Episode Description

Ethics in dental hygiene isn't limited to fraud, legal violations, or the dramatic cases that make headlines. In this episode of the RDH Podcast, Jackie Sanders and Andrew Johnston talk with Catrice Opichka about the everyday ethical decisions hygienists make—from documentation and periodontal charting to treatment planning and patient safety.

Opichka also discusses why dental boards can be misunderstood, what happens when a hygienist's clinical findings don't align with a dentist's recommendations, and how board-mandated remediation can help clinicians regain competence and continue practicing. The conversation offers a practical look at professional integrity, speaking up when something doesn't feel right, and making patient safety a priority even when no one is watching.

Ethics is more than the big mistakes

Jackie Sanders: Welcome back, everyone. My name is Jackie Sanders with RDH Magazine, and we are recording the RDH Podcast live from RDH Under One Roof. I am hanging out today with my co-host and my special guest, Catrice Opichka. Hello, Catrice. Hello, Andrew. How are you guys?

Andrew Johnston: Okay, it's fine. We're doing really good. Yes, absolutely.

Catrice Opichka: I did.

Andrew Johnston: It's been, was that Orlando, I think, right?

Andrew Johnston: Orlando.

Catrice Opichka: Oh, you're right.

Andrew Johnston: Yeah. That was a good time. Yeah, that was a good time. That's when you were on the podcast for A Tale of Two Hygienists. I think so.

Catrice Opichka: First time.

Andrew Johnston: Yeah.

Catrice Opichka: And I love it. Thank you for having me again.

Andrew Johnston: You are, for me, one of the, you're a brilliant brain. And what I like about your brain is that you are a strategist. You are really good at collecting your research. You're also a doer of things, right? Which I think is kind of unique.

Some people can be, like, we talked about this before off air, right? Sometimes you're just like the ideas person, which is probably more of me. And I think other people are like the doers and the ideas person. And you have both. I love that about you.

Catrice Opichka: Well, thank you. Multitasking.

Andrew Johnston: It's one of the things, though, I think that leads you to jumping into roles or positions that maybe you didn't even know existed before, or you get dragged into something and you're like, oh, this is interesting. So tell us a little bit about kind of the things that you're working on currently.

Catrice Opichka: So one of the biggest things that I'm doing, as you probably know, is I work for an organization called CRDTS. And most people know CRDTS as a dental and dental hygiene testing agency, but many people don't know we have a separate arm, and that separate branch or arm of the organization helps dental boards with remediation cases.

We build education for dentists and dental hygienists who have had some trouble. We also help hygienists return to practice. We build programs for dental educators.

Your example is perfect. It's—I get to run these programs, but I also am in the weeds. So I also get to be a part of the programs. I get to visit the sites, visit the dental boards, and really kind of collect the information of what are they looking for, where is this area that there really isn't a lot of education?

So how can we help keep the public safe? And that's basically what I do. But there's so many different aspects of it. And I think that's the thing I love most about it is I can actually be the feet on the street, work with the dental boards, work with the dental hygiene schools, and get this information and education to the people who need it.

Andrew Johnston: Have you ever heard of this type of role ever existing in hygienists, right?

Catrice Opichka: No. In fact, until I was interviewing for actually a different position, I didn't even know the role existed. And so surprised this role existed, and they kind of did a pivot and they're like, well, great, you seem better for this role we haven't even told anybody about yet.

And so it was, it's not even like I applied for this. It just kind of happened. But it really, it's a great fit for me for all of the reasons that you've said and the fact that I really do care about public protection. And I'm seeing—and it's a lot of the things we're gonna talk about today—how a really good person and a really fantastic clinician can head down a path that they didn't expect to head down.

And then how can we bring them back to where they started? And I think that's a good jumping-off point.

Why dental boards are focused on public protection

Andrew Johnston: We're going to talk about ethics today. And I think that sometimes ethics can kind of sound a little bit stiff and boring or whatever, but it's actually not. It's actually quite fascinating in the context that we're going to talk about.

And I want to do a little bit of a caveat and talk about dental boards for just a quick second before we get into some of our questions for you, because I think that people have this—it's usually either it's one of two ideas about what a dental board does in a state.

One, they're out to get you, right? Or two, they don't ever do anything for the people that are bad people. And I don't think—in your opinion, have you found that to be the case?

Catrice Opichka: No, actually, it is funny and not funny. It's sad because they really get a bad rap. The dental boards, I think, because when people work with the dental boards, they're having a dilemma, a crisis. They have something that they need immediately. And so they want somebody to answer their questions or fix their situation quickly. And that isn't always the case.

And I think the other frustration is most people deal with the dental boards when they're not in a situation where they're really seeking it out. And so there is this perception that the dental board is out to get them or looking for something to get them in trouble for. And that's really not their goal.

Their goal comes from a really great place of, again, I'll say it up a million times, but it's public protection. They are charged with that responsibility. It's a huge responsibility.

And I think if we as clinicians think about what we want to see our colleagues do and how we feel about our patients, I think everybody can understand that the dental board is really on our side. And unfortunately, they kind of get a bad rap, but they really are on our side.

Andrew Johnston: I love the way they explain that because the dental boards are made up of our colleagues.

Catrice Opichka: Absolutely.

Andrew Johnston: They know. So sometimes you think like, oh, it's like this person that doesn't know what I'm going through. How could they possibly understand? And then they want to reprimand me. And you're like, no, like these are our peers. They know what we're going through and they're going to help us find the solutions to get us through whatever unfortunate circumstances occurred and get us back on our way.

Catrice Opichka: Absolutely. And I'll have one thing just kind of a haha funny to that is, if you take it a step further, it is not glamorous. And so these are people who are choosing a really tough job, a really busy, tough job, and it's not glamorous at all.

So they're really—they're doing something that many people don't have the time or interest in doing, is sifting through the rules and laws and making sure that people are safe.

Andrew Johnston: The packets you get for the board meetings, like this, they could get every better time, and they don't get compensated for that. Okay, so let's get to the first question.

The ethical decisions hygienists make every day

Andrew Johnston: So I think one of the things that many clinicians think of ethics as, we just need to avoid fraud or someone's breaking the law or something like that. But most ethical dilemmas are way more subtle than that. Do you find that to be true?

Catrice Opichka: Oh, absolutely. It's funny. So even when I think of the first thing that pops into my head is, oh, the dentist accidentally fell into bed with the assistant.

Accidentally. Whoops. Ethical dilemma.

I mean, when we think of an ethical dilemma, and I guarantee you there are people listening who are like, that is the first thing I think of is, oops, someone slept with someone. You don't think of the probably hundreds, maybe thousands of things that happen in a single day.

The decisions that you make, they're all ethical decisions. And so I, from, it's not necessarily all the big stuff. There's plenty of big stuff too. But it's the little things like, wow, I'm running late. What do my chart notes look like? Can I take the easy route? We see that one a lot.

You know, it's just those little things that happen throughout the day, like chart notes, like decisions and perio charting, just everything that we do.

Andrew Johnston: Copy forward, whatever.

Catrice Opichka: Copy forward.

Andrew Johnston: Because they have that feature on a lot of those things right here. Like that pre-populate was last charts, numbers. Oh, it happened to be the same.

Catrice Opichka: Absolutely. It's the copy-paste thing that we see a lot of times. And it's again, most of us, when we think of it, we're like, we would never do that. But if we dig down, most of us are like, oh, there's a time I either thought about doing it or I did it a little. I maybe copied a couple sentences or the whole works.

I have actually worked in practices because I've done a lot of temping, where it's kind of the office protocol is everybody copy-pastes, including the dentist. So it's a very common, but it's a big ethical dilemma. It's an ethical issue. It's a legal issue and documentation.

And those are the things, again, when people think about ethics, they think the big things are going to get you in trouble. This is one of those things that it is a small thing, it seems on a daily basis, but it definitely can get you in trouble.

And you stop protecting yourself too, right? You're not necessarily writing what actually happened during that appointment. And if you don't write it, didn't happen in the eyes of the law.

So copy-paste can get you in trouble really quick.

Jackie Sanders: That's so funny because when I think of ethics, documentation is probably the last thing I think about. I think about actual procedures, right? And, you know, x-rays and all of that stuff. But yeah. So there you go.

Andrew Johnston: I mean, that's what keeps you in trouble too. I mean, for sure. But, like, I would tend to agree. Yeah, I think of the bigger fraud, I think fraud mostly. Like, are you lying about a patient's condition or whatever? Like, that's what I think of.

But even the front office, though, has it where they're like, they're submitting claims, they're copying and pasting all the stuff from claims, like their narratives. Like, it's all—like, there's a certain thing there that's a little bit icky.

One thing, though, that's interesting, I think for students, because we do get some ethics in our programs, not a whole lot, similar to how dentists get some business, but not a whole lot in their dental programs. So as clinicians are moving from the classroom into private practice or DSOs, what ethical challenges tend to catch them by surprise?

Catrice Opichka: I think the biggest surprise and the biggest shift from being a student to being a clinician is, as a student, you're being guided and directed by a bunch of instructors, right? You're being watched everything that you do.

So you don't have an opportunity to make unethical decisions because you're being watched so closely by your instructors. So I don't think we prepare students as they come out into private practice at the different ways that they can very subtly be unintentionally unethical because they're so used to being watched.

Somebody's guiding them. And now all of a sudden, they're on their own. Nobody's watching them the majority of the day. And what tests our integrity the most is doing the right thing when nobody's watching. And as a dental hygienist, nobody's watching the majority of our job.

So making those little decisions on cutting quarters, taking shortcuts.

Jackie said something earlier just a moment ago, and it's basically what people think is clinical issues are the ethical issues you think about. But what we find and what we do is underneath those clinical issues is always an ethical dilemma. It's always an ethical decision that they made early on that led to a clinical issue, diagnosis and treatment planning.

You think of that as basically a clinical thing. Well, it is. But behind that was a decision or decisions to recommend something, to not recommend something, to allow maybe a patient to say, I really can't afford that. And then you go, okay, we'll just do what you want to do because it's the easier route.

Just there's a whole bunch of examples like that where every clinical issue that somebody has behind it is an ethical decision or shortcut that they've made somewhere along the line.

When clinical findings and the dentist's plan don't align

Andrew Johnston: Well, it leads us into, I think, I still want to stay in that realm of treatment planning and all of our diagnostics and our intake, because I think that we collect the data, we know what we're taught, we use our education, we do the thing, right?

You say, okay, this is, and then you warm the patient up to, hey, this is probably what doc's gonna say or whatever. Then doc comes in and they say something completely different. That in and of itself creates a challenge for us.

So how would we go about maybe challenging—maybe not challenging; challenging is maybe too harsh of a word or whatever—but for the sake of this discussion, challenging what to be true versus what doc's saying to be true? Patient has perio, doc says they're healthy. Like, how do you have that conversation?

Catrice Opichka: Oh, right. And so that's a, it's a perfect example. I have other examples I'll use as well, but challenge is a harsh word, but it kind of is.

And we are faced—every hygienist has faced this probably on a daily basis, either small or big—where you have everything laid out, dentist comes in, you've already discussed perio, let's say, with a patient. You have them ready to go. They're all on board. We want to do some periodontal therapy.

And the dentist walks in and says, no, not yet. Let's just wait. No, not enough bleeding, whatever happens.

And then you're now on stage in front of the patient and you have the split second to go, what do I do with that? Do I not say anything? Do we wait until next time? Do we challenge that conversation right here, right now? Do we wait until later?

And I think the question is, what is our responsibility as a dental hygienist?

And what comes to mind when we have these conversations is things that are happening in a lot of different states where the dental assistant role is changing, what dentistry wants that dental assistant role as they're doing a little more of the hygiene procedures in some states.

And what you hear hygienists say is, we have gone to school for this, we have been trained, we have been educated, and our job is important and it is serious.

And when I think of that, that's what I think of when I'm in those situations that are kind of those ethical dilemmas: it's our responsibility to professionally kindly challenge that, if we do, we are the periodontal experts in our office. And we lead that charge of keeping our patients periodontally healthy.

So I think we have a responsibility to challenge, for lack of a better word, when we do know what the right thing is and the right course of action for our patient's health.

Andrew Johnston: I think that'd be a good thing for us to bring on someone for another whole nother episode to talk about that, of like, how do you have that conversation?

Jackie Sanders: Yeah, I actually had an author—well, she actually called me on the phone. This is probably two years ago. We actually did an article about it. I need to find it.

And she had discussed the perio pocketing with the patient, talked about future treatment. Dentist came in and said, no, we're okay for now.

So the way the hygienist covered herself is she documented it all and wrote it all down, got to work the next day, and all of her notes had been deleted.

Oh, wow.

They take it up. So we had a very interesting phone call, and it was an anonymous—she wrote an anonymous article about it.

So you don't even, I mean, I have been out of clinic for so long, I don't even realize this stuff goes on. And I consider myself fortunate that I worked for two dentists that believed in what I knew.

Speaking up when patient safety is at stake

Catrice Opichka: And then I'll take it like the next step outside of perio is the probably weekly times that it happens in a dental practice where you're taking somebody's blood pressure and, man, you took it three, four times and it's still not going down. You go to the dentist and like, this is not a healthy situation. And the dentist says, don't worry about it. Go ahead. Go ahead.

You know, so again, big ethical dilemmas as a clinician, like what do you do in that situation where you're not comfortable?

And I think that's the thing about ethics is, again, as I said at the beginning, it's not like somebody goes into it and says, ha ha ha, I'm gonna be an unethical person, this would be so much fun.

They go into it going, I don't want to challenge it today. So I'm just going to—I just, I don't want to, I don't want the fight. I don't want the argument. I'm tired of all this.

And so you stop fighting those important battles, and those are all ethical decisions. It's the little things that really guide who we are and where we can go home at the end of the night and go, I feel proud of what I did. I feel that my patients are safe and everybody in this practice is safe as well.

Jackie Sanders: So yeah. It's, yeah, it's kind of where Dr. Pam Maragliano went yesterday in her keynote and she talked about what is the vision of this office? What is our mission statement? Where is the dentist head and how do I get all my staff in the same place?

And it's like you have to have those meetings so you don't have this stuff happen.

Catrice Opichka: Absolutely. And a lot of times we don't, unfortunately, don't take the time to have those meetings of getting everybody all on the same page and making it a priority.

If you don't talk about it, if it never comes up, you don't make it a priority. And as Andrew said, like one of your first statements, it's not a sexy topic. It's not an exciting topic. It's not a revenue-producing topic.

And so, you know, we've all been to how many dental seminars, how many times do you see one ethics on the schedule?

Andrew Johnston: Exactly.

Jackie Sanders: If it's something that's not faced, it's one of those things: how expensive can ethics become?

Andrew Johnston: Yeah, exactly. Title it differently. That's intriguing for people.

Catrice Opichka: Exactly. Well, you know, and some dental boards will come and say, you know, well, how much does remediation cost? And boy, this is, you know, it's expensive.

And because they're looking out for licensees as well, going back to, they really are on our side. And the title of the slide that I put up is, What Is the Cost of Public Safety?

And so I struggle, I understand what we have to respect the cost behind it, but what is truly the cost of public safety? I mean, it's like the most important basic thing that we are striving to do is keep our patients safe.

So what is the cost of that?

So my goal is to see it more and maybe frame it in a way where we can have a little bit more fun with it. So it's not so, oh, I don't want to, I just—

Jackie Sanders: Trying to bankrupt you.

What happens when a hygienist is reported to the board?

Andrew Johnston: But let's close on this, though, because I think this is an important thing. Okay, let's say that Andrew, the unethical hygienist that he is, finds himself unfortunately in a situation. The board gives a board order and says, hey, you need to go do this.

Walk us through that process real quick as we're ending this to give the listener some sort of, like, I don't want them to be comfortable because they did something wrong, but give them a little bit of comfort, like, hey, this is a process. This is what the process looks like.

Catrice Opichka: Right. So—

If somebody gets in trouble, it usually is because somebody has reported them. It's a lot of times it's a patient. Sometimes it's a fellow colleague. You'll find with dentists, often it's a patient. With hygienists, it's often a fellow colleague or past colleague that will turn them in.

Hygienists, just a little FYI for what do people get in trouble for. Hygienists, we see two things come in as far as board mandated, and that will be not staging and grading perio, and the other is record keeping.

So we talk about, oh, you don't think about record keeping, but it is like one of two things that hygienists will actually get reported to the board for. Dentists, it's a lot of different things, clinical, but there's always a record keeping component and there's always an ethics component.

But somebody turns somebody in. They go through the legal battle, and all of a sudden now the board—and all of a sudden, I mean usually a year later—the board will say, okay, this is the plan.

They agree on a plan and they'll build in education remediation. And we custom design the education for the licensees so we're not wasting anybody's time and you're really honing in on what they need.

And we do that using a pre-assessment so we know exactly what we need to build in, and then we walk them through the whole process.

So education is built in the area of diagnosis and treatment planning, record keeping, ethics, and then any clinical needs that they need from perio to implants to prost to pediatric dentistry.

And they finish up the course with the post-assessment, proving to the boards, because the boards want to see that competence is achieved at the end, proving that in all of the areas in the board order, competence is achieved.

And then that pretty much, that's it for the license. That resolves the issue.

So, you know, it definitely takes some time. It costs some money. I guess the silver lining is you walk away with—it's great continuing education.

Somebody told you had to do it, but at the end of the day, the worst thing that happens to you is you have to pay a little money, spend a little time, but you get some fantastic one-on-one, oftentimes one-on-one with a subject matter expert in a clinical setting. Like, you don't get that in dental school. It's fantastic education.

So you get some of the best education you can possibly get at the end of the day. So there is a silver lining, and we can report then back to the boards that you are safe.

And I will tell you again, I'll finish up with something that Andrew said. The dental boards don't want to take your license. Like, that's the last thing they want. They are striving to have you achieve competence, even if you're in trouble.

The first thing they're not thinking is, oh, let's grab this somebody's license. They don't want that to happen. So they work really hard. We work really hard to make sure that we can help people stay licensed and stay in this profession they work so hard to get into and practice.

Andrew Johnston: Well, Catrice, this has been great. Thank you for making ethics better, more fun than it usually is, I think, from the stage. If anyone wanted to reach out to you, how can they find you?

Catrice Opichka: Probably the easiest way is at my business email, and that is [email protected]. And any ethics questions, happy to answer those. Any remediation questions or state board questions, happy to answer those as well.

Catrice Opichka: Thanks for being here.

Catrice Opichka: Thanks for having me. Appreciate it.