I recently had a patient cancel her appointment at the last minute. This happens sometimes. It’s frustrating for a dentist or hygienist when we’ve set time aside for a patient and they don’t come. Usually there’s a good reason. In this case, no reason was given.
As I sometimes do…I took it personally. Why did this person choose not to have the treatment done that we discussed? What could I have done better?
This particular patient has been coming to our office for years. She is someone you might describe as “skeptical” of dental treatment. I suspect she had some bad dental experiences before I even came into the picture. She’s at least mildly phobic of dental treatment, too. However, I think she’s probably one of those people that believe that when I come in the room that I’m simply looking for work to do, probably to line my pockets.
It’s a difficult spot for a dentist. Often times we’re both the internist that diagnoses the problem and the surgeon that fixes it. Patient see this as a conflict of interest. The guy who is telling me that I have cavities is also the guy who benefits from them being fixed. I completely understand this. I take my role as a doctor very seriously and I put my patient’s needs first. But can you blame a patient for being skeptical of a doctor’s motivations?
When I examine a patient I’m looking to see what level of dental health the patient has. And when I see a problem, I’m obliged to tell them about it. I have found what I believe is the most effective way to do this. I do all of my recall exams with a dental operating microscope. This microscope magnifies what I can see and has a very bright light that allows me to see parts of the mouth that don’t get lit up very often. I’ve attached an HD camera to the microscope with a monitor mounted over the patient to allow them to see exactly what I’m seeing…as I see it. I feel like this is a great solution to the problem of showing the patient what I see instead of me just describing it. I like it more than still photos because I can show it to them “live” as I’m describing it.
Back to my patient that chose not to come in today. I definitely examined her with the microscope and I definitely showed her what I was seeing. I recommended to some treatment because I saw some problems. I try and do this dispassionately. I try not to “sell” a patient on treatment by showing them what I’m seeing. I try to help the patient choose dental health by showing them what I’m seeing and describing what we can do to correct dental problems.
I have a suspicion that this patient still thinks what I’m describing isn’t a real problem. Like many dental problems, what I’m describing probably doesn’t hurt. Most cavities don’t hurt. Gum disease almost never hurts. Even broken teeth often aren’t painful. If you use pain as the threshold for dental treatment, you’re probably going to end up choosing the most expensive way to fix the problem or worse, sometimes the problem can’t be fixed leading to the loss of a tooth. A small cavity left untreated almost always becomes a bigger cavity, so what may have been easy to fix with a filling could end up needing a crown or even a root canal. This sounds like a scare tactic used by a dentist. Ask any dentist and they’ll explain that they see it. All. The. Time.
So I’m going to suggest that you listen to your dentist’s recommendation. The choice to treat is always yours. But almost always, the sooner you treat a problem, the less expensive and potentially painful the fix is.
Did this make you feel skeptical? Are you feeling put under the microscope? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Me: “Gloria, you have several cracks in this tooth. Some cracks need to be treated more aggressively than others. Unfortunately, the ones I’m seeing here are some that I would recommend you treat right away.”
Gloria: “Really, doc? I’m not having any trouble with it at all. Do I really need to fix it?
I have this conversation quite often. When I suggest to the patient that now is the time to treat what I’m seeing it makes me feel kind of salesy, if you know what I mean. I just created a problem in the patient’s mind that they didn’t have a moment before. Just a minute ago the patient had been enjoying their clean and “just polished” teeth while hoping I wouldn’t come in and find anything expensive to fix.
Here’s the problem. I use at least 6.0x magnification and a ridiculously bright LED headlight for every procedure or exam that I do. At least. Sometimes I use my dental operating microscope which can bump the magification up to 20x along with the insanely bright plasma light source. But I digress. In any case, I see a lot. I have to use the judgement and experience that I’ve gained through 15 years of treating patients and learning new things to decide what’s important enough to suggest treating to the patient and what’s not all that important. This is not an easy job. Often I wish the patient could just see what I’m seeing.
Showing the patient what I can see isn’t as easy to do than you would think. Over the years I’ve used handheld mirrors, patient education software, intraoral cameras, digital SLR cameras of all types among other things to help the patient visualize what I’m seeing. I’ve found that I can explain things much more easily when they have a picture of what I’m describing. According to neuroscientist John Medina vision trumps all other senses. We humans are visual animals. A pretty big part of our oversized brains is used to process the visual images that our amazing eyes take in. We understand things better when we can see them. Or at least when we can form a picture of them in our mind.
Back to my somewhat awkward conversation with my patient. She thought everything was great with her teeth. They were smooth and shiny and pain free. Then I come in and tell her that I see a problem that she should probably fix that’s going to cost her money that she’s rather spend elsewhere. How does she know I’m not trying to sell her something that she doesn’t really need? If she listens to the news she may think that I’m just making up treatment in order to charge her a bunch of money! How can I help the patient understand her dental problems?
First, if I have a relationship with the patient and she trusts my motives, that helps a lot. Secondly, I try to show her a picture of what I’m seeing. Not only can she picture the problem, she sees that I’m not just making stuff up in order to do treatment on her. Most recently I’ve been using a digital SLR camera wirelessly connected to an iPad. This is a very elegant solution because the patient can instantly see the image come from the camera onto the iPad screen. I can show them the problem that I’m seeing at high magnification without the patient having to be leaned back with their mouth open. They can point, zoom and move the image around to ask questions I might not have thought to answer. It helps make the patient part of the diagnosis process. No longer does the patient have to “take my word” about a problem. They can “touch it” as well as see it.
Dental patients should demand this kind of technology from their providers. It’s no longer good enough to just take the doctor’s word for it. When a patient can own their diagnosis, they can own the treatment and make better decisions. Health care and dentistry continues to become more expensive, so we need to be better consumers. These kinds of pictures really are worth a thousand words for well informed patients!
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In the mid-90's, this was a "must have" for every dental student!
I’m a technophile. Which is a really nice way of saying that I’m a sucker for a cool gadget. I had my first laptop in 1993 (an Apple Powerbook 160) and used it to take notes in dental school. It was an absolute clunker and had a greyscale screen, but I loved it. I carried that cinder block around like newborn baby!
Dentistry is a profession that has LOTS of gadgets. In fact, there’s so many gadgets that a dentist really needs to be wise about choosing technology. Many times in my career I’ve brought in a technology that was marketed brilliantly but wasn’t very helpful to patients. I’ve become more choosy about the technology I incorporate as I’ve matured in my career.
Technologies that involve magnification and imaging (taking pictures) are very important to me. I use high powered loupes and an LED headlamp for all procedures and exams, unless I’m using my dental operating microscope. We also have intraoral cameras in each operatory and a digital SLR camera. These technologies also lend themselves to taking photos of procedures and conditions and being able to explain dental problems and proposed treatments using digital photos. Along those similar lines, our office has been using digital x-ray technology since 2007.
Digital x-rays are a cool technology for many reasons. First, how neat is it that we can snap an x-ray of your tooth and it appears on a computer screen in a matter of seconds? I don’t care who you are, that’s just cool! Software allows us to change the size, crop and zoom and even accentuate the image in a way that we never could when we were using film. Further, the image is on a huge computer screen instead of a tiny film. And if that wasn’t enough, digital x-rays use only 20% (or less) radiation than film x-rays!
digital x-rays: less radiation and more options
So, I can make digital photos and digital x-rays of teeth. It’s very convenient and very cool. Here at Mead Family Dental, we’ve taken it one step further. We use the technology to save you money!
Let’s just say you’re my patient and you’ve come in to have your teeth cleaned. When I do your exam I find a raised white patch on the side of your tongue. Now I’ve seen quite a few tongues in my career, but my training is limited in the identification of these kind of lesions. So what do I do? I typically send you to a specialist. In this case, I’d send you to an oral surgeon. The surgeon would first schedule you to examine the spot and then would decide if there is a need to biopsy the lesion. In many cases, the surgeon has had enough experience seeing this kind of pathology that a photo or x-ray would be enough for them to decide whether it’s something that can be monitored or it’s something that needs to be examined in their office.
So now we come back to our slick digital technology. I’ve already taken several photos of this suspicious white patch on your tongue. I email the photos along with a description of the lesion. Usually within a few hours or at most a day or two I get an answer back from the surgeon saying, “I think we can monitor this until their next visit” or “we should probably set up an appointment in our office.” What I did was get an opinion from a specialist without you having to visit the specialist. I do this all the time. Consulting specialists has become much simpler and in many cases much less expensive because of the technology that we have at the office.
Technology in medicine is constantly evolving. Here at Mead Family Dental, we’re trying to choose the technologies that make our patient care better, more efficient and more cost conscious. Doing what’s best for our patients is our #1 goal!
If you like this post, I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.
Sealants. Sold to dentists and patients alike as the cutting edge of minimally invasive and preventive dentistry. The concept was “close those grooves” and you’d save that tooth from getting cavities. The problem is that if the grooves aren’t really explored and cleaned out, under high magnification, then decay can be left accidentally.
In many cases, sealants were being placed by hygienists and dental assistants who aren’t able to diagnose or remove decay. There is a certain mindset that sealants can be placed with no numbing and very little trouble. A lot of these sealants (research suggests 92% after 10 years) are failing, and the result can be big dental problems in the future!
I’ve written about these decay pronegrooves in the past. I think that a lot of dental problems in adults come from undertreating these grooves and missing this hidden decay.
Do you have groovy teeth? Or do you not even know? If you’d like to know, we’d love help out! In fact, we’d like to be your Saginaw dentist! Feel free to call the office at (989) 799-9133, request an appointment online or email me at email@example.com. You definitely should have a groovy life, but we’d less groovy teeth!
I've been a "magnfication junkie" for as long as I've been practicing dentistry. I began using loupes (the magnfiers mounted on glasses) while I was still in dental school and began using a loupe mounted headlamp in 1998. Many patients may remember that I would often forget to remove the fiberoptic cable from the lightbox in the operatory and I would practically strangle myself when I walked away. Good times!
I have increased the magnification of my loupes from 2.0 to 2.8 to 3.8 and now finally to 6.0. The greater the magnification the more detail I'm able to see. 3-4 years ago I attempted to move up to 8.0x loupes. The problem with those was that I literally couldn't hold my body still enough for the magnification. It was so much magnification that the slight movements I made while breathing, even when I was sitting still, made it impossible to see well. Also, there really wasn't enough light, even with my new LED headlamp (brighter, not attached to the counter).
So I had reached my limit of magnification. Which was still awesome at 6.0, but I wanted more! For years I had been kicking around the idea of getting a dental operating microscope. I had seen them in the offices of root canal specialists and I had a chance to see them at dental meetings. I had even tried them in my own office with demonstrations. I held off on buying them because 1) they require a complete change in the way you work and 2) I didn't want it to become a very expensive coat rack in my operatory.
Finally, in November of 2010 I went to the Academy of Microscope Enhanced Dentistry (AMED) meeting in Santa Barbara, California. I had a chance to see lectures from some very forward thinking dentists as well as try out all the different models and features.
At the end of November I went ahead and got one. My only regret is not having done it sooner! It takes care of the "not enough light problem" as well as the "slight movement of my body causing blurring of my visual field" problem.
The microscope is a Seiler Instruments xR6. I have a camera mounted on it that allows me to take high resolution still images as well as high resolution video. My next project is to put high resolution monitors into the operatory that will allow patients and assistants to see what I'm seeing through the microscope in real time!
Why do I go through all of the trouble for my magnification habit, you might ask? The answer is easy. Better magnification makes me do better dentistry than I can do without it. Simple as that. Now that I'm incorporating a camera, it also allows me to communicate with patients and other dentists much better.
This is one of the most exciting developments of my entire dental career! I promise to keep you posted on this exciting piece of technology!
Questions or comments? Feel free to email me at: firstname.lastname@example.org. I read and answer all of my own email and love to hear from readers of the blog!