About a year ago, in my office, we reviewed our protocol for managing and treating patients with traumatized teeth. We reviewed the literature to learn how we could improve how we help our adult patients who have avulsed or mobile teeth following a traumatic event.

Antibiotics? Yes

One of the new things we read and thought about was whether to put the patient on antibiotics. We added this to our protocol—the patient goes on antibiotics for seven days after learning what antibiotics the patient can take, i.e., will not likely cause an allergic reaction.

Splinting? Yes

The literature now recommends splinting the traumatized teeth for two weeks and then removing the split after two weeks. Although there has been a conversation over the years about whether to splint or not to splint and if splinting has anything to do with the teeth ankylosing or resorption, the current recommendation is to splint but for just two weeks.

Improved Counseling of Our Patients? Yes

We learned that three common sense items needed to be reviewed with our patients, because it is easy to retraumatize teeth, and patients easily forget to be attentive to personal “gentleness.”

• We added to our protocol list counseling the patient to go on a soft diet that does not require biting down for three to four days, then longer if they sense the tooth roots are still mobile.
• Similarly, we added counseling the patient to do gentle mouth cleaning. They should brush traumatized teeth very, very gently so as not to re-traumatize or move them.
• We also added to our list making sure patients understand the importance of follow-up visits and radiography to track the health of the traumatized teeth.

Following the Health of the Teeth

We use periapical or CBT radiography to follow the teeth at one month after the initial trauma and again after two months, four months, and six months. If there appears to be healthy pulp and attachment of the teeth to the bone and connective tissue at six months, we can extend the time between making new images.

Imagine your life depicted as a metaphorical four-burner stovetop, with each burner representing a major quadrant of your life, and those quadrants being:  

Obviously, there are many times in life, during which by choice or circumstance, we find our life is severely out of balance, for example, dental school, parenting children, starting a practice, and so on. 

The Four Burners Theory tells us that to be successful in business we need to initially “turn down” two burners to establish an initial beachhead. But frankly, we don’t want to hear that kind of message. Rather, we would rather hear that we can have it all and soon.  

This impatient, short-term mindset has now permeated our culture, even to the point where many people seem to think that somehow “having it all” is their birthright. But viewing life balance as a birthright is a problematic perspective, because it can never be fully realized, and if we cling to it too firmly, it becomes easy for us to start to feel like a victim. 

And victims don’t act. Instead, they blame-shift. They sulk. They over-think. And they fail to act in ways that will move them toward greater life balance. A much more realistic perspective is to acknowledge that our life is full of seasons, around which we need to be aware, adapt, accept, and respond appropriately. 

Dentistry is rapidly segmenting into two distinct professions.

One will be what most patients think of as traditional dentistry. The tooth fixer and cleaner. The technician. These dental offices will focus on bits and pieces of treatment to get full insurance dollars from each patient each year. The staff will likely also be fragmented by tasks.

The other profession will be the doctor of the oral-health system. The valued family advisor on health and wellness. As Pankey-trained dental offices, we are well positioned to become the relationship-based advocates for our patients’ health.

Training Your Team to Advocate for Patient Health

How about your team? Have you put in the time to train and behaviorally change your most valued support?

A most important person in that team approach is the hygienist. Are they having conversations about total health? Social conversations don’t lead to behavior change that improves the health awareness of our valued patients.

Again, as Pankey-trained dentists, our hygienists can have a huge impact on our patients’ perception of our unique thoroughness. Occlusal awareness should be part of hygiene discovery about their health.

Bringing Up Occlusion in the Hygiene Appointment

This can involve simple questions: What have you been noticing about your bite? Chewing? Jaw? Headaches? “What have you been noticing about [fill in the blank]…?” can begin a discussion.

Depending on the conversation, one can follow with: “We are noticing that, as people live longer (keep their teeth longer), we see things slowly develop that can lead to big concerns. In our office, our purpose is unique – we want you to be able to enjoy eating all the foods you love the remainder of your life. I will look at potentially traumatic bite forces for you.”

How do you introduce occlusion in your hygiene exams? Let us know in the comments! 

Many dentist-patient interactions operate under the assumption of limited time on our part and limited ability to accurately explain on theirs. After engaging in hundreds of pre-clinical interviews and conversations during appointments, you will have naturally developed your own preferred style for questioning. But how well does it really serve you?

If you feel something is lacking in your patient care, yet your clinical skills and execution seem immaculate, the problem might be about language. When you communicate with your patients, do you get the sense that they feel limited, misunderstood, or unsatisfied? This could be a direct result of using language to discuss ‘disease’ rather than ‘health.’

Use the Language of Health to Connect With Your Patients

Getting out of the rut of a traditional hygiene appointment starts with how you communicate. Even minor shifts in your word choice can have a profound effect on the patient’s sense of comfort. Open up a discussion about their health to connect with their needs.

A great way to follow this path is to abandon the typical impersonal medical jargon. Instead of asking if there have been changes to the patient’s medical history, pose a question about how their health has been since you last saw them.

Right out of the gate, you are presenting yourself as empathetic rather than turning into the classic brusque medical professional. Ask about how they are feeling, whether they have been taking care of themselves, and what changes they have made in their lifestyle.

These types of questions capitalize on expressive language to make the most of your time. Having the patient rattle off changes in their medical history without knowing how they feel about those changes isn’t as useful. People will generally open up when they are given a safe, non-judgmental space to discuss their health. After all, it is often one of the central preoccupations of our interior lives.

What questions do you think are most productive during appointments?