More letters in response to Dr. Neiburger

Sept. 13, 2001
RDH readers respond to a controversial letter.

To see Dianne Glasscoe's original article, please search for "Speed Demon" in the search box located on the left side of your computer screen. Following is a letter that appeared in the September edition of RDH in response to that article.

Speed it up, "girls"

Dear RDH:

In the July issue, Dianne Glasscoe responded to a letter (Speed Demon) from a hygienist who complained about another hygienist in the office doing a prophy in 10-15 minutes. The remarks concerning this service were negative and Dianne gave a list of 13 items a hygienist should do which would be impossible to do in 10 minutes.

The public, and indirectly, the dentist, are the ultimate sources of what treatment hygienists should do and the level of service and quality that is needed. Today, people want fast food, fast banking, fast gas station fill-ups, and fast dental service. No one likes to wait. No normal person wants to be in the dental chair having his or her teeth cleaned for 45 minutes when the job can be done in 10 or 15 minutes. Patients do not tolerate long procedures and if a quality service is offered at another office in less time, they will take their business to that office. A dental prophylaxis consists of removing calculus and polishing the teeth. The extras mentioned by Dianne (e.g. blood pressure, exam, inquire about dental problems, etc.) does not need to be done by the hygienist and may not be desired by the patient or the dentist. The dentist may want to do this him/herself as is office policy.

A well-trained dental hygienist with sharp instruments and an ergonomically efficient technique can easily do a good scaling and polishing in 10 minutes on most "normal" patients. I'm not talking about someone who has 30 inches of calculus on his lower anterior teeth, but just an average patient who keeps his or her six-month recall appointments. To say it takes more time to do the cleaning and that anyone doing the treatment in less time is providing lower quality treatment is ridiculous. If, after treatment, the mouth is clean and the dentist and patient are happy, then that is success. Do not equate retardation with quality. In today's competitive world, where the consumer dictates the terms, you better provide fast, efficient, quality service. Anything else will result in the loss of the patient, his or her family, and your job. In my and many of my colleague's practices, fast hygienists earn more money and get more respect from the dentists and patients. The slow ones get less. The real slow ones get fired. It's a tough world out there, girls. Are you up to the challenge?

E.J. Neiburger, DDS

Waukegan, Illinois

Following are some of the letters we have received in response to Dr. Neiburger. We will publish additional letters soon. To see additional letters we have also put on our Web site, use the search box on the left side of your computer screen and type in "Neiburger."

Dear RDH

I have just completed reading the September 2001 publication. The Reader's Forum article titled Speed It Up, "girls" got my goat. First, I Iaughed in disbelief and had to check the front of my magazine to see if I really was reading RDH and not a comic book! Then, I got mad at the arrogance of the writer. We, dental hygienists, are not "girls." I think that term applied back in the 1940s -- possibly the era that the author is practicing in.

I have been practicing dental hygiene for almost 20 years. I have worked in every type of private practice environment from high-quality practices with a wealthy clientele to offices that see mostly Medicaid patients. Each type of practice brings new challenges. The number one challenge is to be able to read the patient as you greet them. Yes, some people do want a "quickie" cleaning, but most of them want quality, full service care from a sensitive clinician. I have never felt like I was a quality hygienist when it was demanded of me to do a 10-minute prophy. I might as well wear a sign that says, "scum scraper!" I can't tell you how many times I have seen patients that have had a prophy six months ago elsewhere and I end up finding spicules of subgingival calculus all over their teeth.

Patients will say, "I just had a cleaning six months ago." It is then, that I show them the black calculus that I have removed, and explain to them that this is why their gums bleed. It gets old and tiring having to explain things that should have been said and done at their prior "quickie" cleanings. Most patients appreciate the time and service you give them if it is done in an efficient, professional manner. I think, no, I know that even the busiest movers and shakers want a thorough cleaning. If the touch must be light and time is an issue, they still want their money's worth for that appointment. We are to provide this as professionals to the best of our ability.

All I can say is that I sure am glad I never had to work for a practitioner like Dr. Neiburger, because I would have to resign after my first day. (I probably wouldn't make it past the interview!)

By the way, isn't "quality" quickie prophy an oxymoron?

Cynthia L. Howe, RDH

San Antonio, TX

formerly of Waukegan, IL

Dear RDH,

I have been a practicing dental hygienist since 1976. I followed in the footsteps of a very fast hygienist and learned quickly what I could and could not accomplish in a 30-40 minute appointment. Times have changed and so have the required minimums for comprehensive patient care. In my very educated and very experienced opinion, Dr. Neiburger from Waukegan, Ill., has much to learn in regards to quality patient care. The treatment hygienists should do and the level of quality and service is dictated by the licensing state for each hygienist. You see, we are not just the non-thinking, robotic scaling, uneducated "girls" that Dr. Neiburger would like us to think we are. We are licensed and educated professionals with ethics and standards of excellence of our own. We do not simply sit ergonomically correct with sharp instruments and see how many of what he calls "good" scalings and polishings we can do. I agree that some of the extras he mentioned can be delegated to the dentist or other qualified staff members. I do not agree that what he is proposing is either ethical or comprehensive in care. How many good cleanings does he do every day?

It has been my experience (many times over) that being fast within reason and not sacrificing quality of care can be accomplished. I am what you would call fast in this market where many hygienists require one hour for all recall appointments. I have been praised by multiple patients and doctors for my quality of service as well as the speed and care with which I deliver such service. I am paid at a rate that is the highest in any area in which I have worked. I also have been around for quite a while so being challenged by the tough world doesn't scare me.

This being said, I hope Dr. Neiburger allows his hygienists to perform their patient care with the ability to make decisions based on the patient's needs rather than his scare tactics. (Since when are there so many unemployed hygienists out there that you could just toss one aside and instantly find another?) Patients must be completely probed and charted (that means six readings for every tooth in the mouth) by the hygienist or dentist at a minimum of once annually, every area of every tooth should be curetted to be sure there are no deposits. Polishing should be done at a pace where you are not burning up the tissue and overheating the teeth, so slow down here, building patient rapport and trust is vital to keeping patients happy in your office. No one wants to be a product on a production line.

I hope this letter is forwarded to Dr. Neiburger because I feel he needs a reality check. I realize he wants to increase his production so that he realizes his financial goals. I hope he has not forgotten the real reason he is a dentist. In my opinion, we are in the dental profession to provide the best quality of care that we can, in a caring and sincere atmosphere and in as timely a manner as possible, so that the patient achieves the best oral health possible. Maybe if this were presented to Dr. Neiburger's patients, they would appreciate spending more than 10-15 minutes in his office. Fast is one thing that even McDonalds can't seem to accomplish in a competent, consistent manner. Quality is what should set us above the run of the mill, production line dental offices that none of us would like to receive our care in. Yes, we should see our patients on time. Yes, we shouldn�t waste their time or ours, but 10-15 minutes is not even enough time to say hello, wash your hands, talk with the patient regarding his or her concerns, and clean up the room for the next person.

Give your hygienists the respect they deserve. Give them the time they determine is needed based on the needs of the patient. Pay them the best money can buy. This will give you a hygienist that will boost your practice more than you ever dreamed. This will create an atmosphere of intellect and respect that patients will take note of. This will fulfill your obligation as a dentist to give quality, comprehensive care to every patient in your office.

Susan R. Vogel, RDH, BS, MED