It's dentistry that patients hate, not the dentist


WORD OF MOUTH:Extracting the fear from a dental appointment

‘I HATE dentists . . . no offence but I hate dentists.” “I hate being here.” “If I never see this place again, it’ll be too soon.”

Believe it or not, these lines occur more frequently than you’d imagine in the dental surgery. I can almost see a few heads nodding as you read them.

Some years back, I employed a new dental nurse. She had never worked in a surgery. When she heard a new patient to the practice say, “I hate dentists”, she was gob-smacked (pun intended), so I suggested she record how many times she heard the line. In her first month, she logged 25 times. I hadn’t even noticed one of them.

On starting practice as a new dental graduate, your head is filled with patient care, treatment planning, the fundamentals of restorative dentistry and the myriad of other clinical concerns which face you daily. For you, it’s your job. But for your patient, it’s often a leap of faith.

Why do patients feel this way? With my own patients, I often suggest that they may hate (though I prefer the word dislike) dentistry rather than dentists.

We all have memories of extractions or fillings when we were younger. Some were good experiences, some not so good.

But thankfully time has moved on – we now have faster-acting and longer-lasting anaesthetics. Local topical gels (ointments placed at the injection site) freeze the gum area even before the injection is given and techniques have improved.

The diameter of the modern disposable needle is smaller, making anaesthetic delivery less traumatic for the soft tissue of the inside of the mouth.

“But the size of the needle, doctor, it’s like the Eiffel Tower!”

Here, I use the piano analogy. My twin girls play piano. Once a week the piano book “accidentally” falls behind the piano. I fish it out with an old-fashioned sweeping brush: bristled end in hand, I swing the long handle to knock the book to the side. Using a smaller-handled pan brush would be useless.

Similarly, when delivering anaesthetics to the back of the mouth, using a long needle gives the dentist the ability to safely control the delivery of the anaesthetic from a distance rather than have the dentist’s hand in the patient’s mouth.

“But the last dentist I saw had a knee on my chest, trying to get that tooth out – I was there for two hours.”

I don’t know about you, but balancing on one foot for even a minute takes some doing, never mind trying to perform minor oral surgery.

Extractions today are served by 21st-century radiology imaging. With the advent of digital technology, smaller radiation doses are now available and the images generated can be enlarged and scrutinised on a monitor.

Further investigations can be organised via referral (if required) using e-mail attachment. This is a far cry from dentistry of even 20 years ago.

Form filling is cumbersome and irritating at the best of times, but most dentists use a comprehensive one-size fits-all questionnaire for medical history.

Some patients take a variety of drugs, and to safely provide dental treatment, full disclosure of your medications is essential. Drug allergies can be flagged and also potential drug interactions can be avoided.

A typical example is the blood-thinner warfarin, commonly used by older patients. Its effects on blood clotting have obvious implications for extractions, because patients taking warfarin have longer bleeding times.

“But the bills! I thought the pain in my tooth was bad until I got the bill!”

As highlighted in these pages recently, the previous government oversaw the effective scrapping of the PRSI Scheme which had (since the 1950s) allowed qualifying patients and their dependent spouses access to free examination, free scale and polish and subsidised treatments.

The free examination is still available, though this token gesture falls far short of a comprehensive dental policy.

Concurrently, the HSE has introduced emergency-only treatment for medical card patients – effectively denying the most vulnerable access to basic dental care.

In full swing, those two schemes had covered 80 per cent of the adult population. Their removal has led to unprecedented costs for patients.

Dental health is a necessity not a luxury. Hopefully, the new Government will rethink these cuts and help patients to avoid unnecessary dental pain.

Dr Paul O’Dwyer is a dental surgeon