Being Woke Dentistry and Dental Hygiene

I’m not sure I understand the meaning of “woke.”In 2018, David Brooks, a political commentator, was quoted as saying, “To be woke is to be radically aware and justifiably paranoid.” It doesn’t mean “cool,” and it appears to derive from Jamaican philosopher and social activist Marcus Garvey, who, in 1923, encouraged all of Africa to wake up and connect individuals of African descent worldwide.¹ The woke movement appears to be a renaissance of sorts that coincided with the Black Lives Matter movement following the tragic fatal shooting of Trayvon Martin. Social media posts often include the hashtag, #staywoke, to remind Americans about police brutality and systemic racism, which is all too familiar to many of us who live in the United States, including me.²

Woke is a term to describe an evolving awareness of the needs and concerns of others, and I would like to suggest that we further develop this awareness in the field of health care, specifically dentistry and dental hygiene. For me, being woke in dentistry is a much-needed wake-up call that I’d like to scream at the top of my lungs to those who may be disinclined to listen. To reach clinicians who are becoming increasingly frustrated by corporate interference in the delivery of dental care, I direct my suggestions to the dental and dental hygiene care providers whose work is negatively affected when efficiency trumps clinical excellence.

Being Woke in the Delivery of Dental and Dental Hygiene Care

Becoming aware of the systemic nature of woke in today’s American culture reminds me that we must also be vigilant in our critical consciousness in our professional lives. This means not allowing our professional standards to fall to unacceptable levels as reimbursement rates continue to fall.

It seems to me that many health care providers are now at the mercy of managed care and corporate dentistry.³ We may want to deliver the highest quality of patient-focused care while the corporate interests try to rachet down costs. It is true that for many years, many providers were giving away services and resisted becoming more efficient. However, finding the right formula for becoming more efficient without negatively affecting dental care is key to service excellence.

An aha writing moment for me occurred on the day I accompanied my boyfriend Greg to the dentist. Greg is new to Georgia, and it’s been a few years since his last recare appointment. Having moved to Georgia from California, he was used to high-end care in a quality dental practice that included the placement of a dental implant where tooth #19 used to be. This general dentist was rated No. 1 by patients in the surrounding area, so he made an appointment as a new patient. Being the nosey parker I am, I decided to accompany him and sit quietly in the corner of the dental hygiene operatory.

I didn’t let on that I was a dental hygienist or a seasoned dental hygiene journalist; the written medical history was thorough but not reviewed by anyone. We were ushered into 1 of 6 dental hygiene operatories and greeted by a dental hygienist who was a recent graduate of a Georgia dental hygiene technical college. The visit started out well; the dental hygienist took a full-mouth series of digital radiographs, and I was able to view them from my seat in the corner of the room.

I immediately noticed the dental implant (tooth #19), but I also noticed peri-implant bone loss around it. I didn’t say a word, but I did ask whether I could look more closely at the radiographs. The dental hygienist didn’t perform a comprehensive oral cancer screening, which made my heart drop to the floor. Next, I was expecting a periodontal exam of some sort and as she picked up the periodontal probe from the tray, I was feeling somewhat hopeful. However, my hope was dashed as I watched her take the probe, spot probe in a few spots, then put it back on the tray again. She didn’t even go anywhere near the dental implant.

I’ve spent almost my entire career mentoring dental hygienists in one way or another, and most of my mentoring has been in nonsurgical periodontal therapy. To say I was disappointed in this dental hygienist is an understatement. I can honestly say I almost teared up when she failed to perform a periodontal exam. Next, she used an ultrasonic scaler in several areas of the mouth, followed by a hand scaler of some kind. She looked at the radiographs and seemed to concentrate on subgingival calculus on a few posterior teeth, but I stopped watching altogether and decided my phone messages were more interesting. She polished with a rubber cup, but her technique was very unusual, although none of it surprised me.

She then announced that the dentist was coming in for an exam, and a young dentist (a recent graduate) entered the room. He zeroed in on the dental implant with peri-implantitis and asked the dental hygienist whether she noticed the exudate. She said she hadn’t noticed, which was not surprising because her probe didn’t go anywhere near the dental implant. The young dentist didn’t do much of an exam, either, and he decided to refer Greg to an oral surgeon for an evaluation. I then spoke up, asking whether he could be referred to a periodontist, knowing there was subgingival calculus and alveolar bone loss on the radiographs and peri-implantitis to be evaluated.

I can’t honestly state that dental practice standards were low in this practice because of poorly trained clinicians, the result of managed care that sometimes focuses on financial outcomes, or a combination of these 2 factors. It pains me greatly to think that in 2023, there are clinicians who are practicing this way. It also makes me cringe to think that Greg was totally in the dark about the poor quality of care he received. He’s a well-educated, professional man who trusted the clinicians to provide a certain standard of care, but instead he received substandard care that would have received a failing grade in dental/dental hygiene school. However, he did say to me that he was wondering why the dental hygienist wasn’t recording numbers around the teeth his hygienist in California had done.

Woke in Dentistry: Incompetence, Lack of Quality Care, or Both?

Are we redefining dentistry in Western society based on financial gain at the expense of standards of care? Why are some dental and dental hygiene providers ignoring standards of care while others are excelling in group practices and corporate entities? Today, we have more opportunities to excel in our careers, but it is also more complex and riskier.

Woke culture has evolved to mean that we must be aware of the menace of discrimination and political, social, racial, and gender oppression. In our dental culture, as solo private practices disappear and are replaced by group practices and dental service organizations, professionalism must win, and ethical challenges must be addressed.For example, dental professionals should not put themselves in a position of compromising care for patients. Professionals set their own high standards and show that they care about every aspect of the job. You must hold yourself accountable to your principles, words, and actions while your patient is in your care. Professionalism is not the job you do; it’s how you do the job. Be woke in these changing environments for dental and dental hygiene practice, and don’t ever let efficiency overtake clinical excellence.

References

1. Encyclopedia Britannica. Marcus Garvey. Encyclopediabritannica.com. Last updated August 13, 2022. Accessed. March 10, 2023. https://www.britannica.com/biography/Marcus-Garvey
2. Markman T. The evolution of ‘woke.’ May 12, 2021. Accessed March 10, 2023. https://tiffanymarkman.medium.com/the-evolution-of-woke-865c4e826e7f
3. Investigative report on the corporate practice of dentistry. Academy of General Dentistry. 2013. Accessed March 10, 2023. https://www.agd.org/docs/default-source/advocacy-papers/agd-white-paper-investigate-report-on-corporate-dentistry.pdf