Guiding pregnant patients’ oral care

I love having pregnant women in my chair for prophylaxes! It allows me to really hone in on proper home care for mother and child. Since most soon-to-be mothers are concerned about doing everything right, it is rare that they become upset when I review oral hygiene instructions.

By the time I finish explaining the importance of home care, they usually have many questions for me. This is a great opportunity to build rapport with patients and gain their trust. Let’s be honest; this interaction is something that often gets pushed aside because of the high demand placed on hygienists to produce and do more throughout the day.

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Pregnant patients

It is usually through the medical history that I find out a woman is pregnant. I like to ask a few questions to feel out whether the patient is happy about the pregnancy before I congratulate her. Most of the time the woman is happy, but I do have patients who aren’t exactly thrilled with the situation, and I have to respect that too. I usually ask how far along they are, when they’re due, if it is a high-risk pregnancy, and how they’re feeling.

Based on their answers, I can usually detect if the pregnancy is good news or not, and then I can continue on with boy or girl questions, offer congratulations, and more. It is always good to have the information about the patient’s obstetrician on file in case the dentist needs to consult with him or her about the patient’s case.

The many ways hygienists earn extra income

An inside peek to adding bottom-line value

Creating and sustaining a viable alternative income stream is not a new idea. What are the driving forces for hygienists who work outside of a clinical setting, and how do those forces contribute to their financial health? In July 2018, 152 dental hygienists shared their thoughts in a short anecdotal poll (figure 1). The results painted a very colorful, diverse, and intriguing picture.

Figure 1. Motivations for nonclinical positions

Motivating factors

Dental hygienists are resourceful. Those who seek additional income are creative, inspired, and unwilling to let anyone define where and how they’ll make those extra dollars. Their enjoyment of something was their number one driver as more than half of the respondents said they earn income doing work they truly enjoy. Diversity was high on the list, and many said the nonclinical work feeds their creativity or provides an intellectual challenge.

Surprisingly, money was not the primary driver, but it was an important aspect for one-third of the respondents. Fourteen percent said they are building a nest egg, and just under 5% reported working in a nondental family business.

The poll revealed some surprising paths to pad RDHs’ bottom lines. Some split their time between a previous occupation and clinical practice, while others made a complete career shift. Sadly, a number said their job changes were spurred on by the physical toll of dental hygiene practice through the years.

I want to be my own boss

Many hygienists can only dream of a day when they own their own dental practice, but business ownership is becoming a reality in more areas of the country. This husband and wife team give hygienists hope that business ownership can be realized when state legislatures remove barriers that block hygienists from owning their own practices.

Derrick and Anna Robertson are dental hygienists who reside in Bucksport, Maine. They met while attending hygiene school at the University of Maine at Augusta, Bangor Campus.

“I craftily dreamt up excuses to talk to Anna, and we started dating the beginning of my last semester,” Derrick said. Anna was homeschooled, and then headed straight to college. Dental hygiene was a second career for Derrick. He had previously worked as a marketing associate for Sysco Foods and as a service writer for an auto center. Derrick graduated from dental hygiene school in 2003 and Anna in 2005.

One of the operatories in the Robertsons’ practice with a beautiful summertime view.

Making it legal

In July 2008, the Maine legislature passed a bill that allowed for the independent practice of dental hygiene. The application statutes for independent practice dental hygienists (IPDH) state that hygienists are required to have worked in a clinical setting for at least two years and 2,000 hours before they can apply for their license if they have a bachelor’s degree, or six years and 5,000 hours if they have an associate’s degree. Applicants must retake the jurisprudence exam, pass a criminal background check, and pass a board interview. At present, there are approximately 100 IPDHs.

Periodontal maintenance or prophy? Yes, periodontitis can be cured

Dear Dianne,

I work in a solo practice with another full-time hygienist. We both graduated 10 years ago and our doctor is a great guy. We pride ourselves on delivering high-
quality care to our patients and we focus on making sure our patients are happy with their experience.

However, I recently had a new patient in my chair who was definitely not happy when she left. This nice lady recently moved to our area and was referred to our practice by a neighbor. I seated her and gathered all the preliminary data plus took a full-mouth series of x-rays. Her medical history was uneventful and she had no history of smoking. She indicated that she had experienced some periodontal problems in the past, but as far as she knew, everything was fine now. Her periodontal charting revealed no bleeding on probing and no signs of disease activity. When I did a tour of her mouth, the tissue looked great and I only found one reading at 5 mm and a few areas of recession. Her home care was very good.

The policy in our office is if a patient has periodontal disease, past or present, the code for their preventive care is D4910. So that’s what I marked. But when the patient checked out, she was most unhappy with the charge and the business assistant’s explanation. She said, “I just came in to get a cleaning and I feel like I have been ripped off!” When the business assistant told me about the situation, I decided to send the patient a written explanation through email. I explained while there is no cure for periodontal disease, we try to control it, much like diabetes, and I was following the policies of my office. The patient replied she will never return to our practice.

Dental hygienists’ role in advocacy

The profession must continue to advocate for the oral health of a population

Dental hygienists who practice advocacy have a real chance at making significant improvements in the public’s health. As practiced in dental hygiene, advocacy is the action of trying to improve a population’s health in a logical and collaborative manner.

Dr. Alfred Fones defined the role of dental hygienists in advocacy when he wrote, “Those who may still be skeptical are finding it difficult indeed to suggest any other means by which similar good results can be accomplished for large groups of people.”1

Through the years, our professional association has consistently described the advocacy role, which exemplifies the significance of advocating for others in the practice of dental hygiene. Although the terms may have changed in the description of dental hygiene roles through the years, the practice and skill set of advocates remains.

The concept of social advocacy is probably the most common idea associated with advocate, and sometimes this can become quite political. The term can be used to span many disciplines but is predominantly associated with the business and legal worlds. There is really no political entity that owns the term because a social advocate is an individual who causes social change intended to benefit others. Although many disagree about the way to obtain a desired outcome, most agree on the final outcome, such as the improved oral health of a population.

Hygienists should continually advocate for the population. In order to do this effectively, hygienists should collaborate, be motivated to advance the practice, and have a deep desire to care for others.

A link to pancreatic cancer

Researchers pinpoint two bacteria for a connection

It’s amazing how many different varieties of bacteria there are in the oral cavity. Some of them are very dangerous and pathogenic and may have more implications in other diseases than we now know. Last month we looked at how the bacteria Fusobacterium nucleatum (F. nucleatum) is closely related with colorectal cancer. Several studies have linked them together and the bacteria is found in many rectal cancer tumors. This month, I want to look into another type of cancer and another link with a periodontal disease bacteria—pancreatic cancer and its link with Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans).

Let’s quickly review a few studies that have discussed their link. A study by Julie Jacob found that more than 50% of patients who had pancreatic cancer also had a high percentage of the two pathogenic periodontal bacteria in their oral cavities, P. gingivalis and A. actinomycetemcomitans. “More than 50,000 people will be diagnosed with pancreatic cancer this year.” Researchers found that the people who had these two bacteria in their mouths had a greater chance of developing pancreatic cancer. This gives researchers another marker to investigate and study. The researchers looked at why this occurs and hypothesized that the “oral bacteria dysbiosis” is a main reason.1

A study by Harvard School of Public Health looked at more than 51,000 male health professionals for more than 16 years. “After adjusting for age, smoking history, diabetes, obesity, diet, and other potentially confounding variables, the researchers concluded that men with a history of periodontal disease had a 63% increased risk of pancreatic cancer compared to men without a history of periodontal disease.”2

Erythritol low-abrasive powder: Its broad implications for oral health

I am a born-again low-abrasive air polishing dental hygienist. I make no qualms about advocating this novel method of biofilm removal to all dental professionals. The evidence supports it, and my job and the patient experience became a lot easier once I shifted appointment protocols to remove biofilm first by using low-abrasive glycine powder to air polish the “enemy” away. For years I have had “erythritol envy” of dental hygienists outside the United States who were able to use erythritol low-abrasive powder rather than glycine on their patients. Now that erythritol powder is FDA-approved and available to all US dental professionals, I’m preaching its benefits.

So what’s the big deal about erythritol air polishing powder? Isn’t glycine good enough? Some of you reading this column have already experienced the new Hu-Friedy Air-Flow Plus powder in your air polishing devices. For those of you who have not, its implications are pretty amazing!

First, let’s revisit glycine. It is still a fantastic, safe, comfortable powder for use in air-polishing devices designed for low-abrasive powders, so some clinicians may elect to stick with glycine. So, why does this new erythritol powder include “plus” in the name? That’s because the potential of erythritol powder extends beyond biofilm and stain removal. Like glycine, erythritol powder obliterates biofilm safely and effectively. But it also has anticariogenic, antibiofilm, and antioxidant properties, and is more efficient in stain and biofilm removal compared to glycine. Additionally, erythritol has antibacterial potential against specific pathogens. So, air polishing first with erythritol powder has the potential for additional benefits over simply removing biofilm and stains.

A good support network is key to managing stress in dental hygiene

A good support network is key to managing stress in our profession

Work life, home life, and personal life—how does this puzzle fit together? Finding a balance and expecting your partner at home to understand the emotional and physical challenges of dentistry can be challenging. Not every spouse or partner is able to comprehend what we do and the relationships we make with patients on a daily basis.

Let’s face it—being in the dental world, we don’t top many people’s “favorite people to see” list. How many people over the age of eight look forward to dental visits and periodontal therapy? Even so, getting to know patients and families is one of the most rewarding aspects of our careers. Work is what you make of it. It is not the physical work, but the emotional and personal connections that make my career an integrated part of my daily life. Over my years in a family-oriented practice, I have watched children grow and have seen grandchildren come into the world. I have laughed and cried along with patients. For many, we are as much a listening ear as we are clinicians, so getting emotionally invested in patients is almost inevitable.

The stress we feel as hygienists may carry over into the home when we switch to our roles as moms, dads, spouses, and partners, and it can be overwhelming at times. I admit I don’t always transition from wearing one hat to another smoothly. Hygienists are often perfectionists. Feeling like we need to do it all is frustrating, and overcoming that feeling can be hard. But how do we get our significant others to see and understand the stressors of the dental profession?


The stress of running behind schedule, having patients tell us how much they dread a dental visit, and dealing with an office full of difficult coworkers and an overpowering doctor is enough to cause anybody’s head to spin. Office conflict and lack of teamwork can make any day miserable when the office is not running smoothly. That said, hygiene is a rewarding, satisfying career spent caring for others and seeing the changes that we make in patients’ lives, while creating new relationships and friendships with coworkers and patients alike.

How dental hygienists can invigorate their careers

Forums like Facebook make it easy for clinicians to congregate and share thoughts on everything from products to office politics. It’s exciting that it is so easy to get information, but it’s also sad to see how many in our profession are unhappy. Obviously, there is no way to accurately measure the overall discontent, but it appears to be at an all-time high as compared to previous decades.

Those of us who have enjoyed or are enjoying satisfying careers are scratching our heads. While we are not so naïve to think that everything is perfect in every clinical practice, we love this profession and are disturbed by how desperate some are to leave. At times the anger is palpable, as clinicians lash out at employers, patients, coworkers, and the health-care system.

Certainly, not everyone is cut out for clinical work, but that is where most jobs are these days. The traditional office setting with a handful of doctors and employees is becoming more and more rare. Some aspects of the future are scary and disturbing, while others, such as more open practice acts, are exciting and invigorating. Today’s clinicians will have to be nimbler than ever in adapting to the changing landscape. Dental hygiene has a growing number of practice models, including corporately owned offices, multilocation practices, federally qualified health-care centers offering multidisciplinary care, and the advancement of dental hygiene services provided outside of a traditional office setting using portable dental equipment.

Here are some strategies that can help refocus your future as our profession evolves to meet these changes.

Remember why you chose this profession

Most of us chose dental hygiene because we wanted to take care of people, earn a decent living, and have a flexible schedule that allowed us to have a reasonable work-life balance.

Hygiene Proud: How to correctly display dental hygiene credentials

Should there be a consensus on how we display our professional credentials?

There is no dental hygiene program that issues an “RDH degree.” Entry level dental hygiene educational institutions that are accredited by the Commission on Dental Accreditation grant associate in applied science (AAS) degrees in dental hygiene. Many programs also offer bachelor of science in dental hygiene (BSDH) degrees and the master of science degree in dental hygiene (MSDH). We can celebrate the fact that a doctorate degree in dental hygiene (DDH) is now offered. But hygienists earning any of these degrees do not come away with an “RDH degree.”

Where did the idea of placing the RDH credential after one’s name come from? Who started it? If someone can answer this, I would ask that he or she enlighten us all. It may be that we followed the example of registered nurses, or RNs. Even that is not a degree but the name of the profession. I understand the sense of pride and belonging when we display our credentials, but what is the protocol for the letters we add after our names? In other words, just what is the proper way to list our degrees, licenses, and credentials?


The fact that jurisdictional statutes require dental hygienists to maintain an active or registered status does not reflect our educational degree. If you practice dental hygiene, you’re required to keep the license active or registered in the state where you practice. What does licensure mean? It means that a licensing agency vouches for your education and competence, hence the DH (dental hygienist), RDH (registered dental hygienist), or LDH (licensed dental hygienist). These letters tell the profession that you have authority and certification to practice.