#11 – Exhibits good health practice

Most of us have made fun of the doctor that smokes telling others to stop.  This same problem exists in dentistry. If you drink sugar pop, floss only occasionally, and don’t have regular check ups, how can you honestly ask a client to do better?  A secretary that works away from the client may say, “How will they know what I do? I’m not working with them anyway?”

The answer is ‑ we’re health professionals.  I believe when we work in a health field we should try to be healthy.  Not just our teeth, but our whole bodies.  Nutrition, physical fitness, stress management. These are the keys to a successful life.  If you are going to be successful professionally, you must be successful personally. Establish good personal habits.  They will give you the energy and peace of mind to be successful with others.  To accomplish this task successfully you should try to:

  • Eat breakfast daily
  • Avoid high fat diets and keep your weight with 10 pounds of ideal
  • Learn to relax
  • Exercise at least 3 times per week
  • Brush and floss daily
  • Don’t have sugar more than twice per day

Thorough Dental Exam

Now it’s time for you to experience a thorough dental exam.  An easy test of the effectiveness of our front desk is the number of new clients that begin with a thorough exam rather than a cleaning.  When things are going well, 70% will begin with a thorough exam. Here is the difference between a cleaning/exam and a thorough exam: The average dentist will spend no more than 3‑5 minutes with the client at the end of a prophy appointment ‑primarily checking for decay, gum disease, and focusing on concerns by the client or hygienist.  In a thorough exam, the doctor will spend the first 15 minutes in the private office getting to know the client as a person, review the medical and dental histories, and determining the initial goals of the client.  Next, the doctor will escort the client to a treatment room and spend the next 15 minutes systematically reviewing and recording an entire exam of the head and neck.  Finally, the doctor will review the initial findings with the client and they will together decide what other information (x‑rays, models, etc.) are necessary and what steps to take next.  If everything seems ok, a cleaning would be next.  If gum disease is present, soft tissue management would be appropriate.  If extensive dentistry is needed, a conference with the doctor to review a written treatment plan would be best.  This conference time should avoid the 3 deadly sins:

  1.  X‑raying the clients wallet ‑ designing treatment recommendations based on your assumption of what clients could afford rather than what they want/need
  2. Confusing them with high tech talk
  3. Lecturing them so they feel like guilty children

As you can see, a thorough exam gives us the opportunity to provide the best care for the client in the most relaxed manner.  Involved treatment will be organized quietly by the doctor, written out, and discussed in the doctor’s office, usually one week after the exam. This conference gives the doctor time to educate the client and discuss treatment in a non‑threatening environment.  So how do we arrange for our clients to have a “perfect” first visit?

  1. Listen to everything the client says ‑ verbal and non‑verbal
  2. Learn everything about our client you possibly can
  3. Offer choices so the clients can make their own decision
  4. The client must feel “in charge” ‑ controlling the treatment and the outcome
  5. Seek first to understand and then to be understood.  What are the client’s values, expectations, and needs.
  6. Be a trusted advisor, not a know it all parent
  7. Client questions ‑ Go into detail and make the client feel like it’s the first time you’ve ever heard that question.  Help them to feel that you like them and you want to help.
  8. If we make a mistake, send a tube of Rembrandt toothpaste along with the apology.
  9. Be aggressively courteous.  If you notice that a client may have a problem, ask the client.  Don’t wait for them to complain.

What must the client decide before they accept treatment from us?

1.  Does the service meet their needs and is it priced so the clients believe they receive value?

2.  Are the benefits clear?

3.  Does it satisfy their chief concern?

4.  Do they trust you to provide this treatment?

This good first impression helps us achieve these goals

1. Client accepts comprehensive treatment

2. Client refers others to us

3. Client is always on time for appointments

4. Client returns for continuing care appointments

5. Client takes responsibility for own health

The Perfect Beginning

Your first contact with a client is very important.  In fact, it will take at least 7 future appointments to change this first impression.  Here are assumptions the client will make at this first contact:

  1. Level of success
  2. Trustworthyness
  3. Credibility
  4. Financial success
  5. Education level
  6. Social position
  7. Sophistication

 

Your responsibility is to quickly (without preaching), show the client the value of a thorough exam.  Rehearse what you’re going to say.  It might go something like this: “Mrs. Jones, thank you for selecting us.  How may I help you?” Fill out the top of the yellow sheet.  Preferred name.  Chief concern.  Be thorough

Client ‑ “I’m due for a cleaning and a check up.”

Recep ‑ “Many of patients that are new prefer to begin with a thorough exam.  During this visit the doctor will review your past medical and dental care and discuss the type of care you prefer.  next your dentist would thoroughly examine your head, neck, and TMJ.  Finally, the doctor would review the findings with you and discuss treatment options.  This is a good way to get to know your doctor, learn about your dental health, and have a say about how you like to be treated.

Client ‑ “I don’t understand:  A dentist has always checked me after, the hygienist cleaned.  Isn’t that a good exam?”

Recep ‑ “That type of exam is just a quick check, mainly for decay and gum disease.  In a thorough exam, the dentist will spend about 1/2 hour with you.”

Client ‑ “Oh, well that sounds like a good idea.  Is it very expensive?”

Recep ‑ “No, the doctors think that this is so important that they only charge $___ for this exam.”

Client ‑ “Okay.  I’d like that kind of appointment.”

Recep ‑ “Fine.  Is there anything else I should know to make you more comfortable?” “I’ll write that down and make sure the doctor is aware of it.”  Write it down.

Recep ‑ (Always using benefits statements) “To help you get acquainted with us before you come in, I’ll send you some information about us. I’ll also enclose a health questionnaire so you’ll have plenty of time to fill it out.  If you have any questions about any of this, please call me (not “If you don’t understand.”)  I would recommend that you come 10‑15 minutes early so I can meet you and answer any questions you might have.”

When this client arrives for the appointment, stand up and acknowledge him/her on arrival.  Extend your hand.  Greet by name. Clients will notice first in order: clothing-> gestures (smile) -> eyes.  Always offer a handshake/ be firm and watch their pressure for 1-2 seconds.  Watch your body language.  Point with your whole hand, not a finger.   Don’t cover your mouth when you talk (hiding something).  Don’t fiddle with hair, jewelry, pen, shuffle feet

In the best practices, 80% of new clients come from direct referrals. Ask satisfied clients for more referrals.  “I’m so happy that your treatment turned out so well.  I really enjoyed working with you.  We’d like to serve lots of people just like you.  If you have friends that you would like to refer to us, have them mention your name and I’ll make sure they get every consideration.”

This may seem like a lot of your doctor’s time for very little fee. However, this is the time to build a relationship.  We will gift our new client this time in order to build confidence and understanding. Your client won’t care how much you know until they know how much you care.  This exam is our best way to show this concern.

This thorough exam gives our staff time to get to know the client and vice versa.  The clients experience the time we are willing to invest in their health.  Time shows our dedication to quality and will build trust.  Spending time to find out the health status of clients and then discussing their choices and answering their questions saves us from having to guess at what a client wants, or worse, trying to force clients to accept what we think is in their best interest.

The clients who receive poor service will feel frustrated and angry. They expect “good” service, so our job is to exceed our clients’ expectations through attention on detail. A first time client is easy to please.   However, on the 3rd ‑ 5th visit the client will look for all the details. Is there dust on the baseboards? Did the secretary acknowledge the clients as they came in? By the third visit, every detail is important and we are being evaluated under a microscope.

Goes through a new client exam and OHI personally    (You never get a second chance to make a good first impression)

You have been with us long enough to know how hard we work to care for people and provide quality care.   The cornerstone for this quality care is a thorough exam.  I wish every client would allow us to provide this service.  This is the most significant opportunity we have to communicate with clients. In order for you to promote this service to our clients, you should experience it yourself. You may have your own dentist and choose to maintain this relationship.  That’s certainly ok.  However, I would still like for you to have the exam so you can see how valuable it is in establishing a positive relationship with our clients.

Put yourself in the shoes of this new client.  No one likes to visit a dentist.  The first visit magnifies all these fears/concerns.  They don’t know if we know what we’re doing.   Will we hurt them?  Will it cost too much?  Will they be treated like children?  Help! How can we make the first contact with us a bang‑up positive experience?  First of all, it’s not the first 10 minutes that count, it’s the first minute. Once a client enters the office, what the secretary does speaks much louder than what she says.  Keep these things in mind:

1.  Your sitting or standing posture

2.  Your eye contact

3.  How you hold your head

4.  Your general expression and demeanor

5.  Be polite

Let’s assume that the client’s first contact went well.  The secretary was friendly.  She found out the chief reason for our client’s visit.  She discussed the value of a thorough exam.  The client accepted.  She sent the client a health questioner.  Our client brought it in for the first appointment.  S/he was greeted by name. We were on time and if not, a staff member apologizes if we’re more than 5 minutes late.  The reception room was clean and neat.   Your doctor or his assistant will greet the client personally in the reception room.  The client is escorted to the doctor’s office.  Now your doctor is responsible for the following sequence:

  1. Learning about the client as a person
  2. Find out who referred them to our office.
  3. Reviewing the past dental history
  4. Reviewing the past medical history
  5. Thorough dental exam, including: a. Extra oral soft tissue exam, b. Intraoral soft tissue exam, c. Exam of TMJ, occlusion, decay, gums

As your dentist finishes this appointment, s/he will tell the chairside what is needed:

  1. Necessary X-rays
  2. Intraoral camera pictures
  3. Blood pressure

Discussion with the client ‑ either at this time or at a follow up conference if the treatment is extensive to review existing conditions and various treatments and fees. Clients accept treatment if we answer these questions:

  1. Does it meet their personal needs?
  2. Does the fee seem fair (good value)?
  3. Are the benefits important to them?
  4. Do they trust us to provide the service?

Now the client is returned to a secretary to arrange:

1. Next appointment

2. Finances

3. Answer any other questions

Either at the first appointment, in for a cleaning, or at the second appointment after a thorough exam, each new client begins to learn from our hygienists our approach to becoming dentally healthy. Our hygienists will develop a partnership with our clients focused on their home care.  The hygienist will show confidence in the client’s ability, usually with some lifestyle changes, to stop decay and gum disease. So you can answer any client questions, one of our hygienists will update you on the current concepts of home care.

Stress

Even at a beginner’s level in dentistry, you’ll be under constant job stress.  There’s no way to avoid it.  When you accept more responsibilities you increase your potential stress. I’ll discuss ways to reduce this stress in the office in later levels, but now I’d like to give you some ideas for reducing the stress at home now that you are working an “extra” 30 or more hours a week plus all the other jobs you had at home before you began working with us.

These ideas are for those of you who have children at home.

  • Make the morning rush less of a hassle.   a.  Set the breakfast table the night before.    b.  Make lunches the night before    c.  Set out everything that the family wants to take to work or school the night before     d.  Set out the clothes for everyone the night before
  • Get children to bed early with a good routine.   What’s going to happen tomorrow?  Lay out tomorrow’s clothes. A story, a prayer, a kiss, a hug.  Tuck in.
  • Make sure you get 8 hours of sleep before work.  Go to bed 10 minutes earlier and get up 10 minutes earlier so you won’t be so rushed.
  • Simplify your morning routine and use weekend time to do once per week items. Have a simple haircut that does not require lots of morning attention.
  • Give your kids a clock radio so you don’t have to wake them. Serve easy breakfasts ‑ but serve breakfast!   a.  Milk and cereal  b.  Instant oatmeal in microwave

Ten years ago balancing your job and your family was enough. Today, you also need to be aware of your cholesterol level, manage your stress, reduce your percent of body fat, and exercise to control your blood pressure. Whew! One of our goals at is to help you retire years from now in such good health that you can enjoy your retirement for many more years. We want to support you so that you can be the healthiest you can be. Healthy people have numerous advantages:

  • Manage stress better
  • Have more energy to enjoy family and friends
  • Get sick less often
  • Have a body image they are proud of
  • Live longer, more enjoyable lives with fewer aches and pains

In order to improve everyone’s level of health, we encourage staff to consider joining the YMCA  to help provide personal training, fitness instruction and nutrition education focus. As you move up the levels, you will receive a health benefit in each level to help you improve your health as you build your career.

Flu

Usually flu shots begin in early October. You’ll have the antibodies in 2 weeks and the flu season starts in November.

What to do

  1. Personally
    1. Cough into your elbow
    2. Wash your hands often
    3. Avoid touching your eyes, nose, & mouth
    4. Don’t shake hands – bump elbows
    5. Cover a sneeze / cough with your elbow.  An uncovered sneeze will spread the virus 3 – 6 feet over a wide area.  Covering your sneeze with your hand allows you to spread the virus to everything you touch.  The virus remains active for 8 hours.
    6. Avoid close contact with those who are sick
    7. Stay home when you are sick
  2. At home
    1. If someone in your family gets the flu, you have a 1 in 8 chance of getting it.  (Child 1 in 4 chance)
    2. Keep surfaces clean with dilute bleach or disinfectant
    3. Particular areas: bedside tables, toys, bathroom and kitchen counters
    4. Isolate family members with flu – separate room, dishes, utensils, wash everything they touch on hot setting (and wash immediately after touching)  60% of H1N1 cases are children.
    5. Stockpile: cough drops, tissues, Benadryl (runny nose, sneezing, watery / itchy eyes), aspirin / Tylenol / Advil/ Aleve (lower fever, body aches), thermometer, tissue, hand sanitizers.
    6. What to do
      1. Get plenty of rest
      2. Drink clear fluids: water, broth, sports drinks, or electrolyte beverages for infants.
      3. When in public:
        1. Shop off peak hours
        2. Avoid crowds
  3. In the office
    1. Waiting room
      1. Clients taken immediately to treatment rooms
      2. Only 3 – 4 magazines – throw them away daily
      3. Chairs 2 feet apart
      4. Hand disinfectant offered on entrance / exit of clients.
      5. Limit being within 6 feet of others when possible
      6. Schedules – as flu hits our staff
        1. Staff: fewer of them in shorter shifts if necessary
        2. Reschedule infectious clients
        3. No hand shaking
        4. Send ill staff home – If a staff member comes in and our forehead thermometer shows a temperature of 100 degrees or more, the staff person will be sent home for 3 days. Staff can return after they have been fever free for 24 hours without the aid of medications.

For staff that appears ill.

We will take temperatures of staff that appear ill.

Fever over 100º and  Family member has the flu  and  Did not get H1N1 vaccine
If above threshold – sent home-may return in 2 days if normal temperature without taking any medications

If develops flu-may return 1 day after all symptoms gone (usually 7-8 days)

If any staff member chooses to not take the flu shot, that person will be isolated from the rest of the staff and clients as much as possible until flu season is over.

People become infectious 1 day before getting sick and 7 days after.  That means if you get the flu, you may miss 2 weeks of work.  So get your shots!

Stay home and call us if you have 2 or more symptoms:

  1. Fever > 100 degrees F: chills, sweats
  2. Coughing up heavy mucous or blood
  3. Dehydrated (dry mouth, dark urine, confusion)
  4. Trouble breathing, pain / pressure in chest / abdomen
  5. Dizziness confusion, prolonged vomiting, diarrhea
  6. Tired
  7. Children also ill
  8. Throughout office
    1. Lots of tissues and wastebaskets
    2. All frequently used items: keyboards, telephones, etc – each shift try to use only “yours” – wipe down after use.
    3. Inventory – Very likely may be hard to get, make sure we have plenty of:
      1. Tissues
      2. Disinfectant
      3. All dental supplies – 6 month supply and reorder point at 3 months
      4. Masks and gloves will be hard to get – triple your order
      5. Clients
        1. If they come in and have flu-like symptoms cancel and call in two days to reappoint.
        2. If they some in and have flu-like symptoms have a dentist evaluate.

“How nice of you to worry about our schedule.  However, the way you feel, I think it would be very difficult for you to sit through a dental appointment today.  We’ll call you in a couple days to set up a new appointment.  I hope you’re feeling better soon.”

Flu Vaccinations-Health Department

Please sign the following declination form if you don’t plan to be vaccinated.

Declination of H1N1 Influenza Vaccine 

Please print:

NAME: _______________________Birth date: _____________________

I have been offered H1N1 Influenza vaccination by my employer.  I understand that because I work in a health care environment I may place others at risk – patients and co-workers – if I work while infected with the H1N1 influenza (flu) virus.

In declining an H1N1 vaccination reasons, I am aware that:

  • The vaccine does not cause the flu
  • I can be infected by the influenza virus – but not feel ill – and pass the virus to vulnerable patients who are at-risk of complications or death from influenza.  I can also pass the virus to my family, friends and co-workers
  • The vaccine has been made similarly to the  seasonal flu vaccine, and has not been shown to have additional side effects
  • Previous seasonal influenza vaccination or  infection is not likely to protect me from H1N1 influenza

Reasons I do not wish to take the vaccine – please check the applicable reason:

□       I cannot take the vaccine for medical or religious reasons

□       I am concerned about side effects

□       I don’t believe this vaccination is important – I never get the flu

□       It was too inconvenient to get the vaccine when it was offered

□       I receive the vaccine elsewhere.  I will/have provide(d) record of my immunization to the practice

□       Other Reason: _______________________________________________________

I have read and fully understand the information presented above.

________________________________                ____________________ Signature                                                                                            Date

Hepatitis B

Hepatitis is a devastating disease. Most children are vaccinated before they start school. The federal Occupational Safety and Health Administration (OSHA) states that hepatitis infection is the single worst and most at risk disease dental staff may acquire. Although you could get this infection simply by eating off unsterilized silverware in a restaurant, the group most likely to be infected is healthcare workers who are infected by contact with clients’ blood or saliva.

            It just makes no sense, given the many ways you could be infected and the devastating symptoms you would have to live with for the rest of your life, to not be vaccinated. However, you do have the right to decline this vaccination. Be sure to sign the appropriate declaration and give it to your dentist.  If you have been vaccinated in the past, the Center for Disease Control (CDC) does not recommend a booster. The protective antibodies stay with you for over 25 years.

Health Tips

Hand Dermatitis – Dermatitis can be caused by:

  1. Not completely washing antiseptics off your skin
  2. Irritation from cornstarch in latex gloves
  3. Excessive perspiration under gloves
  4. Failure to dry hands completely.

You can reduce the potential for dermatitis by using:

  1. Commercial non-irritating hand cleaning solutions
  2. Hand lotions
  3. Using waterless cleaners
  4. Avoiding petroleum based lotions – They react with latex to make them more permeable and less safe (water based lotions are best).

Hand cleaning routine for hygienists and chairside assistants:

Step 1 – clean any visible material off your hands first thing when you start your shift or anytime your hands are visibly not clean during the day.

  1. Scrub with soap and water
  2. Use a brush to scrub under your nails
  3. Dry your hands

Step 2 – When ready to treat a client, use a foam emollient before putting on gloves.

Cough –  

  1. Drink tea with honey to soothe your throat
  2. Use a cough medicine (over the counter) with dextromethorpan and/or guaifenesi