Dental Hygiene Educator Works to Ease Vermont’s Hygienist Shortage

The state of Vermont is struggling with a severe shortage of dental hygienists. Vermont has only one dental hygiene school, and one of its professors Heather Blair, MPH, RDH, FADHA, is working to bring more clinicians into the profession. She is the co-coordinator of the Dental Hygiene Department and an assistant professor in the Oral Health Sciences Department at Vermont State University in Montpelier.

Blair began in the field of oral health as a dental practice manager, then working in clinical practice and as a “tooth tutor” in three elementary/middle schools as well as Head Start programs. She became involved in dental hygiene education. Today, she is responsible for the initiation of the medical/dental integration rotation with the University of Vermont Medical Center Children’s Hospital and a clinical rotation within a middle school for senior students delivering onsite care. Blair has worked in the profession of oral health/dental hygiene for 25 years.

Blair has worked to lengthen the state’s dental hygiene program from 2 years to 3, grow class sizes, and prevent a boomerang effect with a flooding of the employment market. She recently shared about her career with Sunstar Ebrief.

• What was your path to becoming a dental hygienist?

I took a nontraditional path to becoming a dental hygienist, beginning as a business manager in a dental practice. We were a small office and, from time to time, we all pitched in to help, so we all were cross-trained. We all could answer the phone if our patient coordinator was unavailable and if our dental assistant was out, then I would step in to help the dentist. I found that I really enjoyed working directly with patients.

The dentist I worked with had a background in public health, which impacted the way she practiced. In the mid-2000s, our office was invited to participate in the Practitioners Engaged in Applied Research and Learning network, or PEARL, a practice-based research network through New York University. Our dentist was the principal investigator and I was the practice-based research coordinator. During our involvement with PEARL, we attended the annual meeting, where the results of the practice-based research were shared. The meeting was fascinating, and I realized that I didn’t just want to report the data but wanted to develop the skills and training to collect the data.

A calling toward public health also influenced my decision to become a dental hygienist. I had been administering my children’s fluoride mouthrinse program in their elementary school on my day off but wanted to do more. I realized that I needed to expand my education and become a dental hygienist – the disease prevention and maintenance specialist of the oral health profession.

• What drew you to higher education?

A year after graduating from dental hygiene school, I had reached my initial goals of working in clinical practice, serving as a tooth tutor in our local school system, working with Head Start, and entering a Bachelor of Science in Dental Hygiene (BSDH) program. During that time, I was also invited to join the dental hygiene faculty at Vermont Technical College as a clinical associate, working directly with dental hygiene students during their clinical sessions. I fell in love with not only reinforcing my own skills and knowledge, but helping my future peers and colleagues learn and grow their skills and confidence. When they had a great day in clinic, I felt like we both won; when they struggled in clinic, I felt would strive to learn better ways of delivering instruction, encouragement, and reflection.

I really enjoyed public health and going to where the children were, whether it was at their school, health fairs or home visits; there were so many ways to help families overcome their barriers to receiving oral healthcare. However, I also realized that while the difference I made in the individual lives of the families I worked with was significant, I felt like I could make an even bigger difference if I could share my passion for providing services to the disadvantaged populations with students.

During this time, I completed a BSDH but realized I would need to continue my education to obtain the right credentials so I earned a master’s degree in public health. During this time, we also saw many changes across the country in the dental hygienist’s scope and areas of practice. Our dental hygiene program then transitioned from a 2-year Associate in Science (AS) degree to a 3-year AS degree with a fourth year online to complete a BS. The drivers of this change were to improve our attrition rate, to make the curriculum more manageable for students, and to add some experiential learning experiences. We developed a middle school-based direct access rotation and a rotation at our Children’s Hospital where students work with patients and their families.

As educators, we are not just teaching our students to work in a clinical private practice or federally qualified health center setting. We also want to educate our students about the opportunities in alternative settings, such as direct access setting in schools or assisted living facilities, public health with WIC (women, infants, and children) families, and dental hygiene education.

• What has prompted Vermont’s dental hygienist shortage?

It seems that COVID-19 is taking the hit on this one, but I don’t believe that is entirely the case. COVID absolutely affected our workforce, there is no doubt about that! However, other factors have also played a role, for instance, many dental hygienists would graduate to find they had to split their time between two offices if they wanted to work full time, because there were no full-time positions available. In the past, many private small dental practices may not have been able to offer a competitive wage and benefits. Many hygienists had not seen their wages increase in years. In fact, there was a time when if you wanted a raise, you just needed to find a new office.

Some work environments were not always ideal with dental hygienists being tucked away inside operatories not designed with good ergonomics in mind and their instruments may not have always been replaced in a timely manner. The treatment we provide is physically demanding and repetition often has led to repetitive strain injuries for many hygienists. This has led to shorter clinical careers. We have also seen dental hygienists leave the field because they wanted a career change.

Vermont, for many years, had the largest percentage of dentists nearing retirement without enough new dentists to fill those gaps. Many of those dentists had small private practices and would only work a 4-day work week. Our state dental society has done a great job recruiting dentists in the past few years, and we have had many new dentists come to Vermont and purchase or start practices. To increase access to care, many of these dentists expanded their days and hours of operation, thus, increasing the need for dental hygienists. These factors have now led to a dental hygiene shortage in our state, and seemingly every other state in the United States. This wave has an ebb and flow, and in time, this will level out.

• What strategies has the dental hygiene school used to ease this shortage?

It all begins with our admissions department vetting candidates and offering admission to the strongest candidates for the dental hygiene program. In the past, we have experienced retention issues in the first few weeks of the semester. Students were unprepared or unaware of the rigors of the curriculum and did not have adequate knowledge about the dental hygienist’s scope of practice. We have addressed this by meeting with admitted students a number of times prior to the beginning of the fall semester. In late April, we hold an information session over Zoom to discuss the program’s expenses, requirements, rigor, and commitment necessary to be successful. In late June, we have an in-person orientation to introduce them to the university and faculty; discuss their individual curriculum maps; order their loupes, scrubs, and over garments; and make a personal connection. Prior to the fall semester, we have incoming students complete an observation in their local dental practice to observe a typical day in the life of a dental hygienist. Finally, we have an experienced and dedicated dental hygiene faculty that supports our students to foster and encourage their individual success.

• What do you think the employment market for dental hygienists in Vermont will look like in the future?

Right now, it is a great time to be entering the profession of dental hygiene. Dental hygienists are earning competitive wages, enjoy robust benefit packages, and, most important, are being recognized for the education, experience, and contribution that they bring to the oral health team and field of oral health science.