It is so easy to become complacent in private practice because of the `time` issue. It`s as though we`ve become robots...
Tammy Lynn Carullo, RDH, PC
As dentistry continues to evolve, we can remark on how the days of traditional protocol established in dental hygiene classrooms are "long gone." In those days, attention to detail was paramount, and time restraints were simply not an issue. Life is all about progress and change, but not all changes are for the best. Many of the important tasks that we performed as students tend to fall by the wayside when we enter the "real world" of private practice. The most important question is, "Why?"
Just because the setting has changed from a mass group in clinic to an 8-by-10-foot room with one chair, one patient, and one hygienist does not make the necessary classroom protocol any less important or crucial in providing excellent care to patients. If anything, the opposite is true.
We should be paying more attention to details because, quite frankly, we need to act as our own instructors, checking our work and making absolutely sure that excellence prevails. But given the time restraints placed upon hygienists by dentists, we have been forced to give up these essentials and simply conduct the very basic in dental hygiene services.
Now, before any feathers get ruffled, I am in no way suggesting that my fellow hygienists do not make every attempt to incorporate these services as much as possible. The fact remains, however, that we can only do so much in 45 minutes.
Some practices, though, are starting to come around to the philosophy of implementing comprehensive dental hygiene services. This philosophy can be considered to the hygiene classroom of old.
What services need honing? How about extraoral examinations, intraoral examinations (such as oral cancer screenings), gingival and periodontal classification, charting, comprehensive medical history, plaque index by disclosing, detailed patient education, nutritional counseling, full-mouth series or X-rays, or rechecking our work? How many of these services can you honestly say you conduct with each and every patient? If you can answer yes to all of the above, congratulations; you are among a select few. For most of us, however, the majority of common practices in a hygiene school setting are not so common in the private sector.
The individuals who designed the curriculum necessary for a dental hygiene college to attain accreditation obviously felt these services were important enough. So why are they no longer considered important enough for every patient in every private practice?
The average hygiene appointment tends to mirror this example more commonly than the extensive list above. During the medical history review, we often verbally ask if there are any changes in the patient`s health and then confirm the medications he or she is currently taking. Well, that`s great, but what happened to a detailed, comprehensive medical history evaluation at every appointment, not to mention covering our behinds legally by having a patient`s "John Hancock" to ensure the information is correct and updated, or at least that you are not liable? Next generally come two bitewings, maybe a Panorex. Forget the FMX; it`s too time consuming, right? Never mind that the patient with posterior 4 to 6 mm pockets with BOP would benefit far more from an accurate picture of the exact periodontal status. Our clinical instructors would have coronaries all around for this type of inadequacy.
Finally, there is the issue of soft tissue management. While every hygienist I know probes and records anything above 3 mm and BOP areas, what happened to full-mouth, six surfaces per tooth, extensive probing with thorough gingival and periodontal evaluations?
Well, time is of the essence. So on to the cleaning with maybe some verbal patient education during that process. If time allows, we`ll have a quick look around the mouth, and then we`re off to get the dentist for the exam.
It is so easy to become complacent in private practice because of the "time" issue. It`s as though we`ve become robots instead of professionals who use our intellect coupled with the highest standards and ethics we learned in school. But what is the answer? How do we get that fire and precision back?
The way to return to these basics of dental hygiene is by educating patients about the time restraints and taking a stand in the dental community that these services are still vitally important in patient care. We need to establish a partnership between dentists and dental hygienists and get back to putting the patient first and foremost. Even if the time would ever come that dental hygienists would be nationally independent, we would still rely on dentists for collaborative patient treatment.
All dental professionals care about the oral health of our patients. The time restraint issue needs to be one of the past. The time management issue needs to be one of the future. The time is here to start working in unison, toward a common goal of professional excellence.
Tammy Lynn Carullo, RDH, PC, is president of Practice by Design Consulting, Inc. She is an active member of the American Society for Training and Development, the ADHA, and, effective in May 2000, a the Linda Miles Speaking and Consulting Network.
