Patient Perceptions

Just from visiting my dentist from time to time, I reckon that the patients there might have a neg. perception of dental professionals.

That is to say, it must be hard reassuring someone that the pain "won't take long" and that "it's almost done now" when it takes a long time!!
How can we reassure our patients without exaggerating or being dishonest?

I remember when one dentist asked if their client was "feeling all right" during treatment. He had asked out of courtesy, but the client made a face and shook his head (as much as could with a drill in his mouth, anyway).
What should one do then? Stop the treatment immediately and just wait for the pain to go away and then resume?
Or just apologize and continue?
If it is the latter, I wonder why one would ask to begin with if it would be useless to help alleviate the pain? Or should we inquire purely on a politeness-basis?

You raise some very good points.

I believe that the dental profession as a whole has underutilised many available pain and anxiety measures. We perform our procedures in a highly sensitive region with our patients reclined in what many describe as a vulnerable position. They often feel that they have no control of the situation and are at the mercy of the dentist and their assistant.

Fortunately, many dentists realise there is more to dentistry than just the technical aspects and that we need to focus on the patient as a whole (and this includes their anxieties and fears). The courses I occasionaly present on pain and anxiety control are usually fully subscribed.

Dentistry is still generally regarded in the media as the gold standard of what people like least...

I don't think any dentist (except on the rarest of occasions) should expect a patient to endure pain during treatment. There are a host of different pain and anxiety control measures available ranging from the way we talk to patients through to pharmacological adjuncts. For instance, there are quite a few alternatives to the standard Halstead mandibular block to acheive local anaesthesia in the lower jaw.

If a patient is experiencing any pain or problem treatment should be stopped immediately and the situation rectified.

I believe it is important for the patient to feel that they have a degree of control during treatment. I advise them to signal me if they have any concerns by raising their hand. It is then extremely important to react to that signal by stopping treatment and rectifying their concern. This builds confidence in the patient.

Hope this helps.

Thank you for the explanations!
When you said that the problem should be "rectified", do you mean reapplying LA to the patient?

And I've one other question (that doesn't really fit in this thread though): most people believe that dentists have the highest suicide rates, would this be fact or fiction? If it does end up being true, could you please shed any light on why this may be? I thought unappreciative patients might be one reason.

One dentist I asked told me that it was merely a rumour created by "jealous" medical students (but I think it was meant to be a joke)

I believe that in 1990, statistics placed dentists at the top of the list of professionals that had the highest suicide rate. Usually this is psychiatrists, I believe. I'm under the impression that this is primarily due to stress created by the job.

Yes. Maybe consider giving a different block.

I'm not sure if this is still the case, but it would not surprise me if dentists were higher up the list than average. As mentioned above, stress of the job would be the main factor. This is due to a combination of patient expectations and responses, and also to the dentist's own expectations and desire to provide treatment of exceptional quality. On top of this, owners of the practice are also trying to run a small business with the usual staffing and logistical problems!

This suicide myth is just not true. Yeasr ago I went to a lot of trouble trying to find the original research that everybody quotes. I found that in one state in the USA, some time in the fifties, one study showed that compared to other professionals dentists were top of the pile for suicide. This study only looked at professionals and not people such as unemployed young males who have a much greater propensity for suicide.


The whole suicide myth is a classic case of people quoting other people who are quoting other people who are quoting other people.

And anyway a recent Australian study (once again only of professionals ) showed accountants to be 'most likely to kill themselves.'

I think this could belong to the 'urban legend' category.

Below is a portion of an article available at Jobs Rank Low As Risk Factors For Suicide - New York Times


"Urban legend notwithstanding, the relationship between suicide and occupation is far from clear-cut, experts say, and what someone does for a living does not say much about the potential for suicide.

''There is a lot of fantasy out there amidst the reality,'' said Dr. Roger E. Alexander, a professor at the Baylor College of Dentistry, who last year called into question the common notion that dentists were highly suicidal.

Dr. Ronald Maris, a forensic suicide expert in Columbia, S.C., said he had compiled a list of 15 major suicide predictors. ''And none of them concerns occupation,'' he said. "

When I did a search of this subject I kept finding conflicting information. It seems to be difficult to find credible data on this topic.

I remember when one dentist asked if their client was "feeling all right" during treatment. He had asked out of courtesy, but the client made a face and shook his head (as much as could with a drill in his mouth, anyway).



If the dentist continues treatment after the patient says that they are not happy, you can be sure of one thing: the patient will not return. You will not build up goodwill. They may return to finish treatment but they will not return for a recall and they will tell everybody that you are a butcher. Some people you don’t want to return but it is better they go on your terms.

If the patient is unhappy there are two possibilities:

One: that they are actually feeling physical pain. This can happen. You start drilling and the tooth is not numb. In this case you stop, apologise and make the tooth numb. If you do this effectively you will gain a patient for life. They know that if something goes wrong you will fix it. They will trust you.

The second possibility is that discomfort is not easily fixed. The patient doesn’t like impressions down the back of the moth, the scaler is sensitive, the suction irritates them, the noise of the drill irritates them, they don’t like lying prostrate, and they feel out of control.

A few random thoughts about what you can try:

You could start by asking them what they are worried about.

Take control. Say there is nothing to worry about. Tell them ‘I am going to do …. You are not going to feel a thing’. Keep on and on repeatedly telling them, “You are going very well.”

Side with the patient. Agree that it is a terrible experience. Tell them we are in this together ‘together we can work this out.’ ‘I know it’s difficult but it has to be done so lets get it over with nice and quickly.’ Some people will regularly come every six months and spend the whole visit complaining. That’s their paradigm.

Distraction is another way to go. Talk to the patient. Make them think of something else. Best of all ask them a question? Ask them something about themselves.

Confident manner and movements are mandatory in controlling patient anxiety. You can either pretend to be confident and positive or actually be 100% assured. It is alright to say that you should always go with the former option but occasionally you get stumped or surprised. It happens. In which case you have to fake it. The last thing you want when you don’t know how to get the root out is a patient who knows you don’t know.