By Eileen Morrissey, RDH, MS
Normally, I practice clinically two days a week. During the summer months, though, my teaching work goes away, and, in an effort for my wallet not to do the same, I schedule extra clinical dental hygiene days.
When I have difficult patients during the extended clinical schedules, I find myself burning out and in pursuit of positive solutions. Let me define what constitutes a difficult patient. I don’t mind scaling calculus, and I appreciate motivated patients. Work can, in fact, be quite fun.
For me, a difficult patient is someone who consistently presents with a generous amount of white, furry biofilm throughout the mouth or food particles that I can actually identify. This person is also blessed with good tissue resistance. When a patient is bleeding with other signs of inflammation, there is no issue with presenting the clinical evidence and the importance of addressing it. Rather, I’m talking about the ones who have no inflammation, whatsoever. Further, they never get decay. Discussing preventive measures seems to go in one ear and out the other. From their perspective, they have never experienced a cavity, nor do their gums bleed. Having an unclean mouth does not appear to bother them. These patients are my worst nightmare.
If I have too many patients like these on too many clinical days, I become irritable, and, thankfully, it is not my clinical norm. For inspiration in dealing with such clients, I share with you some of the practice philosophy of Mary Walker, RDH. Mary discloses almost every patient that she sees in her general practice. She shows them the results in a hand mirror and dispenses a toothbrush.
Mary states that she then “sits with them, wets the brush to address a small area for them so they can see, feel, and fully experience the proper angle and action for the brush.” She also coaches each patient tirelessly on effective interproximal care.
On a recent visit to Colorado, I spent some time interviewing her about her patient interactions.1 She told me that she never knows when she will see a patient again, and it’s her present moment opportunity to try to make a difference in their lives. Based on patient feedback throughout the years, she believes that she has truly achieved this.
I expressed to Mary that I would find such an encounter embarrassing for the type of patient I am referencing in today’s column. Shaming them, if you will. Mind you, I teach in a dental hygiene program, and disclosing every patient is standard operating protocol for the students. Yet, that seems different. The academic institution is recognized as a learning environment, and patients understand such protocol is going to take place.
In addition, my employer has given me his point-blank opinion on what he perceives as confrontational. “Don’t use it on these particular patients, Eileen! I’ve tried! People like these are not going to change, and I am grateful that at the very least, they are sitting in your chair being cleaned. They process it as nagging, and do not want to hear it. Clean them up, and schedule them again in six months, because it’s unlikely you will get them back sooner!”
Nonetheless, after researching this more, I continue to be impressed with hygienists such as Mary Walker. Karen Davis wrote an article in RDH expressing that perhaps the wonderful world of disclosing deserves a second look.2
Here is my peace. I believe that the use of disclosing solution can be a valuable tool in creating awareness and potentially changing patient’s behavior. As a dental hygienist, how can I justify being a part of our profession, if not believing behavioral change is possible, and that I can indeed be an agent for such change?
Mary’s husband told me that he was a former “mediocre” patient who sat in her chair, and he was very embarrassed at the results that the disclosing solution revealed in his mouth. Mind you, this was pre-courtship of Mary! But it made him see the light, and he is now a total advocate for such a learning lesson.
Yet the stubborn side of me holds to my belief that change, for some folks, is very, very, difficult. My ophthalmologist told me that the reason that so many with glaucoma lose their vision is because they do not use their prescription eye drops. Imagine that - a lack of compliance with the insertion of drops that may result in blindness, and it fails to motivate! So I find it hard to believe that one session of disclosing solution for the patient is going to result in a behavioral change for a person that has no dental disease and no “prior proof” that neglect will result in harm. Still, are we not bound by the very pledge we take as dental hygienists to try to inspire change?
I’ve reached the conclusion that the best way for me to use this important tool will be as follows. From my lifelong mentor Wayne Dyer, I re-quote the following words of wisdom: “When the student is ready, the teacher will appear.”
The operative word is “ready.” How I propose disclosing solution as an educational tool is by invitation and consent. I will ask any patient: “Would you like for me to disclose, so that I can show you some areas of concern? I have the tool if you’d like for me to use it.” If he declines, so be it. If he agrees, perhaps he is indeed that student who is ready for the teacher (me) to appear. It would seem appropriate to offer this to every patient every time. The use of the verbiage “areas of concern” comes directly from Mary Walker. I like her perspective that offering to disclose to show “where you are missing” potentially places the patient on the defensive, and not likely to result in a win/win.
This approach makes sense, and it is a practice I can feel comfortable with. Onward we go; it is in our hearts’ core. RDH
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Rowan College at Burlington County. 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.
1. Interview with Mary Walker, RDH, July 1, 2017, Colorado.
2. Davis K. “To disclose or not to disclose? Routine use of disclosing agents helps the dental clinician out too.” Dec. 13, 2016. RDH magazine.