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Reader's Forum

June 1, 2007
In reply to your April editorial in RDH magazine, “A passel of trouble,” since you focus on SB 1144 in the Illinois legislature and comment specifically on the position of the Illinois State Dental Society in this regard, I believe a comment is in order.

Comment on Illinois access

Dear RDH:
In reply to your April editorial in RDH magazine, “A passel of trouble,” since you focus on SB 1144 in the Illinois legislature and comment specifically on the position of the Illinois State Dental Society in this regard, I believe a comment is in order. Setting aside the humor in your editorial and focusing on the substance, you obviously feel that dental hygienists in Illinois should be able to practice without any supervision of a licensed dentist, and in particular, practice in this manner on low-income, Medicaid patients.

It should come as no surprise to you that Illinois dentistry holds that the ability to diagnose a patient and develop a treatment plan is the absolute responsibility of a dentist because of his/her higher level of education. To trivialize the treatment of patients, and especially the Medicaid population, as you do in your editorial not only insults dentistry but also insults dental hygiene as well. Proper diagnosis and treatment planning is as important for the Medicaid population as it is for other patients.

If passed into law, SB 1144 would permit dental hygienists to be primary dental caregivers to low income patients without the benefit of having first received an examination, including X-rays, and appropriate diagnosis of their dental condition by a licensed dentist. This is the right of any patient, rich or poor. The Illinois State Dental Society will not tolerate a dual standard of care in our state, especially for the least fortunate patients.

While we all firmly believe in the importance of disease prevention, the truth is that most low-income patients are in need of necessary restorative treatment and more complicated specialty services that cannot be delivered by a dental hygienist. For some reason, persons who support your position to allow dental hygienists wholesale access to patients without dentist supervision also make the gigantic leap that, once the law is passed, hordes of well-meaning hygienists will leave their comfortable jobs and “take care” of the access problem by going out and treating all the low income population.

Click here to enlarge image

The serious issue of access to care for low-income, Medicaid patients is a multi-factored one that includes inadequate funding, broken appointments, low priority of dental care, and an adult program with no preventive services. Until the state of Illinois wakes up to the fact that this problem can only by solved through an economic solution, then the issue of access to care in Illinois will continue along its current road.

Robert A. Rechner
Executive Director
Illinois State Dental Society
Springfield, Illinois

Changing the author’s intent

Dear RDH:

In the article, “Compliance and Your Patients,” (March 2007 issue), Dr. Mahtab Partovias references an article I published in 1979 (Dent. Hyg. Vol 53, June 1979:277) to describe and compare four plaque control programs.

I focused on the dental hygienist as the implementer of the program while Dr. Partovias chose to highlight the dentist. While it is important to encourage all members of the dental team to interact with the patient on oral hygiene issues, historically it has been the purview of the hygienist to attend to the patient’s oral hygiene education and practice, which is why I felt that this was an important clarification.

Dr. Partovias so closely tracked my article but changed its intent with this change in emphasis.

Joyce Tassone Turcotte, RDH, M.Ed
Monroe, Connecticut

Editor’s Note: Ms. Turcotte is referring to a “tipped-in” continuing education supplement that was published with the March issue. If your copy of the issue is still intact, the supplement appeared between pages 32-33 in the issue. Readers can also view the article at

Finally welcoming oral irrigators

Dear RDH:
I just wanted to write and thank you for a great article on the dental water jet. I, too, remember learning in dental hygiene school that the “water pik” didn’t remove plaque, so it was not considered worthy of use. Then the common thought was that, well, it breaks up the plaque colonies, so it might do some good. Now it has been proven an effective adjunct to the toothbrush.

It just goes to show, even without scientific evidence, if the clinician is seeing a trend of health and good results from use of a product, the product or therapy could be of great value. We just might not understand the mode of action at the time!

Your article was a great addition to the magazine. Easy to read for the majority of the clinicians out there, practical, evidence based, and encouraging!

Terri Patrick, RDH, MS, CHES, CDHC
Assistant Professor of Dental Hygiene
Tarrant County College
Hurst, Texas

Research xylitol products

Dear RDH:
The article, “Food Allergies Can Kill,“ in the December 2006 issue of RDH was very informative. I hope every dental hygienist reads it.

I have become a label reader out of necessity. Sometimes it takes numerous phone calls for further research. Because of my inquiries, I have found xylitol to be troublesome because the dental community is touting all its benefits with no disclaimers. Not all xylitol is created equal. The source of xylitol can be from one or a combination of sources including:

  • Corn
  • Berries
  • Fruit
  • Vegetables
  • Various nuts
  • Birch wood fiber

These sources are not listed on the product.

Some of those ingredients will probably be a red flag for consumers with certain allergies or sensitivities.

Each manufacturer of a product will need to be called and questioned about the components of the xylitol in their product. It usually takes a few days for a reply.

Finally, a friend just told me that she had seen an article on the bulletin board at her veterinarian’s office that xylitol can also be deadly to pets. After ingesting chewing gum or candies with this ingredient, the animals died from liver damage.

Joy D. Brown RDH

Where we might climb

Dear RDH:
What a thrill to see one of my most beloved photos in the latest RDH (March 2007) issue! Linda Wacholtz, RDH, Executive Director of Prevention Partners, is the other Maine mystery hygienist to the right of Dr. Paul Keyes.

This photo decorates my office desk. Patients often inquire about the gentleman in the picture. I thank them for asking and let them know Dr. Keyes is one of my personal heroes! I tell them of my very first lecture with Dr. Keyes in 1981 (first of many) when some dental colleagues used strong language, too astonished by Dr. Keyes’ research!

What an honor it was to attend Dr. Keyes’ last lecture in May 2006. Personally informing Dr. Keyes he is one of my personal heroes was a dream come true! Meeting Lynne Slim was icing on the cake! Seriously, my heart was pounding with excitement! I have followed her periotherapists’ group since its inception. I informed Lynne it was my only connection to dental hygiene when I took a four-month leave of absence to stay with my mom who was dying of cancer and my only ever break from private practice.

Lynne’s March 2007 column (page 14) prompted these comments. So I thank her greatly for the motivation!

Why are we in dentistry content to diagnose periodontal disease, then treat and prescribe antibiotics without bacterial testing of periodontal infections? Many will argue radiographs and probing scores are the standard of care. I call probing fertilizing old history! Grand for a history buff! How could we fertilize? Probe device: a possible bacterial transport. Should we irrigate prior to probing (discussion for another time)?

Please do not misunderstand me. Probing data establishes a baseline of only what terrain is left to salvage.

Does microscopic testing identify what is occurring right now? Does this definitively co-diagnose the infected periodontal pocket lesion? Does this justify when to delay treatment, when to proceed with dental modalities, what to prescribe, what to irrigate with (both at home and in-office), when to further test with (for example) BANA, anaerobic cultures, interleukin identification, salivary pH and viscosity tests, when to refer for cardio CRP profiles, diabetes susceptibility scores, thyroid testing, free radical and metabolic typing? In my opinion, you bet!

Does a doctor prescribe without strep testing? Or prescribe blood pressure medication without multiple BP readings? What if the patient had a virus? What if a yeast infection was active? Would antibiotics be prudent? What if the patient had recently been diagnosed with diabetes? Would immediate root debridement therapy be warranted if the bacterial sample revealed too-numerous-to-count white blood cells and all sizes of spirochetes? How do we decisively treat inflammation? Do we treat bacterial inflammation the same as “diet/sugar-related” or “mouth breathing-related” inflammation?

Are we putting patients at risk for future periodontal breakdown without bacterial identification? Would more optimal results be achieved by recommending suggestions to assist strengthening one’s immune system first? Could Lynne’s “floss whisperer” transport infection, fertilizing future sites?

How could any of us attempt to answer these questions without bacterial testing evidence?

I share Dr. Keyes’ concern that “dental students have been abysmally neglected with regard in learning diagnosis/management of bacterial infections that impact dental caries and periodontal lesions.” It has been documented that it takes a general practice 25 years to adopt an updated scientific philosophy and a specialty practice 40 years. Can we as a nation afford to wait given the impact of oral inflammation upon systemic disease and skyrocketing healthcare costs?

Do you think patients are more likely to own and more clearly understand their oral infections at earlier stages? Do you think they will grasp your concern about the contagiousness of the disease after a visual view of their “bugs” on the monitor? Absolutely!

Lynne Slim praised Judith Corbin-Price for involving a concerned mom. Could these moms become our best ally for demanding higher standards of care? Should we lobby ADHA to partner with multiple nationwide mom’s & women’s organizations?

Could dental hygienists educate and license ourselves to implement enhanced technology protocols utilizing constantly evolving science? Are we ready to practice the above accepted standards?

We are blessed with passionate dental professionals such as Dr. Keyes, Lynne Slim, as well as the RDH editor, Mark Hartley. I applaud them for their efforts on behalf of dental hygiene professionals today. I am truly grateful for the platforms we have to mentor one another and the excitement of what we may be graced with in the future.

My remarks are my own and do not reflect my alliance to any organization. My intent is not to insult anyone’s current efforts, but to challenge where we might climb.

Mary Lynne Murray-Ryder, RDH, BS
Hermon, Maine