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Mastering Change: Challenging Beyond Your Routine

Sept. 1, 2009
People play Sudoku and work crossword puzzles to keep their brains sharp. Stretching our minds is a key to brain fitness.
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By Patti DiGangi, RDH, BS

People play Sudoku and work crossword puzzles to keep their brains sharp. Stretching our minds is a key to brain fitness. Yet for many of us, routine is the order of the day. Each day is somewhat like the plot of the movie Groundhog Day: we wake up day after day hearing Sonny and Cher singing I Got You Babe. Patient after patient, our chart notes and care are much the same — prophy/exam, prophy/exam, prophy/exam/4BWX, little bleeding, needs to floss more. This routine no longer serves our patients and can actually degrade our brain.

Back in our dental hygiene school days, we learned an amazing amount of information. In our skill development, we went through specific stages. Our skills eventually work on automatic pilot, so we no longer have to consciously think about the individual steps. We have mastered the skills. Or have we? Have you ever thought, “Now did I say this to this person or did I say it to the last person?” How well does that serve our patients? The sidebar scenario shows the type of dilemma we can face. The second question is, what does that mastery do to our brain?

The human brain is incredibly adaptive. Our mental capacity is astonishingly large, and our ability to process widely varied information and complex new experiences with relative ease can be surprising. The brain's ability to act and react in ever–changing ways is known, in the scientific community, as neuroplasticity. Because of the brain's neuroplasticity, old dogs, so to speak, regularly learn new tricks. Yet the brain's innate ability to change itself can be both positive and negative. The very plasticity that allows us to learn can also lead us to be stuck in a rut. The problem is that wisdom and mastery can make us lazy. We stop challenging ourselves as the brain ages partly because the challenge itself gets harder. This is the paradox of plasticity. It's like a mountain covered with snow — when you are at the top, there are a lot of different paths to take down. But once you take a path, the second time it becomes easier to take the same path, and the path eventually becomes a rut. The plasticity that allows us to learn new things is the same one that can keep us in a rut.

Article after article, CE course after CE course, we learn more about options like saliva testing, early oral cancer detection, risk assessment, remineralization techniques, the oral–systemic connection, and much more. We are reminded of the importance of routinely taking vital signs, complete accurate documentation, recording periodontal charting at every visit — those things we did during dental hygiene school yet are not part of our current routines. We come back from a course or are motivated by an article and with renewed energy we decide to make a change. Yet often we fall back into the same rut. We have probably seen it happen with our dentist employers, as well. They come back from a course excited and diagnose whatever they learned on everyone for about two weeks, and then they go back to the way they always did things.

Getting out of a rut requires consistent and progressive challenges. Changing our pattern of thinking changes the brain's structure. We have the ability to remodel our brains. To change the wiring in a skill, you must engage in an activity that is unfamiliar to you, yet related to that skill, because simply repeating the same activity only maintains already established connections. Many of us no longer use the word cleaning in relation to the care performed by a dental hygienist. Each time the term is used, it can make our care seem less professional. What word can we substitute that people will understand? Hygiene care is a broad term that better fits current views. That word transition, even for this author, was challenging and difficult to start. The change was not only about the word; it was about changing the thoughts behind the word. It was about using the plasticity of the brain and reprogramming it with new learning. It can seem easier to stay in the same rut, and we often readily fall right back into it. Yet the mental strain and stretch can assist in forming new and different synapses and connections to your neural assemblies. You can actually improve your brain function by doing the work it takes to make the change. The change can happen, and eventually you can even feel comfortable. Once mastered, the neurons initially recruited for the learning process are free to go to other assignments, to learn and stretch and grow more, which is a key to brain fitness.

Changing your brain to keep it healthy is also enhanced with regular physical exercise, good nutrition, laughter, friendships, travel, and more. (See Box 1) To keep on task with change, it can help to get an accountability partner such as a coach, mentor, or friend to kick your butt, encourage you, provide feedback, and hold you accountable.

If you want your brain to stay sharp, you have to keep challenging yourself. Avoid the temptation to fall back into the rut and take the easy way out by avoiding things you aren't already good at. It's important to embrace lifestyles and workstyles that will use your brain plasticity. Growth and change can help our patients, and more importantly, it can help keep your own brain fit.


  1. Johnson R. Mental Gymnastics. December 2007. Available at:
  2. Campbell G. Brain Plasticity Gives Hope to Everyone. March 9, 2009. Available at–merzenich–brain–plasticity–offers–hope–for–everyone/
  3. Ratey J. Learning to Change. Excerpted from A User's Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain. Available at
  4. The Brain Fitness Program. PBS. DVD available at

About the Author

Patti DiGangi, RDH, BS, is a speaker, author, practicing dental hygiene clinician, and director of CareerFusion ( a retreat providing personalized training in all facets of career evolution. She can be contacted through her Web site at

Ten Habits of Highly Effective Brains

  1. Appreciate your brain's beauty as a living and constantly developing dense forest with billions of neurons and synapses.
  2. Take care of your nutrition.
  3. Exercising your body helps sharpen your brain: physical exercise enhances neurogenesis.
  4. Practice positive, future–oriented thoughts until they become your default mindset and you look forward to every new day in a constructive way.
  5. Thrive on learning and mental challenges.
  6. Aim high. Once you graduate from college, keep learning. The brain keeps developing, no matter your age, and it reflects what you do with it.
  7. Explore, travel, and adapt to new locations. This forces you to pay more attention to your environment. Make new decisions; use your brain.
  8. Don't outsource your brain. Make your own decisions and mistakes. Then learn from them.
  9. Develop and maintain stimulating friendships.
  10. Laugh often, especially to cognitively complex humor full of twists and surprises.

Adapted from: Fernandez A. “The Ten Habits of Highly Effective Brains” Aug. 22, 2007, available at–habits–of–highly–effective–brains/

A scenario ...

You attend a course on polishing. During your hygiene school education you were taught selective polishing with fine paste only. Your office and patients' expectations are to polish everyone. Your office manager orders only coarse and extra–coarse products. Though uncomfortable at first, you've grown accustomed to these products.

During the CE course, the speaker says continuous polishing can, over time, cause morphological changes in the teeth by abrading tooth structure away, and fluoride in the outer layers of enamel is removed through polishing. The speaker asks the audience to consider the aging of our patients. The baby boomers have kept their teeth their entire lifetimes, and many have had quarterly prophylactic procedures to remove microns of enamel with 20 times as much loss on the roots when polished with pumice–based products. This cumulative damage must be considered.

You learn of a number of therapeutic products that work differently than the traditional polish, including Enamel Care with ACP (Premier Dental, Plymouth Meeting, PA,, Clinpro with Perlite (3M ESPE, St. Paul, MN,, Cosmetic Polishing Restorative–CPR (IC Care, Silverdale, WA,, and NuSolutions with NovaMin (Dentsply, York, PA,, and NovaMin Technology Inc. Alachua, FL, to name a few.

You're now even more confused and unsure of what to use. It seems easier to go with the flow at the office and just use the same stuff on everyone. Even if you want to make changes, how can you ever talk the office manager into it?