By Cappy C. Snider
In baseball, a term is used to describe the player who comes to bat after a few others have had their turn. That player is expected to help get as many of the other players who are on base back to home plate. That player is expected to "clean up" the bases and help his team score. A recent discussion on the [email protected] e-mail community prompted a comparison between baseball's cleanup batter and the hygienist who is often expected to step into that same role.
I have found myself in that position — as many of you have also, if you've been doing this for any length of time. It can be a very frustrating position to be in, and it's one that often leaves me feeling less than adequate. I am sure that others have felt like they are cleaning up after me while seeing a patient for whom I was only able to perform treatment I would have considered far below my usual standards. Over the years, there have been several instances where this was the case.
Early in my career, one of my employers had been performing his own prophys and periodontal treatment for several years before I was hired. I thought it would be a challenge to step into the role of the first hygienist in many years for this practice. Boy was I in for a surprise! Almost everyone had been treated as a prophy, and very little was done in the way of subgingival scaling. There was not even an ultrasonic unit of any description in the office! Imagine my feelings of uselessness enduring day after day of that tenacious subgingival calculus with only hand instruments to remove it with. Talk about sore fingers at the end of the day.
I soon realized that this opportunity would be much more than I was ready for at the time. I eventually decided it was time to move on. My first attempt at batting clean-up had not been the rousing success I had hoped. I did feel good about the patients who I was able to educate and restore to good oral health, but I was not up to the daunting task.
Don't get me wrong. I am not knocking dentists here. I think we all know, though, that the time spent in dental school learning how to remove calculus from teeth is very limited compared to what we learn in hygiene school. I am sure the doctor was doing the best he knew how to do.
I had also entered an established practice and basically inherited those patients who have not been getting thorough treatment and found that all I could do was to try to slowly catch them up over time. Little by little at each recall appointment more calculus was removed. Some of it was probably never removed as I had only scalers and ultrasonics at my disposal. If I'm not mistaken, explosives are not safe to use intra-orally, so I could not use this option although at times it seemed like my only answer. I often wondered what the subsequent hygienists thought about the quality of my work when they came across these patients. I am now a little more secure in the knowledge that I did the best I could when faced with a difficult situation.
I cannot dwell on what someone else's opinion of my work is when they had no idea of what obstacles I had to face at that time. I, in turn, try not to judge other's work when I did not know their circumstances. Were they forced to use inferior instruments, the kind with no identifiable cutting-edge? Were they subjected to an impossibly short time allotted for the treatment? Too many factors come into play to compromise the level of treatment we are able to give at a particular time.
Complications during an appointment are often many, and we can only deal with them the best we can. We have all had the hypersensitive patient for whom absolutely nothing will help. We have also all had the phobic patient who needed to be eased into treatment. I would rather spend my limited time with that type of patient in establishing trust and building a relationship so they will actually follow through with my recommendations. Otherwise, the approach of "remove the calculus at all costs" often will drive them away and further postpone any procedures.
It will not cause a fatality if some of the same calculus that has been on a patient's teeth for the past 10 years is left for subsequent visits. I always hope that I am the hygienist who is able to follow up with these patients, although sometimes I am not.
This is where good documentation comes into play. Clear, concise notes with as many details as possible are a good way to paint a picture of what I may or may not have been able to accomplish with a particular patient. Noting where unremoved calculus is located will give the patient's future hygienist a good "playbook" to follow. Other details, such as the patient's past dental experiences, fears, and concerns are all very important notes to include.
Part of the online discussion mentioned earlier focused on new graduates vs. veterans. Some hygienists had the experience of working with new graduates who were not as focused on doing a thorough job as they were in showing off great production numbers. I feel that this is not a new graduate vs. veteran issue. I have seen plenty of hygienists who had been in the field a few more years than they were happy with, which may mean practicing only five years. These folks were just going through the motions. It is more a matter of conscience and doing the best job you possibly can under the circumstances. Regardless of experience, if your standards are not set very high, the outcome will be a patient who will have to endure some pretty intensive scaling at some point to reverse what could have been an easily resolved problem in the initial stages.
Why do we put such pressure on ourselves? I think there must be a special gene for hygienists that make us want to be perfect — you know the one I'm talking about. It's the way we line our scalers up "just so" on the bracket table, the ever-so-neat stack of 2x2 gauze squares (usually a specific number in the stack) that lie next to the scalers, the exact placement of the container of floss on the tray, right next to the specific brand of prophy paste we love to use, and of course, the only brand of prophy angle that will do the job we expect.
If you are like me, the drawers in your operatory are well-organized, with related items placed together, and your pens and pencils are always replaced in their holder between use — unless of course, it's your special pen, then it's placed in a pocket so no one else can take it. With these tendencies, it's no wonder we stress over any calculus that may have been missed during an appointment.
I hope that we all try to do our very best with each and every patient who sits in our treatment chairs. Sometimes our best has to be redefined, depending on the circumstances. Knowing when and how to be flexible seems to alleviate much of the stress of perfectionism I put on myself. I can only do the best I can do. Perfection is an unattainable goal when dealing with human beings. I choose to be my best, and that is the best thing for me.
Cappy C. Snider, RDH, graduated from Tarrant County College in Texas in 1987. She has practiced continually for the past 15 years. Snider currently practices clinical dental hygiene with Dr. Brooke Porter of Azle Dental Care in Azle, Texas. She may be reached at [email protected].