Why patients expect polishing

Jan. 1, 2002

The data collected showed the reason patients expect to have their teeth polished is because they think it is necessary for dental health.

Recently, I did some research pertaining to polishing patients' teeth. I waded through a lot of information — some so old I had to go to the basement of the Marquette University Science Library. I had to ask the librarian for the key to the special room down there. The light wasn't very good, and the source I needed was at the far end of the shelf, furthest from the light and on the very bottom. I also looked at new research, as well as various textbooks.

One thing I could not find was research on how patients felt about having their teeth polished. When I asked hygienists, they sang a chorus of "patients expect it." I could not find any research to bear this out, so I thought I'd find out for myself what patients expected.

Years ago, I had read that polishing wasn't necessary and that it was harmful to the enamel. So, instead of quitting altogether, I explained to the dentist with whom I worked that I would offer it as an option. I started giving patients the choice of having their teeth polished or not.

The first patient to decline it set my heart racing. I hadn't expected a physiological response on my part. I even started to perspire! The physical manifestations lasted a few minutes after I released the patient. They decreased in duration for every patient who chose not to have his teeth polished, until one day I remained totally calm in the face of eliminating this venerable procedure.

It turned out that only about one person per day asked me to skip it. Not very impressive. Personally, I hate that part of the prophy. I had figured that more people would opt out. I often wondered why they didn't.

When it came time to research the article, I thought it would be appropriate to do a little research study of my own, since the question of patient expectation wasn't fully addressed in the literature. I designed an unscientific study to find out if patients really expected to have their teeth polished, if they thought it was necessary, and/or if hygienists assumed that patients expected it.

I asked some of my friends and a dental hygiene Internet bulletin board if they'd like to help me. About 20 hygienists volunteered, providing me a convenient sample of nearly 200 patients. No one was compensated in any way.

Questionnaires were sent to the hygienists, and the instructions were to hand the forms to patients before the bib went on and without any conversation other than to ask if they'd take a moment to fill them out. Most hygienists found that the process took less than one minute.

Here are the survey results:

  1. I know what polishing is. 92% answered yes
  2. I like to have my teeth polished. 81% answered yes
  3. I mind the grit from the polish. 74% answered no
  4. Polishing is necessary for oral health. 75% answered yes
  5. Polishing is a cosmetic procedure. 53% answered yes

There was no room for qualitative comments on the forms. I just wanted to know specific things of the patients: what they knew, not what they thought.

The data collected showed the reason patients expect to have their teeth polished is because they think it is necessary for dental health. They do not expect it to be a cosmetic procedure (some patients circled "yes" and "no" for that statement). Most patients do not seem to mind the grit, and a good percentage really like having their teeth polished, but it is still in their minds that they need it.

One hundred sixty-three patients reported liking having their teeth polished, and 151 thought it was required for health.

In contrast, here are the dental hygienists' perceptions:

  1. I practice selective polishing. 55% answered yes
  2. I polish every patient every time. 55% answered yes
  3. I was taught to always use fine paste. 73% answered no
  4. I believe patients expect to have their teeth polished. 95% answered yes
  5. I believe polishing is essential. 91% answered no

It's interesting to note that while 55 percent of hygienists responding to this survey practiced selective polishing (it was not defined for the survey), 95 percent thought patients expected polishing. The research indicated that hygienists are the ones who expected to polish. They, like me a couple of years ago, can't imagine life without it. Patients do not know what to expect until we tell them.

There was room on the survey for hygienists to supply comments, and they did.

One hygienist pointed out that we often get to see each patient only two hours a year. How much education can happen in that amount of time? One hygienist, practicing in the same office for more than 20 years, said she hasn't seen any ill effects of polishing on the patients she's had since they were little tykes.

Another stated that the doctor insisted she polish every patient every time, because patients expect it.

Yet another commented that all patients leave the treatment room plaque-free. Hygienists also thought polishing and the resulting smoothness of enamel was a good motivator. A number of responding hygienists commented that they sometimes use toothpaste to polish and do not insist if the patient objects to the polishing. None asked patients whether or not they objected.

Hygienists have time to learn about the new boat a patient has; the patient, in turn, learns about the hygienist's vacation. We do have time for education if we use our time wisely. From the time patients are teenagers, oral health-care providers can educate them on the simple concept of an elective procedure.

Autopilot sure is easy: Put the scaler down, pick up the handpiece, pick up the floss, and they're out of there. Next please. It takes a little bit of time to manufacture teachable moments ... a very little bit of time.

Patients must get the message that, while philosophies can be different among hygienists, science is science, and science does not support compulsory polishing.

Shirley Gutkowski, RDH, BSDH, has been a full-time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected]