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Vital to the national defense

Nov. 1, 2011
When you think of national security, dental hygiene is typically not the first thing that comes to mind;

Dental hygienists help meet oral care needs of military

by Cathleen Terhune Alty, RDH

When you think of national security, dental hygiene is typically not the first thing that comes to mind; however, dental hygienists play an essential role in meeting the oral care requirements of our nation’s military.

Military dentistry dates back to 1872 when William Saunders was first assigned to provide dental services to the cadets at the West Point Military Academy. As the size and complexity of the nation’s military has grown, so has its oral health requirements.

Dental hygienists are an essential part of the military’s dental care team.

Today the nation’s military is comprised of more than 1.4 million active-duty military members and over 700,000 reserve forces. Maintaining the oral health of service members is an enormous task. Each branch of service has employment opportunities for dental hygienists, either as a civilian, a contracted employee or as active duty military. Each has its advantages, depending on the career goals of the hygienist and the needs of each branch of the military. Service locations can be found all over the U.S. and around the world.

Hygienists in the U.S. Army

Oral care is so important that the United States Army devotes an entire command to oversee it. The The U.S. Army Dental Command, or DENCOM, is responsible for managing nearly 150 dental clinics around the world.

What comes as a surprise to many is that much of the oral care is provided by civilians. “Over half of DENCOM’s employees are federal civil servants,” said John Heath, DENCOM Human Resources Manager. “The percentage is higher for dental hygienists.”

“Our civilians are essential to operational continuity,” said Heath, “When our military members deploy, our civilians remain to ensure that local oral care needs are met. Unlike their military counterparts, civilians are not subject to employment contracts, boot camp, or mandatory relocation. Qualified providers can work at any of our facilities without having to secure additional licenses.”

Dental hygienists working for the military benefit from exceptional job security, competitive salaries, and extensive benefits. In addition to comprehensive health, life, continuing education, vacation, and retirement programs, civilians enjoy extensive morale, welfare, and recreation offerings.

As an example, civilian hygienists are eligible for special rate-subsidized resorts like the Shades of Green Hotel within the Walt Disney World complex, or the Hale Koa Hotel on Hawaii’s Waikiki Beach. They also have access to installation sport leagues, clubs, restaurants, youth programs, or special events featuring high profile entertainers.

Being one of the world’s largest dental care networks also provides technological advantages. Leading edge tools such as the Corporate Dental Application (CDA) equip hygienists with their patients’ complete oral care history from the time that they enter the service. This includes digital imagery and comprehensive information on virtually all care that has been rendered or scheduled.

“Because of the vast scope of the operations, the diversity of assignments and growth opportunities are almost limitless,” said Pam Richter, a DENCOM employee of over 34 years. Ms. Richter began her career as a chairside hygienist, advanced to a community health hygienist, and now serves as a senior member of the DENCOM headquarters staff.

“I take great pride in being able to care for our troops,” said Richter. “The camaraderie within the military is really special. You go home each day knowing that your efforts make a difference in the lives of those that are defending our nation’s freedoms.”

Additional information on the USA Civilian Dental Corps, including current career opportunities, is available online at

Dental hygiene in the U.S. Air Force

Civilian, contract, and active duty dental hygienists also serve the active duty military population for the Air Force at bases worldwide. Staff Sergeant Kristen Pool, 28th MDOS dental hygienist, was added to the Ellsworth Air Force Base (South Dakota) dental operations team in October 2010 after a year of requests. Pool is one of only 52 active duty military dental hygienists in the entire Air Force. As a result, dental hygienists, such as Sergeant Pool, are in very high demand and not all bases have them.

“To my knowledge, since we restructured from a full hospital to a servicing medical clinic, this is the first time Ellsworth has ever had a dental hygienist on staff,” said Sergeant Rhodes, NOIC of dental operations.

Prior to her arrival, service members with special dental needs were given referrals to be treated at off-base facilities. Sergeant Rhodes says he feels very fortunate that Sergeant Pool has arrived at Ellsworth.

“While an Air Force dental technician who has accomplished the Air Force Oral Hygiene Course can conduct routine cleanings for our active duty personnel, hygienists are specialists in the oral hygiene field,” said Sergeant Rhodes. “They are specially trained providers, nationally certified, and are not only able to provide routine care, they can administer in-depth advanced oral care to Air Force personnel with major or complex dental concerns. Having a dental hygienist allows Air Force dental clinics more flexibility in terms of specialty care. They bring a vast amount of knowledge and resources to the clinic. Having this local expertise equips dental leadership with a resident expert who can provide technicians with an opportunity to gain advanced knowledge and skill.”

Unlike dental technicians who are trained only to assist doctors with cleanings above and slightly below the gum line, Sergeant Pool is fully licensed with a degree in dental hygiene from St. Petersburg College, Fla., to treat periodontal disease. She is also authorized to administer local anesthesia and local antibiotics, to organize programs and give presentations for children and pregnant women about the importance of fluoride, brushing, and flossing to maintain good oral health.

“While I still work under the supervision of a dentist, I have much more professional freedom to help treat diagnosed problems,” Sergeant Pool said.

One of the most common diagnoses Sergeant Pool treats is periodontal disease. Airmen usually only require a dental exam once a year, but Sergeant Pool treats patients with special hygiene needs as frequently as every four to six months.

Due to current staffing at Ellsworth, appointments with Sergeant Pool are limited to active duty personnel. Maintaining good oral health not only improves quality of life, it also enhances mission readiness as Airmen must be cleared by a dentist to deploy.

“As the NCOIC of dental operations I am thrilled that we were able to obtain a hygienist for the 28th Bomb Wing,” said Sergeant Rhodes. “We were very fortunate to get this position, as it is such a small group of specialists who are in very high demand. This increases the scope and quality of care we can provide to our Airmen to meet today’s war fighting mission.”

The author’s experience as a contract dental hygienist in the U.S. Navy and Marine Corps

I have been serving as a dental hygiene contractor with the Navy since February 2011. I have been in dental hygiene for 31 years and I can already say this job will be one of the highlights of my career. It is such an honor to help our military achieve better oral health. I work two days per week at a naval base in Virginia and one day per week at a naval base in Maryland. My patients are only active duty military from all branches of service, so I do not see any families. Although most of my patients are Navy, I see many Marines and a few Air Force, Army, and National Guard personnel who are either working on the base or working in the community near the base. Enlisted personnel and officers come from all over the world and from all socioeconomic levels.

The facilities I work in are fairly up to date including digital X-rays and a remineralization protocol. The larger clinic where I serve has four operatories, three dental technicians (corpsmen in the military), and an active duty navy dentist. I see approximately six patients each day. The corpsmen/dental techs can perform supragingival prophies but not subgingival or any perio treatment. I report directly to the dental officer but am given much freedom in determining the scope of dental hygiene care. The medical and dental professionals I work beside are dedicated and compassionate in their quest to do what is best for the patient and our country’s military readiness.

The military has its own culture and is rich in tradition. It’s like stepping into another reality when on base. I am fascinated with the history of the military, the politics, and the pageantry. The language is different, mostly due to the presence of acronyms. These take some time to get used to because even simple things become letters (for example, the sterilization area is called CSR) but most people will define the alphabet soup if questioned.

The main difference I have noticed between private practice and the military system is that money is removed from patient care equation. There is no third-party payer deciding what is “covered” and what is not; if the patient needs it, it is provided at no cost. Patients do not have co-pays, deductibles, or limitations on treatment. For example, a patient with active periodontitis can have a recall interval of whatever you think is best. The dentist also has no financial incentive driving treatment options. Most patients are given the best treatment protocol for their circumstances, even including implants and adult orthodontics if necessary.

Some limitations exist on specialized services, based on demand and physical proximity to the clinic offering the specialized care, but it is possible. Some patients are referred to off-base dental care providers for specialized dental services.

The biggest challenge is that the patient population is highly transient, usually remaining in a duty station for a maximum of three years, but often just a few months. Most of my patient population is between the ages of 18-25 as many are students at a specialized training school located on the base. These patients have the same issues as civilian young people — tobacco usage, poor home care and nutrition choices, and dental caries issues. Dental care usually begins in boot camp where the initial examination discovers and prioritizes treatment. Once all treatment is completed, including a prophylaxis, the patient is considered deployable.

Often, treatment will span over several duty stations, over a deployment at sea, or in a foreign country. Dental records are still paper, although there are programs in place to transition to all digital in the future. Patients hand carry their records from duty station to duty station, which is helpful in reviewing what treatment they have received throughout their military career. But sometimes the records are lost in the moving process. I find it interesting to note where a patient has been as they are required to have an annual examination and cleaning once per year, wherever they are located.

The benefits for the hygienist are huge. I feel I am serving my country by helping these young people achieve optimal oral health. I am privileged to be inside the military culture and have gained some understanding of its operation. I have developed a deep respect for the military, their ethics, and commitment to their country. I feel they care very much about the oral hygiene level of every active duty member.

My personal benefits include being well compensated for my years of practice and the knowledge and skill I bring to the clinics. I can practice with my present state license as no additional dental hygiene license is required as long as I practice at a government installation. The federal government greatly emphasizes training. There is mandatory online training as well as out of the office training at regular intervals.

Continuing education is highly regarded and time off to attend is generally not a problem. A contract employee has everything spelled out upfront in the contract, so there are no misunderstandings.

My contract clearly spells out what I can and cannot do, and what I gain from my employment with the government. Even though I am part-time, I earn sick leave and vacation, retirement, continuing education, paid holidays, incentive awards as well as uniform and PPE supplied at no expense to me. I also have optional health, life, and long-term care insurance through the company that holds my contract.

Requirements include up-to-date Red Cross BLS, annual flu shot, pre-employment physical, TB and HIV testing, and possible random drug test, as well as keeping my state dental hygiene license up-to-date and in good standing with CE and ethical practice.

My salary is paid by the contract company, who bills the government for the hours that I work. My production is tracked so my contribution/necessity to the military is measurable. Probably the only downside is that contract employees are always held captive to the budget, meaning if budgets are cut, contract jobs can be cut as well, without much warning.

I landed this position by calling the local naval base when I moved to the area in July 2010. The dental clinic told me they had never had a dental hygienist before but were in the process of putting a contract together to hire one part-time. It took several months for the contract to be approved through the government channels, and then the contract was put out for bid. Several dental contracting companies bid on the contract and one was finally selected by the government. I was then offered the position through the contract company. It took several months for all the background checks and other paperwork to be complete and I’ll admit that it was frustrating waiting for everything to come together. Finally, I started in February 2011 and it was certainly worth the wait.

If you are interested in becoming a contractor, I suggest you contact any nearby bases and inquire about dental hygiene staffing. Another option is to contact dental staffing companies, submit your resume and wait for a contract to become available.

Cathleen Terhune Alty, RDH, is a frequent contributor who is based in King George, Va.

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