By Laurie A. Milling, RDH, BS
In 1897, a young girl named Virginia wrote a letter to the New York Sun asking if there really is a Santa Claus. In response, the Sun editorial writer advised her not to be “influenced by skepticism.” Although we currently face challenges and frustrations in our chosen careers, we need to look back to appreciate where we’ve been, where we are today, and where we’re heading in the future. There’s no time for skepticism. The dental hygiene world has changed, and changed for the better in many respects. Everything from infection control, widespread ultrasonic use, pain control, nonsurgical periodontal treatment, and chairside whitening products are different now. “Yes, Virginia, there is a Santa Claus.”
Sunstar Americas recently held a roundtable discussion at the 2010 Chicago Midwinter Dental Convention to discuss industry trends with a group of dental hygienists. In addition to the roundtable meeting, Sunstar conducted a nationwide survey of dental hygienists that became the impetus for this article.
Where did it all begin?
“Dental nurses” began to provide prophylaxis treatment as a method to prevent disease in the 1880s. By 1906, Alfred C. Fones trained his assistant, Irene Newman, to act as an apprentice, scaling and polishing teeth. Fones disliked the term “dental nurse,” so he changed the title to dental hygienist. Although other dentists at that time were training their dental assistants to scale and polish teeth, by 1910 the Ohio College of Dental Surgery offered a formal course for “dental nurses.” However, dentists in Ohio strongly opposed the formal training school, and those who completed the coursework were never allowed to practice.
How did dental hygiene become regulated by dentists?
Several years after the Ohio “dental nurse” school closed, Dr. Alfred C. Fones trained a total of 97 dental hygiene students in three classes. These hygienists were finally licensed and allowed to practice. In fact, Connecticut was the first state to allow prophylaxis treatment by a trained dental hygienist. Because many dentists in Connecticut were concerned about giving hygienists duties that could possibly lead to more extended functions, the state amended its dental practice act in 1915 to include the regulation of dental hygienists. Dentists in other states followed the Connecticut model by enacting dental hygiene regulations under their own dental practice acts. Thus, the world of dental hygiene became regulated by dentists.
By 1914, state dental hygiene associations formed, and the national hygiene organization, known as the American Dental Hygienists’ Association, soon followed. In 1923, Dr. John O. Butler began marketing his first two-row toothbrush to these upcoming dental professionals and founded the John O. Butler Company.
Amazing progress has been made since then. Take a moment to look at the progress of our profession.
Celebrating 50 years: let’s look back ...
Happenings and hygiene in the 1960s
The hygiene buzz of the 1960s:
- ADA provided endorsement for fluoride effectiveness, 1960
- First electric tooth brush in U.S., 1962.
- The Butler Stimulator and Butler Dr. Bass toothbrush gained popularity.
- ADHA bylaws amended to allow equality for male dental hygienists, 1965.
- ADHA provided continuing-education recommendations, 1967.
Happenings and hygiene in the 1970s
Did we ever really find out who shot J.R.? You probably ran home on Friday nights to watch the ever-talked-about “Dallas.” Here are a few of the popular shows that aired in the 1970s: “The Odd Couple,” “The Partridge Family,” “Happy Days,” “The Streets of San Francisco,” “Laverne and Shirley,” and “The Love Boat,” which debuted in the fall of 1977.
The hygiene buzz of the 1970s:
- The National Board exam became a function-oriented exam.
- The first dental hygienist was appointed to a state board of dentistry in Maryland in 1974.
- Sealants gained more popularity as a tool for caries prevention.
- Ultrasonic scalers gained popularity.
- Hygienists organized widespread school fluoridation programs.
- Dental hygiene uniforms changed from dresses to pants to adjust for sitting.
- The state of Washington allowed dental hygienists to administer local anesthesia. (Now 44 states allow dental hygienists to administer anesthetic.)
Average fees among general practitioners (1975):
Average fee Service
$6.00 Dental hygienist’s average hourly wage
$6.39 Cost of two bitewing radiographs
$22.11 Cost of full-mouth series of radiographs
$13.58 Cost of adult prophylaxis
$5.62 Cost of periodic oral evaluation
Happenings and hygiene in the 1980s
The 1980s were a time of change. The turbulence of the 1970s was over, and a new kind of music and sense of responsibility emerged in the United States. Inflation was everywhere, from the cost of a new home to double-digit interest rates. Political conservatism took hold as President Ronald Reagan sought to end the Cold War. Clothing styles went from psychedelic T-shirts to blouses with padded shoulders and big hairdos. Video arcades popped up in restaurants and hotels, and the personal computer was born for both personal and business use. Hardware and software innovations began as “bulletin boards,” later to become the World Wide Web.
And who rushed home, made dinner, and put everything away in time to see MacGyver get himself out of another close call? Or by now we could tape shows on our new VCR player so we could watch our favorite show whenever we wanted. Drama and mystery shows such as “Cagney and Lacey,” “Matlock,” “Hill Street Blues,” “Columbo,” “Miami Vice,” and “Dukes of Hazzard” grabbed the ratings. Sit-coms about family and friends were also popular, such as “The Golden Girls,” “Cheers,” “The Cosby Show,” “Family Ties,” and “Growing Pains.”
A health scare, later identified as HIV/AIDS, was spreading across the world in the early 1980s. At that time, no one knew how HIV/AIDS was contracted. Some believed they could contract HIV/AIDS from their dental offices. By 1985, OSHA provided recommendations for infection control. In 1988, OSHA mandated changes in sterilization and personal protection equipment (PPE). Gloves, eyewear, and a mask were now required while providing dental treatment.
The hygiene buzz of the 1980s:
- The first edition of a new magazine for dental hygienists, RDH, was published in 1981.
- HIV/AIDS identified, 1981.
- Caps no longer worn. Pinning ceremonies replaced capping ceremonies.
- In 1988, the John O. Butler Company was acquired by Sunstar, Inc.
- First home bleaching kit becomes available, 1989.
Average fees among general practitioners (1982):
Average fee Service
$15.00 Dental hygienist’s average hourly wage
$10.14 Cost of two bitewing radiographs
$ 32.63 Cost of full-mouth series of radiographs
$ 22.41 Cost of adult prophylaxis
$ 9.68 Cost of periodic oral evaluation
Happenings and hygiene in the 1990s
The 1990s were characterized by advances in technology and medical science. Cloning a sheep named Dolly as well as breakthroughs in stem cell research sparked moral and ethical debates. Genetic engineering became a reality for many U.S. crops, and by the late 1990s it is estimated that more than 100 million acres of crops were planted using genetic modifications to help make crops resistant to insecticides and herbicides.
Technology such as the Internet and cell phones went from a small business in the early 1990s to a booming business by the late 1990s. The first Harry Potter book was released in 1997, with six more books and movies to follow. Other events that shaped the 1990s include the Gulf War, which brought our troops to the Middle East.
Musical groups that topped the billboard charts in the 1990s included U2, Counting Crows, Red Hot Chili Peppers, and Dave Matthews Band. Top billboard songs included “Vision of Love” by Mariah Carey, “I Will Always Love You” by Whitney Houston, and “It’s All Coming Back to Me Now” by Celine Dion.
The show “Seinfeld” topped the charts as the number one show of the 1990s, running for nine seasons. Legendary shows such as “The Cosby Show,” “Cheers,” and the endearing “Johnny Carson Show” all came to an end in the 1990s. The reality show “Survivor” and “Friends” both debuted in the 1990s.
The hygiene buzz of the 1990s
- The format of the National Board Exam added a case-based section in 1998.
- Added functions for dental hygienists were legalized in response to a need for access to care.
- Ultrasonic use becomes routine in dental offices.
- Teeth whitening and esthetics gained tremendous popularity.
- AmyRDH.com was founded in 1999.
Average fee among general practitioners (1995):
Average fee Service
$18.00 Dental hygienist average hourly wage in 1995
$19.89 Cost of two bitewing radiographs
$62.25 Cost of full-mouth series of radiographs
$44.55 Cost of adult prophylaxis
$20.82 Cost of periodic oral evaluation
Happenings and hygiene in the new millennium
At the turn of the century, Y2K passed without incident. Fears of computer glitches and possible chaos are replaced with debate over the presidential election between Vice President Al Gore and challenger George W. Bush. Disputed votes in the state of Florida caused the presidential election results to be delayed for a month. Meanwhile, the dotcom industry plummets while the computer virus “ILOVEYOU,” which spread via e-mail, shuts down computers worldwide.
On the hygiene scene, digital radiography gains popularity. The number of states allowing dental hygienists to administer local anesthesia increases. Although the term plaque has been used for years, the new buzzword in hygiene is biofilm.
The hygiene buzz of 2000 through 2009
- Patient demands are high for esthetic services such as veneers and whitening products.
- Private offices address concerns over heightened latex sensitivity, and more nonlatex products become available.
- New products for dentinal hypersensitivity come to the marketplace.
- More private offices offer digital radiography.
Current happenings and hygiene 2010
Hygienists today have many more treatment options to offer patients than in years past. Not only can we offer several choices for pain control, both in-office and take-home, but we can provide several nonsurgical techniques for periodontal therapy that were not available to early hygienists. For example, after scaling and root planing, we have the option to irrigate periodontal pockets with liquid chlorhexidine, administer localized chemotherapeutics such as doxycycline gel, the chlorhexidine chip, or minocycline microspheres. Also, hygienists are learning to use soft-tissue lasers as an alternative to nonsurgical periodontal treatment.
In addition, today’s dental hygienists are permitted to do more functions than ever before. Do you know what’s allowed in your state? Currently certain states allow hygiene functions based on supervision levels. To see currently permitted functions and supervision levels for dental hygienists by state, go to www.adha.org. Click on the “Governmental Affairs” tab on the left side, then click “Practice Issues.”
Here is a description of the supervision levels allowed:
Direct supervision — dentist needs to be present
General supervision — dentist needs to authorize treatment or services prior to treatment or services being rendered, but dentist presence is not required
Direct access supervision — hygienist can provide services as she/he determines appropriate without specific authorization.
For example, many states have passed legislation to allow registered dental hygienists to administer nitrous oxide under direct supervision. In addition, in some states, hygienists can perform certain functions under either general supervision or direct access supervision, depending on whether the hygienist is in a private setting or public setting.
20/20 hindsight: Would you do it again?
After all is said and done, would you go into dental hygiene again? According to the survey conducted by Sunstar, an overwhelming 69% of hygienists said yes, despite the frustrations, they love their profession and would do it again.
A rewarding career choice? What is your greatest achievement in dental hygiene? Your first reaction may be to think of one event or one award or achievement for which you were recognized. However, you may be surprised at what your fellow hygienists reported as the top five achievements.
- Improving and positively affecting patients’ health
- Mission and community volunteer service
- Listening to my patients and learning from them
- Oral health education and oral cancer detection
- Educating the dental professionals of the future
If you could change one thing, what would it be? According to the recent survey, “If you could change one thing in the dental hygiene profession, what would it be?” the survey respondents reported:
37.3% Improve access to care
25.0% Autonomy, independence, self-determination
23.0 % Paid benefits (medical, disability, vacation)
9.5 % Salary
3% Other *
* Other — Includes requiring a minimum of bachelor’s degree for entry level, increased respect from the dentist, national licensure vs. state-regulated license.
A glance into the future
Some of the most exciting medical advances and research will allow dental hygienists to expand their scope of practice in the clinical setting, as well as open new doors of opportunity in teaching and research. Below are the advancements taking place now and expected in the not-too-distant future.
- Saliva test to determine markers for periodontal disease, heart disease, and some cancers
- Chairside blood testing as a screening tool for:
- C-reactive protein (an inflammatory marker produced by the liver) which can indicate heart disease and other inflammatory diseases
- Heart disease
- Independent practice legislation in certain states to treat the underserved and rural communities
- Paperless, all-digital office
- Working without supervision, allowing autonomy/self-determination
- Advanced practitioner license
In addition, more opportunities exist for careers in dental hygiene outside the private office setting. Access to care has created opportunities in several states for public service in rural areas and long-term-care facilities. Collaborative practice agreements in Minnesota and New Mexico, limited access permits in Oregon, and public health endorsements in Nevada and Maine are making inroads to the access to care dilemma.
Opportunities exist in both teaching and research for those who obtain post-secondary degrees. The Advanced Dental Hygiene Practitioner license, obtained with a master’s degree, will allow dental hygienists to provide midlevel oral health care such as minimally invasive restorations and limited prescription authority, in addition to oral hygiene education and routine hygiene services.
Yes, Virginia, there is a Santa Claus. As a profession, dental hygiene has moved forward aggressively and has made significant progress. Too often we are influenced by the negativity that makes headlines and causes us to be skeptical about our future. However, if history and a strong belief in our cause are indicators of the future, there is no need for skepticism. Climb aboard and support your profession’s endeavors! Santa Claus will be checking his list.
Laurie A. Milling, RDH, BS, attended Purdue University where she received her B.S. in financial management. She worked as a technical writer as well as a software designer and tester in the financial field for 20 years, researching and writing manuals and other technical assignments until returning to dental hygiene school in 2005. She has been a practicing dental hygienist since graduating in 2007. Milling is the current president of the West Suburban Dental Hygiene Society, has served as a student advisor to ADHA, and is currently a delegate to the Illinois Dental Hygiene Association.
- Brown LV. Dental procedures and fees 1975 through 1995: How much have they changed? Journal of the American Dental Association, 129:1291-1295. Retrieved May 4, 2010 from Worldcat.org: http://jada.ada.org/cgi/reprint/129/9/1291.pdf.
- Danner V. Looking back at 75 years of the Journal; former editors reflect on their time with the Journal. Journal of Dental Hygiene, Winter 2002; 76(1):10(4). Retrieved April 22, 2010, from Academic OneFile via Gale.
- Dental hygiene program education statistics. Education and careers (education). Nov. 2009. Retrieved May 5, 2010, from American Dental Hygienists’ Association Web site: http://www.adha.org/downloads/edu/dh_program_stats.pdf.
- Gladstone R, Garcia WM. (Nov 2007). Dental hygiene: reflecting on our past, preparing for our future. Access, 2007; 21(9):12(9). Retrieved April 22, 2010, from Academic OneFile via Gale.
- Hagerman J. Controlling the stress of change. RDH, 2003; 23(6): 76. Retrieved from Academic Search Premier database.
- Local anesthesia administration by dental hygienists state chart.
- Governmental affairs (practice issues). Retrieved April 22, 2010, from
- American Dental Hygienists Association Web site: http://www.adha.org/governmental_affairs/downloads/localanesthesia.pdf.
- McCombs GB, Gadbury-Amyot CC, Wilder RS, Skaff KO, Green ML. Dental hygienists’ contributions to improving the nation’s oral health through school-based initiatives from 1970 through 1999: a historical review. Journal of Dental Hygiene, Spring 2007; 81(2)p.NA. Retrieved April 22, 2010, from Academic OneFile via Gale.
- Motley W. Founding the dental hygiene profession. History. ADHA 75th anniversary scrapbook. Retrieved April 22, 2010, from American Dental Hygienists’ Association Web site: http://www.adha.org/downloads/history/part1.pdf.
- United States Postal Service, history, significant dates. Retrieved April 22, 2010, http://www.usps.com/postalhistory/significantdates.htm.
- Methods of charging and the fees charged for dental hygiene services in traditional and nontraditional settings. Journ of Dent Hygiene, Mar 1990; 64(3):144-9.
- Journal of Dent Hygiene, Jan. 1990; 64(1)40-4 “Economics of ...” The economic contribution of dental hygienists’ activities to dental practice: review of the literature.
Trivia tidbits of the 1960s
- $5,315 was the average income in 1960.
- $5,500 was the average annual salary for the dental hygienist in 1965.
- $12,700 was the average cost of a new house.
- $2,368 was how much you needed to buy a new Mustang.
- 25 cents could buy a gallon of gasoline.
- 4 cents was cost of a first-class stamp.
Trivia tidbits of the 1970s
- $9,350 average income in 1970.
- $7,000 average annual salary for a full-time dental hygienist in 1975.
- $23,400 average cost of a new house.
- $3,869 cost of a new Datsun 210.
- $.36 a gallon of gasoline.
- $.06 cost of a first-class stamp in 1970. Increased to .08 cents in May, 1971.
Trivia tidbits of the 1980s
- $19,170 average income in 1980.
- $29,160 average annual salary, full-time clinical dental hygienist in 1985.
- $68,714 average cost of a new house in 1980.
- $7,570 cost of a new Camaro Coupe in 1980.
- $1.19 a gallon of gasoline 1980.
- $.15 cost of a first-class stamp in 1980.
Trivia tidbits of the 1990s
- $28,970 average income in 1990.
- $36,082 average annual salary, full-time clinical dental hygienist in 1995.
- $123,000 average cost of a new house in 1990.
- $15,999 cost of a new Plymouth Voyager, 1996.
- $1.34 a gallon of gasoline, 1990.
- $.32 cost of a first-class stamp in 1995.
Trivia tidbits of the 2000s
- $40,343 average income in 2000
- $51,000 average annual salary, full-time clinical dental hygienist in 2000.
- $134,150 average cost of a new house in 2000.
- $24,750 average cost of a new car in 2000.
- $1.26 a gallon of gasoline, 2000.
- $.34 cost of a first-class stamp in 2001.