Th 198798

A letter to Dr. Fones

Jan. 1, 2006
Today I received an exciting publication called RDH magazine.

Irene M. Newman, RDH
Mountain Grove Cemetery
2675 North Ave.
Section 8, Lot 42
Bridgeport, Connecticut

Dearest Dr. Fones,

Today I received an exciting publication called RDH magazine. Quite honestly, I have never heard of this periodical - perhaps you have. According to the cover, the magazine is celebrating its 25th anniversary this month!

It is amazing to just learn about RDH, a magazine that has reported the comings and goings in dental hygiene since 1981! Why do you think we did not hear about this important periodical sooner? Maybe the publisher or editor did not know our whereabouts until now. Despite this, it is truly exciting to read that our beloved profession appears to be moving forward with an ever-expanding view of the vision we shared nearly 100 years ago.

In our day, some hailed us as pioneers and visionaries. Others thought we were revolutionaries bent on destroying the entire dental profession. History credits us as being some of the first to understand that cleaner teeth would improve general heath. Articles in RDH magazine report a person’s oral health profoundly affects the total health. Your vision a century ago articulated this very idea.

Textbooks credit us as the creators of the profession. Nevertheless, the true story is shown in Wilma Motley’s monumental book The History of the American Dental Hygienists’ Association 1923 -1982. The idea of a female dental auxiliary had been tried over and over for nearly 50 years before we began our grand experiment. Remember how the earlier forays were short lived and suffered from terrible opposition in the dental community at that time. However, we were the pioneers that made dental hygiene practice legal in this country.

It did, however, take nearly a half century for dental hygiene to become a legal profession throughout the nation. In 1950, the Texas legislature finally passed the laws that allowed dental hygiene practice in the Lone Star State. This was the final victory. With the passage of that legislation, dental hygiene was legal in every state.

While the struggles for professional recognition appear to be ever present, do you remember how dental hygienists in individual states tried to form their own professional organizations? I still recall how the dental associations were dumbfounded that we wanted our own group. Dentists were amazed when the American Dental Hygienists’ Association was formed in 1923.

Would either of us have ever believed that there would be both men and women putting RDH at the end of their signatures? You were convinced that the female temperament was better suited to performing dental hygiene procedures and articulated these very thoughts in a July 1911 address at the National Dental Association meeting with this statement: “A man is not content to limit himself to this one specialty, while a woman is willing to confine her energy and skill to this one form of treatment. A woman is apt to be conscientious and painstaking in her work ... I think she is better fitted for the position of prophylactic assistant than is a man.”

Your thoughts mirrored the times in which we lived - an era where women were not even allowed to vote. With further research, I discovered the first male hygienist graduated from the University of New Mexico in 1965. Men were finally allowed to join the American Dental Hygienists’ Association the following year. According to Wilma, as recently as the early 1970s, there were still state laws that required dental hygienists be females. The laws have been amended now, and men are entering the profession in record numbers. Many women are also becoming hygienists after raising children. Around half of all dentists are now women.

Oh, Alfred, as I read this important issue of RDH, it was stunning to see how much dental hygiene has advanced. Today’s hygienists are scientists, not that we weren’t, but they are thinking about evidence-based dental hygiene practice. They are looking for reasons and the research that will help them make an accurate dental hygiene diagnosis and provide patients with specific treatments.

Today’s hygienists are assessing patients in unique ways. They are certainly an inquisitive lot, asking about medications, diseases, disorders, illnesses, and lifestyles. Some of their questions make me blush, but important information is being gathered.

Radiographs are quite different. Sometimes patients have every tooth

X-rayed using special aiming devices that ensure accurate film placement. Films are packaged in a way that make them easy to use, and the exposure time is a mere fraction of a second. There are even machines that move around the outside of the head and take a picture of the entire dentition on one large film. Some dental hygienists use digital radiographs where the image is created without the X-ray film, so no one has to breathe the fumes from the dark room solutions. Digital images are viewed on an electronic screen seconds after they are taken. You can even view different parts of the tooth in color!

We never thought of using photography in our original version of dental hygiene. Now there are little cameras that record intraoral findings. These images are instant and magnified so everyone can see the minutest details in a patient’s mouth. Isn’t that wonderful! Now patients can see what we see: cracked teeth, broken fillings, bleeding gums, and even microscopic specks of calculus left behind on root surfaces.This seems like such an advancement that demonstrates the need for dental health.

Even more amazing than the radiographs are the new diagnostic tests that dental hygienists can perform. They have found a way to harness light and use new devices to quantify the structural health of the tooth, microscopes to assess bacteria found under the gums, tests to analyze saliva composition and flow, and mechanical probing devices. Dental hygienists counsel patients about nutrition, effects of medications, the harmful properties of tobacco, which you and I felt so strongly about, and other complex health issues.

Many are now defining a new specialty called periodontal medicine. Its foundation is much like the demonstrations we had in Bridgeport. You would be gratified to see your thoughts in such a positive light.

The machines and devices hygienists now use are so different from hand scalers and porte polishers. It is really hard to recognize some procedures. Even the hand instruments are different. They have bends we never imagined, and the handles are so large in diameter.

The most popular new machine is called an ultrasonic scaler. There are many forms of this device and it has gained tremendous popularity over traditional hand instruments. It uses sound wave energy to create tip vibrations that remove deposits from teeth very efficiently. I understand that it was used originally to remove tenacious hard deposits that used to cause women’s hands to cramp. It looks a lot easier to use this type of device, and there is the added benefit of killing bacteria now known to cause dental diseases.

Scientists have proven that mouth bacteria live in very complex communities called plaque biofilm. This really helps explain why some patients had so much more disease than others. According to RDH magazine, these power scalers disrupt difficult-to-remove plaque biofilm much better than our hand instruments ever did. Another machine uses focused light energy to kill bacteria below the gum line without a blade. This device known as a laser also helps mouth ulcers heal faster.

I remember how you marked extracted teeth with a carpenter’s pencil. It was so hard to remove that stain. We eventually reached the goal using moist pumice applied with a series of deft strokes from the wooden points in our porte polishers. Today’s hygienists do not even remember belt-driven polishers; they now use handpieces driven by compressed air through hoses or devices that act like miniature sand blasters.

The paste is so different. It’s premixed, flavored, and colored, and comes in special disposable containers. There are pastes that reduce tooth sensitivity as well as rebuild tooth structure lost from earlier acid assaults. Who would have ever thought that teeth enamel could be restored without a filling? Scientists have even discovered ways to confuse bacteria with naturally occurring chemicals or compounds that keep bacteria from developing. The list keeps growing but it appears that we are on the brink of an exciting new direction in preventive dentistry.

Minimally invasive dentistry focuses on remineralization, which means growing back healthy tooth structure, rather than surgically removing it with a burr. In addition, if remineralization was not exciting enough, there is a procedure called pit and fissure sealants where susptible grooves are filled with material that prevents bacteria from getting into these parts of the tooth. Dental hygienists are the perfect clinicians to address these issues and perform these vital clinical procedures.

Do you remember how hard it was to stand all day long? Oh our aching backs and necks! Apparently, a lot of dental professionals have gotten hurt through the years. Now there is a new science called ergonomics, and there are many ways injuries can be avoided. Most in the office sit while they perform clinical procedures. Some even have chairs with arms. Imagine how much more comfortable that would be!

Hygienists now look through special glasses that have little binoculars. Surgical magnification loupes are all the rage and some even have miniature lights mounted above the binoculars. While I do admit they look a bit strange, imagine how nice it would be to see clearly without having to bend over.

The times are obviously very different. Do you remember how we used to sterilize our instruments in a big vat of boiling water and wipe down the equipment with alcohol and gauze? Instruments are now placed in small pressurized steam chambers called autoclaves that kill organisms. Many items are made out of a new material called plastic and only used once. Disposable plastic covers prevent bacterial contamination on light handles, handpieces and chairs. Surfaces are wiped with strong disinfectants. All hygienists wear masks or face shields. Jackets catch the splatter and they use disposable gloves for hand protection. These measures make so much sense.

Some dental hygienists use the term client instead of patient. I’m not sure how I feel about this. Client seems to redefine the relationship we have with those who trust us for care, but of course we should have an open mind and keep up with the times.

We were so fastidious about our dress and proudly wore those beautiful starched white uniforms and big white caps. The caps are gone, white is passé, and most wear pants. Men and women dress alike in multicolored uniforms called scrubs, which look a lot like summer pajamas. Some still wear traditional white lab coats.

Click here to enlarge image

While there have been many leaders in the profession of dental hygiene, three names come to mind immediately. Today’s students use an updated version of the original 1959 comprehensive textbook authored by by Esther Wilkins, RDH, DMD. March Fong Eu, RDH, EdD, led a successful effort in 1957 while president of the ADHA to eliminate all discriminatory clauses found in state association constitutional documents. Irene Woodall, RDH, PhD, carried the dental hygiene vision forward as the first editor of RDH magazine. Alfred, while I would love to tell you about others, it would take me hours to highlight all who have moved the profession forward.

In our wildest dreams, I’m not sure we could have ever imagined the revolution we were creating in 1913 in Bridgeport. Alfred, there are more than 150,000 dental hygienists in North America alone, and dental hygienists now practice all over the world, saving teeth and helping people achieve a much better quality of life.
Click here to enlarge image

Along with the leaders, trends in the profession are fascinating. Do you remember how we knew that a one-year educational program would not be enough? Through the years, preceptorship programs have gone by the wayside, except for one state. There are nearly 280 accredited educational programs in the United States alone and one is even named after you, the Fones School of Dental Hygiene at the University of Bridgeport.

Most hygienists now have at least three years of college and many are getting their bachelor’s and master’s degrees and even doctorates! Some dental hygienists complete additional degrees through distance-learning programs where most course work is sent via a new technology called computers. With the explosion of knowledge, continuing education is now the standard for license renewal in all but two states.

It is so interesting to note that exact definitions and duties of dental hygienists vary not only from state to state but also from country to country. Perhaps it is like different dialects of the same language, but honestly, these different dialects seem to slow the profession down. As a result, patients do not always receive valuable services.

Eighty percent of the states now allow dental hygienists to perform most if not all procedures on patients of record without a supervising dentist on site. Two-thirds of all states allow hygienists to give injectible anesthesia and 40 percent of all states allow some type of direct patient services. Oregon hygienists can now officially perform a dental hygiene diagnosis.

In the early years, we viewed dental hygiene as a school-based profession with a few hygienists gaining employment in private dental offices, but now hygienists practice in many different settings. They are expanding the professional dreams that you and I spoke of in our many conversations. Hygienists now work as researchers, teachers, writers, inventors, in school systems, prisons, nursing homes, public health facilities, the armed forces and private businesses. Progressive states see the need to expand hygienists’ roles outside of the traditional dental practice. These hygienists must have more education and additional credentialing, but more patients than ever receive important services.

As I review the milestones of the dental hygiene profession from its inception to its status in 2006, I marvel at the strides so many brave outspoken hygienists have made. Somehow I feel the profession that we love so much still faces an uphill battle to gain the recognition it so richly deserves.

In our wildest dreams, I’m not sure we could have ever imagined the revolution we were creating in 1913 in Bridgeport. Alfred, there are more than 150,000 dental hygienists in North America alone, and dental hygienists now practice all over the world, saving teeth and helping people achieve a much better quality of life!

Well, my dearest cousin, my mind is racing but my fingers are weary from writing this long discourse; however I will write the RDH editor a note extending our hearty congratulations for a job well done and make sure that he includes both of us in all future mailings! We’re sure to rest well for many nights to come knowing that the future of dental hygiene is so bright!

Your most devoted cousin,