Things they didn't teach me in school: What to do when a patient complains of a sore tooth

BY Jannette Whisenhunt, RDH, BS, MEd, PhD

Since my column focuses on newer hygienists, I want to do a series of articles on "Things they didn't teach me in school." I've been a dental hygiene educator since 1987, and I can certainly say that the curriculum has evolved over the past 28 years. The scientific method and structured research in dentistry and dental hygiene has transformed our curriculum. The information is vast, and there is so much for dental hygiene students to absorb and learn. But there are a few things that we don't have specifically in the curriculum that can be daunting for new RDHs to learn as quickly as needed. I tell my students during their last semester that they've learned so much and will do so well on their national board examination, but there is still so much to know that they're not done learning.

I had some wonderful students at Guilford Technical Community College where I taught for 15 years before becoming the department chair at Forsyth Technical Community College. There are two in particular, Vicky Councilman and Pam Causey, who are very creative and visionary. They started a side business where they buy back hygiene instruments from graduates and repurpose and sell them "slightly used" to hygiene departments in dental offices. Their business is called Saving Graceys. I bring this up because they have a great idea, and when they spoke to our students last year, they also discussed what is expected of new RDHs. The three main things they believe they were not taught in school - and that new RDHs need help with - are dealing with patients who have a sore tooth, unfamiliarity with insurance codes, and interviewing skills.

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Other articles by Whisenhunt

• Sidestepping the office drama: A third personality profile helps us understand why colleagues behave the way they do
• On this time schedule? Right!
• Working for free?

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It helps when graduates can prepare for their new field by hearing from someone who is doing the job every day, and from someone other than their teacher. These people offer a fresh perspective. It is difficult for new hygienists to know what to do when a patient comes in with a sore tooth. In school, students are accustomed to their instructors or a dentist in clinic making the decisions. As they get closer to graduation, we try to help them with their critical-thinking skills. Some of them have a hard time deciding what to do and how to handle it. So, with help from Vicky and Pam, we've come up with some guidelines for making the sore-tooth decision easier. The following are some possible solutions for common patient problems.

Of course, RDHs need to make these decisions by following their state rules and guidelines, as well as the instructions from their employers. As dental hygienists, we know that we cannot diagnose a dental issue. When a patient sits in your chair, they often have a tooth that is bothering them and needs attention. It may be helpful to have the patient rank their pain or sensitivity on a pain scale from 1 to 10 (10 being the worst). This may help the dentist decide whether or not a referral is needed. You may need to take additional films that you were not planning on, and these guidelines will help you save time. Your dentist will depend on you to make these critical decisions. This will help the dentist make a quick diagnosis and will save an additional appointment for the patient.

The longer you're in dentistry, the easier these decisions will become. But for new RDHs, there can be a big learning curve. Dentistry changes quickly and constantly, and there are always new materials out there that may require special attention from the hygienist. Having a good relationship with the dental assistant is important to help you understand some of these new materials. The assistant has read the instructions and has received training in them. The assistant can be a valuable resource for the new hygienist in a new office.

I remember years ago when a new crown material called Dicor came out, and the dental assistant told me that polishing it with normal prophy paste would take off the color. Boy, was I glad she let me know that bit of information, because I sure didn't want to ruin the new crown on No. 8! I placed that information in the patient's chart, and I was much more diligent about checking the crown material from then on. I don't think that material is even used anymore, but it goes to show that materials are constantly changing and it's difficult to keep up.

In next month's column, I'll go over some other issues for which new hygienists may need guidance. There are other things that can be overwhelming for new hygienists when they start that first job. There are a few things experienced hygienists do that they were not taught in school. We'll review some of these items in the next few months. Happy scaling! RDH

References:

1. Bird DL, Robinson DS. Modern Dental Assisting, 11th Ed., Saunders Elsevier. April 2011, St. Louis, Missouri.
2. Iannucci J, Howerton LJ. Dental Radiography: Principles & Techniques, 4th Ed., Saunders Elsevier. March 2012. St. Louis, Missouri.
3. Saving Graceys, Councilman V, Causey P. [email protected]
4. Wilkins EM. Clinical Practice of the Dental Hygienist, 11th Ed. Lippincott Williams & Wilkins. Jan. 2012 Philadelphia, PA.

Jannette Whisenhunt, RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at [email protected].