It is true that 80% of the population stays away from the dentist on a regular basis. Although most would rather be somewhere else than at the dentist, there are those who only seek dental care when their pain level exceeds that of their fear. Most often fear starts from negative past dental experiences involving lack of compassion, lack of adequate time to inform, pain during treatment or a combination of the above. Many of my “dental converts” have told me that they would actually become nauseous or undergo a panic attack even while picking up the phone to call the dentist. Although we can use relaxation medications or nitrous oxide/oxygen (“laughing gas“) to “get the work done”, most of these patients indicate that the most important thing that helped with their fear was the time given to be truly heard & understood, which is crucial in the development of a trusting, therapeutic relationship. True wellness involves allowing enough time to listen, because people don’t care how much you know until they know how much you care. A dentist who cares will be compassionate and have the stage set to listen to his patients and understand the nature of their fears, possible misgivings or skepticism. It is only through this that the mistrust barrier can be broken. Although I believe that it is extremely important to deliver high quality dental treatment, it is equally important to have an atmosphere of mutual trust. This is necessary to create magic through proper diagnostic, preventive and restorative care that can change and extend people’s lives!
Another obstacle in the way of a health-centered approach is that of having been trained solely to repair mouths and as indicated, having no training in teaching. With this early mechanistic outlook, at first I stumbled in my efforts to teach patients who were used to only having things “done” to them. I found that I was rushing my patients into solutions to their dental problems that they had not yet owned. It was too one-sided, as they did not yet realize that the best chance for success depended upon our becoming partners as dentist and patient. It wasn’t the patent’s fault, as I too had a lot to learn. I persisted, as I noticed early on that those patients with whom I had developed good relationships experienced the best dental outcomes. Those with whom this type relationship did not exist continued to have dental problems. This realization compelled me to continue integrating teaching into my practice. This learning journey taught me a lot about myself. I discovered that to effectively create this partnership with my patients, I would have to change my way of thinking, which was based on my early dental school experiences. Since I discovered this need to involve my patients more in the process of treating their dental problems, I learned to value more the initial time with them during the first appointments to develop trust. In medicine this is known as a “therapeutic relationship.” I know that without it, the process won’t get off the ground.
However, as I mentioned before, to allot this time is another risk because insurance companies provide little or no paid benefits for education and diagnosis, that only further supports the mode of “fixing teeth” for many dentists. Most patients (probably including yourself if you can admit it) are used to paying to “have something done.” To pay the dentist to take the time needed to develop a trusting relationship, and to work through a “co-learning” process, seems foreign to most patients, and I understand this. I understand that I am asking for a lot of mutual trust up-front when I suggest to you that it would be in your best interests to take this time initially to learn. For example, if I would tell you that you would benefit from special self-care training that would allow you to have better dental and general health, or that your excessive teeth wear would require more extensive investigation, would you be willing to spend the time and monetary investment necessary to do this, even if your insurance company wouldn’t cover it?
A little insight into the dental insurance industry: Insurance companies see patients essentially as “units of work” in a “factory,” to be handled cost effectively as they move along through various dental treatments. They pay mostly for basic “repairs,” not listening and learning procedures that involve prevention and the promotion of health. This emphasis on repair rather than a learning process only helps to support the public’s already low value of taking the time to learn and diagnose by offering “fix it” benefits only. The whole language of dental insurance companies presents a view of dental health not so much as a service, but as “units of things being sold,” such as fillings, crowns, partials, dentures, and cleanings. Their benefit schedules list one fee for each procedure, with no flexibility for the differing needs of each mouth, tooth or patient. I find that this way of thinking has permeated most of dentistry as well as being the expectation of many dental patients. The insurance industry is influencing dentistry in much the same way that it has the medical profession with denial of benefits, limitations on treatment, and fee schedules that necessitate increased patient visits with little time for the all-important feature of interaction.
I have found dentistry to be a wonderful and challenging profession, one that is a true blend of art, science and skill. As crucial as it is to provide excellent technical skill, the one type of skill-learning that was missing in dental school was that of interpersonal relations. Which leads me to my next point that was another important realization: No matter how gifted, skilled or technically able the dentist may be, true dental health cannot be achieved by the dentist alone. It must involve the participation and partnership of the patient as well. This is why I take the time to get to know my patients, and to gain their confidence and trust before we even begin dental treatment. If one has a willingness to learn and improve as a patient, combined with my expertise and passion as a dentist, the true formula for success appears! This relationship development and emphasis on patient learning is the core of what has been called the “health-centered” dental practice, to which mine has evolved.
A little insight into the dental profession: Most dentists typically are not the greatest of teachers. We were selected for dental school based mainly on our manual dexterity and analytical skills, not on our ability to interact with people. We were taught to diagnose dental problems and to “fix teeth.” We were expected to perform procedures on patients who sit passively in dental chairs, not to involve them in learning, which is an interactive process. Consequently, most dental offices you see today are designed mainly for “doing” or “fixing” rather than for “teaching” and “learning.” I have made a concerted effort, over time, to gear my practice towards offering learning experiences for my patients that can empower them to take a large portion of their dental health into their own hands.
This may sound simple enough, but there are obstacles that work against the dentist developing a health-centered approach to their practice. For instance, if you are a new dentist starting out today, you are saddled with major debt. It is not uncommon for the new dental school graduate to have an indebtedness of $200,000, to which a return on invested capital including interest, as well as lost income while in school must be realized. Add to this the fact that, unlike a physician for example, who has hospital privileges, which includes staff, the dentist must set up and operate his/her own dental “hospital” with expensive equipment and quality staff. This financial burden puts pressure on the dentist to produce, rather than to take the time to further their studies and teach their patients. These realities are what tempt the dentist to feel the necessity to be concerned more with quantity than quality.