All in? Doctor's tendency to launch new hygiene services without training is aggravating

By Dianne Watterson, RDH, BS, MBA

Dear Dianne,

The doctor I work with has always been interested in trying new things. He goes to lots of courses about all kinds of things, but he never invites the staff group to go. Some of the courses are about treatments that are “alternative” in nature and not part of standard dental care. He usually comes back from these courses all pumped up about how we can incorporate this or that into our treatment offerings. He will spend lots of money on equipment and supplies to implement some new treatment. Usually, the enthusiasm fades away and we’re back to our same routine. A good example was his leap into the “sleep dentistry” field. He purchased all kinds of equipment and even did his first case on one of the assistants. But he hasn’t done a case since the first one.

His latest new “fad” is ozone treatments. (I don’t expect this to fly either.) I know very little about ozone treatment in dentistry, but I do know that ozone is a toxic gas.

The doctor wants me to “sell” new treatments or technology to patients when I don’t understand the basics of the treatment. I was taught to be “evidence-based” in my thinking. To be honest, I feel the evidence is lacking in some of the treatments he espouses. How do I reconcile this? The thought of promoting dental treatment that may be nothing more than voodoo makes me physically sick!

- Candice, RDH

Dear Candice,

I see two problems here. First, your doctor is remiss when he decides to implement new treatments without the understanding and support of staff members. Second, the implementation of new technologies that aren’t supported by solid, high-grade evidence is risky at best and may be downright dangerous.

Why is it that some doctors do not see the value in educating the whole team, especially in the area of new technology? It makes no sense to expect team members to get excited about a new treatment if they don’t know “diddly” about it. Yes, it costs money to pay for everyone to go to a course. But it costs more money to not educate the whole team, and then experience serious roadblocks to implementation simply because they don’t understand and have not been given the opportunity to learn why and how this would benefit patients.

Some companies insist that the doctor bring his or her team to their meetings because they know team participation and understanding is vital to successful implementation.

You mentioned two areas of interest by dentists that are outside the boundaries of traditional dentistry, such as sleep dentistry and ozone. My experience with offices that offer treatment for sleep apnea et cetera is that only a small percentage of dentists succeed in making this a profitable area of practice. Depending on the state, some dentists have run into roadblocks from the medical profession or even their own state board of dentistry. Some physicians feel dentists are practicing outside their scope when they attempt to enter the field, and unfortunately, some state boards agree with them. (I’ve seen the same result when dentists want to offer cosmetic options, like Botox.) Most every profession has a “turf” that they feel the need to protect.

Ozone treatment in dentistry is another of those emerging therapies that seem to have promise but is definitely not mainstream. If you Google the topic, you will find numerous articles, mostly from blogs and websites, that support the use of ozone therapy. If you search PubMed, you will find many studies about ozone use in endodontics and caries. If you go to the American Dental Association website and search for articles about ozone (as well as JADA), you will find almost no information. Yet, you can also find articles in many non-peer-reviewed journals written by dentists touting the great benefits of ozone use in dentistry.

It sounds like your boss is one of those CE junkies that are always on the hunt for the next big thing. Often supported by slick salesmen that are excellent at selling their wares, they promise high ROI after an “initial investment” that is sure to pay for itself many times over. The problem is that some modalities have steep learning curves that require a large investment in time and patience to master. Two such modalities come to mind: perioscopy (endoscopy) and CAD/CAM technology. Mind you, there’s nothing wrong with the technology, but the person buying this technology has to be willing to expend time and effort to master the technique. And some dentists are low on patience. After the initial enthusiasm melts, the equipment becomes a dust gatherer. It is a recurring problem that I’ve seen many times.

There is certainly nothing wrong with being evidence-based in your approach to patient care. Just remember that science often trails behind technology, sometimes way behind. Who knows what the future holds? In the next 30 years, there may be many changes in how we treat caries and periodontal disease.

As the hygienist in the practice delivering care and assessing treatment needs, you have an obligation to practice responsibly. It is not unreasonable to want to see solid, well-designed research before jumping on the bandwagon of some novel treatment modality. We should be curious, investigative, and willing to learn.

Your boss certainly has the liberty to try new things and implement new technologies for the good of his patients first and secondarily, his practice. It would be advantageous for you to learn all you can, since hygienists are in the best position of all the staff members to discuss treatment options with patients. There’s certainly no harm in relaying to the doctor that you are interested in learning new things and doing all you can to provide the best care. If you request that he include you and possibly your coworkers when investigating a new technology, he may come to see how the practice can benefit from educating everyone, thereby optimizing the chances of success.

If you are asked to promote something that you clearly do not understand, the best thing you can do is be forthright. Find out if there are studies available, and show the doctor that you are willing to learn.

Finally, some of your peers might call you lucky that your boss is not one of those who shuns anything new. The truth is that we need to find balance between being stuck in the past or running after every shiny new moonbeam.

All the best,

DIANNE

RDH

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and two books. Dianne’s new DVD on instrument sharpening is now available on her website at wattersonspeaks.com under the “Products” tab. Visit her website for information about upcoming speaking engagements. Dianne may be contacted at (336) 472-3515 or by e-mail at [email protected].