A hill to die on?

In this very troubled world, it is sometimes difficult to decide what we should be getting aerated about and what we should just let go. Personally, oral hygiene is the hill I am willing to die on. Having recently referred a patient back to their dentist because of inadequate oral hygiene, I received a letter from said general dental practitioner yesterday telling me that ‘the patient's oral hygiene was good’ having seen the hygienist 2 weeks previously.

I therefore went to the patients Dolphin file, which had high-quality photographs from the last visit, where I had disclosed the patient personally, and clearly demonstrated plaque covering the embrasures, some of the gingival margins and even the labial surfaces of many teeth (Figure 1). These were taken on a day the patient was coming back to see me, purely for a re-assessment of their previously inadequate oral hygiene, and presumably they were trying to impress me with their level of toothbrushing, following the ‘frank and forthright’ discussion we'd had at the previous visit. How then is it possible that the dentist thinks this patient's oral hygiene is good? In what universe is that a helpful message to give to patients, or indeed their parents? There is clearly room for improvement, which is a necessity if we are going to be able to guarantee doing more good than harm with our orthodontic ministrations.