Artifacts and Reflections

NUTRITION – JOHN HOWARD SOCIETY

Based on this population’s needs assessment, I collaborated with my dental hygiene student-team and the dietetics student to develop an informal nutrition session highlighting daily nutrition needs and goals and its impact on oral and overall health for John Howard Society (JHS) clients.^1,2,4 This development and collaboration originated when I observed a nutritional counselling session with the dietetics student at JHS, where I assessed the nutritional health literacy of various clients. From this interaction, it was evident that there is a knowledge gap regarding food and nutrition, and its implications on oral and overall health.³ Thus, a need for this lesson was determined. With initial lesson brainstorming, I presented my lesson plan idea to my dental hygiene team, community instructor, the dietetics student, the JHS manager, and two JHS social workers. Together, we collaborated on the appropriate approach of the nutritional lesson, the activities included, the budget, and the need for this particular lesson within the community.

As the population of this site involves individuals with a history of incarceration, once clients have served their time, they may struggle to reintegrate back into society. Focusing on food services and nutrition, Correctional Service Canada has a developed an Acts, Regulations and Policy document outlining guiding principles and implementation protocols on the food and health services provided to incarcerated individuals within penitentiaries.³ However, what is classified by Canada’s Food Guide as healthy food, portions, and serving size to maintain a healthy and well balanced diet and lifestyle is not a standard met in many Canadian penitentiaries.³ Therefore, once individuals are released and working towards social reintegration, the struggle to meet basic human needs poses as a challenge.

This lesson plan was well received by all participants and clients upon lesson implementation. The initial rapport built between my team and the JHS clients and their social workers allowed for open communication in a safe setting. The opinions and comments presented by the JHS staff was highly considered when developing our lesson plan, and was in the forefront of our implementation when involving and interacting with the JHS clients. This interprofessional collaboration was well received by the JHS clients during and post-implementation of the lesson, as verbal and written positive comments were communicated to the dental hygiene team. With this, the specific qualities of professionalism were met:¹

• Design and implement services tailored to the unique needs of individuals, families, organizations, and communities based on best practices;
• Demonstrate ownership of the profession through community service activities and affiliations with professional organization;
• Apply principles of risk reduction for client, colleague and practitioner safety, health, and wellbeing.
  • g. Provide information to clients about cariogenic and high fat food choices.

References:

1. Canadian Dental Hygiene Association. Entry-to-practice competencies and standards for Canadian dental hygienists [Online]. 2010 Jan [cited 2019 Apr 1]. Available from: https://www.cdha.ca/pdfs/Competencies_and_Standards.pdf
2. Correctional Services Canada. Health services sector [Online]. 2011 Jul [updated 2012 Feb 3, cited 2019 Apr 1]. Available from: http://www.csc-scc.gc.ca/health/002006-0005-eng.shtml
3. 3. National Post. ‘Yuck!’ Hungry offenders bartering sausages as prisons try to cut costs with new menu, ombudsman says. 2017 Mar 21 [cited 2019 Apr 1]. Available from:https://nationalpost.com/news/canada/prison-food
4. Correctional Services Canada. Food services [Online]. 2000 Feb 21 [updated 2007 Jun 30, cited 2019 Apr 1]. Available from: http://www.csc-scc.gc.ca/lois-et-reglements/880-cd-eng.shtml

LOW-COST DENTURE CLINICS – JOHN HOWARD SOCIETY

During my community practice at John Howard Society (JHS), I had a lot of clients approach me in need of denture care. As many clients have minimal to no insurance coverage, attaining dentures is difficult. Therefore, based on the need’s assessment of this population, I developed a local low-cost denture clinic list for clients and their social workers to use.¹

To expand, the idea to develop a list for low-cost denture clinics for clients to use was initiated with a client came to JHS in dire need of full dentures. This previously incarcerated individual explained his difficulty in obtaining a new full denture, and how the lack of teeth affects his ability to eat safely, speak, and decreases his confidence and emotional well-being. With this, I took initiative to call many local denture clinics and advocated for the client, noting that financial support was minimal.^1-3 While contacting an upwards of ten local denturists, I aimed to get a price quote on full-mouth dentures with potential discounts for first-time and/or low-income clients. Many denturists also sympathized with this client’s situation, and offered various options for assistance. Within this search, I spoke to the director of CDI College Denture School (Surrey) to assess program requirements for how my client could also become their client, as they surprisingly offer free dentures.³

Once I had completed my research, I compiled my information in a list format of the low-cost denture clinics, including the information of which insurances they accept, the approximation of each type of denture a client may need, and respective denturists with their phone numbers. A copy of the list was given to the client, as well as their social worker, and was distributed to other JHS staff. This interprofessional experience provided an insightful experience in the health inequities of vulnerable populations, such as previously incarcerated individuals, and how health care providers communicating and collaborating with social workers can make a positive impact on an individual’s health and quality of life.^1-3

References:

1. Canadian Dental Hygiene Association. Entry-to-practice competencies and standards for Canadian dental hygienists [Online]. 2010 Jan [cited 2019 Apr 1]. Available from: https://www.cdha.ca/pdfs/Competencies_and_Standards.pdf
2. Institute of Medicine. Establishing transdisciplinary professionalism for improving health outcomes: workshop summary.Washington (DC):National Academies Press (US); 2014 Apr 7.
3. Holtman MC, Frost JS, Hammer DP, McGuinn K, Nunez LM. Interprofessional professionalism: linking professionalism and interprofessional care. J Interprof Care. 2013 May 14;25(5):383-5.

FLUORIDE VARNISH APPLICATION ROTATION – FRASER HEALTH INSTITUTE

Dental caries is one of the most prevalent oral disease, worldwide.¹ This poses a great risk to the dental development of individuals during childhood and adulthood. As the profession of dental hygiene focuses on disease prevention, it is imperative for myself to have the opportunity to shadow dental hygienists who treat children with a high prevalence for caries.

Fortunately, I had the opportunity to shadow and participate in a fluoride varnish rotation with Fraser Health Institute in Port Moody, BC. During this experience, I learned new techniques in managing pediatric clients in collaboration with their parents. The dental hygienist used the first client to demonstrate the knee-to-knee technique for examining the client’s dentition and for the application of fluoride. Afterwards, I had hands-on experience with the dental hygienist and the next clients to provide knee-to-knee dental hygiene care inclusive of fluoride application. Furthermore, I used this opportunity to educate parents and guardians on the importance and benefits of fluoride, and brushing (with fluoridated toothpaste) techniques that can be practiced at home with their children to prevent future caries lesions.²

This community rotation was very enriching as it strengthens the notion that dental caries are very prevalent in children, and the importance of teaching oral health education in early childhood development.¹The knee-to-knee technique for fluoride application proved to be successful and very helpful in my pediatric rotations at UBC, where I also educated parents about fluoride, dentition, and nutrition.

References:

1. Canadian Dental Association. The state of oral health in Canada [Online]. 2017 Mar [cited 2019 Apr 2]. Available from: https://www.cda-adc.ca/stateoforalhealth/_files/thestateoforalhealthincanada.pdf
2. Frank S. What are the benefits, side effects, and recommendations for fluoride treatment?[Internet]. 2018 Mar 13 [cited 2018 Nov 30]. Available from:https://www.healthline.com/health/dental-and-oral-health/fluoride-treatment

ONLINE SELF-DIAGNOSIS

During client practice in third year, I had a senior client who preferred a naturopathic approach to meet her health care needs. While alternative methods of treatment are acceptable, the client was very resistant to change (low on the transtheoretical model of change) and proved to be challenging to oral health education.^1,2 Educating the client on nutrition, self-diagnosis, dangers of online browsing, and evidence-based research were topics of discussion throughout appointments. To start, my client was very vocal on her methods of acquiring information from various online sources for a variety of vitamins, supplements, and therapies. Throughout every appointment, I was able to elicit information about the client’s oral health knowledge, beliefs, and attitudes regarding her personal self-care habits, diet, medications, and lifestyle.¹ In clinic, I had the client participate in a food diary assessment, providing the client with nutritional counselling. From the results, it was evident the client was not receiving well-balanced nutrition with food variety as the client had designed a specific plant-based diet for themselves. The client also noted that her allergies were self-diagnosed, which affect her food choices; therefore, impacting her nutrition, dental, and overall health. Upon assessment, the client refused the recommendation of seeing a physician for allergy testing. Furthermore, while I was able to teach the client personal self-care through toothbrushing and flossing methods and techniques, the topic of working together to find credible sources for information was commonly discussed. At the end of the appointment, credible sources were provided to the client, such as Dieticians Canada, to provide her with more evidence-based information.¹

Online research using unreliable online sources such as WebMD, Wikipedia, and eHow, can be dangerous if used incorrectly. Certain sources are unreliable if they have a lot of advertisements on their webpage, if directions and claims are unclear, if the website is out-of-date, if the site requires the entry of personal information, and if the site has an unreliable domain. Moreover, if a client does not understand the etiology of their medical conditions, and the required therapy needed to manage their condition(s), intake of unnecessary supplements and medications, inaccurate dose and frequency, and contraindications may surface and pose dangerous, if not deadly. Statistically, older adults, ages 65 years and older, are susceptible to complex health care needs, consequently, relying on past health experiences and medical knowledge to guide self-diagnosis.³ While commonly facing difficulty in navigating computer and Internet tools, one in five senior citizens use the Internet as a source for health information; however, many are misled to unreliable sources and misdiagnosis of themselves or others as 58% of seniors do not check sources for reliable information.^3-5 Many individuals are drawn to online self-diagnosis as a form of relief.⁴ While there are a few benefits associated with this form of diagnosis, such as doctor appointment preparation, and understanding of symptoms and conditions, the risks of online diagnosis outweigh the benefits.⁴ Risks include misinterpretation of unreliable information, replacing the physician with the Internet, delay in seeking treatment, and inaccurate, incomplete, and harmful treatment facts and options suggested.^4-6 A recommendation to all health care professionals is to recognize behaviours clients present; encourage client participation and autonomy for client’s health by providing credible sources and evidence-based information, while being receptive and aware of alternative medical approaches.⁴

References:

1. Canadian Dental Hygiene Association. Entry-to-practice competencies and standards for Canadian dental hygienists [Online]. 2010 Jan [cited 2019 Apr 1]. Available from: https://www.cdha.ca/pdfs/Competencies_and_Standards.pdf
2. Tillis TS, Stach DJ, Cross-Poline GN, Annan SD, Astroth DB, Wolfe P. The transtheoretical model applied to an oral self-care behavioral change: development and testing of instruments for stages of change and decisional balance. J Dent Hyg. 2003;77(1):16-25.
3. Houston T, Suls J, Older adult experience of online diagnosis: results from a scenario-based think-aloud protocol. J Med Internet Res. 2014 Jan 16;16(1):16.
4. Gass MA. Risks and benefits of self-diagnosis using the internet. Salem State University. 2016 May 1. Honors Theses. 96. http://digitalcommons.salemstate.edu/honors_theses/96
5. Kaiser Family Foundation. e-Health and the elderly: how seniors use the internet for health information – key findings from a National Survey of Older Americans [Internet]. 2005 Jan [cited 2018 Apr 11]. Available from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/e-health-and-the-elderly-how-seniors-use-the-internet-for-health-information-key-findings-from-a-national-survey-of-older-americans-survey-report.pdf
6. Oliveira M. More than half of Canadians use ‘doctor Google’ to self-diagnose. The Canadian Press. 2013 Jul 13 [cited 2018 Apr 2]. Available from: https://globalnews.ca/news/752415/more-than-half-of-canadians-use-doctor-google-to-self-diagnose/

Practice Observation

 

BUSINESS MANAGEMENT REFLECTION

In February 2019, Ms. Susanne Sumi attended our class to present ‘The Business of a Private Dental Practice”. Initially, Ms. Sumi defined the purpose of business, and it was pleasant to hear that the purpose of business is not ‘profit’. This, I feel, parallels with client-centered care.

I found this presentation very informative in that, my original assumptions of what I thought owning a practice consisted of were debunked. I did not consider the option to buy a fully equipped dental hygiene practice, and have to consider the amount of yearly revenue of practice, location, number of client files, and style of practice.(1) Overall, I did not anticipate the price of owning a dental business to be upwards of $500,000.00CAD!(1) Opposingly, there is the option to build a practice up. For this, there has to be a budget in place to predict cost of equipment and supplies, number of employees and their hourly rate, and variable and fixed expenses.(1)

This presentation definitely puts in perspective the amount of time and financial stability one must consider prior to and while owning a dental practice. Moreover, I recently completed an assignment with my team where we developed a dental hygiene program for utilizing mobile dental units in long-term care facilities. By practicing in writing a grant application, my team and I discovered the cost analysis of our project and realized how much financial dedication is necessary to run a successful dental business. An example for our mobile dental unit practice is the initial amount we need, being $75,000.00CAD, just to initiate our pilot study. Going forward, keeping in mind the cost analysis and budget of purchasing and maintaining a practice will always be on the forefront of my future practice, as every aspect of running a practice needs to be detailed and considered in order for it to be successful.

References:

1. Sumi S. The business of a private dental practice [unpublished lecture notes]. 410: Dental Hygiene Knowledge and Theory, University of British Columbia; lecture given 2019 Feb.

CAUSE ADVOCACY PROJECT

During my last term in the UBC Dental Hygiene Entry-to-Practice program, my team and I developed a cause advocacy project: dental hygiene care for cannabis consumers. We chose this topic in light of the recent legalization of cannabis in Canada (October 2018).¹ The aim of this project is to reduce disparities of reluctance in support and care by dental hygienists, by implementing educational workshops and seminars for dental hygienists to continue providing comprehensive dental hygiene care for cannabis consumers. The goal of our program is to improve implementation of dental hygiene processes of care model for cannabis consumers by increasing dental hygienists’ knowledge and understanding of cannabis.² On January 2, 2019, the Canadian Dental Hygiene Association (CDHA) released media in regards to the new legalization of cannabis stating the focus to be setting new goals and resolutions for dental hygienists in response to increased oral health risks from cannabis use.³Additionally, the importance of obtaining consent and avoiding impaired practice is a reinforced message by the College of Dental Hygienists of British Columbia (CDHBC).⁴

My team and I developed two scenario-based videos incorporating dental hygienist and client interaction; a client who is a cannabis consumer. We hope that these videos will aide as educational tools in depicting culturally-safe health care practices and client management, inclusive of motivational interviewing, informed consent, and comprehensive medical history intake.²Additionally, my team and I developed a poster that can be displayed within the clinic and operatories to show clients that our practices are ‘cannabis friendly’, with the intention of creating an open and culturally safe environment, where clients can feel safe to share their experiences with cannabis.^2,3

Currently, my team and I are currently in the process of publishing our work to respective stakeholders, and hopefully disseminating our work for the CDHA website, and incorporating our work in educational curriculums.

References:

1. Government of Canada. Cannabis market data [Online]. 2018[updated 2018 Dec 4; cited 2019 Jan 28]; Available form:https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/licensed-producers/market-data.html
2. Chang R, Haxhiavdija H, Shen J, Uy M. Dental hygiene care for cannabis consumers – cause advocacy project [unpublished]. 410: Dental Hygiene Theory and Knowledge, University of British Columbia; presented 2019 Mar 21.
3. Canadian dental hygienists start the cannabis conversation [Online]. 2019 [cited 2019 Jan 27]. Available from: https://files.cdha.ca/NewsEvents/tag/2019/New_Years_Resolution–cannabis.pdf
4. Guyader J. Root of the matter: upcoming regulation changes – legalization of non-medical cannabis [Online]. 2019 [cited 2019 Jan 30]. Available from: http://www.cdhbc.com/Documents/Fed-Gov-legislation-of-non-medical-Cannabis.aspx