My friend, Steve, had exercised his entire life. He ate healthfully. He had regular medical and dental checkups. He passed the exercise stress test with flying colors. By all appearances, Steve was doing everything right. 

Yet Steve died of a massive heart attack at 37 years old.  

After his death, I learned something that changed the way I practiced. 

Steve’s wife mentioned that he had noticed a little bit of pink in the sink, but his dental hygienist never mentioned that it was a problem. Steve prioritized his health, so I knew he would have addressed his bleeding gums had he known they pointed to systemic inflammation and were a sign of an increased risk of cardiovascular disease. 

I will never know whether periodontal inflammation played a role in Steve’s heart attack. We cannot make that causal connection in an individual patient. But research published in 2017 by Bale and Doneen points to periodontal pathogens as being causal for atherosclerosis.¹ And ongoing research states that periodontal disease is a contributing risk factor for both heart attacks and strokes.² 

Steve’s death opened my eyes very early in my career to something I have never forgotten: What we notice in the dental hygiene operatory may have significance far beyond the mouth. That realization changed my personal standard of care in my third year of practice. 

The standard of care is the foundation 

As licensed, registered dental hygienists, we have a standard of care to uphold.3 This standard of care establishes the minimum level of care we are expected to provide to practice safely, competently, ethically, and within the requirements of our profession. It protects our patients, our licenses, and the integrity of our practice. 

But the standard of care should never be considered the ceiling. For me, it is the foundation. From that foundation, exceptional clinicians continue to build an elevated, evidence-based personal standard of care based on new knowledge, ongoing research, improved technology, and a deeper understanding of the patients we serve. 

Meeting the minimum asks: What am I required to do? 

Elevating our standard asks: What is the best care I am capable of providing based on what we know today? 

Those are very different questions. 

Science does not stand still 

Dental hygiene school gives us a foundation. It was never intended to teach us everything we would need to know for the rest of our careers. The science is moving too quickly for that. The half-life of medical knowledge is such that approximately half of the facts we learn in school are proven wrong during the span of our professional careers. This means that we must stay open-minded about what we believe to be true. 

Our understanding of periodontal disease, inflammation, the oral microbiome, diabetes, cardiovascular disease, airway, medications, salivary health, cancer detection, behavior change, and oral-systemic connections continues to evolve. That means our clinical protocols must evolve too. 

One of the responsibilities I take most seriously as an educator and clinical coach is staying current with the research, translating that science into practical clinical language, and helping teams integrate it into patient care protocols that make sense in the real world. Research is only valuable if it changes what we do. 

Evidence should shape our protocols 

Too often, clinicians work from habit. 

“This is how I was taught.” 

“This is how we have always done it.” 

“This is what I have done for 20 years.” 

Those statements may describe experience, but they do not necessarily describe current best practice. Evidence-based protocols give clinicians confidence that their recommendations are grounded in credible science rather than personal opinion or outdated habits.  

It may mean strengthening our medical history conversations. It may mean performing a thorough extraoral and intraoral head and neck examination consistently rather than only when something looks suspicious. It may mean taking bleeding more seriously. It may mean updating our approach to periodontal therapy as we learn more about the inflammatory burden of disease. It may mean adding new diagnostic tools or technologies when they genuinely improve our ability to assess risk, understand disease, or communicate with patients. 

The goal is not to chase every new trend. The goal is to remain curious, evaluate the evidence, and make thoughtful changes when the science supports them. 

We are meant to keep learning 

Professional growth is not optional if we want our profession to remain relevant. We must stay informed. This means reading professional journals, attending continuing education courses, questioning assumptions, and learning from other medical disciplines.  

We must revisit our protocols and calibrate with our teams. We must ask ourselves if the care we are providing today reflects the most current knowledge. 

The best clinicians I know are not the ones who believe they have mastered everything. They are the ones who remain curious. They are willing to say, “I used to think this. Now the evidence tells me something different.” That is not weakness. That is professionalism. 

Elevating our profession requires autonomy 

There is also a larger issue at stake. If we want dental hygiene to continue advancing as a profession, we must take responsibility for advancing it. We need a strong professional identity. We need critical thinking. We need clinicians who understand the science behind their recommendations and can articulate it with confidence. And we need professional autonomy. 

Autonomy does not mean practicing without collaboration. Dentistry is at its best when dentists, hygienists, physicians, and other health-care professionals work together. But dental hygienists must be empowered to think, assess, educate, advocate, and practice at the highest level of their education and licensure. 

If we do not continually elevate our own profession, someone else will define our value for us. I feel very strongly that we should not be content to be viewed primarily as providers of a procedure. We are health-care practitioners. And with that identity comes responsibility. 

Our patients deserve the best of what we know 

Every time the science advances, we have a choice. We can continue doing what is familiar, or we can ask whether our standard of care needs to rise. That does not mean every new study changes clinical practice. It means we remain engaged enough to know when the evidence has become strong enough that it should. 

We owe that to our patients. We owe it to our profession. And we owe it to ourselves. 

Steve never knew how profoundly his death would influence the way I cared for my patients. But it did. His story taught me never to dismiss bleeding as “just a little pink in the sink.” It taught me that what appears routine may not be routine at all. And it taught me that our standard of care cannot remain frozen at the point where we graduated from school. 

The standard of care is our foundation. What we build upon is up to us. We are meant to keep learning. We are meant to keep growing. And we are meant to keep elevating the care we provide. Because our patients deserve nothing less. 

References 

1. Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J. 2017;93(1098):215-220. doi:10.1136/postgradmedj-2016-134279 

2. Shetty B, Fazal I, Khan SF, et al. Association between cardiovascular diseases and periodontal disease: more than what meets the eye. Drug Target Insights. 2023;17:31-38. doi:10.33393/dti.2023.2510 

3. ADHA proudly presents the 2025 Standards for Clinical Dental Hygiene Practice sponsored by Crest + Oral-B. American Dental Hygienists’ Association. https://www.adha.org/resources/standards/