This term for my community externship I was situated at Broadway Pental Coastal Lodge long term care facility. This facility is a Christian based lodge and has three different floors of elderly living there. When I first started my rotations at the lodge I was extremely nervous and did not enjoy working with the residents. I afriad because of how unpredictable they can be and didn’t know how to react if they became upset with me. I was unsure if I would even be successful at this particular externship, and didn’t know if I’d be able to provide care for the elders at all.

As the term went on the I slowly began to feel more comfotable around the eldery in terms of providing treatment and communicating with them, until the day I met Larry. He is a 92 year old resident who lives on the third floor of the lodge. He helped me to understand some of the issues that the residents are faced with and a few of the diseases they may be faced with (such as dimentia).

Larry was more cognitively available than any other elderly I had provided treatment for. He told me that he was lonely and that he just wanted someone to talk to. Each time I visited him to provide dental hygiene treatment I would set aside time to just simply speak with him. I could tell that it was more important to him than the health of his teeth. I learned that he has traveled the entire world over four times and he has quite the sense of humor! After I finished his care I began to develop rapport with the rest of the eldery, if possible, before I provided treatment. It made me feel great because I could tell that most of them really did just want someone to speak to. An elderly lady even told me “it’s great to have such a nice young lady come and talk to me because I get tired of looking at old folk all day”. I actually laughed out loud, but felt great about the fact that in some way, even if it was insignificant, I was providing companionship for a short while to the elders.

Professionalism:

Artifacts:

1) Tag: Clinic at UBC, Hypertension

            I have been providing treatment to a client for two semesters, who we will refer to as Mr. Smith that has controlled hypertension. His readings are consistently between 130-150 for systolic pressure and 80-90 for diastolic pressure. I spoke with his family physician and she assured me that Mr. Smith sees her on a regular basis and that his blood pressure readings are usually in the stage 1 of hypertension category. She also told me not to worry because he takes his medication regularly and has a check up once a month. Mr. Smith would also explain to me that he sometimes experiences the “white coat effect” and that because of this it could make his blood pressure more elevated. One evening during a clinic session I routinely took Mr. Smith’s blood pressure prior to debridement and it read 204/102 mmHg. I was definitely alarmed and took another reading after five or so minutes had passed. The next reading was still around 200/100 mmHg. I informed Mr. Smith of the situation and explained that I would have my instructor take his blood pressure to be sure. Mr. Smith did not seem too concerned with what was going on; even though he was well aware from seeing his physician so frequently that this was definitely a high reading. My instructor came and took it again and the reading was now 203/102 mmHg. I know that was in stage 3 of hypertension, and that Mr. Smith should definitely be escorted to emergency. I communicated my concerns to him in a very calm and collected manner so that I did not alarm him anymore then needed as he was already quite upset. He was aware that his blood pressure was too high to do any invasive treatment, but there was a disconnect pertaining to the importance of his overall health because of his high blood pressure. I informed him about the severity of this reading and because of this new knowledge he gained he reluctantly agreed to come to the UBC hospital with me. If I had not of communicated in such a calm and professional manner with my client while relaying the information to him, he might not have understood how potentially dangerous the situation actually was, and therefore may not have gone to the hospital either.

2) Tag: Community- Surrey: The Orchard (Union Gospel Mission), Antibiotic Prophylaxis, Professional Collaboration  

I recently completed assessments on a client in the community that had a liver transplant seven years prior. I was unsure if this client needed antibiotic prophylaxis prior to invasive dental hygiene treatment. I therefore took the initiative to contact his family physician. After several phone calls back and forth with the receptionist I finally was able to speak with his doctor. She was unsure if he needed the antibiotics, so he gave me the phone number to the clinic where the transplant was performed. I again left several messages with the receptionist and finally spoke with the specialist. She was very helpful and faxed me a review of the patient’s last liver evaluation (which is done monthly) and a document stating that this particular client did not need the use of the antibiotic prophylaxis treatment. I felt this was an important experience for my learning because not only did it enable me to communicate professionally and effectively with other practitioners, but it also allowed for me to embrace collaboration with other health care environments.                                                                                                    

3) Tag: Community- Surrey: The Orchard (Union Gospel Mission), Client Rapport

            During our community rotations at The Orchard I found it apparent that the target population expressed anxiety towards dental care, even dental hygiene treatment. They also exhibited lack of knowledge of oral disease and the link between oral and systemic health. Building rapport with this population not only facilitated change with their perceptions of dental care, but also enabled them to trust us and therefore be open to new information and knowledge. I felt this was extremely important for all community programs to assist them in building trust in the dental hygiene profession as well. Here is a photograph that I took at The Orchard that some of the residents that live there and the clients that we say made for us.

4) Tag: Clinic at UBC, Local Anaesthetic

            I recently have been providing dental hygiene treatment to a client who has severe hypersensitivity. She also has a phobia of the dental office, especially of needles, but she is motivated to improve her oral health. This posed a huge problem for me because I couldn’t even probe her dentition without local anaesthetic. I thought that if I explained every step of the procedure to my client and gained her trust she would be more susceptible to having local anaesthetic administered. It worked, but while I was depositing the solution she began to scream. It was definitely alarming and it was an incident that I hadn’t experienced before. Luckily my clinical instructor was in my operatory and she held my clients hand while I calmly told her that she was “doing really well”. The screaming began to become quieter after I began speaking with my client, and was almost non- existent at the end of the injection. After it was finished I asked her if she was in pain, and shockingly she said she wasn’t, and claimed she screamed because it was invasive to her personal space. I realised that she was afraid of the idea of the needle and not the actual administration of it, and I spoke to her about this throughout the appointment to make the up-coming sessions go more smoothly. Client management and calming communication are extremely important in clinical practice to ensure that the patient feels comfortable.      

Oral Disease Prevention:

 1) Tag: Clinic at UBC, Periodontal Disease

            I treated a recall client of another fourth year student a few months ago. She was a seventy six year old lady who was involved in more extracurricular activities, such as dancing, singing and learning Mandarin, than most people. However, she had poor oral self care habits, and had a molar with severe chronic periodontal disease that had a class four furcation involvement, as well as 9mm pocket depths encompassing the tooth, and over 3mm of recession on all surfaces of the tooth. She also stated that when she brushes the molar it bleeds excessively. Upon examination I realized that it was almost impossible to clean the tooth with brushing and flossing alone, so I suggested she used a proximal brush with cylinder brush tips to actually enter into the furcation. I debrided the molar, as well as the rest of what teeth she had remaining and scheduled her for a re-evaluation appointment six weeks later. When she returned she said that the bleeding has gone down significantly when brushing and she said she was using the proximal brush as well. When I re-assessed the tooth the inflammation had become minimal and there was 60-70% less calculus than before. There was minimal bleeding as well. I felt as though this particular client’s zest for life and staying healthy really made me want to assist her in keeping her molar and her remaining teeth for as long as possible. With proper maintenance, technique, oral disease education and dedication, the progression of her periodontal disease can decrease and ideally stop from worsening.      

2) Tag: Douglas College- New Westminster, Caries

            I have a recall client at Douglas College that had only had her teeth cleaned once before, prior to myself providing her with treatment. Her chief complaint was that she had generalized pain throughout her mouth. During her periodontal and dental examinations I noticed she had a lot of calculus build up, many restorations and multiple dark, sticky, suspicious areas. I took a few radiographs and had the dentist on site interpret them. He confirmed that she had multiple carious lesions, ten to be exact, and the majority of which were interproximally located. I explained the situation to my client and assessed her oral self care techniques. She admitted that she doesn’t floss, and demonstrated an ineffective brushing technique. I informed her of how caries occur and how to properly brush and floss properly to aid in prevention of disease, as well as pain. This was important because I knew that this client would be motivated to change her ways due to the amount of pain she was in and therefore will hopefully continue keeping up her oral hygiene. 

Health Promotion:

 1) Tag: Community- Surrey: The Orchard (Union Gospel Mission), Calculus

            I was scheduled to complete debridement on a client, but at the last minute they informed me that they couldn’t make it to the appointment, so instead I did paper work and helped my classmates chart. About half an hour later a woman approached me and was inquiring about orthodontic treatment for her daughter. We spoke for approximately fifteen minutes and she began asking me questions pertaining to herself, in particular about her halitosis. She informed me that she is a smoker, but is trying to quit. She also stated something that I thought was very out of the ordinary; she said that her bottom teeth were “growing” in the back surfaces (linguals of sextant 5). She also stated that she thought the growth might have been due to the medication she was taking for seizures (Dilantin). She told me that she hadn’t seen a dental hygienist or a dentist in over ten years.

I spent the next thirty to forty minutes educating my client about calculus, and bacteria of the oral cavity. I also explained that her medication is causing inflammation of her gingiva (in lay terms of course), not that it was causing her teeth to “grow”. She was hesitant at first to let me take a look in her mouth, but after I built a bit of rapport she agreed. There definitely was a tenacious wall of calculus in sextant 5 that I emphasised needed to be removed. The reason the knowledge that I provided to this particular client is so important is because I have not seen anyone have such an epiphany, or gain such a new perspective in the entire four years I have been in dental hygiene school. It felt as though she “saw the light” and wanted to drastically change her oral self care habits.

2) Tag: Community- Surrey: The Orchard (Union Gospel Mission), Table Clinic

            One of the main issues that was identified about the target population at the Orchard in Surrey BC was the general lack of knowledge pertaining to oral health, especially oral diseases. My group decided to focus on this major issue as the topic of our table clinic because informing the public about the importance of oral self care to promote health and prevent disease are extremely important in the profession of dental hygiene. Here is a photograph of the rough draft of our table clinic presentation (better picture coming November 30^th 2011).    

Clinical Therapy:

1) Tag: Clinic at UBC, Debridement

In third year I was assigned a new client who was a sixty year old female. Her chief complaint was that she had “sore gums that always bleed”. She also told me that they only bleed when she brushes her teeth, so she stopped brushing over two weeks ago. The assessments revealed that the woman had a lot of calculus and generalized plaque induced gingivitis with localized slight chronic periodontitis. She also stated that she has not seen a dental hygienist in over fifteen years because every time she used to go her “gums would bleed”. I explained extensively that her gingiva was not bleeding due to tooth brushing, but rather oral disease caused by plaque bacteria build up. After a very long educational session she finally agreed to allow me to debride her teeth. Upon re-evaluation she stated that her gums had stopped bleeding and were no longer sore. I felt that this was an important learning experience because not only did she gain important knowledge, but I was able to recognize tissue/disease healing.

2) Tag: Clinic at UBC, Flossing and Brushing Technique

I had a client at the UBC clinic that informed me never flosses and only brushes his teeth when he has food stuck in between his teeth. He told me that it is a waste of time because it doesn’t actually help remove plaque. He was a thirty three year old man who immigrated from India a few years prior. I realised that he probably didn’t value oral health as much as we do here in North America and that’s why he might not have been doing oral self care on a regular basis. I explained to him what oral diseases were, how they develop and then I thoroughly demonstrated proper brushing/flossing technique. He now understands the importance of oral hygiene and how it prevents disease from progressing. I thought this was important because it shows that there are certain populations that really do need basic oral health education to build a foundation around its importance.

I had a client at the UBC clinic that informed me never flosses and only brushes his teeth when he has food stuck in between his teeth. He told me that it is a waste of time because it doesn’t actually help remove plaque. He was a thirty three year old man who immigrated from India a few years prior. I realised that he probably didn’t value oral health as much as we do here in North America and that’s why he might not have been doing oral self care on a regular basis. I explained to him what oral diseases were, how they develop and then I thoroughly demonstrated proper brushing/flossing technique. He now understands the importance of oral hygiene and how it prevents disease from progressing. I thought this was important because it shows that there are certain populations that really do need basic oral health education to build a foundation around its importance.

In third year I was assigned a new client who was a sixty year old female. Her chief complaint was that she had “sore gums that always bleed”. She also told me that they only bleed when she brushes her teeth, so she stopped brushing over two weeks ago. The assessments revealed that the woman had a lot of calculus and generalized plaque induced gingivitis with localized slight chronic periodontitis. She also stated that she has not seen a dental hygienist in over fifteen years because every time she used to go her “gums would bleed”. I explained extensively that her gingiva was not bleeding due to tooth brushing, but rather oral disease caused by plaque bacteria build up. After a very long educational session she finally agreed to allow me to debride her teeth. Upon re-evaluation she stated that her gums had stopped bleeding and were no longer sore. I felt that this was an important learning experience because not only did she gain important knowledge, but I was able to recognize tissue/disease healing.

One of the main issues that was identified about the target population at the Orchard in Surrey BC was the general lack of knowledge pertaining to oral health, especially oral diseases. My group decided to focus on this major issue as the topic of our table clinic because informing the public about the importance of oral self care to promote health and prevent disease are extremely important in the profession of dental hygiene. Here is a photograph of the rough draft of our table clinic presentation (better picture coming November 30^th 2011).

I was scheduled to complete debridement on a client, but at the last minute they informed me that they couldn’t make it to the appointment, so instead I did paper work and helped my classmates chart. About half an hour later a woman approached me and was inquiring about orthodontic treatment for her daughter. We spoke for approximately fifteen minutes and she began asking me questions pertaining to herself, in particular about her halitosis. She informed me that she is a smoker, but is trying to quit. She also stated something that I thought was very out of the ordinary; she said that her bottom teeth were “growing” in the back surfaces (linguals of sextant 5). She also stated that she thought the growth might have been due to the medication she was taking for seizures (Dilantin). She told me that she hadn’t seen a dental hygienist or a dentist in over ten years.

 I spent the next thirty to forty minutes educating my client about calculus, and bacteria of the oral cavity. I also explained that her medication is causing inflammation of her gingiva (in lay terms of course), not that it was causing her teeth to “grow”. She was hesitant at first to let me take a look in her mouth, but after I built a bit of rapport she agreed. There definitely was a tenacious wall of calculus in sextant 5 that I emphasised needed to be removed. The reason the knowledge that I provided to this particular client is so important is because I have not seen anyone have such an epiphany, or gain such a new perspective in the entire four years I have been in dental hygiene school. It felt as though she “saw the light” and wanted to drastically change her oral self care habits.

I have a recall client at Douglas College that had only had her teeth cleaned once before, prior to myself providing her with treatment. Her chief complaint was that she had generalized pain throughout her mouth. During her periodontal and dental examinations I noticed she had a lot of calculus build up, many restorations and multiple dark, sticky, suspicious areas. I took a few radiographs and had the dentist on site interpret them. He confirmed that she had multiple carious lesions, ten to be exact, and the majority of which were interproximally located. I explained the situation to my client and assessed her oral self care techniques. She admitted that she doesn’t floss, and demonstrated an ineffective brushing technique. I informed her of how caries occur and how to properly brush and floss properly to aid in prevention of disease, as well as pain. This was important because I knew that this client would be motivated to change her ways due to the amount of pain she was in and therefore will hopefully continue keeping up her oral hygiene. 

I treated a recall client of another fourth year student a few months ago. She was a seventy six year old lady who was involved in more extracurricular activities, such as dancing, singing and learning Mandarin, than most people. However, she had poor oral self care habits, and had a molar with severe chronic periodontal disease that had a class four furcation involvement, as well as 9mm pocket depths encompassing the tooth, and over 3mm of recession on all surfaces of the tooth. She also stated that when she brushes the molar it bleeds excessively. Upon examination I realized that it was almost impossible to clean the tooth with brushing and flossing alone, so I suggested she used a proximal brush with cylinder brush tips to actually enter into the furcation. I debrided the molar, as well as the rest of what teeth she had remaining and scheduled her for a re-evaluation appointment six weeks later. When she returned she said that the bleeding has gone down significantly when brushing and she said she was using the proximal brush as well. When I re-assessed the tooth the inflammation had become minimal and there was 60-70% less calculus than before. There was minimal bleeding as well. I felt as though this particular client’s zest for life and staying healthy really made me want to assist her in keeping her molar and her remaining teeth for as long as possible. With proper maintenance, technique, oral disease education and dedication, the progression of her periodontal disease can decrease and ideally stop from worsening.

I recently have been providing dental hygiene treatment to a client who has severe hypersensitivity. She also has a phobia of the dental office, especially of needles, but she is motivated to improve her oral health. This posed a huge problem for me because I couldn’t even probe her dentition without local anaesthetic. I thought that if I explained every step of the procedure to my client and gained her trust she would be more susceptible to having local anaesthetic administered. It worked, but while I was depositing the solution she began to scream. It was definitely alarming and it was an incident that I hadn’t experienced before. Luckily my clinical instructor was in my operatory and she held my clients hand while I calmly told her that she was “doing really well”. The screaming began to become quieter after I began speaking with my client, and was almost non- existent at the end of the injection. After it was finished I asked her if she was in pain, and shockingly she said she wasn’t, and claimed she screamed because it was invasive to her personal space. I realised that she was afraid of the idea of the needle and not the actual administration of it, and I spoke to her about this throughout the appointment to make the up-coming sessions go more smoothly. Client management and calming communication are extremely important in clinical practice to ensure that the patient feels comfortable.      

During our community rotations at The Orchard I found it apparent that the target population expressed anxiety towards dental care, even dental hygiene treatment. They also exhibited lack of knowledge of oral disease and the link between oral and systemic health. Building rapport with this population not only facilitated change with their perceptions of dental care, but also enabled them to trust us and therefore be open to new information and knowledge. I felt this was extremely important for all community programs to assist them in building trust in the dental hygiene profession as well. Here is a photograph that I took at The Orchard that some of the residents that live there and the clients that we say made for us.