by Amber Metro-Sanchez, RDH, BA
Let's face it, we've all heard stories about the "rough hygienist" whom patients don't look forward to seeing, or the one they ask to avoid at their next dental visit. We've all heard people complain about how it hurts to get their teeth cleaned, and I believe it doesn't have to be this way. If we all take the time to focus on patient comfort, dental hygiene can gain a more positive reputation and patients will be more than glad to have their turn in the dental chair.
I've actually had regrettable experiences with uncomfortable cleanings. As a child I remember getting the "rough" hygienist, and my brother always getting the gentle hygienist at our pediatric office. The woman who cleaned my teeth had sharp nails that dug into my lips and cheeks. She flossed around my teeth so quickly that it was a painful experience every time. When I was fortunate enough to have the gentle hygienist work on me, I was beyond relieved and completely relaxed. The difference between these two hygienists couldn't have been more dramatic. I always wondered if the "rough" hygienist knew how her patients perceived her, and if so, would she have changed her ways?
It takes extra time and consideration to ensure that our patients' visits are as pain free as possible. Removing all of the calculus and plaque we find in a patient's mouth with the least amount of discomfort is definitely a challenging task. I believe that this goal is attainable and that we all must make every effort to make our patients' experiences positive ones. Here are some of the key tools hygienists can use to keep our gentle touch alive.
Watch your patients' faces
The first thing I always do is keep an eye on my patient's facial expressions. I'm definitely a face watcher, and sometimes I even tell my patients that I'm doing this. Their facial expressions tell a lot about what's going on in their head. I never hesitate to ask questions or make comments about my observations. This communication definitely helps show patients that I'm empathetic toward their experience in my chair and that their comfort is a priority.
I've had situations where I've noticed a pained expression on a patient's face and I was immediately alarmed. On one occasion I asked a woman what was wrong and to my relief she said she was upset by what she was watching on the overhead television. Another time I checked on a patient, and she said that the mirror was lying against her bone and causing pain. The point is that we don't know until we ask. Then, once a cause is pinpointed, a solution can be found so that an uncomfortable appointment is quickly avoided.
Be proactive about keeping sensitivity at bay
The next way I keep comfort a priority is by addressing any potential issues that may cause sensitivity. As hygienists, we all know that time is scarce, but that's never a valid reason to sacrifice patient comfort. I always try to view the situation from my patient's perspective and imagine that I'm the one lying in the chair. This is a very vulnerable position to be in, and I feel most comfortable with a clinician who has compassion and understanding for me.
There are several steps I take to ensure that my patients have a positive experience with the least amount of discomfort. If I notice that my patient has a large amount of buildup, especially if it has been a long time since the patient was last seen, I absolutely do not attempt to rush through the treatment in one visit. This would be a painful experience for the patient and a stressful appointment for the hygienist. I take the time to update the treatment to the appropriate procedure code and explain the changes to the patient. Typically, my patients are very understanding about the situation and seldom put up any resistance as they want to be treated to the highest standards.
I try to take full advantage of all of the tools I have at my disposal to keep my patients comfortable. One of the amazing things about dental hygiene is how many tricks we have up our sleeves; there are so many great products that make our jobs easier. Besides injections, topical anesthetics, such as Oraqix gel (dentsply.com) or Cetacaine liquid (cetacaine.com), can be used to make subgingival scaling more comfortable for sensitive patients. Applying Colgate Sensitive Pre-Procedural Desensitizing Paste (colgateprofessional.com) before scaling can help relieve discomfort for "touchy" patients. We just have to remember what's available to us and keep it accessible and ready to use.
Use the best instrument for the job
For hygienists to scale proficiently, it is essential to have a wide variety of instruments to choose from because we encounter a variety of "anatomical challenges" in the mouth. When scaling areas of tenacious calculus, I change instruments frequently if I'm having trouble removing it. When I encounter an area with tight tissue, I prefer to use scalers with slender tips so I can access the area more readily. In posterior areas, I like to use the 2, 3, or 4 Nevi scalers from Hu-Friedy (hu-friedy.com) or the Montana Jack scaler by PDT (pdtdental.com). In anterior teeth, especially when accessing taut tissue in the upper areas, I find the 0/00 Morse scaler by Hu-Friedy very helpful. I realize that the quicker and more efficiently I can get the task accomplished, the easier it will be on my patient.
Sometimes the best instrument for the job is not the one that works best for the patient. In a situation where a patient is sensitive to the ultrasonic scaler, try to be flexible and find a scaler that can effectively remove the buildup. Sometimes lowering the power setting helps, but that won't be enough for some people, especially when working on root surfaces.
Keep the lines of communication open
As I'm working on a patient's mouth, I try to address any potentially painful area as soon as I come into contact with it. If something is hurting a patient, I let the person know immediately that it's due to calculus and plaque buildup causing inflammation. Otherwise the person may unknowingly assume that it's due to overzealous scaling on my part. This is especially true if it is the patient's first visit to my office and they're not familiar with my scaling technique.
Verbal acknowledgements can comfort a patient when working in tender areas. I do not hesitate to apologize when I'm removing tenacious calculus from inflamed tissue and the patient is experiencing discomfort. My patients often tell me they know that they should have taken better care of their teeth. When the appointment is complete, I congratulate them for all of their efforts, such as keeping their mouth open wide, staying still, and for anxious patients, having the courage to show up. These remarks help to create a positive dental experience for my patients as they know that I'm truly concerned about their comfort.
Be aware of all possible causes of discomfort
I believe that making patients' appointments as pain free as possible can be our most difficult task. We must think in multiple directions at the same time. We must be cognizant of where our mirror is positioned, where the light hits, where our fingers are located on the instrument, and where the tip of the scaler is positioned. These factors are all necessary in order for us to remove buildup. Then we have the additional task of keeping our patients comfortable while doing all of these things. We must keep our full focus going at all times in order to perform optimally.
If I'm working on a patient with orthodontics, I make sure that my fulcrum finger is not pinching the soft tissue against a bracket. If my patient has a canker sore, I constantly remind myself to avoid touching that area. If any of my nails are too long, I'm careful about my positioning so I won't cause my patient any discomfort. There are a multitude of issues that can lead to a distressing appointment. By keeping patient comfort in the forefront, we're doing everything to make their visit a positive one.
To sum it all up, dental hygienists must be natural born multitaskers in order to keep patient comfort a priority. This task can be very challenging, but it's attainable when we keep the techniques discussed here in mind. A gentle and thorough hygienist is an extremely valuable asset to any dental office, and I think we all want be the clinician that our patients look forward to visiting. RDH
Amber Metro-Sanchez, RDH, BA, has practiced dental hygiene for the past 11 years at Comfort Dental with Dr. Chris Bible in Fort Wayne, Indiana. She was a member of the 2015 Colgate Oral Health Advisor Board. Amber has been a contributing author for the Colgate Oral Health Advisor webpage since March 2016. She can be reached at [email protected].