Which big dog protects you?

May 1, 2007
It’s not easy keeping a 90-pound dog exercised in a 9-foot by 13-foot yard, and even harder to contain his enthusiasm while he is leashed.

by Lory Laughter, RDH, BS

It’s not easy keeping a 90-pound dog exercised in a 9-foot by 13-foot yard, and even harder to contain his enthusiasm while he is leashed. Therefore, we take our dog Spencer to the dog park several times a week. These outings give him a chance to socialize with other dogs on a 10-acre, leash-free hillside. There is even a walking loop around part of the park so the people can also add a few steps to the pedometer.

Observing the dogs at the park has revealed a pattern not unlike human behavior. The older dogs rule the grounds and keep the other dogs in line. They control the environment mostly by intimidation. At the other end of the line are the newcomers, mostly puppies, who learn the pecking order quickly. Spencer is somewhere in the middle. He knows his place, but he seeks a higher status by occasionally pushing the limits. Middle dogs are braver in groups, and not so brave on their own.

Even when the puppies outnumber the older dogs, the pecking order remains intact. But get a few middle dogs together and the balance can shift. The middle dogs respect the older dogs, but they seem to feel strength in numbers. When the older dogs are outnumbered by the middle, they appear more willing to give ground. When confronted by the group, an older dog will do one of three things: go off to be alone, play along with the group or start a fight. Amazingly, the middle dogs rarely lose. Yet with each new day the older dogs are again in charge.

In the world of organized dentistry, the ADA appears to be the older dogs. They make the rules, control our education, and often use intimidation to keep team members under control. On those occasions when the ADHA seems to have the advantage, the ADA will often sulk off and refuse to acknowledge others. The arena is definitely in the hands of the older dogs, but the middle dogs are growing in numbers, pushing the limits more and with louder voices.

Wagging the tail for new members

I am proud of the efforts made on behalf of my profession by the ADHA.

One way the ADA is trying to tip the balance is by focusing attention on the newcomers. In many states, the ADA is pushing a membership category for auxiliaries. Recent dental hygiene graduates are presented with the idea of being a part of the largest organization in dentistry. What is not mentioned is that auxiliaries are non-voting members.

By joining state dental associations and the ADA as an auxiliary member, the dental hygienist becomes nothing more than a number. Numbers mean power when presenting an argument to legislatures and governing bodies. If the ADA can say they also represent X number of dental hygienists, why shouldn’t laws pertaining to our practices go the way of the ADA? This makes sense to those making the laws. Each of us shares the responsibility of letting new dental hygienists know the facts about association membership. Our professional organization is the ADHA and not the ADA. By giving our members to organized dentistry, we are writing our own obituary.

Another way to even the fight is to increase the educational levels for dental hygienists. I am not suggesting that a bachelor’s degree ensures better scaling skills or that higher education makes a better clinician. I am suggesting that we cannot keep fighting for more responsibility and less restrictions while refusing to increase our educational standards. The mere suggestion of a scaling assistant can turn a dental hygienist red in the face. Yet we have no problem telling the dentist with a doctorate degree that a certificate or associate’s degree qualifies us to take over some of his or her duties. A doctorate in dentistry requires at least eight years of education to diagnose and treatment plan; it must seem like a slap in the face to tell them we can acquire those skills in less than half the time.

One common trait among dogs at the park is concern for their humans. Spencer will leave a roaring game of chase to make sure I’m safe and secure. Even during romps with his best friend,

Fiona, Spencer will look back to see if another dog is getting my attention. The humans and their safety are most important, even at the dog park. It should be no different in the dental world. Public safety and health must be placed above all other goals or agendas.

It is my earnest belief that organized dentistry knows it cannot serve all the needs of the public by itself. Rather than go off to a corner away from hygienists or start another fight, I believe most dentists would like to play along with the rest of the group to promote oral health for the public. My suggestion is one rarely mentioned, but perhaps the most logical. The ADA and ADHA should sit down for negotiations - with a mediator if necessary. I am not so naïve to believe it would be a quick solution to the standoff or even an easy one, but short of an all-out fight, it might be the only solution.

During these discussions, the ADA could explain why their plan for a Community Dental Health Coordinator is necessary.

The ADHA, in turn, could prove that the Advanced Dental Hygiene Practitioner is the best option for providing care to underserved populations. The challenge may be in convincing both sides that dental hygienists are willing to live in the areas requiring our services. Such an opportunity for open discussion could be the starting point in allowing us to control and provide accreditation for our own educational programs. But we should not expect the ADA to hand us everything we want if, as a profession, we are not willing to raise the bar.

No single member of the dental team can get care to every person who needs it. As dental hygienists we need dedicated and competent dentists to provide restorative and surgical services. Dentists need to be willing to turn over some, if not most, of the diagnostic and preventive services to qualified and educated dental hygienists. And perhaps the hardest step of all - dental hygienists must accept that properly trained assistants can polish teeth, apply sealants, and teach home care skills.

These ideas may be past the edge of acceptance for some dental professionals, yet time is running out and the fight continues at a stalemate. One sad truth keeps the negotiation table out of reach - membership in our professional organization is too low. The percentage of dental hygienists who belong to the ADHA must equal or surpass the membership percentage of dentists in the ADA. Only then will our seat be secure and our voice be heard at the legislative level. Give peace a chance - join the ADHA and get involved.

Lory Laughter, RDH, BS, practices in Napa and Sonoma, Calif., in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists Against Heart Disease and other organizations, Lory hopes to bring a total health concept to the dental practice. You may contact her at [email protected].