What’s healthier than a root canal?

I’ve been lurking in a holistic health Facebook group where I read some mind-boggling posts. A frequent thread is about alternatives to traditional dental care. These folks really don’t like dentists. Here are typical posts: "Can anyone please recommend vitamins/supplements for teeth?" "I am going to start oil-pulling today as well (coconut oil)." "My teeth are bad as it is, starting to go to dentist, but the $$ is ridiculous (even with insurance)!" Another poster wrote: "This may be far-fetched, but is there anything I can do to heal my cavity instead of a root canal?"

Want to know how the other members of this group responded? Here are some of their comments:

Root canals have been linked to cancer.
Oil-pulling healed four cavities for my daughter.
Do wheatgrass powder instead of oil-pulling.
I changed my diet and healed myself.
Clean with iodine solution and supplement with vitamin D and minerals.
Cure your chipped tooth with juicing.
Emotional healing has helped my tooth.

Several dental health professionals in this Facebook group did not agree with these views or solutions. But just like arguments about COVID vaccines, these professionals’ perspectives were discounted by the other group members who insisted that oil-pulling and wheatgrass were viable alternatives to root canals.

This ongoing conversation reflects a significant dilemma in dentistry. How can we respond to patients who see themselves as sophisticated advocates for their health and who perceive dental treatments as “unhealthy”?

A bad case of confirmation bias

Let’s take a mini-detour into an interesting psychological process called confirmation bias. Many of us tend to interpret information in a way that confirms our preconceptions. In other words, we see what we expect to see. Unfortunately, this means that we cherry-pick information: we focus on the things that support our beliefs and discount or ignore evidence that conflicts with our biases. As Warren Buffett said, “What the human being is best at doing is interpreting all new information so that their prior conclusions remain intact.”

An enormous problem with confirmation bias is that it clouds our judgment and influences us to make decisions based on beliefs rather than empirical evidence. But the truly startling thing about this process is that people will hold fast to their beliefs even when confronted with solid evidence that these biases are incorrect or even destructive.

Even highly intelligent, well-educated people find ways to discount contrary facts when they interfere with their personal beliefs or experiences. We become like toddlers having a tantrum and screaming: “It’s not true! You can’t make me believe it!”

So, what can you do when you encounter patients who insist that wheatgrass will cure them or that x-rays cause irreparable harm or that fluoride treatment is akin to malpractice? How can you reason with these patients?

Beat them or join them?

Remember the adage: “If you can’t beat them, join them?” I’m not saying that dentists should provide vitamins instead of fillings. But you will not win an argument using logic with someone who is making an emotional decision.

This is a critical lesson, so let me say it again: You will not win an argument using logic with someone who is making an emotional decision.

While many of us insist that our decisions are based on facts, our choices are more often rooted in emotion. Your patients make their treatment decisions based on how they feel—that is, how they feel about you, how they feel about their health, how they feel about money, and how they feel about risk.

However, most patients are not aware that they are making decisions based on feelings. They may insist that the crazy things they say to you (or write on Facebook) are facts.

What happens if you challenge one of your patient’s “facts”? What if you told one of those Facebook posters that wheatgrass powder would not be a good substitute for a root canal? Do you think that patient would jump out of the chair and hug you with gratitude for setting them straight? Not likely. What would happen? The patient would either perceive you as someone who has been sadly duped or as an enemy intent on inflicting damage because you don’t know “the real truth.”

This is the problem when folks have a strong confirmation bias. Arguing with people about their beliefs only results in a more stubborn mindset. Remember the scene in Raiders of the Lost Ark when Indiana Jones shoots the guy brandishing a sword? When you employ logic as your “weapon” to confront mistaken beliefs, you bring the wrong tool to the conversation. You may have the sword of truth, but your patient is bringing a bazooka.

How to work with your patients’ beliefs

There is an old theater improvisation game called “Yes, And.” In this game, each partner agrees and adds to whatever their improv partner says. If your partner suggests you need to walk a lavender dog, your job is to agree and add a nuance—yes, a lavender dog who eats orange food.

When you encounter a patient who wants to do oil-pulling instead of your treatment plan, think, “Yes, And” instead of “No, This.” Focus on your areas of agreement. This is easy, because you and your patient agree that you want the patient to be healthy. Your position is to agree with the patient that you want the best, healthiest option for them too.

If possible, find a way that the patient can incorporate their alternative healing methods along with your treatment. If a patient tells you that iodine and diet will regenerate their teeth, don’t argue; say, “Yes, And.” Here’s what that could sound like: I get it and respect that you want to treat your condition as conservatively as possible. That’s exactly what I want for you too. Let’s partner together so that you do your part in healing yourself through diet, and I do my part by providing the healthiest treatment option for you. Let’s create a treatment plan for you that incorporates your ideas along with my own. This way you can be assured that everything we do is in your best interests.

Saying yes when the answer is no

This verbiage allows your patient to feel heard and respected while simultaneously steering them to a more practical and viable treatment plan. I call this method, “Saying Yes When the Answer is No,” and it can be used in any situation where you can’t or won’t do what the other person wants. It reduces the other person’s defensiveness because it sounds like you’re agreeing. The focus is on demonstrating how the other party can get what they want . . . when they do it your way.

The “Yes, And” method creates a bridge between two seemingly opposing positions. The next time a patient cites “alternative facts,” use this technique to guide them to better decisions.

Editor's note: This article appeared in the August 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.