Ephrem on the vanguard of dental hygiene evolution

For more than a century, the professional and academic discipline of dental hygiene experienced numerous changes and evolutions with many more to come, including the declaration of October as National Dental Hygiene Month.

One person on the forefront of these changes is School of Dentistry clinical professor Hiwet Ephrem, MSDH, RF. While she’s been a faculty member at the School of Dentistry since 2000, her inspiration came two decades earlier working as a dental hygienist in a small North Minneapolis clinic.

“We had one dentist, one assistant, one administrator and two part-time dental hygienists,” Ephrem said. “The majority of our patients presented moderate to high dental needs. This is an underserved access-to-care issue and a large number of people who came in were emergency patients only. The initial idea was to reduce intensity of discomfort and schedule appointments for treatment. But we realized that would be three, four weeks out.  This delay affected patients and the morale of the staff. This is the beginning of the journey.”

While the challenges loomed large, the situation also provided Ephrem and her team an opportunity to reshape the clinic into one that fully utilized the dental hygienist and provided quality, timely care to patients. This led Ephrem to secure a Restorative Expanded Function Certificate from the School of Dentistry. She later recruited two other dental hygiene graduates with certificates to North Minneapolis with her. Armed with knowledge and motivation, Ephrem returned with a new approach that would prove transformational.

This “team-based care” approach would not only elevate the dental hygiene profession as a key member of the oral health care team, but create a better patient experience.

“I did not have any formal training to train staff, but our objective with the team approach was to provide as much care to patients during the scheduled appointment time,” Ephrem said. “The positive reaction from patients and the increased satisfaction to the team approach was the highlight. This was my passion for patient-centered care. … It was the flexibility and open-minded attitude of dentists and staff that made the team approach successful.”

In 2000, Ephrem came to the School of Dentistry to work with dental hygiene students, empowering them to find new ways to provide care and seek to connect dots in new ways. And with her came her passion for this new team-based care model.

Dental hygienists are often the first people to see the patient, and therefore have a unique opportunity to not only make a large positive impact but to also drive the treatment strategy. In the team-centered approach, the dental hygienist’s role becomes critical.

“It is in our fingertips to make the changes our patients need,” Ephrem said. “We spend a lot of time with our patients. We are the ones who connect the dots between the head and the rest of the body. The students are inspired and being trained by bright, true leaders at the school.”

Her success in North Minneapolis led to a large-scale research project at the School of Dentistry where she joined with Division Director of Dental Therapy Dr. Karl D. Self, and current Assistant Dean for Faculty Development and former Division Director of Dental Hygiene Dr. Christine Blue among others in establishing a Team Care Clinic at Moos Tower in 2015.

This clinic featured doctor of dental surgery students, dental hygiene students and dental therapy students working together in a clinical setting. Her results were later published in 2018 in the Journal of Dental Education.  This collaborative approach also has led to dental hygiene expanding beyond the dental office.

“If we respect each other, listen to each other and work together, we become successful,” Ephrem said. “Cyndee Stull is the director of the Master of Science in Dental Hygiene program and leading students on hospital rounds to perform oral cancer screenings. Students work with physicians, nurses, pharmacists in this inter-professional environment. … We are so proud and we are headed in the right direction.”

Ephrem’s ability to not only inspire but to collaborate has led to numerous accolades, including the 2017 Distinguished Dental Alumna award. However, for Ephrem and the Dental Hygiene division, the reward isn’t plaques or money. It is, and will always be, about providing the best care to those in need.

“I am hopeful to see what we can do in the future,” Ephrem said. “We’ve come a long way from the 80s. I remember in the 80s, HIV was what changed our mindset to put gloves and masks on. I remember because I was a student. Dentistry evolved. Dental hygiene evolved. And the only way to succeed is if we work together. The future is bright and the sky is the limit for dental hygiene.”