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The Job Behind the Mask: A Dental Hygienist Talks Business

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The Job behind the Mask: A Dental Hygienist Talks

The Job Behind the Mask: A Dental Hygienist Talks Business

November 07, 2005
Part One
By: Jean Johnson for Dental1

Nina Lieblick, R.D. H., earned her associates degree from the University of Louisville in 1999 and is a registered dental hygienist. She currently works in several dental offices in the Portland area and on a golden fall day before the rains set in, I found myself in her examination chair responding to her very courteous, “Open please.”
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Dental Care Facts

The American Dental Association recommends that dentists see children by their first birthday.

Pediatric dentists specialize in treating youngsters to age 18.

Patients who stay with the same hygienist have the advantage of continuity in care. “We can see what’s working,” said Lieblick. “And for what’s not, we can help them try something else.”

People of all ages, even those with dentures, should see hygienists at least annually if not every six months.


Business can work both ways, though, so I made a follow-up appointment with Lieblick to get her thoughts on teeth and cleaning. What follows is a mix of my experiences as her patient and her comments about her profession. In other words, if you could actually talk to the person working in your mouth, this is how the conversation might go.

Patient Attitudes

From under her white lab coat and plastic glasses, Lieblick looks entirely capable. Her blonde hair is trimmed neatly and from her ear lobes small diamond studs catch an occasional ray of light. She picks up a metal instrument and probes around the gum lines of all my teeth, evaluating the margins. While she’s doing that, though, I want to know how receptive patients are to learning about oral care.

“When I was in school my instructors said that the number one problem we’d find is that patients want to come in for their cleanings and have the hygienist fix all their problems in an hour,” Lieblick said. “And it has been my experience that many patients don’t want to know what’s going on in their mouth. Ignorance is bliss in a lot of ways. It seems like a lot of people kind of take their mouths for granted, and they don’t think of them like they do the rest of their body. It’s the mouth and the eyes that often take the most abuse.”

In part, Lieblick agrees that we patients act that way because we’re just emerging from an older, more patriarchal model in which dentists would tell their patients what they thought they needed to know and that was that. “Now people are asking more questions because there is more knowledge available. So, when I see that someone is interested, I think it is my job to help educate them.”

That said, she notes that half the battle is figuring out who won’t get overly defensive. “You become good at reading people and then hope that they actually own up to the idea that it’s their mouth. What I try to do is educate without being too overboard.”

Periodontal Disease

“That especially goes for with periodontal disease. We can see signs patients can’t feel – inflammation (puffiness and redness) that indicates a problem. Periodontal disease is so slow progressing that sometimes it’s hard to know if something’s going on. Bleeding, for example, we’re finding out, is not normal. But, I don’t think people always realize that if their gums bleed at home it’s a problem. It’s just the same, though, if you had an infection in your foot and your toe bled. No difference at all.”

Oral Cancer Screening

The day is golden, but it’s also blustery and leaves drift down from the stand of alders on the hillside beyond the office’s large picture windows. Lieblick puts some warm water in her sprayer for my sensitive teeth and then does a screen for oral cancer – runs her gloved finger around the inside of my gums and then squeezes my lips and cheeks in a quick professional massage that could have gone on much longer than the few seconds it took.

“It’s a little cheek massage,” she says with a light laugh. “Oral cancer screening is so important, and the only place people get that is when they go in to have their teeth cleaned. That’s why I tell patients – even those with dentures – to get in at least once a year if not every six months.”

Dental Cleanings

She switches on the ultrasound. The soft, high whine of the machine and the swish-hiss of its thin water spray becomes a presence in the room. In the background the suction does its thing, while with mirror in hand, she goes to work.

It turns out I get a good report. “Your crowns are not bad. Usually they pick up plaque and tartar, but these are in good shape.” That said, she takes a metal instrument called a sickle scaler and starts scraping away with little squirrel-like scratches. The sound of metal on enamel raises the hair on my arms. I pull my sweater a little closer around my body and look off to the hillside and the bright yellows of the fall day.

The scaling doesn’t take too long, though, and soon the smell of mint fills the air. I can feel the pressure of her rotating brush on my teeth one by one, front and back. And the grit of the polish in my mouth makes me want to horse-smile. Once that’s done, though, it’s just a last rinse and a swish, and I’m out of there.

Of course, I’m carrying a bag of oral hygiene goodies. A new brush, floss, paste, even a purse-size jug of mouth wash. So, if you’re interested on what Lieblick has to say about using all that paraphernalia not to mention sugar, tobacco and bulimia, check back next week for Part Two.

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