At a recent dental meeting, a famous panel of dentists and consultants fielded questions about how to improve our practices. Leadership, teamwork, vision, communication, strategic planning, focus, and many other great buzz-word ideas were discussed. When the dust settled after the discussion, I realized that we are completely out of touch with our cosmetic dentistry patients.
As we evolve and behave like business owners, we sometimes forget that the patients are still thinking the same old thing-they “hate the dentist!” While we are excited about various occlusion philosophies, new materials, and high technology, the patients are still “afraid of the shot!” While we are dinking around refining the perfect crown margin, the patients “hate the sound of the drill!” While we are concerned about diagnosis and treatment, the patients are worried about gagging, drowning, smelly tooth dust, pain, “germs,” scary noises, sharp x-ray films, scolding hygienists, sweaty palms, dentists with halitosis, and getting the heck out of the chair! Dentists want to work on more teeth, but patients want to be comfortable!
Dentists deserve a lot of credit for inventing local anesthetic, high-speed hand-pieces, and so many other techniques, materials and equipment. But our reputation runs deep in the minds of the public. Movies, TV, jokes, and popular culture depict dentists as sadistic, painful, and altogether dreadful. “As bad as a root canal” and “like pulling teeth” are obvious similes. Every day, new patients come into our offices and say, “Nothing personal, Doctor, but I hate the dentist.”
We should be taking this personally–and seriously. 50% of the public does not see a dentist even if they have dental insurance. It is up to us as a profession to work hard to earn a better reputation. All of us should be learning everything we can to make a dental visit completely comfortable so that patients will get the care that they need. We now know that this is not just about saving teeth.All the latest research shows that dental health reflects conditions throughout the body, so it is really a matter of public health.
Complacency would be easy. After all, most of us think we are doing a pretty good job in the comfort area; and it would be so hard to change our reputation when we could just keep laughing about it in good-hearted, self-deprecating humor. However, we could learn from the Japanese. After World War II, the words “Made in Japan” were branded to mean poor quality. Now, the Japanese have turned quality into a science and everyone knows that Japanese products set the standard for reliability. Dentists can similarly change reputations by proving ourselves anew.
I have seen many dentists in my life, all of them conscientious and some of them famous. I am certain that they all thought they were comfortable and painless, but only two of them really were. Some of the experiences were downright unpleasant. I’ve had blocks that hurt like a tetanus shot. I’ve been gagged by impressions. I’ve had anesthetic wear off then “reassured” that “we’re almost done.” I’ve weathered a two-hour crown prep. I’ve had a root canal without being completely numb. I’ve had repairs done with no anesthetic at all. I’ve had my tongue nicked, my lips bruised, and my throat jabbed! The interesting thing is that I am not a dental phobic and I don’t “hate the dentist.” I just want to have the pleasant, comfortable experience that I know is possible-after all, I’ve experienced comfortable dentistry in the past. My wife, Allison, wisely says that it doesn’t matter how great the dentistry is if we hurt the patient, because the pain is the only thing they will remember. She’s absolutely right.
Each of us owes it to our patients to do everything we can to make each visit completely comfortable. If a patient is genuinely phobic or simply prefers to be sedated, we should be trained in oral conscious sedation. But for the vast majority of procedures, we should carefully begin earning the reputation of being painless and comfortable. There is so much we can do. It starts with genuine compassion. We can be on time. We can use a great topical and allow time to let it work. We can revisit our “painless” injection technique and do it every time with The Wand. We can be gentle in our manner. We can be comforting in our communication. We can provide our patients with pillows, blankets and video glasses. We can teach our team to be friendly in interactions, comfortable in assisting, and gentle in hygiene techniques. We can buy equipment and materials that make the experience comfortable. Micro Ultrasonics and lasers reduce the need for scaling and for perio surgery that patients despise. Digital x-rays sensors are now rounded for comfort. New implant techniques eliminate flap surgery. Rubber dams and Isolites provide comfort and relaxation, while reducing gagging and drowning. Intraosseous anesthetic guarantees profound numbness in difficult situations. Rotary endo techniques are quick and painless. New bonding protocols reduce sensitivity. And so do new whitening products. Proper medication eliminates post op pain. The list is endless.
Comfort is the new frontier in dentistry. As dentists, we think we have overcome this hurdle but we have not. Luckily there are materials, equipment, and techniques to make our patients completely comfortable. All we have to do is make a commitment to improve, invest appropriately in our practices, and avail ourselves of the education to provide our patients with consistently comfortable experiences. It’s time for us to surprise our patients with comfort. Imagine how fabulous it would be if dentistry was universally known as the most comfortable area of health care. It can be. The reputation of our profession depends on each of us-every day.
To help you get started, here are some essentials:
Topicals: EMLA (AstraZeneca) before injections, Oraquix (Dentsply) for localized scaling.
Anesthetics: Use a little Citanest plain first, then Septocaine for local infiltration. For blocks, after a little Citanest plain, use Carbocaine followed by lidocaine.
Syringe: Don’t use one except for intraosseous injections! Get The Wand (www.milesci.com) for every operatory. In fact, get a spare! A slow injection is a comfortable injection.
Intraosseous anesthesia: When you can’t get them numb, use the X-Tip (www.x-tip.com), invented by Dr. Kit Weathers. (Stands for Total Instant Profound anesthesia-and they’re not kidding.)
Video glasses: www.i-vue.net. Patients will laugh while you work-if you show them the right DVD’s. Office favorites are: Jerry Seinfeld Live on Broadway, Robin Williams Live on Broadway, Kings and Queens of Comedy, Blue Collar Comedy Tour.
Hygiene: 80% of your hygiene procedures should be done with micro ultrasonic scalers. We use a Pro-Dentech piezo scaler (www.prodentec.com) with warm water and a cap full of mouthwash such as Tooth and Gum Tonic by The Dental Herb Company (www.dentalherbcompany.com). For laser perio, get a diode laser by Hoya Con Bio (www.conbio.com), or get the new cordless diode laser by Ivoclar (www.ivoclarvivadent.com). Patients don’t like “the scraper” or “gum surgery.” Speaking of lasers, throw out that painful, time-consuming retraction cord and use your diode laser to trough, when necessary, around your preps. Better yet, keep your preps supra gingival.
X-rays: Digital x-rays are superior to film in so many ways. And they cost less. Look at products by Dexis (www.dexray.com) and Schick (www.schicktech.com). Patients will like the low radiation and comfortable sensors.
Implants: New implant systems by Zimmer, Dentsply and Nobel Biocare allow for flapless implant surgery when used with implant planning software by coDiagnostiX (http://www.leomalindds.com/codiagnostix.htm). Make sure you see the third dimension by using an iCAT image. Flapless implant surgery means your patients will have a comfortable recovery without sutures.
Rotary Endo: If you do endo, you can do it faster with rotary instruments. Call Endo Solutions and get their Endo Magic kit. All patients want their root canals completed quickly and comfortably. www.endomagic.com
Isolite: Rubber dams are great and should be used for bonding, but get yourself an Isolite for prepping. It is a single unit that is a bite block, a retractor, a light and a suction. www.isolitesystems.com
Bonding: Technique is everything when bonding so get the training you need. Then look carefully at bonding agents, luting cements and composites by Ivoclar, Kerr, Dentsply, Discus, 3M, Clearfil, and Parkell.
Burs: A fresh diamond bur is more comfortable on your patients and shortens the procedure. Take a critical look at your burs through your patients’ eyes, then see what Axis (www.axisdental.com) and Brasseler (www.brasselerusa.com) are offering these days. Get some nice, clean new bur blocks, too.
Orthodontics: Braces are uncomfortable, they’re ugly, they cut your lips, they’re difficult to clean, and some people are allergic to the metal. In many cases, braces are necessary but when they’re not, Invisalign is a great option. (www.aligntech.com)
Sedation: If you want to offer sedation, the Dental Organization for Conscious Sedation or DOCS (www.sedationdoxs.com) can give you the training you need to offer this outstanding service.
You have more phobic patients in your practice than you think. Sedation allows them-and you-to relax through the procedures.
Whitening: Sensitivity from whitening is a common problem, which can be overcome with proper technique and materials. Discus Dental (www/discusdental.com), Ultradent (www.ultradent.com) and Rembrandt (www.denmat.com) offer excellent products to comfortably whiten your patients’ teeth. To get your patients’ teeth their absolute whitest and do it comfortably, learn the “Deep Bleaching” technique by Dr. Rod Kurthy at www.rodtheideaguy.com.
To really reduce your patients’ anxiety (and yours!), offer comfortable payment options. Care Credit (www.carecredit.com) has excellent options with no down payment, no interest and low interest.
This is only an abbreviated list. If you are interested in providing increased comfort to your patients, please contact me at firstname.lastname@example.org.
Dr. Josh Bernstein is the founder and president of The Academy of Dental Arts and Sciences, Dental Professionals Dedicated to Patient Comfort. He is a Senior Clinical Instructor at the Las Vegas Institute for Advanced Dental Studies. Dr. Bernstein maintains a private solo practice in Piedmont, California, where he focuses on cosmetic dentistry, TMD, and sedation in an atmosphere of outstanding service.