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7.07.06 Issue #226


The Patient That Demands A Cleaning

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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You come to work on Monday morning and look at your schedule and charts. Oh great!  Mr. Jones is coming in or, you have a new patient in your schedule that demanded to the Scheduling Coordinator, “I just want a cleaning.” In many states it is illegal for the hygienist to see a new patient before the doctor has seen him. Now what do we do?

I recommend you do what the patient wants initially. The Scheduling Coordinator will tell the patient, “I will go ahead and schedule you with the hygienist.” Don’t say what for. You want to get that patient in your office.
Now the patient is in your chair and you have the doctor come in the hygiene room and look at the health history, do a visual exam, and inform the patient, “We will need to have more comprehensive information in order to provide you with quality of care. Hanna, my hygienist, will be doing an examination of your gum tissue and taking pictures of your teeth and gums. This will be a starting point in determining what type of professional cleaning you need. We have five different types of professional cleanings with different names and until we know which one is best for you we cannot proceed. This would be like me giving you a medication just to give you something without really knowing what the problem is.”

Now you have a captive audience. However, you will need to use your people skills to determine the best time to start educating your patient. I would not recommend beginning until you have built some rapport with your patient. I am not talking about asking about their hygiene habits or grilling them about when they had their last professional cleaning. I am talking about developing trust and a friendship with your patient. That way, you’re not just another dental professional out to take all of their hard earned money by selling them dentistry they don’t need. This is what a lot of these patients think and is why they don’t come to the dentist regularly. They know better than you what they need to have done when it comes to their mouth.  Remember the main reasons people do not accept or seek treatment is because of money, fear, or perceived need.

Individuals will make the best decisions for their healthcare when they are safe to express their thoughts and feelings, experience themselves as heard, understood, liked, and there is empathy.

Once you feel they have established this with you as their hygienist, you can talk to the patient about what future treatment may be needed based on what you are seeing in their mouth. Make sure you don’t overwhelm them all at once. This is one approach.

  1. Now that I have had time to explore your mouth and look at the x-rays, I am observing a lot of infection in your gums.
  2. There is a disease called periodontal disease that does not always show signs or symptoms that it is present. Many times a person can have it and not even know because they are not experiencing any pain.
  3. However, based on what I am seeing today, you have periodontal disease and will need further treatment. The doctor will more then likely recommend you have gum therapy because of the amount of bacteria you have in your mouth and under your gums. I will be the one performing this treatment and it is virtually painless to most people.

The hygienist will want to retrieve the doctor and treatment plan the root planing today. This allows the patient to appoint for a comprehensive exam and root planing. Of course make sure today’s schedule is full for all of the hygienists and the doctor before dismissing the patient.

This is a great way to approach a returning patient like Mr. Jones too. He has not been in since 2001 and at that time he had 5 and 6 mm. pocketing. However, he “just wants a cleaning today.” The advantage you have with a returning patient is that you already know quite a bit about his/her personality, how and when to approach. Remember, sometimes silence will encourage questions from the patient. A patient that is asking questions is entering into the self-interest stage of the learning ladder. Educating your patients and developing trust are the two keys to patient acceptance. You just need to know how and when to turn those keys.

For more information on McKenzie’s Hygiene Practice Enrichment Program email

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