Impact Your Patients’ Quality of Life––And Yours By: Trisha O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

You can tell when it happens. They walk in with more confidence. They seem to stand taller, smile more and of course, give you compliments. I’m talking about your patients. Maybe not all of them yet, but the number is growing. These are the people whose quality of life you’ve impacted.

You think it’s about dental hygiene, perio, plaque, calculus, brushing and flossing, but it’s not. It’s not about bleeding gums and periodontal disease. It’s about making a difference in someone’s life. Good oral health allows people to eat, smile, talk and feel confident about themselves and live a life free from oral pain. Your dual role as the preventive specialist/periodontal therapist in the office plays an essential part in changing the quality of your patients’ lives. Remind yourself of that daily.

You know you’ve made a difference by the comments you hear from your patients. You can measure the plaque scores, bleeding points, and pocket depths, but it’s what your patients say to you that lets you know you’ve made a difference beyond plaque and gingivitis. I’ve asked a few hygienists to tell me about their recent successes and how their dental hygiene skills have made a difference in someone’s life.

I asked Cori Gwilliam if a particular patient came to mind whose quality of live was changed by her education and treatment. She didn’t hesitate. “Yes,” she said. “Ralph*.”

“Ralph has been a patient in our office for several years, Cori continued. “He’s undergone perio surgery before, and has lots of exposed roots with 4-5 mm pockets in the interproximals and two remaining deep furcation areas on the maxillary first molars. I dreaded seeing him because I never seemed to have enough time to get the plaque and calculus deposits off. The furcation areas were the worst as they were always infected, so I definitely wasn’t effective at cleaning out the plaque and Ralph wasn’t either. Every time I saw his name on the schedule, I dreaded the appointment. Finally, I convinced him he needed to go back to the periodontist for treatment of the furcation areas. Thinking I was off the hook, I breathed a sigh of relief––it didn’t last long.

“The periodontist sent Ralph back with a letter saying there wasn’t much he could do and I should just keep the furcation areas as clean as I could. Darn! That’s not the answer I wanted.

“Not knowing what else to do, I told Ralph to use a Waterpik to clean the furcation areas, as well as all the subgingival and interdental spaces. He agreed and the results were nothing short of amazing, to both of us.

“After just three months, the heavy bleeding and plaque were gone. The tissue was healthier and the pocket depths had reduced significantly. The furcation areas were still a problem, but nothing like before. Ralph was so excited he told me about how the water felt as it pulsed between his teeth. He just knew it was working. He also reported that his bad breath problem was much better, which pleased his wife who had been after him to ‘do something’ about it!

“I no longer dread seeing Ralph’s name on the schedule and he thinks I walk on water,” she concluded.

Cori’s work with Ralph improved the quality of his life, made his wife happy and resulted in making Cori’s work and therefore her life better as well. Turning a frustrating and discouraging situation into a rewarding experience for both patient and hygienist is what it’s all about. The rewards of dental hygiene come from working with a difficult clinical situation to achieve the goal of oral health for patients. The challenge is what makes it fun and motivates us.

I don’t know about you, but my “failures” come to mind quicker than my successes. Our successes are often over shadowed by a single case that seems to defy all attempts at treatment. Hygienists are often hard on themselves, focusing on the “failures” and not celebrating the successes as often. Success stories are part of what you do everyday and can be easily taken for granted and expected. Remember them and even write down the details. On a particular challenging day these memories will serve to bolster your confidence and remind you of your impact on people’s lives.

Everyday successes come from just doing your “job” according to Amy Beth Cody. When I asked Amy for a success story she told me about a man she treated recently who needed periodontal therapy. The periodontal exam revealed 62 bleeding points, 48 4-5 mm pockets, and two 6 mm pockets. Amy wasn’t surprised when he reported brushing once daily and flossing irregularly. Amy went to work with detailed explanations of plaque biofilm, periodontal disease and personalized oral hygiene instructions. She saw him for several scaling and root planing visits and was anxious to see how he did at his six-week evaluation. She was definitely surprised and pleased with the results. The 50 pockets he stared with were now just five 4 mm pockets and only two bleeding points.

When Amy inquired about his homecare he told her she was the first hygienist to really explain exactly what was going on in his mouth and what needed to be done to restore health. Understanding the healthy mouth healthy body concept changed his values and his commitment to oral health. He followed Amy’s recommendation and bought a Sonicare toothbrush and also began flossing every night. The best part Amy tells me, is how all this affected his wife. She had been nagging him to take better care of his teeth for quite some time and was thrilled with the results. Amy really felt as though she made a difference in this patient’s life. As Amy puts it, “I was just doing my job with enthusiasm and passion.” The results improved his periodontal health and also the quality of his life. No more nagging at home!

When I asked Cynthia Chillock to recall a patient experience that changed the quality of someone’s live she didn’t hesitate at all. Here’s her recollection:

“I will never forget this particular day when Anita arrived for her hygiene visit in tears. Anita was an attractive, high-energy woman in her mid 30s who’s been coming to me for cleanings every three months for 10 years. Due to several medical problems, Anita works hard to maintain a healthy lifestyle by eating a healthy diet and exercising regularly. Her positive attitude and the sparkle in her eyes always brought joy to the dental office. Only on this day, she was red-eyed and almost sobbing.

“Her husband of 13 years had just told her the passion was gone from her kisses, their life, and he was not sure if he could go on in this relationship. He said it seemed her kisses had become perfunctory in the last year and that she acted more like his sister.

“After lots of discussion, and by the way no “cleaning” that day, just listening; I discovered that about one year earlier she began taking a new medication that made her dry mouth increasingly worse. She said she could hardly swallow her food and had lost interest in eating. As a result she had lost weight, had no energy and also her home care was slipping. I spoke with her about the important role of saliva and gave her several Biotene saliva-substitute products to take home. She left that day still very sad and weepy, but with at least some hope that she could once again enjoy eating food, gain some strength and clean her teeth as she always had in the past. I saw her a week later to actually complete her hygiene visit and see how the saliva substitute products were working. Her home care already looked better and she reported being able to eat and swallow with no problems. She was feeling much better than she had the week before.

“I saw her three months later and believe me, it was a remarkable change. She was smiling from ear to ear and had the sparkle back in her eye. She could hardly wait to tell me that she and her husband had just returned from a second honeymoon in Hawaii. She thanked me for saving her marriage. Now, I don’t think I can really take credit for that, but it seems the instructions I gave her plus the dry mouth products helped more than her oral hygiene. They allowed her to eat more comfortably, gain the weight she’d lost which gave her the strength to resume her workout routine and begin to feel better about her body image. As it turns out, her dry mouth was so severe that she was not enjoying passionate kisses with her husband. Dealing with her immediate oral health problem, not just plaque and calculus, definitely made a change in the quality of her life.”

Cindy recalled another very challenging case treating a family member. This case wasn’t an overnight success, but with persistence and experimentation, it was a success in the end.

Sometimes treating family members is such a challenge that the thought of referral quite often comes to mind. Brothers and sisters don’t readily take to the idea that you are now an expert and your instructions should be listened to and followed carefully. Cindy definitely considered referring her older sister, Phyllis, but never quite managed to do it!

It all began when Cindy was a dental hygiene student at the University of Pittsburg in the early 1970s and began treating Phyllis. Phyllis hated to come in back then as she claimed Cindy hurt her and it was Cindy’s fault Phyllis’ gums bled. Phyllis swore up and down she was doing everything Cindy asked her to do, but Phyllis still had puffy, bleeding gums every time she came in.

For many years, Phyllis was married to a lab technician who arranged trade-outs for whatever dentistry she needed. Her care was piecemeal dentistry from many different dentists. Despite being the wife of a lab tech, her crowns were often over contoured, making cleaning difficult. Add to that her many allergies, including an allergy to non-precious metals, and we had a recipe for a dental disaster.

Over the years, Cindy instructed her sister on proper oral hygiene many times and in every way she could imagine. She had Phyllis try every new toothbrush, toothpaste, and mouthrinse that came along. She claimed she flossed every day but her technique did not result in tissue health, so Cindy tried various interdental brushes, sticks and picks. Several years ago she provided Phyllis a Sonicare toothbrush and provided her with an endless supply of toothpaste and mouthrinse. Still no change! Phyllis still hated to come in every three months and her gums always looked puffy and bled profusely despite periodontal surgery and replacement of many of the crowns.

Cindy was extremely frustrated and wanted to find out if the plaque Phyllis was unable to remove was enough to cause all the problems or it if was something else. To answer this question, Cindy decided to implement the two-week interval test, in doing so, they could find out once and for all if impeccable plaque control would make a difference and allow Phyllis’ gum tissues to heal.

Cindy saw her sister every two weeks for polishing and flossing and after three months Phyllis had no pocketing and only 10 bleeding points––not the gushing bleeding points she had before, but very light bleeding points. It was clear that thorough plaque control did make a difference for Phyllis, but it was also apparent she didn’t have the tools or dexterity to remove plaque from her heavily restored teeth. Cindy needed something that would reach every subgingival and interproximal area, and based on research she’d read she decided to try oral irrigation. She gave Phyllis the ShowerFloss oral irrigator and insisted Phyllis use it daily. The results were amazing to both of them. With daily oral irrigation Phyllis no longer needed two-week visits and never had more than a few slight bleeding points at her three-month hygiene visits.

Phyllis worked hard to get a good report card and she finally did with her sister’s help. Her difficulty adapting oral hygiene aids to over contoured teeth and difficult to reach areas was overcome with oral irrigation. She reported she could actually feel it working and reaching between her teeth. Her gingival tissues healed and are actually stippled again.

Her comment at the first hygiene visit to Cindy after using the ShowerFloss was, “Oh my gosh! Is this what it’s supposed to feel like when you get you teeth cleaned? All these years I hated coming in to see you. This is the first time it hasn’t hurt! What a huge difference!”

The quality of Phyllis’ life was definitely changed. Her hygiene visits are more comfortable, with practically no bleeding and her attitude has changed 180 degrees when it comes to taking care of her mouth.

That was 10 years ago and Phyllis has maintained periodontal health since then. I’m not sure who is happier with the results, Cindy or Phyllis. The quality of Phyllis’ life has changed, but so has Cindy’s. My guess is, Cindy is even more thrilled with achieving periodontal health for her sister.

Tell me one of your success stories. Log on to www.hygienetown.com and visit the “Main Menu.” Click on “Venting” and look for the “Bragging” message board in that section. Several hygienists have already posted great examples of improved quality of life for their patients following dental hygiene care. I enjoy reading these success stories and I’m anxious to read yours. I’ll be looking for you on Hygienetown!

*The patient’s name has been changed to protect the patient’s identity.
Trisha O’Hehir is a member of Sonicare’s Industry Leader Advisory Board.