Where Do We Stand? A Hygienist’s Reflection on the COVID-19 Pandemic
By: Ms. Kathy Forbes, RDH, BS
When I was asked to write an article about, “how the pandemic has affected the hygiene profession and your thoughts regarding the
future,” my first thought was sure, “I can do that!” After all, having been a dental hygienist for over 40 years as well as an educator, speaker, and author to a variety of publications, this is what I do.
I researched the current surveys, particularly the ADA/ADHA, “COVID-19 Prevalence and Related Practices among Dental Hygienists in the United States” as well as, “Employment Patterns of Dental Hygienists in the United States during the COVID-19 Pandemic.” There was also the DentalPost and RDH magazine survey, “The State of the RDH Career in 2021.” Add to that the many articles on the subject in almost every dental publication and a plethora of dental and dental hygiene Facebook groups where dental professionals have shared feelings, opinions, and insights into what is really happening in their practice settings. So, after digesting these publications, here is my take on the good, the bad and the ugly.
The President declared COVID-19 a national emergency on Friday, March 13, 2020. Yep, that’s right. It was Friday, the 13th and, little did I know, it would be my last day of clinical teaching until June 1, 2020.
Statewide stay-at-home mandates were being issued across this country beginning with California. Dental practices were closed except for emergency care. Dental teams were sent home; mask mandates; aerosol directives; additional personal protective equipment when treating emergency patients; taking temperatures and other screening; etc. I followed the CDC, OSHA and state of Colorado websites daily to understand the most current protocols.
Hygienists (and most of the country) thought they would be back to work in two, maybe three weeks. But then what about the PPE shortages? Could their employer ensure workplace safety standards for them and their patients? Adding to the uncertainty was that dental hygienists were identified as one of the most at-risk, non-hospital occupations with a rating of 99.7 out of 100 due to contact with others, physical proximity and exposure to disease and infection. Many began questioning not just when they could return to work but if it was safe to return to work at all.
The Colorado Dental Hygienists’ Association (CODHA) provided daily updates, keeping all hygienists (not just members) informed of current
policies, protocols, and practices. They maintained an open dialogue with the Colorado Dental Association (CDA) to address hygienists’ concerns.
When dental offices began opening, many offices were not completely following CDC/OSHA/Colorado state mandates for PPE due to mask
shortages. Hygienists and other members of the dental team needed to re-use single use masks, gowns and more. Some hygienists chose to voluntarily leave the workforce until, “after the pandemic is under control.” Concern over workplace safety standards, including PPE practices as well as many other factors was important to the dental hygienists in terms of influencing their decision to voluntarily leave their job.”1
CODHA’s contact with hygienists through Zoom meetings and webinars reflected these same concerns here in Colorado; but also shared remarkable stories of dentists who went out of their way to provide for their team during the closure. These included the continuation of benefits during the stay-at-home mandate as well as having weekly Zoom meetings to keep in touch with everyone. They created a caring, understanding and supportive environment.
As hygienists returned to practice in the summer of 2020, the biggest challenge, outside of PPE shortages and aerosol-generating procedures, was re-scheduling patients, especially perio maintenance patients who were now three to four months overdue. To schedule the backlog as well as those who originally scheduled became a huge challenge for the business staff. But to top it off, hygienists were sometimes told they had to continue to work within the 60 minute appointment time.
When the profession became more vocal about their workplace conditions and concern for the safety of their patients, some were met with resistance. Even now, some hygienists are struggling to treat patients during that one-hour block of time and additionally perform all the necessary, increased sanitation, disinfection, sterilization, and refreshing of PPE between patients plus skillfully treat the overdue patient. Perhaps 60 minutes really isn’t enough time anymore?
As to the future of dental hygiene in Colorado, I believe the outlook is good. Dental hygiene programs have no lack of applicants, even though they are all aware of the risks. Although nationally, 7.9% of dental hygienists have exited the workforce since the onset2 research also shows that many were already approaching retirement, and COVID-19 was the key factor in their decision.
To move forward together, dentists and their hygienists need to have open conversations about workplace/safety conditions and scheduling. It should not be just about production. Although there seems to be a shortage of hygienists (or an increase in patients who are overdue seeking care), it is up to individual dental practices to cultivate a work environment that promotes quality workplace/safety protocols as well as dental hygiene scheduling which accurately reflects the time to perform those protocols and still provide quality care to patients. Dental practices that do this will not lack for hygienists as the word will spread.
The pandemic has affected the dental profession in so many ways. This is one hygienist’s point of view. We can all get through this with open, honest, collaborative dialogue between hygienist/employee and dentist/employer to determine what is best for both their patients and the team.
1, 2 ADHA/ADA Employment Patterns of Dental Hygienists in the United States during the COVID-19 Pandemic, The Journal of Dental Hygiene; Vol. 95, No.1, February 2021
Dr. Sampada Deshpande is a general dentist based in Seattle. A foreign-trained dentist from India, Sampada earned her DDS from the University of Washington in 2018, where she is also a current LEND trainee. Outside of clinical dentistry, she enjoys hosting the New Dentist Business Club, going on hikes with her husband, and reading books on Finance & Management. You can reach her directly at @dr.deshpande on Instagram or visit her website www.sampadadeshpandedds.com for more information.