Tiffani Hutchinson talks about her experience going back to practice as a dental hygienist, and explains what the future might hold.
At the end of March 2020, the UK went into lockdown. For a lot of us in the dental industry, this meant no more work and no more patients for the foreseeable future.
All of us will have our own stories to tell regarding how we felt and what happened in the last few months. Here are my thoughts and experiences of lockdown and the eventual return to work.
Lockdown
The first couple of weeks of lockdown weren’t that bad. I enjoyed a little bit of extra time doing all the things I love outside of work. As the weeks turned into months, the worry started to set in.
I began to see other clinicians talking about early retirement, career changes and the possibility of not returning. It was disheartening to see those in the profession for a long time start to question their career. It was making me think about my own options and what this may mean for my work, life and income.
My mind began to race with ‘what-ifs’. What if I couldn’t return to work? What if I did return but I didn’t enjoy it anymore because of all the changes?
As a self-employed clinician who wasn’t eligible for any government grants, how would I cope if this went on long term? Being a newly-qualified hygienist, it should have been an exciting time getting stuck into work. I was however, now beginning to think of alternative careers. It felt like a whirlwind.
Then finally, we all found out that dental practices could reopen on the 8 June. It was a shocking revelation, considering we found out at the same time as the public. For me though, it felt like a wave of relief to know I would soon be back to doing what I loved.
After having three and a half months off work, July was the month that I got to return to practice. I was nervous for change, but I was ready and willing to combat any challenges that I might face upon return.
Preparing to return
In the weeks before I was due back in practice, I started to familiarise myself with everything new. New policies and procedures. New precautions and restrictions. Staff and patient screening on arrival to practice. Extra PPE. Donning and doffing. FFP2/3 masks. Fallow time. Working with non-AGP and handscaling in one practice. Working with AGPs and the ultrasonic scaler in another.
There was a lot more to think about too. How would patients cope with the changes? Would they be happy to return? Would the stress of the last few months have a negative impact on patient’s oral health? The work environment would of course be different, and there would be limitations that I hadn’t experienced before. It felt overwhelming, but I knew it was all going to be a learning curve.
I tried to prepare as best I could, so that I could begin to feel a little more ready for my return. I made sure I had appropriate PPE and hand instruments and made sure I had a good selection of oral health information aids and leaflets. With these things ready and waiting, I started to look forward to getting back. Overall, I just couldn’t wait to get back to see my patients and colleagues again.
Non-AGP
My first day back began with non-AGPs and using hand instrumentation only. It was, in one word, exhausting. I didn’t realise how much I relied on powered instrumentation and I felt a bit rusty with the handscalers. University was great at teaching techniques, but I don’t think anyone could have prepared me for eight hours of stain, biofilm and calculus removal by hand. For someone who certainly wasn’t used to this way of working, it was full on.
Two things I found that really helped to make the day a lot easier: regular breaks and nursing support. With all the extra time needed for handscaling, PPE, cleaning and paperwork, I definitely would have struggled without assistance. I couldn’t be more grateful that this support was provided.
One thing that I did happily notice was that patients were much more receptive to focusing on prevention. Patients seemed keener to find out how they could prevent any problems and have a healthy mouth long term. This may have been due to limited access to dental care in the last few months, or that there has been a bit more focus lately about looking after yourself.
Whichever it is, it seems to have had a positive impact. I began to put even more emphasis on oral hygiene instruction which worked well for the patients, and for my hands!
AGP
Prior to working with AGPs, I needed fit testing. It wasn’t the most pleasant experience, but the practice made me feel relaxed about the whole thing. I passed with the first mask I tried and am now the owner of a lovely ‘Bane-looking’ FFP3 respirator mask. I know others who have failed with practically every mask out there. So I count myself lucky.
To allow for fallow time, I would be working between two surgeries. With all the extra PPE and back and forth it was a lot hotter than usual. I ended up looking like a sweaty mess by the end of the day. Again, I had nursing support, and this made a huge difference in making the workday run smoothly. After working with hand instrumentation only, I was extremely glad to be using the ultrasonic scaler again. It felt like a treat!l
I did have a hard time communicating with patients whilst wearing the respirator mask. Patients seemed to find it difficult to hear and at first, I struggled. I felt limited when it came to giving oral hygiene instruction, which had recently become the focus for me.
However, I soon learnt to adapt and found ways that worked for myself and patients. This involved reception handing out OHI leaflets for me and asking patients to return for follow-ups when things will hopefully have settled. It also involved a little shouting on my part, and a lot of repetition.
I find the days to be more tiring than before with all the extra things to think about. Each week is getting easier, and it all feels worth it when patients are so grateful just to see us again.
The future
Prevention has always been a key focus when it comes to improving oral health. The knowledge around prevention is increasing, and more and more clinicians are starting to steer their work in this direction. I think this is an important tool to focus on as we move forward, especially with the risks of further local lockdowns.
Amber Ojak, a fellow dental hygienist and therapist, founded ‘The EME approach’, which I feel is really going to help change the way we interact with our patients.
She explains that: ‘The EME approach is designed to bridge the gap between oral health education at home and in the practice. It’s for us to educate, motivate, and encourage our patients to take control of their oral hygiene for the better. It will benefit both clinicians and the patients as we are fully able to utilise all of our tools to increase patient compliance. It will mean we can focus on education and prevention more than ever before to change the way patients view us as clinicians and change oral hygiene appointments forever’.
I also hope that we can bring more emphasis on the need for nursing support for hygienists and therapists. I don’t know how well I would have coped in the last few weeks without the help of all the wonderful dental nurses at my practices. Having full-time assistance increases the amount of time I can spend with the patient. It has certainly helped to improve my work overall. I know not everyone has the choice of assistance, but I think this time has increased awareness on the importance of support.
Conclusion
It’s taken a bit of adjustment, but I’m glad to be back at work doing what I love. It’s been a hurdle to overcome but I feel that as clinicians, we are good at adapting. After a lot of uncertainty and fear, I keep my fingers crossed positive changes will come from this journey. It’s been a long road with a long way to go, but I remain hopeful that things will get better both in and out of practice.
Whether you have gone back to work or you’re still waiting to return, remember to look after yourself and stay safe!
