Spring 2015

Myth Busters

There’s a lot of dubious data about dental care out there. Our experts offer advice for helping your patients separate fact from fiction

By Helene Ragovin

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Illustration: Dan Page

Among the skills a dentist must possess—clinical knowledge, nimble hands—the ability to listen to and communicate with patients has become more important than ever. As health care moves toward a more patient-centered model and as patients often arrive in the operatory with information they have gathered from the Internet or other sources, the ability to guide them to sound decisions about treatment is an essential part of your health-care toolkit.

That’s not always easy—especially if a patient is attached to an idea that isn’t good practice or can’t be supported by scientific evidence.

“There’s more emphasis on making patients an equal player in the decision-making process. So yes, ideally, we want patients to be coming in and questioning,” says Nicole Holland, director of health communication, education and promotion at the School of Dental Medicine.

“There is a lot of health information out there, and many consumers don’t know how to filter good health information from bad,” she says. That means dentists and other health-care providers have to be both educators and clinicians. And that requires a delicate balance of dispensing information, dispelling myths and cutting through quackery while maintaining patients’ trust.

“If we encourage people to get involved in their own health care, we need to give them the tools to do that well.” —Jennifer Towers

Most dentists stress that patients who are hesitant about—or even hostile to—certain treatments because of misinformation are a small minority in their practices. “But naturally, those are the ones who stick in our minds,” says John Ficarelli, D73, DG76, D10P, DG12P, a pediatric dentist who practices in Brookline and Walpole, Massachusetts.

The proliferation of social media and other online sources of health information have quickened the pace at which misinformation can travel—but mistaken ideas are not new to dentistry or to health care. “This type of thing is as old as the practice of medicine,” says Samuel Shames, D75, D17P, director of practice management at Tufts.

Indeed, the scientifically disproven idea that root canals can cause systemic disease has been in circulation for almost a century. The use of fluoride has been questioned since it was first introduced as a public health measure 70 years ago, despite considerable evidence of its safety and efficacy. Other issues that routinely come up are the safety of X-rays, amalgam fillings and sealants, or the use of alternative therapies, such as the recent popularity of “oil pulling”—rinsing the mouth with coconut or sesame oil for 20 to 30 minutes—to supposedly reduce plaque and fight infection. (Some promoters also claim oil pulling helps conditions such as headaches, diabetes or asthma.)

Sometimes, misguided ideas are driven by an antiscience mentality, or by a general wariness about the use of chemicals or substances not considered “natural,” says Jennifer Towers, director of research affairs for the dental school and an instructor in the health communication program at Tufts School of Medicine. (Both Towers and Holland earned master’s degrees through the program.) For example, a 2014 study in the American Journal of Public Health found that caregivers who refuse to have their children immunized are also likely to refuse fluoride treatments for their kids. Earlier in her career, Towers worked for the dental manufacturer Dentsply and recalls fielding inquiries about the safety of the company’s products.

Much of this thinking “stems from a lack of understanding of medicine and how drugs are made, and distrust of government,” Towers says. “When you mix the two, along with patient autonomy, there’s a lot more education that needs to be done. If we encourage people to get involved in their own health care, we need to give them the tools to do that well.”

The proliferation of social media and other online sources of health information have quickened the pace at which misinformation can travel.

Dental students and those already in practice need to remember that the goal is to maintain a good relationship with the patient—“because if a patient doesn’t come back, they are definitely not going to get proper treatment,” says Shames, managing member of the Gentle Dental of New England dental support organization.

“Some patients will not change their opinions [about a particular notion] right off the bat,” says Holland. “You do not want to be alienating. You want to steer them in a respectful way.”

Our Tufts experts offer the following advice for communicating with your patients about sensitive subjects. Take note: A lot of the work starts even before the patient sets foot in the office.

Be prepared. Pay attention to health-related topics in the media. “We’ll see a ripple: Anytime something is picked up in the media, people will ask about it,” Ficarelli says. Shames says he investigates pertinent topics that generate media attention and passes his findings onto the doctors at Gentle Dental’s 29 offices. “I don’t want them to be blindsided.” And know what’s trending on social media. “Not every dentist is on Facebook or Twitter, but someone in the office should be monitoring social media,” Towers advises.

Include your staff. Talking points should be shared with the whole office so that dentists, hygienists, assistants and front-desk staff are reinforcing the same messages. Because hygienists often spend the most time with patients during routine visits, it’s especially important to keep them well-informed, Towers says.

Don’t be dismissive. Remember, your patients take these concerns seriously. “Don’t say, ‘That’s crazy,’ ” says Shames. “Listen. Carefully ask questions. Let them explain their rationale. Tell them, ‘I understand.’ Keep the dialogue going.” Holland suggests exploring where a patient’s ideas are coming from and framing your answers with that in mind.

Don’t be condescending. “Expertise is important, but don’t cross the line into being patriarchal,” says Towers. “People are emotional about their health and the health of their children. People who are making choices to believe things from the Internet, whether they’re antivaccine or antifluoride, really believe they are doing this in the best interest of their children or themselves.”

Explain the consequences. “If patients don’t want X-rays, my job is to let them know the downside of not taking X-rays,” Shames says. “I can say, ‘Just so you’re aware, yes, not having X-rays will mean there will be less exposure to radiation, but we may miss some disease.’ ” Holland advises thoroughly documenting these conversations and any recommendations that were made in the patient’s chart. “Patients are autonomous, and we as dentists can have the conversation, but we can’t force a patient to undergo treatment,” she says. (The exception would be in cases where pediatric or elderly neglect is suspected, or for a medical emergency, such as an abscessed tooth.)

Set the groundwork early. When Ficarelli sees children for their initial visits, he explains to their parents that he does not do routine X-rays. “They hear that from me on the first visit, and on the second and the third, so by the time I do need to take a radiograph—when I’m about to do some treatment, or suspect some decay, or any number of scenarios—they have already heard from me, not once, but many times, that I don’t do this on a regular basis, so they know there must be a good reason.”

Provide alternate sources of accurate information. The American Dental Association provides talking points that dentists can use for topics that often arise. ADA members can sign up for periodic “Issue Alerts” and a daily “Morning Huddle” via email. Holland also recommends having reading material available for patients to take with them. But, she cautions, “The educational piece is not one-size-fits-all—just like every other aspect of care.” Ask the patient, “Would this be helpful to you?” Also, don’t assume every patient has Internet access.

Be aware of your patients’ belief systems and cultural profiles. “Don’t make the assumption that because someone is going to the dentist that they necessarily follow Western medicine,” says Towers. “If the person is practicing something at home that is not necessarily harmful, such as oil pulling [which has its roots in Indian ayurvedic tradition], don’t spend time telling them not to do it. Just make sure they understand not to rely solely on that.” Some followers of traditional Chinese medicine will not brush their tongue or use mouth rinses. “Be respectful of that,” Towers says, “even though it flies in the face of what we’re taught in the U.S.”


Information for Dentists

The “Science in the News” section on the ADA website: www.ada.org/en/science-research/science-in-the-news

The ADA Center for Evidence-Based Dentistry:

Information for Your Patients

Journal of the American Dental Association handouts that can be printed and distributed: www.ada.org/en/publications/jada/jada-for-the-dental-patient


American Dental Association: www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/ada-fluoridation-resources

Centers for Disease Control and Prevention:

National Institutes of Health: www.nidcr.nih.gov/OralHealth/Topics/Fluoride

Oil Pulling

American Dental Association: www.ada.org/en/science-research/science-in-the-news/the-practice-of-oil-pulling

Contact Helene Ragovin, the editor of this magazine, at helene.ragovin@tufts.edu.

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