TBT Troubleshooter: The divide over tattoos and piercings in the dental office

Is it generational differences of opinion, or is it just not a good idea for dental professionals to sport piercings and tattoos in the dental office? This issue generated a couple of interesting and very well read Thursday Troubleshooters. In honor of TBT, we're sharing the Q&As with readers in today's column. Want help with tough questions? Email us at [email protected].

Facebook Feedback: Here are some of the opinions this TBT Troubleshooter generated from DIQ readers on Facebook:

• I'm an assistant, and though it doesn't affect me doing my job, I do hide my tattoos and have removed all my piercings. We are providing a safe and hygienic facility. Showing those "personal belongings" would look unhygienic and not sanitary in my opinion.

• "...inking portrays one as less intelligent, less healthy, and less attractive." ‪What?! People are too judgmental. Ever heard of not judging a book by its cover? I personally only wear my earrings in one hole and only one tattoo shows when I'm wearing my scrubs.

• Facial piercings are a NO! This is as much for the professional's protection from aerosols as it is for patients. Not to mention it will hurt like the dickens if am agitated patient were to grab a facial piercing. Tattoos, as long as they are tasteful and not offensive, are no problem, in my opinion.

• When a DA has long fingernails it can be very hard to work with them, especially during a crown cement! At a minimum, no tongue piercings should be allowed, since they don't promote oral health.

• I think as long as I do my job to the best of my ability, my personal idea of expressing myself shouldn’t matter. I’ve had patients compliment me before on a piercing and my subtle tattoos. Also, I think if who you’re working for is okay with it, then that’s what matters most. I do have a problem with fake or long nails in the dental office. We use our hands most of all and they are breeding grounds for bacteria.

• I say sport it. I think tattoos and piercings do not affect how we do our job. I think they should leave it alone

• I'm an assistant. I wear an undershirt and cover my tattoos. Patients look at us differently when they see tattoos.

• I was made to take out my teeny tiny nose stud and hide my small tats.

QUESTION: I'm a dental assistant instructor and some of the students entering the program have tattoos on their necks, arms, and hands. They also have face piercings, tongue piercings, and dermal piercings, which are surgically placed piercings in the skin on their face. I coach and try to mentor the students on proper professionalism for the dental office, and I am met with resistance from some of the students. Am I wrong, or have things changed that much during the few years I moved from a dental professional to a dental assistant instructor?

ANSWER FROM SHELLEY RENEE,Shelley Renee Consulting:
Whether we like it or not, our appearance creates an impression on others. In seconds, our look evokes a response, without a single word being uttered. The question to ask is, what message or feelings are we evoking?
In recent years, starting with the generation X members, more of a tolerance has developed for inking and multiple piercings. Some corporations such as Starbucks have relaxed the dress code to appeal to their younger customer base. However, according to a 2012 Harris poll among those without tattoos, inking portrays one as less intelligent, less healthy, and less attractive.
Simply put, the dental office dress code calls for two considerations — image and safety. The image must portray to all patients that they are in the care of competent and trustworthy individuals. Inking is not congruent with the dental focus of removing stains and whitening. Also, dangly jewelry in piercings may pose a risk of injury or cross contamination.
The bottom line is that dentists have the right to require dress that reflects the professionalism of the practice. Even though there has been an increase in acceptance for some job markets, most job interview advice columns strongly advise all interviewees to cover inking and remove all piercings except for ears. The traditional advice holds true. Conservative attire befits respect in the dental industry.

ANSWER FROM ROBIN MORRISON,RLM Healthcare Marketing:
As a dental assistant instructor, you are in a unique position to help your students launch a long, professional, and successful career by setting themselves apart from the rest. While their assisting skills are extremely important, their communication skills and professional image will help them rise through the ranks more quickly than their colleagues. The employees who have a polished and professional image will have more opportunities in leading dental practices.

In most cases, team members in leading practices are better compensated than in average practices. Whether we like it or not, employers and patients (people in general) make decisions based on first impressions. A good first impression may mean getting hired by an employer, or a patient accepting treatment and feeling confident about the practice. I would stress to your students that in a competitive work environment, they should stack the cards in their favor by having excellent professional skills, excellent communication skills, and a professional image.

The second popular Troubleshooter on the issue:

QUESTION: I read the article on DIQ about how important it is to dress professionally in the dental office. I believe we have a little problem with this in our office. I'm a hygienist who has been in this office for 35 years. We recently hired a 30-year-old assistant who has several tattoos. The one that shows is the "tramp stamp," based on how the article described low riding pants and short tops. When she is sitting and assisting in the chair, and when she bends over, the tattoo shows. She is a good assistant, but she likes to get people's attention and reactions. Her tattoo bothers not only me, but some patients have also commented on it to me.

I haven't discussed this issue with anyone because as you know, women can be gossipy. The dentist has seen the tattoo because he jokingly commented on it. I wish I could tell him it bothers people but I don't know how, and I wish someone else would talk to him. I don't want to be the tattletale because I've been in the office the longest and I don't want people to think I'm a complainer. What would your recommendation be on this matter? Thank you!

ANSWER FROM LINDA DREVENSTEDT, Drevenstedt Consulting, LLC:
Yes, the times they are a changin’ for sure. The generation clashes are occurring in many dental practices. I recently attended the AADOM meeting and one of the discussions was about the new option for low rider uniform pants. There must be a demand for them or companies would not make them. (They might work in ortho or pedo practices.)

There are several things to consider on this topic. First, the generation breakdown—people's different values and different expectations might be a good topic for a discussion in your practice before you tackle the sticky uniform topic. Here is a broad generational breakdown:
• Gen Z, Centennials, or Nexters: Born 1996 and later
• Millennials or Gen Y: Born 1977 to 1995
• Gen X: Born 1965 to 1976
• Baby Boomers: Born 1946 to 1964
• Traditionalists or Silent Generation: Born 1945 and before

You can do some Google research and find more about each of these groups. Share the facts and then have a discussion about the differences. Discuss who you all are as a team. If your practice is the age you say and several team members are long timers, then you probably have a lot of baby boomers as employees and patients. Baby boomer attire expectations are very different from millennials, etc.
Second, learn the patient majority with a quick computer report on your practice demographics. This report is called Patient Analysis or Patient Demographics. It will tell you what generation most of your patients are. Discuss with the team the expectations of that group when they visit a professional dental practice. Then that should become the standard to use as you develop a dress uniform.

Third, together with the team, gather uniform catalogs or go online and look at what is appropriate for your patients' expectations. Dental teams have to consider the customer service part of any decision in the practice. The attire of the team is an internal marketing decision. If a large majority of your patients are turned off by low rider pants that expose tattoos, then that is what is called un-marketing.
Fourth, once you have a uniform standard, it should become a part of your office personnel manual and be used in the interview and as a written protocol for the practice. This takes it out of gossip or complaining and into a standard for all.

Fifth, and the most critical, share this article with your dentist owner about how to make the change and get his approval first. If he is not willing to uphold a new dress code standard, then you are whistling in the wind since it is his practice and he is the one who makes the uniform guidelines.

ANSWER FROM ANGELA CLAYTON,Clayton Consulting Services:
If your office has not done so already, implementing a standard dress code is a must. When you do, keep in mind that less is always more. Keeping a professional appearance at all times should be a protocol that is enforced. My suggestion would be to go directly to your doctor or office manager and explain your concern, and remain positive during the conversation. Avoid talking with other team members about this issue because gossip has no benefit whatsoever.

Remind your management team that you take pride in the fact that your practice provides quality care to patients. Keeping a neat, clean, and professional appearance speaks volumes for the type of practice you are and helps set your team apart from the rest. It shows that your team takes pride in how you carry yourselves and that you value and respect each other and your delivery of care to your patients. If the office doesn't do so already, see if the team is willing to create a uniform policy structured so that the entire team is provided a specific number of uniforms per year. But first have a detailed dress code in place that covers all aspects, including uniform tops, pants, lab jackets (cotton or disposable), shoes, hair, nails, jewelry, and makeup. Lab jackets can keep "eyesores," in this case alower back tattoo, covered and keep your clinical team in OSHA compliance.

Once the dress code is in place (don't forget to put it in writing) have an office meeting and present the new or refreshed protocol to the entire team. Your team will feel more confident and comfortable when looking their best. Take a team picture and place it on the practice website and post it to office social media outlets to remind everyone how awesome the team is. This approach should help avoid a direct personal attack of the team member who frequently reveals her tattoo. If this doesn't work, then your doctor or office manager should privately discuss the matter with the team member. Good luck!

Send your questions for the experts to answer. Responses will come from various consultants, many of whom are associated with Speaking Consulting Network, Academy of Dental Management Consultants, Dental Consultant Connection, and other expert dental support and human resources organizations. Their members take turns fielding your questions on DentistryIQ, because they are very familiar with addressing the tough issues. Hey, it's their job.

Send your questions to [email protected]. All inquiries will be answered anonymously every Thursday here on DIQ.

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