Years of Malpractice – How Is It Possible?

dental-revelations-blog
Where there is smoke, there is fire. Dentists negligent behaviour should be act upon.

Ever wondered how it is possible that the dentists who are not practicing dentistry up to the standards get caught only after years of practicing the profession? Well you have come to the right place to find out.

Is It the Patients’ Fault?

Nope. Absolutely not.

The patients cannot tell the difference between a good and bad dentist when it comes to the skills of a dentist. Or if the procedures have been done as they should and if they are necessary in the first place. Or if the instruments entering their mouth have been properly cleaned (take a look at my previous post about this).

An average patient can only judge the dentist by the looks of him and the practice, and by the dentist’s chairside manners. The rest is build on a trust of receiving good and adequate care. But every once in a while this trust is broken and the dentist ends up in the headlines.

But please remember that not all the dentists ending up to the headlines are rogue dentists as I have written previously.

Collegiality Gone Bad

Collegiality between the dentists means respect to one another’s abilities to work towards the same purpose. Helping patients. But collegiality has an ugly side as well. It is an unwritten code between the dentists which means one should not interfere or especially under any circumstances critizise a fellow dentist’s work. It is a code one should not break. The hygienists are expected to play by the same rules.

Now, this creates a problem. When a dentist is underperforming, the colleagues hear this from the hygienists and nurses. They see see it from the teeth of the patients who come too see them instead of their regular dentist (e.g. for emergency visit or whilst the regular dentist is on a holiday). They know there is a problem but very rarely they raise questions.

Instead the patient is kept under an illusion that the regular dentist has made the right decisions by distorting the truth.

Distorted truth:

“This decay is in such a difficult area to notice.”

The truth:

“This massive decay is so big that even my half-blind grandmother would find it.”

Distorted truth:

“Your dentist has marked it as an early decay, something to be kept an eye on… it has now grown bigger and needs a filling.”

The truth:

“Your dentist needs to have his eyes checked. This decay should have been filled ages ago. If you are lucky enough, you avoid the root canal treatment.”

Conclusion

It should be every dentist’s duty to report problems in colleague’s way of practicing dentistry. The Code of Ethics by ADA state the following:

Dentists should be aware that jurisdictional laws vary in their definitions of abuse and neglect, in their reporting requirements and the extent to which immunity is granted to good faith reporters. The variances may raise potential legal and other risks that should be considered, while keeping in mind the duty to put the welfare of the patient first. Therefore a dentist’s ethical obligation to identify and report suspected cases of abuse and neglect can vary from one jurisdiction to another

In my opinion, you don’t pull out the biggest guns if you suspect negligent behaviour from your colleague. The dentist in question should be given adequate time to correct the problem e.g. by revising.

The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

If nothing changes, more severe means should take place. This includes giving warnings and as a last resort filing a complaint to the relevant authorities.

Naturally, if the negligence is severe, one should not hesitate to contact authorities urgently.

The bible of dentistry aka ADA’s Code of Ethics 2016 in full.

If you fancy further reading on the subject, here’s a true story by yours truly. 

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Repost with Forewords: Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

Dental Revelations Blog

I am reposting one of my blog posts in the light of the news of the 10-year-old Briony who died from herpex simplex virus which the doctors failed to diagnose.

In this blog post I wrote about a dental nurse who contracted the herpes simplex virus whilst the dentist was treating a patient with a cold sore. I wrote that the GP diagnosed a primary herpes (meaning she had never had herpes infection which most people do have as a child). What I did not share with you was the fact that the dental nurse attended the GP’s practice on Friday and the GP sent her home thinking she had gingivitis. The nurse tried to tell the GP that she had seen a periodontist in her practice due to the ulceration in her mouth and it definitely wasn’t gingivitis. Nevertheless the GP advised the use of chlorhexidine mouthwash and sent her home.

Over the weekend she developed high fever (40 degrees) and could not eat anything due to sore mouth. At this point the ulceration was covering every corner of her mouth including the lips. She returned the GP’s practice on Monday morning and was barely able to stand up. Still the GP insisted it was gingivitis. But at that point the nurse realised the GP needed to see more than what he could with her just opening the mouth and him poking with this wooden spatula. So she grinned as wide as she could. The GP jumped back and said “Well that is definitely a herpes infection!” and prescribed the antiviral medication.

So it is not so uncommon that the herpes infection goes undetected by the professionals. This is one more reason to take the virus seriously – even though the deadly side of the virus should be enough of a reason, eh? Please read the post below by clicking the link.

In case you haven’t read the news about Briony, click here.

My heart goes out to Briony’s family who must be devastated. RIP little Briony.


A patient came in for a long appointment to have a bridge done. This appointment was to include filing down the teeth to abutments which meant that the high-speed drill was to be used. A lot. High …

Source: Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

Blast from the Past

Do you know how it was like to work at dental practice in the 70’s?

Once upon time there was a young nurse Jane. She was hard working and liked by the dentists. One day Jane moved to another town and applied for two dental nurse’s posts. She was offered a job from both of them but she chose a dental practice of four dentists. She was allocated to work with a 30 year old dentist Anna.
Anna was pleasant in behaviour towards Jane. Using kind words and voice when talking to her. Jane was very happy to have found such a good workplace.

But then – and not very long after Jane had started working there – became a day when everything changed. Jane had done something to upset Anna. It was something that Anna found completely incomprehensible.

“You are not a very good nurse, are you?! Not half as good as your predecessor! She at least cleaned my windows!” Anna said with a raised voice.

Jane wasn’t sure how to react. She was in shock about this sudden change in Anna’s behaviour. What windows did she possibly mean?

“I don’t understand what you mean?” Jane said cautiously.

“You… What… You… Don’t understand?!” Anna gasped.

“MY windows of course. My windows at home!” She added and stormed out of the room.

Jane was standing still for a while holding the instruments she was organising. She didn’t know she was supposed to clean dentist’s private windows as well. And probably on her own time as working hours she spent in the practice. That’s not what she signed for.

From this day onwards Anna treated Jane like garbage. Shouting and swearing at her even in front of the patients. Jane felt humiliated and insecure. Should she leave? She didn’t want to as nurse’s jobs were hard to find. So she stayed and the thing that made it easier to put up with Anna’s bullying was the practice’s other dentists’ support to her. They told Anna off many times but it made no difference whatsoever.

One morning Jane came to work and was walking practice’s long corridor to her surgery. Just when she was reaching to open the door Anna came out. She was sitting on her chair and rolling it forwards with her feet.

“Odd.” thought Jane, “What a peculiar thing to do…”

She watched Anna and her transporter chair rolling to the other end of the corridor where the toilet was. In she went and so did the chair without Anna getting up. Her long white saggy uniform got stuck between the door and it went up and down as Anna tried to pull it in without opening the door. Jane was amused and was wondering if Anna has completely lost it. Probably has.

The bullying – and the chair rolling – carried on for the next 4 months but Jane put up with it and did her job as well as she could. But she did not clean Anna’s windows. Nor her home. That’s where she drew the line. She was a dental nurse, not a servant!

Jane had been working for Anna for almost six months when Anna one day – at the end of the day – said to Jane

“Your employment will be discontinued in a fortnight.”

Jane was caught by surprise and wasn’t able to say anything sensible to Anna. But perhaps the question mark over her head was so obvious that Anna continued with a blunt voice

“I am pregnant and my due date is in a month.”

Now Jane was even more surprised but suddenly it all made sense. The saggy uniform, rolling with the chair, mood swings… It wasn’t because Anna was a loony. She was pregnant which now was obvious!

Jane felt angry and helpless. There was nothing she could do but to find a new job. Should she have known it was a temporary post she would have chosen the other job she was offered.

The working relationship between these two ladies came to an end. Whenever Jane saw Anna in town with her baby and husband she never greeted Jane or made any gesture she knew her.

Today is the day of the retirement for Jane but she remembers Anna and her bullying like it was yesterday. Even 40 years was not enough to forget or forgive and she secretly feels satisfaction over the fact that Anna is in a care home suffering from the Alzheimer’s.

“Karma” She thought when she closed the door of her work place for the last time.

Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You

Dental Revelations Blog-

It is (finally!) time for the final part of the series of posts. This time it is of course the nurse’s role in the dental practice which probably is the most difficult one. Here’s why.

Experience Brings Wisdom

The dentist may know dentistry but he does not necessarily have any people skills. Or respect for others. Or ability to feel empathy. This kind of dentist is not fun to work with. Not even close to pleasant.

The nurse needs to put up with the dentist’s whimsy ways and misuse of a power. Some nurses might tolerate this for a long time but some do find another job quite quickly. Especially those who are experienced ones.

But having said that, sometimes experienced nurses are allocated purposely to assist difficult dentists. To kind of bring them in the line. And oh boy if the dentist resists the change. He will have miserable time as the nurse tells him off about everything. The dentist’s whining is quickly silenced by the quick-witted nurse who do not tolerate any nonsense.

So the wisest dentists will comply very quickly as it is crucial for the congenial atmosphere of the work place. Plus the wisest dentists understand that the experienced nurses are worth their weight in gold no matter how they seem to disrespect the outdated hierarchical structure of dental practice.

Experience Brings Knowledge

In the Part I of this series of posts I wrote that sometimes the hygienists can have better knowledge on how to treat the gum disease. It is the same with the nurses – especially the nurses with 20+ years of experience. They have stared at people’s mouths for such a long time that they know a cavity when they see one. They can tell if the soft tissues look suspicious or if the filling has sharp edges that would bother the patient’s tongue.

If the dentist is lucky to have this kind of nurse assisting him he should be grateful to have extra pair of eyes looking out for problems in the patient’s mouth. But too many let their ego come in the way of team work (please read Part II for more on this subject). They ignore the fact that the nurse is looking at the mouth from another angle and can see things that are on dentist’s blind side.

Nurse Aka the Barista

One thing I have never understood is that why is it the nurse’s duty to make a cup of coffee/tea for the dentist? Please tell me one good reason why the person behind the title nurse should be considered as a servant? If anything, it should be the dentist making the coffee for the nurses as once they are finished with the patient they can enjoy their lunch in peace whilst the nurse disinfects the surgery’s surfaces and deals with the sterilisation of the instruments.

Another thing I have never understood – which I have already written about on my second post – is the fact that the patients bring gifts to the dentists but not to the nurse. Wine, chocolate, sweets, books you name it. I guess they don’t realise that dentist would not be able to do any treatment without the nurse (well without compromising good quality of treatment).

About Qualification Requirements

You may not need any qualifications to start as a trainee dental nurse.

This is a quote from National Careers Service’s website. It amazes me that in the UK you are still able to begin working as a dental nurse trainee without any qualifications and train yourself on the job. When I began working in the UK over a decade ago the dental nurse did not need to be qualified. Anyone could work as a dental nurse. Any random gal from the street. Seriously.

Somebody who has no clue about cross infection control or how to use all the equipment and materials safely would seriously compromise the patient’s, the dentist’s and the nurse’s own health.

In my current country that I work in the trainee nurses need to have certain modules accomplished before they can work as a trainee nurse. In my opinion this is far better system.

Hard Work Does Not Pay Off

The amount of work the nurses do does not show in the salary. They are very poorly paid and are expected to work on their lunch breaks if the dentist runs late and they are even expected to open the surgery in the morning on their own time.

I will tell you about one of my workplaces I used to work at. In this rather big company the nurses working hours were from 9am to 5pm. This was the time they got paid for. The problem with these working hours were that the patient came in at 9am and the surgery needed to be opened prior to that. All the nurses and the dental hygienists know that if you open your surgery properly it will take at least 30 minutes. Who would want to work 30 minutes for free? No-one apart from the charity volunteers but dentistry is no charity.

This meant that the nurses came in around 8.45am to open the surgery and they cut corners where ever they could. The same happened in the afternoon when the last patient had left. Closing the surgery also should take around 30 minutes but it was often done in less than 15 minutes. Needless to say that something important is left undone.

Pay Enough to the One You Want to Keep

Now on this final chapter I will give an advice to all the dentists who have nurses as employees. It is an advice that will make your practice a success story.

If you think your nurse is doing magnificent job

  • pay her enough money for that. Even more than what would be current going rate of the nurse
  • be flexible and take her personal life into consideration. Show that you care if she struggles with the demands of bringing family life and work life together
  • give her gifts every once in a while. Perfume, chocolate, her favourite music… anything
  • make sure you apologise if you run late before the lunch break. Let her go for an extra break later to compensate the lost time
  • buy her a lunch every now and then – after all you make gazillion times more money
  • make sure you both work in an ergonomic position
  • respect her

These are the only ways to stop your nurse looking for another job. You see every nurse know eventually that there are dentist’s who do value them more. Believe me, I know many nurses who have been rewarded generously by their employer – they have been paid more than an average nurse, they have been taken on board to a course trip overseas (even to Mauritius!), they get extra time off…

You see the dental practice who’s supportive staff keeps on changing all the time is not giving a very good impression to the patients. And that alone can be a reason for them to change dentist.

Part II: Just Another Day at the Office

Dental Revelations Blog-
“The most dangerous irony is, people are angry with others because of their own incomptence” – Jar of Quotes

Goodness gracious me! It has been too long since my last post. Hope you are still there and reading my posts!

It is time for the dentist’s point of view as a team member of dental practice.

At 8.45am

Oh no, not the Ms. Flumsy again” thought the dentist in the morning when she entered her surgery. Apparently her regular nurse was off sick or something as the practice manager (PM) had called in the temp. The one that had visited the surgery before.

The dentist was disappointed at the PM who clearly had not listened to her when she said she would not want to see this temp again.

You see, everything was wrong with this one. She had long and colourful nails. She had heavy makeup and strong perfume. She didn’t have any idea of assisting a dentist. She thought that using the suction was the most important thing as a nurse. And every task she did took ages to do. And she did them in wrong order. And knew nothing about cross infection control. And went for a cigarette when she should have called a new patient in.

Even though the dark cloud hanging above the dentist head was obvious she forced a smile and said with overly sweet voice “Good morning. How are you?”

“I’m good. And you? Okay?” replied the nurse with a wide cockney accent sending shivers down the dentist’s spine.

The dentist took a look at the day’s schedule. She could feel panic increasing the further she read the day’s treatment plans. Check-up, root canal treatment, crown work, extraction of wisdom tooth, check-up… And of course the time-table had been planned so that the dentist would have her regular nurse assisting her. It was a tight schedule but manageable when the nurse knew her business.

Nevertheless the dentist made a decision not to cancel any patients.

At 9.05am

The first patient was sitting in the patient chair with the bib and safety glasses on. She was about to have a check-up done.

“Oh, I didn’ remember yew ‘ave dis computer software! Don’ know ‘ow ter use it” the nurse says suddenly. The dentist sighs and gives a piece of a paper to the nurse to record her findings.

Then she begins her check-up routine and after checking the teeth with a mirror and a probe she reaches for the fiberoptic. Only it’s not there. She turns her gaze at the nurse who is at the front of the computer screen cleaning her fingernails and looking disinterested.

“Could I please have the fiberoptic?” she says with overly calm manner.

The nurse begins to go through the drawers but cannot find the device. The dentist waits. The nurse checks the autoclave.

“Gawdon Bennet! There are instrumun’s ‘ere from yesterday but its not ‘ere, innit.”

The dentist remembers that her colleague sometimes borrows the fiberoptic as the practice has only one of them. She asks the nurse to go and check from there. She examines the patient’s soft tissues meanwhile.

“Here i’ is” the nurse says triumphantly when she returns and waves the fiberoptic in the air and attaches it to the unit. The dentist notes that the nurse did not wipe it with disinfectant but she thinks it’s not that big deal especially now when she’s running 5 minutes behind the schedule.

She completes the check-up and sends the patient to the reception. Then she records her notes to the computer as quickly as she can.

“Exam” she writes. No time for all the gibberish.

Then she updates the chart from the piece of paper and checks the next patient’s records. A root canal treatment. She notices that the nurse has placed only the basic instruments on the tray and disappeared somewhere – probably for a ciggie. The dentist starts to collect instruments she needs and calls the patient in. She feels her blood pressure raising.

I really cannot be doing nurses duty, simply just cannot…” 

She is numbing up the patient when the nurse walks in.

“Oh, yew ‘ave already taken da patien’ in! Wasn’t da appointmen’ at 9.45?” 

The dentist does not reply and carries on with the treatment.

At 10.10am

The dentist is done with the filing of the root canals and is about to rinse the canals with the sodium hypochlorite for the last time. The nurse grabs the suction.

Silence.

The nurse places the suction back to its holder and takes it off again.

Silence. Not a sound.

The dentist realises that something is wrong and it cannot be fixed quickly. She asks the nurse to inform the practice manager about the malfunction.

Meanwhile she tries to figure out how she can finish the treatment without the suction. Luckily she wasn’t born yesterday and she takes a sterile gauze and places it close to the root canal treated tooth before she rinses the canal with the sodium hypochlorite. The gauze absorbs the liquid. She puts the calcium hydroxide to the root canals and seals the canals with temporary filling.

She escorts the patient to the reception in an intention to ask the PM what she has done about the suction but then she sees two practice’s regular nurses entering her surgery. She goes after them to see if they can fix the problem.

The nurses try to figure out why the suction is not working even though all the other suctions in other surgeries are fine.

The dentist checks the time. She’s now over 10 minutes late from the schedule. And the next treatment is crown work and that cannot be done without the suction.

The nurses need to return to assist their dentists and the PM needs to call in repairman. This means the dentist needs to cancel the next patient’s appointment. Zero income for the next two hours or so or until the suction is fixed. She walks to the reception to meet the patient and break the news.

The patient is not happy. He has taken two hours off work to come to the appointment. In a fear of losing the patient to another practice the dentist promises a discount from the treatment.

At 12.30pm

The dentist has tried to make a use of the spare time and goes through laboratory bills in her surgery. The repairman has not been in yet and it is soon lunchtime at the practice. Things are not looking good. She won’t be working until the late afternoon.

The surgery door opens and the hygienist pops her head in.

“Great, you don’t have a patient. Would you mind coming in to my surgery to check something? I have your patient in the chair and I think I found a decay on the lower right 6 and also something on soft tissues…”

The dentist walks in the hygienist’s surgery and greets the patient. She puts the gloves and face mask on.

Dentist: When did I do the last check up?
Hygienist: Err, yesterday…
D: And where was it that you suspect a decay?
H: On lower right 6. On the buccal side just below the gum line. There is another one as well but I think it is still in early stages…
D: Where is this?
H: On upper right 2, mesially. I don’t have a fiber optic so I couldn’t check it properly.
D: There is one in my surgery.
H: I know, but the turbine attachment is not working in my unit.
D: Ok then, let’s have a look…

The dentist takes the probe and checks the lower right 6 first while the hygienist stands on the nurses side and watches.

D: It seems to be ok…
H: It’s more subgingivally. You need to push the gum aside slightly.

The dentist feels this unpleasant feeling in her stomach when the probe sinks inside the tooth on the site hygienist mentioned.

D: Yes… yes, you are quite right. This needs to be repaired. Let’s see what we can do about it as it is quite deep… How about the other one. It was the upper left 2?
H: Upper right 2 mesially.
D: You are right it is decay but hard to say without the fiber optic if it’s advanced. I will check it on the next visit.
H: There is also something on the soft tissues I’d like you to have a look. It’s on the cheeks and under the tongue. Could it be lichen planus?

The dentist takes a look.

D: I can see what you mean. Hard to say for sure without biopsy but it does look like lichen.

Then she goes on informing the patient about lichen and asks the patient to book an appointment to decide what can be done to the lower right 6.

The patient looks shaken. Yesterday she got all clear and today she hears there is something seriously wrong with one of her back tooth plus something – possible cancer – on her soft tissues. She is not convinced when the dentist says there’s nothing to be worried about.

The dentist leaves the surgery and feels like going home. Or to the pub. This day is just one of those days she would like to forget. But she must stay to treat the rest of the patients – providing that the suction is fixed before this.

But it is time for a lunch first and she decides to go out for the full hour.

At 2.30pm

The dentist returns to the practice after the lunch break and chats with the receptionist before going to the surgery. The receptionist tells her that the repairman came in and did his magic in 15 minutes. The suction works again. Whoopty doo!

When the dentist reaches the surgery she can see through a glass tile window that the surgery’s lights are off. She opens the door and sees the unit lifted up to the highest position which the nurses do at the end of the day.

“What the hell?” comes out of the dentist’s mouth.

She walks back to the reception to see the PM.

“Why is my surgery closed?”

“Oh is it?” replies the PM and walks to the surgery.

“Oh lord” she says when she sees the surgery, “the temp must have gone home… I thought she went for a lunch!”

“I cannot believe this… this is unacceptable… did I or did I not tell you that I do not want to have this temp assisting me ever again?”

“I’m sorry but I did not have…”

“I don’t care. Your job is to keep the surgery running and I have seen only two patients today which is outrageous. And those two I have had to treat practically alone as the nurse is useless…”

“I understand. I see what I can do… I will try to reach the temp. Maybe she’s somewhere close by. I don’t understand how she thought she could go home.”

The dentist was fuming. She did not want the temp back but she did not have other options if she wanted to see the rest of the patients. But she soon learned that the temp was nowhere to be reached. The PM offers to come in to assist her.

“Well it’s better than nothing” she replies.

After she had seen the first patient for the check-up she was much calmer. She took in the next patient who had just seen a hygienist for a scale and polish.

When the patient opened the mouth she started to get annoyed again. The hygienist had not rinsed the polishing paste properly. It was in every between the teeth, this gritty blue paste.

“Seriously, who uses this much polishing paste!” she thought whilst her cheeks were getting red from the annoyance. You see, this wasn’t the first time. It happened with every patient who came to see her after the hygienist treatment. Soooo annoying!

At 5.30pm

When the day was over the dentist felt like she was the only one in this practice who knew her business. How was it possible that she was surrounded by so many incompetent people? She thought about changing jobs.

But would the patients follow? Some probably. Would it go from bad to worse? Yes possibly. Should she start her own practice? Definitely not, too much stress. Should she quit dentistry? Yes, it would be the wisest thing to do but she wouldn’t afford it as she’s still paying the student loan.

She went home fearing what the next day would bring. One thing she has learned in these couple of years of practising dentistry was not to check the next day’s patients. It was about minimising the stress. But there were so many other things she had no control over that sometimes just felt too overwhelming. Way too overwhelming.

 

 

Part I: Is It a Skyskraper? No, It’s Your Ego.

Dentalrevelations

On my second post I promised to write about personalities of the staff in dental practices and how they may affect the dental practice and the treatment given to the patient. I’m going to fulfil this promise today. And on my next post. And the next.

I am going to write a series of posts about this topic. Each post will have a viewpoint of one dental professional. Today it will be the hygienist’s.

I’m Not Going to Play with You

As long as there have been dental hygienists there have been dentists who are afraid of losing their living because of them. These dentists either refer only the simple scale and polish to the hygienist or do not refer at all.

They treat the patients with advanced gum disease themselves as it requires more visits. More visits equals more money per patient. And the money is the only motive they have for this silly way of practicing the dentistry.

The problem with these kinds of dentists is that most often the hygienist would have better skills to treat the advanced gum disease than the dentist and this is revealed when the patient sees the hygienist six months later. Often there is subgingival (invisible) calculus still left even though it should have been removed on the first course of treatment. Plus the patient has no clue how to clean her teeth effectively.

Big Ego

It is a fact that the oral and maxillofacial surgeons have a big ego. Or to precise – they have a huge ego. But in my opinion they have all the right to have one. They NEED one to be able to perform all the talent requiring hocus pocus on patients mouth, jaw and face. Plus they don’t use their ego against co-workers or the patients.

But when a dentist has a big ego it rarely is attractive or talent enhancing. I will give you an example from a real life.

A dentist does a check-up for a patient. Then the patient sees a hygienist for a scale and polish. Whilst scaling with curettes the hygienist notices there are potential cavities in three different sites and she checks the patient’s x-rays. The x-rays confirm the suspicion.

The hygienist checks the dentist’s notes for the check-up visit to see if there is a treatment plan to fix these cavities. There isn’t. It appears as if the dentist has missed the cavities when doing the check-up.

The hygienist sends the patient back to see the dentist. When the dentist sees the hygienist’s message about the cavities he acts as if the patient has come in unnecessarily.

“I’m sure there’s nothing there”

he says to the patient. He quickly checks the sites with a mirror, sighs and continues by saying

“One of these suspected cavities is a borderline cavity. We could do a filling for that so that you didn’t come this far for nothing. The other two we can still monitor.”

The hygienist sees a patient for another scale and polish couple of weeks later. She checks the dentist’s notes and realises that only one cavity has been filled. She asks the patient if the dentist has asked her to come back to have the other two to be done. Negative.

The hygienist is baffled. She checks again with her curette the other two suspected cavities. The instrument goes between the filling and a tooth and sinks deep into a soft area – it is a cavity for sure.

The hygienist decides to ask another dentist to come and have a look there and then. The dentist confirms the two remaining cavities and recommends the patient to have them filled.

At this point the patient is very confused. Who is not doing their job properly? Who to believe?

This was just one example. There are plenty more but I won’t write them down as I am not writing a novel. But my point is that when a lower ranking dental professional finds something the almighty dentist didn’t the ego goes before the patient’s best interest.

Not good. Not good dentistry at all and everyone who recognise themselves from this should be ashamed.

But why the dentist did not notice the cavities even from the x-rays? That is completely another story.

Hygienist’s Difficult Role

It is tough to be a hygienist. They often have skills to make the same diagnosis as the dentists but only the dentists have a right to make one. The hygienist must always remember to add a question mark after their findings or the hell will break loose and she is quickly put back to her place by the dentist who kindly reminds her that she has no right to make a diagnosis.

And when she finds something that the dentist missed she will be between rock and a hard place. Especially if the dentist does not agree with her because of the big ego problem. The confused patient often thinks the dentist was right which makes the situation even more difficult.

But the time is on hygienist’s side. She has recorded every finding on the patient’s dental records – with the question marks! She has recorded that she has consulted a dentist. Sooner or later the cavity (or whatever her finding was) will get worse. There will be pain. Or the crown will come off as the cavity has eaten the tooth under it and perhaps so much so that it is beyond repair.

The dentist can only hope the patient do not file a complaint.

Lonely Rider in a Cupboard under the Stairs

Another side of being hygienist is the fact that they are often quite alone in the practice. It is often so that the practice has only one hygienist. This means they don’t have peer support in the practice. Peer support is something that every dental professional would need.

Also the hygienist is given the oldest dental unit in the practice and the smallest room, the one without a window. Or perhaps the room under the stairs. Not sure if the Harry Potter fate has happened for real – perhaps it was just sarcasm from a hygienist that I once knew?

Conclusion

Why do the dentists feel so threatened by hygienists? Why is it hard to be wrong or admit that you have missed something? Why do they need to feel and let others know that dentists are at the top of the command chain?

I’m afraid I do not have the answers. One dentist once said to me that the dentists are non-qualifiers for medical school which means that the dentistry was not their first choice of profession. Are these kinds of dentists letting everyone else suffer for their disappointment?

I will remind you that not all the dentist are like this of course. But in my current workplace two out of four dentists are. That’s 50%. That’s a lot!

I hope practice owners will start to value their hygienist more than before. And get them the brand new dental unit, a saddle chair (or whatever chair the hygienist prefers) and curettes the hygienist wants so that there would be even a small chance to work in an ergonomic position during the treatment. After all they bring in steady flow of cash with very little expenses.

And dear dentists, we are all equal human beings no matter what our profession is.

Want to Have a Say?

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Are you a patient who is annoyed about certain things that you encounter at the dental office? Have you had bad experiences at the dentist?

Or are you a dental professional who is cross about something a dentist/hygienist/nurse/management/patients do?

I believe problems in dentistry are universal and I want to give you a chance to have your say. Send me an email on dentalrevelations@gmail.com and pour your heart out (trust me, it is liberating). Please write to the subject field My Say.

What I hope you will mention on you e-mail is:

  • your gender
  • age range (20-30, 30-40, 40-50, 50-60, 60-70…)
  • what size of a town did the thing you are writing about happen
  • your profession (applies only the dental professionals)

I will handle all the emails with utmost confidentiality but I might use direct quotes of your text so please write in non-identifiable manner.

Yours sincerely,

Dental Revelations Blog