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Readers’ forum

Jan. 1, 2007
Dear RDH: I was so happy to see Lynne Slim's article titled, "Baltimore and Syrian Hamsters."

Tribute to Dr. Keyes

Dear RDH:
I was so happy to see Lynne Slim’s article titled, “Baltimore and Syrian Hamsters.” I, too, attended the seminar in Baltimore at Mercy Hospital. I was so pleased that Lynne acknowledged me with all the greats in anti-infective periodontal care.

Basically, all of this thought process in modern times was started by Dr. Paul Keyes. His work has only recently gained the recognition that I think he should have received many years ago. And still he is the most selfless and modest person anyone could meet.

Unfortunately, few dental practitioners use microscopic and other forms of bacterial testing in today’s periodontal care. The industry promotes the elimination of harmful bacteria leading to periodontal and systemic diseases with so few actually knowing what organisms and how many they are even dealing with. Let alone know whether they have addressed them or not.

For too many years, Dr. Keyes’ work was not given the proper attention it warranted. The others mentioned in Lynne’s article have also made a tremendous impact on anti-infective therapy and have helped many people achieve health.

It is really time for microbial testing to be the standard of care. Dr. Keyes and others are our leaders for periodontal care for the future. I hope he will be here a long time and see how powerful his contribution is to not only dentistry but general health as well.

Sandy Sheffler RDH
Towson, Maryland

Polishing first is wrong direction

Dear RDH:
I would like to respond to an article in the November 2006 issue by Tammy Maahs, RDH, titled, “A Different Spin on Polishing.” In this article, the author presents anecdotal evidence to suggest that pre-polishing most patients is more time-efficient, therapeutic, and patient friendly than the traditional post-polish/selective polish procedure most of us are familiar with. As a dental hygienist with 10 years experience in multiple settings,

I understand and appreciate the desire to tackle the task of heavy stain and plaque removal and get it out of the way. What I take issue with is the suggestion that this is the most efficient and therapeutic way to handle this chore. Ms. Maahs refutes evidence that shows the damage done to enamel by over-use of coarse prophy paste. She minimizes this by rationalizing the benefits of the polishing and using an arbitrary percentage of practicing hygienists who utilize coarse paste as proof of its safety and efficacy.

I thought that the hygiene profession was trying to focus on evidence-based practice and depending less on arbitrary, nonscientific, anecdotal methods of care! Perhaps I am mistaken, but hasn’t the research shown that ultrasonic debridement prior to hand scaling is the most beneficial therapy for removal of stain, plaque, calculus, and biofilm? The routine use of ultrasonic scalers when used correctly has not been shown to damage enamel or gingival tissue, while providing exemplary benefits to the oral health of patients. The same cannot be said for routine polishing of teeth.

This article recommends a change in the old routine of exam/hand scaling/polishing to benefit both patients and clinicians. I agree with this sentiment. Nevertheless, we should be encouraging the widespread use of ultrasonic debridement, which has been proven, scientifically, to be of benefit. Urging the adoption of a standard of care that has not been proven as therapeutic, other than anecdotally, is irresponsible and a push in the wrong direction for the dental hygiene profession.

Melissa Ng, RDH
Worcester, Massachusetts

The doctor goes first

Dear RDH:
As a continuing education presenter, former faculty member of the University of Pennsylvania School of Dental Medicine Department of Periodontics, and author, I make a point of reading every response that Dianne Glasscoe (author of Staff Rx column) writes in RDH. To that end, I loved your comment, “In a faraway land called ‘Dental Hygiene Utopia,’ new patients see the doctor first ...”

My husband and I have a general practice in Stowe, Vermont, along with one other associate and three other dental hygienists. He has attended several of the Pankey Institutes after which we decided to arrange new patient exams with the doctor first. We did this at least 20 years ago, and what a relief! I insist before I intercept a new patient that the radiographs are current and the doctor has outlined a restorative treatment plan, and any medical concerns are taken into consideration.

The doctor may introduce the patient to potential periodontal issues but the periodontal treatment plan is designed by one of our hygiene staff.

This protocol where the doctor see new patients first enables our hygiene staff to develop a periodontal treatment plan (perhaps advising the doctor the preferred restorative treatment area to start based on periodontal breakdown) and spend the better part of the one hour and 10 minutes allowed for every new patient educating the patient about their periodontal needs. Usually at that appointment, debridement with ultrasonics only is performed so that the patient can achieve the first benchmark of health. Then the patient is rescheduled based on the suggested periodontal treatment plan.

The hygienists in our office appreciate the time we allow to review the medical history, reinforce the restorative plan and design a comprehensive periodontal therapy treatment plan. In this manner, we feel we have achieved a “team” approach to reach the end point of restorative and periodontal therapy success.

It is sad to me to read how many practices still push patients through in such an abbreviated manner, not only at the first appointment but at subsequent recare appointments.

Thank you, Dianne, for your excellent comments.

Lucinda B. McKechnie RDH, BS
Stowe, Vermont

Second thoughts about spa dentistry

Dear RDH:
I laughed out loud, along with my colleagues, while reading Debra Grant’s article, “The Pleasure Palace,” in the November 2006 issue of RDH. I have been practicing dental hygiene for 15 years and have never heard anything as ridiculous as some of the suggestions in Ms. Grant’s article. I, too, believe in making my patients comfortable and relaxed in the dental chair and have been known to provide a soft pillow to comfort a neck, or a warm blanket to relieve a chill, but performing Reiki, polishing nails, and even more bizarre - removing facial hair and blackheads is just plain weird.

As dental hygienists, we are trained professionals - trained to instruct our patients about proper dental care, provide evidence for diagnosis and treat disease. We are not aestheticians or nail technicians. Making our patients feel relaxed and comfortable in a possibly intimidating environment is one thing, performing services such as nail polishing and facial treatments is another.

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These services are out of the realm of a dental professional and they “cheapen” our profession. I think the time has come to think twice about “spa dentistry.” Dental hygienists have worked long and hard to be respected - as valued members of the dental team and as professional dental providers. Would an RN be encouraged to polish my nails or wax my eyebrows while I am waiting for my physician to examine me? I think not. What is this teaching those new to our profession? Ms. Grant, please don’t encourage these “extras” that demean our credibility.

Sheri Gubash, RDH
St. Charles, Illinois

Web friendly CE

PennWell Corporation announced the enhancement of the http://INEEDCE.COM Web site in December. INEEDCE.COM is a tool for dental professionals to complete continuing education credits online. The enhancements include more user-friendly capabilities that allow the user to take dental continuing education tests in real-time, enabling them to read and answer questions directly on the site and see results immediately. Other enhancements include new log in and payment pages along with easier navigation through the site.

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PennWell’s Dental Division includes Dental Economics and RDH. Other publications include Woman Dentist Journal, Dental Office, and Grand Rounds in Oral Systemic Medicine. PennWell also produces several conferences and seminars, including “RDH Under One Roof.”

Anne Guignon, RDH, the author of the Comfort Zone column in each issue of RDH and senior consulting editor for the magazine, writes a blog devoted to the annual RDH Under One Roof conference.

Readers can view her blog at: