ADHA Access — March 2012
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Dental Hygiene Diagnosis
Graduated from dental hygiene school in 1977, happy and excited to become one of “the preventive dental professionals.” I had been a preventive dental specialist in the Air Force before hygiene school. As most hygienists, I worked for several different dentists before I really found the one I felt most comfortable with. I noticed, in my years of dental hygiene practice, diagnosis varied with different dentists. I found one I felt comfortable with and loved my job. The dentist and I saw nearly eye to eye on diagnosis of caries and periodontal disease. As I “matured,” I had trouble thinking of myself working for this dentist until age 65, and knowing he was older than I, wondered what I would do if he retired ..rst. So I decided to go to dental school. My plan was, when I got out, I would only practice preventive dentistry. I took the pre-requisites and applied; happily, I entered dental school. In the four years of dental school, I began to think of the feasibility of having only a preventive practice. Many patients do not go to specialists when referred—would I be only managing neglect? As my education continued, I chose to become a pediatric dentist, where I felt I could concentrate on prevention and hopefully have to treat little disease as a result. I now am very happy with my choice; I do operative dentistry only 13 hours a week and spend the rest of the time with prevention, exams, diagnosis and treatment planning. Nearly 70 percent of my practice income is diagnosis and prevention. I have many healthy patients and happy parents.
Reading the articles in the November 2011 Access promoting dental hygiene diagnosis concerned me on several levels.First, when a diagnosis is made, questions arise with the patient: what is the treatment going to be, what will it cost, will it hurt, etc. These questions cannot be answered by diagnosis alone. Treatment planning always goes along with diagnosis; an independent hygienist not providing treatment cannot answer these questions. Unanswered questions cause anxiety and noncompliance in patients and are a detriment to their health.When a hygienist works on a dental team, they know their dentists and can answer most questions the way that dentist would treatment plan. I noticed with the dozen or so dentists I worked with in private practice, treatment planning would vary greatly between dentists.
Since the most common dental diseases, caries and periodontal disease, are chronic diseases, the questions arises when to refer. Do you refer when you see caries in the outer third of the enamel? Do you wait until it is halfway to the pulp in the dentin? Modern diagnosis and treatment planning of caries following a CAMBRA approach may dictate completely different treatments for the same lesion in different patients.Is a hygienist really the one to make the decision? I know many hygienists that have completed dental school. We all have a special bond and love with dental hygiene, but no hygienist-turned-dentist I know believes anyone with less than a dental school education should diagnose. This is not about turf battles; it is about “you do not know what you do not know.” Caries and periodontal disease are the easier things to diagnose. Can all hygienists diagnose a potentially impacted cuspid and refer at the proper time? How about ectopic erupting six-year molars? Would they see the odontoma I saw last week on a 10-year-old that will block her tooth from eruption if not treated timely? Now, with over 40 years in the dental professions, I feel the most important dental procedure a patient can get is a thorough examination by a well-trained dentist.As far as patients having to drive an hour to see a dentist as in Oakridge, Ore., I bet they drive that hour to go to Costco, Sam’s or the mall. What they need to hear from the local hygienist is, “this visit is no substitute for a thorough dental exam; please make an appointment with a dentist for the next time you head for the city.”
Most of the hygienists I know do not want the responsibility or the liability of diagnosing. I feel dental hygiene diagnosis is going down the wrong path. I feel the same about hygienists performing operative and surgical dentistry; it is simply not the answer to the public’s dental health problems. We are the “preventive dental professional”—have we given up on prevention? We should not be swayed by those that see lack of access to dental care as a problem of too few dental health care providers; it is a problem of too much disease—preventable disease! The efforts of the ADHA and all hygienists should be in promoting prevention, promoting health, not diagnosing or treating disease.
Ben Taylor, RDH, DDS
By email
Radiographs and Respect
I teach radiology at a community college in North Carolina, so I was drawn to the article “Radiation Safety: Patient Communication Strategies” by Heather Borso, BSDH, RDHAP [Access, January 2012]. The factual content of the article is correct and provides a good review. My concern is with the numerous references (five at least) that it is the dentist who determines the need for radiographs when, in reality for hygiene recare visits, the dentist doesn’t see the patient until the end of the appointment and the radiographs are taken, mounted and previewed by the hygienist and, in some instances, the assistant.
How then can we communicate the legal process to our patients and then not follow this process? The dentist should, in fact, review the chart, examine the patient, determine the risk factors of disease, and then prescribe the radiographs that would be necessary for that appointment. There is a definite disconnect here between theory and practice and communication to our patients. What would happen if a hygienist waited for the doctor to glove up, examine [the patient] and prescribe the necessary radiographs before the hygienist would consent to taking them? Of course, my comments are not directed to Ms. Borso for stating the legalities; however, if we all agree that hygienists are educated in the process of determining the need for radiographs based on history, risks and clinical exam, I just want a little RESPECT as Aretha Franklin so proudly proclaimed.
Connie Preiser
By email
Send letters to Access Mail, 444 N. Michigan Ave., Ste.3400, Chicago, IL 60611. Send email to JeanM@adha.net and identify your message as a letter to the editor. Your name may be withheld if requested, but unsigned letters will not be printed. Letters may be edited for clarity and length.
Graduated from dental hygiene school in 1977, happy and excited to become one of “the preventive dental professionals.” I had been a preventive dental specialist in the Air Force before hygiene school. As most hygienists, I worked for several different dentists before I really found the one I felt most comfortable with. I noticed, in my years of dental hygiene practice, diagnosis varied with different dentists. I found one I felt comfortable with and loved my job. The dentist and I saw nearly eye to eye on diagnosis of caries and periodontal disease. As I “matured,” I had trouble thinking of myself working for this dentist until age 65, and knowing he was older than I, wondered what I would do if he retired ..rst. So I decided to go to dental school. My plan was, when I got out, I would only practice preventive dentistry. I took the pre-requisites and applied; happily, I entered dental school. In the four years of dental school, I began to think of the feasibility of having only a preventive practice. Many patients do not go to specialists when referred—would I be only managing neglect? As my education continued, I chose to become a pediatric dentist, where I felt I could concentrate on prevention and hopefully have to treat little disease as a result. I now am very happy with my choice; I do operative dentistry only 13 hours a week and spend the rest of the time with prevention, exams, diagnosis and treatment planning. Nearly 70 percent of my practice income is diagnosis and prevention. I have many healthy patients and happy parents.
Reading the articles in the November 2011 Access promoting dental hygiene diagnosis concerned me on several levels.First, when a diagnosis is made, questions arise with the patient: what is the treatment going to be, what will it cost, will it hurt, etc. These questions cannot be answered by diagnosis alone. Treatment planning always goes along with diagnosis; an independent hygienist not providing treatment cannot answer these questions. Unanswered questions cause anxiety and noncompliance in patients and are a detriment to their health.When a hygienist works on a dental team, they know their dentists and can answer most questions the way that dentist would treatment plan. I noticed with the dozen or so dentists I worked with in private practice, treatment planning would vary greatly between dentists.
Since the most common dental diseases, caries and periodontal disease, are chronic diseases, the questions arises when to refer. Do you refer when you see caries in the outer third of the enamel? Do you wait until it is halfway to the pulp in the dentin? Modern diagnosis and treatment planning of caries following a CAMBRA approach may dictate completely different treatments for the same lesion in different patients.Is a hygienist really the one to make the decision? I know many hygienists that have completed dental school. We all have a special bond and love with dental hygiene, but no hygienist-turned-dentist I know believes anyone with less than a dental school education should diagnose. This is not about turf battles; it is about “you do not know what you do not know.” Caries and periodontal disease are the easier things to diagnose. Can all hygienists diagnose a potentially impacted cuspid and refer at the proper time? How about ectopic erupting six-year molars? Would they see the odontoma I saw last week on a 10-year-old that will block her tooth from eruption if not treated timely? Now, with over 40 years in the dental professions, I feel the most important dental procedure a patient can get is a thorough examination by a well-trained dentist.As far as patients having to drive an hour to see a dentist as in Oakridge, Ore., I bet they drive that hour to go to Costco, Sam’s or the mall. What they need to hear from the local hygienist is, “this visit is no substitute for a thorough dental exam; please make an appointment with a dentist for the next time you head for the city.”
Most of the hygienists I know do not want the responsibility or the liability of diagnosing. I feel dental hygiene diagnosis is going down the wrong path. I feel the same about hygienists performing operative and surgical dentistry; it is simply not the answer to the public’s dental health problems. We are the “preventive dental professional”—have we given up on prevention? We should not be swayed by those that see lack of access to dental care as a problem of too few dental health care providers; it is a problem of too much disease—preventable disease! The efforts of the ADHA and all hygienists should be in promoting prevention, promoting health, not diagnosing or treating disease.
Ben Taylor, RDH, DDS
By email
Radiographs and Respect
I teach radiology at a community college in North Carolina, so I was drawn to the article “Radiation Safety: Patient Communication Strategies” by Heather Borso, BSDH, RDHAP [Access, January 2012]. The factual content of the article is correct and provides a good review. My concern is with the numerous references (five at least) that it is the dentist who determines the need for radiographs when, in reality for hygiene recare visits, the dentist doesn’t see the patient until the end of the appointment and the radiographs are taken, mounted and previewed by the hygienist and, in some instances, the assistant.
How then can we communicate the legal process to our patients and then not follow this process? The dentist should, in fact, review the chart, examine the patient, determine the risk factors of disease, and then prescribe the radiographs that would be necessary for that appointment. There is a definite disconnect here between theory and practice and communication to our patients. What would happen if a hygienist waited for the doctor to glove up, examine [the patient] and prescribe the necessary radiographs before the hygienist would consent to taking them? Of course, my comments are not directed to Ms. Borso for stating the legalities; however, if we all agree that hygienists are educated in the process of determining the need for radiographs based on history, risks and clinical exam, I just want a little RESPECT as Aretha Franklin so proudly proclaimed.
Connie Preiser
By email
Send letters to Access Mail, 444 N. Michigan Ave., Ste.3400, Chicago, IL 60611. Send email to JeanM@adha.net and identify your message as a letter to the editor. Your name may be withheld if requested, but unsigned letters will not be printed. Letters may be edited for clarity and length.
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