When they stop smiling

While attending the American Dental Hygienists' Association meeting in Nashville, I boarded an elevator that had three bikers going down too.

Aug 1st, 2001

While attending the American Dental Hygienists' Association meeting in Nashville, I boarded an elevator that had three bikers going down too. They were not sinister-looking at all — just the usual dominance of black and denim in their attire. The next floor down, a hygienist boarded, quickly identifiable because of a blazer with the initials "RDH" prominently displayed. One biker asked, "Do those letters mean you're a dental hygienist?"

"Yes," she said, and they all got nervous.

Nah, just kidding. I don't ever recall seeing a nervous biker. She endured a couple of one-liners about teeth and fired back, "Got any questions? Don't forget to floss and see your hygienist every six months!" By the time we reached the ground floor, they were just grinning at her as if she had offered them a six-pack of their favorite brew.

On an airplane, I started reading a manuscript for RDH when the woman next to me noticed the article's title and remarked, "Do you have something to do with dental hygiene?" After I identified myself, she identified herself as a dental hygiene student from Louisiana. She was very articulate and very understanding of the career path she was training for at school. Even though she has yet to treat her first "paying customer," so to speak, we had a delightful conversation about the profession and dentistry. I really was having a forgettable day up to the point when she decided to interrupt my editing. But she turned the day all around. I got off that plane with a smile on my face — all because of somebody who wants to be a dental hygienist.

I've got a feeling thousands of smiles are created each day by hygienists.

However, I was reading the June issue of DentalTown, which is published by the always thought-provoking Dr. Howard Farran. In an article on page 48, the magazine answered e-mails about managing hygienists. The e-mail precipitating the most interesting responses came from a doctor who was trying to work through a problem with a 'relatively new hygienist."

The doctor's former hygienist was 'efficient but not quite as thorough" when scaling patients. This new hygienist, though, provoked a female patient to complain to the doctor. The patient was "almost in tears saying that her cleaning was the worst and most painful she had ever had."

The doctor's e-mail concluded as follows: "My question is how should I deal with patients who are complaining about sensitivity when I know they are getting what they need and what will be best for them? I feel better about the new hygienist because I know she does a great cleaning, but I don't want patients upset that my new hygienist is much rougher than the old one was."

Four colleagues responded to the e-mail. One replied, "I don't care how thorough she is. If she ain't gentle, she'd be out the door faster than I can say it ... You'd better sit that hygienist down and tell her that this better never happen again." The doctor apparently fired someone who didn't listen to this instruction, as did another one of the colleagues responding to the e-mail.

The other two were not quite so bullish in their reactions. But the universal bottom line is that, if patients are scared away from dentistry because of a hygienist, then we're not just talking about revenue taking a dip — at least a handful of people are not getting the dental care they need.

One of the calmer responses noted, "It is absolutely imperative that hygienists and dentists develop strategies to perform scaling without pain! ... One has to be an automaton not to know you're hurting a patient."

All of a sudden, we've come a long way from everyone beaming from their encounters with dental hygienists. Now we're talking about people who are shopping elsewhere because oral hygiene hurts too much. (Obviously, patients shouldn't be smiling all the time, especially if they're sick — a blunter way of describing periodontal disease.)

Maybe I've been lucky. I've never left a dental practice due to a hygienist. My caregivers in the hygiene operatory inevitably make me smile. A little math on a notepad reveals that I switched dental offices five times as an adult (where I paid my own bills, not Mom and Dad). Five times in almost 30 years, changing offices on average once every six years. Is that good or bad?

Twice I changed because I relocated to a different city. Once I felt the dentist was a dinosaur. I thought another one was a little too zealous with his treatment planning. I said goodbye to the fifth one because his assistant handled too many duties associated with a crown placement; I was paying for his expertise, not hers. Pain wasn't an issue at any of the offices. If these practices miss me (which I seriously doubt), they're killing idle time by complaining about how hard it is to find good help anymore. No one would fire them, of course, since they own the joint.

The DentalTown doctor said the hygienist's treatment was correct and apparently was getting the patient back on the road to recovery from sickness. Apparently, she was a little 'rough." What's the reaction? Get her out of dentistry ASAP!

Where's the fine line between pain and treatment in the hygiene operatory? Is the pressure to make everyone smile (pain-free) all the time too much? What's your opinion?

Editor Mark Hartley can be contacted at markh@pennwell.com.

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