No one can argue that a dentist’s best friend is a patient with symptoms. Symptoms represent the highest level of motivation for patients to get treatment. The other day I noticed my lab technician rubbing her jaw. I asked her what the problem was and she explained that her jaw had been killing her lately. I did a quick examination and saw plenty of signs that revealed occlusal disease but the discomfort was taking center stage. So I made her an occlusal splint.
The very next day…after a good night’s sleep with the splint, she came in smiling and thanking me for helping her get out of pain. I was a hero. It felt great to be an overnight sensation.
We all know how easy it is to treat symptoms and help people get out of pain…physical and emotional. There’s nothing like an easy pulpotomy or a Class IV composite on a central incisor to turn that frown upside down.
It’s the signs of disease that I am concerned about, because can we really cure an asymptomatic patient?
When there are no symptoms we must rely on our extraordinary communication skills to build trust and motivate the patient toward proper treatment. This is a great source of frustration for many dentists, because we see signs of disease all the time and have difficulty persuading patients to take action. That’s why we love symptoms.
And that is why splint therapy should be a big part of the dentist’s armamentarium. The splint helps patients to realize that there are subclinical symptoms present. In my lab tech’s case, she realized that the splint uncovered more than just muscle soreness. It exposed the clenching she had been doing (now we could talk about the signs), and the headaches she had been getting which were leading to a few bad moods.
The point is that our examination should go further than finding signs…it should expose symptoms from the overt to the covert. A starting point for that is a full understanding of the role of occlusion and the use of splints.
When I first employed splint therapy into my practice, I never fully understood the behavioral component of the splint. I made many splints for patients who never fully understood “why” I was recommending the splint. Needless to say I had some very unhappy patients. Knowing how to make a splint and why “we” use splints doesn’t help the patient understand its value unless they “feel” the importance.
Including an occlusal examination for every new patient is a great starting point for helping the young dentist explain complete treatment better and building trust.
Of all the things I do in my practice, an occlusal splint is the toughest “sell” of all… especially with asymptomatic male patients. Like you said, there is a HUGE behavioral component. I tell them it’s like wearing a helmet when riding a motorcycle. You have to WEAR it for it to work. I also tell them that if they are not committed to wearing it, we shouldn’t make it.
I just heard back from the folks at WordPress… my “spam” status should be fixed. Let’s see if this gets posted to your blog! 🙂
Comment by TheDentalWarrior — April 13, 2015 @ 10:52 PM
Hey Mike–good to have you back. Also glad that you got my main point…I was half asleep while writing the post—but yes, as you say the splint can be a tough “sell” without symptoms…yet so many dentists (including myself) make splints without completely getting through to the patient.
Comment by Barry — April 13, 2015 @ 11:13 PM
It’s very tough to sell a “solution” to a problem a patient doesn’t believe he has. How often have we heard:
“I don’t think I grind my teeth.”
“I used to grind my teeth, but I don’t anymore.”
“My last dentist ground my teeth down this way.”
Comment by TheDentalWarrior — April 14, 2015 @ 9:38 AM
One of my favorite questions is, “can you cure an asymptomatic patient? It’s interesting that over so many years in practice this is where most communication breakdowns occcur. People understand much better when we are addressing a very tangible concrete issue. When the problem is vague to them—or when we have to explain that they have a problem—things get dicey. Physicians are in the same boat – when they treat asymptomatic conditions like high pressure and they get non-compliance from patients. A few months ago I placed an implant—patient had HBP so I wouldn’t do it until he saw a physician. He did and I proceeeded…but now months later, I asked him if he was taking his meds—he said no. I asked why and he he said…”We all have to die of something.” I don’t think this is a trend—but I do think that symptoms mean a lot in a person’s treatment…and this is why health care professionals need more training than just the hard technical skills.
Comment by Barry — April 14, 2015 @ 11:47 AM