Gordon Laurie on Special Care Dentistry
Gordon Laurie is a Specialist in Special Care Dentistry. He has a long history of working in the Community Dental Service, initially working with children and later in the then-new Special Dental Care Team. Before his retirement in 2017, he was Assistant Clinical Director Dentistry at NHS Highland (click here for a more complete bio). Gordon has been with Dental Fear Central from its very inception, and could be described as DFC’s co-founder. Our DFC volunteer Nikoleta Gehrmann travelled all the way to picturesque Onich (in the Scottish Highlands) to interview him!
This is an abridged version – you can read the full PDF version with lots more info here.
Nikoleta: Why did you choose to become a dentist?
Gordon: My usual answer is that I was drunk and woke up in dental school (laughs). I wanted to do something that involved working with people, and involved working with my hands. Dentistry seemed like a happy medium.
For my first five years I worked in a general practice and realised that I didn’t like it, so I fell into the special care stuff that seemed to suit me and I thought “This is what I enjoy”.
N: What part of your job was working with dental phobics?
G: Dental phobics wasn’t a main part of my job but something that just happened. My responsibility was special care: people with learning disabilities, complex medical problems, mobility issues, housebound people who couldn’t get to a dentist.
N: Can you tell me what exactly dentistry for special needs is? What are special needs?
G: Anyone with a medical or psychiatric or physical problem that would stop them from going to a normal dentist.
Anybody with a learning difficulty who would be too complicated to be treated in a general dental practice, someone with medical problems that could interfere with local anaesthetic, someone who may need a general anaesthetic from time to time.
Basically anybody who a normal general practice dentist doesn’t want to treat. Quite often the dentistry would be straightforward, but getting to do that on that patient was the complicated part.
N: What are some special skills a dentist for special needs needs?
G: You have to be able to establish rapport quickly. You have to be accepted quickly. You’re a fairly threatening person as a dentist. Even if they’re not phobics, they’re generally not fans. You are literally invading their personal space.
When you’re coming into their home and you’re bringing a lot of stuff, you have to put people quickly at ease.
You have to keep things understandable, and at the same time not talk down to someone.You have to have a good idea of different medical conditions and how they relate to dentistry, and knowledge about different drugs. Good networking skills.
You’ve got to be able to drive! You have to have a good sense of direction, be able to find people (laughs).
You have to be flexible. You’re not always going to be able to do the very best dentistry you can. You may look at somebody and think “They could have four root canals, four crowns, sorted”. But there’s no way you could do that, so you’ll have to consider an alternative. As undergraduates we were taught to do things at a very high standard all the time. Not being able to can be difficult.
You have to keep good notes to justify what you haven’t done. Sometimes you have to accept that maybe you just have to not do anything.
Dentists are doers, they want to do something but you may see someone who’s got a couple of decayed teeth but they’re very frail and very uncooperative due to dementia, so if you’re going to treat them, it’s going to have to be under general anaesthetic and they may not survive. How are you going to do it?
You have to be patient, especially with phobic patients. You might think “This is very easy, you’re in a lot of pain, I can get you out of pain in 30 seconds”. That can try your patience. But if you lose your patience, that’s going to mess things up completely, you have to remain calm and go at their pace.
N: How do you do that?
G: I can be extraordinarily patient when I’m working and not when I’m not. I had the same dental nurse for about 20 years and she used to think it was ridiculous what I would put up with. I would be prepared to do almost anything to treat somebody. I had one wee girl and we finished up with me singing ABBA songs to her to take her teeth out! Maybe it’s because I don’t like to lose. If I don’t get the treatment done, I’ve lost.
Other stupid things I have done… I made a Down’s Syndrome boy teeth like Elvis Presley’s.
N: Really? Tell me more about it.
G: One of the things with Down’s Syndrome, they have short conical roots on their teeth and they are prone to gum disease, which often means they would lose their teeth quite young. This lad’s teeth had to be removed and he refused to get false teeth.
His mum was getting married and desperately wanted him to have teeth for the wedding. We discovered he was a huge Elvis fan so I said “Bring me photographs of Elvis’s teeth and I’ll get your teeth made the same.” Then my wonderful technician made his dentures as close to Elvis’s teeth as we could and he wore them. You have to be prepared to be flexible and think outside the box.
What else? You have to be physically flexible. Physically the most demanding thing I have ever done was crowns on a lady with advanced multiple sclerosis, in a special wheelchair. It took about three hours and by the time I got home I could barely straighten up.
The other thing you need is a really good assistant. I was blessed with some really superb nurses, Lesley, Karen, Eileen, Carrie Anne. You need that. Not just to help with dentistry, you need the assistant on board and working with you as a team.
I‘ve spent time thinking about language, people can say the wrong thing and it can have a profound effect. For instance, I never tell people something wouldn’t hurt if I knew it would. You must not break that trust. If something is going to hurt you have to tell the patient, but in ways that it doesn’t make it a big deal. So you’d say “You’ll feel a sharp scratch, a wee bit of pressure, this will be a little bit uncomfortable.”
You have to tell people the truth but you don’t have to tell the absolute unvarnished truth. On the other hand, outright lying to patients won’t get you anywhere.
You need back-up. These days there is a lot more formal training for special care, thanks to the British Society for Disability and Oral Health amongst others. Special Care Dentistry is now recognised as a speciality by the General Dental Council so we have formal training pathways.
N: You mentioned the ability to build rapport quickly with many different kinds of people. How do you do that?
G: It comes with practice to an extent. You find something to talk about. I have one of those brains that remembers loads of trivial things. That usually gets me some hook, and I can bluff my way through on lots of subjects.
I don’t watch much TV but I know roughly what’s going on in the soaps, I keep up to date with what’s happening in the cinema so I can find a common ground. If you know somebody’s interested in something, go there.
Part of it is trying to be as different from other dentists as possible.
I know I’m quite a big person, I can be a bit overbearing so I try not be. I smile a lot, make eye contact, work on my body language.
People relate more to you if you tend to copy what another person is doing with their body language. You find yourself doing that unconsciously. The thing that works for me usually is making daft jokes. I have a huge repertoire of appalling jokes. Some people don’t like that and I have had one or two patients tell me to be serious please, but often humour works well.
Another thing that worked well for me is to be different. They have usually been through several normal dentists and it didn’t work with them. So you have to be the abnormal dentist.
N: What do you mean by that?
G: Usually I introduce myself to people as a strange kind of dentist. Unfortunately due to cross infection control nowadays you have to wear scrubs but I didn’t used to. I would wear a polo shirt and trousers, never a white coat. I don’t wear a face mask, I don’t care about catching the odd cold.
I do wear magnifying loupes (sort of like magnifying glasses) but I don’t wear a face mask so I can talk to people and they can see my face. Other dentists will get the patients in and get them in the chair quickly, but I had an ordinary chair in my surgery so sat them in that and chatted first.
The other thing that helps with phobic patients is they seem to think that they’re the only person to have this problem. Saying “You’re the 14th person like this I’ve seen this week” can be a big help.
A lot of people think they will be seen as stupid and a nuisance. I’m quite lucky, I’m phobic about fish, so my usual line is “Being afraid of the dentist is sensible‚ because we can do bad things to you, but I’m scared of fish! How stupid is that?” They’ll laugh with you. I know everyone is scared of something. The ones who aren’t scared of anything just haven’t found it yet! If can I get people laughing at me then they’re not so scared of me.
N: You mentioned 10% of your patients being phobic, that doesn’t sound like much.
G: I think there are probably very different numbers of phobics depending on the local population. You can’t generalise.
They come in all shapes and sizes. I had one guy who was an ex-paratrooper in the Falklands war and he happily jumped out of the airplane in the dark – but get a tooth filled? No chance. There’s no logic – you can see great big men in tears in the waiting room.
What seems to happen is that there’s been an underlying tendency towards dental phobia and then there will be something come along and reinforces it, e.g. a dentist who fails to get a tooth numb and won’t stop, then it becomes a really immense issue. We’re back to the issue of losing trust again.
A lot of phobic patients, they decide for their own reasons to do something about it. I think dental phobics are tremendously brave because they’re really really scared of something and face up to it.
OK, they can get help from drugs, from a friendly dentist, but at the end of the day they are the ones who ended up doing it and facing their fear. I have a huge respect for that.
I think a lot of phobics are very hard on themselves, thinking they’re being stupid. They forget that even going to the dentist, getting sedated, or getting knocked out and getting the treatment done they’re still getting over their fears. I think it’s quite humbling if someone is facing up to something they’re absolutely terrified of.
Sometimes there’s an external factor – they’re getting married, or a new girlfriend or boyfriend, that’s the pressure to do it, but they have still conquered a major fear.
N: If you have a patient who you can’t help, what would be the reason for that?
G: Probably because they wouldn’t let me, usually if I have not managed to make the connection with them. Either they decide they don’t like me or they won’t let me help them. Which would be my fault because I haven’t managed to make the connection. It doesn’t happen often.
N: What would you like to let your younger self at the beginning of your career know if you had the chance to?
G: I don’t know. There are a lot of things you learn the hard way and a lot to learn. My old boss always said that the best feedback was negative feedback.
Back to the question… probably “Don’t think you can be everybody’s dentist”. You can’t please everybody.
N: What was your favourite part of dentistry?
G: The thing I enjoyed the most was making dentures. I was really good at it. I also liked taking teeth out, I probably shouldn’t mention that! That’s the physical dentistry stuff I enjoyed most, but the thing I got the most pleasure out of was if someone was a real phobic and I got them through that.
N: Is there anything you would like nervous patients to know?
G: We are trying to help. We’re not here to hurt you. Dentists don’t wake up saying “Maybe I can hurt someone today!” Most of us do dentistry because we wanted to do good things and help people save teeth. We don’t enjoy hurting people, or making them feel bad.
If someone comes with a mouthful of cavities I wouldn’t think “What a mess, how the hell did you get it into that state?”. I’d think “How am I going to sort this?”
People with a phobia seem to be sure they were going to get told off. Not in my experience.
N: But where does this fear of being told off come from?
G: I don’t know. Maybe dentists used to be like that, but nowadays they aren’t, in my experience.
When I was a kid I almost never brushed my teeth, I also ate rubbish! I don’t remember a dentist ever scolding me. I had loads of fillings, he used to just get on with it. I think he was getting his new Rolls Royce paid for.
You asked me why I became a dentist. My mother was a terrible dental phobic. She had false teeth from about age 20. She was such a dental phobic that she wouldn’t come into the clinic for me to make them. I had to bring the stuff home and do it in her house.
When I was about eight I had to get a tooth extracted. My mother was so afraid of taking me to the dentist that the dentist wouldn’t let her drive us home because she was shaking so much. So he put us into his Rolls Royce and he drove us home.
So maybe that’s where it comes from. And I never did anything with my mother’s phobia, she was beyond help (laughs).
My mother-in-law was just about as bad, she used to tell me stories about putting mustard powder in her teeth to kill the nerves! What do you think a dentist is gonna do that is worse than that? Maybe that’s how I became interested in phobics, I seem to attract them (laughs).
N: Is there anything you would like young dentists or dental students to know?
G: Be nice to your patients, and they will be nice to you. I know of some dentists who were the most appalling clinicians whose patients adored them. Luckily they are not on the register anymore! Patients can’t tell how good or bad the dentist is. They just know whether they are a nice person.
The advice I was given by the Dean of Dentistry at Glasgow when I was a student: if your false teeth don’t fall out, your injections don’t hurt and you are nice to your patients, you’ll do fine. That was Jimmy Ireland, a lovely man, he was a very wise chap.
This was an abridged version – you can read a longer PDF version of this interview with lots more info here.