Reader's Forum

It was with great interest that I read Karen Kaiser's article on how to creatively manage the hygiene department's budget through reconsidering purchasing habits (October 2010 issue).

Dear RDH:
It was with great interest that I read Karen Kaiser's article on how to creatively manage the hygiene department's budget through reconsidering purchasing habits (October 2010 issue). Ms. Kaiser recommended a few simple and easily attainable ideas to help decrease office expenses. I would like to mention that Ms. Kaiser's recommendations for decreasing overhead expenses also provide an opportunity to be environmentally conscious.

Transitioning from disposable products to save money is something every dental practice can do over the long term, not just when the economy is lean. Dental offices can contribute to reducing the amount of waste that ends up in landfills very easily while still providing optimum patient care. Purchasing prophy paste in jars and dispensing a small amount into a dappen dish that can be sterilized, and oiling metal prophy angles may take a little more time when setting up trays in the morning, but the decrease in office waste is substantial over the course of one year.

As Ms. Kaiser points out, nondisposable products are not substandard care. When you do your part to think and act green while cutting costs, everyone wins.
Rose Straebel, RDH
Charlevoix, Michigan

Dear RDH:
Gratitude is complex. Gratitude isn't a new idea; most spiritual practices and philosophies emphasize gratitude and compassion for others. But in recent years, gratitude has shifted from an idea to a concrete tool that people can use to become happier and healthier. This practice focuses on appreciating what others do for us, deemphasizing anger, and not blaming others for our problems.

After reading Lory Laughter's November 2010 RDH column, "An attitude of gratitude," I agree that gratitude isn't a blindly optimistic approach in which the bad things in life are whitewashed, ignored, or used as an excuse to "sit on our hands." Thus, I wanted to re-emphasize that practicing gratitude is a matter of where we put our focus and attention.

Yes, pain, professional frustration, unhealthy work environments, and pure cruelty exist in this world – inside and outside the dental hygiene profession. But when we focus on the gifts of life, we realize a feeling of well-being. We feel more energized to reach out to others. We feel we have the power to positively affect and change our world – either professionally or personally.

Practicing gratitude provides us with the courage and tenacity to pursue our ambitions and goals. Gratitude reminds us of everything we have and what we remember, as well as strengthens us to build positive futures.
Kristine A. Hodsdon, RDH, BS
Director, RDH eVillage
Chester, New Hampshire

Dear RDH:
I read your article about air polishers with interest (November 2010 issue). I have been trying to get our local hygienists and our local school of dental hygiene interested in holding down aerosols, but with little success. Sometimes I feel that I am more concerned about hygienists' health than they are. There is a terrible inertia amongst hygienists – and it is matched in spades by the dentists in my area. I write about infection control for my local dental society newsletter, and have written about aerosols (including those from air polishers) for the past three years. Last year I spoke to the local hygienists association about aerosols. But, from what I can tell, only a few have taken my advice to heart.

I hate to promote a particular commercial product as an answer to the aerosol problem, but when there is only one, then I must relent. First, there is an attachment for the Prophy-Jet1 that is easy to use, costs about $1.50 per patient, and is effective in reducing spatter to almost nothing. I have used it, and so has a hygienist who I introduced it to. We both like it very much. It does the job.

Secondly, there is an attachment to the Cavitron2 that will suck up 90% of the aerosols produced by that instrument. It is made to fit that particular instrument, but can be adapted to fit some of the other ultrasonic scaler brands. The cost is about $1.25 per patient. There is a little bit of a learning curve with this instrument, but after a few uses I adapted to it quite easily.

Getting the schools on board is essential to having hygienists in private practices use these devices. So far, the schools are a great disappointment to me. See what you can do in your community.

Aerosols are not "chicken soup" for the lungs. Aerosols from ultrasonic scalers have been shown to contain blood, bacteria, and viruses (100,000 per cubic meter). Most are less than 50 microns, so we don't see them. No way do I want to breath that stuff if I don't have to. But the attitude is that "no one else is doing anything about it," so obviously there is no problem. And, most importantly, the schools don't teach that there is a need to control aerosols. California has adopted (what I consider ineffective) standards for aerosols created in the dental office. And OSHA is considering adopting standards. However, the ADA wrote a letter to OSHA opposing any aerosol standards. I was the lone voice urging them to adopt standards. Such is life.

Some would say, "but we wear masks." Go to fda.gov and look up surgical masks. You will see that surgical masks are not intended to protect the wearer from aerosols (60% to 70% effective), but are used to protect the patient from us spitting on them. Some are fooled into thinking that the PFE and BFE percentages we see advertised apply to aerosols. But they do not! We need to reduce aerosols at the source. And it can be done.

I hope you continue to write about aerosols and the potential for disease transmission.
Henry M. Botuck, DDS
Springfield, Virginia

1) Aerosol Reduction Device: Dentsply Raintree Essix, part # AR-K, refills # AR-R 1-800-883-8733
2) Safety Suction: Quality Aspirators 1-800-858-2121

Dear RDH:
I am writing as a response to the article "Dental hygiene as a profit center" (Periodontal Therapy column, November 2010 issue). I am in the unique position of being the dental hygienist and office manager where I work.

I agree and disagree with the article. First of all, when asked in 1973 during my interview for the University of Missouri at Kansas City's dental hygiene program," What is the role of a dental hygienist?" I answered, "We are the educators in the office." I believed that then and I believe it now. That means we educate patients on everything, including restorative dentistry. I don't consider it selling. I consider that I am educating patients about what needs to be done and why. It's so easy and takes so little time. I take photos of the disease and then use models, brochures, or books to explain how we are able to fix it.

Most hygienists don't think about economics, but in these perilous times that is foolhardy. Think of your office as a ship. If the ship sinks, then everyone drowns. In a typical office, the hygiene department should produce 25% of the total production and the doctor 75%. That is a lot of work for the doctor to do. Think about it. He has to take the time to check recalls and talk to new patients and get his work done. Anything the dental team can do to shorten the time the dentist talks to patients will really help the overall production.

I agree that most dentists do not recognize the importance of their hygiene department. That is foolhardy also. Our hygiene department has kept our ship afloat in these economic times. Patients will come in for recalls when they have been in the habit of doing so.

In our office, we do most of our periodontal treatment ourselves. A certified dental assistant does the new patient appointment, which includes an exam by the doctor, radiographs, and photos. At that time, periodontal disease or gingivitis is addressed when necessary. All patients are made aware that any periodontal issue must be addressed before any treatment can occur. The patient is also made aware that a second exam will take place after the patient has been to the hygiene department. There is no charge for that exam.

In our area, periodontal disease is higher than the national average. I would say that 90% of our new patients either need scaling and root planing or debridements. This is put in the original treatment plan, and we require that it be done first.

So I see the patients many times and develop a relationship of trust with them. It is logical, then, that I also be the one to address their restorative needs.

It works both ways in that the doctor and assistants are always reinforcing the need for regular recalls and complimenting patients for getting their hygiene treatment done.

We work as a team to take the stress off of our doctor so he can produce. That is what keeps us all employed.

Now you ask, "How are you able to do all of this and stay on schedule?" It's simple. I work out of two rooms, and I have a very well trained assistant. I only see patients 12 and over. (I can always be called into another room for light scaling, if necessary, on younger patients.) I see patients every 45 minutes for every procedure. Since I will be seeing periodontal patients more than once, I don't stress if I'm done or not; it will all get done eventually. In fact, the first time I see them, a lot of time is spent talking and the patient really appreciates being listened to and educated.

This is what works for us economically and professionally. The whole team has one plan to have a profitable day and educate our patients so they can have the healthiest mouths possible. If hygienists want to have a stable job, they need to be part of that education team and not have the attitude that it isn't their job to talk about restorative dentistry.

I just wanted to present another point of view from someone with 35 years of experience, who also has to be aware of the bottom line.

Linda J. Schowengerdt, RDH, BS
Nevada, Missouri

To submit letters to the editor, send to: RDH, P.O. Box 3408, Tulsa, OK 74101; markh@pennwell.com; or (918) 831-9804 (fax).

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