Content Dam Diq Online Articles 2016 08 Dental Office Hygiene Thumb

I replaced a dental hygienist who was fired for ignoring perio

Aug. 18, 2016
When this RDH took a job in what she believed was a periodontially focused office, she was in for a surprise.

Replacing an adored, seasoned dental hygienist is a challenge many hygienists face in their careers. Replacing the dentist’s RDH sister, who was fired for ignoring patients’ periodontal conditions for over a decade, is an even greater feat.

I had the opportunity to start in a new practice, which was described as being periodontally focused. My excitement builded knowing I’d be surrounded by colleagues who shared my passion for health. Unbeknownst to me, the office’s new mission statement would be shared with patients for the first time at their next hygiene appointment. The initial interview did not indicate any of the drama that was about to unfold.

“Bleeding and pus-filled pockets were ignored for far too long.”

Most patients do not realize that a loved hygienist has left until they return for their next appointment. I could see the look of abandonment in patients’ eyes as I met them for the first time. The familiar room they had known for years was about to change into foreign territory.

Fun hour-long chat sessions were replaced by appointments consisting of blood pressure readings, periodontal exams, oral cancer screenings, and intraoral photos. I began to realize that the procedures I had done for almost 20 years were foreign to my patients. The education they needed took longer than the 60-minute could provide. Lightning-bolt glares from the front desk shot at my back while patients continued to line up in the waiting room.

READ MORE | Hygienists can't treat perio effectively, dentist looks other way

It became clear within days that periodontal disease was under-diagnosed and ran rampant in this office. I could only surmise that periodontal readings had been typed into the computer without having been done. As the probe sank to depths I hadn’t seen in years, my stomach sank even more. The numbers jumped from 3 mm to 7 mm on the screen. Mounds of burnished black calculus seemed to be the cement holding teeth in the patient’s head. Bleeding and pus-filled pockets were ignored for far too long.

Patients complained that I was poking them and causing them to bleed. They became angry about the time wasted doing an exam they didn’t understand and didn’t ask for. Patients did not believe that the changes happening in the office were for their benefit.

Each day felt like déjà vu. Genuine conversations with my patients were difficult. They seemed to start and end the same way. Every. Day. You have periodontal disease. No, I didn’t cause it by doing the gum exam. I don’t know why the last hygienist didn’t tell you. No, I do not work on commission. Fine, I’ll let the doctor verify my findings and tell you the same thing I just told you.

My confidence wavered when patients asked me to leave the room so they could speak to the dentist privately and tell him that his new hire didn’t know how to do her job. Remaining on schedule was daunting as the exams went from talking about patient care to patients having lengthy conversations with the doctor about what they perceived as negative changes in the office.

“She was their friend. I became the enemy.”

The changes weren’t easy for anyone. The dentist was tiptoeing through difficult conversations with patients. He had to tell them why their disease wasn’t discovered earlier without throwing his sister—or himself—under the bus. The phones rang off the hook with patients asking us to transfer their records to the office where their beloved hygienist had been hired. The front desk assistants were bombarded with calls to insurance companies to determine periodontal coverage. All while patients were grumbling about wanting to get what they’d always been given—bloody prophies.

I began to feel set up. I took this job expecting patients to be well controlled or at least told that they had issues. The last hygienist inadvertently ruined my reputation by doing the bare minimum. Patients saw her as being the ideal hygienist who didn’t make them bleed or tell them anything was wrong. She was their friend. I became the enemy.

READ MORE | Perio maintenance or managed neglect? Why are we watching and waiting before referring?

My anger towards her did not help me form relationships with my new patients. I became defensive. It was hard to not take patients’ negative reactions personally. I started to doubt my own clinical assessments and wondered if my chosen career had been the right one. My drive to work was filled with feelings of impending doom.

One day, after being called a “used car salesman” when presenting periodontal therapy to one patient and being called a liar when I told another that she had gingivitis, I realized my approach had to change. Months of banging my head into a wall had to stop. Lecturing didn’t work. Selling expensive periodontal treatment plans without patients seeing evidence of the disease didn’t work, either.

I decided to stop presenting periodontal therapy. Not because they didn’t have disease, but because they needed time to feel the grief of their loss and understand the new procedures being performed. I began asking what they would be willing to do to get healthier and negotiating with them to try new home-care regimens. Patients seemed to respond better when they felt they had control. Gums would be reevaluated at the next visit. They were told they had periodontal disease but they were given a chance to improve their oral health on their own before treatment options would be presented.

Some patients got healthier. Some did not. The patients who improved were excited to see pockets and bleeding decrease as a result of improved home care. The ones who didn’t became angry at the true enemy, bad bacteria. Validation came when they realized that the bleeding gums their last hygienist reassured them were OK actually were not. BINGO. Enlightenment. They finally got it.

Months passed and positive changes continued. I was slowly being seen as an advocate instead of an adversary. Patients began asking questions about their health and wanted to talk about their progress. The doctor started humming again as he did his hygiene exams. The stress between staff members melted away as patients were seen on time and left with a smile. It didn’t happen overnight but the drama did settle.

READ MORE | Redefining conservative: Explaining the need for perio treatment to patients


Many hygienists will find themselves during their career filling in the shoes of a loved long term hygienist. Most will not be in a position in which a dentist fires a family member and the office philosophy of patient care changes dramatically. Our job is to connect with patients in a professional way to help them make educated decisions about their own health, not to be their friend.

Virginia Carroll, RDH, BS, is a dental hygienist who describes herself as an oral health-care coach having worked in private practice for over 15 years. Dedicated to dental and medical collaboration, she has spent time educating pediatricians and cardiologists about the role oral health plays in treating their patients. She believes that an informed patient becomes a healthier patient. Virginia Carroll is a pen name.