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Forget perfect

April 22, 2020
As dental hygienists, we are detail-oriented by nature. We want everything just right. But sometimes conditions don’t allow perfection. What do we do then?

We as dental hygienists are famous for being perfectionists. But sometimes patients or conditions don’t allow us to be perfect. As professionals, how can we make peace with that?

This one is a toughie. Does imperfection mean compromising the standard of care? Are we putting our license on the line if we don’t do everything 100% correctly? When we leave hygiene school, we no longer have three-hour appointments and the ability to stretch them into more visits, so how can we do all that we are qualified to do, stay on time, and not overwhelm the patient?

Dentistry is at a pivotal moment. Modern medicine and the general public have finally figured out that the mouth is connected to the body. (Not that that was news to any of us!) With this new awareness comes new opportunities and responsibilities. Some offices are testing blood sugar, performing HIV tests, offering vaccines, and so many more out-of-the-mouth procedures. Stack these on top of a more thorough medical history, a blood pressure check, intra- and extraoral cancer screenings, x-rays, airway assessments, nutritional counseling, periodontal exams (with bleeding points and recession), caries risk evaluations, restorative exams, biofilm disruptions, and—oh!—have I mentioned the patient is just there to “get their teeth cleaned”? How in the world can we get it all done perfectly in the 45–60 minutes allotted in the schedule and turn the room over with proper infection control?

The impossibility of perfection

I’m going to tell you something here—and I hope I won’t lose my license for it—the truth is, we can’t be perfect. We cannot do all of these things perfectly every single time. I’m not saying it can’t be done; what I’m saying is that despite the perfect checklist and routine that we establish, there is a living, breathing patient involved in all of this who can (and will) throw it all out of whack. We all know that patient whose saliva turns toxic the moment we lay them back, or the patient with tori so large there is no way to get a good bitewing, or the chatty patient who requires at least 15 minutes of dialogue before you even get them to open their mouth. We have to figure out where we can be flexible. We might—gasp—have to leave a little lingual stain in favor of some crucial oral hygiene instructions to save a patient from losing a tooth down the road.

I once worked at an office where the dentist had just bought a retiring dentist’s patients. Everyone loved Dr. K, the retiring dentist. Patients now in their 60s had been seeing him since they were born. Well, Dr. K and his hygienist had not been perio charting or scaling subgingivally, and here I was seeing these new patients with ledges of radiographic calculus, poor restorations, and no dental IQ. But remember, we love Dr. K. So how does a perfectionist hygienist handle this situation? I could let each patient know the exact state of his or her mouth (thereby bashing the beloved Dr. K), schedule each one for scaling and root planing, proceed with a full-mouth reconstruction, and bring them back to health. And do you know what would happen? Each one of Dr. K’s patients would walk right out the door, because this young whippersnapper dentist and “his nurse” just wanted to make some money! Or I could do a little at a time. Build a relationship with these patients, establish trust, and lay down the foundation of their dental knowledge.

Was this perfect? Was this textbook? Not at all. I’ll admit I did some bloody prophies that, without question, should have been SRPs. At that first visit, I showed them the calculus and explained how this newfangled ultrasonic scaler could help us. We talked about those numbers I called out and what they meant and introduced some simple home-care instructions. Then three (if I was lucky) or six months later, we picked up where we left off, adding on more discussion about perio (or quite frankly repeating all over again like it was new information), nutrition, oral-systemic connection, and whatever was needed. But the key thing was that they came back. My imperfection was an opportunity to build a strong dental foundation for these patients. Given the situation, it was perfect.

So perhaps we need to redefine our definition of perfection. Is there any such thing as the perfect dental appointment? If we check all the boxes on the list, is that better than diagnosing and explaining a patient’s airway issue? It’s key to document the appointment. If you didn’t get to the FMX that visit because the patient’s xerostomia was so out of control that your mirror stuck to the inside of their cheek, write it down. But know that helping them figure out ways to combat their dry mouth was worth the time spent for the teeth you just saved. They can always come back for those x-rays.

Tips for building trust with patients

  • Remember—Don’t make the patient repeat their issues and concerns to each person who comes in the operatory or even at each visit. Learn how to do a good handoff and take good notes so the patient feels heard and valued.
  • Tone—Pay close attention to how you sound; maybe even practice and record yourself. No one wants to feel judged or blamed for their condition.
  • Open-ended questions—To keep the lines of communication flowing, avoid yes/no questions. Use phrases like “Tell me”... (about how you care for your teeth on a daily basis), “I’m curious to know”... (what has kept you from coming to the dentist for so long?), “If you could”... (wave a magic wand, what would you want your mouth to look and feel like?)
  • Permission—Before jumping in with information, ask the patient if they would like to hear recommendations/options. They might be overloaded with information or simply not ready to process what’s happening.
  • Show—Get the patient in on the process. Show them what you are seeing on the x-ray, get out your intraoral camera, or you can even take a picture of something with the patient’s phone. It’s much easier for them to own their condition once they’ve seen it.

The takeaway

Take these tips and discover the best way to practice given all the limitations that challenge you. Remember that as a dental hygienist, it's OK to be perfectly imperfect!

Amanda Hill BSDH, RDH, has been in dentistry for over 25 years. She currently practices part-time clinically and is an industry educator for DentalPost.net. Recently she begun is sharing her passions by writing for dental companies and magazines, She is a member of the advisory board for RDH magazine and is hosting her very own podcast on the Dental Podcast Network! Amanda is a proud RDH, Navy spouse, and mom of three, and is intent on spreading kindness wherever she goes.