[LEAKYSEALS951]

Originally Posted by Nickshu

While it seems simple from a layman's view, instrumenting teeth with scalers and curettes without flap access is quite technically demanding, especially to do it well, comfortably, and effectively (Effectively being the important point). While a dentist certainly can do it, you are correct that it is highly doubtful that 99% of dentists are proficient enough to do this well, especially on periodontally involved teeth. Hygienists are the experts here. Periodontists like me can probably do it better than a general dentist, but my hygienists are still much better at it than I am.

Sort of like how your mechanic can rebuild your engine, but ask him to do a 100 point detail on your car's paintwork...yeah he can do it...but it may not be the greatest work. Best to leave it to someone who does it every day and knows how to use the tools with precision.

Not directed at Nick, or Don, but more of openly talking-

I want to take a couple of minutes and elaborate on my statements from the other night. This thread was originally about safety during covid, but due to comments from "yours truly" , has taken a bit of a detour. Please let me "briefly" clarify

My specific issue with the original statement was that Hygienist were trained better than dentists in the realm of cleanings. At our school, many of the hygiene and dental classes were combined in periodontics- and two, there are some local community college hygiene programs that, well, are perhaps not as capable/ have the resources as larger school's hygiene program, where I attended/ worked as adjunct faculty.

The second issue, was, the perception dentists who did not employ hygienist were 'cheapskates.' A properly run hygiene program should be somewhat of a profit maker for the practice owner. There are a number of reasons, other than money some dentist choose not to employ a hygienist. One- fwiw, right now, there is a tremendous shortage of hygienist, some of that due to covid. Things are so desperate, a local practice is offering a 10K sign on bonus to attract a new hygienist. A neighboring dentist, last night, joked "Maybe I should sell my practice and go work there."

From Don Davis's comments, I can almost bet his ex wife had less than ideal experiences with one or more previous employers who did not value hygiene to her degree (degree meaning "her level of commitment", not degree (rdh,dds,dmd,etc.)). I'd also bet Don has gotten an earful about it over the years, but I bet her experience isn't an educational (meaning she knows more than the dds) gap, it's more likely a complacency (he learned it, but lost it along the way) gap. On the flip side, I have come in behind numerous hygienists and found tartar that I have had to touch up. Same with probing discrepancies. No one likes to find a 6-7 mm pocket behind last month's 3-2-3-2-3 probings. In that sense, a team approach has it's advantages.

I agree that in the sake of day to day proficiency, a hygienist might be more proficient, but I would also add, that I have seen a wide berth of proficiency between dentists and hygienists in terms of training and effectiveness. I have seen some very motivated hygienists who have even gone on to get dental degrees. Some enjoy cleaning during flap surgery, some hate the sight of blood. Some give local anesthesia, some prefer to have local anesthesia given, some prefer to attempt deep cleanings with no anesthesia. I've seen the results (particularly with the latter), that while well intended, haven't worked so well, and even in my own cleanings would be lying to claim I've never missed a chunk of subgingival tartar at some point. In terms of hygienists, I have also seen some, from various community college programs, where, some, are better than others. I have seen some hygienist who are despised by their patients for being rough, but get good results, some patients who love their hygienist for being gentle, who aren't thoroughly cleaning, and the most prized hygienist of all- someone who causes minimal/no pain buts gets maximum results. The point is, the degree doesn't really qualify/disqualify someone as much as their motivation/talent/skill.

Both practices I work at use hygienists, and I would also add a team approach can benefit the patient (I believe "the more eyes, the better"), but the idea that they are better than 99% of dentists would indicate that dentist should not clean teeth at all. Especially aligned with the wide talent levels I have seen, 99% is a pretty damning odd. Although, I'm sure nickshu is giving a well deserved shoutout to his staff, my concern is that could undermine the trust of people who actually have dentists who clean their teeth. I know many general dentists who enjoy it, who limit their own practice to simple fillings and cleanings, referring out all oral surgery, endo, and even fixed. I know one pedodontist, who does cleanings, but would not attempt a simple class one filling on a permanent tooth. A lot of the proficiency comes from experience. Non surgical treatment of larger pockets brings up a higher level of skill needed, but at that point, in my experience, patients who need such, are generally referred to periodontal care for management/treatment.

Where I work, I haven't done a lot of flap surgery for over 15 years. We have the laser too, but, I'm at a point I generally refer out periodontal issues.

By the 99% parameter, all care should be specialist provided. All implants/ extractions by oral surgeons. All endo by endodontist. All fixed crowns/removable by prosthodontist. All ortho by orthodontist. All cleanings by not only a periodontist, but their periodontist's hygienist.

If someone reading this is concerned that their general dentist who does clean their teeth is not doing a good job, I would recommend the following:

Don't focus on the practice, or what their friend's practice is doing (dentist vs hygienist), or what Dr. Phil says. Instead, focus on the idea of "How is my dental health in general?- specifically periodontal health."

At the next cleaning, mention this thread as a starting point for discussion. 1. "Hey, I was reading something about hygienist vs. dentists cleaning teeth. Which is better? Is there a difference? Interesting read, lots of different opinions. " Ask them what they (the dentist) thinks about this. 2. Ask them specifically about the patient's own periodontal situation. "Got me thinking. How are my gums? Am I in good shape? Do I have gum disease? What can I do better? " and 3. Finally asking "If I/ or somebody did have gum disease, at what point do you recommend making a referral? Are there any areas where you think I might eventually need to see a specialist for? If so, would seeing a specialist now help? What are some of the things that a specialist would excel at?

Finally, following up with a "phew... good thing I don't have any of those things/ or/ okay- let's do (x) to address (y) issue."

At the end of that conversation, the patient should have a much better view on the philosophy of the treating dentist, as well as how things really are in their mouth. It might open up some really good dialogue.

Edit- and no offense meant towards Don/Nick, etc.