by Shannon M. Nanne, RDH
Here we are, dental hygienists in the 21st century. Are we really supposed to know everything? Our patients, family, and colleagues think we should. Because you are in "the dental field," people think you should know all there is to know about every little tooth or issues involving the gums. During the past 10 years in pediatric, general, and periodontal practices, I have come to the conclusion that even if I don't have the answer, I better make up something that sounds good. Over the years, regardless of age, patients come up with some of the most off-the-wall questions. After the laughter and deep breath, I answer these questions with a grain of salt and put these inquiring minds to rest.
I'll start with the young ones, who are usually the most interesting. In their case, I like to ask the questions first. This takes children's minds off where they are and why they are there. First, ask if they are married. Yes, I'm speaking about a five-year-old. I can almost guarantee they have not been asked this before. It gives them a moment to forget that the scary tooth cleaner with sharp tools, weird purple gloves and a face mask doesn't even realize they're only five and could not possibly be married. Their laughter puts them at ease. Your next question should be, "Well, if you aren't married, how many kids do you have?" By this time, you have laid them back in the chair and started doing what needs to be done.
If you find that this doesn't work for you, try my next favorite. Whether it's a boy or girl, compliment them on a part of their outfit. Then ask, "Can I have it?" Even though the shoes are adorable, they obviously won't fit you, and children know it. By this time, you have started to tickle their tiny pearls with a yummy flavor of paste they never knew existed. But here comes the hard part —fluoride. Yes, I said fluoride. Ask them if they like sundaes. The most important part of a sundae is the whipped cream, right? Offer them several flavors of special whipped cream for their teeth that will make them strong and healthy so they won't get cavities! I have used fluoride foam since it was invented, and nothing has made my job easier. While this takes care of my questions for them, what about their questions for me?
Kids love to ask why. Remember, you hold the keys, so use them. I've always been one for bribes, and I take advantage of the opportunities. Dispensing fun toothbrushes, toys, and stickers can make your day easier. These small items can make a difference and give your patient a happy, open mouth. Now here comes that question — why? The answer is, "If you let me count and clean, you can visit the toy chest."
A slightly more difficult conversation is with parents. You never know what may be the most important question for moms and dads. One of my favorites is, "I bring my child to the dentist every six months, so why is he still getting cavities?" You realize from the deep overbite and deep overjet with moderate areas of decay that the child is being put to sleep not only with only a bottle, but with a bottle filled with something other than water. Have these people noticed the large advertisements on the back of the buses? How many ways can we educate about baby bottle tooth decay? Gently discuss the importance of no bottle — or at least only water in the bottle.
Another one I like is, "Why does my child grind his teeth? I never did that, and I can hear him in the next room. Will he need braces?" These concerned parents need reassurance. I have found that not really answering the question may be the best answer. Unless you are a clairvoyant, there is no way you can honestly answer yes or no to these questions. Explain the child is too young to make that kind of assessment, but he needs to be closely watched. Let the parents know you will make a note to have their questions answered during the next visit.
We encounter many types of questions, but here are a few for which I've finally found "the answer." The questions used to stump me, so I had to come up with some kind of response that would pacify people.
I have found that the best/right answers to questions come from the heart. As dental hygienists, we have found our way into this profession for a reason. What is your reason? Once you figure that out, it makes a lot more sense to come to work. Let's face it, our jobs aren't pretty. Our profession takes us deep into some pretty nasty places. I remember being told in hygiene school, "Wipe the chair and clean the room as if you were cleaning it for your mother." I have lived by that statement and treated each patient as if he or she were a family member, even if it was sometimes difficult.
Even though the majority of people do not want to be in your chair, isn't it nice to know they may be excited to return? This will come in time, so be patient, but most important, have fun and try to find the right answers.
"Does my breath smell?"
I used to hate this question the most. You know this patient hasn't seen a dentist in two years, and their breath could kill an elephant. I now answer after I floss between two and three very deeply. I hold the floss up to their nose and ask them if they smell an odor. Nine times out of ten, I think they are going to pass out. When they say yes, I tell them that is the odor coming out of their mouth. Most of the time they are horrified, but it may get them to floss.
"Do I have to floss?"
This is one of my favorites, and probably so for any dental hygienist. We all have probably used the following response at one point or another. I just tell them no. Then I add, "I'll make a deal with you. Just floss the ones you want to keep." They may look at me like I'm nuts, but so what? When it comes down to it, it's a true statement. Let them decide which ones are important to them. Hopefully it will be all of them, and this will open their minds to flossing more often.
"If you want me to use a soft toothbrush, then why do the stores sell medium and hard bristled toothbrushes?"
This one took me a bit longer to answer, but I finally got it. I tell them there are many patients who have lost their teeth and need dentures or partials. Most of these are made of metal and very strong acrylics. The medium and hard bristles clean these artificial surfaces. Do they want to use a denture toothbrush in their mouth? The majority of patients do not want to use something in their mouth after they know it is used primarily for denture wearing patients. This is psychology at its best!
"Why do I need X-rays? Didn't I have them last time?"
Yes, a year ago. I have not figured out why people are still afraid of X-rays. But this is one aspect where I actually give kudos to insurance companies. I tell people, "You know how strict insurance companies can be with what they cover. It is recommended that we take a few pictures to check in between your teeth for cavities that we cannot see in the mouth. Believe it or not, your insurance company agrees with us and will pay for them at 100 percent. We want to prevent any problems that may be creeping up on you and protect your investment." They like the word investment. If they still refuse, let's face it — you can't make someone do something that they are dead set against, so document it in the chart. I actually have the patient initial next to the words refuse X-rays. When they ask why they must initial, I explain that we are not responsible if they have a problem in the future that could have been prevented by a radiograph. About half the time they change their minds.
Shannon M. Nanne, RDH, practices in the state of Ohio. In 1994, she graduated from the University of Pittsburgh Dental School. She became a part-time technical representative with Laclede, the makers of Biotene, in 1999. She is a national speaker who lectures to dentists, hygienists, pharmacists, and oncologists, as well as to support groups, hospitals, and dental schools. She also has published, "A Patient's Guide to Periodontal Disease," available through Lexi-Comp. Shannon can be reached via email at [email protected].