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Problems, Consequences and Solutions

I have been practicing as a general dentist now for more than 30 years (I know, it's a lot!). I integrated orthodontics into my practice for more than 20. I do not communicate the same way today with my patients that I did when I started  I changed, and I like to believe that I improved!

First thing, I listen now more than I did. Someone told me once: we have two ears and only one mouth. We should listen twice as much as we talk! Wise advise! (thank you, Jerko!)
When it comes to communicating with patients, we have to remember a couple of things:

  1. They are not comfortable
  2. They don't know dentistry
  3. They will listen for a very short period (about 10 sec)
  4. We are boring to them!


I know the last one is hard to accept, but it is a fact. And I will repeat it to ensure you remember it well: we are boring to our patients!!! The way we communicate is critical. When I started, I was so excited when I could find something to do for a patient that I would only try to convince them to do it.

"Mrs. Jones, you need a crown, and we can do it in two appointments, and it's made in metal and porcelain (remember I've been in practice more than 30 years!), and blah blah blah, yadda yadda yadda…". I would explain how a crown is done and give all the details as we learn in university.

Same thing with clear aligners: "Mrs. Jones, we can do an Invisalign treatment to straighten your teeth. It's made of plastic, and it's transparent, and blah blah blah, yadda yadda yadda…"

And Mrs. Jones would stop listening after 10 seconds, starting to think about what she will buy at the grocery, thinking of the children she must get at school and mostly, thinking about how long I could go like this! And I could go for a looooooong time… The thing is, I ultimately was losing all the "Mrs. Jones" I was seeing. Well, not all of them, but let's say I could have done a lot more than I did.

I guess this is how we learn. And I did. I understood at one point that patients will not "buy" something if they don't think they need it. And they will buy it when THEY are ready, not when I am ready.

Also, they will do the treatment when they feel understood. In fact, they will start to understand when they will feel understood. This is why listening to their story and their chief complaint is crucial.

Then, before talking to them about a solution (for example, restoring teeth or aligning teeth), it's essential that they understand the PROBLEMS, and the CONSEQUENCES first. 

Let's go back to Mrs. Jones, who has a bite problem:


"Mrs. Jones, I am concerned to see that your teeth do not properly close together (I am not mentioning "occlusion" because most patients don't understand the concept of occlusion). The upper teeth are supposed to go over your lower teeth like a lid on a shoe box. This is not what you have. And you know what happens when a lid does not fit a box? At one point, something has got to give!


"In your case, because you have too much pressure on your teeth, they are wearing out. They are shifting and colliding. I know from experience that this will not improve with time. What do you think about that, Mrs. Jones?"

Now… SHUT UP! And let her talk. Wait. Silence can be uncomfortable, I agree. But you need to let Mrs. Jones say something. Maybe she doesn't care. Perfect! At least you know. And you did what you had to do. Why would you bother talking about a solution if she doesn't care? It doesn't mean she will never care. Maybe now is just not the right time. You will have Mrs. Jones in your office for more than 20 years. You will (and must!) have the time to discuss her problems again. And to see it get worse. 

"Now, Mrs. Jones, I just want to avoid any embarrassment later, and I want to make sure you understand that it will never be as easy, and it will never cost less than today to fix the problems that you have"

On the other hand, if Mrs. Jones is interested, she might ask herself: What should I do, doctor? A question I always answer: I don't know what you should do, Mrs. Jones, but let me tell you what I would do if I had these problems myself!

And now, you can talk about the solution. And be careful: Invisalign is not a solution! Fixing a bite or moving or repositioning teeth is a solution. And for that, we will use an appliance called clear aligners or Invisalign.

Most of the time, Mrs. Jones will want to think about it. It is important then to follow up with her. And maybe Mrs. Jones will decide to wait. Don't worry. One day or another, she will do it. She'll have no choice. And it will be more complicated and will cost more money.

So, remember, don't force anything. Address the problems and consequences first. Open your patient's ears. Wait until they understand the problems. Wait until they OWN the problems. These are not your problems! And when this is clear to them, continue with the solutions (there can be more than one).

You decided to be a dentist to help your patients have better lives. Your job is to keep Mrs. Jones in your practice and maintain her confidence. You are a dentist; therefore, you are a perfectionist. And when Mrs.Jones will require some help, you will be there for her.

Have fun Making the MOVE!

Stephane Reinhardt, DMD
Director Education Program
The CLEAR Institute

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