A small fraction of skills

I am yet another "outsider" responding to the letter submitted by Vicki Nelson and Debbie Bates in the June 1999 issue of RDH regarding preceptorship in Alabama. No, I have not interviewed anyone from Alabama who has been through the preceptorship program. My concern lies with the patients, not preceptorship trained hygienists.

Dear RDH:

I am yet another "outsider" responding to the letter submitted by Vicki Nelson and Debbie Bates in the June 1999 issue of RDH regarding preceptorship in Alabama. No, I have not interviewed anyone from Alabama who has been through the preceptorship program. My concern lies with the patients, not preceptorship trained hygienists.

I, too, was a dental assistant before going to hygiene school. I was knowledgable about many dental procedures and developed good communication and clinical skills. There are many highly qualified dental assistants working in the field. Being a dental assistant is hard work and many may not receive adequate compensation for the valuable service they provide in the dental office. My concern is for the standard of care patients receive. Now that I am practicing dental hygiene I realize I only knew a small fraction of what I know now after graduating from an accredited dental hygiene program at Ferris State University. Qualified assistants are experts on dental procedures and have a great deal of skill. Dental hygiene is not just about good clinical skills, it is about total body health for the patient.

Although you may be able to "scrape" as well as a formally educated hygienist, will you be able to explain the etiology of periodontal disease to a patient with generalized 4 to 6 mm pockets?

A formally trained hygienist has a strong science background. We have been educated in the areas of biology, anatomy and physiology, general chemistry, organic and biochemistry, general and oral pathology, microbiology, radiology, nutrition, pharmacology, embryology and histology, and head and neck anatomy to name a few. We have also had all the "basic courses" required for a well rounded education such as literature, psychology, ethics, and interpersonal communications. In addition we have a minimum of two years clinical training under the direct supervision of qualified dentists and dental hygienists.

Although you may feel this educational background is not necessary for removing calculus, it is crucial to treat the person as a whole. How does this apply to treating patients? First of all it helps me to take a thorough medical history and most important, understand the medical history. If you are not taking thorough medical histories you may end up being responsible for a patient becoming very ill. Are you able to explain the risks of bacterial endocarditis to a patient with a pathologic heart murmur or infection that can result when a patient with a prosthetic knee or hip doesn`t take antibiotic premedication prior to their appointment?

My background in microbiology helps me to teach my patients about the etiology of periodontal disease and caries and the importance of sterilization and infection control. General and oral pathology has helped me to identify signs and symptoms of potentially serious or even fatal diseases such as squamous cell carcinoma. Do you know where you are most likely to see a suspicious lesion and that undiagnosed and treated it can metastasize? A background in nutrition helps to identify that a patient presenting with atrophic glossitis may have a vitamin B-12 deficiency and they may have pernicious anemia, or that bleeding gums may be a result of a vitamin C deficiency? When patients fail to report a specific medical condition on their health history my background in pharmacology alerts me to these conditions by the patients list of current medications.

Will a preceptorship trained hygienist be able to differentiate between a diabetic coma and insulin shock? This can happen to a patient in your chair, will you know the signs? What would you suspect if a patient presents with hairy leukoplakia on the lateral borders of the tongue? They may be infected with HIV. This is a small fraction of why a degree in dental hygiene is so important. After all, our main concern is for the patient.

If a doctor truly has the best interest of the patient in mind and not his or her wallet, they would discourage preceptorship programs for dental hygiene. So though I am sure you are both caring and qualified dental assistants, if you like dental hygiene do the work and get the degree. It`s for the patients!

Erin Straley, RDH

Naples, Florida

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