Comfort Zone: The big chill

Feb. 1, 2001
Forget having a patient who will hang on your every word or recommendation. 'The Big Chill' has taken over, sending one more patient into an emotional deep freeze.

We all know the list. You say, "What list are you talking about?" You know - that long list of things about a dental visit that drives patients crazy. We all studied it in school - that list of things that turns the most rational, cordial, and cooperative dental patient into a charter member of the Hyde family. High on the list is "The Big Chill."

Imagine this scenario from a patient's perspective. It's late in the afternoon in July. Your patient arrives clad in a T-shirt and shorts. The office air conditioner is running full blast. The office staff, covered head to toe in OSHA-approved garb, busily ushers the patient back and invites him or her to sit down in the dental chair. Bare legs come into immediate contact with some type of cold, synthetic material, often covered with a flimsy dry cleaning bag. A metal chain holding the essential bib grazes the back of the neck.

As we begin to recline the chair, the patient is frozen in expectation of what's next. Suddenly, an icy cold mirror is thrust into a warm, moist mouth. It fogs up instantly. Quickly, we take advantage of Mother Nature's natural defogger by rubbing the cold mirror surface on buccal mucosa. Then we begin our patient assessment, meticulously poking here and there and, if necessary, using a blast of cold air to inspect an area. Finally, we pick up an instrument and begin the relentless scraping, over and over, tooth by tooth, with "the pick." A patient may declare, "You're poking me!" Another may warn, "Careful, you're making me bleed!" Someone else may alarm you by saying, "Don't touch that tooth, you'll hit a nerve!"

Suddenly, we are the ones searching for emotional relief, so we frantically grab the air/water syringe and proceed to fill our patient's mouth with freezing water, politely murmuring, "Rinse please." In less than 15 minutes, this once pleasant, reasonable, intelligent patient has been transformed into a dental-hygiene nightmare. Forget about making friends. Forget having a patient who will hang on your every word or recommendation. "The Big Chill" has taken over, sending one more patient into an emotional deep freeze.

Can we take "The Big Chill" out of the hygiene appointment? What is our battle plan? Let's look at this, one issue at a time.

All of us are working up a sweat while bundled up in layers of OSHA-mandated clinical wear, and some of us are even warmer with hormonally out-of-whack body thermostats. Anxious patients can get chilled easily, while elderly patients (with poor circulation) often feel cold all of the time. If a patient spends an hour lying in a dental chair like a corpse, a severe outbreak of goose bumps can erupt. Cover the patient with a snuggly blanket - not your father's old scratchy wool discard - and watch the tension disappear. Higher-tech solutions include a full-length, programmable massage/warming pad fitted to the patient chair or pillows filled with soothing herbal preparations or buckwheat. Many pillows can be warmed gently in a microwave, but don't forget to check before you do this!

Patients must think we store our instruments in the deep freeze. How about holding your mirror under warm water before you place it in your patient's mouth? Warm mirrors don't fog up, and they are more comfortable.

Why not ask your patient if there are any sensitive areas before you dive in and perhaps make an enemy for life? Sensitive patients can be cranky, but can you blame them? Why not get to the heart of the matter? Cold sensitivity hurts. Effective fluoride or potassium oxalate desensitizers are available for chairside use, so it just doesn't make sense to have an uncomfortable patient. Most products take only a few minutes to apply. Your patients will gladly pay for this treatment, and you will be dubbed a dental-hygiene miracle worker! Don't forget to discuss the role of diet and hygiene when you treat this type of sensitivity, and always encourage patients to continue desensitizing therapy with home fluoride preparations or desensitizing toothpastes. Patients also may develop cold sensitivity from using tartar-control toothpastes; discontinuing these products should eliminate the problem. Generalized cold sensitivity also may be a symptom of chronic bruxism, cracked tooth syndrome, or pulpal involvement. These conditions all require more complex treatment.

If your patient is sensitive to air and no desensitizing agent is available, try to limit using the air syringe. If possible, use gauze to dry the area. Also, don't forget about the saliva ejector. To the sensitive patient, it's an air syringe in reverse and can hurt just as much as a blast of air. You may have to park it in an unaccustomed place, use it selectively, or have your patient control the saliva ejector.

There are so many ways to warm the liquids we use that it just makes sense to remedy this problem. For starters, give your patient a cup of tepid water for rinsing. A better, long-term solution is to install an in-line mini-water heater. I had one installed in 1975; it's still working, and the patients are still comfortable.

Older ultrasonic scalers need copious amounts of water to cool the tips. As a result, the water never warms up. Manually tuned ultrasonic scalers require less water, so the water has a chance to get warm. When operated in lower power ranges, the latest generation of auto-tuned units also needs less water. Some units have self-contained water/ medicament dispensers. Consider warming these fluids in a microwave-proof container. Make sure the liquid is tepid, not hot. You remember the McDonald's hot coffee episode, don't you?

Should we take our time and effort to deal with "The Big Chill"? Should we spend some of our precious dollars on products like mini-water heaters, dentin desensitizers, or contemporary ultrasonic scalers? It's your decision, but if you think all this is frivolous, just remember how many obstacles our patients overcome just to walk into our treatment rooms. Consider changing your perspective for the joy of treating our patients in the 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 ( She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].