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Generation Gap

June 1, 2001
Hygienists from the 1950s, 1970s, and 2001 chat about what happened in the last 50 years ... as well as what will happen.
Two generations pose for a photograph (from left to right): Holly Bock, Jennifer Donovan, Mary Lou Kinsey, Julie Gage, Pam Arnold, and Lisa Arnott. The in-between generation, represented by the author, took the photo.
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Mary Lou Kinsey of East Liverpool, Ohio, is a woman to whom the profession of dental hygiene has been very good. Hygiene provided her with a living when she desperately needed it, gave her a purpose in life when she wondered what to do with herself, and is sustaining her even in retirement. In 2000, she celebrated her 50th year as a hygienist and is still going strong.

Gage and Bock listen to Kinsey describe a 1950s hygiene operatory.
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After graduating in 1950 from Ohio State University, she went to work for her future father-in-law, Dr. Collin F. Kinsey, in her hometown of East Liverpool. Two of Dr. Kinsey's sons, C. Marvin and Jay, were also dentists there, and another son, Dale, was the office's lab technician. Mary Lou married Dale, and the couple happily began their lives together, having two daughters and building their dream home. Tragically, Dale died after only seven years of marriage.

In all, Mary Lou worked 25 years for the Kinseys, and another 24 for their successor, Dr. Lee Swearingen. Now, at age 72, she does temp work one or two days a week. She believes working keeps her young. "When you quit for good, you just kind of fold up. I think everyone should keep working as long as possible. I feel if people quit working when they don't have to, they get old before their time. This has kept me young. Someone asked my daughter just the other day how soon I was going to be 60."

Recently, Mary Lou and I went to West Liberty State College (my alma mater) in West Virginia to talk to an enthusiastic group of second-year hygiene students. Carol Frum, the program's director, very kindly arranged the meeting. The students were Holly Bock of Moundsville, W.Va.; Julie Gage of Cambridge Springs, Pa.; Jennifer Donovan of Pittsburgh, Pa.; Pam Arnold of Toronto, Ohio; and Lisa Arnott of Monaca, Pa.

As a 1974 graduate, I represented the bridge between the two generations. Our discussion made it clear that the more things change in hygiene, the more they remain the same.

Bock: What's the biggest change you've seen in hygiene?

Kinsey: Well, first of all, I think it's the way offices are run nowadays. Most offices do not have big, round cuspidors. And we didn't wear gloves or masks. Everything was scrubbed and put in cold sterilization. At that particular time, there wasn't such a thing as AIDS that we had to worry about.

Seckman: No one even thought about tuberculosis and hepatitis being transmitted in a dental office?

Kinsey: No, of course not. And we were dressed in uniforms - no pants. No scrubs; we didn't even know what scrubs were. We usually wore our caps. I got tired of mine falling off and hitting the light, so then I quit wearing it.

There was a nervous pause. The students were a little shy at first about asking questions. I'd prepared some sample questions, and Mary Lou referred to those to get the conversation going again.

Kinsey: I was just looking at the questions here. Yes, we did give fluoride treatments, but we painted it on. We used unflavored stannous fluoride. As far as polishing, it was dry pumice. No flavored paste. We just wet it from the water syringe.

I don't know whether you girls have seen anybody with green stain? Well, you know it's hard to get off. I'd use pumice and put a little bit of iodine with it, and it did the job. Of course, we had belt-run engines, and we didn't have Cavitrons. And, yes, I used to get my hair caught in the belt.

When I started, I was the first hygienist in East Liverpool. My employer eventually became my father-in-law. When I graduated and got my license, he had cards sent out introducing me to his patients. When the patients came in, they weren't surprised.

I knew a lot of people because I was raised there. So they accepted me very, very well with the exception of one man. He just refused to let me work on him. So Dr. Collin said, "Well, we'll humor him and I'll go ahead and do his prophies." When Dr. Collin died, my two brothers-in-law, Dr. Marvin and Dr. Jay, refused to clean his teeth. They said, "No, she's here to do it, and she's going to do it." So the man relented, and we became pals after that.

The laws were a lot different back then, you know. The dentists would go away, and when they did, I'd still work. Cathy, I don't know if this should be off the record or not.

Seckman: I don't think we'll talk about that.

Kinsey: Well, I think it would be interesting for the girls to know.

Seckman: OK. Was it illegal then?

Kinsey: If it was, we didn't know it. I packed dry sockets, I recemented crowns, and I even put a filling in for my brother-in-law. And there wasn't such a thing as an AQP or an EFDA then. So I've done a little bit of everything.

Why am I still working? I guess it's because I've worked so long, I hate to give it up. By temping, this way if I have something I have to do or want to do, I just don't accept the assignment. But it's nice to meet new people. I guess it's just in my blood.

How did I become a hygienist? Originally, I wanted to be a nurse because I like surgery. My dad said, "You don't want to do that dirty job. Why don't you go to OSU and see what else you can find?"

I really did want to go, so I did, and while I was there I kind of scouted around to see what I could find in the medical departments. I heard about dental hygiene, so I went over and checked into it.

I had known the Kinsey family since I was a little girl, so, when I got home, I went to see Dr. Collin. I talked with him, and he thought dental hygiene was a great idea. He wrote a letter to help me get into the program, and he said, "When you finish, you'll have a job here." So I came back to East Liverpool after college. And that's the story of my life, or part of it.

What about you girls? Jen, how did you get interested in dental hygiene?

Donovan: I always liked going to the dentist. My cousin was my dentist and I was kind of lucky there. I thought, do I want to be a teacher or a hygienist? I thought, oh, with hygiene I can work with kids and I can clean teeth. I'm kind of weird; I like teeth.

Kinsey: Well, we all like teeth; everyone here does.

Donovan: People at home are always saying, "Why do you like teeth? That's strange; nobody likes teeth."

Arnold: I always liked to get my teeth cleaned. When I was getting ready to go to college, my mom said there were a lot of ads in the papers for dental assistants, so I ended up going to assisting school. Then I did the expanded-functions program. Then I decided I wanted more. The money's more, and it's more rewarding because you get to do your own thing, and not just, you know ...

Seckman: Assist.

Arnold: Right. Assisting gets really boring.

Arnott: Like you, I wanted to be a nurse at first, then I took a shadowing program at school. They took a couple of us to a dental office in my junior year. Then I applied to dental hygiene programs and got accepted here. At home, whenever people ask me what I go to school for, they say, "Why do you want to do that?"

I think my mom and dad - they're not sick of it - but whenever I go home I ask, "Did you floss today?"

Gage: When I was in 10th grade, they wanted us to research a career, and I didn't know what I wanted to do. My aunt is a receptionist in a dental office, and she said, Dental hygiene has really good pay. It's a two- or four-year program. Just check it out."

I got really interested because my teeth are like - I don't know, I guess I'm really weird about it too. I thought it seemed like a good thing, because I want to be a mother, work, and do all that. I thought I'd be really interested. I came down here and saw the clinic, talked to Mrs. Frum quite often, and I'm real glad I chose this profession.

Bock: It's kind of odd how I ended up in hygiene. When I was in school, I wanted to study biology. I grew up on a farm so I wanted to be a vet or go into science. But I didn't want to go to school for eight years. I had braces, put so much money in my mouth. Some people don't even care about their teeth like they should. I think then I realized that I wanted to let other people know how important it is to take care of your mouth and your teeth. Because it's so important to me, I want it to be better for others.

Kinsey: Well, things really have changed, like when you take X-rays, for instance. I guess you stand behind screens here. I've held many an X-ray in a child's mouth in order to get it. So far, I've still got all my fingers. They're not glowing either.

It's really remarkable, the big changes that we've had.

Donovan: Like HMOs and stuff. Have you seen a big difference?

Kinsey: With the insurance? Well, a lot of people today wouldn't have a lot done if they didn't have insurance. If they're told they need a crown or a bridge, they'll say, "I just can't do it." And you'll have to go the best route without. What we tell them is just keep your regular checkups, keep them nice and clean, do your home care, and try to preserve what's there.

Donovan: Does the dentist ever say, "Well, we can cut you a break; we can let you ... ?"

Kinsey: Well, years ago, there wasn't such a thing as insurance.

Donovan: That's what I mean.

Kinsey: At the office I worked in, they could pay so much down, so much a month. So we had a lot on the books, but most people were very good about paying. Of course we had the mill, Crucible Steel up in Midland. When they came up with insurance, all of their employees were very happy, because there were a lot of them who went to the dentist who couldn't go before. Couldn't, or wouldn't - I don't know which it would be. It makes a difference. It makes a big difference, especially the way work is sometimes.

Arnold: Is there a difference in the number of patients you see today, compared to the number you saw back when you first started?

Kinsey: No, same amount. We book them about every 45 minutes - for a child, maybe half an hour. I'd see maybe 10 patients a day. We started at 8:30 in the morning and we were lucky to get out by six. And we were lucky to get out at lunchtime. Now, in temping, it seems like wherever I've worked, we get out for lunch. And if you book a five o'clock, you're out at six. If you book a four o'clock, you're out at five.

When I graduated, we didn't have the, oh, my mind went blank. That's known as a senior moment, girls.

Seckman: Boards?

Kinsey: National boards, that's it. I graduated in 1950, and in 1964 I went back to Columbus and took the national board.

Seckman: Fourteen years later? Why did you do that? Did you have to, or did you want to?

Kinsey: I wanted to. By then, I had relatives in California. So I went traipsing out to California and took a board out there. Now out there, you had to do both - clinical and written. Then my brother was living in Georgia, and I went to Georgia and all you had to do there was clinical. They accepted the national board.

And some of the students who were there taking the national board said, "What do you want to take it for?" Well, I wanted a license.

They said, "Oh, we're so worried about taking it!"

I said, "You shouldn't be; you just graduated." So I got the licenses anyway.

Seckman: Wow. After so many years out of school.

Kinsey: Well, I worked full-time all that time. I think working had a lot to do with my success.

Gage: What about preceptorship down south? How do you feel about that?

Kinsey: What's this, now?

Gage: When they just bring people in off the street and train them to clean teeth. You have to be an assistant for six weeks or something?

Seckman: She's talking about in-office training for hygienists.

Kinsey: Oh, I didn't know anything about it.

Gage: They can just hire somebody, and they don't have to go to school. It's called preceptorship.

Kinsey: Ew! I wouldn't want that.

Seckman: The dentist is responsible for seeing that you study and teaching you to scale and polish, and then if you can pass the test, you're a hygienist.

Kinsey: Oh, dear.

Seckman: Is that only in Alabama?

Students: Right now, yeah.

Kinsey: I've never even heard about it.

Arnold: They can only work in Alabama. They can't just go anywhere.

Kinsey: Hmm. Well, I hope it doesn't become a trend.

Arnott: What's your favorite part of the hygiene profession?

Kinsey: My favorite part? Well, I don't know that I have a favorite part. Nowadays, so many of the patients take such good care of their teeth that when you're doing your prophies and things, there's not much there, unless they have some periodontal problems.

But I had a patient the other day, and I just did a gross scale because he had so much calculus. I had to use the Cavitron to blow it off of there. And I hadn't had a patient like that for a long time. Used to have a lot.

I felt kind of good. It feels like you're really helping somebody when you do that. Of course he's going to come back for deep scaling, maybe some periodontal work. The calculus was just bridged, especially on the lower, and I hadn't seen that for a long time.

Most patients who come in every six months really take good care of their teeth and floss. They just don't get a lot of buildup. This was something different. After I was finished with him, I gave him a mirror. He ran his tongue around there and said, "Oh, my!"

I said, "Now you can feel your teeth." He was a good patient, didn't complain. Once in awhile I get someone like that, and you feel like you're really helping.

Bock: I think that's the best part. Our clinic is, you know, not as expensive as a regular office. But the appreciation we get from the patients makes us feel good. We can teach them so much they don't know. You just make a difference for them, and it really makes me feel good.

Kinsey: Ads on TV about taking care of your teeth have helped too, as far as the general public is concerned. When I started, there was very little TV exposure.

Gage: Do you ever regret becoming a hygienist?

Kinsey: Well, there are days when I ... yes, I'd be telling a story if I said no. Especially when you get a real nasty patient. And you get them. All you want to do is be done, and get them out of there.

But most of the time, though, it's fine. It came in handy for me because I had two babies to support, and I could cut back after they got older. I could even take care of my daughters' teeth.

Holly, you said something about the clinic and what people could afford. Is it $6? When I started working in 1950, that's what the prophies were. So, you see, it's come a long way.

Seckman: When I started in 1974, I think it was $12 for kids and $15 for adults.

Donovan: That's how much a haircut is now! Was it difficult for you to adjust to all of the changes in dentistry?

Kinsey: They just said, this is what you do, and I did it. No, it wasn't hard. When I worked full-time, I had a Cavitron and a Prophy Jet. I haven't seen too many Prophy Jets around in the offices where I temp. I think they're great, especially for stain. Have you girls used that?

Students: No.

Kinsey: Have you learned to put in sealants?

Students: Yes.

Kinsey: See, I didn't learn that in school. I learned it later. They didn't offer sealants then. I've learned a lot, believe me.

Bock: Because we work with our hands, have you had any problems with carpal tunnel or anything like that? Do you think it's just a matter of using the right hand movements in your wrists?

Kinsey: I really don't know, Holly. I've never had any real trouble. Once in a great while maybe my hand would cramp a little bit if I was working with a difficult patient. Because before the Cavitron you just got down in there with a scaler, and it took strength to get that out.

Back in 1983 or 1984, my hands started to break out and we were using this sterilization stuff called gluteraldyhyde, and it was really potent. In fact, I learned later you weren't even supposed to breathe it.

But my hands started to break out and itch. In order to work, I had to wear cotton gloves and put rubber gloves over them. This was before anyone wore gloves, so I had to find them, and that was a hard thing to do.

My hands still break out once in awhile, and I still wear cotton glove liners because if I don't, my hands perspire and start to itch. The whole problem went on for probably five or six years.

Bock: That would be scary.

Kinsey: Mmm-hmm. It was awful. I was so embarrassed, when I'd go somewhere I'd sit on my hands to hide them. What kind of gloves do you use here?

Students: We use powderless.

Arnott: I use nitrile.

Arnold: That powder drives me crazy; you get it all over the place, on your scrubs.

Do you ever talk to any of the girls you graduated with? Do any of them work around here?

Kinsey: No. There was one I graduated with; her husband was a dentist in East Liverpool. I talked with her once in awhile, and she'd say, "I want to work, but he won't let me. I'd just like to go in a day or two a week."

Gage: Was it a big change when you were in Columbus to come back and work in a small town?

Kinsey: At that time, no, because Columbus wasn't a big city. I go there a lot now, because I have a daughter who lives there. She graduated from Ohio State.

Gage: Is she a hygienist?

Kinsey: No, but I have a niece who's a hygienist and a nephew who's a dentist.

Gage: Were you an influence on her?

Kinsey: Yes, that's why she's a hygienist. She always told everybody she chose that because her Aunt Mary Lou is a hygienist. Her father and grandfather were dentists.

Arnold: Do you think it was different going to school at Ohio State because there were dentists there too? Did you ever have to help them out?

Kinsey: Yes, I did, because I had been working as an assistant during the summers. I'd mix fillings and so forth for the students. Of course, we didn't have composites, just amalgam, gold, and so forth.

Arnott: What advice do you have for a hygienist just starting out?

Kinsey: Be very accommodating to your patients. Be friendly. After awhile you get to know them and you get to know their families, especially if you stay in the same office. Just be yourself. I can't really think of anything else. How about you, Cathy?

Seckman: I always say that my favorite part of dental hygiene is talking to patients. I do hop around a lot. Mary Lou has worked in two offices, except for temping, and I've worked in 10 or 11.

But I stay several years and get to know people. I see the little three-year-olds come in, and pretty soon they're 10 years old. That's part of it, to make friends with your patients. Then you find out where they go on vacation and you know what their hobbies are, and it's like seeing an old friend once every six months. That's the best part of it, really. Just enjoy it.

Kinsey: And the more you talk - and I talk a lot - especially to the ones I don't know as well. It relaxes them. If you talk with them and try to find something they're interested in, first thing you know, every chance they get, they're talking back. With some of them, you have to wait until you get a chance to get in their mouth to work.

There's a good future and a lot of work satisfaction in hygiene.

Seckman: Let's discuss that for a minute. How do you girls see the future of hygiene? How do you see yourselves in it? What are you going to do in the future? Do you think you'll be a hygienist when you're 50?

Bock: There's always going to be a need for it, obviously. Our teachers tell us now the age rate is so much higher of everyone having their natural teeth. That just means more patients for us. I think there's always going to be a definite need for hygienists.

Seckman: Do you think the profession is going to change a lot? Do you think hygienists will have more power over their profession?

Gage: I think if more hygienists get involved and are more knowledgeable about what's going on, yes. We might have a little bit more say, even be in control of our own profession. In the future, people need to stay more involved and fight for what we want. We've talked about it before in class. If we want things to happen, we are going to have to get involved with our profession and make a stand for what we want.

Kinsey: What do you want?

Gage: No preceptorship. Probably to be in control and be able to say what an associate's degree can do, what a bachelor's can do, because now we have no control. Everyone from associate's to master's has the same pay, because we're controlled by a different profession. We're the only profession out there that doesn't set our own standards. Someday we need to change that.

Seckman: Do any of you want to be self-employed?

Students: No.

Donovan: I wouldn't want all of the headaches. If I wanted that, I'd be a dentist. Do you think that, if hygienists could open up a separate clinic, they would actually get all the patients? Patients have to have hygiene care, but they also need dental care. Patients aren't going to want to go to two different offices.

Arnott: If people went to a clinic just to get their teeth cleaned, they might think that was all that was necessary. Like in our clinic, when we tell them this doesn't take the place of a visit to their regular dentist, they just kind of shrug it off. If it doesn't hurt, why go?

Bock: They come back with the same carious lesions six months later. I think the dentist, hygienist, and assistant are all a team. No one could do it without the help of the other.

Donovan: But the other thing is, why can't we go into nursing homes? Why can't we go into schools? Those kinds of things are important. Why can't we do that?

Kinsey: I used to go to a hospital and clean a Parkinson's patient. And that isn't easy, believe me.

When I started working, we stood up. We didn't sit down. I didn't start sitting down until my legs started bothering me. Then I told the doctor to get me a stool. I think that was in 1985. Sometimes you have a patient who can't be put back - they have a heart condition or something. I had one the other day and got a backache. I didn't realize what a difference a stool makes - how much easier it is.

Bock: You didn't sit down at all?

Kinsey: Oh, no, never. You girls will be standing up, too, one of these days, when you have a patient who requires that.

Donovan: I had to stand up with a little kid once, and it was tough, trying to see.

Kinsey: You tell a person who has a 15-month-old child, and the parent is trying to brush their teeth, "Lay them down. Lay them down on the bed, or the floor if you have to. It's easier."

I had a patient who was a veterinarian, and I took my schnauzer to him, and he used to say, "Are you cleaning this dog's teeth?" I'd say no, and he'd say, "Well, they're clean."

Donovan: My lab, when I say it's time to brush your teeth, she'll get really excited and run downstairs. But I just think she likes the toothpaste because it's chicken flavored. I try, but she just licks it off the toothbrush.

Bock: Cathy, I notice you're left-handed. I am too. Do you work left-handed? I just wonder if most offices can accommodate that.

Seckman: When I came to school here in 1972, they made us learn right-handed, because Miss Faivre said no dentist would turn his chair around for a hygienist. And I don't think it was any harder for me than it was for the right-handers, because we were all awkward at first with the instruments and working in a mirror.

I just learned to do it right-handed. And I like it, because I can walk into any office and not worry. I move around a lot, and I do temp jobs, and I never have to worry about it.

Now, they just let you learn either way. I think you're handicapping yourself when you can only work left-handed. But then, on the other hand, offices are a lot more modular than they used to be, and it's easier to rearrange things.

Arnold: Mary Lou, when you were working, you said you were full-time, so did you have medical benefits under dentists whom you worked for? Because that's what I'm afraid of, that I'm not going to get a full-time position, that I'll have all these part-time ones. It seems like a lot of dentists don't offer benefits, and that worries me.

Kinsey: Well, when I was working full-time, I had health insurance. Just for the last 24 years, I guess, not before that. Nowadays, even the dentists work part-time. One dentist I'm temping for is cutting back to three days a week. I guess it's a problem for you young girls.

Seckman: I've never had insurance offered to me, because I've never had a full-time hygiene job. It hasn't been important, though, because my husband has had insurance. But when you're single ... Mary Lou has been widowed for a long time, and she needed insurance.

Arnold: That's it. I don't want to have to be dependent on somebody. I just hope I'm making enough that I can buy my own if I don't have it.

Seckman: You can buy health insurance through the ADHA.

Arnold: Do you need to buy insurance to cover yourself if there's a lawsuit - malpractice insurance? Have you ever had a problem with that in any of your offices?

Kinsey: No.

Arnold: Your instruments never break off or anything?

Kinsey: Oh, I've had them break off, especially when you're working on the lower anteriors.

Arnold: That's scary.

Kinsey: Our office was on the fifth floor of the Little Building in East Liverpool, and we didn't have any air conditioning. In the summer, the windows were up, because we got a nice breeze. Of course, when you got home, your hair looked like you'd been in a war.

A friend of mine who worked with me for a long while was Dr. Collin's assistant, and they were trying in a crown - a gold crown; they didn't make porcelain then - and the window was up. When he took the crown out, it went out the window, down on Sixth Street.

June hurried down, and there she was, walking along, looking in the gutter and on the sidewalk. One of our patients came along and said, "June, what are you doing, looking for gold?" She said, "As a matter of fact, I am." She brought it up, we cleaned it, and put it in.

Gage: I had a little kid - they come in from the schools - and he's sitting there, and I'm giving him his fluoride, and I put the saliva ejector in there, and he's sucking on it.

I said, "OK, don't swallow the fluoride."

He said, "OK, I won't." I give him the saliva ejector and said, "Hold this, and when I take the trays out, put it back in."

He looks at me and swallows. There is so much fluoride in his mouth. He said he was OK. Then he walked out and threw up all over the waiting room, and one of our instructors had to clean it up.

We all had to do a mock board this semester. Some of us haven't done it yet, because we can't find patients. Arrgghhhhh!

Kinsey: What are mock boards?

Gage: A mock board patient has to meet the same criteria as a board patient. I'm hoping today that my patient will qualify.

Kinsey: When I took my Ohio boards, my patient was supposed to meet me outside the clinic, and he never showed up. I ended up running up and down the halls, and I finally found somebody.

Seckman: They had to be a certain difficulty, right?

Kinsey: Yes, it couldn't be just anybody. I found this young fellow and asked him. He said, "I'll help you if I can." I took him to the instructor who was in there and told her what happened. She just sat him in the chair, looked in his mouth, and said, "OK." I lucked out.

Bock: I think hygiene school is very, very hard, and I don't think most people realize that. When I say what I'm in school for, people say, "How hard is that, scrape a couple teeth?"

I just get so mad. And then patients don't realize how it's hurting us when they make an appointment and then don't show up. Like Lisa said, we work hard.

Kinsey: Are you all going to graduate this spring?

Bock: Hopefully! Come back and see us in May, and we'll tell you.

Kinsey: Girls, I think we've all chosen a really wonderful profession, and, as the years go by, it's going to even get better for you.

Cathy Hester Seckman, RDH, is a frequent contributor who is based in Calcutta, Ohio.

Future plans

Lisa Arnott: "Upon graduation from WLSC and pending verification of national and NERB Board results, I plan to obtain Pennsylvania and Ohio licenses. I hope to be able to remain close to my hometown in the Pittsburgh area."

Pam Arnold: "Following graduation I will move back to my hometown in Toronto, Ohio. Upon receiving board results, I plan to seek employment in a general practice. While working, I will continue to further my education. My goal is to become a dentist."

Julie Gage: "I will graduate in May with an associate degree. I am returning to West Liberty in the fall to complete the requirements for a bachelor's degree in the marketing track option available for dental hygiene. I will be seeking employment in the Wheeling area or back home in Pennsylvania."

Holly Bock: "I am graduating in May with both an associate's and bachelor's degree in dental hygiene. I will be getting married in June and plan to seek employment in the Moundsville or the Wheeling area.

Jen Donovan: "After receiving board results, I plan on moving back to my hometown of Pittsburgh and working in a pediatric office for the summer. I will then return to West Liberty to complete my final credits to earn my bachelor of science degree in dental hygiene.