Th 200297

No Compliance in the future

Feb. 1, 2006
“What would the future of dental hygiene be if it were written by dental hygienists with the freedom to envision, to aspire, and to accomplish?”

“What would the future of dental hygiene be if it were written by dental hygienists with the freedom to envision, to aspire, and to accomplish?”

Great question isn’t it? This question was the basis for Dental Hygiene: Focus on Advancing the Profession by ADHA, released in June 2005. This document clearly articulates ADHA’s plan for advancing our profession. The ideas will be prioritized and incorporated into ADHA’s three-year strategic plan. It is the document that drives the activities of our board of trustees and councils. You can download this document at

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This report helps provide the future focus for our profession. Thinking and deciding where you want to be in the future provides direction in times of change and uncertainty, improves the quality of decision-making, dispels feelings of helplessness in turbulent times, and helps individuals and organizations focus on their goals and achieve remarkable results. In the 1960s, Bob Dylan sang “The Times They Are A-Changin’.” He was right then and is still correct today. The times are changing and we are on the threshold of a golden age of biomedical science.

Here’s a word we don’t hear or use very often - nanotechnologies. Nano (small) technologies use artificially made molecules called polymer nanofibers that are electro-spun and injected into prepared nano-tube-sized cylindrical holes in the jawbone via a robotic arm. Little “nanobots” (see photo) could be used to repair red blood cells or used to reconstruct teeth and gum tissue. Sounds like sci-fi? It’s real.

Stem cell biology is another direction. You may be thinking about the controversy that surrounds the use of stem cells that come from fetal tissue, but there are other sources. Teeth, particularly baby teeth, are a great source. Stem cells responsible for forming dentin and enamel can be identified and isolated and can be stimulated to grow into a tooth bud. Yes, soon we will be able to re-grow whole teeth!

The Human Genome Project (HGP) will increasingly require oral health-care practitioners to gain more knowledge of human genetics and the application of new molecular-based diagnostic and therapeutic technologies. Saliva will become the diagnostic fluid. Currently, research is being done on a saliva test for the early detection of oral cancer. Can you imagine the day when there are no expensive and invasive medical tests? All that will be needed is a few drops of saliva placed on a microchip to determine the state of health. That day is closer than we think.

Are you ready for that future? We are in a time of rapid exponential change, yet many of us are doubtful, afraid, and tied to the past. Those who fail to see the future are still doing the best to make the most of the past. When you’re stuck in the past, you do some or all of the following:

• Glorify the past and try to find ways to justify current practices

• Seek answers to the wrong questions

• Hire consultants to gather worthless data

• Institute “quick-fix” programs

• Try to “patch up” current systems

• Agree in public but disagree in private

How many CE programs have you left with really good ideas that never came about? Even if you changed a few techniques or added a few new products, did the change last? Did you go back to the same old way, particularly when you got busy or short on time? Changing behavior alone is like wagging a dog’s tail in an effort to make him happy. To effect permanent change, the beliefs on which behavior rests need to be changed. Beliefs are the foundation of behaviors. From where do your thought patterns arise? What are your behavior patterns based on? What are your beliefs?

The word “paradigm” has been used in many articles, yet many of us still don’t know what it means. Paradigms are the pattern or model of our world. Paradigms help establish boundaries and create a filter through which we view our world. They are a set of rules and regulations. They are our beliefs. Paradigms are very helpful in getting through our day, yet they can also limit our vision and prevent us from seeing, accepting, and understanding change. We can shape our future and if we don’t, someone else surely will.

In August 2004 Dental Economics, Dr. Bill Blatchford listed many common dental paradigms or thought processes that may be holding us back from seeing and creating the future. The relates sidebar lists some of them. He said if any of these paradigms hit you between the eyes or you start to argue for one of them, it is time to reappraise who you are and how you can break out of the chains of the old paradigms and embrace a new vision.

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But why should we want to change? Prevention has been successful. Yet, how successful have dental hygienists been in prevention of disease? Interesting question ... the answer fully depends on one’s point of view. Each time the caries process cavitates into a hole, it is a failure. Each case of oral cancer that isn’t detected until Stage III or IV is a failure in early detection, as our statistics clearly show. Most teeth are still lost due to periodontal disease, including many patients that do seek the regular care of dental health professionals. This, too, is a failure.

Back in the 1970s, the father of the preventive dentistry movement, Dr. Robert Barkley, offered some great insights as to the reasons for these failures. Dr. Barkley said: “Dental health is peculiar. The rich cannot buy it and the poor cannot have it given to them. I can make people more comfortable, more functional, and more attractive but I cannot make them healthy. I can teach them how to become healthy; whether they remain that way will be up to them.”

Dr. Barkley’s work helps us understand that health is a result of personal responsibility. This may fly directly in the face of what we learned in hygiene school or in active practice. We learned the idea - which continues to be reinforced by many speakers, courses, and articles - that we are to make patients well through a series of technical and clinical procedures. We continue to believe we are the healers of others. We are to teach those who come to us. Our job is to fix, to correct, to repair, and to remediate. Our success is measured by creating good, compliant patients.

Dr. Barkley correctly said health can only be the result of a sense of personal responsibility because fixing doesn’t really fix, correcting doesn’t correct for very long, repairs don’t last, remediation has to be re-remediated, and teaching doesn’t cause learning. Yet, we continue our same behaviors and patients continue theirs. Flossing is the ultimate end-all for many dental hygienists. In many ways, in the 35 years since Dr. Barkley’s important work, we have changed little. We cling to the same old ideas and the same old ways and continue to seek compliance.

Is compliance what we are really seeking? Let’s look at the definition of compliance. Several definitions include conformity as in acting according to certain accepted standards; a disposition or tendency to yield to the will of others or submission; and the act of submitting, usually surrendering power to another. The illustration shows what compliance often really means.

In their best selling book Boundaries (Zondervan Press), popular speakers and psychologists Dr. Henry Cloud and Dr. John Townsend identify compliance as a boundary conflict. What’s a boundary? In the physical world, a boundary is easy to see - like a fence, wall, or hedge. These are physical boundaries helping us to understand where an individual property begins and ends. As Drs. Cloud and Townsend use boundary, it is intangible yet it is the line that defines what is me and what is not me. Compliant people have fuzzy, indistinct boundaries and melt into what others want. Does this resonate with Dr. Barkley’s words that health is a result of personal responsibility? Compliance should not be our goal.

As health professionals, we can be helpers and act as resource people. Motivation stems from an individual’s personal needs and desires - not ours. Optimal health is more than absence of disease. We can’t force learning; we can’t force optimal health. We really don’t want compliance. Dr. Barkley told us this 35 years ago. Are we ready to internalize these thought processes ourselves? Are we ready to learn and change? Are we ready for the future?

Dental paradigms ...

... about money

• Patients will not pay for dentistry - too expensive or insurance won’t cover
• Dentist should never present fee
• Stating total treatment plan fee will scare patients away
• Dental practices should finance

... about insurance

• Patients only will accept what insurance will pay
• Must keep fees acceptable to insurance carriers
• Insurance is a life raft for the practice

... about staff

• Only the receptionist should know the fees and how money works
• Dentist is the only one who “sells” or presents the case
• Only the dentist can make decisions
• No one except the dentist is accountable

... about marketing

• If technically competent, no marketing is needed
• Patients refer others “automatically”
• Marketing is unethical
• Most production comes from new patients
• Do not offer comprehensive care to existing patients
• Prejudge people and their financial status

... about profits

• Do not emphasize profit
• Emphasize gross production
• Base fees on whatever others are doing
• Finding cheapest materials and equipment will save money
• Just a “little office” can’t make a difference
• Empty chair is expensive
• Full schedule means profit
• Must book RDH every 45 minutes

Adapted by author from Dr. Bill Blatchford’s column in Dental Economics, August 2004