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7.4.08 Issue #330 Forward This Newsletter To A Colleague

Angie Stone RDH, BS
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Is Your Hygiene Department Embracing the Shift?

As the days and years go by, new research in the medical field comes forth, resulting in new recommendations. Two recommendations that come to mind are those of cholesterol levels and blood pressure readings. Remember when it was ok to have cholesterol levels over 200? Now, over 200 is considered borderline high. No longer is the total cholesterol number looked at alone. The number is now broken out in HDL and LDL numbers. There has been a paradigm shift regarding cholesterol levels.

Remember when blood pressure readings were within normal limits as long as they were under 140/90? Now normal is less than 120/80. 120–139 systolic reading and 80–89 diastolic readings are considered pre-hypertension. This represents a paradigm shift in blood pressure recommendations as well.

The dental profession has not escaped paradigm shifts either. Consider the treatment of occlusal caries. Previously, caries on occlusal surfaces would be watched until an explorer could be plunged into the occlusal grooves and then the decay (and healthy enamel) would be amputated with a high-speed hand piece and the hole would be plugged with amalgam. Today dentistry and patients benefit from technology such as laser caries detection, which can detect cavities well before an explorer can detect decay, the preparation of the carious tooth with micro abrasion and the placement of resin restorations. This paradigm shift is being made across the country.

There have also been enormous shifts in periodontal paradigms. The soft tissue management paradigm shift occurred in 1985. At that time, there was a void in the general dentists' treatment of periodontal disease. No treatment was rendered for the population that needed more than a prophy but did not require surgery for advanced disease. The shift closed this void by providing soft tissue management to patients exhibiting early stage periodontal disease. No longer were 5–6mm pockets “watched” until they got deeper for referral to the periodontist for surgery. Scaling and root planing of these pockets began taking place in the general dental practice.

Today dental hygiene is undergoing another paradigm shift as a result of current research. No longer should hygienists overlook bleeding tissues. No longer should patients be encouraged every six months for years on end to “floss more” with no resolution of bleeding. Current research supports proactive treatment of 4mm bleeding pockets; however, seasoned hygienists across the country are struggling with this shift. This is happening because whatever hygienists learned in their formative years is what sticks in their minds. Most people find it impossible to let go of their old paradigms and mind-sets.

Bill Landers, president of Oratec, said, “Sadly, it takes usually a generation or more for paradigm shifts to be fully accepted and integrated, not so much because the new ideas replace old ones, but because the holders of the old ideas start dying off. There’s a gradual transition as the new generation grows up with the knowledge of both old and new paradigms and can choose one or the other without having to abandon the old for the new. Some psychologists think we are genetically programmed against radical change. Most organisms thrive in a homeostatic environment where everything is the same all the time.”

That said, how can hygienists make the shift from beginning periodontal conditions at 5mm bleeding pockets to beginning it at 4mm? Change begins in the mind of hygienists. So, first and foremost, they need to be re-educated in interceptive periodontal theories. New textbooks need to be reviewed; current periodicals need to be read; up-to-date continuing education courses need to be attended. McKenzie Management’s Hygiene Enrichment Program provides this kind of education. With the awareness of new research, it is easier for the mind to let go of old ways of thinking. Once hygienists are confident that what they are proposing to patients is in their best interest, they will be successful in re-educating them.

Discussing periodontal disease with patients of record is always the most difficult for the hygienist. The question is always, "How do I tell Mrs. Jones that she has this gum disease when I've been treating her for years?" This is where scripts come in to play. Most often times saying something as simple as, “The research shows…,” or, “We now know about the connection between periodontal disease and heart disease <diabetes, etc.>. As a result of this new knowledge, we now treat this disease differently.” This conversation can be supported by giving the patient a newsletter developed by the doctor and/or hygiene department, pamphlets, articles, etc. that support what the hygienist has discussed. Patients are hard-pressed to decline recommendations when they are given researched-based information. Just as the hygienist needs to be educated about new research and treatment recommendations, so do the patients.

Dental hygienists need to decide that it’s time to push the current paradigm shift to ensure continued improvement in the oral and general health of the patients they serve.

Interested in knowing more about how to improve your hygiene department?

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