Th 181562

That was then ... this is now

June 1, 2005
Yes, we know, the author is not that old. But when a 1987 graduate marvels at the ‘then and now,’ we marvel right along with her.
Click here to enlarge image

The year was 1987, and I had a newly earned “RDH” set of credentials. I was ready to rid the world of plaque! Of course, I knew there was much to learn, because I had been repeatedly reminded that I was simply a beginner - that there was much to learn. They had also told me a lot of other things in dental hygiene school.

Click here to enlarge image

So what did “they” say and who were “they?” Recently, I had the great pleasure of meeting Dr. Richard Nagelberg, a dentist from the Philadelphia area. He talked about “they.” He pointed out that we have become “they,” but while in school, “they” consisted of my dental hygiene instructors, who seemed to have all of the answers. Don’t misunderstand; I did receive a great education and had top-notch educators to deliver the information.

However, I realized shortly after the doors at Northcentral Technical College in Wausau, Wisconsin closed behind me, how much I really did not know.

So what did I learn then and what do I know now?

Then I learned that ultrasonic scaling was something you used on patients who had so much deposit that it made it too difficult to hand scale. I also learned to always hand scale after the ultrasonic, because use and tip selection was limited, to say the least. I mean, how far subgingivally could you really go with that old beavertail tip?

Now I can’t imagine clinical practice without my ultrasonic scaler. Criteria for use have dramatically changed, as well. There has been a shift to now term it as periodontal debridement, as opposed to scaling and root planing. Periodontal debridement is the removal of hard and soft deposits and changing the microbiology of the pocket by disrupting the biofilm. Who knew? Tip selection has also changed, since we now have a wide selection designed for more specific tasks. I did not learn to use anything other than a magnetostrictive scaler, and now piezo electric is another technology at our disposal.

Then The practice of dental hygiene was mostly limited to a one- or two-doctor practice, and this offered the best opportunity in my area. There were a few who practiced in alternative settings, but did anyone know who these clinicians were, or did we just hear of their existence?

Now How times have changed! While I know many dental hygienists who still work in a one- or two-doctor practice, I now know many more who work in alternative settings. I have dental hygienist friends across the country who are educators, lecturers, business consultants, legislators, sales representatives, public health dental hygienists, volunteers, and much more.

I recently made a shift in careers myself. After 17 years in clinical practice, 16 of those with the same prosthodontist, I took a position as the director of dental hygiene with Midwest Dental, a group with 36 offices in Wisconsin, Minnesota, and Illinois. In my new role, I work primarily as a resource and an advocate, developing our hygiene department and providing support to our doctors and management team. However, the ability to practice clinically still exists, and I enjoy being able to take advantage of that, too.

My job evolves every day and provides an opportunity for me to use my dental hygiene and business education. We have protocols and treatment strategies in place that ensure great care for our patients. Our offices range in size from one to three doctors, and I am exposed to more learning opportunities than I could ever have imagined. I’m now rewarded through seeing the growth of other hygienists, which translates into more healthy patients. I have also recognized that the great mentors I’ve had over the years, allowed me to learn and grow. It is now my turn to give some of that back!

Then Treating patients was easy. In school you learned to assess, make a dental hygiene diagnosis, develop treatment strategies, and to recommend treatment, which the patient always accepted. Of course, most of the “patients” were friends and family who knew their role as a “requirement” to graduation.

Now There are many questions to consider and think through on our own. Many patients have dental insurance and often believe this is the golden rule to the level of care that they need. We need to help them understand that this is not the case. I have often said that I would like to remove any evidence of dental insurance benefits from patient charts, or what the fees are for treatment. I think this would encourage clinicians to make recommendations based on need, and not on the policy coverage or what we think our patients might invest to ensure good care.

Some clinicians have also developed a fear of the word “diagnosis.” In practicing dental hygiene, it is critical to make a dental hygiene diagnosis and partner with our doctors in their dental diagnosis. Comprehensive treatment plans for our patients must include both preventive and restorative needs. We are educated, licensed professionals and should use every ounce of our education to provide the best care for our patients.

Then Fluoride was a key factor in the dental hygiene treatment plan; all patients received a fluoride treatment.

Now Caries risk assessment is much more comprehensive. Not only should we be looking for obvious carious lesions in the mouth, but we should also be thinking about strategies for remineralization for individuals with a high caries risk and that may have inadequate saliva. We now have many fluoride therapies to select from, and have learned that the twice-a-year in-office fluoride treatment may not be universally suitable.

We still have the gels and foams, but now also have fluoride varnish, rinses, home care gels and lozenges to meet the specific needs of our patients. We should never have an age limitation on fluoride therapy for our patients. In school I learned of the benefits of fluoride, but never once did I learn that it was only beneficial up to the age of 14. It is also exciting to have technology like the DIAGNOdent to aid in diagnosis, and to see increased awareness of therapies such as Xylitol.

Then “How often do you brush and floss?” was the question that every patient was asked.

Now I have learned that “not as often as I should” is the standard answer from most patients. So what does this really mean? Some patients might never floss. I have recognized that I need to accept that and be ready to offer them alternatives for cleaning between their teeth.

I ask my patients more interactive questions now, such as “Tell me what you use to clean in between your teeth?” This encourages discussion and I recognize that a toothpick, floss holder, interproximal brush, or some other interdental device might be effective for that individual. Are they as good and as effective as dental floss? Some may argue this, but the patient is using something in between their teeth, and I see that as a small victory.

Then I was told that hygienists should be expected to earn a certain level of compensation. There really was not much discussion in any of my courses about the business aspect of dental hygiene services within a practice.

Now I don’t believe that any position automatically entitles a person to compensation, just for being physically present every day. The practice of dental hygiene is similar to many other occupations that can be measured by performance-based outcomes. Today, we know that roughly 75 percent of the population has some form of periodontal disease.

Therefore, if you are only performing “prophy” services on the majority of your patients, then you are not providing comprehensive care. As hygienists, I think that we should have benchmarks set for the types of services that we should be providing for our patients, and we certainly should understand the connection between productivity and compensation.

I am not in any way suggesting that ethical care be compromised to accomplish this. In fact, when protocols for patient care are established, it becomes clear that an elevated level of service will allow most hygienists to work smarter and not harder. I always found it empowering to share this information with my employer, to establish my commitment to patient care and to the growth of the practice.

So what am I really saying ... the more things change, the more they stay the same? Not at all! While this may be true in other areas of our lives, it is most definitely not the case in the practice of dental hygiene. If you are doing things the same way as you did years ago, then you are not standing still, but are actually sliding backwards. It is a great time to be working in the dental field; patients are receiving important oral health education through more avenues than ever before. Don’t be left behind, make the commitment to your profession and to your patients - it is so much more exciting and rewarding in the “here and now!”

Tammy L. Filipiak RDH, BS, is a practicing dental hygienist with 17 years experience in clinical and educational settings. She currently is the Director of Dental Hygiene for Midwest Dental, a group with offices in Wisconsin, Illinois, and Minnesota. She was a 2003 winner of the Butler/RDH Healthy Gums Healthy Life Award of Distinction. She is an active member of the American Dental Hygienists’ Association and is a past president of the Wisconsin Dental Hygienists’ Association. She owns Paragon Dental Resources and serves as the executive director of the Wisconsin Dental Hygienists’ Association. You can reach her at [email protected].