Dr Charlie Nicholas explores how dentists may communicate to best effect with endodontic patients, to make sure they have all the information they need to make an informed decision about their treatment.
Whilst General Dental Council Standards require dentists to ensure patients have enough information and time to ask questions and make an informed decision in relation to all aspects of care, anecdotally there seems to be added pressure on the dental team when it comes to endodontics.
I believe a significant contributor to those types of feelings is that you need to plan your treatment based on an X-tray that could ultimately be misleading, depending on the angle, and so on. It might look easy radiographically but when you get in there, it is a challenging job (and vice versa). That goes for both previously untreated teeth and retreated teeth.
Plus, of course, every root system for every tooth is unique. Then so is the treatment, although there are protocols and instruments to make the whole thing easier. More on that later.
The crux here is that it can be difficult to communicate all this information to a patient effectively, when, to some extent, you do not know what you are going to be dealing with until you get below the gum line.
And yet, you need to be able to give your patients a good idea of how well the treatment is likely to work, in essence the tooth’s prognosis.
Because of all of this, we dentists need to bear in mind that it is not just about choosing the right way forward in terms of treatment, it is also about choosing the right patients!
Planning with patients
For example, if you have a patient who has incredibly high expectations combined with a case that is very challenging, you must make sure that that patient understands the level of complexity and the likely outcomes, depending on what happens during the treatment process and afterwards.
Some patients like to hear statistics, while for other such figures are meaningless. For instance, where one patient might find a success rate of 85% reassuring, another might consider it has nothing to do with their circumstance – it will either work for them or it won’t.
The million-dollar question then is – how do you make sure your patients understand the risks and benefits, and guide them to make an informed choice?
Give the patient as much information as you have about the situation and what you are proposing. Be honest. If you are not confident performing the treatment you think is needed, I think it is fair that you convey that to the patient. If something were to go wrong and then they found out later that you were not confident about doing it, they will most likely feel aggrieved.
Offering your patient a second opinion with a specialist or a GDP who specialises in endodontics is also very important. That does not necessarily mean the patient has to travel elsewhere. If you have good links with colleagues in various specialisms, you can always make a quick call or send an email to get that second opinion.
So, if you are not sure how to move the case forward, patients respond really well if you tell them you are going to refer their case to a colleague and make an appointment for them in a week’s time or so to discuss the whys and wherefores of their treatment options. It actually makes them feel special, so you have bought yourself some time and the patient is happy.
Talking the same language
The term ‘endodontics’ is interesting, as to my mind it is the single dental discipline that is predominantly meaningless to the general public.
Mention ‘root canal’, on the other hand, and pretty much everyone has an idea of what that involves. This perfectly highlights the significance of the language we use with our patients.
Do they know what the pulp is? Probably not. Gingival tissue? Unlikely. Gutta percha? I’d be extremely surprised.
Your level of rapport with patients is incredibly important here. It gives you valuable insight into what they are likely to understand, and to amend your approach accordingly.
The sort of language I use in most cases simplifies the situation without dumbing it down too much. To offer a rather ridiculous example just to emphasise the point, you do not want to say, ‘We create a funnel and chuck bleach down it’.
My script goes something like this: ‘We are going to use a rubber dam because it protects your airway. It stops the bleach that we’re going to be using potentially going down your throat. There’s no blood supply in the space below that affected tooth anymore because the tooth is dying / dead. Therefore, your immune system can’t get at the bacteria and we need to kill them. So, I will remove the source of the infection, which is inside the tooth, using instruments created for the job and clean out the system.’
Then, if patients want to ask questions to get a more in-depth understanding of what is going to happen, I am delighted to share greater detail.
Difficulty grasping the concept
On the other side of the coin, there are patients who cannot grasp the concept of root canal. No matter how hard you try to simplify it for them. When that happens, I suggest that they go home and talk to a family member or friend about things. Then, invite then to come back with that person. Often, a loved one knows best how to communicate effectively with someone who has low health literacy.
For these patients especially, having access to literature to add to the verbal information we provide can be valuable.
The key thing here is for us is to signpost reputable organisations and websites. This is to try to avoid the patient emotionally investing in some opinionated and unknowledgeable social media contributor!
For me, the best place to send them is the British Endodontic Society. It has tab to patient-friendly FAQs on its home page.
If you do not feel confident about communicating with patients effectively, you are not alone. So, how can you build confidence?
I would suggest you get yourself in a room of like-minded individuals; our peers are a mine of great information. Finding a good training course on endodontics is going to help you do exactly that.
One possibility is ‘Hands-On Rotary Endo Training’. This is a one-day, hands-on endo session. It uses a combination of lectures and live instruction that invites delegate input and questions. Further information, dates and locations can be found at https://endoperfection.com/products/hands-on-rotary-endo-training.
In addition, beyond talking about endodontic treatment with your patients, having the right tools for the job can add assurance. For instance, the Varyflex range of files from Endoperfection offers amazing value. It doesn’t compromise on quality and is simple to use.
The files have incredible flexibility due to the heat-treated nickel titanium alloy and an 11mm shank. This is shorter than usual, making working with Varyflex very comfortable and easy.