Jonathan A. Bregman, DDS, FAGD

	Imagine this: The doctor is doing his/her examination with a dental hygiene patient and discovers an area of concern while doing the oral cancer screening. 

	Questions begin to swirl in the patient’s head. The doctor answers the patient questions, then leaves the hygiene room. The hygienist answers additional questions before finally handing the patient over to the business team.

	But the patient starts asking questions again-this time directed to the business team.

	Does your business team have the education and training about oral cancer detection to answer the patient’s questions? Do they have the training that would give them clarity of verbal scripting needed to calm patient fears?  Would the hygienist have to be called out from patient care to handle these additional questions?

Related reading: The importance of oral cancer screening in the dental practice

	Even with a clinical issue like oral cancer, training must include the doctor AND the entire dental team. Everyone must be involved out of necessity.

	So, what about carrying out a clinical protocol? Who needs to be trained/educated in the office?

	For the oral cancer office protocol, the business team must clearly understand “next steps,” so that they can re-appoint the patient effectively in two-to-three weeks for follow-up or ensure proper referral to a specialist, if needed. All team members should be able to explain the next steps to the patient.

	For a referral, any team member (clinical or non-clinical) should be able to quickly, easily and accurately put together all necessary information that needs to be sent to the specialist as determined by the written protocol for oral cancer. There should be more than one person in the office that knows what to send.

	By training and educating the doctor and the entire team, everyone should be able to understand the return visit in two-to-three weeks and put together the necessary elements for referral to a specialist related to oral cancer concerns.

	But let’s not forget the key role the dental assistant plays with oral cancer detection. The dental assistant should have all of the necessary tools to discuss patient concerns regarding a detected problem area after the oral cancer screening examination, if it happens when the assistant is involved with patient with oral cancer issues. The assistant needs to know and understand the written office protocol; i.e., the next steps for the patient after initial discovery of an area of concern or after a two-to-three week follow-up.  

Related reading: What you need to know about HPV, oral cancer and your dental patients

	As you can see, the doctor, hygienist, dental assistant and the non-clinical team members must be equally educated, not only about the office’s commitment to early detection of oral cancer and clear patient communication but every step of the written office protocol for oral cancer. Including everyone in discussions and training about oral cancer is critical to a smoothly functioning office and, most importantly, effective patient care.

	Take the time to ensure that you have an effectively written protocol for oral cancer and all other clinical protocols. Ensure your team has the necessary education and training to follow and understand the protocol, so that everyone can communicate consistently with patients and answer their questions and concerns. Your patients will thank you for it!

Articles

Ensuring your entire team has the necessary education and training to follow and understand oral cancer detection protocols can be crucial to effective patient care.

Why educating the entire team in oral cancer detection protocol is critical

Since Dr. Terry Myers started experimenting with lasers in dentistry almost 30 years ago, people have tried to dismiss this technology as a passing fad. But even a quick look at national journals for the dental and dental hygiene professions over the past six months shows a significant number of articles that address lasers in all aspects of dental care. Why is this “fad” captivating the professional imagination? To me, the answer has two parts.

First, laser-assisted dental hygiene and laser-assisted dental procedures are improving the quality of care for patients. A new standard of care is emerging using this technology. Second, the laser is a piece of equipment the entire team can utilize and benefit from. Currently in the U.S., only 36 states permit dental hygienists to use dental lasers. However, even in the cases where the hygienist isn’t using the laser, she can be an integral part of helping her practice adopt the technology or at least learn more about its capabilities.

Regardless of whether or not you are in a state that permits you to use the laser, it is critical for you to understand what this technology can do for your patients; my personal philosophy is that patients deserve not just the best that I can do for them but the best that the profession can offer them.

Dental lasers fall into two groups based on the energy they emit, their wavelength (measured in nanometers). Wavelengths have significant implications regarding effectiveness, depth of penetration, patient comfort and ease of use. The specific wavelength of a laser is created when the energy source (power) and the ‘fuel’ combine to create laser energy. In the case of a diode laser (wavelengths from 810 nm to 980 nm), the power is electrical and the fuel is a semi-conductor chip. In the case of all other dental lasers (wavelengths over 980 nm), the power is a flash of energy created by a lamp or other mechanism, and the fuel is a mixture of gas, liquid and crystal.

It is most important for the hygienist to be aware of the opportunities afforded by the diode lase, since it is prevalent among general practitioners; according to a May 2007 Dental Products Report survey, 56% of respondents own a diode laser and 57% of non-owners were planning to buy a diode laser. Used in soft tissue procesdure only, the diode laser energy-either continuous or pulsed-is attracted to pigment, and in our case, hemoglobin. (Other lasers, such as Er:YAG and Er,Cr:YSGG, can be used in both hard and soft tissue and are attracted to water and/or hydroxyapatite.)

Many soft tissue procedures can be completed in a matter ofminutes and, depending on the laser used, require no injectable local anesthetic and cause minimal to no post-treatment discomfort for the patient. This is a great selling point with your employer! Go over this list with him or her to see if keeping certain procedures in-house in addition to improving efficiency and predictability of standard procedures might make adoption more feasible.

		Incising and draining of all gingival tissue

Likewise, there are a variety of hard procedures the hygienist and dentist can perform that can help bolster productivity and predictability while reducing stress and patient discomfort.

		All routine restorative procedures for enamel, dentin and cememtum

In my opinion, the most important use of a dental laser by a dental hygienist is as an adjunctive tool to facilitate access to the root surfaces. Once this improved access is accomplished, standard instrumentation can then be used to completely remove the deposits and toxins from the root surfaces. Along with this improved access, a dental laser can de-epithelize the infected tissues in lining the periodontal pocket. The end result is greatly improved periodontal healing after scaling and root planning (SRP) procedures. If the goal is to demineralize calculus in the pocket, removal is easier using an Er,Cr:YSGG laser for the process; a diode laser will not demineralize calculus.

If your employer is reluctant to incorporate laser-assisted dental care into the practice after hearing about these possible improvements in periodontal care and knowing the many things the laser can do that go beyond SRP, remind him or her that the primary concern should, of course, be the patient. When using laser, patients experience better outcomes and less post-treatment discomfort. These “soft” perks become all the more important when you consider the enormous percentage of patients who need comprehensive periodontal care. Using a technology to do it more effectively and comfortably should be a priority for every dental practice.

As a dental hygienist, you are a leader in the practice and in the profession. Chances are you already recognize that lasers are here to stay and poised to change the way we all provide care. Make it a point to learn what lasers can do for you specifically and for your practice in general. Help adopt laser technology into your practice and see the quality of care improve dramatically and dental hygiene become more fun to deliver. The practice will soar, as will you!

Jonathan A. Bregman, DDS, FAGD, has been practicing dentistry for more than 30 years. Over the past 15 years, he has served as an adjunct faculty member of the University of North Carolina Dental School at Chapel Hill. Also working as a speaker and consultant, Dr. Bregman’s energized and thought-provoking laser dentistry presentations show how lasers dramatically improve the patient experience, increase practice profitability, and put fun back into dentistry.