The wedding reception appears to be winding down. Some couples are still dancing, but most guests are just talking in small groups around the tables. Tom1 and I sit alone on folding chairs against the wall at the far end of the reception hall. He's finally eating his piece of cake. Since Margaret is the designated driver, I choose one more beer over cake.
"Hodsdon was really excited about Maine, huh?" Tom asks.
Out of curiosity, I was watching the bride's family celebrate. We did not know them since our kids grew up with the groom.
"What?" I replied.
"Hodsdon. Kristine Hodsdon. Sally showed me the RDH eVillage article2 about unsupervised practice in Maine. She was pretty pumped, huh?"
Sally is Tom's wife. She is a dental hygienist. I replied, "Darn-tooting Kristine was enthusiastic. She just lives across the border in New Hampshire."
"She's a big fan of Maine all of a sudden? Is Kristine going to move there?"
I shrug. "I doubt it. It's still uplifting to have a neighboring state accomplish something like that. Sally has a pretty good career in Oklahoma. It means something that New Mexico has collaborative practice, and Colorado has independent practice. Not all of our neighbors are as favorable to dental hygienists. If you base your retirement plans on dental hygiene practice acts, Sally's gonna balk at relocating south or east of here."
"Thank you very much, counselor. Are you going to send me a bill for your advice?"
I casually point across the room. "The bride's family looks like a good group of folks, don't they? I hope our kids fare as well with their spouses."
He set his plate down on the vacant chair next to him. "So I guess you approve, huh? I guess you'll let us know when you approve of unsupervised practice in Maine?"
I turn my attention to him. "What's the matter with you?"
"RDH eVillage is in a celebrating kind of mood. RDH isn't. What's up with that?"
"I don't know," I say, surprised by the question. After a moment, I answer, "The ADHA has this map-slash-chart on its Web site.3 It lists all of the states that have turned the tide in favor of dental hygiene. Sucker's getting to be a rather long list, know what I mean?"
Tom upends his palms at me. "Sounds great, I think. But it's hard to tell with Mr. Excitement next to me."
"Oh, I sometimes think organized dentistry is biding its time, waiting for dental hygiene to fail."
"So you think dental hygienists are going to fail at delivering their care separately from dentists?"
"No. What I believe is that dentists think hygienists will fail and they're waiting for a told-you-so moment."
Tom looked at me for a moment and then laughed, tilting his head back. "Hey! I've been married to a hygienist for 29 years. Dentists love to wait and say, ‘If you'll remember, I warned you about this.' You're not telling me anything new about dentists."
One of the bridemaids walked over to us, carrying a plastic tray that was obviously from her kitchen, not the caterer. I think Margaret told me her name. As it happens with the hearing impaired, her name was a sound that evaporated before it hit my eardrum.
"My mother made these for the reception. Plenty left over. Would you like to try one?"
Tom pointed to his cake plate. "No thank you. I'm full."
The treats looked salty rather than sweet, a better match with the beer, so I took one. I thanked her, and we watched her walk over to a nearby table.
"I should go find Sally and have her come over and slap you," he said.
I snorted, "She would slap you for making us think about work on the weekend." I paused and mustered up some fake enthusiasm for him. "Isn't what happened up in Maine great!?!"
"Yeah, OK. Forget I brought it up. I just remember Sally saying something about how glad she was for hygienists up there."
The bridesmaid's treat is filled with a sweet, chocolate filling. I stand up to reach over Tom and drop the other half of the sweet on his plate. Obviously, I've had too many beers. So I set the plastic cup down too. I remain standing.
"Sorry about that, Tom. I guess I've been on edge. You have to remember that it was only about three years ago that the American Dental Association said independent dental hygiene practice in Colorado was a bust.4 Even last spring, the ADA News published this article by this dentist in Colorado who was originally from Minnesota.5 If you're excited about Maine, then you should be excited about Minnesota too6, since they just got the governor to sign off on the new oral health practitioner position.
"Anyway, this doctor ... I still remember the exact words ... said he worked with an independent Colorado hygienist to make their arrangement quote an intolerable situation tolerable unquote. The whole article was anything but a glowing endorsement of how dentists view the future of preventive dentistry, as far as dental hygienists are concerned. I'm telling you: The most positive thing you can say is that dentists are quietly wary about all of this progress in dental hygiene.
"So, yeah, I haven't done my best in getting excited about Maine. OK with you?"
"Sit down," Tom instructed.
"You're blocking my view of the bridesmaid."
I sat down. "I'm just going to comment that I now know Sally would slap you and not me."
1. See Editor's Notes January 2003 and February 2006 for the other fictional conversations with Tom.
2. Hodsdon's Director's Message for the May issue of RDH eVillage appears at http://www.rdhmag.com/articles/article_display.html?id=329786.
3. "States Which Directly Reimburse Dental Hygienists for Services under the Medicaid Program" can be viewed at www.adha.org.
4. The 2005 ADA report can be accessed at http://jada.ada.org/cgi/content/full/136/3/289
5. The April 2008 ADA News ViewPoint can be accessed at http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2966
6. As well as Alaska, California, and Maryland, where sweeping changes in scope of practice have occurred for the dental hygiene profession.
by Mark Hartley