CODHA Explorer August 2023
A REVIEW OF SIXTY YEARS OF
THE EXPLORER
The Official Newsletter Publication of The Colorado Dental Hygienists Association
by Deb Astroth, Korki Stroud, Terri Tilliss
A review of 60 years of past hard-copy issues of The Explorer newsletter revealed a valuable written history of the Colorado Dental Hygienists Association. A variety of important developments evolved throughout those years. These included where and how we convened, what we focused on, legislative challenges and certainly how we looked and dressed. What emerged from the review was a great deal of pride for our state association along with respect and gratitude for the leaders who persevered and brought us to where we are today in the profession dental hygiene in Colorado. Another recognition that emerged after this review is how much change there has been over 60 years
For many decades our state association was viewed by the American Dental Hygienists Association as the prototype of a well-run constituent. Other states modeled their constituents with inspiration from the Colorado Dental Hygienists Association. Although it was an impossible task to fully summarize the events of 60 years, the reviewers felt that the best way to describe some of information was to categorize it into headings.
- A Brief History-Some Key Dates
- Organizational Structure
- Social Aspects
- Community Service
- Legislative
- Education
Brief History of the Dental Hygiene Profession in Colorado
A Few Key Dates
The first organized body of Colorado dental hygienists was in 1919, at that time called the Colorado Society of Dental Hygiene. The President of the Society was Ethel Covington. Ethel became the 3rd president of the American Dental Hygienists’ Association, which was established in 1923. To this day, we still honor one dental hygienist each year with an award in Ethel’s memory. This group of dental hygienists established a constitution and by-laws and a code of ethics. That same year, the Colorado Legislature established dental hygiene licensure. This was also the year that the first class graduated from the University of Denver’s School of Dental Hygiene located alongside the Colorado School of Dental Surgery, also at the University of Denver. No records of meetings of the Colorado Society of Dental Hygiene were found between Nov 1931 to Jan 1948. During that time the Colorado School of Dental Surgery and Dental Hygiene were closed and WWII brought a transient society. However, a small group of dental hygienists continued to meet informally monthly. The original charter of the Colorado Dental Hygienists’ Association was dated and signed in 1923 by ADHA President Winifred Hart.
By law as early as 1961, a dental hygienist could practice for 14 days each year in the office of any employing dentist without the dentist being physically present, possibly to accommodate the vacation plans of the dentists.
1963: First male, Jack Orio, enters an accredited dental hygiene program at the University of New Mexico (not really part of CODHA history, but still interesting!)
1978-1979: Notice how our officers wore dresses (except Korki- who was a trendsetter)!!
For 30 years, there was no educational program in Colorado to prepare dental hygienists. Finally, a dental hygiene education program was established in Rangely Colorado, in the northwestern corner of the state, graduating the first class in 1964. It was then called Rangely College, now Colorado Northwestern Community College School of Dental Hygiene.
1997- ADHA member Glo Hess is a candidate for Speaker of the House of Delegates of the ADHA. Glo has serves 2 terms a President of MDDHS, 2 terms as President of CDHA, N9 years as delegate or alternate from Colorado to ADHA, was the Parliamentarian to the Colorado Association of Parliamentarians, and this is just a partial listing of her achievements.
1981: Governor Dick Lamm issues an Executive Order proclaiming May 10-16 as Colorado Dental Hygiene Week.
October 1981: JoAnn Grant, CDHA member, after 28 years of working for dentists, opened her own dental hygiene practice in Ft. Collins, CO. According to ADHA, Ms. Grant is the only hygienist in the nation who maintains a private practice with only limited supervision by a dentist.
1987: Deborah Bailey McFall , CDHA member, appointed to Colorado State Board of Dental Examiners
June 1988: Deborah Bailey McFall, CDHA member, announced her candidacy for First Vice President of ADHA! ADHA Annual Session was held in Seattle that year. Debi was completing a two-year term as District X Trustee representing Colorado, Utah, Montana and Wyoming.
1988: Deborah Bailey McFall, CDHA member, announced her candidacy for First Vice President of ADHA
1991: Deborah Bailey McFall, CDHA member, elected President of Colorado State Board of Dental Examiners
1992-93: Deborah Bailey McFall, CDHA member, served as President of ADHA!
Spring, 1993: ADHA launches ‘Commitment to Responsible Healthcare’ focusing Infection Control Practices due to concerns regarding AIDS. Consumers are encouraged to ask practitioners if they are following guidelines of CDC and OSHA.
Fall of 1994: Deborah Bailey McFall appointed to National Commission on Allied Health of the Health Resources and Services Administration. The purpose of the Commission is to provide advice and recommendations to the Secretary of Health and Human Services, the Committee on Labor and Human Resources of the Senate and the Committee on Energy and Commerce of the house of Representatives with respect t possies related to US allied health personnel.
August 1, 1993: CDHA member Diane Covington became director of the Oral Health Program at the Colorado Department of Health, the first dental hygienist in this position.
Apparently, there was no official publication of our Colorado dental hygiene association until The Explorer became the official publication of the Colorado Dental Hygienists’ Association in December 1963. It was hard copy format and placed in an envelope and then mailed to dental hygienists at their homes. The CODHA historical files include copies of the Explorer newsletter from its genesis in 1963 until 2010 when it shifted from hard copy to an electronic version. The announcement at the time stated, ‘We are going green!’
See below how our Explorer Logos Changed Over the Years
In the 60-year review, we identified at least 20 different members who served as editors of the printed version of The Explorer. We are grateful for their contributions to our recorded history.
As of now, no CODHA volunteers have stepped forward to carry on the tradition as editors of our newsletter. As such, the Explorer, as we have known it, may end in 2023. The five categories below provide a glimpse into 60 years of Dental Hygiene in the state of Colorado.
Organizational Structure
In the early days meetings were in person and there were many meetings of all types. Our organization was divided into 6 geographical groupings which were and still are referred as components. These include Metro Denver, Western Slope, Colorado Springs, Boulder, Northern, Southern. Most of these components met monthly. Often there was a business meeting, followed by a speaker or other educational program. Meetings were frequently held in private rooms at restaurants, and sometimes in member’s homes. Components were active locally and on the state level.
After years of conducting our business in conjunction with the CDA annual conference, in 1979, the first House of Delegates was established to address the business of the association, set policy and to establish a budget. It also provided representation from all corners of the states because the delegates came from each component. Our state association created a sense of pride as the stage was set for CDHA delegates to shine at the ADHA House of Delegates. This first HOD was held at a hotel in downtown Denver, and then located around the state to accommodate the various components.
Orientation Workshops, with the goal of orienting new component officers, chairs, and council members, were held annually over a weekend in a cabin in Poudre Canyon, near Fort Collins. The Vice-President of CDHA organized which components would bring which meals. Not everybody even had a bed, they brought sleeping bags!
Strategic planning meetings were initiated in 1986 at the urging of ADHA and held annually. They were held in meeting rooms in churches, a member’s mountain cabin, at the CU School of Dentistry or at member’s homes. The location of strategic planning meetings was moved around the state to accommodate where members lived.
Colorado was a member of ADHA’s district 10 along with Wyoming, Montana and Utah. District meetings were held annually rotating fashion within these states. Held always in the spring, this allowed the delegates from each state to caucus in order to determine their position on various issues affecting the profession in preparation for the ADHA HOD.
By 2016 Colorado Dental Hygienists’ Association, CDHA, was re-named as CODHA in order to distinguish our signature from states like Connecticut association (CDHA).
Thanks to the consistently capable leadership of the Colorado Dental Hygienists’ Association over the past 60 years this organization has been at the forefront in many arenas when compared to most constituent (state) associations within the ADHA. One such area has been our business structure and compliance. However, change was on the way…
In 2014, ADHA became aware that the national association structure needed a renewed organization. This came about when an association constituent (not Colorado) became a part of a personal divorce lawsuit of a DH officer in that state. That association (again, not Colorado) allowed association funds to be a part of a personal bank account. ADHA was drawn into the divorce melee and as a result, ADHA realized not all state constituencies, although a part of the ADHA ‘family’, were legally compliant. Having a responsibility to the membership and the profession, ADHA faced a complete reorganization with the help of legal counsel. ADHA created new Charter agreements which CODHA signed in 2016. CODHA re-incorporated and adopted revised bylaws. The components chose to unincorporate but remain entities within CODHA’ s structure without separate bylaws or bank accounts. This unified CODHA under a collective brand with ADHA. Our logo became ADHA’s. Our structure and identity was changed forever under the umbrella of ADHA.
In 2022 the CODHA House of Delegates voted to replace the HOD structure with a General Membership type of meeting to usher in renewed opportunities for the changing membership.
Social Aspects
Dental hygienists in our state were socially connected and involved in each other’s personal lives, even beyond professional and work interactions. Since members could be the only dental hygienist in a practice setting, they looked forward to the comraderie of colleagues at component and CDHA events. These associations resulted in life-long friendships. The Explorer newsletter actually included mention of when members married, had children, moved, or passed away. There were component holiday parties which often included both members and their spouses/partners. There were even ski meetings and educational workshops which just happened to be at Colorado ski areas. Friendships developed at these gatherings, whether local or on a national level, were strong and life-long, enduring to this day. In general, there was a much stronger social component to our CODHA lives than in present times.
Community Service
Providing community service was an important precept of our state association. There was a concerted effort to both provide oral health information and oral health services to the public, and to educate the public about the role and scope of practice of dental hygienists. The Explorer served as the call for member volunteers to attend and donate their time to these community service functions (no email!). An example was the annual Day at the Denver Zoo, later renamed Boo at the Zoo. Toothbrushes, toothpaste, floss and oral hygiene instruction were provided for adults and children. Deb Astroth remembers that she and Donna Karras fashioned a hippopotamus-sized toothbrush out of a pushbroom and used it to clean the zoo’s hippo’s teeth!
There were several ways that our members provided community service, and it seemed that there were volunteer opportunities almost weekly. Smiles are Ageless was a program to teach oral hygiene care to the aids at geriatric nursing facilities to meet the mandate in 1976 of the Colorado Board of Health that all nursing care facilities have an annual in-service training course. The project received an award from the Volunteers in Aging Association.
Metro Denver city busses displayed placards inside the bus in a PR campaign called Miles of Smiles to encourage oral health care provided by a dental hygienist.
Grocery store paper bags even carried the message about the importance of dental hygienists and the care we provide. Sealants were provided to school-children by our member volunteers in the ‘Choppers Toppers’ initiative.
In more recent times, our members volunteered at ‘9 Health Fairs’ sponsored by channel 9 television station and held throughout the community. Our dental hygiene members also volunteer annually at COMOM (Colorado Mission of Mercy) a 2-day no-cost dental clinic held at one different location around the state each year. Dental hygienists provide oral cancer screenings, oral hygiene education, and perform intra-oral dental hygiene care at this state-wide volunteer project.
When the COVID -19 (corona virus) pandemic occurred, dental hygienists were unable to work during the societal lockdown until proper methods were established enabling oral healthcare procedures to proceed safely for patient and provider. Once vaccines were developed and made available the Colorado dental hygiene community rose to the occasion, by helping to vaccinate the public against COVID-19. This is a great example of community service. Our profession still values the importance of community service, although it seems that community service is no longer as big of an emphasis as in the first 50 years of our association.
Legislation
Colorado has been a national leader in legislative initiative to expand the scope of practice for dental hygienists.
Dental hygienists worked in early coal camps!
Around 1916, in a talk on public health dentistry to a parent-teachers group in Salida, CO, Dr. Charles Monroe discussed the work of Dr. Alfred C. Fones, the originator of the dental hygiene profession. After the meeting, Dr. R. W. Corwin, Chief Surgeon of the Colorado Fuel and Iron Company (CF&I), questioned Dr. Monroe on the feasibility of employing dental hygienists in the CF&I’s health program. As a result of this discussion, CF&I included the services of two dental hygienists from Dr. Fones’ program in the welfare program of their coal camps in southern Colorado.
First evidence of a dental hygiene license in Colorado!
On March 5, 1919, the Colorado Legislature established a dental hygiene license. Provision for licensure was graduation from a school of dental hygiene. Once licensed, dental hygienists were allowed to examine and clean teeth in schools and public or charitable institutions or programs, as well as be employed in dental offices. The first class graduated from the University of Denver’s School of Dental Hygiene in 1919 and in December of that year the Colorado Society of Dental Hygiene was established.
Early law for dental hygiene practice with no dentist present!
In 1961 language was added to the statute or law, that a dental hygienist could practice for 14 days a year in the office of an employing dentist without the dentist present. Although the rationale for this amendment was so that a dental hygienist could continue to treat patients while the dentist was on vacation, this language provided the basis for dental hygienists to be able to practice unsupervised since unsupervised for 14 days out of the year for the past 25 years resulted in no reported problems.
Introduction of the term ‘auxiliary’ and restrictions
By 1971 most references to dental hygienists in the statute were removed and the term auxiliaries was included along with language that gave dentists the power to delegate, supervise and restrict the authority to diagnose, treatment plan and perform therapeutic and corrective duties to dentists only. The legislature also allocated funds to begin the development of the University of Colorado School of Dentistry and the Department of Dental Hygiene that actually opened in 1973.
Direct supervision for infiltration anesthesia; First dental hygienist on State Board of Dental Examiners!
In 1976 language was added that allowed dental hygienists to be delegated under direct supervision to perform infiltration anesthesia after appropriate education and training. The composition of the State Board of Dental Examiners was modified to add a dental hygiene member, Carol Odden, with full voting powers.
First Sunrise/Sunset Review (1978); Practicing in certain settings without direct or general supervision; 2nd dental hygienist added to state board
The first Sunrise/Sunset Review Process in Colorado was the Dental Practice Act in 1978. The Sunset Bill expanded dental hygiene practice by delineating the tasks and procedures that were allowed and dental hygienists were authorized to practice in various institutions and clinics run by corporations for their employees without the personal direction (general or direct supervision) of a dentist. This addition to the statute was pursued by the Gates Rubber Company so that dental hygienists could provide services on days the staff dentist in the dental clinic was not present. This amendment further laid the foundation for the Colorado Legislature to establish unsupervised practice. Monitoring of N2O was allowed to be delegated to dental hygienists and dental assistants. A second dental hygiene member, Shirley Shreves-Shroeder, was added to the Board.
First dental hygiene practices established; FTC gets involved
During this time the first dental hygiene practice was established in Colorado Springs by Virginia Palermo and Melody Rhodes. The practice challenged conflicting language in the statute and prompted the State Board, the Department of Regulatory Agencies (DORA), and the Colorado Legislature to take a closer look at the practice of dental hygiene and the impact of the supervision restrictions imposed upon the practice of dental hygiene.
In 1981 Federal Trade Commission (FTC) representatives met with CDHA leadership to discuss dental hygiene practice ownership and supervision issues. Later that year JoAnn Grant opened her practice in Fort Collins.
Second Sunset Review (1985-86)- Dental hygienists own practices without dentist supervision; Local anesthesia administration clarified
The second Sunset Review in 1985-86 resulted in dental hygienists being able to own their own practice and to practice without the supervision of a dentist. The legislation clarified local anesthesia to include both block and infiltration under direct supervision and provided for licensure by credentials. The composition of the Board was modified from 5 dentists, 2 dental hygienists and 2 consumers to 4 dentists, 2 dental hygienists and 3 consumers.
Lawsuit regarding dental hygiene practice without dentist supervision filed and dismissed
A lawsuit was filed by two CO residents claiming the law to allow dental hygienists to own their own practice jeopardized their safety as they needed premedication prior to oral prophylaxis and the dental hygienist could not prescribe medication and that the Accreditation Standards state that dental hygienists are educated to work under the supervision of the dentist. They were represented throughout the lawsuit by the American Dental Association’s chief legal counsel. Judge Sparr dismissed the case stating that the defendants were not required to see a dental hygienist that had their own practice, they could request their premedication from their physician and that perhaps it was time for the Commission on Dental Accreditation to update their Standards to reflect the current scope of practice.
Bloodborne pathogens standards adopted
In 1992 OSHA adopts the Bloodborne Pathogens Standard and compliance requirements for dental offices and State Boards across the country adopt rules for compliance training.
Nitrous oxide administration; limited liability partnerships
The Colorado Legislature in 1996 again modified the composition of the State Board to 5 dentists, 2 dental hygienists, 3 consumers. Also included was administration of nitrous oxide by dental hygienists and dental assistants, inactive, temporary and retired licenses, and the authorization of group practices and professional service limited liability partnerships among dentists and dental hygienists.
Dental hygienists as third-party providers and can bill Medicaid
The Legislature adopted a bill in 1997 that included dental hygienists as a provider of third-party payments. A bill was adopted by the 2001 Legislature that allows unsupervised dental hygienists to bill Medicaid directly for services provided to Medicaid enrolled children.
The 2002-2003 Sunrise-Sunset Bill was vetoed by Governor Owens who stated that he opposed any bill that limited the practice of unsupervised dental hygiene along with other aspects of the bill that he opposed; 3 dental hygienists now on board
As a Senator in 1986, Bill Owens chaired the Committee that had heard the bill that enacted unsupervised practice. A one-year extension was granted by Governor Owens and a bill was adopted in 2004 to avoid the Dental Practice Law being sunset. This bill increased the State Board to 7 dentists, 3 dental hygienists and 3 consumers and divided the Board into two panels. The bill also defined “accredited” and specified sealants as topical preventive agents.
Bills in 2006 and 2008 clarified that a dentist could have arrangements to use a dental hygiene practice and equipment to treat dental patients and that information regarding ownership of a dental hygiene practice be available upon request at the reception desk.
Landmark legislation allows unsupervised practice for certain services; indirect supervision for anesthesia administration with professional liability insurance
Landmark legislation in 2009 allowed the following while practicing unsupervised: dental hygiene assessment, diagnosis and treatment planning for dental hygiene services; order and administer fluoride, fluoride varnish and antimicrobial solutions; root planning; identification of dental abnormalities; preparation of study casts; and radiographic and x-ray surveys. The administration of anesthesia was moved to indirect supervision and required practicing dental hygienists to maintain professional liability insurance coverage.
Prescriptive authority and mandatory continuing education
Highlights of the 2014 Sunrise-Sunset Bill included prescriptive authority for dental hygienists, mandatory 30 hours of continuing education every two years, anesthesia permits, authorized the Board to promulgate rules for laser use, modified and updated language for supervised and unsupervised dental hygiene, gave the Board fining authority, revised the powers and duties of the Board and repealed the jurisprudence exam.
Interim Therapeutic Restorations
A coalition of stakeholders lead by Caring for Colorado Foundation introduced a bill in 2015 to allow dental hygienists to place interim therapeutic restorations (ITR). The Foundation initiated the SMILES project to deploy dental hygienists in underserved areas utilizing telehealth technology. The Foundation collaborated with Community College of Denver to provide the education and training courses to qualify for ITR permits for dental hygienists.
Lasers and silver diamine fluoride
The 2017 Legislature clarified and modified the use of lasers by dentists and dental hygienists. In 2018 legislation passed concerning the application of silver diamine fluoride (SDF) by dental hygienist under direct, indirect or telehealth supervision.
Peer assistance for dental hygienists; Dental therapists and scope of practice
Dental hygienists were added to the Peer Assistance program through legislation in 2022. That year, legislation was also introduced, without the initial support of either the Colorado Dental Hygienists’ Association or the Colorado Dental Association, to allow dental therapy, identify licensure qualifications, education requirements, and scope of practice. Both organizations worked extensively to modify the language in the bill to be acceptable and to maintain the dental hygiene scope of practice.
Summary
As you can see, the Colorado Dental Hygienists’ Association has been a diligent and consistent player at the Legislature throughout our history. Countless hours have been spent by your leadership, council members, volunteers, and our lobbyists in meetings with other organizations, legislators, and testifying throughout the years. As a result, we have the ability and opportunity to practice our profession to the fullest in Colorado. Thank you for your membership to support our ability to secure your profession.
Education
1964- Rangely College, now named Colorado Northwestern Community College School of Dental Hygiene graduated their first class offering the AAS degree.
1975- First class graduated from the University of Colorado Dental Hygiene Program, the only program in the state at the time granting the bachelor of science in dental hygiene degree. The last class graduated in 2009.
1978- Pueblo Community College graduated their first class (AAS and now BAS degree offerings)
1998- Community College of Denver graduated their first class (AAS and now BAS degree offerings).
2012 -Concorde Career College, offered the AAS degree.
At this time (2023), there are 4 additional dental hygiene educational programs in various planning stages in our state which should help with the current workforce issues and need for more dental hygienists.
For the first 50 years of our association, dental hygienists did not have access to the plethora of continuing education opportunities that are now available. Today dental hygienists can learn in their own homes via synchronous or asynchronous virtual learning systems, or they can attend in-person. For most of our history, our only opportunity for CE was to learn together at in-person conferences. We also attended CE courses on evenings or weekends. Often these were held in conjunction with our monthly component meetings. Such CE courses were generally only offered by our professional association, by the professional dental associations or at the dental/dental hygiene schools. When CE was part of our local component meetings, they were dinner meetings where a business meeting was held followed by a speaker who taught us something new. Continuing education was not mandatory for licensed dental hygienists in Colorado until 2014. Prior to that, our members attended CE courses regularly because it was the right thing to do as a healthcare provider. Dental hygiene students were taught the importance of being a ‘life-long learner’, and doing so was not considered optional.
Another important activity in the education realm were Table Clinics. Dental hygiene students were often required to prepare a table-top presentation about a topic relevant to our profession. They first researched the topic and then prepared poster-like visuals to explain the topic. Later, as technology developed, slides were sometimes projected to illustrate concepts. Students competed at the local level and at the Midwinter Dental Convention (later referred to as the Winterregional Convention, and today as the Rocky Mountain Dental Convention). Winners were determined and they were able to compete at ADHA conventions. There were also opportunities within ADHA for members, rather than students, to present table clinics as well.
Conclusion
This review article has only provided some selected highlights from the illustrious history of CODHA. The authors may, in the future, prepare a more comprehensive review. If any CODHA members would like to participate in that project or even just have as much fun as we did looking through old issues of The Explorer—please do let us know. Contact Terri at Terri.Tilliss@incidentalsconsulting.com or Alyssa Aberle at Alyssa@codha.org
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