By the Book

Whenever Professor Emeritus Esther Wilkins, D49, DG66, conducts a continuing education course—she’s done more than 800 to date—students inevitably crowd around her, clutching their textbooks, hoping to snag an autograph or snap a photo with her. She complies, of course, usually with a wide smile. That’s just what rock stars do.

It’s not only that Wilkins, 95, wrote the first comprehensive textbook on dental hygiene, an enduring manual now in its 11th edition. Or that she has a dental instrument—the Wilkins/Tufts Explorer—named after her.

It is her enthusiasm for her work and her drive to educate thoroughly as many people as she can about the power of prevention that has made her a celebrity, “a shining star in dental and allied dental education,” as Richard W. Valachovic, president of the American Dental Education Association’s Gies Foundation, puts it.

It was also, he said, what made her “an obvious choice” to receive the prestigious Gies Award for Achievement by a Dental Educator this year, presented on March 19, during the ADEA annual meeting.

Spreading the word on preventive treatment has meant educating not only dentists, as she has done at the Tufts University School of Dental Medicine for 45 years, but dental hygienists. Wilkins practiced as a hygienist for six years before enrolling in dental school, and has continued to be a cheerleader for the profession.

“I know a lot of hygienists who have gone to dental school, and they don’t ever look back,” says Linda Boyd, N98, dean of the Forsyth School of Dental Hygiene in Boston. “She is unique in that way. Her heart has always been in hygiene.”

The Woman for the Job

Wilkins wears her age well. She uses a cane, a consequence of a broken leg five years ago, but her posture is enviable, and she is proud of her twice-weekly workouts with her personal trainer.

When she sat down recently to talk about her career, and how she enrolled in dental school when less than 2 percent of practicing dentists were women, and soon after wrote a groundbreaking textbook, she said she didn’t even realize she was being a trailblazer.

“I never had a feeling of that,” she says, looking thoughtfully through her purple-rimmed glasses. “People use that word, or ‘pioneer.’ I didn’t really feel it. I was just there to do it, get it done and work hard.”

Wilkins was born in 1916 in Chelmsford, Mass., and grew up in nearby Tyngsboro. Her older sister, Ruthie, was her first mentor and model of what a teacher could be. When Ruthie saw that her little sister was struggling in French, she took it upon herself to tutor her every night, helping her get a C in the class.

So when Ruthie told Esther it was time to figure out what she was going to study at college, she listened up. They decided she would be a nurse, even though Esther knew little about the profession. She enrolled in the nursing program at Simmons College, but later switched to a general science major. With no money to live in the dormitory, she would take the five-cent bus to North Station, and the 5:14 train back to Tyngsboro every night.

In her senior year, one of her professors lectured on public health careers. Dental hygienist was one of them. She had never met a dental hygienist before, but something about it appealed to her. That very day, Wilkins walked to the Forsyth School, a beautiful marble building with big glass front doors. On her second visit, she went into the large, bright dental clinic, equipped with child-sized dental chairs. She saw the teachers in purple-banded caps and the students all in white dresses, shoes and hose. She was smitten.

After receiving her certificate from Forsyth in 1939, Wilkins took a position with Frank Willis, D13, who had a practice in Manchester-by-the-Sea, Mass. “He was very, very conscientious,” she says. “I learned a lot about good, honest preventive dentistry.”

The Ambition to Do More

Four mornings a week during the school year, she and Willis would walk to the local middle school and provide dental care for all the school children in a two-chair clinic in the school’s attic. She began to appreciate the impact preventive dentistry could have on lifelong oral health. “The students went to high school with all their teeth,” she says. “It was just a beautiful concept.”

Wilkins enjoyed the seaside town, and didn’t even mind when, on the way to the grocery store, she would pass a patient across the street who would call out her to, “Esther! Is my appointment on Monday at 1 or 2?”

“I didn’t really want to leave,” she says. “But somehow or other, I had an ambition to do more.”

She applied to and was accepted at Tufts Dental School, but Dean Basil Bibby, D39, encouraged her to defer a year, when at least one other woman would be enrolled. She ended up being one of three women who started with the class of 1949.

Meanwhile, Willis, who had “put up a big fuss” when Wilkins told him she was leaving, lamented to her that he couldn’t find a hygienist to take her place. So she practiced there during school vacations whenever she could. After she graduated from Tufts, he hired a new dental hygienist within a matter of weeks. It was then that she realized he had been giving her the opportunity to earn money for her college expenses, which she very much appreciated.

As much as she liked Manchester, she wasn’t drawn to private practice. “Not that I didn’t have idealism about how it should be,” she says. “Dr. Willis gave me a wide background on how you can have a little practice in a little town and do a lot for a lot of people.”

Instead, she took an internship in children’s dentistry at the Eastman Dental Dispensary in Rochester, N.Y. Soon she was asked to take on a whole different mission: to establish, from the ground up, a dental hygiene program at the University of Washington in Seattle.

She Wrote the Book

She started from scratch, doing everything from ordering instruments to recruiting clinical faculty. The dental hygiene textbooks that existed were painfully out-of-date. “Dr. Fones’ book itself, that was still available,” she says, referring to Alfred Fones, who is credited with training the first dental hygienist—his cousin—to assist him in his practice in 1906.

“There was one chapter on instrumentation, one on anatomy—chapters on things you should have a whole course on,” Wilkins says. “No mention of X-ray, because X-ray hadn’t come along.”

So she began writing up her own text on specialty subjects in dental hygiene, which she distributed to students as mimeographed handouts collected in a loose-leaf binder.

“The first two years, I taught most of the courses myself. When I taught the X-ray course, I used the same program that my teacher at Tufts had used. I had them buy the same textbook. I gave the same contents of lectures that he did. So those X-ray classes were definitely what were being taught in dentistry back at Tufts.”

Wilkins admits she has always been a rigid teacher, particularly in the clinic. “They used to say I could find calculus [tartar] that wasn’t there. One of my strong beliefs is that we must get all of the calculus off in order to control the inflammation in the gingival tissue. If it’s not possible in one appointment, then you divide the mouth into two or four appointments. You don’t jump around. You have a very systematic plan.”

By 1959, her mimeographed lessons had piled up. One day, a textbook salesman making his usual rounds spied the thick stack on her desk. He asked to take a look. “We should publish this,” he said. “Can you have it ready for fall?”

“So I said yes,” Wilkins recalls, “not knowing I was forecasting for the rest of my life.”

Judging a Book by Its Color

All that summer, she and a colleague worked on the book, rushing into the main clinic (the only air-conditioned area in the dental school) as soon as the clinic patients were gone. They would proofread until the school closed. The first edition of Clinical Practice of the Dental Hygienist was published that fall.

Her standards for each subsequent edition have been just as exacting. The 11th edition, which was just released in January by Lippincott Williams & Wilkins, clocks in at 1,264 pages, plus CD-ROM. But even as the first copy arrived on her desk, she cast a critical eye, right down to the cover, which looked to her like a dark blue. She wrote back to the publisher: “We wanted purple. Is it too late?”

The cover’s hue is more than trivial. Among hygienists, it is a secret handshake of sorts. “Every edition is a different color, you see,” Wilkins explains. “When I ask a dental hygienist what year she graduated, she’ll say ‘Yellow book.’ So I know immediately it had to be between ’71 and ’76.”

From the first edition, the book would become a constant presence in her life, even as her original coauthor moved on to other projects. After 12 years at the University of Washington, Wilkins returned to Tufts for postgraduate study in periodontics. An old Tufts classmate, James Gallagher, D49, who had become a full-time assistant professor in the Department of Complete Dentures, had also started studying for his degree in prosthodontics. They began spending time together. Not long before she was set to graduate, he proposed.

“I said, ‘Oh no, you don’t want to marry me,’ ” she recalls. “ ‘You don’t understand about this book. It’s a full-time job.’ ” By that time, she was working on the third edition. “He said, ‘Well, I guess I could put up with it.’ ”

They married in 1966, and she began teaching part-time in periodontics. He passed away in August 1988.

A True Educator

Although Wilkins has won many awards, the Gies Award is particularly meaningful. Being a teacher and mentor is something close to her heart.

“She is just a true educator,” says Boyd, the Forsyth School dean, who sees Wilkins when she visits the school for weekly lunches with small groups of dental hygiene students, who ply her with questions. “When she is with the students, her eyes light up,” Boyd says. “She talks with the rest of us, but it is not with the same gleam in her eye.”

Sheldon Duchin, D74, an assistant professor of periodontology at Tufts, says Wilkins was his favorite instructor when he was a student. “You had to spend a long time with her doing your periodontal diagnosis. If you did scaling with her, she would detect every small particle of calculus on a patient’s tooth. And she would go through brushing and flossing with a patient endlessly, until the gums were in perfect condition.” While this might not appeal to every student, Duchin found it a welcome challenge.

Without specifically steering him toward a specialty, Wilkins was a big part of why Duchin went into periodontology. “You often decide to do things based on how enthusiastic your instructors are, the excellence they exhibit,” he says. “And I think that’s what happened to me. Somehow the message went across that periodontics was the way to save patients’ teeth, that this was a very important part of dentistry. And that’s what I decided I wanted to do.”

When he was accepted to Harvard’s graduate program in periodontology, the first person he told, after his parents, was Wilkins.

Wilkins’ students at Tufts knew little of her celebrity in the dental hygiene world. Duchin happened to come upon Clinical Practice of the Dental Hygienist, with Wilkins’ name on the cover, in the library. When he asked her about it, she said, “Yeah, I actually wrote the dental hygiene bible.” His helpful instructor, he discovered, was “really quite a famous person.”

Wilkins’ view on education could be summed up in four words: “the more, the better.” When Patricia Cohen was considering taking a college course a semester toward a bachelor’s degree, while being a full-time mom and a part-time dental hygienist, Wilkins said, “Maybe you can take two courses.” So she did.

“I had busy days and lots on my to-do list,” Cohen recalls, “but somehow I managed because she encouraged me.”

After graduating from Northeastern University with honors, Cohen thought she could rest on her laurels, but Wilkins was quick to say, “You must continue with a master’s degree.” Once Cohen earned a master’s in health communication from Tufts School of Medicine in 1998, Wilkins said, “And now, how about a law degree?” Cohen, who is now an assistant clinical professor of periodontics at Tufts, has yet to tackle that.

“This prodding and encouragement seems to be a trend with Esther,” Cohen says. “She encourages lifelong learning and is always learning new things herself.”

Cohen, who has worked with Wilkins on continuing education courses for dental hygienists and workshops for second-year dental students, finds her a powerful role model. “Her usual approach to new ideas and projects is ‘Why not?’ And that’s not a question. It’s her way of saying, ‘Let’s do it, and let’s do it now!’ ”

Julie Flaherty can be reached at julie.flaherty@tufts.edu.