Yet Another Anti-Patient

Dental Revelations Blog-24982

How on earth did I not remember this type of Anti-Patient? I guess it is all coming slowly (but surely) back to me after returning to work.

Before you read any further, it might be good idea to read my post Anti-Patient so you know what I am on about.

Anti-Local Anesthesia

Now, this type of patient is not so uncommon in the dental chair. Let me tell you about the two of the most typical situations I face.

Patient Case I

I am about to start the scaling and root planing and I can tell from the looks of the gum that it is going to be painful. I offer local anesthesia (LA) but the patient declines by saying:

“I once had such a bad experience with LA that I have not taken any since..”

Or

“Oh, I never take any LA, not even when I have a filling done.”

I explain that it will most likely hurt but the patient does not change his mind. Not even when I explain we could use topical LA (I use Oraqix) which would not require needles.

So I begin the treatment. The sonic scaler goes relatively well but when I begin to scale those deep pockets the patient is jumpy (as if somebody was poking his limbs with a needle), turns his head suddenly (exaggeratingly) and is kinda slowly sliding towards my lap as he’s pushing from the handles of the chair.

After I have nearly injured my own finger and patient’s lips for the third time because of the unpredictable motions and after I have three times asked patient not to move his head, I stop the scaling and tell the patient that I won’t be able to carry on unless he keeps the head absolutely still. Because it’s not safe. I offer the LA again and usually at this point they agree.

Patient Case II

The patient (who also just declined LA) keeps still throughout the treatment (scaling) and says she’s fine when I ask her if she’s ok  (multiple times). So naturally I carry on to finish the treatment.

Once the patient gets up from the chair she does not look happy and says

“It hurt a lot.”

Or

“Oh I hate having this done.”

Or

“It’s never hurt before.”

Soooo annoying! Did I or did I not offer you LA? Of course it hurts if you decline LA when it is recommended. And why would you say you are fine when you are not?

What is the most annoying in all this is that she will go and tell ten of her mates how horrible experience it is to have the teeth cleaned. Simple marketing rule – bad experiences you tell to ten people, good experiences to one. So unfair!

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Anti-Patients

Dental Revelations Blog-24982

I have a confession to make. I am not perfect as a dental professional even though my posts may give the expression that I do everything as we are taught at the dental school. I do my best but I have weaknesses as well.

Another confession. I sometimes feel quite overwhelmed by some patients’ way of arguing about the well researched facts on dental health. Banging your head against the wall is not fun in the long run and in our business it tends to make us cynical and worn out mentally.

Of course there are good days and bad days. On bad days I have thought about changing my profession to the one where I could sit between piles of paper and no-one to talk to (anyone care to hire me?). On bad days I have given up trying to convince the patient about cleaning between the teeth when I have faced a non-cooperative patient the fifth time that day.

Fine, carry on practicing your beliefs…

Sooner or later you will learn I was right…

It’s your teeth not mine…

This does not happen often, but I wanted to bring out the great mental load we have on our profession. We need to have sort of a mental radar on ALL the time so that we can find the right approach to each patient. As each patient is different. But there will be a patient that slips beneath our radar. I have come to conclusion that with these patients there is no right approach. I call these patients Anti-Patients.

There are at least 5 types of Anti-Patients that I have listed below. If a new one comes to your mind, please share it in the comment box.

Anti-Fluoride

When I interview patients on their first visit, one of my questions is:

Which toothpaste do you use?

The most common reply is:

Dunno… Anything they sell in the supermarket.

But if the patient is a health-conscious one, they know exactly which toothpaste they use. And it won’t be just anything from the supermarket’s shelf. They also know that often their beliefs in health can be found controversial amongst the health professionals.

So after they have told that they use the aloe vera toothpaste/herbal toothpaste or any other non-fluoride toothpaste, they will carry on explaining the reasons behind it with fists raised into boxer’s pose (not really, but you get the gist?).

The fluoride is toxic..

There is fluoride in the drinking water anyway…

The fluoride is linked to health problems like cancer…

I only listen, let the patient finish and then carry on to the next question on the interview. I leave the toothpaste issue until I have build up a little bit more trust and until I have examined the patient’s mouth.

I know what I am going to find especially when the patient has used non-fluoride toothpaste for a long time. In my experience about 1 in 1000 patients has oral hygiene habits that good that my interference is not needed. One in thousand! And the likelihood that this one patient is the one who uses the non-fluoride toothpaste is close to zero. This means that poor oral hygiene together with non-fluoride toothpaste results in decay. And that is what I am going to find from the anti-fluoride patient’s teeth.

A faint white line on the enamel of the tooth close to the gum line that is the first stage of the decay. They are still reversible lesions of decay but they will often get discolouration that ruin the aesthetics of the smile. Sometimes the decay is already beyond stopping and requires a filling.

As some anti-fluoride patients take the advice on board, many don’t. And the most disheartening are the ones who practice their anti-fluoride beliefs on their children as well.

Want to know more impartial information on fluoride? Click here.

Anti-Amalgam

Amalgam has been used for about 150 years on people’s teeth. Although we have passed the peak of the amalgam phobia long time ago, there are patients who still believe the amalgam is a health risk. They either do not want to have a new filling made of the amalgam or they want to have the existing ones to be removed and replaced with white ones.

Now, there are dentists who have dollar/pound/euro (or whatever your currency) signs in their eyes whenever this kind of a patient walks in. They do not discuss about the reasons behind the patient’s wish or what the operation of changing the amalgam into white fillings mean. Of course they don’t. They do not want the patient to change their mind.

When a patient expresses this kind of a wish to me, they get this info every time:

  • Composite filling is not an option for an amalgam. Instead the ceramic or gold fillings are and those are many times more expensive than amalgam
  • Amalgam can last a lifetime, whereas average lifespan of a composite filling is somewhere way under 10 years and ceramic’s just slightly higher
  • If there is no problems with the amalgam filling, there is no reason to replace it
  • Replacing many amalgam fillings with white fillings will affect the bite
  • There are no health risks with amalgam as a filling
  • If choosing to have all the amalgam replaced with white fillings anyways, find a dentist who does laboratory-made ceramic/gold fillings and uses proper protection when removing the amalgam fillings as it is the most hazardous part of the life of an amalgam filling

I am always happy when I learn on the next visit that the patient has changed his mind about having amalgam replaced. And for some reason the patient is relieved as well.

It makes me sad when beautiful amalgam fillings have been replaced with composite fillings. It just isn’t right.

Note for professionals: Do polish the amalgam fillings regularly as the darkened amalgam fillings work as retention for bacteria. This is important especially with patients who have advanced periodontal disease.

Anti-X-Ray

X-rays are the vital part of making a diagnosis for the dentists and certain conditions will go undetected without them.

Refusing to have an x-ray taken is just pure madness. It is almost the same as if you would take your car to the car mechanic and tell him that

There is something wrong with the car but do not look under the hood.

In the worst case scenario, your life might be at risk. In the matter of the car and refusing the x-rays.

Anyone concerned about radiation with dental x-rays should read this and simply trust the dental professional’s judgement on whether or not you need to have x-rays taken.

Anti-Safety Glasses

Why on earth would you decline using the safety glasses that are meant for the protection of your eyes? Beats me.

We drill at high speed just a short distance of your eyes and anything can fly out of the patients mouth – a piece of an enamel, calculus (tartar), a broken bur and all sorts of nasty bacteria and viruses. We use chemicals that are acidic when making a filling. None of these you want in your eyes, believe me.

“We should not treat a patient who refuses to use the safety glasses”, I was told on one of the health and safety courses. In ideal world yes. But when you work at a private practice it is totally different story. What do you think that would happen if I send a patient home for not using the safety glasses. No income for the practice and who is the blame? Me.

So we let the patient to refuse the use of the safety glasses and tell them to keep their eyes closed. But they never do, do they?

Anti-Everything-You-Say-or-Do

I know the fear of the dental visit can bring out the worst in people. But it is always frightening when a patient comes across as aggressive from the moment you call the patient in. They walk to the surgery, throw their belongings to the side table and almost jump to the dental chair with arms crossed. They

  • dismiss everything you say
  • do not take the safety glasses
  • are suspicious of everything you do and want to see every instrument you have
  • tell you that they do not want to have a lecture
  • ask when you graduated
  • tell you how another dentist/hygienist did things differently compared to you

Thank goodness these kinds of patients are rare. But when I am faced with this kind of a hostile situation, I speak only when it is absolutely necessary and just do my job. I am glad when the patient is gone and hope we never meet again. But there is an exception. You see sometimes a miracle happens somewhere between the polishing and goodbyes.

The patient that just moments ago was a manifestation of the devil is suddenly the opposite and full of questions about oral hygiene. “Now he wants advice!” is my thought when I have couple of minutes time left before the next patient. But I do not have a heart to ask the patient to leave when I realise that all the hostility was due to the fear of the dental visit. The amazing fear!


Want to know one more Anti-patient type? Click here for my post Yet Another Anti-Patient.