About Me: Hi, I'm Kara and I'm the founder of Dental Hygiene Answers! I started this site to expand the dental hygiene community beyond my Facebook page, Dental Hygiene with Kara RDH. I get many questions on a daily basis through my FB page, so I thought I would create a space where I can share my answers, as well as give other hygienists the opportunity to answer questions from their peers. I am always looking for ways to improve this site, so if you have any suggestions feel free to contact me on my FB page!
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Location: Portland, Oregon
Clinic can be nerve racking at first! As time passes, as you get experience under your belt and start to feel more comfortable, the shakiness may fade. Don’t forget about the almighty fulcrum! Proper fulcruming really steadies your hand. After a few months, if the shaking doesn’t get better, it may be time to visit your primary care physician, or who ever prescribed your anxiety meds. Assessing how well your meds are working, talking about stress reducing practices, and the fact that you are in hygiene school and shaky hands are an issue, might be in order. They may have some good advice for quieting your mind, which will quiet your hands.
To be honest, I was a bucket of anxiety when starting clinic and my hands shook too. Heck, I’m a bucket of anxiety in general! However, like I mentioned above, as I got more comfortable it got better. I also figured out that I couldn’t have any more than one cup of coffee before clinic to prevent the shakes. I also told myself that everyone was learning so there was no reason to be nervous and the patients knew that too. Easier said than done, but mind over matter is a powerful thing!
Please don’t quit the program before giving it some time, and if needed, speaking to your doctor. Deep breathes, you got this!
Question: Shakey Hands | March 29, 2017
I would explain to the patient that by law you have to bill for what is done based on the state of the patient’s oral health. A prophy is a preventive procedure, where perio maint. is to maintain health after periodontal disease. With previous periodontal disease, you just cannot treat them as if they never had it. You must treat the patient, not treat them according to insurance coverage. If the insurance wants to downgrade perio maint. to a prophy, that’s up to them, but for you to do it, it is fraud. Does the patient want to commit fraud or have you commit fraud? I would suggest to the patient that if they have questions on why their insurance covers (or doesn’t cover) certain treatment, they should contact them directly, as you have no control over that. Insurance is such a pain!
Question: Patient's insurance covers 4 prophies per year for perio instead of periodontal maintenance visits? | March 24, 2017
I would really look into the new medicine this patient is taking and see if it poses a bleeding risk or xerostomia risk. I say this because if nothing has changed with her homecare, you have to look at the factors (lifestyle, meds, homecare products, etc.) that have changed. Not that we treatment plan according to insurance, but with pockets of only 2-3mm, I doubt insurance would even cover the treatment of SRPs. Maybe they would take into account of CAL, but I’m not sure. I guess my question is, is this patient’s gingiva inflamed or does she have active bone loss (lamina dura present?)? Of course all of this is hard to say without seeing the patient myself, but from the sounds of it, my thoughts are more aligned with the other hygienist.
Question: Conflict Srp | March 24, 2017
There are many career paths you take as a dental hygienist besides working clinically in an office. Here is a link to a good list:
Clinically, you can work in a general practice, in a pedo (kids) office, in public health, in a perio office, as just a few examples. What each person likes is different for each hygienist. Generally speaking, many hygienists enjoy the interaction and relationships with their patients, no matter what kind of office they work in.
Question: Future Dental Hygienist | March 21, 2017
Plastic instruments can leave residue on implants which can lead to peri-implantitis. Some periodontists and others state stainless steel instruments are fine to use. However, they are harder than the implant itself and can scratch. A scratch to bacteria is like the Grand Canyon to a human. Meaning you are adding surface area for bacteria to colonize. Why take the risk? Patients pay a lot for implants and I personally wouldn’t want to damage the surface. Titanium instruments are widely recommended for use on implants. You want to make sure the titanium instruments you use have a Rockwell hardness scale less than the implant itself as to not scratch the implant. I am not aware of an article that states scratches are better than calculus. Again, I see calculus or scratches as excess area for bacteria to colonize. If your doctor shares the article with you, I’d love to read it, see the source and the research behind the suggestion.
Question: Stainless steel instruments for implants? | March 16, 2017
At a previous office I worked at that accepted state insurance, I saw any where from 1-4 SRP patients per day. At another office that was extremely established, I maybe saw 1-2 SRP patients per month. It really depends on the particular office, from my experience.
Question: Number of SRP | March 16, 2017
Wow, unbelievable! First, who is the person who is in charge of patient’s insurance and doing the insurance breakdown? If it’s not you, then YOU should not be “punished” for THEIR (big) mistake. Coverage should be checked before the patient even sits in the chair! So in my opinion, doing any work (especially SRPs!) you should be compensated and no it’s not fair that you aren’t. The Fair Labor Standards Act, which is Federal law, states that any work done on behalf of your employer must be compensated at or above minimum wage. Of course I believe you deserve more than minimum wage, but that’s just what the law says! So this almost makes me wonder if a Federal law is being broken here…
Regarding the no shows: I wonder why there are so many no shows. Do you have an office policy that patients sign stating that after so many no shows they will be released from the practice? Also, are these recall patients not showing up or new patients? If its recall patients, then something is going on there. Whether it be a patient care issue, front desk issues, whatever, finding out why this is happening, so it can be fixed, should be number one. I have heard of some offices making the hygienist clock out if there is a no show, however I think if you remain busy stocking, sharpening, even filing, I believe you should be paid for the same reasons I stated above.
If these things continue to be a problem, honestly, I would look for another office to work for. I know that’s hard, especially since you are only working part time right now and are probably looking for a full time job anyway. On the bright side, if and when the patient base grows in the practice getting paid on production can be extremely lucrative.
I hope I was able to help at least a little, and best of luck going forward!
Question: Should I still be getting paid if there is an insurance screwup and the office doesn't get paid? | March 16, 2014
Oil pulling is popping up all over the internet lately and I too am starting to have patients ask me about it. In fact, one patient of mine who has been oil pulling is now in need of SRPs as he presented with radiographic calculus, generalized 6mm pockets, mild bone loss, furcation involvement, and recession. I could barely get through perio charting as he was so tender due to infection. I don’t like not having a science-based answer when it comes to patient questions (even though clinically I had my answer) so I began my research into oil pulling.
Oil pulling is an ancient Ayurvedic remedy for oral health and detoxification. It involves the use of pure vegetable oils as agents for supposedly pulling harmful bacteria, fungus, and other organisms out of the mouth, teeth, gums, and even throat. As a hygienist, I’d like to focus on the oral health benefit claims as many people are oil pulling instead of brushing and flossing.
First, we need to look at dental plaque. For review: dental plaque is a bacterial biofilm that forms a physical barrier, a polysaccharide matrix, which protects bacteria from the effects of antibiotics, antiseptics (rinses), and your immune system. This is why taking an antibiotic for gum disease is not effective, as the antibiotic cannot break through the biofilm’s protective layer. The claim that oil can break this through this barrier has not been proven. The most effective and proven method to disrupt biofilm is through mechanical/physical means, in other words by brushing and flossing.
Next I’d like to comment on the claims of oil pulling “healing” gum disease. Simply rinsing with mouthwash, oil, or any other liquid only reaches 2 mm into a gingival sulcus. Most people have deeper pockets than this, especially when they have gingivitis or periodontitis. This is why rinsing, alone, is not the delivery of choice. Like mechanical removal of biofilm, this has been proven in scientific studies. So why would oil be able to miraculously get deeper into the pocket? Until I see a valid, reproducible, scientific study, again I must hold true to what has been proven thus far.
When you read these articles online I hope you notice who they are written by. Were they written by a dental hygienist or dentist? When studies are referenced validating the claims of oil pulling are you able to easily find these studies and fact check? I’ve noticed that the study results referenced in many articles were written in a way to make oil pulling look effective, but the actual results of the research were actually left out! For instance, saying oil pulling was effective after 4 weeks regarding plaque reduction, but leaving out the control group using chlorhexidine was effective at 2 weeks. Further, wouldn’t just swishing with water or any liquid for 20 minutes be just as “effective?” The studies do not delve into if it was the actual oil or the act of swishing that made it effective. Also, what about probing depths, bleeding indices, using a control group of just water or salt water, etc. So many questions unanswered!
Finally, brushing for two minutes twice per day along with flossing for a few minutes once per day, simply takes less time. I have a hard time motivating patients to brush for two minutes let alone swish with oil for 20 minutes! So if a patient chooses to oil pull, doing it in conjunction with brushing and flossing and not as a substitute, would be my recommendation as an oral healthcare professional whose job is prevention. A healthy mouth is a healthy body; so until I see scientific research that shows that oil can reach the bottom of a gingival pocket, can break through the barrier of biofilm, among other points of interest, I’m sticking with what is proven!
As hygienists, it is our duty to use science-based evidence so I urge you to do your own research and use your critical thinking in combination with what you know to be fact from your hygiene education to base your opinion on this fad.
Question: What are your thoughts on oil pulling? | March 22, 2014
In most cases, any pain or discomfort will get better without treatment. But if you have severe, ongoing pain, medication can help. These are examples of what your doctor or dentist may prescribe:
Over-the-counter pain relievers
Mouth rinses with anesthetic
Corticosteroids applied directly on the tongue
If you’re wondering about steps you can take to hasten the relief of symptoms, try limiting these substances or avoid them altogether:
Hot, spicy, or acidic foods or dried, salty nuts
Toothpaste with additives, whitening agents, or heavy flavoring (toothpaste for sensitive teeth is a better choice)
Question: Does anyone know how to soothe the burning of Geographic Tongue? | May 2, 2014
With time comes confidence. It sounds like you may be getting stressed out because of the limited time you have for SRPs. It also sounds like you are perceiving it as a need to question your technique, instead of the circumstances you are faced with. This may be presumptious, but is it time to move on from your current office? Top-notch patient care seems important to you and if you don’t feel like you have the proper time to accomplish this, it’s just not worth the stress. As far as taking BWX after SRPs, it’s not a must, unless as Sue Halverson stated, there’s a tenacious, questionable area. Just make sure you have an 11/12 explorer handy! That may not be the most popular answer, but I feel like you might be held back by working with an office that doesn’t share your same patient care standard. I want to applaud you for trying to be the best you can be! You are a professional, you got this!
Question: SRP | September 27, 2014
If an OSHA inspector saw this, your dentist would be fined. OSHA states to change masks between patients or during patient treatment if the mask becomes wet. A gown can be worn all day unless it becomes “visibly soiled.” It may help to print out OSHA guidelines to show the people who are in question.
Question: Using same mask all day | August 2, 2014
In my experience, I’ve not been given a lower pay rate for attending mandatory training or meetings – and I’ve worked for some very frugal doctors. I do agree with you that your time should be valued! My question would be, is every one in the office getting a lower rate of pay? If not, than that inflates the issue. It is my understanding that under the Fair Labor Standards Act, pay can be lowered but I believe you need to be informed and consent. I’m not an attorney, so that may be worth investigating. It’s hard to be a team player, if you are not valued as part of the team. This is a tough issue to address with the doctor, but it may be worth a chat him if only to express your feelings of being undervalued. I wish you the best of luck with this!
Question: Regular pay rate vs. education pay rate | February 5, 2016
Congratulations on passing the NBDHE exam! I would recommend reading through the ADEX Candidate Manuals as they can answer many of the questions you might have. Here are links to both:
Best of luck to you!
Question: International dentist in Florida after NBDHE | February 24, 2017