Readers' Forum

Feb. 1, 2003
I've never been one to sit down and read all of the articles and information that the periodical offers, but today I did and I would like to express my sympathy to Dianne Glasscoe on the loss of her husband (December 2002 issue).

Every day is a festival

Dear RDH:
I've never been one to sit down and read all of the articles and information that the periodical offers, but today I did and I would like to express my sympathy to Dianne Glasscoe on the loss of her husband (December 2002 issue). I also would like to commend her on her appreciation of life with the passion for happiness.

Little over one year ago, I found my husband passed out on the bathroom floor, having seizures and convulsions. It was the worst day of my life. I've never felt so helpless. All of my years of CPR and first aid could not deliver what was needed. The rescuers could not find a pulse and I thought my world was over. Thankfully, nearing the emergency room, the EMTs were able to get a pulse and bring him back.

It took 13 weeks to get a diagnosis on his condition. His continued heart condition granted him a medical retirement and a lifetime of daily medication — a lot to endure for one who is only 40 years of age.

We were very lucky and have learned that life really is too short. For years, I moaned and groaned about work, co-workers, employers, etc. And for what? (I'm sure I drove my husband crazy with all of my daily complaints.) To be happy, you have to choose to be happy. You can't change others. You can't save the world. Your opinions and others' opinions don't always match. I've learned to not offer unsolicited advice and to keep my mouth shut.

I had not been happy for years, and, with this life-changing moment, every day is like a festival. Like the verse in Proverbs reads, "A merry heart hath a continual feast."

We are happy. My greatest strength comes from prayer, thanking God for the time we have together and to accept the things we cannot change so that we can know what happiness really is.
Lisa Morgan, RDH
Baytown, Texas

Why fear Alabama?

Dear RDH:
I am writing in response to the Editor's Note and a letter from an Alabama hygienist in the December 2002 issue. Please allow me to clarify some issues and voice an opinion. First, there are fathers in Alabama who take their children to the dentist, not just mothers. And I fail to see how mothers or fathers taking children to the dentist for hygiene twice a year is not taking "the best possible care" of them, unless you advocate more frequent dental visits.

How could "preceptorship" rob anyone of anything? If lower wages are the concern, keep in mind the cost of living in Alabama is lower than much of the nation and the affordability of dental services probably boosts the access to dental care. This promotes health overall rather than placing one more barrrier to receipt of oral health services. Thus, the "cheapskates" you mention would seem to be more concerned with oral health and place a premium on providing a service to the public by keeping dentistry affordable.

Second, training of hygienists in Alabama is not a preceptorship. The program is set up and administered by the board of dental examiners in Alabama by first teaching the sponsoring dentists how to be teachers, setting the standards and curriculum for the students, and providing dentists (including periodontists) and other licensed hygienists to provide lecture time in a university setting. This is in addition to the hands-on skills learned in the dental office and one-on-one instruction by the sponsoring dentist. Standards are high and strictly enforced. Each hygiene candidate must have at least a year of chairside dental assisting before consideration for the program and uses standard texts on dentistry and hygiene.

As stated in the letter from Ms. Vicki Nelson, Alabama Dental Hygiene Program students hold their own with school-trained hygienists when allowed to take the same tests, such as national boards, and do as well or better than school-trained hygienists on the Alabama State Boards.

If the hygiene training is so superior in the rest of the nation, then why is there fear to allow Alabama Dental Hygiene Program graduates to take the national boards and show they are just as competent as anyone else?

Finally, I find Roseanne Federico's comment referenced from the October 2002 issue about the proficiency of dentists to provide hygiene skills very suspect in many respects. The dental student in accredited dental school programs spends hours ad naseum doing scaling, root planing and curettage, and other hygiene and periodontal procedures. The dentist must also provide a diagnosis, based on examination, of the periodontal condition and overall health and the proficiency of hygiene therapy provided.

Frankly, the main question evoked by her statement is, "Why would one lower oneself to work for a dentist that was not proficient in provision of oral hygiene therapy?" And, yes, Alabama dental school graduates routinely rank in the top on national board examinations.

I realize this letter will not settle a controversy that shouldn't even exist. Keep in mind that, in medicine, although the training has some differences, it makes no difference whether you go to an allopathic physician (MD) or an osteopathic phyisician (DO) for your overall health care. If all perform to the same standards for the same procedures, there should be uniting rather than ostracizing and division.
Mark King, DMD
Birmingham, Alabama

Doing just enough — no mumbo jumbo

Dear RDH,
I know that the subject of preceptorship has been done to death in the Readers' Forum, but I feel compelled to respond to Vicki Nelson's letter from the December 2002 issue. Her arguments for preceptorship have not "fallen on deaf ears."

What I hear Vicki and other preceptorship-trained hygienists saying is that learning just enough to pass the boards is acceptable. Maybe we should eliminate college all together and just on-the-job train all professions — doctors, nurses, engineers, etc. Why learn all that extra mumbo jumbo ... who needs it?

As a hygienist, I am ashamed that such programs even exist. They severely undermine our profession. I agree that it is possible to do regular prophys without too much training, but that is beside the point. The field of dental hygiene is a profession that is respected by the general public.

But once we start lowering standards (yes, what you are doing is setting lower standards and you will never convince me otherwise) to the level of "on-the-job trainee" we will lose respect and confidence from our patients and other professions. I feel that the dental hygienist should have a minimum of an associate's degree and work up from there by completing his/her bachelor degree or by getting more than the minimum amount of continuing education credits per year and continually updating his/her skills.
Fabi Small, RDH
St. Louis Park, Minnesota

Experience vs. knowledge

Dear RDH:
I am writing in response to all of the issues involving associate's degrees, preceptorship training, and bachelor's degrees. What is the true issue here?

I attended the Alabama Dental Hygiene Program, which allowed me to take my Alabama State Board (and I add that I passed with a very high grade average). Since then, I have been working on an associate's degree, which I have almost completed.

I have worked in the dental field for 13 years and I know from experience some things you cannot learn from reading a book. There is no experience like hands-on experience. You may read it, but you do not actually know unless you have experienced it for yourself. Alabama hygienists must work hands-on for a full year before being able to even qualify to take a state board! And let me add these girls are very well instructed during this time.

Do other states allow this? Like other states, Alabama hygienists are required to pass a state board, which consists of a one-day written exam and a one-day clinical exam. And let me once again add their patient must meet certain qualifications ... I'm not sure if everyone is aware of this.

I have a question for Ms. Rainieri of Virginia (October 2002 issue). Let's say you have been rolled into a surgery room. Your about to have your gallbladder removed. To your right stands a doctor that has performed this surgery hundreds of times (all being successful). He was instructed very well by a prior surgeon during his internship. Now you look to your left and their stands a surgeon fresh out of medical school and you're about to be his very first patient. He has had all requirements and finished medical school.

Which one do you want to do your surgery? Wait! Let me guess ...

In my opinion, what makes a dental hygienist good is not what school he or she attended or how many years he or she went. A good dental hygienist is measured by the quality of his or her work, concern for patients, and the professional manner in which he or she conducts him or herself.

The bottom line is either you know your job or you do not. So let's display ourselves in a professional manner.
Christa Akins, RDH
Fort Payne, Alabama

Thinking critically

Dear RDH:
I would like to comment on the "Ignorance About Preceptorship." We have been dancing with this issue for some time now and we seem to banter back and forth about "skills" and doing "prophies." What appears to be missing, in my opinion, is the most important consideration: the ability to think critically.

I believe one of the most valuable ways to learn, enhance, or promote this quality is to be questioned, repeatedly, over a period of time, about many different types of classifications of patients, regarding every aspect of care — not just the "instrumentation" aspect. There is so much more to dental hygiene care than "the cleaning." The ability to make a dental hygiene diagnosis, formulate a dental hygiene care plan, implement that plan with outstanding skill and judgment, and communicate it clearly to the patient, from a strong knowledge base, cannot be overemphasized.

How we are able to reach this point is up for debate. Working in a dental hygiene program as well as in a dental school environment, I see what standard is required and enforced by instructors and professors who do not get paid much (compared to private practice), and dedicate themselves to guiding students in critical thinking.

I am an RDH, practicing 21 years. I attended a two-year, A.S. Program in order to become a hygienist. I have been exposed to two-year, four-year, and one-year assisting, plus one year of dental hygiene programs. I cannot imagine a preceptorship program that allows one to acquire the necessary skills to think critically. It simply takes time and experience to earn and learn this skill. I can't even imagine a "gifted" preceptor-trained clinician being the type of person who would just "clean teeth."

The National and Clinical Boards are not even being mentioned in this letter; that's another situation that one can, in reality, be taught to the test. This letter is about the ability to "think on your feet," given varied situations and conditions, and knowing, and doing, what is best for the patient. All this is done with a strong sense of confidence. This sense of certainty and assuredness only comes with time, experience, and compelling questioning.
Juli Kagan, R.D.H., M.Ed.
Boca Raton, Florida

More familiar than you think

Dear RDH:
I am writing this in response to Dana Rainieri's letter in the October 2002 issue. I have read all of the letters to your magazine regarding the preceptorship hygiene program and feel as though Dana went too far with her criticism.

I am a graduate of the Alabama Dental Hygiene Program. Let me begin by saying that I have been a dental assistant since 1987 and a RDH since 2001. I have lived in numerous states because my husband is in the U.S. Army, and I have taken assisting certification/registration exams in all of those states. I have also spent time taking prerequisites such as anatomy and physiology, chemistry, biology, world history, and numerous English and math courses (I believe these are the same classes you took).

When I moved to Alabama, my employer suggested I attend the state's hygiene program. I enrolled and spent 13 months studying to become a registered dental hygienist. This was not only "on-the-job training" that you assume it is. We spent 640 hours in the classroom and at least the same amount of time working with patients under the supervision of a dentist who is required to be certified in order to participate in our training.

I would now like to comment on Dana's statement that preceptorship-trained hygienists could not pass the national board. If the ADA would give us the chance to take the national board, they would be very surprised to see that the majority of us are extremely well trained and capable of providing exceptional patient care! If you feel so strongly that we could not pass the examination, please feel free to contact the ADA and support us in our fight to be able to take the national board.

As far as you feeling superior to us, it is a shame that you have to feel so unsure of yourself that you need to insult people you do not even know. We regard our title of RDH as seriously as you do, and, yes, we struggled just as you did to pass the boards and find just the right patient for the clinical exam! Or, did you not know that we took boards that included a written exam and a clinical exam? By the way, I passed the state board with flying colors — 91 percent.

We are also required to have 12 hours of continuing education per year, which is more than some states require. By the way, Dana, if they ever had an on-the-job training program to practice dentistry, my 15 years of assisting experience would unquestionably be more valuable than your associate degree from West Liberty.

One day we will be able to take the national boards and it will put this topic to rest once and for all. I hope one day that we (perceptorship graduates) can work side by side with you (graduates from two- or four-year programs), so that you can see how ridiculous this argument has been, and give us the respect we definitely deserve.
Tammy L. Bennett, RDH
Woodbury, Minnesota

Assisted hygiene

Dear RDH:
I am writing in response to the article titled, "The One Hour Appointment" (October 2002). I understand that assisted hygiene may not work for everyone, however, this article left me disheartened. The same point could have been made without demeaning other members of the dental profession as stated, "Good assistants are as rare as hen's teeth in my area."

Was I a good hygienist when I first started practicing clinical hygiene 15 years ago? Would our first employers have rated us good right out of school? Remember how slow we were? Ever second-guess yourself or were unsure of office protocol? I recall the guidance of fellow staff members such as hygienists and assistants. This encouragement allowed me to grow to appreciate each member's contribution to providing optimum care for each patient. Developing a fresh attitude as to how you can contribute to your practice includes involving fellow team members, such as training hygiene assistants or networking with hygienists, promotes a winning combination for this ever-changing profession.

For the past six years, I have been practicing assisted hygiene. Our relationships with our patients have increased. For example, while working with a nursing home patient whose oral hygiene was not getting the attention needed, we were able to accomplish optimum care. (1) Two caregivers made this visit much easier for the patient and hygienist. (2) OHI, such as a spinbrush, is given to nurse's aide for patient by first caregiver while second caregiver is informing patient's son with details of the visit including OHI. (3) Forms for nursing home and office completed (4) Patient pre-appointed for preventative care and/or restorative. (5) Lending a hand to escort patient out. The time involved for this particular patient was 60 minutes. I wonder how long this may have taken a hygienist to complete practicing solo.

A problem may occur when the hygiene assistant calls in sick, though the same is true for any team member, in addition to the doctor. The importance of the word "teamwork" may now reveal itself.

Personally, I feel that my career has lengthened practicing assisted hygiene. An ergonomically equipped room continues to be a fairytale to me; nevertheless we remain focused on creating the best dental hygiene department for our practice and patients. I believe that the staple for all hygienists is customizing your schedule to complement your abilities in providing effective treatment. This profession enables us to constantly strive for improvement. In view of that, I agree with the last sentence in the article which states, "Every day can be 'Make a Difference Day.' "
Anastasia L. Turchetta, RDH
Kill Devil Hills, North Carolina