This year we again honor those dental hygienists who have made a significant difference within their areas of expertise—academia, clinical practice, industry, “mover and shaker,” public health, and research. These visionaries have sculpted their own careers and made a significant impact on the field of oral health.
Nancy W. Burkhart, EdD, MEd, BSDH, AFAAOM
With more than 23 years of experience as a dental hygiene educator, Nancy W. Burkhart, EdD, MEd, BSDH, AFAAOM is currently an adjunct professor at Texas A&M College of Dentistry in Dallas. After earning a master’s and doctoral degree from North Carolina State University in Raleigh, she completed a 1-year post-doctoral fellowship in the section of oral pathology at the University of North Carolina-Chapel Hill Adams School of Dentistry. The faculty co-host of the International Oral Lichen Planus Support Group, Burkhart founded the organization in 1997 through Texas A&M College of Dentistry. A prolific writer, she is co-author of General and Oral Pathology for the Dental Hygienist for which she has written 30 chapters for the textbook’s three editions. A past representative on the Joint commission on National Dental Examinations for Dental Hygiene from 2014 to 2018, Burkhart is now a member of the Tri-County Human Trafficking Task Force-Dental Outreach for the Tri-County’s Healthcare Subcommittee in Charleston, South Carolina.
Q How did you become involved in efforts to eliminate human trafficking, and how can dental hygienists play a role?
A In 2020, I relocated my home base to Charleston, South Carolina. The COVID-19 pandemic had just begun, and the quarantine allowed me a lot of time to regroup. One bonus was the added time to do more reading. I got a copy of James Patterson’s book Filthy Rich, which outlines the life of Jeffrey Epstein and his involvement in human trafficking. As I read, I became amazed at how the human trafficking went on for many years with a host of individuals knowing full well how terribly wrong it was, and how young girls were being used, abused, and hurt. The traffickers were even obtaining them from a local high school. As I read other literature on the subject, many healthcare providers were actually treating these victims in emergency departments and clinics without even realizing they were trafficking victims. Sex or labor trafficking involves perpetrators from all realms of society and regions of the world. I began thinking that with my pathology background, oral, head, and neck signs were really not being identified in dental offices. If physicians and nurses in emergency departments were often missing the signs, the same was probably true for those of us in dentistry. So I contacted South Carolina’s State Attorney General’s Office, which put me in touch with a local organization that wanted to work with me to help obtain dental care for human trafficking victims. At this point, I have two national continuing education (CE) courses on the subject and I work with the Low Country Human Trafficking Task Force. I would like to see information about human trafficking become part of every dental curriculum and I want to provide CE on the subject, adding “dental indicators” to the discussion. South Carolina continues to make human trafficking a priority. There are legal issues and dental offices must be “trauma informed” in their approach, which requires special training. Child abuse must be reported by healthcare providers; however, the victims span many age groups, are male and female, and are both American and from other countries with a language barrier. The website of the National Human Trafficking Resource Center and Polaris—polarisproject.org—provides information on anti-human trafficking efforts. The oral, behavioral, and physical signs should not be ignored. This is a global issue that must be solved on a local level.
Q What inspired your passion for oral pathology? Please share about your work with the American Academy of Oral Medicine.
A My master’s degree is in adult education/interdisciplinary so I took quite a few courses with many other healthcare professionals such as nurses, pharmacists, and health educators. When I began my doctoral work, I was a faculty member at the University of North Carolina (UNC) at Chapel Hill, and I had the opportunity to spend a year in the Department of Oral Pathology. I always had an interest in oral pathology even in my undergraduate work. The two oral pathologists there at the time were John Jacoway, DDS, and E.J. Burkes, DDS, MS. Both were great educators who focused on the “why” a lesion occurred. I learned so much during this time and decided to write my dissertation on oral lichen planus. It was at this point during my fellowship that I assisted in microscope work/teaching; taking the graduate pathology courses, including forensic dentistry; preparing tissue samples; and observing the biopsy read-outs daily. After the 1-year fellowship, I was hired for an additional year in the pathology department. I left UNC, after the 2 years to become a faculty member at Baylor College of Dentistry with a joint appointment in the periodontics department/stomatology clinic and the Caruth School of Dental Hygiene in Dallas. In 1997, Terry Rees, DDS, MSD, and I began the International Oral Lichen Planus Support Group that I manage today after more than 20 years as an “outreach” function.
In 1997, I joined the American Academy of Oral Medicine (AAOM). Currently, I chair its Academic Affiliate Fellowship and Affiliate Membership Committee. Professionals from nursing, pharmacy, dental hygiene, dental assisting, and others involved in oral medicine are members. One feature of the AAOM is the opportunity for nondentists to become an Academic Affiliate Fellow. I obtained fellowship in 2016. I personally have made so many friends and learned so much from those involved with the organization. In 2007, Leslie DeLong, RDH, MPA, and I began to write the first edition of our General and Oral Pathology for Dental Hygienists textbook with the editors from Lippincott, Williams & Wilkins. We are currently in our third edition of the textbook and the publication is written with an oral medicine concept. I was able to draw on many of the friends/members of the AAOM and pathologists for assistance with images and advice in writing the book. I feel very fortunate to have a diverse group of colleagues.
Michaela Nguyen, RDH, BSDH, MS
Since 1998, Michaela Nguyen, RDH, BSDH, MS, has been practicing clinical dental hygiene in general/cosmetic dentistry in the Los Angeles area. She is also the pre-clinical director and senior clinical instructor—focusing on manual and ultrasonic advanced instrumentation techniques, body mechanics, and dental photography—in the Dental Hygiene Program at Herman Ostrow School of Dentistry at the University of Southern California in Los Angeles. She co-authored the chapter on hand-activated instrumentation in the 5th edition of Darby and Walsh’s Dental Hygiene Theory and Practice. Nguyen conducts and participates in advanced instrumentation hands-on workshops throughout the country and internationally. She is a regular contributor to Dimensions of Dental Hygiene on the topic of instrumentation.
Q What do you find to be the most important factor in improving your instrumentation skills?
A I have a fundamental routine when treating patients, but I never treat every patient exactly the same way—even if it’s a patient I have treated at least four times per year over the past 22 years I have been in practice. Because each mouth is so unique with varying qualities and quantities of soft and hard deposits and different types of gingival tissue, oral anatomy, and periodontal pocket depths, being complacent with the same instrumentation skill or technique is not an option.
Since graduating from dental hygiene school, I have remained in education because I realized that the highest level of learning occurs while teaching someone else how to perform a skill. It requires analyzing techniques to help problem solve. In doing so, teaching forces me to methodically examine and break down in detail why something is being done and what can be done to achieve the optimal end result. When I’m treating patients in private practice, I do the same with myself. It’s always been my character to evaluate and assess my own skill set, determining my own strengths and weaknesses. It’s important to identify your mistakes so you can correct them. The notion of “this is how I have always done it” in the face of better techniques is the most detrimental attitude because it only hinders you from improving your clinical skills.
Hands-on workshops, online classes, journal reading, and continuing education courses on instrumentation are useful ways to keep up with the research and stay current with the latest techniques. They can help you relearn what you may have forgotten how to use, teach you what you didn’t know, and help you to avoid bad habits. Remaining open to trying new instruments, fulcrum placements, and clinician positions can help you take your clinical skills to the next level, such as gaining better access, preventing repetitive physical injury, etc.
To keep up your instrumentation skills, you must be open to learning new ways to instrument and be constantly thinking about what can be done to provide the best treatment to prevent periodontal diseases. Because complex cases or challenging areas are common, dental hygienists must be prepared and knowledgeable to tackle the most difficult of cases and achieve the best possible outcomes.
Q What advice would you give to new dental hygiene graduates who are just beginning their clinical careers?
A Take lifelong learning to heart and make it a daily practice in your professional life. Appreciate and be aware of why you just spent a few years learning about dental hygiene. Many graduates are eager to step into the real world of clinical practice and their formal education starts to become a distant memory. They get comfortable and don’t realize their level of education eventually stops after they finished school. Therefore, they must start to take the initiative and own responsibility to continue their learning as they practice the same routine day in and day out. With this ever-changing profession and world, it’s more important than ever to stay current and up to date.
The practice of lifelong learning benefits your patients and those who put their trust and health in your care. Since the appearance of COVID-19, how we treat patients has been greatly impacted. Many of my patients rely on me to keep up with the most recent evidence-based research on the latest dental treatments, products, techniques, especially with the association of oral health and COVID-19. Following and understanding the COVID-19 guidelines and knowing the best practices ease patients’ minds and gains their respect and trust. It’s such an important role to understand that I feel a sense moral and ethical duty and responsibility to continue to practice this way.
With the expectations and responsibilities as a dental healthcare provider, every procedure and recommendation provided in your care ultimately impacts each and every patient. So don’t get comfortable with your daily work life routine. Always challenge yourself to be better and learn something new that would benefit your patients. Don’t lose sight of why you decided to be a dental hygienist or dental health profession in the first place.
Michele Lash, RDH, BA
With more than 20 years of experience in the dental hygiene profession, Michele Lash, RDH, BA, is a clinical educator for Dentsply Sirona in York, Pennsylvania. She spent many years in clinical private practice and in education at her alma mater, Harrisburg Area Community College in Harrisburg, Pennsylvania, where she served as an adjunct clinical faculty member and first-year clinical coordinator. Lash currently sits on the college’s Dental Hygiene Program Advisory Board. Over the past several years with Dentsply Sirona, she has developed scientific, evidence-based clinical education curricula and resources for oral heath professionals, key opinion leaders, and internal team trainings. Keeping abreast of scientific literature and clinical trends allows Lash to provide insights for new product development. She assists in organizing and facilitating digital content creation for the development of educational resources for oral health professionals across multiple formats. Her current focus is ultrasonic debridement, aerosol management, and best practices in infection control and prevention. She is a current member of the American Dental Hygienists’ Association and Organization for Safety Asepsis and Prevention (OSAP). Lash has served on committees for OSAP and the OSAP–DentaQuest Task Force. Recently, she attained the OSAP-DALE Foundation Dental Infection Prevention and Control Certificate.
Q What advice would you give to dental hygienists who are interested in entering a career in industry?
A Frequently attending educational courses and keeping up with scientific research are key components to preparing for a career in industry or to further a career in this field. The dental world is ever changing and even more so now in light of the many challenges presented by the COVID-19 pandemic. Research will help guide us in adapting to this new dental world.
I would advise dental hygienists interested in a career in the corporate world to do your homework. There are many different paths to take in industry. Explore those that interest you and determine which opportunities offer the most flexibility. Networking with industry representatives prior to taking the leap will allow you to understand the roles, job functions, and prerequisites needed for your new career path. I met some wonderful people who took me under their wing and helped guide me into my current position. Many of these connections still serve as my sounding board and mentors.
Q What do you like and dislike about your career in corporate dental hygiene?
A There are many factors I enjoy in corporate dental hygiene! I love collaborating with my colleagues and accomplishing goals as a team. As a clinical dental hygienist, I never realized the extensive amount of work that goes into making a great product. I now understand the months of research and development required to create new devices, including the importance of listening to practicing clinicians in order to meet their current needs. To be part of a team that works from concept through research and development to product launch is one of the most satisfying parts of my job. The networking opportunities are also invaluable. I have been fortunate enough to travel throughout North America and Europe. Engaging with dental professionals from different cultures has been fascinating. These interactions have allowed me to understand how clinicians from other parts of the world operate and the unique emphasis each region places on dentistry. Through these endeavors, I have developed worldwide friendships and collegial contacts.
While I love working in industry, I do miss my patients! As dental hygienists, we all build personal and professional relationships. Now I incorporate my past patient experiences when creating resources to enhance clinician and patient interactions.
.“Mover and Shaker”
Amy E. Coplen, RDH, EPDH, MS
In 2009, Amy E. Coplen, RDH, EPDH, MS, joined the faculty at Pacific University School of Dental Hygiene Studies in Forest Grove, Oregon, after completing a Master of Science in Dental Hygiene degree from the University of Michigan in Ann Arbor. She is now a tenured associate professor and program director at Pacific University. Coplen is passionate about increasing access to care among underserved populations. Her research interests include interprofessional education and exploring alternative dental workforce models to reach individuals with limited access to dental care.
Q What sparked your passion for improving access to care through a dental therapy model?
A The first time I was introduced to dental therapy was while taking a “Current Issues in Dental Hygiene” course during graduate school. We learned about the New Zealand-based Alaska dental health aide therapist and the advanced dental hygiene practitioner. I was completely fascinated with the idea of a midlevel provider. Over the years, I have grown to support both models as evidence-based ways to bring oral healthcare to currently underserved populations. Beginning my career as an educator at Pacific University was what solidified my desire to help bring access to care to underserved populations. The curriculum is designed to prepare dental hygienists to practice independently in a variety of public health settings. In 2011, legislation passed in Oregon to that allowed the implementation of pilot projects that explored new workforce models to increase access to oral healthcare. Through the work of my predecessor, Lisa Rowley, CDA, RDH, MS, we began to develop a dental therapy pilot project designed to teach practicing dental hygienists with a restorative endorsement the additional skills of a dental therapist. As our state was approved for pilot projects specifically seeking innovative workforce models to increase access to care, we had the unique opportunity to try something that has never been done before. I began working closely on the dental therapy pilot project when it was still in the approval process in 2018. I am pleased to say we began educating our first cohort of dental therapy trainees in 2020. Being part of the dental therapy initiative has been one of the greatest privileges of my life. However, working on this project has also been one of the hardest things I have ever done. The obstacles and opposition continue to be very real, but the idea is definitely gaining momentum. I am willing to embrace the difficulties and push forward for the chance to bring oral health to those who desperately need it.
Q What do you think the provision of oral healthcare will look like in 10, 20, 50 years?
A I have no idea what the future of oral healthcare will look like, but I can honestly say, I think the future is bright. Within the next 10 years, I foresee the number of states with legislation allowing dental therapists to practice at least doubling. I am hopeful Oregon will be one of them. In the next 20 years, I think we are going to see the number of accredited dental therapy programs across the country increase. I hope we will see the use of teledentistry expand exponentially. Teledentistry could be a real game changer when it comes to access to care, allowing direct-access dental hygienists and dental therapists to bring preventive and therapeutic treatment to all populations. With the increase of dental therapy, direct-access dental hygiene, and increasing interprofessional practice settings for oral health professionals over the next 50 years, we have a real shot of bringing oral healthcare to every corner of every neighborhood, not just the affluent ones. It will take a lot of “movers and shakers,” though, which are really just ordinary people committed to advancing a cause.
Crystal Spring, RDH, BS, LAP
For the past 22 years, Crystal Spring, RDH, BS, LAP, has been wildly passionate about her work and the dental hygiene profession. Growing up on the Fort Peck Indian Reservation in Northeastern Montana, Spring noticed early on there was a desperate need for access to care. Living in an impoverished area and watching many of the people she loved struggle financially, emotionally, and physically profoundly impacted her desire to work in public health. In 2014, Spring started her own business working as a dental hygienist in assisted living and skilled nursing facilities. Later that year, she contracted with the Fort Peck Tribes to work in school-based clinics 1 week a month. And in 2017, she joined with another dental hygienist to start the nonprofit organization, Smiles Across Montana (smilesacrossmontana.com), which is dedicated to providing affordable and quality preventive treatment, education, and community outreach. Also passionate about the American Dental Hygienists’ Association (ADHA), Spring has enjoyed the support of fellow dental hygiene leaders within the organization that have helped stoke her passion for helping disadvantaged populations access the dental care they desperately need. She is currently an ADHA trustee for District X.
Q How has the experience of growing up on the Fort Peck Indian Reservation influenced your career in public health?
A My experiences have played a big role in the choices I have made and the drive I have for equity in oral health. Once you have seen and experienced the disparity and hopelessness surrounding areas with limited access to care, you cannot unsee them. These experiences have molded me into the person I am, and Fort Peck will always be my home. I am drawn back to the reservation and the culture. It is what I know, and it is where I feel I can make the greatest impact. My hometown is like so many small towns in America, but undeniably different in its sense of community and devotion to its people. Rich in cultural and spiritual values, it has left an imprint on my heart that inspires me to fight for equality, to serve the underserved, and to use my voice for those whose voices have been silenced. Most of my dearest friends, mentors, and many family members are Native American. I have watched the difficulties so many of my loved ones have experienced, driving hundreds of miles and spending hours on the road to receive not only restorative treatment but also the preventive care that so many of us take for granted.
My journey into public health began with the Special Smiles program (my brother was a Special Olympics athlete) and working in nursing facilities (my first mobile clinic was in the nursing home where my Grandma Harriett had spent the last several years of her life). In 2014, Kenny Smoker with Health Promotion Disease Prevention in Poplar, Montana, shared his vision of school-based clinics with me and there was no turning back. I will never forget the way I felt after my first time working in a school-based clinic. I was overcome with gratitude and pride in my profession, and I knew that I had found my life’s work.
Q What inspired you to start Smiles Across Montana and what work does the organization do?
A I had seen firsthand the positive difference that school-based oral health programs make in the lives of children and the communities they serve. Montana is a geographically vast and rural state. There were so many communities that could benefit from services that school-based oral health programs provide. I partnered with Cara Reck, RDH, who also had a heart for public health, and we started working in Head Start programs using our limited access permit. We worked in this capacity for about 1 year. Our patients were graduating into elementary school and the communities were asking our program to serve their older children also. We then teamed up with Nasim Aleagha, DDS, a pediatric dentist in Bozeman, Montana. The addition of a dentist made it possible for Smiles Across America to serve in schools. We then collaborated with Leslie Hayes, DDS. Hayes’ passion for equity and serving on Native Lands is inspiring to say the least. Kirk Stetson, DDS, joined our team. He served as a dentist in the Air Force and in private practice. His compassion for people and his quiet, humble, and agreeable personality make him a perfect fit.
We have five full-time dental hygienists working for Smiles Across Montana currently and we are planning for more in the near future. COVID-19 has prevented the opening of several clinics throughout our state. The addition of each dental hygienist has upped our game tremendously. Melissa Kjos Peterson, RDH; Julie Baylor, RDH; and Jamie Purcell, RDH, have brought so much knowledge and expertise to our program. We are definitely team driven and supported. I am constantly humbled by the success, and growth of our program.
Smiles Across America is a nonprofit mobile and school-based preventive dental program. We provide preventive dental services (prophylaxis, periodontal therapy, fluoride treatments, sealants, X-rays, exams (tele-dental exams when dentists are not present) community and classroom education, and referrals at no cost to our patients or their families. Continuity of care is the key to success in changing oral health outcomes. Smiles Across Montana partners with local dental offices to assure that each patient is receiving the care they deserve on a consistent basis.
I have always been a bit of a “fairness freak” and my work with Smiles Across America and in public health has enabled me to level the playing field among the underserved. I can honestly say that I LOVE my job. I am so appreciative of the American Dental Hygienists’ Association and its commitment to our profession and to our patients. To everyone who has fought the hard fight, lobbied, and hit the streets breaking down barriers that keep dental hygienists from working to their full scope and education, I cannot thank you enough. Your work has made a difference in the lives of Montana’s children!
Rella Christensen, RDH, PhD
Currently, Rella Christensen, RDH, PhD, leads TRAC Research, which is part of the nonprofit educational Clinicians Report Foundation, an organization she co-founded and directed for 27 years. TRAC Research is devoted to oral microbiology, minimally invasive dentistry, and dental restoratives research. Throughout her career, Christensen’s work has focused on the development of practice-based controlled clinical protocols to monitor treatments and outcomes as they occur in actual clinical dental offices. A practicing dental hygienist for 25 years, she also worked as a laboratory technician fabricating cast gold and ceramic restorations, in addition to founding and directing the Expanded Function Dental Hygiene Program at the University of Colorado School of Dentistry in Aurora. Earning a PhD in physiology with an emphasis on microbiology from Brigham Young University in Provo, Utah, Christensen also completed post-graduate training at Virginia Polytechnic Institute and State University in Blacksburg under the W.E.C. Moore team, noted pioneers in anaerobic microbiology. She has taught at the undergraduate and post-graduate levels, authored many research abstracts and reports, and received numerous honors.
QWhich research topic has most fascinated you and why?
AAlthough my teams and I have had the opportunity to delve deeply into many different topics of high relevance to dental clinicians over my many years in practice-based product and technique research, for me, oral microbiology has been the most fascinating. I am appalled at the incredible concentrations of the microbes we are finding in saliva, dental caries lesions, and periodontal pockets. We have developed techniques that allow us not only to quantify the organisms present, but also to identify them by genus and species, and map their locations. This work has helped me gain new insights into why some treatments we render as clinicians sound logical but do not result in successful outcomes. It turns out that microbes are far more numerous, resilient, and sophisticated than we were all taught.
In our work, we see the incredible abilities of the microbes to insure their survival. They communicate with each other, they move back and forth between aerobic and anaerobic pathways, they develop ways to evade our chemicals, and they have an unbelievable capacity to increase their numbers rapidly over short periods of time. Because their size renders them invisible to our eyes, we like to think we have eliminated them. I am sure we have all wondered why the pathologies we have worked so hard to treat sometimes improve, but do not resolve. We wonder why we end up managing diseases, but we can seldom claim a cure. I believe future microbe research will reveal answers to these dilemmas.
I believe dental hygienists are uniquely positioned to be at the clinical forefront of oral microbiology in the future. Everything we thought we knew about microbes is changing. Molecular biology techniques are changing the microbes themselves, as well as using microbes to edit parts of the human genome that code for pathologies. To me, this is indeed most fascinating!
From Dimensions of Dental Hygiene. December 2020;18(11):22-25.