The power of the dental hygienist is a formidable force in patient care. Or not.

By Karen Davis, RDH, BSDH

For many years, I was privileged to be a consultant representing the JP Institute, where I gained entrance up close and personal into many successful dental practices. That exposure, coupled with the countless years I have practiced dental hygiene, have revealed something I refer to as the “power of the dental hygienist.” Since the majority of clinical dental hygienists work in tandem with dentists in private practice, I am referring to what happens inside the context of hygiene appointments. Think about it - when patients come to visit a dental hygienist for preventive care or ongoing periodontal maintenance, many avenues of education, preventive or therapeutic services, and diagnostic screenings take place. Or not.

Dental hygienists have the “power” to engage patients in conversations about the beverages they drink, inform them about the erosive effects of sugary drinks, and enlighten them on the benefits of multiple xylitol exposures, or not address these things at all. We have the power to update patients’ comprehensive periodontal evaluations and assess risk factors, or simply provide the dental “cleanings” patients have grown to expect, urging them to “floss more” as we wrap up their appointments.

Hygienists have the power to show patients who present with old, worn restorations before-and-after images of beautiful, functional restorative and esthetic cases, or not. This power that hygienists possess encompasses whether or not patients are offered fluoride varnish, whether or not they receive thorough head and neck oral cancer screenings, whether or not diagnostic radiographs are updated consistent with their risk factors, whether or not patients are educated about the benefits of power brushing, whether or not pockets are probed and bleeding sites documented, whether or not novel products are introduced to manage various conditions, whether or not referrals are suggested. This “whether or not” list is practically endless. The power dental hygienists have is significant, and it can actually affect many outcomes for patients.

So, let’s break down a dental hygiene appointment for George, a periodontal maintenance patient who sees his hygienist every three months, and examine the power of the dental hygienist in two possible scenarios.

Scenario 1

George presents with stable periodontal pockets, but he has isolated bleeding in 12 areas, generalized exposed root surfaces due to 2-4 mm of recession, and exposed dentin on the lower anterior teeth. The dental hygienist updates his medical history, takes his blood pressure, provides intra- and extraoral examination, spot-probing, generalized ultrasonic scaling, site-specific hand instrumentation, followed by polishing with polishing paste and a rubber cup, and then oral irrigation with chlorhexidine. Daily disease control instructions include a reminder to floss daily and continue with use of a power toothbrush twice daily.

Scenario 2

George presents with the same clinical conditions of 12 isolated bleeding sites, generalized root exposure, and exposed dentin on the lower anterior teeth. The dental hygienist updates his medical history, inquires about what George drinks throughout the day when he is thirsty, and learns that he usually has two sodas, one cup of coffee with sugar, maybe one energy drink, and the rest of the time water each day. The blood pressure update and intra- and extraoral examination are uneventful. The dental hygienist updates the patient’s comprehensive periodontal assessment and discovers the 12 isolated bleeding sites are all from lingual surfaces that are harder to access. The hygienist uses a disclosing solution and takes intraoral images to assist the patient in visualizing areas of plaque accumulation at the gingival margin and subsequent inflammation. Due to the generalized exposed root surfaces, the hygienist elects to air polish the patient’s teeth with a low-abrasive glycine powder for biofilm removal, followed by site-specific ultrasonic and hand instrumentation to remove calcified deposits.

Daily disease control instructions include the following:

• Education about the erosive power of sugary and citric acid drinks, with recommendations to add flavored stevia drops to water instead of the sugary drinks and add five to six exposures of xylitol gum or mints per day
• Suggestions to start power brushing on the lingual surfaces first to target areas of inflammation
• A recommendation to add an AirFloss for easier interproximal cleansing
• A recommendation to begin using an anti-inflammatory toothpaste with triclosan twice daily
• A recommendation to apply topical antioxidant gel on the oral tissue in the morning and evening to help resolve inflammation

The hygienist uses an intraoral camera to show George exposed dentin on the incisal edges of his lower anterior teeth, as well as a similar case where the incisal edges had been restored with a strong nanoparticle resin to help prevent additional wear. George is interested in protecting his teeth long term, so this resonates with him. The hygienist also shows him a sample occlusal guard and discusses the benefits of protecting his teeth from accompanying wear due to bruxism. Lastly, the hygienist informs him about the benefit of applying fluoride varnish on the exposed root surfaces during each visit, and then ends the appointment with an application of antioxidant gel on the tissues and fluoride varnish on the teeth.

Imagine how different the outcome might be for George both in the long and short term between scenarios 1 and 2. Consider how different the doctor’s examination, diagnosis, and treatment enrollment for the patient might be between the two scenarios, if the dentist relies on a synopsis of findings from the hygienist for future care.

Did you notice that not only did the hygienist go in a different direction with education and treatment recommendations in scenario 2, but also used different technologies during the visit? She used technologies that were less abrasive for exposed roots, technologies that included visual learning for the patient, and technologies that provided anti-inflammatory and antibacterial benefits.

Clinicians use their clinical judgment, passions, and their own willpower to determine how appointments unfold for each patient. One observation I have consistently made through years of practicing, consulting, and lecturing is that empowering dental hygienists with necessary tangibles - such as adequate appointment time for customized education and treatment, and state-of-the-art technologies - increases the likelihood of comprehensive care being provided consistently.

Dental hygienists, we have a lot of power. This is a call to action to maximize that power with every patient, at every appointment. And for any dentists who are reading this article, this is a call to action to empower your dental hygienists. But hang on to your hat - the power of the dental hygienist can be a formidable force for optimal care! RDH

Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at [email protected].