Thoughts on the profession “then and now” from Bonnie Craig, BCDHA President 1964-1973

bonnie craigAs part of Dental Hygiene Week, BCDHA has the pleasure of featuring some thoughts on the profession from our past-presidents. 

1. What was different about dental hygiene (techniques, practice etc.) during the decade in which you were President?

Dental Hygiene practice between 1964 and 1973 was primarily clinical occurring in private dental practice settings and revolved around a serial listing of duties assigned through the Dentists’ Act with regulation of dental hygienists by the College of Dental Surgeons of BC. Dental hygienists did not wear gloves, nor did we utilize masks or eyewear. We simply washed our hands between patients and then went home to prepare dinner. What a change from today!

Additionally, dental hygienists mainly provided treatment and oral health education as instructed by our dentist employers. There was little individualized client care. The Process of Dental Hygiene Care model to guide dental hygiene practice had not yet been developed. Assessment, dental hygiene diagnosis, care planning and evaluation were not part of dental hygiene care at this time. Dental hygienists pretty much did as they were told by employers, the dentist.

When patients came to see us they didn’t really know who were and often assumed we were yet another member of the dentists’ staff.  When people came to a dental office, they expected to see the dentist so when they were appointed to see someone else they were leery of our ability to provide care. From a patient perspective, they had little or no experience with dental hygienists, which made us a complete unknown to them. I was lucky in that I worked for dentists who took the time to introduce me and explain that I had a formal education and was a graduate of a dental school so people were clear about my qualifications, but I know this was not the case for many others who were met with suspicion from patients. Simply put, dental hygienists lacked any real identity as distinct health care professionals.

When I would meet with my friends or attend parties and outings as part of my social group and was asked what I did for a living, people rarely understood it. They almost always said ‘So you’re a dental assistant’, not understanding my work at all. When I explained that I was a dental hygienist my peers were often a bit perplexed about what it was I really did. There was simply no broad frame of reference for what dental hygiene was.

2. What do you wish had changed between then and now that has not?

I think today people do understand that dental hygienists exist mostly because many have been to see one before. That doesn’t mean they have stopped thinking of us as dental assistants though. There is still a fundamental lack of understanding about what our role is. People still think we clean teeth and we still use this term ourselves.

I think that we have some work to do within the profession to effect real change. As a profession, we don’t tend to grab on to our identity in the same way other health care providers do.  With self-regulation comes immense responsibility to the public.  We have to own this responsibility and consider it the privilege that it truly is. In my opinion there are a couple key elements in helping the profession in this area. First, I think education is critical and second, I think that the entire structure of the way in which we practice needs rethinking.

Dental hygienists with more formal dental hygiene education gain more confidence. They learn to hold their own with other health care providers and can better speak to research and evidence-based practice. They’re collegial with other health care providers as opposed to being caught up in a hierarchy of education levels. This is tricky within our profession because we have dental hygienists graduating from two, three and four year programs all deemed equal for registration to practice by DH regulatory authorities. Health care is complex enough that these nuances really do impact the external perception as well as internal perceptions of our capacity.

In the area of work-life, most dental hygienists are still employed by dentists. It’s tricky to know which relationship between the professions takes the lead. An employer/employee relationship is not the same as a relationship that between self-regulated healthcare professionals. What I see is that it is often the employer/employee relationship that prevails, leaving the dental hygienist in a secondary role to the dentist.  If we can marry the education side and remove the barriers to opening our own practices clinical and/or community or partner in practice ownership with dentists/health professionals (not spas though) we could do a lot to further advance the DH profession. Entering into a business partnership, as equals owning a practice, would go a long way in challenging dental hygienists to really embrace professionalism.

I sincerely wish that in the last 50 years dental hygienists had become more equal and respected members of health care teams by us taking on full responsibility for our practicing the DH scope of practice. I wish dental hygiene education had progressed like Occupational Therapy (OT), Physical Therapy (PT) and Nursing have. They and dental hygiene in the 1970′s were two-year diploma programs. OT and PT are now masters-levels programs and Nursing is bachelor-level. The dental hygiene profession is still resisting the bachelor’s degree as the entry-to-practice credential. We continue to blame dentists for what doesn’t work for dental hygiene. We continue to want public recognition yet resist developing a profession that truly warrants credibility in the eyes of the public. We continue to forget that we cannot point a finger at anyone without pointing three fingers back at ourselves. In many ways we are still our own worst enemies.