More Than One Way To Skin a Cat

Aug. 1, 2007
I watched my teenage son cook dry noodles tonight. Not an exciting event, but one that reminded me of a valuable lesson.

by Lory Laughter, RDH, BS

I watched my teenage son cook dry noodles tonight. Not an exciting event, but one that reminded me of a valuable lesson. I know I taught him the proper way to boil stale, dry strings into something near edible, yet there he was measuring water and dumping in the noodles before a rolling boil was evident in the pot. Unable to hold my silence, I finally asked if his method produced acceptable results. His curt reply was, in effect, there is more than one way to skin a cat. I can laugh at his response now, but I admit there was a day when my way was the right way and the process was more important than the end result.

Teaching responsibility and a strong work ethic is a high priority in raising my family. Tasks and chores were given at an early age. With the first few I took the time to show each of my children exactly how the task should be accomplished. And to be honest, I know I valued the process rather than the outcome. Financial necessity and a desire for education found me outside the home when my younger children were mastering the art of doing chores. Imagine my surprise when I discovered a dishwasher can be loaded top rack first and everything will still come out clean. The older rebels had discovered shortcuts and passed along the information to their younger siblings.

It was not an overnight success, but after the revelation of the dishwasher, I tried harder to focus on the end result and let go of my “process issues.” Now that my family is older and only three of us live at home full time, the positive results of letting go are more evident. Not only are chores accomplished with a positive outcome but also my children notice what needs to be done and do it without a written request (the dreaded chore list).

It is easy to get caught up in the process in our careers. Many of us were taught to use an explorer and radiographs to diagnose decay, leading us to believe that a shadow and stickiness are the only indicators of caries. The introduction of laser fluorescence (DIAGNOdent) for carious lesion detection was met with skepticism by many in the dental field, while others left their explorers behind and embraced the new technology. In my opinion, too many took the either/or approach and ignored other adjunctive tools, such as staining, altogether.

Radiographs are a valuable tool in detecting decay, especially interproximally, but we need to remember that radiolucencies are not only caused by carious lesions. A suspicious area detected on a radiograph must be examined visually in the mouth before diagnosis. A staining product such as Pulpdent’s Snoop Caries Detection Stain™ can help when other methods of detection are inconclusive. In fact, some dental professionals use staining to confirm every diagnosis of caries. The end result of caries detection is, obviously, treatment, so once the discovery is made it matters little whether a lesion is discovered through the use of an explorer, laser fluorescence, or radiographs.

We also encounter the process vs. product dilemma during patient education sessions. There is a common fantasy among dental hygienists that all patients will do exactly what we tell them to do. We assume that our show-and-tell sessions will be filed in our patients’ brains and replayed every time home care is undertaken, and we take offense when our cries of “brush and floss” are not heeded by all. I remember being fresh out of college and complimenting a patient on his great flossing skill. His tissue was pink and there was no debris, plaque, bleeding, or deposit to be found. When he told me that he brushed once a day and used paper matches to clean between his teeth, it shattered my dental world - yet the results of his home-care efforts were impressive.

I still recommend a powered brush and interproximal cleaning, but how that cleaning is accomplished at home varies. The desired result is healthy tissue, no trauma, and plaque removal to decrease pathogens. How this result is achieved is not that important. Patient confessions of poor flossing habits are common and often start even before the chair is reclined. Do we really want to be responsible for that level of guilt?

The end result of one such confession was a learning experience for me. Ms. Nofloss had been a patient for three or four years and had resisted my suggestions of flossing and oral irrigation. Every appointment started with her apology for lax home-care efforts. A few months ago, Ms. Nofloss smiled when I greeted her and said, “I have some news you may not like.” She had abandoned all efforts to incorporate flossing into her routine and instead started using a product she found at the supermarket. For the previous four months, Ms. Nofloss had been using GUM Soft-Picks® several times a day in addition to a powered brush once a day. (I hear the gasps!) The results were positive - no plaque, no bleeding, pink tissues, and the biggest bonus: a happy patient. While I can’t endorse her process for every patient, it has given me one more option when making recommendations. GUM Soft-Picks® now comes up in almost every discussion with nonflossers.

Strategies for overcoming job burnout issues should be evaluated by the outcome. Effectiveness can only be determined by whether or not the process worked for you. For many dental hygienists, burnout cycles around and each episode requires a new approach to combat the life-draining feeling of helplessness. The first time I faced burnout, the solution was easy - go back to college. But, when the second round hit, attempting to take even one course only irritated me more and a break was the answer. The last time the burnout demon entered my space, a colleague suggested accepting it and almost embracing the feeling of restlessness, a concept that sounded crazy at the time but which actually worked very well.

I believe that everyone will face the reality of burnout at some point, unless jumping from career to career and relocating often is a viable option. Anticipating the crash by having a plan in place may be the best defense. Ask for suggestions and opinions, but also realize that whatever potion worked for your neighbor may not be the answer for you. The failure of a recommended healing process does not mean failure to overcome the obstacle; it is merely a nudge to look for another cure. Success means taking a risk and holding on until you achieve an acceptable result.

Results definitely outweigh the process in most circumstances, but we must remember not to judge the results of others too harshly. Residual deposits post-treatment may not be a sign of lousy skills, but rather a focus on more important factors. When rendering nonsurgical treatment, many clinicians focus at the base of the pocket with the knowledge that supragingival deposits can be removed at a future appointment with little or no negative effect. A lingering case of burnout in a coworker is not necessarily an indication of weakness or surrender. It’s likely an appropriate antidote has just not been found. Most importantly, remember to apply the same principle of not judging others too harshly to yourself. Give yourself an occasional pat on the back and overlook the small stuff.

While working on this column, it occurred to me that writing is a task where the end result is pretty much all that matters. One of my mentors always has a number of articles in the works and on short notice can polish up a piece on almost any topic for submission. Another writer I know works on each column for an entire month and has a finished product long before any deadlines. My process resembles a sprint more than a marathon. Often I do not know my topic until I sit in front of my keyboard and stare at the screen. I have topics on file and thoughts jotted on pieces of paper all over my desk, but the final decision usually takes place as my typing begins. True to my procrastinating nature, deadlines are challenged, but met. I know my process sometimes puts stress on the editor, but it works for me. (Luckily the editor’s process includes patience for writers like me.)

The author does not receive any compensation from companies or products mentioned in this article.

About the Author

Lory Laughter, RDH, BS, practices in Napa and Sonoma, Calif., in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists Against Heart Disease and other organizations, she hopes to bring a total health concept to the dental practice. You may contact Lory at [email protected].