From Our Archives: Biological Dentistry = Patient-Centered Care

by | Jun 30, 2021 | Biological Dentistry

One of the things that surprises some folks when they first visit a biological dentist is how much time the dentist typically spends getting to know them. The dental exam and evaluations are important, of course, but the mouth doesn’t exist in isolation. It’s connected to a person – body, mind, and spirit.

And what happens in the mouth can affect the health of the whole, and vice versa.

Dr. Rehme talking with a patientSo we take time to learn about you. We take and review a thorough medical history. We get to know your priorities, goals, values, and needs. This way, we can work together to create a plan of care that’s specific to you and your oral/systemic health situation.

We also take time to teach you about the mouth/body relationship, as well as the pros and cons of your various treatment options – including the option of no treatment at all. This, of course, is the very basis of informed consent. The more you know, the more able you become to make good decisions about your health. You become a partner in the process and the agent of your own well-being.

While some conventional dentists also take this kind of patient-centered approach to care, it’s, sadly, not the norm, as illuminated by a very small but very telling study published recently [Sept. 2020] in the BDJ.

Compared to other healthcare professionals, its authors note, dentists tend to stay “deeply anchored in a biomedical vision” of patient health and well-being. This raised a dual question for them: How do dentists perceive patient-centered care and what prevents them from embracing it?

Conducting in-depth interviews with 11 Canadian private practice dentists, the research team found, sadly, that “dentists had little interest in understanding the life and stories of their patients.”

Furthermore, their openness to share decision-making was limited to procedures that they considered of relatively low value and less for procedures they considered of higher value, such as indirect restorations.

How could you not want to know about the patients who have entrusted their care to you? How could you not want to understand where they come from and what matters to them? What their experiences have been?

The study authors go on to suggest that

dentists’ reluctance to understanding and shared decision-making is rooted in the old-established identity of dentistry as an art. Dentists indeed considered the dental craft as sacred – an art form with unbreakable axioms that defined quality of care.

Understandable. There is an artistry to it. But to see it primarily as a craft tends to reduce dentistry to a matter of fixing problems, with far less emphasis on preventing them from cropping up in the first place through proper nutrition, good hygiene, and healthy life choices.

As we’ve noted before,

dentistry is still often treated as something more like a skilled trade than a healthcare profession. It’s seen as a source of mechanical fixes rather than a part of supporting whole body health.

In this old view, the emphasis is mainly on function and aesthetics, the local rather than the systemic. The teeth and gums are seen as somehow disconnected from the rest of the body. It’s a view that has supported a whole range of practices with potential systemic effects, including the use of mercury amalgam and root canal therapy.

Yet as Dr. Reinhold Voll famously noted, “80 to 90 percent of systemic problems are caused or influenced by the oral cavity, tonsils, and sinuses.”

We’d all do well to keep that more in mind.

One of the hidden blessings through the pandemic thus far is that more people have begun to understand that dentistry shouldn’t be treated as the red-headed stepchild of capital-M Medicine but as an integral part of health and wellness. Perhaps as that understanding continues to grow, we’ll see less resistance to patient-centered care and more appreciation of what biological dentistry has been doing for the past 30+ years since the term was first defined.


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