Hygienists have a paramount opportunity to educate and inform clients about their esthestic options.
Kristine A. Hodsdon, RDH, BS
All team members should be enthusiastic and well-versed when discussing esthetic materials and procedures. Hygienists, however, interact with clients at 2 to 6-month intervals. Theirs is a continual relationship, providing clients with an intimate, secure, and non-threatening environment to share their overall oral health goals. It also allows the team to discover their clients` subjective needs and wants during the smile evaluation and assessment phase of the dental hygiene process. Most importantly, this ongoing relationship gives hygienists a paramount opportunity to educate and inform clients about their esthetic options.
Establishing and maintaining an esthetic and cosmetic focus, however, requires a shift in philosophy for hygienists. To effectively provide a comprehensive esthetic assessment, hygiene professionals must first of all believe in the superiority of adhesive restorations. It is tempting to "hang on" to traditional methods, such as amalgam and porcelain fused to metal, simply because we are comfortable with them. But adhesion restorations are better. They are minimally invasive, seal and reinforce teeth, and allow the dentist to add to, rather than subtract from, tooth structure. Esthetic restorations also have a remarkable effect on our clients` self-esteem, a fact well-documented in literature.
Optimal adhesive dentistry also requires hygienists to support the dentist, and promote his professionalism and expertise to the patients. The hygienist`s confidence in the treatment, and with the dentist providing it, transfers to the patients, who recognize the value of and sincerity in the care plan. Finally, hygienists must learn to connect their clients` wants and needs with preventive and restorative actions, and give them the knowledge and education they need to truly interact in the care process.
A smile evaluation includes both clinical and subjective investigations. The client`s involvement from the beginning is essential to the interactive process. Clients can "kick start" the evaluation by completing a written cosmetic questionnaire. This gives the hygienist an ideal focal point from which to begin an interactive co-assessment with the client. It`s an opportunity to educate the patient about appearance enhancing dentistry, and its impact on their health.
Next, the hygienist evaluates other variables of the "smile stage." This involves all supporting structures, lips, gingival tissue, osseous tissue, and teeth. When a client smiles, note the lip line at rest, and during a wide smile. Does the client show a small or an obvious space between the maxillary posterior teeth and the inner cheek/buccal corridor? Does the profile exhibit a wide smile, with the pre-molar and molar regions on display ala Julia Roberts? If so, should it be included in the smile redesign?
The gingival tissue forum includes color, the absence or presence of disease, amount of gingival showing ("gummy" smile), and the amount of attached gingival. The hard tissue should be evaluated for symmetry, thickness, and amount of bone loss. Assess the teeth for mobility, color, size, shape, position, and arch position. The exploration can also reference the integrity of previous dentistry. Look for dark lines in the gingival margins (which are a sign of biological width violation), breakdown of previous tooth-colored restorations, opaque crowns, or missing teeth. The principles of occlusion, which include grinding, clenching, incisal guidance, and the temporomandibular joint, also need careful evaluation. Detailed assessments may also require diagnostic study casts, updated radiographs, full-mouth periodontal assessment, and photography.
An office protocol using technology as part of a comprehensive esthetic examination should be developed. Technology is an essential interactive tool which further encourages client participation. Computer imaging, for example, can realistically illustrate the final outcome for the patient; it also helps the team remain focused on the patient?s concept of a beautiful smile. Using an intraoral camera can help educate and enlighten the client during the data collection stage.
Clinicians may be surprised by the knowledge base a hygienist must acquire to perform esthetic evaluations. But care plans for esthetic dentistry can involve a varying spectrum of restorative, periodontal, and implant techniques. An extensive understanding of cosmetic mediums, such as whitening and veneers, is also essential.
Hygienists must also establish measurable goals in their desire to perform smile evaluations. Merely stating at a team meeting that you will start to use the intraoral camera, or talk about adhesive procedures, are admirable, yet vague, objectives. Instead, commit to using the intraoral camera with at least three clients each morning. Give a smile evaluation form to all 3-month recare clients. Reschedule any client for an esthetic examination should time constraints prevent it during a recare session. Definitive goals such as these give focus, and can be measured, evaluated, and rewarded.
Clear parameters should be established for both the dentist and the hygienist regarding responsibilities during smile evaluations. Clients often turn to hygienists for verification, asking: ODo I really need this treatment?O It enhances the hygienist?s professionalism and the practice?s esthetic mission if the doctor restates the points outlined in the initial evaluation. When the diagnosis confirms the assessment, clients can confidently ease into case acceptance.
Once the guidelines have been agreed upon by both professionals, a specific model can be implemented into theassessment phase of the dental hygiene process. This will ensure the level at which the dental hygienist feels confident in performing data collection and evaluations.
References available upon request
Kristine A. Hodsdon, RDH, BS presents seminars nationally about
esthetic hygiene. Her company, Dental Essence, is based in Hudson, N.H. She can be e-mailed at [email protected].