How COVID-19 Permanently Changed Dental Hygiene

Worldwide, the COVID-19 pandemic changed how people view a lot of areas in their lives: health, safety, job security, and even relationships. In addition to adapting to new infection control approaches such as masks and copious amounts of hand sanitizer, people explored the importance of face-to-face relationships (or lack thereof), and evaluated their professions—discussions that most likely will not end with the ebb and flow of the pandemic.

These trends were no different in the dental hygiene industry. As clinicians continue to evaluate their lives, professions, and relationships, the industry has evolved indelibly. While some changes may not seem astronomical—infection control practices are nothing new to dental hygienists—others have reshaped how hygienists approach work, patient relationships, and their own place in the industry.

Patient Care and Relationships
One area the pandemic has altered is patient relationships and education. Tina Clarke, RDH, MEd, a dental hygiene educator, has seen patient relationships evolve in new ways as everyone works through health and safety concerns.

“Right now, one of the biggest struggles that I personally have is that when I see my patients and greet them for the first time, we’re all still very masked up,” Clarke says. “You know, they wear their masks when they’re coming into the health care setting. And I have to wear my mask the entire time, and so we’re never getting to have the unmasked, face-to-face conversation about their health and their life and what’s going on before actually diving into their mouth.”

Clarke says she misses having those moments and feels like there’s an extra layer of barrier in the conversations since she has to keep her mask on. “I would say for sure that this has been a big challenge with patient care in that regard” she says. It also presents challenges when trying to create a less stressful environment for hesitant patients.

“Patients still have general concerns about their environments and they’re very cautious, so I think it’s increased patient anxieties—when perhaps they’ve already been anxious about dental care,” Clarke explains. “And now they’ve heard all of these things about aerosols and coming into the environment with all these questions makes them unsure of what’s going on. So it’s increased the anxiety for some patients who were already trying to find reasons to avoid coming in; now there’s an added reason to not addressing their oral health care.”

Clarke says that as the pandemic has waned, she has definitely seen the level of environmental anxiety lessen, but it’s still there in the background. One upside of the pandemic, however, is an increased awareness of overall health and wellness.

“In general, I think individuals have started taking a closer look at their own personal health,” Clarke says. “And as a result, patients are a little more receptive to information about how they can improve their own personal health. They are understanding how important it is to stay healthy and that when we’re healthy, we’re likely to reduce our opportunities for sickness and illness and infection. So that has been a silver lining from all of this when it comes to talking with patients.”

In addition to a greater awareness of overall health, Clarke has seen an increase in interest and understanding of oral-systemic health, which is helping dental professionals combat some anxiety about dentistry by promoting its importance to whole-body health. This interest has also opened the door for more oral-health education.

“People are grasping the concept of oral-systemic health in a new way,” she says. “They’re saying, ‘Oh yeah, that makes sense.’ There is just this general understanding that’s starting to happen and this desire to find out what else they can do to keep themselves healthy. When patients are more receptive, clinicians are more apt to have those conversations.”

Health Effects
It’s not just oral health that is at stake; the pandemic has also taken a toll on the systemic health of hygienists. With increased personal protective equipment (PPE) has come increased physical strain on already stressed systems.

“The career of dental hygiene has always been very strenuous on our bodies,” Clarke says. “And now we have started implementing more of these protective barriers that we probably should have been wearing on a more regular basis. I’ve always been a proponent of wearing face shields on a regular basis, especially when we’re using our ultrasonic instrumentation. But that’s an extra thing that’s on our upper body; it’s another thing that we have to carry on our bodies.”

While face shields may not seem heavy—there are some that weigh less than 3 oz—any bit of additional weight can have a big effect. Add in a pair of loupes, an N95 mask, and other PPE, and it all adds up very quickly.

“It is very, very taxing on our bodies,” Clarke says. “And one of the things that we can see industrywide is that dental professionals are leaving the dental field or not working as much in the dental field because their bodies are just exhausted, absolutely exhausted from all of the additional parameters that we have on ourselves and needing to have all these extra precautions that we’re wearing on a regular basis. Partner that with poor ergonomics and we just can’t keep up and just can’t handle it anymore.”

And there have been plenty of hygienists who are too exhausted or worn out to continue to put their bodies through the strain on a daily basis.

“I know a lot of hygienists who went from working 4 days a week to 2 days a week, or they’re working every other day instead of every day,” Clarke says. “Or they are even looking to see if they can do early retirement. I’ve even seen a lot of friends who have completely left the field of dental hygiene and have gone and gotten into other things like real estate—just completely something different because their bodies were just too stressed out. They just couldn’t do it anymore.”

In addition to physical stressors, many in the dental industry are facing increased mental stress at work. Differing views on the pandemic have caused division within the workplace for many people, both with coworkers and patients.

“There’s a new level of anxiety,” Clarke says. “There are people who live in different camps. Some people are taking a conservative approach when it comes to precautions, and like having all the barriers and safeguards. And then you have some who believe we should go back to the way things were in 2019 and 2018. It’s stressful trying to find that balance. If you have that in 1 office, then you have those office tensions as well.”

Essentially, the pandemic has taken a toll on hygienists’ bodies and mind in a trend that doesn’t seem like it will be abating anytime soon.

“You have the physical stress, you have this mental and emotional stress, and then you have your patients coming in sharing all of their philosophical and political views,” Clarke says. “And having to manage all of that is very, very taxing and can increase one’s anxiety.”

Employment Opportunities
Health and wellness have not been the only reasons hygienists are leaving the field. As a predominantly female occupation (the American Dental Hygienists’ Association [ADHA] reports that 98% of practicing dental hygienists in the United States are female1), hygienists were particularly affected by the challenges of the pandemic. Nationwide, nearly 2 million women—especially mothers with young children—considered leaving the workforce or stepping back from their careers in 2020.2 This carried over into the dental industry: According to an article by the ADHA, the pandemic led to an estimated 8% reduction in employment for dental hygienists.3

In a study by McKinsey & Company,2 women reported a variety of reasons for stepping back, including an increase in household responsibilities. Researchers found that 75% of women said they spent at least 1 additional hour on household responsibilities daily than before the pandemic, with 15% reporting they spend 5 or more hours per day. These increased caregiving or housework burdens, coupled with a lack of flexibility at work, difficulties sharing with managers the challenges they are dealing with, and concerns over job performance all contributed to many women leaving the workforce.

“In talking with some of my hygiene friends and seeing discussions on Facebook communities and forums, I see a lot of conversations unfolding about the need to stay home,” Clarke says. “Women are saying, ‘I’m not sure if I can come in, or when I can come back in.’ They’ve felt the need to be home with their kids.”

And Clarke says many of them may not be returning, even after the pandemic subsides; the reduction in the workforce may be a permanent situation.

“I’ve talked with people who were like, ‘I didn’t realize I was going to enjoy being home with my family and having the freedom and flexibility to do these things,’” Clarke says. “Some thought they were dependent upon the income they had, but maybe they found they aren’t, or that it makes more sense for their finances to stay home. That’s not true for everybody but I have heard people say that if they can be home with their kids and their finances are met then maybe they don’t want to go back.”

The increase in hygienists leaving the field has opened the door for both new hygienists and those looking to transition to a different practice or work environment. Established clinicians can now be a little more discerning about where they work—which also opens doors to have more conversations about compensation.

“A clinician who leaves a practice probably left because they tried to do some bargaining with the office and it didn’t work and they were already in that kind of unhappy state even before the pandemic,” Clarke explains. “And so they think, I have opportunities where I can look elsewhere and go somewhere where what I bring to the table is valued and appreciated. And they want compensation to reflect that.”

For new hygienists just entering the workforce, the increase in job opportunities has left them with bargaining chips they may not have had before. New hires have the chance to make more money and be hired on at a higher wage than past generations. This, Clarke believes, has caused some stress in the industry.

“New clinicians have the opportunity to make really excellent money,” Clarke says. “They are being hired on at a higher wage and higher compensation package than some clinicians who have been doing it for 10, 15, or 20 years. I think it’s really important for practices to really take a look at that if they are bringing a new hire on. Take a look at what are you are offering to those who have been with you for a while and who you already have established relationships with, and remember those individuals.”

Adapting to a New World
Even as the pandemic continues, the problems facing dental hygienists haven’t changed, Clarke says. Many of the challenges they face—and will continue to face—are the same as pre-pandemic. This begins at the school level: While students faced a tricky few years of board exams taken on mannequins and concerns about emerging into the profession feeling unprepared, Clarke finds that the questions students face are the same as pre-pandemic.

“During the pandemic, there were a lot of questions of, ‘How do I answer the question about my boards because I didn’t take it on a live patient and how will this affect me?’” Clarke says. “But I think now with this group that’s getting ready to emerge into the profession, that they’ve witnessed this and that everybody else ahead of them has survived it and that they’re coming into a workforce that’s normalized a little bit more. I see the students who graduated in 2020 and 2021 and they seemed less confident in their own skill sets because of the reduction of what they were exposed to in school and feeling like maybe they didn’t learn everything they needed—but they are qualified, competent clinicians.”

Now, having made it through the first 2 years of transition into the new pandemic “normal,” things are beginning to even out, Clarke believes.

“It seems that 2 years in, we are normalizing, and things that were ‘different’ are now kind of a normal thing, so it’s not so crazy,” she says, “you know, the questions of wanting to know an office’s infection control policies or sterilization processes. Those types of things might be more of a forefront question now before going into an office, but really, it’s still back to how do I fit in here? Does the patient care philosophy that the office holds match with my patient care philosophy? You’re not just looking at if infection control policies work for you; you’re looking for a good match.”

References

1. Callahan R. Oral health fast facts. American Dental Hygienists’ Association. Accessed May 21, 2022. https://www.adha.org/resources-docs/72210_Oral_Health_Fast_Facts_&_Stats.pdf

2. The pandemic’s gender effect. McKinsey Quarterly. Accessed May 31, 2022. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/five-fifty-the-pandemics-gender-effect

3.Gurenlian JR, Morrissey R, Estrich CG, et al. Employment patterns of dental hygienists in the United States during the COVID-19 pandemic. J Dent Hyg. 2021;95(1):17-24.