DentistsOur language and our actions are ways that we communicate to others. This article suggests that we analyze some of our interaction with patients from the perspective that what we actually communicate may not be what we intended.

One of those common techniques that I feel certain is only based on what we hope will result in the patient developing more effective home care is the use of disclosing solution or tablets. The deep pink color of the supragingival plaque illustrates its presence on the tooth surfaces and could be the basis for a patient understanding the need to effectively remove the plaque.

If the experience were only to share a biologic principal we would be on solid ground, but since patients typically regard the amount of stained surface as a grade, it could be a source of embarrassment for some patients. Would any member of the dental team want to use the disclosing substance several hours or later after their own flossing and brushing and ask others on the team to score them? Do any of us really expect to make an “A+”? I have asked for volunteers in workshops I have led to demonstrate this, and have yet to have any attendees jump at the chance. Used locally on a tooth or two or selecting a non-esthetic site, would certainly be more consistent with how we would want to be treated. How would any of us feel if we demonstrated the stain in the image provided here?

plaqueI also wonder what patients think when we prescribe “oral hygiene instruction.” To some we may seem to be assuming an element of their personal hygiene is deficient or we would not use that terminology. Do we really want them to conclude that we think they have ineffective personal hygiene? Describing cavities as dental disease and periodontitis as an inflammatory bone disease, allows me to offer to help a patient develop more effective home therapies for a disease.

Using the term “home therapy” in place of “home care” or “oral hygiene” techniques has consistently provided both clarity of purpose and value to many patients. Not surprisingly, after using the term “therapy” they often then ask for confirmation of effectiveness of their current techniques and/or coaching in developing enhanced skills. At a patient’s first appointment I weave into the preclinical dialogue the value of what they already accomplish at home. I ask if their primary intent is food removal for reasons of personal oral hygiene and cavity prevention and when they answer “yes,” I affirm the effectiveness of their efforts. I explain new science has recently discovered bacterial films on teeth that are much more difficult to remove than we have understood in the past. I describe the biofilms that are directly or indirectly responsible for damage to our hard and soft tissues.

Then I ask them if we could help refine their current skill set and use it to address the recently discovered need to consistently and frequently remove dental biofilms, would they then like to receive that training in a non-critical, non-judgmental atmosphere? I ask the propositional question “If your mouth could be healthier and you could become more knowledgeable about your oral health before we collaboratively make any strategic decisions about your ongoing care, would that appeal to you?” I have yet to hear a “no” or find that a patient was not at least interested in being healthier or better informed.

Every dental professional reading this article has a heart for their patients, which is one of the highest genuine compliments any of us can receive. We do our best to help patients make healthy decisions and we always hope we provide care consistent with each person’s best interest. Let me encourage all of us to be observant and to be sensitive to our patients’ reactions to the words we choose and the care we recommend. Our efforts to do so indicate the respect and compassion we have for each of them.

Michael J. McDevitt, DDS, is a Contributing Writer for Spear Education  


Commenter's Profile Image Pete D.
July 4th, 2016
Dear Dr. McDevitt, what a well written article, a consultant many years ago increased my awareness on terms that can evocate fear or negative thoughts in patients. Surgery vs. treatment. Waiting room. vs. reception area. x-rays vs. diagnostic films. . Cleaning vs. supportive periodontal care etc. etc As I read your article, I can remember patient's faces after discolosing their mouth. We always inform the patient's that we are using this to help us do a better job of removing the bacteria that is causing the disease in their mouth, We never use a score, or a judgement, and ask them if they would like to see. As a periodontist, it has been a struggle for me to have patient's understand, that periodontal disease is preventable with good home care and with inadequate home care disease is likely to occur. How to balance education and helping the patient own their disease while trying not to embarrass a patient, is certainly a challenge for me and your article will give me some tips to take back to my team. Dr, Peter Domagala- Visiting Faculty Spear Education.