Working together in metropolitan Stockholm, Sweden, dental technician and lab owner Åsa Sjöholm and prosthodontist Dr. Nicole Winitsky of the Eastman Institute have developed an approach to communications that not only puts patients at the center of treatment, but recruits them as members of the prosthetic team.Both are members of the Nordic Esthetic Group, a network of women dental professionals focused on esthetic dentistry.
The two of you lecture to great effect on the topic of communication in dentistry. Why is that so important?
Åsa Sjöholm: In the field of implant dentistry, we talk a lot about the importance of teamwork but sometimes forget that effective collaboration is only possible when every member of the team is bringing his or her best work to the case at hand. To contribute at that level, one has to be heard. Equally important, one has to be open to each other’s insights.
For the benefit of the patient, I think all of us have a desire to make each and every successive case better than the one before. To do so, open lines of communication are essential.
Dr. Nicole Winitsky: It’s really quite simple: Good clinical results are not possible without good teamwork — and thus good communication — between all the members in the team. The dental technician needs to be in the loop in order to make informed decisions, for example; and it goes without saying that a dedicated, effective and well-informed nurse is also an essential member of the team.
To make sure that patients know how to take care of their teeth before, during and after implant treatment, the dental hygienist’s contribution is also crucial.
Åsa and I even consider our patients to be a part of the team. Their cooperation is very important to the end results of the treatment. They need to attend scheduled appointments, of course, but they also need to refrain from smoking, maintain good oral hygiene and use necessary orthodontic retention (when called for). It is up to every member of the team to motivate patients to take an active role in their treatment.
Is your relationship with the patient as important as your relationships with the rest of the team?
Sjöholm: Without question! In order to perform our best in each individual case, all the members of the team need to be mindful of, and working towards, the same goals — and this applies, not least of all, to the patient.
As far as the professionals on the team are concerned, we all have different relationships with the patient. Depending on which part we have to play, we see the patient from different perspectives, which lets us see different sides of the patient.
Keeping your eyes on a common goal is the glue that holds the team together…
Winitsky: …and the best way to reach our goals is through good communication before, during and aftertreatment: Before — through multidisciplinary treatment planning (where NobelClinician can be a valuable tool);during — through discussions and technical aids such as surgical guides and prep guides; and after — through feedback and a preparedness to review and discuss what went well and what can be done better.
Can you run us through your routines step-by-step?
Winitsky: Once I have done my initial examination and prepared a preliminary treatment plan for the patient have a lot of important information at my disposal. Some of this information needs to be passed on to Åsa. What can I tell her about the patient she’s going to meet? Will she be meeting a demanding patient? Is the patient facing psychosocial challenges or frightened of dentistry, perhaps? All of this information will facilitate their first encounter.
Sjöholm: I have a small window of opportunity: Only one or maybe two appointments, during which I need to get as many particulars as possible from the patient. Therefore, it helps me a lot to know what kind of patient to expect. But that’s only for starters.
Winitsky: That’s right! I also convey my full treatment plan for the patient to Åsa — not just details about the crown or bridge that I’m ordering with the impression, but also the details of the other reconstructive work I plan to do.
You’re describing a flow of information from the dentist to the dental technician. Is there a reciprocal back-flow of guidance?
Sjöholm: After I have had my meeting with the patient, I usually have a lot of information to share with Nicole, ranging from esthetic preferences to motivational issues.
In most dental disciplines, when we meet and treat patients, we easily lose ourselves in all the small, beautiful details, many of which are technical in nature. These details are, of course, very important, but we must not forget the person behind the smile.
Winitsky: When the patient is at the dentist’s, there are a lot of distractions. For the patient, it can be a stressful environment. She might be frightened about an injection or nervous about the impression that is going to be taken.
Sjöholm: But at the dental technician’s, it’s a different story. In most cases, when the patient meets the dental technician, it’s for something that is conventionally called “shadetaking” but which I prefer to call “esthetic analysis.”
The meeting that I have with the patient provides a golden opportunity to listen to the patient and gauge his or her desires and prospects with no distractions like drills, suction or syringes. In this environment, the patient is often much more relaxed and anticipates none of the discomfort that he or she may associate with the dentist’s office. As a result, the patient is often prepared to share more information — and information of a different nature — with me, as a dental technician, than with Nicole, as a dentist. Together, we can build up a much better picture of what the patient needs and hopes for than we could ever do alone.
I’m not familiar with the term “esthetic analysis.” What does that process entail?
Sjöholm: When I perform an esthetic analysis, I first of all observe the patient. Does the patient seem to be happy with her smile? Is she trying to hide something? Does she tense her lips?
But most of all I listen to the patient: I ask if she has any questions about the treatment. In many cases, I’ve found out things about the patient’s concerns and expectations that the patient never tells the dentist, or even the nurse.
Maybe she has special wishes I need to know about when I make the crowns. In some cases new questions have come up regarding the material that Nicole has discussed with the patient.
Then I do the shade selection, of course, that encompasses such variables as shape, shade, texture and gloss. I always document the case with a standard set of photos, which — without fail — comes to good use in subsequent treatment planning discussions with Nicole, as well as during the laboratory work.
Open doors and a willingness to share each other’s insights about patient needs and expectations are obviously distinctive aspects of dentistry as you practice it. How do you reply, however, to the skeptic’s query: “To what end?”
Winitsky: Satisfying our patients is our ultimate goal. To get there, we do our best to optimize function, appearance, phonetics, biocompatibility, the preservation of healthy tissue and the patient’s well-being.
To get it done well, we have to be willing to share each other’s insights. Only then can we speak about teamwork worthy of the name, expect our patients to be content with our work and find personal pride and satisfaction in our chosen professions.