Office Visit: Texas Hygienist a Diva of Dings by Kyle Patton, Associate editor

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, Read on about Walraven in this humorous and candid office visit.

What drew you to being a hygienist? What inspired your career decision?
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 ( 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, or
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 professional life.
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 our kids.


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