Making Patients Comfortable

Some tips on ensuring a patient's tranquility in the dental chair.

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by Lois Serafini, RDH

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One reason many hygienists choose our profession is that it's a people-oriented job. Hygienists like people, and we care about our patients. Keeping patients comfortable is a natural extension of this. When patients are comfortable, they are more relaxed. Their dental experience is more positive. They also develop a personal loyalty to the practice.

Since I began practicing dental hygiene, I've developed a number of ways to help patients feel more comfortable. Some are a matter of common sense. Others are based on choosing the right tools. And some have evolved from reading people's signals and adapting to their needs.

Beginning at the beginning

The practice for which I work is based in an affluent community with a large percentage of retirees. As many hygienists know, senior citizens often have special needs that require special attention. Their skin and tissues may be more fragile and prone to abrasion or bruising. Many are on prescription medications that can cause side effects, such as dry mouth. These side effects can affect their comfort during dental procedures. Conditions such as arthritis can make it harder for older patients to sit comfortably for extended periods of time. Older patients may also be more sensitive to ambient temperatures.

Of course, these sensitivities vary by individual. So the first step I take to accommodate patients' comfort needs is to ask about their sensitivities. Any time I see a new patient, I ask questions to help me understand their comfort needs. For example, when I ask whether patients have problems with their gums or teeth, their answers not only help guide later diagnostics, but also help me gauge their level of sensitivity to pain and other sensations.

I also ask new patients about their previous dental experiences. The majority of patients have had good or neutral experiences, but on occasion patients will reveal that they've experienced pain or some other discomfort. Sometimes patients will recall a bad extraction, or perhaps that they felt pain while getting a filling. Sometimes they have felt pain during a scaling. I've found, in particular, that if patients have had bad experiences in childhood, it tends to color their expectations even decades later.

In addition to talking to the patient, I also consider comfort during the preliminary hygiene exam. If I find significant build-up, I may recommend that we perform the cleaning in multiple appointments, instead of trying to get it all completed in one appointment.

Of course, I always try to be gentle while I give cleanings. However, if a patient reports a former negative experience, or seems prone to extra sensitivity to pain, I am even more slow and careful. In addition, once I begin the cleaning, I keep up a dialogue with the patient. I tell patients what I'm about to do before I do it. For example, I explain that I do clean below the gum line, and before I begin, I warn the patient that it may pinch.

Finally, I watch for non-verbal feedback from the patient. Body language is important. A patient who moves around in the chair is probably feeling discomfort of some kind. Wincing is a more obvious sign that the patient feels uncomfortable.

Anesthesia — If I discover that a patient feels pain or discomfort during a cleaning, I start by using a topical anesthesia, such as Sultan Topex® or a similar product. In most cases, this numbs the area enough and I'm able to continue with the scaling.

From time to time, we have a patient who is particularly sensitive, or who has extensive build-up of debris and calculus. For these patients, we schedule quadrant scaling. For each of four appointments, our doctor administers an injectable intraoral anesthetic in the quadrant to be cleaned. This approach ensures that the patient will be pain-free for even extensive scaling and root planing.

In addition to anesthetics, a variety of hygienist tools helps improve patient comfort. Ultrasonic scalers are one example. Particularly for subgingival cleaning, today's thinner, specialized tips help cleanings go faster, and many patients comment that scaling is more comfortable. For this reason, we use a Cavitron ultrasonic scaler more and more in our practice.

X-ray exams — X-ray exams are another area of patient care where comfort is important. We've recently incorporated a new product specifically to improve patient comfort during X-rays: Kodak™ SureSoft™ packets. These packets have a cushioned edge that is easier on patients' mouths when they bite down on the film. Patients often notice the difference, even when I haven't mentioned that it's a new type of packet.

As an added bonus, the film packaged with SureSoft packets is a high-speed X-ray film, Kodak InSight™ intraoral dental film. This helps us improve patient comfort in two other ways. First, many of our patients are concerned about radiation exposure. Being able to tell them that we use a fast film helps set their minds at ease.

Second, the film helps us speed up the exam process. Since switching to it, we've reduced our exposure times by half. This means patients don't need to hold a foreign object in their mouths for as long. It makes a big difference for a full-mouth series in particular; I'd estimate that we've reduced the average time needed for a full-mouth series by three to five minutes.

Managing X-ray exams so they'll take the least amount of time is useful from an office management perspective. It can help the practice schedule more patients, which can contribute to the practice's revenue goals. But it also contributes to patient comfort. In general, I choose a slower pace for procedures where I need to spend time to do a good job. I strike a careful balance with scaling, for example. I want our patients to know I've done a thorough, careful job. At the same time, most want to have the cleaning over with as quickly as possible.

For procedures such as X-rays, however, it's possible to manage the process quickly without impacting standards of care. Since many patients are anxious about getting X-rays, finishing quickly is a nice way to improve comfort. So, in addition to using a fast film, we try to make the X-ray exams efficient. For example, when we review patients' charts at the beginning of the day, we note how many bitewings or full mouth series we will need for the day. Then we count out the films we will need and mount them in our Rinn holders. With everything set up in advance, we can move patients quickly through the X-ray exam process.

We also keep our X-ray cone mounts well-oiled so that we can reposition the cone smoothly.

We've found that this attention to efficiency pays off. New patients in particular often comment to me about how quickly I complete their X-rays.

Comfort in the chair — Sometimes keeping patients comfortable is a matter of the latest, greatest products. Other times it comes down to old-fashioned touches. Because it's often hot and humid here in Florida, we make sure our operatories are cool, because many patients tend to feel more nervous if they get too warm. At the same time, some of our elderly patients can become chilled in the air conditioning. For this reason, we keep blankets in our operatories.

Wraparound-style neck pillows are another amenity our patients appreciate, particularly seniors who may feel stiff after sitting for a while.

When a patient has tori, a bit of cotton can help improve comfort during X-ray exams by further cushioning the area around the growth.

Finally, the overall ambience of the office is important. We look for ways to add personal touches to the office. For example, our doctor raises orchids and keeps many at the office to serve as conversation pieces and to soften the décor. While keeping patients comfortable is a matter of common sense, it helps to put a little thought into it as well.

Lois Serafini, RDH, has been a practicing hygienist for 26 years and is a member of the American Dental Hygienists' Association. She is currently the head hygienist for a private practice in Delray Beach, Fla.

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