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Reader's Forum

Nov. 1, 2011
I experienced a wonderful moment this summer while relaxing on the sand at Virginia Beach, Va.

Dear RDH:

I experienced a wonderful moment this summer while relaxing on the sand at Virginia Beach, Va. My 16-year-old daughter, Molly, looked over to me and asked, “Hey Mom, what are you reading?” I replied with glee, “My September issue of the dental hygiene magazine.” To my surprise my daughter replied, “Wow, Mom, you are cool.” Thanks RDH for that mother-daughter moment.

More importantly, thanks to all of the editors and contributors for helping me stay on top of my game in the field of dental hygiene. The articles keep me informed, energized, and ready to share with patients, friends, and colleagues. I know that dental hygienists are multifaceted people with full lives and interests; I appreciate you making your deadlines each month to help us grow, question, and ponder.

I graduated from Thomas Jefferson University in 1991 and interviewed with JoAnn Gurenlian in 1987; JoAnn was the chair of the department at that time. It is her column in RDH that I read straight out of the mail box as I walk up my driveway. Keep up the stellar work!
Christine Barnabei Lane, RDH, BSDH
Charlottesville, Virginia

Dear RDH:

I read the “Editor’s Note” in the August 2011 issue of RDH. I would have to say that the editorial tries to be inflammatory while disguised as a tribute to Irene Woodall.

The CODA hearing at the ADHA was just that, a hearing to get issues on the table, not an attempt by anyone to stifle ADHA or hygienists’ input.

Please get your facts straight before you report on issues in an attempt to tear our professions of dentistry and dental hygiene apart. People in responsible positions should be working to bring our professions together, as they function best.

First, CODA is not a committee of the ADA. The Commission on Dental Accreditation is a fully independent commission with representatives named to it by independent groups as followed in the table:

“The broad communities of interest, those affected by the Commission’s accreditation activities, are represented on the Commission. Members of the Commission are selected by the participating organizations; these selections are not subject to review by any other organization. There are 30 members on the Board of Commissioners. The Commission membership reflects a wide geographic distribution and includes both genders and underrepresented ethnic groups.

“Summary of CODA Representatives: American Dental Association — 4 members; American Association of Dental Boards — 4 members; American Dental Education Association — 4 members; Postdoctoral General Dentistry — 1 member; Recognized Dental Specialties (one each) — 9 members; American Dental Assistants Association — 1 member; American Dental Hygienists’ Association — 1 member; National Association of Dental Laboratories — 1 member; General Public — 4 members; Students — 1 member. Total, 30 members.

“As noted above, the participating organizations select their own representatives. The Commissioner representing postdoctoral general dentistry is jointly selected by the American Dental Education Association and the American Association of Hospital Dentists. The Commissioner representing students is jointly selected by the American Student Dental Association and the American Dental Education Association. All Commissioners serve one four-year term, except for the Student Commissioner who serves one two-year term.”

Second, neither the ADA or CODA has anything to do with how many or where dental hygiene schools are built. Just as with dental schools, the marketplace and the desires of states or local communities are the factors that decide if new schools should be built. CODA (not the ADA) merely checks these schools to see if they meet the standards for accreditation. The ADA has nothing to do with an abundance or shortage of dental hygiene programs. The hygiene profession is subject to the same forces that have often overpopulated and then underpopulated the dental profession in the past; the market and government attempts to correct perceived shortages, both of which result in overcorrection. To take this issue and attempt to blame it on the ADA in an inflammatory editorial is a disservice to both of our professions!
Robert J. Gherardi, DMD
Albuquerque, New Mexico

Editor’s Note: First of all, we wish to thank Dr. Gherardi for his clarification. He makes some excellent points about the Commission on Dental Accreditation. We do have a couple of clarifications as well. The editorial in question was simply a round of applause for two separate events that occurred at the last ADHA annual session — a tribute to Woodall, a dental hygiene pioneer, and the CODA hearing. There was no “disguise” involved with it. We regret confusing readers by blurring the line of distinction between the ADA and CODA. However, there are three points to remember. First, CODA’s information, including the schedule for its agenda of hearings, is hosted at, the official website of the American Dental Association. Secondly, despite the proclamation of broad representation, 20 of the 30 members are doctors in dental medicine or science. Thirdly, CODA does have a role in “approving accreditation standards by which programs are evaluated,” and a significant concern within the dental hygiene profession is the trend toward fast-track dental hygiene programs to satisfy a perceived shortage of dental hygienists in the marketplace. The aforementioned CODA page at also offers “institutional administrators and/or educators who are considering developing a dental hygiene program” a guide for developing dental hygiene programs for a “fee.” The website then refers the visitor to a separate ADA council for more information.

Dear RDH:

I’m sure the authors of “The Clock is King” article in the June 2011 issue meant to help hygienists provide their services more comfortably. But what is suggested in the article simply doesn’t work in a practical sense. Doing what is right for the patient, both morally and legally, simply does not fit in a box of time, because there are too many variables.

When one adds up the time for each procedure in Table 1 on page 66, we find it takes 50 minutes for a simple adult prophy, which the authors determine is adequate. Very few dental offices today are willing to schedule that much time for that procedure. But taking a closer look at each suggested time slot, one can see that those times are not adequate, even if all goes well. “Greet and seat” is given two minutes, but more often than not, the patient needs to stop at the desk for one last chat or use the restroom before being seated and two minutes goes out the window. I would say five minutes is more realistic. But if the patient is late, it becomes a whole different animal.

Another two minutes is allowed for “medical history/patient concerns,” but, after patients get back from the restroom, they are very serious about why the office scheduled them in the first place, as they were just in for a filling the other day. Then they ask why you are so concerned about their heart murmur. But they do remember that their physician mentioned one time that they needed to take some pills before dental work. But they just had a filling and didn’t need to take medication then, so they don’t know why they need it now. They also didn’t know that they were to fill out both sides of the health update form, and want to take care of that while someone calls their physician to inquire about possible pre-medication. So much for the two minutes. I would say that five to 10 minutes is more realistic.

If anyone has ever taken digital X-rays, they know that it is hard to take good diagnostic pictures in four minutes, especially if the patient questions the need for the X-rays in the first place. X-ray time also depends on what type of series are needed, such as bitewings, full-mouth, periapicals, panorex, or a combination of exposures. I would say that five to 30 minutes is more realistic.

I know for a fact, as I have timed the procedure using a very efficient assistant, it takes a minimum of three minutes to correctly probe and another five minutes to do a comprehensive oral inspection and head and neck exam. One must now inform the patient and the dentist of the findings, and the patient must approve of the scheduled and proposed procedures before any services can be provided. I think the minimum is 10 minutes, but 15 minutes is more realistic.

Now comes the big one, “power and hand scaling” with a whopping 15 minutes. It just happens that while probing, one feels the subcalculus in all posterior teeth in an otherwise healthy looking mouth. It’s not enough to produce pocketing yet, but one must take the time to effectively remove it so it doesn’t create pocketing in the future. How many hygienists know when their Cavitron tip is worn out? The manufacturer recommends the tips be replaced yearly, which is not generally on any dentist’s ordering list. Now, the patient is unhappy with the use of the ultrasonic and just wants the hygienist to use the instruments. I guarantee you those 15 minutes will fly by in an instant. Comprehensive scaling takes 20 minutes and a polish takes about five minutes, for a total of 25 minutes.

The only way you would have zero minutes for a “doctor wait time” would be if the doctor was hovering over you. Probably two to five minutes is more realistic if the dentist comes right over.

“Operatory turnover” is about right, if everything is convenient, autoclaved, and ready to go. But that time can be used only if there is an assistant preparing the instrument packs for the autoclave.

So, how much time do we have now? Let’s see, 5 + 5 + 5 + 10 + 20 + 5 + 2 + 4 equals 56 minutes. This is the minimum time one needs for normal adult prophy maintenance procedures, if all goes well. But this does not include the dentist’s exam time which could take two to 10 minutes, depending on the findings. Then the patient must be scheduled for those procedures. This means that the patient cannot be released until the dentist is finished and the room cannot be turned over until that time. As you can see, the dental hygienist needs the minimum of 60 minutes or more to provide appropriate care to a patient with a reasonably healthy mouth. There also needs to be time in the schedule for the dental hygienist to document the legal information in the patient’s chart.

Dental offices need to understand all of these needs and schedule accordingly to aid the dental hygienist in providing appropriate and complete patient care while building a practice that relies on these ideals. It’s sad when a dental office is more concerned about how fast a dental hygienist is, rather than how thorough and comprehensive he or she is. And, it’s even more sad that many dental hygienists subscribe to such a philosophy.
Carol Levanen, CDA, RDH
Yacolt, Washington

Correction: The July 2011 column of “Perio Team” contained six charts relating to monitoring patients’ overall health, including, for example, blood pressure, body mass index, and cholesterol. One chart incorrectly listed the HbA1c level in pre-diabetes conditions as 6.1 - 6.0%. The measurement should have read 6.1 – 6.9%.

Correction: The July 2011 column of “Public Health” featured a photograph of the Arkansas governor signing legislation pertaining to community water fluoridation. A crowd of onlookers stood behind the governor during the signing ceremony, including Dr. Lynn Douglas Mouden, the director of the Office of Oral Health in the Arkansas Department of Health. However, we incorrectly identified someone else as being Dr. Mouden, and we regret the error.

Editor’s Note:As readers may have noticed, many of the preceding letters comment on editorial content dating back to June 2011. We apologize for not being more punctual in publishing readers’ comments in this space and promise to be more timely in the future. We very much value the time and thought that goes into writing a letter to the editor.

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To submit letters to the editor, send to: RDH, P.O. Box 3408, Tulsa, OK 74101; [email protected]; or (918) 831-9804 (fax).