Starting out

Jeanette: I left school at 16 and planned to join the Army or Royal Air Force. I had to find employment until I was old enough to join the Women's Royal Air Force (WRAF) and saw a job advertised at a local dentist's for dental nurse/receptionist. It was close to home and I thought ‘oh that will do me for a year until I'm 17-years-old’. I had previously considered general nursing so had an interest in health care.

I worked in Crossgates, Leeds for a dentist who had three practices. I really enjoyed the contact with people, and being in a health related profession. However, I was not too happy with ‘clearances’, the removal of all teeth and replacement with immediate dentures. These happened fairly regularly under general anaesthetic in the surgery with some heavier patients being strapped into the chair to keep them ‘safe’! I can still hear the sound of extracted teeth being dropped into a kidney dish whenever I'm at the hairdressers and hear plastic perm curlers dropped into the sink! Perhaps my enthusiasm for prevention rather than cure was initiated in Crossgates?

Gemma: When I first left school I went to Sixth Form College to study A-levels in English Literature, Media Studies and Government and Politics and worked at weekends in a photography developing shop.

After my A-levels I enrolled at Manchester Metropolitan University on a Humanities degree course, but I left after three months, as I knew it wasn't the path I wanted to pursue. I decided I needed a job while I made my mind up and went to the local job centre where I saw a vacancy for a trainee dental nurse. I went for an interview the same day and got the position. I shadowed a colleague for a week and was then put in with the dentist and learnt as I went along! I worked in this NHS practice for six months and began my NVQ Level 3 Oral Health Care: Dental Nursing.

Jeanette: The dentists I worked for in Crossgates trained me in the surgery. I don't recall there being a recognised qualification for dental nurses in the 1960s. However, when I joined the WRAF I had to complete a three month initial training course for dental nursing prior to beginning a dental hygienist course.

From nurse to hygienist

Gemma: After six months working at the NHS dental practice I moved to a private periodontal and endodontic referral practice. This sparked off my interest in becoming a dental hygienist; Mr Philip Greene who was a partner in the practice and Mrs Maggie Jackson the senior dental hygienist were my inspiration! I applied for the Liverpool School of Dental Hygiene and got accepted for the course starting in October 2004.

Jeanette: When I went to the RAF recruiting offices in Leeds and completed the application tests the officer suggested that as I had been doing dental nursing and had eight GCE O-levels, I should apply to be a dental hygienist. I had never heard of the job!

So, I returned to work and quizzed my dentist, but he didn't seem all that sure either!

Actually for about the first 20 years of my career the majority of my first time patients had never heard of a hygienist.

However, it sounded like a ‘promotion’ in dentistry to me, and I liked the idea of actually being able to work in a patient's mouth (no four-handed dentistry in those days). Also I felt I was ready for a challenge and keen to do some more studying – so followed the recruiting officer's advice.

Gemma: My family were very proud and encouraged me to pursue my goal of becoming a dental hygienist.

Jeanette: I think my family were concerned that I was joining the WRAF, and never quite understood what a dental hygienist was! My parents both had F/F dentures and had never experienced a scale and polish. In fact it was only when my mother heard Jimmy Young on the radio interviewing a dental hygienist that she got excited and started to tell me all about ‘dental fluff’ – she meant ‘dental floss’!

Gemma: I was offered a place on both the Sheffield combined hygiene and therapy diploma and the hygiene only diploma at Liverpool School of Dental Hygiene. I accepted the place at Liverpool, as I knew I wanted to concentrate on becoming a dental hygienist and after visiting I knew Liverpool was the place for me.

Jeanette: I had to go for interviews at the Dental Training Establishment (DTE), RAF Halton in Buckinghamshire. Although a degree of academic capability was required there seemed far less emphasis on this than there is today. Communication skills and personality seemed important with one of my interview questions relating to my ability to knit or sew! Testing out my manual dexterity I guess. I was accepted and after completing the three month dental nursing training I began a 12 month hygienist course.

The wonderful thing was that we sat the same final exams as the civilian trained hygienists and so on leaving the WRAF I was able to work in general practice.

Hygienist training

I can still hear the sound of extracted teeth being dropped into a kidney dish whenever I'm at the hairdressers and hear plastic perm curlers dropped into the sink!

Gemma: My dental hygiene course involved numerous topics such as periodontology, oral microbiology, human biology, oral medicine, radiography and pharmacology to name a few.

I enjoy initial therapy the most: starting with a periodontally compromised mouth and working with the patient to create a more stable environment is the most fulfilling aspect of my job. Changing the way patients see their personal oral health and changing their ingrained behaviour is the most challenging aspect.

Jeanette: My dental hygiene course included general anatomy and physiology, dental anatomy, tooth morphology, periodontology, medical history, instrumentation (no ultrasonic scalers) and dental health education.

The initial weeks of my dental hygiene training tested our patience and manual dexterity via ‘tooth carving’. We were given an extracted tooth and a piece of hard wax and had to carve an exact replica of the tooth. I still have all mine! Dental health education amounted to just 12 pages of an exercise book and the creation of one dental health poster. We did have one day trip to Hesketh House in London, the home of Gibbs dental care products. All our notes were dictated by our tutor, no print outs and I only recall one textbook. We were shown one film relating to maxillofacial injuries sustained mainly by aircrew during the war. It was horrendous. I had to close my eyes but then my imagination proved even more vivid and I almost fainted. We had progress tests every Friday afternoon.

We trained in clinic firstly by removing shellac from door handles, followed by removing shellac from phantom heads. When our instrumentation was sufficiently competent we progressed to working on each other (that was a true test of friendship). Eventually we were allowed ‘real’ patients. These were mainly RAF apprentices who were marched down to the clinic for treatment!

Interestingly I trained ‘BP’ – that is Before Plaque. We referred a lot to ‘materia alba’ when explaining mouth care to patients. I was very intrigued on returning to work after a five year gap whilst my children were young, to find everyone talking about plaque – and had a lot of catching up to do on mouth bacteriology!

Gloves were not available to use when treating patients and masks were optional. We didn't sit down to work, nor stand; we sort of perched on stools. The dental chair was raised by means of a foot pump – no electronics. Our means of lighting was an angle poise lamp.

Dental health education is my favourite part of being a dental hygienist. I like the satisfaction of seeing patients improve their mouth care because I've managed to persuade them that it is possible to do; removing gross deposits so that a patient can see and feel the difference; and achieving treatment for a patient who is ‘terrified’ and has not coped with dentistry before.

It can be challenging not having enough appointment time with a patient to do all that I would like to, although this has improved in the last few years. I also find severe periodontal problems a challenge – and patients with huge tongues!

Professional development

Gemma: I have extended my duties to be able to provide Nightguard Vital bleaching – I completed a British Society of Dental Hygiene and Therapy (BSDHT) one day course. I would like to train to be a dental therapist in the future but for now I'm enjoying concentrating on being a dental hygienist. I would also like to see hygienists being able to specialise in periodontology and being allowed direct access to patients.

I think dental nurses deserve all the respect in the world – I know many dentists who would crumble if it weren't for their nurse!

I always get the comment ‘oh no you're not a dental hygienist are you’ from new people I meet who aren't involved in dentistry. I've met several people who think being a dental hygienist just involves ‘cleaning teeth’ when in fact it's a complex and challenging profession.

I do think that DCPs are now seen as integral members of the dental team and think that registration makes DCPs more credible to patients. I think dental nurses deserve all the respect in the world – I know many dentists who would crumble if it weren't for their nurse! I am glad dental nurses are now recognised as professional people.

Jeanette: In 1976 I was appointed by Marks & Spencer to become one of the 12 hygienists initially involved with their Dental Health Education Scheme and was eventually responsible for 23 stores in Yorkshire. The company provided training in public speaking and communication skills. It was all dental health education with no clinical work involved.

I also trained as a ‘Look After Yourself’ tutor and was able to offer courses in healthy eating, exercise and relaxation.

Some patients that I have treated have thought that hygienists are dentists who have specialised in dental hygiene. However, in one practice where I worked I did receive a Christmas card from the practice cleaner which said ‘Greetings from one cleaning lady to another’. Lovely, and true!

Gemma: In my practice the dental hygienists are treated as associates, but in no way do I see myself as ‘better’ than any other member of the dental team. I'm glad the training of dentists is evolving to involve team-based training; hopefully this will break down any remaining barriers between dentists and DCPs.

Jeanette: I have always felt I was verbally respected by my employers, colleagues and patients. However, in the early part of my career the surgery and equipment provided for the hygienist definitely appeared to be what was ‘left over’. I'm sure one of my early surgeries was a recycled cupboard. In 1980 I joined a practice where there was a designated hygienist surgery and actually stayed there for over 20 years.

When I first qualified I was still in the WRAF and so there was the hierarchy of rank as well as dental status to cope with, and then when I started to work in general practice there was always the acknowledgement that the dentist was ‘boss’ and I would never have addressed him/her by their first name! This has changed over time and I definitely feel that members try much more to work as a team. I think though that the hygienist has frequently had a lonely position within a practice because they are usually the only one there at the time, and in the past have felt ‘stuck in the middle’ with the nurses thinking the hygienist ‘belongs’ with the dentist, and the dentist thinking the hygienist ‘belongs’ with the nurses. In the last couple of years I've had the opportunity to work alongside another hygienist in a practice and it was a very supportive experience.

Because of the isolation felt by some of my hygienist friends they started a regular get together for a meal – ‘Hungry Hygienists’ I call it – where we meet socially but always end up discussing dentistry!

Staying up-to-date

Jeanette: Compulsory CPD has only affected me within the last three years, but prior to this I always tried to stay up-to-date by attending national BDHA conferences, and local BDHA groups (now the BSDHT – British Society of Dental Hygiene and Therapy). I also read professional journals and attend courses when organised by my workplace.

I'll miss the connection with people and the job satisfaction that comes when patients say “thank you”.

I always do the CPD questions in Vital and other journals, but rarely send them in – probably because I know I will be retiring in July 2011.

Gemma: Even before my compulsory CPD cycle started I obtained CPD to keep up-to-date with my profession. Dentistry is an ever-changing world and CPD is essential to keep abreast of new developments. I obtain my CPD hours from courses and journals with verifiable CPD. I do a lot of reading for my non-verifiable hours.

Work-life balance

Gemma: My 2-year-old daughter Shannon goes full time to a private nursery, which she loves. My son Seamus is at home with my fiancé Anthony who is a stay-at-home dad at the moment. Anthony staying at home made coming back to work much easier; I know Seamus is well looked after!

If you can teach a 2-year-old the importance of oral health I think you can teach anyone.

Shannon visits the dentist every six months and is only allowed sweets with meals (this is very rarely!) and has her teeth brushed twice daily with a family strength toothpaste. She's funny; I went into her nursery three months ago to be told she had been teaching the other children how to brush their teeth! That was a very proud moment; if you can teach a 2-year-old the importance of oral health I think you can teach anyone.

Working full time means I spend my spare time enjoying my family. We have a dog called Charlie who we take for long walks; mostly we just enjoy spending time together.

Jeanette: My children only had sweets at weekends and they grew up thinking that you could only buy chocolate biscuits at Christmas! My son would tell his friends that ‘Mum thinks Polo is a “four letter word”’ because all peppermints were banned. And I once resorted to pinning a small label on my 3-year-old daughter (probably considered as child cruelty now) because neighbours would keep giving her sugary snacks and drinks despite my asking them not to. The label read ‘Please do not feed me’. I do feel guilty about that now, but she is 40-years-old now and has no fillings (my son has one filling – probably due to the banned use of peppermints).

Jeanette is asked how she will celebrate becoming a ‘lady of leisure’ when she retires

Jeanette: I don't think ‘lady of leisure’ comes into my vocabulary! I have so many interests; still doing the knitting and sewing (but to ward off arthritis now rather than maintain manual dexterity!); fell walking, gardening, voluntary work with children and young people and I've just taken up flat green bowls!

I will miss dentistry (my husband says he'll miss the money). I'll miss the connection with people and the job satisfaction that comes when patients say ‘thank you’.

It has been the most wonderful career, and I know I'm probably looking at it through the rose coloured glasses of retirement but considering I fell into dentistry almost by accident, it has just been the very best profession for me and I will always be grateful for the inspirational training received from the staff at Dental Training Establishment, RAF Halton.

Vital would like to thank Jeanette for putting forward the idea for this article and wishes her a happy retirement.

Interview by Kate Maynard