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When interacting with challenging patients, behavior awareness can help

As my patient pool grows, the dentistry doesn’t change much, but the person in my chair changes every day. I connect with most patients pretty well, but every now and then I am presented with a challenge. What I would call a difficult patient has nothing to do with the dentistry required in their mouth. The difficulty comes from the patient interaction. I know myself, I know the dentistry, but there is something missing in my understanding of the patient.

Dr. Carolyn Norton

Dr. Carolyn Norton

Luckily, I received some insights from one of my attendings who comes to my GPR program one day a month and who is an instructor at The Pankey Institute. He discussed with me this concept of social styles models, which is something they teach at Pankey when discussing relationships based dentistry. In addition, our discussion led me to find this TRAMCOM Group website, which further elaborates my understanding on the social styles model to dentistry.

In the 1960s Roger Reid and John Merrill created the Social Styles Model to help predict human interactions in business relationships. They identified three variables that determine a person’s social style: assertiveness, responsiveness, and versatility. Within these behavioral dimensions four social styles emerged: analytical, amiable, driving, and expressive.

Responsiveness is determined by how much you control or reveal your emotions. Assertiveness is based on where you fall in the spectrum of ask versus tell, or lead versus follow.

No one social style is better than the others, and each style has its own pros and cons. Once you get familiar with each social style, you will begin to pick up on clues that tell you which style your patient uses. Here are four unique behavioral patterns recognized in the Social Style Model, according to The TRACOM Group:

ADA New Dentist guest blogDriving style patients control their emotions and speak assertively. These people want to know the facts about their treatment. Be direct and practical regarding their problems and treatment options. They are focused on the end result and want to know you have a plan.

Amiable style patients show their emotions and prefer to ask questions than give orders. These patients are friendly and ask questions because it makes them feel more comfortable. Take the time to talk with them and get personal. It will definitely pay off.

Analytical style patients control their emotions and prefer to ask questions than give orders. They ask questions because they want to know all of the details. They want to understand each step, the cost, and maybe even the number of appointments. They appreciate precision and accuracy. Take time to develop their treatment plan to show that you care about these things too.

Expressive patients show their emotions and speak assertively. These patients will share their thoughts and feelings regarding their dental problems, but may need your direction. Let them speak, you listen, and then help them focus on their needs.

The next time you have a challenging or difficult patient, look at this social style chart and see where they belong. If you understand why a patient is behaving a certain way, then this may help you alter your social style to make the interaction successful and prevent frustration. This is where versatility comes in. Versatility is primarily the responsibility of the dentist in the patient-doctor relationship. A versatile dentist can alter their social style to make the patient more comfortable. This requires a certain level of awareness and compassion for the patients social needs, not just their dental needs.

I can easily recall patients that fit each social style. Seeing them through this lens makes me like them better as people, and I will definitely change how I interact with them at our next appointment.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is in a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

Customize, share your own 2015 World Oral Health Day poster


Celebrate and promote this year’s FDI World Oral Health Day on March 20 with your own customized poster — which can include your own smiling faces. The poster is available at the event’s website: worldoralhealthday.org/picture.

Then share your customized campaign poster with colleagues and friends worldwide on Facebook or Twitter. The FDI created a kickoff Facebook post to get things started. Or simply print your poster and display it in your dental practice or dental schol.

WOHDMarch 20 is World Oral Health Day, an opportune time to raise awareness for dentistry worldwide.

All the individual posters will be incorporated into a collage to create a giant WOHD logo. A video promoting this app will be displayed on the NASDAQ screen in Times Square.

This year’s rallying global tagline is Smile for Life, urging dentists and patients of all ages to get involved.

Organized by the FDI World Dental Federation, World Oral Health Day encourages FDI member dental associations — including the ADA — schools, companies and other groups to celebrate the day with events organized under a single, unifying and simple message: “It’s time to …,” with the rest being customized to each participant’s campaign.

Interested in promoting good oral health care routines? Then an adapted call to action might be, “It’s time to rinse after brushing your teeth.” Or, “It’s time to chew sugar free gum after every meal.” How about pointing out the importance of visiting the dentist? The campaign could be, “It’s time to visit your local dentist for a checkup.”

According to the FDI, 106 countries participated in 2014’s celebration. Help make sure it’s an even bigger success than last year.

 

Tips for controlling upper back pain

As a dentist, you do many procedures that require a close visual field and fine, controlled movements of your hands for long periods of time.

Center for Professional SuccessThese procedures also require sustained postures and twisting and bending of your neck and upper back.  These postures and movements can place stress on your upper back and neck, contributing to the development of or aggravation of upper back pain.  This can impacts your well-being and the efficiency and productivity of your office.

As always, consult a physician for any persistent problem, but here are some tips for controlling upper back pain from the ADA Center for Professional Success.

  • Maintain proper posture.
  • Use magnification, such as loupes, and adequate lighting to bring your field of vision closer and decrease the extent to which your neck is held forward and flexed down.
  • Position the patient’s head at a level that gives you access to the oral cavity while being able to hold your shoulders in a relaxed, neutral position (rather than a hunched up position) and you are able to hold your elbows at about a ninety degree or less flexion.
  • When possible, use chair arms to support your upper arm or forearm when doing fine, precision work with your hands.
  • Wear properly fitting gloves.
  • Keep equipment in good working order.  Improperly maintained equipment can cause you to use unnecessary pressure and extra time when performing certain procedures.
  • Position equipment within easy reach and visibility to reduce repeated twisting of your neck or torso.
  • Take a break in between or during long or difficult cases.
  • When possible, set up your schedule to rotate long, difficult cases with short, easier cases.

Seek medical consultation for upper back pain, especially in the following instances:

  • After recent significant trauma, such as a fall, a motor vehicle accident or other such accidents.
  • When sleep is disrupted or pain is worse at night.
  • With a history of prolonged steroid use.
  • With a history of osteoporosis.
  • With a recent history of infection or a temperature over 100 degrees F.
  • Numbness or tingling in arms.
  • Severe, sudden headache.
  • Dizziness.

To read the full CPS article, which includes information on symptoms and causes, click here. The article is only available to ADA members.

Other resources on the topic include the American College of Sports Medicine, American Academy of Orthopedic Surgeons, American Physical Therapy Association.

It’s flu season: What to know about influenza prevention and control

We’re at the peak of flu season.

Since many symptoms of influenza are non-specific, it’s possible that the patient you are treating may have the flu virus without any noticeable symptoms. The spread of the flu can occur among patients, your dental team and yourself.

Cold Here are five major components that should be part of your infection control program, according to the ADA Center for Professional Success.

  • Education and training: Annual education and training around occupational exposure to potentially infectious agents and infection-control procedures is an important aspect of an infection control program. The Centers for Disease Control and Prevention has a PowerPoint available online called Guidelines for Infection Control in Dental Health-Care Settings.
  • Immunization: Annual vaccinations are a critical part of limiting exposure and deciphering from other communicable diseases. Consider covering the cost of vaccination for your team, or providing vaccinations in the office during work hours.
  • Sterilization: Proper and consistent sterilization practices of all materials in contact or in close proximity to patients are paramount. Verify that your sterilization methods and equipment meet compliance standards.
  • Exposure prevention and post-exposure management: Make sure your practice is screening symptomatic patients. Develop etiquette regarding respiratory hygiene and coughing. Placing cough etiquette reminders in the waiting area and the staff operatory can be helpful.
  • Policy on work-related illness: Encourage patients to seek preventative and curative care, and to report signs or symptoms of illness. Create a work environment that does not punish employees for illness.

Remodeling your practice

Grand Rapids, Mich. — When Dr. Andrea Toth bought an existing practice in October, she knew she needed to remodel.

Dr. Toth

Dr. Toth

Soiled carpets. Furniture from the ’70s. Wallpaper falling apart. White walls no longer white. Bathroom floors appeared moldy.

“The equipment needed updating,” Dr. Toth said. “The dental X-rays and countertops were green. The chairs and upholstery were ripped. It all needed to be cleaned up and modernized.”

Three months later, she got her wish. New equipment. New dark wooden floors. Modern furniture. Clean new granite countertops.

“It’s given me a completely different feeling when I come in to work,” Dr. Toth said. “The best part is that my staff and my patients love it.”

Dr. Toth spoke with ADA New Dentist Now blog to share some advice and suggestions, based on her experience, for making a remodeling experience as smooth as possible.

With financing, be patient

The biggest obstacle Dr. Toth said she faced in the process was the issue of finance.

“I was trying to get a loan from a bank, but it was taking so long,” she said, adding that when she finally heard back regarding the loan, the bank wanted to hold the practice as collateral.

“My husband and I just decided to pay for it,” she said. Even then, with the holidays and the search for contractors, the construction and remodeling couldn’t start until Jan. 10 — finishing a week later.

For those who can’t afford it and need a loan, be patient.

“I would advise that you have a realistic idea of how long this this will take,” she said. “Give yourself enough time and plan ahead. Realize that you can’t have it all in an instant.”

Lobby (Before)

Lobby (Before)

Lobby (After)

Lobby (After)

Find the right people

Another process that took time was the search for a contractor to be tasked with the construction — replacing the floors, painting the walls, removing the wall paper, etc.

The dentist that Dr. Toth had bought the practice from had been in the space for over 30 years. When she came to acquire it, she didn’t have the layout of the of the facility.

“I didn’t know what were in the walls,” she said. Contractors asked where and how the plumbing was set up; where the electrical wires were.

“My guess was just as good as theirs,” she said. “So some contractors didn’t want to work with me.”

In addition, some companies would send someone to visit the practice, then never submit a bid as promised. Then there were contractors who would submit bids that excluded costs on certain work — which made their bids appear low.

In the end, Dr. Toth found a local contractor, Copper Rock Construction from Grand Rapids.

“They were very upfront with me on the costs,” she said, adding that they were more affordable compared to the other bids. “They said that if they go over budget, it won’t be over 15 percent. They were sincere, with good prices and did good work.”

Dr. Toth also went with Dental Equipment and Repair, of Kalamazoo, Michigan, to remove and reinstall all dental-related items such as cabinets, dental chairs and dental equipment.

“I was very happy with the results,” she said.

Utilize the Internet and friends

When it came to decorating the space, Dr. Toth said, Dental Equipment offered to furnish the space.

However, after conducting simple Google searches, she found pieces that were much more affordable, including artwork, mirrors and furniture.

It was through looking at photos online of other dental practices that she was inspired and decided to get dark wooden floors.

“The rest sort of fell into place,” she said. “I met with neighbors and friends to give me some input on what they thought. And I considered what they said in my decisions.”

Operatory (Before)

Operatory (Before)

Operatory (After)

Operatory (After)

Oversee the operation

Once you’ve hired the right people, don’t disappear.

Dr. Toth said she made sure she was available to coordinate schedules. For example, Copper Rock Construction couldn’t paint until Dental Equipment finished installing a certain equipment or cabinet.

“I would come over and make sure everything was going as planned,” she said.

In addition, her front desk staff worked during remodeling week to answer phone calls from patients.

“If anything needed my attention,” she said. “I instructed them to call me.”

For more information or tips on remodeling your practice, visit the ADA Center for Professional Success website here.

Integrating checklists into your practice is key to get things right

Time outs are performed minutes before a procedure begins. In dentistry, this is commonly done before an extraction or a root canal. Do I have the right patient? Is the correct radiograph displayed? Is the necessary equipment present? Do I know which tooth? How often do we breeze through this checklist or not read it at all?

Dr. Carolyn Norton

Dr. Carolyn Norton

The Checklist Manifesto by Atul Gawande shows how checklists which identify critical steps or points of failure can make up for our own human inadequacies. Checklists don’t stop at the example above. As the volume of dental procedures I preform increases every day, I have developed my own mental checklists to make sure I’m working efficiently and producing quality dentistry. Even your morning huddle is a checklist.

In 2001, a central line placement checklist was implemented at Johns Hopkins Hospital by critical care specialist Peter Pronovost. Nurses were allowed to intervene if they saw a doctor not following the checklist. After two years of data collection, the central line infection rate went from 11 percent to zero. Dr. Pronovost found that checklists, “establish a higher standard of baseline performance, help with memory recall, and set the minimum necessary steps in a process.”

When the World Health Organization (WHO) contacted Gawande in 2006 to help create a solution to prevent death and/or harm in surgery throughout the world with no funding, Gawande went to visit a master of checklists, Daniel Boorman from the Boeing Company. Aviation heavily relies on checklists. “Only 1 in 500,000 flights ever suffers an accident of any kind.” Was your last flight delayed for 45 minutes due to maintenance? Someone was using a checklist.

Mr. Boorman says checklists must be “precise and to the point. They do not try to spell out everything — a checklist cannot fly a plane.” He suggests keeping the list between five and nine items. It should take no more than 60 to 90 seconds to run the list. “You must define a clear pause point at which the checklist is supposed to be used.” My favorite part of this book: a checklist for making checklists is provided in the appendix.

Dr. Gawande’s WHO safe surgery checklist included seven checks before anesthesia, seven checks before the first incision, and five checks before removing the patient from the operatory. The effect of their safe surgery checklist was studied in eight hospitals around the world. In every hospital, complication rates fell 36 percent and deaths fell 47 percent. Seventy eight percent of hospital staff “actually observed the checklist to have prevented an error in the operating room.” When asked if they wanted the checklist used if they were to have surgery, 93 percent of hospital staff said “yes.”

After reading Dr. Gawande’s book I see checklists all around me, and I believe they work. No one is perfect, and checklists are great tools to help even doctors to get things right. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

How do you use checklists in your dental practice? Share your best ideas and checklists with us below.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is half way through a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

 

Did Hermey inspire you to be a dentist?

He didn’t want to build toys. He dreamed of becoming a dentist.

According to ADA News, Hermey the Elf continues to do his part in increasing oral health literacy among children and adults — 50 years after the animated classic “Rudolph the Red-Nosed Reindeer” first aired on national television.

Hermey the Elf

Hermey the Elf

The ADA is featuring Hermey the Elf in an online campaign to help promote oral health literacy, stressing nutrition, dental hygiene and dental visits as key factors in preventing cavities.

Through the campaign, the ADA’s MouthHealthyKids.org will feature free downloadable educational coloring book pages featuring Hermey along with the ADA’s tips for maintaining good oral health. The coloring pages will be available for download through the end of December.

MouthHealthy.org will also include a fun dental health quiz for families and a separate sweepstakes drawing to receive a Rudolph the Red-Nosed Reindeer prize package.

In addition, Hermey was designated a DDG, or Dental Do Gooder, by Dr. Maxine Feinberg, ADA president, for promoting good dental health to his friend Rudolph the Red-Nosed Reindeer and everyone in the North Pole.

“Hermey’s passion for dentistry, coupled with his devotion to helping others feel good about themselves inside and out deserves recognition,” said Dr. Feinberg. “I know Hermey the Elf, DDG, will continue to inspire young people and those who are young at heart to follow their dreams.”

The animated special, “Rudolph the Red-Nosed Reindeer,” tells the tale of how Rudolph and Hermey were initially rejected by their peers for being different, yet they go on to triumph when they show that their differences make them unique and helpful to their community. The program airs Dec. 9 on CBS.

Register now for 2015 Give Kids A Smile Day

Registration is open for the 2014 Give Kids A Smile Day. The national celebration is set for Feb. 6, 2015.

Give Kids A SmileRegister online by Nov. 10 to be considered for free product donation. The ADA will post a list of product recipients on the website in December, and recipients will receive their products the week of Jan. 19, 2015.

Give Kids A Smile is made possible through the generous support of corporate sponsors, Henry Schein, Colgate and DEXIS; dentists; and other oral health care professionals who volunteer their time and services to provide needed oral health care to underserved children.

For more information, email gkas@ada.org or call 312.440.4600.

Have you participated in Give Kids A Smile programs in the past? What was your experience like? Share in the comments.

Building Trust with a New Patient

The 28th New Dentist Conference is in full swing right now in Kansas City, Missouri. A number of CE programs are taking place right now, including Take This Job and Love It! presented by Dr. Mark Hyman.

Earlier this year Dr. Hyman spoke with ADA New Dentist News about people skills new dentists can use in the practice. Here’s one suggestion that stood out for us:

Dr Mark Hyman

Dr. Mark Hyman

“Dentists don’t do themselves any favors by spending the first moments with a new patient asking about insurance coverage,” Dr. Hyman observes. Instead Dr. Hyman thanks the patient for choosing his practice, and asks about the patient’s goals for her smile, her teeth and her health. And, unless the patient is new to the community, he asks why she is no longer seeing her previous dentist.

“The answer might be, ‘He was always pushing me to get a crown.’ So I would reply, ‘do you think you need a crown?’ And I would follow with, ‘as I examine your mouth, if I find evidence of dental disease, do I have your permission to tell you?’ And that takes it out of the realm where I’m the expert here to diagnose and deliver bad news. My approach builds trust because it puts us on the same team working towards the same goals. Once you have truly heard the patient’s goals, the more quickly you can build trust.

You can find more of Dr. Hyman’s tips from ADA New Dentist News here.

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Dr. Hyman will be presenting Drill ‘Em, Fill “Em and Thrill ‘Em in one of the courses offered in the New Dentist Track of CE options at ADA 2014. New dentists (those who graduated from dental school in 2005 or later) receive a 20% discount off of the fee courses that focus on a mixture of business, ergonomic and clinical topics that have been curated by new dentists.

See the entire new dentist track and register for courses here.

What to do when Delegating Goes Wrong

NegotiationWhen we talk with new dentists, one challenge comes up frequently — the difficulty in getting comfortable with delegating. But whether you own a practice or work for one, there is simply no way to do it all yourself.

Over at the HBR blog, Elizabeth Grace Saunders has a series of suggestions for how to delegate effectively. Here’s a tip that caught our attention:

Once you start to let go of control, inevitably there will be a time when something doesn’t get done in the way that you would prefer. Your gut reaction will lead you to blame yourself for letting go — “Why did I ever let anyone else do this?” – which typically manifests on the surface as anger toward or frustration with others. But instead of immediately putting the work back on your agenda, transform this situation into an opportunity for learning. First, evaluate whether you could do anything differently in the future. Second, help the people who did the work understand what they need to know to complete the work successfully next time. Often you don’t know what went wrong until you really dig in.

What is your best advice for someone new to delegating tasks? Share your answers in the comments.