There are some very important tasks that must get done in a routine dental hygiene appointment. Each of us has our check lists: medical history update, extra oral and intra oral examination, periodontal charting, scaling etc. There is a standard of care for each of these components. We have a limited amount of time to “get it done.” Patients deserve the best care. But in charging through our duties, how can we bring more humanity into these tasks? How can we inject some “total patient health” into the chairside discussion? Can we tweak some lifestyle habits? Can we inspire some behavioural change?
There is no doubt we live in an anonymous world where we feel the algorithm collecting data with every one of our online clicks. I know you desire to make your patients feel like individuals and not just your “2 o’clock.”
The patient environment is very important to me as with all of you. If the patient asks to keep their coats on, maybe it is too cold in the room. Our office is designed to allow patients to choose the latest movie on Netflix and their favourite genre of music video on YouTube to help them relax and feel at home. I love the natural light that streams through the windows in every operatory. Studies have shown that having a window in a medical setting supports well-being and quicker healing time.
Medical history update is standard. High blood pressure and cardiovascular disease is still the number one killer world-wide, taking 26,000 people every day. Regular blood pressure checks pick up undiagnosed high blood pressure. People come in for their teeth to get cleaned for their special occasion, but sometimes need to get reminded we are health care professionals playing a vital role in keeping them ALIVE. A new medication might affect their tissue response during our treatment (i.e. blood thinners like Eliquis and ASA). Thirty percent of all medicines have a side effect of dry mouth1. This affects digestion, speech, enamel erosion, oral hygiene, halitosis, chapped lips, caries risk, traumatic ulcers, etc. Saliva isn’t just for lubrication of the oral cavity; it contains antibodies like IgA for immune health to a natural painkiller. Did you know saliva has a substance called opiorphin that is six times more powerful than morphine2? This is where our expertise comes in. Individuals who suffer from xerostomia appreciate our recommendations: maintain hydration, consume more whole water rich fruits and vegetables, stay away from sticky carbohydrates and meticulous biofilm control.
Patient sleep habits are important. Neuroscientist Matthew Walker reports3 that poor sleep is commonplace in adults, and they have higher levels of chronic inflammation in their bodies, weaker immune systems and lower pain thresholds. All the more reason to ask about shift work and sleep habits because these individuals need more TLC and pain control during their hygiene appointments. Poor sleep has many causes: obesity (40 percent of adults), short or thick neck (16” circumference for women 17” for men), big tongue, big tonsils, inactivity, eating a large meal before bed, drinking alcohol before bed, electronics, bedroom too hot, bedroom not dark enough, caffeine intake, dogs on the bed. You can see how many factors influence sleep quality or quantity.
Stress ignites the fight or flight nervous system and puts long term healing on hold4 and supports chronic inflammation. You can see how if a patient was having major challenges at work, experiencing family drama or financial issues that this might eventually show up in their oral tissues-lichen planus, aphthous ulcers and herpes labialis, etc. Irrespective of their home care, their immune systems could be overburdened by the push and pull of their daily lives. Instead of introducing a new home care regimen to a patient that is already on point, ask about what’s going on in their life. I make gentle suggestions such as mindful breathing, exercise, meditation or a book suggestion (Breath © 2020 James Nestor).
Nutrition is something hygienists often think is outside our scope of practice. But most of us do at least 20 hours in our training which empowers us to do diet surveys and recommendations. Healthy eating can be overwhelming and confusing—here’s what I do. I keep things simple. I suggest increasing anti-inflammatory foods and decreasing inflammatory foods. What is good for the mouth is also good for the body5. And of course, letting them know this is a journey and falling off the wagon is part of the process.
Inspiration can be woven into every chairside conversation. We don’t have to be a Jillian Michaels or Tony Horton, but we can celebrate their small steps in their journey. I enjoy making notes in the digital chart about what hobbies, life goals or health goals my patients are working on. This allows me to make them feel valued and connected in their otherwise routine health care appointments.
Parting words don’t have to be chastising them for not coming in since the pandemic started or not flossing enough. Positive psychology shows most of us respond better to a forward lift than the negative chant of criticism.
References
- Physicians’ Desk Reference 64th edition Montvale, NJ, USA: PDR Network, LLC 2010
- Enders G., Gut Greystone Books; Revised Edition © 2018
- Walker M., Why We Sleep. © 2017 Scribner
- Mayer E., The Mind Gut Connection © 2016 Harper Wave
- Chapple Iain., “Potential mechanism underpinning the nutritional modulation of periodontal inflammation” Feb 2009 JADA
About the Author
Mahsa Bakhshandeh, RDH, graduated from Durham College and has been in private practice for 12 years. She enjoys traveling and exploring the world, its many cultures & their variety of wonderful cuisines.
