WHOSE FAULT IS IT?
When dental disease
surfaces, must we always
blame the patient?
BY SHIRLEY GUTKOWSKI, RDH, BSDH
eat right. No one can even say what “eating
right” is, even while the airway is compromised
by tongue ties, and dental interventions may
be the true issue. Eating right comes after airway; obstructed airways contribute
more to inflammation than periodontal disease. Unless
they are making
money on it, too
refuse to allow simple recommendations for eating foods
as close to their natural state as possible.
Money is being
wasted on treatments and recommendations of ineffective
Let’s end the blame game, take professional responsibility for helping patients find
a way to be healthy. Professional curiosity
is what we need to when embracing true
Shirley Gutkowski, RDH, BSDH, is a
practicing dental hygienist and orofacial
myofunctional therapist. Her practice, Primal
Air, focuses on the prevention and treatments
of orofacial myofunctional disorders, such as
snoring and immobilized tongues. She can be
reached at firstname.lastname@example.org.
Can you imagine being blamed for a ruptured
appendix? In the United States, we have become so accustomed to being blamed as a
patient, as well as prone to blame as a provider,
that anything outside of patient responsiblity
is difficult to address.
Recently, a rash of adult patients with tongue
tie brought this blame-the-patient idea to a head.
It always amuses me when conditions cluster.
One day no one needs x-rays; on another day,
everyone does. One day everyone has cavities; on
another day, no one does. Months can go by, and
you never come across a restricted tongue. Suddenly, everyone has one. A restricted tongue leads
to gingivitis, smaller palate, and an inability to use
the tongue to chew or remove food debris from
all areas of the mouth, leading to decay and periodontal inections (and more importantly leads
to mouth breathing and contributes to an obstructed airway).
Here’s the problem with decay; it’s not normal,
it’s common. Professional ethics are to continually
recommend fillings and instruct the patient to
brush better, floss more, and use more fluoride.
Fluoride deficiency is not the reason for decay.
Worse is blaming patients, telling them their teeth
decay because they did something wrong. To be
completely ethical, a practitioner should look
further than the patient’s tooth brush. The tide
of blame has been hitting patients for so long that
when another answer comes up that removes
fault from them, they don’t know how to handle
IMPACT OF NO PREVENTION
A restricted tongue is not a direct relationship
to decay or periodontal disease such as biofilm
accumulation. A tethered tongue is an insidious
cause and under-recognized. When patients hear
of their restricted tongue being the cause of the
problem, they don’t know what to do about it.
They lash out at the person pointing it out.
Patients don’t want to feel guilty for not brushing or flossing, but they’re used to it. Being
blamed is common.
Dental decay and periodontal
disease are multifactorial. Range of
tongue motion is one of those factors. Not evaluating or addressing
the tie as early as possible, even at
age 50, is not helpful for the patient
or for the profession.
Dentistry has kept people in
teeth, and has lost sight of the practice of dentistry. The biological dimensions of the tooth or the arch
can be repaired. There have been
strides in those areas, and dentistry
has lost sight of the rest. Perhaps this
loss of attention is the fault of dental hygiene—
the prevention arm of the profession.
Very few leaders in dental hygiene have
taken up the prevention flag and run the full
distance with it. Dental hygienists have followed in the footsteps of dentistry, focusing
on treatments for dental conditions. Then
blame patients for their disease and apply more
treatments. Dental hygienists have relinquished their reins over prevention, it seems.
The country is at a crisis in health care. The
costs are bankrupting individuals, families,
states, and the country. Health care tries hard
not to let people die and focuses on esoteric
aspects of disease prevention—exercise and
The tide has been
for so long that
answer comes up
that removes fault
from them, they
don’t know how to
handle the news.