Special Feature
by Carol A. Jahn
about a true dental hygiene hero and mentor, Irene Woodall, RDH, PhD.
A True and Beloved Iconoclast for Dental Hygiene
Before Facebook, before blogging, before tweeting, there was a woman who held tremendous influence over practicing dental hygienists the old-fashioned way, via a monthly magazine column. Her name was Irene Woodall. What made Irene unique and inspirational was her keen understanding that for the profession to grow, dental hygienists had to grow too. Whatever the subject of her column, there was also that concurrent message of inspiration and empowerment.
In January 1993, at age 46, Irene's life was irrevocably changed and her career cut short by a brain aneurysm and disabling stroke that severely affected her cognitive and physical abilities. For many dental hygienists of that era, learning that this life force of dental hygiene would no longer be able to "talk" to us each month felt like the loss of a dear friend. It didn't matter whether you had actually met or personally knew Irene; through her words, she had become teacher, mentor and friend to many.
The Essence of Irene
Carla Williams, a former student and friend of Irene, said one of the things that made Irene compelling was that she was fearless and visionary. "She was not afraid to change things for the right reason. She was willing to shed tradition or practices that were considered sacred if they didn't make sense anymore." Friend and colleague JoAnn Gurenlian, RDH, PhD, agreed, "Irene had all of us 'thinking outside the box' before that expression was created. She challenged us to think beyond today and to make practice better for tomorrow."
Irene's decision to become the editor of RDH magazine is a perfect example of her willingness to break tradition. In 1981, the main, if not only, publication for dental hygienists was the Journal of Dental Hygiene. Deb Astroth, RDH, BS, friend and colleague of lrene, relates a conversation they had about her decision. "She felt there was a need for a publication with quick-read articles on clinical and other issues. It was very important to her that she would have the ability in her editorials to freely challenge the status quo. She wanted to encourage us to be self-confident and self-reliant individuals and to be willing to stand up and be vocal about what we believe."
Williams said she believes that Irene did not want us to be afraid of challenges; that she felt we should respect them, but never fear them. Gurenlian concurred, and admired the way Irene had both the presence and courage to say what others thought but could not articulate or dare to say aloud. Astroth observed the impact Irene made on dental hygienists. "She was able to articulate in such a way that dental hygienists from around the country could relate to her. Often I would meet someone who would say, 'I just read Irene's recent editorial. You know I never thought about that from her perspective, but now I get it!'"
Looking Back on Her Words of Wisdom
Irene was RDH magazine's senior consulting editor from January 1981 until January 1993, with her editorials appearing in the front of each issue. Her last original work was published in February 1993. Electronic access to this body of work is not available. In 2010, Dentistry IQ published some of her more popular quotes.
"The role of the dental hygienist can be a lonely one unless there is an opportunity for collegial exchange and a feeling of unity and purpose."
- RDH, January 1981
This statement, which likely appeared in her first RDH column, is telling in that she not only understood the need, but she also knew the solution. Her unique ability to generate "I thought the same thing" played a huge role in simply helping dental hygienists feel understood. In 1981, there were fewer dental hygienists and fewer opportunities for interaction. Today, social media has decreased the likelihood of feeling isolated. Gurenlian is sure Irene would have capitalized on every available means of communication. "She would be tweeting, blogging, and posting on Facebook."
Astroth adds that Irene wouldn't just be using social media to further her own opinion. Rather, Irene always believed in the "informed opinion." "Her style was to identify the issue, provide the evidence, present perspectives from both sides and encourage us to make our own decision," Astroth said.
Irene was a "coach" before the concept of coaching came in vogue. She never told us what to think. Rather, she seemed to have wisdom about what was already deep inside of us, and she found a way to bring it out.
"Dental hygiene's lack of preparedness for the economic costs we currently endure, partly as a direct result of our growth in size, does not speak well of our foresight and initiative.... We have grown in size but we have not been able to pull together to shape our future."
- RDH, March 1981
This statement, penned during the 1981 recession, is still relevant today. More dental hygiene programs, people staying in the workforce longer and an unprecedented recession have made the job market tighter than at any other time. What would Irene say about today's employment challenges? It's easy to imagine her encouraging us to think beyond clinical practice and capitalize on the emerging outcry of the public for better access to oralhealth. It's also more than likely she would tell us that we hold the key to our own destiny. Gurenlian agreed. "Irene believed that many of our issues will never change unless we institute the change. She wanted us to stop waiting for others to make our lives/profession better and for us to take the reins and create the change that will make the lives of others better." As an entrepreneur herself, she would have encouraged us to creatively define and develop what a 21st century dental hygienist looks like.
"How can we specify our research goals or our proper place in the continuum of patient care, or upgrade our educational programs, or tell the public about ourselves, if we see ourselves as appendages to dentistry?"
- RDH, January 1988
Irene firmly believed in the clinician. More than anything, she wanted us to believe in ourselves. Her thinking about dental hygiene, including clinical roles, was very expansive. Williams remembers that, even as a student, "She wanted us to see dental hygiene through a lens that went beyond 'cleaning teeth.' She encouraged us to think for ourselves and own our role in the delivery of care." Mid-level providers, collaborative practice, direct access — Astroth said, "Irene would celebrate these successes with unleashed enthusiasm. She would also be thrilled that so many states have enacted legislation that opens the door for providing care in schools and charitable and public settings and institutions."
Irene would have seen this as an opportunity for dentistry as well Again, well ahead of her time, she embodied the new "collaborative leadership" style. One of Irene's first public speaking appearances was in 1968 before the American Dental Association. In a February 1991 column, she wrote, "Some of the dentists were shocked, some were thrilled and delighted that the obvious had been said." Her message made the front page of the ADA News.
"Organized dentistry rarely supports dental hygiene self-regulation, largely because dentists interpret self-regulation as synonymous with unsupervised or independent practice."
—Comprehensive Dental Hygiene Care, 4th Ed, 1993
Irene was not naive about the challenges. Nearly 20 years after she wrote this, organized dentistry still uses independent practice as a way to inflame and incite fear among dentists and even some dental hygienists. Irene would likely be both amused at organized dentistry's continued fixation with independent practice and pleased that dental hygiene grows despite the rhetoric. In the early '90s, independent practice was used to motivate dentists and hygienists to fight self-regulation, general supervision and local anesthesia. Today, 44 states permit general supervision within a dental practice, 45 states allow local anesthesia and 18 have some form of self-regulation. The number of states with independent practice: one. This has not changed since 1986.
As a change agent, Irene was an early proponent of using evidence to support change and fight these falsehoods. When Astroth was involved in pursuing statutory changes to expand the scope of Practice in Colorado, she found Irene to be a great sounding board. "She would want to know what went well and where we needed to improve. She was an early supporter of evidence-based decision making, so her mantra of 'Why?' Or 'What does the research say?' Or 'Do we have any data on that?' Contributed to better strategies and rationale for expanding our scope of practice and our subsequent successes."
"There is one roadblock to major change for dental hygiene. We have the resources, the people, the intelligence, the commitment, the energy and even the possible paths to follow. But we are lacking a crucial element if we are to succeed with our respective dreams. This missing link is a clear image of how dental hygiene is unique as a profession."
—RDH, October 1987
Astroth remembers that Irene would often say, "Dream the future, make the future the reality." To me, that meant we need to face the challenges, use the evidence, be prepared, and move forward with confidence. We have moved forward since this statement, and Astroth knows Irene would be proud of where we have come in the last 20 years.
"She was passionate about dental hygiene issues such as professional and personal advancement, leadership development, research, building the dental hygiene body of knowledge, moving dental hygiene to BS degree entry level, and acknowledging dental hygiene diagnosis as a part of our practice," Astroth said.
Astroth and Gurenlian have shared some of ADHA's recent achievements with Irene. "Dental hygiene still resonates for her," they said. "When we told her that ADHA had hired a dental hygienist as its executive director, and that Colorado added the dental hygiene diagnosis to the scope of practice, her eyes lit up."
Would Irene think these advances helped create a clear image of our profession? "Undoubtedly," said Gurenlian. "I can imagine Irene shaking her head and saying being a profession is not about having a debate that we are a profession, but rather, as dental hygiene continues to grow in knowledge, research, autonomy and accountability, that defines the profession."
"I would love to see us channel our vitality and commitment into a unified, grassroots involvement that focuses on the evolution of our profession. I would love to see a renewed focus on productivity and quality, but with these terms having a much different meaning from their traditional connotation."
—RDH, February 1993
Irene understood the power of the grassroots movement. She would have been in awe of the power of dental hygienists and their ability to mobilize using social media to take on The View this past summer. And she wouldn't have wanted it to end there. It's easy to imagine her writing a column urging us to use that energy and passion to open new doors, create work settings, and improve access to care. Or telling us that productivity and quality are not about how well we scale teeth or how much revenue we generate for the practice, but rather about how many people can get access to our services and how that can improve the quality of their lives.
Lessons for Us All
No one ever imagines the type of life-altering health crisis that beset Irene. Yet it could happen to any one of us at any time. What would Irene want us to take away from what has happened to her? Find your voice and use it now. Tomorrow is no guarantee.
Today, Irene resides in a long-term care facility in Chicago. She is cared for and supported by her daughters, Charlotte and Amanda, and her three grandsons. She is beloved by staff and all that meet her. Part two of this series on Irene will chronicle her life today and the physical and oral health challenges that she faces.
Carol A. Jahn, RDH, MS, is a lifelong ADHA member who has had many roles and elected positions including ADHA treasurer. Currently, she is ADHA's representative to the International Federation of Dental Hygiene and serves on its Leadership Development Committee. She is employed by Water Pik, Inc. as senior professional relations manager. She can be reached at cjahn@waterpik.com.
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