For patients who resist, offer disclosing as a motivation
Normally, I practice clinically two days a week. During
the summer months, though, my teaching work goes
away, and, in an effort for my wallet not to do the
same, I schedule extra clinical dental hygiene days.
When I have difficult patients during the extended
clinical schedules, I find myself burning out and in
pursuit of positive solutions. Let me define what
constitutes a difficult patient. I don’t mind scaling
calculus, and I appreciate motivated patients. Work
can, in fact, be quite fun.
For me, a difficult patient is someone who consistently presents with a generous amount of white,
furry biofilm throughout the mouth or food particles
that I can actually identify. This person is also blessed
with good tissue resistance. When a patient is bleeding with other signs of inflammation, there is no issue
with presenting the clinical evidence and the importance of addressing it. Rather, I’m talking about the
ones who have no inflammation, whatsoever. Further,
they never get decay. Discussing preventive measures
seems to go in one ear and out the other. From their
perspective, they have never experienced a cavity,
nor do their gums bleed. Having an unclean mouth
does not appear to bother them. These patients are
my worst nightmare.
If I have too many patients like these on too many
clinical days, I become irritable, and, thankfully, it is
not my clinical norm. For inspiration in dealing with
such clients, I share with you some of the practice
philosophy of Mary Walker, RDH. Mary discloses
almost every patient that she sees in her general
practice. She shows them the results in a hand mirror
and dispenses a toothbrush.
Mary states that she then “sits with them, wets
the brush to address a small area for them so they
can see, feel, and fully experience the proper angle
and action for the brush.” She also coaches each
patient tirelessly on effective interproximal care.
On a recent visit to Colorado, I spent some time
interviewing her about her patient interactions. 1 She
told me that she never knows when she will see a
patient again, and it’s her present moment opportu-
nity to try to make a difference in their lives. Based
on patient feedback throughout the years, she believes
that she has truly achieved this.
I expressed to Mary that I would find such an
encounter embarrassing for the type of patient I am
referencing in today’s column. Shaming them, if you
will. Mind you, I
teach in a dental hygiene program, and
disclosing every patient is standard
for the students. Yet,
that seems different.
The academic institution is recognized
as a learning environment, and patients understand such protocol is
going to take place.
In addition, my employer has given me his point-
blank opinion on what he perceives as confronta-
tional. “Don’t use it on these particular patients, Ei-
leen! I’ve tried! People like these are not going to
change, and I am grateful that at the very least, they
are sitting in your chair being cleaned. They process
it as nagging, and do not want to hear it. Clean them
up, and schedule them again in six months, because
it’s unlikely you will get them back sooner!”
Nonetheless, after researching this more, I continue
to be impressed with hygienists such as Mary Walker.
Karen Davis wrote an article in RDH expressing that
perhaps the wonderful world of disclosing deserves
a second look. 2
Here is my peace. I believe that the use of disclosing
solution can be a valuable tool in creating awareness
and potentially changing patient’s behavior. As a dental
hygienist, how can I justify being a part of our profession, if not believing behavioral change is possible, and
that I can indeed be an agent for such change?
MS, is a practicing
clinician, speaker, and
writer. She is an adjunct
dental hygiene faculty
member at Rowan
College at Burlington
County. Eileen offers CE
forums to doctors,
hygienists, and their
teams. Reach her at
or 609-259-8008. Visit
her website at www.
does not appear
to bother them.
are my worst