July Q&A: Dull Instruments

Ask IDH – July 8, 2019

Sharon R. RDH, Chandler, AZ
I would like your help to settle this discussion. I share my instruments with another dental hygienist, and I sharpen my instruments for every patient. She says that we only need to sharpen instruments when they get dull. Coincidentally, she says that she never sharpens our instruments because I keep them sharp enough for her. At a staff meeting, she has, in the past, accused me of over-sharpening our instruments. I’ve requested our own individual cassettes of instruments, but the office isn’t willing to invest in separate cassettes. Who’s right? Can I sharpen my instruments for each patient or should we sharpen once we decide that our instruments are dull?

Pamela Maragliano-Muniz, DMD, RDH
Thank you for bringing up this important topic. While it is true that dull instruments can result in greater hand fatigue, burnishing calculus/incomplete removal of debris, longer appointments, and reduced productivity, they may not require sharpening prior to every patient visit. Some instruments are created with harder, tougher alloys that prevent dulling and don’t require sharpening as often as traditional stainless-steel scalers. My recommendation is 3-fold: first, investigate which instruments you have and identify the manufacturer’s recommendation for maintaining sharpness. Second, it may be useful to obtain sharpening sticks to test whether or not the instrument “bites” into the stick. (In general, if the instrument doesn’t bite into the stick, it needs to be sharpened.) Third, it seems that if a common understanding is reached with your co-worker, your instruments will be optimally maintained, and hopefully this will no longer cause disharmony in your office. Perhaps it might be enjoyable to take a course or watch a video together regarding the proper technique for sharpening your instruments. This may help to get you both on the same page with your techniques. I hope the two of you can come to a respectful understanding when it comes to maintaining your instruments.

June Q&A: Tips for Achieving Work-Life Balance

Ask IDH – June 10, 2019

Desiree, RHD, Atlanta, GA
I need your help! I really do love my job, but I am overwhelmed with everything. I see patients 5 days a week in a busy private practice. I have children and I try to be an active participant in their activities, including helping them with their homework every night. I also have a house, a husband, and a dog, and I feel that I don’t have any time for myself. I have been a dental hygienist for 13 years, and when I read about 4-wall syndrome or hygiene burnout, I feel like I might be reading about myself. What do dental hygienists do to combat this?

Pamela Maragliano-Muniz, DMD, RDH
Thank you for reaching out to us! Unfortunately, many hygienists feel burned out and let those feelings fester until they no longer enjoy their career or finally leave clinical dental hygiene. It sounds to me that you could use some serious “me time.” I know this is easier said than done, but it is essential for all people to have a stress-relieving outlet, regardless of how busy life can be. One day I will share my story in its entirety, but one thing that has helped me is to find something that is enjoyable (and not related to dental hygiene) and make time for it. I knew that I needed to make time for personal wellness, but I had never been able to stick to a consistent activity or hobby. I decided that I would explore different activities and promised myself that I would make it a priority for 3 months. If I found something I enjoyed, I planned to prioritize it for an additional 3 months; otherwise I would look for something else to do. I started practicing hot yoga, and I absolutely love it! I look forward to going and it has become a part of my weekly schedule. As a result, I do not feel as stressed at home or at work, and I feel more present in my daily activities.

What’s important here is that you have recognized that you are feeling overwhelmed and hopefully you are ready to practice self-care. I recommend finding time to explore various activities that you might enjoy, and keep in mind that you may want to pursue different outlets at different times of the year. I wish you luck as you find the thing that brings you joy, and I hope it helps you to create a healthier work–life balance.

May Q&A: What Hygienists Need to Know about Sleep Apnea Screening

Ask IDH – May 13, 2019

Cathy, RDH, Pittsburgh, PA
I work in an office with a large staff, and there is a tendency for workplace disagreements to occur. Issues between my coworkers are often blown out of proportion, and small misunderstandings can spiral into affecting our entire team. It is hard when members of the staff are not getting along because it slows down our work and makes the days seem longer. I do not supervise anyone, so I feel helpless in trying to help in these situations. Is there anything I can do?

Pamela Maragliano-Muniz, DMD, RDH
Disputes with coworkers are never easy. Regardless of whether you are a party to the disagreement, they create discomfort in your work environment and contribute to reduced productivity. There are a few things you can do to promote positivity and respect within your team.

On average, we spend more time at work than we do with our loved ones. It is in everyone’s best interest to make an effort to avoid conflicts, but when this is not possible, it important to communicate in a respectful manner. Constructive communication is a key component of any successful team. When disputes arise, communication tends to halt and the initial reason for the disagreement can get lost in misinformation. If you are involved in an issue, it is best to find an appropriate time that does not interfere with your office responsibilities to talk with your coworkers to clear the air. Acknowledge your willingness to maintain a positive working relationship with your coworkers and be sure to fairly balance the conversation to allow equal time to listen to their concerns.

Improving how your team communicates as a group can prevent issues as well. Team meetings are a great way to strengthen communication. One strategy that works in my office is to have morning huddles and monthly team meetings. Morning huddles are excellent for creating a game plan for the day and offer an opportunity for each of us to communicate any small concerns on a daily basis. Monthly meetings are longer, lunchtime meetings where we all have an opportunity to have a more in-depth communication about issues that may arise or anything that may require a discussion or a decision. If your office does not allocate time for meetings, this may be an opportunity to institute meetings to improve communication with your team. You can support this initiative and encourage your coworkers to participate by voicing positive feedback about the positive attributes of your team’s dynamic. Difficult situations, including interpersonal conflicts and disharmony in the office, may be most effectively resolved with the guidance and help of the office manager or practice owner. I appreciate you for bringing this topic up; it's a reality in many dental practices, and I applaud you for being proactive and intentional in creating a positive work environment.

April Q&A: IDH Discusses Oral Cancer Awareness Month

Ask IDH - April 02, 2019

Rebekah, RDH, Raleigh, NC
Although I have been a dental hygienist for 13 years, I still need help when it comes to documenting oral lesions. I document lesions in the chart, and I think that I am good at describing lesions properly. But I sometimes struggle when deciding what I should document: should I document everything, including cheek bites and amalgam tattoos, or just lesions that appear suspicious? Since I am unsure, I ask the dentist if I should document each lesion and leave it up to him. I work in a busy practice, so I worry that I may not remember if a lesion was there. I am also concerned that if the patient is rescheduled with a different dental hygienist, they may not have an accurate follow-up.

Thanks for any tips you can give me.

Pamela Maragliano-Muniz, DMD, RDH
This is such a great question, because you brought up many good points. First, I think that properly documenting and describing lesions in the dental chart is essential. Taking continuing education in oral pathology on a periodic basis is important to reinforce best practices for lesion detection and documentation. I would suggest documenting every lesion that is seen in the oral cavity, even a cheek bite. Any lesion, especially traumatic lesions, may be an indicator of another problem, so keeping records of every lesion will help to provide a thorough history of each patient’s oral cavity.

I would additionally suggest taking an intraoral photograph of every lesion that is identified. Photos are excellent for educating patients and encouraging them to perform self-exams for oral cancer. Photos will also help the clinician identify if the lesion has changed. It is also good practice to photograph lesions with a standard measuring tool (eg, a periodontal probe) next to them to demonstrate a calibrated way to document a size of a lesion. In my office, we photograph everything. We also take follow up photographs at least yearly, so we can continually monitor benign abnormalities or send the photos to the surgeon or ENT for further diagnosis.

You brought up another excellent point: proper follow-up. As much as we love our patients and want the best for them, we cannot always remember every tiny detail of everyone’s mouth. This is why documentation is critical for optimal care of a patient. In addition, if you work in an office where multiple dental hygienists practice together, I would suggest that you all meet to calibrate your documentation practices. If you are all on the same page, it is more likely that proper follow-up will occur and that you are communicating optimally for your patient.

I hope you find these tips helpful for your documentation practices.

March Q&A: The Connection Between Oral Health and General Health

Ask IDH - March 11, 2019

Rebekah, RDH, Raleigh, NC
I have read about the connection between oral health and general health, but I’m not sure how to talk about this issue with patients. If I bring this up, am I overstepping my boundaries as a dental hygienist? If a patient has poor oral health, should I ask the dentist to refer him or her to a doctor? I’m just not sure how to use this knowledge with my patients and could use some pointers.

Pamela Maragliano-Muniz, DMD, RDH
These are all great questions. First, I applaud your efforts to educate your patients about this important topic. It is not overstepping your boundaries to discuss this with your patients, but it is important to discuss this with the dentist that you work with first, so you can deliver a consistent message. I find that discussing the connection between oral health and general health is often motivational for patients who are non-compliant. When patients understand the negative impact of poor oral health on their general health, they often pursue recommended dental care and are more intentional with their daily regimen.

I suggest that when a patient presents with a chronic general health condition that can be worsened or exacerbated by uncontrolled periodontal disease or caries, it is essential to discuss the importance of pursuing recommended dental treatment and optimal oral hygiene practices. Educating patients about how maintaining oral health can help to promote favorable general health outcomes will differentiate you as a practitioner, as well as demonstrate that you practice at the highest standard of care.

February Q&A: Educating Parents of Pediatric Hygiene Patients

Ask IDH - February 11, 2019

Jennifer, RDH – Boulder, CO
I receive numerous questions from the parents of my pediatric patients concerning the importance of early oral health habits. Additionally, parents often ask for tips to help encourage their child to cooperate when introducing new methods to care for their teeth into their daily routine. How can I provide enough crucial information to parents without overwhelming them and do you have any suggestions to help encourage children to participate?

Pamela Maragliano-Muniz, DMD, RDH
It is always a positive sign when parents are interested in learning more about proper oral health for their children at a young age. Parents often don’t know where to begin. Furthermore, many common misconceptions about pediatric oral health create more confusion. Parents often rely on information provided by family members based on outdated oral health practices. Theories such as primary teeth cavities do not affect permanent teeth, flossing primary teeth is not necessary, dental sealants are not safe for pediatric patients, and children do not need to attend annual dental appointments until all permanent teeth are present, discourage parents from seeking treatment until after a potentially harmful oral health condition exists.

Educating parents on disease and caries prevention in a manner that is easy to understand is critical. Provide a clear overview of why preventative oral health habits should begin as soon as soon as deciduous teeth begin to erupt. Creating a timeline for the suggested frequency of dental visits based on a patient’s age and existing conditions is a great place to start.

Encouraging proper dietary habits is often overlooked. Another common misconception is that sugar found in healthy foods, such as fruit, does not cause tooth decay and enamel erosion at the same rate as foods that contain “bad sugars,” such as candy and drinks with artificial sugars.

Finally, provide an easy-to-follow checklist of tasks to add to a child’s routine. Reviewing the best practices for tooth-brushing frequency, when to begin using fluoride toothpaste, how much toothpaste should be dispensed onto the toothbrush, flossing techniques, and appropriate use of mouth rinse, will provide clear guidelines for daily management of their child’s dental health.

While every child is different, advancements in pediatric dental products have significantly improved parents’ ability to entice children to engage in hygiene habits. Toothbrushes, including those with superheroes, princesses, and popular animated characters, brightly-colored dental floss picks, and flavored mouthwashes, are just a few of the kid-friendly products on the market to make dental care fun. During my time as a dental hygienist and as a practicing dentist, my patients have shared successful non-clinical tips to make hygiene less stressful for children and parents. Involving the entire family in a child’s daily hygiene routine is one way to encourage consistency. Creating a game that involves brushing their teeth, such as playing music and challenging their child to complete their hygiene routine by the end of a song, can create a helpful distraction from this mundane task. When all else fails, there are apps to help encourage proper oral hygiene habits for children!

Regardless of the creative options parents employ, the important thing for them to remember is they have taken the most important step by working with their child to exercise positive hygiene habits.

January Q&A: Nonabrasive Prophy Paste

Ask IDH - Januray 14, 2019

Danielle C., RDH, Charlotte, NC
With so many new materials released every year, it is difficult to keep up with the information necessary to stay current on new products. Is there an area of materials advancing that you are particularly excited about at the moment?

Pamela Maragliano-Muniz, DMD, RDH
Dental hygienists who make it a priority to be well-informed on developments in hygiene materials are able to play an active role in treatment planning for patients.

If you work in an office that offers cosmetic dentistry, especially with CAD/CAM restorations, it is extremely important to be mindful of the type of prophylaxis (prophy) paste that you are using. Recent advancements have shown that some of the coarser prophy pastes can actually ditch margins of composites and scratch anterior composites, resulting in the loss of the polished surface of the composites and reduction in the lifespan of direct or indirect resin restorations. With ceramic restorations, coarse prophy pastes can deteriorate the surface stain and glaze, resulting in the loss of the surface staining or a reduction of the surface luster of the restoration. New, nonabrasive prophy pastes are available that hygienists can use to replicate the prophy process without damaging the restorations, thereby preserving the significant efforts of the dentist and acting as a lasting, cost-saving measure for the patient. I urge you to research this area to identify your preferred prophy paste.

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