Pennwell web 200 305

The pain of stain drives me insane

Feb. 1, 2012
Did I mention that I have the privilege of working two days in a general dental practice with an employer who is an angel?

Did I mention that I have the privilege of working two days in a general dental practice with an employer who is an angel? I am very fortunate.

The other day, after a tedious morning of treating one patient after another with stain all over their respective teeth, and from memory, knowing that my first patient of the afternoon would follow suit, I stopped by Dr. Antonio Cifelli’s office before lunch. He saw my angst and asked what was wrong.

I told him how frustrating it is to work with some of the patients who have heavy stain. (I should tell you that in the four years I have worked with Dr. Cifelli, he has never once picked up a scaler in my presence or made a negative comment about my work.

Feedback is always positive. Please don’t consider this a braggadocio session, because my work is far from perfect.) Suffice to say that I do the best I can in the time I have. I reminded Dr. Cifelli that I am very aware of his kind nature, but nonetheless, I torment myself by working to the last second trying to remove all stain from patients who don’t prevent it themselves, thus leaving minimal time for the exam, and compounding my stress as I try to turn the room over for the next patient.

He listened to me patiently. (You should know that once in a blue moon, Dr. Cifelli will do a prophy.) He said, “I realize you do the best you can, and I know it is frustrating. You do understand that on 90% of patients, the stain will be back in a few weeks despite your efforts?”

I said, “Yes, I know.”

He said, “You know, Eileen, to be honest with you, when I do cleanings I remove the stain that the person can see, i.e., the anterior facials. But if you think I’m going to stress myself trying to completely remove stain that patients cannot see, will not prevent, and I know will be back on their teeth shortly, you’re nuts! Keep them happy but stop tormenting yourself.”

Is this man a prince? So I try to stay mindful of his advice as I struggle with my urge to get patients completely stain-free. I’m doing better, but I know it is more important to stay on schedule and not become stressed. So the message of this column is — stain is not a disease source; it’s a nuisance.

I’m spending more time educating patients on where their stain is coming from and strategies on how they can prevent it. I’ve seen some really good results. Listening to an ethnic woman tell me how important it is in her culture that she brush immediately upon getting up in the morning and before breakfast is very enlightening. My “mission accomplished” was helping her to realize that the two cups of tea she drank after brushing would only contribute further to her stains.

Seeing the results in patients who will not do a midday brushing, but will at least make the effort to rinse with water after coffee and tea is amazing! Hearing from a number of those who won’t brush more than twice a day because they are afraid of causing gingival recession, and are hence stain-laden, has been jaw dropping, and educating them is a joy. Kudos to automatic toothbrush converts! And you gotta love the straw users.

All of these tips to patients have an impact, and when they hear that it makes their cleanings easier and gives more impressive results, I have found that more than a few are trying to do as I ask.

Onward we go; it’s in our heart’s core! RDH

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

More RDH Articles
Past RDH Issues