Dental hygiene practice: Is there a new model?


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Taking blood pressure, saliva and occlusion testing, checking for signs of sleep apnea, joint vibration analysis and engaging in small talk — how is a dedicated dental hygienist going to get everything done in the standard appointment time? (DTI/Photo provided by Shirley Gutkowski)
Shirley Gutkowski, USA

By Shirley Gutkowski, USA

Wed. 15. June 2011


You’ve been learning about all the new products and risk assessment tools in lectures, articles in magazines and on the Internet. Saliva tests have evolved from simple litmus paper evaluating the oral pH to tests that measure the periodontal pathogens and whether the patient has an HPV infection. Encouragement from thought leaders has dental hygienists taking blood pressure, perio charting, saliva testing and even taking blood samples for periodontal therapy management.

Testing occlusion, checking for signs of sleep apnea, joint vibration analysis, oxygenation of the blood, caries manifestation and engaging in small talk are all good dental hygiene practice, but when do you get to scale and polish? The bread and butter of dental hygiene appointments can’t go away, can it?

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The framework of dental hygiene is changing. Dr Fons thought having someone around who could clean the teeth, often, would be a great adjunct to a dental practice. That idea evolved to someone who could educate and clean the teeth then to someone who could do some diagnostics, educate and clean the teeth.

The cleaning alone in Dr Fons’ time took the better part of an hour. Adding these other processes into the dental hygiene appointment is just getting crazy, right? How is a dedicated dental hygienist going to get everything done without resorting to heroic efforts?

It is time to rethink the status quo. The number of diagnostic tools and instruments we have in dentistry today, the level of technology and the incredible information they provide is proving to be very time consuming.

A simple salivary test to show the health of someone’s saliva takes about 10 minutes, add to that a good oral cancer screening of at least five minutes, then a perio chart and blood pressure check and most of the appointment time is gone. A new position in the office called a Risk Factor Manager (RFM) may alleviate the time crunch.

Imagine if your dental hygienist position in the dental office was shifted to one of gathering data only. The RFM is the person in the office who would perform blood pressure and saliva tests, and when needed, also caries and oral cancer screenings, test blood for inflammatory markers and glucose management and perform occlusal screenings and joint vibration analysis.

Perio charting and all other data would be gathered by the RFM for all new patients before any treatments, and the collected data reported to the dentist who would evaluate that data for a diagnosis. In the ideal practice, the RFM would alternate with the dental hygienist at some interval, perhaps weekly.

It’s so important to gather this data, yet the gathering of it interferes with dental hygiene treatment, thus the time has come for a new practice model. A RFM could be in charge of many other things, too. Tasks that are shuffled to the bottom of the priority pile and never see the light of day, such as gathering practice data.

Can you find out, in short order, how many patients with pockets over 6 millimeters are in your practice, and of those, how many have diabetes? Is that an important piece of information? It sure is! The data in dental hygiene to support the science of our practice is lacking. Having case data — a practice being a case — can streamline dentistry immensely once it’s reported.

In the light of the 2014 mandate for interoperable electronic health records (EHR), our data has to hold up to the scrutiny of medical records. Actual diagnosis, not just treatment plans, will be part of the insurance model of payment as well.

We won’t be able to be paid for periodontal therapy without a diagnosis of periodontal therapy and lab proof of an inflammatory response and pathogens. The current model of dental hygiene as a part of dentistry doesn’t allow time for this level of data gathering.

We also know that there are many interrelationships between oral and systemic health. Patients don’t know all there is to know about the links, and we don’t expect them to. However, we do know that it sure would be nice to have that data.

For instance, if we have patients present with periodontal disease and they do not know they have diabetes, or if they do know, it’s important to us. An interoperable electronic health record would allow us to go into their health records and find out before treating diabetes as if it were periodontal disease. A RFM would have time to locate that information and share it with the dentist before the patient sees the dental hygienist.

Here’s an example: There’s a new correlation between obstructive sleep apnea (OSA) and periodontal disease. Having access to a patient’s health record could allow a dental practitioner to encourage that patient to have treatment for his/her OSA, which will allow the periodontal condition to improve. The benefit to this RFM model at this time in health care is a boon.

Synchronizing new research is nearly impossible in the current dental practice model. Having a RFM on the team will make it a little easier as this person could also be tasked with monthly reporting of new findings during the team meetings.

Keeping up with the advances in health care is everyone’s job in a small practice, which often turns out to have been “nobody’s job.” Having one person researching, considering and reporting on all of the changes, as well as having a total focus on managing patient risks while collecting diagnostic data, is a win for everyone in the office.

About the author

Shirley Gutkowski, RDH, BSDH, FACE, is an international speaker and award-winning writer. She is co-creator of Adopt A Nursing Home, a board member and Fellow of ACE and a member of the World Congress of Minimally Invasive Dentistry. Gutkowski is also co-director of CareerFusion, a retreat for clinicians interested in evolving their clinical career. You may contact her at

Editorial note: This article was originally published in Hygiene Tribune, Vol. 4 No. 6, June 2011.

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