Dental Secrets

Stephen T. Sonis

• Publisher: Elsevier
• Year: 2014
• ISBN:
  9780323262798
• Edition: 4
• Topic: Medicine
• Subtopic: Dentistry

Offering practical tips and expert answers to topics in dentistry and oral medicine, Dental Secrets, 4th Edition provides an ideal preparation tool for exams, clinical rotations, and board certification. A concise, illustrated Q&A format covers key areas such as oral pathology and radiology, periodontology, endodontics, restorative dentistry, prosthodontics, orthodontics, infection control, and oral and maxillofacial surgery. Written by Stephen Sonis and a team of expert contributors, this mini-reference makes it easier to prepare for real-world clinical scenarios and review for the NBDE and other certification exams.

• Over 2, 000 questions include concise answers for core topics in dentistry and oral medicine, providing valuable pearls, tips, memory aids, and 'secrets.'
• Question-and-answer format makes this the perfect review tool for certification exams, a clinical refresher, or a quick reference guide.
• Over 100 illustrations, tables, and bulleted lists highlight key information.
• Expert contributors share practical tips, answers, and secrets on safe and effective dentistry practice.

• UPDATED content includes the latest advances in the science and practice of dentistry, including CBCT, CAMBRA, new methods for diagnosing caries, mini dental implants, platform switching, early childhood caries (ECC), and more.
• NEW illustrations provide high-quality dental images.
• NEW two-color design highlights questions and other features such as tables, boxes, and bulleted lists, making it easier to find information.
• ThreeNEW contributors — Nathaniel Treister, Jennifer Frustino, and David Kim — provide fresh insight in the chapters on treatment planning and oral diagnosis, periodontology, restorative dentistry, and prosthodontics.

Chapter 1: Patient Management

The Dentist-Patient Relationship

Elliot V. Feldbau, and Kathy Kommit

Case Examples

After you seat the patient, a 42-year-old woman, she turns to you and says glibly, “I don’t like dentists.” How should you respond?

Tip: The patient presents with a gross negative generalization. Distortions and deletions of information need to be explored. Not liking you, the dentist, whom she has never met before, is not an accurate representation of what she is trying to say. Start the interview with curiosity in your voice as you cause her to reflect by repeating her phrasing—“You don’t like dentists?”—with the expectation that she will elaborate. Probably she has had a bad experience, and your interest gives her an opportunity to elaborate on that and to understand what she needs from you better. It is important to do active listening and allow the patient who comes to the office with some negative expectations based on past situations to express her thoughts and feelings. Therefore, you can show that perhaps you are different from a previous dentist with whom she had a negative experience, and you can communicate that you want this to be a more positive dental visit. The previous dentist might not have developed listening skills and left the patient with a negative view of all dentists. The goals in a situation in which someone enters the office with an already formed negative predisposition are to enhance communication, develop trust and rapport, and start a new chapter in this patient’s dental experience.

As you prepare to do a root canal on tooth number 9, a 58-year-old man responds, “The last time I had that dam on, I couldn’t catch my breath. It was horrible.” How should you respond? What may be the significance of his statement?

Tip: The comment, “I couldn’t catch my breath,” requires clarification. Did the patient have an impaired airway with past rubber dam experience, or has some long-ago experience been generalized to the present? Does the patient have a gagging problem? A therapeutic interview clarifies, validates, reassures, and allows the patient to be more compliant.

A 55-year-old man is referred for periodontal surgery. During the medical history, he states that he had his tonsils out at age 10 years and, since then, any work on his mouth frightens him. He feels like gagging. How do you respond?

Tip: A remembered traumatic event is generalized to the present situation. Although the feelings of helplessness and fear of the unknown are still experienced, a reassured patient who knows what is going to happen can be taught a new set of appropriate coping skills to enable the required dental treatment to be carried out. The interview fully explores all phases of the events surrounding the past trauma when the fears were first imprinted.

After performing a thorough examination for the chief complaint of recurrent swelling and pain of a lower right first molar, you conclude that given the 80% bone loss and advanced subosseous furcation decay, the tooth is hopeless. You recommend extraction to prevent further infection and potential involvement of adjacent teeth. Your patient replies, “I don’t want to lose any teeth. Save it!” How do you respond?

Tip: The command by the patient to save a hopeless tooth at all costs requires an understanding of the denial process, or the clinician may be doomed to perform treatments with no hope of success and face the likely consequence of a disgruntled patient. The interview should clarify the patient’s feelings, fears, or interpretations regarding tooth loss. It may be a fear of not knowing that a tooth may be replaced, fear of pain associated with extractions, fear of confronting disease and its consequences, or even fear of guilt because of neglect of dental care. The interview should clarify and inform while communicating a sense of concern and compassion.

With each of these patients, the dentist should be alerted that something is not routine. Each patient expresses some concern and anxiety. This is clearly the time for the dentist to remove the gloves, lower the mask, and begin a comprehensive interview. Although responses to such situations may vary according to individual style, each clinician should proceed methodically and carefully to gather specific information based on the cues presented by the patient. By understanding each patient’s comments and feelings related to earlier experiences, the dentist can help the patient see that change is possible and that coping with dental treatment is easily learned. The following questions and answers provide a framework for conducting a therapeutic interview that increases patient compliance and reduces levels of anxiety.

Patient Interview

• 1. What is the basic goal of the initial patient interview?

The basic goal is to establish a therapeutic dentist-patient relationship in which accurate data are collected, presenting problems are assessed, and effective treatment is suggested. The patient should feel heard and validated, which leads to a feeling of safety and trust.

• 2. What are the major sources of clinical data derived during the interview?

The clinician should be attentive to what the patient verbalizes (i.e., the chief complaint), manner of speaking (how things are expressed), and nonverbal cues that may be related through body language (e.g., posture, gait, facial expression, or movements). While listening carefully to the patient, the dentist can observe associated gestures, fidgeting movements, excessive perspiration, or patterns of irregular breathing that might indicate underlying anxiety or emotional problems.

• 3. What are the common determinants of a patient’s presenting behavior?
• • 1. The patient’s perception and interpretation of the present situation (the reality or view of the present illness)
  • 2. The patient’s past experiences or personal history
  • 3. The patient’s personality and overall view of life

Patients generally present to the dentist for help and are relieved to share personal information with a knowledgeable professional who can assist them. However, some patients also may feel insecure or emotionally vulnerable because of such disclosures.

• 4. Discuss the insecurities that patients might encounter while relating their personal histories.

Patients may feel the fear of rejection, criticism, shame, or even humiliation from the dentist because of their neglect of dental care. Confidential disclosures may threaten the patient’s self-esteem. Thus, patients may react to the dentist with rational and irrational comments, and their behavior may be inappropriate and even puzzling to the dentist. In a severely psychologically limited patient (e.g., one with psychosis or a personality disorder), their behaviors may approach extremes. Furthermore, patients who perceive the dentist as judgmental or too evaluative are likely to become defensive, uncommunicative, or even hostile. Anxious patients are more observant of any signs of displeasure or negative reactions by the dentist. The role of effective communication is extremely important with such patients.

• 5. How can one effectively deal with the patient’s insecurities?

Communication founded on the basic concepts of empathy and respect gives the most support to patients. Understanding their point of view (empathy) and recognition of their right to their own opinions and feelings (respect), even if different from the dentist’s personal views, help deal with and avert potential conflicts.

• 6. Why is it important for dentists to be aware of their own feelings when dealing with patients?

Although the dentist tries to maintain an attitude that is attentive, friendly, and even sympathetic toward a patient, he or she needs an appropriate degree of objectivity in relation to patients and their problems. Dentists who find that they are not listening with some degree of emotional neutrality to the patient’s information should be aware of any personal feelings of anxiety, sadness, indifference, resentment, or even hostility that may be aroused by the patient. Recognition of any aspects of the patient’s behavior that arouse such emotions helps dentists understand their own behavior and prevent possible conflicts in clinical judgment and treatment plan suggestions. It is important to strive to be as neutral and nonjudgmental as possible so that the patient can feel safe and trusting.

• 7. List two strategies for the initial patient interview.
• • 1. During the verbal exchange with the patient, all the elements of the medical and dental history relevant to treating the patient’s dental needs should be elicited.
  • 2. In the nonverbal exchange between the patient and dentist, the dentist gathers cues from the patient’s mannerisms while conveying an empathetic attitude.
• 8. What are the majo...