Thursday Troubleshooter: Discouraged new dental hygienist tries hard, yet receives no encouragement

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QUESTION: I’ve been a dental hygienist for almost two years. As a new graduate, I quickly learned I was accidentally leaving calculus behind; I would sometimes see it on radiographs and worse, the dentist sometimes found missed calculus. But the dentist was always understanding and patient as I navigated the learning curve of moving from school to practice. I took everything as constructive criticism and motivation to improve. Fast forward a year, and I feel that I’ve made great efforts and accomplishments in effectively removing calculus. I always check with my 11/12 explore and I’ve become more comfortable getting right under the contacts and using more lateral pressure. However, the dentist recently pulled me aside and told me I am still missing areas because probe readings on some of my patients have increased and missed calculus is to blame for causing the inflammation and deeper sulcus depths. But he never praises me if I’m doing well.

Honestly, I’ve started to wonder if I’m having issues with tactile sensitivity because the dentist thinks I’m not being thorough, although I can feel the difference between smooth and rough, spicules, ledges, etc. But what if I can't detect the very fine calculus? I’d like to think I’m able to. I also struggle to complete everything in time, which is one hour, not to mention find time to sharpen instruments, send pre-authorizations, and print and review treatment plans and estimates with patients. Needless to say, my time management skills have also become an issue as I try my best to be thorough with my scaling and that takes up most of my hour. It's very discouraging when I’ve been trying so hard and I have not been recognized for it. I am entertaining the idea of leaving the dental field, but that would mean more student loans and debt. I would like to remain a dental hygienist because I worked so hard to get where I am, but I feel very discouraged these days. Any words of advice would be greatly appreciated. 

ANSWER FROM JAMIE COLLINS, RDH-EA, founder of MyDentalEducator.com:
First and foremost, give yourself a break! There is not a hygienist on this earth who hasn’t missed calculus from time to time. What stands out is your willingness to take criticism and continue to learn and grow. That in itself shows the difference between those who really strive to be the best they can be and those who don’t. A few tips I would suggest is to always check with the 11/12 explorer after scaling to ensure everything feels as smooth as it should be.

One trick I do on patients who are more difficult to treat or if I’m not sure I was able to get to the base of the pocket is to take a post-operative bitewing after scaling. In those cases, I do not charge the patient. It really doesn’t cost any more to take images with digital sensors. By taking an image you can see if there is calculus that remains and go back in if needed. I will inform patients about this by stating, “I want to take an image to see if what I’m feeling is anatomy. I don’t want to keep picking on you if it is root structure.” Almost all patients are fine with this, and this is a good way to check yourself. Even after 22 years in dentistry, I still use this trick from time to time.

What also makes me question you missing calculus is, how good are your instruments? Are they sharp and still holding a good working end? If they are not you are only as good as the instruments you have to work with. If they are not in good condition, go to your dentist and ask about replacing them, even if it’s just a few each month.

Time constraints often make you feel rushed, but the longer you practice the better you will become at managing appointment flow. I suggest combining parts of the appointment. For example, are you discussing treatment needs and home care while you are scaling, or are you sitting the patient upright and going over this at the end of the appointment? I find that in most cases we can discuss home care while I am scaling, and I explain to the patient what I see in the oral cavity in relation to places the patient needs to focus on. I can hand patients a mirror mid-appointment and show them directly what I find or use an intraoral camera to capture an image. 

I ask my patients about health history changes while preparing the x-ray sensors. This is multi-tasking to be efficient. One final trick I have adapted to over the years to ensure I stay on schedule is that if I am running behind, I make relevant notations on the paper schedule for the day and go back and do my chart notes at some other time during the day. I do this as we update the medical history to ensure I don’t forget anything by the time I get it to the computer, even if I chart within the allotted hour.

Pre-authorizations and administrative work are a different story. Is there an assistant or office person who can discuss finances with patients? Talking money and estimates with a patient rarely falls upon the hygienist, and though I will discuss clinical treatment recommendations, I always tell patients we will discuss finances with the people in the front who deal with insurance estimates and billing. In my experience, the hygienist talking finances with patients is the exception rather than the rule. That one duty being handled by the administrative office will free up a lot of time during your hour.

Dental hygiene is an incredibly rewarding, hard, and exhausting career that I would choose all over again if I had to. It sounds like your passion and heart is in it, but we can be our own worst enemies at times. Just because this doctor does not acknowledge your efforts, please don’t think they’re all like that. There are some amazing employers out there. I would encourage you to seek employment at another office before you give up the hygiene field all together.

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