by Lynne H. Slim, RDH, BSDH, MSDH
When I answered my phone one evening, the voice I heard was a familiar one. I knew I would be on the phone until I could no longer form a coherent sentence. Judith Corbin, RDH, BSDH, was on the other end of the line, and I’d love to brag about her briefly. Judith is unlike any other hygienist I’ve ever met: She’s a one-of-a-kind RDH whose brilliant mind is on overdrive 24/7. She and I could talk for hours on end, and Judith’s ideas, thoughts, and stories are endlessly fascinating. Having spent years in public health, I especially enjoy hearing stories about her public health patients, and that night’s conversation kept me in stitches.
Judith laughed like a giddy teenager when she told me the story about a mother and two siblings she recently met. The two adolescents presented with localized aggressive periodontitis (formerly called localized juvenile periodontitis), and Judith began treating one of them in her operatory. For one reason or another, the hygiene visit didn’t go well and the adolescent complained to his mom about the “mean old woman” who “cleaned his teeth.” When his mother called to complain, she was encouraged by Judith to accompany her other adolescent to the clinic for his appointment. The clinic receptionist told Judith that the mother was so angry she was “ready to take off Judith’s head,” but instead Judith turned the situation into a positive learning experience for all members of the family!
Judith is well known for her approach to oral infection-control therapy (as she calls it), and she customizes education to meet the needs of her patients. Employing lightning-quick thinking and strategy helped Judith turn the mom into a dental assistant who donned a disposable gown, a mask, and safety glasses. While Judith debrided her teenage patient, the mom suctioned with a saliva ejector, and Judith was able to spend invaluable one-on-one time with her. As a result, the mom left the clinic as a well-informed parent who was motivated to support Judith’s treatment plan.
As readers of RDH’s “Periodontal Therapy” column, you’ve undoubtedly heard me sing the praises of another one-of-a-kind person, Dr. Paul H. Keyes, who has made countless contributions to our nation’s oral health. Dr. Keyes recently e-mailed RDH editor Mark Hartley, and here is what he had to say:
Thank you very much for your reply to the letter I e-mailed to you. The written copy will get in Wednesday’s mail as today has been a national holiday in memory of President Ford. Lynne Slim is indeed a very talented and dedicated hygienist. Her profession is most fortunate to have someone with her abilities trying to advance the mission of dental hygiene.
Not feeling comfortable in the “dark ages” of dentistry - i.e., not knowing how to intercept and prevent dental caries or anything about “pyorrhea” - I left practice in 1943 and began my research in dental caries at the University of Rochester. When I was in dental school at the University of Pennsylvania (1937 to 1941), there was absolutely nothing in the dental curriculum related to periodontics. As a matter of fact, one of the textbooks I still have says bacteria are of no etiologic importance in the pathogenesis of periodontal diseases. I know for a fact that none of my classmates knew how to identify patients at risk for periodontal infections. I don’t know how many, but for all too many years dental students were not taught how to diagnose periodontal lesions, to say nothing of recognizing that they were dealing with bacterial infections.
In the article that appears before Lynne Slim’s column, Dianne Glasscoe provides some advice for “Breaking the Bad News” to hygienists who see patients who have been poorly treated for many years by their dentists. She says this failure can be called “supervised neglect.” What one also sees is the unfortunate result of “supervised ignorance.” To use the word “neglect” implies that clinicians know what to do but don’t do it. To be sure, one cannot exclude this possibility, but it is my opinion that in past years dental students have been abysmally neglected with regard to learning how to diagnose and manage the bacterial infections that cause dental caries and periodontal lesions. In my opinion, infection control should be the nucleus of the dental curriculum.
Ms. Glasscoe provides her readers with suggestions for enlightening patients who have experienced untreated periodontal infections. For those hygienists who use a microscope-TV system, informing and educating patients can be very easy. Looking at seething bacterial fields and pus cells too numerous to count for just a few minutes will immediately reveal the need for infection control.
Paul H. Keyes
The e-mail above was one of those “Ah-ha!” moments in dental hygiene where I felt some validation of my thinking that organized dentistry still chooses to ignore periodontal infection! And not only is organized dentistry often guilty of this crime, many dental hygiene clinicians are culpable as well! In my role as dental hygiene educator and practice-management consultant, I continue to come across dentists and dental hygienists whose approach to oral infection control consists of nothing more than whispering in the patient’s ear about the importance of daily flossing. That’s it? Is that all there is? How boring and totally and infuriatingly ineffective can a message get! If we’re dealing with “infection,” how does a hygienist whispering in a patient’s ear about flossing play a role?
I recently communicated with Dr. Keyes regarding his perceptions about the failure of the dental profession to control dental caries and periodontal infections. He has a lot to say on this subject and we hygienists need to take it to heart! Dr. Keyes credits Dr. Thomas B. Hartzell as the first dental professional to identify bacteria as the etiologic agent in periodontal lesions. Ready for me to divulge the date? Get this: Dr. Hartzell established the first course in periodontics at the University of Minnesota in 1897. According to Dr. Keyes, “Hartzell tried to tell his fellow dentists for the better part of 40 years that ‘pyorrhea’ was caused by germ-life growing on the necks and roots of teeth, and that by controlling bacteria one could prevent and arrest periodontal lesions.”1 Dr. Keyes has often wondered how dental hygiene would have evolved had Dr. Hartzell started a school of dental hygiene! Dr. Keyes frequently referred to Dr. Hartzell as a voice in the wilderness, and we dental hygienists can certainly relate to that. Feeling frustrated after decades of “supervised” care to our patients, we have lacked autonomy and our services have been limited by legal constraints. Supervised dental hygiene practice is due in part to gender politics and a perception that dental hygienists belong in a supportive/auxiliary role.
It’s important to remember that Dr. Alfred C. Fones, one of the most prominent supporters of dental hygiene in the early 1900s, viewed the employment of women as appropriate due to their even temperament. (My husband would not agree with this statement, especially the part about even temperament!) Dr. Fones also stated, “A woman is apt to be conscientious and painstaking in her work. She is honest and reliable, and in this one form of practice, I think, she is better fitted for the position of prophylactic assistant than is a man.“2 Dr. Fones, however, was very supportive and committed to preventive care for the masses, and the Bridgeport, Conn., Board of Health was involved in the education of dental hygienists so that these “women-assistants” could work in the Bridgeport area schools.3
As a dental student in 1937 to 1941, Dr. Keyes resented the fact that there was nothing in the dental school curriculum on periodontal diseases. He states, “I don’t know if the readers of RDH magazine would have any interest in the tragic history regarding the diagnosis and treatment of periodontal infections. It is a very sad one and no credit can be given to the dental profession ... and even today, many dentists are not serving their patients well. Hygienists are doing a far better job!” How kind of Dr. Keyes to recognize our contributions, but he is also concerned that many hygienists are not comfortable telling patients that they have a contagious bacterial infection. Dr. Keyes would like to see us focus on the pathogenesis of periodontal infections in ways that would be more meaningful to patients. In addition, he would also like us to educate our patients without focusing on the terms “pocket,” “bleeding,” and “periodontal disease.”
Most dental professionals I know have never read the article about Dr. Keyes that was published in Reader’s Digest in 1986 titled “Do These Dentists Do Too Much?”4 Dr. Keyes, a researcher for 27 years with the National Institute for Dental Research (part of the National Institutes of Health) advocated a nonsurgical approach to treating even advanced periodontal diseases, and challenged the status quo of periodontists whom he described as “too quick to cut.” You can imagine the firestorm that ensued and has continued even to this day! He and his colleagues even went so far as to imply that money was one primary reason why periodontists disputed the Keyes system. In addition, it was thought at the time that periodontists disliked the Keyes system because the general dentist could perform it and the periodontal community did not want general dentists treating periodontal diseases. Dr. Keyes’ system included the use of systemic antibiotics, and tetracycline was the antibiotic of choice at the time. Systemic antibiotics were not advocated for every patient but were used in advanced cases. Dr. Keyes still argues to this day that the nonsurgical approach yielded results as good as surgery at far less cost.
Isn’t it interesting to note that as we’ve entered a new millennium, routine periodontal pocket reduction surgery is being replaced by nonsurgical periodontal therapy? In addition, systemic antibiotics are making a comeback and are now being utilized in treating aggressive periodontal diseases. The addition of systemically administered antibiotics enhances the therapeutic response from scaling and root planing.5
So, was Dr. Keyes right all along? It’s something to think about, especially as we look at modern periodontal therapies. When I first met Dr. Keyes, it didn’t take me long to fall madly in love with him as a true professional. He’s a gentle but formidable soul who has committed his entire career to advancing his message of hope to patients whose periodontium and dentition have been ravaged by chronic bacterial infections. Judith Corbin is no different, and the best way I can describe both of them is “one-of-a-kind.” They’re the best kind, even though their voices are frequently lost in the wilderness, just like that of Dr. Hartzell. Let’s go beyond the whispers of “flossing” and “pockets” and customize our messages in a purposeful way. Gender issues for dental hygienists, based on our heritage, are still alive and well, but I believe that we will work hard to prevent them from becoming our legacy.
As we settle into a new year, I’d like to applaud my readers for reading my column and giving me feedback. Thanks for your continued support and for sharing your views with me. Please don’t ever hesitate to write and let me know what you’re thinking. Best wishes for your best year ever! RDH
Lynne H. Slim, RDH, BSDH, MSDH, is a practicing hygienist/periodontal therapist who has more than 20 years’ experience in both clinical and educational settings. She is also president of Perio C Dent Inc. (Perio-Centered Dentistry), a practice-management consulting firm that specializes in creating outstanding dental hygiene teams. Lynne is a member of the Speaking and Consulting Network (SCN) that was founded by Linda Miles, and has won two first-place journalism awards from ADHA. Lynne is also owner/moderator of a periodontal therapist yahoo group: http://yahoogroups.com/group/periotherapist. She can be contacted at [email protected].
1 E-mail communication with Dr. Paul Keyes. Jan. 5, 2007.
2 Jones JG. Dental hygiene as a female dominated semi-profession. L’Hygieniste Dentaire Du Canada 1979; 13(3):62-66.
3 Fones AC. Mouth Hygiene. New York: Lea & Febiger. 1921; 485-490.
4 Pekkanen J. Do these dentists do too much? Reader’s Digest Oct. 1986; Reprint.
5 Teles RP, Haffajee AD, Socransky SS. Microbiological goals of periodontal therapy. Perio 2000 2006; 42:180-218.