Shirley Gutkowski, RDH, BSDH

	- "Aging is a risk factor for oral cancer"

	- "Restorative dentistry restores oral health"

	What is the truth and current science behind these statements? The automatic answer has a high likelihood of being dated, incorrect or incomplete. The public and many of us believe what happens in clinical dental hygiene practice is based on science. Yet, is it?

For the past decade, the term evidence-based practice (EBP) seems everywhere. Let’s think about this patient in your chair: She lists on her health history Hashimoto’s Thyroiditis. What do you do with this information? What oral health risk might she have? What systemic risk could you cause with unthinking/unexamined care?

Tech-savvy millennials will research online. Do you have a millennial thought process? Pew Research Center has a 14 item quiz and that can tell you 

 You might find it interesting in clarifying how you think and process in our current world (and what the heck, these online quizzes are fun!).

Trending article: Breaking the law, dental hygiene style

Let’s start with the most commonly cited definition of evidence-based practice from Dr. David Sackett, Canadian physician and EBP pioneer: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Thanks Dr. Sackett but what does that really mean?

Many hygienists love structure. Good news: The process of EBP is actually quite structured with a bunch of specific steps; it should be easy. Then why isn’t it used? It makes theoretical sense, yet how many practitioners have the time to go through the EBP process when a patient sitting in their chair?

Trending article: The 5 new words of dental practice ... and what you should know about them

On Facebook this week, you remember seeing something about Hashimoto’s so you go back and find the post about a book 

Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause

 by Dr. Izabella Wentz. It hit the NY Times Bestseller list for two months in a row. So you link to Amazon.com and the marketing section says, “Hashimoto's is more than just hypothyroidism. Most patients with Hashimoto's will present with acid reflux, nutrient deficiencies, anemia, intestinal permeability, food sensitivities, gum disorders and hypoglycemia, in addition to the typical hypothyroid symptoms such as weight gain, cold intolerance, hair loss, fatigue and constipation.”

You have limited knowledge of Hashimoto’s. How can you examine the information in this book? How much is hype? How much is accurate? You don’t have the time while the patient is in the chair to examine any of it. So is EBP really feasible?

Laser-assisted periodontal therapy is routinely performed by many dental hygienists though still controversial in some circles. Codes have been submitted over and over to the Code Maintenance Committee to add to CDT (Current Dental Terminology) for this care. The committee continues to vote “no” to a variety of laser-assisted periodontal therapy submissions (as recently as for CDT 2015). The American Academy of Periodontology (AAP) is leader in this opinion. Is AAP once again using evidence as a mallet? In earlier versions of CDT, there was a code for curettage.

, the procedure code was removed. If you look at the references to support their statement, there is not a single reference from this century. Okay, so the statement was written in 2002, yet it is still on the AAP website as position they support. The 24 references are from: 1927, 1952, 1954, 1956, 1957, 1958, 1959, 1962, 1966, 1980 and two each from 1981, 1982, 1983, 1987, 1989, 1996, 1997, 1998 and 1999. It looks like the evidence didn’t drive the statement, rather research was found to support a position. Is that EBP?

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Clinical treatment guidelines are some of the best and quickest ways for healthcare providers to learn the science behind making the best clinical decisions for their patients. Generally, a panel of experts is convened to review the scientific literature and to create informed treatment recommendations. The experts crafting the guidelines explain which treatments are helpful to the greatest number of people within a certain patient group. Carrying the official backing of established societies, the implications of the release of guidelines are many.

In theory, healthcare professionals review the new guidelines, weigh the scientific evidence, and implement the new 

 is accomplishing this process in dentistry. The guidelines have the official backing of ADA and will be considered best practices by insurance carriers and others. What can be of concern to any practice is how the concept of 

 has been used in medicine to limit treatment options and decrease reimbursements. Are you willing to allow ADA to control it all? Is that the direction EBP really going?

Trending article: A size 25 soft toothbrush: Missing in action (Part 2)

(MMH) articles with more questions than answers because that is true hallmark of a MMH-asking questions and continuing to search for the answers. We’re interested in hearing your take.

Articles

 - "Aging is a risk factor for oral cancer"  - "Everyone needs to floss"  - "Restorative dentistry restores oral health"  What is the truth and current science behind these statements? The automatic answer has a high likelihood of being dated, incorrect or incomplete. The public and many of us believe what happens in clinical dental hygiene practice is based on science. Yet, is it?

Evidence, hype or manipulation?

	Dental hygienists are arguably an officious bunch. They love their rules; they trot them out like prize ponies, showing everyone that they know the score and were taught well. But U.S. dental hygienists have a secret. They are thugs, and they don’t even know it.

Whenever a new product advertisement comes out featuring a dental hygienist, the internet groups are all abuzz commenting on the model's hair length, mask placement, patient goggles, open or closed collar on the lab jacket, earrings, makeup, nails, infection control protocol breaks and who knows what all else! They break their arms patting themselves on the back for noticing that the faucet still has knobs in the background of the picture. Chairside, they continue to charge out the prophy code in patients who they are obviously treating for a periodontal condition. Who’s it hurting? Everyone.

Look at the case of Dr. XX who was jailed for 

 fraud because he never noticed his office manager double-billed for procedures and pocketed the money. The dentist paid the price for that negligence.

Dental hygienists, the same people who notice an open collar on an advertisement, practice on a patient with bleeding and periodontal pockets and never recommend a salivary test for periodontal pathogens. They sweat bullets and take “after” radiographs to determine if the calculus is removed and charge out a simple preventive appointment, D1110. Is that insurance fraud? What’s the risk?

Does it matter what the risk is? Laws are intended to be followed. Laws are society’s way of agreeing on how to live. Insurance rules are in place to help keep businesses on track. When a dentist does a crown and charges a filling, what’s that called? Aside from being called crazy, it’s fraud. It's the same when a dental hygienist uses his/her skills to work in a bloody field deep below the crest of the tissue but charges for a simple procedure reserved for healthy tissues. It is also a crazy fraud. But it’s even worse because they are, in effect, committing crimes, namely:

 – From the employer by giving away services

 – To the patient, employer and insurance company

 – To all the other hygienists who are fighting the good fight trying to keep their job and prove their worth to employers who only see someone who will be paid $45 an hour and produce $90
		 

Straight talk: Revisiting a controversial article and the importance of the Modern Millennial Hygienist

Where do you sit? If you’re reading this, you’re probably seething because you know someone who is not the epitome of a dental hygienist; someone who has turned off their brain years ago.

 dental hygiene groups was about a “new” type of practitioner invented by the 

. In this role, someone would scale and polish teeth for next to nothing and be trained on the job. Oh, the horror! The Modern Millennial Hygienist, someone who has grown up under the team metaphor, will look at this development and wonder how it got to be that way. What motivated the ADA to make this recommendation? Money is the obvious answer, but what happened to make this such a priority? There are already too many schools, too many unemployed and too few dental school graduates, so why offer another team member?

We’re interested in hearing your take. Are you a thug, battering patients and stealing from your employer, forcing it to find alternatives to the classic dental hygienist? Voice your opinion below-only a voice can tease this problem apart.

In the future, we’ll explore the idea of the two-year degree. Did you really graduate in two years? We didn’t think so.

Listen to a podcast on breaking the law dental hygiene style below:

	Check Out Business Podcasts at Blog Talk Radio with 

Related reading: The 5 new words of dental practice ... and what you should know about them

 Dental hygienists are arguably an officious bunch. They love their rules; they trot them out like prize ponies, showing everyone that they know the score and were taught well. But U.S. dental hygienists have a secret. They are thugs, and they don’t even know it.

Breaking the law, dental hygiene style

American Dental Educators Association (ADEA)

 formed a committee charged with assembling a glossary of terms for dental educators. Their labors were published in 

July 2010 Dental Clinics of North Americas

. They found this necessary because the teaching of dentistry had changed in light of 

CAMBRA-Caries Management by Risk Assessment

The words used were from a time when surgical treatment was the only option for dental diseases. Redefining words in light of the current science was overdue. Some changes that occurred redefined words and gave a framework to instructors and clinicians alike. The word “

 was defined and declared as obsolete. “Watch” would no longer be used as a term that educators can teach in the context of this century.

 is very comfortable with “Watch” being obsolete. We have products and support that allow enamel healing, brush biopsies of minute visible changes, and ways to detect and treat a periodontal infection before it destroys bone, so there’s no good reason to passively 

 anything. We have a great scientifically minded group of people who know that watching is not helping, and every little defect can be treated or a protocol administered.

Sometimes we have to go backward to go forward. Take a look at these words -- 

caries, restoration, prosthesis, and diagnosis

. Since you’re a program graduate, there’s probably never been a reason to look at the definition of those words in your daily life. You found a definition that works for you back in school and you’re using it, right? Why not act like it? No definition of caries includes the phrase 

 (as we discussed last time). Yet when a tooth presents with a cavity in it, from whatever cause, fluoride is the first treatment that comes to mind … and too often it’s the only treatment. Caries is a bacterial infection that manifests as damaged enamel as does GERD.

Restoration is a word we routinely swap out for prosthetic in dentistry. The words should live in the two different worlds of dental hygiene and dentistry. Dental hygienists restore the mouth to health and dentists place prosthetics to restore function. Not many dentists want anything to do with prosthetics. However, they don’t mind placing restorations. The questioning nature of millennials forces this wordplay into the foreground. Industry has provided oral health care practitioners with the tools and means necessary to restore the oral flora and enamel back to health. We now have to alter our language to be more accurate.

In medicine, there’s a diagnosis and a treatment. An appendectomy is the treatment for appendicitis. In dentistry, we skip over the diagnosis and go right to treatment, as if every diagnosis were identical. This lack of diagnosis, the 

 of the condition that needs the treatment, has really kept our profession in the dark. We’re still doing dentistry and dental hygiene too much like we were doing it in the 1980s. Sure, we’re using loupes, seeing more patients more often, but we’re still scraping hard deposits off of teeth with sharpened instruments and 

 patients on how to keep their teeth a lifetime. All are treatments. Looking for a diagnosis first, a reason why the teeth are decaying or a periodontal lesion is presenting, is how we can better relate treatments to or patients. They’re expecting that from us.

Related: 4 reasons Modern Millennial Hygienists	should track their production numbers

We’re now living in an age when our understanding of disease, mixed biofilm, obesity, and foodstuffs that are altered at the genetic level has changed in the last generation. Our knowledge base changes twice a generation, so jumping to treatment without diagnosis is dangerous and expensive. Is that periodontal condition exasperated by a food allergy or sleep apnea, or an undiagnosed tongue tie? Is that cholesterol profile out of sorts because of the inflammatory load caused by an untreated periodontal infection that includes a fungus that is growing in the periodontal biofilm? Those are burning questions that should be asked by the oral healthcare provider.

Related: 5 downtime activities to show you are an indispensable Modern Millennial Hygienist

There you have it … the 5 words that need to be redefined and their true meaning needs to be dusted off and internalized. When you ask why an oral condition has arisen and make a proper diagnosis, you will be amazed by the rise in treatment acceptance. With increased treatment acceptance comes increased income. Millennials like a paycheck as much as anyone else, that’s certainly something they have in common with the Boomers and Gen Xer’s.

Next time, we will look at what BOP does or doesn’t mean and delve further into compensation. We look forward to your thoughts and comments.

 In 2008, the American Dental Educators Association (ADEA) formed a committee charged with assembling a glossary of terms for dental educators. Their labors were published in July 2010 Dental Clinics of North Americas. They found this necessary because the teaching of dentistry had changed in light of CAMBRA-Caries Management by Risk Assessment. 

The 5 new words of dental practice ... and what you should know about them

	Mass media face tight restrictions on time and space. There are limited minutes to deliver the message in a fast-changing, ever-more complex world, and the tendency can be to oversimplify.

Oversimplifying complex issues and giving simplistic answers can feel like the best choice; the saying “If all you have is a hammer, everything looks like a nail” can apply here.  This concept applies to other industries as well. In dental hygiene with our limited minutes, care often falls into two almighty, seemingly unchallengeable f-words: Floss and fluoride.

Trending article: Navigating uncharted waters for your dental practice in 2015

When you say you are as dental hygienist, how many times has the response been, “I didn’t floss?”  Advertising seems to indicate the permeation of fluoride into most dental products is the golden ingredient to oral health. The public now believes, based on our constant hammering, that everything can be solved with floss and fluoride.

Hammers are useful tools but only if they are used for the right purpose. There is nothing better than a hammer for driving nails, but nothing worse for cleaning glass or scratching your back. When it comes to patient care, it’s time to rethink and discover more than just the dental hygiene F-words.

Dental caries is a transmissible bacterial infection of the teeth resulting in white spot lesions, cavitation and potential tooth loss

 It sounds simplistic but it is very different from traditional cariology. Dental caries is a pH imbalance of normal 

 on the teeth. This means that caries balance is an ever-changing and requires monitoring. Yet over and over in the presence of the infectious outcome-cavities, an immediate oversimplification starts. The hygiene f-word – fluoride – is automatic solution. Caries infection is NOT a shortage of fluoride! It’s time to quit seeing fluoride as our only or best option. It is an arrow in the quiver, yet deciding which arrows match the individual patient is best based on risk-assessment and diagnosis – the “why” of the infection.

Trending article: The latest hourly and salary numbers for dental hygienists, dentists and dental assistants

In 2012, many dental professionals were upset with a 

 (AHA) that poured cold water on the idea that periodontal disease contributes to heart disease. The statement was the supported by the 

. How absurd? Could this be? As hygienists, we know that if someone flosses they can prevent heart disease. Though few us will go that far, our communication seems to indicate that if they entire world flossed, we would have world peace.

The AHA statement clarifies the difference between causality and association. Causality means there is irrefutable proof that one entity is consequence of other. Association means they share characteristics and possibly risk factors, yet one does not necessarily cause the other. The question of whether a clinically significant association exists between periodontal disease and heart disease has tremendous importance.

Research continues to evolve almost daily, yet the real message here is again oversimplifying the complex. What risk factor assessment and diagnostic tools are we using to make the diagnosis? Was a diagnosis made?

More often, a huge leap is made to the f-word as part of our treatment plan. The patient must floss to reach and maintain periodontal health. Floss is an arrow in the quiver yet deciding which arrows match the individual patient is best based on risk-assessment and diagnosis – the “why” of the infection (didn’t we say that already?).

More from Patti DiGangi and Shirley Gutkowski: What Modern Millennial Hygienists need to know about  allergies

Millennials are a generation of individuals who are consuming content in tiny, multimedia-saturated bites

If you have ever used Twitter, you know 140 characters means you have to be concise. That means you have to know exactly what you want to say and say it in as few words as possible. Millennials have discovered more concise ways to communicate. It does not mean oversimplifying. Concise language forces us to exercise our vocabulary; it can make us better writers. It also has the opportunity to make us more concise thinkers.

	Check Out Health Podcasts at Blog Talk Radio with 

Next time, we will explore the 5 new words for dental practice. 

 Mass media face tight restrictions on time and space. There are limited minutes to deliver the message in a fast-changing, ever-more complex world, and the tendency can be to oversimplify.

Hammering the two dental hygiene F-words

 are more conscious than ever of how food affects their health.

The obesity and diabetes epidemics have cast food in a negative spotlight, and millennials have demanded healthier choices. Shirley has become acutely aware of this topic with recently diagnosed food 

, and Patti has faced this challenge for many years. What does that mean for us? As modern millennial hygienists (MMHs), we now understand allergies are an inflammatory response.

Study: Link between periodontitis and diabetes

Chairside experience can equal rote behavior

How do newly discovered allergies really affect 

 treatment unless the patient is allergic to stainless steel or latex?

As we rediscover the interrelationship between oral condition and system-wide effects, we don’t know exactly how one affects the other. Allergies are just as big an issue as 

. Food allergies are proving to be an untapped aspect that could be an answer to patients who won’t respond to traditional periodontal therapy.

Related reading: 4 reasons that modern millennial hygienists should track their production numbers

Allergies present themselves in two ways: one overt and the other covert. The traditional rash, boils, hives, itching, cramps, vomiting, sneezing, wheezing, coughing, skin color changes, itchy eyes, fatigue, irritability, etc. are overt manifestations. In some areas of the industrialized world, up to 50 percent of the population is affected with allergies. The real issue (covert manifestation) is Immunoglobulin E (IgE), the antibody responsible for 

 all of those overt responses. IgE stimulates, or rather initiates, mast cells. Mast cells, as we were always taught, have binding sites for IgE stimulated by allergens, which triggers the release of substances from mast cells that can cause inflammation, which is where the perio connection comes in.

The increased covert inflammatory condition contributes to the overt periodontal markers, like bleeding. Will that affect health care providers' recommendations on 

? The inflammatory cascade is working overtime, especially if the patient was unaware of his or her allergy status, like Shirley was.

10 questions: Genetic testing, periodontal disease and the role of the dental professional

A body under attack from undiscovered toxins/allergens may be in an overreaction situation. The most critical consequence of this underlying inflammatory load is the laying down of arterial plaques. An undiagnosed IgE response increases the likelihood of having arterial plaques, which increases the likelihood of a periodontal condition.

 is another under recognized problem that may be related to allergies and, even on its own, will cause an inflammatory response. Obstructive sleep apnea (OSA) occurs when the breathing is interrupted because of an obstruction of upper airway blocking air flow into the lungs while sleeping. Common signs of OSA are gasping and choking during sleep, dry throat upon awakening and excessive daytime sleepiness. The correlation between allergies and sleep apnea is the airway swelling as a response to allergens starting at the nose. The nose, obstructed by discharge, is a blocked airway.

Research: Snoring increases risk for cancer

Oral symptoms of sleep apnea include a scalloped tongue and enlarged uvula. Sleep apnea decreases systemic pH, including the oral cavity; increases the time for oral dryness; and, most importantly, increases inflammation in the body. Whether on the health history or stumbled upon during the 

screening, these things can open the door to a meaningful conversation about the patient's entire health. Then, the conversation about insurance and payment can be mitigated to a level of understanding never before experienced.

As we gain scientific knowledge about inflammation’s role in health and disease, applying that knowledge becomes more important and requires a new level of engagement by the clinician.

More efforts must be dedicated to the understanding of allergic sensitization and how it can be prevented. The identification of the pathological role of IgE and the subsequent release of inflammatory mediators and cytokines has enabled physicians to treat allergic symptoms with regard to the underlying immunological mechanisms.

Related reading: 3 steps to increasing acceptance for periodontal services

As MMHs become the growing representative member of the health care team, this knowledge comes to the forefront. As rethinking and exploring status quo is innate, millennials will take more of a global look at the patient’s health and overall risk profile for catastrophic events. The one thing everyone needs to know about allergies is that they’re not just inconvenient.

Can you imagine a better health history? What would that look like? What questions would be added? Use the section below to share your thoughts and comments.

Related reading: What are your sacred cows?

 Millennials are more conscious than ever of how food affects their health.

What Modern Millennial Hygienists need to know about allergies

	Millennials need to feel as if their treatment is important and that they are on the right track; this means being inquisitive. Is there anything in the practice of dental hygiene that should be exempt from questioning and examination? 

Apparently, periodontal probing should not be questioned, making it a sacred cow. Being a 

Some religious beliefs hold a high reverence to cows. Sacred cow status means something reaches a level of belief where it becomes exempt from examination or criticism. In dental hygiene, just to name a few, they often include:

Time after time, you have sat in a course, read an article or been introduced to a new product, gotten excited by the possibilities – yet end up doing things basically the same way you always have. How many of us have any extra time to add more? Many us of have gone through a half or full day and never even taken a bathroom break. If we do make changes, the change is more about tweaking around the edges rather than contemplation about how things are now and what they could be. What can stall the thinking are those should and musts, those sacred cows.

Trending article: 3 reasons why a Modern Millennial Hygienist does NOT perio chart

 "We must do targeted research and be sure that we are asking the right people the right questions so that we get real-world answers to real-world problems. There can be no sacred cows". To emphasize her point, she brought a blowtorch to the podium saying it was part of her required instruments for dental school and that there are items that have only historical significance but have lost their relevance in world. 

Slaying sacred cows: is it time to pull the plug on water fluoridation?

 people questioning deeply held beliefs to find their current relevancy. This 2012 article appeared in the journal 

, a publisher that has been publishing academic research since 1798. The paper is valid not just in the UK, and the current trend of looking only at research from the USA is crazy in this world of interconnectivity and global economy. Looking only at US-published papers, or research and articles published in our peer-reviewed journals is another sacred cow.

Free E-book: How floss alternatives can help patients improve preventative care

Many of us feel a struggle every day we practice as we put what we learn in articles and courses to the test. We continue to struggle because we are bombarded daily with information on how to create a career of choice. The authors believe that many of us are kept from our potential by an inability to see what is possible. The profession of dental hygiene, guarded by the profession of dentistry, continues to allow others to define our place, worth and limitations. We continue to perform according to the calves, “I was always taught…” or “The patients expect….” Or “I will lose my job if….” Are these your thoughts or your interpretation of others expectations?

Sacred cows are myths and traditions that distort our thinking. The cows are thoughts and beliefs widespread and constantly perpetuated or reinforced by educators, online groups, professional originations and friends. What happens is the beliefs become so pervasive they are rarely questioned and even less often defeated. Much of what we describe as being a MMH is designed to be spicy/controversial to provoke an emotional response that advances thinking and questioning. It isn’t throwing the baby out with the bathwater; it’s revisiting the foundations of our actions by examining what, where and when they are based and whether they continue to be of service. Explore those ideas, and evaluate their necessity in the practice of an oral health care provider. 

Do yourself and your patients a favor and wonder about your own sacred cows. What beliefs, if challenged, have you seen others react to? What bring up an emotional response in your own body? We invite your to share your Sacred Cows by putting them into the comment section below. 

Trending article: Finding your own superhero and conquering your kryptonite

 Millennials need to feel as if their treatment is important and that they are on the right track; this means being inquisitive. Is there anything in the practice of dental hygiene that should be exempt from questioning and examination? 

What are your sacred cows?

 because they want freedom of choice in everything. They may not balk at the assignment itself but instead may challenge the methodology. A 

 questions the same old way of charting and diagnosing periodontal disease. A Modern Millennial Hygienist knows that symptoms-disease-dysfunction does not make sense with science. The symptoms are the last part to appear. Waiting until symptoms appear doesn’t make sense and creates unintended consequences. Why are we still so intent on perio charting? Why is this process a measuring stick of professional worth? What does charting really do?

The most significant unintended consequence, ignored by nearly everyone in our profession, is the iatrogenic vector type disease transference caused by the periodontal probe.

We have a good understanding that periodontal disease originates at a specific site so we blissfully go about periodontal charting as if moving mature biofilm from one site to others has no consequence. It does. Each biofilm is its own entity and life form. Host response notwithstanding, moving that biofilm around is disease promoting and should end immediately.

. Only a few of us know what is considered normal. Measuring from the alveolar crest to the CEJ should be 1.5-2mm. Isn’t it important to understand what we mean by loss? Loss from where? Yet what does the presence of bone loss tell us anyway? Like a fever, bone loss tells us that something has happened, but there’s no way to tell when or how. The probe tells you there was damage in the past. That’s it.

Breaking through the base of the sulcus/pocket is another unintended consequence of periodontal charting. Invading the pocket with a probe is not without consequence. It’s painful, and increases hormones like cortisol, or we’d see that it increases cortisol in our patients if we look. Damaging that intricate tissue may contribute to advancing a bacteremia, injecting pathogens right into the bloodstream. Studies have identified oral bacteria in nearly every body part, including amniotic fluid, cardiac veins and arteries, brain tissue and more.

MORE FROM THE AUTHORS:	4 reasons that Modern Millennial Hygienists	should be tracking their production numbers

A Modern Millennial Hygienist knows periodontal disease is a 

 and our diagnostics should do more than reflect a single consequence of active periodontal breakdown.

: For starters, a saliva test for the pathogens known to be present in periodontal infections gives great information. 

 of the bacteria present in the saliva shows whether periodontal pathogens are present. Knowing if the pathogens are present is a good starting point for treatment, and knowing they are no longer present is helpful as well.

· Inflammatory level lab tests: There are also tests available to determine inflammation levels that may be attributed to the presence of periodontal pathogens. As those values fluctuate with treatment, the clinician determines the treatments’ effectiveness.

As compared to periodontal charting where the pressure exerted, the angle of the probe, the person reading the probe and the tissue tightness all interfere with the readings; lab values do not. They give the best, most accurate and most easily repeatable information.

MORE FROM THE AUTHORS:	5 downtime activities to prove you are an indispensable Modern Millennial Hygienist

Our dental hygiene education taught to chart the periodontal condition using a periodontal probe, an instrument designed and perfected in the late 1800s. Today’s periodontal probes are not much different than those created more than 120 years ago. Was it ever really intended as the essential diagnostic tool we use it for today?

Get your critical thinking cap on and recommit yourself to ultimate patient health care that starts in the mouth. Regardless of your age, or what school or year you graduated, one message stands out above all else for the Modern Millennial Hygienist: Our goal is to help bring each patient to their individual highest level of health which is impossible to accomplish with a bent wire with or without markings.

Next time we will be looking at researching technology that will work for you in your office. 

Editor's Note: Photo credit Gutkowski/Kinsell

Millennials balk at doing things the way we’ve always done it because they want freedom of choice in everything. They may not balk at the assignment itself but instead may challenge the methodology. A Modern Millennial Hygienist questions the same old way of charting and diagnosing periodontal disease. A Modern Millennial Hygienist knows that symptoms-disease-dysfunction does not make sense with science.

3 reasons why a Modern Millennial Hygienist does NOT perio chart

Millennials are natural entrepreneurs and are not much satisfied with status quo. The 

 crisis has brought to light the need for proper personal protective equipment and procedures. Yet there needs to be funds to pay for it. The 

 needs to be more than a nebulous idea. A 

 recognizes the consequences of their production numbers and wants to know.

In the traditional dental hygiene model, compensation is based on some vague per hour, per day or “going rate” idea. Practice management consultants say 

 should be no more than 1/3 of production (though none say why this is an accurate figure). MMHs know it’s time to reevaluate the entire game and look at employment from an entrepreneurial point of view.

You have probably heard, “work smarter not harder.” What does that mean? No one ever says what working smarter really means. Most all of us work hard already even to the extent that you may find that you haven’t even taken a bathroom break for half or even the entire day. We are already smart though we can all get smarter. Perhaps what is needed is to be more deliberate and use measurable systems.

Shirley created a numbers tracking tool for her 

1. To have a way to truly see how you’re managing your time

2. To prove you’re practicing your beliefs rather that only what others expect from you

3. To show the value you bring to the patients and practice

4. To create an increased compensation plan

This tracking tool has one purpose: to help you to focus. You can see on a daily, weekly, and/or monthly basis if you’re meeting your goals. If you are thinking, “I can’t get the numbers,” we call that 

. Be creative … you know what is being done in your chair. Which answers the next question: Should the dentist exam/evaluation and radiographs be counted in your production? Absolutely yes! If the care was performed in your chair, that means you couldn’t be performing other care. Besides, the hygienist generally performs the majority of both of these procedures. Don’t mix payment for procedures and politics with what your treatment room produced because you are in that room.

Additional learning opportunity:	How to manage hypersensitivity in your dental patients

That fourth purpose of tracking your numbers is 

. First, you need to decide what compensation means to you. Don’t start with everyone else’s definition, figure out your own. Dream big! There are no limitations in this part of the exercise except what you put on it. What’s the ROI (return on investment) you want for your work? So you decide $1 million. Is this possible? Why not? Yet compensation does not mean $$ only. Compensation may mean health benefits. It may mean having the practice pay for something like a personal item like 

. It may be schedule flexibility. MMHs don’t just think in the traditional ways. When you track your numbers, you have the ammunition to make reasoned arguments. Oh, we don’t like that word “argument” because it means disharmony, disagreement and negative thinking, right? Not really. An argument is a logical, well-structured discussion of business facts and figures.

Dental hygiene is on a precipice of amazing opportunity. MMHs look ahead to see and help to create those changes. When an MMH learns to help direct the “sails” of change, he or she can also create “sales” for themselves. That is the way of the entrepreneur … and that is the way of the millennials.

Next time, we will be talking about the three reasons why an MMH does NOT perio chart.

Millennials are natural entrepreneurs and are not much satisfied with status quo. The Ebola crisis has brought to light the need for proper personal protective equipment and procedures. Yet there needs to be funds to pay for it. The cost of doing business needs to be more than a nebulous idea.

4 reasons that Modern Millennial Hygienists should track their production numbers

, we introduced the idea of the Modern Millennial Hygienist (MMH). MMH challenges our brains to use higher level revolutionary thinking. Growth and change can 

 return on investment (ROI) and profitability for the practice AND the hygienist. This issue, we will look at how a MMH uses the opportunities downtime provides.

One of the tenants of the millennials we can learn from is they don’t work off the clock. In the world the pre-millennials created, people struggle with 

. An entire industry cropped up over it. 

This time of year, moving into fall, can be downtime in our offices. There’s a limit to how many times you can organize a drawer. The number of patients may be down and the no-show/broken appointments may be up for a number of reasons … but that doesn’t mean you can’t be productive.

Here are five revolutionary ideas you can do to make your job more secure and help the practice serve patients better.

 When’s the last time that happened? What usually happens in protocol development is that someone thinks this new product or procedure would work great and it’s added in. Take advantage of the time in September to see if things really are working by printing off the codes and matching them to the perio charts of the patients. Are they getting better?

Additional reading:	The Perio Percentage KPI ... how does your dental practice stack up?

Create or reconstruct your caries management protocol.

 protocols? Are your patients on prescription fluoride experiencing less decay? How does that compare to patients on using remineralization therapies?

Evaluate your head and neck oral cancer screening processes.

 How many suspicious soft-tissue lesions did you refer out for evaluation in the first half of the year? According 

, a normal practice will see about one or two potentially cancerous lesions a week. If your practice doesn’t, what could you do better?

Start a protocol that identifies tongue ties. 

Have the patient open his or her mouth as wide as possible, then lift the tongue to the palate. How much does the mouth close to accommodate? Check out this link to 

. This is the true research you need to do to find out if products are going to work and how. Set up the search feature to look only for human studies and you’ll be off to the races. Find free full articles too. Once you’re signed in, a link in the upper right area (at this writing) will appear to choose showing only free full articles.

Set a team meeting for the hygiene department to compare notes and figure out:

· what changes could benefit the practice most

· calibrate with other hygienists and dentists

· set a strategy for the next slow month (February)

In this time of high hygiene unemployment, a MMH knows making the best use of time is critical. Going home is not a good option for most paychecks, but filing charts or cold calling patients is not a good option for the practice bottom line. Applying the MMH strategies above prove you are a keeping yourself employable and retainable.

Next time, we will look at how MMH weigh the pros and cons of juggling many responsibilities at once.

In our previous article, we introduced the idea of the Modern Millennial Hygienist (MMH). MMH challenges our brains to use higher level revolutionary thinking. Growth and change can warp-speed return on investment (ROI) and profitability for the practice AND the hygienist. This issue, we will look at how a MMH uses the opportunities downtime provides.