How stress sets in and affects the dental team.
The concept of dental clinics is becoming more popular throughout the world. Creating a dental office requires a minimum investment of $300,000, usually more. Because dentists, in general, lack the business training related to how to set up and manage a dental practice, big groups (often but not always connected to insurance companies) have come into the picture with visions of the big bucks on the bottom line.
This can be a positive model because it gives business professionals the power to deal with logistics, human resources, equipment, and marketing while allowing dentists to focus solely on their profession. The situation becomes tricky, however, if the dentists in a group practice do not have full clinical decision autonomy and are bound to unrealistic productivity goals.
Suppose your prospective dentist’s office belongs to a group (called a DSO – Dental Service Organization – in the United States). How can you determine whether they have the authority to make treatment decisions based only on your needs? First off, do your research with due diligence. This may or may not involve a direct conversation with the practitioner, as groups, being financially oriented, generally prefer to market their brand rather than a specific professional. Which would you choose: knowing the skill you need for correct treatment is in the hands and ethics of an expert or a brand? Some DSOs will preserve the individuality of their doctors and specialists; in that case, you
have nothing to worry about.
The team that comprises a dental practice is made of beautiful human beings who dedicate their lives to a fascinating health profession but with markedly distinct levels of training and often disparate backgrounds.
The dentist is surrounded by dental hygienists, dental assistants (which are called dental nurses in some countries), a front desk team, and often a practice manager. Also, depending on the country, there can be specialties within the profession. When this is the case, coordination and communication among the dental team must be appropriately handled.
Sometimes, but not always, a dental laboratory staffed by lab technicians (“lab techs”) shares space with the office.
This can be a different business entity with separate management or not. Whichever the case,
consider it a part of the dental team. Alas, it is not always the case. Suppose I try to go in-depth into the psychological aspects of the interactions within the dental
team. In that case, this will no longer be the essay I intend it to be but will resemble epic science fiction, a four-hundred-page manuscript. Not to mention that they’ll ban me from most dental clinics worldwide, and I’ll be reduced to performing self-cleanings and self-fillings from now on (which might happen anyway).
Just as I believe dentistry is among the most challenging occupations there are, the dentist is possibly one of the most neurotic professionals there is. Remember: I’m a dentist, so bear with me.There are two reasons dentists have a 99 percent divorce rate and a 70 percent rate of suicidal thoughts (we rank first in actual suicides as well). One is what I call the “willpower pump,” and the other is the direct effect of rewiring our brain. The willpower pump is a process that occurs every day, almost routinely. While sleeping at night, your willpower reservoir gets replenished, and you start the new day fresh, full of will perform a slew of tasks, and face thousands of challenges. As the
day progresses, things don’t always go your way, and you must push that massive rock of obligation up your emotional Kilimanjaro. Your willpower is depleted, and you can accomplish less and less. As dentists, we must adapt to eight or ten patients daily, and our willpower diminishes. The more significant the emotional gap between the patient and us, the more energy is required to breach it. We must adapt to every patient that enters our office and connect at a deep level, despite the differences in education, cultural baggage, or social origin. The more patients we see, the bigger the effort. Our resilience gives in.
As for rewiring our brains, the concept is interesting.
Imagine that every day you wake up, I give you a box with tennis balls combined with golf balls, and I ask you to separate them and place them in two containers. We do this ten times a day for a year.
One evening, you go to a friend’s house for dinner. He plays tennis and golf. When you arrive, you see a vase next to the couch with a few tennis balls and some golf balls mixed inside. What will you want to do?
Whether you go ahead and do it doesn’t matter. Your eyes will be “REMing” back and forth to the vase throughout the evening. You want to get up and organize it like a crooked painting on the wall.It might unconsciously alter your mood during the evening, so you take the vase and stick it behind the curtains. If your friend is a dentist, you’re okay. If not, who knows?
Now imagine that for the next five, ten, or fifteen years, we do the same thing with grains of salt and pepper. Can you imagine what would happen if you’re in a restaurant and you see a grain of pepper in the saltshaker? Can you imagine how anxious this would make you since every day, time after time, you separate the black grains from the white?
What you are feeling right now is what we call neurotic behavior.The dentist works on tiny surfaces eight to ten hours a day. Often a millimeter can alter the outcome of a treatment.
Add to that the noise permeating the treatment room and the fact that if you get scared, you might grab my hand anytime, jump, or scream. What will be my stress level when you leave the dental chair? How do you think I will react if there is a fly in the room?
If you are the second most annoying patient in th e office that day, and two hours before seeing you, I treated the first most annoying one, how do you think my neurotic connections and willpower will handle you? Come on, think!
You’re already making me nervous, see? No, I cannot explode and throw your denture out the window (the first thing that comes to my mind), so to control my reactions with you, explosions will be rerouted to the team and then to my loved ones at home.
There are rules, like not scheduling two red-listed, annoying patients on the same day (pro tip).Dental assistants and, to a lesser extent, hygienists have the most challenging position on the team. Unless the management has the right level of awareness, we often undervalue their work – and pay them according to our misguided perspective. Undervaluing dental assistants is more often linked to their training and experience than to their responsibilities and the pressure they endure, which is very unfair. I have always been a vigorous defender of dental assistants.
As for the lab techs, there is nothing much to say. They are consistently wrong. It is continuously their fault because first, we are neurotic, and second, we have six-plus years of undergraduate training plus often as much in postgraduate credentials, and they don’t. So they cannot be suitable or know more than we do, even in their profession.
Uh, right?
Their specialty is undergoing lightning changes as technology has rapidly caught up with the dental profession.
Most dental work is now digitally milled by machines or printed with 3D printers. The “craftsman” side of dental technology has been highly minimized, requiring fewer lab techs but with different skills.
I take my hat off to a branch of our industry that has always had a tough time dealing with us dentists, with our usual arrogance and lack of empathy toward them. The dental lab is the one that makes your dentures, veneers, crowns, onlays, and bridges. (Please refer to the Glossary of Treatments for more information about these vital appliances.)
Behind every prosthetic device we deliver, there is always, in the background, a fantastic dental technician or team.
At this point, you can understand how, with this level of disparate teams and skills in addition to psychological disharmony, undeniable communication gaps occur in clinical dentistry. As they cannot always be bridged, they will trigger unspoken errors – what some might consider collateral damage.C.K. Labalen (2020). “Show me your teeth” – Introduction (pages 27-33). Published by C.K. Labalen Inc.