Dr. Tim Donley is a practicing periodontist from Bowling Green, Kentucky, whose knowledge and education are vast. He coauthored the first-ever comprehensive textbook on modern ultrasonic treatment for periodontal disease and speaks internationally. He is a graduate of the University of Notre Dame and Georgetown University School of Dentistry and completed his periodontics and implant training at Indiana University.
I find his humor and candor refreshing, and in true generous form, when I asked if he would be willing to be interviewed, he said yes. The result is this four-part interview series that may flip some of our current oral health paradigms on their heads and will certainly give us pause.
This installment is about the role of dental hygienists and the need for change. In part two, Dr. Donley shares his thoughts on our “deep beliefs” vs. a science-based treatment approach and provides questions to ask ourselves regarding goals and protocols. Part three is a discussion about chronic inflammatory periodontal disease (CIPD), which throws out most of the guidance I received in dental hygiene school. Part four is the wrap-up, discussing research, our future, and potential collaborators.
Anne Rice: I have heard you talk about changing the narrative of dentistry. What specific thing do you feel we need to change and how hopeful are you that we will get there?
Dr. Donley: It is certainly time to leave behind the limited image of the dentist as the senior member of the oral hygiene police with dental hygienists the loyal foot soldiers in the war against plaque. The fact that our “brush and floss or else your teeth will fall out” mantra has not motivated the throngs of patients with legitimate needs to come in and have those needs addressed is not evidence that the message has failed to get through. Dentistry has been amazingly successful in delivering the message of the importance of oral hygiene. The only problem is that it is the wrong message. Tell anyone that you are a dental hygienist and invariably the person will either start confessing their oral hygiene sins to you, or they will ask you the question that apparently continues to plague mankind, “Which is better, waxed or unwaxed floss?” Dentistry should be about so much more than that.
The narrative of dentistry needs to change so people realize that partnering with a dental hygienist for life (one who does more than simply clean teeth) is an important part of an overall strategy to maximize their wellness for life. Dental hygienists are often the only ones who can determine if there is any inflammation in a patient’s mouth, counsel the patient on risk factor modification, prescribe an approach that will eliminate any oral disease, and then help the patient keep it that way. Doing so is proving to be an extremely vital part of overall health. The dental hygienist should be the most important primary health-care provider that a patient needs to see over their lifetime to achieve the highest level of oral health.
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For that to happen, though, the typical recare/maintenance appointment must become less of a beauty visit and more of a health visit. For too long now, people have come to us to get their teeth cleaned, get scolded on their oral hygiene efforts, get checked for cavities, and then conclude whether they got a “good” or “bad” checkup. That must change. Patients should be partnering with us for life for more than a cleaning. The story needs to change so that people realize that when they come in for that regular visit, the least important thing we are doing for them is the prophy. Rather, patients need to understand that only with regular hygiene maintenance can they achieve and sustain a preferred level of oral health. That maintenance needs to consist of continual risk evaluation and reduction, constant surveillance for any areas of inflammation, ongoing efforts to get inflammation to resolve, and then assisting patients to maintain the preferred oral health once it has been achieved. The evidence is now abundantly clear that patients who achieve a preferred level of oral health are more likely to live longer and healthier lives.
I am tremendously hopeful that dentistry can forge a new way forward. But to do so, while we need all stakeholders in dentistry to push this new narrative, dental providers must be the main drivers of this new message. We can make a difference in your overall health if we help you improve your oral health.
Editor's note: This article appeared in the August 2023 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.