I'm a dental hygienist, not a therapist (or social worker … or saleswoman … or psychiatrist … or detective)

I recently co-authored a manuscript on patient compliance, discussing the different theories/methods that dental hygienists may use in order to motivate their patients to improve their oral hygiene behaviors.

The first step to writing such a thing is to do a thorough review of the literature (articles written by experts) and get as much good, solid information from good, solid researchers who have devoted themselves to getting to the bottom of things. That's what a good scientist does - forms a hypothesis then tests it and honestly reports the results. We, as the readers, are left to make our own judgments regarding the scientists' success or failure at proving their hypotheses.

In doing the literature review, I quickly became depressed. There were words in those articles that were foreign and unpleasant such as cognitive dissonance, cognitive behavioral interventions, reasoned action, social cognition models, and operationalization.

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My motivation for writing the manuscript came from my own experiences in private practice and realizing that my patients were no more dedicated to homecare practices now than they were 20 years ago when I first became a hygienist. Regardless of my enthusiasm, dedication, knowledge, or approach, they do not adopt my recommendations for the long term. Honestly, it’s frustrating!

So I looked to find the latest theories and the most effective methods I can use, according to the experts, to get my patients to do what I think is best for them. Additionally, I have the added responsibility of passing that knowledge on to my students via lectures and getting them to become really good at it as they work with patients in three semesters.

Read more of her frustrations and solutions on the next page...

The problem is that any student would need a solid background in psychology in order to even begin to understand the terminology, let alone effectively use the techniques with their patients in the clinic. Let’s not forget this has to be done simultaneously as they are learning instrumentation, radiography, treatment planning, etc.

Often I see articles about how “the dental hygiene visit is the ideal time to” discuss teeth whitening, do sleep apnea screening, diabetes screening, oral cancer screening, and HIV screening. Because, you know, dental hygienists have plenty of time to provide care (obtaining vital signs, scaling/root planing, polishing, CAMBRA, treatment planning, FM probing, exposing radiographs, patient education, expose a PAN, apply sealants and fluoride varnish, desensitize, pain management, check occlusion, discuss TMJ disorders, dietary counseling, etc.), so adding in these “little” things would only take a few minutes and would provide a valuable service to our patients. Other authors have alluded to how “compassion leads to compliance” (in fact, all the evidence clearly points out that the patient’s intrinsic motivation is the only thing that can lead to compliance and that our jobs as clinicians is not to “compassion” our patients over the head but to be persistent in our educational efforts) and, my newest favorite, salivary diagnostics.

I ask:

• If I did an HIV screening on a client and the results were positive, what training do I have (even with a master’s degree) to properly support that patient at that moment?

• Who’s going to pay for the fancy salivary diagnostic kit? My socioeconomically stable patients who have low incidence of disease or the socioeconomically unstable patients who have no insurance benefits? Because we clearly know the people who need us most are those who are poor and uneducated.

• Approximately 1 out of 11 Americans have diabetes; approximately 9 out of 10 are prediabetic and don’t know it. You need only ask physicians and nurses how successful they are at getting patients to comply with their medications/dietary recommendations to understand that this is an multifactorial epidemic and screening for it in a dental environment will barely make a dent in its resolution.

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What ends up happening when we keep piling on all these responsibilities to the dental hygiene appointment is that the really important work, that of education and disease prevention, falls by the wayside. Regarding oral diseases, periodontitis and caries, researchers have stated repeatedly and unequivocally:

The importance of sugars as a cause of caries is underemphasized and not prominent in preventive strategies. This is despite overwhelming evidence of its unique role in causing a worldwide caries epidemic. Why this neglect? One reason is that researchers mistakenly consider caries to be a multifactorial disease; they also concentrate mainly on mitigating factors, particularly fluoride. The long-standing failure to identify the need for drastic national reductions in sugars intakes reflects scientific confusion partly induced by pressure from major industrial sugar interests.¹

Periodontitis affects more than 50% of the adult population and its severe forms affect 11% of adults, making severe periodontitis the 6th most prevalent disease of mankind. Chronic gingival inflammation in response to microbial biofilms is considered the key risk factor for the onset of periodontitis, or its progression in treated patients. A preventive approach to care requires diagnosis, education and motivation towards behaviour change, with patients taking greater responsibility for their own health under the guidance of and with support from the oral care team.²

I would like to see all dental hygienists, in every capacity in which they work (writers, clinicians, educators, consultants, speakers, etc.) remember that our responsibility is primary to prevent oral disease and that we have very clear evidence as to how best to do that. It has long since been the time for dental hygiene to be a Bachelor’s level degree and I stand behind any efforts that promote that. But as long as we have two short years to educate dental hygienists, disease prevention must remain our focus in practice.

References
1. Sheiham, A., and W. P. T. James. "Diet and Dental Caries The Pivotal Role of Free Sugars Reemphasized." Journal of Dental Research (2015)

2. Tonetti, Maurizio S., et al. "Primary and secondary prevention of periodontal and peri-implant diseases." Journal of clinical periodontology (2015)

About the author
Diana Macri is an assistant professor in the dental hygiene department at Hostos Community College. Previously, she was as an adjunct lecturer at New York City College of Technology and a clinical instructor at New York University College of Dentistry, both in New York City. Within these programs she taught both clinical and didactic courses. Currently, she teaches three core courses: Dental Hygiene Practice I and II and Ethics, Jurisprudence and Practice Management. In addition to her teaching duties, she has presented lectures at professional conferences locally and nationally. She serves as a trustee on the National Board of the Hispanic Dental Association and is the chair of the Communications Committee. Additionally, she has been appointed to the Minority Affairs Advisory Committee of the American Dental Education Association. She is involved in many advocacy efforts, specifically those which seek to resolve oral health disparities seen in the Hispanic population. Prof. Macri obtained a bachelor's degree from the University of Bridgeport and a master's degree in higher education administration from Baruch College. She happily resides in New York City with her three sons.