WINTHROP — When Kim Morgan Fichthorn first moved here last year from Texas, she looked for work as a hygienist in one of Maine’s dental offices but couldn’t catch a break.

“Unfortunately, there’s not a lot of jobs for hygienists,” said Fichthorn, who has been cleaning teeth for more than 20 years. “A lot of places have the max number of hygienists they can have. … I kept running into that: ‘No jobs.’ ‘No jobs.'”

So, Fichthorn continued, “It kind of forced me to open my own practice.”

In fact, when Fichthorn moved to central Maine – after her husband took a job in Skowhegan, near his hometown, Madison – she already was thinking of starting a business where patients could receive cleanings, screenings, fluoride treatments and other preventive services in a spa-like setting.

The result is Maine Dental Boutique, which opened two weeks ago on the first floor of the Winthrop Commerce Center. The small office includes a waiting area, a reclining chair, a station for sterilizing tools and a fountain that serenades visitors with a low bubbling sound.

A decade ago, it would have been impossible for Fichthorne to offer her services without the supervision of a dentist. But in 2008, Maine passed a law allowing hygienists who have obtained a special type of license to work independently.

Since then, the number of licensed, independent practice dental hygienists, or IPDHs, in Maine has inched upward. In 2012, there were at least 37 in the state – compared with 1,196 hygienists who had a traditional license requiring them to work under the supervision of a dentist – according to a report by the Center for Health Workforce Studies at the University at Albany State University of New York.

As of last week, 99 licenses were issued to independent hygienists, according to the Penny Vaillancourt, executive director of the Maine Board of Dental Practice.

The new class of licensing has helped hygienists weather a tough job market by allowing them to strike out on their own or find work in other settings such as denturist offices, nursing homes or schools, according to Bonnie Vaughan, a hygienist who received one of Maine’s first independent practice licenses. She now oversees two independent hygienists as the manager of Kennebec Valley Family Dentistry, a nonprofit clinic in Augusta.

The new class of license also arrived amid a scarcity of dental care in more rural areas of Maine, which has worsened in the ensuing decade.

In 2017, 63.6 percent of Mainers reported seeing a dentist or dental clinic in the previous year, down from 71.3 percent in 2010, according to America’s Health Ranking. That was lowest rate in New England in 2017, and below the national average of 65.3 percent.

A LIMITED ROLE

In 2008, the legislation creating a license for independent practice dental hygienists was controversial, drawing opposition from the Maine Society of Periodontology on the grounds that, among other things, hygienists might not be qualified to administer local anesthesia or nitrous oxide on their own.

To help expand access to dental care in Maine, the University of New England started a dental school, which graduated its first class just last year.

Hygienists, though, say they are well-prepared to offer a number of services. They are required to have worked in a clinical setting for at least 2,000 hours before they can apply for their license. Some also provide X-rays to their patients, but they must stop short of diagnosing conditions.

Hygienists also say the new licensure has helped them expand access to oral health care in Maine, especially for patients who don’t have the means to either afford a dentist or travel to see one.

It’s not clear whether the efforts of independent hygienists have, in fact, increased the ranks of Mainers receiving adequate dental care.

“I asked around, and there isn’t really any current data on the impact” of independent practice dental hygienists in Maine, said Angela Westhoff, executive director of the Maine Dental Association, in an email.

Judith Feinstein, who directed the oral health program at the Maine Center for Disease Control & Prevention for an 18-year period ending in 2015, agreed about the lack of data.

“Nobody has done any data collection that would be valid, showing that we have X number of IPDHs, and they have provided Y number of visits,” said Feinstein, who now volunteers as the interim coordinator of a coalition trying to improve access to oral health care in Maine. “When we passed the legislation and put the rules into place, no baselines were taken looking at how many people were getting access.”

Even if there haven’t been measurable gains, Feinstein does think independent hygienists have had a positive effect.

A DOOR OPENS

“Anything that gets someone to see a dental professional is a good thing,” she said. “It makes preventive care available to them. It’s a door that opens.”

Independent practice dental hygienists aren’t the same as dental therapists, a new class of provider that was created by a Maine law in 2014. Working under a licensed dentist, dental therapists can perform more services than a hygienist, such as filling a cavity, but fewer tasks than a dentist.

While hygienists supported that bill, Vaughan, who runs the nonprofit Augusta dental practice, said she’s not aware so far of any dental therapists who have become licensed in Maine.

The more workers who are trained in all levels of dental care, the easier it is for clinics to stay afloat as dentists come and go, particularly if they are in remote areas and their patients have limited resources, Vaughan said.

However, she added, it can be hard to start an independent dental hygiene business without local experience and connections. She knows some independent hygienists who have continued to work part time for established practices after starting their own ventures.

“Independent practice has been very beneficial in a variety of situations,” she said. But “it’s not easy to get an independent practice going. You need to look for niches or fall into them.”

In Winthrop, Fichthorne thinks her practice, into which she has invested about $40,000 so far, will help meet some of the demand for dental care in the region.

For $75, an adult can receive a cleaning, without the need to pay for the X-ray or examination that might be required at a dentist’s office. For a child, the same service costs $55. In her first two weeks, she offered a discount rate and saw about two or three patients a day. She hopes to grow her practice enough to move into a larger space.

She also hopes to attract patients who might want to have their teeth cleaned or polished more frequently than every six months. To create a more relaxed atmosphere, she offers amenities such as lip balm and pillows that lie over patients’ eyes to block out the light.

If Fichthorne, who now lives in Winthrop, thinks that a patient might require diagnosis and further treatment, she will refer that person to an area dentist.

“There are some people that may feel, ‘I can’t get a dentist. I have no dental insurance. I can’t even step in the door without leaving with $300 in bills,'” she said. “(I can) target those people that just want a teeth cleaning, and want someone to look at their teeth and say what’s going on there.”

Charles Eichacker can be contacted at 621-5642 or at:

[email protected]