Many hygienists face challenges in their offices but feel too rushed during the day and too tired or defeated to recommend changes. When we graduate and are ready to start working as a hygienist, it is impossible to imagine cutting corners, not probing, not pre-diagnosing or skimming over disease. Many of us can relate to the challenges of hygiene school, where everything was done at the highest standard: “The Gold Standard.” We had challenges but we had four hours to get things done! We as hygienists want to deliver the best treatment for our patients; unfortunately, busy schedules and mismanagement of time (among other issues) can lead to a diminished standard of care, creating forgetfulness in technique and performance. This can happen due to the structure of the hygiene department. Some issues we have seen arise from this include:
- Hygiene appointments are shortened to allow for maximum daily appointments.
- Assisted hygiene is attempted without a plan.
- Additional tasks are added to appointments without proper training of new technologies, thus slowing the hygienist and creating a stressful workday flow. As a result, the routine tasks that make up the standard of care become lax and often forgotten.
Time constraints lead many hygienists and patients to think and wish for shortcuts – I wish we could skip the periodontal probing! However, in order to follow the standard of care, it must be done. A dental hygienist is independently responsible for the care that is given and the standard that is followed. Many of the great dental hygiene organizations have standards of care and process that are strongly recommended. And over time, these standards can often become brushed over or even skipped over due to time, stress and overall fatigue. I want to encourage you to stay intentional to those standards of care. Here are some standards of care and ways to stay on track, be intentional and to bring the best possible care to every appointment.
History of the Patient
This is the initial data collection phase and it is important to gain the proper information to identify the patient’s needs (ADHA, 2016). This assessment takes the majority of the initial appointment. The hygienist is responsible for gathering the health, social, medical and pharmacologic histories.
Situations that can happen could include:
- Late patient arrival to the appointment
- Fifteen to 20 minutes taken to complete the information
- A chaotic day and a busy business team is not able to alert the clinical team that the patient has arrived. With an hour appointment and the initial data collection taking the bulk of the appointment, time is not going to be your friend!
How can we overcome these obstacles? Control what you can. For example:
- Have the patient come into the treatment room to discuss changes and updates.
- Hold the form.
- Control the conversation and make the updates with the patient as opposed to having them fill it out.
This strategy for gathering information can save you critical time in the appointment.
Clinical Data Collection
Radiographs are taken or updated, the oral cancer screening is performed, periodontal charting is completed, and dental charting is also done. This process is the start of the dental hygiene diagnosis, each part of the initial assessment is needed in order to make a full diagnosis (ADHD, 2016).
One piece that I see many hygienists and dentists skip over or minimize is the screening process for oral cancer. Time, again, is the primary issue. Steps or the entire screening are forgotten. The hygienist and dentist do not focus together on the findings. It is not uncommon for a team to forget several steps in the oral cancer screening. If we do not have a check and balance system, the screening becomes easier to forget and steps are skipped.
I was observing in a dental office recently and a patient was in for a six-month recare and evaluation appointment. I was pleased when the hygienist and doctor each did an oral cancer screening at different times. However, there was no discussion of findings between the two providers during the evaluation and definitely no conversation happened with the patient about the screening! These two items caused a big disconnect. Four eyes are better than two during the screening; however, if there is no review of findings, you lose that benefit. Some steps to elevate your oral cancer evaluation system are below:
- Let the patient know why you are doing the extra-oral and intra-oral evaluation. Discuss initial findings with the patient.
- Complete the screening the same way each time to create value for the patient and a habit for yourself.
- When the Doctor arrives for the evaluation be certain to review everything that has been done up to that point. Also, give a verbal run down of your findings from the performed screening in front of the patient to the Doctor.
- The Doctor needs to perform the screening as well, again discussing this with the patient.
- In order to place more value on the OCS, avoid minimizing words such as; “lumps & bumps” and “just take a peek.”
Make certain that each screening happens this way for each patient. Each patient deserves the best effort from you and the doctor.
Technique is often overlooked with a full day of patients; it is challenging to ensure that all providers are probing in the same excellent technique and pressure. If the team doesn’t spend time calibrating their technique, readings and diagnosis will fluctuate and consistency for the providers and the patient will be elusive.
I recommend having a calibration meeting with the team periodically and as new hygienists or Doctors come to the practice. An easy way to accomplish this type of meeting is to:
- Schedule the time and second arrange a patient or team member on which to practice.
- Gather the probes and make sure that each clinician is reading them the same way.
- Observe each clinician’s technique.
- Review of a video may be helpful to see the proper angulation and pressure needed to gain an accurate reading.
- Practice on each other and offer constructive advice.
- Several of the most common mistakes that I and others have observed are:
- Not reading the correct measurements.
- Not walking the probe along the gingival margin.
- Keeping the probe inserted in the gingiva and over angulation.
For large and small hygiene departments, monthly meetings are essential to keep skills sharp and on point. Offices that have calibration and team meetings experience great success in their improved techniques and non-surgical periodontal programs.
To wrap up, work as a team to make certain that sufficient time is allowed for each patient for “The Gold Standard” of care. Make certain that you are utilizing your time with the patient effectively and efficiently. Keep your skills sharp, attend hands-on courses and hold yourself accountable for the care you give.
References
- American Dental Hygienists’ Association (2016). Standards for clinical dental hygiene practice.
- Retrieved from https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf
- PERIO.ORG (2019). Proceedings from the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. Retrieved
from https://www.perio.org/2017wwd
About the Author
With a successful background in hygiene and implant periodontics, April brings a wealth of knowledge and passion to her role as a Jameson advisor and chief of Northeast hygiene development. April believes in providing valuable, patient-first service to those that consider you their dental home and brings that concept to her coaching with dentists and teams every day. Her passion for dentistry and learning led her to co-found a dental implant and periodontal study club for dental hygienists in Michigan – which ultimately led to her becoming a phenomenal advisor for Jameson. To learn more about April and Jameson’s spectrum of coaching and marketing services, visit www.jmsn.com.
