Hygienists must facilitate the transition from prophy-based, schedule-driven cleaning departments to diagnosis-driven perio hygiene departments.
Beverly Maguire, RDH
Dental hygiene has undergone a metamorphosis during the past 10 years. We have refocused our energies from "cleaning teeth" to diagnosing and treating periodontal disease. This paradigm shift is understood widely within our profession, but it is implemented on a marginal basis. How could this possibly be the case?
We have stood in wait of the dentist to give the go-ahead before we reorganize the manner in which we treat our patients. Yet, we are the professionals trained extensively and most capably who must meet the challenge and make the changes necessary. If we meet the challenge, we will see the results in the standard-of-care we deliver, productivity for our practice, and professional and financial benefits based on a win-win situation for ourselves.
I have, in years gone by, practiced my profession as a "cleaning lady," working eight hours a day in a pool of blood and wearing no gloves. Looking back, its quite surprising that any of us even wanted to be dental hygienists! In reality, we were "calculus-driven" cleaners. Oh, how we loved the sight of those big chunks of calculus flying off the teeth! We labored over our patients, most of whom bled profusely while they complained about how "we made them bleed" and were too rough. This process was repeated with every patient every six months, because the six-month recall was the law then. We worked our fingers to the bone for one hour, called it a cleaning, and did it all over again six months later.
This was not a very inspiring situation. In fact, it was a slow progression to patients losing their teeth. In retrospect, I would call it "supervised neglect." Once the teeth became loose, patients were sent off to a periodontist. What a shame to require the periodontist to be some kind of miracle worker, with us expecting the impossible. How could anyone save teeth, once 3/4 of the bone support had been destroyed?
Today, I see patients with varied levels of periodontal disease. My cleaning focus has shifted to looking for the early signs and symptoms of periodontal involvement, which we can so effectively treat in our general practices. Behind my safety glasses are "perio eyes" and it`s amazing what I find! As obvious as this transition appears on paper, unfortunately there is no assurance that a patient could be in any hygiene operatory in any city across the country and be diagnosed with periodontal disease and treated in a consistent manner. For that matter, how many of our patients honestly could give an accurate report of their perio status as of their last hygiene visit?
Why is this still a problem in our profession, as we approach the coming century? Perio obviously is not a new subject. We are all quite knowledgeable and informed on the issues involved in periodontal disease today. Seminars, research and articles abound on the subject. But, a complex triad of issues seems to be involved here.
The first issue involves the manner in which we were trained as hygienists. Without a doubt, hygienists receive an excellent education in the colleges and universities across the country. We are well-trained clinically and philosophically. Fortunately and unfortunately, we are graded on how effectively we remove calculus from the teeth and root surfaces. If we miss any deposits, we are graded poorly. This is deeply imprinted on our psyche.
Failure to remove all of the calculus means being a "bad hygienist." This becomes a bigger problem as we enter the marketplace and strive to do the "perfect cleaning" in one hour, getting to the bottom of all pockets and "cleaning" whatever is present. Without intending to do so, we begin to clean the teeth of periodontally involved patients with a prophy mentality - i.e., time frame and fee attached. The patient thinks we are "watching" the situation ... and that they should floss more!
The second factor involved is the schedule-driven nature of the dental profession. We are run by that almighty schedule on the wall. We generally have 60 minutes to do our best "cleaning" for each patient on the schedule that day. We strive for excellence, gentleness, to be on time, to be friendly and personable, and to sell needed dentistry that our doctors can do. Unfortunately, probing and charting, followed by an accurate perio diagnosis, is not the first priority. Who can possibly write down all of those numbers with no help? OSHA would be appalled, as well as the patient, who insists upon receiving the "cleaning" they came in for! Without intending to do so, most hygienists find their excellent training in perio replaced by the reality of the prophy mill.
The third factor involves the dynamics of change and leadership. This is the area where we must begin. The hygiene department should be protecting, treating, and maintaining a sound foundation of health, bone and tissue, so dentists can focus on excellent restorative and cosmetic dentistry. To effectively organize the hygiene department into what it was designed to be, the staff must create and support the philosophy of a perio-focused, diagnosis-driven hygiene department. This is only possible with the full support of the entire team dedicated to an agreed-upon philosophy and systems designed to treat disease.
The doctor plays a critical role in the actual diagnosis of the disease. The hygienist`s role is to gather accurate data, inform the doctor and patient of the findings, follow through with the case presentation, and perform the actual therapy. Front-office personnel are responsible for affirming the need for treatment and answering patient questions, as well as scheduling and billing for treatment. Without the involvement of all team members, this approach will fail.
A majority of hygienists I have worked with and consulted with over the years do want to deliver the highest standard of care to their patients. However, hygienists have felt limited by the clock, the schedule, and, in many cases, the restorative focus of the doctor. Doctors, in my experience, are very "teeth-oriented." They see the teeth and view them through "restorative eyes." Hygienists see through "perio eyes!" For our patients to receive the best possible care, don`t we need each other to see the total picture both restoratively and periodontally?
I see no better alternative than to have the hygienist take leadership of the hygiene department. We must educate the staff on the current research and new approaches to perio hygiene, as well as facilitate the changes necessary to provide excellence in this area of the dental practice. An organized, systematic approach to early periodontal disease is our area of expertise. I say it`s time for us, as trained professionals, to facilitate the transition within our practices from prophy-based, schedule-driven cleaning departments to that of a diagnosis-driven perio hygiene departments.
Beverly Maguire, RDH, is a practicing periodontal therapist and president of PerioAdvocates, a periodontal management systems consulting company in Littleton, Colo. She can be reached at (303) 730-8529.