Handling dental patients’ rights to refuse treatment

Dear Dianne,

I’ve written to you in the past and I always look forward to your advice in RDH magazine because the issues are so relevant in our day-to-day practice life.

My question to you is twofold. We have a conundrum in our office regarding scaling and root planing (SRP). My coworker has taken over for a hygienist who recently retired, and she has found that many of our patients need SRP. The difficult part is getting some patients to agree to treatment. These are longtime patients of the practice who have been informed repeatedly of the need for SRP and have declined time and again.

Here’s the rub. My coworker has told me that she once worked in a practice where they allowed a patient to forego scaling and root planing, and he actually signed a “refusal of treatment” form stating that he was aware of the risks involved in not receiving treatment. It further stated that he would not hold the hygienist or doctor responsible for any negative consequences. Then, when he lost teeth, he sued the practice and won!

My coworker contacted our state board of dentistry, and someone there informed her that failure to provide scaling and root planing to periodontal patients who require this service could result in legal action and loss of our hygiene licenses.

I am very concerned. Now my coworker refuses to treat any patients who have been diagnosed with periodontal disease and refuse scaling and root planing when it has been treatment planned.

New year, new professional fitness: A series for dental hygienists

We’ve all heard it. It’s the most popular cliché this time of year: “New year, new me.” But as we think about next year, we have to look back to last year. Many of us probably had disappointing ends to last year’s resolutions—especially those pertaining to wellness and health. (There are years that I sure have!) But there’s no need to give up. There’s no reason to walk away in defeat. It’s time to get what you want in terms of fitness! In this three-part series, I want to give you the tools and state of mind to get there.

My story

I’m no stranger to pain, and I’m no stranger to body transformation. At one time, I was a dental professional who was unhappy with my fitness. I struggled mightily with musculoskeletal pain. Look at my before-and-after photos. The photo on the left is from 2004. I’m a dental student who is struggling and in pain. But the photo on the right is me now. It shows me years out from dental school. I’m out of pain and back in shape.

As someone who’s been down this unpleasant road, I know what it takes to persevere and get what you want. I also know that no New Year’s resolution will get you the progress you desire just because the calendar year turns over. What will get you there are two things: First, it requires a decision to change. Second, it takes steady, consistent work toward your goal. That’s how it happened for me. I got completely fed up with the state of my body, and I took action to change it. What I learned, I will share.

In 2004, I was in dental school. My fitness had plummeted to an all-time low. My problems began innocently as “a twinge.” It happened when I did a slight twist to pick up a handpiece. Then, the pain started to radiate down my back. As days passed, a feeling that was bothersome became unbearable. It hurt to turn my head. It hurt to sit down. It hurt to study. It hurt to see my patients. Yet, I saw no reason to modify my daily clinical routine or fitness plan.

Life doesn’t stop for hygiene school


Dropping out of hygiene school was a difficult decision, but that’s life—sometimes it pitches nasty curveballs. Just after the very first semester of the program, an unexpected incident occurred in my personal life. My fiancé and I were involved in serious and tragic car accident, and unfortunately he was partially at fault.

Things had been great up until that point. I had just been elected vice president of my class and had excelled in my first two classes. I remained in the program until the fall before graduation. The accident had left a mark of uncertainty for my fiancé and me, and we lived in constant fear of the near future. It had been quiet for a little while, almost like the calm before the storm. But as more information rolled in and we began to get a clearer picture of what was ahead, I became more and more overwhelmed and had to make a decision.

At the time, my family was my top priority, and I was at a point where I felt it was impossible to give my full and focused attention to school. I was just past the halfway mark (peak intensity), but the time I had left with my fiancé was ticking before we would be separated for years. Even one mistake has harsh consequences, and the reality was that he was going to serve time for his. He was going to prison, and every kind of preparation was in order. I withdrew from the dental hygiene class of 2017. I remember telling myself and others around me that I was not going back.

But then the year I spent out of school really placed things in perspective. My fiancé’s departure was my breaking point, or in my mind, my “waking” point. I became so focused. Never had I expected that I would be filled with so much drive and determination. I was going back to hygiene school, finishing my degree, and getting my license. It was like I sat alongside while a different person took the wheel. A part of me came out that I didn’t know was there. I had to do it for myself—I had to do it for us.

The physical pain of the helping professions: Musculoskeletal pain and improper ergonomics

Advocate for yourself, do everything in your power to prevent cumulative trauma to your body, and always be prepared for situations over which you have no control. You have the ability to help shape your future.

“Mommy, why are you so mean?” These words were spoken by a child to her mother when she arrived at home from her 11-hour workday in the dental office. When Mom had left the office that day, she didn’t leave her mental and physical stress in the operatory. It had traveled home with her.

She had spent the day hovering over patients while perched upon a rickety operator stool with one half-hour break in the middle of the day. She was overbooked and overworked. Her body and mind had been used and abused by her own doing, and she was completely drained.

Years of neglect and denial had created physical and emotional wounds. She thought she hid them well, but they came to the surface that day. The pains she thought only she had felt had impacted her family and had broken the heart of her young daughter. Her strained neck, which she acquired from working in pediatrics early in her career, had progressed to sharp
electric-shock pains traveling down her arm 12 years later.

Throughout her career, she had contorted her body into different positions to ensure that her patients would be comfortable. She even complied with the demands of a toddler patient’s parent that she “figure out a way to see into [her] child’s mouth even if [she wanted] to sit on a bicycle.” She was not a contortionist, but she tried to be for the comfort of her patients.

A herniated disk was the cause of years of pain resulting from improper workplace ergonomics

The challenges of hygienists who care for aging parents

I recently completed a podcast for MOMgienists with the podcast’s founders, Jasmin Haley, RDH, and Christie Lincoln, RDH, on the topic of work-life balance and caring for aging parents.1

MOMgienists’ goal is to reach hygienists who are mothers with topics of interest to them. I was honored to be invited and asked if I could discuss what I had learned while caring for my parents. Having presented several seminars on work-life balance, caring for elders added a whole new dimension to my presentations.

© Pressmaster | Dreamstime.com

Here are some eye-opening facts published by the Pew Research Center.

• There are 40.4 million unpaid caregivers of adults ages 65 and older in the United States.

• Adults ages 45 to 64 are the most likely to be caregivers. About a quarter (23%) of adults ages 45 to 64 care for an aging adult.

• Most caregiving for aging parents is not in the form of financial support or personal care. More commonly, adults help their parents with errands, housework, or home repairs.2

Why I fell in love with dental conventions

For a long time, I thought that dental conventions weren’t for people like me. I was just an ordinary dental hygienist who went to work and left my job behind when I came home. I was a busy mother dealing with a world of responsibilities. During that period of my life, dental hygiene was just a job. But then, 10 years into my career, I attended my first dental convention, and something inside of me changed. I learned about how much untapped passion I had for my profession, and since then I have never looked back.

How I got my start with dental conventions

The first dental convention I ever attended was the Chicago Midwinter Meeting in February 2016, and I wasn’t very excited about it. I only went because my boss offered to pay for the trip and my coworkers urged me to come along with them. The dentist I worked for (and still work for), Dr. Chris Bible, had been a long-time fan of dental conventions, and I didn’t understand where all his enthusiasm came from. He regularly attended Chicago Midwinter and the Greater New York Dental Meeting. He became like a child filled with excitement as the events approached each year.

Selfie from my hotel room in New York City for the Greater New York Dental Meeting

When I got to the Chicago Midwinter Meeting at McCormick Place convention center, I was utterly amazed at the enormity of the event. There were close to 30,000 people in attendance. Dr. Bible had always tried to explain how large the event was, but I didn’t come close to understanding until I saw it in real life. It was like a dental professional’s paradise—row after row of dental exhibitors—and I got the opportunity to be a part of it all. This was the place where any question I had on almost any product could be answered by a real-life expert. I could feel my adrenaline beginning to surge!

RDH Editorial Advisory Board member profile: Kristin Goodfellow, RDH

Behind the scenes of RDH magazine, we have many unique, accomplished dental hygiene professionals helping us share helpful, timely content. Let’s meet one of them!

Dental Economics Advisory Board member profile Tarun Agarwal, DDS


Kristin Goodfellow, RDH
Professional affiliations:

Clinical director of education at OraCare, hygiene liaison for Wilmar Management, Freedom Day USA advocate

Morgantown, West Virginia
Areas of expertise:

Dental consulting, product sales, interoffice communication, patient education, and professional speaker

What changes in dental hygiene are you most excited about in the next few years?

The face of hygiene will be forever evolving because hygienists are innovative, motivated, and ready to take action. What I am most excited about are the opportunities that hygienists are creating for themselves and others. Many RDHs are forging their own paths. They aren’t waiting for opportunities to happen to them, but rather creating opportunity for themselves. It has been truly inspiring to see, and it makes such an impact on our community. “Cleaning teeth” is not our only specialty, and we are showing this to the world!

What’s been the most memorable part of your career journey?

The day I was offered my current position is still one of the most outstanding moments in my journey. When the owner of 12 dental practices (plus multiple other companies) calls you the day before leaving for Christmas break, you don’t think that you are being offered a job … you think you’re getting fired. So when my manager told me that “the big boss” was on the phone for me, I instantly panicked. But that quick conversation changed my life in so many good ways. I know that was a pivotal moment, and it is what started me on this path that I am on now.

Why RDH Under One Roof could be your next ‘inspiration vacation’

It’s January, and maybe you’re thinking about some of the things you’re excited for this year. I know the staff at RDH is, especially when it comes to this year’s RDH Under One Roof (UOR) conference in Grapevine, Texas. The conference has grown and grown since its introduction in 2001, when we welcomed 100 attendees and 8 exhibitors in Denver, Colorado. Last year, more than 1,800 hygienists descended upon National Harbor, Maryland, to learn, network, laugh, and rediscover what had brought them to dental hygiene.

We’ve had a huge response to this year’s show location in Grapevine, Texas, at the Gaylord Texan resort. We have more registrations than we ever have before at this time of year, with the event still seven months away. But guess what? We still have room for more of you! Our goal for UOR is to connect dental hygiene professionals with the best continuing education—and with each other—to elevate the profession.

Many people feel intimidated by the thought of going to a conference where they know no one. This year, we’re trying something new to help make it easier to meet people before the show or to ask other members of your profession your burning questions—a closed Facebook group! Log into your Facebook account, search “RDH Under One Roof Official,” and request to join. In our group, you can ask conference veterans questions, find people to attend receptions with, and hear buzz about show events. You don’t have to be registered to join the group, just interested in the show.

In this issue, we have a great article from former dental convention skeptic Amber Metro-Sanchez, BA, RDH (page 12). She writes, “The first time I went to a dental convention I thought, ‘Why should I spend my free time immersing myself in dentistry?’ That is what I did during all my workdays. I thought that getting an escape from dentistry on the weekends was a needed break. Little did I know how inspiring a dental convention could be. Like all dental professionals, I have felt potential burnout creep up on me from time to time. Going to a dental convention is the number one trick to get myself back on track again.” If you find yourself facing burnout this winter, a dental show can be a wonderful way to meet that head-on. Some of our attendees have taken to calling UOR their “inspiration vacation”—a chance to get away from the obligations of daily life to earn in-person CE credits for their licenses, connect with other professionals, get the most advanced information they need to care for their patients, and just remember why they joined dental hygiene in the first place. To learn more about the event, open up the cover, visit rdhunderoneroof.com, and stay tuned for sneak peaks of conference content in future issues of the magazine.

Risk assessments: Integrating intraprofessional health models

A respected chiropractor in my community was at yoga this morning. Knowing that she had moved her chiropractic practice to a new location six months ago, I asked her how she liked her new location. She lit up with excitement, and without a nanosecond of hesitation said she loved it. She felt that the move had elevated the care of her patients. You see, her office had moved to a health facility that had a physician, a pharmacist, a hearing specialist, a physiotherapist, and a massage therapist all in the same building. She expanded on the benefits of this holistic model, revealing that the proximity to other health-care providers offered her the ability to consult about the needs of her patients and design care in a holistic manner. I listened intently and noted that, as of yet, there was no dental professional in the building.

The model of multiprofessional health-care providers in the same location stems from the growing recognition that the systems of the human body are interconnected. What is diseased in one region often displays symptoms somewhere else. We are whole beings, after all, not just a back, a heart, or a mouth. Consulting with other health professionals only makes sense.

Change is occurring. One forward-looking group, the Wellness Dentistry Network (wellnessdentistrynetwork.com), is developing “whole” health dentistry. Leading organizations such as the Mayo Clinic say that the mouth is the window to the health of the body.1 Many others, including myself, have written on the inflammation connection of periodontal diseases and the diseased body.2

Caring for special needs patients in the dental office

Every day I get to treat at least one patient who has special needs, and honestly, they are my favorite patients. You might think the exact opposite, and believe me, until I gained experience, did some research, and attended some courses about special needs, I felt the same way!

If you’re stressed, so is your patient. Patients can sense how you’re feeling based on the way you present yourself. Your facial expressions, eyes, tone and pitch of your voice, and gestures give patients signals and they feed off of those. They’ll respond based on how you make them feel. You need to act confident, talk to your patients, and comfort them through their appointments. Remember, they’re nervous too.

© Tomasz Markowski – Dreamstime.com

I have toys and plush animals that I let patients hold during their appointments, and I also use these as oral hygiene instruction (OHI) tools. They’re friendly and create a comforting space for patients so they don’t feel alone. If a patient is very scared, I use a puppet to demonstrate everything first. You won’t get far in some appointments, but it is progress and they will improve by their next visit.

The energy you bring to an appointment will determine how that appointment will go. Be positive and friendly, and smile and talk to your patients! Let’s discuss my top five must-haves for appointments with special needs patients:

1. Cavitron

2. Flavored prophy paste

3. Blanket or lead apron