The Root of the Problem

The Oregon Dental Association requested that lawmakers address the shortage of dental assistants and dental hygienists in the Beaver State. Thus, House Bill 2979 was written. It asks lawmakers to appropriate $20 million toward increasing the number of dental assistants and dental hygienists in Oregon. It does not mention dental therapists; the licensure of dental therapists has been legal in Oregon since 2021. However, the state does not have any dental therapy education programs.

The bill stipulates that the $20 million be divided into five areas:

1. $5 million to community colleges in grants for student scholarships, expansion of programs, recruitment, etc
2. $5 million in grants to school districts to promote and develop technical education programs for dental professions
3. $7 million to increase and retain dental professionals in rural areas, low-income communities, and tribal lands
4. $1 million to promote entry into dental professions by Indigenous people in Oregon
5. $2 million to state workforce for development of education modules to train dental assistants on the job

I read written testimony from the public, of which eight supported the bill and 28 opposed it. Most of the opposing testimony came from dental assistants, who stated that training modules were already available and the $2 million would promote uncertified dental assistants. A dental hygiene faculty member wrote that the bill excluded university dental hygiene programs, of which there are two in Oregon, and didn’t provide any money for dental therapy programs.

Beyond Funding Education

The total ask—$20 million—is a lot of money. Are there other ways to increase the dental hygiene workforce besides funding education? Let us first consider the reasons why dental hygienists dropped out of the profession during the COVID-19 pandemic.

I believe that fear was the main reason dental hygienists left the workforce. In the beginning of the pandemic, limited personal protective equipment (PPE) was available, vaccinations had not been developed, little or no knowledge existed on what the virus did to the body, testing wasn’t widely used, and there wasn’t a way to know if patients were infected.

People were also dying from COVID-19. States closed dental offices and dental and dental hygiene school programs, which heightened the fear. Masks became mandatory and staying 6 feet apart was encouraged. Limiting the number of people to whom you were exposed was advised. How did any of these mandates or recommendations fit into dental hygiene?

Then, it was announced that aerosols were the predominate way SARS-CoV-2 was spread. We were advised to reduce aerosols by using hand instruments instead of ultrasonics and to avoid polishing.

Extraoral devices that vacuumed away the aerosols were in high demand, while gadgets that attached to high-speed suction became the rage. At the same time, many dental hygienists did not have health insurance or paid sick days offered through their employers, which added to the unease.

When “dental hygienist” was named the most at-risk job for contracting COVID-19, it legitimized what dental hygienists must have been thinking: we are not safe at work. Therein lies the reason for the mass exodus from the workforce. Research also supports this idea, according to a survey of dental hygienists by the American Dental Hygienists’ Association and American Dental Association, “safety concerns for self and others were the primary reasons for hygienists not returning to work.”¹

I believe dental hygienists want to know—with certainty—that the dentists who employ them will protect their health. We need to be provided with measures that ensure safety in the workplace. We must be confident that the air we breathe while working is safe for our patients and ourselves.

Moving into the 21^st Century

Dental hygiene is thought of as a “pink collar” job (ie, stereotypically dominated by women). The image of a dental hygienist as a wife and mother, in other words, one who is not the primary breadwinner, is outdated.

We want paid sick days and health insurance, in case we need treatment for contracting a respiratory infection from our 6-inch proximity to the oral cavity. We want PPE, HEPA filtration, aerosol-reducing devices, and patient screening so we are not exposed to those who are sick.

Shortage Is Ubiquitous

The shortage of dental hygienists extends across the United States. Our federal lawmakers should be eager to cross the partisan divide in order to solve problems for the American people, and the healthcare worker shortage is high on the list of areas on which both sides can agree.

We, as dental hygienists, have much to gain in terms of changes that would benefit our profession. We need to make federal health committee members aware of our needs. They want to know what will grow the dental hygiene workforce. On the individual, local, state, and national levels, dental hygienists must ensure our voices are heard to enact the necessary changes for our profession.

We have a duty to all the dental hygienists who will come after us to fight for changes that will pull us out of the “pink collar” stereotype and guarantee us a safer, healthier, more valued profession.

Reference

1. Morrissey RW, Gurenlian JR, Estrich CG, et al. Employment patterns of dental hygienists in the United States during the COVID-19 pandemic: an update. J Dent Hyg. 2022;96:27–33.

From Dimensions of Dental Hygiene. April 2023; 21(4):16-17.