Guest Commentary: Boldly pursue freedom

Feb. 1, 2001
Do we see ourselves practicing in many different settings, independent of a dentist? Or do we see ourselves functioning as 'supervised girls?'

Editor's Note: As you can read in the related article about Ms. Gatterman, Ms. Gilman was quoted as a source in the article. Ms. Gilman then wrote the comments below, which we think are thought-provoking and inspirational.

Beate Gatterman, RDH, has succeeded in accomplishing her dream. She is now the only independent hygienist in Germany with her own practice. She, along with very few others in the world, will be moving our profession out of the Dark Ages and returning us to a good starting point, our roots. In the beginning of dental hygiene - according to Dr. Alfred C. Fones' vision - we were independent. Logically, it is the only right thing to do if we want and believe in preventive oral health care. America was the birthplace of such a dream, free to be a separate profession, working in schools and other locations without dentists.

Sadly, that freedom to pursue our destiny and to find our happiness has been denied us ever since. We are denied of even the smallest part of access and freedom.

For the moment, in this race for access, the baton has been placed in the hands of one hygienist in Germany. For those who think that American hygienists may be asleep or even blinded, maybe some of us are. But most of us are simply horribly harmed and wounded.

One past president of a state dental association was even heard to say that he'd keep hygienists "on their backs, battered and bloodied." Traumatized by the system referred to as organized dentistry (with the American Dental Association at its head), as well as our political system, we fight "the cause" and have barely won a battle. The biggest issue facing us today, I think, is saving us from self-extinction by way of organized dentistry's destructive campaign. They would rather destroy us than reach out and do what's best for all.

Most hygienists, and I would hope most dentists, would truly prefer the high road. Having virtue and being assertive shouldn't be underestimated nor condemned.

Ms. Gatterman lifts us to new heights. It is so nice to see her succeed, because, frankly, there have been far too many disappointments. With organized hygienists wanting self-regulation and autonomous practices, could this vision of our future come to fruition? Will this goal of ours take another 20 years of trying to free ourselves from the grip of our employer-dentist. Shouldn't we be allowed the same freedom that all Americans have in choosing to master control over a business? (Have you noticed the tattoo artists and the piercing specialists in all the malls of America lately?)

We have a remarkably overlooked and just cause. We have licenses, attend accredited schools, receive college degrees, and become registered. Hygienists can ADPIE (assess, diagnose, plan, implement, and evaluate). Yet we are told by organized dentistry that we are not safe or fully qualified to do our jobs. It just doesn't make any sense.

How would the public be better served? Well, I believe many people would choose professional hygienists first before they would go to dentists, if they had a chance and a choice. The mouth is such a private, sensitive, and personal part of the body, and an oral prophylaxis is a lot less frightening for most of us than getting teeth filled or removed.

The reality is that hygiene issues receive insufficient attention from dental boards, even though our licensure fees contribute to this insanity. Simply put, there is a conflict of interest with dentists regulating hygienists. Hygienists should regulate hygiene issues instead of paying to regulate dentists. From my viewpoint, the most important issue at hand is that people should have the freedom to choose their own accredited, degreed, licensed, and registered dental hygienist. Not anything less.

I believe semantics not only is part of the solution, but it shades our reality. As long as we continue to use the words "unsupervised and supervised," we will be treated as children. And getting self-regulation will be twice as hard. The entrepreneurial hygienists, or independent hygienists, have been scientifically judged to have equal or better practices than their counterpart dental offices with hired hygienists. Clients who had never visited a dentist in their life were motivated by independent hygienists to seek out a doctor.

In addition, the California Health Manpower Pilot Project relating to independent hygiene practice opened the door marginally for greater access. The project, which was truly independent and lasted for more than 10 years, differs from the actual way the ensuing laws were written. The laws are excessive, unfair, and require limitations that make it nearly impossible to open a successful business. However, there are a few shining stars of success, such as Laurelyn Borst, RDH, MS and Judith Boothby, RDH. Even though all of the HMPP hygienists participated and paid for graduate school at California State University-Northridge and then graduated, of the original 45 or so participants, only 25 were "grandmothered" in. Future freestanding dental hygiene practices are not allowed by law. RDHAPs are succeeding despite these unfair dental practice acts regarding the Registered Dental Hygienist in Alternative Practice (RDHAP). Shouldn't there be an investigation into these trade restrictions?

Access is still a major concern as reported by the U.S. Surgeon General in May 2000. Let's take this vital power within ourselves, the power of our own thinking, and let's make it happen. We can increase access to oral health care and improve quality. Do we see ourselves practicing in many different settings, independent of a dentist? Or do we see ourselves functioning as "supervised girls?" Has the power of semantics created a child-like status for our profession? Or should we name our future properly and proudly with the word "independent," something America stands for and has fought and died for.

We are self-assured about our skills, but do we have the will? Do we have the will to gain control over our own professional lives, create our own authority, autonomy, and access ... or not? What is the solution? Speak up, be involved, and stand up for quality heath care!

Gail B. Gilman, RDH, BSDH, MS, is the public relations chair for the San Diego Dental Hygienists' Society and a public health hygienist for the San Diego Fluoridation Task Force. Gilman, who has been licensed for 23 years, also writes children's dental hygiene books for Bossy Flossy & Co.