For Dental Hygienists Only!

Are you a hygienist who wants to work independently & are interested in EPP? (Note: it is no longer called a “LAP”; it is instead an EPP -Expanded Practice Permit.) Do you see my website and go…”oh, I want to do what she is doing!”, “I want to work independently of a dentist!”, “I want to own my own business!” This blog is for you!
After getting umpteen numbers of phone calls, emails, and other contacts from hygienists & hygiene students all around Oregon, I’ve decided I need to blog about how to work independently, as a hygienist in Oregon.
As much as I would love to mentor you guys, I don’t have the time or bandwidth, so please don’t call me and ask me to walk you through this process! But I will give you some tips and starting points to direct you toward working independently.
First off: have you joined ADHA/ODHA (American/Oregon Dental Hygiene Association)? If you haven’t, really, you need to. If it weren’t for people like Lynn Ironside, an ardent ADHA/ODHA member and fabulous Government Relations Council Chair, NONE OF YOU would have the advantages and benefits of our license that we have here in Oregon. So you need to become a member and come to all our conferences! ODHA has a ton of conferences that helps you as a hygienist whether you are a hygienist working in a dentist office or one that works out in the field independently, or all the other myriad ways hygienists work in the world today (public health, research, education, advocate, etc..). Every May ODHA sponsors and puts on a conference JUST FOR YOU, the Expanded Practice Dental Hygiene Conference. Every year is a different set of classes that address topics hygienists normally don’t have any clue about: business planning, marketing, all the ways EPDH’s work, how we work, where we work, networking, clinical concerns (have you considered how you would deal with a medical emergency if you are in the field?), you name it, we have had a class in it. Take advantage of this fabulous opportunity of how ODHA can make your life easier!!
OK, now that you have attended some of the conferences and you have a little better idea of what you want and how you want it, what is next?
Read your State of Oregon Board of Dentistry Practice Act. You will have to do this to get your EPDH (if you don’t have it already, that is) and it will tell you exactly what you can and cannot do with your new permit. You will want to know early on if you plan on working with a collaborative agreement with a dentist or not. (And if you don’t know what a collaborative agreement is, read the Practice Act to find out!) P.S. you can find the practice act online on the Oregon Board of Dentistry website.
My number one advice is this:
Create a business plan. I was lucky that we were made to create a business plan when I was in hygiene school. My school paved the way for us to get our EPDH’s upon graduation and licensure (due to the efforts of both Lisa Rowley and Lynn Ironside, among others) and part of the curriculum was a business class! Most of my classmates just dreamed up their plans as they assumed they would work for a dentist, but I decided to use the opportunity to create my REAL BUSINESS PLAN with 2 other students and my professor critiqued it! Yay! So I graduated from school with a plan that had the input of 3 other people beside myself and that served me very well indeed. What makes up a business plan? Without creating a whole class on the subject, here are the essential components of a business plan:
• Mission statement and/or vision statement. Exactly what area will you target for working independently? Babies? Children? Low income? Underserved populations (which ones)? Seniors? Developmentally disabled children/adults? Mentally ill? Prison inmates? Homeless? What is your niche? Is anyone else in your area filling this?
• Description of your company and service
• Description of how your service is different
• Will you have a collaborative agreement with a dentist? Describe how this relationship will work.
• Market analysis that discusses the market, competitors (anyone else doing what you are doing where you plan to do it?), where you fit, and what type of market share you believe you can secure;
• Description of your management team, including the experience of key team members and previous successes. While you say you are going to do it “all” on your own, consider what it means to do your own accounting, marketing, etc. Really? At a minimum you need to have a lawyer, a CPA and a bank.
• How you plan to market your service;
• Analysis of your company’s strengths, weaknesses, opportunities, and threat, which will show that you’re realistic and have considered opportunities and challenges;
• Develop a cash flow statement so you understand what your needs are now and will be in the future. Don’t underestimate the costs of doing business. It is more than just buying some equipment and going at it! You need insurance, you need to belong to several organizations to network (think ADHA, Chamber of Commerce, etc.), permits, licenses, State of Oregon business registration fees, -you name it. You won’t believe how much it costs just to have a shingle!
• Revenue projections –otherwise known as “how do you plan on getting paid”.
• Summary/conclusion that wraps everything together (this also could be an executive summary at the beginning of the plan).
And before you go….”yeah, yeah, yeah, I’ll do that later!” note that I couldn’t open my business account at the bank without my business plan, I couldn’t talk to my lawyer without my business plan, …well, you get the idea. It all starts with a business plan. If you feel this is all way too daunting, go visit your local community college business department, your chamber of commerce, your small business administration, your local business start-up organization that helps nurture new entrepreneurs in your area and they will help you step through all the steps.
Whew! That seemed hard, didn’t it? Ahhh, that is only the beginning!
You need to register with the Fed’s for your tax ID number (EIN), you will want to get your NPI (National Provider Identifier), and consider being a Medicaid provider (DMAP). You may need to get credentialed with insurance companies and with dental care organizations. EIN & NPI are easy; you just go to the websites and register. All the others take a lot of paperwork and a lot of patience. It can take MONTHS to get your DMAP and some organizations take months to get credentialed. Get used to paperwork, follow-up, hurry-up, more paperwork and WAITING.
Next: OK, here is the fun part; you get to pick your equipment! Price it out, decide what you need now and what you can buy later. Will you have your own sterilizer? Or will you “borrow” your dentist’s sterilizer? Will you have your own room in your house to store all your equipment, have a sterilizing area (clean/dirty), a desk for all the paperwork, cabinets for your files, and laptop for your business? My advice is to start small and work up. It is easy to spend $5K, $10K, and up to $50K on mobile equipment, vans, RV’s, you name it before you have done all your homework on how to make it all pay for itself. But ultimately only YOU can decide what you can live with or without. After you start seeing your patients you will understand exactly what you need. It is easy to buy too much too soon. I’ve heard numerous hygienists start out with $10K (or more) of equipment and after a few months realize they only use a fraction of what they purchased! Arrrg!! That isn’t a smart way to spend your money!
Are you a good speaker? You better be! You will be asked to speak at all kinds of places. It is how you grow your business. You speak at Chamber of Commerce events, you speak at Skilled Nursing Care facilities, you speak at schools, you speak at conferences, you speak to your fellow hygienists, you create classes for caregivers, or CNA’s, or for fellow health professionals, or to the general public such as at health fairs, senior events, diabetes clinics, children at school,….get the idea? I give 1-2 talks a month and I have about a dozen different slide shows for different audiences and for different time slots (2 hours, one hour and 30 minutes). Some discuss oral health and systemic health, some are about basic mouth care, some are for hygienists in how to work in the field, some are for people who have no idea they need to know about what you know! Hate to talk? Freeze at the thought of speaking in front of people? Then join toastmasters to help you get over your fears. You will not be successful unless you can talk about your business. Oh, by the way, be able to describe your business in 30 seconds or what is called “the elevator speech”. You want to be able to tell people what you do quickly and succinctly, the time it takes to take an elevator.
Next: Repeat after me: it takes three years. Repeat after me: it takes three years. What am I talking about? It takes three years to build a hygiene business that starts paying for itself and paying you. And those are hard years of pounding the pavement, knocking on doors and getting doors slammed in your face. Toughen up your skin baby; you are going to need it! Don’t assume you will make a ton of money out of the gate. You won’t. It takes about three years to build your business. Three years before people start referring you to their patients, clients, friends, and loved ones. Three years before all your hard work starts paying off. Don’t expect to get rich. You aren’t doing this to get rich.
Accounting: Do you know Quickbooks? Consider taking a class at your local community college in bookkeeping and in software. Or will you hire someone to do this for you?
When you decide on your lawyer and CPA, make a list of all your questions. You will be paying them to answer your questions by the hour, so make the most of it! Don’t forget your bank, they are another resource too.
Marketing: you will need business cards, brochures, a website, Facebook page, blog, twitter page. Are you on LinkedIn? Social networking is just one of your marketing tools as well as joining every organization that might be able to help you or network you. What about advertising? How much are you willing to spend? It costs a lot of money to advertise and it takes a long time to reap the benefits from advertising. Spend your money wisely. It is all about the plan.
Have you talked to all the dentists & hygienist in your town or area? Do they know what you are trying to do? They should! You want them to refer their patients to you depending on what service you are trying to provide. Have you talked to your local Department of Public Health? They are both another resource and a potential business opportunity to tap into.

Below are questions I have gotten from hygienists & students over that last year that I have collected and answered:
1. How many years after you received your Dental Hygiene License did you apply for the Expanded Practice Permit (EPP)?
Don’t make assumptions about years. I received my LAP permit 6 months after graduation. New graduates from Pacific receive it upon getting their initial license if they want it.
2. Why did you decide to become an Expanded Practice Dental Hygienist (EPDH)? Please provide specifics if you can.
I’ve always had a passion for public health and this is an extension of that. It is also a “tight” market for dental hygiene and I had a mix of experiences as a temp. I didn’t want to have to compromise patient care because of a dentist or a dental group if I didn’t agree with their practices. Being on my own means I can practice dental hygiene as I was taught and using my own critical thinking, not as it is practiced in the “real world” by the dentists supervising the hygienists. Some dentists are great and some are considerably less so.
3. How did you learn about the EPP? Did you practice with Limited Access Permit as well?
I graduated from Pacific University. They emphasize the LAP/Expanded Practice work. LAP was just the earlier form of EPP with a few small exceptions. Anyone with an LAP automatically had their EPP when it changed over.
4. What does it take, or what advice can you offer, about starting to practicing independently apart from what it identified on the EPP application? (2,500+ clinical practice, active BLS/CPR, 40 hours approved CE, and Professional Liability). Please provide specifics if you can.
Pacific University made it easy as by graduating from there, we are automatically eligible for the LAP/EPDH permit, given the number of hours of rotation at various sites.
You have to be a “self-starter” and be strongly self-motivated or you won’t survive. You can’t be afraid of putting yourself “out there” and talking, talking, talking to people one-on-one, in interviews, in groups and giving presentations to large groups. Most people have never heard of such a thing and you have to teach the world what you do.
5. How much does it cost to get a business license? Is it required to practice?
It only costs about $100 to register your business with the state. I wouldn’t practice without it! It allows me to register as an LLC which helps protect my home assets. It also protects my name and my business name. In fact without registering my business name, ANYONE could just “take it” from me. I’ve worked hard to create a “brand”, why would I want someone else to steal it from me? I don’t know if it is a LAW, but I sure can’t see having a business without registering with the state. There are too many advantages.
6. Can you offer any business advice?
HAVE A BUSINESS PLAN! We were required to create one in school. Most people just made it up because they weren’t planning to use it. I DID plan on using mine, so I created it with the intention of actually using it while I was in school. It helps clarify exactly what you want to do, who you want to serve, how to get paid, and how to grow, accounting, marketing, etc. It isn’t written in stone, but it gives you a roadmap of how to proceed. It makes you think about how to do business. While I’ve made a few deviations, it still “holds water” for the most part.
7. Where do you practice and what underserved population(s) do you treat?
Right now, 90% of my client base is seniors that are unable to access dental care due to physical or mental disability and are in long term care of some sort. I have also been working in schools for sealants for 1st graders (Oregon Health Authority) and I work at a dentist office part time as well.
I recently became a provider for E.N.D.S. (exceptional needs dental service) which took about 6 months due to all the paperwork, becoming Medicaid provider, and credentialing with Willamette Dental, Capitol Dental and Managed Dental Care of Oregon.
I am also working with my marketing to help the developmental disabled as well.
8. Could you describe, in as much detail as possible (including treatment protocols, operatory set up, sterilization, patient forms and paperwork, information you give to the patients), how you are utilizing your EPP?
Wow, could you ask for more in one “question”? That is about a dozen questions in one! This could be a book in itself. I will keep it to a couple of paragraphs.
Well, generally speaking, I look at the risks: Caries &/or Periodontal disease. I screen for oral cancer. For the most part I’m unable to do perio-pocket charting because patients won’t allow it (not with severe dementia). You only have a few minutes to do the most good as fast as possible. I rarely do any root planning (SRP). My goal is generally to try to maintain status (perio maintenance or prophy), but if the family or caregivers are motivated I can see great improvements in both perio issues as well as reducing caries risks. I do palliative care which is all about addressing pain, infection and preventative treatments. I customize treatments based on what the patient needs, what the patient can handle and what the caregiver is willing to do. I have many “tips and tricks” for the caregiver to make their job EASIER, not harder. If it is harder, it won’t happen. And I always refer the patient – either to their own dentist, a new dentist, or to whomever it makes sense for them to see. About half the time they are able to get to the dentist, and about half the time they aren’t. Depends on the severity of what I see and how hard I will emphasize the need. I want my patients to see a dentist once a year for an exam and x-rays. That doesn’t always happen. If I think the neglect borders on abuse (broken/bombed out teeth, pain and infection and not going in to see a dentist) then I will do all I can in my power to help the family get their loved one to see a dentist.
Everything I need is in a plastic tote that I pull in my foldable cart. I wipe down whatever table they have plus my equipment and my tote. I have “clean” boxes and I have “dirty” boxes when I’m on the road. I converted my 3rd bathroom into a sterilization room with a clean and dirty side. I purchased an ultrasonic instrument cleaner, a sterilizer and a cordless prophy handpiece.
I took the “best” paperwork I’ve seen used by others and created my own for HIPPA, patient information, health hx, medications, and charts. If there is a prescription, I call it in to the pharmacy. You can go to my website for some of this information.
9. If you wouldn’t mind sharing, how much were your start-up costs and what did they entail? If you feel comfortable, could you please provide specifics? I would greatly appreciate the insight.
It depends on what you already have and what you need!! Every hygienist needs to figure it out and for whom they are taking care of. For me, it was about $3,000 for bare minimum costs, but start-up costs are only the beginning. You have ongoing costs too. It only cost me a couple hundred dollars to convert my bathroom. I already had some equipment, instrument sets and supplies. -Do you need a vehicle? Some people want a van. I didn’t. Some people want the full set up of dental chair, stool, ultrasonic scaler, suction, hand piece, etc. which costs THOUSANDS of dollars-I didn’t (and you need some of this if you are going to do sealants for children). Do you want to take x-rays? That alone will cost you about $8-9,000 dollars. The lowest price sterilizer is $700. But you could spend $5K easy. I know one hygienist who was able to borrow her dentist’s sterilizer. Re: chairs: Most my patients can’t transfer anyway, so I just work on them in their wheelchair, which makes me more portable. Everything I use is pretty much hand instruments. I do have a self-contained cavitron and a small suction machine which I use quite infrequently since most my patients have choking risks. I have a portable, battery hand piece for polishing. You have to spend money on insurance, on business cards, on brochures, on association fees (i.e. chamber of commerce), and on advertising, etc. I am lucky that my husband is an “IT” guy, he helped create my website and web presence. I got that all for free! I have no idea how much that would cost in the real world. I used to work in accounting and I have a background in graphic design, so I used my own experience for that. My weakest link has been marketing, but I’ve actually been doing a pretty good job of it! But do you need to hire an attorney? Do you need to hire a marketing/graphic arts person? Do you need a web designer? Do you need an accountant? Do you want to hire someone for insurance? Do you want to take some business classes? Do you want to network with other business people? Do you want to join associations that will help your business grow? Do you want to be at health fairs with a booth? How do you plan on reaching your target market? What about advertising? Do you want to hire an assistant? That all costs money that isn’t “clinic” related. You better figure it out!
10. If you have a collaborative agreement with (a) dentist(s), what does it entail? What services can you provide within this agreement?
I do not have a collaborative agreement. This means I can’t write a prescription for pre-meds, prescribe anti-inflammatory meds, restore teeth or use local anesthesia. Since I don’t do much SRP, that isn’t a problem and if they need a pre-med, their doctor can write the prescription. I don’t want to restore teeth. I don’t see the great need an agreement for myself. I think it would just make the doctor nervous. Again, this depends on what you are trying to do and who you are trying to help and to what degree. I wouldn’t really feel comfortable doing anesthesia when I’m by myself as over 50% of all medical emergencies have to do with giving anesthesia as well as my patient population is mostly severely compromised. It is a risk I’m not willing to take, to be honest.
11. For the services you provide, what do you charge for each of them? Please provide a specific list if you can and feel comfortable doing so.
I charge $120 per hour for my services. Since 90% of my clients do not have insurance anyway, it works out. If they need me to spend more time because they are more difficult, my time is paid for. If they are “easy”, then I spend less time. I think it works better than “fee for service”, because I will automatically add fluoride varnish if I think that patient needs it. We don’t have to dicker about what services to add or not – it is simple and easy for the families to understand. And it makes my treatment planning easier – I can do what I think is best for the patient.
For Medicaid/ENDS I am working under a contract with them for my services, which is fee for service.
12. Do you choose to bill insurance for the services you provide? If so, what are the obstacles, if any, have you run into when attempted to bill insurance? Any advice that you would like to share in regards to insurance?
I don’t bill insurance. If the families want, I will give them the form for my services so they can get reimbursed. It can take me 8 hours on the phone to get paid for one hour of service and it doesn’t make sense. I’m not an insurance expert. Maybe I will change, but for now that is what it is.
13. Any other advice or specific details that you would like to share? Any information would be greatly appreciated.
Have a business plan! That is the number one advice I would give!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Interdental Cleaning (aka “flossing”)

Hate to floss? You aren’t alone. There are MANY ways to clean between your teeth besides the traditional 12-18 inches of “string”.

Think about it: if you showered daily, but never washed your hair, would you really feel clean? Same with your teeth and gums! Brushing correctly for two minutes only cleans about 40-50% of your mouth (and most people only brush for about 30-40 seconds -significantly less!). Flossing (or interdental cleaning) correctly gets another 20-25%. Scraping/brushing your tongue gets another 15-20%. Using a mouthwash and vigorous swishing for a full minute gets another few percentage points. (Even just chewing xylitol gum will help clean the mouth too).

I found that when I started to REALLY clean my mouth before going to bed, I would wake up WITHOUT the dreaded “morning breath”! How COOL is that?!?

What is important is to find which floss or floss alternative WORKS BEST FOR YOU! Because you won’t do it unless it is easy and painless! Are your hands “too big” and your mouth “too small” to use traditional floss? Do you have arthritis or other dexterity issues? Or, maybe you have very tight contacts, have areas that are food traps, have implants, bridges, lingual bars or braces, or maybe you have old fillings that shred your floss? All of these obstacles can be overcome! Easily! I promise! For every problem there are at least two or three alternatives that can help.

If your hands bled when you washed your hands you might realize you have a problem…right? Same with your gums. If your gums bleed when you brush or floss that is an indication of disease! After brushing and flossing correctly regularly for 3 weeks you should notice significantly less bleeding (or NO bleeding!). If your gums are still bleeding, even a little, it is time to visit a dental professional to determine the cause, as there can be several reasons and they have the instruments and tools to diagnose the specific issue.

The important thing is to clear the area around the base of each tooth of the sticky plaque & food debris that collects in the little collar of tissue where the gum and tooth meet (called the sulcus). If not regularly removed, the bacteria can fester, cause bleeding, develop deep “pockets” in your gums next to your teeth and can eventually cause your teeth to loosen! Yikes!

Here are examples of floss alternative products I like and  regularly recommend.

FlossAlternatives

Pictured: Reach Access Flosser (great for tight contacts & no hands in the mouth!), GUM Soft-Picks (very tiny rubbery toothpick slides between teeth at the base of teeth -great if you have lingual bars or if floss shreds between certain teeth), Sulcabrush (narrow tipped brush that can fit between teeth and BEHIND those very back teeth-again, no hands in the mouth!), GUM rubber tip Stimulator (not usually my first pick, but better than nothing!), and Water Pik oral irrigator -which is great if you still really hate flossing, have areas that continue to bleed or have dreaded food traps (I LOVE my Water Pik irrigator after I eat popcorn!! Gets every little hull out!).

But wait! There’s MORE! There are also traditional toothpicks (if used correctly), Stimudents (which are softer than traditional toothpicks & a little kinder to gums), Go-Betweens/proxabrushes (they are small bristle-brushes that look like bottle brushes that fit between gaps in teeth & under bridges), numerous small pre-threaded flossers (great for on-the-go & for kids to learn how to floss), special flossers for braces -no threading required! (Platypus ortho flosser, is one) and a few sonic/electronic flossers. There are so many floss alternatives it is hard to list them all!

How to floss CORRECTLY: 

Note: there are MANY different types of floss too..from very slick floss that slips between very tight teeth, to fluffy filament floss (almost like yarn) that cleans around implants, bridges and other dental work and many in-between. Try different types to find the one that works best for you.

To receive maximum benefits from flossing, use the following proper technique:

  • Starting with about 18 inches of floss, wind most of the floss around each middle finger, leaving an inch or two of floss to work with.
  • Holding the floss tautly between your thumbs and index fingers, slide it gently up-and-down between your teeth.
  • Gently curve the floss around the base of each tooth, making sure you go beneath the gumline. Never snap or force the floss, as this may cut or bruise delicate gum tissue.
  • Use clean sections of floss as you move from tooth to tooth.
  • To remove the floss, use the same back-and-forth motion to bring the floss up and away from the teeth.

If you have any special needs, problems or issues, you can contact me with your question and I would be happy to help recommend products that would help you achieve better oral health!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

#putthemouthbackinthebody

I’m starting a new hashtag, even if it isn’t a new concept. Put the mouth back in the body.  Dentists and oral health is considered to be on “one side” of a cultural divide, while medicine and wellness is on yet “another”.  This is crazy, as our teeth and mouth is actually attached to our body. Our mouth is the beginning of our digestive system. Healthy food  (like fruits, vegetables, and nuts) are much easier to eat when we have a full complement of teeth. Our mouth is where we express ourselves through speech and facial expressions. Our facial structure depends upon our teeth and the bone they are set in. As stated by at least a couple of surgeon generals, we can’t be considered “healthy” unless we have good oral health too.

We know there are connections between oral health and overall health; with positive associations to heart disease, diabetes, pneumonia & lung disease, arthritis, obesity, complications of pregnancy, dementia & Alzheimer’s, and yes, even erectile dysfunction.  A few people in the U.S. die every year due to untreated cavities as infection spreads to their brain. (Are you flossing yet??) A lot of it has to do with inflammation (periodontal disease is primarily a disease of inflammation) but there are also bacterial implications as well and links that we have yet to uncover. No, the reason for our smile is not just for cosmetic reasons.

My dad was a medical doctor, my mom a nurse, a sister a nurse, a brother a pharmacological researcher. Medicine is in my DNA.  I decided to become a dental hygienist as a way to bridge the gap between these two cultures that SHOULD be on the same side, but sadly are not.

At least not yet.  I’m working on it!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

MTI Dental Van Volunteer

Images are from Medical Teams International, please visit their website at http://www.medicalteams.org/

April and June 2013

MTI_Dental_Van

I enjoy volunteering with Medical Teams International a few times a year, which is about as often as I can. I think I “get” as much as I “give”. So many of the patients are in so much chronic pain!

During a normal volunteer stint I will review the medical history with the patient, find out “where it hurts”,  take the radiographs (x-rays), start cleaning the teeth like mad, and sometime prep the patient for the doctor by giving the patient their local anesthesia injections.

Most of the time we treat adults who don’t have the money or the dental insurance for dental treatment in a dental office.  Our priority is to get the adults “out of pain” and treat any infection. Generally, children are taken care of through Oregon Health Plan, but some kids do fall through the cracks given their specific circumstances.

I had the pleasure of taking care of one 14 year old. When I placed the lead apron on him prior to the radiographs he asked “why are you putting this on me?” I answered, “to protect you”, he freaked out and asked “to protect me from WHAT?!?”  It then dawned on me that he had never been in a dental office EVER. He had no idea what we do, how we do it and what it entailed. I stopped what I was doing to explain EVERYTHING that was around him – from the air/water syringe, the suction, the chair positioning, the light, the x-rays, the mirror, etc… and I saw that he started to calm down. The X-rays were easy now. Then the doctor asked me to anesthetize him for an extraction.  While I’m confident in my ability to provide a comfortable injection to my patients, in the back of my mind I thought “great! I get to be the bad guy!” and I was a little nervous that I would be this patient’s first experience. So many patients are traumatized by dental experiences and we work so hard for them to be as comfortable as possible!  I explained to my patient exactly what I was going to do, what he would feel and how it would happen.  I could tell he was nervous, and I explained that while he would feel a slight pinch, to trust me, he would much rather have a local anesthetic injection than NOT, for his extraction.  I followed all the protocol that had been drilled into us in hygiene school, to go SLOWLY, take our time and give an “atraumatic injection”. I told my patient to close his eyes, he followed all my instructions and after it was all over he was “wow, that wasn’t bad at all!”, then he was amazed at how fat his lip started to feel! I had to give him a mirror to convince him that his lip wasn’t changing shape.

After the doctor performed the extraction, I asked him how his total experience was. He shrugged his shoulders and said “not too bad” through the gauze packed between his teeth! That made my day! While I would always want patients to have a GREAT experience, if a 14 year old kid’s very first dental experience is an extraction and if it “wasn’t too bad”, then I guess we have to celebrate that as a success!

One day we won’t need Dental Vans to help get people out of pain, because in my ever optimistic view, we will find a way to avoid all oral diseases and find a way to keep people healthy- mouth included!

MTI

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

 

EPDH Conference

EPDH conference (Expanded Practice Dental Hygiene)

Every year ODHA (Oregon Dental Hygiene Association) sponsors a conference tailored to the EPDH hygienists (Expanded Practice Dental Hygiene). This year, just like last year, I had a hard time deciding which classes to take –they all sounded great and it was a hard choice! It was held in Springfield, Oregon May 3 & 4, 2013.

The first class I took was “Management of Early Childhood Caries” taught by Karen Hall, RDH, BSDH.  She has spearheaded the “First Tooth” project here in Oregon.  Children need to be seen by a dental professional when they start to get their primary (baby) teeth.  Primary teeth are important! They help guide the permanent teeth -so you want to keep the primary teeth until they naturally wiggle and fall out. Children will have difficult time learning in school if they are in dental pain. If they become decayed years earlier the permanent teeth are more likely to come in crooked and needing orthodontia work to maintain dental health as an adult.  The ADA recommends children have their first visit by 12 months old. It is all about prevention! How to halt the disease process we call caries (and you probably know of as “Cavities”).   Contact me if you have any questions about how to prevent your children from developing decay.

The second class I took was “Use of Silver Nitrate for Non-Surgical Management of Dental Caries” taught by Dr. Gary Allen, DMD, MS. This is an exciting time to be in the dental field! We can now start to treat Caries as a disease, much like we treat any disease in the medical model. Caries is an INFECTION that is TRANSMISSIBLE. Silver nitrate is a promising new treatment protocol that can halt the disease. Drilling and filling only treat the symptoms of dental caries and they do NOT treat the underlying infection.

The third class was “Farming or Hunting? Marketing in a Social Media Age” by Rosalea Peters, BS Ed. Even though I didn’t learn a lot of new information in this class, I did learn that I am doing everything right! About the only thing I’m not using to reach my audience is Twitter.  This is all an evolution of tools we have to help teach people about what we do and how we can help our patients.

The last class was invaluable! “Managing Medical Emergencies for Dental Patients in Alternative Practice Settings” by Gail Aamodt, RDH, MS and Bill Laird, EMT-P. What a great team!  Although I’ve taken several classes on medical emergencies, they have all assumed to be taken place in a regular dental clinic. In this class we assumed we were “out in the field”, away from a dentist and our traditional medical emergency kit. Lots of great ideas and creative solutions were discussed.  My patients are safer!

Thank you ODHA for sponsoring this great opportunity to network, trade ideas, and get valuable information on being better providers!

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!

Reflections: The Power of Touch & Validation

Reflections on the oral cancer screening event at the Live Well Age Well Expo:
People need to be touched. I had one woman (older, widow) break down in tears while I was examining (and palpating her head and neck) because it had been so long since someone had just touched her. Why are we so afraid to reach out to each other? After the five minute exam she held out her arms and asked for a hug. I’m so glad she did and I hope she will get more hugs soon.

Two other women (separately) stopped by my booth for exams. One had been experiencing difficulty in swallowing for the last few months. She had not seen a doctor for this. As I was examining her head and neck, I felt a mass/thickening over a large area in her neck. I told her she needed to see a doctor immediately and wrote her a referral letter. I had the sense she needed validation from me for what she was noticing herself to see a doctor. I wish she had seen a doctor as soon as she noticed the difficulty in swallowing. The second woman had a swelling between her orbit and her nose. Again, she had noticed this for the last few months but had not yet seen a doctor.

When we notice something out the ordinary or out of what is ordinary for us, we need to have it checked out by our doctors.  Please don’t wait!  Please don’t feel you need validation by someone else to go to your doctor! I hope all  goes well for both these women and that they will have both these conditions resolved soon. I’m only glad if I can help people access their doctors and can give referrals.

Ann Ossinger is a Registered Dental Hygienist who owns DoorStep DentalHygiene, LLC, a mobile dental hygiene service that provides dental hygiene services to people who would otherwise be unable to go to a regular dental clinic in the Linn-Benton Counties of Oregon. 541-990-0814. Please contact Ann if you have any questions!