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Product Details
| ISBN-13: | 9781546205579 |
|---|---|
| Publisher: | AuthorHouse |
| Publication date: | 09/12/2017 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 146 |
| File size: | 278 KB |
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CHAPTER 1
PREVALENT HORROR STORIES ABOUT DENTISTS
There are as many horror stories about dentists as there are dentists. We seem to be the only professionals who are always told, right in our faces to boot, that we are disliked. It has in fact become the opening conversational piece in many dental offices. A lady, or a man, walks reluctantly into the operatory (dental office), looks around for a place to sit, although there is only one obvious chair for her to sit on (many times I have come into the operatory with a patient sitting on either my chair or the assistant's chair!). Of course the assistant should seat the patient, technically, but I have seen places where the assistant just takes the patient to the door of the operatory and asks the patient 'to sit in the chair' without indicating which of the three chairs in the room is for her. Finally the patient gets to sit, reluctantly and hesitatingly, in the appropriate seat in the patient's chair, and the first sentence she utters is: "I must tell you I hate dentists." And as if an after-thought, she quickly adds, "but it's not you personally." I have heard this so so many times that even though I think I understand, that it is just a crying out for help –'please, pretty please, don't hurt me', I still, after all these years, feel a little flicker of guilt and anguish when I hear it.
And then there are the men who, although will say this in a jocular manner, really mean the same thing by the humorous remark: "we don't want to hurt each other, do we now!" In my many years of practice, I have come to rationalize these utterances, rightly or wrongly, as coming from people who are primarily apprehensive and anxious about the impending surgery and really do not mean any harm. What I have always wondered, however, is what lasting effects these remarks have in the long run on the psyche of dentists who are bombarded with this jocular but subliminal debilitating verbal abuse every day. No one has done any studies to verify this but do these remarks, for example, have any connection with the observed fact that dentists are reputed to have the highest suicide rates among all professionals? And you still wonder why dentists are nuts, huh?
But probably the most prevalent horror story about dentists is the one about drilling teeth with inadequate freezing. I have heard these anecdotes so many times that now I listen to them without actually 'hearing' them, you know, where you are listening, but you are not there? Almost every patient has a story of the dentist who insisted on doing a filling without enough freezing. It is probably not an exaggeration to say that dentistry has changed a whole lot in the last thirty years. But have freezing techniques changed that much? The reason I am usually rather skeptical about all these accusations is that I am a lot older than many of these complainants so it is not that long ago when they must have had their dental work done, even as children. And I learnt what freezing technique I presently use about fourty something years ago and it still seems to be pretty adequate, from all accounts. It all seems to boil down not to the era but generally to impatient and rushed dentists, if all these accusations are true. But true or not, what I gather from these comments in my own work is for me to be as caring as I can and to the best of my abilities provide the needed treatment as comfortably and as painlessly as I know how.
I believe a patient should be able to draw the dentist's attention to the fact that the freezing is not enough. I feel it is just human and good sense to acknowledge the patient's feelings. In fact it is mandatory in my office "to let me know if the freezing is not deep enough so that I can add a little bit more to make it comfortable." Funny, but every time I have said this at the beginning of the work, which is with every surgical patient, I have always chuckled to myself, being constantly reminded of the announcement made on commercial airlines by the flight captains just before the flight. It has become so repetitious to the point now that I plan to record my instructions and have the assistant play it just before I start the surgery. "Lady (or gentleman), please fasten your seat belt. Your dentist today is Dr. T.F. (Tooth Fairy) Bruce. At any time, while I am working, if you find you need a little more freezing please don't hesitate to put your right hand up and I will stop to add a little more freezing to make you comfortable, (as if 'comfortable' can be used to describe a dental experience!) And by the way, have a nice day." This information is for me just as much as for the patient because somehow, personally, I am not able to perform as fast and as efficiently if I suspect that the freezing is inadequate. Usually, the body language of the patient in the chair will tell me if a little bit more freezing is warranted. And then if at that juncture, when I stop to add more freezing, the patient feels everything is fine, he will let me know. Moreover, I almost always enter into an agreement with each patient to put the right hand up (so that if they have any inclination to hit, I can stop them. I have a reason to my madness and I am also right-handed, I'll have you know); but it's a simple way to empower patients to signal me to stop whenever there is the need for more freezing. And I must tell my fellow dentists that adding more freezing to make sure the patient is comfortable does not mean you are incompetent. It just makes good surgical sense.
It does not work that well with my child patients, however, or I should say it works too well with them, and I am presently looking for a better way to let the child patients understand to let me know at any time if more freezing is needed by raising the right hand. So far, every time I have given this instruction to a child patient the child immediately shoots a hand up as if to see if I really mean what I said. And coming to think of it, the child is right. Didn't I say "at any time"? And they figure right at the beginning is as good a time as any. Funny, kids. The other problem is that the hand comes up very frequently throughout the procedure, at the slightest hint of even a detectable change in the pitch of the drill. You stop and ask them if they need more freezing, and a lot of times the answer, with a very straight face, is No! with a sideways shake of the head.
But I have also come to the conclusion that many dental visits are or were not as horrible as people have painted the occasions to be. In a lot of cases the patient gives you horror stories abound in the marketplace about dentists, only to 'sensitize' the dentist to their impending situation. One person says this, and this person says it to another person and before you know it the harmless incident has been so embellished and is now such a horror story.
Like, for example in this incident. The dentist has just finished taking five badly decayed teeth on the same side of the mouth out of a 45 year old man. As the gentleman walks back into the reception area, a nosy acquaintance waiting her turn turns around and inquisitively asks:
"What did you have done?"
"I had five teeth removed," replied our friendly neighbour.
"Boy, that must hurt!," offered the nosy 'friend'.
"Actually, no it didn't hurt at all." Calmly, the gentlemen, without malice, this time really deflates her balloon. "You know, that has never bothered me!"
Good for you! You see, some people always have to appear more knowledgeable than others when it comes to this dental thing. But what these rumour mongers, like our nosy neighbour, have to remember is that not everyone experiences events the same way they do. To some people, dentistry, believe it or not, offers a very beautiful experience. I know people who have conditioned themselves to liken the vibration of the slow-speed drill to the calming effect of a vibrating pillow and therefore don't find it annoying at all. In fact, it makes them snooze off. So you see, forcing your personalized, embellished and prejudicial opinions on others may prove disastrous on your frail ego if you tango with the wrong person. And the more you do this the more you reveal some notions which others around you may come to find boring and controlling should their experience happen to be in fact complimentary and positive.
The bad news is that only the few incidents of bad treatment at the hands of a few dentists get rumoured around. The good news is that I also know that good dentistry also gets rumoured around, so there is hope for dentists yet to recover from years of bad publicity.
Dentistry has changed and is still changing. Dentists are, in my opinion, very compassionate people trying to do what they can to alleviate pain. But many people, even when subsequent experiences happen to be painless, cannot believe their luck and will still adhere to their first impressions (because they cannot believe it can be so good an experience) and therefore deny themselves and others the enjoyment of a beautiful experience.
CHAPTER 2
MAKING THE APPOINTMENT
One of the nightmares of the dental receptionist is the patient on the phone who wants to know what a dental filling costs. It is impossible to answer this question without first going into the whole dental anatomy of the tooth. The receptionist cannot answer this question because the dental fees for fillings depend on many factors. Let's go through one incident for you to see what I am talking about.
Krr — krrr — krrr
RECEPTIONIST: Hello! Dr. T. F's office! (from here on we will use Dr. T.F. for Dr. Bruce)
PATIENT: I would like to have a tooth filled – could you tell me how much it will cost to fix it?
RECEPTIONIST: (eh, pausing with frustration in her voice) – Maam, it is difficult to give you a quote. Would you like to come in for the dentist to see you first? (a big sigh but off the record–)
PATIENT; (impatient) all I want is just one filling (Little does she know! Now here we go —)
RECEPTIONIST: Ok, Maam, is it a front tooth or a back tooth? (The receptionist hears the patient muttering something like –What? — in the background so she goes on to explain) — I mean, is the tooth you want to have fixed in the front or in the back of the mouth?
PATIENT: Oh, I don't know – it is one of the back teeth — eh, in the middle, I think. Wait, let me see. (After what seems like ages) – it is one of the smaller back teeth in the middle, yes.
RECEPTIONIST: (wondering whether the patient is in the bathroom looking in the mirror or just peeking through her compact mirror) – Maam, on which surface or side of the tooth is the cavity?
PATIENT: The surface – what do you mean? And cavity, you mean the chip on my tooth, what cavity?
RECEPTIONIST: (almost thinking out loud) I mean, is the hole on top or on the side of the tooth?
PATIENT: There is a big hole on the top and my tongue keeps getting at it. My tongue is all raw from rubbing it.
RECEPTIONIST: — (fighting the urge to tell Maam to get her blasted tongue out where it does not belong – you can't control your tongue, can you? She takes a deep breath as she has been taught to do in times like this and manages to add –.) Does the hole involve only one or two surfaces of the tooth? –(now trying to compose herself) — sometimes it may appear like it is on only one surface but it may involve another surface in which case the fee is for two surfaces.
PATIENT: Oh, I see.
RECEPTIONIST: Now, do you want a white filling or a grey filling?
By this time, I am sure the patient would have already hung up the phone and probably gone to another dental office. But to reach a specific quote of a fee for any specific filling on a tooth the receptionist and the dentist have to consider all these variables. The easiest way is to make an appointment for consultation at which time a specific examination will be done and a fee quoted.
The Emergency Appointment
Because of time constraint, most dentists will generally restrict an emergency appointment to just what it says –an emergency visit. All too often a patient will show up for an emergency appointment but then will decide unilaterally that whilst he is in the chair that the dentist should do this tooth and then that tooth all in that one appointment. Much as most dentists that I know would like to do everything the individual may need done (after all he is making more money by doing so) many factors may prevent him from obliging the patient.
This ruse is particularly employed by individuals who have stayed away from the dentist for years and now have to go because some teeth have 'bombed out' (rotten away) and now need treatment in a bad way. Other times it is the patient who admits to you he is so petrified of dentists (read, "dental treatment") that he wants everything done all today, now that 'you've got me in the chair.'
One of the problems with some dental emergencies is that the status of the tooth may in fact preclude a more definitive treatment at the time it is presented. The dentist may need at this stage to provide a palliative (soothing) treatment for now and put the tooth on observation for a prescribed period before a more definitive treatment can be scheduled. Of course there will be a fee charged for this phase of the treatment as well as when the final treatment is provided.
Then consideration has to be given to those people who have already made their regular appointments. In many busy offices an emergency appointment is usually sandwiched between regular appointments. It is therefore not fair to let the legitimate appointment wait and wait while the emergency appointment stretches into hours. In my office all emergencies are advised that I will have time to alleviate the pain; if there is more time, however, sure, we can do more work.
There have been instances where it would also have served both the emergency patient and myself well to have kept strictly to this emergency rule. There have been some occasions where a patient suffering with an excruciating acute phase of an abscess, should have been given antibiotics and dismissed to go home for about a week or so before returning for the extraction. With empathy and an obvious appreciation of the situation I had gone ahead in many of these situations to freeze the tooth and ready it for extraction only to find that all attempts at the freezing (the tooth) ended up inadequate. I don't know how other dentists feel but I have always felt very frustrated and disappointed (not mentioning the patient's) when all attempts at freezing a tooth fail. One redeeming aspect though is that all that freezing helps reduce the pain from the bad tooth so at least the patient is a little more comfortable than when he came in. But it still does not solve the underlying problem.
Dentists, typical surgeons than they are, are often reluctant to leave a tooth alone and allow the situation to resolve reasonably with a prescription before putting the forceps to the tooth. And they cannot be blamed because patients always expect a dentist 'to do something' at each visit. But then, surgeons have always been blamed for being scalpel happy anyway. And you feel like you have not done enough for the patient who has come to you seeking relief. It appears that in dental surgery you really do not spell 'relief' with a prescription! In dentistry, you give real relief only when you've done the surgery for relief of the pain. Many a time a prescription is met with the retort — "is that all?" or "You are not doing anything today?" As if the last 10 minutes spent looking in the mouth and planning the treatment was "nothing".
Toothaches And Self-Examination
In many cases the offending tooth at a toothache appointment can be easily identified. In some cases, however, the patient is not able to identify which tooth is causing the problem. It is a widely-observed truism, as most patients and dentists alike will well attest, that toothaches have a notorious reputation of vanishing just when the patient presents at the dentist. This particular tooth may have been bothering the dickens out of the patient for days but just when the patient shows at the dental office the tooth with the ache takes the fifth amendment and decides to cool it! Of course sometimes the patient would have taken some pain-killers prior to the appointment and that helps sooth the tooth some.
(Continues…)
Excerpted from "Understanding the Dentist"
by .
Copyright © 2017 Ishmael Bruce.
Excerpted by permission of AuthorHouse.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface, xi,
About The Dentist, xiii,
Introduction, xvii,
Chapter 1 Prevalent Horror Stories About Dentists, 1,
Chapter 2 Making The Appointment, 6,
Chapter 3 Consultation And Examination, 13,
Chapter 4 Diet, Nutrition And Cavities, 30,
Chapter 5 Dental Disease – The Three Main Types, 36,
Chapter 6 Dentistry And Pain Control, 79,
Chapter 7 Root Canal — An Undeserved Bum Rap, 86,
Chapter 8 Crooked Teeth, Braces And Orthodontic Work, 98,
Chapter 9 False Teeth. 'Denture', 'Plates' Or Falsies, 105,
PROLOGUE, 119,
USEFUL REFERENCES, 125,