Things people say- Unusual requests and strange questions patients have presented over the years

2e1ax default entry nervous denta patient

Being a Dental Hygienist for nearly thirty years has afforded me many encounters with patients which can be awkward from time to time. Following are some of the most unusual requests and questions I’ve witnessed over the years.

  • Do you clean the instruments between patients? The answer is a resounding YES! Instruments are carefully transported to the sterilization area where they are placed in an ultrasonic cleaning device with an enzymatic cleaner. The ultrasonic action removes any debris on the instruments considering debris must be dislodged before the instruments can be sterilized The instruments are then placed in an autoclave where they are sterilized by pressurized steam.
  • Upon entering the operatory, I’ve had patients request: no x-rays, no scaling, no polishing, and no flossing. What??? My sarcastic self wants to ask why they’ve come in for an appointment. Instead, I regain my composure and ask why they are refusing the proposed treatment. If I identify what exactly they fear or dread, I can explain why each step of the appointment is necessary, and some parts of the procedure can sometimes be shortened while still providing thorough treatment.
  • I can’t lean back at all, so you’ll have to stand to clean my teeth. Again, my sarcastic self wants to tell them that it’s fine and I’ll stand on my head. After a few deep breaths, I inquire as to why they have to sit upright. There certainly are instances where a patient can’t lie flat, and that’s respected and honored. For the most part, if it isn’t a legitimate request, the reason for not wanting to lean back is fear and loss of control. Simply explaining to the patient that they are one of many patients treated daily and trying to treat them while they sit fully upright is detrimental to my long-term health. Some clinicians prefer to stand while providing treatment, but the patient is reclined. Treating patients fully upright can contribute to Musculoskeletal Disorders and end your career.
  • I just want a cleaning today. I don’t need to see the doctor- In most states, an examination by the doctor after a prophylaxis is the law. There are some states in which hygienists can open their own practice without a dentist ever being present. Also, some states allow for a patient of record to be seen without a dentist being present if they have received an exam within 12 months and are appointed for a regular prophy. For the most part, the patient must be examined by the doctor.

Some other funny things patients have said:

  • Upon handing the patient a sealed lip blam to use during the appointment they, in turn, ask me if I give the same one to the next patient. I smile and say, “No, this one is special for you to take home.”
  • “Where does the stuff go that you suction out of my mouth?” After a chuckle, I inform them that the “stuff” first goes through a filtration and separation system and the remainder goes down the drain just like it does at home when spitting in the sink.

 Patients can be the source of some unusual requests and questions, but it certainly makes the office more fun. Oh well, it’s all in a days work.

Miss Manner's Rules for Proper Etiquette In and Out of the Operatory

root canal

Should you be concerned with etiquette in the operatory? Although it may seem to be a strange question, some clinicians aren’t even aware they’re violating the protocol of OSHA and HIPPA. Not all of the infractions listed below are HIPPA and OSHA requirements; they’re just plain rude. Here is a list of things to avoid in and out of the operatory:

  • Leave your cell phone OUT of the operatory. A patient in the chair DOES NOT want to witness your conversation or text message. Furthermore, the patient’s appointment time isn’t an opportunity to catch up on emails or social media. Smartphones have enabled us to have the world at our fingertips, and it’s tempting to engage with the phone instead of the patient since there can be plenty of downtime during the appointment. Try engaging with the patient instead and educate them, make them comfortable, or just let them vent.
  • Never blow your nose or cough in the presence of a patient. Excuse yourself and go to an area where you’ll have privacy. Even if the patient can’t see you, it’s not something anyone wants to hear, especially in a medical setting.
  • Never have a heated discussion with a team member in front of a patient. Leave any cross words or even a calm discussion for later when it can be addressed out of the operatory and in privacy.
  • Avoid conversations about religion or politics. Even if the conversation is agreeable, a patient in the next room may hear and find you being improper and unprofessional.
  • Avoid conversations about patients with team members unless in a closed room away from any observers. HIPPA violations are very real and can end in fines and jail time. Additionally, ignorance of HIPPA laws can’t be used as an excuse.
  • Pay special attention to the patient's personal information. When you have a chart in your possession, this information must be kept confidential. If anyone other than a team member gets access to another patient’s personal information, very serious consequences can ensue. HIPPA personnel will become involved and again, impose fines and in some cases, prison. These fines can be imposed per occurrence which means that you’re not facing one fine, but separate fines for each patient whose information is compromised. The front desk is a prime example of where opportunists might gather patient information. The reception area and front desk are very busy places with many things happening at once. Also, the communication in the front office includes credit card numbers, names, addresses, social security numbers, and insurance information.
  • Don’t eat or drink in the operatory or in front of a patient. Keeping food and drinks in the treatment room can cause them to become contaminated. With the use of high-speed and low-speed handpieces, particles enter the air and land everywhere. Even at the front desk where contamination may not occur, eating in the presence of the patient is rude.
  • Watch what you say outside of the office. It’s no surprise that people vent about the workplace. However, you never know who’s sitting in the next booth. Mixing in alcohol can also be a huge problem if it encourages you to talk louder and be more open. HIPPA exists outside of the dental office, and you absolutely can violate HIPPA guidelines and have to face the consequences.

Fun can still be had while treating patients, however, be sure to stay within reason of the rules and guidelines. The workplace will be safer and more pleasant for the team and the patients.

Don't Forget Your Child's Oral Health During Summer Break

summer break oral health

As the school year comes to a close, thoughts turn to no schedules, vacations, and kid’s camps. During the school year, schedules abound with everyone staying on task including paying close attention to personal grooming. When it’s time to prepare for “back to school,” many parents find that their child has been neglecting their oral hygiene with a trip to the dentist and receiving a bad report. This type of diagnosis can be avoided by following a few simple rules.

  • Don’t let the routine fall by the wayside- Continue the normal routine regardless of it being summer break. It’s very easy to stay up late and sleep late while forgetting to brush and floss. Also, much more junk food is probably consumed leading to a greater risk of decay.
  • Pack the necessary tools- Vacations are great because it’s a time to leave all the stress behind. However, make sure the toothbrush and floss aren’t left behind with the stress. While most children can pack their luggage by age 12-14, they are likely to skip the brush and floss. Give their packing a once over confirming the presence of oral hygiene supplies. Also, if you’re with the children on vacation, make oral maintenance a priority. Many times, children from six to fourteen and beyond are in some phase of orthodontics making brushing and flossing imperative. Another great idea for use all year round is an over the counter fluoride rinse.
  • Going off to camp- Sending kids to camp is a time-honored Often, it’s the first time parent and child are separated. In this case, advice must be given and written to help the child remember to take care of themselves. A written reminder sent along can make the child feel less homesick and more likely to follow the rules. It’s also wise to pack extra toothbrushes and travel size toothpaste to be given to the counselors for safe keeping.

By taking some extra simple steps, your child can remain cavity free as the summer comes to a close. It will also be easier to resume the school year routine when the alarm clock sounds once again.

Are Doctors and Team Members on the Same Page?

HealthSafety

Dental offices are busy places where clinicians run from room to room with only seconds to spare. Occasionally, in all the confusion, team members and dentists aren’t on the same page regarding the patient’s treatment plan. As a result, the patient receives an employee’s plan and the doctor's opposing plan concerning the same treatment. This type of miscommunication is common in practice all over the world, and the one who suffers is the patient.

Usually, there are two reasons for an inconsistent treatment plan. The first reason is that the team and the doctor haven’t reviewed the plan together. The second reason involves the hygienist, assistant, or front desk team members not agreeing with the doctor’s prescribed plan.

If the problem is related to not being familiar the treatment plan, time must be set aside to review who’s in the chair, proposed treatment, areas on “watch,” and any other necessary facts to ensure the patient is handled professionally. A morning huddle is a good idea with the team and doctor’s attendance being mandatory.

The second cause of confusion with an existing treatment plan involves a team member who doesn’t agree with the doctor. While it may be difficult for clinicians with years of experience to accept, the only person who can legally diagnose and change proposed treatment in the office is the Dentist. Hygienists, assistants, and front office team members are not legally permitted to diagnose or change any doctor’s diagnosis or prescribed treatment.  

Disagreeing causes some team members to revise the dentist’s recommended treatment by justifying that they know what’s best for the patient or by making financial assumptions involving the patient. Following are some guidelines to help prevent and avoid this type of confusion and insubordination. Otherwise, the doctor’s treatment plan is devalued and suggests to the patient that the dentist is trying to take advantage.

Step one-

A team meeting lead by the doctor outlining the manner in which patients should be handled clinically is a great start. There should also be documentation of this protocol, and each team member must sign. If a team member refuses to sign, it may be time to part ways.

Step Two-

Incorporate scripts that teach each team member how to have conversations regarding treatment with the patient. Role-playing within the team can help with any awkwardness. Each team member must be familiar with the scripts and adhere to the wording.

Step Three-

Stick to the plan and always offer support. Avoid slipping back into old habits through continuous training.

Although difficult at first, devising and following through with a system outlining the proper way of presenting and following through with prescribed treatment plans will allow everyone involved to be on the same page.

Human Papillomavirus (HPV) and Oral Cancer- Part Two

iStock Oral cancer

As discussed in Part One of this blog, HPV is the leading cause of oropharyngeal (tonsils and base of the tongue) cancer. Oral cancer caused by HPV is very serious, and most patients aren’t even diagnosed until they present with symptoms because the symptoms are often painless and subtle. Physicians are enlisting the help of the dental profession in assisting with detection, diagnosis, and referral for treatment. In this blog, we’ll discuss the difficulty in diagnosis, symptoms, and treatments of HPV related oral cancer.

Difficult to Diagnose-

HPV is present in millions of males and females. In most cases, it clears on its own and treatment isn’t necessary. It rarely causes any symptoms making it very difficult to detect. There are many oral cancer detection kits on the market, but none are accurate in detecting HPV related cancers. Paying close attention to the patient’s medical history and any unusual lumps or lesions is imperative in helping with detection. It’s necessary to have a conversation regarding the seriousness of HPV related oral cancers and the availability of the HPV vaccine.

Symptoms-

Symptoms are rare, and if they do appear, it’s most likely that the cancer has been present for a while. While the symptoms listed aren’t necessarily linked to HPV oral cancer, it’s prudent to take detailed notes and have the patient return to your office if any of the following are present for two to three weeks or longer.

  • A painless lump present on the outside of the neck with a duration of at least two weeks
  • Numbness in the lips or mouth
  • A persistent cough or coughing up blood
  • A unilateral earache lasting for at least two weeks
  • A recurrent ulcer or sore that doesn’t heal after two weeks
  • A black, red, or white discolored patch on the soft tissue
  • Difficulty in swallowing or the feeling that something is stuck in the throat
  • Unilateral painless and inflamed tonsil. Both tonsils should be approximately the same size
  • An ongoing sore throat or hoarseness

Treatment-

If oral cancer is suspected, it’s crucial that the patient is referred to an oral surgeon, periodontist, or an ENT immediately. Upon examination by a specialist, a laryngoscope or pharyngoscope may be utilized to explore the base of the tongue and tonsillar areas. A biopsy of the suspect tissue will be taken. Depending on the results of the biopsy, a treatment plan will be created which may include surgery, radiation therapy, chemotherapy, or all three. Sometimes, surgery is sufficient. With any treatment, reconstructive surgery may be necessary.

HPV related oral cancers can be prevented with the vaccine and safe sex practices. Although this discussion may be awkward, it’s necessary to educate patients and parents about the devastation caused by this growing crisis.

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