By Anne Nugent Guignon
Certainly, most of you are familiar with the timeless music of the folk trio Peter, Paul and Mary. They've been around for years. Each is a talented performer individually, but when their voices blend, the music achieves a unique richness.
Three patients came to see me last week. While each appointment was a thrill, the combination of events reinforced why I have always loved clinical dental hygiene. I turned to my mother at my graduation ceremony in 1971 and told her that I wasn't going to practice clinical dental hygiene because it was too boring. Instead, I decided to pursue a master's degree in public health.
But a funny thing happened. Since money was scarce, I had to practice several days a week while I was in school, and I fell in love with the patient relationships. I've been in clinical practice ever since then.
Last summer I alluded to Peter in my Mission Possible article. I called him Mr. Tense, but I didn't discuss him any further. The article was getting long and I knew that his story deserved a different showcase.
Peter, a high-level executive in a large oil company, arrived at my clinical office in December 2002. My doctor warned me that he had just returned from a three-year stint in Russia. He didn't have any dental care while he was overseas, and his mouth was a mess. Peter's full series of X-rays confirmed this.
He was 15 minutes late for his first appointment and was obviously agitated. His face was covered with sweat, and he was so nervous he could hardly talk. His tension was palpable. Clearly, I needed to remain calm and non-judgmental. When I started to inquire about previous dental treatment, he told me that his brother was the last dentist to see him. Apparently, Peter's brother yelled at him and his sister-in-law is a hygienist. Peter found the hygiene visit very painful. What a challenge — a patient with dental phobias and family issues.
When Peter finished recounting the events of this last visit, I asked him what he wanted to do. His request was simple. He wanted to keep his teeth and he didn't want to floss. Fair enough. He gave me his parameters to work with.
Through the years, I have learned that we really need to listen to what our patients are telling us. Peter needed respect, not badgering. He needed an action plan that would fit his request. Based on the clinical findings, I recommended three things: full mouth periodontal debridement, a Sonicare toothbrush, and a regular three-month maintenance interval. This approach may seem overly simplistic, but I wasn't interested in overwhelming him at the first visit. I wanted to cultivate the relationship, not run him off. He agreed with the plan and seemed visibly relieved that life could be that simple.
Several months passed and Peter did not come back to the office. I often wondered what happened to him. His wife and daughter had started coming in for care, so I felt that the relationship was still alive.
Last week, 10 months later, not three, I saw Peter's name on my schedule. He arrived on time, smiling and perspiration-free. Even though he had not changed his brushhead in 10 months, was very overdue, and still did not floss, things were different from the first visit, when there was incredible bleeding and heavy, tenacious, black calculus everywhere. This time there was very little new calculus and only slight to moderate interproximal bleeding. His probing depths were two to three millimeters less than before. Peter grinned from ear to ear as I told him the good news that he was much better off than last time. Before he left, he made his next two recare appointments and purchased new brushheads. Peter now had a winner's attitude.
I am blessed with a memory for details. Most of the time it is totally useless, but I do remember the patients that I've worked with through the years. Several months ago, a man stopped by my office looking for the hygienist who used to see him in the 1970s and 1980s. His chart went into storage years ago, but everyone concluded that he must have seen me. His name was familiar, but I couldn't put a face to it.
When Paul arrived, I recognized him immediately. He is 60 years old now. The years have not been kind to him. He was injured over a decade ago so now he can hardly work. Money is a big issue. Even though he is eligible for Medicaid benefits, he decided he wanted my care again.
His teeth, which never needed a restoration, were still beautiful. His periodontal condition was generally stable. Yes, there was some stain and calculus and a few areas of very slight bleeding, but this was his first professional appointment since 1987! Paul has always valued his oral health. Even though he did not have professional care for 15 years, he still took care of himself. He proudly told me that he changed his Oral-B 35 toothbrush every three months and bought his floss at the dollar store.
Paul was fascinated with my ultrasonic scaler. The device was new to him. We laughed and joked. The hour flew by. Paul was beaming when we finished and he shared his favorite recollections of our previous appointments. He remembered that I always made him laugh.
Marty showed up in my office 24 months ago. He is the son of a well-to-do Nicaraguan physician. Marty had all 32 teeth, lots of decalcification, large amalgam restorations and very active periodontal disease everywhere. Probing depths ranged from three to seven millimeters. There were large deposits of calculus, accompanied by profuse bleeding. It had been years since his last dental visit. Based on the clinical findings, I explained that we recommended full mouth periodontal debridement. He readily agreed to active therapy, quarterly maintenance visits, and was willing to take steps to improve his home care.
Initially, Marty found it difficult to master his home care routine. He was using a power brush with a manual brush technique. Nevertheless, he kept trying to improve his technique at each recare visit. When I didn't see him for a year, I wondered what happened. Life just got in the way. Marty had recently gone through a high stress period at his architectural practice. Suddenly, he was back on my schedule again. What was I going to find? Marty assured me that he was using his power brush twice daily and changing the brushheads on a regular basis, as well as flossing periodically.
When I started probing, I noticed the soft tissue was pink, not glossy red like the first visit a couple of years ago. There were still some four and five millimeter pockets in every quadrant, along with some bleeding, but his mouth did not have the same level of disease as before. Yes, he needed full mouth debridement again, but his baseline had changed. He was forward to health — not backwards towards disease.
You are bound to have had some wonderful experiences like these. Just like the songs by Peter, Paul and Mary, these patient experiences are special in their own way. Together, the trio gave me another wonderful week of dental hygiene practice. Believe it or not, Peter and Paul are real names. The analogy was just too perfect!
Without relationships, we'll never be anything more than scalers and polishers. Real people own these teeth and gums. We are important to them. Is it our obligation to develop relationships where they will want to return for our care? You have the power to make that decision. We are their comfort zone.
Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].
