By Katie Melko, RDH, MSDH
It’s so easy for hygienists to get into a daily rut. The days start to run together, and back-to-back 30- or 45-minute appointments can make our days tiring and stressful, leaving us feeling undervalued, overworked, and defeated.
How can this be changed? Only we can change our feelings, desires, and attributes in our careers. We are the change and the force, and we have the fuel to make those 30- and 45-minute appointments valuable, beyond patients simply getting their prophylaxes. Most hygienists like to give the same care to each patient. I think this is great because I believe everyone deserves the same quality care, but this doesn’t mean that appointments can’t be tailored slightly to meet each individual’s needs.
Here are the top 10 patient types for which I have tailored my appointments:
- Dry mouth - I have patients rinse with Biotene before getting started with the appointment. I ask questions about how they like the dry mouth product they’re using, or if they’re using one. I then share a list of different options to help reduce dry mouth, and I offer a sample.
- Heavy stain - I use the Cavitron, selective pumice, and stain remover paste. I recommend baking soda toothpaste at home to help neutralize pH, and recommend three- to four-month recall.
- Special needs - Depending on someone’s diagnosis, I offer a blanket or use an apron, and a Cavitron if possible. I offer ideas for toothbrush dexterity issues, and I offer positive reinforcement. I recommend four-month recall.
- Diabetics - I recommend integrated care (foot, eye, and A1C testing from medical), and recommend three-month recall. I use Peridex in the Cavitron, recommend dry mouth supplements if applicable, actively look for thrush, and discuss periodontal disease.
- Pregnant - I recommend four-month recall, the Cavitron, I educate about pregnancy gingivitis, and I provide education about the oral health of the baby.
- Geriatric - I discuss denture care, offer ideas for toothbrush dexterity issues, and discuss dry mouth and interproximal brushes for dexterity. If hygiene is poor, I recommend three-month recall.
- Orthodontic - I always use a Cavitron, the GumChucks flossing tool, provide education on threaders and Super Floss, and recommend the Water Pik electric toothbrush and fluoride. I recommend four-month recall.
- Back and neck surgery - I have a neck pillow available if patients want it. I recline patients only halfway, and I always stand up for these appointments.
- Periodontal maintenance - I do periodontal charting, use the Cavitron, provide localized deep cleaning, recommend Peridex if needed, and recommend nonalcoholic mouthwashes. I recommend three-month recall.
- Children - I have a puppet with teeth in my operatory to help with oral hygiene instruction. I use fun-flavored paste, and I have an animal-shaped paste holder and animal-themed polisher head. I use a soft voice, as well as nicknames for the instruments, and I give lots of positive reinforcement.
By modifying each appointment to fit the patient in my chair, I’m able to use the allotted time efficiently and effectively to maximize the experience for each patient. Each of these 10 appointment types includes education. Depending on the patient and his or her needs, my oral hygiene instruction and nutrition counseling is modified to cover each patient’s issues.
I also have a top five list of things that all patients receive that I think they will benefit from:
- Oral cancer screening
- Periodontal charting
Another way to help tailor appointments is with oral health aids. Finding products to suit each patient’s needs is a challenge that I enjoy. There’s a product for everyone, and sometimes it takes a while to find what it is, but when I do it’s extremely satisfying for the patient and for me. Many products provide the same relief, so if one product doesn’t work, there’s always another option. I inform patients that it may take a few tries, but we’ll find something to help them. I also tell patients to give a product at least seven days before deciding if it works or not. Trying something once or twice or inconsistently won’t give the patient or provider a clear picture of whether or not it’s working.
Smoking cessation is another topic that can be difficult but necessary. I like to bring it up and get a feel for the patient based of his or her responses. If someone is willing and open-minded to the topic, then I continue, but if not, I give a short explanation of what smoking does to the oral cavity and the risks involved and then I move on. At my job, we have a hotline that we offer patients and I put the information in their “goodie” bag. This way they can determine in private whether or not this is something they’re ready for.
Patients with sensitivity can be hard to treat. I generally don’t use the Cavitron and just hand scale them. I use a sensitivity polishing paste and recommend using an extra soft toothbrush. I also advise patients to place a thin layer of sensitivity toothpaste over the sensitive area before bed to see if they find relief. If none of the over-the-counter sensitivity toothpastes work, I talk to the doctor about prescribing Prevident Sensitive as a last resort before recommending restorative work.
It’s good to try to learn what patient type you’ll be seeing during each appointment. It’s important to interact with patients in their communication style to get them to be compliant and receptive to what you’re saying. This can mean being blunt, long-winded, serious, soft toned, firm, or relaxed in a joking tone. Each person has a way of processing information, but you have to know how to get the message across effectively (see sidebar).
As dental hygienists we all have certain ways that we like to approach things. Sharing them helps us become better providers. We’re always going to have difficult patients, but I believe that if we can effectively communicate with those patients, they often come around and aren’t as difficult. We never know what our patients are going through, so I try to remind myself of that when I become frustrated. All we can do is our best and have a positive attitude, and most of the time that’s what patients will see also. I love to see patients leave my operatory smiling, especially if that isn’t the way they entered. It makes my day and makes up for the bad days.
I recommend making your own patient appointment list to help your days run smoothly and efficiently. I hope my lists help you tailor your appointments so that you can maximize your time with your patients and continue to make a difference in their lives. I always say that education and communication are the two most important aspects of treating patients. Strive to be at your professional best and the rest will fall into place. By doing this and hearing our patients’ responses, we make an impact on their health and daily lives. RDH
Katie Melko, RDH, MSDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She sits on three workgroups, two for ADHA and one for NBDHE, and has practiced dental hygiene since 2009.
In charge of the appointment
There are patients who will need a few days to absorb what you’ve said, and others who might agree immediately. Then you have those patients who ask lots of questions. By responding, you make them feel like they’re in charge of the appointment. Some patients don’t hear you at all and are constantly looking at their phone. Here are some examples of how I handle certain patients.
A teenager or young adult who can barely put down their cell phone - I like to use an oral hygiene app or have them Google gingivitis, calculus, or plaque buildup, or play a video on YouTube. This engages them and usually grosses them out so that they actually listen to what I’m saying. We live in a digital world, and it can be challenging to get patients to disconnect from technology and live in the moment. This solution seems to work well when I have this type of patient in my chair.
Anxious patients - I find that letting them know what I’ll be doing before I proceed with their appointment helps them relax because they know what’s coming. I keep my tone light and casual. I try to encourage conversation to take their mind off the appointment. When it comes to oral hygiene education, I start with the solution and work into what is going on so that they know from the beginning there are ways to improve their situation. I also use positive reinforcement to let them know I see their efforts; they just need to be redirected or tweaked. This tends to take the fear out of the equation and lets them focus on getting better.
Uninterested patients - “I just want my teeth cleaned.” I’ve learned that saying nothing to this statement is best. Most patients are so surprised that I don’t lecture them or try to change them that they ask me at the end of the appointment how everything looks. That’s when I give them an abbreviated version of what I normally say. Patients appreciate this, and I find they’re more open at future appointments. These patients also seem to be the ones who like things to be said in the most direct way. They don’t want all the details, just the facts, and they want things done quickly. There are also those patients who sit down and inform me that they hate the dentist and their teeth didn’t hurt before but they sure will now. I chuckle and say, “Well, it’s a good thing I’m not a dentist then.” Then I talk softly and remove their doubt by saying that I will be gentle, and to let me know if they need me to stop or if they want a break.