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Readers’ Forum

Nov. 1, 2005
Dear RDH: I was very disappointed with the article, "Distance Learning," in the August 2005 issue of RDH.”

Web cams facilitate “classroom” interaction

Dear RDH:
I was very disappointed with the article, “Distance Learning,” by Maggie Vivoda in the August 2005 issue of RDH. She states, “A drawback to distance learning is the lack of face-to-face interaction.”

That couldn’t be further from the truth. I am currently in my second year in University of Missouri at Kansas City’s (UMKC) degree completion program. The classes are given online using a Web cam and are absolutely fantastic! They offer a more productive interaction than any other class I have ever taken - Internet or traditional classroom.

We meet in an on-line session on Centra once a week. We are able to see the instructor and fellow classmates in real time from coast to coast. We are also able to view a PowerPoint presentation navigated by the instructor and a side text chat at the same time. The instructor can navigate to course assignments and view the Internet to aid presentations. As students, we are able to click on icons to check yes or no questions, raise our hand, clap, and laugh.

This program offers more interaction than I have had in most traditional courses. If anyone is interested in a wonderful educational experience they need to check out UMKC ([email protected], Kim Bray director of UMKC distance program).

Web cam is the way to go!

Tracy Brookshire, RDH
Champaign, Illinois

Fraud is just the tip of the iceberg

Dear RDH:
The letter in the Staff Rx column regarding fraudulent billing (September issue) came as no surprise. I have been in dentistry for 30 years and feel like I’ve seen it all, often while temping. One dentist in my community actually scans digital X-rays of patients, looking for one that will fit a narrative he wants to write for services on another patient! Another dentist removes the existing restoration in a tooth requiring work, and then takes an X-ray to submit along with a narrative that justifies a high fee restoration.

I have been asked to change my perio charting or increase AAP classification, so that RPSC is justified for a client needing to return for further scaling, even though no bone loss is present (just poor oral hygiene and a long time between dental hygiene services). This of course, is said to me under the guise of “benefit of the patient,” so that their insurance will cover the charges.

Having a patient take responsibility for their oral condition seems unheard of these days. Dental offices are afraid of angering clients and having them leave. Therefore, they resort to fraud.

As a hygienist, I do not believe my experience is unique. When I refuse to change periodontal numbers or classifications, I am often made to feel like I’m not a “team player” or that I don’t care about the patients. Frequently, the numbers or classifications are changed anyway, and I am left feeling like “the prima donna hygienist.” Eventually I resign my position.

While I have empathy for the concerned hygienist over fraudulent billing, I am more concerned with the prevalence of dental assistants hired off the street and “trained in office.” This practice is done for the sole purpose of saving the dentist money. (Typically, the same dentists who practice fraudulent billing.) It is unfair to the “assistant” who receives an improper education and low starting wage. But worse, it poses a threat to the public through cross-contamination of instruments, treatment rooms, darkrooms, etc.

An uneducated assistant has no idea of the type of bacteria present in the mouth, or of the bloodborne pathogens and microorganisms they are cleaning up. This is a threat to their personal well-being, as well as that of the patients. Treatment rooms are often improperly disinfected, and dirty gloves are used to set up for the next procedure.

Uneducated personnel also pose a hazard to our environment through the dumping of hazardous materials, especially in lax offices. Very often, the lead in X-ray packets is thrown in the garbage, along with amalgam waste and biohazard material, such as bloody gauze from extractions. This frequently happens in offices that do not want to pay for “pick-up” services.

I have seen old fixer and developer poured down the drain, thus contaminating the water supply. Again, this occurs in offices that do not want to pay for pick-up.

I often wish I could turn a blind eye and that it didn’t bother me. Unfortunately, when a sensitive issue such as this has been brought up, I have actually been told “why do you have to make such a big deal out of everything?”

This lose-lose situation is more prevalent than one might believe. After 30 years in dentistry, I am disheartened to say the least. My fervent hope is that unethical practices will eventually go out of business or be forced to make changes, and that regulation of all dental personnel will be required for the betterment of society.

Name Withheld Upon Request
Mill Creek, Washington

Challenges for high salary worth it

Dear RDH:
This correspondence is in response to “Salary is not a top priority” (Readers’ Forum, September issue). I am a new graduate: June 2003 to be exact. I was also a dental and orthodontics assistant for seven years prior to entering hygiene. So, I am not really a “newbie,” yet I am. I absolutely agreed with Tamara Maahs’ letter ... until the last few paragraphs.

I concur that experience, continuing education, and the desire to provide the best possible health care should be rewarded with a great package.

However, because new grads are asking for the “going rate” does not mean that they are not the warm and caring health-care providers that many hygiene role models before us have been. Is it truly the new graduates’ “fault” that they receive the rate that they were advised in hygiene school to ask for?

Or, is it the dentist who is willing to pay that hourly rate for the new graduate because statistically speaking there is a shortage of hygienists?

Does this employer not appreciate the years of experience, the years of dedication, the skill level of their hygiene department that they are willing to pay top dollar for a hygienist, any hygienist?

These are the questions on my mind as a new graduate. I have come to the realization that in order for a new graduate to see the yearly raises that may have been typical for generations of hygienists, a recent graduate has to “job jump” until he or she is satisfied. It is not a great future for the practice I have just spent two years in, if you’re asking for my opinion. This practice even offers a 401k to promote longevity.

Speaking for myself, I almost want to be offended by the challenges presented in Tammy’s letter. Why? In a recent seminar I attended given by Anne Guignon - “Battling biofilm and other hot topics in hygiene” - Anne asked the group how many hygienists use ultrasonics on 90 to 95 percent of their patients. I was one of eight in a group of 60 who raised their hands. That alone was a shock to me considering all that I learned in school about ultrasonics and their effectiveness in disrupting the biofilm.

Anne then asked the group when they graduated. A few graduated in the 1950s, some in the 1960s, etc. I was the only one from the new millennium. At this point I asked myself: I was taught all of this stuff about ultrasonics, locally applied antimicrobials, and ergonomics in hygiene school, so why am I here? Is this information really for me, the new graduate? In my program, we placed products like Arestin in school as proficiency tests to pass the course.

When I left Anne’s course, I felt great. I truly felt like the two horrific years I spent in hygiene boot camp was worth it. That the 34 hours of continuing education credits I just earned in two years was worth it. That the salary I asked for when I got hired was worth it.

Barbara Walter, RDH
Philadelphia, Pennsylvania

Team success

Dear RDH:
A dental office is comparable to a baseball team. Everyone has to come together to win the game. If one player’s morale is down, the whole team feels it. This holds true for a dental staff. Our patients also feel when morale is down.

A dental office is comparable to a baseball team. Everyone has to come together to win the game. If one player’s morale is down, the whole team feels it. This holds true for a dental staff. Our patients also feel when morale is down.

Click here to enlarge image

We would not like our team’s players to be late for a game. Therefore, we would like our co-workers to be on time for work - early, in fact. Our huddle 15 minutes prior to our first patient is crucial.

Communication is the key to success as well as continuity. Having systems and protocols will allow the office to flow smoothly.

Office hierarchy is an “out.” We are all equal team players. We should all help one another with our jobs. It is important to have knowledge of other positions in the office.

I am fortunate to work with a team of all-stars! Everyone steps up to the plate and gives 100 percent. We huddle 15 minutes prior to our first patient. We get an understanding of the flow of the day.

If an assistant is available, he or she will help the hygienist with a patient’s X-rays. If the hygienist is available, she will help the assistant break down the rooms. Our office manager even puts on her scrubs and is ready to offer a hand. Our boss even helps out at the end of the day.

So, everyone let’s get out on the field and play our best game!

Dawn McNamara, RDH
Manalapan, New Jersey

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