30 minute recall patients... Is it even possible?

The doctor said my recall patients will be seen every 30 min. Is it possible to update med history, xrays and cleaning in 30 mins? I mean some people's mouths are dirtier than others. And what if they show up late.

StaceyinDetroit in Detroit, Michigan said: The doctor said my recall patients will be seen every 30 min. Is it possible to update med history, xrays and cleaning in 30 mins? I mean some people's mouths are dirtier than others. And what if they show up late.

I sure hope that you have an assistant and another operatory to move your patients into for their exams because you are correct, 30 minutes is NOT enough time to do everything that you legally are supposed to do. I hope that you are including a soft tissue/oral cancer exam and full periodontal probing once a year as well. Maybe the dentist is going to do all this for you in the exam....LOL

It is obvious that in this office, you are only going to be the "cleaning lady".

StaceyinDetroit in Detroit, Michigan said: The doctor said my recall patients will be seen every 30 min. Is it possible to update med history, xrays and cleaning in 30 mins? I mean some people's mouths are dirtier than others. And what if they show up late.

I sure hope that you have an assistant and another operatory to move your patients into for their exams because you are correct, 30 minutes is NOT enough time to do everything that you legally are supposed to do. I hope that you are including a soft tissue/oral cancer exam and full periodontal probing once a year as well. Maybe the dentist is going to do all this for you in the exam....LOL

It is obvious that in this office, you are only going to be the "cleaning lady". If they show up late, I bet that you will be expected to see them anyway.

StaceyinDetroit in Detroit, Michigan said: The doctor said my recall patients will be seen every 30 min. Is it possible to update med history, xrays and cleaning in 30 mins? I mean some people's mouths are dirtier than others. And what if they show up late.

No, It is not enough time to do a proper prophy. Mills are happening everywhere now...even in PP. Unless you are working in a Pedo office with exceptionally clean pt. teeth and pt.'s are on time and you have enough kits, an assistant, etc...NO it's not enough time...you end up doing a 1/2 ......job....

I agree that 30 minutes won't be enough to finish all the job especially when patients came late. And also just what you said, patients have different oral conditions, the dirtier the mouth is, the more time is needed for cleaning.

Good Luck! I did it for quite a while and it leads to major burn out!! I used a Cavitron constantly and a prophy jet when possible. So much quality gets cut out you start to resent everyone in the office and feel used and abused. The more you do the more the dr expects. I've worked out of 3 ops, out of 1 op and it doesn't matter. The faster you get, the faster he thinks you should be. I've had to force myself to slow down, do the probing, do the pt education. Stick to your gut instincts and don't let them push you faster than you know you can do a good job to treat the pt well.

I'm a new grad & I have my first working interview this thursday for an office that does 30 minute cleanings, and 45 minutes for new patients. The doctor had told me that I would be jumping from one chair to another, & an assistant would be helping me break down the room & setting up, but as far as xrays go..i think i may be on my own on that :-/ ... I told him I am usually fast & i wouldnt have a problem with this..but in my head I am thinking WTH?!!! What have I got myself into???!!! I couldn't disagree with him, as I was afraid I would not get the job & I am desperate!! Anyone have any advice for me??

Suzanne in Terre Haute, Indiana said: Good Luck! I did it for quite a while and it leads to major burn out!! I used a Cavitron constantly and a prophy jet when possible. So much quality gets cut out you start to resent everyone in the office and feel used and abused. The more you do the more the dr expects. I've worked out of 3 ops, out of 1 op and it doesn't matter. The faster you get, the faster he thinks you should be. I've had to force myself to slow down, do the probing, do the pt education. Stick to your gut instincts and don't let them push you faster than you know you can do a good job to treat the pt well.

Suzanne,
What is a prophy jet?
Used and abused is definitely correct words for what you explained, how can someone not get negative about their job over that?
You used mostly cavitron? Ive only been practicing 1.5 yrs and I 85% use my hand instruments but I want to utilize my cavitron more (but will always follow up with some hand scaling!) because it is supposed to help with hand fatigue but I feel that everytime I use the cavitron and I go back and check with hand instruments, it is never completely plaque/calculus free. I just dont know how to get to the point where I can be confident that I was able to remove most/all of plaque/calculus with cavitron. Any advice?
Also what do you do for water evacuation, I struggle with areas where I need to use a mirror to retract, the suction doesnt hang in all patients mouth equally!

I let the patient hold the suction tube during most of the appointment but especially when using the cavitron. This way they can get excess water out of their mouth at any time they wish. This lets them have an element of control and often makes anxious patients relax a bit. They know that they can stop the appointment at any time with the need to get water out of their mouth.

iluvteeth,
A prophy jet is a hand held adjunctive for polishing. You can look in any dental supply catalog and find one. They utilize a baking soda/salt powder with water to polish and it removes stain like crazy. It is very messy and some pt's don't like it because they can leave with a face looking like flour. Have them wear safety glasses and a cape like in a beauty shop. I learned to use it by practicing shining pennies. Once you get the technique down, you'll love it! I had pt's who said they liked it better than bleaching. Lots of docs won't fork out the cash for it and I've had some who charge extra. Great on ortho and smokers. Yes, I used the cavitron all the time. After 17 years of scaling I've never had trouble with my hands. But I was trained to use it. My instructors were all veteran hygienists who knew what was down the road. I always bend the suction tip in an upside down U, have the pt turn towards me, I set on their left, and just rest it in the corner of the mouth. I use my leg to move it lots of times just a little bit and keep on going. Or I use my little finger on my right hand next to where I'm holding my mirror and move the suction with me. Same as when I'm polishing with prophy paste. If you still find calculus after you are done with the cavitron, you may be pressing too hard or grasping it too tightly. The more you press against the tooth surface, the less power the instrument has. Let it do the work, you just guide it. Take an empty pop can and put some super glue on it. Kind of drizzle it all over and when it's dry practice with your cavitron. It won't take you but a couple of minutes to see how lightly to hold it and how to feel what you can't see. You'll learn to use the tip to get under the calculus and pop it off in big pieces. Good luck and let me know if it helps! :)

To iluvteeth in Manteca,

A prophy jet is like an oral sandblaster that uses baking soda to blast plaque and stain off teeth. It also removes light veneer calculous. Works great around braces/brackets, crowded teeth, to remove tobacco stain, and in furcations.

Start using the cavitron regularly. I found quite by accident 20 yrs ago that beginning the appt /w coarse polishing paste and the prophy angle removed all the easy stuff and left the residual calculous brittle so it popped off much more easily. So now, as standard practice, I polish first, then cavitron, touch up polish, air-dry teeth to check for any missed calc, then use hand instruments in those areas as well as checking all the interproximals. I also use a polishing strip for IP's of the lwr ant's, followed by floss. And yes--I work in a prophy mill too. My schedule routinely has 16 or more pts a day in it. Fortunately, several do not show, and this gives me time to do a proper job. I *make* time for OHI. In the practice I am at, I never do x-rays. They are done in a separate appt before they see me. This is not the type of practice I desire to be in. It's the *only* one offering a job in the last 20 months where I live. Jobs just are not a dime a dozen like they were 20 yrs ago.

As for suction, I saw a class mate twist hers into a corkscrew that was a bit compressed, not a stretched out corkscrew. Hangs great that way. Twist one direction for left, the other for right. Play with it. You will figure it out.

(by the way, I am in So. CA now, not VA)

@ Stacy --> No, it's not possible to do all that in 30 mins. I've tried and failed. I run behind farther and farther.
@ exp in Newmarket--> I agree. Ditto. I do not get to do the kind of job I am trained to do. Frustrating.
@ Ashley920--> Get your OHI shpeel down pat and make it succinct. See my method above. Polishing 1st /w coarse saves a lot of elbow grease. Work the flange of the rubber cup sub-gingivally esp interproximally. Spend longer using the prophy cup. Change it if it tears or gets weak. Veneer calculous comes off /w pumice. Follow /w cavitron, then scale, the touch up polish where calc was heaviest. Air dry to ck for missed calc.

I am a dental hygienist and I live in Manitoba, Canada. I am allowed 50 minutes per patient for scaling, prophy and fluoride. I perform an oral screening exam every appt as well as a PSR exam. Previously, a dental assistant with her scaling module performed cleanings so if I need extra time for perio treatment, I am granted this. I love knowing that I have done a thorough job at the end of each appt and that I have offered the best service I can provide. I provide OHI for individuals who have specific needs as well as nutritional counselling.

Also, I never focus solely on supragingival calculus. Removal of supragingival calculus has very little effect on periodontal health. Rather I focus on deep subginigval calculus and make sure as much as possible is thoroughly removed. I use cavitron inserts as well as hand instruments.

AdriannaD in Winnipeg, Manitoba said: Also, I never focus solely on supragingival calculus. Removal of supragingival calculus has very little effect on periodontal health. Rather I focus on deep subginigval calculus and make sure as much as possible is thoroughly removed. I use cavitron inserts as well as hand instruments.

I suppose you would be proud of yourself because you are doing so much better of a "cleaning" than the assistant before you was. However, focussing on getting "as much(calculus) as possible thoroughly removed" during your 50 minute appointment is what worries me. Do your clients know that you are leaving some behind? If not, you are not being ethical, Adrianna. Actually, I don't think you can put "as much as possible" and "thoroughly removed" in the same sentence! Furthermore, if I was your client I would want my supragingival AND subgingival calculus "thoroughly removed". You may want to consider rebooking some of your 50 minute clients before they become a part of your "perio treatment" group.

It IS possible but it is very stressful. Do they have a dental assistant that will help you clean the room between patients? But yes I have worked in offices with 30 min recalls. It is tough but these patients are used to it. Don't chit chat too much with the patient because when their lips are moving you can't clean their teeth! You should give it a try if it is the only job available. Make sure to ask every patient if they have any medical changes (have they had any surgeries in the last 2 years? Any new medications?) then take xrays (usually bite wings for recall patients) and run over and put the xrays to develop (if using films). Then do a quick intra/extra oral exam and then proceed to scale. Pull out the ultrasonic scaler if they have a lot of calculus or stain. These patients are used to having short appointments. Do your best. Get all visible large calculus off their teeth first. Polish as quick as possible or selectively polish only visible stains. Then floss and call the dentist for the exam. Do a quick perio check once a year or while waiting for the doctor to come in. Just go around and write down only 4+mm pockets in the chart. Make sure you aren't chit chatting much and remember dentists who want 30 min recalls aren't looking for perfection. They want gently, quick cleanings that get off all the large visible calculus and all or most of the staining.

Oh and to save time I only let the patient sit up and rinse themselves after I polish all their teeth and then at the very end when I am done flossing them. It wastes time to have them sit up and then back down, etc. So as I scale I suction or let them hold the suction. And every time I finish 2 quadrants of scaling I rinse and suction their mouth with the air/water syringe because then they don't move and don't take too much time rinsing. Some patients like to swish again and again if you give them a cup and a sink. I use the water syringe myself and just explain to the patient that I "don't want to make them dizzy sitting up then laying back down over and over". So I rinse them myself and let them rinse at the end of polishing and then after I floss them. This helps save precious minutes.
In this bad job market do NOT pass on any job they are willing to hire you for. Remember in an office that does 30 min prophys they aren't like school was. They don't expect full perio charts each visit (you can just do a quick check for 4mm+) and they don't expect all sub calc will be removed. These patients are used to barely having their teeth cleaned, sadly. So you must go VERY EASY on their mouths or they will complain about you to the front desk.

granolagirl in Airdrie, Alberta said: I suppose you would be proud of yourself because you are doing so much better of a "cleaning" than the assistant before you was. However, focussing on getting "as much(calculus) as possible thoroughly removed" during your 50 minute appointment is what worries me. Do your clients know that you are leaving some behind? If not, you are not being ethical, Adrianna. Actually, I don't think you can put "as much as possible" and "thoroughly removed" in the same sentence! Furthermore, if I was your client I would want my supragingival AND subgingival calculus "thoroughly removed". You may want to consider rebooking some of your 50 minute clients before they become a part of your "perio treatment" group.

You're right, I shouldn't put "as much as possible" and "thoroughly removed" in the same sentence :) I rebook someone if I think I have not removed all calculus and I do tell my patients this. I remove supragingival calculus but this is not my primary focus especially if someone has +4mm pockets. Otherwise thanks for the suggestions :)

RDHCJ in Boston, Massachusetts said: It IS possible but it is very stressful. Do they have a dental assistant that will help you clean the room between patients? But yes I have worked in offices with 30 min recalls. It is tough but these patients are used to it. Don't chit chat too much with the patient because when their lips are moving you can't clean their teeth! You should give it a try if it is the only job available. Make sure to ask every patient if they have any medical changes (have they had any surgeries in the last 2 years? Any new medications?) then take xrays (usually bite wings for recall patients) and run over and put the xrays to develop (if using films). Then do a quick intra/extra oral exam and then proceed to scale. Pull out the ultrasonic scaler if they have a lot of calculus or stain. These patients are used to having short appointments. Do your best. Get all visible large calculus off their teeth first. Polish as quick as possible or selectively polish only visible stains. Then floss and call the dentist for the exam. Do a quick perio check once a year or while waiting for the doctor to come in. Just go around and write down only 4+mm pockets in the chart. Make sure you aren't chit chatting much and remember dentists who want 30 min recalls aren't looking for perfection. They want gently, quick cleanings that get off all the large visible calculus and all or most of the staining.

Wow...this is shocking. 30 minutes...SAD.

RDHCJ in Boston, Massachusetts said: It IS possible but it is very stressful. Do they have a dental assistant that will help you clean the room between patients? But yes I have worked in offices with 30 min recalls. It is tough but these patients are used to it. Don't chit chat too much with the patient because when their lips are moving you can't clean their teeth! You should give it a try if it is the only job available. Make sure to ask every patient if they have any medical changes (have they had any surgeries in the last 2 years? Any new medications?) then take xrays (usually bite wings for recall patients) and run over and put the xrays to develop (if using films). Then do a quick intra/extra oral exam and then proceed to scale. Pull out the ultrasonic scaler if they have a lot of calculus or stain. These patients are used to having short appointments. Do your best. Get all visible large calculus off their teeth first. Polish as quick as possible or selectively polish only visible stains. Then floss and call the dentist for the exam. Do a quick perio check once a year or while waiting for the doctor to come in. Just go around and write down only 4+mm pockets in the chart. Make sure you aren't chit chatting much and remember dentists who want 30 min recalls aren't looking for perfection. They want gently, quick cleanings that get off all the large visible calculus and all or most of the staining.

Wow...this is shocking. 30 minutes...SAD.

AdriannaD in Winnipeg, Manitoba said: You're right, I shouldn't put "as much as possible" and "thoroughly removed" in the same sentence :) I rebook someone if I think I have not removed all calculus and I do tell my patients this. I remove supragingival calculus but this is not my primary focus especially if someone has +4mm pockets. Otherwise thanks for the suggestions :)

Good to hear, GL and hopefully you will get longer appointments some day! Especially if you keep bringing them back for a second appointment ;)

I wish I didn't have to but when there is calculus visible everywhere on x rays, I don't have a choice. Oh well, I haven't heard of too many offices that do 30 minute recalls in Canada yet so I count myself lucky for that.