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Posts for the ‘Patient Education’ Category

Orthodontics and Periodontal Disease

Wednesday, March 27th, 2013

Does having periodontal disease mean I can’t or shouldn’t have braces to straighten my teeth?

Periodontal disease, when active, results in bone loss around teeth.

Orthodontics involves moving teeth through bone to relocate them in better places for both appearance and function.

The process of moving teeth activates bone cells to remove bone in front of the moving tooth and lay new bone down behind it. All of this occurs due to the light forces being applied by either wires or appliances patients must wear over the months necessary to accomplish the task.

What is not helpful, as active orthodontics is taking place, is to have a bacterial infection and inflammatory response going on at the same time.

This does not mean, however, that people who have had periodontal disease treated and controlled cannot undergo orthodontic procedures. In fact, sometimes this is desirable because it moves teeth to positions that are more easily cleaned.

So let’s discuss how someone might proceed through orthodontics who has or has had periodontal disease.

Make sure the periodontal disease is under control. Do not start orthodontics until released by the dentist involved with treating this condition.
Understand the risk to each tooth before starting orthodontics as well. If a tooth has a poor or questionable prognosis (outlook for future retention and stability), it may be best to remove the tooth before starting treatment.
Commit to on-going periodontal supportive care at a tighter interval to assure that periodontal disease does not recur. Usually following active periodontal therapy involving surgical procedures it is wise to be on a three-month supportive care interval for the first year. However, when starting orthodontics, this interval should be cut in half. This means having supportive periodontal therapy every six weeks through active therapy and starting this care within a few weeks after initial banding, bracketing or using aligners. If over time, it can be shown that conditions are stable enough, the interval can be stretched.
Once active orthodontics is completed another comprehensive periodontal evaluation needs to be performed in order to see if any problems have developed that need to be addressed before returning to supportive periodontal therapy. There are cases where orthodontics vastly improves pocket depths, but nothing can be assumed and after-treatment measurements are very important.

If a tooth is lost because of orthodontics, does this mean that it was a bad idea to have the teeth straightened?

To answer this question, let me ask another one. Should a weak tooth or teeth dictate decisions for people? Keep in mind that teeth of this nature can easily be lost without orthodontics. Perhaps orthodontics accelerates a process but it doesn’t cause periodontal disease. Certainly as much as is possible it is good to predict possible outcomes in order to prepare for what might happen, but let’s remember that there are ways to exchange weak teeth with dental implants. This can actually result in a stronger longer lasting tooth or teeth over attempting to hold on to weak ones a little longer.

Which brings me to my final point when planning orthodontics.

If you need a dental implant but you also are considering having your teeth straightened in the future, please let your dentist know. Dental implants, once placed, do not move like teeth do. For this reason, dental implants are often placed after orthodontics is completed. There are exceptions to this because many dentists and orthodontists use dental implants as anchors for moving teeth.

So in conclusion, if you want your teeth straightened and you have or have had periodontal disease, discuss this with everyone who will be involved with your care during the planning stage. Periodontal disease must be under excellent control and managed throughout the process of active orthodontics and dental implants may need to be delayed until active orthodontics is completed.

Posted in Patient Education, Thoughts For Patients | No Comments »

How to Succeed in Periodontal Therapy Part 5

Sunday, March 17th, 2013

Frankly, I have no illusion that I can single handedly change the quality and nature of periodontal therapy in every dental office in the world – at least not over night.

There will come a day when dentists and dental hygienists train patients in ways very similar to how they perform clinical procedures today, because that is how they will be trained themselves. Even communication within dentistry is a trainable procedure. In time, the importance of effective communication within periodontal therapy will grow to the point where it will no longer be considered an esoteric topic. Instead it will be taught as a learned communication skill requiring memorization, rehearsals and performance. Critical conversations will be planned out behind the scenes and standardized into templates similar to composing musical compositions – and every member of the office team will learn how to read the music and perform their important role in patient support. Eventually more dentists will begin to grasp the overarching protection provided by proactively training patients and their teams. Informed consent will simply be subtly built into the everyday conversations office personnel have with patients because it has simply become a part of the story and culture of the office. When this happens friction between patients and dental offices will dramatically decline. Dental teams (not just a handful of dental hygienists) will no longer simply accept that patients never will floss or that they always do. Instead they will actually and automatically show them how to do it effectively and work with them when they have difficulty getting the hang of it. And patients will change their attitudes about their responsibilities when it comes to dental care, no longer treating it like a commodity or entitlement. Instead they will actually understand and acknowledge how fundamentally important it is that they take care of themselves effectively first. How do I know all of this? Well, it’s what goes on in my office every day and what I want to show you so you can do it in yours.

Having stepped out and made all of these bold predictions, I will readily acknowledge that right now trends in dentistry actually seem to be going the other way. Patients more than in the past seem to hold others responsible to give them health and yet decline to accept responsibility for what only they can do. In large part I believe this is due to living in an intense advertising/sound byte culture that promises quick fixes to complicated problems in order to push products and procedures. Dentists and other healthcare providers in general, who know better, are, for the most part, permitting patients to live under untrue assumptions because they fear that the required patient interactions would be time consuming and fall on deaf ears anyway. Sadly, by being silent we are giving tacit endorsement to the messages others are promoting for their own benefit and not our patients’.

But it won’t go this direction forever. Bubbles burst. False assumptions are unsustainable indefinitely. And like a pendulum, rational principles of patient treatment, will swing back at some point.

So, what’s my advice?

Buy low and sell high. Become a leader and help start the movement back. Get ahead of the crowd. Speak out. Keep reading.

How long does it take to change or impact culture? There are so many variables I dare say no one knows for sure.

What we do know is that it is one decision at a time, one person at a time, and that momentum builds when choices made are positive, repetitive and strong. At the same time it’s good to remember that every good idea is opposed and that every bad idea is fixable. What can’t be fixed is the belief that nothing can or ever will change and to therefore go passive. This is not the same as accepting that some people will refuse to change in ways we want them to. The question is, should this stop change agents? Leadership always requires courage because it is the position of most exposure. It is the willingness to take slings and arrows.

And what’s wrong with becoming a dental office culture that fights for better dental care for patients over and above other worthy goals – like lighter work, shorter work days, higher pay?

Patient care actually is the only idea, or common denominator, that can draw an office together and turn it into a team. None of these other desires are wrong, they just are not enough to improve morale and ultimately result in a sustainable business. Frankly, other than working together for the best interest of patients, team members really have little in common. We aren’t equal educationally or with regards to earnings or potential earnings. Even our personal life missions are just that, personal.

In fact, let’s face it. Everyone who works in the dental office is doing so for two basic reasons and neither is cohesive in nature. First we go to work where we do because we choose to do so. This doesn’t necessarily mean that we want to be there, but we always choose to be there, at least for now. Certainly when wanting and choosing are in line, there is the possibility for career longevity, otherwise we will choose to be where we are today and may decide to go somewhere else tomorrow. Secondly, everyone is in the dental office (including patients) because each one, independent from the others, is building a life somewhere else. They are in the office because they want something. We all have families, friends and interests elsewhere and anyone who believes that dentistry is their entire life needs therapy.

So I say the common denominator is patient care. If you can think of another, let me know.

More specifically, the common denominator is patient care within the profession of dentistry. To the extent that dental teams keep this as the primary focus will be the extent to which the practice will not just survive, but thrive, in spite of the two personal reasons each one of us comes to work in the first place.

What does a dental practice need in order to make patient care the common focus of the team?

I believe it needs at least two things. First, it needs a leader, and the leader it most needs is the dentist.

Now I can already hear people reading this saying a couple of things. First, some are saying that everyone is a leader. Others are saying that I don’t know their dentist otherwise I would know this is a bad idea. They believe that a more democratic office is to be preferred.

Both of these, in my opinion, are misunderstandings of good teachings on leadership. True, everyone has influence, and perhaps everyone has a sphere in which they are the leader, however, whenever anyone takes the leadership role of the dental practice over the dentist, the best that can be expected is mediocrity. So if I am a dental assistant, an office manager, a dental hygienist and I am offered opportunities to work in two offices, one where the dentist leads and one where the dentist is passive, I will pick the office with the leader simply for this reason. I will make more money and will work in an environment with less stress.

Good leadership stabilizes the work environment. But what about a dentist who is autocratic and harsh? Surely this individual should not lead. First, if he doesn’t lead the culture will suffer and office turnover will likely be high. Secondly, to describe what this dentist is doing as leadership is incorrect. True there is an automatic pecking order depending on who hired who and what people are paid, etc. so orders can be given and taken – for a while. But true leadership persuades and inspires. True leadership can gain cooperation from people in ways in which they feel better about themselves and others, not worse. Finally, good leaders lead themselves first. They own responsibilities including a high respect for others and personal self control. And they lead by example.

The second thing a dental practice needs to center activities on patient care, in my opinion, is a common strategy. I see this as a common message and, yes, I call it the dentist’s story. It is what this dentist believes about how dentistry helps people and how he or she fits into this vision. It is the dentist, as leader, who must own and continually teach every member of the team. The story is the script or blueprint that connects teams and patients together on the journey toward better health and better working relationships for the duration. If this sounds sappy or silly, it is because it is not embraced by the dentist. The dentist, followed by everyone else, will quickly become detached from any story when it is not personally embraced and constantly discussed.

The story sounds basic and simple, doesn’t it? It sounds to be beneath the level of the office’s combined intelligence, and that’s because it is. But it is not beneath the level of patients who didn’t go to dental school and don’t work in a dental office every day.

The purpose of this story is to put people on the same page when it comes to care and the one who needs to know it most is the patient. Spending the time telling patients how they can reestablish health and then maintain it for life is not a waste. Rather it is the foundation for forming a long-lasting alliance, one that will cause patients to trust more and send their friends and family to your practice. The story by far is the most important internal marketing strategy for the office. Having said this, many will not incorporate it into their offices simply because it requires work and the discomfort that always comes with significant change.

So now let me tell you my version of the dentist’s story. I expect you to modify it, but still I recommend you study it in depth. As I go through it here I will discuss all the principles behind the words that I can think of and within reasonable constraints of time. Shortly I will record my presentation and will show you the form I have created to document the discussion.

For today, let me simply tell you the story behind the title.

I call my presentation A Tooth has Four Parts.

It isn’t profound or glamorous as a title, but I went for functional over clever. The reason I call it this is in order to help everyone on my team know how to start the talk. Tell the patient that “A tooth as four parts.”

Why do I start with a tooth? Because most everything in dentistry can be explained by starting here. If it doesn’t start with a tooth and it is in the mouth, it’s oral medicine. Even a discussion about dentures should begin with the tooth. But my subject is periodontal disease so I will travel down this line. If I were going to talk about veneers or a root canal, I would move in a different direction, after explaining that a tooth has four parts.

So what are the four parts? Enamel, dentin, pulp and cementum.

Isn’t this too much technical information?

Anything less and you are changing reality. Patients, unaware of the fact that enamel is a shell, or that dentin is more organic than enamel and thus can be utilized as food for some bacteria, or that pulps have nerves and throbbing toothaches are the result of the fact that this nerve is encased in a solid block of material that doesn’t expand, are at a loss at really understanding what it is you propose to do. Always describe normal first.

But it’s the fourth part of the tooth that is important in periodontal disease because cementum holds little fibers that surround the dentin in all directions attaching the tooth to the bone and gums. Without this understanding, patients don’t understand that bacteria are attacking a weakness between cementum and bone, or why a dental implant is fundamentally different in the way it attaches to the body compared with a tooth.

Is everything I have just told you in my presentation?

No. But everything I need to explain to a patient comes out of first explaining the parts of a tooth. Normally, what I have just shared with you takes twenty seconds or less. That’s how far into the presentation we are right now.

A penny for your thoughts.

Until next time.

Posted in Dental Hygienists, Dental Schools, Dental Students, Dentists, Patient Education, Periodontal Therapy | 2 Comments »

How to Succeed in Periodontal Therapy Part 4

Tuesday, March 12th, 2013

Where Are We?

It should be obvious by now that this presentation is not a “best practices” consensus on the subject of periodontal therapy. Rather it is my personal, but experienced advice on what I consider the best way for dentists to treat and manage chronic periodontitis. I also believe that reading and implementing some or all of my recommendations here will help your practice grow.

The purpose of these blog posts, which will eventually be consolidated into a manual and used in training seminars on line or in person, is to explain in a comprehensive way how to establish and then operate a periodontal therapy program; one that provides the best care beginning in the general dental office that is working in concert with a periodontist colleague. In other words it is assumed that there will be patients who fall outside of the more predictable and routine, so for this reason, it is always smart to have a periodontist on your Periodontal Therapy Program team. This brings confidence to patients in your program and makes referrals, when indicated, easier to achieve. Remember, it is important that your referral recommendations are followed by your patients in order to make sure they return to you later. Patients who leave any office to find “somebody” to help them with “something” easily lose confidence in the practice that seems to have sent them away. On the other hand, when patients understand the story and how and when referrals are made, and to whom they are made, as simply a matter of fact in the early presentation, this builds greater trust in the referring dentist.

Briefly, here are some of the unique elements of this periodontal therapy program that differentiates it with others:

1. It starts with the dentist.

Often this isn’t the case. This is why, if what I have written up to now, has moved everyone but the dentist, the office periodontal program is still at the starting block. Dentists who are employees in a corporate structure, government system or non-profit entity still have to take on this role within the office in order to change the culture enough for patient’s to feel supported within the program.

2. The dentist needs to understand the power of story and create an office culture that listens carefully to patients.

Patients have a story we need to hear. Often, however, we are afraid their talking will mess with our finely tuned schedules. There are ways to manage this and it is my next topic below. I call it The Story Exchange.

3. Create a story for the office that can effectively be given to patients in the context of their unique situations.

This requires an office team with the ability to connect and care for people even at the emotional level. The broader the ability of the office to care for people of all personality types, the broader the patient treatment base and the healthier the practice. Another way to put this is to understand that the less patients have to look, think, and act like you and your team, the healthier practice you have.

4. The story for the office must be personalized with the dentist’s story.

In other words, as I have already said but can’t emphasize enough, without the involvement and endorsement of the dentist empowering the team, the effectiveness of the program goes to almost zero. This requires intentionality also known as rehearsals. This is fun and scary for some. I will talk more about this later in another post.

5. I will teach you a simple story that explains dentistry and periodontal disease in layman’s terms.

This information is transferable through all members of the team, but it again, starts with the dentist. This story doesn’t speak down to patients but it helps them understand what they need to know in order to manage their chronic problem. Uninspired, disinterested patients who believe that cure for this condition is solely the responsibility of the dentist will not get better. This is because the patient’s activities are foundational to any procedures performed in the office. Uninformed, unfocused patients place the dental office at risk for accusations of malpractice when therapeutic results do not turn out as they expect. For this reason the story should be established within the office in a way where it can be shown that the patient was informed early in care on the essential information about this condition and how it is treated and managed. In fact, those patients who hear the story understand that when they don’t fulfill their obligations to themselves, treatment results will be disappointing. Consequently, thoughts of legal actions are automatically understood to be unproductive and without merit.

Do all patients do well in the program? Are you kidding? But what does happen is that those patients who are potential problems for the practice self-eliminate, usually doing so in ways that keep doors open for their return. Also they go without fireworks.

6. The story, although focused on the patient, aligns the activities of the team.

It teaches the front office and youngest dental assistants what they need to know in order to talk with patients who may be older than they are. It also reduces the weight of responsibility from the dental hygienists for being the exclusive program managers, trainers and cheerleaders. This actually makes them more effective within the office performing duties unique to them while enabling them to support, and be supported by, other members of the team.

The Story Exchange

People like visiting. They like telling their stories to people who are good listeners.

Good listeners are not mute statues.

For a good BAD example of this we need go no further than the classic picture of the patient lying on the psychiatrist’s couch. The doctor is sitting in a chair looking anywhere but into the patient’s eyes while scribbling notes and periodically mumbling something.

In contrast, a great word picture is that of two people sitting in a coffee shop talking. When one is listening the other is supporting the conversation non-verbally through smiles and nods. Periodically the listener interjects questions and comments that propel the conversation forward. Ultimately when one has spoken and is satisfied that he or she has been heard, the roles can then reverse. A good rule for dentists in private practice is never teach until you have first listened extremely well.

In school we are taught the important questions to ask and they usually come in a list or on a certain form. I am not arguing that the information is unimportant, but seasoned practitioners know how to collect this information by allowing the patient to tell his story in the course of a directed conversation.

So here is how I might start this conversation: “Good morning Mrs. Schmedlap, I’m Dr. Young. It’s nice to meet you. How may I help you?”

I make sure the patient, if in the dental chair, is sitting up. I position myself on a stool in front of the patient looking eye ball to eye ball. I have a pen and paper and as the she speaks I am taking notes.

Of course the worry is that the patient is a talker and she will give me three pages of notes. So what? The more you permit her to talk, the more you will learn and the more she will trust you. Worst case scenario is that she talks for the scheduled time and nothing else is done. That’s OK, you simply tell her that the two of you need more time to document and complete the conversation and examination.

There is one exception to this general pattern and that is when the patient is in pain. People in pain are not able to listen and make long-range decisions. Your objective for them is to get them out of pain and then have the conversation and more comprehensive examination at another time.

Drop the objective of accomplishing a comprehensive examination on the first appointment. If you can do it, great, but this should not be the objective. The primary objective of the first meeting is to get acquainted and establish trust. I know to many this will seem like a big waste of time, so let me stop and ask you to think about the appointment, not based on what you want to get out of it, but what the patient wants to get out of it. Obviously you want to know what the technical problems are and what you can do to fix them. What does the patient want to know? How do you really know if you do not ask? Why assume and be wrong most of the time?

I can say this in general, patients want to know if you are kind, gentle, safe, and respectful. Are you in it for the money or do you care about them? To understand more about you, they will study how you relate to your team members. They see this as a big clue as to whether or not you are a good dentist technically. If the team is relaxed and happy, you must be good. If there is tension or any other bad vibe, maybe you’re not so good… How else will they be able to determine your skills? After all, they aren’t dentists.

Many doctors get into ruts and they use their social status to move patients to do what they want. After all, they are the doctors. The problem is that people can give us external messages of respect and still not trust us. So if you are thinking you don’t need to do what I am advising, it’s possible you are just not tuned into the real situation.

So here comes a dentist who sits down and listens to the patient’s concerns. How important do you think this is? If this dentist can stop everything she is doing and focus on this patient who is afraid and uncertain and simply listen and take notes – without giving any immediate answers and launching into some automatic lecture, it is very possible that this patient will be a patient for life. And if this took five additional minutes is it worth it? By the way, it is always less time to listen than it seems at the time. That’s why I take notes and work hard to look and stay interested.

Objection! Dr. Young, what if the patient is no-nonsense and wants to get on with the work?

Not a problem. Remember, you asked the patient and are listening to him. If he doesn’t have a lot to say and wants to move on, I will pick up the pace. By this, I mean I will ask my unanswered questions. (I list a few of these below). However, let me give you a cautionary note here.

When talking with the brief and brusque personality, remember that there are some patients who want to move past conversation because they are not planning to cooperate. They believe that they can maintain control of the dentist by treating him with suspicion and so obligate him to bow to unreasonable demands. This doesn’t work and isn’t healthy for either party. When a patient begins dictating treatment, what she will and will not allow, then this becomes a part of our conversation. I do not believe I am everyone’s dentist or periodontist, and so I also believe I have to be comfortable in the relationship just like the patient. It’s rare that I elect not to treat someone, but on occasion it has happened. One more thing, and I will leave this unpleasant and fortunately rare situation. Any patient who disrespects any member of my team answers to me. I do not permit patients to verbally attack someone who is my public representative. This is important because my employees should not have to defend themselves in my office. I want them concentrating on being nice and respectful to others, which means I am the one responsible to defend them. I guess I don’t buy into the idea that the customer is always right. Fortunately I have only had to do this a couple of times in thirty years, but I’m prepared and will respond if and when necessary.

Now let me give you some of the questions I need to have answers to. Remember, because we are having a conversation, the order is not important. So don’t have a list of questions in front of you. A pen and blank sheet of paper are best in my opinion.

But what about a computer or smart device of some sort to help take notes?

I personally think this is a bad idea. I love technology, but I want it in the background supporting the interpersonal communication in the office. Who do I want patients to think they saw during the appointment, me or a computer monitor?

Good Questions to Ask

- What is the patient’s primary problem or concern? Many are trained to call this the Chief Complaint. When people have lots of problems, don’t waste your time trying to identify which is most important. Just listen and take notes. As long as they have a problem to tell you, you are listening.
- When did the patient last see a dentist? Who, where, why and what happened?
- When did the patient last have a cleaning?
- Has the patient ever had periodontal treatment? What was it and what happened after that?
- When was the cleaning before the last one? I am wanting to know what the interval has been for patients in dental offices and having routine cleanings. Ultimately I want to know the patient’s entire history with dentists and dentistry at least back to childhood or when the care was provided by their parents. Even then, I want to know if they thought it was good care.
-Is the patient afraid of dentists and dentistry?
-Is the patient happy with her smile?
- When was the patient’s last medical physical examination?
- How does the patient feel about his overall health?
- How long has the patient lived here and is she planning to stay a while?
- If I could do anything for this patient and money was not an issue, what would this be?
- What is this patient most afraid of happening to themselves or their teeth in the future?

Keep in mind, it is not possible to create a complete list of questions that need answers because some answers by the patient should stimulate more questions. Also it isn’t necessary to ask every question listed above. If they don’t give me certain answers then there are no problems in that particular area. Remember, once you have established a conversational rapport with the patient, should a question need an answer going forward, you simply ask. After all, that’s how friends behave.

Does the dentist have to be as transparent as the patient in this conversation?

No, because this conversation is about the patient and why he or she made the appointment.

Does this lack of disclosure on the dentist’s part inhibit the patient’s trust?

It might if there are no ways for the patient to learn about the dentist. This is why the office needs a good website that includes a well written dentist bio. Also, the office team is responsible for answering questions about the dentist to patients. So dentist, make sure your team knows about you well enough to give patients a few important details. For example, do your employees know where you went to dental school and when you graduated?

One other website tip — rather than pictures of people who are obviously models, have nice pictures of the office personnel including the doctor. As patients get to know you better through the website, it takes less time in the office talking about who everybody is, and this translates into more time available to listen and get to know the patients.

Where is the dental assistant during the patient interview?

The dental assistant is listening and might be taking notes as well to pass to the front office. Everyone in the office needs to understand who this patient is and what he needs. Dental assistants work to know this along with the dentist. Also, the dental assistant’s primary responsibility in my office is what I call “Patient Support.”

Dental Assistant Duties

(Consider this bonus material)

This is as good a time as any to give you my dental assistant job description, and I will put it in the order of most important to least important.

Broadly speaking the assistant has three areas of responsibility. Keep in mind that these are areas where the assistant must accomplish tasks with little to no direct supervision. If I cannot trust the assistant to perform these three functions then this assistant cannot work for me.

1. Patient Support.

The dental assistant is the friend to the patient who is there for them in a potentially scary environment – the treatment-side of the office. The assistant will greet the patient in the waiting room and escort her back to the dental treatment room. While doing this, the assistant is friendly and conversational in order to assess the patient’s mood. If the patient is worried, the assistant is supportive and gently encouraging. Nobody likes to hear that everything will be OK as a brush-off dismissal of their real feelings and concerns. What they want to know is that they are heard, understood and will not be left to handle this on their own. My rule is that an assistant stays with patients in dental treatment rooms keeping them company until the dentist arrives. The only exceptions to this are when they inform the patient that they need to do something quickly and obtain the patient’s permission first. Then they make sure that their departure is brief and that the patient has something to occupy the time in the interim.

One of the most powerful behaviors in treatment I require from my dental assistant is to touch and lightly rub the patient’s shoulder during a dental injection. It is distracting the patient’s attention away from their mouths and also assuring them that someone is here with them. They are not alone.

As the dentist I am automatically a threat to the patient. I can inflict pain. Therefore, it may never be that patients are completely comfortable in my presence and why the dental assistant’s primary job is to be that patient’s advocate in care. It is healthy for the patient to hear the dental assistant speak up on their behalf telling the dentist what the patient has just shared with them about their pain or problems. Also the assistant is able to help explain any questions the patient has after the conversation with the dentist. I think I am very clear in my explanations, but it doesn’t matter what I think. Fear affects listening. The office environment must be one where patient’s questions are always taken seriously. So when the dentist leaves, a good question the assistant can ask the patient is, “Did you understand everything Dr. Young said? Would you like me to go over anything with you?” Sometimes it is smart just to call me back in and explain in front of the patient, what the question is once again. The patient learns by this that the assistant has clout with me and therefore is a good person to have in the room if you are a patient.

One last, but important point, about dental assistants and patient support. Dental assistants do not talk about patients away from the office.

2. Office Safety

The dental assistant is in charge of infection control. This individual stands between some very nasty bacteria and viruses and the other human beings in the office. Most of this work is not directly supervised. For this reason dental assistants must be intelligent and of high moral character. Beyond infection control, general treatment room, hallway cleanliness and patient restrooms are in their area of responsibility. They must be up on CPR and know what to do in any and every emergency scenario.

3. Assist me

Unless the dentist assigns the duties as I have done here, most dental assistants will assume that assisting the dentist is their most important function. They believe that they are primarily judged by the dentist for their ability to assist during procedures. I am all for dental assistants making me happy, but they can only really do this by making patients happy and making sure that none of us in the office are getting sick due to failures in infection control. And when there come moments when the patient needs the assistant, or infection control requires something that takes the assistant away, I will get along by myself if necessary. Later, of course we can look back and discuss how to improve our systems so this happens as infrequently as possible, but I want my assistants to know that I trust them and understand that their primary duties will sometimes inconvenience me — and that I’m actually good with this.

Next time we will get into the periodontal therapy story I call A Tooth Has Four Parts.

Posted in Dental Hygienists, Dental Schools, Dental Students, Dentists, Patient Education, Periodontal Therapy, The Human Side of Dentistry | 2 Comments »