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Advocacy for Oral Health and Sustainability at the United Nations – Academy of Dentistry International takes a Unique Role

Posted By Stephanie Wilhelm, Tuesday, August 14, 2018
Updated: Wednesday, August 15, 2018

Press Release

Academy of Dentistry International

Immediate Release

Advocacy for Oral Health and Sustainability at the United Nations – Academy of Dentistry International takes a Unique Role

New York, August 14, 2018. The Academy of Dentistry International (ADI) was granted Special Consultative Status to the Economic and Social Council of the United Nations (ECOSOC) on 24 July 2018. This consultative status is unique for an oral health-related membership organization and as such, enables a loud and direct voice for global oral health to be heard at the highest levels of the United Nations’ member states, the UN Secretariat and Agencies.

As an NGO with Special Consultative Status, the Academy will submit statements and provide advice on matters related to its areas of competence –

·         Promotion of oral health as a critical element of general health;

·         Role of oral health in the achievement of the UN’s Agenda for 2030 – the Sustainable Development Goals; and

·         Social responsibility and volunteerism of the dental profession.

This unique status is granted at a pivotal time for oral diseases when over half the world’s population have no access to even basic and essential dental care. The ‘Global Burden of Disease Studies’ funded by The Gates Foundation report that untreated dental decay in permanent teeth is the single most prevalent disease on the planet, severe chronic periodontal (gum and underlying bone) disease the sixth most prevalent and untreated decay in deciduous (‘milk’) teeth the 12th most prevalent. According to the World Health Organization (WHO) 60% to 90% of children worldwide have dental caries. Unfortunately, oral diseases affect the most vulnerable individuals, children, elderly and members of racial and ethnic minorities. The economic burden of these preventable diseases is severe. The indirect costs, such as time away from school and work, amount to more than US$140 billion per year, ranking the indirect costs of oral diseases among the top 10 causes of death. The World Oral Health Report (published by WHO) concluded that oral disease is still a major public health problem in high-income countries and the burden of oral diseases is growing in many low- and middle-income countries. Oral diseases are linked to diabetes, heart disease and stroke, and pre-term low birthweight babies among other conditions. Common risk factors for many of these diseases include sugar, tobacco, alcohol, lack of hygiene, unsafe water, and lack of injury prevention. There is a clear social gradient to the inequalities and disparities in oral health, and  the social determinants for oral diseases are common to many other Non-Communicable Diseases.

In the build-up for this unique role the Academy, together with many other civil society organizations, has submitted statements to the forthcoming High-level Meeting on Non-Communicable Diseases to be attended by heads of State and Government during the 73rd session of the UN General Assembly in September 2018.

The Academy’s mission is brought to life through the service of its members in volunteer work and oral health projects serving communities in need. The ADI spearheads social responsibility among the oral health community supporting its members and others to design and deliver health programs, and to provide advice on oral health to governments and other NGOs worldwide with focus on the under-privileged and under-served. Through a number of its members, the Academy has close working relationships with the WHO Global Oral Health Programme. The President of ADI, Dr. Gerhard Seeberger, a dentist from Cagliari, Italy, views this new status as a major game-changer for the reductions in oral diseases and their harmful effects on general health and quality of life.

“As oral health professionals we need to talk less among ourselves, and truly reach out to Governments and other NGOs within the health sector and beyond, to work together to make health and improved well-being  a reality for all peoples. Special Consultative Status brings the call for essential oral health and disease prevention closer toward achievement of the SDGs and the UN’s 2030 Agenda - Transforming our World.”

      

The designated representative to the UN on behalf of the Academy of Dentistry International is the Academy’s Vice President for International Affairs, Dr. David Alexander a  specialist in dental public health and the study of oral diseases. In describing the goals for the Academy with ECOSOC, Dr. Alexander added:

“We are strong supporters of the Sustainable Development Goals and put significant focus on a broad number of the goals which together will not only help prevent oral diseases but promote health and well-being in general. Currently the Academy is the only voice for oral health within ECOSOC and we hope others will join us and align around common goals for the betterment of mankind. It’s time to stop the needless suffering from these preventable diseases.”

About the Academy of Dentistry International

The Academy of Dentistry International is a global network of over 3000 oral and other healthcare professionals in more than 80 countries around the globe dedicated to the improvement in the oral health and quality of life for citizens of every nation. As an international honor society, ADI supports and undertakes service projects for the health and welfare of the underprivileged, underserved people of the world and advocates for the 2030 Agenda – Transforming our World: the Sustainable Development Goals, rather than the needs and personal interests of members. See www.adint.org

 

Media Contacts:

Mr. Fred Herbst (Germany) Chair, Public Relations, ADI                                                                                            

ChairPublicRelations@adint.org                                            

+49 172 6900469                                                                       

 Dr. David Alexander (USA) V-P International Affairs, ADI

david@appoloniaglobalhealth.com

+1 732 484 0582

Central Office

Academy of Dentistry International

3813 Gordon Creek Drive

Hicksville, OH 43526  USA

info@adint.org

+1 419 542 0101

Tags:  ECOSOC  SDG's  UN  United Nations 

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Rule 5: 6 E’s

Posted By Stephanie Wilhelm, Wednesday, July 25, 2018
The Basic Rules of.....

Basic Rule 5: 6 E's

When I first started to read about Dr. Earl Pound’s removable prosthodontic technique what immediately became apparent was how organized he was with his patient care. His organizational skills were such that he made removable prosthodontics a predictable procedure or at least as predictable as one could make such a discipline. He did this by having multiple steps and appointments with each one obviously being a precursor to the next but also involving the patient in the process along the way. This had the effect of doing two things. Firstly, the patient was apart of the process and could put their input in as required or desired. If they were agreeing with each step along the way then a successful outcome for treatment was more or less assured. What a relief to know we are on the right track, isn’t it! Secondly, and most important, if the patient was not satisfied with the process no matter what the cause, the services could then be terminated. Wow. Imagine, your half way threw treatment and you leave on pleasant terms. Why was this possible? Because before treatment commenced he followed the 4 E rule (I have added two more “E”‘s to make it the 6 E rule).
 
The E’s are:
1. Evaluate
2. Educate
3. Empower (my “E”)
4. Estimate
5/ 6. Enter or Exit (Pound had Eliminate)
 
The process of the E’s means that we are thorough with our patient interviews, case work-up, and case treatment planning and execution. By making the patient an equal partner in the process, ie. co-discovering, with us we are working towards a common goal like a team.2-4 We are up front with our patients with regards to treatment options, treatment length of time, costs, and efficacy. There are no surprises. And we expect to get renumerated at each appointment, just as Dr. Pound did. Dr. Pound received a fee at each appointment so that if services were terminated he was not out of pocket, the patient paid for what was done to that point, and the patient left the practice knowing full well that the pre-treatment contract had been honoured. Pretty smart. This concept can be applied to 21st century dentistry be it comprehensive fixed or removable prosthodontics, or just the routine everyday basics.

In my practice I follow the 6E’s. We thoroughly evaluate. There are no exceptions to this rule. Then we educate. Remember Basic Rule 2. Empowering of the patient results whereby they become a participant in their own care. Furthermore, this education process is not only about our diagnosis, treatment options, and empowering but also about fees and termination of services. We make each step of the way sequential and progressive such that records and treatment to date can be picked-up and continued at another practice of choice if in the unlikely event that “E” #6 (exit) occurs. We insure also that our fees have been looked after as well to this point.

A good example of our approach to comprehensive oral rehabilitation is the common way we provisionalize. In generalized moderate wear, erosive cases we frequently directly bond with hybrid composite; we like to call this the “prototype phase”. We do our thorough examination and evaluation followed by a thorough education of etiology, risk factors, treatment options, and efficacy. Costs are estimated and agreed too. We then perform our diagnostic provisional “prototype” phase (i.e. we have entered (“E” #5) into the treatment phase; in this example we bond establishing form, function, and vertical dimension re-establishment (Figures 1-3).

Figure 1

Figure 2

Figure 3

Figures 1-3: Composite bonding done in one appointment reestablishing form and function to the stomatognathic system.

This can usually be done in maximum one appointment per arch. At this point we have accomplished the first 5 E’s and have been renumerated. We can then proceed to the definitive restorative phase with the material of choice (gold or porcelain) at our leisure (ie. reenter (“E” #5) the relationship again) or services can be terminated depending on the circumstances (ie. exit (“E” #6) the relationship). Therefore, treatment has been predictable and stress free.

The 6 E’s offer another vehicle to optimize patient communication and interaction. The 6 E’s also just make good business sense. As oral healthcare providers we dance a fine line between professionalism and business. Nevertheless, a high regard for professionalism coupled with business acumen will ensure that we keep the busyness that us top professionals deserve.

Further Suggested Reading and References:
1. Pound E. Personalized denture procedures: dentist manual. Anaheim: Denar Corp.; 1973.
2. Roth SR. ProSpective volume one. Reclaiming the passion of dentistry. Seattle: ProSynergy Press; 1993.
3. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
4. Roth SR. ProSpective volume three. Advancing the profession of dentistry. Seattle: ProSynergy Press; 1996.

Tags:  Basic Rules  Racich  Rehabilitation  Treatment 

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India Chapter presenting Global Conclave Oct 6-8, 2018

Posted By Stephanie Wilhelm, Wednesday, June 13, 2018

The ADI India Chapter has organized a huge program of speakers presenting a wide range of CE! Please come and join ADI in Lucknow! Topics include Zirconia Implants, CAD-CAM, Regeneration and Esthetic Dentistry as well as Volunteerism and the Global Burden of Oral Disease on whole body health. Please plan to attend!

View full size flyer HERE

Registration is through the India Chapter at www.adiindia.net (This link takes you to another website.)

 

Tags:  CAD-CAM  CE  Estehtic  Inda  Lucknow  Regeneration  zirconia 

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Rule 4: What Could Go Wrong?

Posted By Stephanie Wilhelm, Friday, April 13, 2018

The Basic Rules of …..

Basic Rule 4: What Could Go Wrong?

 

When we really stop and think about it, what could go wrong with our oral rehabilitations and why? The answer I break down into three main areas: diet, hygiene, and parafunction. All three of these etiologies are patient preventable only. We act as the facilitators of dental education and patient oral care. That is why excellent communication and rapport are essential before embarking on a major undertaking such as an oral rehabilitation. Let’s now take a look at these three etiologies.

Dr. John Kois has championed the concept of risk factors and assessment for restorative and prosthetic dentistry. This is a profound concept and one that must be completely assessed before treatment commences. Dr. Kois discusses risk assessment in the areas of esthetics, occlusion, and periodontics for example. I agree with his approach.1-3  When we look at risk factors especially post treatment with an eye to their effect on oral rehabilitation longevity we can readily appreciate that a non-compliant patient will doom our efforts. I can attest to this. The saying “good judgment comes from a lot of experience and a lot of experience comes from a lot of bad judgment” I am sure we have all learned the hard way. In fact, a patient that refuses to participate in effective personal and professional oral hygiene care will undoubtedly have future problems or compromises with their oral health. Root caries, periodontal issues, and esthetics (eg. staining) to mention a few. The patient has to be advised pre-treatment on a lifetime of maintenance requirements. This is documented in their file and the patient is to be reminded of this if they are found to be waning.

Diet is another source for failure. Specifically, sweet intake. The patient needs to be educated on the relationship between sweets and caries and the significance of the frequency verses the volume of consumption. The patient also needs to appreciate that sweets are more than just chocolate and candies. There are many sources of sweets that the patient might not realize that are damaging, such as fruits or sports beverages (sweet/ food breakdown product “acid” attacks or acidic substances).4,5 Age and the associated decline in salivary flow also require explanation. Strategies to offset lifestyle decisions can then be formulated. Protection with daily fluoride rinses or stimulation of salivary flow with sugarless gum or lozenges could be introduced. Once again, this is documented in the patient’s file and they are to be reminded of this if they are found to be waning.

The third and most significant reason for oral rehabilitative failure is parafunction, better described as bruxism.6 We have known for quite some time that a patient’s teeth are never to be together unless they are chewing or swallowing.7 A patient’s teeth might touch for a split second when they chew or they might touch when they swallow (my teeth do not touch when I swallow). We all have patients that ask how long their new restorations will last or what kind of guarantee I will give them. My standard response is “I will guarantee the work for the rest of their life but only on one condition - as soon as their teeth touch once, the guarantee is off.” This of course is unrealistic and somewhat of a sarcastic response but it nevertheless gets the patients attention and drives this point home. Keep your teeth apart! Isn’t this the first thing we tell TMD (temporomandibular disorder) patients to do? Oral rehabilitative patients are no different. For those patients that brux at night or who just want to protect their investment while they sleep, it is a simple task to fabricate a full coverage hard acrylic maxillary orthotic. It’s that simple.8

Diet, hygiene, and bruxism. Make the patient aware of these three vices and we are well on our way to a successful post-treatment scenario.9 Failure to properly educate and monitor these three etiologies will be your undoing.

Further Suggested Reading and References:

1. Kois Center. https://www.koiscenter.com/  info@koiscenter.com

2. Kois JC. The restorative-periodontal interface: biological parameters. Periodontol 2000 1996;11:29-38.

3. Malament KA, Socransky SS. Survival of Dicor glass ceramic dental restorations over 14 years: part 1. Survival of Dicor complete coverage restorations and effect of internal surface acid etching, tooth position, gender, and age. J Prosthet Dent 1999;81:23-32.

4. Coombes JS. Sports drinks and dental erosion. Am J Dent 2005;18:101-4.

5. Lussi A, Hellwig E, Zero D, Jaeggi T. Erosive tooth wear: diagnosis, risk factors and prevention. Am J Dent 2006;19:319-25.

6. The glossary of prosthodontic terms. J Prosthet Dent 2017;117 (5S):e1-e105

7. Lundeen H, Gibbs C. Jaw movements and forces during chewing and swallowing and their clinical significance. In: Advances in occlusion. Boston: John Wright PSG, 1982. p. 2-32.

8. Racich MJ. The basic rules of occlusion. Markham: Palmeri Publishing; 2012.

9. Racich MJ. The basic rules of being a dental patient. Markham: Palmeri Publishing; 2016. 

Tags:  Basic Rules  Racich  Treatment 

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ADI Foundation co-sponsors "International Volunteer Project Workshop: Exploring Challenges & Developing Best Practices

Posted By Stephanie Wilhelm, Wednesday, March 21, 2018

The ADI Foundation is proud to co-sponsor the ADA Foundation's International Volunteer Project Workshop: Exploring Challenges and Developing Best Practices

This one-day workshop is designed for groups and institutions that are already involved in planning, directing, or implementing international volunteer dental projects dedicated to either the provision of care or training. The workshop will include presentations by keynote speakers Dr. Francis G. Serio and Dr. David Frost, followed by breakout groups that will discuss the myriad challenges of these projects and develop best practices.

May 11, 2018

For more details: www.adint.org/event/IntlBestPractices2018

 

Tags:  ADA  Best Practices  Volunteerism 

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Dental Asia Jan/Feb issue features ADI's "Global Burden of Oral Disease" symposium.

Posted By Stephanie Wilhelm, Wednesday, March 14, 2018
Dental Asia Jan/Feb 2018 issue featured an article on the ADI's "Global Burden of Oral Disease" Symposium. Click the link to read the article on the right page. Dental Asia Jan/Feb 2018

Tags:  Dental Asia  Global Burden 

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Rule 3: 3 Reasons for Treatment

Posted By Stephanie Wilhelm, Tuesday, December 5, 2017

Basic Rule 3: 3 Reasons for Treatment

People seek dental treatment for three main reasons: appearance, comfort, and function. Dr. Earl Pound spoke and wrote about this concept decades ago and in today’s supercharged world of cosmetic dentistry these words still hold as true now as they did back then.1 Dr. Pound was a removable prosthodontist who realized that the main reason that people sought out his services was for appearance, however, he also realized that the patients would never be happy with their appearance unless they were comfortable and functioning satisfactorily. We see this often in our practices. A good example is a procedure such as anterior veneers. Let’s say for example that a patient has some cervical temperature sensitivity after cementation of some freshly placed maxillary central incisor conservative laminates. Chances are that the patient will inspect their new restorations to possibly find a minuscule amount of root exposed on one of the teeth. A minor discomfort issue might then escalate to an appearance concern. On the other hand, let’s imagine that one of the new veneers is contoured incorrectly in the incisal one-third such that phonetics (ie. function) is altered. They are unable to say “F” as they did before. The patient might once again inspect their new restoration closely and once again an appearance concern might ensue. It is of critical importance therefore to listen to patients’ chief concerns and although cosmetic or esthetic priorities quite frequently top the list, the prudent practitioner must identify discomfort and dysfunction considerations first.

Discomfort concerns are either of an acute or chronic nature. The dental profession has become very proficient over the last century in handling patient acute pain situations. Prompt, efficient care is important and we can thereby move forward with our treatment in a timely and sequential manner after we address the acute concern.  Chronic pain is another matter. It’s as if the average practitioner runs for the hills when confronted with a patient or patients with conditions such as long term TMD (temporomandibular disorders). Interdisciplinary care is widely preached and encouraged by academics and leading clinicians but sadly this aspect of it is commonly ignored. More frequently the sexier and more lucrative cosmetic dental disciplines get the limelight unfortunately.2 There are many fine, contemporary textbooks available that cover the topic of patient discomfort, that are easy to read and allow immediate clinical application.3,4 Please avail yourself of this literature or refer your patient to other health care providers in a timely fashion in order to provide optimal care and service for your patients in an evidence-based manner.

Dysfunction is multifaceted and it also needs to be definitively addressed as well before moving forward with oral rehabilitative treatment, comprehensive or not. Dysfunction can be psychologic, physiologic, anatomic, behavioral, or pathologic. We have to identify which one it is and either structure a program to deal with it or refer to another medical or dental health care provider. If the dysfunction is related say, to bruxism, then patient education and appropriate follow-up (ie. evaluation, differential diagnosis, and preliminary treatment plan) is indicated. For bruxism as an example, the patient would be educated on diurnal bruxism (ie. “keep your teeth apart”) and for sleep-time they would be advised that bruxism is now considered a sleep movement disorder.5 The later would be managed with a sleep-time only orthotic use and referral to a sleep clinic for assessment would be offered.6 Oral rehabilitation could then proceed following The Basic Rules of ...

Appearance dentistry is driving the dental industry today with unprecedented demand for cosmetic services. I hope that I don’t have to remind you that esthetic and cosmetic dentistry are not one and the same. Cosmetic dentistry can’t always be made esthetic but esthetic dentistry can always be made cosmetic. Cosmetic is defined as “superficial measures to make something appear better”, whereas esthetic is defined as “pertaining to a sense of the beautiful”.7 It’s esthetic dentistry then that will make our patients happy with their appearance more times than not. There are many books available to help clinicians understand and practice smile design and facially generated treatment planning that is highly esthetic (and cosmetic if the patient so chooses). 8-14 This essay series will address esthetic dentistry in detail as we go through The Basic Rules.

 Three Main Reasons for Treatment:  Three Main Reasons for
Restorative/Prosthodontic Failure:
  • Appearance
  • Function
  • Comfort
  • Diet
  • Hygiene
  • Parafunction

Knowing the three main reasons why patients come to our office is an essential overall concept to understand, but defining what could go wrong with our oral rehabilitations and why, is mandatory. The answer I break down into three main areas:  diet, hygiene, and parafunction. All three of these etiologies can be prevented only by the patient. Poor dietary choices, bad hygiene, and relentless bruxism are three vices to make our patients aware of and if we can, then we are well on our way to a successful post-treatment scenario. We act as the facilitators of dental education and patient oral care. Failure to properly educate and monitor these three etiologies will be our undoing. That is why excellent communication and rapport are essential before embarking on a major undertaking such as an oral rehabilitation. 

Dr. Pound was right about appearance, function, and comfort. Dr. Pound also developed and enhanced a total body approach, not just the teeth and smile, to his patient care experience by discussing with patients general health guidelines many of which are standard today. He discussed with his patients the importance of exercise, diet, vitamin and antioxidant protocols. When his patients came to him with one of the reasons for treatment, he dealt not only with their chief concern, but he also gave them a whole lot more and never forgot that the patient would never be happy with their appearance unless they were comfortable and functioning satisfactorily.

Further Suggested Reading and References:

1. Pound E. Lost – fine arts in the fallacy of the ridges. J Prosthet Dent 1954;4:6-16.
2. Roblee RD. Interdisciplinary dentofacial therapy: a comprehensive approach to optimal patient care. Chicago: Quintessence; 1994.
3. McNeill C. Science and practice of occlusion. Chicago: Quintessence; 1997.
4. Okeson JP. Orofacial pain: guidelines for assessment, diagnosis, and management. Chicago: Quintessence; 1996. 
5. Blanchet P, Rompre P, Lavigne GJ, Lamarche C. Oral dyskinesia: a clinical overview. Int J Prosthodont 2005;18:10-9.
6. Racich MJ. Predictable fabrication and delivery technique for full-coverage hard acrylic non-sleep-apnea dental orthotics. J Can Dent Assoc 2006;72:233-6. 
7. Flexner SB, ed. The Random House dictionary of the English language. 2nd ed. New York: Random House; 1987. 
8. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition. A biomimetic approach. Chicago: Quintessence; 2002.
9. Chiche GJ, Aoshima H. Smile design: a guide for clinician, ceramist and patient. Chicago: Quintessence; 2004.
10. Fradeani M. Esthetic rehabilitation in fixed prosthodontics. Vol. 1 & 2. Esthetic analysis; Prosthetic treatment. Chicago: Quintessence; 2004, 2008.
11. Racich MJ. The basic rules of oral rehabilitation. Markham: Palmeri Publishing; 2010.

12. Racich MJ. The basic rules of occlusion. Markham: Palmeri Publishing; 2012.

13. Racich MJ. The basic rules of facially generated treatment planning. Markham: Palmeri Publishing; 2013.

14. Racich MJ. The basic rules of being a dental patient. Markham: Palmeri Publishing; 2016.

 

Tags:  Basic Rules  Racich  Treatment 

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Rule 2: Patient's Wants and Needs

Posted By Stephanie Wilhelm, Friday, August 11, 2017

The Basic Rules of …..

Basic Rule 2: Patient’s Wants and Needs

 

We all have wants and needs. Needs are necessities or obligations. Life rolls along a lot smoother if our needs are taken care of and we are not in “dire need” of the basics of life. Wants, on the other hand, are desires or wishes. What then do our patients want/need? It is critical that we identify their wants/needs before we embark on comprehensive care (Figure 1).

 
 Figure 1: We must understand our patient’s wants and needs

 

Sandy Roth in her book “Defining The Mission of Dentistry” explains that every patient is unique and every patient will always make a better decision for themselves.1 This holds true whether it is wants or needs based. Our job is to act as consultants and help our patients clarify their goals all within the confines of their reality, our core values, and accepted dental standards of care.2,3 We listen carefully to our patients in our initial interview and we define what the patient qualifies as a need and what is qualified as a want. We optimize the placebo effect (Basic Rule 1) by realizing that “everybody wants to be treated like a somebody”. Needs could be pain relief or cosmetic anterior tooth replacement. Wants could also be cosmetic anterior tooth replacement, for example a fixed partial denture, or replacement of non-tooth coloured restorations with tooth coloured. Although it is tempting to do what the patient wants as a priority, that approach might come back to haunt us later in the relationship. The patient has to be cognizant of the delicate wants/needs balance and make wise, customized decisions on the information provided.4,5 Clearly we need to address the patient’s chief concern (want or need) first, but it is essential that the patient’s needs are addressed as quickly as possible. The wants, after clarification and after realistic expectations have been set, are then addressed.

 

I don’t know about you, but we find that the more time we spend consulting with a new or existing patient, the fewer problems we have. We want to find out as much about our patients wants and needs to better facilitate their decision making. We consult as often as the patients’ requests. We keep the consultation visits to under an hour. Usually all that is required is just one consultation appointment. It’s probably because we have set in our minds that we are not in any hurry that it only takes one consultation. Having stated this, occasionally we might see the patient three or four times. Relationship building and clarification of patients’ wants and needs are too important to be rushed. Please do not forget that with each consultation we also thoroughly document what transpired.

 

In our practice our patients’ chief concerns are respected, be it needs or wants based. We are not foolish about this approach and it does have its limitations. For example, a patient presents with a chief concern of a cosmetic anterior tooth replacement, say a fixed partial denture, even though the patient in question has posterior edentulous areas with associated bite collapse. This is wants based. A needs based solution of posterior stabilization first with anterior fixed partial denture provisionalization or adhesive cosmetic bonding could readily satisfy the patient’s wants as well as provide the needed and necessary care. Whatever and wherever the chief concern leads us we definitely deal with needs issues in our practice as soon as possible before we tackle the wants knowing full well that it is the patient’s wants that motivate them to attend dental offices.6-9   Remember, we listen to our patients and respect their value system but work with our core values and accepted dental standards.10,11

 

There is another spin to this wants/needs equation that involves us, the team. As oral health care providers, we have needs such as seeing a certain number of patients and performing a number of procedures to provide our practices with a certain amount of cash flow. Qualifying the type of patients or procedures that we would preferably seek out to do, fits the wants department. This is all fine and dandy in a world where we could do whatever we want, provided we have the skill set. The need to pay the bills should not overcome our abilities to perform comprehensive dental care and the taking on of cases that are beyond our skill level.2 To improve our skill levels so that we can perform to a level that comprehensive care demands is noble and mandatory, and I encourage it before biting off more than we can chew. The dental team although faced with these practice considerations must look beyond their own plight to advance the cause of the star of the show, ie. the patients, and place their wants/needs first.

 

For the dental team a well choreographed balance between needs and wants has to be found for the patients’ best interests to be honoured. For the patients, they must be listened to.3,4,9-11  After the chief concern has been entertained their wants are addressed with respect for their needs. It’s a difficult balance to strike at times but with patience, perseverance, and proper planning we will get the job done to everyone’s satisfaction.

 

Further Suggested Reading and References:

 

  1. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
  2. Malament KA. Prosthodontics: achieving quality esthetic dentistry and integrated comprehensive care. J Am Dent Assoc 2000;131:1742-9.
  3. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior.
    Community Dent Oral Epidemiol 2003;31:368-77.
  4. Liebler M, Devigus A, Randall RC, Burke FJ, Pallesen U, Cerutti A, Putignano A, Cauchie D, Kanzler R, Koskinen KP, Skjerven H, Strand GV, Vermaas RW. Ethics of esthetic dentistry. Quintessence Int 2004;35:456-65.
  5. Priest G, Priest J. Promoting esthetic procedures in the prosthodontic practice. J Prosthodont 2004;13:111-7.
  6. Smith RN, Smith ME. Marketing the cosmetic practice via television. Curr Opin Cosmet Dent 1995;:100-6.
  7. Demas PN, Braun TW. Esthetic facial surgery for women. Dent Clin North Am 2001;45:555-69.
  8. Alsarraf R, Alsarraf NW, Larrabee WF Jr, Johnson CM Jr. Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery. Arch Facial Plast Surg 2002;4:105-10.
  9. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior.
    Community Dent Oral Epidemiol 2003;31:368-77.
  10. Klages U, Bruckner A, Guld Y, Zentner A. Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults. Am Orthod Dentofacial Orthop 2005;128:442-9.
  11. Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.

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Rule 1 The Patient

Posted By Stephanie Wilhelm, Friday, June 9, 2017
Updated: Tuesday, May 23, 2017

Section 1: The Patient

“When asked where most practitioners fail in their extreme makeover cases.”

Dr. Bill Dorfman (Discus Dental; Extreme Makeover TV series) answered: 

“They don’t listen to their patients …”

Dentaltown 2003

The Basic Rules of …..Basic Rule 1: Be Nice

                                                                                                                  

Upon embarking on the journey for an oral rehabilitation the practitioner first and foremost must recognize that they will spending a considerable amount of time with their client, ie. the patient. It only makes practical sense therefore that everyone gets along with each other. It’s far easier to work with someone that we like and care for rather than in an adversarial relationship. In fact it’s imperative! One way we can build successful relationships is by being nice. Being nice means more than just smiling and telling jokes. Being nice involves developing a good relationship with our patients where mutual respect is fostered. Open communication and active listening are an integral part of this as well. The roadway of oral rehabilitation is fraught with many forks and pitfalls. A team approach which incorporates patient values as well as those of the dental personal will help smooth the ride when the road gets bumpy. Patients generally do not sue the practitioners they like.1-6

 

Over the years I have made my share of technical blunders. This I am not proud to state but it is a fact of my life. Nevertheless, the one smart thing that I always have done, though, is tell the truth. When it became apparent that a serious error had occurred, the patient was always informed immediately. Looking the patient in the eye and admitting that the treatment I have performed is less than ideal has always been, and still is, a humbling experience for me. Using simple words to express what has occurred and saying I’m sorry always goes miles in improving customer relations and satisfaction. Patients realize that I’m only human and their level of trust in our team skyrockets because of our honesty and the fact that we spent the time on developing a solid relationship before treatment commenced. In other words, we’re nice.

 

Being nice also takes advantage of the placebo effect or the “complex social interaction” that occurs between humans.7 It’s sort of like “love at first sight”. Research has shown that up to 50% of treatment efficacy for chronic pain patients is placebo related.8 Furthermore, it is known that the endogenous opioid system is activated in this process. Not only are placebo effects (the vehicle) of merit but also is an understanding of patient expectations. Through open communication and relationship building, what the patient realistically expects and the practitioner can reasonably deliver can be ascertained and leads to a nice way to practice dentistry. On the other hand, the harmful effects of an adverse patient-clinician interaction (nocebo effect), whereby negative words and attitudes of the clinician may induce negative expectations, can occur as well.9 A good example of the power of words is the fascinating study by Pollo A et al.10 In this study three separate groups of patients were created. Each group was told that they were being given a complementary medication to supplement an analgesic. All were given the same placebo (saline solution), however, each group were told they were being given something different. The first group was told they were being given a rehydrating solution, the second group that it could be a potent analgesic or a placebo, and the third group was told they were being given a potent painkiller. Group three ended up having a significant decrease in the amount of the original analgesic that was required compared to the other two groups. Therefore, placebo and expectations are another way to look at practice management and the delivery of optimal services through developing good, open, caring relationships with our patients.

As dental professionals we are caring, trustworthy individuals. Aren’t you? So being nice is easy enough for us to do. And it will definitely make our journey as smooth as possible on the road ahead.

Mike Racich  

 For questions or comment: Contact me at  mike@drracich.ca  or (604)922-3465 or Skype at mikeracich1 

Further Suggested Reading and References:

 

 

  1. Dunne M, Brown JL. Risk management in dentistry.
    Curr Opin Dent. 1991;1:668-71.
  2. Irving AV. Twenty strategies to reduce the risk of a malpractice claim.
    J Med Pract Manage. 1998;14:130-3.
  3. Colon VF. 10 ways to reduce medical malpractice exposure.
    Physician Exec. 2002;28:16-8.
  4. Worthington K. Customer satisfaction in the emergency department.
    Emerg Med Clin North Am. 2004;22:87-102.
  5. Lal S. Consent in dentistry.
    Pac Health Dialog. 2003;10:102-5.
  6. Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-33.
  7.  Stockstill JW. The placebo effect in the management of chronic myofascial pain: a review. J Am Coll Dent 1989;56:14-8.
  8. Benedetti F. How the doctor’s words affect the patient’s brain. Eval Health Prof 2002;25:369-86.
  9. Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: Unraveling the mechanisms of the nocebo effect. Neuroscience 2007;147:260-71.
  10. Pollo A, Amanzio M, Arslanian A, Casadio C, Maggi G, Benedetti F. Response expectancies in placebo analgesia and their clinical relevance. Pain 2001;93:77-84.

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The Basic Rules of......

Posted By Michael J. Racich, Thursday, March 2, 2017

The Basic Rules of …..


The solution to complex puzzles is often quite simple. When something that has perplexed us for a long time is finally solved it can be very gratifying to put our minds at rest. Sometimes it can be exasperating too as we might wonder why we did not think of the simple solution first. This applies not only to all walks of life but also dentistry. When it comes to dentistry and performing any restorative or prosthodontic task we are often confronted with this conundrum. Such questions as: “Is it really this difficult?” or “Is there an easier way?” immediately come to mind. The simplification of the art and science of oral care, specifically oral rehabilitation, is what I wish to share with you over the ensuing months via a series of short essays. 

Like most of my colleagues I attend numerous programs and congresses throughout the year. As I attend these meetings a common thread appears to run through them as I tend to hear the same messages over and over. Instinctively, I want to distill down what was really important from these messages for our profession and what is on the periphery so to speak. I have spent a considerable amount of time reflecting on and reviewing what is essential for an oral rehabilitation and what our profession has recommended over the last six decades and it appears to me that there are some basic fundamentals that optimize success; basic rules if you like. Yes, being a meticulous single tooth dentist and paying attention to all the details for an oral rehabilitation is important but it is essential to know the overall basic rules and what the end points are. This series of essays will be a tribute to this concept.

As such, I plan to be as transparent in my writing as possible. These essays will be written as an overview of the complex topic of oral rehabilitation. They will be also written to be concise and entertaining, food-for-thought if you like, that can be easily read on an overseas flight or poolside. In no way will these essays be assembled as a definitive source or to minimize the heroic efforts of the countless published academics and master clinicians that have made dentistry the wonderful profession that it is today. We all owe an immense amount of gratitude to these individuals. My intention, therefore, is to be synergistic and complimentary to the works of others. Evidence-based dentistry affords the practitioner the tools to rate the information that is presented to them and blend this information with patient values and professional beliefs and experiences; this is the key thought behind the motivation for these essays.

The Basic Rules of Oral Rehabilitation essay series will create and simplify for the reader a practical approach for the diagnostic, treatment, and maintenance phases of patient care by providing Basic Rules which are memorable, sequential, and gratifying. Appropriate references are included with each Basic Rule for further study by the reader. The Basic Rules will be divided into 4 major sections: The Patient, The Plan, The Process, The Payoff. Each major section of the Basic Rules essay will sequentially lead the reader through the steps necessary for an oral rehabilitation. 

I hope you enjoy these informative essays as much as I will enjoy putting my thoughts into words.  Depending on the feedback from this first essay series foray, a second Basic Rules essay series (The Basic Rules of Occlusion) will follow. I enjoy the art, science, and practice of dentistry and I particularly enjoy sharing it with my colleagues. Please feel free to contact me at your convenience, preferably via media such as Skype (mikeracich1). I wish you good health and continued success in your dental journey, no matter how lofty or humble you choose it to be.

 

Tags:  Basic Rules  Racich  Rehabilitation 

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