Monthly Archives: November 2011

Wipe twice!..Even at community (oral disease prevention)

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Figure1. Arielle sitting on a disinfected chair.

As dental hygienist it is important to follow through with universal precautions as we are exposed to varying diseases. Infection control would protect both the clinician and the client or community.  My community group and I incorporated proper infection control knowledge even in the community setting. In the community setting at Pioneer house, we set up our “clinic” in their arts, and tv room. Hence, we had to utilize radio, pool table,chair surfaces as areas to place our instruments. To prevent the spread of disease we used double layer of bibs,wiped down twice and barrierred door handle. We also set up and labelled an area for the used instruments.

Despite not being in our usual dental office clinic setting, we translated the knowledge of infection control. We prevented the spread and acquisition of oral disease.

Stop that Lesion! (Oral Disease Prevention)

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Figure 1. The outside view of BPL

At Broadway Pentecostal Lodge I provided care for a 98 year old lady. During the assessment I found a lesion at the floor of the mouth. I recorded the lesion description measurements, colour, appearance,texture. My clinical instructor also took a look and took an intraoral picture. We followed the protocol of the site by taking immediate action since it was causing the client discomfort. We consulted Dr. Laronde and we also put an order up for the client’s medical doctor to come take a look. As a result, nystatin was applied topically in that area. The following week I found out that the lesion was most likely some type of fungal lesion as it has started to resolve. On the third week follow-up the lesion had no longer the whitish-yellow cheese curd appearance and no longer was giving the client pain.

From this experience I reflected that through the following protocols, I had taken part in preventing the progression of the lesion.

Health Promotion

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Currently the British Columbia’s Medical Service Plan (MSP) does not cover for dental care. With the only minor exception for emergency dental care provided at hospitals and residents 19 years old or younger who are a part of a low to moderate income family. (1) Thus, my group ( consist of Arielle,Nancy and I ) want to advocate and work towards including oral assessments with in the MSP. The oral assessment would include intra/extra oral exam, dental exam, and periodontal exam. We believe as health care professionals, it is important to view health in a holistic sense. People go to their doctors to get their yearly blood work done to prevent diseases, maintain health, and ensure the health of the individual. because they want to know that everything is healthy. Likewise, an oral assessment is a baseline indicator to whether the mouth is healthy or unhealthy. We also believe that by inputting oral assessment as apart of the MSP, the population will gain an insight on the notion of prevention and maintenance of the oral health. Moreover, Integrating oral health into the MSP, coincides with the Ottawa Charter of reorienting health services so that different health care professions work together to satisfy the need of a person as a whole. (2)

As apart of our cause advocacy project, we plan to act on this by means of A) Writing a letter to Michael De Jong B) Starting a facebook page to gain support from fellow hygienists.

In doing so, we hope that once this is in place there will be a decrease in oral health disparity present in BC and also promote the notion of maintenance of oral health as apart of overall health.

Please see the link below for the Facebook page we created

https://www.facebook.com/groups/324277417620415/

Our letter to Michael De Jong is found below.

DHYG410_Cause_Advocacy_Nancy_Anna_Arielle

 

Reference

  1. British Columbia Ministry of Health. Medical and health care benefits [Internet]. [cited 2012 March 28].  Available from: http://www.health.gov.bc.ca/msp/infoben/benefits.html
  2. World Health Organization. Ottawa Charter for Health Promotion. First International Conference on Health Promotion; November 21, 1986. Ottawa: WHO; 1986. p.1-4.

 

 

Risk model for oral cancer development (Professionalism – Scientific investigation)

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Figure 1. This is me presenting at UBC Research Day 2012.

Figure 2. This is a screenshot of my poster. For a legible version of my poster, please see attachment below.

Professionalism – Scientific investigation

With UBC Dentistry Faculty’s foundation built on evidence-based research, we have some renown researchers  present in the staff and faculty. Over the four years in our  program, we have had the opportunity to be expose to lectures containing the ongoing research present in the various specialties.

In the summer of 2010 until now, I have had an exciting chance to be apart of a research project on oral cancer. Under the supervision of Dr. Catherine Poh and Dr. Lewei Zhang , the project would entail the construction of a risk model for predicting oral cancer developement. Prior to the initial stage of the population-based project, I had to do a review of the literature to be better versed. It was found that health professionals have used reliable risk predicting tools to identify those at high risk for breast and lung cancer. In doing so, there was a decreases in prevalence, better prognosis and cost-efficiency.(1-5)  However, in the current literature there is no risk factor model for oral cancer. Thus, our project’s goal is to use easily accessible clinical characteristics of the lesion and patient description to aid us in constructing such model. The project would look at specially oral mucosal lesions from the last 30 years.

To obtain the data, we would access patient pathology report and biopsy request forms from the Oral Biopy Service (OBS). I would manually read and scan each individual files.

As one can see, there is a lot of work involved. For more details and ongoing results/ and progressive conclusion on this project, please see the poster that I had to assist in constructing and presenting on UBC research day 2012.

From this experience I have gained some insights. That is, when it comes to researching, it takes a lot of dedication,passion and time involved. Being apart of research means there is interprofessional collaboration from different buildings, organization, province. It also  means being apart of the going body of knowledge.

Ultimately, through this we want to better understand oral cancer and provide the best treatment and outcome for our clients.

Risk_Factors_for_Oral_Cancer_2012_FINAL

  1. Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, Mulvihill JJ. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81(24):1879-86.
  2. Raji OY, Agbaje OF, Duffy SW, Cassidy A, Field JK. Incorporation of a genetic factor into an epidemiologic model for prediction of individual risk of lung cancer: the Liverpool Lung Project. Cancer Prev Res (Phila). 2010;3(5):664-9.
  3. Speight PM, Palmer S, Moles DR, Downer MC, Smith DH, Henriksson M, Augustovski F.The cost-effectiveness of screening for oral cancer in primary care. Health Technol Assess. 2006 Apr;10(14):1-144, iii-iv.
  4. Gail MH. Value of Adding Single-Nucleotide Polymorphism Genotypes to a Breast Cancer Risk Model. J Natl Cancer Inst. 2009;101:959-63.
  5. Guillaud M, Zhang L, Poh C, Rosin MP, MacAulay C. Potential use of quantitative tissue phenotype to predict malignant risk for oral premalignant lesions. Cancer Res. 2008;68(9):3099-107.

 

Why your smile matters. (Health Promotion)

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Figure 1. This is the table clinic my group and I made.

At our externship sites in term 1, my group and I had  our first exposure to the mental illness population. It was apparent that both Pioneer and Lina’s place had immense need for oral care. Upon completion of the situation analysis, review of the literature and assessments we were able to piece the puzzle together. One of the most predominating factors would be the lack of self-esteem and lack of motivation present in this special needs population. (1) As a result, our group decided to promote oral self care behaviour that tailors to the resident’s motivational and self-esteem. As these homes are transitional homes, we promoted the relevancy of taking care of their oral health to the advancement of the next stage of their lives. We talked about how research having disease free mouth was related to more smiling and more smiling was related to higher self-esteem.(2,3) Not only did we promote oral self care practices using psycho-social factors, we talked about overall well-being. As a result of our table clinic the residents were engaged and asked a lot of questions and some of them express that they did not know about a lot of the knowledge that we shared with them.

Please see the attachment for our pamphlet that accompanied the table clinic.pioneerpamph

 

Reference

  1. Griffiths J et al. Oral health care for people with mental health problems: guidelines and recommendations. Report of BSDH Working Group. British Society for Disability and Oral Health. January 2000.
  2. Patel RR, Richards S and Inglehart MR. Periodontal Health, Quality of Life, and Smiling Patterns – An Exploration. J Periodontol. 2008;79:224-31.
  3. McKeown L. Social relations and breath odour. Int J Dent Hyg. 2003;3:213-7.

Say NO! to polish, with the help from research

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I am fortunate to have the chance to undergo my dental hygiene schooling at UBC. Here at UBC I have access to an extensive journal databases. Moreover, the dental hygiene program at UBC emphasizes the importance of evidence-base literature. This is significant as the evidence-based literature would serve as a practice guideline and facilitate in decision making. Subsequently, the recommendations given to clients would be of beneficence.The use of evidence-based recommendation is often used in my own dental hygiene care. I have had many clients who request for polishing and they usually ask me “My previous dental office always gave me polishing before the fluoride. Why don’t you?”. I would then provide them with what the recent research on rubber cup polishing. That is, RCP would remove micro layers of enamel, and that it is not needed for fluoride uptake. (1)  In addition, I would have clients who have equated a to a white smile to a healthy smile and wanted bleaching. I would then have to dispel this myth and explain the risk of bleeching their teeth. Once I provide my clients with this information, they are usually surprised and they make their own decision to decline polishing.

Reference

1. Azarpazhooh A, and Main PA. Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and gingivitis: a systematic review of literature. Br Dent J. 2009;207(7):328-9.

Teaming up with other health professionals!

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As a health care professional, one should provide care that is high-quality and client centered. To achieve this, interprofessional collaboration is a must. (1)  I was able demonstrate this with my client, Mr. F, that had schizophrenia, artificial heart valves, and SLE. Firstly, for the dental hygiene care be delivered, I had to work with Mr.F and the facility to schedule an appointment that that fit best for all of us. I also had to collaborate with the on site nurse and Mr. F’s physician. There was a need for pre-medication of Clindamycin prior to dental hygiene treatment due to Mr. F’s artificial heart valve. The nurse then phoned Mr.F’s physician and had the order in for 600mg of Clindamycin. Also, since Mr. F was on warfarin, I asked the nurse about his INR levels. The nurse did not know and we had to contact the physician again. Subsequently, Mr. F had to be taken off the blood thinner 48 hours prior to treatment. With the collaboration with the client, facility, the nurse, and GP I was able to deliver dental hygiene care that was quality assured.

Reference

1. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;(3):CD000072.

Mrs.N- The lovely,hip Russian grandma ( Professionalism;communication)

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Living in a culturally diverse city, it becomes important that I am culturally competent and have good communication skills. One of the clients that I saw in the beginning of the year at UBC Oral Health Center was 67 year old Russian lady. She immigrated to Canada five years ago. In Russia she was a professor at an university and is now retired, stylish grandmother. Mrs.N knew very little English and had especially hard time in speaking. In a sentence of ten words, (depending on the content) two words would be in English and the rest would be in Russian. As one can imagine, this may pose a challenge for the clinician in terms of going through the assessment,proposing the treatment plan,client education and building client rapport. Initially, it was extremely difficult to understand her, let alone talk to her in English. However, through patience, careful listening, and observations of the non-verbal cues I was able to understand her most of the time. I was also able to communicate to her through the use of short, simple sentences. I did not use baby talk as I kept in mind that she probably knew the content, just not in English. Also, she would have probably found it offensive, as she is highly educated. If the use of brief sentences were unable to convey to her, I would use a combination of drawing, acting, and google translator. At the end of the sessions, Mrs.N was very appreciative of the care that I provided her with and gave me a heart-felt hug as we departed.

Mr. C (Clinical Therapy)

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Prior to entering the program, I had a misconception that the oral health literacy of the general population were at a particular standard. As we live in country where the health care system is ranked top 30. Also, my parents have always had dental insurance and I would visit the dental office every six months. However, I gradually learn throughout the program, a client’s oral status and oral health perceptions is mediated by social determinants. In my senior years in dental hygiene, I was able to experience what we learned in class first hand. Mr.C a 65 year old man who was recently divorced,neglected by family members and recently moved to east Vancouver. With the castastrophe Mr. C was experiencing in his current stage of life, his oral health was in a similar state. When asked when was the last time he brushed, he stated he could not remember. Mr. C acknowledged that he had neglected taking care of his oral health, but also stated that he stopped brushing his teeth due to pain and the excessive bleeding. Mr. C thought that the bleeding of his gums was caused by his tooth brushing. Through debridement, client education, and oral self care sessions, there was a gradual improvement of his oral health. Moreover, there was visible change in his overall well-being as well. There was an increase in self-esteemed as Mr. C understood that he had control over his own oral health. He would enthusiastically give me weekly updates of the decrease in bleeding that he was experiencing. In addition, he would tell me about how he was meeting up with friends more often now as well. Through the supportive dental hygiene care that I was providing Mr. C was able to maintain his oral health and optimize his oral functions.

Community externship at Pioneer ( Clinical Therapy)

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During term 1, I had the opportunity to experience what it was like for a dental hygienist to work in a community setting. More specifically, our group was allocated to the mental illness population. For the special needs population, there appears to be more complications with their systemic health, mental health, psychosocial health, and drug interactions. Thus, it important as a dental hygienist to record a detailed and in depth assessment. One of my client had schizophrenia, artificial heart valves, systemic lupus erythematosus (SLE) and had penicillin allergy. Moreover, he was on a whole list of medications. As a primary care giver, it was my responsibility to ensure the side-effects of the drugs, possible contraindications, and also see if pre-medication is necessary prior to treatment. Through the use research, critical thinking, and communication and collaboration with the on site nurse, some adjustments were made to his medications prior to treatment. My client’s warfarin had to be taken off 48 hours prior to treatment and 600mg of Clindamycin had to be ingested one hour prior. Ultimately, clinical therapy was demonstrated by identifying clients at risk for medical emergencies and I used appropriate strategies to minimize such risks.