Celebrating Excellence in Dental Hygiene
Myriad Changes Mark Evolving Dental Career
By Susie Phillips Gonzalez
In 1976, the first dental hygiene students began classes with the goal of earning a two-year certificate in dental hygiene. At that time, the program was under the auspices of the then-named School of Allied Health Sciences. The Class of 1978 consisted of 43 graduates who entered the dental profession as certified dental hygienists.
While some parts of dental hygiene education and the profession have not changed—including educating patients on preventative measures and providing compassionate and highly skilled patient care—other aspects would be very unfamiliar to these first graduates.
Today’s students enroll to earn a Bachelor of Science in Dental Hygiene that enables hygienists to pursue jobs not only in a traditional dental clinic but also in the newest areas of interprofessional health integration. Opportunities are available in higher education, marketing, sales, insurance, school based-prevention programs or research.
Hygienists who want to pursue careers in dental hygiene education, public/community health care and research go on to earn their Master of Science in Dental Hygiene.
“The dental hygiene profession is ever changing, now more than ever,” says Jo Ann Diaz Jordan, M.A., B.S.D.H. Class of 2001, RDH, director of the Dental Hygiene Division for the School of Dentistry at UT Health San Antonio. Once hygiene students graduate and pass clinical and written boards administered by the Texas State Board of Dental Examiners, they receive a license that allows them to practice, with the requirement to complete 36 hours of continuing education courses every three years. “Hygiene students know for the rest of their career they are students,” she added.
Jordan says graduates for the last three years have posted a 100 percent pass rate on clinical boards. Because of the pandemic, national boards were delayed this year. One student did not pass the national board in the 2020 class.
One of 25 dental hygiene schools in Texas, the UT Health program is highly competitive, Jordan says, adding that an average of 25 students enter every year and not every student is accepted on the first try. Lynn Smiley, M.Ed., RDH, assistant professor of dental hygiene, said, “Dental hygiene students are extremely motivated. It’s quite an accomplishment to get into dental hygiene school, especially this one. The students are overachievers.”
When the program first started it was in the School of Allied Health Sciences but was overseen by a faculty dentist, John Preece, D.D.S., who had recently arrived from Old Dominion University in Norfolk, Virginia. Seeing the potential for growth of the new program, Dr. Preece decided to recruit Juanita “Nita” Wallace, Ph.D., RDH, from Old Dominion. Arriving in 1979, Dr. Wallace became director by 1980 and brought competency-based teaching to the program.
Dr. Wallace remained the director of dental hygiene until 2009. She served as assistant dean for faculty and staff development from 2007 through 2011, and then served for two years as the interim dean of the School of Health Professions. She retired in 2013 with 34 years of service.
During Dr. Wallace’s years as director, the department established in 1995 a Bachelor of Science completion program for those who had earned the certificate. A Master of Science in Dental Hygiene was added in 1996. The department initiated a Bachelor of Science in Dental Hygiene in 1997 and phased out the two-year certificate in 2006.
When Dr. Wallace stepped down as dental hygiene director in 2009, Taline “Talley” Dadian Infante, Ed.D., M.S., RDH, was appointed to the position. Dr. Infante served in the role until April 2013, when she died after being treated for six months for a brain tumor. She was 56. An associate professor of periodontics, she won the university’s Presidential Teaching Award in 2009. She was a nationally recognized dental hygiene educator. The Taline Dadian Infante Dental Clinic at the SAMMinistries Transitional Living and Learning Center in San Antonio was named in her memory.
In July 2013, Jordan became director of the program. Jordan said while leadership changes occurred since the 1970s, there was one constant in the program—Barbara Floyd, who started in the spring of 1977 as the administrative assistant to the program chair.
“Barbara saw every dental hygiene class go through here. She was here for every change,” Jordan said. When the program became part of the School of Dentistry, Floyd served as the head administrator and helped the program transition to its new home. “Once we were transitioned to the dental school, and she knew we were in good shape, Barbara retired,” she added. Floyd retired in December 2019 after 42 years of serving dental hygiene faculty and students.
A NEW HOME
A significant change to the dental hygiene program occurred in 2012 when it left the School of Health Professions to become part of the Department of Periodontics in the School of Dentistry.
Because dental hygienists in Texas are required to work under the indirect supervision of a dentist and cannot operate their own practice, hygienists should view dentists as partners, striving for good communication skills, Jordan said. Now that the dental hygiene program is part of the dental school, it is easier for students in both areas to develop relationships that are carried to professional life upon graduation, she added.
Today’s students learn the latest techniques from seasoned hygienists who have many stories to tell from their early careers. For example, Jordan says she remembers when all records were handwritten and kept in file folders. “Sometimes you had to pull your own charts for the patients scheduled for the following day. You had to sit at a desk and call to confirm your patients,” she recalls. However, the trend today is for record storage to occur using an electronic health record or EHS.
ADVANCES IN TECHNOLOGY
Technological advances have also changed another part of the profession. Years ago, some dentists required hygienists not only to take a patient’s dental X-rays but also to follow a precise film-development protocol to guarantee an image of a patient’s oral cavity. “You had to do it just perfect,” Jordan says. “If you left the film in one chemical or the other too long, you’d ruin the X-ray.” Next came the emergence of the automatic processor.
Carol A. Nguyen, M.S., RDH, director of the B.S. Degree Completion Program, said, “Over the years, dental radiography has grown and paralleled medical imaging: moving from dental film to digital radiography using electronic sensors such as photo-stimulating storage phosphor plates (PSP), digital sensors and laser scanners where the image is created, edited, and processed with the use of a computer and viewed on a monitor. The greatest benefits include reduced radiation exposure for patients and the ability for the clinician to edit the final image without retakes.”
As instruments to remove calcified biofilm (commonly known as tartar), hand scalers gave way to ultrasonic scalers, lasers, endoscopes and other power instruments that do not discharge mouth debris into the air, she said.
“The biggest evolution in preventive measures to reduce caries risk in dental hygiene over the past 20 or so years were the changes in anti-cavity treatments for in-office care. Over time, dental hygienists moved from topical foam trays that had acidulated phosphate fluoride to a topical fluoride varnish and finally to topical silver diamine fluoride (SDF) that stops decay from spreading. SDF is not a silver bullet, but it is certainly effective especially for the underserved and vulnerable,” Nguyen said.
Many of today’s dental hygienists started working in an era without gloves, a fact that shocks current students in the School of Dentistry. But in fact, the personal protective equipment (PPE) so commonplace in the dental offices of 2020 was nowhere to be found 40 years ago.
Smiley said she has seen the incredible evolution of the use of PPE. When she arrived in the early 1980s, gloves were being issued in response to the HIV/AIDS epidemic. Now, dental hygienists hold one of the riskiest jobs among frontline workers for transmission of the novel coronavirus. Professors are conducting online teaching on the proper donning and doffing of PPE, screening of patients for COVID-19 symptoms, and modifying treatment procedures during the pandemic, Smiley added.
Students and staff caring for patients at the Center for Oral Health Care and Research use the traditional PPE of a gown, gloves, goggles, hair cover and masks, but now they also wear N95 masks or half-face respirators.
One aspect that has not changed from the early days is the fact that hygienists must be able to communicate well with and show compassion for patients, says Nguyen. Many patients are fearful of dental procedures, Nguyen says, and hygienists must be able to evaluate the situation so that each patient can achieve and maintain good oral health.
The instructor’s role is even more complex in a teaching environment, she says. “As a teacher, you have to balance student anxiety and patient anxiety to meet student learning and patient care objectives. For students, one of the skills they must learn is how to read their patients’ verbal and nonverbal cues to offer patient-centered preventive measures—it’s one of the skills the hygienist has to have.”
Blending teaching with clinical skills is one of the hallmarks of the dental hygiene faculty. Many first earned certificates but were able to work part time as clinicians while attending school to pursue bachelor’s or master’s degrees that enabled them to teach.
“I like educating patients because our work helps to restore and retain their periodontal health. I enjoy teaching because of the positive impact on the community and next generation of health professionals,” Nguyen says of her profession. “And there
is the added bonus of flexibility for work-life balance.”
Faculty members enjoy keeping in touch with former students who encounter job or post-graduate education challenges and seek advice. Jordan was particularly moved by two recent graduates who doubted their career choice when the COVID-19 pandemic hit. Ultimately, the former students stayed in the profession because they remembered learning in school that hygienists serve and help patients. “They said, ‘If we don’t serve and treat the patients, who else will do it?’ I told them they were true professionals. I love to see the graduates grow, move forward and develop critical thinking skills,” Jordan says.