Th 225188

Fun, scary, and exciting

Sept. 1, 2006
Here it is - Column No. 12. I've been writing "From the Edge" for one year now.

Here it is - Column No. 12. I’ve been writing “From the Edge” for one year now. How time flies when you’re having fun. I am no longer a newbie. It seems like only yesterday. Insert your own cliché here. It has been a wild year on this platform for sharing pertinent information and my warped sense of humor.

Today a co-worker asked me what I write about in my column. After shaking off the shock that she doesn’t read me every month, I just had to laugh. I have written about my shoes, my kids, my dog’s gas, and Dorothy after Oz. But let’s be fair. I have also written about research, the advancement of our profession, the importance of taking a stand, and my distaste for scaling teeth. I can do serious.

My world is now littered with Post-it® notes - on my computer screen, refrigerator, car dashboard, and the inside of my cubby door at work. Ideas can be found scribbled on opened envelopes and occasionally on a real notepad. Being somewhat of a neat freak, these Post-it®s can cause me some stress, but I realize they are necessary. Progress can be measured by the number of multicolored squares of sticky paper in the trash can next to my desk.

While my physical world has changed in little ways, my enthusiasm for our profession has grown immensely during the last year. I am no longer satisfied with the status quo and view proposals and legislative battles from a whole new angle. Annoyance and frustration are a part of my life in ways that actually produce positive responses. Everyone should be lucky enough to feel this natural, internal high.

One topic that has gained my attention this past year is dental care for underserved populations. It’s not a new problem; I remember writing on the topic for an English assignment in college. The situation has come under new scrutiny since the ADA lawsuit against dental technicians in Alaska. Here is a population that is not being served and a community willing to find a solution. Trained technicians from New Zealand were willing to fill that void. Yet once again, organized dentistry rallied behind their “no care is better than that care” attitude.

An agreement was finally reached that allowed some care to be provided by the technicians, with input from licensed dentists on some services. Despite this agreement, the lawsuit is moving forward. In response to the outcry for some type of dental care in these remote areas, the ADA came up with a proposal that reads like The Emperor’s New Clothes. Organized dentistry is telling the public what it wants to hear by suggesting a new dental team member, but if you read all the print, there is nothing there. The public is merely to imagine the problem is covered, just as the Emperor imagined he had on new clothes.

Something to talk about

Patient education is another subject that has entered my writing thoughts. Actually, this interest was kick-started a few years ago when C. Austin Risbeck, RDH, invited me to be a part of Dental Hygienists Against Heart Disease, and it has flourished in my writing.

Patient education has moved beyond the outdated advice of “brush and floss or lose your teeth.” In fact, many patients don’t require that education once they master adequate plaque removal. It’s like riding a bike - put a toothbrush in their hand and most adults remember how to use it. Our conversations during preventive appointments now require addressing the connection between oral health and systemic conditions.

I had a patient recently who reinforced this need for education. John was upset with himself for ignoring signs of illness, and with his previous health-care providers for not telling him about the oral signs of diabetes. He was equally annoyed that he was never informed about the increased damage periodontal inflammation could cause to his coronary disease. While he tried not to place blame, he thinks someone, somewhere in his health-care system should have educated him about family history increasing the chances for these diseases.

John has slow-onset Type 1 diabetes, high blood pressure, high cholesterol, and periodontal disease. He visited my operatory for full-mouth nonsurgical treatment and education, yet I was the one educated that day. John’s theory is that oral/systemic health education should start in junior high and be a required component of all high school and college health courses, and should be more prevalent in the dental office. He believes that if he had been told about the signs, symptoms, and family risk factors, he would have taken steps

for an earlier diagnosis of his diabetes. Instead of fighting the first signs of sight loss at age 54, John wishes he was controlling disease progression and maintaining a more healthy body.

Freedom outside the law?

National licensure and development of a stand-alone profession for dental hygienists is another soapbox I frequented. Getting out from under the thumb of the ADA is the only way I can envision a bright future for our careers. Most readers take that to mean I am anti-dentist, but nothing is further from the truth. The public needs dentists, but hygienists provide distinctively different services than dentists and deserve - even require - our own profession.

It should be noted that not all dentists view dental hygienists as a threat to their careers. In fact, a frequently heard complaint among hygienists is that dentists ask us to practice outside our respective practice acts. Many think they are doing us a favor or showing great respect by allowing us to work outside the law, but in truth this is dangerous for the licenses of both parties.

If the dentist you work with wants you to give anesthesia when he/she is out of the office, and this procedure is direct supervision in your state, your answer must be no. Instead, the dentist should rally some like-minded colleagues and petition the governing board to change the restriction. Likewise, as professionals in need of expanding our duties, we should petition that same governing body to allow us forward progression. Better yet, let us govern ourselves.

Think globally, act locally is a great slogan for recycling and preserving our natural resources; it is the opposite of the action needed to achieve national licensure. If we hope to have a scope of practice that is the same no matter what state we call home, we all need to participate on a national level. The excuse that legislators and dental boards only care about the opinions of their own voters should hold no bearing on our actions. For example, each of us should be aware of the Senate and assembly bills in California that allow better access to care for the underserved and organizing our own governing board. Letters of support should be coming from every state.

Wisconsin’s dental board should have known very well that all dental hygienists supported the bill to allow direct Medicaid reimbursement for services provided by a registered dental hygienist in specific settings. Everyone who values our profession should be appalled at the slow action in Tennessee to implement local anesthesia for dental hygienists. Our voice is loudest when we speak together. That voice is better understood when we speak clearly without name-calling or finger-pointing.

It is not too late to write to the Ohio Board of Dentistry and the Ohio Dental Association to lend support of House Bill 518. According to the ODHA Web site, this bill would “allow a dental hygienist with experience in practice to collaborate with a dentist to provide dental hygiene services, before examination by a dentist.” The bill also adds settings where a hygienist can practice and requires referral to a dentist for diagnosis and treatment. You can visit the Web site at for more details.

As you can see, some serious issues do cross my mind and hold my interest long enough to appear on these pages. Rest assured, the humorous part of my life is going strong and will definitely make appearances during the next year. We have cured the dog’s gas issues, but in a large family where most of the kids are entering adulthood and striking out on their own, funny stuff will happen.

It is fun, and a little scary, to look back over the last 12 columns and see where my thoughts have been dwelling. It is exponentially more exciting to think about where my mind will go from here. Oh, if only my body were as active as my imagination! I honestly have no idea what the next year will bring to the Edge; hopefully it will be something that moves even one person to action.

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Lory Laughter, RDH, BS, practices in Napa and Sonoma, California, in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists against Heart Disease and other organizations, she hopes to bring a total health concept to the dental practice. You may contact Lory at [email protected].