by David Campbell, DDS

As professionals in dentistry, our joy of serving our friends and community becomes a process of repeatedly greeting and warming up old friendships and occasionally rekindling lost friendships. Good dentistry is about befriending our customers, perhaps more than any modern day remaining professions. We still have our role in every responsible community member’s life, providing competent cleaning and check ups every six months (annually for the edentulous). There’s some debate over the frequency of concern for perfectly healthy dentition for a very compliant patient, but over the years, I have come to better understand that the aging of life brings different dentition challenges that need the semi-annual check ups, with only very minimal population qualifying for the honor of annual care, in my professional opinion. Certainly, we all agree that the edentulous can transition into annual check ups as they mature past their transition into their removable prosthetics. I even confess, despite professional scorn, that some of my clients will have my blessing on annual check ups as a reward for dental excellence in home maintenance and adequacy of public water fluoridation. Yet, as I age, I do recommend to my younger colleagues to beware of recommending annual check ups too frequently. There’s room for provision of annual check ups, but I have been wrong. I have been surprised when I have seen the perfect dentition transition straight to endodontics or even implant care because of a few missed annual appointments. There are transitions in maturity from 20s and 30s to 40s and 50s that have brought significant dental treatment for the first time much later in life than traditionally expected. Is it a reduction in saliva flow? Is it a change in diet or natural supplements? Often, it’s another factor that few have skillfully mastered. Today, I would like to discuss our role in detecting stress in our patient’s lives.

While in dental school, I measured my life stresses on the rhythm of classwork. We detune from finals into vacation and gradually ramp up our stress to the next set of finals until we get to the lifetime climax of boards. As successful students and serious pre-professionals, we focus and tackle the challenges we encounter. For a majority of dental students, the process has been engrained from high school through our young 20s. Perhaps, as young professionals, there is another rhythm that arises where we look at our practice success on a monthly or annual basis of black or red financial measures of debt repayment or staff payroll pressures. Here, I am as an elder professional, looking back, having finally found some space to slow down. I am getting in touch with my patient’s stresses. I always saw them and talked with them about the role of stress in their dental care, but now I am realizing we play a role in helping them through their stresses. At this point in the development of dental care, I firmly believe this is a primary role of a dental professional, if you really focus on preventive care and our role in public health in prevention of late life dental complications. This may be the foundational reason I have never felt comfortable relinquishing dental hygiene procedures completely. Now, later in life, I am appreciating that preventive care should be two tiered. Simple oral hygiene instruction is, of course, the primary foundation of every preventive practice. The second level of preventive care includes…stress management.

This may seem radical. I hope it does. I hope this can add to your responsibilities in a way that completely changes your perspective on preventive dentistry. I have been a faculty member at two dental schools and managed more dentists than most anyone I have ever met. I supervise more dentistry every year than most dentists provide in their careers. Like Paul, I do not want to boast, for the Lord provided this call, and it is not of myself or my accomplishment but the call of Christ in my life. So, with this as my foundation of expertise, I would like to emphasize that the second tier of preventive dental care beyond oral hygiene instruction, should be stress management for our patients.

No, not yoga, but like yoga, we need to help our patients see how destructive excessive stress can be for a perfectly healthy dentition. We all need to relax. As a dentist, I emphasize this message for every patient who poses any dental pain that is not specifically indicated by bacterial infection. As I sit here and write this, I have more confidence than ever that this truth can transform your practice and your professional satisfaction.

Stop grinding on your teeth. I don’t say it this succinctly, because most of these patients deny it. I gently introduce a discussion about their personal lives. “There’s actually nothing on the x-ray that specifically indicates which tooth or what pain you have.” Now, tons of our colleagues are going straight to root canals, and these days some go straight to implants. I support their professional judgment. They have learned from successful dentists in their communities. Our profession is still dominated by small practices with independent offices that are primarily fee for service. We are still the envy of the healthcare professionals, setting our own fees and surviving on the trust and generosity of our community contacts, family and friends. The pressures to see a painful tooth and begin aggressive treatment are real for most of our colleagues. I support their decisions. They have found these decisions to provide competent care for their community in their experience and applying their skills. I am not being cynical nor resentful when I say that this style of treatment also has generated adequate financial support from the community. But I firmly believe I have found the freedom to adjust my practice to a much more conservative and healthier preventive approach to aggressive treatments such as endo, perio and implants.

Where do we go, when we do not see any indication for treatment except pain? I have found myself getting personal with the patient. As a Christian, I find myself getting spiritual at times, as I ask about stress in their lives. Stress in a patient’s life is much more prevalent than ever. Your patients will provide you reassurances at first that they are fine. Their discomfort with personal sharing about their own problems beyond their toothache will sometimes engender their resentment. You may even endure the scorn of fellow professionals that you are afraid to begin aggressive treatment. You may be accused of incompetence. Yet, if managed successfully and with cooperative patients, you can preserve your reputation for excellence and create a much more conservative preventive practice. If a patient responds negatively, I refer to endo specialists. I can do any endo for caries or following crown and bridge indications, but with a few personal questions, you may be able to get to the real cause of a significant number of vague references to light pain.

If you isolate stress points in their lives, you may be able to provide a word of counseling, or a moment of ministry, but the key to best treatment is to recommend that all your patients keep their teeth apart. My advice is, “You should never let your teeth touch, unless you are eating.” A good persuasive and gentle reminder about the destructive and traumatic results of incidental teeth contact will transform your practice.

I want to thank CMDA for giving me this moment to share my practice and my ministry with you. This is literally ministry. You are doing the best for your patients, and you will see the Lord bless your practice, your patients and your heart as you learn that every unexplained pain might lead to a heart connection with your patients. You may be entering that privileged space where the patient is only able to see their life’s most significant problems and the personal cost of those stresses. We are a much more mature culture. We understand caretaker stress, and we understand provider stress, and we understand elements of post traumatic stress have significant deleterious effects on our personalities, our lives and especially our community dentition. I fear you are going to stress about this newfound responsibility. Please take this to the Lord, and then apply these thoughts as you are led by the Lord. I come to you as a uniquely experienced dentist, with a recommendation that may not be applicable to young dentists who serve in group practices. So, in closing, the Lord wants to use us in our role as dentists to bless people and bless churches and bless communities. I humbly submit this as an idea or perhaps as a goal. Try to find a way to let the Lord guide your style of practice. Yearn to serve each one of your patients as you would Christ. But, know we are forgiven and imperfect souls, with unique practices and unique callings by the Lord. With forgiveness we celebrate our salvation together and fellowship as professionals in Christ.