Cleanup on Isle... Everywhere (UPDATE!)
Greetings, fellow hygienists!
It is I, your frequently grumpy, always awkward, brazen, verbose, —tism anointed hygienist with another (absolutely justified) rant and need of your wise counsel.
As mentioned in previous blog posts, I do temp hygiene full-time. I have several offices that I consider my “favorites,” and I always try my best to accommodate them when they need me. I take extra care at these offices to superglue my normal human mask into place, to be hyper-aware of my facial expressions so my resting bitch face isn’t so… bitchy, and to adjust my vocal tone so I sound more like Loretta Devine and less like Wednesday Addams.
In terms of technique and skills, my greatest strength is also the source of my eventual and premature demise: I am unfailingly (and perhaps obnoxiously) thorough. I leave NOTHING behind. I have literally broken my body due to my inability to allow a spicule of calculus to remain on a patient’s teeth. Frankly, I don’t trust any hygienist who has been practicing for over three years and still has any feeling left in their dominant fulcrum finger. All or nothing, I scale to competition and will not compromise in this regard.
I should also add that my background is in perio, and NSPT is my forte. It is what I’m most passionate about, where I am most skilled, and what I most enjoy doing. I take periodontal disease very seriously and maintain strict rules when diagnosing. I only recommend them when absolutely necessary—especially in older, established practices that often don’t react kindly to some noob coming in and informing their patients they need some expensive newfangled fancy cleaning thingy.
With all of that personal context established, let me set the scene…
I have been working at an office fairly regularly since October of 2024. They needed someone to fill in while they looked for a permanent hygienist. They hired one in December, but then she had an injury to her wrist and couldn’t start for a few weeks. So, they asked me to fill in on Mondays and Tuesdays until she was healthy enough to work. That start date has now been pushed back three times, so I’m currently booked with them through the end of March.
The office is tiny: one doctor (with a very light schedule), two assistants (who also work at the front desk as needed), two hygienists, and an office manager. The doctor is fairly young (but not green) and bought the practice several years ago from a retiring dentist who seemed to be beloved by his patients.
The current doctor Is a little too conservative for my liking, choosing to “watch” areas I believe need addressing considering the patient’s inadequate homecare. He’s one of those doctors that you need to take by the hand, point out the troublesome areas, and essentially diagnose for them, or they simply don’t see it. It’s a bit frustrating.
He’s very timid and mild-mannered, almost to a silly degree. He always asks the patients ridiculous questions like, “Can I adjust your chair?” It’s your chair, doc. Just tell them you’re going to lean them back. Or, “Do you mind if I take a look?” Really? You do know that’s your job, right? What are they going to say? No? It's very bizarre. But patients seem to have taken his acquisition of the practice positively, so I just roll my eyes and shut my trap.
The assistants are lovely and very helpful, keep the office running like a well-oiled machine, are loved by their patients, and seem to be excellent at their jobs.
Everyone is very sweet, and the overall vibe is pleasant and calm.
…Except in my operatory for reasons that did not originate with me. I’ll explain.
The other hygienist is a man (rare, I know) in his late 40s who has been in hygiene a little longer than I have. The first thing I noticed as I walked into the closet-sized break room on my first day was a sheet of paper taped to the wall with “Don’s Spot” printed on it in clipart with an arrow pointing down to the countertop below. The two assistants are the only other people who eat in the break room (I hide in my car during lunch at every office I work in), so this was entirely unnecessary. A little territorial and petty, are we? I thought, setting my bags in the chair next to his “spot” where he eats his Lean Cuisine for lunch, stinking up the office with shrimp scampi—
📢🚨⚠️WARNING! Anyone who brings seafood, broccoli, or pork rinds into a dental office is on my hit list, and you deserve to be thrown into a volcano. Your Sisters in Scalers thank you for your compliance with rule #H8-S71NK-i. Have a fabulous day.
Sorry for the interruption. Where was I? Oh yes, Don…
I was surprised to discover he was straight, married, with two grown sons. But he sure did act like a snobby little bitch. After working a few shifts, I noticed that Don was doing 35-minute prophys. All. Damn. Day. Me? I’m generally staying on time but struggling due to all the sub-gingival calculus I find on nearly every single patient.
Because I turned a mental illness into a career, I’m very used to cleaning after lazy and technically poor hygienists who do the bare fucking minimum to keep the doctor happy and the patient thinking they’re “just so gentle.” If I can see a boulder of calculus on the distal of a second molar (seriously people, it’s just not that hard to reach back there), I frequently warn my patients beforehand as I show them the deposit on the x-ray that “I might be doing a little extra digging to remove this, so don’t be alarmed.” I am also frequently told that I’ve just given them the best cleaning they’ve ever had, so I know that this is appreciated and that I am very good at my job.
That being said, things have been getting so much worse over the last month.
I arrived one morning and logged into the computer to check my patient’s charts for the day. Both the previous hygienist who retired (whose position I was covering) and Don had notes that can only be described as “legally adequate” but clinically useless. It’s the same thing written over and over giving irritatingly little detail as to what kind of clusterfuck I’m about to encounter. They both seem to lie and say things like, “perio 3-5mm” but when you look at the perio chart, none has been done. It’s maddening.
I work my way down the schedule, arriving at the patient right after lunch and read through the notes for the last few appointments (which again, doesn’t really tell me anything). Just prophys again and again with “inflamed tissue” and “moderate deposits.” Does that mean heavy bleeding and an active infection? Is that moderate plaque or moderate calculus? Why do you repeatedly write the same thing without doing a 4346 or NSPT? Who the fuck knows…
So I opened up her x-rays, and I was horrified to discover enormous ledges of calculus EVERYWHERE with 4-6mm of generalized bone loss. I’m even more horrified to look at all of her x-rays taken since 2008 and can see THE SAME DAMN DEPOSITS OF CALCULUS. This woman needed NSPT since 2008, and NO ONE did a damn thing back when her (now severe) periodontal disease was in its infancy and more easily treated. I looked up her perio chart, and SHE’S NEVER HAD ONE RECORDED. I am beyond livid. I’m disgusted. I’m about to lose my shit. I—need to fix my face…
One of the assistants comes in and tells me that I’m seeing the dentist’s daughter who previously owned the practice. She tells me the name, and I’m absolutely mortified to realize that I’ve been reviewing her chart for the last five minutes and that my day just got really, really shitty.
I show the x-rays to the assistant and tell her there’s no way I can do a prophy on this woman. My normal human mask flew off, and I could feel my eyebrows dancing wildly on my forehead and fire coming out of my eyes.
“How did this happen??” I pleaded with her, knowing she didn’t have an answer for me. Her face looked like I had slapped her, and I realized I needed to pull myself together. “I’m sorry,” I said, “I just don’t understand why a dentist’s daughter has periodontal disease that hasn’t been treated in seventeen years! The notes say nothing about this. Has everyone just placated her because of who her dad was? Is she mean? What’s the deal???”
I took a deep breath and tried to rearrange my face into something less unhinged. “When she comes in, I will need help doing a perio chart after I update her x-rays. Can you help me?” The assistant smiled and told me she’d be happy to. I thanked her and chewed on my lip as she left the room.
I’ve had to explain to dozens and dozens of people over my career that they have periodontal disease after coming religiously every six months for years because their asshole dentist and hygienist didn’t do their jobs. This is called medical negligence, and it fries my ass. It puts people like me in the awful position of awkwardly having to provide lame excuses for why they haven’t been receiving the care they deserve, and how not receiving that care has now contributed to the degradation of the bone literally holding their teeth in their head.
⚠️📢🚨WARNING! Do not be the person who makes dentistry a living hell for people like me. These conversations are uncomfortable, frequently invoke anger that is pointed in my direction when I’m not at fault, and force me to lie (badly) for you as I attempt to explain why I found what you missed—sometimes for years—and why the patient now needs to fork over hundreds of dollars for an invasive and uncomfortable cleaning. Your fellow Mouth Maids against s. Mutans thank you for your compliance with rule #D0-B3773R-mmk. Have the day you deserve.
Hmm? Who was that? Oh, just my dental hygiene cyborg overlord. She gets a little cranky when people break the rules. You should see her when offices aren’t OSHA compliant. She gets really loud and flails around like a used car lot noodle man. Anyway, as I was saying…
Before I saw the retired dentist’s daughter, I had to change two patients’ treatment plans into 4346s due to the amount of sub-gingival calculus and bleeding so heavy that it looked like I was killing them slowly. You could see the calculus on the previous x-rays, so this was shit that should have been removed at their last prophy, but obviously wasn’t touched. Thanks Don, you useless nitwit…
So, how did her appointment go?
About as bad as it gets.
I took her x-rays and held my breath (partly out of necessity) as the first image loaded on the screen. I had some faint hope that maybe Don had bothered to do his job and removed some of the boulders from beneath her gums. But alas, my heart sank as I saw the same ledges, even bigger than before, clearly visible on the radiograph.
I wiped down the tube head and tried to steel myself for what would surely be an unpleasant situation. I adjusted my voice so I sounded gentle and began explaining what I saw on her x-rays. I asked her if anyone had told her about periodontal disease or what needed to be done to treat it. Her eyebrows scrunched together, and her eyes started getting red. “No,” she said tersely.
I continued, explaining the disease process and why she would need a deep cleaning to remove the calculus deep under her gums when she suddenly interrupted me, becoming very loud and animated with tears welling up in her eyes. “How much is THAT going to cost?? I can’t AFFORD THAT! I just want a CLEANING!!!”
I told her I don’t handle dental insurance, but I’ll get her a treatment plan together so she can review everything with the front desk. I apologized and said, “I know this is upsetting, and I don’t know why no one told you before. But with a deep cleaning, hopefully, we can get you healthy and—”
“So you’re NOT going to clean my teeth today!?” she snapped, now sobbing like I had just murdered her pet. “I can’t,” I lamented, becoming increasingly flustered by this interaction I was failing to control. Crying people make me incredibly anxious because I have no idea what to do with them. Angry and crying is just adding fear to the cringe, and the combination is overwhelming and befuddling. I tried to stick to my script, still talking softly. “You have a gum and bone disease that we have to treat. You don’t qualify for a ‘regular cleaning,’ and I would be committing malpractice if I knowingly performed an inappropriate procedure that didn’t treat the underlying cause of your periodontal disease.”
Her face reddened, and the tears were now soaking her ugly, ill-fitting t-shirt. “Well, if YOU won’t clean my teeth, I’ll just get DON to clean them!”
I was starting to get annoyed at this point. Why the tears? Why the hysterics over a cleaning? Why the resistance to receiving the cleaning she actually needs? How does the daughter of a dentist have breath this bad and care so little for the 28 little body parts in her mouth? I’m the daughter of a dentist, and I’ve never had a cavity. Her mouth smells like week-old garbage, and she cares more about getting her “free cleaning” than she does about potentially losing her teeth to a treatable gum disease.
The dramatic waterworks started to feel very manipulative, and she became increasingly hostile. I sensed that this was a woman who used crying as a weapon to get what she wanted. It was all too… extra. Unfortunately for her, she picked the wrong unempathetic, emotionally constipated, autistic girlie to try and pull that bullshit on. My voice was much less gentle now.
“I’m sorry, but it doesn’t work like that. It’s not that I won’t clean your teeth; it’s that I can’t. I’ve determined that you need a different type of cleaning due to the large deposits and severe bone loss I can see on your x-rays. Don would have to do a deep cleaning on you as well.” I didn’t tell her that Don should have done a deep cleaning on her years ago and that he’s a lazy twatwaffle who should have his license revoked for this. I didn't think she would have taken that well, so I kept it to myself.
“And who’s decided this? YOU?? I want to speak with the doctor. NOW!! He’ll tell you to clean my teeth!” I don’t always read facial expressions accurately, but rage was one of which I was intimately knowledgeable. Something short-circuited in my brain, and I suddenly felt like I was standing inside a tunnel that was only three inches tall. My stutter came back as I said, “O-oh, o-of course. I’d-d like to f-finish m-my exam (I needed to perio chart) and then I’ll g-get the d-doctor right after s-so he c-can do his-s exam, check f-for cavities, and an-answer your qu-questions.”
She wiped away more tears and wiggled out of the chair. “I don’t feel comfortable waiting here with YOU. I’ll wait up front for the doctor. I want to speak with him. NOW!”
She left the room and I stood motionless in shock. Why is it always me? Who treats a total stranger like this? I’m trying to help her. Did I not explain that? What did I do to make her uncomfortable? She has the audacity to think I’m going to risk my license and clean her teeth against my will?? Has this person lost their damn mind? My brain wouldn’t shut up. I wanted a cigarette (I quit smoking years ago). I needed my vape. I hauled ass into the staff bathroom and worked on putting my face back into place.
I walked to the doctor’s office and explained the situation as best I could, trying to get my stutter under control. He looked at her x-rays as I pointed out the same hunks of calculus that had been there since 2008. I told him she was waiting for him in the lobby because she didn’t want to wait in my room. He looked confused, but I didn’t elaborate further.
I tried listening to what the patient and doctor said while hidden behind the front desk, but their voices were too low to hear. I went back to my room to pout. The doctor came back about fifteen minutes later. I walked back to his office and asked how it went. He backed me up and told her he agreed with my assessment, which was a relief. Then he told me that she probably wouldn’t be coming back. “Any office she goes to will recommend NSPT. She should have had it done years ago," I said bluntly. He agreed, and I went back to write up my note. I didn’t want to linger and give him a chance to fuss at me.
Over the next three weeks, I saw more and more patients with heavy deposits plainly evident on x-rays taken six months to several years ago, all only having prophys completed. I saw two patients that were seen as new patients six months ago who had no perio charts recorded and prophys noted in the ledger that I had to reschedule for NSPT due to bone loss and heavy radiographic calculus—both seen by Don.
I had a patient who hadn’t had x-rays taken since 2019 that Don was perfectly fine seeing blind all these years, but I refused to treat her without current radiographs. She asserted to me that she “didn’t need them.” You don’t need them, pookie. I NEED THEM. And Don (and the dentist) are both morons for not putting their foot down and insisting that they needed updated x-rays for them to see her, too. I won’t put my license at risk by allowing a patient to dictate how I do dentistry, forcing me to unethically treat someone without reasonably current x-rays. Fuck that. She had radiographic calculus on the x-rays taken in 2019, so I knew the situation would be a nightmare. But I guess now I’ll never know. She was rescheduled and put back on Don’s schedule since ethics don’t matter much to him.
And just this past Tuesday, I treatment planned two patients back to back with NSPT who had never had perio charts recorded and had 3-7mm pockets with heavy bleeding. Both were seen for prophys by the previous retired hygienist and Don the Doofus for the last several years.
One of those patients had an abscess on a previously root canalled tooth that I had no idea was there until I probed and saw exudate seep out of the probing site. They had taken an x-ray of the tooth six months prior, but the radiograph didn’t go past the root apex, meaning the image was useless and should have been retaken. After probing, I took a diagnostically flawless image (which the patient had no trouble with, so there was no excuse not to retake the image) that confirmed the abscess. We referred her to the endodontist and she promptly made an appointment to have it re-treated and came the very next day to have the right side of her NSPT competed.
And that’s the reason why we probe. That’s the reason why we get x-rays right the first time. That’s the reason why we scale sub-gingivally. That’s the reason why we accurately assign the appropriate procedures. Our patients won’t know they have something that requires treatment if we don’t inform them. Most patients want to know if something is wrong so it can be fixed. Doing a supra-gingival prophy, patting them on the head, and sending them on their way is robbing them of their agency to make serious health decisions and lifestyle changes that’ll improve their outcomes. It isn’t right, and frankly, I’m angrier than a hornet’s nest that got mistaken for a piñata.
So here’s my conundrum: What the fuck do I do about this? The doctor seems completely oblivious to the fact that his patients have been severely neglected—some for decades—by his current and previous hygienists. I’m not going to be there permanently, so I’ll have no involvement in his patients’ future treatment. I feel like the doctor needs to be made aware that Don isn’t doing his job and is harming these people by being a lazy clinician.
But if the doctor hasn't noticed by now, does he even care? Would telling him do any good? Is he so nonconfrontational that he won’t stand up to his patients to demand x-rays or his staff to demand competency? I don’t want to burn any bridges, but my ridged sense of justice is screaming at me to advocate for these people.
What should I do? Tell the doctor what I’m seeing with receipts, showing him the dozen (or so) charts that support my claims? Or finish out my time there and move on without rocking the boat?
⚠️📢🚨WARNING! System overload. Must reboot and await further instructions. Thank you Damsels of Dentistry for your compliance with rule #43LP-M3-PL33Z.
Oh no!
<Ctl, Alt, Del>
*blue screen of death*
Eek!
C:/___ *blink blink*
<Run Program: Temp-Dent-Hyg-Prob-Fix>
<Enter>
Retrieving Data: Please Wait…
🔄
Let me know in the comments!
*hums Headstrong by Trapt*
⚠️UPDATE!!
The office manager messaged me to cancel my services. I was disappointed that I would no longer have the opportunity to discuss my concerns with the doctor in person. But honestly, I'm an introvert and a writer, so I'll just assume the universe is doing me a solid by limiting my options to only conversing via text.
I've posted the screenshots of our conversation below.
It's off my chest and in their hands now. I've done what I could. Now I'll deal with Don the Dimwit and yeet his incompetent ass into the gaping maw of the state dental board. I'm sure he'll find a new "spot" on the dental board's list of naughty dental professionals who now have their licenses revoked. Don crossed scalers with the wrong mouthmaid. 👿🦷
I offered to return as a polite gesture, but I always assume I won't return to an office once they fill the position I'm covering for. I never received a response after this. I wish them the best.
Except Don. Don can go fuck himself.
