Th 70132

Raising the level a notch higher

Sept. 1, 2001
You know your job is important. It's you who detects the first signs of gum disease.

by Shirley Gutkowski, RDH, BSDH

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You know your job is important. It's you who detects the first signs of gum disease. The patient/client is prepared for anything the doctor might recommend, because you're the one who often sets up the treatment plan before the doctor even gets to see the patient in your chair. Sometimes the doctor even wonders aloud how the heck you found that decay!

You love the assistant you work with at the office. She's the godmother of your first child, but heaven help the person who mistakes you for an assistant. You want to be recognized as an educated educator, not just Dr. Marvelous' "girl who cleans teeth." You are someone who knows the pain of setting a difficult goal and has gone through the spanking machine called college en route to licensure.

It is imperative in this climate that hygienists use the basic education required for their degree to further the cause of healthy patients and their profession. Hygienists of all education levels can do a number of things to raise the profile of the profession as a whole. Removing deposits from teeth is the smallest portion of our professional duty to health. It is proven again and again: The focus, or origin, of breakdowns in many of the body's systems may be the mouth. It may not be the germs so much; rather, what their presence does to the rest of the body's systems while trying to exorcise them. In any event, our patients need to know that we are educated and at the pinnacle of progressive thinking.

Many states are at the threshold of something big. Some of the thresholds are at doorways that lead to growth and self-fulfillment. Others are doorways that lead not only to the degradation of dental hygiene as we know it today, but arguably the health and safety of the population at large. Supporting the cause with money is always an option. Alas, money doesn't grow on trees, but that doesn't take away the obligation of professional dues. Another way to support the efforts of those in the front lines is setting an example of an educated, knowledgeable health-care provider.

Here are a few ideas to increase the public's awareness that dental hygienists are college-educated and a vital part of the dental team. The objective is to have our patients/ clients know that their head is in the "lap" of a college graduate.

Write letters and be active in the community as hygienists. Write letters to the editor of the local newspaper. Write true stories relating to dental hygiene for women's magazines. Write to legislators about the goofy system that is in place today, where dentists rule hygiene when hygiene is nowhere near what it was when Dr. Fones started the first hygiene school.Have "RDH" printed on your personal checks.Develop an Oral Infection Control Badge for Girl Scouts or Boy Scouts, instead of (or in addition to) serving as a den mother/ father. Having time to be with your children is one of the big benefits of being a dental hygienist. Children need parents, and they need parents to be involved in the things that they do. But why stop being a hygienist? Sign all progress notes with your full signature and "RDH" and other degrees at the end. If you do this in front of patients, it increases their awareness that you're not just a janitor. When other staff members come across it in the notes, it sends a clear message to them that you're a professional (this suggestion was contributed by Anne Guignon).Start a campaign to have all sports-playing kids, including girls, wear mouthguards. There is a serious gender gap in safety equipment requirements between sports for girls and sports for boys. Be a parent/hygienist. Support a movement to require children to wear mouth protection for the list of sports set up by the American Dental Association. Track oral lesions and their referrals in your office. By doing this, you will see firsthand how we are helping patients and possibly saving their lives every single day. In large and small offices alike, when a patient is referred to the oral surgeon, the doctor gets a letter of what the biopsy showed. Does your doctor share that letter with the hygiene department? Wouldn't patients be astounded to know that you detected three oral cancers since Jan. 1, 2001? Why not post it in your treatment room? Take down the poster that shows brushing and flossing. Put one up that says: "Dr. Donut's Dental Health Care Team detected cancer in five patients this year. Please report any lumps or lesions to us at any time."Have "RDH" printed on business cards to give to every patient. I use mine to make notes for patients to take home — for instance, what to buy at the store: fluoride mouthwash, special floss, and things like that. Make sure the initials RDH are on the card. You earned them through hard work, sleepless nights, and resoled shoes.Mat and frame your diploma, and hang it in your treatment room.Refer perio cases to their physician for diabetes, bone density, and cardio risk factors. What says "I'm a health-care provider" better than referring your perio cases to a physician for further investigation of co-diseases? Because the links are just starting to be established, the effect of periodontal debridement on the risk of systemic diseases hasn't been demonstrated. Why not assume that it works that way? Be diligent with perio therapy. Treat the noncompliant patients; do not wait until they start brushing daily or discover floss. It's not known whether this therapy will reduce their risk, but act as if it does. Talk to the dietitians who counsel diabetics. Make them aware that only half of the population sees the dentist and that 80 percent of the population has some form of gum disease. This unmanaged infection could be the turning point between managed or unmanaged blood glucose levels.Take patients' blood pressure. This will give you another opportunity to show that you are caring for the entire body. Answer questions. I once took a woman's blood pressure and it was breathtakingly low. I wondered aloud how she could even stand. I then took the pressure in her other arm, which was higher than normal. I referred her to her MD. In fact, I told her to stop there on her way home. She did and the MD did an exam that revealed a large thyroid tumor. Lots of hygienists have stories like this one. Get a story like this for yourself.Contact diabetes educators at the major hospitals in your area. The National Oral Health Information Clearinghouse has a slide show with narration that you can purchase and present to their support group.Contact sales reps from various companies and ask if they have slide presentations about their products. CollaGenex, Laclede, and others have presentations that they give to interested people.Introduce yourself with your first and last name. Professionals are not afraid to use their last name. When confirming appointments, address the patient with your first and last name, as in: "Hello, this is Shirley Gutkowski from Doctors Dental Dungeon. I'm calling to remind you of your appointment tomorrow at 10." If harassment becomes an issue, deal with that issue. Do not discard the use of your professional name because someone might give you grief. You do not encourage full-mouth extraction just because someone might get a cavity.Join the ADHA. The ADHA has a full-time staff person to help with issues ranging from legislation to increasing visibility. Just the fact that you are a member of a professional organization will make you feel more like an expert. Feeling and acting professional will bolster the idea to your patients.If you are a member of ADHA, publish meeting times and dates in the newspaper. This is usually free. The more often people see that hygienists have a professional organization, the more they will view hygienists as educated dental health-care providers.Check to see if any of the free publications at the doors of grocery stores have a section on promotions or new hires in various corporate venues. If they do — and some newspapers do too — contact them after every election with the list of new officers, state- and component-wide.Create a document that outlines what a dental hygienist is, what education is needed, what services we can perform, and how we help educate patients and prevent diseases. Print it on fancy paper, frame it, and hang it in the operatory for patients to read. Or laminate it and use it as bookmark giveaways (this suggestion was contributed by Marilyn Chew).Choose to read professional journals during downtime, and refer to those articles while speaking to your patients. Get rid of the women's magazines. They will do nothing to further your education and simply make for idle chatter that leads nowhere in the treatment room. Lately, the term "client" has come into vogue instead of the term "patient" when talking about the person in the "big chair." A client may be interested in the latest color of wallpaper in Brad Pitt's bedroom, but to me, this kind of discourse takes away from time you could use to dazzle your patients with what's new in dentistry and, more importantly, steps to increase their awareness of their own mouth and health.Mat and frame your license, and hang it in your treatment room.Speak to a cardiologist about sending his/her patients to your office for a periodontal risk screening. Ask your doctors for their support or involvement.Keep in contact with the hygienist at the periodontist's office to which you refer patients. Imagine how happy you would be if another hygienist called or sent you a note about a patient you shared. This impacts the profile of hygienists directly by showing the patient that there is professional courtesy between hygienists.Write a note about the patient to the periodontist upon referral. Was the patient a regular? Did the patient comply with home care? Was this your first encounter with this patient? Did you already do four quadrants of perio therapy? When the time comes for the patient to alternate between you and the perio office, keep in contact with that office. Write the hygienist a note about the patient who tried to pull a fast one on you or to whom you recommended a Prox-a-brush. Frame the participation diploma from the most current continuing-education lecture you attended. Keep it current.Offer to provide the staff in your local nursing home or long-term-care (LTC) facility with oral health education. Did you know that the main reason nursing assistants do not provide oral care for residents is because they are uncooperative? Call a long-term care facility near you. Most have some kind of oral care in-service once a year.Provide an information sheet for the resident's admission package in LTC about the importance of oral care. For the most part, residents' families do not understand that, even without teeth, these people need oral exams. Family members have to take the resident to the dentist in more than half of all long-term-care facilities. More and more people are keeping their teeth longer. Elderly patients in residential settings are at equal risk for decay as that of children in unfluoridated areas. Get to know some nurses. School nurses can be great contacts. Develop a caries risk-management protocol with the school district. Childhood decay can be managed with assiduous use of xylitol, fluoride varnish, and CHX. Develop a protocol for fluoride varnish and xylitol studies in the United States or in your school district, since most of the available studies are from Europe. This would raise the dental profile a mile in your region.Use a preprocedural rinse of some antimicrobial mouthwash. Explain to patients that it is for infection control, not because they have halitosis.Finish a baccalaureate degree.

Once the level of dental hygiene — even dentistry — is established a notch or two higher, care providers' jobs will appear more challenging. Professional growth is something with which any professional should be comfortable.

Raise the bar, and raise the profile!

Shirley Gutkowski, RDH, BSDH, has been a full-time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected]