Dental Hygiene Transformation in 2020





By Lexi Marino December 23, 2020

In this episode, we interviewed Amanda Hill BSDH, RDH and industry educator for DentalPost.net to hear her thoughts on how the dental hygiene profession has transformed in 2020.

Watch this video to learn the following:

  • How our industry can help patients understand why bleeding gums are just as critical as high cholesterol
  • Why the industry should place high importance on cleaning dental water lines
  • Importance of “trustworthy” information sources who are mentors
  • How additional intraoral HVE helps dental teams stay healthy from disease transmission

Rolando Mia, from Zyris, is the host of our series, Dental Voice. In this show, we focus on the latest news, topics, and conversations happening in dentistry and assess differing views across the nation. In Season 2, we’re focused on, “What’s Working and What’s Not”, where we’re debunking myths by assessing trial and error since the start of Covid-19.

Transcription

Rolando Mia: Good day everybody, welcome to Dental Voice, season two with Zyris. My name is Rolando Mia, and today I have Amanda Hill, who’s a registered dental hygienist, who went to Old Dominion. So, how are you? Thank you for joining us Amanda. It’s such a pleasure to talk to you.

Amanda Hill: Well, thank you for having me, I am excited to be here today.

Rolando Mia: So, I want to get right into this, and I have to ask you, because I found out you wrote a letter to Dr. Anthony Fauci, is that right?

Amanda Hill: I did write a letter to Dr. Fauci, yes.

Rolando Mia: Okay, you got to tell us about this, what was that all about?

A Letter to Dr. Anthony Fauci

Amanda Hill: So, it was pretty early on in COVID, and Dr. Fauci was giving a press conference, and he was talking about the health disparities and how certain groups were really more at risk for complications from COVID. And in that, he said that it’s really important when we get through this whole thing, that we really need to look at healthcare and those healthcare disparities. And so, I wrote him a letter to talk to him to let him know that when he’s looking at these healthcare disparities, to not forget about dentistry and to not forget that oral health is whole body health.

I think so often in our nation, when we are looking at the healthcare system, we are only talking about, we take the mouth out, for some reason, it’s out there and then we worry about healthcare from head to toe, but no mouth. And so, I always say that dentistry and medicine had been social distancing before it was cool.

Rolando Mia: So, wait a minute, so did you get a response?

Amanda Hill: I did not get a response from Dr. Fauci.

But you know, you know, this was, you know, I’m sure he put this away for once we get through COVID and then he’s going to call me to be on his task force for us to revamp healthcare and oral care, because oral care is healthcare together, and I’m there for you Dr. Fauci.

Rolando Mia: Oh, well, first of all, I love the fact that there’s a passion and there’s an energy and that you’re willing to do that and everything, are you like a Fauci fan or something like that?

Amanda Hill: I wouldn’t call myself a Fauci fan, I mean, I just like to keep my drinks cold.

Rolando Mia: You have a Dr. Anthony Fauci koozie.

Amanda Hill: I do, after I wrote my letter, my amazing neighbors got me a koozie for my birthday. So now I have my koozie.

Rolando Mia: Oh, that is, okay, so, first of all, thank you for sharing that, that’s incredible.

Amanda Hill: Absolutely.

Rolando Mia: You are an educator and you’re a dental hygienist educator, that’s fantastic. When you look at dental hygiene, and when you look at the message about dental hygiene, what is the top thing that you have to get across or that you educate people about regarding hygiene?

Number One Thing People Should Know About Dental Hygiene

Amanda Hill: I think that hygienists are more than just tooth pickers. And what we are here to do is to help you have health from head to toe that the mouth is the gateway to the body, and that if you don’t have a healthy mouth, you can’t have a healthy body. And I think that’s really important, and I think the public is finally kind of jumping on board with us, which is great.

Media’s finally pulling in some of those things, but I knew this back when I graduated from high school or college in the 90s, but it was really hard to convince people of that. You know, decay doesn’t hurt until it’s really bad. But cholesterol doesn’t hurt either. And yet, somehow, we think cholesterol is important, or we know that cancer doesn’t hurt until it’s really bad, but we would definitely deal with cancer the moment we heard about it, but bleeding gums, they’ve always bled, it’s not a big deal.

So, to really help patients understand that actually now bleeding gums is a big deal.

Rolando Mia: So that’s the, oh, holy cow, I love the context between, there are all these other things that don’t hurt until it’s a, well, the same thing with the advent of COVID, with the advent of this coronavirus and the scare. I mean, think about it, talk about psycho scare five, six months ago when it all just broke out, hygiene was literally at the top of the heap of risk.

So now you’ve got people who don’t really pay attention because, you know, I’m one of them. And then now hygiene is up there. What’s kind of the, what’s the experience that you’re seeing, or what’s kind of your thoughts around exposure, risk, coronavirus, all that and hygiene?

COVID-19 Made Us Listen in Regards to Infection Control

Amanda Hill: So, the biggest thing I think that we need to do is step back and remember we’ve actually always been at the top of that risk ladder.

So, I just, in fact, just went back and I was reading a journal of the JAMA, Journal of American Medical Association, JAMA, their journal, and it was a 2004 article written by John Molinari talking about aerosol versus splatter and the risk to dental hygienists. So, this was 2004. And if you read it today, you’d have been like, “Oh, that was written like yesterday, right?” So, the conversation has been happening, we just didn’t listen.

And so, I think COVID-19, what it really did, is it made us start to listen a little bit more, and you know what? We needed a listening. Like we needed a good talking to, and it was time for us to start paying attention. So, I think that’s the first thing.

I have temped in many offices, I’m a military spouse, I’ve lived all across the world, and I have yet to be in an office that has perfect infection control that’s doing all the things. And I think COVID was a great time for offices to say, “Oh crap, like we’ve been supposed to be doing all these things, like we better do some of these things”, and patients are getting smarter and they’re saying, “Hey, are you doing this? Like, you know, you’re supposed to be taking my temperature, you’re supposed to be doing this.”

I mean, so I hope that through COVID, that some of these changes happen where infection control is much more noted. I hope that the front desk never ever once again utters, “Don’t worry, you can come in if you’re sick, she wears a mask.” Like I never want to hear those words come out of a front desk ever again in my life.

We need to start being smarter about not just PPE, because really PPE is the, that as the last layer of defense, we need to think about those environmental controls and we need to think about patient screening and all those kinds of things, and we should have been doing that long before COVID.

Rolando Mia: So, then there’s been so much talk, you know, kind of dovetailing into the comment that you mentioned about, you know, you’ve been in so many different clinics or offices and nobody does infection control perfectly. It makes sense that COVID is bringing this more top of mind.

There’s been a lot of dialogue and it continues, where hygienists are feeling apprehension, fear, I don’t know what the word is, but are not fully comfortable because offices are not, you know, really, I don’t know, would you say they’re not taking it seriously, or they believe, or there’s a belief that things are okay? Cause we talked to a lot of offices who were way over the top in safety, but as it turns out, there are also a lot out there that are not, is that what you’re seeing?

Having Tough Conversations When You’re Uncomfortable

Amanda Hill: Absolutely, I mean, you have some older dentists, they’re like, “Ah, I made it through AIDS, I don’t need to worry about this.” You know, and you’re like, we still need to do these things. And then you have offices where, you know, we’re walking around in like space suits and we look like astronauts.

And so, and I’m not saying that, you know, that that’s wrong, but we definitely need to figure out what the entire office is comfortable with, definitely need to follow the guidelines. You know, the CDC guidelines, whether your state has adopted the CDC guidelines as required or not, they’re good guidelines. So, you know, look to those guidelines.

I think the big thing about hygienists, assistants, front desk, you know, not feeling comfortable, is there are some offices out there that aren’t having the conversations as a team, and this really has to be a team effort, everybody needs to be able to voice their concern, their opinion, talk about what they heard, there’s so much sort of false, you know, narratives out there, and then there’s real narratives and then we change, we have guidance and interim guidance, and what does all that mean?

So, to be able to sit down and have a thoughtful discussion that involves critical thinking, where you figure out what’s the best for your office, is really key. I think when somebody just says, “This is the way we’re going to do it, and you’re coming back tomorrow and you’re doing it.” That’s where a lot of the breakdown has occurred.

And so the office that came back slowly, that they had many offices, I know I’ve lots of friends where they had like a test day, where they just brought in their family and they, you know, did dental work on their family members and they cleaned their family members teeth, but they got to try on the PPE, they got to feel what it was going to feel like, they slowed down a little bit, they didn’t, you know, they weren’t seeing somebody every 50 minutes, cause I got to tell you, that that PPE is tiring. I mean, no matter how you slice it, it’s hard.

Last week I was in the op and I had my N95 and that thing got put on at 8:00 AM and it didn’t come off until 1:30. I never took a sip water in that amount of time because it was just, I didn’t have time, it was attached to my face. So, I get where the fear comes from, but I think that we need to be really smart about how we treat patients and how we treat those protocols.

And those protocols I was talking about, about our environmental controls that we think about, not just your PPE and what you’re doing, reading your instructions for use on your disinfectant, making sure you’re using these things like they’re meant to be used. I think so many of us assume that new product works just like the old product when it totally doesn’t. So those are really important things. Did I get off topic? I might have.

Rolando Mia: No, that was perfect, thank you for sharing that. I hear it from both, actually all sides, there seems to be a dichotomy with regard to the engagement and the practice, the ones that are doing incredibly well and doing what you mentioned, and then there’s a population out there of hygienists and dental assistants who work in environments where they’re not comfortable and there’s friction, there’s quite a bit of friction.

What advice would you give those folks who are in that environment? How do you overcome that initial, you know, to say, “hey doctor, he, she, they, I need to talk to you.” What advice would you give those folks?

Having the Courage to Speak Up to Your Boss

Amanda Hill: So, first off, you know, take a deep breath and get your courage up because it’s really hard to have those difficult conversations, but if you’re not willing to have those difficult conversations, then that means you have made the decision to be stuck.

So, you have to decide like, “Okay, all right, I’m going to be brave”, and so you’re ready to be brave. And so, come to your doc, not in front of a patient, not when you’re rushing from patient to patient, but say, “Hey doc, I really have something I’d like to talk to you about, can we set up a time?”

Then when you talk to that office manager or that doc, whatever, use a lot of I statements, “hey, I have been reading this, I have some concerns about this, I would feel more comfortable if we had this to help me treat patients.” So, a lot of “I” statements, but try to base your I-statements and some facts. There’s a lot of great data, a lot of great information out there. And so really find ways to bring that conversation.

I got to tell you just complaining on a Facebook forum or complaining, you know, the front desk and the hygienists hiding in the back room complaining is not going to move the needle forward, it’s actually only going to like increase your angst in your chest and, so you have to decide, and it’s hard, I’m not the one telling you that, you know, this is easy.

It is hard to decide that you want to have that, that sort of confrontational conversation. But when you come with, you know, kind of open heart and that “I” statement, it really should help diffuse the situation, and hopefully that will open those lines of communication.

Maybe you need some sort of high-speed evacuation suction, like that’s the thing that you’ve decided you really need or maybe you need new hand instruments or, you know, there’s something that you need that you’re not getting, and help them understand why.

Rolando Mia: That’s cool, yeah. I could see how, anytime you’re approaching a difficult situation, it does get, it gets difficult, and I think it’s important to really frame it. Makes sense, makes sense.

So how did you overcome or did you have fear going back?

The Role of Oral Health in Overall Health

Amanda Hill: In the beginning I was like, “No way, forget that, like I’m not going back in the op, I’m done.” That was just sort of that initial thing. And then I remember that, you know, oral health is whole body health, and, you know, thankfully the news media reminded me with these great studies that are coming out that talked about, you know, poor oral health leads to more extreme COVID response, you know, and I remembered these things and I remembered why I got into hygiene to begin with.

So, I got back to the remembering, but it was easy, it was easy to get sucked into the fear, there was just so much fear, and I think the big thing with COVID is, you know, as a hygienist, as a dental professional, we base so much of what we do in science.

You know, I mean, I can rattle off some good science about periodontal disease, and I can rattle off some good science about, you know, diabetes and COVID didn’t have the science, like I couldn’t rattle off any science, and what I thought was science one day but got debunked the next day and got contradicted the next day and that was scary, there was no hard data to hold onto. And so, I think that was part of what made it scary.

Once I was able to kind of take a minute and settle down and remember, you know, why we do what we do, and then I think being told I was non-essential, I think I might’ve gotten a little, like “What, hang on, what do you mean? I’m essential.”

So, a little bit of that also kind of probably came into play too, but remembering that, you know, oral health has whole body health and how important it is that we be that sort of beacon for patients. And sometimes, you know, maybe we’re the first health care professional that they’re willing to see post COVID. And so really trying to help them remain healthy.

Rolando Mia: So how did you separate everything that you were hearing, I’m going to call it the hysteria and craziness with fact, how did you separate what was real and what was, fact versus fiction?

Amanda Hill: I just listened to my buddy Dr. Fauci. So, I do think, I mean, it was taking a little bit of time to look to those professionals that you already trust. You know, the people that the infection control experts that I already trusted, John Molinari, you know, what was John Molinari saying? What was Shannon Mills saying? What was OSAP saying? You know, what were they telling me?

Because I know that when they’re talking, they’re not going to talk from a place of pushing a product, they’re not going to talk from a place of trying to get back into the op before the op was ready, because I think that’s where a lot of hygienists and assistants got spun up, is that offices were rushing back without the proper PPE, without any new infection control practices in place, without critically thinking through the process.

So, I look to those people that I knew were going to do that critical thinking and we’re going to do it databased, and we’re going to do it based upon the science, the best science we had at the moment. And then weren’t afraid to say, “okay, I know we said that last week, but now we’re changing it because we have new science.” That’s how an emerging disease works.

So, I really kind of leaned on them and tried to stay away from some of the Facebook forums and certainly stay away from the national media, which, you know, was feeding all sorts of stuff into my brain and it gave me an angst, and so I had to step away from that.

Rolando Mia: So, appreciate that. It makes sense. The other thing that everyone is talking about, and it’s interesting, HIV was all bloodborne. So, we got into the gloves and the mask and all that and there’s been a lot of, you know, people got comfortable with that, but all of a sudden, the fact that there’s a question whether or not COVID is an aerosol, all of a sudden aerosol became a huge thing because fomites, wipe it down, right?

Droplets, great, wipe it down, cover yourself. But then all of a sudden, now you’ve got this aerosol. How did you or what are your thoughts on aerosols and how is that affecting kind of how you’re treating patients and kind of the experience that’s happening around that?

Dental Aerosols and the Research Behind Them

Amanda Hill: Yeah, so aerosols, and particularly because we don’t, still don’t understand, you know, how long does COVID live in the air, is it 15 minutes? Is it seven hours? Like, I don’t understand. How far does it go? Is it going to go five ops away? Is it going to just stay in my op?

Like, and so I think that that’s where some of that, there’s residual fear that exists, hence the N95 mask and so, you know, now I have an N95 mask, I have a level three mask, I have a face shield, I have my loops, then I have a face shield, then I have a lab coat that isn’t coming off, you know, and then disposable lab coat, you know, so there’s a lot, like it’s a lot to put on.

I’ll be interested as the science goes on, where we settle. However, one of the big things that I had started to do kind of pre COVID, but not all the time, was high-speed suction. And you know that article that I mentioned that John Molinari did back in 2004, he talked about the importance of hygienists when using ultrasonic scalers, when using air water syringes, when using air polishers that we should be using high evacuation section.

That was 2004, that was a long time ago that that recommendation came out, I never heard that, I missed it. I don’t know where I was, I was having my third baby, I think. And so, I totally missed that recommendation, but so now I’m figuring out ways to incorporate high evacuation suction into the whole appointment. It should have been there to begin with.

And so, if that’s the big change that comes out of hygiene that we now realize, like you throw that in. I was reading the stats in the article that John Molinari posted. And he was saying by bringing in high evacuation suction while using the Cavitron, you reduce aerosols 98% from an ultrasonic scaler or a powered scaler and air water syringe 99%.

Importance of Cleaning Dental Water Lines

So, but another big study that came out in the journal Periodontology just this past summer, took, they captured the aerosols within an operatory and figured out where the aerosols were coming from. And the vast, vast majority of those aerosols are not coming from aerosolized saliva like we imagine, in our brain, we imagine you put that ultrasonic in and every single spit particle, just gone into the universe.

But in reading this study, I really understood it even more today that ultrasonic scaler is shooting out so much water. That’s actually the vast number of aerosols that you’re consuming, that you’re breathing in, your patient’s breathing in, are coming from your dental unit water lines. So, a huge thing, if you are not testing if your office is not testing your dental unit water, you got to start like today. Look, I have, I’m a huge fan of dental unit water line testing scissor, quick pass water tests from ProEdge. And you just fill this little guy with water.

You can even do a pooled sample, so you can do a little bit from your air water syringe, a little bit from your ultrasonic scaler, anything that has water in your op, you fill it up with water, you put that guy in, you lay it down for a minute, then you dump it out and you let it sit for 48 hours and then it’ll grow the colony forming units, and then you can tell whether your water is safe or not.

And if it’s not, you need to shock your water and you need to maintain your water. That’s what you’re breathing, way more of what you’re breathing your patients aerosolized saliva. Not that that’s not important, but way more water from your dental unit water line. So, way more legionnaires’ disease, micro bacterium, pseudomonas, all kinds of yucky stuff. I know, right?

Rolando Mia: Wow, it’s interesting.

People show these instruments, high-speed instruments, and there’s all this stuff coming out and that’s not even coming from the patient, that’s coming from the waterline. So really appreciate it.

How do you, with regard to the things that you’ve seen, you personally have seen, for getting rid, in addition to HVE, are there other systems that you’ve seen or used that are effective or you feel comfortable with?

Importance of Secondary HVE

Amanda Hill: So there definitely are those extra oral units. I haven’t actually used one yet, you know, they have like, they bring in the, they roll in the little cart and it sits over the patient’s head, the office where I currently work, they are actually the field test for a new product called Life Air. And it’s actually a whole HVAC system that’s cleaning the entire offices air, changing the air over faster.

They use it in vitro fertilization labs, which is interesting, so, you know, so they’re really trying to turn over, the HVAC is turning over that air really fast so that, you know, if COVID lives in an aerosol for 16 hours, if you’re changing over the air, it’s not living that long within your ops. So, I’ve experienced that.

I can’t say that, like I walked into the office and I didn’t feel or notice a difference, but, you know, they tell me it’s working, I don’t know. But definitely, and then I certainly using preferences for our patients. So perhaps we’re decreasing some of the, you know, some of the bacteria in their mouth. I do question how quickly our saliva changes over though, and how effective that is. But you know what, it’s not going to hurt us.

So why not try that as well? So, there’s definitely different things out there that people are trying, that people are happy with to do. But I really think that high evacuation section, with that bigger bore hole, cause that’s the big thing, right? That’s your wheelhouse, right Rolando? Is understanding like the low speed doesn’t have a big enough, right? Isn’t that the term borehole, is that the right?

Rolando Mia: Eight-millimeter borehole? Well, it’s a function of the suction. So, and saying your suction system is really critical because if that’s not sucking well, it doesn’t matter what you have, right?

Amanda Hill: Suction doesn’t suck, it sucks.

Rolando Mia: Suction doesn’t suck that we’ve heard layering different systems because not every single one of them is a silver bullet for the guard to that. Have you seen any of that type of stuff?

Amanda Hill: I have used Isolite before, I have not used the Isolite 2.

I adore it. Oh my gosh, it is the greatest, it is the bomb when placing sealants too, oh my word, talk about a dry field, so glorious.

Rolando Mia: So, let me ask you this, in the context of COVID and everything that we’re finding out, how do you see this affecting us going forward? Do you think they’re going to be a lot of changes that are still going to be coming down the road with regard to how we’re doing, or do you feel just doing more and being a lot more mindful of what’s going on?

Amanda Hill: So, I think, I think there’s two discussions here. One is what are we doing in the clinic? And I think hopefully, I hope that this brings a whole new awareness to infection control, I hope that everybody is testing their water now. Do you know only 33% of offices test their water? 33, that’s not very many. So that’s a lot of people that are breathing in stuff that, water that maybe hasn’t ever been treated.

So, I hope that we’re getting better at infection control. I hope that we’re, you know, people are, if you’ve never downloaded the CDC app, they have a free app called Dental Check. It’s this cool free app. And you can actually go through and do a checklist in your office to like, pretend it’s almost like being your own inspector and you can see whether you’re doing all the things cause there’s a lot of things to do. And so that really helps you figure out if you’re doing the things.

So, I hope that that’s part of it, I hope that we’re always using high evacuation suction. We should have been using that back in 2004, I mean, per John Molinari.

Changes in Dental Staffing

Now the next question is staffing and what our teams look like. And I think that’s going to change for a little while, at least, at the very least until we get our kids back in school. And so, you know, dentistry is 98% female. Typically, you know, the female is who is taking care of the children. And so, a lot of clinicians, you know, front desk, dental assistants, dentists, hygienists are torn between trying to help their kids with virtual school and trying to be in the op at the same time. And so, I think that ops, the offices are going to have to figure out how to be more flexible.

So, one of the jobs I have of my many hats I wear, is I work for Dental Post, which is a dental job board. And they recently did, they’d been doing job trend reports. And their latest job trend report said that 77% of new grads want to make sure that they have a flexible work schedule. So maybe that means you have a morning hygienist and an afternoon hygienist.

So instead of having a Tuesday, Thursday hygienists like you used to, maybe you’re doing half days, maybe you’re staggering or something like that, you’re doing more job sharing that allow people some of that flexibility that they’re looking for, but offices are having a hard time finding the staff that they need in general.

And I think a lot of that has to do with our children at home. Certainly, some of it has to do with fear as well. And so, I think when offices are searching for someone, a big thing, instead of writing their, you know, their ad to be like, you know, we need a hygienist that will do all these things for us. The ad almost has to flip now. And it almost has to say, we want you and this is what we’re going to do for you, because it’s kind of a job seeker market. And it’s just in how you phrase it.

Like it’s pumping up your office, it’s saying, you know, we brought in the PPE, during shutdown, we had awesome communications, we continued to have virtual happy hours and we, you know, listened to our staff and we respect the education of our dental team members, which I think sometimes in some offices, you know, that doesn’t always happen. And so being able to woo someone to your office, I think is going to be really crucial, at least for a while.

So, I think there’s two, there’s kind of ends to this sort of change and what dentistry is going to look like, but I hope upon Dr. Fauci that we really work hard at connecting whole body health to oral health and that patients really get their help, you know, we can get patients there with us.

Rolando Mia: Really appreciate that. Yeah, I love the context around having an understanding, you know, there is a deficit of hygienists out there now, some retiring, the context of work-life balance has become huge now, especially as you’ve mentioned with kids being home and having to homeschool and having an understanding of that. And then also it’s really important to note too that it’s not just about my way or the highway, it’s about a collaboration and we’re seeing practices that are collaborating really well. That is so cool.

If you were kind of to sum up for our viewers, for people who are here and kind of with regard to hygiene and the dental office, what’s a closing message that you’d like to give folks who are here visiting us and going to be listening to this over the next several days.

Continuous Learning Will Excite Your Dentistry

Amanda Hill: Oh, I think the big thing is always keep learning. And particularly right now there’s so much, so much new information that’s coming out. And so, you know, I think at one point sometimes people view their job as you know, “Okay, I see patients from nine to five and then that’s my job.” But always continue to seek more information because when you know more, not only can you treat your patients better because you have more information.

Remain excited about your profession, about dentistry, remain excited about treating patients, you can feel empowered to be like this amazing difference maker, like I feel like I can seriously do some stuff, like I can help someone because of what I know and that’s truly because I continue my education all the time.

I’m always watching webinars and I’m reading my dental magazines when they show up, and I’m active on dental forums so that I’m understanding what’s new and what’s cutting edge and being able to base that in data and in science, not just on, you know, the fly by night, you know, something that’s true and works. And then being able to understand, like I was talking when a crisis happens or when something new comes aboard, knowing who to look for that is going to be that resource that you know you can trust.

And so yeah, my biggest piece of advice is to never ever stop learning, because if you keep that way, I got to tell you, you’re going to remain excited about what you’re doing.

Rolando Mia: That is so cool, thank you for that. Thanks for everything you said to us. I love the kind of the perspective that you bring here. I love, I learned a couple of new things about it, the waterline, that’s incredible.

So, if people wanted to ask you questions or wanted to kind of learn more about some of the things that you’ve been doing, a presentation, a podcast you’re doing, what would be the best way for them to do that?

Amanda Hill: You know, I’m Amanda Hill RDH on Facebook. I’m amandahillrdh.com is my website. So, you can get me on any of those. Oh, and Instagram, amandahillrdh. Thankfully there aren’t a lot of us, so yeah. So, it’s pretty easy to find me.