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Ask Dr. Christensen

Sept. 1, 2006
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers.

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an e-mail to [email protected].


I have heard you speak about expanding the role of dental hygienists to optimize their potential in a dental practice. It appears to be a major project. How can I do this, and what responsibilities can or should I delegate?


Dental hygienists are extremely valuable in a busy dental practice, and their conventional responsibilities are highly important. However, the capabilities of hygienists are potentially more than those currently considered to be within the normal range of dental hygiene procedures. I suggest the following actions for you, assuming you want to increase the role of hygienists in your practice:

Interview. In a personal interview with your hygienist(s), find out if there is interest in expanding clinical responsibilities. I have found, with a few exceptions, that beginning hygienists are often not comfortable with expanding their responsibilities because they are still learning basic dental hygiene. Often, mature hygienists are more interested in expanding their clinical activities since they think they know basic, conventional tasks well. Most hygienists are interested in expanding their clinical role to provide more variety in their work activity.

Regulatory agencies. Determine what clinical tasks may be legally delegated to hygienists. Most states are quite liberal relative about what can be delegated. I suggest obtaining a written list from your professional licensing department of the tasks that can or cannot be delegated.

Which tasks to delegate: Every practice is different relative to the desirable functions to be delegated. You must determine which responsibilities you want to delegate. For many years, in addition to conventional hygiene tasks, I have delegated the following responsibilities to hygienists: (Some of the following tasks may not be legally delegated. Please check each one.)

Preventive appointments using trays and fluoride or remineralizing pastes.Diagnostic data collection.Tooth desensitizing with various chemicals and resins.Denture adjustments.Patient education in all aspects of dentistry.Local anesthetic delivery.Occlusal splint construction and placement.Alginate impressions and pouring casts.Conservative periodontal therapy in a broad realm.Some conventional expanded dental-assisting tasks.Other tasks as needed.Some of the described tasks are income-producing and others are part of additional income-producing procedures carried out by the dentist. For most of the income-producing procedures, I usually provide a bonus of 10 percent of collected gross revenue over the normal hygiene salary. After many years of experience with delegation of hygiene tasks, I have yet to find a hygienist who wants to go back to conventional hygiene.Hold in-service educational sessions or send the hygienist(s) to courses for education on how to accomplish the tasks. Your hygienist(s) should learn the procedures you prefer to delegate one task at a time. The results of the delegation is that the hygienists will be more satisfied professionally, patients will be served better, and you will have more income in the practice as an additional benefit.Implement the tasks into your daily practice activity.It has been my observation that when working together, assistants and hygienists soon become a productive TEAM, respecting one another and the dentist. I strongly recommend expanding the role of hygienists.Our new PCC video, V4714 “Effective Use of Four-Handed and Six-Handed Dentistry,” shows some of the characteristics that are necessary for a true TEAM practice. For more information, contact Practical Clinical Courses at (800) 223-6569, or visit our Web site at www.pccdental.com. QIn spite of recent ADA and AMA support of the continuing use of amalgam, I am still having patients reject the use of amalgam. Should I continue to place amalgam in spite of patient disapproval and in light of the current support by the major organizations?AFor many years, I have faced the same dilemma. Millions of amalgam restorations have served successfully for many lifetimes. Nevertheless, when considering the alleged negative health challenges of amalgam, and especially for esthetic reasons, many patients do not want amalgam, or even our longest-lasting dental restoration, cast gold, in their mouths.I suggest that you and I educate patients about the materials that are available for their treatment. I find that most patients want tooth-colored restorations in their posterior teeth. After years of personal research and clinical use, I can honestly tell patients that properly placed, current generation, Class II, resin-based composite restorations - placed in small to moderate-sized cavity preparations - are competitive with amalgam. Similarly, tooth-colored inlays and onlays made with currently available products, such as pressed ceramics - the most popular of which is IPS Empress (Ivoclar Vivadent) - are highly acceptable. Tooth-colored inlays and onlays made from the current generation of polymers such as belleGlass (Kerr), Sinfony (3M ESPE), and Sculpture® Plus (Pentron® Laboratory Technologies) are also serving acceptably. CEREC® (Sirona Dental) restorations, produced by computer-driven milling in-office, are serving well, and now have more than 20 years of service and research. Patients have many acceptable options that are tooth-colored, and if esthetic appearance is not a factor in their decision, amalgam is still an option.In my opinion, amalgam use will not be significantly diminished because of its alleged health challenges. But I suggest that amalgam will gradually fade from the market because of esthetic unacceptability.You and I must use our own judgment, combined with the wishes of the patient, to decide on the material of choice for each patient. There are now many reliable and research-supported alternatives.
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known “CRA Newsletter.” He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

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