Was my dental cleaning improper?
June 26, 2010 7:27 PM   Subscribe

Was my dental hygienist incompetent? I had a recent dental cleaning that just didn't seem right to me, and I would like some insight as to whether I am off-base in my suspicions or not.

I went for a dental cleaning on Wednesday, and things just didn't seem right for a number of reasons. Could you please help give me some insight as to whether I'm just imagining things, or whether something inappropriate may have gone on?

Here's what led up to this visit:

I had not gone to the dentist for about 18 months since I really had no money to pay for any work that would need to be done. I do have dental insurance, but the portion I am responsible for has a tendency to add up. So I went a couple of months ago, and it turned out I needed three fillings replaced and some seriously intensive cleanings ("root planings" I think?) due to a lot of buildup and deep gum pockets developing.

I had the intensive cleanings, done in two visits, which cost me about $200. It was unpleasant and severe, but it needed to be done obviously, and I have no doubts about the competence and thoroughness of the hygienist for those visits, whom I will call Kathy.

So that's the background. This most recent visit was a two-month followup regular cleaning, since they want me on a more frequent schedule to keep on top of things and check my gum pockets for improvement.

I go to the office and Kathy is not there, instead I get a different hygienist, let's call him Ken. He seems like a nice enough guy, we talk about videogames, and stuff like that. No problem. He does seem a bit unsure of himself as he's explaining some stuff to me about my visit, with lots of "um"s and "uhhh"s and pauses, but I figure it's no big deal, some people are just nervous when speaking with clients.

Onto the cleaning. First he measures my gum pockets. This is my first intimation that something is a bit off, because he doesn't seem to insert the probe very far or very forcefully, he's barely touching my gums. When it was done before (by Kathy), I remember it being a bit uncomfortable. Ken tells me the pockets are not as deep as they were, which is good news.

The next thing that happens is he gets out the spinny thing with the gritty paste stuff, and goes over my teeth with it. I don't know and I'm hoping you can tell me, is this not the polishing implement, intended for the last step, not the first? It seemed weird to me. He is awkward with the instruments and seems to have difficulty positioning the light, my chair, his chair, and the instruments. He uses the foot pedal to spin the device for intervals of about a tenth of a second at a time, hitting it repeatedly very quickly. This was unlike any other time I've had that tool used on me.

He rinses my mouth only after he has completed the whole thing, not after each section as I would expect. When he squirts the water, it goes everywhere (I had an eye shield on, luckily) and it just seems like he doesn't have a very skilled hand with it. He starts out using the dental mirror but later uses his fingers. For awhile he's holding the suction pointed down next to my head, which seems odd to me.

Finally he's done and he rinses my mouth and on to the next part.

Now he brings out the hook-type tools for the scraping part. He scrapes my lower front 4-6 teeth and that's it, it's over. I was wondering why he didn't do the rest at all, but by that time the visit has gone on for almost an hour and I need to get back to work. And I had a weird feeling about this guy's skills at this point so I didn't really want him poking around in my mouth anymore.

Does this sound like a standard reasonable cleaning, or what? And if it sounds off to you, how should I address it with the dentist? I am very non-confrontational so I didn't say anything at the time, and I'm just not sure that my suspicions are really correct.

If I should bring it up with the dentist, I'd prefer to do it in writing. That would give me the best chance to compose my thoughts and also give him a chance to rebut each thing I said if they bring it up with him.
posted by marble to Health & Fitness (14 answers total) 1 user marked this as a favorite
Planing and scaling! Hah! I've had that done TWICE, believe it or not. *rolleyes*

I've been seeing the same hygienist for two years, and she does the same steps every time but always in a different order. Sometimes it's manual scraping first, sometimes it's ultrasonic, sometimes it's polishing. I think she does it to make her life more interesting. Either way, I leave with clean teeth.

Your guy sounds like a newbie, fresh out of school. His awkwardness says to me that he just hasn't done the twenty thousand cleanings that your other hygienist has done. He'll get better with practice. I'm sure he knows he was terrible, after all, he's been to hygienist school or he wouldn't be cleaning your teeth in the first place.
posted by goblinbox at 7:41 PM on June 26, 2010

I have had cleaning done for decades every few months. I have never seen a cleaning performed as you stated. I would assume he was new and inexperienced. Of course you should tell the dentist. And writing it will give you the best opportunity to not leave anything out that you need to tell him.

His sequence is very odd and I have never had a cleaning or exam done in that way.

Actually I can hardly believe that he was that incompetent .You really need to tell the dentist.
posted by JayRwv at 7:44 PM on June 26, 2010

This doesn't sound very strange at all. It didn't hurt when he checked the gums because they were in better shape (this part SHOULD NOT hurt at all). He didn't scrape all the teeth because you were just there 2 months ago there should not have been too much to remove.

I'm pretty sure that there is not a whole lot of rinsing that ever goes on. All the other stuff was pretty minor and different because last time you had an epic cleaning done. He just sound new or nervous but not wrong or incompetent.
posted by saradarlin at 7:46 PM on June 26, 2010 [3 favorites]

What saradarlin said.

In my experience, they scrape whereever there happens to be plaque buildup. Sometimes that's all over, sometimes there's hardly any scraping. Also, I have never experienced pain from them measuring my gums, even the first time I went after not seeing a dentist for over ten years. That's not normal unless whoever is doing it is jabbing you in the gums really hard or your gums are very inflamed.

As an aside, if you keep up with your cleanings, there will be much less of the expensive work to be done later.
posted by wierdo at 8:02 PM on June 26, 2010

Sounds ok to me. I have had this done a few times.
posted by fifilaru at 8:17 PM on June 26, 2010

I can't speak to the competence of your hygienist, but I can speak to the relative comfort/discomfort of having gum pockets checked. When I first returned to the dentist after a seven year absence, having my gums checked was excruciating, and I had to have a scalar root planing done. (I actually needed an SRP, a root canal, two crowns, and 17 fillings. They knocked my ass out and did it all in one marathon 9 hour session.) When I returned for my next appointment, 2.5 months later, the gum check was probably about half as painful as it had been before. Now when I go it literally just feels like the hygienist is massaging my gums with a Q-tip.

The whole point of the root planing is to get rid of the ick that is making your gums inflamed and painful. With that gone, the check is going to hurt a LOT less.
posted by KathrynT at 8:20 PM on June 26, 2010

I would not write to the dentist about it. Reading through your review of his performance, you seem to focus more on his unconfident manner (the umms and uhhs, the fumbling, the re-positioning of instruments, himself, his chair, etc) than the actual cleaning process. He certainly sounds new, nervous, and awkward about it all....but aren't we all that way with some job or chore we're supposed to do, at some point? He will get more comfortable with it in time, and I don't think it needs to be brought up with his supervisor.

I've been to the dentist twice for cleanings in the past year. His procedure does not sound odd to me. The only thing not in line with my own visits, is that yes....I was scraped with the metal hook before I was polished each time. But I was only asked to rinse once after scraping, and once after polishing both times. And they did not scrape me as much on my second visit as they had on my first. On the first visit, I had not been previously for a couple of years, so that cleaning process was longer. When they measured my gum pockets in the beginning, the first visit was much more uncomfortable than the second by quite a bit as I also hadn't been flossing before then.

If you're still concerned about it though (perhaps my own experiences are not the norm), why don't you call the front office, say you have a couple of questions, and just ask what their normal cleaning procedures are? Without mentioning your last experience or Ken at all. Just say you're curious about their cleaning procedure, ask if they always scrape before they polish, and if they always scrape all of the teeth. If your experience is out of line with what they say (for instance, if they say "yes we always scrape before we polish") then okay, consider writing the letter.
posted by Squee at 8:28 PM on June 26, 2010

Did the Dentist check your teeth after the procedures were complete? Whenever I go to the Dentist, after the hygenist does her/his work, the Dentist comes in and checks everything and will tell me if any further work needs to be done.
posted by cleo at 8:36 PM on June 26, 2010

I've had the polishing done first when, after a preliminary look around my mouth, the hygienist decided there wasn't a whole lot of scraping to do. Sounds like that was the case for you if he only did a few scrapings.
posted by otherwordlyglow at 8:39 PM on June 26, 2010

I could have written the OP, minus the concern about whether or not it was 'reasonable'. Nothing sounds negligent or out of place... with multiple visits and a lot of work being done, the things that are going on in your mouth just change from one visit to the next. Be happy that checking your gums didn't hurt - that means what they are doing is working. And be happy that each cleaning is less intensive - that means your teeth are cleaner and healthier. The rest sounds like it is just nervousness on the part of someone right out of school, but none of it sounds like neglect or malpractice.

If you do talk to your dentist about it, I wouldn't complain about the hygienist. Just ask why measuring your gums didn't hurt the second time, and why that final cleaning was only on the front teeth. If the dentist thinks those things are odd, they will talk to the hygienist on their own. Lodging a complaint could mess up someone's career or make future visits awkward, and it doesn't sound like what happened merits that.
posted by foobario at 8:46 PM on June 26, 2010

You could always tell the office manager that Ken seems like he wants to do well, but needs to be a little more assertive and upfront when he's explaining procedures so that the patients know he's doing everything necessary.

My dentists of the moment (oh boy, one root canal this month and maybe one next month) are so informative that sometimes I have to suppress a "yes, been here, I know" moment, but it's understandable that they want people to be completely aware of what's going on.

Also, set up a "hey, take your tools out of my mouth for a second" hand signal with your hygienists so they can stop and you can rinse/ ask questions when possible. Question everything, assume an active interest in what's going on. I have far-ranging drug allergies, and I know now to eye the vial and say "Hey, what's that, anyhow" before anyone puts a needle near my gums. The more they explain, the more you know what's going on, and if they're not explaining enough, just ask to consult with the dentist before you leave.
posted by fairytale of los angeles at 8:51 PM on June 26, 2010 [1 favorite]

When I'm flossing regularly and have had my teeth cleaned on schedule, the back of my four lower teeth is the only place I have buildup that needs to be scraped. So that piece didn't seem odd to me. Likewise, having my gum pockets measured has never been the least bit uncomfortable for me.

The sequence is odd--they always do the scraping before the polishing, IME. But overall I'd say Ken seems awkward but not incompetent. Not sure it merits a complaint; that's up to you. If I were uncomfortable with how often I was being rinsed during polishing, for instance, i'd just make a mental note to mention it before my next cleaning.
posted by not that girl at 9:34 PM on June 26, 2010

I just got my teeth cleaned in Japan, and here they didn't even do the polishing part! I felt kind of sad about that.

The hygienist did however, just clean the back of the lower front teeth, and also told me that that is where plaque is most likely to accumulate for most people, along with on the upper back teeth. If you are brushing well, then it isn't surprising you didn't have to have much plaque scraped away.
posted by that girl at 12:27 AM on June 27, 2010

That sounds pretty normal to me. When I have my gums checked, it never hurts. I would imagine as your gums get into better shape, the check won't hurt.

The order that this hygenist did things in seems rather similar to the order my hygenist does things, except sometimes she uses the motor scrubby brush for polishing twice --- once at the beginning and once at the end. I also only ever rinse once she's all done unless I ask to rinse between instruments, which she is fine with. If you prefer to rinse more, then ask to do so at the start of your visit. I can't believe it would be an issue.

All in all, sounds just fine and like your teeth are getting better. Keep it up! And go in for a regular cleaning in six months.
posted by zizzle at 6:51 AM on June 27, 2010

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