I used to be brainwashed by one of the biggest electric toothbrush manufacturers and thought that there is no better toothbrush than these round-headed ones. I was so stuck in this illusion that I didn’t even give another toothbrush a chance to be better.
But then I moved to another country where two of the biggest toothbrush brands were almost equally popular compared to my country of origin where this manufacturer with round-headed toothbrush was and is dominating the markets.
In my new country of residence I was offered a free trial of the Philips Sonicare. I was amused by the looks of it (it was the old model) and thought it wouldn’t be a very good toothbrush. I almost declined the free trial because I was so convinced about the superiority of this round-headed toothbrush.
But then I gave it a go. It was ticklish as hell at first but thankfully my colleague dentist had warned me about it. I carried on using it for the full two minutes. Once I was done I got my moment of awakening. My teeth had never felt better. So smooth, so clean.
Patient Case
I was treating a lady – lets call her Sue – at her early twenties for severe gum disease. She had already had periodontist treatment and understood the severity of the situation considering her young age. Sue was very motivated to look after her teeth and did everything she was advised to do.
Sue had a surface retained glass fibre reinforced periodontal splints (everStick®PERIO) on her lower and upper teeth. She was using Tepe interdental brushes of various sizes twice a day and an electric toothbrush – the round head one. She changed the brush heads every month (even though she was informed it was necessary every 3 months). Her brushing technique was checked many times and it was perfect.
But every time I saw Sue for the 4-monthly scale and polish she had supragingival (visible) calculus on her lower front teeth. Lots of it. And she started to be very distressed about it because she was doing all the right things to prevent it. I tried to ease her worry and told that the supragingival calculus was not a problem gum wise as long as it was removed regularly. And in her case the gum didn’t even get inflamed by the presence of supragingival calculus. But it did not calm her mind. She didn’t like the looks of it as it was clearly visible when she smiled.
I had no idea what to advice more than I already had. She had all the right tools – interdental brushes and a latest model of an electric toothbrush. She used them often enough and with a correct technique.
Then I thought about Philips Sonicare I was using. I suggested to Sue that she could change her toothbrush. I expressed my frustration over the fact that she had spent quite a lot of money for the current toothbrush but this was all I could think of that might help her. I showed her the correct technique of the Sonicare just in case she followed my advice.
Next time Sue came in she had a wide smile on her face when she entered my surgery. She said the calculus had not built up at all! Sue had gone straight to the shop after the last visit and bought the Philips Sonicare toothbrush. She was very happy and thankful for the advice I had given.
This was even more of an eye opener for me than my own first experience with Philips Sonicare.
Why Is It Better?
The name says it all. It’s because of the sonic vibration. When used correctly the sonic vibration can reach beyond the bristles as the sonic vibration travels through the liquids in mouth.
People who think Sonicare is not a good toothbrush have not used it with a correct technique.
I have noticed in the past 15 years of using the Sonicare that I and my patients who us it, get less stains. Hardly any even though I drink coffee and tea.
Conclusion
In my country where I live and work now, the Philips Sonicare toothbrush is not very widely used or recommended by the dental professionals. I am considered as odd one out when I tell I use one. And even stranger it seems that I recommend it to some of my patients. Almost as if I didn’t know my business.
In the dental show case I didn’t even find a representative of Philips Sonicare from any stands. And I cannot find any contact details for a rep to invite her to my practice or to express my views over their marketing strategy. You see the marketing is very poor compared to their competitor who has given trial models to my practise with disposable brush heads so that the patient can be shown the correct technique etc. They give out free electric toothbrushes to the professionals (I have written about it on my previous post) and visit practices regularly to promote their products.
But thankfully the Philips Sonicare toothbrush is available in the shops. And I am doing a small-scale marketing for them. My hope is that they would take more aggressive approach to the almost non-existing marketing. I could even go to the next show case as their representative just to annoy the rep of their competitor who told me that the Philips Sonicare is as effective as manual toothbrush (you can read about it here).
It would definitely make my work easier when convincing the patients about the superiority of the Philips Sonicare toothbrush. And perhaps my colleagues will start to recommend it too.
Here are couple of models of Philips Sonicare electric toothbrush:
It is (finally!) time for the final part of the series of posts. This time it is of course the nurse’s role in the dental practice which probably is the most difficult one. Here’s why.
Experience Brings Wisdom
The dentist may know dentistry but he does not necessarily have any people skills. Or respect for others. Or ability to feel empathy. This kind of dentist is not fun to work with. Not even close to pleasant.
The nurse needs to put up with the dentist’s whimsy ways and misuse of power. Some nurses might tolerate this for a long time but some do find another job quite quickly. Especially those who are experienced ones.
But having said that, sometimes experienced nurses are allocated purposely to assist difficult dentists. To kind of bring them in the line. And oh boy if the dentist resists the change. He will have miserable time as the nurse tells him off about everything. The dentist’s whining is quickly silenced by the quick-witted nurse who do not tolerate any nonsense.
So the wisest dentists will comply very quickly as it is crucial for the congenial atmosphere of the work place. Plus the wisest dentists understand that the experienced nurses are worth their weight in gold no matter how they seem to disrespect the outdated hierarchical structure of dental practice.
Experience Brings Knowledge
In the Part I of this series of posts I wrote that sometimes the hygienists can have better knowledge on how to treat the gum disease. It is the same with the nurses – especially the nurses with 20+ years of experience. They have stared at people’s mouths for such a long time that they know a cavity when they see one. They can tell if the soft tissues look suspicious or if the filling has sharp edges that would bother the patient’s tongue.
If the dentist is lucky to have this kind of nurse assisting him he should be grateful to have extra pair of eyes looking out for problems in the patient’s mouth. But too many let their ego come in the way of team work (please read Part II for more on this subject). They ignore the fact that the nurse is looking at the mouth from another angle and can see things that are on dentist’s blind side.
Nurse Aka the Barista
One thing I have never understood is that why is it the nurse’s duty to make a cup of coffee/tea for the dentist? Please tell me one good reason why the person behind the title nurse should be considered as a servant? If anything, it should be the dentist making the coffee for the nurses as once they are finished with the patient they can enjoy their lunch in peace whilst the nurse disinfects the surgery’s surfaces and deals with the sterilisation of the instruments.
Another thing I have never understood – which I have already written about on my second post – is the fact that the patients bring gifts to the dentists but not to the nurse. Wine, chocolate, sweets, books you name it. I guess they don’t realise that dentist would not be able to do any treatment without the nurse (well without compromising good quality of treatment).
About Qualification Requirements
You may not need any qualifications to start as a trainee dental nurse.
This is a quote from National Careers Service’s website. It amazes me that in the UK you are still able to begin working as a dental nurse trainee without any qualifications and train yourself on the job. When I began working in the UK over a decade ago the dental nurse did not need to be qualified. Anyone could work as a dental nurse. Any random gal from the street. Seriously.
Somebody who has no clue about cross infection control or how to use all the equipment and materials safely would seriously compromise the patient’s, the dentist’s and the nurse’s own health.
In my current country that I work in the trainee nurses need to have certain modules accomplished before they can work as a trainee nurse. In my opinion this is far better system.
Hard Work Does Not Pay Off
The amount of work the nurses do does not show in the salary. They are very poorly paid and are expected to work on their lunch breaks if the dentist runs late and they are even expected to open the surgery in the morning on their own time.
I will tell you about one of my workplaces I used to work at. In this rather big company the nurses working hours were from 9am to 5pm. This was the time they got paid for. The problem with these working hours were that the patient came in at 9am and the surgery needed to be opened prior to that. All the nurses and the dental hygienists know that if you open your surgery properly it will take at least 30 minutes. Who would want to work 30 minutes for free? No-one apart from the charity volunteers but dentistry is no charity.
This meant that the nurses came in around 8.45am to open the surgery and they cut corners where ever they could. The same happened in the afternoon when the last patient had left. Closing the surgery also should take around 30 minutes but it was often done in less than 15 minutes. Needless to say that something important is left undone.
Pay Enough to the One You Want to Keep
Now on this final chapter I will give an advice to all the dentists who have nurses as employees. It is an advice that will make your practice a success story.
If you think your nurse is doing magnificent job
pay her enough money for that. Even more than what would be current going rate of the nurse
be flexible and take her personal life into consideration. Show that you care if she struggles with the demands of bringing family life and work life together
give her gifts every once in a while. Perfume, chocolate, her favourite music… anything
make sure you apologise if you run late before the lunch break. Let her go for an extra break later to compensate the lost time
buy her a lunch every now and then – after all you make gazillion times more money
make sure you both work in an ergonomic position
respect her
These are the only ways to stop your nurse looking for another job. You see every nurse know eventually that there are dentist’s who do value them more. Believe me, I know many nurses who have been rewarded generously by their employer – they have been paid more than an average nurse, they have been taken on board to a course trip overseas (even to Mauritius!), they get extra time off…
You see the dental practice who’s supportive staff keeps on changing all the time is not giving a very good impression to the patients. And that alone can be a reason for them to change dentist.
“The most dangerous irony is, people are angry with others because of their own incomptence” – Jar of Quotes
Goodness gracious me! It has been too long since my last post. Hope you are still there and reading my posts!
It is time for the dentist’s point of view as a team member of dental practice.
At 8.45am
“Oh no, not the Ms. Flumsy again” thought the dentist in the morning when she entered her surgery. Apparently her regular nurse was off sick or something as the practice manager (PM) had called in the temp. The one that had visited the surgery before.
The dentist was disappointed at the PM who clearly had not listened to her when she said she would not want to see this temp again.
You see, everything was wrong with this one. She had long and colourful nails. She had heavy makeup and strong perfume. She didn’t have any idea of assisting a dentist. She thought that using the suction was the most important thing as a nurse. And every task she did took ages to do. And she did them in wrong order. And knew nothing about cross infection control. And went for a cigarette when she should have called a new patient in.
Even though the dark cloud hanging above the dentist head was obvious she forced a smile and said with overly sweet voice “Good morning. How are you?”
“I’m good. And you? Okay?” replied the nurse with a wide cockney accent sending shivers down the dentist’s spine.
The dentist took a look at the day’s schedule. She could feel panic increasing the further she read the day’s treatment plans. Check-up, root canal treatment, crown work, extraction of wisdom tooth, check-up… And of course the time-table had been planned so that the dentist would have her regular nurse assisting her. It was a tight schedule but manageable when the nurse knew her business.
Nevertheless the dentist made a decision not to cancel any patients.
At 9.05am
The first patient was sitting in the patient chair with the bib and safety glasses on. She was about to have a check-up done.
“Oh, I didn’ remember yew ‘ave dis computer software! Don’ know ‘ow ter use it” the nurse says suddenly. The dentist sighs and gives a piece of a paper to the nurse to record her findings.
Then she begins her check-up routine and after checking the teeth with a mirror and a probe she reaches for the fiberoptic. Only it’s not there. She turns her gaze at the nurse who is at the front of the computer screen cleaning her fingernails and looking disinterested.
“Could I please have the fiberoptic?” she says with overly calm manner.
The nurse begins to go through the drawers but cannot find the device. The dentist waits. The nurse checks the autoclave.
“Gawdon Bennet! There are instrumun’s ‘ere from yesterday but its not ‘ere, innit.”
The dentist remembers that her colleague sometimes borrows the fiberoptic as the practice has only one of them. She asks the nurse to go and check from there. She examines the patient’s soft tissues meanwhile.
“Here i’ is” the nurse says triumphantly when she returns and waves the fiberoptic in the air and attaches it to the unit. The dentist notes that the nurse did not wipe it with disinfectant but she thinks it’s not that big deal especially now when she’s running 5 minutes behind the schedule.
She completes the check-up and sends the patient to the reception. Then she records her notes to the computer as quickly as she can.
“Exam” she writes. No time for all the gibberish.
Then she updates the chart from the piece of paper and checks the next patient’s records. A root canal treatment. She notices that the nurse has placed only the basic instruments on the tray and disappeared somewhere – probably for a ciggie. The dentist starts to collect instruments she needs and calls the patient in. She feels her blood pressure raising.
“I really cannot be doing nurses duty, simply just cannot…”
She is numbing up the patient when the nurse walks in.
“Oh, yew ‘ave already taken da patien’ in! Wasn’t da appointmen’ at 9.45?”
The dentist does not reply and carries on with the treatment.
At 10.10am
The dentist is done with the filing of the root canals and is about to rinse the canals with the sodium hypochlorite for the last time. The nurse grabs the suction.
Silence.
The nurse places the suction back to its holder and takes it off again.
Silence. Not a sound.
The dentist realises that something is wrong and it cannot be fixed quickly. She asks the nurse to inform the practice manager about the malfunction.
Meanwhile she tries to figure out how she can finish the treatment without the suction. Luckily she wasn’t born yesterday and she takes a sterile gauze and places it close to the root canal treated tooth before she rinses the canal with the sodium hypochlorite. The gauze absorbs the liquid. She puts the calcium hydroxide to the root canals and seals the canals with temporary filling.
She escorts the patient to the reception in an intention to ask the PM what she has done about the suction but then she sees two practice’s regular nurses entering her surgery. She goes after them to see if they can fix the problem.
The nurses try to figure out why the suction is not working even though all the other suctions in other surgeries are fine.
The dentist checks the time. She’s now over 10 minutes late from the schedule. And the next treatment is crown work and that cannot be done without the suction.
The nurses need to return to assist their dentists and the PM needs to call in repairman. This means the dentist needs to cancel the next patient’s appointment. Zero income for the next two hours or so or until the suction is fixed. She walks to the reception to meet the patient and break the news.
The patient is not happy. He has taken two hours off work to come to the appointment. In a fear of losing the patient to another practice the dentist promises a discount from the treatment.
At 12.30pm
The dentist has tried to make a use of the spare time and goes through laboratory bills in her surgery. The repairman has not been in yet and it is soon lunchtime at the practice. Things are not looking good. She won’t be working until the late afternoon.
The surgery door opens and the hygienist pops her head in.
“Great, you don’t have a patient. Would you mind coming in to my surgery to check something? I have your patient in the chair and I think I found a decay on the lower right 6 and also something on soft tissues…”
The dentist walks in the hygienist’s surgery and greets the patient. She puts the gloves and face mask on.
Dentist: When did I do the last check up?
Hygienist: Err, yesterday…
D: And where was it that you suspect a decay?
H: On lower right 6. On the buccal side just below the gum line. There is another one as well but I think it is still in early stages…
D: Where is this?
H: On upper right 2, mesially. I don’t have a fiber optic so I couldn’t check it properly.
D: There is one in my surgery.
H: I know, but the turbine attachment is not working in my unit.
D: Ok then, let’s have a look…
The dentist takes the probe and checks the lower right 6 first while the hygienist stands on the nurses side and watches.
D: It seems to be ok…
H: It’s more subgingivally. You need to push the gum aside slightly.
The dentist feels this unpleasant feeling in her stomach when the probe sinks inside the tooth on the site hygienist mentioned.
D: Yes… yes, you are quite right. This needs to be repaired. Let’s see what we can do about it as it is quite deep… How about the other one. It was the upper left 2?
H: Upper right 2 mesially.
D: You are right it is decay but hard to say without the fiber optic if it’s advanced. I will check it on the next visit.
H: There is also something on the soft tissues I’d like you to have a look. It’s on the cheeks and under the tongue. Could it be lichen planus?
The dentist takes a look.
D: I can see what you mean. Hard to say for sure without biopsy but it does look like lichen.
Then she goes on informing the patient about lichen and asks the patient to book an appointment to decide what can be done to the lower right 6.
The patient looks shaken. Yesterday she got all clear and today she hears there is something seriously wrong with one of her back tooth plus something – possible cancer – on her soft tissues. She is not convinced when the dentist says there’s nothing to be worried about.
The dentist leaves the surgery and feels like going home. Or to the pub. This day is just one of those days she would like to forget. But she must stay to treat the rest of the patients – providing that the suction is fixed before this.
But it is time for a lunch first and she decides to go out for the full hour.
At 2.30pm
The dentist returns to the practice after the lunch break and chats with the receptionist before going to the surgery. The receptionist tells her that the repairman came in and did his magic in 15 minutes. The suction works again. Whoopty doo!
When the dentist reaches the surgery she can see through a glass tile window that the surgery’s lights are off. She opens the door and sees the unit lifted up to the highest position which the nurses do at the end of the day.
“What the hell?” comes out of the dentist’s mouth.
She walks back to the reception to see the PM.
“Why is my surgery closed?”
“Oh is it?” replies the PM and walks to the surgery.
“Oh lord” she says when she sees the surgery, “the temp must have gone home… I thought she went for a lunch!”
“I cannot believe this… this is unacceptable… did I or did I not tell you that I do not want to have this temp assisting me ever again?”
“I’m sorry but I did not have…”
“I don’t care. Your job is to keep the surgery running and I have seen only two patients today which is outrageous. And those two I have had to treat practically alone as the nurse is useless…”
“I understand. I see what I can do… I will try to reach the temp. Maybe she’s somewhere close by. I don’t understand how she thought she could go home.”
The dentist was fuming. She did not want the temp back but she did not have other options if she wanted to see the rest of the patients. But she soon learned that the temp was nowhere to be reached. The PM offers to come in to assist her.
“Well it’s better than nothing” she replies.
After she had seen the first patient for the check-up she was much calmer. She took in the next patient who had just seen a hygienist for a scale and polish.
When the patient opened the mouth she started to get annoyed again. The hygienist had not rinsed the polishing paste properly. It was in every between the teeth, this gritty blue paste.
“Seriously, who uses this much polishing paste!” she thought whilst her cheeks were getting red from the annoyance. You see, this wasn’t the first time. It happened with every patient who came to see her after the hygienist treatment. Soooo annoying!
At 5.30pm
When the day was over the dentist felt like she was the only one in this practice who knew her business. How was it possible that she was surrounded by so many incompetent people? She thought about changing jobs.
But would the patients follow? Some probably. Would it go from bad to worse? Yes possibly. Should she start her own practice? Definitely not, too much stress. Should she quit dentistry? Yes, it would be the wisest thing to do but she wouldn’t afford it as she’s still paying the student loan.
She went home fearing what the next day would bring. One thing she has learned in these couple of years of practising dentistry was not to check the next day’s patients. It was about minimising the stress. But there were so many other things she had no control over that sometimes just felt too overwhelming. Way too overwhelming.
Dental Revelations 