Traditionally, a superhero is a fictional character noted for feats of courage and nobility with a colorful name, costume, and abilities beyond those of normal human beings. The superheroes of this article practice dental hygiene in a variety of office settings, and perform feats beyond the “accepted” mentality of many hygienists. These superheroes of hygiene are grassroot hygienists who fight the daily fight against periodontal disease and the loss leader mentality that surrounds the dental hygiene department.
This article is not structured to tell you how to perform clinical dentistry. You, the reader, are the expert on that. I will explore two qualities that all superhero hygienists have in common. If you can understand and apply these ideas to your business, your dental hygiene department will shore up.
Hygienists take “it” personally
According to the American Dental Education Association, the number of dental hygiene students in 2004 tallied 16,354. Of this amount, roughly 92 percent are female. By nurture or nature, the majority of registered dental hygienists embrace their role as caregivers. Generally, dental hygienists have a high likability bucket that rarely gets filled by dentist-employers and/or team members. They are tired of being thought of as the black sheep of the dental team. The mind-numbing words that are used to describe hygienists (prima donnas, mouth maids, gum goddesses, militant hygienists, etc.) are really old and tired. Hygienists are working hard to gain control of their reputations and profession. They are handing in their “cleaning tools,” and plowing ahead as researchers, skilled clinicians, and educators. So, respect is, what respect does. Consider filling your hygienists’ likability bucket daily. If you don’t, your patients probably will.
To say that many hygienists are socially connected to their patients is stating the obvious. I believe that hygienists could be used as informants for the FBI or CIA. We know and remember who is married to whom, what colleges a patient’s children are attending, who is engaged, family vacations, triumphs and tragedies. Name something going on in a patient’s life and the hygienist knows about it.
This connection translates into a wonderful marketing advantage when doctors support the goals of increased hygiene appointment time and effective communicating. Superhero hygienists are achieving the “art of prioritization” in clinical procedures and communication in the hygiene appointment. They know how to build a relationship, visit socially, and do all the catching up in a concise amount of time. We have heard it said: “Quality care begins with a quality hygiene exam.”
So in order to move your hygienist into superhero status, invest in the time allowed for each hygiene service. If you consistently schedule only 45 to 50 minutes per hygiene visit, you may need to revisit your philosophical approach to hygiene. When hygienists begin an appointment with inadequate time, it lends itself to settling for spot probing (or no probing) rather than complete periodontal charting, or to four horizontal bitewings instead of a full series. Then, the “cleaning” is quick in order to get a patient in and out of the office so things stay on schedule! If this system is repeated often enough, patients end up coming and going with squeaky-clean clinical crowns, but the teeth often rest on top of a diseased foundation and office philosophy.
A superhero hygiene exam includes reestablishing the relationship with a patient. This includes social graces for a few minutes; a review of the patient’s dental and medical history, noting any potential systemic risk factors/connections to periodontal health; addressing patient questions or concerns; intra- and extraoral cancer screening with adjunctive technology; comprehensive periodontal charting; intraoral photographs and radiographs; and an analysis of occlusion, teeth, and existing restorations. Many consider this the minimum amount of information you need to render a periodontal diagnosis and treatment plan. The extended time frame has a significant return on investment with a correlating increase in periodontal therapy and diagnostic procedures, especially when billed appropriately to the patient.
This commitment to the hygiene schedule will not cause an immediate cease in dribble conversation. (I define dribble or gossip conversation as useless conversation that continues throughout hygiene visits. It is an inappropriate use of time, and it doesn’t move the patient closer to oral health goals or treatments.)
If you now employ a “Sam Social” or “Suzie Social,” let this person know that you want him or her to assess each patient, and catch and treat as conservatively as possible any periodontal or restorative changes. This approach, although the hygiene professional’s standard of care, is rarely supported.
“I thought I was getting a cleaning?”
Effective communication is a comprehensive subject to tackle. For this article, I would like to address the confusing semantics sometimes heard in dental offices. The hygienist uses terms such as “infection” and “nonsurgical therapy” when talking to patients. During the examination, the doctor uses the terms “inflammation” or “root planing.” Then the patient is handed off to the appointment coordinator to discuss financial arrangements, and the treatment is called “deep scaling” or “quadrant scaling.” The patient wants to think about the proposed treatment, and does not schedule a follow-up appointment. Why? Patients are not sure what they are scheduling, or to what therapy they are agreeing. Hygiene consultant Karen Davis states, “Clinical semantics must be clear, consistent, and not too technical to achieve effective patient communication - no matter which office professional is educating the patient or answering questions.”
During the next team meeting, make a list of the most common words used to describe your services, treatments, reasons for therapy. Begin by making sure all team members are speaking the same language. By providing more time within the hygiene appointment for complete data collection and supporting effective communication, a hygienist is on his or her way to becoming a hygiene superhero.
Know your boundaries
We have read reports that dental schools are graduating fewer dentists, and that the edentulous rate is continuing to drop. Plus, according to authorities, 52.7 percent of those ages 17 and older have some form of gingivitis, while 24.9 percent have severe periodontal destruction with at least a 1 to 4 mm pocket.
If this is indeed true, with the declining dental labor pool and increasing consumer importance on prevention and intervention, I maintain that dental hygienists will expand their scope of practice. Politics aside, educated, registered dental hygienists will emerge in alternative practice settings, solo practices, mobile units, interdisciplinary medical care, etc.
With this premise, the superhero hygienist is already aware of these trends and continues to seek education, whether academically or through researched-based continuing education articles and programs.
While dentists are currently the main employers of hygienists, some say that periodontal disease is not their first “love” (which is not the case for hygienists). Thus, I encourage hygienists to have a clear and easy-to-use periodontal treatment protocol that is based on science. This system should be arranged so that the hygiene team can implement it and believe in it. If a dentist is attempting to ask a hygienist to (hypothetically) drive a new sports car, and then holds that person accountable for the laps traveled and wins earned - yet neglects to provide an engine because the dentist does not have the time or the inclination to develop such a system - the hygiene department will not be high-achieving. Rather, it will repeatedly crash and burn. So by doctors knowing your boundaries, if you are not 100 percent sure that your current perio program includes, for example, emerging research about the connection between periodontal disease and total health, then “delegate, delegate, delegate.”
After committing to healthy foundations, the next step is to review the following “ingredient” checklist in order to develop an easy-to-understand perio protocol:
- Latest AAP papers and academy reports
- Knowledge about evidence-based dentistry, Web sites, articles, clinically relevant information
- Biological diagnosis and treatments
- Ultrasonic instrumentation
- Medical vs. the surgical model
- Pharmacological solutions
- Locally applied antibiotics and varnishes
- Salivary engineering
- Periodontal risk factors:
- IL-1 genotype
- Tobacco use
- Pharmacological and homeopathic meds
- Systemic diseases
- Diabetes, CVD, HBP
- Pre-term, low birth weight
- Occlusal discrepancies
- Inadequate oral hygiene
- Diet, nutrition
If this task seems too arduous, determine if one of your budding hygiene superheroes is interested in tackling it (with pay, of course). You also could hire a hygiene consultant to get the department on track, or rely on a hygiene manufacturer who may be able to jump-start your task with an already-developed protocol that can easily be adjusted to meet a specific office’s philosophy and/or goals.
Since this article is geared to periodontal superheroes and how their employers support the journey, yet I would be remiss if I did not mention that dental hygiene goes beyond the gums. In order to continually have a healthy hygiene department, a practice should consider a mix of procedures. This could comprise cleanings, generalized and localized periodontal therapy, periodontal maintenance to include locally administered antibiotics, pain management to include syringe-delivered, topical subgingival agents, sealants, caries management protocols, whitening, desensitizing therapy, temporary occlusal guards, and self-care products. This is a brief list of the services and not necessarily the armamentarium that a full-service hygiene department can expect to provide.
Hygiene superheroes also understand when to position the oral health report in the hygiene appointment, and how it can be delivered with more value so the patient will realize the importance of continuing with care.
Traditionally, patient education has been left to the end of the appointment. If there is a time crunch, it is often omitted, or reduced to a 30-second “brush and floss” commercial. An alternative approach to breaking this boundary would be to present the patient findings before any hygiene instrumentation takes place. If applicable, the hygienist can begin with “I have noticed an area of concern on your medical history that I would like to discuss with you. With the emerging research that connects a mouth infection with a corresponding effect on the entire body, XYZ may put you at greater risk for periodontal disease.” Or you might say, “I have noticed an area of concern on your medical history that I would like to discuss with you. With the emerging research that connects a mouth infection with a corresponding effect on the entire body, your untreated periodontal infection may be negatively affecting XYZ.”
Second, since bleeding tissue is currently the most applied evidence of disease activity, a hygienist and patient should evaluate the tissue response together. Again, prior to any hygiene instrumentation, a superhero hygienist may say “Let’s take a look at your tissue response.” This phrase should replace “How are you doing on your flossing?”
Positioning this education first, before instrumentation, automatically eliminates a patient’s thinking that bleeding is the hygienist’s fault. Before implementing this technique, I heard from my patients many times, “Well, if you didn’t dig so deep, my gums would not bleed.” This statement tells the hygienist that the patient is transferring the blame for the infection to the clinician. Patients do not fully understand the balance, or more precisely, the imbalance between the patient’s immune response that may be weakened by too many environmental or internal risk factors and the pathogenic biofilm, which has been given the opportunity to cause disease.
Another twist in traditional boundaries can be explored during the new patient examination process. If a new patient schedules an appointment with the doctor (please check your state practice acts as to who is required legally to see a new patient first), consider during the initial examination having your registered dental hygienist enter the operatory. You can then introduce the hygienist to the new patient. This can be achieved by saying, “Catherine will be handling your hygiene therapy appointments. She is my eyes and ears when it comes to your oral health. Keeping appointments and following through with your home-care regimens may decrease your cost and time spent in my chair with drilling and filling. I am completely confident in Catherine’s ability, and I am sure she can support your goals for periodontal health.”
I started this article with the theme of hygiene superheroes. I was part of the generation that was in “ahhh” of the lasso-toting, invisible jet piloting, bulletproof bracelet-wearing Princess Dianica. I was one of the lunchbox-owning, patriotic little girls who wanted to be Wonder Woman. Why? I felt she was the greatest female superhero of all time.
After all, Wonder Woman took on the Nazis, the Bermuda Triangle, assorted bad guys, and occasionally, aliens. Like so many hygienists who want to stomp out periodontal diease, I encourage you to consider this article’s main messages: “Hygienists take it personally” and “Know your boundaries.” If a dentist can connect better with a hygienist and encourage superhero strength and feats, patients will ultimately benefit. Then the hygiene department can ward off the villains of “loss leader” and “complacency.”
Kristine A. Hodsdon, RDH, BS, is the director for RDH eVillage, an online newsletter from PennWell Corporation. She is a hygiene marketing consultant and speaker who frequently contributes to industry publications. She has presented more than 200 lectures, both nationally and internationally, on topics such as dental hygiene marketing, the future of dental hygiene, and communication skills. Kristine is scheduling for her newest program entitled How to Address Patients “E”ase: Education, Entertainment and Emotions. She can be reached at KristineHRDH@Pennwell.com.