THE GRID OF UNDERSTANDING
August 2, 2011
In my career in the profession of Orofacial Pain and Dental Sleep Medicine, I have always been drawn to the excitement of learning new concepts and new approaches to understanding and applying this understanding to treating patients with these conditions. I would go to conferences and seminars and come back with a head full of information. Then I work hard and try to make it applicable and integrate these new concepts into my practice. In other words, I have always approached learning with a spirit of an open mind to what information is provided. I would put this information through scientific process as far as validating its worthiness. However, I always kept an open mind to what people had to say and to consider it as either true, partially true, or false. This has put me into the position of providing the best care possible for my patients.
In the last few years, I have had the opportunity to take this understanding to a new level with research that I have been doing with the patients in my practice. It is difficult to do this because of the fact that I have to run the business of medicine at the same time. In doing this, I have collaborated with various other medical specialists and have come to understand a new thinking of the role of sleep disorder breathing in Orofacial Pain.
As I share this new understanding with my fellow colleagues in Orofacial Pain and Sleep Medicine, I have several observations to make. As I share my new understanding with fellow Dentists in the role of teaching, these concepts have been very well received by my colleagues. It just makes common sense when you consider it with the evidence that is out there. Even though this is so new that the research is very sketchy at this time, it just makes sense. I am involved in research studies to validate these new concepts, which I hope will verify the understanding that I have come to integrate into my thinking of orofacial pain and TMD. I am talking about the relationsihp between bruxing and the collapse of the airway at night.
However, when it comes to sharing my understanding with my peers who also treat exclusively orofacial pain or dental sleep medicine, my teaching is met with much skepticism. At first, I was shocked by this perception, however, I have also come to realize what the problem is. The problem is what I call the “a grid of understanding.” This comes after years of learning and using this knowledge to treat patients. When you come to understand a concept and you integrate it into your grid of understanding, it becomes further validation of what you already know to be true. As new information comes on board and is presented, it has to fit that grid of understanding or it will probably be rejected. The longer you stay on that grid that the more difficult it is to bring new information and concepts into the world from which you operate. This becomes a challenge when new concepts are presented especially as “radical” as the concepts that I might be presenting. I also have a grid of understanding, however, I tried to keep my grid open to new ideas and new concepts, while very carefully putting them through filters of scientific reasoning and validation.
I do not fault my colleagues in orofacial pain at all. What I am trying to put forth is of course very new and I know full well that these ideas may pan out to be only partially true. That is the way I do present these theories, however, it is very interesting the different ways it has been received by my colleagues.
I personally do not mind being challenged because it causes me to defend my ideas and when I have to defend them, I have to question them myself. I enjoy this type of interaction with my peers, so I embrace their skepticism and challenges. My only thought in regards to this is that I sometimes wish they would receive ideas with more open mind or at least consider these new ideas as they go back and work it through their filter or their grid of understanding. Then they can come back to me with their cause of their concerns or possibly further validation of new ideas.
Ronald S. Prehn, D.D.S.
Diplomate of the American Board of Orofacial Pain
Diplomate of the American Board of Dental Sleep Medicine
