Should Dental Assistants be Cleaning Teeth?

fake plastic teeth at a workshop to show an example of teeth

A hygienist asks why so many offices are allowing dental assistants to clean children’s teeth. She is frustrated seeing kids who have had cleanings but still have plaque, calculus and more on their teeth. What can be done about this? Of course Rich and Dave get into a nice discussion about this topic with an interesting answer. Then of course we do the call of the week, which is being stepped up to a new level in Season Two! Witness what happens when a simple question is asked such as “Do you see children in your practice?” If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!

Should Dental Assistants be Cleaning Teeth?

The Dental Practice Fixers Podcast is brought to you by the Madow Center For Dental Practice Success. To find out how we can help increase the success of your practice, check out madow.com  or call us at 1-800-258-0060. 
 Dr. David Madow: Welcome to the Dental Practice Fixers Podcast. I am one of your hosts, Dr. David Madow and this is the beginning of season two and I just want to before I bring my brother Rich in just for one quick second say, thank you so much for the success that you have given us in season one. Our idea was to kind of come out with this podcast, it is a little bit different than all the other ones out there because let's face it, there are a ton of other ones out there, when Rich and I just want to do something a little different, a little better, a little more interesting and bottom line is we really want to help you in your dental practices and season one I think was a huge success and we did exactly what we wanted. Season two is going to be even better maybe crazier but we'll find out in a second as I bring my brother, my co-host, Dr. Richard Madow right into the show. 
 Dr. Rich Madow: Hey everybody in podcast land. Well, I just got to tell you Dave, I know we’re both so excited to start season two of the Dental Practice Fixers and we really, really, really appreciate the comments that you have given us throughout season one. So, thanks to our podcast listeners; for others we've gotten mostly favorable comments, we got a few crackpots with some nasty comments but we love those comments too. We delete them immediately but we still love them.
 Dr. David Madow: It just means people are listening, so that's okay with us. 
 Dr. Rich Madow: Can’t please everyone.
 Dr. David Madow: That’s exactly right.
 Dr. Rich Madow: What we also got was a lot of questions and one of the things we'd like to do in season two is concentrate a little bit more on questions from our podcast audience. So, we'll be getting to a lot of the questions, still be doing our secret shopper calls of course.
 Dr. David Madow: Which by the way, it seems to be like one of the most popular parts of the show. So, we cannot get rid of that. 
 Dr. Rich Madow: There's no way no way and if you haven't heard it yet, please check out the special episode. Maybe you'll want to call it a bonus episode, it was released fairly recently where it's nothing but some of the best calls from season one, some of the best secret shopper calls from season one of the Dental Practice Fixers podcast. So be sure to check it out. Thanks for all the 5-star ratings and telling your friends and all those great things that help keep the lights on as they say. 
 Dr. David Madow: Yeah, I got an idea by the way Rich, if there's any way possible let's crank up the calls a little bit for this season. I mean let's just take like, if you know what I mean like the next level. 
 Dr. Rich Madow: I think we're going to take them to 11.
 Dr. David Madow: Do you think we can crank them up to 11? 
 Dr. Rich Madow: I think last season maybe they were a 10. This season we're going to crank them up to 11. They're going to be better, more instructional and maybe even funnier and crazier.
 Dr. David Madow: What's funny, we've had people say, ‘hey, I think it would be great if your entire show was just with just calls’ and we thought about it, but we still want to give information outside of the calls as well. So, we're going to make it a nice combination but the calls will be I'd say phenomenal. 
 Dr. Rich Madow: They should be like the trademark of the Dental Practice Fixers.
 Dr. David Madow: I think so. So, we have a question. We have a question that somebody wrote, they write in, do they call in, do they go on the Dental Place…
 Dr. Rich Madow: Actually, this question was posted on our Facebook group the Dental Place. So, if you're not a member of the Dental Place, please be sure to do that. Go on Facebook, it's a discussion forum. We know there are a million dental discussion forums on Facebook.
 Dr. David Madow: Oh really? I didn't know that.
 Dr. Rich Madow: The Dental Place doesn't have 20,000 members nor do we want 20,000 members, but we try to keep it free from a lot of fluff and a lot of BS and for a lot of people Facebook is like going back to middle school with these stupid petty arguments, it doesn't happen on the Dental Place. We also don’t allow people pimping their products and services every second except us of course because, hey, it's our group but we try to keep that to a minimum.
 Dr. David Madow: We try to keep it minimum, we don't overdo it. But I'll tell you something Rich, you go into some of these other groups and it's just, I hate to say like this it’s a pimp fest, it's incestuous, there's the same people pimping their stuff.
 Dr. Rich Madow: Not only their stuff but also, they just keep telling each other how great they are and again I'm sure there are a lot of great people in all these other groups but they tend to attract people who think like putting up an inspirational meme every day makes them some kind of expert in dentistry, well guess what? It doesn't. You can get a thousand likes, but you know what? You can't take those likes to your practice to have them help you and earn you more income and fund your retirement. You can't do that with Facebook Likes, but you can do with great information. 
 Dr. David Madow: I'm in big trouble.
 Dr. Rich Madow: Yeah, big, big trouble. Anyway, check out the Dental Place. I believe is it facebook.com/groups/dentalplace123 something like that.
 Dr. David Madow: You totally got it. I think that's pretty darn accurate.
 Dr. Rich Madow: If that's not right, you can just go and search for the Dental Place and you’ll have to answer some very tough questions like are you alive and then we'll let you in. 
 Dr. David Madow: How many days are in a year?
 Dr. Rich Madow: Right. Don't do that on a leap year, could get very tricky. Well, hey since we're talking about questions, we're going to really try to focus on questions from listeners this year. So, let's start with this one, it was actually posted on the Dental Place which is fun because you get other people's opinions as well. It's from Shannon Kistler Hale. I hope I'm pronouncing that right Shannon. Shannon Kistler Hale. She writes in and says, ‘why are general dental and pedio offices continuing to have assistants do and this is in quotes “child prophys.” I find this unethical and insurance fraud. I find calculus on almost all children and I always subjectively remove and disturb bacterial biofilm around every single tooth. It SUCKS. It SUCKS to see a patient in private practice for the first time at 18 or older that has had a dental assistant clean their teeth. It's so disappointing and a huge mess often requiring 4346 follow-up 1110. I'm honest and respectful to the patient and parent that the care they were receiving was inadequate. I guess that I made the mistake that everybody thinks like I do when they provide the best possible care and working practices with the same philosophy. I'm lucky to work with amazing people. It really saddens me, it's either ignorance or greed probably the latter.’ 
 Dr. David Madow: I think we should edit that down a little bit that was a lot of stuff. I think the question could have been asked was simple, hey, what do you think about assistants doing child prophys?
 Dr. Rich Madow: In Jerry Seinfeld, ‘sorry, what's up with these assistants doing child prophys? It's unethical.’ 
 Dr. David Madow: First of all, is that a big thing? I mean do most pedio offices and even general offices have the assistants prophying the kids? That's doesn't sound right to me. 
 Dr. Rich Madow: I certainly never did it in my practice.
 Dr. David Madow: No way, me neither.
 Dr. Rich Madow: And I don't want to rat on anyone that I used to work for when I was an associate before I had my own practice, but I'll just say, I have seen this.
 Dr. David Madow: Really?
 Dr. Rich Madow: That was many, many years ago, but look, Shannon sees it happening now. I'm sure it's happening all over the place. 
 Dr. David Madow: So, I'm wondering and I don't know the answer to this. Rich, maybe you do. Are there some states that actually it is, I think there are some states that it is legal for the assistant maybe it's an EFDA or something, to actually do a child prophy, but I'm sure she's referring to a state that absolutely it's not legal. 
 Dr. Rich Madow: Yes, let's assume it's not legal.
 Dr. David Madow: Well, I mean my opinion is if it's not legal, why are you doing it? I mean if it's not legal, there's a reason it's not legal and it is unethical to have an assistant who is not trained as a dental hygienist or a doctor to be performing a procedure that they're not qualified to do or not trained to do. That is not right. Let's face it, I don't think anybody would say this, it's okay to do. Now offices might be doing it to cut costs or just to free the hygienist up to do the more, the more productive patients or something but it's totally not cool. I don't recommend it at all. 
 Dr. Rich Madow: How would you feel if you were the mom and found out that your kid was getting an illegal prophy from somebody who wasn't properly trained or licensed to do that procedure?
 Dr. David Madow: I'd be pissed as hell. Let's just say I went to a doctor. I'm just making this up on the spot, but I went to a dermatologist and I look like pretty clean. So, the dermatologist said to the assistant, Dr. Dave Madow looks pretty clean, just go ahead and do a quick skin check, if you see anything let me know. I would be pissed as hell. 
 Dr. Rich Madow: And by the way if you can pop that pimple on his forehead? 
 Dr. David Madow: Oh, you saw that?
 Dr. Rich Madow: You and John Lennon. It’s doing a procedure.
 Dr. David Madow: It is actually doing a medical or dental in this case a dental procedure that you're not authorized to do. It's totally illegal, not cool. 
 Dr. Rich Madow: Yeah, I got to tell you Dave. We both know each other's horror stories of the practices we worked in before we had our own practices, but I got to tell you I was working in this practice. I won't say the dentist's name, but he let an assistant do x-rays that wasn’t x-ray certified. Now, it didn't seem like that big of a deal, the x-rays were great, she was really good at it but she was not legally allowed to do.
 Dr. David Madow: Let’s say the x-rays were pretty darn good though, right?
 Dr. Rich Madow: They were good.
 Dr. David Madow: No cone cuts.
 Dr. Rich Madow: No cone cuts, no coffee stains. 
 Dr. David Madow: Let her do it.
 Dr. Rich Madow: Besides the point, right?
 Dr. David Madow: It's totally beside the point.
  Dr. Rich Madow: So, she got pissed at him for something and turned him in and he wound up getting published in that publication that says all the sins the dentist have and I think he like was fined or I don't know, he had to sit in the penalty box, something bad happened to him and he was so humiliated. He actually wound up retiring shortly thereafter. And if he hadn't let her do that no matter how pissed she got at him she couldn't have complained to the board that he was doing anything illegal.
 Dr. David Madow: I think the bottom line is there is a reason that the State Board issues dental licenses, hygiene licenses. There's a reason for that. I mean Rich, not that long ago, I think it was within the past year for sure that a dentist, I can't remember what state maybe Texas but I could be totally wrong, oh I say dentists loosely in quotes, because there was somebody working for one of the DSOs doing dentistry every single day and she turned out not to be a licensed dentist. You remember that?
 Dr. Rich Madow: Yeah, it was unbelievable. Because do you think of anything those DSOs, those are publicly held corporations with lawyers and HR departments and all that stuff, you think if anyone would have fished this illegal dentist out it would have been them, but yet some unlicensed woman, unlicensed practicing at one of the major DSOs… 
 Dr. David Madow: Let me ask you a question. Suppose, let's just say hypothetically her crowns, her implants, whatever she…
 Dr. Rich Madow: Hell, she didn’t even know to do a crown prep.
 Dr. David Madow: Let's just say, let’s go with me on this one. Suppose, she did great clinical work. Would that matter? Would that change anything? Suppose she was like the best clinician around?
 Dr. Rich Madow: Well, if it were one of the DSOs, she probably was. Still illegal.
 Dr. David Madow: That's the point. That's the point. So, if you think your assistant is doing like the best cleanings and she or he, and we won’t be sexist here, is doing a great job, it's not legal, you can't do it.
 Dr. Rich Madow: Send them to the hygiene school.
 Dr. David Madow: Exactly.
 Dr. Rich Madow: If you want them to do prophys that badly. You know it's funny I know another time in my practice. My front desk person, my office manager Carol, she was just fantastic. She worked for the previous dentist before I bought the practice and I remember one time a patient came in, it was an emergency patient, it was after hours. They paid cash, they even joked around with Carol, I bet Dr. Madow’s going to love this and Carol went to hand me the cash because she said that's the way the Dr. Bob did it and I said, absolutely not. We've got to do it legally; this needs to be completely annotated and registered. I have to pay taxes on all that. Believe me, I would have loved to stick a couple hundred bucks of cash in my pocket, who wouldn't?
 Dr. David Madow: You didn't take the cash?
 Dr. Rich Madow: If people in your office know that you do things that are cheating or unethical then what else do they think and where else do they think they can get away with?
 Dr. David Madow: That's exactly right, and not only that kind of the example you gave before, it takes one disgruntled employee, not gruntled but disgruntled employee that knows what's going on to turn you into who knows, the State Board, the IRS, whatever it might be. It's not worth it, it's totally not worth it at all.
 Dr. Rich Madow: It kind of reminds me to go on a little tangent here. There was a threat on the Dental Place. There was this practice, I think they were in Las Vegas, apparently a really fantastic practice and they posted some holiday pictures on their Facebook group of their holiday party. Do you remember?
 Dr. David Madow: I saw that. I know exactly what you're talking about.
 Dr. Rich Madow: If you know exactly what I'm talking about, what was in the pictures?
 Dr. David Madow: Well it was, I'm assuming this was the dentist, it was a woman. She's kind of dressed up as like some kind of holiday like maybe even Santa Claus, she's dressed up and she's got this guy, I don't even know if the guy was part of the office.
 Dr. Rich Madow: Looked like he was a stripper to me.
 Dr. David Madow: He did.
 Dr. Rich Madow: I could be wrong, but I think it was a stripper.
 Dr. David Madow: I remember. So, I remember one of the pictures very, very clearly. This guy was like grabbing her from behind and he's in a position where you know they could have had kids. That’s what it looked like.
 Dr. Rich Madow: It's a nice way to put it. And possibly did.
 Dr. David Madow: And possibly did. And she had like this smile or face like it was kind of like give me more. It looked like that, like give it to me, and they posted this on Facebook to like market their practices.
 Dr. Rich Madow: Unbelievable and this is what's going on at the holiday party and look, Dave and I are not prudes in any way, we've all done numerous crazy things in our life that, our lives that would make you blush if you heard about them. I am not saying it's good or it's bad, but my point is we're not choir boys, but we also know that you do that kind of stuff in your office and then that dental assistant gets upset about some or a dental assistant in your office gets upset about something, the next thing you know you're going to wind up in court. She's going to be saying that, I can't think of the term, what's the term? It's not sexual harassment. Something workplace. I can't believe [crosstalk].
 Dr. David Madow: Something workplace. Well, the thing is, when you get these, when you get to be over sixty at least I am. [Crosstalk] It's hostile work environment. That's exactly what it is.
 Dr. Rich Madow: Yeah, you want to wind up in court with somebody accusing you of a hostile work environment and then have them show these pictures to the judges and say, here's an example of what goes on in our practice. You are done.
 Dr. David Madow: The sad thing about that about an employee claiming anything like that, is that whether you're guilty or not, you've got to defend yourself. So, whether or not your assistant is giving prophys, whether you've got somebody taking radiographs, you still have to defend yourself if somebody goes after you. Now, if you're doing something wrong and that's, you've got a real problem. So, I guess the bottom line is in the rule that kind of how Rich and I live, our lives and our business and whatever we do is like if you don't do anything wrong, if you don't cross the line into something illegal, you never really have to worry. Just be ethical in your life and in your business, your practice, do it the right way and then you can put your head on the pillow at night and say, nobody's going to come after me for this because I'm kind of doing it right.
 Dr. Rich Madow: You can still do crazy stuff, you can still have fun
 Dr. David Madow: Totally. Again, like you just said, we do crazy stuff, but again, when it comes to legality, well pretty much stay on the right side of the law. 
 Dr. Rich Madow: The famous movie director once said, ‘Do the right thing.’ That’s the name of one of his movies.
 Dr. David Madow: Who was that?
 Dr. Rich Madow: Spike Lee. Do the right thing. It doesn't mean you can't do crazy stuff with consenting adults outside of the workplace. 
 Dr. David Madow: Sounds like a fun weekend.
 Dr. Rich Madow: Exactly. Doesn't mean you can't do things that other people might say are edgy and crazy, but illegal you're asking for trouble. Oh right, good question. Thank you so much Shannon. We really, really appreciate that. We're going to go into the secret shopper call of the week in just a second, but I just want to give you a quick reminder or maybe if you didn't listen to season one, this won't be a quick reminder at all but just new information for you. There's a brand-new way to do credit card processing, it will save you tons of money and best of all, you don't get that percentage markup from the bank or the credit card processor. There's no markup after the credit card company does whatever they do, it’s just a low monthly fee. We've told a lot of practices about this and they are all saving money. So please check it out. The company is called Fattmerchant. It's fatt with two Ts. And of course, since you're listening to the Dental Practice Fixers, we've arranged a special deal for you, a free terminal when you sign up. Just go to www.fattmerchant.com/lp/madow. So, it's fatt merchant with two Ts. fattmerchant.com/lp/madow and you will take the first step towards better credit card processing and saving a ton of money. What do you think?
 Dr. David Madow: And it ain't no backslash, it's a forward slash.
 Dr. Rich Madow: Anybody use backslash?
 Dr. David Madow: The funny thing is some people like say back backslash but they actually mean forward slash, so it's just a slash.
 Dr. Rich Madow: I think there was a place for backslash in today's society.
 Dr. David Madow: It's the old maybe more MS DOS type thing.
 Dr. Rich Madow: Yeah, yeah, yeah. Guitar player for Guns and Roses told me it's slash.
 Dr. David Madow: Right, but I will say something Rich. We've heard a lot of great feedback from our followers, friends anybody in the dental community who is using Fattmerchant now and they've had great, great things to report from Fattmerchant. 
 Dr. Rich Madow: We’re really taking into the into this modern tech area, they've got a dashboard so you can follow all your activity, all kinds of cool stuff, just do yourself a favor and check it out. 
 Dr. David Madow: And we love associating ourselves with companies that just do great things and help our listeners and dental friends. So yeah, check them out.
 Dr. Rich Madow: Absolutely. 
 Dr. David Madow: Should we do a call?
 Dr. Rich Madow: Let's do a really good one.
 Dr. David Madow: So you want to do like the best ever but then we have to keep getting better and better.
 Dr. Rich Madow: We don’t know, so we do that it's the best ever, that’s the problem. 
 Dr. David Madow: Let's try one right now. 
 For Quality Assurance this call may be recorded. 
 Melissa: Thank you for calling, how may I help you?
 Dr. David Madow: Hi Melissa, I have a question. Do you all see children?
 Melissa: We certainly do.
 Dr. David Madow: You do. I'm trying to find a place. My son has had very bad luck in the dentist and just trying to find like the right dental place. Hold. Herbert. I'm on the phone please son, just be quiet. So how old does a child have to be to come to the dentist?
 Melissa: Young as a year old.
 Dr. David Madow: Really? One year old. What do you normally do like on the first visit?
 Melissa: I am not the hygienist, we’ll take him back, explain everything to him. How old is he?
 Dr. David Madow: He's like six. 
 Melissa: Okay, yeah and if he will allow us to…
 Dr. David Madow: Herbert I'm on the phone I'm on the phone with the dentist right now. Herbert, please be quiet. I'm talking to the dentist right now, quiet son. Sorry, go ahead.
 Melissa: Okay and we will clean his teeth, getting x-rays and then the doctor will come [inaudible]. 
 Dr. David Madow: He thinks the dentist's going to hurt. 
 Melissa: Oh, no, no, no.
 Dr. David Madow: Herbert, the dentist will not hurt you on the first visit. Herbert you are going to the… Herbert, listen to me. Do you want dessert tonight? What do I do with him? I mean he needs to go to the dentist but he just refuses to go somehow, he just doesn't…
 Melissa: Explain this to him, maybe this will help but ask him if he wants to have all of his teeth, so he's able to eat his food. 
 Dr. David Madow: Herbert, do you want to have all your teeth? Do you all have all your teeth to eat your food? Herbert, the question I'm asking you now son is, do you want to have all your teeth to eat your food even when you get older? You'll eat oatmeal. You don't care about your teeth. He doesn't, maybe he doesn't care about his teeth. I don't know. I mean what do you do with a kid like this?
 Melissa: I don't know.
 Dr. David Madow: He's been a problem. Herbert, stop crying. Herbert, stop you're sulking now. Herbert, can you maybe, could you… do you think it would be good if you talked to Herbert, would that work? Explain what you do.
 Melissa: Yeah, let me talk to him.
 Dr. David Madow: Herbert, the dentist wants to talk to you. You don't want to talk to her? I don't know, he's not in the mood to talk right now. 
 Melissa: Maybe another day. 
 Dr. David Madow: Maybe we'll try that. 
 Melissa: Just try to approach it you know in a calm manner. Is there anything medically that we need to be aware of?
 Dr. David Madow: Hold on. Herbert, you don't have any medical issues Herbert, do you? Any medical problems? He's pretty well other than his tantrum sometimes, he's pretty good. Herbert, stop sulking.
 Melissa: Okay. I mean if you don't want to, because once they have a bad experience that kind of just does it for them so if he's not ready to come now I wouldn't force the issue because they're going to make matters worse, maybe give it a few months.
 Dr. David Madow: Herbert, you don't have to go, you don't have to go, you don't have to go now, we’ll wait a few months. Herbert, stop it, stop it now. And I'm going to tell your mom about this too Herbert. Okay. Well, thank you very much your help. I really appreciate that. 
 Melissa: Oh, you're welcome. Just try to be patient with it, because if you've already had a traumatic experience, you know that's what he is focusing on. So just try to keep explaining to him, not now but maybe in a few days as well yeah you know how important it is to keep your teeth and how important it is to have the cleanings because that's involved your overall health.
 Dr. David Madow: Right, exactly. I'll try it. We'll try to educate him, we'll get back to you. Thank you so much.
 Melissa: Oh, you're welcome. Good luck, 
 Dr. David Madow: Thank you very much.
 Melissa: You're welcome. 
 Dr. David Madow: Bye.
 Melissa: Bye-bye.
 Dr. David Madow: Well, I think that about wraps up the first episode of season two. We'll see you soon. 
 Dr. Rich Madow: That poor Herbert that poor kid, I mean he just does not want to go to the dentist, what can you do? Thanks everybody, see you next time. 



If you enjoyed this podcast, check out our previous podcast, The Very Best Dental Secret Shopper Calls

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