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The inner hygienist never dies: One former hygienist's thoughts difficult patient education situations

April 5, 2018
Can you quit the habit of telling others to quit? One former hygienist found it harder than she expected, especially when it came to spit tobacco. The experience caused her to reflect on some of the more difficult aspects of dental hygiene patient education.

The moment I walked away from my 15-year hygiene career to pursue another passion—writing fiction—I thought that would be the last of my instructing people over their home care and “bad habits.” I knew I’d probably still hector my one brother about his smokeless tobacco habit and other family members about the importance of flossing, but I really thought I’d leave other people alone. And I did for a long time. I really did.

Let’s go back to my brother. He’s used spit tobacco for years. Started when he was in college and has never quit. He’s made a few attempts (half-heartedly, in my opinion) but has never kicked the habit. And here’s the thing. He really doesn’t want to. He used to live in Indiana, so the only time I had to “educate”him was when he came back a week in the summer and then again at Christmas. I’d tell him all the gory things I could think of—one time even telling him that once he got to heaven, God would make him go to hell when he needed to spit. (I know. That was a low blow even for me.) He took all this in stride. But his wife was the one who kept me on course. She told me not to quit. Not to give up on him.

Then they moved back to Kansas. I had more time with him and as we’d sit and talk, he’d take a dip and then spit into a pop can. Now that’s hard to watch and not say a thing. And boy, I tried everything to get him to change, somehow believing that with the right words, he would give it up.

But I finally quit. And this is why. I didn’t want him to dread seeing me. To cringe when I walked in the door. Therefore, I haven’t mentioned it in a long, long time. In fact, when he’s at my house, I’ve even given him a can to spit in. Yes. Yes, I have. I’ve become an enabler. So, I thought I was done with the “chewing lecture” until my husband and I went with a group of strangers to New York. We enjoyed everyone on the tour . . . well, there were a few I could’ve done without . . . but we had a great trip.

One day as I was standing outside waiting to get back on the bus, I saw one of the younger men stuff a wad of tobacco in his mouth. I started to let it go, but then that hygienist in me just burst forth. I asked him how long he’d been chewing. Too long was his answer. About this time, his wife joined us. I shared a few tidbits, but nothing overbearing since we still had several days of the tour left, and I didn’t want him to avoid me the rest of the trip. His wife said nothing, but he laughed a few times, and then informed me that he enjoyed it and wasn’t interested in quitting, thank you very much. It ended there, and we got on the bus.

That evening as we were all together for the evening meal, his wife took me aside and thanked me. She then got all tearful and said she was going to have their young granddaughter talk to him. That seemed like a low blow but nothing worse than I’d done in the past. Sometimes shaming works especially if it’s from a young family member. But then she said the thing that broke my heart. He refused to go to the dentist because he didn’t want to hear “the lecture.” Didn’t want to hear another conversation about his chewing habit.

That brought back a memory, and I wince every time I recall it. I had a patient who after years of smoking finally quit. His teeth, which were normally tobacco stained, were pretty much stain free. When I mentioned this, he said that he’d quit smoking. He was so proud of himself, and I bragged about him when the doctor came in to do his exam. I wrote a detailed note in his chart. At his next appointment, I could tell that he’d been smoking just from the smell of him alone. As I updated his health history, I asked about his smoking. He said he’d never quit, and he didn’t know what I was talking about. When his appointment was over, he asked to be scheduled with the other hygienist. I never had him for a patient again.

What went wrong? What did I do that alienated him? Should I have simply made a note in his chart that he’d started smoking again and never called him out on it?

So, what’s a health-care professional to do? Not have the discussion? Are we inadvertently turning people away? But on the flipside, we can’t ignore what’s in front of us and not have the conversation.

All this has got me thinking. Why does smokeless tobacco bother me so much? Why can’t I leave users alone? There’s no secondhand smoke. They aren’t drunk and acting inappropriately. A chewer has never spit on me although they may have wanted to. I wouldn’t go to an overweight person and tell them that third donut is totally inexcusable. But just seeing that round tin, that small hockey puck, in the back pocket of a man’s jeans sets my teeth on edge. So why this obsession with chewers? I can’t answer that. Maybe it’s because I’ve seen what it does in the mouth. How it changes the tissue. That mouth cancer is just dreadful.

Where does this leave me? Well, in quite a quandary. Since I’m no longer a practicing hygienist, I’ve found another way. Another avenue where I can teach (preach), hopefully, without intimidating. As a fiction writer, I’m having a hygienist in every book. I haven’t had a character yet who’s a habitual user, but I’m thinking about it. Will that hygienist get him to quit? Who knows? But it’s worth a shot.

Linda Cookson, RDH, received her dental hygiene degree from Wichita State University. In 2011, she quit her job to pursue a writing career. The Mortician’s Wife is her debut novel. Small Details is due out in late 2018. Her website is, and she can be contacted at [email protected].