I recently overheard an exchange between a patient and her hygienist where the patient was explaining why she hadn’t been to the dentist in more than a year. Besides the now-common excuse of COVID-19, this patient explained that she’d also had a health scare and had to undergo treatment, which put her off course with her dental visits. The hygienist showed great concern and assured her he’d get her back on track, to which she replied, “I know there’s a lot going on in there, but I only want to get a cleaning!”
The appointment continued and the hygienist commented on some concerns with the patient’s gums, along with a cracked tooth. He was mindful of his observations, knowing she was concerned with other health issues. I watched him as he trod lightly on his findings throughout the visit. While inquiring about the status of her health, the patient shared that she’d completed treatment and then added, “I don’t know…I just do whatever they tell me!”
When the doctor was ready to do the exam, the hygienist shared his concerns. The doctor confirmed the findings and recommended the patient return for scaling and root planing and consider having the broken tooth repaired before it caused a bigger problem. The appointment concluded with the doctor telling the patient to “just call us when you’re ready,” and he sent her out the door with no follow-up scheduled.
Medical versus dental treatment acceptance
In so many other aspects of our health, we are ready and willing to follow the advice of the clinician, even when we don’t fully understand the treatment and sometimes before we even consider the monetary expense. I visit my dermatologist each year for a “skin check.” All the doctor has to do is use the word “suspicious” and I’m not only telling her to remove a mole right then and there, but I’m practically willing to have my whole arm cut off if it means she’s ridding me of a potential health threat. No one wants to hear bad news from doctors about any health issues. We usually heed the advice of our clinicians by changing our diets, taking prescribed medications, and getting the necessary follow-up tests and procedures.
Are you minimizing the problem?
But when it comes to oral care, we are less likely to accept and schedule the recommended next steps. We’d rather throw caution to the wind and hope that the problem doesn’t worsen. In dentistry, we tend to have a wait-and-see mentality that promotes reaction over prevention. Many doctors and hygienists are contributing to the problem by minimizing it.
The cancer patient who presented with a multitude of oral health issues had me thinking about the disconnect between the way we prioritize health-related procedures versus dental procedures. What more can dental providers do to get their patients to say “yes” to treatment before something painful and more costly arises? How can we change the public perception that while some dental procedures are optional, the majority are being recommended because they are necessary?
The first step is to consider how we, as a team, are presenting information. It’s time to ask ourselves: Are we adequately communicating our concerns based on our clinical expertise, or are we allowing patients to ignore the warning signs, contributing to the watch-and-wait mentality that’s often present within our profession?
Common objections and solutions
Let’s examine some common objections and alternative solutions to help patients agree to treatment:
- “It doesn’t bother me!” Whether you are talking about tooth wear, gum recession, or crowding, many patients don’t see the problem because there is little to no pain or discomfort. All too often we hear a patient say, “Well, I’ve lived with it this way for years…” signaling their intention to do nothing about the problem you’ve discussed. It’s the classic “if it ain’t broke, don’t fix it” mentality. The irony is that it is broken, but we’re not effectively explaining why it’s concerning, and the risks involved in doing nothing. Many patients ignore warning signs because they view their oral health from more of an esthetic perspective rather than a functional one. It’s up to you to keep the focus on the overall health of teeth and gums, not just how they look.
- Confusing or no visual aids. What visual aids are you using in your practice? Do you have x-rays, intraoral photos, or digital scans projected in front of the patient during their visit? Don’t take for granted that the patient can see what you see, especially on an x-ray. Take time to ensure that the pictures you are using to communicate make sense to the patient. Remove distractions, such as TVs tuned into talk shows or loud music, when doing your examination. Utilize full-mouth scans, YouTube videos, or even pamphlets and posters over x-rays, hand mirrors, or no visual aids at all. It’s not enough to talk at patients about your findings when presenting treatment recommendations. Patients’ comprehension will increase exponentially when you use visual aids they can relate to.
- Jumping to the solution before talking about the consequences. Many patients decline treatment because they don’t understand the true value of it in the long run. Do you emphasize with your hygiene team the importance of “preheating” the conversation for you? For example, when they see more calculus buildup between crowded teeth, are they relating the problem to malocclusion and saying things like, “The crowding is preventing you from keeping this area clean”?
If they see a patient with worn cusps or thinning enamel, are they bringing up the concern that those teeth can become less functional over time as they break down? We need to slow down the conversation and encourage our team to have more “see it, say it” moments. Present issues that are associated with the findings, preferably using an intraoral photo or 3D scan, to help the patient associate the problem with its consequences. The role of the hygienist is geared toward prevention. If hygienists aren’t educating their patients on what they are seeing throughout the cleaning, the likelihood of treatment acceptance will be much less. It’s important that both the hygienist and the doctor stress the need for treatment.
- Fear of dental procedures. The mere mention of going to the dentist produces some element of anxiety in most people. Our minds automatically think about drilling and scraping and poking! I’ve heard countless patients who are told they need a root canal respond with, “Well, how important is that tooth?” It’s astounding to me how many people ask to have a tooth pulled rather than saving it, mostly stemming from their fear of the process. We are falling short in explaining that the profession exists to help people keep their teeth for a lifetime (not remove them), so whenever we can save a tooth, we must let patients know that is the best option. Ultimately, we need to better communicate issues from the onset to prevent them from becoming more invasive and more serious in the future.
- Casual versus urgent language. No clinician in a dental practice wants to feel like they are trying to “sell” treatment. Too often, we use words like “no pressure” or “it‘s up to you” because we are so afraid of coming across as pushy. But by doing so, we often minimize the situation. Our wait-and-see approach leads patients to draw the conclusion that it’s really no big deal if they heed our advice. Meanwhile, changes are occurring in their mouths that they aren’t even aware of. We minimize the problem to spare feelings and allow patients to make decisions without pressure, even when we know they need the treatment. When a patient asks, “Is this something I need to do right away?” be sure they are aware that issues tend to worsen over time and may require more extensive treatment the longer they wait.
- Money. People will find ways to pay for things they see value in, regardless of the price tag. When we take time to explain why we need to take x-rays or why we are recommending certain treatments, patients are less likely to question it. While many people are concerned about the financial impact a procedure may have, they are more apt to consider treatment when its value is clearly presented to them. Focus on the “why” over the “what,” and patients will be more grateful for the explanation and potential money it will save them in the long run to move forward with treatment.
The doctor’s responsibility
Patients will continue to delay or refuse dental treatment as long as they can if there is minimal to no discomfort. It’s the doctor’s responsibility to highlight risks and help patients better understand the solutions being presented. If your patients are hesitating or putting off treatment recommendations, it’s time to ask yourself: What was the appointment lacking that caused this patient to opt out of my clinical treatment plan? Did I, along with my team, educate with the right verbiage and visual aids to help the patient understand why I proposed treatment? Did I speak with a sense of urgency and share my concerns in a meaningful way?
None of us has a crystal ball to predict when something in the body will ultimately break down. However, when we see signs of erosion in the teeth and gums, we need to put all preventive measures into play. After all, we are in this field to help people keep their teeth, not lose them. If patients are thinking all treatment recommendations are optional, ask yourself: Am I being a minimizer? What could I have said or shown to help this patient make the wisest choice to preserve their oral health? Add value to the services you provide by sharing what you know in a way that patients trust your expertise and allow you to take care of them to the best of your abilities.