Dear RDH:
I am responding to the "Back to Basics" article in the March issue. I, too, have been placed in the awkward position of giving a new patient the "bad news" that they have some serious oral problems that need to be addressed. Sometimes these patients have come to us from other area practices and have experienced a change in their insurance plans or been referred to our office based on our reputation for excellent and gentle dental care. I agree with Ms. Heisey that this can be a tricky situation and requires some diplomacy.
My own brand of diplomacy involves the bald truth. They have not been managed well in a few of my peers` hands. Why should I lie for someone I do not know and feel fairly certain has not been caring for his or her patients as he or she was trained to do?
I routinely probe anyone that has less than great home care and who is exhibiting radiographic evidence of bone loss. I do not probe very healthy gingiva with the exception of noted pockets as it is extremely uncomfortable and my recall patients bone levels are very closely monitored. We routinely refer patients for consultations with area periodontists if all of our efforts are not paying off in signifigantly decreased depths. We do not practice "supervised neglect" in our little piece of the planet.
If Ms. Heisey`s patients are objecting to being poked, then perhaps she needs to work on her skill level and technique. Rather than skewering patients` entire mouth the minute they are in the chair, we probe a few typical problem areas and note the depth, bleeding, etc. If a patient needs a full mouth debridement, we use anesthetic and only probe after the subgingival deposits have been removed. We get true pocket readings while the patient feels no added discomfort.
I personally feel that to waste 30 minutes of my valuable time with each patient by just probing would be an injustice to the level of care that I am in the habit of giving. Probing is merely one of the many tools that we have in our arsenal to help all of our patients make it to their graves with a healthy set of teeth. It is not and should not be the sole focus of each hygiene appointment. And, yes, it can be performed in a relatively pain-free manner that does not inspire patients to "grab your wrists" and ask why they are being poked.
If Ms. Heisey`s patients are that uncooperative in the chair and report that no one has ever stabbed them like that before, maybe it is just because their previous clinicians did not make such a painfully memorable experience out of probing.
Aven C. Coulson, RDH
Friendswood, Texas
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