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The Fones Brainchild

Feb. 1, 2005
Public health dental hygiene lives on in Bridgeport, Conn., nearly a century after its birth there.

by Judith E. Sulik, RDG, MBA

Sometimes it seems as if something just always was. But every program or career that exists today was someone’s brainchild. So, too, with dental hygiene.

Dental hygiene was Dr. Alfred C. Fones’ idea. A dentist in Bridgeport, Conn., Fones started a program in 1911 to train auxiliary dental personnel to perform prophylactic services, raise dental awareness, and provide education for patients. The program operated through the city’s health department and is considered the beginning of the public health system and a national model.

Mary Ann Burr sits in a dental chair at Waltersville School in Bridgeport, Conn.
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According to Helen O’Brien, the supervisor of Bridgeport’s Dental Hygiene Division, in the early years there were 23 hygienists, two supervisors, one assistant supervisor, and three dentists. Interestingly, nearly 100 years ago, the three dentists were women. The team was known as the “Dental Corps.” The Dental Corps took its mission seriously, working so closely with the education department that students could not be promoted unless their teeth had been taken care of first. A Dental Honor Roll was created; a gold star was placed by the student’s name when dental work was finished (as a Bridgeport student in the 1960s, I still remember my gold stars).

At the turn of the 20th century, Bridgeport was a city of exploding immigration and industrialization. Children and their parents were in dire need of all health services, including dental care. Today, the city is still accepting immigrants from around the world, and the need for dental services, especially for lower income children, remains.

But much has changed during the intervening nine decades. There are now seven full-time school dental hygienists serving about 20,000 students in the public and parochial schools. Yet, despite some changes, their responsibilities remain similar to those of their predecessors. Changes include no longer providing the once popular summer clinics at the schools. More recently, school-based clinics were established in 10 of the 40 school sites. It could be said that the introduction of school-based health clinics that benefit the children made the hygienists’ job more difficult.

According to O’Brien, for much of the department’s history, a dentist and dental hygienist worked together at several schools. Now only students who attend those schools with the school-based clinics can enroll in the program and receive access to that school’s dentists. Previously, any Bridgeport student could get care. These changes don’t mean that fewer children are being served, they’re just being served in a new way.

Each hygienist will see a fairly equal number of students by the end of the year, but some will visit more schools depending on the school’s population. Every hygienist begins the school year by screening about 3,500 students who are given a Dental Honor Roll card. If a child needs dental work, a referral is made to either a school-based dentist, clinic, or private dentist.

Mary Ann Burr chats with students during a National Children's Dental Health Month event.
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The Dental Honor Roll cards play an integral role throughout the year. The cards are collected to see if the work was done and, if it wasn’t, a call is made to the parent. Another card is sent home in February if one hasn’t been returned during the year. The hygienists will contact parents about problems, discuss oral care with them, and they interact with school and support staff. Permission forms and health histories must be returned before prophys are scheduled. Priority is given to students in second, fifth, and eighth grades, ages that follow tooth eruption.

I visited with Mary Ann Burr at two of her schools to get an idea of how a school dental hygienist spends her day. One thing was apparent immediately: her job is not a boring one.

Since the hygienists move from school to school, their working environment can be unique, and flexibility is a necessity if one wants to work in the school system. Some schools were built with dental operatories; others weren’t.

For example, Burr, who has worked for the department for 12 years, had to find a new location in one school when a copier was put in her first floor room. She now works in a cozy storage closet in a vacant classroom. Actually, the space is more suitable than it sounds: she keeps her supplies stocked on shelves and there is just enough room for her to open up her portable chair which folds up into a carry bag. It resembles a lawn-lounger and her patients say it is comfortable. School staff help her carry it and the portable lights up to the second floor.

Some locations require the use of two swish-and-spit cups per patient while other sites have “real equipment.” At this school she uses a re-chargeable battery-powered prophy brush on her patients who look like celebrities in the sunglasses she gives them to wear during the appointment to protect their eyes. Sterilization is done at another location so she brings more than seven set-ups with her each day. She’s making an understatement when she notes that her job involves a lot of planning and organization since she alternates between two schools.

One of the oldest schools in Bridgeport, Waltersville, has a six-chair set-up. Graduates of Fones School of Dental Hygiene at the University of Bridgeport will remember doing their rotation there, and current students continue the tradition. Back in the simpler days, neighbors would walk over to the school during the summer and have their teeth cleaned. Burr noted that the “simpler” days didn’t require as much paperwork.

These hygienists work hard, but they have great independence and control over their schedules. They know what they need to accomplish during the 10-month school year, and they determine how they’ll achieve their goals within or despite the constraints of the academic day. They are also able to tap into their creative sides when they develop their lesson plans which begin when arrangements are made through the principal and teacher.

Lessons Burr has presented include giving a chart to kindergartners and asking them to fill it in every time they brush their teeth during the next two weeks. When they return it signed by their parents, she gives them a certificate and stickers to reinforce the importance of brushing.

She created a good-hygiene booklet for first and second graders and asked them to read it to their younger siblings. Teachers review the lesson later with the class, and, she said, some in the higher grades use it as a test while others use it when teaching about the body. Nutrition is another topic Burr covers, including how to read food labels to determine how much sugar is in a bottle of soda and how much is added to their favorite cereals. She also sends home information about different dental procedures like sealants.

Burr’s day begins seeing students after morning announcements. If it’s a day scheduled for prophys, the teacher knows she’ll be calling for patients but the students won’t know that this is the day they’ll be seen (a tricky way to see if good brushing and flossing practices are being followed). No day is predictable, with students knocking on the door with a toothache or loose tooth - or, more unusually, like on the day I was observing, a student coming for an appointment with a rash around her mouth (a rash the nurse identified as poison ivy).

Burr described her routine as screening, distribution and collection of the Honor Roll cards, clinical and lessons, Dental Health Month, then more distribution and collection of cards, re-checking those who need care, and then wrapping up the school year with the last prophys and lessons, reminders to visit the dentist during the summer if work still needs to be finished, and awards to Honor Roll students.

She misses the days when she could work five days a week at the same site; now she is rarely at the same place for an entire week because of limited space. For example, she said that at one school she can’t work there on Mondays because the dentist uses the room. At another school, the room is used on Tuesdays and Thursdays for tutoring. The city is planning to build three new schools over the next few years and building plans include 100 square feet for dental services within the health suite - good news for the future of the dental hygiene division in the city of Bridgeport.

Practicing public health dental hygiene offers more autonomy, variety, and a different sense of accomplishment than private practice provides.

It is nice having summers and school vacations off, too. Bridgeport has a history of hiring hygienists who love the work so much that one hygienist recently retired after 35 years and another is celebrating her 31st year.

O’Brien said, “We are very fortunate to have a caring, dedicated staff who truly enjoy their work. The rewards are endless working with our students. The positive results and smiling faces make your efforts worthwhile in spite of the obstacles you must overcome each day.”

Judith E. Sulik, RDH, MBA, is president of Finely Finished Press of Bridgeport, Conn., and is the publisher of “No Sinks? No Counters? No Problem! 50 One-Pot Meals To Get You Through Kitchen Remodeling.” She can be reached by email at [email protected].