At their own rate of speed

April 1, 2007
Several years ago, over 200 dental professionals attended a continuing education course sponsored by the Nebraska Dental Hygienists’ Association.

by Anne Nugent Guignon, RDH, MPH

Several years ago, over 200 dental professionals attended a continuing education course sponsored by the Nebraska Dental Hygienists’ Association. The majority gave the program good reviews.

Most speakers glean information and guidance from audience evaluations. They want to know if they connected with the participants. They want to provide information and insights on how to make dental hygiene and dental practice more rewarding, interesting, enjoyable, and safe.

Reviews that read like a standing ovation are a joy to peruse. Evaluations that are not so stellar are harder to take, and sometimes the speaker wonders if the participant was really in the room.

The Nebraska program was typical in that a few vocal souls did not get the message, but a critical message came through loud and clear in the homily at the old St. Mary’s Cathedral the following morning.

The old wooden pews in the downtown church were packed. I felt like the priest was speaking directly to me. Over 600 people heard his sermon, but according to the priest, no one would hear the same message. Some would only hear what they wanted to hear. Others would hear what they needed to hear.

That homily changed my thoughts forever on the relationship between a speaker and his or her audience. Speakers and writers have a responsibility to provide good sound information. The audience will absorb and process the information at their own speed.

The relationships we develop with patients are no different. Family members, students, and patient relationships share a time-honored lesson - the teacher appears when the student is ready. I sometimes hear clinicians lament that a patient just will not agree to the recommended treatment. Did the patient really hear the message, or did he or she simply receive a verbal finger wagging?

Then there are patients who have too much external stimuli in their busy lives. The speaker’s message may never get through their static-filled psyche because they don’t have the mental energy to tune in.

What can clinicians do? First, we can be happy that the patients showed up in our dental hygiene chairs. Every time patients come in for care, clinicians have another opportunity to move the experience forward. A tuned-in practitioner will respect the patient’s decision to deny treatment. Often patients are hesitant to reveal why they are reluctant to move forward, and some have no idea themselves. Unless we can read minds, we may never know. Patients are in charge of their own health and as adults, they are free to choose any type of treatment, which can include no treatment.

Over time, you will develop a relationship based on trust and caring. A positive rapport will allow you and your patient to identify problems honestly and begin developing goals. Patients who take baby steps in developing a relationship can frustrate fast-paced clinicians focused on the ultimate goal of patient health. But imagine how frustrating it must be for a reluctant patient to spend time with a fast-paced clinician.

People will hear what they need to hear only when they are ready for the message. If a patient doesn’t like a message, they may seek a different messenger. Sometimes we’re able to deliver the same message in a new way, on a new day, and the information gets through the seemingly impenetrable emotional and intellectual brain barrier.

Watching the light bulb turn on

Recently I had two amazing patient breakthroughs in one day. I confess I still get giddy when a lightbulb goes on, even at the lowest wattage. Subjects like dental hygiene ergonomics and owning one’s own career make me pretty intense, but working with patients brings out an entirely different side of me. My patients guide the success, and I’ve learned to take things at their speed in order to move forward.

Bob has been coming to our office for decades. He’s 64 and his record for dental hygiene care is pretty spotty. We never know if he is going to keep his appointment, a pattern that has been well documented.

Along with his casual approach to coming in for professional care, Bob’s oral care habits are less than stellar.Thick bands of plaque biofilm cover the apical one third of every clinical crown on every visit. The only thing regular about Bob is his ability to give his dental professional a blank stare when anything related to teeth or disease is mentioned. You know the look, the one where you’re certain you’re speaking about astrophysics in a foreign tongue. I take a deep breath, release a mental sigh and wonder what makes Bob tick.

In January 2006, Bob showed up on my schedule. He has two upper right molar implants, loads of dollars, and plenty of time. After an hour of being knee-deep in biofilm and blood, I gently suggested two approaches: a three-month recall interval, and using a power brush rather than a manual brush. He agreed.

How Bob guided success

Fast forward one year. Voilà! Bob was on my schedule again. His record revealed that he had been in the office in April and July for dental hygiene visits. I did not work with him either time, but that is not the point. He came in at the recommended intervals.

He walked into my treatment room and said, “I know it’s been too long. That short interval really helps. I really need this appointment because my teeth are really dirty.” Well, you could have knocked me over with the proverbial feather!

It gets better. Bob did not like the sound and volume of the first brush, but he did switch to another power brush. When I asked about the brand he said, ”Oh, I don’t know, I think it spins or something.” Victory! He was using a power brush, something, anything to keep the piles of biofilm down.

Then I brought up the idea of an oral irrigator. Bob really heard me and thought it was a good idea. I gave him a SulcaBrush to use on the implants in the meantime, and he accepted that as well.

As I raised the patient chair up, Bob glanced at the Sonicare poster on the wall that details the links between oral health and systemic disease. With his characteristic Texas drawl he said, “That’s mighty strong stuff.”

It was clear that Bob was taking ownership of his oral health. As I walked down the hall to get Dr. Kaestner for an exam, I was still totally amazed at what had happened over the past hour. The look on Dr. Kaestner’s face was priceless when I told him what had transpired. He had never seen Bob take any personal care recommendations seriously.

Before Bob left the office, he scheduled an appointment in April with me. I really like to follow cases like this. Who knows? Next time I may even suggest disclosing with the yellow Butler Plak-Check solution.

But we’ll see. I’m going to let Bob guide the success. A story like this is the reason I have loved dental hygiene for so many years. If we’re smart enough to build our relationships at the patients’ speed, we can practice in an amazing, challenging, and rewarding comfort zone.

You and your patient may not start with the same set of goals but that can change over time. If you thrive on hard and fast rules, then you’ll find it quite frustrating to care for patients over time. If on the other hand, you tune in to what they are really saying, both verbally and nonverbally, you can truly become a partner in their paths to success. Ultimately, we must accept that our patients are in the driver’s seat when it comes to their health outcomes. Accepting your patients as people and keeping the dialogue open are the keys to success in dental hygiene.

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member who has practiced clinical dental hygiene in Houston since 1971. You can reach her at [email protected] or (713) 974-4540. Her Web site is