Using habits to teach

There are two things that dentists are generally noted for: saying ‘open wide’ and asking questions when their patients are unable to answer. Why is this, I wonder?

I spend most of my time asking patients to close their mouths because without my saying anything they open as wide as they can (bless their hearts), thus stretching the buccal and labial mucosa so tightly that all I can see and reach are the occlusal surfaces. Even the lingual surfaces are inaccessible because the muscles are so taut.

Some years ago I realised that this is just what happens when they are brushing, and why they consistently miss large patches of tooth surface. I used to become irritated by this but now I’m just amused. In my imagination I am a conductor; as I raise my mirror and probe like a baton, the mouth opens without a word being said. I smile and ask politely if they would slightly close their mouths.

When I neglect to insert the word ‘slightly’ before ‘close’ I’ve found my hands and instruments trapped inside the mouth because they responded to my request so quickly! You really have to laugh when this happens, but it just shows how important it is to make our instructions as clear as possible! Patients respond when you’re not expecting them to, and when you think they’re listening they are miles away.

I use the ‘open wide’ scenario as a means of teaching them about the facial muscles. I ask them to place a finger over the buccinator muscle to feel it as they open and close their mouths. Then I explain that this is the resistance they are encountering when they try to brush there with the mouth stretched wide open, like bashing up against a wall. This lesson does work because frequently patients return and say: ‘I remember you telling me about not opening my mouth too wide and I’m brushing more effectively now.’

Another area inaccessible with the mouth stretched open is the cervical margin of the lower anteriors, yet when the lip is relaxed and retracted by a thumb and forefinger it‘s as if a curtain is drawn back. Stains and plaque gather there because there’s no room to position the bristles of the brush. They just splay out. It’s obvious to us, but not to the patient.

So why do dentists ask questions when patients are unable to answer? I really don’t know, but it does happen. I was walking through a surgery one time and actually witnessed a dentist, his hands in a patient’s mouth, ask: ‘How are the children doing at university?’ ‘Mumble, mumble’, came the reply.

Perhaps I’m nosy, but when I ask questions I really want an answer so I wait until they can respond, otherwise I try to keep up a monologue, or direct any questions to the nurse, if I have one. It’s hard, but I’m keen to reduce the stress levels on both sides as much as possible.

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