Stinking thinking

May 1, 2005
I work full-time in a dental practice with two doctors. Each doctor has two full-time dental assistants...

Dear Dianne:

I work full-time in a dental practice with two doctors. Each doctor has two full-time dental assistants, for a total of four assistants. There are three other hygienists besides me, working out of three hygiene operatories.

In our practice, all new patients come through the hygiene department first. Of course, many patients require a full-mouth series of radiographs, and all require a full periodontal charting.

In addition, we must go over their medical history thoroughly; take a blood pressure reading; conduct a thorough intraoral and extraoral assessment; chart existing teeth and restorations; determine periodontal status; conduct an oral cancer exam; take intraoral images of broken or unesthetic teeth; and discuss any pre-treatment concerns. Also, if the patient is not a periodontal patient, we are expected to complete a prophylaxis - all in one hour.

One thing that really helps is if the hygienists get some help with charting and developing radiographs. Here’s where the problem begins.

The dental assistants in our office do not want to help us. Just about every time I ask for help, one of the following things happens:

• I’m told to find someone else; the assistant says she is too busy.

• The assistant says she will be there shortly but never shows up.

• I get “the look” and an attitude, which I interpret as, “Well, OK, but this is not part of my job.”

There are days when the assistants are not very busy. It’s common to see one or two assistants in the staff lounge or at the business desk chatting. I wonder if they have made a pact among themselves not to help the hygienists!

This lack of cooperation is stressing me out! I try to stay on time, but in the absence of help with chartings, etc., it is impossible! Many days, I go home angry, frustrated, and near tears.

Except for the cold shoulder from the assistants, I really like this office. However, I’m beginning to wear down and feel that maybe I need to look for another job. What advice can you give me?

Needing Help in New Mexico

Dear Needing,

There are several observations I’d like to make. First of all, assistants do not understand your job. They don’t have a clue how hard it is to chart solo or the pressures that come to bear on a hygienist trying to do everything that is necessary and stay on time. Assistants, who often work very hard trying to keep things running smoothly, sometimes feel resentment toward hygienists and have expressed their feelings to me with comments like, “I work twice as hard as she does, yet she gets paid double what I make!”

Indeed, that’s why some of us, who were formerly assistants, went to hygiene school in the first place. (In my seminars, when I ask the question, “How many of you were assistants before you went to hygiene school?” often one half or more of the attendees will raise their hands.)

Since I was an assistant, I know how assistants feel. That’s when I tell them, “I think assistants make great hygienists. Why don’t you go to hygiene school?” They don’t know what they don’t know. The longstanding rivalry between assistants and hygienists that comes from jealousy over the difference in pay for the two professions does not excuse or justify resentment. This is a good example of what I call “stinking thinking” from assistants.

However, I would be remiss if I did not admit that some hygienists deserve to be resented. Some hygienists would not dream of lifting a finger to help an assistant. I have seen hygienists casually head for the staff lounge to read a magazine during downtime, while dirty instruments are piled up in the sterilization area awaiting preparation for sterilization. I have observed assistants literally running from room to room, trying to attend to the doctor’s needs, while the hygienist is engaged in personal telephone calls.

Sometimes, assistants need help too, especially if the doctor uses two (or even three) operatories and has only one chairside assistant. Chairside assistants like this are often overworked and cannot be expected to help hygienists, except when there is downtime for the doctor - which is rare. The point is that the old mantra of “that’s not my job” can apply to hygienists too.

The second observation is that this is an efficiency/productivity issue. A hygienist can do a full-mouth periodontal probing in about three minutes with an assistant, as opposed to 12 to 15 minutes solo. That’s an additional nine to 12 minutes that could be spent on patient care or home-care issues. It could also mean the difference between staying on time and being late with the next patient. Every time the hygienist has to stop probing to record, time and momentum is lost, not to mention cross-contamination problems from the patient’s mouth to the patient chart or keyboard. Developing and mounting radiographs, especially full-mouth series, takes significant time that could be spent in direct patient care.

In your case, each doctor has two assistants. Since the doctor can only be in one place at a time, one assistant for each doctor will not be engaged in direct patient care, except when making temporaries or impressions for bleaching trays, etc. There should be plenty of opportunity for one of the assistants to help hygienists with chartings and developing radiographs.

In the rare instance when all the assistants are tied up in direct patient care, the next best alternative would be to use a small recording device. I have observed hygienists calling the numbers out to a cassette recorder and playing it back later for manual recording in the patient chart. The voice-activated charting systems also are wonderful, but that would not help you with radiograph processing or sealant patients.

You must be respectful that assistants have many duties and not expect them to immediately drop what they are doing to help you. You must be flexible during the appointment as to when your charting can be done. Be willing to drop what you are doing when an assistant can break free to help you.

In your situation, the doctors need to become involved and inform the assistants that they are expected to help with chartings and processing films for hygiene patients. This is all about patient care, not helping hygienists. They need to understand that assisting the hygienists with that aspect of patient care is not optional. In fact, it should be written in their job descriptions, just like “helping with residual clinical duties” should be in hygienists’ job descriptions.

A dedicated hygiene assistant can increase productivity and cut down stress in a multi-hygienist practice. Most doctors are interested in ways to be more productive and relieve stress.

Talk to your doctor in a calm, nonconfrontational way. “Dr. _________, over the past several years that I’ve been employed here, I’ve come to appreciate the good dentistry you do and how you care for the patients. But there’s something I’m having a problem with, and I hope you can help me.

“I know how important periodontal charting is, but to do it solo takes me at least 15 minutes. With an assistant, it takes about three minutes. That’s 12 more minutes I can use on the scaling. Yet often, when I seek an assistant to help me, I get the cold shoulder and a resistant attitude, like I’m imposing on them.

“It is causing me lots of anxiety, and the tension is affecting me physically. I’m not interested in games, but I am interested in giving your patients the best care that I am capable of providing. Sometimes, I need an assistant’s help. I’d like to know your thoughts on how we can solve this dilemma, and I have some thoughts of my own I’d like to share.”

Then let the doctor talk. Afterward, you can offer the solutions I’ve listed above.

In an ideal team, everyone helps everyone else so the day runs smoothly. There are no inequality issues. People should not have to be told to help other members of the team by doing whatever they can to make caring for our patients efficient, relaxed, and productive.

If the bottom line is excellent patient care, that involves a team effort. Hygienists should be willing to help assistants when the opportunity arises, and assistants should help hygienists with those tasks that are best undertaken with two people. Furthermore, any assistant who chooses to carry a chip on her shoulder and refuses to help the hygienists should be fired. The same logic applies to a hygienist who refuses to help an assistant when the opportunity arises.

Best wishes,

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her Web site at

Help Wanted!

The three situations where hygienists most often need assistance are:

• Recording chartings, both restorative and periodontal

• Developing FMX

• Helping with some sealant patients

Delivering excellent patient care in the most efficient and productive manner requires teamwork. It takes everyone helping each other.

You need to talk with the doctors. Ask them to consider how productive they would be if:

They had to set up/tear down for every patient they saw

They had to process their own instruments

They had to develop and mount all their own radiographs

They had to do all their chartings solo, which takes five times longer

They had to do every procedure they do with no assistance

They had to make every patient’s next appointment

If your practice is a high volume practice, another good option would be to hire a dedicated hygiene assistant who does the following:

All developing and mounting of radiographs

All sterilization for hygienists

All charting

Assistance with sealant patients as needed

Occasionally suctioning on periodontal patients (you would be amazed how much this cuts down on procedure time)