Steady is a good word for describing the dental hygiene profession. If you work clinically, most days may feel the same. A list of patients awaits you requiring periodontal debridement, either in the form of a prophylaxis, periodontal maintenance, scaling in the presence of inflammation, or non-surgical periodontal therapy/SRP. The instruments used each day are pretty much the same, and radiographs 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 performs an exam. You see the patient off by giving them a 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 while looking forward to others. 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 wishes apply to all of us?
1) A prayer for a no-show
I often wish that at least one of my patients wouldn’t show up. While I love interacting with my patients, getting to know them and educating them, I’m always happy when I get this surprise break. 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, set up my patient trays, sharpen instruments, help with sterilization, 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 to happen 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 and get caught up. Later in the day, I am also tired, so a break that is welcomed.
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, and every minute of that time is precious. There is so much (and then some) that needs to be done, including a health history review, vitals, IO/EO, radiographs, perio charting, scaling, flossing, polishing, 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 a patient is late, the entire schedule gets disrupted. 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, wishing that with some miracle, you will finish in time.
3) A prayer for working equipment
Oh, please let all the equipment work properly. 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 chunks 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, radiograph 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 appreciate the hygiene treatment being provided. They will try their best to cooperate with you during the appointment.
However, sometimes, you encounter hurdles that delay your work. Some patients may be fussy during every stage of their appointment, such as refusing radiographs or perio charting, rejecting ultrasonic scalers because they dislike the sound, or answering their phone and 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 their tongue tries to kick out the mirror, scaler, suction, and your fingers out of their mouth. Other times, it’s a very active cheek musculature that prevents you from accessing the inside of your mouth. Dental fear, anxiety, or trauma can also consume patients so much that they have a hard time tolerating treatment. Mouth breathing can make you nearly work 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 or calculus left by the time I complete treatment. Hygienists tend to lean toward perfection, and we don’t like things that are incomplete. Once finished instrumentation, 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. It would be 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 between #24 and #25. So, once I complete treatment, I quickly check to see if I can find anything remaining one more time before the dentist comes to my operatory.
Even when I am done polishing, and if by some miracle I have some time with my patient, I will keep exploring. Patients have taken time off work and out of their daily schedules to come in for their hygiene appointment, so it is our duty to make their mouths as healthy as possible during that time.
In Closing
If you’ve ever wished for a no-show, a cooperative tongue, or working equipment, know you’re not alone. These little wishes are simply the reality of being a hygienist as we strive to give our best to every patient who sits in our chair.
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