My undergraduate years were spent in the old Dental School in Newcastle-upon-Tyne. During my five years I learned about dentures, amalgam, gold, porcelain and of course the use of forceps of all shapes and sizes.
I know there was a periodontology department, my tutor was a senior lecturer. The staff were perceived as a bit wet, uninspiring and dominated by the rest of the “cons” floor. Our restorative treatment plans always ended with the phrase “S&P”. There was a hygienist training school but our paths only crossed socially and the idea of integration was years away.
We had to do a “perio" case as a final year project, and mine was to be shared with another student. The patient was wore a chrome partial denture and “needed” a full mouth gingivectomy. My colleague did his half of the mouth, using whatever technique was fashionable then, reviewed her and re-appointed for my ministrations in a month. With gingivectomy knives all set I looked in her mouth, looked at the notes, looked back again and realised that I couldn’t tell the difference between the treated and untreated sides. Patient discharged and my case written up with the patient described as “non-compliant”. I passed - so that’s OK then.
Three years of oral surgery only added to my ignorance. Then the move into general practice, an NHS amalgam factory with a hygienist. One serving five dentists. The mystery deepened, what were these things called PGTs and why did they have to be booked at 11.45am? The answer, the appointment straddled midday so covered two sessions. My introduction to gaming.
I moved from practice to practice, some scale and polishes were bloodier than others, sometimes the blood oozing around the matrix band or the acetate strip was a nuisance. In 1985 I joined a practice where there was a newly qualified hygienist whose company I enjoyed, she explained that her role was primarily as a communicator. There was a glimmer of light at the end of the tunnel.
But then the practice was sold. The new regime sacked the two hygienists as being unprofitable and told the associates that they should be looking to do at least four crowns on every patient. I jumped ship - again. It seemed that everywhere I worked patients were treated as mouths on legs whose teeth were there for the benefit of the dental profession.
In December 1987, disillusioned by dentistry but searching for something, I rolled up at the Grand Hotel in Leicester for an evening course given by Phillip Greene. I met the WHO/CPITN probe.
A revelation! First move, order half a dozen CPITN probes. Second, explain to each and every patient what was going on, why it was important and what would happen next. Then a setback, the hygienist was sacked for having the temerity to tell the practice owner’s patients that they had gum disease. He explained it to me by saying that, “hygienists were mostly cosmetic really, a bit like hairdressers”.
For a decade I had drifted but was now a man possessed. I had a dream and a plan. I had been reactive, patients brought their diseases for me to treat. Time for a paradigm change, let’s make a presumption that people want to be healthy and to stay healthy.
The only solution was to start my own practice, so I did. It went well, so I started another 12 months later. In those days I used nurses to inform, to educate, to explain what the diseases were and how they could be controlled. No scaling until plaque control was good. I persuaded “the hygienist” to move to Gloucestershire to join me and for the next fifteen years we worked in adjacent surgeries sharing our patients.
I did the first BUOLD course in perio, I joined the BSP, I bought and read Jan Lindhe’s textbook.
The patients who had good plaque control had fewer problems, their endo treatments worked, they didn’t get recurrent caries, working on them was easier win/win.
We became a practice that listened and talked to our patients. When the time came to leave the NHS most understood why and stayed with us. When treatment options were explored the patients got it, there was already a relationship so we never had to worry about “selling”. Choices were offered, benefits outlined, costs explored and commitment gained, either then or further down the line.
All because everything was done on a basis of health.
Nearly 30 years on from my epiphany I talk to clients and find that many dentists are still driven by what they can do to patients rather than for them. Perio (along with paediatrics, prevention, pathology and public health) is still a Cinderella subject. Hygienists still work in cupboards.
Yet those practices that embrace health thrive, are profitable and happy.
I see your posting from time to time and often wonder if Dave Bridges was your hygienist,(because he was right up the sharp end, someone who I greatly admire), before he took to Therapy.
As you may know I had two full time hygienists for one dentist but since I sold my practice, where two dentists took over from me, it seems that the hygiene side of the practice has decreased. Sad really.
I agree with you, dentists are hell bent on 'doing' and find communicating difficult.
I even told my new dentists that I would go in and educate them and their staff in the ART OF COMMUNICATION but it seems to have fallen on stony ground. I note too that they often leave the educating/communicating to staff, two of whom are Slovakian and are arguably worst than the English girls. When I watched one of the English girls educating a new patient I absolutely cringed, breaking just about every rule in the book.
As you may know Colin Hall Dexter was my mentor and education from people like that, possibly you, should be part of the education system.
Communication is a real art, but it can be taught as I'm sure you know
Thanks for taking the time to comment.
Although Dave Bridges and I practiced in the same city (Gloucester) we were not in the same practice. I was fortunate enough to both work with and be married to my hygienist, Susan. She started working with me the day after a weekend with C.H.D. that her previous boss had paid for as a "thank you" for her time with him.
I hoped for the best but feared the worst when you sold your practice, sorry to hear about the changes that have happened. I learned the lessons the hard way when I sold up: 1) don't go back, it will never be quite the same and 2) give yourself some time to grieve over what you have had but no longer have. I tried re-visiting the place a few times but it was clear I wasn't wanted. A family member who had sold his own business said, "you wouldn't go back to a house you had sold and criticise the new curtains - just let go". The contrast of course is that watching the years that you have spent building relationships and helping people to health disappear is very hard indeed.
As for communication, so much comes from the heart, it can be taught but only if the people want to learn and there hangs the problem, words are easy. Listening is not, caring is not.
Enjoy your retirement, I'm writing this from my home in South West Cork where I can see the light from the Fastnet lighthouse from my workroom window - gale force 9 maybe 10 or 11 forecast for this evening, you wouldn't want to be sailing in that!