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Dental Hygienists’ role as Educator in Stem Cell Research
By James Andrews
Saving a tooth could help protect your patients’ health
Stem cells are found in baby teeth that are naturally coming out and other healthy teeth being extracted, such as wisdom teeth. Dental stem cells have the potential to be used in both dental and medical applications, and have already been shown to regenerate mandibular bone and used to treat periodontal disease in human research studies. These new stem cell therapies are known as “regenerative medicine.” Research published in 2011 showed that dental stem cells can produce insulin, 1 suggesting they could eventually play a role in treating type 1 diabetes. Similar to cord blood stem cells (which have been used to treat leukemia and blood-related cancers), dental stem cells are also being studied by researchers for treating conditions such as spinal cord injury, stroke, heart attack and neurological diseases like Parkinson’s and Alzheimer’s.
1.Refer to http://www.ncbi.nlm.nih.gov/pubmed/21335539 or http://www.store-a-tooth.com/applications/diabetes.php.
Case Selection: Which teeth can be saved?
Any tooth with healthy dental pulp and an active blood supply is a viable candidate for stem cell preservation: exfoliating baby teeth, teeth pulled for braces, extracted wisdom teeth.
How “wiggly” can a baby tooth be?
For baby teeth, the optimal case is where the root has not fully resorbed, e.g. where the tooth has not exfoliated past the gum line. However, as long as there is some healthy dental pulp, it’s possible to harvest the stem cells. If there is only a small amount of pulp left, we generally recommend the parents choose a cell culture service. (This is where the cells are grown briefly in culture in order to expand the number of stem cells that will be cryopreserved.)
Which is better: exfoliating deciduous teeth or permanent adult teeth?
Both. Research shows that the younger the tooth, the more proliferative the stem cells, so that points to saving baby teeth. However, wisdom teeth generally have more dental pulp, so may provide a larger quantity of stem cells that can be preserved.
Which is better: incisors, bicuspids or molars?
All can be successfully stored. There is reason to believe that exfoliating incisors or bicuspids may yield a greater amount of dental pulp. It’s often helpful to review the child’s X-rays in order to choose the best candidate for tooth collection.
How to talk about dental stem cell banking with your patients
Do you have a child who’s losing a tooth soon?
Has your child in high school or college had their wisdom teeth extracted yet?
Did you bank or consider banking your child’s cord blood?
Dental stem cell banking offers another chance to save your family’s stem cells. Banking dental stem cells with a service like Store-A-ToothTM enables families to collect and save the stem cells from their own teeth.
If you did bank your child’s cord blood, you can think of dental stem cells as complementary to cord blood stem cells (and vice versa!). Dental stem cells are more suited for solid tissue applications than those from cord blood, while cord blood contains hematopoietic stem cells and can be used for a bone marrow transplant, which dental stem cells cannot do.
Does the child have a known health condition or family risk factor?
If you know someone who has diabetes, you may be interested in hearing this. Recent research showed that stem cells from teeth can produce islet-like cells which produce insulin in a glucose-responsive manner. This is still early research, but suggests that dental stem cells may play a role in a future treatment for diabetes.
Conclusion:
Like OBGYNs before them with cord blood, it is the role of the dental hygienist to inform and educate their patients so that they can make an educated decision about storing their adult stem cells.
You can contact James for more information at www.Store-A-Tooth.com
No longer are Dental Hygienists employees only; they are employers and entrepreneurs.
It’s been many years since graduating from the University of Toronto, Dental Hygiene programme. As a matter of fact it’s exactly 40 years this month. I just received information on our upcoming reunion. As I reflect on the first few months, I recall the capping ceremony, yes that’s right we wore nurses caps with a mauve velvet stripe. The previous year’s students then lit our candles to signify a passing on of sorts. Can’t quite remember what was being passed on but I’ll attribute the memory lapse to forty years of life’s experiences.
After graduation I entered public health to educate primary school children on oral health and to conduct very cursory intraoral examinations on a selected segment of the school population. Examination instruments were soaked in a disinfecting solution for roughly thirty minutes before being used for the next group of children. I did not wear gloves, a mask, and safety glasses or, wash and use hand sanitizers between children. Throughout those early years a little voice in my head questioned what long-term health effects would befall me in later years. Aside from the direct contact with oral fluids, disinfecting solutions and breathing in aerosols I was exposed to a plethora of other chemical contaminants and biological hazards. This continued as I transitioned into private practice.
Enter once again that little voice suggesting that my health and safety were at risk.
Practising Dental Hygiene was a privilege and a passion. For over half my career I specialized in paediatric and orthodontic disciplines. When it was time to hang up my scalers I was far from ready to “retire”. Instead there was an opportunity to found a company specializing in workplace health and safety. One of my sincerest desires was to address issues that affect Dental Hygiene practitioners.
Dental Hygiene has come a long way since I graduated. No longer are hygienists employees only; they are employers and entrepreneurs. Along with these new roles come responsibilities under federal and provincial health and safety laws. Historically dentists have done everything possible for the safety of their clients but, as employers, not nearly enough to keep their employees safe and healthy. Interestingly, the following quote, although from an American source, identifies the lack of emphasis on health and safety for the health care worker.
May 18, 2011
“Health care is the second-fastest-growing sector of the U.S. economy, employing over 12 million workers. Women represent nearly 80% of the health care work force. Health care workers face a wide range of hazards on the job, including needle stick injuries, back injuries, latex allergy, violence, and stress. Although it is possible to prevent or reduce health care worker exposure to these hazards, health care workers actually are experiencing increasing numbers of occupational injuries and illnesses. Rates of occupational injury to healthcare workers have risen over the past decade.” Centers for Disease Control and Prevention
It is my personal quest to raise health and safety awareness for the Dental Hygiene profession. I look forward to contributing future Blogs and resources. You are welcome to email me with comments, suggestions or questions.
Carola Hicks graduated from Dental Hygiene, University of Toronto and is founder and CEO of Workplace Safety Group, experts in workplace health & safety – HTTP://WWW.WORKPLACESAFETYGROUP.COM
Is it possible for your Dental Hygiene practice to survive a recession?
By Cindy Isaak-Ploegman RDH
When I first graduated in 1989 it was easy to find employment as a dental hygiene clinician. At all three dental offices I had an interview; the only question I was asked was, “When are you able to start?” Three years later I was laid off due to a reduction in the client base. Due to the economic recession at the time, dental insurance companies were reducing their coverage of regular dental hygiene appointments from every six months to every nine months. Now it seems we face similar fiscal concerns again.
Do you every wonder if you are going to survive this recession? There is a constant pull between loyalty to professional values and economic pressures. As repugnant as daily production goals are, if a certain amount of revenue is not generated, renumeration for dental hygiene staff and practice sustainability is not possible. But how much revenue is enough exactly? Do we need to have an upper cap at all? How are we able to serve someone who we are trying to squeeze more income from based on our interests and not their own?
The idea of treating clients as sources of consumer dollars, who we need to compete for with the dental office down the hall, definitely suggests a business model of client care and not a professional or client based model (Ozar, 1985). If we find that our focus on production places clients’ values or our professional or personal values in jeopardy, our upcoming webinar May 16, 2012 with presenter Laura Kessler on “Finding your voice in Dental Hygiene practice” will cover tips on how to succeed in your professional practice and remain in alignment with your personal integrity.
Sometimes a recession is a good thing as it causes us to re-examine why we do what we do, for whom we do it, and how we approach our role as professionals.
Client education has been highlighted as the key ingredient to ensure our clients are aware of the importance of what dental hygienists role is in maintaining their oral health and the link to their overall health (Christensen, 2011). There are huge opportunities to promote wellness in our dental hygiene practice given the recent research on systemic conditions and oral health as well as the importance for preschool age children to maintain good oral hygiene.
However, this does not imply that we should threaten clients by telling them that they will have a heart attack if they refuse to attend their regular periodontal maintenance appointment, or we then risk being accused of breeching veracity (Wentworth, 2011). The truth is that not every client is diabetic or at risk of a stroke, endocarditis, or having a low weight pre-term baby.
If clients know the value of a health service, they will not hesitate to seek treatment regardless of financial limitations (Christensen, 2011). This is true of treatment deemed unavoidable, but possibly expensive, such as the removal of suspicious lesions.
The challenge is managing our client load with care. Some practical suggestions include replacing diminutive terms such as ‘cleanings’ with periodontal maintenance appointments, preventive care appointments, or oral cancer examinations when referring to dental hygiene appointments (Elster, 2009; Levin, 2009). Also included are suggestions for replacing the term ‘confirming appointments’ with reminding clients of upcoming appointments (Levin, 2009).
As a research assistant for a dental implant study, I was faced with a challenge of having research participants attend sample collection appointments over the span of a year at preset times, with only a ten-day window for change and my own limited availability. I realized I had to connect with each of these clients in a personal way or they would not be motivated to be compliant with the series of appointments, especially after their crowns were placed.
I also found that discovering their preferred mode of communication was necessary. Turns out that some don’t use email, some don’t have answering machines, and some never answer or return my phone calls, but they have all attended their appointments. Scheduling the follow up appointment at the last appointment is key and following up that arrangement soon after it is made is a good idea.
Educating clients, connecting with our clients personally, and not denigrating our value to the dental health care team are all consistent with client-centered professionalism.
I would love to hear your comments about this timely concern and of your strategies or challenges.
**Please note our webinars are also available in the archived version so if Wednesday evening does not suit your schedule you are able to access Laura’s webinar presentation and question and answer period at your convenience by logging into our website.
References:
Christensen, G. J. (2011). Helping patients understand and accept the best treatment plans. Journal of the American Dental Association, 142(8), 197-200.
Elster, M. (2009). Recession proof your practice through patient retention in hygiene. Hawaii Dental Journal, 40(6), 15.
Levin, R. P. (2009). Making the most of hygiene appointments. Journal of the American Dental Association, 140, 1305-1306.
Ozar, D. T. (1985). Three models of professionalism and professional obligation in dentistry. Journal of the American Dental Association, 110(2), 173-177.
Wentworth, R. B. (2011). What are the ethical issues I need to consider when developing marketing strategies for my practice? Journal of the American Dental Association, 142(8), 966-967.
Slander mixed with power: A tasty but nasty cocktail
By Cindy Isaak-Ploegman
Slander is defined as making a statement about another person with the intent to implicate them in a criminal activity, ruin their professional reputation, imply they have a terrible disease, or cast doubt on their chastity (Jerrold, 2001). Slander may cost individuals their client base, employment opportunities, promotion, and a good name.
In my opinion slander when mixed with power, is one of the most repugnant unprofessional behaviors. Foucault maintained that power is not an entity, but occurs only in relationship and cannot be exercised without the production of truth or knowledge (Foucault, 1980). This is why students are vulnerable to the power exerted by their educators (Nicholas, 1999), and clients are vulnerable to power by those who provide them with dental hygiene care and health education.
Educators need to be mindful to avoid creating or allowing a culture infused with slander between professionals or between students and instructors. Practitioners need to be careful not to speak disparagingly of those they serve: their clients.
We seem to be almost gleeful in our quest to know details of other’s dirt and are so hooked on casting light on evil doing, but we seldom question the veracity of the information. Freedom of speech does not include a departure from professional conversation or the truth.
Even the grave offers no insurance from slander (Taff, 1988). When Whitney Houston passed away, we felt we were owed all the gory details not considering the implications to her family and friends of the speculations that were made.
The legal implications of slander involve a defendant needing to prove that the statements were not meant to be slanderous, but were expressions of fact or merely a difference of opinion, and the plaintiff is not required to prove harm was done (Jerrold, 2001). Even though a slanderer may not be found liable in a court of law, they may be found guilty of professional misconduct by their governing body, so statements of superiority, negativity, and commenting inappropriately about a colleague should always be avoided (Jerrold, 2001). Although escaping paying punitive action in the courts, a governing body still has the power to remove a professional’s license.
Other implications may include a professional’s liability insurance that only covers the professional if the context in which the slander occurred included a professional service, and may not cover a professional choosing to speak disparagingly of a fellow colleague outside the context of client care (O’Hern, 1968).
The implications for the workplace are obvious, as power exists between those being bullied and those being employed. It has even gone full circle with employers now hesitant to provide an honest assessment of former employees in a reference due to the risk of being accused of slander (McConnell, 2000).
The antidote to slander is communication between colleagues and between professionals and clients to diminish potential misunderstandings. Clarification goes a long way to explain what we may assume is unethical (Broad, 1982) or suspect behavior or character.
And finally, what goes around comes around. Our slanderous comments may not definitively land us in a legal battle or cost us our licenses, but we know for sure we do not want to be on the receiving end of slander. If we are honest most of us have participated in slander: its gossip after five minutes. If you have been the victim of slander, you know it only leaves a nasty taste in your mouth. I look forward to hearing of your experiences and views on this topic.
References
Broad, W. J. (1982). NIH grapples with misconduct. Science (New York, N.Y.), 217(4556), 227.
Canadian Dental Hygienists Association. (2002). Code of ethics. Retrieved from http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf
Crow, S. M., Hartman, S. J., Nolan, T. E., & Zembo, M. (2003). A prescription for the rogue doctor: Part I–begin with diagnosis. Clinical Orthopaedics and Related Research, (411)(411), 334-339. doi:10.1097/01.blo.0000068762.86536.c6
Foucault, M. (1980). Two Lectures. In C. Gordon (Ed.), Power/Knowledge: Selected Interviews and Other Writings 1972-1977 (pp. 78-108). Kate Soper, trans. New York, NY: Pantheon Books.
Jerrold, L. (2001). Sticks and stones. American Journal of Orthodontics and Dentofacial
Orthopedics, 119, 455-6.
McConnell, C. R. (2000). Employment references: Walking scared between the minefield of defamation and the specter of negligent hiring. The Health Care Manager, 19(2), 78-90.
Nicholas, B. (1999). Power and the teaching of medical ethics. Journal of Medical Ethics, 25(6), 507-513.
O’Hern, V. M. (1968). Liability insurance for slander and libel. JAMA:The Journal of the American Medical Association, 206(13), 2985-2986.
Taff, M. L. (1988). Libel and slander protection for the dead. another problem for medical examiners. The American Journal of Forensic Medicine and Pathology, 9(1), 1-4.
C4. Explore complex issues from many points of view recognizing biases and assumptions.
C4. Explore complex issues from many points of view recognizing biases and assumptions.
Example: Analyze local newspaper articles related to fluoridation of a new community to determine the arguments being made against fluoridation. Review existing literature to determine the credibility of evidence to support or refute community water fluoridation. Examine dental hygiene regulatory issues from the perspective of the dental hygiene profession, other health professionals and the public.
By Sharon Boyd, RDH
Controversial issues are nothing new to dentistry. Whether it’s amalgam fillings or water fluoridation, opponents have created a widespread support against their use backed by evidence and research that usually do not allow any room for the support of the topic at hand. Riding the fence so to say is usually impossible because publications are either on one side or the other.
Because we will have patients and professionals alike that are on both sides of these type of arguments, we should be able to open mindedly read and explore the research at hand in order for us to offer unbiased information and advice.
When preparing to discuss topics like water fluoridation with our patients (especially those inclined to more holistic and natural therapies) we need to have a thorough knowledge of the evidence at hand. If we continually ignore the arguments put forward by groups like those who are against fluoridation, we will not be able to address their concerns.
I remember several years ago there was a news special on the water being used in the dental offices and how people could become infected with these horrible microorganisms that lived in the water lines. It was weeks before a day went by where none of the patients brought it up.
It will be the same for you if your local newspaper publishes a report on the horrors of water fluoridation. Remember that publications many times aim for the sensationalism of it all (especially if it’s on television) to catch more readers or viewers. By playing up fears and concerns from the most extreme of circumstances, almost anything can be painted in a negative light.
While it would not be wise to ignore these claims, it is important for us to dig further into the research so that we know all of the facts. Offering counter-arguments or information to show the entire story can help patients and the public to make their own educated decisions. A good source for research literature is PubMed online. Statistics and research can be used in comparison to show both sides of an issue.
One study doesn’t necessarily prove a point, but consistent findings recorded in a scientific manner can help explain the general overall conditions surrounding complex issues that have a wide variety of viewpoints. As healthcare practitioners our job is to present information to our patients and allow them to choose the method of treatment that they deem is most suitable and appropriate from what we are able to offer them. We can never make other people believe certain things or choose some things over others, but by understanding the information on all sides of the topic we can be at a better position to address our patient’s needs and personal beliefs.
In 2008 a process began to establish a new base upon which to build entry to practice standards for dental hygienists. Much collaboration and deliberation has occurred over these many years with many dental hygiene stakeholders. The result is that the Entry to Practice Competencies and Standards for Canadian Dental Hygienists has been accepted by the Federation of Dental Hygiene Regulatory Authorities (FDHRA) who have instructed both the Commission on Dental Accreditation of Canada and the National Dental Hygiene Certification Board to revise their requirements to meet these standards. In recognition of the new standards this series of blog posts addresses issues drawn from the standards.
If you have an interest in contributing a blog post to this series please contact us.
Ergonomics and the use of Loupes
By Scott Gibson
Studies of ergonomics in the field of dental hygiene reveal that due to repetitive movements and constant body contortion to accommodate clients, dental hygienists benefit the most from wearing loupes. The benefit is by helping them to take control of their posture. Evaluating if the magnification is right for you begins with identifying your needs.
Questions to
ask include: Do you wear contacts or do you need prescription glasses? Are you susceptible to headaches from wearing safety glasses? What types of safety glasses cause irritation? Does having an adjustable nose pad eliminate your headaches? Or are you sensitive to the tightness of your temple arms? Are your arms longer in proportionate to your body length? How much can you adjust your clients’ chair after you have set your posture? Balance of loupe weight is most important even if specifications make it a heavier product.
The reason you do not focus on magnification to evaluate loupes is because there is no universal standard for magnification. Most companies have their own metric system. What is important to know is that all loupes are within 15% of their stated magnification power. A better way to differentiate loupes is based on their clear Resolution, and width and depth of field.
Why clear resolution? Because dental hygiene practice involves making observations in millimeters having a loupe without high resolution is useless. An example is imagine you are watching your favorite cable show on an old analogue television, big picture (like big magnification), but poor resolution and compare this with a new HD television flat screen. The flat screen is wider and has more resolution.
Why do you need a really wide field of view? A wider field of view, the smoother of a transition to bring your instrument from unmagnified view to a 2.5 times magnified image.
Lastly, why do you need a long field of depth? The loupe has corrected your posture, but if you do not have the ability to see past the anterior, to the posteriors you are losing your macro view of your patients mouth and you will need to still move in closer for you to achieve the clear view. The longer field of depth means you have the ability to sit up right with correct posture and see both anterior and posterior.
Two different dental hygienists could be shown the same loupe and because they have different faces, nose, and comfort levels they will have different perceptions. That is why it is so important to try the loupe on as higher quality loupes have the adjustment function to balance the weight proportionately on different faces. Someone might say one loupe feels lighter than another even though, per specifications, it is a heavier loupe. Most importantly, whatever loupe solution you choose, you must ensure it will have the ability to maximize your effort five days a week, eight hours a day and for the next five to ten years.
I would love to hear about your experiences with using loupes in clinical practice or address any further questions you may have.
Scott Gibson, loupes specialist
Goals or Results
By Dr. Susan Ziebarth
Ah, mid-February and the ground is covered with snow (or at least it supposed to be) and you are sitting by the fireplace trying to remember just what were those New Year’s resolutions I made in January. For some remembering is not a problem because they set the same goals/resolutions every year. For others, the goals/resolutions are easily forgotten because by January 2nd you have already done something that goes against the goal and you might feel, “well maybe next year”.
Goals are a major part of most professionals’ lives. So why is it that some goals can be met and some just do not seem to ever be attainable? Could it be we are missing the mark on goals by setting goals that are not fully under our control to reach?
For the sake of discussion, let’s list a few hypothetical goals:
- Have my client Natasha start flossing.
- Participate in one continuing education program a month from September to June.
- Lose 15 pounds.
- Have my house as clutter free as my operatory.
Would you say these are potentially all good goals? The voices in my head that represent you my dear reader are saying “yes – those might not be my goals but they are reasonable”. Those same voices in my head would be wrong because three of those four stated goals are results not goals. Some of you may now be thinking I should get those voices in my head checked into.
For us to set goals, we form the idea in our mind from a mixture of intellectual desires and felt emotions. We then take action and get a result.
- Idea and Feeling
- Action
- Result
But of those four stated goal examples above, only one is really within our span of control. For Natasha to start flossing she has to take action – are you going to floss her teeth every time for her? To lose 15 pounds you can exercise and count your calories but other factors in your metabolism, emotions, environment can have an effect on your ability to lose weight and thwart your ability to reach losing 15 pounds. Having your house as clutter free as your operatory may be a goal and reachable by you if you live alone. But if you have children or a clutter attracting room-mate or spouse reaching that goal is not totally within your control. All of these things are results that you may or may not achieve as they are outside of your span of control.
Participating in one continuing education program a month from September to June is within your control as the decision and action are within your control (Shameless promotion – DHPro does offer continuing education programs in each of these months for an amazing membership fee of only $35.00 and you can access our full library of courses for replay whenever you like).
Look back at some of your goals that are frustrating you because you have not been able to achieve the results you desire. Are you really not good at meeting your goals or are they not your goals but desired results? The goal should be the action to achieve the desired result. My goals is to, “do this and this” to reach my desired result.
This kind of thinking is very different than the goal setting treatment plans. How does this approach to thinking of your goals make you feel?
Osteoporosis medication and oral health.
In the Theoretical Thursdays Blog, it is our objective to bring dental hygienists current peer-reviewed articles that you may find of interest. While we cannot post the article, we will provide the citation, describe it to you and tell you where on the internet you can find it if it is an open access article, email it to you for personal use if allowed by the publisher, or if a librarian is not available we will help you locate the article. Please contact us with the journal title for assistance.
Migliorati, C. A., Mattos, K., & Palazzolo, M. J. (2010). How patients’ lack of knowledge about oral bisphosphonates can interfere with medical and dental care. Journal of the American Dental Association (1939), 141(5), 562-566.
The above study examined 73 patients of whom 74% were prescribed oral biphosphonates for osteoporosis, 22% for osteopenia, and 1% for breast cancer. These patients were interviewed to determine their knowledge of why they were taking the medication: 82% reported they were not informed by their physician of the side effects such as osteonecrosis of the jaw and 80% reported they did not know the duration of their treatment. The implications of this study are to ensure dental health professionals obtain a thorough medical history prior to planning dental treatment, secure patients’ signed informed consent prior to invasive procedures, and not recommend patients discontinue medical therapy without consulting their physician.
The following fact sheet is available for dental patients: Osteoporosis medications and oral health. (2009). Journal of the American Dental Association, 140, 812.
For discussion of the risks of osteonecrosis of the jaw associated with taking oral phosphonates see the article below:
Edwards, B. J., Hellstein, J. W., Jacobsen, P. L., Kaltman, S., Mariotti, A., Migliorati, C. A., & American Dental Association Council on Scientific Affairs Expert Panel on Bisphosphonate-Associated Osteonecrosis of the Jaw. (2008). Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: An advisory statement from the american dental association council on scientific affairs. Journal of the American Dental Association (1939), 139(12), 1674-1677.
Please note that there is discussion that osteonecrosis of the jaw may not be associated with a history of taking biphosphonates. See the article below:
Kyrgidis, A., & Toulis, K.A. (2011). Denusumab-related osteonecrosis of the jaws. Osteoporos International, 22(1), 369-70. DOI 10.1007/s00198-010-1177-6
Patient Ownership and Patient Stealing
By Cindy Isaak-Ploegman RDH
Do we own our patients? The issue of patient stealing has become a recent concern due to fiscal restraint in the dental community nationwide. When you combine this with dental hygiene employment opportunities that are at a premium, the issue of patient stealing causes us to take a step back and examine what is unacceptable and what is appropriate in terms of informing patients of our new employment opportunity.
If pleasing a new dentist employer or attempting to be successful in an independent practice means resorting to unethical means to secure a patient base, we need to be careful to not to win the battle, but lose the war. The war, in this case, is our license to practice.
I find I agree with Maihofer (2011) only on one point, that it is unethical to go through a former employer’s charts to gain patient’s personal contact information to lure them to another dental practice. Firstly, it breaches confidentiality to use patient information in a context it was not intended for (Canadian Dental Hygienists Association, 2002) and secondly, securing the information for the primary goal of personal gain is unacceptable (Canadian Dental Hygienists Association, 2002). It is also unprofessional, the insinuation being that the patient will not be treated properly if they remain in the former dental practice. In other words, “Come to see me for the real dental hygiene care.”
We need to bear in mind that no one owns the exclusive right to offer dental health care to a specific person and patients are free to go to another practitioner at any time for any reason (Jerrold, 2002). For example, if an associate dentist left an employer and his/her patients followed, specifically those patients who had contact with the associate prior to the associate working with the employing dentist (relatives and friends), the former associate could not be found to breach the restrictive covenant that normally protects sharing a patient list (Jerrold, 2002). The issue is the permanence of the patient/professional relationship and the patients’ right to autonomy, that is, the right to choose where they receive their dental care.
Even though I may be convinced, I am the most caring dental hygienist in the universe, and I may even have a clientele that reinforces that thinking, I still don’t own my patients. I find the message of promoting me versus promoting care can be separated by a tiny subtle area.
When patients ask about former hygienists, I frame the conversations in an exclusively positive light, but divulge no information on where they currently practice, even if I know. If I shared this information I would be undermining my practice setting. I had one patient who expected me to provide him with my home phone number so I could talk him through his flossing, because the former hygienist did it; I declined.
We need not enable co-dependencies to satisfy our personal insecurities or resort to unethical practice to pay our bills. The primary ends and means of dental hygiene care are to put the patients’ interest first.
If patients perceive they are cared for they will remain in my practice. But some of my biggest fans, for whatever reason, have moved on. It may be due to location (they moved residences or changed jobs), the smell of my new soap, my red color uniform, my conversation, having to pay a delinquent bill, or they are tired of paying for parking. The list goes on.
It is easy to forget sometimes that we offer a fee for service and our relationship with patients is a tricky one. We need each other. But we are both fickle. We are free to change employment settings and patients are free to change their dental hygiene providers.
I would love to hear from you and your comments on this timely topic.
Cindy Isaak-Ploegman
References
Canadian Dental Hygienists Association. (2002). Code of ethics. Retrieved from http://www.cdha.ca/pdfs/Profession/Resources/CDHA_Code_of_Ethics_public.pdf
Jerrold, L. (2002). I knew him when. American Journal of Orthodontics and Dentofacial
Orthopedics, 121, 236-7.
Maihofer, M. (2011). A hygienist is stealing my patients! Journal of The Michigan Dental Association, 93(5), 24-25.
Burnout
By Judith Rance
My friend, Deanna, had been on the job almost two years when, suddenly one day, it was “down tools, and away.” As co-workers and friends, some of us had noticed Deanna’s increasing tension and irritability over the preceding months. Although we knew her quite well, we had no idea what was causing the change in her attitude. Interestingly, a few months later, I also walked off the job abruptly and several months after that, the third of our Three Musketeers left in tears.
Were we working in a bad environment, for difficult managers, or were we all suffering from some inner crisis? It’s hard to say if it was either or both factors. Certainly we were working in an emotionally-charged area of medicine that included long hours and competing demands on our time. Admittedly, some of the managers we worked with were unenlightened, and there is no doubt that we all had the usual share of personal challenges to deal with. I do not believe any of us had any underlying medical or psychological problems that would have led us to give up our jobs.
There had to be some reason we three rational people made the decision to give up these well-paying jobs that many people would envy.
So what happened? Who walks away from a permanent job with a decent salary? I’ve often looked back on that time and tried to find some insight. Like many career women, over the years I have made several strategic job changes, but these have been thought-out and goal-oriented, not emotionally based.
If this had only happened once in my career I might not have become as concerned as I am at this time. Unfortunately, just about year ago this month, I began to feel the same way again. The job I had once loved became a tiresome, frustrating chore. As the months went by I became chronically irritable and began to find even simple tasks overwhelming. What surprised me was the intensity of my emotional and physical response to the situation. Apart from losing my usual positive approach to life, this time I did have a serious physical reaction. After extensive medical investigation, my physical issue was attributed to stress. During this time I was not able to rebound with the usual “weekend recovery” that most of us rely on, and even now, months later, I am not at my usual level of energy and production.
On reflection, and after discussions with my doctor, I realize I had, and still have, burnout. Ultimately, the only solution I could find after 12 months of soul-searching, was to give up my job and although I was deeply saddened by this, I ultimately did give it up.
Until this most recent experience I thought the topic of burnout was something that made an interesting conversation on Oprah but was otherwise a rather vague catchall term. Although I have a background in medicine, I was not quickly convinced that burnout was a legitimate medical diagnosis. In fact the medical community, represented by the Merck Manual (a medical diagnostic manual used by physicians) has very little formal comment on burnout. (1) This is because burnout has a wide range of symptoms that can be confused with other medical problems. Another problem is that there does not appear to be a biological basis for burnout, although this implication bears further research.
What do we know about burnout? The dictionary defines it as: “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration” but I believe this is a fairly simplistic definition for a problem that is impacting so many lives.
We need to look at some of the other factors that are generally seen in a burnout situation. They include stress due to our hectic lifestyles. These days we are all in the workforce and many of us are trying to raise children, maintain relationships, and often provide care for our aging parents at the same time. If that is not bad enough, many of us set the bar very high in terms of the quality of our work. We are so busy that it can become very hard to find time to unwind. We live so fast these days that we seldom have time to reflect and evaluate our situations or to even question what we are doing – and the fallout from this is devastating in terms of job loss, family breakdown, and financial loss.
Over the next months I will be looking at the research on burnout in order to more deeply explore the causes, symptoms we should be watching for, the prevention and the cure for this troubling issue. I also will look at some of the other areas of our lives, like our marriages and our families, which can be impacted by burnout. This is a serious issue and we all need to be aware of the problem, the prevention, and the solutions. For me, this research will be personally helpful and I hope it helps you too.
- http://www.merckmanuals.com/professional/index.html
- Dieter, Korczak. Beate, Huber. Kister, Christine. “Differential Diagnostic of the Burnout Syndrome.” GMS Health Technol Assess. 2010; 6: Doc09. Published online 2010 July 5. doi: 10.3205/hta000087