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RDH, disrupter, and entrepreneur: An interview with Shirley Gutkowski, RDH

Sept. 17, 2019
Shirley Gutkowski is not your typical dental hygienist, and she doesn't apologize for it. Learn more about her journey from grade school disrupter to dental hygiene disrupter in this interview by Amber Auger, MPH, RDH.

How long have you been an RDH?

I have been a dental hygienist since 1986. I graduated from a technical school in Madison, Wisconsin, and completed my undergraduate degree through the College of Health Sciences at Marquette University in 1999. I was the last graduating class from that University. I took my postgraduate training on orofacial myofunctional training through the Academy of Orofacial Myofunctional Therapy on the University of California, Los Angeles,  campus.

When did you decide to create your own company?

I soon became disenchanted with the clinical aspect of dental hygiene work. It became painfully obvious to me that the practice of dental hygiene is diametrically opposed to the practice of dentistry. My income was based on my failure. We are taught right out of the gate that prevention doesn't cost—it pays. But in the real world, cavities are a failure of dental hygiene, and cavities are in the realm of the dentist. When you get right down to it, I get paid because the dentist gets paid for failures. There’s a real conflict of interest in many dental practices, and if the Federal Trade Commission is ever asked, they have so far voted on the side of the dental hygienist.

After I graduated from Marquette University, absolutely nothing happened. Even though I didn't think anything would happen, it was still a surprise. Chairside clinical dental hygiene became even more impossible for me. Thank God for the internet. I became a member of the AmyRDH Internet community about 1999. I honed my writing skills by writing insightful and humorous posts. I found different ways of saying things that everyone was thinking. I found other people who were dissatisfied the same way that I was, but more importantly, I also found others who were practicing the way that I wanted to practice.

I toyed with the idea of starting my own speaking and writing business, and in 2003 that's what I did. My main topics were on prevention, which came to be known as early intervention or minimally invasive dentistry or dental hygiene practice. I wrote for RDH magazine for three years as a monthly columnist, then three years for the peer-reviewed journal Contemporary Oral Hygiene. I was one of the first people to write about xylitol. I was one of the first people to bring out the idea of remineralizing enamel. And with the support of company sponsors, I quit my full-time dental hygiene job and started to write and speak professionally as a full-time business.

I also became involved in CareerFusion to help dental hygienists to become more marketable and help them find ways out of chairside clinical dental hygiene. One of the top things dental hygienists need to know to get out of their current situation is computer skills. In particular, they need to know how to use the Microsoft Office suite of programs—most importantly,  Word, PowerPoint, and Excel. So I taught those skills at CareerFusion. I still teach those skills virtually and through in-person Talent Accelerators, teaching those skills to dental hygienists interested in taking their career to the next level. I'm very happy to share with whomever is interested.

In the year 2014 I became painfully aware that breathing and the airway are the true gateways to oral and systemic health. So, I changed my topic. That brought on complications that I wasn't surprised to see but had to deal with. Mostly, there were no companies ready to support a speaker on the airway and breathing. At that time I was doing more subbing, and I realized that I had this newfound knowledge. I had the blinders fall from my eyes, if you will. When I found signs of tongue ties or sleep apnea, there was no one to refer patients to. I learned in 2014 that myofunctional therapy was a piece of the solution of improving people's airway and breathing. By 2016, I started a practice called Primal Air in my hometown Sun Prairie, Wisconsin. I now practice exclusively as an orofacial myofunctional therapist. We have just added a second therapist and I'm very excited about the future.  

What is the mission behind your brand?

That's a good question. My mission is to be part of the solution to our current health-care situation. I'm doing that by preparing patients from an epigenetic perspective to be healthier in the future. The other piece of the mission is to raise up dental hygienists to offer them a solution to working chairside clinically on a treadmill that never seems to end. At Primal Air we expect to have many dental hygienists working with us virtually or in Sun Prairie to take care of the needs of those who require myofunctional therapy. This is a continuation of my attempt to get hygienists up to speed to get out of clinical dental hygiene or augment their clinical dental hygiene practice. I'm also offering a place for trained myofunctional therapists to practice orofacial myofunctional therapy without having to start a business.

How do you want to impact the profession?

When I was a child, I was disruptive in school. That was bad. In fourth, fifth, and sixth grade, my desk was pushed up against the wall next to the blackboard so teachers wouldn't have so many distractions from the other students. I can focus, but I'm easily distracted.

Today, the term disruptive is something to be heralded. I’m still attracted to being disruptive. Dentistry and health-care both need disruptive influence. I'm obviously not the only one being disruptive, but if I had to choose one thing, that’s it.

In five years, how do you think the dental hygiene profession will change?

20 years ago when I started to speak on the oral systemic link pointing out that periodontal disease was a larger influence on influence inflammation then just about anything else no one believed me. I was nearly fired in 1997 because I brought it up to a patient. They say that changes in medicine are measured one funeral at a time. They are referring to the educators. The changes in dental hygiene practice will change now that we have more men in the industry. It causes me physical pain to say that but I believe it to be exactly true. We will have more autonomy and we will focus on systemic health with an eye towards oral health. Some states currently allow dental hygienist to work in medical practices And I see more of that happening as medicine realizes how valuable dental hygienists are that there is no turf war to worry about. There are dentists who are actually afraid of their medical colleagues. So, the disruptions will continue to happen until there's an evening out. After which more disruptions will happen.

I also see that with the ongoing science of epigenetics dental hygienist will have even a larger role in oral health care as they also become airway advocates and treat more than just the enamel or pockets. The changes in airway are real they've been going on for nearly 200 years we are the first People to recognize it. When I was speaking in New Zealand this past spring I think I may have nailed it for all of the hygienist in my age group, i told my audience that i had looked at thousands of throats and I only first saw an airway in 2014.

What piece of advice do you want to give new graduates and students?

My advice is to maintain professional curiosity. Cultivate professional curiosity. Every five years,  evaluate what you're doing to your patients and why. Is your treatment plan still relevant? What has changed? Current conversations on Facebook groups about whether to floss before or after brushing are a very poor example of how far we've come.

In 2004, I published a book called The Purple Guide: Developing Your Clinical Dental Hygiene Career because new graduates were asking the same questions in 2004 that I had in 1986. That book is still in print and available because people still have the same questions today!

We need to cultivate our curiosity to stop asking ourselves the same questions over and over again and really reflect on what we're doing to our patients. Is it relevant? Wonder whether our treatment is harming, not helping. Here's a good example: in the pits and fissures of molar teeth is a niche of bacteria in a biofilm. That niche houses bacteria that are unique in metabolizing glutens. Now that we've spent 20 years putting in sealants on permanent molars, how have we affected the oral flora and how has that affected the rest of the alimentary canal? Why is it that I've only had conversations of this nature with one dentist? Why aren't all dentists talking about this or wondering about this?

I'm not special. I graduated in the bottom third of my high school graduating class. I made the dean's list at universities I’ve attended, so I'm no dummy. I just wasn't handled correctly in elementary school or in high school. I can't be the only one asking these questions and looking for answers to questions such as these: Why isn’t ozone in every treatment room? Why aren’t all new graduates looking at airways instead of throats? Why is the profession of dental hygiene not recognized as a profession? Why is the executive director of the association not in the papers more? Why doesn’t the American Dental Hygienists' Association  have a white paper or position paper on breast feeding? Why do dental hygienists think they can train nursing assistants how to take care of the oral cavity of dependent adults? Are dental hygienists offering regenerative products for teeth in their offices in states where they can practice independently? What about exosomes? Can we recommend more to patients for dental decay than fluoride? Why don’t dentists hire nutritionists to be part of the practice? Why don’t we act on the nutritional news that dental decay in children may be a vitamin D or iron deficiency? Why are people who mouth breathe not sent to a specialist to help them get their mouths closed? Why is a baccalaureate degree still not the entry level for an RDH license? Why aren’t dental hygienists required to publish an article or case study once a year to be eligible for a raise? Why are there over 70,000 medical codes and only a few hundred dental codes? Why are dental hygienists afraid to make a diagnosis? Why don’t dentists make a diagnosis if they’re so protective of their license to do so (periodontitis is a diagnosis, scaling and root planning is not)? How many patients are there with PTSD from dental treatment? Why do we still call fearful patients dental phobia patients when a phobia is defined as having no cause? Why do researchers still research the effects of fluoride on tooth enamel? Why are metanalyses such a big deal when there are only fewer than 20 papers to analyze? Why are there no peer review dental hygiene magazines? Why is the only peer review dental hygiene magazine only rehashing the same old thing? That’s the tip of my iceberg.

Where can people find you?

People can find me everywhere. Sometimes I think I'm obnoxiously obvious. I've spent the last three years with my head down building Primal Air, so it may look like I've gone away, but I haven't. This past summer my article on sugars and sweeteners came out, and you can find more articles in the near future. I'm on Facebook quite a bit. I also have a YouTube channel. The best thing to do is to get me via email. I’ve had this email address for nearly two decades, [email protected].

Amber Auger, RDH, MPH, is a practicing dental hygienist and clinical innovations implementation specialist. With 14 years of experience in the dental industry, Auger works with practices to provide customized protocols, to refocus on the patient experience, and to utilize systemic approaches to periodontal therapy. She is a regular contributor to RDH magazine, a featured author for DentistryIQ, and host of #AskAmberRDH. Auger provides preventive services abroad yearly and is always willing to have dental professionals join her team. She can be reached at [email protected].

About the Author

Amber Auger, MPH, RDH

Amber Auger MPH, RDH, is an international lecturer, the 2019 Sunstar RDH Award of Distinction, editorial director for RDH Graduate, creator of Thrive in the Op, and the Functional RDH Certification. Amber has more than 18 years of experience in the dental field and has been practicing dental hygiene since 2010. An active mentor to fellow hygienists, she champions personal and professional growth through her innovative Thrive in the Op on-demand courses and live coaching sessions. She can be reached at [email protected]. 

Updated January 22, 2024