Steady is a good word for describing the dental hygiene profession. If you are working in a clinic, most days may feel the same. A list of patients awaits you, requiring gingival or periodontal debridement either in the form of prophy, periodontal maintenance, scaling in the presence of inflammation, or non-surgical periodontal therapy/SRP. The instruments used each day are pretty much the same. X-rays and perio charting are done routinely. There is the same technique of holding your instruments in each quadrant. After debridement, you educate the patient, and then the dentist comes and examines the patient. You see the patient off by giving them a goody bag of oral hygiene products.
When I started my career, I noticed that as I drove toward the dental clinic each day, I anticipated certain things with dread and looked forward to other things. I would wish for things to happen a certain way, and it wasn’t just on certain occasions. These wishes took the form of prayers that I chanted before entering my operatory. I wonder if it’s just me, or do these prayers apply to all of us?
1) A prayer for a no-show
I often wish that at least one of my patients doesn’t show up. This one is a bit selfish, but I can’t help wishing for getting 30 minutes to an hour off to slow down, maybe to write down some extra points in my clinical notes, arrange my prophy trays, sharpen instruments, go to the bathroom without any hurry, or just stretch my poor, old back.
This wish also has an asterisk: I don’t want this happening early in my day. If there is a no-show, I would rather have that later in the day when I can work on my previous notes. Later in the day, I am already tired, so that a break is welcomed. I love interacting with my patients, getting to know them, educating them, yet I always am happy when I get this surprise break when someone does not show up for their appointment.
2) A prayer for punctuality
I pray my patients are not late. This can be very frustrating since we have no control over it. Depending on what is scheduled, we are usually allotted anywhere from 30 minutes to one hour per patient. Every minute of that time is precious. There is so much (and then some) that needs to be done ─ health history review, vitals, IO/EO, radiographs, perio charting, scaling, flossing, polishing, fluoride varnish, and OHI.
If all those tasks are not enough, we also must answer patients’ questions and wait for the dentist to come and examine the patient. When the patient is late, the whole schedule gets messed up. No matter how fast you work, you cannot catch up. This can make your head spin, but you meet your patient with a smile as they apologize for being a “little late,” ushering them towards your operatory, praying that with some miracle, you will finish in time.
3) A prayer for working equipment
Oh, please let all the equipment work smoothly. I am sure a breakdown or malfunction must have happened to all of you. You are using an ultrasonic scaler, and everything is going great. The patient is comfortable, and you have your rhythm. The calculus is coming off in those big chucks that we love to see. Then, suddenly the ultrasonic insert stops working.
Instinctively, you look at the clock, and you only have 10 minutes left with this patient. Your soul screams, you stamp your foot multiple times on the paddle, tweak the frequency, change the insert, and by the time it starts working, you are left with three minutes. It’s not just the ultrasonic scaler, but sometimes the software hangs up on you, x-ray sensors start acting up, water runs out at the last minute, and the list goes on. Equipment failure is no fun, and I dread it every day.
4) A prayer for cooperation
I hope I have a cooperative patient. Before elaborating on this one, I must say that most patients are very cooperative. They are usually aware of the importance of good oral hygiene and are grateful that you are making their mouths clean and healthy. They will try their best to cooperate with you during the appointment.
But sometimes, either due to their behavior or the way their mouths are structured, you are met with hurdles that delay your work. Some patients will fuss during every stage of their appointment, such as refusing radiographs or perio charting, rejecting ultrasonic scalers because they do not like the sound of it, or starting to talk while you have a sharp instrument in their mouth.
5) A prayer for smooth sailing
Then we have the patients who mean well, but their mouths do not cooperate. Sometimes the tongue tries to kick out the mirror, scaler, suction, and your fingers out of the mouth. Sometimes it’s a very active cheek musculature that prevents your accessibility inside the mouth. Sometimes the dental fear consumes the patients so much that they hardly follow your voice commands. Mouth breathing can make you nearly working blind, and then there are patients with very active salivary glands where you find yourself working with your instruments submerged in saliva. All of these obstacles can slow you down considerably.
6) A prayer for pristine surfaces
Let there be no plaque/calculus left by the time I am done with my patient. Hygienists are finicky. We don’t like incomplete things. Once done with full mouth scaling, we keep on searching for any piece of calculus that is hiding from us.
I remember one of my dental hygiene teachers instructing me to have the patient’s mouth in pristine condition before the dentist examines it. After every time I scale, I hastily check to see if I can find something before the dentist comes to my operatory. It is very embarrassing for me if some plaque gets stuck on the explorer during a dental examination or if the dentist finds a rough piece of calculus stuck in between #24 and #25.
Even when I am done polishing and if by some miracle I have some time with my patient, I will keep exploring. The patients have taken time off from their daily schedule and work to come for their routine hygiene appointment; it is our duty to make their mouths as healthy as possible during that time.