Taking the stress out of ‘bad news’

March 1, 2006
One of the most difficult things dentists have to do is communicate things to their patients that they do not want to hear.

One of the most difficult things dentists have to do is communicate things to their patients that they do not want to hear. I’ve had a number of such instances, but since I installed digital radiography, the process of delivering bad news is much easier than it was when I used film radiography. If I didn’t have digital radiography, I would have had a difficult time convincing several of my patients to have the necessary work done.

The first case involved an elderly gentleman in his mid 80s who had lost a number of teeth and had partial upper and lower dentures. He had not been to the dentist’s office for a number of years, and one of the first things I did, of course, was take a full-mouth series. I discovered that he had deep decay in one of his canines. The decay was so deep that the tooth needed to be removed.

I knew from talking with him during my new-patient interview that he was not particularly happy about coming in for a dental visit and, further, because of his attitude, he might have difficulty accepting any treatment plan, let alone one that involved his losing another tooth. I also knew that he had no pain or discomfort related to any of his dental problems. And so, when I looked at the X-ray image of the canine tooth, I knew I had my work cut out for me.

One of the first things that flashed through my mind was, “Thank heaven I’ve got digital radiography.” I can’t imagine how I would have even approached such unwelcome news to this reluctant patient without it. I pictured myself positioning a tiny piece of film (a film image actually measures 11/4” by 19/16”, exclusive of mount) on a lightbox, trying to get him to see what I saw, and I realized it would have been nearly impossible.

He just didn’t want to believe he would have to lose yet another tooth. It didn’t hurt, he’d lost so many teeth already, and he’d have to add another tooth to his partial. I double-clicked on the X-ray image to display it full-screen on the monitor. Then I used my system’s free-draw capability and drew a red circle around the lesion so he could really see the extent of the decay. His first response was, “That’s a big black hole, isn’t it?” It was clear at that moment he understood the seriousness of his problem and that he would have to lose the tooth.

I’m relating this story not just because of the improved diagnostic capability of digital radiography over film, but also to explain that it takes a great deal of stress off the dentist. I didn’t have to say to this gentleman, a new patient with whom I had no history and no time to develop a high level of trust, “You’ll just have to take my word for this,” as I would have with film. The size and clarity of the image meant that he could see exactly what I saw without taking anyone’s word for it.

Another patient, in his early 30s, had received excellent dental care through his teen years, but like many younger adults, he had not had regular dental visits after college. When he finally made an appointment with me for a routine examination, it had been eight years since his last dental visit. He told me he hadn’t seen the necessity for visiting a dentist because he hadn’t had a single cavity - ever. “I’ve been blessed with my mother’s strong teeth,” were his exact words. But now, unfortunately, the full-mouth series I took revealed extensive problems: he had nine cavities. I have to confess that I hesitated briefly. I was concerned that when I gave him the bad news about his strong teeth, he might feel that I was criticizing his mother by proxy. Talk about a stressful situation!

As I do with so many of my patients, I took advantage of the ClearVu enhancements of my DEXIS® digital radiography system. I explained what we were looking at with the X-ray image displayed, then used these enhancements to make it clear to him exactly what the problems were. I find that it’s very helpful in all cases - but especially in cases such as this one - to have patients watch the transition as the enhancements are used. It helps them understand what’s really going on and, by doing so, it makes them more receptive to even difficult diagnoses.

Sometimes, when we’re seeing 10 patients a day, we’re also seeing 10 different personalities. It’s simply invaluable to have a tool such as digital radiography available to soften the blow of unpleasant news for the patient. And it doesn’t hurt that it reduces the stress to the dentist who must deliver it. As the old saying goes, “Showin’s better than tellin’.” Nowhere is this more true than with digital radiography, although I might change the saying slightly: “Showin’s better - and less stressful - than tellin’.”

Dr. Cynthia Brattesani maintains a private practice in San Francisco. She won the prestigious ADA Golden Apple New Dentist Leadership Award in 1996. She is an enthusiastic member of organized dentistry, having held positions at the local, state, and national levels. You may reach her at [email protected].

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