Readers' Forum

I know that everyone has personal obligations, but it's one Saturday a year! What about your professional obligations?

Dear RDH:
I have been reading articles about all of the pain hygienists are having in their neck, back, and shoulders. Also, many are developing carpel tunnel syndrome. The articles state ways to improve posture, as well as various exercises to help prevent these problems.

As a hygienist who has been in continuous practice for 35 years, may I offer a suggestion? Train hygienists to be ambidextrous.

When I applied to dental hygiene school in Cleveland, Ohio, in 1964, I was told that no left-handers were allowed. So I was forced to use my right hand only for the majority of my clinic work. Believe me, it was a challenge but it certainly turned into a wonderful advantage. Now all my scalings are done half right-handed and half left-handed. You end up working from both sides of the chair and it gives direct visual access. While doing root planings, always wear larger gloves and change hands if one becomes fatigued.

It is hard at first to learn to use both hands but the result is well worth it. After all these years— no pain, no CTS.

Susan Halder, RDH
Oak Park, California

Dear RDH:
This is an open letter to Cheryl Frazier, RDH (October 2001 Readers' Forum). All I have to say is, "Wow! What an ego!"

I don't think going back to school is in your best interest, or in the best interest of the public at large. There are enough egomaniacs in the profession. And besides, what would happen if you hired a hygienist who had less experience than you, less education than you, much less at stake than you, and only worked for two previous dentists? What if they told you how to practice dentistry?

I don't think you would be very happy in Colorado either. I don't think there would be enough patients and personnel that would appreciate your incredible fussiness and self-righteous opinions. Think how awful it would be to file for bankruptcy because not enough people wanted you.

I do think it would be best for you to find your own private island. Then you could pick and choose who would live and work there, and you wouldn't have to learn diplomacy, discretion, teamwork, and kindness.

Karen Badynee-Kwolek, RDH
Walled Lake, Michigan

Dear RDH:
Last weekend (Sept 28-29) was the annual session for the Oklahoma Dental Hygienists' Association. It was a great session with very informative classes. I was very impressed not only with the topics, but also with the speakers themselves. We also got an update on the current legislative issues facing hygienists in our area from our lobbyist. As all of you know, there are many things happening to the north (Kansas) and south (Texas) of us here in Oklahoma.

I would, however, like to say that I was terribly disappointed in the lack of attendance. I was shocked that there were so many empty seats in the lectures. I suspected that the Friday classes had such low attendance because there are many hygienists who worked that day. However, very few people in the dental field work on Saturday. I was disappointed to find that there were even fewer people in attendance on Saturday! I drove 90-plus miles one way to attend both days. I am very glad that I did. I know that everyone has personal obligations, but it's one Saturday a year! What about your professional obligations? We must join together, as a unit, if we expect anyone to take us seriously when we start to defend our profession.

Commit yourselves to your career. If you don't, you won't get needed support from other hygienists. We are the only ones who really understand what we face from day to day.

I want to encourage everyone to support your profession. If you are not a member of the ADHA, what are you waiting for? If you are lucky, your boss might pay your yearly dues; if not, pay it yourself. It is little more than $200; most of us make more than that in a day, and it's tax deductible. Do you know that dentists pay $1,000 per year to be in the ADA? If you are a member already, I hope you are attending monthly meetings and keeping abreast of current scientific/technological advances and legislative happenings. Encourage others to join the ADHA as well. It is a great organization to be associated with.

Denece Redwine, RDH, BS
Ada, Oklahoma

Dear RDH:
This is in response to the letter by Dr. E. J. Neiburger that was published in the Readers' Forum (September 2001 issue). I could write a chapter for my response, but, in the interest of time and space, I will try to condense my thoughts.

The first statement that I take umbrage to is: "The public and indirectly the dentist are the ultimate sources of what treatment hygienists should do and the level and quality of service that is needed." Is that right? The dental hygienist is a licensed professional, and as such, is ultimately responsible for the care he/she renders, legally, ethically, and morally.

Another statement was, "A dental prophylaxis consists of removing calculus and polishing teeth. The extras mentioned by Dianne [Glasscoe, who Neiburger criticized in his letter] (e.g. blood pressure, exam, inquire about dental problems, etc.) does not need to be done by the hygienists and may not be desired by the patient or the dentist."

Obviously, what is forgotten here is that the mouth and teeth are part of the entire body, and that oral disease affects the entire immune system, not just the teeth. If a client does not want a blood pressure check or a medical history taken, they need to be educated about the value of those procedures. The standard of care in most offices is to monitor the general and oral health of the client, especially if anesthesia is to be used on the client. What if the client has a prosthetic valve or is pregnant? Would that not make a difference in any care that is rendered?

A third comment was, "A well-trained dental hygienist with sharp instruments and an ergonomically efficient technique can easily do a good scaling and polishing in 10 minutes on most 'normal' patients."

First of all, the only "trained" dental hygienists are those in preceptor states; the others (the majority, thank God) are educated within an accredited dental hygiene program, which requires an average of 1,948 clock hours of curriculum. This includes 585 clock hours of supervised clinical dental hygiene instruction. Also, most dental hygienists are using ultrasonic instrumentation, and are using selective polishing. Obviously, Dr. Neiburger is not current with state-of-the-art research in providing oral health care.

He also wrote, "If after the treatment, the mouth is clean and the dentist and patient are happy, then that is success."

Excuse me, but is our main goal to make the patient and dentist happy? I think not. My main goal is to render the most effective care to restore the client to a state of health, and/or to maintain health. Calculus is not the primary culprit of oral disease, bacteria are. And, the immune system of the client plays a large role in the success of the treatment rendered, whether it is maintenance procedures, periodontal debridement, etc. However, if we were not concerned with a medical and dental history, how would we know?

He also noted, "In today's competitive world, where the consumer dictates the terms, you better provide fast, efficient, quality service."

The consumer does not "dictate" the treatment in our office. We collaborate to see if we share the same philosophy of treatment, and proceed with the appropriate treatment. If the client would request something that is inappropriate, or lower than the standard of care, we would refuse treatment and suggest the client find an office that allows them to dictate their treatment.

Finally, he said, "In my and many of my colleagues' practices, fast hygienists earn more money and get more respect from the dentists and the patients. The slow ones get less. The real slow ones get fired. It is a tough world out there, girls. Are you up to the challenge?"

This is the ultimate insult, and shows Dr. Neiburger's ignorance. His patronizing, demeaning attitude is what gives dentistry a bad name. It appears that he is also a misogynist — one who shows no respect to women. Professional dental hygienists are interested in quality client care.

Yes, client. I assume that Dr. Neiburger wants only patients, those that are dependent on him and his speedy "girls." It might surprise him to learn that there are male dental hygienists, as well as female. Perhaps he enjoys being called a "boy," but I can tell you, I, and most of my colleagues, do not relish the thought of being called a "girl." I am thankful that most of the dentists with whom I have relationships are themselves professional, and respect dental hygienists for the professionals that they are.

Working quickly and efficiently is not mutually exclusive to providing quality care. It is sometimes possible to render quality care in an expedited fashion. However, that does mean that you sacrifice vital parts of the process of care, such as a thorough medical and dental history, oral and extra oral exam, blood pressure, and providing the treatment necessary to restore or maintain oral health.

The dental hygiene process of care requires assessment, diagnosis, treatment planning, implementation of the plan, and evaluation. Only then can you be sure, to the best of your ability, that you have not missed an oral cancer, a periodontal or endodontic abscess, or a medical condition that might warrant premedication.

The Surgeon's General Report on Oral Health discusses the oral/systemic link; perhaps someone should send a copy to Dr. Neiburger.

Maria Perno, RDH, MS
San Carlos, California

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