I’m feeling reflective today having got the day off to myself. I was supposed to be heading home to see my mum but I forgot I was going to see Hot Chip tonight, so I’ve been a little at a loose end.
I’m afraid I don’t feel like writing about dentistry much today. I had one of those days yesterday where the job got me down and I’ve been stewing on it all day.
Mind if a share my stewing about yesterday?
Well at first there was a patient with a terminal upper bridge and lower denture worn to nothing. Last visit I suggested he really needed to move to an upper denture and get a new lower one. Yes I appreciated £198 was a lot of money but the bridge really was on the very last legs and I didn’t think he could keep getting it re-cemented every month. Yesterday I attempted to take primary imps and do a full exam. Question “could you take the denture out please sir”, answer “I haven’t been able to for 4 months and it has only been out twice since it was made.”
Well the horror must have showed on my face as I resorted on trimming back the slimy denture in the mouth to release it and expose the most unbelievable path of insertion I’ve ever seen. I then had to scale all the teeth fully take impressions and adjust the denture to something reasonable, running miles late in the process. None of that bothered me but it was the overriding feeling that the patient thought I was ripping him off. That the work was not needed, that I’d conned him into having new dentures and insulting the old dentist by trying to correct the current set. “Your a very good salesman” he told me when I first convinced him to get a new set, “A good salesman but a lousy dentist” was how it sounded now.
Then later a set of complete dentures at try-in, I’d been asked to make a new set by another dentist at the practice after he’d struggled twice to match the ladies expectations. I’ve done the works on these dentures and had some trouble with the lab but I thought they were going well god fit, excellent extensions, occlusion spot on, yes the upper needed a wash impression as the cast had a large air blow but they were a pretty good. “Not happy” said the lady “the lower denture moves” she said thrusting her tongue forward. And that was when it hit me… I could never match this ladies expectation of what a complete denture could achieve on almost no ridge. I tried to explain and make her understand the limitations but then I heard “well if I’d known that I wouldn’t have paid you to let you try to make a new set”. The miscommunication was my fault, I’m sure, and I still hold out hope of wowing her when they are finished.
What hurts is despite all the effort I make with dentures, the books the greenstick and the time I take, she still felt I’d ripped her off. Even though the cost of the dentures had already far outweighed her cost, even though I thought I’d explained at the start the limitations, she still felt I’d ripped her off.
I’m sure you have felt like this in your job. I was ready for a holiday, tired and exposed and took it too personally. I see that know and I’m over it, I’m going to do my best to amaze them next time I see them anyway: perfect dentures all round. But if not I’ll tell them the truth; that I’ve done my best, better than some would do and that I’m sorry I couldn’t do more.
I wish that was easy for me to do. I want every patient to be delighted with treatment I provide to understand how I’ve excelled when it’s finishe, but that is an unreasonable aim. They are not dentists; they want “no pain” and speed, not beautiful posterior crown margins. I need to stop trying to show off to them when I get in a sclerosed canal after 20 minutes hard slog. It’s too important to me to do my best for me to change how I work but I need to toughen up mentally, improve my communication skills to ease these situations, stop seeking constant approval and have more confidence in what I’m all about.
I have therefore decided today to make this goal for myself:
I am going to develop an inner confidence in what I do and be proud
of that. Proud enough that I do not need the constant approval of others or to favorably compare myself against others in order to remain proud.
Maybe you already have this. Insecurity is my least favorite weakness I see in myself from time to time and I hate how it affects my relationships and mood. I’m not saying I’m a complete arse, or at least I try not to be, however I acknowledge there is certainly room for improvement.
So in the spirit of my new resolution I’d like to share something personal with you all. This is a poem I wrote when I was 18. I’ve given it a little rework recently and it was supposed to be part of a larger collection that never really took off. I wrote about 5 poems in all and sent them to this little competition. Having failed miserably to even get some feedback I sort of stopped writing. This was my favorite from the failed venture and I’m still a little proud of it and now I have an excuse to share it. I am nervous to share it, like the first time I blogged, or put up clinical photos and that usually means it’s a good thing to do.
Hope you enjoy it but if not don’t worry, I’ll not lose sleep over it
Now I am officially ready for the floor!
All the best
Chris
#1 by Alex Jones at February 18th, 2010
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Hope you had a good night Chris! I am reminded about a comment a consultant oral surgeon made to me back when I was an undergraduate- ‘it’s a shame you care about their teeth more than they do’.
You will always get situations like this throughout your career, like you correctly say, it’s how you deal with them.
#2 by Matt at February 19th, 2010
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Hopefully the day will soon come when all but the most unfortunate few won’t need dentures. I’m sure your dentures were as good as dentures could be. The idea that a denture could be a decent substitute for natural teeth is just laughable to us but that’s what our denture patients long for and is really (apart from a previous denture of course!) the only thing they have to compare their pink and white lump of acrylic to.
I find making dentures the most stressful part of dentistry because they are the one thing we provide that I don’t believe in…… if only implants were affordable to everyone!
#3 by jamie maguire at February 25th, 2010
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Always disheartening Chris, particular the second scenario – you live and learn.
My standard line now whenever I see some-one requesting complete dentures is to ALWAYS offer an implant-retained mandibular over-denture (IRMOD) as the gold standard lower denture, and if the patient declines an IRMOD (usually for financial reasons), I then advise that I will do my utmost to make as technically good a set of dentures as I can, but that the lower denture will always be somewhat loose. Thereafter the decision to proceed is up to the patient, and make sure you record details of the conversation at consultation in the patient records. If the patient declines treatment, you might have saved yourself a head-ache…
#4 by ChrisO'C at February 28th, 2010
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Thanks Jamie, Matt and Alex,
To be honest I just enjoy making complete dentures and I think I got a bit overconfident as I’ve had some great success recently.
As Jamie and Matt both say the lower complete is always a sorry excuse for teeth. Lets face it none of us would want a set.
I just wanted to share the experience as it’s too easy to only talk about the cases that went well. You learn more from your failures than any of your success.