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Feeling self-confident with the doctor

Dec. 1, 2004
I can relate to Janet Hagerman's column on "Professional Harmony" in the October 2004 issue. Attempting to develop congruence between professionals from different educational backgrounds is difficult...

Dear RDH:

I can relate to Janet Hagerman's column on "Professional Harmony" in the October 2004 issue. Attempting to develop congruence between professionals from different educational backgrounds is difficult, especially when regulations give so much more power to the one who has less knowledge of the subject than the one performing the procedure. It is ironic that an article aimed at teaching dentists how to diagnose dental hygiene work is written at about the same time as the American Dental Association House of Delegates (ADA) spent much of their time trying to convince themselves that diagnosis is safe only when it comes from a dentist or physician. I'd like to describe how I developed professional harmony with a dentist that is not merely philosophical congruence but mutual respect for each other's area of expertise.

First, I moved to a state where dental hygienists are not required to work under a dentist's supervision. The knowledge that I am not obligated to be an employee is empowering. When I first started working with my current dentist, we had numerous arguments in which he asked me to do prophys or full mouth debridements (FMD) when I knew root planing would be needed. I do not believe I would have been as insistent if I could do nothing but work under the supervision of another dentist who had no more training in dental hygiene work than this one does.

Second, my employer is a corporation, not a dentist. I am not there to be a representative of someone whose health-care philosophy differs from mine. My company cares more about public image and profitability than it does about whose professional opinion its customers seek. The managers in the company support my professionalism, quality, and productivity. They are prepared to transfer me to another office if my work is not appreciated in the current one.

Third, I keep thorough records. I did a few prophys and FMDs for clients against my better judgment early in my current position, but I did complete periodontal charting before treatment and recorded my concerns against doing so, and I did a complete periodontal evaluation upon the client's return. After seeing a few people with worsening periodontal disease after this supervised neglect, the dentist stopped arguing against my recommendations and instead supports my recommendations very strongly with my clients. At the same time, I have developed more confidence in his work and feel comfortable when I support his restorative recommendations. The only major philosophical difference we have now is that I am very much in favor of using sealants while my dentist fears that sealants will fail and cause more caries to develop. I suspect his fear comes from seeing incorrectly applied sealants that had been administered by poorly trained assistants.

Fourth, I have skills other than dental hygiene. Even if the state no longer allowed dental hygienists to practice our profession, or I developed an injury that precluded my work, I could still earn a good living doing things I enjoy. I also find many relationships among my various skills and knowledge such that I can apply my cross training along my range of skills. This gives my practice of dental hygiene a unique quality with a more holistic feel than I experienced in school.

Finally, I stay involved in my profession and community. The more active I am in my state association, the sooner I see and act upon things that impact our profession. I speak with state legislators and association lobbyists. I write letters to manufacturers and publishers who mention dentists when they should have mentioned dental hygienists as experts to consult or support their products. I talk with people outside the profession about how dental hygiene care can greatly reduce the need to treat dental and systemic disease and the costs associated with those treatments.

While my approach may be more in-your-face than Ms. Hagerman's, I believe we both recognize the importance of self confidence to approach dentists as equals with a different area of expertise. I believe we are gaining that self confidence, individually and collectively, and as a result gaining greater respect from ourselves, other professionals, and the public. I suspect this growing respect is why the ADA referred, rather than adopted, resolutions questioning dental hygienists' determination to expand our profession through the Advanced Dental Hygiene Practitioner resolution.
Howard M. Notgarnie, RDH, MA
Aurora, Colorado

About the cover
Click here to enlarge image

A 1978 graduate from the University of Southern California in her native state, Tricia Osuna has been practicing for 23 years, and lecturing and consulting for the last dozen years. RDH columnist Ann-Marie DePalma wrote about Osuna in March 2003: "Born into a seventh generation California family from the original Spanish/Mexican land grant families, Tricia attended schools where family members always surrounded her. She applied to the University of Southern California to be close to family and friends upon graduating from high school."

The setting for this month's cover is her backyard. Tricia said, "The flamingos, well, they are there simply because they are too funny! I bought them along with a plaster Indian chief while on a trip to Mexico. Pretty interesting yard decor."

Since her graduation, Osuna has served the California Dental Hygienists' Association in a variety of capacities, including as president in 1992. She has been an ADHA delegate for approximately 18 years.

"The most important aspect of dental hygiene to me has been making a difference to patients, peers and students. I have always wanted to share the passion I have for dental hygiene with anyone who is willing to listen. I support membership in the ADHA and recognition of our professionalism, creating an awareness of our value to both employers and patients."

DePalma also wrote in her 2003 column, "Living well and laughing are two of Tricia's passions. She describes herself as outgoing, curious, and sensitive, and wonders who will be surprised by those descriptions!"


In the October 2004 issue, the Web site for the American Academy of Periodontology was incorrectly listed in the New Heights column on page 76. The correct Web address for the association is We regret any confusion.

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