By Dr. Ron Shafer

I have been asked by many of you to get back to writing my blog and have resisted for no other reason than the demands of serving the needs of our membership. Yet today, after numerous phone calls and emails asking for help, I am compelled to write again for the minimum reason of hopefully providing a slight flap of a butterfly’s wing to set in motion the winds of change.

To set the tone of this blog, please allow me to briefly review this week’s calls for help:

 A dental hygienist in British Columbia asks is there any relief that can be sought from an insurance company who will pay a dentist directly but not a dental hygienist. The dentist can be paid directly for the work of a dental hygienist in his or her office but the insurance company will not pay for the same work in a dental hygienist office.

A dentist in Ontario tells his staff of dental hygienists that all their salaries will be reduced by $10,000 annually effectively immediately. Could the reason be that to keep the business going, he needs to reduce cost? Unfortunately, no. Business is actually growing.

A dental hygienist is planning on eventually opening her own practice and unfortunately mentions this to one of her colleagues. The colleague promptly informs their employer that this dental hygienist is planning on going out on her own. The dentist fires the dental hygienist who intended on opening her own practice immediately.

A dentist not really caring about the community’s oral health decides that in his office he is going to pit dental hygienist against dental hygienist by making their income dependent on performance quotas. Within each hour, a dental hygienist is expected to see so many clients. Should a dental hygienist take too long with a client, other dental hygienists can take the next appointment and now the dental hygienist who is trying to provide good oral health care has their quota and their income decreased – I am sure you can see where this is going. In a particular example, when the dentist was told that the client who had limited mobility required more time than allotted, the dental hygienist was told to do just the basics and have the client come back again for another appointment.

 In Ontario, it is legal for dental hygienists to apply a localized antibiotic. The only problem is dentists do not want dental hygienists taking a piece of their income away, so they first launched a campaign to misinform suppliers that it was illegal for dental hygienists to apply the antibiotic. The company reacted by no longer supplying the drug to dental hygienists. Once this misinformation was corrected, the company then sold the drug and the new company has been scared away by fears of liability.

The last example of this week’s phone calls involves our government. In 2008, the Competition Bureau was commissioned to conduct a study on the dental industry. The Minister in charge of the competition bureau changed hands and the study continues to sit on the shelf. When dental hygienists began calling and emailing the competition bureau and their candidates during the election campaign many of the people answering the phones and emails had no idea that dental hygienists could practice without a dentist in most jurisdictions in Canada and had no explanation why a report begun in 2008 with such fanfare still is in draft form and cannot be released.

These six examples of phone calls and emails that came to DHPro this week cover a wide range of issues caused by a wide range of people and interests. Let’s see …. Insurance company, dentist and employment regulations, dental hygienist going to the dentist with her concerns rather than speaking with her colleague, dentist violating fair employment practices with impunity, oral health vendors discriminating against a profession, and maybe worst of all, members of the government colluding to protect their financial benefactors.

Now for the hard question - how can this be? What allows an insurance company, a dentist, oral health vendors, government officials, and unbelievably, dental hygienist themselves to discriminate and quite possibly enslave a profession? Is it socio-economic (dentists have a 4 to 1 ratio of income over dental hygienists), demographic (dentists are primarily male and dental hygienists are primarily female), or is it strategic (dentist are more united than dental hygienist)?

You all have seen the commercials that say 9 out of 10 dentists recommend. I have never had a dentist recommend anything but a root canal. Toothpaste, floss, mouthwash, and toothbrush have all been recommended by my dental hygienist. Why do people say when they are going to have their teeth cleaned that they are going to the dentist?

As a social scientist, the problem of the dental hygienist profession is clear to me. Before I go any further, I would be greatly interested in your opinions as to what you feel is the problem (or maybe you do not feel there is a problem) and what possible solutions might be provided. Please use the comment form at the bottom of this blog to express your thoughts. Your identity will be protected.