Dental hygienist Trish Walraven is a busy woman. The self-proclaimed
diva of dings, Walraven has more on her tray than just the
tools of her primary trade. When Walraven is not busy with patients
in her Texas practice, she works as a dental communication software
specialist. As though that wasn't enough, she is an accomplished writer
who contributes to numerous dental publications and websites, including
one she started, DentalBuzz.com. Read on about Walraven in this
humorous and candid office visit.
What drew you to being a hygienist? What inspired your career
Walraven: What I tell everyone is that I had a role as Jan,
the “brusha, brusha, brusha” “Pink Lady” character from “Grease”
when I was in high school, which cascaded into an unhealthy obsession
with teeth. But the real reason I got into dental hygiene was
on the suggestion of a friend of mine who was already in dentistry.
I looked into the curriculum and found it more to my aptitude
than the pre-med courses I was taking at the time (organic chemistry
was kicking my butt).
That and I was terrified to end up with a degree that had no
skill-set attached, just in case I didn't make it into medical school.
The other thing that was weirding me out in college was the
thought that I might accidentally kill someone if I were a physician,
so dentistry seemed like a safe bet.
Your life story. Ready. Set. Go.
Walraven: I had a pretty rough go of it at around age 6, but
otherwise have had a blessed life since then. At that time our mom
decided she needed to be single, leaving my younger brother and
me with our dad, who had just been diagnosed with Hodgkin's
lymphoma at age 27. It was a struggle, but Dad made it through.
In fact, he just got through battling cancer a second time, but our
mother sadly passed away when she was 60, a short 10 weeks after
she was diagnosed with bladder cancer. My husband and I have
been married for 22 years—we're trying hard these days to raise
two awesome, crazy teenagers, and he runs a dental communication
software company (BlueNoteSoftware.com) that has been going strong for almost a decade now.
Dr. Rossen has been my employer since 1999. Before that I
worked as a hygienist in the private practice of Robert Williams,
the Dallas County forensic odontologist, and occasionally looked
on as he worked on criminal cases of bite-mark evidence, postmortem
identification, and court cases where a dentist as expert
witness was needed. It was pretty cool at times, but mostly it was
sobering. Some of the physicians at the medical examiner's were
also patients at our office, and once one of them came straight
from a decomp site for her hygiene visit. I will never forget the
smell on her clothes, or her hair.
How is your work place laid out? What is the workflow like?
Describe a typical day.
Walraven: As far as our workflow goes, we have three doctor
operatories in one wing and five operatories in the other. The
larger wing is mostly hygiene, with an overflow room when we're
extra busy. Each hygienist works out of two rooms and we share a
former dancing Rockette hygiene assistant. Sweet, right?
Our dentist is really great about making sure we have the products
and tools we need to provide the best care for each of our
patients and is always learning about new techniques and procedures.
Probably the biggest change we've seen in the office was the
addition of CEREC and iTero scanners. Patients are blown away
that we no longer have to take vinyl impressions and that crowns
are placed the same day. We've been to so many continuing-education
vacations that I've lost count—several times to Hawaii, Las
Vegas, many other places. I call them vacations because—hello? It
really is a nice break to be with our office team outside of a work
setting, just to relax and have a little fun. We've all been together
so long that we love each other just like any other family.
The typical day has me seeing about six hygiene patients in the
morning and another eight in the afternoon of an eight-hour day.
I usually have 90 minutes for a full-mouth gum disease therapy
treatment (4341x4), 30 minutes for an adult prophy, and 20 minutes
for a child prophy, maybe 40 minutes for a perio maintenance visit.
Occasionally I'll take X-rays if the other assistants are busy, or wait
with the doctor, but the norm is for me to move back and forth
from one room to another providing hygiene services on an accelerated
schedule. One thing that keeps me on track is relying heavily
on the use of ultrasonic scalers and the prophy jet for most patients.
Here in Texas dental hygienists aren't permitted to use local
anesthesia, so what we do instead for our gum-disease therapy
patients is to use a compounded topical consisting of 10 percent
lidocaine, 10 percent prilocaine and 10 percent tetracaine. We simply
syringe a ribbon of the pink compound onto cotton rolls, place
those in the vestibules to provide whole-tooth anesthesia, and supplement
with a little cotton-tip application to the gingival margins.
Patients are amazed at how much relief is provided and that they
get so numb with no shots.
What is your work philosophy?
Walraven: To build relationships that promote the optimal
oral health that I hope to inspire in all of my patients. Or to put
it bluntly, I want patients to do my work for me every day instead
of allowing infections to simmer in their mouths. We both win
that way. Think of it as the Bart Simpson philosophy. As he is
leaving the dental office in one episode Bart says to his hygienist,
“Okay wait: you want me to do your job?! Every night?! At home?!
Yeah, right.” And as he walks out he tosses his new toothbrush
in the trash. Even if it stems in part from not wanting to work
my butt off, I do love finding new ways to motivate patients. I
tell them, “I can either be your coach or your therapist.” They
get the “atta-boy” if everything is great. And if it's not…well, you
get the idea.
Also I find it very fulfilling to get to the core of my patients, to
figure out where their motivations are by really listening to them
and understanding what it is that I'm supposed to do for them.
What is my role in their life and how can I make theirs better?
What are your concerns for up-and-coming hygienists?
Walraven: I hope that new grads continue to have the sense of
respect for themselves and the profession that was instilled in me
by my dental hygiene instructors. In fact, at my first work assignment
I remember crying in joy afterwards because it was so easy
compared to everything I'd been prepared to handle. Come to find
out, the sense of easiness is a sly illusion, one that dentists and hygienists
can find themselves accepting in the sense that they begin
to see the job description only as a tooth cleaner and/or money
driver. When a job is all about the mechanics, critical thinking can
be left out of the loop, and without that stimulation it makes sense
why hygienists get droned out and stop using all the skills they
originally brought to the table.
How do you use hygienetown.com, or dentaltown.com?
Walraven: Some of the best stories that I've written have
come from the people who post on Dentaltown and Hygienetown,
because often it's the first place I'll hear about a new product or
development related to dentistry. Especially if I'm suffering for inspiration,
it's just a good space to compare notes and, even though
this is cliché, it's so true—there is a heartbeat in dentistry, a vibe,
and it's just nice sometimes to connect to it, get my fi x, feel like
part of the tribe, all that. That's what Dentaltown and Hygienetown
provide to me.
How did you learn about Hygienetown and Dentaltown?
Walraven: From one of my husband's business associates, actually.
She was looking for a way to market to dentists and was
surprised I was not already a member. I think she only posted
once. That's all it took for me to get hooked, and I've been coming
back at least weekly ever since.
What would you like to see the hygiene profession change in the next five to 10 years?
Walraven: Dental hygienists have the best position to act as
point of first access to dental care and dental prevention when it
comes to public health. I'm not saying we need to be providingautonomous treatment, but we are all trained with excellent assessment
skills, and where do those end up? In private practices,
mostly. There just aren't that many paying jobs for dental hygiene
expertise at this point.
School districts pay for nutritionists on staff; why not have
a dental hygienist who is paid to implement strategies in the
schools as well? I think many hygienists would enjoy a job that
entails visiting every school in the district, talking about teeth,
checking each child and sending home referral slips if early or
advanced problems are detected, sending home reminders for all
second-graders and middle-schoolers to get their two sets of molars
sealed, all of that. Nurses send home reminders for immunizations,
so why can't a nationwide dental-prevention initiative be
set up in the public schools?
Who are some of your mentors?
Walraven: Well, who wouldn't love to say they've hugged
Naomi Rhode, RDH, Omer Reed's little sister, not just once, but
twice when she's visited your practice? She is one of the most inspiring
speakers I've ever known. Everyone in our office just loves
her. And Trisha O'Hehir. I clearly remember reading her magazine
column in hygiene school and being thrilled that there was a
well-known hygienist with a name like mine! Over the years I've
seen her speak about the usual topics with the most unconventional
perspectives. She's a great writer, and she challenges me
to think, to really think, and she's a friend to me. Most recently
in the process of trying to convince a major toothpaste company
to remove the plastic particles in their products, Trisha has been
nudging myself and another Hygienetown regular to action, and
I know I wouldn't have felt the guts to do something like that
without her influence.
Personally speaking, I am forever grateful to my 91-year-old
grandmother who has always nurtured the joy in my heart, and
my stepmom and dad for giving me wings and showing me that
anything is possible. And of course my husband, my best friend
and partner in life.
What is your favorite procedure?
Walraven: This is where you tease out the creepy side of a
dental hygienist's inner world, right? I think all of us are born
pickers; you know, we're that one monkey who really enjoys picking
the fleas off the other monkeys. With that said, I think my
favorite treatment is a case of mega-gingivitis, with just a touch of
bone loss. The more calculus the better, but I like the huge heaping
of hope that follows when I'm catching early perio just in time.
This is the moment to really inspire the patient to take the reins.
You contribute as an author sometimes. What got you into writing?
Walraven: In the early days of the internet, Google didn't exist
yet, so to find information, people formed these loose societies
known as Web Rings. That's where we would share links and
eventually personal stories. There wasn't a word for online diarywriting, so those of us who wrote
called it journaling. It was a great
place to hone the craft, to meld the
art of living with the art of writing.
These days it's called blogging, of
course, and everyone does it now, for
all sorts of reasons. My blog entries
lately just happen to be about dentistry.
DentalBuzz is exciting because I
can take it in multiple directions at the
same time. I can be serious and silly all
at once. Don't you get tired of reading articles that are dry and
lifeless? That's probably the only requirement for anything posted
to DentalBuzz—it needs to be a bit more playful than the usual
stuff you read in dentistry.
Describe your most successful or rewarding experiences in your
Walraven: The first time was when we were at the Southwest
Dental Meeting demo-ing a rough mockup of what would later
become BlueNote Communicator. We had so many dentists sign
up for a product that hadn't even been created yet that it surprised
even us! In fact, the main product that my husband was showing
was a dental telephone system and it was totally ignored in favor of
this new software. He and I designed it together, so yeah, it's sort
of our third child, and you know how parents feel about their kids.
Also it feels amazing to know that because of an article I wrote
earlier this year, hygienists all over the United States and Canada
became aware that the blue microbeads they were seeing under
patients' gumlines were made of decorative plastic that was being
left behind after brushing with certain toothpastes. They were
able to rally the public for me, resulting in thousands of complaints,
and Crest has responded! Procter & Gamble has promised
to remove the polyethylene plastic entirely from their products in
about 18 months, starting in March 2015.
What do you like to do when you are not working?
Walraven: I play the piano, love face-painting whenever anyone
will let me for fundraisers or whatever, enjoy choral singing,
collect glass insulators from old telephone poles, have a complicated
relationship with IKEA and modern furnishings, and get
a kick out of riding off-road in our Jeep with my husband and