by Lynne H. Slim RDH, BSDH, MSDH
Mr. Perry O'Donnell enters a dental hygiene operatory first thing Monday morning. He hands Mary, RDH, a file folder that includes a copy of his digital FMX and a pretreatment estimate for nonsurgical periodontal therapy from a nearby franchised dental practice.
"What brings you here, Mr. O'Donnell?" Mary, RDH, asks.
He smiles at her and then, with a puzzled look on his face, scratching his chin absentmindedly, tells her he is confused about what periodontal procedures were performed.
"Last month, I had about an hour of what they called 'deep scaling,' bought some weird-tasting mouthwash, and they then handed me a fancy electric toothbrushing gadget to use every day," he explained. "My gums are still bleeding and I'm now in a lot of pain.
"I like my new toothbrush, though! These new-fangled things are amazing."
"Well, Mr. O'Donnell, we've reviewed your paperwork, and it's true you were billed for four quadrants of deep scaling," Mary replied. "I'm going to repeat the periodontal exam and then we'll talk."
Mary performed a comprehensive periodontal exam. Probing depths ranged from 4-9 mm in posterior sextants and heavy, burnished subgingival calculus was detected in every sextant. Bleeding on probing was spontaneous and generalized. Radiographs showed generalized horizontal bone loss and clinical examination revealed several grade III furcations.
Mary tapped gently on her employer's office door where he was busy paying bills and told him she was ready for him to enter the operatory. She reviewed her findings and urged Dr. James to refer Mr. O'Donnell to a periodontist for further assessment. After confirming Mary's findings, Dr. James suggested a re-treatment of "deep scaling," and he did not feel it was necessary for Mr. O'Donnell to see a periodontist.
A new year is a good time to get our dirty laundry out in the open. Why not start with a discussion about the down and dirty world of nonsurgical periodontal therapy?
I'd also like to throw in some of my thoughts about the future of supervised dental hygiene in private practice. I began this discussion in my November 2010 column and have some new ideas for readers to chew on. Many dental hygienists around the United States, including me, are frustrated in private dental practice because our voices are not being heard. Since when do some practice management consultants and general dentists know more about nonsurgical periodontal protocols and preventive dentistry than dental hygienists? Dentists and dental hygienists used to respect each other's area of expertise and make decisions about referrals based not on profitability motives but on what's in the best interest of the patient. When and why did this change, and what can we do to reverse this unfortunate trend?
Economic forces may be responsible for the failure of some general dentists and hygienists to refer patients to the periodontist. There are positive economic consequences as a result of not referring the patient. I sometimes overhear clinicians agree with patients about exorbitant specialist fees and unwanted side effects of periodontal surgery, and I believe they are prejudicing the situation instead of being objective and doing what's in the best interest of the patient.
If unscrupulous individuals are not providing enough time for dental hygienists to meticulously debride root surfaces and disinfect pockets, shame on them. To those dental hygienists who comply with a shoddy protocol, I also say shame on you because you know better.
Dental practice management consultants, dentist/employers, and practicing dental hygienists can close the gap between unethical clinical decision-making and high standards of care if there's a firm commitment by all parties. Here are some suggestions that will help in achieving that particular end:
• Develop criteria for referral to a periodontist, and partner with a trusted periodontist to accomplish this objective.
• Attend evidence-based continuing education courses by individuals whose interest is in promoting successful health outcomes. Recognize that ongoing professional development is based on progressive, high-quality, and career-long education and skill training.
• Adopt a patient risk assessment tool like myDentalScore.com and the validated Oral Health Information Suite (OHIS) from PreViser to assist in accurate diagnosis and risk assessment of patients to ensure appropriate care, meaning no overtreatment, no undertreatment. MyDentalScore.com allows patients to self-assess for oral disease and can be a useful marketing tool for the general dental practice. PreViser's OHIS is the clinical companion technology designed to be used in the operatory. Patients can self-evaluate on a dental practice Web site using MyDentalScore.com; however, it should not be used as a profitability tool. Treating disease should never be part of a profitability formula!
General dentists/employers and dental practice management consultants need to embrace a healthy respect for registered dental hygienists. Dental hygienists can lead in the establishment of a hygiene department mission that includes principles of beneficence. Patients rely on us to offer sound advice and to place their well-being first. Oral health-care practitioners must put the interests of their patients ahead of their own interests or those of third parties.
Dental hygienists with advanced degrees can be utilized in large group practices as dental hygiene practitioners. General dentists and practice management consultants are not credentialed to make decisions about dental hygiene services, especially those services that focus on health promotion, disease prevention, health education, and counseling. Dentists need to partner with dental hygiene practitioners and embrace their area of expertise.
As I already mentioned in the November 2010 column, the era of the omnipotent dentist and the subservient hygienist has ended. Supervision of a dental hygienist can no longer be used as a political football to limit our scope of service.
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: www.yahoogroups.com/group/periotherapist. Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. She can be reached at [email protected] or www.periocdent.com.
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