JOURNALOF ENOODONTICS Printed in U.S.A, Copyright © 1999 by The American Association of Endodontists VOL. 25, No. 4, APRIL1999 The Dental Hygienist as a Co-therapist in the Endodontic Practice Marylou E. Gutmann, RDH, MA, and James L. Gutmann, DDS This paper explores the potential contributions to patients, the practice, the endodontist, and the dental hygienist that may be realized by the em- ployment of one or more dental hygienists to serve as endodontic co-therapists in the delivery of end- odontic treatment. An endodontic co-therapist is an individual who participates with the endodontist in the assessment, planning, implementation, and evaluation of treatment much like the periodontal co-therapist relationship that exists between peri- odontists and dental hygienists. Dental hygienists are ideal individuals for this role because of their education in basic, clinical, and behavioral sci- ences. Suggestions are provided for which ser- vices could be delegated by the endodontist to the dental hygienist during each phase of care. Advan- tages of this contemporary approach to the deliv- ery of endodontic treatment are also addressed. Imagine seeing this classified advertisement in the employment section of the Sunday newspaper: DENTAL HYGIENIST WANTED: Exciting opportunity for a motivated, caring, registered dental hygienist interested in a career move that would enable full use of prior education and experience. Responsibilities will be varied and include exposure control policies, patient assessment procedures at multiple levels, specific data preparation, analyses and doc- umentation, patient treatment, patient education, and practice management. Salary commensurate with education and ex- perience. For the dental hygienist, this type of employment opportunity sounds too good to be true, but it has the potential to exist in almost every large endodontic practice. General dental practices usually employ the greatest numbers of dental hygienists. However, dental specialists (such as periodon- tists, pediatric dentists, prosthodontists, and orthodontists) may also employ dental hygienists (1-5). The only dental specialist that rarely, if ever, employs a dental hygienist is the endodontist. 272 Various reasons exist for the tack of hygienists in endodontic specialty practices. One of the primary reasons is economics. An endodontist can usually employ a dental assistant at a lower salary than a dental hygienist. Secondly, the scope of practice of dental hygienists is generally associated with preventive or periodontal services, although some dental hygienists are involved with restor- ative services in states where the practice act permits these services (3). If asked about the possibility of dental hygienists working within an endodontic practice, most endodontists and dental hy- gienists would wonder what a dental hygienist would do in this setting. The purpose of this paper is to explore the potential contributions to patients, the practice, the endodontist, and the dental hygienist that may be realized in this contemporary ap- proach to the delivery of endodontic treatment. Practice management experts have begun to look at the tradi- tional roles of allied health personnel in medical, as well as dental, practices. In addition, the emergence of Health Maintenance Or- ganizations (HMO's) and Preferred Provider Organizations (PPO's) has generated an increased emphasis on individualization of care (including self-care education), office efficiency that hope- fully results in cost containment, streamlined administrative and business practices, and effective infection control procedures. As a result of these various influences, all dental practices have been encouraged to rethink their structures, business plans, modes of delivering care, quality assurance procedures, and established ways of practicing. One approach to meeting these challenges is to use the depth of education and experience that allied personnel can provide. This is particularly true in the case of the dental hygienist. In most dental practices, dental hygienists spend the majority of their time on one procedure--the scaling and polishing of teeth (3, 6). One practice management expert believes that three major advantages occur when dentists delegate legally permitted tasks to dental hygienists (6). Patients are better served at lower costs, dental hygienists have more diverse responsibilities which in turn results in increased job satisfaction (7, 8), and finally "dentists are relieved of some professional tasks" that give them time "to concentrate on the clinical services that demand their additional education" (6). Variety in scope of practice also accounts for long-term retention of dental hygienists in the same practice setting (7, 9). A computer-generated search of the literature revealed no in- formation on the employment of dental hygienists in endodontic practices. As previously mentioned, other specialties do employ dental hygienists to provide a variety of patient care and admin- istrative services (1-5). For example, orthodontists in the United