Aggressive Patient

Dental Revelations Blog-

The lift is broken and my dental surgery is on the 6th floor. The last patient is slightly obese 50+ year old lady who has a heart medication. It is the last appointment of the day and most of the practice staff has left the building.

She walks into the reception. She huffs and puffs when I call her in. The first wave of complains hits me. Apparently it is my fault the lift is broken. I manage to calm the situation and she sits down in the patient chair.

I am super-cautious with everything what I say but she – still out of breath – takes another round at me. Now she’s shouting. I try to follow the protocol of how to deal with an aggressive patient. No help. I ask if she’d rather cancel the appointment. She wouldn’t. Instead she demands me to start the treatment and not to speak to her.

But I must speak. This job cannot be done without informing of certain things.

I suggest again that we could reschedule the appointment. It’s the end of the world for the patient and she nearly screams at me. I sit silently, my whole body trembling (which I pray God she wouldn’t notice). The patient demands me to carry on with the treatment and I do so in a fear of… not sure what but I rather carry on than stop the treatment to find out.

I must use calming deep breaths every time the patient does not notice as otherwise it would be difficult to hold an instrument in my hand. But still I must support my mirror hand with the other hand to stop the handle clattering against the patient’s teeth.

Once we are finished with the treatment the patient has calmed down. She even apologies her behaviour. I smile and I’m friendly towards her but inside me I am totally worn out and in a need of comforting.

Aggressive Patients And the Protocol

When a patient is hostile towards you and criticises everything you do there is no way to stop your heart pounding. You may try to hide it and act as we are thought – be calm, remember to listen, listen, listen, address the patient’s feelings with sympathy

I’m sorry you feel this way…

I understand that you are upset…

and let the patient finish until you ask

Do you want to continue with the treatment or should we reschedule?

At the same time your heart is racing like mad and you think the patient can hear from your voice that you are far from being calm. If she doesn’t notice it from you voice she will notice your hands that shake frantically.

Sound familiar? Been there done that!

We Are Not Perfect And Definitely Not Superhumans

No matter how good people skills you have there will be a day when a patient does not like your chair-side manner. The patient might be verbally aggressive towards you or passive-aggressive when you sense that all is not well (arms crossed and hardly answering your questions). Or the patient might act normally during the visit and later on you find out that complaint was made against you.

Whaaat? Me? But I’m always liked by my patients!

I have learned long ago a very important thing that keeps me sane in my professions when it comes to the patients:

You cannot please everyone!

Embrace this sentence and remember it when you hit a difficult time with your patient. If you feel that you have done your best you can calm yourself down by repeating this simple sentence in your mind. And offer it to the newbie who has met her first aggressive patient.

The same was done to me by a kind and wise dentist after one aggressive patient.

Y o u  c a n n o t  p l e a s e  e v e r y o n e!

After Words

I have noticed that there is a pattern of the aggressive behaviour amongst the patients. The fear of dentist is one thing for sure. But the ones that have given the hardest time on my professional life have been female patients between the age 50 to 60. I cannot help but thinking that this unstable behaviour (from 0 mph to 70 mph and back again) could be due to an undiscovered menopause.

Now could it?

But for your safety do not under any circumstance suggest this to the patient. It might be the last thing you do.

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Should You Use a Mouthwash?

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Yes and no.

If you are a patient and you ask this question from two dentists there is a BIG chance that you will get two answers. The other shows you the green light and the other the red.

There is no consensus amongst the dental professionals about the recommendations. Even the professors in dentistry argue about the recommendations publicly. They give statements to the press for and against the mouthwashes after a new study about the risks of the mouthwashes is released. Some negate all the study’s conclusions.

So no wonder it leaves patients confused if us professionals are too.

Well Should You?

Generally no.

If you have a good oral hygiene – brushing twice a day and cleaning between the teeth most nights – and you use a fluoride toothpaste there’s no reason to use a mouthwash.

But there are exceptions – naturally!

If you suffer

  • from a gum disease you might be advised to use a mouthwash containing chlorhexidine (CHX) during and after a periodontal treatment. It is a very effective ingredient that kills bacteria. But remember to use it only as advised by a dental professional
  • from an extreme dryness of the mouth through an illness (e.g. Sjögren’s syndrome) you might be advised to use fluoride mouthwash regularly to prevent decay

Remember that in both of these cases you should choose the alcohol-free version.

Dangers of Using a Mouthwash

Oral cancer

If you use a mouthwash that has alcohol (ethanol, but I’m going to use the word alcohol instead) levels of 25% or higher and you have been using it since your teenage years the studies state that you have higher chances for getting an oral cancer.

One leading brand (the one that rhymes with word blistering) can have alcohol levels as high as 26% and this high level is thought to be toxic for gingival tissues when used in abusive amounts. But – and it is a big but – why do they add alcohol to the mouthwashes when it is a known fact that for alcohol to be toxic for bacteria it must be used at 40%? This means that there is no help from alcohol levels as low as 26% but it can still be harmful to the gingival tissues.

Discolorations

If you use a mouthwash containing CHX for a longer period of time it will stain your teeth. Stains can be removed but it will cost you of course.

In my professional life I have noticed that for some unknown reason the leading blistering-rhyming mouthwash stains the teeth with some patients even though it doesn’t contain the CHX. Actually the looks of the stains is different to those that build up from the CHX. After a thorough interview of the patient no other explanation was found to the stains than the mouthwash the patient had been using. The staining stopped once the patients stopped using the mouthwash.

Dry mouth and bad breath (halitosis)

Alcohol in mouthwashes can dry the mouth and the dry mouth is prone to halitosis. People often seek help from the mouthwash for the halitosis but it can actually make the matters worse.

Lichen planus

If you have been diagnosed with lichen planus you should not use any mouthwashes unless advised by a professional. But even in this case you should not use mouthwashes with alcohol.

WELL SHOULD I?

Wouldn’t it be the wisest thing to do if you DIDN’T use a mouthwash whilst us professionals argue about the health risks of the mouthwashes? It’s your health that is gravely at risk if the alcohol in mouthwashes is proven to be harmful.

I have seen patients who are going through the cancer treatments for oral cancer and I have seen the 50% of them who survived the cancer. I can tell you that it’s not a pretty sight. Not during the treatments or after surviving it.

Why would you play a Russian roulette over your health? I wouldn’t and therefore I am not using any mouthwashes.

If You Still Want to Use a Mouthwash

Always choose the alcohol-free fluoride mouthwash.

Remember

  • it can stain your teeth
  • it never replaces brushing or cleaning between the teeth
  • that in many countries the mouthwashes are considered as cosmetics by law. In some countries they are considered both cosmetics and drugs. But when considered as cosmetics they are not that highly regulated as drugs are. So what you could actually be rinsing in your mouth is a cocktail of chemicals that no-one knows (or cares) how they affect the health
  • that if you are also a heavy smoker it increases the risk of getting an oral cancer. If on top of that you are a high consumer of alcoholic drinks you are even at higher risk

Conclusion

I really don’t get it how we cannot decide if the mouthwashes containing alcohol should be recommended or not. It’s just ridiculous that even inside one dental practice opposite recommendations are given to the patients.

What all of us professionals agree is the fact that alcohol is an aldehyde and it is metabolised by the oral bacteria to acetaldehyde which is carcinogenic in humans. Carcinogens cause cancer! And yet we argue about the risks of using an alcohol containing mouthwash.

What are the reasons behind all this? Some have suggested that some of the dental professionals have financial commitments to the manufacturers of the mouthwashes. I must emphasise that this is a hearsay. But if you have read my previous post about the integrity amongst dental professional you understand that everything is possible.

If you are interested to read about groundbreaking study about the risks of using the alcohol containing mouthwashes (one that caused a mayhem amongst dental professionals) visit here.

Morals in Dentistry

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It’s time to get serious again. In this post I will get to the bottom problem of the dental industry. The lack of morals and the urge to maximise profit at the cost of the individuals is like a plaque that sticks around before the cure is found. For about half of the dentists I have met fall into that category and that’s a lot considering that we – the health care workers – should be the ones having the highest integrity of all.

What I will do next is give examples of the lack of morals amongst dental professionals. It will be just a (thin) slice of a (big) cake but you will get the idea no doubt. For clarification, all the examples are from real life and witnessed by yours truly.

NHS Dentists

For those who are not familiar with the NHS, it is the UK’s National Health Service. The NHS dentists work under a contract and receive payments for the treatments done.

Before the year 2006 (when the contract was replaced with a new one) the misuse of the system was widespread. The dentists were laughing at the system that was like a gold mine to them. They could easily make an outstanding pay by doing certain treatments that would not raise questions. It did anything but raise questions. The treatments made them look like they were concentrating on preventive care and looking out the patient’s best interest.

A revelation:

The truth is that they did not care about patients. Patient was merely a tool for money making. An example: The dentists made fissure sealants for every patient who did not have them and they made them from first premolar to the last molar. There was no evaluation if the fissure sealant was needed and it was an easy treatment to justify to the patient as it was preventive treatment.

“It prevents you getting a decay…”

Who would say no to that?

Fissure sealant was very quick treatment to do as it could be done in batches (all the premolars and molars from the left side in one go and next the right side) guaranteeing a very productive day moneywise for the dentist. There are probably millions of people in the UK whose teeth are coated with fissure sealants.

Eventough the NHS contract was renewed in 2006, the dentists found new ways of misusing the system.

Root Canal Treatment on Wisdom Tooth… What The?

The most immoral dentists have found a way to make the most out of every tooth – moneywise. Normally the decision to remove a fully erupted wisdom tooth is made lightly if there are any problems like decaying, periodontal problem, malocclusion with the tooth. But more than once I have seen wisdom teeth that have been heavily filled, root canal treated and even have had crowns on them (on top of the root canal treatment).

There is no other explanation to this than a dentist who is practicing dentistry only to gain wealth.

Performing Treatments Without Having the Skills

Some dentists suggest treatments they have no skills to perform and charge the patient as if they were specialists. An example: A dentist recommends periodontal treatment to the patient. The course of treatment consists four 30 minute visits to remove calculus one quadrant per visit and the cost is the same as if a periodontist would perform the treatment. Once the course of treatment is done by this wannabe specialist, the patient goes to see a hygienist for oral hygiene instructions. The hygienist soon realises that there is still lots of subgingival calculus left and therefore the gum disease is still active.

The hygienist does her best to remove the calculus (which she has skills for) and the patient is left under an illusion that nothing is wrong.

It is called collegiality what just happened. Dental professionals covering for each other’s mistakes and malpractice.

Root Canal File in the Root Canal

In our business the equipment can malfunction and instruments can break in use. In these cases it is good practice to tell the patient what happened. For example a curette’s tip can break inside the pocket of the tooth. It can be found from there but the patient needs to know what happened. Some dentist cover these kinds of incidents or mistakes they have made by simply not informing the patient. Now THAT if anything is malpractice.

An example. A root canal file broke inside the patient’s tooth whilst the dentist was performing a root canal treatment. The nurse did not notice the incident until a control x-ray was taken and the file was clearly visible. The dentist did not inform the patient about the broken file or attempt to remove the file.

Conclusion

The dental industry draws in immoral individuals because it has been allowed to happen. It wasn’t until the 21st century when the dental schools started to interview the applicants for the undergraduate programmes of dentistry. Before this the suitability of the applicant’s personality was not measured by any tests. This means there are dentists in the field that should not be dentists.

In my opinion all the dentists who have not gone through the MMI should be asked to have one. If they fail, they should be struck off their profession.

But no test is a fool proof way of finding the bad seeds. The most rotten souls can often talk their way through any obstacles. And the reason why these individuals are drawn to the dentist’s profession is the well known fact that they make rather nice pay (here’s one article about it).