Dental hygiene school equips future hygienists in many ways, but some lessons simply come with time and experience rather than books.
As graduation season rolls around, I can’t help but reflect on my 13-year career in dental hygiene. I remember the excitement of walking across the stage, applying for jobs, and officially becoming a Registered Dental Hygienist (RDH). A blank slate lay in front of me with a million possibilities. But that excitement was paired with a feeling of being unsure of myself and whether I was really prepared to walk into the “real world” of dental hygiene. Fortunately, I quickly learned that my dental hygiene education had prepared me well. Even with that in mind, there are definitely a few things that I know now that I wish I had learned in dental hygiene school.
I recently asked in several Facebook groups what experienced hygienists wish they had learned in hygiene school. While everyone's experiences are different, some repeated themes were emerging. So, here are a few things I (we) wish I (we) had learned in dental hygiene school.
Protecting your body is a top priority
In my informal Facebook surveys, the overwhelming majority of hygienists said they wish proper emphasis had been put on ergonomics and ways to reduce health risks in our profession. I recently wrote another article that touched on many of these health risks and how to prevent them. We know as hygienists that prevention is the key, and it is no different with our musculoskeletal system.
Proper ergonomics begins with correct posture. So much of our day-to-day lives is affected by how we sit and stand, and while that seems straightforward, for many of us, it’s not. Keeping your spine in a neutral position is important all the time, not just when we’re practicing clinically.
Luckily, there are many tools available today that are ergonomically designed, many of them created by hygienists who know firsthand about the issues we face. Over the past 2 years, we’ve seen a huge increase in high volume evacuation (HVE) utilization for dental practices. Now, more than ever, we realize the need for preventing aerosols in the dental practice to help protect us and our patients, but while helping protect us from 1 thing, it has caused wrist, arm, neck, and shoulder issues. Many dental hygienists work solo and therefore are trying to figure out how to hold a larger, heavier hose for an hour (or more) at a time. Products like CordEze®, Purevac®, ErgoFinger®, Aerosol Assist, and more have been designed to help us manage the HVE while letting us maintain ergonomic positioning. Many other products on the market like newer, lighter loupes, including prismatic lenses, ear protection, and dental delivery units focused on operator positioning are all helping us start preventing issues earlier in our careers.
I feel like my dental hygiene program talked about ergonomics quite a bit. All students were required to purchase loupes in our first year and use them during clinic. Despite their good intentions, these purchases were made before we really had any clinical experience. Most of us made these purchases based on better esthetics without an understanding of our personal ergonomic issues. The average age of students in my hygiene class was probably early to mid-twenties too. So, as much as you can try to reinforce messages about the need to implement work practice controls early, it’s hard to convince younger people of the importance of these things until they learn from experience.
Calculus does not equal scaling and root planing (SRP)
This statement just makes me laugh. Of course, the presence of an irrational factor does not indicate a specific procedure to be done or a specific Current Dental Terminology (CDT) procedure code to be used, but unfortunately, many new graduates from dental and dental hygiene school think this way. We get so focused on meeting clinic requirements, checking for “clicks” of calculus, and meeting criteria for a clinical board exam that we forget that what we should be focusing on is diagnosis and treatment planning. Once you’re working, these critical thinking skills are much more important and allow you to offer something valuable to your patients and your practice.
The American Academy of Periodontology (AAP) classification of periodontitis is characterized by a multidimensional staging and grading system. Digging deeper into this system for classification and really understanding each factor for determining a diagnosis for your patient is key to determining the proper treatment options, communication with your patient, and understanding the expected outcomes and prognosis. While dental hygiene diagnosis and treatment planning is taught as part of the dental hygiene process of care, it still doesn’t seem to be the focus. So much of our clinical education is still based around mechanical removal of calculus and scaling. Even our board exams are focused on detecting and removing calculus. My hope is that as we start to rethink our curriculum and accreditation standards, we continue to prioritize the need for critical thinking skills at all steps in the process of care. Removal of calculus does not necessarily correlate with health of a patient or absence of disease, and we need to prepare our future clinicians for how to treat a patient from a more holistic perspective looking at all factors in their disease.
Another aspect to this issue is the inability of new clinicians to understand how their diagnosis and treatment plan fit within our CDT procedural codes. I am the first to jump up and say that our current coding system is flawed and need some significant overhaul, but it is the only system we currently have. After working in a federally qualified health center alongside many medical providers, I have seen firsthand how they are able to incorporate education and chronic disease management into their care for patients with conditions like diabetes, high blood pressure, mental health concerns, and more. Their coding system is much more focused on diagnosis and outcomes than on procedures. They can see patients more often, for varied amounts of time, and in a variety of settings like group care visits, to address chronic health concerns and talk about disease management. Shouldn’t we be able to do the same? We know that caries and periodontal disease are both chronic conditions and multifactorial, so why are we still trying to address them from a surgical and procedural frame of mind when it comes to treatment planning. In a world where CDT codes and insurance reimbursements didn’t exist, would we still be doing things the same way, or would we be treating the patient more holistically?
And yet, our current CDT procedural codes are what exists for now, and what we have to use in order to document the care we’re providing to our patients. While limiting, it is important that we understand the codes as they are currently written while continuing to advocate for change as well. Many new graduates, and experienced hygienists for that matter, really struggle to understand the indications and limitations of each CDT procedural code and the implications of the patient’s diagnosis on which codes can be used. For example, I can’t count how many times I’ve seen a question asked on Facebook like, “Can I alternate between a periodontal maintenance (D4910) and an adult prophylaxis (D1110) on a patient every 3 months?” The answer is clear that according to the CDT code descriptions you cannot perform an adult prophylaxis on a patient with periodontal disease and you can’t perform a periodontal maintenance on a patient with healthy periodontium. But the question itself indicates that so many of us do not understand how to use the existing codes properly and how much misuse exists because of insurance reimbursement limitations. Maybe some hygiene programs incorporate this aspect of treatment planning and billing into their programs, but I don’t remember much from my program.
Dental hygiene is a business
As a hygienist who has gone on to complete a Master’s Degree in Business Administration, I see the importance of dental hygienists gaining a deeper understanding of how the business operates and our role as a dental hygienist in the health of our practice. Many dental hygienists shy away from getting involved in the business aspects of their practice because they feel like it makes it “just about the numbers.” They don’t consider that these “numbers” are what keep the lights on and allow us to continue providing care for our patients.
When dental hygienists invest in understanding the metrics in the practice, we can start to see the bigger picture of long-term sustainability and the overall health of the practice. We can understand where most of the money is spent (usually salaries) and contribute ideas on ways to be more efficient with finances. Contributing to the practice at this level increases your value to the practice owner because now you are collaborating to find solutions. Many of these metrics will also give insight to your individual role in the practice and allow you to measure your productivity over time. While productivity numbers are just one part of the value you offer to your practice, you can use these numbers to assess where the gaps are and where there may be opportunities for improvement.
One of the areas that always has room for improvement in a practice is accounts receivable (patient payments and third-party reimbursements). Most of the public really does not understand what dental “insurance” is including what’s in their coverage, what limitations exist, how to select a provider based on their dental coverage, or how the provider gets paid. I would argue that most dental hygienists don’t really understand it either, especially when they are recent graduates. Taking time to understand dental office operations on this level can really increase the dental hygienist’s value to the practice. By understanding a patient’s coverage and benefits, we can better communicate with our patients about their treatment plan, the necessity of what is or isn’t covered, and increase case acceptance.
Be a lifelong learner
One thing is certain, nobody walked across the stage at graduation as the same clinician as they are 10 years into their career. Luckily, we learn things along the way that make us better clinicians, but also more well-rounded thinkers. Experiences in our lives, both work-related and not, force us to see things from a different perspective sometime. Learning how to acknowledge when we’re wrong, adapt to uncomfortable situations, and learn from our mistakes makes us better. Unfortunately, the dental hygiene education environment sometimes doesn’t encourage us to fail. Every checkpoint and test that’s graded reinforces our desire to achieve perfection. Every course is aimed at preparing us for our board exams. I often speak to local student chapters of the American Dental Hygienists Association and when I offer some topics that I’d like to speak on, the student leaders tell me, “If it’s not on boards, we don’t get much engagement from our classmates.” I know that’s not indicative of every student, or every program, but I think the sentiment is familiar. There is so much pressure and attention put on memorizing facts for a board exam, that we lose sight of the things that make excellent dental hygienists after graduation - critical thinking, taking initiative, seeking evidence-based research, and creativity.
I know the purpose of the existing examinations for healthcare professions, but I think a much more subjective assessment would be helpful in some ways. I wish that my peers were better equipped to find and digest evidence-based research. I wish that my peers better understood jurisprudence, the licensing procedures, and legislative process. In today’s world, there is so much information at our fingertips. Many textbooks are out-of-date almost before they’re published. What’s more beneficial than memorizing facts for a test is understanding how to find the best and most current information when you need it.
All 50 states in the U.S. require dental hygienists to complete continuing education hours. But not all continuing education is created equally. It’s very easy for us to just check the box to fulfill a requirement instead of using this opportunity to really grow and teach us. There are so many dental professionals (and non-dental professionals) that offer continuing education courses on subjects that they are passionate about and learning about. We should take advantage of these courses and really lean in to learn something that challenges our current perspective. There are so many areas that we know more about now than we did even when I graduated 13 years ago. There are conversations about oral/systemic connection, airway, lasers, myofunctional therapy, biofilm management, medical management of caries, and so many other topics that weren’t even known a decade ago. It’s our responsibility to engage and continue to learn all that we can about these new ideas to better serve our patients and grow as professionals.
Find Your Passion
When people first hear that I’m a dental hygienist, they think of teeth. They talk to me about their teeth. They talk to me about my teeth. I must really love teeth. And yes, I do like teeth (as evidenced by my purses, luggage tags, lapel pins, t-shirts, etc.). But what I really love, and what drew me to this profession, was the drive to help people. My passion for dental hygiene is partly about my desire to help people improve their oral health, but it’s more about my desire to help them lead healthier and happier lives - the way I do that just happens to be through helping them understand and improve their oral health.
There are a lot of niches in the dental world. Don’t be afraid to try new things until you find something you’re passionate about. Temping as a new graduate may be intimidating, but it can also introduce you to a lot of different practice settings and environments that you would not have known existed. You may be able to find practices that focus on community health, laser dentistry, pediatric or senior populations, periodontics, prosthodontics, or a practice that includes a little bit of everything. Take risks and learn as much as you can. Eventually you will find something that connects with you and reminds you why you chose this profession in the first place.
For me, one of the greatest blessings in my career has been my involvement in professional organizations. I am a member of the American Dental Hygienists’ Association, American Mobile and Teledentistry Alliance, Organization for Organization for Safety, Asepsis and Prevention, and Dental Entrepreneur Women. Throughout my involvement in these organizations and participation in conferences and professional development events, I have met some of the most incredible people. I have been mentored by incredibly passionate and accomplished dental hygienists, and it has motivated me to continue pursuing my own passions. There is an entire community of dental hygienists at your fingertips through social media groups and online communities that are waiting to welcome you into our profession and cheer you on.
Luckily, I did learn that during dental hygiene school and I entered my profession feeling encouraged and supported. I hope that every dental hygienist can find their support system and launch into a long and successful career.