5 interesting questions hygienists asked Kara RDH in July

August 4, 2016

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As the founder of dentalhygieneanswers.com, Kara Vavrosky has heard a lot of questions this month. Here are some more of the ones that stuck out the most to her.

As a well-known and accomplished dental hygienist, Kara Vavrosky often gets asked for advice.

She runs the popular Facebook page Dental Hygiene with Kara RDH and is also the founder of dentalhygieneanswers.com, a question-and-answer platform for dental hygienists.

Here, Vavrosky shares five more interesting questions she's been asked recently, along with her answers.

Continue to the next page to view our slideshow of these questions and answers.

Managing phobic patients

Any tips on managing patients with dental anxiety/needle anxiety to make the appointment less overwhelming and tense?

Patients can have dental anxiety for a variety of reasons; a previous bad dental experience, fear of pain, fear of embarrassment or even fear of feeling they aren’t in control. I like to find out what the patient is most fearful of; it gives me something to work with when it comes to easing the fear. When discussing their anxiety I show true concern and compassion to let them know that “I get it” and am not judging them. I even give examples of myself for needle-phobic patients about how I am when I get my blood drawn and things like that. Discounting their fear has the potential to only make it worse. Another thing that can cause anxiety is if you are acting rushed. Stay calm around fearful patients. Your demeanor should set the mood.

It also helps to give these patients a sense of control. I do this by allowing them to hold the suction if they want and letting them know that if they need me to stop treatment to raise their hand. I always explain everything I’m going to do, before I do it. Knowing what is coming helps ease nerves for some. This is especially helpful for patients with a needle phobia. I even explain what they feel during the injection (epi is acidic, like lemon juice, but I will go very slow to keep it as comfortable as I can). I’m also very encouraging while giving the injection, telling them how awesome they are doing, etc.

Distractions help too. If they want to bring earbuds and listen to music during treatment, I’m all for it. If you have a TV in your operatory, turn it on and have the patient put it on a channel they like.

Most of all, be encouraging. For the patient who hasn’t been in for years, and has anxiety because they are embarrassed, let them know how great it is that they did decide to come in and how they should be very proud of themselves for following through. Stress the point that you aren’t judging them – do this with actions not just words.

Commission percent

I work for 25 percent commission of what I produce. My daily goal is $1,000. I get paid holidays at $150 per day and no paid sick days or benefits. I get five vacation days also at $150. After my last vacation day, my boss told the office manager he wants a fill-in hygienist when I am out. I feel like this is taking money out of my pocket. Not only am I being paid less for a vacation day or holiday, someone else will be getting the commission for seeing my patients when I’m out. He has two assistants and there are two people at the front desk. They are all either hourly or salary and get the same pay for their days off. I’m not sure how to bring this up to the doctor especially since he has a short temper. Also, is 25 percent commission too low? I feel like it should be in the 30 percent range? Also, since I started a year and a half ago, hygiene production has been up every single month compared to the same month before I began.

Having a fill-in hygienist when you are out is standard practice. To expect the doctor to cancel an entire day of hygiene for your vacation day isn’t practical business-wise. With that said, if your co-workers are all getting full pay for vacation days or holidays, you should too. However, in reality, be glad you get paid vacation at all, as many hygienists don’t. The industry standard for pay based on production is about 35 percent. To be completely clear, this 35 percent is based on production, not collections. You shouldn’t take the hit if the patient doesn’t pay or for the office’s negotiated fees because you still did the work.

When talking to your boss, I would be very prepared. Print out your monthly production stats showing the increase month over month to prove your case. There are several articles online stating the 35 percent industry standard for production that I would print out too. Addressing the vacation/holiday pay is a tough one so I would just state the facts: both assistants and both front desk employees get their normal wage and paying you different undervalues you as an employee. It’s especially hard when the doctor has a short temper, but it’s important to stand up for what is fair.

It’s a tough situation to be in, but having the conversation in a cool and collected manner, with facts in hand, will help your case. I hope this helps and I wish you the very best of luck!

Continue to the next page for the rest of the questions hygienists have been asking Kara RDH.

Ultrasonic frustrations

When I use the ultrasonic I have trouble trying to hold the suction, mirror and the ultrasonic. If I just hold the suction, there are some areas in the mouth I can’t see with direct vision and my ergonomics go out the door trying to see, but if I hold the mirror, the patient drowns in water. I feel like patients think I’m clumsy and I’m wasting a lot of time juggling all three. Any suggestions or is there anything out there that can help?

Grow a third arm, of course! All joking aside, I feel your frustration. You do have some options though. The option I like the least, is having an assistant suction for you. I don’t like this option because personally I like to be as self-sufficient as possible. Another option is to bend the suction and have it hang from the patient’s mouth. However, this doesn’t always suction the water very efficiently and can fall out if the patient’s mouth if they move, leading to the clumsy problem. The patient could always hold the suction themselves, but not all patients are great at suctioning pooling water or even want to do it. There are some that are, but others that simply aren’t.

The easiest option is using an isolation device. For example, Zirc makes mr. thirsty one-step which is placed in the patient’s mouth and suctions, isolates and is a bite block all in one. It’s like having a third arm that not only saves you time and keeps you from looking clumsy, but lets you use your mirror and not ruin your ergonomics because your hand is free from the suction. Whatever you do, don’t let your ergonomics go out the door. It’s easy to think that it’s only for so many minutes per patient, but those minutes add up and can lead to musculoskeletal injuries down the road.

Worsening back pain

I have been practicing only about two years in corporate dentistry. I have started experiencing horrible mid-back pain (where your bra strap goes). After one or two patients, my back hurts and feels as if it is on fire. It has hurt so bad I could cry. I have ordered a saddle stool and I wear loupes. I’ve also been seeing a chiropractor for about five weeks with no luck. I use Icy Hot and take ibuprofen. I have been considering getting an anti-inflammatory from my primary doctor. This pain makes me not want to go to work, and very worried for my future. I don’t think my body can do this much longer. Help, please!

Check your ergonomics: elbows in, sitting on top of your tailbone, shoulders down, etc. You may also want to check if your saddle stool is adjusted correctly. Saddle stools can make things worse if the adjustment isn’t perfect. Also, strengthen. Yoga, pilates, anything to strengthen those back muscles. Don’t forget to move. What happens when we stay in the same position for long periods of time with our muscles tense is blood flow gets cut off. I would keep seeing a chiropractor, get massages and even go to physical therapy if the pain doesn’t let up.

If you do see a physical therapist make sure they are NAIOMT trained. Their credentials will say something like Name, PT, RPJ, COMT (the COMT is important). It may be worth seeing your primary doc for a referral and possibly getting imaging done (MRI). If you have a bulging disc, you need to know sooner rather than later. The other thing worth considering is how long are you given for appointments. If you aren’t given ample time, stress can cause you to tense up, again cutting off blood flow to muscles and tissue hence causing damage and pain. Make sure your instruments are sharp as well. My biggest advice is finding the reason for the pain, not just covering symptoms with meds. Meds help in the short term, but over the long term, they don’t solve the problem. It’s like placing Arestin into a diseased perio pocket without removing the irritant (calculus) and expecting it to heal. I wish you the best of luck with this, chronic pain is the worst!

Really bad anxiety at work

What is a hygienist supposed to do when the office is so bad it gives you anxiety just thinking about going to work? It is starting to affect me physically. I want to quit in the worst way but there are zero jobs out there. What have other hygienists done when faced with this dilemma? I really love hygiene but have become bitter about it due to how I have been treated. I’m feeling lost and unsure of what to do, or where to go from here. Thanks!

It is so sad, not to mention infuriating, to me that there are offices out there that would give an employee so much anxiety it makes them physically ill. Like many other hygienists, I have been in your position and dreaded going to work and actually becoming a bit bitter about the profession. Please know that you aren’t alone in your situation. I cried more from that office than I did in hygiene school, if you can believe that. I was sick, “praying to the porcelain God” if you get my hint, more times before work than not. You must find a new office. When in that same situation, I made finding a new office like a second job. When I would go into work I told myself over and over, it’s only temporary.

Extend your work search to areas that may be further than your ideal commute time, if you have to. I’d argue it’s better to spend a bit longer driving than to be completely miserable. You can also temp. Some hygienists actually like temping more than working at a permanent office because, if it’s a not-so-good office, you don’t have the worry of being there for an extended period of time. Many hygienists find their “forever office” through temping. Next, you need to network. Reach out to your local ADHA component and even attend meetings if you can. They may keep a list of hygienists who are available to temp and/or of offices that may be hiring, but aren’t necessarily advertising that they are. Don’t hesitate to drop off resumes at all offices in your area. You never know when something may come up and you may get a call. I actually got a call a few weeks ago from an office that I had dropped a resume off at years ago. You’d be amazed at some offices that hold onto resumes of hygienists who really put the effort into getting their resume out there. You can also volunteer. If there is a children’s clinic or the like, that runs on volunteers of hygienists and doctors, get your time in there. Doctors who volunteer are more likely to hire hygienists who do the same, in my experience.

You can also tweak your career path. While looking for a new office, you may be able to work for a dental company as a product educator and do lunch and learns. Heck, you might even like that more! Attend dental conferences and pick the mind of the reps, the speakers, and others you talk to. You may be surprised at how they landed in the career path they are in and have great suggestions and connections. Dental conferences are a great way to network in general. Or, if you have ever thought about becoming an educator, now might be the time to explore that option. Reach out to those you know in the dental field, including your former dental hygiene instructors, without hesitation and start asking questions!

With all of this said, it may be wise to break down the situation and really figure out what is giving you this anxiety. I say this because all offices have their quirks, some of which can change and some that cannot. Some patients will always be difficult, some days may be better than others, and sometimes there is a disagreement with a co-worker (however, I’d hope it could be resolved easily and professionally). Maybe some of the things giving you anxiety can be changed through speaking with your employer. If you find the opposite to be true, you need to move on. Do find the root of the anxiety though.

On a final note, I did find an awesome office, though it did take some time. It changed my whole view on dental hygiene as a profession, so please keep trying. I also expanded my career path, which has led me to writing this very article, because of my experience. Life is too short to be miserable. I wish you the very best of luck. Keep your head up, you are destined for great things to come!