The Formula to Happier Patients
"My hygienist wasn't that great. She only used the water." - My Aunt
"My hygienist was super lazy. She didn't even use the water." - My Sister
"My hygienist said I need shots in my mouth and all this stuff... I don't know why. I think she was just confused with all the bleeding." - My Friend
"My dentist wants me to come back after the root canal to get a crown, instead of having the endodontist do the crown. He is definitely trying to get my money." - Another Sister
Yes, there will be some patients that are NEVER happy. But, I think you'll see an increase in satisfaction and compliance among your patients by following the formula below.
State Observation + What you're going to do and why + "Let me know"
Here is an example for a patient that has generalized gingivitis.
Observation: You have 10 areas in your mouth with an active bacterial infection. We used to not be as aggressive treating gingivitis. However, studies are finding a strong link between your body and your overall health. I'm going to do everything I can here and then "adjust" your brushing slightly so you'll be more effective at home.
Procedure/Why: Research shows a mix between this water instrument and hand instruments are the most effective way for removing the harmful bacteria.
"Let me know": If you experience any discomfort, please let me know.
Hygiene Edge Challenge: Follow the above formula for 2 procedures per patient.
Selective Polishing or Polish Selection?
Remember learning about selective polishing when you were in hygiene school? Has selective polishing come to be just asking your patients to select what flavor of polish they would like you to use?
Remember learning about selective polishing when you were in hygiene school? Has selective polishing come to be just asking your patients to select what flavor of polish they would like you to use?
If it has, you are not alone. I took an impromptu poll of my hygienist friends asking them if they find themselves coronal polishing every tooth on every patient. The most frequent answer was “yes” with few stipulations like “not gold crowns” or “only along the margins of crowns”. So, while there were stipulations I don’t think they would qualify as the “selective” your instructor and text books taught you.
While working as a Dental Assistant the words “prophy” and “polish” was synonymous. You can imagine my surprise when I learned the truth! Maybe our patients will feel the same when they learn that same truth. Polishing is only and aesthetic treatment meant only to remove the extrinsic staining on the teeth. Polishing does not qualify as a therapeutic service, meaning that it doesn’t help treat disease or sustain health.
Selective polishing indicates that we as dental professionals are evaluating the present stain and choosing appropriate polish grit to remove the stain efficiently without injuring the tooth structure. This requires us to be educated on what abrasive particles and other additives are found in the polish is available to us.
Next time we reaching for the coarse paste, knowing that it will take anything off (including tooth structure,) we can use the time that saved us to read the manufacturer's instructions that come with our prophy paste.
Not all patients are in need of this aesthetic service but all seem to expect it. I choose not to polish the same day that I debride (SRP) as to not irritate the tissue (polish past gingivitis is a thing!) and I cannot count how many times my patients express distress at the thought of not getting polished. I have found that when I preface the scaling and root debridement with EDUCATION the distress is greatly reduced. It also gives them an incentive to come back for their re-eval when their tissue have healed to be polished. What kinds of things can you do in your practice to educate your patients?
Trish Jones RDH, BSDH shared some valuable information in her article, Selective Polishing: An Approach to Comprehensive Polishing. “As the dental health-care provider, it is important to let the patient know the thought process behind selective polishing prior to performing the procedure. This in turn enhances the patient’s experience, adding value to the procedure. This is called pre-framing, a term used in the psychology of behavioral science. In this case, pre-framing involves explaining the procedure to the patient before and after it is completed to ensure they have a complete understanding. For example, when the patient is in the chair, the hygienist can let the patient know the purpose of abrasive type pastes and cleansing pastes. These include why the paste is splatter-free, why it rinses very quickly and minimizes the gritty feel (flash rinsing), and how the product can remove stain so a beautiful smile can be maintained. Patient concerns can also be addressed at this time.”
She went on to give great examples of how to approach that conversation:
“In order to preserve the investment in your smile, we are going to use a specialized paste that not only removes stain, but also polishes the teeth to a lustrous shine.”
“Research has now shown us . . .”
“Because I know white teeth are important to you . . .”
“I know you love the feeling of smooth teeth and fresh breath . . .”
“So we can reduce the gritty feeling when I am done . . .”
“Because you told me your teeth are sensitive, I have a special technique . . .”
“Because I noticed this about your smile, I am implementing a procedure and have chosen a product just for you that will ...”
As we educate our patients they feel that we care about them. So next time, think twice before offering that delicious grape flavored coarse paste to the lady with light stain and recession. Instead, explain the benefits of that mild mint desensitizing polish that will help with her hypersensitivity. She and her teeth will be grateful.
Holiday Dental Gift Ideas
November is already half way over. Can you believe it? Now is the time to start thinking all things Holiday, especially gifts for your dentist, office manager, dental assistant, or even your dental hygiene school bestie.
We've searched all over for some of the most unique dental gifts for any dental enthusiast.
Dental Tie Clip
If you dentist or office manager wears a tie regularly, this is the perfect dental accessory.
Tooth Pin
Enamel pins are a perfect way to jazz up a white lab coat. Plus, they can be wiped down at the end of a long SRP day.
Tooth Blanket
If your dentist is a big movie or baseball fan, wrap this gift with a Redbox gift certificate and some movie treats, or baseball tickets to a local team.
Tooth Bag
Fill this bag with their favorite treats, or wrap it with a gift certificate to their favorite store or to your mall.
Tooth Magnets
So cute tooth magnets (or could also be pins) from Lilac Paper Company. This is a perfect stocking stuffer if you have a dental professional in your family.
Dentalopoly
Why not get this dental game for office team building? Based of Monopoly, this game of full of dental humor, plus the proceeds help support free dental clinics.
Hopefully this list of dental gifts can help alleviate some holiday shopping stress as December gets closer! We are always looking for new gift ideas for the dental people in our lives! What are your dental gift ideas this year? Let us know!
How To Use The New Code D4346
Code Number:
D4346
CDT Nomenclature:
Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.
Description:
The removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures
Facts/When To Bill:
D4346 is Therapeutic (Not preventive like 1110.)
Not age or dentition base (can be done on children, consider ortho patients diagnosis).
Full mouth procedure (not billed in quadrants like 4341/2).
Available to start billing January, 2017 (It may take a few months for insurance to recognize payment).
Generalized=30% of the mouth must have generalized moderate OR severe gingivitis. Not based on the amount of calculus.
When NOT To Bill:
If you have localized moderate-severe gingivitis the code to use is still D1110.
If you have generalized slight gingivitis use the code D1110.
If periodontitis is present on 1+ teeth use D4241/2.
What Treatment Is Next:
“The dentist is in the best position to determine when the patient can assume a regular preventive regimen that includes oral prophylaxis.” -ADA
Interpretation- Determine with the dentist when the patient should be seen next.
Options include:
1- Perform the initial D4346 procedure then wait 2-6 weeks for a re-eval and at the re-eval do a D1110 prophy. Then reappoint for the regular maintenance care from 4-6 months.
2- Perform the initial D4346 procedure then reappoint in 4-6 months for the regular maintenance care.
Set up a protocol on what is best for your office and patients with the dentist.
Insurance Coverage:
Unknown at this time. Since it is a therapeutic procedure, it may be covered just like the other 4341/2 codes at a percent with a deductible.
We shouldn’t base treatment on insurance coverage. If the patient has generalized moderate-severe gingivitis then this code should be billed.
Evidence of the disease should be documented with full mouth probe depths including bleeding points and the diagnosis. Consider sending intra-oral photos as well. You may have to update your protocol on when to probe children/adolecense. In many office it is at the age of 18 but since this code is not age specific it may be necessary on our younger patients.
Verbiage With The Patient:
We (with your assessment and the dentist's diagnosis) found today that you (or your child) have generalized moderate/severe gingivitis. The good news is that this is reversible. I will give you a few actions at home you need to be doing. I will also need to do a therapy on your gums to get the healing process started today.
NOTE: It would be helpful to show the patient evidence of the disease by taking intra-oral photos and their probe depths with bleeding points.
Treatment Planning:
D1330 Perform oral hygiene education as per the patient's needs.
D4346 Perform the scaling in presence of gingivitis therapy.
D9630 Consider chlorhexidine rinse as needed.
References:
The above information was summarized from the ADA publication below. http://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_Final2016May17.pdf?la=en
If you want more information I would recommend the following resource as well.
Yoga For the Dental Hygienist
If you've ever come home from a day of hygiene feeling "stiff" raise your hand!
Willi went form having hygiene work related injuries to being able to joyfully handle hours and hours of hygiene a week. She attributes much of her stamina in hygiene to specific yoga exercise. You can read more about her experience here.
We suggest bookmarking this video and doing these specific yoga exercise to kick off your hygiene day or as a relaxing way to unwind.
What Your Patients are Talking about: Quip
What you seen this new toothbrush brand called Quip? We did a giveaway a few weeks ago with a few brushes for National Dental Hygiene Month. They also do quite a bit of advertising on social media. If you haven’t seen it, I’m sure your patients have and they will no doubt be asking you about it very soon.
Quip sells toothbrushes, both manual and electric, and toothpaste. They also offer a replacement system where every 3 months, new brushes, brush heads, or toothpaste is sent to the patient automatically which is pretty handy for most of our patients that don't think too much about their oral health care. Their brushes come with a slim travel case.
A couple things I liked about Quip after using it for a few weeks:
1. The subscription component. I love the ideas of having a new brush automatically shipped to a patient after 3 months of us. It will definitely make patients aware how fast 3 months will go between toothbrushes, and keep them up to date with changes their brushes.
2. The handle design. First off, it just looks clean. Second, the handle is weighted, so if you place the toothbrush down on your sink counter, the bristles are always going to pointing up and never touching the counter, giving it the perfect placement to completely dry in between brushings.
3. On the back of the toothpaste, there is a diagram of exactly how much toothpaste to use on the toothbrush. Sometimes, patients associate the mint taste of toothpaste with being clean and can go a little overboard with placing so much paste on their brush. However, with limiting the amount of toothpaste will hopefully make patients aware of how their teeth actually feel without biofilm.
Some things that weren’t my favorite:
1. The electric toothbrush. Though it is advertised as being comparable to a Sonicare or an Oral B, it definitely isn’t. It would compare more to a Spinbrush since it is battery operated and the vibration of the bristles doesn’t come close to how a Sonicare works. I ended up using the electric brush as a manual without turning it on. For patient’s, recommend they try out the manual toothbrush instead of spending the extra money on the electric brush.
2. The bristles are a bit on the tough side when compared to an extra soft or sensitive toothbrush. For a heavy brushing patient, I probably wouldn’t recommend this brush system for them.
They also have a new professional section where dental professionals can order their own products to try out for cost. So you don’t have to take my word for it, you can try it out yourself! Once you have, let us know what you think!
Have your patients asked about Quip, or any other product advertised on social media, yet?
Maevn Scrubs Giveaway
Congratulations to Catherine for winning our last giveaway for National Dental Hygiene Month! Please email us at hygieneedge@gmail.com with you contact information so we can mail you your prize!
Book Review: "Confessions of a Perio Princess"
I stumbled across Jamie Freitag’s book as I was browsing around Amazon looking at dental hygiene textbooks I want to purchase one day (doesn’t every dental hygienist do that?). The title caught my eye- “What they didn’t teach you in delta hygiene school”. I’ve been graduated for a several years, so I was curious if we had learned the same things. Turns out, we have! I felt like I could put myself in her same situations since I lived them over my hygiene career.
This book is an easy read and only takes an hour or so to get through it. It has some great insights for new grads to get the inside scoop on what dental hygiene is. It also highlights how to be a great employee and a great dental hygienist to star a career on the right foot. My only complain was the Kindle format. Unfortunately, when the book opens on the App, the formatting it off and makes reading it difficult at times.
This book would be a perfect gift for a graduating dental hygienist, or even a hygienist that has taken some time off of practice and is getting back into their career.
Have you read any dental hygiene books recently? Let us know in the comments! We are always looking for a new read.
Getting to Know Us: Meet Melia, RDH, BSDH
Melia is one of those people that has a presence. She is the person that when you're not sure which direction to go, you look at her. But its not a loud presence, but more like there is a quiet confidence and charisma about her- that allows her to do amazing things without making them seem like it was a big deal. I don't think I've met someone that is so grounded/analytical, yet, so creative (rare combination). Melia sees a need and she fills it. Undoubtedly, Hygiene Edge would not be as effective without her contribution.
You have to meet her! Read below.
Why did I want to become a dental hygienist?
Honestly, Dental Hygiene wasn't my first choice for a career. I always wanted to be a doctor. However, my dad is a dentist and loves it. Seeing him love his profession, treating patients, and patient's loving him, inspired me to try out a dental career. And I'm so glad I did! Dental Hygiene is definitely one the best careers on the planet. There is always something to learn and something to grow at.
The best part of dental hygiene:
So many! First off, there are so many amazing hygienists to meet and learn from. Dental Hygienists are some of the smartest, kindest, and hardworking people! Getting to know so many different ones through working in offices, through the American Dental Hygiene Association, and through going to conferences has been amazing. Second, there is always something new and exciting going on in dental hygiene. There are always better ways of doing things, better instruments being released, or new techniques to make the practice of dental hygiene even better. It is so interesting to keep up with them all and it makes dental hygiene interesting. Third, the patients. As a dental hygienist, you spend about an 1 hour with a complete stranger in very close contact. You get to know so many personal details about a person so fast and can be come friends quickly. You grow to love and trust your patients just like they are family.
Favorite part of a dental hygiene day:
Treating and educating a periodontally involved patient, and sharpening instruments! If there was a sharpening company near by, I would definitely apply for a job there!
Funny story from dental hygiene:
Mine was from dental hygiene school. I was treating a wonderful 90 year old woman that happens to grow up in the same town I am from, so we had an instant connection. She had partial upper and lower dentures, and I had placed them in an ultrasonic bath in Ziploc bags to be cleaned. After chatting with my patient and educating on some home care things, I went back to the ultrasonic and the dentures were missing! As a first year dental hygiene student, I freaked out and ran around the entire clinic trying to find them. Turns out, another student had accidentally taken them since their patient also had partials. Thank heavens they hadn't tried them in or given them to their patient.
GIVEAWAY- Maevn Scrubs
This is our LAST giveaway for National Dental Hygiene Month! We've loved hosting these giveaways throughout the month to celebrate with hygienists and are a little sad that October is ending!
For this giveaway, Maevn Scrubs is giving you a scrub top and bottom of your choice from their new Red Panda line. Who wouldn't want to end this month feeling fresh in a new pair of scrubs? The fabric is amazing and has a slight stretch to stay comfortable, but not too stretchy that you feel slouchy at the end of the day.
To enter, let us know below what YOU like to wear to work- scrubs, warm up jacket, profession attire? Winner will be announced next week!