Efficient. Meticulous. Client-centered.
As a fourth year student and soon to be alumni, I hold a lot of pride and respect for the program. Looking back on the past four years, it is incredible to reflect on how far I’ve come in regards to my character, confidence and passion for oral health. Thus, it only comes natural to me to grasp every opportunity available to mentor younger students and advocate for the program.
Imagine Day 2014 Orientation Leader
Student Panel at the DHDP Open House 2015
Imagine Day 2015
This past academic year, I was nominated to be a part of the Dental Undergraduate Society (DUS) as their Dental Hygiene Degree Program (DHDP) fourth year sponsorship representative. Part of my duties as a sponsorship representative was to arrange lunch and learn sessions for my colleagues and acquire sponsorship for our community initiatives throughout the year. Informational sessions helped my colleagues and I acquire knowledge about the latest oral health products and assisted us in making informed decisions in our clinical practice and recommendations to our clients. Furthermore, it gave us the opportunity to network with those already in the dental industry and understand the business aspect of this field.
Throughout the year, I managed to coordinate numerous events for an audience of 80 to 100 students with various dental product representatives such as Oral B, GUM Sunstar, P&G, Sonic Care and WaterPik. This position has allowed me to build and maintain networks with established professionals in the dental industry.
During the Pacific Dental Conference, I had the opportunity to catch up with each of the representatives to thank and appreciate them for taking the time to visit UBC to present on their products.
This past semester, I had the opportunity to develop and implement a preventative oral health program at Union Gospel Mission’s (UGM) Orchard Complex for my community rotation. UGM is a non-profit Christian organization that aims to transform communities by overcoming povert
y, homelessness and addictions. The Orchard is a subsidized housing complex with 75 town homes, aimed to provide long and short term housing to new immigrants, refugees and low socioeconomic individuals. Similarly to Pioneer Community Living association, my role as a student dental hygienist was to provide preventative and non invasive therapeutic services such as dental hygiene exams, oral cancer screenings, debridement, fluoride administration and oral health instruction. Although the majority of clients are individuals living in the Orchard complex, we recruited new clients through the community health nurse, referrals from current clients and from a local church that is sponsoring two Syrian refugee families that arrived in February. At this community site, three dental chairs and two portable dental units were shared between four students.
This was a community site that helped me develop efficiency in my clinical skills. I was required to see an average of three clients per session, and my cultural competence was tested as the clients varied greatly in terms of culture and ethnicity. The two greatest challenges at this community site was the language barrier between the client and myself, and the fact that the majority of the new clients had not seen a dental professional due to poor access to oral health services in their home countries or financial restraints. These challenges were managed by speaking slowly, using hand gestures and pointing to the area of concern when explaining the client’s diagnosis and treatment plan. Overall, the community initiative was successful as we treated a total of 69 patients, 18 of which were new patients. 
![IMG_2010[1]](https://blogs.ubc.ca/dhwithdelwyn/files/2016/04/IMG_20101.jpg)
Individuals living with intellectual disabilities face greater health issues than others, yet rarely receive adequate care to address their health needs. In partnership with local health professionals from various health disciplines, Healthy Athletes aims to address this issue through offering health services and education to Special Olympics athletes. The goal of the “world largest public health program” is two fold: first, to address individuals living with intellectual disabilities health care needs; second, to improve health professionals’ competence in dealing with this marginalized population.
On March 19, 2016, I volunteered for Special Smiles with the mindset to use the clinical and client management skills I have acquired to give back to the community. In collaboration with student dental hygienists from the University of British Columbia (UBC) Dental Hygiene Degree Program and Vancouver College of Dental Hygiene, we provided free dental screenings, oral health instruction on brushing and flossing, applied fluoride varnish, and issued preventative oral health supplies such as toothbrushes, floss and toothpastes to participating Special Olympics athletes. Throughout the day, I had the opportunity to reflect on the difficulty this population has in maintaining their oral health, to empathize with their current situation, and to give them support and the skills to improve their current oral health state. This initiative not only gave me experience in managing clients with intellectual disabilities, but helped fuel within me a passion and desire to work with this population in the future.![IMG_2038[1]](https://blogs.ubc.ca/dhwithdelwyn/files/2016/04/IMG_20381.jpg)
T
he holiday season is often times associated with building a lifetime of memories with friends and family, and to all gather in celebration of another year. However, for Sonia and I, our holidays were spent away from loved ones on the other side of the world, and for justifiable reasons.
From educating children and health professionals about oral health, to providing clinical therapy, and conducting oral cancer screenings, this initiative gave me the opportunity to exercise all aspects of the dental hygiene scope of practice. A moment that stands out, one that I often revisit, is walking through the overcrowded and non-air-cond
itioned Oncology Hospital, seeing beds occupied by two to three patients who are battling advanced stage cancer with tumours the size of a grapefruit. This moment of enlightenment truly provided realization that although dental hygienists are not involved with treating such serious conditions, they play a significant role in the early identification of such complex and fatal oral conditions.
I went into this initiative thinking that coming from North America where resources are abundant and the quality of life is high in comparison to developing countries, I would be able to give back and share the wealth of knowledge I have obtained from my undergraduate program; however, now I feel that I have gained more than I could have ever given. Although the health professionals we were highly educated, they were humble in their knowledge and gave us outstanding respect as we conducted educational sessions. Furthermore, even though oral health professionals working in the university and hospital receive very little salary (~$150USD/month), they worked tirelessly to raise up a new generation professionals and develop a caring relationship with their patients ensuring to deliver the highest quality of care. After a day of work at the university or hospitals, they will work in a private practice until late at night just to make enough money to survive. Seeing them pursue their passion and devote all their energy to their career without any restraints encouraged me to look past the money aspect in my career and strive to make a difference in my community and facilitate the advancement of my profession.
While I continued to develop a deeper appreciation for this profession and explored different practice settings in Vietnam day after day, it has further reaffirmed the significance of my role as an emerging licensed dental professional. I have left Vietnam even more passionate to advocate for preventative services to reduce the prevalence of oral diseases, increased access to healthcare services, and increase awareness.
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.
Due to British Columbia’s (BC) relative proximity to Asia, BC experiences a great influx of immigrants from Asia. Over 250,000 immigrants migrate to Canada annually, and approximately 35,000 of those arrive in British Columbia (BC), making up a high proportion of the population in BC.(1-4) New immigrant’s combination of language barriers and low oral health literacy can create a challenge in an oral health setting. As primary health providers, it is important to be aware of this populations health needs and come along side them to provide assistance in navigating Canada’s healthcare system.
During my second year, I chose to plan and implement an initiative at the ISS of BC’s English Language Services for Adults (ELSA) Program for my community rotation. ISS of BC is a non-profit organization aimed to assist new immigrants and refugees assimilate in Canada and the ELSA program achieves this by offering English language training program that provides basic and intermediate level English classes for adult immigrants and refugees. In addition to attaining English skills in reading, writing, listening, and speaking, the students also learned about Canadian culture, community resources, healthy living and the Canadian job market.
My team and I educated the students about the importance of oral health, differentiating between a health and unhealthy mouth, methods to maintain oral health, communicating with a dental profession and presented reduce cost clinics. Due to the language barrier between the students and myself I had to speak slowly and use hand gestures and pictures to ensure they grasped the concepts and hand skills. My team and I were able to test their understanding and increase their English literacy by through role play and hands on activities.
Debates have been used as an instructional and education tool in dental programs as it empowers participants to critically think on their feet, advocate for the implementation of health policies and bring about understanding to controversial subjects such as water fluoridation.1 Debates are ideal platforms for dental hygienists to create awareness of the profession and demonstrate their expertise and knowledge, which is substantiated by scientific research.
In 2014, I participated in the annual fluoride debate where my class was divided into three teams: pro-fluoridation, anti-fluoridation and critical colleagues. I was chosen to be on the critical colleagues team, which was in charge of marketing the debate to enhance attendance, moderating, time keeping and generate challenging questions for the two teams from the perspective of the general public. Although I knew the benefits of water fluoridation was well supported in literature, I had to remain neutral and speak from the public’s perspective. In the process of preparing for the debate, I honed my critical thinking, scientific investigation and research use competencies through examining the current literature regarding the risk and benefits of fluoridation and developing questions for both teams.
Although all the team members on the anti-fluoridation team believed in the efficacy of fluoridation, they won the debate due to their superior abilities in reasoning. The debate revealed the importance of understanding the risks and the benefits of the products and services that I recommend to my clients to ensure I am providing unbiased and objective information. Furthermore, it reinforced the importance of using literature to ground my clinical practice.
Mental illness is becoming increasing prevalent in Canada as statistics reveal that in any given year one in five Canadians experiences a mental health problem.1 Additionally, literature shows that people are more likely to visit their oral healthcare providers on a regular basis than their other primary healthcare providers.2 It is reported that adults aged 20-44 rarely visit their family doctors for preventive care, yet they visit their oral healthcare professionals at least once a year.2 Therefore, understanding this population`s barriers to oral health care can help clinicians managed this population and treat them with dignity they deserve. In addition to providing clinical services, my team and I held a table clinic to educate the population about the difference between healthy and unhealthy gums and showed them how to care for their oral health daily. The goal of the table clinic was to encourage the population to equip them with the basic knowledge and skills to care for their oral health daily.
Pioneer Community Living Association (PCLA) challenged me in the area of professionalism and client management as I provided treatment to a population living with multiple mental illnesses. I learned the importance of not labeling the residents by their condition, but instead understanding that they are people living with a chronic condition. During the meeting with the care manager of the facility, she stated that the residents “have enough
difficulty getting out of bed in the morning, more so caring for their oral health”. Keeping this in mind and having mindset of empathy, allowed me to understand the justification behind the poor oral health state of some of the residents. My community rotation at PCLA has equipped me with the skills to successfully create andmanage a community oral health program as my team and I were responsible for managing all aspects of the program including: assessing and diagnosing the needs of the population, developing a plan that catered to the needs, manage inventory of supplies, implement the plan, and evaluated the population.
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.