Viewpoint from a dental patient: Why you must talk to your patients about pain

What happens when you have a chronic dental patient? You know, the patient who has one problem after another after another. I know you try to teach him or her over and over again when you really want to scream, “JUST BRUSH YOUR TEETH THE CORRECT WAY!” You keep reviewing how to floss correctly when you really have some “other” ideas on what they can REALLY do with that floss!

Well, dear reader, as a dental patient, I truly am your worst nightmare. One dentist actually said to me, “You are my worst pain patient in the past 30 years.” How does one respond to that? “Uh, thank you?” I am the patient you dread getting. I am the patient who has pain issues and is fearful of what you are going to inflict on me.

Here is my story (an abbreviated one) that will show you what YOU can do to address the pain issue for “difficult” patients like me.

I have TMJ (my son says the acronym means, “Too Much Jawing”). Yep, basically it means I talk too much. My adventure began in 2001 when I couldn’t open my mouth and was in terrible pain. This journey has led to two sets of braces, orthotics, crown lengthening surgeries, new crowns, and a dental implant. This, my friend, is a $33,000 mouth. Imagine the gorgeous convertible I could be driving around in if I hadn’t spent all that money on my big mouth. But, I am a “valuable” patient. You know, the one who needs a boatload of dental care. The truth is I am terrified of pain from TMJ. I am also afraid of the pain in my wallet with another procedure or surgery. Also, I am afraid it just isn’t sexy to have orthotics in your mouth every night when you sleep (we will not even address the joy of morning breath that has had plastic in all night).

Now you know the history, but the latest chapter happened last month. It was gum graft surgery (fun, fun). My wisdom from this experience to share with you is to encourage IV sedation—not for you—for your patient. That is the only thing that kept my sanity with this last round of excitement. Forgive me for sharing my personal trauma, but this is a patient care issue. As a social worker, I often see a patient being written off as being a “drama queen” or “attention seeking” because of pain (often you tend to only trust what you see big mistake). You must have at least one patient who reports having pain issues, but you don’t see him or her grimace or cry out in pain. Many of us suffer silently to the best of our abilities. You see, there is another fear that dental professionals will view us as “difficult” and become passive aggressive towards us.

Last year, I needed an implant. We ran into some trouble from the very beginning. For some reason, the Novocain just didn’t work. I got injection after injection after injection. The periodontist finally said, “I don’t know what to do.” He could send me to the oral surgeon so I can be sedated or just “do it.” Me? I am a smart one. Even without dental insurance, my response was “oral surgeon.” Please understand that I try to be social and friendly and be the “perfect” patient. I present well and don’t complain. Yet, you would never know by looking at me that I have pain issues. You have to ask and listen to what your patients say. I know you don’t want to inflict physical or mental pain, but please talk to your patients about pain. Ask how much they can tolerate. Do they have a high pain tolerance? Are there certain things that can help them get through a challenging time in the chair? Do they have a transitional object that helps? Do your patients need to do something the night before to keep from getting anxious? What have they done in the past to manage pain?

Also, be honest about telling the patient what to expect. Some patients want to know blow by blow what you are going to do to them. Some don’t. The dentist who tells me I will feel a pinch or where we are at in the procedure is a huge help to me in managing my pain. Find out what your patient wants to know and when by just asking.

The bottom line is this: Make sure you get a thorough pain history from your patient at the consultation stage. It is just good patient care.

Here are your takeaways

Ask extensive questions about pain tolerance.

Listen to what the patient says (that means, stop multitasking and really listen).

Pay attention to nonverbal behaviors while in the chair.

Don’t be judgmental labeling the patient as “difficult” or a “drama mama.”

And ALWAYS ALWAYS put yourself in your patient’s position. What would you want if you were in pain and in a dentist’s chair?

This wraps up this month’s thoughts. I’ll talk to you next month. If you want to shoot me an email and share stories from the trenches, contact me at diana@discussdirectives.com.