Final Goodbye

Well, now that The DEZiree Show has ended, I’d like to know what you REALLY thought about it. And, if you were a DEZiree Show regular, what aspects of this blog will you miss the most and why? If there was one thing in particular that kept you coming back week after week, what was it? We really appreciate your honest and upfront input. And finally, if there’s anything you’d like to tell DEZiree, please let her know by posting a comment. Thanks again for being a loyal DEZ fan!

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Handling Stress at the Job

What do you do to relieve stress of the job—did we leave anything out? Speaking of stress: in your opinion, what’s the most stressful thing about being a dental hygienist? What’s the least stressful thing—or the thing (or things) that make it all worthwhile to you? Your answers are appreciated—post your comment below.

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RDH Advisory Board Q&A

Linda O. asks:

“What influenced you to become a hygienist? Was it your childhood dental hygienist? Your love of science and passion to help others? What’s your story?”

Debbye Krueger, RDH, BS, MAADH, responds:

I backed into dental hygiene. I had received an academic scholarship and had headed to the University of Tennessee to become either a pharmacist or pediatrician. (Your love of science and passion to help others? Perhaps.) I had dated my fiancé all through high school and he accepted a football scholarship at a different school, to my dismay. I had a cousin, who was a dental assistant, who suggested I come back to the mountains and apply to the new Dental Hygiene program at ETSU. Long story short, I gave up my scholarship, graduated from ETSU, and married my high school sweetheart. Almost twenty years, and a divorce, later, I returned to school to complete my BS and work in the community to improve the health of children. I have worked in Public Health and Research now for going on 30 years, and love the profession that I backed into.

Tracey Thompson McGonagle, RDH, responds:

My after-school job in high school working for a dentist influenced me to become a dental hygienist. I was fortunate to work for Dr. Kevin Dugas in Durham, NH. He encouraged my interest in the dental field by teaching me about all the various aspects of dentistry as we worked. I initially started off by doing very basic office jobs, then the more I was in the office, Dr. Dugas would show me different procedures, explaining what he was doing. He is a fabulous teacher. I am still trying to get him to work with me as an adjunct instructor in the dental hygiene program in Boston! Dr. Dugas has had four women who worked for him go on in this field.

I still enjoy dental hygiene as much now as when I first started. There are many directions one can go in. I highly encourage at least a BS degree; don’t stop with an Associate’s. After I graduated from the University of Rhode Island (BSDH), I moved to Switzerland for several years. Dental hygiene was a relatively new field there, so it presented an interesting challenge professionally. Private practice has been rewarding, and now I also work as an adjunct clinical instructor in Boston.

Cynthia A. Chillock, RDH, EF, AP, responds:

My story is that I am old. When I was growing up, females could be a nurse, a teacher, or a secretary. I have two older sisters, and one was going to become a teacher and one a nurse. No way was I going to do what either one of them did! I was college material and did not want to become a secretary. So, I had no idea what I would do. I only knew I would go to college.

When I was 15 years old, we had a fire in our high school and I went to school from 1-6 PM. So, I decided to get a job in the mornings with a local dentist . (He was not our regular family dentist; I had gone every six months to our dentist, but had never seen or heard of a dental hygienist. Our dentist told us to “go home and scrub your teeth with Comet cleanser,” and it would work just as well.)

I had never had any dental hygiene services and did not even know what a dental hygienist was when I went to work for this dentist. It was a small town and he was the only dentist of four in town who employed a dental hygienist. That RDH “cleaned” my teeth after I was there for about 2 weeks. It is a very long story about the condition I was in and I required a great deal of treatment. I fell in love with the profession instantly and never looked back. In May 2012, that will be 47 years ago! I still am very passionate about what I do and how we can impact our patients’ lives in a positive way. When I started was when research was just changing the procedure from a cosmetic procedure to an actual treatment considered necessary for oral health. I have seen so many changes, but believe that if I stay current and continue to learn and grow both personally and professionally, and pay it forward, I will remain passionate about this career.

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Treating Baby Boomers

Q: I’ve read that baby boomers are going to be the largest segment of the population soon, and I’m noticing that shift in the increasing number of seniors we treat. Are there certain things to look for when treating older patients?

A: According to an article in the American Journal of Public Health, the first wave of the “baby boom generation” comprised of nearly 80 million people has reached retirement age this year. This means from now until 2030, the age group of 65 years of age and older will make up approximately 22% of the entire population, which will vastly change our patient population, and also lead to an increase in patient load. Dental concerns for this population include old, leaking fillings, periodontal diseases, and complications stemming from the oral/systemic health link. Another article in the journal Special Care in Dentistry states, “To some extent, we are all going to be geriatric care clinicians. There is little doubt that there will be a great demand for services in restorative dentistry, endodontics, periodontics and perhaps orthodontics.”

It’s the perio portion of that list that dental hygienists will be dealing with most as part of routine prophylaxis and SRP treatment. Over 25% of 65-74 year olds have severe periodontal disease, so this will definitely be something dental hygienists will be seeing and treating more often. It’s also known that as people get older, the tendency to develop significant oral health and dental issues increases. It’s a cumulative effect: as previous dental work begins to fail over time, it will inevitably require remediation. Generally speaking, as patients enter their golden years, they’ll typically find oral health threats are present in greater numbers than when they were younger.

And as people age, the body’s ability to heal itself may also decline, so a mild case of gingivitis can progress to the moderate and severe stages much faster and become more difficult to reverse. Gingival tissue loses its ability to stretch, muscles become soft and bone tends to become brittle. The amount of saliva produced by the salivary glands is frequently reduced as well, leading to dry mouth. Dry mouth is known to increase the rate of tooth decay, and in older adults, decay appears most frequently around the gingival margins.
According the National Institute of Dental and Craniofacial Research (NIDCR), the increase in oral cancer becomes more rapid after age 50 and peaks between ages 60 and 70. Because of this, it’s wise to incorporate an oral cancer screening exam into your typical prophylaxis treatment regimen.

Have you noticed an increase in older patients coming to your office? If so, is there anything you look for or do differently than when treating younger patients? Let us know—leave a comment below.

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Driving Production in Dental Office

Is there anything in particular, like a recurring decision you have to make on the job that you struggle with most often? What is it, and how do you deal with it? Let us know in the comments field below.

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Are Your Instruments Sterilized?

Biological Monitoring Dental Sterilizers
By: Pat Pine, RDH

You might think, “What a silly question, of course my instruments are sterilized” – but not always. Recently, personal experience opened my eyes to a serious problem in dentistry. While providing temporary hygiene services at a very prominent office, a situation occurred that could have been dangerous to the patients’ health.

While setting up for my next patient, a local anesthetic was needed, but syringes were nowhere to be found. I asked the dental assistant where syringes were kept, and she went to the drawer in the sterilization room and pulled out sterilized syringes in a pouch. My first instinct is always to check the chemical internal and external monitoring indicators. When I did, I discovered that these instruments were NOT processed through the sterilizer, as the pouch monitoring devices had not changed color.

My experience is not unique. In 2010, a St. Louis veterans clinic discovered faulty sterilization techniques. This mishap had the Department of Veterans Affairs notifying 2,000 veterans that they could have been exposed to viral infections caused by an inadequate sterilization process.

How dangerous could your instruments be? Without proper sterilization techniques, the health of all patients could be at risk. Infectious diseases can be transferred via blood and saliva, while numerous kinds of harmful bacteria and viruses can be spread through contaminated instruments, including hepatitis A, B, and C, HIV/AIDS and pneumonia, among others.

Sterilization is a process designed to kill all microbes. Actually, testing whether all microbes are killed during the sterilization process is impossible, but it is possible to determine whether the process will kill the most resistant microbes. So how do we know appropriate microbial kill has taken place? By employing all three of the available monitoring methods.

Chemical Monitoring – Performed on each package of instruments, this monitoring method uses heat-sensitive chemicals to assess the physical conditions during the sterilization process. This type of monitoring involves the use of indicators that change color when exposed to high temperatures or to certain combinations of time, temperature and the presence of steam. Items like autoclave tape and special markings on pouches and bags use chemical indicator strips.

Biological Monitoring (BI) – Used at least weekly or on each load, BIs contain the bacterial endospores used for monitoring. This method is intended to demonstrate the sterilization results in actual bacterial spores killed.

Mechanical Monitoring – This type of monitoring should be employed during each sterilizer load. This involves observing the details of the sterilization cycle, such as verifying proper dial and gauge settings, as well as listening as the sterilizer functions. Keeping track of each load can be overwhelming, but is essential.

A few simple suggestions:

  • DO not overload the sterilizer.
  • Make sure packages or cassettes have not been loaded too close together, even without overloading.
  • Ensure that steam can rotate around each and every package, pouch or cassette.
  • Time and temperature must be accurate to ensure total sterilization.
  • Ensure that timing for sterilization has begun before the proper temperature has been reached.
  • The number one error with sterilization is human error! Read the manufacturer’s instructions.
  • Reviewing the manufacturer’s directions prior to use is beneficial to the patient, the practice, and the ethics of safety.
  • Sterilization techniques need to be reviewed annually, and with each new employee.

OSHA in-office training is required on an annual basis per the BBP Standard. Don’t take risks; know the CDC guidelines; take the OSHA Boot Camp Challenge. For further training on sterilization and much more behind-the-scenes safety for teams and patients, contact www.oshatrainingbootcamp.com.

Research:

http://www.medicalmalpracticeattorneysource.com/medical_malpractice/surgical_mistakes/contaminatedinstruments.html

Infection Control and Management of Hazardous Materials for the Dental Team, First Edition. Chris H. Miller and Charles J. Palenik. Mosby, 1994.

Read about risks at:

http://www.columbiamissourian.com/stories/2010/06/30/update/

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The Tongue/Organ Connection

Question:
What is the tongue’s connection to other organs, and does the way it looks tell anything about a person’s health?

Answer:
In Chinese medicine, different areas of the tongue are believed to reflect the health of different organs. The back of the tongue is said to be connected to the kidneys and bladder; the left and right sides represent the liver and gallbladder; the center of the tongue represents the spleen and stomach; and the tip of the tongue is associated with the lungs and heart.

Chinese medical practitioners look at the color and physical appearance of the tongue in those areas to determine what may be ailing the patient. Of course, this post is meant for informational purposes only; an accurate tongue assessment can only be made by a qualified practitioner.

In modern evidence-based Western medicine and dentistry, practitioners do not assign different bodily organs to corresponding areas of the tongue. However, there is a reason why doctors ask patients to open wide and say “ahhhhhh.” Medical doctors, especially otolaryngologists—commonly known as ear, nose and throat specialists—will examine the tongue for certain signs or changes that may indicate what disease a patient may have.

A healthy tongue should be pink, clean, moist and covered in taste buds. Aphthous ulcers (canker sores) are one of the most common ailments of the tongue. There’s not much you can do to treat a canker sore; they are self-limiting, which means they get better and heal without treatment. Applying an over- the-counter canker sore ointment will protect it from pain caused by eating and drinking.

When the tongue looks white and pasty, with thick white or cream-colored deposits, it could be an indication of infection, such as bacterial or fungal overgrowth (known as thrush), or an autoimmune- related inflammatory disease. Thrush is typically treated with a prescription oral rinse.

A “hairy” tongue is one in which the filiform papillae, or taste buds, become elongated and make the tongue look furry. Several factors can cause filiform papillae to grow, including bacterial infection, certain antibiotics, or having an extremely dry mouth.

“Geographic tongue” is an inflammatory condition of the tongue characterized by discolored (primarily yellowish/grayish) regions of taste buds that form irregularly shaped patches in contrast to the healthy taste buds that surround these sites. People with geographic tongue often experience stinging or burning tongue pain when they eat spicy and acidic foods. There’s no cure for geographic tongue, as it commonly goes away on its own. However, some health professionals recommend zinc supplements. If a patient presents with thrush or geographic tongue, they should be referred to their primary care physician or an otolaryngologist.

Have you ever treated a patient who was experiencing problems with their tongue? Was it one of the diseases discussed in this blog post, or something different? Let us know with a reply below.

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Ergonomics in the Operatory

Do you have aches and pains after a long day in the operatory? If so, what are your problem areas—your hands, your wrists, your neck, your back? Leave a comment and let us know, and let us know what you’ve done to help alleviate the problem. Also, are there any instruments in particular that you think have really made great strides or advances in the ergonomic department over the years, and if so, in what ways are they better?

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CMW Recap

The buzz from the 147th Chicago Dental Society Midwinter Meeting was electric! It is one of the largest exhibits of dental products in North America and among the top four health care tradeshows in the country, according to Expo magazine. The exhibition, held at McCormick Place in Chicago, spanned from February 23rd – 25th and welcomed 31,169 guests. The tradeshow floor was busy with exhibitors launching new products and techniques, and attendees rushing to see more than 120 speakers, attend 190 courses and partake in 38 hands-on courses.

DentalEZ® was just one of the exhibitors eager to share in the excitement of a new product line – the Concentrix® family of handpieces. This new, economical line of StarDental® handpieces gained the attention of those interested in purchasing top-quality products at an affordable price.

If you were unable to attend the show but are interested in the sights and sounds of the show, then fear not! Social media is soaring to new heights within the dental community. More practices and manufacturers have Facebook pages than ever before, so the need for on-demand information was at its peak during the show. CDS had their blog reporters roving the show floor looking for the latest dental happenings. New for 2012, there was a live stream of a patient whitening systems course directly from the show floor. Also on their radar was the announcement that the Chicago Dental Society Foundation, the philanthropic arm of the Chicago Dental Society, plans to open a dental clinic in DuPage County (IL) by working with volunteers from the recently closed dental program at DuPage Community Clinic.

Numerous events were held to support non-profit organizations in their effort to boost access to dental care. The 22nd Annual Oral Health America Gala and Benefit took place at Navy Pier. Guests had the opportunity to support the OHA by bidding during a live auction.

Overall, it was an exciting, action-packed and educational show! Now, I want to hear from you. Were you able to attend the show? If so, what was your favorite part? If not, what would you like to learn more about?

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RDH Advisory Board Q&A

Sarah K. asks:

“As a student who just graduated and took WREB, I was interested to find that we are the only profession, besides dentists themselves, who have to use a patient for our clinical boards. I also saw this topic in the recent ADHA magazine, but I am curious to know what other hygienists think, whether this is ethical for a patient to have them be checked by a student, then ask them to wait for treatment, have them checked by examiners (we had a patient who was checked by five or more), finally receive treatment, and then have them checked again. We then have to consider if the needed radiographs are retaken or not.

I know it’s important that hygienists are well tested and that we know what we’re doing, but is it fair or ethical to the patient? And is it fair to us as a profession? Nurses only have to do so many clinical hours and then take a written. Why don’t we?”

Debbye Krueger, RDH, BS, MAADH, responds:

Your point about comparing our profession to nursing has not fallen on deaf ears here! Registered nurses are the most closely equivalent profession to registered dental hygienists, in my opinion, and yet we enjoy so few of the same recognitions. When Tammy Byrd, a Past President of the ADHA, won her case against the South Carolina dentists through the Federal Trade Commission, she compared the education and training of RNs to RDHs and proved that RDHs had more hours of both education and training. I honestly feel that our lack of professional recognition is an issue of a turf war. Nurses are nurses, regardless of which state you live in. Sadly, the only organized group advocating for all dental hygienists is the ADHA, and the membership percentages are embarrassingly low. In my state, it is less than 10%. Hard to push for change, including where you use live patients on boards, when the folks you are dealing with are only too happy to point out that you truly do not represent the majority of your profession (I have heard this personally from State Legislators).

While at the last ADHA Annual Session in Nashville, Tennessee, the Kellogg Foundation had a panel dealing with such issues (yet another reason to be an ACTIVE member of your professional organization). When asked how they managed to achieve mid-level provider status in selected states, the answer was that it came from consumer demand, rather than professional battles. While the role of Community Organizer has been vilified in this country, it is indeed the most successful model for change. Partnering with organizations such as AARP, and other large groups, is an idea pregnant with possibilities. I would personally like to see us partner with physicians and be allowed to work in medical offices as well as dental offices. It would be interesting to hear the dentists’ arguments that we are not well enough educated to supervise ourselves. Would they also argue that physicians were not well enough educated to supervise us? As Margaret Mead once said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

Cynthia A. Chillock, RDH, EF, AP, responds:

Well, this is a hot topic and important, ethical questions. To carry your comparison even further beyond nurses, do surgeons need to remove a gallbladder to become licensed? What about oral surgeons, do they extract a tooth unnecessarily or resect a mandible? There is so much to consider.

I am currently full-time faculty and a 2nd-year clinic coordinator for a dental hygiene program, and this question comes up in academia on a frequent basis. If a dental hygiene program must be accredited and the student shows proficiency in skills, do we really need a board at all? Requirements are created to develop students who will be able to pass the board. But if those same requirements are in place, do the students need yet another test to show proficiency? As for the patients, they are checked a minimum of six times by examiners. Three must check them in and three check them out. That does not count what the student is doing while performing the procedure. And, if it is questionable regarding whether or not the patient qualifies, they may be checked by yet another examiner. One of my jobs is to create a “mock board” experience for the students in the last semester that is as close to the board as possible. The students are not approved to take the WREB until they have passed a “mock board.” If that is the case, why do they need a board in addition to the experience in school? As for x-rays, they are either diagnostic or not. If not, the student fails. There are no retakes for the board. However, that does not mean that the student has not taken multiple x-rays to achieve the perfect set to pass the board.

Without a board to pass, we would need some kind of uniform criteria for requirements across the country. That is not an easy thing to do, since we cannot even get Board agencies from multiple states to agree and create a national, clinical board. Until we have better uniformity in program teachings, I do not see eliminating boards as something that will happen in the near future.

Here is my two cents worth. Our students already do a computerized process to care exam that shows proficiency in critical thinking and treatment determination, along with a computerized national board. And, they most likely have taken a local anesthesia board to become anesthesia certified. That means dental hygiene students have to take four expensive boards to practice, so that they can then be supervised by another profession. Very interesting to me! With some of the computerized simulation labs I have seen in the nursing programs, why can’t we create a simulation with a mouth that has the appropriate level of calculus for removal on an inanimate model? Do we really need a live patient? This might satisfy both those who think we need to perform the procedure for a board, and those that think it is unethical to expose a patient to what some consider “cruelty” or “torture.”

Tracey Thompson McGonagle, RDH, responds:

Your question raises many interesting points, for both sides of the argument, actually. I think a board patient should be made aware that the process of care is unusual, given the circumstances (of a board examination).

The larger debate is if recent graduating hygienists from an accredited school should be required to take the clinical board exam. The ADHA has proposed Resolution 64H to eliminate human subjects from licensure. Cathy Elliott has written an interesting article about this in the May-June 2011 Access. It is a challenge to calibrate the clinical board exam. It is nearly impossible to standardize this exam using live patients, and there are also problems with calibration among the examiners.

I feel the clinical board exam does have merit. As a dental hygiene instructor, I see the pressure from the school to graduate students. The “final” check is this exam. A student can be successful in the written areas but not be able to perform clinically. This exam is the only way to check this. New York is substituting the traditional clinical exam for dentists with a “post-grad” year after graduation, called the PGY-1. Minnesota is offering the PGY-1 as a choice for licensure, as well as the traditional exam.

I wish there was only one national clinical board allowing your license to be valid in all fifty states. This would make it easier for hygienists to move and find jobs in other areas of the country. It would minimize the number of clinical boards to be taken, thus requiring fewer “live” patients overall.

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