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Nursing Homes

April 1, 2002
This letter is in response to the article, "The nursing home's view of oral care (Thinking Sharply column) published in the February 2002 issue.

Readers' Forum
Like anything, the more we function as a team, everyone benefits, especially the patients. After all, that's why we are all here.

Nursing homes
Dear RDH:
This letter is in response to the article, "The nursing home's view of oral care (Thinking Sharply column) published in the February 2002 issue.

I have practiced dental hygiene for 32 years &ndash the last 19 years I have focused on long-term care. I have worked in four different facilities, the last for 17 years, and have had relationships with other hygienists who specialize in treating the long-term care resident.

I agree that nursing assistants have a difficult job. But I also know the following:

  • Those same residents that they are afraid to treat for fear of biting, kicking, spitting, etc., sit well for me in their wheelchairs or in my dental chair. Most patients can tolerate some form of oral care. While it may not be ideal, any amount of care is better than none.
  • Those dentures that aren't a big deal to rinse and brush don't get cleaned.
  • There are many studies out there that assess attitudes of nurses, nursing assistants, and dentists with regard to the importance of oral care. Because someone thinks the answer is to say that oral care is important doesn't mean the job will get done.
  • I have done more in-services than I care to remember. I have led process action teams to help determine what will help get the job done. These committees included the nursing assistants that were responsible for the delivery of care. I have been part of the nursing assistant training. As to their welcoming us, it is always difficult to get people to leave the units or to stop doing what they are doing for in-services, dental or not.
  • I have done on-site, in-room demonstrations. I have done oral care on those residents who have presented problems for staff with staff present. I have always told staff that I am available should they need help in delivering care.
  • I have personally shown both nursing assistants and nurses specific instances of poor oral care. I document every instance where staff intervention is necessary.
  • I have been witness to many "nurses station" gatherings of nursing assistants who could be spending some of that time doing oral care.
  • There have been attempts to use "an oral care specialist" that have been successful.
  • My observations and experiences are not different from other hygienists in my area who work in long-term care.

The bottom line is oral care doesn't get done because it is not important to those responsible for its delivery. Nursing assistants have told me that their priority is to make sure the residents are not wet and that they don't smell. These are the things that get noticed first. The next things to be noticed are cleaniness, neatness, and shaving. Oral care doesn't get done because it doesn't get noticed as not being done.

Oral care doesn't get done because there are no repercussions for not doing the care. The belief that oral care is important has to come from the top down. When the charge nurses on the units believe it is important, then the task is more likely to get done. I have personal experience with this. One charge nurse made all the difference. Her unit had good oral care. When she left the position for another in the main hospital, her values went with her. Just yesterday, however, she called me to ask for help in order to improve the oral care on her unit. She will make sure that her staff follows through.

Lisa K. Shaw, RDH, BS
Utica, New York

Bridge the gap
Dear RDH:
I have been reading RDH for the last several months. My reason was twofold &ndash expand my knowledge of hygiene products and services and also try to understand the issues and thoughts of the hygiene community. I would like to see us all close the gap between dentists and hygienists.

My initial impressions are that I would like to see an increase in technical and educational articles. Knowledge of any kind is invaluable and I would like to see hygienists expand their knowledge even beyond hygiene issues. I would also like to see a dentist write an article that touches on areas that will bring out our concerns and challenges. Likewise, I would like to see a hygienist write an article in a magazine primarily read by dentists on similar issues.

My intention is not to diminish the human-interest type articles but to increase areas of education and bridge our disciplines together. Like anything, the more we function as a team, everyone benefits, especially the patients. After all, that's why we are all here.

Thank you for your time and consideration.

Robert S. Deaver, DDS
Chicago, Illinois

Editor's note: Since we're in daily contact with each other, the editors of RDH, Dental Economics, and Dental Equipment & Materials probably assume the relationship between the three magazines is perfectly obvious to readers. We apologize for that assumption. We strongly encourage interested hygienists to read Dental Economics; if the magazine is not distributed to your office, visit www.dentale On the other hand, we're delighted when doctors make an effort to better understand dental hygienists. Both Anne Guignon and Kristine Hodsdon, who are RDH columnists, have written for Dental Economics recently. Dr. John Wilde and Carol Tekavec primarily are known as Dental Economics authors, but they contribute to RDH as well. So there is a strong synergy between the publications. However, the primary audience for Dental Economics is dentists, and the primary audience for RDH is dental hygienists; the magazines ultimately are tailored for their respective audiences.

Feeling rejuvenated
Dear RDH:
My daughter and I had the honor of being "cover models" for your November 1999 issue. I have been an avid reader for most of my hygiene career. I look forward to each issue. The February issue was by far the best I have read in some time. I read it cover-to-cover in one sitting; I just couldn't put it down.

After a long day at the office, RDH often rejuvenates my enthusiasm for dental hygiene. Too often, we find ourselves in the rut of scraping and polishing, over and over. I think all hygienists should find RDH as uplifting and educational as I do.

Thanks for reminding me once again why I love my career. Keep up the good work!

Holly Proctor, RDH
Woodbine, Georgia

A story about Mom
Dear RDH:
I just received my February issue of your magazine. I was very excited to see the article titled, "Mobile Force One." You see, my mother, Nancy Brug Hagan, was one of the pioneers of the school system's dental health education program. I have many wonderful memories about my mother and her work, but mostly how she enjoyed working with the kids and making their dental health better through education. Upon her untimely and very tragic death in July 1981, she had worked for the school system for more than 20 years.

With a little encouragement and persuasion on the part of Dr. and Mrs. David S. Maddox, I chose the profession of dental hygiene as well. I graduated in 1986 from Ohio State, and I am proud to say that I still enjoy my profession on a part-time basis. I am currently working for a wonderful dentist, Dr. Scott Kelly, who has a general practice on the southeast side of Columbus.

Jane Hagan Durkin, RDH
Reynoldsburg, Ohio

Impressions of book
Dear RDH:
I have just finished reading Dr. Neiburger's book on "speed dentistry." I cannot say that I am impressed after taking much of my time to get this book, since it was not easily accessible on his Web site as noted. I sent an email, was told to send a check, did so, and have received the books today. Let me just say this: The one page that he devotes to dental hygiene just belittles the profession. I feel that, again, in his book as well as in his letters he has badmouthed hygienists. All he has to say about gum control or perio disease is to encourage the patient to use toothpicks or Stimudents! He states that he can do an adequate prophy with three tools!

I have worked in a large, progressive practice for 14 years. I have treated many patients every 6 months during the whole 14 years. Some of the patients can have a visit with me and the doctor's exam in 30 to 40 minutes time, when they have little to no calculus present. But to do this without a perio probe is unthinkable, and this was not one of the three instruments he mentions. I check every single patient over the age of 18 for perio pockets (as well as under 18 if I am noticing problems).

I have detected a case of juvenile periodontitis in my career, and many, many cases of periodontal disease. Most of the population in the United States today has some degree of periodontal disease. It is very prevalent. I wonder if Dr. Neiburger would have to leave the room to find a probe if he suspected a problem?

A hygienist is trained to screen for periodontal disease, as well as educate the patient about the disease, home-care, general nutritional counseling, and many other things. A hygienist does not simply provide prophys. I am told that a dentist, on the other hand, has maybe a few classes concerning prophys and very little training in handling the instruments.

I have seen both of the dentists I work with handle a sickle scaler, and it was a very scary thought. I would not want a dentist to do a prophy on me. My dentist is very straightforward with the patients about explaining that the hygienist is the professional in this area.

Some of Dr. Neiburger's thoughts on "speed dentistry" are interesting and a lot of them are being utilized in the practice I work in.

I think I would be very burned out if I was just providing prophys. I very much enjoy soft tissue management, home whitening, nutritional counseling, sealing teeth, fluoride treatments

That's my two cents worth. Thank you for the opportunity.

Becky Cooper, RDH
Troy, Ohio

Click here to enlarge image

Huong Pham and her daughter, Julie Pham, practice in separate dental offices in the Oklahoma City suburbs. As illustrated by the photograph appearing on the cover, both are very proud of their Vietnamese heritage. Huong immigrated to the United States from Vietnam in 1975. Upon settling in Oklahoma, Huong obtained employment as a dental assistant and eventually drifted toward dental hygiene, earning her degree from Rose State College in 1990.

Julie became a hygienist in 1995 after graduating from the University of Oklahoma. She is an active athlete, playing volleyball and softball, and participating in road bike races. She also is a runner, recently completing the Oklahoma City Memorial marathon.

"We both have fun entering runs together," Julie said. "I run the longer distances, and Mom runs the shorter distances.

"It is so much fun that we feel blessed doing things together whether it's professional or personally. We are just fortunate that we have the best of both worlds as mother and daughter."