Are you in tiptop shape for returning to work?

April 1, 1996
An extended leave of absence allows a hygienist to do a variety of things, such as spending quality time with a newborn. But collecting paychecks again may require a little preparation.

An extended leave of absence allows a hygienist to do a variety of things, such as spending quality time with a newborn. But collecting paychecks again may require a little preparation.

Frances Wolfe

"Left, right! Left, right! Head up, elbows in! Pick up mouth mirror! Probe pockets! Engage scaler! Polish crowns! Floss contacts! Polymerize sealants! Assign new toothbrush..."

Sounds a bit like boot camp for dental hygiene, doesn`t it? This boot camp, of course, is only fictitious. But what if there were such a place? Hygienists wishing to "re-enlist" after a leave of absence could sign up for "camp" and hone their clinical skills? Wouldn`t it be great?

Interestingly, such a concept may not be far away. Recent studies published by the American Dental Hygienists` Association cites reasons why hygienists are leaving the profession, as well as factors influencing the decision to resume a career. These factors are important for a number of reasons. First, people considering hygiene as a career option are encouraged to carefully weigh their decision. Secondly, the profession now knows how to better improve the influencing factors, striving to keep hygienists from leaving the field. Finally, the profession can encourage those who have taken a leave of absence to "re-enlist."

Why do hygienists take a leave of absence?

- Family responsibilities is the most common reason. Because the hygiene profession is approximately 98 percent female, family responsibilities will always be a significant factor. However, it is comforting to know that, while family responsibilities are a major reason behind temporary leaves of absence, they are not why hygienists depart from the field permanently.

"Temporarily," though, may mean a significant number of years away from the workforce - often totaling as much as eight to 10 years. Many mothers who choose to spend the formative years with their offspring are more likely to return to the dental office once the children are older.


- Negotiate a shorter work day to accommodate children`s school hours.

- Negotiate a job-sharing arrangement or partial child-care fees as terms of employment.

- Make arrangements ahead of time for sick children or family emergencies.

- The issue of salary and benefits is, of course, important to the hygienist when returning after a leave of absence. At career re-entry, many hygienists have found salary and benefits to have remained about the same during their absence.

This, combined with little or no opportunity for advancement within the office, has led hygienists to seek other career opportunities outside the operatory.


- The hygienist should wisely and carefully track her production on a daily, weekly, or monthly basis upon returning to work. This information is extremely helpful at periodic pay reviews, and it opens the door for negotiating remuneration. By increasing the skill level and, therefore, the amount of production tracked, a firm basis is established for negotiating an increased salary in the future.

- It`s no secret that the cost of medical coverage rises constantly. Health coverage and retirement funds are two of the most valuable benefits available to the American worker. Since each hygienist has individual needs, it is helpful to negotiate a "cafeteria plan" of benefits available during the interviewing process. Often, employer co-participation for health insurance premiums or partially matching 401k programs for retirement are a suitable compromise.

- Boredom is a significant factor behind the attrition in the dental hygiene profession. Hygienists in the middle range of their careers are most likely to cite boredom as a reason.

Often, the lack of decision-making opportunities, the lack of co-participation in patient diagnosis and treatment, employer restrictions, and the lack of advancement are factors cited that contribute to boredom in private practice. Overcoming the boredom factor is essential to keep hygienists from leaving the field.

The solutions or alternatives are as varied as the cause of boredom itself. All of the actions listed below can result in reduced attrition, an increase in job longevity, and enticing former colleagues to re-enter the field.

The career-minded hygienist who will ultimately benefit the practice keeps abreast of the latest treatment modalities and the expanded functions allowable in the state in which she practices. By offering fact-based production figures on achievable practice growth, she can position herself to the employer as desiring more decision-making opportunities.


- Increasing and varying the responsibilities of the hygienist.

- Increasing decision-making opportunities.

- Creating a collaborative environment and reducing the implied limitations of treatment.

- The risk of contracting an infectious disease has been a serious concern voiced by hygienists throughout the last decade. The possibility for transmission of a variety of contagious diseases has always existed in the dental office. The potential for AIDS transmission - sometimes referred to as "FR-AIDS" - has pushed this concern to the forefront. Often, the age of the female hygienist in relation to childbearing years is a significant fear factor.

In practices where procedures and protocols for infectious disease transmission are not initiated, this could have a tremendous impact on re-entry into the field.


- A very successful solution is giving increased responsibility to the hygienist for setting and maintaining infection control policy in the practice. Her participatory role as infection control coordinator helps the hygienist assume a leadership role in the practice. Her direct input also significantly reduces any fear of contracting a contagious disease.

- Reciprocity has also been cited as an obstacle to career re-entry. Ironically, statistics from geographical areas that offer regional licensing do not appear to offer an advantage to hygienists who list reciprocity as a re-entry barrier. Possible explanations might include the high cost associated with regional licensure, as well as the cost of maintaining multiple state licenses.


- The dental profession, as a whole, could consider national licensure by credentials.

- Availability of re-entry courses has been highly ranked as an obstacle for more than half of the hygienists surveyed. Typically, hygienists designate a need for re-entry training courses in their geographical area that are available at a reasonable cost.


- College and university-based programs could make intense, "boot camp" re-entry training programs and self-paced study programs available for hygienists considering a return to the profession.

- Disability caused or aggravated by hygiene practice has prompted nearly one-fifth of hygienists to leave the profession permanently. Specifically (and not surprisingly), hygienists list carpel tunnel syndrome, other hand or wrist problems, and back and neck problems as the most common forms of disability.

Interestingly, hygienists living in northern states seem most affected by these disabilities. Could there be a correlation to living and practicing in a cold climate?


- Continue self-education about the signs and symptoms of carpal tunnel syndrome and repetitive motion injuries associated with clinical practice.

- Allow sufficient stretching and flexing between patients.

- Alternately scheduling heavy and light cases throughout the day.

- Taking proper preventive measures, including vitamin B6 supplements, may help.

- Wearing properly fitting gloves and using hand instruments with larger diameter, knurled handles.

So what can the returning hygienist do?

Alas, there is no boot camp for dental hygiene. But here are 10 things you can do to ready yourself for career re-entry.

- Talk openly to hygienist friends who have undergone a similar experience. Ask them to share their experience. Seek out the wisdom and benefit of their advice.

- Ask a hygienist friend to be a "partner." Perhaps the hygienist in the office which you are about to re-enter would agree to such a relationship. Ask her to make an intense teaching, sharing, and learning experience out of it. You`ll both benefit, and you will be amazed at how much information will come back to you - quickly!

- Ask the hygiene program nearest you for re-entry assistance. Take the instructor into your confidence, asking if you can observe during lecture and clinical sessions. Borrow videos and other teaching adjuncts from the program.

- Search the literature in periodicals and textbooks for the latest information on instrumentation techniques.

- Contact advertisers in periodicals for up-to-date product information and samples. They are delighted to supply additional research, supporting information, and equipment instructions upon request. To facilitate customer service, most advertisers have a toll-free number, or a periodical will supply a number to circle on an information request card.

- Practice on a family member, friend, or neighbor.

- Trust your instincts and talents. Your clinical skills will come back ... like riding a bicycle.

- Request a light work schedule for the first few days, allowing you to adjust to the office routine, get to know the staff and build relationships with patients.

- When you resume treating patients, share with them that you are returning to the profession following a leave of absence. Communicate your excitement about being a part of such a dynamic team practice. State your enthusiasm about the wonderful doctor, staff members, and patients you look forward to surrounding yourself with on a daily basis.

- If you need help, don`t be afraid to ask for what you need. Often, other staff feel awkward around the new hygienist. A prompt from you such as, "I really need your help," can initiate and solidify long-term team relationships, as well as lasting bonds of friendship.

Frances Wolfe is a pen name for a long-time dental editor.

Top reasons why hygienists take a leave of absence

- Family responsibilities

- Salary and benefits

- Boredom

- Risk associated with contracting infectious diseases

- Reciprocity complications

- Lack of re-entry courses

- Disability associated with hygiene practice

Incentives for working again

- Salary and benefits

- Participation in reducing risk of disease transmission

- Increased participation in policy setting

- Increased decision-making or co-participation

- Clinical course availability

- Lecture course availability

- Childcare considerations

- Flex-time or job sharing

- Part-time employment option

Mom discovers world didn`t push ahead without her

Clara Duenas Koss is a registered dental hygienist who stepped away from the dental chair for 12 years to become a mom. Taking a break from hygiene to give birth and raise her two sons was not as difficult as deciding to go back to work.

Koss graduated from St. Petersburg Junior College in Florida in 1973. "I found a job quickly in Miami Beach and met my future husband there when he visited me as a patient. We married one year later," she recalls. "After working for eight years, I started thinking about getting pregnant," she says.

Around this same time, her husband was opening a second retail store and needed her help. Koss decided it was the right time to take a leave of absence from dental hygiene.

"Once I had my children, I wanted to stay with them for a few years before going back to work. I thought it would be easier to spend more time with them if I worked in the family business. But I also worried that I would forget how to do my job because I knew I would be gone from hygiene for a long time. I took my parents advice and kept up my professional license while I wasn`t working. That made things easier to go back to work later," she says.

The advice paid off years later when things changed for the Koss family. Business had slowed and both stores closed. Her husband had found a new job, and Koss was at home full-time.

"Because we no longer had the business, we started to feel financial pressures, and I thought about going back to work," Koss says. "Also, our boys were at an age where we felt they could be on their own for a few hours after school," she says.

Koss was looking forward to returning to hygiene, but she was also full of doubt. She knew recent graduate hygienists would likely be competing with her and possibly commanding lower salaries. She wasn`t sure if the dental community would hire someone back who had been away from hygiene for so long.

Fate soon put to rest at least some of her worries. "I had just begun to think about finding a job when I got an opportunity," she says. "One of my cousins had gone to my former employer for an appointment. The dentist sent the message to come by and see his new office.

"After a tour of his office, he asked me if he could schedule patients for me for the following Monday."

Koss was pleased at how quickly she got a job. But after 12 years away from her professional life, she was less confident in her skills than her employer was. She also realized she would be back at work in just a few days.

She recalls, "I felt my dental language skills would be rusty in comparison to the hygienists in the office. I was offered a full-time job, but I chose to start part-time because I was a little nervous. I spent some time reading books on periodontal care during my free time. Actually, things went better than I expected at the office. Everyone was surprisingly helpful and even the patients complimented me. I felt good when they scheduled future appointments."

The speed of her re-employment, though, brought adjustments at home. "I was concerned about the change of routine for the boys. Working half days gave me time to find someone to pick them up from school and take them home. After that, I was able to extend my week to 40 hours," she says.

Koss` husband was thankful for the added income, but had to adapt to changes in their routine at home. Her sons were not happy when their mother suddenly landed a job. The boys began rebelling, sometimes in creative ways. The youngest continuously lost his house keys. That meant frequent calls to the office and trips home to let him in. The oldest complained she was not there after school to help with homework. These tensions made her transition back to work harder.

Koss now holds two part-time positions. At one office, she is the only hygienist on staff. Her work station is clean and meticulously organized. A faded photograph of the 33 women in her graduation class and her diploma hang in her area. Serious and attentive in action, smiling and charismatic in-between, she is efficient with her time.

"I average 10 to 12 patients at either office per day," she explains. "It`s a challenge to complete a prophylaxis, hard and soft tissue exams, home care instruction, and disinfect and sterilize the room in 45 minutes. Sometimes I take X-rays and chart probing measurements within this time frame," she notes.

Time isn`t the only thing that challenges Koss. She has had the opportunity to learn new technology, sterilization techniques, and products. She looks pleased with herself and modestly smiles as she says, "Using the intraoral camera was something new for me, and I like the fact that the patients can clearly see what we find." Recently, she completed a required course on domestic violence awareness.

Koss works hard at getting patients to start better hygiene habits. "My proudest moments on the job are when I can motivate patients with poor home care to follow my suggested routines. I feel I`m accomplishing something when I see patients` oral health improve at each visit," she says. "That makes my job easier too, because patients come back happier and more cooperative," she explains.

As her sapphire eyes sparkle, Koss says, "Going back to work was a big change for me, but it was the best thing I could have done for myself. I no longer feel the world is moving ahead and I`m staying behind."

Written by Selma Rapoport-Zolotas. She is a freelance writer in Miami, Fla.