Dental Hygienists Smile Through It All
A journey through the field with Jennifer Cullen
—By Avery Roxbury
The waiting room was calm and serene as patients were waiting to be seen, but through the tall, wide clinic double doors was another environment. The overhead lighting is so bright it makes the entire room sparkle. The cubicles are squeaky clean. The room is buzzing as if it were 3:59 PM on Wall Street. Students and patients are efficiently yet rapidly moving from room to room, station to station. Professors perfect their students’ skills while simultaneously directing patients from room to room. The smell of fluoride lingers in the air. This action-packed room may be the scene of UM’s on-site dental clinic now, but in 2020-21, students reverted to practicing treatments at home on typodonts (models of a mouth used for dental practice), and suddenly, this room was empty.
I was fortunate to see UM’s dental clinic in action three years after the pandemic, and I had the pleasure of speaking with Professor Jennifer Cullen. Professor Cullen is an oral disease prevention expert who practiced dental hygiene for 16 years and eventually moved into the administrative side of dental hygiene at UM’s school of dental hygiene. Still, even she would not be able to predict the effects Covid-19 would have on the field of dental hygiene and dentistry as a whole.
Society’s thoughts on dental hygiene
Dental hygiene has been a widely overlooked field for many years; some people even call dental hygiene professionals “tooth scrapers and cleaners,” as stated by Professor Cullen. This stereotype and language are widely used because it is “easy language.” Still, Professor Cullen has made it her duty as an oral disease prevention expert to educate citizens about the unknown truths behind dental hygiene. Cullen said that the academic rigor behind dental hygiene provides students with a “holistic view of their patients.” Students are required to take more than just the run-of-mill STEM classes. At a minimum, students applying to UM’s dental hygiene school must take sociology, psychology, and public speaking. Even before the Covid-19 pandemic, dental hygienists prioritized cleaning their patient’s teeth and using their training in social science courses to give their patients the best possible care for them, not just their teeth.
Along with a rigorous education, dental hygienists are trained to be public health professionals. The goal of dental hygienists is to have the opportunity to talk with their patients and prevent tobacco usage, teeth grinding, poor diet, and brushing habits before they have severe implications on a patient’s health. The average US citizen visits their dentist every six months, whereas they only see their primary care physician once a year. “This gives dental hygienists two times the chance to check in on their patients,” says Cullen. “Every patient comes into your chair with their own trauma, their own baggage, their own history.” Many patients don’t understand that several holistic health exams are taking place while they are in the chair. Dental hygienists would not be doing their duty as public health professionals if they didn’t take this position of disease prevention seriously.
Brooklyn Rochow, a first-year student in the program, claims that her holistic education is highly applicable to dental hygiene as a career, and non-STEM courses have helped her “understand and connect with patients.” Rochow explains that courses such as “psychology and public speaking have taught her why patients may experience dental anxiety.” Learning why dental fear and anxiety arise has also helped Rochow “develop alternative care options for patients.”
A holistic course load benefits students and their patients and can help students explain dental hygiene’s importance. Rochow observes that people often “underestimate the extensive schooling dental hygienists have to undergo.” Often, dental hygiene students are “taking classes alongside graduate dental students,” states Rochow. Along with the rigorous education, the holistic relevance of oral health is frequently overlooked. Rochow explains that it is important that patients know “how much your oral health correlates with the systemic health of your whole body.” For example, Rochow explains that “diseases of the gums and connective tissues of the mouth often make chronic conditions like diabetes and heart disease harder to manage.”
How the drought of dental hygienists came about
According to the Journal of Dental Hygiene, nearly one-third of surveyed dentists in the US reported actively recruiting dental hygienists, and 90% of those surveyed found it significantly more challenging than before the pandemic. When asked why the 30% nationwide decline in hygienists has been so sharp, Professor Cullen stated that hygienists “were primarily concerned with being compromised and infected with Covid-19.” The risk in any healthcare environment was heightened during the pandemic, and some front-line workers respectfully opted not to risk their health and safety.
Hygienists were already concerned about risking their safety, and for most women in this field, the consideration of risking their children was not taken lightly. According to Data USA, 94.4% of dental hygienists are female as of 2022; Cullen expressed that since this is the case in the field of dental hygiene, many women reportedly left the field during the pandemic because “childcare and the lack thereof was a real issue, there was nowhere for their kids to go and ultimately they couldn’t work.” The dilemma of choosing between the care of others and the safety of their children became an issue in this field.
How Covid-19 affected the admissions process for dental hygiene programs
Even though Michigan has a steady flow of dental hygienists entering the field, Covid-19 has had many harsh impacts on the number of students entering the field and on how the currently enrolled hygienists have learned. Cullen praised UM when asked how they handled the situation— “UM provided iPads and typodonts to every dental student” so they could Zoom with their professors and practice their skills even during the darkest hours of the pandemic.
Although students persevered in this learning challenge, many students previously seeking education in a medical profession “were hesitant due to the fear they might be exposed or compromised.” This fear and reality led to a significant decrease in applicants to UM’s school of dental hygiene. Many other programs also felt this decline in applicants, and “some universities are still struggling to get their numbers back up,” Cullen stated.
How Covid-19 impacted dentistry as a whole
Covid-19 prevented patients from seeing their hygienist for up to two years, let alone every six months. This decrease in visits affected the ability to see patients on time when the government lifted enough restrictions for patients to return to their regularly scheduled appointments. The backlog of patients increased, and private practices struggled to see patients on time due to the high demand for appointments after many months of dental offices being inoperable. The backlog of private practices experienced severely “increased wait time, and ultimately, this became an access issue,” states Cullen. Recent studies done by the Journal of Dental Hygiene have shown that the backlog of patients is already beginning to show a correlation to increased oral disease rates post-Covid-19 closures.
In addition to the patient backlog, many offices are experiencing staffing issues: “This is not only hygienists but assistants and the front desk too,” says Cullen. According to research by the American Dental Association, 1.6% of workers intended to leave the profession following the Covid-19 pandemic, making up 3,300 hygienists nationwide. Cullen assured me that dental hygiene is also an “aging field,” and the rate of “retirees during this time also accounts for a reasonable portion” of this statistic.
Thankfully, the number of admitted students nationwide “has increased to higher enrollment now than before the pandemic.” This trend is expected to continue and remain steady in lieu of enrollment droughts in 2020-2021.
Professor Cullen is working tirelessly to recruit and find the next best dental hygienists, specifically “motivated strong STEM students interested in public health.” This type of student is essential to the thriving of this career, and this type of professional is why dentistry has persevered through the Covid-19 pandemic.
Who knows where the field of dental hygiene would be today without rigorous education, a public health perspective, and disease prevention screening tools. Through it all, dental hygienists always find a way to smile and persevere.
Feature photo, Michigan School of Dentistry clinic exam rooms; Photo Credit, Avery Roxbury