REPORT
ANSWERING AND REFERRING QUESTIONS IN DENTAL PRACTICE
Communication is the key to success in running a dental practice and decisive in the patient’s decision regarding following up with the dentist for the particular treatment. Patients are able to trust those dentists with whom they believe they can communicate effectively, and need an understanding professional who will guide and treat them through a treatment over which the patient may be very anxious.
It is very common to see anxious patients in the dental office, and it is very crucial that they be put at ease about the various procedures of dentistry. On the other hand, there are patients who may be mistrustful of the dentists, as is the popular belief in our society, and therefore, may regard all interaction taking place with the dentist as suspicious. The dentist’s only hope in convincing the patient of his or her true intentions and the validity of the need of a particular treatment is by building a solid rapport.
Therefore, when explaining various procedures, the dentist needs to be very eloquent and easy to communicate with. He or she should be able to convey the complex dental and anatomical concepts in simple and easy to comprehend language. By explaining various concepts through comparisons etc. the dentist might be able to provide the patient with a very clear idea about how a certain procedure is undertaken. Also by explaining through simple language, and explaining the different steps along the way of the treatment, the patient feels much informed and comfortable at the thought that he or she knows what is being done with her.
This is the technique widely taught and this is the same technique that I employ whenever I am communicating with the patient. It is very common to hear the very general comments of the patients regarding their dental and oral conditions. They may say, “I have bleeding in my gums” or “I am having pain in my tooth” etc. It is my duty to identify the cause of the problem and explain in easy words, the pathology and the treatment plan.
For example, if a patient comes to me with bleeding gums and plaque accumulation, I explain to him that there is a build-up of bad bacteria and their products on the teeth, which forms a layer, which is commonly referred to as plaque or tartar. I tell them that by eating frequently, not brushing regularly, and by eating sweet agents, the bacteria in the mouth get constant nourishment and they use it to attach themselves or “settle themselves” on the tooth surfaces. I then tell them that in order to protect themselves, the bacteria use the sugars in the mouth obtained through intake of food and build up their attachments on the surface of the teeth. As they grow, they irritate the gums, which either “move away” from the bacteria, leading to recession of the gum line, or begin to bleed to try to get rid of bacteria.
Regarding scaling, polishing and cleaning procedures, I explain to patients that in order to remove the already present bacteria from damaging the gums further, we need to remove the “walls” of plaque and “dirt” that they have built on the teeth. This can be done through scaling, which is a procedure with which teeth are cleaned. When explaining the process of cleaning or scaling, I give them the example of a house wall, which is dirty. In order to change its paint, I need to first remove the old paint and impurities and dirt on the wall, which one does through sand blasting the wall. I explain to them, that this is the same type of procedure in scaling, where we use the scaler to remove the build-up on the walls of the teeth. This helps us get to the “real wall” underneath and thereby makes the area cleaner.
Regarding polishing, I explain to them that just like when a wall becomes rough upon sand papering, and becomes more prone to gathering dust again, so too the scaler can cause minor (though not damaging) abrasions on the tooth surface. In order to “smooth out the walls” we then use polishing materials to help reduce the rough surfaces in the walls. The polishing, I explain helps to reduce the chances of plaque build up again, but also improves the beauty of the tooth by giving it more “shine”. This is how I explain the process of scaling and polishing procedures.
There are times, however, when patients may want to know the difference between various procedures that may seem similar but have different techniques or purposes. For example, many patients may question what the difference is between tooth polishing and tooth whitening procedures. I explain to them using the analogy of the wall again. I state that if I were to only polish a wall, it would clean the surface and make it brighter, but will not change its original colour. However, if I were to apply some form of bleaching agent after cleaning it, it will lead to a change in colour of the wall through and through. So, scaling and polishing are only able to clean the surfaces but not improve or change the colour of the tooth. On the other hand, the whitening procedure helps in improving the colour of the tooth structure.
There are however, certain very common yet complex procedures that may be very hard to explain to the patients. The root canal treatment is a very common yet one of the most difficult procedures to explain. It is very hard to explain the concept of pulp anatomy and filing procedures etc. For this I have gathered for myself some models of the teeth sectioned which are also named of their structures. I have also prepared some already extracted teeth and carried out pulp extripation and filing. I show these to the patients and explain the entire procedure as follows.
Just as we have bone marrow, a live tissue within our bones, so too we have live soft tissue within our teeth called the “pulp”. This pulp provides the tooth the nourishment and sensitivity to keep it healthy and to make sure that we don’t stress the tooth too much. When bacteria eat away the outer hard and strong protective layers of the tooth, they reach the pulp. Since the pulp is very fragile, and bacteria infect it, it begins to give messages to the brain that “invaders are coming in the tooth”. This we feel as pain. What we do in the root canal treatment is that we remove the pulp tissue, since it is infected, and infected tissue may help bacteria grow faster. Therefore, we remove this pulp tissue, we clean out the roots of the teeth which are “stumps of the teeth in the jaw bones supporting the tooth” by placing files or mini cleaners in them. We wash these areas constantly with materials, so that the bacteria flush out of the system or die and are then removed. This takes a few visits. When we are sure that there are no bacteria left, which you will feel as reduction in pain and swelling, and no pus or blood discharge, we fill that area up with an inert material and thereby “seal the tooth”. Since the damage by the bacteria and then due to our cleaning procedures may weaken the tooth considerably, we advise the “covering or capping or reinforcing” of the tooth with a crown, bridge, onlay or a “cap” to protect the tooth from fracturing under stress and to improve its aesthetics. Most of the time, the patient is able to understand this procedure easily and is more cooperative. The visual aids are very helpful tools and intraoral cameras are also very helpful in clearing out these concepts.
Regarding orthodontic procedures, I explain to patients that we use brackets or steel holdings attached to the tooth surfaces to move and guide the teeth to their correct position and alignment. In order to give a uniform effect, these brackets are joined with the help of wires. I explain to the patients that just like bone healing takes time, so does moving the teeth from one position to another takes times, since it is also somewhat similar to the bone structure. I explain to them that this is why orthodontic treatments may take long, especially if they are difficult cases or where a lot of movement is needed.
To children, the management is much different since they do not easily understand the concepts of various dental procedures. But most importantly, they may be confused by the enormous collection of instruments that a dentist uses. When carrying out a GIC filling, I tell the children that we will “wash and polish your teeth”. I show the handpiece and I tell them that we will do “car wash” of the tooth and it will “tickle a bit”. I then show them the etchant brushes and GIC that this is our super strong tooth paste and super small tooth brush and we will now brush your teeth with them. Through this manner, I am able to get the patient cooperation, the child has fun during the procedure, and the procedure is completed easily.
Making of a bridge may be another area of confusion among the patients. I explain to them that the bridge is just that, a bridge. It aims to connect two remote teeth together, by stringing a line of “teeth” between them. Just like in the bridge, there needs to be strong support lines in the base. The present teeth serve as these “supports and abutments” which are “modified in shape and trimmed” to give maximum support. These are then made along with the new teeth and are placed as a whole to create “the bridge between two separate and distant teeth”. In this way, the bridge covers the gap that was present before, and helps provide a good base for chewing, eating and smiling.
There are, however, incidences where I am not able to communicate clearly to the patients regarding the different procedures. In such situations, I try to communicate with the help of visual aids and models. I try to replicate the procedure while explaining to the patient on a model, and during this process try to engage the patient into saying what he or she has understood so far. If that does not work, I ask for some time from the patient so as to find some visual aids such as movie clips etc. which can show patients the method to take place in the procedure and what is achieved. Usually it is helpful in clearing out confusion in the patient’s mind.
These are some of the techniques I use to communicate with my patients regarding various dental procedures. I also keep many visual aids, samples, and models with me in order to communicate better. Also, during the procedure, I make sure that I tell them what I plan to do next, how I will approach this issue and what is to be expected. Usually, this form of communication creates confidence in my patients, and most of them have their procedures done uneventfully.