Partnering in Health Part 2: There Is No Suffering We Cannot Care About  

May 6, 2024 Mary Osborne RDH

By Mary Osborne, RDH  

Think for a moment: Is there a change you think you could make in your life that would contribute positively to your health? Is there anything you could be doing—or not doing—that could improve your overall health and wellbeing? Most of us can think of something we could do, or do more consistently, to improve our health. Next, ask yourself if the reason you have not made the change you need to make is because you do not have enough information. Our clinical training taught us that if we give people the right information they will change their behaviors. It’s easy to get disappointed in ourselves and our patients when that turns out to not always be true.   

Reflecting on our own past and current health challenges is a way to remind ourselves that health is a journey, not just a set of strategies. What makes perfect sense to us now, may not have been relevant 20 years ago. Often we have heard the relevant information before but were slow to act on it. We may have conflicting priorities, such as time, or money. We may have had fears or doubts. When we can look at our own journey with understanding and compassion we are better able to see our patients that way.   

I remember a patient who came to us with a lot of dentistry that needed to be done. As we talked with her about recommendations for treatment, her eyes welled up with tears. “It’s nothing,” she said when I asked her what the tears were about. Eventually she shared with us that she and her family had been saving up to build a deck on their house. Doing the dentistry she knew she needed would mean they could not build the deck. There was a time when I might have thought, “What’s more important, a deck or your dental health?!?” But I was moved by her struggle. I can’t judge what a deck may mean to her and her family, but I can relate to her sadness in letting go of something they had been saving toward.   

As you advise patients, it’s helpful to share that are you on a path to better health yourself, and that it is not always easy. In this way we can step outside of the role of “expert” and come to our conversations as fellow travelers. And when we do come as fellow travelers, we bring our empathy, our humanity, and we allow ourselves to feel compassion. We are likeable.  

One of my favorite books is Dr. Rachel Naomi Remen’s Kitchen Table Wisdom: Stories That Heal. She quotes the psychologist Carl Rogers, who said:  

Before every session, I take a moment to remember my humanity. There is no experience that this man has that I cannot share with him, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever his story, he no longer needs to be alone with it. This is what will allow his healing to begin. 

Because we are on a journey of becoming healthier just like everyone else, we can sit side by side with a patient. We can say, “I get it. It’s not always easy.” We can allow ourselves to feel compassion—that urge to genuinely help someone, and gently invite them to understand they are no longer alone.

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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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Explaining Dentistry in a Way Patients Understand

February 14, 2024 Clayton Davis, DMD

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?” 

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Clayton Davis, DMD

Dr. Clayton Davis received his undergraduate degree from the University of North Carolina. Continuing his education at the Medical College of Georgia, he earned his Doctor of Dental Medicine degree in 1980. Having grown up in the Metro Atlanta area, Dr. Davis and his wife, Julia, returned to establish practice and residence in Gwinnett County. In addition to being a Visiting Faculty Member of The Pankey Institute, Dr. Davis is a leader in Georgia dentistry, both in terms of education and service. He is an active member of the Atlanta Dental Study Group, Hinman Dental Society, and the Georgia Academy of Dental Practice. He served terms as president of the Georgia Dental Education Foundation, Northern District Dental Society, Gwinnett Dental Society, and Atlanta Dental Study Group. He has been state coordinator for Children’s Dental Health Month, facilities chairman of Georgia Mission of Mercy, and served three terms in the Georgia Dental Association House of Delegates.

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Making Endodontic Diagnosis More Accurate 

February 13, 2023 Lee Ann Brady DMD

It can often be difficult to make an accurate endodontic diagnosis when patients present with tooth pain. We want to be able to get clear results from diagnostic testing so we can feel confident in our treatment recommendations.

One of the things I know to be true for my office and for many of our offices is the challenge of getting clear endodontic diagnostic information. One of the things that can cloud our diagnosis is the effect of over-the-counter medications.

To get accurate endodontic information, the patient must not take pain medication or anti-inflammatory medication in the 8 to 10 hours before you are doing your diagnosis. So, we need to ask patients if they have taken any Tylenol, Advil, or Aleve. We also need to think of patients who are taking nonsteroidal anti-inflammatories on a general basis. These are patients who are not taking them for the tooth but on a routine basis for other reasons such as arthritis.

If I am going to refer the patient to an endodontist and they are going to continue the diagnostic process, I want to coach the patient to not take any pain medication or anti-inflammatory medication for about 8 hours before that appointment. Otherwise, they may not be able to provide the accurate information needed for an accurate diagnosis and most appropriate treatment.

This is something I have passed on to the team members who answer the phone and schedule appointments in my practice. When someone calls to schedule an appointment to diagnose their discomfort, we tell them to do us a favor and not take any more pain medication or anti-inflammatory medication before we see them. Ideally, any of these drugs will be out of the patient’s system before the patient arrives.

Note that your patients who suffer from chronic inflammatory pain conditions such as bursitis, arthritis, and fibromyalgia are often prescribed anti-inflammatory medications that are long-lasting, for example, Celebrex and Meloxicam. These drugs are taken every 24 hours, so their effects last longer and pose a greater risk of clouding a pulpal diagnosis.

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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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Dental Risk Factors: Management Versus Treatment

June 1, 2022 Lee Ann Brady DMD

One of the most important things I aim to do is create clear expectations for my dental patients. Over the years I have intentionally tried to shift my language from discussing “treatment” to “management” when talking with patients who have dental risk factors that will persist throughout life. Perhaps, the following short discussion will empower you to do the same.

By being intentional about this, we can:

  • Reduce patient frustration,
  • Avoid patients thinking we have failed them,
  • Boost their confidence that we are working together to address their oral health problems, and
  • Inspire them to try management therapies and return to therapies that helped in the past when there are flare-ups.

When I describe something as a treatment versus describe something as a management therapy, I inform my patients about the difference and explain why management therapy may or will never eliminate the underlying cause of their oral health issue — but by continuing to manage their issue therapeutically throughout life, they will hopefully reduce discomfort and disease.

I make a clear distinction that treatment fixes a problem, and in their case, the problem may not be fixable, although it can be managed. For example, I focus on this when the patient is truly at high risk for periodontitis. This is a patient who has suffered from bone loss and has a body that is highly reactive to the bacteria in the inflammatory disease known as periodontitis. I also focus on this when the patient has significant TMD issues.

When I tell a patient, that we are going to treat something, the use of the word “treat” sets the expectation that the problem will be eliminated. That is very different from a management strategy that helps to reduce the symptoms and/or the continued degradation of their oral health. When we tell patients we are going to do scaling and root planning and we’re going to “treat” their periodontitis, it can be really challenging for them when we recommend that they do additional periodontal therapies.

When we think about periodontal risk, functional risk, and caries risk, the reality is that risk is a bell curve. There are some people whose risk factors are easy to manage, and some people whose risk factors are very challenging to manage. We need to help patients understand that when they have certain risks, certain disorders, there really is no treatment. What we do have is a lot of therapeutic modalities that can help manage the damage, manage the symptoms. Sometimes these modalities are so effective that it appears the disorder has gone away.

We need to recognize and the patient needs to know that the disorder really has not gone away and can surface again. With clear expectations, our patients (and we) do not have to experience disappointment and frustration. Instead, we can have supportive, empathetic conversations, and move ahead with restarting therapies and trying new ones.

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About Author

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Lee Ann Brady DMD

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

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