Readers' Forum

Dec. 1, 2008
Although I respect Diana Lamoreux, RDH, very highly and appreciate all that she does as an educator, I have to disagree with her about proper progress (treatment) notes ...

Dear RDH:

Although I respect Diana Lamoreux, RDH, very highly and appreciate all that she does as an educator, I have to disagree with her about proper progress (treatment) notes (page 48, September 2008, RDH). I do agree totally that "well–written records are tedious and time–consuming." I also think that the chart she has developed is a wonderful "checklist" for the hygienist in a clinical setting. For students, such a checklist would be invaluable for checking that they have documented everything.

But the reality is that in a court of law, the jury, lawyers, and judge want a written picture that they can all understand and see. Many of the abbreviations in the chart are wonderful for the professional but unfortunately abbreviations are frowned upon in a court of law. Most laypersons would not understand many of the abbreviations in the chart that was recently printed in RDH.

Also, the common abbreviation of "WNL" really means no more than "we never looked," and there should be a complete explanation of intraoral and extraoral findings, a perio exam, and hard tissue exam.

Of course, everyone is entitled to their own opinion but having had exchanges with many malpractice attorneys and attended many board of dentistry meetings (especially disciplinary sessions), I have to disagree with Diana about the validity of the wonderful checklist chart she has developed.

I do not mean any offense by my disagreement, but I do still think that proper treatment notes should be written out in their entirety to be able to successfully "paint the picture completely" when necessary.

With deepest respect to Diana,
Jane Weiner, RDH
Tamarac, Florida

Dear RDH:

I wanted to say what a wonderful article in your October issue by Dianne Glasscoe–Watterson titled "Get Over Yourself." I found myself asking if she was hiding somewhere in the previous office where I had worked for 15 years.

It wasn't always that bad, but with staff changes and new office management, it certainly became exactly what she stated. I would come home every night after work wondering why my boss seemed so critical of almost everything I did, wondering why the office manager, instead of thanking me for answering the phone and appointing a patient, yelled at me for putting the patient 15 minutes too early, and why the other front desk woman was only interested in making tea and talking about shopping. So much for team work.

The stress was overwhelming.

I was asked to leave with no advance notice at the end of a Saturday work day.

This was the dentist's method of operation with previously discharged staff members.

Aside from being worried about finding another job, I felt a sense of relief and now almost two years later I am very happily employed in a great office with great team players.

I would say that if a hygienist sees any of the personalities mentioned in Dianne's article, he or she should start looking for another job.

There is no reason that she should allow the negativity of others to bring her down, make her feel less valued, and question whether she should just give up hygiene altogether. I am renewed, which after practicing for more than 30 years, is not easy.

I realized that I should have left many years before when one evening, our last patient of the night complimented the dentist on what a great staff he had and he answered, "I deserve it, don't I?"

Keep up the informative articles.
Jan Hopman, RDH, BS
Teaneck, New Jersey

Dear RDH:

Two big thumbs up for finally telling the "emperors" they are not wearing clothes. Since the filter between my brain and mouth has a leak, I do, to my frequent detriment, tell it like it is. So if I had to spend even a week reading all the whining letters you get, or consulting with these same, charming people, I'd either be homicidal or suicidal.

Point of evidence: A few days ago, a patient told me that despite many chart notations of refusing X–rays, recommending three month recalls, and finally, SRP's, no one ever told her that she was in danger of losing her teeth, and that although she had generalized BOP and pockets in excess of 5 mm, she still did not want X–rays because nothing hurt, and she really couldn't afford it.

I looked at her and asked, "If your medical doctor told you that HE saw bleeding that indicated an infection inside your head, and he needed to take an X–ray to determine its severity and plan treatment, would you say, "Nah, I'm saving for Christmas. Let's just wait and see what happens."?

She said, "Take the X–rays."

My mother and grandmother firmly believed that "God helps those who help themselves" and that "You only get walked on if you're laying down," and they passed those values down to me. My kids also have learned to "whistle a happy tune," "pick yourself up, dust yourself off, and start all over again," and to only call me at work if the bleeding is arterial.

Sue Morrison, RDH
Chicago, Illinois

To submit letters to the editor, send to: RDH, P.O. Box 3408, Tulsa, OK 74101; [email protected]; or (918) 831–9804 (fax).

A Moment in Dental Science
Oral Cancer: Just When You Thought You Knew It All*

Squamous cell carcinoma (SCC) malignancy is associated with squamous cells that invade through the basement membrane; it is most common in oral cancer (90%). However, the face of oral cancer is changing due to changing etiology factors (see No longer is the victim thought of as just a 70–year–old man who's been chewing tobacco and drinking whiskey all his life; it can also be a young woman who seems healthy (see

• Etiology: chronic tobacco and/or alcohol use, and/or human papillomavirus (HPV, sexually–transmitted disease, STD); because of HPV, may occur in younger group as well as those = 40 years; varies in appearance.

  1. Skin and oral signs: red and/or white papule, plaque, or ulcer that does not heal; pain and bleeding possible.
  2. Jaw signs: swelling, pain, numbness (paresthesia).
  3. Pharynx and larynx signs: dysphagia (difficulty swallowing), continued hoarseness, lump (mass).
  4. Salivary gland signs: small, persistent unilateral lump, little to moderate pain.

• Location: Mostly on the lower lip, lateral border or base of tongue, floor of mouth, and/or soft palate complex (including tonsillar region); mainly hidden areas that the clinician should access thoroughly during an intraoral examination; however, if HPV involved, can be present in any location.

• Diagnostic dental office tests: brush biopsy (OralCDx), ultraviolet (UV) light kit, toluidine blue dye kit; exfoliative cytology (not recommended anymore); all noninvasive tests do not take the place of surgical biopsy.

• Pathogenesis: does not heal or show response to palliative treatment; may metastasize to cervical lymph nodes.

Source: From Review of Dental Hygiene, 2nd edition, Saunders/Elsevier, 2009 (Fehrenbach, Weiner), available Dec. 2008.