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Inside Dentistry
January 2019
Volume 15, Issue 1

Empowering Hygienists to Work at Full Capacity

Q&A with Pamela Maragliano-Muniz, DMD

Pamela Maragliano-Muniz, DMD, Private Practice Salem, Massachusetts

Inside Dentistry interviews Pamela Maragliano-Muniz, DMD, a former dental hygienist, a practicing prosthodontist in Salem, Massachusetts, and a faculty member at Tufts University School of Dental Medicine

INSIDE DENTISTRY (ID): With your dual perspective as a practicing clinician who was also a hygienist, how do you utilize hygienists to positively impact your patients and your practice?

PAMELA MARAGLIANO-MUNIZ, DMD (PM): It's really important to recognize that dental hygienists receive a lot of education. When compared with the education that I received in dental school, the education that I received on scaling, root planning, instrumentation, and even prevention in dental hygiene school was much more extensive. Clinicians should empower hygienists to take the reins in their areas of expertise. In addition to motivating hygienists to take an interest and become engaged in their own careers, when clinicians give their hygienists the opportunity to use the education that they have, it's beneficial for the dentist, hygienist, patient, and practice.

ID: Regarding how dentists can empower their dental hygienists to "use the education that they have," can you give some examples?

PM: There are a few things that come to mind.I see my hygienist's patients at the end of their appointments. There are times when it would be more convenient for me to stop in during the middle, but I want to allow her the time to go through all of her assessments. During her time with the patient, she has the opportunity to perform a caries risk assessment, a periodontal risk assessment, and an oral cancer screening. She takes and reviews blood pressure values and radiographs and looks at the patient's dental condition.

When I walk in to meet the patient, we follow a team approach for treatment. She gives me a rundown of everything that she observed, then I also conduct a full dental evaluation and oral cancer screening. There have been occasions when she has identified issues that may otherwise have gone undetected. Having an educated, second set of eyes observing the patient with you is in the best interest of the patient and is always going to enhance the care that they receive.

Of course, I diagnose any disease that I identify and make the appropriate recommendations and referrals, but it is a common occurrence that I simply confirm her findings and recommendations. She knows the patients and can identify new oral health problems very successfully. She educates the patients on their dental conditions using intraoral photographs, radiographs, and caries detection technology. She makes my job a lot easier because the baseline evaluation that she provides allows me to target and confirm each patient's specific needs more efficiently.

ID: What do you consider to be the most underutilized resource in dental hygiene right now?

PM: Time. The sentiment that a practice can be more productive and make more money when it sees more patients is misguided and can lead to dental hygienist burnout. Unfortunately, it can also lead to improper patient education and improper documentation. When the hygienist is allowed the appropriate amount of time to spend with each patient, then it's better for the patient and the practice.

For example, in my practice, we take the time to do a caries risk assessment for every single patient at every single appointment. Because a large percentage of our patients can be categorized as high-risk, my hygienist takes the time to educate them, and in addition to other preventive strategies, we suggest fluoride varnish treatment or a toothpaste that they can use to reduce their risk. The revenue generated by my practice from treatments associated with these risk assessments far supersedes what it would make if we didn't perform them and squeezed in one more patient each morning.

ID: Have changes in patient populations required you to change your approach to educating your patients on prevention?

PM: Absolutely. If you look at what is happening in any industry, people increasingly want things that are individualized or customized to their specifications. Although it's not a new topic,we're coming full circle in the sense that we have to provide individualized care to our patients.

The needs of a child are significantly different from the needs of an adolescent, an adult, an older adult, or a geriatric patient. The varying populations also have specific risk factors that affect patients at different ages. As clinicians, we have to understand the needs of each population, so we can provide appropriate recommendations and treatment modalities that will promote long-term outcomes and excellent patient experiences. This keeps both the hygienists and dentists interested because we're not doing the same cleaning, polishing, and treatment planning eight times a day. Our patients have individual needs, and we treat them as such.

ID: Of the recent developments in the field of dental hygiene, which ones are you most excited about and what do clinicians need to know?

PM: I believe that the concept of utilizing hygienists to their full capacity is becoming more in vogue, which is really exciting. Another aspect of dental hygiene that is getting some attention is the focus on the connection between oral and general health. More and more hygienists are providing HbA1c, blood pressure, and airway screenings, and this is enormously impactful, because many patients see their oral healthcare providers more frequently than their primary care providers. We have the ability to identify risk factors that can encourage our patients to seek the medical care that they need.

Another recent development in dental hygiene that is interesting is that dental hygienists are now addressing the oral cavity as an environment and offering services and education that go beyond merely cleaning teeth or teaching patients how to brush and floss. Dental hygienists are trained to consider the patient's entire history, risk factors, comorbidities, and oral environment when identifying disease or providing comprehensive soft-tissue management.

Regarding advances in dental hygiene treatment, new techniques and related products have been developed that add benefits for patients, further improving their oral health and the outcomes of their procedures. For example, many of the new air abrasives that have been released disinfect the oral cavity to create a healthier environment for the teeth and gingiva, which has a positive effect on the overall health of the patient. Because of the evolving treatment modalities that are now available, it's more important than ever for clinicians to stay up-to-date with dental hygiene education.

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