Building the Multi-Generation Dental Team

How would you describe your outlook? How about your work ethic or view of authority? There’s a good chance that when you were born affects your perspective on such things.

You may be a "traditionalist," born before 1946, with a tendency toward a practical outlook, dedicated work ethic, and respectful view of authority. Perhaps you’re a "boomer," born between 1946 and 1960, with an optimistic outlook, driven work ethic and love/hate view of authority. Or maybe you’re part of "Generation X," born between 1960 and 1980, and tend toward a realistic outlook, balanced work ethic, and unimpressed view of authority.

No matter where you fall on this generational scale, one thing is certain. All three groups come together in the workplace. For dentists, integration of the generations on a team is essential as California and the nation face a shortage of dentists, hygienists, and dental assistants. In light of this, leaders in dentistry are focusing on today’s employees and what motivates them to enter and stay in the profession.

Generational attributes and expectations were the focus of the sixth annual Allied Dental Health Symposium "Generation X and The Dental Team" presented in July by CDA’s Council on Education and Professional Relations. Attendees included leaders in dental hygiene, dental assisting and dental laboratory technology as well as CDA President Kent Farnsworth, DDS, and President-Elect Jack S. Broussard, DDS.

The symposium facilitator and keynote speaker, Kathleen Shanel-Hogan, DDS, MA, is concentrating her current PhD studies on transformative learning and change. "When working with different groups, you encounter different expectations," she explains. For instance, "I identify with the ‘boomer’ work ethic where I get out there and work hard; if someone asks for nine yards, I give them 10. However, it can cause dissonance if I place the same expectations on someone else who is prepared to give nine yards when asked for nine yards, eight hours of work when asked for eight hours. That’s why it’s important to clarify expectations of employees and employers; to give both parties a chance to address their needs and feel like they’ve been heard."

Pieter Linssen, DDS, a 1997 dental school graduate says he has found respect and positive relationships as an associate working with two private practices in Placerville and Granite Bay, Calif. "Both offices foster a family atmosphere and respect is given to all members of the teams. They are both smaller practices, with fewer than 10 people, and you get a chance to know people and find out about their thought processes."

He admits that in some cases he has had to relax his expectations a little bit. "If you constrict someone in a business sense, you constrict them in an artistic sense as well. Someone may not have the exact technical expertise I want, but he or she may have a positive attitude or other attribute I would never want to restrict."

Linssen says he has found pros and cons to working with both younger and older team members. "Older colleagues offer wisdom and experience. They have seen everything. On the down side, there may be resistance to new ideas. With younger team members, there is enthusiasm; they want to learn and see everything. On the other hand, there is the lack of experience."

Shanel-Hogan points out other variances in perspective that can result from coming of age in different decades. "‘Gen X’ had different role models as they were growing up; they have witnessed authority figures who have slipped and fallen, and they have seen their parents be ‘downsized’ by companies they were loyal to for many years. They tend to have a more realistic view of things. A ‘boomer’ may view this as cynical." Or a young team member may ask why things are being done a certain way and a more traditional person could see this as a challenge. Also, ‘Gen Xers’ have been criticized for being materialistic when often they are concerned about money due to large educational loans hanging over their heads.

"When I went through school, tuition and fees were $3,200 a year," Shanel-Hogan says. "It’s hard for me to image students coming out of school with $100,000 or more debt, but I would want them to know I understand their situation."

"My generation’s greatest fears are failure and lack of security," says Linssen, who contributes these fears to coming of age in the late 1980s when the economy wasn’t as strong, and families were experiencing an unprecedented boom of divorce. "In dentistry, the opportunities to start a new practice are not nearly as bountiful as they once were. The cost of education and technology places a lot of limits on start up."

Still, Linssen says he has a positive outlook on his career, even though his generation has a tendency to define success in a different way than previous generations. "It’s becoming harder and harder for us to define ourselves. I hear a lot of people my age saying: ‘I will never work 8 to 5 or have a desk job.’ It seems that the opportunity to travel and do more ‘soul-searching’ is important now. I feel fortunate that dentistry offers not just a chance to make a living but a lifestyle."

Despite the departure from a more traditional view of success, Linssen says that qualities like work ethic are very individual. "Work ethic comes from what you were taught growing up."

Shanel-Hogan also notes that the qualities and characteristics of different generations are just "starting points for discussion." When we talk about differences, it’s just as important to find out about differences between individuals."

In her presentation at the symposium, Shanel-Hogan included information from the book Beyond Generation X, a guide for managers by Claire Raines. "Claire talks about the most frequent requests ‘Gen Xers’ make of their managers (see sidebar). This is a good place for dentists to start for ideas; take a look at this list, brainstorm ideas about how it might work and then talk to staff members."

Building these trans-generation skills will also be helpful for communicating with the up-and-coming "Generation Y."

Low Vitamin C Can Increase Risk for Periodontal Disease

People who consume less than the recommended dietary allowance for vitamin C have slightly higher rates of periodontal disease, according to a study in the August issue of the Journal of Periodontology.

Researchers analyzed vitamin C intakes and periodontal disease indicators in 12,419 U.S. adults. They found that patients who consumed less than the recommended 60 mg per day (about one orange) were at nearly 1 1/2 times the risk of developing severe gingivitis as those who consumed three times the RDA.

Researcher Robert Genco, DDS, PhD, chair of the Oral Biology Department at the State University of New York at Buffalo, says the relationship between severe vitamin C deficiency and gum health has long been known. "In the late 18th century, sailors away at sea would eat limes to prevent their gums from bleeding," Genco said. "The relationship between vitamin C and periodontal disease is likely due to vitamin C’s role in maintaining and repairing health connective tissue along with its antioxidant properties."

"Periodontal disease is an inflammatory disorder that increases tissue damage and loss. Since vitamin C is known as a powerful scavenger of reactive oxygen species, which form part of the body’s antioxidant defense system, low levels of dietary vitamin C may compromise the body’s ability to neutralize these tissue-destructive oxidants," Genco said.

Recognizing Burning Mouth Syndrome

Burning mouth syndrome has been described as a complex of many symptoms with very few signs and multiple etiological contributing factors. Although it is often not definitively diagnosed, dentists should take the condition seriously and perform diagnostic testing to rule out causes, treat the symptoms, and attempt to arrive at a true diagnosis, according to an article in the May-June 2000 issue of Northwest Dentistry.

Burning mouth syndrome is characterized by chronic (at least six months), continuous, progressive, unexplained pain, the authors state. Estimates are that more than 1 million people in the United States suffer from the condition.

Possible explanations for the symptoms of burning mouth include ill-fitting dentures, nutritional deficiencies, disturbances in salivary flow, and hypersensitivity to dental materials. Usually no single factor is entirely responsible.

Dentists must rule out as many of the potential contributors as possible, the authors said. When no clear etiological factor is found or only minimal relief is obtained by treatment of the identified contributors, then the default diagnosis of burning mouth syndrome is customarily made. However, after diagnostic testing to rule out causes of oral burning symptoms and/or treating those symptoms with some success, a definitive diagnosis of true burning mouth syndrome may emerge.

According to the authors, it appears that true burning mouth syndrome is a neuropathic disorder, or hyperalgesia. The study also indicated that hormonal activity may play a role because all the patients studied had significantly lower than normal estrogen and progesterone levels.

Smoking Bans Send Kids the Message

Parents may be able to reduce the chances that their teenagers will take up cigarettes by banning smoking within their homes, even if they smoke themselves, according to a study in the British Medical Journal.

A survey of more than 17,000 U.S. high school students found that restricting smoking at home, at school, and in public places appears to reduce teen smoking.

"Smoke-free environments lead to smoke-free kids," said Dr. Melanie A. Wakefield, the lead author of one of three studies on secondhand smoke and children published in the Aug. 5 issue of the British Medical Journal.

The link between smoking restrictions and reduced teen smoking was strongest for smoking bans set by families in their homes, the report said.

"Communities that pass strong laws to restrict smoking in public places will not only be protecting their residents from the effects of environmental tobacco smoke, but can protect their children from becoming smokers," Wakefield said. "If you are a parent, banning smoking inside your home can decrease the chances of your child taking up smoking. This applies even if you are a parent who smokes."

Transplant Recipient Using New Hand

A 38-year-old man who received a hand transplant was able to write and tie his shoes one year after the surgery, according to an article in the Aug. 17 issue of the New England Journal of Medicine.

Four months after the first human hand transplantation surgery in France, a similar operation was performed at the Jewish Hospital of Louisville, Ky. The left hand of a 58-year-old male, matched for size and skin tone, was transplanted to a 37-year-old man who had lost his dominant hand 13 years earlier.

Although moderate acute cellular rejection of the skin of the graft developed six, 20, and 27 weeks after transplantation, all three episodes resolved completely after treatment.

By one year, temperature, pain, and pressure sensations had developed in the hand and fingers. In addition, the patient was able to perform many activities he was unable to do with his prosthesis, including throwing a baseball, turning the pages of a newspaper, writing and tying his shoelaces.

Physicians Reclaim Practices at Bargain Rate

As physician practice management companies continue to struggle financially, many physicians are buying back their practices, sometimes at bargain prices.

According to a story in the Aug. 21, 2000, issue of American Medical News, the newsletter of the American Medical Association, many physicians are now buying back their practices from both practice management companies and hospital systems at prices far below the original price paid to acquire the practices in the first place.

For example, MedPartners, a now-defunct practice management company, paid the 120 members of the Talbert Medical Group in California $95.2 million to buy their practice. Just a few years later, in 1999, the medical group bought the practice back for $3.7 million, only $31,000 per physician.

Poor performance explains the bid of practice management firms to jettison their assets, according to Robert Bohlman, a consultant with the Medical Group Management Association. However, the practices most often being sold back are those owned by hospital systems. Eighty percent of hospitals that bought practices -- to ensure a flow of referrals -- lost money in the millions per year. Many hospital systems have decided to get out of the business of owning physician practices.

Honors

Paul A. Reggiardo, DDS, has been awarded the American Academy of Pediatric Dentistry’s 2000 Merle C. Hunter Leadership Award. He is in private practice in Huntington Beach, Calif.

Upcoming Meetings

2000

Oct. 1-4 Pacific Coast Society of Orthodontists 64th Annual Session, Reno, Nev., (415) 441-2410

Oct. 14-18 ADA Annual Session, Chicago, (312) 440-2500

Oct. 19-21 Academy of Surgical Research Annual Meeting (612) 545-1919, http://www.surgicalresearch.org/00sess.htm

Oct. 26-28 American Society for Dental Aesthetics, Millennium International Conference, San Francisco, (800) 454-2732, www.asdatoday.com

Nov. 5-11 U.S. Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524.

Nov. 15-18 American College of Prosthodontics annual session, (312) 573-1260, Ext. 15.

Nov. 29-Dec. 2 FDI World Dental Congress, Paris, http://www.fdi.org.uk/congress/index.htm

2001

March 4-10 U.S. Dental Tennis Association Spring Meeting, Longboat Key, Fla., (800) 445-2524

April 19-22 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.