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School celebrates 100 years of teaching dental hygienists

The story of a century of educating dental hygienists at the School of Dentistry is like many aspects of the University of Michigan School of Dentistry tradition. It features high-achieving educational leaders who used their intellect, foresight, commitment, research and dedication to lead and develop a fledgling profession. That was true of the first leaders of the dental school when it was founded in 1875. A group of visionaries were at the forefront of transforming dentistry from an unregulated craft to a licensed profession with high standards based on science, education and rigorous training. Thirty-five years later, in the early 1910s, the school’s leaders researched and embraced the early adoption of an ancillary profession that was gaining momentum around the country – dental hygienists. Dr. Alfred C. Fones of Bridgeport, Connecticut, is credited with training the first dental hygienists, in 1913, and their services were soon viewed as valuable to dentists and patients. Over the next three years, private and public hygiene schools opened in the eastern U.S. and three eastern states licensed hygienists to practice. By 1919, a debate over the trend had reached the Michigan State Dental Society. It commissioned its Oral Hygiene Committee to conduct a report, which was presented at the society’s annual meeting in April 1920 by Dr. Hertha Hartwig, a Detroit periodontist who had graduated from the U-M dental school in 1915. Hartwig was a proponent of the growing dental hygienist movement. She compiled an exhaustive report documenting how hygiene was being successfully administered, most often for children in clinics administered by school systems, all around Michigan and the country. The report advocated for a state Dental Health Program that would publicize and educate the public about good oral health, and include a law requiring dental inspection of every school child. Dr. Marcus Ward, the dean of the School of Dentistry, also made presentations to the state dental society, the Michigan legislature and the University of Michigan Board of Regents in support of creating a dental hygiene program at the dental school. The Michigan Legislature passed the hygiene certification act in 1919. In May 1921, the U-M Regents approved the creation of the dental hygiene program at the School of Dentistry.

Dr. Dorothy Hard, ca. 1967. The DH Class of 1952 on the west steps of the Kellogg Building. Director Dorothy Hard is in the back row, third from right. Instructor Victoria Tondrowski is fifth from right in the front row.

The first class in the fall of 1921 had eight students for the one-year course of study. Laura May Helmar, a nurse who had worked as an assistant in a dental office and in school clinics in Jackson, was the instructor even as she was also listed as a student in the class. In the spring of 1922, the eight graduates received certificates as trained dental hygienists. During the summer of 1922, Dean Ward needed to upgrade the course instruction. He corresponded with a familiar figure – Dr. Hertha Hartwig – and convinced her to join the program as its instructor. She stayed only two years. Faced with finding a new instructor for the fourth year of the program, Ward made a momentous decision in 1924 that can be credited with making the school what it is today – a national leader in the education of dental hygienists. Ward hired a 1922 DDS graduate of the school, Dr. Dorothy Hard, who had worked for two years as an industrial dentist in the Parke Davis laboratories in Detroit. Returning to the university as the dental hygiene instructor in 1924, Hard began a 44-year career as the program’s leader, encountering and solving countless problems, large and small, as she shaped the program into a national model. Hard’s first decade progressed with few apparent obstacles as she built interest in the program and as demand for hygienists grew. However, as the impact of the Great Depression hit the country in the early 1930s, the program – and dental hygienists in general – faced a serious problem. Demand for dental care dropped because fewer people could afford to pay a dentist and in turn dentists couldn’t afford to pay their hygienists. That economic reality may have been the foundation for a backlash that grew against hygienists among Michigan dentists, some of whom wanted the state to withdraw its certification of hygienists. Dentists complained that hygienists had poor skills and training, that they were performing treatments that only dentists were licensed to do and that they committed ethical breaches such as taking patient lists with them when they moved to new dental practices. By 1935, the Michigan Dental Association was compelled to address the issue and formed a committee to solicit pros and cons. Among those who presented arguments was Dr. Russell Bunting, a widely respected faculty member at the dental school who had just become dean that year. Bunting (who would later marry Dorothy Hard, in 1948) presented a lengthy defense of hygienists and their new profession. He acknowledged the problems cited by Michigan dentists, but argued, among other points, that dentists bore responsibility for monitoring and ensuring the quality of their hygienists’ work. As the dental association continued to work through the issues, it invited Dr. Hard to join the committee examining the issue. She was later praised for her straight-forward acknowledgement of the dentists’ complaints and her steadfast conviction that changes could be made to the dental school’s hygiene curriculum that would solve many of the concerns. Among many changes, the most significant was doubling the length of the program from one year to two, which was implemented in 1938 for the 14 students who joined the program. Over the next decade, World War II created an increased demand for hygienists because many dentists and hygienists left their communities to help in the war effort. By the end of the war, demand surged even more as the post-war boom years ensued. In 1948, Hard implemented an optional BSDH degree that required two years of undergrad courses at the university and two years in the hygiene program. As time went on, more and more students chose this option, but the two-year certificate program continued. The last major advancement in the program during the Hard era came in 1964 when the school became the second in the country to create a graduate master’s degree program. It was in response to a growing demand for hygienists, which caused a shortage of DH faculty. It also reflected growing interest in hygiene research. The program was established through the Horace H. Rackham School of Graduate Studies and was

A copy of a scrapbook page showing the eight members of the first DH graduating class in 1922. It doesn’t indicate why four of the students are pictured twice, but they may have been class officers. (Photo courtesy the Michigan Dental Hygienists' Association.) Centennial Celebration Postponed to August 2022 The Dental Hygiene Centennial Celebration, originally scheduled for this August, has been moved back to August 19-20, 2022, because of state and university restrictions related to the ongoing COVID-19 pandemic. “Our priority for events is to ensure a safe campus environment for our alumni and friends at a time when everyone feels comfortable with travel, accommodations and large gatherings,” said Program Director Janet Kinney. DH alumni are invited to the event, which will include a centennial program, optional continuing education, and tours of the newly renovated School of Dentistry. The second biennial Dental Hygiene Symposium, originally timed to the centennial event this August, was canceled and will resume the summer of 2023. For more information about the centennial celebration in August 2022, contact Gretchen Hannah in the Alumni and Development Office at 734-615-2870 or email her at yankleg@umich.edu.

originally funded by a grant from the W. K. Kellogg Foundation of Battle Creek. Today the U-M program is the longest standing graduate DH program in the country.

Pauline Steele, 1968-88

With Dr. Hard’s retirement in 1968, the school reached out to another dental hygiene leader who had developed a national reputation. Pauline Steele had started her career in business for eight years, then changed direction and entered The Ohio State University, earning a Dental Hygiene certificate, a bachelor’s in DH and a master’s in health education. After two years as an instructor at OSU, she was hired as an assistant professor at the University of West Virginia, where she organized and directed a new DH program, the first four-year program in the country. She moved to the University of Cincinnati and again upgraded its DH program, before agreeing to replace the legendary Hard at U-M. During Professor Steele’s two decades as leader of the program, it grew into a fouryear bachelor’s program, expanding student career opportunities into areas such as geriatrics, public health, education, hospital dentistry and oral biology. She initiated changes to provide more clinical experience for students. The opening of the new dental school building in 1971 allowed DH class sizes to double from about 40 to 80, and more faculty were hired as well. The on-campus degree completion option started in 1975. Steele was an active author and editor, contributing to and compiling three DH textbooks. She was associate editor of the Journal of the American Dental Hygienist’s Association and served on the American Dental Association’s Committee on Dental Hygiene. She was an ADHA regional consultant and contributed to proficiency standards for the profession.

Victoria Tondrowski (center wearing glasses), the program’s clinic director, supervises students in this photo from the mid-1950s. Tondrowski was a 1926 alumna of the program who returned to instruct from 1939 until retiring in 1969.

Far left: A DH student holds the patient’s paper chart for a classmate during a clinic appointment in 1970, long before the move to electronic records. Left: The modern day equivalent is illustrated by the computer screen behind Olivia Zabel (BSDH 2017) as she treats a patient in 2016.

Wendy Kerschbaum, 1988-2012

Wendy Kerschbaum

started as a dental hygiene student at U-M the same year Pauline Steele started as director of the program. After Kerschbaum graduated with a BSDH in 1970, she joined the school as a part-time clinical instructor and worked her way up through the faculty ranks to associate professor in 1983. Along the way she earned an MSDH degree in 1972 and a master’s in Public Health in 1982. Steele became a mentor to Kerschbaum during the nearly 20 years they worked together. Kerschbaum’s tenure was a transition period from several longstanding traditions to a more modern age. Probably the most important change was the dental school’s move to Vertically Integrated Clinics, or VICS, which allowed DH students to be in clinics with DDS students for the first time. DH faculty made major changes in the way both clinic and didactic courses were taught and scheduled. “DDS and DH students were side by side,” Kerschbaum said. “From a professional standpoint, that’s how we’re supposed to practice healthcare – as a team. I’ve always felt that having them work side by side makes them both much more aware of what each person is capable of.” Other changes included dropping the certificate option and moving entirely to a baccalaureate degree, which had been put in motion by Steele. The creation of online degree completion in 2008 and then developing the online Master’s Degree Program in 2012 were major developments that helped draw students to the school who otherwise wouldn’t have been able to come to campus to earn their degrees. And in what may have been the most appreciated change for students, if not faculty and administrators, Kerschbaum oversaw the gradual loosening of the uniform requirement for DH students in the late 1980s. The all-white skirted uniform, hose, shoes and cap gave way to scrubs, pants and tennis shoes. Also during that period, though, latex gloves and face masks were added in response to hepatitis and HIV. Kerschbaum says she’s proud to have helped maintain the program’s history of excellence as one of the leading hygiene programs in the country. “I hear this a lot from dentists who graduated from our school: they want a U of M hygienist. The dentists say, ‘I know what they know. I know the kind of education they’ve had. I’ve been in classes with them. I understand the depth and breadth of their education.’ ”

“When I became director, I always lived under that sense that we were the University of Michigan and anything we did we were going to do to the very best of our ability,” Kerschbaum said. “The really outstanding thing about the Dental Hygiene program, being under the umbrella of the dental school, is that it’s always been ingrained that we are part of ‘the leaders and best’ phenomenon. It is who we are. So that mantra has served the University of Michigan very well. Somehow we have all assimilated that into our essence.”

Janet Kinney, 2012-present

In Janet Kinney’s nine years as director, she has already led several major developments in this latest chapter of the program. Just this spring, the program graduated two cohorts of BSDH students. The first was the last group of students to complete the degree in three years while taking summer breaks. The second group of graduates were the first to complete the degree in two years, with no summer breaks, which will be the standard moving forward. The curriculum timetable was revised over a three-year transition period as the old schedule was phased out and the new one phased in. “We felt our hygiene students needed to have more involvement, activities, interaction and patient care with dental students,” Kinney said. “And for their clinical skill-building, they now will have instruments in their hands for two straight years with no breaks between spring and summer where they potentially lose some of their hand skills.” The COVID-19 pandemic last year brought a set of challenges that required the DH program to implement creative and groundbreaking solutions when a portion of the traditional in-person classes and hygiene training were forced to move online. Kinney credits her faculty with developing, in an extremely short period of time, an innovative, video-based curriculum using laptops, iPad cameras and Zoom sessions. The new process allows faculty to watch distant students as they use instruments on typodonts in real time or in recorded videos made by the students. Faculty share the same critiques that previously would have been delivered in-person in the Sim Lab at the school. While in-person training has resumed, faculty and students found advantages to the virtual method and faculty expect it will remain a valuable tool moving forward. Kinney earned her BSDH at U-M in 1983 and embarked on a 20-year trek through clinical practice in the United States and Europe. When she returned to the program in 2004 to pursue her MSDH, she also added a master’s degree in Clinical Research Design and Statistical Analysis from the Department of Biostatistics and Epidemiology at the School of Public Health. Much of her research has involved salivary diagnostics as predictors of periodontal disease progression. After finishing her graduate degrees in 2007, Kinney joined the DH program as an adjunct clinical lecturer for a year, then was hired as a clinical assistant professor. In 2012, she was named Director of Dental Hygiene and became a full professor in 2020, all within the Department of Periodontics and Oral Medicine, which is home to the DH program. Kinney likes to invoke the “It takes a village …” truism as she describes her leadership of the program. She cites the history of excellence and the “incredible leaders among the faculty and the great students” who contribute to the success of the program. “It’s kind of awesome to sometimes stop and think about working with so many people dedicated to excellence at the dental school,” she said. “I work with some phenomenal people who just give their all every single day.”

The alumnae family

About 30 DH alumnae joined two Zoom online sessions this spring to offer memories of their time at the dental school and to share how obtaining their certificates or BSDH and MSDH degrees affected their careers and lives. Participants ranged in vintage from the Class of 1959 to more recent graduates in each of the decades since. They live in all corners of Michigan, as well as California, Illinois, Minnesota, Florida, West Virginia, Washington, Oregon and Colorado. After seeing former classmates online, listening to the stories and being reminded of the shared elements of their hygiene education, one remarked at the end of the evening, “I feel like I’m part of a family.” Dean Laurie McCauley reminded the group that she earned a dental hygiene degree before completing her DDS, MS and PhD.

1919 The state’s dentists petition the Michigan legislature and it enacts a law authorizing dental hygienists. 1921 The University of Michigan Board of Regents approves the Dental Hygiene Course of Study at its dental school and it opens that fall with eight students. 1922 First DH class of eight graduates with certificates. Dr. Hertha Hartwig hired as instructor for the second year and stays for the third year of the program as well. 1924 Dr. Dorothy Hard hired as the program’s instructor. 1935 –1937 A debate about the fate of hygienist certification grows in Michigan after dentists register a variety of complaints. The Michigan Dental Association holds a lengthy series of committee hearings. The resulting report recommends that hygienists continue to be certified, with several educational changes. 1938 The DH curriculum is expanded to two years at the recommendation of the MDA report. 1948 An optional four-year curriculum leading to a B.S. in Dental Hygiene begins – two years in LS&A and two years in dental hygiene. The certificate program remains. 1955 Enrollment increased to 44, with 30-40 the norm for many years. 1964 The new Dental Hygiene Graduate Program started in the fall to address the need for more hygiene instructors at programs around the country. 1968 Longtime program director Dorothy Hard retires and Pauline Steele is named director. 1975 Degree completion program starts on campus. 1985 The two-year certificate is dropped and all DH students earn only a baccalaureate degree – one year of liberal arts courses followed by three years in dental hygiene leading to BSDH degree. 1988 Wendy Kerschbaum begins as DH director. 2008 E-learning Degree Completion program begins. 2012 Online MSDH program begins. Janet Kinney named DH director. 2018 –2021 The curriculum shifts from a three-year schedule with summers off to a two-year, year-round schedule.

She is the first dean of the dental school with a DH degree, which adds to her distinction as the first woman to serve as dean. She said she was recently reminded of her hygiene education as she walked through a dental school clinic and could hear the sound of a hygienist’s instruments on a patient’s tooth. “I had a flashback to when I was working in dental hygiene and I remember a faculty member telling me that they could tell just by the sound if I was doing appropriate instrumentation. It really made me reflect back and think about how the core of my education began in dental hygiene.” McCauley thanked the alumnae for their continued interest in the school and remarked on the vast changes in educating hygienists and in the profession over the last 100 years. She noted that only about one-third of U.S. dental schools have DH programs. “I think our dental school is better because of our Dental Hygiene program, and our Dental Hygiene program is better because of the dental school,” she said. “It is mutually beneficial and creates a special learning environment.” She praised the current faculty, students and director Janet Kinney for showing dedication and resilience over the last year and a half of the COVID-19 pandemic. They implemented and carried out innovative new ways of educating students, she said, much like the DH program has evolved continually during its century of educating students. “It is truly remarkable to think about the significance of the program thriving for 100 years.”

Those were the days

Alumnae who shared their stories found common themes in their recollections about the school, no matter the decade or director of the program at the time. They recalled that Dr. Hard and Professor Steele were very similar in their “by the book” approach to the curriculum, clinic training, behavior expectations and dress code. The alumnae from the Hard and Steele eras recounted the crisply starched white uniforms with skirts, hose and caps; jewelry restrictions; short hair requirements; and the admonition that DH students “don’t even look at the boys who are dental students.” They also recall admissions questions and requirements, particularly by Hard, that would never be asked today: Do you have a boyfriend? Do you plan to get married? Both were frowned on. Two alumnae recalled being surprised when Hard asked to see their hands during the admissions interview. “I guess she was looking for dirt under my fingernails,” said one. More recent graduates, from the eras of program directors Wendy Kerschbaum and Janet Kinney, may have had more flexible dress codes, but they recall the same challenging curriculum, faculty who were demanding but always supportive, and a sense of accomplishment at mastering a rigorous course of study from a prestigious university. Most of the DH alumnae practiced part-time or full-time in private practices or other public health settings for at least a few years. Some retired after lengthy hygienist careers, while others practiced for a few years, then stayed home to raise their children, either permanently or temporarily before rejoining the dental hygiene workforce. That flexibility of part-time or full-time, and moving easily into and out of jobs depending on where their families lived or moved to, were cited as one of the advantages of a dental hygienist career.

Professorship to Honor Dorothy Hard

The School of Dentistry announced earlier this year that it will create the Dr. Dorothy G. Hard Legacy Professorship to honor the program’s first director and foundational figure. It will be the first professorship for dental hygiene faculty and the first to honor a female faculty member at the School of Dentistry. The professorship is made possible through the generous financial support of alumnus Dr. Robert W. Browne (DDS 1952, MS orthodontics 1959). More details will be announced later this year. The professorship will join a student scholarship named for Hard in 2018 with a gift from Susan Welke (BSDH 1961, MSPH 1964) and her husband, Robert, of Champaign, Illinois. Many alumni praised the school for the way it prepares students to see career possibilities beyond the traditional technical skills of a hygienist, through its emphasis on research, science and oral health. Several of the alumnae in the conversation went on to teach dental hygiene or other subjects at colleges and universities around the country. Others went into business or healthcare management, one as president of a major healthcare insurance plan. One graduate practiced hygiene for several years in a clinic for patients with special needs, then went to law school and today is an immigration attorney, drawing on the same empathy skills she practiced as a hygienist. Numerous U-M DH graduates have held leadership positions in local, state and national professional hygiene organizations. Amy Coplen earned her BSDH in 2002 and MSDH in 2009, both from U-M. She is a professor and program director at the Pacific University School of Dental Hygiene Studies in Hillsboro, Oregon. Actively involved in access-to-care issues in Oregon, she received a prestigious Gies Award from the American Dental Education Association in 2018 for her creative approach to teaching and leadership in oral health issues affecting the public. “Michigan prepared me well for the current position I’m in,” Coplen said. “The contacts and faculty still continue to mentor me along the way and have always been available in giving me advice as an educator and helped me to advance my career in multiple avenues. I am very grateful for everything those at Michigan have done for me, and the weight of the degree and what it means across the country and the world.” Coplen’s reference to the value of a degree from U-M was echoed by numerous other alumnae, including Janis Eisman of Flint, Michigan, who was a hygienist in Livonia and Flint for many years after earning her BSDH in 1971. “Hats off to everything Michigan continues to do to make it absolutely an exceptional program,” she said. “(Having a degree from U-M) got me jobs wherever I went. You didn’t even have to say anything else, other than that you graduated from Michigan.”