Satu Sihvo

I have had a private practice for twenty years, almost since I graduated. My first thought after Michael's question was that I am, of course, solution orientated most of the time. My second thought was that the more I have learned about solution orientation, the more comfortable and relaxed I have felt with my work: it is OK to be myself and use what I have found working without being as authoritative and "professional" as my teachers were.

It may take time to let clients talk and take part in the planning of next steps, but it is worth doing. They become members of the team. To have one's say activates you, and is good for motivation. Also, humor is helpful for teamwork. Most likely, many dentists work along these lines even though they would not call it solution orientation. They talk about "good patient relationship" and other occupational skills.Most of my clients belong to the recall, i.e., they come not because of the problem but because of the solution: prevention. Prevention is the king of solutions in dentistry, even though old solutions like fillings and extractions are still in use.

Prevention means that dental care is done mostly by clients. So, a client comes - as a part of the prevention - to a kind of feedback session, where the dentist checks if the solutions found so far still work well enough. Since change is an essential part of life, new solutions or new modifications of old ones are often needed. Perhaps it is time to brush up motivation, too.The client and the dental staff make a team. Even though each team is different and consists of unique human beings with different roles and likings, we do have something in common: we are all motivated by credit, acknowledgement, and validation.

If I had to name just one or two ideas used in solution orientation that really work in dentistry, I would point out acknowledging and giving credit, and paying attention to small steps of progress. These ideas are very useful with periodontal problems and their prevention. They are useful in caries prevention too, but here, changes take more time to bear fruit. The more I have learned to give credit, the more skillful clients have become with their brushes and flosses, and the more the whole team enjoys its work. Suppose we find five new caries lesions in spite of all prevention. We might ask ourselves: why? Are there other significant changes? What is the difference that makes difference? Among other things, we might find that the client, after her son's suicide, has become very fond of chocolate. Many people who mourn their losses - like death, divorce or a job - are not looking for big changes. Both the will and the ability to take care of oneself is there, but the energy seem to go somewhere else.

The task of the team is to find out those steps to solution that the client feels it is possible and realistic to take. My next step with the above patient might be to ask if she likes xylitol chocolate (which is more teeth friendly), and to suggest that it might be a good idea to try fluoride chewing gum (it does some repair, and will not stick to her new fillings).Dentists need to know about medication since many drugs have side effects. We are interested in knowing if the client has noticed any decrease in flow of saliva, a common side effect which goes hand in hand with increased caries risk. For example, if the client says that he has got medication for his depression, we go on talking about saliva and end up discussing dietary habits and other aspects of caries prevention. I do not deal with his "mental problem", but hopefully the way I do my job is encouraging and supportive and serves other ongoing work.

There are many little things the client can do. I do believe that small positive changes somewhere in the system influence the whole system. And when change includes some concrete action and has a straight link to other things, a lot can happen. At least teeth and gums may stay in better condition. Everyone grinds their teeth sometimes. But everyone does not get frequent tooth fractures, or kill their teeth just by biting, or develop severe muscle pains and/or joint problems. There are many theories about bruxism and dysfunction, and there are many ways to deal with the situation; from bite plates and medication to acupuncture and hypnosis, to name a few.

For me, it makes sense to say that for some reason the unconscious regulation has put the muscle tonus on high gear. I may ask the client that if the theory that there is stress involved is true, then what would be the best way for him to relax, or to turn the tonus gear a bit lower. Almost always people come up with something that supports the treatment. Sometimes a biteplate (a personal plate made of acrylic that fits between teeth and is often used at nights) is a useful and relaxing companion. The biteplate has many good sides, one of them is that after the first weeks its use is up to the client and his feelings of stress. E.g., one teacher/author wears her biteplate when working with the computer. There is also a lot of things going on that I am not aware of.

Sometimes we are able to create wonders in spite of an enormous tongue, tight cheeks, and flowing saliva. In my relief after a difficult restoration I have even given thanks to the angels that the client perhaps has brought to help us. There have been many occasions when I have expected some complication and in spite of, because of, or independent of all my doubts and warnings, the client has not got the slightest symptom. The tendency to heal oneself is within us.

Solution Dentistry
by
Finland

Michael Hjerth, the editor of this newsletter, asked me - when he found out that I was a dentist interested in the solution focused approach and NLP - if I really use any solution focused things in dentistry? Do I really? Read on and decide for yourself.