Unstuck from the old routine

I started my career by working for a temporary service. It was an adventurous two years. Every day I walked into a new office, every day I worked with a new doctor.

By Shirley Gutkowski

I started my career by working for a temporary service. It was an adventurous two years. Every day I walked into a new office, every day I worked with a new doctor. At last count, I worked at more than 80 offices for more than 100 different dentists, some more memorable than others. During my first summer, I did a stint for Dr. D, filling in for his hygienist who was on maternity leave. She was on her fourth child with her fourth husband getting disability/ unemployment for those three months. Some people know how to use the system.

At the time, the doctor complained about the new equipment the dental school had purchased. In the mid-1980s his grievance was that the students now had fiber optics to use on their handpieces. His class 25 years prior used belt-driven handpieces. This fiber optic came on the heels of a recent upgrade to air turbine handpieces. He couldn't believe how the school just "threw money around."

New products are invented and old products are made better all the time. As we complain today about how bad things are, a number of companies and individuals are figuring out ways to enhance our caregiving experience. Good examples are the hygienists in the October 2002 issue of RDH who invented products to make hand instruments more ergonomic and safer.

Handpieces are becoming lighter, more versatile, ergonomic, quieter, and cordless. Fluoride application has evolved from a four-minute affair that kept kids gagging and coughing to a foam, then to a flavorless varnish that doesn't take resources to apply, just an explorer tip. Home fluoride delivery also has evolved from strictly prescription gel to fluoride lozenges that have a longer contact time, making them more effective.

The lowly anesthetic syringe hasn't gone through many changes for over a century until the electronic version came onto the scene with the Wand®. It is ergonomically superior to the regular aspirating syringe. Make a mental note of body positioning during an injection one day. Adding contortionist to a resume wouldn't be stretching the truth at all.

Diagnostics have evolved too — digital radiovisiography, faster speed film, laser caries detection, sulfide-detecting perio probes, automated blood pressure cuffs, pathology detecting lights, and scalpeless biopsies.

Here's the problem, though. Why aren't all of these advances in every dental office? Are they too expensive? Well, that may be true of the digital X-rays, but it certainly is not in the case of a fluoride lozenge. They don't help the practice enough? Electronically delivered anesthetic can eliminate the genesis of the legacy of fear produced by injections. Some patients don't even know a needle is attached — plus it is ergonomically superior and certainly helpful to staff. The sulfide probe surely increases perio case acceptance. The beep of the probe detecting biofilm waste products attracts the patient's attention, as well as the clinician's.

Maybe, just maybe, reluctance to purchase updated equipment is due to the "if it was good enough for me, it's good enough for them" attitude, like the doctor I worked for so many summers ago. Imagine using a belt-driven handpiece or a porte polisher in daily patient care. Do you know what a porte polisher is? It's quiet, cordless, lightweight, and doesn't use electricity. It's also low tech, time consuming and labor intensive.

Let's figure out if jealousy is keeping clinicians from having up-to-date technology at their fingertips. If someone ended up with a disease would they rather be diagnosed:

• By 1920s technology (as evidenced by the explorer or stethoscope)
• By 1950s technology (#2 film, excision)
• By 1970s technology (perio probe, pulse oximeter)
• By 1990s technology (digital radiographs, chemo-therapy)

Or 2002 technology? I dare say that a dentist or hygienist that chooses 1950s technology is a fibber. She would want all that modern medicine has to offer to prolong and enhance life. Across this great nation dentists are locating (deciding on) decay with a bent wire; treating bacterial infection (decay) with surgical techniques invented in the early part of the last century and using amalgams to restore biological dimensions of teeth when we know that composite resins and remineralization are options. Hygienists today use only a bent wire to detect tissue breakdown in sulci. Pocket tissue is so fragile that it's impossible to detect disease activity with a probe. Even the AAP recognizes that bleeding on probing is not indicative of absence or presence of disease. Up until now that's all there was available.

It's soon to be criminal that offices hyper-radiate patients when digital X-ray has such a marked decrease in radiation over conventional methods. There are obstacles with digital imaging, and hackers are a good example of the possible problems there.

There are barriers that arise when bringing new technology into a practice, such as early acquisitions. Purchasing 1990s technology in the 1990s was a financial stretch for many offices. The costs of 1990s technology have lowered quite markedly while the products continue to improve. Cords are another problem. My operatory is lousy with cords. More than twenty at last count to roll over and get tangled in:

• Ultrasonic scaler — three
• Orascoptic loupes — one (around my neck)
• Handpieces — three
• Suction — two
• Air/water — one
• Diamond Probe — three
• DIAGNOdent — one
• Rheostat — one
• Intraoral camera — two
• Computer anesthesiology — three

So, to the manufacturers, get on cord patrol!

To clinicians, get into the 1990s and formulate a plan to join the 2000s. Be honest, is the reason for retaining tried and true equipment because of the cost, or because it's been good enough all these years? Look out the window at the car you drive, is it newer than dirt? Is digital sound really necessary driving to the office and back every day? Is air conditioning that important, or mag wheels, or satellite pinpoint positioning, or a friendly voice when lost, or a cell phone, or a million other things? Our patients deserve the best in diagnostics and treatment, just as we do when we see our physicians.


Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at dentwrite@aol.com.

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