Dentisign

[dentisign]

Thank you for taking the time to comment on DentiSign.

You state that it places an emphasis on saving time - that is one of the potential benefits, but not the core benefits.

- Providing a communication method restores a sense of control, reducing anxiety and establishing a trust relationship between patient and dentist.
- Communication enables the patient and dental professional to become a team, again reducing anxiety as the patient has control in the procedure rather than having something DONE to them.

The signs are easily learned in less than 15 seconds by all age groups per my experiences. Users of DentiSign will use the signs that they need and may not use them all, but having them available and being encouraged to use them gives the patient the confidence to express themselves and thereby improving their dental experience.

Sometimes, just knowing that you can ask for your needs to be addressed can be the first step in addressing dental anxiety and providing a better dental experience.

Conventional wisdom in the dental community is to use a 'stop-signal' to stop the procedure if need be. By it's very nature, this is a negative STOP.... If that is the only sin available, then every thing is STOP, reinforcing the negative... we need to break the negative, we need more than one signal - we need communication... hence DentiSign.

Most patients will not suffer in silence - they may not be in pain, and simply want to scratch their nose or have their mouth rinsed out - yet they wait and wait and wait for an opportunity as they do not think it warrants a STOP...

Your thoughts...

 

[letsconnect]

I've got a memory like a fish (hence the avatar) and certainly wouldn't be able to remember them in 15 seconds (15 minutes more like it, lol - and even then I'd probably forget half of them). And I doubt someone who felt panicky would be able to remember them at all - in fact, it may make it harder for them to make any sort of stop signal (due to the fact that they'd be searching their brains in a state - the panic response - when searching your brain just isn't an option!).

HAVING SAID THAT, I reckon it's a brilliant idea, especially when tailored to the needs of the individual! For example, we had a poster here a while back whose main fear was that she felt she was suffocating when having water in her mouth. In that instance, having a signal that tells the nurse/assistant to use the suction tool would be brilliant.

I also really like the OK signal, which can be used by the dentist to check up on their patients that they're feeling comfortable - I think it would be much easier for patients to make an ok signal than to try nodding in the middle of something .

 

[brit]

HAVING SAID THAT, I reckon it's a brilliant idea, especially when tailored to the needs of the individual! For example, we had a poster here a while back whose main fear was that she felt she was suffocating when having water in her mouth. In that instance, having a signal that tells the nurse/assistant to use the "suction tool" (Mr. Hoover in dentist talk) would be brilliant.

I also really like the OK signal, which can be used by the dentist to check up on their patients that they're feeling comfortable - I think it would be much easier for patients to make an ok signal than to try nodding in the middle of something .

I think I am ok 'thumbs up' would be good because it might encourage dentists to check in more often as they could do so without totally stopping....they should do this more actually as contrary to what you say (patients won't put up with pain), there is a minority of dental patients who are intimidated to such an extent they do put up with (avoidable minor) pain unless truly unbearable and it is easier for such patients to complain/respond negatively, to a direct enquiry from the dentist/hygienist.

I agree with Letconnect it needs to be individualised because there are too many variables on why you might need to talk or stop for a break....e.g. I want to scratch an itch, blow my nose, need a comfort break, I feel sick, too much water, water too cold, too much saliva, the nurse is catching my lip everytime she does that, I want more LA and finally 'stop' that hurts. No one would want to have to remember individual signals for all these (dentists probably wouldn't want to have to look out for all of them either) and since most situations involve stopping anyway, it means just 3 signals 'stop', 'I am ok' and 'I want to say sth/talk' are really all you need.....only 'I am ok', could avoid a break in proceedings.
True communication is stopping what you are doing and giving the patient's needs your full attention, showing you really do care and are not just thinking about rushing through to get your next patient in early.
There should be less of an onus on the patient having to complain when in discomfort and more on the dentist/assistant actively looking for signs of discomfort and then enquiring....hence stopping and discussing.

I don't like the pain ones unless you are having to do sth which is intrinsically painful but think the 'it hurts a lot, a little' would be hard to remember and that putting a number of fingers up to communicate the pain level might be easier for patient and dentist to interprete...1 raised finger indicates hurts a little, 4 indicates hurts a lot for instance.

I am not phobic (just dislike dentists causing me unnecessary pain which historically they have), am educated to degree level and yet would not want to have to remember all those signs...the stress of it would interfere with 'feeling relaxed' which is easier to do with a dentist you like and already trust to respect your comfort level.

Incidentally on all the occasions I have actively been given a stop signal by a dentist or hygienist, I have never actually had to use it, as dentists offering it as a matter of course seem to be the more solicitous ones of patient comfort anyway....I have also successfully used a 'stop' with a dentist who caused pain during drilling even though it hadn't been pre-agreed.

 

[Snowball]

This feels like Dragons' Den, and am afraid I'd have to be the Duncan Ballantine.

Got to say I agree with Brit. I also have a degree and even studied psycholinguistics at postgrad level; at one point, had some sign language (long since forgotten) but I can't make head nor tail of that rather dry and old fashioned illustration, let alone hope to remember any of it. Or assume I could recall it under stress. What's wrong with thumbs up or agreed stop sign? Do they really need to know my degree of discomfort, or reason for a stop (wee wee, discomfort, swallow, converse, rest, change battery in ipod..... surely the list is endless)?

Also think that psychologically, it's a bad idea to even put the thought 'PAIN' into a child's head, in association with the dentist. Really bad. I used to be a teacher and noticed this interesting phenomenon. Take a coachload of Key Stage 1 (young elementary) kids on a school trip. Don;t mention the phrase 'travel sickness' Voila. No vomit. Take same busload and someone mention 'being sick' - pass the mop and bucket! Very very very bad idea.

Thumbs up or Stop. Rather not need the use the latter. If you do, you want them to stop instantly, not hang around whilst they figure out a sign, then the degree of urgency.

Would also say read the article linked to on this site re. patients who have been abused in the past. Some go into dissociative states very easily. Am not sure such a patient (most in need of help) would be at all able to communicate this way for the reasons given in that excellent article.

 

[dentisign]

In response to the last comment, it is true that some people will not utilize the hand signals for one reason or another - some stated by the last poster.

The hand signals posted are simple to learn, and in trials, children learn them within 15 seconds and use them. Patients find that simply knowing that they have the permission to communicate their needs is enough, especially kids.

Dental professionals find the signals useful as it is an ice breaker and allows them to better guage the patients approach to the dental procedure and adjust accordingly.

The use of 'stop-signals' has been used in dentistry for a long time, we need more than one word to enable patient-dentist teamwork.

The signs posted are the basic communication primatives required, all other communications begin with these.

Simply knowing that one can tell the dentist that you want, even if you don't can alleviate distress.

-all the best.

 

[brit]

Your post reminds me a bit of a Government Communications Department Press Release...you have asked for our feedback and we have given it in an honest and thoughtful manner....and yet each time you counter that our thoughts are wrong because in your research kids have learnt the signals in 15 seconds etc etc .

Most of the people who have given their opinion are parents who have taken steps to avoid fear of dentists arising in their own kids...this has always scrupulously involved not associating dentistry with pain for kids..and/or finding dentists for them with painless techniques.
Your signs make this unwelcome 'dentistry= pain' association upfront and for kids therefore are inappropriate in my view. Most kids can avoid cavities these days anyway...making the association even more ill-conceived.

I also don't see why you should make money out of marketing sth like this (if this is your intention) the only 3 signs anyone needs are ok thumbs up, please stop and at a push...I want to talk non-urgently so pls stop when next convenient.

 

[brit]

Dental professionals find the signals useful as it is an ice breaker and allows them to better guage the patients approach to the dental procedure and adjust accordingly.

The best way to break the ice is with non-dental conversation actually ...trust me I'm a dental patient . My dentist/hygienist are fantastic - they offer stop/break signals.

 

[dentisign]

I appreciate all the feedback to date, it is a perpective I have not heard to date, as I have not focussed upon those with dental fear alone.

The larger community of dental patients may not experience severe dental fear, they want a better dental experience and dentisign is providing that to them.

I first posted here as I thought that DentiSign would also have an application in the dental fear community, and have heard from you all, that this may or may not be the case.

I have continued to respond to posts here in an attempt to elicit a more detailed argument on the application of DentiSign to those that experience dental fear as the debate/feedback to date has been pretty narrow in it's viewpoint - patients with severe detnal fear.

The posters comment that they believe that the signs associate pain with dentistry, yet, isn't that that what people with dental fear think also?

Getting that fact out in the open and reasuring that patient that they are empowered to communicate their needs is surley better than 'raise your hand' - how has that been working for everyone for the past 30 years. The majority of dental whitepapers on dental fear and anxiety state that most patients will suffer in silence rather than 'rasie their hand'.

DentiSign is an attempt to move past 'raise your hand' - I am looking for feedback that can help in the process.

So, if you think that the signs need changing, let us know what you think they should look like - improve , not only disapprove. I look forward to your comments, as I would like to incorportate the wisdom and experiences of this board to better the dental experience for all.


All the best.

 

[Snowball]

We are a specific community here, though. Either dental phobics or ex. We can only give you that perspective and if you don't want to know what phobics think, why ask? You surely can't expect to elicit only positive feedback? Or want to move on quickly, rather than explore issues raised, surely? Trust me if I had anything positive to say, I'd happily say it.

 

[brit]

The posters comment that they believe that the signs associate pain with dentistry, yet, isn't that that what people with dental fear think also?.

Not necessarily....believing dentistry is painful is not the way to persuade yourself that going to the dentist is a good idea. The best way to get the whole dental profession 'to raise their game in the comfort stakes' is to tell people it is perfectly possible to provide painfree dentistry (we are talking during treatment here...not the afterpain of healing).

The UK BDA used to say in Press Releases in the 1970s that dentistry is 'virtually painless' and I wanted to believe them and in fact both my seriously bad experiences have been with non-UK trained dentists so I would say the BDA was not lying even back then.

Getting that fact out in the open and reassuring that patient that they are empowered to communicate their needs is surley better than 'raise your hand' - how has that been working for everyone for the past 30 years. The majority of dental whitepapers on dental fear and anxiety state that most patients will suffer in silence rather than 'rasie their hand'..

It is not a fact that dentistry is painful.....I have had upwards of about 25 dentists/more if you count hygienists (not my fault used to be on an Associate's list as a teenager and now I relocate around the world a lot) over the years and only two have ever caused me pain and both unnecessarily (by denying anaesthetic)....even for that particular moment in history. Both non-UK trained as I said above.

My current dentist advertises and delivers caring painfree treatment just with local anaesthetic (no sedation in my case)...the LA is delivered imperceptibly.
Obviously when I move house, this makes me very fussy about who I choose as my new dentist...once you've experienced pleasant treatment, you don't want to go back to a more 'hit and miss' approach. Basically all dentists are not the same and the comfort level of their treatment just like their technical competence is not equal.
So it is because I think painless dentistry is possible (I had a long run of it for 30 years after all before getting a shock in the early 2000s while living outside the UK) that I do not associate nor want to associate dentistry with pain.

I think stop signals do work when genuinely offered by a caring dentist who you feel will actually be able to do sth to alleviate the discomfort if you do stop them.....thesedays it is a no-brainer for me (more LA please) but for patients who fear injections..(and have dentists with bad technique)......it may be a close run thing between 'shall I put up with this? rather than ask for another (painful) injection?

Someone posted on this website this week that she recently complained of pain during treatment and was told to 'shut up and put up'. Now because of the general media/public perception that dentistry is painful, she thought she had no choice and that it was indeed supposed to be like that...when arguably the dentist bordered on commiting assault by insisting on continuing without providing adequate anaesthesia.
This dentist part of the rogue minority still creating phobics/anxious patients would not have behaved any better with Dentisign, would he? He just plain didn't care about her comfort.
So in my view the best dentists already operate at the communication level to which you say Dentisign aspires....but they do this just by caring enough to check on patients, observing their body langauge, asking if they are still ok from time to time, and by offering break/stop signals.

So, if you think that the signs need changing, let us know what you think they should look like - improve , not only disapprove. I look forward to your comments, as I would like to incorportate the wisdom and experiences of this board to better the dental experience for all.

If you wish to pursue it as you no doubt do...I think the version for dentally anxious and children should leave out the 'it hurts a little, it hurts a lot' signals and these should only be produced if sth is being done which is indeed causing pain (personally I would seek sedation in this case)...I said before I thought sticking fingers up to indicate pain level was easier to remember than the signals you have proposed.....people can even write a number on a pad on their lap as well as an alternative.

I agree that two additional signals are useful alongside the long-established (but rarely offered by bad dentists) stop signal ......I do want this signal to be offered to my kids if they are having treatment but along the lines of 'if you want me to stop because sth feels bad or you need a break, just raise your hand like this'
The two good additional signals you propose are: ok thumbs up for use in response to a caring dentist's enquiries as to whether patient is still comfortable and MAYBE 'I want to talk non-urgently'.

So I think I am meeting you halfway....I do not think every patient (mainstream or anxious/phobic) wants to be confronted with the chart as it stands when they first visit a new dental practice...having to memorise so many symbols is stressful and to have the pain word raised at the beginning of the relationship just doesn't contribute to a relaxing atmosphere.....

If you really want to improve a patient's dental experience, dentists need to allow more time per patient and treat them as individuals not just sets of teeth on a production line...I choose dentists who do this and actually enjoy going as a result because the quality of the interaction is greatly improved. The chairside chat is at a much more stimulating level than with my hairdresser for instance my hygienist will stop working on me so I can reply to a non-dental comment she has made or laugh at an anecdote...when you laugh in the chair you know you have come to the right place! I did not go to this practice as an anxious patient I am getting their usual patient-centred treatment.

The other bugbear is poor LA technique....dental schools only teach the basics apparently...this is why those with anatomical variation or infected teeth sometimes experience painful appointments......if a dentist can't get their patient numb they shouldn't work on them

Can't Get Numb

Find out why you may not get numb enough, what dentists can do to get you numb, and how to ensure your treatment is painless.

www.dentalfearcentral.org