An In-Depth Look at Comfortable Patient Treatment
Next Level Hygiene: Team Materials
Connect and Be Receptive, So You Know Who You’re Treating
As we summed up in The Dental World, patients need to be seen and heard to feel comfortable and cared for, and to help you out with feedback and compliance.
You will also have a better touch with your instruments when you know who you are treating. So take time to connect.
When you speak to a patient, look into their eyes and watch their body language. Take in everything.
Ask them if they have any concerns. Be very sensitive to everything contained in their answer.
You can usually tell if someone is in a rush, or wants to talk, is nervous or anxious, excited or upset.
“How’s everything? Any concerns?” Remain very open and receptive. Feel the energy in the room as the patient sits down. Engage them again positively. “It’s nice to see you (again).”
Use the cues you catch to adjust your language and nonverbal signals, specifically your pace of speaking and the softness and musicality of your tone of voice.
If you’re picking up a possibility that they are an anxious patient, feel them out for specifics before you begin so you can be prepared. A question that helps for every patient is:
“Do you have any sensitive teeth, or any areas that are sensitive when we do a cleaning?”
This will also provide the patient with an opportunity to speak up about any of their unique issues, e.g., “Sometimes I have trouble not swallowing the water,” or “My jaw gets tired quickly.”
You can then validate their feelings, and assure them that you will do whatever they need to be comfortable, and that you want them to speak up whenever they wish. For an anxious or nervous patient, use a soft voice and gentle language, and try to listen to what they have to say before you begin.
Reassure them you understand what they are saying, and make it clear that you are interested in their feedback.
“Is it ok if I put the chair back?”
Ask if they are off for the day or in a rush so you can adjust your treatment accordingly. “Are you off work today?” Or “What time do you have to be out of here?” are two good questions, depending on prior conversation.
This helps them focus on the finite duration of the treatment, and reminds them that you care.
Don’t Treat A Stranger
Before you even put the dental chair back you should know what type of a patient you are treating.
Is this someone who will tell you their whole life story? Someone who wants to get it over with and prefers you don’t get into too much personal banter?
Start Strong, Start Gentle
“First I am going to check all of your teeth to make sure everything is healthy”
This is the time to be at your most gentle. Focus and purposefully project calm and confident awareness. Let them feel your peaceful and warmly protective energy. Making an effort at this stage is good because it allows you to get a sense of and overcome your own baseline mood and affect.
Notice if you are rushing, aggressive, overpowering, or, conversely, low-energy, not present, or noncommittal. Especially before and after meal times, your blood sugar can influence your affect to a noticeable degree. Compensate and correct.
Check your posture: relax and bring your shoulders down, take a deep breath. Relax, for yourself and for the patient.
Patients will feel your energy if you are tired from a busy day, if you’re running behind, upset from previous patient, or in a rush to get this patient done so you can go on your break or go home.
For their sake and yours, forget about all of that for the time being and focus on getting into your relaxed professional power zone.
Periodically imagine how you’re coming across from the patient’s perspective. Do you have a smile under the mask? How do you sound? For the most part, they can’t see you, so focus on what they hear and feel.
Beginning the Treatment
As you are evaluating all their teeth, walk them through it using a calm voice. Share neutral observations: “As I am looking at your teeth I am noticing some wear from clenching and grinding.”
As discussed under “All Is Well,” always avoid blaming language, bad news, and surprised language such as:
“oops,”
“oh boy,”
“wow there is a lot of grinding going on here,”
“that’s not good,”
and so on.
Permission and Preview of Perceptions
Anticipate what they are feeling sitting in the chair. Give them some notice. Tell them when you are ready to begin.
Ask for permission to use certain tools or techniques unobtrusively as you introduce them and the sounds and sensations they will produce.
“I will be using a water pick, if that’s okay with you. It sprays a lot of water and makes a lot of noise.”
Wait for their response, then let them know,
“I will start very slowly and give you lots of breaks. Please let me know if you want me to stop, or you need a break.”
Sometimes a patient’s “bravery” wears thin once the tools are out. This is good because it gives you an opportunity to see their true level of comfort.
Reassess their body language to see if they are comfortable or tense. Are their hands gripped on the arm rests? Are they pulling their head away from you? Are their eyes closed?
When you start scaling, talk during the procedure to let them know what is next and what you are actually doing.
“I will be starting on the lower front teeth, very slowly and gently. Let me know if there is any sensitivity. These teeth are usually the most sensitive areas for everybody, so I will take my time so you can get used to the noise, vibration and the water.”
At this point stop to use the suction to remove any water and saliva from both corners of the mouth and readjust the slow suction to be in the lower right corner with patient’s head tilted towards you slightly so no water accumulates at the back of the throat. This is an extremely uncomfortable sensation.
At this time, ask the patient if their are doing okay and are tolerating the Cavitron vibrations. Proceed if they are comfortable and continue. Then stop every 10-15 seconds or so to use the saliva ejector again in a similar fashion. Never let the water accumulate at the back of the throat to a point where patient feels overwhelmed.
Steady Does It
Use a steady and systematic scaling pattern transition smoothly from one quadrant to another. Let the patient know, e.g., “Now I will continue to clean around your lower left teeth,” “Now I will move to the right side,” and so on. Let them know ahead of time, especially if their eyes are closed.
If you talk during the entire time while you are scaling, using a pleasant, soothing tone of voice and carefully chosen language, it will take their mind off of feeling sensitivity and cold water, often completely. Your voice will be a calm and positive sound that they hear more clearly than the less pleasant “Dental World” sounds. Every time you stop to suction the water out, ask again if everything is ok.
Preparation
You can’t work steadily unless you’re prepared. Are you constantly reaching over for an instrument? Are you constantly readjusting the light? Are things in your way keeping you from continuous scaling? Are you opening the drawers because you are missing instruments?
Eliminate the need to adjust your chair or the overhead light. It is too disruptive. Once you start scaling, maintain a steady, effective scaling. A systematic approach creates a peaceful environment and a prompt, easily endured treatment. Settle on a set method of preparation and commit to it.
It will make your life much easier, and improve the quality of the care you give.
Maintain sharp instruments to reduce the amount of instrument strokes and discomfort.
Use universal instruments to minimize the need to reach over and change a scaler.
After scaling, always use you air syringe to dry the common “build-up areas” such as lower anterior and max posterior buccals to see if there is any calculus build up. Get permission and let the patient feel the air on their cheek first to anchor the sensation.
Final Bits
Lastly, use the explorer to check all interproximal areas using a very gentle touch. Remember, you are not scaling.
Be careful when you floss. Most patients have tight teeth. Cutting into their gums will not help them learn to love flossing.
Give patients a choice of polishing paste flavor. It will taste better if they choose.
Be gentle when polishing. Remember: speed, grit, and pressure can create heat and sensitivity. Let them know it can tickle.
Let the patient know that you will let them rinse at the sink. This avoids post-treatment cold-water shock from spraying for them, which can activate otherwise latent sensitivity and shift their feelings toward the entire cleaning at this last step.