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Hygiene Department Visit: She's Redefining the Standard of Care Benjamin Lund, Editor, Hygienetown Magazine

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She's Redefining
the Standard
of Care

by Benjamin Lund, Editor - Hygienetown Magazine

Welcome to the fifth installment of Hygiene Department Visit, where we visit Townies in their practices and profile their equipment, procedures and hygiene philosophies. If you would like to participate or nominate a colleague, please e-mail ben@hygienetown.com.

This month we visited the Hood River, Oregon, practice where one of Hygienetown's most active Townies, Julia Gonzales, RDH, BSDH, aka "JGonzalesRDH" works. In speaking with Gonzales, her indomitable passion for dental hygiene becomes increasingly obvious – so much so that it permeates every fiber of her being. In this interview, Gonzales discusses how she communicates with patients, how she handles non-compliance, her excitement about Hygienetown and how much her team rocks!		  

Hygiene Highlights

Equipment
• CEREC MCXL
• Dentsply Cavitron
• Isolite
• KaVo DIAGNOdent
• KaVo Everest Milling Machine		 • Kodak PracticeWorks Systems
• Peri-Optix 2.5x FlipUpLoupes
• RDH Midwest Handpiece
• Satelec Piezo
• Two-way radio system

Instruments
• Hu-Freidy Ever Edge Collection
• Nordent
• PDT (Montana Jack, O'Hehir curettes)
• Standard Setup— Barnhart 1-2, 5-6; Gracey 11-12R, 13-14R; anterior sickle H6-H7; PDT Montana Jack; ODU (Old Dominion University) 11-12 explorer; perio probe with explorer; double-sided mirror		 • SRP setup — Barnhart 1-2, 5-6; Gracey After Five 11-12R, 13-14R, Gracey 15-16, 17-18, Gracey Mini Five 11-12, 13-14; McCalls 13-14; Loma Linda 10-11; Hirschfeld files; anterior sickle H6-H7; PDT Montana Jack; ODU 11-12 explorer; perio probe; double-sided mirror

Medications
• Arestin
• Biotene Oral Balance
• CariFree technology and products
• 0.12% CHX		 • 1.1% NaFl toothpaste (Floridex)
• MI Paste Plus
• Zilactin

Oral Hygiene Products
• All Sunstar products
• CariFree Boost Spray and Maintenance Rinse
• Discus tongue cleaner
• J&J fluoride woven floss, mint waxed, dental tape
• J&J Stim-U-Dents		 • Oral-B electric toothbrushes
• PDT Platypus ortho flossers
• WaterPik
• Zila Rotodent RotoPoints

Photography Equipment
• Canon Rebel XTI
 • Canon 20D

Radiography Products
• Kodak Practice Works
  

Supplies
• Fluoride varnish (3M and Halo)


Click Here to view Julia's Top 5

 • Premier Enamel Pro Polish
  Name: Julia Gonzales, RDH, BSDH
Townie Name: JGonzalesRDH
Graduate from: Oregon Health & Science University
Year graduated: 2000
Dentist/Employer: Curtis C. Haynie, DMD
Practice Location: Hood River, Oregon
Number of hygiene ops: Four hygiene ops and
one overflow
Staff: Three dentists, five hygienists, four EFDAs,
two DA/HAs, three front-desk administrators, one certified dental technician, one student.

Julia, why did you choose a career in dental hygiene?
It's a family affair. My grandfather was the oldest practicing orthodontist west of the Mississippi River until he retired in 2003. His passion and enthusiasm for his career was my ultimate motivation in seeking a career in dentistry.

What appealed to you about the current practice in which you work?
Fresh innovative ideas and advanced technology. As a start up, I had an opportunity to create a hygiene department that would embrace new philosophies and raise the bar to the standard of care.

You're very proud of your teammates, tell me a little more about the other hygienists you work with.
I love my ladies! What makes our practice attractive is we are a team. As hygienists, we embrace working as a team to redefine the standard of care to offer patients the best support. I feel privileged to work with our hygienists because we all respect each other's ideas, skills and are eager to listen to innovative concepts of how we can be even better hygienists to serve our community. For example, we initiated a CAMBRA approach to treating dental caries and we are currently working on providing in-services for the local medical community to discuss the pivotal role of systemic diseases linked to periodontal disease. It's very rewarding to work in an environment where there is strong motivation to consistently improve in all aspects (self, team and patient relations). I admire their clinical and communication skills and their hard work to succeed. It's very reassuring to feel confident that if another hygienist were to see a patient of mine, that patient would receive the same care.

What is your favorite dental hygiene procedure to perform?
SRP (Scaling and root planing)!

How has Hygienetown impacted the way you practice dental hygiene?
Well, now that I can acknowledge that I am an official addict I suppose I can share with you why Hygienetown is instrumental in shaping my ideals. First, it is streamlined with current products and educational updates. Second, I like reading about challenges that we face every day in hygiene and the well thought- out responses on how to solve them. It's exceptional because it is open to any dental professional or student. This embraces a team approach in providing outstanding oral health care to our patients. It also creates a bridge of respect between dental professionals, which is also a critical relationship to establish. Third, I always feel motivated to learn more after reading Hygienetown. It's a wealth of knowledge, which you can quickly access. Fourth, it allows me to stay connected to my profession. Fifth, I have developed great relationships with other Townies whom I would have never met otherwise.

Who are your favorite Townies on Hygienetown.com and why?
"annieb925" – she's very committed to excellence and has a source for everything!
Trisha O'Hehir – I respect her expertise and dedication to sharing innovative products and current information that shapes our field.
"scottingham" – great hygiene coach and eloquent communication skills.
"needardh," "LMD," "skrRDH," "mp2006" – smart! They share their expertise and experiences to support hygienists' desire to become the best in our field.
EverdaySurgery.com aka "dhwong" – is smart, funny and modest. His posts always impress me.
  
Julia's regular tray set up.		   
Julia's tray set up for periodontal cases.

What are the biggest challenges you face as a hygienist?
TIME! I never seem to have enough of it.
Battling insurance companies/patients basing their dental treatment on their insurance "benefits."

What is your periodontal therapy philosophy? (e.g.: What do you treat and what do you refer out?)
As a hygienist practicing in Oregon, we have the unique opportunity to diagnose and treatment plan all dental hygiene services, including non-surgical periodontal needs.

I believe that treating periodontal disease involves a team approach. Members include the patient, hygienist, dentist, and could expand to include a periodontist, oral surgeon, and medical physician/naturopath. Understanding that periodontal disease is a multi-faceted event, it requires a multi-faceted approach. Clinicians' treatment recommendations must be as dynamic as the activity of the disease. I take on periodontal disease from the etiological aspects of mechanical removal of irritants, educating the patient on custom home care regimens and encouraging immune enhancements (ie: increase vitamin C intake, xylitol, CoQ10, decrease stress, etc.).

Once complete records are obtained (Med HX, FMX, full periodontal charting), I can begin my initial diagnosis using AAP guidelines to help me determine an ideal treatment plan for the patient. Generally, we begin all initial periodontal treatment (slight, moderate and severe cases) in our office and the patient is informed that, in certain cases, we will need to bring on a periodontist to stabilize their current periodontal disease infection. I will refer out any patient who has not achieved successful stability. This could occur at the first visit, one-month tissue check with the dentist, or any subsequent follow up periodontal maintenance appointment.

What is your typical day of appointments (how many children, adults, new patients and perio patients do you see on average each day)?
I mostly treat adults/teens and of adults, 45-50 percent of them are perio patients. Our practice boasts, on average, 60 new patients a month, so I have plenty of perio to treat.

How do you explain your treatment to patients?
Depends on what modality the patient communicates most effectively with (visual, auditory, kinesthetic), and I strive to adapt my communication style to match theirs. I use silent cues and incorporate the patient's dental values into our conversation and never lecture. I might relate the subject matter to something they are familiar with metaphorically. One lesson I have learned from a dentist I work with is what I call a "mirage technique." Allowing your patients to believe they are making their own decisions on what type of treatment suits their needs.

For example when working with a new patient I'll say, "We are going to evaluate the health of your gums and the way we do this is by measuring the space where the floss slides between the tooth and the gum. Numbers 3 and below generally indicate health, 4 is your "fence sitter" number and anything 5 and above will indicate some localized periodontal disease or bone loss."

I complete a full periodontal charting saying the numbers out loud to an assistant. Then, I sit the patient up (non-verbal cue) and ask, "What did you think about those numbers?"

The patient might say, "Oh, well, there were some high numbers in the back and some sensitive spots."

I'll then say, "I'm glad you were paying such close attention because that is important information to have before we review this chart (bring out the monitor w/perio chart displayed). You see these red points? They each represent an area of active inflammation in your gums and we can quickly see that roughly 50 percent of your gums have some form of inflammation. So it's great that you chose to come in today so we can begin restoring your gums to health. Now, in these areas in the back where you have some 6mm pockets, that means you do have some localized periodontal disease. The good news is that we are catching the disease at an early stage and it is contained to these specific areas. If left untreated, the disease will gradually spread to affect your healthier teeth. Knowing that keeping your teeth for a lifetime is important to you (a value that they shared at the beginning of the appointment) I would recommend a second appointment called scaling and root planing to specifically address these sites. That process involves getting you comfortable or numb so we get down to the base of the pocket and remove the pathogenic factors. Does that make sense so far? Great. To clarify, the cleaning we are doing today will address stabilizing the gingivitis and then we will reserve an hour-long appointment to address your active periodontal disease."

Throughout the appointment, I will discuss home care recommendations and the systemic risks associated with periodontal disease – specifically if they have an auto-immune disease or cardiovascular disease. I'll also discuss the need for three-month re-care intervals to keep the disease stabilized or to catch early resurgence. I schedule patients for their SRP appointments in my operatory before they leave and ask what questions they have for me.
How do you battle patient non-compliance? What do you do to motivate your patients?
If a patient is non-compliant (ie: re-care interval recommendations, home care, etc.), I will apologize to the patient for failing to communicate the importance of the recommendation and review why the recommendation was made to support their dental values and ask them to share with me their hesitations. It's an offensive approach to better understand my patient and what obstacles we face.

When that doesn't work, I refer in-house." Another
hygienist's communication skills might be more approachable with that patient.
Julia Gonzales (third from left) and her team.
I believe the most sincere way to motivate patients is by simply acknowledging the person. I love to do this when the dentist comes in for the exam so he can share in the accomplishments. Sometimes it's as simple as, "Dr. Haynie, I want to take a minute and acknowledge Mr. Smith for his commitment to his oral health. After their initial periodontal treatment, he has been committed to his three month perio maintenance cleanings and I think it's fantastic that we have all worked well together to maintain our success. Mr. Smith, thank you for that experience."

What is the most rewarding experience you've had as a dental hygienist?
Working with a highly motivated hygiene team.
Traveling to Guatemala with Rotarians to provide the first hygiene services to several remote villages. Their gratitude was overwhelming and it made me realize that as a hygienist I can make a difference in someone's life, and through teamwork we can create miracles.

If you could add TWO new pieces of equipment to your hygiene department, what would it be?
1. Perioscope
2. Veloscope

If you weren't a dental hygienist, what do you think you'd be doing right now?
Something in the health field; most likely I would be practicing dentistry.

Tell me something people would be surprised to know about you.
  • In high school, I played the Virgin Mary in our church play.
  • As a student at the University of Oregon, I dressed up as a monkey and was placed in a cage outside the science department to protest against laboratory testing on animals.
  • I've never been in a bar fight.
All the above are true (That's a hard question! I had to ask my mom for some ideas). I'm really an open book so it's hard to know if people would really be surprised at that or just laugh.
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