What’s your goal as a registered dental hygienist?
Is it to create whiter smiles, or something more?
Hygienists know their breadth of skills and knowledge extends far beyond simply cleaning teeth. Registered dental hygienists are in a unique position to connect with patients and impart personalized dental advice that can benefit them for years to come.
Unfortunately, a dental office operates on a tight schedule, leaving little to no time for hygienists to talk with patients one-on-one.
This raises an important question: is it worth spending less time on clinical care to spend more time on counselling?
Michelle Strange is a practicing hygienist, surgical assistant and educator. She is also a self-proclaimed perfectionist.
“I need to know I am doing the best job I can while striving to do it better,” she writes. “Sound familiar?”
In the beginning, Michelle felt she was making the most of her limited time with patients by eradicating every last stain on their teeth. She still took the time to give thorough home care instructions, of course – but if there were a minute to spare, she’d rather have used it to deliver additional clinical care.
That all changed when she discovered motivational interviewing.
“If I have to choose to spend 5 minutes getting every speck of stain off of a patient’s lingual surfaces or 5 minutes making sure they can use a toothbrush properly, I choose the latter”, writes Michelle.
It’s a stark difference, but one that Michelle feels will benefit her patients far more in the long run. And she’s not alone. Motivational interviewing is gaining ground in the dental profession, with an increasing number of dentists and hygienists embracing the view that what patients do at home is just as important as the care they receive in the dental chair.
What is Motivational Interviewing in Dental Hygiene?
Pioneered in the world of cognitive therapy, motivational interviewing describes an approach to patient care that puts the clinician in the role of a coach or a counsellor more than an authority figure – someone who guides patients in the right direction instead of lecturing them.
In dentistry, this approach can apply to how registered dental hygienists educate people about dental self-care. By asking questions and listening without judgement, clinicians can help patients understand choices that affect oral health and feel empowered to make positive change.
For example, rather than simply cleaning the patient’s teeth, a hygienist would take time to help them understand why the stains occur and answer any questions the patient may have about flossing and brushing.
As Michelle puts it, “Treatment is only going to last so long. If the patient continues to build calculus in the same place every time we see them, are we performing successful patient care?”
When clinicians take a non-judgemental interviewing approach, patients are more comfortable asking questions and speaking honestly about their current dental self-care. The hygienist can then provide personalized recommendations that meet the patient’s level of disease, obstacles to care, and lifestyle.
Motivational Interviewing in Practice
With this approach, you may find that patients are more receptive to your advice and motivated to make positive changes. Start by incorporating the four basic motivational interviewing techniques: open-ended questions, affirmations, reflections, and summaries.
Ask open-ended questions that invite the patient to elaborate, such as: “What do you find works for you in your current home care routine?” and “What do you find difficult about dental care?”
Give affirmations that recognize good choices and encourage patients to continue, such as: “I can tell you’ve been flossing.”
Reflect the patient’s answers in a way that gives them meaning. If the patient says they only want a treatment that falls within their insurance coverage, you could say, “We’ll have to keep dental care within your budget.”
Summarize the patient’s thoughts to confirm their answers and show you are listening.
Motivational interviewing isn’t the only way to approach patient care, but it is one way to ensure they get more from the appointment than a whiter smile.
When dentists place new amalgam fillings or remove old ones, water containing amalgam particles is flushed into chair-side drains. These mercury-containing particles then enter the wastewater disposal system and water treatment plants. From there, the amalgam particles may be incinerated, land-filled, or made into fertilizer pellets for lawns or gardens. In each case, mercury from amalgam fillings is discharged into the environment, where it may bioaccumulate in fish and contaminate the food chain.
To summarize, dental offices that work with amalgam fillings (including “mercury-free” practices that only remove them) flush amalgam particles containing mercury down the drain and into the wastewater system. These particles ultimately become environmental pollutants.
The regulation applies to most dental practices that discharge waste into a public sewer or wastewater system. The basic requirements are:
Using amalgam separators (or equivalent devices) to remove dental amalgam solids from all amalgam process wastewater;
Implementing best management practices;
Complying with reporting requirements; and
Maintaining certain records documenting compliance.
Practices have until July 2020 to comply.
What Are Amalgam Separators?
An amalgam separator is a device installed on a dental vacuum line to filter out mercury and other particles from water waste before they enter the sewer system. The captured mercury can then be recycled to industry or safely disposed of.
Traditionally, dental practices used chair-side traps and vacuum filters to capture amalgam waste; however, the ADA estimates that 6.5 tons of mercury bypass these filters annually.
In addition to reducing environmental pollution, using an amalgam separator can help to extend the life of vacuum pumps by preventing solid particles from entering and damaging the pump.
To comply with EPA regulation, an amalgam separator must be ISO 11143:2008-certified to remove greater than 95% of solids by weight. Most amalgam separators on the North American market meet this standard.
Dental x-rays are an important diagnostic tool. They reveal oral health issues that could otherwise go unnoticed: areas of decay, bone loss, abscesses, tumours, and conditions of the root canal. Unfortunately, some people are wary of dental x-rays, dental practitioners aren’t always sure how to ease their concerns.
These tips can help you educate patients on the significant benefits and minimal risks associated with dental x-rays so they can make a well-informed decision about their care.
Do Dental X-Rays Cause Thyroid Cancer?
If you’ve worked as a dentist or dental hygienist in the last few years, you’ve probably heard it before:
Are dental x-rays safe? Can they cause thyroid cancer?
According to an article in Today’s RDH, much of the fear surrounding dental x-rays originates from a talk show several years ago. The show presented a link between the radiation from dental x-rays and thyroid cancer. Video clips shared widely through email and social media sites, sparking an increase in patients refusing x-rays out of concern for their health.
Regardless, this trend is a challenge to dental practitioners. The public is not well-informed about radiation, and not all practitioners are prepared to address their concerns. The absence of x-ray images can make it difficult to effectively diagnose and treat patients.
However, with the right approach and a bit of patience, many dentists and dental hygienists can help patients understand that dental x-rays are safe.
1. Have Empathy
For many patients, visiting the dentist is unpleasant to begin with. The added uncertainty surrounding radiation can make the experience more frightening.
Your patience and empathy can make a world of difference in this circumstance. As always, it’s crucial to communicate openly with the patient and take time to explain things in a way they understand.
2. Respect Different Backgrounds and Beliefs
Understand that dental x-rays are not common everywhere in the world. Newcomers, along with older adults who have little experience with the dentist, may not be familiar with dental x-rays.
Acknowledge that you may have to take a different approach with patients of differing cultural backgrounds. It may help to have an interpreter explain the process to them.
3. Explain the Precautions Taken
Take time to assure your patients that you and your staff take measures to ensure that dental x-rays are as safe as possible. Explain the purpose of a lead apron, lead thyroid collar, and the ALARA principle for radiation exposure.
4. Compare Dental X-Rays to Other Radiation Sources
The average American receives about 620 mrem of radiation each year, half of which comes from natural background radiation. The radiation ‘dosage’ associated with dental x-rays is just 0.005 mSv, less than a single day’s worth of background exposure.
Making this comparison can help patients understand that dental x-rays are not something to fear. However, the information should be delivered with empathy and not to belittle the patient’s concerns.
There are many ways to boost patient satisfaction in your dental practice. Clear communication, good time management, friendliness, efficiency, and empathy are significant factors in a patient’s overall expectations of their dental experience.
But according to the Canadian Dental Association, one quality stands out above the rest: confidence.
A dental practitioner’s confidence, and the ways in which they demonstrate it, ranks as the #1 influencer on how patients perceive their quality of care, according to the latest Canadian Dental Association survey.
Why? Confident people attract positive attention — no secret there. It’s natural to be attracted to people with high self-esteem, whose confidence shines through their charisma, appearance, speaking, writing, and listening skills. Confidence is a sign of competence, not arrogance, in the dental practice.
To promote and maintain patient satisfaction, professional dental care providers need to keep confidence at an optimum level to ensure ongoing quality of care. Below, we’ll discuss some of the ways to grow and maintain that confidence in your practice.
Ways to Be Confident and Boost Patient Satisfaction
A person’s levels of confidence can swing up and down due to positive or negative experiences, and criticisms. We are most confident when we are performing routine and familiar tasks.
Here are ways to show your confidence as a dental practitioner or hygienist:
Be optimistic. Think positively. While it may sound cliché, there are tangible and proven benefits to adopting an air of optimism, and your positive outlook will rub off on your patients.
Focus on the present. What do you want to accomplish today? Don’t dwell on the past. Once you have acknowledged your mistakes, learn to accept them and move forward.
Accept compliments graciously. Say thank you. What may seem like minor work to you can have a profoundly positive impact on your patients’ lives, so you should always be open to their praises.
Face your fears. When you have a busy day ahead, tackle the tasks you like least first. You will face the remainder with the confidence of knowing the worst is over.
Break down large tasks into smaller sub-tasks. Knowing how to prioritize your to-dos is key to ensuring you accomplish your daily goals.
Learn and research new skills and technology. The world of dentistry is continuously advancing, and being prepared will help you keep a competitive edge.
Recognize your strengths and achievements. You have come a long way to get where you are. Remember to celebrate successes.
Manage stress. Don’t let your own wellness get lost in the daily grind. Develop effective coping strategies, and take moments to just breathe throughout your day.
Smile. Learn to laugh at yourself. Take pleasure in your daily tasks.
Believe in yourself and your team. Positive reinforcement will help everyone in the practice grow their confidence and boost patient satisfaction.
The North American opioid crisis is not only an issue for public health and law enforcement officials; it also concerns dentists and dental hygienists in private practice. In fact, dentists can play a significant role in protecting their patients from succumbing to addiction and substance abuse.
As medical professionals who prescribe opioid drugs to patients, it is imperative for dentists to understand the link between opioids and dentistry, and the steps they can take to help combat the opioid crisis.
Opioids and Dentistry
Despite great advancements in dental techniques and technology, pain is often a necessary consequence of performing dental work. Fortunately, we have also come a long way in developing effective steps to lessen patients’ discomfort, and pain management is a top priority of any dental practice.
Among the pain management tools at a dentist’s disposal are analgesics (painkillers) and other prescription drugs. In many cases, drugs like acetaminophen and anti-inflammatories are sufficient in managing a patient’s dental pain. However, there are cases where non-opioid drugs are not enough, and that is when dentists might consider prescribing an opioid analgesic like codeine or oxycodone.
All drugs carry risks, but opioids are more liable to misuse than most, and opioid abuse can result in grievous harm. In 2016, over 42,000 peopled died from overdosing on opioid drugs in the United States alone. Many people who use narcotics first developed a dependency to legally-prescribed analgesics.
It’s not to say that dentists are unaccustomed to making judgement calls; exercising professional judgement is a part of what dentists and other healthcare professionals do every day. However, with opioid abuse causing a record-number of overdose deaths in Canada and the U.S., dentists must be especially careful in weighing the potential benefits and risks of prescribing these drugs to a patient.
In a message to America’s dentists, ADA president Joseph Crowley asks dentists to take four specific steps to prevent opioid analgesics from harming patients:
1. Consider using non-narcotic pain relievers as the first line of treatment.
2. When prescribing an opioid pain reliever, consider prescribing fewer pills in accordance with state law and the latest pain management guidelines.
3. Counsel patients about the benefits and drawbacks of using opioids to relieve pain, especially the risk of addiction.
4. Learn to recognize when a patient might have a substance use disorder or be more prone than others to addiction.
The ADA also provides a free continuing education course on how to incorporate safe and effective protocols for using opioids to manage dental pain and offers a reference manual on how to manage dental pain for patients who are at risk of substance abuse.
With more and more people making an effort to be informed on the chemicals and materials they’re exposed to every day, many dentists are looking to reduce the number of chemicals used in their practices.
Proper cleaning and disinfection in a dental office is a legitimate concern. After all, if disinfection isn’t done properly, a patient could be harmed. Everyone in the practice is responsible for ensuring the safety of all patients that walk through its doors.
The best way to avoid making a patient sick is to make sure that any sources of infection are properly contained. Unfortunately, it’s all too common to hear that evacuation systems aren’t cleaned daily—or aren’t properly disinfected when they are cleaned.
Reasons for the lapse in cleanliness could partly be due to the work involved, but also the perceived dangers of the continuous use of chemicals every time the system is cleaned. Over the past three decades, newer and stronger chemicals have been introduced to keep surfaces, water lines, and evacuation systems clean and sterile. However, the number of chemicals can also create issues, and many are harmful on their own.
The alternative is microbiological cleaners. But what are they, and how do they work?
It was over 150 years ago that doctors figured out washing their hands before surgery drastically reduced the patient’s risk of infection. This jumpstarted the field of microbiology, or the study of microscopic organisms.
Once we started looking, we discovered bacteria everywhere.
It’s estimated that there are more bacterial cells in a human body than there are cells that make up that whole person. The sheer number of microbial organisms that constantly surround us is staggering, which is why it’s so hard to create sterile environments. We need to use intense stressors like temperature, pressure, or chemicals to eliminate microbial growth.
We simply must accept that we are, and always will be, swimming in a sea of bacteria. The good news is, though, that the clear majority of bacteria won’t make you sick. Most bacteria really do not affect us. In fact, there are plenty of microbes that actually keep us healthy. Your gut, for example, is chock full of bacteria that is helping you to remain healthy and digest your food.
The good bacteria in your gut also keeps dangerous, harmful bacteria at bay. It’s this same principle that makes microbial disinfection such a good alternative.
As an alternative to chemicals, disinfection can be done using microbial cleaning products. These products seed and jumpstart the growth of “good bugs.”
These good bugs not only help to kill harmful ones, but they also work to keep the bad bugs away. This is one clear advantage to chemical sterilization—the harmful bacteria is kept at bay for longer.
Products like Bio-Pure can keep an evacuation system clean of harmful bacteria on a continuous basis. It does this by introducing a cleaning microbe into the system. Microbial growth is exponential, which means one microbe can quickly become 10,000,000. This army of good bacteria cleans out all other microbes and creates a barrier against bad bugs.
Short of cleaning out the system before and after each use, Bio-Pure is the most effective way to keep a system clean and safe at all times. Plus, there’s no need for harmful chemicals.
When concentrating on efficiency and making the best use of the available space, it can be easy to forget a dental office also must provide the right atmosphere for clients. Although many dental practitioners have done their best to reduce anxiety for clients, Ondontophobia is still all too real for many people.
While some of these individuals require therapy to manage this issue, practitioners can still do their part to reduce anxiety experienced by anyone dreading a trip to the dentist. A great way to start is by reducing a client’s apprehension before they sit in the examination chair.
Here are some things to keep in mind for dental office design that will help to generate an inviting, relaxed atmosphere for your patients.
In the old days, dental offices often had a tropical fish tank in the waiting room. These provided a gentle distraction for patients, particularly children. Many still do, but now many offices are also installing televisions.
These generally play programs and movies without the sound, but with closed captions activated so interested viewers can follow what is happening.
A TV can provide a relaxing diversion, but you need to be careful about what is on. Violent shows or ones that are particularly suspenseful will be counterproductive, as will news channels on days when the reporting is particularly negative.
Soothing Colours and Artwork
Personal preference always plays a big role when choosing colours for an office, but here are some suggestions to consider. When choosing your colour scheme, aim for hues that induce a sense of tranquility and do not have any hint of threat.
Colours able to bring about a calming energy include those people commonly enjoy in nature, such as sky blue, green/sage, and tan/brown.
White suggests cleanliness and reminds some of anti-septic, but can be triggering for some due to its hospital connotations.
Bright colours, while attractive, can actually put people on edge (red is particularly strong in this regard), so try to stay away from them.
Do not choose only a single colour; pick a main one as well as another that provides a notable contrast, but not too harsh (e.g. a darker and lighter version of the same hue). Solicit opinions from your staff, and ask what they would prefer for areas only they will use.
Artwork can also provide both decoration and visual interest. Be sure to choose art the average person can easily relate to and does not include an abundance of off-putting shades.
Plants and Furniture
Plants will help to reinforce the natural theme and suggest that your practice is a healthy and vibrant place. Be sure to regularly water and maintain them so wilted, dying leaves are never apparent. If it is apparent that everyone on staff is too busy to ensure this happens, hire an outside company to do it.
Choose chairs that look and feel comfortable, but can also hold up well to steady traffic and children. Side tables should be big enough to accommodate patient’s incidentals, but not take up so much space that it becomes awkward to move around.
Include magazine and brochure racks for those who would prefer to read.
Provide a View
If building design permits, and you are lucky enough to be in a picturesque area, provide a window view in the waiting and exam rooms.
This offers another healthy and natural way for patients to get their minds off their procedures, both before and during the process.
It's human nature to concentrate on the main details of a situation. For example, if you were going in for an open-heart procedure, you would likely concern yourself with the surgeon’s track record. This particular specialist is the main part of the operation, but they receive assistance from other highly qualified professionals.
If you a love a movie, you make a point of remembering the director’s name, but not necessarily the editor or key grip, both of whom are likely also exceptional at their jobs. Let’s face it, there are very few specialists who work entirely alone, but it is often customary for the world to have only one person take a bow.
Veteran dental hygienist Candice Feagle attended a function awhile back and when mentioning what she did for a living, the person she spoke to replied, “Oh, you’re just a hygienist.” Most of us take pride in what we do and it was understandable that Candice had a negative reaction, though she kept it to herself. It wasn’t the first time this had happened to her or other people in this profession.
However, after mulling it over the next day, she decided to write about the incident for Dentistry IQ.
Not "Just" Collecting a Paycheck
The vast majority of dental hygienists worked hard to earn their certification, and continue to enhance their knowledge by taking advantage of related learning opportunities.
"Oh, you're just a hygienist"
Like any profession, some hygienists are content with their current routine, but there is room to grow in this role. Candace felt at several points that she was indeed “just” a hygienist, which prompted her to expand her career possibilities. Most recently, Candace chose to pursue a bachelor’s degree in allied dental health, allowing her to experience the nonclinical side of the profession, an aspect many patients do not realize exists.
Not "Just" Cleaning Teeth
The average client probably doesn’t realize how much their hygienist does for them. Is it the dentist who reviews their medical history with them and goes out of their way to help ease their anxiety? Does the dentist perform oral cancer screenings, sterilize the equipment, conduct fluoride treatments, take blood pressure, or do periodontal charting?
They can, but in the vast majority of cases, the hygienist performs these as well as other key aspects of a dental appointment.
As Candace also points out in the article, motivated hygienists can go on to become public health professionals, researchers, administrators, entrepreneurs…you name it!
Not every job will make you a millionaire or put your name up in lights. Sometimes the greatest satisfaction comes from knowing you are making an important contribution to a person’s health and well-being.
“Having been in the dental profession for the last 26 years, I can honestly say I love my profession...I know the varied abilities and diverse opportunities being a hygienist represents.”
The pride Candice expresses in that statement makes it clear she knows the value of what she does. And that’s just fine with her.
When you visit your dentist’s office, you expect one of the dental hygienists to greet you in the waiting area and bring you to the exam room. It is customary for them to make conversation with you, floss your teeth, conduct a dental cleaning, and then call in the dentist.
Dental hygienists spend a large portion of their workdays in front of patients, primarily cleaning, polishing, and scaling the patient’s teeth. Most people, if asked what dental hygienists do all day, will likely give that as a response. However, there are also some tasks they perform either completely behind the scenes or some that patients simply do not notice during their appointment. Keep reading for the reveal of the four most significant behind the scenes tasks dental hygienists perform during their daily duties.
Checking Facial Expressions
When the dentist is checking your teeth, they are wearing what is essentially a powerful magnifying glass on their eyes. This allows them to really look closely at your teeth and determine things such as cavities, signs of gum disease, et cetera. However, it also prevents them from really seeing your face and facial expressions, which makes them blind to any winces and other signs of discomfort. In many instances, the dental hygienists often observe the patient’s facial expressions in order to determine if everything is going well. Patients are often too preoccupied to notice dental hygienists commonly do this.
Stocking the Office
Every dental office needs a vast array of supplies, including surgical masks, protective gloves, glasses, and the tools used to perform cleanings, suction, et cetera. How do all these supplies and equipment stay in the required quantities at the dental office? This duty often falls to dental hygienists, who stock up the exam rooms and office as a whole when they are not working directly with a patient.
Cleaning the Exam Room
It is necessary to clean exam rooms and sanitize all the tools before a new patient enters for their dental appointment. After all, a dental office is a medical environment. So who cleans the exam rooms in between patients? This is where the dental hygienists come in. In many instances, they have their own exam room for patients, which they will clean and sanitize before bringing another patient back. This usually includes cleaning the chair and the glasses used, plus disinfecting the dental tools (or replacing them with new ones while they undergo additional cleaning).
Reviewing History and Charts
Your primary doctor will often rely on your medical record, which includes notes from past appointments as well as details on any vaccinations you may have received. Your tooth records are just as important to a dentist. In fact, you may actually need to provide information from your overall medical history to the dentist and dental hygienist. Such information can include any medication you might be taking, surgeries you have had, allergies, et cetera. The task of reviewing and updating patient history and charts, including ensuring updated x-rays are in the file, almost always falls to the dental hygienists.
Gone are the days when a sole practitioner could know clients by name and store their information in a single file cabinet. Most dental hygiene offices have many patients and sometimes multiple practitioners and hygienists.
However, even smaller practices have a duty to ensure the most accurate record keeping and efficient customer service possible.
Computer software solutions help to make that possible and there are a number of excellent packages designed specifically to meet the needs of the dental health community.
Here are five such software solutions especially good for use in a busy practice:
One of the main concerns of any practice with mounds of data is computer reliability. What if your hard drive crashes and you don’t have a back-up of your patient data?
Cloud storage is an excellent remedy and Curve Dental allows practitioners to send digital images from an array of devices directly to the cloud. That way, if disaster should strike, you need not worry about the practice’s most important resource. Curve’s easy-to-use software also offers efficient options for charting, scheduling, credit card processing, billing, and online patient forms.
Practice management can be overwhelming without the right program to keep everything organized and accessible. There are a number of options to choose from here, but Ace Dental offers more features than most of them. Fortunately, ease of use is one of this program’s strongest assets.
Patient records are a snap to retrieve, and the system provides other pertinent data with little more than a single mouse click per inquiry. Your appointment schedule also has all of the necessary treatment details included. This safeguards against confusion over who is appearing at what time, and what they require. Ace also makes the organization and sending of insurance claims simple, and that allows administrative staff to devote their shift time to other important duties.
Denticon is another cloud-based option that offers excellent storage and retrieval options. It assists with both administrative and clinical treatment components, providing ample room for the inclusion of detailed patient treatment histories and insurance details.
In a nice touch, Denticon helps to revive a bit of the old-time service feel from days past. Practitioners can include personalized messages on patient statements that provide handy reminders of treatment methods or other important details discussed during appointments. It also incorporates a number of other useful features, and solid security ensures patient confidentiality.
Some dental procedures require patients to use medication for a period afterward. Keeping track of such information is tricky, but Dentrix streamlines things and makes the sending and tracing of prescriptions much easier.
The program also offers a flexible and efficient practice management system that will more than suffice for most office needs and patient rosters.
You would be hard-pressed to find a dental professional not in favor of making digital dental imaging and software more efficient and easy to use. Carestream Dental has risen to that challenge and succeeded by providing a system that meets these needs through greater speed and accuracy.
Carestream’s eConnections also helps to consolidate online marketing, appointment reminders, and patient solutions, allowing a practice to consolidate many different responsibilities into a single dashboard. This makes marketing and return on investment decisions much easier to consider.
Once you have the software side of the business sorted out, don’t forget to address your dental hygiene gear. Using the latest and most effective equipment guarantees that you and your staff deliver the latest in oral health care.