Anastasia Turchetta has spent 28 years as a registered dental hygienist in three states, so she has her fair share of stories. Like the patient who went to Mexico to get cheaper dental implants, then walked into her office asking to get them fixed. "It can be gruesome, because you are going to have patients coming in, and their breath will blow you against the wall," Turchetta told ValuePenguin. "There’s no other profession where you lay your head in my lap, consciously, for an hour. I would never get near your personal space like I can in dentistry." We asked the veteran RDH all about what she and her peers do once you're in their chair. It's a lot more than a "cleaning," as she explained.
Why dental hygiene?
I wanted a job that was flexible. I wanted a job where I could serve, but also if I wanted to move, I could move, and still stay in my profession. Because at that time I just didn’t know, am I always going to be in the north? Or am I going to move west? And I wanted to have a career that I felt, not only could I serve, but I’d have a voice in it, particularly if I wanted to go full-time. I also liked the relationships that you would make.
How did you get started?
I actually went to my guidance counselor in high school. He recommended that I reach out to a couple of dental hygienists in the area, which I just did not think about. So I reached out to a couple of dental hygienists and asked them what was their day like, and would they choose what they did again and why? And I chose to actually interview one who was full-time, one who was a mom that was flexible -- because we don’t know what will happen to us in life. And I was really glad I did, because I had a couple of different perspectives.
Then I started looking at different colleges, and I saw one was a two-year college, which I went to, Allegheny College. It’s in Cumberland, Md. There were a lot of other schools to choose from where you could stay another two years and get your Bachelor’s.
What was your experience at Allegheny College like?
I don’t think anybody can ever prepare you for hygiene school.
I call it a wellness visit when you go to a hygienist, I do not like the word “cleaning” at all, especially for 2016. Doing everything we’re supposed to do, legally, I feel that it’s wellness, it’s about health. So, how do you prepare for it? That’s a really good question.
We took sociology, we took psychology and we took English. We took microbiology, nutrition. Then you took dental materials; so we had to take impressions, understand how impressions work. Then we took biology, we took radiology, periodontology, pharmacology -- to cram that in, I cannot even express to you. Then we had to do public health.
My dad was actually my project patient, so he would come in every week. At the time my dad smoked, which is not something you look for, but obviously it’s something you would look at for a project patient. You mark down everything. They had to come in. You learned what instrument was for what; you learned about infection control.
It was really stressful for the two years; I don’t know what it would be like for four. But to have everything so condensed, it was good for me, because you had focus. You were always busy, and it was almost overwhelming. Yet, the community of students and instructors are amazing. They just get it. You’re there to serve, and they just want to help you understand, because it’s going to benefit you when you get out.
What did you have to take care of after graduating to become an employable hygienist?
Obviously you had to pass and prove that you had your license. That was a clinical board; that was called Nationals then. And so you had your board patient, which was physical. And then you had your written, and then you had your state exam. And then once all of that was passed and you were within that particular state, then you could be employable. So what I did was I worked as a dental assistant and a hygiene assistant until I got my license. Because you don’t get your license right out of school. You may pass, but you have to have that paper to work. So I found a gentleman who was going to need a hygienist, and I worked as a dental assistant and as a hygiene assistant until I got licensed.
Are new graduates going through a similar process?
From what I hear from friends who are in it, once they pass, it’s more like, where will they get a job? So when I was going through it, it was very different. I could pick a job, and if I didn’t feel that I was at my best, or maybe that office wasn’t a good fit, I was able to move. Whereas I feel sometimes some places are really oversaturated. So to answer your question, that might be harder for somebody, even if they do pass, to get a job. There’s a lot more saturation; there are more hygienists out there now. It’s still a great job; it’s still a great career; but there’s definitely way more of us than there used to be.
Early on, did you ever question your career track?
My only question was, "Where will I be at my best for my employer?" In other words, I never questioned what my role would be, but I questioned, would I be allowed to live up to that role? Hygienists have to practice the vision and the philosophy of the dentist. So even though I came out and I've been trained on oral cancer screening and everything else, I would have to work under the dentist. And I think that was the only thing I questioned: Would I be able to recognize if this was a fit for me? But I never questioned the profession.
In what kinds of environs have you worked as a hygienist?
I worked in, mainly, one-practitioner practices. In Pennsylvania, it was one dentist, but he had three hygienists. And then I would temp on the weekend, and some of those offices would associate-type dentists. You could tell who ran the building, versus somebody who was an associate that came in and they were newer. And that was interesting. So I got to work with people who were seasoned dentists and new dentists.
Then in Florida, I was mainly temp, and that was really some of the best learning experiences, because I got to see personalities and dynamics. My last position was for a single practitioner on the Outer Banks in North Carolina.
How did you maintain your licensure from state to state?
When I got into the profession, we are able to move from state to state; however, for me to be licensed in New York, I have to take clinical boards again, and the law exam, and the written exam. To be quite honest, I did it when I moved from Pennsylvania to Florida, and then I did it when I moved from Florida to North Carolina, and I just don’t want to do that again! I’ve proved myself after 28 years.
If an RN can do travel nursing, or get into a travel program and provide service, there is no reason in my mind why an RDH couldn’t do the same thing. Now, that being said, if you enter into a state where you allow local anesthetic — applying Novocain, for example, to numb somebody up — then I do feel, obviously, you need to have a course on that, and then pass that. And to take a law exam, to understand that that state’s law is different.
How would you describe the day in the work life of a dental hygienist?
For the first seven and a half years, when I moved to the Outer Banks, the gentleman I worked for was an hour and a half away. So I would leave the house at 6 a.m., and I got home at 6 p.m.. So from 8 a.m. to about 4:30 p.m., I was working.
We had to be there at 7:30 a.m. for a team huddle, where we'd go over the day's schedule or patients: "What did you discuss last time with that person? Did they have an area that either was active decay, and they didn’t get that taken care of? Are they taking any medications that contribute to dry mouth, or periodontal disease? Did they have high blood pressure, cholesterol, diabetes?" We went over that.
Then, for an hour — 8 to 9 a.m., 9 to 10 a.m. and so on — you would seat the patient, review their health history — like complete health history, asking everything that you can think of — and noting any health conditions that were not on health histories. For example: Some of the health histories will say, “Do you smoke?” You have to realize, I was North Carolina. That’s like the smoking state; especially for smokeless tobacco, which is a risk factor for oral cancer. As of up to a year ago, when you were talking about risk factors for oral cancer, HPV was not on there. So I always made sure that I would ask that. So that’s all lumped into it. "Were you vaccinated with Gardasil?" E-cigs, I asked about a year ago. Hookahs. Food allergies. So, any relations then to the medications, because they have side effects — from birth control pills to other types of antidepressants, anti-anxiety medications. Then I would take their blood pressure and record that. Perform an extra-oral exam; so, feeling along your hairline, looking in around your jawline, your ears; feeling around your neck, like your thyroid. Basically, looking for any abnormalities or lumps. Then I did an intra-oral exam, took some X-rays if the patient needed them. I also took an ultrasonic.; it’s a higher-powered instrument that uses water to cool it, but it also vibrates off the tarter above the gums, and it can disrupt the biofilm, being the plaque. So it’s a win-win situation. Then I would use different types of prophy paste to polish. If you had a dental implant, or you had a crown, you don’t want us to use paste that has a coarse grit, because we’ll scratch it, and you spent thousands of dollars on that. So going over it with the patient, to explain you want to keep the luster. I would record periodontal pockets around teeth, and we would discuss recession, mobility, bone loss. Discuss oral hygiene care, because I don’t think everybody should be flossing. I understand that the American Dental Association promoted a brush-floss-rinse routine, but the truth of the matter is, nobody flosses. And if you did floss, you’re not going to floss effectively. So, I would introduce, hey, what about a toothpick? What about an interdental brush — it looks like a little Christmas tree. Different things like that. Or a water pick. I feel things like that are so important to suggest to our patients. And then I’d take a photo with an intra-oral camera. Let the patient know, “Hey, because of your diet, because of your health condition, because you have orthodontics, this is your current state of caries; you’re a low, moderate or high. Then we would talk about, obviously, risk factors for oral cancer. If it was Autism Awareness Month, or whatever month that was, we would discuss it.
After all that, I would pre-appoint them. And I always call it wellness. And the reason for that is because, if Starbucks can get us to talk “tall, grande, and venti,” when most of us would ask for a small, medium or large, we can say “wellness." It’s not a cleaning. “Cleaning” means, get your Swiffer out, and Ajax. We don’t do that; what I just described is not a cleaning. Then obviously we’d have the doctor to come in, and we would co-diagnose, to share, this is what we did notice. People may have sleep apnea. Or if you just had a baby, if your wife had a baby, and she’s having trouble breastfeeding… it’s because the baby’s tongue-tied. And we can work with that via laser to release the tongue, because that will affect how you kiss later, that will affect how you speak, and obviously more importantly at the time, it will affect how you breastfeed. And that can be really painful for the mom, but they don’t know. And this is the kind of stuff that we bring to light for our patients.
What are hygienists' career options outside the clinical setting?
I would say what a hygienist can do today with their career is really incredible. For me, I went the consumer route. Originally I started giving continuing education content to dental hygienists. And then I just realized there needed to be a voice for consumers.
Take yourself for example. Many times, hygienists get so busy in that hour. Not that it’s right or it’s wrong, it just is. Things get missed. And you wouldn’t know choices that you have, and questions that you may have that could be answered. I developed my online brand to help people understand. There’s no excuse, though, to have caries or tooth decay be an epidemic in the United States. There’s just no excuse. And where do we stop that? We stop it at the parental level. It’s really difficult in public health, or in rural settings, to treat kids or get the message to the parents, because the parents are the ones who are making choices for the kids. They’re making the choice to not bring their child in for a wellness visit. In my opinion, that’s neglect. Because hours of school will be missed when the child has a toothache. They won’t pay attention, their grades won’t be good; it’s proven.
How else can a hygienist advance? Today, we're actually getting positions where we can work, without a dentist, in rural settings. And that’s super-cool. Or if you would like to go into corporate settings, you can do that; whether it be on your own as a clinical educator — so maybe you could work part-time clinical. There are different companies that you can leverage that with, and I think that’s the really inspiring thing: that companies want dental hygienists, instead of business-oriented individuals, because hygienists get it. Other hygienists decide to do more nutritional advances as a side business. Others start with beauty, like with Nutrium. And I think that’s so cool, because they almost take that entrepreneurial role — like what the dentist does — and they cultivate it on their own. And then others are doing special care with our aging population in assisted homes and nursing homes.
There are just so many ways to serve and stay empowered, and that’s more new than corporate. Corporate was always around, but to be able to branch out and be able to do multiple things is really neat.
Why not become a dentist?
I know I never did, because I knew personally that I would have to go through oral surgery -- you have to go through general dentistry to specialize. I loved working with kids, and I loved orthodontics. I loved seeing somebody’s mouth, or teeth, that are misaligned, and being able to align them... to give them a smile that they also wanted, that was functional and healthy and, oh by the way, aesthetically pleasing.
But to go through general dentistry was not appealing to me. I didn’t want to pull teeth; I didn’t want to look at abscesses when people would come in; I didn’t want the responsibility; I didn't want to be called on a weekend, on a holiday to deal with employee matters, because I think that’s what people don’t see when you have a business. That's not to mention the financial aspect, because getting out of dental school today, these future leaders are getting out at $500,000 in debt.
With that said, what are the challenges of being a hygienist?
For somebody who is new, the challenge would be getting a job. And the challenge would be, knowing what you were taught in school does not mean that is what you will be providing in the workplace. The challenge would be accepting that sometimes something has to give. I think that’s really it. Because there is no way you could apply every single thing in an hour with a patient. The challenge is staying on time; the challenge is being respected as a licensed health care professional, versus seen as a cleaning, which is degrading; that’s the challenge, is to overcome that.
Is there anything innate that great hygienists typically share?
The mindset to understand, going into this profession, that you are a patient advocate. It is only up to you to motivate you. If you don’t have that kind of self-starter attitude, if you cannot find it in you to continually fuel the passion for why you got into this, and how you can literally save someone’s life from oral cancer, for example, then it's not for you. To me, that separates someone who’s great, or not. It’s dedication, it’s commitment, it’s never-ending.
Anastasia Turchetta's Reading List:
- Think Big, Act Bigger,” by Jeffrey Hayzlett
- The Image of Leadership," by Sylvie di Giusto -- "I feel image is so important, because you can’t have a dental hygienist with messed-up looking teeth. And for us to tell you your teeth need to be straightened, or whitened, or the crown in the front or veneer in the front needs to be replaced, when our teeth are funky -- you can’t do that. That’s just not cool."