	You’re going about your day. You’re rockin’ your hygiene thing, yucking it up with your dental cronies in the lab, or perhaps you’re in the operatory for the periodic exam with the dentist, then all of a sudden- WHAMMO! 

	You’re going about your day.  You’re rockin’ your hygiene thing, yucking it up with your dental cronies in the lab, or perhaps you’re in the operatory for the periodic exam with the dentist, then all of a sudden- WHAMMO!  Out of nowhere, a brick wall made up of complete and utter “huh?” headbutts you and leaves you thinking… what the hell? What just happened?

	We’ve all had them. I’ve had quite a few myself. In fact, I’ve had some superfreaky instances that left me thinking to this day, “It’s not me. That was ridiculous!”

	The following are some of my personal favorite “WTH?” occurrences that left me sad, distressed and simply at a loss for words. And just to mix it up a bit, I did offer responses to these statements. (It was hard to remain silent afterwards.) I’ll admit they weren’t the most elegant of replies but sometimes it’s hard to compose yourself when you’re choking on some stupid.

These quotes happened to have come from dentists. For the record, I love dentists.They’re awesome and some of them make me giggle. Quite a few have taught me how to properly educate our patients and some have taught me an onslaught of skills I’ll use till I’m old and crotchety. However…
	
	

	“Use your toothbrush to massage the gums back down.”
	
	Whaaaaat? Did the dentist just- oh, my god, he did!  The patient was so excited about ‘curing’ her gum recession that she didn’t take her eyes off the dentist during his explanation. After he left the operatory, I approached the patient gingerly.

	“Ummm… you don’t have to massage those areas frequently. Not that frequently at all.” 
	Sometimes it’s difficult to correct the painfully incorrect… in this case a dentist that’s been practicing for close to 30 years… ouchy.

	“We don’t want those losers in our practice.”

	He just called those patients losers. Is he insane?! The ‘losers’this different dentist was referring to were low-income patients that did not have dental insurance.  In this instance, I had no reply. Can’t talk… still gagging.

	“Why does this patient keep asking me questions about the procedures? Just do it, already.”

	Why does he keep- Because you’re the dentist!  My reply:  “I know. What a pain in the butt, right?” 

	“I don’t do cleanings. That’s your job.”

	A lot of dentists don’t perform prophylaxes.  That’s not surprising nor was I severely traumatized by this particular dentist’s statement.  It’s just that… I was the only hygienist in the practice.  I only wanted a teeny-weeny prophy on my teeth. “So you won’t scale my teeth?”  I waited for another reply from this particular dentist. “Well, can’t you get your teeth cleaned by one of your hygiene friends?”

	I didn’t feel very special that day… sniff.

	Thought I would leave the #1 spot for Modern Hygienist readers. Oh, come on.  I know you have some.  Share with us.
	 
	 

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 You’re going about your day. You’re rockin’ your hygiene thing, yucking it up with your dental cronies in the lab, or perhaps you’re in the operatory for the periodic exam with the dentist, then all of a sudden- WHAMMO!     Eva Watson, RDH.   You know how this goes.

Top 10 "What just happened?" moments in dental hygiene

	SYRACUSE, N.Y., July 6 /PRNewswire/ -- Practicing good oral hygiene and receiving regular dental exams are critical to good oral health, yet many Aspen Dental dentists report that patients continue to delay care, a decision that can prove costly down the road.

	"The current economic environment has forced many Americans to delay seeking dental care, cutting back on everything from cleanings to dentures to treatment of gum disease," said Dr. Arwinder Judge, vice president of clinical support at Aspen Dental Management, Inc. "Considering the link between gum disease and certain health conditions like heart disease, diabetes and stroke, patients should try to make regular visits to the dentist just as much of a priority as regular visits to their primary care physician."

	Adds Dr. Judge, "Ultimately, seeking preventative care and taking care of small dental problems before they become big problems pays off."

	According to a report by Oral Health America, early dental treatment is cost effective. In fact, the cost of providing preventive dental treatment is estimated to be 10 times less than the cost of managing symptoms of dental disease in a hospital emergency room. Moreover, the report notes that improving oral health by multiple preventative approaches, including periodontal (gum) disease management, saves more than $4 billion per year in treatment costs.

	Regular oral care is just as important for the nearly 50 million Americans who wear full or partial dentures. Even patients who have no natural teeth should have their mouth examined annually not only for signs of oral cancer, but also for proper denture fit. The tissues in the mouth change over time, and bone and gum ridges shrink, which can result in ill-fitting dentures that make eating uncomfortable or downright painful. While the American Dental Association recommends that dentures be replaced every five to seven years, many people keep the same set of dentures for much longer.

	Another key concern for people with dentures is the use of denture adhesives. While adhesives can help dentures feel more stable and secure, long-term excessive use can potentially pose health risks. Patients should closely follow labeling instructions for denture adhesive products. If dentures feel loose or cause discomfort, it is important to contact your dentist as soon as possible about an adjustment or replacement.

	Doctors and staff at Aspen Dental work to help break down the barriers that keep patients from getting the oral care they need, offering convenient locations, extended hours including select Saturdays, affordable fees, and a wide range of flexible payment plan options. Aspen Dental practices work with all insurance plans.  Walk-in patients and those with emergencies are welcome.

	To help encourage patients to take the first step toward good oral health, Aspen Dental offers free new-patient exams to patients who do not have the benefit of insurance; free denture consultations for all denture patients; special promotions and senior discounts. Patients can learn about what to expect during their first visit to Aspen Dental at 

www.aspendent.com/appointment.first.visit.html

.
	
	To make an appointment, call 800-ASPEN DENTAL or visit 


	
	One of the largest and fastest-growing networks of denture and dental care providers in the U.S., Aspen Dental practices are committed to providing patients with affordable, high-quality care under the Aspen Dental brand.

	Aspen Dental practices are nationally accredited by the Better Business Bureau (BBB) and maintain an A+ rating with the BBB's Reliability Report.

	The Aspen Dental network currently has more than 250 locations in 20 states. In 2009, Aspen Dental doctors recorded more than 1.5 million patient visits, including visits from more than 340,000 new patients.

	Aspen Dental doctors and staff help meet the demand for high-quality, yet affordable denture and dental services by offering convenient retail locations, extended hours, affordable fees and a wide range of payment plan options. The offices work with all insurance plans.

	For more information about Aspen Dental practices and services, please visit www.aspendent.com. To learn more about careers at Aspen Dental, please visit 

 SYRACUSE, N.Y., July 6 /PRNewswire/ -- Practicing good oral hygiene and receiving regular dental exams are critical to good oral health, yet many Aspen Dental dentists report that patients continue to delay care, a decision that can prove costly down the road.

Aspen Dental dentists report that patients continue to delay care

	Senior Mobile Dental is a non-profit organization focused on bringing dental hygiene services to the elderly population of the Colorado Springs area.

	In 2000, the Surgeon General reported on Oral Health in America, finding that ‘there are profound and consequential oral health disparities within the U.S. population’.
	For years now, the elderly community has slowly become an invisible population; their position in the dental industry is no different. It’s no secret that the majority of dental care providers are family practices and most public support programs are focused on children ages 18 and under. So how has a majority of our population failed to receive proper dental care?

	One of the most common concerns the elderly population has about receiving proper dental care is cost. According to MEPS, in 2000 people ages 65 and older paid more than three-quarters of their dental expenses out of pocket. Since most of the elderly receive Medicaid or financial support from family members, the near 3,000 dollar cost for dentures can seem overwhelming.

	Still, dentures are a seemingly easy fix compared to abstractions extractions and restorative procedures which are significantly more expensive. “Most of these people are on a fixed income, so their dental care is put off,” registered dental hygienist and founder of Senior Mobile Dental, Michelle Vacha said.

	“There is some kind of barrier, and I’m not sure what it is. Maybe these people are afraid knowing if they go to the dentist they will find something wrong, and they’ll be hit with heavy costs in order to fix the problem,” Vacha said.

	While cost may be the root of the problem, it isn’t the only issue for the elderly. Access to care is just as troublesome. The elderly are also frailer; transporting to a dental office can be very traumatic. Loss of dexterity, makes it difficult to impossible to brush their teeth themselves. And while many of the elderly live in assisted living and skilled nursing facilities, little instruction is given to CNA’s for proper oral hygiene. Elders also face decreased salivary flow leaving them with heavy plaque and materia alba buildup, which Vacha compares to “velcro on their teeth.”

	Everyone has their embarrassing moments they’d be only too happy to forget. Vacha says as she recounts one of her first experiences with an elderly patient. Incontinence is a major issue they face while transporting out of homes.

	“I had an elderly woman that was dropped off for a dental appointment; while I was with another patient she went to use the restroom," Vacha said. "When I finished with my patient and I walked to the front office, staff was standing around the bathroom. The woman needed help and she sat there for over half an hour and no one went to see if she needed help.”

	Once they make it to a dental office, often times the elderly will find that the facility does not cater to their needs beyond the chair.

	“The general public is not used to providing them with the help they need,” Vacha said. "And in truth, it can be uncomfortable for the clinician and patient; yet another reason a lot of elderly people opt out of going to the dentist. The dental industry needs to find a way to help the elderly community with their dental needs, while allowing them to keep their dignity intact."

	Still, the biggest hurdle the elderly need to overcome is cost. A typical checkup can run anywhere from 250 to 300 dollars. Not to mention the cost of dentures, fillings, restorations and extractions. Medicaid and Medicare and public support in funding need to be reassessed, in order to help this community receive the dental care they need.  Very little options are available for preventive oral health care.

	“We need to start addressing these issues now before it really hits us,” Vacha said.  "Poor oral health relates to all kinds of health issues ie, the oral/systemic relationship which could be avoided by getting the proper dental care. Dental care is important to us all, overlooking a generation that is seemingly ‘invisible’ will cause an epidemic, and with that will come health issues and crisis across the board."

	Vacha’s main observation: “If this population still has their teeth at this stage of their life, it shows they have taken care of their teeth their whole life. Why should their standards of care change now due to retirement and loss of dental insurance, loss of dexterity or loss of their ability to transport to a dental office? This is why I founded Senior Mobile Dental; to address the issues older adults face in access to care and their financial barriers.”
	 

   Senior Mobile Dental is a non-profit organization focused on bringing dental hygiene services to the elderly population of the Colorado Springs area.  Photo: Courtesy of Senior Mobile Dental

Dental care and the elderly

	The concept of providing dental services in a hospital dates back to the late 1700's in New York City, to treat the poor.  The majority of the dental care rendered in many hospitals is focused on the diagnosis and treatment care necessary to support the recovery of the medically compromised patients admitted for serious head and neck diseases, infection, or trauma. To support the need for training dental personnel, teaching hospitals include training programs for graduate dental students, and rotate them through a dental department and other appropriate departments such as emergency medicine, internal medicine and anesthesiology. Every year more than 1,000 dentists receive training in a hospital. The scope of practice varies greatly, being dependent on such factors as bed capacity, funding and the level of specialty expertise.

	The duties and responsibilities of the dental hygienist in a private practice have been established  over many years by laws as well as tradition. Less defined, however, is the role of a dental hygienist in a  hospital setting. The services that a dental hygienist provides in a hospital go far beyond the traditional duties of teaching oral hygiene instructions, exposing radiographs, scaling and root planning. The dental hygiene patients in a public health setting are typically underserved groups.  Many hospitals provide a great portion of their primary care through their outpatient services including dental care. This is especially true in neighborhoods with high poverty rates and large number of uninsured individuals.

	A dental hygienist in a hospital setting is in a unique position to perform a variety of duties in meeting the oral health needs of the inpatients and outpatients of the hospital. Establishing outreach programs for different patients is an exhilarating experience. One can begin with the prenatal outpatients by informing expectant mothers about the importance of proper dental care starting early in a child's life. Another outreach activity is coordinating preventive oral health programs for pediatric inpatients. It is gratifying to see how much the children enjoy the oral health presentation.  

	In order to be successful in a hospital environment, a dental hygienist must be highly organized and detailed oriented.  The documentation and infection control requirements in a hospital are far more stringent than a private office.  There are many governing agencies both at a state and federal  levels that monitor a patient's safety. Hospitals routinely have accreditation inspections by various agencies including  the Joint Commission Accreditation of Health Care Organizations (JACHO ). Hospitals either public or not-for-profit depend on positive outcomes from these agencies to receive further funding.

	A typical day for a dental hygienist in a hospital outpatient dental clinic can include providing care to 5-10 patients each day.  Most of these patients are special needs patients or medically compromised. Patients with conditions such as the developmentally disabled, physically challenged and cancer survivors, to name a few, are best treated in a hospital based dental clinic. Many of these patient's primary care physicians are located within the same hospital. It is convenient for consultation between the physician and the dental staff. The services provided by a dental hygienist in this setting, includes periodontal debridement, root planning, polishing and home care instructions. A dental hygienist also has to be creative as how to provide patient care since some of these patients are wheelchair bound or need assistance getting into the dental chair. Motivating patients to improve their oral hygiene care can be a life changing experiencefor the patients. Many patients have had emergency dental care and few have received preventive instructions. The patients are very satisfied and appreciative after receiving theseservices. It makes the essence of being a dental hygienist more rewarding. The hospital setting provides the dental hygienist the advantage of working along side a team of oral surgeons, dentist, nurses and medical doctors. The dental hygienist on staff may be asked to provide dental hygiene instructions to the nurse's for their beridden patients.

	Nurse’s are educated on the correlation of biofilm in the oral cavity and systemic diseases. This information is well received by the nurse's during their regularly scheduled inservice. The amount of knowledge an individual gains from the daily interaction of working with these healthcare professionals is insurmountable! A dental hygienist becomes proficien in emergency care, medicine, pharmacology and pathology. The unexpected becomes the norm!

	Someone who is considering a hospital dental hygiene position, must keep in mind that the position requires a great deal of patience, ingenuity and dedication to the patients. Many of these patients may be encountering preventive oral hygiene care for the first time in their lives. Due to the present economy, hospital dental practice is now becoming an alternative for dental care rather than the traditional private office setting. Most hospitals accept Medicaid, private insurance and sliding scale fees for the uninsured as payment for dental services.

	Hospital dental hygiene is a very exciting and rewarding career. The constant changes keep one sharp and abreast. I should know, I practiced dental hygiene in two hospitals for over ten years! My best memories are the smiles from patients when they thanked me for such a pleasant dental experience. They would always say, "I have never had my teeth cleaned that way before!" Check your local hospital's personnel office to see if your dream job is waiting for you!
	 

		Entry 1: Journal of a changed hygienist

		Part Two: Diary of an unemployed hygienist 

		Part Three: Diary of an unemployed hygienist

modernhygienist.com-2010-07-01

Top 10 "What just happened?" moments in dental hygiene

Aspen Dental dentists report that patients continue to delay care

Dental care and the elderly

Dental hygiene in a hospital setting