Category Archives: Professionalism

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.

 

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.