By Michael (Mike) Rogers, DDS

Close to my office there is a small strip center that includes a realty group and a small church. At one end, there is no sign to show what it is, but it has a drive-through window. Every day there is a significant line of cars going up to that window. Cars line up waiting their turn, and the line is so long the cars snake through the parking lot, out into the street, with hazard lights flashing. 

I have a friend who loves to create stories about what is going on in strangers’ lives. Why is someone driving so fast? What meal are they going to create with food in a shopping cart? Why are two people arguing?  

Fantasized from some level of observation, my friend has captured what this drive-through is all about. He believes that because the drive-through is adjacent to a church, you can pull up to the window and are given a donut along with a prayer. It’s a small ministry for people to have a better day. That’s not a bad narrative but no real basis for the story. I say that as the line of cars grows longer, the prayers gain power. I get a warm feeling of their impact on others. 

I find we make up stories in my office as well. We make them up about why someone didn’t show up for an appointment, why someone didn’t move forward in care that has been advised, or why someone won’t pay a balance. Our tales are based on some level of observation, but they are tales none the less. 

I try to remember to look at these moments in three ways. 

• What do I know? 
• What do I think I know? 
• What do I want to know? 

We practice this in our office. I encourage my team to not live in “what I think I know.” This state of mind too often leads to creating stories that reflect a judgement. If I hear a team member begin to create a narrative based on a circumstance with the phrase “I think…,” I try to politely make them aware of what they are doing. They most certainly recognize when I do it and politely let me know. I just grin to hide my disappointment in myself. Maybe someday, I’ll say, “thank you.” 

In relationship-based practices, we have such marvelous opportunities to help people be healthier. Asking questions about what we’d like to know and sometimes creating self-discovery for the patient as well. We often get repeated moments to connect and learn with each other. The need to make up stories is dissolved when we get to hear their story. Sometimes that story is fun, other times hard. We get to walk along that story with them. What a gift to live a life in that connection! 

Recently, a member of the realty group on one end of the strip center came in to see me. I couldn’t resist asking what the line of cars is about. It turns out it is an Ignition Interlock site for people that have had a recent DUI. You go up to the window for your installation time of the small handheld breathalyzer to prevent your car from starting after drinking alcohol. 

I haven’t shared that with my friend. I like his story better. 

Kelley Brummett, DMD 

After you do a crown preparation, do you tell your patients that you’re going to make them a temporary or a provisional?  

Provisionals are more than temporary restorations. They are part of a process. They’re the dress rehearsal to the final outcome. They are the prototypes for the final restorations.  

The “provisional” process is an opportunity to gain trust with the patient while modifying the length of teeth, the shape, or the color. It is also a way to communicate with the patient how their functional and parafunctional findings may have contributed to the destruction of their teeth. 

As the patient comes back to have their bite checked and to talk about what they like and don’t like, we are building trust. We’re involving them in understanding what they feel and think. We’re listening to improve their conditions. 

I’ve had patients who were fearful about moving forward with extensive treatment because they couldn’t envision the transition from the prep appointment to the final. What would those temporaries look like? What would they feel like? How would they function?  

So, when I am discussing a case with a patient, provisionals are all part of one treatment fee. We talk about the prep process, the provisional process, the lab process, and the final seating process—all as one process for which there is a fee. We discuss how the provisionals will guide us in optimizing the lab plan to achieve the desired comfort, function, and aesthetics.  

Whether it’s a single tooth or whether it’s multiple, I encourage you to help the patient understand that what you are providing in the interim between a preparation and a seat of a restoration is called a “provisional.” 

A provisional protects the underlying tooth structure. It keeps tissue in place. It helps the patient feel confident. It allows us to understand what might be going on functionally. It helps us communicate better with the lab. It’s more than a temporary restoration. It’s a guide on our journey toward predictable and appreciated relationship-based dentistry. 

In a previous blog, I wrote about how we use multiple flavors of topical in my dental practice and the positive patient experience this creates. In this article, we will look at the topical application technique we use to create maximum patient comfort.

I have often debated in my mind whether topical actually makes patients feel more comfortable when anesthetic will be injected. The scientific literature confirms it works great on the surface of mucosa, but it does not reach nerves under the gums or in teeth. From working with my patients, I know it makes a difference to them in how they perceive the injection feels. And there are studies in which patients overwhelmingly self-report that the initial pinch feeling of the needle entering the tissue is reduced after topical.

Before applying topical, thoroughly dry the area so the topical goes directly on the tissue you want to numb. If topical is applied to saliva, its effectiveness is greatly reduced. Ideally, let the topical work for 60 seconds but minimally 30 seconds prior to beginning the injection. My technique is to thoroughly dry the mucosa, swab the dry area with topical, leave the cotton tip applicator in place against the mucosa, cover it with a 2×2, and have the patient close to hold it in place while I watch the clock for 60 seconds to make sure I am not rushing.

To deliver anesthetic I use The Wand computer-assisted anesthetic delivery technology. While I am waiting for the 60 seconds, I explain to the patient that the anesthetic delivery may be different than they have experienced before and how the anesthetic will be delivered.

In my last blog, I wrote about the value of offering patients a choice of topical flavors. I can also fill some of the 60 seconds by asking the patient if the topical administered tastes like the flavor of topical they selected. As soon as the 60 seconds have passed, I immediately remove the 2×2 and cotton tip applicator and begin delivering the anesthetic.

There is good science behind some types of topical acting faster than 60 seconds, so you may want to do some research and select one of these types.

Even if you think topical is not effective, think about the placebo effect topical has on the patient. We are doing something to improve their comfort. We are actively doing something to make the procedure more comfortable and to help them through the process. I believe this act of caring has value to the patient that even exceeds the value of the numbing effectiveness reported in clinical trials.