What will we 'profess' in the future?

Oct. 1, 2001
Hygienists will find better ways to serve the community at large and will press on for less supervision so that our creative juices can flow.

Hygienists will find better ways to serve the community at large and will press on for less supervision so that our creative juices can flow.

The following scenario occurs periodically in my life, and I cringe every time it happens. Mr. Nerdnose approaches me after Sunday church service. He shakes my hand and says, "You're still working as a dentist, aren't you?" If it's not Mr. Nerdnose, then it's someone else, somewhere else, and I always correct them immediately and change the title from "dentist" or whatever else they think I might be to "hygienist." I ramble on in trivial conversation with the individual, but that stabbing, gnawing feeling lingers inside of me.

A couple of Christmases ago, a well-meaning relative bought my daughter, Katie, a Dentist Barbie doll. Dentist Barbie stands tall with a knockout figure, and she is wearing a white lab jacket with a name tag that reads "Barbie DDS." When you push the button on her back, the doll speaks using various phrases such as "Let's brush!" and "Great checkup!" In addition to the phrases, you can hear a toothbrushing sound and a pretty awesome water/suction sound. The Dentist Barbie Doll kit comes complete with a child patient, a dental unit including a dental light, and tiny plastic instruments including a toothbrush, dental mirror, saliva ejector, air water syringe, and a face mask. What impressed me most were the dental charts that came with the kit, which are similar to those we use for patient education.

So much for Barbie DDS. Do you think that Mattel, Inc. will ever produce a Barbie or Ken RDH? I wonder if the doll designers that work for Mattel ever thought about renaming Barbie DDS to Barbie RDH instead?

Lately, I've been scratching my head and doing some serious thinking about our profession and wondering where we are headed. How far have we really come in the practice of dental hygiene since the days when Dr. Alfred C. Fones and other dentists organized the education and training of dental hygienists? Connecticut dental law in 1915 defined dental hygienists as "women assistants" who could work in the office of any licensed dentist or in any public or private institution under general supervision. Father Fones described our work in public schools as follows:

"This work in the schools is essentially woman's work, and is a great field for the dental hygienist, to whom it opens up paths of usefulness, activity, and inspiration hitherto unheard of, allying her with the working of the world who are helping the world in masses."

In pondering this question, my mind takes me to different sources for exploration and analysis. Follow along with me, if you're interested, and maybe we can reach some conclusions or perhaps raise even more questions about our chosen profession.

The word "profess" means "to lay claim to" and often refers to a branch of advanced learning. Leaders in dental hygiene have certainly worked tirelessly to establish our identity since our genesis in the early 1900s. Dental-hygiene researchers have created an impressive database upon which we can build intellectually. True professions, I believe, are both an art and a science, and dental hygienists all over the world are artistic and intellectual. Artistically, dental hygienists are deeply engaged in society's burning health-care issues. Intellectually, they are involved in imaginative problem-solving and inventiveness, forever looking for new technological approaches to the services they deliver.

Professionalism is not always viewed as a good thing. George Bernard Shaw wrote "all professions are conspiracies against the laity." In Daniel Patrick Moynihan's book on U.S. social policy, Miles to Go, professions are described as large bodies of professional persons who have taken on themselves the concerns of only a small percentage of the population that is outside the mainstream of American prosperity. Moynihan asserted that organized professions are traditionally poor at involving their members in helping the poor. Instead, he said, we spend a lot of time protecting our own selfish interests.

Dental hygienists know this to be particularly true of some dentists, whose professional associations have fought us repeatedly and unceasingly as we have tried to expand our services and regulate our own profession. Our leaders cry out repeatedly that we are sick of our ancillary role as a vocation that supports dentistry. We still are in bondage in most states because we still are controlled by boards of dentists. Self-governance and the ability to accredit our own educational programs are still pipe dreams. Our legislative bodies, the ADHA and our constituencies, are like soldiers in reserve waiting to empty our forces behind enemy lines.

One of the most thought-provoking addresses on professionalism that I've ever read was given by Lynn Jones, a dental-hygiene educator. Her address was presented to the Ontario Dental Hygienists Association in Toronto in 1979. The title of her address was "Dental Hygiene As a Female-Dominated Semi-Profession." Her presentation reflected much of her research that had been done as a master's degree requirement, which involved a comprehensive review of legal history and the sociological status of hygienists in the province of Ontario. In her analysis of existing professions of law, medicine, and the church, she revealed the following seven characteristics of a "true" profession. Details about the characteristics are listed in the accompanying box.

Lynn concluded that the first characteristic (lack of autonomy) is missing in dental hygiene, and thus differentiates dental hygiene from other aforementioned professions.

As we have now passed into the new millennium, where are American hygienists headed as a profession and should we be optimistic about our future? As the eternal optimist, I believe that our greatest strength is perseverance. As Henry Wadsworth Longfellow once said, "If you only knock long enough and loud enough at the gate, you are sure to wake up somebody."

Yes, dental hygiene still is a female-dominated profession. Women increasingly spend more time in the workforce; therefore, female dominance should work for us, not against us. Hygienists today and in the future will continue to find that dental practices, based on their structural limitations, will restrict opportunities for advancement. Therefore, the artistic and intellectual side of hygienists will continue to develop at full speed.

Hygienists, I believe, have a stronger sense of professional commitment than ever before. Hygienists will find better ways to serve the community at large and will press on for less supervision so that our creative juices can flow. A large percentage of hygienists who suffer from "burnout" — caused by structural limitations in dental practices that limit their chances of promotion — are becoming entrepreneurs. We read about them every month in RDH magazine and marvel at their ingenuity.

Intellectually, too, we have worked together in our national, state, and local associations on imaginative problem-solving and research. These gatherings involve vigorous group discussion and debate. Just as nurses have matured in their profession, so will dental hygiene associations expand in the future. We're overdue for new associations that focus on specialty areas such as the prevention and treatment of periodontal diseases, (perio-hygiene), gerontology (gero-hygiene), special needs patients, and pediatrics (pedo-hygiene). I predict that these new associations will emerge in the near future as our database for dealing with these patients continues to grow.

I think it is fair to say that we still are evolving as a profession and that we are a lot closer to our goals than we were 20 years ago. Here's the prescription I would write to help us reach them:

  • Remember our roots, but don't dwell on the past.
  • Enter the new and varied millennium with a pioneering and intellectual (problem-solving) spirit.
  • In the words of Walt Whitman, "Never must we be divided; in our ranks, we are united."

Lynne H. Slim, RDH, MS, is an assistant professor at Clayton College and State University in Morrow, Ga.

Seven characteristics of a profession
The characteristics below were proposed by Lynn Jones and were originally published in a 1979 issue of L'Hygieniste Dentaire Du Canada.

  • Autonomy, self-regulation, and self-control are characteristics that are expressed in the following ways:
    • Access to the profession is controlled through certification and licensing requirements.
    • Boundaries of their special sphere of activity or competence are defined (a form of monopoly).
    • There is resistance to supervision, particularly by someone from outside the profession.
    • Professionals are disinclined to criticize one another publicly, as well as have a preference for dealing privately, rather than publicly, with members who may deviate from approved ways of behavior.
  • Professions are related to the central values of society. For example, law and medicine are related to such basic values as justice and health. Professionals are often concerned with matters of life and death.
  • There is a systematic body of theory and esoteric, abstract knowledge. The professional's claim to expertise rests upon his presumed mastery of the body of knowledge.
  • The training period involves extensive study of highly specialized knowledge, with a strong emphasis on acquiring the ability to manipulate ideas and symbols rather than (but sometimes in addition to) things and physical objects.
  • Professional groups emphasize the primary goal of service to clients and public as a part of their ideology. Self-interest and the desire for monetary gain are not the desired norms. An expression of this factor can be seen in the Canadian prohibition against advertising among physicians, lawyers, and dentists. The implication is that the professional's dedication to his calling and concern for his client preclude the possibility of self-serving behavior that might be to the detriment of the client.
  • There is a strong commitment of members to the profession and a tendency to view the work as a long-term, if not a lifelong, commitment.
  • The professional community has a sense of common identity and common destiny, as well as the possession of a distinctive culture. These shared values and norms may extend to control of nonwork life as well and influence choice of leisure-time activities, political orientations, and interpersonal relationships.