Back to basics

March 1, 2000
If hygienists aren`t probing, what are they doing? The author offers this as a wake-up call to the profession!

If hygienists aren`t probing, what are they doing? The author offers this as a wake-up call to the profession!

Kelly Heisey, RDH

A patient`s hand flies up, grasps my wrist and says, "Wait - why are you poking me like that!?" Oh, not again!

In the last couple of years, the frequency of this scenario was starting to wear me thin. At first I was bewildered, but then it began to outrage me. Why was it happening? Inquiries are understandable from people who`ve only seen dentists for problems, but they`re disturbing from patients who`ve seen hygienists for years and should be very familiar with the procedure! Yet, it happened again and again, bringing a large number of hygienists to trial in my mind.

I asked patients what their previous hygienists` routines were, and their answers were what I expected, but still disturbing. "She just cleaned my teeth - she never poked me with that thing," most replied. That "thing" is a periodontal probe. I found myself mulling this over at home each evening, wondering why it occurred so often. My patients come from all over the nation. It made me wonder if that many of us were not probing?

My only evidence was what patients relayed, but I suspected a national waning of professional motivation in need of a "wake-up call." It was only when I decided to investigate that the scope of my concern widened. If we aren`t probing, what else aren`t we doing? I realized that it wasn`t just about performing procedures, but about all the responsibilities hygienists have and getting back to those basics.

My research began by obtaining a sampling of numbers and keeping track of "NBP" (never been probed) patients in my office for one year. I noted only those patients who`d seen a hygienist most of their lives, had histories of regular check-ups, and were fairly knowledgeable about what went on during a "cleaning" appointment.

By the end of the year, I`d tallied over 120 patients, an average of 10 per month. However, numbers don`t give reasons for their existence or solutions to a problem they represent, so I decided to seek out possible contributing factors. Dr. Cindy Walker, a successful private practitioner in Garner, N.C., believes that there are at least two.

"Some offices don`t allow enough time for hygiene appointments," she says. "Some are as short as 30 minutes, so something has to give. Unfortunately, probing is sacrificed, so that there`s time for everything else."

Dr. Walker also feels the supervising dentist is partly responsible. "If probing is overlooked by the dentist, it sends a message to the hygienist that it`s okay to skip and then it becomes a habit," she adds. "Dentists need to allow ample time for probing, and then make sure it`s being done."

Although this is only one view, patient commentary is proof that probing isn`t always happening. The bottom line is that no tolerable excuse exists for anything that deprives patients of standard quality treatment. All we can do here is explore possible reasons why some of us may be falling out of rank.

Not just a job

Perhaps if more of us saw hygiene as our profession, instead of just a job, we`d be more apt to do what`s expected. Some of us portray hygiene in the same light as a haircut or manicure, as if we`re dealing with nonvital tissues and surface appearances only. On the contrary, hygienists can make a physiological difference in a person`s oral health or disease. It`s our duty to make patients aware of this, introduce them to their personal colonies of subgingival nasties, and provide arsenals for their battles.

The dishonor of being dubbed "teeth-cleaners" contributes to some attitudes, and it`s no wonder when research is done on dental hygiene at a public library. The U.S. Department of Labor publishes the Occupational Handbook manuals for obtaining career information. Each profession sports a blurb called, "Nature of the Work." The first sentence a person encounters about our work reads, "Dental hygienists clean teeth," followed by less-than-vague information about the whole host of other responsibilities we have.

The Encyclopedia of Careers and Vocational Guidance is another reference book culpable of depicting us in this light: "Only the dental hygienist is licensed to clean teeth." If we see ourselves solely as teeth cleaners, that`s what we`ll be. We are, in fact, "periodontal therapists," and since patients have no concept of the comprehensive tasks involved in their appointments it`s up to us to provide more than just service. Awareness of the complexity of dental hygiene is important and we must be the sole educators for our patients if we ever want to become more than "teeth cleaners."

Not probing...what happens later?

Non-probing hygienists may not realize its repercussions. It not only lets disease go untreated, but also causes the patient and the patient`s next hygienist a lot of stress. Trying to answer in vain as to why the last hygienist never probed isn`t one of our responsibilities, yet patients want answers. Ethically, we shouldn`t say anything, but simply tell patients we`re presently doing what`s best for them. We shouldn`t have to pick up slack, make excuses for, or second-guess each other on a professional level. We should look out for each other as well as our patients, and always remember why we`re here. When we don`t, we have to deal with the inevitable.

Loyalty to our profession

This brings us to service and our almighty ally - the probe. Thorough periodontal probing is the only dependable method to accurately assess a patient`s gingival health and to know what the next step should be. It should be seen by all of us as the most primal procedure we perform. It should not be the one that gets left out or the one that is quickly squeezed in by committing the misfeasance of "spot-probing."

This unethical shortcut seems to have evolved from being pressed for time, and maybe even from a little professional burnout. Whatever the case, it`s not a bona fide procedure and it isn`t taught in hygiene curriculums. It`s inaccurate, inadequate, and ineffective when trying to ascertain true tissue health. Stopping short of what patients deserve and expect should make us question our place in the profession, and it should make others question it, too.

It would be interesting to have a group of hygienists in a room together and tell them they`re only allowed to use the mirror and one other instrument to treat a new patient. Without having read this article, which instrument would most choose?

Loyalty to our team

We also must demonstrate loyalty to our employers (as dentists and as people), to our offices, and to our staff members as team players. We deserve and should expect the same from them. Offices depend on teamwork to become a functioning unit. It is a vital part of any successful practice.

Sally McKenzie, a certified management consultant with more than 32 years of experience and dental clients spanning 40 states, offers this advice on teamwork: "If hygienists aren`t team players and don`t participate in such things as staff meetings and helping assistants when they have down time, it hurts morale," she says. "Poor morale is like a cancer throughout the office." Patients also suffer if staff solidarity is absent. "When a hygienist doesn`t promote the doctor`s treatment plan, it hurts patients` health because they don`t perceive the need for dentistry," she adds.

Additionally, hygienists who balance family and a hygiene career through subbing are not exempt from teamwork. We still learn duties of other staff members and be able to adapt to situations in any office with enthusiasm and tact. Subs who read magazines between patients and make a mad dash for the door at lunch and quitting time hurt the office and damage their own reputations.

Remembering who we are

Dental hygienists are distinctive as a professional group. Our specialized services and operational dynamics are in a category all our own. We`re not zealots climbing corporate ladders; we`re already at the top of our chosen profession. Society has deemed us worthy of licensure, granting us an exclusive place among white-collar professionals that validates us as educated and competent. Public faith has been placed in us to balance total body health with that of individual oral concerns.

Although part of a team, we`re separate entities with very specific objectives directed toward unspecified conditions every day. For example, dentists know whether they have a filling or a crown scheduled, but we have no way of knowing what`s in store when our new patient arrives. We must be cognizant enough to hone in on the diverse needs of each person, customize treatment plans, and develop a working partnership toward the goal of optimum oral health. We are unique ... but this truth needs to be regularly refreshed!

Other responsibilities

All of us should be concerned with civic duties. However, we also should volunteer skills and knowledge of our profession to schools, health departments, and take any other opportunity to motivate people toward better oral health. We don`t have to be public health hygienists to make valuable contributions. Wilma E. Motley, author of Ethics, Jurisprudence and History for the Dental Hygienist, says it best in Chapter 3: "In some manner, dental hygienists must be adhesive and cohesive forces in this galaxy of opportunities."

We aren`t just "teeth-cleaners." We have responsibilities. We have duties. We have the power to make a difference, and we have to remember why we`re here. It`s not only about probing ... but that`s a good start!

Kelly Heisey, RDH, has been in the dental field for 16 years, six as a dental technician in the U. S. Navy and 10 as a full-time hygienist. She lives in Garner, N.C. and can be contacted by e-mail at [email protected].

Delivering the bad news

Being the first to tell someone they`ve developed gum disease isn`t always easy. Reactions range from surprise to dismay, depending on the stage of periodontitis present.

There have even been tears in some cases, caused by feelings of betrayal by a trusted dental team. The N.P. "new" patients (with periodontitis) transferring from other offices are skeptical of probing at first. They go along with the program, assuming it`s a good thing. Then they hear words like "bleeding," "pockets," "disease," and "treatment." Denial occurs after a brief moment of confusion, and suddenly probing is a bad thing. If you hadn`t poked them with that thing, this wouldn`t be happening!

Anger sets in as the patients spew accusations of "you`re just trying to get my money." They argue that they can`t possibly have gum disease since their previous hygienist "never said a word all those years." How could they "suddenly" have it now? Surely, we`re out to pick their pockets (no pun intended).

Even on top of probing discomfort, bleeding, radiographic evidence, and a dentist who backs all of this as accurate, these patients still are hard to convince. If rescheduling is required for root-planing, it causes outbursts like, "What? You mean you`re not going to clean my teeth today? I`ve had this appointment for five months!"

Although you labor through explanations of how to treat the disease, these patients still will ask, "Can`t you just do a `regular` cleaning today?" We`ve all been there, but we all should know that performing a simple prophy on an angry perio patient isn`t just improper. It`s malpractice!

No matter what the circumstances, it`s an extremely difficult situation to be in, both as a patient receiving the bad news and as a hygienist who`s trying to give the best care possible. Appointments become stressful and negative. Patients may leave with a dark cloud over their heads. After all, who likes hearing they have a disease? Scenarios like this might be prevented if we all took our ethics and responsibilities (especially probing) seriously. We have to have loyalty to the profession of dental hygiene.