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Author Topic:   Preceptorship or On The Job Training hygienist | Page views:
Toothfairy
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Registered: Mar 2001

posted 03-08-2001 08:26 PM     Click Here to See the Profile for Toothfairy     Edit/Delete Message   Reply w/Quote
I think I am about to start a riot w/ this topic. For those of you who are not familiar w/ preceptorship..also known as on the job training or as the phrase from Texas representative it's called "equivalency training" for the next generation of dental hygienists. Let me explain what this is all about and I will try to cut it to the core. In dentistry there is a battle going on many yrs now between dentists and hygienists. Dentists have always had the upper hand due to more members, more resources, finances..etc than the hygienists. Basically it's the ADA (American Dental Association) vs ADHA (American Dental Hygienists' Association) which I am a proud member of since graduation from hygiene school. Dentists are claiming there is a shortage of hygienists. This is their base on trying to impliment preceptorship. I firmly believe most of it is due to hygiene salary. If doctors hire preceptorship hygienist then they would not necessarily have to pay them what we are getting now. I think it's a salary issue for most of them.

Hygiene school consists of two yrs of clinical as well as book work with dentists and hygienists as our instructors. It's not an easy program to go thru. It basically takes you 2 yrs to learn how to clean teeth properly as well as all the ins and outs of being a hygienist. Then you take your National Board Exam, after passing that you sit for State Board Exam to obtain your license so you can work. Here is where preceptorship comes in...anyone can be trained to be a hygienist. That person will be trained by a dentist on the job or another hygienist. They will be trained so many hrs until they meet the requirements to take their board exam. One of the difference between the tradionally trained hygienist and the preceptorship hygienist is the preceptorship hyg can only work in that state. She can not take another state's exam. The state of Texas has submitted a bill that will more than likely be passed in a couple of weeks allowing this to go thru. So what is the big deal??? Public welfare will be in jeapardy, their safety, quality of care delivered will be compromised, and probably more gum or periodontal disease will arise due to inproperly cared teeth. There is more to cleaning teeth than just cleaning teeth. You have to be knowledgable to take a thorough medical history of the pt, recognize signs of health problems that may compromise their health by just a cleaning, etc. Here is another thought: Most dentists are very busy treating their pts so when is he going to have the time to properly trained someone to be a hygienist? Also how many of you trusts dentist to clean your teeth? (To all you dentists, this is not meant to be offensive). If your dentist clean your teeth how long does it take him? About 15-20 or perhaps 30 minutes if he takes his time?
I will admit there is a slight shortage of hygienist where I am (Florida). From time to time I have dentists call or email me looking for a hygienist for their practice. I am president of the local hygiene society that is why they call me.

Here is one question for everyone to think about...would you prefer a traditionally trained hygienist to clean your teeth or someone who was trained on the job with much less amount of schooling? I will keep you all posted on the legislative decision from Texas. For more info visit www.adha.org
Feel free to reply, I would be interested to hear what everyone on this board thinks about this issue.

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Ship
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From:Bristol, TN
Registered: Jan 2001

posted 03-08-2001 10:00 PM     Click Here to See the Profile for Ship     Edit/Delete Message   Reply w/Quote
I agree with you Toothfairy... I personally feel that a well trained hygienist is an indespensible member of any dental team. In the military we have "prophy technicians" who take an 8 week course instructing in the fine art of adult prophylaxis. While they generally do ok for the gingivitis patients they're not competent (in my opinion) to do any kind of ScRP. They don't have the proper training to recognize potential medical problems either. Also their knowledge of dental procedures and proper oral hygiene instructions is very limited... A good hygienist is a HUGE practice builder! Many patients trust their hygienists more than their dentist and feel a better rapport with them. My parents for example frequent a particular practice not because they like the dentist but because they LOVE the hygienist! A good hygienist can save a lot of time with oral diagnosis and getting a patient to accept a treatment plan. My cousin says that he often walks in for a hygiene check and the patient knows what procedures are required and is prepared to procede with treatment. I think that we as dentists are quite lucky to have you wonderful professionals...

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Toothfairy
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posted 03-08-2001 10:14 PM     Click Here to See the Profile for Toothfairy     Edit/Delete Message   Reply w/Quote
Hi Ship again...

That's a very positive attitude coming from a dentist:-) Most dentists feel the same way you do about their RDH. And you are right, a good, competent hyg saves the doc valuable time and pts tend to trust us more than the doctors. I suppose they figure what do I have to gain from it, I'm just an employee there. I'm lucky enough to work for a young doctor who values my skills and doesn't take me forgranted. It's nothing worst then to work for someone who does not appreciate you and your contribution to the practice.

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Bonnie
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From:Hendersonville,TN,USA
Registered: Nov 2000

posted 03-08-2001 10:50 PM     Click Here to See the Profile for Bonnie     Edit/Delete Message   Reply w/Quote
First let me say that I also agree that a tradionally trained hygenist is the only person that I would let clean my teeth or my childs teeth. I wouldnt even let a "prohpy tech" clean my teeth and I have a cert. to clean teeth. I have been a chairside expaned duties asst. for 20 years.
I am glad to see a DDS is agreement with us, but I think that when he gets out into a private practice he might change his mind.The biggest expense in private practice is a hygenist, right now Ship isnt paying for one. I hope he isnt influenced by some DDS's when he gets into private practice.
If a DDS uses a hygenist to her fullest potenial, she/he might be their biggest expense but also their biggest money maker too.
Now yes I have worked with many primadonas over the years in hyg. but also in asst. too.This is another area that if an office policy is in place then there can be no primadonas. But I do believe that the DDS's are trying to cut back on the expense of hyg's and thats why they are all for this new idea. I wonder what the going salery will be. If it will be hirer then what an asst. makes , well all the asst's will go this route and then there will be an asst. shortage. Big domino effect. Keep us posted, thanks Bonne

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Shaelle
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posted 03-10-2001 02:16 AM     Click Here to See the Profile for Shaelle     Edit/Delete Message   Reply w/Quote
This on the job training that is done in Alabama, is a bunch of $h!++, for lack of a better word. Preceptorship lets anybody into the profession, and degrades the quality of not only the dentistry performed but also the level of professionalism. If this trend continues the hygienist of the future will be reduced to people who lack a high school diploma, simply because the Dentist would be able to pay them less. We are talking about Dr.'s who yearly increase their fees but yet keep trying to get the cheapest labor they can find. And let me add that in Alabama, where preceptorship is occuring, the cost of dental care is the same, yet the pay for their "in office trained hygienists" are the lowest in the nation. The patient doesn't benefit from the lower cost of labor. I don't know exactly what the "hygienists" are paid there, BUT, I do know that the assistants in Arizona are paid more than the "hygienists" in Alabama. Lets think about this one a little more....Would you want an "in office trained" NURSE (who has no formal training) doing the delegated duties of a physician?? Would you want this NURSE making life threatening decisions for you? I know many of you don't think a dental hygienist makes any life threatening decisions, but we do. That is why we collect and review a patient's medical history prior to any cleanings. For some individuals need antibiotic premedication prior to cleanings to prevent serious bacterial infections that could result in death of a patient. There are people with bleeding disorders, and medications that cause a slower blood clotting rate. These are all things that need to be taken into consideration prior to performing certain proceedures. All of which is extensively covered in an Accredited Dental Hygiene School, and none of which (or very little)is covered in preceptorship. Most dentists don't feel that they have had a successful day unless they have done at least 3 crown preps in one day. Now how is a Dentist going to take 20 minutes out of his day to show his hygiene trainee how to properly scale tarter from below the gumline, WHY would he want to do that when he could get in a $150 filling done in that amount of time.

Something that Toothfairy didn't mention is that in order to even be accepted in a Hygiene school, you need to have about 2 years of college education to even apply to a hygiene school. In those two years a pre-dental hygiene student takes many courses on Biology, Chemistry, Anatomy, Physiology, & microbiology. In Hygiene school the student learns: Dental biology, physiology, pharmacology, and pharmacology of dental anesthetics. Imagine all of this crammed into a 6 hour lecture. How much do you think is learned? Remember the office trained Nurse....do YOU want that Nurse administering you medications that she knows nothing about, or doesn't have the knowlege of what kinds of reactions or side effects they may produce? I'd want to know my health is in the hands of a professional, a professional who knows what s/he is doing! If it's happening to dental hygienists, it will soon happen to the nursing profession too....because there is also a nationwide shortage of nurses. What about a shortage of doctors????? Should we lower the education standards of doctors?? Do you believe the cost of healthcare will go down if we lower the education standards of doctors? NO, they will not go down, and the only thing you will get in return is a poorly trained physician who doesn't know a lick about your problems.

[This message has been edited by Shaelle (edited 03-10-2001).]

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Bonnie
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From:Hendersonville,TN,USA
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posted 03-10-2001 08:49 AM     Click Here to See the Profile for Bonnie     Edit/Delete Message   Reply w/Quote
Something that Toothfairy didn't mention is that in order to even be accepted in a Hygiene school, you need to have about 2 years of college education to even apply to a hygiene school

This is changing with most schools now. I dont know how long its been since you went to school but most colleges are now making hygiene a 2 year program. AT least here in TN they are and several other states too.
Bonnie

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JudyP63
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Registered: Feb 2001

posted 03-10-2001 09:38 AM     Click Here to See the Profile for JudyP63     Edit/Delete Message   Reply w/Quote
I can't believe they would do that!!! Here in Canada hygiene was one year. Now it's 2....and you have to be an assistant first and then be accepted to the hygiene course. I'd NEVER let a dentist scale my teeth or my childrens. I did it once and he did a lousy job going subgingival. So NEVER again. Hygienists are there for prevention. Dentists are restoring. A good hygienist can do a treatment plan and alert the dentist before he looks in the patients mouth as to what's going on. My hygienist is awesome and she feels she's still got a lot to learn. The entire time she's scaling she's giving you the spiel on good oral hygiene, showing you where you are not brushing properly. She checks for mobilities and recession....she's wonderful. She's doing her job and doing it well. I also know a new hygienist. She's doing very well. She's been doing it for 4 months and I see a vast improvement. She's gaining her confidence and getting the sub much better. She also went through the 2 year program and will be a great hygienist. To just walk in and basically scale someones teeth without the science courses is hard to imagine.

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Toothfairy
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posted 03-10-2001 12:10 PM     Click Here to See the Profile for Toothfairy     Edit/Delete Message   Reply w/Quote
Hello everyone,

Thanks for all the support and positive feedbacks. All the states are trying to implement the "Alabama" model of hygiene. I believe Kansas has already allowed assistance to scale coronally (above the gum line). Here in Florida, the FDA (Florida Dental Assoc.) has been trying to pass the preceptorship bill for a few yrs now. FDHA of course fought that bill and we were able to set it back. I'm sure it will be brought up soon in the near future. That is why we are so concerned about the "equivalency training" bill Texas is tying to pass. If that bill is passed, Florida will likely follow their foot step. Another important issue Florida hygienists are trying to implement is passing the local anesthesia bill. This would allow hygienists to administer local anesthesia before root planing. This bill has been an issue amongst us since 1987. It has since been put on the back burner due to the preceptorship problem. I believe there is 21 or 23 states have already passed this bill to allow hygienists to administer anesthesia. Florida is just extremely tight about all aspects of dentistry when it comes to dealing w/ hygienists' duty. We are strictly under their umbrella. At times it's frustrating to have to wait for the doctor to numb a pt for root planing. If he is in the middle of a procedure w/ his pt, he is not likely to free up and come numb your pt. We often have to wait...10, 15, up to 20 minutes for doctors to numb the pt so we can get started. That is valuable time that can be spent scaling/root planing the pt. I think the dentist is afraid of giving us an inch fear that we may want more. If they allow us to admin. local anesthesia, the next thing we want is to branch out on our own and open our own clinic or practice. That is not the case. We would be more efficient in the office if we can numb our own pt w/o waiting for him and using his valuable time. Plus when he is running behind w/ his pts we can numb his pts for him while he is w/ another pt. That would speed things up and is more efficient in running the office and pts won't have to sit and wait so long.

In Fl hygienists are allowed to monitor and adjust nitrous oxide. We can't flick the switch to administer nitrous but yet we can adjust to whatever level we want. The dentist has to come in the room to flick the switch on and hyg can adjust to the level necessary. It seems silly we can't turn on the unit but yet we can hike up the level of nitrous. If we were allowed to turn on the switch it would be considered administering drugs that is why we can't do that. But I know many hygienists just turns it on themselves for the pt. It seems pointless at times to wait for the doctor to come and turn it on. Most doctors would rather the operator turn it on instead of having to bother him.

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Shaelle
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posted 03-10-2001 03:55 PM     Click Here to See the Profile for Shaelle     Edit/Delete Message   Reply w/Quote
I have worked in Wyoming and Arizona, both of which allow dental hygienists to administer local anesthesia and nitrous oxide. Arizona is very strict with the schooling that you recieved with anesthesia. In fact the course I took in Wyoming is not Arizona approved, even though both states require that you take and pass the Western Regional Board Exam. Which I have done, but now I still have to take another course on local anesthesia. Florida just wants to keep the hygienists from adminsitering the local anesthesia, because in order to do so, you must have some kind of pharmacology background, which in return requires a college education. Preceptorship requires NO college education. I think it will be a big win for hygienists in Florida if they ever are allowed to administer local anesthesia. Are the hygienists allowed to administer anesthesia in Texas?

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Toothfairy
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posted 03-10-2001 08:53 PM     Click Here to See the Profile for Toothfairy     Edit/Delete Message   Reply w/Quote
In hygiene school, I had a semester of pharmacology during my senior year. We would gladly take an expanded course and be certified in administering local anestesia. We are not asking to just be trained on the job or take a crash course over the weekend and be certified. We realize education and knowledge before being certified is very important. It would be a big win for us if the bill ever gets passed. I don't think I will see that happen during my career. But it's something to look forward to and keep fighting to keep the issue alive. FYI, Florida is one of the most difficult state to be licensed for dentists and hygienists from out of state.

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