The Cosmetic Dentistry: Roundtable

March 1, 2002

Leaders in aesthetic dentistry and materials share their insights and knowledge.

We are continuing our discussions with leading trendsetters in cosmetic dentistry. Kristine A. Hodsdon, RDH, BS, has been changing the landscape of dental hygiene for the past 15 years as a practicing clinical hygienist, sales representative, author, and national speaker. She is a pioneer in aesthetic hygiene and also is the developer of Pre-D Systems™, a prediagnostic, computerized team software for comprehensive restorative and aesthetic care. Her international seminars push, prod, and provoke participants to reinvent team roles and professionalism. She currently writes a monthly column, "Esthetic Hygiene," in RDH magazine, co-authors a new team section in the Journal of Cosmetic Dentistry, is a member of the ADHA and AACD, and serves on industry advisory boards. She is writing her first book, Demystifying Smiles: Strategies of an Esthetic Team, to be published by PennWell later this year. For more information about Pre-D Systems™ or her programs, visit or email [email protected].

In this month's edition of the "Cosmetic Dentistry Roundtable," Kristine will examine the role of the hygienist in the dental practice. She has a number of strongly held views about that role and how it can influence the education of our patients.

Distinct or extinct: clarification for teams
Here are two of my many "Kristineology" mantras that I weave throughout my writing and speaking:

Show up, connect, and infect (not in the disease-transmission mode, but with enthusiasm, a positive attitude, and outstanding self)

Hygiene by design (taking initiative and eliminating the "would haves" or "should haves")

Have these messages always been well-received by audiences? No. But it is my observation that since many team members are not clear on what they want for themselves professionally and do not actually know what business their practices are in (i.e., smile design, periodontal, oral surgery, orthodontics, etc.), they can fall victim to going through their professional lives in a fog.

I often encourage team members to do some soul-searching to determine their professional goals, clarify their expectations, clearly look at how they function in their current practice, and make sure all aspects are in harmony. This will help to disarm the negative fall-out from a dysfunctional team and eliminate burnout.

Implementing a practice vision — for example, "to consistently provide comprehensive restorative, aesthetic, and periodontal care" — takes a team, one that holds a shared vision. Since the practice of dental hygiene is actually a practice within a practice, and dental assistants usually work interdependently with the doctor, it is imperative that all share not only values and goals, but also a vision of where they want to take the practice. This aligned vision is like a road map to the practice of their dreams.

How can all team players expect to end up at the same destination if they don't share the same map? If the doctor is heading down one road toward his or her personal and professional goals and another team member is driving in another direction — or, worse, has no direction at all — neither will create what they wish for. Both will feel dissatisfied and possibly underappreciated. A barrier to success in many practices stems from a difference between the doctor's vision and that of the team.

Aesthetic dental hygiene
I categorize aesthetic dental hygiene as a change in attitude and a purposeful design that includes aesthetics and restorative possibilities in all aspects of the hygiene process. The traditional assessment phase can be transformed into smile evaluations, which assess smile behaviors, products, smile zone, shade, size, and texture of teeth, lip line, gingival frame, etc.

When developing the dental hygiene diagnosis and care plan, take into account the clinical aesthetic and restorative needs, as well as the client's wants and desires. The products and prevention goals include what is best from the viewpoint of restorative dentistry and the client's health. The appropriate clinical instrumentation will preserve the integrity of the dentistry and management of disease.

Lastly, the implementation and evaluation will contain restorative management and renewal services in addition to periodontal health and stabilization. Aesthetic hygiene refocuses a dental hygienist's world from "the gums and below" to the "entire smile stage."

Hygienists as social influencers
Many hygienists are caring, loving professionals who genuinely enjoy the personal side of their profession. Hygiene sessions typically are scheduled at anywhere from two- to 24-week intervals, with appointment length lasting 30 to 90 minutes or more. Connecting with the client in a intimate, secure, and nonthreatening environment can provide immeasurably good outcomes. Hygienists are social influencers, who often have the freedom to talk about anything and everything with their clients, sometimes even at the expense of discussing dentistry.

Hygienists know who is divorcing whom, whose child attends which college, and so on, but ask them how their 9:00 a.m. client feels about proceeding with veneers and it may become very quiet in the room. Team members need to be compassionate and empathetic, but we should not become the "Dear Abbys" of the dental office. Our clients really do not want our advice in regard to their personal lives. The challenge lies in drawing that line in the sand. A team member can exchange genuine pleasantries, but always remember to redirect the dialogue back to the reason why the client scheduled the appointment in the first place. Once a team member distinguishes between professional banter and gossip, open-ended questioning about the client's needs can be initiated.

Once the team member begins oral-health-related conversations with clients, professional trust between the two parties is achieved. Then, educating and enrolling clients into comprehensive aesthetic and restorative dentistry is more easily attained.

"Selling" dentistry?
I often ask my audiences, "Do you present all aesthetic and restorative possibilities to 100 percent of your clients?" If the answer is no, I follow up with, "Why not?" One explanation that is very discouraging is, "I do not want to 'sell dentistry.' " Somehow, the "s" word became the ugly stepsister of dental hygiene. Another "Kristineism" is: Education is a marketing approach to selling dentistry.

Team members shouldn't try to convince clients to have elective cosmetic dentistry, but educating them about the clinical and functional reasons for upgrading older dentistry or scheduling nonsurgical periodontal procedures is our duty. Remember, there are millions of large, old, amalgam restorations in posterior regions that are breaking down or showing clinical signs of wear and microleakage. Instead of showing them to the client, we passively write in the chart "w" or "watch" or "no treatment at this time (NTATT)." Once we start to educate our clients on the clinical possibilities in posterior areas, for example, and on the merits of nonmetallic restorations, they will begin to ask about upgrades for their front teeth or their smiles. Theissue of selling is no longer valid; we are educating about clinical possibilities ... and those possibilities often turn into future desires.

Key distinctions
What I have come to understand after speaking with team members is that for them to commit to discussing and educating about optimum, comprehensive, elective smile design and restorative and preventive oral-health treatment plans, some key distinctions need to be made. First, a critical point of a team's aesthetic marketability is communication and self-knowledge. Team members must understand the alternatives to amalgam, porcelain-fused-to-metal, and learn smile design principles. If a hygienist does not know about adhesion dentistry, microdentistry, new restorative options, optimal techniques and materials, aesthetic evaluations, whitening, etc., how can he or she educate clients about such procedures? So begins the domino effect. If the hygienist does not know about or value the service, then clients will never pursue the procedures because they will sense apathy from the person to whom they have given their trust. Additionally, team members must know about and believe in the services so much that they are willing to or already have had them performed in their own mouths. All of this stems from educating the team first; then, their zeal will flow to the clients.

A second element is the need for team members to support the integrity of the dentist. They must truly believe that the doctor has the client's best interests in mind when recommending treatment plans ... and they must believe the doctor is capable of providing the recommended service. Doctors should understand that hygiene-care plans first have the ultimate goal of achieving perfect periodontal tissue. Within that lies the hygienist's secondary goal of definitive restorations that are bio-compatible, functionally long-lasting, and aesthetically pleasing.

Time management
Many hygienists believe that they do not have enough time during the classic hygiene appointment to screen, prediagnose, treat, and educate the client on periodontal heath, much less address aesthetic and restorative needs. Time management in a hygiene session gets tricky when you consider all that is involved: sterilization and disinfection procedures; updating the health history; social graces; oral cancer, periodontal, and restorative screenings; I.O.C.; photography; appropriate radiographs; codiagnosis; anesthesia/instrumentation; polishing, renewing, and management of restorations; documentation; computer time; doctor's examination; and education.

A nonsurgical periodontal program that is time-organized, easy to implement, involves codiagnosis, supports education of the client, and is profitable is the "bow on the package." Since hygiene is a gateway for more aesthetic and restorative treatment recommendations, once hygienists practice the type of prevention and therapy for which we were educated, it will automatically create possibilities for further comprehensive restorative screenings and discussions.

Transforming lives
I believe that when teams merge their traditional education with more in-depth knowledge of current trends in dentistry and dental hygiene, they can truly create an opportunity to link together all of the pertinent information for their clients. Team members can provide client-centered care because they see the larger picture of comprehensive, interdisciplinary health. At the same time, they are facilitating true codiagnosis with clients within the realm of enrolling more aesthetic, restorative, and periodontal cases.

I have had the privilege of experiencing how aesthetics can transform lives. The oft-told stories of a once-shy child, who, after finishing restorative treatment with tooth-colored restorations, was transformed into a participating student and became involved in senior-high activities encourage us. Success stories abound for older clients as well. These stories have shown and continue to show the power of a team and a smile — they capture the human side of dentistry.

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