Checking occlusion
Dear RDH:
I enjoy reading RDH every month with its superbly balanced blend of clinical and life issues. I have always read Trisha O'Hehir's columns with particular interest, as they are unfailingly interesting and informative. Her November column on toothbrush (or toothpaste) abrasion was as incisive (pardon the pun) as ever.
I wish to add to her fine dialogue by mentioning a critical issue I rarely hear discussed within hygiene - occlusion. Occlusal prematurities can lead to cervical sensitivity by creating abfraction lesions, often secondary to bruxism or clenching. Treating the symptoms of cervical discomfort - without addressing the bite-related cause - is of little value.
Bite irregularities also can cause mobility in periodontally healthy teeth and destroy the supportive bone of teeth compromised by disease.
I hope every hygienist looks for signs of occlusal dysfunction - such as fractured fillings and teeth, wear facets, or mobility - during the course of every patient visit. Sadly, it has been my experience that many dentists lack knowledge in this essential field, but no practice can attain excellence without addressing occlusal relations with some sophistication.
John A. Wilde, DDS
Hamilton, Illinois
The starting point is the same
Dear RDH:
Regretfully, I was unaware of the survey conducted on the Alabama preceptorship program. If you can stand just one more response ... indulge me, since I feel compelled to do so.
In layman's terms, one could study artistry for 20 years, but does it make a true artist? Would you possess the hands, the finesse, the stroke, the effectiveness from all of your time studying art? One may only take up the brush (scaler/probe) to determine the depth of "knowledge" learned.
From what source does the "degreed" hygienist learn the hands-on technique? A rotation through a roster of willing offices? "Clinical" days at school? "Hands-on" with other students? The point is that there is a beginning point for all of us to pick up these instruments of our chosen career and begin to use them.
I am a preceptor graduate (1995). Throughout the preceptorship, my dentist's reputation was on the line for services I rendered through his office. If your co-pilot has no real knowledge of the controls or maneuvering, what pilot would keep that person as their partner? Unfortunately, there may be dentists who have no desire to play an active role in the quality of the hygiene department. For those, the Alabama hygienists have been categorically placed in an unprofessional, untrained light.
Can you teach such things as tactile sensitivity, probing technique, cavity detection, compassion, commitment, desire for the best treatment for all the patients who grace your hygiene chair without a human subject? No. Does the anatomy of a tooth feel anything like the models studied? No.
"Degreed" hygienists picked up the scaler with all the knowledge of design, technique ... technique ... technique and used them for the first time, too, on a human subject. Did they do so within an established dental office where the dentist's reputation was at stake for services rendered through in that office? Was a temporary license (an "I'm not quite through the program all the way" sticker) prominently displayed in the patient's view? I cannot answer that for them, because I do not know. I wish they would allow the same courtesy for Alabama hygienists.
I will continue to be amazed at the opinions made regarding preceptor hygienists. I had no idea, regardless of degree, that there was any question of periodontal probing in this era of dentistry. It would be unfair to say we all have equal standards of practice, but it is equally unfair to be determined as inferior.
Anyone can decide to go to college to become a hygienist, just as one may decide to go to college to be a chemical engineer. I feel the preceptor's background in dental assisting is a stepping stone (an overview of chairside for minimum of one year) that a freshly "degreed" hygienist has no experience in. Could this be the reason for the low percentage of degreed hygienists (31 percent) who are looking forward to a lifetime in hygiene compared to preceptors (83 percent)? Perhaps.
I certainly feel that a heavy background in education is simply owed to the patients we treat. It is the hygienist's role to co-diagnose and readily be knowledgeable in all aspects of hygiene. Dentistry is a rapidly changing field. A true key is also continuing education, where even the "degreed" hygienist may find her techniques and knowledge outdated.
My favorite comment made from a "degreed" hygienist was, "Don't even get me started on all the subgingival calculus left, even after a one-hour, four-quadrant root planing." (November 2000 RDH). Perhaps it's my Alabama "southern" ways, but I normally am only able to treat two quadrants of root planing in an hour. Call me s-l-o-w, but also call me thorough.
If you feel you would be most comfortable climbing into a hygienist's chair staring at an Oklahoma license rather than in Alabama, so be it. I hope all your dental hygiene visits are wonderful experiences. I'll let you in on a little secret: We all can tell whether you've really been flossing or not!
Victoria Powell
Scottsboro, Alabama
