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Hygiene Department Visit: Getting the Best Results Benjamin Lund, Editor, Hygienetown Magazine

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by Benjamin Lund, Editor - Hygienetown Magazine

Welcome to the third installment of Hygiene Department Visit, where we visit Townies in their practices and profile their equipment, procedures and hygiene philosophies. If you would like to participate or nominate a colleague, please e-mail ben@hygienetown.com.

This month, we visited Sarah A. Cottingham, RDH, in the Mesa, Arizona, practice where she works. Sarah, who is also the director of hygiene leadership for BCS Management, discusses patient education, her practice philosophy of treating periodontal disease, and how she helps hygiene departments in other offices become the best they can be.
Name: Sarah A. Cottingham, RDH

Graduate from: Northern Arizona University

Year graduated: 1991

Dentist/Employer: Christopher Martin Farnsworth, DMD

Practice Location: Mesa, Arizona

Number of hygiene ops: Two hygiene, two doctor
Back row, from left: Sheba, RDH; Veronica, front office; Barbara,
front office; Dr. Farnsworth; and Sue, back office. Front row, from
left:Cathy, RDH; Lesa, front office; Cristin, back office; and Sarah.

Hygiene Highlights

Equipment
Click Here to view Sarah's Top 5
• Brasseler BSK Varios 350
• Brasseler NSK Series slow-speed handpiece
• Dentrix office software and probing module
• RGP operator chair with two arms
 • Sheer Vision TTL Loupes & headlight
• Spectrum International Prometey Diode Laser
• Titan SW scaler with swivel
• Vista Piezo Scaler

Instruments
• 11/12 explorer
• Brasseler instruments
• Double sided #5 mouth mirror
• G. Hartzell & Son instruments
 • Hu-Friedy instruments and files
• Hu-Friedy Sidekick Sharpener
• UNC15/23 probe-explorer

Supplies
• ALL solutions 2% neutral sodium fluoride
  rinse — DENTSPLY
• Cetacaine topical anesthetic liquid
• Colgate Periogard
• Dermatec+Plus powder-free latex exam gloves
• Duropro disposable prophy angle tapered brush
• Henry Schein Acclean Foam fluoride in trays, high
  volume suction, saliva ejector, 1/8-inch surgical
  aspirator and 2x2 non-woven sponges
 • Henry Schein Benzo-Jel topical anesthetic gel
• Henry Schein ear loop procedure masks
• Kendall Monojet 27 gauge long and 30 gauge
  short needles
• Omni Vanish 5% Sodium Fluoride White Varnish
• Premier Enamel Pro ACP formula prophy paste
• Septodont-Septocaine 4% with epinephrine 1:100,000
• Young Contra ELITE disposable prophy angle

Oral Hygiene Products
• Colgate Prevident 5000
• Colgate Wave soft compact head toothbrush
• GUM Eez-Thru Floss Threaders
• GUM End Tuft Brushes
• GUM sulcular brushes
• Johnson & Johnson Reach gentle gum care
  fluoride woven floss
 • Oral-B interdental brush system-tapered
  and cylindrical
• Oral-B Super Floss
• Prospec MI Paste
• Sonicare toothbrush
• Tip-A-Dent denticator interdental cleaner
• Young 2Tone disclosing solution

Photography Equipment
• Gendex EZ1 intraoral camera
 • Spandex Lip Retractor, Hager worldwide

Why did you choose hygiene as a career?
My mom and dad had been in dentistry for years (mom was an assistant and dad sold dental equipment for Patterson Dental). My mom was after me for years about becoming a hygienist, but I had plans to become a trauma nurse. After a couple of years in school I decided that nursing was not for me so I moved back home. Eventually the dentist who my mom worked for (Dale Ring, DDS) hired me as an assistant for his hygienist, Betsy Price. The first time I assisted on an aggressive periodontal case, I was hooked! From that moment I had a vision of becoming a forward-thinking, perio-focused hygienist - just like my mentors Betsy Price and Diane Brucato-Thomas. After completing hygiene school I returned to that office and practiced for several years; that is where I got my roots, beliefs about teamwork and the philosophy that all patients deserve the best!

What appealed to you about the current practice in which you work?
To balance clinical work and consulting, I worked through a temporary agency and had the opportunity to work with Dr. Martin Farnsworth in Mesa, Arizona. At the end of my first day, Dr. Farnsworth asked me about my coaching program and from that point we stayed in communication about what the needs were for his practice and how I might be able to work into the practice. I started working at the office one to two days per week and now we have built the department up to eight days of hygiene per week. Dr. Farnsworth is extremely forward thinking when it comes to general dentistry and he values my opinion regarding our patients' periodontal needs. He has been very generous, allowing me to design my clinical hygiene schedule so it would compliment my coaching schedule. I knew I had a place to call home and a place where I could have a definitive impact on patients. I have also loved the temporary and longer assignments that I have had over the last several years; it is from those experiences that I have grown the most as a clinical hygienist.

Sarah's regular tray set up.
Sarah's additional tray for periodontal cases.

How has Hygienetown impacted the way you practice dental hygiene?
Hygienetown has impacted my belief in myself. After getting feedback from hygienists on Hygienetown I realize that my opinion is valuable and respected. I have always said that I had a passion for contribution and many years ago I thought that meant "one patient at a time." I have come to realize that was not big enough for me, I now know that I can work with hygienists and teams to assist them on a journey of how to help their patients accept the treatment that will lead to optimal oral heath; thereby contributing exponentially to the profession and the patients!

What is your experience with lasers?
Using lasers has added an even more profound understanding of what an amazing thing the human body is and how, with the right assistance, it can heal itself. I have personally had many cases where patients were told that the prognosis was hopeless and they chose to try anything to not lose any teeth; and they have responded and are now maintaining stability.

When did you start using the Perioscope, and what has been your experience in using it?
I had the pleasure of utilizing the Perioscope when I worked with a forward-thinking periodontist in Phoenix, Arizona - Dr. Orest Komarnyckyj. With the assistance of this valuable tool I honed my clinical skills as a hygienist. With this impressive equipment I was able to see what I was scaling and the results - magnified! I have again been blessed with having access to a Perioscope that I intend to utilize to train hygienists on definitive scaling techniques where they can see the results - not just guess.

What is your periodontal therapy philosophy?
My philosophy is that all patients deserve to have optimal oral health! Many individuals do not understand what that is, and it is my job to educate them and educate other hygienists on being able to have all patients understand what optimal oral health is. I treat disease; when they present with 4 and 5mm pockets I will always begin with the initial phase of therapy (SRP). For the extremely difficult cases I will begin initial therapy as well, and educate them regarding the possible referral to a periodontist for additional treatment if necessary. During SPT appointments I always probe at every visit and we celebrate success and take corrective action for any areas that need additional support.

What is your typical day of appointments?
The perfect day for me is one that starts early and ends early. I am at my best in the morning and I believe that my patients deserve the best. I start at 7 a.m. and work until 4 p.m. During that time I template out two SRP patients, four re-care patients (D4910 or D1110) and one re-evaluation (D4999), typically I see seven patients a day. There are days that I have templated that I will see two new patients (comprehensive perio exam D0180 and FMX), two SRP patients, one re-evaluation and one re-care.

How do you explain your treatment to patients?
From the beginning I involve the patient in the diagnosing of the case; I educate about probing and why I am doing it and what the numbers mean. Once I am complete, I sit them up and ask them what they thought about the numbers they heard. Then the patient is involved in the discussion, I am not "telling" them what they have going on - we are going through a process of co-discovery. Prior to the probing, naturally I have completed a very detailed medical history review and have elicited information about family members, systemic issues and periodontal history. With all of the information (including X-rays) we will sit together and discuss the "disease" that is present and the permanent destruction of bone that has occurred, which will continue to occur until we take steps to treat the infection. During the conversation I am always utilizing the information that they have already given me regarding their current health status and how it relates to the periodontal condition. Then I offer them hope when I present information about the treatment that will be appropriate for them and how it will benefit them. From there we review the treatment, the cost and schedule all of the appointments.

What is the most unique case you've worked on? How did it turn out?
Very early in my career I worked on a gentleman who had several teeth treatment planned for extractions. I evaluated the teeth that were to be extracted and thought that I could help him save them. After consulting the doctor he indicated that I should work on them. He said, "What could it hurt, they are going to be extracted anyway." The challenge was there; I could show him we could save these teeth! The patient did not have to have any of his teeth extracted and the doctor was able to build an even better partial for the teeth that were already missing because he had more to anchor on to. The patient was extremely happy and the doctor was amazed at the results!

You're currently the director of hygiene leadership at BCS Management. Can you explain a little bit about how you got involved with BCS and what your duties are in that role?
I knew the positive reputation of BCS management from several offices where I had temped. I personally worked in two offices that were utilizing the services of BCS and the doctors and teams were excited about the coaching and results. BCS recognized that I had taken the management philosophy and applied it clinically and was able to get unprecedented results. When they were looking for someone to develop the hygiene leadership portion of their program, it was a perfect marriage. Their motto of "bottom line, we get results" and my hygiene philosophy that the health of the patient comes first and the money will follow, compliment one another. With the hygiene leadership program, I assist dental practices by enhancing their current hygiene departments by showing teams how to enroll patients into optimal oral wellness, having the department become a pivotal part of office production and ensuring hygienists are rewarded for their efforts. It is about being great time economists, monitoring results and maximizing human potential to have a hygiene department that exceeds all expectations. You can get additional information about BCS Hygiene Leadership at www.bcsmanagement.com.
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