November 2007 | MH Web Exclusive

Why remin matters

An MI specialist shares her reasons for making the trend part of her standard of care. by Thais Carter

In seeking to provide a full scope of information on any trend, Modern Hygienist spoke with Wendy Fitzgerel, RDH, a minimum intervention (MI) specialist for GC America, to see how her personal experience as a dental hygienist, and working with dental hygienists in her territory,  could supplement our November article on remineralization technology.  In the end, she provided a wonderful perspective on where the average dental hygienist is in her MI prowess, and what it will take to bring the entire dental profession along in recognizing this as a new standard of care.

Modern Hygienist: If we zoom out to look at the dental and dental hygiene professions, it seems obvious that there is a trend towards minimally invasive care. We’re seeing it more and more in continuing education courses and in products, but if we move from looking at the profession to looking at individuals, would you say that the MI mindset is making a difference in the daily workflow of dental hygienists?
Wendy Fitzgerel: Absolutely. For the last 50 years, the only basic tools we’ve had to prevent caries are fluoride and a toothbrush. Now, we’re able to bring calcium and phosphate into the picture with fluoride. Now we’re able to test saliva for its protective qualities, because it’s a major player in why a person’s oral health goes bad. We have an answer for all those things now, so it’s a pretty exciting time.
As far as where the hygienist is right now: their minds are open; they’re the preventive specialists. I think in their hearts, and as a dental hygienist myself, in my heart, I’ve always wanted to do more than just perio. I’ve always felt like there was something missing in the total package of treating a patient. In the past, I’d see someone in my chair with a cavity and all I’d be able to say is, “I know a guy who can fix it,” instead of treating it as a disease.
We’ve reached a time when all the sciences are coming together. I tell the hygienists I work with: It’s time to open your mind, but then again, not so big that your brain falls out. There’s so much going on that there’s some confusion too; some manufacturers are taking the marketing too far. The dental professional, not just the dental hygienist, needs to understand research and know that eight references to research is not enough, 20 is not enough. Who’s doing the research? Who’s getting it and who’s getting paid for the research. And most importantly, the methods of the research; if the methods aren’t correct as per the material being used, the results will be skewed. Open your mind and use the clinical skills that you’ve been taught to make good decisions.

MH: If there’s a hygienist in a rural area, or a practice that doesn’t make it possible for them to attend many meetings or CE courses, how do you recommend they find the up-to-date clinical information and resources to help them make these decisions?
WF: The best place to start, if they have a question about a product or treatment, is to go straight to the manufacturer. That can be risky, yes, because it’s all about sales for the manufacturer, but if it’s a new science or a new technology, nobody knows that product or material better than the manufacturer rep; they’re the experts. From there, look to the educational department. For example, GC has quite a bit of free continuing education on the Web site, written by various doctors and dental hygienists. It’s a great resources for someone who can’t make it to Chicago Midwinter or a similar meeting.

MH: Not everybody is buying MI Paste or the other remineralization products available. Some people are still hesitant; they haven’t made the mental shift. What, in your opinion, is the barrier there?
WF: Skepticism, 100%. Even though I worked for GC, when they initially launched the MI Paste, they were so excited and when someone told me that it can reverse white spot lesions, as a clinician, I just chuckled and thought, “Whatever. Sure. You’re dreamin’.” It wasn’t until I saw the first pictures coming back from doctors in my territory that I realized they weren’t kidding and I became more passionate about it. Everyone has been burned in the dental office by someone just trying to make a sale, saying their stuff is the latest and the greatest. It’s natural to have that skepticism; it’s is a protective factor, and that’s okay. It just has to be the right time for that dental professional to make the change. That’s the key. I’ve gone back three times to an office before the light goes on. When they connect the product with a patient and it hits their personal/professional daily life, that’s when it sinks in.

MH: How do you try and communicate your remineralization message to the hygienists you talk to? Do they get it?
WF: I present a CE course called, “Remineralization revisited.” We’ve been so comfortable in fluoride for so long, that we forget that remineralization is a process and that calcium and phosphate are critical to deep remineralization; fluoride only heals the superficial veneer of the enamel. The lesion never changes with fluoride alone because it never gets to the underbelly of the lesion. The course brings back into our brains as an industry that remineralization is important and it’s not found in any product’s quick fix; it is a process.

MH: One of the things that we’ve found is that when it comes to great new products, sometimes it’s not a enough for it to work. The hygienists have to convince their employers that its important enough to purchase and that it can be a viable part of the profit center. What are some tips for how dental hygienists can do this with remineralization products?
WF: It’s a no-brainer that remineralization is the most ethical profit center in any practice. It’s a tool. If the patient is in a chair with disease, with caries, there’s a mineral imbalance. It’s not necessarily a fluoride imbalance, it’s a mineral imbalance. You have to treat the patient an individual. Most dental professionals are in this to make the patient better, so the profit center is secondary.
One way I combat, “I can’t get my doctor to bring it in,” is I hand out samples and tell the hygienist in question to pick one patient who really needs this, who they think will benefit from the therapy, and make it a case study. Deliver that case study to the doctor, because at the end of the day, our job is to combat disease. I can’t imagine a doctor who would look at that case study and say, “No, I don’t think it’s a good idea.” And if you do, you’re working for the wrong doctor. It takes one sample, setting up that one case study; the proof is in the chair. We can talk about research all day long, but that one case and that one patient in your chair is what makes the difference.

For more information on remineralization products offered by GC America, visit www.gcamerica.com.

To view a product information video on GC America MI Paste, click here.

Related Article: MID: Stand in the Gap  by Maria Perno Goldie, RDH, BS