by Cathleen Terhune Alty, RDH
The John O. Butler Company and RDH magazine pay tribute to the recipients of the 2002 Healthy Gums Healthy Life™ Award of Distinction.
Eight dental hygienists received the Butler GUMRegistered/RDH 2002 Healthy Gums Healthy Lifetrademark Award of Distinction on August 2 during a ceremony held in conjunction with RDH's Under One Roof conference in Chicago. Earlier in the year, the eight winners composed essays about the differences they make to help patients have healthier lives, differences they make in their community, and offered tips for improving patient compliance.
Several similarities run through every profile of the Award of Distinction winners. Most are moms; all were passionate about their profession and dedicated to helping people. All were influential in their community and ADHA. But the one similarity I noticed the most was they all mentioned how many continuing education courses they attended. All of them stated they attended more CE courses than were required and all suggested from their essays they were on the cutting edge of the profession. They all seemed to say that if you're learning and growing, the envelope of dental hygiene practice is growing as well. The more you know, the more you can help, which is good advice for all of us!
A third of each "essay" was devoted to "top five tips for improving patient compliance." Their excellent, inspirational ideas may serve as models for the entire dental hygiene community.
Cathy Anne Anderson, CDA, RDH, BS
Cathy Anne Anderson is a practicing hygienist, a dental educator, and is sometimes known to dress up as "Flossie" the beaver! Well, most hygienists will go to great lengths to reach children and teach dental health lessons, and Anderson is no exception. Patient education is paramount and she addresses it in detail in her essay.
"I have found that to make a difference in our patients' health, we must first give patient education the important priority it deserves," Anderson says. "We must address it first, during each and every hygiene visit.
"How can we expect our patients to listen and comply if we continually skip or rush through patient education due to time constraints? What message are we really sending to our patients? By establishing a rapport with your patients built on trust, concern, and consistency, you can build the firm foundation needed for successful patient education, appointment compliance, and, in turn, good health."
Anderson also advocates going the extra mile for patients, using appropriate visuals, being prepared, and always following up the visit with a note or phone call to reinforce what was discussed at the appointment.
She campaigned for, designed, and now teaches a course designed to prepare senior dental hygiene students to take the national boards. She is the hygiene coordinator for the Special Olympics, Special Smiles Southern Illinois component, in charge of organizing, recruiting, screening, and patient education.
Anderson volunteered during National Children's Dental Health Month, visited a local elementary school, and presented dental health programs to many children. Anderson has donned the "Flossie" the beaver suit at a local Children's Health Fair, as well as organized and implemented a weeklong oral cancer screening and denture cleaning program at a local nursing home.
Anderson finds great fulfillment inside the office as well as outside its parameters, and considers the intangible awards as valuable as the more tangible, financial ones. "The rewards reaped from service to my profession and community far outweigh those seen from any office bonus or paycheck. If you let your heart guide you in your profession, you will find happiness, fulfillment and longevity. If you let your paycheck guide you in your profession you may only find financial security. If you're lucky enough, you'll find both."
Anderson's top five tips for improving patient compliance
After 10 years of dental experience and serving as both an educator and clinician, I've learned that simply working "off the CUFF" improves patient compliance dramatically. It's an easy acronym to remember.
C is for comfort. Always address your patients' physical comfort. Do everything in your power to take the "dread" out of dental visits, and make your patients feel special. Appeal to all of their senses. Make your office look, feel, smell, sound, and taste nice. Your goal is to make your patients oblivious to the dentistry being perfomed!
U is for understanding. The first 10 minutes of any dental appointment should be reserved for interaction with the patient. The importance lies in establishing a sense of trust and emotional comfort with the patient. It's critical to know where the patient is coming from.
F is for fun. Laughter inspires feelings of joy and happiness, goodness and comfort. So have fun with your patients! Think about giving your patients a reason to stop by the office when they don't have an appointment!
F is for follow-up. Follow-up reflects integrity, commitment, and, in some cases, concern. Touch base will all of your patients frequently. Surprise them with a phone call or note.
Patient involvement is the fifth and most indispensable tip. Get your patients involved in the promotion and marketing of your practice. Start an "ambassador of good oral health" club.
Kannapolis, North Carolina
Sandra Boucher has worn many hygiene hats in her 23 years of full-time dental hygiene practice, working in private practice, hospitals, military bases, dental school research, clinical dental hygiene professor, as well as in a pediatric dental clinic at a major medical center. She currently is a public health dental hygienist working as a program manager in a community program and a book reviewer for a national dental hygiene journal.
As a public health hygienist, Boucher says her patient is the community.
The Surgeon General's Report on Oral Health in America has helped open doors for Boucher to promote awareness of lack of care for children in Cabarrus County, North Carolina. "I talk to dentists and ask them to volunteer to screen children in preschools. I talk to childcare providers and give them the education and tools they need to teach children the importance of good oral health. I talk to parents and teach them how to take care of their children's mouths, even before their babies are born. I talk to educators, pediatricians, and legislators, educating them of the situation and working to find solutions."
Boucher also interacts with other dental hygienists to network and brainstorm ideas. She says she has found that professional paths "continue to cross throughout life and the fruits of the collaborative efforts will bring joy."
While a volunteer at the World Special Olympics in 1999, Boucher was part of a team of hygienists and dentists who were performing screenings, placing sealants, and making mouthguards for the athletes. "These special athletes taught us that even though there was a language barrier, there were no communication barriers. Loving what you do and doing it with love speaks in any language."
Boucher's top five tips for improving patient compliance
- Listen compassionately and with empathy. People will listen to you and learn when they feel cared about. Everyone has a dental story. Listen to each story in its entirety. Listen for an opportunity to educate. Education is the key to prevention. Historically, dentistry has received a lot of negative publicity. (We have all heard about those painful root canals or the dentist who climbed on the patient's chest to pull a "wisdom tooth.") Accept the challenge to turn a patient's perception of dentistry from critical to complimentary, so that the next dental story told will be one of appreciation rather than apprehension.
- Always use positive words and phrases to describe ways the patient can improve a technique. For example, instead of saying, "Mrs. Jones, you are missing this area," say, "Mrs. Jones, if you will rotate your wrist just a little more like so, I believe your toothbrush will be able to reach this hard to get area." Never criticize or ridicule.
- Personalize oral hygiene instructions to each person. Give tips and advice that are specific to the patient's situation. Use disclosing solution and X-rays to point out specific areas needing closer attention.
- Do not just tell them, show them. Use the "tell, show, do" technique. When delivering oral hygiene instructions, show exactly in which areas the "toothbrush" needs to spend more time.
- Give patients the tools they need to get started. When recommending certain home care products, dispense the product to the patient.
Say "Aloha" to Diane Thomas, who has been practicing dental hygiene for 23 years and lives in Hawaii. Thomas specializes in using a "whole person" approach to periodontics, as well as being very active in professional and volunteer organizations. Thomas decided to become a dental hygienist at age 13, and to specialize in perio at age 17 after working afternoons as an assistant in a periodontal office.
She says her purpose in life is to make a difference, so she has invested energy, time, and money to improve her skills and develop a patient-care philosophy that "respects the individual and treats the whole person."
When moving from Arizona to Hawaii, the lack of continuing education courses on the island where she lived motivated Thomas to create the Hawaii Institute for Wellness in Dentistry in 1994. This increased dental professionals' access to CE courses and helped raise the standard of care in Hawaii. Thomas also has received an award for legislative efforts to include local block anesthesia for hygiene patients in Hawaii and a grant to include dental professionals in an interdisciplinary coalition to prevent abuse and neglect of children and elderly in her community. She has served as anesthesia examiner for the Western Regional Examining Board, recorder for the Hawaii State Board of Dental Examiners, vice president of the Arizona Dental Hygienists' Association, and is currently vice president of the Hawaii Dental Hygienists' Association.
Thomas volunteers as a counselor for the mentally ill, is a gifted storyteller for schools and her community, is a published writer of short stories and poems, and is a creative writing instructor to teenagers. She enjoys hula dancing, aerobic weight training, swimming, and bicycling. Her 15-year-old son is a unicycling fire juggler!
Thomas said she was "honored and amazed" to win this award and credited patients as well as mentors such as Trisha O'Hehir, Betsy Price, and Phebe Blitz for "instilling passionate views and laying the foundation for the hygienist I have become."
Brucato-Thomas' top five tips for improving patient compliance
Number one: Accept your clients for who they are and at what level of health they are. They may not be ready to change. Periodontal disease does not happen overnight. It is a lifestyle disease. Changes in lifestyle take time.
Number two: Give information and options. Let the client make his or her own treatment decisions based on information. If the client owns the decision, they will be more committed to the treatment.
Number three: Never lecture or come across as condescending. State your findings and give the opportunity to ask for information. If they don't want to hear the details, respect their wishes. This is about building trust. When they are ready to hear the next message, they will hear the next message.
Number four: Remember the client lives in that body, not you. Never assume you know more about what they can fit into their lifestyles than they do. One of my favorite questions to ask is: "How healthy can you stand it?" Ask yourself! Maybe you will floss every day, but would you be willing to give up your coffee?
Number five: Celebrate every step made by the client toward better health. When a client returns for periodontal maintenance, maybe he or she finds a cocktail umbrella in the pre-rinse cup. If his or her BOP score is 10, give a silver star; 5, a gold star. Silly? No. Just fun.
You'd have to admit Marilyn Chew has the perfect name for her career in dentistry. A nine-year veteran of the profession and a mother of six (yes, six) children, she thrives on helping her patients get healthy. She has created a health library in her office, collecting information to share with patients from women and children's issues to diet, exercise, and smoking cessation. "I feel it is my responsibility to research, learn, and share this knowledge and information to help my patients have healthier lives. I can only share what I have. The more I have the more I can help."
Chew is concerned about hygienists who feel they are in a rut and not aware of where the profession is going. "I attend more CE than I need to. Lots more. I have always been a member of the ADHA since I began school. I read about new ideas and philosophies. I network with other hygienists and dentists. I learn too much new stuff to ever be tired with hygiene."
Chew is the president-elect of the Oregon Dental Hygienists' Association and has actively worked with legislators to bring change to the profession. One example is the Limited Access Permit, which allows hygienists to practice independent of a dentist in nursing homes, adult foster homes, and other areas. She writes, "I feel strongly about my profession being able to promote overall health while dealing with dental health. I prepare myself to fill that role."
She encourages hygienists to be involved in professional organizations. "We could be a very strong voice when it comes time for us to support or not support certain issues. We will have to take a stand somewhere, sometime for something. Be prepared. Be a member. The greater numbers in the supporting group the louder and stronger the voice we raise - the more likely we will be heard and recognized as the authority in our field."
Chew's top five tips for improving patient compliance
First, I use the phase contrast microscope. Periodontal patients want to know the cause of the bone loss. The patient can see the many bacteria associated with periodontal disease in a sample of their own subgingival plaque viewed under the microscope.
Second, I use the ultrasonic scaler. The patient wants to know how to get rid of "the bugs." The liquid that cools the vibrating tip of the ultrasonic scaler kills the bacteria they saw on their slide. I explain that, if enough of the bacteria are eliminated, the disease process stops.
Third, I individualize the treatment plan to meet the needs of the patient. Treatment must be tailored to the patient by evaluating all the information that was gathered in the new patient appointment. The health history, past and present radiographs, home care technique, probe measurements, amount of bleeding, and risk factors are essential factors to consider when individualizing treatment.
Fourth, I individualize home care. I find some type of tool and/or technique that the patient likes and uses effectively. It seems to make a patient more compliant. I then give a few suggestions. They make the choices. The next time they come in I ask what they used and if they found it to be effective.
Fifth is caring and confidence. The patient has learned that I care about his overall well-being, and that I can help him get healthy and stay healthy.
"To make the best, better" - this is Judith Corbin's motto for life. This year marks her 42nd year of dental hygiene practice, although in the beginning Corbin had visions of a different career. "One reason for going to dental hygiene school was to support myself through veterinary education." Corbin claims to remain animal focused, even though her dental hygiene career never became a stepping stone to something else.
Corbin attended the University of Louisville and practiced in a rural, coal-mining area of Kentucky during her first 12 years of practice with her husband, who is a dentist. She also worked part-time for the public health department in a seven county area. "My husband and I gained much experience as we relied on one another's support both professionally and privately. We were able, in this setting, to implement many preventive practices that may have been more difficult to do in an area which deemed itself more sophisticated and enlightened. The persons we cared for were a grateful population and once they realized that we were there to enhance their well-being they, in turn, enhanced ours."
The Corbins moved to Georgia, and Judith was soon serving in various leadership positions in the profession and community. She plunged into politics and was tapped to sit in on many panels and committees at the local and national level. As the home nest emptied, Judith accepted an internship at the University of Washington and completed her certification in gerontology at West Virginia University to be a geriatric dental hygienist. Her educational pursuits continued, earning a certificate as a certified nurse assistant. Corbin's pursuit of education, as a teacher as well as a student, is impressive. She has also served the ADHA in many leadership positions.
Judith summed it up best when she said, "One does not take off one hat to wear another, nor does one leave one precept to pursue another - but continues as the same person who has been enriched and empowered by the experiences of each encounter. My life has been committed to the profession of dental hygiene and the impact of any accomplishment could be through the lives of those I have nurtured."
Corbin's top five tips for improving patient compliance
- Listen to your patients. Listen to what they say as well as what they do or do not do.
- Empower patients; don't overpower them. Remember that each person is an individual and, from time to time, has special dental needs.
- Never, never, never quit learning! Use what you learn from one patient and share it with another.
- Combine evidence gathered in practice and experiences with research. Don't limit this to just dental hygiene.
- Nurture and enlarge your own invisible university.
Tammy Honold, RDH
Tammy Honold has been in dental hygiene for 18 years and claims to be "a lifer!" She also wears many hygiene hats, working in public health with Indian Health Services in Southwestern Colorado. In addition to clinical hygiene, she is involved in many innovative programs, including oral health education and fluoride varnish programs at a tribal private school, performing oral evaluations and other procedures at a well child clinic, offering oral health instructions for diabetics, prenatal education, and tobacco cessation counseling.
She also owns a mobile dental hygiene business. Somewhat like George Jetson, she has a dental office that folds up and fits in the back of her car. "I see patients at nursing homes as well as homebound patients who have no access to care."
Honold also helped organize a local dental hygiene association when the ADHA component was too far away for meetings. The goal of the group is simply to help their community. Activities of the association include participating in children's dental health month activities, in-school education, Head Start screenings, career fairs and health education, and continuing education courses.
Public health hygiene is Honold's passion.
"Being an RDH does not mean scaling teeth all day. As preventive dental care specialists, there can be a lot of variety in our work, especially in the field of public health. Dr. Fones had a vision of a hygienist being a public health worker. If you are tired of the day-to-day grind, go back to our roots. Look into the options of public health, read past articles, and talk to your school districts and public health departments. We can make a difference."
Honold's top five tips for improving patient compliance
- Be an active listener. Ask your patients simple questions about their current habits and then acknowledge their positive accomplishments. Gently introduce new habits as part of their current activities. For example, "Mr. Smith, you are doing a great job brushing at the gum line of the upper right. I see a little redness in this hard-to-reach, inside left corner. You may want to angle a little lower here as well."
- Think outside of the box. There are so many marvelous oral hygiene tools available to our patients today! Be creative in finding which one works for each individual patient. Listen for what the patient feels comfortable with.
- Only change one habit at a time. If we give our patients one habit to change at a time, the chances of them mastering that one skill will be good. You can introduce another change at subsequent recall appointments.
- Don't nag. Your patient is nervous and afraid of you. If you come across as the caring friend rather than the nagging parent, they will be more open to you.
- KISS. Keep it simple, silly (see all of the above).
Karen Kaiser, RDH
Karen Kaiser must get some very interesting mail. Her email address is "dental hygenius" (after a patient claimed she was a genius), and she routinely signs correspondence "Smiling Sincerely." In between, she fills the page with passion, conviction, and lots of CAPITAL LETTERS for emphasis.
In dental hygiene practice for 15 years, Kaiser is thankful for all of the supply reps, product consultants, and magazines that evaluate preventive products, allowing her to help her patients' health. Armed with a list of patient concerns, Kaiser said she peruses the dental conference marketplaces searching for answers. She celebrates with patients who make progress by writing encouraging notes, no matter how small the victory. Kaiser encourages patients to e-mail her with questions or concerns about their health, and suggests accompanying a patient when referred to a specialist. She gives patients an exit letter with "goals and motivational inspirations" and keeps a stocked patient care center with the recommended products ready for purchase to enhance compliance.
Raising cancer awareness is important to Kaiser, as she and her office team ran in the Race for a Cure against breast cancer in June 2002. She routinely visits daycare centers where she offers information to children and adults on nutrition and oral hygiene care, and she participates in local high school career days to "raise the profile of the profession."
"Winning the Award of Distinction is very gratifying and a grand accomplishment in my hygiene career," she said. "I have always considered myself an average hygienist, but it's splendid to be recognized for my daily approach to patient care. Hygiene is so much more to me than making a living. I enrich and change lives, and I realize this. I follow my dental hygiene passion with conviction."
Kaiser's top five tips for improving patient compliance
- Merge technology with patient education
- Positive reinforcement
- Customize your approach - adapt to your patients' needs
- Willingly give home-care product guidance
- Celebrate small successes
By utilizing high-tech education, I can show-and-tell with my patients in ways that I never thought possible. As a routine, I take intraoral camera shots of patients at each visit. Before-and-after treatment images of their perio conditions, cracked fillings, tissue changes, or calculus buildup can be a wonderful motivation for patients to take ownership of their oral health when they can view it themselves. Too often, I hear, "Is that my mouth! I never knew it was like that!" It opens up a unique and uncoventional way of presenting the oral exam. Then I conveniently print it and give a color copy to the patient so they can ponder it at home.
Positive reinforcement with a motivating and enthusiastic attitude can accomplish so much when you create an environment for acceptance of your hygiene services. For example, after I perform periodontal therapies, I hand an exit letter to my patient containing goals and motivational inspirations I have formulated. This reinforcing handiwork helps the patient realize this is a co-therapy between them and myself toward health.
Customize and adapt. If an adult patient needs a child's size brush, for goodness sakes give them one! Routinely perform care calls. If the time comes that you need to refer for care, why not accompany your patients to specialty offices for treatment?
In-office merchandizing really boosts patient compliance. You recommend the product and have it available. My patient care center is centrally located in the office and has a plethora of dependable products - malodor control, whitening touch-up kits, and battery brushes, to name a few. Anything from denture care to infant products can be found. Also, be familiar with over-the-counter products because patients daily need this professional recommendation. They depend on you.
Lastly, celebrate small successes. If a patient smokes one less cigarette, drinks one less carbonated beverage, has less bleeding, flosses some, lost a few pounds, it's time to rejoice. Send patients encouraging notes, too.
Debra Ozanich, RDH, BS
A former waitress, dental assistant, and dental assisting instructor, Ozanich has been practicing dental hygiene for 14 years. She incorporates her active and healthy lifestyle into everything she does, including her dental hygiene practice. "My lifestyle, coupled with the expertise that I have developed over the years, has shown me that I make a difference both inside and outside the office," she says. For example, Ozanich walks two miles to and from work, often under the watchful eyes of patients. "Providing a role model for them and encouragement can often begin a new, healthy regimen," she says.
Ozanich encourages other hygienists to perform health screenings prior to the prophylaxis, even though she's aware that some offices do not allot enough time. A patient credited her with saving her life when Ozanich noticed a lump on the patient's neck and referred her to a physician during a routine head and neck evaluation. The lump was malignant, was surgically removed, and the patient is now cancer free.
She also mentions how rewarding it is to share her knowledge of dental hygiene with the mentally compromised. Building rapport, increasing awareness, meticulous patient screenings, and offering undivided attention with sincerity are ways Debra provides excellent care to her patients.
In service to her community, Debra established a bike ride as a fundraiser for a local county outreach service. She also has an interest in the elderly, and visits the local retirement home and older persons who are homebound with illness, offering companionship, meals and gifts at Christmas time.
"I feel very honored to receive this award," Debra said, "mostly because I am an accomplished clinician who does make a difference in people's lives."
Ozanich's top five tips for improving patient compliance
- I have found that the first eye contact is the most important. Welcome each patient with a heartfelt smile and a sincere welcome, even if they are several minutes late. Instead of the redundant "How are you today?" greeting, use more compassionate greetings such as, "I am glad to see you today" or "You're looking great!"
- Be an extremely sincere listener. Many of my patients are lonely and/or elderly and just want companionship. In time, patients develop a sense of trust and in turn comply with your suggestions.
- Never act like you are in a hurry. Even if the patient comments on keeping you behind, let them know that your time is devoted to them.
- Being professional and aware of the latest information about dental products will allow you to answer with ease questions from your patients. This establishes and reaffirms hygienist/patient confidence.
- Recall appointments are a means for accomplishing the goal of compliance. Always compliment with excitement the accomplishments made by the patient. Find some positive comment even with the less compliant patient. It has been important for me to never assume because of age that a patient may have all the necessary skills to be proficient in their oral hygiene regimen.