Why zero pain?
"My patients' pain is truly unbearable to me"
Since the start of my career, the idea of hurting patients, or even of being faced with nothing more than their apprehension of pain, has always been very uncomfortable for me. As a clinician, my patients' pain became, over time, genuinely unbearable. So very early on, from the beginning of my practice, I looked for every possible way to control it, and even to remove it entirely during treatment.
What does that mean in practice?
"You don't get a second chance to perform a first painless clinical gesture"
Borrowing the spirit of a well-known saying, I adopted this mantra: "You don't get a second chance to perform a first painless clinical gesture." In particular, I reduced the risk of pain, however small, from the injection of the anesthetic onward.
Then, over time, thanks to effective anesthetic techniques, to behavioral techniques, to command of the clinical gesture and to experience, I ended up finding the means to treat preoperative pain as quickly as possible, to prevent any operative pain, and even to reduce postoperative pain significantly.
Pain is a more complex phenomenon than it first appears. It took me years to understand and master these aspects. Watching many patients, including the most stressed, fall asleep during treatment, I was able to see that only total pain control delivers the comfort needed, not just for the patient, but for the practitioner and the dental assistant as well.
So zero pain is not only for patients?
"For the practitioner and the team too, the dental office is a source of physical pain, and frequently of emotional pain as well"
Physical pain in the dental office comes from the fact that this profession places heavy demands on posture. Dentists are particularly prone to musculoskeletal disorders. The ergonomics of equipment and instruments of course matter, but it is above all the management of posture that is decisive. Initial training is often insufficient on this point. And contrary to a widespread belief, there is no such thing as a good posture. Only movement is decisive. We are not statues.
And beyond physical pain, it is essential in my view to take account of a need that dentists themselves often pass over in silence: preventing emotional pain.
What causes that emotional pain?
"A need that dentists themselves often pass over in silence: preventing their own emotional pain."
The number of cases of professional burnout is worrying. One source of emotional pain lies in interactions with patients who are themselves expressing suffering, stress and apprehension. Dentists are not trained at all in the relationship, neither during their studies nor, to any real extent, in continuing education. The relationship is not just about "being nice".
The dental office generates a great deal of stress for the people who work there. Dentistry is a very demanding profession, and one that can feel thankless and solitary, given its rather poor public image.
"Contrary to the old image of the tooth-puller, dentists do not like to hurt people. And like any human being, we suffer from seeing others suffer."
Faced with that reality, when it cannot easily be dealt with using the means at our disposal, a common response of the human brain is to play down, or even deny, the suffering of others, whether physical or emotional. This frequent cognitive bias, unconscious by definition, is well described in the scientific literature. It can become a real problem for the relationship between patient and clinician.
What is the answer, since the reaction is unconscious?
"Being capable of empathy is not a quality you are more or less born with. Training in listening and empathy gives you a skill that is extremely useful for controlling pain day to day."
Alongside total control of every operative pain with the right techniques and equipment, being capable of empathy is necessary.
Many believe it is a quality you possess to a greater or lesser degree depending on your personality type. That is not quite accurate. Training in listening and empathy, on top of purely clinical technique, gives you a skill that is extremely useful for controlling pain day to day, to the benefit of the patient and of the dental team.