The little value placed on preventive services harms the public, curbs important research

Is prevention alive and well within dentistry? That`s debatable! Prevention is still around, but dying slowly. Individuals make valiant efforts to keep it alive, but always against great odds. Prevention is not economically desirable within the dental field today and, for that reason, is considered to be of little or no value. We must understand this perspective if we truly see ourselves as preventive specialists.

Nov 1st, 1997

Trisha E. O`Hehir, RDH, BS

Is prevention alive and well within dentistry? That`s debatable! Prevention is still around, but dying slowly. Individuals make valiant efforts to keep it alive, but always against great odds. Prevention is not economically desirable within the dental field today and, for that reason, is considered to be of little or no value. We must understand this perspective if we truly see ourselves as preventive specialists.

How do you define preventive dentistry? To me, it means preventing dentistry; a disturbing thought when the bottom line is considered to be so important. The success of a general dentist depends on dental disease - i.e., providing dentistry. If the dental hygienist in that practice is a successful preventive specialist, the dentist`s practice will fail. In other words, if the dental hygienist successfully prevents dentistry, production from restorative and periodontal therapy in that office will fall.

The dental profession has set an extremely low value on prevention, the public has accepted it, and the dental hygiene profession has struggled with it for decades. In some cases, we have given up and gone to the other side. Sad to say, but I`ve been one of those traitors for years. I`m a slow learner. It`s taken me 30 years to realize that prevention of disease, not treatment of disease, still is the foundation of dental hygiene.

Don`t get me wrong; providing high-quality periodontal-debridement therapy still is an essential for dental hygienists. But rather than treating and retreating patients, successful debridement therapy should only be provided once, together with appropriate prevention strategies to maintain periodontal health and to avoid the need for future retreatment. That should be the ultimate aim of our therapy - to establish periodontal health and prevent the need for future treatment. "It`s not that easy," you say, but don`t get trapped into thinking it isn`t possible. If prevention is of little value, no effort will be made to assure its success.

Establishing the value of prevention has a domino effect. The profession values treating disease more than preventing it. As a result, education places more value on calculus removal, fillings, crowns, bridges and surgery than on health. The next step is licensure, which focuses on treating disease, not preventing it. For dental hygienists, that means measuring our worth and value by how much calculus we can remove rather than our effectiveness in preventing its accumulation.

Out in practice, the devaluation of prevention continues. The higher the fee, the more valuable the service. We as dental hygienists have fallen into the same trap as the dentists. Fees for conservative periodontal therapy are considerably higher than those for preventive services.

In most cases, oral hygiene instructions are given away free! No value there. At one time or another, we all have been told, "You`ll get more done if you don`t talk to the patients so much."

From there, the domino effect continues to the general public. Since we, the experts, place more value on disease than prevention, is it any surprise that the public assumes that same value system? Despite these odds, we continue to struggle. We interject any preventive information we can, only to hear, OJust clean my teeth. I don?t want a lecture today!O The public, as a result of this thinking, places a higher value on treating dental disease than on prevention.

The managed-care approach to dental hygiene removes all value from our services by providing them free ? but, at the same time, limits the frequency. If a dental practice or a managed-care group truly believes in prevention, hygiene services would not be limited by traditional ideas and would be valuable enough to command a fee. Ancient Chinese medicine held that the doctor was paid to keep the patient healthy, but did not receive payment if the patient became ill.

Not only is this devaluation of prevention reaching the public, it also influences research. Why develop more effective preventive strategies if this part of the practice is not productive? Clinicians are looking for ways to improve therapy and increase production at the same time. Little or no research is being done on prevention unless it involves a high-tech product or a chemical, since it is assumed the average person is unable or unwilling to effectively remove plaque. If that really is the case, hygienists must be genetically different from the rest of the population, since we don?t seem to have any trouble preventing disease in our own mouths. Dental work done on hygienists generally can be traced to a lack of prevention when we were young, rather than the development of new disease since becoming a hygienist. Prevention works; hygienists are the perfect example.

It would be interesting to see what dental hygienists would do if given the opportunity to actively pursue prevention. Despite our knowledge, skills and interest in this area, we have attempted to prevent dentistry with the constraints of tradition and the lack of value placed on successful prevention.

I don?t know how to change the present value system, but I believe it can be done. We already are seeing a shift in the general health area, as people focus on diet and exercise and quit smoking. Why not dental hygiene? Let?s set our sights on dental health, rather than disease.

Dental hygienists are the ones to lead the way, but not without a struggle. History shows that others have attempted to meet this challenge unsuccessfully. Some of you may remember the prevention-oriented organizations of the past: the American Society of Preventive Dentistry and the Western Society of Preventive Dentistry, just to name a couple. Sadly, those organizations died for lack of interest!

Remember, prevention is not good for business, but maybe that depends on what business we?re in!

Trisha E. O`Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. Her e-mail address is teohehir@futureone.com.

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