ESTHETIC HYGIENE: Say it loud and say it proud

May 1, 2001
But we cannot allow our clients' "stuff" or our assumptions about their financial issues to affect how or if we present our pre-diagnostic findings and subsequent fees.

Jim, a dental hygienist, and his client, Mr. Snowal, begin discussing oral health goals and desires that were agreed upon in a previous appointment. Jim's clinical analysis noted that some older amalgams were showing signs of breakdown and wear. His pre-diagnostic assessment yielded the conclusion that the lower right quadrant should be scheduled for definitive restorations, and the total fee would be around $8,000.

During the discussion, Mr. Snowal informs Jim that he is going through a divorce. Jim may react in one of the three ways described below.

  • Reaction S: Jim asks sensitive questions of Mr. Snowal in an effort to support his client. As the appointment draws to a close and after hearing all of the "gossip," Jim is feeling pressure because he has not facilitated a conversation concerning Mr. Snowal's restorative needs. He then decides to wait until Mr. Snowal's next hygiene session to present the pre-diagnostic findings. Jim justifies his decision, after all, by thinking that Mr. Snowal is probably not in the mood to talk about dentistry. So Jim writes in the record, "No treatment at this time."
  • Reaction E: Jim shows compassion by stating, "Mr. Snowal, I am sorry to hear about these obviously sad changes in your marriage." He then continues, "You are scheduled for an esthetic management session today. I have completed your pre-diagnostic examination, and noted some concerns with a set of teeth on the lower right side. It is my responsibility to assist you with your oral health plan and alert you to any changes in your mouth that could negatively affect your desired outcomes. But before I continue, may I ask you if you think these changes in your life will affect your dental goals? How would you like to proceed with today's session?"
  • Reaction P: Jim shows compassion by stating, "Mr. Snowal, I am sorry to hear about these obviously sad changes in your marriage." He continues, "You are scheduled for an esthetic management session today; I have completed your pre-diagnostic examination, and noted some concerns with a set of teeth on the lower right side." But Jim thinks to himself that Mr. Snowal probably cannot afford $8,000 now to complete his dentistry. So he downplays his concerns and writes "Watch" in the chart.

How would you react?

Do Jim's reactions in S, E, or P resemble how you react in similar situations? The "S" in the first reaction stands for sympathy. The "E" in the second reaction stands for empathy, and the "P" in the third reaction stands for personal.

In his sympathetic reaction, Jim exhibited sympathy for Mr. Snowal's personal situation. In fact, his sympathy derailed the esthetic management session, and he never discussed his clinical findings.

The esthetic management session is a service that Mr. Snowal is paying for, and Jim, as a professional, is being compensated for that service. What type of service did Mr. Snowal ultimately pay for? Counseling? Legal? It certainly was not a session that focused on oral health needs. What type of service did Jim provide? Whether you describe it as legal, psychological, or merely friendship, it was not what Jim is licensed to perform.

If Jim wanted to show Mr. Snowal sympathy or extend a shoulder for him to cry on, then Jim should have made arrangements to meet Mr. Snowal for lunch or after work. A dental practice is not the appropriate place for such intimate discussions.

Jim displayed empathy for Mr. Snowal in the second reaction, but he did not allow Mr. Snowal's personal situation to sabotage the esthetic hygiene session. The session was one that Mr. Snowal had committed to and ultimately expected a service from that Jim is legally licensed to provide. In the third scenario, Jim also displayed empathy for Mr. Snowal's situation, but allowed his personal judgments and fear of discussing fees to thwart the purpose of the session.

How to handle the "stuff"

How often do we find ourselves "mothering" our clients, especially if they have been in our practices for a long time? We know that Mrs. Jones is going to have a hysterectomy, Ted's son just got arrested, and Mrs. Heel's cocker spaniel will be attending discipline classes again because "Pooches" failed the first time. We know all kinds of "stuff" about our clients. In fact, their "stuff" sometimes causes us to feel bad about presenting the restorative fees.

This may seem harsh, but many of the conversations that go on in the hygiene gallery are inappropriate. Please do not misunderstand me; dental hygienists should feel compassion and genuinely care for clients. But we cannot allow our clients' "stuff" or our assumptions about their financial issues affect how we present our findings and subsequent fees.

Some dental hygienists are not influenced by their client's "stuff," but they allow their personal "crossover points" to control them. Dr. Paul Homoly, the author of Isn't It Wonderful When Patients Say "Yes?" ( talks about the "crossover point" in his book. Crossover points are the points where the treatment and/or fee become so "large" that you're hesitant to mention them. Your objectivity turns into fear of presenting fees, fear of presenting the case, fear of an angry client, fear of not knowing what to say when the client asks if the dentist is "buying a new car," or fear of rejection.

Many times, we unconsciously allow our fears or our own beliefs concerning the recommended dentistry and fees to affect the treatment that we present. For example, the practice may be charging $1,500 for a crown. If you believe that the fee of $1,500 is high or unjustified (based on the dentist's clinical ability, knowledge, or skill), then you begin to place yourself in your client's shoes. You assume that - because you think $1,500 is a lot of money to pay for a crown - your clients would feel the same way. You base this conclusion on the "stuff" that you think you know about your clients. You have already decided the outcome of the conversation, and you choose to not offer the clinical findings and fees.

What hygienists must realize is that just because we may know a little about the client's life and perhaps we may not be able to afford the smile design case, does not mean that our client cannot afford it. Team members must appreciate that the treatment is not about them, but about their clients.

It is not our responsibility to sugarcoat or place on hold any of our clients' oral health concerns, simply because we assume that they are not ready to hear it, they cannot afford it, or we ran out of scheduled time. We have a legal, moral, and ethical responsibility to be "oral health experts." This includes sharing the good and not-so-good news.

So after your next pre-diagnostic examination, take a line from The Little Mermaid II: "Say it loud and say it proud!"

Kristine A. Hodsdon, RDH, BS, presents seminars nationally about esthetic hygiene. She also has developed Pre-D Systems, a pre-diagnostic esthetic enrollment software for oral health professionals. She can contacted through