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Frustrated and Don’t Know Where to Start

I recently started a mostly (3-4 days a week) full-time position with an office. I’m a little concerned with starting out on the wrong foot concerning patient care and what I was taught in school and feeling like crap at the end of the day. When I accepted this position I was thrilled to have found my dream job so soon. The dentists main focus is patient education about periodontal disease. There were many promises about opportunities and room for growth.

Here is the downside:

1. My office does FMD and adult prophys with 3-4 mos re-evals on new patients really needing SRP. The way my office does it, is upon comprehensive eval, if there are 4+ mm pockets in either quad both facially and lingually, the recommendation is SRP. Which is fine. But all of these patients get FMD or an adult prophy (whichever insurance with cover) before that SRP. In school I was taught that FMD can cause the pockets and tissue to heal basically trapping bacteria and toxins increasing the opportunity for abscess.

2. The hygienists see one patient per hour which is fine, but if I have a patient with little to no build-up, extremely good homecare, their cleaning is not going to take a full hour if all I am doing is an adult prophy and exam. The office manager has said I am getting done too quickly (45 minutes) and need to spend the entire hour cleaning. My thought process is do the cleaning and OHI, exam, then schedule the patient leaving 5 minutes for notes so I can start my next patient at their scheduled appointment time. Is this wrong? Right now, I have the front desk bringing my patients back to be seated sometimes 10-15 minutes before their appointment time while I’m still with another patient. It leaves no time in between to write up chart notes let alone a bathroom break.

3. Our office does laser therapy after SRP. Because I am not yet trained on this, I don’t get to do SRP unless a patient opts out of laser treatment. It’s frustrating because I feel like my tactile sensitivity is going to disappear. I’m not exactly sure where I’m supposed to have this growth if I’m not able to see challenging cases.

I want to give it some time. I really do, but, I just see all of these signs and flags telling me I should already start looking for something else. I’m supposed to be the main hygienist and yet I don’t quite feel that way yet.

Any suggestions or words or encouragement?



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2 Answers

First, congratulations on finding a job! To address your concerns: I completely agree with what you were taught in school regarding FMD before SRP. FMD should only be done if the doctor cannot do a proper exam due to debris, plaque, calculus, etc. for the exact reason you stated (perio abscess risk). The patient should be treated as an individual based on need, not treated in accordance to what the insurance pays for. My suggestion would be to sit down with your doctor and express your concern about this risk. I would search online and print articles, studies, and even bring in your hygiene school books to back you up. When you explain, make sure your concern is for the patients and not just that the office protocol is wrong.
 
Concern 2: Again, I agree with you in that if the patient has great homecare and you finish in 45 minutes, then so be it. It’s not like you are finishing in 15 or 20 minutes. You absolutely need time for notes, turning your operatory over, etc. Personally, I’d rather run early than late because running late makes me a stressed out mess and the patients notice this. Further, the office manager should not be dictating patient treatment on any level (unless he/she is a licensed dental professional). Like your first concern, it may be something that needs to be addressed with the doctor. If the office manager doesn’t dictate time for treatment for the doctor, then they shouldn’t be doing it for you either.
 
Concern 3: I don’t think your tactile sensitivity will disappear due to not doing all SRPs, you are still scaling patients everyday right!? Are you scheduled for training on the laser yet? My suggestion would to be get on that right away.
 
Like you mentioned, I would give it time. Try to have a conversation with the doctor about your concerns and see if things change or at least get a bit better. If they don’t, and you continue to feel like crap at the end of each working day, then it may be time to make a decision. I feel I must mention that even perfect offices have a few downfalls; you just have to decide if these downfalls outweigh the good. I wish the best of luck to you!

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Once again Kara, thank you!

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