Bill (not his real name) and his family have been patients of mine for over 27 years. Bill loves licorice ropes. He chews on them every day. Bill has a cavity problem. We have talked about it over the years, but he has not changed his habits. Then COVID-19 happened, jobs were lost, incomes changed, and it was more than 18 months between visits. He returned because a bridge on the upper right side of his mouth fell out.
Unfortunately, the premolar abutment had rampant caries that extended down the root to the bone level, and the tooth was hopeless. We needed to remove the tooth and place two implants and new crowns. Bill was upset. His first reaction was to question how I could let this happen to him. And, when people react strongly from an emotional standpoint, we naturally respond emotionally, too, and, briefly, doubt crept into my mind.
Barb (not her real name) and her family have been patients of mine for more than 30 years. She works in the oil and gas industry, and, with the collapse of that industry in Alberta, she has been in and out of work. That has been especially stressful for her because her husband had to give up his career as a helicopter pilot due to early and rapidly advancing Parkinson’s disease. Then the COVID-19 pandemic was thrust upon us, and her stress levels went beyond. She was clenching uncontrollably. She first broke her lower right first molar, and we were able to get her in for a filling to restore the tooth and plan for a crown. Before we could even consider making a protective appliance, she returned with pain on the upper left. We could not see anything broken, but a radiograph revealed she fractured her filling at the cavosurface. This tooth already had a four-surface filling that shoed two cusps. We recommended a crown but warned her that the tooth may be fractured deeper and/or need more work.
We completed the treatment, but the tooth did not calm down. She had no pain with biting or heat, but the tooth was wildly sensitive to anything cold. After many weeks, it did not improve. Regretfully, endodontic treatment was recommended. Barb was angry. After spending time searching the internet — the great harbinger of misinformation — she came back certain that this tooth was now going to cause all sorts of systemic issues that would debilitate her and make her unable to care for her family who depend on her. She demanded a refund for the crown as well as for me to pay for her endodontic treatment, and, if necessary, removal of the tooth, placement and restoration of an implant, and any other health issues she may endure due to this. Of course, this was an unreasonable set of expectations. Nevertheless, doubt crept into my mind.
Caries, periodontal disease and other issues in the oral region are not caused by us. Our role is to do our best to help our patients prevent disease and to identify when it presents so we can do our best to prevent or alleviate suffering. And we do amazing jobs. Dentistry has come so far so fast that we routinely perform our professional duties with such accuracy and an extremely high success rate that failures surprise us and our patients, and sometimes that results in an angry response. And the blame train takes off.
Dentistry has also taught too many of us to be perfectionists. We work in microns and fractions of millimeters. We use magnifying loupes, microscopes and more to be ever more exacting and precise. But always striving for perfection sets us up for failure, and that failure sets us up for self-doubt. It is called “impostor syndrome,” and this serious situation (it can be considered an illness) has been debilitating for some and career-ending for others.
We need to find a way to overcome this. We need resilience in the face of commonly occurring situations. We need tools to build ourselves up and not succumb to mental illness. Fortunately, there are a growing number of people who have created amazing resources for us. Here are some of my favorites:
Dr. Jessica E. Metcalfe was one of the first dentists I had heard talking earnestly and honestly about impostor syndrome and how she almost succumbed to it.
Dr. Sally Safa is another colleague who talks about acknowledging the reality of a situation and practicing mindfulness to overcome these issues so we can move forward positively.
Dr. Alan G. Stern is another colleague who, like me, has decades of experience and talks a lot about how we can all be better, richer and stronger through the strength of relationships.
Holly Anne Mitchell is not a dentist but she has reached out and is connecting with the dental community because we need people like her. Her back story is incredible, and her current triumphs are extraordinary. She teaches how to use hypnosis and neurolinguistic programming to change our days for the better.
Dr. Romila “Romie” Mushtaq is a neurologist and integrative medicine specialist who talks and teaches about mindfulness, nutrition and more, bringing science to the conversation about wellness, both physical and mental.
Dr. Karen Tindall is another colleague who has great messages about the need for balance in our lives. She has a great weekly meeting on Clubhouse she calls “Self-Care Saturdays.”
And finally, Dr. Laurie Santos, a psychology professor at Yale University, has created an extraordinary (and free!) podcast called The Happiness Lab. She uses science to prove our misconceptions about happiness and offers steps to improve our mental health and well-being.
There are many more people and resources I did not mention. I have no affiliation with any of these people, but I use their resources, connections, podcasts, LinkedIn articles, Facebook posts, Clubhouse discussions and more to help me continue to realize that I don’t have to be perfect to be great.
Bill came around and accepted his role in his oral health. Barb never did, but I cannot do anything about her mental stress and family situation. That is not my role as a dentist. I did the dentistry to the best of my ability in both cases.
Now go and take care of yourself. We are shaped by our thoughts. We become what we think. Turn your phone off. Get outside, go for a walk, and think about anything other than dentistry.
Until next time.
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