Success with a Patient!
As every practicing hygienist knows, patients often resist perio treatment. It’s so common that we often have at least one patient per day, whom we have identified as needing periodontal care, tell us to “just do my cleaning.” Resistance to perio treatment has many sources. It can range from mistrust of the office, hygienist, dentist and other staff, to a perception that tooth loss is inevitable and unpreventable. I have had many patients even tell me that since they are so “old” (age 60) they don’t think it is worthwhile to spend the effort or the money to make their mouths healthier. That’s why it is such a great feeling when a patient believes that his or her oral health is worth protecting, accepts my explanation as to what is transpiring in their mouth, receives scaling and root planing, returns for periodontal maintenance four times a year, and gets healthy. Here is what happened with one such patient:
“Jim” is a nice-looking professional man in his late forties. He is always impeccably dressed and is intelligent and articulate. Incongruously, he has lost several teeth and did not have strong home care habits when he first came to our office. After radiographs and a complete exam with our dentist, we assessed him as having moderate to severe periodontitis. He came to me for scaling and root planing.
Our first visit was scheduled for two hours. He was very nervous when he came into the treatment room and told me, “I really hate coming to the dentist.” I proceeded very slowly and started by telling him what I wanted him to do in the way of self-care on a daily basis. Because of his history of limited interest in home care, this essentially boiled down to toothbrushing twice a day. I gave him a soft toothbrush and went over all quadrants of the mouth, sulcular technique, with him holding a handmirror to observe. I explained that even though all of us brush our teeth, often we are not as effective as we can be. When explaining brushing, I always try to make sure I am not perceived as talking down to anyone. It’s not surprising that many people may be somewhat insulted to be shown something as “rudimentary” as toothbrushing.
After this, topical and then local anesthesia was implemented on the maxillary and mandibular right, and I made sure that he was very numb. Scaling and root planing was arduous, and his tissues were swollen and bled extremely easily. He knew he was bleeding and I explained that after his tissues were healthy, this bleeding would become less and less evident. He told me that his teeth always bled when he brushed and he had assumed this was normal. I told him that when he was healthy, bleeding would be a thing of the past.
When our appointment was over, I scheduled him for the next week to complete the other half of the mouth. I called him that night to see how he was getting along, and he said that the numbness was gone and his mouth was sore, but he was doing ok. I reinforced my toothbrushing message and told him I would see him next week. The day before his next appointment I called him myself to be sure that he was confirmed and would be coming.
At our second appointment, I had Jim in my chair for 90 minutes and introduced interproximal brushing. I gave him several interproximal brushes which are small, portable, and designed with removable and replaceable covers so they can be carried in a pocket. In addition to regular brushing twice a day, I instructed him to clean between all of his teeth a minimum of once per day. I had him look at the tissues on the side of his mouth that we had cared for the previous week, and showed him the differences in appearance and bleeding from the opposite side. He could definitely see and feel the difference.
While I like to see scaling and root planing patients two weeks to a month after treatment for reassessment and further care if needed, our treatment coordinator had already told me that Jim did not want to schedule this because his insurance would only cover periodontal maintenance when performed at least three months subsequent. Therefore, I scheduled him for three months in the future. While I know that insurance coverage should not trump care, the reality is, it is very important to many patients. I certainly did not want to jeopardize his treatment due to a possible problem with fees and insurance. I crossed my fingers that he would continue to do what I had shown him for home care, and would be stable or improved at his three month visit.
The good news is that when he arrived for his periodontal maintenance, his condition was much improved! He told me that he felt so much different about himself, now that his mouth was clean and his gums were not bleeding. Several pocket areas had improved by at least a millimeter. He loved the interproximal brushes, and I gave him a handful as replacements. He asked why I had not told him to use floss, and I explained that the purpose of floss was to clean between the teeth, but that it was not the only mechanism to do this. I explained that I highly recommend floss, and showed him in his own mouth the best technique. I told him that the important thing was to remove plaque thoroughly and daily from all tooth surfaces, regardless of what implement is used.
It has been a year since his first maintenance visit and he continues to observe excellent home care. He is scheduled to receive implants in the areas where teeth had been previously lost later this month. I consider this patient to be a wonderful success story. Scaling and root planing followed by the use of very basic home care tools have resulted in a complete halt to, and in some areas reversal of, destructive periodontal disease.
Our patients are wonderfully individual, and we owe it to them to look for ways to connect with and help them. Some of my patients use electric brushes, some use yarn, some use waterpiks, some do well with chlorhexidine. I guessed correctly that Jim would accept and do well with the basics, and I couldn’t be more pleased. He told me at the end of his last appointment, “I just wish I would have come to this office sooner and had this type of care from a hygienist.” He has already referred several of his friends. The hygiene department is an essential part of a successful practice. We do well when our patients do well.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email email@example.com.
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