What a smartmouth would say

July 1, 2003
Have you ever told your kids that they have used up all their allowable words for the day? It's usually said when their questions or stories persist, non-stop.

By Kristine A. Hodson

Have you ever told your kids that they have used up all their allowable words for the day? It's usually said when their questions or stories persist, non-stop. These enthusiastic chatterboxes can even track you down in the bathroom, where you mistakenly thought you could find some refuge. By that time, your ears are aching from listening, and you have no idea what they have been telling you. Was there a point to this verbal assault? To the child there was, but, as the listener, you crossed the threshold of caring a long time ago, successfully filtering out the never-ending babble.

Well, how many times in your hygiene career do you think you have caused your patients' ears to long for silence? We talk, talk, and talk, and then — when there is silence — we talk some more to fill in the void. What are we saying? Is it of any value? Is it building relationships or breaking them down? When talking with my patients, it is a constant struggle not to use up my allowable words during patient education. As hygienists, we need to become "smartmouths." My definition of a "smartmouth" is someone who continually develops smarter ways of talking with patients.

I would like to give you some hints for a "smartmouth" approach when discussing two types of restorative dentistry — composite bonding and ceramic restorations. I begin with a hygiene update to familiarize us with each procedure and then discuss advantages and disadvantages. The examples of what a "smartmouth" might say can be used as a guide to increase your potential.

For your information, I am not a fan of memorizing scripts, turning all team members into "Stepford Staffs." I do believe in the congruency of messages delivered within a practice, but it must be sprinkled with individual flare and style.

Composite bonding

Hygiene update — Composite bonding means bonding a tooth-colored restorative material to a tooth. In the past, amalgams had to be mechanically retained in the tooth. This meant that the dentist had to create retention in the preparation after the decay or defect was removed. This was accomplished by cutting away sound tooth structure. Without this retention, the restoration would become loose and fall out.

Composite bonding allows for the restoration to be adhesively bonded to nonrententive preparations. Because of the additional preservation of tooth structure, bonding allows dentists to restore a tooth more conservatively. Composite bonding procedures can restore posterior or anterior teeth.

Posterior composites are indicated for small to medium restorations in back teeth, and can also be used for the replacement of broken or lost fillings. Anterior composites are indicated for restorations or smile redesigns in front teeth. They can mimic enamel, are highly esthetic, and have a high polishability.

Advantages — Conservative; may reinforce tooth structure weakened by a defect or decay; require less removal of the tooth structure; highly esthetic.

Disadvantages — Technique sensitive — more difficult for dentists to place; more costly than silver amalgams; limited durability; possible staining, wearing or chipping over time; case selection critical.

Smartmouth example — "Mrs. X, posterior composites are tooth-colored materials that can reinforce back teeth. They tend to be more conservative than silver amalgams because they are bonded to tooth structure. Composite-type fillings have been used in the front teeth to repair defects or decay for a long time, and we now know that they can be used successfully in back teeth. Posterior composites will make the tooth appear natural, rather than silver or dark, which may occur when amalgam is used."

Ceramic restorations

Hygiene update — Ceramic restorations are tooth-colored restorations indicated for anterior or posterior teeth. They can be used for inlays, onlays, veneers, metal-free crowns, and crowns with metal substructures.

These restorations are made by firing, casting, or milling in a dental laboratory. The laboratory specialists use a model of a tooth preparation made from an impression taken by a dentist.

Unlike composite restorations that can be placed in one appointment, ceramic fillings require two sessions. During the first appointment, the tooth or teeth are prepared, impressions are taken, temporaries are placed, and home-care instructions are given. At the second appointment, the temporaries are removed and the ceramic restoration is tried in and cemented.

Advantages — Esthetic; bond adhesively to the tooth; can strengthen the tooth.

Disadvantages — Learning curve for dentists using ceramic as an alternative to a crown; requires two appointments.

Smartmouth example — "Mrs. X, ceramic restorations are tooth-colored materials used to reinforce teeth. In your case, Dr. Y has recommended a ceramic inlay for one of your back teeth. These durable restorations are made in the laboratory, using a model of your tooth. This type of restoration requires two appointments. At the first appointment, the tooth is conservatively prepared, impressions are taken, and you will leave our office with a comfortable temporary filling. You will be able to eat, chew and laugh with the temporary filling, as if it is your natural tooth. At the second appointment, when the filling fits like a glove, the doctor will cement it. In some cases, ceramic fillings look and feel better than a person's natural teeth."

As part of the quest for "smartmouth" hygienists, we need to learn a few simple lessons along with the insistent child — understand the topic, be concise, embrace the silence, and, above all, please do not follow the patient into the bathroom to continue patient education!

Kristine A. Hodsdon, RDH, BS, is an international speaker, author, and software developer. She is the author of Demystifying Smiles: Strategies for the Dental Team. The book is available online at www.pennwell-store.com. She can be contacted about speaking or coaching at [email protected]. Visit her on the Web at www.reachhygiene.com.