© Koldunova Anna | Dreamstime.com

Troubleshooter: Getting real about poor infection control, overbooked schedules

Oct. 19, 2021
This hygienist knows she needs to talk about some of the things she's seen, yet she dreads having an uncomfortable conversation. Check out the communication model that Amanda Hill, BSDH, RDH, says can help ease these sticky situations.

Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to [email protected].

QUESTION: I’m a hygienist and I’ve been temping in different offices. I’m noticing a trend that I’ve never seen before. We did not do this in the offices where I worked before. The trend is using extension cone paralleling (XCP) for x-rays, wiping them with CaviWipes, and then placing them in another person’s mouth. The staff is given only one set of XCP to be used by the entire team, so they don’t have time to run them through an autoclave and sterilize them properly. It makes me very uncomfortable that they do this.

Another thing I’ve noticed is offices that take Medicaid overbook the hygienists in case some patients don’t show, but if all the patients show, they’re all treated. In one instance a hygienist told me she and her assistant saw 23 patients. That’s about three patients per hour, and that seems ridiculous to me. I don’t understand this, and patients aren’t even aware of all this. Many times, patients expect to be in the office for only 15 minutes for a cleaning! I’m disgusted by this because people have no idea what type of care they’re getting. 

ANSWER FROM AMANDA HILL, BSDH, RDH, amandahillrdh.com.
Thank you for sharing your concerns. You are absolutely right to feel uncomfortable about these things. As dental professionals, we are educated to follow infection control guidelines and protocols. X-ray positioning devices are considered semicritical because they come in contact with mucous membranes and are designed to be heat tolerant. Therefore, they must be sterilized by heat according to the instructions for use and the Centers for Disease Control and Prevention (CDC) guidelines for dentistry.1 Gone are the days of putting x-ray holders in cold sterile and considering them clean. They need to be bagged and sterilized between each use.

This is something you will need to address with your team. It’s often hard to have conversations that we perceive might be confrontational. There’s always a chance they don’t know better or don’t understand the why behind the regulations.

More popular Troubleshooters

To report or not report poor and inconsistent infection control
Hygienist upset at claims of painful dental cleaning
What are a 15-year-old's "dental rights"?

In our office, we implemented a communication technique called the Awareness Wheel to give us a guideline during difficult conversations. Having a model to use is much like having a standard operating procedure (SOP) in the op. Using a model like this helps us respond to any issue in a calm, fact-based, and thoughtful manner. 

Here’s an example of how to use it:

Fact: I notice we’ve been wiping down the XCPs with wipes between patients. According to the CDC dental guidelines and the instructions for use of the product, we should be bagging and heat sterilizing them between each use.

Feelings: I feel like we are cutting corners when it comes to infection control. 

Imagine: I worry that we could potentially harm patients or get in trouble if we are inspected. 

Need: I need our team to agree to follow proper infection control guidelines to protect our patients and office.

Agreement: Can we come to an agreement?

Perhaps coming at these issues with a clear SOP will give you the courage to point out the issues and come to a proper resolution. 

When it comes to what you’ve heard about Medicaid practices, I understand your feelings here also. As health-care professionals, we want everyone to receive comprehensive quality care, and when we hear that’s not happening, it’s easy to get frustrated. I like to give the benefit of the doubt whenever possible, and I hope this office is working hard to figure out how to strike a balance between keeping their schedule full so they can successfully run a business and providing excellent care for their patients regardless of how they pay for it. But I know that isn’t always the case. 

I worked in a Medicaid practice when I was in hygiene school, and it was some of the most fulfilling work that I’ve ever done. The opportunity to provide care for those who have been overlooked in our system gave me a real sense of pride. But had it been run the way you discuss here, I’m not sure I could have stayed in that environment. Public health often has the stigma of providing substandard care. I’m proud to say the public health dental professionals I know provide above-and-beyond care to their patients.  

May we all be dedicated to our profession, be able to communicate effectively, and be able to do the right thing no matter who is watching. 

Best of luck!


  1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings—2003. MMWR 2003;52(No. RR-17):[inclusive page 3]

Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to [email protected]. for the experts to answer. Remember, you'll be helping others who share the same issue. Responses will come from various dental consultants, as well as other experts in the areas of human resources, coding, front office management, and more. These folks will assist dental professionals with their various issues on DentistryIQ because they're very familiar with the tough challenges day-to-day practice can bring. Inquiries will be answered anonymously here on DIQ.