Docs in white coats

Dec. 1, 2009
Last night I felt the urge to read some blogs and watch some videos online at Obama for America headquarters.

by Lynne H. Slim RDH, BSDH, MSDH
[email protected]

Last night I felt the urge to read some blogs and watch some videos online at Obama for America headquarters. I was especially drawn to the video of the president's remarks before a group of doctors visiting the White House in support of health reform. "Docs in white coats," I thought. "Where are the nurses and dental hygienists in their white coats? Doesn't anyone remember the message from C. Everett Koop?" I clicked on the comments section of the blog and expressed my disappointment that we and other health–care providers were absent from this gathering.

I've read a few of President Obama's books. He speaks about the necessity of finding new ways of thinking in a globalized world, and how the transition to an uncertain future will not be easy.

Looking over what I've learned and how my thinking has changed about dental hygiene in this uncertain economy, several thoughts came to mind.

Dental hygienists in the U.S. are threatened by an uncertain future, too. We've witnessed many states being flooded with new dental hygiene programs when none were needed, and we're now watching in horror as new graduates cannot find work.

It's never been more important to calculate hygiene revenue in private practice to secure our jobs and keep business afloat. The growing mix of hygiene services and the proper use of technologies are changing the way we practice, and this includes hygienists who work unsupervised in states such as Colorado, or in community dental clinics.

We're working to protect our intellectual property as oral health care professionals with expertise in disease prevention, and we're busy creating new opportunities for RDHs in unique settings. We're adapting in an uncertain state of the economy, and this will be reflected in patient decision–making.

I've thought about what I've learned this past year and how it's influenced my chairside decision–making.

• When performing a periodontal exam, I'm more concerned with bleeding and risk susceptibility than with periodontal probing depths. Environmental, acquired, and inherited risk factors such as diabetes, smoking, poor oral hygiene, specific microflora, and stress are significant risk factors.

• A medical history for an adult female includes questions about long–term oral bisphosphonate therapy or IV bisphosphonate therapy. Bisphosphonate–induced osteonecrosis of the jaw (BIONJ) may be a complication of these therapies. Before my patient sits in the dental chair, I open the medical history page on my computer as a reminder to review pertinent information.

• In treating patients nonsurgically, remaining pocket pathology, i.e., deep, bleeding pockets with burnished calculus that is inaccessible, needs to be referred to a periodontist. Re–treatment won't work unless we can get into these inaccessible areas, and most of the time we're working blind. Deep pockets associated with molars, furcation sites, and angular bone defects have been shown to respond less favorably to repeated nonsurgical instrumentation. 1

• I explain biofilm with analogies that give patients a framework to understand biofilm dynamics. I talk about sinus, bladder, or ear infections that some people get repeatedly and never get rid of them completely. Systemic antibiotics can't completely kill the biofilm, and the remaining bacterial slime just keeps regathering strength.

• Our main goal in treating chronic periodontal infections is to reduce the bacterial load below the individual's threshold for disease.1 Let your power–driven scaler reduce the bacterial load. These tips enable access to root surfaces, and research is ongoing to modify tips for enhanced cavitation production.

• One–stage, full–mouth disinfection compared to quadrant scaling and root planing is more efficient. This full mouth protocol isn't appropriate for every patient, but there's no doubt in my mind that its time has come. I'll be writing about this topic again in 2010.

I appreciate your e–mails and will do my best in 2010 to provide you with cutting–edge and evidence–based information on periodontal therapy.


1. Tomasi C, Wennstrom JL. Full–mouth treatment vs. the conventional staged approach for periodontal infection control. Periodontology 2000, 2009; 51: 45–62.

About the Author

Lynne Slim, RDH, BSDH, MSDH, is an award–winning writer who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of dental practices. Lynne is also the owner and moderator of the periotherapist yahoo group: In addition, Lynne is the editor of the Sunstar Americas e–newsletter "The GUMline." Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene–related topics. She can be reached at [email protected] or