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A hygienist’s answer to “what do you do?”

March 11, 2015 By DentalBuzz Staff 8 Comments

If you read Dentaltown Magazine, you may have received the edited, paper version of this article today in your snail mail box. But because I don’t have to make room for saliva ejector advertisements in the sidebar (seriously, this article helps sell SALIVA EJECTORS!) you can enjoy the original here in its more raw form.

shakehands

A hygienist’s answer to “What do you do?”

by Trish Walraven RDH, BS

You’re at a gathering of acquaintances, a general hob-nobbery of casual conversing, one of those social obligations that you love/hate because you’re really more of an outgoing introvert, someone who plays well with others but enjoys their quiet, navel-gazing world too. Sooner or later you know that the question will be asked.

“So, what do you do?”

No hesitation here. You know what your profession is. You have a title, a position, a calling.

Then that inner part of your thinking begins to twitch.

You weren’t asked about your job title, actually. You were asked a direct question: What do you do?

The typical reaction of hearing that you’re a dentist or hygienist involves a full disregard of the art and compassion that you put into your profession. People want to tell you about their bad experiences as a child, or how much they hate you (but don’t take it personally!). They just nod, warily, quietly, at your response and quickly think of a way to change the subject.

Instead of giving away the conversation and letting it slide into other people’s thought bubbles, then, you can steer the dialogue back to the original question, and the feel-good answer you’ve prepared instead.

“I take care of people’s teeth.”

You’re a regular Mother Theresa now, aren’t you? The way you dedicate your life’s work to helping others, it’s so freaking noble. This response elicits a smile of comfort and familiarity from your obligatory small-talk partner. The conversation can move forward now that your profession has been deemed socially acceptable.

An hour later, driving home, you’re blissfully alone with your thoughts, rewinding your earlier social interactivity, musing over the highlights, and you really, deeply, ask yourself in hindsight, “what do I do?”

I can’t speak for dentists, but if you’re a dental hygienist, you do some pretty strange things, actually.

First of all, perfection to you is wave-shaped. It’s the curve of a thin scallop of attached pinkness that anoints each interproximal space with a coral-tipped point of the healthiest gingiva imaginable. Anything less than this in your patients’ mouths is limbo. Chaos is the reason your job exists, but you always hunger for order and balance. To achieve this imagined perfection in a mouth that is not optimal, then, means that you often resort to some diversions along the way. It’s about the journey, not the destination, right?

How do you handle the patient whose lower anterior linguals are piled with a couple of grams of Grade A calcium phosphate? Sure, you could just chunk the calculus off. But sometimes, when you’re feeling a little dastardly, you carve out the top and the bottom of the tartar evenly, so that you’ve left a neat chalky white mustache, complete with curlicues. With artistic satisfaction, you turn your attention back to your duty and politely erase the Banksy-esque dental graffiti from your patient’s teeth.

This is not something you tell people that you do.

You also tell no one that your deepest fear is running into anything artificial while you’re cleaning someone’s teeth. Your ultrasonic scaler turns into a fierce lead pencil in those situations, which means not only that you are wearing down your precious metal antennae into useless nubs, but also that you’re leaving dark lines where there was once only whiteness. Every last bit of old orthodontic cement has now been revealed like a charcoal rubbing, thanks to you. And you would never admit to leaving a grey streak on a brand new porcelain crown. How could you slip like that? You hope like heck that the prophy paste will get that scary line off before anyone notices.

When it comes to things that you enjoy, then, there’s a bit of hesitation about sharing those stories as well. Like hovering around the periapical abcess that’s begging to be relieved? Or when you’re spraying baking soda slurry under a bridge and the patient becomes aware that its odor speaks more than the thousand words that you could ever say about superfloss? To you the stink is like scoring a point. Or why your trophy at the end of a particularly difficult appointment is a 2×2 gauze loaded with something that looks like buckshot, but is really your patient’s carefully extracted calculus? Fun times.

Probably the most difficult part of your career, though, has to do with patient management. Unless you’re regularly disengaging people from their mouths via nitrous oxide, there are forceful tongues, and lip pulls, and saliva ropes, and people who forget that it’s safe to swallow their own spit. Suck. Suck. Suck. Ten times a minute. At least this way they’re remembering to breathe. When they forget to breathe they feel like they are drowning. It’s not the water; they’re just suffocating because you’re blocking any chance of mouth breathing. Never mind that noses are much more optimal for breathing but whatever. Not everyone has learned how to snorkel either. And how do you convince patients that unless they just ate a handful of almonds, brushing immediately before their dental appointment won’t make your task any easier?

Then there are the patients themselves. Not just their mouths, but the whole person. Patients whose embarrassment about their teeth are the reason they haven’t been to a dentist in a while. People who not only open their mouths but open up to you, tell you their secrets, their fears, their wishes and hopes. People who trust you to take care of them, to love them, to nurture them towards health. They see something special in your eyes, and they open wide.

So go ahead and make it known out there in the big world that you’re hygienist. Or a dentist. You scale teeth. You drill teeth. No biggie. That’s what you do.

What really matters, though, are the reasons why.

 

trishmouth  Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She is a bit of an an introvert when she’s writing dental articles, but you get her together with her best friend from high school and Irish festival beer and she begins to make faces like this. She also makes faces like this under her mask if her patients aren’t paying attention to her flossing instructions.

Filed Under: Anecdotes, Featured, Humor, Operative Dentistry, Preventive Care Tagged With: "i hate dentists", dental humor, dental hygiene, dental hygiene therapy, outgoing introvert, ultrasonic scalers

Patients: Floss Your $%#*^@# Teeth!

October 17, 2012 By Eva Watson 10 Comments

Now… don’t let the title of this piece make you cower into your stinky underpants drawer.

My intention is to simply explain the importance of why you lovely patients must floss your teeth.  After seven years of clinical experience and seeing the outcome of a non-flossing lifestyle, my hope is that those reading this highly important dental topic will gain the vital understanding of flossing and how gum disease will affect your life.

Let’s start by me asking for your full attention by you getting your crusty, Starbucks-stained teeth out of your $8.00 latte you really can’t afford but feel the urge to economically consume every, single morning before you go to your soon-to-be outsourced job that just increased your dental insurance premium for a minute because here’s what I have to tell you.

Are you ready?  Good.

If you don’t floss your gums will become a festering, disease-ridden, smorgasbord of unrelenting bacteria that will ultimately make your gingivae bleed in buckets every, single day of your life.  If you don’t floss your gums you will spend thousands (I’m not kidding) of dollars to simply control the incurable disease (and it is a disease) that you have let build up over years and years of utter neglect.

Exudate will ooze out from underneath your gums and after questioning by the clinical professional (How YOU doin’?) the finding(s) will be defined as ‘asymptomatic’.  That is, you will feel no pain.  What you will feel is the false sense of dental health with the perpetual lie you keep telling yourself when you think, “It doesn’t hurt,” while the blood-filled pus continues to bubble and percolate underneath your gums.

Allow me to continue.

Your social life will remain that of the lonely-lived bachelor/bachelorette whose breath completely, I mean, completely reeks so intensely, you will have no realistic chance of any dating prospects.  You will continue to waste money on the premium whitening kits at your local store to give off the illusion of a healthy mouth in the hopes of attracting a mate.  Your highly offensive, (Not  joking. It’s awful.) metallic-smelling breath from your lack of flossing is so oppressive no one will want to kiss you nor come within five feet of you.  (Yes.  The odor is that strong.)  And we can still smell it through the masks we wear.  Sorry.

Once your teeth become mobile, or loose, from the lack of flossing and the prolific bacteria eating away at your bone that supports your teeth, then, and only then, will you notice and mention the finding to your dentist and/or dental hygienist. (Hey, that’s me!)  You will hear the word ‘unsalvageable’.  You may even hear the word ‘hopeless’.  That means your loose tooth/teeth will have to be pulled out from your rotting mouth because you were lazy and didn’t floss.

You’ve just lost your tooth… which could have been prevented if you only had used that little piece of string.

Sleep tight.

 

Filed Under: Humor, Preventive Care Tagged With: dental humor, dental hygiene

The gum whisperer

October 13, 2012 By Trish Walraven 4 Comments

First things first: yes, this “whispering” phenomenon has invaded every niche of our well-being. It all started in a novel with just this one guy, he whispered to horses, then Cesar Millan got famous shushing dogs on TV. There are book whisperers, baby whisperers, ghost whisperers. OMG, there’s even a Bra Whisperer if you need someone to speak quietly with you or your wife’s upper anatomy.

So I just realized the other day that, I am, in fact, the gum whisperer.

Is it because I’m the world’s utmost authority on periodontal disease? Do I have such a kingdom of knowledge that it only makes sense to become an intellectual philanthropist to my patients and can cure them of every infirmity that sits just inside their lip line? Do my mad hand skills mean that I can strip only the glue off of a postage stamp with a Gracey 13/14 while it’s still stuck to an envelope behind my back as PROOF of my superior subgingival scaling abilities?

No.

I am the gum whisperer because… I actually whisper to people’s gums.

“Hang in there, interproximal gingiva! Give that #5 an extra squeeze for me today because that class II mobility is making my probe shake.”

When you’ve given up trying to convince the lifelong smoker that nicotine is his enemy, sometimes it’s just time to try a new approach. Maybe the person attached to those gums will think you’ve gone a little cray-cray, or maybe, just maybe, they might realize that you’ve started digging into your bag of desperation because they just don’t want to hear what you have to say. They’d like to give you their problem instead of dealing with it themselves.

Years ago, I took care of a patient that was into visualization, in a new-agey kind of way. She asked me to paint pictures and describe what healing needed to take place in her gums, so that she could create a pathway for sending her healing energy into the periodontium. I dunno, it was kind of soothing for me, too.

So occasionally I’ll speak softly to a patient as I’m nudging their gums, kind of like scratching a dog’s belly, “You like that, yes you do, yes you do!” Well, not that silly — definitely more clinical-minded because really, I don’t want people to start asking me to read their auras or anything like that.

Please let me know if you’ve found yourself talking to teeth, tongues, whatever body parts have engaged your healing linguistics, so that I don’t feel so all alone in this situation. And if I really am crazy, then it’s probably best not to let me in on the truth.

 

 

Filed Under: Anecdotes, Operative Dentistry, Preventive Care Tagged With: dental hygiene, gum whisperer, periodontal disease

Postcard from a square operatory

May 29, 2012 By Trish Walraven 1 Comment

Originally published in the May 2012 British print magazine Dental Hygiene and Therapy, this article was written as a snapshot of life as a hygienist in these United States, delivered as a postcard to the UK, and corrected to their spelling preferences. So if your spell-check throws up all over this piece, just remember, the intended audience is civilised hygienists and dental therapists.

_______________________ 

 
by Trish Walraven

I live in Texas, and work in a box.

Well, not really. But at the same time, really! This box, like most boxes, has four walls. There’s a ceiling and a floor, too, but those aren’t what drive this story. It’s all about the walls. When I look at the walls, instead of trying to climb one (or get driven up one!) my inner designer starts its analysis. What decorations help to make this box more enjoyable?

Most importantly, there’s a patient in the centre of my box.

So there’s a sky blue wall behind me as I’m facing the patient. This is the dental hygienist scope of practice in the state of Texas. You’ll notice the sleek steel shelf hung firmly on that wall that lets me provide all hygiene services – even when the doctor is away. On that shelf are my preventive allowances: pit and fissure sealants, fluoride treatments, periodontal therapy, temporary fillings, restoration polishing, and even a flashing snowglobe of laser-assisted bacterial decontamination. This wall is also marked by an ugly patched-up area. If you pulled off the patch, you’d find a pretty big hole, left by a restriction that the Texas laws place on the administration of local anaesthesia by hygienists. Texas is in that 10% of the US where a handful of Board dentists hold the rest of their profession hostage with this issue. It seems to deflect attention from those other efforts that will give hygienists better governance over their work lives but, for now, it is difficult to get the laws changed in favour of hygienists. The patch is cool, though. It’s made up of an intense pharmacy-compounded topical gel that I use on my patient when she needs scaling and root planing. It’s not perfect, but it does keep the dentist from having to stop what he’s doing to anaesthetise her, and she loves that there is no post-injection pain and lingering numbness afterwards.

Which brings me to the second wall: a green-means-go fluorescent mural featuring a hot pink clock. It flashes the amount of time I have with my patient: 30 minutes! And that’s if she’s on periodontal maintenance or has staining. If she’s healthy or a child the clock starts ticking at 20. Everything mounted to this wall is geared towards squeezing the most out of every moment. Ultrasonic tips? The thinnest, curviest ones available, and enjoyed even by my youngest patient because they knock off every bit of calculus and plaque at a range of comfortable settings. Baking soda jet polisher? Much faster than the rotary polishing cup and paste. Oral hygiene advice? Suggested as I’m performing the initial examination and demonstrated later with a hand-held mirror and floss. Assistants instantly appear to chart and record probing depths with the click of a mouse, loupes and a headlamp keep me from having to reach up and change the overhead light position. I am a master of efficiency.

The third wall is a more subtle shade of green. It’s the one with all the niches and windows, with family photos and favourite mementos left by patients. I love this wall the most because it lets me see the world outside. One of the windows faces the reception room. The room is empty – not because we don’t have patients, but because none of my patients ever have to wait there, thanks to a well-coordinated  team using custom-designed communication with audible BlueNotes that chime as soon as a treatment room is open, or when a patient arrives, or when the dentist needs supplies because of an unanticipated event. This kind of empty reception room can be found in all corners of the world. Many practices are now implementing this idea – a spark that came out of my brain and then became a computer programme. I am proud of helping to shape the world outside my box.

The final wall is painted metallic gold, with the words ‘Preferred Provider’ stencilled in black all along the baseboards. From this wall emerges a door into a second operatory where a dedicated hygiene assistant is waiting with my next patient. I’ll see him and then move back in here once my services are complete. I’ll also use my diagnostic skills to let the patient know the doctor will be recommending a crown on one tooth, a bridge in the opposite quadrant. Focusing on treatment plan acceptance and dollars on the doctor’s bottom line is how I make up for the 30% or more discount patients receive in this middle tier of managed care here in the US. And it’s how I earn all those glittery stars on the wall: my home, a car, vacation time, designer handbags.

I like my box just fine. But if I had my own way, the walls would be different. Maybe they would all be windows.

 

 

You can also view this article in its original PDF from the paper magazine.  Also, many, many thanks to Eva Watson and DH&T’s editor Julie Bissett for the opportunity and for getting this published!

Filed Under: Anecdotes, Operative Dentistry Tagged With: dental efficiency, dental hygiene, dental hygiene scope of practice, dental therapists, linkedin, postcard from America, topical anesthetics

Ethics videobites

March 28, 2012 By Trish Walraven 2 Comments

Today’s video from “The DEZiree Show,” produced by DentalEZ, like most dental humor, is almost there:

So you watch this clip, then you wonder, how many hygienists in job-saturated markets don’t even have the luxury of being able to wrestle with these sorts of ethical dilemmas? They’re just happy to have an income. And if you don’t want to work faster than you should, there’s the door, honey. We’ve got five more hygienists waiting for your position when you leave.

If you must ever make a decision to follow your halo out of a practice like that, remember, there are also dentists who would rather have ethical hygienists than ones who will do whatever they’re told to do regardless of whether or not it’s best for patients.

Just please, promise yourself, you will never, NEVER, consider taking a personal day to go watch a movie, especially NOT the upcoming Twilight one, like DEZiree is pretending to skip out for. Eyes will roll as your credibility sinks beyond all hope.

And a shirtless Robert Pattinson is just one of those things you can’t unsee.

Filed Under: Money, Practice Management Tagged With: dental hygiene, dental office production, DEZIree Show, hygienists, practice management

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