by Lynne H. Slim, RDH, BSDH, MSDH
I’m a bookstore and library junkie, especially on cold wintry days. Last week, I picked up a new magazine called Empowering Women while at Barnes & Noble bookstore. I was attracted to this periodical at once, and I couldn’t wait to get home and read it cover to cover. My favorite article was written by a top professional photographer named Dewitt Jones who is also a motion picture director. Jones approaches life with an attitude of curiosity, openness, and celebration. He defines creativity as the “ability to see the ordinary as extraordinary.”
Jones compares creative moments to falling in love. “Think about it. First, when we’re in love with something, it really is extraordinary. We see its uniqueness, feel its potential, celebrate its excellence, and we are open to its growth. Second, when we’re in love with something, we take care of it; we treat it with respect and compassion. Finally, when we’re in love with something, we find ourselves in touch with a source of incredible energy ... we call it passion.”1
Several months ago, I met a dental hygienist extraordinaire who celebrates her career in a way that allows her to practice with self-assurance. She embraces change rather than fearing it, and, from all that I know about her, she lives life to the fullest. Diane M. Brucato-Thomas exudes confidence, and I laughed when she gave me her credentials. Besides being an RDH with a bachelor of science degree, Diane uses the initials EF (expanded functions) in her signature but she let me know that the EF stands for “Extra Fine.” Go Diane!
Before I introduce you to the professional side of Diane, I’d like to share a few details about her personal life. How many of us honeymoon in paradise and then end up building a dream home there? Not me because my honeymoon was a bit of a disaster (more about that some other time) but Diane ... yes! She follows her dreams until they become reality. She and her husband, Gene, honeymooned in Hawaii and ended up living there in a VW bus before they could move into a 600 square foot garage which eventually became a house! As Diane loves to say, she doesn’t do too much traveling because she already lives in paradise!
I’ve already mentioned before in this column that I have four dogs. They are a handful for me to manage, especially when it comes time to feeding them. The two larger dogs are greedy piglets, and they try to steal food from my two miniature dachshunds. I have to stand guard every morning (with coffee in hand) until all of the dogs have finished the food in their bowls. Diane and Gene, on the other hand, own three dogs, a horse, two sheep, 50 chickens, three cats, and a catfish! Just imagine the daily feeding regimen in their household.
She practices on the west side of Hawaii Island but she lives on the east side. So traveling one way to work takes three hours. Fortunately, her employer provides her with a place to stay so she works from two to four days every other week, depending on her patients’ needs.
Diane interests me for many reasons but her dedication and passion for periodontal therapy stand out among her many accomplishments.
I asked Diane if she considers herself to be a periodontal therapist (a taboo word, if you listen to the turf-conscious dentists out there). She indicated that she has the education and clinical expertise above and beyond the norm. Diane was certified in expanded functions periodontics from Northern Arizona University back when this certification was offered in the 1980s. She completed 300 additional didactic and clinical hours in histology, cell biology, biochemistry, immunology, periodontal pathogenesis, and wound healing along with clinical root planing, curettage, and suturing. Currently, Diane practices with a highly competent dentist and team that she trusts completely. She focuses on the conservative treatment of moderate to advanced periodontal diseases and has been doing so since 1983.
How many practicing hygienists do you know who purchase their own periodontal endoscope and high-end ultrasonic unit? Since 2001, Diane has invested about $22,000 in the purchase of a periodontal endoscope, loupes with fiber-optic light, piezo and manually-tuned ultrasonic units, a high-end dental hygiene handpiece, and inserts that accompany both ultrasonic units.
Diane doesn’t skip a beat when it comes to providing state-of-the-art, evidence-based care for her patients and she is open-minded about change. For many of us, change is the enemy. But Diane embraces it and challenges herself to practice in a dynamic way. She does not hesitate to apply new techniques, products, or protocols that are supported by scientific evidence.
I chat with Diane often by e-mail and in my periotherapist yahoo group (we now call ourselves the PT Cruisers!). Diane’s creative approach to finding solutions, or her ability to offer a different perspective on a periodontal topic, is admirable. What does she have that we can emulate and carry with us in our efforts to find happiness in our careers?
Commitment and passion are words that describe Diane’s approach to life and to her professional undertakings. She is unafraid to challenge the status quo. Like the photographer Dewitt Jones, she approaches her career from an attitude of abundance rather than scarcity.
Here’s a good example of Diane’s approach to a particular patient as was posted on the periotherapist yahoo group. Here’s Diane’s written post:
In the late 1980s, I met a patient who presented for a periodontal evaluation. He was diagnosed with generalized severe periodontitis with pockets as deep as 9 mm. He said: “Hmmm. You said this was caused by the bacteria that I have been missing in my home care, right? Well, I’d like to see what I can do on my own without doing anything.”
Without hesitation, I felt very strongly that this was an opportunity for a case study!
I replied, “Well, I don’t see any harm in that. It certainly did not happen overnight, so a couple more months probably won’t make a big difference, especially if you are disturbing the plaque every day.”
He sat back in his chair, thought about the plan for a moment, and then said, “Great! You tell me what to do and I’ll do it. I’ll come back in three months and you can check my scores again.”
I instructed the patient in the use of the Perio-Aid and sulcular brushing. I can’t remember whether or not I recommended oral irrigation, too, but it’s highly likely because irrigation was very popular at that time. His wife was interested in creative visualization (the ability to see images and an attempt to make them come true), so he asked me if I thought that approach to wellness would help. I told him it couldn’t hurt so we created a visualization exercise of the white blood cells like Pac-Men, hunting down and munching the bacteria and the tissue zipping back up the side of the teeth.
Three months later, the patient returned and announced that he had been faithful in his daily regimen and that he had also been using various herbals (myrrh and goldenseal, as I recall). He rubbed them into his gums as an antimicrobial agent. We were both amazed that his pockets had reduced in depth and he didn’t have a pocket depth deeper than 6 mm.
He asked me if I thought the improvement was due to the herbs he was using and I told him that they may or may not have contributed to his success. I told him that the pocket depth reduction was probably due to the attention he was paying to his home care for the first time in his life. I then suggested to him that he now let me do my part. He was so excited about his initial results that he asked me if he could go yet another three months with extra effort devoted to the deeper pockets before I intervened.
When the patient returned in another three months, there was even more improvement. In the interim, he had his third molars extracted and there were no pockets deeper than 5 mm. The patient begged for one more round of extra home care effort before I took over and I agreed to go along with his plan, one last time.
The man returned three months later (it was now nine months since the initial diagnosis) and he had no pockets over 4 mm in depth! He allowed me to scale off the calculus, which I was able to do without anesthesia, and I placed him on a three-month maintenance schedule.
Diane was so proud of her conservative therapy in this case study that she tried to share it with the periodontal community. The case study was eventually submitted to several periodontal journals but was turned down.
Attitude is everything
Attitude is everything, as the saying goes, and Diane is like Dewitt Jones who approaches his photography with curiosity, openness, and celebration. What an incredible combination of positive attributes!
Besides her commitment to periodontal endoscopy and conservative nonsurgical therapy, Diane is now excited about the possibility of using a product like Emdogain® as a way to regrow hard and soft tissue lost due to periodontal disease. Emdogain® has been used by periodontists for several years to repair lost components of the periodontium including alveolar bone, but the procedure has only been successful when placed during periodontal surgery. Diane found a brilliant hygienist in Washington state, Judy Carroll, who has been using Emdogain® with a nonsurgical (or closed) technique in combination with periodontal endoscopy and doxycycline hyclate to regenerate bone. Diane takes to these new research adventures like a duck to water, and she is hoping that she will see more research innovation by hygienists before she hangs up her hygiene cap!
I asked Diane whether or not she disinfects pockets every time she cleans them and I liked her answer. Here’s what she said:
Yes, I disinfect every time I clean a pocket nonsurgically with an ultrasonic scaler. Science has shown us that the ultrasonic cavitation is bacteriocidal, as the droplets of water coming off the tip cause the bacteria to implode. I have used chlorhexidine gluconate (CHX) in my ultrasonic; however, some studies have also shown that water alone is an effective irrigant. All in all, it’s a numbers game. My goal is to switch the microbial flora from Gram-negative anaerobes to Gram-positive aerobic bugs that are less harmful to the periodontium.
I follow my conservative periodontal therapy appointments with 2 two-week interval postoperative appointments because it takes that long for the bacteria to re-establish themselves. My purpose is twofold: First, I like to evaluate the tissue response to see if I’ve missed anything and to check the patient’s home care and, secondly, knock the bugs down so the body can concentrate on healing itself instead of fighting microbes. Because plaque formation begins at the gingival margin, I de-plaque with a rubber tip and disinfect again with CHX with an irrigating syringe. I use CHX because of its substantivity. More than anything, I rely on the patient to do his/her home care as instructed.
I highly recommend home oral irrigation on a daily basis. Studies I’ve read have shown that water alone is just as efficacious as water combined with an antibacterial agent. Sometimes I advise a patient (who prefers to add an antimicrobial agent to the water bath) to follow a recipe that was given to me by a periodontist. The recipe calls for 2.5 oz of povidone iodine combined with 6.5 ounces of an OTC mouthrinse for flavor combined with enough warm water to fill a liter bottle. The important thing is that they irrigate. Period.
I do the best that I know how to do with each individual and that’s all I can do. Because periodontal diseases are greatly influenced by lifestyle, no matter what I do, I will get the best therapeutic result only if the patients are willing to make the necessary lifestyle changes, including meticulous home care. In my attempts to achieve satisfactory therapeutic outcomes, I continue to focus on improving my ability to get the patient to commit to an oral wellness plan. I do this by getting them to verify their values, to think about how long they want to live, and what level of health they wish to achieve. I ask them to imagine their lives as a movie. If they can see themselves in the last frame in a state of health and well-being, I have them look at all the previous frames to determine what they have to do to get there. When they can see the big picture, it is easier for them to commit to the lifestyle changes that will be necessary to achieve periodontal health.
Lastly, like those of us who are the movers and shakers in society, Diane embraces change. She is not unhappy about her supervised role in private practice in Hawaii because she works for a dentist who offers her a great deal of autonomy and respect. She offers the following advice to young dental hygiene graduates in focusing on nonsurgical periodontal therapy in clinical practice:
- Learn all that you can
- Go to every periodontal course given by known researchers. Read the journals
- Learn how to conduct research and apply what you learn
- Find outstanding mentors as I have done
- Be humble. Never be afraid to learn, grow, and change
- Question everything. Trust your gut.
- Understand science at a cellular level and apply what you have learned
- Learn about human behavior and communication.
I have grown to love Diane’s larger-than-life philosophy and positive outlook. She’s genuine and filled with compassion and love for mankind and all of God’s creatures, including her 50 chickens! Like the photographer Dewitt Jones, Diane’s days are filled with a desire to find extraordinary solutions to ordinary problems, and she is the essence of a creative spirit.
Lynne H. Slim, RDH, BSDH, MSDH, is a practicing hygienist/periodontal therapist who has more than 20 years’ experience in both clinical and educational settings. She is also president of Perio C Dent Inc. (Perio-Centered Dentistry), a practice-management consulting firm that specializes in creating outstanding dental hygiene teams. Lynne is a member of the Speaking and Consulting Network (SCN) that was founded by Linda Miles, and has won two first-place journalism awards from ADHA. Lynne is also owner/moderator of a periodontal therapist yahoo group: http://yahoogroups.com/group/periotherapist. She can be contacted at [email protected].
1 Jones D: Seeing the ordinary as extraordinary; techniques for unlocking your creative potential. Empowering Women 2007: 2(1): 21-23.