How Are You Responding To Patient Worries?
Have you ever had a patient jump so suddenly and wildly while you were scaling a tooth that you were lucky the scaler did not puncture the lip or cheek? Have you experienced this same reaction to rinsing or drying a tooth? What causes this reaction? More important, what should be done to prevent this reaction?
In a normal tooth/gingiva relationship the gingiva covers the root surface. As years go by, gingiva recedes, exposing root surfaces. Some causes of recession are toothbrush abrasion, periodontal surgery and compromised occlusion. Initially when gingiva recedes there is not much sensitivity because cementum is intact on the newly uncovered root. It may not be long, however, until cementum disappears. Cementum is a thin protective layer over the dentin that erodes easily from exposure to external substances. It can also be mechanically abraded, usually by a toothbrush. Once cementum has disappeared, dentinal tubules are open to the elements in the oral cavity. Herein lays the cause of sensitivity. Fluid movement within the tubules is caused by temperature change or physical pressure change and is detectable by the nerve in the tooth. This translates to a feeling of pain in the absence of protective cementum.
So what is the cure? Either the nerve needs to be desensitized to make it less responsive to stimulation, or dentinal tubules need to be plugged to prevent fluid flow. Potassium nitrate claims to desensitize the nerve. It is theorized that potassium nitrate penetrates through the tubules to the nerve and depolarizes it, resulting in no pain impulse being sent to the brain. There are products on the market that contain potassium nitrate that are approved by the ADA. These products are found in the form of a paste.
When considering blocking the tubules, there are many products that can be considered. Many clinicians recommend stannous fluoride. Though this substance has been found to be somewhat successful, no over-the-counter, ADA-approved sensitivity toothpaste contains this product. Strontium chloride, which also has the ability to occlude tubules, is no longer available in over-the-counter toothpastes either.
SensiStat has proven very effective in sealing open tubules. SensiStat contains an arginine bicarbonate/calcium carbonate complex and is applied to tubules at a professional cleaning appointment to plug and seal open dentinal tubules during a routine polishing. The procedure is painless and the reduction of tooth sensitivity is usually immediate. Patients report the ability to eat ice cream or drink cold drinks after one treatment. Treatment can be followed up by dispensing a toothpaste containing SensiStat for home use.
Novamin (calcium sodium phosphosilicate) is also able to occlude open tubules. When Novamin is added to toothpaste and exposed to saliva, particles are deposited onto the dentin surfaces and mechanically seal the tubules. Although Novamin is not a specific product, it can be found in several products and is gaining popularity.
ReCaldent is also on the scene. ReCaldent is a complex of casein phosphopeptite (CPP) and amorphous calcium phosphate (ACP). ReCaldent can assist with sensitivity by delivering calcium and phosphate to cover dentinal tubules. It also helps to buffer the acidity of plaque that increases sensitivity.
Clinicians have many options to consider when it comes to combating sensitive teeth. It is far more complex than just offering a patient a tube of gel or paste containing stannous fluoride. There are many choices, but no single agent or form of treatment has been found effective for all patients. It is important to realize that even though some agents/treatments may work quite well for some patients, they may not work at all for others. It is the responsibility of the dental professional to understand the etiology of sensitivity, existing treatments and products available to assist in the reduction of sensitivity. If one agent does not work, different products should be recommended until an agent that reduces the patient’s sensitivity is discovered. When sensitivity has been arrested, the worry of misplacing an instrument due to a jumpy patient will be greatly reduced. Patient and hygienist will be elated with this result.
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Dr. Nancy Haller
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Your hygienist talks to you privately about another employee, also a hygienist. She tells you her coworker isn’t cleaning up quickly enough at the end of the day, and is intentionally slow with charting to avoid helping out. Wanting to fix this quickly, you agree to talk to the other hygienist.
Watch out… You have just entered the triangulation zone! Triangulation is a term that is most commonly used to express a situation in which one person refuses to talk directly to another person and instead gripes to a third person, thereby forcing the third person (in this case, you) to be part of the triangle. No positive outcome will occur. A lot of emotional energy is wasted. Relationship back-biting worsens and practice productivity is sabotaged. And you, the triangulated “middle (wo)man,” is stuck with escalating conflict—and probably a headache.
In my conversations with dentists, I hear about this all the time. Why? Dental offices are largely comprised of people who are oriented toward taking care of others. Their compassionate nature is a plus, until it results in conflict avoidance. Because they want everyone to get along and/or are afraid of hurting someone, these feeling-based people sidestep issues. They often hope that the negativity will just go away on its own.
Be careful that you don’t dismiss this situation as “high school antics” that will blow over. When one of your employees complains to you about someone else’s performance, it’s serious because it means the team is lacking in trust. Without trust, employees are afraid to communicate directly with each other about disagreements. They are unwilling to be vulnerable about their mistakes, fears and behaviors. They engage in a kind of political behavior that wastes everyone’s time. Without a climate of trust, teams are limited in what they can accomplish, and this impacts your bottom line!
First and foremost, when an employee complains to you about another staff member, do not be too quick to take sides. In all likelihood you only have one perspective, one side of the story. By staying objective you refrain from jumping into action and making a bad situation worse.
It’s all right, even helpful, to acknowledge the emotional impact. For example, to the employee in the above example, you might say, “I know you need to get out of work on time because of child care, and it’s stressful when we have such a busy day.” Validating the feelings behind the complaint is good. It lets the employee know that you understand and that you care about her.
The next thing you need to say is, “Have you spoken to that person yet?” In all likelihood the answer will be no, followed by a string of explanations (i.e. excuses). Be careful not to take sides at this point, because these could seem reasonable and justified.
Here is where the buck stops—with you!
Communicate your expectations so the employee understands what he or she should do.
For the hygienist who complains about her coworker, spend a couple of minutes talking about the details of her frustration. Devote the remaining time to setting goals. She needs to address this directly with her peer and the two of them —NOT YOU—must iron out a clean-up plan. Your job as the practice leader is to coach this hygienist to find her own solution. You can make suggestions, but it’s up to her to fix it. Establish a time frame for this to be completed, perhaps one week. In a follow-up meeting, discuss her progress. If nothing’s been done, explore the obstacles and set another goal.
Here are a few questions that could be helpful in coaching your staff when they complain:
In this way, you guide an employee through a thought process about her own responsibility. You could role play it with her, too. Suggest that she try out what she has practiced with you, then come back and let you know how things are going. In this way, you are not in the middle intervening but rather on the sidelines coaching.
Even the best teams have conflict and it will be uncomfortable from time to time. The tendency is to want to fix things and make the problem go away. However, by showing patience and strength to tolerate discomfort, you enable your team to move to higher levels of productivity and profitability. As the Dental Leader, one of your most important jobs is to develop your employees. Normalize conflict and help them learn constructive ways to resolve their differences.
An empowered team is built on trust and mutual respect. Team-building retreats are an excellent way to establish that foundation. Obviously that takes time away from the office, but it will pay BIG dividends as a result.
Employees should try to resolve their own problems before coming to you. If you don’t like being the middle (wo)man, step aside—but stay on top of the conflict. As the Dental Leader, you can help your staff learn to have adult conversations in the workplace… and save yourself a lot of wasted time and headaches.
Dr. Haller is the Leadership Coach at McKenzie Management. She can be reached at email@example.com.
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