Clinical Therapies for Pregnant mothers at Jim Pattison Maternity Clinic

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At UBC Dental clinic, I had never seen a pregnant woman as a client so it was an unique yet challenging experience form me to provide effective clinical therapies for pregnant mothers at Jim Pattison Maternity Clinic. The pregnant mothers at that site usually had medical conditions, especially gestational diabetes, and other social problems (ie. addiction and income) which add difficulties and seriousness of cases. As well being pregnant mothers, many of them could not handle usual long dental hygiene appoints happened at UBC dental clinic. Also my ergonomics had to be compromised as pregnant mothers had to be upright positions with a wedge under right lower back to have comfortable postures for the mothers. Another challenge came up with language barrier, as most of the mothers spoke Punjabi with no or little English literacy so it was difficult to present diagnosis and treatment plans as well as to build rapports to gain their cooperation. Many mothers presented with generalized plaque-induced gingivitis modified by hormonal fluctuations from pregnancy,

Patient care at Jim Pattison Maternity Clinic (L: Dr. L. Donnelly; R: K. Nguyen)

which was closely related to their chief concern of sensitivity teeth and bleeding gums. There was limited equipment as no powered-instruments and local anesthetics were not available. Also, being a left-handed clinician, there was no space for me to come to the left side of the medical bed to effectively position myself to provide therapy. Yet, I managed to each case effectively by going over all the medical considerations ahead of time to maximize my given time, removed calculus effectively by using various provided tools and built rapport with my patients by discussing about babies and pregnancy. I also interacted many children and babies by providing toothbrushes and talking about oral hygiene habits for children and babies which intrigued mothers to have better oral health status and to gain knowledge about oral hygiene habits. Overall, I improved my clinical therapy skills by overcoming all the listed obstacles and interacting a new cohort of clients.

Impact of iatrogenic dentistry on oral health

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I had an older patient who was regularly seen by a graduated dental hygiene student. From

Radiolucency found on 37 perapical region in 2011

my initial dental hygiene assessment, I found a perapical radiograph that revealed a periapical radiolucency on tooth 16. I looked for a referral or any intervention that has been done on the area but could not found any. My periodontal exam revealed a deeper pocketing and worsened

Larger radiolucency found at the same area in 2013

clinical measurements on the area compared to the time the graduated dental hygiene student measured.

I took a new perioapical radiograph for the area and identified the remaining periapical radiolucency, which was bigger and spreading to other areas. I immediately refereed the patient for an emergency clinic for a possible periapical abscess. Later, the emergency dentist’s report identified periodontal abscess with root necrosis which resulted in tooth extraction. One of the major concerns for the patient was too keep his remaining teeth; however, the practitioner ignorance on follow-up with identified lesion cost the patient to suffer much more serious infection than he initially had and a tooth. This case reminded me of the importance of ethical and moral duties of dental hygienists who are striving to provide holistic care as primary care providers.

Clinical efficacy CHX rinse after periodontal therapy to avoid any oral infection at the debrided site

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Although dental hygienists in BC are not allowed to prescribe any medications including at-home chlorhexidine (CHX) rinses, collaborating with other dental professionals to prescribe CHX rinse needs to be adopted in dental hygiene profession. I had noticed many of my

Client with severe caries and signs of oral infection

colleagues not working with dentists to prescribe CHX rinse in active periodontitis cases due to lack of time and fear of adverse of effect of CHX rinse – staining. For my practice, if I recognized any symptoms for oral infections, aggressive periodontitis, and uncontrolled chronic periodontitis, I worked with a dentist to make sure that clients would have in-home CHX treatment. All the clients were advised the appropriate use of CHX rinse, especially use it less than 2 weeks to prevent from getting stains. All the clients reported that they felt their oral pain/discomfort had subsidized from using in-home CHX rinse. I had a case in which the client had multiple caries, abscesses, and aggressive periodontitis. I helped him to receive in-home CHX rinse as soon as possible and his oral pain had significantly subsidized and his periodontitis had been relatively stable. I had prevented possible oral infections and stabilized progression of oral diseases using an appropriate use of in-home CHX rinse.

Importance of proper management of denture care

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Edentulism was a common dental condition that could be found in Broadway long-term care facility. With continuous effort of educating care staffs regarding the importance of daily denture care led to better management of dentures. However, I had one incidence, in

Unidentified black patches on the soft-lining of lower denture

which an elder was wearing her lower denture that had been covered with unidentified black patches for several months. The alarming news was that even though the caring/nursing staffs had recognized the patches on the denture, they had not reported the mobile dental hygiene unit or other professionals because they did not understand the seriousness of the denture condition. This incidence highlighted the lack of understanding among staffs to recognize normal and abnormal dentures and to properly manage dentures if they recognized abnormalities as well as there was still a lack of communication between staffs and dental hygiene unit in the facility. So I advised the nursing staff to isolate the denture until the issues of the denture would be resolved, contacted the family members and a denturist to notify the situation as well as further assess overall oral health status of the elder for any signs of spread of infections. The elderly fortunately did not present any other symptoms of oral infections and the process of having a mobile denturist into the facility and resolved issue took less than a week. The quick response to the incidence prevented possible oral diseases and further similar incidence by educating the nursing staffs.

Oral health presentation at Jim Pattison Maternity Clinic

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In early 2014, Kim Nguyen and I had a pleasant opportunity to visit Jim Pattison Maternity Clinic and present topics about oral caries and infections in front of doctors, gynecologists, and registered nurses. The topics were chosen because oral carries and infections were prevalent among pregnant women going to the maternity clinic. The presentation provided

Carious lesions show on 24 and 25 buccal cusps for a pregnant mother at Jim Pattison Maternity Clinic

brief knowledge regarding the etiologies of the oral caries and infections and presented intra-oral photos and x-rays taken from the pregnant women and other clients at UBC dental clinic. After the brief presentation, we provided set of questions that RNs could ask the women such as “do you have any discomfit or pain in your mouth?” to probe oral health status and information regarding Pacific Oral Health Care to refer women who are suffering from caries and oral infections. The nurses were very pleased with the presentation as they said that they learned information that they have not been introduced before, and that they feel more confident to refer their clients to dental clinics. This session helped to merge different professions (medical, nursing, and dental hygiene) and encouraged an integrated care for pregnant women. This was a great opportunity to present scope of knowledge, practices, and skills of dental hygiene in front of other healthcare professionals.

Table clinic: Relationship between nutrition and oral health for an elderly population

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Table clinic was one of the widely methods used in dental hygiene to disseminate information in various venues. In winter 2013, the 4th year dental hygiene students at UBC

Table clinic at UBC Woodward building; From left: Suji Kang, Jillian Tan

hosted table clinics in UBC Woodward building and various community sites regarding various oral hygiene issues. Jillian Tan and I presented a topic regarding nutrition and oral health, emphasizing the bi-directional relationship of the two aspects. Many spectators, including healthcare students, professors, and working healthcare professionals at long-term care facility, visited the table clinic to listen how insufficient nutrition can lead to inflamed gums and oral pains that would further impact the clients having nutritious foods in their diet. There was a huge discussion about dry mouth, especially at the long-term care facility, because the majority of the elders of the facility suffered or showed symptoms of dry mouth. We handed-out 2 pamphlets; one that had a list of medications and medical conditions related to dry mouth and another one summarizing information

Table clinic at Broadway Pentacoastal Long-term Care Facility on December 4, 2013

regarding nutrition and oral health. The spectators appreciated all the information that we presented and were intrigued to further research about the topic. It was a great opportunity to promote the issue regarding nutrition and oral health and to promote the profession how dental hygienist not only considers oral health but also overall health as well.

Pilot study: Efficacy of translated consent form to increase the understanding of informed consent in population with low English literacy at UBC dental clinic

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One of the most frequently emphasized topics in my studies at UBC Dental Hygiene program was cultural sensitivity. Cultural sensitivity was a huge issue in healthcare professions, especially in areas like Vancouver where multiculturalism was evident and various naturopathic/cultural remedies were prevalent. In addition, UBC dental clinic served for populations from diverse cultural backgrounds. Most of these populations are recent immigrants and low-socioeconomic populations with low English literacy. The issue of prevalent low English literacy prevalent among my clients, I often had challenges of obtaining informed consent, especially the one in which the clients had to provide their understandings of dental hygiene diagnosis and treatment plans. Such difficulties happening during informed consent procedure, which is a crucial element of care for both

Understanding cultural sensitivity helped to build a good rapport with a Korean client.

legal and ethical reasons, intrigued me to perform a pilot study at UBC dental clinic regarding the efficacy of translated consent forms to increase the understanding of informed consent in cohorts with low English literacy. The study were conducted among 50 clients from Chinese, Japanese, Korean and Punjabi backgrounds using translated survey forms and informed consent. The cohorts were asked to read the original English informed consent for care and to fill out a survey from that asked what were their current English literacy (low, medium, high) and whether they understood the original consent form (10-20%; 20-40%; 40-60%; 60-80%; and 80-100%). Later, they were asked to read the translated versions of the original consent forms and asked fill out another survey form that asked whether their understanding of the information written on the informed consent has increased (10-20%; 20-40%; 40-60%; 60-80%; and 80-100%); whether they found the translated versions were helpful; and whether UBC Dental clinic should have the translated version in conjunction with the original informed consent.  The result showed that the understanding had significantly increased the understanding of the information written on the informed consent by more than 70% and about 85% of the cohort responded that UBC Dental clinic should implement translated versions of the informed consent for ethical and cultural-sensitive reasons. The pilot study showed significantly positive results in the cohort and highlighted the potential use for translated informed consent form in addition to the regular English informed consent in dental practices serving for similar cohorts. This experience helped me to be a better healthcare professional by understand the importance of language and cultural-sensitivity in obtaining informed consent. With this knowledge, I currently use translating programs to increase my clients’ knowledge about informed consent processes, to build better rapport, and to provide more culturally sensitive care.

Literature review: Exploration of clinical efficacy of alendronate on periodontal health

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Alendronate is a type of bisphosphonate used for osteoporosis patients. Use of bisphosphonate has been negatively viewed among dental professionals, as there has been evidence of bisphosphonate-induced osteonecrosis of jaw. Recently, there have been researches on use of alendronate as a therapeutic mechanism for chronic and aggressive periodontitis. So far the initial human-researches suggest positive outcomes of alendronate as the anti-osteoclast property of the chemical reduced the progression of the periodontal diseases. Although the research was at a preliminary phase, as a dental hygiene professional, I believe that by following up with current research would help me to gain various perspectives regarding periodontics-related topics, especially controversial issues like the use of alendronate. These creative treatments for periodontitis might later expand our scope of practice in conjunction with traditional periodontal therapy, which will increase my professionalism.

Importance of Interprofessional collaboration for patients with HIV/AIDS

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Over the summer of 2013, I had one of the most exceptional experiences at an interdisciplinary health science course about how to interact with clients with HIV/AIDS.

Insite addiction clinic at Vancouver Downtown Eastside. Photo from: fullcomment.nationalpost.com

The course was a combination of lectures regarding medical, nursing, dietetic, social work, public health, and dental aspects for people living with HIV/AIDS as well as community rotations at various sites. It also incorporated a Problem-Based-Learning (PBL) team assignment in which student from the listed healthcare backgrounds congregated as a team and discussed about given situations of a Native woman with an addiction problem. All the lectures increased my professionalism by increasing my understanding of different healthcare professions, which would help me to refer my clients for appropriate cares in the futures. The community rotations also helped to build my professionalism by increasing the true impact of social determinants of health on lifestyle and health status of people. I got a chance to visit single-room-occupancy hotels, an addiction-specialized pharmacy, and an addiction in Vancouver Downtown Eastside. From those visits, I could directly interact with the people who are living in sheer poverties and addiction problems, which helped to gain their perspectives of their situations and rationales why they were in those situations (majorly social and upbringing issues). Learning how social and upbringing issues impacted other aspects of social determinants of health, especially their choices for lifestyle such as drug/alcohol addiction, changed my conceptions of people living in Downtown Eastside and with HIV/AIDS. These experiences broke down my prejudices and misconceptions of those living with various physical, mental, and social difficulties which would help me to grow as a healthcare professional who could better connect with those individuals and better cater customized care for them.

 

Community rotation: Broadway Pentacoastal Lodge – Care Conference

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Building rapport with an elder at Broadway Lodge

Broadway Pentacoastal Lodge was a long-term care facility that provided integrated healthcare services for elders who required living-assistance and palliative care. The demographic of the residents and staff members were from various ethnic and cultural backgrounds. Such aspect was a great opportunity to understand how facility provided culturally-sensitive care and how different professions with different backgrounds could work as an integrated care team such as participating in Care Conferences. Although I had contacted doctors regarding medical conditions and medications for my previous clients at UBC dental clinic, I never had an experience to interact with other healthcare professionals face-to-face. The Care Conferences included a case manger, MD, RN, LPN, a dietician, a recreational therapist, and a chaplain who presented their perspectives for each elder. One time, I had a case in which the elder has a malfunctioned, infected denture so that the elder was advised not to wear the denture until the issue would be resolved. When I presented that case, as an integrated healthcare team, I would work with the dietitian so that the elder would maintain good nutrition from blend food diet. This unique experience of being a part of an integrated team helped me to build up my professionalism because I learned scope of practices of different healthcare professionals, how they communicate/work as an integrated team in a long-term care facility, and how as a dental hygiene student, I could contribute to improve not only oral health but also overall health of the elders.