Clinical Dental Hygiene is a Great Career Choice

As we enter the new year, I’m troubled by what I read online about dental hygienists leaving their careers and choosing other paths. Even when it means returning to college, I read about dental hygienists who are so frustrated with their jobs that they dream of throwing their curettes up in the air and bolting out the office door, never to return!

One of my close friends was so exasperated with her clinical position that she would find herself going next door to the bar for a margarita almost every night after work. She was frustrated because she was working in an assembly line dental practice which meant she had no time to herself and could not treat her patients in an ethical manner. Somehow, management ended up giving her 2 columns of patients to treat instead of 1 and she found herself shortchanging her patients.

The COVID-19 pandemic has allowed many dental hygiene clinicians to re-examine their careers. Since some hygienists have left dental hygiene or have chosen to stay home instead, clinical dental hygiene positions have become plentiful. This allows many practicing hygienists to leave positions they aren’t satisfied with, and with more jobs to choose from, hygienists can carve out a position that meets their professional and personal needs.

Dental hygienists are in a unique position in a profession unlike any other. When the profession was born in the early 1900s, hygienists were trained as “women assistants.”¹ Graduates of the Connecticut dental hygiene program at the time worked in public schools. When I graduated from Fones School of Dental Hygiene in the 1970s with an Associates in Applied Science degree in Dental Hygiene, I entered clinical dental hygiene full-time in New Jersey. My first clinical position was a nightmare because my dentist-employer was very controlling, and my daily schedule was almost empty. I would mope around the office and decided I deserved better so I began interviewing at different practices. I ended up working in a delightful general dental practice located in Closter, NJ. I was only 20 years old at the time and I loved my job and the entire dental team. Believe it or not, I worked with an ultrasonic back then and even though it was a clunky, old Cavitron box with 1 insert, I used it on almost every patient and never had a single patient complain. I was scheduled to see adult patients every 45 minutes, but the day was very relaxed. I had minimal assistance, but clinical dental hygiene was easier and mostly consisted of scaling and rubber cup polishing. We took radiographs and developed films in a film processor with rollers and occasionally, all the films on the rollers would get stuck! I once took an 18-film series of radiographs on an elderly gentleman and every single film was ruined in that processor. At the tender age of 20, I had to look him in the eye and explain that I needed to re-take all of his films.

Back in the 1970s and in recent years, dental support organizations (DSOs) evolved but when I started practicing dental hygiene, dentistry was a cottage industry. I was paid well, and it was a daily, not hourly wage with a few benefits like vacation and sick pay. Dentistry wasn’t making money from the hygiene department but from crown and bridge which was all the rage at the time. Jobs were plentiful and I was happy as a lark in my employment.

So much has changed in dental practices today and in those states where hygienists are still ‘supervised’, there was period of time where many dental hygienists were not appreciated and valued for their contribution. Instead, dental hygienists were treated as a means to a monetary end, and I blame, in part, a practice management trend that created this conundrum. The introduction in practice management of dental hygiene as a profit center began 20-30 years ago when it was recognized that additional sources of profit from the hygiene operatory could be “passive income” with minimal additional chairside time.²

It was thought that hygienists could become salespeople in addition to oral health-care professionals. Soft tissue management programs sprang up in the 1980s as periodontal diseases were increasingly receiving non-surgical treatment. Hygienists enjoyed providing non-surgical periodontal therapy and periodontal maintenance procedures including the administration of local anesthesia in most of the United States. The dental hygiene department of a general dental practice that was once described in the past as a “loss leader” was replaced in the early 2000s as a potential profit center. Non-surgical periodontal therapy procedures and adjunctive sustained release local antimicrobials, professional oral irrigation, and diode laser therapy were added to scaling and root planing (SRP) regiments to further increase productivity in the dental hygiene department.

Burnout in dental hygiene does not seem to be related to additional job duties or salary requirements. Instead, it festers when hygienists feel stressed, unappreciated, and when working a haphazard schedule with inadequate assistance. About 8 percent of dental hygienists left the workforce since the onset of the COVID-19 pandemic.

How to Have a Great Career in Clinical Dental Hygiene

If you are a “supervised” dental hygienist working as an employee in a dental practice, these career nuggets are for you. These nuggets come from a seasoned clinician (me) who sometimes learned the hard way. I failed miserably in some clinical positions but I’ve learned some valuable lessons over the last 4 decades.

1. Always remember that you are a “professional” who needs to set high standards for yourself, showing that you care about every aspect of your job. It also means holding yourself accountable for your thoughts, words, and actions. As a professional, you have specialized knowledge, and it is your duty to keep those skills up to date. Professionalism is an approach to your clinical position that helps you get the job done- and done to the best of your ability.
2. One vital component of professionalism is lifelong learning. Staying up to date in your career isn’t easy. Because of the mountains of information at our fingertips to sort through but there seems to be a difference between dental hygienists who are excited and self-motivated in their pursuit of knowledge and those who are not. Many professionals end up teaching, advising and even consulting whereas a technician, who is also competent, focuses on more specialized work in a narrower frame of reference. For example, I used to work with a dental hygienist who was an excellent clinician. Her skills were top notch, but she could never think outside the box and resisted group problem solving and self-directed learning.
3. Don’t start your career without a financial planner!You may think you have plenty of time to save for retirement, and somehow it doesn’t seem real. Building a sizeable nest egg that earns interest in retirement becomes more difficult if you don’t begin early. Many dental practices offer a retirement program to employees through the American Dental Association (ADA) with funds matched by your employer. Don’t laugh when I tell you it’s a must that you ask about this benefit before accepting a position in a dental practice.
4. If you accept a full- or part-time position in a dental practice or if you perform temporary dental hygiene services, you need to stop accepting a 1099 form and start being issued W-2 forms. If you are supervised in a dental practice, you are an employee and not an independent contractor. The classification of an individual is largely dependent on federal and state tests, not an employer’s desire to reduce administrative burdens and payroll costs.
5. Read the 2021 article by Newkirk and Slim on Burnout and Bullying in Dental Hygiene. Bullying is real in dental practices and for those of us who are susceptible, the bullying experience shortens many careers. Most bullying involves employees strongarming their peers and employers not holding bullies accountable for their action. Better yet, enroll in a Jiu Jitsu course in martial arts and be prepared to control an opponent. (Kidding, just kidding!)
6. Invest in your career. Don’t expect your employer to buy everything on your wish list. Profit margins are tight and overhead is high so treat yourself to that cordless polisher or special headlamp. When you begin a new position, be prepared to learn the business side of the dental practice and ask to participate proactively in the success of the practice. Compare notes with other dental practices and dental hygiene clinicians and build your knowledge base in this area.
7. If, for whatever reason, you are not skilled in evidence-based science as it applies to the practice of dentistry and dental hygiene, it’s imperative to learn. In an evidence-based practice, best evidence is applied from well-designed studies, patient values, and preferences but it is not part of the curriculum in dental hygiene programs. The ADA offers a variety of resources to help clinicians interpret relevant clinical evidence and provide recommendations that can be applied to patient care. For example, if you’re discussing the use of topical fluoride to prevent root caries in a 70-year-old patient, the ADA provides a clinical guideline that you can read and apply. The clinical guidelines are developed by a panel of experts who are qualified to interpret relevant research.
8. On a practical level, professional dental hygienists need to honor themselves. Sometimes it means saying no and honoring our truth and our deeply rooted values. There are times when we have to face whatever reactions surface when we do not speak or act merely to please others and make them happy. Sometimes, we need to leave a job, knowing that deep down our integrity is being compromised. Practicing with integrity means that our health and happiness are much more important than cold, heartless, financial or material comfort. In 2022 and beyond, it’s possible to have a fabulous career as a dental hygiene clinician as long as we never compromise our inner truth or deep self-respect.

References

1. Fones AC. Mouth Hygiene ; a Text-Book for Dental Hygienists. 4th ed. Philadelphia, Lea & Febige; 1934.

2. Stefanou A. Profit centers. RDH Mag. Published January 1, 2000. Accessed January 10, 2022. https://www.rdhmag.com/pathology/periodontitis/article/16407530/profit-centers.