An oral surgeons perspective on patients vulnerability

Consider the very common procedure of removing four impacted third-molar teeth. Patty trusts her dentist`s judgment that it is appropriate care for her to have four asymptomatic teeth removed. In spite of the horror stories she has heard from friends and relatives about third-molar surgery, she presents to our office trusting the abilities she perceives us to have. She hears the comforting words of our receptionist or assistant. We gain her confidence with words of reassurance and let her know w

Stephen L. Black, DDS, PC

Consider the very common procedure of removing four impacted third-molar teeth. Patty trusts her dentist`s judgment that it is appropriate care for her to have four asymptomatic teeth removed. In spite of the horror stories she has heard from friends and relatives about third-molar surgery, she presents to our office trusting the abilities she perceives us to have. She hears the comforting words of our receptionist or assistant. We gain her confidence with words of reassurance and let her know we think she has shown good judgment in selecting this treatment.

At this time, Patty is extremely open, vulnerable, frightened and may even be having second thoughts. She is placed in a dental chair or operating table in a supine position, head slightly lower than the chest. An electronic probe is put on her finger and EKG leads are placed. A blood pressure cuff is applied to her arm. A nasal mask is strapped to her head and an IV is started. Her IV medications now block out her control, sometimes resulting in a relaxing nap, sometimes an emotional roller coaster.

Her mouth is opened and a prop put in place just before multiple injections of local anesthetic are properly dispensed.

Incisions are made, bone is removed and the teeth are cut into pieces with care and caution. In the meantime, copious irrigation floods the oral cavity and is suctioned away. The wisdom teeth, formerly a part of this human being, are sectioned, split, removed and discarded. Sutures, surgical dressing and gauze packs are placed to help in the beginning of the healing process.

The patient is aroused, disconnected from all monitors and devices, carefully taken to the recovery area, allowed to return to a normal level of consciousness and, at the appropriate time, dismissed after careful review of postoperative instructions.

We have provided an excellent service efficiently and professionally in a caring office environment. But what about invasion? Imagine that physical invasion of the human body can be placed on a scale from 0 to 10, with 0 being noninvasive and 10 being rape or murder. I submit that removing four third-molar teeth as just described ranks about 7.

From this perspective, we have the opportunity to look at how we are caring for the personal needs of the patient beyond the technical skills.

We must not lose sight of our personal contact with patients. We have an obligation to provide extraordinary care of the personal needs that patients face at the time of their oral surgical care and to respect their vulnerable position.

Vulnerability - the word, the feeling, the way of being - is not commonly referenced in our professional literature.

The "looking beyond" requires that we combine our surgical skills with compassion. That is, we assess and consider other`s feelings above our own by placing ourselves in their shoes, caring for them through their eyes, understanding with love and without judgment. Only with a compassionate attitude can we observe how our patients are open to their surroundings and how they feel about what they are experiencing. This compassion enables us to support them emotionally during our surgical care.

Patients entrusted to our care, often on referral, have established a long-term relationship and confident rapport with their dentist. We are foreigners to these patients - a different office environment, different personnel, a different doctor.

There are no national guidelines or federal regulations overseeing this aspect of our work. It is the responsibility of each dentist and staff member to involve ourselves in a personal way with patients so that the experience provided is the least invasive. Our reputation as a nurturing profession demands such care and our patients absolutely deserve this extraordinary attention.

Dr. Stephen Black is a Diplomate of the American Board of Oral & Maxillofacial Surgery. He practices oral surgery in Bozeman, MT.

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