Dental Hygiene discussions ... independent practice

Discussion in 'Dental Archive' started by Joel M. Eichen, Oct 7, 2004.


    Cher, I don't think you are being quite as honest about what
    independent hygiene is or what an advanced training degree is. If you
    want to be a periodontist, go to dental school, then move on to
    graduate training. My interactions with every "periodontal therapist"
    to date has been negative and given me quite a different impression as
    to why they want to do what they do. I'll give you a sampling, and
    you may see a familiar quote or two. If you think you somehow have
    the training to make the decisions I make as a periodontist or a
    dentist does, I believe it is out of lack of knowledge of what it is
    we do...or maybe you've been unlucky enough to only work for idiots.

    1. There is one that writes for dental economics and proudly calls
    herself a periodontal therapist-which is like being a prominent
    discombulator since the term is completely fictitious by the way. If
    you want to put credentials in, they should be recognized ones. She
    said that although the periodontist is trained in surgical therapy,
    they don't have as good a grasp on non-surgical therapy as a hygienist
    does. I'm betting she doesn' t know Ramjford or Badersten, but that
    statement clearly demonstrates she has no idea of the training
    involved-or where the data on non-surgical therapy originates from.
    She's making a case where there isn't one by claiming all a
    periodontist knows is a scalpel. Sounds like a team player who knows
    when to refer. If you don't know much about surgical indications,
    knowing when it is warranted must be tough. There are some that get
    quite good with experience and training over time, but the statements
    made by this RDH are not grounded in anything but her own imagination.

    2. Independent hygiene is a concept I can't get. There is not
    sufficient training for a hygienist as to know what to do when. I
    can't find many that can tell me much about when and where GTR works
    best....without that knowledge, substandard care is the norm. If you
    don't know what is indicated when, how can you know when to do what
    AND keep up with the new trends when you don't know the old ones.
    Don't even get me started on what I've seen with the use of lasers.
    When I review the materials and methods behind LDD I mostly get blank
    stares. It is very significant. I think sometimes things look really
    easy to people who don't really recognize the intricacies involved.
    When I watch gymastics, I get when someone falls they lose
    points...but that's about it, and I have trouble knowing which
    movement is harder than the other to make.

    3. "Hygienists are the periodontist of the GP, we are the link
    between the GP and the periodontist. We have more experience in perio
    than any GP, so why would a GP be over seeing us? That doenst make
    any sense, you wouldnt want a contractor over seeing your dentistry.
    He lacks the knowledge to be a good judge of quality or proceedures.

    Im not agaisnt working WITH a doctor, but in some situations, it would
    appear that the hygienist would be better suited working independently
    (Especially if you read some of these forums!). The hygienist could
    preform the preventative side of oral health and then refer to the
    doctor for restorative work."

    Really, you think because you are taught in exhaustive fashion how to
    mechanically debride that you have a good knowledge based for when to
    do what restoratively as well as when it is beyond your scope? Sorry,
    if you want to be a dentist, get the degree. In addition, if you want
    to practice alone, feel free to take on all the liability that comes
    with it. A hygienist has more experience debriding teeth than a
    GP.....that's it. The rest of the things that are covered are a mile
    wide and an inch deep (try me, I used to teach).

    4. You made this statement: "If you think about it, we work in
    diffrent realms of oral health. The doctors work on the restorative
    end while the hygienist works on the preventative end. Shouldnt we be
    working together, like a good marriage, and compliment each other's
    profession instead of tearing each other down? Together we obtain
    complete oral health for our patients." But you also made this one,
    which I will put in bold for ya:

    My personal opinion....Is there really a shortage of DH, or a shortage
    of hygienists willing to work for some of the denstists? How about we
    get a profile of the "typical" dentist and compare it to the dentist
    who has a hygienist working for him/her for 12+ years?
    Personally, I left the field in Feburary because I felt like my ethics
    were being challenged. I would rather stay at home than lower my

    Why would I need to lower my standards?

    You go further to indicate you know more than a dentist about
    restorative as well:

    We attend CE and hear how we can make a diffrence in production and
    quality, then return to the office where the boss wants to keep things
    the same. We learn about cosmentic dentistry, but the boss places

    The reason certain groups of hygienists want independent hygiene is
    that they think that they somehow know more than the dentist about
    everything. Between your statements and the hygienist in Dental
    Economics, you're helping make that point. Post after post you
    declare how hard it is for someone to match your standards. At some
    point, is it them..or you? Before this you make the statement saying
    a dentist should not oversee your work as a hygienist (like a
    contractor overseeing their resotrative work), and yet you can somehow
    oversee the dentist's restorative judgement. I can't fathom how this
    does not set off the alarm bells associated with cognitive dissonance
    in your head. There are a few guys that have not opted to have
    hygienists in their you think you're better than they

    I've heard this comparison to an NNP, and since there isn't actually a
    need, I can't fathom the logic. The NNP evolved because in a hospital
    setting they were certainly as knowledgeable as the RESIDENTS passing
    through for one month on rotation, had experience, had a training
    program, and saved the hospitals money. It continues to press forward
    in medicine because of the sense of entitlement people have and the
    need for the doctor to see higher volumes of patients as their
    payments continue to dwindle thereby delegating some duties while
    technically still under the indirect supervision of a doctor-they DO
    fire is being shot over the bow of hygiene in that mechanical
    debridement is really not necessarily tough-we can train the prophy
    techs from the militart and give them a degree to fill the perceived
    void and at least the patients would still be under the care of a real

    5. Here's another nice zinger from you so everyone knows your

    "I want to treat my patients the way I would treat my own
    mother/brother/son/daughter (isnt that what we were all taught?) But
    am limited to what the boss wants.

    When we know too much to stay, we have no choice but to leave."

    This definitely illustrates what independent hygiene and your role as
    a hygienist is. You know more than a dentist and thus should in
    essence be the primary care provider. Somehow, with less training for
    what you will refer out for, you will make the right calls. I did an
    implant for cost for a friend of a hygienist while the hygienist that
    was practicing "independently" and unofficially missed decay for at
    least a year giving the tooth a poor prognosis due to extent of decay.
    She said to get a second opinion on crown lengthening. 2mm from the
    furcation with no tooth structure above the gumline...apparently the
    training on furcation management doesn't extend to it's implications
    in restorative dentistry.

    If you don't like working for someone else and want to establish what
    you think is the proper standard, feel free to do so. It will take 4
    years of dental school. If you want to be a periodontist, add 3 years
    to it. You do not have the grasp of GTR, implant therapy, furcation
    management, osseous surgery, restorative dentistry, etc. that I
    do...but I bet you can root plane a bit better. The amount of training
    that it will take to get you up to speed on that is more than you'll
    get in a few weekend courses or a year of extra school.

    Your posts have been nothing but antagonistic and self-congratulatory
    on your own ability with disdainment for all but one dentist you
    worked for (who as best I can gather, paid you handsomely). You don't
    demonstrate an ability to work with anyone. If you did refer out for
    something, based on your posts, you would somehow think you could
    dictate how it was done even though you've never done the procedure
    yourself (see comments in bold for reference). I think you need to
    take a good hard look at what you're saying and wonder if you're right
    or the world is wrong.

    I'm an easy guy to work for, I teach, I take input, but in the end,
    it's my butt not the hygienist and if business lags, one of us
    experiences a drop in income. I collaborate with my
    staff.....hygienists, assistants, front desk, etc. Given how you've
    boiled down dentistry, one solution for the "shortage" is to train
    people out of high school to do prophies. That's a waste of someone
    with your skill. In addition, we can reduce cost, increase
    access...everybody wins right? The doctor does the exam and simple
    cases go to the prophy tech. Is that any different than the stretch
    your making?

    I hope I'm wrong about you, but I can only base my assessment on what
    you've posted. I come off a bit more sharp tongued here than in
    person, perhaps you write with more of an air than you mean to. I
    believe there is a hygiene dedicated website that will
    demeanor there will be quite different. However, based on your posts,
    you decided to come here and urinate on dentists in general and call
    it rain (granted that some of it may have been caused by what some
    dentists here wrote..but your beliefs are there for all to see).
    Joel M. Eichen, Oct 7, 2004
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