Readers' Forum

Dec. 1, 2002
I am writing in response to the self-described "rantings" of Dr. Duff (November 2002) regarding the article I authored in the September 2002 RDH issue on full-mouth disinfection (FMD). First and foremost, I do not consider his comments to be rantings, nor would I assume to classify him and his "ilk" as anything but part of the controversy alluded to by this article.

Not ranting, but a little confused

Dear RDH:

I am writing in response to the self-described "rantings" of Dr. Duff (November 2002) regarding the article I authored in the September 2002 RDH issue on full-mouth disinfection (FMD). First and foremost, I do not consider his comments to be rantings, nor would I assume to classify him and his "ilk" as anything but part of the controversy alluded to by this article.

The focus of this article was to highlight research in the area of this topic, and Dr. Duff in his review missed the key points. First, the FMD research completed instrumentation in two appointments, not one. Secondly, while the article recounted protocols utilized and suggested alternatives, its primary focus was to question treatment completion time involved with SRP protocols and to call for standardization of such processes. To suggest that leaving acute or chronic infections to spontaneously heal over weeks is ludicrous, outdated, and, according to RDH audiences all over the country, ineffective!

Recent review of the literature (Journal of Clinical Periodontology) continues to suggest that acceleration of instrumentation may offer many benefits, most of which were mentioned in the article. However, it was my opinion that this protocol could also result a more expeditious referral to the periodontist, which should please Dr. Duff. Dr. Duff's letter confirms the confusion in reading even the most basic of dental literature as he missed these key points and focused only on the premise of the original data, instead of the author's message.

He further quotes four weeks as treatment time for SRP — I welcome his evidence-based source(s) for this statement and remind readers that, in fact, accelerated instrumentation has been routinely practiced in most adjunctive therapy research. Full-mouth SRP is generally completed in under two weeks in these studies with the additional placement of a local delivery agent only after full-mouth SRP has been completed. Is this the reality behind use of these agents or even basic SRP? While evidence-based care seems to be all the rage, how does it truly apply in reality?

To that end, his quoting of Dr. Greenstein is most concerning as the unpublished data that Dr. Greenstein cites dispelling accelerated instrumentation is based on the evaluation of only four sites per case. This is a prime example of propagating confusion, instead of evaluating new approaches that will result in advancing the art and science of dental hygiene, while optimizing therapy potential and facilitating a client-centered approach.

I thank Dr. Duff for his comments and to his agreeing that he has "no problem" with the basic premises presented, and I respectfully remind readers that RDH magazine provides a venue where opinions are welcome, new possibilities explored, and mutual respect and collaboration encouraged. To paraphrase Einstein's definition of insanity, repeating the same activity over and over again and yet expecting a different outcome — RDH magazine and similar publications offer hope that the insanity will stop!

Kristy Menage Bernie, RDH, BS
San Ramon, California

Tiers would fragment profession

Dear RDH:

I am writing in response to the article titled, "Tiers for our trade" (October 2002 RDH). I agree with some of Ms. Gutkowski's comments, such as: "Education does not make a good hygienist." I am also in agreement that there are those in the profession that are there just for the paycheck. However I do not think fragmentation of the profession is the answer. I greatly disagree that this fragmenting would not further divide our profession. It definitely would.

There is somewhat a degree of fragmentation that already exists, as has been evident in articles always designating associate degree hygienists and baccalaureate degree hygienists. This tone even exists in Ms. Gutkowski's article.

Back to the statement of "education does not make a good hygienist." I am an associate degree hygienist and am very proud of the education I received. I attended Virginia Western Community College in Roanoke, Va., where 100 percent of my instructors were members of the ADHA and very active. They taught me not only how to be a "educated" hygienist, but a "professional" hygienist!

Tiered hygiene is not the answer to quality oral health care, because, even in that situation, there will be those that perform at the top of their tier and those that choose not to. We cannot enforce how someone will deliver care; we can only educate and mentor them to be the best they can be.

Passion is not something you can teach. I, too, became frustrated with those less dedicated and passionate about dental hygiene. But I feel the best I can do for them and our profession is to be a positive role model for dental hygiene. It is even more important now than ever that our profession stand strong together to protect its integrity and to move the profession forward. I just do not feel "tiering" would be a positive, forward-moving action.

Marina D. Mcgraw, RDH, EMT-E
Charlottesville, Virginia

Ignorance about preceptorship

Dear RDH:

I read with amusement the letters from hygienists and their ignorance about the preceptorship program in Alabama. I've never figured out how so many people can make a judgment about something they know absolutely nothing about. I've written in before and given the pros of the program, so I won't bother to state my case again since it falls on deaf ears.

However, I have to respond to Roseanne Federico's comment in the October issue. She said "most dentists are not proficient to deliver hygiene therapy themselves, much less teach someone else these skills. I would not want my employer to give me a prophy much less supportive periodontal therapy or SRP." Yikes! What a sad commentary on your dentist's schooling.

My dentist spent many hours in dental school doing prophys and root planing. He was a good teacher to me, just like all the professors in the program were. We have many of the same professors teaching us who teach the dental students. Maybe that's why the program works here — our dentists can do prophys.

I'd also like to respond to Dana Rainieri from the October issue. We also have to pass a written and clinical exam. It was the same written test the college-trained hygienists took. I know that because we all took the same test in the same auditorium. Then we went to the dental school for the clinical exam. And yes, I had the same stress of finding a suitable candidate for the clinical exam as you did. And if you ever move here and want to practice dental hygiene, then you will have to take the same test we did.

This magazine makes it a point to keep this issue stirred up without getting all the facts. Dani pointed out that until we pass the boards then she won't give us the credibility or respect we think we deserve.

I have no respect for people like you who make inaccurate statements based on hearsay. The ADA looked at our program and approved. I think that speaks highly of the program. The National Board exam was open to preceptorship hygienists about a year ago. The majority who took it passed. We're hoping it will be offered on a regular basis soon.

It's sad to see a magazine waste so much time on an issue without presenting all the facts.

Vicki Nelson
Cullman, Alabama

Editor's Note: We encourage readers to submit letters about any topic on which they would like to express an opinion. The key word is encourage. RDH certainly doesn't force anyone to write a letter to the editor. As for the topic of preceptorship, we're comfortable with the results of our 2000 survey of Alabama hygienists. In that survey, published in the November 2000 issue, many of the state's own hygienists questioned the "teaching methods" that they encountered during their training. So it's not just non-Alabama residents who think preceptorship is flawed.

Staying busy

Dear RDH:

I just have a comment about the Readers' Forum of June 2002. I am so busy with getting final credits to apply to dental school, family, full-time hygiene, and community service that I have not been able to read all my professional journals, but ... I would like to address Connie Sidder from Colorado. I am sure other dental hygienists were insulted by her implication that if you are paid commission you must somehow be compromising your ethics! If you read her statement and use her logic then you are left to think all dentists must be a little shady. All dental businesses only end up paying the dentist a percentage of their work.

Just because you make commission does not mean you are not constantly being compassionate, thoroughly treating the entire person, and diagnosing periodontal disease accurately (and not sweeping it under the carpet), or are lacking in a sense of ethics.

Dental hygienists are a vital part of the oral health care chain! Regardless of how we are all paid, we have a duty to inform, treat, and care for our patients.

I was a cosmetologist for eight years before becoming a hygienist. I know a lot about customer service and communication. Having worked under a commission system most of my hairdressing career, I did not give "poor" quality work just because I was being paid a percentage. But commissions motivated me to stay busy and not sit around and have a cup of tea.

I, too, pride myself on the quality of work I perform, not how much I make. But I think Ms. Sidder is kidding herself if she thinks you have to be paid hourly to be proud of your contributions to your dental office and to your family. My experience has taught me (being licensed in two states and having passed the Washington restorative exam for hygienists) that a hygienist will make far more on commission than hourly (and you still get benefits).

Sunny Brant, RDH, BS, RC
Portland, Oregon

Five Comments

Dear RDH:

I have several questions to ask and comments to make about your October issue.

1) Dr. Larry Burnett's article, "Tales From the Swamp" was very good concerning biofilm, but I was wondering if he was aware that microbes can be grown in povidone iodine. It would seem to me that there is the most benefit is the cavitation with only a 12 percent increase due to iodine. But with that in mind and only 223 participants, and lack of knowledge about the compliance of these patients not listed in the study, I would like to see a repeat of this study done on a larger basis and with home-care compliance charted.

I am really interested in this because almost everything else we use — even CHX4 — has a negative aspect to its use, such as being desquamnative, cytotoxic, or negative for collagen formation.

2) Paperless offices. When I already go into countless offices with very little in the way of documentation and 45-minute appointments, I find minimal time to enter enough of the things I am seeing, so that much goes undocumented in these offices.

Prevention to me is catching things early before they become a problem. I think computer people need to check with hygienists on how to organize a system so I can run comparisons on say, lesions, or MAG, furcations, or bleeding.

The biggest problem with computer probes is that bleeding happens after you are about two teeth away or more. Also, the ability to change computer records bothers me quite a lot. Is the information you write down one day changeable on another day or even on the same day by another person?

3) X-ray comparison. If you give me a set of X-rays that compare six sets of bitewings, my eye can flip far faster from one X-ray to the next to do the comparison than I find the current digital X-ray to do. By the way, I rarely even see comparative X-ray holders in charts; it's almost non-existent. Sifting through charts to see if there was ever a PA taken on a tooth in question is a huge time-consumer. And the same question arises in my mind, once that X-ray is taken: Can it be deleted or changed in any way?

4) Twelve practice-management myths. The ninth one addressed how a hygiene assistant can effectively solve the problem of seeing more patients per day. I am not so much concerned about patients missing the personal interaction of the hygienists as hygienists seeing the same patient in offices that have many hygienists in order to ascertain differences in that patient; sometimes changes are subtle and feeling that a change is important.

In this day and age where everyone is using every antimicrobial imaginable, tissue doesn't always bleed where there is a problem developing. Practice management is all about more money and very often at the expense of good prevention. I often need to take PA's where the bleeding is abnormal or pocketing is hugely different after digital bitewings are taken and the assistant has already moved to the next chart's X-rays, which I can't access until she is through. Enough terminals and/or split -screen capability (keeping two charts' X-rays active) would be a huge help.

5) To Bill Landers, president, OraTec Corporation, since the average pocket has eight square inches of pocket to detect microbes on, and since the Biofilm Institute with their probe that is 1/100th of a mm notes that bacteria can be replicating 1/500th of a mm away from an area that is completely free of bacteria, and given the fact that bacteria has a quorum-sensing capability as well as an ability to lie dormant or non-replicating for long periods of time, do you see your probe as being accurate enough and does it detect non-replicating vs. replicating bacteria so that even when you are not seeing bleeding that you can detect bacteria at all costs? Also, if it does detect non-replicating bacteria, do you suggest using antimicrobials there even without the bleeding?

Donna B. Rice, RDH, BS
Chesterfield, Missouri

To submit letters to the editor for publication in Readers' Forum, send by:
• Mail — P.O. Box 3408, Tulsa, OK 74101
• E-mail — [email protected]
• Fax — (918) 831-9804
Besides a "signature," letters also must indicate the city and state where the writer resides or practices.

About the cover

Rebekah Mitchell Anzalone is the current president of the Louisiana Dental Hygienists' Association. She was a member of the state's delegation to the ADHA's annual session last summer where an RDH sales manager started chatting with her. He was so impressed with her initiative that he referred her to the RDH editor.

"I am very excited about the career I have chosen," Anzalone said. "I hope to be involved in dental hygiene on a state and local level for many years, trying to increase membership in our state."

A native of Louisiana, Anzalone grew up in the Baton Rouge area. She and her best friend in high school compared ambitions and settled on the dental hygiene program at Louisiana State University Health Sciences Center in New Orleans.

"We applied together and were accepted the same year," she said. "We moved to New Orleans together, and we are still very close to this day. I believe I really owe my career choice to her. That is also where I met my husband (in dental school). We got married a year after graduation (in 2000) and moved back to New Orleans, so he can complete his education."

The couple live in the Lakeview area of the city, which is beside Lake Ponchatrain, a place where they enjoy evening strolls. She jokingly refers to her husband as a "professional student," but he's actually wrapping up his post-graduate residency in periodontics at LSU.

"In our very spare time, he is teaching me to play golf," Anzalone said. "We have all the home acessories you can buy off the Internet. My living room is sometimes mistaken for a putting green. Although I am not very good, I am learning."

She works in an uptown periodontal office three days a week and in a general practice one day a week. Anzalone also dabbles as a makeup artist for Clinique a couple of weekends a month.