They Wasted an Hour "Poking my Gums"
In the era of Google Search, details pertaining to just about anything can be found at the click of a mouse. It is eye-opening to read some of the information that is out there. Recently I encountered a new patient who had done quite a bit of personal investigating concerning dentistry in general and periodontal disease in particular. He explained that he had been going to the same dentist for many years but that suddenly everything at that practice had changed. He said that he was now getting a “used car salesman vibe” from his dentist, and he did not trust what he was being told. He had been informed that he had periodontal disease and needed expensive “gum treatments” to take care of it. He was skeptical because he wondered how this had developed so suddenly. After all, he had been seeing this dentist and his hygienist twice a year for many years. Why hadn’t they noticed this gum disease before? Why was the treatment so expensive? Plus, if the disease was present, why didn’t he notice anything wrong in his own mouth? He went online to look for answers.
One of the first sites he came across was a question and answer forum. On that site many patients described how they had been “duped” by their dentists into accepting expensive gum treatments that they were sure were unnecessary. Several expressed that the treatment they eventually received was “no different from a simple cleaning.” In addition, one patient wrote that “to justify the fee, the hygienist wasted an hour poking my gums” rather than doing the “cleaning” that he wanted.
We know that there is a lot of misinformation online. We can’t change the internet, but we can focus on our own practices and how we handle our patients. We need to ask ourselves what we can do to better explain the nature of periodontal disease and our treatment recommendations to possibly skeptical patients. We want our patients to understand and agree to the treatment that they need. We certainly don’t want them believing that we are “wasting an hour poking their gums” to justify our fees! Here are some ideas:
Most people understand the concept of infection and how the body can become infected with germs. Many also understand the basics of inflammation as a result of infection, such as if you have an infected splinter under your fingernail you may experience swelling, redness, and pain.
The fingernail example can help us explain that germs can start growing in the spaces around the teeth attracted to sticky plaque and rough calculus, just like germs are attracted to a splinter (I often describe plaque as a superglue type film and calculus as a thick sandpaper coating). Just as a splinter may take awhile to become infected or painful, so can the tissues take awhile before a person notices a problem. We can explain that it is the job of the dentist and hygienist to identify early signs of infection and inflammation before damage gets too extensive, and perhaps even before the patient has noticed any changes.
Prior to performing periodontal probing and recording, a detailed explanation of what we are doing is in order. We can express that the gums fit around the teeth like a turtleneck sweater fits around a person’s neck. We measure the little “tooth turtleneck” to see if it is tight and shallow, which is healthy, or loose and deep, which can indicate disease. We can explain that we use a little ruler divided into millimeters, and that the numbers the patient will be hearing us say should ideally be no deeper than 3mm. Now the patient has an understanding of what is going on and can participate by listening to the recording process.
If problems are discovered, we can explain that just as high blood pressure can develop where no high blood pressure was seen previously, periodontal problems can develop where none was seen previously. Even if a patient has been coming to the dentist for “cleanings” for many years, periodontal disease can arise.
We can discuss ways of dealing with periodontal disease, including scaling and root planing, and explain how “germs” that are implicated in periodontal problems are also related to other illnesses. While information concerning the mouth/body connection is becoming more widespread, you may find that your patient is unaware of how his mouth can impact his general health. Rather than using this information as a “scare tactic,” approach the topic as an avenue to facilitate education and discussion.
Putting articles on your website to which you can refer patients is also a great idea. Patients may need time to process the information you have provided before deciding to go ahead. If they do not agree to treatment today, call them in a few weeks to talk over your recommendations again.
If patients wonder why scaling and root planing is more expensive than a cleaning, explain that local anesthesia may be needed, periodontal irrigation might be used, and possible placement of medicaments around the teeth might be required. When a patient receives scaling and root planing, it goes without saying that the experience MUST be different. If an office is delivering the same service as a “cleaning” but calling it something else, it should come as no surprise that the patient will be upset and mistrustful.
We know that a healthy mouth promotes a healthy body - but we can't force patients to agree. It is our job to present all information and treatment choices available. However, high-pressure tactics have no place in a health care setting, and typically push patients away rather than actually encouraging them to receive treatment.
Carol Tekavec RDH is the director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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