My intention is to simply explain the importance of why you lovely patients must floss your teeth.  After seven years of clinical experience and seeing the outcome of a non-flossing lifestyle, my hope is that those reading this highly important dental topic will gain the vital understanding of flossing and how gum disease will affect your life.

Let’s start by me asking for your full attention by you getting your crusty, Starbucks-stained teeth out of your $8.00 latte you really can’t afford but feel the urge to economically consume every, single morning before you go to your soon-to-be outsourced job that just increased your dental insurance premium for a minute because here’s what I have to tell you.

Are you ready?  Good.

If you don’t floss your gums will become a festering, disease-ridden, smorgasbord of unrelenting bacteria that will ultimately make your gingivae bleed in buckets every, single day of your life.  If you don’t floss your gums you will spend thousands (I’m not kidding) of dollars to simply control the incurable disease (and it is a disease) that you have let build up over years and years of utter neglect.

Exudate will ooze out from underneath your gums and after questioning by the clinical professional (How YOU doin’?) the finding(s) will be defined as ‘asymptomatic’.  That is, you will feel no pain.  What you will feel is the false sense of dental health with the perpetual lie you keep telling yourself when you think, “It doesn’t hurt,” while the blood-filled pus continues to bubble and percolate underneath your gums.

Allow me to continue.

Your social life will remain that of the lonely-lived bachelor/bachelorette whose breath completely, I mean, completely reeks so intensely, you will have no realistic chance of any dating prospects.  You will continue to waste money on the premium whitening kits at your local store to give off the illusion of a healthy mouth in the hopes of attracting a mate.  Your highly offensive, (Not  joking. It’s awful.) metallic-smelling breath from your lack of flossing is so oppressive no one will want to kiss you nor come within five feet of you.  (Yes.  The odor is that strong.)  And we can still smell it through the masks we wear.  Sorry.

Once your teeth become mobile, or loose, from the lack of flossing and the prolific bacteria eating away at your bone that supports your teeth, then, and only then, will you notice and mention the finding to your dentist and/or dental hygienist. (Hey, that’s me!)  You will hear the word ‘unsalvageable’.  You may even hear the word ‘hopeless’.  That means your loose tooth/teeth will have to be pulled out from your rotting mouth because you were lazy and didn’t floss.

You’ve just lost your tooth… which could have been prevented if you only had used that little piece of string.

Sleep tight.

So I just realized the other day that, I am, in fact, the gum whisperer.

Is it because I’m the world’s utmost authority on periodontal disease? Do I have such a kingdom of knowledge that it only makes sense to become an intellectual philanthropist to my patients and can cure them of every infirmity that sits just inside their lip line? Do my mad hand skills mean that I can strip only the glue off of a postage stamp with a Gracey 13/14 while it’s still stuck to an envelope behind my back as PROOF of my superior subgingival scaling abilities?

No.

I am the gum whisperer because… I actually whisper to people’s gums.

“Hang in there, interproximal gingiva! Give that #5 an extra squeeze for me today because that class II mobility is making my probe shake.”

When you’ve given up trying to convince the lifelong smoker that nicotine is his enemy, sometimes it’s just time to try a new approach. Maybe the person attached to those gums will think you’ve gone a little cray-cray, or maybe, just maybe, they might realize that you’ve started digging into your bag of desperation because they just don’t want to hear what you have to say. They’d like to give you their problem instead of dealing with it themselves.

Years ago, I took care of a patient that was into visualization, in a new-agey kind of way. She asked me to paint pictures and describe what healing needed to take place in her gums, so that she could create a pathway for sending her healing energy into the periodontium. I dunno, it was kind of soothing for me, too.

So occasionally I’ll speak softly to a patient as I’m nudging their gums, kind of like scratching a dog’s belly, “You like that, yes you do, yes you do!” Well, not that silly — definitely more clinical-minded because really, I don’t want people to start asking me to read their auras or anything like that.

Please let me know if you’ve found yourself talking to teeth, tongues, whatever body parts have engaged your healing linguistics, so that I don’t feel so all alone in this situation. And if I really am crazy, then it’s probably best not to let me in on the truth.

_______________________ 

 
by Trish Walraven

I live in Texas, and work in a box.

Well, not really. But at the same time, really! This box, like most boxes, has four walls. There’s a ceiling and a floor, too, but those aren’t what drive this story. It’s all about the walls. When I look at the walls, instead of trying to climb one (or get driven up one!) my inner designer starts its analysis. What decorations help to make this box more enjoyable?

Most importantly, there’s a patient in the centre of my box.

So there’s a sky blue wall behind me as I’m facing the patient. This is the dental hygienist scope of practice in the state of Texas. You’ll notice the sleek steel shelf hung firmly on that wall that lets me provide all hygiene services – even when the doctor is away. On that shelf are my preventive allowances: pit and fissure sealants, fluoride treatments, periodontal therapy, temporary fillings, restoration polishing, and even a flashing snowglobe of laser-assisted bacterial decontamination. This wall is also marked by an ugly patched-up area. If you pulled off the patch, you’d find a pretty big hole, left by a restriction that the Texas laws place on the administration of local anaesthesia by hygienists. Texas is in that 10% of the US where a handful of Board dentists hold the rest of their profession hostage with this issue. It seems to deflect attention from those other efforts that will give hygienists better governance over their work lives but, for now, it is difficult to get the laws changed in favour of hygienists. The patch is cool, though. It’s made up of an intense pharmacy-compounded topical gel that I use on my patient when she needs scaling and root planing. It’s not perfect, but it does keep the dentist from having to stop what he’s doing to anaesthetise her, and she loves that there is no post-injection pain and lingering numbness afterwards.

Which brings me to the second wall: a green-means-go fluorescent mural featuring a hot pink clock. It flashes the amount of time I have with my patient: 30 minutes! And that’s if she’s on periodontal maintenance or has staining. If she’s healthy or a child the clock starts ticking at 20. Everything mounted to this wall is geared towards squeezing the most out of every moment. Ultrasonic tips? The thinnest, curviest ones available, and enjoyed even by my youngest patient because they knock off every bit of calculus and plaque at a range of comfortable settings. Baking soda jet polisher? Much faster than the rotary polishing cup and paste. Oral hygiene advice? Suggested as I’m performing the initial examination and demonstrated later with a hand-held mirror and floss. Assistants instantly appear to chart and record probing depths with the click of a mouse, loupes and a headlamp keep me from having to reach up and change the overhead light position. I am a master of efficiency.

The third wall is a more subtle shade of green. It’s the one with all the niches and windows, with family photos and favourite mementos left by patients. I love this wall the most because it lets me see the world outside. One of the windows faces the reception room. The room is empty – not because we don’t have patients, but because none of my patients ever have to wait there, thanks to a well-coordinated  team using custom-designed communication with audible BlueNotes that chime as soon as a treatment room is open, or when a patient arrives, or when the dentist needs supplies because of an unanticipated event. This kind of empty reception room can be found in all corners of the world. Many practices are now implementing this idea – a spark that came out of my brain and then became a computer programme. I am proud of helping to shape the world outside my box.

The final wall is painted metallic gold, with the words ‘Preferred Provider’ stencilled in black all along the baseboards. From this wall emerges a door into a second operatory where a dedicated hygiene assistant is waiting with my next patient. I’ll see him and then move back in here once my services are complete. I’ll also use my diagnostic skills to let the patient know the doctor will be recommending a crown on one tooth, a bridge in the opposite quadrant. Focusing on treatment plan acceptance and dollars on the doctor’s bottom line is how I make up for the 30% or more discount patients receive in this middle tier of managed care here in the US. And it’s how I earn all those glittery stars on the wall: my home, a car, vacation time, designer handbags.

I like my box just fine. But if I had my own way, the walls would be different. Maybe they would all be windows.

You can also view this article in its original PDF from the paper magazine.  Also, many, many thanks to Eva Watson and DH&T’s editor Julie Bissett for the opportunity and for getting this published!

So you watch this clip, then you wonder, how many hygienists in job-saturated markets don’t even have the luxury of being able to wrestle with these sorts of ethical dilemmas? They’re just happy to have an income. And if you don’t want to work faster than you should, there’s the door, honey. We’ve got five more hygienists waiting for your position when you leave.

If you must ever make a decision to follow your halo out of a practice like that, remember, there are also dentists who would rather have ethical hygienists than ones who will do whatever they’re told to do regardless of whether or not it’s best for patients.

Just please, promise yourself, you will never, NEVER, consider taking a personal day to go watch a movie, especially NOT the upcoming Twilight one, like DEZiree is pretending to skip out for. Eyes will roll as your credibility sinks beyond all hope.

And a shirtless Robert Pattinson is just one of those things you can’t unsee.

I also remember wanting to hurl myself into the bathroom. The speech I had to give moments before gave me nervous diarrhea really bad.

We have our clinical side. Then we have our human side. The clinical side is a given: do what we were trained to do. My human side? A bit more personal. I tend to muse about extra-special people that I would give anything to have in my chair. Anything. Just once. And it’s because of their gender, race, SES, political ideology, etc., that I must perform my titillating hygiene duties on them.

We all have our idiosyncrasies. My OCD compels me to share mine. Hee-heeee!

Dream Patient of the Week: Steven Colbert

Mr. Colbert, if there’s any chance you accidentally enter this site while surfing the internets for plaque-disrupting inspiration, I would like you to know that I love you. Every American-y, flag-waving inch of you. I adore you. Are you tall? I like tall. You appear taller than John Stewart. I also like suits. You wear a lot of suits. I like that. And I’m not crazy. My husband tolerates me just fine. He’s just playing Skyrim again.

I love your smile. I love the way you single me out and point that finger at me when you’re in my television. I love your ties, your glasses, and your opening-credit eagle that swoops into my face and shrieks hello. That eagle looks like it’s gonna fly right into me. Here it comes–  wheeeee!  I like that eagle.

I will also state the obvious: I love your teeth.

Let me see those patriotic beauties- oh! There they are. I don’t care how much calculus is on them. I love every one of your teeth equally. If you had the blackest, most tenacious chunks of bad boy tartar stuck to every inch of enamel in your mouth, I would still love you. That’s not strange, Mr. Colbert. That’s dedication. All I ask is for the chance to have you lay waaaay back on my USA-made operatory dental chair while I give you such a stone-cold, subgingival scaling it will flip your cyclopean Super PAC, baby.

And, after I gently marinate your inflamed gums with a superfreaky course of chlorhexidine gluconate, I would like to hold your hands and teach you how to floss… properly. That’s right.

In closing, I would appreciate an opportunity to express my respect and admiration of your brain… because it’s silly. You have a silly brain.

Bored with Dental Hygiene?

Enter an exciting, new career as an International Companion!

Hello and welcome!  My name is Sophia Arrapato and I am the founder and CEO of ‘Italiano Scortares’, a Trans global company dedicated to servicing the needs of our exclusive clientele.

As a previous dental hygienist, I have treated many patients for over twenty years.  After my 18^th year of removing plaque and calculus, I eagerly wanted to pursue a new career as an entrepreneur, specializing in carnal pleasure. It only took less than twenty-four hours to say to myself, “Ho, scoperto!  Sesso!”

It took intense market research and interviewing countless women, but I officially opened my doors in 2010 and business has been booming!

You will be known as an International Companion for Italiano Scortares, and as such will have the best plastic surgeons at your disposal, an endless array of erotic dancing apparel, and, after completing six weeks of intense training, you will be awarded with your very own Little Black Book. As the CEO of Italiano Scortares, I will screen all prospective clients prior to assignment; I insist on the enduring scruples and respectability I have incorporated into my empire.

As a new employee, you will have the honor of training under Nicole Minetti, an Italian dental hygienist, esteemed lap-dancer, and long-time political advisor to Italian Prime Minister Silvio Berlusconi. Her experience is vast and hilariously adulterated, so I ask you pay close attention to Ms. Minetti’s teachings and advice. She will guide you through your career and enhance your presence and clientele list here with Italiano Scortares.

I thank you for visiting our website and hope to meet with you soon. Make sure to floss daily!

Questo è amore!

Click on the images and links above to see why dentistry was dragged into this whole sordid saga.

Yesterday brought the unveiling of The DEZIree Show, a “just between us” video blog for dental hygienists. Will she be engaging, relevant, and positively bloom in her fun weekly rants so that her viewers want to share her messages and spirit? Or will this be a failed publicity experiment that a corporation is trying in order to find their place in the social media order?

Currently it could go either way. But you should totally root for DEZIree because she seems worth five minutes of your time per week.

Just so we have this straight: lasers are okay, but needles? Not so much. Texas is a bit behind the times regarding local anesthesia. But the great news is that their state board just recently issued a statement that affirms the legality of laser use by formally trained hygienists for treating periodontal disease that is not responding to traditional therapy.  Here it is in the Board’s own words:

Texas State Board of Dental Examiners’ Position Statement on the Use of Lasers by Dental Hygienists

The Texas State Board of Dental Examiners is aware that lasers can be used to replace or supplement traditional dental instruments such as handpieces, scalpels, curing lights, and the explorer.

It is the position of the Board that licensed dental hygienists may use lasers that are not capable of cutting or removing hard tissue, soft tissue, or tooth structure to perform clinical tasks that are otherwise within the hygienist’s scope of practice. Dental hygienists must perform intraoral procedures involving a laser under the general supervision of a licensed dentist.**

Whenever a new treatment modality is brought forward, it is the Board’s policy that the licensee must have proficiency and training in the use of the technology for the procedure performed. Licensees utilizing new technology must maintain documentation of the satisfactory completion of formal continuing education or training using the technology for the procedures performed. The particular technology utilized performing any particular clinical task does not alter the requirement that a dentist is ultimately responsible for any procedure delegated to an auxiliary and the auxiliary performing the procedure remains responsible for performing the task within the standard of care.

** “General supervision” means that the dentist employs or is in charge of the dental hygienist and is responsible for supervising the services performed by the dental hygienist. The dentist may or may not be present on the premises when the dental hygienist performs the procedures.