Wednesday, December 5, 2007

The Dental Hygienist From Hell

I had the worst dentist visit ever in my life.

Even worse than the sadistic pediatric dentist who pulled absessed molars with no novocaine or other painkillers when I was 12 or so.

Although this time, it wasn't the dentist who was the problem for me. It was the hygienist.

I guess it started when she asked how I was doing and I said I wasn't having a very good day. I probably need to learn to just say I'm fine, but it seems so dishonest when I'm not fine and haven't been since sometime before last June. Or maybe March. I don't go into detail, but I do tell people I'm having a lousy day when I am.

She led me to the room and told me to have a seat on the chair, and then proceeded to sit in a chair to my right and about three feet behind me. I wasn't comfortable talking to someone without looking at them, and it was painful to try to turn around and make eye contact. So I asked her if it was possible that she could move where it was easier for me to see her. So she moves so she is exactly next to me, and I had to point out that that was still painful for me to turn my neck that far and could she please move to where I pointed. So she moved to somewhere between directly next to me and where it would have been comfortable for me to look at her.

Then she starts asking me if I brought my records from my previous dentist and I said that I thought her office requested them. She wanted to know if I'd signed a consent form, and I'm sure I sounded exasperated when I said that my records had been there in my file when I was there in August. Sure enough, she opens my file and there are my records.

The hygienist then asked if I'd had any medical changes since then. You know, I really didn't feel like going into a long explanation of my current medical status. So I mentioned a cancer scare and that it looked like I have an undifferentiated connective tissue autoimmune disease. She had no idea what that was, so I said it was similar to lupus and rheumatoid arthritis. I don't think she had much understanding of what that was either.

So before she takes my x-rays, I tell her I have a very strong gag reflex. Instead of doing what other hygienists have done for me, and getting the equipment set up before putting the bite wing in my mouth, she insisted on putting the bite wing in first and slowly getting things set up. So it took five tries to get the two pictures she wanted. Meanwhile, the coughing from the gagging was making my chest hurt worse.

As she starts cleaning my teeth, I tell her that it's painful to hold my jaw open and I need frequent breaks. In my mind, I thought she would give me a break after doing each quarter of my mouth. But she wanted to do all the way from side to side before giving me a break to close my mouth. And when I did get to close it, instead of giving me a minute or two, I got maybe 20 seconds. And that's estimating generously.

As I got more tired and my pain grew, I told her that I wanted to skip doing the part where they measure how much my gums have receded. "That's Dr. Chin's call," she said. Actually, I said, it isn't. It's my call. She started going on about state requirements, and I said fine, I'd sign a waiver that I had refused treatment.

"You don't understand how little time it takes to do it," she said, estimating it at 10 minutes. "No, you don't understand the level of pain and fatigue I have," I responded.

What I wanted to say, but didn't, was that it was illegal to force unwanted medical (or dental) treatment on a patient who refuses it. And if I wasn't allowed to leave when I wanted to, the criminal charge for that is kidnapping.

Yeah, I was getting a little worked up. But I didn't feel well; I was tired, she was making my pain grow exponentially, and of course I was very overdue on my pain meds because I refuse to drive after I've taken narcotics.

Finally, I told her stop before she finished scraping at my plaque, that I couldn't do anymore today, that I didn't feel well and needed to go home. By the time the dentist came in to talk to me briefly and look at my teeth, I was on the verge of tears. Of course, I've got two new cavities that will need to get filled sometime soon. Oh, joy.

(I've had lousy teeth since early childhood when my baby molars came up without enamel. My permanent teeth didn't have that problem, but they seem to have thinner than typical enamel, or so I've been told by several dentists.)

As I was leaving, the hygienist told me to come back next time when I was having a good day. "It's a little challenging to plan those in advance," I responded.

I don't know. Maybe I should have postponed the visit until I feel better, but I don't know when that's going to happen and when I go longer than six months between visits, I always end up needing work done. I actually did consider calling this morning and rescheduling, but thought I could do it because it shouldn't be that hard to lie in a dental chair.

But I was there for over an hour before I walked out. And that's all I'd expected to need since that's the typical length of the cleanings I've had done. And it was just too much for me.

Should I have called in advance and gone over some of the accommodations I might need, such as longer and more frequent breaks to rest my jaw? Is there some way I could have explained my illness to the hygienist, who didn't seem to understand that I actually was ill even though I look mostly fine to someone who doesn't know me?

It was just so frustrating. And I felt lame for crying over it, and humiliated that I cried in the office in front of the nastiest hygienist I've ever had.

And I'm sure she wrote down in my file somewhere that I am a "difficult patient."


And now my jaw and entire face hurt, and I'm even more exhausted than usual, and I didn't even get my teeth fully cleaned. And it won't surprise me if it takes me more than a day to recover from.


Catherine said...

I'm sorry your dentist visit was so awful. There was no excuse for the hygienist treating you as she did, in my opinion. I would suggest that you talk to the dentist about it, if you really like him, and if he has another hygienist, ask for her/him. Or, if he has an understanding of lupus, maybe he can treat you himself. I just did a quick Google on "lupus dental" and there are all kinds of issues that arise and dentists should be aware of them. If yours is not, I would consider getting another dentist (which is probably what I would do anyway, as I'm a big chicken when it comes to confrontation). Hope you recover from this fairly quickly.

Sherril said...

I'm so sorry your appointment was so horrible. I have a lot of dental stuff, too. I'm probably the Queen of Difficult Dental Patients. My comment here is turning into another blog post. I'll let you know when it's published.

Anonymous said...

"Is there some way I could have explained my illness to the hygienist, who didn't seem to understand that I actually was ill even though I look mostly fine to someone who doesn't know me?"

Yes. My suggestion is to call in advance and request a call back from the dentist. Hygienists do not have deep medical education. Many have only an associates degree from the community college. Lupus and other diseases don't come up in their education, is my bet.

The best thing you can do for *any* medical professional who is not involved in your care is to educate them in advance. Expecting that people know is only going to cause more trouble.

Maybe they should know, but it's not the real world. The hygienist is human, and it sounds like she may need a little training, but, you also have a responsibility to communicate with the dental practice before hand. How else will they know?

By talking with the dentist, it is similar to talking with a doctor about your care. It is the dentist's job then, to ensure that the staff knows how to accommodate you.

I'm got very difficult with this illness. And so did your role in receiving great care. You don't have room for mistakes or assumption - be assertive in advance. Not angry, just clear communication. "I'm going through a very difficult nondiscript illness that causes great fatigue and pain, especially when stressed. I may need to break the appointment into two shorter sessions to be able to tolerate it. How can we work together for this to be a successful visit?"

It's not fun to take on all responsibility for proactive and communication to prevent bad experiences, and it is a lot of work. It also is no assurance that things will be better, but it does help.

That being said, I am really sorry that you had to go through all this. The dentist is my least favorite thing to do in the world (second to the gyn).

I hope you feel better soon.

Anonymous said...

1. I hate hate hate that you have to go through this horrible illness. I am saying a prayer for your comfort right this minute.
2. I am a hygienist, and I promise that there are hygienists with a better bedside manner out there.
3. Do NOT trivialize your illness. I know you are tired of explaining it all the time, but the anonymous post before mine was right. If you were in my chair, I wouldn't have known to treat you any differently than I would have treated an ornary old lady. If I knew that you were going through what you were, I'd have done everything possible to make sure that you were as comfortable as you could be.
4. Hang in there, and kiss and hug that sweet baby as much as you can.

Aviva said...

Gosh, you guys are wonderful. Thank you for all the supportive comments on here. I really think my problem was that I didn't anticipate how hard it would be. I mean, gosh, how hard is it to recline in a chair and open your mouth? But it was, and now I know better.

And I think my mammogram went better for having the experience I had at the dentist's office, because this time I knew to at least say something up front about needing possible accommodations and that I wouldn't know exactly what I needed until I tried doing it.

And thanks too for the good advice in addition to the sympathy. I can't even begin to put into words how much that really helps.

Elizabeth said...

Hey Aviva,
I am anonymous comment #2. I am a teacher of dental hygiene in Mississippi. May I copy your blog post and use it in one of my lectures? I teach a course on practice administration where I teach about special needs patients. I would love for this NOT to happen to anyone else, and the way you worded things will really hit home to the students. If not, that's okay.......

Aviva said...

Elizabeth, I really appreciate your asking, and I'm very happy for you to use my posts if they will help your students learn about what some of their patients might be going through. I too would love for this not to happen to anyone else! It was certainly a very painful lesson for me to learn, and my jaw is still not completely recovered from the experience. But I know better what to do next time around, and I'm applying the lessons learned here to other experiences too. Thank you again for your earlier comments, which really made me feel better.

Elizabeth said...

Thank you aviva........I will be thinking about you and praying for you.

Anonymous said...

Well I am sorry for your suffering I know this is from long ago but I had the urge to post a comment. Yeah she did wrong by not letting you rest. You told her your jaw hurt and she was not considerate. I as a dental hygiene student happen to know alot about Lupus since I was taught about it so it came as a surprise to me when that DH did not even know the basics of it. If you have so many dental problems you should really go every 6 months but if you can not afford it why not try a school. Like citytech who charges 10 dollars for a cleaning or NYU or any other dental or dental hygiene school. I bet they have many recommendations for you.

Anonymous said...

Are you kidding? As a hygienist we do have knowledge of diseases and how oral manifestations can occur. We also know that the person is treated as a whole and not just a "mouth" We know how your medicines and bodies react to illnesses and address these issues when in treatment. Patients are treated accordingly. You sound like a difficult ungrateful patient. Just because you are sick does not mean you can treat any caregiver with such animosity. Do you really think you are the only sick person to ever get your teeth cleaned? You sound like you want a pity party thrown for you because of your illness. At any point you could have said I need to rest my jaw, instead you played a victim in your treatment and then cried and complained later. We are not mind readers. Make your needs known at the start and try to cooperate instead of being insistent on having a bad experience. You sound like you wanted to be angry. Luckily there are people unlike you that make this profession joyful and fulfilling.

Sherril said...

OMG! Another HFH! And on your own blog yet. I'm pretty sure you don't need that kind of grief and just wanted to put my two cents in that you and your blog are wonderful resources for me, and I really look to the quality of your writing as something to aspire to.


Aviva said...

Thanks, Sherril! I find it very telling that she (eek, now I'm being sexist by assuming it's a female! ;-) commented as "anonymous" rather than using any sort of ID, even a nickname. :-)

I do appreciate your support, Sherril. And while that was ever so long ago that I made that post, I feel no guilt about venting about it nor that I eventually complained about the awful hygienist. (And apparently, I was far from the only complainant. She was fired a few months after that, and I'm told they'd received complaints from about a dozen people before she lost her job.)

I still go to the same dentist, who's great, and the hygienist I now see is very accommodating.

It just makes me laugh to read this hygienist claiming to have encyclopedic knowledge of every single disease out there and how each individual patient might react to it. Clearly I should track her down because I bet she'd get me a solid diagnosis (besides whiner) and I wouldn't be a medical mystery anymore.

*hugs* to you, Sherril, for your kind words and wonderful response to my nasty little anonymous attacker. :-) (Btw, that isn't meant as a knock against everyone who comments w/o leaving a name. Apologies if I'm insulting anyone who's been kind enough to leave helpful, supportive comments for me in the past!)

Anonymous said...

I am so sorry you had an awful time on the chair. I am a dental hygienist and I have many patients who need breaks to rest. I would offer a bite block for jaw discomfort, so u can actually relax on the chair. I don't know where your hygienist went to school, but where I went we had a "special patients" class and learned the basics of common diseases, syndromes, etc..
I think a call in advance to the dentists office would have definitely helped. I usually know, from the great office staff, when a patient needs special accommodations. It's good for us to know too, so we can prepare ourselves mentally. It is more stressful for us to deal with someone not having a " good day" due to pain, but we are also understanding people ( at least some of us). We are compassionate and caring and want our patients to have a positive experience.
I would suggest maybe scheduling a half hour instead of an hour appt. and just cleaning half of the mouth, if that is more tolerable for you. The office SHOULD be able to accommodate you. I chart half of the mouth (pocket readings) at each appt. for one of my patients who has bad TMJ and have her use a bite block to prop her mouth open & relieve some stress on her jaw.
Again, I am very sorry u had such a bad experience.

Anonymous said...

In addition to my last comment: I take it upon myself to learn about the conditions that my patients suffer. There are great resources out there for us to learn from. Lots of illnesses have consequences on oral health, that is one of the reasons why we update medical histories, so that we can have clues to a particular patient's oral health and contraindications to dental treatment.
I think u may need to explain your symptoms a little more to your future hygienist. Unfortunately for us, a lot of our patients express their pain as anger towards us, so it can be difficult being on the other side of the chair too.
I definitely think u should consider shortening the length of your appts.

Sherril said...

I'm going to be moving one of these days and am already not looking forward to finding a new dentist. It will "only" be a 3 hour drive and if I was healthy I would just make the drive... but then again if I was healthy I wouldn't need to!

In re-reading this great post and the comments I'm going to remember the hint to call ahead - and warn them that I'm difficult and I'm coming.

Aviva said...

@Sherril: There's nothing like having a conversation ahead of time with the dentist! I'd recommend that you not only explain your situation and what accommodations you need, but also ask if there's a hygienist who s/he recommends who is particularly good with special needs accommodations. Personally, I don't like the bite blocks; I'd rather be able to partly or fully close and relax my mouth while the dentist/hygienist switches tools, etc. Even the smallest one that my dentist usually uses on kids feels *so* big in my mouth! Since getting sick, I have started using nitrous oxide when I need drilling, etc., and find the extra expense (which isn't covered by my dental insurance) really worth it!! Good luck, both with the move AND with finding a new dentist. I always try to get personal recommendations from people who have bad teeth. ;-) Seriously -- I find it not very helpful to get recommendations from folks who have never had a filling or crown, etc., with a particular dentist. My teeth suck!

@Anon: You sound like a wonderful hygienist! Three years after I wrote this post, I do know that the fact that I didn't know my own limits was definitely a contributing factor with that awful experience I had. I also wasn't as comfortable (or experienced!) advocating for myself as I am now. That makes a huge difference. But I do think that hygienist had her own issues too, if only because I was far from the only one complaining about her (and she ultimately lost her job due to the number and causes of complaints). These days, I simply play it by ear and ask for what I need at the time, and none of the hygienists or dentists I've dealt with since have had any problem understanding.

iamkathrinfrey said...

I never want to encounter a dental hygienist such like that.

Whitni said...

To the person who wrote this ridiculous blog entry. You sound like a total pain in the ass. As a hygienist, I'd never put up with your crap. And by the way, it's below the standard of care to not measure recession and probe depths. The office you go to has the right to excuse you for compromising their license. Suck it up, everyone has hard days but that doesn't give you the right to blame it on someone else. Take responsibility.

Aviva said...

Wow, Whitni -- that's a lot of meanness you're spewing. But you're certainly entitled to your opinion. For the record, however, my dentist disagreed with your assessment, and I continue to go to her office every six months and as needed. Also, for the record, the hygienist in question apparently had garnered a large number of other complaints from patients and is no longer employed at my dentist's office. (She was not fired because of my complaint. However, eight months later, she no longer worked there and I was told that there had been dozens of patient complaints about rudeness and bullying and she had been let go.)

Meanwhile, I hope you're never in the kind of health crisis I was enduring when I wrote that post six years ago.