John J. Maggio, DDS
If a high level of service is vital to the success of a full-fee private dental practice, excellent communication is clearly the core of that service. Most consultants advise that dentists make post-operative telephone calls to patients, but an equally important element of a solid doctor-patient relationship is the establishment of realistic post-operative expectations.
Post-operative expectations differ from post-operative instructions. Instructions are limited to steps for a patient to execute. Expectations not only include follow-up instructions but also paint a picture for the patient of the post-operative course, both short and long-term. Ideally, these expectations should be in written form, for quick and easy reference once the patient has left the office.
Benefits of written expectations
The advantages of having personalized, written post-operative expectations for each procedure performed in a practice include the following.
(1) Comments made to a patient while in the office - whether before, during, or after an office visit - are likely to be forgotten by the patient, whether those verbalizations were made by the dentist, assistant, hygienist or administrative staff. Written expectations act as a reference guide as anesthesia subsides and possible sequellae begin to appear.
(2) If distributed during the visit, this list of expected outcomes can be a source of conversation if a patient has questions, before any complications arise.
(3) A listing of potential experiences after therapy can help allay patient fears, especially if it is noted that those side effects are common and short-lived. This can reduce `panic` telephone calls, which saves the patient time and stress.
(4) When none of the possible sequellae occur, the dentist appears both thorough, in informing the patient properly, and clinically adept, as the post-operative course was much easier than the patient expected.
(5) Written advice for the period following treatment helps protect the dentist legally from false accusations that the patient was not properly informed.
(6) Dentists can proactively communicate under which circumstances a patient should contact the office for treatment of complications that require intervention, such as a dislodged provisional crown, a premature restored contact, or a lost suture. In this way, the final result can be improved, and patient comfort can be maximized.
(7) The routine use of treatment expectation sheets can be a powerful practice-marketing tool. Patients are likely to be impressed by this protocol, and may show the written information to friends, family, and coworkers.
Optimally, the dentist, or the dental team, should design and write the copy for post-operative literature, to personalize it for the practice and its patients. Individual expectation sheets should be developed for every distinct service provided, to allow for proper detail and accuracy. Similar procedures that have slightly different treatment courses should have separate literature. Soft temporaries for esthetic inlays, for example, exhibit different properties than acrylic provisional crowns, indicating slightly different post-operative instructions. Also, written expectations after the preparation and impression phase for a crown would be different from the literature distributed after crown cementation.
The text should begin with a section on likely post-operative experiences. This part of the document should describe predictable, common, normal events that follow a given procedure. Areas to include are discomfort, sensitivity, bleeding, swelling, texture, and appearance. Each possible outcome should be ascribed a reasonable time-frame for onset and duration. After reading this section, the patient should have a good understanding of the normal post-operative course. For example, if a patient`s gingival tissues are tender and edematous due to cord placement or rubber dam isolation, that patient is less likely to suspect a problem or call the dentist if he or she has been prepared for that possibility.
The next section should give explicit instructions for optimal maintenance. Instructions for pain control and medications prescribed, rinses, and plaque removal are discussed, along with special recommendations for eating. This is a good opportunity to communicate the importance of follow-up care and patient compliance. Patients should be reminded after endodontic therapy that a final restoration must be placed. Patients completing periodontal procedures should be informed that the prognosis depends on rigorous home care and continuous maintenance visits. Similarly, post-operative expectations following cementation of indirect restorations should emphasize the importance of meticulous home care and return visits.
The last section should present scenarios where the dentist would want the patient to contact the office. These would include lost provisional restorations, severe swelling, spontaneous discomfort, and tooth fracture. As a nice touch, patients should be invited to call if they have any questions at all.
Format and presentation
Each individual post-treatment sheet should include a title, as well as the practice name, address and phone, and any logos or practice mottoes, to personalize it. Colored pages can serve two purposes. While making the literature look more professional, colors also allow staff to distinguish the various sheets from each other. Whenever possible, I have selected colors that match the procedure, to help my staff identify the one they need quickly. My post-operative document for endodontic follow-up, for example, is printed on salmon-colored paper, the color of gutta percha. Ivory-colored paper is used for instructions following placement of direct composite restorations. Literature we distribute describing gold onlay procedures resemble the color of that restoration.
Font selection should be appropriate for the text, and should be reflective of the practice`s philosophy. As a rule, more than two different fonts on the same page can be distracting, unless the third style is used to set the practice name apart from the rest of the text. Font size usually should be no smaller than 12 points for easier reading. Bold-faced, underlined, or italicized text loses its effect when overused.
Word selection should be appropriate for the target audience. Simple, non-technical language is advisable, although the text should not be so simplistic that it is insulting, and the words selected should not be so common that they no longer accurately describe the clinical procedure. I have a problem, for example, with the words `filling` and `cleaning`. While recognizable to all patients, these words do not effectively convey the scope of therapy being provided. The terms `restoration` and `maintenance visit` are more informative, and can be easily understood if the time is taken to educate patients.
Staff training and distribution
For any project to be successful, all team members must understand and share the vision of the end-product that endeavor will bring. A staff meeting should be held before implementation, and possibly even before design and fabrication, of post-operative literature. The benefits, as stated above, should be enumerated. The best rationale for this undertaking is the expected decrease in miscommunication, decrease in post-treatment telephone calls, increase in patient satisfaction, and increase in new-patient referrals. The team should decide who will be responsible for the distribution of literature to the patient, and who will be responsible for inventory and
restocking. Ideally, someone should be involved in eliciting feedback from patients as to the usefulness of the post-operative expectations.
A protocol should be developed for explaining the post-operative expectations to each patient. Certainly, these papers are not meant to replace oral communication. Several options are available. The team might decide to touch on the most important elements verbally, or it may be decided that each point should be explained as the patient reads along. Alternately, the patient could be left alone to read for a few minutes, after which a staff member could address any questions or concerns. In any case, the entire team must be knowledgeable and conversant on the contents of the literature being utilized.
Customized post-treatment expectations can become a vital part of any practice wishing to improve its level of service. They can serve as a template for handling post-operative questions and concerns. They convey to each patient that the entire team is experienced and concerned with the outcome of his/her treatment. Perhaps most importantly, they produce a better educated patient, with a renewed value for the services our profession provides.
Aftercare Following Endodontic (Root Canal) Therapy
What To Expect
(1) It is not uncommon for a tooth to be uncomfortable or even exhibit a dull ache immediately after receiving root-canal therapy. This should subside within one week.
(2) Your tooth will be sensitive to biting pressure and may even appear to feel loose. This feeling is a result of the sensitivity of nerve-endings in the tissue just outside the end of the root, where we cleaned, irrigated, and placed filler and sealer material. This feeling will be short-lived.
(3) You may feel a depression or rough area (on the top of a back tooth or the back of a front tooth) where our access was made. There is a soft, temporary material in that area, which may wear away to some degree before your next visit.
(4) Occasionally, a small `bubble` or `pimple` will appear on the gum tissue within a few days after completion of a root canal. This represents the release of pressure and bacteria which no longer can be sustained around the tooth. This should disappear within a few days.
What To Do
(1); We recommend you take something for pain-relief within one hour of leaving our office, to get the medication into your blood system before the anesthesia we administered begins to subside. Generally, only one dose is needed. We recommend ibuprofen (Nuprin, Advil, Motrin) - 800 mg (four tablets). If you have a medical condition or gastrointestinal disorder which precludes ibuprofen, acetaminophen (Tylenol, Excedrin) is a substitute, although it does not contain anti-inflammatory properties. Aspirin and aspirin-containing products are not advisable, as they tend to increase bleeding from the area that was treated.
(2) Whenever possible, try to chew on the opposite side from the tooth we have just treated, until you have a crown or onlay placed, or until the access area is restored. Until that time, your tooth still is weakened and could fracture.
(3) Please avoid chewing gum, caramels, or other sticky, soft candy, which could dislodge the temporary material or fracture your tooth.
Please Call Us If ...
(1) you are experiencing symptoms more intense or of longer duration than those described above.
(2) you encounter significant post-operative swelling.
(3) the temporary material is dislodged, feels loose, or feels `high` when biting.
(4) your tooth fractures.
(5) you have any questions at all.