The hygienist may be either the second, third, or fourth member of the treatment team the patient meets. However, the hygienist usually is the first who actually performs treatment and therefore must be fully proficient in hygienic techniques and subtle investigation while maintaining a reassuring manner. Many times the hygienist will develop a special relationship with your patient. This rapport can result in learning crucial information that can make your treatment a success or warn you of possible failure. The hygienist must be both inquisitive and observant enough to help discover potentially harmful habits and bring them to the attention of both the patient and you. Such habits include lip, cheek, or nail biting, chewing ice or other foreign objects, or grinding of teeth (see Esthetics in Dentistry 1st ed., Vol. II. Chapter 20: Personal Habits). As the teeth are being cleaned, the patient’s desires in regard to esthetic treatment can and should be determined. Preliminary observations can be made concerning obvious discolorations, necessary restoration, ill-fitting crowns, etc. The approach can be in the form of a question, such as, “Does this concern you? If so, the doctor may be able to correct it.” The possibility and applicability of esthetic treatment should be of central concern, but the concern should not manifest itself at this time as direct recommendations or specific advice to the patient. The hygienist must be alert to cues that indicate a patient’s interest in esthetic dentistry. A patient who covers his or her mouth when laughing is making a wordless, vitally important statement. Lips pulled tightly over the teeth, constricted cheeks, or a tongue pressed against a diastema are subconscious signals from the patient. Directly or indirectly, they express a patient’s concern for his or her appearance. The hygienist should communicate these observations to the dentist in private.

At the initial visit, the patient may see the dentist for a comparatively brief time. This depends upon the patient’s ability and desire to spend up to several more hours for the “second visit” at the same appointment. If the patient is from out of town, it is usually advisable to plan both first and second visits at the same appointment to reduce the patient’s travel time and costs.
Good rapport must be established while convincing the patient that only after a thorough study of radiographs and other diagnostic aids will treatment alternatives be suggested. In addition to a medical and dental history, thorough charting of both periodontal and general tooth conditions, diagnostic models, occlusal analysis, computer imaging, and color photographs or slides are taken at this visit. Normally, specific suggestions should be postponed until the second visit. At that time, you should examine and discuss treatment alternatives as well as the patient’s own esthetic evaluation as it is revealed in the smile analysis unless the patient has previously completed this self-examination.

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