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Resuming your career

Sept. 1, 1998
Thinking about returning to dental hygiene? Here`s what you need to do to become an active practitioner again.

Thinking about returning to dental hygiene? Here`s what you need to do to become an active practitioner again.

Cathleen Terhune Alty, RDH

Were you a dental hygienist in a former life? No, you don`t need to call the latest psychic hotline to find out! But, if you have worked in the long-ago or not-too-distant past and now are thinking about returning to a dental hygiene position, you may be wondering what steps to take to return to the profession. You don`t need a crystal ball to figure out what to do; just read on.

Step 1: licensing

Licensing is the first step in returning to the profession. Are you licensed for the state you want to practice in and is your license valid? If so, move to step two. If you have a license, but it is lapsed or retired, call the dental board or professional licensing bureau in the state to find out how to reactivate it. Usually, once you pay, a fee you will be back in business.

If you are not licensed in the state, call the board of professional licensing or state dental board and ask for their requirements. Do they offer reciprocity, licensure by credentials, or licensing by exam? For states offering reciprocity and licensure by credentials, you usually pay a fee, send your college transcripts, and request a letter from every state you`ve ever been licensed in that verifies any disciplinary action. You also may need to provide a brief essay, explaining what you have been doing since you ceased practicing.

In states that require examination for licensure, the procedure gets a bit more intense and expensive. Some states will advise you to take their regional board, while others do not participate in regional boards and have their own state exams. Most states require that if you are going to be licensed by examination and took the national board over 10 years ago, you must retake this test as well.

Before you throw in the towel and assume it`s impossible, first look at what you would need to do. According to Jane Weiner, an RDH in Florida who helps hygienists who need to retake national and state boards in Florida, you must need to take it one step at a time. "First thing is to know you can do it," says Weiner. "You`ve done it before; you`ve got the knowledge in your head. You just need to dust off the cobwebs. Some things don`t change; a few things do. You need to focus on passing the test. No one asks you what score you got."

The next step Weiner suggests is that you get support from your family. "You need to study daily to prepare yourself and it will be very intense. You need study and quiet time. Let your family see how it benefits them for you to get your license. Involve them by letting them test you on the facts. If they can`t pronounce the words, they can read the letters on an answer sheet. If you make the commitment that this is what you want to do, then do it."

When studying to retake the national board, she suggests finding out what subjects are covered. "Be prepared to refresh what you learned before and learn a few new things. You don`t have to memorize, but familiarize yourself with the facts." Review courses and books are helpful here, but not all are as helpful as others. Weiner says not to study haphazardly.

"Don`t skip around. Do a subject, do it completely, then go on to the next one. Some subjects logically follow another, like radiology, then pathology, then gross anatomy, then dental anatomy. Each subject reviews from the previous one and that makes it easier to study and retain. Some subjects stand alone, like community (which used to be called public health) and dental materials. Use association to help you remember the information.

"Remember that if you must take the national board, you can take it anywhere it is offered. So, if you are moving to a new state and still living in another, you can take the national board in your current state. This can save travel time and money."

When taking a state board examination or regional exam, Weiner suggests you first call and find out what the state`s criteria for licensure is. "Don`t just speak to anyone. Ask for the Board supervisor because he or she will give you the best information. For example, in Florida, you are required to take a one-hour domestic violence course, a four-hour HIV-AIDS course, and have your own malpractice insurance before you even sit for the board exam."

She also suggests inquiring for specific details about the exams. "Ask for the test dates, locations and for the exact patient criteria," Weiner said.

Some additional questions could be:

- Do you scale the entire mouth at the exam? How many natural teeth are required? Are periodontal pockets, perio-charting, visible calculus, full mouth X-rays, bitewings, root-planing, or polishing required?

- Can you use ultrasonic scalers? What about the handpiece: Can you rent or do you have to purchase one?

- Who are the examiners: dentists, hygienists, both? Do you go by a name or a number? If the examiners go by numbers only, do not have a name anywhere - not on X-rays, jewelry, lab coat, etc.

- What is the clothing/uniform criteria? The answer could be anything from an OSHA paper gown to wearing whatever you want.

- How many days should you plan to be in the city. What is the application deadline? The examiners will not bend this for you if you miss it. Is there a cut-off number of those who are allowed to take the test?

In some states, it`s first come, first served; once they are full, they do not take anyone else. Some boards will take as many people as apply. Ask what you will be tested on - OSHA or state regulations? Ask about the jurisprudence portion of the test. Is it an open- or closed-book test? Request a copy of the state`s statutes even if it is not the most up-to-date one and begin learning as soon as possible. Ask lots of questions, but ask the right people. Clerks will sometimes give you good information, but why take a chance of getting shut out of a test because you didn`t get the correct or complete information. There are no stupid questions!"

Step 2: refresh clinical skills

Whether or not you have to retake any board examinations, brushing up on your clinical skills before returning to work is a necessity. Your self-confidence level will rise dramatically and you will be of greater benefit to the practice and your patients. Find courses that focus on what`s new in the clinical practice of hygiene, as well as hands-on patient care to help hone your hand-scaling skills. Watch for continuing education listings in professional journals and local and state hygiene newsletters for advertisements.

Call hygiene temporary agencies to see if they can recommend a course. Call local hygiene schools and ask if they have an extra chair that you could use for your practice. If there is no hygiene school nearby, call a dental school, VA hospital, or public health department.

If you still have it, dig out your old hygiene school scalers! Weiner claims this works when you have nothing else to use.

Don`t forget to learn about OSHA regulations and infection-control protocols for you and your patient`s safety if you`ve been away from the workplace. Once you are hired, your employer is responsible for your training, but already being aware of proper procedures is important. As a professional, you need to know what infection control is all about and what the law requires.

Check with your state board to see what continuing education requirements are needed and what types of courses are allowed. You may need to show proof of continuing education before receiving or renewing your license.

Step 3: consider your health

If it has been awhile since you were in active practice, be sure to get your hepatitis B vaccination, an OSHA requirement. It`s a series of three vaccinations, with the second give one month after the first and the third given six months after the second vaccination. Also consider the physical demands that hygiene practice will put on your body.

Jason Latona, MS, LNT, a physical therapist and massage therapist in Plantation, Fla., suggests several exercises to help prepare your body for your vocation. "If you`re not used to sitting for long periods of time, check your posture. To sit upright, you need strong lower back and abdominal muscles. Strengthen these by doing crunches (lie on your back and pull in knees and chest) and hyperextension (lie on stomach, lift chest off floor) exercises.

"To test your posture, sit in a chair and have someone put his/her hands on your shoulders and push down. With proper posture, you will not collapse forward or downward. If you have poor posture, you will lean forwards and your lungs will not inflate all the way and you won`t get a full breath. Your muscles aren`t getting the oxygen they need and they fatigue easier. As a result, you slouch even more and your neck and shoulders slump."

Latona also suggests exercises for hands to strengthen and to help prevent carpal tunnel syndrome. "Stretch your wrist by holding your arm out, palm down. Take your other hand and press up on the palm of the hand you`re holding out, then press down. Strengthen the hands by doing wrist curls with weights. Using light weights (one to five pounds), pick up weight and curl wrist up with the palm down. Then turn hand over and curl weight with palm facing up. Sporting good stores also sell handgrip devices that help to develop the forearm and increase grip strength. There is a squeezing putty that comes in different colors and offers different amounts of resistance, or just try squeezing tennis balls."

For back and shoulder muscles, Latona prescribes pulling shoulder blades together in towards the spine to strengthen the back muscles and to stretch and open up the chest area. For a great stretch, stand in an open doorway with hands on either side of the doorjamb. While holding on to the jamb, allow your body to lean through the doorway, squeezing shoulder blades together and allowing the body to stretch through the opening.

In addition to stretching and strengthening muscles, Latona says these exercises will help reduce stress.

"A one- or two-minute stretch between patients is a good preventive measure for occupational injuries," he notes. Latona suggests the doorway back and chest stretch and a neck stretch (tilting the head from shoulder to shoulder, then doing a rotation from chin to chest) for a between-patient break. He also points out that a full-body stretch at the end of the day will alleviate muscle strain and is a good way to take care of yourself.

Step 4: analyze insurance needs

Malpractice (professional liability) insurance and disability insurance can be an important consideration when returning to work. According to Cindy Hoffman, director of benefits for the Pennsylvania, New Jersey, and Delaware Dental Hygienists` Association, you should be insured under your own policy for your protection. "It`s true that a hygienist practices in the office under her employer`s malpractice policy. But what happens if both the dentist and hygienist are sued? The policy pays for one attorney."

If push comes to shove, that attorney will be defending the policyholder - the dentist - more than the employee, the hygienist. Hoffman also notes that if you`re sued under the dentist`s policy and the plaintiffs collect, they still could come after you for the money.

"Why take a chance?" she asks. "There are more lawsuits, more attorneys, and more litigious patients. You need the protection of your own attorney ... one who is experienced defending health-care professionals. The insurance is inexpensive and I passionately believe that you should have it."

Hoffman also suggests that if you depend on your dental-hygiene income, you need good disability income insurance. "If you can`t work, who is going to pay the bills? The younger you are, the cheaper it is. We offer noncancelable, guaranteed renewable, level premiums to age 65." Startling statistics show that a 30-year-old RDH has a 50 percent chance of being disabled for 90 days. Statistics also show that women are more prone to carpal tunnel syndrome than are men.

You do not need to be a member of a professional organization to receive the benefit of a group rate on malpractice or disability insurance. Shop around for the best deal and coverage.

Step 5: getting a job

Your resume should be updated and neatly printed. Include names and phone numbers, pertinent jobs held, and the dates of those jobs. Before interviewing, be prepared for the usual interview questions (i.e., What are your goals? Where do you want to be in five years? etc.) and have answers ready. You may want to think of some questions to ask as well. You may be asked for a copy of your license or for some other proof that you are indeed a hygienist.

Consider using a temporary agency to find you interim positions that will help you increase your speed and confidence. Let the agency know you are returning to practice and ask to work in "slower" offices in the beginning to help you get used to the transition.

Consider purchasing your own uniform if you are planning to substitute. Many offices supply their staff with matching uniforms (OSHA wants the doctor to control where the uniforms are laundered) and take care of its maintenance.

By now, you should have a good idea of what it takes to get back into the profession. Don`t let any of this alarm or overwhelm you! Just take it step by step and you`ll be practicing shortly. And, if you`re thinking of taking another sabbatical from the profession soon, keep your license updated and save yourself many headaches!

Author`s Note: For more information on re-entering the profession, contact Jane Weiner by e-mail at [email protected] or by phone at (954) 722-6759. To find out more about malpractice insurance, contact the Professional Buyers Guild Inc., Lakewood, N.J., at (800) 545-4724; Maginnis & Associates, Chicago, Ill., at (800) 621-3008; or Malpractice/Disability Insurance, Cindy Hoffman, at (800) 743-6385 or (610) 660-4163.

Cathleen Terhune Alty, RDH, is a consulting editor for RDH. She is based in Rochester Hills, Mich.

Getting creative got me back into dental hygiene

I resumed my dental-hygiene career after a 15-year absence. I left the field after five years of practicing because I was bored with the routine and annoyed with dentists in general. It was, after all, the hedonistic `80s, when clawing your way to the top of your field was the fun thing to do. I longed for my own office, a business suit instead of a uniform, a real job title, and a chance to use my talents in corporate America.

Cleaning teeth could not satisfy my ambitious dreams, so I naively turned to a health-care corporation. I went to work in insurance and enjoyed it very much at first. But after a few years, my eyes were opened to the reality of the workplace I had chosen. Playing politics in the corporate arena wasn`t fun; it was painful. Most of the people I worked with could be classified as either working for beer money or enjoying the hurt they inflicted on others as they pursued their own goals. Those who were at the top were concerned only about staying there, whatever the cost. I was disillusioned. I worked harder and got my proverbial corner office with a window and an important-sounding title, but I was miserable. I began to pursue a part-time, freelance-writing career as I struggled with my feelings about climbing to the top and whether I wanted to be a part of this corporate culture anymore.

Motherhood provided a convenient out and, with twins on the way, I had a different sort of labor in mind. I permanently "retired" from my job when we were transferred by my husband`s company to another state. I enjoyed those long days with my children, and soon had another baby to care for. I continued to write for dental publications as my children were growing up as a way of keeping up with the profession. I also enjoyed my contact with other "grown-ups." I loved being a stay-at-home mom and took on the role of "Mrs. Cleaver" with passion.

But by the time my "baby" entered first grade, I wanted to contribute to the family income in a bigger way. Hygiene was not my first choice; but, by the time I looked over all the options for part-time, "school-hours" positions, I was left with close to minimum wage at a dead-end job, even with a college degree. When a fellow hygienist shared with me her great working hours and reasonable pay, I decided to investigate what it would take for me to get back into the profession.

I was fortunate that the regional board exam I took fresh out of hygiene school included my new home state. I had to write a few letters, pay some fees, purchase malpractice insurance, attend continuing education courses, and all the rest. But overall, I was amazed at how easy it was.

Once I had everything in order, I went job hunting. I was shocked at my competition! I was interviewing for clinical hygiene jobs that had 20 applicants, all with lots of experience and who were employed in the profession. There was no shortage of hygienists in my town, so I became discouraged. Even though I felt confident about my skills, I had been out of practice for 15 years and every doctor I interviewed with seemed to end the interview when I shared this fact.

So, I got creative. When it was obvious during yet another interview that I wouldn`t get the job, I said: "Keep my name and number and I can sub for you." Those were the magic words! I soon started subbing and found my niche. I work when I want, for whom I want, at my price. The office staff usually is so grateful that I`m able to fill in on short notice that they treat me like a queen, even if I do occasionally cone-cut an X-ray!

Even though I don`t have the continuity with patients as a regular employee would have, I love the variety and the challenge of working in a new place. I have worked with some great dentists and have had my dismal view of dentistry adjusted. I can take summers off to be with my kids and get right back to work when school starts again. Hygiene is exactly the flexible career I needed and it pays well for part-time positions. I`m happy to be back!

- Cathleen Terhune Alty, RDH

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Cathy Alty appeared on the August 1991 cover with her children.