by Juli Kagan, RDH, MEd
Remember learning about the inflammatory response in dental hygiene school? There was discussion about vasodilation, edema, cellular infiltrate, what came first, how long it took to heal, and so on. It was all so confusing!
Then the teacher said, "Think of a piece of calculus like a splinter in the finger. The calculus is partly responsible for the inflammatory response." Now that was something we could relate to. Yes, the finger did get red, swollen, and it hurt when some pressure was applied. It even hurt when the tweezer was used to take it out. But, oh, what a relief it was once that irritating splinter was out! This is the same analogy we sometimes use with our patients. The splinter is like calculus creating puffiness, and the tweezer is like the instrument used to take it out.
That teacher taught an invaluable lesson — the importance of speaking metaphorically to enhance understanding. How boring it would have been to simply memorize and regurgitate the physiology of inflammation!
This idea of speaking metaphorically, or using similes and analogies, is exceptionally beneficial for patients. They often hear things in "dental terms" even when the intent is to keep it as simple as possible. The beauty of communicating this way is that the more one uses metaphors, the more inclined one will be to stay away from "dental jargon." Giving the patient something tangible that they can relate to causes comprehension to skyrocket. With greater understanding and awareness of a dental situation, the greater the likelihood of trust. And with trust comes patient ownership of a problem and increased compliance, whether it is treatment acceptance or plaque control at home.
Often, the first instrument used during the prophylaxis is the periodontal probe. It can be likened to an oil dipstick in a car. The patient can recall that a dipstick has measurements on it. Show the patient a probe.
Follow this with an explanation such as, "Just as a dipstick is used to measure the amount of oil in the car, the probe is inserted around the gumline and we use it to measure the health of the gums. If you hear low numbers such as 'one, two, or three,' that means the gum is healthy at that site. When you hear readings of 'four' or more that is a signal that the gum is not as healthy. The greater the number, the more disease. Think of the readings as a golf game; lower numbers equate to a better score."
People understand this, and it captures their attention. With all the enthusiasm you can muster, have you ever tried showing patients the probe, describing its design and function and the patient looks ... in another direction? One of my favorite metaphors describes how pants pockets are like periodontal pockets.
The first question I ask is: "Do you have any pants where the pant pocket comes halfway down your thigh? Do you ever wear pants where you can barely squeeze three fingers in the pocket?" Periodontal pockets are very similar; some are deep, and some are shallow. In dental health, we want the shallow ones because we can reach to the bottom.
In regard to deeper "pants pockets," I may request they literally reach for the bottom and ask: "What's at the bottom?" The patient often will respond, "Lint, sand, just stuff!" That's when an analogy of lint and sand can be likened to plaque and calculus in the deepest area of the gum pocket. "And just as it takes time and patience to get all of that sand out, it will take some time and special care to get all of the plaque and calculus out of the pocket." Talk about an "a-ha moment!"
The key to creating and using metaphors effectively is gearing it to the lifestyle or profession of the patient. For example, when discussing root planing and how it differs from a conventional cleaning, consider discussing "spring cleaning the house" to a stay-at-home-mom (or any woman for that matter.) Spring-cleaning takes more time, more energy, more attention, and maybe more cleaning tools than a routine weekly cleaning. Spring-cleaning also is often dedicated to a room at a time, just like a quadrant or half mouth will be needed for the root-planing appointment. Best of all, the maintenance is much easier once the cleaning is done.
It's not only important what you say, but how you say it. Some of the suggestions below appeared in the February 2001 issue of Dental Economics ("The Awesome Power of Words" by Dr. Nate Booth).
• Cut a tooth vs. Shape a tooth
• Staff (people who cater to a leader) vs. Team (people who work together)
• Waiting room (where people wait) vs. Reception area (where people are received)
• Drill (a tool that digs a hole) vs. Handpiece (an instrument held in the hand)
• Checkup (or even a "check") vs. Continuing care examination
• Tell (to direct) vs. Advise (recommend)
• Cancellation (plant a seed here!) vs. Change in schedule (shift happens!)
Wouldn't it be nice, the next time your car needs to go to the auto shop, if the car mechanic describes what the car needs in layman's terms? How impressive it would be if he used an analogy related to dentistry? Ah, wouldn't that be nice? The beauty is that we can use analogies every day with every patient. It just might take a little shifting of your current communication paradigm.
Discussing complicated dental concepts with patients can be confusing and complex and thus requires creativity. Communicating using metaphors clears up many of these concepts with relative ease. When used effectively and routinely, this communication style absolutely promotes greater understanding for the patient, simplifies the complex, and, ultimately, increases case acceptance and compliance. Now that's talking!
Juli Kagan, RDH, MEd, teaches clinical dental hygiene, periodontology, and preventive dentistry at Broward Community College in Ft. Lauderdale, Fla. She also teaches instrumentation and clinical application for the periodontics department at Nova Southeastern University. She can be reached at (561) 305-5854 or by email at [email protected].
Some further thoughts and ideas:
• Suggested time interval for perio maintenance — Like changing the oil in your car. It all depends on how you drive the car. There is no particular time frame that fits all people. It's an individual decision. The speed demon will have a different schedule than that Sunday morning driver.
• Recurrent decay — Like a rusty car. The edges of the filling crumble and are not sealed. The car needs more than body work. You can't fix the car properly without taking care of the rust first. You need to remove the rust from the tooth and then take care of the bodywork with a white filling.
• Quadrant dentistry — Why not do it all at once? Otherwise, it's like buying wallpaper at different times. The paper will come from different dye lots and might not match as well. (Other reasons include less anesthesia.)
• Taking out partial dentures at night — You wouldn't go to bed with your shoes and socks on, so don't go to bed with your partial in.
• X-ray refusal — Like asking the mechanic to diagnose a problem from the sound of the car but not letting him look under the hood.
• Periodontium — Like the foundation to a beautiful building. You wouldn't build a house on quicksand.