Author: Ted Neal

Sharpening in the trenches: Survey results

Instrument sharpening is rarely part of discussions about the business model of dental hygiene. This isn’t surprising given that sharpening is often literally left out of the hygienist’s day, whether he or she likes it or not. Our recent survey on sharpening revealed that of hygienists who say they aren’t sharpening as much as they’d like, 73% cite a lack of time as the main issue.

From our survey, it also became clear that some hygienists’ employers (both individual dentist-owners and DSOs) don’t value sharpening. They don’t provide reasonable time to accomplish it, expecting hygienists to do it after hours—that is, unpaid. Some employers even downright discourage it. One respondent said, “The doctor gets upset when we sharpen and thinks we will ruin the instruments.” There were many other comments such as this one.

Why is something as central to the practice of dental hygiene as a sharp scaler so neglected in some practices’ models of productivity and everyday activities? Why should hygienists feel confident in including sharpening as an important part of their work, both as clinicians and as generators of revenue? In this installment, we’ll explore these questions and hear what experts have to say about them.

The money

Let’s be cynics for a moment. We all know that not every dental professional has the patient’s best interests at heart. We’ll explore the clinical consequences of dull instruments in an upcoming article, but what about consequences that are spelled out in dollars? Sometimes even dire clinical consequences are not enough to push a practice owner to prioritize patient care, but such a person or entity will pay attention when the practice loses money. So, it’s worth asking: Can dull instruments actually hurt a practice’s bottom line?

When exposing radiographs, some techniques may alleviate the reaction

By Patricia Pine, RDH, COM

Our gag reflex is a natural protective automatic response designed to keep us alive. It keeps us from allowing any foreign object from going down our throat. It’s one of many survival responses, like jerking our hand away when we touch something hot. We don’t think about gagging; it just happens. Have you ever gagged when having x-rays taken? This is not pleasant.

The pharyngeal reflex or laryngeal spasm activates the gag reflex when something touches the back of the throat, roof of the mouth, tongue, or uvula areas. The tissues constrict in the back of the mouth, which causes a person to gag or feel like throwing up. Many people become concerned when the gag reflex activates, and this makes them feel uncomfortable or nervous.

The gag reflex starts in the first months of life. If the infant’s brain perceives something that’s too lumpy, the hypersensitive reflex activates. Once the infant starts to eat solid foods, the gag reflex diminishes and is less important for survival, unless, of course, a bitter taste is detected and interpreted as dangerous or poisonous. The bitterness will cause someone to vomit and eliminate the hazard immediately. Cotton rolls can also activate the gag reflex.

Patient perception

Some people have a terrible time preventing their gag reflex from activating. This is embarrassing, and they don’t really know why it’s happening. Gagging can be a physiological fear of losing control by vomiting. Some people can see the x-ray holders coming toward their mouths (it’s not even in their mouths yet) and they start to gag. As dental professionals, this can be frustrating, time consuming, and scary. I have told my patients that if they throw up, I’ll be next. I’m a “sympathy gagger.” However, we should offer our patients who gag encouragement, patience, and a positive attitude.

I came up with my article topic when one of my myofunctional patients visited a dentist for her prophylaxis and new-patient examination. When she returned to her therapy appointment, she told me that she went to her dental appointment, but because she had a sensitive gag reflex, they told her to see another dentist. They actually dismissed her from their practice! I was flabbergasted! This patient truly has a severe gag reflex. The dental team did not understand how to handle or temporize the situation. Aren’t dentists always looking for new patients? What do you think this patient will have to say about that office? Negative publicity will not grow a practice.

As a prevention specialist, I felt so bad that she was turned away because of a problem she could not control. So we discussed ways to eliminate her gag reflex. She has a narrow palate and small mouth. We started some remedial activity. The most successful technique was using a small graham cracker placed between her tongue and mandible. She was able to tolerate this and did not gag.

Placing that huge x-ray holder in a little mouth is a challenge for both patient and dental professional. There are other ways to collect radiographic records, such as a panorex, child-size sensors or films, or piggyback bitewing tabs on the sensor to move it toward the center of the palate to avoid contact and gagging. Crosstex has excellent Wrap-Ease Cushions for sensors with barriers. These prevent the mandibular and palatal tori from being injured. They’re also comfortable and easy to use.

Professional swallowers

Think of a sword swallower. I gag just thinking about that, and I’m not a gagger! How did they train themselves not to gag while putting that long sword down their throats? What about people who “swallow” fire or other items mentioned in books like Ripley’s Believe It or Not!

Do these people not have gag reflexes? How do they overcome any gagging? Do they use continuous training such as mind over matter? What about people who are professional eaters? They have to overcome gagging in order to swallow enough food to win a contest. Participants practice in order to put on great shows for audiences. Patients can also practice at home to desensitize their gag reflex.

In the dental office, gagging takes most people out of their comfort zones. Gaggers often don’t want to return for more dental care. Every experience can be traumatic. Treatment is often postponed until it becomes an emergency. Future recare appointments are frequently cancelled due to anticipated stress and fear.

Every office should consider creating a standard operating procedure for these patients. Every team member should learn techniques to make appointments as comfortable as possible. Stress management is a significant step in this process. Patients could practice at home to desensitize their gag reflex each time they brush their teeth.

Gagging is a defense system of the body to prevent choking. I hope this article helps lay this gagging reflex problem to rest. You can collect some little bags of salt to use, and remember, they are infection-control friendly.

Patricia Pine, RDH, COM, is a national and international speaker specializing in OSHA, infection control, lasers, and orofacial myology. Pine conducts in-office trainings, boot camps, online seminars, and lectures at dental/dental hygiene conventions. She is a member of OSAP speaker’s/consultant’s bureau and publishes regularly in several dental magazines. Pat provides both OSHA Boot Camp and orofacial myofunctional therapy. Contact her at info@oshatrainingbootcamp.com.

References

1. https://www.medigoo.com/articles/hyperactive-gag-reflex/

2. https://www.ncbi.nlm.nih.gov/pubmed/8647679

3. http://www.dentalhygiene411.com/how-to/x-rays-gaggers/

Properly applied sealants are a cornerstone of dental hygiene prevention, especially for young patients—but they’re not just for kids. We recently asked our editorial advisory board how they would handle sealant application in two very different patient situations. If you’ve got patients who love gummy worms and patients who love coffee (and we know you do), read on!

Patient A

This 7-year-old patient is at high risk for caries due to his diet, which includes sugary drinks and sticky foods, and his oral hygiene habits; he brushes just once a day and flosses only occasionally. He has normal dexterity for oral hygiene for his age, and while he seems mildly interested in home-care instruction, his parents are not particularly interested in enforcing good habits at home.

Patient B

This 42-year-old patient has excellent oral hygiene awareness and habits but is suffering decay issues. She has medication-
induced xerostomia. She enjoys a few cups of sweetened coffee spread throughout the day, which she drinks slowly. She is frustrated by the current state of her oral health and is interested in additional preventive measures.

Amber Metro-Sanchez, BA, RDH

What is your sealant of choice for these patients, and why?

For the younger patient, I would use UltraSeal XT hydro by Ultradent. This sealant material works well in a moist environment, which thankfully reduces the constant need for saliva control in this age group. This product also releases fluoride after placement and has excellent wear resistance, so it is a winner for this patient all around.

By Katie Melko, MSDH, RDH

I love having pregnant women in my chair for prophylaxes! It allows me to really hone in on proper home care for mother and child. Since most soon-to-be mothers are concerned about doing everything right, it is rare that they become upset when I review oral hygiene instructions.

By the time I finish explaining the importance of home care, they usually have many questions for me. This is a great opportunity to build rapport with patients and gain their trust. Let’s be honest; this interaction is something that often gets pushed aside because of the high demand placed on hygienists to produce and do more throughout the day.

Pregnant patients

It is usually through the medical history that I find out a woman is pregnant. I like to ask a few questions to feel out whether the patient is happy about the pregnancy before I congratulate her. Most of the time the woman is happy, but I do have patients who aren’t exactly thrilled with the situation, and I have to respect that too. I usually ask how far along they are, when they’re due, if it is a high-risk pregnancy, and how they’re feeling.

Based on their answers, I can usually detect if the pregnancy is good news or not, and then I can continue on with boy or girl questions, offer congratulations, and more. It is always good to have the information about the patient’s obstetrician on file in case the dentist needs to consult with him or her about the patient’s case.

An inside peek to adding bottom-line value

By Anne Guignon, MPH, RDH, CSP

Creating and sustaining a viable alternative income stream is not a new idea. What are the driving forces for hygienists who work outside of a clinical setting, and how do those forces contribute to their financial health? In July 2018, 152 dental hygienists shared their thoughts in a short anecdotal poll (figure 1). The results painted a very colorful, diverse, and intriguing picture.

Motivating factors

Dental hygienists are resourceful. Those who seek additional income are creative, inspired, and unwilling to let anyone define where and how they’ll make those extra dollars. Their enjoyment of something was their number one driver as more than half of the respondents said they earn income doing work they truly enjoy. Diversity was high on the list, and many said the nonclinical work feeds their creativity or provides an intellectual challenge.

Surprisingly, money was not the primary driver, but it was an important aspect for one-third of the respondents. Fourteen percent said they are building a nest egg, and just under 5% reported working in a nondental family business.

The poll revealed some surprising paths to pad RDHs’ bottom lines. Some split their time between a previous occupation and clinical practice, while others made a complete career shift. Sadly, a number said their job changes were spurred on by the physical toll of dental hygiene practice through the years.

By Dianne Glasscoe Watterson, MBA, RDH

Many hygienists can only dream of a day when they own their own dental practice, but business ownership is becoming a reality in more areas of the country. This husband and wife team give hygienists hope that business ownership can be realized when state legislatures remove barriers that block hygienists from owning their own practices.

Derrick and Anna Robertson are dental hygienists who reside in Bucksport, Maine. They met while attending hygiene school at the University of Maine at Augusta, Bangor Campus.

“I craftily dreamt up excuses to talk to Anna, and we started dating the beginning of my last semester,” Derrick said. Anna was homeschooled, and then headed straight to college. Dental hygiene was a second career for Derrick. He had previously worked as a marketing associate for Sysco Foods and as a service writer for an auto center. Derrick graduated from dental hygiene school in 2003 and Anna in 2005.

Making it legal

In July 2008, the Maine legislature passed a bill that allowed for the independent practice of dental hygiene. The application statutes for independent practice dental hygienists (IPDH) state that hygienists are required to have worked in a clinical setting for at least two years and 2,000 hours before they can apply for their license if they have a bachelor’s degree, or six years and 5,000 hours if they have an associate’s degree. Applicants must retake the jurisprudence exam, pass a criminal background check, and pass a board interview. At present, there are approximately 100 IPDHs.