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By Tricia Wonderly, RDH
No hygienist worth his or her weight believes they are performing at a unacceptable level when clinically treating their patients. Whether a hygienist just graduated and has a confidence that comes with a degree, blood, sweat and tears from 2-4 years of grueling courses, and having been told they are ready to conquer the dental hygiene world with their new knowledge and superior skills or whether a hygienist has been practicing for 4 decades and can clean teeth with eyes closed, it is not likely that that hygienist will think they are a terrible clinician.

Yet, here I am after thirty years of practicing dental hygiene, and have experienced working for dozens of dentists as a permanent or temporary hygienist and can honestly say that most hygienists I’ve encountered are completely comfortable with what they do in their appointments. So who am I to judge what other hygienists do, how they rank among other clinicians, and think I can tell them how to practice better? In part, it has to do with my exposure to many different protocols and practice management styles over the years, in part my production results speak for themselves, and in part my positive feedback from doctors and other hygienists. I am well aware there are hygienists that are knocking it out of the park and are cutting edge and can probably run circles around me. I love learning from them any chance I get. There are also those who would not necessarily think they are making mistakes and if they would be very self-critical and honest, they might see where they could identify with these five mistakes great hygienists make. It is for those that are humble enough to look at themselves and see if there are areas to improve upon that this is written. The top five mistakes I have seen with well-meaning and intelligent hygienists, who, if they realized the cost of these mistakes, would correct and address these immediately.1. A hygienist who gives away periodontal therapy and calls it a prophy. To know if this is you, ask yourself some questions. “Is there any bleeding present when I scale at a prophy appointment? Do I use my cavitron to knock of calculus subgingivally because it is there? Does your patient have only a few 4mm pockets or just a little bleeding? Do you believe that if your patient could just brush and floss better that their gums would be better, so you tell them for the um-teenth time that they should swish with Listerine or floss daily and their bleeding should improve…and you say this year after year? Do you explain to a patient when they have any level of infection and have a specific protocol to address it? Patients are walking out thinking bleeding is not a problem, but their ‘norm’ and have no idea that they have an infection that could be eating away at their bone, or worse, putting them at risk for a myriad of inflammatory disease.

2. A hygienist who accepts overlaps and cone cuts in their x-rays without self-correcting their technique by retaking an image so that it’s textbook quality. In part, I blame dentists for this because they accept this and succumb to substandard x-ray quality from their hygienists. I also blame the hygienists who don’t think they can retake an x-ray or don’t know how to change their angles to get the right technique by the trouble-shooting to correct the error. And shame on the hygienist who knows the quality is not their best, but figures it’s good enough because nobody holds them accountable. These patients are walking around with undiagnosed disease because a hygienist did not learn how to or care how to do something different.

3. A hygienist who does not have, does not use, or does not use well an intraoral camera during a routing hygiene appointment on every patient is making a very costly mistake. Are you looking at every tooth on every surface with an intraoral camera? Are you drying off teeth first so you can see the fossa and fractures? Do you only use a camera when you see a problem with your mirror and explorer? Is every photo saved clear enough to have a conversation with the patient where they can see with certainty the problem you are seeing? Do you know how to take a full mouth tour and when and how to use it during the doctor exam? Do you realize that over 50-75% of treatment that needs to be discussed is discovered when a hygienist uses the intraoral camera effectively?

4. A hygienist who does not know how to effectively educate patients during a hygiene visit on discussing what treatment is needed and waits for the doctor to come in for an exam and figure it out on their own. These patients often can question the dentists motives and the necessity when they are being told by the dentist for the first time about treatment recommendations. Doctors spend unnecessary and precious time talking to your patient about their dental conditions and needs because you either did not take the time, did not understand what the treatment should be, or were not confident in your ability to co-diagnose. Does your dentist have to go on a scavenger hunt during their exam to find the problems? Do you have a photo or periodontal chart up for the doctor and have a system of talking about the patients needs without talking too much?

5. A hygienist who believes that what he or she learned in hygiene school, whether you graduated in May of 2018 or in May of 1988, is still how dental hygiene needs to be practiced every day. For years I knew I provided a great experience for my patients. I intentionally connected with them; I educated them well and spent time teaching my patients to floss better than any hygienist I knew; I helped them understand their disease and need for treatment and had a very high treatment acceptance rate, I took the best x-rays, the best impressions, was more thorough with my periodontal charting than most hygienists I knew, and had the best patients in the practice. Yet, I believed for years that having glassy smooth roots scaled with my sharpened Barnhardt 5/6 and 204S was the most important part of providing that patient with what they came for…an amazing cleaning! One where I couldn’t find any calculus left on their teeth! I recommended those typical dental products that every big pharma company dispensed free sample of and assumed that if something didn’t have ADA on it, that it probably wasn’t the best. Today, my ideal dental hygiene appointments include taking the patient’s blood pressure and blood glucose, discussing their medical history to a degree that I never realized I could and can connect their inflammatory diseases to the specific pathogens I tested for in their own mouth by doing a saliva test of the top periodontal disease causing bacteria. I provide a personalized treatment based on what they need, not on a one size fits all kind of therapy. And I continually am open to new technology, new products, and new ways to communicate so the patients can stay aware of current evidence based dentistry available to them. While it was easy and comfortable practicing dental hygiene the way I always had, I quickly realized I was being left in the dark and needed to up my game. Do you implement new techniques when you read about them? Do you read the latest research on the buzz topics in dental hygiene? Do you realize that treating your patients the way you always have can put your patient at 50% risk for a heart attack or stroke? Are you aware that 5 pathogens that cause periodontal disease are actually scaling and root planing resistant?

If you are one of the great hygienists out there who needs to pause and reflect on if any of these 5 mistakes are ones that you have fallen prey to, whether by your own choice or the choice of the dentist you work for, rest assured that you are in good company. I have coached many dental hygienists and have seen those ah-ha moments happen. It’s exciting. It’s rejuvenating. It’s what makes a great hygienist their best. Thankfully, to create a shift in how to fix these mistakes, it only takes a split second decision to do things differently. To implement the highest level of dental hygiene takes a willingness to change and improve, and like any athlete, it takes the hard work of practicing and executing dental hygiene excellence and holding yourself to the highest standard. Then once that has been accomplished, it takes a level of self-confidence, humility, competence and mastery to truly know that you are a great hygienist.

Patti, Lora, Julie, and Tricia
Dental Hygiene Excellence