Reconnecting Practicing Hygienists with the Nation's Leading Educators and Researchers.

One Size Does Not Fit All 

I recently received a question on Dimensions of Dental Hygiene’s “Ask the Expert” online forum that elated and angered me at the same time.

I recently received a question on Dimensions of Dental Hygiene’s “Ask the Expert” online forum that elated and angered me at the same time. The reader, a dental hygienist working in a general dental office, asked if the profession was moving toward the provision of limited periodontal treatment to all patients with pockets less than 3 mm when bleeding is encountered during prophylaxis.* This recommendation had been made by consultants from a practice management company hired by the owners of the dental office.

I didn’t know whether to smile or cry. On one hand, I’m happy to see that periodontal assessment and treatment are finally getting more attention in general dental offices. Assessing conditions early based on clinical parameters and risk factors may ensure better patient outcomes. As research has shown, the prevalence of periodontal diseases in the United States has been underestimated by about 50%.1 Approximately 64.7 million American adults have periodontitis, accounting for more than 47% of those tested. Out of the 64.7 million, 38.5% have moderate to severe periodontitis. In response to this prevalence data, the American Academy of Periodontology has launched a national consumer campaign, “Love the Gums You’re With,” to educate the public on the importance of prevention and early diagnosis of periodontal diseases. Visit for more details.

Bringing attention to these numbers is a step in the right direction. But this “one-size-fits-all” model of care is not what’s best for patients. When the evidence-based approach to dentistry gained traction during the mid-1990s, it was meant to serve as the impetus for patient-centered care. Unlike the tradition-based care of the past, evidence-based dentistry taught clinicians to treat each patient individually, considering unique conditions at every visit. Moreover, we’ve learned that site-specific treatment ensures better success than nonspecific care. In other words, we should determine the best approach to treating a certain site based on the available research, the patient’s needs, and the clinician’s best judgment.

The reader’s question of whether this is the direction in which dental hygiene is headed is the most poignant aspect of the discussion. As dental hygienists, we have the power to control where our profession is headed, and we need to be vocal when outside forces, even if well intentioned, try to steer us in the wrong direction. Our ultimate duty is to provide our patients with the highest quality of care. As long as this remains our fundamental goal, we’ll know how to proceed.

Jill Rethman, RDH, BA
Editor in Chief


  1. Eke P, Dye B, Wei L, et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010.J Dent Res. 2012;91:914 –920.

From Dimensions of Dental Hygiene. May 2014;12(5):8.


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