1189Woodallcommentary

The article below was originally published in the November 1989 issue of RDH magazine

by Irene Woodall, RDH, PhD

Expectations and reality. Too bad those two so often do not jibe. And too bad that seems to be at the heart of the so-called shortage of dental hygienists.

Students enter dental hygiene with the idea that there will be considerable esteem associated with the practice of dental hygiene — whether in a private practice, a school system, a hospital or the outback. They enter with high hopes of an active role in the management of patient care, in helping people get better. People entering a career do so, in part, because they want to feel good about who they are and what they do. That wish is no different among people who enter dental hygiene.

Add to that premise the notion that, typically, young women are no longer looking for short-term "jobs" that serve as a stopover between high school and marriage. That may have been the case for many of my classmates 25 years ago, but the assumptions have changed over the past two decades. The career a young woman chooses is often one she looks forward to keeping for a good many years. I can remember my classmates deciding that they could "stand" to clean teeth hour after hour for two to three years, but that they would then be glad to earn their "MRS" and retire, perhaps working a day or two per week after the children were in school. I practiced full-time for five years, both in general and periodontal practices, with nearly all my time spent scaling and root planing teeth. There is no question that I was looking for options, too.

Using What You Learn

Teaching dental hygiene (my first choice option) was exciting in the early '70s, in part because we could teach our students that there was a lot more to dental hygiene than scaling and root planing. The students were learning to give anesthesia, place and carve restorations, perform soft-tissue curettage, and take charge of the preventive program patients were entering. There was a new-found interest in prevention, and the dental hygienist was the logical and appropriate choice as the person to design and carry out programs. There was an expected increase in patient demand for care; so delegation of functions and responsibilities was an exciting topic and one encouraged by the dental profession. We taught our students to think, to take responsibility, to learn as much as they could during their formal education, to seek perfection, and to expand horizons past the basic functions of cleaning teeth.

Perhaps the disillusionment began when they graduated and found so few employers willing to capitalize on what the students had learned. They spent their time cleaning teeth.

Perhaps the die was cast when salaries decreased in the face of spiraling inflation in the early 1980s. We were graduating dental hygienists at a healthy rate, but the jobs were few, and hygienists went begging for jobs. Those who wouldn't beg left the profession.

Maybe it was the whole ballyhoo about independent practice. So many hygienists felt no need to practice unsupervised or to own their practices. But they felt, many times, the need to support the position of hygienists who did not want to give up their careers but who could not find a secure position with a reasonable living wage. Where did that leave the conventional dental hygienist, if a hoard of dental hygienists went off on their own. Did that make the employed dental hygienist a second-class citizen? Most likely it left the employed dental hygienist on the fringes of, or in the middle of, a debate that seemed to have no victor. Others felt they had to be "closet supporters," secretly cheering on those few hygienists who moved out on their own.

Now I think the disillusionment rests on the relentless efforts of some dental societies to change the law to permit preceptorship. On-the-job-trained "dental hygienists" would be licensed in some states to try to ease the shortage. The sad part is that hygienists predict that such training will consist of teaching people to scale and polish. Here we are, back cleaning teeth full-time, again. Only this time, there is no formal education to support that procedure. How sad to look at our profession and see the core of its prestige tainted by a few desperate states who believe the way to ensure adequate numbers of dental hygienists is to train them themselves.

Authority and Esteem

I think a recent American Dental Hygienists' Association survey reveals several key points. Perhaps the most important one is that dental hygienists are looking for more authority and more esteem in clinical practice. They want to be able to use their knowledge and skills and not be insulted by comments that they are not competent or well-educated enough to make decisions.

We can all be grateful for the numbers of dentists who see dental hygienists as having meaningful input and as deserving respect. We can be grateful for the employers who make a special effort to nurture new graduates until they are sufficiently experienced to accept authority.

Irene Woodall was RDH's senior consulting editor during the 1980s.