal should not be to build more trust. Our goal should be to become more trustworthy.

The established science of trustworthiness says that it requires high levels of competence, reliability, benevolence, and integrity in our life and practice to be present and experienced by others. Integrity, or aligning our intentions with our actions, is the most important.  

That same science says that real trust takes time and friction, at least some minimal friction, to establish. When a relationship is established seamlessly and instantly, there isn’t even the time and opportunity to ask the question: “Should I trust this person with something that is important to me?” That is the minimum amount of friction required.

Many organizations and a significant amount of behavioral research conclude that the strongest relationships are those that have experienced a problem and found a way to reconcile the issue. In other words, friction strengthened the relationship through solving the problem.

Have you listened to or read anything by Rachel Botsman? Join the conversation below … !

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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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Become a World-Class Listener Part 1

August 10, 2018 Bill Gregg DDS

Dr. Pankey had an advantage most of us do not that made him a world-class listener. Often labeled a disability, Dr. Pankey was hard of hearing. Because of this, he had to learn how to listen intently to his patients.

Dr. Pankey learned to listen for feeling over content. Listening is a skill that can be developed and improved. It requires intention and attention. One must practice! Here are a few tips that help:

Actionable Skills to Become a World-Class Listener

Offer Your Empty Presence

Most important of all is the intent to be present. Be here, nowhere else. Never enter a room without taking a deep belly breath to quiet the sympathetic, judgmental lizard brain and enhance the empathetic brain.

Empty presence is being fully available for the patient with no agenda, no busy talk going on in your mind, no judgment about what is said, no mental correcting or explaining chatter going on in your head for when you get a chance to talk.

I like to imagine an empty white balloon completely devoid of anything. My objective is to simply let the person fill it with their own thoughts and feelings. Really focus on what they say and how they say it and especially the feelings behind it. You are a gatherer of their information, not an explainer, corrector, teacher, or judge.

Let the Person Finish Their Story Without Interruption

Take a deep belly breath again once they have gone silent. What they just told you is simply what they first told you. There is probably more. When a person has finished their story, the silent period is when they are understanding what they just said.

Silently offer your open heart with compassion, allowing them time to spill out everything they need to say. Silently count to 10 before speaking, then use simple encouragements: “Is there anything more,” “Yes, I understand,” “I’m glad to know that,”  “I’m sorry to hear that,” or “Tell me more.”

To be continued …

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Bill Gregg DDS

I attended South Hills High School in Covina, Denison University in Granville, Ohio and the University of Redlands in Redlands, California prior to dental school at UCLA. My post-graduate education has included an intensive residency at UCLA Hospital, completion of a graduate program at The L.D. Pankey Institute for Advanced Dental Education ; acceptance for Fellowship in the Academy of General Dentistry (FAGD); and in 2006 I earned the prestegious Pankey Scholar. Continuing education has always been essential in the preparation to be the best professional I am capable of becoming and to my ongoing commitment to excellence in dental care and personal leadership. I am a member of several dental associations and study groups and am involved in over 100 hours of continuing education each year. The journey to become one of the best dentists in the world often starts at the Pankey Institute. I am thrilled that I am at a point in my professional life that I can give back. I am honored that I can be a mentor to others beginning on their path. As such, I have discovered a new passion; teaching. I am currently on faculty at The L.D. Pankey Institute for Advanced Dental Education devoting 2-3 weeks each year to teaching post-graduate dental programs. In other presentations my focus is on Leadership and includes lifestyle, balance and motivation as much as dentistry.

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Trust in the First 10 Seconds

July 23, 2018 Bill Gregg DDS

Do you want to develop an emotionally engaged, relationship-based practice where people choose you over the insurance-driven option? It is not going to be your technical knowledge that does this. It is in how you touch people’s hearts.

Trust or the lack of it can be built within seconds. How can we best emotionally engage people? Immediately as you greet a person, focus on them – each and every time. Give the S-O-F-T-E-N approach a try:

How to Develop Trust in Only 10 Seconds

Smile: A welcoming greeting in any language.

Open up: Open body language – relaxed, welcoming, arms open, palms up.

Forward body lean: Again, welcoming, not aggressive. A slight forward lean can demonstrate attention, interest, engagement.

Touch: Lightly when and where appropriate. Studies indicate people feel a warmth of endorphins with a light human touch. A gentle handshake with the left hand also touching lightly can work. A light touch on the shoulder or arm is effective too.

Eye contact: This is the most important thing you can do to gain immediate connection. Immediately look the person in their right eye. Not to stare. Especially while you are speaking to the person. Recent studies indicate eye contact has dropped to the 30-60% range in today’s digital smartphone era. That’s a huge drop into disengagement. It drops even more when one is speaking.

We are losing human connection to the soul, yet 60-70% eye contact is ideal. Practice glancing into their right eye consistently. Yes it feels awkward at first and yes it takes conscious intent. Why the right eye you ask? Mostly so you don’t stare at the bridge of the nose and look cross-eyed, but also the right eye engages a person’s creative, intuitive parts of the right brain more quickly.

Nod: A slight affirmative nod as the person is speaking is a strong indicator to continue. Studies indicate a person even accepts criticism and correction better if one nods slightly while presenting bad news. A nod tends to indicate support, not just agreement.  

Interestingly, the reverse is also true. A shake of the head while giving supportive news can create a sense of skepticism. Yes, I can look like a bobblehead at times. Emotionally engaged attention is becoming a lost art. But it is the greatest way to touch a person’s heart.

In dentistry we have a huge advantage. We have multiple interactions every day with good folks who trust us enough to do scary things in one of the most intimate parts of the body. We can grow that trust to emotional engagement one person at a time.

What is the result of an army of emotionally engaged dental missionaries? Lots of loving people who say: “You have to go see my dentist. They’re the best in the world!” Whose world? Theirs.

How can you achieve an emotionally engaged, relationship-based practice where people choose you over the insurance-driven route? Practice, practice, practice – on people, not just their teeth. Start with your family! And love the practice.

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Bill Gregg DDS

I attended South Hills High School in Covina, Denison University in Granville, Ohio and the University of Redlands in Redlands, California prior to dental school at UCLA. My post-graduate education has included an intensive residency at UCLA Hospital, completion of a graduate program at The L.D. Pankey Institute for Advanced Dental Education ; acceptance for Fellowship in the Academy of General Dentistry (FAGD); and in 2006 I earned the prestegious Pankey Scholar. Continuing education has always been essential in the preparation to be the best professional I am capable of becoming and to my ongoing commitment to excellence in dental care and personal leadership. I am a member of several dental associations and study groups and am involved in over 100 hours of continuing education each year. The journey to become one of the best dentists in the world often starts at the Pankey Institute. I am thrilled that I am at a point in my professional life that I can give back. I am honored that I can be a mentor to others beginning on their path. As such, I have discovered a new passion; teaching. I am currently on faculty at The L.D. Pankey Institute for Advanced Dental Education devoting 2-3 weeks each year to teaching post-graduate dental programs. In other presentations my focus is on Leadership and includes lifestyle, balance and motivation as much as dentistry.

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How to Show You Care

May 10, 2018 Mary Osborne RDH

Our good intentions and true thoughts surrounding a difficult situation with a patient can get lost in the communication process. When we fail to meet patient expectations, we can almost become a different person.

Our patient interprets what we say and do as demonstrations of our character. This is why, if we want to resolve conflicts and make patients feel understood, we need to pay special attention to showing that we care.

How to Show You Care About Patient Concerns

There are many ways to show you care that can be beneficial on both sides. It also helps to take criticism not as a personal affront, but as an opportunity for improving our communication skills. It may seem counterintuitive, but the best way to soothe or diffuse heightened emotions is to let people experience them. Allow patients to fully express their upset, instead of trying to shoot them down or make light of the situation.

Then, truly embrace empathy. Don’t just listen and nod without truly empathizing with their upset. Let them know that you understand how hard the situation is for them. Next, acknowledge the challenge of revealing their true feelings by thanking them for their honesty and for telling you what they think.

And then there’s the hardest part: apologize. You don’t need to admit you’re guilty and beg their forgiveness. You simply need to express how sorry you are that they are experiencing upset. Also, don’t assume that you can guess how to fix the problem.

Ask your patient how they want to be helped and be honest about whether you can make it work. By patiently listening and acknowledging their feelings, you may have already given them exactly what they wanted.

How do you show your patients that you care? Let us know in the comments! 

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Mary Osborne RDH

Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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In the Details: Personal Patient Care

May 9, 2018 DeAnne Blazek DDS

Throughout my dental hygiene, dental school, and residency programs, I was blessed to have exceptional instructors and role models. All of them encouraged me, believed in me, and most importantly, impressed upon me the importance of lifelong learning. Many of them recommended Pankey, telling me to go there as soon as I could.

A Journey to Deeper Patient Relationships

That journey began in 1994. I will never forget sitting in Dr. Irwin Becker’s philosophy class as he talked about the Crosses of Dentistry. He discussed “Knowing Your Patient” and I remember becoming very emotional.

As a young hygienist, it would bother me when I would see a re-care patient and not remember what we talked about the previous time. I started jotting things down on index cards about each patient and keeping them in a private file. Not the things you would typically see in chart notes, but personal things they felt comfortable sharing.

Each time they came in, I would refer to the personal card file and refresh my memory as to where we left off. There was no way I would have been able to remember all those special discussions, so I had to write them down. Each time they came in, the next chapter began.

I also started sharing more information about myself. I found the more I shared, the deeper the conversations went. I really wanted to know my patients on a much deeper level and that is what happened over time.  

When I came back to the Pankey Institute for the second continuum, I was pleasantly surprised to be greeted by name by Dr. Ernie Anderson, one of the course instructors, as I stepped into the elevator of the condos. Obviously, he had taken time to look at the roster to see who was in the class and that was very impactful. The kindness, thoughtfulness, and encouragement shown to me at the Institute were instrumental in demonstrating how I wanted to make my patients feel during my care.

Time spent getting to know my patients has resulted in lifelong relationships. Of all the things I’ve learned, this is one of the most important keys to a meaningful and enjoyable career.

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DeAnne Blazek DDS

Dr. DeAnne Blazek's love for dentistry began in the fifth grade while under the excellent care of her uncle and orthodontist. She enrolled in a dental hygiene program and then continued on to become a dentist. During dental school, Dr. Blazek worked as a hygienist for her uncle Louis Dellios. Upon graduation, Dr. Blazek was asked to join his practice and eventually became the owner when he retired. Dr. Blazek's main goal has been continuing the deep level of caring for patients that her uncle provided. The trusting relationship she creates with her patients puts them at ease and assures them that she will provide gentle, loving care at every visit.

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The Power of Listening in a Pre-Clinical Interview

March 5, 2018 Pankey Gram

A key tenant of Pankey philosophy is to know your patient before you treat them. It’s one of the most important lessons learned in our Essentials 1 course, Aesthetic & Functional Treatment Planning You begin to develop a self-awareness that you can cultivate throughout your professional life.

The concept of ‘knowing’ is worthy of much exploration, especially because what counts as knowing your patient is subjective to each individual. It’s about more than simply gathering data on their past dental history and current concerns in a pre-clinical interview.

To know your patient, you must be fully present with them. Then you must listen, truly listen. It’s difficult to remain quiet as your mind jumps from different solutions and possibilities to potential responses. That’s what makes listening a skill worth cultivating.

How to Listen More Effectively in a Pre-Clinical Interview

Start by taking stock of the moment before you even enter the room and acknowledge the patient. Pause. Evaluate your own mental space. Become curious about the unique individual who seeks your guidance and expertise.

Once you’ve transitioned to the interview, remind yourself that the patient should be doing 80% of the talking. It requires practice to stifle the urge to interrupt or re-direct, especially if you’re naturally talkative. On the other hand, during extremely busy days it can be a relief to settle back and focus on someone else’s thoughts.

Create a More Comfortable Environment for the Patient

One thing that helps you begin to know your patient is creating the right environment. Focus on them exclusively so that in the moment they genuinely feel like the most important person in the world. Hold eye contact, but also learn to take conversational cues from the patient. If they seem reticent, give them the space and freedom to be at ease.

During the interview process, ask open-ended questions capable of uncovering their values around health, fears or anxieties, and more. By providing them with answers to their questions and listening closely, you are already performing a service that is likely a rare experience in their daily life.

How do you cultivate understanding and trust in your pre-clinical interviews? Share your tips or advice with the Pankey community! 

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Harness the Language of Health

February 17, 2018 Pankey Gram

Many dentist-patient interactions operate under the assumption of limited time on our part and limited ability to accurately explain on theirs. After engaging in hundreds of pre-clinical interviews and conversations during appointments, you will have naturally developed your own preferred style for questioning. But how well does it really serve you?

If you feel something is lacking in your patient care, yet your clinical skills and execution seem immaculate, the problem might be about language. When you communicate with your patients, do you get the sense that they feel limited, misunderstood, or unsatisfied? This could be a direct result of using language to discuss ‘disease’ rather than ‘health.’

Use the Language of Health to Connect With Your Patients

Getting out of the rut of a traditional hygiene appointment starts with how you communicate. Even minor shifts in your word choice can have a profound effect on the patient’s sense of comfort. Open up a discussion about their health to connect with their needs.

A great way to follow this path is to abandon the typical impersonal medical jargon. Instead of asking if there have been changes to the patient’s medical history, pose a question about how their health has been since you last saw them.

Right out of the gate, you are presenting yourself as empathetic rather than turning into the classic brusque medical professional. Ask about how they are feeling, whether they have been taking care of themselves, and what changes they have made in their lifestyle.

These types of questions capitalize on expressive language to make the most of your time. Having the patient rattle off changes in their medical history without knowing how they feel about those changes isn’t as useful. People will generally open up when they are given a safe, non-judgmental space to discuss their health. After all, it is often one of the central preoccupations of our interior lives.

What questions do you think are most productive during appointments? 

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