Newbie Dentist

Dental Hygiene is cool and sexy.

Sue Rusalen

Now that I have discussed the general mindset of newbie dentists, let me begin to discuss the mindset related to a common clinic procedure. Many dentists often underrate this procedure, but I believe it is the most important clinical procedure – the “scale and clean”.

I always found it disturbing to hear the phrase, “It is just scale and clean”!!

My insight into the importance of scaling and cleaning teeth started in my dental school days. When we were taught how to write up a treatment plan for our patients, the professor told us, “If I don’t see the scale and clean appointments at the beginning and the end of the treatment plan, you’ll get an F for failing.” At first, I thought he just wanted to stress the importance of providing complete patient care. However, I discovered later that this relatively simple procedure also significantly impacted my growth and career as a dentist.

Suppose you ask someone with no dental background about what dentists do. I bet most of their answers will be along the lines of “taking care of someone’s oral health by examining teeth, cleaning teeth, filling teeth, and removing teeth.” In other words, in the general public mind, a good/great dentist is the one who masters all these skills. They don’t care as much if you can cut a perfect crown preparation with less than 10 degrees convergence or place a dental implant at the perfect angulation, but they do care and expect you to do a good “scale and clean” on their teeth. After all, “scale and clean” is probably why the patients attend a dental clinic in the first place.

We all learned in dental school that “scale and clean” is essential to improve the patient’s oral health. We are also well aware that oral health, according to the 74th World Health Organization (WHO) meeting in 2021, “is a key indicator of overall health, well-being and quality of life.”¹

So, during my newbie dentist years, I made a commitment that I would always provide the best possible “scale and clean” for all of my patients. I always remind myself, “If I can’t thoroughly clean their teeth, what chance do the patients, who are less skilled than me, have?”

Little did I know then that this mindset brought me many successes in dentistry. When I was working in the health fund clinic early in my career, I constantly received many “thank-you” gifts and notes from the patients. The dentist in charge was shocked because it hadn’t happened previously, let alone to a young dentist who had only graduated about two years ago. He thought I must be a good communicator or had done some major makeover on their teeth. But I knew that couldn’t be the reason because I didn’t do any complex treatments at the time and not talkative. Later, the patients told us the “thank you” notes were because they appreciated my effort to clean up their teeth. They felt they had been cared for rather than just being treated as another patient in a quick turnover system.

I have had the same patient comments everywhere that I have worked. When I started my clinic, the same mindset helped me build up my book from 2 days per week to being fully booked within 6 months. Some may argue it is because of my demographic, but I’m afraid I have to disagree.

Consider this: the prevalence of gingivitis and periodontitis was approximately 30%² in Australia (about 20-50% globally)³, which means 1 in 3 people required a good “scale and clean”. We know it is much easier for patients to accept a simple preventive treatment than a complex restorative treatment, such as an implant, right? But wait, that’s more! These patients also need to come in regularly to maintain good oral hygiene. So, there you go. This is my secret to build up my appointment book. I am not saying that you don’t need to perform complex treatments for the patients; I am saying that you can build up your patient base effortlessly when you put an effort to do well on simple preventive treatment and your patients appreciate it. This is why “scale and clean” is known as the bread and butter of dentistry and is the most performed procedure in any general dental clinic.

Another benefit I realised by doing well in “scale and clean” is that you would improve your tactile sensitivity and manual dexterity. It is because you must retract the cheek and tongue property, angle the scaler in all different directions around each tooth, and apply the correct amount of pressure without hurting the patients. This improved sensitivity and dexterity helped me tremendously when performing complex or challenging cases later on.

There is one more skill I got improved over “scale and clean” appointments, which is communication skills. As an introvert like me, the whole dental communication was very challenging. When I was a newbie dentist, I didn’t know how to communicate with patients effectively about their treatments: I didn’t know how to sound confident, I didn’t know how to explain the procedures easily for them to understand, and I didn’t know how to stress the importance of some treatments. Over the years, little by little, I have polished my communication skills through these “scale and clean” appointments because the patients usually feel less stressed or threatened. I have learned what words to use for explaining, I have discovered how to build rapport with patients, and I have understood the anxiety that many patients have, particularly when they are new patients of my clinic who have never known me before. Good communication not only helped relax the patients but also improved their understanding of treatment and their trust in you, hence improving case acceptance.

So, newbie dentists, please don’t underestimate the “scale and clean” compared to the crown prep appointment. You can develop many skills, and your patients are expected and rely on you to be good at it.

In part II, I’ll discuss tips on improving the “scale and clean” appointments clinically.

Reference:

     1.    Lobbezoo F, Aarab G, Kapos FP, et al. The Global Need for Easy and Valid Assessment Tools for Orofacial Pain. J Dent Res. 2022;101(13):1549-1553.

     2.    Amarasena N, Chrisopoulos S, Jamieson LM, Luzzi L. Oral Health of Australian Adults: Distribution and Time Trends of Dental Caries, Periodontal Disease and Tooth Loss. Int J Environ Res Public Health. 2021;18(21):11539.

     3.    Albandar JM, Rams TE. Albandar JM, Rams TE. Global epidemiology of periodontal diseases: an overview. Periodontol 2000. 2002;29:7-10. Periodontol 2000. 2002;29:7-10.