Tag Archives: community practice

Ray Cam Community Clinic

Ray Cam Community Clinic stirred in me a great interest in the low socioeconomic population. Currently 1 in 7 Canadians live in poverty.1 Low income populations tend to experience greater health inequities such as poor access to health services, systemic health conditions (high blood pressure, obesity), and poor oral health.1 The low socioeconomic population face the double burden of having the highest level of oral health problems and the greatest barrier to oral health care.2,3 Cost of dental treatment remains to be a deterring factor for those struggling financially.1 Although, the Canada Health Act states “continued  access  to  quality  health  care  without  financial  or  other  barriers  will  be critical to maintaining and improving the health and well-being of Canadian”, there is a absence of a policy  attempting  to  achieve  “continued  access  without financial or other barriers” enacted for oral health care.2,3

The clinic was held in Ray Cam Community Centre, situated in Downtown Eastside in Vancouver, a region known as Canada’s poorest postal code. Many individuals who sought care from the clinic were predominantly elderly individuals of Chinese descent and had not seen a dental professional for 10 to 15 years. Working along side an experienced registered dental hygienist and two other dental hygiene students we managed to provide dental hygiene services to more than 30 individuals. This was also my first exposure to an individual with severe chronic periodontitis and an “wall to wall” calculus. This community initiative allowed me to use my the talents, skills, and knowledge I have acquired from my undergrad career to serve a marginalized population.

  1. The Canadian Academy of Health Sciences. Improving Access To Oral Health Care For Vulnerable People Living In Canada. 2014
  2. Provincial Health Services Authority. Towards reducing health inequities: a health system approach to chronic disease prevention. Vancouver (BC): Population & Public Health, Provincial Health Services Authority; 2011.
  3. Health Officers Council of BC. Health inequities in British Columbia: discussion paper. Vancouver (BC): Public Health Association of BC; 2008.

Document, document, document

Every dental professional is responsible for their client’s chart as it is a legal representation of dental services provided.1 Documenting all procedures, client communication and clinical findings ensure the clinician accountability to the government, insurance company and client.1 Additionally, effective documentation can protect the clinician if the chart is called upon as evidence during a legal dispute.1

The importance of documentation was reinforced during a clinical session when a client that presented with numerous dental complications refused to receive local anaesthetic (LA) on numerous occasions.  After many attempts to help her understand the benefits and few risks of LA, she insisted that I proceed with scaling without LA. Respecting her wishes, I proceeded to document the discussion with my client – first, to protect myself should a dispute occur; second, to ensure future clinicians are informed of this situation. The client was referred to the DMD program; however, she had a history of refusing treatment when she was contacted and was permanently banned from the program. During her recall appointment, she was upset that she had not received a call from a DMD and insisted on speaking with the clinical coordinator. After a long discussion involving the clinical coordinator and a look through the communication history, it was clear that the client had been deferring dental treatment due to fear of needles. Although the client claimed that she had not been contacted and that such events did not occur, it was documented in the system. Due to the unreliability of the client, we could not initiate another referral to the DMD program and had to dismiss the client from the DHDP program due the risk of possible allegations of supervised neglect.

Supervised neglect is defined as a case in which a “regularly examined patient shows signs of a disease or condition but is not informed of its presence or progress”. In our case, although we informed the client about her disease status and the importance of receiving treatment, she consistently refused treatment and would deny that the clinic’s attempt to contact her for dental treatment. This experience helped me truly appreciate the detailed documentation that we are taught throughout our clinical experience. Although documentation can be time consuming and tedious, documentation of client procedures, communication and clinical findings will prevail, especially in situations where the client is making allegations against the clinic or clinician.

  1. Charangowda BK. Dental Records: An Overview. J Forensic Dent Sci. 2010 Jan-Jun; 2(1): 5–10. doi:  10.4103/0974-2948.71050
  2. CHDA. Dental Hygiene: Definition, Scope, and Practice Standard. 2002.