RCC Honors History Project

“To Treat Properly, First Deal With the Fear” An article written by a dentist

Posted by dmcneal347 on May 23, 2009

By GEORGE D. RESKAKIS
Published: November 17, 2008
It was the first time I had met Cynthia. She was dressed impeccably in a blue suit with an understated brooch on the collar — a woman who clearly took care of herself. So I was surprised when she complained of bad breath.

She said she just wanted a teeth cleaning and was in my office because she needed a change from the dentist she had been seeing regularly for 10 years.

As part of the standard conversation with new patients, I asked several questions and explained the need for a proper evaluation, including X-rays.

She was unequivocal, as I recall: “X-rays! No way.”

In 28 years in general practice, I have seen the full range of reactions to the dentist’s chair. Personal experience plays a part. So do the stories of friends and family, and “I’d rather have a root canal” jokes. The Internet can give people enough knowledge to be dangerous, as the cliché goes, and the irrational fear that often accompanies a trip to the dentist gives people the motivation to be insistent, even demanding, regarding care that might not be appropriate.

If I do what they want, I risk missing something or making poor treatment decisions. If I do what is right, I risk losing a patient who needs help.

I explained to Cynthia my belief that for a dentist seeing a new patient, a thorough examination and a set of good X-rays are the foundation of good care. I told her that under current guidelines from the American Dental Association, healthy adults without evidence of tooth decay or additional risk factors should have films taken every couple of years; panoramic films should be taken every five years. I asked her when she had last had dental X-rays.

She looked at me suspiciously and said, “I remember it perfectly because it was the day before Sept. 11.”

“Three years ago!” I exclaimed. “I think you’re due.”

That wasn’t enough for Cynthia. We talked for 15 minutes more about X-rays — the modern, digital systems, the minimal amount of radiation she would be exposed to, the quick and painless nature of the whole thing.

“I just want my teeth cleaned,” she pleaded.

It was puzzling, really. Here was an educated, successful professional who knew she had a problem and wouldn’t even consider the most basic level of care.

I did not want to lose her as a patient, but I could not give in.

I told her I couldn’t ignore the possibility of underlying disease. I needed X-rays if I was going to treat her.

“Fine,” she said finally. “Take your stupid X-rays.”

As it turned out, her bad breath was caused by decay between two teeth — to such an extent that she would need root canals on both teeth in addition to gum surgery, two posts and two crowns, or she would have to have the teeth extracted and replaced with implants.

For many adults, decay of this magnitude can be painless, until infection sets in or the teeth are beyond saving. In the end, Cynthia had the teeth extracted and replaced.

It wasn’t until after we completed her treatment that Cynthia confided the reason she had fought so hard against X-rays. Her mother, she said, had died of cancer that was caused by radiation treatment as a child.

We talked again about radiation, and the difference between diagnostic radiation doses and therapeutic doses. In the early 1950s, I told her, the doses were hundreds of thousands of times what is used today; there was not enough evidence yet of radiation’s harmfulness.

Cynthia came around to the idea that X-rays are a safe and useful medical tool.

And I was reminded that in a profession where anxiety is often the starting point of a doctor-patient relationship, the standard patient questionnaire will never go deep enough. Asking about flossing habits won’t lead to fears that trace to events 60 years ago. In our armchair-psychology way, we hope to get to that level of trust eventually. In the meantime, we clean and drill, and insist on X-rays.

George D. Reskakis is a dentist in Manhattan.

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