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Readers' Forum

April 1, 2003
I am writing in regard to the letters concerning the Alabama Dental Hygiene Program in the Readers' Forum. I am a hygienist from Alabama who did choose to go to school for my training and can say without a doubt that the preceptor program in Alabama is flawed.

Former Alabama hygienist comments

Dear RDH:
I am writing in regard to the letters concerning the Alabama Dental Hygiene Program in the Readers' Forum. I am a hygienist from Alabama who did choose to go to school for my training and can say without a doubt that the preceptor program in Alabama is flawed. No one who attended the Alabama Dental Hygiene Program will ever convince me that they are proficient in any of the subjects that we spent semesters taking while they attended only a number of weekend classes during the year that they were in "school."

Several of the women who wrote letters failed to mention the bias that was already present at the Alabama Board Examination because the same people giving the test were the ones who were their instructors for the past year. There is no double-blind system at work, as there is at other state board exams. Those of us who actually attended school were easy to pick out of the crowd. As for finding a suitable candidate for the clinical exam, they cannot compare their stress in finding a suitable candidate. The criteria for patient selection for the Alabama state board are significantly less than those in other states that allow only college-trained hygienists to take their boards.

No one can be in all of the offices to see who is actually trained and who is not. I am confident that some of the dentists who oversee this program in their offices take it seriously and spend time training their students. But, overall, this is just not the case. Unfortunately, many employers see this program as a way to get a hygienist for minimum wage and they begin seeing patients the day they begin the program.

All other arguments aside, my main concern with the program is the fact that the majority of citizens in Alabama — the patients whose best interests we claim to have in mind — have no idea that this program even exists. Those who attend the ADHP refer to their training as "school" so the patients have no reason to believe that they were trained otherwise. They come to the dental office having no idea that the hygienist who is cleaning their teeth may be seeing a patient for the very first time. The mere fact that this information is not disclosed indicates to me that there are inherent flaws within the program. If the training is equivalent to an accredited school's curriculum, they would not have to keep their training secret.

In theory, I would agree that this program can work, but unless they institute a better way to oversee all of the people in the program, it will never produce the caliber of hygienists that are produced in the accredited institutions throughout this country.

Ashley Dowlen, RDH
Lexington, Kentucky

What's the problem?

Dear RDH:
After reading my RDH, I always find myself asking, "What is the problem?" Specifically, why does one profession (namely dentists) want to eliminate the existence of another profession (namely dental hygienists)? Why is there a constant black cloud over unsupervised practice for the dental hygienist?

Originally, the dental hygiene profession was an independent profession that was specifically designed to provide education and preventive dental health care to the public. How and why did the dental hygiene profession get locked into the confines of the dental office? Now the type of degree — whether two years or four years — has come under fire. In Washington state, legislation is being considered that requires a bachelor's degree for unsupervised dental hygiene practice, despite the fact that many of those programs are closing.

Dentists are submitting legislation that allows a dental assistant to do anything that is "reversible." Simply said, the trained, unsupervised dental hygienist would be required to do something that may not be possible, and the untrained assistant would be able to do almost anything in a dental office. Other health professions with various educational requirements are allowed to peacefully practice in all practice settings, so why not the dental hygienist? What is the problem?

I turn to the educational requirements of health professions and the Washington state RCWs. Health professions subject to "RCW 18.130.020 Regulation of Health Professions — Uniform Disciplinary Act" are listed in the state manual titled, The Law Relating to Dental Practice and Dental Hygiene Practice. It is a long list of health professions, and formal education for these health care providers range from six months to 10 years. In comparing these professions, I believe the dental hygiene educational requirements of either an associate's or bachelor's degree fulfill the training necessary to provide quality dental hygiene care, regardless of the setting.

When a graduate of an accredited school is tested, the focus of the examination is whether the applicant knows the rules and regulations of the dental hygiene profession and can safely and accurately provide care. If they cannot, they do not receive a license, regardless of the degree. Other health professions do the same.

The dental hygienist is to dentistry what a registered nurse is to medicine. No one questions the professional ability of one who sports the letters, RN, after their name, nor do they question what type of degree they received. All but a few of the health providers on the long list of professions provide their services in all practice settings. One of the exceptions is the dental hygienist. So what is the problem?

Recent health care studies confirm that dental disease is rampant in the United States. It seems obvious that current dental practice settings are simply not working. Dentistry should be asking how those settings can be changed to successfully address the public's urgent need for dental care, while utilizing the most qualified and capable providers. Creative settings should be applied to augment the traditional setting. Access to care needs to be accurately defined. Dental professionals should work together in deciding who can best eliminate the problems, and willingly allow each profession to do what they know best. The "king of the mountain" mentality will have to stop, if the dental profession is to move forward. So, what's the problem?

Everyone knows that economics play a major role in all health care fields. Business and government continue to look for ways to reduce overhead and increase income. In a traditional dental office, higher wages mean higher overhead. Just as independent physical therapists complement a medical office and independent massage therapists complement a chiropractic office, the college-trained dental hygienist working independently would complement the dental office, while reducing overhead. We live in a society of litigation, and malpractice insurance is expensive. Independent dental hygienists would eliminate one liability to the dentist, yet retain comprehensive dental care. But, curiously, some dentists want to hire lesser trained employees to do the same procedures. Federal, state, and local revenues have dramatically fallen with the current economic slump. Dental hygienists added to IRS and state B&O tax rolls as individuals, would go a long way in reducing deficits.

New products continue to come on the market to aid the public in cleaning their teeth and keeping their mouths in a healthy state. The public is becoming keenly aware of what they can do themselves to prevent dental disease. Remember, before dentistry became a profession, the local barber was often the one who pulled teeth. We all know that the public can do what we do by themselves. Of course, we all cringe at such a thought. But does it have to come to that before dentistry realizes that all of us are dispensable?

Dental care has always been an "elective" health benefit for the public, and people who are losing their dental insurance because of economic conditions can't afford costly dental procedures. When this happens, they stop going to the dentist. Current and future economic climates threaten everyone, making cooperation among the professions vital. Unsupervised dental hygiene in any practice setting makes good economic sense. So, what is the problem?

As I see it, other health professions seem to look at the actual impact to the public and require educational and clinical training accordingly. They all seem to reasonably respect one another and are able to independently work together toward providing a vast array of comprehensive health care in many practice settings. With dental disease, poor access to dental care and economic threats ever looming over oral health, the dental professions would be wise to follow that example. The registered dental hygienist plays an important role in the delivery of dental hygiene care, and the public knows it.

Dentists are wasting their time, money, and possibly their profession by refusing to acknowledge the fact. Major changes are needed in dentistry and the dental delivery system. All of the professions in the system must be free to enhance the profession in any way possible for the common good of all — just as other health professions have been doing for a long time. So, what's the problem?

Carol Levanen, CDA, RDH
Yacolt, Washington

Remember Painless Parker?

Dear RDH:
The flurry of letters from and about "preceptorship graduates" generates endless questions and responses. For example, Tammy Bennett's comment, "... if they ever had an on-the-job training program to practice dentistry ..."

Once upon a time, "they" did. Just read about "Painless Parker;" there are many books describing the activities of itinerant "dentists" and "barber-surgeons" who extracted teeth. Evidently, a need was seen for formal education in the best interest of the patients, and, subsequently, laws were made — for a good reason. There has never been a movement to lower the standards for dentistry and dental education — what dentist would support an on-the-job method of turning out more dentists?

Apparently, a lot of recently graduated dental hygienists are practicing without the sense of professionalism and importance of maintaining the standards our profession has attained that my peers and I were instilled with over 30 years ago. The educational foundation I received has been strong enough to build on, and to keep me motivated to pursue more knowledge as research continues. The benefit to my patients and their appreciation of information goes way beyond people saying that their teeth "feel clean."

I am amazed that vast numbers of hygienists aren't demanding that our educational standards be upheld. Those who think to undermine our standards or who think that the accreditation process of dental hygiene programs is "overboard" and unnecessary must not have a very clear understanding of what a professional dental hygienist can be.

I can understand (if not agree with) dentists wanting to limit our upward progress, if they feel their "turf" is threatened. I cannot understand them considering reducing the educational background required for the practice of dental hygiene. The definition of a dental hygienist needs to expand with our role in health care. I strongly resent the message to the public that "tartar" is the cause of disease and that removal of visible calculus is the hygienist's contribution to oral health. We know better.

Nurses don't become RNs by taking an abbreviated course or on-the-job training. Registered dental hygienists should be able to expect the same protection of their standards.

I am aware that Alabama has maintained their preceptorship system for at least 35 years; I am surprised that they have not figured out that the other 49 states created higher standards for a reason. How do they train dentists in Alabama? Are their graduates qualified to be licensed in other states?

Cheryl A. Todd, RDH, AS
Lynchburg, Virginia

Periodontally involved adults need experts

Dear RDH:
I wholeheartedly agree with the comments in the February 2003 issue of RDH from Fabi Small and Christa Akins. We are professionals and patients seek our help and advice when it comes to their oral health care. We make decisions daily with each patient's situation, and this can only be done with a formal education that a dental hygiene program offers, not from a preceptorship type of background.

Think about it. Most of our patients (adults) are periodontally involved to some degree. We are responsible for patients keeping their teeth through education, information, treatment, and referral (if needed). Would any of my colleagues seek medical attention and treatment from an "on-the-job" trained doctor?

In conclusion, the "Voltage Regulator" article by Julie Kagan (February 2003 issue) was excellent! Using metaphors not only captivates the attention of patients but leads to a motivated patient with their home care. I use metaphors daily with an 85 percent success rate in patient compliance.

Judy Koningh, BSDH
Santa Cruz, California

Trained chairside to be dentists?

Dear RDH:
In response to the letter from Mark King, DMD, I have only one comment I'd like to make after reading his letter (February 2003 issue). I've been a dental hygienist for 26 years and certainly am not in favor of "preceptorship." If students in the Alabama program can become practicing hygienists, then perhaps it's time for registered dental hygienists to become dentists. We can be trained chairside under the same stringent conditions imposed upon the hygiene students! Imagine the health care services we can provide at a fraction of the cost dentists can provide them!

Lynda Neiss, RDH
Island Park, New York

Shortage of assistants

Dear RDH:
Anastasia Turchetta, who wrote a letter for the February 2003 issue, misunderstood my comment that "good assistants are as rare as hen's teeth in my area" (October 2002 issue). In no way was this meant to demean dental assistants. In fact, I have been a dental assistant, as well as an office manager where I was involved in the hiring, firing, and training of many dental assistants. I fully realize how vital they are to the success of any dental practice.

In central New Jersey, there is a severe shortage of assistants. Every Sunday, 20 to 30 ads are in the newspaper. When our assistant moved to Florida, my employer had an ad in for three weeks with no response. Eventually three people applied. One had an ankle-monitoring bracelet (under house arrest for drug charges), one was unqualified, and the third was hired. The hygiene assistant could be an entry-level job. My point was that even if you wanted to do assisted hygiene, you may not be able to find one.

Since I wrote the article, I discovered that 90 percent of the hygienists in California see eight patients a day, an hour per patient, because no one will work a tighter schedule, according to Linda Belaus of They've seen too many hygienists with health problems, burnout, and shorter schedules that compromise the patient's well-being. In my opinion, there are more negatives than plusses to assisted hygiene.

Barbara Burlew, RDH, BS
Ocean, New Jersey

Responding to the call to be a mentor

Dear RDH:
I would like to congratulate Amy Nieves on winning the first "Mentor of the Year" award presented at the RDH Under One Roof conference in Las Vegas in February. As a "lister" on the [email protected] list, I have had many questions answered, even though I've been in private practice for 33 years. I've even been able to answer some questions too.

We should always be open to new ideas and new answers to old problems that keep recurring in our dental offices. I recently had the opportunity to really think about the mentoring process, as my last summer's dental hygiene assistant, Morgan, was accepted into dental hygiene school in the Houston area in 2002. Morgan still works part-time in our office on the days she does not have a lab, hygiene clinic, or classes.

I have always tried to answer Morgan's questions about our profession honestly, and I try to educate her when I see something of interest in one of my patient's mouths. Morgan is learning "on the job" as she goes through her first year of dental hygiene school.

About a month ago, Morgan came and asked if I would possibly be a patient for her in clinic, because she could not find anyone who would come that first day. The school she attends is almost an hour's drive away from my home in Sugar Land. But I remembered that someone was my patient many years ago on that very first day of clinic. It was now my time to give back to Morgan.

At that first appointment, Morgan had to take health history, blood pressure, temperature, pulse, respirations, and then begin her intraoral/extraoral examination. The clinic runs from 8 a.m. to 11:30 a.m., and that was all that was accomplished that first day. Morgan asked if I could come back in a couple of weeks for another clinical appointment. I told her that I would come back.

As I have thought about this process, it has brought back many memories from dental hygiene school at Caruth, which is located in the Baylor Dental School facility in Dallas. There are so many areas of importance in the body that center around the blood supply, nerves, muscles, teeth, nutrition, medications, and over-all general health. All dental hygiene students have so much knowledge to cover in those two years of dental hygiene school. Who would know that better than a practicing dental hygienist?

Therefore, it was a real privilege to be Morgan's patient on that first day of clinic. When one of the dental hygiene instructors came over to examine my mouth and check all of Morgan's records, she was pleasantly surprised to learn that I was a dental hygienist. She thanked me with lots of emotion, as she knew the sacrifice that I had made to be there that day. I had my second appointment with Morgan, and she completed the rest of her records and one-half of my prophylaxis. It will take one more appointment for Morgan to complete the other half of my mouth.

It's been such a great time of reflection for me to go back and remember the educational process. The reason I wanted to bring this to your attention is because we all have so many opportunities to be "mentors" to young ladies or gentlemen, who might be considering dental hygiene as a profession. We might have a junior or senior in high school who is asking questions about what a dental hygienist actually does all day. We need to be able to express our answers with enthusiasm and with a pride for our profession that we hold so dear.

I was so touched when I attended the RDH Under One Roof meeting in Las Vegas, because the excitement of seeing other hygienists from all over the country and feeling their energy was so encouraging! After 33 years, I still have a passion for practicing dental hygiene that has never diminished.

In closing, I would like to say a big thank you to Amy Nieves for the way she has mentored all of us on the [email protected]. I was so excited to finally get to meet Amy and hug her. I feel like I know her so well, as we have emailed each other for almost five years. It was my good friend, Jane Weiner, RDH, from Florida, who introduced me to Amy's list, and for that I am grateful. Let's all be aware of the opportunities that we have to mentor others and bring wonderful practitioners into our beloved profession. Also, I would like to thank the wonderful crew at RDH magazine for making the Under One Roof meetings a true celebration for hygienists all over the country. I will definitely come back to another UOR in the future!
Shirley Cross, RDH, BS
Sugar Land, Texas

About the cover
Click here to enlarge image

The photographs of Velaina Greenwood were taken in mid-February. The RDH staff knew that it was February because, when we looked out the window, there was snow on the ground and the north wind was howling. Granted, we knew that Florida typically enjoys a different kind of February from the rest of us, and Greenwood does live and practice in the Orlando area. When we talked with her about what she likes to do with her personal life outside dental hygiene, we told her that we'd concentrate on photographing her doing something other than water skiing. After all, it was February weather outdoors.

We underestimated Greenwood.

For 12 years, she was a professional water skier at Cypress Gardens, a theme park known for its water skiing shows. So a little cruise around the lake with RDH's photographer was no big deal.

"I was able to participate in several world-record achievements, such as being on the top of the world's first five-tier pyramid and the longest 26-person swivel line," she said of her former career.

When she retired, she kept things fluid, enrolling in Valencia Community College to become a dental hygienist, and she graduated in 1987.

"Even though water skiing was a great life, I thank God every day that I decided to educate myself (she turned pro at age 18) and become a dental hygienist," Greenwood said. "The ability to make a great wage doing something I love anytime anywhere makes me feel empowered and free."

Greenwood is employed by Drs. Vic and John Gammichia, a father-son dental practice in Apopka. In her spare time, she is earning a certificate to become a personal trainer. She said, "I would like to develop an exercise video tailored for dental hygienists, targeting our specific needs, such as bad backs and necks, and other physical problems we usually have."