Admitting Our Imprefections

May 1, 2008
Nearly every person I've met since I decided to care about my profession again impresses me. From those who listened to me vent, to those who challenged me to action, dental hygiene is loaded with amazing folks.

by Lory Laughter, RDH, BS

Nearly every person I've met since I decided to care about my profession again impresses me. From those who listened to me vent, to those who challenged me to action, dental hygiene is loaded with amazing folks. Yet every now and then I see something that makes me laugh — or cringe.

Egos abound in the world of dentistry. We have all encountered dentists or oral surgeons who think they know by merely looking that a lesion is not cancerous. They display such confidence by stating, "It's nothing— we can watch it." As if dysplasia or pre-cancerous cells can be spotted with the naked eye alone. My all-time favorite ego comments come from hygienists who just know they can remove every speck of calculus from any given tooth surface. I've heard of new grads that have such scaling confidence that they know this career will be a breeze. Right next to this ambitious soul is the seasoned hygienist who is equally sure of his or her root planing skills because they have three hours for each quad of treatment.

I've met more than one hygienist who likes to survey extracted teeth to see how much calculus might remain. I quit looking when I realized just how much stuff I left behind. Scaling extracted teeth was a teaching method in college, but seeing our limits firsthand in the real world doesn't hold much excitement.

Most of us will admit we can't remove all the biofilm, plaque, calculus and debris from a mouth. We have limits — such as working by tactile sense most of the time. To be honest, even when we can see the build-up, there are times when it just cannot be completely removed. We strive for perfection; we live in reality.

Fantasy Versus Reality

Another fantasy in the realm of dentistry is that good oral homecare will cure disease. We judge and lecture our patients as if universal flossing will bring world peace. How egotistical we must appear to some people. We cannot know if Mr. Smith is ignoring our instructions or if bigger life issues prevent him from focusing on proper rubber tip usage. Regardless of how sweet and approachable we may be, our patients don't tell us everything.

We can become so distracted by being right that we may refuse to see what is really important. I've met hygienists who refuse to change because it will mean they have been "wrong" for 40 years. Change does not indicate a faulty past – it shows a talent for progression. Diann Bergman, RDH, recently noted that we don't want endodontists to perform root canal therapy the same way they did years ago. Gone is the three appointment root canal with hand filing. Most endodontists now complete therapy in one appointment with precision hand pieces and intricate measuring devices. Hand filing wasn't wrong; it's just been improved upon.

It is my firm belief that leaving a tiny bit of hard deposit on a supragingival surface of a root is not detrimental to health. In fact, if the root looks like a young boy whittled on it for years with a dull pocketknife, further scaling for the sake of smoothness is contrary to a healthy structure. Time might be better spent demonstrating proper methods for subgingival bacterial control than tediously continuing to destroy cementum.

During my college education we were given scores on several areas of patient treatment. One of the scores was for case management, and now I realize this was the most important skill I learned. We were graded on how well we interacted with our patients, and if we were able to treat the whole case, not just remove the plaque and calculus. If a patient had to be dismissed due to high blood pressure or forgotten premedication, our grade was based on how we handled the situation. If our words were not respectful or were out of line, points were deducted from case management. While it was not evident at the time, I am very appreciative of every instructor's willingness to teach me proper management. Every lost point for sarcastic undertones or disrespect of my peers was a lesson I carried into my clinical career.

Ego doesn't end with how we treat patients. In fact, sometimes our harshest judgments are placed upon fellow professionals. We tend to evaluate the skills of a prior clinician based on the calculus present during a subsequent visit. If a patient presents with hard deposits, especially subgingivally, the previous hygienist must not have been very good at scaling. Whether we admit it or not, all of us have made this assumption at one time or another. In the absence of good documentation, you might not know that the previous appointment was spent largely on homecare instruction and/or health issues. Calculus removal in office is for the immediate, and teaching home skills is the best way to accomplish long-term oral health. Few of us have the option of treating each patient every month, week or day.

Lending a Sympathetic Ear

In my experience, judging our peers does not end with clinical skills. I occasionally receive e-mails from readers sharing their stories of trauma at the hands of colleagues. During the winter months, these letters increase in frequency. I am often astonished at just how cruel humans can be to one another.

Burnout is a term heard often among health-care professionals. Yet some of us who think we have the cure want to force-feed it to anyone with symptoms. Not every disgruntled professional needs the "pull yourself up by the boot straps" lecture. Sometimes an ear is all that is required. There are times when well-meant advice can do more harm than good: especially when compassion is removed from the equation.

You cannot determine when laziness and an unwillingness to participate in professional activities may actually be depression. Few of us are qualified to determine when procrastination has progressed to an inability to cope with life issues. None of us has the right to judge the trials and challenges of our colleagues. I dare say that most of us might not even realize when these conditions affect a co-worker.

In the real world, opposition creates balance. If perceived laziness is met with an offer of help and apathy is met with compassion, perhaps judgments can be left to those holding the proper qualifications. When a willing ear listens to someone's venting, perhaps more hygienists would be willing to share their concerns about our profession. At that point, maybe we can all leave our egos behind and strive for a better future as professionals, friends, co-workers and humans.

About the Author

Lory Laughter, RDH, BS, divides her full-time clinical practice between general and periodontics practice in Napa and Sonoma, Calif. She is co-owner of Dental IQ, a continuing-education provider responsible for bringing quality courses and speakers to the entire dental team. In her spare time, Lory enjoys writing, speaking, volunteering, and providing shelter to homeless pets. You may contact her at [email protected] or through