Dental psychology

Dental psychology that I like

Dental psychology or really just psychology that I find that interests me personally.

Dunning–Kruger effect

Dunning-Kruger is a failure of metacognition, the ability to gauge what you know and what you don’t know. Although the Dunning–Kruger effect was formulated in 1999, Dunning and Kruger have noted earlier observations along similar lines by philosophers and scientists, including Confucius (“Real knowledge is to know the extent of one’s ignorance”),[2] Bertrand Russell (“One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision”),[10] and Charles Darwin, whom they quoted in their original paper (“Ignorance more frequently begets confidence than does knowledge”).

Image of dunning kruger effect

Four stages of competence

The four stages of competence leaning process. Thsi one ties in with the Dunning-Kruger effect.

Four stages of competence


Image of the four stages of competence from dental psychology blog

Pygmalion effect and the Golem effect

The jist of both of these is that people tend to live up or down to the expectations people put on them.

False memories

Brain hack by Julia Shaw.  Elizabeth Loftus is an expert on the topic and it is interesting to read the probably expected push back she got on the topic. People definitely do not want to believe their memory is anything except infallible. It’s my opinion the more erratic and less historically accurate individuals are far less prone to accept that their memory could be inaccurate. Overly emotional people are much more likely to make something up and believe it, which is dangerous.

Hawthorne effect

Another one of my all time favorites is the Hawthorne effect or the observer effect.

Behavioral economics

The study of humans predictably irrational behavior and actions against their own best interest. Deals with a lot of cognitive bias.

Cognitive bias

Confirmation bias involves selectively gathering and interpretation evidence to conform with one’s beliefs, as well as neglecting evidence that contradicts them. An example is refusing to consider alternative diagnoses once an initial diagnosis has been established, even though data, such as laboratory results, might contradict it.

“This bias leads physicians to see what they want to see,” the authors wrote. “Since it occurs early in the treatment pathway, confirmation bias can lead to mistaken diagnoses being passed on to and accepted by other clinicians without their validity being questioned, a process referred to as diagnostic momentum.”

Anchoring bias is much like confirmation bias and refers to the practice of prioritizing information and data that support one’s initial impressions of evidence, even when those impressions are incorrect. Imagine attributing a patient’s back pain to known osteoporosis without ruling out other potential causes.

Affect heuristic describes when a physician’s actions are swayed by emotional reactions instead of rational deliberation about risks and benefits. It is context or patient specific and can manifest when physician experiences positive or negative feelings toward a patient based on prior experiences.

Outcomes bias refers to the practice of believing that clinical results—good or bad—are always attributable to prior decisions, even if the physician has no valid reason to think this, preventing him from assimilating feedback to improve his performance.

Salient bias is selection of more emotional striking information. Present bias is opting for smaller reward now rather than larger reward later, opposite of delayed gratification. Planning fallacy refers to our tendency to over=estimate our ability to complete a task in a given time. Interesting article on using behavioral economics to get patients to keep their dental visit. Wang JADA 2020

Kubler Ross Stages of Grief

The following is from an email but I can’t find it in his blog to link to so here it is.

It was the similarity to grief that learning of any form causes. Once I tell you, you to will see it in colleagues, patients, friends.


A new idea comes out, Socket shield perhaps.

  1. Write blog explaining why it’ll never work! (denial).
  2. This is a terrible idea and those that do it should be reported to someone (said in angry voice).
  3. Well, perhaps it works, but older methods work better! I don’t trust it. (bargaining).
  4. You remember all your denials and anger when the procedure becomes widely accepted and feel down about being so wrong. (depression).
  5. Stand up in front of audience and show a case… (acceptance).

It’s important to know that we do not necessarily go through them in this order. The timeline is not equal (we can get stuck in one for a long time). And we may not go through the process at all and just move straight to acceptance. You can see your friends and colleagues go through this process every day online. Often the anger is not directed at you personally for upsetting their world, but is the normal reaction to a shocking change. Even if it is just in their dental knowledge world. It is because of the mistaken belief that learning is a smooth gradual thing, which generally it is not. Learning is made up of sudden jumps in learning where something “clicks” and we suddenly understand. However, we can resist the new information or the better way for a considerable time.

I’m subject to this as much as anyone. I’ve resisted new learning often. Been angry at those doing things different to me. Realized that the new learning that supplanted the old, has now been supplanted by the resurgence of old ideas. The cycle is continuous and endless although being aware of our reactions to things does make them less bothersome.

We also see it in our patients.

One of the reasons that the second opinion always gets the job is because by the time the patient gets to them, they are starting to accept the idea that they need significant expensive treatment. They can do the the “bargaining” stage with the new dentist, who can give the patient the slight changes that make the treatment acceptable.

When the process becomes dangerous is when dentists who lack self-awareness see things that make them angry. It might be that they are justified in their anger. However, I’ve seen cases where a specialist endodontist in a position of power in this country, gets angry at some of the modern concepts of non-intervention at radiolucencies and would use his position to punish those that move to this more patient-centered way of thinking. I see similar quite frequently in the UK, where people (often who have little or no private clinical work) use un-elected positions of power (elitism) to attempt to punish those that have ideas different to themselves (they get stuck in the denial/anger stage).

So if you challenge, expect to see these emotions surface. And remember, you cannot force someone to learn. Trying to make someone learn something is fruitless and counterproductive. They will learn when they are ready. It’s why it’s sometimes better to exit an online discussion than to try to continue to the point that the other party acknowledges your rightness. It’s usually impossible for them to come to that point in a short timeframe.

– Linc, Gayle, Jynni, Nicole and Erin
Restoring Excellence Team

Image of the Kubler Ross Grief Cycle

I cover a few others that are more directly impactful to dentistry in the placebo blog.


Random interesting stuff.

Our sense of touch, then, arises from an exceedingly complex interaction between electrons around the molecules of our bodies and those of the objects we encounter. From that information, our brain creates the illusion that we possess solid bodies moving through a world filled with other solid objects. Touch doesn’t give us an accurate sense of reality. And it may be that none of our perceptions match what’s really out there. Donald Hoffman, a cognitive neuroscientist at the University of California, Irvine, believes that our senses and brain evolved to hide the true nature of reality, not to reveal it.

“My idea is that reality, whatever it is, is too complicated and would take us too much time and energy [to process],” he says. Discover magazine 2018

Great quotes

“Watch your thoughts, they become words;
watch your words, they become actions;
watch your actions, they become habits;
watch your habits, they become character;
watch your character, for it becomes your destiny.”



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2 Responses to “Dental psychology”

  1. February 19, 2019 at 7:02 pm #

    Dr. Bauer. I like your Four Stages of Competence. They are true to my experience and one can go through the stages several times maybe
    more. Then there’s the stages of grief. I’ve found one cycles through these, too. I wrote a caustic comment about the All on Four and the seeming fraud that I felt I experienced. Allow me to say that when I wrote the first comment, which I regret somewhat, I was and continue to be cycling through grief having lost my only child. This is the reason that I requested that you remove my previous comment. Knowing, doubting, wondering, knowing once again can be very confusing. It is my concern that IMy comment may harm my dentist who happened to take the brunt of my grief and truly has been the most gifted prosodontist I’ve known. I’m 74 and been in the dental chair for 64 years. No exaggeration. Thank you.

    • February 26, 2019 at 3:27 am #

      I changed your name so there is no way anyone can ever know it was you but I think sharing your experience is important because others will go through the exact same thing. It’s the human experience.

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