Tossing out a few words

March 1, 2007
In today’s fast-paced world, people use words and phrases that have become very fuzzy around the edges.

by Anne Nugent Guignon, RDH, MPH

In today’s fast-paced world, people use words and phrases that have become very fuzzy around the edges. For example, what does a simple word like quality mean? What are the real meanings of conservative or comprehensive?

Think about business cards. It’s quick, easy, and inexpensive to order cards that use a stock template. Just drop in the pertinent information and voilà, a business card is born. A custom-designed card can be expensive. The cost increases with the quality of paper stock. Using embossing or multiple colors also increases cost, and hopefully the impact of the card.

Business cards often contain words such as quality, caring or comprehensive. These are used so frequently that their meanings have become lost. Who in their right mind would want to visit a practice that provided poor service or had an uncaring staff? Why waste ink and space on words that don’t convey a significant message?

By definition, comprehensive means complete or all-inclusive. Is your definition the same as mine? Do your doctors share the same definition of comprehensive as you do?

There are no hard and fast rules that define comprehensive dentistry. It is important to understand that comprehensive means many different things to many different people. Use of the word may be only a marketing tool and may not reflect the actual services rendered in your mind.

For example, what is the definition of a comprehensive new-patient exam for a nineteen-year-old? Does a comprehensive exam include four traditional bitewing X-rays or seven vertical bitewings? Does such an exam include a panoramic film or a complete series of individual periapical radiographs? Obviously a risk assessment on the actual patient and many other factors determine the answer. In some practices, the office policy or coverage by a third-party carrier determines patient treatment decisions. Does this make the examination more or less comprehensive?

Conservative is the next word I want to discuss. What does it really mean? When someone asks, “Do you know a good, conservative dentist?” they may not be using the right words to desribe what they really want. The person posing the question may have a very different idea of what a good, conservative dentist is than the person who answers, “Yes, Dr. Wonderful’s practice is exactly what you’re looking for!”

Just what is a conservative dentist? When someone asks for a referral to a conservative clinician, are they looking for quality or do they want a clinician who “won’t find too much wrong” or “won’t recommend expensive treatment”? Years ago, conservative implied resistance to change, but in today’s dentistry conservative can have an entirely different meaning.

Today’s practices that embrace minimally invasive or minimal intervention dentistry are conservative because their focus is on preserving or remineralizing existing tooth structure, rather than picking up a drill at the first sign of decay. Definitive periodontal debridement procedures that disrupt significant plaque biofilm deposits without surgical intervention are also minimally invasive if the result is a healthy periodontium.

Now let’s examine the word quality. According to the online encyclopedia, Wikipedia, the word quality has four distinct but closely related definitions.

  • A specific characteristic of an object (the qualities of ice - i.e., its properties)
  • The achievement or excellence of an object (good quality ice - i.e., not of inferior grade)
  • The essence of an object (the quality of ice ­­- i.e., “iceness”)
  • The meaning of excellence itself

According to Wikipedia, “The first meaning is technical, the second practical, the third artistic and the fourth metaphysical. All four meanings, and therefore the meaning of quality, are synonymous with good.” It’s interesting that one word can have so many meanings and applications.

Speaking of quality, can clinicians who work without magnification and illumination deliver the same quality as those who use these devices? This is a tough question. Devices that improve visual acuity can help clinicians be more accurate if they use them properly, but the mere use of technology cannot guarantee high quality clinical judgment or skill.

Will a clinician who is deemed conservative, who wears magnification and illumination, and who practices with today’s minimally invasive dentistry philosophy deliver higher quality care than one who has not integrated these approaches into his or her practice? Who has the right to make these judgments? In some states it’s illegal to advertise superior quality due to the use technology. There are no black and white answers to these questions.

Here’s another dilemma. Is a “conservative” dentist who does not provide a safe working environment for the staff a quality employer? Does quality come to mind when hygienists acquiesce to provide adult dental hygiene care every 30 minutes without additional clinical support?

Integrity is the last word in this discussion. Integrity is possessing firm principles, and adhering to high moral principles or professional standards. In essence, having high integrity means living your life honestly.

Periodically, life hands us situations that cross the line. Each person has a unique set of boundaries based on previous experiences, current environment, and deep-seated ethical values honed over a lifetime. To make the situation more complicated, these boundaries change as our knowledge grows and we gain clinical experience.

How we respond to the events that challenge our boundaries can change our relationships forever. Sometimes the outcome is distressing. Other times the result turns out to be more favorable than we would have imagined.

Sometimes it’s good to stand back and re-examine how we use words that have become overused. Understanding and embracing the true meaning of words such as quality and integrity creates a certain level of peace and confidence when making a difficult decision. Also, our boundaries are the foundation of our personal and professional comfort zone.

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member who has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540, and her Web site is