For years I have been amazed that when a restorations requires more than a few passes to adjust the occlusion that patient’s seem to get anxious or frustrated. We have all been in the situation where it appears all the teeth are marking and the patient still feels like they hit the new restoration first. In these situations as I ask the patient to let me know how it feels I get a variety of answers like “still high”, “Not Yet”, “Way Off” and so on. The other day when just this situation arose and I found myself feeling uncomfortable by my interaction with the patient instead of staying silent and hoping we would be done soon, I spoke into the silence “I appreciate your feedback on how this tooth is feeling”. The patient turned his head up to me, pointed to the articulating paper I was holding and said “Just take away what that paper tells you to and we’ll be done”. I almost laughed as it hit me after 25+ years pf practicing that patients have no idea about what the articulating paper does, and wonder why we have them tap on it and then ask them how the bite feels, much less why we have to repeat this process multiple times to get things just right.
Since then I have started to share with my patients some information about the process of adjusting the bite on their new restoration. Almost every time I have done this the patient has shared that they never knew the reason they bite on the paper is only to show the dentist where the teeth touch, and can’t show how much to take away. Many of them have seemed amused and relieved to understand that we need their input to get the bite correct, and that they can perceive much smaller increments of change than we can see. In addition to learning that many patients think articulating paper is magic and communicates everything we need to know to adjust their bite, patient shave shared that they assume that multiple adjustments mean something isn’t right, either with the restoration or with their ability to feel their bite. Now some of the time this would be an accurate assumption, but most of the time it is simply the variability introduced during the process of impressions, mounting, and fabricating the restoration. Either way I would rather the patient understand then make assumptions.
I have added an explanation of the process of checking and adjusting their occlusion that takes about thirty seconds, and has taken all of the discomfort and emotion out of the process and I hope eliminated some incorrect assumptions, worries or concerns.
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