EXCLUSIVE! More letters in response to Dr. Neiburger

Sept. 24, 2001
RDH readers respond to a dentist's 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:

Congratulations! I have finally been motivated to write a letter to a magazine, and you are the recipient! Unfortunately, you may have to increase your postage, because you will have to add pages in your magazine to print all the letters that may be forthcoming, responding to the unbelievable remarks by E.J. Neiburger of Waukegan, Ill. I will not dignify his title by calling him Dr., because he is not one. He is a blatant salesman, doing whatever necessary to make the big bucks as fast as he can, with no regard for the health and well being of the public. Surely he could have found a profession better suited to his goals, without endangering patients. Has he tried professional wrestling?

After reading his ignorant remarks, my mouth dropped open in disbelief. When I recovered from the initial shock, I began to laugh. Is he serious?!? What toadstool does he live under? A "quality" scaling and polishing in 10 minutes? I would like to inform him that "normal" patients are human beings with health issues, and periodontal concerns, and red blood surging through their veins.

They do not arrive, nor leave, on a conveyor belt. How could any self-respecting hygienist work for this man?

And PLEASE, do not call me a girl (you knew this would get to me). Your lack of knowledge and decency do not equip you to practice dentistry, let alone share my planet.

There, I do feel better. Thanks RDH, you are doing a great job!

Rosemary Marshall, RDH

Youngstown, Ohio

Dear RDH,

I knew by the third paragraph who wrote "Speed it up Girls" (Dr. Neiburger of Waukegan, Ill.). As RDHs, not "girls" (what century are we in?), we provide quality care SAFELY. We cannot pull the doctor away from his work to do "our" job of a thorough medical screen. And 15-minute prophys WON'T DO!

It is our license that could be taken away if we don't do this. Who's to say the patient forgot to tell us of a hip replacement or new heart condition or something that could alter the treatment plan? How often has this happened? Most doctors are thrilled to have someone protect them legally with such a screening, because in the end YOU the doctor may get sued if we don't! Most dentists are thrilled when their patients are treated like the icing on the cake � that includes a medical screen, normal chit/chat, recording data, scaling, and polishing. You, Dr. Neiburger, are the exception! While it may not always take 45 minutes to an hour to do a screening, X-rays, scaling, polishing, and education, it certainly can not be done in 10-15 minutes.

Could it be patients have lost teeth due to improper care that they have so few to clean and that is why it only take 10-15 minutes for care? Yes, I suppose then a 10-minute appointment could be executed in that case � two teeth really don't take too long. Are you charging your extra-clean patients less money? After all- time is money and, if they don't get their money�s worth, they will find someone who has a little bit more time for them than 15-minute oral care procedures.

RDH magazine � enough from this person! Time to cancel his subscription and stop printing his letters. He is mocking all that we stand for, and he has an ego the size of the Sears Tower. Although we need to hear all sides, his is one that is done out of malice. This is his second time writing (two years ago he said, "Don't delude yourselves � anyone can do your job") and degrading RDHs, women, and employees. Enough is enough! His perceptions on people and ethics are poor- and cancel him out- or I will cancel my subscription (which I would hate to do!) to RDH. How about a few letters from dentists that like their employees?

Embarassed I'm in the same state and county,

Julie Buttacavoli RDH

Long Grove, Ill.

P.S. And no, doctor, I can not come work for you. I guess I would be too slow for your 15-minute productivity quota, and I would guess my finesse with patients would outshine you (and you would never tolerate that!)

Dear RDH

After reading the letter submitted by E.J. Neiburger, DDS, in the September 2001 issue of RDH, I felt compelled to respond immediately. I found his comments to be degrading and unprofessional to say the least. It saddens me to know that with all the opportunities available to dental hygienists today that any formally trained and educated hygienist would seek employment in his office. The doctor seems to have very little regard for his patients total body health. The oral cavity is connected to the rest of the body. He also must not read much research on the connection between oral health and total health. The comments made also made me wonder what types of sterilization procedures are utilized in this office. I think we all know that the disinfectants we use require a 10-minute application in order for them to work effectively.

It would be impossible to provide even substandard care in a 10-minute prophy, even on a "normal" patient. I find it hard to believe that there is any oral hygiene instruction or periodontal probing (which is the most important component of the hygiene appointment) in the 10-minute prophy. I can tell you that many of the new patients in our office have left their previous dental offices because they felt they were receiving an "assembly line prophy." Does he offer a discount for a 10-minute prophy? I have been thanked many times by patients for taking the time to do a quality prophy, discussing their concerns and fears, and providing oral hygiene instruction. No, I am not retarded. The doctor that I work for spends a minimum of 10 minutes on his post-prophy exam. That is certainly what I would expect as a paying consumer.

Doctor, if you feel it is appropriate to say that hygienists who provide a quality prophy and take the time to do so can be equated with retardation, I feel it is appropriate for me to say you must provide very substandard dentistry. I feel sorry for your patients and your employees. Maybe you should try letting your hygienists dictate to you how long you need to do a three-surface restoration on #31. Ten minutes? I can assure you that most patients do not feel faster is better when it comes to their health. I am thankful that I have not had to work for a doctor with such a prehistoric view on the services dental hygienists provide, nor should any hygienist ever put himself or herself in this position. It is completly unethical. I think we are "up to the challenge" of finding quality offices to offer our services and declining the offers from the dinosaurs.

Erin Straley Wieschowski, RDH

Naples, FL

Dear Dr. Neiburger,

First of all, I'm impressed that a person with DDS behind his name would even take the time to read RDH, but I'm also very disturbed with your reply.

I am 39 years old and graduated from dental hygiene school in 1999 (#1 in my class). Upon entering the profession, I've done nothing but clean up the sub-gingival calculus by hygienists who are performing 10-15 minute prophys.

I realize you are a dentist, but I also know your training in prophylaxis from dental school doesn't equal that of a hygienist. You seem to have forgotten that periodontal probing, X-rays, and health history evaluation prior to prophylaxis are integral parts of a hygienist's treatment to which we are qualified and licensed to perform. And don't forget the home care instruction that is so desperately needed by most patients.

It seems to me that the forefront of your practice is time and money, not the health and well-being of the paying patient. We are treating patients, not deboning chickens on an assembly line. I feel very sorry for your hygienist. Please let her know that there are dentists who will respect and value her education as a healthcare provider, not a prophy machine.

I pray for the sake of your patients you are nearing retirement. You give all dental professionals a bad name. So I challenge you to perform your own prophylaxis procedures for a day and don't forget you only get 15 minutes per patient!

P.S. Please read an article in Dental Economics (Sept. 2001 issue) entitled "Hygiene Hamric" by Robert E. Hamric, DMD. He states "If your office is performing 30-minute prophys on adults who have all of their teeth, you are doing malpractice. So if your office can do it in 10-15 minutes, what type of care do you think your offering?

Again I challenge you to re-think the quality of care you are offering the people of Waukegan, Ill. They deserve more!

Vicki L. Daney, RDH

Mesa, Ariz.

Dear RDH:

After last week�s tragedy, I decided to take some time away from the news, and read my journal. Only, I did not expect to have to read of tragedy within my own profession!

Where do I start? So many incredulous thoughts raced through my mind as I read this nonsense.

Colorado Springs has a high patient turnover due to the many military bases here, and people coming and going. And, on some of these new patients that come in, I find to be up to my elbows in residual, black old calculus.

"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." What a bunch of crock! When patients schedule their appointments, they expect to be in the dental office for a minimum of one hour. Yes, they are pleased if it ends up less time, but the most common feedback I have received during my trials with residual calculus are: "This is the most thorough cleaning I have had in years. Thank you."

Like you wrote: "Don't equate retardation with quality." Honestly, how could a patient know whether their mouth is cleaned of subgingival calculus? Heck, for that matter, how could a patient tell if you happened to leave some decay under their new restoration you just placed, since it behooves you to be more focused on time. Of course they will leave happy because they entrusted you with the care of their mouth. But let's ask them how happy they are when some time later, they need flap surgery due to the periodontal pocket that formed from their 2 mm sulcus they had when they first started in your practice. Or perhaps, the high number of root canals you must also profit from since you must have your rheostat mashed to the floor to beat the clock on your preps.

Quite frankly Dr. Neiburger, the only respect I truly need, is for, and from myself. The rest all falls into place. I have complete lack of respect for you and your "colleague's" practice philosophy that is focused on stopwatches and firing of quality hygiene care.

Michelle Noblet, RDH, BS