Sunday, March 13, 2016


For those of you who don't know, I'm a mom to 3 kids and a part-time hygienist. I love my job/career, but I love being a mom more and being home with my kids as much as possible. THAT being said, I filled in for the other hygienist I work with and worked more days then usual last week. Can we say PERIO MADNESS PURSUED!! 

Half of my patients this past week had ACTIVE periodontal disease. Guess how many accepted my proposed treatment of a deep dental cleaning (scaling root planning)? ZERO. NADA. ZIP. NO ONE! I was feeling seriously rejected...despite my thorough education for the patient and telling them why I felt a deep cleaning was necessary, they just wouldn't accept! Most of them didn't even seem concerned! So is this normal? Unfortunately...yes, this is very normal.

How do you deal with this rejection? As a hygienist  you KNOW the only way to get these patients back to health is by doing a deep scaling! However, begging & pleading do no good. All you can do is inform your patient of the risks involved with no treatment and let them know you're concerned about their oral health. I then write a thorough note in their chart about what was discussed & proposed and that the patient ultimately refused and signed the refusal form.

I always do a "regular" cleaning on the patients that refuse the deep cleaning and I never try to sneak anything past them by doing a "mini" SC/RP on one or two teeth and then billing out for it. Honesty is the best policy for ME. I want my patients to trust me and know that I have their best interest at heart. I try to gain this trust a little at a time and by revisiting their "diagnosis" at each subsequent visit. I'll remind them "HEY remember 6 months ago when we talked about perio?? Well you still have it! It didn't just heal up on its I informed you that it wouldn't". ;-)

That being said I'm reminded of a story from this past week...I had a patient come in that I hadn't seen in over a year. The last time she had come in I had informed her of her active perio and had recommended SC/RP. She refused and I went about the normal cleaning but informed her that this wouldn't correct itself.

Fast forward a year later, when I see her again I ask how she is! And she informed me she went to a different dental office for her last cleaning and that they told her she actually didn't have perio! I said "Oh yeah?? Well since it's been a year I was planning on doing a full mouth probe on you today and I would love to see how everything is going!"

I then proceed in doing the FMP and guess what? SHE STILL HAS PERIO! And it had gotten worse. She had generalized 5-6mm pockets (last year they were 4-5mm) and generalized BOP (bleeding on probing). Her mouth and gums were a mess! :-( I then had the joy of informing her that my diagnosis from a year ago still stood and that she did indeed still have active perio. I felt like I had been put into an awkward situation though and needed to handle it gently and not accusatory whatsoever.

After the FMP, I sat her up and went over my findings with her and how they compared to her last appointment with me. She seemed very confused and upset (not at me...just in general) and stated that at her last appointment with the new office she hadn't felt they had done a thorough job...but was hoping they had been correct. She had come back to our office because the other place was pushy about procedures she had felt were unnecessary, but perio wasn't one of them! THAT being said...she still refused treatment for the deep cleaning! AHH!

Moral of this post? #rejection hurts...even in the dental chair.


  1. Hi, I don't know if you'll read this or have the time to respond, but I thought you'd be the best person to come to for advice.
    I'm going into a dental hygiene program in August but I'm not under my parents' insurance anymore & I can't afford regular cleanings, so I'm basically left on my own to take care of my teeth & keep them as pristine as I can.
    I follow my routine very closely, I keep them as nice as I can but I know that they aren't as nice as they could be if I could afford to have them cleaned often.
    I'm extremely embarrassed, because in the first year of the dental hygiene program we'll be working on each other & everyone else is older than me or married, so naturally they've got the funds for regular cleanings. I'm so freaked out that I'll be judged by all my classmates because of my teeth. I mean, they're white & clean & I keep them as pristine as possible, but I'm worried that they'll be horrible compared to my classmates' teeth.
    Do you have any advice on what I might do? Thanks.

    1. Hi! Sorry for the delayed response but I do try to respond to every reader that comments on my blog.

      I know right now you not having had a cleaning seems like an extremely big deal but I am here to reassure you that it shouldn't be. EVERYBODY is going to have calculus to clean off. No one will be exempt from this UNLESS they have just gone to get a cleaning and in that case...they are just as self conscious as you and shouldn't be judging! The fun of learning on each other is to find tartar here and there. I am guessing you don't have as much as you think you do. If you are young (sounds like you are) and you didn't have issues in the past then you are probably fine. I wouldn't make an issue of it when you begin the program. Maybe make a joke, "HEY, can't wait for this cleaning you guys because its been FOREVER!". I know for me it had been 2 years or so since I had had a cleaning and I even had a 4mm pocket! (you'll understand that more once you're in). No one teased me or said I was gross. SO with all that being said IF you are still worried and my post didn't make you feel better, go get them cleaned. You can always find cleaning specials for around $99. If that will give you peace a mind that is what I would do. It's worth it to spend a little now then stress and worry.

      Good luck on starting your program! Buckle up for the next 2 years because it'll be a wild ride. Feel free to keep reading & commenting if you need to get things off your chest!

  2. I feel your frustration, I have been a Dental Office Manager for over 4 years and understand the struggle of gaining patient acceptance for treatment that is based on Dental Necessity. I firmly believe that if you continue to conform to what the patient "wants" then they will never go forward with necessary treatment. But when they are at the point of osseous surgery they will blame their provider. We have 99% acceptance of Scaling and Root Planning because we will not perform a prophylaxis on a Perio Patient. This is not pushy, this is necessary. IF your patient was diagnosed with a tumor, they can not ask you to just ignore it. If they had a lump on their breast and needed a mammogram you couldn't just do a normal physical. No matter what their insurance pays or how much it would cost them; they either have the mammogram or not but a lesser service can not be substituted. You are doing an awesome job educating your patient and requiring them to sign a waiver releasing you from fault but by performing a prophy your handing them the license to not do the needed treatment. As for the woman who went to another office I would have asked her to have her records sent over. If there wasn't a perio chart in her records I would have made sure she understands that they could not have possibly diagnosed her effectively. I also wonder where your doctor is in all this diagnosing, your doctor is there to back you up and reinforce your diagnosed perio needs. Any way, your blog hit so many buttons lol. You know as far as rejection goes at an office your temping with, this is very normal. Especially if they have always had 2-3 and now have 4-5 or if they have had "deep pockets" but never had their active perio disease discussed with them. That's not your fault, they are always going to want their doctor to validate your reccomendation or wait for thier "regular" Hygienist. When that happens I schedule them a 6 week follow up 30 minute appointment with their "regular" Hygienist to re-evaluate and we don't finish the cleaning. No Prophy, just exam and xrays and all that education. Then let their hygienist perio chart and re-educate and I can almost guarantee Scaling and Root Planning will be completed. That can take a little discussion with the office manager and doctor just so they understand what you want and they are willing to comply. That's my 2 cents after 7 Years in Dental. ;0)