Discussing treatment needs

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by Dianne Glasscoe Watterson, RDH, BS, MBA

Dear Dianne,

I have been a hygienist for two years in an established practice. Our practice sees people from many different socioeconomic backgrounds, and the doctor does beautiful dentistry. All new patients come through hygiene first. My problem is that I don't know how to broach the subject of dental needs with my patients. I'm quiet by nature, and I feel as if I'm insulting the patient if I tell someone that he has periodontal disease or extensive dental needs. I get nervous and my hands tremble. I'm so afraid my patients notice my nervousness. I haven't discussed this with anyone. I will also share with you that I had some very bad dental experiences as a child. Do you have any advice to help me overcome this problem?

New York RDH

Dear New York,

It's really amazing how long-suppressed memories can suddenly bubble to the surface when given the right opportunity. On the surface, it seems that your fear of dentistry appears when you encounter patients needing extensive dental care. Even though you are not the one needing the care, it would appear that you are experiencing a "sympathetic fear" for your patients. A traumatic childhood dental experience can stay with you for a lifetime, although you might not be able to actually recall the experience.

My oldest son was almost 4 years old when we adopted him. He had several badly decayed teeth, and we were told that he needed immediate dental care. I took him to a local pedodontist who was wonderful with him. He used nitrous oxide to help Terry relax and treated him with utmost care and compassion. However, Terry developed an abject fear of dentistry (I believe) from having to endure very extensive treatment at a young age. I was his personal hygienist all of his childhood and adolescent years, and he did not experience any further decay until he became an adult and moved away from home. When he was 20 years old, he had several areas of decay. I pleaded with him to see a dentist and offered to pay his bill. He's 32 now, and the only time he will go to a dentist is if he's in pain. It grieves me to think that he will probably wind up in dentures. Although he cannot recall a "bad" dental appointment, I think the memory of dental pain is firmly planted in his subconscious, and he associates all dental offices with pain.

Given your situation, it is surprising that you chose to go into dentistry. It shows that you are courageous. It is also likely that you have patients who are just as nervous as you. Some people have to garner a tremendous amount of courage just to walk through our doors. Writing for the ADA, Dr. James Bahcall estimates that more than 40 million people do not seek professional dental care for one reason -- fear.

Fear is an environmental barrier to communication. Phobic patients come to us with the expectation that we are going to hurt them. They reason that we use sharp, pointed instruments and needles in their mouths. When we cause pain, especially on a first visit, we have lived down to their expectations. Dental hygienists who are "heavy-handed" can perpetuate dental fear in patients. I distinctly remember a patient who shared with me that he had left his last dentist because he was tired of the dental hygienist treating him roughly. He called her the "blood and guts hygienist" and said "she ripped my gums to shreds!"

Dental hygienists can play an important role in helping patients overcome their fears through gentle, empathetic, and compassionate care. Once you gain the patient's trust, the task of helping patients understand the treatment they need becomes easier. We have a variety of tools available to help us deliver care in a pain-free manner, such as topicals that can be expressed directly into the sulcus and, of course, local anesthesia and nitrous oxide.

Hygienists are well positioned to assess needs and set the stage for the doctor's diagnosis. However, the way in which the treatment is presented can be pivotal in whether a patient will adhere to recommendations or run for the hills! One of the biggest mistakes I see is when the dentist ambushes the patient at chairside with a diagnosis that ultimately overwhelms the patient. It is far better to develop some treatment options and then sit down with the patient outside the operatory to discuss how his or her dental needs can be met. Let the patient have a part in the decision-making process.

As a hygienist, the best thing you can do is share a "time of discovery" with the patient. By this, I suggest that you engage the patient in discovering with you as you gather data and conduct the initial assessment. You are not diagnosing anything, but, rather, making observations. For example, if you discover periodontal disease, you could ask your patient a couple of questions: "Mr. Jones, have you noticed this area bleeding when you brush?" or "Have you noticed this tartar buildup on the backs of your teeth?" All you are doing is calling attention to conditions you observe in the mouth. Using an intraoral camera to point out what you are seeing is THE best way to convey problems.

Today's intraoral cameras help good communicators to become GREAT communicators. Some of the newer models are cordless and provide great images. I am particularly fond of the Carestream 1500. I also like the Polaris Intraoral Camera that has a pivoting head.

Concerning your personal fears in relaying patient needs, I think it is important for you to focus on the endpoint of helping your patient to achieve optimal oral health, rather than the journey. Think of how wonderful it will be for your patient to be free of caries and/or periodontal disease. Set your sights on how much better your patient will feel when his or her smile is healthy and radiant. Focus on the endpoint of healthy, pink gingiva with no bleeding and the good that your care contributes to optimal overall health.

It's almost like going on a long trip to a nice vacation spot. There's all the hard work of packing and preparation, then the travel. But once you get there, all the difficulties are forgotten. You delight in the destination and forget all about the earlier work to get there.

If you are not confident about what to say, I recommend that you have a discussion with your employer. Be forthright about needing help, and ask the doctor if he or she has any suggestions as to how you can initiate the conversation about dental needs in a courteous manner. The discovery process is a great way to start. RDH

All the best, Dianne

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at www.professionaldentalmgmt.com.