By Eileen Morrissey, RDH, MS
My topic for today's column is important. It's the issue of halitosis and how we are interacting with our patients on the matter.
First, and semi-related, is the protocol I follow with regard to having my patients pre-rinse prior to treatment with an antimicrobial mouth rinse. As you are likely aware, pre-rinsing is helpful in reducing the microbes produced while using motor-driven instrumentation. In years past, I would efficiently fill a cup with mouth rinse, and dilute with water (to avoid hearing complaints about burning) in advance of the patient being seated. The mouth rinse would "fizz down," leaving the cup half filled. I vividly remember the day a patient turned to me, after lowering her voice (as if she did not want to get me into trouble), and remarked: "Eileen, I think you forgot to change this cup." I nearly screamed aloud, as I adamantly reassured Mrs. Patient that I would never forget to change a cup, and hers was indeed fresh.
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The second interest in my protocol related to my asking patients to pre-rinse, and their subsequent comments about me probably not wanting to smell the garlic from today's lunch. This happened more than a few times, and I knew I needed to improve the pre-rinse dynamic so that patients would realize: A. They indeed had a fresh cup, and B. They were not being asked to pre-rinse because of breath issues.
The new and improved strategy is to leave a clean cup face down on the bracket table in view of the patient. I then state that I am asking her to pre-rinse with an antimicrobial because it reduces the microbes that are produced when we use motor-driven instruments, which helps with infection control for everyone. (Note: All clinicians throughout the practice, including dentists, should be consistent with this protocol so that the patient doesn't wonder why infection control is not important in every treatment room.) This new and improved approach avoids any misconceptions about used cups; educates the patient as to why we do what we do; prevents hurt feelings about bad breath; and prompts me (who sometimes forgets) to make sure I'm offering the pre-rinse.
This leads to the discussion of how we can help patients who do indeed have issues with halitosis. It's easy when they bring it to our attention first. I can offer suggestions that will help them with whatever might be contributing. Whether it is a dry mouth, or periodontal concerns, or smokers' breath, there are any number of ideas and tips that may help. If source is not easily identifiable, I personally love to recommend tongue scraping on the home front; and the mouth rinse Closys (available online or at Walgreens) as a solution that I have seen help many.
It is the patients who have a severe halitosis problem and no apparent self-awareness that are most challenging for me. I have surveyed RDHs, and I don't hear much offered about how this critical issue should be addressed. Who better to raise this concern than a patient's trusted hygienist? There have been times where the odor is downright offensive, and I have cleaned the teeth of the individual and said nothing, which really bothered me afterwards. I wasn't doing my best work by holding back on the discussion. So, I am passing along a couple suggestions offered by five-star dental hygienists I have met at my seminars.
If the person has periodontal issues and has not followed through on treatment, raising the matter of the inflammation, infection, and the effect on breath can be a powerful motivator. People need to know that the source of the problem needs to be addressed, and nothing will mask or cover up the odor of a true infection. Alerting a patient to the dry mouth and subsequent malodor that might be a byproduct of medications, medical treatment, and even orthodontia can take place during a medical history update, and precede any mouth even being opened. This sometimes makes it easier; we are suggesting hypothetically, as opposed to reacting to a mouth that has been presented. It may be better received. We can then reassure (or alert, if needed) that ideally, it's always better to prevent halitosis from occurring. Most recently, Amy Petrillo, RDH (of nationally acclaimed AmyRDH.com), offered Salese by Nuvora as a highly effective OTC solution for dry mouth.
One superb hygienist made what I thought was the best suggestion of all. If she noticed a breath odor, she would state to the patient the following: "John, as I am scaling this one area in your mouth, I'm noticing an odor. My worry is that this could affect your breath overall. Here are some suggestions that you can try to help prevent a bigger problem." She would then discuss tongue scraping, effective hygiene, mouth rinses, or whatever else she thought was appropriate for the patient's needs.
I love this approach. Why? Because she softens the blow as she initially presents the problem to the patient, by stating it seems to be confined to the area she is treating. (If I am a patient, I'm going to find that easier to hear.) Yet she expresses concern that the problem could permeate, so let's nip this one in the bud! Kudos to this effective hygienist!
Addressing halitosis is a challenge and one in which we should take the initiative as true service providers.
Onward we go; it is in our hearts' core!
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.