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After just six months, I left private practice to work as a hygienist in a hospital with a dental General Practice Residency program. I’ve now been there seven years and truly enjoy the many challenges the hospital and residency setting offers.

Working as a dental hygienist in a hospital isn’t for everyone, but I have considered it a privilege. My cases are unique in terms of both the variety of medical conditions patients may have, as well as the coordination of schedules with the new dental residents and experienced doctors I work with.

I have learned to take the challenges of hospital hygiene in stride—it’s normal to me now. My director often reminds me, however, that my schedule is by no means “normal” for most practicing dental hygienists.

no ‘typical’ day

Many, although not all, of the patients I treat are medically compromised, ranging from “special needs” patients to the chronically ill to average healthy people. Reviewing and updating a complete medical history is vital with every case—understanding a patient’s health status takes on an entirely new significance when medical clearance is often needed prior to treatment. The patient’s physician will list specific precautions and contraindications if any, such as premedications or avoiding use of ultrasonic scalers with certain types of pacemakers .

Many times I may need to collaborate on an appropriate treatment modality with our general dentist and the patient’s physician. If the patient is wheelchair- or stretcher-bound special efforts may be needed to access the oral cavity and prop the mouth open. The telephone is an important part of my hygiene armamentarium as I consult with patient’s physicians and caretakers on a frequent basis.

a day in the life

Let me take you through one of my most recent days at the hospital.

Patient 1. I started with a patient who has Treacher-Collins Syndrome (TCS), a genetic, craniofacial birth defect characterized by a range of distinctive facial anomalies. Because of her TCS, the patient is mildly mentally retarded and has a peculiar birdlike visage with a concomitant oral cavity deformity.

Patient 2. Next, i treated a patient with post-traumatic stress disorder who also was taking multiple medications for depression and bi-polar syndrome. Needless to say, the various psychiatric problems required special care.

Patient 3. The last patient of the morning was wheelchair-bound due to Huntington’s Disease, a degenerative disease that causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. She is nonverbal and cannot clean her mouth. Her care involved help from the caregiver as the patient has uncontrolled movements and difficulty opening her mouth.

Patient 4. After lunch—spent in a “lunch and learn” lecture with dental residents—I treated a patient who, at 6 years old, had surgery to remove a brain tumor. As a result, his growthis stunted and now his head is smaller than his body and his mouth opening is quite small. His oral hygiene had improved since our last meeting, but due to limited opening and a strong gag reflex, some areas were difficult to access.

Patient 5, 6, 7, and 8. After treating three more patients, my day ended with someone who hadn’t received dental treatment in 20 years. We spent a lot of time discussing  oral hygiene and reviewing pamphlets on periodontitis.

my professional health
Meeting so many different people, being in a position to care for them, and working with our dental residents are major benefits in my “alternative” career. I am fortunate to work in a setting where, on certain days, attending specialists such as oral surgeons, endodontists, periodontists, pediatric dentists, or implant specialists join our day-to-day team. Numerous times I refer my patients to our residents and specialists. I am able to monitor my perio patients and others who have had a consult for implants, as well as assessing pathology for potential oral cancer. This helps ensure that patient’s receive optimal care and helps me follow up more consistently.

Everyday poses new opportunities for growth as a healthcare provider. Are you up for the challenge?