QUESTION: I have a dilemma that has troubled me for years no matter which office is in question. How is a dental hygienist to deal with a patient who has been previously treated by another hygienist who has been less than thorough? Keep in mind that a proper scaling requires extra time that is not scheduled, and bringing the patient back incurs extra fees, as well as added discomfort that the patient may experience. Many thanks for your enlightenment!
ANSWER FROM HEIDI ARNDT, RDH, BSDH, of EnhancedHygiene:
There are times as dental hygienists where we see patients and question the quality of their previous dental care. There is no doubt this situation can often leave us with a pit in our stomach, and make us question what our next steps should be.
First of all, no matter the history of the patient in your chair, you must start with completing an assessment on every patient. If this is your first time to see the patient, you may need to spend more time completing the assessment and connecting the dots on the patient’s current oral health. Your thorough assessment will ensure the patient receives the appropriate care; the care you and your doctor feel is appropriate for this person.
Your comprehensive assessment will provide you the information necessary to suggest the best treatment options possible. If during the assessment the patient presents with signs of gingivitis or periodontal disease, you will need to address your findings with the patient.
“Mrs. Smith, what I’m seeing in your mouth today is…”
“Your oral health has changed since we saw you last…”
It is important to focus on the oral health of the patient as the person presents to you, that day in your chair. If the patient presents with signs of gingivitis or periodontal disease, then you must treatment plan accordingly. You should not complete a “super prophy,” especially if the patient shows signs of disease. As a rule of thumb, if you spend one hour scaling a bloody mouth, then you are providing more than a prophy. Remember, a prophy is designed for healthy patients only. No matter what your assumptions may be on past care, you should not provide a “super prophy” to make up for something you believe a previous dental hygienist missed. Use the evidence from your comprehensive assessment and treat accordingly.
Second, throughout your career you will run into situations where you feel the previous dental care may have been substandard, and is ultimately attributing to a person’s current oral health issues. However, you cannot always be sure this is the cause, especially since oral health can change rapidly based on the patient’s overall health, medication, home care, etc. We need to make treatment recommendations to get them back to health based on what we observe during the assessment.
As unfortunate as it is, we will see patients that we feel received substandard care in the past. However, there are many circumstances that could have contributed to this past care. For example, maybe the patient was informed of his or her oral health, but insisted on having a “cleaning” for financial reasons. There are many circumstances that come into play with each patient. We need to do our part by educating patients on what we see that day. Our ultimate goal is to help people gain or maintain optimal oral health. But remember, each patient has the right to choose the level of care they want.
I hope this is helpful.
ANSWER FROM ANDY CODDING, RDH, AndyRDH.com:
This is always an uncomfortable situation when seeing patients that are not typically "yours." The same can be said about finding evidence of untreated periodontal disease. You have to keep in mind that no one is forcing these patients to come to the dentist. They come of their own free will and without them, we would be either unemployed or underemployed. The quickest way to scare away a patient from returning to your practice is to insinuate that they are receiving substandard care.
Truth be told, we don't know what their previous appointment was like. We didn't see what they looked like prior to the other hygienist’s treatment. We don't know what the schedule was like, the patient's tolerance level, sharpness of instruments, bleeding and inflammation levels, etc. Don't throw anyone under the bus by saying anything to a patient, even though you may be thinking it. If it's something you see constantly from a certain provider, then a discussion with the dentist could be warranted so the dentist understands the need for more time on your schedule.
I feel a polite phrase such as, "Mr. Jones, you have quite a bit of buildup on your teeth (and anything else that needs to be said here). There could be various reasons for this and some of them can include your homecare, diet changes, or changes in your body chemistry and saliva pH, and other issues. To perform the thorough treatment you're paying for and deserve, you and I both need a little more time than what's scheduled today." Don't be guilty of saying too much. If you say it with confidence, without hesitation, and put the ownership of the patient's condition on the patient, then in my opinion you've done everything necessary.
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