When It Didn’t Hurt Until You Touched It. What to Say and How to Handle.

It’s the classic lose-lose situation: a patient walks in with no pain, goes home, and calls you back and says, “I’m having pain and it didn’t hurt until you touched it.” Even when you do everything right, you still get the blame.

In this episode, you’ll learn exactly what you can say in appointments to avoid conflict, the treatment planning mistakes that can come back to bite you, and how to handle to patients who demand you pay to fix what’s “wrong.”

Topics discussed:

• Why new dentists struggle with patient complaints
• How to communicate risks with empathy
• The importance of decisiveness in treatment planning
• Using AI to address post-op pain
• How to explain post-op sensitivity and possible complications
• How the DPH coaches handle retreatment and refund demands
• Learning from mistakes and addressing issues with your team

This episode was produced by Podcast Boutique https://www.podcastboutique.com

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Chapters

• 0:00 The Dreaded “You Touched It” Moment
• 4:00 Meet the Hosts & Mastermind Pulse
• 5:17 Expectation Setting That Prevents Blame
• 9:42 Empathy Scripts That De‑escalate
• 14:40 Treatment Planning: Stop Being a “Hero-dontist”
• 19:25 Occlusion: Adjust With Purpose
• 24:50 Language Choices: Nerve vs Root Canal

Transcript

Paul: 1:24

It didn't hurt until you touched it, Doc. If that sentence makes your stomach drop, you're not alone. From post-op sensitivity to bite issues to the dreaded, you may need a root canal, these moments test every single one of us dentists. And in this episode, we're gonna break down how to set the expectations before problems start, how to respond with empathy instead of defensiveness, and how to protect both your reputation and your peace of mind when dealing with the unexpected outcomes that sometimes come from treating patients as a dentist. If you've ever been blamed by an upset patient, this episode is for you. You are listening to the Dental Practice Heroes podcast, where we teach dentists how to step back from the chair, empower their team, and build a practice that gives them their life back. I'm your host, Dr. Paul Etchison, dental coach, author of two books on dental practice management, and owner of a large four-doctor practice that runs with ease while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started. Hello and welcome back to the Dental Practice Heroes Podcast. I'm your host, Dr. Paul Edgison, and I'm joined with my two DPH coaches, the magnificent Dr. Steve Markowitz, a uh sixth practice, multi-practice owner on the East Coast of the United States of America. And also Dr. Henry Ernst, who is also from the United States. We're all from the United States, and Henry's got an 18-out practice. And we just so we don't practice a lot anymore.

Henry: 3:08

I started doing the Pledge of Allegiance during that, uh, Paul.

Paul: 3:11

I was about to stand out myself. This is the worst intro ever, but we're gonna leave it. Let's go. Cool. So just recently we had our first two meetings of the new mastermind this year, and man, the group is awesome. But it's been interesting to hear some issues that a lot of docs are having. And one thing that has come up recently with a few of our coaching clients is we've noticed that sometimes doctors, we just don't know what to do with, I don't want to say like upset patients, but how are we managing patients? Like you get a patient that comes back for a bite adjustment and then they're upset, or you you get a tooth you work on, and now it didn't hurt until you touched it, Doc. And now they need an endo, and then they want you to pay for the endo. So I think these are tough situations to navigate, but nonetheless, I think very, very simple if you follow a few principles. And we thought it'd be great to go through down this rabbit hole today and talk about, give you guys some tips so that you can figure out like how to handle these better because they're stressful. I mean, let's face it, we don't want to go through these things. So I'm gonna pass it to you, Steve, first. What are your thoughts on this? What do you see? What do you think? What advice would you have?

Henry: 4:11

Yeah, I feel like this is probably the most stressful thing for new dentists when they're feeling like they're trying to help this patient by jumping in and seeing decay or under a crown or doing a whatever it is, and then the patient comes back and what they thought was gonna happen, there was some kind of complication. And just happened a couple of times this week in our in our group where there was a decay under a crown, doctor came in, the patient came in, doctor cleaned it up, made a new crown, made a new temporary, and now the patient's in pain coming back and says, What the heck did you do? And I totally understand that. I think there's a couple things that are really important to help navigate these. Number one, set expectations. Patients don't know enough. All they know is they weren't in pain, now they are in pain, and the only thing to them that changed was they saw the dentist. So of course it must have been you, dentist. That's the only thing I know that's different. The other thing is we have to lead with empathy. This patient comes in, they're in pain. That sucks. We should acknowledge that. The way that we try to accomplish that, which is more challenging, especially when we're navigating this for the first couple of times, is no matter how big or small that decay is, it was bigger than I thought it was going to be. And I tell the patient, I'm glad we were able to take care of this. This is what I expect to happen. I expect to have you to have some temperature sensitivity, I expect you to have some discomfort. I don't expect this, this, and this because the decay wasn't encroaching the nerve. However, every single time you touch a tooth, there is a risk that there can be an adverse reaction. So if you're experiencing pain on biting, prolonged temperature sensitivity, I need to be the second person to know you're gonna be the first. I make that joke. And then and the reason why I want you to do the sound call.

Paul: 6:05

That was a great one. Thank you. Your assistant has to roll her eyes right there.

Henry: 6:09

Well, it's I have the same script of five things I say all day. So and the reason why it's so important that you let me know is because this tooth has been through a lot, and because it's been through so much, I don't know exactly when it's gonna be the point when the tooth says no more. And if it's you're experiencing those symptoms, you more likely than not may need the nerve to be addressed. I don't use the word root canal, I say nerve for being addressed, and then I leave it at that. That's my spiel every single time I leave a crown appointment. And then it gets even further back to I don't treatment plan things that I know are not gonna work out, and that comes with experience. So treatment plan, worst case scenario. And then when those times that happen where the patient comes in pain, I am sorry. This sucks. I'm sorry you're in pain. I wish I could have foreseen that with all this tooth has been through, that this would have been the outcome. We were trying to be conservative in our approach, but I want to make sure you're comfortable. I want to make sure we take care of you, and I'm so sorry you're feeling this way.

Paul: 7:08

I remember being early in my career, and you get this feeling like you go in there and like maybe like you thought the decay was really deep, but then it like it wrapped maybe a little facial or lingual, and it wasn't as close to the nerve as you thought. And you're really happy about this. So, like you look the patient in the eye, you say, Hey, you know what? I think everything's great. It's not as bad as I thought. It's everything's gonna feel great. And I remember doing this with a patient and coming back and going through this like loss of sleep, and like, my God, did I do something wrong? And why is this person so upset? It's their tooth. I mean, we see this on the Facebook forums. This is not your problem, this is their tooth, blah, blah, blah. But I think you're right, you've got to come from a position of empathy that, hey, their tooth really didn't hurt until you touched it. So, what are you gonna do? I love that you bring that up, Steve. One thing that you said that I think is huge for anyone listening is I cannot stand this when I my associates do this. It might be a root canal. We'll figure it out day of. Is it a root canal or it's not a root canal? Because if you say it might be a root canal and you decide the day of it's a root canal, you're an asshole. Okay. And if you say it might be a root canal and you don't do the root canal and it needs a net root canal, you're an asshole. So you always lose. You need to pick is it a root canal or is it not? Is it a crown or is it not? And I think that comes with time and treatment planning. Like you just learn it's just not worth it. If it's close to the nerve with experience, you realize that's gonna go endo. What are we waiting for? My thing for endo is does it percuss? If it percusses, it's endo. I mean, that's just me. What are your thoughts on this, Henry? You remember a time like where you got kicked in the butt by one of these? Oh, we've all been there.

Steve: 8:43

I don't want to kind of Steve made some great points. A lot of those I say the same exact thing. And I think it's most important to understand that you're always gonna, as the dentist, we'll always be the one. It's always our fault. The second we touch it, it's our fault. So always remember that. And I come from a point of working with multiple associates in the practice where we have to calibrate and we have to understand that when we tell the patient something ahead of time, we're giving them a reason. There was a lot of decay. There was this, there was that. If we tell them afterwards, then it's just an excuse. And the patient thinks that we're backpedaling and it's it's our fault and this and that. So from the beginning, make sure echoing some of the statements, treatment plan it correctly. Younger dentists tend to be what I call a hero dontist. They look at a tooth that really needs a crown, and for some reason, they for some reason they want to put a filling on that darn tooth. Why? I don't know. And I always tell them you're gonna put this big filling on this tooth, and you think that you're doing the patient a huge service and you're their hero. But you know what happens? They come back into the practice about eight weeks later with a broken tooth. And what do they tell when they see some other doctor? Oh, yeah, the doctor touched his tooth, now it's broken. Treatment plan it correctly the first time. And always say any potential complication that day or even beforehand, right? This way, it is not an excuse, it's a reason. I probably, I'm just like you, Steve. I probably have these spiels that my assistants joke in their head, they probably can like stop me mid-sentence and finish it. Anytime I cement a crown, I always say the same thing. Hey, listen, you know, your bite feels really great right now. I want you to test drive it. Kind of like I give you the keys to a brand new car. I want you to test drive it. You should be able to chew totally, completely comfortably. Maybe once in a while, maybe 2% of the time, patients come back a few weeks later, a month later, and they'll say something like, hey, Doc, you know that tooth you touched there that you put a crown on? It just feels weird when I'm biting something crunchy. If there's anything weird like that, call me, come back in. Sometimes the way that you're biting today on our paper may be different than chewing a juicy cheeseburger and maybe needs a little adjustment. So this way, I don't get people thinking that's abnormal, you know, and it really is true. It doesn't happen that often. And I think we made some comments, Paul, before we talked on this podcast is just sometimes people being very wishy-washy. Like when you're gonna adjust the bite, adjust the bite, right? Yeah, get aggressive, get it right, get it right, get it right the first time. Treatment plan things correctly. I think that's the number one thing that's gonna save you. And I think I will add this also is that I have been become a fan of the AI technologies. You know, we adapted Pearl in our practice a couple months ago. And I think it's really great for those scenarios where you can show the patient, you know, the pictures of the tooth parts and you can show them the where the decay is. So always tell them ahead of time, dentist too. I'll tell them this path is gonna suck for the first few weeks. You may even lose weight, right? And they always say, Oh, that's great. No, that's not great, but this may happen. So you're always just preparing them for the absolute worst. This way it sounds better. Yeah. When they actually undergo these things.

Paul: 12:25

Yeah, I think you're so right. It's all about setting expectations. And I think we just come out of school and we don't think this is an important part. We think it's all about the clinical, but it's so much about managing the emotions of the patient. And the thing with the occlusion, I'll see some of my sometimes my associates will do this. Somebody comes back and they've got they're having post-operative sensitivity on a filling or a crown or something. And the associate will mark it and say, No, it's fine. You just got to give up more time. Just buzz it. You got to do something. You know, they want you to do something. And even like I'm thinking situations where crowns de-ment, it's occlusion. It is almost nine times out of ten there's something you have to adjust in the occlusion, and they don't touch it, and it happens again and again. We're shooting ourselves in the foot. And I think from a patient perspective, and I'd love to hear what you guys think of this, but I think most patients will tolerate, I don't know, two to three occlusal adjustments, like where you tap, tap, tap, and you adjust it some more. After that, they start to go, like, what the hell's going on here? What are we doing? Like, why do we keep checking this? I mean, they don't realize how inexact that science is, but if you adjust it twice and you got to adjust it a third time, like I'm always biting and seeing how discluded the anterior teeth are. And if they're really discluded, I'm not doing that with a fine burr. I'm grabbing a coarse burr and I'm going to town, and that thing is not gonna touch for years, maybe not years, but you get what I mean. I'm gonna get aggressive with it. So, I mean, there's so much that we can do. I love it. You know, what you said as far as verbiage, and I'll give mine is I tell anyone we work on a tooth, whether it's a filling or it's a crown. This, I guess I would say this more for crowns, is I say, hey, everything went really great. We got all the decay cleaned up. I'm really happy with it. But anytime we mess with a tooth, it always causes sensitivity to the nerve. That is totally normal. But you should know that there is always a chance that this tooth may need a root canal. And they go, and I go, there's no way to know. It could be two months from now, it could be 25 years from now from the decay that was here today. We just don't know. I think it's gonna be good. We cross our fingers, we hope for the best. If it needs a root canal, we'll cross that bridge when it comes. Don't worry about it. And that is literally just my real quick and easy. I don't know. That might be just like, hey, don't worry about it. It's gonna be cool, man. Just chillax. And then I tell them when I know it's deep, I say, Hey, when this starts to hurt, because it's going to, it's gonna get sensitive. You got two options. One, wait it out. Two, let's do a root canal. You pick. So that way they don't even call me and say, like, hey, what happened? They know the rules, it's your choice. You know, either we're gonna do a root canal or we're gonna keep moving. So those are like things that popped in my mind there. You got anything else, uh, Steve, that popped in there?

Henry: 15:00

Yeah, I think when, especially with newer dentists, they're afraid to be the bearer of bad news. So they don't share those possible expectations for their with the patient. But in my experience, especially at the more the more I've had these difficult conversations, when I tell patients that something bad's gonna happen and it happens, I'm a genius. When I tell patients something bad's gonna happen and it doesn't happen, I'm an incredible dentist. Yeah, both are awesome. So I would not shy away from possible adverse reactions that may happen, but it needs to be presented in a way not to scare people, but just to have them understand. And at the end of the appointment, if you sit them up and you look at them and you say, Everything went great. I'm really happy we were able to clean up the decay, we're able to clean up this tooth. I do want you to be aware of this as a possibility. If it happens, I am here for you. Like Henry said, give me a call. And then we covered ourselves on that side, but we didn't do it in a way that's like pushing them out the door and making them scared about dentistry.

Paul: 16:06

You know, if this is your opportunity as a dentist to really provide a really good patient experience, that whole appointment could suck. But if you can just slow down and give those post op instructions to let the patient know what to expect and that you care. Same thing. I mean, I care. Call me. My phone number is on the voicemail. Um, my phone number is on all of the business cards, it's on the website. Call me at home if you need anything. Nobody calls. I mean, I wouldn't say nobody, but it's not a nuisance, I guess. I call, but you don't pick up. Yes, that's do not disturb.

Steve: 16:37

That's just for you, especially before 9 a.m. Do not call. Steve is on my black list.

Henry: 16:43

All right, that makes me feel better. I understand.

Steve: 16:45

So, one thing that came into my mind also is I've seen some of these things, Paul, from the other side of it. Our practice sees about 170, 180 new patients a month. And I see patients from other offices. And here's a scenario Patient comes in, they had a crown done recently, and they're having problems with it. And, you know, you look at it and everything looks fine on the x-ray. It's not really sensitive, but they can't bite on it. It's a simple bite adjustment, right? I went there three or four times and they can't figure it out. Like you mentioned, Paul, uh, they're just fed up with it. Now they're going somewhere else. And you know what? I do a bite adjustment. I adjust the opposing cusp. That's a big thing a lot of times. People don't understand that. And all of a sudden you relieve that now, like you said, Steve. Now all of a sudden I'm the hero. Oh my God, that other guy couldn't figure it out. I'm nothing special. I just what do you say when you do that, Henry? What do you say so they're not like, why are you drilling down there? So the number one thing that I'll like, let's say this same scenario. I'm just going step by step. I looked at your x-rays, everything looks fine. Another mistake people make is they always people love to trash the other dentist.

Paul: 17:47

Yeah, I hate that.

Steve: 17:48

And I know that that's like a red flag for me. When somebody trashes another practitioner, that's just, I don't know. I don't look good on that. Everything looks fine with the x-ray. You know what? You're not really having sensitivity when I blow on it. You know what? It looks like you're, it may be just something as simple as adjusting your bite. Your upper tooth has a cusp on it, it's really sharp. I think it's smashing in there. Why don't we just adjust? Let me adjust it a little bit. We don't have much to lose. And you know what? What I'm doing basically costs nothing, right? We charge a little bit for a bite adjustment, but all of a sudden, they maybe walked in with the expectation of there was something wrong with their crown, they needed a root canal. Now I'm like their hero. And now I've probably got a new patient that I stole from this other dentist just because I talked them through it and I just adjusted the, I wasn't wishy-washy with it.

Paul: 18:30

Yeah, that's great advice. And I do the same thing whenever I'm reducing the opposing, it's my mystery. You know, it's like, I know I don't want to thin out this porcelain anymore. And I know I don't want to go back and reprep if I have inadequate clearance. That's one thing. I just say, hey, you know what? The computer's recommending that we we round off this little cusp down here. It's just a little sharp. We're just gonna give it a little manicure on the edges so that way nobody questions it. And a little manicure, it just sounds so minor.

Henry: 18:56

What do you do when someone gets to the point where they're like demanding that you pay for their next treatment?

Paul: 19:02

Yeah.

Henry: 19:02

We see that a lot on the Facebook groups. And I know I have thoughts, but I'd love to hear what you guys do when it gets to the point, and maybe it's not a patient that you saw or have ever seen, but in your office, they're frustrated to the point where they're demanding that we pay for them to go have dentistry elsewhere.

Paul: 19:21

I feel like I've covered those bases preemptively that I don't think the expectation is ever there. I mean, I think if you do the post op right, it's right. Now, not to say that I haven't well gone through that. Now, I have paid for patients to get their endo retreated, and it's because I did an endo, it lasted maybe a year or so, and I can visually see like a short fill, something where I'm like, okay, that could be improved upon. Maybe that's what's causing it. But if it looks gorgeous, I'm not paying for that endo. And I would say the person we refer to 99% of the time does it. She's not charging us anyway. But I'll tell her like she just does a solid because we refer her to so many people. But yeah, that's it's I don't know.

Steve: 20:02

I mean, Henry, what about you? So I would say the scenario comes about maybe with an associate that maybe just wasn't on their ball game that day. And I I love to refer to the photograph of the original tooth before we touched it, right? Which hopefully everybody has. And you show them a photograph, and I look at that photograph, oh yeah, I'm gonna put this really big picture and I show them this picture of this huge amalgam that was leaking, broken. I said, This is what your tooth was like beforehand, right? We fixed it and stuff like that. And some of the points you mentioned before, Paul, is we never know what happens. We tried to be conservative, we put a crown on this tooth, which is certainly standard of care. And we didn't anticipate a root canal at the time, which again is conservative, and now it looks like it needs it. So your choices at this point are to do the root canal on the tooth, or the only alternate is to remove the tooth. And I mean, this is dentistry, right? This is normal. And maybe when you're younger, it's like so, oh my gosh, you lose sleep or this or that. But as you get involved with this, I mean, I think I can't press upon how important it is from the very beginning. If it was done correctly, I mean, I'll knock on wood. I can't remember the last time this happened in our practice. We're very good about telling the patients ahead of time. The worst case scenario is this. Because keep in mind, there are there is a segment of people out there that think that root canals are like the devil. Well, they say, oh no, no, no root canals ever, ever, ever. Then your alternate is just remove the tooth, right? Tell them like it is. Don't be afraid to give the bad news. That's what we're here for. We're not the sugarcoat stuff.

Henry: 21:29

I'm just thinking about I just had this patient that called the office and is demanding that we pay for the root canal, that she had another office and that it was our fault. And I think for me, the pain that I felt and why I feel comfortable in my treatment planning and how I set expectations is because there was a time where if someone were to call me and demand that, I would give them the money. I would just be like, it's not worth my time. Get this the F off my plate. And I actually had to feel the pain. And that was my approach. And what I learned from that is a different way to set expectations with the patients. I think it helped shape my verbiage and how how I'm able to talk to patients because I felt that pain financially. I want all doctors to be able to learn from that. So I think that for me, there is benefits of saying, hey guys, we all need to learn from this. And the only way we truly learn is if the pain isn't enough to change or the reward is strong enough to pull us to change. Which one do we want? Here, let's say we're gonna pay this patient, we're gonna pay for this patient's treatment. And you as a doctor are gonna share with me in that payment so that we can learn and not do that. Because ultimately, what I want them to do, our entire team, is set expectations clearly with the patients, talk about worst-case scenarios and what can happen in a kind and caring way. But I need I need behavioral change because if only every single time I take it off their plate as the doctors and say, I'm gonna take it, or I'll pay the patient back, but it won't affect your collection. We're not learning. So I think it is helpful, at least for me, and you guys can tell me I'm stupid, you do all the time. Um, I think it is helpful for me. You're doing great, Steven. I really needed that today. Thank you, Paul. You're super, you're super. But I think it's really important that that there's opportunities to learn and there's pain from the mistakes that we made. And in this case, the mistake is we didn't set the expectations properly.

Steve: 23:25

Well, let's explain, let's talk about a little bit more specifics here. Let's talk about this specific case you have in your brain right now. So I'm like Paul. If I look at my work and crown looks good and this is good, uh I'm not giving them refund, right? I'm not doing any of that.

Henry: 23:39

Yeah, I get that.

Steve: 23:40

When you say we messed up, what do you mean like clinically? What do you mean by we messed up?

Henry: 23:44

So, like, yeah, so this specific patient, they have 14 and 15, were both blown up. They needed a rookonel. We did the rookonel on 14. That was the one that we thought was causing the pain. 15 was also had a very deep decay, but it we weren't able to test it to make it symptomatic or whatever endodontists do. I don't know. And then we completed the treatment on 14. It was better for a week and a half. Patient came back. Now 15 is bothersome to you. Obviously, we took that 14 out of occlusion, that makes sense. And now the patient is like, you did the wrong tooth. I'm going to another office, you guys messed up. And the endodontist, the new endodontist, said, Yeah, this tooth needs a root canal.

Steve: 24:25

How did they not know? What did How did they not know? But didn't 14 need a root canal, Steve? 14 did too. So then why refund? I'm being devil's advocate here. Why give them anything? I totally get that. I understand it.

Henry: 24:37

But the real answer is we're gonna schedule both of these, we're gonna take care of both of these teeth. And if you, patient, want to choose only one or the other, you need to know that you could be the one choosing wrong. I'm saying both of this need to be done now. But we made the decision for the patient, and we were right, but we were also not complete. So because we weren't complete, the patient doesn't understand that. So I'm like, all right, guys, I totally get it. I want this off our plate. I don't want this patient running around town thinking that we misdiagnose. That sounds way worse. Let's share in this. I'm gonna call over to the endodontist office myself and I'm gonna say, hey, this is what's going on. Here's the story. We don't refer out a ton, so they don't need to give us anything. And we just wrote it, we wrote the endodontist office a check, and that's it, and it's done. And then I don't ever want to see the patient again. They obviously lost trust in us, and I don't think about it ever until you guys made me think about it. And now I'm gonna have not sleep well tonight, so screw you guys.

Paul: 25:37

But all that shame comes back. That's what we're here for.

Henry: 25:40

I do think it's important. I do think it's important for us as a team to understand why someone may be thinking that way, empathy, and then learn from the mistakes so that we can take better care of our patients moving forward.

Paul: 25:55

Yeah, I think that's a great thing that you mentioned, Steve. It's like the important part is we got to learn from it. Learn from it and see what happened. What can we do differently? And what I would like to leave the listener with is that we're asking you and suggesting that you should put a little bit more time and energy into your post-operative instructions. And I know we're busy, we've got to get to the next room. But what I want you to see is that how much time you save by doing that, you don't have a patient coming back, you don't have your front desk answering a phone call for the patient in pain, you don't have somebody complaining, somebody coming and questioning your abilities and questioning your skill and your competence and stuff. So these things are worth doing. So you see how much knowledge is in the room here with us three. I mean, these coaches are great. These are the kind of things that you get from working with an experienced coach. And so if you're looking for a coach for your practice, so you can have a better run practice that gives you more freedom and more time to do the things that you love, please go to our website, dentalpracticeheroes.com, and set up a strategy call with us. We would be happy to talk to you about what options and what we see in the future for your practice. Thank you so much for listening, and we'll talk to you next time.