Things I wish I had known 30 years ago
Author outlines some of the things she wishes she had learned earlier in her career as a dental hygienist.
By Sandra Voelker DeLong, RDH, BS
The boss is ... the boss.
Unless you work in a state permitting independent practice, you will be employed (contracted by, temping for, etc.) by a dentist. The majority of dentists have worked hard to establish a practice; it is their heart and soul. They have fixed ideas of how they want things to operate.
Therefore, do what is asked of you. You may not be 100% "into" some of the ideas, but go with the flow. Practices are all unique. Embrace the ideals of each one. That's what you are getting paid for.
Along with that, always praise your dentist. You are part of a team; speak about your fellow dental team members as you wish they would speak about you. Do not criticize or question in front of patients, saving those issues for a later private moment.
You may think that a certain course of action is the perfect solution to a problem, and then the dentist will have a completely different idea. Accept that they are the boss and discuss it later, listening to the reason.
You can't change anybody (for the most part).
I worked for a wonderful dentist who told us, "We are not here to fix people; we are here to do dentistry." You can make yourself crazy trying to convert every patient into a completely-compliant-totally-healthy dental patient.
Sometimes you will succeed! It's great when it happens — the hygienist’s dream come true. Now this patient has great oral health, has reduced those pockets, no bleeding, has fresh breath, has quit smoking, and even ate their vegetables! Go you!
Then, there is reality. No matter what kind of great advice you offer, presents you place in the goody bag, or threats of doom and despair you throw at them, these things will have absolutely no affect on some people. Next appointment: same situation. No change. Not a bit. Still smoking, bleeding gums, "that tooth still hurts,” thick plaque, not flossing. Ugh.
Here are my little bits of advice, for what they are worth. First, be grateful they are coming to see you. It's good for them, they realize the benefit of it, and it's why you have a job. They come to you to do what they cannot do themselves; you are the expert at this.
Second, don't nag or criticize. Offer advice and recommendations, keep it simple, smile, and schedule their next appointment. We all know that routine daily maintenance is the secret. It's important to us, and it's what we want all of our patients to embrace.
Third, the mouth is a very private thing. Yes, a good smile is one of the first things noticed about someone, as is a bad one. People are very sensitive about their mouths, and embarrassing a patient by pointing out trapped food, stains, crooked teeth, or bad breath will get nothing but resentment and backlash. Unless they are absolutely clueless, they are aware of these situations.
To us, it's a mouth, a job, a thing to be cleaned. To the patient, it is a private orifice, a reflection of themselves. Respect that. Be tactful. If they are concerned about an issue, they will bring it up. Ask if they have any concerns, offer the appropriate solution, and then let it go.
People will do exactly what they are motivated to do when it is important to them. Period. If you can guide them to better health, fabulous! But when Mr. Jones shows up again (thick plaque, coffee stained, chicken between 14 and 15), smile at him, thank him for coming, and get his smile into the best shape you can. Make him feel good about seeing you, glad he got his teeth cleaned, don't they feel great?
Eventually, the change will come. And if it doesn’t? Well, you have done your part in keeping things as good as they can be.
Guess who’s on the schedule?
There are some patients that you should be fore-warned about. If you can, have a private system that lets you know about these special patients in advance of an appointment, it keeps you from getting frustrated and allows things to proceed smoothly.
- The Looker — We all know that during an appointment, we are mere inches from our patients’ faces. This patient will spend the majority of the time looking right at you, almost studying you. You think “You know I can see you looking right at me.” It’s a bit odd, but they usually mean no harm. You are just in their personal space. Oh, and try to make sure your glasses aren’t reflective, they may be watching what you are doing and getting grossed out.
- The Drowner — Study all the fantastic types of suction available to us, and keep a few things on hand. For some patients, having any liquid in their mouth makes them feel like they are choking. Consider allowing them to hold the saliva ejector, and then just work around the constant vacuuming. An assistant can possibly help during ultrasonic use, but have the patient turn their head toward you to assist in the run-off — above all, be patient.
- Tight Lip — Everything is tense from the patient’s toes to the tip of their head. Lips are almost white in a tiny “o.” The tongue is clamped protectively over the lower anteriors. You will struggle the whole time while soothingly repeating, “Please open wider and relax.” Sometimes you can place the mirror against the gingiva so the patient feels discomfort as they tighten, but for the most part, take very frequent breaks and keep on keepin’ on.
- The Catfish — Here everything is loose, mandible slack and dropped back. No help whatsoever with the suctioning, and possibly allowing water to overflow down the cheek onto the neck. Keep a towel handy.
- The Blamer — All the discomfort this patient is feeling is your fault. They had no pain until you caused it. Their last hygienist never hurt them like this. They give you the evil eye the whole time. They know, down deep in their heart, that this is uncomfortable because of their own lack of home care, and may be embarrassed about it. All I can offer here is to do your best to be gentle, soothing, and reassuring. Oddly enough, these patients will often become your most faithful, requesting to see you every time.
- Momma’s Little Angel — This child never drinks soda, always brushes and flosses twice a day, and never eats candy. Yet their teeth are dis-gus-ting. There hasn’t been a brush in there for a week. Add braces … oy vey! Tread lightly here. Mothers often see their children as a reflection of themselves, and open criticism can make a bad situation worse. Evaluate the situation, offer easy solutions, allow the mother to see a positive outcome. If the child is truly in danger of serious decay (already has cavities, decalcification, and severe gingivitis), then you may want to use disclosing solution and demonstrate home care in a caring, concerned way. Take the age of the child into consideration, and hope for the best.
- Insurance Only and When it hurts — These uphill battles are frustrating for the entire dental team. Some patients will only allow services that are covered by their insurance (preferably at 80% or more) no matter how desperately they need other work done. Make your best recommendations, try to work within their insurance limits, and then expect to be shot down. Document your conversations well. And if you ever figure out a solution to this, let us all know.
- Oh, Hello Doctor! — You asked about changes to the medical history: “None.” Problems with your teeth or mouth? “No.” Any concerns? “No.” Commence with prophy appointment. The doctor comes in for the exam. ”Oh, hello Doctor! Ever since my car accident after the heart transplant, all my upper teeth ache when I eat bananas.” Really?!? Yup. It happens to all of us. Remain calm. Deep breaths. You are not alone.
Don’t be a diva.
You may have considerably more education and experience than everyone else in the office, but you are not a princess. Clean up after yourself, offer help when you can, and be part of the team.
Females dominate our profession, and drama can take over a practice quickly. This is never good. Study your co-workers, and understand their talents/struggles. Be kind, be helpful, and be the co-worker you want to work with. Be a diva, and you will stand alone.
Consider reading: Human Resources for Dental Offices: I-9 forms, and payroll debit cards
It's not all about the money.
In my part of the country (the Deep South), dental hygiene is a pretty decent living. You aren't going to be rolling in dough, but you can do quite nicely. If you are really lucky (and smart), you will find a practice that pays well, fits your style, has a great staff, and just makes you happy to go to work.
But that’s not always the case. Some offices are very high speed, some are very money driven, and some are very laid back. When you are offered a position that pays much more than what is the norm for your area, step back and ask yourself “Why?” Is it high pressure, high volume, really strange hours, difficult staff, dentist is a jerk (there are a few out there), long drive, very exclusive/quality area? Be honest with yourself. “Can I do this? Can I be a salesperson? Can I deal with the doctor’s bad temper? Can I work until 9 p.m. four days a week? Can I do 12 adult prophies in an eight-hour day?” There is a reason for the higher pay, figure out what it is, and if it is something you can handle and flourish in, then grab it with both hands!
But if not, please give it some serious thought before accepting the job. Practices with high pay and high turnover are that way for a reason, and you truly don't want to be miserable.
Sit up straight.
Remember what we were told in school: "Sit up, use correct hand motion, find the fulcrum ... blah, blah, blah.” Hmm, turns out, they were right. Your back, hands, and eyes should be treated well; they are your most important tools. Wear good gloves, keep your back in good condition, and wear whatever eyewear you need to be able to see. Invest in the loupes, find a good chair, sharpen and organize your instruments, arrange your work environment to suit you, and hold your instruments properly. Keep your body in decent shape outside of work by doing some form of exercise and eating well.
Trust me, not taking care of these basic things is the downfall of so many of us.
Practices run the gamut from very basic to ultra-high tech. I’m not saying you need to know it all, but I do advise you to read dental hygiene magazines and explore products at conventions. Talk about what’s out there and available. Know the basics of operating the major dental software systems (Dentrix, Eaglesoft, Dexis). Things change fast in this industry and you need to be able to job hunt with confidence and answer patient’s questions without sounding clueless.
I have been in the dental field for a long time, and I hope I have given some food for thought. Be kind, be generous, and don’t be a diva. Be understanding and compassionate. Take care of yourself, your tools, and your office. Enjoy our profession. I wish you the very best in it.
Sandra DeLong, RDH, BS, graduated from Armstrong Atlantic State University with an associate’s degree in dental hygiene and a bachelor’s degree in biology. She currently practices at Kennestone Dental Designs in Marietta, Ga.