No right or wrong answers

Nov. 14, 2014
Who should provide supplies or equipment to the practicing dental hygienist? Visualize a bell curve. The answers to this complicated question fall somewhere between the two extreme points found on any bell curve.


Who should provide supplies or equipment to the practicing dental hygienist? Visualize a bell curve. The answers to this complicated question fall somewhere between the two extreme points found on any bell curve. Some feel the employer should provide everything. Hygienists who work independently in their own settings - such as California's RDHAPs (alternative practice), those in Oregon or Maine with LAP (limited access permit) status, or Michigan hygienists who provide care under special public health permits - generally use their own equipment and supplies.

One way to ensure a longer, healthier career is to practice with equipment and supplies that fit your body and reduce musculoskeletal stresses. While most students today begin their clinical career with loupes and headlights purchased during their academic training, hygienists who were in school decades ago and want to wear magnification face the dilemma of who will pay for the equipment. Since the benefits of magnification and illumination are well known, many now purchase their own. Others rely on the doctor to supply loupes, or the two parties split the cost.

Each plan has pros and cons. If you buy your own magnification system, you get:

• The exact product you want

• The freedom to take them with you if you change practices

• The deduction of the cost of the loupes, just like any other non-reimbursed business expense

If the doctor pays, the practice has every right to select the brand and keep the magnification if you choose to leave (an odd approach if the loupes are custom made to fit a specific user). If you co-own the loupes, it can get really sticky, unless there is a written agreement.

A growing number of hygienists are now investing in alternative seating systems such as saddles, power scalers, or hand instruments. A small number even own periodontal endoscopes. In this scenario, more complicated questions arise. Can a co-worker use the equipment you purchased? Who pays for repairs, and who covers the cost of disposable products or worn parts?

To further muddy the waters, should hygienists who supply their own equipment be paid more, or should they lease the equipment back to the practice? If the equipment allows the hygienist to provide a unique, specialized procedure such as perioscopy, should the hygienist receive additional compensation? Clinicians skilled in perioscopy can provide a far more definitive outcome than periodontal therapy using an ultrasonic scaler without the assistance of a scope, with a subsequent higher fee scale.

Consider disposable products such gloves and masks, or reusable products such as scrubs or lab jackets. What if your skin is sensitive to certain brands of masks? What if the gloves the office supplies don't fit your hand properly, creating thumb or finger pain? Many practices are open to providing the masks and gloves that fit the individual user, but there are offices that expect everyone to use the products supplied, regardless of the health effects on the user. Again, these conditions are negotiating points that should be brought up if there is an issue with fit or quality.

When it comes to hand instruments, every practice has its own approach. Some hygienists are expected to share instruments, a practice that seems sensible, but is full of fallacies. Some hygienists sharpen instruments regularly, others never pick up a stone, and others are lucky enough to have scalers and curets made with sharpen-free technology. Sharpening techniques vary and dull instruments don't work well and play into the development of hand and wrist injuries.

Another problem arises with the design of hand instruments. For example, I was never trained to use a 204 S, an instrument that is very popular in schools in Texas. For some reason, the design and application baffles me. When it comes to curettes, I prefer the Banhardt 1/2 over the far more popular 5/6 design. In the power-scaling world, I fell in love with a manually tuned magnetostrictive ultrasonic scaler so much years ago that I bought my own unit back in 1998 - a purchase that my colleagues at the time thought was nuts. I've never regretted that move, and my body thanks me every time I pick up the lightweight handpiece and use an ultra-slim tip.

Hygienists who own their own equipment do so for a variety of reasons. Some prefer to select what works well in their hands (pun intended). Others want the freedom to select equipment that reduces their risk for developing a musculoskeletal disorder, and some work in practices that will only provide the most basic equipment and supplies. In today's challenging job market, it would seem more sensible take or keep a job, even if it means supplying certain pieces of equipment or supplies.

If you are in a practice that does not supply what you need to perform your job well or in comfort, what measures have you taken to change the office policy regarding purchases? Doctors are not mind readers, and they are busy running an entire business, the dental practice. If you don't speak up, how can they know your needs? But if you do decide to broach the subject, eliminate whining from the discussion.

Come to the table with a plan. Some hygienists have a monthly supply budget and are free to use the dollars as they see fit. Others are allowed to order a certain number of instruments at specific intervals. Larger equipment expenditures often need to be planned out, and many doctors love to take advantage of special tax advantages at the end of the year.

Don't forget the specials offered by companies. For example, the manufacturer of a new polishing handpiece might offer a free or discounted handpiece when a year's worth of angles are ordered. Some companies offer special pricing for items such as loupes or lights to members of ADHA, at specific CE events, or during major meetings such as RDH Under One Roof or ADHA Annual Session. Other companies offer reduced pricing when multiple items are purchased, and some have interest-free payment plans designed to soften the financial impact.

Every company is structured differently. Some companies can sell their products directly to us. They want our business and work hard to build solid, long-term relationships. Dental supply companies sell a huge variety of products, but only a handful will sell directly to a dental hygienist. The companies that do understand dental hygienists know that we're not going to purchase thousands of dollars of supplies every month, but we are loyal to those who want to work with us.

When I started practicing in 1971, dentist employers supplied everything, but over time I wanted to branch out and try new products and instruments. The dentist that I worked with did not have the same interest in new technologies as I did. It made sense to me to invest in myself. My colleagues thought it was nuts then and some still do even to this day. It was the right approach for me, but not necessarily the right path for others. We all have to come to terms with what we will and won't do to support our professional careers. Each of us has our own unique comfort zone. There are no right or wrong answers. RDH

ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.