How to respond to 'But you said I should floss'

2016 08 10 14 34 04 532 Butler Jen 400

Stress is at an all-time high for dental professionals. The need to stay modern comes with rising costs, shrinking reimbursements, the desperate need for social proof, and navigating the informed, and ill-informed, patient base. With the release of the Associated Press (AP) article regarding the lack of evidence-based studies on flossing's effectiveness, patients are now questioning the education you and your staff provide and, in some cases, the providers themselves.

Jen Butler, MEd.Jen Butler, MEd.

You can manage conversations in which you educate your patients in one direction when research sends them in the other. This does not inherently set you up for confrontation. It actually provides you with an incredible opportunity to further your relationship with your patients, deepen their understanding of oral health, and earn their trust along the way.

Below I share with you specific communication elements to be mindful of so you can come through these conversations in a positive light and the detailed steps in how to prepare for such conversations.

Be mindful.

Don't be offended by 'Why?'

“It actually provides you with an incredible opportunity to further your relationship with your patients.”

People use "why" questions as a starter to curiosity. It's the simplest of words that demands response. The word may become a barrier to effective communication because it requires a person to justify. For example, "Why did you tell me to floss all these years?" Or, "Why did you think flossing was good for my teeth?"

Even in the sweetest and softest of tones, the message puts the listener on the defensive. Don't be triggered by the why questions. Simply remind yourself that patients are looking for more information and then provide it.

Stick to facts

Focus on facts, not feelings. Facts include all the elements of a situation that are trackable, observable, and measurable. Even though your feelings are important, they are not always relevant, especially in a case in which one article is questioning years of professional advice.

The fact is the article is not claiming conclusively the impact of flossing is irrelevant to oral health. It merely states that the evidence today is "currently weak" and the "evidence is questionable." So the fact still remains, there needs to be more clinical and reliable research studies that focus on the long-term effects of flossing as it relates to periodontal health.

Focus on the truth

When you focus on truth and transparency, you always come out on the positive side of any talk. Here are some truths to bring up in your talks with patients:

  1. The widely reported AP article examined 25 peer-reviewed studies on the effectiveness of flossing and found weak or unreliable evidence that flossing had long-term benefits.
  2. The report was not telling practitioners or patients to stop flossing, only that there are some questions unanswered about its impact.
  3. When we know better, we do better. And when we aren't sure exactly what to do sometimes, it's best we do nothing. Meaning, until studies show conclusively that flossing helps us, for now it definitely isn't hurting. Let's err on the side of caution.
  4. The report never stated that providers championing daily flossing are wrong, incompetent, deceiving, or misinformed. It simply is looking at the behavior of flossing -- don't personalize the information.

Be prepared

Some patients will be direct in asking about the report, while others will be more subtle in their approach. Regardless of how it is brought up during the patient experience, it's vital you are prepared. Here are some essential tips to prepare for those difficult conversations.

  1. Name the problem. The problem isn't the report, so what is the problem?
  2. Clarify the issue. The issue will be different for each patient, so this step is essential.
  3. Determine the current impact. How will this situation specifically impact this patient, this experience, and this relationship?
  4. Determine future implications. How you manage this will give evidence to patients as to how you will handle other difficult conversations.
  5. Acknowledge personal contributions. You can't change what research or reports say. You can control what you share and how you share it with others.
  6. Time to decide. Decide the who, what, when, where, why, and hows of the conversation.
  7. Follow up. When there has been a difficult moment or bit of tension in a conversation, always follow up to see how things are. This can come in the form of an email, phone call, or note. The delivery isn't so much the focal point but rather the message.

If difficult conversations are a stressor for you, whether it's with patients, team members, or those in your personal life, visit for a full conversation prep sheet to help you navigate even the most challenging of talks.

Jen Butler, MEd, is the CEO and founder of JB Partners and has been working in the area of stress management and resiliency training for more than 25 years. Learn about her services at, or contact her at [email protected]. You can learn about her Catalyst Seminars and download a free e-book.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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