Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1154 Laurie Rowland RDH, MS, Dental Hygiene Instructor at Blinn College : Dentistry Uncensored with Howard Farran

1154 Laurie Rowland RDH, MS, Dental Hygiene Instructor at Blinn College : Dentistry Uncensored with Howard Farran

3/11/2019 6:58:05 PM   |   Comments: 0   |   Views: 167

Laurie Rowland is a dental hygienist and educator with 20 years of experience. She earned her Bachelor of Science Degree in Interdisciplinary Studies and her Master of Science Degree in Curriculum and Instruction from Texas A&M University in College Station, Texas.

VIDEO - DUwHF #1154 - Laurie Rowland

AUDIO - DUwHF #1154 - Laurie Rowland

In 1999, she received her Dental Hygiene license after graduating from the Blinn College Dental Hygiene Program in Bryan, Texas. She is now a professor at Blinn College, serving as Clinic Coordinator and teaching Pre-Clinical Dental Hygiene, Dental Hygiene Care, and Dental Hygiene Practice.

Howard: It's just a huge honor for me today to be podcast interview Laurie Rowland RDH MS who is a dental hygienist an educator with 20 years of experience, she earned her Bachelor of Science degree in interdisciplinary studies and her Masters of Science degree in curriculum instruction from Texas A&M; University in College Station Texas which is less than an hour from four of my five grandchildren. In 1999 she received her dental hygiene license after graduating from the Blinn College dental hygiene program in Bryan Texas. She is now a professor at Blinn College serving as clinical coordinator and teaching pre clinical hygiene hygiene dental hygiene care and dental hygiene practice and I'll tell you what I loved your article this month in dentaltown magazine, you really hit the nail on the head it says no answers how hygienist should respond when asked to overlook or ignore clinical violations. I wanted to get you on the show the minute first of all thank you so much for writing that article, it was amazing and I have heard you know I've met so many hygienists over the last 31 years and so many of them say you know the doctor will say we need to redo this crown on number 19 because that's open margin and she's sitting there thinking well dude you put two crowns in her mouth and they both have bigger open margins than this one and he's like why did those I know there's everything's good underneath there and so I'm so talk about that that article what what made you write that and why did it hit such a nail on the head?

Laurie: Well I had 10 years of experience prior to coming on full-time in the education world and even though I personally didn't experience a lot of issues being asked to do things like that, the more that I experienced having students go out into the real world and contact me afterward I realize that it's almost more than norm you know then one would think to keep put in some degree of situation like that where they felt like they were being a little bit pressured to not follow what they were taught.

Howard: and do you see this I mean you've been doing this for two decades do you see this is a bigger problem today than it was 20 years ago or would you say it's always been that way?

Laurie: I think it's always been this way but I think that we're becoming a little bit more empowered to say something about it and also realizing how important it is to you know pulled our license and make sure that we're doing the best for our patients and you know as ethical decision makers and dental professionals to you know do what's right for the patient, although I think with more offices you know in competition with each other with the prevalence of some dental offices I know in our town and there is kind of some pressure out there to increase your profitability and I think sometimes you know that creates a little bit more of a pressure to then break the rules out of an effort to maximize profits.

Howard: Well when you say maximize profit do you think it's a bigger problem with dsos or do you think that dsos are just are more in the limelight and it's just as prevalent in private practice as it is in big DSOs?

Laurie: I think absolutely it's an equivalent across the board whether it's a private practice or more of a corporate setting and just because they both have different motivations and kind of rules under which they practice. So I think it's you know equally prevalent in my experience.

Howard: So what did would you give to a hygienist listening to you right now or a dentist? You know i i've seen so much dysfunction in dental offices where a hygienist asked a question about x-ray and a dentist will say something like well that's why i went to dental school and then that that's the answer i'm like holy moly man if you can't explain this to your hygienist with four years of college who's been working with you then what does that say about your treatment plan presentation.I mean  I think having everybody with wet hands and even up front with the dry hands on deck everybody has to understand the clinical diagnosis and treatment plan and protocol.

Laurie: Absolutely well my advice hygienist would be to absolutely first of all be familiar with all of the you know rules and regulations and under which they practice and it's overwhelming it's a you know large volume of material to go through and it's you know pretty dry and at difficult metal through but the importance is you know can't be overstated to be familiar with what your dentist's obligations are, the assistants, the hygienist and dental labs everybody involved in the entire process and you know if you're not familiar with those you don't know you know if you are being asked to do something that illegal or unethical and so first of all to be familiar with those and you know even if you don't have everything memorized at least being familiar you can say I know that was referenced in my you know rules and regulations and you can easily go back and find that and the first time you're asked to do something that you know is illegal to you know make sure that you don't do that and have a visit with the dentist's or whomever is asking you to do something that is out of your scope of practice and express to them your concern and you know if they're not familiar with that a law to bring it clear attention and you know set the precedents right then and there the first time that happens because you know just like in any other scenario the first time you agree to do something that goes against you know what you're supposed to be doing legally you're just going to be asked to do that over and over and then one thing leads to another. So you know you've just got to be really prepared to go out there and I don't like to give my students a negative impression of the dental field but because I know how often it occurred I do want them to think about that and be prepared if they are put into that position because it's very difficult for anyone to stand up for their employer I think and a lot of times it's you know younger females and you know they might their family might even have a line on their income or you know they might really need that position and feel very awkward about bringing that to the dentist attention but they just have to do it and they just don't want to end up working in the office for anyone that it's going to ask them to jeopardize their license.

Howard: Well can you give some examples because there might be some dentists listening to you right now that say oh I would never do that and they don't even realize they're doing it. What are some concrete examples that would you share?

Laurie: Absolutely, well one thing it's a very common problem at least here in Texas is there are very strict rules about the monitoring of nitrous oxide and dentists you know one one concrete example that happened recently that I heard about from a former student was the dentist wanted them to initiate the nitrous oxide on her patient and there's it's cut and dry that's absolutely not permissible in Texas to initiate that nitrous oxide and the former students refused to do that and so the dentist sent his assistant and to start it which is just as illegal for the assistant to initiate it. So our former student told the assistant you know it's also illegal for you to do this but you know that's just one example and another dentists wasn't wanting lead aprons to be used on their patients if it was a good time and cleans from the process of having those lead aprons for every patient so that's another example and not taking vital signs on a patient unless there's something wrong which is important if somethings wrong if you don't take their vitals. I think that's an important service that we provide for our patients is an important part of what we do. So you know those are just a few of the examples that I'm called about on a routine basis or you know being asked to see a patient that hasn't had a dental exam within a year that's very common and absolutely you know no cut and dry that that's not permissible. So you know there are a lot of things like that that either the dentist is not thinking about or the front desk you know may not be aware of that and scheduling patients that don't fall into that category so it's just making sure that you know about the laws and making sure that you don't do anything to compromise that and then you know visiting with those people asking you to do that and explaining why that is not going to occur with you.

Howard: Now the one thing that's so confusing to the young when if you're still in dental kindergarten or hygiene kindergarten school and you haven't got out yet, you're on social media you're on dentaltown or hygienetown or Facebook and you hear about how dentists are doing that you think oh well we live in one country but we don't really live in one country we live in 50 different states and the Devils in the details and these states are different from state to state. So when your Facebook friend is telling you that she does this and she's in Louisiana then you're in Texas and the other girl chimed in ins from New York you might as well you could be living in three different countries, would you say would you agree with that or not really?

Laurie: Absolutely that's why it's so imperative to be informed with your own States you know Dental Practice Act and rules and regulations because it does vary from state to state and so you know Texas is one of those states that is a little bit less progressive and the duties that dental hygienist is allowed to perform but you know not that that's right or wrong but you know whether we agree with it or not or they don't you know I feel very comfortable initiating not the nitrous oxide I feel like that's something that you know I would be capable of doing it's it's against the laws. So whether I agree with it or disagree with it or think you know you know I've seen so many patients on nitrous and it doesn't seem that you know ever be you know an issue that makes me concerned about doing you know initiating the nitrous that is something that in Texas is absolutely illegal so they just have to kind of stand up for themselves and and refuse to do something that they know it's against the rules and regulations but it does vary drastically by state and you just have to you know again be aware of the rules under which you practice and make sure that you're following those and aware of them.

Howard: So besides matric now besides nitrous oxide what's another example?

Laurie: Well yeah like I said taking vitals on every patient, using lead aprons, infection control procedures, you know doing what others in your profession with your license would consider standard of care and also the you know those are really common ones that we hear and a lot of former students feel very pressured to turn out as many patients as they can per hour and a lot of times that by skipping proper assessments, pareo charting, intraoral exam, extra oral exam and documentation kind of falls by the wayside when you're you know trying to see a patient every twenty minutes. So the standard of care really suffers when that time limit is imposed on hygienists or certain paths are delegated to other members of the team where they can be lost you know what exactly has been done for this patient, have we followed the right protocol throughout because you know you might assume that the assistant took the vital signs for the patient before you saw them and you know that could absolutely not be the case because of rushing between you know from one patient for the next one.

Howard: The other thing you're talking about on vital signs I mean you know you go to any doctor, physician, anywhere the first thing they do is take vitals they at least take temperature, weight, height. You know anesthetic I lived in Arizona I've been practicing out here since 87 we've had a and just a lidocaine death of a child and of course they didn't even weigh the child. I mean okay have you into a physician in the last 10 years that when you walked in there didn't start with temperature, blood pressure, weight?

Laurie: Absolutely not.

Howard: I think every doctor visit that I've gone to in 20 years they had you stand on a scale they take your weight they take your blood pressure, pulse all in that. I mean it's just it's standard operating procedure and you don't think it's anything that big a deal but when you have a four year old child die because and you can't say how many carpules of anesthetic you gave them and how much of the patient weigh and you know what was the maximum dose and when you have these one-liners well you can give this many to a human. What's the variance of weight in Texas I mean you could have you have a 90 pound little girl all the way to a 400 pound cowboy.

Laurie: Absolutely I know documentation again is you know just vital and just making sure that we you know look at what's truly important and that's take good care of the patient and we end up seeing a lot of patients here in our school and in private practice that may not go to see a general practitioner they have never had any had outward symptoms or signs of things like you know having elevated blood pressure and you know we're kind of a great resource for those patients that you know maybe have always felt like routine dental care or emergency dental care was something that they were more prone to pursue and maybe haven't been to a regular physician for anything in the recent past and we really make a huge service for those patients by informing them if they have readings that are out of the out of the ordinary. We had a child in our clinic years ago the his blood pressure was you know very very very high for a child her age and it turned out that was the first indication that she was having extreme kidney failure and had to be actually after she went to the physician had to be airlifted to a Children's Hospital out of town and that was the only you know the only indication was from our students taking that child's blood pressure so it you know she would have exhibited signs eventually but it was such a blessing that it was caught so quickly because of the student taking those vital finds and paying attention a lot of people do it so unattentively that they kind of just you know listen how heartedly and don't really take the time if they're doing it manually to make sure that their reading is accurate or take it twice. So that's one example where vitals can potentially save a child's life and you never know when that opportunity is gonna present itself.

Howard: So if they were someone listening right now how can they find their state laws? Where would they go, what did you say the dental board?

Laurie: They would go to Texas State Board of Dental Examiners website the TSBDE and there's agency publications the rules and regulations are published and then a separate document is the dental practice Act it's in the occupations code for the state of Texas. Two documents that they publish that the state board publishes the rules and regulations and the dental practice Act which is under the occupations code.

Howard: Yeah I want to go to infection control because back in the day a lot of doctors might be wondering oh this the local hospital and this town saw five or six patients and three of them ate at this restaurant or two of them went to this dental office and it was they just had gut feelings but now it's literally the technology it's a crime scene the CDC can scan come back to you and I've seen this and I've seen some there was one example of a really good old boy in Oklahoma was just a great guy but had no idea the staff weren't following the protocol and wasn't on top of it and sure enough a bunch of people got a virus and they trace it all back to that office and it's in social media it's on the newspaper. I mean when you have the local Centers for Disease Control telling that all of his patients need to be tested that is not a practice builder and then the liability of it. I mean if I was going to you to get my teeth clean and then it turns out that you did not know that your autoclave quite work in a year ago and you don't spore tests and now I have liver failure and I find out you have a big house and a car in a boat guess what's gonna happen?

Laurie: Bye bye

Howard: Yeah

Laurie: It should be that way you know I we should be held accountable for what we do in our practice and people come and trust us and want to feel assured that we're following all of the things that we should know that we need to follow so you know we live in a much more informed society now and you know it's great that people get on the internet and and ask questions and they talk to you about it and any kind of story comes out like what happened in Oklahoma or a child you know dying from an overdose of anesthetic and you know good for them for coming in and being their own advocate and asking questions and you know if the dental team doesn't have good answers then maybe they should you look look elsewhere.

Howard: Yeah I want to talk about Co diagnosis because I I've always believed at the end of the day we're humans and we have a lot of animal behaviors and when you go in there and start talking you know you need a mo mo Dean and pfm you start talking land and greet the patient doesn't even understand but the but the hygienist is in there for an hour and I always told them you know I would my hygienist work we've always been on the same page and she will see a cavity on the disc distal of two she'll show them she'll say it's a flossing cavity not a mo or a do to link it to a behavior they're doing or not doing and whenever I disagree I have always called if she says it's a cavity and I say it's a watch well I don't I don't sit there and say well I'm the doctor and you're like I just I have always for 31 years calling a third party these are calling and another of the dentist or another associates and they come in the room I say hey I'm not telling you how we voted but what do you what do you see on 30 and if they were ever disagree with me like say they said it was a watch and I said was it do then when I was seeing that patient to do the filling as soon as I broke through the marginal Ridge and was getting ready to take out stuff I wouldn't stop and call him the hygienist for that feedback now I'm granted you know my new hygienist has been there nine years so I mean we don't have to do these lessons anymore but it's just so important if I when I look at dentist treatment plan presentation I mean most of them don't even have a 20% close rate and the people who have a 20% close rate they can't even convince their hygienist and when you can get the hygienist the assistance of the dentist to all be on the same page well your treatment plan presentation is gonna skyrocket I mean at the end of the day I got five grandkids and four of them are in Beeville, how far are you away from Beeville are you?

Laurie: I couldn't tell you I heard I know

Howard: You've never heard of Beeville?

Laurie: I've heard of it but Texas is a is a large state

Howard: It's by Refugio

Laurie: Say it again?

Howard: It's about an hour and a half south of San Antonio on about 30 miles west of Refugio, Texas.

Laurive: Beeville is?

Howard: Yeah but you know my goal in office is I would want if my grandchildren went to your office I would want you to be able to attract them retain them educate them self-mastery motivate them to brush and floss and if they did that for cavities to me it's not acceptable that you just aren't good and have a 20% close right I mean if you had a 20% close rate and your sister had a 50% close rate I'd want my grandkids to go to the one that had a close rate because who I don't want my kids my grandkids to be diagnosed with the cavity I want them to get fixed and repaired and then I want them to gain self mastery of how they can prevent this in the future and you just can't do that when the dentist and the hygienist and the assistant are on the same page.

Laurie: Exactly and I think you know a lot of time when I'm when I'm talking to my students about so many of the issues that we see in dentistry these days it so many things boil down to time and you know it takes time to communicate with a patient it takes time for everybody to be on the same page it takes time to do all the assessments and things that we need to, to make sure that we're you know presenting the best plan for the patient and I just I don't know what the solution is except to say that you know if you weren't given enough time to perform the tasks and services that you're supposed to be performing with each patient then something needs to be done about that because you know that just I think one of the biggest factors and I think dentists need to realize that if the hygienists are given more time to build that relationship and the repore and the trust that needs to be established with the patient and their health care providers that you know the case acceptance would you know go way up. That when people feel like they're coming in you know to a cattle call and just kind of one after the next and you know just hold you need to do this, this and this, the level of trust isn't there and that's very understandable. So I think that a lot of the issues that were facing you know in every aspect boil down to the dentist whoever owns the practice not wanting the time could be spent on it when I think it would be a good return on your investment to spend that time that I think it's just not perceived that way.

Howard: So the the only thing when you talk about lead aprons, I want to switch to lead aprons because some things that concern me is like a new technology will come out like a CB CT and then some dentists you know they just have one protocol for a new patient they immediately buy a CBCT and then they just say yeah we're gonna take one on every new patient to screen them for ortho or then I'm like whoa whoa horse you slow down how much radiation is that and some of these guys they might have a lead apron but it does have a thyroid collar and you know I podcasted some oral radiologists that are extremely concerned about some of these new CBCT x-ray machines extremely concerned about a lack of a thyroid collar. So talk light apron so why why and what are your thoughts on let aprons and in these new higher dose machines such as CBCT.

Laurie: Well I personally don't care how much radiation is you know the patient is exposed to in regards you know whether it's a minute amount with digital radiographs or if it's you know higher levels with a panoramic x-ray or whatever the case may be and the says that you need in Texas a lead apron with a thyroid collar. So you know whether or not they're getting exposed the same amount as we have been on an airplane traveling from Texas to California I don't care, you know it's cumulative and you know whether that one exposure is going to you know create any type of problem with that person you know it's not but one it's the law and number two their's no reason not to do it. I just I don't understand what the point would be to not do it other than it does take some time they are and you know an expense for the office.  I think that maybe some of the reps when they talked with in this or maybe touting you know the low radiation exposure of you know their equipment or whatever the case may be and maybe mentioned something like gosh wouldn't even need to use it. I don't know what the cause for this is that that wouldn't be something that would be just such a standard routine not an issue but it is and in practices that I've you know heard of first hand and then you know one hygienist will, a mom will bring in two siblings and one hygienist will feel very strongly about it utilized the lead apron for radiographs and the other hygienist has maybe decided that you know the dentist saying that they don't really need to is good enough and doesn't you know put one on the other sibling and the mom wants to know why did this and why did my you know Sam have a lead apron and my daughter that was being treated you know in the same office not have a led apron with the same x-ray so you know I just a lot of these things I don't see any reason why they wouldn't be followed except the time and the money are the things that unfortunately dictate a lot of you know what what's being done but again that's a cut and dry law that we need to follow and again whether it's minimal or whether it's a larger you know exposure it doesn't matter it's you know a lead aprons without a thyroid collar.

Howard: So in Texas I know that if you are gonna give anybody an injection over the age of thirteen you have to get to have their blood pressure my question being an owner of a dental office I'm who legally can take vitals like in Texas I mean I'm not expecting even know Arizona law but I mean can does that to be the dentist hygienist can the assistant?

Laurie: Anyone, the assistant, hygienist or the dentist can take the vital signs, taken record yes.

Howard: and what about their's a thread on dental town about which vitals do you require taking every appointment and a lot of people say they just asked the wait but I'm sitting here thinking ask the weight. I mean yeah I mean I can't see that's standing up in court, well she told me she was a hundred and forty five well she was a hundred eighty five I mean do you think asking the weight is acceptable on BIOS or do you think they should stand on the scale?

Laurie: Well I think for any procedure that would be you know a great importance with anesthesia that it should be documented and verified a lot of people don't know how much they weigh and you know I think that's an important enough issue that you know if there is a procedure where you know they are going to be under anesthesia that that's something that definitely needs to be reported and not it's just like asking somebody how does your blood pressure normally run. Well they're going to tell you you they don't know or just take a guess or you know even when you take people blood pressure and it's elevated a lot of times they want to make an excuse for that oh I was you know in a hurry or I'm nervous and absolutely some of those things to affect blood pressure of course that you know when it's you know 190 over 110 that's an issue that needs to be addressed or every time they come in you know it's elevated and they have kind of an excuse where every time well you know that's kind of a pattern that works so I think that anytime that vitals are taken it's important that they be accurate. So that's why we take blood pressure you know multiple times if there seems to be any kind of issue with getting you know if something's seen as out of the norm or if you know anything occurs that would make me think that that might not be as accurate as it could be.

Howard: Are you seeing any enforcement I mean are there dentists that you've seen in Texas that weren't doing these things and got in trouble for it?

Laurie: Yes I think that most the time, fortunately there aren't a lot of times when the negligence on not taking some of these vital statistics it you know everything turns out okay and you know that's good and that's bad it kind of makes people relax a little bit on the importance but you know when there is a negative outcome usually it's pretty bad and if it's something that gets brought the attention of the State Board and yes you know there are reprimands and you know loss of licensure and things that have to be done to either reinstate your license and sort of keep it so you know unfortunately I think that it's so probable and you know like I said there's not going to be an adverse outcome every time somebody comes in that is you know in jeopardy for for a negative outcome. So you know it just kind of tends if something really bad happens and so it kind of gets put by the wayside just like with infection control you know you do these practices over and over and thank you you know very lakhs on infection control and you know that can occur for years and years without anything being documented and it's happening because of that and so you know which is unfortunate but some of these things get put to the side because there aren't more negative outcomes to force them into a different action.

Howard: Do the dental practice acts go into much detail about infection control?

Laurie: Not much detail they definitely have protocols but that's more something that is specified you know through continuing education and through school and kind of left to what someone in your similar circumstance would consider the standard of care. So a lot of times it's a little bit like that but as far as like routine you know modern monitoring sort has been once instead of the autoclave you know how you create criticals and my pitiful equipment in the dental office. So all of that is you know outlined but as far as getting really specific you know it would take up quite a bit of  room in that document that pretty much broad delineations of what practices should be put in place for each type of equipment.

Howard: Do you see actual laws talking a lead apron and a thyroid color?

Laurie: Yes, absolutely in Texas yes it's under the dental radiography lab my call it and there's about three or four different regulations under that and you know one of them is that on every exposure, every patient that a lead apron with a thyroid collars is to be utilized in fact I'm familiar now with that one because that's often one that we kind of cut and paste and send out for information for people that are being asked to you know not follow that standard of care.

Howard: Another one I see abused a lot is you know is that is the patient the tail wagging the doctor the dental office the dog or vice first but they call on the phone and they just want an appointment to get their teeth clean and they see an opening and they schedule a new patient in there and the hygienist seats the patients takes x-ray starts doing you the cleaning doing a whole nine yards and many states that's illegal the dentist's would have to diagnose you first and diagnose that you needed cleaning not to mention in my office we have five different cleanings so what talk about that.

Laurie: Well again you know it's on something like that where someone is scheduled and to kind of make the convenience you know that patient the dentist might be scheduled to you know be out of town Wednesday afternoon but this patient really wants to get in the hygiene you know schedule has you know one or two openings so let's get that patient in and you know have the hygenist that's do whatever needs to be done and you know yes as a hygienists especially with some experience you pretty much have a good idea of what a public protocol for that patient would be but once again you know that absolutely illegal and and you know in our office we had a really great protocol where when we had a new patient and of course we had to make sure first of all that the dentist was going to be in the office at that time but the patient would see the hygienist first and there were pretty much standing orders on protocol for minimum and radiographs, assessments that needed to be performed on that patient to get a clear picture of their you know periodontal health and then we would go the hygienist would go and visit with the dentist and kind of give an overview of that patient after we have spent probably an hour with the patient and then the dentist would come on in and do the initial exam and then we get on in the second hour we get started on whatever cleaning was diagnosed and so you know oftentimes that wouldn't be no routine prophylaxis that can be accomplished in that one time but at least we get you know patients do want you to get started they come in for a cleaning you know it does make them feel good to go ahead and at least get started on that procedure. So again with sometime and some you know explanations of patient it's a why it's going to be multiple appointments the acceptance is really great but that was that was the way that we kind of figured out that it was best for our office best for the patient best for the dentist because you know they weren't trying to make snap decisions before all the assessments and my radiographs and then you know if additional radiographs were needed then they could diagnose those and prescribe them at the same time and come back in with the patient after whatever procedure was it was. So we worked it out to have a really good system that I think took great care of the patient and also protected you know everybody's license by following and appearing really taking good care of the patient.

Howard: You know you don't want to be a commodity you want to have a unique selling proposition you want your patients to think that not that all dentists are the same they don't think all restaurants are the same they don't think all cars are the same but you know what they come into your dental office and you take their vitals a lot of people are inching their vitals because it's all about them you don't have to be very narcissistic to be curious about what your blood pressure is. I mean I don't really care about the blood pressure or the guy across the street from me but I think patients really like bad information and then they put you more in the category that you're a doctor and they're not you're taking their vitals you're doing this and then when you tell them they have an infection or a cavity or whatever it's more believable. I want to ask you about your hygiene school, you've been on an instructor at Blinn College hygiene program is that still a mostly male thing I mean a female thing or you seen an increase in males joining the dental hygiene over your last couple decades?

Laurie: There really has not been for our program much of a change we've had in the history of our program I want to say four or five male students come through we accept 14 students we used to only accept 12 students a year but for the past you know number of years we've accepted 14 students into our program every year ours the two-year associate's degree program and we just do not see many males entering the profession and I don't you know I can't say for sure why that is I think that if our a male I guess I probably maybe would feel a little bit uncomfortable going into a predominantly female profession and just out of my own I guess self insecurities maybe but I you know think that that would be a great and you know a great asset for the profession to have more males and we've had male students there's on out more for male dentists, female dentists. So I you know I don't think there should be any reason why it would attract one and sex over the other but you know I do perceive dental hygiene that's kind of a nurturing part of it a little bit I think if you're doing it right you're taking care of that patient you're spending time with them you're connecting with the patient and maybe males you know in general don't find that aspect of it is appealing I you know I don't know I don't know what the answer is.

Howard: Well they don't like to talk about the difference between boys and girls or you're a sexist but there's just clearly a difference between boys and girls. I mean 99% of minors are men and most of the hygienists you go in a hospital it's mostly women I mean there are biological differences between men and women but did I did you know my uncle Mike was the first male nurse in Parsons Kansas you know why he went into nursing?

Laurie: To meet girls

Howard: Well Shirley never went out with him in high school and then when high school is over he was so sad he was never gonna see Shirley again and then he found out she signed up to nursing school so he signed up the next day and bison year I have to congratulate my uncle Mike married Shirley before she got a registered nurse degree and my gosh why is so if you know if your son is single and he can't get a date I'm a my God why would you send him to a hygiene school or nursing school to be the only boy in the class I mean that's when the competition with girls gets good is when you're the only boy.

Laurie: Absolutely

Howard: I also have to say I think there should be I mean I hate to ever lobby for a state law but I think it's a crime that all the nurses so many of the nurses are females because in Arizona in these nursing homes when that when the big man falls in the shower that the two little nurses they can't get them back to bed so they're always calling the fire department. I had patients I work for the fire departments say you know why in Arizona I know this sounds politically incorrect but most of the nurses in Arizona or Latino or Filipino that's it just is what it is I'm not saying right or wrong there they're not boys they're not a bunch of them Russian men they're there and these two little girls can't get a 200-pound grandpa back in bed so that they're forced to call the fire department, the fire department said my friends in the fire department told me it says every every hospital in every nursing home should have at least one man in there that could pick your butt up and get you back in bed. I mean it just it just seems I crazy like that. I want to talk about supply and demand of hygiene. When you're 14 students graduate how easy is it to get employment and does that change any in the last 10 or 20 years?

Laurie: I think that it has always been you know I we are blessed to have a smaller program so and our Twin Cities are fairly small...

Howard: What are your twin cities?

Laurie: Bryan-college station, so College Station has Texas A&M; University so it's kind of a you know they're both large two cities but College Station definitely has a lot of variety and our population depending on if school is in session or not that we are definitely not you know a Houston, Dallas, San Antonio, but we attract students from all over our area and oftentimes they go back to their homes and just because it especially being a two-year program you know they think okay I can commute for two years or I can move here temporarily for two years and then go back at their what they consider home and so we're close to Austin, Houston Dallas, and a good simple location to our students typically do not have any problems whatsoever finding employment and that's been the case you know for as you know long as our program has been in existence. I think that now with you know so many I know speaking for our towns we used to know every single dentist in town, you know it was all private practice. You know you had those establishments that you know everybody knew who they were and we simply use word of mouth or I would you need a hygienist so I know this person that's you know everything word of mouth. I have a small-town feel and now it feels like there's a dental office on every street corner and you know we aren't as familiar with the dentist oftentimes and you know there's so many more practices and I don't think you know sometimes we can't keep up with you know they're too many dental offices right now in my opinion you know that they're having to find ways to complete for patients and you know on for twenty sometimes I think care is you know not really improved when that kind of situation occurs but our students really have found it very easy to go out into different cities and find employment and you know fortunately our school has a great reputation and often students that are out in practices that need another hygienist they will be asked you know do you know of any other Blinn graduates that are available to come in because they were happy with you know the hygienists that they employed so.

Howard: Two more legal things, do you what's the status of dental therapists in Texas is that dead on arrival or do you think that's gonna happen?

Laurie: Right now for sure we're like I said we're pretty much behind a lot of other states as far as our scope of practice for dental hygiene. We're one of the few states where hygienists aren't permitted to deliver local anesthesia and you know

 Howard: Can or cannot?

Laurie: Can not

Howard: See I think that's a because your programs two years after two years of undergraduates requirements first, so it's really a four-year program?

Laurie: They do have quite a few prerequisites that have to be met prior to being accepted into the program it doesn't really equate to two years of you know college experience a lot of our students though you know and it doesn't matter in Texas and graduates with an associate's degree or a bachelor's degree have you know equal responsibilities and you have...

Howard: Do you take kids right out of high school?

Laurie: Well it that just wouldn't be possible just because they wouldn't have had all their prerequisites.

Howard: but how long does it take the average hygiene student in your college to get the requirements?

Laurie: Usually about a year, with Texas A&M

Howard: About a year?

Laurie: About a year and with A&M in our backyard we have a lot of students that come to our program with bachelor's degrees, master's degrees. So you know that's not uncommon for our specific program, when I came to hygiene school here and I already had my master's degree so I looked at it as an opportunity to kind of you know go into a different career and going to the healthcare field and so I you know had my master's degree from Union A&M. So we're a little bit you know in a unique position and that regard without proximity to Texas A&M, so a lot of students get you know a general health degree at A&M and then want to kind of focus that and go into a specific field and then attendants or dental hygiene.

Howard: and so you think I'm independent practice and dental therapists is just not gonna happen in Texas?

Laurie: Not in Texas for quite some time and again it absolutely you know I see these students come through and you know they're highly intelligent and wonderful individuals that are going to go out and really you know do good for the world and the field of Dentistry and you know highly highly capable. I tell them once they finish hygiene school that nothing should be you know impossible for them that they should pursue whatever you know other interests that they may you know have a desire to pursue in the future and after they survive two years of very intensive course work and dental hygiene and but with with Texas is just really you know behind a lot of the states and in the scope of practice for dental hygiene. So having you know anything like that in the near future for Texas is probably you know not something that I'm expecting anytime soon. I think you know the battle for local anesthesia is something that since I was in hygiene school twenty years ago has been kind of a talking point every time that you know comes up for passing and you know the Texas bill association is really is not interested in that in that going through and so they tend to be a little bit more influential and powerful and in the government aspect. So I just don't film through that anytime soon and work and tightness and it's being requested that you know we are permitted to do that get license to be that that the dentists whomever you're working for and opt of course whether or not they would like their - its to perform those duties but you know I guess I'm not sure it's going to happen in anytime soon.

Howard: So then independent practice is just not even I mean if they're not gonna let it get a shot. I can't believe they don't get the anesthesia I mean you go into a hospital a nurse is basically four years college I always considered a registered nurse and a registered dental hygienist the same training and their's not a physician in America that would agree that they're registered nurses shouldn't give the the shots I mean you know it's just it doesn't make any sense to me. So are there any other questions that you I wasn't smart enough to ask that you wish I would ask?

Laurie: I don't think so I think we kind of covered it head to toe I just you know I my purpose in writing the the article for dentaltown in hygienetown was to you know just kind of encourage people to you know dentists, hygienists, assistants to be familiar with with the rules and regulations and to make sure that they were you know doing everything that they were supposed to take care of our patients because that's why those rules are there and you know again some of them you may or may not totally agree with that that's irrelevant and they can just have a board food and have the thought process before getting involved in that kind of situation by you know I encourage our students to fill out and never accept the position until you at least observe a working interview. So you can kind of get a feel for what the hygienist is being asked to do and if any of those things would you know violate what you've been taught and to sure hopefully prior to getting into a situation that the office is doing what they need to do to follow the rules and regulations and then if you are presented with that situation that you stand up for yourself the first time and just you know absolutely don't do anything to compromise your license and make sure you're familiar enough with those laws that you can they can show those whomever is asking you to not follow them and and be able to justify this is how I'm making my decision and I'm not going to do anything to compromise the patient care or my license.

Howard: and also do you, my last question is about teledentistry. Do you see Blinn College hygiene program offering more courses online or do you see it staying at the classroom because we're now starting to see a lot of teledentistry companies came out so see in rural areas like Alaska where hygienists might be you know 500 miles from town and so is online taking off in Bill and you see tella dentistry around the corner for hygienist?

Laurie: Well we have all face to face courses as far as students coming in taking courses at Blinn College and we have a clinic here on site and so everything that our students do at this point is face to face courses and having the clinical experience here on site as far as teledentistry is concerned, I think that's absolutely fantastic and I do think it's kind of one of those things that you know it's going to become more and more popular and I thank goodness because you know there are certain areas that are so under served that if we can get you know some people out there that can use teledentistry to you know getting that access to care that that you know that there couldn't be anything and you know negative to be said about that.

Howard: and one last follow up on your said about you know do a working interview work in the office, one of the things I see hygienists getting very upset is they'll work in a dental office and the doctor will say well if there's any pocket over a five you have to put in some pareo chip or something because there's a insurance code to bill it and they're sitting there thinking well and my professional judgment I don't think it needs a pareo chip and so what I would say to the hygenist is the biggest red flag is that when a non-clinical person is telling you to do something like an office manager it's like you don't you don't listen to an office manager about wet hand stuff that's dry hand stuff and when you go into a dental office and the office manager is telling you things like thirty percent your patients should be pareo or forty percent. I mean that would be like going how would you I do what a physician's me says well forty percent of my patients have to have type 2 diabetes. I mean statistically it has no bearing on the individual sample size I mean statistics can tell me that there's there's more oranges than lemons but if you're holding a piece of fruit in your hand I can't use statistics to tell you what's in your hand. I mean you either have diabetes or you don't, you either have periodontal disease or you don't and when you have and that's why I'm kind of getting old school where I really don't think you should own a dental office if you're not a dentist because I see some of these on DSOs where they're completely owned by non dentist and and office managers are have to do their numbers and the numbers include this many perio chips and this percent, I mean what do you agree or disagree?

Laurie: Well absolutely there's no place in healthcare in my opinion for that type of you know needing to meet those particulars and have a certain percentage of your patients falling under, just like some practices you know incentives and you work on Commission and how many FMX's you take on your patients a certain day. Well you they there's no there's no room for an incentive when it comes to providing care for patients either they need it or they don't need it and I think amending a financial gain on a hygienist for performing certain tasks is about it's unethical as you can imagine and I caution students all the time and I don't think it's I don't hear of many practices that do that but I do know that that is the case and a lot of over treatment. So I just think that you need to have good communication with your dentist, we need to have good communication with the you know front office that's you know scheduling these patients and maybe making these you know reflects of the hygienists and just have you know good open discussions about you know your license and about what's in the best interest of patient and if those who don't line up. You know I don't want students to go into a situation where they have some red flags in the office and they turn around and they you know don't accept the position when it could be something that they could go into that office and establish themselves as a respected member of the team and start kind of bringing about some of the you know information and knowledge and kind of educating the people in the office and encouraging them to kind of rethink some of those things. So you know if you just turn around and you don't accept the position because there's you know one or two red flags depending on the severity of those situations but you know if you see some things that aren't really appropriate with infection control or something like that you accept that position is that something that hold you back and and bring that level of care up in that office and do it in a respectful way and it's helping not only the members their dental community but also the patients because a lot of times assistants and hygienists and even the dentists or doing things that could potentially harm themselves and they're doing these things out of you know just ignorance and if you can let them know that what they're doing could you know eventually harm themselves or their patients, I think that most people are receptive to that and want to do what's best for their own health as well as the patient's so I think it's just sometimes out of I think a lot of times people that have been in practice especially for a long time get a little bit too comfortable with bodily fluids and aren't as you know treat it as successfully as they should and you get a little too comfortable with that and sometimes it takes some fresh eyes to come in and say you know you should not have an open Route 44 sonic drink that's for the ultrasonic Bank that has no lid on it. You know I think sometimes you just kind of forget to take things as seriously as they need to be taken so hopefully we'll get people that are doing the right thing out into these offices and really encourage everyone on the dental team to do what they should be to take care the patient.

Howard: and you know the other thing when you're well you're young is when you go out there I mean the Golden Rule it's not whoever has the most gold the owner rules the golden rule is simply treat other people the way you want to be treated and I know everybody I mean I say things that comes from the Bible, Santana was in Hinduism 3200 years BC one should always treat others as they themselves wish to be treated, Confucius 557 BC well you do not want done to yourself do not do unto others. So I mean every major religion has been telling you for 5000 years don't treat someone the way you don't want to be treated and on that note it was just an extreme honor that you came on the show today Laurie Rowland RDH MS I hope are you gonna write us another article again someday cuz your last articles a huge hit.

Laurie: I hope so I would like to do that

Howard: Okay well thanks for giving all the young kids some guidance as there are you know most podcasters are Millennials and you give these young kids a lot to think on. Thank you so much for coming on the show today.

Laurie: You're more than welcome thank you

Howard: Alright have a great day and if you ever stop and Beeville, give my four grandkids a kiss from grandpa Howie.

Laurie: I'll do it. 

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