Hygiene Edge Thank You Cards Video

Need an evening pick me up after a long day at work? (Who doesn't?!) Check out our latest silly video, fashioned after Jimmy Fallon's Thank You Notes Skit. You will definitely relate, especially after a Monday!

BECOMING AN UNFORGETTABLE DENTAL HYGIENE TEMP

I chose to exclusively temp for 1.5 years due the flexibility with starting a family.  I’ve temped for 16 dentists in 11 offices and have thankfully been invited back by each of them.  

--BEFORE YOU GET NERVOUS ABOUT TEMPING--
 

• 1. Remember this is about  “BECOMING” an unforgettable dental hygiene temp (you don’t have to already be  one). Watch This short video here about “Becoming”
• 2. Watch This short video on how to not be nervous but excited about dental hygiene.  
• 3. Read below the 7 practices I’ve implemented that have been GAME CHANGERS!

 At first temping was very challenging and I had some REALLY difficult days … but as I kept doing it and applying the things that I’m going to share I began to receive comments Like “The dentist loved working with you and he normally doesn’t like anyone” ,  or “We’ve never received so much positive feedback from patients from a temp before” .   I just recently received a hand written letter from a dentist thanking me and it said “You’re such a good hygienist”  I would have never received a letter like  that in the beginning!! 

 I believe there are 7 points to becoming an unforgettable dental hygiene temp.

 TIP 1- HYGIENE NOTEBOOK 

My #1 tip is to purchase a temping notebook!  I honestly believe success is in this notebook.   The shortest pencil is better than the longest memory,  The notebook is where I put all of the pertinent information   (as far as computer commands, staff members names and anything unique the doctor or office likes)

I often get comments how fast I mesh into offices and I honestly believe its because I have everything written down so I don’t have to ask the same question and over.    When I come back to an office after awhile I can easily step back in, remembering how the particular office runs, computer commands and staff members are always impressed that I remember their names.  


TIP 2-RUN AHEAD

Running ahead starts before the patients ever get there by getting to the office early and learning as much and writing down as much as you can before your first appointment. 

I usually try to be to an office 30 minutes early.  

I walk in and immediately introduce myself to the office manager.  I will usually jot down her name with a description in my notebook.  Such as “Jana – office manager-blonde”.  As the office manager introduces me to other staff members I try to quietly do the same- “Tara-assistant- glasses” (I always avoid descriptions of size because you never know who will see your notebook!)

I immediately take a mental note of how the room is set up.  Where the slap wrap is placed and so on.  I  start opening drawers to see where pt bags are located, prophy paste etc….

As soon as possible I will ask an assistant to show me how to get on the pt charts and how to take radiographs/retakes, how to get into my notes, and the probing chart.  

Every command the assistant does on the computer I write down and draw a little picture when I can.   For instance to take radiographs at the office I work at now.  I would put :

x-rays = LR circle (and I would draw the picture of the circle with the squiggly in the middle of it on the Lower Right of the computer) ->new exam-> Schnick Smile exam 

On the next line I would put "retake= double click"

After I’ve written all the pertinent info I will then make sure the air/ water is on and see how the chair is operated.  (NOTHING is worse than trying to figure out how to operate the chair with a patient in it!!).. I locate patient bags, gauze etc.  

 TIP 3- BUILD RAPPORT  

There are two keys to building patient rapport:  Be sincerely interested in the patient and Compliment.

Recently I was temping and by the end of the appointment this older cowboy was excitedly showing me pictures of his saddles, horses and cows while we waited for the dentist.  He knew that I was interested not only in his oral health but in him as a person.    Also, never introduce yourself as "the temp." Pretend that you have been working there for 40 years but if they ask where their "usual" hygienist is I say something like, "they have the day off but I will be taking excellent care of you today." 

The second step is to COMPLIMENT, COMPLIMENT, COMPLIMENT.  Every office has something special about it. Nothing makes a patient feel more secure with their choice of office, and an office more happy than hearing you pointing out something great about their office.  I’ve said complements to the patients like “I LOVE how nice and friendly the staff is here”, Or “Wow I’m super impressed how up to date the doctor is on the latest technology and products” .  Or isn’t this such a beautiful office if I can’t think of anything else.?

TIP 4- BRING VALUE TO THE OFFICE


Add value by leaving the office/patients with a new idea or product.

No matter what the previous hygienist does- give the highest standard of care.   Cancer screening and probing, patient glasses (I used to bring my own sunglasses, xylitol samples etc.) and so on. This means that you are recommending fluoride and electric toothbrushes.  Recently I was in an office for two weeks and was able to introduce MI past to their office as a product and showed the DDS how he could offer it to his patients for white spot remineralization. The office manager ordered it and we went through two boxes while I was there, which increased their production and gave them something to offer their patients when I left.  


Bringing value means staying on time.  This is difficult when temping but having the notebook helps avoid having to ask too many questions and will speed you up!  If I’m running a bit behind I will walk my patient to the front and have the front office manager schedule his/her 6 month appointment.  

Bringing value also means that you are constantly looking for ways to contribute, not just production wise, but to the actual office by always staying busy.  It means that if you have time, you help break down the doctors rooms, and if your patient cancels, that you are scrubbing baseboards. I heard from a temp agency that a lot of doctors kept calling and requesting the hygienist that cleaned baseboards and windows if her patient cancelled.  

TIP 5:  LEAVE WITH A BANG

At the end of the temp day individually thank the DDS and each staff member.  And let them know that you would love to come back.  If you are temping for an extended period of time bring cookies or treats for your last day.  It’s something small but I will say it goes a loooong way!   I  also heard from a temp agency that the dentist kept requesting the hygienist that ordered the office pizza for lunch.  That is a small expense for all the temping work she got from that gesture.

 TIP 6: REVIEW:
When the temping day is over, spend 5 minutes in your car and write down anything unique to the office for next time, and any questions you would ask when you return.

 TIP 7:BECOME THEIR FIRST CALL:  

When the dental office calls you to come in again and you can’t, make sure that you help find them someone who can.  This not only helps your dental hygiene friends but they will always call you because they know if you can’t help them out that you will find someone that can.  

How To Reach Those Hard To Access Areas

Wow this Craigslist posting for a hygienist had me in awe! I read it in an article in the December 2012 issue of the RDH magazine entitled IS THERE REALLY A HYGIENE SHORTAGE? 

"The World Wide Web is an excellent resource for job searching, if one is careful of the sources used in seeking employment. Sites requiring a fee for job postings are often less packed with offers of part-time work making thousands of dollars weekly — postings worth ignoring. Success in career placement has been found on sites ranging from Monster.com to LinkedIn. The worst posting I witnessed this year came from Craigslist.org and was forwarded to me by a frustrated dental hygienist."

“Dental practice in ______ seeking motivated Hygienist. Looking for someone who can complete task at hand so that I do not have to come in and finish the Distal lingual of the lower right and distal buccal of the upper left on every single patient. Also need you to come to staff meetings with an upbeat attitude, focused on trying to find ways to connect with your patients and help keep your schedule full, rather than have a chip on your shoulder and fail to participate in any meaningful manner. Position will start as part time but with the right person can become full time. With this economy and WDS, times are terrible for practice owners. Most of us have taken 50%-75% pay cuts. The gravy days are over. Pay will start at $35 per hour. Bumping up to the high 40s of yesterday will be determined on your skill level, ability to complete tasks at hand without emotional flare up and attitude. Most importantly, you will be expected to help in keeping your schedule full rather than expecting the front desk personnel to do it all for you. If you want employment, and are willing to put in an effort, send your resume.”

Of course this AD is a disgrace in all aspects but I show you this not to discourage you but to make you step back and ask yourself if you are able to reach #15 DB and #31 L. Are you going to staff meetings with a great attitude? Do you have a recall system in place in your office or do you have one that you can present to the dentist in an interview? Check out our latest video for tips on how to reach those hard to access areas. 

Networking- The Magic Bullet During Job Hunting Season

It is job hunting season for many hygienists. 


My Dad always told me, "It's not what you know, it's who you know." As I have gone through the job hunting process myself, I have realized that Dad was correct.  I currently work in education and private practice. Both of these positions came to me through someone I know. I have also been able to keep these positions because of WHAT I know. Both the WHO and the WHAT I know have been because of networking. Networking is the secret weapon of being an extraordinary hygienist.

My Dad also taught me that relationships are one of the most important things to cultivate. The opportunity to create relationships is one of the reasons I chose to become a dental hygienist. I encourage you to look for every opportunity to create networking relationships. For example, I have come to find that going to dental conventions are not only for CE's but for networking. Conventions are for connections too! We sometimes get CE focused and miss out on the most important part... the relationships! At my first ADHA convention I met incredible hygienists that have impacted the way I understand and engage in with patients and students. The one and only Esther Wilkins even beat me down the hall on the way to a class. 

My fellow RDH friends often comment that I know "everyone" when they come with me to our local convention. The connections that I have made at conventions are invaluable. I have been able to help direct colleagues to products and people that have enhanced their lives. I myself have been introduced to mentors, educators and entrepreneurs that have enhanced my profession. When you find yourself sitting in a CE class waiting for the speaker to start or walking from booth to booth in the exhibit hall, stop, look around and strike up conversation with those around you. You may meet your next boss, a new mentor or become a mentor for someone else.  

Here are some suggestions on how to network:
Join a Facebook group of fellow Hygienists. 
Use Linked In.
Be friends with your former professors!
Join ADHA and be involved in your local chapter.
Attend CE courses.
Stay in touch with your class mates.   


                                                                                                                                          -JESSICA

P. L. E. A. S. E Method

PICTURE THIS:


You are hunched over your patient frantically scaling half hazard strokes...the clock is ticking and you move to the next quadrant, you don't completely adjust your light but you can still kinda see (kinda/sorta).  You clean the distal lingual of 15 and keep moving on...only to realize that the distal of 15 still has a huge piece of calculus still on it.  You go back to 15, remove the calculus and then try to remember which teeth have been cleaned.... Meanwhile your body looks like a human pretzel..your patient is too high, you're too low- your elbows are high, shoulders hunched, your neck is twisted (because you haven't had the patient adjust his head) and some teeth are cleaned while others are not.   The faster you go the less adaptation you have and your patient keeps "jumping".  By the end of the day you've been behind all day, your body is killing you and you're very frustrated with your career choice!!

I remember sitting in hygiene school and one of my professors off handily saying that she wished there was a mnemonic/checklist to make sure that nothing was forgotten in the hygiene appointment.  For years after that comment I would randomly think about it.  One morning I was laying in bed and it came to my mind as clear as glass.



P= Position  for both yourself and patient.  If I was going to clean the lingual of quad 2 (as a right handed hygienist)  I would sit at 9:00. I would have my patient's head up and tilted towards the left.  If you notice yourself leaning…it's because your patient is most likely not in the correct position. 


L = Lighting.  It's important to use your overhead light and mirror for maximum illumination.  Often times (myself included) when hygienists move from one quadrant to the next the light isn’t adjusted in a way to provide maximum illumination and essentially when we do this we are cleaing in the dark.


E = Ergonomics. Make sure you are not leaning to one side in your chair but that you are sitting up straight, that your wrist is neutural and that you are not making chicken wings with your elbows.

A= Adaptation.  If your pt complains of you hurting them it is most likely that the toe third of your instrument is not adapted to the tooth. 

S=Strokes.  The quickest way to fatigue is doing a working stroke too often.  Its important to do exploratory strokes with your instrument and then working strokes.

E= Edge.  The saying "sharp tools make light work" is very true in DH. Continually check to make sure your instrument is sharp.  It's helpful, especially in SRP to have a sharpening stone on your tray. 


Now let's look at the above scenario with the Please Method.  

The clock is ticking.  I sit down to do the lingual of quad 2.  I take a deep breath.  I make sure my chair and the patient's seat is in the correct posistion.  I have my patient put his/her chin up and turn slightly to the left. I adjust my light for maximum illumination.   I check my ergonomics and notice I'm leaning so I adjust my patient more.  I then place my instrument in the distal of 15 and then adapt the toe third of my instrument to the tooth.  I start with exploratory strokes and make sure my instrument feels like it is sharp.  I clean the distal...when it feels great I move onto the straight... and then the mesial.  Then I move onto 14..I clean the distal, when it feels great I move onto the straight and then mesial. I keep going until I need to move onto the next quadrant. I then put the PLEASE method into practice again!!  

 With the PLEASE Method I have noticed that my cleanings are CONSISTENTLY more focused, gentle and thorough while still protecting myself as the dental hygienist.   Want to see it for yourself. Check it out in the video below.

Need a PLEASE reminder? Download the file and hang it where you keep your daily goals and reminders HERE. 

Part 2-Increasing The Dentists Production-An Overlooked Job Title of the Dental Hygienist

Part 2- Finding Treatment Needs

In Part 1 I talked about how to help the dentist increase case acceptance. Part 2 of this conversation is how to find treatment that the patient needs for the dentist. 

At the beginning of every appointment I USED to ask, “do you have any teeth bothering you?” Often times the patient would forget and then once the dentist arrived they would state, “Doc this tooth on the upper right has been hurting for weeks.” I would then have to work backwards, take a PA and have the dentist take another look after the initial exam. CAN YOU SAY TIME WASTER. To prevent this and become a valuable team member, that aids in helping to find treatment needs, I ask that beginning question a little differently now by asking several detailed questions instead. 


1. Do you have any sensitivity to cold? (Potential Fl2, or desensitizing treatment needed)
2. Do you have any sensitivity to hot? (Potential nerve damage= take a PA)
3. Do you have any sensitivity to pressure? (Potential tooth fracture=potential crown)
4. Do you have any sensitivity to sweets? (Potential caries)
5. Do you have any concerns with your smile? (Potential whitening, ortho, veneers, or crown lengthening)

NOTE: this may seem like a lot of questions, if so pick your favorite one, ask it each time and make yourself more valuable. 

During the appointment I always do a brief (about 2 minutes) visual exam with my air and take intraoral photos of areas of concern such as fractures, chips, abfractions, demineralization, darkened areas, or calculus. 

The dentist will usually ask if you have any findings prior to sitting down for the exam. If they answered yes to any of the above or you have found any areas with your visual exam, have them evaluate those areas.

One office I worked in used a DIAGNOdent and I really learned to trust it. (NOTE: we are not paid to say this stuff, and there are several similar products out there available) I would get all of the readings on suspicious areas and if they were demineralized to a certain number (NOTE: ours was 25-30)  the dentist would treatment plan a filling. I was surprised at how many areas of occlusal caries had been going undiagnosed.   By making time to do this in my hygiene appointment (NOTE: I had 1 hour appointments) I was helping to increase the dentist production. Making me more valuable.

I had one hygienist tell me once that she felt like her office would benefit from this tool so she bought one for the dentist knowing that with just 40 one-surface fillings it would be paid for.  She found that many in the first week (NOTE: it was a very busy office with double hygiene and she knew it was an awesome tool because she had used it at a previous office) Wow, did she ever make herself valuable, and of course she was reimbursed for her purchase. I also hope she got a BIG raise. Using this tool, or others like it, also gives us as hygienists an opportunity to talk about the need for sealants which can increase hygiene production. 

NOTE: want to know how to use the DIAGNOdent check out our video HERE.

To summarize, make yourself more valuable to your office by helping the dentist find treatment that the patient needs. Watch for part 3 coming soon as I talk about how to track this information to ask for a raise. Happy treatment finding.

10 Things I Wish I Would Have Known Before I Took Boards

I know a lot of you students are preparing to take National written and clinical boards in the next few weeks. Bah! So close! Let’s pause right here just for a moment of congratulations; you have made it this far! Can you see the light at the end of the tunnel? From my own experience, and the experience of my colleagues, here are 10 things that will help you navigate boards with greater ease and finally get you to the end of that tunnel: 


#1 Cut Out Distractions 
Does this story next sound familiar?  You have planned two hours for some study time and then your phone dings…20 minutes later you crack open your book ready to start. Your phone then flashes; a new Instagram post…15 minutes gone.  Beep beep......a post reminds you to check that video on Facebook…another 45 minutes, poof, gone. You have 40 minutes left of study time and you decide to get serious so you Snapchat a pic of you studying hard with your book. You snap another pic of you chewing your pencil and the next thing you know study time is UP. Does this all sound familiar? When I was studying for boards I had a classmate change my Facebook password so I couldn't log in for 2 months. It saved me time, sanity and helped me focus. To this day my password is still boards suck with my classmate's birthday digits at the end. I smile every time I have to type it in. 

#2 Take Care of Yourself 
Sleep. Eat good things. Sleep. Drink water and did I mention sleep? 


#3 Prepare What You Can Ahead of Time and Don’t Sweat the Small Stuff. 
Write up everything you can beforehand. Make sure all of your ID’s are exactly the same (if your ID has your middle initial in it ALL of your ID's must use your middle initial.) 

#4 Have a Plan
 As far as clinical boards is concerned, remember you have cleaned this type of calculus before. Create a sequence that works for you. My preferred sequence was: Ultrasonic with the triple bend, handscale with area specifics, explore, use your files to crunch any tough spots, return to ultrasonic with the slimline or thinsert, explore, probe and record recession, finish with handscaling any remaining calc. and submit your patient with confidence. I told my patient to think clean thoughts as she passed the point of no return entering the examiners operatories. 

#5 Failure Isn’t the End
 I failed the written anesthesia test the first time I took it. I had driven with some classmates from Utah to California to take the test at USC. We stayed in this hilariously rundown hotel and the campus smelled funny. Back then, we took the test in a classroom, on a piece of paper, with a pencil, a PENCIL. After the test I waited outside of the classroom for results. While we waited we stupidly tried to compare what we answered with each other until the proctor came out and handed each of us an envelope which had a pass or fail slip inside. I opened my envelope and saw those dreaded words. FAIL. I cried…a lot. I learned where I needed to study more,  compassion for others who failed, to curb my comparing, and that failing can be a positive thing. I am a better clinician, colleague, teacher, and friend because of that fail. You can take the test again, really you can. In the meantime… 


#6 Plan for Success 
Obviously you aren't planning to fail. My failure taught me how to plan, progress, and PASS! Visualize it. Talk nice to yourself. I even drew myself as a stick figure, surrounded myself with words of affirmation, and drew a cap and gown on my stick figure body holding a diploma in one hand and a syringe in another! Keep yourself in a growth mindset not a set mindset. Passing boards isn't the end of your professional education. 


# 7 Don’t Compare 
Oh I could write a dissertation about this but, I’ll spare you. Worry about yourself and what you know. Comparison kills. It kills motivation, friendships, kindness and karma. Speaking of karma… 


#8 Karma is a Real Thing 
Karma is a real thing especially when prepping for tests. If you hear about a great boards review class, tell your friends. If you find a book that has been super helpful, tell your friends. If you find an extra boards patient, share with your friends. I have seen it over and over again, those who help each other win with each other. 


#9 Case Studies 
An alarming majority of people I talked with told me they wish they had studied more case studies. The application of 100’s of hours of school in real life scenarios; case studies. The stuff you will see in practice, case studies. The stuff you will be tested on, case studies. Study up, this is soon to be your life! 


#10 You Aren't Just Studying for Boards 
 Newsflash, being a dental hygienist is going to be your PROFESSION! The things you will be tested on actually help you in your soon to be job. You will need to retain a lot of this information for real life. 


You've got this. See you on the other side Colleagues!

Increasing The Dentists Production-An Overlooked Job Title of the Dental Hygienist

(Part 1) Techniques to Increase Case Acceptance

 Of course we should pay attention to the hygiene departments production but may I also suggest that we pay close attention to how much the dentists production is as well. One often overlooked way a hygienist can add value to the practice is by increasing case acceptance.  How does a hygienist go about doing this? Well, as you all know every dentist diagnoses differently and has different philosophies on treatment planning. As you get working with a dentist you will pick up quickly on their diagnosis philosophies and will be able to pre-inform patients of potential concerns WITHOUT diagnosis. For example if you see something that the dentist usually diagnoses bring it up to the patient by saying something like,

     “this looks concerning (or suspicious), lets have the dentist take a look at it.” 


 If they hear it from you AND then from the dentist it put urgency on getting the NEEDED treatment completed. 

To make my point, let me share with you a story. At one office I worked at the dentist always recommended to patients that amalgam filling get replaced with composite ones. When I first started working there I noticed that he would have this type of conversation with every patient, stating something like, "amalgam fillings expand and contract, and over time flex the tooth so much that it leads to fractures in teeth. Therefore, I recommend replacing this with a composite material." 

SIDE NOTE: One may not agree with the dentists diagnosis philosophy, if not you must consider for yourself if it is the right place of employment for you. 

I don’t know what he learned in school or what CE courses he took, nor what research he has studied but I did recognized quickly that this was a conversation that he felt was important to have with all patients with amalgams. Therefore, I started to state to the patients, “ I noticed that you have several amalgam fillings, over time these can potentially expand and contract weakening the tooth. I am going to have the dentist evaluate them and see how they are holding up.” When it was exam time I would state to the dentist, “Mrs. Brown has several amalgam fillings, would you please double check them to see how they are holding up?” With the patient hearing the concern over the amalgam fillings twice they were more willing to accept theproposed treatment plan to replace them.  

Now, not all dentists like to replace amalgam fillings but you will pick up quickly on the treatment needs your dentist puts value on. At one point I was working at 3 different offices. On Mondays and Wednesdays I was informing patients of the need to replace amalgams. On Tuesdays and Thursdays I was informing patients that amalgam was still an awesome filling option, and on Fridays I worked for a dentist who didn't like composite or amalgam, ONLY inlays/onlays.  It was quite the juggling act to remember where I was and what my pre-informing scripts were for the day.

There are many other scenarios that you may find in practice. Becoming an amazing dental hygienist includes developing the skill to increase case acceptance of the treatment plans that the dentist proposes to the patients by pre-informing them of suspicious areas and potential remedies. Getting good at this skill will increase your value to the office because it will help increase the overall office production as patients are hearing and understanding treatment needs from 2 professionals. 

Get started increasing case acceptance by using the formula below and recognize how your dentist diagnoses and have pre UNDIAGNOSTIC conversations with your patients about concerns, suspicious areas and potential remedies.      

             
                                                                                                                                                                -Shelley

The Importance of SRP Post OP Instructions

Periodontal debridements are hard work! After a long scaling and root planning appointment, the last thing you might be thinking about is educating your patient, and the last thing they want to hear is more information! However, post op instructions are vital to the healing and health of your patient. Here are a few reasons why:

1. They will be sore a couple hours after treatment, especially if anesthesia was used. Most patient weren’t experiencing gingival pain before the treatment, and could be upset that they are sore after being seen by a hygienist. Explaining to them that pain is normal and will get better in a few days is helpful to ease their mind.

2. Giving proper post op care is essential to healing. You spent several hours numbing, scaling, placing antibiotics, and removing bacteria. The last thing they need it is for the bacteria to reculture in 24 hours and make all that work for not! Having good home care will not only help heal the gingiva and periodontium faster, but also have the patient comfortable quicker.

3. Tooth structure will be exposed after treatment that has not been for, possibly, years, and will be sensitive to the elements we put our mouths through. Help your patient understand that this happens to everyone, and there are ways to prevent being uncomfortable. Daily fluoride mouth rinses, sensitive toothpaste, or prescription pastes can all help with the hot and cold tenderness that follows SRP.

The easiest way we have found to give the best post op information and care to your patient is with a hand out. After a quick explanation, slip one in their Oral Hygiene Bag. It will greatly comfort them if questions arise in the middle of the night and they feel they have nowhere to go. This little gesture goes a long way with our patients and shows how much we care as hygienists about their oral and overall health!

What do YOU tell your patients about home care after treatment?

Need a Post Op hand out to give to your patients? We’ve included ours! Just click and print!

lick HERE for your own downloadable version.

Successful Pediatric Appointments

       As we end national children dental health month I ask myself what is a successful dental appointment for a child. I was a pediatric dental assistant for years before I became a dental hygienist. I saw temper tantrums, tears, terrorists and some teeth marks too. One of the phrases I found myself recite over and over to disappointed parents was, "don't worry, this is common behavior," when their young child wasn't ready to jump in and love the dentist experience. 

             So, how to define a successful appointment is through evaluating progress (see more about adopting a growth mindset HERE.) The ultimate goal is to create successful appointments throughout the child's lifetime.  A few ways to do this are, one, to start small by keeping detailed notes about the child's behavior so you can praise their improvement. For example, "Jonny, I am so proud of you for letting me polish 10 teeth today, that is 5 more than last time. Good job!" Two, I would recommend that you ask the parent to stay in the waiting room. My experience has been that children behave better when the parents are out of sight. Last but not least, make the parent and child want to come back and see you again by ending on a good note. What I mean by this is offer a little prize to remember you by. Some examples of this are:


-letting them pick something from the treasure chest  
-ice cream/taco coupons 
-make them a balloon chicken as shown in the video below


My experience with this is that they will love you forever.  

What are some of the things that you do to make your child appointments a success?  

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                                                                                                           -Jessica